Aligner Techniques in Orthodontics

16 Chapter 19Fig. 19.1 Classic NiTi archwires were only available on standard sizes and s...Fig. 19.2 Expansion can be defined in a precise way, with the decision about...Fig. 19.3 Expansion with aligners can be defined in between Fa point (blue l...Fig. 19.4 Dentoalveolar expansion can be achieved with aligners, as with bra...Fig. 19.5 In this situation, if we ask for the same amount of expansion in b...Fig. 19.6 Check smile In unilateral masticatory side the patient will expose...Fig. 19.7 Asymmetric expansion.Fig. 19.8 Blue arrows indicate proper posterior torque, white ones show arch...Fig. 19.9 Pearl necklace effect.Fig. 19.10 Smile picture.Fig. 19.11 Symmetric compression causing anterior open bite.Fig. 19.12 Pretreatment extraoral and intraoral views.Fig. 19.13 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 19.14 Interproximal reduction.Fig. 19.15 Upper superposition.Fig. 19.16 Lower superposition.Fig. 19.17 Initial right ClinCheck view, with CAD designer instructions.Fig. 19.18 Initial left ClinCheck view, with CAD designer instructions.Fig. 19.19 Comparison of initial and final occlusion.Fig. 19.20 Comparison of initial and final occlusal.Fig. 19.21 Comparison of initial and final smile overjets.Fig. 19.22 Comparison of initial and final smiles.Fig. 19.23 Final panoramic X‐ray and teleradiograph.Fig. 19.24 Edge to edge bite with open bite tendency.Fig. 19.25 Pretreatment intraoral views (right, front, left, upper, lower)....Fig. 19.26 Initial extraoral view: short display.Fig. 19.27 Pretreatment panoramic and lateral X‐rays.Fig. 19.28 Pretreatment ClinChecks (right, front, left, upper, lower).Fig. 19.29 Refinement intraoral views (right, front, left, upper, lower).Fig. 19.30 Refinement smile.Fig. 19.31 Refinement ClinChecks (right, front, left, upper, lower).Fig. 19.32 Final intraoral views (right, front, left, upper, lower).Fig. 19.33 Final smile picture and lateral X-ray.Fig. 19.34 Symmetric compression.Fig. 19.35 Pretreatment intraoral views (right, front, left, upper, lower)....Fig. 19.36 Pretreatment panoramic X‐ray, teleradiograph and cephalometry.Fig. 19.37 Upper CC superimposition and instructions to CAD designer.Fig. 19.38 Lower CC superimposition and instructions to CAD designer.Fig. 19.39 Attachments and IPR can be seen in several areas of the ClinCheck...Fig. 19.40 Right ClinCheck view, initial situation.Fig. 19.41 Left ClinCheck view, initial situation.Fig. 19.42 Views before starting refinement.Fig. 19.43 Final views.Fig. 19.44 Comparison of initial and final occlusal (upper and lower).Fig. 19.45 Final expansion reducing buccal corridors.Fig. 19.46 Final Panoramic X‐ray and teleradiography.Fig. 19.47 Symmetric compression with loss of attachment.Fig. 19.48 Pretreatment extraoral and intraoral views.Fig. 19.49 Pretreatment panoramic X‐ray, teleradiograph and cephalometry.Fig. 19.50 Upper CC superimposition and instructions to CAD designer.Fig. 19.51 Lower CC superimposition and instructions to CAD designer.Fig. 19.52 Interproximal reduction is necessary to upright lower incisors.Fig. 19.53 Right and left ClinCheck view, initial situation.Fig. 19.54 Comparison of pretreatment (upper) and final (lower) views.Fig. 19.55 Comparison of initial and final occlusal.Fig. 19.56 Comparison initial of and final smile and overjet.Fig. 19.57 Posterior bilateral crossbite.Fig. 19.58 Initial extraoral views.Fig. 19.59 Initial intraoral views (right, front, left, upper, lower).Fig. 19.60 Pretreatment Clinchecks: right, front, left, upper, lower.Fig. 19.61 Refinement: intraoral views (right, front, left, upper, lower).Fig. 19.62 Refinement ClinChecks: right, front, left, upper, lower.Fig. 19.63 Refinement 2: intraoral views (right, front, left, upper, lower)....Fig. 19.64 Refinement 2 ClinChecks: right, front, left, upper, lower.Fig. 19.65 Final intraoral views (right, front, left, upper, lower).Fig. 19.66 Pretreatment and final smile.Fig. 19.67 Posterior bilateral compression.Fig. 19.68 Initial intraoral views (right, front, left, upper, lower).Fig. 19.69 Initial intraoral views (right, front, left, upper, lower).Fig. 19.70 Pretreatment ClinChecks: right, front, left, upper, lower. Fig. 19.71 Refinement: intraoral views (right, front, left, upper, lower). Fig. 