Occlusal Cant Research Articles

Nonsurgical correction of occlusal canting using temporary anchorage devices: A systematic review

ObjectiveThe recent development of temporary anchorage devices (TADs) allows orthodontic canting correction by selective intrusion of the molars. The purpose of this study was to review the treatment strategy and outcomes after orthodontic correction of occlusal canting using the TADs based on published literature including the case reports. Materials and methodsA systematic review of published English-language human clinical studies was conducted by electronic search of PubMed, Embase & Medline, and Scopus reviews up to Dec 2023. For inclusion, reports required documentation of subject demographic characteristics; location or type of TADs; diagnosis; presence of maxillary occlusal canting (MOC); and treatment outcomes (MOC correction). Studies were excluded if they involved orthognathic surgery to correct MOC. Critical appraisal for all included studies were conducted with the case reports/case series appraisal checklist of the Joanna Briggs Institute (JBI). The current study was registered in PROSPERO (CRD42021226432). ResultsThe search identified 260 reports and a total of 33 case reports met inclusion criteria with 46 individual patient cases. The results reported that occlusal canting could be resolved by unilateral intrusion of maxillary posterior teeth using TADs. The reported the amount of maxillary molar intrusion ranged from 1 mm to 4.8 mm. However, there were fundamental limitations in study subjects, paucity of data regarding the long-term stability, lack of standardization in intrusion mechanics, and variations in TAD devices. ConclusionsAlthough the previous reports mentioned that orthodontic canting correction with TADs could avoid maxillary surgery or orthognathic surgery itself, it cannot be concluded that non-surgical correction of occlusal canting can be comparable to surgical treatment. Further comparative investigation between surgical and nonsurgical canting correction is needed to clarify whether orthodontic intrusion can be an alternative to surgical canting correction in terms of efficacy and stability.

Two-step cluster analysis based on three-dimensional CT measurements of craniofacial structures in severe craniofacial microsomia

BackgroundThe Pruzansky-Kaban and OMENS classifications do not provide additional details on temporomandibular joint deformities. The aim of this study was to classify and quantitatively delineate severe forms of craniofacial microsomia based on three-dimensional maxillofacial measurements, focusing on deformities in the zygomatic, temporal, and mandibular bones. MethodsMaxillofacial computed tomography(CT) scans of children with severe types of CFM from 2010 to 2020 were collected. Three-dimensional measurements of zygomatic arch length, height of mandibular ramus, height of maxilla, and occlusal cant were performed. Two-step cluster analysis was conducted based on zygomatic arch continuity, occlusal cant, the ratio of affected side to unaffected side(A/U ratio) for zygomatic arch length, mandibular ramus height, and maxillary height. ResultsFifty patients (32 male, 18 female) were included in the study. They were classified into 2 clusters through cluster analysis. Cluster 1 comprised subjects (44% of patients) with continuous zygomatic arches. Cluster 2 comprised subjects (39%) with discontinuous zygomatic arches. The zygomatic arch A/U ratio in Cluster 1 was greater than that in Cluster 2, with statistical significance observed. Additionally, the maxilla height A/U ratio in Cluster 1 was lower than in Cluster 2, also with statistical significance. There was no statistically significant difference observed in the ramus height A/U ratio and occlusal cant between Cluster 1 and Cluster 2. ConclusionsBased on craniofacial measurements, severe CFM can be categorized into two types: continuous zygomatic arch and discontinuous zygomatic arch. This cluster analysis complemented the OMENS classification and could assist in the selection and design of prosthetic joints for patients with CFM.

Diagnosing Maxillary Occlusal Cant with average 3D Skeletofacial Model Template.

