Correction of severe deep vertical overlap using clear aligners in an adult patient with a hypodivergent profile: A case report

Background: The efficacy of clear aligners for the intrusion of anterior teeth and protrusion of posterior teeth is limited, making levelling of the dental arch and correction of deep vertical overlap challenging. In adult patients, treatment is more difficult because of the influence of masticatory force and temporomandibular joint remodelling.
Case description: The patient was a 22-year-old man diagnosed with Angle Class I malocclusion and a skeletal Class II relationship, and who exhibited a hypodivergent growth pattern. Clinical examination revealed a 100% deep vertical overlap and a 7-mm horizontal overlap. Non-extraction treatment was initiated using clear aligners. A stepwise intrusion technique was employed to intrude the anterior teeth, and the posterior segment of aligners was cut off to elevate the posterior teeth, thereby correcting the deep vertical overlap. Retraction of the maxillary anterior teeth resolved the excessive vertical overlap successfully. These simple mechanics contributed to the retraction of the lips, slight clockwise rotation of the mandible, favourable profile changes and stable results at the 1-year follow-up.
Practical implications: A carefully designed tooth movement strategy combined with effective clinical techniques can aid in achieving favourable treatment outcomes in cases of severe deep vertical overlap using clear aligners.