Treatment Planning: Visualization Software ClinCheck min45
David A. Chenin, DDS Manager of Clinical Process Development Today s Clinical Expert Align Technology Managed the incoming inspection of >50K cases Developed Online Prescription & Diagnosis and Case Evaluation Process Clinical Trainer for Costa Rica Treat Operations facility Primary contributor to Certification Training, Clinical Monitoring Guide, and numerous other publications Investigator for the first clinical study on Invisalign, University of the Pacific Invisalign Feasibility Study, 1998 Faculty, Restorative Department, University of the Pacific School of Dentistry 2000-2003 Starting Pacific s Ortho Program this summer
Treatment Planning: Visualization Software ClinCheck Intro to Invisalign Treatment Visualization Software Discussion of ClinCheck Features Hands on Demo of ClinCheck How to Review your ClinCheck Hands on Review of Case 1
The Invisalign Process 1) Diagnosis 2) Records 3) Treatment Plan VIP (Virtual Invisalign Practice) ClinCheck 4) Initial Treatment 5) Monitor 6) Finish Six Steps to Clinical Success
Planning Tooth Movements Patient s PVS impressions transformed into 3-D images Clincheck software utilizes treatment form to generate computerized final state including all stages in between Movements for anteriors are projected at approx..20 -.25mm each 2 weeks or.5mm per month.
Go to www.invisalign.com
Click on Tab that reads I m a Doctor I m a Doctor
Enter User Name and Password Enter username Enter password
FIRST: Download ClinCheck
ClinCheck Invisalign cases waiting for Your Response
ClinCheck
ClinCheck
ClinCheck
Evaluating ClinCheck Comments Tab Reproximation form Attachment form Comments are specific case feedback from Align Technology.
ClinCheck ClinCheck is... a way to make modifications and provide Align with a final approval NOT a way for Align to send a doctor Align s treatment plan Invisalign does NOT treat patients - WE do.
Why learn ClinCheck? Improves Treatment Planning Better awareness of treatment options Better treatment results Begin with the end in mind Improves Treatment Monitoring Better Patient compliance Fewer mid-course corrections/refinements Improves Communication Doctor to Patient/parent Doctor to Staff Doctor to Related Doctors
ClinCheck Align Technology will NOT manufacture your patient s Aligners until you have approved the ClinCheck file.
ClinCheck Review Modify & Accept Aligners are shipped approximately 10 business days after ClinCheck accepted.
min60 Session 4 Treatment Planning: Visualization Software ClinCheck Intro to Invisalign Treatment Visualization Software Discussion of ClinCheck Features Hands on Demo of ClinCheck How to Review your ClinCheck Hands on Review of Case 1
ClinCheck 1.7 Introduction and Basic Features Presentation
ClinCheck
A Quick Review of Features Preferences
A Quick Review of Features Predefined Views
A Quick Review of Features Gallery Views
A Quick Review of Features Tooth numbering Universal Palmer FDI
A Quick Review of Features Tooth numbering
A Quick Review Features View Resolution Resolution of the 3D model image High is now default Low allows smoother, faster movement of the models High may result in jerkier, slower movement, but a sharper picture. High is best for evaluating interproximal contacts Selected button is recessed & lighter Default can be reset in Preferences
A Quick Review of Features Tabs
A Quick Review of Features Analysis w/ Grid
A Quick Review of Features Analysis w/ Grid
A Quick Review of Features Show/Hide Arches Show Upper & Lower Show or Hide Upper Show or Hide Lower
A Quick Review of Features Show/Hide Attachments * This feature does not effect the manufacturing of the aligners. It is only for visual purposes.
