The approach to skeletal dysmorphisms in the maxillofacial area usually requires an orthodontic treatment by means of fixed appliances, both before and after the surgical phase. Since its introduction, Invisalign system has become a popular treatment choice for clinicians because of the aesthetics and comfort of the removable clear aligners compared with the traditional appliances.
Therefore, the aim of the present report was to illustrate the management of malocclusion by means of the Invisalign system associated with the traditional surgical technique. The present paper shows a case of a 23-year-old male patient characterized by a Class III malocclusion with lateral deviation of the mandible to the left side and cross-bite on teeth 2.2, 2.3, and 2.4. Invisalign system was used during the pre-and post-surgical phases rather than fixed appliances.
The posttreatment cephalometric analysis emphasized the stability of the dental and skeletal symmetry corrections, occlusion, and functional balance, over a 6-year follow-up. The results achieved at the end of the treatment showed how Invisalign can be effective in the management of the orthodontic phases in orthognathic surgery. The follow-up after 6 years emphasizes the stability of the treatment over time.
For many patients, the surgical treatment of Class III malocclusion represents the only available therapy. It requires time, due to not only the diagnostic and planning phases but also the duration of the treatment itself. For this reason, in these patients, motivation is an important issue that must not be underestimated .
One of the most relevant problems, particularly with regard to adult patients, is represented by the need to undergo orthodontic therapy for several months. The aesthetic problem, associated with the worsening of oral hygiene conditions, may discourage many patients even before the beginning .
Invisalign system (Align Technology, Inc., San Josè, California, USA) could represent a suitable solution to solve such problematic [3–5]. It consists of a series of transparent aligners that are able to perform orthodontic movements without compromising the aesthetic of the smile. Hence, the purpose of this paper was to show the effectiveness and the advantages of this device in the surgical treatment of a Class III malocclusion.
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2. Case Presentation
A 23-year-old male patient presenting a Class III malocclusion with a lateral deviation of the mandible to the left side associated with a cross-bite of teeth 2.2, 2.3, and 2.4 came to our attention (Figure 1). Articular dysfunction in both Temporomandibular Joints (TMJs) was present, particularly focused on the left side. On the working side, it was possible to observe a shorter and thicker condyle and mandibular ramus; conversely, on the opposite side, both areas appeared longer and thinner.
Furthermore, it was possible to notice a steeper articular eminence on the left side, associated with a more posterior position of the condyle, responsible for symptoms such as pain and articular dysfunction (Figure 2). Spee and Wilson curves were more accentuate on the left side, where reduced dental and articular vertical dimensions could be observed (Figure 3).
As a consequence, Spee and Wilson curves underwent remodeling to compensate for the loss of posterior occlusal contacts. In the present case, both skeletal and dental asymmetries are presented. The cephalometric analysis highlighted a brachyfacial type with a negative convexity associated with a slight tendency to Class III, even in the presence of a normal (Xi-PM) value (Table 1).
The negative convexity value was related to the mandibular shifting toward the front and the right, due to the left cross-bite. The horizontal position of the maxilla (Pf-Na-A) showed a normal value (Figure 4). Thus, since this was not a real skeletal Class III, the surgical approach was performed in order to correct only the skeletal asymmetry developed during the years.