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An Introduction To Orthodontics - Part II

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An Introduction to Orthodontics - PART II …

An Introduction to Orthodontics - PART II

A Presentation presented as part of the Refresher course for Jordanian Newly-Graduate GDPs | November 2011

Published in Health & Medicine
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  • 1. AN INTRODUCTION TOORTHODONTICS PART II Shadi Samawi BDS, MMedSci(Orth.), MOrthRCSED
  • 2. .jo doc .s w w |w 1 01 i2 aw am ORTHODONTICS iS ad The First Recognized Dental SpecialtySh©
  • 3. .joIN THIS PRESENTATION oc d .s w w |w Sequelae of Biology of Malocclusion Tooth Movement 1 01 i2 aw am Removable, Fixed & Orthodontic iS Functional Appliances Retention & Relapse ad Sh ©
  • 4. .joIN THIS PRESENTATION oc d .s w w |w Biology of Tooth Movement 1 01 Sequelae of i2 aw Malocclusion am Removable, Fixed & Orthodontic iS Functional Appliances Retention & Relapse ad Sh ©
  • 5. .jo doc .sSequelae of w Dental wMalocclusion & Periodontal |w Health 1 01 i2 aw Oral Function Aesthetics am (Psychosocial & TMJ iS Considerations) adSh©
  • 6. .jo oc d .sSequelae of w Dental wMalocclusion & Periodontal |w Health 1 01 i2 aw am iS adSh©
  • 7. .joDENTAL & PERIODONTAL HEALTH oc d .s w w |w Malocclusion• Risk of Caries 1 • Research fails toaw demonstrate a strongi2 01 ? am relationship between caries and malocclusion! iS Caries ad Sh ©
  • 8. .joDENTAL & PERIODONTAL HEALTH oc d .s w Poor OH & w |w Motivation + High 1 = 01 Caries i2 Plaque aw + Risk! am iS Malocclusion ad Sh ©
  • 9. .joDENTAL & PERIODONTAL HEALTH doc .s w Sadowsky & BeGole, Am J Orthod; 1981 w |w Polson AM, University of Michigan Press; 1987 1 Weak Evidence Of Benefit Of Orthodontic Tx 01 On Long-term Dental Health! i2 aw am WR Proffit: Contemporary Orthodontics. 4th Edition, 2007 iS If Individuals With Malocclusion Are More Prone To Tooth ad Decay, The Effect Is Small Compared With Hygiene Status. Sh ©
  • 10. .joDENTAL & PERIODONTAL HEALTH oc d .s w w |w Malocclusion• Gingival & Periodontal 1 01 ? Health i2 aw • Weak association am between malocclusion & periodontal health! iS Periodontal ad Health Sh ©
  • 11. .joDENTAL & PERIODONTAL HEALTH oc d .s w Poor OH & w |w Motivation High + 1 = 01 Periodontal i2 Plaque aw Damage + Risk! am iS Malocclusion ad Sh ©
  • 12. .joDENTAL & PERIODONTAL HEALTH doc .s w w Crowding |wOne or more teeth squeezed out of alveolar bone! 1 01 i2 aw Traumatic Overbites am iSIncreased loss of periodontal support palatally or labially. ad Sh ©
  • 13. .joDENTAL & PERIODONTAL HEALTH oc d .s w w |w 1 Malocclusion 01• Dental Trauma i2 aw • Strongerassociation am with malocclusion! Dental Trauma iS ad Sh ©
  • 14. .joDENTAL & PERIODONTAL HEALTH oc d .s w Nguyen et al, EJO; 1999 w |w Meta Analysis of 11 Studies 1 01 Increased Risk of trauma to upper incisors i2 Overjet > 3mm increased by 2X aw (Class II Div 1) am iS Enamel Fractures, Devitalization or Avulsion! ad Sh ©
  • 15. .joDENTAL & PERIODONTAL HEALTH oc d .s w Nguyen et al, EJO; 1999 w |w Meta Analysis of 11 Studies 1 01 Boys i2 aw Girls am Incompetent iS Competent Lips ad Lips Sh ©
  • 16. .jo oc d .sSequelae of w wMalocclusion |w 1 01 i2 aw Oral Function am & TMJ iS adSh©
  • 17. .joORAL FUNCTION & TMJ doc .s w• Effects on Masticatory Function w |w • Severe malocclusion may lead to impaired chewing ? 1 01 i2 aw am iS ad Sh Anterior Open Bite (AOB) Increased / Reverse Overjet ©
  • 18. .joORAL FUNCTION & TMJ doc .s w w• Effects on Masticatory Function |w 1 01 Even less severe malocclusions tend to i2 affect function, not by making it impossible, aw but by making it more difficult. am iS ad WR Proffit: Contemporary Orthodontics. 4th Edition, 2007 Sh ©
  • 19. .joORAL FUNCTION & TMJ doc .s w w• Effects on Speech |w Generally, speech is little affected by malocclusion.. 1 01 i2 Anterior Open Bite No aw Lisp = Anterior (AOB) am Incisor Interdental Increased / Reverse iS Sigmatism Contact Overjet ad Sh ©
