Orthodontic intrusion can beeffective in adult patients

with periodontal disease,1,2 aslong as light, continuous forcesare used and excellent oral hy-giene is maintained.3,4 Suchtreatment can reduce infrabonydefects and improve periodontalhealth,5-7 but requires a multi-disciplinary approach8,9 and ahighly motivated patient.

Stable posterior anchoragecan be difficult to achieve in pa-tients with missing teeth.10 Al-though skeletal anchorage maybe useful, the following casedemonstrates intrusion of theupper incisors using only remov-able Invisalign* appliances in anadult patient with periodontaldisease.

Diagnosis andTreatment Planning

A 43-year-old female pre-sented with extruded, protrusive,and labially inclined upper in-cisors and generalized anteriorspacing (Fig. 1). A fixed prosthe-sis had replaced the upper rightbicuspids and molars. Bleedingwas evident on periodontal prob-ing, and the patient had a flatupper labial frenum.

Invisalign treatment wasplanned for derotation and intru-sion of the upper incisors and ca-nines and uprighting of the upperright central incisor. The lowerarch required slight intercanineexpansion to allow the alignmentand uprighting of the upper in-cisors.

The final ClinCheck** pro-vided 15 aligners for the upperarch and 10 for the lower (Fig.2). The predicted duration oftreatment was about eightmonths.

Treatment Progress

Scaling and root planingwere performed before the startof orthodontic treatment, withthe scaling repeated every eightweeks.

The first through 10th

VOLUME XL NUMBER 3 © 2006 JCO, Inc. 171

CASE REPORTIncisor Intrusion with Invisalign Treatmentof an Adult Periodontal PatientGAETANO TURATTI, DDS, DOSRANDOL WOMACK, DDSPIETRO BRACCO, MD, DDS, DOS

Dr. Turatti is in the private practice of orthodontics at via F. Pao-lini 12, 10138 Turin, Italy. Dr. Womack is an Associate Profes-sor, Orthodontic Department, Arthur A. Dugoni School of Dent-istry, University of the Pacific, San Francisco; he has presentededucational workshops for Align Technology as an independentcontractor. Dr. Bracco is Chairman, Department of Orthodontics,University of Turin, Italy. E-mail Dr. Turatti at gaetanoturatti@aliceposta.it.

Dr. WomackDr. Turatti Dr. Bracco

*Registered trademark of Align Technology,Inc., 851 Martin Ave., Santa Clara, CA95050.

**Trademark of Align Technology, Inc., 851Martin Ave., Santa Clara, CA 95050.

©2006 JCO, Inc. May not be distributed without permission. www.jco-online.com

aligners were worn for 15 dayseach, except that a frenectomywas scheduled during the sixthaligner period to reshape the gin-gival marginal without tractionfrom the upper frenum (Fig. 3).This aligner was worn for threeweeks as the tissue healed.

The last five upper alignerswere changed every three weeks,

while the last lower aligner wasbeing worn, to allow root move-ments. At the end of active treat-ment, the patient wore the last setof aligners for an additional fourweeks.

The entire Invisalign treat-ment lasted 11 months (Fig. 4).Fixed lingual retainers were thenplaced in both arches.

Discussion

Invisalign appliances pro-vided a viable alternative to con-ventional orthodontic intrusionin this patient, aligning the ex-truded incisors in a relativelyshort time with no need to re-move the posterior prosthesis.The post-treatment radiographs

172 JCO/MARCH 2006

Incisor Intrusion with Invisalign Treatment of an Adult Periodontal Patient

Fig. 1 43-year-old female patient with extruded, protrusive, and labially inclined upper incisors, prostheticreplacement of upper right posterior segment, and periodontal disease before treatment.

VOLUME XL NUMBER 3 173

Turatti, Womack, and Bracco

Fig. 4 Patient after 11 months of Invisalign treatment.

Fig. 3 Frenectomy performed to reshape gingival margin without trac-tion from upper frenum.

Fig. 2 Invisalign treatment planning with ClinCheck.

beforeafter

clearly showed upper incisor in-trusion and a reduction of the in-frabony defect.

Moving the teeth at a rateof about .25mm per aligner,Invisalign applies a light, contin-uous force.11 Attachments arebonded to the teeth adjacent tothe extruded teeth to provide amechanical lock for the alignersand to allow pure sectional intru-sion, using the same biomechan-ics as the segmented-arch tech-nique. The aligner dissipates thereactive force over the entireposterior segment, which servesas the anchorage unit.

In contrast to fixed ortho-dontic appliances, the alignerscan be removed for eating andbrushing, allowing optimal dailyhygiene.12 The comfortable, es-thetic appliances have been en-thusiastically accepted by pa-tients. Chairtime for aligner re-placement is minimal, and theclinician can compare the pa-tient’s results with the virtualClinCheck images to immediate-ly verify treatment progress.

REFERENCES

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2. Cardaropoli, D.; Re, S.; Corrente, G.;and Abundo, R.: Intrusion of migratedincisors with infrabony defects in adultperiodontal patients, Am. J. Orthod.120:671-675, 2001.

3. Wennstrom, J.L.; Stokland, B.L.; Ny-man, S.; and Thilander, B.: Periodontaltissue response to orthodontic move-ment of teeth with infrabony pockets,Am. J. Orthod. 103:313-319, 1993.

4. Boyd, R.L.; Leggott, P.J.; Quinn, R.S.;Eakle, W.S.; and Chambers, D.: Perio-dontal implications of orthodontic treat-ment in adults with reduced or normalperiodontal tissues versus adolescents,Am. J. Orthod. 96:191-198, 1989.

5. Thilander, B.: Infrabony pockets and re-duced alveolar bone height in relation toorthodontic therapy, Semin. Orthod.2:55-61, 1996.

6. Polson, A.; Caton, J.; Polson, A.P.; Ny-man, S.; Novak, J.; and Reed, B.: Perio-dontal response after tooth movementinto infrabony defects, J. Periodontol.55:197-202, 1984.

7. Boyd, R.L. and Baumrind, S.: Perio-dontal considerations in the use of bondsor bands on molars in adolescents andadults, Angle Orthod. 62:117-126, 1992.

8. Vanarsdall, R.L. Jr.: Adjunctive ortho-dontics for the generalist, J. Tenn. Dent.Assoc. 59:15-18, 1979.

9. Musich, D.R. and Crossetti, H.W.:

Assessment and description of the treat-ment needs of adult patients for ortho-dontic therapy, III. Characteristics of themultiple provider group, Int. J. AdultOrthod. Orthog. Surg. 1:251-274, 1986.

10. Burstone, C.J.: Deep overbite correctionby intrusion, Am. J. Orthod. 72:1-22,1977.

11. Clements, K.M.; Bollen, A.M.; Huang,G.; King, G.; Hujoel, P.; and Ma, T.:Activation and material stiffness ofsequential removable orthodontic appli-ances, Part 2: Dental improvements,Am. J. Orthod. 124:502-508, 2003.

12. Taylor, M.G.; McGorray, S.P.; Durrett,S.; Pavlov, S.; Downey, N.; Lenk, M.;Oxford, E.; Dolce, C.; and Wheeler,T.T.: Effect of Invisalign aligners onperiodontal tissues, J. Dent. Res. 82(Spec. Iss. A):1483, 2003.

Incisor Intrusion with Invisalign Treatment of an Adult Periodontal Patient

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