The Keys of Sagittal Treatment with Aligners Isobel Flores Allen. Episode 73. December 21st 2020

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Farooq Ahmed

The Keys of Sagittal Treatment with Aligners. Isavel Flores Allen


Class 2 cases


Options for class 2 correction with aligners


1.     Molar derotation

2.     IPR

3.     Distalisation

4.     Simulation class 2 – in young patients, NOT in adults with elastics, rely on growth

5.     Extractions


Upper first molar rotation correction

·      Why does 1st molar rotate mesially = take space of primary molar.

·      Correction via:

o   Attachment if 20-30 o

o   Buttons and force couple 30o +



·      Maximum 0.5mm in clincheck

·      Bolton discrepancy

o   Focus tends to be on anterior teeth

o   There is a discrepancy posterior – requiring IPR in premolars


Sequential distalisation

·      Predicable: 2-4mm in younger patients with elastic use

·      How does it work:

o   Upper 7s is ½ of the way then the 6 begins to move

·      TIP: No more than 2 teeth distalise at the same time


o   Extraction of 8s required

·      Aesthetic start:

o   Anterior rotated tooth correct whilst distalising

o   Through proclination, intrusion etc

o   Retraction when canine ½ way through distalisation

·      Elastics from the outset

·      At least when 5 begins distalise

·      Precision cut / hook Vs button:

o   Cut aid retroclination

o   Button when no retroclination required


Premolar extraction 1st premolar

o   Up to 2mm of mesialisation in maximum anchorage: G6 procotol: 7s are required to be present

o   Medium anchorage 2-5mm

o   If absolute anchorage = TAD

o   No Invisalign protocols for 2nd premolar extractions, use conventional attachments





Typical changes to clincheck for distalisation case

o   Precision cuts on upper 2nd premolars for class 2 elastics

o   When 1st premolar begins to distalise, change to conventional attachment and cut out (cannot have optomised attachment and cut out on the same tooth, but can have conventional attachment)

o   When 3s retract replace optomised attachment to conventional attachment and cut out

o   Vertical attachments on upper 6s and 7s

o   With class 2 elastics lower molar may mesially tip: use mesial attachment on 6 to upper 5 short elastic to upright





Elastics 4.5 ounces 3/16th

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