Authors: Dr Gurkeerat Singh, Sherif Kandil & Aswathy Menon
Over the last two decades, extensive research has been carried out to alleviate the two major shortcomings of orthodontic treatment: visibility and duration. In order to decrease treatment duration, three methods have been proposed: chemical-led interactions, surgery, and device-assisted therapies. The chemical-led interactions require further research to be accepted as routine methods and the surgicalmethods are found to be invasive and rarely acceptable to the patient. A simpler and less invasive method is the use of micro-osteoperforation, which increases the local inflammatory response, promotes osteoclastogenesis and leads to faster tooth movement through the bone. This process has been proven to be safe and repeatable and well tolerated and accepted by patients. Deepbites are difficult to treat using aligners and often lead to prolonged treatment time.
To facilitate this movement, Invisalign uses attachments on the premolars for anchorage, while an active intrusive force is placed on the incisors as well as bite ramps built into the lingual of the aligner of the upper anterior teeth that act as a bite plane; as yet no data exist on the effectiveness of these auxiliaries. Active intrusion can be facilitated with TADs. Even though aligners might be the most aesthetic, hygienic, as well as acceptable treatment modalities available with the orthodontist, a decrease in treatment time is often desired by the adult patient. A case report is presented with the combined short-term use of bonded appliances, TADs combined with clear aligners from K Line Europe GmbH, Düsseldorf, Germany (K Clear) for an aesthetically conscious patient.
Keeping the patient’s professional commitments and the limitation of aligner therapy in mind it was decided to place a fixed bonded appliance for a short duration, along with TADs placed between the maxillary central and lateral incisors bilaterally for intrusion of anterior teeth (Figs. 2a–d).
An appliance that satisfies the aesthetic needs of the patient and also the orthodontic goals of the treating clinician in a short duration should be chosen to treat patients. Customisation is the new in thing in orthodontics.