Dr Cory Costanzo demonstrates how the SureSmile platform guided treatment for two distinct malocclusions, utilizing clear aligner therapy in one and custom fixed appliances via digital indirect bonding (IDB) in the other.
Treating adult patients often requires navigating complex clinical histories and malocclusions, making robust digital planning essential for achieving predictable outcomes. Two case studies from Cory Costanzo, DDS, MSD, demonstrate how the SureSmile platform from Dentsply Sirona can be leveraged to effectively manage challenging adult cases using both clear aligner therapy and digital indirect bonding (IDB), highlighting the power of digital simulation in treatment planning and patient communication.
The first case involved a 57-year-old patient presenting with an end-on Class II malocclusion, narrow arches, a 5 mm overjet, and a 5 mm deep bite with a moderate curve of Spee. Utilizing SureSmile aligners, the treatment plan aimed to establish a Class I occlusion and ideal overjet and overbite through posterior arch expansion (labially tipping posterior crowns) while preserving gingival health in the presence of mild recession. Mandibular anterior interproximal reduction (IPR) and Class II elastics were incorporated into the plan. Deep bite correction was achieved through mandibular incisor intrusion, facilitated by the force delivery of a straight extended trimline. The combination of effectively planned biomechanics and strong patient compliance allowed the case to finish in 12 months without refinement, six months ahead of the initial estimate.
The second case highlights a 49-year-old patient with severe mandibular crowding (10 mm) and a maxillary right lateral incisor in crossbite. For this fixed appliance case, Dr. Costanzo evaluated six different treatment simulations—ranging from non-extraction to various extraction patterns, interproximal reduction (IPR) levels, and elastic strategies. The selected plan involved the extraction of the mandibular right central incisor, moderate mandibular IPR, Class III elastics, and SureSmile® digital indirect bonding (IDB) with self-ligating brackets. Visually demonstrating these treatment pathways via SureSmile simulations was key to securing patient acceptance for the extraction and IPR, according to Costanzo. The final clinical outcome corresponded well with the predicted setup, showcasing the accuracy of the digital IDB system.
Together, these cases underscore the clinical value of a versatile digital ecosystem. Whether planning predictable aligner therapy utilizing a straight extended trimline or executing complex extraction setups with custom-placed brackets via digital IDB, a unified platform that integrates comprehensive simulation and treatment planning is essential for managing diverse adult orthodontic challenges with clinical confidence and diagnostic predictability.
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Photo: Dentsply Sirona
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