List of problems

• Labial inclination of upper anterior teeth.
• Buccoversion of 25, labial inclination of 43 and lingual inclination of 42.
• Class II molar relationship in left.
• Moderate and severe crowding of upper and lower teeth.
• Periodontitis.
• Gingival recession, buccal alveolar bone resorption and root exposure of upper and lower anterior teeth.

Treatment Objective

•  Align upper and lower teeth, retract upper anterior teeth, close the space, adjust the occlusion and protect periodontal health.

Orthodontic treatment plan

• Regularly refer to the Periodontal Department before and during operation to improve fundamental treatment and maintenance treatment.
• Adopt the clear aligner for light traction and to make for periodontal maintenance.
• Extract 25 and 42. Extraction and IPR were performed on upper and lower teeth to create space and eliminate crowding. Appropriately retract 11 and 21, disrotate some teeth, and align upper and lower anterior teeth.
• Maintain maxillary midline, and the patient has been informed of no mandibular midline.
• Improve the left posterior occlusion relationship.  
• Occlusal adjustment is required during treatment, to avoid occlusion interference.

Comparison before and after correction

Before correction

After correction

Before correction

After correction

Severe crowding

Basic situation

Product:Smartee Clear Aligner

Diagnosis:Angle Class III

Doctor:Gao Deguo

Doctor's summary
1.Work out the asymmetric extraction plan of 25 and 42 based on the degree of crowding, facial analysis and periodontal condition.
2.For gingival recession and root exposure of anterior teeth of the patient, the clear aligner can be used for light traction, which makes for gingival health and periodontal maintenance and imposes better control over the torque of teeth with root exposure, preventing resorption of gingiva and alveolar bone. Comparison before and after treatment shows no further resorption of the gingiva and alveolar bone. 
3.As asymmetric extraction was adopted, it was worried before treatment that the proper midline of original maxillary teeth would deviate, but the clear aligner didn’t lead to deviation of midline of maxillary teeth, and obviously improved the upper and lower dental arch.   
4.There was no significant abnormality in position of four wisdom teeth and occlusion of this case, therefore, extraction of four wisdom teeth was not considered when working out the plan. IPR was performed to create space. Current analysis considers extraction of wisdom teeth on both sides of maxilla and retraction of upper anterior teeth to create space (except for extraction of 25 and 42).
Orthodontic treatment steps and cycle

Maxilla:24 sets

Mandible:24 sets

Cycle:12 months