Aligner Theraphy - Demystified.pdf
- 1. Dr. Harsimran Singh Kapoor
- 2. Influence of appearance in personal and professional lives have led to a considerable interest among the adult population seeking orthodontic treatment in the last few years. Invisalign or clear aligners are the new age aesthetic orthodontic treatment methods developed especially for adults who are very self conscious of how they appear.
- 3. Aligner is an orthodontic device that uses incremental transparent trays to adjust teeth. It is used as an alternative to dental braces It offer patients an aesthetically agreeable solution, using a computer-assisted technology that produces a series of clear plastic overlays
- 4. Aesthetic Comfortable Less chair time Customised Removable
- 6. Aligners are worn for at least 20 hours a day to reach the desired maximum effectiveness. Each aligner is worn for 2 to 3 weeks before changing to the next one. The length of treatment with aligners depends upon the severity of each case. Each aligner is designed to move the teeth a maximum of about 0.25 to 0.3 mm over a 2- week period, and is worn in a specific sequence.
- 7. Clear aligner treatment falls into • ESSIX RETAINER & INVISALIGN The first category consists of thermoformed appliances sometimes known as ESSIX RETAINERS. This are fabricated by making adjustments to the tooth positions on models and fabricating one or more aligners to correct a minor malocclusion.
- 8. The second category is Invisalign, which is a proprietary orthodontic technique that uses a series of computer generated custom plastic aligners to gradually guide the teeth into proper alignment. It is both a brand name and a technique and is used synonymously. Invisalign is the computer aided design and manufacturing (CAD – CAM) Precision aligner product. The company and the technique was the brainchild of two graduate students at Stanford university – 1997,Kelsey Wirth and Zia Chishti.
- 9. The appliance is currently recommended for adults and for adolescents with fully erupted permanent teeth who meet an acceptable standard of compliance. Excellent compliance is mandatory since the appliance has to be worn a minimum of 20 to 22 hours a day and each aligner should be worn 400 hours to be effective.
- 10. Mild crowding (1-5 mm) Mild spacing (1-5 mm) Deep overbite (Class II div 2 cases ) Narrow arches that can be expanded without tipping the teeth too much. Absolute intrusion (1 or 2 teeth) . Lower incisor extraction for severe crowding cases. Tip molar distally.
- 11. Moderate to severe crowding and spacing over 5 mm. Skeletal anterior-posterior discrepancies of more than 2 mm Centric-relation and centric-occlusion discrepancies. Severely rotated teeth (more than 20 degrees). Open bites (anterior and posterior) Extrusion of teeth. Severely tipped teeth (more than 45 degrees) Teeth with short clinical crowns. Arches with multiple missing teeth.
- 12. Better esthetics as it is a clear material and no metal show as seen in fixed appliances. Since these are removable appliances, they are more comfortable and better maintenance of oral hygiene can be achieved and lesser white spot lesions during treatment. Less chair side time for the orthodontist. Technically it is more easier to fix/fabricate than lingual appliances. Treatment duration is more predictable as it can be calculated more precisely than braces.
- 13. Since most clear aligner treatment involves interproximal reduction, extraction of premolars in minor to moderate crowding cases can be avoided. Decreased occlusal abrasion from parafunctional habits during treatment. Disarticulation of the teeth may be advantageous for patients with TMJ problems. Better periodontal health and less risk of enamel decalcification by avoiding brackets
- 14. Since aligners are removable, they require more patient motivation to achieve the desired results. These devices must be worn 22 hours a day. Clear aligners must be removed during meals, when drinking hot drinks that could spot or cause deformation, sugary drinks and during the oral hygiene.
- 15. Treatment time may exceed due to patient non-compliance to dentist’s instructions, not wearing aligners the required number of hours per day, missed appointments, excessive bone growth, poor oral hygiene and broken appliances which can also increase the cost, and thus can affect the quality of the end results.
- 16. Data Acquisition - Intra Oral Scans - Radiographs - Intra & Extra-oral photographic records Digital Treatment Planning & Clin-check Aligner fabrication
- 17. Getting started: • Orthodontist evaluates and discusses any problems or goals for smile with patients. • Once patient and dentist establish that aligners are the right treatment option, digital intra-oral scan, impressions, photographs, and radiographs (OPG, Lateral Ceph.) are taken.
