Why can’t everyone’s ideal occlusion be the same.
Because everyone has a different skeletal structure.
I saw a patient last month for a retainer recall. He came with his father for his appointment.
I checked the lingual bonded wires; I checked his upper and lower night time retainers; I checked his Masseter muscles for tonicity; I checked his jaw joints for clicking. There were no problems. I congratulated them for everything being OK and said “See you next year”.
Then the dad said “My wife wants to know why my son’s teeth are sticking forward!”
(Of course, it’s always the parent who is not there who needs to know.)
This was an opportunity for me to explain about dental compensation for skeletal disharmony.
This patient has a prognathic mandible and a concave midface. In an extreme situation the teeth would be in an anterior crossbite and would have required Orthognathic surgical assistance to get a Class I occlusion. However, this was not an extreme situation and I felt that if I tipped the upper incisors forward and the lower incisors back, I could achieve an acceptable and stable occlusion without jaw surgery.
You can see in the photos that there is dental compensation to accommodate the large mandible and small maxilla. It is not an ideal Class I occlusion. It has a tendency to Class III and there is also a tendency to posterior crossbite as well.
I feel that this was a good choice in this case. Many of my other cases do require Orthognathic surgery when the skeletal disharmony is too large.
PS: I have moved my office to join a group practice at Sheppard Yorkland Dental across the road from Fairview Mall. The phone number is the same so please continue to call me!
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