Discreet but Effective Treatment
Treatment carried out by Jessica Wake
Jessica graduated from Birmingham in 1989 with a degree in Dentistry and has been at St John’s Hill for a number of years now. She especially enjoys general family dentistry and cosmetic dentistry using minimally invasive techniques. Jessica’s special interests include tooth whitening, edge bonding and anterior alignment orthodontics using the ClearSmile Brace system, ClearSmile Aligners and ClearSmile Inman Aligner. She has recently achieved her Accreditation in the ClearSmile Brace system and has been accepted onto Prof. Hobson’s Advanced Orthodontic Course starting in November 2018.
30 St John’s Hill
Tel:01743 343 115
The patient is a lovely young lady who came to see me as she was unhappy with the appearance of her front teeth. She was aware of them ‘sticking out’ and not being straight, noticing this particularly in photographs. She also admitted being embarrassed about her teeth and always thinking people were looking at them, hence she had lost confidence.
The patient had previously undergone extensive orthodontic treatment as a child, including functional appliances, but she unfortunately lost her upper retainer and the position of her teeth had relapsed. She was happy with her lower teeth and continued to wear a lower retainer.
On examination of the patient, a full orthodontic assessment was conducted. There was proclination of the UR1, UR2 and UL1. The patient was happy with the appearance of the UL2 so it was decided to use this as a landmark tooth. The options of fully comprehensive treatment, fixed appliances and treatment with the ClearSmile Inman Aligner were discussed, but she preferred the discreet nature of the ClearSmile Aligners as she was only concerned with correcting the alignment of the upper 2-2.
|Skeletal||Class II division I|
|Lower Face Height||Reduced|
|Soft Tissues||Shortened upper lip and deep labiomental groove|
|Displacement on Closure||None|
|Incisor Relationship||Class II division II|
|Molar Relationship||Right: Class I | Left: Class II ¼ unit|
|Canine Relationship||Right: Class III full unit | Left: Class II ½ unit|
|Teeth Present||764321 | 1234678 | 8765431 | 1234568|
|Centrelines||Small deviation of the upper centre line, teeth canted to the right of facial midline by 1mm. Lowers coincident with facial midline|
The full assessment, diagnosis and treatment plan were posted on the IAS Academy ClearSmile Aligner forum along with a Spacewize+™ crowding calculation to show the suggested new arch and to estimate the amount of space and interproximal reduction (IPR) required to realign the teeth. The proposed results were discussed with the patient and she was happy with the Archwize™ interpretation produced by the lab. This showed that five aligners would be needed and that the total IPR would be approximately 1.5mm.
The support on the ClearSmile Aligner forum was very helpful, giving appropriate advice, useful tips about bonding the attachments and polishing the composites etc. The feedback was always supportive and encouraging and the response time always excellent. The mentoring on the forum is so valuable, providing an easy way to ask questions about procedures and to discuss progress.
During the first appointment, two force drivers were fitted on the UL4 and UR4 following the templates produced by the lab. About half of the recommended IPR was also performed on the 3-3, and the first ClearSmile Aligner Light was fitted. The retriever was demonstrated, ‘chewies’ were advised twice daily to help the aligners seat and 22 hours wear a day was recommended.
Subsequent IPR was carried out over two visits. The patient wore the series of aligners as instructed and progress was reviewed after the second and fifth aligner.
Photos were taken at the end of treatment and, although the patient was happy with the alignment of her teeth, she was still not completely happy about the shape and length. The uneven wear and the discrepancy in the length of the teeth were discussed in detail. To show the patient what could be done to improve aesthetics, a mock up was fabricated with composite added to the tips of the teeth to even things out and gain some symmetry. The patient was shown these in the mirror and photographs were taken. She was happy with the potential aesthetics achieved so edge bonding was indicated and she provided consent to proceed. The patient also carried out some whitening in her last aligner – wearing Phillips Day White 6% Hydrogen Peroxide, for 40 minutes each day for two weeks. The palatal bonded retainer was then fitted.
Edge bonding was performed on the 3-3 using Venus Pearl OLC and A1 shade, following Dr Tif Qureshi’s reverse triangle edge bonding procedure from the IAS Orthodontic Restorative course. The patient returned two weeks later for final polishing and adjustments, and when she was happy with the shape, impressions were taken for the final Essix retainer to wear at night.
The patient was delighted with the final results and has subsequently reported that she feels much happier and more confident in herself thanks to the improved aesthetics of the teeth. I was pleased that I had the chance to show her what the teeth could potentially look like when I did the temporary mock up of the teeth.
I was thrilled with the results of this case and on reflection I do not think I would have treated her any other way. The technique for minimally invasive edge bonding on the incisors has worked very nicely and will be very useful in many future cases. The teaching that I have received from the ClearSmile Aligner course including the ‘hands on’ has been excellent. I have found the IAS Orthodontic Restorative course and IAS Photography courses particularly valuable and have been very impressed with Tif Qureshi’s edge bonding technique, which is very reproducible. The Align, Bleach and Bond (ABB) philosophy will be extremely useful when treating my patients as well, improving their aesthetics whilst using minimally invasive techniques.