Canine Relationship Research Articles

Üst Gömülü Kanin Dişlerin Maksiller Kaide ile İlişkisinin Değerlendirilmesi

Objective: The aim of this study was to evaluate the relationship between impacted maxillary canine teeth and maxillary base length.Material-Method: 142 patients (67 males, 75 females; a mean age of 16.34±1.07 years) who were admitted to the Department of Orthodontics of İstanbul Aydın University - Faculty of Dentistry for treatment were included in our study. In the retrospective study, the positions of maxillary canine teeth and their relationship with maxillary base length were examined in detail in cephalometric and panoramic radiographs. Results with p <0.05 were found to be statistically significant.Results: There was no statistically significant correlation was found between gender and canine impaction. Unilaterally impacted upper canines were found to be higher between genders. Palatal plane value of the unilaterally impacted canine group was found to be statistically greater. Significant difference was found between palatal plane variable and impacted canine. No significant difference was found between age and effective midfacial length variables based on canine. Examination of the correlation between effective midfacial length and palatal plane variables revealed a strong positive correlation, which was statistically significant. There was no significant difference between age, effective midfacial length and palatal plane variables in terms of gender.Conclusion: This study is the first to specifically address the relationship of impacted canines with the palatal plane. Therefore, the position of the canines has a major place in the evaluation of their relationship with the adjacent anatomical structures and teeth, especially during treatment planning.

Surgically assisted rapid palatal expansion for transverse maxillary discrepancy in adults - Case report.

Introduction and importanceTransverse maxillary deficiency is one of the most detrimental problems to midfacial growth and the integrated dentoalveolar structures. Early diagnosis and proper treatment of such cases is most important to maintain the balance between the basal bones and stable occlusion.Case presentationIn our case, a 17-year-old male had irregular upper front teeth with an unpleasant smile. Detail examination revealed a symmetrical face with an orthognathic profile, mild malar deficiency, competent lips, asymmetrical arches, Class I molar and canine relationships bilaterally. Crowding was present in the upper anterior arch with 2 mm of anterior open bite and posterior cross bite present in the premolar region and molar region bilaterally. Lefort-1 osteotomy, midpalatal split, pterygomandibular disjunction without down fracture was done. The HYRAX appliance was cemented. Distraction started after four days of surgery. One mm distraction per day was done for 10 days. The patient was transferred to fixed orthodontic treatment to relive the anterior crowding. Records were taken after 1 year of follow up and analyzed. Skeletal relationships were in harmony. Dental crowding, anterior open bite and posterior crossbite were corrected.Clinical discussionThe zygomatic buttress and the pterygomaxillary junction are considered as the critical areas of resistance for maxillary expansion. Literature claims lefort-1 osteotomy in combination with palatal distraction results in more displacement and less stress in the maxilla.ConclusionSARPE has proved to be clinically effective and stable for the correction of transversely deficient maxilla after cessation of growth in adult patients.

Asymmetric Orthodontic Space Closure of Unilateral Congenitally Missing Second Premolars

This case report presents successful orthodontic management of unilateral retained deciduous second molars and congenitally missing second premolars using an additional anchorage in conjunction with the segmented arch approach. A 21-year-old female patient presented as skeletal Class I malocclusion, mild crowding, straight facial profile, and orthodivergent facial pattern. The treatment plan was established to extract deciduous teeth and close the extraction space by molar protraction. A Nance appliance and lingual holding arch were used as an additional anchorage to maintain the facial profile and dental midline, with pure molar protraction performed using a segmented arch and sliding mechanics. After 1 year of molar protraction with well-controlled molar angulation and rotation, a continuous arch was performed for full mouth refinement. The total treatment duration was 34 months achieving unilateral molar protraction and bilateral Class I molar and canine relationships with satisfactory facial esthetics and functional occlusion.