19.72 Refinement ClinChecks: right, front, left, upper, lower.Fig. 19.73 Refinement ClinChecks: right, front, left, upper, lower.Fig. 19.74 Check first column on both charts to see how much expansion was a...Fig. 19.75 Refinement 2: intraoral views (right, front, left, upper, lower)....Fig. 19.76 Final intraoral views: right, front, left, upper, lower.Fig. 19.77 Pretreatment and final smile.Fig. 19.78 Final lateral, cephalometric analysis and panoramic X-ray.Fig. 19.79 patient with severe periodontal disease.Fig. 19.80 Pretreatment views. Note the critical periodontal situation of up...Fig. 19.81 Initial panoramic X-ray, teleradiograph and cephalometry.Fig. 19.82 Problem list.Fig. 19.83 Treatment plan.Fig. 19.84 It is important to relate clinical view to the Clincheck.Fig. 19.85 Upper and lower CC superimposition and instructions to CAD design...Fig. 19.86 Goal of treatment. Open space by asymmetric upper expansion on th...Fig. 19.87 Right ClinCheck view, initial situation.Fig. 19.88 Left ClinCheck view, initial situation.Fig. 19.89 Pontic to open space for a second upper right canine.Fig. 19.90 Views before refinement.Fig. 19.91 Comparison of initial (upper) with final (lower) occlusion. Compo...Fig. 19.92 Comparison of initial and final occlusal.Fig. 19.93 Comparison of initial and final smile and overjet.Fig. 19.94 Comparison of initial (left) and final panoramic x‐rays (right). ...Fig. 19.95 Final teleradiograph.Fig. 19.96 Asymmetric compression.Fig. 19.97 Pretreatment views.Fig. 19.98 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 19.99 left‐side deviation of lower jaw.Fig. 19.100 Upper and lower CC superimposition and instructions to CAD desig...Fig. 19.101 Interproximal reduction is necessary to reduce the lower dental ...Fig. 19.102 Initial views before refinement. The posterior open bite on left...Fig. 19.103 Goal of treatment: correct posterior crossbite from 23 to 27.Fig. 19.104 Initial and final design of the asymmetric expansion of the uppe...Fig. 19.105 Comparison of initial and final occlusion.Fig. 19.106 Final occlusion. Both midlines centred. Unilateral posterior cro...Fig. 19.107 Improvement in the smile and in the final torque of upper inciso...Fig. 19.108 Improvement in the profile by clockwise rotation of the mandible...Fig. 19.109 Posterior crossbite with anterior crowding.Fig. 19.110 Careful diagnosis of the crossbite origin will lead to a great r...Fig. 19.111 Cone beam computed tomography: three dimensional radiological ex...Fig. 19.112 Pretreatment intraoral views (right, front, left, upper, lower)....Fig. 19.113 Pretreatment smile and lateral X‐ray.Fig. 19.114 Pretreatment ClinChecks: right, front, left, upper, lower.Fig. 19.115 Refinement: intraoral views (right, front, left, upper, lower)....Fig. 19.116 Smile after first set of aligners.Fig. 19.117 Refinement ClinChecks: right, front, left, upper, lower.Fig. 19.118 Final intraoral views: right, front, left, upper, lower.Fig. 19.119 Pretreatment and final smile: we can observe how posterior expan...Fig. 19.120 Cone beam computed tomography sections. From left (pretreatment)...Fig. 19.121 Posterior crossbite, with anterior crossbite and edge‐to‐edge oc...Fig. 19.122 Smile and upper and lower arch view.Fig. 19.123 Panoramic and lateral X‐rays.Fig. 19.124 Measurements were performed after iTero scanning and OrthoCad so...Fig. 19.125 Skeletal compression has to be approached with a surgical proced...Fig. 19.126 First phase: initially, the patient had a gingivectomy performed...Fig. 19.127 First phase: initially, the patient had a gingivectomy performed...Fig. 19.128 Upper pre‐miniscrew‐assisted rapid palatal expander (MARPE): pos...Fig. 19.129 Right, Front, Left Post miniscrew‐assisted rapid palatal expande...Fig. 19.130 Second phase. Measurements were performed after iTero scanning a...Fig. 19.131 Second phase ClinChecks (front, upper, lower).Fig. 19.132 Third phase: intraoral views (front and upper).Fig. 19.133 After 16 aligners space was closed, palatal suture was still ope...Fig. 19.134 Third phase ClinChecks (front, upper, lower).Fig. 19.135 Final intraoral views: front, upper, lower.Fig. 19.136 Pretreatment and final smile.Fig. 19.137 Initial and final cephalometric measurements, with the final pos...Fig. 19.138 Final panoramic X‐ray. Patient smile was widened and skeletal ba...

