What began as a routine consultation would unfold into one of the most intricate and inspiring cases we’ve ever had the honor of treating. Ines’s story spans more than a decade—rooted in precision, persistence, and partnership. Let’s take it back to where it all started.
The Initial Consultation: Understanding the Foundation
Ines’s initial treatment plan started in 2013. She had a skeletal bite imbalance (a Class III case), meaning her lower jaw was more prominent than the upper. To fix this, we began with braces to decompensate her teeth and prepare her bite for surgery.
Pre-Surgical Braces Progress: Setting the Stage for Surgery
Ines’s initial treatment plan started in 2013. She had a skeletal bite imbalance (a Class III case), meaning her lower jaw was more prominent than the upper. To fix this, we began with braces to decompensate her teeth and prepare her bite for surgery.
Surgical Hook Placement: Final Steps Before Surgery
At this appointment, we placed surgical hooks on Ines’s braces in preparation for her upcoming jaw surgery. These small hooks are added to the wire so that during surgery, the oral surgeon can attach elastics or surgical bands to help guide and stabilize the jaws in their new position.
Placing the hooks ahead of time is a crucial step in surgical orthodontics—it gives the surgeon the ability to guide the bite to its ideal position. This was one of the final appointments before her operation, and you can see in the photos how carefully we set everything up for success.
Post-Surgical Healing & First Check-In
This visit took place shortly after Ines’s jaw surgery. You can already see early healing and improved alignment in her bite. The surgical hooks, which had been placed on her braces prior to surgery, were used during the procedure to help the oral surgeon position and stabilize her jaws with elastics. Post-surgery, these hooks also supported her recovery by guiding the bite into its ideal position. This phase is all about monitoring healing, checking for stability, and making sure everything is progressing as expected.
PROGRESS POST SURGICAL WITH LINGUAL BUTTONS ATTACHED TO COME OUT OF CROSS BITE 9-18-2014
Now in the healing phase after surgery, Ines entered one of the most important parts of treatment: bite guidance. To help her jaws settle into their new position, we used a combination of elastics (rubber bands) and lingual buttons—small attachments placed on the inside of the teeth.
While the surgery repositioned the jaw structure, these tools were essential to fine-tune how the teeth came together and to guide muscle memory. The elastics applied gentle pressure, connecting hooks or buttons on the upper and lower teeth to help shift the bite into ideal alignment. The lingual buttons allowed us to place elastics in very specific positions, adding a discreet but powerful level of control.
This stage demands serious consistency—Ines had to wear her elastics for most of the day, every day. Missing even a few hours could slow down progress or lead to relapse. Her dedication to wearing them exactly as prescribed made all the difference in getting a stable, functional bite.
First Debond: Braces Off, Progress Locked In
After years of treatment, Ines reached a major milestone—her first debonding, where we officially removed her braces. This moment marked the end of active orthodontic treatment and the beginning of the retention phase.
Removing braces is more than just a cosmetic step—it means that her bite, jaw alignment, and tooth position had reached a place of functional balance and long-term stability. Getting to this point took time, teamwork, and trust: from surgical planning and Invisalign refinement to rubber band wear and check-ins.
But debonding doesn’t mean the journey is over. After braces, retainers play a crucial role in holding everything in place while the bone and surrounding tissues adapt. For patients like Ines—especially those with surgical or complex bite cases—retention is just as important as treatment.
This stage is all about preserving the progress and protecting the smile she worked so hard for.
Early Retention: Small Shifts, Close Monitoring
By 2018, Ines had been in the retention phase for a few years following her first round of braces and jaw surgery. At this point, her smile was still looking great overall, but we began to notice subtle changes in her bite—the kind of minor shifting that can happen even with a retainer in place.
This is common, especially in complex surgical cases. After treatment, the bone and soft tissue continue to adapt, and without perfect retention wear, small adjustments can slowly appear over time. It doesn’t mean something went wrong—it means we need to stay proactive.
During this visit, we documented those early changes and reinforced the importance of consistent retainer wear. We also began evaluating whether future refinements—like clear aligners—might be needed to prevent those shifts from becoming more significant.
Ines’s case is a great example of why long-term follow-up matters. We caught these movements early, which gave us more options and less invasive solutions moving forward.
Catching the Shift: Early Signs of Relapse
At this visit, we noticed the early stages of bite relapse. Ines’s teeth were beginning to shift subtly—nothing dramatic, but enough to signal that her smile needed a closer look.
Relapse can happen gradually over time, especially in surgical cases where the bite has been heavily corrected. Even with retainer use, changes in jaw pressure, habits, and natural aging can influence tooth movement.
Rather than rushing into retreatment, we chose to observe and monitor these changes closely. We discussed long-term options with Ines and her family and emphasized the importance of ongoing retainer wear and check-ins. This was a critical turning point—not because things had gone wrong, but because we caught the shift early enough to plan ahead.
Starting Invisalign: A Clear Path to Refinement
After carefully monitoring the bite changes over the past year, Ines was ready to begin a new treatment phase—this time using Invisalign clear aligners to address the relapse.
Invisalign allowed us to refine her bite and tooth alignment with more control and comfort than traditional braces. Using iTero scans, we developed a customized digital plan that included attachments for specific tooth movements and elastics to correct bite discrepancies. Our goals during this phase were to:
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improve interdigitation
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Expand the upper arch for balance
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Intrude molars to improve the bite
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Guide the jaw into a more stable, functional position
This wasn’t a restart—it was a targeted refinement plan to protect the years of progress Ines had already made and prevent further relapse.
Final Refinement & Completion
While many would consider this the “home stretch,” Ines’s treatment is still very much active. At this stage, we are continuing to use attachments and aligners to refine the final details of her bite and tooth position.
These attachments—small, tooth-colored shapes bonded to the teeth—allow for precise movements that clear aligners alone can’t accomplish. We’re focusing on bite settling, rotational corrections, and midline adjustments to ensure her end result is both functional and lasting.
Even after years of treatment, surgical cases like Ines’s require incredible attention to detail and patience. This isn’t a quick finish—it’s about making sure every part of her bite is stable and balanced before we remove the final tools.
Her journey is a powerful example of why orthodontics isn’t one-size-fits-all. Progress takes time, but every aligner and adjustment gets us closer to a result that’s truly built to last.