A Quick Review of Features Images
A Quick Review of Features Movie
A Quick Review of Features Images
A Quick Review of Features ClinCheck Movie
A Quick Review of Features Superimpose
A Quick Review of Features Navigation Panel Navigation Panel Translation Zoom In/Out Rotation Selective Zoom Tip: Keyboard shortcut = Shift and Mouse drag
A Quick Review of Features Navigation Panel Navigation Tab Translation Zoom In/Out Rotation Selective Zoom Keyboard shortcut = Control and Mouse Drag
A Quick Review of Features Navigation Panel Navigation Panel Translation Zoom In/Out Rotation Selective Zoom Keyboard shortcut = Mouse Drag
A Quick Review of Features Navigation Panel Navigation Panel Translation Zoom In/Out Rotation Selective Zoom
A Quick Review of Features Hidden menu Click right mouse button to view hidden menu Hide/Show upper or lower arch Select from 14 predefined views Print displayed view
The latest ClinCheck Past ClinCheck(s) Treatment Comments Online Treatment form
Viewing ClinCheck Treatment Comments Online Reproximation form Online Attachment form Online Treatment form ClinCheck Static Images
min65 Treatment Planning: Visualization Software ClinCheck Intro to Invisalign Treatment Visualization Software Discussion of ClinCheck Features Hands on Demo of ClinCheck How to Review your ClinCheck Hands on Review of Case 1
Hands on Demo Go to Case 1 folder
min90 Treatment Planning: Visualization Software ClinCheck Intro to Invisalign Treatment Visualization Software Discussion of ClinCheck Features Hands on Demo of ClinCheck How to Review your ClinCheck Hands on Review of Case 1
Evaluating ClinCheck General Questions Are there any teeth moving that should not be moved? Is chief concern addressed? Compare start to finish Is there adequate access for reproximation during treatment (if applicable) Are any extrusions unrealistic? Are there any unrealistic rotations?
Evaluating ClinCheck Anterior View/Both Arches Midline - Did you request midline correction? Avoid Extrusions - If you are attempting, did you stage them at end of treatment? Is overbite relationship satisfactory?
Evaluating ClinCheck Anterior Anterior Esthetics a.tip b.torque c.incisal Height Intrude first if appropriate, Avoid Extrusions d.observe for Black Triangles Are there any that you want to reduce? Request IPR if present.
Evaluating ClinCheck Example of a black triangle in ClinCheck and then clinically.
Evaluating ClinCheck Upper Occlusal with Lower Is the overjet relationship satisfactory? Is the overjet symmetrical?
Evaluating ClinCheck Occlusal Arch Form a. Left/Right Symmetry Alignment a. Rotation b. In and Out Is the space closure satisfactory, are there spaces left for restorations (if applicable)?
Are You Seeing Spaces? Default setting for viewing ClinCheck is Low Detail - this allows for faster manipulation of virtual models Use High Detail setting to better evaluate interproximal contacts and spaces.
Evaluating ClinCheck Occlusal Is correction of crowding satisfactory? Is amount of proclination compatible with periodontium? Is amount of IPR consistent with my goals? At what stage and on what teeth is IPR being done? Do I have clinical access to do the IPR? Check Reproximation Tab.
Evaluating ClinCheck 1.71 Superimposition Tool Pre-Treatment Virtual Treatment The Superimposition Tool allows one to view the amount of proposed movement (virtual treatment) overlapped with any stage of treatment.
How to Use It 1.71 Superimposition Tool 1) Click on Superimpose 2) Click on Enable 3) Blue teeth denote stage you select (default = 0, initial stage); this can be changed to monitor treatment from any given stage in time with subsequent treatment aligners 4) Play ClinCheck 5) Analyze. Are you comfortable with this much proclination?
Evaluating ClinCheck Pontics Applies only to extraction cases- Not 3-3
Evaluating ClinCheck Buccal Upper and Lower Right/Left a. Canine Relationship b. Anterior Overjet.
Evaluating ClinCheck Buccal Lower Right/Left Buccal View a. Anterior torque b. Check Amount of Incisor Intrusion.
Evaluating ClinCheck Are less predictable movements staged toward end of treatment? Staging Do I have access to do IPR clinically when and where reproximation form tells me too?
Attachment Indications Intrusion Retention Rotation Uprighting Significant Space Closure
Attachment Types Ellipsoid Intrusion Retention Rotation Rectangular Uprighting Space closure
Attachment Placement Rationale Intrusion Cuspid to cuspid place on first and second bicuspids Lateral to lateral place on cuspids and first bicuspids Retention Short Clinical crowns Rotation On cuspids On bicuspids (Cert II)
Attachment Placement Rationale Uprighting On any tooth as needed Significant Space Closure Diastema place on central incisors Other spaces place on teeth adjacent to space
Evaluating ClinCheck Attachments Ensure attachments in your ClinCheck are sufficient and logical Are there any teeth with attachments that should not have attachments? (Veneers/ Crowns) Are there any teeth that do not have attachments, but require attachments?
