Even more complex malocclusions can be treated with aligners when combined with small anchorage implants. This case report illustrates this using the example of an open bite with a closed gap.
Complex aligner cases (anterior open bite, extraction) with skeletal anchorage.
Some orthodontic cases are particularly challenging—for example, when multiple misalignments are present at the same time and a tooth needs to be replaced or a gap closed. The following real-life case from our practice in Cologne demonstrates how even such a complex case can be resolved using clear aligners when combined with stable anchorage on the palate.
The initial situation
An adult female patient required extraction of her upper first molar. Instead of replacing the resulting gap with an implant, she wanted an orthodontic solution that was as inconspicuous as possible. In addition, several other findings were present: severe crowding in the lower jaw, an open bite in the anterior region, and a unilateral crossbite. Such a combination requires particularly careful, three-dimensional planning.
The treatment approach
Closing the gap instead of an implant
Instead of artificially filling the gap, the back teeth were carefully moved forward to close it naturally. Moving large teeth over such a long distance is only possible with very stable anchoring—which was provided by a system attached to the palate using small mini-implants. You can read in detail about how this technique is used for classic gap closure in the posterior region on our page about the mesial slider in the posterior region.
Aligners for comprehensive correction
Clear aligners were used for the actual tooth alignment. They provided virtually invisible treatment and precisely guided tooth movement. To correct the severe crowding in the lower jaw, a single lower incisor was also removed—a proven method for quickly and gently creating space in such cases without compromising the profile. You can learn more about treatment with clear aligners on our expertise page.
The outcome of the treatment
In the end, the gap left by the extracted molar was completely closed, the open bite was corrected, and the teeth were aligned into a harmonious, functional bite. The patient achieved a balanced smile and a stable bite—without implants and without visible braces during treatment.
What this case shows
Even complex initial conditions involving multiple simultaneous malocclusions can now be treated with clear aligners, provided they are combined with appropriate skeletal anchorage. While this article presents a particularly challenging case, you can find detailed information on standard gap closure in the posterior region on our page about the mesial slider in the posterior region. In any case, precise planning and good patient cooperation remain crucial.
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