Non-Extraction Crooked Canine Orthodontics with Invisalign: Treatment Using Wisdom Teeth

Hello, this is Apgujeong Invisalign Orthodontic Clinic.

There are occasional cases where a patient starts Invisalign treatment, but later finds it difficult to keep wearing the aligners diligently and ends up switching to Clippy-C wire braces. Today, I’d like to share one of those cases.

23.05~25.07

This patient first visited in May two years ago for Invisalign treatment.

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The canine crowding is quite severe.

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The last molar at the very back is positioned too far backward.

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The last molar indicated by the blue arrow is being pushed by an impacted wisdom tooth, so it would be difficult to upright it unless the wisdom tooth is extracted.

However, after taking a CT scan, we found that the impacted wisdom tooth was touching the maxillary sinus, making extraction difficult.

If extraction is attempted forcefully, complications such as sinus perforation may occur.

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In such cases, if the wisdom tooth is similar in size and shape to the molar, it is better to remove the second molar at the very back and guide the wisdom tooth to erupt into that space.

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We decided to hold the canines in place and move the upper molars backward to create space for aligning the crowded canines.

Since even the very back molar was removed, posterior movement of the molars was relatively easy.

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On the X-ray, you can see that just six months after starting treatment, the wisdom tooth had quickly come down into the space left by the extracted second molar.

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The blue arrow shows the wisdom tooth that moved down into the space left by the extracted molar at the very back.

Looking at the photo from six months after treatment began, the molars had been moved backward and space had opened up between them. Quite a lot of space was created for the crowded canine to align.

However, around this time the patient was not wearing the aligners properly, so they no longer fit and had to be remade.

The remade aligners were started in January 2024. But the patient was unable to return to the clinic until August 2024.

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This is how the patient looked when they returned after seven months.

They admitted that they had not been able to wear the aligners.

Unfortunately, the space between the molars that had clearly opened up seven months earlier had completely disappeared while the aligners were not worn at all.

If Invisalign treatment has to be paused for some reason, you should continue wearing at least the last aligner you were using, even if only while sleeping.

Otherwise, most of the teeth that were moved will return to their original positions.

The tendency for teeth to move back to where they started is stronger than many people expect, which is why fixed retainers and removable retainers are essential.

In addition, the patient had an important event coming up next year and wanted to finish treatment within nine months, so they wanted to proceed with Clippy-C braces and complete treatment as soon as possible.

Since they had not worn the aligners for a long time and the teeth that had been moved had returned to their original positions, the situation at the time the Clippy-C appliance was attached was

similar to the initial examination in May 2023.

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At the upper jaw, two orthodontic mini-screws were placed to gain space for aligning the crowded canines by moving the molars backward.

Since there is no photo of the Clippy-C appliance being attached, I am using an X-ray instead.

After 11 months with the Clippy-C appliance in place, treatment was completed.

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The bite achieved a Class I relationship on both sides, which is good.

Left: Before treatment / Right: After treatment

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The blue arrow indicates the wisdom tooth.

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Now let’s look at the before-and-after comparison.

The period during which Invisalign treatment was attempted was 1 year and 3 months (of which 7 months were a long absence from the clinic), and the period of treatment with the Clippy-C appliance was 11 months.

23.05~25.07

23.05~25.07

Orthodontic treatment makes the face look slimmer.

Some people say that even if wisdom teeth are removed, the face doesn’t become slimmer, so how could orthodontic treatment make it slimmer?

If you’re curious about the reason, please refer to the post below. In the latter part of the post, the reason orthodontic treatment can make the face look slimmer is well organized.

Let’s look at the smiling photos.

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The crooked canine crowding has been resolved, creating a refreshed buccal corridor.

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A cleaner smile

There was no root resorption over 2 years and 2 months, and the root parallelism is good.

What is especially noticeable is the improvement in the root axis of the canines and premolars that had been tilted toward the crowded canine area.

It is a pity that if the patient had worn the Invisalign aligners consistently, we likely could have achieved a good result without needing to attach Clippy-C braces, but every patient’s situation is different.

We took a bit of a detour, but fortunately the result is good.