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How to plan the perfect clincheck. Pedro Costa-Monterio Isabel Flores Allen. Episode 74. December 21st 2020

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Hosted by
Farooq Ahmed

How to plan the perfect clincheck. Pedro Costa-Monterio Isabel Flores Allen

 

Steps recommended

1.     Final position

2.     IPR

3.     Staging

4.     Attachment design

5.     Overcorrection

 

A good clincheck is dependant on good records

·      With teeth out of focus – cannot assess relationship

·      With mirror shots not at 45 degrees, miss evaluation of tooth position relative to bone

·      Extra oral photos – for orthodontists assessment and planning

 

 

1st clincheck – road map

·      Be detailed when planning

·      How to communicate with someone at the end of the laptop

o   Eg intrude upper incisor

§  Technician can intrude 0.1-4mm

§  Ideal – intrude UR1 1.5mm

§  Plan with the end in mind

·      Final position of upper incisors at aligner 4

o   Torque, tip of aligner 4

o   Final position of upper molar at aligner 8

 

Keep biology in mind

·      CBCT for Pedro’s cases

 

Monitor progress

·      Clincheck represents force system – not the movement in the mouth

 

 

 

IPR

·      Some cases IPR prior to tooth movement

·      Some cases require round tripping  – idealise contact points then IPR and retract

·      Which stage and which teeth – clinician to chose

·      If one does not control the IPR

o   Can do 0.5mm in initial clincheck

o   Then further IPR in refinement – beyond biological limits of enamel

 

 

Overcorrection

 

·      C-chain for space closure between 3-3

·      Powerchain for space effect between 6-6

 

 

Lite / i7 package

·      Change aligners every 10/7

 

 

Scissor bite

·      Plan for intrusion with auxillaries – no other movements at the same time as using TADs

·      Positive torque 10 degrees

·      Reference tip for movement – symmetry of molar position

·      Expansion only on 1 side

o   TAD x 3

o   Elastic chain from TAD to cut out with button

·      Cross elastic from lingual L4-L7 to Upper 4-7

 

Tooth size discrepancy

·      Resolve with spaces around diminutive teeth – lateral incisors

 

Tips

·      Calibrate photos to true horizontal line

·      Initial position of dental midlines to facial midlines

·      Final position of incisal edges

 

Communication

·      Orthodontist and Prosthodontist discuss case

o   CAD design

o   Mock up for patient

 

 

 

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