mastering clincheck review ate final - amazon s3 · 2015-08-31 · • instructor, ld pankey,...

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Mastering G3:Maximizing Clincheck for the Efficient Restorative Dentist

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ALIGNTECH INSTITUTE ASK THE EXPERT

MAY 6, 2011

• DDS, Georgetown University, School of Dentistry

• Master and LLSR Recipient, Academy of General Dentistry

• Fellow, ICD, ICOI, ADI

• Instructor, LD Pankey, Dawson, Scottsdale Institutes

DR. BRIAN GRAY

and 8 Universities

• Board of Directors, TIADS, DCDS, ADA Council on Scientific Affairs

• Product Evaluator, Non-profit Clinical Research Groups, ADA-ACE & private industry

• Certified over 14,500 GP’s for Invisalign

• Full Time private practice, Washington, DC

WHO IS THIS COURSE DESIGNED FOR?

• The novice to moderately experienced Invisalign doctor interested in improving clinical outcomes and reducing treatment times.

• My goal is for you to complete a comprehensive Initial Clincheck Review in less than 5 minutes AND reduce your overall treatment time by at least one monthyour overall treatment time by at least one month.

OUR AGENDA:

1. Quick G3 Overview2. Writing a Prescription

3. Clinical Preferences

4. Reviewing Clincheck (+ 5 Key Views)

5. 5 Essential Tips, Summary, Questions

INVISALIGNG3

The Most Significant changes in Align’s history.

1. New and Improved SmartForce™ features.

2. New Doctor Site (formerly known as VIP).

3. New Class II and Class III features

4. New Clincheck 3.0 Software

Go to AlignTech Institute for tutorials, videos and ATE’s on

G3 and SmartForce™

CLINCHECK 3.0 SOFTWARE

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OUR AGENDA:

1. Quick G3 Overview

2. Writing a Prescription3. Clinical Preferences

4. Reviewing Clincheck (+ Key Views)


FEATURE AVAILABILITY FOR

INVISALIGN TREATMENT OPTIONS

Invisalign Assist

Invisalign Full

Invisalign Express

Invisalign Teen

Tooth Movement Assessment Compliance Indicator Appointment Planning Progress Tracking

Mid Course CorrectionsProgress Tracking Mid-Course Corrections Tracking Available

Refinements 1 for fee, if qualifies

Passive Aligners Compensation for Erupting Teeth Up to 6 Free Replacement Aligners Precision Cuts

OUR PRESCRIPTION FOCUS TODAY:

• Invisalign “Full” Treatment

• Express – Simple, 10 aligners…

• Assist – Ideal, predictable, limited Rx…

• Teen – Vertical changes, eruption, compliance…

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STARTING A PRESCRIPTION

New Patient Record Completed

Doctor may now start the Prescription

ONLINE FORMS & CLINICAL PREFERENCES

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With each question the related Clinical Preference is accessible and maybe changed for the current patient’s treatment or changes can be applied universally as your default Clinical Preferences

ONLINE FORMS & ATTACHMENT REQUESTS

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Situation Example Default By Doctor Request

Cuspid Rotation

Optimized rotation attachment Not available for optimized attachments. Cannot be combined with lingual attachments

Bicuspid Rotation

Optimized rotation attachment Rotation of other teeth: You may request attachments for rotations not included in default – Very minor rotations of teeth do not receive rotation attachments by default

Anterior ExtrusionOptimized extrusion attachment

Horizontal Beveled Incisally1 mm thickAnterior Intrusion

No bicuspid rotation

-1 mm thickAttachments will be placed bilaterally

Anterior Intrusion Plus a bicuspid rotation

Vertical Rectangular - 1 mm thick

Lower Incisor Extraction

Vertical Rectangular -1 mm thickPlacement on two teeth adjacent to extraction site

Bicuspid Extraction

Vertical Rectangular -1 mm thickPlacement on two teeth distal and one tooth mesial to extraction site

PRESCRIPTION SUMMARY

New Full Rx is easy and intuitive

Comment Section

1. Bullet point your requests 2. Be brief and concise3. Always use reference pointsy p4. Use specific terms for direction5. Quantify amount of movement

Don’t get hung up on your Rx. You will get a chance to address tough issues in your

Clincheck!

DONEis better than

PERFECT

OUR AGENDA:


2. Writing a Prescription

3. Clinical Preferences4. Reviewing Clincheck (+ 5 Key Views)


CLINICAL PREFERENCES

1. Tooth numbering system set in preferences now - not in Clincheck screen.

2. Dual arch treatment – pick similar start or finish. Express is similar finish.

3. Passive aligners are Zero Movement aligners. Applies only to dual start or dual MCC. Not available for Assist.

4. Removing IPR on first CC usually shows a longer, more conservative TX

5. Delay IPR or attachments will slow down TX. Does not apply for MCC or refinement.

Half Size Pontics (or less) will provide better grip on adjacent teeth

Controls where you want to expand in the arch

Amount of expansion per quad (not arch!)

Simplified from old Rx

Classic “Cosmetic set up” - High-Low-High

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Allows for easier insertion/removal

Squeezes teeth together – tightens contact

Apply attachments same for every case

Bodily move teeth with manufactured hooks and button cutouts in aligners

Retrieve your old Special Instructions and paste them here

CLINICAL PREFERENCES

Default settings should only be changed based on your own treatment experience…

Place your Clincheck SettingsClincheck Settings to Align Defaults!

OUR AGENDA:




4. Reviewing Clincheck (+ 5 Key Views)5. 5 Essential Tips, Summary, Questions

CC REVIEW

Standardized System – for every Clincheck

1. Photos, models, Punch List, turn on Advanced Tools and Tooth Movement Assessment.

2. Overview: 90 seconds - write notes!

3 5 Key Views: 2 1/2 minutes write notes!3. 5 Key Views: 2 1/2 minutes– write notes!

