Troublesome laterals: the elephant is in the front!

“Lateral incisors were found to be among the most incorrectly angulated teeth.”

Lawrence Andrews

Despite our tremendous efforts to correct occlusion in all three dimensions, idealise interdigitation and finish without much proclination, our patients are commonly focus their most attention on the upper front teeth. As a result, we have to be very vigilant not to make mistakes in this esthetically sensitive area. 

In this short blog post, I am going to highlight a mistake in maxillary lateral incisor bracket positioning I had been occasionally doing for a number of years. As some of you know, I have recently started my Instagram account and began exploring this mysterious realm of glossy images and catchy slogans. Therefore, I became perfectly aware that this mistake is pretty ubiquitous among many orthodontists. Hopefully, this blog post could raise some awareness of the issue.

The problem arises when a clinician erroneously uses an incisor edge as an angulation landmark while bonding a bracket to the upper lateral incisor. This way the bracket often becomes angulated to the long axis of the crown and not to the long axis of the tooth. This mistake will eventually manifest itself in excessive lateral angulation of the tooth. Such position looks unesthectic and may lead to an unideal contact with the maxillary central incisor.

I hope this small piece of text and my illustrations are helpful. It is critical to angulate brackets to the long axis of a tooth. For more fundamentals on the straight wire appliance I highly recommend this classic book by Lawrence Andrews. No financial interests to declare.

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