Dr Rose Ameen presents a case involving a 48-year-old female patient with mild to moderate crowding in both the maxillary and mandibular arches, treated with both ClearSmile Aligner and Inman Aligner solutions.
The patient initially sought care due to dissatisfaction with her smile aesthetics. She was particularly concerned about the misalignment of her upper left lateral incisor and crowding in the maxillary anterior region. She wanted to improve the alignment of her upper dentition and achieve a more natural, pleasing smile.
Following a referral from her general dentist, her treatment involved the alignment of both the maxillary and mandibular anterior teeth. Aligning both arches was deemed essential, establishing an ideal overbite and overjet that would mitigate the risk of mandibular displacement and prevent excessive occlusal forces on the maxillary teeth. This also optimises conditions for oral hygiene.
The treatment plan incorporated the ClearSmile Aligner and Inman Aligner systems, which were selected to 
address the patient’s aesthetic concerns while achieving functional outcomes.
An initial treatment assessment was conducted in the summer of 2022. The patient presented with skeletal Class I with average Frankfort-mandibular plane angle (FMPA) and lower face height. Moreover, the patient presented with a bilateral Class I molar relationship in the posterior segments, accompanied by mild anterior crowding in the maxillary arch and moderate crowding in the mandibular arch.
A Class I incisors relationship with an overjet of 3 mm and an overbite of 60% was also noted, and the lower midline had shifted to the left by 3 mm. The patient had excellent oral hygiene and no underlying health conditions.
Along with the diagnostic records that included periapical radiographs, intraoral scans and clinical photographs obtained with a DSLR camera, a Spacewize+ space analysis was performed to quantify crowding and confirm case suitability for the proposed orthodontic interventions.
Various treatment options were presented to the patient, including a comprehensive alignment using fixed orthodontic appliances with an orthodontist, alignment limited to the upper arch, simultaneous alignment of both the upper and lower anterior teeth, and a non-treatment option. Each option was thoroughly discussed, highlighting both the benefits and risks to ensure the patient was adequately informed and could provide informed consent.
The patient opted for orthodontic treatment involving both arches to avoid relapse in the malocclusion. Removable 
aligners were selected due to their aesthetic advantages. Two types were recommended, tailored to the unique requirements of each arch. In the upper arch, the ClearSmile Aligner was suggested due to its capacity for enhanced control and effectiveness, while also providing an aesthetic appeal. For the lower arch, characterised by mild to moderate crowding, the Inman Aligner was considered optimal for achieving efficient results within a shorter timeframe. Following these discussions, the patient consented to the proposed treatment, and dental impressions were subsequently taken to initiate the aligner fabrication process.
At the end of 2022, the orthodontic treatments commenced simultaneously. Impressions were taken for the ClearSmile Aligner at intervals of five aligners, ensuring accurate fitting throughout the treatment. Upon initial placement, the patient reported mild tenderness associated with the Inman Aligner, though this soon subsided. The ClearSmile Aligner posed no issues, and the treatment progressed without complications. The patient was advised to use “chewies” multiple times daily to promote optimal aligner fit and enhance treatment outcomes.
This case was supervised by Dr Claudia Waddell, an IAS Academy mentor. Dr Waddell’s recommendations, particularly concerning interproximal reduction (IPR), aimed at accelerating tooth movement while maintaining minimal reduction to preserve natural tooth structure. The patient returned every two weeks for limited IPR.
The IAS Academy’s mentorship, particularly from Dr Waddell, was invaluable, offering reassurance and clinical support throughout the process. The IAS Academy’s online platform allowed for seamless photo 
sharing, enabling Dr Waddell to review progress, provide guidance, and confirm adherence to best practices. Her feedback often required only minor adjustments, which was encouraging for both the clinician and the patient. This minimally invasive approach contributed to excellent outcomes.
The patient wore the aligners for the recommended 20-22 hours daily, 
which contributed to a more efficient and successful treatment. Upon treatment completion, the patient reported significant aesthetic improvements, reflecting the effectiveness of this carefully managed orthodontic approach.
Upon completing the teeth alignment, impressions were taken for the fabrication of upper and lower fixed bonded retainers. After placing the 
retainers with Venus Pearl, impressions were sent to the IAS Laboratory to produce custom bleaching trays.
The patient then underwent a two-week tooth whitening regimen, utilising Philips Zoom Day White gel containing 6% hydrogen peroxide. The patient was instructed to apply the gel twice daily for 30 minutes. The whitening process achieved a final shade corresponding to A1 on the Vita shade guide.
Two weeks after completing the whitening procedure, composite edge 
bonding was performed on the upper anterior teeth (UR2-UL2) using Venus Pearl composite in shade A1 to enhance aesthetics and symmetry.
The treatment protocol for teeth UR2-UL2 began with a 30-second etching using 37% phosphoric acid, followed by a 15-second rinse with an air-water spray. Subsequently, a universal adhesive (Prime & Bond active, Dentsply Sirona) was applied with a micro brush, air-dried for 5 seconds, and light-cured for 20 seconds. For the restorative material, Venus Pearl composite (Kulzer) was selected for its 
superior aesthetic properties.
After shaping the direct composite restorations with an ultra-fine diamond flame bur, the surfaces were polished in stages using Super-Snap disks, provided by Shofu. The next step involved the application of Venus Supra Twist Disks, which acted as both pre-polishers and gloss-polishers. M3 ESPE Sof-Lex polishing strips were delicately employed to refine the finish in the interproximal areas.
For retention and stability post-treatment, fixed bonded retainers were supplemented with both upper and lower Essix retainers in October 2023, ensuring continued retention and reducing relapse risk.
The completed treatment delighted the patient, and I am equally happy with the outcome. The minimally invasive 
orthodontic treatment enhanced oral hygiene outcomes and improved aesthetics. In appropriate cases, this is recommended instead of veneers or composite bonding without orthodontic treatment, as if the teeth have been 
aligned properly, only minimally invasive cosmetic restorations are necessary.
Having someone to support your aligner treatment over the sometimes-prolonged amount of time is a great comfort. This means that treatment can be delivered safely and securely, with excellent results, as in this case.
At the patient’s most recent visit a year later, she renewed the Essix retainers and was still using them. This is a rewarding feeling, and it has encouraged me to take a comprehensive but minimally invasive ortho-restorative approach to similar cases.
Authors bio: Dr Rose Ameen
Dr Rose Ameen is a qualified dentist committed to excellence in restorative and aesthetic dental care. She graduated from the University of Münster in Germany in 2010 and is currently practising at Llanedeyrn Dental Practice in Cardiff, where Dr Ameen offers a full range of dental treatments tailored to patient needs.
Recently, Dr Ameen gained an M.Sc. in Restorative Dentistry from the University of Birmingham, reinforcing her focus on minimally invasive, high-quality dental care. She is certified in several leading aligner systems, including Inman Aligner, ClearSmile Aligner, and Invisalign.
