When can I use Invisalign for a patient living in another country?

Orthodontics is the art of moving teeth to a place of patient satisfaction. We do not cut, trim, mask or cover teeth to get this desired position. We have to use our skills as dentists to propose a series of tooth movements and the teeth must follow.
Tooth movement does not always go to plan and that is why it is imperative that the patient attends regularly for review of treatment.
About 18 months ago a couple turned up and the groom wanted his teeth straightened. The problem was that he was leaving in the next weeks for India and would not be back for 12-16 months.
He had:
upper centre line was off to the right
upper and lower crowding
upper lateral incisor was in a crossbite and not visible on smiling
So I examined the patient and assessed his condition and with some trepidation, agreed to provide Invisalign.
Invisalign is a series of clear aligners that are changed in a series every 2 weeks creating orthodontic movements.
Invisalign also needs some interproximal spaces and composite attachments
that are usually done after the scanning and planning process.
But the patient was leaving soon and could not come back when the aligners were here.
So I had to give him attachments and make spaces.
Attachments are usually put on after the aligners arrive as the box contains a template for the attachment process.
So at day 1 I improvised.
I had a patient case unused with an attachment template and used it to place attachments where I deemed them necessary.
I also carried out some interproximal spacing where I thought necessary.
I then took the impressions.
It is very unusual to start a case with attachments already on, but Invisalign did not notice.
I viewed the scans and agreed with the movements.
I stipulated that there should be no more spacing/dentist intervention until the end.
The braces arrived and the patient paid for them to be delivered to India.
BUT customs got hold of them and wanted money.
They were held up in customs for 2 months before the patient got hold of them.
During the treatment he sent me some pictures of the aligners in the mouth.
18 months he came back and WOW
the teeth were exactly as the scan and I had predicted.
He had some cleaning to do and very little else. But to get his moneys worth he wanted a little more pushing out of the aligner…cheeky bugger.
Anyway enjoy the picture of Invisalign 18 months in 1 visit

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