Classe II div 1, Articulé croisé postérieur, Surplomb accru, Deep bite, Arcades asymétriques, Décalage de la ligne médiane maxillaire, Décalage de la ligne médiane mandibulaire, Décalage des lignes médianes, Encombrement, Rotations
Distalisation
, Mésialisation
, Nivellement de la courbe de Spee
, Égression
, Ingression
, Expansion
, Rétraction
, Vestibulo-version
, First premolar extraction
, Autre extraction
, RIP
, Élastiques : Classe II
, Elastics: Class II in Additional Aligners
, Élastiques : Classe III
, Élastiques : Vertical
, Extraction
Courtesy of Dr C. Hock Lou,
2021
Treatment Summary
Patient Information
- Age: 16
- Gender: female
- Invisalign Submission Option: Invisalign Full
Total Treatment Time
- 24 mois
Nombre d'aligners
- Maxillary: 52 + 23 = 75
- Mandibulary: 52 + 23 = 75
Aligner Wear time
- 7-14 days
Rétention
- Maxillary: Other clear
- Mandibular: Other clear
Results achieved
- Relation de Classe I obtenue
- Guidage fonctionnel des canines des deux côtés
- Articulé croisé postérieur corrigé
- Surplomb normal et recouvrement obtenu
- Amélioration significative du recouvrement
- Amélioration significative du surplomb
- Les axes médians coïncident
- Inclinaison axiale correcte des incisives
- Curve of Spee leveled
- Arcades alignées et coordonnées
- Forme de l'arcade améliorée
- Ligne de sourire esthétique obtenue
- Cas dont les objectifs de traitement ont tous été atteints
- Obtention d’arcades harmonieuses
Commentaires
- 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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