Pacific Coast Society of Orthodontists Bulletin Summer 2023 - 76

Presentation Summary
crowns of the teeth. The resultant narrowing of
the anterior arch form will open the posterior
bite (Figure 2).
2. A less common error is the choice of a new
archwire (after surgery) that does not match the
new arch form or width of the patient's maxilla.
With multisegment LeFort 1 osteotomies, the
arch form and width are changed and the plane
of occlusion can be altered. If the orthodontist
does not rebracket and the archwire is inserted,
the brackets will re-express the two-plane
occlusion that existed preoperatively, opening
the bite. If the archwire that is chosen does not
match the new arch form and/or width, the
cusp tips will collide, again opening the bite.
3. Finally, the consistent wear of vertical elastics
may cause palatal/lingual torque of the teeth.
This happens more readily if the patient talks
frequently, the archwire is not rigid enough, or
the periodontal health of the patient is poor.
Solution
To immediately manage torque changes secondary
to power chains or archwire/arch form-width mismatch,
the elastic and/or the archwire may be cut
at the sites where the multisegment LeFort were
made. Obviously, removing the power chain and
choosing the correctly sized archwire is the definitive
solution to the problem. As for torque changes
from elastic wear, vertical elastics after orthognathic
surgery are not necessary if the bite is correct and
the fixation is solid, so they may be discontinued
without problem under those conditions.
Figure 2.
open if the inclinations of the anterior teeth are not
managed correctly at the first archwire change. The
three main causes of this kind of bite change are (1)
power chains with flexible archwires, (2) inappropriate
archwire selection, and (3) excessive labial
elastic wear.
1. The placement of a whole arch power chain
without the archwire filling the slot or being
stiff enough to resist the forces of the elastic
power chain will cause palatal/lingual roll of the
Problem: Improper Management of Tooth Size
Discrepancies
In my experience, the most observed orthodontic
change that opens the posterior bite after orthognathic
surgery is the mismanagement of tooth
size discrepancies. Often, spaces are requested
distal to the laterals in the maxilla. It is thought
that these spaces enable the vertical osteotomies
of a multisegment LeFort 1 osteotomy to be performed
without encroaching on the tooth roots.
If the roots are maintained in a straight, natural
position, there is ample room to make the vertical
76
PCSO Bulletin Summer 2023

Pacific Coast Society of Orthodontists Bulletin Summer 2023

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2023

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Pacific Coast Society of Orthodontists Bulletin Summer 2023 - Cover1
Pacific Coast Society of Orthodontists Bulletin Summer 2023 - Cover2
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Pacific Coast Society of Orthodontists Bulletin Summer 2023 - 2
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