Class II div 2
,
Deep bite
,
Narrow arches
,
Asymmetric arches
,
Maxillary midline deviation
,
Midline shift
,
Crowding
,
Rotations
,
Pre-restorative

Leveling Curve of Spee
,
Intrusion
,
Expansion
,
Retraction
,
IPR
,
Space Closure
,
Restorative
,
Elastics: Class II
Courtesy of Dr. R. Bordin, 2022
Before picture of treatment

Treatment Summary

Patient Information

  • Age: 68
  • Gender: female
  • Invisalign Treatment Option: Invisalign Comprehensive

Total Treatment Time

  • 29 months

Number of aligners

  • Maxillary: 42 + 25 = 67
  • Mandibulary: 42 + 25 = 67

Aligner Wear time

  • 2 weeks in first set, 10 days in second set of aligners

Retention

  • Maxillary: Other clear
  • Mandibular: Other clear

Results achieved

  • Class II relationship maintained
  • Normal  overjet and overbite achieved
  • Deepbite improved
  • Overjet improved
  • Proper axial inclination of incisors
  • Curve of Spee leveled
  • Arches aligned and coordinated
  • Alignment of both arches through derotation
  • Arch form improved
  • Aesthetic smile line was achieved 
  • All treatment goals were achieved case
  • Harmonic arches were achieved

Comments

  • Patient wanted to improve her smile the best it could be done, without extracting any teeth, at this stage of her life (68 years old), as she said.
  • Afterward,  she wanted to "clear" her teeth from the "dark" and old fillings she had.
  • I opted not to fully correct her Class II, but to give her proper overjet and overbite and to align and level her teeth the best I could.
  • I performed then a great amount of IPRs on the upper arch, to create room for her cusps and her remaining lateral incisor.
  • I did more than the recommended 0.5mm between teeth on some posterior teeth, which would later have their fillings re-done.
  • Even with the IPRs, I did some expansion on the upper arch, to improve its form and match the lower arch's planned expansion.
  • I also used bit ramps to help me correct the overbite and to help to level the Spee Curve.
  • In the lower arch, I performed some minor IPRs, but I did lateral arch expansion and lower anteriors' proclination, in order to create interference with the upper arch anteriors and also help to correct the Curve of Spee.
  • I also overcorrected the curve of Spee in the Clincheck to an edge-to-edge bite, to achieve a proper correct overbite.
  • She used Class II elastics full-time in the first set of aligners. In the second set, they were not needed anymore.
  • I was delighted with the outcome in the first set of aligners, where most of the alignment and overbite were already corrected.
  • I used a second set of aligners to correct some rotations, mainly on tooth #4.3, and better align and give proper torque on upper anteriors and tooth #2.4.
  • In the course of her treatment, some old fillings fractured or fell, so I had to replace a few of them, making them "fit" into the aligners. We finished the second set of aligners at the end of 2019.
  • In the course of the next two years, with the Coronavirus pandemic still on, we gradually replaced most of her dental fillings to more proper ones, and I let the occlusion settle. She's 72 now!

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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