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
