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.
 

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