Treatment of a skeletal Class II malocclusion growing patient using clear aligners with solid occlusal blocks: A case report

This case report describes a two-phase orthodontic treatment of an 11-year-old adolescent patient with a Class II malocclusion. Before orthodontic treatment, the patient exhibited adenoid hypertrophy, mouth breathing, and snoring. He was referred to an otolaryngologist and diagnosed with paediatric obstructive sleep apnoea (PedOSA), which was treated with tonsillectomy and adenoidectomy. Thereafter, given that the patient was at the pubertal growth peak and preferred aesthetic appliances, clear aligner functional therapy was selected for orthodontic treatment. During the first phase (mandibular advancement), deep overjet and Class II molar relationship were improved using clear aligners with solid occlusal blocks, resulting in significant improvement in the patient's facial profile. In the second phase (comprehensive orthodontics), alignment and levelling of the dentition were performed. After approximately three years of treatment, all treatment objectives were achieved. This case suggests that CA with solid occlusal blocks, as a novel option, can be used for growing Class II malocclusion patients. The improvement in the facial profile appeared to result from a combination of minor skeletal changes and significant dentoalveolar compensation.