ORTHODONTICS Procedures:
1. Patient and parent education
Prepared by: Danna Marie Lantin, DMD, MSCD 2. Supervision of growth and development
3. Caries Control
Unfavorable sequelae of malocclusion 4. Elimination of oral habits
• Poor facial appearance 5. Space Maintenance
• Risk of caries
• Predisposition to periodontal diseases 1. Patient and Parent Education
• Psychological Disturbances
• Risk of trauma Aim: Increase dental awareness
• Abnormalities of Function Begins before birth:
• TMJ dysfunction • Infections
• Teratogens
Aims of orthodontic treatment • proper nutrition
Jackson’s triad: After birth:
1. Functional Efficiency • Proper Brushing technique
2. Structural Balance: • Breast feeding? Bottle Feeding?
• Dentoalveolar system
• Skeletal Tissue 2. Supervision of Growth and Development
• Soft Tissue including Musculature
Visit the dentist as soon as the 1st tooth comes out.
3. Esthetic Harmony
The dentist should:
• Check what is “normal”
Scope of Orthodontic Treatment
• Age and Sequence of eruption
3 main tissue systems:
• Dentition
• Skeleton Permanent Teeth
• Facial and jaw Musculature Sequence:
Maxillary: 61245378 or 61243578
Orthodontic changes due to Mandibular: 61234578 or 61243578
• Alteration in tooth position
• Alteration in skeletal pattern Age of eruption
• Alteration in soft tissue pattern Maxillary
1: 7-8 2: 8-9 3:11-12 4:10-11 5:10-12 6:6-
7 7:12-13 8:17-21
3 branches of Orthodontics Mandible
1. Preventive 1:6-7 2: 7-8 3: 9-10 4: 10-12 5:11-12 6:6-7
2. Interceptive 7:11-13 8: 17-21
3. Corrective
• Surgical Orthodontics Deciduous Dentition
Sequence:
Maxillary: ABDCE
Preventive Orthodontics Mandibular: ABCDE
Characteristics of a deciduous dentition
• Flush Terminal Plane Age of eruption
• Generalized spacings on anterior teeth Maxillary: a:7.5 b:9 c: 19 d: 14 e: 24
• Tight contacts on posterior teeth Mandibular: a: 6 b: 7 c: 16 d: 12 e:20
• Minimal OJ and OB
• Primate spaces • Less than or equal to 3 months
difference in contralateral side
Characteristics of a mixed dentition exfoliation and shedding
• Early Mesial shift • Eruption should be 3-6 months after
• Late Mesial shift: leeway space exfoliation
• Mesial inclination of the roots of 1 and 2 • Delayed eruption:
• Mild Crowding of antertior teeth Check for presence of:
• Over retained deciduous
teeth/roots
1 TOPRANK REVIEW ACADEMY- DENTISTRY MODULE
• Fibrous gingiva • Positioning of the tongue downwards
• Supernumerary teeth and forward
• Cysts • Forward head posture
Clinical Features: Long face syndrome/ classic adenoid
3. Caries Control facies
• Long and narrow face
a. Fluoridization: application of fluoride on teeth • Narrow Nose and nasal passage
Fluoride changes Hydroxyapatite crystals to • Short upper lip
Fluoroapatite crystals • Expressionless or blank face
• Anterior marginal gingivitis
Different types of fluoride used • Higher predisposition to caries
Fluoride Gel:
1.23% Acidulated Phosphate Flouride Effect:
• Long and narrow face
b. Fluoride Varnish: • Skeletal open-bite
5% Sodium Flouride • Posterior crossbite
• Labial flaring and spacings of the lower
c. Placement of Sealants on deep grooves and fissures anterior teeth
Appliance:
d. Restorative procedures • Oral Screen
Important because: • Vestibular shield
It Maintains space for underlying successors
Preserve arch length – Me-di width Tongue Thrusting
Preserve vertical height – Oc-Gi height Effect:
• Anterior open Bite
4. Elimination of oral habits • Proclined anterior teeth
• Posterior crossbite
3 approaches to eliminate oral habits:
Appliance:
• Reminder Therapy
• Lingual Pearl
• Reward Therapy • Palatal crib or tongue reminder
• Appliance Therapy • Tongue rake
Factors which will determine severity of malocclusion
due to habits Lip Sucking/Lip Biting
• Duration Effect:
• Increased Ovejet
• Frequency
• Labial flaring of maxillary anterior teeth
• Intensity
• Lingual tipping of lower anterior teeth
