Treatment of Retroclined Upper Anteriors Correction Using Clear Aligner System.


Initially it was thought that aligners could only treat limited number of minor malocclusions but now their scope has increased. A 23 year old female patient reported to our practice in 29th October 2019 with the chief concern of palatally inclined upper centrals. Her main concern was her malaligned upper arch and ‘back positioned teeth”. She wanted to improve her smile by aligning the upper arch, enhancing her facial and dental aesthetics.She was successfully treated with Clear Path Aligners with her chief complaint resolved and improved facial and smile esthetics. She was treated with Clear Path Aligners. Her smile improved & the severely retroclined incisors proclined. She was confident & sense of self likeness developed.

Case history:

A full orthodontic examination was carried out and records were organised for analysis including, intra-oral and extra-oral photographs, OPG with upper and lower alginate impression for study models. 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 impression for study models taken & sent for treatment planning to the Clear Path Facility.

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


Analysis revealed retroclined upper centrals with decreased over jet. Right & Left molars & canines were in class I relation. Moderate anterior crowding was present in lower arch. However, patient opt for upper arch treatment only. The upper midline was centered, with the lower slightly shifted towards the left. The patients did not have any concerns about the bite and wanted anterior alignment only. Hence the case was proceeded accordingly, anterior upper dentition was the main focus of the treatment planning.

Once the treatment plan was approved the aligner ,movement record form and an IPR form was received from Clear Path.

After discussion with the patient, the treatment plan without any modification was approved though the modification option was provided by ClearPath but it was not utilized.


Treatment Objectives:

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

  • To improve patient’s smile
  • Increase patient’s over jet
  • Procline the upper incisors
  • Increase the incisal visibility.
  • Alignment and leveling of the upper arch to achieve ideal arch form.
Treatment Alternatives:

The following treatment options were discussed with patient in detail.

  • Arch alignment with conventional braces
  • Clear Path Aligners for upper arch only.

The patient being 23 years old did not like the idea of using conventional braces as it would have been socially embarrassing for her. Restorative treatment would have done nothing to reduce the overlap of her teeth. She wanted to treat the malocclusion with in a hassle free invisible way that did not pose any social dilemma for her, therefore she chose Clear Path Aligners.

An Orthodontic treatment and diagnostic form was discussed with her in detail as well as the need for Inter proximal tooth reduction (IPR) to create space for teeth alignment.


Treatment Progress:

IPR was performed and the patient was given 1st aligner For this case 27 upper were required in total. Initially case was proceeded in batches of 5-5 aligners, to ensure proper compliance by the patient. Each upper and lower aligner was worn for a period of 2 weeks before moving to the next set until all aligners were used. The aligners were worn 22 hours per day and only removed while eating or cleaning teeth.

Then she was called once a few months for a follow up visit a lot of emphasis was made on keeping good oral hygiene and it was maintained and monitored at each visit. The case proceeded well and the upper arch was leveled and aligned. Ideal smile arch was achieved the customer was happy with the new smile and the case was finished after the customer’s approval. Records were taken mid treatment to evaluate the fit of the aligners.

The customer showed good compliance & visited the dental clinic on time. Multiple factors including the accuracy of the clear path aligners , patient cooperation & clinical coordination helped in achieving these results.

Mid Treatment Records:

The aligners were well fitted and the case was tracking fine. Mid treatment intra oral photographs were maintained for the record of the treatment progress. The patient showed compliance and was kept on follow up after every stage, aligners were fitting fine and no mid treatment ill fitting or loss of tracking was observed .

The patient did not complain of any mid treatment problems, no gingivitis or periodontal deterioration was seen .

The aligners did not impinge the customer at any stages.

Neither was the treatment painful for her. She was happy with the mid treatment progress of aligners.

Following are a few mid treatment photographs attached, to show the fit of the aligners.

Results & Discussion :

Ideal alignment was achieved the upper centrals were proclined which resulted in an ideal smile. Following are the results

The superimposition of before and after cast models was done for better analysis of results achieved with Clear Path Aligner therapy: With superimposition of old and new models for both arches, total amount of movement achieved in 10 months can be shown (Yellow: Old, Green: New).

The case was started in October 2019 and completed by September 2020. It roughly took around 10 months and around 20 upper aligners to achieve the desired results.

Consent & Conflict Of Interest:

A written consent form was signed from the customer for use of the dental records for publications & social media marketing. Also there is no conflict of interest with this paper.

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