Clear Idea #3

www.acasociety.com | info@acasociety.com 13 SUMMARY This case would be incredibly challenging and destructive without incorporating orthodontic treatment. The patient was open toclearalignertreatmentbuthadcommented that he would not have been interested in fixed braces. We were able to design a stable, functional and aesthetic smile incorporating a mix of orthodontics focusing on facial and traditional principles, elastics, whitening and routine hygiene that, on completion, exceeded our patient expectation. Although I would have preferred to close the black triangle in the 11/21 region, the patient was happy and as such, didn’t want any further active treatment. The use of clear aligners in teenagers will only get more and more popular as time goes on, and as a closing remark, we would like to stress that with proper diagnosis, treatment planning and excellent compliance – clear aligners are a wonderful treatment option. Remember to always keep your teenage patients responsible for their own treatment. Total treatment time was 16 months using a combination of: • Sequential Aligner Therapy • External tooth whitening • Enameloplasty The case has been reviewed and stable for 1 year. FINISHING Once alignment finished with class I molar and canine relationship, we spent two months ensuring close interdigitation of the bite. We had achieved nice balanced arches which are facially harmonious. There is great improvement at the axial inclinations of upper centrals, as well as gingival heights. The end result showed dramatic improvement in his smile however, a black triangle had appeared between 11/21. Option was given to: i. 0.5mm IPR to improve final midlines and upper black triangle OR ii. Finish as is and move into retention OR iii. Composite restorations to close black triangle (not recommended) The patient and parents opted to finish as is and move into retention. Phillips Zoom take home whitening was used with the patient and parents consent. RETENTION First three months full time zendura retainers that can be used as whitening tray TREATMENT OPTIONS Discussion: Given his age, and presenting dentition, it is the authors opinion that the best and most conservative option to present to the patient for improvement of his smile is orthodontic tooth movement. Analysis of his teeth showed they are of good proportion, healthy colour and minimal chipping or wear. This meant that if they were in correct alignment, both dentally and facially, it is more than likely the patient will be satisfied with the end result. The use of third party orthodontic software tools and simulations to assist the patient convey what his concerns were, as well as show him the potential result as a motivating factor. The patient mentioned in his consult that he doesn’t want to undergo fixed braces. We made it clear to him that clear aligner treatment is very much centred around compliance. We had a long and frank discussion with the patient regarding the expectations we have of him during treatment including the need for excellence compliance including hygieneandconsistentwearingofthealigners for 22+ hours a day. A discussion regarding gingival heights, ongoing maintenance and long term retention was also had. The treatment option offered to the patient are: i. Sequential aligner therapy (+/- orthodontist referral) ii. Tooth whitening iii. Fixed orthodontics iv. Gingivectomy to improve gingival heights if required post-orthodontic treatment 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, black triangles and risk of pulpal devitalisation. PROGRESS 13 months CAT using strategic movement velocities, correct attachments, elastics and good patient compliance. Importantly, the authors spent time discussing with patient prior and during the need for good elastic wear. After treatment