Longitudinal analysis of the quality of orthodontic treatment outcome and stability of occlusal traits

Objectives To assess the quality and stability of orthodontic treatment outcome relative to the initial malocclusion. Material and methods The study was performed in one public health care clinic in Finland. Study subjects comprised 51 orthodontic patients (age range 12.7–18.7 years). Pre-treatment medical records and lateral skull radiographs were analysed for malocclusion type. The main reasons for orthodontic treatment were mandibular retrognathia, Class II distal bite, deep bite and crowding. At the end of a retention phase (Examination 1), the quality of treatment outcome was assessed using the occlusal morphology and function index (OMFI) and patients were asked about treatment satisfaction. Stability of occlusal traits and patient satisfaction were re-evaluated after a two-year follow-up (Examination 2). Occlusal characteristics descriptive statistics were performed. Results At Examination 1, all six morphological criteria for acceptability were fulfilled by 76% and all functional criteria by 82% of the patients. All OMFI criteria were met by 67% of the patients. At Examination 2, 68% of the patients fulfilled all morphological and 82% all functional criteria of acceptability. At Examination 2, all the OMFI criteria were still met by 64% of the patients and 92% expressed satisfaction with own occlusion. The main reasons for unacceptability were deficiencies in canine relationship and overbite, in addition to functional protrusion interferences. Conclusions In the evaluated health care clinic, patient satisfaction and the quality of treatment outcome were high. However, deep bite showed a tendency for relapse.

Exploring Owner Perceptions of the Impacts of Seasonal Weather Variations on Canine Activity and Potential Consequences for Human-Canine Relationships.

Climate change is leading to more instances of seasonal weather variation. Studies have explored the impact of adverse winter weather on dog walking, but the impact on the dog's overall activity levels have not been previously considered. This study explored dog owner perceptions of the effects of both summer and winter weather on their dog's activity levels. An international online survey recruited 3153 respondents between May and December 2018, to explore the impact of summer and winter weather conditions on baseline activity levels. Owners reported their dogs were more impacted by cold (48.2% less likely to exercise their dog in the cold) and ice (64.0% less likely), than rain (25.3% were less likely). In hot weather, over 80% of owners reported reduced exercise duration and vigour for their dogs. Carrying water or walking near water to facilitate activity in the summer was the most popular mitigation strategy (90.8%). Participation in dog sports appeared to reduce the impact of winter weather on canine activity and increase owner awareness of cooling strategies to facilitate summer activity. Strategies to promote safe activity participation are needed to maintain canine activity levels amidst rising global temperatures, including better understanding of cooling strategies for exercising dogs.

Ectopic mandibular canine with supernumerary teeth - A Case Report

Odontomesare asymptomatic benign tumors often identified during a routine radiographic investigation. Mandibular canine impaction is a less common dental anomalyfrequently associated with Odontomes. The management of impacted caninesare mainly based on position and direction of the impacted tooth, root development and space available in the arch. This case report involved impacted 43 and Odontome in relation to 43 on askeletal class II base, Angle’s class I molar and canine relationship. Key Words Mandibular canine, Impaction, Odontome.

First molar extractions related to molar-incisor hypomineralization (MIH) in a special need patient: case report

Although most orthodontists avoid extractions, treating patients with biprotrusion traditionally involves removing teeth. In the current case report, a 15-year-old deaf patient had a Class II molar and canine relationships, 8 mm overjet and 3mm overbite, 3 mm of a discrepancy between U/L midline, crowding in both arches (3 mm in the upper and 7 mm in the lower). The first right upper molar (16) and the first right and left lower molars (36 and 46) were severely MIH affected. Extraction of the first four molars was proposed, since a large amount of space was required and three of the four molars were very compromised with severe MIH. Tooth 26 was extracted to maintain the symmetry of the arch and because the extraction of a premolar would not allow for alignment associated with class II correction of canines on the left side. During the closure of the extraction spaces, upper and lower third molars eruption was observed, in an appropriate position. Facial analysis shows us the coincidence of the upper midline with the face and good exposure of the incisors in the smile. There was considerable reduction of overjet and dental protrusion, enabling passive lip sealing. A perfect fit of the Class I superior teeth was not obtained since the patient considered that the treatment was already very good and did not want to collaborate with hygiene and the use of orthodontic appliances for more time.

