George Anka, DDS, MS and Duane Grummons, DDS, MSD
Introduction: The treatment of canted occlusal plane has long been a challenging one in orthodontic treatment. The recent development of TAD offers solutions toward better symmetric results without surgery. The applications of the technique and the devices will be explained. The concepts of grower and non-grower treatments will be elaborated as well. Cases of the canted occlusal plane correction will be shown.
Aim: There is need to innovate a way to correct the occlusal plane when it is canted, and to improve patients function whether or not it is a problem of the oral structures, which may have effect to the patient’s self-esteem or with the possibility of decreasing quality of life. Patients can be better corrected when they still have growth. (17) Some of them who have finished growth should be corrected with consideration beyond the growth adaptation factors. This is a preliminary proposal and report of the method that will contribute to the basis of future refinement techniques for the correction of occlusal plane discrepancies. These methods are additional steps regarding the present study of intrusion technique to correct the canted occlusal plane. (1, 2, 3) The technique will include a comprehensive frontal cephalometric analysis used to detect problems and 3D mechanics with control of the teeth and their alveolar bone within the boundary of the nasal bone.
Methods: Temporary Anchorage Device (TAD), a mini-screw device is being used to as the anchorage source in applying force application to move a tooth or teeth, mainly within the vertical dimension. The Grummons Frontal Analysis (4) is one of the main criteria besides the lateral cephalogram, smile line and lip relationships at rest and dynamic smile positions, photographs and clinical findings including using dental floss examination.
Results and Conclusions: Asymmetry of facial parts including a tilted cant of the occlusal plane is very common in most people, rather than being the exception. It is important to recognize and integrate asymmetry correction if possible during the routine orthodontic treatment. Recognition of the problem (awareness), and correction of such asymmetric disproportions will provide these benefits to the patient: Enhanced oral function, optimal symmetric esthetics, and increased quality of the orthodontic result.
We desire to provide our patients the best facial form and morphology no matter what problems they begin with. We have to understand the etiology of the skeletal pattern and degree of difficulty of each individual, whether dolicofacial or brachyfacial for instance. We have seldom questioned in the past whether a brachyfacial skeletal patient can be modified to become less brachyfacial, and whether the dolicofacial skeletal patient can decrease the vertical growth direction by adulthood. Such a treatment may have been initiated in the past, but with the introduction of the TAD in orthodontic treatment, it has improved the capability of such treatment.
The TAD offers an irresistible device that helps control a tooth or teeth in 3 dimensions. (12) In this paper, we will emphasize how the TAD can control and influence the vertical dimension as it relates to treatment of the canted occlusal plane. We believe in the possibility to apply this technique at a younger age, since earlier treatment of asymmetry confirms better chances to have it effectively corrected. (4)