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A Voice in the Arena: Early Cant Protocol: Asymmetric Bite Turbos and Elastics by Dr. Chad Foster

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A Voice in the Arena: Early Cant Protocol: Asymmetric Bite Turbos and Elastics

by Chad Foster, DDS, MS, editorial director

The orthodontic “system” of cellular response is never activated as intensely as it is during the earliest stages of treatment. Thoughtful mechanical strategies that take advantage of this early activation can yield significant results in efficiency of desired tooth movements.

Use of early bite turbos will always have some effect on the teeth the turbos are applied to. Think about it: You take the patient’s entire masticatory muscle load, which was previously shared by the entire dentition, and now isolate that same total force to just two individual teeth. And we expect that to not have an effect on those teeth? As I have written about previously, I’ve found that shaping and strategically placing bite turbos can be an opportunity to quickly, inexpensively and creatively redirect the force of the bite to my mechanical advantage in many types of cases.

Another extremely effective technique is use of early elastics in nickel titanium wires to achieve occlusal goals. The great Dr. Tom Pitts has written and taught extensively on the application of early elastics. Additionally, I have found that early elastics often pair extremely well with appropriately shaped and positioned bite turbos in certain cases.

Both early elastics (via extrusion) and early occlusal forces on bite turbos (via intrusion) have the potential to alter the occlusal plane. In some cases, this can be an unintended consequence that creates major problems, but with proper case selection and conscientious planning, these applied forces can be a real game-changer.


Case illustration
Figs. 1–4 show a simple bite turbo and elastic pairing that I have found to work very well for mild anterior cants. Case selection is important, and this technique is not at all proposed as a fix-all for all cants. For more severe cants, TADs are the go-to. These photos show progress over 3½ months.
A Voice in the Arena: Early Cant Protocol: Asymmetric Bite Turbos and Elastics
Fig. 1
A Voice in the Arena: Early Cant Protocol: Asymmetric Bite Turbos and Elastics
Fig. 2
A Voice in the Arena: Early Cant Protocol: Asymmetric Bite Turbos and Elastics
Fig.3
A Voice in the Arena: Early Cant Protocol: Asymmetric Bite Turbos and Elastics
Fig.4


On the right side, the turbo has an intrusive force on the UR3 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 UL3 is free of occlusal forces and the two elastics worn to that tooth act to extrude it. The elastics also further act to asymmetrically tip the posterior occlusal planes, which is most often needed in canted occlusions.

The Class 2 and Class 3 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 3 elastics and the midline elastic are 5⁄16-inch, 2.5–3.5-ounce elastics, and for the Class 2, 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.

Give this bite turbo and early elastic pairing a try in your next mild anterior occlusal cant case!
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