Diastema closure using Invisalign and composites

This entry was posted on Thursday, December 14th, 2017 is filed under Uncategorised.
RHONA ESKANDER uses the Invisalign system as part of her inter-disciplinary approach.

As a GDP we are constantly meeting patients who want to undergo aesthetic dental treatment. The patient’s chief complaints were:

  1. Gap in upper teeth
  2. Lower crowded incisors
  3. Broken lower left molar

The patient was medically fit and well, brushed twice daily without interdental aids. He presented with carious LL6, prominent frenulum, asymptomatic UL1.

An orthodontic assessment  was carried out and the following was noted: Skeletal Class I, average FMPA, average LAFH, competent lips, mild Class III molar relationship on the right hand side, Class I molar relationship on the left hand side, Class I canines on both sides.

The upper centreline was coincident with the face, the lower midline shifted to the left. Incisors were Class I. The overbite was normal, the overjet was increased. Upper incisor crowding was 2mm whilst lower incisor crowding was 3mm

PHASE 1

The LL6 was restored by the patient’s existing dentist. UL1 was root treated and after two months internal bleaching was commenced by using 6% H202 at six-hour intervals by the so called inside/outside bleaching technique. Two visits to the hygienist were arranged to optimise plaque control.

PHASE 2

Treatment planning was based on alignment and retraction of the lower anterior teeth to allow uprighting and diastema closure on the upper teeth. Midway through treatment, the frenectomy was carried out using a diode laser.

 

Clincheck plan (Initial)
Clincheck (After)

PHASE 3

Following alignment of the lower teeth it was noted that the overjet was sufficient, taking into account the envelope of function and avoiding incisal interferences.

After Invisalign

PHASE 4

Having assessed the proportions of the teeth, the need for composite resin bonding had already been anticipated. The upper centrals were treated and a mock-up restoration was made. The teeth were isolated with opragate. The facial enamel was bevelled with a course Soft Lex disc (3M Espe) and the interproximal contact points using a metal finishing strip (Komet).

The interproximal walls were built up with Venus pearl shade b1 using a curved posterior matrix strip CL translucent enamel was placed on the incisal edge. The final layer was placed over the surface and the restoration cured under an oxygen barrier.

Before Invisalign
After Invisalign and restorations

RETENTION

Upon ensuring sufficient occlusal clearance, a fixed retainer was bonded on the upper arch.

The wires used were multi-strand stainless steel wire. An indirect retainer was made by sending polyvinyl silicone impressions sent to the lab. The wire was transferred to the teeth using a specially made jig and bonded using flowable composite.

The flexibility of the arch wire allows for physiological tooth movement and prevents bond fracture through occlusal forces. Periodontal ligament stability is also achieved with this technique. In my experience, a combination of fixed and removable retainers gives additional security for retention.

Fact File

Dr Eskander graduated from Leeds University in 2010 and completed her vocational training in a practice in Kent. She was titled Best Young Dentist in 2016/2017 at the prestigious dentistry awards. She has been shortlisted for several awards and also won an award at the 2017 Aesthetic Awards (botulinum toxin category). Rhona is a Diamond Provider for Invisalign and also a key opinion leader for Philips.