microviti e invislign presentazione

8/12/2019 Microviti e Invislign Presentazione

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MINISCREWS (TADS) AND ALIGNERS

POSSIBILITIES

The statements, views and opinionsThe statements, views and opinions

expressed in thisexpressed in this program and relatedprogram and related

course materials are those of thecourse materials are those of the

speaker.speaker.

Align Technology, Inc. may notAlign Technology, Inc. may not

endorse such statements, views orendorse such statements, views or

opinions.opinions.

Attendees are responsible for legalAttendees are responsible for legal

and regulatory compliance of anyand regulatory compliance of any

marketing and referral programs.marketing and referral programs.

Dr. David PaquetteDr. David Paquette

EDUCATION AND TRAININGEDUCATION AND TRAINING

Maintains Orthodontic Practice in Charlotte and Mooresville, North CarolinaMaintains Orthodontic Practice in Charlotte and Mooresville, North Carolina

Orthodontic Specialty from Saint Louis University Medical CenterOrthodontic Specialty from Saint Louis University Medical Center

Pediatric Dentistry Specialty from University of North Carolina at Chapel HillPediatric Dentistry Specialty from University of North Carolina at Chapel Hill

BOARD CERTIFICATIONS:BOARD CERTIFICATIONS:

American Board of Orthodontics, Diplomate 2001American Board of Orthodontics, Diplomate 2001

American Board of Pediatric Dentistry, Diplomate 1985American Board of Pediatric Dentistry, Diplomate 1985

HONORSHONORS

AAPD Graduate Research Award 1983AAPD Graduate Research Award 1983

Member Align Alpha Group 1999Member Align Alpha Group 1999--Present, Clinical Advisory Board 2006Present, Clinical Advisory Board 2006--PresentPresent

Speaker at US and European Invisalign SummitsSpeaker at US and European Invisalign Summits

Speaker at US and European Damon ForumsSpeaker at US and European Damon Forums

Member Schulman Study Group 2006Member Schulman Study Group 2006

Fellow American College of Dentists 2007Fellow American College of Dentists 2007

EXPERIENCEEXPERIENCE

Invisalign Certified since 1999, over 700 patients treatedInvisalign Certified since 1999, over 700 patients treated


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INTRODUCTION TOMINISCREWS (TADS)

What are TADs?What are TADs?

((A.K.A.A.K.A. TTEMPORARYEMPORARYAANCHORAGENCHORAGE DDEVICE EVICE TADTAD))

VariousVarious implants, screws, pins orimplants, screws, pins oronplantsonplants placed specifically for theplaced specifically for thepurpose of providing orthodonticpurpose of providing orthodontic

completion of treatmentcompletion of treatment..

The term that I will use isThe term that I will use is MiniscrewMiniscrewalthough with patients we call themalthough with patients we call them pinspins..

Why Use Miniscrews?Why Use Miniscrews?

Orthodontics =Orthodontics = AnchordonticsAnchordontics

In planning orthodontic therapy, it is simply notIn planning orthodontic therapy, it is simply not

possible to consider only the teeth whosepossible to consider only the teeth whose

movement is desired.movement is desired. William R. Proffit

ToothborneToothborne anchorage is one of the greatestanchorage is one of the greatest

limitations of modern orthodontic treatment,limitations of modern orthodontic treatment,

because teeth move in response to forces.because teeth move in response to forces. Thomas D. Creekmore


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The idea of using screwsThe idea of using screwsfor anchorage is not afor anchorage is not a

new ideanew idea


It was first proposed in 1983!It was first proposed in 1983!

a was years agoa was years ago

The Possibility of Skeletal Anchorage,

Creekmore, TD and Eklund, MK, J Clin


If skeletal anchorage could be applied to orthodontic tooth

movement , it might offer capabilities heretofore unavailable. With

screws, pins, or some other readily removable implant anchored

to the jaws, forces might be applied to produce tooth movement in

any direction without detrimental reciprocal forces. Orthopedic, , , - ,forces might be applied directly to the jaws through skeletalanchorage rather than through toothborne anchorage. The need

for extraoral forces and the removal of teeth might be greatly

reduced.


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I gave a lecture to both the ORMCOI gave a lecture to both the ORMCO

Insiders Group and the South Florida OralInsiders Group and the South Florida Oraland Maxillofacial Surgery Study Club inand Maxillofacial Surgery Study Club in

orthodontics with very little interest.orthodontics with very little interest.


