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Case Presentation of a typical orthodontic case of moderate difficulty using the Invisalign method Name: A S , DMD IV, 2012 Date: March, 2012
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Page 1: Invisalign presentation

Case Presentation of a typical orthodontic case of moderate difficulty using the Invisalign

method

Name: A S, DMD IV, 2012Date: March, 2012

Page 2: Invisalign presentation

OcclusionRight Side Molar Class: I Canine Class:

I

Dental Midline

Upper: On Lower: On

Left Side Molar Class:

N/A Canine Class: I

Pre-Treatment

Page 3: Invisalign presentation

Intra-Oral Examination

Teeth Present:11-17, 21-25, 2731-35, 37, 41-47

Arch Shape: Upper: Normal to tapered

Lower: Normal to tapered

Pre-Treatment

Page 4: Invisalign presentation

Intra-Oral Examination

Clinical Findings: Molars: Class I on right; Missing 26 & 36 on left Canines: Class I Missing: 18, 26, 28, 36, 38 & 48 OJ: 2 mm on right; 3 mm on left OB: 50% Mild crowding on both upper & lower incisors

Pre-Treatment

Page 5: Invisalign presentation

Intra-Oral Examination

Amount of Crowding:

Upper Arch: Mild ~ 3 mm

Lower Arch: Mild ~ 3mm

Pre-Treatment

Page 6: Invisalign presentation

Panoramic Radiograph Analysis

Clinical Findings:

No suspected decay or bone pathologyPermanent dentition: 26 teeth present (Missing 8’s, 26 & 36)

Pre-Treatment

Page 7: Invisalign presentation

Cephalometric AnalysisAngles Ceph.

ValuesNormal

Skeletal Measurements

SNA 79.5 81 ± 3

SNB 75.0 78 ± 3

ANB 4.5 3 ± 2

Witts -4.0 2 mm ± 2mm

Facial ∠ 86.0 88 ± 4

MPAST 38.0 32 ± 3

Y axis 60.0 60 ± 4

Dental Measurements

(UI,NA) 16.0 23 ±6

(LI,NB) 23.0 27.5 ±5

(UI,LI) 135.0 130 ± 7

(LI,MP) 91.0 91.4 ± 4

Pre-Treatment

Page 8: Invisalign presentation

Dental Cast AnalysisBolton Analysis – Ideally 77%

• UA (Σ 13-23) = 41.7 mm• LA (Σ 33-43) = 31.4 mm

• ( 31.4 / 41.7 ) x 100 = 75.3%

Tooth Upper right Upper left Ideal

Central Incisor 8.5 8.0 8.85

Lateral Incisor 5.5 6.0 6.9

Canine 6.7 7.0 7.88

Tooth Lower right Lower left Ideal

Central incisor 5.1 5.0 5.5

Lateral incisor 5.3 5.4 6

Canine 5.4 5.2 6.95

Pre-Treatment

Page 9: Invisalign presentation

Summary of Findings Dental:

Molars: Class I on right; Missing 26 & 36 on left Canines: Class I Missing: 18, 26, 28, 36, 38 & 48 OJ: 2 mm on right; 3 mm on left Increased OB (50%) Lower dental midline deviates 2 mm to the left upon opening Mild crowding on both upper & lower incisors Normal to tapered arch shapes 6 mm of upper incisors showing at rest Bolton analysis: 75.3%

Skeletal: Symmetrical face; Normocephalic Decreased lower face height Slight-moderate convex profile Pre-Treatment

Page 10: Invisalign presentation

Diagnosis

Class I molar/canine Maxillary anterior crowding Mandibular anterior crowding 50% overbite Flat to slight curve of spee

Pre-Treatment

Page 11: Invisalign presentation

Objectives of Treatment

Pre-Treatment

Resolve patient’s chief complaint of crowding

Decrease overbite Maintain class I molar/canine

relationship Maintain nasolabial angle Maintain midlines

Page 12: Invisalign presentation

Exactly One Year Later

Post-Invisalign Treatment

Page 13: Invisalign presentation

OcclusionRight Side Molar Class: I Canine Class:

