11/7/2009 EXPAND YOUREXPAND YOUR11/7/2009 1 MINISCREWS (TADS) AND ALIGNERS EXPAND YOUREXPAND YOUR...

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MINISCREWS (TADS) AND ALIGNERS

EXPAND YOUREXPAND YOUR POSSIBILITIES

The statements, views and opinions The statements, views and opinions expressed in thisexpressed in this program and related program and related course materials are those of the course materials are those of the speaker.speaker.Align Technology, Inc. may not Align Technology, Inc. may not endorse such statements, views or endorse such statements, views or opinions. opinions. Attendees are responsible for legal Attendees are responsible for legal and regulatory compliance of any and regulatory compliance of any marketing and referral programs.marketing and referral programs.

Dr. David PaquetteDr. David Paquette

EDUCATION AND TRAINING EDUCATION AND TRAINING Maintains Orthodontic Practice in Charlotte and Mooresville, North CarolinaMaintains Orthodontic Practice in Charlotte and Mooresville, North CarolinaOrthodontic Specialty from Saint Louis University Medical CenterOrthodontic Specialty from Saint Louis University Medical CenterPediatric Dentistry Specialty from University of North Carolina at Chapel HillPediatric Dentistry Specialty from University of North Carolina at Chapel HillBOARD CERTIFICATIONS:BOARD CERTIFICATIONS:American Board of Orthodontics, Diplomate 2001American Board of Orthodontics, Diplomate 2001American Board of Pediatric Dentistry, Diplomate 1985American Board of Pediatric Dentistry, Diplomate 1985HONORSHONORSAAPD Graduate Research Award 1983AAPD Graduate Research Award 1983AAO Milo Hellman Award 1990AAO Milo Hellman Award 1990AAO Milo Hellman Award 1990AAO Milo Hellman Award 1990Member Align Alpha Group 1999Member Align Alpha Group 1999--Present, Clinical Advisory Board 2006Present, Clinical Advisory Board 2006--PresentPresentSpeaker at US and European Invisalign SummitsSpeaker at US and European Invisalign SummitsSpeaker at US and European Damon ForumsSpeaker at US and European Damon ForumsMember Schulman Study Group 2006Member Schulman Study Group 2006Fellow American College of Dentists 2007Fellow American College of Dentists 2007EXPERIENCEEXPERIENCEInvisalign Certified since 1999, over 700 patients treatedInvisalign Certified since 1999, over 700 patients treated

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INTRODUCTION TO MINISCREWS (TADS)( )

What are TADs?What are TADs?((A.K.A. A.K.A. TTEMPORARY EMPORARY AANCHORAGE NCHORAGE DDEVICE “EVICE “TADTAD”)”)

Various Various implants, screws, pins or implants, screws, pins or onplantsonplants placed specifically for the placed specifically for the purpose of providing orthodontic purpose of providing orthodontic anchorage which are removed at theanchorage which are removed at theanchorage which are removed at the anchorage which are removed at the completion of treatmentcompletion of treatment. . The term that I will use is The term that I will use is MiniscrewMiniscrewalthough with patients we call them although with patients we call them pinspins..

Why Use Miniscrews?Why Use Miniscrews?

Orthodontics = Orthodontics = AnchordonticsAnchordontics“In planning orthodontic therapy, it is simply not “In planning orthodontic therapy, it is simply not possible to consider only the teeth whose possible to consider only the teeth whose movement is desired.” movement is desired.” – William R. Proffit

““ToothborneToothborne anchorage is one of the greatest anchorage is one of the greatest limitations of modern orthodontic treatment, limitations of modern orthodontic treatment, because teeth move in response to forces.”because teeth move in response to forces.”– Thomas D. Creekmore

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The idea of using screws The idea of using screws for anchorage is not a for anchorage is not a new idea…new idea…


It was first proposed in 1983! It was first proposed in 1983!

Th t 25 !Th t 25 !That was 25 years ago!That was 25 years ago!

