Everything you need to know about a canted occlusal plane.
Apr 5, 21
5 min read
Many patients with a canted smile come to us utterly perplexed by their smile. They may already have healthy, pearly whites but often still say they hate smiling in photos. Something just seems off! Eventually, they finally notice the culprit - their smile is canted. Let's find out what a canted smile is, what factors are involved, and what are the potential treatments, including a one of our own cases.
To put it simply, a canted smile is a smile that is tilted or slanted. In other words, a smile that is not level with the rest of the face, instead creating a diagonal line. Dr. Halligan has a neat trick to confirm whether the frontal occlusal plane (Your smile from the front!) is canted. Just bite a tongue depressor (It's just a popsicle stick!) lengthwise. It should be a straight line, parallel to your lips, eyes and ears. Now, mind you, even a straight smile might be just a little bit slanted here. But if you have canted smile, the tilt angle should be fairly obvious with this test. (1) Of course, this is only a quick and easy rule of thumb. The best way to determine if you have a canted smile is to seek an examination with a qualified professional.
In our experience, most patients with canted smiles come to us with cosmetic concerns only. However, depending on what the fundamental cause is, a canted smile can introduce functional problems like tooth wear, difficulty with tooth eruption, and skeletal developmental problems. (2)
That leads us to the potential causes of a canted smile. There are a few factors that can produce a canted smile. Without understanding the underlying factors, it is impossible to know the most suitable treatment. An important point to keep in mind is that it could also be a combination of factors.
Common forms of malocclusion include overbite, crossbite, and overjet. All of these mean that your jaw is not properly aligned, which can affect the symmetry of your smile line, potentially leading to a canted smile. (3)
Other forms of malocclusion result from individual misalignment of certain teeth. In some circumstances, their misalignment leads to visual asymmetry, such as uneven teeth lengths. (3)
How much your teeth appear in your smile is, of course, affected by a commonly ignored factor - your gums! As our teeth grow, the gums naturally recede to reveal the smile. If a part of your gums receded less than others, it can lead to the appearance of a canted smile, even if your teeth are aligned.
Injuries, especially childhood ones, to your teeth, gums, or lips will affect the appearance of your smile. Heavy grinding is also a possible culprit. If any of these factors affect a part of your smile more than other parts, they could lead to a canted smile.
Since a canted smile can develop through a combination of factors, very often a combination of treatments is required as well. As always, the best way to find out which treatment is suitable for you is to consult a qualified health professional.
Let's explore some potential options.
Also called gum lift or gum contouring. You guessed it! - This one is best suited to address an uneven gum line. Gum laser surgery uses a soft diode laser to reshape the gum line, revealing more of the teeth. There is a limit to how much can be revealed safely. It's best to discuss with your dentist to see if this is a suitable option for you. Your gum health, natural tooth length, and pre-existing conditions are all factors here.
If your canted smile is resulting from malocclusion, straightening it through orthodontic treatment - like braces or Invisalign - can help. Which orthodontic options are available to you depends on your malocclusion. A through examination with a dentist can help you determine this. A qualified health professional can also guide you through key considerations of each option, like treatment time, cost, and convenience.
While some patients choose veneers as an immediate alternative to orthodontics, it is sometimes the only option for certain situations and objectives. For example, for a case where short teeth length from heavy grinding creates a canted smile, the only way to lengthen teeth may be veneers. With veneers, patients have the option of designing their ideal smile - whether to more closely match their natural proportions, or to totally transform their smile. Suitability depend on a variety of factors. It's always best to consult with a qualified health professional to understand the options available to you.
In our case, the patient came to us with aesthetic concerns surrounding a canted smile and a gummy smile. She chose the porcelain veneer option as she also wanted to improve shape and colour. This was paired with gum contouring to even up the gum line.
Canted smiles are certainly befuddling. If it's bothering you, we always recommend to find out your options and do some research. The best decision is an informed decision.
Chronic maker of bucket lists and chaser of internet rabbit holes. Currently ripping through another mystery novel, most likely multitasking.
Clinical Photos, clinical content, cosmetic and restorative dentistry by Dr.Deepan Duraisamy (Dr Dee) BDS., MSc., FICCDE , FICOI , Vogue Dental Studios.
The best way to find out which options are suitable for you is through a thorough examination.
1.The canted plane revisited: One thing you MUST check [Internet]. Halligantmj.com. [cited 2021 Mar 23]. Available from: https://halligantmj.com/the-canted-plane-revisited-one-thing-you-must-check/
2.Cecchini- J. The systematic treatment of a canted smile [Internet]. Oralhealthgroup.com. 2018 [cited 2021 Mar 23]. Available from: https://www.oralhealthgroup.com/features/systematic-treatment-canted-smile/
3.Şenışık NE, Hasipek S. Occlusal cant: Etiology, evaluation, and management. Turk Ortodonti Derg. 2014;27(4):174–80.
All dental procedures have their risks and benefits. Please seek a second opinion from an appropriately qualified healthcare professional.
Clinical content and cases are from Dr.Dee’s personal gallery, full-face photos are with due consent from our patients.
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