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MINISCREWS (TADS) AND ALIGNERS
POSSIBILITIES
The statements, views and opinionsThe statements, views and opinions
expressed in thisexpressed in this program and relatedprogram and related
course materials are those of thecourse materials are those of the
speaker.speaker.
Align Technology, Inc. may notAlign Technology, Inc. may not
endorse such statements, views orendorse such statements, views or
opinions.opinions.
Attendees are responsible for legalAttendees are responsible for legal
and regulatory compliance of anyand regulatory compliance of any
marketing and referral programs.marketing and referral programs.
Dr. David PaquetteDr. David Paquette
EDUCATION AND TRAININGEDUCATION AND TRAINING
Maintains Orthodontic Practice in Charlotte and Mooresville, North CarolinaMaintains Orthodontic Practice in Charlotte and Mooresville, North Carolina
Orthodontic Specialty from Saint Louis University Medical CenterOrthodontic Specialty from Saint Louis University Medical Center
Pediatric Dentistry Specialty from University of North Carolina at Chapel HillPediatric Dentistry Specialty from University of North Carolina at Chapel Hill
BOARD CERTIFICATIONS:BOARD CERTIFICATIONS:
American Board of Orthodontics, Diplomate 2001American Board of Orthodontics, Diplomate 2001
American Board of Pediatric Dentistry, Diplomate 1985American Board of Pediatric Dentistry, Diplomate 1985
HONORSHONORS
AAPD Graduate Research Award 1983AAPD Graduate Research Award 1983
Member Align Alpha Group 1999Member Align Alpha Group 1999--Present, Clinical Advisory Board 2006Present, Clinical Advisory Board 2006--PresentPresent
Speaker at US and European Invisalign SummitsSpeaker at US and European Invisalign Summits
Speaker at US and European Damon ForumsSpeaker at US and European Damon Forums
Member Schulman Study Group 2006Member Schulman Study Group 2006
Fellow American College of Dentists 2007Fellow American College of Dentists 2007
EXPERIENCEEXPERIENCE
Invisalign Certified since 1999, over 700 patients treatedInvisalign Certified since 1999, over 700 patients treated
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INTRODUCTION TOMINISCREWS (TADS)
What are TADs?What are TADs?
((A.K.A.A.K.A. TTEMPORARYEMPORARYAANCHORAGENCHORAGE DDEVICE EVICE TADTAD))
VariousVarious implants, screws, pins orimplants, screws, pins oronplantsonplants placed specifically for theplaced specifically for thepurpose of providing orthodonticpurpose of providing orthodontic
completion of treatmentcompletion of treatment..
The term that I will use isThe term that I will use is MiniscrewMiniscrewalthough with patients we call themalthough with patients we call them pinspins..
Why Use Miniscrews?Why Use Miniscrews?
Orthodontics =Orthodontics = AnchordonticsAnchordontics
In planning orthodontic therapy, it is simply notIn planning orthodontic therapy, it is simply not
possible to consider only the teeth whosepossible to consider only the teeth whose
movement is desired.movement is desired. William R. Proffit
ToothborneToothborne anchorage is one of the greatestanchorage is one of the greatest
limitations of modern orthodontic treatment,limitations of modern orthodontic treatment,
because teeth move in response to forces.because teeth move in response to forces. Thomas D. Creekmore
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Why Use Miniscrews?Why Use Miniscrews?
The idea of using screwsThe idea of using screwsfor anchorage is not afor anchorage is not a
new ideanew idea
Why Use Miniscrews?Why Use Miniscrews?
It was first proposed in 1983!It was first proposed in 1983!
a was years agoa was years ago
The Possibility of Skeletal Anchorage,
Creekmore, TD and Eklund, MK, J Clin
Why Use Miniscrews?Why Use Miniscrews?
If skeletal anchorage could be applied to orthodontic tooth
movement , it might offer capabilities heretofore unavailable. With
screws, pins, or some other readily removable implant anchored
to the jaws, forces might be applied to produce tooth movement in
any direction without detrimental reciprocal forces. Orthopedic, , , - ,forces might be applied directly to the jaws through skeletalanchorage rather than through toothborne anchorage. The need
for extraoral forces and the removal of teeth might be greatly
reduced.
