Inclined Central Incisors by Nishan Dixit

Demand for adult orthodontics has grown enormously in recent years, with an increasing number of people wishing to straighten their teeth in pursuit of an improved smile.

The ClearSmile Inman Aligner appliance.

As a result of the time and financial restrictions faced by many patients today, anterior alignment orthodontic treatment has become particularly popular by offering a safe, highly effective and efficient solution.

Case Presentation
A healthy 33-year-old patient presented with concerns about the appearance of her central incisors, which had become palatally inclined because of poor retention after previous orthodontic treatment. Her main intention was to align the anterior teeth without using fixed braces again.

The patient did not drink alcohol or smoke cigarettes, regularly attended dental appointments and followed a strict oral care regimen that included brushing twice a day and flossing. Her dental notes also revealed that her upper premolars had been extracted during her previous orthodontic treatment.

Orthodontic Assessment
Assessment confirmed good oral health with no signs of periodontitis, although the patient did show signs of discolouration as a result of tea consumption. There were no signs of a crossbite and the lips were competent at rest. An orthodontic assessment was also carried out. (See Table 1).

Table 1:

Digital Case Planning
Once the necessary examinations were complete, the patient was presented with treatment options including clear aligners, fixed orthodontics, veneers and the ClearSmile Inman Aligner removable appliance. options. These included clear aligners, fixed orthodontics, veneers and the ClearSmile Inman Aligner removable appliance.

Because the patient was desperate to avoid comprehensive orthodontic treatment again, and veneers are considered to be a more invasive option, she opted for the ClearSmile Inman Aligner because it was more suitable for tipping the incisors than clear aligners. She was also made fully aware that there would be an increase in overjet after proclination.

She was also made fully aware that there would be an increase in overjet following proclination.

To confirm suitability of the treatment method, I utilised the IAS Academy’s Spacewize+ arch evaluation software. The results of the crowding calculator concluded that approximately 0.75mm of space would need to be created, ensuring that the ClearSmile Inman Aligner was appropriate for the patient’s needs.

After subsequent photographs and radiographs were taken (Figs. 1–11), study models were put together. Through these, the patient was able to see the expected results, which was a great tool for boosting motivation and ensuring compliance.

Treatment

Table 3:

Self-Appraisal
Because the patient’s concerns were addressed and her smile was improved with minimal tooth reduction, I am pleased with the outcome of the case.

The aim had been to complete the case without any tooth reduction, but to close or reduce the black triangle toward the interproximal area of the upper central incisors, a small amount of IPR was necessary (to which the patient consented). The patient was very happy with the final result and can now smile with confidence.

In a review 10 days after the completion of the treatment, the patient had adapted to the fixed retainer well and had not reported any complications or discomfort. The retention will continue to be monitored to ensure no further orthodontic treatment is required in the future.

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  Fig. 1: Pretreatment.

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  Fig. 2: Pretreatment, lips at rest.

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  Fig. 3: Pretreatment, smile.

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  Fig. 4: Pretreatment, right view.

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  Fig 5: Pretreatment, left view.

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  Fig. 6: Pretreatment, retracted.

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  Fig. 7: Pretreatment, upper anteriors.

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  Fig. 8: Pretreatment, retracted right view.

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  Fig. 9: Pretreatment, retracted left view.

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  Fig. 10: Pretreatment, upper occlusal.

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  Fig. 11: Pretreatment, lower occlusal.

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  Fig. 12: Posttreatment

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  Fig. 13: Posttreatment, lips at rest.

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  Fig. 14: Posttreatment, right view.

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  Fig 15: Posttreatment, left view.

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  Fig. 16: Posttreatment, retracted.

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  Fig. 17: Posttreatment, upper anteriors.

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  Fig. 18: Posttreatment, upper occlusal.

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  Fig. 19: Posttreatment, lower occlusal.

References:

1. Qureshi T, Bradstock-Smith T et al. The Inman Aligner Clinical Manual (2nd edition). Straight Talk Seminars/ Inman Aligner, 2013. 
2. Mitchell L. “An introduction to Orthodontics” (9th edition). Oxford 2013.
3. Qureshi T. “The Inman Aligner for Anterior Tooth Alignment”. Dental Update 2008; 35: 377-384.
4. Noar JH, Sharma S, Roberts-Harry D and Qureshi T. “A Discerning Approach to Simple Aesthetic Orthodontics”. BDJ Vol 218 no.3 Feb 2015.
5. Dawson PE. “Functional occlusion: From TMJ to smile design”. Mosby publishers, 2007.

Dr Nishan Dixit is the founder and principal dentist of Blue Court Dental in Harrow, Middlesex, with a special interest in smile makeovers and cosmetic orthodontics.
Dixit is also the current scientific director of the British Academy of Cosmetic Dentistry.