The Possibility of Skeletal Anchorage, Creekmore, TD and Eklund, MK, J Clin Orthod Vol 4 No 4 266 269 1983


“If skeletal anchorage could be applied to orthodontic tooth movement , it might offer capabilities heretofore unavailable. With screws, pins, or some other readily removable implant anchored to the jaws, forces might be applied to produce tooth movement in any direction without detrimental reciprocal forces. Orthopedic

Orthod, Vol 4, No 4, 266-269, 1983forces might be applied directly to the jaws through skeletal anchorage rather than through toothborne anchorage. The need for extraoral forces and the removal of teeth might be greatly reduced.”

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I gave a lecture to both the ORMCO I gave a lecture to both the ORMCO Insiders Group and the South Florida Oral Insiders Group and the South Florida Oral and Maxillofacial Surgery Study Club in and Maxillofacial Surgery Study Club in 1992 on the use of “mini implants” in1992 on the use of “mini implants” in1992 on the use of mini implants in 1992 on the use of mini implants in orthodontics with very little interest.orthodontics with very little interest.


Multiple articles in 2003 by Dr. Park and Multiple articles in 2003 by Dr. Park and colleagues as well as several other colleagues as well as several other Korean orthodontists finally brought Korean orthodontists finally brought miniscrew anchorage into mainstream miniscrew anchorage into mainstream acceptance.acceptance.


And now…And now…

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Conventional Orthodontic Treatment is ruled by Conventional Orthodontic Treatment is ruled by NewtonsNewtons 3rd Law:3rd Law:

ForceForceactionaction == ForceForcereactionreaction

All induce reciprocal tooth movementAll induce reciprocal tooth movementMost of which is unwantedMost of which is unwantedNone of which is completely predictableNone of which is completely predictable


Conventional Orthodontic AnchorageConventional Orthodontic AnchorageExtra OralExtra Oral

HeadgearHeadgearReverseReverse--Pull Headgear (facemask)Pull Headgear (facemask)

Intra OralIntra OralTPATPATPATPANanceNanceLower Lingual ArchLower Lingual ArchElasticsElasticsLip bumpersLip bumpersTweed molar tip backs Tweed molar tip backs

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No conventional anchorage schemes provide No conventional anchorage schemes provide the answer for all these desired orthodontic the answer for all these desired orthodontic movements:movements:•• Molar intrusionMolar intrusion

M l i htiM l i hti•• Molar uprightingMolar uprighting•• Molar mesialization or distalizationMolar mesialization or distalization•• Incisor intrusionIncisor intrusion•• Leveling occlusal cantsLeveling occlusal cants•• Correcting arch asymmetriesCorrecting arch asymmetries•• En masse retractionEn masse retraction


Provides an alternative means to treat a Provides an alternative means to treat a full range of orthodontic cases without full range of orthodontic cases without compensating for the inadvertent compensating for the inadvertent reciprocal movement of adjacent teeth. reciprocal movement of adjacent teeth.

If utilized correctly the net effect should be If utilized correctly the net effect should be the reduction of treatment times though the reduction of treatment times though the use of simplified mechanics.the use of simplified mechanics.


Miniscrews are the most exciting trend in Miniscrews are the most exciting trend in orthodonticsorthodontics

Can now accomplish movements that were Can now accomplish movements that were previously not possiblepreviously not possiblep y pp y pWill significantly reduce number of Will significantly reduce number of surgery casessurgery cases

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The aligner may seem like it is selectively intruding or extruding an gindividual tooth, but it actually puts inverse forces on adjacent teeth.


Here temporary anchorage serves to intrude the 1st molar with no unwanted effect on adjacent teeth. Quickly

d il th li i i and easily, the clinician makes the desired movement without round-tripping or compromise.

Head

Tissue

Eyelet

T l

Miniscrew Anatomy

Neck

Miniscrew threads

Suppression Collar

Cutting Flute

Transmuccosal Collar

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MiniscrewsMiniscrews

Most miniscrews are selfMost miniscrews are self--t i d lft i d lf d illi td illi ttapping and selftapping and self--drilling to drilling to virtually eliminate the virtually eliminate the need for pilot drilling or need for pilot drilling or tissue punches.tissue punches.