An Overview of Orthodontic Patients Visiting in a Tertiary Care Hospital in Northern Region of Bangladesh

Background: Malocclusion is still not considered as a dental problem because of more emphasis is given to the treatment of dental caries and periodontal diseases due to pain complained by patients. Objective: The study was conducted to find out the pattern of diseases of orthodontic patients visiting in a regional tertiary care hospital in northern area of Bangladesh. Materials and Methods: This snap-shot study was conducted on randomly selected 84 patients attended in the Department of Orthodontics & Dentofacial Orthopaedics, Dental unit Thengamara Mohila Sabuj Sangha (TMSS) Medical College and Hospital, Bogura from July 2016 to June 2017. All data were collected from patients’ history and clinical examination of the patients. Descriptive statistics were calculated using MS Excel from the collected data. Results: One third of the patients (33.33%) have normal over bite. Class I and Class II molar relationship are distributed as 44% and 53.5% respectively. Class I and Class II division 1 Incisor relationship is distributed as near about same, 44% and 34.52% respectively; and 14.29% have Class II division 2. Class I and Class II Canine relationship are distributed as near about same, 44% and 48.80% respectively. Forty four percent patients have normal over jet, 34.52% patients have increased over jet, and 7.20% patients have reversed over jet. Conclusion: The epidemiological data on the prevalence of malocclusion is an important determinant in planning appropriate levels of orthodontic services in the Bangladeshi population and further studies are required to provide accurate estimates of the orthodontic treatment. KYAMC Journal.2021;12(02): 92-97

Management of Class II Division 1 Subdivision malocclusion using unilateral bicuspid extractions and fixed functional appliance: A Two Year Follow-Up

Introduction: Management of Class II Subdivision cases pose a clinical dilemma and require a careful diagnosis to ascertain the source of asymmetry. Various treatment modalities involving: different protocols of tooth extractions; molar distalization; fixed functional appliances or orthognathic surgery have been proposed for the same.
 Objective: This article reports a unique approach for management of a severe skeletal Class II with Angle’s Class II Division 1 subdivision malocclusion using unilateral bicuspid extractions in mandibular and maxillary arches and a fixed functional appliance.
 Results: A 13 year 1 month old male in CVMI transition stage was successfully treated. Extraction of #44 was done to alleviate crowding in the mandibular anterior region and #15 was extracted to protract #16 to achieve a Class II molar relationship. A pre-functional Class II molar and canine relationship with co-incident midlines was achieved. The functional phase consisted of a fixed functional appliance (Forsus FRD) for mandibular advancement to correct the severe skeletal Class II. Class I molar and canine relationships were achieved with reduction of facial convexity and overjet. Result remained stable 24 months after treatment. The improvement can be quantified by the reduction in scores of orthodontic indices measured pre and post treatment.
 Conclusions: Management of Class II subdivision malocclusion requires careful planning. This paper presents a unique approach utilizing unilateral extractions and fixed functional appliance to address severe skeletal Class II discrepancy and the subdivision dilemma.

The efficiency of mandibular mini-implants in reducing adverse effects of class II elastics in adolescent female patients: a single blinded, randomized controlled trial

