Dr. Benedict Miraglia

When it comes to clear aligner treatment, accurate impressions matter. 

3M™ ESPE™ Imprint™ 3 VPS Impression Material

 for clear aligners can help you achieve those accurate impressions, giving patients the final results they’re after.

As a dentist who provides orthodontic treatments with 

Align Technology’s Invisalign clear aligners

, I know the importance of capturing a flawless impression.
	The impression is crucial in these cases because it is used to create a digital impression, which then serves as the baseline to generate a custom series of clear aligners for the patient. In many cases, patients progress through more than 25 aligners, each one building upon the subtle changes of the last-and all of them built on the foundation of the initial impression.

For this reason, the impression material and technique used for clear aligner treatments is vital. The technology of the Invisalign scanner is only compatible with VPS impression materials, but dentists have many options within this category. In my eight years of experience providing this treatment, I have found 3M™ ESPE™ Imprint™ 3 VPS Impression Material to be an ideal solution.

This material makes it easy to capture an accurate impression on the first try, and clearly displays all of the fine details needed to create aligners-even for challenging cases. Additionally, using Imprint 3 VPS impression material allows me to simplify my inventory, because I can use the same impression material for crown and bridge cases as well.

The clinical properties of Imprint 3 VPS impression material help explain why it is so useful in clear aligner treatment. The material offers better memory than competitors, meaning it is less likely to distort upon removal.

It is more hydrophilic than most other VPS materials, allowing it to capture better detail in a moist environment. Finally, Imprint 3 VPS impression material is tougher than many other VPS materials. This helps it resist tearing during removal.

There are several techniques dentists can use to capture an accurate impression with Imprint 3 VPS impression material, but the one most consistently used in my office is the “four-handed technique.”

In this technique, the teeth are dried and light body impression material is traced around the gum line. At the same time, the assistant dispenses heavy body material into a tray, which is then seated over the light body material around the teeth. The tray is held in place for 4 minutes and then removed. Using these simple steps, I can consistently capture an ideal impression on the first take, in less than 10 minutes.

You also can use a “two-handed technique” in the event an assistant is not available. In this procedure, heavy body material is used to fill the tray halfway, and a layer of light body is dispensed on top of the heavy body (using only the mix tip and not the intraoral tip). The tray is then seated in the mouth, and the material reliably flows into every nook and cranny. This technique also makes great impressions, and is convenient for one person to perform independently.

In most Invisalign treatments, the patient progresses through a first set of aligners and then requires a small amount of refinement before the final result is achieved. In these cases a second impression is taken after the patient has completed wearing the first phase of aligners.

Therefore impressions are captured twice for the vast majority of patients. This underscores the importance of paying careful attention to technique and material selection for impressions. Not only will this make the experience more comfortable for your patients, it will contribute to a better final result as well.

The following summaries illustrate a few challenging clinical cases where we successfully treated patients using Invisalign. The foundation for each case was an accurate impression, made possible by Imprint 3 VPS impression material.

This patient was a 55-year-old woman with a large space in her lower arch (Fig. 1). Despite this space, the patient was not missing any teeth. Figure 2 shows the impression-taking challenge-capturing the distal edge of the molars while also capturing the forward angle of the front teeth.

The impression was successfully captured on the first try, and the patient was treated with a series of 32 aligners over 16 months. The final result shows the closed space in the mandible and the dramatic esthetic improvement (Figs. 3 and 4).

This case showcases a woman in her mid-30s who had an anterior open bite, as well as a history of bulimia (Figs. 5-6). The eating disorder led to severe wear, which can be seen on the upper arch. The gum line was also very irregular. The impression accurately captured the detail of the teeth and a series of 12 aligners was made.

Following this initial phase, an additional impression was taken for six more aligners. Finally, one more impression was taken with Imprint 3 VPS impression material to create crowns for tooth Nos. 3-14. This treatment significantly elevated the patient’s level of confidence in her smile (Figs. 7 and 8).

This treatment was performed on a male patient in his early 40s (Fig. 9). The patient had an omega-shaped upper arch, as seen in Fig. 10.

An impression was taken that successfully captured the complex crowding and narrow omega arch (Fig. 11), and the patient was treated with 28 aligners over 14 months. This case also illustrates use of the clear aligners as whitening trays, with the final result showing a smile that is not only straight, but also much brighter (Figs. 12-14).

This case was performed on a patient in her late teens who presented with a very deep bite and severe crowding, as seen in Figs. 15-17.

The patient had consulted with multiple dentists who informed her that the lower lateral incisor would have to be extracted and that she was not a candidate for Invisalign. However, with an accurate impression we were indeed able to successfully treat this case with Invisalign, first using a series of 27 aligners, and then following up with an additional impression and eight more aligners for refinement (Figs. 18-20).

This case demonstrates the outcome of treatment on a young male patient with an anterior crossbite, deep overbite, severe crowding and periodontal disease (Figs. 21 and 22).

Again, these complex details were well captured using the Imprint 3 VPS impression material, and the patient was treated first with a series of 20 aligners, followed by a second impression and an additional 10 aligners. The hygiene issues were addressed as well, and the final result shows what we were able to achieve without resorting to periodontal surgery or grafting (Figs. 23 and 24).

