Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 41

Case Report

the L3-3. During the visit before her debonding appointment, metal or clear buttons were
placed on all the teeth that were not touching (Figure 7). On the right side, single heavy
elastics (1/8 in, 6 oz) were used from UR6 to
LR6, UR5 to LR5, and UR4 to LR4; on the left,
three single vertical elastics were used to sock
in the bite from the UL3 to LR4, UL4 to LL5,
and UL5 to LL6. After the bite was detailed,
all attachments and buttons were debonded.
Fixed lingual retainers were placed on U2-2
(Stainless Steel Orthoflex-Tech, Reliance Orthodontic Products, Itasca, IL) and L3-3 (Round
Retainer Wire, Gold'nBraces, Palm Harbor,
FL). Invisalign retainers with bite ramps were
created for the patient to be worn every night
to maintain the bite opening and prevent a
relapse of the deep bite (Figure 8).
Treatment Results
The total treatment time was 24 months,
including the time it took to wait for the
refinement aligners to arrive. Posttreatment
photographs and digital study models demonstrate the achievement of a Class I dental
relationship. Both dental arches were leveled,
and the maxillary dental midline was more
coincident with the facial midline; however,
the mandibular dental midline was still slightly to the right because of mild mandibular
asymmetry. The impacted maxillary canines
were successfully brought into the arch using
interarch elastics (Figures 8 and 9). The final
panoramic radiograph illustrates that all the
roots appear parallel and well positioned
(Figure 10). Looking at the superimpositions,
the maxillary and mandibular molars were
extruded, and the mandibular incisors were
intruded slightly. The use of the bite turbos
and the ramps built in the clear aligners made
it easy to open the deep bite. The inclination of
the initially reclined maxillary incisors was improved significantly by successfully controlling
their lingual root torque. This was achieved
with the use of power ridges prescribed in the

Spring 2021    PCSO Bulletin	

Figure 8. Final facial and intraoral photographs (15 years, 11 months)

Figure 9. Final digital models

41



Pacific Coast Society of Orthodontists Bulletin Spring 2021

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