Treatment date: 8-6-2008

Kelly checked in today wearing aligner 24 of 35 total aligners. The current aligner is fitting very nearly identical to what we have seen the last few visits. The fit of the lower aligners is good except for the lower left lateral incisor.

The attachment is still being captured by the aligner and there is an open contact on each interproximal surface. Starting with aligner 28 the ClinCheck shows that this will be the only tooth moving for the last eight aligners.

In the upper arch it is pretty much the same old story. The only teeth not exactly in the aligners are the upper right lateral and cuspid. The picture showing the elastic wear that was started today demonstrates the small amount that the teeth have consistently lagged behind (see Figure 2). Repositioning the attachments at the last appointment has proved to work well because the attachments are squarely in the aligners. It has become routine that the contacts are tight around these teeth. Once again, a hand strip was used to lighten the contacts on these two teeth. The total surface area that has been removed to date is 0.2 mm on the mesial and distal surface of the upper right cuspid. The distal of the upper right lateral has been reduced 0.2 mm and the mesial 0.05 mm to date. This is quite interesting considering that no IPR was scheduled in the upper arch, but has been necessary to allow movement of these teeth.

The major treatment decision today was to initiate Class III elastics on the right side (see Figure 2). The elastics are attached to the aligners by slits cut into the aligners on the facial surface of the upper right first molar and the facial surface of the lower right cuspid. The goal is to help correct the midlines and develop overjet. A 5/16ths, 4.5 oz elastic is to be worn full time.

Planning ahead, we will be needing case refinement. I may elect to go to case refinement prior to aligner 35 based on the fit of the aligners on the teeth noted previously. Should any of these three teeth develop a poor fit of the attachment in the aligner I will probably elect to send for case refinement as opposed to any other type of aligner modification. If the aligners continue to fit the same, I will probably start using the dimple pliers to augment pressure on these three teeth.