Severe deepbite with some TMJ pain · Dr. Bella Shen Garnett

Presentation

Chief complaint. " I want to fix my overbite and my back teeth do not fit together."

Diagnosis. Class II canines and Class I molars. 3mm Overjet and 80% impinging overbite. Crossbite teeth #2, 4,13, 15, Chin deviates to the left and there is a slight anterior cant down to the right.

Why I chose this approach

My goal was to open the severe impinging deep bite and improve how his teeth fit together while preserving a facial profile he was happy with. His overjet was only 3 mm, so I planned limited upper distalization and minimal anterior retraction, with the aim of maintaining upper lip support. I chose Invisalign with bonded bite turbos behind the upper lateral incisors to open the deep bite and create clearance. The intention was to allow the lower jaw to settle slightly forward into a more comfortable bite position as the restrictive anterior contacts were relieved. Only a small amount of upper distalization was needed to help correct the Class II canine relationship. Invisalign and Class II elastics allowed us to coordinate the arches, address the posterior crossbites, and refine the tooth contacts while monitoring his clenching and TMJ soreness. We achieved a Class I dental relationship with improved overjet, overbite, and overall bite coordination. Fixed retainers and nighttime Vivera retainers with bite ramps were used to help maintain the deep bite correction.

Measurements

Cephalometric values before and after treatment
Measure	Norm	Pre	Post
SNA	82	85	85
SNB	80	78	78
ANB	2	6	6
Wits	0	4	2
SN-MP	32	35	33
U1-SN	102	104	95
L1-MP	90	94	97
Overjet (mm)	2–3	3	2
Overbite (mm)	2–3	4	2

Treatment

Objectives. Open bite

Plan. Treated with Invisalign, bonded bite turbos behind the U2s and distalized the upper teeth till the canines were Class I

Appliances and materials

Invisalign
Bond bite turbos — Behind the lateral incisors
Class II elastics — 3/8 Heavy elastics
Vpro5 — 7 day change

Progress records

Outcome

We successfully distalized the maxillary dentition to achieve a Class I relationship, while also improving the vertical dimension and overall bite relationship. Treatment resulted in: Class I dental correction Improved overjet and overbite Improved smile esthetics Improved dental asymmetry Better upper and lower arch coordination Improved vertical relationship and bite opening Overall, the treatment goals were achieved with a well-coordinated, functional occlusion and improved smile balance. Treatment Summary Treatment duration: 20 months Initial aligners: 50 Refinement #1: 22 aligners Refinement #2: 19 aligners Number of visits: 10 Aligner change interval: Every 7 days

Retention

Fixed U2-2 and L3-3 permanent retainer and wears an Invisalign Vivera retainer at night with bite ramps so that the deep bite does not relapse.