Treatment of anterior open bite with the Invisalign system.

nvisalign* was initially developed to correct mild-to-moderate crowding, to close naturally occurring spaces, and to produce dental tipping. 1,2 After years of experience with the system, orthodontists have reported its successful use in more complex cases, such as those involving extractions, open bites, and Class II malocclusions. 3-7 This article describes two anterior open-bite patients who were successfully treated with the Invisalign system alone. 2 A 15-year-old female presented with anterior open bite, anterior spacing, lack of lateral canine guidance, tongue dyskinesia, and sigmatism during speech (Fig. 1A). Before starting orthodontic treatment, she was advised to undergo myofunc-tional therapy. Vertical rectangular attachments were bonded to the upper incisors, canines, and first premo-lars and the lower canines and premolars (Fig. 1B). Thirty upper and 20 lower aligners were used to close the open bite, derotate the lower premolars, and close the anterior spaces. The refinement phase required another 10 maxillary aligners— seven for a 1.1mm extrusion of the maxillary incisors and three for retraction and space closure. After 20 months of aligner treatment, the anterior open bite had been closed, the spaces between the central incisors had been closed in both arches, and canine guidance had been achieved bilaterally, with functional overjet and overbite (Fig. 2A). The final ClinCheck projections closely matched the post-treatment results (Fig. 2B); frontal superimpositions of the ClinCheck pretreatment analysis and post-treatment projection indicated the amount of relative extrusion needed for closure of the open bite (Fig. 2C). The patient's bite closure and other corrections remained stable 12 months after the completion of Invisalign treatment (Fig. 3).