Predictability

There are some malocclusions that are less predictable with aligner therapy in general. Let's start with the challenges before moving on to what works really well.

1. Posterior Cross-Bites:
   • Terminal Molars: Posterior cross-bites involving terminal molars (e.g., teeth 2 and 3) are challenging because of insufficient anchorage.
   • Example Issue: Attempting to expand these molars can create an anterior open bite due to the lingual cusps riding up on the opposing teeth.
2. Class III Skeletal Malocclusions:
   • Significant Underbite: Cases with a prognathic mandible and retrognathic maxilla are difficult to treat with aligners alone due to bone disharmony.
   • Recommendation: These cases should be referred to an orthodontist and oral surgeon for potential surgery.
3. Significant Crowding:
   • Severe Crowding: When expansion is not possible without extractions, aligners alone may not be sufficient.
   • Recommendation: Significant crowding should be handled by experienced orthodontists, possibly involving extractions and elastics.
4. Ectopic Erupting Canines:
   • Blocked Out Canines: These are difficult to treat with aligners due to the risk of gingival defects and the need for extra space.
   • Recommendation: Such cases may require traditional orthodontic approaches.
5. Myofunctional Problems:
   • Tongue Thrusting and Thumb Sucking: Aligners are less effective if habits causing the malocclusion are not resolved first.
   • Example Issue: Anterior open bites caused by these habits need to be addressed before starting aligner therapy.
6. Complex Open Bites:
   • Molar to Premolar Open Bites: These are challenging due to potential skeletal issues or myofunctional problems.
   • Lateral Open Bites: Rare but difficult to treat due to tongue thrusting habits in a width direction.
7. Class II Skeletal Problems:
   • Small Mandible: Cases with a retrognathic mandible often require surgical intervention for optimal results.
   • Recommendation: Treating these cases dentally alone may not provide the best aesthetic and functional outcomes.
8. Missing Teeth:
   • Periodontal Issues: Missing teeth leading to tipping and super-eruption create complex occlusal problems.
   • Recommendation: Uprighting and restoring such cases may require more than just aligners, potentially involving orthodontic and periodontal treatments.
9. Intruding Molars:
   • Super Erupted Molars: Aligners alone are less effective at intruding molars.
   • Recommendation: Use of temporary anchorage devices and other orthodontic tools may be necessary.

What works well with Promonitoring aligners?

While the above issues present challenges, our aligners excel in many areas of orthodontic treatment. Here are some examples:

• Mild to Moderate Crowding: Aligners are very effective at aligning teeth with minor to moderate crowding.
• Spacing Issues: Closing gaps between teeth is predictably achieved with aligners.
• Minor Bite Corrections: Adjustments to mild overbites and underbites can be successfully managed.
• Aesthetic Improvements: Aligners are great for improving the overall aesthetic appearance of the smile.

By understanding both the strengths and limitations of Promonitoring aligners, you can make informed decisions about the best treatment options for your patients.