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Purpose: The aim of this study was to evaluate the effect of adding 10-MDP to resin-modified glass ionomer on its dentin bond strength and fluoride release.Aim: the aim of this case report is to confirm that Invisalign First system is an optimal and effective therapeutic choice in growing patient with deep bite and dental crowding.
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Giuseppina  Laganà
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Annali di stomatologia
growing patient
Deep bite and dental crowding in a growing patient treated using invisalign first: a case report
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Case Report
2023-11-20
2023-11-17
2023-11-05
2024-01-11
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Ann Stomatol (Roma)
Giuseppina  Laganà
2023/11/20
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Department of Systems Medicine, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
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growing patient
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Deep bite and dental crowding in a growing patient treated using invisalign first: a case report
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                                                                                                        Case report


Deep bite and dental crowding in a growing patient
treated using invisalign first: a case report



Arianna Malara1                                               valid strategy to solve orthodontic issues such as dental
Silvia Fanelli1                                               crowding, arch forms, and space loss for normal dental
Giuseppina Laganà1,2                                          eruption. Furthermore, a good esthetic, proper oral hy-
                                                              giene and stable results were obtained using Invisalign
1
  Department of Systems Medicine, University of Rome          First system.
“Tor Vergata”, Viale Oxford 81, 00133
Rome, Italy                                                   INTRODUCTION
2
  UniCamillus - Saint Camillus International University of
Health Sciences, Rome, Italy                                  Case report
                                                              This case report describes a growing male patient with
Corresponding author: Arianna Malara                          dentoskeletal class I, dental crowding and inadequate
drariannamalara@gmail.com                                     space for of 1.2 e 4.2 eruption, treated successfully with
                                                              aligners.
Abstract
Aim: the aim of this case report is to confirm that In-       MATERIALS AND METHODS
visalign First system is an optimal and effective ther-
apeutic choice in growing patient with deep bite and
                                                              Diagnosis and etiology
dental crowding.                                              A 7-year-old growing Caucasian male presented for
                                                              treatment with a chief complaint of absence of
Keywords: Invisalign First, deep-bite, dental crowd-          1.2 and 4.2. The general medical history was negative
ing, growing patient.                                         for illness and allergy. The patient did not receive any
                                                              previous orthodontic treatment and clinical examination
                                                              showed no sign of bad habits. Extra-oral photos (Fig.
Materials and Methods                                         1) and frontal and lateral examination revealed a facial
R.P., 7 years old, male, showed a dentoskeletal Class I       symmetry, coincident midlines and good exposure of up-
relationship with dental crowding in both maxillary and       per incisors. The profile had a convex aspect.
mandibular arches, inadequate space for the eruption of       Intra-oral photos (Fig. 2) and clinical examination re-
1.2 e 4.2, mesial rotation of 1.6 and 2.6, coincident mid-    vealed dental class I, coincident midlines, deep- bite and
line and increased overbite.                                  dental crowding with mesial rotation of 1.6 and 2.6. Peri-
The treatment plan lasted 12 months and provided an           odontal biotype and oral hygiene were good.
esthetic orthodontic approach using Invisalign First sys-     At intra-oral evaluation, the patient showed inadequate
tem to expand and restore arches form, to recover space       space for 1.2 and 4.2 eruption; uncoordinate upper and
for the 1.2 and 4.2 eruption, to obtain crowding resolu-      mandibular arches, a bilateral molar and canine Angle
tion, and manage space for elements 1.3, 2.3, 3.3 and         Class I relationship, increased overbite and ideal overjet
4.3 eruption.                                                 (Figure 2).
Pre- and post-treatment records are presented.                Lateral cephalometric radiographs and panoramic ra-
                                                              diography were obtained and analyzed. The panoramic
Results                                                       radiography (Figure 3A) revealed an early mixed dentition
                                                              with the absence of tooth developmental anomalies of
At the end of the active therapy, functional occlusion with
                                                              number, size, shape and structure, a lack of bone defects,
Class I molar relationship was maintained, space was
                                                              no infection, no temporomandibular joint abnormalities
created for the 1.2 and 4.2 eruption and dental crowd-
                                                              and inadequate space for the eruption of 1.2 and 4.2.
ing was solved in both arches. Spaces of 0.1 millimeters
                                                              According to Steiner’s cephalometric analysis [1], Later-
mesial and distal the upper and lower deciduous canines
                                                              al cephalometric radiograph (Fig. XX) showed skeletal
were opened for the later eruption of the permanent ca-
                                                              Class I relationship (ANB= 3°; Wits= -2 mm) and a nor-
nines as evident in the OPT. Good intercuspation was
                                                              modivergent growth pattern (SN^GoMe=36°; FMA=26°).
achieved and midlines were maintained coincident.
                                                              Maxillary incisors were normally inclined (INC-
                                                              SUP^PF=106°) and mandibular incisors had a correct
Conclusion
                                                              inclination (IMPA=90°). Overbite was increased at the
In the presented case report Invisalign First system          beginning of treatment (OVB= 6) and overjet had ideal
combined with an appropriate treatment staging is a           values. (OVJ=4mm) as reported in Table 1.