  • 20. .joORAL FUNCTION & TMJ doc .s w w• Effects on Speech |w 1 Distorted speech is rarely noted even though an 01 individual may have to make an extraordinary i2 effort to produce normal speech... aw am Because of adaptive jaw, lip & tongue behavior. iS ad WR Proffit: Contemporary Orthodontics. 4th Edition, 2007 Sh ©
  • 21. .joORAL FUNCTION & TMJ doc .s w w• Effects on Speech |w 1 In certain limited cases, malocclusion may make 01 it difficult or impossible to produce certain i2 sounds, necessitating preliminary orthodontic aw treatment prior to speech therapy. am iS ad WR Proffit: Contemporary Orthodontics. 4th Edition, 2007 Sh ©
  • 22. .joORAL FUNCTION & TMJ oc d .s w w |w 1 No Reliable Methods To Quantify Functional 01 Adaptations And Test Jaw Function Yet Exist! i2 aw am iS ad Sh ©
  • 23. .joORAL FUNCTION & TMJ oc d .s w w• Effects on the Temporo-Mandibular Joint (TMJ) |w 1 01 i2 aw TMD Temporo-mandibular am Malocclusion ? Joint Disorders Orthodontics ? iS ad Controversial! Sh ©
  • 24. .joORAL FUNCTION & TMJ oc d .s w Multifactorial ? w |w 1 Psychological 01 Genetic i2 aw Hormonal am Traumatic iS Occlusal ad Sh ©
  • 25. .joORAL FUNCTION & TMJ d oc .s w Research ? w |w 1 01 TMJ Pain i2 aw mostly due to Joint Pathology, am Muscle Fatigue iS & Spasm ad Sh Egermark et al, Angle Orthodontist; 2003 ©
  • 26. .joORAL FUNCTION & TMJ d oc .s w Research ? w |w 1 01 TMJ Pain correlates i2 aw with a history of Bruxism & am Clenching iS ad Luther F., Orthodontics & The TMJ: Where are we now?, Sh Angle Orthodontist; 1998 ©
  • 27. .joORAL FUNCTION & TMJ d oc .s w Do Minor Occlusal Interferences Cause TMD ?? w |w 1 50-70% Of Population 01 Have Moderate Malocclusion .. Unlikely i2 aw Malocclusion alone Only 5-30% is the cause! am With Reported TMD! iS ad WR Proffit: Contemporary Orthodontics. 4th Edition, 2007 Sh ©
  • 28. .joORAL FUNCTION & TMJ d oc .s w Do Minor Occlusal Interferences Cause TMD ?? w |w Posterior Cross-bite 1 e.g. Few 01 Malocclusions with Shift on Closure i2 Correlate Positively aw But Only 0.3 - 0.4 With TMD! am Correlation Coefficient! iS ad WR Proffit: Contemporary Orthodontics. 4th Edition, 2007 Sh ©
  • 29. .joORAL FUNCTION & TMJ d oc .s w w |w If Stress = Clenching ? 1 01 i2 Malocclusion Tends To Make The Problem Worse! aw am iS ad WR Proffit: Contemporary Orthodontics. 4th Edition, 2007 Sh ©
  • 30. .joORAL FUNCTION & TMJ d oc .s w w For The Majority of Patients.. |w 1 01 .. No Clear Association Between i2 aw Malocclusion & TMD Exists! am iS ad WR Proffit: Contemporary Orthodontics. 4th Edition, 2007 Sh ©
  • 31. .joORAL FUNCTION & TMJ d oc .s w w Malocclusion + Muscle Pain & Spasm |w May Indicate A Need For Adjunctive Orthodontic Therapy 1 01 i2 Orthodontics Is Almost Never Indicated aw As The Primary Treatment Alone! am iS ad WR Proffit: Contemporary Orthodontics. 4th Edition, 2007 Sh ©
  • 32. .jo doc .sSequelae of w wMalocclusion |w 1 01 i2 aw Aesthetics am (Psychosocial iS Considerations) adSh©
  • 33. .jo AESTHETICS (PSYCHOSOCIAL CONSIDERATIONS) doc .s w• Severe Malocclusion is likely to w be a Social Handicap! |w • Appearance affects 1 01 expectations of peers, teachers & employers. i2 aw • Physical defects strongly am influence our self-esteem. iS .. Not "just Cosmetic"! ad A Major Impact on Quality of Life. Sh ©
  • 34. .joKEY POINTS oc d .s Both Aesthetic (psychosocial) & w w Functional Handicaps Can Produce 1 |w Significant Need For Orthodontic 1 Treatment 01 i2 aw Less Clear Evidence Exists That am Orthodontics Reduces The 2 Development Of Dental Disease iS Or Symptoms Of TMD Later In Life! ad Sh ©
  • 35. .joIN THIS PRESENTATION oc d .s w w |w Sequelae of Malocclusion 1 01 Biology of i2 aw Tooth Movement am Removable, Fixed & Orthodontic iS Functional Appliances Retention & Relapse ad Sh ©
  • 36. .joBIOLOGY OF TOOTH MOVEMENT d oc .s w w• Everything depends on the Periodontium! |w 1 01 The Periodontium responds to mechanical i2 loading by remodeling alveolar bone & aw translocation of the tooth & surrounding tissues. am iS ad Laura Mitchell: An Introduction to Orthodontics. 3rd Edition, 2007 Sh ©
  • 37. .joTHE PERIODONTAL LIGAMENT d oc .s w Alveolar Bone To o t h w Fibroblast |w Osteoclast 1 Type I Collagen 01 i2 Proteoglycans R o o t Osteoblast aw am Cementoblast Glycoproteins iS Extracellular Matrix ad Sh ©
