Posterior Extrusion Failed - Watch Me Replan The Case

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If you're new to my channel, hello and welcome ! I'm Dr. Petra van der Merwe, an orthodontist with over 30 years of experience.

I specialise in clear aligner therapy and bring a deep clinical background in prosthodontics, periodontics, and oral pathology. This channel is dedicated to helping dentists and orthodontists improve their aligner results with practical, real - world tips.

The short life story

I decided to follow family tradition and study medicine. Here is the journey so far:

Age 19: Enrolled at medical school
Age 22: Found the clinical reality of incurable diseases overwhelming and switched gears into Dental school
Age 25: Qualified with a BChD degree, graduating with several distinctions
Age 26: Appointed as a Lecturer at the Dental School. I loved getting involved in research, and when the opportunity presented itself, I enrolled for a Master’s in Oral Pathology
Age 30: Obtained my MChD in Oral Pathology
Age 35: Obtained my MChD in Orthodontics
Age 36: Started my main private practice as an orthodontist, Beautiful Smiles
Age 37: Opened four additional satellite orthodontic practices, running five practices in five different cities
Age 41: Closed the four satellite practices to improve my quality of life and shifted all my focus to my main orthodontic practice
Age 54: Made a conscious decision to continually educate myself in the field of orthodontics. I faithfully attended every local orthodontic conference and every renowned international speaker visiting South Africa. Still, the dots didn’t fully connect, and I began venturing beyond the traditional borders of orthodontics in search of answers
Age 59: Downscaled my practice from five locations to two, and eventually to a one-chair practice. I began focusing on multidisciplinary dentistry, serving mainly adult patients. My emphasis shifted toward a restorative approach-function, occlusion, and the forever-moving target of stability
Age 61: Approached by a tech start-up, Mia Healthcare. I was tasked with setting up the aligner department, particularly overseeing education and quality control
Age 62: Started working full-time as Chief Clinical Officer at Mia Healthcare, while still seeing patients at my private practice

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In this video, I’m working through a refinement after a failed attempt at posterior extrusion with aligners. Extrusion in general can be unpredictable and when it comes to closing a bite through posterior extrusion, the challenge increases even more.

In this video, I’ll walk you step by step through how I analyze the setup that was sent to me, what I look for when vertical movements haven’t been achieved, and the adjustments I make to work around the lack of posterior contact. You’ll see how I compensate for failed extrusion and rethink the design to create functional occlusion.

If you’ve struggled with extrusion, especially posterior extrusion, this video will give you insight into how I approach these difficult cases, what I’ve learned from failures, and how I adapt my design strategy.
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DISCLOSURE

The information shared in this video is for educational purposes only and is not a substitute for professional training or clinical judgment. Orthodontic cases may vary significantly, and results are not guaranteed. Clinicians should evaluate treatment strategies carefully and apply them within the scope of their own expertise and patient needs.

All patient cases featured here are shared with full written consent. Names, faces, and identifying details are never disclosed to ensure complete confidentiality.

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