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Dental Tribune United Kingdom Edition

page 20DTà April 23-29, 2012United Kingdom Edition Our specialist knowledge of the dental market enables us to provide a high quality and bespoke service to our clients. WWe can advise on all aspects of the legislative framework which regulates dentistry, as well as being able to advise on contractual documents and variations. We can offer you specialist expertise and experience in a comprehensive range of areas including: - Commercial contracting - Dispute Resolution- Dispute Resolution - Employment - Goodwill - Healthcare Law - Incorporation & LLP formation - Partnership Agreements - Professional Regulation &- Professional Regulation & - Registration - Sales & Purchase - Surgery Ownership & Development For further information onFor further information on our services visit: www.lockharts.co.uk or call 0207 383 7111. the crowded anterior segment? A few years ago I attended the Straight Talk Seminars hands- on Inman Aligner course, and I would now like to share with you my first ever case. The patient was a 45-year- old gentleman who was en- quiring about the options to improve the look of his lower anterior teeth that had... yes, you guessed it, relapsed after fixed orthodontics as a teen- ager. Admittedly he blamed himself for this, as he had stopped wearing his retainer. He presented with mild to mod- erate crowding in the upper anterior segment and moder- ate crowding in the lower ante- rior segment. It was, however, only the lower incisors that concerned him. Over the years he was given various options for treating this from various dentists. These included the quick fix porce- lain veneers, fixed orthodontics and Invisalign. Luckily, he had always declined the veneer op- tion and didn’t want the fixed orthodontic option. I made him aware of lingual orthodontics but due to costs and length of treatment time, this was de- clined. Although Invisalign was a viable option, it was twice as costly and would have taken twice as long as what I pro- posed...the Inman Aligner. He hadn’t heard of it before but re- ally liked the fact that not only was it removable but it was also quick, usually taking three-four months and was cost effective. Good case selection is es- sential and a parallel technique digital long cone periapical radiograph was taken of the lower incisors. This is essen- tial not only to assess whether any apical pathology is present but also to assess the spacing between the roots. If the roots are as crowded as the crowns, then this may be a difficult case and you should proceed with caution. This case exhibited no pathology and some spacing between the roots. The patient therefore went ahead with im- pressions at his consultation appointment. This is quickly done in alginate in metal Rim- lock trays and an alginate fin- ger sweep into embrasures lin- gually and labially for accurate bubble-free impressions. The fit appointment was two weeks later and took 15 min- utes. Lingual and labial com- posite attachments were placed to engage the palatal bow and prevent the labial bow from slipping towards the gingiva re- spectively. Some selective and progressive interproximal re- duction (IPR) was carried out. The patient received instruc- tions as well as demonstrations of insertion and removal of the appliance. It was emphasised that both nocturnal and day- time wear is essential in Inman cases, with an average of 18 hours of wear per day. Figure 1. Preoperative 1:2 Anterior Retracted View showing lower anterior segment crowding. Note how much lower down the LL1 tooth was compared with the other incisors. Figure 2. Postoperative 1:2 Anterior Retracted View at 13 weeks. Whitening and incisal edge bonding was offered to the patient but was declined as he was so happy with the end result as it was. Figure 3. Preoperative 1:2 Retracted Right Lateral View. Note degree of lower incisal crowding Figure 4. Postoperative 1:2 Retracted Right Lateral View. Note good incisal alignment. Figure 5. Preoperative 1:2 Retracted Left Lateral View Figure 6. Postoperative 1:2 Retracted Left Lateral View Figure 7. Preoperative 1:1 Anterior Close Up View Figure 8. Postoperative 1:1 Anterior Close Up View. Bonding was offered to level incisal edges but was declined.