Classe II div. 1, Morso crociato posteriore, Aumento dell'overjet, Deep bite, Arcate asimmetriche, Deviazione della linea mediana mascellare, Deviazione della linea mediana mandibolare, Spostamento della linea mediana, Affollamento, Rotazioni
Distalizzazione
, Mesializzazione
, Livellamento della curva di Spee
, Estrusione
, Intrusione
, Espansione
, Retrazione
, Proclinazione
, First premolar extraction
, Altra estrazione
, IPR
, Elastici: Classe II
, Elastics: Class II in Additional Aligners
, Elastici: Classe III
, Elastici: Verticale
, Estrazione
Courtesy of Dr C. Hock Lou,
2021
Treatment Summary
Patient Information
- Age: 16
- Gender: female
- Invisalign Submission Option: Invisalign Full
Total Treatment Time
- 24 mesi
Numero di aligner
- Maxillary: 52 + 23 = 75
- Mandibulary: 52 + 23 = 75
Aligner Wear time
- 7-14 days
Ritenzione
- Maxillary: Other clear
- Mandibular: Other clear
Results achieved
- Relazione di Classe I
- Guida funzionale dei canini su entrambi i lati
- Morso crociato posteriore corretto
- Overjet e overbite normali
- Miglioramento significativo dell'overbite
- Miglioramento significativo dell'overjet
- Linee mediane coincidenti
- Inclinazione assiale corretta degli incisivi
- Curve of Spee leveled
- Arcate allineate e coordinate
- Miglioramento della forma dell’arcata
- Linea del sorriso estetica
- Tutti gli obiettivi di trattamento sono stati raggiunti
- Armonizzazione delle arcate
Commenti
- 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!
398 
392 
