Invisalign SmartForce Features - Amazon S3...and canine rotations using standard tooth velocities • Customized to patient’s individual teeth Anterior extrusion attachment CuspidCanine

9/30/2011

1

© 2011 Align Technology, Inc. All rights reserved. 1

Welcome

InvisalignG4

Ask the Expert Webinar

The webinar will begin shortly

•For technical issues: please click on the “help” tab at the top right hand side of the player window.

•Following the video presentation, there will be a live audio-only

Q&A session. To submit a question -Please click on the Q&A tab at the bottom left hand side of the player

window.

-Type in your question and click on the “ask” button.

•All questions will be answered via the email address you used

when registering for this event

© 2011 Align Technology, Inc. All rights reserved. 2 © 2011 Align Technology, Inc. All rights reserved.

InvisalignG4 – Ask the Expert

October 7, 2011

Dr. René Sterental – Clinical Director

John Morton – Director of Research & Technology


Today’s Focus

The next generation of SmartForce® clinical

innovations


Innovations


• Original Clinical Protocols

• Prioritizing the most challenging movements

with Invisalign aligners

• Using Science to create a

foundation for Innovation

• SmartForce® Features

customized to each

patient’s individual teeth

• Clinical Advisory Board / Best Practices Protocols

The Pursuit of Predictability of Clinical Outcomes

© 2011 Align Technology, Inc. All rights reserved. 6 © 2011 Align Technology, Inc. All rights reserved. Confidential

Invisalign SmartForce® Features

REVIEW

9/30/2011

2


Power Ridge® for Lingual Root Torque - 2009

Power Ridge® designed to deliver lingual root

movements for the upper incisors


Invisalign G3 Power Ridge® for Lower Incisors

Power Ridge® features control the movement

of the root with respect to the crown


Buccal and Lingual Power Ridge® pair improve

control of the upper incisors undergoing root torque with retraction

Invisalign G3 Lingual Power Ridge®


First Optimized Attachments - 2009

• Designed to optimize forces for improved incisor extrusions

and canine rotations using standard tooth velocities

• Customized to patient’s individual teeth

Anterior extrusion attachment Canine rotation attachment Cuspid rotation attachment


Invisalign G3 Optimized Rotation Attachments

A variation of the Optimized Rotation

Attachment can be placed on most any canine or bicuspid that requires rotation


G3…Optimized Rotation Attachment for the bicuspids

Optimized Rotation Attachments are available

for the upper and lower 1st and 2nd bicuspids

9/30/2011

3


Clinical Results

Before

After

Before

After

Optimized Rotation Attachments Optimized Extrusion Attachments

Case provided courtesy of Dr. Donna Galante Case provided courtesy of Dr. Ronda James


Clinical Situations

•Greater root tip control for canines and upper

centrals

•Improved predictability for upper laterals

•Better clinical outcomes for open bite treatments


Improving Predictability of Tooth Movements with

InvisalignG4 SmartForce®

Features

John Morton Director of Research & Technology


A Biomechanical Approach to Aligner Treatment

Does the tooth move because its

shape matches the aligner ?

…It is the force system that controls the

movement of the tooth.


Desired

Movement Determine Force

System

Design

Appliance

Foundation of Biomechanics

. © 2011 Align Technology, Inc. All rights reserved. 18

SMARTFORCE® FEATURES

The process allows us to get to

the correct FORCE SYSTEM faster

Design Process

9/30/2011

4


• Optimized Root Control Attachments for Upper

Centrals and Canines

• Multi-plane movement of Upper Laterals

• Multi-tooth Anterior Extrusion for Open Bite

Treatment

1

9

SMARTFORCE®

FEATURES


Optimized Attachments….

Active Surface

The attachment surface that engages the aligner

The aligner applies force to the Active Surface


SmartForce® Optimized Root Control

Attachments

Upper Centrals

2

1


ANGULATION of the tooth

Roots are divergent and not aligned

movement is

along the arch


Biomechanics of Root Control

2

3

F1

M

Aligner staged movement:

-applies force (F1) to the crown

-produces an unwanted tipping moment (M)



2

4

F1 F2

M A second force (F2) is

needed to control the movement of the root.

