CDE0111

32 I I MICD _ Inman Aligner cosmeticdentistry 1_2011 causeshewantedaquicktreatmentanddidnotwant anything stuck to her teeth, which is the reason that she had refrained from orthodontic treatment. Sev- eralyearsago,shemaywellhavehadveneersplaced. On viewing her teeth before the occlusal photo- graph, it was quite clear that this would have in- volved massive preparation of the upper central teeth.Preparationwouldhavebeenwellintodentine and may have even involved elective endodontics. Her lateral teeth would have needed little prepara- tion, but the emergence profiles would have been poor, creating unrealistic aesthetics and a possible periodontal risk later on. Instead, the alignment was completed with an Inman Aligner in ten weeks. Her treatment sequence is detailed below. BACD-style digital photographs were taken and the amount of crowding was calculated using an electronic crowding calculator, which can also be done by arch evaluation of the patient’s study mod- els.Wemeasuredtheidealcurveandsubtractedthis measurement from the total mesio-distal widths of the teeth being moved.3 The results showed that there was only 1.6 mm crowding. This seemed less than one would have expected; the reason for this was that because the laterals were being pushed out, the arch was being expanded, thus creating space. It was clear from the photographs that despite the obvious crowding, there was some less obvious irregulartoothwear.Itwasimportanttoindicatethis to the patient, as this would become more evident once the misalignment had been corrected. The patient was quoted for three incisal composite tips. SheoptedforanInmanAlignerwithanincorporated expander. These expanders are a very handy way of creating extra space either to treat cases that are morecomplexortouseinsteadofperforminginter- proximal reduction (IPR). In this case, no IPR was performed. We planned togetnearlyallspacebyusingthemidlineexpander. Thepatientwasinstructedtoturnthemidlinescrew once a week after one week of wear. Each turn is 1/4 of a revolution and equates to 0.25 mm. At week six, bleaching was started with soft rubber sealed trays. After nine weeks, the patient had expanded 1.8 mm and her teeth were in alignment. (As a rule, less than 2.5 mm expansion with an incorporated expander is easily tolerated.) Looking at her post-alignment result, the golden proportion, gingival heights and axial-inclinations had improved dramatically, all without a handpiece being picked up and in the space of nine weeks. What was very clear to the patient at this point was that she only needed some simple bonding to im- prove the incisal edge outlines. Without the use of an anaesthetic, the edge outlines were prepared with very slight roughening of the edge, bonding of hybrid composite on the load bearing edge and amicro-fillonthefacialsurface.Theedgeswerethen polished.Fig. 13 Fig. 10Fig. 9 Fig. 12 Fig. 11