17 Chapter 20Fig. 20.1 Precision cuts and button cutouts: to hold the intermaxillary elas...Fig. 20.2 Precision hooks would equal to archposts in fixed appliances.Fig. 20.3 Button cutouts allow bonding a metal/ceramic button.Fig. 20.4 Class II, division 2 will benefit from two button cutouts for clas...Fig. 20.5 Class II, division 1 will benefit from canine hook and molar butto...Fig. 20.6 Mesial‐in rotation of the canine.Fig. 20.7 Mesial‐out rotation of the canine.Fig. 20.8 Whenever a lingual button is placed on the lingual surface of the...Fig. 20.9 Occlusal view of lingual buttons on upper canines.Fig. 20.10 Pontic to cover missing 34.Fig. 20.11 Traction of impacted canine using elastic from button in canine t...Fig. 20.12 Interproximal reduction can be performed on upper premolars to di...Fig. 20.13 With class II or class III elastics use, visualization will be sh...Fig. 20.14 From a ‘left 90 degrees view’ the sequential distalization is see...Fig. 20.15 Sequential distalization increases surface contact with molars on...Fig. 20.16 Effect of a coil spring opening space is similar to sequential di...Fig. 20.17 Effect of a coil spring opening space would lead to lack of torqu...Fig. 20.18 Effect of a coil spring opening space would lead to anterior proc...Fig. 20.19 Posterior Powerwings on aligner help advancing mandible on growin...Fig. 20.20 Class II profiles will benefit from this feature.Fig. 20.21 Class II, division 2 incisors need treatment sequence like this: ...Fig. 20.22 Class II, division 2 incisors need a treatment sequence such as: ...Fig. 20.23 Upper expansion leads to higher arch depth reduction and resolvin...Fig. 20.24 Clinchecks: a 45 degree upper molar derotation solves up to 1 mm ...Fig. 20.25 Intraoral views: a 45 degree upper molar derotation solves up to ...Fig. 20.26 Lower mesialization is represented in yellow, and results from th...Fig. 20.27 Biomechanics is the basis of an orthodontic treatment, regardless...Fig. 20.28 Distalization should start just after wisdom tooth extraction so ...Fig. 20.29 Growth has to be carefully checked before a mandibular advancemen...Fig. 20.30 Eruption compensator in a canine.Fig. 20.31 Any contact over 12 g will interrupt the tooth eruption.Fig. 20.32 Terminal molar tabs prevent molars supra‐eruption creating poster...Fig. 20.33 Initial intraoral view.Fig. 20.34 Pretreatment extraoral and intraoral views.Fig. 20.35 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 20.36 Intraoral situation after Herbst appliance. After the first phase...Fig. 20.37 Upper and lower ClinCheck views.Fig. 20.38 Comparison of initial (upper row) with final result (lower row)....Fig. 20.39 Initial (left) and final occlusal(right).Fig. 20.40 Initial (left) and final overjet (right).Fig. 20.41 Mandibular changes.Fig. 20.42 Changes in profile.Fig. 20.43 Initial smile (left), smile at the end of first phase (middle) an...Fig. 20.44 Initial and final lateral X‐rays.Fig. 20.45 Intraoral initial picture.Fig. 20.46 Initial extraoral and intraoral views.Fig. 20.47 Occlusal contact at the beginning of the treatment.Fig. 20.48 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 20.49 Initial upper and lower ClinCheck views.Fig. 20.50 Initial right and left ClinCheck views.Fig. 20.51 Initial frontal Clincheck view.Fig. 20.52 Goal of treatment: mandibular advancement into a bilateral class ...Fig. 20.53 Initial occlusion (upper), month 6 of evolution (middle), with al...Fig. 20.54 Mandibular advancement in the first six months of treatment.Fig. 20.55 New ClinCheck, asking to level the curve of Spee before continuin...Fig. 20.56 Aligner 17 of additional aligners using class II elastics.Fig. 20.57 Position of class II elastics (from lingual of upper first premol...Fig. 20.58 Situation at the end of mandibular advancement phase, before aski...Fig. 20.59 Comparison between initial (upper) and final occlusion (lower).Fig. 20.60 Final arch development.Fig. 20.61 Comparison initial and final overjet.Fig. 20.62 Comparison of initial and final smile.Fig. 20.63 Mandibular changes after 18 months of treatment.Fig. 20.64 Comparison in chin projection between initial, before additional ...Fig. 20.65 Final lateral X‐ray.Fig. 20.66 Initial intraoral view.Fig. 20.67 Pretreatment extraoral and intraoral views.Fig. 20.68 Lower skeletal asymmetry. Normal upper incisors exposure at rest ...Fig. 20.69 Initial panoramic X‐ray, teleradiograph and cephalometry. The AimFig. 