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9/30/2011
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© 2011 Align Technology, Inc. All rights reserved. 1
Welcome
InvisalignG4
Ask the Expert Webinar
The webinar will begin shortly
•For technical issues: please click on the “help” tab at the top right hand side of the player window.
•Following the video presentation, there will be a live audio-only
Q&A session. To submit a question -Please click on the Q&A tab at the bottom left hand side of the player
window.
-Type in your question and click on the “ask” button.
•All questions will be answered via the email address you used
when registering for this event
© 2011 Align Technology, Inc. All rights reserved. 2 © 2011 Align Technology, Inc. All rights reserved.
InvisalignG4 – Ask the Expert
October 7, 2011
Dr. René Sterental – Clinical Director
John Morton – Director of Research & Technology
© 2011 Align Technology, Inc. All rights reserved. 3
Today’s Focus
The next generation of SmartForce® clinical
innovations
© 2011 Align Technology, Inc. All rights reserved. 4
Innovations
© 2011 Align Technology, Inc. All rights reserved. 5
• Original Clinical Protocols
• Prioritizing the most challenging movements
with Invisalign aligners
• Using Science to create a
foundation for Innovation
• SmartForce® Features
customized to each
patient’s individual teeth
• Clinical Advisory Board / Best Practices Protocols
The Pursuit of Predictability of Clinical Outcomes
© 2011 Align Technology, Inc. All rights reserved. 6 © 2011 Align Technology, Inc. All rights reserved. Confidential
Invisalign SmartForce® Features
REVIEW
9/30/2011
2
© 2011 Align Technology, Inc. All rights reserved. 7
Power Ridge® for Lingual Root Torque - 2009
Power Ridge® designed to deliver lingual root
movements for the upper incisors
© 2011 Align Technology, Inc. All rights reserved. 8
Invisalign G3 Power Ridge® for Lower Incisors
Power Ridge® features control the movement
of the root with respect to the crown
© 2011 Align Technology, Inc. All rights reserved. 9
Buccal and Lingual Power Ridge® pair improve
control of the upper incisors undergoing root torque with retraction
Invisalign G3 Lingual Power Ridge®
© 2011 Align Technology, Inc. All rights reserved. 10
First Optimized Attachments - 2009
• Designed to optimize forces for improved incisor extrusions
and canine rotations using standard tooth velocities
• Customized to patient’s individual teeth
Anterior extrusion attachment Canine rotation attachment Cuspid rotation attachment
© 2011 Align Technology, Inc. All rights reserved. 11
Invisalign G3 Optimized Rotation Attachments
A variation of the Optimized Rotation
Attachment can be placed on most any canine or bicuspid that requires rotation
© 2011 Align Technology, Inc. All rights reserved. 12
G3…Optimized Rotation Attachment for the bicuspids
Optimized Rotation Attachments are available
for the upper and lower 1st and 2nd bicuspids
9/30/2011
3
© 2011 Align Technology, Inc. All rights reserved. 13
Clinical Results
Before
After
Before
After
Optimized Rotation Attachments Optimized Extrusion Attachments
Case provided courtesy of Dr. Donna Galante Case provided courtesy of Dr. Ronda James
© 2011 Align Technology, Inc. All rights reserved. 14
Clinical Situations
•Greater root tip control for canines and upper
centrals
•Improved predictability for upper laterals
•Better clinical outcomes for open bite treatments
© 2011 Align Technology, Inc. All rights reserved. 15 © 2011 Align Technology, Inc. All rights reserved. Confidential
Improving Predictability of Tooth Movements with
InvisalignG4 SmartForce®
Features
John Morton Director of Research & Technology
© 2011 Align Technology, Inc. All rights reserved. 16
A Biomechanical Approach to Aligner Treatment
Does the tooth move because its
shape matches the aligner ?
…It is the force system that controls the
movement of the tooth.
© 2011 Align Technology, Inc. All rights reserved. 17
Desired
Movement Determine Force
System
Design
Appliance
Foundation of Biomechanics
. © 2011 Align Technology, Inc. All rights reserved. 18
SMARTFORCE® FEATURES
The process allows us to get to
the correct FORCE SYSTEM faster
Design Process
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© 2011 Align Technology, Inc. All rights reserved. 19
• Optimized Root Control Attachments for Upper
Centrals and Canines
• Multi-plane movement of Upper Laterals
• Multi-tooth Anterior Extrusion for Open Bite
Treatment
1
9
SMARTFORCE®
FEATURES
© 2011 Align Technology, Inc. All rights reserved. 20
Optimized Attachments….