In each of these cases, more invasive “quick fix” treatments may have been possible, but Invisalign presented these patients with an opportunity to conservatively achieve outstanding esthetic and functional results.

After treating hundreds of Invisalign cases with Imprint 3 VPS impression material, I have seen firsthand its reliability and consistency in helping to achieve dramatic makeovers with clear aligners. These capabilities allow dentists to create beautiful smiles and healthy occlusion that will serve patients well for decades. 
	
	
	
	
	
	 

Articles

When it comes to clear aligner treatment, accurate impressions matter. 3M™ ESPE™ Imprint™ 3 VPS Impression Material for clear aligners can help you achieve those accurate impressions, giving patients the final results they’re after.

How to create accurate impressions that enable drastic makeovers using 3M ESPE Imprint 3 VPS material [VIDEO]

	General dentists see volumes of patients each year. However, only 1 in 4 adults has straight teeth and a healthy stable bite. General dentists can add Invisalign® to their practices knowing there are many patients who can benefit from treatment.  An excellent way to market Invisalign is to educate patients about its benefits.

	Thankfully, GPs have a built-in target audience in their practices. Most people do not have perfectly straight teeth with a good, stable bite. In fact, statistics indicate that approximately 70% of the adult population has some amount of spacing, crowding or malocclusion. Dentists have a unique opportunity to address these issues because patients come in regularly for checkups.

	Our practice has offered Invisalign treatment since 2005. We realized most adults would refuse traditional braces even if they needed them to correct significant periodontal issues.  When offered Invisalign as an option, most patients were excited to consider treatment because they wanted to improve their oral health and their smile-they just didn’t want to wear braces to do it.


	Marketing Invisalign to patients in our practice is all about educating them about the benefits of straight teeth and a healthy bite. At 3-, 4- or 6-month recall visits, patients spend almost an hour with the hygienist and approximately 5 to 10 minutes with the dentist. This provides an excellent opportunity for us to educate our patients on the many benefits of Invisalign therapy.

	Dental hygienists are one of your most important resources in promoting Invisalign to patients. It is very important for hygienists to understand-and be confident discussing-that Invisalign is a comprehensive orthodontic system that can be used to treat almost any amount of spacing, crowding and malocclusion. The hygienist has a full hour to spend with the patient. While the scaling is taking place it should be easy to explain to the patient that the position of the teeth contributes to the amount of plaque and calculus present. Teeth that are crowded are more difficult to clean and thus accumulate levels of plaque and calculus that cause gingivitis.

	In our practice, patients often respond favorably to this information with comments like, “my teeth weren’t always this crowded,” or, “I had braces when I was younger, and they shifted when I lost my retainers,” or “I floss for a few weeks after a cleaning but then I stop,” or “I try to floss these teeth…but the floss breaks or shreds so I give up.”

	It is easy to explain to a patient that the bacteria in the plaque and calculus live in the spaces between the gum and teeth. Gingivitis that is left untreated eventually can lead to bone loss or periodontal disease. The patient can easily understand that crowded teeth are more difficult to clean and maintain appropriately, and will respond favorably to educational information presented in a manner which they feel is beneficial to their oral health.

From conversation to treatment conversion

	Once the patient has been educated in this manner, then it is easy to introduce treatment options. The hygienist explains that Invisalign is not just used for improving someone’s smile-although that is an excellent part of the equation. Invisalign also is used to align the teeth and improve periodontal hygiene. Patients who are concerned about maintaining oral health will be glad to hear that straighter teeth are easier to clean and maintain at home.

	Finally, the dentist gets to spend 5-10 minutes with the patient to reinforce what the hygienist has already discussed and answer any questions the patient may have. The dentist can then explain the difference between a good occlusion and malocclusion.
	This educational process is an excellent way to “market” Invisalign to patients in a manner that is supportive of their oral health. I find the two best “educational” aids provided by Invisalign are the demonstration models and the educational brochures. Patients can handle the models and sample aligners to see its shape, thickness and strength. Most patients are very excited at how clear the aligners are and how smooth and comfortable they look.

	The need for Invisalign extends far beyond patients who are looking to improve their smile. While those are excellent patients, Invisalign can help treat or prevent periodontal disease and malocclusion as well.  It also is persuasive for patients who might not “treat” themselves to a more attractive smile, but will take steps to improve or maintain their oral health. 

	General dentists who add Invisalign orthodontics to their practices will have a unique opportunity to market it to existing patients. All patients who have spacing, crowding or a malocclusion should be educated about the benefits of Invisalign. Most patients are excited to learn about Invisalign and eager to start treatment-and those patients are already sitting in your practice.

 General dentists see volumes of patients each year. However, only 1 in 4 adults has straight teeth and a healthy stable bite. General dentists can add Invisalign® to their practices knowing there are many patients who can benefit from treatment.  An excellent way to market Invisalign is to educate patients about its benefits.

Dr. Benedict Miraglia

Articles

How to create accurate impressions that enable drastic makeovers using 3M ESPE Imprint 3 VPS material [VIDEO]

The invisalign effect