Aligner Techniques in Orthodontics

Table of Contents

1  Cover

2  Title Page

3  Copyright Page

4  Preface

5  About the Authors

6  Acknowledgements

7  About the Companion Website

8  1 History, Present and Future of Aligners 1.1 History of Clear Aligners 1.2 Origins of Align Technology 1.3 Early Clear Aligner Manufacturers 1.4 Align Technology Development 1.5 Current Situation and Future of Aligners 1.6 Promising Aligner Initiatives 1.7 Future of Clear Aligners

9  2 Basic Principles with Aligners 2.1 Forces 2.2 Engagement 2.3 Anchorage 2.4 Case Selection to Start with Aligners Technique

10  3 Why Invisalign? 3.1 Why Did We Begin Prescribing Invisalign in Our Practice? 3.2 Our Motivation

11  4 Patient Communication Skills 4.1 Invisalign Equates to Health, Wellness and Outstanding Results 4.2 Effective Patient Communication

12  5 Keys to Practice Growth 5.1 How to Get the Best Results with Invisalign

13  6 Patient Selection

14  7 Predictability of Movement 7.1 Treatments to Gain Familiarity with the Technique

15  8 Types of Treatments with Invisalign

16  9 Pillars of the Invisalign Technique 9.1 Aligners 9.2 ClinCheck Software 9.3 Attachments and Features of SmartForce 9.4 Auxiliary Techniques 9.5 Technician (CAD Designer)

17  10 Conventional Attachments

18  11 Clinical Preferences

19  12 Attachments Bonding and Interproximal Reduction 12.1 Bonding Attachments Protocol 12.2 Interproximal Reduction Procedure

20  13 Digital Workflow 13.1 Records 13.2 Creating a New Patient Record

21  14 ClinCheck Software 14.1 The Perfect ClinCheck Review in 10 Steps 14.2 Communication with the Technician

22  15 Treatment Monitoring and Appointments Protocol 15.1 Tracking Treatment Progress 15.2 Appointments Protocol for Invisalign Patient

23  16 Troubleshooting and Retention 16.1 Auxiliary Techniques 16.2 Finishing Techniques 16.3 Retention

24  17 Arch Length Discrepancies 17.1 Spacing 17.2 Crowding

25  18 Growing Patients 18.1 First Treatment 18.2 Teenage Patients

26  19 Transversal Problems: Symmetric and Asymmetric Expansion 19.1 Things to Consider in Expansion Cases 19.2 Symmetric Expansion 19.3 Asymmetric Expansion 19.4 Tips for Transversal Arch Compensation

27  20 Sagittal Discrepancies 20.2 Class II Cases 20.3 Class III 20.4 Dentoalveolar Protrusion Skeletal Class II

28  21 Vertical Problems 21.1 Open Bite 21.2 Deep Bite: Classification According to Complexity Bibliography

29  22 Asymmetries 22.1 Growing Patients with Asymmetry 22.2 Non‐growing Patients with Asymmetry

30  23 Extraction Cases 23.1 Incisor Extraction 23.2 Extraction of Premolars

31  24 Multidisciplinary Cases: Implants 24.1 TADs to Intrude Upper Molars 24.2 Upper Midline Shift 24.3 Posterior Bite Collapse 24.4 Posterior Bite Collapse with Deep Bite 24.5 Biomechanics of the Locatelli for Mesialization of the Lower Dental Arch Opening Space for Implants 24.6 Gingivectomy, Passive Eruption Case 24.7 Anterior Intrusion Anchored on Dental Implant 24.8 Anterior Torque Anchored on Dental Implant

32  25 Prerestorative Orthodontics: Veneers 25.1 Bleaching 25.2 Veneers to Solve Lateral Bolton Discrepancy in a Class III Patient 25.3 Space Opening for Anterior Crowns and Implants 25.4 Anterior Intrusion for Two Central Incisor Veneers 25.5 Edge‐to‐Edge Bite Preparation for Veneers

33  Index

34  End User License Agreement

List of Tables

1 Chapter 20Table 20.1 Extra resources for class II patientsTable 20.2 Protocol when treating a growing patient with class II

