Correction of Class II Malocclusions with Aligners: The importance of the Treatment Staging

The recent advent of clear aligner treatments offers new, efficient and comfortable options for achieving appreciable results in Class II malocclusion treatments. Younger patients may be extremely unwilling to undergo treatment by fixed appliances for esthetic and social reasons, but parents and specialists have often been uncertain about their enthusiasm to cooperate in wearing removable clear aligners.
Moreover, despite the number of publications on Class II treatments with aligners treatment protocols are not so clearly evidenced at times so as to allow for a standardization and simplification of such orthodontic treatments.
Objectives: The aim of the present article is to suggest a schematic protocol of treatment in Class II treatments and emphasize the importance of a proper patient selection.
Materials and Methods: An explicative case of full class II malocclusion corrected using clear aligners in a growing patient is presented. Clearly, correct diagnosis is essential to obtain success and only Class II malocclusion depend on dento-skeletal issues, rather than on actual skeletal have to be considered. The biomechanical 5 steps routinely followed by orthodontists in non-extraction treatments of Class II malocclusions are listed and the step by step procedure is explained considering aligner technique. In our protocol, for proper Class II correction, the use of interarch elastics is required from the initial steps in order to perform upper molar distal rotation and sequential distalization of bicuspids and cuspids but, thanks to using aligners, adverse effect of the elastics can be limited. Moreover, the further advantage provided by aligners consists of the mandible’s freer movement easing its mesial posturing.
Results: The patient was successfully treated within 22months and all the treatment objectives were achieved. At the end of the treatment, the class II relationship was were corrected with a pleasant modification of the smile and facial esthetics.
Conclusions: While considering alternative treatments, the use of clear aligners in order to correct Class II malocclusions in growing patients should be strongly considered as an effective and reliable option when biomechanics and treatment staging are correctly applied. Compliance could be a problem but our experience evidences that new generation are very active during orthodontic treatment when using aesthetic and comfortable appliance as Aligners.
Clinical Significance: Class II malocclusion represents more common problem to face in growing patients. Today it’s possible to correct also this malocclusion by aligner technique but it’s necessary to program by Clincheck accurate biomechanic planning and careful dental movements staging to allow clinical realization of virtual treatment.

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