Susana Palma Moya - Aligner Techniques in Orthodontics

18 Chapter 21Fig. 21.1 Vertical cause, excess posterior facial height.Fig. 21.2 Dentoalveolar cause (protrusion).Fig. 21.3 Transversal cause, lingual torque of posterior teeth.Fig. 21.4 The amount of lingual tipping of upper and lower incisors helps to...Fig. 21.5 Gummy smile.Fig. 21.6 Low smile, short display.Fig. 21.7 The facial lower third determines whether to intrude or not to int... Fig. 21.8 Anchorage attachments. Fig. 21.9 Chewies or fitters are good for minor open bite cases.Fig. 21.10 Miniscrews used for absolute posterior intrusion greater than 3 m...Fig. 21.11 Open bite requires careful biomechanics planning.Fig. 21.12 Optimized anterior extrusion is mostly predictable if it is plann...Fig. 21.13 Posterior intrusion will have saggital effects as a result of man...Fig. 21.14 We have to face predictability of vertical movements in order to ... Fig. 21.15 Single optimized attachment for extrusion.Fig. 21.16 Optimized anterior extrusion is mostly predictable if it is plann...Fig. 21.17 Posterior open bite is a good overcorrection in this case.Fig. 21.18 Unpredictable posterior intrusion is assisted by upper and lower ...Fig. 21.19 Open bite solved with LITE treatment.Fig. 21.20 Initial extraoral and intraoral views.Fig. 21.21 Initial occlusal contact.Fig. 21.22 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 21.23 Initial upper and lower ClinCheck views.Fig. 21.24 Initial right and left ClinCheck views.Fig. 21.25 Interproximal reduction necessary for relative extrusion of upper...Fig. 21.26 Initial intraoral views (upper) and views before refinement (lowe...Fig. 21.27 Final intraoral views.Fig. 21.28 Initial (left) and final occlusal (right).Fig. 21.29 Initial and final smile.Fig. 21.30 Final panoramic and lateral X‐rays. Fig. 21.31 Initial intraoral view.Fig. 21.32 Initial extraoral and intraoral views.Fig. 21.33 Panoramic X‐ray.Fig. 21.34 Teleradiograph: proclination of upper and lower incisors, narrow ...Fig. 21.35 Initial upper and lower ClinCheck views.Fig. 21.36 Interproximal reduction to create relative extrusion of incisors....Fig. 21.37 Palatal attachments prevent upper incisors from intrusion during ...Fig. 21.38 Initial right and left intraoral ClinCheck views.Fig. 21.39 Triangular elastics in class II. The technician was required to e...Fig. 21.40 reciprocal movement of anterior extrusion and posterior intrusion...Fig. 21.41 Sequential distalization.Fig. 21.42 Initial (upper) and final (lower) views.Fig. 21.43 Initial (left) and final occlusal (right).Fig. 21.44 Initial and final smiles and overjet.Fig. 21.45 Final panoramic and lateral X‐rays. Fig. 21.46 Initial intraoral view.Fig. 21.47 Initial extraoral and intraoral views.Fig. 21.48 Goal of treatment: close open bite by upper and lower distalizati...Fig. 21.49 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 21.50 Mechanics of simultaneous distalization from temporary anchorage ...Fig. 21.51 Temporary anchorage devices in left tuberosity failed. It was cha...Fig. 21.52 Mechanics with temporary anchorage device in the tuberosity.Fig. 21.53 Mechanics for upper and lower simultaneous distalization. Opening...Fig. 21.54 Simultaneous distalization of lower arch using temporary anchorag...Fig. 21.55 Initial views before refinement. Opening space for missing 13, up...Fig. 21.56 Final panoramic X‐ray, after placing the implant for 13 and remov...Fig. 21.57 Initial and final intraoral images with composite veneer for 13 i...Fig. 21.58 Initial (left) and final (right) occlusal (composite veneer in 13...Fig. 21.59 Initial and final smile. Correction of the open bite without crea... Fig. 21.60 Initial intraoral view.Fig. 21.61 Initial intraoral views: right, front, left, upper, lower.Fig. 21.62 Initial panoramic X‐ray.Fig. 21.63 Initial extraoral views.Fig. 21.64 Initial Clinchecks (right, front, left, upper, lower).Fig. 21.65 Refinement intraoral views (right, front, left, upper, lower).Fig. 21.66 Refinement Clinchecks: right, front, left, upper, lower.Fig. 21.67 Refinement: extraoral views.Fig. 21.68 Refinement: a third set of aligners was ordered for final settlem...Fig. 21.69 Lateral and panoramic X‐rays showing final situation, and wisdom ...Fig. 21.70 Final intraoral views (right, front, left, upper, lower).Fig. 21.71 Before and after smiles. Fig. 21.72 Initial intraoral view.Fig. 21.73 Initial intraoral views (right, front, left, upper, lower).Fig. 21.74 Initial smile: short incisor display required aesthetic improveme...Fig. 21.75 Initial panoramic and lateral X‐rays.Fig. 21.76 Initial Clinchecks (right, front, left, upper and lower).Fig. 21.77 Refinement: intraoral views (right, front, left, upper and lower)...Fig. 21.78 Refinement Clinchecks (right, front, left, upper and lower).Fig. 21.79 Final intraoral views (right, front, left, upper with tongue tame...Fig. 21.80 Smile before and after treatment.Fig. 21.81 Final lateral X‐rays. Fig. 21.82 Initial intraoral view.Fig. 21.83 TheOrthopulse device was used by the patient to accelerate treatm...Fig. 21.84 Initial set of intraoral views (right, front, left, upper and low...Fig. 21.85 Initial panoramic and lateral X‐rays and