Top 10 Things That Can Go Wrong

Transcription

1 Top 10 Things That Can Go Wrong Dr. David Galler 150 Broadway Suite 1310 NY, NY CREDENTIALS Graduate of University Of Pennsylvania Omicron Kappa Upsilon Honor Society Certified Invisalign 2004 Elite Premier Provider Presenter at Invisalign Summit Vegas 2007, 2008, Offices in New York Several Cases Featured on invisalign Website Invisalign Case Report Published by New York State Dental Journal Jan 2009 WHAT DO YOU DO AT EACH APPOINTMENT?? I. TRACKING OR NOT TRACKING? II. CLINCHECK COMPARISON 1

2 TRACKING EXCELLENT TRACKING GOOD TRACKING 2

3 PROBLEM TRACKING POOR TRACKING CLINCHECK CHECK 3

4 CLINCHECK CHECK STAGE 3 CLINCHECK CHECK STAGE 8 CLINCHECK CHECK STAGE 20 4

5 TOP 10 MONITORING TECHNIQUES 1. COMPLIANCE 2. TIGHT CONTACTS 3. ATTACHMENTS 4. EXTERNAL FACTORS 5. ALIGNER MISHAP 6. DIFFICULT MOVEMENT 7. LATERALS 8. CROSSBITE CORRECTION 9. TISSUE IMPINGEMENT 10. ROOT POSITION 5

6 I. COMPLIANCE I. COMPLIANCE SIGNS TO LOOK FOR: 1. MISSED APPOINTMENTS 2. NOT WEARING ALIGNERS AT APPOINTMENT 3. TROUBLE PUTTING ON ALIGNERS 4. ALIGNERS THAT ARE TOO CLEAN I. COMPLIANCE SOLUTIONS: I. Wear Aligner For Longer Time II. Motivational Speech III. Magic Blue Dot 6

7 II. CONTACTS ARE TOO TIGHT II. TIGHT CONTACTS NOT ENOUGH IPR: 1. INCORRECT MEASURING 2. IMPROPER TECHNIQUE 3. NOT DONE IN TIME 4. NOT PROGRAMMED INTO CLINCHECK 5. OTHER TEETH DID NOT DISTALIZE/ROTATE II. TIGHT CONTACTS SOLUTIONS: 1. MEASURE WITH UNWAXED FLOSS 2. IDENTIFY LIKELY TIGHT SPOTS 3. USE PROPER TECHNIQUE 1. Use the Galler Spacing Technique (GST) 4. USE PROPER INSTRUMENTS 7

8 II. TIGHT CONTACTS II. TIGHT CONTACTS II. TIGHT CONTACTS 8

9 II. TIGHT CONTACTS Upcoming Invisalign GST Courses Mar 5- Las Vegas, NV April 14- Philadelphia, PA April 22- Fort Lauderdale, FL April 23- Miami, FL May 5- Toledo, OH May 6- Dayton, OH May 7- Indianapolis, IN June 4- Toronto, ON June 17- Joplin, MO June 18- Tulsa, OK Aug 4-6 TBD, Florida Oct 6- Minnesota, Iowa III. ATTACHMENTS VS. CRITICAL FOR CERTAIN MOVEMENTS WHEN YOU ARE OFF YOU ARE OFF!! 9

10 III. ATTACHMENTS PROBLEMS THAT CAN ARISE: 1. Excess Flash Material 2. Too Many Attachments 3. Attachments Put On Incorrectly 4. Not Enough Attachments 5. **Aligner Not Fully Seated** III. ATTACHMENTS SOLUTIONS: 1. Use Pressure to Help them Seat 2. Wear the Aligner for Longer Time 3. Trim the Attachment Carefully 4. Remove the Attachment 5.NEW ATTACHMENT PROTOCOL III. ATTACHMENTS 10

11 III. ATTACHMENTS Matt Frasure New Protocol Attachment III. ATTACHMENTS 11

12 III. ATTACHMENTS IV. EXTERNAL FACTORS BE CAREFUL OF: 1.Calculus 2.New Dental Work 3.Pt Chipped a Tooth IV. EXTERNAL FACTORS 12

13 V. ALIGNER MISHAPS V. ALIGNER MISHAPS MISTAKES WITH ALIGNERS: 1. Patient is Wearing Wrong Aligner 2. Invisalign Package Wrong Number 3. Invisalign Case Mix-Up 4. Attachment Area Is Filled 5. Extra Bleb of Plastic V. ALIGNER MISHAPS PT. CASE NUMBER Original vs. Retainer UPPER VS. LOWER ALIGNER NUMBER 13

14 V. ALIGNER MISHAPS VI. DIFFICULT MOVEMENT DON T BELIEVE EVERYTHING YOU SEE ON CLINCHECK 14

15 VI. DIFFICULT MOVEMENTS PROCEED WITH CAUTION: 1. Tipping vs. Translation 2. Extrusion 3. Rotations 4. Moving Several Teeth at One Time 5. Root Movement VI. DIFFICULT MOVEMENTS SOLUTIONS: 1.Learn the Limits of Invisalign 2.Add Attachments to Help 3.Make Refinement Part of the Plan VII. LATERALS 15

16 VII. LATERALS LUCK THE FATERALS VII. LATERALS LIKELY CAUSES: 1. Surrounded By Two Big Teeth 2. Cingulum Problems 3. Surface Area Problems 4. Early Detection System 5. Intrusion VII. LATERALS SOLUTIONS: 1.Add Attachment 2.Buttons and Elastics 3.IPR 4.Conservative Movements 5.**FINISH THE CASE** -IF THE TOOTH IS IN THE RIGHT POSITION IT DOES NOT MATTER- 16

17 VII. LATERALS VII. LATERALS VII. LATERALS 17

18 VIII. CROSSBITE CORRECTION COMMON PROBLEM: 1.Anterior or Posterior 2.Tracking is Excellent 3.Doesn t Match Clincheck 4.**Patient s Bite is Hiding Progress** VIII. CROSSBITE CORRECTION SOLUTION: 1.Instruct Patient on Occlusion 2.Wait and Track Progress 3.Do Nothing IX. TISSUE IMPINGEMENT 18

19 X. ROOT POSITION X. ROOT POSITION THANK YOU Questions? Dr. David Galler 150 Broadway Suite 1310 New York, NY