Sir, I write in response to R. Chate's Opinion article and follow-up letter1,2and would like to invite him to an Inman Aligner programme to understand the differences between 'Clear Aligners' and the Inman Aligner as patently it seems he has no idea of how cases are prescribed, set up and planned, or how the system actually works.

These pieces have unfairly lumped all short-term orthodontic treatment (STO) systems into one when there are very clear differences of which he does not seem aware. For example, he states: 'In essence, short-term orthodontic treatments that reposition anterior teeth to facilitate their minimally invasive aesthetic restoration must involve inter-canine expansion and incisor proclination, both of which are inherently unstable orthodontic movements.' This is completely false in the case of Inman Aligners and demonstrates a lack of understanding of the treatment modality, planning with arch evaluation, use of 3D printing in diagnosis, appliance build and case execution.

To then link Inman Aligners and Clear Aligners and imply that somehow a rise in complaints of 'aligners' could be attributed to Inman Aligners without any direct evidence, or any real idea of the actual numbers of STO cases carried out in the UK to compare any rise to, is in my opinion highly suspect. The cynical side of me feels that that both pieces simply smack of simple protectionism. If equally vociferous articles or letters were forthcoming during the years where thousands of patients had crooked teeth prepared for veneers instead of having orthodontics, I might feel differently. I sincerely hope I am wrong and hope to enlighten him on this particular modality of treatment. Despite the above comments, the invitation is warmly offered.

R. A. C. Chate responds: Like many protagonists of short-term cosmetic orthodontics, Mr Qureshi has incorrectly presumed that in its published comments on this topic, the Faculty of Dental Surgery of The Royal College of Surgeons of Edinburgh has acted in order to either protect conventional orthodontists or to have short-term orthodontics as a potential treatment option be withdrawn from clinical practice.

In his listed references to the Faculty's previous publications he has clearly missed the one in relation to the point/counter-point debate between Mr Maini and myself, in which the above two myths are dispelled.3

Mr Qureshi claims I have unfairly lumped all short-term cosmetic orthodontic treatment modalities together and in relation to the Faculty's previous statement that 'short-term orthodontic treatments that reposition anterior teeth to facilitate their minimally invasive aesthetic restoration must involve inter-canine expansion and incisor proclination, both of which are inherently unstable orthodontic movements'4 he states this is completely false in the case of Inman Aligner therapy.

He believes I lack an understanding of his treatment modality and extends an invitation to attend one of his training courses.

I have reviewed the Inman Aligner website for further details and was interested to read the pages on 'Results', 'Case of the month' and 'How it works.' 5

From these it is clear the modus operandi of Inman Aligners involves straightening irregular anterior teeth through opposing labio-lingual, removable appliance tipping pressures and all of the cases that have been illustrated have not involved the extraction of any teeth.

As such, the only way Inman Aligners can create additional space to straighten crowded teeth is either through arch width expansion, incisor proclination, interproximal enamel reduction or a mixture of any or all the above.

Therefore, it is unsurprising that the final bullet point on the web page of 'How it works' states, '...retention is recommended for life to prevent relapse. Retention can come in the form of a lingually bonded retainer or an Essix retainer.'5

However, no mention is made about the potential long-term failure rates of either of the above retainer systems nor, as a consequence, what the biological and financial consequences might be for a patient who subsequently experiences rapid relapse after a course of short-term cosmetic orthodontic treatment, both of which the Faculty, in its original guidance publication, has suggested should be essential informed consent patient information.4

In relation to Mr Qureshi's criticism that the published data from Dental Protection are insufficiently refined to differentiate between the claims made against the different short-term cosmetic orthodontic treatment systems, the data are irrefutable.

Irrespective of whichever treatment system is used, they all align irregular teeth in a similar way and as such, carry the same risks and consequences.

Finally, it is interesting to note that Mr Qureshi has declined to comment on the Faculty's concerns in relation to what has been suggested general dental practitioners should charge when using short-term cosmetic orthodontic appliances, including Inman Aligners.

Since many might regard such fees as exorbitant, his silence is revealing.