Justin arrived for his second monitoring visit and did not report any problems. After inspection with his aligners in place the tooth movements appeared to be following the virtual representations. There appeared to be minimal movement lag with some slight incisal edge lag apparent in the case of the maxillary extrusion. Justin easily removed the aligners. Even though there was no IPR in this case, we used floss to check for tight contacts.

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 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.

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 Justin: