An “Align, Bleach, and Bond” Orthodontic- Restorative Case With SureSmile®

A 28-year-old patient was treated for esthetic reasons and also differential tooth wear, determined to be caused by a constricted envelope of function. The "align, bleach, and bond" process allows for simultaneous functional and esthetic improvements for a stable, long-term outcome. SureSmile^® (Dentsply Sirona, suresmile.com) software provides a cross-sectional view of the "before" and proposed "after" envelope situations. In this orthodontic relapse case, decisions on orthodontic-restorative landmark teeth were made according to IAS Academy (iasortho.com) protocols. Scans were taken, and the case submitted. The setup was reviewed, horizontal and vertical landmark points were confirmed, and a 0.5-mm flat trimline was chosen to minimize attachments. Staged interproximal reduction (IPR) was carried out to create space and improve the shape of the central incisors. The case used 22 maxillary and 20 mandibular aligners. No refinements or mid-course corrections were needed. Simultaneous in-aligner whitening was started at aligner 10. Seeing the improvement in the appearance of her teeth, the patient opted for composite edge bonding. No-preparation edge bonding was done using TPH Spectra^® ST (Dentsply Sirona) using the reverse triangle technique.* Polishing was performed, and retainers were bonded. Final SureSmile Essix retainers were created.

KEY TAKEAWAYS

Combining orthodontic alignment, whitening, and direct bonding can provide patients a smile makeover result similar to porcelain veneers without damage to teeth.

Using orthodontic-restorative parameters and a predictable aligner system, the envelope of function can be controlled, correct guidance provided, and excellent esthetics achieved.

Often when patients are able to see progressive improvements in their smile through the combined treatment of whitening and aligners, only bonding is needed to complete the case, thus reducing cost and potentially expanding the clinician's demographic of care.

Tif Qureshi, BDS
Founder and Clinical Director, IAS Academy;
Past President, The British Academy of Cosmetic Dentistry

Figures and Images

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Figure 1

Fig 1. The patient was unhappy with her wide central incisors and the color, wear, and position of her teeth, which looked aged beyond the patient’s years.

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Fig 2. Pretreatment, left side view showing differential tooth wear caused by a constricted envelope of function.

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Fig 3. Pretreatment, front retracted view showing color and shape of central incisors.

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Fig 4. Pretreatment, maxillary occlusal view. The landmark point was the mesial aspect of tooth No. 9.

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Fig 5. Pretreatment, mandibular occlusal view. The landmark point was tooth No. 23.

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Fig 6. “Before” (left) and “after” (right) envelope of function views using SureSmile® software.

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Fig 7. Accurate staged IPR was carried out using bonded diamond files (SpaceFile®, Dentsply Sirona) and checked with leaf gauges.

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Fig 8. Detailed attachments on maxillary dentition, used to ensure predictable outcomes.

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Fig 9. Detailed attachments on mandibular dentition.

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Fig 10. Front view after the use of 18 aligners and a few weeks of simultaneous whitening.

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Fig 11. Maxillary occlusal view at 6-month review.

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Fig 12. Mandibular occlusal view at 6-month review.

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Fig 13. Post-treatment, left side view. No refiners were needed.

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Fig 14. Final outcome after the align, bleach, and bond process.