Dental News - Mandibular occlusal plane management with micro-screws to correct an edge-to-edge incisal relationship

Dr Macarena Luengo Alarcón

Dr Valentina Aichele Petridis

Dr Tomás S. Salazar

Thu. 29. October 2026

save

Adult patients with a Class II skeletal pattern and bimaxillary dentoalveolar protrusion may present with reduced overjet or an edge-to-edge incisal relationship. Treatment planning should therefore address sagittal and vertical control of the incisal relationship, including occlusal plane orientation, as part of the biomechanical strategy.¹ In these cases, dentoalveolar compensation may already be close to its biological limit, and this can restrict mandibular incisor retraction and the overbite correction achievable through tooth movement alone. This is compounded by the recognised limitations of aligners in controlling root movement and bodily tooth movement.²

In these cases, correcting the anteroposterior and vertical relationship of the incisors is not simply a matter of retracting the mandibular dentition. When aligner biomechanics are combined with interradicular micro-screw anchorage and intermaxillary elastics, it may become possible to modify the orientation of the mandibular occlusal plane itself, offering an additional biomechanical lever for the correction of an edge-to-edge incisal relationship without relying exclusively on incisor retroclination.³ This case report describes the use of maxillary interradicular micro-screws combined with Class III elastics and aligners to produce a controlled counterclockwise rotation of the mandibular occlusal plane, correcting an edge-to-edge incisal relationship.

Case presentation

A 27-year-old male patient presenting with a Class II skeletal pattern and bimaxillary protrusion was treated using Invisalign aligners (Align Technology; Figs. 1–3). The initial treatment phase consisted of 12 active maxillary aligners and three active mandibular aligners. The digital treatment plan included interproximal reduction of 0.3–0.5 mm in the mandibular anterior region.

Fig. 1a: Extra-oral full-face photographs before treatment. Frontal view at maximum smile.

Fig. 1b: Extra-oral full-face photographs before treatment. Sagittal view at maximum smile.

Fig. 2a: Intra-oral occlusal views before treatment. Maxillary arch.

Fig. 2b: Intra-oral occlusal views before treatment. Mandibular arch.

Fig. 3a: Intra-oral lateral photographs before treatment. Right posterior view with the teeth in centric occlusion

Fig. 3b: Intra-oral lateral photographs before treatment. Left posterior view with the teeth in centric occlusion .

To complement the aligner biomechanics, 3/16 in., 6.5 oz Class III elastics were prescribed. The elastics extended from interradicular micro-screws placed bilaterally between the maxillary first molars and second premolars to precision-cut hooks incorporated into the mandibular aligners at the level of the mandibular canines (Figs. 4 & 5).

Fig. 4a: Intra-oral photographs of the interradicular micro-screws placed bilaterally between the maxillary first molars and second premolars. Frontal view.

Fig. 4b: Intra-oral photographs of the interradicular micro-screws placed bilaterally between the maxillary first molars and second premolars. Lateral view.

Fig. 5: Intra-oral lateral view of the patient wearing the maxillary and mandibular aligners with the elastics extending from the micro-screws to the precision-cut hooks at the mandibular canines.

Biomechanical rationale

The primary biomechanical objective of this configuration was to produce a counterclockwise rotation of the mandibular occlusal plane. While the aligners controlled the programmed dental movements, the force generated by the Class III elastics extending between the maxillary skeletal anchorage and the mandibular canine region was intended to modify the orientation of the mandibular occlusal plane.

From a biomechanical perspective, the line of action of the Class III elastic force passed anterior and superior to the estimated centre of resistance of the mandibular dentoalveolar complex.⁴ Because the force vector did not pass directly through the centre of resistance, a moment was generated, promoting counterclockwise rotation of the mandibular occlusal plane.⁵

Therefore, the biomechanical effect of the elastics should not be interpreted solely as a distalising or retracting force acting on the mandibular dentition. Rather, the spatial relationship between the force vector and the centre of resistance of the mandibular dentoalveolar complex generated a rotational tendency of the mandibular occlusal plane. This counterclockwise rotation resulted in an increase in both overjet and overbite (Figs. 6 & 7).

Fig. 6a: Intra-oral occlusal views after treatment. Maxillary arch.

Fig. 6b: Intra-oral occlusal views after treatment. Mandibular arch .

Fig. 7a: Intra-oral lateral photographs after treatment. Right posterior view with the teeth in centric occlusion

Fig. 7b: Intra-oral lateral photographs after treatment. Left posterior view with the teeth in centric occlusion.

Importantly, the increase in overjet was intended to occur primarily as a consequence of mandibular occlusal plane rotation rather than through simple posterior retraction or retroclination of the mandibular anterior teeth. This distinction represents a key component of the biomechanical rationale of the treatment protocol.

Additional aligner phase

After the initial phase, an additional aligner sequence was prescribed to achieve the final treatment objectives and refine the occlusion. This phase consisted of 12 active maxillary aligners and nine active mandibular aligners.

Clinical outcomes and final considerations

At the completion of treatment, the previous edge-to-edge incisal relationship had been corrected, and clinically adequate overjet and overbite had been established through controlled rotation of the mandibular occlusal plane rather than isolated mandibular incisor retroclination (Figs. 8 & 9). No adverse events related to micro-screw stability or soft-tissue response were observed, consistent with previously reported clinical outcomes for interradicular anchorage combined with intermaxillary elastics.^6, 7

Fig. 8a: Low-angle intra-oral frontal photographs with the teeth in centric occlusion before treatment.

Fig. 8b: Low-angle intra-oral frontal photographs with the teeth in centric occlusion after treatment.

Fig. 9a: Extra-oral full-face photographs after treatment. Frontal view at maximum smile

Fig. 9b: Extra-oral full-face photographs after treatment. Sagittal view at maximum smile.

This clinical application illustrates how the combination of micro-screw-supported Class III elastics and aligner therapy can be used as a deliberate strategy to manage the sagittal and vertical position of the mandibular occlusal plane, rather than relying solely on dental compensation. This is consistent with recent systematic reviews suggesting that skeletal anchorage primarily enhances the precision and predictability of tooth movement in aligner therapy, improving control over anchorage loss and unwanted side effects rather than simply increasing the magnitude of movement achievable.^8, 9

By reframing the force vector generated by the elastics as a rotational tool acting on the mandibular dentoalveolar complex rather than as a simple retraction force, this approach may extend the range of cases involving Class II or III skeletal patterns, bimaxillary protrusion and edge-to-edge incisal relationships that can be more predictably managed with aligners, warranting further investigation in case series. The integration of interradicular micro-screw anchorage into digital aligner workflows represents a promising compensatory strategy for managing complex sagittal and vertical discrepancies in aligner therapy.

Editorial note:

The list of references can be found here.