Simple but powerful solutions

03 November 2021
4 min read
Published:

Jessica Wake presents a recent case to demonstrate the power of simple yet highly effective anterior alignment orthodontics, alongside the ABB (align, bleach and bond) concept.

The patient is a regular attender at our practice and sees the clinical director for her regular dental care. She was referred internally to see me for some potential orthodontic treatment. 

The patient had recently become more conscious of her upper and lower anterior teeth and had noticed they were starting to become crowded. She’d previously had orthodontic treatment as a teenager, but gave up wearing her night time retainers in her early 20s and since then her teeth had gradually relapsed. As this was beginning to bother her, she was interested in treatment to correct the position of her teeth once again.

Orthodontic assessment
A comprehensive orthodontic assessment was conducted (Table 1) to determine the patient’s suitability for removable orthodontic treatment.

Table 1:

Skeletal pattern

Class II moderate

FMPA

Low

Lower face height

Average

Facial asymmetry

Yes, nose very slightly to left

TMJ

NAD

Soft tissues

Competent lips, obtuse nasolabial angle, slightly high lip line on smiling

Overjet

3mm

Overbite

20 per cent

Crossbite

No

Displacement on closure

No

Incisor relationship

Class I

Molar relationship

Right: Class II full unit Left: Class II full unit

Canine relationship

Right: Class II ¼ unit Left: Class I

Teeth present

876  4321

    1234   678

7654321

1234567

Centrelines

Lower centre line deviated to the right by 1mm

 

Treatment planning
A full set of clinical photographs, x-rays and intraoral impressions were taken. The Spacewize+ programme was used to assess the degree of crowding and arch form, and all were uploaded to the forum for approval. The Archwize digital simulation software from the lab confirmed case suitability for the ClearSmile Aligner Light appliance. It estimated that five upper and eight lower aligners would be required for alignment, alongside a total of 0.2mm upper and 1.1mm lower interproximal reduction (IPR) to create sufficient space for tooth movement. The Archwize results were posted to the IAS Academy support forum for confirmation of suitability, as well as clinical reassurance from the academy mentors and the go ahead for treatment.

The entire treatment plan was communicated with the patient, who was more than happy to proceed and we went through the consent process. The importance of retention was emphasised and the patient understood her role in terms of wearing retainers for life to maintain the results achieved.

Orthodontic treatment
Treatment progressed as planned, with the patient wearing each aligner for 22 hours a day for two weeks before moving onto the next in the pre-determined sequence. Progress was checked and oral hygiene instructions reiterated during review appointments.

Anchors were placed on the UR2 and UL12 and the LL3 and LR2 during the first visit and the recommended IPR carried out at this visit. Usual protocols were followed in relation to our covid policies using non aerosol generating procedures.

After the patient had been wearing aligner five for two weeks, a new lower impression was taken to ensure the case was tracking correctly. The lab was then able to make the next two aligners in the sequence.

Once alignment was complete and both I and the patient were satisfied with the results, upper and lower bonded retainers were fitted. Following the ABB (align, bleach and bond) concept, tooth whitening was performed with two weeks of night-time Phillips Zoom Nite white 16 per cent tooth whitening solution, using the IAS Lab to make the whitening trays for the patient. Once the patient was happy with the whitened shade she had achieved, very slight composite edge bonding was completed on the upper left central incisor and the upper laterals to improve their shape and optimise the smile aesthetics. Finally, night time Essix retainers were provided to wear indefinitely in order to maintain the new position of the teeth.

The patient was very happy with her treatment and the outcome, as was I.

Discussion
The mentors from the forum recommended getting the IPR done early in the treatment to make the space required to allow the teeth to start moving. The IAS support forum is a great tool to have cases assessed and approved. Any advice the mentors provide is useful to ensure treatment is tracking correctly and this is appreciated.

The skills I have learnt from IAS Academy removable appliance, ABB and ortho-restorative courses have been put into action here to produce a very nice result.

My experience with IAS Academy training has been excellent. The background teaching regarding full orthodontic case assessment, diagnosis and treatment planning is covered in great detail, helping you to understand what you are doing and keeping you safe in the treatment process for consistent results. The hands-on training is thorough so you feel confident about transferring these skills into practice. I would recommend IAS Academy courses.

I have been very happy with the ClearSmile Aligners and the IAS Laboratory process is excellent. The aligners always fit well and cases are carefully planned in the Archwize planning department so you know the movements you are creating are safe and I get very consistent results.

For anyone wanting to treat similar cases, it’s important to ensure the patient is diligent in wearing the aligners and that IPR is done accurately accordingly to the treatment protocols. You will then feel confident treating patients with mild crowding – the results are lovely to see and you will have a very happy group of patients.

For more information on upcoming IAS Academy training courses, including those for the Inman Aligner, please visit www.iasortho.com or call 01932 336470 (Press 1)

Jessica graduated from Birmingham in 1989 with a degree in Dentistry and has been at St John’s Hill for six years now. She especially enjoys general family dentistry and cosmetic dentistry using minimally invasive techniques. Jessica’s special interests include tooth whitening, edge bonding and anterior alignment orthodontics using the ClearSmile Brace system, ClearSmile Aligners and the ClearSmile Inman Aligner. She has recently achieved her Fellowship award with IAS Academy, having completed Prof Ross Hobson’s Advanced two-year orthodontic programme, which allows her to complete more complex orthodontic cases. She is working towards her accreditation in the IAS removable appliance system.