BackgroundExcessive proclination of lower incisors and other undesirable consequences usually result from the use of class II elastics during orthodontic treatment. The purpose of this study was to attempt to limit the adverse effects of class II elastics by the use of mini implants placed in the mandibular arch in adolescent class II female patients.MethodsThe sample comprised 28 patients, (a mean age of 15.66 ± 2 years for intervention group and 15.1 ± 2.2 years for conventional group) with one-fourth or one-half unit class II canine relationship. The sample was divided into two equal groups. Randomization was carried out by a computer sequence generator with a 1:1 allocation ratio. In the intervention group, the mini implants were inserted between the lower second premolar and first molar, while the conventional group underwent regular class II elastics therapy. The active elastics treatment time was 8 months for both groups. Results were assessed by measurements from pre- and post-elastics lateral cephalometric radiographs.ResultsThe change in L1 inclination (0.97 ± 0.92°) and L1 AP position (0.31 ± 0.63 mm) did not show a statistically significant difference between the two groups, but a statistically significant difference was found in the U1 retroclination (5.23 ± 1.92°) and U1 distal movement (4.05 ± 1.4 mm) [P ˂ 0.001] and [P ˂ 0.05] respectively in favor of the intervention group.ConclusionMini-implants in conjunction with class II elastics had no skeletal effect, mainly dentoalveolar and it did not prevent the proclination of lower incisors. There was more distal movement in the upper incisors in the skeletal anchorage group which helped in enhancing the camouflaging of class II malocclusion.Trial registrationTrial registered “FUE.REC (10)/10-2018” at the FUE registration council for clinical trials/IOP Orthodontic Program October 2018.

A combined Surgical-Orthodontic treatment in skeletal Class II malocclusion patients

Skeletal Class II malocclusion with mandibular deficiency is one of the most common problems that patients seek treatment. Adult patients with severe skeletal Class II malocclusion need orthognathic surgery for successful treatment. Bilateral sagittal split osteotomy (BSSO) is the most often preferred technique for these patients. This case report briefs about two male patient of age 24 years presented with Class II Skeletal relation, mesoprosopic facial form, horizontal growth pattern and Angle’s Class II div 1 malocclusion who were treated with Bilateral sagittal split osteotomy (BSSO) mandibular advancement. The ideal anteroposterior relation was established along with a Class I molar, incisor, canine relationship and ideal overjet, overbite and the overall facial esthetics were significantly improved. Combined surgical-orthodontic treatment aims to obtain a more harmonious facial, skeletal, dental and soft tissue relationship with an added patient self esteem.

Incisor- Molar Hypomineralization Phenotype Characteristics and Comparison with Amelogenesis Imperfecta: An Approach to a Differential Diagnosis

Background: Incisor-molar hypomineralization (IMH) presents various clinical characteristics that generate confusion for differential diagnosis with other enamel abnormalities such as amelogenesis imperfecta (AI). Purpose: To analyze dental, facial, and skeletal characteristics in people with IMH and compare them to those with AI in order to identify diagnostic differences between these two enamel defects. Methods: Analytical observational study. Twelve 7-to-10-year-olds with IMH and 10 8-to-49-year-olds with AI were studied. IMH was assessed according to the European Academy of Pediatric Dentistry’s diagnostic criteria, Mathu Maju’s criteria (2006), and Neeti Mittal’s phenotypic classification (2016), while Witkop’s criteria (1989) were used to analyze AI. Clinical, radiographic, facial, and skeletal analyses were performed to establish IMH phenotypes, information that was fed into an Excel® database for subsequent statistical analysis (SPSS 22.0) (p<0.05). Results: Statistically significant differences were found between IMH and AI. Only patients with IA presented dilaceration, dental agenesis, and taurodontism. There are similarities regarding facial features such as facial asymmetry, increased intercanthal distance, decreased lower third, biprochelia and convex profile, and occlusal features such as molar relationship, canine relationship, and overjet. Concerning transverse relationships, micrognathism was more frequent in IMH and in vertical relationships, deep overbite was greater in IMH than in AI. Conclusions: The main differences between IMH and AI were evident in skeletal characteristics and associated dental alterations.