Diagnosing maxillary occlusal cant involves varied methods, yet classification remains incomplete. This includes determining if the cant results from equal faults on both sides or if one side exhibits overdevelopment while the other underdevelops. This study introduces an innovative average 3D skull template for classifying maxillary occlusal cant instances. Sixty adult patients were divided into two groups: 30 with a mesoprosopic facial type and 30 with a leptoprosopic facial type. Using seven pairs of anatomical landmarks (N, Or (L, R), Lo (L, R), Zy (L, R)), the average skull models were aligned and superimposed onto the patients' skull models. Image resizing facilitated optimal registration area fitting. Vertical distances from the U6 mesial buccal cusp tip to the FH plane were measured to analyze occlusal cant, classified into three classes: overdevelopment (Class A), underdevelopment (Class B) and equal fault on both sides (Class C). In the mesoprosopic group, Class B t was most common (40%), followed by Class A (27%) and Class C (33%). In the leptoprosopic facial type group, Class B remained prevalent (50%), followed by Class A (43%) and Class C (7%). Statistical analysis revealed a significant association between facial types and the three classes. Contrary to expectations, equal fault patterns were not predominant; instead, underdevelopment of the maxilla constituted the majority of occlusal cant cases. Utilizing average 3D skeletofacial models as templates emerges as an effective tool and alternative for diagnosing the instance of maxillary occlusal cant. Therapeutic, II.

Comprehensive treatment approach for hemifacial microsomia: Integrating orthognathic surgery with sequential customized implantation

ObjectiveThis study aims to evaluate the clinical outcomes of combining orthognathic surgery with staged patient-specific implants (PSIs) for comprehensive craniofacial asymmetry reconstruction in adult hemifacial microsomia (HFM) patients. MethodsSix adult HFM patients (1 Type I and 5 Type IIa) underwent orthognathic surgery to correct skeletal malocclusion and chin deviation. Sequential PSIs were implanted to address craniofacial asymmetry. Digital lateral cephalograms and cranial CT scans were obtained at four time points: pre-orthognathic surgery (T0), within three months after orthognathic surgery (T1), one year after orthognathic surgery and just before personalized implantation (T2), and after personalized implantation (T3). Evaluation parameters included skeletal and dentoalveolar measures, occlusal cant, chin deviation, skeletal stability, and facial contour symmetry. ResultsAt T1, no significant differences were observed in skeletal movements compared to planned surgical movements (p > 0.05). Similarly, at T2, skeletal movements did not significantly differ from those observed at T1 (p > 0.05), indicating surgical precision and stability. Analysis of skeletal and dentoalveolar parameters, occlusal cant, and chin deviation revealed significant increases in SNB, FH-NPo, and ST N vert-Pog at T1 compared to T0 (p < 0.05), along with notable improvements in chin deviation and occlusal cant (p < 0.05). Comparison of T2 to T1 showed no significant changes in SNB, FH-NPo, ST N vert-Pog, chin deviation, or occlusal cant (p > 0.05), indicating substantial postoperative stability. Following personalized implantation (T3), further significant improvements were observed in skeletal symmetry. ConclusionCombining orthognathic surgery with staged PSIs effectively reconstructs craniofacial asymmetry in adult HFM patients, achieving significant improvements in skeletal alignment, occlusal cant, and chin deviation, with stable outcomes over time.

Facial asymmetry outcome of orthognathic surgery in mild craniofacial microsomia compared to non-syndromic class II asymmetry

