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The current instructions for use contains the following: "precautions - a tooth that has been previously traumatized or significantly restored may be aggravated.In rare instances, the useful life of the tooth may be reduced, the tooth may require additional dental treatment such as endodontic and/or additional restorative work, and/or the tooth may be lost.".No root cause provided.No root cause provided.Align's clinical review noted that the patient records identified that the initial panoramic radiograph showed teeth #30 and #31 were already missing and had been replaced by a fixed bridge, with teeth #29 and #32 serving as abutment teeth.The clinical review also identified that tooth #29 had previously undergone endodontic treatment and demonstrated radiographic findings consistent with a periapical lesion.In addition, the treatment plan included programmed movement for teeth #30 and #31 despite these teeth not being present clinically.The patient had worn nine aligners from the initial treatment series at the time of the reported event.There is no conclusive evidence provided that supports or opposes whether the invisalign system caused or contributed to the reported permanent damage.Based on the available information, the patient had permanent damage, and the invisalign system was being used.Therefore, an mdr will be filed in the united states per 21 cfr 803.
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