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     Deep bite and dental crowding in a growing patient treated using invisalign first: a case report




     Figure 1. Extra-oral photos before the treatment.




                                                                                             Figure 2. Intra-oral photos before
                                                                                             the treatment.


     Table 1. Cephalometric analysis before the treatment.

                                                                  T1                                         V.N.

                                              SAGITTAL SKELETAL RELATIONSHIP

                        SNA°                                      77                                      82 +/- 2°
                        SNB°                                      74                                      82 +/- 2°
                        ANB°                                       3                                       2 +/- 2°
                       WITS                                        -2                                    0 +/- 2 mm

                                              VERTICAL SKELETAL RELATIONSHIP

                       FMA°                                       26                                      25 +/- 3°
                    SN/Go-Me°                                     36                                      33 +/- 5°
                   SN/ANS-PNS°                                     9                                       7 +/- 3°
                 ANS-PNS/Go-Me°                                   28                                      28 +/- 6°
                     ArGoMe°                                      128                                     130 +/- 7°
                                                  DENTAL BASE RELATIONSHIP
                       U1/PF                                      106                                     105-110°
                        IMPA                                      90                                      94 +/- 5°
                      L1/A-Pg                                      2                                     2 +/- 2 mm
                      OVB mm                                       4                                    2,5 +/- 2,5 mm
                      OVJ mm                                       4                                    2,5 +/- 2,5 mm



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A. Malara et al.


        A




        B




      Figure 3. Panoramic radiography (A) and lateral cephalometric radiography (B) before the treatment.



According to the Cervical Vertebral Maturation meth-            Treatment progress
od [2], the patient was in a prepubertal phase without
completing his craniofacial growth (between CS1- CS2)           The Invisalign ClinCheck plan dictated 35 aligners for
(Figure 3B).                                                    each arch. To achieve expansion and restoration of arch
                                                                forms, the plan involved a sequential expansion with
                                                                “molars move first” staging planning [3-5]. The plan also
Treatment goals
                                                                involved arches alignment and deep bite resolution. In
The primary objective was expansion and restoration of          order to achieve correct alignment and valid intercuspa-
arch forms, space recovery for the eruption of 1.2 and          tion, Invisalign attachments were planned, while no IPR
4.2, management of space for the eruption of permanent          was requested in the treatment plan. The patient was in-
canines, resolution of crowding and obtain ideal overbite       structed to wear each aligner 22/h per day and to move
using Invisalign First system.                                  on to the next one in the series after 7 days.



10.59987/ads/2023.3.17-22                                                                                                   19
     Deep bite and dental crowding in a growing patient treated using invisalign first: a case report




     Figure 4. Extra-oral photos after the treatment.




                                                                                                    Figure 5. Intra-oral photos
                                                                                                    after the treatment.



