When and how obtain the mandibular shifting

Orthodontists think that solving the deep bite and expanding the maxilla, mandible comes forward. There are some orthodontic philosophies that have based their approach on the occlusal release.
The experience leads us to say that is not always so.

In fact, the literature suggests that the Mandibular Anterior Shift (see other post in the blog) is often just a pipe dream.
However there are some recognizable conditions (anatomical features, signs and symptoms) that can make us schedule a treatment of class 2 malocclusion hoping in a spontaneous mandibular repositioning. We try to list them:

image

Cephalometric features: Class Two and ipodivergence. Relevant horizontal length of the mandibole (Go/Me = SN). Vertical inclination of upper and lower incisors.
Occlusal features: deep bite (even on canines). Class 2 molar incomplete (< mm). Upper first molars rotated on the mesial side. Shrinking upper teeth. Inadequacy of transverse diameters when incisors are edge to edge. Negative torque of premolars and upper molars (Curve of Wilson flat).
Signs: Fremitus incisors (finger on upper incisors to sense the pressure of the lower incisors during tapping). Occlusal contacts reported with articulating paper on incisors and canines.
Symptoms: bilateral or unilateral joint clickingt that disappears in advancement. Occlusal contacts on the frontal teeth after occlusal device application.

Despite the pyramid of EBM (see picture) says that the opinion of colleagues is not relevant, those listed are in my opinion the situations that can make getting the correction of malocclusion through spontaneous repositioning. Both in growing patients than in adults.

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Move up your hand if you disapprove!

Gianluigi Fiorillo

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