Question:
This patient is keen to have her UR1 and UR2 aligned. She has been advised that she will need to align the lower incisors first so that there is room to align the upper incisors. There is enough room to align the teeth in each arch. Is it possible for the upper arch can be corrected alone by increasing the overjet? Can the UR1 be derotated? Are these cases suitable for the Inman Aligner?

Answer:
This is a good case. Ideally, treating the upper on its own would require an increase in overjet. The UR1 can be derotated, but it will need a composite anchor on the palatodistal incisal edge and the mesiolabial surface about 3mm from the gingival, so that the bows wit in the incisal 1/3rds. If you are going to treat both, then treat the uppers first. The patient can always return to complete the lowers later. For cases like this, you can do the upper with just IPR, but I tend to commonly incorporate Expanders to speed up the process and reduce the amount of IPR needed. Remember, with an incorporated Expander, you can only expand by 2.4mm max. Once the 11 is aligned, it is going to look long so you need to warn the patient that she may need some contouring and bonding post-alignment. I have carried out Spacewize calculations with arbitrary initial measurements. They reveal that the cases are suitable with the Inman Aligner and should yield successful results.

Tags: Mild Lower Crowding, Moderate Upper Rotation, Suitable Case, Combined Inman and Expander, Combined Upper and Lower Treatment, Composite Anchor, Differential Wear Post-Treatment, Spacewize Calculation, Expansion, Tips on Expansion