20.70 Initial upper and lower ClinCheck views.Fig. 20.71 Lateral ClinCheck views.Fig. 20.72 Initial frontal Clincheck view.Fig. 20.73 Comparison between initial (upper) and final occlusion (lower).Fig. 20.74 Initial (left) and final occlusal (right).Fig. 20.75 Initial and final smile.Fig. 20.76 Panoramic and lateral X‐rays.Fig. 20.77 Initial intraoral view.Fig. 20.78 Pretreatment extraoral and intraoral views.Fig. 20.79 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 20.80 Initial upper and lower ClinCheck viewsFig. 20.81 Initial right and left ClinCheck views.Fig. 20.82 Initial front ClinCheck view.Fig. 20.83 Upper sequential distalization and lower sequential mesialization...Fig. 20.84 Comparison between initial (upper) and final (lower) occlusion.Fig. 20.85 Before (left) and after (right) lower occlusal views.Fig. 20.86 Initial and final smile and overjet.Fig. 20.87 Final panoramic and lateral X‐rays.Fig. 20.88 Initial intraoral view.Fig. 20.89 Pretreatment extraoral and intraoral views.Fig. 20.90 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 20.91 Upper and lower occlusal ClinCheck views.Fig. 20.92 Right and left ClinCheck views.Fig. 20.93 Front ClinCheck view.Fig. 20.94 Treatment interproximal reduction.Fig. 20.95 Sequential upper distalization pattern.Fig. 20.96 Before (upper) and after (lower) intraoral views.Fig. 20.97 Initial (left) and final (right) occlusal.Fig. 20.98 Initial and final smile and overjet.Fig. 20.99 Final panoramic and lateral X‐rays.Fig. 20.100 Initial intraoral view.Fig. 20.101 Pretreatment extraoral and intraoral views.Fig. 20.102 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 20.103 Superimposition, upper occlusal ClinCheck view.Fig. 20.104 Superimposition, lower occlusal ClinCheck view.Fig. 20.105 Biomechanics for simultaneous distalization.Fig. 20.106 Clincheck view.Fig. 20.107 Right and left ClinCheck views.Fig. 20.108 Initial views (upper), before additional aligners (middle) and f...Fig. 20.109 Before (left) and after (right) occlusal views.Fig. 20.110 Simultaneous distalization pattern.Fig. 20.111 Before and after treatment smile.Fig. 20.112 Final panoramic and lateral X‐rays.Fig. 20.113 Distalization from 3 to 7 in a row pattern.Fig. 20.114 Extraoral analysis: mandibular asymmetry.Fig. 20.115 Initial intraoral views.Fig. 20.116 Scissor bite on left side.Fig. 20.117 Scissor bite on left side.Fig. 20.118 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 20.119 ClinCheck upper occlusal view. Correct class II by simultaneous ...Fig. 20.120 ClinCheck lower occlusal view.Fig. 20.121 Interproximal reduction.Fig. 20.122 Lateral views: Class II elastics from upper 4 to lower 7.Fig. 20.123 Evolution after 13 months.Fig. 20.124 Rein horse to distalize upper molars from TADs in the tuberosity...Fig. 20.125 Evolution after 17 months.Fig. 20.126 Correction of scissor bite.Fig. 20.127 Initial (upper) and final occlusion (lower).Fig. 20.128 Before (left) and after (right) occlusal.Fig. 20.129 Comparison of before (left) and after smile (right).Fig. 20.130 Before (left) and after (right) profile.Fig. 20.131 Final panoramic and lateral X‐rays.Fig. 20.132 Simultaneous distalization from 5 to 5 pattern.Fig. 20.133 Pretreatment extraoral and intraoral views.Fig. 20.134 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 20.135 Initial upper and lower ClinCheck views.Fig. 20.136 Interproximal reduction from 33 to 43 to upright lower incisors....Fig. 20.137 Right and left ClinCheck views.Fig. 20.138 Intra‐arch Powerchain from upper canine to first molar to guide ...Fig. 20.139 Initial (upper) and final (lowe) intraoral views.Fig. 20.140 Occlusal before (left) and after (right) treatment.Fig. 20.141 Final occlusal contact.Fig. 20.142 Initial (left) and final smile (right).Fig. 20.143 Final panoramic and lateral X‐rays: maintenance of lower incisor...Fig. 20.144 Top jet appliance.Fig. 20.145 Pretreatment extraoral and intraoral views.Fig. 20.146 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 20.147 Distalization