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18 GENERAL DENTISTRY Dental Tribune Middle East & Africa Edition | 4/2017 Two appliances for optimum results By Dr Richard Field, UK For patients with minor to moderate anterior crowding or protrusion, IAS Academy offers a number of appli- ances that provide a minimally in- vasive treatment pathway alongside ethical, effective and safe delivery. In this case, two separate appliances were chosen, using the Academy’s universal technologies for both, in- cluding the SpacewizeTM crowding calculator, ArchwizeTM 3D treatment planning, 3D printed models and space creation guides. Case presentation A 29-year-old female patient pre- sented to the practice looking to improve the aesthetics of her smile before leaving the country to go travelling for one year. Medically, she was fi t and well and her general oral health was satisfactory. ways, highlighting the benefi ts and disadvantages of each appliance. In the end she opted for a Slim Bow ClearSmile Inman Aligner for the lower arch – which is visually invisible from the front on – and ClearSmile Aligners for the upper arch to slightly rotate the UL1. Home whitening was also discussed for both arches, with UL1 to have whit- ening on labial and buccal surfaces of the tooth and fi nally composite bonding to bring the laterals into a more ideal proportion. As part of the diagnostics, photo- graphs were taken and the Spacewiz- eTM digital tool used to analyse the arch form. The SpacewizeTM tool is used to confi rm the patient’s suitability for ClearSmile Inman Aligner treat- ment and predicts the approximate amount of IPR (interproximal re- Skeletal FMPA Lower Face Height Facial Asymmetry Soft Tissues Overjet Overbite Displacement on Closure Incisor Relationship Canine Relationship Molar relationship Teeth Present Centrelines 1 Average WNL WNL WNL Nil 3mm nil 1 1 1 7------------------------ --------------------------7 7------------------------ --------------------------7 Coincident Table 1 Initial Second Third Fourth Fifth Sixth •Slim Bow ClearSmile Inman Aligner fi tted in lower arch •Composite anchors placed labially on LR1 and palatally on LL1 •First ClearSmile Aligner fi tted in upper arch •Instructed to wear both appliances for approximately 20 hours a day •ClearSmile Inman Aligner intact •Second ClearSmile Aligner fi tted •ClearSmile Inman Aligner intact •Third ClearSmile Aligner fi tted •Alignment in both upper and lower arch complete •Impressions for whitening trays and waxup •Whitening trays provided and instructions given •Waxup review •Direct composite bonding •Fixed retainer in upper and lower arch bonded for retention •Impressions for fi nal Essix retainer The patient’s main aesthetic concern was the lower crowding as well as the diminutive upper laterals. The pa- tient’s UL1 was darker in colour com- pared to surrounding teeth, most likely as a result of sclerosis from pre- vious trauma. Further tests revealed that the UL1 remained vital with no signs of apical pathology. From an orthodontic perspective, there was mild lower anterior crowding as well as mild rotation of her upper left cen- tral incisor. (Fig. 1-3) Treatment planning The option of comprehensive fi xed orthodontics was discussed with the patient in addition to a number of other possible treatment path- duction) needed. The curve is set so that the teeth are moved to the most functional, stable and aesthetic position with the use of landmark pointing. The SpacewizeTM trace also acts as an occlusal plan, so the digital setup made by the lab follows exact- ly the planned prescription from the trace provided. Both digital and physical 3D printed models were made and discussed with the patient. This is an impor- tant step of consent as it shows the patient the actual possible outcome and the physical contact with the models, which helps the patient to feel connected to the treatment plan. (Fig. 4 and 5) Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 8 & 9 Fig. 11 Fig. 13 Fig. 7 Fig. 10 Fig. 12 The digital setup predicted three aligners with no IPR needed on the upper arch and 0.6mm needed for the lower arch. Treatment pathway Once fi tted, the upper ClearSmile Aligners were changed every two weeks as well as reviewing the lower ClearSmile Inman Aligner. (Fig. 6) The total time for alignment was six weeks. Once satisfi ed with tooth position several sets of impressions were taken. The fi rst was for a wax up of the upper arch to be used as a guide for composite bonding as well as whitening ÿPage 19 Fig. 14