Orthotown June 2022 - 27

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Is compliance going to be a problem with this patient, who's already been treated by another orthodontist twice?
This patient is 19 and was previously treated twice with Invisalign by another orthodontist.
He is a very good clinician and sent me some pre- and posttreatment photos. The patient reports
that immediately after the fi rst round of Invisalign, her teeth began to shift. (She had bonded
upper retaining wires at the time.) She was re-treated, but said after the second round if she left
her clear retainers out for even a day, she would feel her teeth moving.
These scans and photos show her occlusion now. She is Class I on the right side but full Class II
on the left, and #9 is positioned facially. While the patient prefers to have Invisalign again, she
of course wants this to be the last orthodontic treatment she has to go through.
I'm considering extraction of #13 and fi xed appliances to alleviate the crowding and make
a more stable occlusion. Normally I stay away from asymmetrical extractions because I rarely
like the results. Also, had this patient come in with no previous history of treatment, I wouldn't
consider extraction, but I am worried that relapse could occur again (for the third time!).
I'd appreciate any thoughts on how best to approach this case. Thanks! ■
jamortho
Member Since: 03/11/09
Post: 1 of 6
5/16/2022
Her OH seems pretty bad, from what I am seeing. How's her motivation? Did the former
treating ortho say anything about her cooperation? And what happened to her bonded retainers?) ■
The wires were placed after the fi rst round of Invisalign, but removed before the second. The
5/17/2022
original orthodontist thought compliance may have been an issue during the fi rst round, and possibly
in wearing retainers after the second, but lost touch with the patient so he couldn't be sure. ■
5/17/2022
I'm not sure this patient has realistic expectations. She knows her teeth moved after round
one, even though she had retainers. Then she went for round two, and seems to not have worn
any retainers at all after that. So why will round three be any different? Even if you get every
single thing where you want it, whether or not you do extractions, if she does not comply with
retention, it will all go to heck again. Remember that the best predictor of future behavior is past
behavior, no matter what she may be telling you. ■
5/18/2022
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dhmjdds
Member Since: 11/16/04
Post: 5 of 6
jamortho
Member Since: 03/11/09
Post: 4 of 6
dhmjdds
Member Since: 11/16/04
Posts: 2 and 3 of 6

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