CDEN0210

10 I I MICD _ Inman Aligner cosmeticdentistry 2_2010 El-Mangoury et al.8 and Radlanski9 have demon- strated that there is no increased risk of caries afterIPR,providedsurfacesaresmoothedcorrectly. Heinsetal.10 andTal11 havedemonstratedthatthere is no increased risk of periodontal disease, despite the decreased interproximal space. Critically,InmanAlignertreatmentusesprogres- sive, anatomically respectful IPR. While the extent of IPR required is already known, it is never carried outinonetreatment.Inordertoensureminimalrisk, IPR (0.13 mm per visit per contact point) is carried out only in small increments. The patient is sent away with the Aligner. Owing to the Aligner forces, the gaps will be closed after two weeks. Interproxi- mal reduction is performed at each appointment only as needed, using strips or discs, which ensures the stripping is far more anatomically conservative thanwouldbethecaseusingburs.Thissignificantly reducestheriskofexcessspaceformation,gouging or poor contact anatomy. Lingual/labialanchors Composite resin just incisal placed either incisal orgingivaltowherethebowscontactwillhelpthem tofunctionmoreefficiently.Thiscanalsobeusedfor the labial surface, especially in cases in which teeth are being retracted. Strategic placement is vital for success and can be very helpful in the treatment of rotated teeth and the extrusion of teeth. Applianceadjustment The forces can be varied by adjusting the spring components or replacing springs for larger, longer springs. Generally, adjustments are not necessary, except in more complex cases, for which training is requiredtounderstandthecorrectspringtypesand compression rates to use. _Case I The 25-year-old female patient complained about the appearance of her lower anterior teeth. She gave a history of orthodontic treatment in her teenage years, having a fixed appliance fitted for a period of two years. She had been given a retainer at the time but was told to wear it at night for three monthsonly.Shehadnoticedherlowerfourincisors starting to become crowded again. Treatment op- tions discussed were invisible braces, conventional fixed brackets or an Inman Aligner. The amount of space required for reduction was calculated as 3.5 mm. Interproximal reduction was performed using diamond strips (Brasseler). A reduction of 0.13 mm at each contact point was achieved at the fitting appointment. This was veri- fied with a thickness gauge. The patient was seen three weeks later and a further 0.13 mm reduced at each contact point. The teeth were aligned in just over nine weeks. The Aligner was left in for one month to stabilise the tooth positions. Tooth whiteningwasundertakenfortwoweeksduringthe last two weeks of treatment. Simultaneous bleach- ing is a significant advantage in removable systems and helps patient motivation. Finally, an orthodon- ticretentionwirewasbondedinplaceonthelingual surfaces, ensuring the patient could still use super floss for hygiene. _Case II A female patient presented complaining mainly aboutherrotatedupperrightcentraltooth.Shewas considering veneers to redistribute the space over the four front teeth. This would have meant that she would undergo three aggressive preparations and one invasive preparation with endodontic treatment of the upper right central tooth. Space calculation with model analysis indicated that treatment would be possible with an Inman Aligner. Because of the relatively low cost, the pa- tient selected this option, understanding that we would not be able to achieve Golden Proportion, owing to the width and length of her lateral teeth. Fig. 9_Close side view before treatment. Fig. 10_Close side view after treatment. Fig. 10Fig. 9