SmartForce Features Protocols...1The Invisalign default protocols are used to create the initial...
Transcript of SmartForce Features Protocols...1The Invisalign default protocols are used to create the initial...
SmartForce Features Protocols
1© 2017 Align Technology, Inc. All rights reserved. Confidential – For Internal Use Only
2© 2017 Align Technology, Inc. All rights reserved. Confidential – For Internal Use Only
SmartForce Features
Introduction
• SmartForce features are designed to allow the Invisalign clear aligners
to apply the optimal simple and complex orthodontic force systems to
the teeth, either individually or in segments, where the direction,
magnitude and point of application of these forces are optimized in
order to achieve the desired treatment outcome.
• SmartForce features can be built into the intrinsic shape of the
aligners (Power Ridge features & Pressure Areas/Points) or require
composite material to be bonded to the teeth in pre-defined shapes
that interact with features built into the aligners (Attachments).
• They are automatically placed by the software based on patient’s initial
clinical situation and Doctor’s Clinical Preferences, treatment goals
and strategies.
• Cannot be prescribed and position cannot be adjusted, only removed.
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SmartForce Features and Attachments
Optimized Attachments and aligner features:
• Provide the optimal force system to achieve predictable
tooth movements.
• Are tailor-made for each tooth width, long axis and
contour.
• Are positioned precisely to deliver the forces while
eliminating interferences. Crown size and tooth anatomy will
determine the ideal placement.
• Are used individually or in predefined combinations.
SmartForce Features and Attachments
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Buccal Power Ridge FeatureVisual Feature Available on Movement
Threshold
for
placement
Maximum
Velocity
Buccal Power
Ridge feature
Upper and lower
incisors
Lingual Root
Torque3 degrees of LRT
1 degree /
stage
Buccal + Lingual
Power Ridge
feature
Upper incisors
Lingual Root
Torque + incisor
retraction
3 degrees of LRT
+ anterior
retraction
1 degree &
0.25mm /
stage
SmartForce Features and Attachments
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Visual Feature Available on MovementThreshold for
placement
Maximum
Velocity
Optimized
Rotation
Attachment
Upper and lower
canines &
bicuspids
Rotation 5 degrees of rotation 2 degrees / stage
Optimized
Extrusion
Attachment
Upper and lower
incisors, canines,
bicuspids and
molars
Individual
extrusion0.5mm of extrusion 0.25 mm / stage
SmartForce Features and Attachments
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Visual Feature Available on Movement
Threshold
for
placement
Maximum
Velocity
Multi-tooth
Extrusion
Attachment
All four upper
incisorsIncisor extrusion
0.5mm of
extrusion0.25 mm / stage
SmartForce Features and Attachments
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Visual Feature Available on Movement
Threshold
for
placement
Maximum
Velocity
Optimized Root
Control
Attachment
Upper incisors,
upper and lower
canines &
bicuspids
Mesio-Distal root
tip
0.75 mm of M/D
translation of
center of
resistance
0.25 mm / stage
Optimized
Multi-Plane Attachment
Upper lateral
incisors
Extrusion ±
crown tipping ±
rotation
OR
Rotation with
intrusion or
extrusion
Absolute extrusion
0.1 mm + crown
tipping + > 5 deg
rotation
Rotation > 5 deg
+ intrusion
Rotation > 5 deg +
extrusion
0.25 mm / stage or
2 degrees / stage
SmartForce Features and Attachments
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Available on
Threshold
Movement
Pressure AreasVisual Feature Available on Movement
Threshold
for
placement
Maximum
Velocity
Pressure areasUpper and lower
incisors and lower
canines
Absolute intrusion 0.5 mm intrusion 0.25 mm / stage
Optimized
Deep Bite Attachment
Upper and lower
premolars.
For retention, can
also be placed on
canine or molar if
can't be placed on
premolar
Anchorage/
retention during
anterior intrusion.
Activated for
premolar
extrusion
When anterior
intrusion and/or 0,5
mm premolar
extrusion is
planned
0.25 mm / stage
SmartForce Features and Attachments
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Visual Feature Available on Movement
Threshold
for
placement
Maximum
Velocity
Optimized
Support Attachment
Upper lateral
incisorsNA
Intrusion > 1mm
on either adjacent
canine or central
incisor
0.25 mm / stage
Precision Bite
Ramps*(* are not SmartForce
features per se, but
can be prescribed by the
Provider, and
are placed depending on
compatibility
with other features)
Upper incisorsDisocclude the
posterior teethNA NA
SmartForce Features and Attachments
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Multi-Tooth UnitVisual Feature Available on Movement
Threshold for
placementMaximum
Velocity
Multi-tooth unit
OptimizedRetraction
Attachment
Upper and lower
canines
Canine
retraction
First premolar
extraction planned for
maximum or moderate
anchorage or up to 2
mm of mesial crown
posterior movement
for maximum
anchorage or 5mm for
moderate
0.25 mm / stageOptimized Maximum or
Moderate Anchorage
Attachment
Upper and lower
second
premolars and
molars
Posterior
moderate or
maximum
anchorage
Optimized Anchorage Attachment
Upper molars and
second premolars.
