Conservative and Comprehensive Treatment with Invisalign by Dr. Lauren Shepard

Last updated September 27, 2023

Case Background

39 year old female patient presented with anterior wear #7-10, reverse smile line, deficient buccal corridor and undersized laterals. Her goal was to be conservative but still achieve ideal aesthetics. How did we achieve so much with just 4 ceramic units?

Assessment & Treatment

Invisalign with a 12 month plan, allowed us to idealize the buccal corridor by expanding and uprighting teeth. We vastly improve the gingival symmetry by intruding 7-10 and creating room to restore the worn teeth and address the reverse smile by lengthening approximately 1mm.

This case began with comprehensive records and treatment planning accompanied with occlusal analysis by Gold Dust Dental Lab. This allowed me to work with my lab to set the case up with Invisalign to idealize the results. They also created a diagnostic wax up 7-10 & 22,27, essix retainer for mid treatment and a guide to achieve canine guidance with resin bonding on the lower canines. They also were able to equilibrate before beginning restorative which served as a guide to chair side equilibration in order to idealize the occlusion.

After Invisalign treatment was complete, the patient whitened and was held in a retainer until the desired shade was achieved. After 2 weeks, to compensate for any rebound in bleaching, the patient was prepped for 4 E.Max veneers utilizing reduction guides (remove…in) included with the wax up kit. In order to idealize the width and shape of laterals, I designed the preps to break contacts and create room for porcelain. The patient-approved temporaries were the guide to discuss the shape, length, and color. We selected a youthful, oval shape. The ceramist fabricated 4 units with e.Max press in a MTBL3 ingot with a natural cutback, and layered ceramic with a MiYo A shade for highlights. After adhesive bonding, I utilized a hard essix from the wax up and fabricated an Anterior Discluder Slider made for long term, nighttime protection. The final appliance was an anterior discluder/slider built into full arch Essix retainers to serve as ortho retention and bruxism appliance.

Steps

1. Deprogram

2. Records

3. Occlusal Analysis

4. Invisalign

5. Wax Up Kit

6. Whitening

7. Equilibration

8. Prep and Provisionalization of 7-10

9. Resin bonding on lower canines for anterior guidance

10. Cementation of 7-10

11. Hold with hard essix for wax up – take scan for Anterior Discluder Slider

12. Deliver nighttime device

Conclusion

The results created an ideal smile, protected from parafunctional habits.

Case by CMS Faculty Dr. Lauren Shepard