1. ©2006 JCO, Inc. May not be distributed without permission. www.jco-online.com
CASE REPORT
Incisor Intrusion with Invisalign Treatment
of an Adult Periodontal Patient
GAETANO TURATTI, DDS, DOS
RANDOL WOMACK, DDS
PIETRO BRACCO, MD, DDS, DOS
O rthodontic intrusion can be
effective in adult patients
with periodontal disease,1,2 as
Diagnosis and
Treatment Planning
The final ClinCheck** pro-
vided 15 aligners for the upper
arch and 10 for the lower (Fig.
A 43-year-old female pre-
long as light, continuous forces 2). The predicted duration of
sented with extruded, protrusive,
are used and excellent oral hy- treatment was about eight
and labially inclined upper in-
giene is maintained.3,4 Such months.
cisors and generalized anterior
treatment can reduce infrabony spacing (Fig. 1). A fixed prosthe-
defects and improve periodontal sis had replaced the upper right Treatment Progress
health,5-7 but requires a multi- bicuspids and molars. Bleeding
disciplinary approach8,9 and a Scaling and root planing
was evident on periodontal prob-
highly motivated patient. were performed before the start
ing, and the patient had a flat
Stable posterior anchorage of orthodontic treatment, with
upper labial frenum.
can be difficult to achieve in pa- the scaling repeated every eight
Invisalign treatment was
tients with missing teeth.10 Al- weeks.
planned for derotation and intru-
though skeletal anchorage may The first through 10th
sion of the upper incisors and ca-
be useful, the following case nines and uprighting of the upper
demonstrates intrusion of the right central incisor. The lower
upper incisors using only remov- *Registered trademark of Align Technology,
arch required slight intercanine Inc., 851 Martin Ave., Santa Clara, CA
able Invisalign* appliances in an expansion to allow the alignment 95050.
adult patient with periodontal and uprighting of the upper in- **Trademark of Align Technology, Inc., 851
disease. cisors. Martin Ave., Santa Clara, CA 95050.
Dr. Turatti is in the private practice of orthodontics at via F. Pao-
lini 12, 10138 Turin, Italy. Dr. Womack is an Associate Profes-
sor, Orthodontic Department, Arthur A. Dugoni School of Dent-
istry, University of the Pacific, San Francisco; he has presented
educational workshops for Align Technology as an independent
contractor. Dr. Bracco is Chairman, Department of Orthodontics,
University of Turin, Italy. E-mail Dr. Turatti at gaetanoturatti
@aliceposta.it.
Dr. Turatti Dr. Womack Dr. Bracco
VOLUME XL NUMBER 3 © 2006 JCO, Inc. 171

2. Incisor Intrusion with Invisalign Treatment of an Adult Periodontal Patient
aligners were worn for 15 days while the last lower aligner was Discussion
each, except that a frenectomy being worn, to allow root move-
was scheduled during the sixth ments. At the end of active treat- Invisalign appliances pro-
aligner period to reshape the gin- ment, the patient wore the last set vided a viable alternative to con-
gival marginal without traction of aligners for an additional four ventional orthodontic intrusion
from the upper frenum (Fig. 3). weeks. in this patient, aligning the ex-
This aligner was worn for three The entire Invisalign treat- truded incisors in a relatively
weeks as the tissue healed. ment lasted 11 months (Fig. 4). short time with no need to re-
The last five upper aligners Fixed lingual retainers were then move the posterior prosthesis.
were changed every three weeks, placed in both arches. The post-treatment radiographs
Fig. 1 43-year-old female patient with extruded, protrusive, and labially inclined upper incisors, prosthetic
replacement of upper right posterior segment, and periodontal disease before treatment.
172 JCO/MARCH 2006

3. Turatti, Womack, and Bracco
Fig. 2 Invisalign treatment planning with ClinCheck.
Fig. 3 Frenectomy performed to reshape gingival margin without trac-
tion from upper frenum.
before
after
Fig. 4 Patient after 11 months of Invisalign treatment.
VOLUME XL NUMBER 3 173

4. Incisor Intrusion with Invisalign Treatment of an Adult Periodontal Patient
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174 JCO/MARCH 2006