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Special Feature
7 (
2
); 69-72
doi:
10.4103/apos.apos_29_17

Advanced Aligner Orthodontics

Director, Smile Innovation Orthodontics, Tokyo, Japan

Address for Correspondence: Dr. Ojima Kenji, 2-39-5-2F Hongo Bunko-ku, Tokio, Japan. E-mail: kenjiman2007@yahoo.co.jp

Licence
This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Disclaimer:
This article was originally published by Wolters Kluwer and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Invisalign initially had limitations which have now been overcome. Advances in the quality of aligner materials, attachments and the introduction of a new force system, have expanded the range of treatment possibilities from severe crowding to more difficult extraction cases, open bite cases, and lower molar distalization cases.

Keywords

AcceleDent
accelerate orthodontics
aligner
aligner orthodontics
craniomandibular dysfunction
extraction orthodontics
Invisalign
midline shift
open bite
orthopulse
temporomandibular disorder

In recent years, adult patients have demanded inconspicuous orthodontic appliances.[1-7] Even with aligner therapy, one of the greatest sources of dissatisfaction among adult patients remains the length of treatment. This article descibes three patients with difficult malocclusions. The first case is a four premolar extraction treatment. The second case is a Class III case treated with lower molar distalization. The last case is a patient with an anterior open bite.

CASE 1: ANTERIOR CROWDING +ACCELEDENT

This 25-year-old female had a chief complaint of anterior crowding and a highly placed canine [Figure 1].[8-11] We planned four premolar extractions and used Invisalign aligner treatment with elastics.

Initial clinical check
Figure 1
Initial clinical check

After extraction, we started retraction of canines and leveling of the full arch at the same time [Figures 2-5].

Initial clinical check
Figure 2
Initial clinical check
First aligner set post four premolar extraction
Figure 3
First aligner set post four premolar extraction
Case 1 treatment procedure (a) Initial (b) Postextraction (c) Attachment (d) Start retraction (e) Anterior retraction (f) Torque (g) Detail (h) Final
Figure 4
Case 1 treatment procedure (a) Initial (b) Postextraction (c) Attachment (d) Start retraction (e) Anterior retraction (f) Torque (g) Detail (h) Final
Final clinical check
Figure 5
Final clinical check

This case used an acceleration device AcceleDent[12-18] everyday for 20 min per day at home. Aligners were changed every 5 days

Finally, we obtained space closure and functional guidance.

Treatment time was 18 months for this case [Figure 6].

Final
Figure 6
Final

CASE 2 - INVISALIGN + TEMPORARY ANCHORAGE DEVICES, LOWER MOLAR DISTALIZATION

A 25-year-old male presented with a chief complaint of anterior open bite and Class III[19-21] relationship with a midline shift to right [Figure 7]. We placed temporary anchorage devices in the mandibular arch and used elastics.

Initial oral
Figure 7
Initial oral

This case used acceleration device AcceleDent everyday for 20 min per day at home. Then, aligners were changed every 5 days. Finally, we improved functional guidance, over bite, overjet, and attained a Class I relationship between canine and molars. Treatment time was 18 months for this case [Figures 7-13].

Cephalogram and orthopantomogram
Figure 8
Cephalogram and orthopantomogram
Initial clinical check
Figure 9
Initial clinical check
First aligner set
Figure 10
First aligner set
Treatment procedure
Figure 11
Treatment procedure
Final clinical check
Figure 12
Final clinical check
Cephalogram and orthopantomogram
Figure 13a
Cephalogram and orthopantomogram
Final
Figure 13b
Final

CASE 3 - OPEN BITE+ACCELERATION

A 40-year-old female presented with a chief complaint of anterior open bite and crowding [Figure 14]. She used Invisalign aligners. Normal Invisalign protocol needed 46 aligners.

Initial oral
Figure 14
Initial oral

However we combined Orthopulse,[22] an acceleration device, that allowed the patient to change aligners every 3 days. Orthopulse was used 10 min per day at home. This treatment finished in 6 months (compared to 23 it would have taken with conventional mechanics) [Figures 14-20].

Aligner set with attachment
Figure 15
Aligner set with attachment
Good Aligner fit during treatment
Figure 16
Good Aligner fit during treatment
Final oral
Figure 17
Final oral
Clinical check (a) initial and (b) final
Figure 18
Clinical check (a) initial and (b) final
(a) Initial and (b) final orthopantomogram
Figure 19
(a) Initial and (b) final orthopantomogram
Initial and final superposition
Figure 20
Initial and final superposition

CONCLUSION

Aligners are not only comfortable and esthetically pleasing to adult patients but, they are easily removed and hygenic. In future, aligners are likely to be used in even more complex cases involving rotations, open bites, and four premolar extractions and lower molar extractions.

Further clinical investigations are needed into the effects of accelerated tooth movement in such cases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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