After the clinical examination, the patient expressed that the midline deviation was less of a problem than the increasingly anterior crowding. She also accepted a reduced overbite and slightly open bite in the right lateral area. She was informed that edge bonding could be performed on the right upper and lower laterals after treatment if she wanted.
Treating Orthodontic Relapse
Treatment carried out by Erik Svendrud
Erik Svendsrud, Cand odont Oslo 1987, has worked in his own private practice in Oslo, Norway since 1990 with a special interest in preventive and minimally invasive dentistry. Inspired by his mentor, Sverker Toreskog‘s way of thinking since 1993, Erik lectures around the world. He is also the former president of the SAED (Scandinavian Academy of Esthetic Dentistry).
Tannlege Erik Svendsrud
Vogts gate 46 – Torshov
Tel:22 35 25 05
|Lower Face Height||Average|
|Facial Asymmetry||No facial asymmetry|
|Soft Tissues||Healthy gingiva, no retractions|
|Incisor Relationship||Class I|
|Displacement on Closure||No displacement of closure|
|Molar Relationship||Right: Class I | Left: ¼ Class III|
|Canine Relationship||Right: ¼ Class II | Left: ¼ Class III|
|Teeth Present||All teeth from second molar to second molar present|
|Centrelines||Lower midline 2mm to the right|
|Mild upper and lower crowding|
|Movement of the lower right lateral|
|Treatment aims – ideal:|
|Align upper and lower arch|
|Move and rotate lower right lateral into ideal position|
|To achieve Class I relationships of molars and canines|
|Remove midline deviation|
|Treatment aims – compromised:|
|Align the upper and lower arch|
|Accept midline deviation and the existing canine and molar relationships|
|Accept slightly reduced overbite|
A number of treatment options were discussed in depth at this time, including comprehensive orthodontics, which she declined. Instead, the patient opted for the ClearSmile Inman Aligner for the lower arch and ClearSmile Aligner for the upper arch. To determine the suitability of using both of these appliances, the IAS Academy’s Spacewize+™ arch evaluation software was utilised. This predicted that 1.3mm of space would need to be created in the upper arch and 2.7mm in the lower arch. This was within the parameters of the ClearSmile appliances, confirming case suitability. The patient received the IAS consent form regarding alternative treatment options as well.
On receiving the appliances back from the lab, the patient was shown how to remove and apply the aligners safely. She was instructed to wear the ClearSmile Inman aligner for at 18-20 hours per day and the clear aligners all the time, except when eating and drinking. Alongside this, the patient received oral hygiene advice.
During treatment interproximal reduction (IPR) was carried out from canine to canine progressively. Predictive proximal reduction (PPR) was also performed on the most triangular teeth with a coarse polishing disc, during the first appointment. The patient was instructed to exercise reading out loud for approximately 15-30 minutes in the evening in order to improve speech while wearing the ClearSmile Inman Aligner during the day at work.
After PPR was performed in the lower arch at the first visit, a lingual anchor was placed on the right central. When the right central was correctly aligned, the anchor was removed and two further composite anchors were placed on the right lateral – one distolingual and one mesiofacial to derotate the lateral. Some flowable composite was also placed on the distal aspect of the facial bow to tighten it when the teeth were nearly aligned. In the upper arch, no composite anchors were used.
In total, eight ClearSmile Aligners were used in the upper arch, alongside ClearSmile Inman Aligner treatment in the lower. The patient was very happy with the final result achieved – she was surprised at how easily the treatment progressed and that she was capable of wearing the ClearSmile Inman aligner at work. Fixed retainers were bonded onto the upper and lower 3-3 to provide retention for life and Essix removable retainers were provided for wearing at night for at least the first year, and for 2-3 nights a week thereafter.
Upon reflection, I was also satisfaction with the outcome of this case. I found the IAs support forum very useful throughout the case – I uploaded photos from each patient visit and I received valuable feedback from the mentors. For example, they advised to move the composite anchors more to the approximal area so as to encourage better rotation of the lateral. I think that the treatment in the upper arch would have gone faster with fewer aligners, if composite anchors had been planned and placed throughout, but this is something I now know for next time.