Case of the month by Dr Erik Svendsrud

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Treatment carried out by Dr Erik Svendsrud

 

Vogts Gate 46
Norway
Oslo
0477

Tel:+4722352505
Email: erik@eriksvendsrud.no
www.tannlege-svendsrud.no

Woman 28, she had ortho for 5 years earlier without getting retention after treatment. She observed that it has been increasingly crowded in the lower but also in the upper. She has seen that especially right lateral has moved facially. 
Skeletal class 1, Face height average, Molar right and left side; class 1, canine right side 1/4 class 2, left side class 1, lower midline deviation approx. 2 mm to the right, she is not bothered by the midline deviation, she notices increasingly open bite between upper right lateral and lower right lateral/canine. She was informed about all options also referral to orthodontist which she declined. We used Inman aligner in the lower and clear aligners in the upper. Treatment time was 4 months.

Case of the month by Dr Alexander Herz

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Treatment carried out by Dr Alexander Herz

 

Zahnarztpraxis Dr. Alexander Herz
Münsterstraße 7
49377 Vechta
Germany

Tel:+49 (0)4441 995757
Email: anmeldung@dr-herz.com
www.inman-aligner-vechta.de

Here, Dr. Alexander Herz, a practice owner and dentist in Vechta, Germany, outlines a case using the ClearSmile Inman Aligner. Dr Herz has been a certified user of the appliance since 2014.

I first heard about the ClearSmile Inman Aligner from Michael Nix, one of IAS Academy’s German trainers, which led me to take the course – since then, I have become an extremely enthusiastic user! For anterior crowding or protrusion, I find this particular solution to be a great minimally invasive treatment, one that allows me to treat a number of simple to moderate cases. In comparison to the cases that I took on in the following months after I became a certified user of the IAS Academy appliance, I am able to address much more complex alignment issues. This is made all the much easier thanks to the outstanding support that is available from the online platform.

Assessment

One of my most recent cases was a 31-year-old female who presented to my practice having been recommended by her brother-in-law, whom I had previously treated with an aligner with successful results. Medically, her records indicated nothing untoward, while her dental records revealed that she had undergone previous orthodontic treatment during childhood. Due to failed retention, the patient had become dissatisfied with the position of her upper anterior teeth. The clinical examination revealed misalignment in the lower arch too, but at this time the patient wished to focus on the uppers only. It was explained to her that a much more stable and accurate result could be achieved should she agree to undergo treatment on both arches simultaneously, but it was her intention that we simply monitor and reassess in the future. After the regular dental examination, impressions of the upper and lower arches were taken as well as X-Rays of the anterior teeth.

Digital Case Planning

During the digital case planning, the Spacewize+™ arch evaluation software estimated that roughly 1.8 mm of space would be needed to achieve the intended outcome. This was later confirmed as 2.2mm by the lab. Digital images also revealed the extent of malocclusion in UR1, but as planning indicated the alignment of UR2 would create some space, there were no concerns about the result.

The only other concern at this point was whether the patient’s deep bite would leave enough room for the placement of the retainer. Just in case, it was explained to her that implementing the Dahl principle might be a possibility if problems occurred with positioning the retainer after alignment treatment was complete. To give the patient an idea of what the final result would look like, we had a digital mock up done, which she said was extremely helpful.

Treatment Process

First Appointment
• ClearSmile Inman Aligner fitted with lateral bite planes
• 0.18 interproximal reduction (IPR) on UR4-UR3
• 0.13 IPR on UR3-UR2
• 0.1 IPR on UR2-UR1
• 0.1 IPR on UR1-UL1
• 0.1 IPR on UL1-UL2
• 0.13 IPR on UL2-UL3
• 0.18 IPR on UL3-UL4
• Predictive proximal reduction (PPR) was carried out on UR1 and UL2 on mesial surface and on mesial and distal surfaces of UL1

Second Appointment
• Same IPR and PPR as previous appointment

Third appointment
• No PPR needed in this appointment
• 0.13 IPR on UR4-UR3
• 0.1 IPR on UR3-UR2
• 0.08 IPR on UR2-UR1
• 0.1 IPR on UR1-UL1
• 0.1 IPR on UL1-UL2
• 0.13 IPR on UL2-UL3
• 0.18 IPR on UL3-UL4

