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Posted by: Dental Design 16th February 2022

Dr Pavi Sagoo recently treated a colleague’s daughter who was looking to improve the alignment and appearance of her teeth. Here she details the case and demonstrates what is possible with a simple yet effective aligner system.

The patient was a 31-year-old female – the practice receptionist’s daughter. She had undergone fixed orthodontics as a child, but as she didn’t wear her retainers correctly, she had experienced some relapse. The patient was mainly concerned with her upper teeth, though there was some mild crowding on the lower teeth too. She was conscious that the upper incisors were not level, and upon assessment we identified the UR1 as being more palatally positioned than it should have been. I had been seeing the patient regularly for check-ups and was aware that she always covered her mouth when she smiled. She was keen to boost her confidence and was at a point in her life when she was able to do something about it.

A comprehensive orthodontic assessment was conducted, including clinical photos (Figures 1-4) and a social/medical history. The patient was medically fit and healthy, a non-smoker and only drank alcohol socially. Her oral hygiene was suboptimal, so oral health instruction and support was a priority before orthodontic treatment could commence. She was therefore booked in for a scale and polish.

Orthodontic assessment

The comprehensive assessment revealed:

Lips competent

Nasiolabial angle normal

Overjet 5mm on right, 7mm on left

Overbite 5mm

Incisal relationships: Class I div I on left, Class II div II on right

Canine relationships: ½ unit Class II on left, ½ unit Class I on right

Molar relationship: ½ unit Class II on left, full unit Class II on right

Upper crowing 3mm

No spacing at all in lower arch

All possible treatment options were discussed with the patient in detail, including fixed orthodontics. She wasn’t interested in a fixed solution as she wanted a discreet and removable option in order to better fit her lifestyle. The ClearCorrect^® aligner system was therefore selected.

Treatment planning

Upper and lower digital impressions were taken with the Medit i500 intraoral scanner and uploaded to the ClearCorrect^® Doctor portal for generation of the treatment simulation and 3D digital treatment set-up. This estimated 8 steps with 4 months of treatment for both upper and lower alignment.

The treatment simulation is an amazing tool to support patient explanations and increase treatment acceptance, and it is optimised by a digital workflow. Things were slow when I first started offering orthodontics because I didn’t have an intraoral scanner and it took 2 weeks from the initial consultation to receiving the treatment simulation due to shipping times of the physical impressions, which often lost me patients. The digital workflow is much faster and easier – the treatment simulation is provided usually within 48 hours and I’ve definitely seen improvement in treatment uptake as a direct result; it’s brilliant.

I also really like that you can request no attachments as part of the ClearCorrect^® set-up. Though not used in this case, it is a great option to have to further tailor treatment to patients’ desires and enhance their satisfaction.

We selected the Flex treatment option for this case as only a small amount of movement and a low number of aligners was required and this would offer the most cost-effective solution.

Treatment

As per the 3D treatment set-up, approximately 0.9mm of interproximal reduction (IPR) was performed on the upper teeth over several appointments, while none was required in the lower arch. The patient was shown how to safely place and remove the aligners, and oral hygiene instructions were given. She then returned to the practice every 4 weeks for review of her progress.

During alignment, it was noted that the existing diastema was becoming more prominent. Options to solve this with composite bonding were discussed with the patient, but she was not concerned and declined restorative treatment. Upon completion of alignment, she did seek to improve the colour of the teeth and so proceeded with 2 weeks of whitening using the White Dental Beauty system, wearing trays for 2 hours a day. The patient was over the moon with the treatment outcome (Figures 5-8).

Discussion

With any dentistry, the most important outcome is the patient’s happiness. Though I would have liked to perform some composite bonding to close the black triangle, the patient did not want it in this case.

For any clinicians starting out with removable orthodontics, I would highly recommend the ClearCorrect^®system as my experience has been nothing but positive. The entire team is fantastic, really accommodating and always at the end of a phone or email when I have a question. The clinical support is also excellent, offering advice whenever a case is not tracking exactly as planned. In addition, the new ClearQuartz™ material seems to be even clearer than its predecessor, which patients appreciate. They also seem to have experienced less discomfort with the latest aligners, and fewer adjustments have been required to reduce issues with rubbing along the gumline. At the end of the day, our patients’ comfort and satisfaction is key – ClearCorrect^® aligners make both a possibility.

Dr Pavi Sagoo graduated from the University of Wales in 2000 and has over 20 years of experience in treating patients. She has a keen interest in minimally invasive dentistry where she continues to invest in training with world renowned clinicians in areas such as tooth straightening, tooth whitening, smile makeovers, composite and porcelain veneers and facial aesthetics.

For more information on ClearCorrect^®, visit:

https://www.straumann.com/clearcorrect/en/home.html