# Extreme Anterior Intrusion when teeth are severely worn down - WITHOUT  TADs**

# Question:

One of the goals of this case is to get better alignment of the gum levels in the anterior prior to restorative. Is this too much to ask of just Invis? We aren’t going for perfection, not addressing posterior gummy smile, leaving left side full class 2. 


# Answer: 

In this answer I show one of my own cases of extreme intrusion without TADS for deepbite. 


[https://www.loom.com/share/0e0a7a532f15415fbbfe3ea99c8b8091?sid=29986b9f-73e2-411b-9528-db560bc28990](https://www.loom.com/share/0e0a7a532f15415fbbfe3ea99c8b8091?sid=29986b9f-73e2-411b-9528-db560bc28990)


The question about how much intrusion can be accomplished to level gingival margins depends on the patient's muscular strength. Hypodivergent patients with deep bites present a challenge because we are fighting strong muscle forces. Overtreatment is essential, as seen in this ClinCheck, where the lateral and central incisors undergo overtreatment over a longer period.


For successful intrusion, strong horizontal attachments are needed on the premolar and molars to anchor the trays, allowing forces to push up on the incisal edges of the anterior teeth. In a case involving a patient with a strong, hypodivergent jaw, intrusion was attempted with aligners first, followed by TADs (which failed). Despite minimal intrusion in the first set of aligners, we continued with overtreatment, asking for more and more intrusion.


Rather than rescanning the patient at the end of each set of trays, we ordered the next set of aligners based on the final position of the last tray. By doing this, we continued to apply pressure on the incisal edges and achieve further intrusion by not allowing the incisors to have any pauses in forces at the start of the next series of trays. This approach allowed us to push forward with the same treatment goals, focusing on overtreatment and continued force application.


Through multiple rounds of aligners, each starting from the final position of the previous set, we increased intrusion over time. The aligners were spring-loaded against the teeth, continually applying upward pressure. This method allowed for continued intrusion without reshaping the aligners.


In such cases, patient compliance is crucial. The patient must wear aligners 24 hours a day, and eating with aligners in is highly recommended to utilize muscle forces for additional intrusion. This plan demands overtreatment, strong attachments, and a compliant patient to be effective.