Fourth Appointment
• Alignment of UL1 complete at this stage
• Vestibular anchor placed UL2
• Contact between the outside bow and UR1 and UR2 reduced
• Springs on the outside bow activated
• No PPR
• 0.08 IPR on UR4-UR3
• 0.08 IPR on UR3-UR2
• 0.08 IPR on UR2-UR1
• 0.08 IPR on UR1-UL1
• 0.08 IPR on UL1-UL2
• 0.13 IPR on UL2-UL3
• 0.18 IPR on UL3-UL4

Fifth Appointment
• Impressions taken for fixed retainer (final results meant that it was not necessary to raise the bite in the end to make room for the retainer)
• Composite placed on UL1 to match the length of UL1
• In addition to a fixed retainer, the patient was also given a removable essix retainer and advised to wear for one year during the night

Self-Appraisal

Overall, both the patient and myself are very happy with the final result, though, of course, the preferred outcome would have been to align the lower arch too. As of yet, the patient has not made her decision regarding the treatment of the lower anterior teeth. As such, I have suggested that she uses a retainer to prevent any further relapse.

The ClearSmile Inman Aligner course is part of the IAS Academy pathway of training for GDPs. The course is now a continuum and 2 cases must be submitted and evaluated on completion for website listing.

For more information on ClearSmile IAS Inman Aligner and upcoming training courses, please visit www.iasortho.com or call 020 8916 2024

Biography

Dr. Alexander Herz, born 1971 in Bremerhaven, Germany
Married, two children

1991-1996 Martin-Luther-university, Halle/Saale
2000 doctor’s degree
1996-2006 service as a dentist in the German Air Force
since 2006 work in own dental office in Vechta, Germany
since 2014 Inman Aligner user
since 2016 Clear Smile Aligner user

Case of the month by Dr Calum Imray

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Treatment carried out by Dr Calum Imray

 

Stafford Street Dental Care
24 Stafford Street
Edinburgh
EH3 7BD

Tel:0131 225 7576
Email: info@staffordstdental.co.uk
www.staffordstdental.co.uk

My first Inman Aligner case involved a young female patient who wanted to correct a mild alignment issue before her wedding. Her main complaint was the slightly protruding upper left central incisor. The mild crowding of the lower anterior teeth did not concern her. The posterior occlusion was stable with a class 1 molar relationship and canine guidance and there was no history of parafunction or cusp fractures.

Spacewize analysis showed approximately 1.6mm of space would need to be created by interproximal reduction (IPR) in order to align the teeth. Considering the beauty of the unrestored anterior teeth and the minimal amount of tooth preparation required in this case, the patient and I agreed that orthodontic alignment and some tooth whitening would be preferable to more extensive restorative approaches such as direct or indirect veneers.

After posting the initial photographs on the online forum and receiving advice from two IAS academy mentors, a full treatment plan and 3D printed models of the potential end result were requested from the lab along with the Inman Aligner itself.

At the fit appointment, a small amount of IPR was performed and the patient was instructed to wear the aligner for around 20 hours per day, removing it to eat and brush. After just 10 days she returned with a noticeable improvement and subsequent rounds of photographs and IPR were posted on the forum every two weeks until the case was complete. In total she wore the Aligner for 10 weeks before a fixed retention wire was placed and was delighted with her results!

Looking back at the case, I realise the importance of consistent positioning for clinical photographs, particularly the occlusal mirror shots. I could have displayed the final results more effectively with a little more care when positioning the mirror. In an ideal world we would also have aligned the very slightly crowded lower incisors before they can move any further & require more extensive IPR, but this was not her primary concern and can be addressed at another time.

The support and guidance from the IAS academy mentors on the online forum throughout the case was fantastic and the speed of tooth movements with the Inman Aligner far exceeded my expectations.

Case of the month by Dr Rune Henriksen Bones

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Treatment carried out by Dr Rune Henriksen Bones

 

Torget Tannhelse Sarpsborg
Torget 3
1707 Sarpsborg
Norway

Tel:+47 69 87 87 85
Email: runehenriksen84@gmail.com
www.torgettann.no

Case Details

The patient has all her life been bothered by her smile. She said to me she didn't want to smile, because she was embarrassed by her teeth. Her main concern was her upper left central incisor which was positioned far labially in the arch, but ideally she wanted all the front teeth straightened. She had heard about Inman, and didn’t want fixed braces, so she asked me if it could be addressed.

