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Safe, predictable and ethical treatment – Dr Solveig Skaar

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  Posted by: The Probe      1st May 2019

Dr Solveig Skaar demonstrates how she helped a patient improve their smile aesthetics in a conservative but effective way, all without fixed orthodontics.

A 24-year-old male patient presented with concerns about the appearance of his teeth, which were crowded. The patient therefore expressed an interest in aligning his upper anterior teeth, but was keen to avoid fixed orthodontics.

Assessment and diagnosis

A comprehensive orthodontic assessment was performed (Table 1), including periapical radiographs.

 

Table 1:

Skeletal Mild Class II
FMPA Average
Lower Face Height Average
Facial Asymmetry None
Soft tissues Normal smile line. Minor plaque build up
Overjet None
Overbite 60% overlap of incisors
Crossbite None
Displacement on closure None
Incisor Relationship Class II Division I
Molar relationship Right Class II ½ Left Class II ½
Canine Relationship Right Class II ½ Left Class II ½
Teeth Present 87654321 12345678
  7654321 1234567
Centrelines Coincident

 

The main problem in need of address was the mild Class II skeletal relationship. All possible treatment options were discussed with the patient, including gold standard fixed orthodontic treatment – which he still declined. He was happy to accept a minor compromise in order to proceed with removable appliances (Table 2).

Table 2:

Problem List
Class II relationship
 Ideal Treatment – Aims:
Create ideal Class I incisor/canine/molar relationship

Create ideal archform

Compromised Treatment – Aims:
Align the teeth, retaining anterior teeth in both arches

Accept incisor/molar positions

 

Planning

The treatment plan involved following the ABB (Align, Bleach and bond) concept. We would use the Inman Aligner to straighten the upper dentition and the ClearSmile Aligner Light to straighten the lower, followed by whitening and composite edge bonding to improve the colour and shape of the teeth for the very best functional and aesthetic outcome.

Spacewize™+ and Archwize™ crowding calculations were performed to predict the amount of space that may need to be created. These suggested a total of approximately 0.6mm was needed in the upper arch and 0.7mm in the lower arch, confirming the Inman Aligner and ClearSmile Aligner Light to be suitable appliances for this case.

Treatment provision

Appointment Progress
1 Assessment, photographs, impressions and medical history taken. After the appointment, the case was posted on the support forum.
2 (week 0) Fitted upper Inman Aligner, placing a composite anchor on UR1. Interproximal reduction (IPR) and predictive proximal reduction (PPR) were performed, fluoride applied and the patient was given oral care advice with instructions on how to place and remove appliance.
3 & 4 (weeks 2 & 4) IPR and PPR performed as needed, photos taken, fluoride applied and bows/springs were checked on the Inman Aligner.
5 (week 6) IPR and PPR performed on upper arch, photos taken, fluoride applied and bows/springs checked. Lower #1 ClearSmile Aligner Light fitted, composite anchor placed on LR2 and required lower IPR performed.
6 (week 8) Upper: IPR and PPR performed, fluoride applied and bow/springs checked.

Lower: IPR performed and changed to #2 aligner. Patient was given #3 and #4 due to upcoming summer holidays – he was instructed to change aligners every 10 days.

7 (week 10) Upper: IPR and PPR performed, photos taken, fluoride applied and bows/springs checked. A buccal composite anchor was placed on UR2 and the buccal bow was tightened.
8 (week 11/12) Upper: refiners only needed to complete alignment.

Lower: alignment complete.

Upper and lower impressions taken.

9 Upper: Composite anchors placed on canines to encourage final movements and minor IPR performed.

Lower: Fixed retainer bonded.

Patient given instructions for at home day bleaching with individual trays.

10 Impression taken for upper bonded retainer.
11 Upper bonded retainer fitted. Edge bonding performed on the lower incisors. Impressions taken of both arches for Essix retainers.
12 All edge bonding was polished and the patient was given the Essix retainers to wear at night.

 

Case Appraisal / Discussion

For this case, we were able to deliver safe and predictable treatment thanks to use of 3D planning technologies and on-going mentorship from the IAS forum. It was also very ethical, with no drilling or loss of natural tooth structure. Alignment followed by whitening and edge bonding ensures an aesthetic and functional outcome, helping to reduce further incisal wear in the future. All-in-all, both practitioner and patient were very happy with the outcome of this case.

 

 

 

 

 

 

Figure 1 – Pre treatment smile

 

 

 

 

Figure 2 – Pre treatment anterior

 

 

 

 

 

Figure 3 – Pre treatment left lateral

 

 

 

 

 

Figure 4 – Pre treatment right lateral

 

 

 

 

 

 

Figure 5 – Pre treatment upper occlusal

 

 

 

 

 

 

Figure 6 – Pre treatment lower occlusal

 

 

 

 

 

 

Figure 7 – Week 2 of treatment

 

 

 

 

 

 

Figure 8 – Week 6 of treatment.

 

 

 

 

 

 

Figure 9 – Week 10 of treatment

 

 

 

 

 

Figure 10 – Post treatment smile

 

 

 

 

Figure 11 – Post treatment anterior

 

 

 

 

 

Figure 12 – Post treatment left lateral

 

 

 

 

 

Figure 13 – Post treatment right lateral

 

 

 

 

 

 

Figure 14 – Post treatment upper occlusal

 

 

 

 

 

Figure 15 – Post treatment lower occlusal

For more information on the appliances and upcoming training courses with IAS Academy, please visit www.iasortho.comor call 0208 916 2024.

 

Author biography:

Dr Solveig Skaar graduated from the University of Bergen in 1998 and purchased her own dental clinic in 2005. Now, she is a member of the Scandinavian Academy of Esthetic Dentistry and has been a certified user of the ClearSmile Inman Aligner since 2013.


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