A 30-year-old female patient presented to the practice unhappy with the appearance of her upper anterior teeth. She didn’t like how they stuck out in photos and that her two front teeth were different shapes. She hadn’t undergone orthodontic treatment previously, but was keen to avoid fixed braces and any lengthy treatment.
A full orthodontic assessment was performed (table 1) with the compromised treatment plan explained in detail to the patient for informed consent (table 2).
Treatment planning
The Spacewize+ arch evaluation tool suggested an estimated total of 2.5mm of space would need to be created – well within the 3mm recommended limit of the ClearSmile Inman Aligner. Progressive interproximal reduction (IPR) and predictive proximal reduction (PPR) was planned throughout treatment, with PPR expected to focus on the mesial surfaces of the central incisors. Following alignment, we planned to replace the defective mesial composite restorations on UR1 and UL1 and perform composite incisal edge bonding on UL1. Retention would be provided via a bonded flexible spiral wire retainer, over which would be fitted a vacuum-formed retainer.
Treatment
Treatment proceeded according to plan (table 3).
The online forum was useful in this case, especially with regards to planning the Spacewize+ curve. The online support allows any questions to be answered quickly and comprehensively. There is often input from multiple tutors on the same case too, which allows you to gain different perspectives on how to approach any issues that may arise.
Outcome of treatment
The patient was very happy with speed of treatment. The simple edge bonding on the UL1 and replacement of stained composites complemented the tooth alignment and combined to give an excellent aesthetic outcome.
Case appraisal
The patient was extremely happy with the final appearance of her teeth. However, she struggled to wear the appliance for 20 hours a day and didn’t wear it at all on Fridays as she struggled to speak with it in at work. On reflection, I should have stressed to the patient more from the outset how important it is to speak out loud with the appliance in, especially when it is initially fitted. Although treatment was still completed in a relatively short space of time, it would have been completed sooner had she worn the appliance for longer, with decreased overall chair-time. With subsequent patients using the ClearSmile Inman Aligner, I have stressed the need to speak out loud with the appliance in from the outset and compliance has been much improved as a result.
Table 1.
Table 2.
Table 3.
Fig 1: Pre treatment facial view. Fig 2: Pre treatment retracted view.
Fig 3: Pre treatment left retracted. Fig 4: Pre treatment right retracted. Fig 5: Pre treatment upper occusal view.
Fig 6: Pre treatment lower occusal view. Fig 7: ClearSmile Inman Aligner fitted. Fig 8: Progress from 2nd review appointment.
Fig 9: Post treatment smile. Fig 10: Post treatment right lateral.
Fig 11: Post treatment left lateral. Fig 12: Post treatment retracted. Fig 13: Post treatment left lateral retracted.