with top‐jet before Invisalign treatment.Fig. 20.148 Sequential distalization with class II elastics.Fig. 20.149 Upper and lower ClinCheck views.Fig. 20.150 Lateral ClinCheck views.Fig. 20.151 Comparison of initial (upper) and final (lower) intraoral views....Fig. 20.152 Initial (left) and final (right) occlusal.Fig. 20.153 Initial (right) and final overjet (left).Fig. 20.154 Initial and final smile.Fig. 20.155 Final panoramic and lateral X‐rays.Fig 20.156 Initial intraoral view.Fig 20.157 Deferred sequential distalization, in which some teeth move ‘alon...Fig. 20.158 Initial intraoral views (right, front, left, upper, lower). Pati...Fig. 20.159 Initial extraoral pictures and cephalometric analysis.Fig. 20.160 Initial Clinchecks.Fig. 20.161 Intraoral pictures at refinement.Fig. 20.162 Refinement Clinchecks.Fig. 20.163 Final: intraoral pictures showing improvement of the lower incis...Fig. 20.164 The cone beam computed tomography comparisons show how lower the...Fig. 20.165 Final comparison of lateral X‐rays.Fig. 20.166 Comparison of before and after smile.Fig. 20.167 Extraoral profile views.Fig. 20.168 Initial intraoral view.Fig. 20.169 Manual precision cut on 13 allows optimized attachment on this t...Fig. 20.170 Initial intraoral views (right, front, left, upper, lower).Fig. 20.171 Initial panoramic and lateral X‐rays.Fig. 20.172 Initial Clinchecks.Fig. 20.173 Refinement: initial intraoral views (right, front, left, upper, ...Fig. 20.174 Refinement Clinchecks.Fig. 20.175 Final intraoral views (right, front, left, lower, upper).Fig. 20.176 Final panoramic and lateral X‐rays.Fig. 20.177 Before and after smiles, before aesthetic anterior restoration....Fig. 20.178 Initial intraoral view.Fig. 20.179 Initial intraoral views (right, front, left, upper).Fig. 20.180 Initial intraoral models to check class II relationship before 1...Fig. 20.181 Pretreatment panoramic and lateral X‐rays and cephalometry.Fig. 20.182 Initial extraoral views.Fig. 20.183 Initial Clinchecks (right, front, left, upper, lower).Fig. 20.184 Intraoral refinement (right, front, left, upper, lower).Fig. 20.185 Refinement Clinchecks: right, front, left, upper, lower.Fig. 20.186 Final intraoral views: right, front, left, upper with tongue tam...Fig. 20.187 Before and after smile, showing improvement in upper incisor dis...Fig. 20.188 Final cephalometric measurements (before and after).Fig. 20.189 Final panoramic X‐ray.Fig. 20.190 Posterior interproximal reduction will help create space (before...Fig. 20.191 Posterior interproximal reduction might be up to 1 mm per contac...Fig. 20.192 Sequential lower distalization is meant to be predictable up to ...Fig. 20.193 In class III cases, anchorage is extremely important. The anchor...Fig. 20.194 Temporary implant supported crowns help create posterior anchora...Fig. 20.195 Initial intraoral view.Fig. 20.196 Pretreatment extraoral and intraoral views.Fig. 20.197 Implant placement on 47 before starting Invisalign treatment.Fig. 20.198 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 20.199 Initial front view.Fig. 20.200 Initial ClinCheck front view..Fig. 20.201 Initial occlusal contact.Fig. 20.202 Sagittal priority of movements to solve the anterior crossbite. ...Fig. 20.203 Upper and lower ClinCheck views.Fig. 20.204 Initial (upper), evolution (middle) and situation after 12 month...Fig. 20.205 Arch evolution after treatment for 12 months.Fig. 20.206 Right and left initial ClinCheck views.Fig. 20.207 Arch development after 12 months.Fig. 20.208 Initial and final overjet and smile.Fig. 20.209 Initial intraoral picture.Fig. 20.210 Pretreatment extraoral and intraoral views.Fig. 20.211 Initial X‐ray: panoramic, teleradiograph and cephalometry.Fig. 20.212 Interproximal reduction.Fig. 20.213 Simultaneous movement pattern.Fig. 20.214 Extrusion of 27 owing to missing 47.Fig. 20.215 Anterior cross bite of 12.Fig. 20.216 Initial superimposition, ClinCheck upper and lower occlusal view...Fig. 20.217 Comparison of initial (upper) and final occlusion (lower).Fig. 20.218 Comparison of initial (left) and final occlusal (right).Fig. 20.219 Initial and final smile.Fig. 20.220 Final panoramic and lateral X‐rays.Fig. 20.221 Initial intraoral view.Fig. 20.222 Initial intraoral views.Fig. 20.223 Initial