An Unexpected Opportunity
Dr. Parm Gill from Thorndon Dental Surgery in Wellington, New Zealand, discusses a recent multi-disciplinary case, which required some creativity and ingenuity to achieve optimum results.
A 49-year-old female patient presented as an emergency following a fracture to an upper bridge. She has been a patient of the practice since 2004 after immigrating to New Zealand from the UK, and under my care since 2009. Her oral health was generally very good, she experienced minimal bleeding on probing, had no apparent decay, was a non-smoker and consumed a minimal amount of alcohol.
The patient had fractured a bridge on the UR2-UR3 while eating, and visited the practice in a distressed state in the afternoon of the same day. Recementation was not a viable option as the UR3 had completely broken off subgingivally. The patient wasn’t in pain, so some alginate impressions were taken for a temporary acrylic denture to replace the UR2 and UR3. Removable and fixed options were discussed; including fixed and removable porcelain bridges, and an extraction/immediate implant bridge supported by a fixture on the UR3. The patient preferred the latter option as she hated the idea of having a removable prosthesis, as well as the idea of having her tooth ground down for a cantilever or fixed-fixed bridge.
The extra and intra-oral examinations revealed no abnormalities around the soft tissue and minimally restored dentition with only a few composite and amalgam fillings present. The UR8, UR2, UL5 and LL5 were all missing and a two-unit cantilevered post core/bridge was present from UR3 to UR2 over a root-filled UR3.
Periapical radiographs confirmed no abnormalities with the root filled UR3, or in surrounding adjacent teeth. The UR1, UL1, UR4 and UR5 were all vital with no tenderness on palpation and there was no apical pathology/tenderness associated with the fractured UR3. The patient had a Class 1 skeletal, with a 4mm overjet and 50% overbite profile. The UL2 was proclined and the UR1 and UL1 were retroclined with a slight vertical tilt towards the left when viewed facially.
Just before Christmas, an acrylic two-tooth denture was provided for the patient as a temporary solution. A month later, atraumatic extraction of the root of the UR3 was performed, followed by curettage of the bony socket and immediate placement of a 14mm Straumann Bone Level SLActive implant of 4.8mm diameter. To allow uninterrupted osseointegration, the patient was advised not to wear the partial denture for one week. At this point, she also requested whitening treatment to facilitate the construction of a lighter-shaded implant bridge.
Once the patient’s tooth whitening treatment was completed a month later, her primary concern had become the anterior crowding that affected the UR1, UL1 and UL2. Presenting an unexpected opportunity for further treatment to achieve the ideal smile, I suggested various orthodontic options including fixed braces, Invisalign and the Inman Aligner. The patient was pleased with this option and agreed to proceed with treatment due to it’s ease of use and the shortened treatment time frame. Impressions were taken and sent to the Inman Aligner certified lab (Pearl Healthcare www.pearlhealthcare.com.au) for the technician to design the appliance the acrylic UR2 and UR3.
In order to fit the appliance, IPR (interproximal reduction) was performed using blue strips (0.12mm) on the UL1, UL2 and UL3. Most of the IPR was concentrated on the acrylic UR2 as this was less invasive on the natural tooth structures and it helped to correct the retroclination of the UR1 and UL1. Composite anchors were also placed on the mesiopalatal surfaces of the UR1 and UL1.
The results were very aesthetically pleasing even at this stage, and the most conservative approach was effective for treating the tilting centrals.
The patient returned to the practice every two weeks for the next three appointments, when a further 0.22mm of IPR was performed progressively on the UL1, UL2, UL3 and mesially on the UR2. A composite anchor was also placed on the labial surface of the UL2.
By May, the palatal bow required adjustment to allow the UL2 to move more palatally into the arch. At the end of the month, impressions were taken for a twistflex retainer from UR1 to UL3, and this was fitted a week later. The occlusion was checked and periapical radiographs demonstrated great integration.
An impression was taken two weeks later for the implant bridge and the patient was provided with a removable stiff upper retainer containing two plastic teeth (UR2 and UR3) for cosmetic purposes. After two months, the implant bridge framework and unglazed porcelain was tried in. The lost gingival contour was restored with 1.5mm pink composite around the bridge to ensure symmetry with the UL2 and UL3.
