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This patient is ready for his first refinement. We were successful in eliminating the crowding but 100% deep bite still exists. Due to the staging I've planned there are 70 aligners.

1. Is this clincheck set up for success?

2. Should I have him wear the aligners with eating, and if I do, can I change the trays more often?

Thank you!!

Answer:

Hey Amanda, I wanted to share some insights on this case. The deep bite correction is through lower intrusion. We need to ensure a few things:

1. Use horizontal attachments that are 3 to 5 millimeters wide. On the lower six, replace the broken attachment, as it won’t be effective.

2. Ensure a sharp, crisp surface, especially gingivally. If there's flash or extra composite underneath, it won't retain the tray well. Clean that up, creating a 90-degree contrast with a burr.

Next, for the deep bite correction:

• The focus on rotational movement on the first molar isn’t the priority. Attachments need to support intrusion.

• Lingual root torque is important, but here, you have 40 aligners for torque changes before starting deep bite correction, which seems excessive. You could achieve the necessary torque in maybe 12 aligners. Otherwise, you’re spending around 9 months with no deep bite correction, which is too long.

Additionally, the torque on the lower canines looks excessive and may cause tracking issues. I’d recommend starting the caterpillar or frog staging sooner. I do like the overtreatment of the reverse curve of Spee.

Finally, making sure you have crisp attachments without bevels will help crack deep bite more effectively. Make them sharp, at 90 degrees.

Eating with aligners in helps ensure the trays stay on the teeth consistently, which is crucial for deep bite cases. The magic happens when biting down, especially with lingual attachments. These attachments act like bite ramps, hitting the lower incisors and aiding in their intrusion. When paired with overtreatment and the right attachments, this enhances consistency in treatment. The additional benefit of eating with aligners is that the occlusion during chewing helps intrude the teeth further, contributing to the overall effectiveness of the deep bite correction.