Science in Every Smile

INVISALIGN TEEN TREATMENT TO CORRECT DEEP BITE AND CLASS II MALOCCLUSION IN AN ADOLESCENT PATIENT

DR JASON NG BDS

CASE REPORT

This case report is intended for dental and healthcare professionals, and is subject to applicable local laws, regulations and guidelines.

INVISALIGN, CLINCHECK, and ITERO ELEMENT, among others, are trademarks and/or service marks of Align Technology, Inc. or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries.

The patient in this case is a 13-year-old female, AC, who first presented at my clinic at age 10. At this age her main concerns were about her deep bite spacing in the upper anterior teeth and rotated upper right lateral incisor. The decision at that stage was to wait and monitor her until her deciduous teeth exfoliated and adult teeth erupted.

CLINICAL FINDINGS

• Angle Class II ½ unit molar relationship on the right side and Class I on the left.

• 5 mm overjet.

• 5/7 mm (71%) overbite.

• 2 mm lower midline discrepancy.

• Retruded upper/lower jaws.

• Maxillary gingival display.

TREATMENT GOALS

• Correct deep bite by intruding upper and lower anterior teeth.

• Correct molar and canine relationship into Class I by using Class II elastics and closing the gaps in the upper left segment.

• Align teeth with the aid of attachments.

• Correct midlines with intra-oral elastics.

TREATMENT APPROACH

For this case the deep bite was corrected by a combination of intrusion of the anterior teeth (upper and lower) and use of precision bite ramps that were placed on palatal surfaces of the upper incisor teeth from the first aligner. The patient started wearing Class II elastics at aligner 7 and continued until the end of aligners to place teeth into a Class I molar/canine relationship. Spaces were closed in the upper left segment to achieve a Class I molar/canine relationship on this side also.

A range of attachments were used depending on the type of movement needed for that particular tooth, including Optimised Attachments. A buccal horizontal rectangular attachment was placed on tooth 42 to help with retention and to ensure that tooth movement stayed on track. Power Ridge features were placed on teeth 12, 44 and 34.

No interproximal reduction was prescribed; however, a medium grit interproximal strip was used as required to clear any binding contact points in the upper and lower arches of the anterior teeth. I also asked for a further 1 mm intrusion of the upper anterior teeth in the ClinCheck treatment planning to gain a satisfactory correction of AC’s deep bite. Class II elastics 3/16” 4½ oz were used. No refinement was required. For retention, a lower fixed 3-3 lingual retainer was placed and an upper clear retainer is currently being worn full time.

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CLINICAL PRESENTATION

AC presented again after her

thirteenth birthday with Class II

malocclusion accompanied by

a larger overjet, deep overbite

and a midline discrepancy. Her

sister had previously had fixed

orthodontic treatment with

braces and AC was keen to

avoid this option.FIGURE 1. INTRA- AND EXTRA-ORAL IMAGES BEFORE TREATMENT

FIGURE 2. PANORAMIC RADIOGRAPH BEFORE TREATMENTFIGURE 3. CEPHALOMETRIC RADIOGRAPH BEFORE TREATMENT

TREATMENT DETAILS

Active Treatment Time

44 weeks.

Aligners Used

• 21 upper and 22 lower SmartTrack aligners were used.

Attachments

• Optimised Attachments, as well as buccal horizontal and vertical rectangular attachments were used.

PRE-TREATMENT

Throughout the course of treatment the patient has been highly motivated, wearing the aligners for at least 22 hours a day and changing fortnightly.

TREATMENT OUTCOME

Throughout the course of treatment the patient has been highly motivated, wearing the aligners for at least 22 hours a day and changing fortnightly. We have seen her regularly and she has not missed any appointments. At the time of writing this report the patient is 6 months post-active treatment and is now in retention.

This case study demonstrates that the Invisalign System can be a suitable and good choice for adolescent patients, who are still growing and have a deep bite and Class II half unit malocclusion. The patient in this case is very happy with the result of her Invisalign treatment.

Clinical Tips

1. Spend quality time analysing and adjusting the patient’s ClinCheck treatment plan before approving treatment. This reduces potential stress caused to the physician and patient by saving time and minimising the need for extra impressions and aligners with refinement or additional aligner orders. For rotations I usually ask for a further 10

This case report is intended for dental and healthcare professionals, and is subject to applicable local laws, regulations and guidelines.

INVISALIGN, CLINCHECK, and ITERO ELEMENT, among others, are trademarks and/or service marks of Align Technology, Inc. or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries.

This case report is intended for dental and healthcare professionals, and is subject to applicable local laws, regulations and guidelines.

INVISALIGN, CLINCHECK, and ITERO ELEMENT, among others, are trademarks and/or service marks of Align Technology, Inc. or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries.

POST-TREATMENT

FIGURE 4. INTRA- AND EXTRA-ORAL IMAGES AFTER TREATMENT

Science in Every Smile

CONCLUSION

This case demonstrates the effectiveness of Invisalign aligners with anterior bite ramps for correction of deep bite in a compliant, growing patient. The reduction of the deep bite here was 2.4 mm and I would have found this difficult to achieve in a fixed appliance situation without the use of temporary anchored devices.

Author disclosureDr Jason Ng was provided an honorarium from Align Technology, Inc., for his contribution towards the creation of this case report.

Dr Jason Ng Jason Ng has been practising dentistry for over 25 years. He completed his degree in dentistry in 1989 at Otago University, New Zealand. Having extensively travelled and worked overseas in Asia and Europe, he returned to New Zealand in 1994 and is currently a partner at Titirangi Dental Centre, Auckland. In 2011 Dr Ng was recognised as one of New Zealand’s top Invisalign providers and awarded the Platinum Invisalign Provider status. In 2013 he was once again one of New Zealand’s top Invisalign providers, as well as the top Invisalign Teen provider.

degrees of rotation and at least an extra 1 mm when intruding anterior teeth at the end of aligners. The extra aligners, if not needed, do not need to be used.

2. Check that all teeth have appropriate attachments placed for the particular tooth movement. I find placing a horizontal attachment on the lower second premolar (where appropriate) can aid improvement of retention of the lower aligners, especially when the use of Class II elastics is required.

3. Patient compliance is vital in a successful outcome, in terms of wearing the aligners and using the elastics.

4. Invisalign is my first choice when choosing to intrude anterior teeth for the correction of a deep bite for patients with a larger maxillary gingival display. With the aid of an anterior precision bite ramp and attachments on the premolar teeth for anchorage a successful outcome can be achieved.

FIGURE 5. PANORAMIC RADIOGRAPH AFTER TREATMENT

FIGURE 6. CEPHALOMETRIC RADIOGRAPH AFTER TREATMENT

This case report is intended for dental and healthcare professionals, and is subject to applicable local laws, regulations and guidelines.

INVISALIGN, CLINCHECK, and ITERO ELEMENT, among others, are trademarks and/or service marks of Align Technology, Inc. or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries.

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