A case study of crowded lower anteriors & proclined upper anteriors correction using OrthoPath aligners

A case study of crowded lower anteriors & proclined upper anteriors correction using OrthoPath aligners

A case study of crowded lower anteriors & proclined upper anteriors correction using OrthoPath aligners

A female patient was reported with a chief concern of anterior malalignment of both jaws. Her main concern was her proclined upper teeth and increased incisal visibility on smiling. She wanted to improve her smile by reducing the upper incisal visibility and the protruded facial appearance along with the leveling of the upper incisors. She was successfully treated with OrthoPath Clear Aligners with her chief complaint resolved and improved facial and smile aesthetics.


Invisible braces are becoming increasingly popular in Australia. Initially, it was thought that aligners could only treat a limited number of minor malocclusions but now their scope has increased. The following case study is an example of results and patient satisfaction achieved with OrthoPath Clear Aligners.

Case History

A case was reported at the OrthoPath facility, with the chief concern of labially inclined upper incisors. The patient wanted to improve her smile by aligning the upper and lower arch, enhancing her facial and dental aesthetics.

She did not have any underlying medical disorder, neither was her periodontal health compromised, the teeth showed no mobility, and her oral hygiene was maintained. The patient was a good candidate for orthodontic treatment.

A full orthodontic examination was carried out and records were organized for analysis including intra-oral and extra-oral photographs, OPG, and lateral cephalogram with upper and lower alginate impressions for study models.


Analysis revealed proclined upper and lower incisors with increased overjet. Right and left molars were in class III & canines were in class II relation. Mild anterior crowding was present in the lower & upper arch. The upper midline was shifted towards the right and the lower midline was centered.

Orthodontic Clinical records along with PVS impressions and PVS bite registration were sent to OrthoPath. A treatment plan was received from OrthoPath in 2 weeks. It showed the treatment results in the 3D simulation model. Treatment animations with the expected treatment outcome were provided by OrthoPath to be thoroughly evaluated and discussed with the patient.

After a discussion with the patient, the treatment plan was approved without any modifications.


Once the treatment plan was approved, the aligner movement record form and an IPR form arrived from OrthoPath in two weeks.

Pre Treatment Photographs

Treatment Objectives

As per the patient's concern, the treatment objectives for Orthodontic treatment were:

  • To improve the patient's smile.
  • Alignment and leveling of both arches to achieve ideal arch form.
  • To improve the buccally inclined incisors.
  • Eliminate the spaces.
  • Improve the customer's confidence.
Treatment Alternatives

The following treatment options were discussed with the patient in detail.

  • Arch alignment with conventional braces.
  • OrthoPath Clear Aligners for both upper and lower arches.

The patient did not like the idea of using conventional braces as it would have been socially embarrassing for her.

Treatment Progress

For this case, 20 upper and lower arch aligners were required in total. Initially case proceeded in batches of 5-5 aligners, to ensure proper compliance by the patient. The aligners were worn 22 hours per day and only removed while eating or cleaning teeth. Each upper and lower aligner was worn for 2 weeks before moving to the next set. The patient was seen every 2 weeks initially till she became comfortable with the aligner treatment. A lot of emphasis was made on keeping good oral hygiene and it was maintained and monitored with visits.

The case progressed smoothly, with successful leveling and alignment of the upper arch. We successfully achieved the ideal smile arch that the customer desired, and their satisfaction with the new smile marked the culmination of this case. Below, you can find the treatment results for your reference.

Results & Discussion

After the use of all aligners, both upper and lower arches were re-evaluated for any residual issue since refinement aligners for any residual movement are also provided. The patient opted for mild refinement for improvement of the upper incisors leveling. Following are the results achieved after the aligner treatment.


The case progressed very well. However, tooth number 9 required minor intrusions in the final 2 stages. The customer was suggested refinement and only 2 refinement aligners were shipped. The attached photographs were received at the final aligner stage before refinement. Refinement aligners were provided, and tooth number 9 was successfully intruded and leveled, resulting in the following final results.

The treatment of a seemingly complex case with increased overjet & spaces was completed using OrthoPath Clear Aligners in 12 months. It roughly took around 20 upper and 20 lower aligners to achieve the desired results. Removable retainers were provided at the end of aligner treatment to retain the position of teeth and prevent any relapse. The patient was instructed to wear the retainers full-time for two months and only at night for the next month.

The patient was happy with the treatment outcome and, there was no relapse found after six monthly visits.

Aligners can provide an excellent option for treating malocclusion in adults, where the biggest hindrance is age and social commitments. Aligners can treat moderate malocclusions and the biggest factor in the success of treatment is the patient's compliance and the dentist's vigilance in maintaining a firm eye on case progress.

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