Dr. Bella Shen GarnettBella Smile ↗

Case report · Surgical orthodontics

Surgical Class II Correction with Invisalign

23-year-old female presented with a convex profile, bilateral Class II molar and canine relationships, 7 mm overjet, mild maxillary crowding, moderate mandibular crowding, and proclined maxillary incisors. She also demonstrated a hyperdivergent skeletal pattern, retrusive chin, and slightly small-appearing condyles. She reported recent bilateral TMJ soreness without clicking or popping.

Patient
Adult (18–39), female
Classification
Class II div 1
Active treatment
24 months
Published
September 13, 2026
Initial and Final Profile Photos
Initial and Final Profile Photos
Clear alignersClass IISurgical

Presentation

Chief complaint. I want to fix my crowding and overjet

Diagnosis. Skeletal and dental Class II malocclusion with a retrognathic mandible, convex profile, 7 mm overjet, proclined maxillary incisors, mild maxillary and moderate mandibular crowding, and dental midline discrepancies.

Records

Initial Intraoral photosBefore — Intraoral Photos
Final Intraoral PhotosAfter — Intraoral Photos
Initial Profile Before — Profile Photo
Final profile photoAfter — Profile Photo
Initial Lateral CephBefore — Lateral Cephalometric Radiograph
Final Lateral CephAfter — Lateral Cephalometric Radiograph
Initial PanoBefore — Panoramic Radiograph
Final PanoAfter — Panoramic Radiograph

Measurements

MeasureNormPrePost
SNA828080
SNB807275
ANB285
Wits05
SN-MP324344
U1-SN102110108
L1-MP9010096
Overjet (mm)2–372
Overbite (mm)2–331

Treatment

Objectives. Improve profile, correct to Class I, advance mandible

Plan. Use Invisalign to level and align both arches and decompensate the dentition in preparation for orthognathic surgery. Proceed with mandibular advancement via BSSO to correct the skeletal Class II relationship and improve the facial profile. Following surgery, continue Invisalign for final alignment, detailing, and coordination of the occlusion.

Appliances and materials

  • Invisalign
  • Bella Smile Surgical Appliance — Made by IDX lab, bands on molars with soldered hooks and 19X25 wire
  • Elastics

Progress records

Pre-Surgery
Before Surgery
Scan to make Bella Smile Surgical Device, make sure you treatment plan 0.2-3mm of space mesial and distal to all first molar
Bella Smile Surgical Appliance bonded on 2-3 weeks before surgery and scans made for Surgical Splint
Bella Smile Surgical Appliance
6 weeks post surgery
6 weeks post surgery
Remove surgical appliance and scan for refinement alginers. Patient wore last alginers that she wore before surgery till new aligners arrive.

Outcome

Improved profile, corrected bite to Class I, improved overjet and overbite and TMJ symptoms resolved

Retention

  • Fixed U2-2 permanent retainer
  • Fixed 3-3 retainer with pontic
  • Invisalign Vivera retainers to be worn at night

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