Class II div 1, Increased overjet, Narrow arches, Posterior crossbite

Elastics: Class II, Expansion, Intrusion, IPR

Treatment information

  • Age: 30
  • Gender: male
  • Invisalign Treatment Option: Full

Diagnostic Summary

  • Class II div 1 relationship
  • Narrow Arches
  • Posterior Crossbite
  • Increased overjet
  • Asymmetric arches

Use of:

  • Expansion
  • Intrusion
  • IPR
  • posterior cross elastics
  • Optimized Rotation Attachment (G3) on Buccal 1.3 (UR3), Buccal 1.5 (UR5), Lingual 1.4 (UR4), Buccal 3.4 (LL4)
  • Optimized Root Control Attachments (G4) on Buccal 2.3 (UL3), Buccal 2.4 (UL4), Buccal 4.5 (LR5), Buccal 3.5 (LL5)
Courtesy of Dr D. Smethurst 2018


Click to compare enlarged
Click to compare enlarged


ClinCheck treatment plan

video anterior
video right-left
video upper-lower

Treatment summary

Results Achieved

  • Functional canine guidance on both sides
  • Posterior crossbite corrected
  • Normal  overjet and overbite achieved
  • Significant improvement of overjet
  • Midlines coincident
  • Proper axial inclination of incisors
  • Arches aligned and coordinated
  • Aesthetic smile line was achieved
  • All treatment goals were achieved case

Total treatment Time

  • 19 months

Number of aligners

  • Maxillary: 21 + 9 = 30
  • Mandibular: 24 + 9 = 33

Aligner wear time

  • 2-weeks


  • The use of intermaxillary cross elastics to bonded buttons assisted with complicated and unpredictable, teeth movement, such as maxillary expansion, was necessary, especially in this non-growing patient.
  • The use of cross elastics allowed good tracking of the treatment throughout the planned tooth movements.
  • Full occlusal coverage of all erupted teeth allowed excellent control of the vertical dimension in this patient with a vertical growth pattern.
  • The ‘end-on-end’ right buccal segment relationship was due in part to mesial migration of the upper right buccal segment, an asymmetric upper arch, Bolton’s discrepancy with relative mandibular excess, and small teeth 12 and 22.
  • The patient wanted to avoid restorative veneer build-ups of teeth 12 and 22. Additionally, distalization in the upper right quadrant was not advisable due to the underlying Class III skeletal pattern.
  • This treatment decision to not fully correct the right buccal segment relationship was independent of the Invisalign System.
  • An aesthetic and functional occlusion was achieved despite us not attempting to fully correct the right buccal segment relationship.