MiniscrewsMiniscrews

Variable length Variable length transmucosaltransmucosal collars collars help to minimize chancehelp to minimize chanceof infectionof infectionTissue suppressionTissue suppressionTissue suppression Tissue suppression collar minimizes tissue collar minimizes tissue overgrowthovergrowth

Thread Thread formingforming

Ideal for areas of thinner bone

Thin bone expands with ‘hoop stress’ to allow threads to purchase

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Thread Thread cuttingcutting

Ideal for areas of thicker, denser bone

Cutting Flute

More dense bone cannot expand, so cutting is required to clear away bone

Design of MiniscrewsDesign of Miniscrews

Screw Head DesignsScrew Head Designs

Miniscrew heads have various designs, either to hold archwires or to engage off-the-shelf springs or elastics.

Uni

tek-

Imte

c

GA

C –

Qua

ttro

Den

taur

um –

TOM

AS

RM

O –

Dua

l-Top

Lanc

er -

OA

SI

Med

icon

–A

arhu

s

Med

icon

–A

arhu

s

OR

MC

O-v

ecto

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1 M ill f i l f

1

5

3

The VectorTAS Atlas eliminates guesswork by matching the color-coded miniscrews to the ideal anatomical andbiomechanical implant site.Atlas accounts for bone type, bone density and tissue depth.

1. Maxillary facial surface2. Mandibular alveolar ridge

(mesial to cuspid)3. Maxillary facial & lingual surface

/ mandibular alveolar ridge (mesial to 2nd molar)

4. Mandibular retromolar area5. Infrazygomatic crest

4

2

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Color Diameter Collar Tip Recommended Implant Site(s)

1.4mm 1.0mmThread forming

Maxillary facial surface / mandibular alveolar

ridge (mesial to cuspid), mandibular symphysis

1.4mm 1.0mm Thread forming

Maxillary facial & lingual surface / mandibular

alveolar ridge (mesial to 2nd molar)

Summary Table

2nd molar)

2.0mm 2.0mm Thread cutting

Retromolar area

2.0mm 2.0mm Thread cutting

Infrazygomatic CrestAnd Temporary tooth

replacement

PROFOUND PETPRILOCAINE 10%LIDOCAINE 10%TETRACAINE 4%PHENYLEPHRINE 2%

www.stevensrx.com714-540-8911

MadaJet™ XLNeedle-free anesthetic delivery

Needle-less injector for pain-free comfort!

Eliminates disposal and safety concerns typically associated with conventional syringes

Consistent injection volume (0.1 cc) ensures reliable depth penetration

4.0 cc cartridge size for up to 38 injections with single loading

Interchangeable Extenda Tips for easy sterilization

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Syrijet Mark II NeedleSyrijet Mark II Needle--Free InjectorFree Injector

NeedleNeedle--less injector for painless injector for pain--free comfort!free comfort!

Eliminates disposal and safety concerns typically Eliminates disposal and safety concerns typically associated with conventional syringesassociated with conventional syringes

Accepts any standard 1.8 cc anesthetic cartridge, Accepts any standard 1.8 cc anesthetic cartridge, with dosages adjustable from .00 to .20 cc for deep with dosages adjustable from .00 to .20 cc for deep anesthetic penetrationanesthetic penetration

Easy, rapidly repeatable injections facilitate patient Easy, rapidly repeatable injections facilitate patient anesthetization quickly and efficientlyanesthetization quickly and efficiently

Cushioned conical head permits approximation of Cushioned conical head permits approximation of injection site for maximum patient comfortinjection site for maximum patient comfort

Unbroken sterility from cartridge to orifice ensures Unbroken sterility from cartridge to orifice ensures patient safetypatient safety

Simple to clean with water cartridges used to flush Simple to clean with water cartridges used to flush the inner chamber prior to autoclavingthe inner chamber prior to autoclaving

MadaJet/Syrijet ComparisonMadaJet/Syrijet ComparisonMadaJet Syrijet

Injection Dosage Non-variable: 0.1cc Variable: .00-.20cc

Cartridge Size 4.0cc (38 injections with single loading)

Standard 1.8ccSealed ampoule

Volume Trapped air may increase volume Less tendency for trapped air; lower volume

Ergonomics Hold like a syringe Hold like a hammer for more secure grip

Contra Angle Slight angulation Greater angulation smaller tipContra Angle Slight angulation Greater angulation, smaller tip

Depth Penetration 2 to 2.5mm below epithelium 2 to 2.5mm below epithelium

Sterilization Procedure

Autoclave Autoclave

Package Contents

MadaJet, two ½” Extended Tips, holder, wrench, stylets, two extra pyrex fill chambers, case, disinfectant/cleaner

Syrijet, two rubber caps, three water vials, CD with demo

Is it really that easy?Is it really that easy?

