DentaltownUK June 2018 - 13

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UL1-UL3? His mild Class III skeletal
pattern and low upper lip line meant
that he did not show a lot of tooth
when he smiled.
* He also had a crossbite at UR1 LR2.
Some space could be gained by
proclining the upper central incisors,
which would also make them more
prominent in the smile and correct the
crossbite.
* If we wish to restore with implants,
can we create sufficient space between
the whole length of the crowns and
roots of UR1-UR3 and UL1-UL3?
Initial radiographs indicated that the roots
of these teeth were relatively upright already.
When creating further space, it was important
to ensure that tipping of the adjacent teeth
was avoided. 'SmartForce' attachments mean
that some bodily movement is possible with
Invisalign aligners.
The ClinCheck treatment plan was a
great aid to communication with the patient's
implant dentist, and also with the patient
himself. The implant dentist could dictate
how much space was required to provide
enough room for an implant, as well as the
most appropriate crown width at the end
of the treatment. This can be programmed
into the ClinCheck treatment plan, making
it much easier to achieve than with fixed
appliances, in my experience.
Using the ClinCheck's Tooth Movement

UL2: restored implant

Assessment Tool provided us with a measure
of how challenging the tooth movements
were likely to be. In this case, movement
of UR43 and UL34 were deemed to be
moderately predictable (see blue dots on
Fig. 2, p. 11). This tool was used to help the
patient understand some of the complexities
of his case.
Consequently, he consented to the use
of supplementary techniques, such as 'power
bars' and elastics in combination with the
aligners, if they were needed to apply more
root torque to these teeth. (In the end,
however, this was unnecessary.)
As the spaces between UR3-UR1 and
UL1-UL3 increased, we were able to place
pontics into the aligners. These proved
invaluable after first-stage surgery, providing
the patient with a prosthetic replacement
that was easy to clean and wear but did not
impinge on the surgery site.
The patient required 24 upper and 25
lower aligners in the first phase of treatment.
A second phase of aligners included 11
upper and five lower aligners. There was a
slight posterior open bite at the end of this
second phase; this is not unusual with aligner
treatment. To correct this, the last lower aligner
was trimmed with scissors distal to the lower
canines to enable it to act as a Dahl appliance.
Firm, balanced posterior contacts
were obtained after 6 weeks of wearing
this appliance. ■

UR2: restored implant

Fig. 4. ClinCheck, postorthodontic Phase 1.

Fig. 5. ClinCheck, start of Phase 2.

Fig. 6. ClinCheck, end of Phase 2.

Fig. 7. Post-Phase 2, implant placement
and restoration.

Implants and crowns in this case were provided by Dr Nilesh Shah, MMedSci, BDS, MFGDP(UK)

dentaltownuk.com \\ JUNE 2018

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