Dr Wesley’s Invisalign Journey Episode 10: Refinement Treatment Planning
Orthodontics is an awesome profession! It combines science, art, and critical thinking to produce and beautiful yet functional masterpiece. One of my favorite parts of Orthodontics, is treatment planning (coming up with the treatment and its sequence). It takes a lot of knowledge and though but is very rewording when you see your plan come to fruition. When we take out our refinement records, it is an opportunity for the orthodontist to sit down and analyze the progress that has been made, identify any areas of the plan that are lagging behind, or it creates an opportunity to shift the direction of the plan if they see that it needs to do so.
This video is one of my favorites! In it I review the original treatment goals, talk about the ease of my experience thus far, and discuss how I will be taking my own treatment plan in a new direction. It involves teeth extractions, my big nose, an ankylosed tooth, some metal hardware, and rubber bands! How could you possibly miss this?!
I want to share some additional commentary on the video. You will hear me discuss an ankylosed tooth. This is one of the greatest challenges for an orthodontist. Normally, a tooth is connected to bone via ligaments. This is what allows teeth to move. In the case of ankyloses, the root of the tooth is fused directly to the bone. This means it will not move! You can imagine why this is a challenge for my kind. There are several causes for ankylosis that we can chat about if you are interested. There is however, little that we can do to correct them. Sometimes these teeth can be wiggled loose like a tooth extraction so that they are mobile just long enough to move them in to position. In my case, it was decided to attempt to cut off the root of the area that was thought to be fused to bone. It was a great idea but neither were successful. You will see in this video what a challenge it has caused.
You will also notice that through the several procedures that it took to perform this “root amputation”, combined with aggressive brushing, my roots have been exposed. This root exposure created an opportunity for cavity-causing bacteria to nestle in. This was my first cavity! No matter how diligent I was about cleaning my teeth, there are just some areas, like the little groove between your roots, that are next to impossible to keep free from decay. I share this with you because I want to stress the point that a periodontal specialist MUST be seen when you have recession, bone loss, and especially root exposure. A common problem in dentistry (one that even I had to learn the hard way) is that “if it doesn’t hurt then I don’t need to go”. Proactively taking care of unseen issues saves a lot of time, discomfort, and money.
I also discuss ways that I can correct my “class II malocclusion”. Class II malocclusion means that my top arch is more forward than my bottom arch or my bottom arch is more setback relative to my top arch. This can be a problem with the size or shapes of your jaws. It could also just be in the way your teeth align. In my case, it is more of a jaw size and shape issue. Jaw issues are ideally corrected with surgery but it does not effect my quality of life so much that I want to undergo a procedure like that. I will therefore accept a few compromises (from perfection) and correct the skeletal (jaw) issue, dentally. I could have chosen to do this in several different ways but I saw it as a good opportunity to use an appliance that I use almost daily on my patients. Like my aligner therapy, I felt it was a great opportunity to understand the product from the other patient side.
This video is loaded with a lot more information and I would be happy to chat in more depth about anything that may spark your interest (even the Lions going to Miami for the Superbowl). Please comment on the blog below or email me at firstname.lastname@example.org .
Gerald W. Wesley, DDS, MS