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Miniscrew FailureMiniscrew FailureMiniscrew FailureMiniscrew Failure

Reducing TAD failuresReducing TAD failures

Choose correct length and diameterChoose correct length and diameterRinse with Rinse with chlorhexidinechlorhexidine prior to prior to insertioninsertionBrush with Brush with chlorhexidinechlorhexidine until screw until screw removalremoval

STEADY HANDSTEADY HAND

STEADY HANDSTEADY HAND

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ContraContra--Angle DriverAngle Driver

Easy access to hardEasy access to hard--toto--reach reach areas.areas.Includes two 22 mm universal tips, Includes two 22 mm universal tips, which can also be used in Straight which can also be used in Straight Driver. Driver. Rotating knob on driver helps Rotating knob on driver helps clinician prevent “grip and clinician prevent “grip and release,” maximizing screw release,” maximizing screw performance and preventing performance and preventing failure.failure.

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Brush with 0.12% chlorhexidineBrush with 0.12% chlorhexidine

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4%4%--6%6%4%4% 6%6%

What predisposes miniscrews to What predisposes miniscrews to fail?fail?

“Wallowing out” opening on insertion “Wallowing out” opening on insertion causing inadequate primary cortical causing inadequate primary cortical stabilitystabilityMiniscrew inserted too close to gingivalMiniscrew inserted too close to gingivalMiniscrew inserted too close to gingival Miniscrew inserted too close to gingival crestcrestPatient nonPatient non--compliancecompliance

Stay below gingival crestStay below gingival crest

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ComplicationsComplicationsComplicationsComplications

PainPainRemember the separator effectRemember the separator effectIf OTC’s don’t relieve pain, evaluateIf OTC’s don’t relieve pain, evaluateBe aware ofBe aware of periperi miniscrew tissuesminiscrew tissuesBe aware of Be aware of periperi--miniscrew tissuesminiscrew tissues

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Post impingement sequelaePost impingement sequelae

Up to 2mm of denudation (including cementum) will be repaired with new attachment –Tsukiboshi M: Autotransplantation of Teeth, Chicago, 2001, Quintessence

Ankylosis becomes more prevalant in areas of PDL damage greater than 4mm

Fabbrioni and colleagues – Int Journ Oral Max Surg2004232 intermaxillary fixation screws placed

Post removal contact assessed radiographically

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26 screws (11.2%) had major contacts37 screws (15.9%) had minor contactsOf all contacts, majorminor contactsOf all contacts, major and minor, only one tooth required RCT

Borah and Ashmead – Journ Plas Recon Surg1996Over 2300 miniscrews in 281 patients studiedIncidence of impingement per screw wasstudiedIncidence of impingement per screw was 0.41%NO impinged teeth developed PA abscesses or needed RCT

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ConclusionOur results show that contact between a dentalroot and a drill, screw, or both causes resorptiveroot damage. After discontinuation of the contact,however, repair begins to occur through the depositionof cellular cementum.

P i d ll d d i iPoggio and colleagues recommended a minimumclearance of 1mm between a miniscrewand a root for both periodontal health and mini -screw stability. Therefore, it can be concluded thatminiscrews with a diameter of 1.5mm or less aresafe for interradicular insertion if the space betweenthe roots is at least 3.5mm.

BisphosphonatesBisphosphonates

Oral bisphosphonate use and the prevalence of osteonecrosis of the jaw An institutional inquiry - JADA 2009;1401):61-66.Parish P. Sedghizadeh, DDS, MS, Kyle Stanley, BS, Matthew Caligiuri, BA, Shawn Hofkes, BS, Brad Lowry, BS and Charles F. Shuler, DMD, PhDBackground.

