Lingual Bonded Incisal Blocks are regularly used during full-fixed appliance therapy and can be employed to perform several functions. One of the most common functions is to expedite therapy in cases where an excessively deep bite prohibits bracketing of the lower incisors. Incisal Block placement can provide the clearance needed to allow for mandibular bracketing at the beginning of treatment. This allows you to begin aligning the lower arch and improving the vertical dimension immediately, while protecting the lower brackets from being sheared off by the upper anteriors. After the incisal blocks are bonded, speech may be slightly affected for a day and mastication for a week (sometimes longer for adults). Molar contact will be re-established after three to four months in children and four to six months in adults, but the blocks should not be removed until an effective occlusion with normal incisor relationships is established.

Incisal blocks can be fabricated chair-side from composite, lab-made from acrylic (and delivered with or without a transfer tray), or purchased from several orthodontic supply companies (which typically supply “stainless steel” incisal blocks). Note: Incisal Blocks in the accompanying photo are fabricated from a darker tooth shade to ensure greater visibility. In fact, some suggest following this procedure when placing incisal blocks on your patient. A contrasting tooth shade makes it easier to remove all residue when de-bonding the blocks.

Caution: When using Incisal Blocks, changes in vertical dimension occur because changes in occlusal forces create:

• intrusion of maxillary incisors and canines
• intrusion of mandibular incisors and canines
• extrusion of maxillary molars
• extrusion of mandibular molars.

Care must be taken to control these forces in order to achieve an ideal outcome.