ObjectivesTo compare the facial asymmetry after bimaxillary surgery between mild craniofacial microsomia (CFM) and non-syndromic class II asymmetry.Materials and methodsCone-beam computed tomography scans of adults with Pruzansky-Kaban types I and IIA CFM (CFM groups, n = 20), non-syndromic skeletal class II asymmetry (Class II group, n = 20), and normal controls (control group, n = 20) were compared. The area asymmetry of lower face and jaw bones was quantified. Landmark-based method was used to evaluate the lower facial asymmetry regarding midline, cants, and contour.ResultsThere were no significant postoperative differences in the hemi-facial and hemi-jaw area asymmetry between CFM and Class II groups, both of which were significantly larger than the control group. No significant difference was found in the midline deviation and lip and occlusal cants between CFM and Class II groups. The vertical contour asymmetry in CFM group became significantly larger than Class II group. Compared to the control group, the deviation of pronasale, subnasale, and soft-tissue menton, lip and occlusal cants, and sagittal and vertical contour asymmetry in CFM group were significantly larger, as were the deviation of subnasale and soft-tissue menton and vertical contour asymmetry in Class II group.ConclusionsThe vertical contour asymmetry of mild CFM was significantly larger than non-CFM class II after surgery, while the area asymmetry, midline deviation, cants, and sagittal contour asymmetry of lower face showed no significant difference.Clinical relevanceBe aware that correcting vertical asymmetry of contour, lip, and dentition in CFM is still challenging.

Occlusal Cant-A Narrative Review

Occlusal cant, indeed, plays a significant role in smile aesthetics. It refers to the asymmetry or tilt of the occlusal plane, which can affect the balance and harmony of the smile. The dynamic display zone, which includes lateral, vertical, and anteroposterior characteristics, as well as the cant of the occlusal plane, are important factors to take into account when creating a smile or designing mechanotherapy (treatment utilizing mechanical devices). Ensuring an aesthetic plane of occlusion involves aligning the teeth and jaws in a way that enhances the overall appearance of the smile. This may involve orthodontic treatment, dental restorations, or other interventions aimed at achieving symmetry and balance in the occlusal plane. By addressing occlusal cant as part of smile design and mechanotherapy, orthodontists can help patients achieve optimal smile aesthetics and function This review article decribes diagnosis ,etiology, methods of detecting occlusal cant and treatment alternatives.

The Evaluation of Condylar Position Change in the Asymmetric Mandible Following Sagittal Split Osteotomy.

The change of condyle position following orthognathic surgery affects the stability of treatments. This study aims to assess the correlation between the amount of condyles' position change and the severity of mandibular asymmetry following BSSO. This is a cross-sectional study. Subjects with asymmetric mandibular prognathism following BSSO were studied. Subjects were classified into 2 groups: group 1, subjects had mandibular asymmetry without occlusal cant and underwent BSSO. Group 2, subjects had mandibular asymmetry with occlusal cant and underwent BSSO+ Lefort I osteotomy. The condyle position was evaluated using cone-beam computer tomography (CBCT). Pearson's correlation test was used to assess any correlation between the condyle changes and the change in the mandible in sagittal and anterior-posterior directions. A total of 44 subjects were studied. In group 1, the condyle tilted outward in the deviated condyle and inward in the non-deviated condyle immediately after osteotomy. After 12 months, both condyles showed a rotation relative to the original position. In group 2, the condyles of the deviated sides and non-deviated sides moved inferiorly after surgery (condylar sagging), which was more significant in the non-deviated sides. The condyle rotation was similar to group 1. The severity of asymmetry and occlusal cant correlate with the condylar position change in the two groups. The severity of mandibular asymmetry correlates with the amount of condyles' position change immediately after BSSO. However, the condyles tend to return to their original position 12 months later.

3D-CT measurements of facial symmetry in severe CFM patients: A comparative study between mandibular ascending ramus distraction osteogenesis and bone grafting

