clear aligners and invisalign,,,,.pdf
- 1. GOOD MORNING
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- 4. ○ Localization of impacted teeth ○ Assess level and extent of resorption of teeth adjacent to impacted teeth. ○ Bone scanning before implant placements and surgeries. ○ Assessment of bone thickness for tooth movements Orthodontic uses 4
- 5. CT SCAN CASE : MISS SHILPA 23/F 5
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- 7. ○ Software allows for reformatting and viewing the image data from any point of view in straight or curved planes and in 3 dimensions. ○ With these software tools, the anatomy can be peeled away layer by layer to locate the desired section. 7
- 8. 13-YEAR-OLD MALE PATIENT 8 Two horizontally impacted permanent maxillary right teeth, a impacted central incisor, and impacted canine
- 9. 9 Transverse CT scans s h o w h o r i z o n t a l i m p a c t i o n o f t h e m a x i l l a r y r i g h t p e r m a n e n t c e n t r a l incisor (I) and canine (C) in close proximity to the nasopalatine canal (N).
- 10. 10 3D CT : In addition, they revealed a markedly s u p e r o l a t e r a l l y orientated dilaceration in the apical third of the root of the central incisor, which had not been seen on the panoramic and periapical radiographs b e c a u s e o f superimposition of the two teeth
- 11. ○ Dolphin 3D allows visualization and analysis of craniofacial anatomy from data produced by cone beam computed tomography (CBCT), MRI, medical CT and 3D facial camera systems. 11 DOLPHIN 3D SOFTWARE
- 12. 12 View impacted teeth from any angle Isolate desired region of interest Airway measurements Slice display of airway volume and most constricted area Display of airway volume and most constricted area
- 13. 13 DEMO OF 3D SOFTWARE : CLICK
- 14. RADIOVISIOGRAPHY 14 Parts : X-ray source, Intraoral sensor, Computer It is used to digitize, process and store information received from the sensor within 5 – 10 sec and display image on computer screen.
- 15. APPLICATIONS OF CAD CAM ○ Making of dental restorations ○ Brackets : torque in base ○ Self ligating brackets ○ Lingual brackets ○ Implants ○ Invisilign 15
- 16. ○ Acronym for What You See Is What You Get ○ Prototyping could become a new tool for fabricating brackets and other precision accessories for specific needs. 16
- 18. 18 Pre treatment – elevation in palatal mucosa
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- 20. Image from STL file after elimination of all the tissues and structures Triangular mesh 20
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- 23. “A smile is a curve that sets everything straight.” Phyllis Diller
- 24. Smiles like this can be attained with braces but sometimes traditional braces can be avoided by using Invisalign or other types of clear style aligners
- 27. UPPER AND LOWER INVISALIGN APPLIANCE • UPPER IS FULLY SEATED AND BEARLY NOTICABLE • LOWER IS INTENTIONALLY PULLED UP A LITTLE FOR BETTER VISUALIZATION
- 28. INDICATIONS ● Intrusion and extrusion ● Midline correction ● Minor crowding(less than 4 mm especially from canine to canine) ● Space closure(3-6mm) ● Rotation control,especially rotated incisors ● Crossbite correction ● Arch expansion and contraction ● Passive/active retainer ● Minor relapse correction
- 29. ADVANTAGES ● Esthetic ● Removable ● Easy manufacture ● Useful in borderline cases ● Speedy ● Results are fine ● Less speech problems ● Cost effective ● More biologic for tissue response ● Acts as a relapse breaker and retainer ● As the margins are 4-5 mm above the marginal gingiva it is comfortable to the patient ● Causes less irritation ●
- 30. DISADVANTAGES ● Not everyone is a candidate for Invisalign ● Treament is for adults and cannot be used if deciduous teeth remain ● It is designed for certain tooth movements ● Cost is more than metal braces ● As they are removable they require constant motivation to be worn consistantly ● Can be misplaced ● Cannot be used in extraction cases ● Treatment plan cannot be changed once the appliance series has begun
- 31. PRIOR TO STARTING TREATMENT • Check for caries and periodontal problems • Axial inclination of the teeth • 3rd molar position • Patient cooperation • As certain tooth movements are more predictable than others ,case selection is ultimately determined by the manufacturer .