Prolonged Thumb Sucking Appliance:
Effects: • Lip Bumper
• Labial Flaring and spacings of maxillary
anteriors
• Lingual tipping of lower incisors 5. Space Manitenance
• Increased Overjet Indications:
• Anterior Open Bite
• When e’s are lost before eruption of 5’s
• Narrow Maxillary Arch = Posterior • When e’s are lost before eruption of 6’s
crossbite
• Early loss of d’s
• Appliance:
• Congenital missing 5’s when planned for
• Palatal Crib
prosthesis later
Mouth Breathing • Early loss of primary anterior teeth
Types
• Early loss of 6’s before eruption of 7s
• Obstructive
• When there is loss of space and minor amount
• Habitual
of space has to be gained
• Anatomic
Change that happens during mouth breathing
Factors to be considered for planning of space
• Lowering of the mandible maintenance:
• Time lapsed after tooth loss NOTE: Primary teeth have bigger pulp
• Dental age of the patient
• Amount of bone covering the unerupted tooth 3. Correction of developing crossbite
• Sequence of eruption of teeth • Inclined Plane
• Delayed eruption of permanent tooth • Elimination of occlusal prematurity
• Congenitally absent tooth • Myofunctional appliances
• Time of tooth loss and stage of occlusion Functional Appliances: “acts by either harnessing the
muscular forces or by preventing aberrant muscular
Different space maintainers forces from acting on the dentition”
• Band and loop
• Crown and loop Classified either by:
• Nance Tooth-borne passive – bionator, twinblock, herbst,
• LLHA activator
• Distal Shoe Tooth-borne active – activator modifications
• TPA Tissue borne – Frankel
• Removable dentures
Or:
INTERCEPTIVE ORTHODONTICS Group 1: transmits muscle force directly to teeth
Recognition and elimination of present irregularities and (Inclined plane, oral screen)
malpositions in the developing dentofacial complex Group 2: Transmit force to teeth and other structures
Late mixed dentition (Activator)
May overlap with Preventive orthodontics: Group 3: Operates from the vestibule (Frankel)
• Difference: Timing!
• Interceptive: Taken when the problem Or:
has already manifested or is developing. Myotonic appliance: rely on muscle mass for action
Limits the progress of the problem (activator, bionator)
• Preventive: No problem yet. Myodynamic appliance: rely on muscle movements or
dynamic properties (Bimler)
Procedures:
• Serial Extraction Or:
• Interproximal Splicing of teeth Removable functional appliance: activator, twin block,
• Correction of developing crossbite bionator, frankel
• Control of abnormal habits Fixed functional appliance: herbst, jasper jumper, forsus
• Space Regaining
• Interception of skeletal malrelations Or:
• Removal of soft tissue or bony barrier to allow Force application: most appliances
eruption Force elimination: vestibular shields, frankel
1. Serial Extraction/ “Planned and progressive Upper anterior bite plate
extraction” / “Active Supervision of teeth by extraction” Effect: Increase in vertical height due to eruption of
Principles followed: molars
• arch length tooth material discrepancy Adverse effect: Proclination of upper incisors
• Physiologic tooth movement.
Usually 7-10mm arch length deficiency Inclined plane
Methods: Effect:Labial movement of teeth, eruption of posterior
• Dewel’s Method (CD4) teeth
• Tweed’s Method (D4C)
• Nance Method Activator
Indications Loose fitting appliance which activates the muscles
Class I with musculo-skeletal harmony Advances the mandible to an edge to edge position to
Large Arch length deficiency induce mandibular growth.
No skeletal disproportions Soft tissue: changes in lip competency
Normal OB
Bionator
2. Interproximal Splicing of teeth Modulates muscle activity
0.2-0.5mm of enamel on contact areas Difference with a activator? Reduced acrylic component
3 TOPRANK REVIEW ACADEMY- DENTISTRY MODULE
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