CDE0111

I 31 MICD _ Inman Aligner I cosmeticdentistry 1_2011 comes of varying degrees of improvement to allow thepatienttomakeamoreinformeddecision.While ideal, it is not certain that dentists actually present different levels of treatment to their patients digi- tally. Even if they were able to see various images of their teeth, it can still be difficult for a patient to really see and feel the suggested changes in their mouth. One can question the ethics of allowing patients to commit to a potentially irreversible pro- cedure based on 2-D photographs. Three-dimensional wax-ups can also be very useful at this stage. If a patient is keen on the image, goingtoanadditivewax-upcansometimesallowfor a direct preview try-in using a silicone stent taken from set-up. Temporary material of variable shades canbetriedindirectly,withoutanybondingtoallow the patient to see the proposed outline, form and overall aesthetics. Despitethis,veneersareoftenusedtotreatalign- ment issues and it is very difficult for patients to appreciate the alignment of their own teeth with wax-up or imaging. By approaching these cases with a different protocol in mind, a dramatically less invasive treatment plan becomes evident. The first step is to look at the patient’s tooth alignment. Misaligned teeth often cause issues in gum heights, line angles, light reflections, shades and tooth length. Correcting the misalignment first can create a completely different perception of the apparent problems. Next, the teeth should be bleached. This can be done either immediately after theteethhavebeenalignedorpreferablysimultane- ously. After alignment and bleaching, edge bonding (we term this the ABB concept) should be offered to improve the incisal edge outline. This combination of treatments also works well because the Inman Aligner is a removable appliance and only needs to be worn 16 to 18 hours a day. This means simultaneous bleaching is very possible and straightforward. A recent study from Sweden indi- cates a cost-benefit advantage of treating patients with removable appliances in general dental clinics, ratherthanwithfixedappliancesatspecialistortho- dontists.2 The conclusion of this study is significant, sinceapopularchoiceamongstaestheticdentistsin the UK is removable orthodontics. The cases outlined below highlight patients who, eitheratthestartoftreatmentorforyears,hadorig- inally wanted veneers and had a specific result in mind that only veneers could have offered quickly. They were all concerned about the degree of pre- paration required, so undertook alignment first. Then,partofthewaythrough,startedbleachingand very quickly changed their minds about what they wanted once they saw their own teeth improve. _Case I (Figs. 1–8) Laura was concerned about her very prominent central incisors. She wanted to have them straight- ened and had considered veneers. She had ruled out conventional orthodontics and invisible braces be- Fig. 6Fig. 5 Fig. 8 Fig. 7