Occasionally, as orthodontists, we get a stubborn tooth. We try and try but the tooth won’t move. Here are some of the solutions and resolutions for this issue:

1. Reassess your mechanics. Is what you are doing even biomechanically POSSIBLE? Check articulation. Check contacts. Call a friend who is an orthodontist for a second opinion.
2. If it’s aligners, maybe the patient isn’t compliant?
2. There is a bony defect (can’t do it)
3. It’s ankylosed (can’t do it)

ANKYLOSIS:

if it hasn’t budged at all after 2 refinements or 12 months in braces (it looks EXACTLY the same!)- it’s not going to move – first go back to step 1 and make sure it’s even biomechanically possible.
It might be ankylosed. Try taking a good PA or CBCT and try to follow the pdl.


NON COMPLIANCE:
https://www.youtube.com/watch?v=AkVf08CFxyo&t=20s

This is a hard one but after this many aligners it should be mostly there if it wasn’t ankylosed so either he’s non compliant at les than 22-23 hours a day or it’s ankylosed
Put the patient on on weekly Invisalign virtual check ins or try In-Hand-Dental to rule out the non-compliance issue
Maybe he switches to 24/7 wear with and eats with the upper one in. that often works.

BONY DEFECT:

I recently had an issue like this with a patient – it was a bone defect (we caught it on a CBCT that was professionally read by a dental radiologist) the bone was too ossified and we couldn’t upright the tooth. It wasn’t ankylosed per-say but the bone wouldn’t remodel.

So rule all of this out before jumping to conclusions and placing TADS and wasting the patient’s time and money.