Orthotown June 2019 - 48

Transformational improvements had
occurred with leveling and alignment
complete, arch form developed and deep
bite nearly corrected. A refinement scan
was taken, and the patient remained in
Aligner #19 for two more weeks, until the
series of 19 refinement aligners could be
delivered. To facilitate correction of Class
II subdivision right molar relationship and
achieve coincident midlines, composite
attachments were included on maxillary
laterals, canines, second bicuspids and
first and second molars. Cutouts were
requested for Class II elastics on the
right side only.
The same twice-weekly aligner
Fig. 3: Progress at third visit, after 14.5 weeks.
advancement protocol was again followed,
and a follow-up visit was scheduled in 5
weeks to review occlusion and make any
adjustments necessary with elastics.
At Visit 3 (Fig. 3 and Fig. 5C, p. 50), the
dentition tracking had been excellent
over the 29 sequential aligner exchanges,
in what appeared to be fully expressed
as prescribed movements. The aligners
were fully seated and fitting perfectly.
I recommended we continue with Class
II elastics at 4.5oz on the right side to
achieve Class I molar relationship and
canine guidance.
At Visit 4 (Fig. 4, Figs. 5D and 6B,
p. 50), the results were both clinically and
aesthetically pleasing, and the patient
reported treatment as well-tolerated
Fig. 4: Final visit, after 19 weeks.
and "easy." Achieving results like this in
a time frame of just over 4 treatment months is quite remarkable-this wasn't
just mild anterior tipping.
Importantly, there is clinically no visible sign of decreased root length associated
with the prescribed accelerated treatment protocol (Figs. 6A-B, p. 50). In recently
published studies, VPro+ has been demonstrated to increase bone remodeling
markers1 and to decrease root resorption.2
In my opinion, moving the midline, deep bite correction and uprighting molars
to the occlusal plane in this time frame demonstrates adjunctive biological assistance, enhanced seating and an aligner system capable of delivering consistent,
controlled forces. The patient had a big role in the success of this case because

48

JUNE 2019 // orthotown.com


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Orthotown June 2019

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