Orthodontic Management of Skeletal Class II Malocclusion with the Invisalign Mandibular Advancement Feature Appliance: A Case Report and Review of the Literature

Abstract

The treatment of Class II malocclusion due to mandibular retrognathia is one of the most common challenges met in orthodontic practice. When it comes to a growing patient, functional appliances are the optimal way to achieve growth modification by enhancing mandibular growth. Clear aligners have been part of the orthodontic treatment for several decades but until recently they were only used to correct mild malocclusions. In 2017, Align Technology introduced the Invisalign with Mandibular Advancement Feature (IMAF) which replicates the action of functional appliances. As this device is new to clinical practice, there is limited literature on its clinical efficiency. This case report describes the orthodontic management of a 12-year-old male patient having skeletal Class II malocclusion due to mandibular retrognathia. As the patient was experiencing active growth, the IMAF appliance was chosen for his treatment. The IMAF appliance appears to be successful in the treatment of Class II malocclusion with mandibular retrognathism in a growing patient. As with all functional appliances, the correction of the malocclusion is a result of both skeletal and dental effects and the IMAF presents the advantage of producing less proclination of the lower incisors compared to other functional appliances.

Does mandibular advancement with clear aligners have the same skeletal and dentoalveolar effects as traditional functional appliances?

“…Compared with traditional appliances, MA has good aesthetics, high wearing comfort, higher accuracy and can complete orthopedic and orthodontic treatment at the same time. MA appears to be effective in the treatment of class II malocclusions with mandibular retrusion [7][8][9]. Like functional appliances, the correction of occlusion relationships is combined skeletal and dental effects, and Sabouni et.al found that the skeletal changes may be minor [10].…”

“…, all variables except movement of maxillary osseous base were statistically different. Linear changes measured along the mean functional occlusal plane during treatment are depicted diagrammatically in the pitchforks (Fig 3,4,5,6,7,8,9,10,11)…”

Scissor Bite in Growing Patients: Case Report Treated with Clear Aligners

“…To correct this condition and allow for a favorable tooth position to perform the MA phase with precision wings, two sets of aligners were required, considering the growth potential inherent in the hypodivergent facial biotype. Usually, one set of aligners would be enough, but the biological component of the impacted pre-molar made it necessary to carry out two sets [ 9 , 22 ].…”

“…This can be explained by the fact that the child has a marked loss of the occlusion vertical dimension, with the anterior rotation of the mandible aggravated by the protruded chin. This situation promotes a very concave profile, which, in addition to being considered unsightly, is a typical aged profile [ 9 , 22 ].…”

Evaluating clear aligners and conventional braces in treating TMJ and Speech Impediment

“…Conventional braces make precise wire adjustments within 0.5 mm to intrude or extrude teeth as necessary, making them highly efficient in different cases. Although these two articles conclude that clear aligners should be used in simple malocclusions, 26 studies conducted by Koukou et al concluded that clear aligners effectively treat all class malocclusions 27 . While traditional braces can treat more severe malocclusions because of their strength, control, and precisely adjustable wiring, one article claims that clear aligners have been frequently applied in these situations in orthodontic clinic practices.…”