DTUK1810

19Cosmetic TribuneJuly 12-18, 2010United Kingdom Edition still look uneven - this meant we needed to have a conversation about some potential edge build ups after. All options were discussed. The patient ruled out fixed brac- es, even with more recent faster techniques because she wanted, something removable and we had also discussed the possibil- ity of simultaneous bleaching during the alignment phase. We assessed for an Inman Aligner. At the consultation the occlusion was examined and it was clear that the laterals had room to advance labially and the centrals could also be derotated. We then needed to assess the actual amount of space needed. Inman Aligner cases should be planned carefully to ensure the case is suitable and also to un- derstand how much space needs to be created. This can be done with models using Hanchers technique (1) . The SpaceWize tm crowding calculator was used to assess the patient in the chair. An occlusal photo was taken with a mirror and the upper cen- tral tooth was measured with digital calipers to help calibrate the software. The occlusal photo is up- loaded and the calibration tooth details entered. The mesial dis- tal widths are simply drawn on for the all the teeth to be moved which in Inman Aligner treat- ment is always the front 6 teeth. The software calculated the total of the mesial distal widths and this is described as the Required space. An ideal curve is then plotted with the software with the proposed final position. This is made with occlusion, aesthet- ics and function taken into con- sideration. The curve can be manipulated easily with the soft- ware and this gives us the Avail- able space. The difference be- tween these two measurements is calculated automatically and this is the amount of space that needs to be created to achieve the final result. As can be seen in the Spacewize tracing, 3.1mm of crowding was present. This may seem less than expected when considering the degree of crowd- ing when looking at the occlusal photo, but because the laterals are advancing forward, this will actually create space. It was decided that an In- man Aligner with incorporated expander would be used to treat the case. Incorporated expand- ers are a useful tool to create space supplementary to IPR or as an alternative. They must not be expanded beyond 2.5mm and only supply a temporary degree of space to allow the anteriors to align. The small degree of pos- terior expansion will always re- lapse and the midline can even be unwound after the anteriors have aligned. Each turn produc- es 0.25mm of space. Treatment sequence The Inman Aligner was fitted at the next appointment. In- structions were given and only a small degree of IPR was per- formed over the front teeth (0.1 mm per contact). No IPR was performed ini- tially around the centrals be- cause with the degree of crowd- ing it would be easy to miss the contact point. Instead the teeth are stripped strategically and progressively meaning we re- lease a little room to allow the teeth to align then we re-perform IPR over several visits again only performing a little at a time. Critically Inman Aligner treatment uses progressive ana- tomically respectful IPR. Despite calculating the amount of crowd- ing present, the IPR is never car- ried out in one go. IPRs strips or discs are only used. This gives the opportunity to ensure the stripping is far more anatomi- cally respectful than using burs or heavy discs. This massively reduces the risks of excess space formation, gouging or poor contact anatomy. The contacts are smoothed and the fluoride gel is applied each time.(2-9) . Composite anchors were also placed on the palatal incisal edge of the instanding lateral teeth to ensure the palatal bow engaged correctly. The patient was also shown how to turn the midline screw. She was instructed to do this once a week and did this for sev- en weeks, but was seen every 2-3 weeks to check progress and re- perform a little IPR if necessary. The patient was instructed to wear the Inman Aligner for 16- page 20DTà

Please activate JavaScript!
Please install Adobe Flash Player, click here for download