I’ve engaged in discussions on this topic many times in multiple forums – both online and in person. I’m always shocked by how firmly orthodontists hold to the FACT that one should adjust jagged or worn incisal edges BEFORE placing brackets in order to facilitate “ideal bracket placement”. The commentary and supporting facts are always amazingly consistent and, because most orthodontists agree, the consensus (i.e. THE TRUTH in orthodontic circles) is that one should adjust incisal edges before the initial bond.

I guess that is all well and good except for a few pesky details that are almost always neglected and/or ignored in these discussions:

  1. No one places brackets perfectly or even “ideally” in every case. We need to get over ourselves.
  2. Using a bur to remove tooth structure is a permanent alteration not to be undertaken lightly.
  3. Irreversible procedures are always best deferred if one can gain more information or a chance for a better outcome by delaying.
  4. The likelihood of adjusting incisal edges “ideally” is much greater once the teeth are de-rotated, leveled and aligned. What we think is ideal may change after allowing a couple round wires time to do their magic.
  5. In cases where significant incisal edge adjustment is necessary, the “ideal adjustment” may not be as obvious as we believe it to be pre-treatment.
  6. The entire idea of Ideal is Dumb. It’s all a sliding scale. We want the best possible outcome. Perfection is unattainable due to all the variables and the inherent asymmetries in the human body. The result is the end product not the bracket position or treatment plan.

What’s my point?

It may be a good idea to think about what we say instead of just acting like a parrot repeating what we have heard or what we were taught in school. Democracy has zero dominion over truth. Doing what everyone else does or says is not a guarantee of success or “rightness”. We need to think about why we do what we do and proceed in a way that protects the best interests of our patients instead of our own convenience, comfort or our egos…

Question everything. Your patients will thank you.

Want to interact with other Pragmatic orthodontists and advance your skills? Dr. Derek Bock’s Pragmatic Orthodontic Clinical Discussions is a great place!

7 thoughts on “Adjusting Incisal Edges BEFORE Bonding Is Dumb

  1. bullet points 2 and 3 say it all; could not agree more with your thesis Ben!

  2. From a practical standpoint, I never adjust incisal edges prior to bonding for the simple reason that you can spin your wheels explaining to the patient and parent why you’re adjusting healthy teeth. I’d rather get things lined up and let the teeth show what needs to be done, whether it is bonding or enameloplasty.

  3. I totally agree with Rob’s comment and Ben’s points. This idea of : “We all think it’s right so it has to be true” is food for cats. In the 16th Century, almost everybody believed the Earth was flat, that didn’t make it reality.

  4. Ben, what are your thoughts on bonding or adjusting incisal edges after ortho treatment? I frequently adjust jagged edges and even bond some chipped teeth at debonds. I give them the disclaimer it is temporary but parents are very greatful.

  5. I’m a big fan of cosmetic adjustment of incisal edges at the end of treatment. I have the patient hold a mirror and/or the parent watch. It’s amazing what a fraction of a mm can add to the finish! Patients and parents love it.

  6. Ben, you are spot on as always. Thank you for bringing this important point to our attention. I hope you don’t mind me adding, that incisal trimming prior to bonding may also throw off your tooth position in the pre-adjusted bracket. If the tooth has a concavity and is reduced, the bracket will placed at a different vertical height then it normally would, and the first and third order will be off with the contralateral tooth, due to this concavity. So if you trim a central that has a concavity, and then place your brackets on both centrals with matching vertical heights, the torques and in-out will be different and you will be forced to place compensating bends or do what I think is an impossible repo (unless you do bonding of the incisal edge to bring back what you took off). Similarly, the gingival margins of the contralateral teeth will be off. Resolving this issue post levelling and aligning is a more sound approach to me. I remember you posting a video of using a wheel diamond burr at debond to reduce chips at the end of treatment, I do the exact same thing and it enhances the “good feeling” of the debond appointment. Thanks again for this thought.

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