A simple, minimally invasive solution for crowding and diastema closure
NewsPosted by: Dental Design 17th April 2020
Dr Sigurjón Sveinsson, a dentist currently practising in Iceland, shares a recent orthodontic case he treated with minimally invasive techniques.
A female patient presented with concerns about the appearance of her upper and lower anterior teeth. She wished to straighten the teeth to improve her smile.
Assessment and planning
She was a regular attender to the practice, so we already knew she had a clear medical history, was fit and healthy. A comprehensive orthodontic assessment was performed (Table 1), including radiographs and clinical photographs. Although the patient had competent lips at rest, she did have a slightly high smile line.
Table I: Orthodontic assessment
| Skeletal Pattern | Class I | |
| Lower Face Height | Average | |
| FMPA | Average | |
| Facial Asymmetry | None | |
| Soft Tissues | Nasolabial angle normal, lips competent at rest, no tongue thrust | |
| Overjet | 2mm | |
| Overbite | 20% overlap of incisors | |
| Crossbite | None | |
| Displacement on closure | None | |
| Incisor relationship | Class I | |
| Molar relationship | Left: Class I ½ unit / Right: Class III | |
| Canine relationship | Left: Class I / Right: Class III ½ unit | |
| Teeth Present | 7654321 | 12345678 |
| 87654321 | 12345678 | |
| Centrelines | Deviated 2mm to the left in the lower arch | |
All possible treatment options were presented and explained to the patient, including no treatment, GDP orthodontics and referral to an orthodontic specialist for comprehensive treatment. The benefits and limitations of each solution were described in detail to ensure the patient’s understanding and informed consent. She expressed a preference for removable orthodontics due to the flexibility and convenience of treatment to fit into her lifestyle.
The Spacewize™+ digital programme was therefore used to calculate the amount of crowding present. It estimated that 0.5mm of space would need to be created in the lower arch and 0.1mm in the upper arch. This confirmed suitability of the case for treatment with ClearSmile Aligners.
Following the ABB (Align, Bleach and Bond) concept, tooth whitening and composite edge bonding were also offered to the patient. She was interested in lightening the colour of her teeth to perfect her new smile. Even at this early stage, the importance of retention was highlighted to the patient, as well as the need for good oral hygiene before, during and after orthodontic treatment.
Table 2: Ideal vs. compromised treatment aims
| Problem List |
| Mild crowding in lower arch
Mild crowding in the upper arch Diastema |
| Ideal Treatment – Aims: |
| Create coincident centrelines
Achieve Class I molar relationship on the right side Achieve Class canine relationship on the right side Relieve lower anterior misalignment Relive upper anterior misalignment Diastema closure |
| Compromised Treatment – Aims: |
| Relieve lower anterior misalignment
Align upper anterior teeth Close diastema |
Treatment provision
Upper and lower impressions were taken to allow fabrication of the clear aligners by the IAS Laboratory. In total, four upper aligners and seven lower aligners were required. The patient returned to the practice roughly every two weeks for review and confirmation that she was ready to move onto the next ClearSmile Aligner in the sequence. During these appointments, interproximal reduction (IPR) and predictive proximal reduction (PPR) were performed as and when needed to relieve crowding and facilitate tooth movement. Throughout the alignment process, the patient was very compliant with recommendations and she maintained a good level of oral hygiene.
Once both the patient and I were satisfied with the position of the teeth, we moved onto whitening. The Opalescence whitening kit with 20% carbamide peroxide from Ultradent was used by the patient at home for 2 weeks, taking her dentition from a shade A2/A2.5 to a shade A1. Composite edge bonding was declined by the patient. New upper and lower impressions were taken for the fabrication of the bonded retainers by the lab. These were fitted and the importance of retention and continued oral hygiene emphasised to the patient once again.
Outcome and case appraisal
The patient was very happy with the treatment outcome as we were able to address her chief concerns with a relatively efficient and convenient solution. In particular, she appreciated the fact that we could align the teeth without fixed appliances.
From my point of view, the case went really well. In hindsight, there’s nothing I would do differently and I don’t think that any further treatment or aligning with fixed braces would have improved the outcome.
Images
Figure 1 – Pre treatment
Figure 2 – Presenting smile
Figure 3 – Pre treatment left smile
Figure 4 – Pre treatment right smile
Figure 5 – Pre treatment retracted anterior
Figure 6 – Left lateral
Figure 7 – Right lateral
Figure 8 – Upper occlusal
Figure 9 – Lower occlusal
Figure 10 – Chin up view
Figure 11 – Side profile mid treatment
Figure 12 – Upper ClearSmile aligner in situ
Figure 13 – Anterior view post alignment
Figure 14 – Post treatment
Figure 15 – Post treatment profile
Figure 16 – Post treatment smile
Figure 17 – Post treatment left smile
Figure 18 – Post treatment anterior
Figure 19 – Post treatment upper occlusal
Figure 20 – Post treatment lower occlusal
For more information on upcoming IAS Academy training courses, including those for the Inman Aligner and Aligner system, please visit www.iasortho.com or call 01932 336470 (Press 1)
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