Preserving and Protecting Tooth Structure

Treatment carried out by Maria Kocisova

Dr Maria Kocisova is an associate at Fox Lane Dental Care in London and Complete Smile in Twickenham. She has particular interests in adult orthodontics, facial aesthetics, paediatrics and cosmetic dentistry. Dr Kocisova is also an ambassador at the Dr Bob Khanna Training Institute in Reading.

CONTACT INFORMATION

Dr BK Clinic
115 Queens Road
Reading
Berkshire
RG1 4DA

Tel:0118 9606930
Visit website

Having used the ClearSmile Aligner for three years, I find the ethos of the IAS Academy to be very ethical as it promotes patient safety. It strictly specifies what is possible for the GDP to treat and what needs to be referred for conventional orthodontics. The digital analysis involved is great as it helps the practitioner to control the desired outcome and also enables the clinician to gain informed consent from patients very easily, as they can see what could be achieved. This is without mentioning the continuous support from start to finish from experienced peers and mentors, ensuring practitioners complete cases in the safest and most effective way.

Case Presentation

A lovely 38-year-old patient attended my dental practice for a tooth wear consultation after finding me through our website. He hadn’t had orthodontic treatment before and was not happy about his teeth being heavily worn down. His routine dentist had suggested a soft splint for night time wear, but as he wanted to improve the aesthetics and function of his dentition as well, he was sought another solution. I discussed different treatment approaches with the patient and we agreed on aligning the teeth first to ensure a better relationship and to create space for bonding.

Orthodontic Assessment

Measurement	Result
Skeletal	Class I
FMPA	Average
Lower Face Height	Average
Facial Asymmetry	None
Soft Tissues	Naso-labial angle normal, average smile line, competent lips
Overjet	None
Overbite	0% overlap of incisors
Crossbite	None
Displacement on Closure	None
Incisor Relationship	Class III
Molar Relationship	Right: Class I \| Left: Class I
Canine Relationship	Right: Class III ¾ \| Left: Class III ¾
Teeth Present	7654321 \| 1234567 \| 7654321 \| 1234567
Centrelines	Lower deviated to the right by 1mm

Treatment planning

As the patient was biting edge-to-edge and further damaging the hard tooth structure with additional grinding and clenching, I wanted to bring the arches into a more favourable position, creating a better overjet and overbite.

The plan was to procline the upper arch as much as possible – it was already fairly rounded, creating diastemata mesially and distally on both the laterals. The lower arch needed to be retruded. As the patient preferred a removable and discreet option, the ClearSmile Aligners were considered. The Archwize™ digital analysis tool confirmed case suitability. It also predicted that a total interproximal reduction (IPR) of 1.7mm would be needed, as well as nine upper and 15 lower aligners to complete treatment and achieve the results the patient was looking for.

Problem list
•Moderate lower crowding	•Non favourable overjet and overbite	•Non coincident centrelines	•Class III canine relationship on both sides

Ideal treatment aims
•Create class I canine relationship

Compromised treatment aims
•Accept canine relationship

Appointment	Progress
November 2017	Orthodontic assessment was performed. Impressions and photos were taken, treatment planned.
November 2017	Confirmed suitability via digital analysis and acquired patient consent. Initial IPR and predictive proximal reduction (PPR) performed, composite anchors bonded on UR3 and all lower incisors. First upper and lower ClearSmile Aligners fitted, patient given six sets of aligners and instructed to change them once a week.
January 2018	Additional IPR performed. Patient was given the next three upper and six lower aligners.
February 2018	Impressions were taken in polyvinylsiloxane to assess treatment progress.
February 2018	As the lower incisors were not tracking properly, a new IPR guide (total IPR 1.6mm) was created with final three aligners and three refiners.
April 2018	Teeth were aligned and Essix retainers provided. Philips Zoom in-practice whitening was performed, followed by home bleaching, changing the shade of the teeth from A4 to A1.
May 2018	Edge bonding was performed on UR3-UL3 and LL3-LR3 using Venus Diamond shade A1 and OL. New Essix retainers were provided as the patient declined fixed retainers.

Outcome

Both the patient and I were incredibly satisfied with the outcome of treatment, having been able to improve the aesthetics and function greatly. The teeth are no longer vulnerable with exposed dentine. The patient will wear life-long retention that will keep the teeth in the aligned position and protect the edge bonding from future damage.

Case Appraisal

Throughout this case, I received invaluable support and reassurance from Dr Tif Qureshi, who offered guidance and advice that enabled me to achieve the best result for my patient. Reflecting on the case, I would not do anything differently as this was the most gentle and least invasive approach in terms of tooth structure preservation and future protection. This is a beautiful example of improving a patient’s quality of life by protecting and preserving the tooth structure and preventing further wear.