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Top 10 Things

That Can Go Wrong

Dr. David Galler

150 Broadway Suite 1310

NY, NY 10038

invisaligndoc@gmail.com

CREDENTIALS

Graduate of University Of Pennsylvania

Omicron Kappa Upsilon Honor Society

Certified Invisalign 2004

Elite Premier Provider

Presenter at Invisalign Summit Vegas 2007, 2008, 2009

3 Offices in New York

Several Cases Featured on invisalign Website

Invisalign Case Report Published by New York State Dental Journal Jan 2009

WHAT DO YOU DO AT EACH

APPOINTMENT??

I. TRACKING OR

NOT

TRACKING?

II. CLINCHECK

COMPARISON

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TRACKING…

EXCELLENT TRACKING

GOOD TRACKING

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PROBLEM TRACKING

POOR TRACKING

CLINCHECK CHECK

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CLINCHECK CHECK

STAGE 3

CLINCHECK CHECK

STAGE 8

CLINCHECK CHECK

STAGE 20

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TOP 10 MONITORING TECHNIQUES

1. COMPLIANCE

2. TIGHT CONTACTS

3. ATTACHMENTS

4. EXTERNAL FACTORS

5. ALIGNER MISHAP

6. DIFFICULT MOVEMENT

7. LATERALS

8. CROSSBITE CORRECTION

9. TISSUE IMPINGEMENT

10. ROOT POSITION

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I. COMPLIANCE

I. COMPLIANCE

SIGNS TO LOOK FOR:1. MISSED APPOINTMENTS

2. NOT WEARING ALIGNERS AT APPOINTMENT

3. TROUBLE PUTTING ON ALIGNERS

4. ALIGNERS THAT ARE TOO CLEAN

I. COMPLIANCE

SOLUTIONS:

I. Wear Aligner For

Longer Time

II. Motivational

Speech

III. Magic Blue Dot

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II. CONTACTS ARE TOO TIGHT

II. TIGHT CONTACTS

NOT ENOUGH IPR:

1. INCORRECT MEASURING

2. IMPROPER TECHNIQUE

3. NOT DONE IN TIME

4. NOT PROGRAMMED INTO CLINCHECK

5. OTHER TEETH DID NOT DISTALIZE/ROTATE

II. TIGHT CONTACTS

SOLUTIONS:

1. MEASURE WITH UNWAXED FLOSS

2. IDENTIFY LIKELY “TIGHT SPOTS”

3. USE PROPER TECHNIQUE

1. Use the Galler Spacing Technique© (GST)

4. USE PROPER INSTRUMENTS

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II. TIGHT CONTACTS

II. TIGHT CONTACTS

II. TIGHT CONTACTS

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II. TIGHT CONTACTS

Upcoming Invisalign GST Courses

• Mar 5- Las Vegas, NV

• April 14- Philadelphia, PA

• April 22- Fort Lauderdale, FL

• April 23- Miami, FL

• May 5- Toledo, OH

• May 6- Dayton, OH

• May 7- Indianapolis, IN

• June 4- Toronto, ON

• June 17- Joplin, MO

• June 18- Tulsa, OK

• Aug 4-6 TBD, Florida

• Oct 6- Minnesota, Iowa

III. ATTACHMENTS

VS.

CRITICAL FOR

CERTAIN

MOVEMENTS

WHEN YOU ARE

OFF YOU ARE OFF!!

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III. ATTACHMENTS

• PROBLEMS THAT CAN ARISE:

1. Excess Flash Material

2. Too Many Attachments

3. Attachments Put On Incorrectly

4. Not Enough Attachments

5. **Aligner Not Fully Seated**

III. ATTACHMENTS

• SOLUTIONS:

1. Use Pressure to Help them Seat

2. Wear the Aligner for Longer Time

3. Trim the Attachment Carefully

4. Remove the Attachment

5.NEW ATTACHMENT PROTOCOL

III. ATTACHMENTS

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III. ATTACHMENTS

Matt Frasure

941-527-4454

New Protocol Attachment

III. ATTACHMENTS

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III. ATTACHMENTS

IV. EXTERNAL FACTORS

• BE CAREFUL OF:

1.Calculus

2.New Dental Work

3.Pt Chipped a Tooth

IV. EXTERNAL FACTORS

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V. ALIGNER MISHAPS

V. ALIGNER MISHAPS

• MISTAKES WITH ALIGNERS:

1. Patient is Wearing Wrong Aligner

2. Invisalign Package Wrong Number

3. Invisalign Case Mix-Up

4. Attachment Area Is Filled

5. Extra Bleb of Plastic

V. ALIGNER MISHAPS

PT. CASE

NUMBER

UPPER

VS.

LOWER ALIGNER

NUMBER

Original

vs.

Retainer

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V. ALIGNER MISHAPS

VI. DIFFICULT MOVEMENT

“DON’T BELIEVE

EVERYTHING

YOU SEE ON

CLINCHECK…”

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VI. DIFFICULT MOVEMENTS

• PROCEED WITH CAUTION:

1. Tipping vs. Translation

2. Extrusion

3. Rotations

4. Moving Several Teeth at One Time

5. Root Movement

VI. DIFFICULT MOVEMENTS

• SOLUTIONS:

1.Learn the Limits of Invisalign

2.Add Attachments to Help

3.Make Refinement Part of the Plan

VII. LATERALS

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VII. LATERALS

“LUCK THE

FATERALS”

VII. LATERALS

• LIKELY CAUSES:

1. Surrounded By Two Big Teeth

2. Cingulum Problems

3. Surface Area Problems

4. Early Detection System

5. Intrusion

VII. LATERALS

• SOLUTIONS:

1.Add Attachment

2.Buttons and Elastics

3.IPR

4.Conservative Movements

5.**FINISH THE CASE**

-IF THE TOOTH IS IN THE RIGHT POSITION IT DOES NOT MATTER-

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VII. LATERALS

VII. LATERALS

VII. LATERALS

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VIII. CROSSBITE CORRECTION

• COMMON PROBLEM:

1.Anterior or Posterior

2.Tracking is Excellent

3.Doesn’t Match Clincheck

4.**Patient’s Bite is Hiding Progress**

VIII. CROSSBITE CORRECTION

• SOLUTION:

1.Instruct Patient on

Occlusion

2.Wait and Track Progress

3.Do Nothing

IX. TISSUE IMPINGEMENT

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X. ROOT POSITION

X. ROOT POSITION

THANK YOU Questions?

Dr. David Galler

150 Broadway Suite 1310

New York, NY 10038

invisaligndoc@gmail.com