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EDITOR Robert G. Keim, DDS, EdD, PhD

SENIOR EDITOR Eugene L. Gottlieb, DDS

A S S O C I A T E E D I T O R S B i r t e M e l s e n , D D S , D O R a v i n d r a N a n d a , B D S , M D S , P h D J o h n J . S h e r i d a n , D D S M S D P e t e r M S i n c , l a i r , D D S , M S D B j o r n U . Z a c . h r i s s o n , D D S , M S D , P h D

TECHNOLOGY EDITOR W. Ronald Redmond, DDS, MS

C O N T R I B U T I N G E D I T O R S R . G . A l e x a n d e r , D D S , M S D R arren o b e r t L . B o y d , D D S , M E d R o b e r t S . H a e g e r , D D S , M S W H a m u l a , D D S , M S D J a m e s J . H i l g e r s , D D S , M S J a m e s M a h , D D S . , M S , D M S M e l v i n M a y e r s o n , D D S , M S D R i c h a r d P . M c L a u g h l i n , D D S J a m e s A . M c N a m a r a , D D S , P h D E l l i o t t M . M o s k o w i t z , D D S , M S M i c h a e l L S w a r t z , D D S J e f f B e r g e r , B D S , D O ( C a n a d a ) C a r l o B o n a p a c e , M D , D D S ( I t a l y ) J o s é C a r r i è r e , D D S , M D , P h D ( S p a i n ) J o r g e F a s t l i c h t , D D S , M S ( M e x i c o ) J o n a t h a n S a n d l e r , B D S , M S C , F D S R C P S M O r t h R C S ( E n g l a n d ) G e o r g e s L . S . S k i n a z i , D D S , D S O , D C D ( F r a n c e )

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MANAGING EDITOR David S. Vogels III

ASSISTANT EDITOR Wendy L. Osterman

BUSINESS MANAGER Lynn M. Bollinger

CIRCULATION MANAGER Carol S. Varsos

GRAPHIC DESIGNER Irina Lef

T h e m a t e r i a l i n e a c h i s s u e o f J C O i s p r o t e c t e d b y c o p y r i g h t . I n s t r u c t i o n s a n d f e e s f o r c o p y i n g a r t i c l e s f r o m J C O a r e a v a i l a b l e f r o m t h e C o p y r i g h t C l e a r a n c e C e n t e r ( 9 7 8 ) 7 5 0 - 8 4 0 0 ; w w w . c o p y r i g h t . c o m . A l l r i g h t s r e s e r v e d A d d r e s s a l l o t t . h e r c o m m u n i c a t i o n s J o o u r n a l o f C l i n i c a l O r t h o d o n t i c s , 1 8 2 8 P e a r l S t . , B o u l d e r C O 8 0 3 0 2 . P h ( 3 0 3 ) 4 4 3 - 1 7 2 0 ; f a x : ( , - 3 ne: 0 3 ) 4 4 3 9 3 5 6 ; e - m a i l : i n f o j c o - o n l i n e . c o m S u b s c r i p t i o n r a t e s : I N D I V I D U A L S U . S . A . : $ 2 0 0 f o . r o n e y e a r , $ 3 5 5 f o r t w o y e a r s ; C a n a d a : $ 2 3 5 f o r o n e y e a r , $ 4 2 5 f o r t w o y e a r s ; a l l o t h e r c o u n t r i e s : $ 2 8 5 f o r o n e y e a r , $ 4 9 5 f o r t w o y e a r s . I N S T I T U T I O N S U . S . A . : $ 2 8 0 f o r o n e y e a r , $ 4 9 0 f o r t w o y e a r s ; C a n a d a : $ 3 1 5 f o r o n e y e a r , $ 5 6 0 f o r t w o y e a r s ; a l l o t h e r c o u n t r i e s : $ 3 5 5 f o r o n e y e a r , $ 6 3 5 f o r t w o y e a r s . S T U D E N T S U . S . A . : $ 1 0 0 f o r o n e e a r . S I N G L E C O P Y $ 1 8 U . S . A . ; $ 2 4 l l o t h e r c o u n - t r i e s . A l l o r d e r s m u s t b e a c c o m p a n i e d b y p a y m e n t n i f u l l , i n U . S . F u n d s d r a w n o n a m a j o r U . S . b a n k o n l y .

VOLUME XL NUMBER 9

©2006 JCO, Inc. May not be distributed without permission. www.jco-online.com

THE EDITOR’S CORNER

Adventures in the Occlusal Plane

One of the most difficult cases I have ever tackled involved a finicky middle-age woman with a unilateral buccal crossbite. Other than the Brodie bite on her left side, almost everything else about her occlusion and facial appearance were within acceptable limits. Her upper centrals were a bit upright, giving her smile a divi- sion 2 appearance; nevertheless, the buccal interdigitation on her unaffected side was good, and her overall esthetics were, at least to my eye, attractive. The patient was rela- tively pleased with her appearance, but her general dentist had worried her about the buccal crossbite. Even though the crossbite had not yet caused any pathosis, the dentist was concerned that the compromised mastication on the affected side might eventually lead to temporomandibular dysfunction.

My treatment options were limited. The patient absolutely refused to consider surgery. Since the frontal radiograph indicated that the buccal crossbite was caused by buccolingual tipping of the dentition rather than an underlying skeletal asymmetry, I felt that a non-surgical approach was feasible. In the end, however, that course of treatment would try every ounce of my doctorly patience and strain our doctor/patient relationship to near the breaking point. Had we simply aligned the teeth and then proceeded to surgery, the entire treatment would have taken 20-24 months. While the case did finish out rather nicely, if I do say so myself, I am almost embarrassed to report that the total treatment time was actually more than four and a half years.

Treatment was certainly prolonged by the patient’s inability to accept virtually any means of disclusion that would have allowed me to jump the bite buccally, but we finally got the crossbite straightened out in about 28 months. The next stage proved still more problematic. Even with proper interdigitation, the canted occlusal plane was extraordinarily difficult to correct without overeruption of the unaffected side, which would have opened the bite. In surgical-orthodontic treatment, the buccolingual tipping and vertical repositioning could

© 2006 JCO, Inc.

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