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Why Use Miniscrews?Why Use Miniscrews?
I gave a lecture to both the ORMCOI gave a lecture to both the ORMCO
Insiders Group and the South Florida OralInsiders Group and the South Florida Oraland Maxillofacial Surgery Study Club inand Maxillofacial Surgery Study Club in
orthodontics with very little interest.orthodontics with very little interest.
Why Use Miniscrews?Why Use Miniscrews?
Multiple articles in 2003 by Dr. Park andMultiple articles in 2003 by Dr. Park and
colleagues as well as several othercolleagues as well as several other
Korean orthodontists finally broughtKorean orthodontists finally brought
miniscrew anchorage into mainstreamminiscrew anchorage into mainstream
acceptance.acceptance.
Why Use Miniscrews?Why Use Miniscrews?
And nowAnd now
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Why Use Miniscrews?Why Use Miniscrews?
Conventional Orthodontic Treatment is ruled byConventional Orthodontic Treatment is ruled byNewtonsNewtons 3rd Law:3rd Law:
ForceForceactionaction == ForceForcereactionreaction
All induce reciprocal tooth movementAll induce reciprocal tooth movement
Most of which is unwantedMost of which is unwanted
None of which is completely predictableNone of which is completely predictable
Why Use Miniscrews?Why Use Miniscrews?
Conventional Orthodontic AnchorageConventional Orthodontic AnchorageExtra OralExtra Oral
HeadgearHeadgear
ReverseReverse--Pull Headgear (facemask)Pull Headgear (facemask)
Intra OralIntra Oral NanceNance
Lower Lingual ArchLower Lingual Arch
ElasticsElastics
Lip bumpersLip bumpers
Tweed molar tip backsTweed molar tip backs
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Why Use Miniscrews?Why Use Miniscrews?
No conventional anchorage schemes provideNo conventional anchorage schemes providethe answer for all these desired orthodonticthe answer for all these desired orthodonticmovements:movements:
Molar intrusionMolar intrusion
o ar upr g ngo ar upr g ng
Molar mesialization or distalizationMolar mesialization or distalization
Incisor intrusionIncisor intrusion
Leveling occlusal cantsLeveling occlusal cants
Correcting arch asymmetriesCorrecting arch asymmetries
En masse retractionEn masse retraction
Why Use Miniscrews?Why Use Miniscrews?
Provides an alternative means to treat aProvides an alternative means to treat afull range of orthodontic cases withoutfull range of orthodontic cases withoutcompensating for the inadvertentcompensating for the inadvertentreciprocal movement of adjacent teeth.reciprocal movement of adjacent teeth.
If utilized correctly the net effect should beIf utilized correctly the net effect should bethe reduction of treatment times thoughthe reduction of treatment times thoughthe use of simplified mechanics.the use of simplified mechanics.
Why Use Miniscrews?Why Use Miniscrews?
Miniscrews are the most exciting trend inMiniscrews are the most exciting trend in
orthodonticsorthodontics
Can now accomplish movements that wereCan now accomplish movements that were
reviousl not ossiblereviousl not ossible Will significantly reduce number ofWill significantly reduce number of
surgery casessurgery cases
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Why Use Miniscrews?Why Use Miniscrews?
The aligner may
seem like it isselectivelyintruding orextruding anindividua l tooth,but it ac tually putsinverse forces onadjacent teeth.
Why Use Miniscrews?Why Use Miniscrews?
Here temporaryanchorage serves tointrude the 1st molar withno unwanted effect onadjacent teeth. Quicklya n ea s y, t e c n c a nmakes the desiredmovement withoutround-tripping orcompromise.
