denis krasilnikov
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Denis Krasilnikov
Prof. Mascolo
BIO 211
Invisalign: Clear Braces
A Hollywood smile is a frequent request in a dental office. People desire
straight rows of pearly whites that illuminate a smile. Most individuals, however,
have not been blessed with a perfect set of teeth and turn to Orthodontics for
answers. Prior to resent years metal braces, which were mounted on the teeth for 1-
3 years, were used in order to pull each individual tooth into place. This was not a
popular approach due to the size and discomfort as well as the overall un-appealing
look that metal braces carried with them.
In the late 1990s Zia Chrishti came up with the idea of clear and removable
braces that were to be molded to each individuals teeth. Along with business
partner Kelsey Wirth, Chrishti founded Align Technologyin 1997 and invisalign
braces were created. Invisalign is now used to treat many conditions including
spaced teeth, crowded teeth, overbite, underbite and crossbite.
Invisalign aligners are made of specially designed thermoplastic
material, USP Class VI medical grade, high molecular weight, polyurethane resins,
that appears similar to teeth whitening trays. A series of trays are created in order
to move teeth into their correct position in the sequence determined by the dentist
during the first appointment. To help patients decide if Invisalign is for them, as well
as see the course of treatment, dentist's use a program called Clincheck.
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During the first visit a patient undergoes a "Smile Consulatation" which
determines if the they are to be considered a "candidate" for treatment. In most
cases a patient is eligible if they meet the following criteria: The Patient
Does not have untreated cavities Does not have periodontal (gum) disease Has good oral hygiene habits Is a non-smoker Is committed to treatment and prepared to follow the treatment guidelines
After the consultation qualified individuals are scheduled for a second
appointment during which necessary records are collected. These include full arch
impressions done with ether the iTero/iOC scaner or the traditional PVS impression
as well as x-rays and photos. The iTero/iOC digital scanner is preferred as it creates
more detailed images for better fitting aligners as well as being more pleasant for
the patient than the silicon PVS that must sit on the teeth and has a rather
unpleasant taste, for example "Discus Splash!". These records, along with the
treatment plan created by the dentist, are sent to "Align Technology, Inc." where the
Clincheck movie is produced which determines how many trays will be needed to
align the teeth into their desired position.
Invisalign treatment time varies from patient to patient based on the severity
of the displacement of the teeth and presence of other conditions needing
treatment.
http://www.stroberdental.com/gum-disease-therapy.htmlhttp://www.stroberdental.com/gum-disease-therapy.html -
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When talking to patients who are considering using the treatment it has been
observed that many believe the movement of the teeth occurs because the shape
and position matches up with the aligner, which is not the case. Invisalign uses a
biomechanical approach to aligner treatment with the premise being "the correct
force system controls the movement of the tooth". The Foundation of Biomechanics
is that only after figuring out the required forces for desired movement should the
appliance be created. Following this model, clinical outcomes of the aligners have
become much more predictable with the new improvements made by Align
Tecnologies.
These upgrades were introduced under the name Invisalign G3, followed by
the Invisalign G4, and brought with it SmartForce features. A number of inovation
were added to the aligner trays that made Invisalign an option for a wider range of
patients. In some cases the desired tooth movement might be challenging to
facilitate with only the pressure created by the tray. With SmartForce an attachment
is placed on the tooth in order to correctly direct the forces that shall be acting upon
it. These "Optimized Attachments" can be placed on the canines or bicuspids that
need rotation or can be used to improve incisor extrusions.
There is a number of such attachments that can accomplish different effects
due to their placement. With Invisalign G3 came the "Optimized Rotation
Attachment" which is used to rotate any canine or bicuspid. The aligner tray
engages the attachment surface as well as the lingual side of the tooth in order to
deliver the forces and moments required to rotate the tooth about the long axis.
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With the development of Invisalign G4, three new attachments were
introduced. The "Optimized Root Control Attachments" provide greater medial-
distal root -tip control. Forces applied to the two buccal attachments generate a
moment that is desired for root movement. These attachments are available for
upper and lower canines as well as upper incisors and are applicable for space
closure, medial - distal root up righting and treatment of diastima (space between
the incisors).
The 'Multi-Plane Movement Features" were created to improve control of
upper laterals requiring extrusion along with rotation or crown tip. The active
surface of the attachment is oriented to deliver a pushing force while
simultaneously rotating or tipping the lateral. A pressure point on the lingual side
of the aligner is positioned to apply a second force for control of the multi plane
movement. These attachments are applicable to a wide range of lateral movements
and are customized to the patients required tooth movement .
"Optimized Extrusion Attachments" which is a multi tooth approach to open
bite treatment designed for better outcome when a patient has anterior open bites.
The attachments extrude the four upper incisors together using the posterior teeth
as anchorage. Aligner activation levels are now individually adjusted in order for
sufficient extrusive force to be delivered to the incisors to accomplish the desired
movement.
The "Power Ridge" is an aligner feature which has been shaped specifically to
apply "Lingual Root Torque" which is Bucco-Lingual Rotation of the tooth about the
incisal edge. Power Ridges are designed to deliver the correct moment to force ratio
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to achieve incisor torque with lingual root movement where the root of the tooth
shifts in the direction of the tongue. An M/F ratio of 12-13 is enough to accomplish
torque around the incisal edge. Power Ridges and Optimal Attachments cannot be
used together.
While Invisalign is a more physically appealing option than braces it comes
with a higher price. While cost for the original braces ranges from $1500-3000,
Invisalign on average can cost anywhere upward of $5000. The price for treatment
varies with the number of aligner trays required. Usual treatment requires around
14-16 trays. New trays are created every 2-3 weeks in order to move the teeth into
the necessary positions at the rate that the dentist decides.
Invisalign is considered an Orthodontic procedure and in most cases dental
insurances cover 50-60% of all procedure costs. However, despite this being an
Orthodontic procedure, a general dentist can become an Invisalign trained provider
by attending an 8 hour training session costing approximately $2000.
Invisalign is a very popular option among people looking to fix their smile as
it is practically invisible and very effective. No one is ever excited to go into an
Orthodontist's office with the prospect of metal braces in their future. Adults hate
the idea of metal smiles while young children will rarely get excited to show their
friends the new color of elastics they got on their attachments. Now a beautiful smile
is available to everyone without the need to wear a bulky and uncomfortable metal
device on the teeth for a long period of time.
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References
1. Bovenizer, Todd S., D.D.S. "Invisalign FAQs." - Orthodontist Cary, NC.
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2. Sterental, Rene., "Invisalign G4
- Webinar" 07 Oct. 2011.
3. "Required Records." Web
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4. The Science Behind Invisalign. Web. 2012.
.