Mordida Abierta Invisalign

©2010 JCO, Inc. May not be distributed without permission. www.jco-online.com

Treatment of Anterior Open Bite
with the Invisalign System
WERNER SCHUPP, DMD
JULIA HAUBRICH, DMD
IRIS NEUMANN, DMD

I

nvisalign* was initially developed to correct
mild-to-moderate crowding, to close naturally
occurring spaces, and to produce dental tipping.1,2
After years of experience with the system,orthodontists have reported its successful use in more
complex cases, such as those involving extractions,
open bites, and Class II malocclusions.3-7 This
article describes two anterior open-bite patients
who were successfully treated with the Invisalign
system alone.2
Case 1
A 15-year-old female presented with anterior
open bite, anterior spacing, lack of lateral canine
guidance, tonguedyskinesia, and sigmatism during speech (Fig. 1A). Before starting orthodontic
treatment, she was advised to undergo myofunctional therapy.
Vertical rectangular attachments were bond*Registered trademark of Align Technology, Inc., 881 Martin
Ave., Santa Clara, CA 95050; www.aligntech.com.

Dr. Schupp

ed to the upper incisors, canines, and first premolars and the lower canines and premolars(Fig. 1B).
Thirty upper and 20 lower aligners were used to
close the open bite, derotate the lower premolars,
a nd close the anterior spaces. The refinement
phase required another 10 maxillary aligners—
seven for a 1.1mm extrusion of the maxillary
incisors and three for retraction and space closure.
After 20 months of aligner treatment, the
anterior open bite had been closed, the spacesbetween the central incisors had been closed in
b oth arches, and canine guidance had been
achieved bilaterally, with functional overjet and
overbite (Fig. 2A). The final ClinCheck projections
closely matched the post-treatment results (Fig.
2B); frontal superimpositions of the ClinCheck
pretreatment analysis and post-treatment projection indicated the amount of relative extrusion
neededfor closure of the open bite (Fig. 2C).
The patient’s bite closure and other corrections remained stable 12 months after the completion of Invisalign treatment (Fig. 3).

Dr. Haubrich

Dr. Neumann

The authors are in the private practice of orthodontics at Hauptstrasse 50, 50996 Köln, Germany. Dr. Schupp is a Visiting Professor, Department of
Orthodontics, University of Ferrara, Italy; e-mail: praxis@schupp - ortho.de. Drs. Schupp and Haubrich are members of Align Technology’s Clinical
Education Council.

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© 2010 JCO, Inc.

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Treatment of Anterior Open Bite with the Invisalign System

A

B
Fig. 1 Case 1. A. 15-year-old female with anterior open bite, anterior spacing, and lack of lateral canine guid ance before treatment. B. PretreatmentClinCheck* analysis, showing bonded vertical attachments on upper
incisors, canines, and first premolars and lower canines and premolars.

*Registered trademark of Align Technology, Inc., 881 Martin Ave., Santa Clara, CA 95050; www.aligntech.com.

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Schupp, Haubrich, and Neumann

A

B
Fig. 2 Case 1. A. Patient after 20 months of treatment with Invisalign
only. B.Initial ClinCheck projections, closely matching post-treatment
results. C. Superimposition of pretreatment ClinCheck analysis and
post-treatment projections (treatment goal in blue).

C

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Fig. 3 Case 1. Stability of closed anterior bite and anterior spacing 12 months after end of treatment.

A

B
Fig. 4 Case 2. A. 31-year-old female with Class I molarrelationship, anterior open bite, and anterior crowding
before treatment. B. Pretreatment ClinCheck analysis, showing bonded attachments on upper and lower
incisors and canines.

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Schupp, Haubrich, and Neumann

Case 2
A 31-year-old female presented with anterior
open bite, a Class I molar relationship, and anterior crowding in both arches (Fig. 4A). Ricketts
analysis...