Classe II Div 1
,
Mordida cruzada posterior
,
Aumento do trespasse horizontal
,
Deep bite
,
Arcadas asimétricas
,
Desviación de la línea media maxilar
,
Desviación de la línea media mandibular
,
Mudança da linha média
,
Acavalamento
,
Rotações

Distalização

,

Mesialização

,

Nivelación de la curva de Spee

,

Extrusão

,

Intrusão

,

Expansão

,

Retração

,

Vestibularização

,

First premolar extraction

,

Outra extração

,

IPR

,

Elásticos: Classe II

,

Elastics: Class II in Additional Aligners

,

Elásticos: Classe III

,

Elásticos: Vertical

,

Extração

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 alinhadores

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

Aligner Wear time

7-14 days

Retenção

Maxillary: Other clear
Mandibular: Other clear

Results achieved

Relação de Classe I obtida
Orientação canina funcional em ambos os lados
Mordida cruzada posterior corrigida
Trespasse horizontal normal e sobremordida obtida
Melhoria significativa da sobremordida
Melhoria significativa do trespasse horizontal
Linhas médias coincidentes
Inclinação axial adequada dos incisivos
Curve of Spee leveled
Arcos alinhados e coordenados
Forma de arco melhorada
A linha de sorriso estético foi alcançada
Todos os objetivos de tratamento foram casos alcançados
Os arcos harmônicos foram alcançados

Comentários

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!