Class II div 1, Posterior crossbite, Increased overjet, Deep bite, Asymmetric arches, Maxillary midline deviation, Mandibular midline deviation, Midline shift, Crowding, Rotations
Distalization
, Mesialization
, Leveling Curve of Spee
, Extrusion
, Intrusion
, Expansion
, Retraction
, Proclination
, First premolar extraction
, Other extraction
, IPR
, Elastics: Class II
, Elastics: Class II in Additional Aligners
, Elastics: Class III
, Elastics: 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 months
Number of aligners
- Maxillary: 52 + 23 = 75
- Mandibulary: 52 + 23 = 75
Aligner Wear time
- 7-14 days
Retention
- Maxillary: Other clear
- Mandibular: Other clear
Results achieved
- Class I relationship achieved
- Functional canine guidance on both sides
- Posterior crossbite corrected
- Normal overjet and overbite achieved
- Significant improvement of overbite
- Significant improvement of overjet
- Midlines coincident
- Proper axial inclination of incisors
- Curve of Spee leveled
- Arches aligned and coordinated
- Arch form improved
- Aesthetic smile line was achieved
- All treatment goals were achieved case
- Harmonic arches were achieved
Comments
- 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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