Clase II div. 1, Mordida cruzada posterior, Resalte aumentado, Deep bite, Arcadas asimétricas, Desviación de la línea media maxilar, Desviación mandibular de la línea media, Desplazamiento de la línea media, Apiñamiento, Rotaciones
Distalización
, Mesialización
, Nivelado de la curva de Spee
, Extrusión
, Intrusión
, Expansión
, Retracción
, Proinclinación
, First premolar extraction
, Otras extracciones
, IPR
, Elásticos: Clase II
, Elastics: Class II in Additional Aligners
, Elásticos: Clase III
, Elásticos: Vertical
, Extracción
Courtesy of Dr C. Hock Lou,
2021
Treatment Summary
Patient Information
- Age: 16
- Gender: female
- Invisalign Submission Option: Invisalign Full
Total Treatment Time
- 24 meses
Número de aligners
- Maxillary: 52 + 23 = 75
- Mandibulary: 52 + 23 = 75
Aligner Wear time
- 7-14 days
Retencion
- Maxillary: Other clear
- Mandibular: Other clear
Results achieved
- Consecución de una relación de Clase I
- Guía canina funcional en ambos lados
- Mordida cruzada posterior corregida
- Resalte normal y sobremordida conseguida
- Mejora considerable de la sobremordida
- Mejora significativa del resalte
- Coincidente con líneas medias
- Inclinación axial adecuada de los incisivos
- Curve of Spee leveled
- Arcadas alineadas y coordinadas
- Forma de la arcada mejorada
- Consecución de una línea de la sonrisa estética
- Todos los objetivos del tratamiento alcanzados
- Se han conseguido arcadas armónicas
Comentarios
- 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!
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