  • 38. .joTHE PERIODONTAL LIGAMENT d oc .s w w |w Fibroblasts 1 01Cells responsible for producing & degrading the i2extra-cellular matrix. aw am iS ad Laura Mitchell: An Introduction to Orthodontics. 3rd Edition, 2007 Sh ©
  • 39. .joTHE PERIODONTAL LIGAMENT d oc .s w w |wCementoblasts 1 01Cells responsible for the production of cementum. i2 aw am iS ad Laura Mitchell: An Introduction to Orthodontics. 3rd Edition, 2007 Sh ©
  • 40. .joTHE PERIODONTAL LIGAMENT d oc .s w w |w Osteoblasts 1 01Cells responsible for bone production & i2coordination of bone deposition & resorption. aw am iS ad Laura Mitchell: An Introduction to Orthodontics. 3rd Edition, 2007 Sh ©
  • 41. .joTHE PERIODONTAL LIGAMENT d oc .s w w |w Osteoclasts 1 01 i2Cells responsible for bone resorption. aw am iS ad Laura Mitchell: An Introduction to Orthodontics. 3rd Edition, 2007 Sh ©
  • 42. .joTHE PERIODONTAL LIGAMENT d oc .sResponse to Normal Function w w |w Time (seconds) Event 1 01 PDL fluid incompressible. < 1sec. Alveolar bone bends. Piezo-electric signal generated. i2 aw PDL fluid expressed. 1-2 sec. Tooth moves within PDL space. am PDL fluid squeezed out, tissues compressed; 3-5 sec. iS immediate pain if pressure is heavy! ad Sh WR Proffit: Contemporary Orthodontics. 4th Edition, 2007 ©
  • 43. .joTHE PERIODONTAL LIGAMENT oc d .sResponse to Prolonged Function w w |w 1 Prolonged Force - Even At 01 Low Magnitude - i2 Produces A Differentaw Physiologic Response: am Remodeling Of Adjacent Bone. iS ad Sh ©
  • 44. .joTHE PERIODONTAL LIGAMENT oc d .sPressure - Tension Theory w w |w Alteration In Blood Flow 1 Associated With Pressure Within PDL 01 i2 aw Formation & Release Of Chemical Messengers am iS ad Activation Of PDL Cells & Bone Remodeling Sh ©
  • 45. .joTHE PERIODONTAL LIGAMENT oc d .sPressure - Tension Theory w w |w Alteration In Blood Flow 1 Associated With Pressure Within PDL 01 i2 Tooth aw Tooth Tooth am iS ad Sh Bone PDL Bone PDL Bone PDL ©
  • 46. .joTHE PERIODONTAL LIGAMENT oc d .sPressure - Tension Theory w w |w Sustained Pressure On PDL 1 01 Causes PDL Compression In i2 One Area - Decreasing Blood aw Flow - And PDL Tension In am Another - Increasing Blood iS Flow. ad Sh ©
  • 47. .joTHE PERIODONTAL LIGAMENT oc d .sPressure - Tension Theory w w |w 1 01 The Change In Chemical i2 Environment Leads To Release aw Of Chemical Messengers That am Lead To Cellular Activation... iS ad Sh ©
  • 48. .joTHE PERIODONTAL LIGAMENT doc .sPressure - Tension Theory w w |w Cellular Differentiation & Activity 1 01 Leads To Bone Remodeling By: i2 * Bone Resorption (-) aw On Compression Side. am * Bone Deposition (+) iS On Tension Side. ad Sh ©
  • 49. .joTHE PERIODONTAL LIGAMENT d oc .sPressure - Tension Theory w w |w Cellular Differentiation & Activity --- 1 + - 01 Leads To Bone Remodeling By: + + + i2 + * Bone Resorption (-) - + - aw On Compression Side. - am * Bone Deposition (+) iS On Tension Side. ad Sh ©
  • 50. .joTHE PERIODONTAL LIGAMENT oc d .sEffects of Force Magnitude w w |w Heavy Sustained Forces 1 Undermining 01 Resorption! i2 Occlusion Of Blood Vessels Within PDL aw am iS ad Sh ©
  • 51. .joTHE PERIODONTAL LIGAMENT oc d .sEffects of Force Magnitude w w |w Heavy Sustained Forces 1 Undermining 01 Resorption! i2 Occlusion Of Blood Vessels Within PDL aw am Light Sustained Forces iS Frontal ad Compression Of Blood Vessels Within PDL Resorption Sh ©
  • 52. .joKEY POINTS doc .s w Tooth Movement Depends Mainly on 1 w Cellular Activity in the Periodontal Ligament |w 1 2 01 Pressure - Tension Theory of Movement.. i2 aw Bone Resorption on Compression Side 3 am Bone Deposition on Tension Side iS Frontal Resorption of alveolar bone from 4 ad Light Continuous Forces is More Desirable Sh ©
  • 53. .joIN THIS PRESENTATION oc d .s w w |w Sequelae of Biology of Malocclusion Tooth Movement 1 01 Removable, Fixed & i2 aw Functional Appliances am Orthodontic iS Retention & Relapse ad Sh ©
  • 54. .joREMOVABLE ORTHODONTIC APPLIANCES doc .s w w Space Maintainers |w Passive 1 01 Retainers i2 aw URA With Midline Expansion Screw am Active iS URA With Active Springs... ad Sh ©
