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ePaper created 2018-03-13, 09:28:55 | version 1.38.0
| technique Fig. 1d Fig. 1e Fig. 1f Fig. 1g Fig. 1h Fig. 1d: Treatment sites. Fig. 1e: Immediately after treatment. Fig. 1f: Before and after. Fig. 1g: Merged Ceph/Pan. Fig. 1h: Final. day aligner exchange from three to four months. Where cases are anticipated to extend beyond 50 aligners due to more challenging tooth movements, I then incorporate a second MOP procedure into the treatment plan. For example, in Figures 2a and b, a 28-year-old male patient presented for orthodontic consideration with a vertical Class III skeletal malocclusion characterised by bimax- illary arch constriction, an anterior/posterior crossbite from the left lateral incisor to the left second bicuspid, ret- roclined and extruded mandibular incisors, a mandibular shift to the patient’s left of 3.5 mm, a 1 mm overjet and a 10–15% overbite. A treatment plan including two adjunc- tive MOP procedures and Invisalign with 3/16 in., 6 oz Class III elastics was accepted by the patient. The treat- ment included broadening of the arch form, correction of the crossbite, intrusion of the mandibular incisors with the application of 15° lingual root torque, and intrusion of the posterior teeth to create a mandibular hinge axis of clo- sure of the mandible, to achieve incisal guidance without altering the patient’s maxillary incisal display or extruding the mandibular incisors. In addition, an aesthetic smile arc was planned. The first MOP procedure was conducted at aligner 1, and the patient exchanged aligners every three to seven days, dependent upon the patient’s own assessment of satisfactory aligner tracking throughout the initial set of 45 aligners. The second MOP procedure was conducted at aligner 1 of refinement (Fig. 2c), and the patient exchanged aligners at the same rate of exchange throughout the next 38 aligners. Following with a total of 83 aligners, the patient completed aligner treatment in 16 months 32 ortho 1 2018