CA® CLEAR-ALIGNER Therapeutic Possibilities

Abstract

In this article, different CA® CLEAR-ALIGNER therapeutic possibilities are demonstrated through the case reports presentation.

Keywords
CA® CLEAR-ALIGNER. Therapeutic possibilities.

Introduction

Definition
The CA® CLEAR-ALIGNER technique is an orthodontic treatment whose appliances consist of transparent, esthetic, comfortable, effective, progressive and sequential aligners.
It allows the treatment of many patients who don’t want to wear fixed appliances. Normally, the CA® CLEAR-ALIGNER is used in adult patients, but it also can be used in mixed dentition.

Characteristics
– Three different aligners which vary in thickness are used: CA®-soft, CA®-medium and CA®-hard.
– It is made step by step and one at the time with each impression. It is sequential. According to our experience and depending on the characteristics of the case or circumstances of a patient (if a patient is able to attend the appointments at the dental office, if he is on a holiday, traveling, etc.), 2 or 3 steps can be carried out using the same impression.
– It is a progressive treatment, carried out on the basis of the plaster cast set-ups. The precision of a planning and a set-up realization is a basic principle of an effective treatment.
– It covers 3-4 mm of gingival tissue to improve the esthetics and to optimize the movement.

Advantages
CA® CLEAR-ALIGNER is made from plaster casts poured from the impressions taken at each appointment. This procedure allows:
– To adapt to the changes that might happen in the teeth, such as abrasions, fractures, fillings, etc.
– To use it in mixed dentition, adapting the treatment to the changes that the dentition undergoes, such as exfoliation of temporary teeth, or eruption of permanent teeth.
– To adapt to the possible relapses or dental movements produced due to the poor use of CA® CLEAR-ALIGNER.

Being sequential, the CA® CLEAR-ALIGNER has additional advantages for a specialist.
– It allows the specialist to study the case evolution at each step, and to readjust the treatment plan, if necessary. Therefore, an evaluation and readjustment at the end of the treatment are not necessary.
– The adjustment of CA® CLEAR-ALIGNER is very precise, so any kind of change that might occur in dentition (fillings, etc.) would affect its retention and effectiveness. It is possible that a patient needs some kind of intervention during the treatment, and with a new impression, the CA®CLEAR-ALIGNER can be adjusted again.
– It is very hard to carry out the stripping in a patient with the precision of 0.25 mm. Therefore, in CA® CLEAR-ALIGNER technique, the stripping is carried out before taking the new impressions. In this way, the trimming carried out in a patient is reproduced in the plaster cast, instead of reproducing the trimming carried out on the plaster cast in the patient.
– The relapse doesn’t normally happen in a symmetrical way, reverse to the treatment. That’s why a patient who interrupted the treatment cannot use the same appliances again if he wants to continue his treatment. The relapse, among other things, depends on habits or dysfunctions the patient might have. With the CA®CLEAR-ALIGNER, the treatment can be readjusted by taking a new impression at any moment of the treatment.
– It is not necessary that the whole treatment is paid at the beginning of it – it can be paid step by step, as they are finished.
– The CA® CLEAR-ALIGNER offers a solution to those patients who need smaller movements treatment or a relapse treatment.
– The CA® CLEAR-ALIGNER is: esthetic and comfortable, it doesn’t cause any difficulties in pronunciation (although some patients may need reading exercises during the first days of the treatment).
– It has a simple mechanics, reduced chair-time, it is fast, and the relation cost/benefits is favorable.
– The CA® CLEAR-ALIGNER can also be used in mouth breathers or sleep apnea patients.

CA® CLEAR-ALIGNER

Principles
– It should be an orthodontic treatment with esthetic and comfortable appliances, compatible with the social and professional life of patients.
– The diagnosis and the treatment control should be carried out by dentists and orthodontists.
– It should offer a rapid and efficient solution to the patients who don’t want to use fixed orthodontic appliances.
– It should have a detailed clinical procedure.
– It should have a detailed laboratory procedure.
– It should have an efficient clinic-laboratory communication protocol.
– The results should be predictable.
– The aligners of different thickness are used, and they cover approximately 3 mm of gingival tissue for more effective movement and more esthetic effect.
– The impressions should be taken periodically to adapt the appliances to treatment evolution and to the changes that can occur in teeth and gingival tissues.
– It is mainly aimed at patients who need treatments based on minor tooth movement or treatments of relapse in incisors and canines.

Indications
– Space closure up to 4 mm.
– Crowding correction up to 4 mm (6 mm).
– Correction of anterior teeth rotation.
– Anterior deep bite treatment.
– Anterior open bite treatment (with CA® POWER GRIPS).
– Cross bite treatment.
– Molar uprighting up to 10º.
– CA® CLEAR-ALIGNER used in mixed dentition.
– CA® CLEAR-ALIGNER as a part of other treatments.
– CA® CLEAR-ALIGNER in a relapse treatment.
– CA® CLEAR-ALIGNER as a passive /active retention appliance. Double retention.

Limitations
– Closure of more than 4 mm (6 mm) spacing.
– Correction of more than 4 mm crowding.
– Correction of posterior teeth rotation.
– Extraction cases.
– Bodily movement of the teeth.
– Anterior open bite treatment (without CA® POWER GRIPS).
– Intercuspation and extrusion treatments (without CA® POWER GRIPS).
– Treatments that imply strict control of torque or mesio-distal tipping.
– Class II treatments.
– Class III treatments.

Counter indications
CA® CLEAR-ALIGNER is counter indicated in patients who present:
– Bruxism clenching and grinding.
– Cranio-mandibular dysfunction.
– Habits like nail biting, lip biting, object biting, etc.
– Hyper sensibility to materials CA® CLEAR-ALIGNER is made of, although up to now, such cases weren’t still reported (Polyethylene terephthalate).
– Non-cooperative patients.

Case reports

The CA® CLEAR-ALIGNER therapeutic possibilities can be studied through the following case reports.

Case Nº 01416: Case with spacing in maxilla (8 steps) and crowding in mandible (4 steps).

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Figs. 1-5: Initial intraoral photographs.

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Figs. 6-10: Final intraoral photographs.

Case Nº 01377: 23 and 25 should be intercusped. One CA® CLEAR-ALIGNER step – Forced extrusion of 23-25.

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Figs. 11-15: Initial intraoral photographs.

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Figs. 16-21: Treatment progress.

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Figs. 22-26: Final intraoral photographs.

Case Nº 00561: Crowding and rotation in both arches. Deep bite. Treated with expansion and stripping, and upper and lower incisors intrusion. Maxilla: 12 steps. Mandible: 13 steps.

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Figs. 27-31: Initial intraoral photographs.

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Figs. 32-36: Final intraoral photographs.

Case Nº 00581: Molar Class I with crowding. Maxilla: 4 steps. Mandible: 3 steps.

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Figs. 37-41: Initial intraoral photographs.

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Figs. 42-46: Final intraoral photographs.

Dr. Pablo Echarri