Article ID: WMC005610ISSN 2046-1690Anterior crossbite and crowding correction with aseries of clear aligners: case reportPeer review status:NoCorresponding Author:Dr. Amira Al Habash,dentist, Policlinica Identalia - ItalySubmitting Author:Dr. Amira Al Habash,dentist, Policlinica Identalia - ItalyOther Authors:Dr. David Raickovic,dentist, Policlinica Identalia - CroatiaArticle ID: WMC005610Article Type: Case ReportSubmitted on:18-Mar-2020, 06:16:34 PM GMTPublished on: 24-Mar-2020, 02:51:34 AM GMTArticle URL: view/5610Subject Categories:ORTHODONTICSKeywords:orthodontics, clear aligners, invisalign, dentistry, crossbite, oral medicineHow to cite the article:Al Habash A, Raickovic D. Anterior crossbite and crowding correction with a series ofclear aligners: case report. WebmedCentral ORTHODONTICS 2020;11(3):WMC005610Copyright: This is an open-access article distributed under the terms of the Creative Commons AttributionLicense(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided theoriginal author and source are credited.Source(s) of Funding:The authors declare that they have not received funding.WebmedCentral Case ReportPage 1 of 10

WMC005610Downloaded from on 24-Mar-2020, 02:51:35 AMAnterior crossbite and crowding correction with aseries of clear aligners: case reportAuthor(s): Al Habash A, Raickovic DIntroductionNowadays, there is a growing demand for aesthetictreatment among both adolescents and adults. Indeed,a recent study estimated that 45% of adults areunhappy with their smile and that 20%of these haveconsidered undergoing orthodontic treatment toimprove their appearance. Hence, aligner systemsmust now be able to treat various types ofmalocclusion, and over recent years, many studieshave shown their great efficacy in correcting crowding,crossbite and diastems, and even complex casesfeaturing extraction, open-bite, and poor occlusalrelationships.Invisalign is a new technique able to resolve someorthodontic malocclusions without the use of traditionalfixed equipment.The real innovation of the methodology is representedby Clin-Check, a digital three-dimensional simulationthat allows clinicians and the patients to see a film onthe computer tracking the movements from beginningto end of the dental treatment.The Aligners, made of transparent thermoplasticpolymer, allow a tooth movement of 0,15 to 0,25 mm;they must be worn at least 22 hours a day and have tobe replaced every 10 days with the next aligner. Thepossibility of removing these alignments also allowsthe patient to control daily oral hygiene.Some types of movement are favoured by theAttachments forms at the dental composite used inrelation to their shape and positioning that determinemovements such as intrusion, extrusion, rolling, fluid,torque, up righting of the root. In order to providemasks without defect it is crucial to make impressionswith intraoral scan in order to obtain precise studymodels.Case ReportThis case report describes an adult male patient withclass I subdivision, dental crossbite, and crowdingtreated successfully with aligners.A 35 years old patient came to our observationcomplaining of a relational problem regarding poorWebmedCentral Case Reportaesthetics of the smile (Figs. 1, 2).Clinical examination revealed class I subdivision withlower midline deviation towards the left of the uppermidline, a severe crowding in the inferior (Fig. 4)dental arch, with the presence of cross bite against theelements 2.2, 3.3 (Figs. 3, 5).The pre-treatment OPT (Fig. 7) shows the presence ofall the permanent teeth with overall good alveolarbone density and good root morphology.Periodontal biotype and oral hygiene were good (Fig.2)Treatment objectivesThe treatment objectives were to align the arches,correct the crossbite, centering the lower midline andobtain ideal overate and overbite. Upper and lowercrowding was to be resolved by interproximalreduction.Additionals objectives were to improve facial aestheticand reduce black buccal corridors during smilesThe buccal segment occlusion and Class I molarrelationship was to be maintained with both fixed andremovable retainers to maintain the treatmentoutcomes.In view of the case history, a non-invasive treatmentwas chosen that would resolve aesthetic andfunctional problems. The Patientâ s desire was toimprove the smile, but without going through fixed typetraditional orthodontics.Treatment progressThe virtual set-up dictated 27 treatment steps for eacharch.To achieve the correction of the crossbite, the planinvolved disto-rotation of tooth 3.3 (21.1 degrees D)and proclination of 1.2 (13.1 degrees B) in associationwith lingual bite ramps put on 1.2, 1.1, 2.1, 2.2.To achieve lower midline correction, the plan involvedIPR on lower teeth and sequential movement towardsright side of 4.1, 3.1, 3.2 using spaces of IPR.In order to align lower frontal teeth, IPR in combinationwith proclination and then retrusion and intrusion ofPage 2 of 10