After measuring the width of the central incisor, I plotted the numbers in Spazewize, which confirmed that this was a possible case. Afterwards I posted the pictures on the forum and got some good tips there. The mentors told me to inform the patient thoroughly the things we couldn’t address. I informed her that we would not correct her over-jet with Inman, but she didn’t mind this at all. She just wanted her smile to improve. So we ended up ordering an Inman with combined expander.

I got the aligner back from the lab, and had the patient in for seating the IA. Everything fitted well, and I performed IPR and PPR as prescribed. I informed the patient how to use the expander, and how often to turn the screw, also that she could experience some slight discomfort in the following days. She was very motivated for the treatment, and I had a good feeling this would be a nice case.

So after performing progressive IPR/PPR for every visit, we got the result we wanted. Impressions was taken and sent to the lab for making a fixed bonded wire retainer. While we waited for the lab to make the wire, bleaching trays were made, and she bleached during the hours she was not using the IA. This was really the frosting on the cake for this case. When the retainer came back, this was easily fitted and bonded with flowable composite.

This patient was extremely happy with the result to say the least. After all these years, she finally can smile without hiding her teeth. Now she smiles all the time! This case was really rewarding for me too, it’s nice to help someone get the smile they want, and at the same time in a conservative way. Align Bleach Bond is a fantastic way of doing minimally invasive dentistry.

Patient testimonial

“The Inman Aligner has been a fantastic treatment for me. Now I have the smile I always wanted, and achieving this was faster and easier then I thought. I would recommend this treatment to everyone who wants their teeth aligned”

Anita Jakobsen

Case of the month by Dr Alina Lazar

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Treatment carried out by Dr Alina Lazar

 

Dr. Alina Lazar
Vorderer Alter Berg 22
76327 Pfinztal
Germany 

Tel:00497240926890
Email: alina_lazar_rista@yahoo.com
www.praxislazar.de

Minimally invasive preparation treatment

In this case, the patient – a 47-year-old female – approached the practice after finding us on the internet. She came to me because she was not satisfied with the shape, the colour and the position of their teeth. The patient had a great cold sensitivity.
We opted for the Smile Design Step by Step

Expander and IAS Inman Aligner Treatment

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 anterior alignment, she opted for the IAS Inman Aligner. Although the initial examination showed no abnormalities, the model analysis and Spacewize+™ arch evaluation software calculations revealed that 1,8mm

Following professional tooth cleaning, the patient was shown how to use and remove the IAS Inman Aligner appliance and was instructed to wear this for18 hours a day. Interproximal reduction (IPR) was also performed progressively every three weeks throughout the course of the IAS Inman Aligner treatment. Once the desired outcome was achieved on the upper anteriors, a fixed retainer Venners from 14 to 24.

Bleaching

At this time the patient also had a filling (class five) and performed home bleaching with Opalescence® PF 10%, which was followed by the use of Relief Oral Care Gel to reduce the sensitivity caused by the whitening treatment. An individual vacuum-formed template was created to help guide tooth preparation. Essentially, the digital smile design allowed me to create a virtual mock-up, which was applied to a plaster model, and ultimately improved the effectiveness of treatment planning.

Veneers, Non-Prep Veneers and Crown Lengthening

The next step was to direct mock-up with composite. It was at this point that photographs were taken to monitor the development of the treatment process. It was very rewarding to see the patient become emotional as she realised the changes that were being achieved.

Once the digital smile design analysis and mock-up were complete, only the finishing touches were left. The initial part of this was crown lengthening to 21 which took place at the same time as the preparation. Shortly after, non-preparation veneers were placed on 14, 24 and veneers were placed on 13- 23. and an IPS e.max Press from Ivoclar Vivadent was used on the incisors – the MT Ingots chosen were A1 and were modified using both the cut-back and layering technique

After the anterior alignment, bleaching, mock-up and finishing treatments, the process was complete and both the patient and I were very happy with the final results.

