Clear Aligner Therapy to Correct OverBite and OverJet
The following case uses clear aligner treatment for optimal esthetic results and patient satisfaction, while using manufactured aligners to minimize laboratory time for the doctor and staff
The patient is a 20-year-old female who was concerned with traumatic occlusion to her anterior teeth and presented for an orthodontic consultation. The patient had limited overbite and overjet with mild spacing in the lower incisors. Additionally, the patient had a strong preference for clear aligners.
Digital 3D impressions of the teeth were made with the TRIOS intraoral scanner (3Shape). The digital impressions were uploaded and digital treatment planning software was used to design the clear aligners (ClearCorrect). The initial 2 aligners were created in the software without dental engagers, allowing the patient to adapt to the use of aligners without the additional retention of engagers. The third treatment aligner was designed to incorporate the use of engagers attached to the teeth. The patient was given the first 2 ClearCorrect aligners during the initial treatment visit and received instructions on wear, care, and use—it was recommended that each aligner be worn for 2 weeks; she was given oral hygiene instructions as well.
At the second treatment appointment, the current aligner was checked to ensure that it was fully seated on the teeth and that the patient was ready to progress to the next aligners. Placement of engagers with standard isolation was achieved using an OptraGate retractor (Ivoclar Vivadent).
The teeth were prepared for bonding with Ultra-Etch 35% phosphoric acid solution (Ultradent) and then rinsed. Transbond primer (3M Oral Care) was applied and light-cured. Vasoline (Unilever) was applied to the engager template to prevent bonding of the adhesive material to the template.
A small amount of Transbond flowable adhesive (3M Oral Care) was applied to the bonding template in the engager wells. The bonding template was then seated on the teeth, held firmly in place and light-cured using the FlashMax P4 LED Ortho LED Curing Light (Rocky Mountain Orthodontics) to bond the engagers to the teeth. After bonding the engagers, the template was taken out and excess adhesive was removed with a carbide finishing bur.
Conclusion
The patient was seen for periodic recall visits to monitor progress. At the completion of the case, the engagers were removed with a carbide finishing bur and all teeth polished. The patient was very pleased with the results of the treatment. Retainers were manufactured by ClearCorrect based on the final tooth position in the final aligner. The patient was instructed to wear aligners full-time and was scheduled for a follow-up retention appointment in 6 weeks.
Melissa D. Shotell, DMD, MS
Dr. Shotell is a private practice orthodontist in Sonora, CA. She has conducted research focused on the remodeling of the temporomandibular joint with functional appliances using cone beam imaging. Dr. Shotell has an interest in dental ergonomics and taught CE events focused on providing clinicians with simple and effective techniques as foundational principles of ergonomics to help prevent musculoskeletal disorders.
