Did you know that many people still believe that Invisalign is unable to treat severe bite problems like an overbite?
Since its launch in 1998 Invisalign has had advanced a lot – before being able to treat mild cases gradually, the innovative clear brace system can now address more serious bite issues.
But how does Invisalign perform for deep overbites? Does it affect the treatment time or cost? And most of all; does it work?
Below, we’ll show you a case study from a recent deep bite Invisalign case that saw a patient resurrect her smile and straighten wonky teeth.
Problem: Adult patient concerned about a deep bite and uneven teeth presented a class II malocclusion as well as reduced vertical facial heights.
Main features of the malocclusion:
- Traumatic overbite
- Severe crowding in both upper and lower arches
- Class II buccal segment
- Increased overjet
- V-shaped upper arch
- Severe class 2 malocclusions difficult to treat due to the deep overbites
- More of a challenge compared to adolescent patients where growth is used to correct any vertical discrepancies
- Increased overjet and severe crowding increases the complexity of the case
- Occlusal correction required more considerable thought and care
- The need to be meticulous with anchorage planning
Other prescribed traditional routes:
Upper extractions and fixed appliances. However, the particular patient wished not to entertain any visible components so clear aligners had to be used to save the day.
Overcoming traditional anchorage methods
In typical orthodontics, anchorage is a way orthodontists resist the movement of a tooth by using various methods.
Therefore, it becomes a vital consideration when planning for and correcting complex malocclusion cases.
Typical forms of anchorage usually include headgear, extraction patterns, transpalatal arches, TADs or mini-screws.
However, in this case, sequential distalisation created space to align the crowded teeth and correct the class II buccal segments.
Sequential distalisation is a feature that is often used with complicated Invisalign cases, which focuses on distalising one tooth at a time.
The process begins with the upper second molars, then the upper first molars moving back, then premolars and so on until the retraction of the four incisors.
What this means for treatment
Sequential distalisation can be a long process, which will increase the number of aligners that are used during a treatment plan.
To progress efficiently, patients are put on weekly aligner changes until this section of the treatment has been completed.
“To prevent retroclination of the upper labial segment whilst using class II traction and to ensure the anterior teeth are maintained to a good inclination, it is wise to consider factoring increased buccal crown torque during the prescription stage of the patient’s Invisalign journey.” dentistry.co.uk
With this case, the Invisalign technician requested to level the arc of the Spee by extruding the bottom premolars at a rate of 0.15mm per stage for a total of 3mm and by intruding the lower canine to canine a total of 4mm.
Attachments were also positioned on the lower premolars as occlusal as possible without any interferences with the opposite arch. This ensured a more predictable outcome.
The key here was to finish the deep-bite case with an interincisal angle between 125 and 125 degrees for stability purposes.
Neil Patel’s Invisalign case study was published originally on dentistry.co.uk in 2019.