Clinical Feature DENTAL ASIA SEPTEMBER / OCTOBER 2018 30 Introduction Diagnosis, treatment planning, spaces analysis, occlusion and jaw movements, appliance design and fabrication were usually done by taking dental impressions and making models. 1 Dental impression taking has improved over the past 10 years. Development in 3D digital technology in the medical ̬eld has been used in dentistry to create digital casts. Digital casts are more e ̮ cient in storage and retrieval, increased diagnostic versatility, easily transferable, increased durability and decreased processing time. 2 This article presents a di ̮ cult case treated by combining the use of the iTero scanner and Invisalign aligners while discussing both the pros and cons during the treatment (Fig. 1). By Dr. Kevin Ng and Dr. Zevon Ng Case Presentation A 23 year old male patient wished to seek orthodontic treatment for his 21, upon his girlfriend’s request. There was no relevant medical history, but patient rejected plans o ̫ ered by previous dentists to have tooth no. 21 and 23 removed and replaced by implants. Oral examination reveals severe crowding in both arches and 21 was horizontally impacted. There were ulcers at the upper lip and poor oral hygiene. Upper midline was 2-3 mm shifted to the left and molars were in Class I occlusion (Fig. 2). Treatment plan suggested extractions for tooth nos. 14, 23, 34, 44 and upper left deciduous canine and utilising the iTero scanner to make Invisalign aligners. Horizontal attachment was placed on 21 for maximum coverage (Figs. 3-4). Treatment time was 18 months and the outcome was satisfactory. Patient is now wearing the last ̬ve re̬nement aligners to improve posterior contacts (Figs. 5-10). Discussion The path of withdrawal of impression material was the major obstacle and the wires could cause severe discomfort and pain. It was impossible to perform any traditional impressions and Fig. 1: The iTero Scanner the use of any kind of traditional orthodontic appliance to treat this case. Combining the use of digital 3D scanning and aligners seems to be the only solution for this di ̮ cult case.