Sami Butt presents a case using the Clearcorrect Unlimited Scheme to improve the appearance of a patient’s anterior teeth.
A male patient attended the practice with concerns about the appearance of his anterior teeth. In particular, he disliked the UR2 – which was in-standing.
He had visited general dental practitioners (GDPs) and orthodontists in the past to seek a solution. They told him that he needed extractions to improve the position of his teeth.
The patient was keen to avoid extractions, desiring a more minimally invasive treatment option.
Assessment and planning
I performed a comprehensive clinical assessment. During which, I identified no abnormalities. The patient had no periodontal issues and good oral hygiene. Although, there was some staining around some teeth, such as the UR2, due to difficulty accessing them for proper cleaning.
To determine suitability of this case for treatment with removable aligners, I obtained clinical photographs and took digital impressions using the 3Shape Trios intraoral scanner. This integrates seamlessly with the Clearcorrect portal (Straumann Group) for speed and total convenience.
A huge benefit of the digital workflow with Clearcorrect aligners stands. The patient receives no charges until I actually ordered the aligners. This enabled me to submit the images to the Clearcorrect portal and generate an early simulation of treatment so the patient could better visualise the potential outcome.
Any compromises that might be required for this type of treatment instead of comprehensive orthodontics can therefore be thoroughly explored and discussed with the patient.
In this case, the patient was more than happy with the predicted result. Especially after learning that no extractions will take place. He understood that the outcome may not be perfect and that treatment time could be fairly extensive, but these were concessions he was very willing to make. The patient gave his consent to proceed.
From the Clearcorrect portal, in order to create sufficient space for the desired tooth movement over the course of treatment, it needed 0.3mm of interproximal reduction (IPR).
The digital simulation also predicted when and where this IPR would likely need to be focused, supporting the clinical workflow.
I selected the Clearcorrect Unlimited scheme because this course of treatment required many aligners. This provides as many aligners and retainers as necessary within a five-year period, making it easier for clinician and patient to budget for the procedure, removing the potential for any unexpected costs.
Alignment proceeded with the fitting of the first aligner and meticulous oral hygiene instructions for the patient. Regular digital communication meant that the patient only needed to visit the practice once every several weeks for a physical assessment of progress or to address any potential concerns. Otherwise, aside from the initial appointments to cover oral hygiene, he simply sent me photos of his teeth for me to review if he had any concerns.
During some of the patient’s visits to the practice (only 8 visits) I retook digital impressions to document tooth movement and treatment progression. These images also provided a way for the patient to track and better appreciate the changes that were happening over time.
I performed some IPR, when necessary. After the patient wore the first few aligners, I placed engagers. This further encouraged movement and rotation as required.
The patient wore around 40 aligners over the course of 80 weeks (18 months). At this point, the patient was very satisfied with the position of the teeth.
We had a discussion about the potential final adjustments using refining aligners. However, the happy patient wished to stop treatment there.
I also offered the option of tooth whitening. We will be proceeding with this in the coming weeks. We used Boutique Whitening in his final existing aligners for two weeks at night.
This was an ideal case to demonstrate the benefits of the Unlimited scheme with Clearcorrect. It’s important that GDPs understand when this kind of treatment is achievable. They need to have a realistic conversation with the patient.
Such a case won’t simply take a six-month course of treatment. The patient needs to be aware of the 12- to 18-month timeframe for informed consent and to manage their expectations.
Looking back at this case, I was particularly pleased with the position achieved with the alignment of the lower incisors.
In hindsight, I might have liked to tweak the position of a few more teeth. Also, I could have asked for an over correction on the upper anterior teeth. However, the patient declined further treatment.
I find this happens frequently with clear aligner treatment. The patients often achieve a highly satisfactory result, before the clinician would like to stop.
Of course, the patient ultimately makes the decision. This is what patient-centred treatment is all about. Therefore, if they are happy, I am happy.
This article first appeared in Dentistry magazine. You can read the latest issue here.