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Case Selection with Invisalign:
The First Step to a Successful Outcome
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• DDS ( 1986) and Diploma of Orthodontics from the University of Toronto (1991)
• Orthodontic practice in Toronto, Canada, focused on Cosmetic and Rehabilitative Orthodontics.
• Invisalign Super Elite Provider and member of the Aligntech Institute Faculty
• Lecturer at the University of Toronto, and Guest Lecturer at Tel Aviv University and Hadassah University in Jerusalem
• Featured speaker at the Pankey Institute, Invisalign Forum and Invisalign Summits, and numerous Align events worldwide.
• Member of the AAO and CAO, and other dental organizations
• Married to Ellen Dayan ( Restorative Dentist ), and 4 great children, Laurel, Ariel, Jamie, and Jory
Dr. Willy Dayan
www.orthoclined.com [email protected]
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•Mild Case Selection for Aligner Correction
•Moderate Case Selection for Aligner Correction
•Severe Case Selection for Aligner Correction
Malocclusion Criteria for Aligner Orthodontics
•What is the Orthodontic Treatment Plan Before the ClinCheck
•What will be Required Besides Braces and Wires
•How Would the Wires Look ........ Straight or Not
Aligned Upper and Lower Arches is Not a Treatment Plan
•Mild Case Selection for Aligner Correction• Alignment Correction• Minor Vertical and Sagital Correction• No Significant Root Movements
•Moderate Case Selection for Aligner Correction
•Severe Case Selection for Aligner Correction
Malocclusion Criteria for Aligner Orthodontics
3
Go to Clincheck
Mild Case Selection
Aligner NumbersMx: 25+6=31Md: 25+6=31
Treatment Time: 15 Months
Smart Force Systems and Refinement Aligners are your Friend!
Lets not Doctor Everything!!
4
Refinement Aligners are your Friend!
Before
Stage 11Md rfn
Go to Refinement Md
TrackingStage 11
Go to Refinement Mx
Refinement Aligners are your Friend!
Refinement Aligners are your Friend!
5
Refinement Aligners are your Friend!
Before
After
Detailing Aligners are your Friend!
Treatment Efficiency......Need Staff Systems!!!!
Aligner NumbersMx: 21+6=27Md: 11+7=18
Treatment Appointments: 9(Including Impressions and debond and retention)
+1: Impression+2: Insert Aligners and attachments+5: Invisalign progress at 9,11,15,21,6+1: Debond Attachments and Retention
Traditional Appointments: 12(Including Start and debond and retention)
+1: Bond+7: Arch Changes and Adjustments+2: 2 emergencies per year+2: Debond Attachments and Retention
15
Case 5
Class I Mild Crowding, High Canine
The Advantages of Optimized Attachments
Smart Force Systems in Operation
6
Chief Complaint: •I don’t like my smile •My canine stopped coming down
Significant Clinical Findings: •Class I Malocclusion•High upper right canine•Mild crowding
Records: •Panoramic Xray: WNL•Lateral Cephalometric Xray: WNL
Go to Clincheck Final
17
The Advantages of Optimized Attachments: Smart Force Systems in Operation
Par 2 or Par 3 Orthodontic Case
One Modification....Treatment Plan 2 Accepted
18
Before
Progress
LastAlignersTracking
7
19
Treatment Efficiency
Aligner NumbersMx: 25+0=25Md: 16+0=16
Treatment Appointments: 8(Including Impressions and debond and retention)
+1: Impression+2: Insert Aligners and attachments+4: Invisalign progress at 9,15,21,25+1: Debond Attachments and Retention
Vertical Challenges: In the Developing Dentition
InitialRecords
Go to 1st Order
Go to 2nd Order
21
Vertical Challenges: In the Developing Dentition
8
Vertical Challenges: In the Developing Dentition
Before Progress: Middle of 1st Order
Note how aligners guide maxillary cuspids as they erupt.
