A Voice in the Arena: The Early and Easy Fix for Cants by Dr. Chad Foster

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A Voice in the Arena: The Early and Easy Fix for Cants 

Yes, you can!

by Chad Foster, DDS, MS, editorial director

My column this month is a follow-up on an article I wrote in the September 2024 issue titled “Early Cant Protocol: Asymmetric Bite Turbos and Elastics.” In that article I introduced a novel approach to correcting mild anterior occlusal cants within the first six months of a patient’s treatment. Since that issue came out, I have been messaged by a number of orthodontists who have told me that it has been a game changer in regard to how they efficiently manage these tough cases. My goal in this column is to rehash this protocol and offer a few pearls for its best use now that experience has sharpened my application of it.

The earliest stages of orthodontic treatment represent a uniquely responsive period of cellular activation. We have the opportunity in these first few months to take advantage of this biologic window with thoughtful mechanics to achieve significant tooth movement efficiently. Bite turbos are not simply passive disclusion tools! By concentrating the patient’s entire masticatory load onto only a few teeth, bite turbos create meaningful intrusive forces that can be redirected to the clinician’s mechanical advantage when carefully shaped and strategically positioned.

Early light elastics in the initial light nickel titanium wires during these first few months of orthodontic treatment also take advantage of that period of high cellular activity. Early elastics can create controlled extrusion while the turbos simultaneously generate intrusive forces. Together, these mechanics can intentionally alter the occlusal plane during the leveling phase of treatment. With proper case selection, this combination of asymmetric intrusive and extrusive forces can dramatically simplify correction of mild-to-moderate anterior cants within the first few months of treatment.
Pretreatment smile and intraoral photos showing anterior occlusal cant
Fig. 1

Figures 1–4 are from that original article and show this simple asymmetric bite turbo and elastic pairing. Figure 2 shows the day braces were placed. Figures 3 and 4 show progress from start to 3.5 months. Figures 5–7 are his full pretreatment records, post-treatment records, and smile comparison before and after. Note that the dark color of the UL1 is evident both pretreatment and post-treatment. We received clearance from an endodontist prior to initiating orthodontic treatment.

On the patient’s right side, the bite turbo placed on the UR3 has an intrusive force on this tooth, and the two elastics worn to the LR3 act to extrude it and add (via now stronger occlusal force) to the intrusive force on the UR3. On the left side, the bite turbo is on the LL6, and thus the UL3 is free of occlusal forces. Additionally, the two elastics worn to the UL3 act to extrude it. The elastics also further act to asymmetrically tip the posterior aspect of the occlusal planes, which is most often needed in canted occlusions.
Day braces were placed, occlusal and intraoral views
Fig. 2
Progress photos at start of treatment with braces
Fig. 3
Progress from start to 3.5 months showing asymmetric bite turbo and elastic mechanics
Fig. 4

The Class II and Class III elastics are worn full time, while the midline elastic is often worn just at night. (That one is a bit more annoying to wear full time for most patients.) The Class III elastics and the midline elastic are 5/16-inch, 2.5–3.5-ounce elastics, and for the Class II, I use a 3/16-inch, 2.5–3.5-ounce elastic. Once leveled and in rigid stainless steel wires, the elastics and turbos can be removed or modified, and if there were any mild AP or midline collateral effects, these can relapse or be addressed with lesser effect on the improved cant/occlusal plane.
Full pretreatment records
Fig. 5
Full post-treatment records
Fig. 6
Smile comparison before and after treatment
Fig. 7

There are a few additional pearls that I would like to add to this technique:
  • At the second or third visit, I will actually remove the bite turbo from the lower molar. This allows more of the occlusal force to be concentrated on the intrusive canine turbo. I have found that after the first visit, patients are very well able to tolerate this now unilateral bite turbo.
  • At each visit thereafter, I will actually very slightly add to that canine bite turbo if the patient is starting to feel like they are biting more strongly on the settling posterior teeth. After adding just a bit of composite, I want the patient to tell me that they feel like they are now hitting just a bit harder on that canine than anywhere else. This essentially “reactivates” the bite turbo and its intrusive effect at each of these early visits.
  • Later in treatment, when that canine bite turbo is removed, I will often reposition or step up the brackets in the lower arch just beneath the now intruded canine to close the very mild open bite there, if necessary.
Remember that case selection is important. This technique is not at all proposed as a fix-all for all cants. For more severe cants, TADs are of course my go-to. But for the more common mild-to-moderate cants, I have found this technique to be consistently effective. I hope that you will give it a try for the next mild cant that walks into your exam room. You will not regret it!
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