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Dental Tribune Middle East & Africa Edition | 3/2016 26 gEnEraL DEntIStry Minimally invasive preparation treatment ByDrAlinaLazar,Germany In this case, the patient – a 26-year- oldfemale–approachedthepractice after finding us on the internet. She had already visited three other den- tistsforaconsultationwithhermain complaints being crowding and dental erosion of her anterior teeth. Part of the problem was that she had been drinking more than one litre of sugary drinks, such as cola and juice, everyday–oneoftheleadingcauses ofdentalcariesandenamelerosion. Expander and IAS Inman AlignerTreatment The first step needed to achieve the intended outcome was to complete a full orthodontic treatment. As the patient wanted an effective, safe and minimally invasive solution to ante- rior alignment, she opted for the IAS Inman Aligner. Although the initial examination showed no abnormali- ties, the model analysis and Space- wize+™ arch evaluation software calculations revealed that 2.7mm of space would need to be created before the IAS Inman Aligner treat- mentcouldbegin. Following professional tooth clean- ing, the expander was fitted and the patient instructed to wear it for 22 hours a day and to adjust the appli- ance once every three days by one turn. Over the course of the expand- er treatment, parts of the fan screw were removed. Firstly from 13 and 23 and eventually it was removed from 11, 21 and finally 12. After six weeks and a new Spacewize+™ calculation, the amount of expansion needed hadbeenreducedto1.8mm. After that, the patient was shown how to use and remove the IAS In- man Aligner appliance and was in- structed to wear this for 20 hours a day. During this treatment process predictive proximal reduction (PPR) was carried out on the distal palatal aspect of 12 and 21, mesially distally and labially on 22. Interproximal reduction (IPR) was also performed progressively every three weeks throughout the course of the IAS In- man Aligner treatment. Once the de- sired outcome was achieved on the Pre treatment facialview Post alignment treatment Pre treatment retractedview Digitalsmiledesign DigitalSmileDesignphase2 Facialshot withdigitaldesign DigitalSmileDesign Pre treatment uppers Mockup IASInmanAlignerappliance Mockup Pre treatment upperocclusal Transformation Pre treatment retracted Mockup Pre treatment anterior Post straighteningocclusalview SmileDesignfaceproportions PreTreament smileview upper anteriors, a fixed retainer was bondedfrom13to23. Digital Smile Design and Bleaching To further improve the aesthetics of the patient’s smile, anaxGUM from anaxDENT – a gingiva-coloured composite for the aesthetic recon- structionofthegingiva–wasapplied to 41 and 31. At this time the patient also had a filling (class five) and per- formed home bleaching with Opal- escence®PF10%,whichwasfollowed by the use of Relief Oral Care Gel to reduce the sensitivity caused by the whitening treatment. An individual vacuum-formed template was cre- atedtohelpguidetoothpreparation. Essentially, the digital smile design allowed me to create a virtual mock- up, which was applied to a plaster model, and ultimately improved the effectivenessoftreatmentplanning. Veneers, Non-Prep Veneers andCrownLengthening The next step was to complete a mock-up using a self-curing com- posite material –CS C&B shade BL3 from Ivoclar Vivadent. It was at this point that photographs were taken to monitor the development of the treatment process. It was very re- warding to see the patient become emotional as she realised the chang- esthatwerebeingachieved. Once the digital smile design analy- sisandmock-upwerecomplete,only the finishing touches were left. The initial part of this was crown length- ening to 14, 15, 22, 24 and 25, which took place at the same time as the preparation. Shortly after, non-prep- aration veneers were placed on 14, 15, 24and25andveneerswereplacedon 11,13,21,22and23.Additionally,apar- tial crown was bonded on 12 and an IPS e.max Press from Ivoclar Vi- vadentwasusedontheincisors–the MT Ingots chosen were A1 and were modified using both the cut-back andlayeringtechniques. Outcome After the expansion, anterior align- ment, bleaching, digital smile design and finishing treatments, the pro- cess was complete and both the pa- tient and I were very happy with the finalresults. Ultimately, incorporating smile de- sign is important to the ethos of my practice. Although finishing with compositecontouringorveneersde- pends on the case that is presented, the most important element is to work as minimally invasively as the caseallows.Indeed,Ihavefoundthat whentheabovementionedstepsare carried out in the same way as this particular case study, a very satisfy- ingresultcanbeachieved. References i Majewski RF. Adolescent caries: a discussion on diet and other factors, including soft drink consumption. J MichDentAssoc.2001;83(2):32–34. Dr Alina Lazar has been practising den- tistry since 1994 and founded ‘Praxis Dr. AlinaLazar’inGermanyin2001.Shecom- pleted further qualifications to become a Specialist in Aesthetic Dentistry in 2012 and a certified provider of the IAS Inman Aligner in 2013. Alina also completed the IAS Advanced training course in 2014 to develop her knowledge and skills in ante- rioralignment.