WMC005610Downloaded from on 24-Mar-2020, 02:51:35 AMlower frontal teeth was done. Tooth 3.2 was inclined(9.9 degrees B)in the meantime the root was inclined (9.9 degrees L).In upper arch, element 2.3 was inclined (19.5 degreesM) in order to allow tooth 2.2 to incline buccally (9.9degrees) and be fully aligned.Power ridges were used on 1.2, 1.1, 2.1, 2.2 in orderto improve the overjet.The patient was instructed to wear each aligner for 22h per day and to move on to the next one in the seriesafter 10 days.At the end of treatment a successful outcome wasachieved (Fig. 8). Both upper and lower arches werewell aligned with complete correction of crossbite (Fig.9).Only the midline was not completely centered, but thepatient was satisfied and refused to wear additionalaligners.Treatment resultsPost-treatment records demonstrate satisfactory finalresults with all objectives achieved, only the lowermidline is not completely centred but improved.Extraoral photos show a good profile, correct incisorexposure during smile and absence of buccal corridors(Fig.9). Intraoral examination reveals the achievementof all planned objectives, crossbite correction andcrowding correction (Fig.8). Post-treatment panoramicradiography (Fig.10) showed good root parallelism, nosign of crestal bone height reduction, and no evidenceof apical root resorption.appliances by lay Brazilian adults. Dental Press JOrthod. 2012;17(5):102 14.3. British Orthodontic Society. News release, news/ NOWYouGovSurvey.Accessed 9 Apr 2013.4. Boyd RL, Miller RJ, Vlaskalic V. The Invisalignsystem in adult orthodontics: mild crowding and spaceclousure cases. J. Clin. Orthod. 2000;34(4):04 203.5. Womack WR. Four-premolar extraction treatmentwith Invisalign. J Clin Orthod. 2006;40:493 500.6. Hönn M, Göz G. A premolar extraction caseusing the Invisalign system. J Orofac Orthop.2006;67:385 94.7. Boyd RL. Complex orthodontic treatment using anew protocol for the Invisalign appliance. J Clin Orthod.2007;41:525 47.8. Boyd RL. Esthetic orthodontic treatment using theInvisalign appliance for moderate to complexmalocclusions. J. Dent. Ed. 2008;72:948 67.9. Tuncay OC, editor. The Invisalign system. 1 edQuintessence Pubblishing; 2006.10. Align Technology11. Boyd RL, Oh H, Fallah M, Vlaskalic V. An updateon present and future considerations of aligners. JCalif Dent Assoc. 2006;34:793 805.12. Nedwed V, Miethke RR. Motivation, acceptanceand problema of Invisalign patients. J Orofac Orthop.2005;66:162 173.Summary and conclusionsUse of aligners is an efficacious means of resolvingorthodontic issues such as dental cross-bite andcrowding within a time-frame comparable toconventional fixed orthodontics, but with excellentaesthetics and oral hygiene.References1. Walton DK, Fields HW, Johnston WM, RosenstielSF, Firestone AR, Chirstensen JC. Orthodonticappliance preferences of children and adolescents.Am J Orthod Dentofac Orthop. 2010;138(6):698.e1 12.2. Feu D, Catharino F, Duplat CB, Capelli Junior J.Esthetic perception and economic value of orthodonticWebmedCentral Case ReportPage 3 of 10

WMC005610Downloaded from on 24-Mar-2020, 02:51:35 AMIllustrationsIllustration 1Smile before treatmentIllustration 2Frontal view (t0)WebmedCentral Case ReportPage 4 of 10

WMC005610Downloaded from on 24-Mar-2020, 02:51:35 AMIllustration 3Occlusal view upper arch (t0)Illustration 4Occlusal view lower arch (t0)WebmedCentral Case ReportPage 5 of 10

WMC005610Downloaded from on 24-Mar-2020, 02:51:35 AMIllustration 5Lateral view right sideIllustration 6Lateral view left sideWebmedCentral Case ReportPage 6 of 10

WMC005610Downloaded from on 24-Mar-2020, 02:51:35 AMIllustration 7OPT before treatmentIllustration 8Smile after treatmentWebmedCentral Case ReportPage 7 of 10

WMC005610Downloaded from on 24-Mar-2020, 02:51:35 AMIllustration 9Extra-oral photo after treatmentIllustration 10Lateral view left side after treatmentWebmedCentral Case ReportPage 8 of 10

WMC005610Downloaded from on 24-Mar-2020, 02:51:35 AMIllustration 11Lateral view right side after treatmentIllustration 12Occlusal view upper arch after treatmentWebmedCentral Case ReportPage 9 of 10

WMC005610Downloaded from on 24-Mar-2020, 02:51:35 AMIllustration 13Occlusal view lower arch after treatmentIllustration 14OPT after treatmentWebmedCentral Case ReportPage 10 of 10