Class II div 2, Crowding, Deepbite, Narrow arches, Midline shift

IPR, Expansion, Intrusion, Proclination, Extrusion, Distalization, Elastics: Class II

Treatment Information

  • Age: 25
  • Gender: female
  • Invisalign Treatment Option: Full

Diagnostic Summary

  • Class II div 2 relationship
  • Narrow Arches
  • Midline Shift
  • Deepbite
  • Crowding

Use of:

  • Distalization
  • Elastics: Class II
  • Levelling Curve of Spee
  • Expansion
  • Extrusion
  • Intrusion
  • Proclination
  • IPR
  • Power Ridge Feature on Buccal 3.1 (LL1)
  • Optimized Rotation Attachment (G3) on Buccal 1.4 (UR4), Buccal 2.5 (UL5), Buccal 4.3 (LR3), Buccal 3.3 (LL3)
  • Multi-Tooth Extrusion Attachments (G4) on Buccal 1.1 (UR1), Buccal 1.2 (UR2), Buccal 2.1 (UL1), Buccal 2.2 (UL2)
  • Precision Bite Ramp (G5) on Lingual 1.1 (UR1), Lingual 1.2 (UR2), Lingual 2.1 (UL1), Lingual 2.2 (UL2)
  • Pressure Areas (G5) on Lingual 4.2 (LR2)
  • Optimized DeepBite Attachments for Anchorage (G5) on Buccal 4.4 (LR4), Buccal 4.5 (LR5), Buccal 3.4 (LL4), Buccal 3.5 (LL5)
Courtesy of Dr M. Pedernera 2017

Photos

Click to compare enlarged
upper
Initial
lower
right
front
left
Click to compare enlarged
upper
Final
lower
right
front
left
Click to compare enlarged
upper
Progress
lower
right
front
left

Radiographs

ClinCheck Treatment Plan

video anterior
video right-left
video upper-lower
Download ADF files
Initial
Additional Aligners

Treatment Summary

Results Archieved

  • Class I relationship achieved
  • Functional canine guidance on both sides
  • Normal¬† overjet and overbite achieved
  • Deepbite improved
  • Midlines coincident
  • Proper axial inclination of incisors
  • Curve of Spee levelled
  • Arches aligned and coordinated
  • Arch form improved
  • Aesthetic smile line¬†was achieved
  • All treatment goals were achieved case
  • Harmonic arches were achieved

Total treatment Time

  • 19 months

Number of aligners

  • Maxillary: 34 + 14 = 48
  • Mandibular: 26 + 14 = 40

Aligner wear time

  • At the begging of the treatment every 2 weeks but gradually changed to 1 week

Comments

  • This case was very challenging for me because because it was an Advanced case.
  • The main issue was to solve the crowding of the upper teeth and the high position of 1.2 as well correct the sagital problem.
  • So basically my plan was to distalize the upper arch using the 1/2 protocol and moving maximun two teeth at the time with an aesthetic beginning proclining the upper incisors. To increase the anchorage i used Class II elastics.
  • Also made expansion of both the upper and lower to improve the buccal corridors due to the narrow arches situation, at the same time in the first Clincheck I manage to make extrusion of 1.2.
  • One of the important things in my opinion in this case is the fact of taking the bite records and pictures of the initial situation by centering the mandible (centering the midlines) and setting the starting point of the treatment from this position.
  • In this way i reduced the number of aligners for the first stage.
  • The extraction of the four third molars was done before starting the treatment.
  • A very short phase of additional aligners was necessary to end up in a beautiful finishing and functional occlusion.
  • I have to recognize that her cooperation during the treatment was 10 out of 10.