Question for DrTam

[Wobblydeb]

Hope you don't mind answering a direct question, but I'm interested in how you would deal with a tooth requiring rotation and extrusion that wasn't responding well to the original Invisalign plan?

Many thanks!

[DrJasonKTam]

Hi Wobbydeb

I don't mind posting responses but I'm not sure this is the way to use the forum. I would prefer that any future new posts be directed to everyone on the board, rather than specifically to me. It is very difficult to comment on specific clinical situations. Hope you can understand. That being said, I'll try to answer your question :).

Consider the following reasons why teeth aren't responding well:
1. Poor compliance with wear.
2. Improper treatment planning (order of movement, attachments, etc).
3. May require fixed braces (ie, not suitable for Invisalign)
4. There is inadequate space for the tooth to move.
5. Rotations and extrusions need to be treated with button auxiliaries and elastics.
6. The tooth is difficult to move and it's expected that mid-course correction or refinement will be necessary.

Assuming everything is being done properly by the patient and doctor, we're looking at situations 5 and 6. We would likely attempt rotation and extrusion using elastics and buttons. Sometimes power chains are required with the buttons to help rotate teeth (in a manner similar to fixed braces). In fact, sometimes sectional braces are required to allow the use of Invisalign.

If the aligners are not fitting properly and the patient would benefit from new trays, we would take new impressions.

Hope this helps!

[Wobblydeb]

I understand what you mean about specific questions. However, thanks very much for the response - I promise I won't ask any more!