Minimally Invasive Dentistry and Aligners

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Posted by: Dental Design 9th October 2021

Minimally invasive (MI) dentistry is about delivering dentistry that protects the natural structures as much as possible for as long as possible. With today’s products, techniques and appliances, it is possible to achieve this while delivering exceptional aesthetics and longevity of outcomes as well.

Orthodontic aligners are critical for the minimally invasive dental armamentarium, which is likely why they have had a substantial impact on dentistry in the last couple of years. Aligners have helped to change the mind-set of many general dental practitioners (GDPs), including myself, enabling us to take a more minimally invasive approach towards treatment planning and execution. I personally found the new approach of ABC/ABB (Align, Bleach and Contour/Align, Bleach and Bond) has completely transformed the way I think as a GDP (Figure 1) shows ABC/ABB steps used. It has changed my work from single tooth dentistry to full mouth rehabilitation and to more minimally invasive dentistry. By straightening the teeth first, they form a natural arch to obtain the most ideal functional position of the teeth. Whitening improves the colour of the teeth, any irregularities in the shape and form of the teeth can be corrected by contouring. The result is a visibly improved natural smile.

I found the best way to manage patient expectations when they are only concerned with aesthetics and fast results is through good patient education. Dental awareness can be enhanced by using the latest technology – such as intraoral scanners and 2D photographs – to help patients understand their oral health condition and how to improve and maintain their oral hygiene.

In my personal experience, if the ABC/ABB approach is explained to them and they are shown the difference between this or a more invasive approach, most patients are more drawn to MI dentistry. In fact, there are many reasons why anterior alignment with orthodontic aligners, followed by whitening and composite bonding would be preferable to a full-mouth of crowns and veneers. Not least of these are the difference in cost and the expected longevity of these restorations compared to the natural teeth.

Case study presentation

Patient Z came for a consultation in 2020, concerned about the appearance of the anterior teeth and wanted a quick fix solution. After a thorough examination, we discussed the different treatment options available – including the opportunity for a minimally invasive, ABC/ABB approach. Patient Z was very happy to attend the orthodontic consultation and was keen for a shorter treatment time to reduce any impact on her job.

After exploring all the treatment options, including benefits and limitations of each, the patient decided to go with an upper and lower ClearCorrect® (Straumann Group) removable orthodontic appliance to align the upper and lower teeth. We planned to follow up with tooth whitening and minimal composite edge bonding.

Treatment

Scans were taken and sent to ClearCorrect® for the fabrication of custom aligners, only seven aligners were needed in this case. The aligners were fitted without any issues. The patient returned to the practice two weeks later for an attachment to be placed on UR2.

The patient returned in five weeks’ time for a review of aligner number 5. Even after this short time period there was a significant improvement in the patient’s smile aesthetics. Patient Z was also able to continue working as usual as treatment did not impede on her work.

Seven weeks later, the teeth were fully aligned and the patient was very pleased with the result – which was achieved without touching the drill, ensuring the patient obtained healthy function and great aesthetics. Both patient Z and I were delighted with the outcome.

Tooth whitening was then provided, with Philips Zoom home whitening. Upon patient satisfaction of the shade reached, we proceeded with minimal touches of composite edge bonding on UL1 to combat slight incisal edge wear.

Retention

To ensure the stability of the final appearance, the patient required retainers. As she was not interested in metal-bonded lingual retainers, she opted for removable retainers only. Patient Z was made aware that she will need to wear them as instructed to prevent relapse of the teeth.

A crucial cosmetic dental tool

As we can see from the photos (Figures 2-4), the ABC approach to smile design gave us the chance to significantly improve this patient’s dental appearance without the need for destructive restorative procedures. It helped me to very successfully correct the appearance of my patient’s teeth using minimally invasive cosmetic dentistry.

I think it is crucial that dentists routinely incorporate these techniques into all elective cosmetic and restorative treatments. In cosmetic dentistry today, it is more desirable to align the teeth and then consider teeth positioning and their effect on aesthetics and function, before picking up the drill and cutting healthy teeth.

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