Case 1: Deep Bite w/ Spacing using Temporary Anchorage Devices (TADS)
n this case, the patient presented with a 100% deep bite with large space (diastema) between his front two teeth. It would have been impossible closing the space unless we opened his bite. We decided to use micro TADs, which are the abbreviation of temporary anchorage devices to intrude the maxillary teeth, allowing us to first open the bite, and second, close the space between the front two teeth. This patient was in treatment for 18 months.
Case 2: Underbite with Crowding
This patient presented with a Class III skeletal (underbite) with maxillary (upper jaw) crowding. The patient wore Invisalign for 13 months. During her treatment we performed interproximal reduction in the mandibular (lower) jaw to bring the lower teeth backwards, while we proclined (moved forward) the upper teeth.
Case 3: Early Treatment / Severe Overjet
At Florman Orthodontics we have developed a series of steps and use specific appliances to treat Class II overjet cases like this one. This case was treated in two phases taking a total of three years. In the early phase I we aligned the patient’s teeth and corrected the overjet problem 80 % of the way. We then waited for the remaining permanent teeth to erupt, and then began the second phase of treatment. In the second phase of treatment we corrected the remaining overjet and and aligned the remaining teeth.
Case 4: Moderate Crowding
This patient presented with moderate adult crowding and was treated with braces in 10.5 months. Note special attention and techniques were used not to increase the recession the patient presented with.
Case 5: Invisalign Crowding / Moderate
Case 6: Spacing Invisalign
The following patient requested to be treated with Invisalign to have her spaces closed. The treatment time took 12 months.
Case 8: Crowding Invisalign
This patient presented with an anterior crossbite, moderate to severe crowding and an open bite tendency. We treated this patient with Invisalign and some interproximal reduction. Invisalign offers some posterior bite intrusion to aid in the closure of the bite while we are expanding the arches to make room for the crowding. The total treatment time for this case was 18 months. Due to the amount of crowding in the lower arch there were some black triangles present at the end of treatment which can not be avoided.
Case 9: Spacing Invisalign Treatment
This patient presented with spacing in the maxillary (upper ) arch, and requested Invisalign treatment. What makes some maxillary (upper) spacing cases more challenging than others is when the mandibular (lower) teeth are articulating (touching/hitting/functioning) with the opposing teeth. The only way to correct the spacing problem is to either open the bite, retract the lower teeth, or a combination of both. We performed some interproximal reduction in the lower arch, intruded the upper teeth to open the bite, and retracted the upper teeth. This case took 6 months.
Case 10: Tongue Thrust / Open Bite / Spacing
This patient presented with an anterior open bite and anterior spacing caused by a tongue thrust she had since she was a child. Tongue thrusts are very common and go undiagnosed until patients go see orthodontists to correct spacing and open bite issues. This patient was treated with Invisalign. Spaces in the posterior will be restored with implants in the future.
Case 11: Crowding / Arch Deficiency
This case is an excellent example of a child at age 9 that presented with inadequate room for her permanent cuspids. In her phase one treatment, we used maxillary and mandibular expanders and enlarged the arch circumference in both jaws, creating room for her teeth to erupt. Once we guided the cuspids into place, we began her second phase of orthodontic treatment and finished straightening all her teeth in both jaws. Total treatment time was 33 months for both phases of treatment.
Case 12: Anterior Open Bite w/ Bilateral Posterior Cross Bite
This patient presented with an anterior open bite with bilateral cross bites. We decided to use fixed appliances (braces) to treat this patient. After 13 months, with minor interproximal reduction and posterior occlusal adjustment, we were successful in correcting the posterior crossbites on both sides and the anterior open bite. The reason we chose braces instead of Invisalign was two fold: First, this is considered a very difficult case, and in difficult cases, we have much more predictability using braces over Invisalign. Second, in anterior open bite cases, patients need to use anterior elastics to close the open bite. Invisalign relies on anterior attachments that are just not as efficient. We tell all patients the same thing, if we can guarantee you a better result faster using braces, you should do braces. Recently Invisalign came out with marketing stating that they are able to close open bites. We have done numerous cases using Invisalign to close open bites, and yes we can get some closure, but it is not the same as using fixed appliances with elastic wear in our professional opinion.