List of Illustrations

1 Chapter 1Fig. 1.1 Remensnyder patent file.Fig. 1.2 Kesling patent file.Fig. 1.3 Schwartz and Sheridan patent file.Fig. 1.4 Align Technology logo.Fig. 1.5 Align Technology annual revenue.Fig. 1.6 Align Technology stereolithographic has been heavily awarded.Fig. 1.7 Models and aligners by Clear Correct.Fig. 1.8 Optimized attachments for anterior open bite.Fig. 1.9 Passive attachments for anterior intrusion.Fig. 1.10 Results in PubMed for ‘orthodontics’.Fig. 1.11 Results in PubMed for ‘invisalign’ from 1999 to 2019.Fig. 1.12 ClearCorrect aligner retention chart.Fig. 1.13 SureSmile aligner software combined with CBCT.Fig. 1.14 F22 chromatic stability.Fig. 1.15 3M superimposition for treatment evolution.Fig. 1.16 Ormco results for their TruGEN plastic against SmartTrack (data on fil...Fig. 1.17 Distalizer inserted in an in‐practice aligner.Fig. 1.18 Irok is focused on digital models that can serve different purpose...Fig. 1.19 A6 mandibular advancement launched in 2015.Fig. 1.20 LineDock software.Fig. 1.21 SmileDirectClub self‐polyvinyl siloxane (PVS) ‐impression kit.Fig. 1.22 CANDID aligners process.Fig. 1.23 CANDID aligners set.

2 Chapter 2Fig. 2.1 Forces will be delivered through the combination of plastic and att...Fig. 2.2 Optimized attachments provide an active, flat surface that the alig...Fig. 2.3 These crowns allow enough contact from plastic to exert desired for...Fig. 2.4 Short clinical crowns might reduce movement predictability.Fig. 2.5 Quantification of variable aligner material on retention. (Left) Ve...Fig. 2.6 Brackets have a strong small contact point in comparison with a sof...Fig. 2.7 While second molars are moving, the rest of the teeth are considere...Fig. 2.8 This figure shows a horizontal ‘V’ movement pattern.Fig. 2.9 The second quadrant is being expanded using the first quadrant as a...Fig. 2.10 G6 first premolar extraction has a standardized movement sequence....Fig. 2.11 In this G6 protocol extraction of 14 (from left to right), the pos...

3 Chapter 4Fig. 4.1 Let’s talk about aligner treatment with our patients.Fig. 4.2 The more Invisalign patients you have, the more Invisalign referral...Fig. 4.3 A treatment coordinator is a key success driver for Invisalign.

4 Chapter 5Fig. 5.1 If we plan our growth in advance, we will reach our goals.

5 Chapter 6Fig. 6.1 Invisalign evaluation tool.

6 Chapter 7Fig. 7.1 All treatment predictability can be checked with the Invisalign eva...

7 Chapter 8Fig. 8.1 Align Technology’s 2021 portfolio

8 Chapter 10Fig. 10.1 Ellipsoid attachments. Fig. 10.2 Horizontal attachments have great clinical effects on transverse p...Fig. 10.3 Conventional attachments are selected whenever there are no optimi...Fig. 10.4 Extrusion attachments are placed on teeth adjacent to the ones to ...Fig. 10.5 Vertical attachments bevelled to mesial (left) and distal (right)....Fig. 10.6 Conventional attachments might be placed to achieve similar moveme...Fig. 10.7 Research and development investment has led to a very powerful bio...Fig. 10.8 Conventional dental composite is the material chosen for attachmen...Fig. 10.9 Placement on canines and premolars. Fig. 10.10 Placement on incisor. Fig. 10.11 Placement on premolar.Fig. 10.12 The right side shows how anterior extrusion attachments help to c...Fig. 10.13 The figure on the right shows how optimized root control attachme...Fig. 10.14 Pressure points are usually associated with attachments whenever ...Fig. 10.15 Combination of attachments and lingual pressure points help creat...Fig. 10.16 Sometimes attachments are designed for support instead of movemen...Fig. 10.17 Attachments for molars are relatively new and provide improved ro...Fig. 10.18 Mesiobuccal rotation combined with extrusion.Fig. 10.19 Mesiobuccal rotation combined with intrusion.Fig. 10.20 Molar extrusion.Fig. 10.21 Optimized support attachments are commonly used in first treatmen...Fig. 10.22 Power Ridges are plastic bends exerting ‘push’ forces.Fig. 10.23 Activation exerts forces translated to crown or root.Fig. 10.24 Effect of pressure point on the tooth.Fig. 10.25 Precision Ramps are much comfortable for the patient than convent...Fig. 10.26 Clinical view of Precision Wings in a growing patient.

