Interincisal angulation and Torque
Question:
I have a case where the patient has a traumatic anterior occlusion, I am not sure how to determine if the final interincisal relationship is ideal? Also, do I ask for a final c-chain to tighten the spaces at the end?
Dr. Schalk’s Answer:
Traumatic anterior occlusion presents unique challenges in orthodontic treatment, particularly concerning inter-incisal angulation and the use of C-chains.
C-Chain Utilization
In orthodontic practice, it is advised not to request a C-chain in the initial batch of aligners, as it is considered a waste of resources. The C-chain is more beneficial later in the treatment process.
Deep Bite Correction
Deep bite correction is effectively addressed with horizontal attachments that secure the trays, facilitating the intrusion of teeth into an open bite. This over-treatment is necessary due to the severity of the condition.
Torque Adjustments
Torque is a critical factor that needs attention in both lower and upper incisors. The lower incisors often require lingual root torque due to their lingual positioning relative to the mandible. Similarly, palatal root torque is essential for the upper incisors, especially during intrusion, to ensure proper alignment.
Treatment Plan Modifications
Adjustments to the treatment plan may include reducing torque on canines, as they are not in a significant anterior-posterior position. Additionally, ensuring a step-down from premolars to canines to incisors can improve tray fit, avoiding the need for uniform occlusion across all teeth. This approach enhances the efficiency of treatment and tray fitting.
These modifications are crucial for achieving optimal results in managing traumatic anterior occlusion and ensuring effective orthodontic treatment outcomes.