4. Evaluate staging, IPR, move/change attachments.

5. Request modifications

6. Add Virtual C Chain Overcorrection and Passive Aligners AS NEEDED.

“S I A M”

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CLINCHECK PUNCH LIST: OVERVIEW

First Step…Every time! (90 seconds)

• Anterior View Play Through 1. Hard Tissue – Incisal Edges, Extrusions, Smile Line.2. Soft Tissue – Gingival Height & Contour, Black Triangles.3. Superimposition Tool is helpful here.

• Buccal View Play Through• Buccal View Play Through1. Saggital (A-P) Movement2. Profile Changes

• Occlusal Views Play Through

• Staging IPR Attachments Movement Assessment

TOOTH MOVEMENT ASSESSMENT TOOTH MOVEMENT ASSESSMENT

X Missing Tooth

Movements programmedhave consistently shown success with the use of the ALIGNERS ALONE

Movements programmed may require additional techniques including BUTTONS & ELASTICS for extrusions & rotations and/or Class II/II elastics

Movements programmed often require additional ORTHODONTIC TECHNIQUES

TOOTH MOVEMENT ASSESSMENT CLINCHECK PUNCH LIST: OVERVIEW


• Buccal View Play Through1. Saggital (A-P) Movement2. Profile Changes



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Midline

Gingival Height

Intrude 1mm

Black Triangle

Incisal Edges Attachment in Contact

Round Trip “Crashing”

IPR






?

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5 KEY CLINCHECK VIEWS

1. Anterior Start and Final View (with GRID!)

2. Buccal Start and Final View

3. Anterior Overjet Play Through

4. Canine Contact Final View

5. Lingual Incisor Play Through


1. Anterior Start and Final View (with GRID!)

• Measure Incisal Edge and Midline Change

• Measure Gingival Height Change - (note: Gingival-Incisal length can change due to RELATIVE

Intrusion and Extrusion)

• Evaluate Bicuspid expansion


2. Buccal Start and Final View

• Is The Bite Right???

This is, by far, the most important step in Clincheck evaluation!!!

• Evaluate the Curve of Spee

• Evaluate Saggital movement

• Evaluate Maxillary Anterior changes (Profile)

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FIXING AN INCORRECT CLINCHECK BITE

1. Send in a new Bite Registration (slow)

2. Send digital photos of… (quick)- Occlusion paper “dots” on teeth- Bite Registration with “show through”- Articulated models (lab shot)- A better Buccal View

“V shaped” Buccal Retractors

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3. Anterior Overjet Play Through

• Does anterior coupling change?

• Is there too much contact at final aligner?

• Evaluate Maxillary Incisor inclination


4. Canine Contact Final View

• Will final placement facilitate Canine Guidance?

• Evaluate posterior cusp inclination

• Evaluate interdigitation


5. Lingual Incisor Play Through

• Evaluate change in bite (deep to shallow?)

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HANDS ON SUPERIMPOSITION & GRID REVIEW

1. Show how to turn on/off

2. superimp – adj shade

3. Grid – adj unit of measurement

4. Why for each

OUR AGENDA:




4. Reviewing Clincheck (+ 5 Key Views)


5 ESSENTIALS TO IDEAL OUTCOMES

1. Evaluate anterior coupling

2. Start with the “Right Bite”

3. Maximize Efficiency

4. Go Grid!

5. Understand Occlusion


1. Evaluate anterior coupling- Does overjet space change???- Ask for more room- Use Virtual C chain Overcorrection aligners- Use Passive aligners

Real C-Chain or Power Chain Virtual C-Chain

At the “ideal” stage, the interproximal contacts have adequate contact at stage 10. To ensure that the contacts are tight

clinically, the doctor has requested a virtual c-chain to cinch up the interproximal contacts. The treatment would now end at stage 13, due to the 3 overcorrection aligners.

Tighter Interproximal contacts

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WHAT TO CONSIDER:

Use virtual c-chain aligners one at a time, on an “as-needed” basis

WHY IT’S IMPORTANT:

VIRTUAL C-CHAIN

WHY IT S IMPORTANT:

If contacts are tight and virtual c-chain aligners continue to be dispensed, there is a high probability of inadvertent intrusion due to contacts becoming too tight.

VIRTUAL C-CHAIN OVER CORRECTION ALIGNERS

• 2 or 3 at end of treatment FOR BOTH ARCHES

• If no passive aligners used, “match up” the OC aligners

• Use only if necessary- 95% of the time, I throw them out

• Usually need lower only• Usually need lower only- Occasionally they are used to close space- Mostly they are used to provide excellent occlusion

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2. Start with the “Right Bite”- Evaluate at the start!- If it is “off”, correct it via1. Ask, if correction is obvious and easily corrected2. Send digital pix of occlusion – perpendicular buccal views!3. Send pix of mounted models, with occlusal and buccal marks4 Send a new bite registration4. Send a new bite registration


3. Maximize Efficiency- Evaluate buccal expansion to reduce IPR- Ask for no IPR first if you need a gauge of possible alternatives- Reduce aligners via monitoring round tripping- Anticipate the “hang ups” – ankylosed and stubborn teeth- Place beautiful, “chiseled” attachments”


4. Go Passive!- Passive aligners reduce the grunge factor- Remove attachments first


5. Understand Occlusion- Difference between CR and CO (or whatever you want to call it!!!)- Unintended posterior intrusion- Unintended Lateral Incisor Intrusion- “The Globe” – Curves of Wilson and Spee- Equilibrating post - ortho

Pre Treatment

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Post Treatment

THANK YOU

mastering clincheck review ate final - amazon s3 · 2015-08-31 · • instructor, ld pankey,...

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