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