General Dentist doing Braces, Teeth sticking out! Help!

Presentation

Chief complaint. "I don't like how my teeth stick out and have been in braces for a few months. It looks worse than I started"

Diagnosis. Skeletal Class II malocclusion with severely proclined maxillary and mandibular incisors, 6 mm overjet, mild mandibular crowding, and an anterior open bite extending from premolar to premolar. Class I molar and Class II canine relationships are present.

Measurements

Cephalometric values before and after treatment
Measure	Norm	Pre	Post
SNA	82	84	84
SNB	80	78	78
ANB	2	7	7
Wits	0	4	0
SN-MP	32	32	30
U1-SN	102	125	112
L1-MP	90	114	106
Overjet (mm)	2–3	6	2
Overbite (mm)	2–3	-2	2

Treatment

Objectives. Distalize and retract the maxillary dentition, use mandibular IPR to create space for lower incisor retraction, align both arches, reduce the overjet, close the open bite, and achieve Class I occlusion.

Plan. Remove braces and transition to Invisalign. Sequentially distalize and retract the upper dentition, with IPR as needed, and perform lower IPR to create space for mandibular incisor retraction.

Appliances and materials

Invisalign

Outcome

Open bite closed, dental protrusion and incisor flaring reduced, and Class I occlusion achieved with ideal overjet and overbite, balanced lips, and functional occlusion.

Retention

Fixed L3-3 permanent retainer
Fixed U2-2 permanent retainer
Invisalign Vivera retainers to be worn at night

The U2–2 fixed retainer was extended to the upper left canine to maintain its corrected vertical position and rotation.