cephalometric measuremen...Fig. 21.86 Initial extraoral views.Fig. 21.87 Initial ClinChecks (right, front, left, upper and lower) with vir...Fig. 21.88 Refinement: intraoral views (right, front, left, upper and lower)...Fig. 21.89 Refinement: lateral and panoramic X‐rays.Fig. 21.90 Refinement: profile and smile.Fig. 21.91 Refinement ClinChecks (right, front, left, upper and lower).Fig. 21.92 Current intraoral views (right, front, left, upper and lower).Fig. 21.93 Current lateral and panoramic X‐rays and cephalometry.Fig. 21.94 Final smile. Fig. 21.95 Predictability of vertical movements is important in order to pla...Fig. 21.96 Optimized pressure areas help intruding anterior teeth by combini... Fig. 21.97 Optimized extrusion attachments on premolars create a counterforc...Fig. 21.98 Precision bite ramps are designed to dissoclude posterior sectors... Fig. 21.99 Optimized support attachments are designed to help intruding uppe...Fig. 21.100 Patient with a gummy smile and deep bite. Expand + procline inci...Fig. 21.101 This patient (before and after views) presented low smile with d...Fig. 21.102 When anterior torque is negative relative intrusion might be eas...Fig. 21.103 When pure intrusion is needed, interproximal reduction will help...Fig. 21.104 Incisors protocol in deep bite is: procline crown, intrude, then...Fig. 21.105 Anterior temporary anchorage devices will help with this case.Fig. 21.106 Suggested torque for upper (+17 degrees) and lower incisor (–1 d...Fig. 21.107 Hypercorrection of the curve of Spee usually creates an open bit...Fig. 21.108 A single buccal or palatal power ridge (left and middle) creates...Fig. 21.109 Posterior extrusion might be achieved with optimized extrusion a... Fig. 21.110 Initial intraoral view.Fig. 21.111 Initial extraoral and intraoral views.Fig. 21.112 Initial panoramic and lateral X‐rays and cephalometry.Fig. 21.113 Initial occlusal upper and lower superimposition ClinCheck views...Fig. 21.114 Initial right and left ClinCheck views.Fig. 21.115 Interproximal reduction.Fig. 21.116 Initial (upper) and final intraoral views (lower).Fig. 21.117 Initial (left) and final occlusal (right).Fig. 21.118 Final panoramic and lateral X‐rays. Fig. 21.119 Initial intraoral view.Fig. 21.120 Initial extraoral and intraoral views.Fig. 21.121 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 21.122 Initial upper and lower ClinCheck views.Fig. 21.123 Initial right and left ClinCheck views.Fig. 21.124 On the additional aligners set, distal tipping of the crown in 3...Fig. 21.125 Evolution in last aligner before refinement.Fig. 21.126 Initial (upper) and final (lower) intraoral views.Fig. 21.127 Initial (left) and final (right) occlusals.Fig. 21.128 Before and after smile.Fig. 21.129 Final panoramic and lateral X‐rays. Fig. 21.130 Initial intraoral view.Fig. 21.131 Initial extraoral and intraoral views.Fig. 21.132 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 21.133 Initial upper occlusal superimposition ClinCheck view.Fig. 21.134 Initial lower occlusal superimposition ClinCheck view.Fig. 21.135 Initial right and left ClinCheck view.Fig. 21.136 Initial front ClinCheck view with interproximal reduction.Fig. 21.137 Initial views (upper) and evolution after 12 months (lower).Fig. 21.138 Final intraoral views.Fig. 21.139 Initial (left) and final occlusal (right).Fig. 21.140 Occlusal contact point at the end of the treatment.Fig. 21.141 Initial and final smile.Fig. 21.142 Final panoramic and lateral X‐rays. Fig. 21.143 Initial intraoral view.Fig. 21.144 Initial extraoral and intraoral views.Fig. 21.145 Initial occlusal contact.Fig. 21.146 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 21.147 Initial upper occlusal superimposition ClinCheck view.Fig. 21.148 Initial lower occlusal superimposition ClinCheck view.Fig. 21.149 Interproximal reduction is only needed mesial and distal to 22 t...Fig. 21.150 Initial right and left ClinCheck view.Fig. 21.151 Temporary anchorage devices to provide enough posterior anchorag...Fig. 21.152 Evolution at the end of additional aligners. Intermaxillary elas...Fig. 21.153 Initial (upper) and final (lower) intraoral views.Fig. 21.154 Initial left) and final (right) occlusal.Fig. 21.155 Initial and final overjet and final correction of the deep bite....Fig. 21.156 Initial and final smile.Fig. 21.157 Final panoramic and lateral X‐rays with an appropriate inclinati... Fig. 21.158 Initial intraoral view.Fig. 21.159 Initial intraoral pictures (right, front, left, upper and lower)...Fig. 21.160 Initial panoramic and lateral X‐rays.Fig. 21.161 Initial smile.Fig. 21.162 Initial Clinchecks (right, front, left, upper and lower).Fig. 21.163 Refinement 1: intraoral views (right, front, left, upper and low...Fig. 21.164 Refinement 1 Clinchecks (right, front, left, upper and lower). A...Fig. 21.165 Refinement 2 (aligner): st the end of first refinement, the alig...Fig. 21.166 Refinement 2 (aligner: right, front, left, upper and lower). Ali...Fig. 21.167 Refinement 2 ClinChecks (right, front, left, upper and lower). A...Fig. 21.168 Final intraoral pictures: right, front, left, upper and lower. D...Fig. 21.169 The smile has widened but still gummy, as initially predicted.