extraoral views.Fig. 20.224 Initial cone beam computed tomography and panoramic X‐ray.Fig. 20.225 Initial lateral X‐ray and cephalometric analysis.Fig. 20.226 Initial ClinChecks.Fig. 20.227 Refinement: intraoral views.Fig. 20.228 Refinement: extraoral views.Fig. 20.229 Current intraoral views.Fig. 20.230 Current smile.Fig. 20.231 Current cephalometric measurements.Fig. 20.232 Cone beam computed tomography measurements, before and after tre...Fig. 20.233 Final smile.Fig. 20.234 Initial intraoral view.Fig. 20.235 Initial smile.Fig. 20.236 Initial panoramic and lateral X‐rays.Fig. 20.237 Refinement: initial views after 6 months, when the patient decid...Fig. 20.238 The palatal suture is broken with the same anaesthesia that that...Fig. 20.239 The palatal suture is broken with the same anaesthesia that will...Fig. 20.240 After 2 weeks, the 8 mm screw is fully opened. The palatal surfa...Fig. 20.241 Refinement ClinChecks.Fig. 20.242 Second refinement: intraoral views.Fig. 20.243 Second refinement Clinchecks.Fig. 20.244 Final Intraoral views.Fig. 20.245 Final smile.Fig. 20.246 Final cephalometric examination.Fig. 20.247 Final panoramic X‐ray.Fig. 20.248 Initial frontal intraoral view.Fig. 20.249 Initial intraoral views.Fig. 20.250 Initial panoramic and lateral and X‐rays and cephalometry.Fig. 20.251 Initial extraoral view.Fig. 20.252 Initial Clinchecks.Fig. 20.253 Refinement: intraoral views.Fig. 20.254 Refinement ClinChecks.Fig. 20.255 Extraoral view after refinement.Fig. 20.256 Final intraoral views.Fig. 20.257 Final smile.Fig. 20.258 Initial and post‐treatment cephalometric analysis.Fig. 20.259 Initial intraoral view.Fig. 20.260 Pretreatment extraoral and intraoral views.Fig. 20.261 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 20.262 Simultaneous distalization pattern in upper and lower arches.Fig. 20.263 Upper and lower ClinCheck views.Fig. 20.264 interproximal reduction necessary in order not to procline lower...Fig. 20.265 Lateral ClinCheck views.Fig. 20.266 Rein horse with Powerchain to temporary anchorage devices in the...Fig. 20.267 Simultaneous upper distalization using temporary anchorage devic...Fig. 20.268 Simultaneous lower distalization using temporary anchorage devic...Fig. 20.269 Initial occlusion (upper) and situation at month 17 of treatment...Fig. 20.270 Arch development in 23 months. Powerchain from first upper and l...Fig. 20.271 Pretreatment and final smile and overjet.Fig. 20.272 Final panoramic and lateral X‐rays.

18 Chapter 21Fig. 21.1 Vertical cause, excess posterior facial height.Fig. 21.2 Dentoalveolar cause (protrusion).Fig. 21.3 Transversal cause, lingual torque of posterior teeth.Fig. 21.4 The amount of lingual tipping of upper and lower incisors helps to...Fig. 21.5 Gummy smile.Fig. 21.6 Low smile, short display.Fig. 21.7 The facial lower third determines whether to intrude or not to int...Fig. 21.8 Anchorage attachments.Fig. 21.9 Chewies or fitters are good for minor open bite cases.Fig. 21.10 Miniscrews used for absolute posterior intrusion greater than 3 m...Fig. 21.11 Open bite requires careful biomechanics planning.Fig. 21.12 Optimized anterior extrusion is mostly predictable if it is plann...Fig. 21.13 Posterior intrusion will have saggital effects as a result of man...Fig. 21.14 We have to face predictability of vertical movements in order to ...Fig. 21.15 Single optimized attachment for extrusion.Fig. 21.16 Optimized anterior extrusion is mostly predictable if it is plann...Fig. 21.17 Posterior open bite is a good overcorrection in this case.Fig. 21.18 Unpredictable posterior intrusion is assisted by upper and lower ...Fig. 21.19 Open bite solved with LITE treatment.Fig. 21.20 Initial extraoral and intraoral views.Fig. 21.21 Initial occlusal contact.Fig. 21.22 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 21.23 Initial upper and lower ClinCheck views.Fig. 21.24 Initial right and left ClinCheck views.Fig. 21.25 Interproximal reduction necessary for relative extrusion of upper...Fig. 21.26 Initial intraoral views (upper) and views before refinement (lowe...Fig. 21.27 Final intraoral views.Fig. 21.28 Initial (left) and final occlusal (right).Fig. 21.29 Initial and final smile.Fig. 21.30 Final panoramic and lateral X‐rays.Fig. 21.31 Initial intraoral view.Fig. 