Aligner treatment of Class III malocclusion with anterior crossbite｜【Chris Chang Ortho】CC547

Abstract:
A 19-y/o male came for consultation for a protrusive lip and an unaesthetic smile. He was previously advised against his preferred clear aligner therapy by other orthodontists. His facial profile was concave, and the cephalometric analysis indicated a skeletal Class III relationship(ANB = -2°). His diagnosis was a Class III malocclusion with an anterior crossbite, and an overjet of -2 mm; no functional shift was noted. The molar relationships were end-on Class III bilaterally. The treatment plan was to distalize the lower arch with aligners. Class III intermaxillary elastics were added to increase anchorage. Occlusal attachments were installed on LL6 and LR6 to unlock the anterior crossbite. In the 9th month the anterior crossbite was solved. The patient finished his first set of aligners in the 14th month. Second refinement treatment was initiated to improve the occlusion. The total treatment time was 19 months. Overall, a case with a Discrepancy Index(DI) of 11 was treated with a Cast-Radiograph Evaluation(CRE) of 5 and a Pink & White Esthetic Score of 2.
摘要：
十九歲的男性主訴下唇突出，笑容不美觀。他想透過隱形矯正治療，但先前諮詢其他矯正醫師時被告知他的情況不適合使用隱形矯正。患者的側臉內凹，側顱分析為骨性第三類咬合關係 (ANB = -2°)。本案例診斷為第三類咬合異常，合併前牙錯咬，水平覆咬深度為 -2 mm，且無功能性位移。雙側臼齒關係為 end-on Class III。治療計畫為將以隱型牙套將下排牙齒往遠心移動。當錨定不足時，加入三類橡皮筋來改善此問題。同時，為了矯正前牙錯咬，在下排隱型牙套上設計咬合面附件來打開咬合。第九個月時即解決前牙錯咬的問題。十四個月後，病人完成了第一套隱適美治療。為改善咬合關係，又進行了第二套的隱形牙套。最終總療程為十九個月，本案例術前評量 DI 值為 11 分，術後 CRE 評分為 5，前牙美學的分數為 2。

[@AncaAlbina]

Very nice case and presentation, but the retroinclination of the lower incisors is not too big?

[@dafnashashua1418]

Lovely case!! What is tongue depressor?

[@ChrisChangOrtho]

Thank you for your asking, please refer this:www.artorthodontics.com/2020/01/early-orthodontic-treatment-anterior-crossbite/

[@dafnashashua1418]

@@ChrisChangOrthoexercising the tongue depressor with or without the aligners?

[@MrLogo13]

Are you really happy with that final extraoral smile?

[@changkao0421]

MrLogo13 really happy

[@MrLogo13]

@@changkao0421 You let him with a minimal upper incisor display with all this upper arch intrusion, while the real problem was (and still is) the lower incisor extrusion. Im sure you will say he is happy with the result, but as an orthodontist I would, at least, not be really happy with a compromised smile like this. We treat smiles not only occlusions.