Head
Tissue
Eyelet
Miniscrew Anatomy
Neck
Miniscrewthreads
SuppressionCollar
CuttingFlute
ransmuccosaCollar
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MiniscrewsMiniscrews
Most miniscrews are selfMost miniscrews are self--
tappng an setapp ng an se -- r ng tor ng to
virtually eliminate thevirtually eliminate the
need for pilot drilling orneed for pilot drilling or
tissue punches.tissue punches.
MiniscrewsMiniscrews
Variable lengthVariable length
transmucosaltransmucosal collarscollars
help to minimize chancehelp to minimize chance
of infectionof infection
collar minimizes tissuecollar minimizes tissue
overgrowthovergrowth
ThreadThread
formingforming
Ideal for areas of thinner bone
Thin boneexpands withhoop stress toallow threads topurchase
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ThreadThread
cuttingcutting
Ideal for areas of thicker, denser bone
CuttingFlute
More dense bonecannot expand,so cutting isrequired to clearaway bone
Design of MiniscrewsDesign of Miniscrews
Screw Head DesignsScrew Head Designs
Miniscrew heads have various designs, either
to hold archwires or to engage off-the-shelfsprings or elastics.
Unitek-Imtec
GACQuattro
Dentaurum
TOMAS
RMO
Dual-Top
Lancer-OASI
MediconAarhus
MediconAarhus
ORMCO-vector
1
5
3
The VectorTAS Atlaseliminates guesswork bymatching the color-codedminiscrews to the idealanatomical and
biomechanical implant site.Atlas ac counts for bonetype, bone d ensity andtissue dep th.
1. Maxillary facial surface
2. Mandibular alveolar ridge
(mesial to cuspid)
3. Maxillary facial & lingual surface
/ mandibular alveolar ridge
(mesial to 2nd molar)
4. Mandibular retromolar area
5. Infrazygomatic crest
4
2
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Color Diameter Collar TipRecommended Implant
Site(s)
1.4mm 1.0mmThreadforming
Maxillary facial surface /mandibularalveolar
ridge (mesial to cuspid),mandibularsymphysis
1.4mm 1.0mmThreadforming
Maxillary facial & lingualsurface / mandibular
alveolar ridge (mesial ton
Summary Table
2.0mm 2.0mmThreadcutting
Retromolararea
2.0mm 2.0mmThreadcutting
Infrazygomatic CrestAnd Temporary tooth
replacement
PROFOUND PETPRILOCAINE 10%
LIDOCAINE 10%
TETRACAINE 4%
PHENYLEPHRINE 2%
www.stevensrx.com
714-540-8911
MadaJetXLNeedle-free anesthetic delivery
Need le-less injector for pain-freecomfort!
Eliminates disposal and safetyconc erns typically associatedwith conventional syringes
Co nsistent injection volume (0.1 cc )ensures reliable depthpenetration
4.0 cc ca rtridge size for up to 38 injections with single loading
Interchangeable Extenda Tips for easy sterilization
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Syrijet Mark II NeedleSyrijet Mark II Needle--Free InjectorFree Injector
NeedleNeedle--less injector for painless injector for pain--free comfort!free comfort!
Eliminates disposal and safety concerns typicallyEliminates disposal and safety concerns typicallyassociated with conventional syringesassociated with conventional syringes
Accepts any standard 1.8 cc anesthetic cartridge,Accepts any standard 1.8 cc anesthetic cartridge,
with dosages adjustable from .00 to .20 cc for deepwith dosages adjustable from .00 to .20 cc for deepanesthetic penetrationanesthetic penetration
Easy, rapidly repeatable injections facilitate patientEasy, rapidly repeatable injections facilitate patientanesthetization quickly and efficientlyanesthetization quickly and efficiently
Cushioned conical head permits approximation ofCushioned conical head permits approximation ofinjection site for maximum patient comfortinjection site for maximum patient comfort
Unbroken sterility from cartridge to orifice ensuresUnbroken sterility from cartridge to orifice ensurespatient safetypatient safety
Simple to clean with water cartridges used to flushSimple to clean with water cartridges used to flushthe inner chamber prior to autoclavingthe inner chamber prior to autoclaving
MadaJet/Syrijet ComparisonMadaJet/Syrijet Comparison
MadaJet Syrijet
Injection Dosage Non-variable: 0.1cc Variable: .00-.20cc
Cartridge Size 4.0cc (38 injections with singleloading)
Standard 1.8cc
Sealed ampoule
Volume Trapped airmay increase volume Less tendency for trapped air; lowervolume
Ergonomics Hold like a syringe Hold like a hammerformore secure grip
Sli htan ulation Greateran ulation smallerti ,
Depth Penetration 2 to 2.5mm below epithelium 2 to 2.5mm below epithelium
SterilizationProcedure
Autoclave Autoclave
PackageContents
MadaJ et, two Extended Tips,holder, wrench, stylets, two extrapyrexfill chambers, case,disinfectant/cleaner
Syrijet, two rubber caps, three watervials,CD with demo
Is it really that easy?Is it really that easy?
