Roll, pitch, and yaw control using targeted mechanics in clear aligner therapy – A case report

This case report illustrates the successful use of clear aligner therapy (CAT) in the esthetic correction of a posterior crossbite and crowding in an adult patient. A 33-year-old male presented with a unilateral crossbite on the right side, extending from the first premolar to the second molar, alongside class III molar relationships and bilateral class I canine relationships. The patient exhibited normal overjet, shallow overbite, and mild crowding in both lower and upper dental arches. Traditional fixed appliances were declined in favor of clear aligners. Treatment objectives were focused on correcting the posterior crossbite and achieving an esthetically pleasing outcome with minimal adverse movements. The treatment required correcting malocclusion in all three planes of space - correcting a roll, pitch, and yaw defect by strategic attachment placement, auxiliaries, and careful staging of mesialization and distalization movements. The treatment was completed within 14.5 months, achieving the desired functional and esthetic results. This case demonstrates that clear aligners, when combined with targeted mechanics and staging, can effectively manage complex malocclusions such as posterior crossbite and occlusal cants within a similar timeframe to traditional braces, with a high degree of predictability and patient satisfaction.