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15Dental Tribune Middle East & Africa Edition | November-December 2014 Aesthetics < Page 14 Figure 11. Upper occlusal before. Figure 16. Side smile after. Figure 12. Upper occlusal after. Figure 17. Side smile after closed. Figure 13. Lower occlusal before. Figure 14. Lower occlusal after. Figure 15. Side smile before. © 2014 Ormco Corporation*As compared to Damon Clear, data on file. Standard torque, upper 3-3 brackets. TwinsDigitalAuxiliariesPracticeDevelopmentEducation SelfLigationAlignersTubes/BandsArchwiresLabProducts Damon patients treated by Dr. Stuart Frost. OrderyourDamonClear2 brackets today at ormco.com CanYouSee Who’s Wearing Braces? (Your patients can’t see them either) Introducing the only100% clear self-ligating bracket, now with 2x the rotational control* for meticulous finishing and faster treatment. An aesthetic solution for image-conscious adults and teens, Damon Clear provides the performance and control needed to treat a wide variety of cases with exceptional results. NEW! Ormco-OrthoProd-DamonClear2-June2014.indd 1 5/5/14 2:30 PM The patient was then sent home. The Inman Aligner was worn for 16-20 hours per day with the pa- tient removing it for eating and rest. 20 hours a day is the maxi- mum needed wear and this in- termittent wear reduces the risk of root resorption.10,11 On return 2 weeks later, it was clear that the contacts had closed tight and the teeth had moved a little. More IPR was carried out on both the uppers and lowers. The occlusal contacts of the upper temporary crowns were adjusted to allow clearance for the lower teeth to move and the lower left lateral to advance particularly and the patient was then sent away again for 2-3 weeks. The temporaries were also facially contoured to ensure they were flush with the natural teeth. On the subsequent return visit, it was clear that the teeth were aligning rapidly and espe- cially well (Figures 4 and 5). We then decided to start some simultaneous tooth whitening. Impressions were taken, even though the result was still 25% from completion. Sealed, rub- ber trays were made and careful instructions given to the patient. While the patient is concentrat- ing on using the Inman Aligner, they are always highly recep- tive to using bleaching trays. It adds greatly to motivation and often means they achieve a far better result. DayWhite from Oral Healthcare (Formely Dis- cus Dental) is used so that the patient only needs to wear the bleaching trays 35-45 minutes a day. The patient returned after an- other 3 weeks and was happy with the degree of whitening achieved. Upper and lower alignment was now complete. An impression was taken for a lower retainer wire to be fitted later. The temporary crowns were removed, the preps cleaned with CHX and new im- pressions were taken after some minor adjustments to the buccal margins. A new lower impression was taken of the final lower occlu- sion to ensure the crowns could be made with a good long cen- tric contact. The temps were replaced and impressions sent to the laboratory. The patient booked in for a shade one week later and two weeks after cessa- tion of bleaching where colour and tooth morphology was ex- plained and discussed with the patient. Two weeks later, the pa- tient returned. A retainer wire12- 15 was bonded to the lower inci- sor teeth using a preformed wire on a jig made by the orthodon- tic technician. The temporary crowns were removed and new IPS e.max HT (Ivoclar Vivadent) crowns were bonded using Vari- olink II (Ivoclar Vivadent) and OptiBond FL (Kerr). The occlu- sion against the aligned lower teeth was checked. The patient was extremely happy with the end result and felt his teeth looked natural (Figures 6-12). Discussion The case is another example of why a progressive form of smile design can be so essential in any case where a patient is looking to improve their smile. At every point, the patient sees their smile improving, first with alignmentandthenwithwhiten- ing. If they are still keen to have full ceramics, then at least the teeth are straight and light, so less invasive and more translu- cent veneers can be used. More often than not, patients prefer a more natural result where we make “their own teeth look as good as they can”. In a case like this with previous metal ceram- ics, one can see how integrating alignment, and whitening can enhance aesthetics and simplify restoration dramatically. This makes a stable and aesthetically pleasing outcome far easier to achieve (Figures 13-17). Conclusion In each of our practices, there must literally be hundreds of patients who have issues similar to this gentleman’s complaint. Previously, conventional solu- tions often placed a barrier to treatment, adding time and cost into what was already an expen- sive treatment. Most patients just could not be bothered and would live with it. Now, simple anterior alignment can be so much quicker and more cost ef- fective. I’m amazed at the sheer volume of patients who will have treatment like this done if they are suitable. Being able to combine whitening because the aligners are removable is just another bonus so we can capital- ize on the patient’s current com- pliance and get an even better result. Of course, case selection is absolutely vital! Understand- ing what is treatable and what should be referred to a special- ist orthodontist is essential. This means that patients must be fully consented and understand the risks and disadvantages of not treating any posterior issues if just concentrating on anterior alignment. Disclosure Dr Qureshi runs courses with Dr James Russell and Dr Tim Brad- stock-Smith and lectures on the Inman Aligner worldwide. Acknowledgements The author thanks Inman Align- er Certified Laboratory, Pearl Healthcare, Hampton, Victoria; Donal Inman CDT and the In- man Orthodontic Laboratory; NimrodentalInmanAlignerLab, London; Tony Knight at Knight Dental Design; and Middle East Dental Laboratory, Dubai. References 1. Hancher P Orthodontics for Esthetic Dentistry Part 1. Jour- nal of Cosmetic Dentistry Winter 2005 (20) 4. 2. Sheridan, J.J.: Air-rotor strip- ping update. J. Clin. Orthod. 21:781-88, 1987. 3. Sheridan, J.J.; Ledoux P.M.: Air-rotor stripping and proximal sealants: an SEM evaluation. J. Clin. Orthod. 23:790-94, 1989. 4. Crain, G.; Sheridan, J.J.: Sus- ceptibility to caries and peri- odontal disease after posterior air-rotor stripping. J. Clin. Or- thod.24:84-85, 1990. 5. Sheridan, J.J.: Hastings, J: Air- rotor stripping and lower incisor extraction treatment. J. Clin. Or- thod.26:18-22, 1992. 6. El-Mangoury N, et al. In vitro remineralization after air-rotor stripping. J Clin Ortho 25 (2):75- 78,1991. 7. Radlanski R.(1991) Morphol- ogy of interdentally stripped enamel 1 year after treatment. J Clin Ortho 23 (11) 748-750, 1991. 8. Heins PJ. The relation- ship of interradicular width and bone loss. J Periodont 59 (2):73- 79,1988. 9. Tal H. relationship between the interproximal distance of roots and the prevalence on in- trabony pockets. J Periodont 55 (10):604-607 1984 10. Inactivated periods of con- stant orthodontic movement forces related to desirable tooth movement in rats. T. Kameyama et al. Tokyo Medical and dental university, Tokyo, Japan. For in- formation contact the author at Kame.orts@tmd.ac.jp 11. Apical root resorption in up- per anterior teeth :Brita Ohm Linge and Leif Linge.The Eu- ropean Journal of Orthodontics 1983 5(3):173-183; doi:10.1093/ ejo/5.3.173 © 1983 by European Orthodontic Society. 12. Reprinted: Case CS. Princi- ples of retention in orthodontia. Am J Orthod Dentofacial Orthop 2003;124(4):352-61. 13. Little RM, Reidel RA, Artun J. An evaluation of changes in mandibular anterior alignment from 10 to 20 years post reten- tion. Am J Orthod Dentofacial Orthop 1988. 14. (6) Blake M, Bibby K. Reten- tion and relapse: A review of the literature. Am J Orthod Dentofa- cial Orthop 1998;114:299-306. 15. Becker A, Goultschin J. The multistrand retainer and splint. Am J Orthod 1984; 85:470-4. Dr. Tif Qureshi is Immediate Past President of the British Academy of Cosmetic Dentistry. He has a special interest in minimally in- vasive cosmetic dentistry and presents hands-on courses and lectures on the Inman Aligner worldwide. Dr. Tif Qureshi teaches Inman Aligner Training. Inman Aligner courses can be booked at: www.inmanalignertraining.com For course info visit: www.inmanalignertraining.com or email: inman@mdentlab.com Contact Information