Authors’ Contributions:
Waddah Sabouni: Treatment of the case, supervision and treatment planning of the case.
M. Srirengalakshmi : Writing the case report and revision.
Nikhilesh Vaid: Conceptualization, visualization, supervision and diagnosis of the case.
Samar M. Ade l: Writing the case report, data curation, analysis and interpretation of findings and proofread the final manuscript.
ABSTRACT:
Background: To describe an esthetic orthodontic treatment using aligners in an adult patient with dental class II malocclusion associated with crowding. A 25-year-old female patient with skeletal class I, bilateral class II relation, increased overjet and overbite and crowding in both arches presented for orthodontic treatment. The patient refused conventional fixed multibracket treatment in favor of aligners. Pre- and post-treatment records are presented.
Findings: Treatment objectives were achieved in 10 months, and the patient was satisfied with the functional and esthetic outcomes.
Conclusions: Combining aligners with appropriate attachment location and geometry is an efficacious means of resolving orthodontic issues such as class II malocclusion in a time-frame comparable to that of conventional fixed orthodontics. Staging in distalization increases the predictability of movement. Furthermore, this system is associated with optimal oral hygiene and excellent esthetics.
KEY WORDS: Clear Aligners, Invisalign, Class II, Distalization, Adult Orthodontics, Attachments, Staging.
INTRODUCTION
The global prevalence of Class II malocclusions in permanent dentition is 19.56% [2 - 63%]. Globally, it is considered to be the second most common malocclusion and the most common malocclusion in Caucasian adults.1 Many treatment options are available for the correction of Class II malocclusion in adult patients including extractions, lower molar protraction and upper molar distalisation.2-3
Nowadays, there is an increasing demand for esthetic treatment among both adolescents and adults. The scope of Clear Aligner Therapy (CAT) has improved dramatically over the past decade. Originally directed toward the correction of mild orthodontic problems in adults,4-5 this approach became more challenging when applied to complex anteroposterior discrepancies and orthodontic movements such as posterior intrusion, anterior extrusion and torquing.2
Obviously, successful treatment with clear aligners involves much more than moving teeth virtually by a software.6-7 The application of adjunctive biomechanics through the addition of orthodontic attachments, elastics, and other devices has certainly created more individualized options for more predictable tooth movement across a wider range of malocclusions. Though scholarly literature for treating complex cases is still in its early phase, published case reports have demonstrated satisfying outcomes with complex cases, such as those involving Class II malocclusions.8-9Furthermore, the precision of movements has improved exponentially in recent years reaching values of 70% to 80% due to the continuous research performed by Align Technology and the incorporation of attachments and auxiliaries in the treatment protocols.10
On another note, considering that patients treated with CAT have experienced better quality of life scores and better oral hygiene during treatment, clinicians are driven to proceed further with treatment of challenging cases using CAT.11
To quantify the amount of tooth movement by CAT, 2D lateral cephalograms as well as different digital model registration softwares have been utilized.12-13
This case report describes a case with an effective staging protocol and attachment geometry planning with the Invisalign system in an attempt to correct class II malocclusion in an adult patient.
Case description and results