9y 9m Male with Severe Crowding
SUBJECTIVE: A 9y 9m male presented with his mom for an exam concerned about his crowding.
OBJECTIVE: He presented with a flush terminal plane at the molars, narrow arches, mesial in rotations on the upper first molars, and severe upper and lower crowding. His upper laterals were in crossbite, with a severe rotation on #10, and #23 erupting lingually due to the amount of crowding.
ASSESSMENT: Treatment goals were to:
- Broaden arches, align upper & lower teeth, correct the crossbites of #7 & 10.
- Create space mesial & distal to primary canines for permanent canine eruption.
- Estimated tx time: 12mo.
- Upper & lower Damon Braces OR Invisalign aligners
PLAN: Patient chose Invisalign aligners & Vivera retainers.
Treatment
Initial Invisalign aligners were delivered November 22nd, 2022 with instructions to wear 22+ hours per day and change trays every 7 days, along with instructions for use, care, emergencies, etc.
His first visit back client was struggling to be consistent wearing trays so we elected to have him change every 10 days in an attempt to help teeth track better. In June 2023 he had lost multiple buttons and teeth were not tracking well so we scanned for additional trays for a mid-treatment reset.
We delivered the additional trays July 2023 at which point I had a real heart-to-heart to encourage him to wear the trays better, and we would be having frequent visits to ensure compliance. He showed excellent compliance from that point on at his visits.
We confirmed patient and parent satisfaction on January 16th, 2024 and removed attachments, finishing active treatment. He was instructed to wear upper and lower Vivera retainers at home and at night for 2 months. His first visit back he did not bring his retainer and there was a minor rotation on the lower lateral so he was instructed to begin wearing his retainer full time. He is now being seen on 6 month recalls to await exfoliation of remaining primary teeth and eruption of the permanent teeth.
Treatment Review
We spun our wheels for a couple months with client. His first set of trays didn’t accomplish nearly as much as I typically hope for. However, at the refinement he recommitted and we were able to see dramatic improvement. The rotation on #3 was well corrected, along with the severe rotation of #10. Crossbites were eliminated, arch forms broadened beautifully, and #23 was aligned with great torque.
A critical analysis reveals that #7 could have used additional facial root torque as the occlusal view shows more slope to the lingual aspect of the tooth, and the frontal view shows less root prominence as compared to #10. Furthermore, while there is some space (specifically mesial) to the upper and lower primary canines, I feel he would have benefited from additional space creation for further canine eruption.
I felt that I was able to connect with him and help him be successful in his (and his mothers) choice to use Invisalign aligners for his treatment. I recognized, and am now able to reference, that Invisalign can be a rollercoaster. And that in some cases, a history of poor performance is not fully indicative of future performance/compliance.