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Simple yet effective – Dr Jacqueline Wright

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  Posted by: The Probe      12th November 2019

Dr Jacqueline Wright presents a simple yet effective treatment method to align the upper anterior teeth of her patient.

A regularly attending male patient presented with concerns about the appearance of his upper anterior teeth.

Assessment

A full medical history was taken, finding the patient to be fit and well, taking no medications and with no allergies. The dental history revealed minimal restorative treatment, plus he was a non-smoker. The patient had already investigated NHS options to improve the appearance of his smile and was now seeking further information on other solutions that might help him achieve the results he was looking for.

In order to determine all possible treatment options, a comprehensive orthodontic assessment was conducted (table 1). Clinical photographs were also taken.

Table I: Orthodontic assessment

Skeletal Pattern Mild Class II
FMPA Average
Lower Face Height Average
Facial Asymmetry None
Soft Tissues Competent lips, slightly high smile line, average nasiolabial angle and symmetrical gingival levels
Overjet 0mm
Overbite 50% overlap of incisors
Crossbite None
Displacement on closure None
Incisor relationship Class II Division II
Molar relationship Right: Class II / Left: Class II ½ unit
Canine relationship Right: Class I / Left: Class II
Teeth Present 7654321 1234567
7654321 12345678
Centrelines Upper deviated to the right

—–

Treatment Options

All available treatment options were presented and explained to the patient. These included:

  1. No treatment
  2. Treatment of just the upper arch, or both the upper and lower
  3. Alignment with the ClearSmile Aligner Light or Inman Aligner
  4. Comprehensive orthodontics requiring referral to a specialist for surgery to correct the skeletal abnormality.

The patient preferred the convenience of treatment at his own dental practice, where he had undergone his general dental treatment for some time and which was close to his home. He knew and had confidence in the dentist and the staff. He also didn’t like the idea of traditional fixed orthodontic appliances due to the aesthetics, treatment time and potential need for extractions. As such, the patient requested an aesthetic, minimally invasive, time efficient and cost-efficient treatment. The ClearSmile Aligner Light was selected over the Inman Aligner because it was the most discreet appliance and it was more likely to upright the UL1. All advantages and limitations of this type of treatment were explained to the patient, as well as the potential compromises involved.

Problem list

Skeletal Class II base

Class II Div II incisors

Canine LHS Class II ½ unit

Class II molars

Instanding UR5

Upper and lower crowding

Canted midline

Ideal Treatment Aims

Correct all of the issues identified with comprehensive treatment

Compromised Treatment Aims:

Correct the incisal relationship

Correct the upper midline

Treatment planning

PPR (Predictive Proximal Reduction) was initially performed on the mesial aspect of the UL1 and a PVS impression was taken for the Archwize™ digital software. This was used to calculate that 1.8mm of crowding was present in the upper arch, with 2.6mm of crowding in the lower arch. Well within the limits of the appliance, this confirmed suitability of the case for treatment with the ClearSmile Aligner Light. The digital models returned by the IAS Laboratory indicated where further PPR and IPR (interproximal reduction) may be needed, providing a useful guide. This was sent to the patient for his approval before treatment commenced.

Treatment provision

The first ClearSmile Alight Light appliance was fitted alongside the estimated IPR as per the treatment plan. The patient was shown how to clean, place and remove the appliance safely, and oral hygiene advice was provided.

Treatment progressed with five ClearSmile Aligner Light appliances. The patient returned to the practice roughly every two weeks for review.

Once alignment was complete and both the patient and I were happy with the results achieved, composite edge bonding was performed on the upper centrals and laterals in order to improve the smile aesthetics. Impressions were then taken for a bonded and Essix retainer, which were consequently fitted before final photos were taken. The patient was delighted with the final outcome.

Case appraisal

All went according to plan for this case. Patient compliance was excellent throughout the treatment process, and I found it beneficial to perform good IPR and PPR early on. In my experience, the ClearSmile Aligner Light facilitates simple yet very effective treatment – as do other appliances taught by IAS Academy.

 

Figure 1 – Pre treatment smile

Figure 2 – Pre treatment right view

Figure 3 – Pre treatment left view

Figure 4 – Pre treatment retracted closed bite

Figure 5 – Pre treatment right lateral

 

Figure 6 – Pre treatment left lateral

  Figure 7 – Pre treatment lower occlusal

Figure 8 – Pre treatment upper occlusal

Figure 9 – Post alignment anterior view

Figure 10 – Post alignment upper occlusal

Figure 11 – Post treatment smile

Figure 12 – Post treatment right view

Figure 13 – Post treatment left view

Figure 14 – Post treatment retracted closed bite

Figure 15 – Post treatment right lateral

Figure 16 – Post treatment left lateral

Figure 17 – Post treatment upper 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)

Author bio:

Dr Wright graduated from QUB in 2008 with Honours and attained an MJDF in 2010. She began training with IAS Academy in 2013 and has since completed the Inman Aligner, ClearSmile Aligner and Ortho-Restorative courses.


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