Author Bio:

Dr. Alina Lazar has been practising dentistry since 1994 and founded ‘Praxis Dr. Alina Lazar’ in Germany in 2001. She completed further qualifications to become a Specialist in Aesthetic Dentistry in 2012 and a certified provider of the IAS Inman Aligner in 2013. Since 2013 Digital Smile Design certified provider. Alina also completed the IAS Advanced training course in 2014 to develop her knowledge and skills in anterior alignment. 2016 February - case of the month in IAS Forum. 2016 September - IAS Advanced Ortho Restorative

Case of the month by Dr Finn Andre Hammer

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Treatment carried out by Dr Finn Andre Hammer

 

Farmannsgate 2, Fredrikstad, Ostfold, Norway

Tel:+47 69368800
Email: post@dentzone.no
www.ftann.no/

Author bio:
• Graduated from the University in Oslo 1995
• Started up my own private practice in Fredrikstad, Norway in 1998
• Started Fredrikstad Private Tannhelsesenter in 2010,together with Dr.Kai Hannestad, a mixed private dental office with specialized and general dentists.
• Member of NTF,SAED and AACD
• Member of the IAS Academy,Inman Aligner instructor in Norway
• Worked with Inman Aligner since 2011 and Clear Smile Aligner/Invisalign since 2015
• Lecturing aesthetic composite classes and workshops in Norway.

About the case:
• 32 year old lady called for an orthodontic assessment after she had seen Inman Aligner on my website
• Never had ortho before
• Shows a lot of her upper teeth when smiling.
• Not happy with her upper front teeth and smile.
• Good posterior occlusion,Angle Kl.I
• UR1 tipped mesial over UL1, that is palatinal in the bow.
• Minor lower crowding, that doesn't concern her

Orthodontic assessment:
• Good lateral occlusion ,Frontal crowding
• X-ray studied and no pathology or risk factors were found
• We discussed optional treatment with fixed ortho, Clear Aligners before we decided to treat the upper jaw with Inman Aligner
• We also discussed the risk of “Black Triangle” UR1/UL1 because of the tipped UR1 over UL1
• Inman Aligner was chosen because of the fast treatment time.
• I selected a standard Inman Aligner with an ex.screw to speed up and “unlock “ the teeth
• Treatment time was estimated to 14-16 weeks

Treatment:
• Clinical and x-ray examination
• Planned the treatment with Spacewize and digital SetUp from Esbjerg lab.
• Since I have worked a lot with Inman Aligners, I didn't use the forum help on this case
• Next appointment checked the fit of the aligner.IPR and PPR and putting on the palatinal buttons
• When UL1 was aligned out in the bow, buccal buttons was placed .
• Bleaching with White Dental beauty 30 min for 7 day very happy s the last period of the treatment.
• Total treatment time ended at 12 weeks.
• Patient very happy with the treatment

Case of the Month by Dr Kelly Toft

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Treatment carried out by Dr Kelly Toft

 

Regency Dental
71 Kings Road West
Swanage
Dorset
BH19 1HH

Tel:01929 422515
www.regencydentalpractice.co.uk

Author Bio:

Kelly qualified from Guy's, King's and St Thomas' in 2003. She is currently working as an associate at Regency Dental, Swanage and has been a member of the IAS Academy since completing here initial training in 2015.

The Case

A 48-year-old female patient was referred to me by a colleague in-house. She was unhappy with the appearance of her rotated upper centrals and misaligned lower incisors as they were difficult to clean and kept getting stained. She had been considering veneers when she saw information on the IAS Inman Aligner in the waiting room.

With very little dental history, no restorations and a regular attender to the dentist and hygienist, the patient was medically fit and well.

A thorough orthodontic assessment revealed a Class I occlusion on a Class I skeletal base. There was mild crowding in the upper and lower labial segments, the upper centrals were rotated and the upper canines buccally placed with space distal to these. Periapical radiographs taken of the anterior teeth were clear.

The treatment options available were discussed with the patient in detail. She had already spoken to a specialist orthodontist regarding fixed braces, but the cost and the thought of the suggested four extractions proved inhibitory. My colleague had discussed veneers / crowns and the biological risk to these unrestored teeth, plus the possible aesthetic consequences. The patient was keen on the IAS Inman Aligner as it could be removed to eat or for special occasions. The possibility of whitening and edge bonding were also discussed as part of the ABB (Align, Bleach and Bond) approach.

A full set of photographs were taken and Spacewize+™ arch evaluation software employed to determine the amount crowding present and the ideal tooth positions using the upper laterals and the LL1 as the landmark teeth. Silicon impressions were sent to Nimrodental for a diagnostic set up to ensure the patient was happy with the final smile before the appliances were made and treatment commenced. She was advised that the upper canines would not be moved with this appliance. The patient was happy and full valid consent was obtained.