  • 55. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w Passive Active w |w 1 01 i2 aw am iS ad Sh Retainer Midline Expansion URA ©
  • 56. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w Mode Of Action w |w 1 Tipping "Block" "Free Eruption" 01 i2 Movements Movements aw Movements am iS 2D ad LIMITED RANGE OF MOVEMENTS! Sh ©
  • 57. .joREMOVABLE ORTHODONTIC APPLIANCES doc .s w Mode Of Action w |w Around the 1 Tipping Center of Resistance 01 i2 Movements aw Approx. am 1/3 the Distance from Root Apex iS ad Sh ©
  • 58. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w Mode Of Action w |w 1 "Block" 01 i2 Movements aw am iS ad Midline Expansion URA Sh ©
  • 59. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w Mode Of Action w |w 1 "Free Eruption" 01 i2 aw Movements am iS ad Sh ©
  • 60. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w Mode Of Action w |w 1 "Free Eruption" 01 i2 aw Movements am iS ad Sh ©
  • 61. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w Indications w |w• Dental arch expansion 1 01• Correction of anterior single-tooth cross-bites i2• Applying extra-oral traction to upper arch aw am• Space maintainers / Retention appliances iS• Anterior/posterior bite plane for influencing ad "free eruption" of tooth segments Sh ©
  • 62. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w Design & Components w |w 1 01 ACTIVE RETENTIVE Baseplate i2 Components Components aw am iS ad Sh ©
  • 63. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w Design & Components w |w 1 01 ACTIVE i2 Components aw am 0.5mm∅ SS wire iSActivation:1mm per visit ad Springs Sh Light physiological force over a long activation range. ©
  • 64. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w Design & Components w |w 1 01 ACTIVE i2 Components aw am iS ad Screws Sh ©
  • 65. .joREMOVABLE ORTHODONTIC APPLIANCES d oc .s w Design & Components w |w Adams Clasps 1 01RETENTIVE i2 Components aw am0.7mm∅ SS wire iS ad SouthEnd Clasp Sh Ball Clasps Labial Bow ©
  • 66. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w Design & Components w |w 1 Self-cure OR Heat-Cure Acrylic 01 (Polymethylmethacrylate) Baseplate i2 aw am iS Passive OR Active ad Provides Anchorage Sh ©
  • 67. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w w Common |w Designs 1 01 i2 aw am iS Palatal Finger Spring ad Sh ©
  • 68. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w w Common |w Designs 1 01 i2 aw am iS Z-Spring URA ad Sh ©
  • 69. .joREMOVABLE ORTHODONTIC APPLIANCES doc Active: Expansion Screw .s w w Common |w Designs 1 01 i2 Retentive: aw Adams Clasps am iS Baseplate: Anchorage & Support ad Sh Midline Expansion URA ©
  • 70. .joREMOVABLE ORTHODONTIC APPLIANCES doc .s Active: Finger Spring w w Common |w Designs 1 01 i2 aw Protective SS Sleeve Tubing am iS ad Buccal Canine Retractor Sh ©
  • 71. .joREMOVABLE ORTHODONTIC APPLIANCES doc .s w w Common |w Designs 1 01 i2 Retentive: awSouthend Clasp am Active: iS Palatal adFinger-Springs Palatal Finger-Spring URA Sh ©
  • 72. .joREMOVABLE ORTHODONTIC APPLIANCES oc d .s w Clear Orthodontic Aligners w New |w Trends.. 1 01 i2 aw Invisalign am ClearPath iS ad Sh ©
  • 73. .joKEY POINTS oc d .s w 1 w Very Limited Range of Movement :: 2D |w 1 2 01 Can be Active or Passive i2 aw 3 An Adjunct to Fixed Appliance Therapy am iS 4 ad Best Used by Well-trained Clinicians Sh ©
  • 74. .joFUNCTIONAL APPLIANCES d oc .s w Definition w |w 1Appliances that utilize, eliminate or guide the forces 01 of function, tooth eruption and growth i2 aw to correct a malocclusion. am iS ad Laura Mitchell: An Introduction to Orthodontics. 3rd Edition, 2007 Sh ©
  • 75. .joFUNCTIONAL APPLIANCES oc d .s w History w |w 1Pierre Robins 1st Monobloc appliance: 01for new-born babies with severe mandibular retrognathia i2 awAndresens Activator ... 1920s amThe first orthodontic functional appliance iS ad Sh ©
  • 76. .joFUNCTIONAL APPLIANCES d oc .s w How They Work.. w |w Forward Posture of the Mandible 1 01 (Stretching of Muscles & Soft Tissue) i2 aw Pressure transmitted to Dentition & Skeletal Structures am iS Dento-alveolar Changes ad Claimed Skeletal Changes ? Sh ©
