Skip to main content

Case Selection Guide

  • Updated

Transverse Cases
Vertical Cases
Saggital Cases
Case Studies

Purpose: Help providers understand which cases they should take on based on their clear aligner experience, Dr. Gray walks through different case types and creates a framework for selecting cases:

 

Malocclusions:

  • Class I:
    • Midline correction, intrusion, or extrusion ≤ 2mm
    • Overjet or overbite ≤ 4mm
    • Crowding or spacing ≤ 6mm
    • Rotation ≤ 20-40°
    • Anterior Crossbite
  • Class II:
    • Molar Crossbite 
    • Mixed Dentition
    • TMJ/TMD Issues
  • Class III:
    • Class III
    • Surgical Cases
    • Complex Movements

Transverse Cases

Lingual Inclination:

  • Treat Everyday
  • Teeth would be moving outward and then straightened
  • Movement Type: tipping

Anterior Crossbite:

  • More challenging, however, is if the crossbite is dental and not skeletal, so submit the case for treatment planning. 

 

Molar Crossbite:

  • Can be treated with clear aligners.
  • Would recommend being experienced with clear aligner treatment first. 

 

Crowding:

  • Easily treatable with clear aligners

 

Spacing:

  • If there is spacing in both arches, there is a good opportunity to treat with clear aligners easily.

 

Diastema:

  • If a diastema is present, but the opposing arch doesn’t have spacing, the best way to correct the spacing is to perform IPR on the opposing arch. 
  • It’s also possible to move the central incisors together, leave space between the central and lateral incisors, and close the space by adding bonding to the lateral incisors.



Vertical Cases

Deep Bite:

  • Easily align the arches to correct a deep bite with clear aligners

 

Moderate Advanced Open Bite:

  • Depending upon the spacing between upper and lower arches, teeth can be uprighted to reduce open bite. However, this could require more experience with clear aligner treatment and potential use of attachments. 

 

Unlike Arches (Significant Anterior-Posterior Correction):

  • If the upper and lower arches do not match, cases should be referred to an orthodontist. 

Saggital Cases

Class I (No Anterior-Posterior Correction):

  • Easily treatable with clear aligners

 

Class II (No Anterior-Posterior Correction):

  • Can be aligned better to reduce wear on teeth.

 

Unlike Arches (Expansion Case):

  • Clear aligners can accomplish the spacing needed, but more management could be required to avoid an edge-to-edge relationship at the end.

Case Studies:

 

Treat Every Day

  1.  

  • We can help with his breathing.
  • We can upright the lingually inclined teeth.
  • The crowding is easily manageable. 
  • We can help alleviate wear on his teeth as well.
  • This is an everyday, treatable case. 

 

  1.  

  • We can rotate the tooth.
  • We would either need to perform IPR on the bottom or create space on the upper arch.
  • We would not need to alter the bite. 
  • This is an everyday, treatable case. 

 

  1.  

  • The bite is in a good position.
  • Enamel wear is present.
  • Teeth can be aligned, along with adding bonding to fix the incisal wear.
  • This is a good case for whitening treatment.
  • This is an everyday, treatable case.

 

Advanced Case:

 

  • Lingual inclination could be corrected.
  • Class II bite can be corrected, but this case could take some extra time and experience with managing. 
  • Once you’ve treated some simpler cases, this could be treated with clear aligners.

Related articles