Occlusal (incisal) cant? [Pic]

[ArchWired28]

I have been wearing triangle elstics to bring down my left canine (it was flared and kind of sticking forward). While the left canine has gone down quite a bit, I have noticed that my teeth kind of slant so that the left side seems to be lower than the right side. My midline has shifted to the left as well (although one cannot tell from the pic). I have found it is called an occlusal (or incisal) cant, and can happen if the patient wears unilateral elastics.
Please let me know what you think. Does it look like the left side slants down more than the right side? I hope this can be fixed, because I want to have even teeth that are parallel to my lips.

[bracedfaced]

Your teeth look like they do match your lip line. You are probably just not used to it. Do your teeth match up with your eyes?

[ArchWired28]

bracedfaced

thanks for your reply! One day I look at it and they match, the other day they don't... I don't know what is right or wrong anymore. This elastics causes the muscle in the left side of the face to cramp and tighten, maybe that is the reason I see the slant one day and not the other. It does seem to me like the teeth are lopsided just a tiny bit, maybe because the left canine is now lower than it was. I hope it won't get any worse than that...

[catgyrl]

Hi ArchWired28!

I went through a similar situation with my teeth. I told my ortho once, "My smile is crooked!" and he replied, "Oh... you wanted it straight? Why didn't you say that in the first place?" Anyway, he made some bends in the wire, and tied my left canine with a wire tie to "engage" it. It seems to have helped a lot. If I look really closely, my upper row still seems a wee bit crooked, but then I realized it might be an optical illusion, as I need some shaving/evening out of some of my upper teeth. I'm going to ask him about that next month. I would definitely check it out with your ortho to let them know it bothers you.

I had to think twice about bracedfaced's comment about "Do your teeth match up with your eyes?", but now I get it. Most of our faces are not perfectly symmetrical (Think Shannen Doherty as an extreme example.) And the left side of my face IS a wee bit higher than the right. THAT's why I can't get my eyebrows to match up correctly when I get them done! LOL!

And thanks for teaching me a new term: "Occlusal cant". I think I, too, have a slight case of this; however, to me it's not worth months and months more of braces, or surgery.

Good luck to you!!

[ArchWired28]

Thanks for your kind words, Catgyrl! It is true that perfect symmetry is rare in nature. The more we look, the more we are going to notice things are not symmetrical. I will discuss my concerns with the ortho next time. I do think this elastics has caused my left side to be a bit slanted, because the left front teeth overlap about 1-2mm, while the right front teeth are pretty much edge to edge. Given I have started with almost a 100% deep bite this is great progress, however I dont want to end up with an open bite either. I am sure he can fix it though, I just need to mention that. He does not seem to pay that much attention to small details as I do. I think this is because he deals with much harder cases than mine, but still I want the best smile possible. I will try to also mention the midline, because I do think it has moved to the left. Thanks again!

[ArchWired28]

I have just checked, my eye line seems to be straight. Stared at myself for 5 minutes The upper right teeth do seem to go up a tad, probably caused by that elastics. I will make sure to mention this next time, hopefully he can fix it.

[catgyrl]

I agree, it's probably due to the elastics. I had an extraction on my left side, and that canine had had some form of elastic attached to it since about 2 months into treatment. That's about two years so far, and that's the side that's slightly raised. I'm going to ask mine, too. Let me know how it goes!

[TMJJill]

Hi ArchWired28,

It has been a while since we chatted. Your bite is looking great. You have a very nice midline right now too. I know you were concerned about that.

I see what you mean about the cant, but it really isn't bad. It is probably much more noticable to you than to any one else.

I saw my orthodontist last week and had some serious questions about the positioning of my teeth with where I am curently at in my treatment. He basically responded to me that we were still working on arch development and that it would be later in my treatment before we worked on the final positioning of my teeth.

