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Dr. Antonio G. Secchi

Orthodontic treatment with SureSmile® Aligners

Dr. Antonino G. Secchi details a patient’s treatment using aligners, integrating data from intraoral scanning and CBCT imaging

Patient Amy N., a 45-year-old female, consulted for orthodontic treatment with the chief complaint of “my back teeth are leaning inward; I have spaces when I smile.” 

Figures 1A-1C: Initial extraoral photos. On Figure 1C, notice the “narrow” smile and “black corridors,” which were the main chief complaint of the patient

The patient had braces several years ago. At the time of the consultation, she had a lower fixed lingual bar and no upper retainer. The patient had no discomfort, pain, or any functional problems with the way her teeth were occluding. She was looking for a cosmetic solution to improve her smile. After further clinical examination and discussion with patient, we agreed to start orthodontic treatment using SureSmile® Aligners. Records were taken, including initial photos, a scan of the upper and lower arch with bite registration, and a set of digital X-rays (panoramic and lateral ceph).

Figures 2A-2C: Initial intraoral photos. On Figure 1B, notice the lingual tipping of all posterior teeth from canines to molars on both arches
Figures 3A-3B: Initial intraoral occlusal views showing also the lingual tipping of most of the posterior teeth. The lower arch has a lingual fixed retainer from previous orthodontic treatment

After uploading all the required information to SureSmile Ortho, a Therapeutic Model was developed. In the Therapeutic Model, upper and lower canines, premolars, and molars were tipped buccolingually in order to upright them between 1.5 mm to 2 mm per side. Minor crowding was resolved, and the upper and lower arch were coordinated. Once the Therapeutic Model was finished and approved, stages for the upper and lower arch were developed based on the amount and type of movement required. Thirteen upper and 15 lower clear aligners were made.

Figures 4A-4C: Progress intraoral photos showing both upper and lower clear aligners in place.

SureSmile clear aligners were delivered to the patient with the instruction of wearing them for about 20 hours every day with weekly aligner changes. The patient used the VPro5™ intraoral high frequency vibrator (Propel® Orthodontics) every day for 5 minutes to help seat the aligners.

Figures 5A-5C: Final intraoral photos
Figures 6A-6B: Final intraoral occlusal views. Notice the improved arch form, uprighting of posterior teeth, as well as the alignment of upper and lower incisors

Figures 7A-B and 8A-B show the before and after occlusal views of the upper and lower arch with measurements for inter-canine, inter-premolar, and inter-molar distances. It is important to emphasize that no skeletal transverse correction was aimed for or achieved. Before and after changes represent only tooth movement in a buccolingual direction planned to be within the boundaries of the existing alveolar bone. At the time of treatment planning this case in the version of the SureSmile software I used, the integration of the scanned images with the CBCT data of the patient was not possible. 

Figures 7A-7B: Upper arch before and after treatment dental transverse measurement
Figures 8A-8B: Lower arch before and after treatment dental transverse measurement

Today SureSmile Ortho 7.5 allows the integration of intraoral scan data and CBCT data, which makes the software incredibly powerful for treatment planning of more complex cases.

Figure 9: Final smiling photo. Needless to say, patient is delighted by her new smile!

The treatment progress was uneventful, the patient had no complaints, aligners fit very well, and she was particularly pleased with the clearness of the aligners and the almost invisible look they had. Treatment time was 15 weeks.

Reprinted with permission from Orthodontic Practice US, www.orthopracticeus.com

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