The use of elastics to correct Class II/III dental malocclusion can be reasonably effective with clear aligner treatment, assuming, of course, that the patient is fully compliant in wearing the elastics as directed by the treating doctor.

There are two ways class II/III elastics can be used with aligners, each with their own pros and cons.

#1 - Elastics attached directly to the teeth via buttons

Pros

• Aligners are modified only for elastic wear, instead of having the cut outs on every aligner throughout treatment
• Elastic force applied to the teeth (or alveolar bone if using TADs) is more effective than pulling on the aligners, which may cause them to unseat or distort

Cons

• Staff must modify each aligner, but this only takes seconds, not minutes
• Buttons are on the teeth until class II correction is complete

#2 - Elastics are attached to the aligner via "cut outs" in each aligner

Pros

• Some aligner companies offer Class II cut outs at the time of aligner fabrication (ClearCorrect does not currently support this method)
• No aligner modification needed by Doctor or staff, saves personnel time
• No bracket visible on the cuspids

Cons

• Elastic in cut outs may distort aligner away from the teeth
• Elastic may dislodge the aligner off of the teeth; when aligners do not fit tightly to the tooth, movement effectiveness is reduced
• Cut outs may exist in the aligner beyond the need for elastics
• Elastic cut outs may cause tissue irritation
• Some elastic force wasted as the aligner is pulled against the front teeth, not the posterior quadrants

ClearCorrect aligners and class II/III correction

ClearCorrect primarily supports the method of class II/III correction where buttons are bonded to the teeth for the attachment of the elastics. This method applies force directly to the teeth and supporting structures, promoting more effective tooth movement, hence the class II/III correction. Doctors approve of this method because they only have to modify the exact number of aligners needed to make the correction; this modification can be done easily and quickly by the dental assistant.

In addition to the above, the doctor can use a plier designed to cut slits in the aligners for the attachment of elastics directly to the aligners. These slits can be cut into the aligners so that buttons need not be bonded to the teeth. One must understand that any method that uses elastics connected to the aligners vs. the teeth, results in much of the elastics’ forces being quickly dissipated by the aligner’s contact with the rest of the teeth in the dental arch, retarding the correction of the malocclusion.

We also must not ignore the other methodologies of correcting class II/III occlusions, i.e. by distalizing the upper posterior teeth into a class I relationship, or extracting upper first molars, advancing the upper second molar into a class I relationship with the lower molars, and allowing the upper third molar to erupt into a functional relationship with the lower teeth. Any of these treatments can be accomplished very satisfactorily by ClearCorrect clear aligners.

How to...

Following is a method of class II correction using buttons attached to the teeth.

Parts needed: 

• Resin cement
• Composite resin for bonding
• Ceramic or plastic orthodontic bracket
• Elastic band
• Single-hole paper punch, aligner hole punch plier, acrylic or diamond bur

Technique:

1. Modify the aligner(s) to prepare for bonding of the buttons:

Using a single-hole paper punch, aligner hole punch plier, acrylic or diamond bur, remove a semi-circular area of the aligner’s gingival margin where a button is to be placed.

2. Tooth preparation using conventional etch and bonding protocols:

Etch the area on the teeth where the buttons will be placed. Rinse the acid and dry with the air/water syringe.

3. Button placement:

Bond the buttons to the teeth where you etched in step 2 above. Place the button near the mesiofacial gingival margin.

4. Elastic placement: 

Insert aligner and stretch the elastic between the facial buttons that you placed on the cuspid and molar.

5. Carefully monitor the progress of the correction at each appointment

The elastic is worn until the class II (or class III) is corrected or slightly overcorrected. Overcorrection can be planned in the treatment setup as well to prevent relapse.