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Reducing TAD failuresReducing TAD failures
Choose correct length and diameterChoose correct length and diameter
Rinse withRinse with chlorhexidinechlorhexidine prior toprior to
insertioninsertion
Brush withBrush with chlorhexidinechlorhexidine until screwuntil screw
removalremoval
STEADY HANDSTEADY HAND
STEADY HANDSTEADY HAND
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ContraContra--Angle DriverAngle Driver
Easy access to hardEasy access to hard--toto--reachreach
areas.areas.
Includes two 22 mm universal tips,Includes two 22 mm universal tips,
which can also be used in Straightwhich can also be used in Straight
Driver.Driver.
Rotating knob on driver helpsRotating knob on driver helps
clinician prevent grip andclinician prevent grip and
release, maximizing screwrelease, maximizing screw
performance and preventingperformance and preventing
failure.failure.
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Brush with 0.12% chlorhexidineBrush with 0.12% chlorhexidine
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--
What predisposes miniscrews toWhat predisposes miniscrews to
fail?fail? Wallowing out opening on insertionWallowing out opening on insertion
causing inadequate primary corticalcausing inadequate primary cortical
stabilitystability
crestcrest
Patient nonPatient non--compliancecompliance
Stay below gingival crestStay below gingival crest
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PainPain Remember the separator effectRemember the separator effect
If OTCs dont relieve pain, evaluateIf OTCs dont relieve pain, evaluate
--
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Post impingement sequelaePost impingement sequelae
Up to 2mm of denudation (including
cementum) will be repaired with newattachment
TsukiboshiM: Autotransplantation of Teeth, Chicago, 2001, Quintessence
Ankylosis becomes more prevalant in areas of
PDL damage greater than 4mm
Fabbrioni and colleagues Int Journ Oral Max Surg
2004232 intermaxillary fixation screws placed
Post removal contact assessed radiographically
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26 screws (11.2%) had major
contacts37 screws (15.9%) had
,
and minor, only one tooth required
RCT
Borah and Ashmead Journ Plas Recon Surg
1996Over 2300 miniscrews in 281 patients
studiedIncidence of im in ement er screw was0.41%NO impinged teeth developed PAabscesses or needed RCT
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ConclusionOur results show that contact between a dental
root and a drill, screw, or both causes resorptive
root damage. After discontinuation of the contact,
however, repair begins to occur through the depositionof cellular cementum.
oggo an co eagues recommen e a m n mum
clearance of 1mm between a miniscrew
and a root for both periodontal health and mini -
screw stability. Therefore, it can be concluded that
miniscrews with a diameter of 1.5mm or less are
safe for interradicular insertion if the space between
the roots is at least 3.5mm.
BisphosphonatesBisphosphonates
Oral bisphosphonate use and the prevalence of osteonecrosis of the
jaw An institutional inquiry - JADA 2009;1401):61-66.Parish P. Sedghizadeh,DDS, MS, Kyle Stanley, BS, Matthew Caligiuri, BA, Shawn Hofkes, BS, Brad Lowry, BS and Charles F. Shuler, DMD,
PhDBackground.