Multiple articles in 2003 by Dr. Park andMultiple articles in 2003 by Dr. Park and

colleagues as well as several othercolleagues as well as several other

Korean orthodontists finally broughtKorean orthodontists finally brought

miniscrew anchorage into mainstreamminiscrew anchorage into mainstream

acceptance.acceptance.


And nowAnd now


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Conventional Orthodontic Treatment is ruled byConventional Orthodontic Treatment is ruled byNewtonsNewtons 3rd Law:3rd Law:

ForceForceactionaction == ForceForcereactionreaction

All induce reciprocal tooth movementAll induce reciprocal tooth movement

Most of which is unwantedMost of which is unwanted

None of which is completely predictableNone of which is completely predictable


Conventional Orthodontic AnchorageConventional Orthodontic AnchorageExtra OralExtra Oral

HeadgearHeadgear

ReverseReverse--Pull Headgear (facemask)Pull Headgear (facemask)

Intra OralIntra Oral NanceNance

Lower Lingual ArchLower Lingual Arch

ElasticsElastics

Lip bumpersLip bumpers

Tweed molar tip backsTweed molar tip backs


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No conventional anchorage schemes provideNo conventional anchorage schemes providethe answer for all these desired orthodonticthe answer for all these desired orthodonticmovements:movements:

Molar intrusionMolar intrusion

o ar upr g ngo ar upr g ng

Molar mesialization or distalizationMolar mesialization or distalization

Incisor intrusionIncisor intrusion

Leveling occlusal cantsLeveling occlusal cants

Correcting arch asymmetriesCorrecting arch asymmetries

En masse retractionEn masse retraction


Provides an alternative means to treat aProvides an alternative means to treat afull range of orthodontic cases withoutfull range of orthodontic cases withoutcompensating for the inadvertentcompensating for the inadvertentreciprocal movement of adjacent teeth.reciprocal movement of adjacent teeth.

If utilized correctly the net effect should beIf utilized correctly the net effect should bethe reduction of treatment times thoughthe reduction of treatment times thoughthe use of simplified mechanics.the use of simplified mechanics.


Miniscrews are the most exciting trend inMiniscrews are the most exciting trend in

orthodonticsorthodontics

Can now accomplish movements that wereCan now accomplish movements that were

reviousl not ossiblereviousl not ossible Will significantly reduce number ofWill significantly reduce number of

surgery casessurgery cases


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The aligner may

seem like it isselectivelyintruding orextruding anindividua l tooth,but it ac tually putsinverse forces onadjacent teeth.


Here temporaryanchorage serves tointrude the 1st molar withno unwanted effect onadjacent teeth. Quicklya n ea s y, t e c n c a nmakes the desiredmovement withoutround-tripping orcompromise.

Head

Tissue

Eyelet

Miniscrew Anatomy

Neck

Miniscrewthreads

SuppressionCollar

CuttingFlute

ransmuccosaCollar


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MiniscrewsMiniscrews

Most miniscrews are selfMost miniscrews are self--

tappng an setapp ng an se -- r ng tor ng to

virtually eliminate thevirtually eliminate the

need for pilot drilling orneed for pilot drilling or

tissue punches.tissue punches.

MiniscrewsMiniscrews

Variable lengthVariable length

transmucosaltransmucosal collarscollars

help to minimize chancehelp to minimize chance

of infectionof infection

collar minimizes tissuecollar minimizes tissue

overgrowthovergrowth

ThreadThread

formingforming

Ideal for areas of thinner bone

Thin boneexpands withhoop stress toallow threads topurchase


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ThreadThread

cuttingcutting

Ideal for areas of thicker, denser bone

CuttingFlute

More dense bonecannot expand,so cutting isrequired to clearaway bone

Design of MiniscrewsDesign of Miniscrews

Screw Head DesignsScrew Head Designs

Miniscrew heads have various designs, either

to hold archwires or to engage off-the-shelfsprings or elastics.

Unitek-Imtec

GACQuattro

Dentaurum

TOMAS

RMO

Dual-Top

Lancer-OASI

MediconAarhus

MediconAarhus

ORMCO-vector

1

5

3

The VectorTAS Atlaseliminates guesswork bymatching the color-codedminiscrews to the idealanatomical and

biomechanical implant site.Atlas ac counts for bonetype, bone d ensity andtissue dep th.

