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Comprehensive Orthodontics with Invisalign Dr. William Dayan

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As Invisalign continues to grow in the orthodontic marketplace, many malocclusions are being successfully treated with Invisalign. At the same time, many clinicians have attempted to treat similar conditions with Invisalign and report unsuccessful results. Like so many orthodontic appliance systems, the key to success often begins with understanding the underlying principles of the appliance system, and then using the system in appropriate cases. The key to success with Invisalign is: comprehensive orthodontic diagnosis and treatment plans, and understanding the underlying mechanical principles of how Invisalign can move teeth.

There are many books and courses that deal with comprehensive orthodontic diagnosis and treatment planning, and it will not be the scope of these articles to review this important step. However, one should never skip this step and think that Clincheck software will account for all the possible clinical choices the treating clinician should actively decide.

The purpose of these articles is to demonstrate how the underlying mechanical principles of the Invisalign aligners place forces upon the teeth, and how to take advantage of these principles in certain orthodontic conditions.
The critical message to remember is that the teeth in the patient's mouth move only in response to forces placed upon them. Depending on the direction of the forces, the location of the forces on the teeth, and the center of resistance of the particular tooth in question, the tooth will then move accordingly. In summary, the teeth do not watch the "Clincheck movie," they only listen to forces. The clinician must stop viewing the Clincheck treatment plan as moving teeth. Rather, the Clincheck treatment plan represents future aligner surfaces that will then potentially place forces upon teeth depending on the direction of movement, the surface anatomy of the tooth and other factors to be detailed in future articles.

In order to make these articles very practical and immediately useful to the clinician, the topics to be covered will be typical conditions often encountered as a part of an overall orthodontic treatment in any one patient.

Leveling Curve of Spee and Reducing Deep Overbite
with Invisalign
Many orthodontic cases require leveling of the curve of Spee, or intrusion of anterior teeth as a part of the overall treatment objectives in the orthodontic correction of the malocclusion. Invisalign can be effective at this type of movement, however some special attention is required in both the Clincheck treatment plan setup and in the finishing of such cases.

The Clincheck Treatment Plan Setup:
1. Attachment Design: The anchorage for intrusion of anterior teeth comes from the ability of the aligners to be firmly held onto the teeth immediately distal to the intrusion. This means that if the cuspids are not being intruded in the Clincheck treatment plan, then they can be anchorage for the intrusion of incisors. However if the cuspids are being intruded as well, the anchorage teeth are the premolars and possibly molars (Fig. 1). In order for the aligners to be firmly held onto the anchorage teeth to support the intrusive forces on the anterior teeth, attachments are placed that will maximize the gingival working side of the attachments which will lock the aligners onto these teeth (Figs. 2 & 3).



2. Bite Turbos: To avoid the posterior bite block effect of full-time aligner wear, anterior bite turbos can be placed on the lingual of the upper anteriors (Fig. 4). These bite turbo attachments do not need to be attached to the teeth as the purpose of these ledges are served by the removable aligners, not by actual resin attached to the actual teeth. These ledges in the aligners can help in providing a ledge of aligner material that will act as an anterior bite plane during treatment and avoid heavy posterior contacts of upper and lower aligners (Figs. 5 & 6). If the patient's horizontal overjet is too large for the bite turbos available by the Clincheck software alone, then the clinician can choose to bond other commercially available bite turbos on the lingual surface of the maxillary anterior teeth prior to Invisalign impressions. The clinician can then ask that the aligners be built with this lingual anatomy on the aligners as if it is the actual lingual anatomy of the teeth themselves. Alternatively, one can delay the start of maxillary Invisalign alignment and fabricate local Essix retainers or other removable maxillary anterior bite planes with considerable horizontal length; have the patient wear these other bite planes while the lower arch is started earlier for initial leveling and alignment.





3. Overcorrection: Just as in braces and wires, the reverse curve of Spee correction placed into a wire is exaggerated in the opposite direction of the malocclusion to produce an adequate force system to level the actual curve of spee clinically. The aligners must be built to produce a force system opposite of the present malocclusion to produce adequate correction of the malocclusion. This means some overcorrection of the overbite should be ordered in the Clincheck treatment plan (Fig. 7), even though the actual clinical result (Fig. 8) will be less than the computer image shows.



4. Finishing: At the end of the aligner wear in a patient with a deep anterior overbite, the clinician should plan on trimming or cutting the last two to three sets of aligners into anterior sections of aligners (example: from first bicuspid to first bicuspid, or cuspid to cuspid; Fig. 9). Do plan Clincheck treatment plans appropriately to allow this trimming of the posterior sections off the aligners to not interfere with other objectives desired. This allows the last sets of aligners to act as anterior bite planes, producing disocclusion of all the posterior teeth (Fig. 10), hence allowing for passive posterior eruption in the last few weeks of treatment.

Using these principles leveling curve of Spee and correction of severe deep overbite can be accomplished with Invisalign. Here are three completed cases using Invisalign only and the above priniciples.


Author’s Bio
Dr. Dayan received his DDS from the University of Toronto in 1986, and Diploma in Orthodontics in 1991. Dr. Dayan's Toronto practice provides all techniques of orthodontic services: Invisalign, Temporary Anchorage Devices (TADs), porcelain and metal braces, lingual braces, TMD and bruxism appliances. In addition to his full time private practice in orthodontics, Dr. Dayan is also a clinical instructor of Orthodontics and is currently a guest lecturer at the Department of Orthodontics at the University of Toronto, and has lectured around the world on Adult and Rehabilitative Orthodontics. He is a registered speaker for Invisalign teaching how to use Invisalign to achieve excellent results. For more information please visit www.cityortho.ca.
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September 2025
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