case_images: PMC10907105_01
case_images: 24-year-old female patient with a unilateral right scissor bite, with dental overeruption and very negative torque in the mandibular arch bilaterally: (a) profile photo; (b) smile; (c) overjet view; (d-f) intraoral photos in maximum intercuspation/centric relation; (g) protrusive guide; (h/i) occlusal photos.
case_images: CRID2024-8841829.001.jpg
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case_images: fig1
case_images: The patient has a convex profile (Figure 1(a)). A deep bite with pronounced cant was noted in the lower occlusal plane, on the side of the scissor bite (Figure 1).
case_images: (a) Initial panoramic X-ray, (b) teleradiograph, and (c) cephalometry.
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case_images: fig2
case_images: In a first stage, tooth 1.8 was maintained despite not having its opponent, to promote anchorage to move the adjacent teeth with more predictability (Figure 2).
case_images: Initial ClinCheck  (version 6.0): (a) beginning; (b) planned. Blue dots:moderate movements; black dots:complex movements.
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case_images: fig3
case_images: The patient's treatment approach included the Invisalign  system (Align Technology, San Jose, California, USA) with inter-radicular MS between the upper right molars, connected to buccal buttons, for maxilla compression (Figures 3-5).
case_images: Initial ClinCheck : (a/c) initial and (b/d) planned occlusal contacts.
case_images: CRID2024-8841829.004.jpg
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case_images: fig4
case_images: The patient's treatment approach included the Invisalign  system (Align Technology, San Jose, California, USA) with inter-radicular MS between the upper right molars, connected to buccal buttons, for maxilla compression (Figures 3-5).
case_images: Start of treatment with placement of aligners that were cut into the occlusal surface of the 3rd quadrant, to attach bite ramps to allow the unblocking of the right side. Correction of the scissor bite with MS using elastics and buttons; MS in the mandible: retromolar trigone and mandibular inter-radicular between teeth 44 and 45; miniscrew in the maxilla: palatal inter-radicular between teeth 16 and 17.
case_images: CRID2024-8841829.005.jpg
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case_images: fig5
case_images: The patient's treatment approach included the Invisalign  system (Align Technology, San Jose, California, USA) with inter-radicular MS between the upper right molars, connected to buccal buttons, for maxilla compression (Figures 3-5). On the other hand, for mandible expansion, two MS were placed: one in the retromolar trigone; and one inter-radicular between the right premolars, buccally, associated with elastics to lingual buttons on teeth 47, 46, 45, and 44 (Figure 5). Primarily, bite ramps were placed to promote scissor bite disocclusion, first on the left side on the lower molars (Figure 5), but soon replaced for larger bite ramps on the palatal face of upper canines, just before the additional aligners (Figure 6).
case_images: Removal of the occlusal ramps on teeth 36 and 37 and bite ramps placement in the upper canines. Vertical elastics on the left side to promote posterior intercuspation.
case_images: CRID2024-8841829.006.jpg
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case_images: fig6
case_images: Primarily, bite ramps were placed to promote scissor bite disocclusion, first on the left side on the lower molars (Figure 5), but soon replaced for larger bite ramps on the palatal face of upper canines, just before the additional aligners (Figure 6). A vertical component elastic was used on the left side to promote posterior intercuspation and removed before first additional aligners (Figures 6 and 7).
case_images: (a) Occlusal upper view; (b) overjet view; (c) left lateral photo to note the increased the left open bite due to the previous left posterior bite ramps, before the first additional aligners.
case_images: CRID2024-8841829.007.jpg
case_images: PMC10907105_01_CRID2024-8841829.007.jpg
case_images: fig7
case_images: A vertical component elastic was used on the left side to promote posterior intercuspation and removed before first additional aligners (Figures 6 and 7).
case_images: First additional aligners ClinCheck : (a) beginning; (b) planned.
case_images: CRID2024-8841829.008.jpg
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case_images: fig8
case_images: First additional aligners, with asymmetric crossed elastics.
case_images: CRID2024-8841829.009.jpg
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case_images: fig9
case_images: Photos of the end of 1st additional aligner stage, 1 year after the treatment beginning: (a) profile photo; b) smile; (c) overjet view; (d-f) intraoral photos in maximum intercuspation/centric relation; (g) protrusive guide; (h/i) occlusal photos.
case_images: CRID2024-8841829.010.jpg
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case_images: fig10
case_images: Second additional aligners ClinCheck : (a) beginning; (b) planned.
case_images: CRID2024-8841829.011.jpg
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case_images: fig11
case_images: Removal of the MS: (a) class II elastics on the right side and (b) class III elastics on the left side to improve the asymmetry.
case_images: CRID2024-8841829.012.jpg
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case_images: fig12
case_images: II elastics were placed on the right side, as well as a Class III elastics on the left side to stabilize the sagittal occlusion, even considering the lower dental asymmetry (Figure 12). In the second additional aligner stage, #48 of #52 aligners were used.
case_images: Final photos, 2 years after the treatment beginning: (a) profile photo; (b) smile; (c) overjet view; (d-f) intraoral photos in maximum intercuspation/centric relation; (g) protrusive guide; (h/i) occlusal photos.
case_images: CRID2024-8841829.013.jpg
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case_images: fig13
case_images: Despite the sagittal maintenance of the dental Class II on the right side, there was occlusal stability and improvement of the occlusion vertical dimension (Figure 13).
case_images: (a) Final panoramic X-ray, (b) teleradiograph, and (c) cephalometry.
case_images: CRID2024-8841829.014.jpg
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case_images: fig14
case_images: Presence of the wisdom teeth only on the left side did not collide with our case stability (Figure 14(a)). On post-treatment cephalometric analysis, the following can be found: an hypodivergent biotype with similar value of FMA in the initial and final phase of treatment (FMA = 21.5  to FMA = 21.4 ); pronounced skeletal Class II (convexity of the A point = 7.1 mm to convexity of the A point = 7.2 mm); class II at the ANB level (ANB = 7.2  to ANB = 7.7 ); pronounced alveolar Class II (A-B distance = 9.8 mm to A-B distance = 10.6 mm), with normomaxilla where values do not change during treatment (SNA = 83.7  maintenance) and retromandible (SNB = 76.5  to SNB = 76.0 ); and normal interincisal angle (129.7  to 129.2 ), with accentuated retroclination of the upper incisors (UI/NA = 10.1  to UI/NA = 10.7 ) and proclination of the lower incisors (IMPA = 105.4  to IMPA = 105.5 ) (Figures 14(b) and 14(c)).
case_images: Superimposition of the initial tracing (black) and final tracing.
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case_images: fig15