Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 39

Case Report

How would you treat this malocclusion?
Posttreatment
Case C.N. 15 years, 11 months
Treatment Objectives
The major treatment objectives were to
bring in the impacted maxillary canines and
establish Class I canine and molar relationships on both sides. Other treatment objectives were to increase the lower anterior
facial height, correct her deep bite, level the
curve of Spee, intrude the maxillary incisors
to reduce the gummy smile, and move the
maxillary dental midline to the left to center
it with the facial midline. We intended to
improve her profile with any residual mandibular growth, but this was unlikely as she
was already postmenarchal and at Cervical
Vertebral Maturation stage 5 (Figure 3).
Treatment Alternatives
Two options were provided to the patient
and her parents:
Option 1: Comprehensive treatment with
a fixed appliance. Extract primary teeth A,
C, H, and J, and refer to an oral surgeon to
perform closed exposure of the impacted
U3s and bond buttons with gold chains.
Place a transpalatal arch with hooks, tie in
the bonded chains on the exposed maxillary
canines to these hooks, and pull them distally and facially. Bond bite turbos behind the
U1s to facilitate bite opening; bond brackets
on these two canines when having enough
clinical crown height, and tie into the arch.
Support with Class II elastics to correct the
Class II molar relationship.
Option 2: Comprehensive treatment with
Invisalign clear aligners. Extract primary teeth
A, C, H, and J, and refer to an oral surgeon
for open exposure of the impacted U3s. Use
clear aligners to create space for the impacted
canines by pushing the U2-2 labially so that
space can be created, and move the roots

Spring 2021    PCSO Bulletin	

farther away from the clinical crowns of the
impacted canines. Start to level and align the
arches as the patient wears interarch elastics
to move the impacted U3s away from the
U2-2 roots, and bring them into the arch after
open exposure. Bond bite turbos on U1s to
help with bite opening, and apply Class II elastics to achieve a Class I molar relationship.
The patient chose option 2 because she did
not want to have braces during high school.
She was willing to do whatever it took to be
treated with clear aligners alone.
Treatment Progress
Before the initial intraoral scan, the biteplane type of bite turbos were temporarily
bonded using a DynaFlex mini mold on the
lingual sides of the U1s. After the scan was
done with an iTero Scanner, these bite turbos were removed to prevent any changes
in the initial occlusion before the delivery of
the clear aligners, but they were placed back

on the start date with the clear template. Afterward, the patient was referred to an oral
surgeon for open exposure of the impacted
maxillary canines. At the same time, the
planned Invisalign aligners were prescribed
and fabricated with the design of having
cutouts placed on the L4s and L5s. Optimized rotation attachments were placed on
the L5s to help correct rotations, horizontal
beveled attachments were placed on the L4s
with the cutouts to prevent rotation of the
teeth with the use of elastics, and horizontal
beveled attachments were placed on the L6s
and L2s to help level the lower curve of Spee.
Power ridges were also included in the clear
aligners on each maxillary incisor to correct
the retroclined position. Initially, there were
39 sets of upper and lower aligners. The first
set of aligners were delivered a few days
before her open exposure.
After the impacted maxillary canines were
exposed, the surgeon placed composite on

Figure 4. Progress intraoral photographs (three months after exposure)

39



Pacific Coast Society of Orthodontists Bulletin Spring 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2021

No label
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - No label
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 2
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 3
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 4
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 5
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 6
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 7
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 8
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 9
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 10
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 11
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 12
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 13
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 14
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 15
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 16
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 17
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 18
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 19
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 20
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 21
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 22
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 23
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 24
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 25
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 26
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 27
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 28
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 29
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 30
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 31
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 32
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 33
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 34
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 35
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 36
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 37
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 38
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 39
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 40
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 41
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 42
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 43
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 44
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 45
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 46
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 47
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 48
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 49
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 50
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 51
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 52
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 53
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 54
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 55
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 56
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 57
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 58
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 59
Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 60
http://www.brightcopy.net/allen/pcso/94-03
http://www.brightcopy.net/allen/pcso/94-02
http://www.brightcopy.net/allen/pcso/93-3
http://www.brightcopy.net/allen/pcso/93-2
http://www.brightcopy.net/allen/pcso/93-1
http://www.brightcopy.net/allen/pcso/92-3
http://www.brightcopy.net/allen/pcso/92-2
http://www.brightcopy.net/allen/pcso/92-1
http://www.brightcopy.net/allen/pcso/91-4
http://www.brightcopy.net/allen/pcso/91-3
http://www.brightcopy.net/allen/pcso/91-2
http://www.brightcopy.net/allen/pcso/91-1
http://www.brightcopy.net/allen/pcso/90-04
http://www.brightcopy.net/allen/pcso/90-3
http://www.brightcopy.net/allen/pcso/90-2
http://www.brightcopy.net/allen/pcso/90-1
http://www.brightcopy.net/allen/pcso/83-4
http://www.brightcopy.net/allen/pcso/89-3
http://www.brightcopy.net/allen/pcso/89-2
http://www.brightcopy.net/allen/pcso/89-1
http://www.brightcopy.net/allen/pcso/88-4
http://www.brightcopy.net/allen/pcso/88-3
http://www.brightcopy.net/allen/pcso/88-2
http://www.brightcopy.net/allen/pcso/88-1
http://www.brightcopy.net/allen/pcso/87-4
https://www.nxtbook.com/allen/pcso/87-03
https://www.nxtbook.com/allen/pcso/87-2
https://www.nxtbook.com/allen/pcso/87-1
https://www.nxtbook.com/allen/pcso/86-4
https://www.nxtbook.com/allen/pcso/86-3
https://www.nxtbook.com/allen/pcso/86-2
https://www.nxtbook.com/allen/pcso/86-1
https://www.nxtbook.com/allen/pcso/85-4
https://www.nxtbook.com/allen/pcso/85-3
https://www.nxtbook.com/allen/pcso/85-2
https://www.nxtbook.com/allen/pcso/85-1
https://www.nxtbook.com/allen/pcso/preview-program-2013
https://www.nxtbook.com/allen/pcso/84-4
https://www.nxtbook.com/allen/pcso/84-2
https://www.nxtbookmedia.com