Case report: Shaping a smile with HeySmile clear aligners

Dr Anu Kentala is a Finnish orthodontist working at the Hampaasi Herttoniemi dental clinic. She is also one of the first dental specialists in Finland to offer HeySmile clear aligner treatments for her customers. In the following, we are presenting one of her first HeySmile patient cases from start to finish.

HeySmile provides individual clear aligner treatments for orthodontics and aesthetic dentistry. As part of Planmeca Group, the company offers an all-digital solution for clear alignment treatments that integrates seamlessly into any dental clinic. Dr Anu Kentala, Specialist in Orthodontics, has been using HeySmile aligners for over a year now as one of the first users in Finland.

One of Dr Kentala’s first patients was a 33-year-old woman, who approached Dr Kentala with a wish to realign her upper anterior teeth for aesthetic reasons. As a child, she had already undergone an orthodontic treatment to correct posterior cross-bite with a quad helix expander. Over the years, however, the patient’s teeth had become crowded again and her right central incisor had moved in front of the left one. The patient had had all her four wisdom teeth removed in her early twenties.

After examining the patient’s teeth, Kentala estimated the bite could be corrected with a clear aligner treatment. For the actual treatment plan, a panoramic image was captured with Planmeca ProMax® 2D imaging unit and the patient’s head was scanned with the scanning Planmeca ProMax® cephalostat. Next, digital impressions of the patient’s teeth were captured with a Planmeca Emerald® S intraoral scanner. All patient data was then uploaded into HeySmile online platform for case evaluation and treatment planning.

Fig. 1: Patient’s teeth before the clear aligner treatment.

Fig. 2: A panoramic 2D image of the patient’s teeth in the Planmeca Romexis® imaging software platform.

Fig. 3 & 4: Digital impressions clearly show the deviation in the patient’s dentition.

Treatment simulation supports in patient communication

The treatment plan was discussed with the patient using HeySmile digital treatment simulation. The plan was to expand the gaps of the upper canines and simultaneously tilt the other anterior teeth slightly forward to create enough space for the right central incisor to move backwards into the same line with the other upper teeth. On the lower arch, the goal was to straighten the bite level to prevent a potential deep bite in the future.

The treatment would include 17 aligners for the maxilla and 13 aligners for the mandible. The estimated duration was approximately 22–34 weeks. The treatment plan was accepted by the orthodontist and the patient based on the simulation.

The HeySmile clear aligners arrived to the Hampaasi dental clinic only a week after the plan had been confirmed. Attachments were prepared for the patient’s teeth to ensure the aligners would stay in place and help move the teeth into their desired position. The patient was advised to wear the first sets of aligners for two weeks each and then shorten the interval for 7–10 days, if possible.

Fig. 5 & 6: HeySmile treatment simulation shows the teeth before and after the treatment.

Regular follow-ups help ensure desired treatment outcome

The patient came in for the first follow-up visit as soon as she had started wearing the fourth set of aligners to verify everything had proceeded as planned. During the same visit, Dr Kentala performed interproximal reduction (IPR) on the upper anterior teeth using abrasive coated strips to help reduce friction between the moving teeth. After the IPR procedure, the patient was able to shorten the interval of wearing each set of aligners for one week only, which had not been possible earlier.

The next follow-up visit took place while the patient was wearing the aligner set number ten. At this point, the canines had moved forward as planned and the left central incisor was almost completely visible, indicating there was now enough space in the upper arch for the right central incisor. In the next phase, the right central incisor would be aligned with the rest of the teeth in the upper arch, so the patient was instructed to start wearing each set of aligners for 10 days again to ensure not rushing the treatment at a critical moment.

Fig. 7: The upper left central incisor was already almost completely visible during the second follow-up visit.

When the patient was about to start wearing the 14th set of aligners, her teeth were scanned again with Planmeca Emerald S to verify the lower teeth had reached their desired position and to check whether the treatment plan should be adjusted. The digital impression data confirmed that no adjustments were needed and the patient was instructed to continue wearing the rest of the aligner sets in ten-day intervals. Since the mandible had already reached its desired position, the patient started wearing retentive aligners for the lower arch.

Final results in 25 weeks

As the patient visited Dr Kentala for the next time, she was already wearing the last set of her aligners. Dr Kentala checked that the result corresponded with the plan and removed all attachments from the teeth. The patient continued to wear the last set of aligners for yet another week until they were scanned again for creating final retentive aligners. In all, it took 25 weeks to reach the desired result with the HeySmile treatment.

The retentive aligners arrived again only in a couple of days. The patient was adviced to continue wearing them day and night for the next three months. After that, the patient could gradually start reducing the time wearing the retainers in the daytime but continue wearing them by night. According to Kentala’s estimation, a retention spring would not be required for maintaining the teeth in their new position.

Fig. 8: The patient’s teeth after the treatment.

Fig. 9 & 10: Digital impressions of the upper arch after the treatment.

Positive overall feedback

"My upper anterior teeth had been bothering me for years. As my wedding day was approaching, I decided to get them fixed by an orthodontist simply for aesthetic reasons. HeySmile turned out to be the perfect solution for the treatment. The aligners were barely noticeable and I got used to wearing them quickly, although my teeth and gums felt a little sore for a couple of days after changing into a new pair of aligners during the first few weeks of the treatment. I only had to remember a couple of things: to remove the aligners for eating and to clean them every day,” the patient tells.

“The treatment was completed just in time for my wedding day, and I am really happy with my new smile,” she continues.

As one of the first users in Finland, Dr Kentala helped HeySmile develop the service based on the feedback of her Finnish customers. According to Dr Kentala, the online HeySmile service portal is easy to use and a great tool for communicating with the HeySmile personnel.

“Having previously worked with other clear aligner solutions, I was positively surprised that no adjustments to the treatment plan or the aligners were required for this patient case. It is often necessary to scan the teeth several times during a treatment, adjust the plan or order new aligners, but this HeySmile treatment proceeded exactly as planned. This is of course convenient and cost-effective for the patient as well,” Kentala says.

“What’s most important, the aligners were delivered quickly and predictably within the promised schedule. Additionally, Planmeca’s Finnish distributor Plandent provided exceptional support in Finland whenever I needed it,” Kentala summarises.

Copy: Mari Suominen
Photos: Dino Azinur
X-ray images and digital impressions: Planmeca

Planmeca Oy and Planmeca Group
Planmeca Oy is one of the world's leading dental equipment manufacturers, with a product range covering digital dental units, CAD/CAM solutions, world-class 2D and 3D imaging devices and comprehensive software solutions. Privately owned and headquartered in Helsinki, Finland, the company offers a portfolio of products distributed in over 120 countries worldwide. Planmeca Oy is part of the Finnish Planmeca Group, which consists of several healthcare technology brands, each committed to innovation and design. With 4,500 employees worldwide, Planmeca Group companies achieved a combined pro forma turnover of EUR 1.2 billion in 2021.
www.planmeca.com