9 Chapter 11Fig. 11.1 Dedicate time to setting up clinical preferences.

10 Chapter 12Fig. 12.1 Have materials and equipment ready before any appointment.Fig. 12.2 (a) Place composite on template and (b) ensure there is no composi...Fig. 12.3 A metal interproximal reduction strip is the most common type used...Fig. 12.4 A high‐speed bur interproximal reduction (IPR) is suggested for 0....Fig. 12.5 Interproximal reduction and attachments removal bur set is ideal f...Fig. 12.6 Interproximal reduction has to be carefully planned and performed....

11 Chapter 13Fig. 13.1 Frontal, smile and lateral photographs.Fig. 13.2 90 degrees pictures are mandatory both in right (a) and left (b) i...Fig. 13.3 Intraoral frontal (a) and overjet (b) pictures will help create a ...Fig. 13.4 Blue or red ink on both upper (a) and lower (b) occlusal pictures ...Fig. 13.5 Polyvinyl siloxane (PVS) material placement.Fig. 13.6 Inserting tray with polyvinyl siloxane (PVS) material into the pat...Fig. 13.7 Upper (left) and lower (right) impressions.Fig. 13.8 iTero scanner has several advantages, such as the Outcome Simulato...Fig. 13.9 Lateral and panoramic X‐rays.

12 Chapter 14Fig. 14.1 ClinCheck software on‐screen.Fig. 14.2 Compare ClinCheck with pictures on the same plane before start pla...Fig. 14.3 Distortions of the impression might affect aligner coverage, so it...Fig. 14.4 Anterior view.Fig. 14.5 Overjet view.Fig. 14.6 Buccal right view.Fig. 14.7 Buccal left view.Fig. 14.8 Occlusal view: maxillaryFig. 14.9 Occlusal view: mandibular.Fig. 14.10 Posterior view.Fig. 14.11 Mandibular advancement.Fig. 14.12 Treatment overview helps us understand general structure of the t...Fig. 14.13 Reviewing occlusal views.Fig. 14.14 Analysis of the force vectors: in simultaneous distalization, if ...Fig. 14.15 Anterior positive torque (left) allows pure intrusion to resolve ...Fig. 14.16 The sequence will always be based on three steps: (1) procline in...Fig. 14.17 Staging is mandatory to help achieving desired final position.Fig. 14.18 Checking every stage on anterior sector will prevent from unaesth...Fig. 14.19 Round tooth rotations (canines and premolars) require perfectly s...Fig. 14.20 Ask the technician to perform the extrusion of the canine simulta...Fig. 14.21 The pearl necklace effect explains how to use these mechanics in ...Fig. 14.22 Simultaneous expansion for reduction in arch length (incisor retr...Fig. 14.23 Expansion leads to arch depth loss and anterior retraction.Fig. 14.24 Whenever possible, simultaneous anterior intrusion and posterior ...Fig. 14.25 Superimposition tool.Fig. 14.26 Black dots indicate complex movements.Fig. 14.27 Blue dots indicate moderate movements.Fig. 14.28 Attachments.Fig. 14.29 White boxes indicating interproximal reduction turn yellow at the...Fig. 14.30 Treatment overview also addresses interproximal reduction needs....Fig. 14.31 Buttons and hooks: the biomechanical difference between button cu...Fig. 14.33 Button cutouts will allow composite or metal butons to be bonded ...Fig. 14.34 Upper hook will affect upper anterior torque.Fig. 14.35 Upper cutout for bonded button will have less effect on anterior ...Fig. 14.36 Treatment overview also refers to hooks or button cutouts.

13 Chapter 16Fig. 16.1 An example of poor fitting.Fig. 16.2 Fitting can improve with ‘fitters’ chewing.Fig. 16.3 Detailing pliers are helpful for case finishing.Fig. 16.4 Auxiliary technique to recapture a rotated lower canine with butto...Fig. 16.5 Buccal (left) and palatal (right) view of a lateral incisor extrud...Fig. 16.6 Ectopic canines not covered by the aligner.Fig. 16.7 Uprighting a premolar root.Fig. 16.8 This patient had a distal tipping of the second premolar root. A P...Fig. 16.9 In this case goal was to mesialize 47 and 48 in order to close 46 space.Fig. 16.10 Patient with missing 46.Fig. 16.11 The patient had missing 36 and 46.Fig. 16.12 A Locatelli helps to open space.Fig. 16.13 Temporary anchorage devices help intruding teeth in severe deep b...Fig. 16.14 Posterior extrusion is achieved here with auxiliary buttons and e...Fig. 16.15 Auxiliary buttons and elastics help derotating teeth.Fig. 16.16 Change in smile after expansion of upper arch and offset and rota...Fig. 16.17 Mesial‐in rotation of the canine.Fig. 16.18 Mesial‐out rotation of the canine.Fig. 16.19 Finishing bends.Fig. 16.20 Fixed retention from lateral to lateral.Fig. 16.21 Vivera retainers are manufactured by Align Technology.

