Tips for deep bite correction with aligners
Correcting a deep bite can indeed be challenging, but with the right approach, it’s possible to achieve excellent results.
Tips for virtual case setups:
- Intrusion of the Upper Incisors and Canines:
- Perform a dentofacial aesthetic assessment to determine the final vertical positions of the upper incisors and canines in relation to the smile ark.
- Use the maxillary incisors displayed in the treatment plan as a guideline for intruding the mandibular incisors and canines.
- Flatten the Curve of Spee:
- Intrude mandibular incisors and canines (typically around 2.0 mm for incisors and 1.5 mm for canines), considering the severity of each case.
- Be cautious with labial crown tipping, especially in cases with labial inclination or thin periodontal biotype, to prevent periodontal complications.
- Incorporate interproximal reduction (IPR) in the mandibular anterior sector to avoid excessive labial crown tipping.
- Extrude mandibular premolars and first molars (at least 1.0 mm) and intrude mandibular second molars (at least 0.5 mm) if a deep Curve of Spee is present
- Flatten the Curve of Wilson:
- Prescribe buccal crown tipping to the mandibular premolars and molars, depending on their initial axial angulation (at least 5°).
- Place attachments on posterior mandibular teeth to provide retention for aligners during vertical movements like anterior intrusion and posterior extrusion.
- Apply horizontal bevelled attachments (HBA) gingivally on mandibular molars, premolars, and canines if extrusion is programmed .Attachments are often unnecessary for mandibular incisors for the purpose of intrusion
- Use Class II elastics to assist in mandibular extrusion and mandibular incisor proclination (if planned in the virtual treatment).
- Connect the elastics from buttons bonded on the mandibular first molars and maxillary canines.
- Consider using ramps for brachycephalic patients, cases requiring posterior extrusion, and mandibular mass incisor intrusion.
- Trim Line:
- Utilize trimming of the aligner in a straight extended design to increase stiffness, retention, and gingival adaptation.
- This can improve stress distribution, control of tooth movement, and apply more force closer to the centre of resistance for better control of bodily movement. Orthodontic treatment, especially with clear aligners, requires careful planning and execution.
These tips provide valuable insights into addressing the biomechanical challenges associated with deep bite correction using clear aligners.
However, it’s important to note that individual cases may vary, and consultation with a skilled orthodontist is essential for creating a tailored plan.