
Severe Crowding, Unilateral Posterior Crossbite and 1st. Premolar extraction
Treatment Summary
This case, led by Dr. James M. Crouse, presents the treatment of a 16-year-old female patient with Severe Crowding, Unilateral Posterior Crossbite and 1st. Premolar extraction. Using the Angel Aligner Select system with angelButtonsTM for Severe Crowding, Unilateral Posterior Crossbite with CL II elastics and extraction of maxillary left 1 premolar. In just 12 visits over 17 months with 69 aligners, the approach greatly reduced crowding, especially at frontal canines, improved smile arc and reduction of gummy smile.
Patient introduction
Age: 16 years old
Gender: Female
Treatment time: 17 months
Number of aligners: 69
Chief complaint: The patient had Severe Crowding, Unilateral Posterior Crossbite and 1st. Premolar extraction
Section: Class II division 2 malocclusion
Product: Select
Malocclusion: CL II Div. 2 SUBDIV L, +2/+5, 6mm overbite, 3mm overjet, 16mm maxillary arch length deficiency, 5mm mandibular arch length deficiency, 2.3, 2.4, 2.5 are in crossbite with 3.2, 3.3 and 3.4, 3.7 is impacted, extraction of maxillary left 1st premolar needed.
Protocols and features: angelButton with CL ll elastics
Before & After
Class II div 1 malocclusion
Clinical examination and diagnosis
CL II Div. 2 SUBDIV L, +2/+5, 6mm overbite, 3mm overjet, 16mm maxillary arch length deficiency, 5mm mandibular arch length
deficiency
2.3, 2.4, 2.5 are in crossbite with 3.2, 3.3 and 3.4, 3.7 is impacted, extraction of maxillary left 1 premolar needed.
Treatment plan
Comprehensive treatment with clear aligners for an estimated 18-24 months, CL II elastics, extraction of maxillary left 1 premolar.
Treatment details
• 1st set of aligners – 42 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 17
• Checked at stage 29 Scanned for refinement at stage 38, allowed patient to continue changing aligners at home
• 1st refinement – 17 aligners, a few new attachments, started CL II elastics on the left all the time
• Checked at stage 11
• Scanned for refinement at stage 17, wear last aligner at night until aligners come in, continue with CL II elastics
• 2ndrefinement – 11 aligners, no new attachments, resume full time wear of aligners and CL II elastics
• Checked at stage 8 Deband – Removed attachments at stage 10, did not use #11 due to patient losing it waiting on removal of all 3 molars and exposure of mandibular left second molar
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































