Invisalign Treatment for Adult with Spacing and Previous Failed Orthodontics

This case demonstrates the successful orthodontic treatment of a 50-year-old male patient who presented with maxillary spacing, dental rotations, excessive overbite, and bruxism. The patient had undergone previous aligner treatment at another office that did not achieve his desired outcome. Using Invisalign with interproximal reduction, treatment successfully closed all maxillary anterior spaces, corrected the overbite, and resolved rotations while working around existing mandibular implants. At one year follow-up, the patient's teeth remained stable and he had maintained his smile.

Patient Overview

Patient D.G. is a 50-year-old male who sought orthodontic treatment to address spacing concerns in his upper anterior teeth. He had previously undergone aligner treatment at another dental office for approximately fourteen to fifteen months the year before, but was not satisfied with the outcome. Despite his previous unsuccessful experience with orthodontic treatment, he remained motivated to achieve his aesthetic goals and was willing to pursue treatment again with realistic expectations.

Chief Complaint

The patient's primary concern was the presence of spaces between his upper two front teeth. He specifically wanted to close the spaces in his maxillary anterior region to improve the appearance of his smile. This concern was particularly significant given that he had already attempted treatment elsewhere without achieving the desired result.

Diagnostic Findings

Clinical examination revealed a Class I malocclusion with several notable features. The maxillary arch presented with spacing and rotations, while the mandibular arch exhibited rotations as well. The patient had an excessive overbite that required correction. Evidence of bruxism was present, and gingival recession was noted. Additionally, the patient had dental implants on the mandibular left first and second molars, which would serve as fixed anchor points that could not be moved during orthodontic treatment, requiring all other teeth to be repositioned around these implants.

Treatment Options Considered

Two primary orthodontic treatment modalities were discussed with the patient: traditional braces and Invisalign clear aligner therapy. An alternative non-orthodontic approach was also presented, which involved placing veneers by his dentist on his teeth to close the spaces without moving the teeth orthodontically. Each option was explained with its respective advantages and considerations, particularly given the patient's previous unsuccessful aligner treatment and the presence of mandibular implants that would complicate tooth movement.

Selected Treatment Plan

The patient chose to proceed with Invisalign treatment to address his aesthetic concerns. This decision was made despite having undergone previous aligner treatment elsewhere that did not meet his expectations. Before beginning treatment, realistic expectations were established with the patient. He was informed that he would likely develop some spaces at the back of his lateral incisors and canines, and that some triangular spaces might appear in the upper incisor area due to the shape of these teeth. The patient understood these potential limitations and decided to proceed with orthodontic treatment rather than pursuing the veneer option.

Procedures Performed

Treatment began with the fabrication and delivery of the first set of Invisalign aligners. Interproximal reduction was performed in the mandibular arch to facilitate tooth movement and improve interproximal contacts. The patient progressed through the initial series of aligners as planned. Following completion of the first set of aligners, a refinement scan was performed to assess progress and identify any remaining discrepancies. Additional aligners were ordered based on this refinement scan to complete the final detailing of tooth positions. At the conclusion of active treatment, all attachments were removed from the teeth, and a final scan was taken to fabricate the patient's retainers.

Materials and Technologies Used

The primary treatment appliance utilized was the Invisalign clear aligner system. Interproximal reduction was performed in the mandibular arch using appropriate instrumentation to create space and improve tooth contacts. Digital scanning technology was employed at multiple stages of treatment, including the refinement phase and final retainer fabrication. Clear retainers were fabricated for long-term retention following active treatment.

Clinical Challenges

This case presented several significant challenges that required careful treatment planning and patient communication. The most notable challenge was that the patient had previously undergone aligner treatment at another office for approximately fourteen to fifteen months and was dissatisfied with the outcome. This history required establishing realistic expectations and rebuilding the patient's confidence in orthodontic treatment. The presence of dental implants on the mandibular left first and second molars created a fixed reference point that could not be moved, requiring all other teeth to be repositioned around these implants. This limitation necessitated careful biomechanical planning to achieve the desired result. Additionally, the shape of the upper incisors meant that closing spaces would likely result in some triangular spaces in the anterior region and potential spaces at the back of the lateral incisors and canines. Managing the patient's expectations regarding these aesthetic compromises while still achieving his primary goal of closing the maxillary anterior spaces was essential to treatment success.

Final Outcome

The treatment successfully achieved the patient's primary goal of closing the spaces between his maxillary anterior teeth. All spaces in the maxillary anterior region were closed, and the patient's excessive overbite was corrected. The rotations present in both arches were resolved, and the patient achieved an improved smile that he was very happy with. At the one-year follow-up appointment for his retainer check, the patient's teeth remained stable in their corrected positions. He had maintained his smile, and the treatment results had been sustained with proper retainer wear.

Clinical Lesson for Other Dentists

This case demonstrates the importance of thorough case assessment and realistic expectation management, particularly when treating patients who have had previous unsuccessful orthodontic treatment. When a patient presents after failed treatment elsewhere, it is essential to identify why the previous treatment did not succeed and to communicate clearly about what can and cannot be achieved with retreatment. The presence of fixed structures such as dental implants requires careful treatment planning, as all tooth movement must occur around these immovable anchor points. In cases which certain tooth shape and anantomy, the patients must be counseled that closing spaces may result in triangular black spaces or spacing in other areas due to the altered gingival architecture. Presenting alternative treatment options, such as restorative solutions with veneers, allows patients to make informed decisions about their care. Finally, this case illustrates that even when aesthetic compromises are anticipated and discussed, patients can still achieve satisfying outcomes if their primary concerns are addressed and expectations are properly managed from the beginning.

Treatment Results

• Complete closure of all maxillary anterior spaces, including the spaces between the upper two front teeth
• Correction of excessive overbite to proper vertical relationship
• Resolution of maxillary and mandibular dental rotations
• Successful tooth movement around fixed mandibular left first and second molar implants
• Stable occlusion maintained at one-year follow-up with proper retainer wear
• Patient satisfaction with final smile appearance despite anticipated minor triangular spacing

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Related Dental Services

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