Invisalign Study Club Meeting 1 - Treatment Planning

Invisalign Study Club:Invisalign Study Club:Session 1Session 1

Treatment Planning Treatment Planning

March 20, 2008

Brian H. Bergh, DDS, MS1111 N Brand Blvd, Ste 201

Glendale, CA 91202(818) 242-1173

Doctor BackgroundDoctor Background

• Loma Linda University Dental School• USC Dental School, Certificate in Orthodontics• USC Graduate School, MS Craniofacial Biology• Invisalign Premier Provider • Over 260 cases submitted• Email: brianberghdds@msn.com• Phone #: 818-242-1173

Setting Treatment GoalsSetting Treatment Goals

• An ideal outcome starts with with a good treatment plan.

• Keys to Treatment Planning with Invisalign.

QualityTreatment Outcomes

Treatment PlanningTreatment Planning

FinishingFinishing ClinCheckClinCheck

Keys To Keys To Treatment PlanningTreatment Planning

• Understand the appliance and difficult movements:– Absolute extrusions– Severe rotations of round teeth– Large – span

translations/extractions• Recognize and incorporate solutions

into the treatment plan– Auxiliary Treatment

• IPR, Detail Pliers, Button Kit, Attachments, Elastics

• Strategic staging in ClinCheck• Build in case refinement

Keys To Keys To Treatment PlanningTreatment Planning

• Communication• Be clear.• Be specific.

Examples of Communication:• Be explicit in your requests:

– Instead of “leave spaces for restoration.” – Write: “Leave 2mm of space distal to the upper

right lateral incisor for post orthodontic restoration.”• Instead of “improve anterior esthetics”

– Write: “Add 5 degrees of mesial rotation to the upper left central and distal root tip to the upper left canine.”

• Instead of “Line up teeth with proper alignment”– Write: “Rotate upper lateral incisor mesial in to line

up with upper central.”

1. Invisalign Treated Arches1. Invisalign Treated Arches

• Is there enough overjet to treat one arch only?• If expansion is needed, will it be easier to

coordinate the movement if both arches are treated?

• If anterior crossbite correction is needed, is it easier to coordinate if both arches are treated?.

2. Do Not Move These Teeth2. Do Not Move These Teeth

• Are all teeth marked that should not be moved?

3. Do Not Place Attachments 3. Do Not Place Attachments on These Teeth on These Teeth

• Have all facial / buccal restorations (esp. veneers & buccal alloys) been noted (even if teeth are not being moved)?

4. Midline4. Midline

• If a large midline correction is required, is IPR acceptable to resolve the midline shift?

5. Overjet5. Overjet

• If a large overjet correction is required, is IPR or an A-P change acceptable to resolve the overjet?

6. Overbite6. Overbite

• Is overbite correction required or only incisor leveling?

7. A-P (Sagittal) Relationship7. A-P (Sagittal) Relationship

• Is current A-P relationship / posterior occlusion acceptable as it currently exists?

• If distalization is desired, is patient willing to accept longer treatment time?

• If A-P change is desired, are goals realistic?.

8. Posterior Crossbite(s)8. Posterior Crossbite(s)

• If the crossbite is unilateral and many teeth are involved, then is the patient comfortable with the use of auxiliary techniques to resolve the crossbite?

9. Resolve Spacing and Crowding9. Resolve Spacing and Crowding

• Can all spacing be closed without losing overjet?

• If space must be left, will I simply leave it or have it restored?.

9. Resolve Spacing and Crowding9. Resolve Spacing and Crowding

• Can tooth anatomy prohibit IPR (e.g. small narrow teeth)?

• Do periodontal conditions prohibit proclination or expansion?

• Is there a method of resolving crowding that should definitely be performed or not performed?

• If extracting, is the patient comfortable with the use of auxiliary techniques to achieve an ideal finish?.

10. Tooth Size Discrepancy10. Tooth Size Discrepancy

• If all spaces cannot be closed, can IPR be performed in the opposite arch to close the space

• If not restoring to close spaces, where would it be best to leave space?

• If performing a bonding or veneers, what position of the laterals would allow for best restoration?.

11. Overcorrection11. Overcorrection

• Recommended at Case Refinement Stage

12. Treatment Preferences12. Treatment Preferences

• Is the way I prefer to have this case set-up very different than what is listed in the current treatment preferences?

13. ClinCheck Objectives13. ClinCheck Objectives

• Is the patient comfortable with the use of auxiliary techniques to achieve an ideal finish?

• Real vs. Ideal is the key.

14. Special Instructions14. Special Instructions

• Are there any restorative plans that should be noted?

• Are there any attachment requests that are different than protocol (e.g. lingual, additional, etc.)?

• Will black triangle reduction be necessary?• Are there periodontal concerns that I should note?• Was there pre-Invisalign treatment that would cause

the occlusion to be different than the photos?.