CDEN0210

I 11 MICD _ Inman Aligner I cosmeticdentistry 2_2010 A midline screw was incorporated to allow for asmallamountofoperator-controlledexpansionto providealittlemorespace.(Incorporatedexpanders canbeusedtoreleaseextraspaceincaseswithvery constrainedspace.)Upto2mmofspacecanbecre- ated by expansion, which has the effect of pushing the cuspid away from the lateral. After alignment, this expansion will just relapse. It is a temporary technique to create sufficient space to align the anterior teeth. After alignment, the expander can even be unwound if required. Treatment took 13 weeks with three sessions of IPR. A total of 3 mm was stripped and 1 mm was gained with the expander. The teeth were retained using orthodontic gold chain bonded from canine to canine. An upper Essix Retainer was also worn nightly as back-up for retention. _Case III The patient in this case originally presented for porcelain veneers on her upper anterior teeth. The preparations would have required root-canal treatment of two of her incisors in order to achieve adequate emergence profiles. After case options had been discussed in detail, the patient decided upon an Inman Aligner to align the teeth with veneers following this treatment. The patient was aware that after alignment, reten- tion would be mandatory. Spacewize arch analysis calculated only 0.8 mm crowding in deviation from the ideal curve. AnupperInmanAlignerwithcombinedexpander was fabricated and fitted. Minimal IPR was carried out with a 0.1 mm reproximation strip to separate the teeth. The patient turned the screw every five days for six weeks, which created nearly 2 mm of space.Thisallowedspaceforthecentralstoadvance and de-rotate. At this point, the expander was un- woundtoensurethatanymildresidualspacinghad closed. The teeth were aligned within nine weeks. An Essix Retainer was used to retain the teeth pas- sivelyforafurtherfourweeks,afterwhichabonded wire retainer was placed. The patient was very pleased with the alignment and decided that she would not need veneers. Veneers could always be used at a later stage if necessary, after more enamel has eroded with age and when veneers can be placed additively, for example. The result was not a perfect smile with regard to the criteria defined by Smile Design theory. Yet, that she no longer wanted veneers arguably provides us with a far better and more ethical out- come long term. Retention Retentionforanterioralignmentisessential.12–14 Recommended retainer types are bonded canine- to-canine fixed retainers commonly fabricated from .0195” or .0175” multi-strand stainless-steel wire. An indirect method can be used to adapt the wire to a working model. This can then be trans- ferred to the teeth, using a specially made jig and bonded with flowable composite resin to the backs of the aligned teeth. The occlusion must be clear when placing a retainer on the maxillary arch. Advantages of this method are that the flexibil- ity of the arch wire allows for physiological tooth movement and prevents bond fracture through occlusalforces.Periodontalligamentstabilityisalso achieved with this technique.15 EssixRetainer This retainer is a thermo-formed, clear, thin appliance that is easily made and very comfortable for patients. The recommended post-operative regimen for Inman Aligner treatment is to wear the retainer at night for 18 months and after that for two nights a week indefinitely. Fig. 11_Occlusal view before treatment. Fig. 12_Occlusal view after nine weeks with an Inman Aligner. Fig. 12Fig. 11