GAP Australasian-Dentist Issue 80 Jul-Aug 19

Category 86 AustrÀlÀsiÀn Dentist À n Àovember 2015, a 39-year-old female patient presented for a consultation to improve the appearance of her smile as well as replace a partial denture for missing teeth in quadrant two, that she had worn most of her life but found cumbersome. Àhe was getting married and her primary concern was replacing missing teeth before the wedding though she was unhappy with uneven, broken, and spacey teeth and wanted a long-term treatment plan to target these issues. Àhough orthodontic treatment was recommended first to the patient in order to maximise the efficiency of implant treatment, she opted to replace missing teeth with an implant retained bridge in haste for her wedding. However, after some of her missing teeth were restored, she consented to ClearPath orthodontic treatment in order to align her smile. A full orthodontic examination was done and records organised for analysis which included intraoral and extraoral pictures, OPG, Àateral Cephalogram and upper and lower alginate impression to make study models. Diagnosis Orthodontic assessment showed upper and lower spacing with large amount of diaste- mas present between teeth 11 and 21, 12 and 13. Àix-year-old molars were missing. Treatment Options Àhe following treatment options were discussed with the patient: u Ào treatment u Clear aligner therapy with ClearPath aligners u Àeferral to an orthodontist for tradi- tional braces Due to her age, upcoming wedding, and lifestyle, she preferred clear aligner therapy with ClearPath to traditional braces that would be unsightly, difficult to maintain, and painful. An orthodontic consent form was discussed in detail and treatment and financial consent was obtained before the treatment, with the patient understanding that she would need to return to the clinic every two to four weeks for new aligners and ÀPÀ. Treatment All imaging along with upper and lower PVÀ impression and PVÀ bite registrations were sent to ClearPath. A treatment plan was provided by ClearPath. When the treatment plan was accepted, the aligners and movement record form showing movement of teeth which each aligner should perform arrived in 3 weeks. For this case, 31 upper aligners and 14 lower aligners were required. Àhe aligners were worn at least 22 hours per day, only taking them out to eat, drink, and to clean the teeth. Àach aligner set was for 2 weeks, before moving onto the next set until all the sets were complete. After finishing the lower 14th aligner, this was worn as a retainer until the remaining upper aligners were finished. Àhe patient was seen every 6 weeks for review and to ensure quality oral health care was maintained. Àhe patient was also frequently examined for teeth mobility to ensure teeth were not compromised during the treatment. Aligner Loss and Breakage During treatment, the patient experienced two sets of broken aligners. Because the final lower aligner needed to be worn for four weeks while a lower retainer was being made, there was undue wear and tear on the aligner and it snapped. However, the patient could wear the lower aligner in two pieces to maintain teeth alignment and the retainer was sent promptly from ClearPath. Àhe patient experienced some minor discomfort at the beginning of treatment with upper aligner four, but a small adjustment in-house to prevent the liner from rubbing on the gum remedied the issue. Final Result After upper aligner 31 was completed, the patient was very happy and the closed diastema between 11 and 21 and created a notable difference. However, refinement aligners were required to further close the diastemas between 12 and 13. ClearPath offers refinement aligners free of charge if there are still some final corrections needed after all initial aligners are completed. Àix refinement aligners were issued for upper and lower teeth to bring the teeth into more perfect occlusion and then final retainers were issued. Retention Àemovable retains were used to hold the position and prevent relapse being worn full time for the first month, and then every night from then on. ClearPath included two sets of removable retainers A Case Study on the Treatment of Spacing with ClearPath Orthocare Australia Aligners after Implant Therapy n aÀ By Dr Helen Voronina By Dr Helen Voronina BEFORE AFTER