Invisalign Submission Option: Invisalign Comprehensive

Year: 2024

Difficulty Level: Intermediate

Age: 20

Treatment Time: 1 year 11 months 20 days

Gender: Female
Dr. Ching Cheng Hsu
18996

Invisalign Comprehensive

Patient Chief Concern
My teeth are crooked, and I feel like the center of my lower front teeth is shifted to the right.

What learning would you share with other Invisalign providers?
In patients with mandibular asymmetry, Invisalign clear aligner therapy allows for precise, individualized tooth movement while respecting the existing dentoalveolar compensation. Compared with conventional fixed-appliance mechanics, this approach may help minimize unintended interference with the patient’s natural compensatory occlusal relationship.

What contributed most to this treatment being successful?
Sequential distalization was successfully achieved in the second and third quadrants. In the second quadrant, distalization provided space for maxillary crowding relief and allowed mild leftward correction of the maxillary dental midline. In the third quadrant, distalization created space for mandibular anterior retraction, thereby facilitating correction of the anterior crossbite and improving the mandibular dental midline deviation related to the underlying facial asymmetry.

Clinical Indications

  • Anterior crossbite
  • Asymmetric arches
  • Class I
  • Crowding
  • Facial/dental midline descrepancy
  • Mandibular midline deviation
  • Maxillary midline deviation
  • Narrow arches
  • Rotations
The primary clinical problem was skeletal in nature, characterized by facial asymmetry with rightward mandibular deviation. This mandibular deviation resulted in an anterior crossbite involving teeth #12 and #13 with teeth #42 and #43, accompanied by rightward deviation of the mandibular dental midline. A mild rightward deviation of the maxillary dental midline was also observed. Furthermore, anterior space deficiency was present in both the maxillary and mandibular arches.

Modalities

  • Distalization
  • Elastics: Class III
  • Intrusion
  • IPR
  • Leveling Curve of Spee
  • Retraction
  • TADs
A left infrazygomatic crest TAD was placed to provide skeletal anchorage for asymmetric distalization in the second and third quadrants. Class III elastics from tooth #33 to the IZC TAD facilitated distalization of the mandibular left dentition, creating space for mandibular anterior retraction and contributing to correction of the anterior crossbite and rightward mandibular dental midline deviation. Meanwhile, a power chain from tooth #23 to the IZC TAD was used to distalize the maxillary left dentition, providing space for crowding relief and mild leftward correction of the maxillary dental midline.

Treatment Information

Retainer: Other clear
Smartforce: Conventional and Optimized
Submission Process: Intra-oral scan
Length of Treatment: 23 months
Additional Aligners: 2
Number of Aligners:
Initial Additional Total
Maxillary 49 49 98
Mandibular 49 49 98
Aligner Wear Time: 7 days

Images

Initial
Final
Progress

Radiographs

ClinCheck

Summary

Optimal inter-cuspation was established, along with stable Class I canine and molar relationships and ideal overjet and overbite. Distalization of the third quadrant contributed to correction of the rightward mandibular dental midline deviation.
d

Per conubia nostra, per inceptos hime
Mauris in erat justom etone. Per conub
per inceptos hime naeos.

Where to find us

Social Share