Australasian Dentist Issue 92

CATEGORY 54 AUSTRALASIAN DENTIST spent time discussing with patient prior and during crossbite changes that she will go through a period where she will be biting on the tooth 11 edge-to-edge and to limit hard foods during this period. One of the advantages of clear aligner treatment with anterior crossbites is that the upper and lower plastic (approx. 0.75mm each aligner) disengages the teeth, allowing less interference during movement. Photos and scans were utilised for the purposes of evaluation and future planning. Restorative treatment Once alignment finished, attachments were carefully removed and teeth whitened using 16%CP at home whitening (Zoom). Options were assessed to augment the dentition. We again simulated this using digital software as well as a polycarbonate try-in in the patients mouth made from a digital wax up. A total of six (6) e-max veneers were performed using minimal preparation principles on the upper canine to canine, and two further e-max veneers on the lower central incisors (Series 5). The patient opted for whitening and ceramic veneers 13-23 and composite bonding 31/41. Post restorative work See Series 5 Retention The retention protocol was using thermoplastic upper and lower retainers for three months full time. A three month clinical review showed stable soft and hard tissues and as such the patient was moved tonightly retainer wear with the expectation of life-time retention. The positive anterior overbite also acts as a retention aid. SUMMARY This case would be incredibly challenging and unpredictable without incorporating orthodontic treatment. The patient was open to clear aligner treatment but had commented that should would not have been interested in fixed braces. Utilising technology, we were able to communicate anddesigna stable, functional andaesthetic smile incorporating a mix of orthodontics, restorative, whitening and routine hygiene. Total treatment time was 16 months using a combination of: u Sequential Aligner Therapy u External tooth whitening u Enameloplasty u Ceramic veneers The case has been reviewed and stable for 1 year. u Reference List: Align Annual Report – 2019: http://investor. aligntech.com/static-files/0fd246eb-ab75-4935- b70f-11a2b177ed9b Machado A. W. (2014). 10 commandments of smile esthetics. Dental press journal of orthodontics, 19(4), 136–157. Rotundo, R., Nieri, M., Bonaccini, D., Mori, M., Lamberti, E., Massironi, D., Giachetti, L., Franchi, L., Venezia, P., Cavalcanti, R., Bondi, E., Farneti, M., Pinchi, V., & Buti, J. (2015). The Smile Esthetic Index (SEI): A method to measure the esthetics of the smile. An intra-rater and inter-rater agreement study. European journal of oral implantology, 8(4), 397–403. Proffit, W. R., Fields, H. W., & Sarver, D. M. (2007). Contemporary orthodontics. St. Louis, Mo: Mosby Elsevier. Chan, E., Darendeliler, M. (2017). The Invisalign(R) appliance today: A thinking person’s orthodontic appliance. Seminars in Orthodontics, 23(1), 12-64 Robbins, J. W., & Rouse, J. S. (2016). Global diagnosis: A new vision of dental diagnosis and treatment planning. Hanover Park, IL: Quintessence Publishing Co, Inc. Schupp, W & Haubrich, J. (2015). Aligner Orthodontics: Diagnostics, Biomechanics, Planning and treatment. Quintessence, Berlin. Weir T. (2017). Clear aligners in orthodontic treatment. Australian dental journal, 62 Suppl 1, 58–62. Wheeler, T. (2017). Orthodontic clear aligner treatment. Seminars in Orthodontics, 23(1), 83-89. Shyagali, T. R., Chandralekha, B., Bhayya, D. P., Kumar, S., & Balasubramanyam, G. (2008). Are ratings of dentofacial attractiveness influenced by dentofacial midline discrepancies?. Australian orthodontic journal, 24(2), 91–95. LINICAL Series 5 – Final result post 6 anterior emax veneers Figure 1 – Pre Op Maxillary Arch Figure 2 – After Alignment Maxillary Arch Figure 3 – Simulated final result with 13-23 Augmentation overlayed Figure 4 – Final simulated result Figure 5 – Augmented final result if we didn’t align first. Note how thick the 11 Veneer would have had to be.