21.32 Initial extraoral and intraoral views.Fig. 21.33 Panoramic X‐ray.Fig. 21.34 Teleradiograph: proclination of upper and lower incisors, narrow ...Fig. 21.35 Initial upper and lower ClinCheck views.Fig. 21.36 Interproximal reduction to create relative extrusion of incisors....Fig. 21.37 Palatal attachments prevent upper incisors from intrusion during ...Fig. 21.38 Initial right and left intraoral ClinCheck views.Fig. 21.39 Triangular elastics in class II. The technician was required to e...Fig. 21.40 reciprocal movement of anterior extrusion and posterior intrusion...Fig. 21.41 Sequential distalization.Fig. 21.42 Initial (upper) and final (lower) views.Fig. 21.43 Initial (left) and final occlusal (right).Fig. 21.44 Initial and final smiles and overjet.Fig. 21.45 Final panoramic and lateral X‐rays.Fig. 21.46 Initial intraoral view.Fig. 21.47 Initial extraoral and intraoral views.Fig. 21.48 Goal of treatment: close open bite by upper and lower distalizati...Fig. 21.49 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 21.50 Mechanics of simultaneous distalization from temporary anchorage ...Fig. 21.51 Temporary anchorage devices in left tuberosity failed. It was cha...Fig. 21.52 Mechanics with temporary anchorage device in the tuberosity.Fig. 21.53 Mechanics for upper and lower simultaneous distalization. Opening...Fig. 21.54 Simultaneous distalization of lower arch using temporary anchorag...Fig. 21.55 Initial views before refinement. Opening space for missing 13, up...Fig. 21.56 Final panoramic X‐ray, after placing the implant for 13 and remov...Fig. 21.57 Initial and final intraoral images with composite veneer for 13 i...Fig. 21.58 Initial (left) and final (right) occlusal (composite veneer in 13...Fig. 21.59 Initial and final smile. Correction of the open bite without crea...Fig. 21.60 Initial intraoral view.Fig. 21.61 Initial intraoral views: right, front, left, upper, lower.Fig. 21.62 Initial panoramic X‐ray.Fig. 21.63 Initial extraoral views.Fig. 21.64 Initial Clinchecks (right, front, left, upper, lower).Fig. 21.65 Refinement intraoral views (right, front, left, upper, lower).Fig. 21.66 Refinement Clinchecks: right, front, left, upper, lower.Fig. 21.67 Refinement: extraoral views.Fig. 21.68 Refinement: a third set of aligners was ordered for final settlem...Fig. 21.69 Lateral and panoramic X‐rays showing final situation, and wisdom ...Fig. 21.70 Final intraoral views (right, front, left, upper, lower).Fig. 21.71 Before and after smiles.Fig. 21.72 Initial intraoral view.Fig. 21.73 Initial intraoral views (right, front, left, upper, lower).Fig. 21.74 Initial smile: short incisor display required aesthetic improveme...Fig. 21.75 Initial panoramic and lateral X‐rays.Fig. 21.76 Initial Clinchecks (right, front, left, upper and lower).Fig. 21.77 Refinement: intraoral views (right, front, left, upper and lower)...Fig. 21.78 Refinement Clinchecks (right, front, left, upper and lower).Fig. 21.79 Final intraoral views (right, front, left, upper with tongue tame...Fig. 21.80 Smile before and after treatment.Fig. 21.81 Final lateral X‐rays.Fig. 21.82 Initial intraoral view.Fig. 21.83 TheOrthopulse device was used by the patient to accelerate treatm...Fig. 21.84 Initial set of intraoral views (right, front, left, upper and low...Fig. 21.85 Initial panoramic and lateral X‐rays and cephalometric measuremen...Fig. 21.86 Initial extraoral views.Fig. 21.87 Initial ClinChecks (right, front, left, upper and lower) with vir...Fig. 21.88 Refinement: intraoral views (right, front, left, upper and lower)...Fig. 21.89 Refinement: lateral and panoramic X‐rays.Fig. 21.90 Refinement: profile and smile.Fig. 21.91 Refinement ClinChecks (right, front, left, upper and lower).Fig. 21.92 Current intraoral views (right, front, left, upper and lower).Fig. 21.93 Current lateral and panoramic X‐rays and cephalometry.Fig. 21.94 Final smile.Fig. 21.95 Predictability of vertical movements is important in order to pla...Fig. 21.96 Optimized pressure areas help intruding anterior teeth by combini...Fig. 21.97 Optimized extrusion attachments on premolars create a counterforc...Fig. 21.98 Precision bite ramps are designed to dissoclude posterior sectors...Fig. 21.99 Optimized support attachments are designed to help intruding