Management of maxillary deficiency in a growing child with facemask therapy and RME- A case report

Class III malocclusion is one of the most difficult problems to treat. It has a multifactorial etiology involving both genetic and environmental causes. The dental and skeletal effects of maxillary protraction with a facemask are well documented in several studies. Although incorporation of expansion appliance along with facemask therapy can improve correcting both sagittal and transverse discrepancy of maxilla. The following case shows early treatment of a 9 year old boy with maxillary deficiency using an expansion screw along with facemask. Facemask therapy was followed by fixed orthodontic treatment to settle the occlusion. Treatment was completed after 14 months with positive overjet, class I molar and canine relationship on right and left side.

Class II correction by maxillary en masse distalization using a completely customized lingual appliance and a novel mini-screw anchorage concept \u2013 preliminary results

BackgroundThe aim of the study was to evaluate the efficacy of a novel en masse distalization method in the maxillary arch in combination with a completely customized lingual appliance (CCLA; WIN, DW Lingual Systems, Germany). Therefore, we tested the null-hypothesis of a significant deviation from an Angle-Class I canine relationship and a normal overjet defined by an individual target set-up after dentoalveolar compensation in Angle Class II subjects.Methods This retrospective study included 23 patients, (m/f 3/20, mean age 29.6 years (min/max, 13.6/50.9 years)), with inclusion criteria of an Angle Class II occlusion of more than half a cusp prior to en masse distalization and treatment completed consecutively with a CCLA in combination with a mini-screw (MS) anchorage for uni- or bilateral maxillary distalization (12 bilateral situations, totalling 35). Plaster casts taken prior to (T0) and following CCLA treatment (T3) were compared with the treatment plan / set-up (TxP, with a Class I canine relationship and a normal overjet as the treatment objective). MSs were placed following levelling and aligning (T1) and removed at the end of en masse distalization at T2. Statistical analysis was carried out using Schuirmann’s TOST [two one-sided tests] equivalence test, based on a one-sample t-test with α = 0.025 on each side (total α = 0.05).ResultsNinety-seven percent of planned correction of the canine relationship was achieved (mean 3.6 of 3.7 mm) and also 97 % of the planned overjet correction (mean 3.1 of 3.2 mm), with a statistically significant equivalence (p < 0.0001) for canine relationship and overjet between the individual treatment plan (set-up) and the final outcome. Adverse effects were limited to the loss of n = 2 of 35 mini-screws. However, in each instance, the treatment was completed, as scheduled, without replacing them. Accordingly, the null-hypothesis was rejected.ConclusionsThe technique presented allows for a predictable correction of an Angle-Class II malocclusion via dentoalveolar compensation with maxillary en masse distalization.

Prevalence of malocclusion and assessment of orthodontic treatment needs among Syrian refugee children and adolescents: a cross-sectional study

BackgroundThere is a scarcity of data concerning the prevalence and pattern of malocclusion and orthodontic treatment needs in Syrian refugee. In this study, extra and intra-oral features of malocclusion and the dental health component of the Index of Orthodontic Treatment Need (IOTN) were reported.MethodsExamination of 606 Syrian children/adolescents refugees attending Zaatari clinic was carried out (males = 280, females = 326, mean age = 11.84 ± 2.1 years). Subjects not within the age limit, with a history of orthodontic treatment, or with craniofacial anomalies were excluded. Both extra and intra-oral features of malocclusion were assessed. Intra-oral features included inter- and intra-arch occlusal characteristics: crowding, spacing, crossbite, overjet, overbite, molar and canine relationship, incisor relationship, and centerline shift. In addition, the dental health component (DHC) of the Index of Orthodontic Treatment Need (IOTN) was recorded. Gender and age variations in malocclusion characteristics and IOTN grading were tested using chi-square and nonparametric tests respectively (P < 0.05).ResultsThe prevalence of malocclusion was 83.8% (52.6% class I, 24.2% class II, 7% class III). The most common features of malocclusion were crowding (71.1%) followed by centerline shift (52.1%), increased overjet (36.1%), high vertical proportions (34%) and deep overbite (31.2%); there were significant gender and age differences for a number of occlusal traits. The prevalence of moderate to severe need for orthodontic treatment was 67.7%.ConclusionsThis study provides baseline data on the prevalence of malocclusion in Syrian refugee children/adolescents in Zaatari camp where data concerning oral health of this population are lacking. The prevalence of orthodontic treatment need was high warranting the need for a comprehensive interceptive orthodontic program to prevent increasing oral health problems in the future. This high burden of oral diseases has a negative financial impact on the hosting country which can be reduced through public health interventions and implementing community-based dental healthcare for this underprivileged population.

