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Dental Tribune United Kingdom Edition

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 pa- tient was aware that after align- ment, retention would be man- datory. Spacewize arch analysis calculated only 0.8 mm crowd- ing in deviation from the ideal curve. An upper Inman Aligner with combined expander was fabricated and fitted. Minimal IPR was carried out with a 0.1 mm reproximation strip to sepa- rate the teeth. The patient turned the screw every five days for six weeks, which created nearly 2mm of space. This allowed space for the centrals to advance and de-rotate. At this point, the expander was unwound to en- sure that any mild residual spac- ing had closed. The teeth were aligned within nine weeks. An Essix Retainer was used to retain the teeth passively for a further four weeks, after which a bonded 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 enam- el has eroded with age and when veneers can be placed ad- ditively, for example. The result was not a perfect smile with regard to the criteria defined by Smile Design theory. Yet, that she no longer want- ed veneers arguably provides us with a far better and more ethical outcome long term. Retention Retention for anterior alignment is essential.12–14 Recommended retainer types are bonded ca- nineto- canine fixed retain- ers 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 transferred 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 re- tainer on the maxillary arch. Advantages of this method are that the flexibility of the arch wire allows for physiological tooth movement and prevents bond fracture through occlu- sal forces. Periodontal ligament stability is also achieved with this technique.15 Essix Retainer This retainer is a thermo- formed, clear, thin appliance that is easily made and very com- fortable for patients. The recom- mended 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. Conclusion With the Inman Aligner, pa- tients previously put off by the treatment time and fixed brack- ets of traditional orthodontic techniques or the expense of more recent invisible braces, could, if their case is suitable, achieve anterior tooth align- ment far more quickly with a simpler, single appliance. In- man Aligners are suitable for alignment of incisors and ca- nines with up to 3mm of crowd- ing — 5.5mm once the treating clinician is trained in using the system — and represent a very conservative and potentially revolutionary alternative to radical tooth preparation for achieving tooth alignment using porcelain restorations. The Inman Aligner allows for a rapid and aesthetic align- ment at low risk and cost to our patients. The patient is able to preview the staged changes of alignment, perhaps followed by bleaching and bonding. As a result, the Inman Align- er is profoundly changing the approach to cosmetic dentistry by those using it with the ad- vanced techniques of domino effect, combined expansion and strategic anchor placement in the UK and Europe. This new approach to cos- metic dentistry in the UK has been confirmed by figures from the British Academy of Cosmet- ic Dentistry (BACD). The 2008 study of data from 200 BACD members demonstrated a mas- sive 345 per cent increase in orthodontics used in cosmetic cases but no increase in the use of veneers. Of this increase, 230 per cent was solely due the use of the Inman Aligner in cas- es in which patients would not otherwise have had their teeth treated, owing to the time cost of fixed braces and no de- sire to have appliances adhered to their teeth. Many of these patients were those who would have opted for aggressive preparation of their teeth for veneers, before the Inman Aligner. Acknowledgements I would like to thank Donal In- man CDT (Inman Orthodontic Laboratory), NimroDENTAL Orthodontic Laboratory—the only Straight Talks Seminars- cer ti fied Inman Aligner labora- tories—and Dr James Russell for Case III. DT A complete list of references is available from the publisher. Fig. 13 Side smile view before treatment Fig. 14 Side smile view after treatment Fig. 15 Spacewize calculation Fig. 11 Occlusal view before treatment Fig. 12 Occlusal view after nine weeks with an Inman Aligner Fig. 8 Smile view after treatment Fig. 9 Close side view before treatment Fig. 10 Close side view after treatment About the author Dr Tif Qureshi is Vice-President of the British Acad- emy of Cosmetic Dentistry. He presents hands-on courses and lec- tures on the Inman Aligner worldwide. For information on course dates and training, please go to www.straight- talks.com or www.inmanaligner. com. Alternatively, contact. Caroline Cross on +44 207 255 2559 or at info@ straight-talks.com. ‘Many of these patients were those who would have opted for aggressive prepara- tion of their teeth for veneers, before the Inman Aligner’ 19ClinicalFebruary 7-13, 2011United Kingdom Edition