A systematic approach

22 March 2021
4 min read
Published:

Kenneth Cheung discusses a case study using the Inman Aligner system.

Dentistry has evolved dramatically in the last few years. With the introduction of digital technology including the use of intraoral scanners, digital smile design software and comprehensive digital workflow, many new orthodontic aligner systems have come into the market. Does Inman Aligner still have its place in the market? This case study shows that by proper case selection in a systematic approach, the use of Inman Aligner can achieve excellent results within a short period of time.

Patient concerns
Ruth was a 25-year-old lady who first came to my practice in September 2019. She was concerned about her orthodontic relapse and had consulted her orthodontist before coming to see me for a second opinion. She did not want to go through another course of fixed orthodontic treatment as was recommended by her orthodontist, as it involved a long treatment time and high fees. She was then referred to my practice by her cousin who was also undergoing Inman Aligner treatment at that time, and we are the only Inman Aligner provider in the area.

With a history of orthodontic treatment over 10 years ago, Ruth noticed that her anterior maxillary teeth had moved back to their original crowded position. There was no relapse in her mandibular teeth as she had a fixed retainer to hold them in place. She said she had been researching about different orthodontic systems on the internet, and she was interested to know if she could have her maxillary anterior teeth straightened with Inman Aligners.

Assessment
Her old dental records with her previous dentist were retrieved; she had conventional fixed orthodontic treatment in 2010 with removal of two upper and two lower premolars. The treatment was completed in two years. Ruth’s recent radiographs, including two bitewings and panoramic radiograph were shown as below.

Summary of findings:

  • Class II Div II incisors relationship with overjet of 4mm and overbite 3mm
  • Severe maxillary labial segment crowding
  • Lower central midline 3.5mm off to left of maxillary central midline
  • Canines Class I relationship on RHS and Class II relationship on LHS

Treatment
A treatment plan discussion was carried out in October 2019. A few treatment options were proposed, which involved fixed orthodontic treatment with a specialist, cosmetic dental veneers, or Inman Aligners. She decided to proceed with the Inman Aligner, and she was given a detailed explanation on the benefits and limitations of the appliance.

The case was assessed for suitability using a systematic approach. Occlusal clearance between the maxillary and mandibular teeth was assessed, to ensure there was enough room for teeth movement. The movement potential of her upper anterior teeth with Inman Aligner was assessed. Spacewize analysis was applied by uploading her intraoral photo in order to calculate the amount of crowding/space needed. The difference between available space and required space is 2.5mm, within the 3mm recommendation for successful treatment. It confirmed that Ruth was a good case for treatment within Inman Aligner limits.

Intraoral photos were emailed along with intraoral optical scans of both maxillary and mandibular arches to a certified IAS laboratory – Pearl Group Smile Corporation. After discussion with Pearl Group Laboratory about this case, we decided to incorporate an arch expansion in Inman Aligner with a build-in midline expansion screw, in order to create additional space by “unlocking” localised crowding of overlapping and palatally positioned upper laterals.

Along with the Inman Appliance, 3D printed resin models of the original teeth and proposed result were received from the laboratory.

A fitting appointment was carried out in November 2019. Predictive proximal reduction (PPR) was achieved by discing the enamel of the proximal surfaces of enamel on teeth 12 and 21 by polishing discs according to the guide. Composite anchors were bonded on palatal aspects of teeth 12 and 21 according to the red colour on the 3D printed model, which helped keep the aligner bow in place and to achieve labial tipping movement of the involved teeth. Strategic interproximal reduction (IPR) was performed strategically and progressively at each subsequent appointment to release enough space to allow the teeth to align (domino effects). Post-procedural care instructions were given, which emphasised on patient’s compliance with the appliance to achieve the best results.

Ruth was reviewed at three to four weekly intervals as treatment progressed and as more teeth came into play. Further IPR and replacement of composite anchors was performed as needed. The proper use of palatal expansion screw by the patient was also reviewed.

Two review appointments were carried out just before our Christmas break in 2019. Her final review appointment was carried out in early January 2020, when her final teeth positions were achieved with Inman Aligner. She was amazed by the results that were achieved within two months.

Alginate impressions were taken during her final review appointment for construction of her upper retainers. In order to prevent any further relapse of Ruth’s maxillary teeth, she was happy to have a bonded lingual retainer as well as an Essix retainer. A 0.0195” canine-to- canine stainless-steel wire was transferred to the teeth with a jig and bonded with composite resin to the palatal aspect of the aligned teeth. Ruth was advised to wear the Essix retainer part-time for a minimum of six months.

Discussion
The Inman Aligner offers a relatively quick and predictable way to improve aesthetic alignment at low risk and cost to the patient. She was very satisfied with the aesthetic outcome, which was achieved within only two months at a very low cost. Inman Aligner provided a naturally beautiful, healthier and more ethical long-term result. Although there has been an increased popularity in the use of cosmetic restorative dentistry and some other aligner systems, with proper case selection, I believe Inman Aligners still has its place in the market. Should Ruth desire for dental veneers in the future, the use of Inman Aligner will make the procedure much more conservative by reducing the amount of tooth reduction, as her teeth have already been moved into a relatively ideal position.

References available on request.