Recently the patient pictured above came in requesting that
I order more Invisalign retainers for her. (She was not returning to the treating orthodontist
because she had moved.) She had been
wearing Invisalign retainers for many years and was happy with how her teeth
looked. She knew that she needed to wear
retainers the rest of her life to keep her teeth straight. Orthodontically the
result was less than satisfactory. The
top teeth overlapped the bottom teeth over 75% in the front (they should only
overlap 1-2mm), and unless the patient postured her lower jaw forward, the
front teeth could not meet like scissors to cut food. In addition, the gum was “creeping
down” on the back teeth so that the roots stuck out. This loss of periodontal attachment is
frequently seen in patients that grind their teeth or wear flexible retainers
(like Invisalign and Essex retainers) long term. The loss of attachment is accelerated
when there is also a little bit of inflammation in the gums (from not brushing
effectively and not flossing every day.) I suggested that we change her retention
appliance. Rigid retainers would
minimize the rate that the gum- coverage of the roots would be lost in the
future. An occlusal guard would give the patient a comfortable place to bite,
at least at night when she was wearing it. We decided to make an occlusal guard
for the top teeth (a rigid piece of plastic which fits on the top teeth, but is
adjusted to touch all of the bottom teeth when the teeth are closed) and a Hawley
retainer for the bottom teeth (an orthodontic retainer with a front wire to
keep the front teeth aligned with the hard plastic which sits on the tongue
side of the teeth).
The result was astounding.
At the visit that the occlusal guard was delivered the patient commented
on how comfortable her bite felt, and that her face felt so much more relaxed
than it did without the guard. The
muscles in her face did not have to work so hard when the teeth were closed on
the guard because the bite against the plastic was balanced from "right to left" and "front to back". This never happened
when she closed her teeth. She assured
me that she would wear the lower retainer and upper guard every night forever,
not only because she wanted to guarantee that the teeth stayed straight, but
because they made her face feel so much better.
I know that patients will continue to ask for aligner
treatment like invisalign, and I know that the results may not always be
satisfactory. But as the case above
demonstrates, there is a long term solution for these patients which will
retain tooth alignment, preserve the bones and gums that hold these teeth in
the mouth (i.e. Keep the periodontal
attachment), and allow the chewing muscles to relax 1/3 of the rest of their
life (i.e. 8 hours out of every 24.) Once again, a patient has left my office
happy with her treatment.
Posts
