#‎IASCaseStudy‬ Dr Tina Hirani
The use of the Inman Aligner for alignment of lower incisors – The benefits of minimally invasive techniques
Dr Hirani, who graduated from Manchester University in 2009 and is now an associate at a practice in Beaconsfield, is a keen enthusiast in using minimally invasive treatments that help her patients smile. With training and continual online mentoring from the IAS Academy and experience in using the Inman Aligner and ClearSmile Aligner, here she explores a case on the alignment of lower incisors.
Patient A, a 30-year-old female, requested treatment for her lower incisors. She had a history of fixed orthodontic treatment involving surgical exposure of the UR3. Though the UR3 finished at a higher level than the UL3, the patient was sure it was of no bother to her. After the previous fixed orthodontic treatment, the patient failed to wear her retainers as directed and, as a result, her lower incisors had rotated and become misaligned. This was her concern and her request was specific to the alignment of these front four teeth.
The patient desired a quick, cost effective and removable solution and, thus, various appliances and methods were discussed to ensure she understood all treatment options available.
It was suggested that patient A could seek either an orthodontic specialist for comprehensive orthodontics or a general dental practitioner for anterior aesthetic orthodontic treatment. While a specialist could deliver ‘gold standard’ treatment the patient was clear that this would not fit in to her lifestyle. Indeed, although the comprehensive orthodontic treatment would achieve upper and lower alignment simultaneously, the patient remained determined that she did not want a fixed appliance and simply wanted the lower incisors aligned.
Thus, to meet this requirement, various removable appliances were discussed including clear aligners such as the ClearSmile Aligner. Although less discreet, the Inman Aligner was a clear favourite for the patient. As she made it known that her objectives were limited to the lower incisors only, I was equally as confident in the treatment method chosen.
During the pre-assessment stages, patient A underwent a basic and comprehensive intraoral and extraoral examination. This included assessment of the skeletal, incisal, molar and canine relationships. Clinical pictures were also taken and an individual tooth measurement used to calibrate the Spacewize+â„¢ arch evaluation software.
(See Figures one to four)
Figure one – Anterior view teeth separated no cheek retractors pre-treatment
Figure two – Anterior view teeth separated pre-treatment
Figure three – Right lateral view teeth separated pre-treatment
Figure four – Left lateral view teeth separated pre-treatment
Using this software, it was calculated that patient A was a suitable case for the Inman Aligner and progression could be made to realign the lower incisors as planned. With further assessment carried out to ensure the roots were healthy enough to move the teeth, X-rays further supported the progression to the next stage of treatment. Finally, impressions were taken and sent to the laboratory.
Two weeks after the impressions had been taken, patient A attended an appointment for the fitting of the Inman Aligner. She was instructed to wear the appliance between 18 and 20 hours a day and to remove it when eating or drinking for an optimum result. At this time, retention and stability of the appliance in the mouth were checked and composite anchors were placed on the LL1 (distolingual) and the LR2 (distolingual). After two appointments a second composite anchor was placed on the LL1 (mesiobuccal).
At her next visit, interproximal reduction (IPR) was carried out using the yellow, red and blue IPR strips as directed by training from the IAS Academy (the guided learning pathway for Inman Aligner treatment). Thereafter, the patient was seen every two weeks with IPR carried out each time – distal to the canines and both mesial and distal to the lower lateral incisors.
After six appointments, the case was almost completed. With only a fraction of mesial movements needed on the LL1 and the LR1 an impression was taken and sent to the lab for a ClearSmile Aligner ‘finisher’ to be made. This achieved the finer end movements enabling a polished result.
Finally, impressions were taken to make a bonded and overlay retainer to prevent relapse from occurring in the future. At this point the importance of following through with this post-treatment was further reiterated. During the last appointment the retainers were fitted and a polishing disc was used to smooth the uneven edges on the incisal tips.
Both the patient and I were pleased with the choice of method and the overall outcome of the treatment. The initial objectives have been achieved with the lower incisors now beautifully aligned.
(See Figures five to eight)
Figure five – Anterior view post-treatment
Figure six – Right lateral view post-treatment
Figure seven – Left lateral view post-treatment
Figure eight – Occlusal view post-treatment
For information on the IAS Academy, visit www.iasortho.com or call 0845 366 5477
