24 y.o. Female with an Active Permanent Retainer
SUBJECTIVE: She presented with concerns over her upper right tooth and the spacing developing. She reported that it was gradual and she really noticed it a few months prior to the exam. Her training schedule took her across the world and she was not open to braces due to the appointment requirements.
OBJECTIVE: The permanent retainer was intact but had become active at some point. It was causing significant flaring of #7 and deforming the anterior arch form. Her molars were Class I bilaterally but her midlines were off by 0.75mm, likely due to the flaring and rotation from the permanent retainer. Posterior teeth were in relatively good alignment with minor rotations on the premolars. The lower arch was in excellent condition.
ASSESSMENT: Treatment goals were to:
- Remove permanent retainer.
- Correct torque of #7.
- Correct anterior arch form.
- Improve #7-10 vertical position and create uniform overbite.
- Align midlines through alignment and/or selective IPR as needed.
- Option 1: Upper & lower Invisalign.
- Estimated tx time: 12mo.
PLAN: Patient chose Invisalign & Vivera retainers.
Treatment
Initial Invisalign aligners were delivered March 30th, 2023 with instructions to wear 22+ hours per day, change trays every 10 days, and minor IPR performed on the lower to address a slight Bolton Discrepancy.
She was seen back and demonstrated excellent tracking at her first few checks back. On her November 2023 visit there was poor tracking so she was instructed to change every 14 days to allow teeth to more predictably.
January 2024 we scanned for additional trays, and delivered them February 2024. We began weekly tray changes at that point. She had a couple of checks to verify tracking over the next few months, which were all positive.
We confirmed patient satisfaction on May 6th, 2024 and removed attachments, finishing active treatment. She was instructed to wear upper and lower Vivera retainers at home and at night for 2 months. She subsequently did not return for a scheduled retainer check 2 months later.
Treatment Review
In residency I had a professor who said “torque takes time”, and the statement is so accurate! Moving a root through bone is a slow and steady process, and her commitment to consistent tray wear aided in the tooth movements I staged in order to achieve an ideal result.
Critically reviewing the final tooth position, #7 could have benefited from a bit more torque to match #10. This would have helped extrude #7 a bit more which would have improved the vertical step between #7 and #8. Doing so would have created more symmetry by matching the vertical step between #9 and #10, as esthetically I prefer the left side step versus the right side.
Overall, the arch form looks awesome, the midlines match, the torque on #7 is drastically improved, and the patient left over the moon with how her smile turned out!