- Mild skeletal Class 2
- Molar relationship ¼ unit Class 3 on RHS
- Mild crowding upper and lower
- Increased overjet with a Class 2 div 1 incisal relationship
- Deviated centerline on the upper teeth
Ideal treatment aims:
- Correct skeletal relationship
- Correct molar, canine and incisor relationships to Class 1
- Torqueing of root and crown to ideal angulations
- Reduce overjet
- Relieve upper and lower arch crowding
Compromised treatment aims:
- Relieve upper and lower anterior crowding only
- Accept the skeletal, molar and canine relationships
- Accept possible increased overjet post treatment
- Accept upper midline deviation
The resulting treatment plan involved upper and lower aligners to upright the canines and premolars slightly, and to relieve upper and lower crowding. The Archwize™ analysis from the laboratory suggested a total of 9 upper and 12 lower aligners and the patient was advised to wear one a week. Tooth whitening and composite bonding on the distal edge of the LR2 was discussed with the patient to optimise aesthetics. Finally, fixed upper and lower retainers, as well as Essix retainers for nightwear were planned to ensure retention.
The patient was happy to accept the slightly increased overjet and the deviated centerline. She was not concerned about the posterior bite that resulted from the orthodontic treatment she’d had when she was younger and she understood that AAO offers only anterior teeth alignment. Had the patient not been happy with these compromises, she would have been referred to an orthodontist.
In order to monitor the patient closely, short appointments were booked weekly, which allowed me to perform any IPR required and take photographs when appropriate. When lower alignment was completed, a bonded retainer was fitted and an Essix retainer provided for night time.
After the prescribed 9 upper aligners, although that patient was happy with the result, the UR3 needed a little more buccal rotation to achieve a better outcome and the patient was very happy to go ahead. New impressions were taken for the laboratory and they prescribed 6 new aligners to complete alignment. Tooth whitening treatment was performed when the upper bonded retainer was fitted, using Opalescence 16% Carbamide Peroxide for two weeks at night. Finally, the composite edge bonding was performed on the LR1 and photos were taken.
Support and Mentorship
Working with IAS Academy makes you feel like you are not working alone. Ultimately, you are the clinician carrying out the treatment for the patient but help and advice is always close at hand. Throughout each stage of the treatment, I was able to post my progress on the online forum to ensure I was carrying out safe and effective treatment for my patient.
The patient was very happy with the final result. I am happy with the outcome but have recently been introduced to IPR leaf gauges – if I were to do this case again I would have used these to determine the correct amount of IPR more accurately, which I find ensures a case progresses efficiently.