Chin cups are a traditional orthopedic appliance used to treat Class III malocclusions. While some studies have found chin cups can temporarily retard mandibular growth and correct the malocclusion through backward rotation, the effects are not consistently maintained long-term. Meta-analyses found chin cups significantly reduced SNB angle and increased ANB and Wits appraisal in the short-term, but heterogeneity between studies was high. Chin cups also increased SN-ML angle and decreased gonial angle, indicating a tendency for increased vertical growth and posterior mandibular rotation. However, long-term stability and the effects of vertical chin cups require more research due to limited data.
Ricketts analysis /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document provides an overview of twin block therapy. It discusses the history, philosophy, design, construction, and stages of treatment using twin blocks. Twin blocks are functional appliances composed of separate upper and lower bite blocks. They are worn 24 hours a day to achieve rapid correction of malocclusions through forces transmitted to inclined planes covering the posterior teeth. Treatment typically involves an initial active phase followed by a support phase to stabilize results.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Frankles appliance Is a myofunctional appliance
Functional appliance are removable or fixed appliances that aim to utilize eliminate or guide the forces arising from muscle function,tooth eruption and growth inorder to alter skeletal and dental relationship
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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This document discusses various aspects of orthodontic anchorage. It defines anchorage and provides classifications including according to the manner of force application, the jaws involved, and the site of anchorage. Biological aspects are covered such as factors affecting an individual tooth's anchorage value like the number, shape, and length of roots. Mechanical aspects include using force couples to restrict unwanted tooth movement. Different anchorage reinforcement techniques are presented such as extraoral appliances, implants, and temporary anchorage devices.
This document discusses the Kesling diagnostic setup, which is a supplemental diagnostic aid involving trimming and repositioning teeth on study casts to simulate various planned tooth movements. It requires well-trimmed study casts, fret saws, modelling wax, and other tools. The procedure involves making horizontal and vertical cuts in the mandibular cast to separate individual teeth, which are then repositioned and held in place with wax. This setup allows visualization of tooth alignment under treatment plans and can help determine anchorage needs, aid in patient motivation, and identify borderline extraction cases.
Dr. Viken Sassouni developed a cephalometric analysis method based on craniofacial x-rays of 100 children. He identified planes, arcs, and points to analyze facial proportions and classify facial patterns. A well-proportioned face has four planes intersecting at point O and equal upper/lower anterior and posterior facial heights. Sassouni found most faces were Type II patterns. His analysis considered vertical and horizontal relationships and classified occlusions, palates, profiles, and dental axes. He concluded that "normal" is relative and proportions are more important than absolute measurements.
Ricketts analysis /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document provides an overview of twin block therapy. It discusses the history, philosophy, design, construction, and stages of treatment using twin blocks. Twin blocks are functional appliances composed of separate upper and lower bite blocks. They are worn 24 hours a day to achieve rapid correction of malocclusions through forces transmitted to inclined planes covering the posterior teeth. Treatment typically involves an initial active phase followed by a support phase to stabilize results.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Frankles appliance Is a myofunctional appliance
Functional appliance are removable or fixed appliances that aim to utilize eliminate or guide the forces arising from muscle function,tooth eruption and growth inorder to alter skeletal and dental relationship
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses various aspects of orthodontic anchorage. It defines anchorage and provides classifications including according to the manner of force application, the jaws involved, and the site of anchorage. Biological aspects are covered such as factors affecting an individual tooth's anchorage value like the number, shape, and length of roots. Mechanical aspects include using force couples to restrict unwanted tooth movement. Different anchorage reinforcement techniques are presented such as extraoral appliances, implants, and temporary anchorage devices.
This document discusses the Kesling diagnostic setup, which is a supplemental diagnostic aid involving trimming and repositioning teeth on study casts to simulate various planned tooth movements. It requires well-trimmed study casts, fret saws, modelling wax, and other tools. The procedure involves making horizontal and vertical cuts in the mandibular cast to separate individual teeth, which are then repositioned and held in place with wax. This setup allows visualization of tooth alignment under treatment plans and can help determine anchorage needs, aid in patient motivation, and identify borderline extraction cases.
Dr. Viken Sassouni developed a cephalometric analysis method based on craniofacial x-rays of 100 children. He identified planes, arcs, and points to analyze facial proportions and classify facial patterns. A well-proportioned face has four planes intersecting at point O and equal upper/lower anterior and posterior facial heights. Sassouni found most faces were Type II patterns. His analysis considered vertical and horizontal relationships and classified occlusions, palates, profiles, and dental axes. He concluded that "normal" is relative and proportions are more important than absolute measurements.
RAPID MAXILLARY EXPANSION VS SLOW MAXILLARY EXPANSIONShehnaz Jahangir
This document provides an overview of rapid maxillary expansion (RME) vs slow maxillary expansion (SME). It discusses the historical perspective of maxillary expansion, articulation and ossification of the midpalatal suture, indications and contraindications for expansion, classifications based on activation and support, examples of RME and SME appliances, activation protocols, and the biomechanical aspects and effects of RME on skeletal and dental structures. Key differences between RME and SME include the rate of activation (rapid vs slow) and appliances used (tooth-borne vs tissue-borne).