Active Surface
The attachment surface that engages the aligner
The aligner applies force to the Active Surface
© 2011 Align Technology, Inc. All rights reserved. 21 © 2011 Align Technology, Inc. All rights reserved. Confidential
SmartForce® Optimized Root Control
Attachments
Upper Centrals
2
1
© 2011 Align Technology, Inc. All rights reserved. 22
ANGULATION of the tooth
Roots are divergent and not aligned
movement is
along the arch
© 2011 Align Technology, Inc. All rights reserved. 23
Biomechanics of Root Control
2
3
F1
M
Aligner staged movement:
-applies force (F1) to the crown
-produces an unwanted tipping moment (M)
© 2011 Align Technology, Inc. All rights reserved. 24
Biomechanics of Root Control
2
4
F1 F2
M A second force (F2) is
needed to control the movement of the root.
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5
© 2011 Align Technology, Inc. All rights reserved. 25
Biomechanics of Root Control
2
5
Optimized root control
attachments are positioned, oriented and activated
automatically by the
software
F1 F2
M
© 2011 Align Technology, Inc. All rights reserved. 26
Optimized Root Control Attachments
2
6
Possible Movements:
ROOT UPRIGHTING
of the
upper centrals
© 2011 Align Technology, Inc. All rights reserved. 27
Biomechanics of Translation along the arch
2
7
When the moment (M) and the
force (F) are proportioned correctly…..the tooth will move
along the arch and maintain its
upright orientation…..translation
F1 F2
M
© 2011 Align Technology, Inc. All rights reserved. 28
Biomechanics of Translation along the arch
2
8
The crown and the root move the
same distance along the arch
© 2011 Align Technology, Inc. All rights reserved. 29
M/F ratios for translation
You must apply the
correct force system to
attain the correct
treatment outcome
Dis
tan
ce
fro
m C
en
ter
of
Re
sist
an
ce
to C
en
ter
of
Ro
tati
on
Center of resistance
M /F ratio at the bracket
translation
Smith and Burstone in “Mechanics of Tooth Movement” (AJODO, 1984)
© 2011 Align Technology, Inc. All rights reserved. 30 3
0
Possible Movements
Diastema closure
Midline shift
9/30/2011
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© 2011 Align Technology, Inc. All rights reserved. 31 3
1
Possible Movements
Diastema closure
Midline shift
© 2011 Align Technology, Inc. All rights reserved. 32
Aesthetics
3
2
#8 : Optimized Root Control Attachment
#9 : Vertical Rectangular Attachment
© 2011 Align Technology, Inc. All rights reserved. 33 3
3
•less obvious = more aesthetic
Rectangular Attachment
Optimized Root Control Attachment
•A portion can be beneath the lip and not show at all
© 2011 Align Technology, Inc. All rights reserved. 34 © 2011 Align Technology, Inc. All rights reserved. Confidential
SmartForce®
Optimized Attachment for
Root Control
Canine
© 2011 Align Technology, Inc. All rights reserved. 35
Force System on Canine
3
5
F1 F2
M
The moment (M) is strong enough to move the canine root.
© 2011 Align Technology, Inc. All rights reserved. 36 3
6
Possible Movements: ROOT ALIGNMENT
9/30/2011
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© 2011 Align Technology, Inc. All rights reserved. 37
M/F ratios for root tip
Dis
tan
ce
fro
m C
en
ter
of
Re
sist
an
ce
to C
en
ter
of
Ro
tati
on
Center of resistance
M /F ratio at the bracket
Smith and Burstone in “M echanics of Tooth M ovement”
(AJODO, 1984)
Root leads
the crown
proportions
© 2011 Align Technology, Inc. All rights reserved. 38
3
8
Possible Movements: space closure
When the moment (M) and the force (F) are proportioned correctly…..the tooth will move along the arch and maintain
its upright orientation…..translation
The crown and the root move the same distance along the arch
M
F
© 2011 Align Technology, Inc. All rights reserved. 39
Aesthetics
3
9
less obvious = more aesthetic
© 2011 Align Technology, Inc. All rights reserved. 40
Aesthetics
4
0
Rectangular Attachment
Optimized Root Control Attachment
© 2011 Align Technology, Inc. All rights reserved. 41 © 2011 Align Technology, Inc. All rights reserved. Confidential
SmartForce®
Multi-plane Movement
Upper Laterals
© 2011 Align Technology, Inc. All rights reserved. 42
Multi-plane movements….what are they?
Extrusion . . . . . combined with other
movements the tooth is undergoing a the same
time . . . .
•rotation
•crown tip (bucco-lingual)
•crown tip (mesio-distal)
9/30/2011
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© 2011 Align Technology, Inc. All rights reserved. 43
Example
Extrusion with
•mesial-out rotation
•crown tip lingual
© 2011 Align Technology, Inc. All rights reserved. 44
Mechanics of Multi-plane Movements
4
4
Two forces are used to control the tooth movement
The tooth should move as programmed…..a multi-plane
movement.
