Dr Benedict Wilmes

Dr Benedict Wilmes


Slider and aligner combination – what are the best treatment planning protocols?

An increasing number of patients seek orthodontic treatment with aligner therapy. Howev-er, pure bodily tooth movement with clear sequential aligner therapy can prove challenging to achieve with a high degree of predictability. Especially molars show a high tendency of just tipping instead of a bodily movement. Additionally, anchorage demands must be re-spected which is true especially in asymmetric cases. Moreover, the potential side effects of intermaxillary elastics must be considered in terms of shift of the anchorage teeth; this might be a severe problem especially in unilateral elastics applications with the potential for development of a midline shift, arch rotation and a jaw discrepancy, and transverse occlu-sal canting. To avoid this anchorage loss and the high demand on elastic wear, orthodontic mini-implants may be used. Currently, the alveolar process and the IZC region are still the most preferred insertion sites for mini-implants. However, due to a failure rate and the risk of root damage, insertion in these areas is far from satisfactory. Additionally, a bodily tooth movement is not guaranteed. On the other hand, the anterior palate provides much better conditions for the insertion and stability of skeletal anchorage devices, as the amount and quality of the available bone is far superior. With the adjunctive use of palatal mini-implants and slider appliances, non-compliance and bodily tooth movements can be achieved. The combination of this mini implant borne slider and customized aligners (BAT – Benefit for Aligner Technique) can be done simultaneously (1-phase) or consecutively (2-phase) with respective advantages and disadvantages. Integration of recent advances in digital technology such as virtual planning of a TAD installation, insertion guides and CAD-CAM design and 3D printing of orthodontic appliances broaden these options signif-icantly.

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