Page 46 - DP Vol 21 No1_Neat

ORTHODONTIC SECTION

INVISIBLE ENHANCEMENT:

AN EXPLORATION OF RETREATMENT

USING ALIGNERS

Vyom Rathi

INTRODUCTION
Often, we hear the baseless statement that aligners and AI are
going to replace traditional fixed orthodontics involving the use
of fixed brackets, elastics and a whole lot of pain. Aligners remain
a subset of orthodontia, with only certain indicated cases to be
treated using aligners (with or without attachments), a bigger
share with aligners and adjunctive orthodontics, which includes
the use of TADs, buttons and elastics and the most severe and
complex cases being best left to fixed therapy and orthognathic
surgery . So, the question arises, how does the practitioner
(1)
incorporate aligner therapy into their ever-expanding arsenal of Fig 1: Patient’s scan pre-op showing slight Bi-Max tendency even after fixed
modalities? therapy. The chief complaint of the patient being the large and masculine
Aligners are transparent thermoformed sheets of a material look of her teeth while smiling.
with high elasticity , typically Polyurethane (PU), Polyethylene
(2)
terephthalate glycol (PET-G), a combination of the two in the
form of sandwiching, where a sheet of PET-G is covered on
both sides by PU. PET-G is a more rigid material, more prone
to breakages as well as patient discomfort. PU was launched
as an alternate which drastically reduced patient discomfort
but retained the movement thresholds. It also reduced patient
discomfort and the amount of time that the aligners have to
be worn before switching to the successor. Aligners earlier
being worn for 10 days have now moved to a much faster 7 day
switching cycles . Aligners are comfortably able to create a
(3)
deflection of translational movement of 0.3mm and rotation of
upto 1.25 degrees from baseline starting position for anteriors,
but the numbers prove to be far more difficult to definitively
prove for the posteriors, due to multifactorial systemic and Fig 2: Patient’s picture smiling pre-op
occlusal differences .
(4)
An interesting case for aligners remains retreatment of
relapsed cases. As Graber aptly stated, “There is only one way
to completely avoid relapse. At the end of treatment, remove
the braces, polish the teeth, make study models and take
photographs. And then take the patient out the back door of the
office and shoot him”. Relapse is relatively inevitable, but offering
the patient a practically invisible option is miraculous. Patients,
for their part, have to be compliant and regular for aligners to
work. A patient who was not regular with their retainer will not
be regular with aligners and if not sufficiently motivated for the
same, no outcome will be achieved .
(5)
When examining such patients, the key observation must Fig 3: Patient’s teeth post IPR before Philips Zoom Teeth Whitening. IPR was
now become the patients new chief complaint. Retreatment done before the whitening to ensure that the inter proximal regions with
cases must be approached as fresh cases, and their planning dense enamel were not bleached unevenly.

46 Dental Practice I January-February 2025 I Vol 21 No 1