September 2020

Melanie Stewart:

  • • Age:  44 yrs

    • Chief Complaint: "I wake up with headaches and jaw pain"

Examination:

  • Complete Medical and Sleep HX, Clinical,  Xray, Perio Exam, Photos, Digital Study Models, Sleep Test, Epworth.

    • Ortho Consult: Recommended Accelerated Invisalign and potential minimally invasive laser palatoplasty and rhinoplasty following the sleep test after Invisalign was completed.

    • Facially Designed Digital Wax-up, direct composite veneers using VOCO GrandioSo Heavy Flow Bleach shade that was cut-back and incisal shade was re-injected and polished.

    • Pt Consult: Risks, Benefits, Alternatives discussed. Patient likes the idea of getting a wider smile to help her sleep and stop her intermittent nocturnal bruxism induced myofascial mypain.

Evaluation: 

  • Lingual inclination

  • V-shaped arches

  • Crowding

Maxillary:

  • Lower arch advanced lower anterior crowding with rotated canines.

Treatment:

• Invisalign Comprehensive Care

• 120aligners / 1 day rotations

• 2 Refinements / 7 day rotations 

• Sleep Testing

Minimally invasive palatoplasty and rhinoplasty using Fotona Lightwalker 4 visits

composite bonding #6-11

• Minimal Gingivoplasty, tooth whitening, and occlusal equilibration. 

• Oromyofunctional Therapy

• 6 mo. treatment  time

Acceleration:

• EOCA Munchies: 10 mins/ 3x day and any time they put their trays back in.

• Microsseous perforation #4-13, 20-29.

Results:

AHI RDI 02

Before 15.5 29.3 82%

After Invis 3.5 5.2 93%

After Laser 0.2 0.5 99%

• Microsseous Perforation #4-13, 20-29

Shon Dempsey