It is frustrating because a couple weeks ago my beautifully placed front tooth suddenly moved over against my other front tooth at a bit of an angle and I've developed gaps around my canines. I'm also at a point where I have quite a few teeth that don't touch yet also. I've been trying to erupt a left molar enough to get my lower braces and it is being so stubborn that I'm months behind my original estimate to getting them on. I know I have to continue to have faith in the orthodontist. Up until now, everything he has done has helped me and I know he has a vision of how he wants things to look when I finish treatment. The problem is that I just can't see it yet. I'd love to have my smile look as beautiful as yours.

[ArchWired28]

TMJJill
wow thank you very much for your reply! It's been awhile since we chatted, I was so frustrated with teeth that felt no desire to read anything teeth/bite/brace related for a couple of months. But now I am back

I was just thinking about you. I hoped you already have the lowers. If one molar does not want to erupt, is it possible to put a composit on that tooth to build up the necessary height and proceed? Especially since you are getting gaps and crooked teeth... Nothing wrong with that however. They can close the gaps and straighten the front teeth very easily. I know how frustrating that is though, watching your smile getting worse. I FEEL your pain Unfortunately, my bite also feels way off and I suspect this is why I subconsciously keep looking for the "smile imperfections" in hopes to "fix" the bite. Sigh... Not that elastics-caused muscle cramps help either... How are you feeling regarding muscle cramping?

[TMJJill]

Hi again. Our stories are so close in so many ways that I'm really a bit jealous of how good your teeth are looking. You really have made some good progress in your treatment. Don't forget that.

I had some serious muscle spasming a couple months ago that took a while to get under control. I had wrist surgery on my right wrist in February and was in a cast for a long time. My shoulder tendonitis flared up because of the ackward way I was shifting my arm to do anything with the cast on. Those shoulder muscle issues eventually creeped up into my TMJ and some of my old pain came back. At least this time I knew what to do. Heating pad, a new prescription for a mild muscle relaxer, NSAIDS and a few visits to my orthodontist for ultrasound treatments (free as part of the cost of my braces) and essential oils from my orthodontist to rub on. My muscles are doing well now though.

I had loads of fun trying to figure out how to get my 5 elastics on with my left hand. I had no idea those tiny little suckers could shoot so far across the room. The ones they have been giving me are clear too so I rarely find them. I eventually got it down though. I did have a couple weeks during that same time period where I was using new elastics my orthodontic office moved to using. They had a patient develop a latex allergy so they decided to switch to all non-latex elastics. I wouldn't have minded except for 2 things: 1. The latex free ones kept snapping within an hour of putting them on and I ended up swallowing a few. 2. They were a bit thicker and trying to get 3 elastics on one hook was pretty much impossible. I complained several times and they finally ordered me in some of the latex ones.

After I lost (meaning probably swallowed) a bracket on my #6 crown, they decided to not try to erupt it and I'll be getting a build up on it until I get out of braces when I'll have to get a new crown. My orthodontist has faith that my other #6 will get there, it is just being slow. As much as I want my lowers, I do want to be able to chew when I get them on. I really do rely on my repositioning splint a lot for that now. With the splint out and my jaw in the more forward position, very few of my teeth are touching now. I'll try to get around to getting a picture posted in the next week or so. I haven't done that on this site yet. I haven't taken pictures of my treatment myself, but I get tons taken every 6 weeks when I go in.

I got to thinking when I had my follow-up appointment last week. I've had some kind of splint in my mouth for over a decade and my TMJ muscles are are happy right now. I really want to move forward with treatment, but I'm actually a bit nervous of loosing the "safety blanket" I've had for so very long. I'm not really bruxing much now but I'm not sure how I'll do when I don't have any protection for my teeth from clenching/grinding at night... especially when I'm still developing my new bite and my clenching is when I'm sleeping. I do wear elastics at night that help hold my lower jaw forward so I know that will continue to help with my TMJ issues some though.

On the flip side, my upper arch has developed very nicely. That is a major step forward. At my appointment last week, my orthodontist also pointed out how my jaw isn't shifting as far to the left when I open and close as it used to as well. That is also another step forward. Sometimes looking at those steps in the journey help get through the day-to-day frustrations.