Clear Aligner Therapy Facilitates Desired Smile Improvement

Maria Jackson, DDS

A 19-year-old woman presented with a chief complaint of disliking the spaces in her maxillary arch and the crowding in her mandibular arch. She desired a "fuller-looking smile." Despite having a bilateral class I molar and canine relationship, her mandibular incisors were unevenly supererupted while teeth Nos. 19 and 20 were intruded. After examination, it was determined that the patient's concerns were attributed to the following: (1) a collapsed mandibular arch, specifically on left side, creating a dark buccal corridor; (2) mandibular anterior crowding causing supererupted incisors; (3) minor crowding in the maxillary arch camouflaged by a "space" between Nos. 8 and 9; and (4) tooth size discrepancy of the maxillary lateral and central incisors. The chosen treatment plan utilized both orthodontic and restorative elements, starting with ClearCorrect^® clear aligner therapy (Straumann, clearcorrect.com) planned for a 3-month duration. Two months into treatment, the mandibular anteriors were not moving as expected, so revision trays were ordered; the patient finished orthodontics in 6 months total. The treatment was completed with whitening of all teeth and anterior composite restorations on Nos. 7 through 10. The incisal edges of the upper and lower teeth were smoothed to level the patient's occlusal plane, creating a subtle but noticeable difference when she smiled, and a nice esthetic result was achieved.

Key Takeaways

Clear aligner therapy may be used to set teeth closer to ideal positions to allow for placement of very conservative restorations.

The use of clear aligner therapy to set teeth into proper occlusion before restorative treatment can allow restorations to last longer in function.

Utilizing a digital workflow with ClearCorrect^® makes it simple to monitor a patient's teeth movements and implement corrections as needed to achieve final goals.

About the Author
Maria Jackson, DDS
Private Practice, Forney, Texas; Fellow, Academy of General Dentistry

Figures and Images

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Figure 1

Fig 1. Full-face photograph before clear aligner therapy.

Figure 2

Fig 2. Pretreatment retracted view demonstrating collapsed mandibular arch in the left buccal corridor, poor spacing in the maxillary arch, and an uneven appearance of the mandibular anteriors.

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Fig 3. Pretreatment mandibular occlusal view demonstrating crowding in the anterior region and lingually inclined premolars.

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Fig 4. Initial scan (TRIOS 3, 3Shape) of the mandibular arch.

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Fig 5. Initial maxillary occlusal view showcasing palatally placed premolars and a slight retruded appearance of the maxillary anteriors.

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Fig 6. Initial scan of the maxillary arch.

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Fig 7. Initial retracted frontal view illustrating mandibular crowding, poor maxillary spacing, and a lingually collapsed mandibular arch on the left side.

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Fig 8. Initial ClearCorrect setup, showing the use of engagers in the treatment plan for an estimated initial nine total trays.

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Fig 9. After 2 months in clear aligner therapy, the mandibular arch was not tracking as expected; thus, a revision was ordered and expansion was increased.

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Fig 10. Post–clear aligner therapy, whitening, and maxillary anterior composite restorations. The patient wanted to wait on doing the gingivectomy in the maxillary arch on the left side.

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Fig 11. Post-orthodontic treatment and post-composite restorations, retracted view.

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Fig 12. Post-orthodontic treatment, mandibular occlusal view, with crowding corrected and premolars moved buccally.

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Fig 13. Post-orthodontic treatment scan, mandibular occlusal view.

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Fig 14. Post-orthodontic treatment, retracted open view, to demonstrate intruded mandibular anteriors and smoothed edges.