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!

Case of the month by Dr Rhona Eskander

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Treatment carried out by Dr Rhona Eskander

 

Chelsea Dental Clinic
298 Fulham road
London
Chelsea
SW10 9EP

The case presented to me due recommendation. The patient wanted straighter, nicer teeth. He had a tumour in his palate as a child and did not want fixed braces. Since he could not take off his obturator I thought the Inman aligner would be perfect. It's removable, quick and will achieve anterior alignment: the only challenge was where to put the clasps on the Inman. They are usually placed on the 6's but due to the obturator the design had to be modified. I contacted Tif and got some support from him. We decided to try the clasps on the 4's. Nimrodental helped with a digital set up: the patient wore the appliance for 3 months. Then we used a diode laser to create better gingival harmony. Composite bonding was applied to create the best aesthetic result and a fixed bonded retainer was placed palatally at the end.  

Patient testimonial

'Before meeting Rhona and her team I'd been led to believe that my options were quite limited when it came to straightening my teeth. Up to that point my Obturator had seemed like a barrier to attaining the perfect smile. Thanks to Rhona's ingenuity and my specially adapted Inman aligner I was able to achieve my desired result with minimal impact or disruption to everyday life'.

Case of the Month by Dr Solveig Skaar

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Treatment carried out by Dr Solveig Skaar

 

Veglo 1
6809 Förde
Norway

Tel:004757821596

Smiles all round – Minimally invasive treatment with highly satisfying results

Solveig Skaar discusses a recent case where minimally invasive anterior alignment provided fantastic results.

A 52-year-old male patient was referred to me by his regular dentist, looking to improve the appearance of his anterior teeth. Upon examination a Class 1 occlusion was identified, with retruded UR1, UR2 and UL1. The UL2 was protruded and incisal wear was detected on all other upper anterior teeth. There were minimal restorations present, and the patient’s oral health was generally OK with just some plaque and calculus build up on the lower anteriors and caries on the UR2.

An orthodontic assessment was carried out and the patient was presented with all options, including ideal treatment via a specialist referral or a compromised treatment. Aside from wishing to straighten his front teeth, the patient was concerned about the increasing wear. This had been addressed several times with composite, but the results had not lasted. The patient also expressed interest in avoiding fixed orthodontics and he was keen to try the IAS Inman Aligner.

The goal of treatment was therefore to straighten the anterior teeth and restore the incisal wear without reducing the enamel further. A long-term solution to prevent any further wear in the future was also important. No action at all would have led to increased wear and crowding, while further restorative treatment with composite would once again have proved ineffective due to the malocclusion and continued tooth movement.

Photographs were taken and the Spacewize+™ crowding calculator was used to establish that 0.1mm of crowding was present. These results were posted on the IAS Inman Aligner online support, where the mentors confirmed it was a suitable case to be treated with the appliance.

Treatment

At the initial treatment appointment composite anchors were placed palatally on the UR1 and UL1, while interproximal reduction (IPR) and predictive proximal reduction (PPR) were performed according to the Spacewize+™ guide with red strips. Polishing was also performed and fluoride applied. Photos were then once again posted on the IAS Inman Aligner online support forum, to document progress and gain assurance from the experts that everything was going well.

During consequent appointments every two weeks, this process was repeated, with the focus on creating space to allow for tooth movement. Six weeks into treatment, a labial composite anchor was placed on the UL2 and the IPR and PPR was increased to create more space. Minimal stripping was required so blue strips were used around the canines until the width was the same as the printed model.

After 10 weeks, movement had slowed, so following expert advice from the online support, the buccal anchor was moved down and the bow was tightened. After a slightly longer break – due to summer holidays – the teeth had achieved the desired movement and all existing composite anchors were removed. A new anchor was placed to help rotate the UL2.

Unfortunately, the appliance was accidentally broken a week later, so a retainer was provided for the patient to wear at night while a new IAS Inman Aligner was ordered. A few weeks after treatment had resumed, clear aligners were used to complete the rotation of the UL2. The patient undertook whitening at home using Opalescence 6% Hydrogen Peroxide Day Whitening for 10 days. As the patient was in no hurry to complete treatment, it was decided to perform edge bonding after the Christmas period and the patient continued wearing the clear aligners at night during this time for retention. The composite edge bonding was then completed using Venus Diamond B1 and Venus Diamond Clear with the Reversed Triangle technique; at the same time the fixed retainer was bonded.

An impression was then taken for the Essix retainer, which would be worn at night, and the teeth were polished. To complete the procedure, a filling was placed mesially on the UR2 to treat the caries.

Outcome

Minimally invasive anterior alignment such as the IAS Inman Aligner provides highly ethical treatment. Due to the Spacewize+™ crowding calculator, 3D model and support and advice from the online forum, the safety and predictability of treatment is significantly enhanced. It was particularly helpful in this case that the patient was in no rush to complete treatment and was very relaxed throughout, so there were no time-pressures affecting decisions or quality at any point. It is very satisfying as the practitioner to realise just what is possible with such a non-invasive treatment and I was vary happy with the result in this case. Plus, the patient was thrilled with the outcome and found it interesting to watch his progress as the teeth moved into position over time.

