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Have I recognized the the over jet must be sufficient taking into account the envelope of
complexity of this case or function and avoiding the incisal interference
potential pitfalls?
As shown above Phase 4: The area was then anesthetized with 4% articaine
the complexity would hydrochloride. The teeth were isolated with opragate. The facial
be anything that goes enamel was bevelled with a Sof-Lex disc (3M Oral Care). A little CL
against the SAFE table translucent enamel was placed on the incisal edge. The final layer
principles. was placed over the surface and the restoration was cured under an
Has my patient been oxygen barrier to remove the inhibition layer and enhance polishing.
explained the scope of Finishing was done using the Sof-lex discs and spirals (3M Oral
what orthodontics can Care). The sequence ranged from coarse to super-fine to achieve life-
do for their malocclusion like polish and shine. The patient was over the moon.
other than just anterior
teeth alignment? Phase 5: Retention – as mentioned in series one a fixed upper
The patient had been retainer was then bonded during the last appointment to prevent
given the options to have relapse occur ring in the future. Bonded canine to canine retainers
her molar relationship have been recommended in the literature. The wires used are multi-
corrected but declined strand stainless steel wire. In this case, an indirect one was made
this. by sending polyvinyl silicone impression sent to the lab. The wire
Is this case better was transferred to the teeth using a specially made jig. The wire was
Fig 18: Happy patient suited for a second bonded using flowable composite. The occlusion was made clear
opinion? when placing a retainer on the maxillary arch. The flexibility of the
Patient’s autonomy must be respected; this is the premise of consent. arch wire allows for physiological tooth movement and prevents
Consent is about effective communication and a trusting relationship bond fracture through occlusal forces. Periodontal ligament stability
between a patient and the dentist. If these conditions are not met the is also achieved with this technique. The patient's main concerns
patient is likely to feel unhappy, violated or misled which can instigate of her smile alignment, and crowding were all resolved. There
a complaint. was improved interincisal angle and contact created. A protected
guidance was created in lateral excursion. n
TREATMENT GOALS
Align the teeth using Invisalign, IPR and attachments. Retrude and
extrude the upper laterals and proline the incisors to improve the
position. Improve the aesthetics of the incisal edges with composite
resin.
• Maintain the posterior occlusion as there are no signs of pathology. ABOUT THE AUTHOR
• Maintain the health of the existing dentition.
• Keep the guidance as it is since there are no signs of wear or pathology. Dr Rhona Eskander graduated from
• The patient's pre-treatment lower arch form should be maintained Leeds University in 2010 and completed
during orthodontic treatment as much as possible. her vocational training in a practice
• Original lower inter-canine width should be maintained a much as in Kent. During this year, she won the
possible because expansion of lower inter-canine width is prone to prize for the ‘Best Case Presentation’– a
complex restorative case which involved
orthodontic relapse. several disciplines in dentistry. She was
• The most stable position of the lower incisor is it pretreatment titled Best Young Dentist in 2016/2017
position and advancing the lower incisors is correlated with at the prestigious dentistry awards. She
compromising stability. has been shortlisted for several awards
• Consideration of retention for life. and also won an award at the 2017
Aesthetic Awards (botulinum toxin category). Dr. Eskander
TREATMENT is dedicated to post graduate training and has successfully
passed her MUDF examinations. Rhona is a Diamond Provider
for Invisalign and also a key opinion leader for Philips and
Phase 1: Impressions were taken for the clincheck with polyvinyl Invisalign. She lectures on behalf of the latter. She has
impressions completed courses at Eastman Institute and is a member of
the British Endodontic Society, the British Dental Association
Phase 2: Treatment planning was based on alignment and and the Faculty of the Royal College of Surgeons. Dr.
retraction of the lower anterior teeth to allow proclination and Eskander also speaks Arabic, and among her many interests
alignment of the upper teeth and hobbies, she has ventured to Peru where she provided
treatment and increased oral health awareness for patients in
Phase 3: Following alignment of the lower teeth it was noted that need.

Dental Practice I November-December 2024 I Vol 20 No 5 51