Evaluation of Cephalometric Standards for Zanjanian Population According to Downs' Analysis

Background: Following the morphological features of different races and ethnic groups, knowledge of standard dentofacial patterns of each ethnic group is essential. Therefore, this study aimed to explain cephalometric standards for the Zanjanian population according to Downs' analysis and compare them to Caucasian individuals. Methods: Seventy lateral cephalometries of Zanjanian adults (17 - 29 years old) who had been referred to a private orthodontic office in Zanjan, Iran with class I molar and canine relationship and normal overjet and overbite as well as minimum crowding/spacing/rotations were scanned and traced with the Novatech scanner and Dolphin software version 10. Next, statistical analyses were performed in order to compare the Zanjanian population to Caucasians. Results: We found a significant difference between males and females in terms of interincisal angle, incisor-occlusal angle, incisor-mandibular plane angle, upper incisor proclination, facial angle, and angle of convexity. Discussion: The analysis of six statistically significant parameters indicates that the upper and lower incisors in women of Zanjan were proclined and protruded compared with those of Caucasian subjects. Due to the statistical analysis on facial angle and angle of convexity, women also show more maxillary prognathism and skeletal class II pattern. Generally, a comparison of Zanjanian population cephalometrics based on Downs' analysis showed an increase in maxillary prognathism, maxillary and mandibular incisal protrusion and posterior rotation of the mandible. Conclusions: In conclusion, the Zanjanian population tends to have more dental and skeletal class II patterns than the Caucasians. In addition, gender comparison indicates lower and upper-incisors protrusion in women of Zanjan.

How efficient is customized lingual orthodontics? An assessment of treatment outcome.

To assess the efficacy of lingual orthodontics by comparing setups and post-treatment casts. Thirty-two consecutive patients treated with a customized lingual orthodontic appliance were included in this retrospective study. Initial casts, post-treatment casts and setups were scanned, and the digital models produced were analysed in terms of overjet; overbite; molar and canine relationships; intercanine, interpremolar and intermolar distances; upper and lower arch lengths; midline deviation; bucco-lingual angulation of all teeth and mesio-distal angulation of anterior teeth. Comparisons between setups and post-treatment casts were performed via paired t tests. Relationships between the planned and actual correction were studied using regression analysis. Statistically significant differences in bucco-lingual torque between setups and post-treatment casts were found for all upper teeth, except for central incisors. In the lower jaw, statistically significant differences in bucco-lingual torque were found between setups and post-treatment casts for the lower incisors and molars. No statistically significant differences in mesio-distal angulation of anterior teeth were found between setups and post-treatment casts. Upper and lower arch widths did not vary significantly between setups and final casts, except upper inter-second premolar and intermolar distances. Customized lingual appliances offer efficient control of mesio-distal angulation of all anterior teeth. Significant differences in torque between setups and post-treatment casts were observed for upper lateral incisors, canines, premolars and molars, as well as lower incisors and molars. However, the torque difference was clinically significant (over three degrees) for upper second premolars and molars only.

Does daily wear time of Twin Block reliably predict its efficiency of classII treatment?

