Orthodontics |5 min read

Case Study: Improve Your Invisalign® Results with These Tips

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®… This text opens a new tab …, 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… This text opens a new tab … 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.


Dr. Justin Silvestre

2 comments on “Case Study: Improve Your Invisalign® Results with These Tips”
  1. Avatar for Dr. Justin Silvestre

    I just lately had a dialogue with a customer orthodontist in Palm Harbor, FL that linked
    a concern posed to him, “My son’s dentist prompt that we start off treatment method with Invisalign Teen. Does it make sense to just begin or would you advise that I find an orthodontic seek the advice of?” Remaining that I
    get the job done in the subject of orthodontics and dentistry, and that I myself have had Invisalign and my
    daughter is currently in braces, I observed an option to support disseminate facts that may possibly help other people in a equivalent circumstance of building very
    good orthodontic treatment choices.

    1st and foremost, and in comprehensive deference to all standard, beauty, and pediatric
    dentists that supply Invisalign or very similar appliances, no orthodontic processes really should
    at any time be designed outside the house of the specialty of orthodontics.
    Even if 1 finally decides to embark on the path of orthodontic treatment
    with his/her dentist, not consulting an orthodontist prior to starting
    remedy can consequence in a much less than fascinating result, in the long run putting you back in an orthodontist’s chair.
    And for the reason that most orthodontists complete a complimentary original consultation there is no reason to not, at
    the quite least, obtain out if their treatment program aligns with that of your dentist.

    The fact is that orthodontics is a specialty that involves at the very least two yrs of submit-doctoral instruction in a method accredited by
    the American Dental Affiliation. The specialty is, in layman’s
    phrases, a examine in the physics and biomechanics of tooth
    movement and balancing facial irregularities. The products, software, and procedures orthodontists use to evaluate the affected person are
    similarly specialised and let much extra precision in creating a therapy program.
    So below are a few suggestions in picking with whom you really
    should look for orthodontic treatment:

    If your dentist indicates that he/she carry out any orthodontic
    method, question for a couple of orthodontic referrals
    for the sake of next belief. He/she really should not be set off by such.

    Request your close friends, family members, and co-employees for tips.
    You’ll be amazed at the myriad of responses. Give more credence to those that really, seriously advocate for a distinct
    Go to the internet sites of the instructed orthodontists and dismiss any that are not qualified by the American Board of Orthodontics.
    Surprisingly 40% of practising orthodontists are not board qualified which signifies they have no official training
    in the specialty of orthodontics.
    I personally went with Invisalign as my orthodontist considered that I was
    a applicant and attained fantastic benefits. He did not abide by the exact strategy
    with my daughter. Rather, he proposed that we go
    the route of lingual braces, braces powering the enamel, for that reality that they, like Invisalign, are not visible
    and would make it possible for a great deal larger handle around tooth motion,
    thus yielding a much extra fascinating final result.

    Invisalign is a great innovation in orthodontic appliances and may be the great
    alternative to developing your ideal smile. But I am no orthodontist, and frankly, neither is your dentist.

    So if you are the human being hunting for Invisalign in Palm
    Harbor do you a favor and question your dentist for a referral.

    1. Avatar photo
      Dr. Justin Silvestre

      Hello! Thank you for your comment. You bring up a great point about the specialty of orthodontics. Many dentists falsely believe that the appliance (ie Invisalign) is the treatment. There has to be a diagnosis and a treatment plan and only a specialist in Orthodontics, in my opinion, can have an honest conversation about which appliance choice is best for that particular person. The appliance is not the treatment! Rather it is the doctor who prescribes that treatment and truly understands the biomechanics for that appliance. There is no questions that digital is here and must be adopted. I will always look at ways we can add value to not only our patients, but also our community and our dental community at large.

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