Treatment date: 10-1-2008

As we progress into the final 7 aligners, critical evaluation is necessary to make changes and alterations in the aligners and in the treatment plan to start developing the final occlusion. The main idea on difficult cases is to get as close to the final occlusion as possible so that major changes do not need to occur in the case refinement aligners.

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.

Treatment date: 6-4-2008

Kelly showed up in her usual cheerful mood and reported that all was well. We delivered the next four aligners, 21 through 24, out of a total of 35 aligners. In the lower arch, the contacts were all light and did not require any IPR. In the upper arch, additional hand reduction of 0.1 mm was performed between teeth 6 and 7. As we initially reported, tooth 23 is the rate determining tooth and will be the most difficult tooth to correct.

Treatment date: 4-10-2008

Kelly is on schedule and reports no problems through aligner 16 of 35 total aligners. The contacts were all checked and I noted that all the lower space that was created with IPR at aligner 6 is now closed. In addition, I reduced the contacts on the mesial and distal surface of tooth #6 in the upper arch, and also lightened the contacts between teeth 21 – 22 and 27 - 28 in the lower arch.

Treatment date: 2-13-2007

Kelly came in for her appointment and reported that she had no problems and was progressing on schedule with her aligners. The customary procedure is to check for tight contacts with floss. This is especially critical at this time because we are extruding the upper cuspids, and correcting rotations on these teeth simultaneously. Several teeth required hand stripping with the 0.10 vision flex strip:

Treatment date: 12-20-2007

Today we delivered aligners 9, 10, 11, and 12. The current aligners (#8) fit well and there was no indication that there were any issues with teeth tracking properly. Her gums were healthy and all her attachments were in place. The front teeth continue to make contact when the aligners are removed. Kelly reported that she has worn the aligners pretty much according to schedule, at least 20 hours per day.

Kelly’s ClinCheck required modification in two key areas: velocity of tooth movement, and attachment design. In the initial ClinCheck, the upper arch showed 24 aligners. However, an important factor was the lack of simultaneous staging in the initial setup (Figure 1). The lack of simultaneous staging meant that the rate-determining tooth was not moving over the course of all 24 aligners.