  • 77. .joFUNCTIONAL APPLIANCES d oc .s w How They Work.. w |w Forward Posture of the Mandible 1 01 (Stretching of Muscles & Soft Tissue) i2 aw Pressure transmitted to Dentition & Skeletal Structures am iS Dento-alveolar Changes ad Claimed Skeletal Changes ? Sh ©
  • 78. .joFUNCTIONAL APPLIANCES doc .s w How They Work.. w |w 1 Growth At The Condylar Joint ? 01 i2 aw Increase In Mandibular Body Length ? am iS Dental Effect > Skeletal Effect! ad Sh ©
  • 79. .joFUNCTIONAL APPLIANCES doc .s w How They Work.. w |w Research Shows... 1 01 i2 Distal Movement aw Mesial Movement Of Upper Dentition Of Lower Dentition am iS Tipping Of Upper Incisors Tipping Of Lower Incisors Palatally Labially ad Sh ©
  • 80. .joFUNCTIONAL APPLIANCES d oc .s w How They Work.. w |w Functional Appliance Tx Effects 1 01 70 %70 i2 aw 53 Research Shows... am 35 iS 18 %30 ad Sh 0 Dental Skeletal ©
  • 81. .joFUNCTIONAL APPLIANCES doc .s w Timing Of Treatment w |w 1 As Close As Possible To The 01 Pubertal Growth Spurt i2 Actively Growing aw Patient am Can Be Used A Bit Later iS In Boys ad Sh ©
  • 82. .joFUNCTIONAL APPLIANCES oc d .s w Timing Of Treatment w |w 1 01 Psychological Factors ? May Affect i2 aw Timing Of am Dental Development ? Treatment! iS ad Sh ©
  • 83. .joFUNCTIONAL APPLIANCES oc d .s w Types Of Malocclusions We Can Treat? w |w 1 01 i2 aw am iS ad ShClass II Division 1 ©
  • 84. .joFUNCTIONAL APPLIANCES doc .s w Types Of Malocclusions We Can Treat? w |w 1 01 i2 aw am iS ad ShClass II Division 1 Class II Division 2 ©
  • 85. .joFUNCTIONAL APPLIANCES d oc .s w Types Of Malocclusions We Can Treat? w |w 1 01 i2 aw am iS ad ShClass II Division 1 Class II Division 2 Class III ?? ©
  • 86. .joFUNCTIONAL APPLIANCES doc .s w Types Of Functional Appliances w |w 1 01 Tooth-Borne Tissue-Borne i2 aw am iS Removable Fixed ad Sh ©
  • 87. .joFUNCTIONAL APPLIANCES oc d .s w Components Of Functional Appliances w |w 1Mandibular Advancement Components 01 i2 awArch Expansion Components amVertical Control Components iS adStabilizing Components Sh ©
  • 88. .joFUNCTIONAL APPLIANCES oc d .s w The Twin-Block w Appliance |w 1 01Tooth-Borne, i2 Removable aw am One Of The Most iSPopular FAs ad Sh ©
  • 89. .joFUNCTIONAL APPLIANCES doc .s The Twin-Block Appliance Components w w |w 1 01 i2 aw am iS ad Sh ©
  • 90. .joFUNCTIONAL APPLIANCES doc .s The Twin-Block Appliance Components w w |w 1 01 i2 aw 70° am iS ad Sh ©
  • 91. .joFUNCTIONAL APPLIANCES doc .s The Twin-Block Appliance Components w w |w Midline 1 Expansion Screw 01 i2 aw Acrylic Blocks Adams Clasps am iS ad Sh ©
  • 92. .joFUNCTIONAL APPLIANCES oc d .s The Twin-Block Appliance Case Example w w |w 1 01 i2 aw am iS ad Sh Initial (Pre-Tx) ©
  • 93. .joFUNCTIONAL APPLIANCES oc d .s w w Initial |w(Pre-Tx) 1 01 i2 aw am iS ad Sh ©
  • 94. .joFUNCTIONAL APPLIANCES doc .s w w |w 1 01 i2 aw am iS ad Initial (Pre-Tx) Sh ©
  • 95. .joFUNCTIONAL APPLIANCES oc d .s w w |w 1 01 i2 aw am iS ad Sh Post-TwinBlock ©
  • 96. .joFUNCTIONAL APPLIANCES oc d .s w w Post |wTwinBlock 1 01 i2 aw am iS ad Sh ©
  • 97. .joFUNCTIONAL APPLIANCES oc d .s w w |w 1 01 i2 aw am iS Post-TwinBlock ad Sh ©
  • 98. .joFUNCTIONAL APPLIANCES oc d .s w w |w 1 01 i2 aw am iS ad Sh Final - Post-Tx ©
  • 99. .jo FUNCTIONAL APPLIANCES oc d .s w w |w Final -Post-Tx 1 01 i2 aw am iS ad Sh ©
  • 100. .joFUNCTIONAL APPLIANCES oc d .s w w |w 1 01 i2 aw am iS ad Final - Post-Tx Sh ©
  • 101. .joFUNCTIONAL APPLIANCES oc d .s w w |w 1 01 i2 aw am iS Post-TB Pre-Tx ad Sh ©
  • 102. .joFUNCTIONAL APPLIANCES oc d .s w w |w 1 01 i2 aw am iS Post-Tx Pre-Tx ad Sh ©
  • 103. .joFUNCTIONAL APPLIANCES oc d .s w The Herbst w Appliance |w 1 01 Fixed-Functional i2 aw am Frequent Breakages + iS Higher Cost! ad Sh ©
  • 104. .joFUNCTIONAL APPLIANCES oc d .s w Medium-Opening w Activator (MOA) |w 1 01 Monobloc-type i2 aw am Breathing Hole iS Anteriorly ad Sh ©
  • 105. .joFUNCTIONAL APPLIANCES oc d .s w w The Bionator |w 1 01 Monobloc-type i2 aw am Buccal Extensions To Allow iS Arch Expansion ad Sh ©
  • 106. .joFUNCTIONAL APPLIANCES oc d .s w Frankel w Appliance(s) |w 1 01 The Only i2 Tissue-borne FA aw am 3 Main Types iS ad FR1 FRII FRIII Sh ©
