Treatment progress
The patient was referred to the surgeon to extract wisdom teeth before
the start of treatment. The ClinCheck virtual set up dictated 44 steps
for each arch (Fig. 2). In the upper arch, sequential
distalisation was planned to gain space for retraction of incisors,
achieving optimal overjet and class I canine and molar relationships
bilaterally. Attachments were planned on most of the teeth to guide
their movement and control their axes. Vertical attachments were planned
for molars and premolars to avoid tipping and aid in bodily movement.
The paired vertical root control attachments on the canines bilaterally
to help achieve bodily movement and control their long axes during
distalization. Horizontal attachments were planned on upper incisors for
extra retention and firmer grip of the aligner.
Class II elastics (3/16inch, heavy force 4.5 oz) were used to augment
the movement. The elastics extended from the upper premolars to lower
molars. The benefit of using short class II elastics is to prevent any
clockwise rotation and bite deepening that might happen due to extrusion
of anterior teeth. Intermaxillary elastics were hooked from notches in
the upper aligners at first premolar to buttons that were bonded on the
lower molars. The lower arch crowding was relieved by the expansion
effect of the aligners and the proclination of the lower incisors. The
patient was instructed to wear each aligner for 22 h per day and to move
on to the next one in the series after 14 days. Mid treatment records
are presented in (Fig. 3).