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Special Issues
July/August 2022
Volume 43, Issue 1

Clear Aligner Case: Spacing and Anterior Open Bite Corrected Without Attachments

David Ostreicher, DDS, MS, MPH

A 35-year-old female patient presented with complaints of teeth spacing and an anterior open bite. She requested clear aligner therapy but refused the use of buttons, elastics, or attachments. Additional complications included a Bolton discrepancy, class II cuspid positions, and the presence of an anterior porcelain crown. Reveal® Clear Aligners (Henry Schein Orthodontics, www.RevealProviders.com) were selected for the treatment of this patient, as these aligners are not scalloped and grab the interproximal areas, creating a firm grip on the teeth and lessening or eliminating the need for attachments. Using this treatment, much of the anterior open bite would be eliminated by relative extrusion (the simple tipping back of the anterior teeth). The maxillary left lateral incisor would need some active extrusion as well, which would be aided by the interproximal contact by the aligners grabbing the neck of the tooth. Curiously, in this spaced case, interproximal reduction (IPR) was needed. Maxillary posterior IPR was required to help provide a better class I cuspid relationship and an improved overjet. Mandibular anterior IPR was needed to reduce the Bolton discrepancy. Treatment was completed in less than 1 year with the use of 22 aligners. The patient was then instructed to wear aligners at night indefinitely.

 

Key Takeaways

Reveal Clear Aligners accurately capture all available tooth and soft-tissue anatomy. The trim of the aligner is contoured to grip the interproximal and gingival margins, reducing or eliminating the need
for attachments.

The ClearWear™ material used in Reveal Clear Aligners enables precise force levels for comfort and speed of treatment.

This case required 22 aligners. The first six were changed at 2-week intervals. With the teeth tracking well, the intervals were shortened to 12 days, and then 10 days.

About the Author

David Ostreicher, DDS, MS, MPH
Professor Emeritus, Columbia University, New York, New York, and University of New Haven, New Haven, Connecticut; Private Practice, Levittown, New York

Fig 1. Front view before treatment.

Figure 1

Fig 2. Right lateral view before treatment.

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Fig 3. Left lateral view before treatment.

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Fig 4. Occlusal view of maxillary arch before treatment.

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Fig 5. Occlusal view of mandibular arch before treatment.

Figure 5

Fig 6. Front treatment setup in treatment planning software before treatment.

Figure 6

Fig 7. Front treatment setup in treatment planning software after treatment.

Figure 7

Fig 8. Right treatment setup in treatment planning software before treatment.

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Fig 9. Right treatment setup in treatment planning software after treatment.

Figure 9

Fig 10. Front view after treatment, which was completed in less than 1 year.

Figure 10

Fig 11. Right lateral view after treatment.

Figure 11

Fig 12. Left lateral view after treatment.

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Fig 13. Occlusal view of maxillary arch after treatment.

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Fig 14. Occlusal view of mandibular arch after treatment.

Figure 14

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