Dental Tribune US Edition, Vol. 5, No. 19

COSMETIC TRIBUNE The World’s Cosmetic Dentistry Newspaper · U.S. Edition Fig. 2: Side smile view after nine weeks with an Inman Aligner. Fig. 1: Side smile view before treat- ment. (Photos/Provided by Dr. Tif Qureshi) Traditionally, cosmetic dentistry has always been faced with the chal- lenge of treating poorly aligned teeth. Treatment options available for mildly and moderately crowded teeth include orthodontics and restorative dentistry. Many patients have chosen the restor- ative approach, for example porcelain veneers, over orthodontic techniques because of longer treatment times combined with either unsightly labial wires and brackets or the expense of “invisible” braces. In cases in which patients choose to have crowded upper and lower anterior teeth treated with veneers, it is extremely challenging to prepare teeth conservatively, owing to their anatomy and the minimum thickness of porcelain required. A difficult bal- ance has to be found between over- preparing the teeth and placing over- contoured restorations. However, owing to the excitement and emotion created by the effect of popular large smile makeovers, aggressive tooth preparations, in which teeth are pre- pared to stumps, seem to have been accepted as normal practice, simply because there has been no alternative that could achieve the patient’s objec- tives in a sufficiently short period. Inman Aligners are now offering a minimally invasive alternative to patients in the U.K. With only one appliance, most Aligner cases can be completed in six to 16 weeks. In ante- rior crowding cases, Inman Aligners have proven to be much more time and cost effective than invisible braces or conventional fixed and short-term orthodontics. To date, I have treated about 1,000 cases and have found that case accep- tance has been close to 100 percent, simply because many patients much prefer a removable solution that fits their lifestyle more easily. Treat- ment can also easily be combined with simultaneous bleaching and final edge-bonding for quick and non- invasive, dramatic results. From this, a new procedure has arisen in cos- metic dentistry — alignment, bleach- ing, bonding — which will be covered in the second part of this series. The cases presented in this article will outline some case types that can be treated. The Inman Aligner For over 30 years, spring aligners were used to correct minor tooth movements. Early designs were developed for minor tooth movements and to treat slight rotations. Previ- ous spring aligners were useful, but several problems always limited the amount of tooth movement achiev- able. Their active components were made from stainless-steel wire, which is relatively inflexible and lacks any innate springiness. As a result, traditional removable appliances required periodic reacti- vation, leading to short-lived force application that limited the speed of tooth movement, owing to the need to allow the bone around the roots of the teeth being moved to ‘rest’ between successive activations. In addition, the direction of force application with tra- ditional springs was less easy to con- trol, leading to a mousetrap-like force that tended to unseat the appliance. These factors limited the degree of correction that could be accom- plished. For larger movements, single appliances were insufficient to com- plete the movement. In developing the Inman Aligner, Donal Inman CDT created a patented design that takes advantage of the gentle, steady and consistent forces generated by NiTi. The design relies on piston-like components driven by NiTi coil springs. Inman designed lin- gual and labial components to func- tion or move in parallel to the occlusal plane, eliminating the mousetrap-like unseating forces and allowing actual physiological movement of teeth. Inman Aligners are ideally worn for 16 to 20 hours a day. Studies have demonstrated that the removal of orthodontic forces for four hours a day massively reduces the risk of root resorption1 and that risk of root resorption is lower in removable ver- sus fixed appliances.2 A standard Inman Aligner as described in the following cases con- sists of both lingual and labial com- ponents. The forces have the effect of squeezing the teeth into alignment. The components can be used in isola- tion to retract teeth with a more steady force, requiring less adjustment than a standard labial bow retractor. In Case III, a unique approach that incor- porates an expander on the Inman Aligner is described. Patient selection Case selection for the Inman Aligner is critical. The following criteria should be met before treatment proceeds: 1. Cases should require movement of incisor and/or canine teeth only. 2. Root formation of the teeth to be moved must be complete. 3. Crowding or spacing should be less than or equal to 3 mm. Arch evaluation must be performed to determine the amount of space required. Cases with over 3 mm of crowding require additional space By Dr. Tif Qureshi, United Kingdom The Inman Aligner: An effective tool for minimally invasive cosmetic dentistry (part I) September 2010 www.dental-tribune.com Vol. 3, No. 9 g CT page 2C AD Fig. 4: Occlusal view after treatment.Fig. 3: Occlusal view before treat- ment.