1. Maxillary facial surface

2. Mandibular alveolar ridge

(mesial to cuspid)

3. Maxillary facial & lingual surface

/ mandibular alveolar ridge

(mesial to 2nd molar)

4. Mandibular retromolar area

5. Infrazygomatic crest

4

2


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Color Diameter Collar TipRecommended Implant

Site(s)

1.4mm 1.0mmThreadforming

Maxillary facial surface /mandibularalveolar

ridge (mesial to cuspid),mandibularsymphysis

1.4mm 1.0mmThreadforming

Maxillary facial & lingualsurface / mandibular

alveolar ridge (mesial ton

Summary Table

2.0mm 2.0mmThreadcutting

Retromolararea

2.0mm 2.0mmThreadcutting

Infrazygomatic CrestAnd Temporary tooth

replacement

PROFOUND PETPRILOCAINE 10%

LIDOCAINE 10%

TETRACAINE 4%

PHENYLEPHRINE 2%

www.stevensrx.com

714-540-8911

MadaJetXLNeedle-free anesthetic delivery

Need le-less injector for pain-freecomfort!

Eliminates disposal and safetyconc erns typically associatedwith conventional syringes

Co nsistent injection volume (0.1 cc )ensures reliable depthpenetration

4.0 cc ca rtridge size for up to 38 injections with single loading

Interchangeable Extenda Tips for easy sterilization


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Syrijet Mark II NeedleSyrijet Mark II Needle--Free InjectorFree Injector

NeedleNeedle--less injector for painless injector for pain--free comfort!free comfort!

Eliminates disposal and safety concerns typicallyEliminates disposal and safety concerns typicallyassociated with conventional syringesassociated with conventional syringes

Accepts any standard 1.8 cc anesthetic cartridge,Accepts any standard 1.8 cc anesthetic cartridge,

with dosages adjustable from .00 to .20 cc for deepwith dosages adjustable from .00 to .20 cc for deepanesthetic penetrationanesthetic penetration

Easy, rapidly repeatable injections facilitate patientEasy, rapidly repeatable injections facilitate patientanesthetization quickly and efficientlyanesthetization quickly and efficiently

Cushioned conical head permits approximation ofCushioned conical head permits approximation ofinjection site for maximum patient comfortinjection site for maximum patient comfort

Unbroken sterility from cartridge to orifice ensuresUnbroken sterility from cartridge to orifice ensurespatient safetypatient safety

Simple to clean with water cartridges used to flushSimple to clean with water cartridges used to flushthe inner chamber prior to autoclavingthe inner chamber prior to autoclaving

MadaJet/Syrijet ComparisonMadaJet/Syrijet Comparison

MadaJet Syrijet

Injection Dosage Non-variable: 0.1cc Variable: .00-.20cc

Cartridge Size 4.0cc (38 injections with singleloading)

Standard 1.8cc

Sealed ampoule

Volume Trapped airmay increase volume Less tendency for trapped air; lowervolume

Ergonomics Hold like a syringe Hold like a hammerformore secure grip

Sli htan ulation Greateran ulation smallerti ,

Depth Penetration 2 to 2.5mm below epithelium 2 to 2.5mm below epithelium

SterilizationProcedure

Autoclave Autoclave

PackageContents

MadaJ et, two Extended Tips,holder, wrench, stylets, two extrapyrexfill chambers, case,disinfectant/cleaner

Syrijet, two rubber caps, three watervials,CD with demo

Is it really that easy?Is it really that easy?


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Reducing TAD failuresReducing TAD failures

Choose correct length and diameterChoose correct length and diameter

Rinse withRinse with chlorhexidinechlorhexidine prior toprior to

insertioninsertion

Brush withBrush with chlorhexidinechlorhexidine until screwuntil screw

removalremoval

STEADY HANDSTEADY HAND

STEADY HANDSTEADY HAND


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ContraContra--Angle DriverAngle Driver

Easy access to hardEasy access to hard--toto--reachreach

areas.areas.

Includes two 22 mm universal tips,Includes two 22 mm universal tips,

which can also be used in Straightwhich can also be used in Straight

Driver.Driver.

Rotating knob on driver helpsRotating knob on driver helps

clinician prevent grip andclinician prevent grip and

release, maximizing screwrelease, maximizing screw

performance and preventingperformance and preventing

failure.failure.


