Treatment date: 7-28-2008
A lot of treatment decisions were made today. The current aligner (23) fit well in most areas. Looking critically with the aligners in place, in the upper arch the upper right lateral was lagging slightly, less than 0.5 mm.
In the lower arch, the lower right second bicuspid was not rotating and the attachment was not fully seated in the aligner. Frankly, I have been so focused on the anterior teeth I don’t specifically remember looking to see if this tooth was tracking, and I have never done any hand stripping to reduce tight interproximal contacts on either side of that tooth.
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
Upon close examination with the aligners out, the lower incisors are not as well aligned as the aligner shows. This could be explained by the occlusion of the lower incisors hitting on the marginal ridges of the upper incisors. Virtual bite turbos should have been used to possibly prevent this traumatic occlusion. A little late at this point to think of that. However, I am currently placing more and more virtual bite turbos in ClinChecks because of this occurrence. With seven aligners remaining, it is time to become proactive to develop the final tooth position, and the final occlusion. The following actions were taken at this appointment:
- The interproximal contacts were made very light, or open, around the lower right lateral, lower left central and the contact between the upper right central and lateral incisor. This was done using a hand strip.
- The attachment was removed on the lower right second bicuspid. The position of this tooth will be addressed in case refinement. This is not considered critical at this time.
- Dimples were added using the dimple plier to augment the pressure on the lower incisors. Dimples were placed bilaterally on the lingual of the lower right lateral. One dimple was placed on the distofacial surface of the lower left central incisor (see Figure 7). These dimples will be placed on all the remaining aligners.
- Unilateral class II elastics were placed on the right side to correct the right posterior occlusion and help correct the midline (see Figure 2). The elastics are being worn from slits cut into the aligners using ligature cutters (see Figure 9). The elastics are 5/16ths, 4.5 oz. and are to be worn full time. Class II elastics were planned for use due to the presence of a surgical shift in the ClinCheck that was approved.
Daniel will be seen in eight weeks to deliver his final three aligners. This appointment is scheduled on 9/22/08.
