Occlusal Cant and Its Challenges – A Review

Abstract

Asymmetries can be considered as a huge challenge for an orthodontist because of the complex mechanics and uncertainty in stability of treatment outcomes. Multifactorial nature of the asymmetry due to wide range has complicated the classification and determination of the cases. The aetiology can be classified as hereditary and environmental factors. The occlusal cant in patients can be evaluated by frontal photographs, lateral cephalograms, clinical assessment and a threedimensional imaging methods. Photographs can be used as one of the methods to evaluate the asymmetries of the soft tissue and also the cant of lips. In recent times with the aid of computers and different software’s like power point or keynote the use of reference lines with the software, facilitates in the analysis of the smile and the occlusal plane. The management of occlusal cant includes different treatment alternatives like orthognathic surgery, orthodontic therapy, or a combination treatment of both orthognathic surgery and orthodontic therapy. The surgical approach depends upon the awareness of the patient with the severity of cant and aesthetic problems as well as the jaw discrepancy in both vertical and sagittal directions. Orthognathic surgery creates an overall skeletal as well as soft tissue improvement including the lips. In cases with OC in anterior segment and deep - bite malocclusion a combination treatment is required. To reduce the anterior vertical height and to achieve more stable results intrusion of molars is considered using skeletal anchorage. The skeletal anchorage (miniscrews or miniplates) can be used for the correction of the cant in maxillary segment and the surgical treatment for correction of the asymmetry of the face like sagittal split osteotomy, ramus osteotomy etc. can be carried out. To achieve satisfactory outcome the clinician must examine and find the etiological factors and proper treatment planning has to be carried out based on the type of occlusal cant such that the outcome shows aesthetic smile along with good facial symmetry. KEY WORDS Occlusal Cant, Facial Asymmetry, Skeletal Asymmetry, Cant.