Class II div 2
,
Increased overjet
,
Deep bite
,
Midline shift
,
Crowding
,
Rotations
,
Pre-restorative

Distalization
,
Leveling Curve of Spee
,
Retraction
,
IPR
,
Restorative
,
TADs
,
Elastics: Class II
,
Elastics: Class II in Additional Aligners
Courtesy of Dr R. Bordin, 2021
Before picture of treatment

Treatment Summary

Patient Information

  • Age: 35
  • Gender: male
  • Invisalign Treatment Option: Invisalign Full

Total Treatment Time

  • 43 months

Number of aligners

  • Maxillary: 39 + 35 + 56 = 130
  • Mandibulary: 39 + 35 + 56 = 130

Aligner Wear time

  • 2-weeks

Retention

  • Maxillary: Other clear
  • Mandibular: Other clear

Results achieved

  • Functional canine guidance on both sides
  • Normal  overjet and overbite achieved
  • Deepbite improved
  • Overjet improved
  • Midlines coincident
  • Proper axial inclination of incisors
  • Curve of Spee leveled
  • Arches aligned and coordinated
  • Arch form improved
  • Aesthetic smile line was achieved 
  • Harmonic arches were achieved

Comments

This case was very difficult to obtain a good result, and it took a long time, 3 years and a half, as the client refused to treat with extractions.

At the first set of aligners, billateral distalization in "V" pattern and IPRs were done, with Class II elastics throughout the whole treatment. A lot of anchorage was lost, and the Class II relationship was not corrected at all, but crowding, alignment, half of levelling of the curve of spee and most of the derotation of teeth were achieved, although there was still some rotations on upper incisors.

At the second set of aligners, again distalization in "V" pattern was done with aid of full-time Class II elastics. Curve of spee improved a lot, midline was still deviated, Class II relationship improved but there was still there was some room to improvement, and overjet to be reduced.

At this point, the client had a pause in the treatment, had his teeth bleached, and had the stained fillings on the upper anteriors re-done, and also, the incisal edges of both #1.1 and #2.1 were re-built with composite resin. After this restorative phase was done, I did the last set of aligners (the second refinement)

In this last clincheck I on purpose overcorrected in excess a lot the curve of spee to the edge-to-edge limit, and distalized again billaterally in a "V" pattern, this time in excess until close to Class III relationship, this time with aid of TADS, placed between #1.5. and #1.6 and #2.5 and #2.6. FInally, the curve of spee was flattened correctly, class II was completely corrected in the left side, and in the right side almost all of it, and overjet and overbyte were corrected. All left rotations were corrected. The client at the end was really satisfied, despite the long time of treatment. And so was I !

Images

Initial and final

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upper
lower
right
front
left
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upper
lower
right
front
left

Progress

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lower
right
front
left
InitialFinal
Before picture of treatment
After picture of treatment
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Radiographs

Initial Final
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