Can Orthodontic Treatment Be Done Even with Implants? An Actual Case of Canting Retreatement

Hello,

This is Yonsei Baro Orthodontics, a Gangnam orthodontic clinic.

Q. If your teeth still appear tilted to one side after orthodontic treatment, is retreatment necessary?

There are cases in which the teeth still appear tilted to one side when smiling even after orthodontic treatment has been completed, or in which the front teeth continue to bite too deeply and cause discomfort.

One representative cause is canting.

Canting refers to a condition in which the occlusal plane connecting both canines or molars is tilted to one side. When the occlusal plane is tilted, the axes of the front teeth are often tilted as well, which can also affect the left-right balance of the face.

Today, through an actual case of retreatment for a patient who had previously undergone conventional wire orthodontic treatment but still had a deep bite and canting, we will take a detailed look at:

✔️ Why canting occurs

✔️ Whether canting can be corrected with Invisalign

✔️ The limitations of orthodontic treatment when implants are present

✔️ How a deep bite affects retainers and relapse

24.02~24.12

Today, I will show how Invisalign can correct a case in which the occlusal plane is tilted along with the axes of the front teeth.

It may also be helpful to observe how the recessed lower lip returns to its proper position when a severe deep bite is improved.

In addition, I will explain the limitations of orthodontic treatment when implants are present.

This patient visited us in January 2024 for orthodontic treatment.

The patient had previously undergone bracket-and-wire orthodontic treatment, and this was retreatment to address several remaining discomforts and concerns.

24.01

The occlusal plane is tilted.

When the plane is tilted in this way, the front teeth are often tilted accordingly.

The upper teeth cover the lower teeth extensively, resulting in a severe deep bite in which the lower teeth are not visible at all.

24.01

A fixed wire retainer is attached to the upper front teeth as a remnant of the previous orthodontic treatment.

Why is the wire retainer divided into several pieces?

Because of the deep bite.

If orthodontic treatment is completed while a deep bite remains, the wire retainer may contact the lower teeth, causing discomfort, frequent detachment, and other problems. A deep bite can therefore become a major obstacle to preventing relapse and maintaining the results after orthodontic treatment.

It is best to address it completely.

The blue arrow indicates an implant.

On the side with the implant, tooth movement is limited, including movement of the implant-supported tooth.

Therefore, there are limitations to achieving an ideal bite on the side with the implant.

If the molar occlusion is not the same on both sides, this can also affect the midline of the front teeth, and treatment may be completed with the upper and lower midlines not fully aligned.

The patient accepted this limitation, proceeded with orthodontic treatment, and chose Invisalign treatment.

To correct the canting, a miniscrew was placed on one side and elastics were attached to it.

24.07

This is the appearance after wearing all the aligners in the first set for five months, from February through July 2024.

Because the patient cooperated well with wearing the aligners, the deep bite was completely improved during the first set.

In addition, the tilt of the front tooth axes and the tilt of the occlusal plane were also completely corrected.

24.07

The improvement in canting can be confirmed once again in the facial photographs.

The canting was improved in five months.

One point to emphasize here is that front-tooth attachments are essential when uprighting tilted front tooth axes.

Attachments were also placed on this patient's four upper front teeth.

Many patients say they would prefer not to have attachments on their front teeth because they seem as though they would be highly visible.

However, as you can see in the photographs, front-tooth attachments are actually not very noticeable.

Instead, canine attachments are more visible.

24.07

The occlusion on the left side, where tooth movement was limited because of the implant, was still less than ideal.

Although the midline could not be aligned completely because of the implant, additional aligners were made to achieve further improvement.

24.08

Additional aligners were worn for another four months, from August through December 2024.

Elastics were also added on the right side to improve the midline.

Finally, treatment was completed in December, after 11 months.

24.12

The tooth axes, occlusal plane, and deep bite were all corrected to normal. The midline was still slightly less than ideal.

However, this was the best achievable result given the limitation on molar movement caused by the implant.

24.12

Many of you may wonder what happens to the site after a miniscrew is removed following orthodontic treatment.

As shown in the photograph, the tissue fills the site immediately after removal.

There is no open hole.

24.12

The occlusion on the left side with the implant was further improved with the additional aligners.

The teeth bite together properly, as expected. Treatment is not completed if the occlusion is not good.

24.12

Unless it is a case involving premolar extractions, fixed wire retainers are generally bonded only from canine to canine.

However, even in a non-extraction case, the wire retainer needs to be extended to the premolars to help prevent recurrence of the deep bite.

The removable retainer was also made as a rigid Vivera retainer that covers the occlusal surfaces to help prevent recurrence of the canting.

The patient was pleased that, because the deep bite had been resolved compared with the previous orthodontic treatment, the wire retainer was finally comfortable.

Let's look at the before-and-after comparison.

The total treatment time was 11 months, and the aligners were remade once.

24.01~24.12

24.01~24.12

24.01~24.12

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The occlusal plane and tooth axes were completely improved in the relatively short period of 11 months.

To prevent future relapse, the design and type of retainer should be given special consideration.

24.01~24.12

The panoramic image shows that the lower front teeth, which had been raised at the initial examination, were intruded to a considerable extent.

24.01~24.12

During the deep bite, the lower front teeth were hidden behind the upper teeth, causing the lower lip to appear recessed. After orthodontic treatment, the lower lip regained its volume.

Correcting canting by raising one side of the dentition to straighten the occlusal plane is one of the types of orthodontic correction that can be treated effectively with Invisalign.