Pacific Coast Society of Orthodontists Bulletin Fall 2019 - 43

Let's Talk About That

ly, the lower incisor brackets quite incisally, and
again, place the bite buttons on the upper 4s (on
most deep bites, I place ramped bite buttons on
the upper first premolars and later move to the
lingual of upper centrals, which allows me to
control the overbite and finish earlier). Again, I
would begin with short, light Class II elastics from
the lower 6s to upper 4s. This helps to erupt the
lower 6s and tip the occlusal plane in a clockwise
direction. I never have to use reverse curve wires.
For Class III, deep bite, I typically place bite buttons behind the lower 1s and Class III light elastics
(3/16″, 2.5 oz) from the lingual upper 5s to the
labial of lower 3s for two appointments to help
widen and then switch to labial of upper 5s for
attachment of the elastics.

Figure	3. Before (a) and after (b) treatment
For a Class I deep bite case, I generally place the
bite buttons on the upper first premolars and
have the patient wear light elastics from the lower
6s to upper 4s full-time (3/16″, 2.5 oz). This helps
tip the occlusal plane and erupt the lower 6s. If
slight lower crowding exists, I have the patient
wear "through the bite" light, short Class III elastics (3/16″, 2.5 oz) from the lingual of upper 5s to
the labial of lower 3s for two appointments then
switch to short Class II elastics (full-time wear).
This assists in widening the arches (particularly if I
use widened archwires; this restricts forward proclination of the lower and upper incisors). I know,
this is counterintuitive! All bite buttons are fairly
thin so as not to open the bite too much. When I
place bite buttons on the upper first premolars for
Class I or Class II malocclusions, I make a ramp to
let the mandible functionally slide slightly forward
(a la Keith Sellers in Charlotte, NC.)
For Class II, deep bite, deficient incisor display, I
place the upper anterior brackets quite gingival-

Fall	2019	 	 PCSO	Bulletin	

For open bites, I place the bite buttons on the occlusal of the first and second molars with Pitts PT
squeeze exercises, to intrude the molars. I place
immediate light elastics, either Class III triangles or Class II triangles from the upper canines,
depending on the malocclusion (3/16″, 2.5 oz). I
also place tongue reminders behind the lower
anteriors.
For most cases with crowding and/or open bite,
I have the patient wear a nighttime anterior
"rainbow" elastic (5/16″, 2.5 oz), typically from
the lower 3s up over the upper 1s to the opposite
lower 3. This helps in arch development with the
proper wires. Different configurations are used
depending on the malocclusion and crowding.
I never have the patient wear more than 2.5 oz
elastics in the anterior portion of the mouth. For
open bites, I also use lower tongue reminders
on the lingual of the lower anteriors to help the
tongue subconsciously position up and back from
the anteriors.
As you can see by the cases presented, my objective
is not a "nice" smile, but a life-changing beautiful
"WOW" smile, efficiently (Figure 3). Of course, I
want a great functioning occlusion as well.

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Pacific Coast Society of Orthodontists Bulletin Fall 2019

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