Class II div 2
,
Posterior crossbite
,
Deep bite
,
Narrow arches
,
Midline shift
,
Crowding
,
Rotations

Distalization
,
Intrusion
,
Expansion
,
Proclination
,
IPR
,
Elastics: Class II
Courtesy of Dr. K. Malekian, 2016
Before picture of treatment

Treatment Summary

Patient Information

  • Age: 36
  • Gender: female
  • Invisalign Treatment Option: Full

Total Treatment Time

  • 35 months

Number of aligners

  • Maxillary: 51 + 25 + 16 = 92
  • Mandibulary: 47 + 25 + 16 = 88

Aligner Wear time

  • Treatment aligner change every 14 days.Refinement aligner change every 7 days.

Retention

  • Maxillary: Vivera
  • Mandibular: Vivera

Results achieved

  • Class I relationship achieved
  • Class I relationship maintained
  • Functional canine guidance on both sides
  • Posterior crossbite corrected
  • Normal overjet and overbite achieved
  • Deepbite improved
  • Overjet improved
  • Significant improvement ofoverbite
  • Significant improvement of overjet
  • Midlines coincident
  • Proper axial inclination of incisors
  • Curve of Spee levelled
  • Arches aligned and coordinated
  • Alignment of both arches through derotation
  • Arch form improved
  • Aesthetic smile linewas achieved
  • All treatment goals were achieved case
  • Harmonic arches were achieved

Comments

  • Important Step: Strategy for CC in order to have a predictable upper distalization. We all know that the combination of distalisation + expansion is not so predictable..lets say that distalisation is a complicated movement and it requires a pure distal vector. When you combine distalisation and expansion its easy to loss track and anchorage so tracking issues can occur.
  • From UL3-UR3 AESTHETIC START MOTIVATION & UPPER RIGHT POSTERIOR IN, SIMULTANEOUSLY. From UL1-UR1-UR2 there is proclination of upper anterior in order to improve also torque of upper anterior ( when distalisation reaches upper anterior we need a correct torque of upper anterior in order to retract tem correctly).Also from U1-U13 we lingualize UR7 in order to correct the scissor bite with LR7.Four in a row means that before starting upper right distalisation we need to align UR7,UR6,UR5,UR4 in order to have a predictable pure distalisation on upper right side..
  • Retraction of upper anterior followed by intrusión of upper incisors.
  • Full time aligner+ Class II elastics wear from U13 ( start of upper right distalisation) to the end of treatment.
  • Upper right side distalisation 3.25mm in order to achieve space for a) align high erupted buccal canine b) correct class II molar and canine into class I mmolar and canine
  • Lingual conventional bite ramps at lingual of UR1,UL1 improves intrusión predictability to correct the Deep bite.
  • Important achievement: The patient only had one molar on the lower right side.Due to lower molar distalisation with invisalign technique ( 4.35mm total mm distalisation ) we achieved the space necesssary for implant placement and improve occlussion of the right side.

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

Initial
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