  • 107. .joFUNCTIONAL APPLIANCES doc .s Preparation Alginate Impressions & Wax Bite w w |w 1 01 i2 aw am iS Mandible In Forward Posture Position ad Sh .. Not More Than 50-75% Of Mandibles Max Protrusion. ©
  • 108. .joFUNCTIONAL APPLIANCES doc .s Preparation Alginate Impressions & Wax Bite w w |w 1 01 i2 aw am iS Reactivation (Incremental Advancement) Possible ad Sh Less Patient Discomfort .. Same End Result. ©
  • 109. .joFUNCTIONAL APPLIANCES doc .s Fitting Adjustment & Instructions w w |w 1 01 Check Fit, Trim Acrylic ?, Adjust Clasps i2 aw Full-time Wear Emphasized.. am Will Take Time To Get Used To At First! iS ad Sh ©
  • 110. .joFUNCTIONAL APPLIANCES doc .s Follow-up Initial Review in 2 Weeks w w |w 1 6-10 Weeks Appointments 01 i2 aw Compliance ?? (10-30% Failure Rate!) am Overjet Reduction ? Check: iS Vertical, Transverse Dimensions ? ad Buccal Segment Relationships ? Sh ©
  • 111. .joKEY POINTS oc d .s w Start in the Late Mixed Dentition in 1 w Growing Patients |w 1 2 01 Best for Moderate Class II Skeletal Problems i2 aw 3 Followed by a 2nd Phase of Fixed Appliances am iS %70 Dento-alveolar Effects 4 ad %30 Skeletal Changes Sh ©
  • 112. .joFIXED ORTHODONTIC APPLIANCES oc d .s w w |w The Most Specialized Form 1 01 Of Orthodontic Appliances! i2 aw am Better Reserved For Experienced Specialists iS ad Sh ©
  • 113. .joFIXED ORTHODONTIC APPLIANCES oc d .s Overview Current Systems w w |w 1 Pre-adjusted Edgewise 01 i2 aw am iS ad Sh ©
  • 114. .joFIXED ORTHODONTIC APPLIANCES oc d .s Overview Current Systems w w |w 1 Pre-adjusted Edgewise 01 i2 aw Lingual Systems am iS ad Sh ©
  • 115. .joFIXED ORTHODONTIC APPLIANCES oc d .s Overview Current Systems w w |w 1 Pre-adjusted Edgewise 01 i2 aw Lingual Systems The Tip-Edge System am iS ad Sh ©
  • 116. .joFIXED ORTHODONTIC APPLIANCES oc d .s Overview Current Systems w w |w 1 Pre-adjusted Edgewise 01 i2 aw Lingual Systems The Tip-Edge System am iS Self-Ligating Systems ad Sh ©
  • 117. .joFIXED ORTHODONTIC APPLIANCES oc d .s Basic Principles Bracket Material & Design w w |w 1 01 i2 aw am iS Plastic Metal ad Stainless Steel Ceramic Sh Titanium ©
  • 118. .joFIXED ORTHODONTIC APPLIANCES oc d .s Basic Principles Bracket Material & Design w w |w Wing 1 01 Slot i2 (0.018" or 0.022") aw am iS Hook ad Base Sh Bonding Mesh ID Mark ©
  • 119. .joFIXED ORTHODONTIC APPLIANCES oc d .s Basic Principles Bracket Prescription w w |w 1 01 i2 aw am iS ad Sh In - Out Tip Torque ©
  • 120. .joFIXED ORTHODONTIC APPLIANCES oc d .s Basic Principles Force-Couple Generation w w |w 1 01 i2 aw am iS ad Sh ©
  • 121. .joFIXED ORTHODONTIC APPLIANCES oc d .s Basic Principles Force-Couple Generation w w |w 1 01 i2 aw am iS ad Sh ©
  • 122. .joFIXED ORTHODONTIC APPLIANCES oc d .s Basic Principles 3D Range Of Movements w w |w 1 01 i2 aw am iS ad Sh ©
  • 123. .joFIXED ORTHODONTIC APPLIANCES doc .s Basic Principles Anchorage w w |w 1 Resistance to the forces generated in reaction to the 01 active component of an appliance. i2 aw Resistance To Unwanted Tooth Movement am iS ad Fixed Appliances are Anchorage-demanding! Sh ©
  • 124. .joFIXED ORTHODONTIC APPLIANCES doc .s Basic Principles Anchorage w w |w 1 %40 %60 01 i2 aw am iS ad Fixed Appliances are Anchorage-demanding! Sh ©
  • 125. .joFIXED ORTHODONTIC APPLIANCES doc .s Indications Almost Any Type Of Malocclusion! w w |w Mild to Moderate Skeletal Discrepancies 1 01 Overbite Reduction by Incisor Intrusion i2 aw Correction of Tooth Rotations & Spacing am Active Closure of Extraction Spaces iS ad In conjunction with Surgery or Auxiliaries Sh ©
  • 126. .joFIXED ORTHODONTIC APPLIANCES oc d .s Components 1. Brackets w w |w 1 01 i2 aw am iS ad Sh ©
  • 127. .joFIXED ORTHODONTIC APPLIANCES oc d .s Components 2. Bands w w |w 1 01 i2 aw am iS ad Sh ©
  • 128. .joFIXED ORTHODONTIC APPLIANCES oc d .s Components 3. Adhesives w w |w 1 01 i2 aw Chemical (Self-Cure) Light-Cure am iS ad Sh ©
  • 129. .joFIXED ORTHODONTIC APPLIANCES oc d .s Components 4. Archwires w w |w 1 NiTi (Nickel Titanium) 01 Stainless Steel i2 aw am TMA (Ti-Molybdenum) iS ad Sh ©
  • 130. .joFIXED ORTHODONTIC APPLIANCES doc .s Components 5. Orthodontic Auxiliaries w w |w SS ligatures & Ties Intra Oral Elastics 1 01 i2 aw am iS ad Sh ©
