eXceed Aligners are recommended for treating the following indications:
A diastema of 6.0 mm or below
Anterior teeth and premolars in a crossbite
Space retention in mixed/permanent dentition
Correction prior to an orthopedic treatment
Passive/active/double retention device
The following indications are not recommended for treatment by eXceed aligners:
A diastema larger than 6.0 mm
Crowding larger than 6.0 mm
Expansion or distalization of more than 1.5 mm
Monitoring torque or the distal inclination of the teeth
Deciduous or not fully erupted dentition
Active periodontal disease
Repeating diseases (depends on the severity of each case)
Patients with bruxism, craniomandibulardysfunction or hypersensitivity to materials
Cases of diastema with positive dentoalveolar discrepancy of up to 6.0 mm. Best results can be achieved when the diastema is present in the anterior region, especially when teeth are angled forward (positive torque) and a correction is made using loss of torque. Another category involves cases with a small diastema in the molar region, for example, when there are spaces left after previous orthodontic treatment with fixed appliances.
This type can become more complex if the diastema is present due to the displacement of teeth "in mass" in the middle line. Closing a diastema larger than 4.0 mm requires additional forces to the locking mechanism, for example, maxillary elastics, etc.
Closing horizontal and/or vertical gaps:
Please consider overjet and overbite (vertical overlap or deep bite). Closing anterior upper region diastema, where there is an increased horizontal overlap and decreased vertical overlap, contributes to the efficacy of the treatment, since the increased horizontal overlap provides some more room for movement. Upper posterior teeth and the vertical overlap will increase during the drift.
Closing a diastema in the anterior upper teeth in cases with normal horizontal overlap and increased vertical overlap allows the intrusion of the front anterior teeth, thus providing a gap to push back the front side of the upper teeth.
Treating a diastema in anterior upper teeth in cases with normal horizontal and vertical relationships can be more challenging. It is recommended to first perform compensation of the intrusion/extrusion, depending on each case.
Closing a diastema in the anterior lower teeth can work well if the boundaries of the horizontal and vertical overlap are close, since the drift of the lower posterior teeth increases the horizontal and vertical overlap. Other conditions are less favorable for treatment.
ATTENTION! It is necessary to warn the patient that midline control represents a considerable challenge. In addition, treatment may require some occlusal adjustment, accomplished by limited IPR (interproximal reduction) and other orthodontic techniques.
Cases of misaligned teeth having a negative dentoalveolar discrepancy of up to 6.0 mm. Crowding must occur in the anterior region. eXceed Aligners may be used only in cases requiring first order adjustments or correction of inclination. If correction of crowding is required prior to proceeding with tooth movement, one must ensure a sufficient time frame to bring about the necessary changes. Correcting crowding and rotations can be obtained by expansion and/or IPR.
ATTENTION! - It is necessary to warn the patient that midline control represents a considerable challenge. In addition, treatment may require some occlusal adjustment, accomplished by limited IPR and other orthodontic techniques.
Prior to proceeding with correction of rotations, sufficient space must be established by expansion or IPR. Shape cutters with vestibular and lingual surfaces of the strips contribute to the correction of rotations. In contrast, the rounded shape of the lower canines and premolars makes rotation correction more challenging. In such cases, additional accessories are needed – attachments and power ridges that allow for correction of tooth position. Such tools are automatically included in the eXceed Aligners plan.
Intrusion is particularly effective in cases of deep frontal occlusion. It can be performed with eXceed Aligners in two ways: a) individual intrusion: the intrusion is performed on 1-2 teeth and the movements are pre-programmed into the aligners. A retainer must be fitted on the rear teeth; and b) group intrusion: obtained by programming a gap between the aligners and the occlusal surface of the premolars and molars, which, in combination with the patient's bite in the anterior segment, brings about the desired Intrusive movement.
The impact of eXceed Aligners is always enhanced by chewing. In the treatment of intrusion chewing greatly increases the effectiveness of the treatment so it is highly recommended to advise the patient to gently chew whilst wearing the aligners.
When the prescribed extrusion covers only one tooth, this can be achieved by installing attachments, included in the eXceed Aligners plan.
The purpose of expansion is to secure space, which will be used to deal with a certain malocclusion problem. In crowding cases, expansion must first be performed to provide the necessary space. In the image below, the space between the upper and lower central incisors was formed by an eXceed Aligners expansion treatment.
Types of expansion:
A. Bilateral extension
B. Oblique lateral extension
C. Expansion of A-R (front – rear section)