Patient Information & Diagnosis
Age: 26 years old
Patient Issue: Alexa was concerned about the crowding and didn’t like her smile.
Diagnosis: Patient has a Class I occlusion on left side and a Class II occlusion on right side creating mandibular midline discrepancy. Patient has moderate crowding.
Treatment Duration: 6 months
Number of aligners on upper: 31 (movement was programmed at ½ of traditional movement giving patient weekly aligner changes.
Number of aligners on lower: 31
Treatment Goal: Level and align arches. Patient interested only in treating the crowding issue at this time, not the class II relationship on the right side or the midline discrepancy.
Treatment Plan: Using clear aligner therapy (SureSmile) we will eliminate the crowding and align the teeth to create a more esthetically pleasing smile.
Dr. Brian Wilk’s Comments
Clear aligner therapy has been around for over 20 years, most of the public assumes that it started with Align Technology in the late 1990’s, but it was in 1993 that John Sheridan created the Essix retainer which was designed to move the Anterior Social six. In 1997, two Stanford Graduate students, Zia Chishti and Kelsey Worth, created the first full clear aligner system.
I was in one of the first groups of restorative dentists to become certified by Align Technology in 2001 in the Invisalign system. For over 10 years, I was treating 5-10 patients per year for simple malocclusion issues. As clear orthodontic treatment became more predictable and reliable the case count began to grow in many GP offices. In 2016, approximately 8% of new orthodontic patients were treated with clear aligner therapy.
In 2019, I was introduced to SureSmile. What caught my eye with the SureSmile system was that it actually took into account the position of the roots in the alveolar bone as the teeth were moving; the Invisalign system doesn’t even look at the radiographs in its treatment planning process. In fact, the SureSmile system can merge the Cone Beam scan with the 3D scan from most scanning systems such as 3 shape, Cerec, and iTero thus creating a 3d view of the teeth actually moving in the available bone. After a few issues with post op tooth mobility and recession, I realized how important this aspect of treatment is needed. Another great feature is the ability to merge the patient photographs into the treatment plan showing lip position (see Figure 4) in relation to tooth position at the conclusion of treatment, a key feature that the patients love to see and has generated instant “yes!” decisions on case acceptance.
In the last 4 months, I have started about 15 cases with the SureSmile system. This case is in the first half of those cases.
First visit was the records visit where an iTero scan, photos, a 3D cone beam, and a full mouth series of radiographs were taken. A general discussion of the patient’s objectives was discussed.
“The aligner fit was incredible, I don’t know how else to put it”
At the delivery visit, we placed just 3 rectangular attachments, far fewer than with my Invisalign cases and much more substantial. The aligner fit was incredible, I don’t know how else to put it. The aligners cover 100% of the tooth structure and extended 1-2 mm onto the gingival. I would have thought it would impinge on the tissue, but the patient was fine. The first 2 aligners were delivered, and the patient reappointed for 14 days later.