case presentation TAT

8/7/2019 case presentation TAT

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DP303DP303

Theme ETheme EEsthetic and functionalEsthetic and functional

occlusal considerations for occlusal considerations for restorative patientsrestorative patients

Case 1Case 1

Tye ThompsonTye Thompson


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M ain questions to beM ain questions to be

answered:answered:Will orthodontic treatment solve her estheticWill orthodontic treatment solve her estheticcomplaints?complaints?Is orthodontic treatment justified in a blindIs orthodontic treatment justified in a blind

person?person?

Would you also recommend bleaching of her Would you also recommend bleaching of her teeth since she voiced that her husband is alsoteeth since she voiced that her husband is alsoconcerned about her teeth getting more crookedconcerned about her teeth getting more crooked

What is the problem list and goals?What is the problem list and goals?Does this treatment require a referral to anDoes this treatment require a referral to an

orthodontist or would a general dentist who doesorthodontist or would a general dentist who doesInvisalign treat her with Invisalign?Invisalign treat her with Invisalign?

How long would orthodontic treatment takeHow long would orthodontic treatment takeapproximately?approximately?

Would recommending porcelain laminates as aWould recommending porcelain laminates as abetter and quicker solution for her?better and quicker solution for her?


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Subjective

Subjective

ID: 45 Y.O. FemaleID: 45 Y.O. FemaleCC: M y bottom teeth are fairly crookedCC: M y bottom teeth are fairly crookedand my top teeth are a little crooked and Iand my top teeth are a little crooked and Iwould like them straightenedwould like them straightenedM H: Patient is 95% blind (occurred 10M H: Patient is 95% blind (occurred 10years ago), no current medications, andyears ago), no current medications, andhas not been hospitalized in the last 5has not been hospitalized in the last 5years.years.DH: S he had orthodontic treatment as anDH: S he had orthodontic treatment as anadolescent and has noticed her teethadolescent and has noticed her teethbecoming more crooked since then andbecoming more crooked since then andsince becoming blind can feel with her since becoming blind can feel with her tongue that her teeth are more crookedtongue that her teeth are more crookedeven though she cannot actually seeeven though she cannot actually seethem anymore.them anymore.


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ObjectiveObjectivePE: Free of T M DPE: Free of T M D

Perio: Negative for periodontal diseasePerio: Negative for periodontal disease

XRAY: WNLXRAY: WNL

HTE: carries freeHTE: carries freeExisting dental work (All WNL)Existing dental work (All WNL)

#2 M O alloy#2 M O alloy#3 M O + L alloy#3 M O + L alloy#4 M O alloy#4 M O alloy#9 RCT, post, PF M#9 RCT, post, PF M#13 M O alloy#13 M O alloy#14 O alloy#14 O alloy#15 O alloy#15 O alloy#18 DO alloy#19 O alloy#30 M OD alloy#31 M OD alloyComposite ??? Doesnt look like it


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PrePre--TxTx


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PrePre--TreatmentTreatment


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AssessmentAssessment

M olar M olar classification:classification:Class 1 (bilateral)Class 1 (bilateral)CanineCanine

classification:classification:Class 1 (bilateral)Class 1 (bilateral)OJ:OJ: ~~3mm3mmOB: 10%OB: 10%- - 15%15%


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PrePre--TreatmentTreatment


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PrePre--TxTx

M idline shift to the leftM idline shift to the left ~ 2mm~ 2mmUneven gingival margins/ incisalUneven gingival margins/ incisal

edges.edges.


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Convex profile =Convex profile =Class II S keletalClass II S keletalrelationship (deficientrelationship (deficientM ax or M an)M ax or M an)

mild lip strainmild lip strain


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Lower anterior Lower anterior crowdingcrowding


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Plan/ProcedurePlan/Procedure

PROBLE M LIS TPROBLE M LIS T-- patients ccpatients cc M y bottom teeth are fairlyM y bottom teeth are fairly

crooked and my top teeth are a littlecrooked and my top teeth are a littlecrooked and I would like themcrooked and I would like themstraightenedstraightened

-- midline deviationmidline deviation ~ 2mm~ 2mm

-- anterior crowdinganterior crowding-- convex profileconvex profile-- uneven gingival marginsuneven gingival margins


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G OALSG OALS

-- improve esthetics whileimprove esthetics whilepreserving/improvingpreserving/improving functionfunction-- address anterior crowdingaddress anterior crowding

-- happy patienthappy patient


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S equencing TxS equencing TxEE BBEstheticsEstheticsFunctionFunction

S tructureS tructureBiologyBiology

We choose this sequence because theWe choose this sequence because the

decisions made in each category, especiallydecisions made in each category, especiallyesthetics, will directly affect the decisions madeesthetics, will directly affect the decisions madein the categories that are assessedin the categories that are assessedsubsequently. S peerssubsequently. S peers


