Pacific Coast Society of Orthodontists Bulletin Winter 2023 - 65

Doctors
◾ Place a horizontal beveled attachment on the distal
of the U6 and on the L3s or on the U7s and L4s.
◾ Level the lower arch:
◽ Place 4-mm horizontal attachments on the
L4s and L5s beveled gingivally.
◽ Place 3-mm horizontal beveled attachments
on the L2s.
◾ Place bite turbos once the bite jumps.
◾ Place lingual attachments on the premolars or
molars if at high risk for not tracking.
In conclusion of this second topic of the lecture, the
dental capabilities of clear aligners in the use of Class
III treatment were presented. Clear aligners appear
to have similar dental changes compared with other
Class III correctors in that they procline the upper
incisors, retract the lower incisors, rotate the occlusal
plane in a clockwise direction, distalize the lower
molars, and protract the upper teeth. In addition,
TADs are most often not required to aid lower molar
distalization in Class III teens.
Topic 3: Phase I Treatment of Class II Division 1
Malocclusions
The lecture was concluded with the discussion
of a third challenging case type, that is, Phase I,
Class II, Division 1 malocclusions. Dr. Shen-Garnett
discussed how she treats them using clear aligner
therapy.
She first discussed several advantages of using clear
aligners to treat these cases. First, they are more
comfortable for the patient compared with traditional
Class II appliances such as headgear, Herbst, or Twin
Blocks. Second, no signs of root resorption have been
noted using clear aligners on young patients, and molar
distalization can be done if needed. Clear aligners
are more esthetic, easier to manage with dental phobic
patients, and tend to cause fewer emergency visits
than fixed appliances. Young patients' teeth move
faster than adults, and clear aligners allow for trays to
be changed at a quicker rate. Lastly, Phase I patients
can wear elastics with clear aligners for sagittal correction
early during treatment.
Four Phase I, Class II, Division 1 cases that were treated
with Invisalign were presented. In all these cases, an
improved profile change was noted with the lower
jaw coming forward, and the young patients did well
with wearing their elastics.
The following points summarize Dr. Shen-Garnett's
recommendations for using clear aligners to treat
Phase I, Class II, Division 1 cases:
◾ Expand the upper arch with an expander or
aligner.
◾ Level and align.
◾ Try not to distalize the upper arch if you want the
lower arch to come forward.
◾ Distalize only if the upper jaw is prognathic.
◾ Do a Class II bite jump for sagittal correction and
use Class II elastics.
References
1. Suh H, Garnett BS, Mahood K, Mahjoub N, Boyd RL, Oh
H. Treatment of anterior open bites using non-extraction
clear aligner therapy in adult patients. Korean J Orthod
2022;52(3):210-219.
2. Suh H. The Outcome and Stability of Anterior Open Bite
Treatment with Clear Aligners in Adults [master's thesis]. San
Francisco, CA: University of the Pacific; 2022. Accessed
November 11, 2022. https://scholarlycommons.pacific.edu/
dugoni_etd/31
3. Greenlee GM, Huang GJ, Chen SSH, Chen J, Koepsell T,
Hujoel P. Stability of treatment for anterior open-bite malocclusion:
a meta-analysis. Am J Orthod Dentofacial Orthop
2011;139(2):154-169.
4. Al-Mozany SA, Dalci O, Almuzian M, Gonzalez C, Tarraf
NE, Ali Darendeliler M. A novel method for treatment of
Class III malocclusion in growing patients. Prog Orthod
2017;18(1):1-8.
5. McNamara JA, Franchi L, McClatchey LM, Kowalski SE,
Cheeseman CC. Evaluation of adolescent and adult patients
treated with the Carriere Motion Class III appliance followed
by fixed appliances. Angle Orthod 2021;91(2):149-156.
Winter 2023 PCSO Bulletin
65
https://scholarlycommons.pacific.edu/dugoni_etd/31
Pacific Coast Society of Orthodontists Bulletin Winter 2023

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2023
