She rarely smiled because her lower teeth never showed

Before treatment — in their own words

She put it plainly: her upper teeth felt too long, biting was difficult, her lower teeth were sensitive because of the deep bite, and her lower teeth were invisible when she smiled — which is why she rarely smiled with her teeth at all. The deep bite was both a comfort problem and a confidence problem.

The clinical picture

Examination showed a severe Class II deep bite with a square arch form. The upper and lower front teeth had over-erupted, the upper front teeth were tipped back, and the lower incisal edges were worn from biting into the back of the uppers. The sensitivity came from that wear. Left alone, the wear would only continue.

The plan

Invisalign to intrude the over-erupted front teeth and open the deep bite, broaden the square arch form, and bring the retroclined upper front teeth into a better inclination, with Class II elastics to settle the bite into a Class I relationship. Opening the bite would both show the lower teeth on smiling and stop them being ground down further.

The outcome

After twenty-one months the deep bite was opened to a healthy overbite, the worn lower teeth were protected in their new position, and biting was comfortable. For the first time, her lower teeth showed when she smiled — and she stopped holding the smile back. The arch form looked fuller and more natural than the squared-off shape she started with.