Initial reports of osteonecrosis of the jaw (ONJ) secondary to bisphosphonate (BP) therapy indicated that patients receiving BPs orally were at a negligible risk of developing ONJ compared with patients receiving BPs intravenously. The authors conducted a study to address a preliminary finding that ONJ secondary to oral BP therapy with alendronatesodium in a patient population at the University of Southern California was more common than previously suggested.

Methods. The authors queried an electronic medical record system to determine the number of patients with a history of alendronate use and all patients receiving alendronate who also were receiving treatment for ONJ.

Results. The authors identified 208 patients with a history of alendronate use. They found that nine had active ONJ and were being treated in the school’s clinics. These patients represented one in 23 of the patients receiving alendronate, or approximately 4 percent of the population.

Conclusions. This is the first large institutional study in the United States with respect to the epidemiology of ONJ and oral bisphosphonate use. Further studies along this line will help delineate more clearly the relationship between oral BP use and ONJ.

Clinical Implications. The findings from this study indicated that even short-term oral use of alendronateled to ONJ in a subset of patients after certain dental procedures were performed. These findings have important therapeutic and preventive implications.

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Oral Bisphosphonate-Induced Osteonecrosis: Risk Factors, Prediction of Risk Using Serum CTX Testing, Prevention, and TreatmentRobert E. Marx, DDS,* Joseph E. Cillo, Jr, DDS, andJuan J. Ulloa, DDS

Purpose: To assess the risk and time course of oral bisphosphonate-induced osteonecrosis of the jaws.Materials and Methods: Detailed data from 30 consecutive cases were compared with 11 6 cases dueto intravenous aminobisphosphonates.

Results. Results in part noted a higher incidence related to alendronate (Fosamax; Merck, WhitehouseStation, NJ), a 94.7% predilection for the posterior mandible, and a 50% occurrence spontaneously, withthe remaining 50% resulting from an oral surgical procedure, mostly tooth removals. Just over 53% ofpatients were taking their oral bisphosphonate for osteopenia, 33.3% for documented osteoporosis, and13.4% for steroid-induced osteoporosis related to 4 or more years of prednisone therapy for anautoimmune condition. There was a direct exponential relationship between the size of the exposedb d th d ti f l bi h h t Th l di t l ti b t tbone and the duration of oral bisphosphonate use. There was also a direct correlation between reportsof pain and clinical evidence of infection. The morning fasting serum C-terminal telopeptide (CTX) testresults were observed to correlate to the duration of oral bisphosphonate use and could indicate arecovery of bone remodeling with increased values if the oral bisphosphonate was discontinued. Astratification of relative risk was seen as CTX values less than 100 pg/mL representing high risk, CTXvalues between 100 pg/mL and 150 pg/mL representing moderate risk, and CTX values above 150 pg/mLrepresenting minimal risk. The CTX values were noted to increase between 25.9 pg/mL to 26.4 pg/mLfor each month of a drug holiday indicating a recovery of bone remodeling and a guideline as to whenoral surgical procedures can be accomplished with the least risk. In addition, drug holidays associatedwith C'IX values rising above the 150 pg/mL threshold were observed to correlate to either spontaneousbone healing or a complete healing response after an office-based debridement procedure.Conclusions: Oral bisphosphonate-induced osteonecrosis is a rare but real entity that is less frequent,less severe, more predictable, and more responsive to treatment than intravenous bisphosphonateinducedosteonecrosis. The morning fasting serum C-terminal telopeptide bone suppression marker is auseful tool for the clinician to assess risks and guide treatment decisions.

2007 American Association of Oral and Maxillofacial SurgeonsJ Oral Maxillofac Surg 65:2397-2410, 2007

Case PresentationsCase Presentations

Important Note: Many of the attachments used to treat these cases do not reflect Align Technology’s latest set-up protocols and were used for testing purposes. Please refrain from requesting these attachments for future treatments.

