The centimetre between her teeth

Before treatment — in their own words

She was sixteen when she came in for her first consultation, accompanied by both parents. The family had known for years that she needed orthodontic treatment. Previous consultations elsewhere had involved discussion of extractions and fixed braces, and the patient had resisted both. Her mother explained that she had a particular aversion to the idea of having teeth removed. When told that her case could be managed without extractions using aligners, she looked up from her phone for the first time in the appointment and said, "When can we start?"

She was self-conscious about the protrusion. She described learning, as a child, not to smile with her mouth open in photographs. She was aware that the upper teeth were visibly prominent when she spoke.

The clinical picture

Overjet measured 9mm at presentation. The overbite was increased but not severely deep. The skeletal pattern was mildly Class II. Crucially, she still had residual growth available — the combination of aligner mechanics and Class II elastics could utilise this remaining growth window to achieve correction that would be more difficult in a fully grown adult. There was mild crowding in the upper arch. The lower arch was well-aligned. No extractions were required: the treatment plan relied on upper incisor retraction and lower incisor proclination with elastic assistance.

The plan

Invisalign Teen Comprehensive with Class II elastics from upper canines to lower molars, worn full-time alongside the aligners. The elastic force directed the lower arch forward while the aligners retracted the upper anteriors. Attachments were placed on the upper canines and premolars to optimise the retraction mechanics. She was counselled on the critical importance of elastic compliance — without consistent wear, the tooth movements would not track. She wore them. Every check-up showed excellent aligner fit and tracking throughout.

The outcome

After sixteen months, the overjet had reduced from 9mm to 2mm — within the normal clinical range. The Class II relationship had been corrected to a Class I. The upper lip no longer strained to reach the lower lip at rest, and the profile change was visible in the soft tissue as much as in the teeth. She took a photograph herself in the mirror at the debond appointment, something that would have been unimaginable to her three years earlier. A lower bonded retainer was placed at debond, and Vivera retainers were issued for both arches.