I

Dental Midline

Upper: On Lower: On

Left Side Molar Class:

N/A Canine Class: I

Post-Invisalign Treatment

Page 14: Invisalign presentation

Intra-Oral Examination Teeth Present:11-17, 21-25, 2731-35, 37, 41-47

Arch Shape: Upper: Normal to tapered

Lower: Normal to tapered

Crowding:Upper: NormalLower: Normal

Post-Invisalign Treatment

Page 15: Invisalign presentation

Patient not satisfied with the final position of tooth #32 & tooth #41

Post-Invisalign Treatment Problems

Post-Invisalign Treatment

Page 16: Invisalign presentation

Dimple-maker! Dimples added to:

Tooth #32 - distal buccal incisal area Tooth #41 - distal buccal incisal area

IPR on both tooth #32 & #41 Both teeth rotated into proper position within 2 weeks Dimples then added to:

Tooth #31 - distal buccal incisal area & mesial lingual incisal area Patient now satisfied with final results

Post-Invisalign Treatment Solution

Post-Invisalign Treatment

Page 17: Invisalign presentation

Post-Invisalign Treatment Solution

Post-Invisalign Treatment

Pre-Treatment

Post-Treatment

Page 18: Invisalign presentation

Post-Treatment

Page 19: Invisalign presentation

Pre-Treatment

Post-Treatment

Intra-Oral Examination

Decrease in both overbite & overjet

Page 20: Invisalign presentation

Arch Shape:

Upper: Normal to tapered

Lower: Normal to tapered

Intra-Oral Examination

Pre-Treatment

Post-Treatment

No change from pre-treatment:

Page 21: Invisalign presentation

Panoramic Radiograph Analysis

Clinical Findings:

No suspected decay or bone pathologyPermanent dentition: 26 teeth present (Missing 8’s, 26 & 36)

Post-Treatment

Page 22: Invisalign presentation

Cephalometric AnalysisAngles Ceph.

ValuesNormal

Skeletal Measurements

SNA 80.0 81 ± 3

SNB 75.0 78 ± 3

ANB 5.0 3 ± 2

Witts -4.5 2 mm ± 2mm

Facial ∠ 84.0 88 ± 4

MPAST 39.5 32 ± 3

Y axis 63.0 60 ± 4

Dental Measurements

(UI,NA) 12.0 23 ±6

(LI,NB) 22.5 27.5 ±5

(UI,LI) 141.0 130 ± 7

(LI,MP) 87.5 91.4 ± 4

Post-Treatment

Page 23: Invisalign presentation

Dental Cast AnalysisBolton Analysis – Ideally 77%

• UA (Σ 13-23) = 42.4 mm• LA (Σ 33-43) = 32.2 mm

• ( 32.2 / 42.4 ) x 100 = 75.9%

Tooth Upper right Upper left Ideal

Central Incisor 8.3 8.1 8.85

Lateral Incisor 5.8 5.8 6.9

Canine 7.3 7.1 7.88

Tooth Lower right Lower left Ideal

Central incisor 5.2 4.7 5.5

Lateral incisor 5.1 5.3 6

Canine 6.1 5.8 6.95

Post-Treatment

Page 24: Invisalign presentation

Summary Dental:

Molars: Class I on right; Missing 26 & 36 on left Canines: Class I No atempts made to resolve the skeletal discrepancy OJ: 2 mm on right; 1 mm on left OB (30%) - Decreased from 50% at pre-treatment Lower dental midline deviates 2 mm to the left upon opening Crowding issues on both upper & lower incisors resolved

(addressed CC)

Normal to tapered arch shapes 6 mm of upper incisors showing at rest

Skeletal: Symmetrical face; Normocephalic with dolichocephalic tendenty

remained Slight-moderate convex profile remained

Post-Treatment

Page 25: Invisalign presentation

Conclusions

• Overall, patient is very satisfied as her chief complaint has been addressed.

• Opted for Invisalign type retainers.• IPR avoided any flaring of the dentition • The upper incisors were not torqued enough

but the esthetic result is still very acceptable.