Progressive Treatment That Meets Patient Expectations
Treatment carried out by Stephen M. Miller
Dr Stephen M. Miller completed dental school at the University of Pittsburgh in 1980 and a one-year G.P.R. program at the Eastman Dental Center in Rochester, New York in 1981. Dr Miller has been in private practice since 1981 and focuses on cosmetic and reconstructive dentistry. For 10 years Dr Miller lectured and served as a clinical supervisor for residents in the two-year Montefiore University Hospital Dental G.P.R. program. A member of the Academy of General Dentistry since 1988, Dr. Miller received his F.A.G.D. (Fellow of the Academy of General Dentistry) in 1996 and his M.A.G.D. (Master of the Academy of General Dentistry) in 2001. He earned the prestigious LLSR (Lifelong Learning and Service Recognition) in July 2011.
I have been offering the ClearSmile Inman Aligner appliance for nearly five years. I believe the appliance to be a very efficient solution for moving the anterior teeth and improving both aesthetics and function. I have also been a member of the ClearSmile Inman Aligner faculty for about three years in the United States, teaching the certification course for the appliance.
A 28-year-old female patient presented who worked as a fashion consultant for a custom men’s clothes company based in Pittsburgh, Pennsylvania. Her initial complaint was about the appearance of both her upper and lower teeth. She felt self conscious when smiling and wanted to improve the smile aesthetics.
Assessment and Treatment Planning
A full orthodontic assessment was completed
|Lower Face Height||Average|
|Soft Tissues||Lips competent|
|Displacement on Closure||None evident|
|Molar Relationship||Right: Class I | Left: Class I|
|Canine Relationship||Right: Class I | Left: Class I|
|Incisal Relationship||Class II|
|Teeth Present||All except the 8s|
|Centrelines||Lower midline deviated by 1.5mm|
Several options were discussed with the patient, including gold standard treatment by a specialist orthodontist and the removable ClearSmile Inman Aligner appliance. All benefits and limitations of each solution were provided.
The patient expressed a preference for the latter option due to the shorter treatment time and ease of being able to wear the appliance for the recommended 16-20 hours a day.
A Spacewize+™ digital crowding calculation was performed to determine the amount of space needed to align the teeth. This suggested that 1.55mm of space would need to be created – keeping it well within the 3mm limit of the ClearSmile Inman Aligner appliance. A palatal expander was recommended to help move the teeth more efficiently.
|•Mild upper and lower crowding||•Rotated teeth in the upper arch||•Tooth colour||•Length of upper teeth and asymmetry|
|Ideal treatment aims|
|•Correct upper and lower crowding||•Re-contouring the incisal edges of UR2, UR1, UL1 and LL1 with a soft tissue graft||•Tooth whitening|
|Compromised treatment aims|
|•Correct upper crowding only||•Gingival re-contouring on the upper lateral incisor teeth||•Tooth whitening|
While the ideal treatment would have involved alignment of both the upper and lower arches, financial considerations limited the patient to only doing the maxilla at this time. Planning proceeded to align the upper arch, as this would have most impact on the smile aesthetics.
The patient was shown how to place and remove the appliance and instructed to turn the expander screw once a week for eight weeks. Interproximal reduction (IPR) and progressive proximal reduction (PPR) would be incorporated during review appointments every two weeks to create enough space for the desired tooth movement.
The process went very much according to plan, with the patient remaining very compliant with turning the expander screw, 16-20 hours of wear time a day and her oral hygiene. IPR and PPR were performed progressively as needed throughout treatment, with composite anchors placed to encourage derotation of the appropriate teeth.
After 14 weeks of treatment with the ClearSmile Aligner, two ClearSmile Aligners were used to move the UL2 into the perfect position. Gingival re-contouring was then performed on the upper teeth from UR5 through to UL4 and this was followed by in-office and at-home tooth whitening (GLO Whitening) to improve the tooth shade from A-3 to B-1. A UK wire was provided for retention.
The patient was ecstatic with the treatment results. As can be seen in her before and after photos, she even changed her hairstyle and colour to reflect her newfound self-confidence. She will eventually look to align her lower arch as well, but as finances are a limiting factor for this patient, she was delighted with what has been achieved so far.