Treatment began on the lower jaw. The appliance was checked for fit and the patient was shown how to place and remove it. Interproximal reduction (IPR) was carried out from canine to canine as per lab instructions and predictive proximal reduction (PPR) performed on the mesial aspect of both lower laterals. Composite anchors were placed on the lingual aspect of LR1 and LL2.

At the first review appointment further IPR was carried out and composite anchors placed on the buccal aspect of LL1 and LR2. The lingual anchor was removed from LR1 and placed on the disto-lingual of LR2. By the next appointment the teeth were aligned and impressions were taken for a fixed retainer. This was bonded with Venus Diamond flow two weeks later.

In the meantime, the patient was keen to start with the upper jaw and actually wore the two appliances at the same time for two weeks. Again the fit was checked, a composite anchor placed palatally on UL1, IPR carried out as per lab instructions and PPR on the UR1 mesially.

At the first review appointment the patient mentioned that the UR1 had become quite painful and she’d needed pain relief. In a previous de-rotation case another patient had experienced similar problems that eased after a few days, so this patient was reassured that it should pass. The IAS support forum was consulted and one of the mentors noticed that UR1 looked slightly greyish in comparison to UL1. The tooth was vitality tested and it had become devitalised. The possible reasons and causes were discussed with the patient and it was thought that perhaps past trauma to the tooth had made it susceptible to devitalisation. Treatment was halted and an Essix retainer was made while root canal treatment was carried out, uneventfully.

Once she was pain-free the patient was keen to continue alignment. IPR was performed from 3-3. At the second review, the patient reported no further problems so buccal anchors were placed on both central incisors mesially and the palatal anchor was removed from UL1.

The labial bow was later tightened by adding composite to the springs. I’d received some useful advice from other dentists on the IAS forum with regards to lightening the UR1 and impressions were taken for bleaching trays. The temporary filling and some GP were removed one week later from UR1 and a GIC plug was placed at the neck of the tooth. The patient was shown how to place the bleach in the palatal cavity of UR1 with the tray over the top and advised to do 45mins twice daily. One week later the shade of UR1 had improved and the patient started whitening the remainder of the teeth. Impressions were also taken for a temporary Essix retainer and a fixed retainer.

Once the patient was happy with the shade of her teeth we waited two weeks (as bleaching can affect the bond strength of dental adhesives) before fitting the wire retainer, which was fixed with Venus Diamond Flow. Edge bonding was also performed with Tetric Evoceram to level out the upper centrals. Impressions were taken for final Essix retainers/bleaching trays for optimal retention.

The patient loved the final result, happily showing off her smile as much as possible. I am pleased with the outcome too – we avoided invasive restorative dentistry and gave the patient something that is easy to maintain long into the future. The UR1 will continue to be monitored and further bleaching carried out if the shade isn’t maintained.

This case highlighted for me the importance of going through all the risks associated with any treatment, however rare they may be. The IAS Academy mentors had never seen a tooth devitalise using the IAS Inman Aligner before, although it is a theoretical risk with any orthodontics. Full documentation including photographs and radiographs before treatment begins, is also a must. I don’t think it would have made any difference to what happened in this case, as it couldn’t have been predicted, but in this time of litigation I know I have all the information to show it was okay to proceed with the case at the time. The support from the forum was invaluable during this time to reassure the patient and I that everything would be fine in the end. It is an excellent resource and I’m sure other dentists following my case on the forum will also have learnt from my experiences, although I hope this is the first, and last, case of a tooth devitalising during IAS Inman Aligner treatment.

Case of the month by Dr Line Engelstad

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Treatment carried out by Dr Line Engelstad

 

Line Engelstad DDS is a general practitioner working in a private clinic in Oslo, Norway. Having provided the IAS Inman Aligner since 2014, here she shares two recent cases…

A 24-year-old male was seeking advice to straighten his upper and lower anterior teeth. The patient had previously undergone orthodontic treatment with fixed braces, but he had no permanent retention. The relapse had increased over the last years and the patient wanted not only to stop it, but also to correct it. Orthodontic assessment revealed an angle Class I, no parafunctions or pain, stable occlusion and good canine guidance. Mild crowding was present in the upper anterior region, as well as crowding in the lower jaw. He had some minor enamel defects on the lower incisors and some white opacities, but otherwise was healthy with intact teeth.

