Pacific Coast Society of Orthodontists Bulletin Winter 2012 - (Page 5)

editoriaL INVISALIGN SUMMIT 2012 by Gerald Nelson, DDS, PCSO Bulletin Editor-in-Chief I attended the Invisalign® Summit this year in Las Vegas, and was invited to attend the Educator’s Conference the day before the clinical sessions. More than 50 educator colleagues were there. It has been several years since I have gone to the meeting. I write this report because the information I gathered may be valuable to readers, and because it is information not encountered at our association meetings. First, a few disclaimers: I do not hold Align Technology, Inc. stock—never have—and I have never had any financial arrangement with the company. We use the system at UCSF; each resident has a few patients in aligners. There were discussions of aligner correction for class II div. 1, class II div. 2, class III compensation, interdisciplinary care, treatment of open bites, deep bites, crossbites, TSAD-supported tooth movement, and corticotomy-assisted aligner treatment. Intermaxillary elastics were a common protocol for sagittal changes in the occlusion. Crowded cases were primarily moderate, and treated with expansion rather than extraction. Extraction treatment mostly required a combination of aligners and braces. There was a report of only one lower incisor extraction case and two bicuspid extraction cases, but these are not the norm. Most of the presenters were private practice clinicians and/or educators, and most were ABO Diplomates. Every presenter emphasized the importance of diagnosis, setting goals, and then carefully planning the treatment using the CAD/CAM program called ClinCheck®. The emphasis on planning has grown dramatically since I last attended the Summit. There are a couple of reasons for this; firstly, that the clinical orthodontists using Invisalign aligner therapy have worked hard over the years to understand how to plan to achieve the best biomechanics, sequence of movements, efficiency, and outcome; and secondly, that with feedback from clinicians, technicians and researchers, the company has made dozens of innovations in the planning software, the production hardware and software, the I Web site interface, the variety of attachment designs and the type of plastics used. The following are my notes relating to the tactical planning for a variety of malocclusions: CLASS II CORRECTION ∑ Distalization of posterior teeth, backed up with class II elastics. Evaluate the position of the MX second and third molars. If the eruption path of the third molar is promising, one speaker suggested that removing the second molars allows more efficient correction; the third molars may drop into place to substitute for the second molar, although this is an atypical treatment plan. Distalize and over-rotate (mesial out) the first molars into class I before starting class II elastics. Then proceed to distalize the remaining buccal teeth, supported by class II elastics, starting one at a time to introduce a bit of aligner plastic interproximally to help the tooth to plastic adaptation process. Be sure to introduce incisor torque forces as indicated. Use horizontal beveled attachments on the upper laterals to provide retention, and to make sure laterals track properly. (These teeth most often slip gingivally out of the aligner during movement). ∑ The class II elastics can be attached to buttons bonded to the mesial cusp of the lower molars, with a programmed cutout in the aligner. For the MX elastic hook, use either a programmed custom hook in the aligner or bond a plastic button on the canine, with a programmed customized precision cutout. To open the bite, place horizontal beveled attachments on all four premolars. Division 1. Even if MX incisors need to be tipped lingually, be sure to end the aligner series with 15 degrees of excess torque in order to avoid overtipping. Use TSAD if you need more anchorage than is likely to be achieved with class II elastics. (The patient fits elastics from the TSAD to WINTER 2012 • PCSO BULLETIN 5

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2012

Incremental Change
What a Time it Was!
AAO Trustee's Report
A need, A dream, A reality: A team approach produces an extraordinary outcome
PRECEDENT Orthodontists on Devices
The Complexities of Successful Herbst Treatment
Dr. Bryan Williams
Presentation Software
Treatment Planning: The Magic Step
Comprehensive Mixed Dentition Approach
Social Media 101 for Orthodontists
Update on Bonding 2012
Create the Future by Looking Back: 100 Years of PCSO
PCSO Business
Component Reports
AAOF Report
PCSO at a Glance
Case Report Pre-Treatment
Case Report Post-Treatment
In Memory

Pacific Coast Society of Orthodontists Bulletin Winter 2012