Success From the First Case with the Right Support

Treatment carried out by Lindsey Dixon

Originally from Southport, Lindsey graduated from Manchester Dental School in 2015 before moving South. After working for the Community Dental Service, she moved into private practice to explore more aesthetic and restorative dentistry, continuously trying to improve her knowledge and skills.

CONTACT INFORMATION

20 Linden Avenue
Maidenhead
SL6 6HB

Tel:01628 621810
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I was initially keen to expand my treatment options and start offering orthodontics to my patients. I chose to take the IAS Academy course following recommendations by some of my peers. I think it is a great course – there is a lot to learn on the day, but the support offered by the team on the forum and through the online training afterwards is invaluable. It was with the help of the IAS Academy team that I chose to use the Aligner system for this particular case.

A 24-year-old patient attended the practice complaining of a ‘snaggle tooth’ at the front of her mouth. She had previously undergone orthodontic treatment, but had since experienced some slight relapse. The patient was only really concerned about the UR1 and UL1, and she didn’t want to correct the misalignment of the lower teeth.

Assessment

A comprehensive orthodontic assessment was carried out, including radiographs, and no abnormalities were detected.

Measurement Result
SkeletalClass I
FMPANormal
Lower Face HeightNormal
Facial AsymmetryNone
Soft TissuesNormal nasolabial angle
OverjetNone
OverbiteMinimal with mild anterior open bite
CrossbiteNone
Displacement on ClosureNone
Incisor RelationshipClass II division I
Molar RelationshipRight: Class II ½ unit | Left: Class II ½ unit
Canine RelationshipRight: Class II ¼ unit | Left: Class I
Teeth Present7654321 | 7654321 | 1234567 | 1234567
CentrelinesLower centrelines shifted to left by 2-3mm

Treatment planning

It was explained to the patient that gold standard treatment would be with a specialist orthodontist in order to correct the crowding present, as well as the mild anterior open bite. She wished to avoid prolonged, fixed orthodontic treatment and therefore requested a removable solution if possible.

Silicone impressions and photos were taken and the Spazewize™+ digital software programme was used to calculate the amount of crowding present. It revealed that 0.1mm of space would need to be created in the upper arch and 1.6mm would be required in the lower arch. Well within the 3mm safe limit of the Aligner system from IAS Academy, this option was presented to the patient who was more than happy to proceed.

Problem list
Overlapping upper centralsMild lower crowding
Ideal Treatment – Aims:
Specialist orthodontic treatment to correct mild upper and lower crowding, and anterior open bite
Compromised Treatment – Aims:
Correct mild upper crowdingAccept lower crowdingAccept mild anterior open bite

The risk of black triangles following tooth movement was made very clear to the patient. More importantly, so was the likely need for composite edge bonding at the completion of alignment treatment, due to the overlapping of the teeth and differential wear already present. Neither of these were concerns for the patient and informed consent was obtained to proceed. The impressions were therefore sent to the IAS laboratory.

Treatment

Progressive Proximal Reduction (PPR) was carried out as per the estimates on the returned laboratory documents. New impressions were then taken in order to record the new tooth shapes and positions. Interproximal Reduction (IPR) was sequentially performed ready for alignment to commence.

The first aligner was fitted and the patient was instructed on how to place and remove it safely. The aligners were changed every two weeks during review appointments. In total, four aligners were needed to get as close to the patient’s desired result as possible, with IPR carried out progressively as and when it was needed to encourage adequate tooth movement.

The final movements were achieved with a refiner aligner. As expected, the discrepancy in length between some of the anterior teeth was very apparent following alignment, but composite edge bonding on the UR2-UL2 solved this problem completely. The patient was absolutely thrilled with the outcome and so was I!

Review

With this being my first case, I nervous about starting. However, there was so much support and feedback provided through the IAS online forum from the mentors, that I became much more confident as I went along. I found it really helpful to post each step on the forum in order to check that I was doing everything correctly for my first case. It’s amazing what you can achieve with a little support!

Pre treatment smile
Pre treatment retracted closed bite
Pre treatment right lateral
Pre treatment left lateral
Pre treatment upper occlusal
Post treatment smile
Post treatment retracted
Post treatment right lateral
Post treatment left lateral
Post treatment upper retention

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