Invisalign® First case report series

Phase 1 orthodontic treatment with

Invisalign First clear aligners
Anterior crossbite, anterior crowding, constricted arches

Dr. Terry Gruelle (Cincinnati, Ohio, USA)

Dr. Terry Gruelle is an ABO certified orthodontist and a graduate from the University of North Carolina. He maintains offices in
Cincinnati, OH and Northern Kentucky and has treated over 4,000 patients with Invisalign® aligners.

Patient: Initial records:

Age: 10 year, 3 month-old male

Chief concern: The main concern was the

patient’s underbite and rotated upper teeth.

Diagnosis:

• Early mixed dentition

• Convex facial profile, with a mildly
retrognathic mandible
• Class I molar relationship
• Anterior crossbite of the upper permanent
incisors, with limited labial attached gingiva
on the lower central incisors as a result of
the bite
• Moderate arch constriction
• Severe rotation of the upper lateral incisors
• Mesially-rotated upper first molars

The opinions expressed in this white paper are those of the author(s) and may not reflect those of Align Technology. The author was paid an honorarium by Align Technology
in connection with the white paper. 1
 Invisalign® First case report series
Treatment plan:
iTero Element® intraoral scans for all digital models and
bite registration.
Non-extraction aligner treatment in two separate phases:
• Phase 1: Correct the anterior crossbite so that the
permanent incisors can erupt normally and additional
damage to the incisal edges and lower labial gingiva can be
avoided.
• Phase 2: Address any discrepancies remaining in the fully-
erupted permanent dentition.
Establish an ideal overbite and overjet relationship. Widen the
arches dentally to eliminate the crowding. Leave space distal to the
permanent upper laterals for the erupting permanent canines.
ClinCheck® set-up and staging:
The opinions expressed in this white paper are those of the author(s) and may not reflect those of Align Technology. The author was paid an honorarium by Align Technology
in connection with the white paper.
Invisalign® First aligner features used:
• Optimized extrusion attachments for the upper lateral incisors.
• Optimized retention attachments for the posterior teeth.
• Molar and anterior movements staged first, followed by
buccal segment expansion. Patients and parents want to see
smile improvements early in treatment, and initiating anterior
improvements up front helps sustain the patient’s initial enthusiasm.
• Lingual attachments were used on the upper and lower central
incisors for esthetic reasons. Except for these additional
attachments, the default Invisalign attachments were used in the
ClinCheck® set-up.
Retain the Phase 1 treatment results until the permanent teeth fully erupt.
2
 Invisalign® First case report series

Progress scan after 6 months of Phase 1 aligner Treatment results (11 months from initial records to
treatment (“stage 0” of the additional aligner order): retention, 29 + 19 upper aligners and 29 + 19 lower
Invisalign® First aligners, 37 weeks of active treatment time):

The opinions expressed in this white paper are those of the author(s) and may not reflect those of Align Technology. The author was paid an honorarium by Align Technology 3
in connection with the white paper.
 Invisalign® First case report series

Clinical discussion:

The anterior crossbite was corrected and a normal overbite and overjet
achieved. The anterior crowding was also corrected. The arch widths
were significantly improved.
The mother had been told by another dentist that the patient had
a skeletal issue that might require surgery in the future. With only 7
office visits needed in total during the 11 months from initial records to
retention, she was absolutely elated with our Phase 1 treatment results.
The Phase 1 active treatment time was 37 weeks. 29 + 19 upper and
29 + 19 lower Invisalign® First aligners were used. 19 additional aligners
were used to settle the bite and finish the arch expansion, because after
23 weeks in the initial aligner series, a slight posterior open bite had
developed on the left side from the anterior crossbite not being fully resolved.
We expect the slight openness in the primary molar region to resolve
by itself once the teeth exfoliate and the permanent teeth erupt into
full contact.
The aligners were changed every 5 to 7 days. Since the permanent
roots are not yet fully developed at this age, less orthodontic force and
effort may be needed to achieve the desired alignment compared to
older patients.
The patient’s aligner wear compliance was good, even when a few
attachments fell off the first molars and the aligners became less
retentive. No emergency visits were needed, even after the loss of a
few attachments. The patient’s oral hygiene was excellent.
The retention appliances used were a removable Theroux appliance in
the upper arch (worn only at night) and a 2-2 bonded lingual wire in the
lower arch (0.0195” triple-stranded twist wire).
Treating this case in less time and fewer visits would be difficult even
with traditional braces. With fixed appliances, bonded bite ramps would
have been needed because of incisor interferences from the crossbite, and
the short crown heights would make correct bracket positioning challenging.

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The opinions expressed in this white paper are those of the author(s) and may not reflect those of Align Technology. The author was paid an honorarium by Align Technology
in connection with the white paper.

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