Correcting Class I Malocclusion using Invisalign Correctors by Dr Daz Singh

Dr Daz Singh presents a Class I malocclusion case in which the treatment provided involved Invisalign aligners followed by a restorative plan including ‘all ceramic’ Maryland bridgework and composite resins.

Introduction
The patient presented with a Class I malocclusion with moderate anterior spacing (Figs. 1 and 3). She had congenitally missing upper lateral incisors and lower right central incisor with a retained lower central deciduous incisor. There were also facets on the lower anterior incisors.

Three main issues needed to be resolved:

1. Spacing:After removing the lower deciduous incisor, there would be increased spacing in the lower 3–3 area. Closing this space, however, would result in an increased Class II relationship and would result in a different aesthetic issue.
2. Missing teeth: Because the patient had congenitally missing teeth, managing the spaces and replacing these teeth was required.
3. Shape: Because of their shapes, the lower incisors needed to be restored (Fig. 5). Creating the right vertical dimensions and restoring the correct anterior guidance would be vital to the long term success of the case.

Orthodontic treatment options were discussed with the patient. This included discussion about repositioning the lower teeth to give space to restore the lower anterior teeth and to improve the buccal corridors of the upper arch. The patient chose Invisalign aligners to deliver this outcome. With the aid of the ClinCheck preview feature (Figs. 7 and 8), the patient was able to see the overall treatment plan and the benefits of removing the deciduous incisor.

The benefits of not closing all the spaces in the lower arch but instead redistributing space evenly between the lower ‘4’ incisors were discussed and presented to the patient as the preferred option.
The replacement of existing porcelain-fused-to-metal (PFM) Maryland bridges was discussed and it was agreed that provision of dentures would feel like a step backward. The ideal replacement would have been implant-retained crowns; however, while the patient didn’t want to rule it out for the future, she didn’t have the budget for that option at time of treatment. She instead opted to replace the existing PFM Maryland bridges for ‘all ceramic’ Maryland bridges.

The key to aesthetic success in this case was in the treatment of the lower arch. After removing the lower deciduous incisor and redistributing the space in the lower arch (Fig. 5), a diagnostic wax-up of the proposed final outcome was produced.

The missing incisor was replaced with the bridge, the other lower incisal edges were restored and residual spaces were closed with composite restorations (Figs. 4 and 6). Long-term retention was provided with Vivera retainers.

Multiple challenges were encountered in this case. The key was to set up the positions for the teeth without limiting the patient’s options in the future. Providing a positive aesthetic outcome in a minimally invasive approach was essential for success.

• 

  Fig. 1: Initial Smile

• 

  Fig. 2: Final Smile

• 

  Fig. 3: Initial frontal retracted

• 

  Fig. 4: Final frontal retracted

• 

  Fig. 5: After clear aligner treatment

• 

  Fig. 6: After bridge and composite restorations

• 

  Fig. 7: Clincheck before and after

• 

  Fig. 8: Clincheck before and after

About Align Technology, Inc.
Align Technology designs, manufactures and markets Invisalign, a proprietary method for treating malocclusion that uses a series of clear removable appliances that gently move teeth toward a desired final position. The product line includes Invisalign, Invisalign Teen, Invisalign Lite and Vivera Retainers.

In addition to the Invisalign System, Align Technology makes and markets 3-D digital scanning products and services for orthodontic and restorative dentistry, including the iTero Element intraoral scanner and OrthoCAD software. To learn more about Invisalign or to find an Invisalign-trained orthodontist in your area, visit invisalign.com. For information about the Itero scanner, visit www.itero.com.

Dr Daz Singh graduated from the University of Liverpool in 2005. In 2008 he co-opened a private squat dental clinic in Liverpool city centre called ‘Ollie & Darsh’. It is now one of the leading dental practices in the UK utilizing treatments such as implants, Invisalign, and Six Month Smiles. He has an interest in providing aesthetic, restorative based dentistry which combines orthodontics. He is a Diamond Provider for Invisalign and a Clinical Mentor for Six Month Smiles.