Accelerated and hybrid orthodontic treatment using a combination of 2D lingual appliance and in-house aligner: An anterior cross-bite and TMD case report after 1-year follow-up

Abstract

Anterior cross-bite and Class I malocclusion are common in orthodontics. There are various methods to treat this condition. In this case report, we will be discussing our approach to treating anterior cross-bite in an adult patient. We used hybrid treatment by 2D lingual-fixed appliance and in-house clear aligner to provide esthetic orthodontic treatment. In addition, we utilized 3D simulation to ensure the accuracy of our treatment plan and mechanics. In this article field, we present the case of a 23-year-old woman who came to us with complaints of anterior cross-bite, smile esthetics, and her profile. On examination, we found that she had a skeletal Class I malocclusion and anterior cross-bite on the left side with erosion in her upper left incisors. Although she had good occlusion, there was some minor crowding in her upper and lower teeth. After conducting a 3D simulation, we decided to use a 2D lingual-fixed appliance on her upper teeth and an in-house aligner on her lower teeth. We chose this treatment plan because it was suitable, efficient, and cost-effective. However, after 2 months of treatment, the patient developed TMD, and her mandible shifted to the left. As a result, she had an X-bite on the right side. To address this issue, we removed the 2D appliance and switched to an in-house aligner for both upper and lower teeth. After 2 more months with the aligner, we noticed that the patient had occlusal interference in her left lateral incisor and erosion on this tooth. To fix this problem, we filled the tooth (22) and maintained the position of the lower teeth. We continued the finishing stage with the in-house aligner on both the upper and lower teeth. After 8 months of treatment, the case was successfully completed, and the patient no longer had TMD. Using a 2D lingual appliance and in-house aligner is an effective method for treating anterior cross-bites. Careful TMD control is essential in orthodontic treatments.