Overcoming Crowding Simply and Ethically

Treatment carried out by Smita Dasgupta

Dr Smita Dasgupta qualified in 2004 with a BDS and has since gone on to obtain a Diploma of Membership from the Joint Dental Faculties as well as a postgraduate qualification in Advanced Aesthetic Dentistry from The Eastman Dental Institute. Dr Dasgupta is also a certified user of the ClearSmile Inman Aligner. Here, she describes the treatment of lower mild crowding.


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St Albans

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Orthodontic assessment

In this case, a 24-year-old female had undergone extensive comprehensive orthodontic treatment when she was much younger (including bite blocks), but had not continued wearing her retainers as instructed resulting in failed retention. At the time of visiting the practice to voice her concerns the upper removable retainer still fitted, but the shape of the lower retainer no longer matched the patient’s dentition due to movement.

After discussing how the crowding would likely worsen with age and the various treatment options available, the patient opted for the ClearSmile Inman Aligner removable appliance from IAS Academy for the lower arch, along with a bonded retainer for both arches to prevent any further tooth movement.

Measurement Result
Skeletal Moderate Class II
FMPA Average
Lower Face Height Average
Facial Asymmetry Yes, nose positioned slightly to the left
Soft Tissues No abnormalities
Overjet 4mm
Overbite 50% overlap of incisors
Displacement on Closure No
Incisor Relationship Class I
Molar Relationship Right: Class I | Left: Class II 1/4
Canine Relationship Right: Class I | Left: Class II ½
Teeth Present 7654321 | 8654321 | 1234567 | 1234567
Centrelines Deviated lower left by 1mm

Treatment planning

Bearing the patient’s problem list in mind, the IAS Academy’s Spacewize+™ digital crowding calculator software was used to establish the extent of the crowding in the lower arch. To qualify for the ClearSmile Inman Aligner the difference between available space and required space must be no more than the 3mm recommendation. The patient was well within this limit as the Spacewize+™ calculated that 0.9mm of space would need to be created. .

Silicone impressions were then sent to the IAS Academy laboratory for casting and scanning into the Archwize™ 3D planning software to establish the interproximal reduction (IPR) that would be required during the treatment process. Using the 3D models the laboratory predicted that although just 1.1mm IPR would be needed in total to correct the patient’s lower crowding, the ClearSmile Inman Aligner would not correct the lower canine and molar relationships.

Problem list
•Lower mild crowding •UL2 slightly buccally placed •Left molar relationship Class II ½ unit •Left canine Class II ¼ unit
•Correct lower crowding •Align UL2 •Correct lower canine and molar relationships
•Correct lower crowding •Accept misalignment of UL2 •Accept lower canine and molar relationships


Treatment was carried out in the lower arch using the ClearSmile Inman Aligner followed by bonding of a fixed retainer in both upper and lower arches. IPR was carried out at regular intervals with a total of 1.1mm achieved over the duration of the treatment process.

Appointment Progress
13/1/17 •Initial orthodontic assessment was carried out to establish problem list. •Both periapical and bitewing X-rays taken to confirm diagnosis. •Full set of pre-treatment photographs taken along with silicone impressions for laboratory. •Spacewize+™ digital crowding calculator software was used to validate the extent of the crowding in the lower arch.
18/1/17 •Confirmation received from IAS Academy via the online forum to proceed with case.
23/2/17 •Lower ClearSmile Inman Aligner appliance was fitted, with details given to wear for around 20 hours a day. •0.5mm IPR was completed and composite anchors were placed on LL1 and LR2 lingually.
9/3/17 •LL1 and LR2 aligned at this point but the patient admitted to only wearing the appliance for 14 hours a day so reminded to wear for at least 16 hours. •IPR carried out. •Buccal composite anchor was placed on LR1.
6/4/17 •IPR carried out and progress reviewed.
27/4/17 •LR1 moved but not fully aligned. •Buccal composite anchor on LR1was adjusted so that bar was more bucally placed.
15/5/17 •Composite anchors were removed and post-treatment photos were taken. •Impressions were taken for fixed retainers.
8/6/17 •Fixed retainers were bonded in both arches. •Enameloplasty carried out on the lower teeth to improve overall aesthetics of the patient’s smile.

Critical Appraisal

Overall, both the patient and I are very pleased with the outcome, though the treatment could have been completed in a shorter time frame if she had been more vigilant with wearing the aligner for 16-20 hours a day as instructed. Shorter intervals between appointments might have helped to increase compliance, while moving the anchor buccally earlier may have moved the process along quicker.

As for the IAS Academy, the support was excellent as always. I would definitely recommend the ClearSmile Inman Aligner to other practitioners, as both the initial course and continuing education are very helpful and informative.

Pre treatment facial view
Post treatment facial view
Pre treatment smile
Pre treatment retracted view
Pre treatment left view closed bite
Pre treatment right closed bite
Pre treatment left open bite
Pre treatment right open bite
Pre treatment upper occlusal
Pre treatment lower occlusal
Pre treatment chin up view
Post treatment smile
Post treatment open bite
Post treatment left closed bite
Post treatment right closed bite
Post treatment left open bite
Post treatment right open bite
Post treatment lower occlusal view