Mandibular midline deviation
,
Crowding
,
Deepbite
,
Increased overjet
,
Narrow arches
,
Midline shift
,
Pre-restorative
,
Rotations

Distalization
,
Mesialization
,
Leveling curve of Spee
,
Intrusion
,
Expansion
,
Proclination
,
IPR
,
Restorative
,
Implants

Treatment information

  • Age: 47
  • Gender: female
  • Invisalign Treatment Option: Invisalign Full

Diagnostic Summary

  • Class I
  • Narrow arches
  • Midline shift
  • Mandibular midline deviation
  • Maxillary midline deviation
  • Deepbite
  • Increased overjet
  • Crowding
  • Rotations
  • Pre-restorative

Use of:

  • Distalization
  • Mesialization
  • Expansion
  • Intrusion
  • Leveling Curve of Spee
  • Proclination
  • IPR
  • Restorative
  • Implants
  • Optimized rotation attachment (G3) on Buccal 2.4 (UL4), Buccal 4.3 (LR3), Buccal 3.3 (LL3)
  • Power ridge feature (G3) on Buccal 1.1 (UR1), Buccal 2.1 (UL1)
  • Optimized root control attachments (G4) on Buccal 1.3 (UR3), Buccal 1.4 (UR4), Buccal 2.3 (UL3), Buccal 2.5 (UL5), Buccal 4.4 (LR4), Buccal 4.5 (LR5), Buccal 3.4 (LL4), Buccal 3.5 (LL5)
  • Pressure areas (G5) on Lingual 1.1 (UR1), Lingual 1.2 (UR2), Lingual 2.1 (UL1), Lingual 4.1 (LR1), Lingual 4.2 (LR2), Lingual 4.3 (LR3), Lingual 3.1 (LL1), Lingual 3.2 (LL2)
Courtesy of Dr M. Pedernera 2018

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

Treatment summary

Results Achieved

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

Total treatment Time

  • 17 months

Number of aligners

  • Maxillary: 28 + 25 + 14 = 67
  • Mandibular: 28 + 25 + 14 = 67

Aligner wear time

  • 2 weeks at the beggining of the treatment and every 1 week until the end

Comments

  • This case was challenging taking into account the amount of mm of overbite
  • The main issue was to solve the crowding of the lower teeth and creating at least 7 mm of space for the implant of 1.5
  • The treatment plan was to expand both arches
  • In the first Clincheck I requested to mesialize the 1.4 and 1.3, adding IPR to the upper left quadrant in order to obtain space for the mesialization and also to center the upper mid-line to the left
  • Because the excess of Bolton 6 in the lower arch I applied IPR to compensate this
  • During the treatment 2.8 was extracted because of premature contacts with extruded 3.8
  • Patient was advised to extract all of them, but at this time, the patient is not ready to consent