  • 131. .joFIXED ORTHODONTIC APPLIANCES oc d .s Components 5. Orthodontic Auxiliaries w w |w 1 01 i2 QuadHelix awFor Maxillary Expansion am iS ad Sh ©
  • 132. .joFIXED ORTHODONTIC APPLIANCES oc d .s Components 5. Orthodontic Auxiliaries w w |w 1 01 i2 Hyrax (RME) aw For amMaxillary Suture Expansion iS ad Sh ©
  • 133. .joFIXED ORTHODONTIC APPLIANCES oc d .s Components 5. Orthodontic Auxiliaries w w |w 1 01 Palatal Arch i2 For Added aw Molar Control am & Anchorage iS ad Sh ©
  • 134. .joFIXED ORTHODONTIC APPLIANCES oc d .s Components 5. Orthodontic Auxiliaries w w |w 1 01 HeadGear i2 aw For Distal Control of amMaxilla and Maxillary Molars iS in Class II Malocclusion ad Sh ©
  • 135. .joFIXED ORTHODONTIC APPLIANCES oc d .s Components 5. Orthodontic Auxiliaries w w |w 1 01 Face Mask i2 aw For Treatment of am Maxillary Retrognathia iSin Class III Malocclusion ad Sh ©
  • 136. .joFIXED ORTHODONTIC APPLIANCES oc d .s Components 5. Orthodontic Auxiliaries w w |wTADs - MiniScrews 1 01 For Absolute Skeletal i2 Anchorage aw am iS ad Sh ©
  • 137. .joFIXED ORTHODONTIC APPLIANCES oc d .s Bonding Procedure w w |w Pumicing, 1 01 Acid Etching i2 aw %35 Phosphoric Acid am 15-20 Seconds iS ad Sh ©
  • 138. .joFIXED ORTHODONTIC APPLIANCES oc d .s Bonding Procedure w w |w Washing 1 01 & Drying i2 aw (Water-Air Stream, am 3-5 Seconds ) iS ad Sh ©
  • 139. .joFIXED ORTHODONTIC APPLIANCES oc d .s Bonding Procedure w w |w Application of 1 01 Adhesive & i2 aw Bracket Bonding am (Direct / Indirect) iS ad Sh ©
  • 140. .joFIXED ORTHODONTIC APPLIANCES oc d .s Bonding Procedure w w |w Application of 1 01 Adhesive & i2 aw Bracket Bonding am (Direct / Indirect) iS ad Sh ©
  • 141. .jo FIXED ORTHODONTIC APPLIANCES d oc Figure 2 .s Bonding Procedure w w FACC Line |w FACC Line 1 01 FACC Point i2 aw (Facial Axis of am Clinical Crown) iS FACC Point ad Sh racket placement Figure 2: Axial bracket placement errors wanted rotation, but can result in unwanted tip, but are ©ntion to technique. avoided with attention to technique.
  • 142. .joFIXED ORTHODONTIC APPLIANCES oc d .s Main Risks! Enamel Decalcification w w |w 1 01 i2 aw am iS ad Sh ©
  • 143. .joFIXED ORTHODONTIC APPLIANCES oc d .s Main Risks! Periodontal Damage w w |w 1 01 i2 aw am iS ad Sh ©
  • 144. .joFIXED ORTHODONTIC APPLIANCES oc d .s Main Risks! Root Resorption w w |w Commonly-Affected Teeth 1 01 2+1 1+2 i2 6+2+1 1+2+6 aw am Risk factors: iS Root Form ad Previous Trauma Sh Tx Mechanics ? ©
  • 145. .joKEY POINTS doc .s w Produce Tooth Movements in 1 w all 3 Planes of Space - 3D |w 1 Careful Planning & Monitoring is Essential 2 01 as they are Anchorage-Demanding! i2 aw Patient Co-operation & Good Oral Hygiene 3 am are Essential for Success iS Special Training & Expertise Required as can 4 ad cause Potential Problems in all 3 Dimensions! Sh ©
  • 146. .joIN THIS PRESENTATION oc d .s w w |w Sequelae of Biology of Malocclusion Tooth Movement 1 01 Orthodontic i2 aw Retention & Relapse am Removable, Fixed & iS Functional Appliances ad Sh ©
  • 147. .joORTHODONTIC RETENTION & RELAPSE doc .s Definition Relapse w w |w 1 01 The Return of Some or All i2 British aw Features of the Original Standards am Malocclusion Following Institute iS Orthodontic Correction. ad Sh ©
  • 148. .joORTHODONTIC RETENTION & RELAPSE oc d .s Aetiology Relapse w w |w 1 01 Gingivae & Occlusion i2 Periodontium aw am iS Age & Soft Tissue ad Growth Sh ©
  • 149. .joORTHODONTIC RETENTION & RELAPSE d oc .s Aetiology 1. Gingival & Periodontal Factors w w |w Alveolar Bone 1 01 i2 Prinicpal Fibers aw am Collagen Fibers iS Elastic Fibers ad Sh 0 1 2 3 4 5 6 7 8 Remodeling Time (Months) ©
  • 150. .joORTHODONTIC RETENTION & RELAPSE d oc .s Aetiology 1. Gingival & Periodontal Factors w w |w Alveolar Bone 1 01 i2 Prinicpal Fibers aw am Collagen Fibers iS Elastic Fibers ad Sh 0 1 2 3 4 5 6 7 8 Remodeling Time (Months) ©
  • 151. .joORTHODONTIC RETENTION & RELAPSE d oc .s Aetiology 1. Gingival & Periodontal Factors w w |w Alveolar Bone 1 01 i2 Prinicpal Fibers aw am Collagen Fibers iS Elastic Fibers ad Sh 0 1 2 3 4 5 6 7 8 Remodeling Time (Months) ©
