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Fix Deep Bites Faster by Dr. Bradley Nirenblatt

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Categories: Orthodontics;
Fix Deep Bites Faster 

Advanced aligner treatment in fewer visits

by Dr. Bradley Nirenblatt

Introduction
The patient, a 23-year-old member of the National Guard, wanted to get started with his treatment; however, he was scheduled for deployment from South Carolina to Arizona. After discussing his unique situation during the initial consultation (Figs. 1–4), we determined we could achieve the treatment goals with clear aligner treatment along with remote monitoring. This report details his successful results managed with minimal office visits.
Fix Deep Bites Faster
Fig. 1
Fix Deep Bites Faster
Fig. 2
Fix Deep Bites Faster
Fig. 3
Fix Deep Bites Faster
Fig. 4


Diagnosis and treatment plan
Initial records revealed:
  • Class I malocclusion with posterior crossbite on the left
  • Severe overbite
  • Moderate overjet
  • Moderate upper crowding
  • Severe lower crowding
  • Thin attached gingiva #27

To meet the requirement to treat the patient with no interim office visits, I selected the OrthoFX aligner system. Using a Medit scanner, we uploaded his scan into the OrthoFX portal and received his case back the next day to establish his final treatment plan.

The treatment plan included:
  • Extract all third molars and the lower right lateral incisor
  • Level, align and correct rotations
  • Correct deep bite through lower anterior intrusion and premolar extrusion
  • Upper IPR: 0.3 mm per contact from canine to canine (3-3)
  • Correct LL7 crossbite

The decision to extract the lower lateral incisor was made because of the severe arch length discrepancy. The upper anterior IPR was needed to reduce the Bolton discrepancy and to address black triangles.

Upper beveled attachments were chosen to correct rotations and to facilitate slight upper anterior intrusion. No “torque ridges” or “overcorrection” of torque or other movements were needed because of the efficiency of the proprietary OrthoFX material. Lower beveled attachments were chosen to correct rotations and to create a reverse curve of Spee to intrude lower incisors and extrude lower bicuspids (Figs. 5–8).
Fix Deep Bites Faster
Fig. 5
Fix Deep Bites Faster
Fig. 6
Fix Deep Bites Faster
Fig. 7
Fix Deep Bites Faster
Fig. 8


Clear aligner treatment and remote monitoring
Clear aligner treatment is the obvious choice for patients who want to minimize appointments, since aligners don’t require bracket/wire changes or emergency visits for broken brackets. Aligners have been incorporated in my practice since 1999, when I started using a popular aligner lab for my patients.

In 2016, I decided to 3D print my aligners in-house using a stronger aligner material with a higher trim line. My goals were to reduce my lab fees, reduce the size and number of attachments, and improve the predictability of my results with fewer posterior open bites and refinements. At that time, this was a very big decision for my practice as there were very few other aligner companies. After the change, my cases finished more quickly along with many fewer refinements and fewer attachments.

As I got busier and demand increased, I wanted to partner with a company that could deliver the same results that I was achieving without requiring me to become an aligner lab. I began using the OrthoFX system in 2023 after meeting the team at the American Association of Orthodontists annual meeting. I was introduced to Loc X. Phan, who has been involved in the development of many of the top polymers in the field.

With the advanced polymers OrthoFX offers, I find that my average refinement rate has decreased considerably. Patients are happy and cooperation has improved because the material does not discolor and is extremely comfortable. Plus, the reduction in the number of attachments needed makes both my patients and staff happy.

For this case, all procedures were performed in four appointments as follows:
  • Visit 1: Initial exam, pan, ceph; referral for extraction of the lower-right lateral incisor and third molars
  • Visit 2: Aligner scan with Medit, photos
  • Visit 3: Aligner delivery and upper arch IPR
  • Final visit: Removal of attachments, incisal enameloplasty to address tooth wear, final records, and delivery of retainers

The OrthoFX system includes a remote monitoring app called FXOnTrack that can alert me as needed. The patient was prompted by the app to check in every two weeks.


Treatment summary and results
The patient completed treatment in seven and a half months with normalized overbite and resolved crowding in both arches (Figs. 9–10). Improvement of distal root tip of the LR1 may have been possible had I added a vertical attachment. No refinements were needed, which was critical for this patient’s treatment timeline. The patient reported high satisfaction because of the convenience of remote monitoring and minimal in-office visits.

Summary of treatment metrics:
  • Number of stages: 30
  • Refinements: 0
  • Treatment duration: 7.5 months
  • Polymer selected: FXClear
  • Remote monitoring: FXOnTrack
  • Treatment visits: Four total
Fix Deep Bites Faster
Fig. 9
Fix Deep Bites Faster
Fig. 10

Retention
A set of OrthoFX retainers was included in the treatment package. To streamline the final appointment, retainers were ordered in advance based on the last planned stage and delivered at the debonding visit, offering added convenience for the patient. Future retainers can be ordered and shipped directly to the patient.


Conclusion
This complex case was completed with remarkable efficiency, requiring no refinements and only four office visits. The remote monitoring app, included with every OrthoFX treatment at no additional cost, further enhanced my practice ROI. With a total treatment time of only seven and a half months, this outcome demonstrated how an advanced aligner system can deliver excellent clinical results while also improving both patient satisfaction and practice efficiency.
Author Bio
Dr. Bradley Nirenblatt Dr. Bradley Nirenblatt has been practicing in the Charleston, South Carolina, area for more than 30 years. He earned his DMD from the Medical University of South Carolina and his orthodontic certificate from Columbia University. A pioneer in clear aligner therapy, Nirenblatt has been treating patients with aligners since 1999 with nationally recognized results.
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