A pre-teen with complex orthodontic needs

09 July 2024
Before treatment, lower and upper arch and front view.

Anthony Lam describes a successful story of a young patient who presented with a class II/I incisor relationship on a moderate skeletal II base due to mandibular retrognathia with reduced vertical dimension.

Assessment and treatment options 

At his initial appointment, I discussed his treatment options with him and his parents. The options were: do nothing; place a twin-block appliance followed by upper and lower appliances and then a reassessment for extraction; Invisalign treatment with Mandibular Advancement (MA) or orthognathic surgery once he had stopped growing. 

Several factors caused additional complications to his prospective treatment; an increased overjet, increased overbite, mild overcrowding to his upper and lower arches, previous trauma to 41, retained UL3 and centreline discrepancy.

During the consultation, I explained the function and duration of wear of each modality. Invisalign treatment with MA seemed to present the most comfortable and practical appliance option for the patient.

I find that the Invisalign system is more convenient for young patients. It makes it easier for them to adapt to the treatment due to the absence of bulky acrylic and to remain compliant.

The observable difference in the patient’s teeth and jaw encourages them to adhere to their treatment plan diligently.


To manage this patient’s UL3, I extracted his ULC under local anaesthetic, which made room for his UL3 to drop down naturally. Its position was incorporated into the aligner design from the outset to ensure that its movement and positioning were carefully controlled throughout the treatment process, using the eruption compensators.

I initially asked the young man to change his aligners every 14 days, then moved the change interval to every seven days.  He completed his treatment within nine months.

In total, this treatment was completed with 53 sets of aligners for the first phase of treatment with MA, 22 for the second phase and a further seven for the refinement stage.

The result was both physically and emotionally life-changing for the patient. He has grown in confidence, and his upper incisors are less likely to suffer trauma from the numerous sports he plays. It’s also now motivated him to maintain immaculate dental health

Inspiration and awareness

The emotional issues this patient had previously experienced because of his teeth, heightened our practice team’s awareness of the unique needs and challenges faced by children with similar orthodontic issues.

As a team, we are now more sensitive to the emotional and psychological aspects of orthodontic treatment, particularly for younger patients. The positive outcome achieved by this treatment could be inspirational and encourage other families facing similar challenges.