CASE REPORT
CASE REPORT
A 28-year-old female presented at the orthodontic department at our clinic in Kuwait in February 2025. The chief complaint was open bite and the associated speech problems which affected her social appearance and made her hesitant to smile. The patient had a normodivergent profile and a skeletal Class II malocclusion, with lower incisors protrusion as a compensation.
Intraoral examination revealed an anterior open bite with occlusal canting with Class I molar relationship bilaterally and Class II canine relationship bilaterally with lateral cross bite in the left side. She had a tapered upper arch and oval lower arch.
Dr. Rami Raphael Saad*, Orthodontic Specialist, Kuwait
Dr. Rami Raphael Saad is an orthodontic specialist who graduated from the Faculty of Dentistry at Tishreen University in Latakia, Syria in 2012. He then continued his postgraduate studies and obtained a Master’s degree in Orthodontics from Tishreen University in Latakia, Syria in 2019. He practiced dentistry at his private clinic in Latakia, Syria, before relocating to Kuwait in 2022, where he has since been working in the private sector.
In February 2025, when the patient took her first consultation, Dr. Rami chose Spark™ Clear Aligners as the preferred choice for this case.
The treatment plan included the extraction of teeth 18 and 28. Upper sequential distalization was planned using a 50% protocol — moving no more than two teeth simultaneously — to gain high predictability while correcting canine relationships. Posterior intrusion and anterior extrusion were incorporated to correct the anterior open bite. Lower IPR from 5 to 5 was planned to reduce lower protrusion and resolve black triangles between the lower incisors.
Phase 1: Initial Active Treatment
Phase 1 included 33 active aligners for the upper arch and 14 active aligners for the lower arch. Class II elastics were applied from day 1 with integrated hooks. The patient was compliant, wearing aligners for 22 hours per day, changing aligners every 7 days. Checkups were scheduled every 4 to 8 weeks.
First day:
After 5 months
X-ray before the refinement
After 8 months, the open bite and occlusal canting were corrected. Class II canine relationship improved and overjet reduced. Additional aligners were ordered (14 active aligners with 3 overcorrection stages).
Refinement included Yin-Yang attachment added to upper canines to control roots tipping , Upper and lower IPR to improve interdental contacts
Extra intrusion applied on lower molars to gain flat curve of spee
X-ray after treatment
* Dr. Rami Raphael Saad is a paid consultant for Ormco. The opinions expressed are those of Dr. Rami Raphael Saad. Ormco is a medical device manufacturer and does not dispense medical advice. Clinicians should use their own professional judgment intreating their patients.
MKT-26-1001
