Aligner Techniques in Orthodontics

19 Chapter 22Fig. 22.1 Asymmetries can be managed with specific aligner biomechanics.Fig. 22.2 Initial view.Fig. 22.3 Class II subdivision right, deviation of both midlines equal to th...Fig. 22.4 Pretreatment intraoral views.Fig. 22.5 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 22.6 Initial frontal Clincheck view.Fig. 22.7 Upper and lower ClinCheck archshape changes and instructions to CA...Fig. 22.8 Upper and lower CC superimposition and instructions to CAD designe...Fig. 22.9 Lateral ClinCheck views.Fig. 22.10 Final intraoral views.Fig. 22.11 Initial and final smile and overjet.Fig. 22.12 Final panoramic and lateral X‐rays.Fig. 22.13 Initial intraoral view.Fig. 22.14 Pretreatment extraoral and intraoral views.Fig. 22.15 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 22.16 Upper and lower CC superimposition and instructions to CAD design...Fig. 22.17 Lateral ClinCheck views.Fig. 22.18 Initial frontal Clincheck view.Fig. 22.19 Intermaxillary elastics to correct asymmetric mandibular growth. ...Fig. 22.20 Final occlusion.Fig. 22.21 Initial and final smile.Fig. 22.22 Final panoramic and lateral X‐ray.Fig. 22.23 Patient with maxillomandibular asymmetry.Fig. 22.24 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 22.25 Pretreatment extraoral views.Fig. 22.26 Occlusion in centric occlusion (CO).Fig. 22.27 Occlusion in centric relation (CR). In this situation, photograph...Fig. 22.28 iTero occlusion analysis.Fig. 22.29 The goal of treatment is asymmetric expansion of the maxilla to c...Fig. 22.30 A temporary anchorage device on the tuberosity will assist the mo...Fig. 22.31 Lower arch molar straightening will be assisted with a Lower arch...Fig. 22.32 Occlusal ClinCheck views.Fig. 22.33 Lateral ClinCheck views.Fig. 22.34 Frontal ClinCheck view.Fig. 22.35 Interproximal reduction.Fig. 22.36 Evolution in the occlusal contact.Fig. 22.37 Arch development.Fig. 22.38 Initial (upper) views and evolution at month 18 of treatment (low...Fig. 22.39 Initial (upper), after Invisalign and before prothesis (middle) a...Fig. 22.40 Final occlusal.Fig. 22.41 Comparison of initial and final smile and overjet.Fig. 22.42 Final panoramic and lateral X‐rays.Fig. 22.43 Initial intraoral view.Fig. 22.44 Pre‐treatment extraoral and intraoral views.Fig. 22.45 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 22.46 Lateral sectional wire applied based on a temporary achorage devi...Fig. 22.47 Lateral ClinCheck views showing forces applied.Fig. 22.48 Lateral ClinCheck view showing forces applied with the temporary ...Fig. 22.49 Upper ClinCheck view superimposition.Fig. 22.50 Lower ClinCheck view superimposition.Fig. 22.51 Second set of aligners. Frontal ClinCheck view.Fig. 22.52 Second set of aligners. Lateral ClinCheck views.Fig. 22.53 Second set of aligners. Frontal ClinCheck view.Fig. 22.54 Initial occlusion.Fig. 22.55 Evolution at 3 months with sectional wire to anchor 36 and 46 to ...Fig. 22.56 When the lower incisors are in their final position, mesialize pr...Fig. 22.57 Completing mesialization of second lower molar.Fig. 22.58 Settle the occlusion with elastics.Fig. 22.59 Initial (upper) and final occlusion (lower) views. The full class...Fig. 22.60 Initial (left) and final (right) occlusal.Fig. 22.61 Initial, smile in 22 months and final smile.Fig. 22.62 Initial and final overjet (right and left side).Fig. 22.63 Initial intraoral view.Fig. 22.64 Initial intraoral views.Fig. 22.65 Initial extraoral views.Fig. 22.66 Initial lateral and panoramic X‐ray and cephalometric analysis.Fig. 22.67 Initial Clinchecks: the left side should be in a Class II relatio...Fig. 22.68 After 10 months of treatment, the intraoral situation was good, b...Fig. 22.69 Extraoral view after 10 months.Fig. 22.70 After 10 months, the ClinCheck had vertical overcorrection and vi...Fig. 22.71 Current views after 20 months of treatment, but expected at 24 mo...Fig. 22.72 Pretreatment and current X‐rays.Fig. 22.73 Extraoral pictures after treatment.

