Top 5 challenging movements with Invisalign

Invisalign® has become a household name.

Patients want it and their lifestyles demand it.

They expect Invisalign® to offer the same results as traditional braces, which is why clinicians must become proficient in achieving optimal results with Invisalign®.

If you are not competent in performing challenging movements with Invisalign®, then you will lose potential patients.

Patients don’t like hearing “no” and will find someone who says “yes.” But I can help.

As a board-certified orthodontist, I have years of experience providing patients with successful Invisalign® results in Souderton, PA.

But I have come across a handful of challenging movements with Invisalign®, and there are five notable ones.

In increasing order of difficulty, here are my top five challenging movements with Invisalign®. Plus, I will provide tips on how to increase your chances for success with Invisalign®.

Please feel free to copy and paste when communicating with your Invisalign® lab technician.

#5 Achieving root parallelism

Whenever there is a space between two teeth and you want to close it, the crowns of the teeth will tend to tip towards each other.

Examples occur when closing a large diastema or even when closing lower incisor extraction space.

To avoid tipping of the crowns and ensure root parallelism, you must address the root movements first.

What I usually say to the technician is:

“Please perform a 15-degree virtual gable bend between teeth ___ and ___ before attempting to close the space.”

Another way to phrase it is:

“Please tip the roots of teeth ___ and ___ towards each other before attempting to close the space.”

#4 Lateral incisors not tracking

Inevitably, if you treat enough cases with Invisalign®, you will realize lateral incisors do not track very well.

The best solution is to include a “4 mm horizontal gingival beveled attachment” to the lateral incisors. Always.

This increases surface area and increases your chances of the tooth staying in the aligner.

Also, when attempting to extrude incisors, one cannot simply extrude them. Instead, I request it to be done in 2 steps.

This is called a multi-vector movement and increases your chances of the incisor extruding successfully:

“Please extrude tooth ___ by first proclining it labially and creating space until there is 0.2 mm of space mesial and distal to the contact. Next, extrude and retract the tooth into position until ___.”

Increase your success with Invisalign

#3 Posterior open bites

Often I hear of clinicians addressing posterior open bites by cutting the trays distal to the canines.

While this may work sometimes, often times the posterior open bite is actually due to heavy anterior contacts.

Be very aware of the labial-lingual inclination of the upper incisors. If they are too upright, the patient will occlude on these first in CR and they will have no posterior contact. It will also create an unstable occlusion.

When addressing incisor angulation, it is best to over-engineer:

“Please perform an additional 10 degrees of palatal root torque to the upper incisors.”

Your final ClinCheck should show some excess overjet, which will help prevent heavy anterior contact leading to posterior open bite.

Also, be aware of your overbite and resolve this first…

#2 Deep bites

Years ago, Invisalign® realized correcting overbites was challenging and made several advances.

To date, whenever I see a patient who is brachyfacial and has a heavy musculature and square jawline, I try to prescribe wires and brackets to correct their malocclusion. Regardless of which appliance you choose, the biomechanics are the same.

Often, the upper incisors are in a good vertical position and there is an excessively deep curve of Spee in the lower arch. Moreover, the lower third of the face is short and an increase of vertical dimension can be tolerated.

What I say to the technician is:

“Please level the lower curve of Spee by extruding the lower premolars by 2 mm relative to the occlusal plane. Have the final stage show a reverse curve of Spee in the lower arch with the lower incisors intruded 2 mm relative to the premolars and the canines 1.5 mm relative to the premolars.”

Again, over-engineering is key.

The final stage of the ClinCheck should show a slight open bite in the front. If not, ask for it. You will rarely see an anterior open bite clinically.

#1 Rotated premolar teeth

This is by far the most challenging movement for me to accomplish with plastic.

I still use limited buttons and chain to rotate premolars before scanning for Invisalign®. I have heard of other clinicians who do the following:

“Please create 0.2 mm of space mesial and distal to premolar tooth ___, before attempting a couple to rotate the tooth.”

While I have not used this technique, it makes sense. Make surface area mesial and distal to the tooth you want to rotate and use the appropriate attachment to rotate it.

Questions on improving your Invisalign® results?

I hope you found value in this article on how to improve your results with Invisalign®.

There are challenging movements with Invisalign® or any clear aligner for that matter, but there are techniques and tips to help.

As always, please feel free to reach out with any questions!

Don’t forget to share your thoughts in the comment section below.

Sincerely,

Dr. Justin Silvestre