Richard Brown presents a case involving treatment with Nuvola aligners.

Presentation

The patient presented with class II division II incisors on a mild class II skeletal base. She had mild upper and lower crowding. The patient complaint was that she did not like the prominent upper lateral incisors.

This case was for a long-standing patient of mine – for a number of years, she had mentioned that she was unhappy with the position and angle of her front teeth. She felt that the prominence of the lateral incisors made it look like she had very short upper central incisors and felt that in photographs the front teeth did not look good at all.

Treatment

After a discussion with the patient about the Nuvolaview process and the fact that we could see the predicted outcome before we committed to any active treatment, she was very motivated to proceed. I really like the 3D preview prior to treatment, it is such a luxury because it allows the patient, dentist and technician to work together before anything is physically done to the patient. I also find that it is a crucial part of my informed consent in that we can point out not only all the benefits of treatment, but also anything that will not be corrected by the treatment.

The Nuvolaview was returned in just a week from submission of our impressions. The plan showed 16-18 upper and 16-18 lower aligners. They also showed where attachments were recommended and where to carry out interproximal reduction (IPR). The plan showed that attachments were only required for the upper first and second premolars and that 0.4mm of IPR was required, in total, for the upper and lower arches. I use a number of aligner products and I believe, from repeated experience with the Nuvola aligners, that the strength of the polyurethane allows for more expansion than competitors, thus reducing the need for IPR.

Minimally invasive

The plans for Nuvola aligners consistently come back with low amounts of IPR and the finished arch shapes are well rounded out but not over expanded. The patient was pleased with such a subtle and minimally invasive treatment plan and so we proceeded. The aligners were ordered and arrived between seven and 10 days later – very quick especially over the Christmas period. This case was predicted to take 12 months; we completed it in just under nine months. Patient compliance was excellent and there was very little down time between active aligners.

Following the fit of the aligners I tend to review my patients in a similar fashion to a fixed orthodontic appliance, with visits every six to eight weeks. This is dependent upon patient (and my own) schedule and it is another area where I love the flexibility provided by Nuvola aligners. If the patient has a holiday or works away, we can give more or fewer aligners to suit their schedule. They can therefore continue their treatment uninterrupted whilst they are unable to attend the surgery.

The other great point about aligner treatment is that, unlike fixed, there is a very low chance of irritation of the patient’s mucosa and a virtually 0% breakage rate, ie, orthodontic ‘emergencies’ are extremely unlikely. This flexibility allows me to work in three practices, one of which I only visit one day a month, and still provide my patients with a fantastic service and great care and attention.

Flexibility

Being web based, the Nuvolaview treatment planning and acceptance/ordering portal also allows great flexibility. The interface is viewable on a laptop, tablet or even smartphone. Anywhere with an internet connection can become an extension of your office! I find this really useful for working in multiple practices and it allows me to travel around even though I am the only dentist providing orthodontic services in two of the three practices I work in.

Clear aligners are increasing in popularity on a daily basis, patients are becoming better educated and more aware of the various treatment options available to them. Case selection and quality of the aligner product and excellent, reliable laboratory service are, of course, vital to a fulfilling and enjoyable practice with clear aligners; Nuvola aligners provide all the quality needed so all I have to do is select the correct cases! Simple alignment can improve many other aspects of dentistry too, including implant aesthetics, minimising veneer preparation requirements and allowing for improved success rates in bonding cases.

I find, being a general practitioner, I am really well placed to deal with not only the alignment of teeth but also often the shape of the teeth. The precision of Nuvola aligners allow me to optimally position teeth, whether it be aligning gingival zeniths, leaving space distal to deminuative lateral incisors or simply planning the IPR to reduce the amount of black triangle camouflage needed post-treatment. I find it extremely rewarding to complete the entire case, ie, not having to refer the orthodontic part elsewhere, nor aligning the teeth and being unable to place the definitive restorations.

Figure 1: Preoperative
Figure 1: Preoperative
Figure 2: Preoperative
Figure 2: Preoperative
Figure 3: Preoperative
Figure 3: Preoperative
Figure 4: Preoperative
Figure 4: Preoperative
Figure 5: Preoperative
Figure 5: Preoperative
Figure 6: Postoperative
Figure 6: Postoperative
Figure 7: Postoperative
Figure 7: Postoperative
Figure 8: Postoperative
Figure 8: Postoperative
Figure 9: Postoperative
Figure 9: Postoperative
Figure 10: Postoperative
Figure 10: Postoperative
Figure 11: Preoperative
Figure 11: Preoperative
Figure 12: Postoperative
Figure 12: Postoperative

For more information on the Nuvola system, call 01825 714 601 or email www.geoorthodontic.com.

Be sure to keep an eye on the dental press for your next nearby Nuvola course – we run small group courses of a maximum of 15, for a full day, to ensure everyone can discuss their prospective cases and get answers to their questions prior to embarking on their first cases. You will leave the course with the confidence to start treating patients on the Monday.