Skeletal Class II malocclusion management with clear aligners and mini-implants

Abstract

Vertical control plays a pivotal role in addressing skeletal Class II malocclusion. The advent of clear aligner therapy, coupled with the adjunctive use of mini-implants, heralds a significant paradigm shift in enabling accessible vertical control. Herein, we present a 28-year-old female adult with skeletal Class II malocclusion, hyperdivergence, and convex profile successfully treated by clear aligners. The treatment comprised molar distalization and concurrent molar intrusion, enhanced by the strategic placement of mini-implants in the maxillary infrazygomatic crest, mandibular buccal shelf, and midpalatal suture region. With adequate intrusion of both the anterior and posterior teeth through sophisticated and delicate biomechanical designs, counterclockwise rotation of the mandible and clockwise rotation of the occlusal plane occurred. The counterclockwise rotation of the mandible resulted in a significant remodeling of the bilateral condyles and increased chin prominence. The increase in chin prominence and retraction of the anterior teeth resulted in a straight profile. In addition, the esthetic smile arc was achieved with the clockwise rotation of the maxillary occlusal plane. No significant alveolar bone or root resorption was detected. Sophisticated biomechanical considerations were elucidated. This case report underscores an innovative clear aligner treatment paradigm of biomechanics-guided, esthetics-driven, periodontium-supported, and temporomandibular joint-compatible clear aligner therapy (BEPT-CAT).