Professional Documents
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1. Brief review of literature with conventional fixed 1. Brief review of literature with conventional fixed
treatment , orthognathic surgery, Micro implants (MI) treatment, orthognathic surgery, Micro implants
and Invisalign in regard to Stability (MI) and Invisalign
2. Is open bite a health related functional issue?
3. Case reports (non-extraction and extraction)
-Based on 42 consecutive patients -1 to 9 yrs post
retention –no orthognathic surgery or Micro implants
(will show 14 today)
* For more information refer to Align Technology’s open
bite video available at Aligntech Institute of
Invisalign.com
Long-Term Stability of Anterior Open Bite Treatment How stable is posterior intrusion with micro
with Conventional fixed appliances
implants to close an open bite?
Recent fixed studies–Smithpeter & Covell AJODO
Beck et al. (Oct. 2010) AJODO –Some skeletal
(2010) 137:605-14 –Zuroff et al AJODO
and dental relapse (17 %) in first year post-
(2010)137:302-8 –Reemers et al (2008) Orthod
treatment, but good stablity after 3 years
Crainofac Res 11:32-42
Deguchi et al. (April 2011) AJODO -2 year post
Conclusions:
comparison of MEAW (Kim) to MI’s and bone
Relapse is frequent (40 - 80%) plates (minor relapse)
Associated with increased mandibular plane angle -More relapse with MEAW than plates or MI’s
Anterior tongue position may be most important
variable for relapse
Tongue habit reminders (MFT) are helpful But what if patient declines MI’s or plates?
(repositioning of tongue posteriorly)
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Palatal MI and lower buccal MI’s used for anchorage to
intrude and retract posterior teeth to close an anterior open
Pre vs post (MI Case treated by Cheol Ho Paik and Judie bite and bimaxillary protrusion
Woo , Seoul, Korea)
-Pretreatment
-Posttreatment
Pre vs post
A B
2 years post-good stability with use of MI after Does Orthognathic surgery provide
first year stability of open bite correction?
Studies show that for long term results (< 2 yrs
retention), that if positive overbite is a main goal then
35 % to 52% of patients will not have positive overbite
• -Also, patients may not accept surgery
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Can Invisalign treated patients have Long-Term Stability of Mild to moderate Anterior
acceptable long-term stability of anterior Open Bite Treated with Clear aligners
open bite? Agenda
-Leads to excessive wear of posterior teeth due to loss 3. Case reports (non-extraction vs extraction)
of anterior contact and resulting lack of anterior -Based on 42 consecutive patients -1 to 9 yrs
disclusion post retention –no orthognathic surgery or
-Less efficient mastication Micro implants
Pre
3
One year post- Upper laterals restored but
open bite develops –Decision to use
Invisalign Final aligners fit well
CR
11 year follow-up of open bite Mild extrusion (< 2mm) with force pushing
against attachment
CR
Pre-tx 10 months
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Superimposition -common finding is How does Invisalign close the anterior open
no opening of mandibular plane angle bite? (my hypothesis)
Pre
Pre=solid line
Post =dotted lines
Post
How does Invisalign close the anterior open How does Invisalign close the anterior open
bite? (my hypothesis) bite? (my hypothesis)
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Pre - Edge to edge bite with narrow arches
High mandibular plane angle and long lower
(Does posterior expansion tend to open
bite in the anterior?) 1/3rd facial height
Measures value norm
SNA 74 82
SNB 72 80
ANB 2 2
WITS 0 0
FMIA 56 65
FMA 35 22
IMPA 89 90
SN-GoGn 43 33
U1-SN 98 102
U1-NA (°/mm) 23/7 22/4
L1-NB (°/mm) 28/8 25/4
IIA 126 130
POG-NB 3 2
No change in
mandibular plane
angle
6
.
Pre – Mild open bite treatment with
Six years post posterior crossbite -Previous fixed tx
No contact of incisors
Initial
Final
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Pre -planned for implant to replace # 29 -8 mm space
is needed
Pre, post and 3 yr retention
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Superimposition 2 yrs post ortho
-good stability of open bite
-No opening of mandibular plane angle
Initiall
Final
Pretreatment 11 months
Pre
Post
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8 years post Class I open bite with posterior crossbite
-history of two previous fixed treatments
final
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Pre –Class II subdivision right, anterior edge to edge
with posterior crossbite and high canines
- Class II unilateral elastics used with Invisalign Post
Andrea A.
Button
Cutout
Mesial Hook
11
Post
- Increased clinical crown lengths 1 Year Retention
- Left side has posterior open bite
Pre, post and 1 year Superimposition Class I open bite with crowding treated with premolar
-Note continued closure of mandibular plane angle extractions and 8 months of segmental fixed
Pre 14 months
Initial
Final 24 months 30 months
1 year retention:
12
8 years post
Pre
Post
Nikki A.