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Brush with 0.12% chlorhexidineBrush with 0.12% chlorhexidine


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--

What predisposes miniscrews toWhat predisposes miniscrews to

fail?fail? Wallowing out opening on insertionWallowing out opening on insertion

causing inadequate primary corticalcausing inadequate primary cortical

stabilitystability

crestcrest

Patient nonPatient non--compliancecompliance

Stay below gingival crestStay below gingival crest


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PainPain Remember the separator effectRemember the separator effect

If OTCs dont relieve pain, evaluateIf OTCs dont relieve pain, evaluate

--


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Post impingement sequelaePost impingement sequelae

Up to 2mm of denudation (including

cementum) will be repaired with newattachment

TsukiboshiM: Autotransplantation of Teeth, Chicago, 2001, Quintessence

Ankylosis becomes more prevalant in areas of

PDL damage greater than 4mm

Fabbrioni and colleagues Int Journ Oral Max Surg

2004232 intermaxillary fixation screws placed

Post removal contact assessed radiographically


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26 screws (11.2%) had major

contacts37 screws (15.9%) had

,

and minor, only one tooth required

RCT

Borah and Ashmead Journ Plas Recon Surg

1996Over 2300 miniscrews in 281 patients

studiedIncidence of im in ement er screw was0.41%NO impinged teeth developed PAabscesses or needed RCT


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ConclusionOur results show that contact between a dental

root and a drill, screw, or both causes resorptive

root damage. After discontinuation of the contact,

however, repair begins to occur through the depositionof cellular cementum.

oggo an co eagues recommen e a m n mum

clearance of 1mm between a miniscrew

and a root for both periodontal health and mini -

screw stability. Therefore, it can be concluded that

miniscrews with a diameter of 1.5mm or less are

safe for interradicular insertion if the space between

the roots is at least 3.5mm.

BisphosphonatesBisphosphonates

Oral bisphosphonate use and the prevalence of osteonecrosis of the

jaw An institutional inquiry - JADA 2009;1401):61-66.Parish P. Sedghizadeh,DDS, MS, Kyle Stanley, BS, Matthew Caligiuri, BA, Shawn Hofkes, BS, Brad Lowry, BS and Charles F. Shuler, DMD,

PhDBackground.

Initial reports of osteonecrosisof the jaw (ONJ) secondary to bisphosphonate (BP) therapy indicated that patients

receiving BPs orally were at a negligible risk of developing ONJ compared with patients receiving BPs intravenously. The

authors conducted a study to address a preliminary finding that ONJ secondary to oral BP therapy with alendronate

sodium in a patient population at the University of Southern California was more common than previously suggested.

Methods. The authors queried an electronic medical record system to determine the number of patients with ahistory of alendronateuse and all patients receiving alendronatewho also were receiving treatment for ONJ.

Results. The authors identified 208 patients with a history of alendronate use. They found that nine had active ONJand were being treated in the schools clinics. These patients represented one in 23 of the patients receiving

alendronate, or approximately 4 percent of the population.

Conclusions. This is the first large institutional study in the United States with respect to the epidemiology ofONJ and oral bisphosphonateuse. Further studies along this line will help delineate more clearly the relationship

between oral BP use and ONJ.

Clinical Implications. The findings from this study indicated that even short-term oral use of alendronateled to ONJ in a subset of patients after certain dental procedures were performed. These findings have important

therapeutic and preventive implications.


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Oral Bisphosphonate-Induced Osteonecrosis: Risk Factors,

Prediction of Risk Using Serum CTX Testing, Prevention , and

TreatmentRobert E. Marx, DDS,* Joseph E. Cillo, Jr, DDS, and

Juan J. Ulloa, DDS

Purpose: To assess the risk and time course of oral bisphosphonate-induced osteonecrosis of the jaws.

Materials and Methods: Detailed data from 30 consecutive cases were compared with 11 6 cases due

to intravenous aminobisphosphonates.

Results. Results in part noted a higher incidence related to alendronate (Fosamax; Merck, WhitehouseStation, NJ), a 94.7% predilection for the posterior mandible, and a 50% occurrence spontaneously, with

the remaining 50% resulting from an oral surgical procedure, mostly tooth removals. Just over 53% of

patients were taking their oral bisphosphonatefor osteopenia, 33.3% for documented osteoporosis, and

13.4% for steroid-induced osteoporosis related to 4 or more years of prednisone therapy for an

autoimmune condition. There was a direct exponential r elationship between the size of the exposed

one and e dura on o ora sp osp onae use. ere was aso a drec correa on eween repors

of pain and clinical evidence of infection. The morning fasting serum C-terminal telopeptide(CTX) testresults were observed to correlate to the duration of oral bisphosphonate use and could indicate a

recovery of bone remodeling with increased values if the oral bisphosphonatewas discontinued. A

stratification of relative risk was seen as CTX values less than 100 pg/mL representing high risk, CTX

values between 100 pg/mLand 150 pg/mL representing moderate risk, andCTX values above 150 pg/mL

representing minimal risk. The CTX values were noted to increase between 25.9 pg/mLto 26.4 pg/mLfor each month of a drug holiday indicating a recovery of bone remodeling and a guideline as to when

oral surgical procedures can be accomplished with the least risk. In addition, drug holidays associated

with C'IX values rising above the 150 pg/mL threshold were observed to correlate to either spontaneous

bone healing or a complete healing response after an office-based debridement procedure.

