Dental Tribune United Kingdom Edition

P eople of all ages want a beautiful, natural smile as well as healthy teeth and gums. An increasing number of adult patients with anterior spac- ing or crowding adults are will- ing to undergo orthodontic treat- ment in order to achieve this. However, they usually want the appliance to be as inconspicu- ous and comfortable to wear as possible. In many cases, invisible splint/ brace therapy can be ap- plied successfully. In this case the anterior crowding was treated with In-Line splints, produced in Germany by Rasteder Orthodon- tic Laboratory (www.in-line.eu). Initial situation The patient wanted to resolve her severe maxillary crowding in or- der to improve both the appear- ance of her smile and her dental hygiene.Sheexpressedadesireto have the mal-alignment correct- ed with a therapy which should be as invisible as possible. The severity of the crowding was not immediately appar- ent from a frontal view (Fig 1). However, the mal-align- ment is more clearly seen when viewed from the side or from occlusion (Fig 2, 3, 4). UR2 was noticeably labial to UR1. UR1 was retro-clined, indeed both centrals were mal-aligned. UL2, UL3 and UR3 were also margin- ally mal-aligned. As a part of the diagnostics, a model and OPG were produced. Clinical examination showed that the patient’s teeth and gums were otherwise healthy with no problems relevant to orthodontic treatment. Treatment decision The patient was informed about all the available treatment op- tions.Inadditiontotreatmentwith In- Line splint therapy, the possi- bility of fixed brackets was also discussed. However, even braces made of tooth coloured ceram- ics were rejected by the patient on both aesthetic and comfort grounds. The patient was shown a sample of an In-Line splint to get an impression of the material, the robustness and the thickness of the splint. This solution met her need for comfort; the splints affect the patient’s speech only initially and are visually barely noticeable. In-Line’s laboratory charges are also significantly lower than some competitive brands, which brings the treat- ment within the reach of a wider range of patients. An In-Line splint Treatment planning A quotation with treatment recommendations and a 3D digital set-up was re- quested from In-Line. The 3D set-up includes seven images of the final situation, allow- ing the patient to see how her teeth will appear post treat- ment from all angles. (Figs 5, 6, 7). An overlaid image show- ing the movements made by each tooth is also provided. (Fig 8) In addition to the 3D set- up photographs, study models of the anticipated final situation were also requested. The treatment plan prescribed seven splints for the upper arch and four splits for the lower. In-Line splints must be worn for five- six weeks; each splint can effect a movement of up to 0.6mm. The treatment recommen- dations proposed slight inter- proximal reduction of 0.15mm between five designated con- tact points in the upper arch. IPR was not required on the lower arch. In-Line’s state of the art software is able to accurately calculate the amount of IPR re- quired in advance of treatment. Treatment progress The patient was given new splints successively at individual check- up appointments, at intervals of approximately six weeks. Inter- proximal enamel reduction was carried out incrementally over the first three to four splint fit- tings, until the enamel had been reduced by the specified amount. The patient’s compliance was excellent and made a significant contribution to the success of the treatment. She wore the splints for the recommended time of at least 18 hours a day and the treatment goal was reached ahead of the scheduled eight – 10 months. (Fig 9, 10, 11, 12, 13). A comparison of before and after study models shows the im- pressive results achieved with around nine months of invisible splint / brace therapy (Fig 14, 15). A comparison of the study models showing the an- ticipated final situation (sent by In-Line pre-treatment) and the post treatment study models shows that the treatment goal had been achieved almost perfectly. (Fig 16, 17) Retention Long term retention is crucial following adult orthodon- tic treatment in order to avoid the risk of potential relapse. In-Line initially supplies a retention splint with each splint set, however this splint is only intended to be a short term solution. The Labora- tory also supplies two products for long term retention; an unbreakable retention splint to be worn for three- four nights per week and a 3–3 bonded wire retainer. The patient opted for a 3–3 bond- ed wire retainer as her chosen method of long term retention. DT 26 Advertorial United Kingdom Edition February 27-March 4, 2012 Resolving severe upper anterior crowding with ‘invisible’ orthodontic splint therapy Dr Gary Dorman leads us through the treatment of maxillary crowding using In- Line orthodontic splints Fig 1 Initial situation frontal view Fig 2b Fig 3 Occlusal view of severe maxillary anterior crowding Fig 4 Occlusal view of mild mandibular anterior crowding Fig 5 Fig 6 Fig 7 Fig 8 ‘Long term reten- tion is crucial fol- lowing adult ortho- dontic treatment in order to avoid the risk of potential relaps.’ ‘ In many cases, invisible splint/ brace ther- apy can be applied successfully’ Fig 2a and b Initial situation lateral views