Question:
This patient is concerned about the appearance of her upper anterior teeth, mainly the upper right side.  The UR2 is palatally displaced, rotated and in crossbite. The upper left side doesn't seem to be a problem. There is a midline shift but she is not too concerned about this.  The UR1 seems to be longer in length to the UL1.  She had a removable appliance when she was younger and her restorative and periodontal health seems to be very good.  Would an Inman Aligner be suitable for her treatment needs?

Answer:
This case is definitely treatable, but it will require a Fanscrew Expander and Bite Rising Appliance first.  It would be used for 6-8 weeks.  During this period of time, the patient will have to turn the midline screw every 3 days and wait until the Fanscrew has opened about 4mm.  Once this is achieved, a new impression for an Inman Aligner (with combined expander if Nimrod suggests) is taken.  The patient needs to continue to wear the Expander until the IA is fitted.  Some IPR may be needed, but it should push the lateral out quickly.  The IA may will need a bite raising section on it too.  A composite anchor should be placed behind the lateral close to the incisal edge to ensure it grips well.  This is a challenging case but possible.  As long as the patient is compliant and the space is available, it will work and will give you much confidence.  Altogether it should take 16-18 weeks.

Tags: Severe Upper Crowding, Crossbite, Rotation, Possible Case, Combined Inman and Expander, Fanscrew Expander, Bite Rising Appliance, Composite Anchor