EXPERT VIEW - Tomás Salazar's "pearl"

Here is a “Pearl” from one of the Aligner “greats”: Facial AESTHETICS and Orthodontic Treatment

Dr. Tomás Salazar

Orthodontic approach to facial aesthetics has changed over time, generating a paradigm shift regarding the importance of soft tissue over hard tissue management.
Cephalometrics aid the orthodontist in the understanding of aetiology of malocclusions and gives us some insight on developing a treatment plan, nevertheless, many times the facial profile of the patient points us in another direction.

This discrepancy can be seen many times in mouth breathers: generally, they present a skeletal Class II with a clockwise rotation of the mandible accompanied by anterior open bite or lack or overbite, increased overjet, molar and/or canine class II, and difficulty for lip closure.

Treatment planning in these cases becomes crucial in order to achieve an optimal occlusion without compromising soft tissue aesthetics.

C.M. is a 27 years old female patient whose diagnosis reveals all the mouth breather characteristics named above. Her main goal was to achieve a correct incisor crown inclination without retruding the upper lip. In order to do so, a clear aligner therapy was proposed consisting of 22 Invisalign aligners. The protocol included:

  • Upper molar distalization
  • IPR
  • Use of class II elastics accompanied by a virtual jump of the mandible

Pre-Treatment Records:

On the first visit, attachments were placed and the patient was given 10 aligners with a 10-day wear protocol. After this, she came back to the office and use of class II elastics (3/16”. 4.5 oz) was indicated, giving her the remaining aligners with a 7=day wear protocol.

The treatment was finished without the need of additional aligners and the correction included:

  • Improvement of facial aesthetics
  • Normalized lip closure
  • Open bite closure and over jet correction
  • Normal crown inclination of incisors
  • Molar and Canine class I
  • Lower incisor inclination did not vary

Post-Treatment Records:

Mandibular counter clockwise correction, which can be visualized on the ClinCheck, gives the clinician a powerful tool to improve the sagittal correction of class II patients without the need of only retracting upper teeth.

The author
Dr. Tomás Salazar Sarrat DDS, MSc

EAS Ambassador
Invisalign Speaker

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