Initial reports of osteonecrosisof the jaw (ONJ) secondary to bisphosphonate (BP) therapy indicated that patients
receiving BPs orally were at a negligible risk of developing ONJ compared with patients receiving BPs intravenously. The
authors conducted a study to address a preliminary finding that ONJ secondary to oral BP therapy with alendronate
sodium in a patient population at the University of Southern California was more common than previously suggested.
Methods. The authors queried an electronic medical record system to determine the number of patients with ahistory of alendronateuse and all patients receiving alendronatewho also were receiving treatment for ONJ.
Results. The authors identified 208 patients with a history of alendronate use. They found that nine had active ONJand were being treated in the schools clinics. These patients represented one in 23 of the patients receiving
alendronate, or approximately 4 percent of the population.
Conclusions. This is the first large institutional study in the United States with respect to the epidemiology ofONJ and oral bisphosphonateuse. Further studies along this line will help delineate more clearly the relationship
between oral BP use and ONJ.
Clinical Implications. The findings from this study indicated that even short-term oral use of alendronateled to ONJ in a subset of patients after certain dental procedures were performed. These findings have important
therapeutic and preventive implications.
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Oral Bisphosphonate-Induced Osteonecrosis: Risk Factors,
Prediction of Risk Using Serum CTX Testing, Prevention , and
TreatmentRobert E. Marx, DDS,* Joseph E. Cillo, Jr, DDS, and
Juan J. Ulloa, DDS
Purpose: To assess the risk and time course of oral bisphosphonate-induced osteonecrosis of the jaws.
Materials and Methods: Detailed data from 30 consecutive cases were compared with 11 6 cases due
to intravenous aminobisphosphonates.
Results. Results in part noted a higher incidence related to alendronate (Fosamax; Merck, WhitehouseStation, NJ), a 94.7% predilection for the posterior mandible, and a 50% occurrence spontaneously, with
the remaining 50% resulting from an oral surgical procedure, mostly tooth removals. Just over 53% of
patients were taking their oral bisphosphonatefor osteopenia, 33.3% for documented osteoporosis, and
13.4% for steroid-induced osteoporosis related to 4 or more years of prednisone therapy for an
autoimmune condition. There was a direct exponential r elationship between the size of the exposed
one and e dura on o ora sp osp onae use. ere was aso a drec correa on eween repors
of pain and clinical evidence of infection. The morning fasting serum C-terminal telopeptide(CTX) testresults were observed to correlate to the duration of oral bisphosphonate use and could indicate a
recovery of bone remodeling with increased values if the oral bisphosphonatewas discontinued. A
stratification of relative risk was seen as CTX values less than 100 pg/mL representing high risk, CTX
values between 100 pg/mLand 150 pg/mL representing moderate risk, andCTX values above 150 pg/mL
representing minimal risk. The CTX values were noted to increase between 25.9 pg/mLto 26.4 pg/mLfor each month of a drug holiday indicating a recovery of bone remodeling and a guideline as to when
oral surgical procedures can be accomplished with the least risk. In addition, drug holidays associated
with C'IX values rising above the 150 pg/mL threshold were observed to correlate to either spontaneous
bone healing or a complete healing response after an office-based debridement procedure.
Conclusions: Oral bisphosphonate-induced osteonecrosis is a rare but real entity that is less frequent,
less severe, more predictable, and more responsive to treatment than intravenous bisphosphonateinducedosteonecrosis. The morning fasting serum C-terminal telopeptidebone suppression marker is a
useful tool for the clinician to assess risks and guide treatment decisions.
2007 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 65:2397-2410, 2007
Case PresentationsCase PresentationsImportant Note: Many of the attachments used to treat these
cases do not reflect Align Technologys latest set-up
protocols and were used for testing purposes. Please refrain
from requesting these attachments for future treatments.