9/30/2011

5



2

5

Optimized root control

attachments are positioned, oriented and activated

automatically by the

software

F1 F2

M


Optimized Root Control Attachments

2

6

Possible Movements:

ROOT UPRIGHTING

of the

upper centrals


Biomechanics of Translation along the arch

2

7

When the moment (M) and the

force (F) are proportioned correctly…..the tooth will move

along the arch and maintain its

upright orientation…..translation

F1 F2

M


Biomechanics of Translation along the arch

2

8

The crown and the root move the

same distance along the arch


M/F ratios for translation

You must apply the

correct force system to

attain the correct

treatment outcome

Dis

tan

ce

fro

m C

en

ter

of

Re

sist

an

ce

to C

en

ter

of

Ro

tati

on

Center of resistance

M /F ratio at the bracket

translation

Smith and Burstone in “Mechanics of Tooth Movement” (AJODO, 1984)

© 2011 Align Technology, Inc. All rights reserved. 30 3

0

Possible Movements

Diastema closure

Midline shift

9/30/2011

6


1

Possible Movements

Diastema closure

Midline shift


Aesthetics

3

2

#8 : Optimized Root Control Attachment

#9 : Vertical Rectangular Attachment


3

•less obvious = more aesthetic

Rectangular Attachment

Optimized Root Control Attachment

•A portion can be beneath the lip and not show at all


SmartForce®

Optimized Attachment for

Root Control

Canine


Force System on Canine

3

5

F1 F2

M

The moment (M) is strong enough to move the canine root.


6

Possible Movements: ROOT ALIGNMENT

9/30/2011

7


M/F ratios for root tip

Dis

tan

ce

fro

m C

en

ter

of

Re

sist

an

ce

to C

en

ter

of

Ro

tati

on

Center of resistance

M /F ratio at the bracket

Smith and Burstone in “M echanics of Tooth M ovement”

(AJODO, 1984)

Root leads

the crown

proportions


3

8

Possible Movements: space closure

When the moment (M) and the force (F) are proportioned correctly…..the tooth will move along the arch and maintain

its upright orientation…..translation

The crown and the root move the same distance along the arch

M

F


Aesthetics

3

9

less obvious = more aesthetic


Aesthetics

4

0

Rectangular Attachment

Optimized Root Control Attachment


SmartForce®

Multi-plane Movement

Upper Laterals


Multi-plane movements….what are they?

Extrusion . . . . . combined with other

movements the tooth is undergoing a the same

time . . . .

•rotation

•crown tip (bucco-lingual)

•crown tip (mesio-distal)

9/30/2011

8


Example

Extrusion with

•mesial-out rotation

•crown tip lingual


Mechanics of Multi-plane Movements

4

4

Two forces are used to control the tooth movement

The tooth should move as programmed…..a multi-plane

movement.

Force on attachment

Force from

pressure point


The Applied Force System

4

5

Force The software

determines the

position and

orientation of the

attachment active

surface


The software determines the position and orientation of

the pressure point on the lingual aspect of the aligner


7

THE TWO FORCES TOGETHER CONTROL THE

TOOTH MOVEMENT


Multi-Tooth Extrusion for

Open Bite Treatment

9/30/2011

9


Multi-tooth

force

measurement

apparatus


Multi-tooth anterior extrusion for treatment of open bite

5

0

Optimized Extrusion Attachments extrude the four upper

incisors as a unit, leveraging the posterior teeth as anchorage.

Aligner activation is adjusted individually on each of the upper

incisors…….to ensure all four are extruded at the same time.


How it works….

5

1

The lateral and the central incisor attachments require different aligner

activations to produce the needed force.

ACTIVATION: the interference of the aligner on the active surface of the

attachment; it produces the force

activation levels


2

We anticipate improved open bite treatment with these

Smart Force® features

Extrusive force is applied to all upper anterior teeth


For precise finishes the aligner must be activated

5

3

The aligner is still pushing on the attachment at the end of

the movement

Aligner is “activated” to push on the attachment and seat

the tooth all the way into the aligner cavity

No

activation

With

activation


Summary

• Optimized Root Control Attachment for Canines and

Upper Centrals

• Multi-plane movement of laterals

• Multi-tooth Anterior Extrusion for Open Bite

Treatment

5

4

SMART FORCE® FEATURES

9/30/2011

10


Summary

5

5

The SmartForce® feature process is in place as

evidenced by the releases of these innovations

The design methodology is accepted by practitioners

Doctors using SmartForce® features are reporting

better results

Invisalign is listening and responding to the clinical issues


InvisalignG4 SmartForce®

Features Clinical Protocols

Dr. René Sterental

Clinical Director


Multi-tooth Anterior Extrusion for Open Bites

• Individualized differential activation applied when all

four upper incisors have absolute extrusion

programmed - Threshold: Absolute Extrusion > 0.5mm

• Simultaneous Staging


Individual Extrusion Attachment

• Individual Optimized Extrusion Attachments are now

activated

- Threshold: Absolute Extrusion > 0.5mm

- Activated individually when 3 or fewer Optimized Extrusion

Attachments are present on upper incisors or on any other tooth:

- Applicable individually on all upper & lower incisors & canines

• Simultaneous Staging - Unless LRT Power Ridges are present:

•LRT is staged first @ 1 deg/stage

•Extrusion is staged at the end


Multi-plane Movement of Upper Laterals

• Applicable to upper lateral incisors when:

