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29Dental Tribune Middle East & Africa Edition | January - February 2014 Ortho Tribune active components were made from stainless-steel wire, which is relatively inflexible and lacks any innate springi- ness. As a result, traditional re- movable appliances required periodic reactivation, leading to short-lived force application that limited the speed of tooth movement, owing to the need to allow the bone around the roots of the teeth being moved to ‘rest’ between successive activations. In addition, the direction of force application with traditional springs was less easy to control, leading to a mousetrap-like force that tended to unseat the appli- ance. These factors limited the degree of correction that could be accomplished. For larger movements, single appliances were insufficient to complete the movement. In developing the Inman Align- er, Donal Inman, CDT created a patented design that takes advantage of the gentle, steady and consistent forces gener- ated by NiTi. The design re- lies on piston-like components driven by NiTi coil springs. In- man designed lingual and la- bial components to function or move in parallel to the occlusal plane, eliminating the mouse- trap-like unseating forces and allowing actual physiological movement of teeth. Inman Aligners are ideally worn for 16 to 20 hours a day. Studies have demonstrated that the removal of orthodontic forces for four hours a day massively reduces the risk of root resorp- tion1 and that risk of root re- sorption is lower in removable versus fixed appliances.2 A standard Inman Aligner as described in the following cas- es consists of both lingual and labial components. The forces have the effect of squeezing the teeth into alignment. The components can be used in isolation to retract teeth with a more steady force, requir- ing less adjustment than a standard labial bow retractor. In Case III, a unique approach that incorporates an expander on the Inman Aligner is de- scribed. Patient selection Case selection for the Inman Aligner is critical. The follow- ing criteria should be met be- fore treatment proceeds: 1. Cases should require move- ment of incisor and/or canine teeth only. 2. Root formation of the teeth to be moved must be complete. 3. Crowding or spacing should be less than or equal to 3mm. Arch evaluation must be per- formed to determine the amount of space required. Cas- es with over 3mm of crowding require additional space crea- tion techniques which should only be attempted with train- ing. It is quite possible to treat cases with 5.5mm crowding easily and predictably in less than 16 weeks. 4. Cases should have fully erupted posterior teeth to fa- cilitate retentive clasps, with a reasonably well-aligned arch form to facilitate the path of in- sertion of the appliance. 5. Cases should be stable and preferably periodontal disease free. 6. Patients must agree to wear the Aligner for about 20 hours a day and be responsible for good appliance and oral hy- giene. Should the patient wear the Aligner for 14 hours a day only, treatment will still be successful. Model evaluation/arch anal- ysis with Spacewize Arch analysis should be per- formed before any Aligner case is attempted in order to ensure that the case is suitable and, if not, what additional space creation techniques will be needed to allow the Inman Aligner to work. The extent of crowding present is calcu- lated3 by measuring the sum of the mesial-distal widths of the teeth to be moved. This distance is called the required space. If canines and incisors are to be moved, this distance will be measured from the distal surface of one canine to the distal surface of the other canine. Using an orthodontic retaining or jeweller’s chain or a polishing strip, the ideal arch form is then measured from the distal of each canine in alignment with the ideal arch form following orthodon- tic correction. Critically, the arch needs to pass through the suggested position of the con- tact points and not the incisal edges. This is described as the available space or the curve. It is possible to perform this task more quickly and just as accurately with software such as Spacewize. Just one sim- ple occlusal photograph is The Inman Aligner: An effective tool for minimally invasive cosmetic dentistry - Part 1 By Dr. Tif Qureshi T raditionally, cos- metic dentistry has always been faced with the challenge of treating poorly aligned teeth. Treatment options available for mildly and moderately crowded teeth include ortho- dontics and restorative den- tistry. Many patients have chosen the restorative ap- proach, for example porce- lain veneers, over orthodontic techniques because of longer treatment times combined with either unsightly labial wires and brackets or the ex- pense of ‘invisible’ braces. In cases in which patients choose to have crowded upper and lower anterior teeth treat- ed with veneers, it is extremely challenging to prepare teeth conservatively, owing to their anatomy and the minimum thickness of porcelain re- quired. A difficult balance has to be found between overpre- paring the teeth and placing overcontoured restorations. However, owing to the excite- ment and emotion created by the effect of popular large smile makeovers, aggressive tooth preparations, in which teeth are prepared to stumps, seem to have been accepted as normal practice, simply be- cause there has been no alter- native that could achieve the patient’s objectives in a suffi- ciently short period. Inman Aligners are now offer- ing a minimally invasive alter- native to patients in Australia. With only one appliance, most Aligner cases can be complet- ed in six to 16 weeks. In an- terior crowding cases, Inman Aligners have proven to be much more time- and cost-ef- fective than invisible braces or conventional fixed and short- term orthodontics. To date, I have treated about 1,000 cases and have found that case ac- ceptance has been close to 100%, simply because many patients much prefer a remov- able solution that fits their life- style more easily. Treatment can also easily be combined with simultaneous bleaching and final edge-bonding for dramatic, quick and non-inva- sive results. From this, a new procedure has arisen in cos- metic dentistry - alignment, bleaching, bonding - which will be covered in the second part of this series. The cases presented in this article will outline some case types that can be treated. The Inman Aligner For over 30 years, spring align- ers were used to correct minor tooth movements. Early de- signs were developed for mi- nor tooth movements and to treat slight rotations. Previous spring aligners were useful, but several problems always limited the amount of tooth movement achievable. Their Figure 1. Side smile view before treatment. Figure 3. Occlusal view before treat- ment. Figure 5. Occlusal view before treat- ment. Figure 2. Side smile view after nine weeks with an Inman Aligner. Figure 4. Occlusal view after treat- ment. Figure 6. Occlusal view after 13 weeks with an Inman Aligner.