This study aims to compare the effects of mandibular distraction osteogenesis (MDO) and bone grafting on the facial symmetry of children with Pruzansky-Kaban type IIB and III craniofacial microsomia (CFM).Medical records and three-dimensional computed tomography (3D-CT) data of CFM patients who had primarily undergone MDO and bone grafting were collected. A retrospective analysis of pre-and post-operative 3D imaging data was conducted to compare the improvement rate in facial symmetry between the two groups based on occlusal cant, affected/unaffected ramus height ratio and chin point deviation. The data were tested for normality using the Shapiro-Wilk test. When the data followed a normal distribution, a paired sample t-test was employed for the comparison between preoperative and postoperative data. When the data did not follow a normal distribution, the Wilcoxon signed-rank test for paired samples was used for preoperative and postoperative comparison.The study included 18 children with type IIB and III CFM, 11 in the MDO group and 7 in the bone grafting group. In the MDO group, postoperative Gn-FH and Gn-Cor distances increased significantly, whereas the postoperative Gn-Mid distance decreased significantly. Occlusal cant decreased significantly and ramus height affected/unaffected ratio increased significantly after MDO. In the bone graft group, there was no statistically significant difference in the postoperative ratios of chin deviation, occlusal cant, and ramus height affected/unaffected compared to the preoperative values.Compared to bone grafting, MDO can significantly enhance ramus height ratio, level occlusal plane, and centralize the chin point among patients with CFM. Furthermore, MDO achieves superior enhancements in facial symmetry.

Idiopathic External Cervical Resorption of the Impacted Second Premolar: A Case Report

The tooth impaction of the lower second premolars is an occasional condition but is still seen in clinical practice with a prevalence of 0.6–2.6%. The present case report describes a rare condition of the lower second premolar impaction. An 11-year-old female patient presented with the anteroposterior dental discrepancy, midline shift, and occlusal cant. Intraoral examination revealed the absence of the lower right second premolar with no space available for the eruption. X-ray examination revealed the impaction of tooth #45 in a vertical position, tilting of the adjacent teeth, and two-thirds root length development. The orthodontic treatment plan included space opening using a fixed appliance with a coil spring. The natural eruption of the tooth was expected according to dental age and root development. When the space was opened, no change in the position of tooth #45 was observed. Surgical exposure and active traction were performed. However, the intrusion and tilting of adjacent teeth were observed during the next appointments with no vertical change of tooth #45. Ankylosis was suspected as no tooth movement was recorded. The surgical luxation and osteotomy of the coronal alveolar bone of the impacted tooth were planned for the imminent forced eruption, which was expected due to the young age of the patient. Consequently, the crown of tooth #45 emerged and the bracket was placed. Further traction was planned to use a micro-screw. Following the traction, no vertical displacement of the tooth was observed in the subsequent appointments. Radiographic examination revealed radiolucency in the coronal third of the root. The patient was referred to the endodontist, and CBCT revealed external cervical root resorption in the late reparative stage. ECR in an impacted tooth, mimicking the manifestation of tooth ankylosis, can cause orthodontic treatment failure.

Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach.

Facial asymmetry includes several etiologies, among them trauma to the condylar area during early childhood and congenital malformations such as hemifacial microsomia. This article describes the management of facial asymmetry in adolescents and young adults using a mandible first approach by distraction osteogenesis, followed by maxillary Le-Fort I as a second stage. Eighteen patients 14-25 years of age presented with unilateral hypoplasia of the jaws which manifested clinically by deviation of the chin and canting of the occlusal plane. Etiology included hemifacial microsomia and trauma injuries at early childhood.All patients underwent orthodontic treatment and two phases of surgical treatment. Surgical treatment included unilateral mandibular distraction followed by Le-Fort I osteotomy for alignment of the maxilla. Additional bone graft in the affected side and sliding genioplasty were done as required. Marked ramal elongation of 18.94 mm concomitant with mandibular forward traction of 12.5 mm was noted while achieving symmetry. In all cases, the maxilla was centered to the midline in proper occlusion. Post distraction, posteroanterior cephalometric radiographs demonstrated elongation of the affected ramus, improvement in facial symmetry, and correction of the occlusal canting. Relapse was minimal based on long-term follow-ups of 47.4 months. The two-stage surgical approach that includes elongation of the mandible as a first stage followed by adaptation of the maxilla is useful in correcting facial asymmetry. Using this protocol at the correct age (14-18) is very stable, as demonstrated by our results, yet one should always remember the transverse deficiency in the gonial angle requires additional bone grafting or patient specific implants.

