Treatment date: 9-11-2008

ShiAnn called the office and sounded a little uneasy because she could not get her next scheduled aligner to fit. We asked her to come in for an emergency (eeks!) visit to determine the cause of her problem. My initial concern was that one of the central incisors had not fully fit in the aligner and was being pushed way off track.

This was not the case. What appears to have happened is that the change between aligner 25 and 26 is a result of where the pontic teeth drop out of the ClinCheck (Figure 2 and Figure 3). When this happened, the undercuts around the central incisors were fully exposed and the aligner required considerable force to engage the anterior teeth. ShiAnn had been seating the aligners over all the teeth at one time. With a little education, we were able to show her how to engage the central incisors and then follow by seating the aligner over the posterior teeth. This technique enabled full seating of the aligner. The process to remove aligners is exactly the opposite: disengage the aligners from the posterior and then roll the aligner out and to the front.

In previous visits the central incisors appeared to show a slight lag at the incisal edge of the central incisors. Upon seating aligner 26, the teeth appeared to be fully tracking and completely captured the horizontal beveled attachments (Figure 1). All other teeth in both arches were also tracking well.

The occlusion was checked to make sure the inter-arch contacts occluded only on the posterior teeth. With upper space closure on track, the only unresolved issue is making sure the lower arch levels completely, ensuring we do not have traumatic occlusion on the upper central incisors. In addition, the rotation correction of the lower cuspids will be closely monitored.

During Shi Ann’s next visit, we will deliver aligners 29-30-31 out of 35 aligners in each arch.