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Vertical AsymmetryVertical Asymmetryy yy y

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Anterior Open BiteAnterior Open Bitepp

Anterior Open BiteAnterior Open Bite

Traditionally required Traditionally required surgerysurgery

Allows mandible to Allows mandible to autorotateautorotate, , thereby decreasing anterior facial thereby decreasing anterior facial heightheightheightheightRisk of postoperative morbidity and Risk of postoperative morbidity and high costhigh cost

Alternatives: MEAW treatment, HPHG with comprehensive orthodontics, posterior bite plates, magnets on opposing arches, anterior tooth extrusion, jaw surgery– Adverse side effects– Stability issues

Treatment Using MiniscrewsTreatment Using MiniscrewsAchieves results similar to surgery without the risks and high costAchieves results similar to surgery without the risks and high cost

Intrudes posterior teeth, allowing the mandible to autorotate and Intrudes posterior teeth, allowing the mandible to autorotate and close biteclose bite

Miniscrews may be used to retain intrusion and correct any Miniscrews may be used to retain intrusion and correct any discrepancies without typical extrusive dental side effectsdiscrepancies without typical extrusive dental side effects

Anterior Open BiteAnterior Open Bite

Can use Open-Bite Splint for posterior intrusion :– Force of Ni-Ti coils– Pressure of tongue on 2

transpalatal bars– Pressure of bite on acrylic

covering occlusal surface

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Anterior Open Bite

The following is a patient treated only with screws and braces, no open bite splint. It is important to note that this patient could easily be treated in exactly the samebe treated in exactly the same manner with aligners and miniscrews and no fixed appliances.

StephaniaStephaniaCl II, Open bite, TMDCl II, Open bite, TMD

4-6-06

StephaniaCl II, Open bite, TMD

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StephaniaStephaniaCl II, Open bite, TMDCl II, Open bite, TMD6 months progress6 months progressMini screws placedMini screws placed

facial and lingualfacial and lingual

If I were treating her now I would simply have her wear the aligner with the elastic from screw to screw over top of the aligner. I will demonstrate this with another patient shortly.

11-1-06

StephaniaCl II, Open bite, TMD

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Miniscrews for posterior Miniscrews for posterior intrusionintrusion

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Miniscrews for posterior Miniscrews for posterior intrusionintrusion

Molar UprightingMolar Uprightingp g gp g g

Molar UprightingMolar UprightingDirectDirect

POSITIONIn retromolar region immediately distal to tipped second molar. Such placement maintains rotational control.

Att h il i f th i i t Attach coil spring from the miniscrew to the cleat/button bonded to the molar as mesial as possible.

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Molar UprightingMolar UprightingIndirectIndirect

Indirect setup addresses situations of difficult access to retromolar region due to anatomy or presence of third molars

POSITION

Immediately mesial to anchor tooth.

Vertical Problem with Ankylosed Vertical Problem with Ankylosed CanineCanineCanineCanine

Impacted CanineImpacted Canine

POSITIONIn appropriate position in lower arch to create correct direction of arch to create correct direction of force application.

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DCDC 40y2mInitial

Cl I Cl I Prior treatmentPrior treatmentOcclusal cant up on rightOcclusal cant up on rightAnkylosed upper right canineAnkylosed upper right canine

DC 40y2mPretreatment

Ankylosed upper right canineAnkylosed upper right canine

Combination TreatmentCombination Treatment

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DC 40y2m

DCDC40y9mRefinement

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DC 41y1m

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DC 40y10mDC 40y10mProgressCanine remobilizedMini screw placed

DC 41y7mProgressProgress

DC41y9mFinal

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DC: Treatment Summary


InvisalignInvisalign6 aligners upper only6 aligners upper only16 weeks16 weeks5 visits5 visits

Case refinementCase refinement11 aligners11 aligners40 weeks40 weeks


16 visits16 visitsExtrusion buttons #6 with mini screwExtrusion buttons #6 with mini screw

28 weeks (included above)28 weeks (included above)14 visits (included above)14 visits (included above)

Total active treatmentTotal active treatment15 months15 months21 visits 21 visits

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Class II CorrectionClass II Correction

EMEM 39y9mInitial

Class II Correction

ClCl II sub II sub leftleft

EM 39y9mPretreatment

Slight crowdingSlight crowdingUpper midline to rightUpper midline to rightPost left Post left crossbitecrossbiteCongenitally missing #10Congenitally missing #10Peg #7Peg #7

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PlacedPlaced miniscrewminiscrew

EM 39y9mPretreatment

Placed Placed miniscrewminiscrewretromolarretromolar area distal area distal to #15. Placed chains to #15. Placed chains from buttons facial from buttons facial and lingual #14 to and lingual #14 to miniscrewminiscrew..