20 Chapter 23Fig. 23.1 First premolar extraction, G6 protocol.Fig. 23.2 Lower incisor extraction, with vertical attachments on the remaini...Fig. 23.3 Powerchain helps close final spacing.Fig. 23.4 Perfect root parallelism after tooth extraction commonly needs the...Fig. 23.5 Initial intraoral view.Fig. 23.6 Pretreatment extraoral and intraoral views.Fig. 23.7 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 23.8 Upper and lower CC superimposition and instructions to CAD designe...Fig. 23.9 Attachments can be seen in several areas of the ClinCheck software...Fig. 23.10 Lateral ClinCheck views.Fig. 23.11 Intraoral view.Fig. 23.12 Initial (upper)and final (lower) views.Fig. 23.13 Initial and final occlusal.Fig. 23.14 Initial and final smile.Fig. 23.15 Final panoramic and lateral X‐rays: good final parallelism betwee...Fig. 23.16 Initial intraoral view.Fig. 23.17 Initial extraoral and intraoral views.Fig. 23.18 Occlusal contact at the beginning of the treatment.Fig. 23.19 Periodontal bone loss in upper incisors.Fig. 23.20 Initial teleradiograph and cephalometry.Fig. 23.21 Upper occlusal interproximal reduction to avoid excessive proclin...Fig. 23.22 Pontic for extracted 42. Bevelled attachment on lateral incisors ...Fig. 23.23 Interproximal reduction of upper arch and lower incisor extractio...Fig. 23.24 Lateral ClinCheck views.Fig. 23.25 Initial (upper) and evolution 11 months of treatment (lower).Fig. 23.26 Finishing refinement. Posterior elastic is used to settle the occ...Fig. 23.27 Initial (upper) and final occlusion (lower). Adequate parallelism...Fig. 23.28 Occlusal contact point at the end of the treatment.Fig. 23.29 Initial and final occlusal.Fig. 23.30 Initial and final smile and overjet.Fig. 23.31 Final panoramic and lateral X‐rays.Fig. 23.32 The canine and second premolar in this picture would be ideal for...Fig. 23.33 Extraction of first premolars, absolute anchorage: 0 mm posterior...Fig. 23.34 Extraction of first premolars, maximum anchorage: 0–2 mm posterio...Fig. 23.35 G6 protocol is considered a full system for space closure, theref...Fig. 23.36 Moderate anchorage protocol will start with canine and posterior ...Fig. 23.37 Moderate anchorage protocol will start with canine and second pre...Fig. 23.38 A popular pattern in Asia for extraction space closure.Fig. 23.39 The selection of bonding hooks or buttons has to be carefully pla...Fig. 23.40 Extraction of 5s with minimum anchorage.Fig. 23.41 With the double vertical attachment in molars the intrusion of th...Fig. 23.42 With the Powerarm attachment in molars at the final aligners we c...Fig. 23.43 Staggered technique for second premolar extraction.Fig. 23.44 Staggered technique for first molars extraction.Fig. 23.45 Retroclined incisors might mean increased overbite and need root ...Fig. 23.46 Powerarms are great auxiliaries in achieving root parallelism.Fig. 23.47 Undesired effects of brackets and wires are quite similar to the ...Fig. 23.48 Absolute anchorage with temporary anchorage devices.Fig. 23.49 Pretreatment extraoral and intraoral views.Fig. 23.50 Initial panoramic and lateral X‐rays, and cephalometry.Fig. 23.51 Upper CC superimposition and instructions to CAD designer.Fig. 23.52 Lower CC superimposition and instructions to CAD designer.Fig. 23.53 Lateral Clinchecks.Fig. 23.54 Front ClinCheck view in which we can check deep bite and midline ...Fig. 23.55 Asymmetry is clear from both a vertical and saggital perspective....Fig. 23.56 Pure intrusion of lower incisors from TADs (right, front and left...Fig. 23.57 