Deep bite
,
Class II div 2
,
Increased overjet
,
Narrow arches
,
Asymmetric arches
,
Maxillary midline deviation
,
Midline shift
,
Crowding
,
Rotations

Elastics: Class II
,
Distalization
,
Leveling Curve of Spee
,
Intrusion
,
Expansion
,
Proclination
,
IPR
Courtesy of Dr M. Pedernera, 2019
Before picture of treatment

Treatment Summary

Patient Information

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

Total Treatment Time

  • 22 months

Number of aligners

  • Maxillary: 49 + 13 + 18 = 80
  • Mandibulary: 49 + 13 + 18 = 80

Aligner Wear time

  • 1-week

Results achieved

  • Class I relationship achieved
  • Functional canine guidance on both sides
  • Normal overjet and overbite achieved
  • Significant improvement ofoverbite
  • Midlines coincident
  • Curve of Spee leveled
  • Arches aligned and coordinated
  • Arch form improved
  • Aesthetic smile linewas achieved
  • All treatment goals were achieved case

Comments

  • This case was very challenging for me because it had the most severe deep bite I've ever treated
  • This challenge includes a Severe Brachyfacial and Class II skeletal pattern
  • Significantly favorable is that the patient is very young and the retroclination of both upper and lower incisors will virtually improve the deep bite itself
  • My treatment plan was to expand both arches and de-rotating (especially the 1.6) to improve the patients narrow arches
  • Combined with distalization (aesthetic beginning) of the 1st quadrant.
  • Up to 4 teeth moving together to not only create the distalization of the 1st quadrant but increase anchorage and provoke proclination of the lower incisors
  • I used Class II elastics to increase the anchorage 3/16" 4 and 6 Oz - Nigh time wear
  • IPR was performed in order to minimize the necessity of distalization of the 1st quadrant.
  • Expansion of the lower arch (especially of the premolar area) and proclination of the lower incisors to align the anterior teeth and improve the deep bite
  • Note that in the pictures of intermediate stage I show how I did the intercuspation of the posterior sector by cutting of the molar part of the upper and lower aligner, placing buccal buttons in labial of 1st and 2nd molars using 1/8 6 Oz vertical elastics for 2 weeks

Images

Initial and final

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upper
lower
right
front
left
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upper
lower
right
front
left

Progress

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upper
lower
right
front
left
InitialFinal
Before picture of treatment
After picture of treatment
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Radiographs

Initial Final
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