Optimization Of Vertical Control During Anteriors Retraction Using Custom Device

This case report details the treatment of a skeletal Class I patient with hypodivergent pattern and protrusive profile, upright anteriors adjacent to the labial cortical plate, utilizing extraction-based controlled en masse retraction assisted by a custom orthodontic occlusal-splint combined with clear aligners. Female patient, 17-year-old, had Class II right subdivision malocclusion, moderate crowding in both arches, and 3.7 mm midline deviation. The chief complaint is protrusive lips. Imaging examination revealed a large shadow in the left mandibular body, managed conservatively after multidisciplinary consultation. Orthodontic treatment involved extraction of teeth 14, 25, 35, 45, followed by midline correction and moderate-anchorage anterior retraction. Initial anterior retraction using bite ramps induced a roller-coaster effect (mesial molar tipping and anterior premature contacts). To address detrimental movements, 3-4mm semi-anatomic occlusal splints were added to clear aligners in the premolar region. This modification improved torque control, intrusion accuracy. Significant improvement in the facial profile was achieved with optimal occlusion. The inherent limitations of clear aligner materials predispose to undesirable tooth movements such as the "roller-coaster effect" during anterior retraction, making overbite control a significant challenge in clear aligner orthodontics. Customized occlusal-splints enhanced aligners fit and reinforced vertical anchorage in the premolar region through optimized occlusal contact, which enhanced the efficacy of clear aligners in achieving precise control of anterior teeth. Vertical control is paramount during anterior retraction with clear aligners. Custom occlusal splints effectively counteract the roller-coaster effect with clear aligners.