Complex malocclusions are present in our practices and create many challenges for us to treat our patients best. Besides the range of malocclusions we see every day as orthodontists, there are times when we observe unusual tooth positions and unique problems that require innovative approaches with the appliances we have available. As a result, there have been several patients who I have seen in my practice with such unique challenges. In addition to complex issues, we aim to treat them with clear aligners. In these cases, I have found that using adjuncts helps us deliver predictable outcomes and surpass the challenges presented.
Some of the adjunct treatment modalities we have available include using fixed appliances with a combination of clear aligner treatment. For some issues, it is helpful to bond a simple device that works synergistically with the aligners. These adjuncts can reinforce less predictable movements or achieve movements that fixed appliances do best while allowing the patient to experience all of the benefits of a clear aligner appliance. For example, adjuncts to treatment can be as simple as buttons and power chains and can extend to brackets and wire segments to manage complicated movements. Furthermore, these additional tools can make the patient’s treatment more manageable in complex cases.
Case Study Using Adjuncts with Clear Aligner Treatment
Let’s review an example of a challenging case that had poorly positioned premolars. His primary second molars were retained for this patient, his second premolars erupted palatally, and they were severely rotated. A treatment plan was developed where to extract the primary molars, and clear aligners would be the main working appliance. Buttons and power chains were used as adjuncts to de-rotate the premolars. Precision cut-outs were planned to accommodate the buttons and interface between the two appliances. In these images, you can see the treatment plan’s succession until completing the first series of aligners.
As this case shows, using a combination of fixed and removable appliances can work synergistically to make the treatment more predictable. Consider adjuncts in your complex treatment plans so that you can implement efficient and effective clear aligner therapy.
