Michael: 

• Age 40

• Chief Complaint: Crowding and Smile

Examination: 

• Complete clinical exam, Pano and Xrays, Perio, 

• Sleep screening, Photos and Dental Health Scan

• Perio Specialist consult for post alignment grafting

Evaluation:

• Cl 1 malocclusion

• Advanced crowding

• Lingually inclined

• Narrow vaulted palate

• Active Perio disease and

• Recession

• Compromised hygiene

• Mouth breathing and compromised oral volume

• Screened negative for sleep apnea although high risk factors

Treatment:

• Invisalign comprehensive

• Periodontal consult and therapy

• Ramp up technique:  2 weeks first month 1 week there after

• Progressive IPR and equilibration

• Munchie Madness protocol (Dr Bunkers) 15 min 4 times a day and upon seating

• Phase 1 health- 35 aligners 10 months 

• Phase 2   Esthetic - patient was pleased but we did two esthetic refinements 10 and 8 aligners

• Total tx time 20 months (Covid)

• Final equilibration and whitening

• Vivera retention and Happy Healthy patient 😀