Dental Asia Jul/Aug 2017 - page 69

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DENTAL ASIA
JULY / AUGUST 2017
BEHIND THE SCENES
i g n o r a n t o f ma n y
patients’ wishes and also
of the fact that restoring
a smile can often have
significant functional
benefits.
Practically, what we
also commonly ignore
in dentistry are factors
beyond just the clinical.
Dentists are trained to
make clinical judgments.
Psychological and long-
term judgments are not
always discussed or have
not been researchedwell
in dentistry historically.
The case outlined below
will show how a patient
achieved a dramatic
improvement in her
smile aesthetics and
function, with hardly
any tooth removal. Most
importantly the patient
changed her overall
perception once these
small changes took place. It is notable that
this kind of dentistry is achievable by any
dentist and not just high-end cosmetic
gurus.
This patient and many like her might not
want complex treatments or perhaps
cannot afford them, so they are simply
left with no real solution. Based on my
experience, many patients who think
they want ideal smile design, change their
minds almost without fail once they start
to align/bleach and bond their teeth. They
are usually happy to accept compromises
which they would not have appreciated
if they had gone straight ahead to a final
8-10 unit result. Considering the short
time required in Anterior Ortho cases,
it is essential patients fully understand
these options to make an informed
choice. The argument of, “Patient
did not want ortho,” simply does
not wash, if it is later discovered
that the option they were given
wassolelyacomprehensiveone
that might take over a year.
Case
T h i s p a t i e n t h a d
previously considered
ceramic veneers to
improve he r smi l e ,
howe v e r , s h e wa s
concerned about the
amount of preparation
needed. Thus, she was
happytoalignandwhiten
her teeth beforehand.
On examination, her
upper teethwere slightly
retroclined and the
edgeswere chipped. The
slightly worn, irregular
lower edges of her lower
teeth were causing
chipping on the upper
teeth because of some
para-function.
All orthodontic options
were discussed including
a ceramic solution or
o r t h o d o n t i c s . A l l
available orthodontics
solutions were offered
to the patient, including a referral to
a specialist. A comprehensive and a
compromised planwere both offered, with
the latter including fixed, clear aligners and
Inman Aligners.
Thepatient opted tohaveher
teeth alignedwith removable
appliances – a new Super Slim
Inman Aligner. Her plan was
to do this to avoid any tooth
preparations, but to still have
veneers anyway. The Super Slim
Aligner uses a new clear bow that is
far thinner than the previous design
– this makes the lip seal far easier to
achieve and speech far easier as a result.
In-surgery digital arch planning was set up
to flare the upper centrals forward while
also retracting the laterals. Digital planning
ensured there would be space for a wire
retainer and composite bonded to the
back of the anteriors to regain the occlusal
stop. The digital software (Spacewize
TM
)
allows a dentist to trace a curve that the
laboratory needs to follow. This allows the
practitioner to be in control of the occlusion
and eliminate the risk of flaring out and
causing potential occlusal issues.
The upper teeth had exactly 1 mm of
crowding so IPR was carried out
progressively over three appointments
with strips, using the Super Slim Inman
Aligner 18 hours a day. The lower teethwere
aligned with a single Inman Aligner – also
in 10 weeks.
At week eight, simultaneous bleachingwas
conducted with 6% Daywhite by Philips –
Fig. 7: After wire retainer.
Fig. 8: Right side view before.
Fig. 9: Wearing IA Superslim.
Fig. 10: Right side after edge
bonding.
Fig. 11: Before Front smile view.
Fig. 12: Front view after alignment
and bleaching.
Fig. 13: Front view after alignment, bleaching
and no prep venus edge bonding.
She decided that she did not want
comprehensivetreatmentandchosetoproceed
with the simpler plan of anterior alignment.
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