1. Case Presentation of a
typical orthodontic case of
moderate difficulty using
the Invisalign method
Name: A S, DMD IV, 2012
Date: March, 2012

2. Occlusion
Right Side Dental Midline Left Side
 Molar Class: I  Upper: On  Molar Class: N/A
 Canine Class: I  Lower: On  Canine Class: I
Pre-Treatment

3. Intra-Oral Examination
 Teeth Present:
11-17, 21-25, 27
31-35, 37, 41-47
 Arch Shape:
Upper: Normal to tapered
Lower: Normal to tapered
Pre-Treatment

4. Intra-Oral Examination
 Clinical Findings:
 Molars: Class I on right; Missing 26 & 36 on left
 Canines: Class I
 Missing: 18, 26, 28, 36, 38 & 48
 OJ: 2 mm on right; 3 mm on left
 OB: 50%
 Mild crowding on both upper & lower incisors
Pre-Treatment

5. Intra-Oral Examination
 Amount of Crowding:
Upper Arch: Mild ~ 3 mm
Lower Arch: Mild ~ 3mm
Pre-Treatment

6. Panoramic Radiograph Analysis
Clinical Findings:
No suspected decay or bone pathology
Permanent dentition: 26 teeth present (Missing 8’s, 26 & 36)
Pre-Treatment

7. Cephalometric Analysis
Angles Ceph. Normal
Values
Skeletal Measurements
SNA 79.5 81 ± 3
SNB 75.0 78 ± 3
ANB 4.5 3±2
Witts -4.0 2 mm ± 2mm
Facial 86.0 88 ± 4
MPAST 38.0 32 ± 3
Y axis 60.0 60 ± 4
Dental Measurements
(UI,NA) 16.0 23 ±6
(LI,NB) 23.0 27.5 ±5
(UI,LI) 135.0 130 ± 7
(LI,MP) 91.0 91.4 ± 4
Pre-Treatment

8. Dental Cast Analysis
Bolton Analysis – Ideally 77%
Tooth Upper right Upper left Ideal
Central Incisor 8.5 8.0 8.85
Lateral Incisor 5.5 6.0 6.9
Canine 6.7 7.0 7.88
Tooth Lower right Lower left Ideal
Central incisor 5.1 5.0 5.5
Lateral incisor 5.3 5.4 6
Canine 5.4 5.2 6.95
• UA (Σ 13-23) = 41.7 mm
• LA (Σ 33-43) = 31.4 mm
• ( 31.4 / 41.7 ) x 100 = 75.3%
Pre-Treatment

9. Summary of Findings
 Dental:
 Molars: Class I on right; Missing 26 & 36 on left
 Canines: Class I
 Missing: 18, 26, 28, 36, 38 & 48
 OJ: 2 mm on right; 3 mm on left
 Increased OB (50%)
 Lower dental midline deviates 2 mm to the left upon opening
 Mild crowding on both upper & lower incisors
 Normal to tapered arch shapes
 6 mm of upper incisors showing at rest
Bolton analysis: 75.3%
 Skeletal:
 Symmetrical face; Normocephalic
 Decreased lower face height
 Slight-moderate convex profile Pre-Treatment

10. Diagnosis
 Class I molar/canine
 Maxillary anterior crowding
 Mandibular anterior crowding
 50% overbite
 Flat to slight curve of spee
Pre-Treatment

11. Objectives of Treatment
 Resolve patient’s chief complaint of
crowding
 Decrease overbite
 Maintain class I molar/canine
relationship
 Maintain nasolabial angle
 Maintain midlines
Pre-Treatment

12. Exactly One Year
Later
Post-Invisalign
Treatment

13. Occlusion
Right Side Dental Midline Left Side
 Molar Class: I  Upper: On  Molar Class: N/A
 Canine Class: I  Lower: On  Canine Class: I
Post-Invisalign Treatment

14. Intra-Oral Examination
 Teeth Present:
11-17, 21-25, 27
31-35, 37, 41-47
 Arch Shape:
Upper: Normal to tapered
Lower: Normal to tapered
 Crowding:
Upper: Normal
Lower: Normal
Post-Invisalign Treatment

15. Post-Invisalign Treatment Problems
Patient not
satisfied with the
final position of
tooth #32 &
tooth #41
Post-Invisalign Treatment

16. Post-Invisalign Treatment Solution
 Dimple-maker!
 Dimples added to:
 Tooth #32 - distal buccal incisal area
 Tooth #41 - distal buccal incisal area
 IPR on both tooth #32 & #41
 Both teeth rotated into proper position within 2 weeks
 Dimples then added to:
 Tooth #31 - distal buccal incisal area & mesial lingual incisal area
 Patient now satisfied with final results
Post-Invisalign Treatment

17. Post-Invisalign Treatment Solution
Pre-Treatment
Post-Invisalign Treatment
Post-Treatment

18. Post-Treatment

19. Intra-Oral Examination
Pre-Treatment Post-Treatment
Decrease in both overbite & overjet

20. Intra-Oral Examination
No change from pre-treatment:
 Arch Shape:
Upper: Normal to tapered
Lower: Normal to tapered
Pre-Treatment Post-Treatment

21. Panoramic Radiograph Analysis
Clinical Findings:
No suspected decay or bone pathology
Permanent dentition: 26 teeth present (Missing 8’s, 26 & 36)
Post-Treatment

22. Cephalometric Analysis
Angles Ceph. Normal
Values
Skeletal Measurements
SNA 80.0 81 ± 3
SNB 75.0 78 ± 3
ANB 5.0 3±2
Witts -4.5 2 mm ± 2mm
Facial 84.0 88 ± 4
MPAST 39.5 32 ± 3
Y axis 63.0 60 ± 4
Dental Measurements
(UI,NA) 12.0 23 ±6
(LI,NB) 22.5 27.5 ±5
(UI,LI) 141.0 130 ± 7
(LI,MP) 87.5 91.4 ± 4
Post-Treatment

23. Dental Cast Analysis
Bolton Analysis – Ideally 77%
Tooth Upper right Upper left Ideal
Central Incisor 8.3 8.1 8.85
Lateral Incisor 5.8 5.8 6.9
Canine 7.3 7.1 7.88
Tooth Lower right Lower left Ideal
Central incisor 5.2 4.7 5.5
Lateral incisor 5.1 5.3 6
Canine 6.1 5.8 6.95
• UA (Σ 13-23) = 42.4 mm
• LA (Σ 33-43) = 32.2 mm
• ( 32.2 / 42.4 ) x 100 = 75.9%
Post-Treatment

24. Summary
 Dental:
 Molars: Class I on right; Missing 26 & 36 on left
 Canines: Class I
 No atempts made to resolve the skeletal discrepancy
 OJ: 2 mm on right; 1 mm on left
 OB (30%) - Decreased from 50% at pre-treatment
 Lower dental midline deviates 2 mm to the left upon opening
 Crowding issues on both upper & lower incisors resolved (addressed CC)
 Normal to tapered arch shapes
6 mm of upper incisors showing at rest
 Skeletal:
 Symmetrical face; Normocephalic with dolichocephalic tendenty
remained
 Slight-moderate convex profile remained
Post-Treatment

25. Conclusions
• Overall, patient is very satisfied as her chief
complaint has been addressed.
• Opted for Invisalign type retainers.
• IPR avoided any flaring of the dentition
• The upper incisors were not torqued enough
but the esthetic result is still very acceptable.