Preformed intrusion bulbs on clear aligners facilitate active vertical control in a hyperdivergent skeletal Class II case with extraction: A case report with 4-year follow-up

Active vertical control is critical in the treatment of hyperdivergent skeletal Class II malocclusion. The mechanics have been well shown as successful fixed appliance system with temporary anchorage devices (TADs); however, there are few relevant case reports clear aligner therapy (CAT). present report describes a severe using CAT extraction four premolars. was performed TADs, which facilitated by intrusion bulbs (IBs), that is, digitally designed and preformed vacuum on aligners for wearing intrusive elastics. challenging camouflage finished an improved profile occlusion; specifically, upper central incisors were intruded 3 mm first molars 1.8 mm, counter-clockwise rotation mandible 2.2° decrease ∠ANB 2.6°. After 4-year follow-up (the latter 2 years without retainers), results remain stable whole. According to report, can be successfully achieved active IBs aligners.