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ePaper created 2017-03-17, 13:11:17 | version 1.38.0
aligner application case report | Fig. 1f Fig. 1g Fig. 1h Even though aligners might be the most aes- thetic, hygienic, as well as acceptable treatment modalities available with the orthodontist, a de- crease in treatment time is often desired by the adult patient. A case report is presented with the combined short-term use of bonded appliances, TADs combined with clear aligners from K Line Europe GmbH, Düsseldorf, Germany (K Clear) for an aesthetically conscious patient. bilaterally were provided to provide better retention to the aligners. The K Clear aligners were placed for 5 months (Figs. 4a–d). At the end of active treat- ment, retainer was bonded from canine to canine in upper arch (Figs. 5a & b). Additionally, the patient was provided an Essix retainer for night time wear. The patient is in retention for the past 1 year and the occlusion as well as other movements achieved are stable (Figs. 6a–d). Case report Discussion A 24-year-old male patient presented to the prac- tice with a chief complaint of overlapping front teeth. As a model he wanted to avoid the use of bonded appliances. On examination, he presented with Class II features with the maxillary lateral inci- sors labially inclined and palatally inclined, su- praerupted maxillary central incisors with a result- ant 100 % deep bite (Figs. 1a–h). He had an impacted mandibular incisor along with another incisor con- genitally missing. The patient insisted on getting only the upper arch treated in the shortest time pos- sible with an aesthetic appliance, as he had a mod- elling assignment starting in 4 months! Treatment procedure Keeping the patient’s professional commitments and the limitation of aligner therapy in mind it was decided to place a fixed bonded appliance for a short duration, along with TADs placed between the max- illary central and lateral incisors bilaterally for intru- sion of anterior teeth (Figs. 2a–d). Force systems to achieve intrusion of the incisors to be in force from day 1 for a duration of 3–4 months (Figs. 3a–d) and subsequently to shift him to K Clear for residual bite opening, space closure and final finishing. Attach- ments on the maxillary first molar and premolars, The presented case involves three major aspects of orthodontic treatment, from a patient’s perspec- tive, aesthetics and duration of active treatment and, from a clinician’s perspective, the control of planned tooth movement. Any clinician who has had the opportunity to work with traditional pre- adjusted appliances as well as aligners understands the pros and cons of both appliance systems. It is this recognition of limitations that propels us as clini- cians to seek better appliances in order to deliver treatment results in the best interest of our patients. The aim of orthodontic therapy ought to include words such as ‘in the least amount of time’. It has been postulated by Nicozisis6 that aligners can be changed as frequently as 3–4 days when micro-os- teoperforations are used along with aligner therapy to initiate the RAP phenomenon. The use of TADs not only provides the means of stable anchorage to ap- ply forces from an ideal location avoiding any unto- ward movement, but also cause a local insult leading to an inflammatory response. This case was started with a pre-adjusted bonded appliance along with the use of TADs placed close to the teeth requiring intrusion. When used in this manner, the flexible NiTi wires cause alignment and the vertical forces generated lead to intrusion and ortho 1 2017 21