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ePaper created 2018-03-13, 09:28:55 | version 1.38.0
technique | Fig. 1a Fig. 1b Fig. 1a: Initial. Fig. 1b: Treatment plan. Fig. 1c: Treatment sites. would be used and that the treatment would be com- pleted in 12 months. The treatment plan included creat- ing graduated Curves of Spee in both arches by means of maxillary molar and second bicuspid intrusion and man- dibular first molar and second bicuspid intrusion, follow- ing one of Dayan’s posterior tooth intrusion protocols for anterior open bites.9 The intrusion mechanics were antic- ipated to generate a mandibular hinge axis of closure that would create a forward projection of the chin point to improve the patient’s profile and establish incisal guid- ance while respecting the patient’s maxillary incisal dis- play without the use of elastics. The anticipated forward projection of the mandible offered the secondary benefit of applying interproximal reduction to the proclined man- dibular incisors to create space to upright these teeth to an improved position, and to increase the overjet through incisor retraction to accommodate the forward projection of the mandible. In addition, a broadened arch form was expected to be created to address the dark buccal cor- ridors without concern for opening the patient’s vertical further, by virtue of the occlusal coverage afforded by the aligners as well as the adjunctive treatment. The maxil- lary incisors were extruded less than 1 mm to establish an aesthetic smile arc. Fig. 1c number and position of the perforations conducted. In addition, MOP was also conducted distal to the maxil- lary second molars to maximise molar intrusion. Treat- ment with 49 aligners was completed (Figs. 1f–h) in seven months and three weeks on a schedule of three- to five- day aligner exchanges, dependent upon the patient’s own determination of appropriate aligner tracking. Based upon experience with cases of a comparable nature where MOP was not used, use of MOP in this patient resulted in excep- tional and uninterrupted aligner tracking, achievement of all treatment goals to the patient’s satisfaction, and a treat- ment time truncated by approximately five months. In order to support the intrusion mechanics, MOP was conducted in both arches and supported further by the patient’s use of rubber gum. Figures 1c–e illustrate the Case 2: Occasionally, more complicated cases will require more than one MOP procedure. In my experi- ence, the average MOP procedure will permit a three- ortho 1 2018 31