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ePaper created 2016-03-29, 15:23:51 | version 1.38.0
Inman Aligner appliance case report | 23 cosmetic dentistry 1 2016 had it been treated restoratively.7–9 By using a simple anterior alignment technique, the treatment took only eight weeks to straighten the teeth and a great deal of sound enamel tissue was preserved by con- servatively resolving the unattractive appearance of the maxillary teeth (Figs. 22 & 23). Case 3 Thethirdquestiontobeconsidered:willtheteethre- quirerestorativeworkanyway,evenafteralignment? The case presented serves to demonstrate the ne- cessity of aligning the teeth even before placing ce- ramic veneers.10–13 The patient in this case exhibited moderatemisalignmentwithmajoranterioredgewear due to occlusal trauma. In addition, the teeth were darkened through years of stains being absorbed throughtheworndentineoftheincisaledges(Fig.25). The patient initially requested instant veneers to re- solvehissmileproblem,butaftermockingupthede- sign directly in his mouth, he was discouraged from pursuingthisoptionowingtheamountoftissuethat wouldbelost.Theaggressivepreparationofthetissue was explained to him using the occlusal image of his maxillary teeth. After an extensive orthodontic examinationanddiscussionoftheoptions,thepatient refused fixed orthodontic treatment, as well as clear aligners. He refused the first option because he did notwantanythingfixedinhismouth,andherefused the second option because of the proposed time in- volved. The Inman Aligner system was introduced to thepatient,andhequicklyacceptedthisoptionowing to the short treatment time and removability. The treatment plan was to align the teeth first and then to reassess the restorative work needed (Fig. 26). The appliance was used for 12 weeks and only worn for 16 to 18 hours a day. During the last three weeks of alignment, the patient began to bleach his teeth. Byweek12,theteethwerestraightandwhite(Fig.27). At this point, a direct mock-up was done to show the patient the smile design that could be achieved with composite. He felt that the teeth were still flat and wanted a fuller smile. Because we had aligned the teeth,onlyminimalpreparationwasneededasevident from the wax-up and the decision was made to fabri- cateceramicveneersinstead(Fig.28).Thiscaseshows that for complex situations and considering patients’ high aesthetic demands, pre-alignment is essential to produce minimally invasive veneers with minimal enamelloss.Thisclinicalapproachguaranteesthatthe strength of bonding to the enamel is much greater. Conclusion The goal of this article is to encourage general dentists to reflect on the importance of considering short-term tooth alignment alone or in conjunction with restorative dentistry when treating patients. Hopefully, these three questions and cases will prompt readers in thinking through the process of this treatment modality._ Disclosure: Dr Chayah is the trainer for Inman Aligner Training in the Middle East. He provides hands-on full-day certificatecoursestogeneralpractitioners. Acknowledgement: I wish to thank Dr Tif Qureshi, the founder and Director of Inman Aligner Training in London, forhismentoringandsharingthelastcaseinthisarticle. Editorialnote:Acompletelistofreferencesisavailablefrom thepublisher. Fig. 23: Side view showing the teeth after alignment. Figs. 24a & b: Side views showing the moderately crowded and worn teeth before treatment. Case 3 Fig. 25: Occlusal view showing the tooth misalignment. Fig. 26: Occlusal view showing the result of treatment. Fig. 27: Maxillary teeth after alignment to reassess the restorative work needed. Fig. 28: Natural-looking thin maxillary veneers owing to aligning the teeth first. Fig. 25 Fig. 26 Fig. 27 Fig. 28 Fig. 20 contact Dr Rami Chayah runs a cosmetic dental practice in Lebanon with an emphasis on minimally invasive dentistry. He seeks to share his passion for photographic and video production and believes that through his personalised dental approach, he can demonstrate a more positive way of practising dentistry, helping other dentists to view the dental domain in a different way. You can reach Dr Chayah through his social media links: www.facebook.com/ramichayah and http://instagram.com/ramichayah www.inmanalignertraining.com dentistry 12016