Here's the scenario from a real-life case:
A provider submits an Unlimited case for a patient with heavy crowding and rotated upper lateral incisors in need of extrusion. The patient was compliant, the provider performed the recommended amounts of IPR, and treatment progressed smoothly. However, the lateral incisors stopped tracking once the patient got to phase 5. The incisors were scheduled to rotate, but contacts with other teeth got in the way.
Constant, steady pressure and adequate space are needed to complete any tooth movement. Because the engager wasn't tracking and heavy contacts blocked the movement, treatment could not progress as planned. Instead of sending in a case revision, this provider placed auxiliary brackets on the lingual surface of the incisors to complete the difficult extrusion.
If you are in a similar situation, you can follow this provider's steps to solve the problem:
- Follow the guide to placing auxiliaries on the affected teeth, including removing and replacing the engagers. (Previous tech tips give many guides to making new engager templates and troubleshooting engagers that aren't tracking.)
- Break tight contacts on the mesial and distal sides of each affected tooth to ensure that the tooth has enough space to move.
- Follow instructions for bonding buttons or brackets to the teeth (can be found in this article)
- Give your patient a bag of 1/4" elastics after the procedure, just like a traditional wire-and-bracket case. Because elastic bands lose their retention after about an hour in the mouth, instruct the patient to replace them frequently -- after eating, drinking, or brushing.
- The patient's compliance and dedication to treatment is an integral component of the success of this procedure. Ensure that your patient wears their aligners for 22 hours a day, and regularly replaces their elastics.
- If you need more time to backtrack treatment before moving to the next step, call or email a support rep to place the case on hold. By holding the case until you're ready for the next step, you can stay in sync with our timeline and avoid wasting shipments.
With the addition of auxiliaries, the aligners had enough constant, steady pressure to finish the movement as predicted on the treatment setup. With that movement out of the way, the case progressed smoothly into completion with fantastic results.