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