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ePaper created 2018-03-13, 09:28:55 | version 1.38.0
| technique Fig. 2e Fig. 2e: Final. (Figs. 2d–e), followed by an additional two months of elastic wear with four additional passive aligners (exchanged every two weeks), for a total of 18 months total treatment. Although all patients are interested in reducing their treatment time, some are not amenable to MOP. For these patients, any adjunctive non-surgical device that has the potential to reduce treatment time by 25–30% has been demonstrated in surveys to be of interest.4 While the science supporting vibration as an adjunct for tooth move- ment is sparse, HFV technology appears to be a poten- tially viable alternative for these patients. Clinical experi- ence has demonstrated HFV’s capacity to enhance aligner seating, which is particularly important with patients that fail to wear aligners the recommended 20–21 hours per day. The ability to progress treatment forward with less than fully compliant patients results in a reduction in mid- course corrections and refinements, and thus in effect sec- ondarily reduces treatment time. Moreover, these devices have demonstrated the additional capacity to reduce the discomfort associated with tooth movement.10 Case 3: The following example is illustrative. In Figures 3a and c, a 64-year-old female patient presented with a Class I malocclusion characterised by moderate incisor crowding, a 30% overbite and a 2 mm overjet. She initially agreed to MOP, but changed her mind at aligner delivery. In addition, she refused any attachments. How- ever, she elected to use a VPro5, a high-frequency aligner seater device (Propel Orthodontics) for five minutes daily and to wear the aligners 21–22 hours per day. With a seven- day aligner exchange, her estimated treatment time was approximately eight months and two weeks. Treatment with 33 aligners was completed in five months and three weeks with a five-day aligner exchange, which is a decidedly 30% truncated treatment length when compared with the original anticipated treatment using a seven-day protocol. In addition, the patient indicated that the discomfort associated with new aligner exchange was immediately alleviated with the HFV seating device, and enabled her to progress with a truncated aligner exchange without discomfort. The patient was satisfied with her result and rejected any refinement. Case 4: Over the past two years, I have used MOP in combination with the HFV aligner seating device. The fol- lowing is an example of these cases. In Figures 4a and b, a 60-year-old female patient presented with a Class I mal- occlusion characterised by bimaxillary constriction mani- fested as severe maxillary and mandibular crowding, and a deep bite (80% overbite) with severely retro clined and super-erupted mandibular anterior, and a steep inter- incisal angle (158°) outside of the physiological range. The treatment plan included 3 mm intrusion of the man- dibular incisors and 1 mm extrusion of the maxillary lateral incisors, to preserve the patient’s incisors display while creating an aesthetic smile arc. MOP was conducted from the distal aspects of the first premolar in both arches, 34 ortho 1 2018