A 29 yr old lady, images displayed below, came to see me a while back and was quite depressed with her teeth which had been a hindrance, her whole life. Since she was younger her parents had brought her to see dentists and specialists to see what could be done and she even spent time in the dental hospital being passed from pillar to post.
She has a real skeletal issue which complicated her treatment and all the specialists wanted to fix this as part of any treatment plan. She understood that it was probably the best thing to do but she was unprepared to go through the surgery and at this stage in her life wasn’t keen to wear braces either. She wondered if there was anything I could suggest. She had no issue with her bite, she was only concerned with her appearance. Now this is where I stand up and say that I am on the patient’s side. If it were me I don’t think that I would go for the surgery if there was another option.
Our first stage was to do a diagnostic wax up; this proved what we felt would be the case that we needed to move the teeth slightly in order to restore. My lab technician, Gary Rumbold of Eastwood Dental Services, cut off the teeth from the cast and repositioned them. He then poured up duplicate casts so I could explain the situation to the patient. Once I explained the treatment could be done with Invisalign and would only take around 6 months then she was good to go.
The next stage was to take impressions for Invisalign and using the measurements from the cast I adjusted the clincheck so that the teeth were exactly where we wanted them at the end of treatment. We intruded the lower anteriors so as to alleviate the traumatic bite on the upper palatal mucosa and make room in the overjet for a small amount of anterior retraction .We did not adjust the posterior occlusion at all. This freedom to select which teeth to move and which teeth to leave alone is the single biggest advantage of the Invisalign system. Those of you VERY proficient with brackets and wires may have the same control but for the average GP this technology is fantastic. It allows us to treat cases we otherwise would have to leave alone and allows the patients the freedom to have what they want from orthodontic treatment.
Six months later, the teeth are in the right spot. We removed the attachments and took impressions for a new diagnosis. As you can see from the prep guides we were able to restore the smile with extremely minimal pres. You will also see that on the R side we placed a bridge without prepping the abutment teeth. This was a 360 degree coverage fixed bridge with no shoulder margin of any sort. The bridge is made out of emax press and although unconventional we felt that because of the massive overjet and a very compliant patient that it would work well. Given the choice we all agreed it was better to not damage the abutment teeth and see how things developed.
In this case we placed an extra no prep veneer at no extra cost for the patient to improve the finished result.
The patient was instructed to wear her essix retainer 24/7 for 6 months and every night thereafter. She was finished over a year ago and so far so good.
I hope you like the case, for me it was a great example of how expanding my knowledge into orthodontics has dramatically driven my cosmetic dentistry business. I started with 6 month smiles and Invisalign in 2007 and have not looked back since. It is obvious almost every day that If I didn’t have that string to my bow I would have only done half the number of cases I have now completed.
If anyone has any questions please shout or reply below!
All images shown with the clients permission.
