Clear Idea #3

28 www.acasociety.com | info@acasociety.com ACAS2020 Kesling Award winning case • Over-extrude the anterior segment by 1mm on your first plan to aid close the open-bite. • Mild IPR in the upper arch to prevent excessive tipping with expansion of the premolars and over-zealous positioning buccally of the central and lateral incisors. • Retraction of the anterior dentition will work to close the open-bite also. • Segmentalised movement with over- correction on difficult rotations. • Canine should finish in Class I. • Considerations into crown lengthening of 12 post-treatment. Summary: The finished case should be in a solid functional position with good canine guidance and a centric occlusion that matches maximum intercuspation without interferences. This is not always easy to achieve, but in this case, a zealous teenage patient whom wore her aligners religiously and practiced her tongue thrust exercises daily was able to do so without refinement. As such, we were able to achieve a Class I relationship finish, eliminating her tongue thrust habit and finishing her dentition in a sound occlusal position. During and post treatment the clinician should assess the progress of the tongue thrust by filling the mouth with water and reviewing swallowing while lips apart. Evidence of continued tongue thrust will mean a fixed and removable retention protocol with extensive patient education on the risk of relapse. Understanding clear aligners requires basic sound orthodontic principles coupled with good aligner education. On examination: • Class III skeletal and brachyfacial tendency • Concave profile • Class III RHS Molar (1 unit) and LHS Molar (1/2 unit) • Class III Canine RHS and LHS • Class III Incisor relationship • Anterior cross-bite • Anterior open-bite • V-shaped upper-arch, U-shaped lower-arch • Crowding in the upper arch of 10mm • Crowding in the lower arch of 6mm • Tongue thrust on swallowing TREATMENT OPTIONS: Options of traditional orthodontics versus clear aligner therapy were discussed; both alongside home-exercises to reduce or eliminate tongue thrust. Elimination of tongue thrust habit requires commitment and perseverance from the patient. Exercises to minimize the habit may include swallowing water with lips apart; training the patient to reposition their tongue to the anterior palatal when doing so. Continuation of tongue thrust post orthodontic treatment will likely lead to a relapse of the patient’s open-bite. Furthermore, with a change in horizontal and vertical position of the anterior segment a discussion about fixed retention post orthodontics is necessary at this early stage. INVISALIGN TREATMENT: Treatment duration: 44 aligners IPR: 1.2mm upper arch, 2.8mm lower arch Refinement: 0 Retention: Vivera retainers Invisalign Tips for this case: • Use of anterior and posterior, extrusion and intrusion respectively at 50:50. “A place for everything, everything in its place.” – Benjamin Franklin B ecoming proficient at Invisalign isn’t just about doing more cases; it is about using sound orthodontic principles with clear aligner education tomaximisepatient outcome. Understanding the differences between traditional orthodontics and clear aligner therapy is integral. Trying to move every tooth at the same time will likely lead to unwanted, incorrect or no movement with clear aligners. Segmentalising movement, slowing down movement and predicting limitations in clear aligner therapy will inevitably improve outcomes. Conversely, allowing a technician locally or overseas to complete orthodontic tooth movements without an understanding of the periodontium is poor treatment planning. PRESENTING COMPLAINT: A female teenage patient with a chief complaint of crowding and anterior open- bite. The patient and her mother well versed in Invisalign and wanted to know if treatment was possible. The idea of braces deterred the patient from wanting her teeth straightened. DIAGNOSTICS: Clinical examination showed no soft or hard tissue disease. She has moderate lower crowding, severe upper crowding with an overall class III occlusion. Also evident is a narrow maxillary arch, anterior open-bite and cross-bite. Harold Kesling is long regarded as the forefather of clear aligner therapy. The Australasian Clear Aligner Society is excited to develop an award which pays respect to his remarkable and innovative contribution and legacy to orthodontics! At ACAS2020, we announced our inaugural Kesling Award winner, for best case submission of our members as judged by our expert panel. Following is the case report by Dr Matt. By Dr Matthew Youssef Matthew Youssef