CASE STUDY anterior teeth and outlined the amount of tooth structure that would have to be removed to produce aesthetic looking veneers. It was immediately apparent to the patient that alignment of her teeth would offer a possibly better treat-ment outcome. Her case was suit-able for an Inman Aligner and as only 2.5 mm of crowding was present, this meant it could be treated quickly and simply. Her Inman Aligner was fitted and IPR performed progressively over three visits. At week 8, upper and lower bleaching trays were constructed even though her align-ment was not yet complete. Home whitening was begun with clear and concise instructions. We used rubber trays with a deep seal cut into the model to create a tight dam effect. Over two weeks, her teeth whitened nicely and at week ten, she returned for a review. Interestingly, the patient’s perception of her smile had changed dramatically. Owing to the improved line angles, whiter teeth and balanced gum heights, her eyes were now only drawn to the irregu-lar outline that was caused by chip-ping and differential wear. The patient then inquired about fixing the edges. We offered to bond the incisal edge with virtually no preparation. A hybrid composite (Tetric Flow, Ivoclar Vivadent) was placed palatally and incisally with a microfill on the facial surface. This was done in B0 and B1 shades to match the bleaching. The patient was delighted with the result and a wire retainer was bonded immedi-ately. Despite some clear deviations from her ideal simulated smile, the patient explained that she felt her Fig. 9: Before smile view. that are more complex or to use instead of performing interproxi-mal reduction (IPR). In this case, no IPR was performed. We planned to get nearly all needed space by using the midline expander. The patient was instructed to turn the midline screw once a week after one week of wear. Each turn is a quarter of a revolu-tion and equates to 0.25 mm. At week six, bleaching was started with soft rubber sealed trays. The Inman Aligner is a removable appliance and only needs to be worn 16 to 18 hours a day. This means simultane-ous bleaching is very possible and straightforward. 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, gingi-val 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 improve the incisal edge outlines. Without the use of an anesthetic, the edge outlines were prepared with very slight rough-ening of the edge, bonding of hybrid composite on the load bearing edge and a microfill on the facial surface. Fig. 10: Before side smile view. The edges were then polished. The patient was thrilled with the result we achieved using an Inman Aligner and some simple bonding. She described that when she had once considered having veneers, she had hoped for a similar result. There are still minor imperfections, but, in my opinion, these contribute to her natural beauty. There is a stark contrast between the treatment selected and the potential treatment approaches in this case. Where once a patient, who refused orthodontics, would have consented and received highly aggressive tooth preparations to achieve correct alignment with veneers, now a removable aligner and some simple bonding were able to achieve a similar and arguably better result in less than three months with not a micrometer of tooth reduction needed. Case 2 (Figures 9 -17) This young lady had been a patient in my practice for some time and was aware of porcelain veneers, having seen our previously advertised cases. We had spoken about the aesthetic benefits of veneers years before. However, on reviewing her case, it was clear that we could improve her alignment dramatically in a short period of time with an Inman Aligner. We took an occlusal image of her Fig. 11: Before close up view. 32 Spring 2015 JAOS Fig. 12: After Inman Aligner and whitening at 10 weeks. Fig. 13: After no-prep edge bonding at week 12.
Journal of the American Orthodontic Society Spring 2015: Page 32
