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Invisalign for the extreme crowded patient

This patient had just recently qualified as a medical doctor and came in from a recommendation.

He did not smile and wanted his teeth straightened. He did not want to have fixed braces either.

Initial presentation:

smile transition through the procedure

Class 1: collapsed posterior segments: moderate upper, severe lower crowding: centrelines were not coincidental.

I agreed that we could try Invisalign as the lower arch was very crowded and that the scans would show if lower extractions were necessary.

The planning was done by me and I wanted to avoid extracting upper premolars because the patient was very conscious of his smile and he did not want prolonged treatment if possible. We agreed 2 lower extractions only of 2 premolars with upper expansion.

Treatment schedule:

The aligners came back as 39 uppers and 29 lowers. The upper arch was expanded and interproximal reduction was carried out at the 2/3rd stages in order to help shift the upper centre line and to reduce interproximal triangular spaces. Lower first premolars were extracted at the beginning.

I saw the patient every 8 weeks for reviews. I checked the aligner fit, attachment activation, contacts and collisions.

After a period of 18 months we took refinement impressions for minor corrections and closing the extraction spaces. There were 7 refinement aligners in total.

Final images

A considerable improvement in the patient’s smile by just removing 2 lower teeth and using Invisalign.

smile transition through the procedure