Comparison of pleasant and unpleasant smile characteristics in the perception of the laypeople in an Iranian population

This study aimed to compare the characteristics of pleasant and unpleasant smiles from the perception of laypeople. Two-hundred posed smile photographs were obtained from adult participants with no anomaly, restoration, or severe crowding and spacing in anterior teeth. Photographs were shown to 26 judges to give each photograph a score for attractiveness. Upper and lower quartiles for the most and least rated smiles were determined, and variables including gingival display, smile arc, midline deviation, buccal corridor, smile width, tooth rotation or malposition, diastema, upper and lower vermilion show, and tooth form were measured. Independent-sample t test and Pearson chi-square analysis were used to determine the differences between the pleasant and unpleasant groups for quantitative and qualitative variables, respectively. The linear regression model revealed variables with the most significant impact on the mean score. All quantitative and qualitative variables except tooth form significantly differed between pleasant and unpleasant smile groups (P<0.05). The consonant smile arc was associated with an increase of 12.59% in mean scores compared with the inconsonant smile arc. Each tooth reported with malposition was correlated with a decrease of 9.37% in the scores. In the same way, each 1-mm increase in midline diastema and occlusal cant coincided with a drop of 8.73% and 3.59% in scores, respectively. The results of this study suggested that smile arc, tooth malposition, midline diastema, and occlusal plane canting had the most impact on smile esthetics and should be given priority by orthodontists in the treatment plan of choice.

Preoperative Anatomical Variables Affecting the Outcome of Surgical Correction in Class III Face Asymmetry

Objective: The study investigated the preoperative anatomical variables that affect the outcome of surgical correction in patients with Class III facial asymmetry. Methods: The study recruited 37 consecutive patients with facial asymmetry who had 2-jaw orthognathic surgery. They were divided into two groups based on the surgical outcome: symmetrical (S group) or asymmetrical (A group), according to the asymmetry index. The CBCT images were obtained before surgery (T0) and after debond (T1). The 3D dentofacial measurements were compared between groups S and A by the Mann–Whitney test. Spearman correlation analysis was performed to examine the relationship of all dentoskeletal variables in T0 with the facial symmetry outcome. Results: Significant between-group differences were observed in preoperative time, including maxillary anterior occlusal canting, maxillary posterior occlusal canting, the gonion–Frankfort horizontal plane (FHP) distance, the mandibular ramus axis–FHP distances, and sagittal and transverse of condyle position. Conclusions: For patients with severe skeletal Class III asymmetry, preoperative anatomical variables, particularly preoperative “roll” and “yaw” discrepancies and anatomical limitations of the mandible, should be considered for favorable asymmetry correction. Based on the anatomic variables that affect the outcomes of facial asymmetry correction, prognosis and treatment limitation could be predicted before treatment.

Smile Preferences of Orthodontists and Patients from Frontal View about Gingival Display, Occlusal Cant and Smile ARC: A Study from Isra Dental College

Objective: Was to determine preferences of orthodontists and patients about gingival display, occlusal cant and smile arc. Material and methods: This descriptive cross sectional study was conducted on 65 participants (15 orthodontists and 50 patients). The inclusion criteria were participants who gave consent, Pakistani nationals, age from 20 to 45 years, and Layperson/patients. Exclusion criteria were mentally retarded, uncooperative, color blinded individual and dental students, dental attendants and technicians. Adobe photoshop CS6 was used to alter the smile arc, occlusal plane and gingival display incrementally. Student t test was run to compare the smile preferences between orthodontists and patients. P≤0.05 was considered significant. Results: The mean age of the participants was 33.15±6.29 years. Females (n=38, 58.5%) were more than males (n=27, 41.5%). For 0mm gingival show the score assigned by laypersons (6.86±0. 756) was statistically higher than orthodontists (6.40±0.507) (P=.031). Gingival show of 5mm was less acceptable to laypersons (1.92±0.752) than orthodontists (3.27±0.594) statistically (P&lt;0.001). Ideal smile arc was attractive for both laypersons (8.04±0.638) and orthodontists (9.33±0.724) but statistically more among orthodontists (P&lt;0.001). Significant difference was found between perception of orthodontists and laypersons for normal smile (P=.034) and canted smile (P&lt;0.001). Conclusion: Significant differences exist between opinions of orthodontists and laypersons in evaluating gingival display, smile arc and occlusal cant. Patient should be participated in treatment planning involving alteration of these smile parameters. Keywords: Smile perception, gingival show, smile arc, occlusal cant

