9 Year Old Female with Deep Bite & Severe Crowding
SUBJECTIVE: She presented with her parents and concerns of crowding along with esthetics.
OBJECTIVE: She had premature loss of #i with a band and loop appliance to maintain space which was beginning to submerge on the loop end. Her molars were a flush terminal plane on the right and left, with minimal overjet. Her overbite was 90% and impinging on the palatal tissues. There was insufficient space for the upper laterals to erupt and the lower laterals had erupted lingually with #23 severely ectopic. Overall the arches appeared slightly constricted but with no crossbite, no report of sleep disordered breathing, competent lips, and true consistent nasal breathing during the consult, palatal expansion was not indicated.
ASSESSMENT: Treatment goals were to improve the overjet, decrease the overbite, create space for upper laterals, align teeth, and broaden the arch forms. Option 1: Upper and lower 2×6 (brackets on anteriors as well as first molars). Option 2: Upper and lower Invisalign. Estimated tx time: 9-12mo.
PLAN: Patient and parents elected to proceed with Invisalign.
Treatment
Initial Invisalign aligners were delivered in January 2023 with instructions to wear 22+ hours per day and change trays weekly. Advised parents that as primary teeth exfoliated the trays would not be as retentive and we would order refinements, or additional trays based on updated scans, to provide properly fitting aligners and align the upper laterals as they erupted.
She was extremely cooperative with excellent tracking, arches were broader and her overbite decreasing but by early June 2023 her laterals had erupted with #10 in cross bite. We scanned for additional trays to correct the cross bite and continue leveling and aligning. Refinement trays were delivered early July 2023 with instructions to continue weekly tray changes.
September 2023 elected to order another set of refinement trays due to the fact that #10, though improving, was not tracking well. Her second refinement (3rd set of trays) was delivered early October 2023 with revised staging to improve tracking of #10.
With the revised staging, her teeth demonstrated improved tracking and February 2024 we completed her Phase I with delivery of an upper and lower Vivera retainer to be worn at home and at night. Retainers will be replaced as primary teeth exfoliate and retainer is unable to stay in place.
Treatment Review
Patient, her parents, and I were pleased with the outcome. We accomplished the objectives of improved overjet, decreased overbite, aligned teeth, and broader arches. I was very impressed with patient and her excellence with Invisalign.
Critically reviewing my final records, I wish I had detailed #9 to have additional mesial root tip. Also #23 would have benefited from mesial out rotation, and more labial root torque (left buccal shot comparing the facial of #23 to 24).