  • 152. .joORTHODONTIC RETENTION & RELAPSE d oc .s Aetiology 1. Gingival & Periodontal Factors w w |w Alveolar Bone 1 01 i2 Prinicpal Fibers aw am Collagen Fibers iS Elastic Fibers ad Sh 0 1 2 3 4 5 6 7 8 Remodeling Time (Months) ©
  • 153. .joORTHODONTIC RETENTION & RELAPSE oc d .s Aetiology 2. Occlusal Factors w w |w 1 01 Good Interdigitation at end of Treatment i2 aw is likely to be More Stable.. am .. No Clear Evidence! iS ad Sh ©
  • 154. .joORTHODONTIC RETENTION & RELAPSE oc d .s Aetiology 2. Occlusal Factors w w |w 1 01 Good Interdigitation at end of Treatment i2 aw is likely to be More Stable.. am .. No Clear Evidence! iS ad BUT... Sh ©
  • 155. .joORTHODONTIC RETENTION & RELAPSE doc .s Aetiology 2. Occlusal Factors w w |w .. Clear Situations ?? 1 01 i2 aw am iS ad Sh Edge - Centroid Relationship Corrected Labial Cross-bite ©
  • 156. .joORTHODONTIC RETENTION & RELAPSE doc .s Aetiology 2. Occlusal Factors w w |w .. Clear Situations ?? 1 01 i2 aw am iS ad Sh Edge - Centroid Relationship Corrected Labial Cross-bite ©
  • 157. .joORTHODONTIC RETENTION & RELAPSE doc .s Aetiology 3. Soft Tissue Factors w w |w 1 Neutral Zone Lip Forces 01 + Periodontal Forces i2A Theoretical Area aw =of Tooth Balance amBetween the Lips Tongue iSand Tongue. Forces ad Sh ©
  • 158. .joORTHODONTIC RETENTION & RELAPSE doc .s Aetiology 3. Soft Tissue Factors w w |w 1 Neutral Zone Lip Forces 01 + Periodontal Forces i2A Theoretical Area aw =of Tooth Balance amBetween the Lips Tongue iSand Tongue. Forces ad Sh ©
  • 159. .joORTHODONTIC RETENTION & RELAPSE doc .s Aetiology 3. Soft Tissue Factors w w |w 1 The Most Stable Archform is 01 Archform the Patients Original Archform. i2 aw am Inter-Canine Inter-Molar Inter-Premolar < < iS Width Width Width ad Sh ©
  • 160. .joORTHODONTIC RETENTION & RELAPSE doc .s Aetiology 3. Soft Tissue Factors w w |w 1 The Most Stable Archform is 01 Archform the Patients Original Archform. i2 aw am iS ad Sh ©
  • 161. .joORTHODONTIC RETENTION & RELAPSE doc .s Aetiology 4. Age & Growth Factors w w |w Out of the Orthodontists Control! 1 01 i2 Small Growth aw & Age Changes Risk of Relapse with Time am Late Lower Incisor Crowding ? iS Soft Tissue Changes ad Sh ©
  • 162. .joORTHODONTIC RETENTION & RELAPSE oc d .s Retention To Reduce Relapse! w w |w 1 •Initial Malocclusion 01 Retention •Likely Stability ? i2 aw Regimen •Quality of End-Result am depends on: •Compliance/Oral Hygiene iS •Patient Preference ? ad Sh ©
  • 163. .joORTHODONTIC RETENTION & RELAPSE oc d .s Retainers Removable Or Fixed ? w w |w 1Removable Retainers 01 Hawley i2 aw Retainer am & Variations.. iS ad Sh ©
  • 164. .joORTHODONTIC RETENTION & RELAPSE oc d .s Retainers Removable Or Fixed ? w w |w 1Removable Retainers 01 i2 aw Vacuum-formed am (Essix) Retainer iS ad Sh ©
  • 165. .joORTHODONTIC RETENTION & RELAPSE oc d .s Retainers Removable Or Fixed ? w w |w 1 Fixed Retainers 01 i2 0.0195 inch aw Multi-strand am Stainless Steel Wire iS ad Sh ©
  • 166. .joORTHODONTIC RETENTION & RELAPSE oc d .s Retention Adjunctive Techniques w w |w Pericision 1 01 i2 aw Cutting gingival fibers between and around certain am teeth, after correction of iS severe rotations ad Sh ©
  • 167. .joORTHODONTIC RETENTION & RELAPSE doc .s Retention Adjunctive Techniques w w |w Re-proximation 1 01 i2 aw Interdental Enamel Stripping am 0.25mm limit iS from either tooth contact ad Sh ©
  • 168. .joKEY POINTS d oc .s w Relapse is an Unpredictable Risk 1 w for Every Orthodontic Patient ! |w 1 Can be due to Orthodontic Factors, but also 2 01 due to Age Changes out of our Control! i2 aw Removable & Fixed Retainers are used to Reduce 3 am Relapse along with Adjunctive Techniques iS Patients must be aware of the Long-term Risk of 4 ad Relapse, as well as Ways to Reduce that Risk. Sh ©
  • 169. .joRESOURCES oc d .s w w |w 1 01 i2 aw am iS ad Introduction to Orthodontics.1 Sh 3 rd Edition; 2007 | by Laura Mitchell ©
  • 170. .joRESOURCES oc d .s w w |w 1 01 i2 aw am iS ad Contemporary Orthodontics.2 Sh 4th Edition; 2007 | by William R. Proffit ©
  • 171. .joRESOURCES oc d .s w PDF w |w 1 01 i2 aw am iS ad Download this Presentation as a PDF3 Sh From www.sdoc.jo ©
  • 172. THANK YOU.. & GOOD LUCK!