Treatment evolution.Fig. 23.58 Evolution with aligners. Initial (left) and evolution at 3 months...Fig. 23.59 Posterior teeth have distal root tipping movement planned.Fig. 23.60 TADs are included in the doctor’s treatment plan with these diagr...Fig. 23.61 Initial frontal view.Fig. 23.62 Initial intraoral views.Fig. 23.63 Initial extraoral views.Fig. 23.64 Initial Clinchecks.Fig. 23.65 Refinement: intraoral views after first set of aligners.Fig. 23.66 Refinement: extraoral views after first set of aligners.Fig. 23.67 Refinement Clinchecks.Fig. 23.68 Intraoral views of smile at the end of treatment.Fig. 23.69 Final panoramic X‐ray to check final root paralellism between 13 ...Fig. 23.70 initial frontal view.Fig. 23.71 Initial intraoral views.Fig. 23.72 Initial extraoral views.Fig. 23.73 Initial teleradiograph, and lateral and panoramic X‐rays.Fig. 23.74 Initial Clinchecks.Fig. 23.75 Refinement: intraoral views showing exact position predicted on C...Fig. 23.76 Refinement: Clinchecks showing space mesial to 18.Fig. 23.77 Second refinement: intraoral pictures after two sets of aligners....Fig. 23.78 Second refinement: smile after two sets of aligners.Fig. 23.79 Second refinement: extraoral views after two sets of aligners.Fig. 23.80 Refinement: Clinchecks showing final vertical engagement.Fig. 23.81 Intraoral views after treatment.Fig. 23.82 Final teleradiograph and panoramic X‐ray showing improvement in p...Fig. 23.83 Current extraoral pictures.Fig. 23.84 Initial frontal view.Fig. 23.85 Initial Intraoral views.Fig. 23.86 Initial panoramic X‐ray and teleradiograph.Fig. 23.87 Initial smile.Fig. 23.88 Initial Clincheck with posterior spacing.Fig. 23.89 Refinement: Clincheck with posterior residual spacing, it can be ...Fig. 23.90 Refinement: the midline has been centred and exposure increased; ...Fig. 23.91 Refinement Clinchecks.Fig. 23.92 Second refinement: intraoral views.Fig. 23.93 Second refinement: space distal to 17 can be observed on the pano...Fig. 23.94 Second refinement: space distal to 17 can be observed, as well as...Fig. 23.95 Second refinement Clinchecks.Fig. 23.96 Intraoral views with Powerarms to straighten roots for 13 and 15 ...Fig. 23.97 Current intraoral views pending 5 aligners to the end of treatmen...Fig. 23.98 Initial and final lateral and panoramic X‐ray showing profile cha...Fig. 23.99 Comparison of pretreatment and final smiles.Fig. 23.100 Initial frontal view.Fig. 23.101 Initial intraoral situation.Fig. 23.102 Initial extraoral views.Fig. 23.103 Initial lateral and panoramic X‐rays and cephalometric analysis....Fig. 23.104 Initial Clinchecks.Fig. 23.105 Intraoral views when anterior misfitting was detected.Fig. 23.106 Refinement: intraoral views.Fig. 23.107 Refinement Clincheck.Fig. 23.108 Refinement: extraoral views.Fig. 23.109 A Powerchain was used to reduce rotations resulting from a lack ...Fig. 23.110 Space distribution equal to final ClinCheck position, and patien...Fig. 23.111 Lateral and panoramic X‐rays taken before aesthetic restoration....Fig. 23.112 Current extraoral views.Fig. 23.113 Smile before and after treatment.Fig. 23.114 Initial frontal view.Fig. 23.115 Initial intraoral views.Fig. 23.116 Initial extraoral views.Fig. 23.117 Initial ClinChecks.Fig. 23.118 Refinement: intraoral situation after first set of aligners.Fig. 23.119 Refinement: initial extraoral views.Fig. 23.120 Final views with veneers bonded (aesthetic treatment performed b...Fig. 23.121 Views at start and after refinement with veneers.Fig. 23.122 Final cephalometric measurements.

