This document discusses aligning blocked out maxillary lateral incisors with deep overbites. It describes initially bonding brackets to the lingual surfaces of the lateral incisors to avoid occlusal interference, then using daily elastic wear to realign the teeth over a few months. This allows the blocked out teeth to move into favorable positions so brackets can then be bonded to the facial surfaces to complete alignment. The technique provides rapid realignment of blocked out teeth without need for biteplanes.

1. Alignment of Blocked-Alignment of Blocked-
OutOut
Maxillary LateralMaxillary Lateral
IncisorsIncisors
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2. INTRODUCTIONINTRODUCTION
• Alignment of blocked-out maxillary lateral incisors can be difficult in patientsAlignment of blocked-out maxillary lateral incisors can be difficult in patients
with deep overbite, primarily because of occlusal interfer­ence. A number ofwith deep overbite, primarily because of occlusal interfer­ence. A number of
solutions have been proposed for this problem:solutions have been proposed for this problem:
• 1.1. A fixed glass ionomer biteplane can be used to allow bonding of theA fixed glass ionomer biteplane can be used to allow bonding of the
maxillary lateral incisor brackets. The major drawbacks of this approach aremaxillary lateral incisor brackets. The major drawbacks of this approach are
that construction of a fixed biteplane in glass ionomer cement can be time-that construction of a fixed biteplane in glass ionomer cement can be time-
consuming, and its removal is sometimes difficult. The posterior biteplaneconsuming, and its removal is sometimes difficult. The posterior biteplane
can also cause difficulty with speech and eating, and is moderatelycan also cause difficulty with speech and eating, and is moderately
uncomfortable for patients to wear.uncomfortable for patients to wear.
• 2.2. A removable appliance incorporating a poste­rior biteplane can be used.A removable appliance incorporating a poste­rior biteplane can be used.
Like any removableappliance, however, this will not work without patientLike any removableappliance, however, this will not work without patient
cooperation.cooperation.
• 3.3. Our recommended solution is to initially bond the maxillary lateral incisorOur recommended solution is to initially bond the maxillary lateral incisor
brackets to the lin­gual surfaces, thus avoiding occlusal interference andbrackets to the lin­gual surfaces, thus avoiding occlusal interference and
allowing rapid realignment of the blocked-out teeth.allowing rapid realignment of the blocked-out teeth.
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3. PROCEDUREPROCEDURE
• The lateral incisor bracket is bonded toThe lateral incisor bracket is bonded to
the lingual surface using athe lingual surface using a
conventional acid-etch technique. Aconventional acid-etch technique. A
3.5oz elastic is first brought gingi­val to3.5oz elastic is first brought gingi­val to
the archwire from the facial side andthe archwire from the facial side and
stretched over the lateral incisor tostretched over the lateral incisor to
engage the gingival tie wings of theengage the gingival tie wings of the
bracket . The elastic is then wrappedbracket . The elastic is then wrapped
around the archwireocclusally andaround the archwireocclusally and
again stretched over the lateral incisoragain stretched over the lateral incisor
into the bracket tie wings.into the bracket tie wings.
• The elastics should be changed dailyThe elastics should be changed daily
by the patient. After a few months, theby the patient. After a few months, the
blocked-out lat­eral incisors are usuallyblocked-out lat­eral incisors are usually
in more favorable posi­tions. Bracketsin more favorable posi­tions. Brackets
are their placed in their ideal positionsare their placed in their ideal positions
on the labial surfaces, and theon the labial surfaces, and the
archwire is fully engaged to allowarchwire is fully engaged to allow
complete alignment.complete alignment.
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4. CASE-ICASE-I
• A 15-year-old male presented with aA 15-year-old male presented with a
Class I incisor relationship on a Class IClass I incisor relationship on a Class I
skeletal base. There was moderateskeletal base. There was moderate
crowding in the maxillary arch, withcrowding in the maxillary arch, with
retroclined lateral incisors that wereretroclined lateral incisors that were
both in crossbite, and an overbite ofboth in crossbite, and an overbite of
4mm.4mm.
• Treatment involved the extraction ofTreatment involved the extraction of
four premolars and placement offour premolars and placement of
maxillary and mandibular fixedmaxillary and mandibular fixed
appliances. Nickel titanium push-coilappliances. Nickel titanium push-coil
springs were used on an .018"springs were used on an .018"
stainless steel archwire to providestainless steel archwire to provide
sufficient space for theblocked-outsufficient space for theblocked-out
incisors . Proclination of the maxillaryincisors . Proclination of the maxillary
lateral incisors was achieved withlateral incisors was achieved with
lingually placed lateral incisor bracketslingually placed lateral incisor brackets
and elasticsand elastics
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5. CASE-ICASE-I
• After eight weeks, theAfter eight weeks, the
teeth were in a posi­teeth were in a posi­
tive overjettive overjet
relationship.relationship.
• Brackets were thenBrackets were then
placed on the labialplaced on the labial
surfaces of the lateralsurfaces of the lateral
incisors for furtherincisors for further
alignment .alignment .
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6. CASE-IICASE-II
• A 13-year-old male presented withA 13-year-old male presented with
a Class II, division 1 malocclusion.a Class II, division 1 malocclusion.
There was moderate crowding inThere was moderate crowding in
both anterior segments, with retro-both anterior segments, with retro-
clined maxillary lateral incisorsclined maxillary lateral incisors
that were both in crossbite, and anthat were both in crossbite, and an
overbite of 4mm .overbite of 4mm .
• The treatment plan was to extractThe treatment plan was to extract
the four first premolars and to usethe four first premolars and to use
headgear with maxil­lary andheadgear with maxil­lary and
mandibular fixed appliances.mandibular fixed appliances.
Space was created for theSpace was created for the
blocked-out lateral incisors withblocked-out lateral incisors with
nickel titanium push-coil springsnickel titanium push-coil springs
between thebetween the
• maxillary central incisors andmaxillary central incisors and
canines on an .018" stainless steelcanines on an .018" stainless steel
archwirearchwire
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7. CASE-IICASE-II
• Alignment of the lateralAlignment of the lateral
incisors was then begunincisors was then begun
using lin­gual bracketsusing lin­gual brackets
and elastics; the rightand elastics; the right
lateral was moved prior tolateral was moved prior to
the left.the left.
• In only three months, theIn only three months, the
lateral incisors had beenlateral incisors had been
brought into the archbrought into the arch
enough to permit bondingenough to permit bonding
of brackets in the idealof brackets in the ideal
labial positions for furtherlabial positions for further
alignment with piggybackalignment with piggyback
wires.wires.
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8. CONCLUSIONCONCLUSION
• In patients with severe deep bites, blocked-out maxillaryIn patients with severe deep bites, blocked-out maxillary
lateral incisors can be successfully aligned in a shortlateral incisors can be successfully aligned in a short
period of time by bonding brackets lingually and havingperiod of time by bonding brackets lingually and having
the patient replace the intraoral elastics daily.the patient replace the intraoral elastics daily.
• This technique avoids occlusal interferences without theThis technique avoids occlusal interferences without the
need for cum­bersome posterior biteplanes. It is a simpleneed for cum­bersome posterior biteplanes. It is a simple
and effective treatment when other alternatives are lessand effective treatment when other alternatives are less
certain of success or more demanding of patientcertain of success or more demanding of patient
cooperation.cooperation.
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