SmartStage
activations in both
arches.
Anterior
retraction1 mm 0.25 mm / stage
SmartForce Features and Attachments
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Visual Feature Available on Movement
Threshold
for
placement
Maximum
Velocity
Optimized
Multi-planeAttachment
Upper and lower
molars
Rotation +/-
intrusion or
extrusion
Rotation 5 degrees
in either direction
with or without
extrusion/intrusion
0.25 mm / stage or
2 degrees / stage
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Conventional Attachments
Conventional attachments can be prescribed in addition or in lieu to any other attachment or SmartForce
feature placed by default (depending on compatibility).
Ellipsoid Rectangular Rectangular Beveled
3 mm,
4 mm,
5 mm
2 mm
3 mm
1 mm
0.5 mm
2 mm
1.25 mm
3, 4, 5 mm
2 mm 1 mm
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Conventional Attachments
Conventional attachments can be placed directly
on the 3D model and their placement can be
adjusted with ClinCheck Pro 3D-Controls.
Conventional rectangular attachments can also
be adjusted for prominence and degree
of beveling.
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Clinical Preferences
You can set up your Clinical Preferences for conventional attachments
for rotation, retention, and extrusion through the attachments interface
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Clinical Preferences
Attachments interface
• Default attachment setting includes Optimized
Attachments whenever they are needed according to
protocol.
• If clinical preferences display conventional attachments
on any tooth in which an Optimized Attachment would
apply, software will respect Doctors’ preference.
• The preference can be ‘reset’ to include the Optimized
Attachments.
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SmartForce ProtocolsInvisalign SmartForce Features per Tooth & Movement Programmed default placement rules
Rotation Extrusion Intrusion M/D Root Tip RetentionLingual Root
Torque
Upper
Central
Incisors
n/a
Optimized
Extrusion (single
and multi-tooth)
Lingual Pressure
Area
Optimized Root
Controln/a
Single Buccal Power
Ridge feature or
Dual Buccal + Lingual
Power Ridge feature for
LRT + Retraction
Upper
Lateral
Incisors
Optimized
Multiplane
Optimized
Extrusion (single
and multi-tooth)
Lingual Pressure
Area
Optimized Root
Control
Optimized Support(Individual Central or Canine
Intrusion)
Single Buccal Power
Ridge feature or
Dual Buccal + Lingual
Power Ridge feature for
LRT + Retraction
Lower
Incisorsn/a
Optimized
Extrusion
Lingual Pressure
Arean/a n/a
Buccal Power Ridge
feature
U/L
CaninesOptimized Rotation
Optimized
Extrusion
Lingual Pressure
Area (lower only)
Optimized Root
Control (double or
single + SmartStage)
n/a n/a
U/L
BicuspidsOptimized Rotation
Optimized
Extrusionn/a
Optimized Root
Control (double or
single + SmartStage)
Optimized Deep Bite (Anterior Intrusion Anchorage ±
Bicuspid Extrusion)
n/a
U/L MolarsOptimized
Multiplane
Optimized
Extrusionn/a n/a n/a n/a
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SmartForce Protocols
Optimized SmartForce Default Placement Hierarchy
• High Level Hierarchy:
• P1: 1st Bicuspid Extraction & Multi-tooth Extrusion movements
• P2: Root Movements (Mesial-Distal)
• P3: Single tooth vertical & rotation
• P4: Anchorage for intrusion
• P5: Power Ridge feature for LRT
Note: Power Ridge feature for Lingual Root Torque cannot be placed concurrently with attachments on the same tooth; as such, when
Lingual Root Torque is present with other movements that require attachments, the movements need to be separated (increasing
number of stages) or the Power Ridge feature will not be placed and only the required attachment will be used. Align is now defaulting
to not placing the Power Ridge feature in low stage treatments with these conditions to avoid increasing the number of aligners and
treatment time.
Pressure areas are placed lingually and are compatible with buccal attachments and buccal Power Ridge features.
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SmartForce Placement Protocols – Placement Hierarchy per Tooth
Upper Central Incisors Upper Lateral Incisors
• P1: Multi-tooth Optimized Extrusion – when all four
incisors are extruding
• P2: Optimized Root Control
• P3: Optimized Extrusion (individual)
• P4: Power Ridge feature for Lingual Root Torque
• P1: Multi-tooth Optimized Extrusion – when all four
incisors are extruding
• P2: Optimized Root Control
• P3: Optimized Multiplane (rotation & rotation with
intrusion or extrusion)
• P3: Optimized Extrusion (individual)
• P5: Optimized Support (retention)
• P6: Power Ridge feature for Lingual Root Torque
Note: Pressure areas are placed lingually and are compatible with buccal attachments and buccal Power Ridge features.
