Ideal Occlusion is Not Always the Ideal Treatment Plan William Dayan
Class 2 retrognathic mandible
· Patient declines orthognathic surgery
· Accepting occlusal compromise, however achieving alignment
Class 3 lower incisor extraction case
· Canine guidance not achieved, midlines not correct, molar relationship not ideal
· However alternatives are extraction of lower premolars or surgery,
· Camouflage of the class 3, efficient and effective with lower incisor extraction
Midline shift mandible LHS
· Can use asymmetric elastics, however can result in cant in maxilla
· William’s approach
o Asymmetric curve of Wilson
o Differential toque in power posterior teeth, greater on affected side
o Tip crowns lingually on effected side – not require cross elastics
· Accept lower centreline discrepancy
o Balancing risk of centreline correction Vs negative effects of cross elastics
Severe AOB case, with posterior crossbite
· Level, align, fall together
o Posterior intrusion
o Accept crossbite as alveolar processes distant
· No use of elastics
· Canine crossbite correction – for functional occlusion, accept posterior crossbite
Black triangles
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Reasonable under the circumstances
· Can be biological and appropriate
