Bella Smile ↗Case report · Aligners + acceleration
Severe Overjet- Extraction recommended by all- Treated Non-Extraction
33-year old female presents with a full Cusp Class II malocclusion with 9mm overjet and 30% overbite. Slight recession present on the left molars and premolars.
- Patient
- Adult (18–39), female
- Classification
- Class II div 1
- Active treatment
- 18 months
- Published
- September 7, 2026
Presentation
Chief complaint. "I want to decrease my overjet."
Diagnosis. Full Cusp Class II division 1 Malocclusion with a 9mm overjet and 3mm overbite. Hypodivergent mandibular plane angle and Skeletal deep bite with proclined upper and lower incisors, All third molars have been previously extracted.
Records
Before — Intraoral Photos
After — Intraoral Photos
Before — Lateral Ceph Radiograph
After — Lateral Ceph Radiograph
Before — Panoramic Radiograph
After — Panoramic RadiographMeasurements
| Measure | Norm | Pre | Post |
|---|---|---|---|
| SNA | 82 | 80 | 80 |
| SNB | 80 | 78 | 77 |
| ANB | 2 | 2 | 3 |
| Wits | 0 | 5 | -2 |
| SN-MP | 32 | 23 | 29 |
| U1-SN | 102 | 101 | 93 |
| L1-MP | 90 | 101 | 101 |
| Overjet (mm) | 2–3 | 9 | 2 |
| Overbite (mm) | 2–3 | 3 | 2 |
Treatment
Objectives. Treat non-extraction and distalized all the teeth back to wear the wisdom teeth used to be. Open Bite and increase lower face height and improve skeletal deep bite
Plan. Using Invisalign, we bonded bite turbos on the lingual of the upper canines to open the bite. We then sequentially distalized the upper second molars, followed by the first molars, then premolars, and then the upper canine to canine. Plan is to extrude the posterior teeth to level the Curve of Spee as you distalize, and intrude the lower anteriors. Bond buttons on the U3s with cutouts, and buttons on the mesial of the L6s. Place virtual bonded bite ramps on the U2-2.
Appliances and materials
- Invisalign — Bonded bite turbos on the U3s since the overjet is too severe to bond behind the U1s or U2s
- Class II elastics — Clear buttons bonded on the U3s with a large attachment to counteract rotations and metal button on the mesial of the L6s with attachment on the distal.
- Vpro5 — 7 day aligner change
Progress records
Outcome
Distalized upper molar and retract upper incisors. Intruded lower incisor and extruded lower molar to open the vertical. Duration: 18 months # of Aligners: 61, Refinements: 15 aligners, Number of Visits: 11,Aligner Change: 7 days
Retention
Fixed permanent retainer U2-2 and L3-3 and Invisalign Vivera Retainers to be worn at night with bite ramps built in to help maintain bite opening
Case reports are shared with patient authorisation. Individual results vary.