How to achieve a better,faster and more predictable result with aligner treatment planning

Updated: Jan 6

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Case Report

How to achieve a better,faster and more predictable result with aligner treatment planning

Traditional orthodontic thinking would require a patient with severe crowding and an open bite anteriorly to be treated orthodontically with fixed appliances/braces in combination with dental extractions and more than likely a surgical approach as well.

Could aligner therapy alone (without extractions or surgery) resolve the issues of crowding and anterior open bite - quite possibly.

A 15-year-old female presents with a class 1 posterior relationship with significant crowding in her upper and lower anterior region and a 7mm anterior open bite. What would you do?

From a facial perspective, the patient had a slightly retrognathic mandible. There was a dolichofacial and vertical growth pattern with a long lower facial height and demonstrated significant lip strain on closure.

Initial Photographs

Initial Digital Setup

The initial digital set up was returned and further attachments were placed, staging of treatment was modified significantly and most importantly over correction of the posterior segments was incorporated to provide the digital set up a posterior open bite.

Here is the digital set up and final treatment plan for the first set of aligners.

We decided to treat the patient with Aligner Therapy. The results were extremely impressive:

Photographs after first set of aligners

Through excellent treatment planning – and with a final plan of 17 upper aligners and 15 lower aligners, the following treatment result was achieved – an excellent correction of the anterior open bite and now a further modification is required to perfect the anterior alignment and in particular the crown tip of the lower right lateral incisor and also requiring further improvement in providing a nice socked in occlusion posteriorly and adding further buccal root torque to the upper second molar teeth.

To perfect the result, a refinement is planned with a further 15 upper aligners and 10 lower aligners – making the treatment in total of 32 upper aligners and 25 lower aligners – and the patient has been changing each aligner weekly, so we expect a total treatment time to be less than nine months.

Digital Setup and Final Treatment Plan

Here is the digital set up and final treatment plan for the first set of refinement.

This case demonstrates the value of a good diagnosis, excellent treatment planning which factors in ideal staging of treatment, understanding the use and biomechanics of different attachments, when and how to over correct different tooth movements and ensuring the set up provides predictable movements with aligners to allow a predictable outcome for your patients.

In the past this type of patient - who presented with an anterior open bite and crowding - was traditionally treated with a combination of orthodontics and orthognathic surgery.and dental extractions to resolve the crowding issue.

If left untreated, the patient would have significant functional problems as well as serious occlusal wear on the posterior teeth.

She may also have issues with proper mastication; unable to chew and digest food properly. Not to mention the aesthetic and potential psychological issues she may suffer in her delicate teenage years and beyond as a result.

However, there are a number of potential problems and challenges that many dentists face with aligner therapy, including:

Poor case planning

Incorrect stageing of the tooth movements

Poor placement or use of incorrect attachments

based on the biomechanical requirements

Not providing the necessary over-corrections

Offering an unrealistic treatment outcome; a

common mistake aligner companies cause and

general dentists experience frequently.

With the right team of orthodontists experienced in aligner therapy planning the treatment for you, these mistakes can be avoided and even the most difficult cases can be managed and completed successfully with aligner therapy.

Like to learn more about how to provide high-quality orthodontic aligner treatments with predictable, profitable and positive outcomes every time?

Learn about CAPS, visit today.

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