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

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

Treatment in the Spotlight

We would like to congratulate Dr. Pedernera with winning the 2018 EMEA Peer Review Awards!

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
Award 2018 Peer Review Awards


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ClinCheck treatment plan

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

Treatment summary

Results Achieved

  • 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 start of the treatment every 2 weeks, gradually changed to 1 week


  • This case was an Advanced case and was a good challenge for me.
  • 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.
  • My plan was to distalize the upper arch using the 1/2 protocol and moving a maximum of two teeth at the time, with an aesthetic beginning proclining the upper incisors.
  • For increased 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, at the same time in the first Clincheck I manage to create extrusion of 1.2.
  • In my opinion one of the important things in this case was 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.
  • This helped to reduce 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 finish the treatment with a beautiful and functional occlusion.
  • The patients cooperation during the treatment was 10 out of 10.