Biomechanical protocols and strategies for the correction of sagittal malocclusions part 1 and part 2 Juan Carlos Rivero Lesmes. Episode 72. December 21st 2020

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Farooq Ahmed


Biomechanical protocols and strategies for the correction of sagittal malocclusions part 1 and 2 Juan Carlos Rivero Lesmes


Join me for Juan Carlos’ lecture where he explores class 2 and class 3 correction with Invisalign


Part 1 class 2 cases



·      Most effective movement with aligners 87% efficacy Simon 2014


Method of correction of class 2

·      Sequential distalisation

·      Distal molar rotation

·      Arch expansion

·      IPR / extraction

·      Bite jump with elastics

·      Orthognathic surgery


Sequential correction

·      V sequence


Intrusion in deep bite cases

·      Cannot intrude incisors if roots are labial

o   Require torqueing 1st, then intrusion



·      Differential anchorage

o   Expansion of 6s and anterior teeth 1st

o   Then expansion of 2nd molars


Upper premolar extractions

·      Difficult to mesialise upper posterior teeth with aligners



Post herbst

·      Closing of lateral openbites

·      Cut outs 6s, 5s and box elastics


Class 2 subdivision – asymmetry

·      Differential growth in the mandible

·      Treatment

o   Mesialisation of effected side

o   NOT upper molar distalisation

·      Mesialise effected side with class 2 elastics


Part 2 – class 3 cases


Posterior crossbite

·      Cross elastic posteriorly

o   Palatal cut outs upper molars, buccal cut outs lower

o   128g of force

§  Distance for cross elastics 3mm diameter, interarch 4.5mm



·      Hooks on lower canines

·      Cut outs on upper molars with metal buttons



·      Pre surgical preparation

·      Post surgery – Miniscrews upper and lower anterior segment for IMF


Class 3 case with 8s

·      Lower 8s in situ

·      Require 4mm of space

·      RCT and hemisects L8s, create 8mm of space

·      Use 8 as anchorage unit


Interceptive class 3 case 6 years old

·      Previously treated with RME for disjunction and Chincup

·      Now treatment with Invisalign

o   Attachments each tooth for retention, no secondary teeth

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