Technique Tips
Presented by Dr. Kent Hall
Tip 1: Maximize relative extrusion by reducing proclination of the incisors if there is overjet. Program absolute extrusion using Optimized attachments with Align's standard velocity.
Tip 2: Instruct the patient to use chewie as a force module only in the posterior every time the aligners are inserted. Would have the patient squeeze on aligners if didn't cause TMJ symptoms.
Tip 3: As applicable, use swallowing exercises to correct tongue thrust and forward tongue posturing.
Tip 4: Clear retainers are preferable in open bite cases because vertical control is still needed. Upper and lower aligners worn nightly.
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How to apply Dr. Hall's approach in your prescription form:
In the prescription form on question 7, choose to extrude anterior teeth
On question 11, in the Special Instructions field, type: Close open bite via upper and lower anterior extrusion. Maximize relative extrusion and apply absolute extrusion as needed.
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Technique Tips
Presented by Dr. William Dayan
Tip 1: Maximize relative extrusion by reducing proclination of the incisors if there is overjet. Program absolute extrusion using Optimized attachments with Align's standard velocity.
Tip 2: Instruct the patient to use chewie as a force module only in the posterior every time the aligners are inserted. Would have the patient squeeze on aligners if didn't cause TMJ symptoms
Tip 3: As applicable, use swallowing exercises to correct tongue thrust and forward tongue posturing.
Tip 4: Clear retainers are preferable in open bite cases because vertical control is still needed. Upper and lower aligners worn nightly.
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Watch Video Presentation
(17:00)
Review Case Study
How to apply Dr. Dayan's approach in your prescription form:
In the prescription form on question 7, choose Correct Open Bite:
On question 11, in the Special Instructions field, type:
- Intrude teeth # X, X, X by X mm 2.
- Place horizontal incisally beveled attachments on Y, Y, Y
- Extrude upper and lower anterior teeth as needed to create proper OB/ OJ
- Add virtual simulation of posterior bite closure
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Technique Tips for Mild/Moderate Open Bite Cases
Presented by Dr. William Gierie
Tip 1: 1-2mm of anterior bite closure can be achieved with sequential intrusion of posterior teeth (intruding teeth one at a time from most posterior first)
Tip 2: Horizontal beveled attachments on the teeth mesial to the one being intruded are necessary
Tip 3: The UL7 is intruded first, then UL6, and so on, until a posterior open bite is created. Then the mandibular autorotation closes the open bite
Technique Tips for Severe Open Bite Cases
Tip 1: Orthodontic mini implants (OMIs) are often necessary to achieve open bite closure of 3mm or more. OMI's are usually for the upper as it is difficult to place these on the lingual of the lower posterior.
Tip 2: Request intrusion of the posterior teeth to create an open bite
Tip 3: Use surgical simulation of mandibular autorotation to close the bite
Tip 4: Begin the elastics typically at the second visit so the patient is used to aligner wear
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Watch Video Presentation
(17:00)
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How to apply Dr. Gierie's approach in your prescription form:
In the prescription form on question 7, choose to extrude anterior teeth:
On question 11, in the Special Instructions field, provide specific instructions how you want to correct the anterior open bite:
For Mild/Moderate Open Bite Cases
- Sequentially intrude teeth # X, X, X by X mm
- Place horizontal beveled attachments on Y, Y
- Add virtual simulation of posterior bite closure
For Severe Open Bite Cases (with OMIs)
- Intrude maxillary teeth # X, X, X by X mm
- Place attachments on anterior teeth #Y, Y for retention
- Add surgical simulation of mandibular autorotation to close the bite
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Technique Tips
Presented by Dr. Linda Crawford
Tip 1: Upright the teeth over the basal bone and round out arch forms to create symmetric and coordinated arch forms
Tip 2: If there is overjet, reduce the angulation of incisors to provide relative bite closure. No attachments are necessary for just relative extrusion if spacing is present.
Tip 3: Maximize intrusive forces in the posterior by using chewies and requesting equal number of upper and lower aligners to maintain instrusive forces throughout treatment
Tip 4: Address hard posterior contacts at each visit and make sure to check the bite at the first retainer check appointment following treatment.
Tip 5: Use Invisalign Vivera retainers to continue to improve bite post-treatment; rotate the 4 Vivera appliances on a quarterly basis
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Watch Video Presentation
(38:00)
Review Case Study
How to apply Dr. Crawford's approach in your prescription form:
In the prescription form on question 7, choose to extrude anterior teeth:
On question 11, in the Special Instructions field, type:
- Upright teeth over basal bone (tight hinge on the buccal or lingual). Create a natural arch form that's broad in the anterior
- Avoid posterior expansion
- Anterior extrusion to close open bite
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