Invisalign First for Crowding, Crossbite, and Deep Bite: Pediatric Orthodontic Arch Expansion

Hello.

This is Apgujeong Orthodontic Clinic.

Today, we have another story about Invisalign First for pediatric orthodontics.

24.02~25.07

If the treatment timing is right, it is possible to complete the occlusion all the way into the permanent dentition.

Today, I’d like to talk about that.

This is a 10-year-old child who came in for orthodontic treatment in January 2024.

24.02

It was said that the child had previously had partial front-tooth orthodontic treatment at a pediatric dental clinic three years ago.

So there was a wire retainer attached to the two central incisors on the upper front teeth.

The midline is deviated by about 2 mm, and the axes of the upper front teeth are tilted to one side.

A deep overbite of the front teeth is also visible.

24.02

There is a crossbite due to severe crowding caused by lack of space.

24.02

We recommended Invisalign First treatment with the goal of aligning the crowded teeth through arch expansion.

After wearing all 19 aligners in the first set from February to September 2024, this is the result.

24.09

The midline improved, but a slight discrepancy remains, and both the crossbite and crowding improved.

24.09

24.09

In the meantime, the one remaining primary tooth fell out, and the child entered full permanent dentition.

24.09

To further improve the midline, we decided to make an additional set of aligners.

After wearing all 14 additional aligners from October 2024 to January 2025, this is the result.

25.01

For the additional aligners, elastics were prescribed to improve the midline, but the child wore the elastics so diligently that the midline actually crossed over to the opposite side compared with three months earlier.

In such cases, if the elastics are stopped, the teeth will return somewhat to their original position, so we decided to observe the progress while using the last set of 14 aligners only at night as retention.

25.01

25.01

During the 4 months of observation, this was the appearance at the May 2025 visit.

25.05

As expected, after stopping the elastics, some relapse occurred in the midline and it improved, but

25.05

the front tooth alignment became distorted again, likely because the last aligner that was supposed to be worn only at night was not worn consistently.

To correct this, we unfortunately had to begin a second remake.

25.05

25.05

The occlusion and lower arch alignment have been maintained perfectly.

From May 2025 to July 2025, treatment was completed after briefly wearing additional aligners to improve the front tooth alignment.

25.07

The midline is well aligned,

the molar occlusion shows a solid Class I relationship.

Now let’s compare before and after.

The total treatment period was 1 year and 6 months, with a 4-month break in the middle due to midline issues.

A total of two remakes were done.

24.02~25.07

Because the treatment result was equivalent to a formal adult orthodontic treatment result rather than a pediatric orthodontic one, retention was also managed thoroughly.

24.02~25.07

The deviated midline was corrected, and the tilted axes of the front teeth also improved.

The deep overbite of the front teeth also improved.

25.07

The improvement in the front tooth axes can be seen more accurately on X-rays.

24.02~25.07

24.02~25.07

Now let’s compare the facial profile.

24.02~25.07

24.02~25.07

Rather than being limited by the constraints of pediatric orthodontics, we do our best to provide results comparable to adult orthodontic treatment.

I hope this post is helpful for those considering clear aligner treatment for children.