Question:
This patient is concerned with the severe crowding of her lower six anterior teeth and the slight rotation of the UR1.  The proposed treatment plan is to extract the LR3 and LL3, to crown the LR4 and LL4 to make them look like canines, and then use either Invisalign or the Inman Aligner to align the lower incisors.  The upper jaw will not be treated for the severe deviation of the midline.  Is the Inman Aligner possible for this case?

Answer:
There are some concerns and questions in regards to this case:
1.  Is the periodontal health good? Are the incisors all of good long term prognosis?
2.  Can you create acceptable canine guidance with the final result?  If you’re not sure then get a wax-up done before you commit.
3.  Is the patient aware that you may have some “black triangles” where the lower canines are removed?
4.  Will you not end up with too much space?  It may be better to remove an incisor tooth and then align with fixed orthodontics.
The first thing to do is get an orthodontic opinion, just to be safe legally, and a periodontal opinion if indicated.  I think this is a very hard case and may not be ideal for the Inman Aligner.

Tags: Severe Lower Crowding, Rotation, Unsuitable Case, Extraction Case, Orthodontic Referral