1. INTRODUCTIONAs the number of patients who prefer to avoid the unaesthetic appearance of conventional orthodontic appliances continues to grow, so does the popularity of lingual fixed appliances.[1]With more examples of successful treatment being seen, dental practitioners will be more apt to refer patients to orthodontists proficient in this technique. However, patients wearing lingual appliances experience more pain, speech difficulties, and problems maintaining adequate oral hygiene[2], which may cause them to lose their patience in the technique. Moreover, lingual orthodontic treatment is a field that not all orthodontists can excel at. As a result, iatrogenic treatment outcomes are sometimes observed.Iatrogenic is described as a situation that leads to reversible or irreversible damage to patients who undergo any type of treatment. Iatrogenic usually occurs due to inaccurate growth prediction, incorrect choice of orthodontic appliances, technical failure by the dentist, poor patient cooperation, or lack of control of space and anchorage.[3] This is recognized in orthodontic publications mainly in terms of failures in patient compliance that result in poor treatment, no improvement, or damage. For this case, the patient has been wearing lingual brackets for 1,5 years with minimal improvement. We need to find an alternative solution that maintains a similar focus on aesthetics.Clear aligner in-house is an alternative approach to lingual orthodontics in cases where patients have high aesthetic demands. Indeed, the most obvious advantage of in-house aligner (IHA) is that it provides a more comfortable feeling than lingual orthodontics and does not cause tongue damage and tooth decay due to difficulty in oral hygiene. Moreover, there was no difference in the treatment duration with in-house aligners and fixed appliances.[4]This case report presents an approach using IHA to close space, correct midlines and canine relationships after treatment with lingual bracket therapy with minimal improvement in 1,5 years. The reasons for discontinuing lingual brackets treatment in this case include the poor quality of the previous lingual fixed appliance therapy, difficulty maintaining oral hygiene and discomfort, which led to the patient’s exhaustion with the treatment.

INTRODUCTIONDiastema or spacing in anterior teeth is one of the most complaints of patients for undergoing orthodontic treatment. Abnormalities in tooth size or shape discrepancy are common causes of tooth spacing. The most commonly presenting of these are small lateral incisors. The Bolton Analysis may be used to compare tooth size discrepancies1. This group is often treated by restoring the teeth to standard size and closing the remaining gaps by utilizing the correct inclination of the anterior teeth in case they are proclined.Nowadays, patients not only seek treatment to address their issues but also demand appliances that are both more aesthetic and comfortable2. Clear aligners meet the patient’s needs since the Clear Aligners system is more tolerable and more esthetic than ceramic or metal brackets3. However, orthodontic treatment with clear align presents challenges in controlling anterior mesiodistal tipping and buccolingual tipping. Kravitz et al. showed a mean accuracy of 41% for mesiodistal tipping, in which the maxillary central incisors (39%) had the lowest accuracy and 53% for labial crown tip4. Castroflorio et al.5described the accuracy of inclination (buccolingual tipping) and angulation (mesiodistal tipping) correction for maxillary central incisors as 32% and 22.9%, respectively. Control of mesiodistal tipping and buccolingual tipping is mandatory in cases requiring space closure and reduction of the protrusion of anterior teeth.In this case, the patient requires significant retraction of the incisors to close the gaps. Controlling the movement of the incisors in the buccolingual direction is crucial to ensure the root does not move outside of the alveolar bone, and to minimize root resorption. Additionally, the patient has several incisors with distally inclined roots (teeth 12, 21, 22), which makes it challenging to maintain the proper mesiodistal inclination when closing gaps and retracting the incisors. Clear aligners are not effective in controlling the buccolingual inclination of anterior teeth6.This objective of this case report is to describe an adult male patient with significant spacings and proclined anterior teeth successfully treated with clear aligners, along with some clinical tips we used to control the movement of maxillary central incisors.CASE REPORTA 21-year-old male patient came for consultation with chief complaints of spacing in anterior teeth which affects the aesthetics of his smile.His current overall health is good, and he is no longer affected by his previous condition. He has never had any dental treatment before.

Multidisciplinary treatment with adjunctive orthodontics, surgical crown lengthening, and esthetic rehabilitation

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