Australasian Dentist Issue 92

CATEGORY AUSTRALASIAN DENTIST 53 teeth and also anterior tooth decay. She recently had her tooth 16 and 17 removed at another practice due to decay. Her periodontal health is sound with no periodontal pocketing however she does have 2mm recession on tooth 41. She has chipped and worn anterior teeth and also has a tongue piercing. Facial Aesthetics u Extra oral – Horizontal thirds appear to be equal – Vertical fifths are uneven with the left maxilla region being wider – Nose deviates towards the right hand side – Smile line in line with the interpupillary line – Tending dolicho-facial appearance u Peri-oral – Right hand side lip cant – Upper first premolar to first premolar visible on smiling, lower second premolar to second premolar – 70% maxillary teeth showing, 90% mandibular teeth showing – Moderate to low lipline – Maxillary central incisors midlines are symmetrical with the patient’s facial midline. – The nasolabial line angles wider on right side with narrow buccal corridors. u Dental – Tooth 11 is in crossbite with tooth 41 – Upper and lower central incisors have uneven wear/chipping – Uneven gingival heights anteriorly – Recession present on 41B (2mm) – Missing posterior teeth – Periodontal heath otherwise healthy Treatment options Given the current anterior crossbite, it is the authors opinion that veneers (whether ceramic or composite) to be unsuitable due to the risk of repetitive fracture due to non-axial loading. The use of third party orthodontic software tools and simulations to assist the patient convey what their concerns are and how we can help whether it is further tooth movement, improving the shape, position and colour of her teeth, golden proportions and smile. Additionally, the improvement of alignment and bite relationship will provide confidence that any future anterior restorative work will not be under concentrated force. Given the software set up and the presenting complaint, the patient understood the importance of first undergoing orthodontic tooth movement. A discussion regarding gingival heights, ongoing maintained and the risk of tongue piercing was also had. The treatment option offered to the patient are (bold indicates what the patient selected): i. Sequential aligner therapy to improve anterior crossbite andoverall alignment ii. Tooth whitening iii. Composite resin class IV restoration of teeth 11, 21, 31, 41 and strategic enameloplasty other anterior teeth post orthodontic treatment iv. Composite veneers 13-23 and 31/41 post orthodontic treatment v. Ceramic veneers post orthodontic treatment vi. Gingivectomy to improve gingival heights if required post-orthodontic treatment vii. Replacement of posterior teeth Risks/considerations On embarking on a clear aligner treatment (CAT) plan that applies aesthetic teeth movements, the clinician needs to take into consideration: Patient consent and understanding all the treatment options, the importance of compliance, alternative treatment options and side effects of orthodontic and or restorative treatment such as recession, increase periodontal bone loss, relapse of whitening, maintenance of whitening and retention for life considerations, debonding and/ or staining of bonding and risk of pulpal devitalisation. Treatment with orthodontic aligners Using Invisalign aligners, as well as strategic movement velocities, 10 day changeovers, correct attachments and good patient compliance – we were able to achieve the following progress in 13 months (Series 2). Importantly, the author LINICAL Series 4 – Post chair- whitening photo Series 2 – Mid treatment frontal intraoral photo Series 3 – Post aligner treatment photos