Force on attachment
Force from
pressure point
© 2011 Align Technology, Inc. All rights reserved. 45
The Applied Force System
4
5
Force The software
determines the
position and
orientation of the
attachment active
surface
© 2011 Align Technology, Inc. All rights reserved. 46
The software determines the position and orientation of
the pressure point on the lingual aspect of the aligner
© 2011 Align Technology, Inc. All rights reserved. 47 4
7
THE TWO FORCES TOGETHER CONTROL THE
TOOTH MOVEMENT
© 2011 Align Technology, Inc. All rights reserved. 48 © 2011 Align Technology, Inc. All rights reserved. Confidential
Multi-Tooth Extrusion for
Open Bite Treatment
9/30/2011
9
© 2011 Align Technology, Inc. All rights reserved. 49
Multi-tooth
force
measurement
apparatus
© 2011 Align Technology, Inc. All rights reserved. 50
Multi-tooth anterior extrusion for treatment of open bite
5
0
Optimized Extrusion Attachments extrude the four upper
incisors as a unit, leveraging the posterior teeth as anchorage.
Aligner activation is adjusted individually on each of the upper
incisors…….to ensure all four are extruded at the same time.
© 2011 Align Technology, Inc. All rights reserved. 51
How it works….
5
1
The lateral and the central incisor attachments require different aligner
activations to produce the needed force.
ACTIVATION: the interference of the aligner on the active surface of the
attachment; it produces the force
activation levels
© 2011 Align Technology, Inc. All rights reserved. 52 5
2
We anticipate improved open bite treatment with these
Smart Force® features
Extrusive force is applied to all upper anterior teeth
© 2011 Align Technology, Inc. All rights reserved. 53
For precise finishes the aligner must be activated
5
3
The aligner is still pushing on the attachment at the end of
the movement
Aligner is “activated” to push on the attachment and seat
the tooth all the way into the aligner cavity
No
activation
With
activation
© 2011 Align Technology, Inc. All rights reserved. 54
Summary
• Optimized Root Control Attachment for Canines and
Upper Centrals
• Multi-plane movement of laterals
• Multi-tooth Anterior Extrusion for Open Bite
Treatment
5
4
SMART FORCE® FEATURES
9/30/2011
10
© 2011 Align Technology, Inc. All rights reserved. 55
Summary
5
5
The SmartForce® feature process is in place as
evidenced by the releases of these innovations
The design methodology is accepted by practitioners
Doctors using SmartForce® features are reporting
better results
Invisalign is listening and responding to the clinical issues
© 2011 Align Technology, Inc. All rights reserved. 56 © 2011 Align Technology, Inc. All rights reserved. Confidential
InvisalignG4 SmartForce®
Features Clinical Protocols
Dr. René Sterental
Clinical Director
© 2011 Align Technology, Inc. All rights reserved. 57
Multi-tooth Anterior Extrusion for Open Bites
• Individualized differential activation applied when all
four upper incisors have absolute extrusion
programmed - Threshold: Absolute Extrusion > 0.5mm
• Simultaneous Staging
© 2011 Align Technology, Inc. All rights reserved. 58
Individual Extrusion Attachment
• Individual Optimized Extrusion Attachments are now
activated
- Threshold: Absolute Extrusion > 0.5mm
- Activated individually when 3 or fewer Optimized Extrusion
Attachments are present on upper incisors or on any other tooth:
- Applicable individually on all upper & lower incisors & canines
• Simultaneous Staging - Unless LRT Power Ridges are present:
•LRT is staged first @ 1 deg/stage
•Extrusion is staged at the end
© 2011 Align Technology, Inc. All rights reserved. 59
Multi-plane Movement of Upper Laterals
• Applicable to upper lateral incisors when:
- Absolute extrusion > 0.1mm is programmed
AND
- Center of the Root has minimal displacement
AND
- Crown tipping in any direction is programmed
AND/OR
- Rotation is programmed
• Not applicable when root movements
or intrusion are programmed
• Simultaneous Staging
© 2011 Align Technology, Inc. All rights reserved. 60
Optimized Root Control for Upper & Lower Cuspids
• Applicable for mesio-distal root uprighting - When center of root moves > 0.5mm
• Applicable for mesio-distal space closure - When center of root moves > 0.5mm
- Close spaces mesial or distal to the cuspid with bodily movement
- Separate roots for upper lateral incisor implant placement
• Bicuspid Extraction Protocol Update - Will be applied on bicuspid extraction
cases as long as cuspid bodily movement
is programmed to close extraction space
- Won’t be applied if distal crown tip is
programmed to close extraction space
• Simultaneous Staging
9/30/2011
11
© 2011 Align Technology, Inc. All rights reserved. 61
Optimized Root Control for Upper Central Incisors
• Applicable for mesio-distal root uprighting - When root center moves > 0.75mm
