Dr. Bella Shen GarnettBella Smile ↗

Case report · Aligners + acceleration

Severe deepbite with some TMJ pain

38-Year-Old Male Clenches Severely, Developing TMJ Soreness and Exostoses on Maxilla

Patient
Adult (18–39), male
Classification
Class II div 2
Active treatment
20 months
Published
September 7, 2026
Initial Intraoral photos
Class IIAdultsClear alignersAcceleration

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.

Records

Initial Intra oral photosBefore — Intraoral Photos
Final Intraoral photosAfter — Intraoral Photos
Facial smilingBefore — Smile Facial Photos
Facial smiling final photosAfter — Smile Facial Photos
Initial Lateral CephBefore — Lateral Cephalometric Radiograph
Initial Lateral CephAfter — Lateral Cephalometric Radiograph
Initial PanoBefore — Lateral Panoramic Radiograph
Final PanoAfter — Lateral Panoramic Radiograph

Measurements

MeasureNormPrePost
SNA828585
SNB807878
ANB266
Wits042
SN-MP323533
U1-SN10210495
L1-MP909497
Overjet (mm)2–332
Overbite (mm)2–342

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

Bonded bite turbos with trays in and out
Bonded Bite turbos

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.

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