Orthotown December 2022 - 17
I think I understand that, thanks. So postsurgically, the molars aren't in contact so you can
extrude them with elastics, and then that maintains lower facial height? ■
No, when the advancement is done, the occlusion is " tripodded " so there is contact on the
molars and in the anterior. The intervening teeth are out of occlusion temporarily.
To get this kind of change:
10/11/2022
dhmjdds
Member Since: 11/16/04
Post: 8 of 16
NyceBiteR
Member Since: 10/21/08
Post: 7 of 16
(This was a simulation; not a treated patient yet.) ■
When the mandible is advanced, if the incisors and molars are in contact, the incisors with
10/13/2022
close to ideal OB/OJ, then what happens postsurgically when you level the CoS? We've established
that either the incisors fl are forward or the molars tip back (diffi cult) when you level-but if the
incisors fl are more at ideal OB/OJ, how do you not end up with insuffi cient OB/OJ? Maybe I
need to see an immediate postsurgical ceph and fi nal ceph superimposed to understand. ■
10/13/2022
Quote: (charlestonbraces)
I don't think it will be possible for you to do so. By defi nition, presence of a CoS is crowding
manifested in a subtle way. When you level, they must come forward.
So even levelling a curve of Spee with just using an anterior bite plate will result in incisor
proclination? ■
No. It is really a geometric problem. Diane has a real good example with the arch wire. ■
10/16/2022
10/17/2022
Great discussion, everyone.
I think a bite plate may help decrease fl aring. Forgive me if I'm overlooking something, but
the way I see it:
There is the geometric factor, as previously alluded, but theoretically there is a mechanical
factor as well. Reciprocal leveling will cause relative intrusion of the incisors (fl aring). If the bite
plate allows for easier extrusion of premolars, there may (theoretically) be less of an intrusive effect
on the incisors as you level. Whether this is clinically signifi cant is another story. ■
10/17/2022
There is no free lunch.
However, you can control the torque of the incisors, bringing the roots forward as the crowns
come forward. If there is enough bone labial to the roots to move them enough, which there
often is not. ■
10/17/2022
dhmjdds
Member Since: 11/16/04
Post: 13 of 16
charlestonbraces
Member Since: 06/05/09
Post: 11 of 16
tiramisu
Member Since: 08/27/08
Post: 12 of 16
YJA12
Member Since: 07/09/16
Post: 10 of 16
NyceBiteR
Member Since: 10/21/08
Post: 9 of 16
orthotown.com \\ DECEMBER 2022 17
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Orthotown December 2022
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