Orthodontic Tips June 16, 2014
Is it a concern?
Yes it is and this is why. “Poor occlusion.”
This patient came to see me last week. She was hoping to have her teeth straightened without any extractions. Her maxillary dental arch is over-wide and her lower arch is severely crowded. The extra width causes a lack of cuspid guidance on the left side. Also, the left upper first bicuspid is almost in buccal crossbite. So that tooth won’t have a solid centric stop.
This patient also demonstrates tight Masseter muscles from a bruxing habit. Notice that her dentist in the Philippines tried to the correct crowding on the maxillary left cuspid by grinding it down and crowning it with a smaller crown.
When I accept responsibility to correct this patient’s malocclusion, I also accept responsibility to create an acceptable occlusal scheme with cuspid guidance on both sides and centric occlusal stops on all of the teeth. If the upper arch and lower arch are not coordinated in width, those occlusal goals are not possible.
My treatment for this case will be to extract the 15 to match the missing 25, as well as the lower second bicuspids which happen to be blocked out lingually because of excessive mandibular crowding. Then I will open space mesial and distal to the crown of the 23 so that her dentist can place a proper size crown to match the 13. Following that I will close the rest of the space and coordinate the upper and lower dental arches to create occlusal stops on all of the teeth and gentle cuspid and protrusive guidance in the excursions.
Check your patients for arch width coordination in order to maximize their occlusal gnathology.