     RESULTS                                                          DISCUSSION
     The overall treatment lasted 12 months and included 35           In this clinical case, a functional occlusion with Class I
     aligners. The treatment objectives had been successfully         molar relationship was obtained, space was created for
     fulfilled (Figure 4 and 5), although it will be necessary to     the element 1.2 and 4.2, crowding was solved in both
     plan an Invisalign Phase II treatment for detailed finishing     arches. Spaces were opened for the later eruption of the
     of the case. Follow-up panoramic radiography showed              permanent canines as evident in the panoramic radiog-
     good position of 1.3, 2.3, 3.3 and 4.3 (Figure 6A).              raphy. Good intercuspation was achieved and midlines
     Post-treatment lateral teleradiograph showed that the            were coincident. Good esthetic and stable results were
     treatment guaranteed the initial skeletal and aesthetic          obtained only using Invisalign First protocol.
     values with and improvements of dental values (Table 2           Orthodontic developments, particularly in recent years,
     and Figure 6B).                                                  were accompanied by an important increase in the
     · Skeletal outcomes: cephalometric analysis con-                 esthetic demands of the patients [6]. Since 1990, In-
         firmed the skeletal Class I relationship (ANB=3°,            visalign® technology has become recognized through-
         Wits=-2mm). The patient presented a properly sagit-          out the world as an esthetic alternative to the fixed ap-
         tal position between the maxillary and mandible with         pliances [7]. This system uses impressions or intraoral
         the maintenance of the FMA angle at the end of treat-        scans which are converted through stereolithographic
         ment (FMA=26°);                                              technology (.stl) into virtual models and then launched
     · Dental outcomes: the dental cephalometric analysis             with the ClinCheck software: a three-dimensional mod-
         revealed the maintenance of the inclination of the up-       eling program that allows a virtual simulation of teeth
         per and lower incisors, a proper overjet (OVJ=3mm)           movements. A series of aligners is then produced in or-
         and the overbite improvement (OVB =3mm). The                 der to gain the needed corrections [8]. After its launch,
         mandibular incisors inclination remained stable at the       the system was greatly improved in several ways: new
         end of treatment (IMPA=90°);                                 attachment designs and new materials [9].
     · Aesthetic outcomes: the soft tissue changes in-                Most recently, Invisalign First package was presented
         volved a good profile with the jaws proportionately          to the public, for the treatment of the malocclusions in
         positioned in the sagittal plane. On a frontal view the      growing patients.
         patient showed an ideal smile arc.                           Early orthodontic treatment in mixed dentition is recom-



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A. Malara et al.


             A




             B




           Figure 6. Panoramic radiography (A) and lateral cephalometric radiography (B) after the treatment.



mended to reduce or even eliminate the need for further          is less than that of a multi-bracket treatment, especially
orthodontic treatment, preventing problems or functional         in the first 6 months of therapy [15]. This innovative treat-
anomalies [10-12].                                               ment enables young patients to attend all their school
Orthodontic clinicians are frequently challenged to              and social activities with no aesthetic limitations. In addi-
promptly identify and handle early signs of malocclusion         tion, CA is a removable device which allows optimal oral
that, if left untreated, could lead to the development of a      hygiene along with meticulous oral care. CAT prevents
more severe malocclusion with skeletal compromise and            the deterioration of periodontal status, tooth decalcifica-
temporomandibular symptoms [10].                                 tion during orthodontic treatment and speech disorders
Nowadays, the employment of clear aligners (CA) is in-           due to the bulkiness of the removable appliance [16].
creasingly being considered over other treatment strate-
gies as aesthetics, comfort and oral hygiene are greater
than that of conventional fixed appliances [13-14].
                                                                 CONCLUSIONS
In fact, as concerns the patient’s experience, it is be-         This case report confirms that Invisalign First system is
lieved that the impact of clear aligners treatment (CAT)         an optimal and effective therapeutic choice in growing
on daily activities (oral symptoms, functional limitations)      patient with deep bite and dental crowding.


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     Deep bite and dental crowding in a growing patient treated using invisalign first: a case report

     Table 2. Cephalometric analysis after the treatment

                                                                             T1                                               V.N.

                                                    SAGITTAL SKELETAL RELATIONSHIP

                          SNA°                                               77                                            82 +/- 2°
                          SNB°                                               74                                            82 +/- 2°
                          ANB°                                                3                                             2 +/- 2°
                          WITS                                               -2                                          0 +/- 2 mm

                                                    VERTICAL SKELETAL RELATIONSHIP

                          FMA°                                               26                                            25 +/- 3°
                      SN/Go-Me°                                              36                                            33 +/- 5°
                    SN/ANS-PNS°                                               9                                             7 +/- 3°
                  ANS-PNS/Go-Me°                                             28                                            28 +/- 6°
                       ArGoMe°                                               128                                          130 +/- 7°
                                                         DENTAL BASE RELATIONSHIP
                         U1/PF                                               108                                           105-110°
                          IMPA                                               90                                            94 +/- 5°
                        L1/A-Pg                                               2                                          2 +/- 2 mm
                       OVB mm                                                 3                                        2,5 +/- 2,5 mm
                        OVJ mm                                               3                                         2,5 +/- 2,5 mm




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