Orthodontic aligners treatment: Designing Problems

 

Design 1

1. Segmentation Problems: The treatment plan exhibited significant segmentation

issues.

2. Alignment & Leveling Woes: There were noticeable problems with the alignment and leveling of the upper anterior teeth. This was particularly evident in both the occlusal and submento-vertex views, indicating a need for better planning and execution.

3. Inadequate Arch Shape: The arch shape deviated from the ideal U-shape, which could negatively impact the patient's bite and overall function. This aspect requires immediate attention to ensure proper occlusion.

4. Attachment Issues: The positioning and thickness of attachments were inadequate, particularly on the upper left canine, where the doctor specifically requested no attachment placement. This could lead to ineffective tooth movement and discomfort for the patient.

5. Class III Elastic Mismanagement: The use of Class III elastics on the left side for over three months was a significant oversight. This prolonged application can lead to occlusal canting, complicating the treatment further.

6. Crossbite Correction Fail: Attempting to correct a right-side crossbite without the use of cross elastics and bite raisers is questionable. This approach lacks the necessary support for effective correction.

7. Overjet Concerns: There are issues with overjet, particularly involving collisions between the upper right canine and lateral teeth, as well as interference from the attachment on the lower right canine with the cusp tip of the canine. Additionally, the unevenness observed in the dental submento-vertex view needs to be addressed to prevent further complications.

8. Failure to Achieve Class I Relationships: The treatment plan failed to achieve Class I molar and canine relationships on both sides, especially on the left side, which was a specific goal of the treatment.

9. Excessive Movement Per Aligner: With only 13 aligners, the movement increments exceeded safe limits. This could lead to patient discomfort and compromise the efficacy of the treatment.

10. Simultaneous and Unsynchronized Tooth Movement: There was a lack of synergistic tooth movement, particularly in the lower arch. This could result in inefficient treatment and prolonged duration. Also the movement of posterior and anterior teeth at the same time without staging :

- stage 1 → Posterior teeth movement with correction of cross-bite with the aid

of cross elastics and bite raisers

- stage 2 → anterior teeth movement ( round tripping)

-stage 3 → retraction , midline correction , classiii & ii elastics usage .

11. Restorative Treatment Facilitation: The plan failed to facilitate necessary restorative treatment, including the correction of the overhanging palatal cusp of the upper left second molar and intrusion, as well as the uprighting of the lower right third molar.

12. Midline Deviation: The midline of both the upper and lower arches is deviated,

which needs to be addressed to achieve proper occlusion.

13. Class II Elastic Usage: There was a failure to utilize Class II elastics on the right side as requested to correct the midline and molar and canine relationships, which is critical for achieving the desired treatment outcomes.

14. Rotation of Upper Right Premolars: The questionable rotation of the upper right premolars, combined with improper attachment placement, indicates a lack of space for effective rotation.

Design 2

the treatment plan has several notable differences from Design 1, which impact the overall effectiveness and outcomes:

1. Residual Overjet: The residual overjet is now 3-4 mm, indicating a need for

further correction.

2. Arch Shape Deterioration: The U-shape arch form has worsened, which could

negatively affect the patient's bite and function.

3. Midline Alignment: The midline is now aligned on both the upper and lower

arches, which is a positive change.

4. Canine Relationship: Class I canine relationship was only achieved on the left

side, leaving the right side uncorrected.

5. Molar Relationship: The treatment plan failed to achieve Class I molar

relationships on both sides, which was a specific goal.

6. Proclination of Upper Incisors: There has been proclination of the upper

incisors, which may lead to aesthetic and functional issues.

7. Lack of Cross Elastics and Bite Raisers: Both designs did not utilize cross elastics or bite raisers to correct the posterior crossbite, which is essential for effective treatment.

8. Interdigitation Issues: There is no interdigitation between the upper and lower

anterior teeth, which is crucial for proper occlusion.

9. Precision Cuts: There are no precision cuts on either the right or left side, which

could affect the fit and movement of the aligners.

10. Bottoms on Left Side Only: The bottoms are only present on the left side, which

may lead to uneven forces during treatment.

11. Excessive Upper Right Intrusion: The upper right intrusion is excessive and

cannot be achieved without attachments, also altering the smile arc negative