The different treatment options were discussed at length with the patient, including gold standard orthodontic treatment with a specialist, fixed orthodontics and removable anterior alignment appliances. However, he expressed a desire to avoid comprehensive and fixed orthodontics. Another reason for this was the commute to the practice from Denmark, where he lives for the time being – he was keen for treatment to be simple and time-effective.

Photographs were taken and the Spacewize+™ arch evaluation software calculated that 1.7mm of crowding was present in the lower arch and 0.7mm in the upper. Both within the 3mm limit for the appliance, this confirmed that it was an appropriate case for treatment with the IAS Inman Aligner and demonstrated the total amount of interproximal reduction / predictive proximal reduction (IPR / PPR) that would be required during treatment. The patient was shown the planned tooth movement and final result on a 3D-digital setup, before he gave informed consent to proceed.

Once the appliances had been returned from the IAS Inman Aligner certified laboratory, both the upper and lower aligners were fitted. Highly motivated, the patient insisted on wearing them simultaneously for fast results in both jaws. He was shown how to safely place and remove both appliances and instructed to wear them for 18-20 hours a day.

Review appointments were arranged every three weeks as the patient was travelling from Denmark. It quickly became apparent that his compliance was fantastic – his chart tracking wear time demonstrated up to 22 hours of simultaneous wear a day. IPR and PPR were performed progressively as needed.

As the upper arch reached alignment after five weeks, I was not completely happy with the mesial aspect of tooth 21 so made an IAS Clear Aligner to help drop the tooth down slightly. Within a couple of weeks, the desired position had been achieved.

Once both the upper and lower arches were aligned, the patient underwent seven days of night bleaching with 10 % Carbamide peroxide gel, using the Essix retainer provided. During the final appointment, upper and lower retainers were bonded and composite edge bonding performed alongside minor enameloplasty to hide a defect on tooth 41 using Venus Diamond, B1 and the mesial aspect was lifted a little for a more even incisal level. The patient was informed that ICON-treatment might help reduce the white opaque spots in teeth 31 and 41, but he was not concerned about them for now. The position of tooth 12 was also not perfect, but the patient was more than happy with the overall results achieved.

Case of the month by Dr Line Engelstad

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Treatment carried out by Dr Line Engelstad

 

Line Engelstad DDS is a general practitioner working in a private clinic in Oslo, Norway, with a special interest in minimal invasive dentistry. Following hands-on training, she gained certification to provide the IAS Inman Aligner in Oslo in 2014. Here, she discusses a recent case…

Background
A 22-year-old female patient was referred to me by the hygienist, who had concerns about the lingual position of 41, which made it difficult to effectively clean that region. The patient was also unhappy about the appearance of her smile in photographs.

Clinical Examination
The clinical examination revealed an Angle Class I malocclusion with anterior open bite and proclined maxillary upper central incisors. Crowding was present in the lower arch as a result of the lingual malposition of 41 and a slight midline deviation was identified. Despite this, the patient had no temporomandibular joint and muscle disorder concerns, oral parafunctions or pain and discomfort. The patient was, however, diagnosed with gingivitis and was thus informed about the pathogenesis of the disease and given instruction on hygiene techniques and the importance of daily flossing.

Treatment Options
As the patient had no previous history of orthodontic treatment, all possible options were discussed in length, taking into consideration the patient’s motivation and expectations of outcome.

The first option to be explored was the IAS Inman Aligner, with emphasis placed on the principles of the IAS Academy treatment pathway – correct assessment, diagnosis, treatment planning and appropriate treatment. As it was unclear at this time whether this would be suitable, alternative options were presented including other orthodontic appliances and a referral to a specialist orthodontist for gold standard comprehensive orthodontic treatment. She was informed that the latter could correct her anterior open bite and midline deviation. After the advantages, disadvantages, economic issues and prognoses were thoroughly discussed, the patient opted for the IAS Inman Aligner; she expressed that she only wanted her anterior teeth aligned and was not interested in a fixed appliance. The patient also revealed that her main priority was the alignment of the lower arch, despite the proclination of the upper anterior teeth and misalignment of 21 and 22.

