Tech Tip: Finishing a case

Doctors often request a revision for some final touch-ups to hone in on the treatment goals. For instance, you might want to request some additional aligners to close a gap or complete a rotation, moving the teeth into their final position.

Determining if treatment is finished to your standards and your patient’s satisfaction once the last aligner has been worn gives you both the opportunity to take advantage of all options for correcting any undesirable issues.

Sometimes, your perception of a nicely finished case is different from the patient’s. When you give the patient an opportunity to express their satisfaction of the treatment result before announcing that treatment is finished, your patient will feel like you care about how they feel about their result.

Identifying potential issues prior to the last aligner

Here are some potential issues and the steps you can take to address them:

1. Residual spaces

residual spacing.jpg

What to do:

  • Review the treatment setup to confirm that there should be no spaces remaining
  • Order a case revision to close the spaces
  • Request a ‘digital power chain’ in a case revision to ensure the remaining spaces are closed (ClearCorrect can adjust the 3D model to lingualize all the spaced teeth by about 0.2 mm, pulling the teeth closer together the same way a power chain does)

2. Incomplete rotations

Patients are most aware of “imperfections” with the upper and lower incisors.

What to do:

  • Continue with the last aligner for an additional couple of weeks – you may want to consider using the ‘dimples’ technique to complete the rotation
  • You can fabricate an in-office reset aligner to complete the rotation or request a remake of this last step
  • Order a revision to complete the rotation

Remember – there must be adequate space to rotate into (see image below) 

3. Teeth are not aligning as expected

In the example below, there’s not enough space to align the upper left central incisor.

 incomplete rotations 2.jpg

A situation like the above requires a revision to provide more expansion or proclination to open sufficient space to optimize the alignment of those incisors; there is too much crowding for IPR.

What to do:

  • Order a case revision to get the remaining alignment needed

4. Irregular or uneven incisal edges and marginal ridges

uneven incisal edges.jpg

What to do:

  • In many cases of mild incisor edge irregularities, conservative enamoplasty to smooth the incisal edges slightly will significantly improve the appearance of the whole smile line and impress the patient with how much better their teeth look.
  • In situations of moderate to severe incisal edge or occlusal wear, restorative dentistry could be of great benefit to provide a better esthetic result

5. Occlusion not fully interdigitated or idealized

class 1.png

Not every case will end up with an idealized, fully interdigitated Class I occlusion like the example above, and not every case needs to. It's up to you and your patient to decide what goals you're happy with. If you are aiming for absolute perfection, it's probably going to take some fine-tuning to get there.

What to do:

  • Order a case revision to achieve the full interdigitation desired

6. Posterior openbite due to intruded posterior teeth.

This is thought to be caused by extreme masseter activity when wearing aligners and is the most commonly proposed etiology, which is an intuitive explanation, but not proven by clinical research.

posterior open bite.jpgposterior open bite after.jpg

What to do:

7. Black triangles

Black triangles can happen with any method of alignment, including traditional braces. This is a natural consequence of alignment correction, so it can't always be avoided.

Black Triangle.jpg

What to do:

  • Alert the patient pre-treatment of the potential if it exists
  • Re-contour (IPR) wide incisal edges
  • Emphasize with patient the importance of an optimum oral hygiene regimen

And thats it for now. Until next time...

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