Severe Class II Subdivision Malocclusion in Adolescent Patient Treated with Clear Aligners: A Case Report

Objectives: The aim of this case report is to demonstrate that the Invisalign® clear aligner system is an effective and optimal therapeutic option for the treatment of Class II Subdi-vision malocclusion in adolescent patients. Methods: Z.E., a 13.3-year-old Caucasian female adolescent, presented with permanent dentition, Class II Subdivision malocclusion characterized by a Class II molar and canine relationship on the right side and a Class I molar and canine relationship on the left side, increased overjet and overbite, improper inclination of the upper incisors with diastemas, diastemas also present in the lower arch, and non-coincident midlines. The Invisalign® Comprehensive package was selected, and three sets of clear aligners were planned. The patient was instructed to wear the aligners full-time and to change every 7 days. At each follow-up appointment, scheduled every 4 weeks, a single operator assessed aligner fit, attachment positioning, and patient com-pliance. The treatment plan included expansion and restoration to achieve optimal upper and lower arch form, sequential distalization at 50% in the upper right quadrant, Class II elastics, and a “frog-staging” pattern for upper anterior retraction to achieve appropriate vestibular inclination (torque) of the upper incisors during the final phase. Results: Functional occlusion with Class I molar and canine relationships was achieved on both sides. Proper inclination of the upper and lower incisors was obtained. Good inter-cuspation and coincident midlines were observed at the end of treatment. Conclusions: In this case of Class II Subdivision malocclusion, effective esthetic and stable results were achieved using the Invisalign® clear aligner system.