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.
20 Linden Avenue
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.
A comprehensive orthodontic assessment was carried out, including radiographs, and no abnormalities were detected.
|Lower Face Height||Normal|
|Soft Tissues||Normal nasolabial angle|
|Overbite||Minimal with mild anterior open bite|
|Displacement on Closure||None|
|Incisor Relationship||Class II division I|
|Molar Relationship||Right: Class II ½ unit | Left: Class II ½ unit|
|Canine Relationship||Right: Class II ¼ unit | Left: Class I|
|Teeth Present||7654321 | 7654321 | 1234567 | 1234567|
|Centrelines||Lower centrelines shifted to left by 2-3mm|
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.
|Overlapping upper centrals||Mild 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 crowding||Accept lower crowding||Accept 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.
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!
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!