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

For more information on the IAS Inman Aligner and upcoming training courses, please visit www.inmanaligner.com or call 0845 366 5477

Author Bio:

Dr Solveig Skaar graduated from the University of Bergen in 1998. She bought her own dental clinic in 2005. She is a member of Scandinavian Academy of Estetic Dentistry and has been a certified IAS Inman Aligner user since 2013.
 

Case of the Month by Dr Salman Siddiqi

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Treatment carried out by Dr Salman Siddiqi BDS MFDS RCS Ed

 

Thornaby Dental Centre
31 Allensway
Thornaby
Stockton on Tees
TS17 9HA

Tel:01642 750124
www.thornabydentalcentre.co.uk/

Patient testimonial

"I was never fully happy with the placement of my front teeth after having braces when I was a teenager. I made a appointment with Salman to see if I was eligible for the Inman Aligner. Once I agreed to the treatment, it was predicted that my teeth would be aligned within 6 to 8 weeks. For the first couple of days my teeth were sensitive but not painful. My results speak for themselves as they are amazing and people can not compliment me on my teeth enough."

Dentist Testimonial

Megan, a 21 year old patient attended for a consultation with me in November 2015. Her main concern was the ‘crowded’ appearance of her front teeth, in particular an ‘overlapping’ front tooth (identified as UR1).

Further questioning revealed she had previously had fixed upper and lower appliance orthodontics when she was 18. However, following poor retention of results due to low compliance with wearing her Essix retainer, she experienced relapse around the upper incisors.

ASSESSMENT

A comprehensive intraoral orthodontic exam was performed. The salient features were a Class II division I malocclusion on a class II skeletal base with mild labial segment crowding, retroclined UL1 and palatally positioned UL2. Buccal segment examination revealed a bilateral Class I molar relationship with a right side Class I and left side 0.5 unit Class II canine relationship. Hard tissue examination revealed a minimally restored dentition with good oral hygiene of both smooth and interproximal surfaces.

The extra-oral examination showed competent lips at rest position and facial profile analysis revealed a low Frankfort-Mandibular Plane Angle (FMPA) and average lower face height.

A full series of intra-oral and extra-oral clinical photographs were also taken at the consultation stage. Digital callipers were used to accurately measure the widths of upper anterior teeth and to calculate the degree of crowding involved.

TREATMENT

After valid written consent was obtained an accurate upper putty and wash impression was recorded alongside a lower opposing alginate impression and bite registration. After filling out the lab prescription with details of proposed movements, a request was made for a ‘standard’ inman aligner. All impressions were then posted to Nimro Dental, the selected orthodontic lab for IAS.

The appliance was delivered after 14 days as requested and fitted at the first appointment in December 2015. The lab also provided a 3D printed model of the final outcome treatment which was very useful in achieving patient compliance throughout the treatment.

When the IAS Inman Aligner was fitted, the patient was shown how to place and remove the appliance and was instructed to wear it for at 20 hours a day. Instructions were also given on cleaning and storage of the appliance.

At the fit appointment a composite anchor was placed palatally on the upper left lateral as marked on the guide model. This allowed the palatal bow to rest in the incisal third and provide the required force to labially advance lateral.

Once the lateral was in the desired position, the palatal composite anchor was removed and labial anchors were placed on the centrals to achieve mild rotations.

The space required to achieve these movement was created using interproximal strips. The strips were passed through the required contact points as advised by the interproximal reduction (IPR) guide. Topical fluoride was applied to the surfaces all teeth where IPR was carried out.

The patient was reviewed for appliance adjustment and space creation over 5 appointment at 2 weekly intervals. The total treatment time was 12 weeks.

At the end of the treatment, a palatal wire retainer was bonded using flowable composite (picture to follow). Due to her dental history of orthodontic relapse the patient was also provided a clear essix retainer for night time wear in case the wire retainer debonded.

SUPPORT RECEIVED

I have been a certified provider of the Inman Aligner since 2015. I attended the hands-on certification day in Manchester in June 2015 and found the style of the course delivery very engaging with the right mix of theory and practical techniques covered. Particular emphasis was placed on patient assessment and diagnosis which gave me greater confidence in treatment planning anterior alignment cases.

The IAS trainers are very approachable and provide invaluable guidance and support through the online forum

I would highly recommend the attending the Inman Aligner hands on course as it has truly changed the way I approach anterior aesthetics and treatment planning for restorative cases. The multitude of simple anterior crowding cases that can be treated predictably with the Inman Aligner make it a great addition to the skill set of the modern general dentist.

Case of the Month by Dr Andy Wakefield

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Treatment carried out by Dr Andy Wakefield