# Correcting a Fake posterior openbite!

# Question:

I'd love some advise on how to settle this POB. This is a 2nd refinement. Patient is a 76 year old female . Will just allowing extrusion in the trays be enough to allow posteriors to come back to occlusion?  I think I also have anterior interference that is contributing to POB. I have tried to get some lingual root torque on the upper and lower incisors before but I don't think it really expressed so I wonder if trying again will work. I just watched Dr. Schalk's CSI - is this a situation where I should be asking for intrusion as well to go with the lingual root torque of the upper incisors? Would asking for some nearly passive aligners to act as temporary retainers make sense to allow the bite to settle? Thank you!  <https://shub.invisalign.com/cc-cloud/latest/index.html?locale=en_US&user=user&ccModIntegrity=false&configUrl=%2Fconfig%2Fscsl_cc_cloud&ccId=463274>


# Answer:

[https://www.loom.com/share/80304f59bb934d16923538466cec1292?sid=1f8a09aa-8b00-426c-a976-7a41be79c502](https://www.loom.com/share/80304f59bb934d16923538466cec1292?sid=1f8a09aa-8b00-426c-a976-7a41be79c502)


This treatment plan aims to address a posterior open bite and correct occlusal contacts that are heavy on the palatal cusps and lingual surfaces of the upper incisors. An analysis of the occlusion shows areas of concern, such as palatal root torque and buccal overjet on the upper maxillary teeth, which are further out than the lower teeth.

### Torque and Occlusal Adjustments

For effective palatal root torque, minor intrusion is recommended to aid the expression of torque, particularly on the anterior teeth. It is challenging to achieve proper root movement without attachments on the anterior teeth, as pushing roots back into the bone can be uncomfortable. In this plan, more torque than previously applied is suggested, especially on the centrals, with the removal of torquing ridges to enhance patient comfort. Adding a 3mm attachment with a bevel directed towards the gingival area is recommended to support root movement.

### Posterior Teeth and Arch Positioning

In earlier setups, there was a lack of root movement in the posterior teeth, leading to an uncoordinated arch. This is characterized by a buccal overjet where the upper buccal cusp does not align with the lower fossa, instead hitting the lower buccal cusp directly. Unintended buccal crown movement has caused the posterior open bite by pushing the crown outward and leading to contact on the palatal cusps. Addressing this requires torquing correction on the anterior teeth and reducing the power ridges.

### Arch Constriction for Improved Occlusion

To mitigate heavy contacts on the palatal cusps, arch constriction can be applied, targeting both upper and lower posterior teeth. This approach will encourage the palatal cusp to intrude and the buccal cusp to extrude slightly, redistributing occlusal contacts. Specifically, minor adjustments to the arch form on the upper molars and premolars will help achieve a more inter-cuspidated bite, reducing heavy green contacts seen initially. If needed, attachments can be added to the posterior teeth to secure tray fit and maintain alignment.

### Detailed Finishing and Equilibration Options

For cases needing significant arch expansion, equilibrations may be required instead of constriction. In such cases, the palatal surfaces can be adjusted with a burr to eliminate heavy contacts, encouraging passive occlusion and bite closure. Monitoring the contacts through the final stages ensures that there are no green or red contacts at the end of the series, achieving balanced occlusion across all teeth.