Digital Design for Lower Incisor Position Correction in a Growing Patient with Mandibular Retrusion with Clincheck® Software: A Case Report

Background: The majority of Class II malocclusions stem from mandibular deficiency, leading to chin retrusion. In growing patients, the ideal correction—aiming for a skeletal mandibular response—should avoid common pitfalls such as “Point B” dropping postero-inferiorly, excessive labial proclination of mandibular incisors, or the lingual tipping and extrusion of maxillary incisors. When planning mandibular advancement (MA) using clear aligners with integrated advancement features, biomechanical forces are not the only consideration; precise management of the lower incisor position is critical for success. Current literature highlights not a good control in digital planning software: these platforms are primarily dentoalveolar-based and lack integrated cephalometric analysis. Consequently, mandibular advancement is often defined by standard linear parameters (typically 2 mm per step), while incisor position is managed through virtual alignment without correlation to cephalometric landmarks like the Pogonion, NB line, or IMPA. The software cannot monitor real-time sagittal or vertical skeletal relationships, the software will elaborate the treatment planning after doctor’s prescription, the clinician must manually adjust incisor positioning based on external cephalometric analysis to prevent dental compensation or excessive proclination. Aim: This clinical case demonstrates a specific arch preparation protocol designed to optimize mandibular advancement in a growing patient with mandibular retrusion. Methods: A 12-year-old female presented with a skeletal and dental Class II malocclusion, characterized by increased overjet and a normal overbite. Treatment was conducted using Invisalign® clear aligners (22h/day wear, weekly changes). The treatment objectives were: transverse: Correct upper dentoalveolar contraction and coordinate arch form while restoring midline alignment; sagittal: establish Class I molar and canine relationships by correcting the overjet and reducing the labial inclination of the lower incisors; vertical: level the curve of Spee. A key clinical condition of our protocol was the pre-advancement phase: the lower arch was reshaped by reducing the buccolingual inclination (retroclination) and intruding the lower incisors. This was specifically intended to increase the available overjet space, creating the necessary room for subsequent mandibular advancement. Results Treatment was completed in 24 months with high patient compliance. Objectives were successfully met, including the correction of skeletal and dental discrepancies, the establishment of harmonious arch forms, and precise overjet reduction through enhanced control of the mandibular incisors. Conclusions: This case report outlines an optimized clinical strategy for Class II correction. Cephalometric Integration: Perform an initial analysis outside the digital planning software to define the ideal IMPA and NB angles. Anatomic Verification: Utilize radiographic overlays to ensure tooth movement remains within alveolar bone limits. Pre-MA Optimization: Prioritize a “pre-advancement” phase to maximize the sagittal inter-arch space (overjet). A larger overjet allows for a more significant orthopedic effect from the MA features. Stepwise Advancement: Implement mandibular advancement in increments (≥2 mm) with periodic clinical reassessment to facilitate the adaptation of the muscular sling and functional occlusion.