CASE REPORT
CASE REPORT
This article describes the treatment with Spark Clear Aligners of a 13 years-old female patient, who presented a CLASS II DIV. 1 caused by mandible retrusion, hypodivergent profile, crowding and constriction in both arches, high positioned canines, 6mm of deep bite and strong curve of spee.
Dr. André El Zoghbi*, France
Dr. André El Zoghbi* (Dr. Z) earned his dental degree from the Lebanese University of Beirut and his Master’s degree in Orthodontics and Orthopaedics from the Paris VII University of France. After his speciality studies, he completed a 2 years research program on biomaterials in Orthodontics in the French National Health Research Institute (INSERM) followed by a four year Associate Assistant Lecturer in Orthodontics at the Paris VII University giving lectures for Postgraduate students along with giving Orthodontic Clinical training at the Hotel Dieu de Paris hospital in Paris. He is established in his private practice at Choisy le Roi in the suburbs of Paris and has treated more than 2000 patients with Clear Aligners. Since January 2020 he is a key expert and Speaker for Spark Clear Aligners.
Having in mind the CS2 growth pattern presented by this patient, the treatment goal established was to correct the Class II by performing mandibular advancement – class II mechanics with elastics- together with upper arch retraction, while the deep bite was corrected through lower incisor intrusion and premolar extrusion. Also, expansion was planned to correct the arch constriction and create spaces to correct the crowding.
To perform this, the following was planned in the Approver: expansion of both arches, applying buccal root torque in molars and premolars, derotation of 6s and flatten the curve of spee. In order to flatten the curve of spee, intrusion of incisors and second molars, together with premolar extrusion were requested. Also, identifying the need to have enough overjet for the planned movements, we had to overcorrect proclination of upper incisors and relative intrusion. Having identified that there was gum transparency in the root surface of lower incisors, also lingual root torque was requested for these teeth. Also, the auxiliaries used to apply class II biomechanics were buttons in both canines and molars.
The first 4 aligners were worn for two weeks each as there was expansion planned. During this period no elastics were worn, to avoid cancelling the programmed expansion. Then, the next 10aligners were used according one week wear protocol and the patient started the elastics use(3.5oZ) during the night and after that full day elastic use. When the patient got to passive aligners, the protocol of elastics was 6oZ day and night, changing them every 12 hours until Class II is corrected.
When reviewed after 8 months, the patient still needed distal tip of tooth 2.3, but deep bite, crowding and class II were corrected. The archform achieved after this period was the one planned: parabolic Damon archform with constriction of second molars and derotation of first molars.
At 10 months after start of treatment a refinement was requested with movements to correct the canine torque and tip while the patient kept using elastics allowing for the overcorrection of deepbite induced by the overcorrection of Class I and elastics mechanics.
The right timing for the treatment along with the effective and predictable aligner protocols led to achieving all objectives in less than a year proving aligners being a promising alternative to conventional appliances.
* Dr. André El Zoghbi is a paid consultants for Ormco. The opinions expressed are those of Dr. André El Zoghbi. Ormco is amedical device manufacturer and does not dispense medical advice. Clinicians should use their own professional judgment intreating their patients.