TREATMENT TIME: 30 WEEKS (15 ALIGNERS)
min120 Treatment Planning: Visualization Software ClinCheck Intro to Invisalign Treatment Visualization Software Discussion of ClinCheck Features Hands on Demo of ClinCheck How to Review your ClinCheck Hands on Review of Case 1
Case Demonstration 1 - KP Anterior Crowding
Study Models Case 1 - KP Evaluate the following areas: Molar and cuspid classification Overbite Overjet Midlines Overlapping teeth Spacing/Crowding Rotations
Diagnostic Tool Measurements Case 1 - KP Midline - Upper to right.5mm Overlap Upper right lateral incisor and cuspid.5-1mm Crowding Upper 22+22=44 8+7+8+8+7+8=46 2mm of crowding Lower 17+16=33 6+5+5+4.5+6+7=33.5.5mm of crowding Cuspid Rotations - no rotations over 30º.
Diagnostic Summary Case 1 - KP Class I molars and cuspids 2mm overbite and 1.5-2mm overjet Upper midline to the right 0.5mm 2mm upper anterior crowding and 0.5mm lower anterior crowding Moderately rotated upper cuspids and mildly rotated lower cuspids
Diagnostic Summary (continued) Case 1 - KP Proclined upper left central incisor, upper right lateral incisor, and upper left lateral incisor Lingual crown torque upper right central incisor Mesial root angulation (tip) upper right and left lateral incisors Impacted third molars (asymptomatic).
Treatment Plan Maintain Class I molars and cuspids Maintain overbite and improve overjet to more ideal Correct upper midline Align upper and lower anterior teeth (without proclining) Case 1 - KP
Treatment Plan (continued) Resolve all cuspid rotations Buccal crown torque upper right central incisor Distal root angulation (tip) upper right and left lateral incisors Extract third molars (?). Case 1 - KP
Invisalign Anterior Prescription and Diagnosis Form Case 1 - KP
1. Invisalign Treated Arches Case 1 - KP * Both Upper Only Lower Only
2. Do not move these teeth (Note bridges not to be moved, ankylosed teeth, & implants) Case 1 - KP
3. Do not place attachments on these teeth (Note facial / buccal restorations) Case 1 - KP
*. Midline (limited to 2mm or less) Case 1 - KP Maintain Upper Move R / L: 1-2mm Maintain Lower Move R / L: 1-2mm * *
5. Resolve Spacing and Crowding Case 1 - KP * * * *
6. Tooth Size Discrepancy Case 1 - KP (Check all that apply) If all upper spaces cannot be closed, then leave space: Distal to 2 s Distal to 3 s Equally around 2 s IPR the opposite arch to close all spaces Other-see Special Instructions If no choices are indicated, default will be distal to 2 s
7. Overcorrection Case 1 - KP Not applicable until case refinement
8. Treatment Preferences Case 1 - KP Refer to my on-line treatment preferences for basic guidance on this set-up: No (If box is not checked, we will refer to your treatment preferences)
9. Special Instructions Typical Indications: Overcorrection requests Restorative requests Attachment requests Black triangle reduction Periodontal concerns Pontics Etc. Case 1 - KP
9. Special Instructions Maintain 2mm overbite Case 1 - KP Improve overjet to more ideal (i.e. 2mm lateral incisor to lateral incisor) IPR and retract for proper alignment upper and lower anteriors
9. Special Instructions (continued) Case 1 - KP Buccal crown torque upper right central incisor *Distal root angulation (tip) - upper lateral incisors *No attachments are required since the lateral incisors will be tipped only slightly and the Aligner has enough tooth coverage for retention.
Awaiting ClinCheck on VIP Case 1 - KP ClinCheck should appear on VIP within 10 business days of case receipt by Align.
