Correction of a severely rotated mandibular canine in an adult patient using invisalign: a case report

Abstract

Introduction: The Invisalign system has been used in the orthodontic treatment of numerous types of malocclusions. However some clinicians have reported difficulty incorrectingrotations particularly in canines and premolars using the Invisalign appliance system. This case report describes the orthodontic treatment of an adult patient with severe canine rotation (more than 45°) and crowding on upper and lower tooth.Methods: The clinical examination included extra-oral and intra-oral photographs, panoramic radiographic, lateral cephalometric, stone casts, and upper and lower arch analysis obtained from ClinCheck 3.0.The treatment planningwas resolved the crowding in both upper and lower arches and thesevere rotation of 33 tooth (46°) using Invisalign system as well as the canine and molar relationship, dental verticalization, adequate over jet, overbite and dental midline using the same system. The duration of the treatment was approximately eight months.Results: In Post-treatment extra oral photographs, no significant changes were observed at the end of the treatment. Intraoral photographs showed an important and notable improved aesthetics. The canine relationship improved slightly and molar Class Irelationshipwas maintained. An increase in transverse diameter was observed at the level of first premolars, second premolars and first molars.The overbite was improved. The crowding and the severe canine rotationwere corrected. No obvious root resorption was radiographically evident and slight cephalometric changes. Page 2 Open Science JournalCase reportOpen Science Journal–April20182Keywords:Severe rotation, Canine, Invisalign system.IntroductionIn recent years, orthodontics treatments have increased their popularity betweenadults patients being aesthetics[1]and comfort techniques[2] who preferred them. In this context, the aligners have become one of the most growing orthodontic treatment modalities [3].The Invisalign system (Align Technology) introduced in 1999 has been used as an aesthetic and comfort of the removable clear aligners in comparison with the traditional appliances[4].Previous studies showed that the Invisalign system is effective in the treatment of “mild to moderate tooth crowding and some cases of severe crowding involving extractions”[5]. The patients that used thissystem have worn the aligners approximately 22 hours per day except for meals, drinks and dental hygiene [6].Each aligner is ideally worn for 15 days,moving the teeth at a maximum rate of 0.33 mm and 2 degrees of rotation per aligner [7].However, certain limitationshave been outlined respect tothe aligners and certain tooth movements as extrusion, rotation, bodily movement, and torque [8].In this context, many clinicians have reported difficultiesof correctingrotations particularly incanines and premolars [9].Severe canine rotation more than 15°(clinically discernable amount of malrotation) is an orthodontic movement reported to be difficult to achieve and control with the Invisalign system[10].When rotations are greater than 15°, the accuracy of the canine is significantly reduced [11].This case report shows the use of the Invisalign system in the treatment of an adult patient with severe canine rotation (more than 45°) and crowding on upper and lower tooth.Case reportA female patient aged 33 yearswentto the orthodontic clinic at Cuenca University, Ecuador; thepatient’s main complaint was“My upper and lower teeth are crocked”.An informed consent was obtained from the patient who underwent examination and it was recorded. The clinical examination revealed that the patient presented severe rotation of lower canine (more than 45°) and crowdingon upper and lower arches. The clinical examination included extra-oral and intra-oral photographs, panoramic radiographic, lateral cephalometric, stone casts, and upper and lower arch analysis obtained from ClinCheck 3.0.The extraoralexamination revealedmesocephalic head, proportional facial thirds, straight anterior profile (Fig1).Conclusion: The treatment with the Invisalign system resolved the complaint of our patient so this system could be considered as an option that offered good results in the treatment of upper and lower crowding of arches involving severe canine rotation Correction of a Severely Rotated Mandibular Canine in an Adult Patient Using Invisalign: A Case Report. Available from: https://www.researchgate.net/publication/324319425_Correction_of_a_Severely_Rotated_Mandibular_Canine_in_an_Adult_Patient_Using_Invisalign_A_Case_Report [accessed Jun 11 2018].