Let’s review our initial treatment plan for Stephanie:
- Resolve upper and lower crowding
- Improve right side posterior crossbite
- Resolve canine and bicuspid rotations
- Maxillary expansion and procline with no IPR
- Mandibular expansion and IPR with no procline
- Improve the vertical appearance of deepbite with anterior extrusion
- Maintain posterior CL I A-P relationship
Initial ClinCheck files
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Final ClinCheck files
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After ClinCheck review I felt comfortable with the following:
- A-P relationship was maintained
- Posterior crossbite was resolved
- Canine and bicuspid rotations were resolved
- Maxillary expansion and procline was reasonable
- Mandibular expansion and IPR distribution appeared reasonable
- A reasonable degree of improved vertical appearance of deepbite was established
As in previous cases I noted a “reverse” smile appearance to the anterior view of the maxillary teeth. To improve the value of the grid I wanted the occlusal table perpendicular to the grid feature. I sent the following modifications:
Please note the occlusal table as seen in the buccal views is not horizontal. Use the navigation features to level the occlusal table before following the instructions outlined below.
- Add about 1/2mm of additional EXTRUSION to the Mx right canine cusp tip.
- Add about 1/2mm of INTRUSION to the Mx left canine cusp tip.
- This will set the canine cusp tips equal to a horizontal line passing through both cusp tips. Use the anterior predefined view with the grid feature and 200% zoom to establish the described horizontal line.
- Add about 1mm of additional EXTRUSION to the Mx central incisors.
- Set the incisal edges of the Mx central incisors equal to a horizontal line passing through the Mx canine cusp tips. Use the anterior predefined view with the grid feature and 200% zoom to establish the described horizontal line.
- Add about 1/2mm of EXTRUSION to the Mx lateral incisors. Set the lateral incisor incisal edges 1/2mm apical to a horizontal line passing through the Mx canine cusp tips and Mx central incisor incisal edges.
The second ClinCheck seemed to present acceptable anterior esthetics. I accepted this version. Next for Stephanie will be her aligner delivery. Stay tuned for more!!