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Vertical AsymmetryVertical Asymmetry
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Anterior Open BiteAnterior Open Bite
Anterior Open BiteAnterior Open Bite
Traditionally requiredTraditionally required
surgerysurgery Allows mandible toAllows mandible to autorotateautorotate,,
thereby decreasing anterior facialthereby decreasing anterior facial
iiii
Risk of postoperative morbidity andRisk of postoperative morbidity and
high costhigh cost
Alternatives: MEAW treatment, HPHG withcomprehensive orthodontics, posterior bite plates,magnets on opposing arches, anterior toothextrusion, jaw surgery
Adverse side effects Stability issues
Treatment Using MiniscrewsTreatment Using Miniscrews Achieves results similar to surgery without the risks and high costAchieves results similar to surgery without the risks and high cost
Intrudes posterior teeth, allowing the mandible to autorotate andIntrudes posterior teeth, allowing the mandible to autorotate andclose biteclose bite
Miniscrews may be used to retain intrusion and correct anyMiniscrews may be used to retain intrusion and correct any
discrepancies without typical extrusive dental side effectsdiscrepancies without typical extrusive dental side effects
Anterior Open BiteAnterior Open Bite
Can use O pen-Bite Splint for posteriorintrusion : Force of Ni-Ti coils Pressure of tongue on 2
transpalatal bars Pressure of b ite on acrylic
covering occlusal surface
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Anterior Open Bite
The following is a patient treated
only with screws and braces, noopen bite splint. It is important tonote that this patient could easily
manner with aligners andminiscrews and no fixedappliances.
StephaniaStephaniaCl II, Open bite, TMDCl II, Open bite, TMD
4-6-06
Stephania
Cl II, Open bite, TMD
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StephaniaStephaniaCl II, Open bite, TMDCl II, Open bite, TMD
6 months progress6 months progress
Mini screws placedMini screws placed
facial and lingualfacial and lingual
If I were treating her now I would simply
have her wear the aligner with the
elastic from screw to screw over top of
the aligner. I will demonstrate this with
another patient shortly.
11-1-06
Stephania
Cl II, Open bite, TMD
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Miniscrews for posteriorMiniscrews for posterior
intrusionintrusion
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Miniscrews for posteriorMiniscrews for posterior
intrusionintrusion
Molar UprightingMolar Uprighting
Molar UprightingMolar UprightingDirectDirect
POSITIONIn retromolar region immediately distal totipped second molar. Such placementmaintains rotational control.
ac co sprng rom e mn screw othe cleat/button bonded to the molar asmesial as possible.
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DC
40y2m
Initial
Cl ICl I
Prior treatmentPrior treatment
Occlusal cant up on rightOcclusal cant up on right
l i il i i
DC 40y2m
Pretreatment
l i il i i
Combination TreatmentCombination Treatment
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Combination TreatmentCombination Treatment
DC 40y2m
40y9m
Refinement
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Combination TreatmentCombination Treatment
Combination TreatmentCombination Treatment
DC 41y1m
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DC 40 10m
Progress
Canine remobilized
Mini screw placed
DC 41y7m
Pro ress
DC
41y9mFinal
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DC: Treatment Summary
DC: Treatment Summary
InvisalignInvisalign
6 aligners upper only6 aligners upper only 16 weeks16 weeks 5 visits5 visits
Case refinementCase refinement 11 aligners11 aligners 40 weeks40 weeks
DC: Treatment Summary
16 visits16 visits Extrusion buttons #6 with mini screwExtrusion buttons #6 with mini screw
28 weeks (included above)28 weeks (included above) 14 visits (included above)14 visits (included above)
Total active treatmentTotal active treatment 15 months15 months 21 visits21 visits
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Class II CorrectionClass II Correction
39y9m
Initial
Class II Correction
ClCl II subII sub leftleft
EM 39y9m
Pretreatment
Slight crowdingSlight crowding
Upper midline to rightUpper midline to right
Post leftPost left crossbitecrossbite Congenitally missing #10Congenitally missing #10
Peg #7Peg #7
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PlacedPlaced miniscrewminiscrew
EM 39y9m
Pretreatment
retromolarretromolar area distalarea distalto #15. Placed chainsto #15. Placed chainsfrom buttons facialfrom buttons facialand lingual #14 toand lingual #14 tominiscrewminiscrew..