Complex case treatment: Is there a limit for surgery-first approach?

Are there any limits for Surgery-first approach? the article strives to identify the tenets of effective management of complex cases, such as facial asymmetry, with surgery-first approach. The main purpose of the article is in attempting to itemize prerequisites or determining factors, through various degrees of facial asymmetry severity, for the successful management of facial asymmetry cases. The key factors such as (1) assessment of chin deviation, (2) quantification or discernment of transverse occlusal plane canting, (3) spatial orientation evaluation of differential anterior and posterior region transverse occlusal canting, and (4) contemplations of six degrees of freedom (6DoF) (translation movements combined with rotation axis - pitch, roll and yaw) are evaluated. Furthermore, dental alignment, severity of mandibular and maxillary occlusal (anterior and posterior) plane canting, critical cephalometric parameters, such as, incisor mandibular plane angle, and other vital sub- components of facial asymmetry are analysed, in detail. Subsequently, these are coherently synchronized with the maxillomandibular complex (MMC) rotation surgery during planning for the successful execution of facial asymmetry correction. Additionally, the article describes the (1) usage of orthodontic arch wires, (2) selection criteria of specific surgical osteotomies, and (3) coordination of maxillary and mandibular dentition to establish a transitional or treatable malocclusion. In conclusion, a thorough evaluation of the determining factors, as described in the article, for the correction of facial asymmetry with surgery-first, aid in categorising facial asymmetry cases that require minimal pre-surgical orthodontics or without pre-surgical orthodontic treatment, thereby defining the limits of surgery-first.

Does Orthodontic Treatment Change the Preferred Chewing Side of Patients with Malocclusion?

Whether orthodontic treatment can change the preferred chewing side (PCS) is unknown. This study examined (1) if the PCS changes after orthodontic treatment and (2) which factors contribute to this change. Two hundred fifty patients who visited the orthodontic clinic at Tokyo Medical and Dental University Hospital between 2017 and 2020 were included in the study. Mandibular kinesiograph (MKG) was taken at pre- and post-treatment, and PCS was determined. Patients who showed a change in PCS to the opposite side and those who showed no change in PCS at post-treatment were pooled into the PCS-changed and PCS-unchanged groups, respectively. The demographic, clinical, and cephalometric parameters were compared between the groups. Significant factors associated with changes in were of age &lt; 20 years at the beginning of orthodontic treatment (odds ratio (OR), 2.00), maximum lateral mandibular movement to PCS ≥ 10.0 mm at pre-treatment (OR, 6.51), and change in occlusal canting of ≥1.0° (OR, 2.72). The predicted probability of change in PCS was 13.2%, 36.0%, and 67.5% for no factor, one factor, and two factors associated with PCS change, respectively. Orthodontic treatment may change PCS due to patient age, maximum lateral mandibular movement to PCS, and change in occlusal canting.

Clinical Outcomes in Orthognathic Surgery for Craniofacial Microsomia Following Mandibular Distraction Using CBCT Analysis: A Retrospective Study.

