Journal of Aligner Orthodontics, 02/2025

Discrepancies between the dental midline and facial midline are often a primary complaint reported by patients seeking orthodontic treatment. The first step in the diagnosis of and treatment planning for all patients should be to identify the origin of these asymmetries. This case report presents a patient who had severe maxillary dental midline deviation. Thus, his maxillary left first premolar was extracted to make the midlines match and resolve the crowding using clear aligners. The treatment results showed that satisfactory therapeutic effects were achieved, with a balanced profile and stable occlusion. This case report outlines the diagnosis and orthodontic treatment of midline deviation. Compared to symmetrical extraction, asymmetrical extraction may be considered an optimal choice in some specific cases. Keywords: asymmetrical extraction, clear aligner, dental midline deviation

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. Keywords: adult orthodontics, clear aligners, deep vertical overlap, stepwise intrusion

The present case report examines the clinical outcomes of and biomechanical considerations involved in using overtreatment techniques for molar protraction to replace an extracted maxillary first molar with the second molar. A 37-year-old woman with Class II malocclusion, anterior crowding and posterior scissor bite underwent clear aligner therapy. The treatment involved extracting the maxillary first molar and an overtreatment strategy was employed to counteract tipping during second molar protraction. After 46 months of treatment, significant improvements were attained with regard to dental alignment, occlusion and aesthetics, including corrected horizontal and vertical overlap, aligned maxillary anterior teeth, and the achievement of Class I molar and canine relationships. Cephalometric analysis showed favourable changes. This case highlights the effectiveness of clear aligners combined with overtreatment techniques for managing complex orthodontic movements, emphasising the importance of careful planning, patient compliance and regular evaluations to achieve optimal clinical outcomes. Keywords: Class II malocclusion, ClinCheck, first molar extraction, Invisalign, molar protraction, overtreatment

Joint space width is a crucial parameter. If joint space is reduced, resulting in joint space narrowing, degenerative osteoarthritis may develop, causing a loss of function and subsequently leading to pain. Degenerative osteoarthritis must be distinguished from inflammatory rheumatoid osteoarthritis in a differential diagnosis. The cause of degenerative joint disease across all joints is continuous improper loading. With the help of an occlusal correction, which can be performed both orthodontically and restoratively or through a combination of the two approaches, it is possible to positively alter the temporomandibular joint space. Due to the unique connective tissue structure of the temporomandibular joints, remodelling can be performed throughout life. Keywords: aligner, digital joint tracking, joint space narrowing, orthodontics, osteoarthrosis, remodelling, temporomandibular disorder, temporomandibular joint