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Case Presentation: Fixing an Occlusal Cant by Wm. Randol Womack, DDS, Board Certified Orthodontist, Editorial Director, Orthotown Magazine

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by Wm. Randol Womack, DDS, Board Certified Orthodontist, Editorial Director, Orthotown Magazine

Patient presented in my office on December 1, 2009 with her mother for an orthodontic consultation. She had been in orthodontic treatment for almost two years and was being scheduled by her orthodontist to have her braces removed. We did preliminary records including a pano and photos after which I examined her and found that her occlusion was Class I with ideal overbite/overjet. When I inquired about why they were seeking another opinion they pointed out that her “smile was crooked.” To be specific, she exhibited an occlusal cant that was quite noticeable when she smiled. They related that they had asked the orthodontist if something could be done about “fixing” the crooked smile and he replied that a surgical correction was an option if they wanted to consider it. I also noted that there appeared to be some minor shortening of the upper anterior roots (Figs. 1 & 2).

The patient and her mom were not positive about a surgical option and they asked me for any other options. I suggested that a single TAD in the upper right maxilla, to intrude the buccal segment with vertical elastics to maintain the occlusion of the lower teeth, has shown to be a successful treatment for the occlusal cant and the avoidance of a surgical procedure.

On December 9, we had a consultation to show them records of a typical case that was treated with a single TAD. They then agreed to pursue this option.

The plan was to intrude the right buccal segment (Figs. 3 & 4) and use vertical elastics to enable the lower occlusion to follow the intrusion (Fig. 5).

An upper 17x25 SS archwire with excessive lingual crown torque was used to counter any buccal expansion during the intrusion.

On April 13, 2010, a 6mm Ormco Vector TAD was placed between the upper right first and second bicuspid, which was immediately loaded with a power chain wrapped under the archwire and reattached to the TAD (Figs. 6 & 7).

Progress photos were taken October 9, 2010 showing an improvement in the occlusal cant (Fig. 8).

On January 11, 2011 the treatment was terminated, the TAD and the braces were removed and clear Essix retainers were made for the upper and lower teeth. Final photos and pano were taken (Figs. 9 & 10).

April 8, 2011 a 3D scan was taken to review the treatment and evaluate the dentition, particularly the upper incisor roots. The scan showed minor root resorption but no more than the first pano (Figs. 11 & 12). A frontal volume CBCT shows good parallelism between the occlusal plane and the infra-orbital plane (Fig. 13).

However, it was interesting that an airway evaluation indicated a very low volume measurement and noticeable constriction of the laryngeal airway. We suggested that she be evaluated for a sleep study (Fig. 14).

Six-month post treatment photos were taken July 7, 2011 showing continued stability of the corrected occlusal cant. The patient and mother are very pleased with the results.

The following photos show the progression of the correction into the post-treatment appointment.

This case demonstrated the versatility of TADs to avoid what was commonly achieved by a two-jaw surgical procedure.
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September 2025
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