Twelve days later, the final implant bridge was screwed into place at 30Ncm and the final clear upper retainer provided. As the photographs demonstrate, the results were aesthetically satisfying and the patient was delighted with the final outcome.
This was quite a straightforward case with some ingenuity from the technician to incorporate some denture teeth into the Inman Aligner appliance, serving a dual purpose of cosmetic replacement and tooth movement. It worked very effectively in such a quick timeframe and the results were exceptional.
I started my first Inman Aligner case in May 2012 and have since successfully completed more than 40 cases and am encouraged by the predictability of the treatment outcome. This is definitely something I feel I will be providing to patients for a while to come.
For more information on the Inman Aligner and training courses, please visit www.inmanalignertraining.com or call Intelligent Alignment Systems on 0845 366 5477
Dr. Parm Gill currently works with Thorndon Dental Surgery in New Zealand. He became a certified Inman Aligner user in May 2012, following completion of a training course in Sydney, delivered by Dr. Tif Qureshi.
An Effective Business Builder
Dr Ilan Priess is an Associate Dentist at Bow Lane Dental in London, as well as the owner of UDental, an award-winning private practice in Herzliya, Israel. With a special interest in cosmetic dentistry, Ilan won the prestigious Restorative Smile of the Year Award at the Smile Awards 2009, the 2010 National Smile Award for his work on veneers, and was voted as one of the UK top 25 cosmetic dentists by his colleagues in 2012.
“I am always looking for new tools to add to my armamentarium, so that I can provide a wider range of high quality services to my patients both in the UK and abroad.
“I have been using the Inman Aligner now for about 5 years. I initially sought certification with the appliance as I was looking to develop my understanding and knowledge of this branch of dentistry, and expand my treatment provision. I was already offering some cosmetic orthodontic options, often with little enjoyment, and I found the Inman Aligner to provide a more effective alternative in cases where it was suitable. Within the UK, this is not a new appliance to the industry and patients often recognise the brand. In Israel is where the appliance has made the biggest difference – in fact, it has helped set my practice apart from the rest.
“The Inman Aligner was very different to anything already available in Israel. Initially, I feared that patient compliance might be an issue, as it is removable and treatment success depends on appropriate wear. As we were running an aesthetic clinic, the Inman Aligner was slightly more noticeable than other appliances placed on the lingual and palatal surfaces of the teeth.
“For many patients, however, the speed of treatment provides ten times the motivation of any other procedure, and their complete cooperation ensures fantastic results quickly. Providing further benefits, the appliance is cost-effective and it is very specific to the problem the patient has with their smile. A patient may present with upper or lower crowding or a molar that isn’t quite ideal, but their only concern is the anterior four teeth. If we are able to educate them and show them what is possible with the Inman Aligner, demonstrating every possibility, patients are happy to accept the treatment. If they are happy to only address the anterior teeth, the appliance offers patients a great introduction to aesthetic dentistry.
“This increased patient satisfaction allows us to not only broaden our orthodontic provision, but also expand into other treatment areas. Once a patient embarks on a journey to improve their smile, they quickly become more cosmetically aware. Many patients follow the ABB protocol – Align, Bond and Bleach ¬– so immediately there is a gateway to achieving the smile they desire.”
The Inman Aligner is of course not suitable for every patient, and the hands-on training provided for the appliance ensures all practitioners know and understand how to select appropriate cases for optimum results. As Dr Preiss found, the appliance has helped build the practice even among patient unsuitable for treatment.
“Many patients have visited my practice requesting the Inman Aligner, and even those who are not suitable for the appliance are usually happy to acceptance alternative treatment options. Acting as a great lead to generate interest among patients, the device has definitely encouraged growth in the practice – I built the clinic on the back of the Inman Aligner because it differentiated me from my competition. It has driven traffic through the door, giving my team and I the opportunity to offer effective treatments to more patients.
“A few years ago I was drilling more teeth to provide veneers, and I now feel less guilty by offering a far more conservative solution – I am able to offer the kind of dentistry I would be happy to have performed on myself.”
