• Arch development protocol
  • Extrusion protocol
  • Distalization protocol
  • Rotation protocol
  • Deep bite protocol

Distalization protocol:

  • Vertical attachments as large as possible 17, 27
  • Sequential distalization for 4-5 aligners (50%) of just 7’s. Add light buccal crown-torque to incisors.
  • The also? 6’s for an additional 4-6 aligners
  • Add the 5’s when the 7s are in position. Then the 4’s (MAX 3 teeth at a time)
  • Then canines when the 5’s are corrected, and then the anterior segment (WITH palatal-root torque 1 degree and intrusion 0.2 mm per aligner)
  • Elastics: 3/16 M from 4 to 6 until canines are distalized. Then 1/4 M from 3 to 6.
  • Add lower molar mesialization if necessary (sequential when 3’s are in place)

Distalization protocol 2:

  • Third molar extraction
  • 50 % sequentialization
  • Attachments U7-to-U3
  • Class II elastics: 3/16 – 6oz on upper aligner CUTS
  • Elastics on U4 until end of U4 mov, then move to U3. Buttons on lower 6’s.
  • Esthetic start

When starting distalization of premolars posterior anchorage should be reinforced. Ask for 5 to 10 degrees of distal crown tipping on molars while distalizing premolars.

Upper arch development:

Parabolic arch-shape

Staging:

  • Compression of 7’s while simultaneous
  • distal rotation of 16, 26 and expansion of premolars and
  • buccal crown-torque to upper incisors
  • After contraction: retract upper front with simultaneous palatal root-torque

Leveling the curve of Spee:

  • Never do pure intrusion
  • Couple a sagittal and vertical movement
  • Place retention- attachments on premolars and maybe molars
  1. Upright buccal segments,
  2. Procline to normal inclination and intrude incisors,
  3. IPR 33-43 (if necessary)
  4. Retrude, intrude, and lingual root torque
  5. Final position (90 degrees)
  6. Spee Curve flat

Lower arch development:

  • Protrusion of front
  • Hinge-rotation of the front
  • Lingual root-torque of 7’s while contraction and rotation
  • Retraction after light IPR