14 Chapter 17Fig. 17.1 Interproximal reduction has to be performed carefully in order to ...Fig. 17.2 Interproximal reduction might improve the shape and size of teeth,...Fig. 17.3 Interproximal reduction in cases of crowding might improve contact...Fig. 17.4 Spacing cases are usually related to abnormal tooth size, which le...Fig. 17.5 Palatal root torque is seen on the ClinCheck Pro as blue areas on ...Fig. 17.6 Skeletal class I with spacing.Fig. 17.7 Pretreatment views.Fig. 17.8 Pretreatment panoramic X‐ ray, teleradiograph and cephalometry.Fig. 17.9 Upper CC superimposition and instructions to CAD designer.Fig. 17.10 Lower CC superimposition and instructions to CAD designer.Fig. 17.11 Front CC view.Fig. 17.12 Front intraoral picture.Fig. 17.13 Right ClinCheck view, initial situation.Fig. 17.14 Left ClinCheck view, initial situation.Fig. 17.15 Post‐treatment views.Fig. 17.16 Pretreatment and final smile.Fig. 17.17 Post‐treatment panoramic and lateral X‐rays.Fig. 17.18 Skeletal class I with spacing.Fig. 17.19 Intraoral views left, front, right, upper, lower.Fig. 17.20 Smile and pretreatment panoramic X‐ray.Fig. 17.21 Pretreatment Clinchecks.Fig. 17.22 Refinement: intraoral views, left, front, and rightFig. 17.23 Refinement ClinChecks.Fig. 17.24 Final intraoral views left, front, right, upper, lower.Fig. 17.25 Before and after smile.Fig. 17.26 Final panoramic and lateral X‐rays.Fig. 17.27 Skeletal class III with upper maxillary compression and anterior ...Fig. 17.28 Pretreatment views.Fig. 17.29 Pretreatment panoramic X‐ray, teleradiograph and cephalometry.Fig. 17.30 Planned IPR on midline can be seen in several areas of the ClinCh...Fig. 17.31 Upper CC superimposition and instructions to CAD designer.Fig. 17.32 Lower CC superimposition and instructions to CAD designer.Fig. 17.33 Right ClinCheck view, initial situation.Fig. 17.34 Left ClinCheck view, initial situation.Fig. 17.35 Post‐treatment images (right, front, left, upper, lower).Fig. 17.36 Pretreatment smile.Fig. 17.37 Final smile.Fig. 17.38 Upper crowding and anterior crossbite ‘Lite’ treatment in a class...Fig. 17.39 Pretreatment extraoral and intraoral (right, front, left, upper, ...Fig. 17.40 Pretreatment panoramic X‐ray, teleradiograph and cephalometry.Fig. 17.41 Upper CC superimposition and instructions to CAD designer.Fig. 17.42 Lower CC superimposition and instructions to CAD designer.Fig. 17.43 Right ClinCheck view, initial situation.Fig. 17.44 Left ClinCheck view, initial situation. Fig. 17.45 Planned IPR on midline can be seen in several areas of the ClinCh...Fig. 17.46 Initial intraoral views.Fig. 17.47 Final intraoral views.Fig. 17.48 Initial and final occlusal (upper and lower).Fig. 17.49 Pretreatment smile and overjet.Fig. 17.50 Final Smile and overjet.Fig. 17.51 Upper and lower crowding with anterior crossbite of 22.Fig. 17.52 Pretreatment: extraoral and intraoral (right, front, left, upper,...Fig. 17.53 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 17.54 Upper and lower CC superimposition and instructions to CAD design...Fig. 17.55 Right and left ClinCheck view, initial situation and instructions...Fig. 17.56 Interproximal reduction after improving contact surface between i...Fig. 17.57 Evolution in month 13 of treatment.Fig. 17.58 Evolution in month 17 of treatment.Fig. 17.59 Final intraoral (right, front, left, upper, lower) views.Fig. 17.60 Initial and final smile and overjet.Fig. 17.61 Final panoramic and lateral X‐rays.Fig. 17.62 Skeletal class I with crowding.Fig. 17.63 Protocol excludes crisscross elastics to solve premolar crossbite...Fig. 17.64 Extra palatal root torque premolars, selecting multiple teeth wit...Fig. 17.65 Pretreatment intraoral views (left, front, right).Fig. 17.66 Initial panoramic and lateral X‐rays.Fig. 17.67 Pretreatment ClinChecks with interproximal reduction to avoid exp...Fig. 17.68 Refinement: intraoral views (right, front and left).Fig. 17.69 Refinement ClinCheck: right, front and left (in this set, 37 is i...Fig. 17.70 Final intraoral views (left, front, right).Fig. 17.71 Final panoramic‐X‐ray.Fig. 17.72 Final extraoral views.

