Supported Every Step of the Way

Treatment carried out by Andrew Logeswaran

Andrew Logeswaran BSc (Hons) MSc BDS is a general dentist working in a mixed practice in Colchester, Essex.

CONTACT INFORMATION

2, Upper Fairfield Road
Leatherhead
Surrey
KT22 7HH.

I took the one-day London ClearSmile Inman Aligner training course with Tif Qureshi in December 2015. While there were a lot of ‘short-term orthodontic’ courses available, I felt that the IAS Academy offered a well-structured set of courses to progress from simple to more complex alignment cases. The IAS Academy ethos of providing high quality, ethical dentistry resonated with me. I have been offering the appliance ever since and have found that with good patient communication and planning, my patients have acclimatised well to the aligner and do not find it an issue.
It is important for me to take photographs at each two-weekly appointment to demonstrate progress to the patient and keep them motivated.

Case Presentation

A 29-year-old patient presented to my colleague looking to straighten her front four teeth in time for her wedding in 24 weeks. She also disliked a chip on the mesio-incisal edge of the UR1 and wanted to know how this would look after aligning her teeth. She was not keen on the type of orthodontic treatment my colleague offered due to the proposed treatment time and cost, so she was referred to me to assess suitability for treatment with the ClearSmile Inman Aligner.

Orthodontic Assessment

A full orthodontic assessment was performed (Table 1), including periapical radiographs. Aside from hypodontia of the lower 5s, the patient was fit and healthy and had no relevant medical or dental history.

Measurement	Result
Skeletal	Mild Class I
FMPA	Average
Lower Face Height	Average
Facial Asymmetry	No
Soft Tissues	Normal nasiolabial angle, competent lips
Overjet	4mm
Overbite	25% overlap of incisors
Crossbite	No
Displacement on Closure	No
Incisor Relationship	Class I
Molar Relationship	Right: Class II ½ \| Left: Class II ½
Canine Relationship	Right: Class II ½ \| Left: Class II ½
Teeth Present	7654321 \| 12345678 \| 8764321 \| 1234678
Centrelines	Coincident

Treatment planning

The patient was not concerned about the lower arch and wished only to align the uppers. Using the Spacewize™+ arch evaluation software, it was suggested that approximately 3.0 mm of space would need to be created in the upper arch. The recommended amount of interproximal reduction (IPR) and predictive proximal reduction (PPR) was suggested, as was a ClearSmile Inman Aligner with expander. We planned to de-rotate the laterals and centrals into the desired arch line, followed by an upper bonded retainer, edge contouring on UR1 and tooth whitening. Digital 3D models were created to demonstrate to the patient what we could achieve and where we might need to compromise (Table 2). With informed consent, we were able to proceed.

Problem list
•Mild upper crowding and hypodontia of the lower 5s	•Increased overjet	•Class II ½ unit canine and molar relationship	•Distal kink in UL2 root	•Enamel fracture on mesio-incisal edge of UR1	•Compliance – can the patient wear appliance for enough hours a day?
•Correct upper crowding and lower hypodontia	•Correct increased overjet	•Correct canine and molar relationships	•Restore UR1 mesio-incisal enamel fracture
•Correct upper crowding	•Accept molar and canine relationship	•Correct increased overjet	•Restore UR1 mesio-incisal enamel fracture

Appointment	Progress
May’16	Initial consultation
May‘16	Discussed Spacewize™ results and impressions taken
June’16	Discussed 3D models and consent obtained
June’16	ClearSmile Inman Aligner with expander fitted, instructions provided, IPR and PPR performed, composite anchor placed on UL1 lingual, photos taken
July’16	IPR and PPR performed, photos taken
July’16	IPR and PPR performed, photos taken, composite anchors removed and new anchor placed on UL1
July’16	Patient was concerned that aligner felt lower with the anchor, reviewed
August’16	Patient attended with broken lingual bow – sent to lab for replacement, composite anchor on UL1 enhanced
August’16	Patient collected new aligner
August’16	IPR and PPR performed, photos taken
August’16	IPR and PPR performed, photos taken, UL1 anchor removed, UR1 anchor placed, acrylic of palatal bow at UL3 trimmed
September’16	Patient not expanding as advised so further instructions provided, IPR performed, patient expressed desire for smoothing of UR1 and not bonding
September’16	IPR performed, labial anchor placed on UR2
September’16	Gap forming by UR2, labial bow tightened with flowable composite
September’16	UL2 space closing, composite anchor placed on disto-palatal aspect of UR1
October’16	UR1 incisal edge levelled with Sof-Lex disc
October’16	All anchors removed, light body & putty impressions taken to make a clear aligner to finish treatment
October’16	Impressions re-taken due to distortions
October’16	Upper clear aligner fitted, IPR performed
October’16	Patient was delighted with progress so far and advised that she smiled a lot at her wedding. Clear aligner fitted to be worn over honeymoon
November’16	Impressions taken for fixed retainer
November’16	Retainer bonded

Support Utilised

All ClearSmile Inman Aligner cases need to be vetted by the IAS training team on the forum. Being my first case with this system, I was able to seek a lot of guidance on placement of composite anchors, IPR and general case progression. Replies from the mentors were always provided quickly, within a day or sometimes even within a few hours.

Case Self-appraisal

The patient was absolutely thrilled with the result achieved in time for her wedding. We did have a set back when the aligner fractured as a result of how the patient was placing it. Being without the aligner for a few days caused some relapse, so on reflection, making a vacuum formed splint in practice would have been the best idea.

Approaching similar cases since, I have learnt to be a little more generous with the IPR to encourage movement. I also think it is important to know what size of composite anchor you need. The online forum is also crucial for any practitioners attempting their initial cases.

Moving forward, I am getting interest from patients who would benefit from clear aligners so my next step is to take the ClearSmile Aligner course with the IAS Academy.

My sincere thanks to the IAS trainers for helping me through this case at each step and ensuring we reached the end point predictably.