Klasse II Div. 1
,
Kreuzbiss im Seitenzahnbereich
,
Erhöhter Overjet
,
Deep bite
,
Asymmetrische Zahnbögen
,
Maxilläre Mittellinien-Abweichung
,
Mandibuläre Mittellinien-Abweichung
,
Mittellinienverschiebung
,
Engstand
,
Rotationen

Distalisation

,

Mesialisation

,

Nivellierung der Spee-Kurve

,

Extrusion

,

Intrusion

,

Expansion

,

Retraktion

,

Proklination

,

First premolar extraction

,

Andere Extraktion

,

ASR

,

Elastics: Klasse II

,

Elastics: Class II in Additional Aligners

,

Elastics: Klasse III

,

Elastics: Vertikal

,

Extraktion

Courtesy of Dr C. Hock Lou, 2021

Treatment Summary

Patient Information

Age: 16
Gender: female
Invisalign Submission Option: Invisalign Full

Total Treatment Time

24 monate

Anzahl der Aligner

Maxillary: 52 + 23 = 75
Mandibulary: 52 + 23 = 75

Aligner Wear time

7-14 days

Retention

Maxillary: Other clear
Mandibular: Other clear

Results achieved

Klasse I-Relation erzielt
Funktionale Eckzahn-Führung auf beiden Seiten
Posteriorer Kreuzbiss korrigiert
Normaler Overjet und Overbite erzielt
Deutliche Verbesserung des Overbite
Deutliche Verbesserung des Overjet
Mittellinien symmetrisch
Richtige axiale Schneidezahninklination
Curve of Spee leveled
Zahnbögen begradigt und koordiniert
Zahnbogenform verbessert
Ästhetische Lachlinie wurde erzielt
Alle Behandlungsziele wurden erreicht für den Fall
Harmonie der Zahnbögen wurde erzielt

Bemerkungen

This difficult class II div 1 case with severe deep bite, asymmetrical & constricted arches was treated successfully in 24 months with excellent results.
Extraction: 1.4, 2.4, 3.8 & 4.8.
The lingual crown torque of upper posterior teeth and hyper-erupted teeth made it impossible to place buccal attachments on the lower teeth.
Lingual conventional attachments (Rectangular & Ovoid) were utilized to control the movement of the lower teeth & to improve retention of aligners.
At stage 10: Buttons were bonded at the mesiobuccal side of 3.6 & 4.6 after some intrusion & buccal crown torque of 2.6 were achieved.
Class II elastics (4.5oz 1/4") on both sides applied from U3 Hooks to Buttons on L6.
Tooth 4.5 (Lingual Ovoid) became intruded & off tracked during stages 15-20. The lingual attachment was removed.
As the expansion at the lower right side was a lot more than the lower left, sequential expansion of lower right posterior teeth was performed first to improve the predictability of asymmetrical expansion.
To assist correction of lower midline (2mm to left) from stage 45 onward: Right class III elastic + anterior elastic + left class II elastic.
At stage 49, Buttons were placed at 4.5(B), Cleat at 4.4(L) & 4.5(L) for application of force couple to derotate 4.5 and extrusion of 4.5. Button was also placed at 3.5(B) & 2.6(B) for vertical elastic.
Additional aligners were utilized to flatten the Curve of Spee, create a nice smile arc, get coincident midlines and finalize the occlusion.
The lower 2nd molars were moved successfully despite only partial coverage by aligners throughout the whole treatment!
The keys to success for this difficult case were correct diagnosis & ClinCheck planning. and good patient compliance!