Invisalign versus implant therapy
Every day we are faced with challenging patient cases. Should we extract, file down, build up or move teeth?
But with experience one begins to understand which treatments work, which are too outlandish, and which should never have been started.
When a tooth is destined for removal then the resultant space presents a dilemma for the patient and the dentist.
Should we fill the space, or should we prepare adjacent teeth for a bridge and thereby reduce the life expectancy of these teeth as well.
Restoring a space has evolved from dentures to the use of dental implants and in some cases orthodontics.
It seems logical that if the space is too small to restore then we should try to close the space instead of opening it up for an implant. This option is gentler, quicker and less destructive.
A delightful lady was referred to me for an opinion, on how to restore a failing incisor post crown.
The lady was 60 years of age and in good health. Her brother in law was a dentist and had read one of my articles on Invisalign and hence referred the patient to me for a solution.
She presented as follows:
UR2 lateral incisor had been prepared to bring it into the arch 35 years ago with a metal porcelain post crown.
It was very long and had a tapered crown. The length signified that the tooth must have sat very high labially but would have been short at the incisal edge.
It had a vertical root fracture and was beyond saving. The problem was that the root was still outside the dental arch and the interproximal space was about 3mm.
There was no room for a dental implant so various options were discussed:
As the patient had dental crowding I advised the patient that we could use Invisalgn to:
- Upright the centrals
- reduce the overbite
- correct lateral arch collapse
- correct lower crowding
- close UR2 space
- preserve her natural teeth
The problems that I had were as follows:
Her brother in law removed the UR2 and she came in for impressions.
Invisalign scans were produced and the images are shown as below:
There were 28 upper and 11 lower aligners. The treatment included :
- Arch expansion by derotating 654/456
- Uprighting central incisors
- Intruding upper incisors to reduce overbite and bringing the UR1 closer to UR3
- Intruding lower incisors to flatten occlusal plane
- Derotating UR3 canine mesially towards UR2 space to make it look like an incisor
The patient changed each aligner every 2 weeks and came on Saturdays every 8 weeks for a review.
The space was less noticeable with the aligners in due to the natural reflection of the material.
The patient had no problems in removing the aligners and she started to notice how her smile widened with throughout the treatment.
Once the lower treatment aligners were finished we carried out some minor refinement.
After approximately 15 months the treatment was finished.
You will notice that the UR2 space closed completely and moving the canine mesially maintained an incisive papilla. Lower gum line is even as well. The occlusal photo shows a nicely rounded arch.