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Orthodontic Case Management and Finalization With T-Scan Computerized Occlusal Analysis
Abstract
This chapter reviews T-Scan use in orthodontics from diagnosis to case finishing, and then in retention while defining normal T-Scan recording parameters for orthodontically treated subjects versus untreated subjects. T-Scan use in the case-finishing process is also described, compensating for occlusion changes that occur during “post-orthodontic settling,” as teeth move freely within the periodontium to find an equilibrium position when the appliances have been removed. T-Scan implementation is necessary because, often despite there being a post-treatment visually ‘perfect' Angle's Class I relationship established with the orthodontic treatment, ideal occlusal contacts do not result solely from tooth movement. Creating simultaneous and equal force occlusal contacts following orthodontics can be accomplished using T-Scan data to optimize the end-result occlusal contact pattern. Several tools of the T-Scan software aid the Orthodontist in obtaining an ideal occlusal force distribution and timing during case-finishing. These are the 2 and 3-Dimensional ForceView windows, the Force Percentage per tooth, arch half, and quadrant, the Center of Force (COF) trajectory and icon, the Occlusion Time (OT), and the Disclusion Time (DT). Fortunately, most orthodontic cases remain asymptomatic during and after orthodontic treatment. However, an occlusal force imbalance or patient discomfort may occur along with the malocclusion that needs orthodontic treatment. Symptomatic cases require special documentation at the baseline, and careful monitoring throughout the entire orthodontic process. The clinical use of T-Scan in these “fragile” cases of patient muscle in-coordination, mandibular deviation, atypical pain, and/or TMJ idiopathic arthritis, are illustrated by several case reports. The presented clinical examples highlight combining T-Scan data recorded during case diagnosis, tooth movement, and in case finishing, with patients that underwent lingual orthodontics and orthognathic surgery, orthodontic treatment using clear aligners, or conventional fixed treatment with a camouflage treatment plan, which require special occlusal finishing (where premolars are extracted in one arch only). In addition, a few recent publications will be highlighted that address whether tooth movement with aligners or fixed appliances result in better overall occlusal contact endpoints.
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