Conclusions: Oral bisphosphonate-induced osteonecrosis is a rare but real entity that is less frequent,

less severe, more predictable, and more responsive to treatment than intravenous bisphosphonateinducedosteonecrosis. The morning fasting serum C-terminal telopeptidebone suppression marker is a

useful tool for the clinician to assess risks and guide treatment decisions.

2007 American Association of Oral and Maxillofacial Surgeons

J Oral Maxillofac Surg 65:2397-2410, 2007

Case PresentationsCase PresentationsImportant Note: Many of the attachments used to treat these

cases do not reflect Align Technologys latest set-up

protocols and were used for testing purposes. Please refrain

from requesting these attachments for future treatments.


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Vertical AsymmetryVertical Asymmetry


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Anterior Open BiteAnterior Open Bite


Traditionally requiredTraditionally required

surgerysurgery Allows mandible toAllows mandible to autorotateautorotate,,

thereby decreasing anterior facialthereby decreasing anterior facial

iiii

Risk of postoperative morbidity andRisk of postoperative morbidity and

high costhigh cost

Alternatives: MEAW treatment, HPHG withcomprehensive orthodontics, posterior bite plates,magnets on opposing arches, anterior toothextrusion, jaw surgery

Adverse side effects Stability issues

Treatment Using MiniscrewsTreatment Using Miniscrews Achieves results similar to surgery without the risks and high costAchieves results similar to surgery without the risks and high cost

Intrudes posterior teeth, allowing the mandible to autorotate andIntrudes posterior teeth, allowing the mandible to autorotate andclose biteclose bite

Miniscrews may be used to retain intrusion and correct anyMiniscrews may be used to retain intrusion and correct any

discrepancies without typical extrusive dental side effectsdiscrepancies without typical extrusive dental side effects


Can use O pen-Bite Splint for posteriorintrusion : Force of Ni-Ti coils Pressure of tongue on 2

transpalatal bars Pressure of b ite on acrylic

covering occlusal surface


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Anterior Open Bite

The following is a patient treated

only with screws and braces, noopen bite splint. It is important tonote that this patient could easily

manner with aligners andminiscrews and no fixedappliances.

StephaniaStephaniaCl II, Open bite, TMDCl II, Open bite, TMD

4-6-06

Stephania

Cl II, Open bite, TMD


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StephaniaStephaniaCl II, Open bite, TMDCl II, Open bite, TMD

6 months progress6 months progress

Mini screws placedMini screws placed

facial and lingualfacial and lingual

If I were treating her now I would simply

have her wear the aligner with the

elastic from screw to screw over top of

the aligner. I will demonstrate this with

another patient shortly.

11-1-06

Stephania

Cl II, Open bite, TMD


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Miniscrews for posteriorMiniscrews for posterior

intrusionintrusion


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Miniscrews for posteriorMiniscrews for posterior

intrusionintrusion

Molar UprightingMolar Uprighting

Molar UprightingMolar UprightingDirectDirect

POSITIONIn retromolar region immediately distal totipped second molar. Such placementmaintains rotational control.

ac co sprng rom e mn screw othe cleat/button bonded to the molar asmesial as possible.


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DC

40y2m

Initial

Cl ICl I

Prior treatmentPrior treatment

Occlusal cant up on rightOcclusal cant up on right

l i il i i

DC 40y2m

Pretreatment

l i il i i

Combination TreatmentCombination Treatment


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DC 40y2m

40y9m

Refinement


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DC 41y1m


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DC 40 10m

Progress

Canine remobilized

Mini screw placed

DC 41y7m

Pro ress

DC

41y9mFinal


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DC: Treatment Summary


InvisalignInvisalign

6 aligners upper only6 aligners upper only 16 weeks16 weeks 5 visits5 visits

Case refinementCase refinement 11 aligners11 aligners 40 weeks40 weeks


16 visits16 visits Extrusion buttons #6 with mini screwExtrusion buttons #6 with mini screw