Dr Preiss describes a case he recently completed using the Inman Aligner:
“A 28-year-old female patient presented with concerns about her anterior teeth. She desired to avoid extensive treatment time due to a wedding she would be attending four months later. Following a full examination, various treatment options were discussed. Having decided that treatment for her protruding laterals was most important to her, she requested the Inman Aligner – she was made aware that the long axis of the teeth would not be perfect at the completion of treatment, but she was quite happy with this.
“Treatment with the Inman Aligner proceeded and within 10 weeks we had achieved the result the patient was hoping for, and more. She decided to go ahead with whitening and some incisal edge bonding to enhance the aesthetic result, and she was ecstatic with the final outcome.”
For more information about the Inman Aligner and training course available, please visit www.inmanalignertraining.com, email firstname.lastname@example.org or call 0845 366 5477.
Dr. Sanjay Sethi
When I first heard about the Inman Aligner and rapidly effective results it was producing I was very keen to investigate further.
I have now seen Dr Tif Quereshi lecture on three occasions, one of which was an accreditation hands on course, and feel more than confident to start using this ingenious appliance.
The key to success in this revolutionary appliance is the fact that it works in such a simple yet efficient manner. Case selection is clearly described throughout the course and the criteria that need to be met are all well illustrated by a plethora of cases. The sheer number of cases shown clearly demonstrated the very impressive results in an astonishingly short period of time, often within 4-16 weeks. Cases were also backed with periapical x-rays that showed no adverse effect on surrounding periodontium and also no root resorption.
The purpose of the aligner is to deal with crowding in the anterior sextants of both of upper and lower jaws. The diverse applications in various case scenarios were well covered and documented to show the full potential. It was excellent course delivered in an informal, honest and open manner, by a dentist who understands the value of the patients best interests. It was a hugely enjoyable and productive day of learning and insight into the the world of removable orthodontics.
The support offered by Straight Talk Seminars team provides a service that can help guide you on individual cases and also will list you as an accredited dentist for this product on their website.
Overall the Inman aligner is an exciting addition to my treatment planning. The flexibility of what it can achieve at relatively low cost for the patient, is the reason why so many many dentists and patients are becoming more aware of its potential.
Dr. Bertie Napier
Very good practical aspect. Quality of videos, photography, videos and dentistry is a credit to our profession.
Dr. Nik Sisodia
Best part of presentation. variety of clinical cases shown both definitive and pre-restorative.
Tif your courage to express your honesty about your own journey in cosmetic dentistry is nothing short of admirable and a credit to dentists
Dr. Anoop Maini
Great presentation, very clear.
Dr. James Goolnik
Gave me the confidence to do more cases.
Dr. Tim Eldridge
Very good course, excellent speakers, very approachable and kind even thought they are the best and well respected.
Dr. Klaudia Tombolis
Very informative, concise and honest talk.
Dr. Jag Jeer
Every dentist who has ever placed a veneer needs to take a serious look at using the Inman Aligner.
Dr. Alyson Lampard
Tif is obviously passionate and dedicated to this area of dentistry.
Dr. Jag Shergill
Good theory, good practical and very good format.
Dr. Elena Galindo
Best part is the attention to detail, excellent since beginning, fantastic day, can't wait to start my first case.
Dr. Ian MacArthur
In the top 3 courses I have attended in recent years, Excellent!
Dr. Dee Gawley
The best part of the presentation? The simplicity of the appliance along with the amazing results!
Dr. Ramesh Parmar
Very well presented course. An excellent comprehensive introduction to the Inman Aligner.
Dr. Sunita Verma
Amazing Course, It has opened my eyes to so much better treatment options for my patients.
Dr. Fraser Hendrie
Clear, concise presentation – more about the how to rather than the usual "see how clever I am" type presentation. Great day, thanks very much. This type of development in cosmetic/aesthetic dentistry has been a long time coming.
Dr. Michael Atkinson
Best part of presentation? Changing my philosophy regarding ortho provision, reminding me that you have to give the patient all the choices and manage their expectations in respect of outcome and retention. Sometimes they want a quick if not technically perfect end result from an ortho point of view.