Orthotown May 2018 - 32

Fig. 6: Aligners seated properly after using HFV.

Fig. 7: Before using HFV.

Fig. 8: After using HFV reactively to fit the same
aligner and increase compliance.

My second patient did not want any type of jaw surgery or treatment
other than clear aligner treatment, so we decided on Invisalign therapy, with a
treatment plan that included a course of 28 aligners. The patient had a Class
III clinical bite. The treatment plan was to use interproximal reduction (IPR)
on the lower arch bicuspid and anterior region, and to lingualize and tip the
lower arch back. Proclining the upper anterior teeth forward was also planned
to give him the ideal 1mm overjet and overbite with a better aesthetic result.
However, as treatment progressed, the very large roots of his teeth and very
dense bone seemed to be preventing the aligners from seating and tracking;
there was a 2-3mm space/void between the aligners and the tooth (Fig. 4, p. 30).
We discussed performing a refi nement scan and ordering a new set of
aligners at no cost, or purchasing the HFV device with the goal of finishing
much quicker by getting "back on track" with enhanced mechanical seating of
the current set of aligners. The patient elected on using the HFV device since
it required only five minutes per night. We used the HFV device reactively
in this case to ensure the aligner was achieving maximum contact with all
surfaces of the teeth. This is critical to the delivery of the programmed aligner
forces especially when faced with nontracking, or stubborn teeth (Figs. 5, p. 30
and 6). After creating the ideal interproximation spaces, and with the patient
switching aligners once a week, by the fourth aligner the aligners were seating
well, and the teeth were on the right track and moving in the right direction.
A third patient came to my practice with a Class II clinical deep bite and a
history of bicuspid extractions. The patient had relapsed with lower crowding
and more than a 60 percent deep bite. The treatment plan entailed reducing
the deep bite with the addition of lingual bite ramps on the upper arch and
resolving the lower crowding. In this case as well, we used HFV reactively for
better aligner seating and to increase patient compliance (Figs. 7 and 8).
Both MOP and HFV help me achieve more predictable tooth movement in
a minimally invasive manner and with reduced patient pain. Again, with only
five minutes of daily wear with HFV, patient compliance is very high. All these
benefits save me and the patient time because I do not have to order a new set
of aligners and wait to get the set while the teeth are shifting. In my opinion,
our "science and specialty" has come a long way, and these two options allow
patients to achieve their orthodontic goals with very little effort in a shortened
treatment time. ■
REFERENCES
1.
Shah A, Shah P, Goje KS, Shah R, Modi B. Micro-Osteoperforations in Orthodontics-A Review. International
Annals of Medicine. February 2017;1(1).
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Alikhani M, Raptis M, Zoldan B, Sangsuwon C, Lee YB, Alyami B, Corpodian C, Barrera LM, Alansari S, Khoo
E, Teixeira C. Effect of micro-osteoperforations on the rate of tooth movement. Am J Orthod Dentofacial Orthop.
2013;144(5):639-648.
3.
Alikhani M. A Clinical Guide to Accelerated Orthodontics With a Focus on Micro-Osteoperforations. Boston:
Springer; 2017.
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Alansari S, Sangsuwon C, Vongthongleur T, Kwal R, Teo M, Lee Y, Nervina J, Teixeira C, Alikhani M. Biological
principles behind accelerated tooth movement. Seminars in Orthodontics, Vol 21, No 3 (September), 2015: pp
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Nicozisis J, Shipley T, Brigham G, Sparaga J. Pain reduction observed with orthodontic forces and vibration. [Data
on file with manufacturer, Propel Orthodontics, Ossining, New York] 2017.
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Shipley, T. High Frequency Acceleration Device Effect on Accelerated Aligner Exchange - A Pilot Study. Preprints
2018, 2018040075 (doi: 10.20944/preprints201804.0075.v1).

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