PurposeThe objective of this study was to investigate how daily wear time (DWT) influences class II malocclusion treatment efficiency.Materials and methodsThe study group consisted of 55 patients (mean age 10.4 years) diagnosed with a class II/1 malocclusion. Twin block appliances, with built-in Theramon® microsensors (MC Technology, Hargelsberg, Austria) to monitor patients’ cooperation (daily wear time assessment), were used for treatment. Cephalograms were taken and the following initial and final measurements were compared: Co-Gn, Co-Go, Co-Olp, Pg-Olp, WITS, SNA, SNB, ANB, Co-Go-Me, overjet, molar and canine relationships. The Shapiro–Wilk test, Wilcoxon signed-rank test, Student’s t-test, Levene’s test, Mann–Whitney U test, Kruskal–Wallis test, χ2 test, and Spearman’s rank correlation coefficient with p < 0.05 set as the statistical significance level were used to determine the correlation of the outcomes with DWT; a ROC (receiver operating characteristic) curve was calculated to illustrate diagnostic ability of the binary classifier system.ResultsDWT was very highly positively correlated with change of the Pg-Olp parameter and highly with an improvement in the ANB, SNA, and SNB angles, an increase in the WITS parameter and an increase in Co-Gn distance. DWTs < 7.5 h correlated with significantly less improvement of the investigated variables. However, DWT > 7.5 h did not significantly correlate with the improvement of the overjet and most of the linear parameters in the mandible. The ROC curve and its AUC (area under curve) allowed the determination of a DWT of 7 h and 48 min to be capable of establishing a class I relationship with 83% probability.ConclusionsClass II treatment efficiency was influenced by DWT; an 8 h threshold value had an 83% probability of establishing a class I relationship.

UNILATERAL BIJAW PREMOLAR EXTRACTIONS FOR CORRECTION OF CROWDING, BUCCALLY PLACED CANINES AND ASYMMETRIC DENTAL MIDLINE - A CASE REPORT

This case report is of a 22 year old male patient who presented with irregularly placed and crowded teeth in bothmaxillary and mandibular arch on the right side with both upper and lower dental midlines shifted to the patients right. This case was corrected non surgically merely by employing simple mechanics with the help of Fixed Orthodontic Mechanotherapy by extracting a single maxillary and mandibular 1st premolar of right side followed by retraction and closure of spaces with the help of Elastomeric chains. The case ended in a Class I Molar and canine relationship bilaterally. The case report emphasizes on the need for extracting 1st premolars only on 1 side in the upper and lower arch for the purpose of correcting the shifted dental midlines. The extractions also favour correction of crowding and buccally placed upper and lower canines on the right side. Following fixed orthodontic treatment, marked improvement in patients smile was achieved and there was a remarkable increase in the patients confidence and quality of lifeThe profile changes and treatment results were demonstrated with proper case selection and good patient cooperation with Fixed appliance therapy. The patient was extremely satisfied with the results at the end of treatment.

Using the Invisalign® system in conjunction with extraction for the treatment of Class II malocclusion with severe anterior crowding

Clear aligners are a well-established alternative to conventional fixed orthodontic appliances for treating mild-to-moderate malocclusion. This case report details the successful treatment of a 14-year-old female patient with Class II malocclusion, crowding, and dental crossbite using extraction and the Invisalign® system. Achieving satisfactory anterior guidance by correcting the anterior crossbite and reducing the overjet and overbite was the primary treatment goal. Secondary treatment objectives included upper and lower midline alignment, leveling and alignment of arches, and achieving a Class I canine relationship for adequate canine guidance. Two sets of clear aligners were chosen; the first for alignment and the second for refinement. Extraction of teeth 14 and 24 were performed during the first aligner treatment phase, with space closure achieved by the distal movement of canine and posterior teeth mesialization. The second set of aligners refined the dentition by correcting the posterior open bite and extrusion of posterior teeth. Treatment duration was 13.5 months. By the end of treatment, the Invisalign system in conjunction with tooth extraction established an ideal overbite and overjet, corrected the crossbite, and achieved a Class I canine relationship with minimal disruption to the patient’s esthetic appearance. In addition, root axes were parallel and well controlled, despite extractions and space closure. Awareness of the dental biomechanics when clear aligners and extraction are used may be imperative for yielding successful outcomes for patients with Class II malocclusion and extractions.