cosmetic dentistry - beauty & science

34 I I case report _ Inman Aligner A full discussion was undertaken about the pos- sible treatment options, which were: _no treatment; _comprehensive orthodontic treatment; _fixed short-term orthodontic treatment; _removable alignment treatment; and _restorative treatment/instant orthodontics. The patient did not want restorative treatment anddismissedtheideaofcrownsorveneerswhenwe explained the excessive amount of enamel removal required. The patient was open to the idea of fixed bracket orthodontics but was much happier with a removable appliance for lifestyle reasons. We went into the specifics of interproximal enamel reduction (IPR) and the patient expressed that she was happy with this small amount of enamel removal to create space for tooth movement. _Treatment A full set of clinical photographs was taken and upperandloweralginateimpressionswererecorded. The exact areas of the patient’s smile that caused her concern were discussed using the photographs, and we discussed the tooth movements that would be possible with the alignment treatment. Once the models had been cast from the impres- sions, we were able to assess the amount of crowd- ing. This is done in a very simple fashion when using an Inman Aligner. The maximum width of each in- cisor and canine tooth is measured using a simple micrometer. Using an interproximal metal strip, the required space for the optimal arch form is then measured from the distal of one canine around to the contralateral canine. The difference is equal to therequiredamountofinterproximalreductionand, for this young lady, it was found to be 1.21 mm. Up to 3.5 mm of crowding can be treated with astandardInmanAlignerdevicejustusingIPR.More severe crowding can be addressed with an Inman Aligner incorporating a palatal expander. Anupperseriesofthreeclearalignersandalower Inman Aligner were prescribed and the patient con- sented to the treatment as described. The models were sent to NimroDENTAL Orthodontic Laboratory, the UK’s only Inman Aligner laboratory. The Inman Aligner is fabricated on a Kessling mo- del. The prescribed interproximal reduction is carried out on the plaster model. The teeth are removed and then replaced on the model in wax on the ideal arch form. The first upper clear aligner and lower Inman Aligner were fitted on the same day. Extensive dis- cussionwasundertakenwiththepatientaboutwhat to expect over the coming days and weeks. A small amount of interproximal reduction was undertaken using metal interproximal strips on all the interproximal surfaces of the lower teeth, from themesialofthecaninesaroundtothecontralateral canines, and on the upper teeth, as according to the laboratory instructions. IPR is carried out in this fashion to respect the anatomy of the tooth, simply making the teeth more slender. The patient was seen every four weeks for the fitting of each of the upper aligners in the series, and to carry out further interproximal reduction on the lower teeth. After three months, the upper alignment was complete and the lower teeth were almost straight. After four months, the alignment of the lower teeth wascompleteandimpressionsweretakenforafixed bonded retainer—a multi-strand stainless-steel re- tainer bonded to the palatal surface of the front six teeth with the aid of a custom placement jig. Owing to the type of occlusion, the patient continues to wear an Essix-type retainer on the upper teeth. _Discussion This self-conscious young lady was concerned abouttheappearanceofherteeththatwerebecom- Fig. 9_Upper teeth view pre-op. Fig. 10_Upper teeth mirror view after treatment. cosmeticdentistry 2_2012 Fig. 9 Fig. 10