Webinar course: Aligners from A to Z

- The purpose and advantages of individualizing clear aligners and applying adjunctive forces to increase treatment predictability- A variety of applications and uses for adjuncts to aligners such as miniscrew anchorage, the addition of buttons/elastics, and enhancement instruments- Preparation of streamlined process for enhancing the clear aligner treatment planning process to incorporate individualized modifications for each patient- The scope and predictability of clear aligner options- The limitations of clear aligner treatment based on the published literature- When treatment may be going `off-track` with teeth `lagging behind`- Posterior occlusion issues with aligners - The use of miniscrew anchorage with other adjuncts to clear aligners- The rationale behind the use of `boot-strap` mechanics.

Once limitations of clear aligner treatments were identified, conceptualizing techniques to improve the predictability in producing desired results was the next logical step. A variety of concepts, methods, and adjuncts have subsequently been introduced to enhance the efficacy and effectiveness of clear aligners. As a consequence, the scope of biomechanics and type of malocclusions that can be more predictably treated has increased. As one example, the inclusion of miniscrew temporary skeletal anchorage has permitted the addition of direct and indirect anchorage to support and control more predictable programmed tooth movements with aligners. After reviewing the reported shortcomings of plastic aligners, possibilities for improving predictability and effectiveness were suggested.

- Expansion protocols with aligners- Predictable outcomes with clincheck design- The Best attachments on Invisalign First- Mandibular advance and Aligners- Focus on function - Ectopic tooth and aligners

- Indications and contraindications to an aligner treatment of Angle class II adult patients- Protocols for symmetric cases- Protocols for asymmetric cases- The biomechanical foundation of different movements- The biomechanical effects of class II elastics- Limits of aligner treatment and how to overcome them- The most common mistakes in treatment planning and how to avoid them

Class II malocclusion is one of the most frequent orthodontic problems, with a prevalence of about 40% in our population; therefore, the effectiveness of the different therapeutic options is one of the most debated topics in the literature, with the most controversial results.

The purpose of this presentation will be to discuss the rationale of the clear aligner treatment of adult patients with class II malocclusion.

Using an evidence based approach, the relevant literature will be summarized; furthermore, through numerous clinical cases, the bases of the main mechanics used for an efficient sagittal correction in patients with class II division 1, division 2, and subdivision will be discussed step by step.

In particular, the two currently most used staging protocols will be reviewed, namely the distalization, referring to tooth-by-tooth sequential distal movement, or the jump simulation, representing the simulation of the effect of class II elastics.

Finally, the keys to clinical success and the main mistakes to be avoided will be analyzed.

- Reasonable diagnosis and treatment plan for aligner treatment- The use of CBCT in the treatment of complex orthodontic cases- You will be able to efficiently write and revise Clincheck plans- The use of aligners and TADs: detailed protocol. Сlinical cases- Lifehacks in using attachments- Using elastics. An extraordinary approach- Treatment malocclusion and TMJ dysfunction with aligners- Correction common mistakes during aligner treatment- Treatment strategies for complex clinical cases before using aligners- The use of TADs, segmental braces, minor surgeries and bite plate- 12 keys for working with aligners- Сlinical cases

The main mistakes in planning:

- Why don’t the aligners work in the patient’s mouth as on the virtual plan?
- How to avoid physically impossible movements for aligners

Auxiliaries:

- Complex rotation of incisors, canines and posteriors: how to avoid problems at the planning stage, how to rotate different teeth using chains.
- Extrusion. Attachments or buttons and elastics? How to easily extrude teeth for 1mm per week.
- The use of braces, miniscrews, elastics: possible side effects and how to overcome them.

Aligner pliers:

- Strengthening the retention
- Speeding up rotations
- Enhancing tipping and the other movements

Common mistakes when doing an IPR. What to do if you:

- Did not make an IPR on time
- Stripped excessively
- Damaged tooth anatomy

Aligner retention problems:

- Trays do not fit
- When should I do a refinement and can it be avoided?

Avoiding negative effects at the finish:

- Disocclusion in the posteriors
- Sagittal gap
- Incomplete movements
- Loss of angulation
- Loss of torque
- Unwanted intrusion (watermelon seed effect)

- Discover the potentials and limitations of aligner orthodontics- New insights into the biology of orthodontic tooth movement with aligners- Aligner-attachment interaction in controlling complex orthodontic tooth movements: is it enough?- How to reinforce anterior and posterior anchorage in Class II correction- Buccal or lingual attachments in anterior vertical movements?- Optimized vs conventional attachments in the anterior extrusion of upper incisors- Aligner activation required to control the rotation of rounded teeth

- Understand the competitive advantage of using premium clear aligners over traditional systems.

- Several carefully selected clinical cases will be presented to offer a global vision of how to take care of the biomechanical details to achieve exceptional results, not only in terms of tooth alignment and leveling, but also in terms of the reaction of the tooth support tissues:

       - see the evolution of each case with quality records
       - show the keys to correcting problems and solving less predictable movements
       - assess a management of orthodontic mechanics from a very personal, reproducible and proven point of view

Nowadays aligners are becoming more popular in treating malocclusion with more than 5M patients treated by Invisalign system. The Digital records before and after for all these patients allows us to have a precise information about the predictability and the limit of tooth movement.

The challenge remains in the management of complex tooth movement by using the auxiliaries.

During this presentation several patients with deep bite will be discussed and the mechanics used with the aligners will be detailed.

Bone age, Mandibular growth potential, and the severity of malocclusion will determine the therapeutic strategy for growing patients. Indeed, it is the initial orthodontic diagnosis that will determine whether we will correct the class II by a mandibular growth activator, by molar distalization or by dentoalveolar effect. Recently, the integration of the mandibular advancement system into the invisalign aligners has allowed to create a new generation of Mandibular activators. It has many advantages over other activator systems; it allows teeth alignment simultaneously of mandibular activation with perfect vertical control and good stability of the position of the lower incisors.

During this presentation several growing patients with class II malocclusion will be discussed and the mechanics used with the aligners will be detailed.

- Occlusion and the Evolution of the Human Head- Class. II and class III in Homo Sapiens Sapiens- Functional Orthodontic treatment - The Biological Boundaries in the Occlusion Medicine- The Link between Human, Cybernetic System, treatment and Self-esteem- Occlusion and Aligners

- Treatment of complex class II cases- Treatment of complex class III cases- Treatment of complex deep bite cases- Treatment of complex open bite cases- Treatment of complex crowding cases- Treatment with and without extraction