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3/25/2010
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Top 10 Things
That Can Go Wrong
Dr. David Galler
150 Broadway Suite 1310
NY, NY 10038
CREDENTIALS
Graduate of University Of Pennsylvania
Omicron Kappa Upsilon Honor Society
Certified Invisalign 2004
Elite Premier Provider
Presenter at Invisalign Summit Vegas 2007, 2008, 2009
3 Offices in New York
Several Cases Featured on invisalign Website
Invisalign Case Report Published by New York State Dental Journal Jan 2009
WHAT DO YOU DO AT EACH
APPOINTMENT??
I. TRACKING OR
NOT
TRACKING?
II. CLINCHECK
COMPARISON
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TRACKING…
EXCELLENT TRACKING
GOOD TRACKING
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PROBLEM TRACKING
POOR TRACKING
CLINCHECK CHECK
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CLINCHECK CHECK
STAGE 3
CLINCHECK CHECK
STAGE 8
CLINCHECK CHECK
STAGE 20
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TOP 10 MONITORING TECHNIQUES
1. COMPLIANCE
2. TIGHT CONTACTS
3. ATTACHMENTS
4. EXTERNAL FACTORS
5. ALIGNER MISHAP
6. DIFFICULT MOVEMENT
7. LATERALS
8. CROSSBITE CORRECTION
9. TISSUE IMPINGEMENT
10. ROOT POSITION
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I. COMPLIANCE
I. COMPLIANCE
SIGNS TO LOOK FOR:1. MISSED APPOINTMENTS
2. NOT WEARING ALIGNERS AT APPOINTMENT
3. TROUBLE PUTTING ON ALIGNERS
4. ALIGNERS THAT ARE TOO CLEAN
I. COMPLIANCE
SOLUTIONS:
I. Wear Aligner For
Longer Time
II. Motivational
Speech
III. Magic Blue Dot
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II. CONTACTS ARE TOO TIGHT
II. TIGHT CONTACTS
NOT ENOUGH IPR:
1. INCORRECT MEASURING
2. IMPROPER TECHNIQUE
3. NOT DONE IN TIME
4. NOT PROGRAMMED INTO CLINCHECK
5. OTHER TEETH DID NOT DISTALIZE/ROTATE
II. TIGHT CONTACTS
SOLUTIONS:
1. MEASURE WITH UNWAXED FLOSS
2. IDENTIFY LIKELY “TIGHT SPOTS”
3. USE PROPER TECHNIQUE
1. Use the Galler Spacing Technique© (GST)
4. USE PROPER INSTRUMENTS
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II. TIGHT CONTACTS
II. TIGHT CONTACTS
II. TIGHT CONTACTS
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II. TIGHT CONTACTS
Upcoming Invisalign GST Courses
• Mar 5- Las Vegas, NV
• April 14- Philadelphia, PA
• April 22- Fort Lauderdale, FL
• April 23- Miami, FL
• May 5- Toledo, OH
• May 6- Dayton, OH
• May 7- Indianapolis, IN
• June 4- Toronto, ON
• June 17- Joplin, MO
• June 18- Tulsa, OK
• Aug 4-6 TBD, Florida
• Oct 6- Minnesota, Iowa
III. ATTACHMENTS
VS.
CRITICAL FOR
CERTAIN
MOVEMENTS
WHEN YOU ARE
OFF YOU ARE OFF!!
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III. ATTACHMENTS
• PROBLEMS THAT CAN ARISE:
1. Excess Flash Material
2. Too Many Attachments
3. Attachments Put On Incorrectly
4. Not Enough Attachments
5. **Aligner Not Fully Seated**
III. ATTACHMENTS
• SOLUTIONS:
1. Use Pressure to Help them Seat
2. Wear the Aligner for Longer Time
3. Trim the Attachment Carefully
4. Remove the Attachment
5.NEW ATTACHMENT PROTOCOL
III. ATTACHMENTS
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III. ATTACHMENTS
Matt Frasure
941-527-4454
New Protocol Attachment
III. ATTACHMENTS
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III. ATTACHMENTS
IV. EXTERNAL FACTORS
• BE CAREFUL OF:
1.Calculus
2.New Dental Work
3.Pt Chipped a Tooth
IV. EXTERNAL FACTORS
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V. ALIGNER MISHAPS
V. ALIGNER MISHAPS
• MISTAKES WITH ALIGNERS:
1. Patient is Wearing Wrong Aligner
2. Invisalign Package Wrong Number
3. Invisalign Case Mix-Up
4. Attachment Area Is Filled
5. Extra Bleb of Plastic
V. ALIGNER MISHAPS
PT. CASE
NUMBER
UPPER
VS.
LOWER ALIGNER
NUMBER
Original
vs.
Retainer
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V. ALIGNER MISHAPS
VI. DIFFICULT MOVEMENT
“DON’T BELIEVE
EVERYTHING
YOU SEE ON
CLINCHECK…”
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VI. DIFFICULT MOVEMENTS
• PROCEED WITH CAUTION:
1. Tipping vs. Translation
2. Extrusion
3. Rotations
4. Moving Several Teeth at One Time
5. Root Movement
VI. DIFFICULT MOVEMENTS
• SOLUTIONS:
1.Learn the Limits of Invisalign
2.Add Attachments to Help
3.Make Refinement Part of the Plan
VII. LATERALS
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VII. LATERALS
“LUCK THE
FATERALS”
VII. LATERALS
• LIKELY CAUSES:
1. Surrounded By Two Big Teeth
2. Cingulum Problems
3. Surface Area Problems
4. Early Detection System
5. Intrusion
VII. LATERALS
• SOLUTIONS:
1.Add Attachment
2.Buttons and Elastics
3.IPR
4.Conservative Movements
5.**FINISH THE CASE**
-IF THE TOOTH IS IN THE RIGHT POSITION IT DOES NOT MATTER-
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VII. LATERALS
VII. LATERALS
VII. LATERALS
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VIII. CROSSBITE CORRECTION
• COMMON PROBLEM:
1.Anterior or Posterior
2.Tracking is Excellent
3.Doesn’t Match Clincheck
4.**Patient’s Bite is Hiding Progress**
VIII. CROSSBITE CORRECTION
• SOLUTION:
1.Instruct Patient on
Occlusion
2.Wait and Track Progress
3.Do Nothing
IX. TISSUE IMPINGEMENT
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X. ROOT POSITION
X. ROOT POSITION
THANK YOU Questions?
Dr. David Galler
150 Broadway Suite 1310
New York, NY 10038