Hybrid treatment of a skeletal class II malocclusion using aligners and sectional mechanics

Aim To describe the clinical management of an adult patient affected by skeletal Class II malocclusion treated through a hybrid orthodontic approach combining clear aligners and sectional mechanics, with the aim of improving sagittal correction and managing severe dental rotations while preserving the aesthetic and hygienic advantages of aligner therapy. Materials and methods A 25-year-old female patient presenting with skeletal Class II malocclusion, increased overjet and overbite, transverse maxillary constriction, moderate crowding, and severe premolar rotations (>35°) was treated with a hybrid protocol. Upper arch distalization and Class II correction were planned using clear aligners, optimized attachments and interarch Class II elastics. Severe lower premolar rotations were initially corrected using sectional NiTi mechanics combined with lingual traction chains. Once partial derotation was achieved, sectionals were removed, a new digital scan was acquired, and optimized attachments were incorporated to complete alignment and finishing using aligners alone. Results The hybrid protocol allowed efficient three-dimensional control of distalization, correction of severe dental rotations, alignment of both arches, reduction of overjet, and improvement of smile esthetics. Treatment goals were achieved without surgical intervention, maintaining high patient comfort and compliance. Conclusions The combined use of aligners, IZC screws, and sectional appliances represents an effective biomechanical strategy for managing complex Class II malocclusions and severe dental rotations when aligners alone may be insufficient.