
Significant Arch Length Deficiency and Facially Blocked
Maxillary Canines
Treatment Summary
This case, led by Dr. James M. Crouse, presents the treatment of a 13-year-old female patient with a Comprehensive Correction of a Crowded Class II Div. 1 Malocclusion. Using the Angel Aligner Select Unlimited system with angelButtonsTM for CL ll elastics, the treatment corrected significant Arch Length Deficiency and Facially Blocked Maxillary Canines. In just 11 visits over 17 months with 64 aligners, the approach delivered precise control, greatly enhanced facial refinement, and a dramatically improved smile.
Patient introduction
Age: 13 years old
Gender: Female
Treatment time: 17 months
Number of aligners: 64
Chief complaint: The patient had significant Arch Length Deficiency and Facially Blocked Maxillary Canines
Section: Class II Division 1 malocclusion
Product: Select
Malocclusion: Class II Div. 1, +4/+4, 3mm overbite, 2mm overjet, 6mm maxillary arch length deficiency, 2mm mandibular arch length deficiency, maxillary canines blocked facially.
Protocols and features: angelButton with CL ll elastics
Before & After
Class II div 1 malocclusion
Clinical examination and diagnosis
Class II Div. 1, +4/+4, 3mm overbite, 2mm overjet, 6mm maxillary arch length deficiency, 2mm mandibular arch length deficiency, maxillary canines blocked facially.
Treatment plan
Comprehensive treatment with clear aligners for an estimated 18-24 months, open space for upper canines, CL II elastics.
Treatment details
• 1st set of aligners – 41 aligners
• Delivered 1st 2 aligners to be changed weekly
• Placed attachments at stage 3 and gave patient all aligners to continue weekly changes
• Checked at stage 14
• Checked at stage 29 – started CL II elastics on the left side all the time
• Scanned for refinement at stage 37, allowed patient to change to #38 but did not use the overcorrection aligners #39-41, went to night wear with CL II elastics on left
• 1st refinement – 14 aligners, 0.3mm of IPR between 2.1 and 2.2, some new attachments
• Scanned for refinement at stage 11, did not use overcorrection aligners #12-14
• 2nd refinement – 18 aligners, some new attachments
• Deband – Removed attachments at stage 15, did not use overcorrection aligners #16-18, scanned for retainers
Download the full case to see the treatment results, the conclusion and get more details on the solution

Dr. James M. Crouse
Dr. James M. Crouse, a native of Salisbury, MD, graduated magna cum laude in 1985 from the University of Maryland School of Dentistry.
After completing a general practice residency at Barksdale AFB hospital, he served three years in the United Kingdom before pursuing orthodontic training at Emory University in 1991. He then served as an orthodontic consultant at Spangdahlem Air Base in Germany until 1994 before returning home to practice with Dr. Alfred Beattie, where he continued after Dr. Beattie retired in 1995.
• President of Eastern Shore Dental Society 1997-98
• Diplomate, American Board of Orthodontics 2003
• 14 cases published in the Invisalign case galleries 2010, 2012, 2014, 2016, and 2018
• Invisalign Summit Shoot Out semi-finalist in the class II/class III category 2016
• Has treated over 3000 aligner cases
• Volunteer faculty for the NYU Langone Pediatric dental program since 2014




























