Correcting a class II div II incisor relationship

This entry was posted on Friday, November 30th, 2018 is filed under Case of the month.

Patients presenting complaint:

This young gentleman attended looking to improve his smile after being recommended by a friend that had also had Invisalign treatment. He didn’t like the crowding of his teeth in particular the UL2 “snaggle tooth” which always catches on his lip.

Initial assessment:

On examination he was found to have fair oral hygiene with a unrestored dentition.  There was a class II div II incisor relationship.

The upper arch had moderate crowding, central incisors are retroclined and the UL2 was proclined in a lip trap at rest.  The lower arch showed moderate anterior crowding. The posterior occlusion was a class I molar and canine relationship with good intercuspation.

An iTero outcome prediction was shown to the patient, after seeing the simulation the patient was very keen to start his Invisalign journey.

Before Invisalign
Before Invisalign
Clincheck plan before and after

Overview of case:

After discussion of options for alignment, including referral to a specialist orthodontist or anterior alignment treatment using fixed or removable orthodontic appliances. The patient opted for a removable appliance treatment with Invisalign system. We discussed alleviating crowding and improving the inclinations of the upper incisors as well as increasing smile width slightly to improve the buccal corridors and round off the currently square arch shape. This mild arch expansion and proclination of the incisors would lessen the requirements for interproximal enamel reduction.

No. of aligners:

The initial plan was for 23 aligners but during treatment, around aligner 16 upper laterals failed to track as planned. A second refinement plan of a further 12 aligners was made.

The alignment was carried out over 10 months and the patient was delighted with the outcome. Treatment was finished with gold standard upper and lower 3-3 fixed retainers, removable Vivera retainers and is currently being finished with a course of home teeth whitening.

After Invisalign
After Invisalign
Before and after Invisalign
Before and after Invisalign

Dr Stewart Beggs qualified from Newcastle University in 2015 and completed his vocational training in central London. He works currently as a Restorative and Cosmetic Dentist in the City of London at Bow Lane Dental Group. Dr Beggs has a special interest in restorative and minimally invasive cosmetic dentistry.