Orthotown December 2022 - 8

a voice in the arena
Bite Ramps, Part 1:
Class 2 Bite Ramps
by Chad Foster, DDS, MS, editorial director
O
ver the past two years in my
practice, I don't think there has
been a bigger game-changer in
our clinical process in regard
to treatment efficiency than
strategically positioning and shaping our
bite turbos.
Shaped bite turbos, sometimes called
" bite ramps, " are not new in orthodontics;
they've been around in different forms
and applications ever since orthodontists
started using bonded disarticulation
techniques. Through my participation in
online forums, I have been inspired by the
techniques of others, and in this month's
column, I'll share a case progress example
and my thoughts on how I approach Class 2
bite ramps.
To begin with, Class 2 bite ramps are
not a universal fi x for any and every Class 2
malocclusion. They do not produce orthopedic
mandibular advancement, and they likely
don't restrain maxillary growth or signifi cantly
distalize maxillary dentition. Their principal
A-P effect is similar to that of Class 2
elastics or Class 2 corrector springs-they
advance/mesialize the mandibular dentition.
In this manner, in regard to patient selection,
if a patient is not an ideal candidate for
advancing the mandibular dentition because
of excessive lower anterior proclination or
other patient-specifi c factors, they are not
likely an ideal candidate for Class 2 bite
ramps. On the other hand, if they're deemed a
good candidate for Class 2 elastics or Class 2
corrector springs, they are most likely also a
good case to start with Class 2 ramps. And
to go further: When Class 2 ramps are used
properly in these types of cases, I fi nd the
occlusal correction occurs much faster and
with less reliance on patient cooperation.
For Class 2 patients who are ¼-½-step
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8 DECEMBER 2022 // orthotown.com
Class 2 and diagnostically are favorable for
AP orthodontic correction with Class 2
elastics or Class 2 corrector springs, I place
my bonded Class 2 ramps on the upper
fi rst bicuspids (U4s). I use blue Band-Lok
for the adhesive that is to be bonded and
shaped. The bite ramp needs to extend to
the distal far enough that the disto-occlusal
aspect of the ramp contacts the distal surface
of the lower fi rst bicuspids (L4s). This angle
and position of where the ramp contacts
is critical. In this position under normal
occlusal and masticatory functioning, the
ramp will facilitate (in addition to reciprocal
vertical forces) a distal force on the U4s and a
mesial force on the L4s. In this way, vertical
occlusal forces can partly be redirected in an
A-P direction to aid in Class 2 correction.
For me, Class 2 ramps are always used
in combination with light, short Class 2
elastics (2-ounce, 3/16-inch) worn from the
U4s to the L6s. These elastics are worn full
time immediately after braces are placed.
When bonding the ramps on the U4s,
the adhesive will often need to extend a
bit over the occlusal surface of the upper
second bicuspids (U5s), and attention
should be paid to not bond the U4s and U5s
together if adhesive touches the U5s. Also, as
treatment progresses, it's important to check
the contact position of the ramps at every
visit. As the Class 2 correction occurs, it is
necessary to progressively reduce the distal
aspect of the ramp so it does not contact
the mesial aspect of the L5s. If the mesial
aspect of the L5s touches the ramp, it will
effectively inhibit any further favorable A-P
forces facilitated by the ramp.
It's not uncommon to see space develop
distal to the L4s as the L4-4 segment
mesializes. This is a good sign that the ramp
is working and the space will eventually close,
with the mandibular posterior teeth being
pulled forward under indirect anchorage
of the ramps. Don't be concerned if this
spacing does not occur, however; often,
the mandibular posterior segments track
forward simultaneously as the L4-4 segment
mesializes so the space does not open,
particularly in patients who are doing a
good job with their Class 2 elastics.
Progress case example
The progress case on p. 10 demonstrates
a Class 2 ramp in action. It's not a
dramatic Class 2 correction; it is submitted
as a routine example of the early progress I
consistently observe using these ramps even
in noncompliant patients. This 13-year-old
patient presented with a ¼-step to ½-step
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Orthotown December 2022

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