15 Chapter 18Fig. 18.1 Skeletal growth pattern has to be carefully evaluated in growing p...Fig. 18.2 Upper temporary spacing is 3 mm, on average, while tooth discrepan...Fig. 18.3 Severe crowding on temporary teeth leads to future extractions or ...Fig. 18.4 Disjunction and protraction should be performed on EC1, while mand...Fig. 18.5 Anterior crossbite management should be addressed early.Fig. 18.6 Skeletal class II can be achieved before than usual if overjet is ...Fig. 18.7 More simple devices can achieve less objectives than aligners.Fig. 18.8 Upper compression with posterior and anterior crowding.Fig. 18.9 Views with the Hyrax before Invisalign First.Fig. 18.10 Panoramic X‐ray before Hyrax.Fig. 18.11 After the Hyrax and before Invisalign First (10‐year‐old patient)...Fig. 18.12 Panoramic X‐ray before Invisalign First.Fig. 18.13 Upper CC superimposition and instructions to CAD designer.Fig. 18.14 Lower CC superimposition and instructions to CAD designer.Fig. 18.15 Right ClinCheck view, initial situation.Fig. 18.16 Left ClinCheck view, initial situation.Fig. 18.17 Attachments can be seen in several areas of the ClinCheck softwar...Fig. 18.18 Pretreatment intraoral views (left, front, right) before Invisali...Fig. 18.19 Intraoral views (left, front, right) with first aligner.Fig. 18.20 Actual situation in additional aligners.Fig. 18.21 Initial and final occlusal (upper and lower).Fig. 18.22 Initial and final smile.Fig. 18.23 Severe crowding impeding proper lateral incisor eruption both in ...Fig. 18.24 Taking advantage of aligner biomechanics by distalizing the secon...Fig. 18.25 Pretreatment intraoral views (right, front, left, upper, lower)....Fig. 18.26 Pretreatment panoramic X‐ray showing current dentition status and...Fig. 18.27 Initial extraoral views.Fig. 18.28 Pretreatment Clinchecks (right, front, left, upper, lower).Fig. 18.29 Refinement: (left) 32 has erupted and does not fit in the aligner...Fig. 18.30 Refinement: panoramic X‐rays show the evolution of the sagittal m...Fig. 18.31 Refinement development: Both available arch space and transverse ...Fig. 18.32 Refinement: 12, 22 have erupted but their clinical crowns are not...Fig. 18.33 Final Intraoral views (right, front, left, upper, lower) showing ...Fig. 18.34 Final and final smile views show an improvement in arch developme...Fig. 18.35 Lateral X‐ray shows incisor proclination as a result of the mecha...Fig. 18.36 Class II growing patient, Lite treatment.Fig. 18.37 Pretreatment views before phase 1 with Hyrax and D‐gainer.Fig. 18.38 Lateral and panoramic X‐rays before phase 1 with Hyrax and D‐gain...Fig. 18.39 Extraoral and intraoral (right, front, left, upper, lower) views ...Fig. 18.40 Panoramic X‐ray, teleradiograph and cephalometry before Invisalig...Fig. 18.41 Upper CC superimposition and instructions to CAD designer.Fig. 18.42 Lower CC superimposition and instructions to CAD designer.Fig. 18.43 Right ClinCheck view, initial situation.Fig. 18.44 Left ClinCheck view, initial situation.Fig. 18.45 Attachments and IPR can be seen in several areas of the ClinCheck...Fig. 18.46 Intraoral views (right, front, left, upper, lower).Fig. 18.47 Intraoral views (right, front, left, upper, lower).Fig. 18.48 Initial and final occlusal views (upper and lower).Fig. 18.49 Pretreatment and final smile and overjet.Fig. 18.50 Initial and final profiles.Fig. 18.51 Final panoramic and lateral X‐rays.Fig. 18.52 Initial intraoral picture.Fig. 18.53 Pretreatment views.Fig. 18.54 Pretreatment panoramic X‐ray, teleradiograph