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SmartForce Placement Protocols – Placement Hierarchy per Tooth
Lower Incisors Upper & Lower Canines
• P1: Optimized Extrusion (individual)
• P2: Power Ridge feature for Lingual Root Torque
• P1: Optimized Retraction (for bicuspid space closure)
• P2: Optimized Root Control
• P3: Optimized Rotation
• P4: Optimized Extrusion (individual)
Special situations:
• Optimized Retention attachment placed when incisors
intrude and posterior teeth are covered by Mandibular
Advancement Precision Wing.
• Optimized Retention attachment placed on contralateral
canine on unilateral first bicuspid extraction solution (G6)
to support anterior SmartStage activation
Note: Pressure areas are placed lingually and are compatible with buccal attachments and buccal Power Ridge features.
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SmartForce Placement Protocols – Placement Hierarchy per Tooth
Upper & Lower Bicuspids Upper & Lower Molars
• P1: Optimized Maximum/Moderate Anchorage
Attachment (for first bicuspid space closure)
• P2: Optimized Root Control
• P3: Optimized Rotation
• P4: Optimized Extrusion
• P5: Optimized Deep Bite (intrusion retention)
• P1: Optimized Maximum/Moderate Anchorage
Attachment (for first bicuspid space closure)
• P2: Optimized Multiplane Attachment
• P3: Optimized Extrusion Attachment
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First & Second Molar +
Second Bicuspid:
• Optimized Maximum or
Moderate Anchorage
Attachment
Canines:
• Optimized Retraction
Attachment
Multi-tooth unit
• SmartStage
First Bicuspid Extractions –
Maximum or Moderate
Anchorage
Placement per Clinical Solution
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Deep Bite (anchorage) on
first bicuspids
• If first bicuspid already
has an attachment for a
different movement,
then Deep Bite
attachment on second
bicuspids
• If attachments for
different movements are
already present on both
bicuspids, they remain.
Deep Bite Correction
(without premolar extrusion)
Placement per Clinical Solution
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• Deep Bite attachments
on both bicuspids with
activation for extrusion
Deep Bite Correction with
premolar extrusion
Placement per Clinical Solution
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Upper Central and Lateral
Incisors
• Optimized Multi-tooth
Extrusion
Lower Incisors:
• Optimized Extrusion
(individual)
Open Bite CorrectionPlacement per Clinical Solution
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Default Protocols
• For certain Invisalign treatments, conventional attachments will be placed by default1 (unless otherwise specified in
Clinical Preferences or in the Prescription Form), sometimes in combination with Optimized Attachments in
another teeth.
• Providers may request attachments when aligner retentiveness is a concern. Attachments for aligner retention are
NOT offered by default.
1The Invisalign default protocols are used to create the initial ClinCheck Treatment Plan, based on the Invisalign Provider’s prescription.
However, the final treatment plan remains the responsibility of the Invisalign Provider and should be reviewed carefully and modified as
necessary before the ClinCheck Treatment Plan is approved.
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Molars:
• Conventional Vertical
Rectangular attachment
Bicuspid:
• Optimized Root Control
Attachment
Canines:
• Optimized Root Control
Attachment
Second Premolar
Extractions or First
Premolar extractions not
planned for maximum or
moderate anchorage
Placement per Clinical Solution
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Placement per Clinical Solution
Lower Incisors mesial &
distal to extraction space
• Conventional Vertical
Rectangular attachment
• If any Optimized
Attachment is placed on
the canine, it will be
maintained in place
Lower Incisor Extraction
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SmartForce Placement Protocols
Common reasons why attachments may not be placed
• There isn’t a default attachment defined for a given tooth movement programmed.
• A preference has not been set to place an attachment on a given tooth movement.
• Movement is below attachment placement threshold.
• Movement threshold triggers attachment placement, but another attachment has a higher priority.
• Due to Doctor preferences conflict.
• Due to feature conflict (i.e. Precision Cut and attachment don’t fit together).
• Due to lack of space (short clinical crown).
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SmartForce Placement Protocols
Common reasons why attachments may not be placed
• Movement threshold triggers attachment placement, but there is another feature that isn't compatible.
• Due to higher placement hierarchy rules – clinical protocol.
• Due to doctor Prescription Form instruction.
• Movement threshold triggers attachment placement, but there isn't enough space/clinical
crown/collision/pinching/gingiva.
• Backup attachments alternatives can be used, based on internal protocol or Doctor preferences
INVISALIGN, CLINCHECK, and ITERO among others, are trademarks and/or service
marks of Align Technology, Inc. or one of its subsidiaries or affiliated companies and
may be registered in the U.S. and/or other countries.
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