Surgical manipulation of the occlusal plane: new concepts in geometry

Rotation of the maxillomandibular complex and the consequent alteration of the occlusal plane angulation to improve functional and esthetic results have been well documented. The decision to change the occlusal plane angulation cannot be arbitrary and is made only when desired results cannot be obtained by conventional treatment planning. The geometry of rotation should be accurately planned by establishing a specific point around which the maxillomandibular complex should be rotated to achieve specific esthetic results. Treatment planning using anterior nasal spine and maxillary incisor tip as rotation points has been described and results demonstrated. This article will introduce additional points of rotation that may be considered based on a triangle constructed during treatment planning. Two clinical examples are presented in which these types of rotation were implemented.