Clear Aligners and Miniscrews in a Scissor Bite Adult Treatment

Table 1

Procedures followed in the present case.

Stage	Procedure	Aligners used
Initial	(1) Upper arch—aligners and one palatal MS (inter-radicular between teeth 1.6 and 1.7), with 8 mm (Kubident®, Spain) to connect an elastic (1/4 6 oz) to buccal buttons on teeth 1.6 and 1.7; Lower arch—two MS on the 4th quadrant: one on the retromolar trigone (14 mm, Kubident®); one inter-radicular between the right premolars buccally (10 mm, Kubident®), associated with elastics (1/4 3.5 oz) to lingual buttons on teeth 47, 46, 45, and 44; (i) Posterior bite ramps on teeth 3.6 and 3.7; aligners cut on occlusal surface to readapt to these bite ramps; (2) 6 months after; (i) Removal of the bite ramps on teeth 3.6 and 3.7; (ii) New large bite ramps on the upper canines; aligners cut on occlusal surface to readapt to these bite ramps; (iii) Maintenance of the same elastics method, with the addition of elastic (3/16 4.5 oz) between buttons on buccal surfaces of teeth 2.6/2.7 and 3.6/3.7; (3) 2 months after the canine bite ramps placement; (i) New aligner request	35 of 45
1st additional aligners	(1) Asymmetric crossed elastics: on the right side, elastics (1/4 3.5 oz) between teeth; (2) Class II elastics were placed on the right side, as well as a class III component on the left side to stabilize the sagittal occlusion, even considering the lower dental asymmetry; (3) All the MS were removed at the end of this stage	32 of 42
2nd additional aligners	(4) Maintenance of the canine bite ramps and asymmetric crossed elastics: on the right side, elastics (1/4 3.5 oz) between teeth; (5) Sequential distalization on the 1st quadrant and mesialization of the 4th quadrant, also reinforced by the elastic, in order to stabilize the asymmetric occlusion; (6) Extrusion of the posterior sectors, to promote intercuspation/occlusal contacts and anterior intrusion	48 of 52
3rd additional aligners	(7) Extrusion of the posterior sector to promote intercuspation/occlusal contacts and anterior intrusion, mainly on the upper arch	13 of 13
4th additional aligners	(8) Reinforcement of the posterior sector extrusion to promote intercuspation/occlusal contacts and anterior intrusion, mainly on the upper arch	27 of 27
5th additional aligners	(9) Reinforcement of the posterior sector extrusion to promote intercuspation/occlusal contacts and anterior intrusion, mainly on the upper arch; (10) Removal of all the attachments	13 of 13
6th additional aligners	(11) Aligners used 12 h/day at night and changed once a month, to stabilize prior to the Vivera® retention	16 of 16