12y 9m female
SUBJECTIVE: A 12y 9m female was seen (with mom) for an exam to evaluate for general alignment.
OBJECTIVE: Her initial exam revealed a retained #J and a distoangularly positioned #13. We sent a referral for extraction of #J and a follow up evaluation 4 months later to check for eruption of #13.
The space for #13 was closing at her follow up exam and so we elected to initiate treatment to open sufficient space for spontaneous eruption of #13. If the tooth had not naturally erupted within the first 6 months of treatment we would send for an expose and bond to orthodontically erupt the tooth.
She had a Class I molar with moderate upper and lower crowding. Her upper canines were high, and the upper arch could benefit from increased width in the premolar region.
ASSESSMENT: Treatment goals were to:
- Level and align the upper and lower arches. Extrude upper canines.
- Increase arch width at premolars.
- Create space and align #13, expose and bond as needed.
- Estimated tx time: 14 to 18mo.
- Options: Comprehensive Invisalign OR Damon braces. Expose & bond PRN.
PLAN: Patient chose Invisalign & Vivera retainers.
Treatment
We delivered initial Invisalign aligners May 17th, 2023 with instructions to wear 22+ hours per day and to change trays every 10 days to allow more time for #13 to naturally erupt into the eruption compensator.
She was seen back and demonstrated good tracking at her first few checks. #13 naturally erupted and we were able to avoid an expose and bond. In October 2023 we scanned for additional aligners to capture and align #13, and delivered them November of 2023 with instructions to change every 7 days.
Her follow up checks were all phenomenal with excellent compliance and tracking. On April 23rd, 2024 we verified patient and parent satisfaction and removed attachments. Two weeks later we delivered her final retainers, which she was instructed to wear at home AND at night for 2 months. At her retainer check we observed great compliance with retainer wear, good retention, and instructed her to wear the retainers at night only.
Treatment Review
Reviewing my final records, the upper canines could have used a bit more lingual crown torque in order to lock in the occlusion better. The upper 2nd premolars also needed more distal root tip based on the panoramic radiograph. However the pneumatized sinus/low inferior border of the maxillary sinus may have been preventing effective expression of this movement.
I try to emphasize to patients the variability in biological response to tooth movement. While I expected this treatment to take as much as 18 months due to the unknown of #13’s eruption, the patient was start to finish in barely 12 months with a spectacular result. Nature is truly amazing!