Nishan Dixit describes a minimally invasive alignment, bleaching and edge-bonding case through which the affected person was ‘elated and assured’ after their smile transformation.
This case highlights how the align, bleach and bond strategy is usually a easy and conservative approach to assist remodel a smile. The three steps work collectively completely: first tooth alignment, then whitening, adopted by composite edge-bonding to finish the ortho-restorative course of. Every stage enhances and improves on the earlier one, leading to a minimally invasive makeover and avoiding extra complicated and costly remedy.
A 38-year-old woman attended Blue Courtroom Dental as a result of she was involved a few chipped entrance tooth which had been broken by a fork when she was youthful (Figures 1 and a couple of). She was excited by aligning her tooth to handle the higher and decrease anterior crowding (Determine 3).
Over the long run, she was eager to exchange some current amalgam restorations (Figures 4 and 5). The affected person was additionally sad with the color of her tooth and felt that their general look prevented her from smiling.
Medical examination and orthodontic evaluation
Throughout an in-depth session, an Itero 3D intraoral scanner was used to report on findings referring to the tooth and gums. The orthodontic and purposeful evaluation revealed that the affected person had a category III skeletal sample, excessive Frankfort-mandibular aircraft angle (FMPA) and common decrease face peak.
A category III incisor relationship and a molar class III and canine class III on each side had been additionally recognized (Determine 6). She had an anterior crossbite, reverse overjet and delicate crowding in higher and decrease labial segments. The centrelines weren’t coincident, and her lips had been symmetrical and competent.
The scientific examination additionally concluded the affected person had good common dental and periodontal well being with no excellent points. She had no temporomandibular joint (TMJ) dysfunction complaints or signs.
Therapy choices and planning
A number of orthodontic choices had been mentioned, together with mounted braces, clear aligners and referral to a specialist. The affected person was excited by clear removeable aligners as they might have much less of an impression on her every day life-style.
She was proven a smile simulation on the Itero scanner which visualised the proposed end result after a course of Invisalign remedy. After affirmation that she was pleased with the preview of her new smile, a Clincheck remedy plan was undertaken.
The 3D animation exhibits the expected outcomes throughout and after Invisalign remedy, together with the place of composite attachments and the quantity of interproximal discount (IPR) required (Figures 7 and eight). The affected person selected to proceed with orthodontic alignment utilizing Invisalign clear aligners, adopted by whitening and composite edge-bonding. After alignment, a bonded retainer can be fitted for everlasting retention.
Tooth alignment and whitening
Initially, a sequence of 13 customized digitally designed aligners had been fabricated, adopted by an additional 11 aligners to permit refinements to be made. This was crucial on account of a lapse in compliance throughout the latter phases of the primary set of trays.
The affected person was suggested that she would wish to put on every aligner for 10 days, 22 hours a day, eradicating them just for consuming, ingesting and oral hygiene. Earlier than alignment commenced, the affected person attended a hygienist appointment.
IPR was carried out in accordance with the Invisalign digital software program. Composite attachments utilizing Venus Pearl One had been quickly positioned on 11 higher tooth (UR6, UR5, UR4, UR3, UR2 and UL1, UL2, UL3, UL4, UL5, UL6) and 7 decrease tooth (LR1, LR3, LR4, LR5 and LL5, LL4, LL1) (Figures 9 and 10). The attachments had been positioned to offer extra leverage factors to help tooth motion and increase equipment retention (Determine 11). Alignment was accomplished in roughly eight months (Figures 12 and 13). On the last orthodontic go to, mounted higher and decrease lingual stainless-steel wire retainers had been bonded utilizing Kulzer Venus Diamond Circulation to forestall tooth relapse (Determine 14).
The flowable composite has good bond energy, which helps to securely connect the lingual retainer wire to the tooth. The fabric additionally permits for easy and flush bonding of the retainer, minimising any potential interference with the affected person’s chew and producing a extra aesthetic look.
The affected person was given a two to three-week course of dwelling whitening utilizing the Boutique system, comprising 10% carbamide peroxide for use at evening in her last set of aligners. B1 was recorded on the Vita shade information following the house bleaching course.
Composite edge-bonding was carried out on the UR1 two weeks after tooth whitening was accomplished. The ready interval permits for shade stabilisation and ensures bonding effectiveness, predictability and accuracy. It additionally helps to minimise sensitivity.
The margins had been bevelled, and the tooth was etched with 37% phosphoric acid etch gel and bonded with Kulzer Ibond Common utilizing a selective etch approach. Ibond is straightforward to use and doesn’t trigger sensitivity.
Kulzer Venus Pearl A1 shade was my composite of alternative on this case due to its simple and handy dealing with. Sculpting and contouring is straightforward and easy with none pullback. The fabric has wonderful color adaptation and polishes to a excessive lustre.
The composite was positioned freehand and constructed up incrementally utilizing a single shade (Determine 15). The UL1 was smoothed with Sof-lex discs after which completed utilizing the Kulzer Venus Supra sharpening package. The amalgam restorations are being changed steadily. So far, the LR5 and LR4 have been restored utilizing Venus Pearl One (Figures 16 and 17). I discover that the composite has a ‘chameleon impact’ because the One shade blends seamlessly into the encircling dentition.
The fabric has good aesthetics when positioned in small cavities and is straightforward to deal with, contour and sculpt. The composite additionally gives excessive energy and sturdiness. As soon as absolutely cured, the composite restorations had been completed with Sof-lex discs and the Kulzer Venus Supra sharpening package, which creates a long-lasting, shiny shine in simply two working steps, with minimal materials abrasion.
Secondary sharpening was accomplished with aluminium oxide paste and a felt-coated sharpening level, which provides the restorations an especially excessive lustre. Following the anterior restoration, the affected person returned a few weeks later for a overview. This appointment included a hygiene go to and the bonding on the UR1 was given a last polish.
Profitable aesthetic end result
A profitable aesthetic end result was achieved over roughly 14 months utilizing the minimally invasive strategy of align, bleach and bond (Figures 18 and 19). Nevertheless, the substitute of the amalgam fillings is ongoing.
The affected person was thrilled with the consequence (Determine 20) and posted a five-star overview, commenting that she has had probably the most unbelievable transformation of her smile. She was elated and the remedy has given her a lot confidence in all features of life.
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