Invisalign First: Will It Eventually Need to Be Redone?

“Isn’t it just a device that straightens the front teeth?” I’ll explain with an actual treatment case

Hello,

This is Apgujeong Yonsei Baro Dental Clinic.

Invisalign First, a clear aligner system for children, is not yet a widely standardized treatment.

Even at university hospitals, it is treated as an official clinical subject, but in local clinics there are still many doctors who have not used it much. And even if they have tried it, they may not have had the skill to achieve anything beyond mediocre results.

Because of this, some people seem to limit Invisalign First to a simple pediatric orthodontic device and think of it as only something that straightens the front teeth.

They may say that Invisalign First is only a device that straightens the front teeth, so it will need to be done again later anyway.

They also say that arch expansion does not work well. It seems they tell patients things like this.

The child in this case was a pediatric patient who had been scheduled for treatment at our clinic, and whose treatment timing had been patiently awaited. But before starting treatment, the guardian hesitated about Invisalign First after hearing this at the pediatric dental clinic they had been visiting.

They said that the issue was not just straightening the front teeth, but that the child should focus on growth at this stage. They also said that adult orthodontic treatment would be needed later anyway, and that if another orthodontic treatment was not started right away, something bad would happen, creating unnecessary fear and recommending another treatment instead.

Understanding growth and development is fundamental in pediatric orthodontics.

According to the child’s stage of growth, conditions such as a receding chin, underbite, and facial asymmetry are malocclusions that must be addressed at the right time.

Yonsei Baro Dental Clinic performs a lot of Invisalign First treatment, but also uses face masks frequently, as well as Monoblock and headgear.

However, if an inaccurate diagnosis leads to treatment pressure saying that skeletal correction is urgently needed even when there is no skeletal problem, the patient bears the consequences.

2022.11~2024.10

Invisalign First is a clear aligner system for children, but if the timing is right and the results are good, it can provide orthodontic treatment to the point that adult orthodontics may not be needed.

In November 2022, a 10-year-old child came to the clinic for orthodontic treatment.

At the time the canine teeth were erupting, the crowding was clearly visible, so the child visited for orthodontic treatment.

The child played sports, and one advantage of Invisalign First is that the appliance is not cumbersome, so the risk of injury is also reduced.

2022.11

2022.11

Due to lack of space, crowding is visible, the front teeth are protruding, and protrusion can be seen.

2022.11

2022.11

When the front teeth protrude, it is difficult to close the lips comfortably.

This is called lip incompetence.

The lower lip sits over the protruding upper teeth, making lip closure feel unnatural.

Four primary molars are still remaining.

By the time the Invisalign First warranty period of 18 months is over, that is, at the end of treatment, it is expected that the dentition will be fully permanent.

At this stage, starting Invisalign First pediatric orthodontic treatment was explained as a situation where a lot could be achieved, and if luck was on our side, all treatment could even be completed through to adult orthodontics, so we began treatment.

23.9

After ordering Invisalign appliances, the treatment started about a month and a half later, including the treatment planning period and the appliance fabrication and delivery period.

There was one remaking because the appliance did not fit well in the middle.

This is the appearance after 9 months of treatment.

Space was secured through arch expansion so that the permanent teeth could erupt, and the already crooked front teeth and canine teeth were aligned neatly.

23.09

As the remaining primary teeth fell out, the permanent premolars marked by the blue arrow erupted well.

They came in well, but with a slight rotation, and we decided to make an additional appliance to further address the protrusive appearance by using the remaining spaces.

The blue arrow in the photo is the hook for attaching elastics.

With Invisalign, rotation control for premolars, especially lower premolars that are cylindrical in shape without sharp contours, can be difficult, so additional devices like this are sometimes attached.

We used the additional appliance until March 2024, then took a break for about 3 months until June.

24.06

24.06

The alignment, bite, and everything else look good.

Treatment could have ended here, but if we aimed for 100 points rather than 99, the midline was slightly off and a slight protrusion of the upper front teeth was visible.

We do not usually perform interproximal reduction in pediatric orthodontics, but to achieve results comparable to adult orthodontics, we decided to further adjust the angle of the front teeth and reduce the size between the larger front teeth, while using one more set of additional appliances to align the midline precisely.

24.10

From June 2024 to October 2024, we completed treatment by using one more set of additional appliances.

22.11~24.10

22.11~24.10

The improved alignment is visible.

It is a fully permanent dentition, and retainers are also placed the same way as for adults.

22.11~24.10

22.11~24.10

The protrusion and forward projection of the front teeth have been resolved, and a tight, seamless bite is visible.

The occlusion relationship is an exact Class I.

22.11~24.10

Because of the protruding front teeth, the lips that would not close naturally now close naturally without showing the front teeth.

This is the most noticeable change in appearance.

22.11~24.10

22.11~24.10

It would be better if pediatric orthodontics were a little easier.

If pediatric orthodontics could be completed together with adult orthodontics in one go, patients would not have to go through the hardship twice.

Invisalign First fills this gap quite well.

Pediatric orthodontics is hard for both the child and the guardian.

So the best thing is

“to finish as much as possible with one orthodontic treatment.”

Invisalign First can create highly complete results that extend beyond simple pediatric orthodontics and connect to adult orthodontics if

the growth timing is right and

a precise diagnosis is made.

We provide treatment based on the most appropriate timing and method for the child.

I hope this case was helpful for those who are considering pediatric orthodontics and Invisalign First.