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Special Issues
September 2020
Volume 41, Issue 1
Peer-Reviewed

Use of Clear Aligners in the Restoration of a Severe Anterior Open Bite

Mark Lowe, DDS

A 14-year-old male patient presented with amelogenesis imperfecta and a severe anterior open bite. Due to the absence of adequate enamel to bond fixed appliances, clear aligners were used to achieve the orthodontic goals of the case before restorative rehabilitation. ClearCorrect (A Straumann Group Brand, clearcorrect.com) aligners were selected because of the lack of enamel and inability to utilize attachments/engagers. ClearCorrect aligners would provide the necessary thermal plastic rigidity and a gingival trimline for increased retention and efficacy of the aligner movement. The patient's skeletal open bite, mandibular midline deviation with associated buccal crossbite, and small teeth (reduced surface area) presented orthodontic challenges. However, using the fundamentals of aligner tooth movement, including predictable posterior intrusion, these challenges were overcome through the use of the ClearCorrect aligners, and a dramatic prerestorative occlusal modification was achieved in just 12 months. The anterior restorations enabled a vastly improved esthetic smile change and boosted the patient's self-esteem. The posterior restorative rehabilitation will occur in the near future. Nighttime retention will be needed to maintain the result.

Key Takeaways

ClearCorrect orthodontic aligners are an ideal choice when there is a lack of enamel to bond appliances, and their rigidity and style of trimline decrease the need for attachments/engagers.

The trimline used by ClearCorrect aligners helps overcome a small generalized tooth size (ie, decreased surface area). The relatively high trimline on the gingiva increases retention to overcome the reduced surface area.

In treating amelogenesis imperfecta, restorative dentistry after orthodontic therapy enabled an ideal result to be achieved, including a vast improvement in the patient's smile.

About the Author

Mark Lowe, DDS
Attending Orthodontist, General Practice Residency at Community Regional Medical Center, University of California San Francisco - Fresno; Private Practice in Orthodontics, Fresno, California

BEFORE. Center bite photograph. The patient presented with amelogenesis imperfecta and a severe anterior open bite, mandibular midline discrepancy to the left associated with a buccal crossbite, and generalized spacing.

BEFORE

Fig 1. Panoramic radiograph revealed the hypomaturation and hypocalcification of the enamel. Stainless steel crowns existed on all four first molars and composite restorations on some mandibular incisors.

Figure 1

Fig 2. Lateral cephalometric radiograph. Cephalometric analysis demonstrated the severity of the skeletal open bite and possible need for orthognathic surgical intervention to achieve an optimal outcome.

Figure 2

Fig 3. The outcome simulation produced from the iTero® scanner (Align Technology, Inc., itero. com) exhibited a potential result from clear aligner treatment. Initial scan on the left; final scan on the right.

Figure 3

Fig 4. The Clear- Correct virtual treatment plan presented the prerestorative 12-month treatment objective using 24 aligners.

Figure 4

Fig 5. The trimline on the ClearCorrect aligner (top) is higher on the gingiva than conventional aligners that use a scalloped trimline near the cementoenamel junction (bottom). This characteristic helps make the ClearCorrect aligner highly retentive.

Figure 5

Fig 6. Progress photographs at 6 months (Fig 6) and 9 months (Fig 7) in aligner treatment showed the closing of the anterior open bite and reduction of the midline discrepancy in conjunction with the buccal crossbite correction.

Figure 6

Fig 7. Progress photographs at 6 months (Fig 6) and 9 months (Fig 7) in aligner treatment showed the closing of the anterior open bite and reduction of the midline discrepancy in conjunction with the buccal crossbite correction. Fig 8. Final orthodontic position. After 12 months, the occlusal treatment objectives had been reached before restorative treatment. Fig 9. Restorative result. Twelve anterior crowns were placed to improve occlusion and esthetics.

Figure 7

Fig 8. Final orthodontic position. After 12 months, the occlusal treatment objectives had been reached before restorative treatment.

Figure 8

Fig 9. Restorative result. Twelve anterior crowns were placed to improve occlusion and esthetics.

Figure 9

Fig 10. Pre- and post-treatment smile comparison. The treatment achieved a significant occlusal change and smile makeover. Additionally, the patient’s profile appearance (not shown) was improved from the use of the aligners, decreasing the vertical jaw relationship and contributing to the autorotation of the mandible, thus eliminating the need for orthognathic surgery. (Restorative dentistry: Gregory E. Morgan, DDS, Fresno, California) Before doing additional restorative work, refinement aligners can be used to address the maxillary diastema due to the incisive frenum attachment, and posterior occlusal preparation can be performed before completion of the full-mouth rehabilitation.

Figure 10

Fig 11. Pre- and post-treatment smile comparison. The treatment achieved a significant occlusal change and smile makeover. Additionally, the patient’s profile appearance (not shown) was improved from the use of the aligners, decreasing the vertical jaw relationship and contributing to the autorotation of the mandible, thus eliminating the need for orthognathic surgery. (Restorative dentistry: Gregory E. Morgan, DDS, Fresno, California) Before doing additional restorative work, refinement aligners can be used to address the maxillary diastema due to the incisive frenum attachment, and posterior occlusal preparation can be performed before completion of the full-mouth rehabilitation.

Figure 11

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