# Troubleshooting Edge to Edge Bite # Question: I planned for sequential distalization for this patient and so I included Class 2 elastics as required for this movement. However, the patient is now on Tray #25 and is biting  edge to edge! I have stopped elastics for now. 1. Is this due to muscle splinting or growth during elastic use? 2. How can I still get the distalization movement wihtout the class 2 elastcis? 3. What should I do now moving forward with this case? Thank you! ![](https://outline-production-attachments.s3-accelerate.amazonaws.com/uploads/5e251020-0250-40df-b185-994531667ed4/1159ac69-f0b8-4d89-aaea-1e999afc8527/image.png?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA4EOUDTOVUICLPZ4P%2F20260920%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20260920T213000Z&X-Amz-Expires=86400&X-Amz-Signature=18b92a9bdc552fa05b9ee22c9357b0bdfc085cf92662e4d618149f67becb2d18&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject) ![](https://outline-production-attachments.s3-accelerate.amazonaws.com/uploads/5e251020-0250-40df-b185-994531667ed4/e13d28d3-43a4-4669-b442-11eafd5af4b2/image.png?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA4EOUDTOVUICLPZ4P%2F20260920%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20260920T213000Z&X-Amz-Expires=86400&X-Amz-Signature=9efeadf8c181c60ae4b19d028f59a41fc8a3fc972710a19b7df56123b0fe948a&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject) ![](https://outline-production-attachments.s3-accelerate.amazonaws.com/uploads/5e251020-0250-40df-b185-994531667ed4/42244b00-a957-4bfe-b778-89a095de25d1/image.png?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA4EOUDTOVUICLPZ4P%2F20260920%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20260920T213000Z&X-Amz-Expires=86400&X-Amz-Signature=75be637103210fa38590448f54d107a97b406f2c9cbccfa9aaaa8bcf62634dac&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject) ![](https://outline-production-attachments.s3-accelerate.amazonaws.com/uploads/5e251020-0250-40df-b185-994531667ed4/3523db2c-97ee-460c-94f4-d377ff19d0e5/image.png?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA4EOUDTOVUICLPZ4P%2F20260920%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20260920T213000Z&X-Amz-Expires=86400&X-Amz-Signature=d4b57d41ccd610964d2d44cb98c811be40e1c6bb1022f64ef63338c0df1071e9&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject) # Answer: [https://www.loom.com/share/5b0b02669a6843eca9d7f600e5876001?sid=0a40baed-4af4-4305-afb7-9f284a73be28](https://www.loom.com/share/5b0b02669a6843eca9d7f600e5876001?sid=0a40baed-4af4-4305-afb7-9f284a73be28) In this case presentation, Dr. Schalk discusses the treatment options for a growing patient, approximately 13 years old, presenting with a class II, division A malocclusion. The patient currently bites edge-to-edge on their anterior teeth, raising questions about whether this is due to muscle splinting, growth patterns, or elastic usage. Upon examination in the ClinCheck software, the patient appears to be close to class I on the left side in terms of molar alignment, although the canine alignment is not fully there. On the right side, the patient is in an edge-to-edge class II position. While the patient’s exact age is unclear, the absence of 12-year molars suggests they are still growing. Given this, the lecturer recommends against initiating sequential distalization, as growth modification could potentially correct the malocclusion through natural development. Assessing the patient’s cervical spine (C-spine) helps determine their remaining growth potential. The C-spine evaluation reveals that the shapes of CS2, CS3, and CS4 have not progressed to the notched, square, or rectangular stages, confirming that significant growth remains. Thus, the lecturer suggests modifying treatment to focus on growth management rather than mechanical distalization. A recommended approach involves pausing elastic use for about two to four weeks. This break would allow for a clearer assessment of whether the patient’s edge-to-edge bite is due to muscle splinting or an actual skeletal alignment. If the edge-to-edge alignment persists, it may indicate muscle splinting. At 25 weeks into treatment, it’s possible for the edge-to-edge biting to be muscularly related rather than structurally permanent, so a one-month pause could clarify this. Following this period, a mid-course correction may be necessary, particularly to address issues such as a rotated canine requiring extrusion. The patient exhibits mild anterior crowding on the right side. Addressing this crowding will involve derotating the lateral incisor, which could result in some proclination. The lecturer also notes the potential for a tongue thrust contributing to the anterior crowding and recommends evaluating tongue posture. If a tongue thrust is present and left unaddressed, it could impede successful treatment. In one month, based on the assessment of the patient’s bite and positioning, either refinement aligners or growth modification techniques may be initiated. If the patient’s bite reverts to class II, focusing on growth modification to encourage a natural bite jump could be effective. Sequential distalization should generally be reserved for cases requiring a midline adjustment, often due to premature tooth loss or significant midline discrepancies, which are less common in patients at this developmental stage. In summary, this case emphasizes the importance of growth potential in treatment planning for young patients. Using growth modification rather than sequential distalization may better align the patient’s teeth with minimal intervention, assuming there are no significant midline issues.