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July 12-21, 201020 Cosmetic Tribune United Kingdom Edition 18 hours a day. Studies (10,11) show that this is far less likely to cause root-resorption and the Inman Aligner is highly effective even with the Aligner out eight hours a day. This allows better hy- giene and patients can also fun- ction with day-to-day activities more normally. After nine weeks the laterals were already getting close to the proposed position and the cen- trals were de-rotating nicely. At this point with Inman Aligner treatment we often start to bleach. Impressions are taken even though the result is 25 per cent from finished. Sealed, rubber trays are made and careful instructions are giv- en to the patient. While the patient is highly concentrated on using the In- man Aligner, they are always highly receptive to using bleach- ing trays. It adds greatly to mo- tivation and often means they achieve a far better result. Discus Dental Day White is used so that the patient only needs to wear the bleaching trays for 35-45 minutes a day. The patient was happy with the degree of whiten- ing achieved. It was becoming highly ap- parent to the patient at this stage that she would only need some final edge bonding to achieve a very aesthetic result. The patient whitened for two weeks. At week 11, alignment with the inman aligner was al- most complete. A single clear aligner was used to correct some minor spacing and also to help bring the right canine into line. After using the Inman Aligner, canines are far more receptive to movement with clear aligners. At week 13 the incisal edges from canine to canine were only slightly roughened. No local an- aesthetic is required with this simple additive bonding. Venus from Hereaus Kulzer was used in dentine and enamel shades in B1 was used to build the missing incisal outline. The teeth were then polished with discs, pogo sticks and flexibuff discs. The patient initially was not keen to have centrals that were longer than the laterals so a fairly flat smile line was creat- ed. One week later she returned and asked for another 1.5mm of central incisal length. This was again provided by adding more Venus. At the same visit a wire retainer was bonded in place from canine to canine. (12,15) Results This patient achieved a result in just 13 weeks that she had only previously thought possible us- ing ceramic veneers in this ap- proximate time. She also achieved it without any damage done to the teeth other than truly minimal and anatomically respectful IPR. Her teeth are far better placed for future ceramic restorations if necessary. She commented that she was worried that with veneers, she would have lost the natural character of her teeth, but by a using ABB, this was retained and we just made her own teeth more beautiful. Discussion Any dentist offering cosmetic and restorative dentistry should be aware of all developing tech- niques. Many patients in the UK are choosing this approach and are demanding it in their prac- tices. This approach is becom- ing common with dentists who offer orthodontic solutions, so not offering it and only offering ceramic solutions could result in potential consent issues. The simple fact is that once a dentist is educated in the ad- vanced use of an Inman Align- er, this kind of treatment is far simpler and less risky than treatments where large amounts of tooth structure are removed and where there is a heavy reliance on porcelain for the final result. Being able to align and bleach simultaneous- ly adds huge value and increas- es motivation tremendously. Long-term predictability is far better and the patient doesn’t enter a restorative cycle that can easily worsen the long-term prognosis. Patients are also far happier because the treatment is more affordable, and they understand the benefits of reducing long term risk by aligning, bleach- ing and bonding. Compared to the traditional methods of providing ideal smile design, ABB represents a radical and arguably revolutionary change in the way cases like this are approached. A far more truly conserva- tive result that actually respects the opinion of the patient at dif- ferent stages means that heavy arch form preparations, with aggressive tooth removal just to line teeth up to allow space for veneers, could soon become a thing of the past. Disclosure. Dr. Qureshi runs hands on courses with Dr. James Russell and Dr. Tim Bradstock- Smith and lectures on the Inman Aligner worldwide. Acknowledgements. The author thanks Donal In- man C.D.T. Inman Orthodontic Laboratory, Florida, Nimroden- tal Ortho Lab Paddington Lon- don (The only STS Certified In- man Aligner Laboratories.) DT Course Information Information about course dates and training can be received from www. straight-talks.com or www.inmana- ligner.com. Alternatively contact Caro- line Cross on +442072552559 email info@straight-talks.com Tif Qureshi will be speaking at the BACD Conference “Esthetics Meets Aesthetics” on 23 - 25 September 2010 at the Hilton London Metropole”. To register, visit www.aacd.org References 1) Hancher P Orthodontics for Esthetic Dentistry Part1. Journal of Cosmetic Dentistry Winter 2005 (20) 4. 2) Sheridan, J.J.: Air-rotor stripping update. J. Clin. Orthod. 21:781-88, 1987. 3) Sheridan, J.J.; Ledoux P.M.: Air-rotor stripping and proximal sealants: an SEM evaluation. J. Clin. Orthod. 23:790-94, 1989. 4) Crain, G.; Sheridan, J.J.: Susceptibility to caries and periodontal disease after posterior air-rotor stripping. J. Clin. Orthod.24:84-85, 1990. 5) Sheridan, J.J.: Hastings, J: Air-rotor stripping and lower incisor extraction treatment. J. Clin. Orthod.26:18-22, 1992. 6) El-Mangoury N, et al. In vitro remineralization after air-rotor stripping. J Clin Ortho 25 (2) :75-78,1991. 7)Radlanski R.(1991) Morphology of interdentally stripped enamel one year after treatment. J Clin Ortho 23 (11) 748-750, 1991. 8) Heins PJ. The relationship of interradicular width and bone loss. J Periodont 59 (2) :73-79,1988. 9) Tal H. relationship between the interproximal distance of roots and the prevalence on intrabony pockets. J Periodont 55 (10) :604-607 1984 10) Inactivated periods of constant orthodontic move- ment forces related to desirable tooth movement in rats. T. Kameyama et al. Tokyo Medical and dental university, Japan. Kame.orts@tmd.ac.jp. 11) Apical root resorption in upper an- terior teeth :Brita Ohm Linge and Leif Linge.The European Journal of Orthodontics 1983 5(3) :173-183; doi:10.1093/ejo/5.3.173 © 1983 by European Orthodontic Society. 12) Reprinted: Case CS. Principles of retention in orthodontia. Am J Orthod Dentofacial Orthop 2003;124(4):352-61. 13) Little RM, Reidel RA, Artun J. An evaluation of changes in mandibular anterior alignment from 10 to 20 years post retention. Am J Orthod Dentofacial Orthop 1988. 14) (6) Blake M, Bibby K. Retention and relapse: A review of the literature. Am J Orthod Dentofacial Orthop 1998;114:299-306. 15) Becker A, Goultschin J. The multistrand retainer and splint. Am J Orthod 1984; 85:470-4. page 19DTß ‘This patient achieved a result in just 13 weeks that she had only previously thought possible using ceramic veneers in this ap- proximate time.’