21 Chapter 24Fig. 24.1 Initial intraoral view.Fig. 24.2 Pretreatment extraoral and intraoral views.Fig. 24.3 Initial: teleradiograph, cephalometry and panoramic X‐rays.Fig. 24.4 Initial occlusal contact point.Fig. 24.5 Occlusal ClinCheck views.Fig. 24.6 Lateral ClinCheck views.Fig. 24.7 Interproximal reduction was not planned in the ClinCheck, but was ...Fig. 24.8 Initial frontal Clincheck view.Fig. 24.9 Situation before additional aligners. Results after the first set ...Fig. 24.10 Initial (upper) and final (lower) occlusion. Final result after r...Fig. 24.11 Initial (left) and final (right) occlusals.Fig. 24.12 Initial and final smile.Fig. 24.13 Final panoramic and lateral X‐rays.Fig. 24.14 Initial intraoral view.Fig. 24.15 Pretreatment extraoral and intraoral views.Fig. 24.16 Initial occlusal contact.Fig. 24.17 Panoramic and lateral X‐rays. Cephalometric analysis.Fig. 24.18 Opening space for missing 23.Fig. 24.19 interproximal reduction 3 to 3 to allow lower incisors retraction...Fig. 24.20 Initial lateral ClinCheck views.Fig. 24.21 Powerarm to make roots of 25 and 24 closer.Fig. 24.22 Evolution at 12 months.Fig. 24.23 Evolution after using additional aligners.Fig. 24.24 Final views with implant for 13.Fig. 24.25 Initial (left) and final (right) occlusal.Fig. 24.26 Initial and final overjet.Fig. 24.27 Evolution of the patient’s smile (from left): initial, before add...Fig. 24.28 Final panoramic X‐ray with implant for 23.Fig. 24.29 Final teleradiograph with overjet corrected.Fig. 24.30 Initial left intraoral view.Fig. 24.31 Pretreatment extraoral views.Fig. 24.32 Pretreatment intraoral views.Fig. 24.33 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 24.34 Initial views and views after placing provisional crowns over the...Fig. 24.35 Initial occlusal ClinCheck views.Fig. 24.36 Initial lateral ClinCheck views.Fig. 24.37 Initial front ClinCheck view.Fig. 24.38 Biomechanics applied to the treatment plan.Fig. 24.39 Initial (upper) and final (lower) views: the incisal edges were r...Fig. 24.40 Initial (left) and final occlusal (right).Fig. 24.41 Initial and final panoramic X‐rays: levelling of the occlusal pla...Fig. 24.42 Initial and final smile.Fig. 24.43 Initial frontal intraoral view.Fig. 24.44 Initial extraoral and intraoral views.Fig. 24.45 Initial panoramic X‐ray, teleradiograph and cephalometry: upper m...Fig. 24.46 Mock up to estimate vertical dimension.Fig. 24.47 These are the intraoral views when the case was sent to Align Tec...Fig. 24.48 Initial upper ClinCheck.Fig. 24.49 Initial lower ClinCheck.Fig. 24.50 Initial lateral ClinChecks.Fig. 24.51 Initial frontal Clincheck.Fig. 24.52 class II elastic from upper canine to lower first molar (night us...Fig. 24.53 Initial and final occlusion.Fig. 24.54 Final panoramic and lateral X‐rays.Fig. 24.55 Comparison of initial and final smile and overjet.Fig. 24.56 Simulation of force vectors applied by a Locatelli spring.Fig. 24.57 Locatelli to open space for implanting 35 and 45.Fig. 24.58 Distalization of molars from temporary anchorage devices and mesi...Fig. 24.59 The sequence of opening space for implants of 35 and 45, helping ...Fig. 24.60 Initial intraoral view.Fig. 24.61 Pretreatment intraoral views.Fig. 24.62 X‐ray analysis (panoramic, teleradiograph and cephalometry): norm...Fig. 24.63 Initial occlusal, upper and lower ClinCheck views.Fig. 24.64 Initial left and right ClinCheck views.Fig. 24.65 Initial front ClinCheck view.Fig. 24.66 Intraoral views: right, upper, lower with the Locatelli and the a...Fig. 24.67 Intraoral views: right, front, left with the Locatelli.Fig. 24.68 Intraoral views at the beginning and after placing the implants....Fig. 24.69 Intraoral views after loading implants.Fig. 24.70 Intraoral views before and after treatment (upper and lower occlu...Fig. 24.71 Comparison of smile and overjet before and after treatment.Fig. 24.72 Final panoramic and lateral X‐ray.Fig. 24.73 Skeletal Class I with spacing.Fig. 24.74 Extra palatal root torque to anterior sector, selecting multiple ...Fig. 24.75 Initial intraoral views.Fig. 24.76 Initial Clinchecks.Fig. 24.77 Refinement: after first set of aligners, gingivectomy was perform...Fig. 24.78 Refinement: intraoral images taken before scanning for additional...Fig. 24.79 Refinement: extraoral views.Fig. 24.80 Refinement ClinChecks.Fig. 24.81 Intraoral views and smile at the end of treatment.Fig. 24.82 Intraoral view.Fig. 24.83 Initial intraoral views.Fig. 24.84 Initial panoramic and lateral X‐rays.Fig. 24.85 Initial Clinchecks.Fig. 24.86 Final Intraoral views.Fig. 24.87 Pretreatment and final smile.Fig. 24.88 Final: anterior intrusion is visible on comparison of panoramic X...Fig. 24.89 Intraoral view.Fig. 24.90 Initial cephalometric measurements.Fig. 24.91 Initial intraoral views.Fig. 24.92 Initial Clinchecks.Fig. 24.93 Refinement: intraoral views.Fig. 24.94 Refinement: change of scan to include molars and increased anchor...Fig. 24.95 Refinement Clinchecks.Fig. 24.96 Final intraoral views.Fig. 24.97 Final smile.

