Deepbite
,
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

Treatment information

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

Diagnostic Summary

  • Class II div 2
  • Narrow arches
  • Midline shift
  • Maxillary midline deviation
  • Deepbite
  • Increased overjet
  • Crowding
  • Rotations
  • Asymmetric arches

Use of:

  • Distalization
  • Expansion
  • Intrusion
  • Leveling Curve of Spee
  • Proclination
  • IPR
  • Elastics: Class II
  • Optimized rotation attachment (G3) on Buccal 2.3 (UL3), Buccal 4.3 (LR3), Buccal 4.4 (LR4), Buccal 3.3 (LL3), Buccal 3.4 (LL4), Buccal 3.5 (LL5)
  • Power ridge feature (G3) on Buccal 2.1 (UL1), Buccal 2.2 (UL2)
  • Optimized root control attachments (G4) on Buccal 1.2 (UR2), Buccal 1.4 (UR4), Buccal 1.5 (UR5), Buccal 2.4 (UL4), Buccal 2.5 (UL5)
  • Pressure areas (G5) on Lingual 1.1 (UR1), Lingual 1.2 (UR2), Lingual 2.1 (UL1), Lingual 2.2 (UL2), Lingual 4.1 (LR1), Lingual 4.2 (LR2), Lingual 4.3 (LR3), Lingual 3.1 (LL1), Lingual 3.2 (LL2)
  • Conventional bite ramp on Lingual 1.3 (UR3), Lingual 2.3 (UL3)
Courtesy of Dr M. Pedernera 2019

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
  • Significant improvement of¬†overbite
  • Midlines coincident
  • Curve of Spee leveled
  • Arches aligned and coordinated
  • Arch form improved
  • Aesthetic smile line¬†was achieved
  • All treatment goals were achieved case

Total treatment Time

  • 22 months

Number of aligners

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

Aligner wear time

  • 1-week

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