Australasian Dentist Magazine March April 2021

Category 58 Australasian Dentist Power of clear aligners with multidisciplinary treatment planning – Gummy Smile (Galantis/ Okos) The evolution of clear aligner therapy has transformed the way we can better connect and communicate with our patients. As clinicians, it also has redefined our ability to also better diagnose and treatment plan our patient’s wants and needs. We are all aware that the age of connectivity, and social media means our patient’s wants has gravitated around aesthetics. The digital workflow of clear aligners has enabled technology to arm the modern clinician the ability to automate visual differential treatment plans. This allows the visual collaboration of orthodontics, facial aesthetics and prosthodontic principles. The principles that this author applies refers to Aorta principles amalgamating prosthodontics, aesthetic orthodontic and facial aesthetic principles to establish functional and aesthetic solutions with minimal invasive dentistry and or surgery. The principles can be grouped as 1. Extra oral considerations 2. Peri oral considerations 3. Dentition Based on the Aorta SAC protocols of predictable movements, a gummy smile could be improved by 3mm intrusion of the upper anterior teeth. The principles here is the gingival height will flow the intrusion of the tooth in relation to the enamel exposed supra gingivally. It is then in the clinician’s discrepancy as to how to augment this gummy smile reduction from an orthodontics beginning by gingivectomy, lip fillers, injectables in the upper lip facial muscles rather than conventional/ orthognathic surgery modalities. CASE 1 This patient presents wanting to improve her smile aesthetics. She presents with a significant excess maxilla producing a gummy smile from tooth 15 to 25 of about 5mm. The patient also has an upper midline towards her left side with a thin upper lip thickness. The patient would like to improve her gummy smile with minimal restorative involvement as possible. The patient has a dental class II /I relationship on the left side. This patient presents with healthy gingival tissue biotype of medium thickness with no signs of local or general gingivitis and / or periodontitis. There are also no signs of any restorations or risk or active tooth decay. After six months of weekly change over of the aligners and achieving adequate intrusion of the upper anterior six teeth, the pre restorative segment of the treatment was complete. The next phase was digitally planned gum lift of the upper anterior Aorta Case Studies Series on pushing the boundaries with clear aligners GUMMY SMILE clinical In this first article in the series, we will focus on case studies involving Gummy Smiles. The clinician needs to evaluate whether gummy smile situations can be managed by a minimal invasive approach by using clear aligners to intrude and / or other minimal invasive modalities such as teeth augmentation, gingivectomies, facial injectables, lip fillers, dermal fillers, etc… Or whether we invasively approach the solution by a conventional surgical intervention by orthognathic surgery to correct the arches arch vertical and or transverse discrepancies based on skeletal discrepancies in conjunction with clear aligner therapy. The preferred direction to this problem is becoming clear. The use of digitising the diagnostic process and use minimal intervention is the preferred approach. It is not only in the sphere of orthodontic principles we must look for the solution to the patient’s end in mind but looking for an approach to camouflage and/or use multidisciplinary modalities like facial aesthetic enhancers and /or prosthodontic principles). Gone are the days that we suggest orthognathic surgery and conventional orthodontics or nothing! Figure 1.1: Before Aligners Figure 1.2: After Aligners