22 Chapter 25Fig. 25.1 Aesthetic protocol for veneers preparation with aligners.Fig. 25.2 Anterior teeth width has to be determined carefully in order to en...Fig. 25.3 This bilateral full Class II case has an abnormal 11 size and shap...Fig. 25.4 Auxiliary buttons and Powerchains are used to help with a severe 9...Fig. 25.5 Mesial and distal spacing is planned at the end of the case for a ...Fig. 25.6 The left image is complex if we have to create anterior spacing fo...Fig. 25.7 Transverse space planning is made with protrusion, leaving 0.2 mm ...Fig. 25.8 After no space‐making mesial or distal to affected toot, transvers...Fig. 25.9 After 1.3 mm space planning, this only happens in the lateral with...Fig. 25.10 After attachment and threefold overcorrection, nonpredictable ant...Fig. 25.11 Align’s overjet concept might be different from the one the pract...Fig. 25.12 Natural arch depth loss owing to large posterior expansions has t...Fig. 25.13 In this patient, if 11 is in a proper incisal position we might p...Fig. 25.14 Incisors and canines have usually higher gingival margins than la...Fig. 25.15 This spacing is an example of how final gingivectomy might help i...Fig. 25.16 Incisors and usually canines have higher gingival margins than la...Fig. 25.17 This patient had a selective whitening treatment, focusing more o...Fig. 25.18 Patients habits, included smoking and drinking coffee on a daily ...Fig. 25.19 Bolton discrepancy in upper incisors as well as a maxillary skele...Fig. 25.20 Initial intraoral views.Fig. 25.21 Initial extraoral pictures.Fig. 25.22 Initial lateral and panoramicX‐rays.Fig. 25.23 Initial Clinchecks.Fig. 25.24 MARPE: the design was made considering that aligners would be tri...Fig. 25.25 MARPE: iTero software occlusal analysis.Fig. 25.26 Cone beam computed tomography and panoramic X‐ray and after MARPE...Fig. 25.27 Refinement: after 11 months the patient had the MARPE removed. Th...Fig. 25.28 Refinement Clinchecks.Fig. 25.29 Intraoral and extraoral views of smile before and after treatment...Fig. 25.30 Intraoral views before and after treatment.Fig. 25.31 Final extraoral views.Fig. 25.32 Final panoramic and lateral X‐rays.Fig. 25.33 Initial and final cephalometric analysis.Fig. 25.34 Previous cantilever bridge provided smile aesthetics that were un...Fig. 25.35 The Bolton tool was used to set space neededFig. 25.36 Initial intraoral views.Fig. 25.37 Initial Clinchecks.Fig. 25.38 Initial smile.Fig. 25.39 Refinement: intraoral views.Fig. 25.40 Refinement Clinchecks.Fig. 25.41 Final intraoral views before fitting veneers.Fig. 25.42 Final X‐ray views.Fig. 25.43 Change in smile after ceramic restoration (Dr Ignacio Vázquez Nat...Fig. 25.44 Tooth wear on anterior teeth led to severe attrition of 11–21.Fig. 25.45 Initial intraoral views.Fig. 25.46 Initial lateral and panoramic X‐rays and cephalometric analysis....Fig. 25.47 Initial Clinchecks.Fig. 25.48 Final intraoral views.Fig. 25.49 Final panoramic and lateral X‐rays.Fig. 25.50 Final smile after veneer bonding (work performed by Dr Ignacio Va...Fig. 25.51 Patient wanted to improve smile aesthetics with veneers, for whic...Fig. 25.52 Lower/upper cone beam computed tomography.Fig. 25.53 Bolton analysis showed possibility for lower premolar interproxim...Fig. 25.54 Initial intraoral views.Fig. 25.55 Initial cephalometric analysis.Fig. 25.56 Initial ClinChecks.Fig. 25.57 Refinement: the second Clincheck showed change from edge‐to‐edge ...Fig. 25.58 Refinement: intraoral views and cone beam computed tomography bon...Fig. 25.59 Good final results were achieved thanks to detailed multidiscipli...Fig. 25.60 Final extraoral views.

Guide

1  Cover Page

2  Title Page

3  Copyright Page

4  Preface

5  About the Authors

6  Acknowledgements

7  About the Companion Website

8  Table of Contents

9  Begin Reading

10  Index

11  WILEY END USER LICENSE AGREEMENT

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