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EM 39y9m

EM 39y9m

EM40y9mRefinementRefinement

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EM 40y9m

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EM 40y9m

EM 41y2mProgress

22 months progress22 months progress

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22 months progress

22 months progress

EM 41y6m3 months fixedProgress

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EM 43y0m12 months post

EM: Treatment Summary

InvisalignInvisalign with with miniscrewminiscrew-- 18 18 alignersaligners-- 44 44 weeksweeks-- 6 visits6 visits

Extrusion buttons #11Extrusion buttons #11-- 6 weeks6 weeks

2 visits2 visits-- 2 visits2 visitsCase refinement with Case refinement with miniscrewminiscrew

-- 20 20 alignersaligners-- 38 38 weeksweeks-- 7 7 visitsvisits

Segmental AppliancesSegmental Appliances-- 18 weeks18 weeks-- 3 visits3 visits

Total Total active treatmentactive treatment-- 25 25 monthsmonths-- 18 18 visits visits

Class II CorrectionClass II Correction

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MSInitial

Cl II

MS 36y5mPretreatment

Slight lower crowding

Missing UL Central

Midlines off


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MSRefinement



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MS 38y7mMS 38y7m Placed Miniscrew

MS 38y9m 6 weeks6 weeks

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MS 39y0m

CG 33y0mI iti lInitial

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Cl II sub right

CG 33y0mPretreatment

g

Slight crowding

Anterior open bite

Upper midline to left

CG 33y0m Carriere and miniscrew

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CG33y3m Ready for InvisalignReady for Invisalignimpressions

12 weeks with Carriere, miniscrew and elastics

Distalizer removed, training aligners placed, note continued elastic to miniscrew

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CGCG34y0m 34y0m Invisalign #18Invisalign #18Invisalign #18Invisalign #18

TI 40y0mI iti lInitial

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TI 33y0mCarriere and miniscrew

Class II div 2 deep biteClass II div 2 deep bite

C SC SCourtesy Dr. John M. SparagaCourtesy Dr. John M. Sparaga

Class II Division 2 Deep BiteClass II Division 2 Deep Bite

1/31/2007, Initial, YR. 40 MO. 0

F. Scott

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Division 2 CorrectionDivision 2 Correction

F. Scott

Intrusive TADs 7/3/07Intrusive TADs 7/3/07

7/3/2007, Micro Screws, YR. 40 MO. 5

F. Scott

TADs 12/20/07TADs 12/20/07

F. Scott

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10 Months MX Intrusion10 Months MX Intrusion

July 07July 07 May 08May 08

F. Scott

Intrusion ProgressIntrusion Progress

F. Scott

TAD Elastic AttachmentTAD Elastic Attachment

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Hook FormerHook Former-- Essix Essix

Hook Former in ActionHook Former in Action

#806314041524 Braessler#806314041524 Braessler

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Instant TorchInstant Torch

Instant ThermometerInstant Thermometer

Molar SupereruptionMolar Supereruption

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LB36y5mPretreatment

Supererupted upper molars

LB 36y5mPretreatment

U & L spacing

Missing multiple teeth

Midlines off

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LB 36 5LB 36y5mMiniscrews in

place

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LB FinalLB Final

TTemporary emporary TTooth ooth RReplacementeplacement

Camille Initial

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Note both upper lateral incisors congenitally missing

Screws placed

Final

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To obtain your CE certificate for this program please To obtain your CE certificate for this program please complete a brief survey at:complete a brief survey at:

www.AligntechInstitute.com/asksurvey

Upon completion of your survey* you will have immediate access to your CE certificate.

*This survey is only available to the participants who attend the “live” presentation via the webinar/phone. Participants who complete the archived program on AligntechInstitute.com need to complete a CE test to obtain their CE certificate.

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MINISCREWS (TADS) AND ALIGNERS

EXPAND YOUR

Thank youEXPAND YOUR POSSIBILITIES

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11/7/2009 EXPAND YOUREXPAND YOUR11/7/2009 1 MINISCREWS (TADS) AND ALIGNERS EXPAND YOUREXPAND YOUR...

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