- Absolute extrusion > 0.1mm is programmed

AND

- Center of the Root has minimal displacement

AND

- Crown tipping in any direction is programmed

AND/OR

- Rotation is programmed

• Not applicable when root movements

or intrusion are programmed



Optimized Root Control for Upper & Lower Cuspids

• Applicable for mesio-distal root uprighting - When center of root moves > 0.5mm

• Applicable for mesio-distal space closure - When center of root moves > 0.5mm

- Close spaces mesial or distal to the cuspid with bodily movement

- Separate roots for upper lateral incisor implant placement

• Bicuspid Extraction Protocol Update - Will be applied on bicuspid extraction

cases as long as cuspid bodily movement

is programmed to close extraction space

- Won’t be applied if distal crown tip is

programmed to close extraction space


9/30/2011

11


Optimized Root Control for Upper Central Incisors

• Applicable for mesio-distal root uprighting - When root center moves > 0.75mm

• Applicable for mesio-distal space closure - Diastema closure while maintaining proper root control

•As long as root center moves > 0.75mm

- Separate roots for upper lateral incisor implant placement



Precision Cuts & Cuspid Optimized Attachments

• Precision Cuts are now compatible with Invisalign G3

Optimized Extrusion & Rotation Attachments

- There must be enough room on clinical crown for both features to

fit without overlapping

•1.5mm of separation needed to avoid cutting into attachment well in

aligner

- If both features don’t fit, the default action will be to keep the

Optimized Attachment

• If you have a different preference, enter it in the Special Instructions of the Rx Form

- Not yet tested with Invisalign G4 SmartForce® features


Precision Cuts & Cuspid Optimized Attachments

• Proper procedure to use elastics when Precision Cuts

& Optimized Attachments co-exist:

- Have patient insert both aligners

- Ensure correct seating by biting on chewies

- Engage elastics from posterior hooks/buttons to anterior hooks


InvisalignG4 Clinical Protocols:

SmartForce® Feature Placement


Clinical Protocol: SmartForce® Feature Placement

• Principles of Application

- Features are determined based on movements required to

address the primary treatment goal

- Movements with the largest magnitude are given higher priority

for feature placement



• Upper Central Incisor: 1. Open Bite Optimized Extrusion Attachments (Multi-tooth)

2. Mesio-Distal Root Control

3. Power Ridge® for LRT

4. Individual Optimized Extrusion Attachment

• If LRT & Extrusion are present, movements are separated and extrusion is staged after LRT

9/30/2011

12



• Upper Lateral Incisor: 1. Open Bite Optimized Extrusion Attachments

2. Multi-Plane Crown Movement

3. Power Ridge® for LRT

4. Individual Optimized Extrusion Attachment

• If LRT & Extrusion are present, movements are separated and extrusion is staged after LRT



• Upper & Lower Canines: 1. Mesio-Distal Root Control

• No Precision Cut allowed to co-exist

2. Individual Optimized Extrusion or Rotation Attachment

• Precision Cut allowed to co-exist provided both fit

• Based on movement prevalence

- For large cuspid rotations (>15 deg) the Optimized Rotation

Attachment will supersede the Optimized Root Control Attachments


InvisalignG4 New Class II division 2

Staging Protocol


Invisalign G4 Staging for Retroclined Incisors

Proclination/LRT Phase Intrusion Phase Retraction Phase

• Applicable to retroclined upper incisors only - Commonly found in Class II division 2 cases

- Sequential Staging to improve predictability of outcome

•Power Ridges added to ensure root control


iOC® / iTero® Scanning & Invisalign

Update


Using iOC® & iTero® scans with Invisalign

• Clinical Advantages of scans over PVS impressions: - Better fitting aligners

“Patients report a noticeable difference between aligners originating

from scanning vs. PVS impressions. They fit so tight they are MORE

comfortable and less saliva is trapped under the plastic.” – Dr. Perry Jones

9/30/2011

13


Using iOC® & iTero® scans with Invisalign

• Clinical Advantages of scans over PVS impressions: - Quicker initial ClinCheck treatment plan turnaround time

Based on 1,000+ scans:

• Virtually eliminates rejections

• Time from submission of scan to initial

ClinCheck Treatment Plan posted on the Invisalign Doctor Site = 2 days


To obtain your CE certificate for this program please complete a brief survey at:

www.AligntechInstitute.com/asksurvey

Upon completion of your survey* you will have immediate

access to your CE certificate. *This survey is only available to the participants who attended the “live” presentation on October 7, 2011. Participants who complete the archived program on

AligntechInstitute.com need to complete a CE test to obtain their CE certificate.

Invisalign SmartForce Features - Amazon S3...and canine rotations using standard tooth velocities • Customized to patient’s individual teeth Anterior extrusion attachment CuspidCanine

Documents