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EstheticsEstheticsIncisal edgeIncisal edge -- gingival positions/ relationshipgingival positions/ relationship-- Place a crown on #8 for more cemetricalPlace a crown on #8 for more cemetricalappearance. (Possible to do Lavas on 8 & 9)appearance. (Possible to do Lavas on 8 & 9)

UnevenG

ingival marginsUnevenG

ingival margins- - perio surgery (crownperio surgery (crownlengthening or orthodontic intrusion possibility)lengthening or orthodontic intrusion possibility)

M idlineM idline ~2mm to the left~2mm to the left midline corrections of midline corrections of less than 1mm can frequently be corrected withless than 1mm can frequently be corrected withselective IPR. BPPselective IPR. BPP

-- deviations of up to 3deviations of up to 3- -4mm are not noticed by4mm are not noticed bylay people if the long axis of the teeth are parallellay people if the long axis of the teeth are parallelwith the long axis of the face. Spearswith the long axis of the face. Spears


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EstheticsEstheticsCrowdingCrowding Expand arch G enerally the broader archExpand arch G enerally the broader archform is mor estheticbucal corridors are minimized.form is mor estheticbucal corridors are minimized.BPPBPP

-- IPR if needed (irreversible) note: depending onIPR if needed (irreversible) note: depending onperio status. Dont want thin gingiva, long clinical crowns,perio status. Dont want thin gingiva, long clinical crowns,or recession.or recession.

Color Color (bleaching?) tooth whitening should be part of the(bleaching?) tooth whitening should be part of the

first 1first 1--2 aligners before attachments are placed. BPP2 aligners before attachments are placed. BPP

note (10% Carbamide peroxide for sensitive patientsnote (10% Carbamide peroxide for sensitive patientsand 30% for others)and 30% for others)


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FunctionFunction

Patient presents bilateral Canine andPatient presents bilateral Canine andmolar Class I and presents with no T M Dmolar Class I and presents with no T M D


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Who?What?When?Who?What?When?

Using fixed appliances, aligners, or just fixedUsing fixed appliances, aligners, or just fixedrestorations?restorations?

What should be done?What should be done?


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InvisalignInvisalign

Conservative approachConservative approachM any patients will only haveM any patients will only havecomplaints about thecomplaints about the

appearance of their anterior appearance of their anterior teeth. These patients can beeteeth. These patients can beegood candidates for aligner good candidates for aligner treatment if there is antreatment if there is anacceptable posterior acceptable posterior occlusion. Boydocclusion. Boyd

Patient is in Class IPatient is in Class IHad orthodontic tx in youth =Had orthodontic tx in youth =Higher patient acceptance andHigher patient acceptance andcompliance with Aligner.compliance with Aligner.


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InvisalignInvisalignPeriodontal health canPeriodontal health canimprove duringimprove duringorthodontic treatmentorthodontic treatmentusing the Invisalignusing the Invisalign

system because patientssystem because patientscan remove aligners tocan remove aligners tobrush and floss normally.brush and floss normally.BoydBoydPatientsinvariablyPatientsinvariablyspent more time cleaningspent more time cleaningand brushing the inside of and brushing the inside of their aligners to keeptheir aligners to keepthem invisible. Boydthem invisible. Boyd


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Who should render treatment?Who should render treatment?

The orthodontist?The orthodontist?


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Who should render treatment?Who should render treatment?

Or the general dentistOr the general dentist

Class II & III correctionsClass II & III correctionsare considered difficultare considered difficultmovements and are notmovements and are notrecommended for arecommended for ageneral dentist. BPPgeneral dentist. BPPPatient is in Class IPatient is in Class I


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The G P can do it!The G P can do it!ROCK ON!ROCK ON!


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How long will Tx take?How long will Tx take?

S tandard movement = .25mm per trayS tandard movement = .25mm per trayWe need 6We need 6- -7 mm movement to relieve7 mm movement to relieve

crowding.crowding.2 weeks per tray2 weeks per tray== ~ 50 weeks (about 1 year)~ 50 weeks (about 1 year)

Not including refinement.Not including refinement.


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But she is BlindBut she is Blind

S o why go through tx ?S o why go through tx ?

S he cant see her teeth anyway Right?S he cant see her teeth anyway Right?


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ReferencesReferencesBoyd R.L., Oh H.,Fallah M .,Vlaskalic V. An update onBoyd R.L., Oh H.,Fallah M .,Vlaskalic V. An update onpresent and future considerations of aligners. 2006present and future considerations of aligners. 2006Boyd R.L., Improving Periodontal health throughBoyd R.L., Improving Periodontal health throughinvisalign treatment. 2005invisalign treatment. 2005Boyd R.L., Best Practices Protocal. 2006Boyd R.L., Best Practices Protocal. 2006Proffit W.R., Contemporary orthodontics 3Proffit W.R., Contemporary orthodontics 3 rdrd editionedition--S pear F. M ., Kokich V. G ., M atthews D.P.,S pear F. M ., Kokich V. G ., M atthews D.P.,Interdisciplinary Management of Dental EstheticsInterdisciplinary Management of Dental Esthetics . 2006. 2006

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