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Start simple to build confidence – Dr Florian Klumpp

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  Posted by: The Probe      9th December 2018

I have been using the ClearSmile Inman Aligner for about two years now. I like the IAS Academy because it provides support that helps you to better manage your cases for greater predictability – with someone always on hand you never feel lost. In addition, the collaboration with authorised laboratories is seamless and the lab team are also a great support during the planning of every case.

Case presentation

A female, 18-year-old patient presented with concerns about the appearance of her anterior teeth. All she really wished to do was move tooth 22 into better alignment with her other dentition and enhance the aesthetics in this area. She was keen to avoid treatment with fixed orthodontic appliances.

Orthodontic assessment

A full orthodontic assessment was completed (Table 1). No functional problems with the TMJ were detected and the patient demonstrated good static and dynamic occlusion with really good anterior guidance.

Table 1:

Skeletal Pattern Class II
Lower Face Height Normal
Facial Asymmetry None
Soft Tissues Normal
Overjet None
Overbite 4mm
Crossbite None
Displacement on Closure None
Incisor relationship Class II
Molar Relationship Class II Class II
Canine Relationship Class II Class II
Teeth Present 7654321 1234567
7654321 1234567
Centrelines Coincident

Spacewize+™ and Archwize™ crowding calculations were performed to establish if it would be possible to move tooth 22 back into alignment. The digital software programmes suggested that this would be a suitable case for the ClearSmile Inman Aligner, achieving the desired outcome with light interproximal reduction (IPR) and with proclination of teeth 11 and 21.

It is important to recognise that anterior alignment orthodontics will flatten the anterior guidance, losing the contact between the upper and lower anterior teeth and increasing the overjet (as seen in the Archwize™ analysis). I planned to create new contacts in this case by adding composite to the palatal side of the teeth while simultaneously placing the retainer at the end of treatment.

Treatment planning

Precise silicone impressions and a habitual bite registration were taken, as well as photos, an X-ray and a vitality test. The Spacewize+™ arch evaluation and Archwize™ analysis estimated the total amount of IPR to be 1.1mm – which was well within the 3mm average limit of the appliance. The 3D images and models produced by the laboratory were then used to explain the treatment process to the patient and show her what the end result could look like. She was more than happy to proceed and provided informed consent.

Table 2:

Problem list
·      Poor alignment of tooth 22

·      Poor aesthetics of tooth 22

Treatment aims
·      Align upper anterior teeth

·      Improve aesthetics with crown lengthening

Treatment

Table 3:

Appointment Treatment
1 IPR was performed on teeth 13 to 23, with composite anchors placed on the palatal aspects of teeth 11 and 21. The ClearSmile Inman Aligner appliance was fitted and the patient given instructions on placing and removing it, as well as oral hygiene advice.
2-6 Light IPR was performed during each appointment as necessary between teeth 13 and 23. Most IPR was needed on the mesial / distal aspects of tooth 22.
7 No composite anchor was necessary on the buccal aspect of tooth 22.
8 Alignment complete, impressions and a bite registration were taken for fabrication of the retainer by the laboratory.
9 The fixed retainer was bonded into place, with composite added to the palatal aspects of teeth 11 and 21 to adjust the occlusion. The buccal gingiva of tooth 11 and 21 was also reduced to improve the length of these teeth.

Treatment outcome and case-appraisal

From the initial planning stages and throughout the case, there was great support available from peers and mentors on IAS Academy online forum. With their guidance I felt more competent and therefore more confident to carry out treatment in a safe and effective way for my patient.

The patient is very happy with the outcome of treatment, having achieved the desired results in a short length of time. All her expectations were met, especially when it came to improvement of the pink aesthetics by lengthening the two central incisors. As the dentist I was equally satisfied, because we were able to improve the smile in a predictable way, without affecting function.

In hindsight, there is nothing I would do differently for this case – it was relatively simple to complete and I had the help of the forum throughout. My advice to other practitioners is not to fear getting involved with orthodontic cases like this, especially with IAS Academy as the support is so good!

 

Figure 1 – Pre treatment smile

Figure 2 – Pre treatment right lateral

Figure 3 – Pre treatment left lateral

Figure 4 – Pre treatment retracted.

Figure 5 – Pre treatment chin up view

Figure 6 – ClearSmiel Inman Aligner fitted and composite anchors placed

Figure 7 – 1 week into treatment

Figure 8 – 5 weeks into treatment

Figure 9 – 8 weeks into treatment

Figure 10 – Bonded retainer fitted

Figure 11 – Crown lengthing

Figure 12 – Crown lengthing

Figure 13 – Post treatment smile

Figure 14 – Post treatment right lateral

Figure 15 – Post treatment left lateral

Figure 16 – Post treatment retracted

The ClearSmile Inman Aligner course is part of the IAS Academy pathway of training for GDPs

 For more information on the ClearSmile Inman Aligner and upcoming training courses,

please visit www.iasortho.com or call 0208 916 2024.

Author biography:

 Dr Florian Klumpp took his state examination in dentistry at the University of Tübingen, Germany, in 2000. He became a specialist in aesthetic dentistry in 2011 and went on to work in varius different dental practices in South Germany. Today, he practises at Dr Fischer Dental Practice, Pfullingen, Germany and is a speaker and course lecturer around the country.


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