28 weeks (included above)28 weeks (included above) 14 visits (included above)14 visits (included above)

Total active treatmentTotal active treatment 15 months15 months 21 visits21 visits


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Class II CorrectionClass II Correction

39y9m

Initial

Class II Correction

ClCl II subII sub leftleft

EM 39y9m

Pretreatment

Slight crowdingSlight crowding

Upper midline to rightUpper midline to right

Post leftPost left crossbitecrossbite Congenitally missing #10Congenitally missing #10

Peg #7Peg #7


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PlacedPlaced miniscrewminiscrew

EM 39y9m

Pretreatment

retromolarretromolar area distalarea distalto #15. Placed chainsto #15. Placed chainsfrom buttons facialfrom buttons facialand lingual #14 toand lingual #14 tominiscrewminiscrew..




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EM 39y9m

EM 39y9m

EM

40y9m

ii


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EM 40y9m


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EM 40y9m

EM

41y2m

Progress


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22 months progress

22 months progress

EM 41y6m

3 months fixedProgress


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EM 43y0m

12 months post

EM: Treatment Summary

InvisalignInvisalignwithwith miniscrewminiscrew-- 1818 alignersaligners-- 4444 weeksweeks-- 6 visits6 visits

Extrusion buttons #11Extrusion buttons #11-- 6 weeks6 weeks--

Case refinement withCase refinement with miniscrewminiscrew-- 2020 alignersaligners-- 3838 weeksweeks-- 77 visitsvisits

Segmental AppliancesSegmental Appliances-- 18 weeks18 weeks-- 3 visits3 visits

TotalTotal active treatmentactive treatment-- 2525 monthsmonths-- 1818 visitsvisits

Class II CorrectionClass II Correction


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MS

Initial

Cl II

MS 36y5m

Pretreatment

Slight lower crowding

Missing UL Central

Midlines off



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MS

Refinement




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Placed Miniscrew

MS 38y9m


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MS 39y0m

CG

33y0mi i lInitial


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Cl II sub right

CG 33y0m

Pretreatment

Slight crowding

Anterior open bite

Upper midline to left

CG 33y0m

Carriere and miniscrew


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CG

33y3m

i li i li

impressions

12 weeks with Carriere, miniscrew and elastics

Distalizer removed, training

aligners placed, note

continued elastic to

miniscrew


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CGCG

34y0m34y0m

IIII

TI

40y0mi i lInitial


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TI

33y0m

Carriere and miniscrew

Class II div 2 deep biteClass II div 2 deep bite

Courtesy Dr. John M. SparagaCourtesy Dr. John M. Sparaga

Class II Division 2 Deep BiteClass II Division 2 Deep Bite

1/31/2007, Initial, YR. 40 MO. 0

F. Scott


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Division 2 CorrectionDivision 2 Correction

F. Scott

Intrusive TADs 7/3/07Intrusive TADs 7/3/07

7/3/2007, Micro Screws, YR. 40 MO. 5

F. Scott

TADs 12/20/07TADs 12/20/07

F. Scott


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10 Months MX Intrusion10 Months MX Intrusion

July 07July 07 May 08May 08

F. Scott

Intrusion ProgressIntrusion Progress

F. Scott

TAD Elastic AttachmentTAD Elastic Attachment


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Hook FormerHook Former-- EssixEssix

Hook Former in ActionHook Former in Action

#806314041524 Braessler#806314041524 Braessler


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Instant TorchInstant Torch

Instant ThermometerInstant Thermometer

Molar SupereruptionMolar Supereruption


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LB

36y5m

Pretreatment

Supererupted upper molars

LB 36y5m

Pretreatment

U & L spacing

Missing multiple teeth

Midlines off


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y m

Miniscrews in

place


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LB FinalLB Final

TTemporaryemporary TToothooth RReplacementeplacement

Camille Initial


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Note both upper lateral incisors congenitally missing

Screws placed

Final


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To obtain your CE certificate for this program pleaseTo obtain your CE certificate for this program please

complete a brief survey at:complete a brief survey at:

www.AligntechInstitute.com/asksurvey

Upon completion of your survey* you will have immediate

access to your CE certificate.

*This survey is only available to the participants who attend the live

presentation via the webinar/phone. Participants who complete the

archived program on Alig ntechInstitute.com need to compl ete a CE test to

obtain their CE certificate.


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MINISCREWS (TADS) AND ALIGNERSThank you

POSSIBILITIES


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