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Invisalign First case report series
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Phase 1 treatment results summary: less compliant while waiting for the new aligners, so they did not fit as a
result of the slight relapse in the interim. New intraoral scans were needed,
• The total treatment time from the first aligner delivery appointment which extended her treatment time by 1.5 months. In the future, we would
to the retainer delivery appointment was 9.5 months, but could have also not use overcorrection aligners to tighten the interproximal contacts
been 8 months had the patient been better about wearing the last in this age group, since this can cause the aligners to not fully seat and
aligner while waiting for the additional aligners to be made. Having hold the patient’s teeth securely in place while the additional aligners are
to re-scan the patient to re-make the additional aligners caused a being made. Otherwise, the patient’s treatment experience was excellent.
1.5 month delay. The patient’s oral hygiene was good throughout treatment, and much
better than what would have been expected with fixed appliances.
• The total number of appointments from initial records to the retainer
delivery was 9, including 2 extra visits for intraoral scans in-between Contributing to our success in treating younger patients with Invisalign
the aligner series, when the patient stopped wearing the last aligners aligners is good communication. Explaining what the problem is and how
and temporary retainers as instructed. to correct it by showing the ClinCheck set-up is one way to generate a
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• The patient had zero emergency orthodontic visits. lot of enthusiasm in this age group. I can think of no other appliance that
could have achieved a better or more efficient result. The patient thought
• The number of aligners used: U/L = 17 (+3 for overcorrection) + 12 it was magical how her teeth were straightened by the aligners with so
(+3 for overcorrection). The additional aligners which did not fit and little discomfort. Her parents were very impressed with the results and
had to be remade were not counted. Aligners were changed weekly how easily it all happened. They also liked the improved facial profile that
throughout the entire Phase 1 treatment. was achieved.
• No elastics or bonded buttons were used.
For Phase 1 treatments with Invisalign First aligners, we will use whatever
• For retention, a fixed lower lingual wire was bonded, and upper attachments are needed for each particular case and are not averse to
and lower thermoformed retainers worn only at night for six months. putting attachments on deciduous teeth. Putting attachments on deciduous
Since the crossbite correction was stable once a positive overbite teeth may result in earlier exfoliation at times, but this is of no consequence
was achieved, all retention was discontinued after six months, including as aligners are a wonderful way to maintain space and guide the eruption
the bonded lingual retainer. of the permanent dentition in a controlled way. We usually do not prescribe
interproximal reduction (IPR) when treating younger patients with aligners.
Elastics are used as needed, but require education of the parents on their
Clinical discussion: responsibilities in helping their child use them.
Today, our office no longer uses fixed appliances for Phase 1 treatment of
The ability to start aligning the teeth from the very beginning of treatment younger patients, as clear aligners produce excellent results and deliver
was impressive. With fixed appliances, bracket placement on the upper a more gentle force on a weekly schedule compared to the larger forces
central incisors and lower lateral incisors would have been very difficult delivered by fixed appliances every six weeks. As a result, we have eliminated
due to the anterior crossbite, and the bite would need to be propped open the problem of sharp brackets and wires that often irritate the soft tissues
to avoid broken brackets. The disclusion of the teeth that the aligners and during Phase 1 treatment. Anterior crossbites, posterior crossbites, anterior
attachments naturally provided made the correction of the anterior cross-
bite very efficient and easy, and nothing extra was needed to temporarily alignment, and space recapture cases all respond very well to Invisalign
aligners for Phase 1 treatment. By solving orthodontic problems earlier
open the bite. Good lower incisor root control by the aligners helped us with Phase 1 treatment, our goal is to avoid more challenging problems
achieve a good interincisal angle and improve the periodontal condition later. Our Invisalign First patients and their parents have also been telling
of the lower incisors.
their friends about how effective and convenient their Phase 1 treatment
One lesson learned from this case was the importance of educating the has been, and our practice has been growing as a result. A new era of
patient and parents about needing full-time aligner wear while the patient efficient, effective, and readily-accepted orthodontic treatment for younger
is waiting for any additional aligners to be made. After achieving good patients is here!
results so quickly with the initial series of aligners, the patient became

If you have Invisalign treatment results from your practice that you would be interested in sharing with your
peers, please submit your cases at the Invisalign Gallery:

submit.InvisalignGallery.com

Experiences, results and opinions in this article are those of the doctor in his orthodontic practice and not necessarily of Align Technology, Inc. The doctor was paid an honorarium
by Align Technology, Inc. for his time to develop this article.
© 2019 Align Technology, Inc. All rights reserved. Invisalign, the Invisalign logo, iTero, iTero Element, and ClinCheck, among others, are trademarks and/or service marks of
Align Technology, Inc. or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries. | MKT-0003179 Rev B 4
Dental Practice i July-August 2023 i Vol 19 No 4 59