26-Year-Old Male with An Active Permanent Retainers
SUBJECTIVE: He presented alone with concerns of spacing between his two upper teeth and a “weird bite”.
OBJECTIVE: He had Class I canine and molar on both sides, and his transverse dimension was favorable. There were mild rotations on the upper with a midline diastema of approximately 0.5mm. #8 had been chipped on the disto-incisal corner. #7 and 10 were slightly undersized in both vertical and horizontal dimensions. He had a lower bonded retainer that was glued to #22 and #27 with a solid stainless steel bar spanning #23-26. There were mild rotations in the lower arch and a crossbite involving #10, 11, and 22.
ASSESSMENT: Treatment goals were to align the teeth, close the midline diastema, and correct the left side crossbite. Option 1: Upper clear/metal and lower metal brackets. Option 2: Upper and lower Invisalign. Estimated tx time: 9-12mo. The option to restore the laterals and upper right central were presented as well.
PLAN: Patient elected to proceed with Invisalign without esthetic buildups.
Treatment
Initial Invisalign aligners were delivered March 2023 with instructions to wear 22+ hours per day and change trays every 10 days.
He was extremely cooperative however at his first check back 6 weeks after delivery I was not pleased with how #22 was moving so I requested he change trays every 2 weeks. This resulted in much better movement at 2 subsequent visits. With the crossbite nearly fully corrected we scanned and delivered refinement trays October 2023 with instructions to begin changing weekly.
He had 2 aligner checks between October 2023 and February 2024 to verify tracking at which point on February 5th, 2024 we verified his satisfaction with treatment and completed treatment with removal of attachments. We delivered upper and lower clear Vivera retainers to be worn at home and at night for 2 months, following by night time wear.
Treatment Review
He was pleased with the result. We corrected his crossbite, closed the diastema, and corrected rotations. I was excited to see the Invisalign aligners provide a bite opening effect to correct the crossbite without needing turbos/bite blocks (that dramatically affect mastication) to get #22 to slide under #10 & 11 and into position.
Critically reviewing my final records, I wish I had extruded #7 and improved its angulation with more distal root tip and mesial out. Also from #21 to 23 it appears I overcorrected the crossbite, resulting in a flattened corner of the arch, however intercuspation between #11 and 22 is excellent. The amount of facial surface of the tooth visible from canine to canine is quite similar viewed in the lower occlusal view, leading me to feel the torque control was excellent. This is one area many criticize Invisalign for being unable to control, yet we see well-controlled here.