The aim of this study was to evaluate the outcomes of orthognathic surgery (OGS) in patients with craniofacial microsomia (CFM) who had previously undergone mandibular distraction osteogenesis (MDO). A retrospective cohort study was performed including all patients with CFM who were treated with OGS at a single institution between 1996 and 2019. The clinical records, operative reports, and cone beam computed tomography (CBCT) scans were reviewed. CBCT data before OGS (T1), immediately after OGS (T2), and at long-term follow-up (T3) were analyzed using Dolphin three-dimensional software to measure the occlusal cant and chin point deviation. The study included 12 patients with CFM who underwent OGS (6 underwent OGS without MDO and 6 underwent OGS after MDO). There was a statistically significant improvement in occlusal cant and chin point deviation in both groups postoperatively. Occlusal cant relapsed by a mean of 0.6° (standard deviation [SD] 1.1°) in the patients who had OGS alone compared with 0.7° (SD 1.2°) in the patients who had OGS after MDO (P = .745) between T2 and T3. There was no statistically significant difference in chin point relapse between patients who had OGS alone compared with those who had OGS after MDO (0.1 mm [SD 2.5mm] vs 0.7mm [SD 2.2mm]; P = .808). Within the limitations of this study, these findings suggest that OGS after MDO in patients with CFM can produce stable results.

A Novel Method to Measure Occlusal Cant Clinically

Traditionally occlusal cant angle is measured using a posteroanterior cephalogram. They can also be measured using photographic and 3-dimensional imaging methods. This clinical tip describes an easy method to measure occlusal cant clinically.

Criterion Validity of the Newly Developed Occlusal Cant Index.

Objectives: To assess the criterion-related (concurrent) validity of the newly developed occlusal cant index (OCI). Materials and Methods: Four standardized posterior–anterior (PA) cephalometric radiographs of four patients were obtained at a 0° occlusal cant (OC) and manipulated to create various degrees of OC from 1° to 4° on the right and left sides, with a total of 36 PA images. The angle between the actual horizontal line and the occlusal plane was manually drawn on each PA radiographic image. The set of radiographic images was displayed to 36 orthodontists, who were asked to measure the drawn angle and apply the OCI to each PA radiographic image. Results: The overall criterion-related validity of the OCI was statistically significant among all grades. Conclusion: The OCI is highly valid and recommended for clinical consideration.

Maxillary sinus volume in patients with canted occlusal plane: A cone-beam computed tomography study.

To compare the maxillary sinus volume between both sides in adult patients with upper occlusal canting (>2 mm cant) and a control group (≤2 mm cant) using cone-beam computed tomography scans. This retrospective study included a total of 84 scans (42 scans per group) according to predetermined selection criteria. OnDemand 3-D™ software was used for volumetric and linear measurements of the maxillary sinus. Maxillary occlusal canting was determined at the level of the maxillary first molars. It was defined as the vertical difference between right and left sides relative to the Frankfort horizontal plane. Non-parametric tests were applied. The median difference in the maxillary sinus volume between the sides was statistically significant between the control and cant groups (P< 0.001). Also, the median difference in the maxillary sinus craniocaudal height and apex sinus distance between the sides was statistically significant between the control and cant groups (P< 0.05 and P< 0.001, respectively). In adult patients, maxillary occlusal canting of more than 2 mm was associated with asymmetric maxillary sinus volumes. In the cant group, maxillary first molars on the canted-down side were in close proximity to the sinus floor, which suggests a limited leeway for molar intrusion.

An Alternative Treatment For Correcting Transverse Maxillary Cant

Orthognathic surgery and orthodontic therapy are desired by patients for a number of reasons, including facial asymmetry. The maxillary occlusal cant is commonly associated with asymmetry. Orthognathic surgery combined with orthodontic treatment has been the treatment of choice for correcting an occlusal cant. However, not all patients with facial asymmetry are surgical candidates, patient assessment and selection remain critical components of diagnosis and treatment planning. In this case report, the patient declined any invasive treatment; hence, we opted to treat this facially asymmetrical patient with orthodontic therapy using straightforward mechanics via TADs, which resulted in an exceptional success.