Safe, Predictable and Ethical Treatment
Treatment carried out by Solveig Skaar
Dr Solveig Skaar graduated from the University of Bergen in 1998 and purchased her own dental clinic in 2005. Now, she is a member of the Scandinavian Academy of Esthetic Dentistry and has been a certified user of the ClearSmile Inman Aligner since 2013.
A 24-year-old male patient presented with concerns about the appearance of his teeth, which were crowded. The patient therefore expressed an interest in aligning his upper anterior teeth, but was keen to avoid fixed orthodontics.
Assessment and diagnosis
A comprehensive orthodontic assessment was performed (Table 1), including periapical radiographs.
|Skeletal||Mild Class III|
|Lower Face Height||Average|
|Soft Tissues||Normal smile line. Minor plaque build up|
|Overbite||60% overlap of incisors|
|Displacement on Closure||None|
|Incisor Relationship||Class II Division I|
|Molar Relationship||Right: Class II ½ | Left: Class II ½|
|Canine Relationship||Right: Class II ½ | Left: Class II ½|
|Teeth Present||87654321 | 7654321 | 12345678 | 1234567|
The main problem in need of address was the mild Class II skeletal relationship. All possible treatment options were discussed with the patient, including gold standard fixed orthodontic treatment – which he still declined. He was happy to accept a minor compromise in order to proceed with removable appliances (Table 2).
|•Class II relationship|
|Ideal Treatment – Aims:|
|•Create ideal Class I incisor/canine/molar relationship||•Create ideal archform|
|Compromised Treatment – Aims:|
|•Align the teeth, retaining anterior teeth in both arches||•Accept incisor/molar positions|
The treatment plan involved following the ABB (Align, Bleach and bond) concept. We would use the Inman Aligner to straighten the upper dentition and the ClearSmile Aligner Light to straighten the lower, followed by whitening and composite edge bonding to improve the colour and shape of the teeth for the very best functional and aesthetic outcome.
Spacewize™+ and Archwize™ crowding calculations were performed to predict the amount of space that may need to be created. These suggested a total of approximately 0.6mm was needed in the upper arch and 0.7mm in the lower arch, confirming the Inman Aligner and ClearSmile Aligner Light to be suitable appliances for this case.
|1||Assessment, photographs, impressions and medical history taken. After the appointment, the case was posted on the support forum.|
|2 (week 0)||Fitted upper Inman Aligner, placing a composite anchor on UR1. Interproximal reduction (IPR) and predictive proximal reduction (PPR) were performed, fluoride applied and the patient was given oral care advice with instructions on how to place and remove appliance.|
|3 & 4 (weeks 2 & 4)||IPR and PPR performed as needed, photos taken, fluoride applied and bows/springs were checked on the Inman Aligner.|
|5 (week 6)||IPR and PPR performed on upper arch, photos taken, fluoride applied and bows/springs checked. Lower #1 ClearSmile Aligner Light fitted, composite anchor placed on LR2 and required lower IPR performed.|
|6 (week 8)||Upper: IPR and PPR performed, fluoride applied and bow/springs checked. Lower: IPR performed and changed to #2 aligner. Patient was given #3 and #4 due to upcoming summer holidays – he was instructed to change aligners every 10 days.|
|7 (week 10)||Upper: IPR and PPR performed, photos taken, fluoride applied and bows/springs checked. A buccal composite anchor was placed on UR2 and the buccal bow was tightened.|
|8 (week 11/12)||Upper: refiners only needed to complete alignment. Lower: alignment complete. Upper and lower impressions taken.|
|9||Upper: Composite anchors placed on canines to encourage final movements and minor IPR performed. Lower: Fixed retainer bonded. Patient given instructions for at home day bleaching with individual trays.|
|10||Impression taken for upper bonded retainer.|
|11||Upper bonded retainer fitted. Edge bonding performed on the lower incisors. Impressions taken of both arches for Essix retainers.|
|12||All edge bonding was polished and the patient was given the Essix retainers to wear at night.|
Case appraisal / discusion
For this case, we were able to deliver safe and predictable treatment thanks to use of 3D planning technologies and on-going mentorship from the IAS forum. It was also very ethical, with no drilling or loss of natural tooth structure. Alignment followed by whitening and edge bonding ensures an aesthetic and functional outcome, helping to reduce further incisal wear in the future. All-in-all, both practitioner and patient were very happy with the outcome of this case.