Background: Optimal management of hypodivergent growing patients demands a strict control of vertical dimension and to exploit the growth potential. If a deep bite malocclusion causes a traumatic contact between the upper and lower incisors and affects the facial appearance, an early interceptive treatment is recommended. The aim of this case report is to outline the clinical management of the occlusal plane of a growing Class II division 1 deep bite patient treated with aligners and Class II elastics. Methods: The treatment lasted 11 months and was divided into two phases. Treatment goals included improvement of the soft tissue profile and basal bone relationships through an increase in the mandibular third of the face and a sagittal advancement of the mandible. The correction of the curve of Spee involved intrusion of the mandibular incisors and extrusion of the mandibular premolars. Results: The cephalometric analysis at the end of the treatment displayed significant differences in the skeletal and occlusal pattern along with aesthetic improvements. Conclusion: The final cephalogram showed a consistency between the planned tooth movement and the clinical results. Although definitive recommendations must be withheld until longer follow-up is available, the patient presented here shows that the treatment protocol yielded positive mandibular growth.

Background: Orthodontically driven osteogenesis (ODO) is a surgical tunnel modification of periodontally accelerated osteogenic orthodontics (PAOO), combining selective corticotomy with bone grafting in sequential and/or segmental fashion. This is a minimally invasive approach that enhances periodontal health and allows orthodontic tooth movement beyond the original alveolar envelope. Considering the lack of long-term three-dimensional data on orthodontically driven osteogenesis (ODO), this study aims to quantitatively assess the long-term stability of alveolar bone and buccal cortical thickness following ODO, using CBCT imaging. The null hypothesis is that ODO does not result in significant changes in alveolar bone volume or cortical thickness over a seven-year follow-up period. Methods: Twenty patients (13 females, 7 males; mean age 27.4 ± 5.3 years) who had undergone orthodontically driven osteogenesis (ODO) using a minimally invasive tunnel approach and segmental corticotomy protocol followed by clear aligner therapy were retrospectively evaluated. The mean follow-up period after treatment was 7 years (range: 5–15 years). Cone beam computed tomography (CBCT) scans were obtained at one year postoperatively (T1) and again at the long-term follow-up visit (T2). Buccal bone thickness measurements were taken at standardized levels (3 mm, 5 mm, and 7 mm apical to the cementoenamel junction) and compared between T1 and T2 to evaluate bone stability over time. In addition, histologic evaluation of the previously grafted area was performed in two patients: one sample was collected during an alveolar ridge augmentation procedure six months after ODO, and the other during orthognathic surgery eight months after ODO. The samples were analyzed to assess new bone formation and integration of graft material. Results: Radiographic analysis showed long term stability of the new bone support. Histologic examination showed newly formed lamellar and reticular bone. Bone marrow showed no inflammatory infiltration, and bone particles were still detectable but incorporated in the newly created bone. Conclusions: Based on these findings, ODO appears to be a promising technique that could induce stable bone osteogenesis. A larger cohort study can enhance the evidence of these promising results to popularize this technique.

Deep bite is a common malocclusion characterized by reclining upper front teeth in adolescents and adults. Few studies using Clear Aligners (CA) have successfully corrected severe deep bites. The therapeutic failure was caused by the natural biting force of the patients. Align Technology® (Santa Clara, CA) introduced a specific protocol for Deep Bite correction based on SmartForce Aligner Activation. Specific regions of CA are designed to realize strategic contact areas between CA and the dental element to maximize the predictability of treatment. This study aims to investigate the skeletal and dentoalveolar effects of the SmartForce Aligner Activation Invisalign® G8 protocol in three adolescent patients (two females and one male, aged 11 to 14 years) with severe deep bites. For each patient, intraoral and extraoral photographs, orthopantomographies, and teleradiographies were compared before and after orthodontic therapy using CA and SmartForce Aligner Activation. After two phases using CA, worn 20/22 hours daily, all patients reached a bilateral molar and canine Class I and flattened Spee curves. Post-treatment lateral teleradiographies showed skeletal, dental, and aesthetic improvements. Moreover, new photographs were collected with a one-year follow-up to appreciate the stability of the results. Based on these findings, the SmartForce Aligner Activation protocol may be successful in the orthodontic management of deep bite growing patients.