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Dental Tribune Middle East & Africa No. 3, 2017

24 ◊Page 22 GENERAL DENTISTRY Dental Tribune Middle East & Africa Edition | 3/2017 Pic 13. Front view after alignment and bleaching Pic 14. Front view after Pic 15. Full Face before Pic 16. Full Face after Fig 17. Close view before Fig 18. Close view after able orthodontics solutions were offered to the patient, including a referral to a specialist. A choice be- tween a comprehensive plan and a compromise was offered, with the compromise plan including fixed, clear aligners and Inman Aligners. She decided that she did not want comprehensive treatment and chose only the simple plan. Anterior align- ment was needed, so the patient opted to have her teeth aligned using removable appliances - a new Super Slim Inman Aligner. Her plan was to do this to avoid any tooth prepara- tions, but to still have veneers any- Fig 20. New Inman Super Slim tively made her own teeth look bet- ter without removing any real tooth structure. The treatment also cost her far less financially and biologi- cally, but still achieved a result she was more than happy with. Conclusion What could have been a complex ceramic case, only affordable for a tiny percentage of patients and only carried out by a minority of dentists, instead turned into a simple align- ment, bleaching and edge bonding case that would be far more afford- able for many more patients and would be achievable for many more dentists. This is because the tools are now widely available: various forms of tooth alignment tools, suitable for a range of cases, effective whitening preparations and ideal, easy to use bonding materials. Given the current debate on tooth preparations, one must always con- sider what the patients are aware of. Orthodontics is not a binary solu- tion; there are millions of potential outcomes that vary with time, teeth to be moved, and distance to be moved. Patients who chose veneers because they assume ortho will take a year or so must be aware that an- terior tooth alignment can actually be achieved far more quickly with many forms of orthodontics appli- ance than they might think. In this patient’s case, if she had expected the orthodontics to take a year, she would have chosen veneer prepara- tions. By having a limited goal, we were able to completely eliminate any tooth preparations altogether. Acknowledgments Inman Aligner supplied by IAS Ortho Lab Super Slim References 1) Minimally Invasive Cosmetic Den- tistry Dental Update 2011; 38: 586– 592 -Tif Qureshi 2) Who needs Veneers? Re-thinking the Order of Smile Design planning Journal of Cosmetic Dentistry USA - Spring 2011, Vol 27. Number 1, pg 86- 94 Tif Qureshi Editorial note: The full list of referenc- es are available on request. can Dr. Tif Qureshi, UK. He is a Director of Intelligent Align- ment Systems. You learn about the Unique mentored Path- way of Learning from IAS starting with Inman Align- ers and Clear Smile Aligners, then Clear Smile Braces right up to Clear Smile Ad- vanced taught by Professor Ross Hobson by visiting www.Iasortho.com way. The Super Slim Aligner uses a new clear bow that is far thinner than the previous design; this makes the lip seal far easier to achieve and speech far easier as a result. In-surgery digital arch planning was used to set up to flare the upper centrals forward while also retract- ing the laterals. The digital planning ensured there would be space for a wire retainer and composite bonded to the back of the anteriors to regain the occlusal stop. The digital soft- ware (SpacewizeTM) allows a dentist to trace a curve that the laboratory needs to follow. This allows the prac- titioner to be in control of the occlu- sion and eliminate the risk of flaring out and causing potential occlusal issues. The upper teeth had exactly 1 mm of crowding, so IPR was carried out pro- gressively over 3 appointments with strips, using the Super Slim Inman Aligner 18 hours a day. The lower teeth were aligned with a single In- man Aligner, also in 10 weeks. At week 8, simultaneous bleaching was started with 6% Daywhite by Philips: using super-sealed trays and technique to ensure the teeth were dry before the trays were placed. This consisted of 2 weeks of day time whitening; 2 x 30 minute sessions a day while the IA was out. At week 10, alignment was virtually complete and, post-alignment and whitening, the patient very quickly decided against ceramics because she could see her teeth in a com- pletely different way. Without this opportunity, she would have had ceramics placed. After two more weeks, direct bond- ing was placed on the upper lateral incisal edges to restore the original shape and a little on the palatal of the upper cuspids for better rise. The composite used was Venus Dia- mond (Hereaus Kulzer). Two shades were used; Opaque light and B1 enamel. The composite is laid in a reverse triangle technique, which blocks out the light transmission on the join so no preparation is needed. Each restoration was polished with Flexibuff discs and Enamelize paste by Cosmedent. The patient returned for secondary polishing after two weeks and had an indirect retainer fitted. The patient then continued with an Essix retainer worn at night and made to fit over the retainer wire and new bonding. Discussion The patient was delighted with the results as the treatment had effec-

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