- 32. CLINICIAN’ S OFFICE ALIGN TECHNOLO GY CLINICIAN” S OFFICE ALIGN TECHNOLO GY SHIPPED CLINCHECK SENT VIA INTERNET STEPS IN FABRICATION OF INVISALIGN
- 34. ALIGN® TECHNOLOGY : INVISALIGN APPLIANCE ○ It is an ‘invisible’ way to straighten teeth using thin, clear, overlay sequential appliances. 34
- 35. 35 Impressions are made using Polyvinyl Siloxane Impression and bite send along with a detailed treatment plan. advanced imaging technology transforms plaster models into a highly accurate 3-D digital image. A computerized movie - called ClinCheck® - depicting the movement of teeth from the beginning to the final position is created. After wearing all of the aligners in the series, customized set of aligners are made from these models, sent to the doctor, and given to the patient. Pt to wear each aligner for about two weeks. From the approved file, laser scanning to build a set Invisalign® uses of actual models that reflect each stage of the treatment plan. Using the Internet, the doctor reviews the ClinCheck file - if necessary, adjustments to the depicted plan are made. Procedure
- 38. RECORDS ● The clinician should have the following records ● Photographs ● Full mouth IOPA ● OPG
- 39. IMPRESSION MATERIALS Impression Materials are used to record the dimensions and spatial relationships of oral tissue . • Alginate ● Polyether ● Polyvinylsiloxane ● The impression should be accurate and stable as it is the basis for the 3D dental arch image that is scanned into the computer.
- 40. SCANNING PROCESS The term scanning is used to describe the process of converting a physical object into three dimensional electronic data. Scanning methods: 1.Laser scanning 2.Destructive scanning 3.White light scanning 4.Computerized tomography
- 41. LASER SCANNING ● A laser beam is projected on the object being scanned and the reflection of the beam is recorded. ● The object being scanned is rotated to several predetermined positions so that multiple views can be recorded. ● The recordings made from these different views are incorporated together to produce a 3 D electronic image of the object.
- 42. BITE REGISTRATION ● The clinician takes the bite in centric occlusion i.e maximum intercuspation. ● An accurate impression of the occlusion will help in achieving good results.
- 43. MATERIALS DURAN( Scheu Dental, Germany) •Soft thickness(0.5mm) •Medium thickness(0.62 mm) •Hard thickness(0.75 mm) • It is thermoplastic •Given for a period of 3 weeks, a week each. •Medium aligner reduces discomfort before placing hard clear aligners.
- 44. TOOTH MOVEMENT ● There is a greater surface area of force application to the tooth. ● Bodily movement is possible, particularly if the entire crown is held tightly with no space between the appliance and tooth. ● For the appliance to fit tightly, it may be necessary to add attachments. ● Forces involved for 0.02 mm activation are light continuous nature due to elastic properties of the appliance and small magnitude of individual activation at each stage.
- 45. ATTACHMENTS • Tooth colored acrylic called attachments are bonded to the front or back side of specific teeth to give aligners more grip on teeth to move them in desired position. • They are a part of treatment and removed by orthodontist when the treatment is completed.
- 46. SPACE GAINING IN CLEAR ALIGNERS ● Space can be gained by 1.Extraction 2.Expansion 3.Interproximal reduction ➢In clear aligner treatment , interproximal reduction is done with high speed drill and sandpaper like strips / disks and does not require anesthesia. ➢Always use a cutting device that is thinner than the enamel to be removed.
- 47. TREATMENT TIME ● 1st clear aligner-0.5 mm tooth movement-4 weeks ● 2nd clear aligner-1mm tooth movement-4 weeks ● 3rd clear aligner-0.5 mm tooth movement-4 weeks ● Hence the treatment time will be around 12 weeks
- 48. Problems During Treatment Any discrepancy between the actual clinical appearance of occlusion and the virtual treatment sequence program indicates that treatment should be fully reviewed Reasons for discrepancy • Patient loses appliance. • Patient is not wearing for sufficient time(atleast 20 hours per day). • Appliance has not been fully seated.
- 49. INVISALIGN CLEAR ALIGNERS Model has to be sent to ALIGN TECHNOLOGY which is in USA and Singapore. ➢Treatment is stepwise ➢No 3rd party involved ➢In office lab procedure They provide 30 sets of aligners which is to be used sequentially 3 sets of 3 aligners are custom made and given to the patient sequentially. Margins of aligners ends at the marginal gingiva Margins are 4-5mm above the marginal gingiva. If one tray is not worn regularly, patient has to switch to the older tray and it may not fit properly. If tray is not worn, clinician can return to the cast used in previous step. So, new set of 30 alignrers has to made Clear aligner can be used in mixed
- 50. COW CATCH ALIGNERS ● Used to correct open bite. ● Teeth to be extruded are supplied with buttons and connected to opposite arch with elastics where buttons are attached to aligners ● When the expected extrusion is achieved the respective teeth will contact the inner surface of the aligner so that no additional extrusion occurs
- 51. MODIFIED COW CATCH ALIGNER ● If the patient cannot tolerate the limited opening while wearing cow catch aligners with intermaxillary elastics or needs to verbally communicate a lot, it is recommended to use an appliance modification characterized by buttons on the lingual sides. ● More convenient and comfortable
- 52. The Essex system Creating space within the appliances Inducing tooth moving forces in the appliance How the system works
- 53. Early Correction of Developing Anterior Crossbite with Modified Essix Appliance Amarnath Biradar, G Shiva Prakash, Mala Ram Manohar