- 18. CUSTOM TREATMENT PLAN •Dentist sends patient’s records — Intra-oral scan, photos, and radiographs to Aligner manufacturing company with a prescription. •Lab uses records to create exact 3D models of Maxillary & Mandibular arches. •They maps out a complete treatment plan of gradual adjustments from start to finish. •Once completed, Patient & Dentist will be able to preview the projected results in "treatment set-up” of before and after treatment.
- 19. ALIGNERS ARE COMPUTER CRAFTED - • When Patient & Dentist are satisfied with the projected results shown in treatment set-up, Clin-check, the manufacturing process begins. • Using the digital thermoforming machines such as ministar, custom aligners with computer precision are manufactured. • Aligners are delivered to Dentist for delivery to the patient.
- 20. PROGRESSIVE WEARING OF ALIGNERS • To wear aligners all the time, except while eating and drinking or during daily tooth care, such as brushing and flossing. •When using aligners, a series of slightly different trays are custom made in order to fit over the teeth. Patient must wear each one for a period of 20 hours a day for 2-3 weeks before switching to the next in the line.
- 21. •The aligners are barely noticeable, they won't have an impact on patients day to day life. • Aligner by aligner, patient will be able to see the difference as teeth slowly adjust and align to target smile. • Patient has to visit dentist periodically for checkups to see the progress.
- 22. How do you eat with Aligners? What foods should you avoid? You cannot eat while wearing them. But you can eat whatever you want only after removing your trays and then wear them back again. No food restrictions while you are under aligners treatment. Remember! One need to remove aligners before eating or drinking.
- 23. Do you sleep with aligners? Keep wearing the aligners while you sleep. It is completely safe to keep your aligners on while sleeping since it snugly fits to your teeth, so no fear of it getting dislodged.
- 24. Why do one have to wear aligners for 2 weeks? Because that is time period where most if the teeth movement work starts, gums and bones get adjusted and this time period ensures that proper forces are getting applied to all the teeth which requires alignment.
- 25. Can one leave aligners out for a day? Unfortunately no, because teeth are getting the ample amount of pressure which is causing it to move to desired position. Leaving it for one day may haphazard the pressure and teeth movement as a result the process is delayed or you may have to repeat the process from that point on.
- 26. Can Invisalign push teeth back? Yes, definitely. That’s what they are designed for. They apply pressure onto the teeth that brings about the change in alignment of teeth and attachments are placed onto the teeth which helps in quicker and proper movement of teeth.
- 27. Can attachments chip or damage Aligners? No, attachments are actually smooth resin buttons that are fixed onto teeth that requires movement. The aligner trays are made up of thermoplastic BPA free material that is hard enough to bring on the movements of the tooth and contains attachment areas on which the resin attachments sits and thus pressure gets applied onto the teeth.
- 28. How much does Aligners cost on average? The normal cost of aligners in India is regularly a lot higher than standard braces, yet at the same time less expensive than abroad.
- 29. Is the first aligner tray the worst? It’s not worst but yes you will definitely have a slight discomfort and lot of pressure that is being applied onto your teeth by the aligners tray which is working for the alignment of your teeth.
- 30. How many hours a day should one wear Aligners? 20-22 hours daily is recommended for optimum results. Remove only while brushing, eating and drinking.
- 31. Can you eat with aligners? - No, we cannot eat with aligners. - We need to remove aligners while brushing, eating and drinking any hard/soft cold or hot drinks, since it will damage or warp the aligners material. - We can drink normal water while wearing aligners.
- 32. Are braces or aligners better? Both have the same effect in the alignment of teeth. - Braces are fixed and tend to cause more discomfort and aesthetically unpleasing as compared to Aligners. - Also you can eat and drink as usual when undergoing aligners treatment unlike braces - So yes Aligners have more positive points than Braces
- 33. Aligners have opened up a new area of adult orthodontics, serving patients who may not want conventional fixed appliances Educating patients on the advantages and disadvantages of clear aligner therapy. The results significantly depends on patient’s expectations and compliance.
- 34. One of the benefits of the aligner systems is the opportunity to see the end result of straight teeth and the progression of tooth movement during the multitude of stages. It is essential to continuously motivate each patient during treatment to properly wear aligners to avail benefits of the treatment, ensure patient compliance as well as patient self discipline.