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Important pearls for in house aligners. Renato Martins Episode 67 December 17th 2020

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Hosted by
Farooq Ahmed

 

Important pearls for in house aligners. Renato Martins

 

Join me as I summarise Renato Martins great lecture giving pearls for aligner use regardless of system.

 

 

Conclusion

1.     Stage tooth movement if not favourable for aligners

2.     Overcorrection

3.     Attachment surface – always use bevel edges

4.     Check occlusion if lack of tracking

 

Founder of e-motion: aligner company

 

·      Software recommendation Archform

 

Renato described difference movements with aligners and his tips on achieving them.

 

1.     Synergistic movement

§  Predictable movement

§  E.g. extrusion and retroclination

 

2.     Stand alone movement

§  More challenging

§  Staging movement increases predictability

§  Solution 1 – change to synergistic movement:

·      Rotation LL1:

·      Split rotation correction with

o   ½ proclination and ½ rotation

o   ½ bring back in and ½ rotation

§  Solution 2 – Change to antagonistic movement

·       Not consistent with desired movement

§  i.e. distalise canine, can cause distal rotation

§  Antagonic: create counter moment to prevent unwanted movement

§  Antagonic movements are difficult simultaneously

§  Solution

·      Stage movement

o   Distalise and rotate

o   Then counter rotate to correct

 

3.     Intrusion

·      2 stage intrusion

o   Canines intrude initially

o   Then intrude 2-2

 

 

4.     Rotation

·      Overcorrection

·      Overcorrect rotation by 30-50%, greater rotation, greater overcorrection

 

5.     Attachment design

·      Always use bevel surface for active surface

o   For example extrusion

o   90 degree active surface: when plastic engages with attachment the aligner doesn’t fit fully and the cervical aspect of the aligner loses contact / adaptation, aligner pivots on the active surface due to it being steep / 90 degrees

o   Bevelled active surface: larger surface of active engagement, therefore less deformation and pivoting, better adaptation at the cervical aspect

o   Same as NiTi we focus on the final wire shape, not necessarily the elastic deformation during alignment, same with attachments

 

 

Clinical

·      Flowable composite: Ensure highly filled, if not can abrade

·      IPR: Imprecision in scan / impression, segmenting of teeth = Less than 0.1mm than planned due to imprecision in set up

·      Not tracking: Check occlusal contact as heavy contact can prevent tooth movement, as well as interproximal heavy contact

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