Stephanie returned for her first monitoring visit. Her current set of aligners, stage 3, fit perfectly. I should first report that there was a problem to solve during the scheduled first 3 aligners. Stephanie called us while on her vacation to report that she had “lost” aligners #2. Since the aligner #2, two week activation wear time was almost completed, we instructed Stephanie to move to aligners #3. In most cases, this will work just fine especially when the aligner wear is almost complete for the “lost” stage.

Sheena returned for her first monitoring visit all smiles and reported that she had not experienced any problems. She found the aligners easy to seat and easy to remove. No discomfort was reported during aligner wear, and in fact, she reported that it was as if there was “nothing in my mouth”. She loves the esthetics of Invisalign!

The overall treatment plan for Justin called for removal of the retained lower right deciduous second molar and placement of an implant fixture. Following implant placement, records were sent to Align. Using ClinCheck a proper M-D space was developed for the restoration of the implant fixture. This plan would allow the implant fixture to integrate while simultaneously moving teeth with Invisalign, thus saving the considerable time of implant integration before implant restoration.

Let’s take a look at the attachment rationale for Stephanie.

The following attachments were placed automatically according to Align’s standard protocols:

Generally, vertical attachments serve two purposes. First they provide retention for the aligner and second they aid in movement control for rotation.

Let’s take a look at the attachment rationale for Sheena.

The following attachments were placed automatically according to Align’s standard protocols:

Generally, vertical attachments serve two purposes. First they provide retention for the aligner and second they aid in movement control for rotation. Close monitoring at each patient appointment is necessary for attachments, especially the rectangular option as unintended forces will be applied to the tooth, if the attachment “slips” out of the plastic reservoir of the aligner (Figure 1).

Let’s look at the attachment rationale for Justin.

In the maxillary arch several different attachments were placed. Following Align’s protocols, vertical rectangular attachments were placed on the maxillary left second bicuspid and right canine for the primary purpose of rotation. In this case, the rectangular attachments should also provide sufficient retention and minimize the need for additional attachments.

We followed the same simple attachment placement steps outlined in Sheena's update.

After first trying the attachment template for fit, we used a basic bonding technique to etch, wash, dry and bond the bonding material to the specific teeth scripted for attachments. TPH composite material was placed in the attachment reservoirs and light cured. Excess material was removed and the aligners were delivered.

Let’s outline the basic steps to deliver Sheena’s Invisalign case, with a focus on the attachments!

1. As there were several attachments, first try in the aligner “template” to ensure an intimate fit to the teeth (see figure 1- We check the fit closely to be sure that the teeth fit intimately in the template. Check the occlusal of the attachment template to evaluate that there is no space between the teeth and the occlusal of the template).

Let’s use Justin to summarize the delivery steps and attachment placement techniques we outlined for our other patients, Sheena and Stephanie. In Justin’s case we had to execute treatment to remove a retained deciduous tooth, create a surgical guide for implant fixture placement and place the actual implant fixture. I will outline the construction of the surgical guide and implant placement in a separate blog entry.

Let’s review our initial treatment plan for Stephanie: