Mandibular midline deviation
,
Class III
,
Crowding
,
Narrow arches
,
Midline shift
,
Rotations

Elastics: Class II
,
Distalization
,
Mesialization
,
Leveling curve of Spee
,
Extrusion
,
Intrusion
,
Expansion
,
Proclination

Treatment information

  • Age: 13
  • Gender: female
  • Invisalign Treatment Option: Invisalign Teen

Diagnostic Summary

  • Class I
  • Class III
  • Narrow arches
  • Midline shift
  • Mandibular midline deviation
  • Crowding
  • Rotations

Use of:

  • Distalization
  • Mesialization
  • Expansion
  • Extrusion
  • Intrusion
  • Leveling Curve of Spee
  • Proclination
  • Elastics: Class II
  • Optimized rotation attachment (G3) on Buccal 2.5 (UL5), Buccal 4.4 (LR4), Buccal 3.3 (LL3)
  • Power ridge feature (G3) on Buccal 2.1 (UL1), Buccal 4.1 (LR1), Buccal 4.2 (LR2), Buccal 3.1 (LL1), Buccal 3.2 (LL2)
  • Optimized root control attachments (G4) on Buccal 1.2 (UR2), Buccal 1.3 (UR3), Buccal 2.2 (UL2), Buccal 2.3 (UL3), Buccal 2.4 (UL4)
  • Optimized deepbite attachments for anchorage (G5) on Buccal 1.4 (UR4)
  • Pressure areas (G5) on Buccal 1.2 (UR2), Buccal 2.2 (UL2), Lingual 4.1 (LR1), Lingual 4.2 (LR2), Lingual 4.3 (LR3), Lingual 3.1 (LL1), Lingual 3.2 (LL2), Lingual 3.3 (LL3)
  • Precision bite ramp (G5) on Lingual 1.1 (UR1), Lingual 1.2 (UR2), Lingual 2.1 (UL1), Lingual 2.2 (UL2)
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
  • Proper axial inclination of incisors
  • Curve of Spee levelled
  • Arches aligned and coordinated
  • Alignment of both arches through derotation
  • Arch form improved
  • Aesthetic smile line was achieved
  • All treatment goals were achieved case
  • Harmonic arches were achieved

Total treatment Time

  • 28 months

Number of aligners

  • Maxillary: 50 + 16 + 21 = 87
  • Mandibular: 50 + 16 + 21 = 87

Aligner wear time

  • Every 2 weeks the first set of aligners and every week in the Additional Aligners

Comments

  • To create space for a future implant in the zone of 4.5 I planned on distalizing 4.6 and 4.7
  • Mesialization on 4.4, 4.3 created the opportunity to correct the lower midline and upright the tipped lower incisors
  • The space for the eruption of 3.5 was bigger than needed therefor we distalized 3.4 and 3.3 in order to create a more organic space
  • To solve the deep bite I planned intrusion of lower anterior teeth and intrusion on 3.7 and 4.7, with mild extrusion of lower premolars and first molars.
  • To help with the intrusion we used precision bite ramps in palatal of 1.2, 1.1, 2.1 and 2.2.
  • Upper jaw sequenced expansion by 1/2 protocol and expansion of the posterior teeth
  • De-rotation of 1.6 and 2.6 before aligning the anterior teeth and retruding them
  • The cooperation of the patient during the hole treatment was absolutely fantastic