Go to 1st Order
Go to 2nd Order
23
Vertical Challenges: In the Developing Dentition
Vertical Challenges: In the Developing Dentition
Before
Near End of1st order
Near End of 2nd Order
Go to 1st Order Go to 2nd OrderFinished Retainer #11
From 2nd Order
9
Vertical Challenges: In the Developing Dentition
Before
Go to 1st Order Go to 2nd Order
Finished Retainer #11From 2nd Order
After
Vertical Challenges: In the Developing Dentition
AfterBefore
•Mild Case Selection for Aligner Correction
•Moderate Case Selection for Aligner Correction• Alignment Correction• Need for Vertical and or Sagital Correction• Some Root Movements Required
•Severe Case Selection for Aligner Correction
Malocclusion Criteria for Aligner Orthodontics
10
28
Go to Final ClincheckGo to Clincheck 1
Enhanced Restorative / Prosthetic / Periodontal Dentistry Using Orthodontics
Vertical Challenges: Deep Anterior Overbite with Adequate Vertical Smile
Vertical Challenges: Deep Anterior Overbite
First ClinCheck Final ClinCheck
30
Aligner NumbersMx: 25+0=25Md: 19+0=19
Treatment Appointments: 8(Including Impressions and debond and retention)
+1: Impression+2: Insert Aligners and attachments+4: Invisalign progress at 9,15,21,25+1: Debond Attachments and Retention
Vertical Challenges: Deep Anterior Overbite with Adequate Vertical Smile
Enhanced Restorative / Prosthetic / Periodontal Dentistry Using Orthodontics
11
Vertical Challenges: Deep Anterior OverbiteAre they all the same?
Enhanced Restorative / Prosthetic / Periodontal Dentistry Using Orthodontics
Vertical Challenges: Deep Anterior OverbiteAre they all the same?
Before
Deep‐bite, with desire to open vertical dimension of occlusion with mandibular posterior eruption.
Vertical Challenges: Deep Anterior Overbite with Inadequate Vertical Smile
12
Before
Deepbite, with desire to open vertical dimension of occlusion with mandibular posterior eruption.
During
Vertical Challenges: Deep Anterior Overbite with Inadequate Vertical Smile
When you want an increase in face height…..Braces can be better and faster
Posterior eruption: When we do want it!!!
Go to Clincheck
Before
During
Before After
Vertical Challenges: Deep Anterior Overbite with Inadequate Vertical Smile
When you want an increase in face height…..Braces can be better and faster
13
Go to ClinCheck37
NM:MXD28 No RF!
38
Translating Roots Mesially or Distally
What the tooth needs to feel, and what we need to see!
Translating Roots Mesially or Distally
14
Before
After
BeforeBefore AfterAfter
NM:MXD28 No RF!
Aligner NumbersMx: 28+0=28Md: 28+0=28
Treatment Appointments: 8(Including Impressions and debond and retention)
+1: Impression
+2: Insert Aligners and attachments+4: Invisalign progress at 9,15,21,26+1: Debond Attachments and Retention
Anticipate The Challenging Movement…90/10 Philosophy!!
41
The LL3 needs much root tipping.If one notices non‐tracking mid‐tx.
Apply 90/10 thinkingduring remaining aligners.
Anticipate The Challenging Movement…90/10 Philosophy!!
Before
After
No Mistakes....Only one more way of how not to do it!!!!
15
No Mistakes....Only one more way of how not to do it!!!!
Lets not Doctor Everything!!Just what Needs Doctoring!!
Go toClinCheck
44
16
46
Tracking NearEnd
Progress Near End
Before
After
Doctor what Needs Doctoring....and Lets not Doctor Everything!