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. Pre vs post - Tx
Invisalign with premolar extractions and lower fixed
segments
Pre
Post
Initial
Final
Pre
2 ½ years post –Invisalign with premolar extractions
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Initial Ceph *Chinese norm Initial Panoramic Xray _note lack of root
parallelism –makes Invisalign more difficult
Measures Value Norm*
SNA 82 82
SNB 77 79
ANB 5 3
Wits Appraisal -4 0
FMA (MP-FH) 34 22
FMIA (L1-FH) 53 57
IMPA (L1-MP) 93 93
MP - SN 43 32
U1 - SN 95 102
U1 - NA (º/mm) 13 / 2 24 / 5
L1 - NB (º/mm) 33 / 10 27 / 6
IIA 129 126
Pog - NB -1 2
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Severe open bite with crowding and one Severe skeletal –Significantly increased mandibular
premolar extraction plane angle and long lower third facial height
Pre vs post Measures value norm
SNA 73.5 82
SNB 69.0 80
72
ANB 4.5 2
68
__
4
97
WITS -0.4 0
FMIA 52 65
133
FMA 49.6 22
61 28
-4
123
IMPA 78.4 90
Pre Post -1
78 SN-GoGn 59.6 33
2
Superimposition
Pre vs post treatment
Initial
Final
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3 1/2 years post treatment
7 yrs post treatment
17
5 years post –good stability 32 yr old male with 7 mm open bite
pre
SNA 82 82
FMIA (L1-FH) 56 65
IMPA (L1-MP) 90 90
MP - SN 41 33
U1 - SN 103 102
U1 - NA (º/mm) 21/ 4 22 / 4
L1 - NB (º/mm) 38 / 9 25 / 4
Pog - NB 1 2
Black=Pre, Blue =16 months 21 months –note facial and overbite changes
-Precision cuts used for elastics
Pre
Pre
Mandibulat plane in
3 degrees closure of
12 mo
21 months
16 mo
3 degrees closure of mandibular plane angle
from upper molar intrusion -mandible came
forward 4 mm
18
28 months Long-Term Stability with clear aligners for
mild to moderate open bite
3 anterior teeth touch !
How Successful is Invisalign for How well is deep overbite corrected? (JCO 1997)
Treatment of Anterior Open Bite and -Intrusion of upper central incisors to level gingival line
and leveling of lower Curve of spee
Deep Overbite?
Agenda
I. Mild to moderate Anterior Open
Bite
II. Mild to moderate Deep Overbite
How is deep overbite corrected? Lower anterior Pre and post-Ortho solution was to intrude upper
intrusion to level lower curve of Spee. How stable is central incisors to gingival margins
this correction?
Pre
Pre
Post Post
19
2 years post treatment -excellent retainer
wear (bonded lower ant. wire usually
Note intrusion of incisors to open bite
needed)
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Power RidgesTM change the shape of How do Power Ridges create lingual
material to produce a torquing auxiallry
root torque?
How do they work?
1. Lingual Root Torque is defined as M
rotation about the incisal edge
root
F 1
crown
Power Ridges now available for lower Clinical results of Power ridge testing
incisors -20 degrees torque requested
Pre
Post
Norm
Measures Final Initial *
SNA 83 83 82
SNB 77 77 80
ANB 6 6 2
Wits Appraisal 2 3 0
FMA (MP-FH) 16 16 22
21
Superimposition -12 degrees of torque achieved
from 20 degrees requested Final Panoramic X-ray
-No noticeable root resorption (agrees with Fl and
USC studies)
Initial 24y 7m
Final 25y 9m
1 year Post tx
Daniel Z.
Pre
Aligner fit
Post-bite opened
3 mm + improved
torque
Deep overbite, mild crowding, retro-inclined incisors Note absence of posterior open bite
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Margaret F. -27 yrs-”Overbite”
UC Berkeley Grad student, travels to Africa months
Superimposition at a time for research
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Initial vs end of aligners Pre vs Post PANOs -No Root resorption
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Deep bite and unilateral Class II treated
before G3 or 4 main difference is treatment Deep bite and unilateral Class II -Comparison
efficiency
Pre
Case ref.
Post
1 Yr post -Deep bite and unilateral Class II –Post tx What if overjet is present?
needed more torque and bite opening Place bite turbos on canines (Bill Gierie)
34 yr old Chinese-American with severe Extremely deep overbite due to bone loss
periodontitis and complaint of “teeth stick out ” -Can generalized advanced periodontitis patients be
treated with Invisalign?
Pre
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Pre, during & Post treatment-Note shortening of
crowns by selective grinding to improve C/R ratio Radiographs
and aid in bite opening
Pre-Tx
Initial
Case
Refinement
4 yr
Post-Tx
Final
Pre
Post
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How Successful is Invisalign for
Treatment of Anterior Open Bite and
Deep Overbite? Thanks!
Summary
Robert Boyd DDS, MEd
I. Mild to moderate Anterior Open Bite - Frederick T. West Endowed Professor &
Good results with better stability than Chair
fixed Department of Orthodontics
Arthur A. Dugoni School of Dentistry
II. Mild to moderate Deep Overbite University of the Pacific
-Better results today because of Power San Francisco, CA
Ridges, bite turbos and applying
overcorrection
(but how much actual work? –if you like to work
hard, don’t do Invisalign)
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