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

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