The provision of cosmetic orthodontics is hugely beneficial to general dental practitioners. In the past, cosmetic crowns and veneers or comprehensive fixed orthodontics would have been indicated to treat mild to moderate anterior crowding. Patients often rejected the latter because of the longer treatment time, but the question remained as to whether the GDP should provide the faster but more invasive option. In most cases the answer should now be no. Modern cosmetic orthodontic appliances provide a safe, effective and conservative alternative to crowns or veneers, offering enhanced long-term effects to the dentition.
Removable appliances seem to be popular with adult patients; the ability to remove the product dispels any self-consciousness experienced when in social or important professional situations. I think some of the increased self-awareness amongst the public stems from the popularity of the ‘selfie’ photo culture, as the angles of these images tend to emphasise any misaligned teeth.
Not only do modern options address treatment time and self-image concerns, they are also very affordable for most patients. Employing these treatments enables the GDP to provide solutions to a wider range of patients within their own practice without the need to refer. It is a combination of all these things that has led to the significant increase in demand for cosmetic orthodontic treatment in recent years.
Case presentation
When a 42 year-old female patient presented for a routine examination and clean she mentioned having visited an orthodontist to discuss her lower incisor crowding. She had undergone orthodontic treatment as a teenager but had since relapsed. She was a nonsmoker and generally maintained good oral health. The patient had noticed the crowding getting worse over time, and when she sought advice from the orthodontist she was advised that she would need to wear full braces for 18 months.
An examination revealed that previous orthodontic treatment involved the removal of the upper first premolars and lower second premolar. The upper left lateral incisor was slightly rotated distally while the upper right lateral was palatally displaced by a slight edge-to-edge contact with the opposing canine. The lower left central was displaced buccally and the lower right lateral lingually. The patient was happy with the position of her upper centrals and accepted that the midline on the lower arch was deviated due to the extraction sequence of her earlier orthodontic treatment.
At this point I suggested the Inman Aligner as a possible alternative to fixed orthodontics for her mild crowding. If
suitable, the appliance would be able to straighten her anterior teeth in a much shorter treatment time than the
fixed option previously suggested.
After a full examination and confirmation of the patient’s suitability for the Inman Aligner, treatment time was estimated at six to 12 weeks. The patient was advised that the lower anterior teeth would need to be reshaped in order to facilitate movement. It was also discussed that her upper left lateral was slightly rotated and could be corrected with a singular aligner.
Once the full treatment had been explained in detail and the patient had had an opportunity to ask any questions, informed consent was acquired to proceed with the lower Inman Aligner and a singular upper aligner for the rotation of the UL2, followed by edge bonding.
The Spacewise+ digital tool was then used to calculate the amount of crowding present – 3mm in the lower arch and 0.3mm in the upper. The predicted amount of IPR (interproximal reduction) that would be required throughout treatment was also provided – in the lower arch 0.2mm reduction was suggested for the distal edges of the LR3 and LL3, 0.12mm distal reduction recommended on the LR2 and 0.1mm between the incisors. 0.1mm of IRP was also suggested on the UR2 and UL2. It was agreed that the upper arch would be treated first, so that enough space could be created for the correct movement of the lower teeth.
Impressions were taken and sent to Pearl Dental Laboratory in Melbourne for the upper appliance to be manufactured. Once fitted and checked, the aligner was left for two weeks to rotate the UL2. The same process was then followed for the lower appliance, which was fitted to re-position the lower arch and did so in about seven weeks. When the teeth were satisfactorily re-positioned edge bonding was performed on the incisal edges of the LR1, LL1 and UL2 using Venus flowable shade A2 for optimum aesthetics.
The patient was delighted with the results, particularly considering the shorter treatment time than she was originally offered.