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Question

I was wondering what you would do to fix the posterior open bite at refinement- i asked for BRT and lingual crown tilt to get the buccal cusps into occlusion but i wasnt sure if I should ask for a specific deg?

Also the anteriors at the end, esp the centrals end up w an incisal gap, worse than at beginning of the refinement. I already did a 0.5 IPR there so not sure i want to add more. What would you do to improve that?

Answer

This case involves a posterior open bite at the end of treatment. The question is whether buccal root torque and lingual crown tilt should be used to get the buccal cusps into occlusion.

Initially, there’s heavy palatal cusp contact, and the roots are palatally positioned. The arch seems too narrow, which limits the ability to move the roots outward. Therefore, applying excessive buccal root torque may not improve the situation.

A more effective solution could be to constrict the arch. Constriction pushes the teeth inward from the buccal towards the lingual, which helps the buccal cusps drop into occlusion while slightly intruding the palatal cusps. This approach works best when the roots are hitting the cortical plate, limiting outward movement.

We could attempt to add some buccal root torque in combination with the constriction, but the key factor is managing the occlusion by ensuring there’s no heavy palatal contact.

Now, regarding the incisors: if there is a gap worse than at the beginning of treatment despite 0.5mm of IPR, the issue might be due to improper contact on the cervical third. If more IPR is needed in the cervical area, it can be done using a parallel burr. Alternatively, for true gaps, “fake” IPR can be used in the ClinCheck to tighten contacts without actually performing IPR.