Generally, cases with some crowding is easier to treat. Therefore, elastics were not used until the very last stage for this case.
For this case, I separated the retraction of the canines and the incisors in order to maximize anchorage.
Aligners were changed weekly.
Elastics were used at stage 57 (last stage) using Class III elastics only on the left side for 2 months, followed by approximately 1 month of up and down elastics between upper and lower second molars on both sides. Attachments were removed at this phase.
May 2016
This patient was a very shy teenager who was always hiding his smile because of his teeth, and for him braces were not an option. He saw braces as something that would make him look even worse.
The goal was to treat him without any extractions and to align all the teeth and obtain a Class I occlusion with good function. We knew treatment would be long and the patient was warned that compliance was crucial to achieving excellent results.
The results we achieved with this case are stunning. It is the kind of case that makes you believe that anything can be done with Invisalign and a compliant patient. The patient was really involved in the success of his treatment and it not only gave him back his smile, but his whole personality changed. He became confident. The patient’s last words when we took his final pictures were, “Finally, I’ll be able to put a picture of me smiling on social media…finding a girlfriend is my next goal!”
We had the chance to witness this change and, in a way, be a part of it. It was something that me and my team will forever be grateful for.
April 2016
To reach a better posterior occlusion I cut the upper aligners distal to the canines to allow extrusion of the posterior teeth. In two weeks I obtained a better posterior occlusion and avoided the need of additional aligners. There was no need to use buttons or elastics.
In the end of treatment I used the extra aligners to close spaces in the anterior teeth. There were spaces distal to the canines, in order to avoid collision points, that could cause intrusion or misalignment of the incisors, I´ve done a small IPR in the incisors only to create weak contact points, so that I closed all spaces together.
Despite having a distal diastema of 1.3 and 2.3 I requested an 0.2mm IPR distal to these teeth. I did not use IPR, the idea is to reach an overcorrection to close the diastema, and thus ensure a stronger point of contact. Due to this I finished the treatment with upper aligner number 15. I did not need to use the last two set of aligners,and no additional aligners were needed.
March 2016
Tips:
Procline the upper incisors in the ClinCheck plan more than ideal to achieve the clinical result you want
Use Class III elastics to back up the anchorage
In this case, IPR is used to help decrease the black triangles in the lower incisor region and retract the lower incisors further
Align teeth first before completing the majority of IPR to allow good access
The Invisalign appliance due to the full occlusal coverage allows seamless correction of buccal and anterior crossbites