Aligner NumbersMx: 23 + 0 = 23Md: 23 + 0 = 23
Treatment Efficiency
Treatment Appointments: 7+1: Scan+2: Insert Aligners and attachments+3: Invisalign progress 9,15,21+1: Debond Attachments and Retention
48
Sagital Challenges: Class II Correction: Elastics
Class II Elastics
Go to Clincheck
17
49
Class II Correction During Invisalign
•Continuous Staging•IPR delayed until stage 21•Bite Jump at end of Clincheck
Sagittal Challenges: Class II Correction: Elastics
Before
Class II Elastics: Stage 9
Progress: Stage 9
Before After
Treatment Efficiency ( stopped refinement at #5)
Aligner NumbersMx: 21+4=25Md: 18+0=18
Treatment Appointments: 9+1: Impression+2: Insert Aligners and attachments+5: Invisalign progress and refinemnt at 9,15,21,2,5+1: Debond Attachments and Retention
Sagittal Challenges: Class II Correction: Elastics
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52
Initial
Final
1 year Retn.Mx:Vivera NightsMd: Fixed Wire
Note posterior inter‐occlusalspace closing slowly.
Sagittal Challenges: Class II Correction: Elastics
If it Works for Class II...what about Class III: Class III Correction: Elastics
Class III Elastics
Go to 1st Order
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19
If it Works for Class II...what about Class III: Class III Correction: Elastics
Note how elastics have corrected the crossbite and class III conditions morethan Clincheck shows at same stage.
Go to 1st Order
Stage 15
If it Works for Class II...what about Class III: Class III Correction: Elastics
Before Progress
Go to 1st Order Go to 2nd Order ( Ret/Ref)
Patient did not wear last lower aligners.NO LOWER IPR!!!
57
Not finished yet.
20
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Sagittal Challenges: Crossbite Correction: Invisalign Expansion and Elastics Support
Final Records Previous
Orthodontics
Original Ceph
InitialPhotos
Treatment Plan: Invisalign expansion supported with crossbite elastics and selected intrusion to reduce canted occlusalplane.
Go to ClinCheck1st Order
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Crossbite Elastics Set‐up.....•What is the Orthodontic Treatment Plan Before the ClinCheck•What will be Required Besides Braces and Wires•How Would the Wires Look ........ Straight or Not
Stage 0 Stage 9 Stage End 1st Order
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Sagittal Challenges: Crossbite Correction: Invisalign Expansion and Elastics Support
Before Progress Stage 9
Crossbite corrected clinically............ even before it is corrected in ClinCheck!
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Sagittal Challenges: Crossbite Correction: Invisalign Expansion and Elastics Support
Before
Final
End of 1st Order
Solving the “posterior openbtie” with anterior intrusion
and a bite jump.
Go to ClinCheck2nd Order
Go to ClinCheck1st Order
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Sagittal Challenges: Crossbite Correction: Invisalign Expansion and Elastics Support
Before Final
Go to ClinCheck
Working Smarter …. Not Harder!!
22
Go to ClinCheck
Working Smarter …. Not Harder!!
Avoiding the Openbite!
Before Final
Working Smarter …. Not Harder!!
Aligner NumbersMx: 17+0=32Md: 17+0=32
Treatment Appointments: 6+1: Scan+2: Insert Aligners and attachments+2: Invisalign progress at 9,15,+1: Debond Attachments and Retention
Serious Doctor Time Appts
3Consult,3,15
Before FinalWorking Smarter …. Not Harder!!
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•Mild Case Selection for Aligner Correction
•Moderate Case Selection for Aligner Correction
•Severe Case Selection for Aligner Correction
Malocclusion Criteria for Aligner Orthodontics
68
Par 4 or Par 5 Orthodontic Case
StartRFNMT
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Before
StartMCC.
After
Par 4 or Par 5 Orthodontic Case
VT:MXD27/45, MCC30/30 RFMXD10
24
70
Before
After
Before After
VT:MXD27/45, MCC30/30 RFMXD10
StartRFNMT
71
Before
StartMCC.
After
Par 4 or Par 5 Orthodontic Case
VT:MXD27/45, MCC30/30 RFMXD10
It took me and my partner patient
3 shotsto get the ball in
the hole!