• Applicable for mesio-distal space closure - Diastema closure while maintaining proper root control
•As long as root center moves > 0.75mm
- Separate roots for upper lateral incisor implant placement
• Simultaneous Staging
© 2011 Align Technology, Inc. All rights reserved. 62
Precision Cuts & Cuspid Optimized Attachments
• Precision Cuts are now compatible with Invisalign G3
Optimized Extrusion & Rotation Attachments
- There must be enough room on clinical crown for both features to
fit without overlapping
•1.5mm of separation needed to avoid cutting into attachment well in
aligner
- If both features don’t fit, the default action will be to keep the
Optimized Attachment
• If you have a different preference, enter it in the Special Instructions of the Rx Form
- Not yet tested with Invisalign G4 SmartForce® features
© 2011 Align Technology, Inc. All rights reserved. 63
Precision Cuts & Cuspid Optimized Attachments
• Proper procedure to use elastics when Precision Cuts
& Optimized Attachments co-exist:
- Have patient insert both aligners
- Ensure correct seating by biting on chewies
- Engage elastics from posterior hooks/buttons to anterior hooks
© 2011 Align Technology, Inc. All rights reserved. 64 © 2011 Align Technology, Inc. All rights reserved. Confidential
InvisalignG4 Clinical Protocols:
SmartForce® Feature Placement
© 2011 Align Technology, Inc. All rights reserved. 65
Clinical Protocol: SmartForce® Feature Placement
• Principles of Application
- Features are determined based on movements required to
address the primary treatment goal
- Movements with the largest magnitude are given higher priority
for feature placement
© 2011 Align Technology, Inc. All rights reserved. 66
Clinical Protocol: SmartForce® Feature Placement
• Upper Central Incisor: 1. Open Bite Optimized Extrusion Attachments (Multi-tooth)
2. Mesio-Distal Root Control
3. Power Ridge® for LRT
4. Individual Optimized Extrusion Attachment
• If LRT & Extrusion are present, movements are separated and extrusion is staged after LRT
9/30/2011
12
© 2011 Align Technology, Inc. All rights reserved. 67
Clinical Protocol: SmartForce® Feature Placement
• Upper Lateral Incisor: 1. Open Bite Optimized Extrusion Attachments
2. Multi-Plane Crown Movement
3. Power Ridge® for LRT
4. Individual Optimized Extrusion Attachment
• If LRT & Extrusion are present, movements are separated and extrusion is staged after LRT
© 2011 Align Technology, Inc. All rights reserved. 68
Clinical Protocol: SmartForce® Feature Placement
• Upper & Lower Canines: 1. Mesio-Distal Root Control
• No Precision Cut allowed to co-exist
2. Individual Optimized Extrusion or Rotation Attachment
• Precision Cut allowed to co-exist provided both fit
• Based on movement prevalence
- For large cuspid rotations (>15 deg) the Optimized Rotation
Attachment will supersede the Optimized Root Control Attachments
© 2011 Align Technology, Inc. All rights reserved. 69 © 2011 Align Technology, Inc. All rights reserved. Confidential
InvisalignG4 New Class II division 2
Staging Protocol
© 2011 Align Technology, Inc. All rights reserved. 70
Invisalign G4 Staging for Retroclined Incisors
Proclination/LRT Phase Intrusion Phase Retraction Phase
• Applicable to retroclined upper incisors only - Commonly found in Class II division 2 cases
- Sequential Staging to improve predictability of outcome
•Power Ridges added to ensure root control
© 2011 Align Technology, Inc. All rights reserved. 71 © 2011 Align Technology, Inc. All rights reserved. Confidential
iOC® / iTero® Scanning & Invisalign
Update
© 2011 Align Technology, Inc. All rights reserved. 72
Using iOC® & iTero® scans with Invisalign
• Clinical Advantages of scans over PVS impressions: - Better fitting aligners
“Patients report a noticeable difference between aligners originating
from scanning vs. PVS impressions. They fit so tight they are MORE
comfortable and less saliva is trapped under the plastic.” – Dr. Perry Jones
9/30/2011
13
© 2011 Align Technology, Inc. All rights reserved. 73
Using iOC® & iTero® scans with Invisalign
• Clinical Advantages of scans over PVS impressions: - Quicker initial ClinCheck treatment plan turnaround time
Based on 1,000+ scans:
• Virtually eliminates rejections
• Time from submission of scan to initial
ClinCheck Treatment Plan posted on the Invisalign Doctor Site = 2 days
© 2011 Align Technology, Inc. All rights reserved. 74
To obtain your CE certificate for this program please complete a brief survey at:
www.AligntechInstitute.com/asksurvey
Upon completion of your survey* you will have immediate
access to your CE certificate. *This survey is only available to the participants who attended the “live” presentation on October 7, 2011. Participants who complete the archived program on
AligntechInstitute.com need to complete a CE test to obtain their CE certificate.