Treatment planning
From there, pre-treatment periapical X-rays and a series of intraoral and extraoral images were taken, followed by two alginate impressions for study casts, two silicone impressions for the laboratory and bite registration. Having been made aware of the risks and prognosis of the appliance, the patient gave oral consent.

Thereafter, analysis was carried out on the study casts and the Spacewize+™ arch evaluation software was used to determine the suitability of the IAS Inman Aligner. It calculated that the patient had 0.5mm crowding in the upper arch and 2.3mm in the lower – well within the IAS Inman Aligner’s 3mm limit.

At this stage, the clinical photos and treatment plan were uploaded to the IAS Academy’s online support. The mentors advised that to improve the overall aesthetics and reduce the frontal open bite, the upper arch would need to be aligned with a slight retroclination. I also sent the impressions to the certified laboratory but only requested a 3D set up and printed models at this stage.

During the second appointment the patient was informed of the IAS Inman Aligner’s suitability. We once again discussed the alignment of both arches and after seeing the 3D before and after models, the patient provided written consent to undergo both upper and lower alignment. It was highlighted that the appliance would need to be worn for at least 15-20 hours a day followed by life-long retention to achieve optimum results.

Treatment
To minimise the risk of gingival inflammation returning, the patient received a scale and polish during her second appointment. Two weeks later, alignment commenced on the upper arch using the IAS Inman Aligner and initial interproximal reduction (IPR) was completed. A composite anchor was also placed on the distal palatal surface of 22. She was given instructions for use and a thorough demonstration of how to insert and remove the appliance safely.

After two weeks, the patient attended the practice in high spirits – besides some isolated tenderness to the targeted areas and some minor difficulties with speech during the first week of wear, there were no issues. A composite anchor was placed on the distal buccal surface of 21 to assist with correcting the retroclination. Once removed, the process was complete and a silicone impression was sent to the laboratory for a fixed retainer. During the wait, the patient was given an Essix removable retainer and advised to wear it day and night. Oral hygiene instruction as also given to ensure effective cleaning , particularly interdentally, and therefore optimise dental health and longevity of the achieved outcome.

When the lower IAS Inman Aligner was fitted, initial IPR and predictive proximal reduction (PPR) were completed to reduce crowding by 1mm. A composite anchor was also placed on the mesial lingual surface of 41.

During the lower arch treatment, the upper wire arrived and was bonded into place. Progressive IPR with discs and strips continued to be performed on the lower arch with the patient wearing the aligner for up to 22 hours a day until alignment was complete. Again, a wire retainer was fixed for life-long retention.

Case Outcome
With its safe and predictable approach, the IAS Inman Aligner is an ideal treatment pathway for any patient with simple to moderate protruding or misalignment. In this case, where the patient’s complaint was malposition, the intended outcome was achieved and both the patient and I were extremely pleased with the end result.

Case of the Month by Dr Gunnar Kjendlie

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Treatment carried out by Dr Gunnar Kjendlie

 

Gunnar Kjendlie
Horten Tannlegesenter
Trimveien 41 B, 3188 Horten
Norway

Tel:33 04 25 85
www.hortentannlegesenter.no

My testimonial:

The patient:  Woman. Age: 53. 

She was referred by my colleague because she had been unhappy with her upper crowding for a long time. Her main concern was the palatinal placed UL1 og the rotated UL2. However, she didn´t want traditional fixed orthodontics because of the expected long duration of the treatment and the looks of fixed orthodontics.

The patient was ok with the small amount of crowding in the lower jaw and didn´t want to get them aligned. To avoid more crowding in the lower jaw we decided to put on a bonded wire retainer.

The crowding in the upper jaw was 3,2mm and all the incisors needed rotation. By buccal movement of the UL1, a lot of IPR/PPR and a combined expander we got space to rotate and align the upper front teeth. We used a clear aligner to get the last rotation of the UR1. The patient used the Inman Aligner for 16 weeks and then finished with the Clear Aligner.
For retention we put on a bonded wire retainer and an Essix retainer. There was not enough space for a wired retainer on the canines, so we used the Dahl principle and after only 2 weeks the occlusion in the molar and premolar region was almost there.

To adjust the incisal edges we put composite on the UR2 and UL1 and polished the UR1 with Soflex discs. 

The support and guidance from the instructors on the forum has been excellent all the way! Thanks a lot! As a dentist it is very motivational to see these big changes in such a short period of time. The patient is very happy with her new smile!