Dr. Bella Shen GarnettBella Smile ↗

Case report · Clear aligners (Invisalign)

Class II division 1 adolescent treated Non-Extraction with aligners and Class II elastics and Orthopulse

A 15 -year-old with 8 mm overjet and a retrusive mandible treated during the growth spurt with aligners, and Class II elastics, avoiding fixed appliances.

Patient
Adolescent (12–17), female
Classification
Class II div 1
Active treatment
14 months
Published
September 5, 2026
Initial Records
Class IIClear alignersAdolescentsAcceleration

Presentation

Chief complaint. Patient has been in treatment with another orthodontist for almost 2 years with Invisalign with no progress and her overjet is getting worse. Prominent upper front teeth; parents preferred to avoid braces since she is a cheerleader.

Diagnosis. Skeletal Class II (ANB 6°), overjet 7 mm, deep bite, moderate upper crowding, CVM stage 3.

Records

Initial Intraoral photosBefore — Intraoral Photos
Final Intraoral photosAfter — Intraoral Photos
Initial Lateral CephBefore — Lateral Ceph Radiograph
Final Lateral CephAfter — Lateral Ceph Radiograph
Initial PanoBefore — Panoramic Radiograph
Final PanoAfter — Panoramic Radiograph

Treatment

Objectives. Reduce overjet using Invisalign. Treatment failed previously with previous orthodontist because the ideal attachments were not placed, and elastics were not used in conjunction with molar distalization. Patient wants to use acceleration since she has already been in treatment for 2 years.

Plan. Invisalign Teen — Arch development and alignment, followed by staged sequential molar distalization with Class II elastics, supported by continued Class II elastics throughout treatment and active distalization.

Appliances and materials

  • Clear aligners with with Class II elastics
  • Class II elastics — 1/4" 6 oz full-time
  • Orthopulse — 3 day change for aligners

Progress records

8 weeks into treatment- poor elastics wear compliance
8 weeks into treatment
As we distalize, it is imperative to wear Class II elastics. Because she did not, the front teeth experienced the unwanted equal and opposite force, and the incisors flared forward and the overjet increased.
7 Months
5 months later with compliant Class II elastics wear
Overjet improving as elastics are worn and correct staging and elastics are implemented and planned.

Outcome

Overjet 2mm, Class I molars, profile improved, Curve of Spee leveled, and overbite is now 2mm. Poor initial compliance until I educated her on the need to wear Class II elastics to counteract Newton's Third Law — that every force has an equal and opposite force, which is why her front teeth stuck out when she did not wear the elastics regularly initially. Once she wore them consistently, the overjet decreased rapidly. Duration: 14 Months, # of Aligners: 49, Refinement: 9 aligners, # of Visits: 13, Day Change: 3

Retention

Removable clear retainers nightly; Permanent fixed retainers U2-2 and L3-3 with retainer checks at 6 and 12 months post treatment

Case reports are shared with patient authorisation. Individual results vary.