Review of Initial ClinCheck Items to aid in ClinCheck review: Photos and radiographs Study models Treatment Planning Form Comments Page Reproximation Form Attachment Form Case 1 - KP
Information Tabs Case 1 - KP
Reproximation Form Case 1 - KP
Attachment Form Case 1 - KP
Initial ClinCheck Modifications 1. Remove lower incisor proclination & and add IPR as needed 2. Add 5 degrees more distal rotation to the upper cuspids 3. Make the occlusion of the upper and lower cuspids have contact. Case 1 - KP
VIP Clinical Modifications Form Case 1 - KP
Final ClinCheck After modifications are submitted, ClinCheck is posted 3 4 business days later on VIP ClinCheck can then be reviewed for additional modifications or approval Case 1 - KP After approval of ClinCheck, Aligners will be shipped 10 business days later.
min150 Session 4 Treatment Planning: Visualization Software ClinCheck Intro to Invisalign Treatment Visualization Software Discussion of ClinCheck Features Hands on Demo of ClinCheck How to Review your ClinCheck Hands on Review of Case 1
Helpful Reference... Align Technology, Inc. www.invisalign.com Customer Support Toll Free 888-82-ALIGN (888-822-5446) customersupport@aligntech.com
Clinical Finishing Procedures Incisal edge recontouring as needed for aesthetics according to your preference Occlusal equilibration - as needed for interferences according to your philosophy Lifetime retention.
Viewing ClinCheck Create a consistent process in your office that will maximize your office time.
Viewing ClinCheck Summary of Streamling your ClinCheck Experience 1. Dedicate a staff member to prepare ClinCheck files for your review and to be the contact person 2. Invest in a fast computer with a graphics card 3. View most the movements in the low detail setting 4. Invest in a higher speed internet connection 5. Follow a systematic protocol during each ClinCheck review to ensure thoroughness and maximum efficiency Process Map for Streamling your ClinCheck Reviews ClinCheck Review Guide
Viewing ClinCheck
Improving your ClinCheck The ideal approach to ClinCheck starts with: Diagnosis from proper exam and good records Consideration of all options and alternatives Establishment of treatment goals
Potential to Move to a Full Case Arch Expansion to enhance esthetics of buccal corridor Reproximation of 1 st and 2 nd Bicuspids to alleviate all crowding Rotation of bicuspids Response back from ClinCheck Evaluators Case is Full, not Anterior Case falls within skill sets of Cert I Providers Case converted to a full case Don t forget to change fee to full case.
Advantages of ClinCheck Improves Treatment Planning Better awareness of treatment options Better treatment results Begin with the end in mind Improves Treatment Monitoring Better Patient compliance Fewer mid-course corrections/refinements Improves Communication Doctor to Patient/parent Doctor to Staff Doctor to Related Doctors
Questions? Thank You!!! David A. Chenin, DDS
Review
1. ClinCheck Anterior Views Is esthetic alignment of upper and lower satisfactory? If midline correction was requested, was it done satisfactorily? Is overbite relationship satisfactory? For leveling, was extrusion kept to a minimum and staged toward end of treatment?.
2. ClinCheck Anterior Overjet View Is overjet relationship satisfactory? Is overjet symmetrical?
3. ClinCheck Buccal Views Is molar and canine relationship acceptable? Is overjet sufficient? Is angulation of the incisors satisfactory? Is curve of Spee acceptable?
4. ClinCheck Posterior (Lingual) View Is posterior occlusion satisfactory?
5. Occlusal Views Are arches symmetrical? Is alignment satisfactory? Is space closure satisfactory? Are spaces left for restorations (if applicable)? Is amount of expansion and proclination compatible with patient s actual periodontium?.
6. ClinCheck IPR Assessment Is amount of IPR consistent with treatment goals? At what stage and on what teeth is IPR being done? Is there clinical access to perform IPR?.
7. Staging Are less predictable movements (extrusion, rotation of bicuspids, large translations) staged toward end of treatment? Are tooth surfaces clinically accessible where IPR is needed?.
8. Overcorrection (if requested) To show or hide overcorrection stages, check or uncheck overcorrection menu button
9. Pontics Pontics are automatically placed if there is a virtual extraction. Request a pontic for pre-existing spaces or for extractions done before PVS.
10. Attachments Are there any teeth that do not have attachments but require attachments? Intrusion of anterior teeth - adjacent to teeth being intruded (ellipsoid) Rotation of round teeth - on tooth (ellipsoid) Retention for short teeth - on tooth (ellipsoid).
10. Attachments Extractions - adjacent to tooth extracted (rectangular); space can be filled with a pontic by request Are there any teeth that should not have attachments (restorations, esthetics, etc.)?