uppe...Fig. 21.100 Patient with a gummy smile and deep bite. Expand + procline inci...Fig. 21.101 This patient (before and after views) presented low smile with d...Fig. 21.102 When anterior torque is negative relative intrusion might be eas...Fig. 21.103 When pure intrusion is needed, interproximal reduction will help...Fig. 21.104 Incisors protocol in deep bite is: procline crown, intrude, then...Fig. 21.105 Anterior temporary anchorage devices will help with this case.Fig. 21.106 Suggested torque for upper (+17 degrees) and lower incisor (–1 d...Fig. 21.107 Hypercorrection of the curve of Spee usually creates an open bit...Fig. 21.108 A single buccal or palatal power ridge (left and middle) creates...Fig. 21.109 Posterior extrusion might be achieved with optimized extrusion a...Fig. 21.110 Initial intraoral view.Fig. 21.111 Initial extraoral and intraoral views.Fig. 21.112 Initial panoramic and lateral X‐rays and cephalometry.Fig. 21.113 Initial occlusal upper and lower superimposition ClinCheck views...Fig. 21.114 Initial right and left ClinCheck views.Fig. 21.115 Interproximal reduction.Fig. 21.116 Initial (upper) and final intraoral views (lower).Fig. 21.117 Initial (left) and final occlusal (right).Fig. 21.118 Final panoramic and lateral X‐rays.Fig. 21.119 Initial intraoral view.Fig. 21.120 Initial extraoral and intraoral views.Fig. 21.121 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 21.122 Initial upper and lower ClinCheck views.Fig. 21.123 Initial right and left ClinCheck views.Fig. 21.124 On the additional aligners set, distal tipping of the crown in 3...Fig. 21.125 Evolution in last aligner before refinement.Fig. 21.126 Initial (upper) and final (lower) intraoral views.Fig. 21.127 Initial (left) and final (right) occlusals.Fig. 21.128 Before and after smile.Fig. 21.129 Final panoramic and lateral X‐rays.Fig. 21.130 Initial intraoral view.Fig. 21.131 Initial extraoral and intraoral views.Fig. 21.132 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 21.133 Initial upper occlusal superimposition ClinCheck view.Fig. 21.134 Initial lower occlusal superimposition ClinCheck view.Fig. 21.135 Initial right and left ClinCheck view.Fig. 21.136 Initial front ClinCheck view with interproximal reduction.Fig. 21.137 Initial views (upper) and evolution after 12 months (lower).Fig. 21.138 Final intraoral views.Fig. 21.139 Initial (left) and final occlusal (right).Fig. 21.140 Occlusal contact point at the end of the treatment.Fig. 21.141 Initial and final smile.Fig. 21.142 Final panoramic and lateral X‐rays.Fig. 21.143 Initial intraoral view.Fig. 21.144 Initial extraoral and intraoral views.Fig. 21.145 Initial occlusal contact.Fig. 21.146 Initial panoramic X‐ray, teleradiograph and cephalometry.Fig. 21.147 Initial upper occlusal superimposition ClinCheck view.Fig. 21.148 Initial lower occlusal superimposition ClinCheck view.Fig. 21.149 Interproximal reduction is only needed mesial and distal to 22 t...Fig. 21.150 Initial right and left ClinCheck view.Fig. 21.151 Temporary anchorage devices to provide enough posterior anchorag...Fig. 21.152 Evolution at the end of additional aligners. Intermaxillary elas...Fig. 21.153 Initial (upper) and final (lower) intraoral views.Fig. 21.154 Initial left) and final (right) occlusal.Fig. 21.155 Initial and final overjet and final correction of the deep bite....Fig. 21.156 Initial and final smile.Fig. 21.157 Final panoramic and lateral X‐rays with an appropriate inclinati...Fig. 21.158 Initial intraoral view.Fig. 21.159 Initial intraoral pictures (right, front, left, upper and lower)...Fig. 21.160 Initial panoramic and lateral X‐rays.Fig. 21.161 Initial smile.Fig. 21.162 Initial Clinchecks (right, front, left, upper and lower).Fig. 21.163 Refinement 1: intraoral views (right, front, left, upper and low...Fig. 21.164 Refinement 1 Clinchecks (right, front, left, upper and lower). A...Fig. 21.165 Refinement 2 (aligner): st the end of first refinement, the alig...Fig. 21.166 Refinement 2 (aligner: right, front, left, upper and lower). Ali...Fig. 21.167 Refinement 2 ClinChecks (right, front, left, upper and lower). A...Fig. 21.168 Final intraoral pictures: right, front, left, upper and lower. D...Fig. 21.169 The smile has widened but still gummy, as initially predicted.