Go to ClinCheck
25
Go toClinCheck
40 Aligners
Before After Retainer Refinement
AfterRetainer Refinement
BeforeRetainer Refinement
Before After Retainer Refinement
After Retainer RefinementBefore Retainer Refinement
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Sagittal Challenges: Class III Correction: Lower Incisor Extraction
Go to ClinCheck Final
Go to ClinCheck Trial IPR
Sagittal Challenges: Class III Correction: Lower Incisor Extraction
Maxillary IPRLower Incisor Extraction
Progress Pictures
Sagittal Challenges: Class III Correction: Lower Incisor Extraction
27
79
Refinement In Mandible Only
6 Aligners with 0.2mm IPR from 3 to 3 increase overjet.
Time for Refinement Aligners for Finishing Details
Sagittal Challenges: Class III Correction: Lower Incisor Extraction
Aligner NumbersMx: 36 + 0=36Md: 36 + 6=42
Treatment Appointments: 11(Including Impressions and debond and retention)
+1: Impression+2: Insert Aligners and attachments+7: Invisalign progress at 9,15,21,27,33, 36,6+1: Debond Attachments and Retention
Before
After
Sagittal Challenges: Class III Correction: Lower Incisor Extraction
Initial Records
Go to Clincheck 5 Approved
Go to Clincheck 1 Proposal
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Still in Treatment.....My next biggest openbite closure!!!
Stage 0
Stage 9
Stage 9 Progress Appt.
Go to Clincheck2nd Order
Go to Clincheck 5 Approved(1st Order)
Par 2 or 3 or 4 or 5 or….
Orthodontic Case
Progress....Not Yet 2 Years!!!
All attachments off .... Taking Records for 3rd OrderWe are on the Green….Putting Now!!
It’s His Birthday!!Go to
3rd Order
29
Before Final
Anterior Guidance........No Elastics and No TADS!!
Vertical Challenges: Anterior Openbite
Before Final
When you want an increase in face height…..Braces can be better and faster
Deepbite, with desire to open vertical dimension of occlusion with mandibular posterior eruption.
Hard Posterior contacts
Go to1st Order
30
Before
End of 1st Order
Go to2nd Order
Go to1st Order
End of 2nd Order
Go to3rd Order = RR
When you want an increase in face height…..Braces can be better and faster
Before Final
2 years and a Par 3
When you want an increase in face height…..Braces can be better and faster
In time for the Wedding!
When you want an increase in face height…..Braces can be better and faster
Invisalign and Braces...the Perfect Couple!!
31
Enhanced Restorative / Prosthetic / Periodontal Dentistry Using Orthodontics
Go to Clincheck1
Deepbite, with desire to open vertical dimension of occlusion with mandibular posterior eruption.
BUT THIS PATIENT WILL NOT HEAR ABOUT BRACES!!!!!
Go to Clincheck2( mcc @ stg 4)
Hard Posterior contacts
92
Levelling Deep Curve of Spee In Both Arches
If we use a reverse curve of spee aligner in both arches.....That means extrusion of bicuspids in both arches.....
That mean occlusal interferences and heavy occlusal contacts in posteriors and .....
IT SHOULD NOT BE RESOLVED BY INTRUSION OF POSTERIORS!!!!!
93
In a deep bite if we use opposing curve of spee levelling wires, by definition we are purposefully creating posterior occlusal interferences to open the bite!
32
94
Enhanced Restorative / Prosthetic / Periodontal Dentistry Using Orthodontics
Go to Clincheck1
Go to Clincheck2( mcc @ stg 4)
Before Stage 37
Enhanced Restorative / Prosthetic / Periodontal Dentistry Using Orthodontics
Go to Clincheck1
Go to Clincheck MCC
( mcc @ stg 4)
Before End of 1st Series
Go to 2nd Order
33
97
New G5 Features Now Available…….IT CAN ONLY GET BETTER!!!!
•What is the Orthodontic Treatment Plan Before the ClinCheck
•What will be Required Besides Braces and Wires
•How Would the Wires Look ........ Straight or Not
Aligned Upper and Lower Arches is Not a Treatment Plan
•Mild Case Selection for Aligner Correction
•Moderate Case Selection for Aligner Correction
•Severe Case Selection for Aligner Correction
Malocclusion Criteria for Aligner Orthodontics
99
Dr. Willy Dayan
•www.orthoclined.com