Combination TreatmentCombination Treatment
Combination TreatmentCombination Treatment
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EM 39y9m
EM 39y9m
EM
40y9m
ii
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Combination TreatmentCombination Treatment
Combination TreatmentCombination Treatment
EM 40y9m
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EM 40y9m
EM
41y2m
Progress
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22 months progress
22 months progress
EM 41y6m
3 months fixedProgress
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EM 43y0m
12 months post
EM: Treatment Summary
InvisalignInvisalignwithwith miniscrewminiscrew-- 1818 alignersaligners-- 4444 weeksweeks-- 6 visits6 visits
Extrusion buttons #11Extrusion buttons #11-- 6 weeks6 weeks--
Case refinement withCase refinement with miniscrewminiscrew-- 2020 alignersaligners-- 3838 weeksweeks-- 77 visitsvisits
Segmental AppliancesSegmental Appliances-- 18 weeks18 weeks-- 3 visits3 visits
TotalTotal active treatmentactive treatment-- 2525 monthsmonths-- 1818 visitsvisits
Class II CorrectionClass II Correction
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MS
Initial
Cl II
MS 36y5m
Pretreatment
Slight lower crowding
Missing UL Central
Midlines off
Combination TreatmentCombination Treatment
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Combination TreatmentCombination Treatment
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MS
Refinement
Combination TreatmentCombination Treatment
Combination TreatmentCombination Treatment
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Placed Miniscrew
MS 38y9m
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MS 39y0m
CG
33y0mi i lInitial
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Cl II sub right
CG 33y0m
Pretreatment
Slight crowding
Anterior open bite
Upper midline to left
CG 33y0m
Carriere and miniscrew
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CG
33y3m
i li i li
impressions
12 weeks with Carriere, miniscrew and elastics
Distalizer removed, training
aligners placed, note
continued elastic to
miniscrew
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CGCG
34y0m34y0m
IIII
TI
40y0mi i lInitial
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TI
33y0m
Carriere and miniscrew
Class II div 2 deep biteClass II div 2 deep bite
Courtesy Dr. John M. SparagaCourtesy Dr. John M. Sparaga
Class II Division 2 Deep BiteClass II Division 2 Deep Bite
1/31/2007, Initial, YR. 40 MO. 0
F. Scott
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Division 2 CorrectionDivision 2 Correction
F. Scott
Intrusive TADs 7/3/07Intrusive TADs 7/3/07
7/3/2007, Micro Screws, YR. 40 MO. 5
F. Scott
TADs 12/20/07TADs 12/20/07
F. Scott
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10 Months MX Intrusion10 Months MX Intrusion
July 07July 07 May 08May 08
F. Scott
Intrusion ProgressIntrusion Progress
F. Scott
TAD Elastic AttachmentTAD Elastic Attachment
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Hook FormerHook Former-- EssixEssix
Hook Former in ActionHook Former in Action
#806314041524 Braessler#806314041524 Braessler
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Instant TorchInstant Torch
Instant ThermometerInstant Thermometer
Molar SupereruptionMolar Supereruption
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LB
36y5m
Pretreatment
Supererupted upper molars
LB 36y5m
Pretreatment
U & L spacing
Missing multiple teeth
Midlines off
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y m
Miniscrews in
place
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LB FinalLB Final
TTemporaryemporary TToothooth RReplacementeplacement
Camille Initial
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Note both upper lateral incisors congenitally missing
Screws placed
Final
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To obtain your CE certificate for this program pleaseTo obtain your CE certificate for this program please
complete a brief survey at:complete a brief survey at:
www.AligntechInstitute.com/asksurvey
Upon completion of your survey* you will have immediate
access to your CE certificate.
*This survey is only available to the participants who attend the live
presentation via the webinar/phone. Participants who complete the
archived program on Alig ntechInstitute.com need to compl ete a CE test to
obtain their CE certificate.
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MINISCREWS (TADS) AND ALIGNERSThank you
POSSIBILITIES
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