and cephalometry.Fig. 18.55 Upper CC superimposition and instructions to CAD designer.Fig. 18.56 Lower CC superimposition and instructions to CAD designer.Fig. 18.57 Interproximal reduction necessary to upright lower incisors befor...Fig. 18.58 Right ClinCheck view, initial situation.Fig. 18.59 Left ClinCheck view, initial situation.Fig. 18.60 Pretreatment intraoral views (left, front, right).Fig. 18.61 Month 6 of evolution: intraoral views (left, front, right).Fig. 18.62 Refinement: month 15 of evolution; intraoral views (left, front, ...Fig. 18.63 Final intraoral views (right, front, left, upper, lower).Fig. 18.64 Pretreatment and final smile.Fig. 18.65 Final panoramic and lateral X‐rays.Fig. 18.66 Class III growing patient comprehensive treatment, with 23 includ...Fig. 18.67 Intraoral views (right, front, left, upper, lower).Fig. 18.68 Panoramic X‐ray, teleradiograph, cephalometry.Fig. 18.69 Upper CC superimposition and instructions to CAD designer.Fig. 18.70 Lower CC superimposition and instructions to CAD designer.Fig. 18.71 Right ClinCheck view, initial situation.Fig. 18.72 Left ClinCheck view, initial situation.Fig. 18.73 Interproximal reduction in lower arch to create positive overjet....Fig. 18.74 Opening space for 15 (lateral view).Fig. 18.75 Opening space for 15 (occlusal view).Fig. 18.76 Locatelli to open space for 15 and 23.Fig. 18.77 Situation at the end of first set of aligners.Fig. 18.78 (a–f) Transversal development of the arches.Fig. 18.79 Month 18 of evolution, intraoral views.Fig. 18.80 Final views with15 and 23 in place.Fig. 18.81 By labial.Fig. 18.82 By lingual.Fig. 18.83 Class I deep bite Lite treatment.Fig. 18.84 Pretreatment views (right, front, left, upper, lower).Fig. 18.85 Upper CC superimposition and instructions to CAD designer.Fig. 18.86 Lower CC superimposition and instructions to CAD designer.Fig. 18.87 Attachments and IPR can be seen in several areas of the ClinCheck...Fig. 18.88 Left ClinCheck view, initial situation.Fig. 18.89 Right ClinCheck view, initial situation.Fig. 18.90 Pretreatment panoramic X‐ray, teleradiography and cephalometry.Fig. 18.91 Pretreatment (upper) and final (lower) results.Fig. 18.92 Initial and final occlusal (upper and lower).Fig. 18.93 Pretreatment and final smiles and overjets.Fig. 18.94 Final panoramic and lateral X‐rays.Fig. 18.95 Ectopic palatal canine.Fig. 18.96 Initial intraoral views (right, front, left, upper, lower).Fig. 18.97 Initial extraoral views.Fig. 18.98 Initial intraoral views: traction 1, 2, 3.Fig. 18.99 Initial lateral and panoramic X‐rays.Fig. 18.100 Refinement: intraoral views (right, front, left, upper, lower)....Fig. 18.101 ClinChecks: right, front, left, upper, lower.Fig. 18.102 Traction 4 and 5. Initial traction was delivered with constant f...Fig. 18.103 Refinement 2: intraoral views (right, front, left, upper, lower)...Fig. 18.104 Smile at refinement 2.Fig. 18.105 Refinement 2 ClinChecks (right, front, left, upper, lower).Fig. 18.106 Final intraoral views.Fig. 18.107 Final smile view.Fig. 18.108 Current cephalometric measurements.Fig. 18.109 Ortopantomographs (OPG) 0, 1, 2, 3. Evolution of the canine with...Fig. 18.110 Temporary 52.Fig. 18.111 Initial intraoral views (right, front, left, upper, lower).Fig. 18.112 Pretreatment panoramic X‐ray with wisdom teeth present.Fig. 18.113 Final intraoral views (right, front, left, upper, lower).Fig. 18.114 Initial and final panoramic X‐rays. Right class I was achieved e...Fig. 18.115 Final lateral X‐ray and cephalometric analysis.