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses the correction of Class 3 skeletal problems using reverse pull headgear or facemasks. It begins by describing Class 3 malocclusions that are due to maxillary deficiency or mandibular excess. It then discusses the types and etiology of Class 3 malocclusions. Reasons for treating Class 3 issues are provided. The document focuses on describing reverse pull headgear and facemasks, including their definition, indications, components, types, force parameters, biomechanics, treatment completion indications, advantages, and effects.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Orthodontic tooth movements and biomechanics.Sk Aziz Ikbal
The document discusses biomechanics principles related to orthodontic tooth movement. It covers topics such as:
- Forces applied to teeth can cause movement through bone remodeling.
- Biomechanics refers to mechanics applied to biological systems. Knowledge of forces is needed to control orthodontic treatment.
- Teeth can move through light forces during normal function but heavier sustained forces over 1 second are needed for orthodontic tooth movement.
- Forces have magnitude and direction, while scalars only have magnitude. Resultant forces and moments from multiple applied forces are calculated.
- Different force systems and moment-to-force ratios produce different types of tooth movement such as tipping, translation, rotation, and torque.
This document discusses various fixed appliance techniques for maxillary arch expansion. It begins by classifying expansion appliances based on whether they are fixed or removable, and whether they provide rapid/orthopedic or slow/dentoalveolar expansion. It then describes several common fixed appliances for rapid and slow maxillary expansion, including tooth-borne appliances like Hyrax and tooth/tissue-borne appliances like Haas. The document discusses the effects of rapid maxillary expansion on the maxilla and mandible, as well as indications/contraindications and clinical management of rapid maxillary expansion. It concludes by mentioning bonded rapid palatal expanders as an alternative to banded appliances.
This document summarizes Nance appliances, transpalatal arches, and quad helix appliances. It describes the design, indications, and disadvantages of each appliance. For transpalatal arches, it notes they are used to prevent mesial migration of upper first molars and can provide anchorage, arch width stabilization, and be used as a retainer. Quad helix appliances are used to expand arches and derotate molars through a fan-like sweeping action. Nance appliances maintain posterior tooth positions and can be modified to provide an anterior bite plane.
This document provides information on performing a functional examination as part of an orthodontic diagnosis. It discusses examining the postural rest position and maximum intercuspation, as well as the temporomandibular joint, orofacial dysfunction, and various functional movements. Methods for determining and registering the postural rest position are described. Examination of swallowing, tongue posture, speech, lips, respiration, and craniofacial skeletal relationships are also covered to evaluate orofacial dysfunction. The document emphasizes that a functional examination is important for a complete orthodontic diagnosis beyond just a static evaluation of dental relationships.
This document discusses the management of open bite malocclusions. It begins by defining open bite and classifying it as either skeletal or dental in nature. Skeletal open bite is caused by excessive vertical growth of the jaws while dental open bite is due to reduced incisor height. Common etiologies of open bite include thumb sucking habits, tongue thrusting, and abnormal skeletal growth patterns. The document outlines various treatment approaches for different open bite classifications and etiologies.
Anchorage management is essential in orthodontics to control unwanted tooth movement during treatment. Various classifications and sources of anchorage are discussed. Anchorage planning and different savers like reinforcement, subdivision, tipping, and skeletal anchorage can help minimize anchorage loss. Different appliance systems utilize anchorage differently, like the edgewise appliance relying on distal tipping of posterior teeth to neutralize forces. Maintaining optimal force levels and proper anchorage are key to achieving desired tooth movements.
This document provides information on headgear, including its components, principles of use, types, and applications in orthodontic treatment. Headgear delivers extraoral force from a cranial support to intraoral appliances. It consists of a facebow, force element, and head cap. Forces from headgear can distalize teeth and maxilla through different anchorage points. Types include cervical, occipital, and high pull headgear. Headgear is useful for orthopedic effects, anchorage reinforcement, molar distalization, and space maintenance.
This document describes Dr. Duane Grummons' posteroanterior (PA) cephalometric analysis for evaluating facial asymmetry. The analysis involves constructing reference lines and planes to compare bilateral landmarks and structures. Measurements are made of linear distances, angles, ratios and volumetric comparisons. The comprehensive analysis evaluates multiple structures and parameters while the summary analysis focuses on key dental and skeletal factors. The analysis is useful for orthodontic-surgical treatment planning to determine the extent and location of asymmetries and surgical corrections needed.
The document discusses various concepts related to mandibular growth rotations proposed by different orthodontic researchers over time. It begins by introducing Arne Bjork who first described growth rotations in 1955. It then covers Enlow's concept of remodeling and displacement rotations. Bjork's 1969 classification of forward and backward mandibular rotations is described, including his identification of three types of forward and two types of backward rotations based on their center of rotation. The document also discusses concepts by Bjork and Skieller on total, matrix, and intramatrix rotations. Fred Schudy's concept relating rotation to the disharmony between vertical, anteroposterior and horizontal growth is summarized. Finally, Dibbets' re
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document summarizes Dr. Pratik Yadav's journal club presentation on Downs WB Analysis of the dento-facial profile. It discusses the 10 parameters in Downs analysis, which includes 5 skeletal and 5 dental measurements. The parameters are measured based on landmarks and reference planes on lateral cephalograms. Downs analysis is one of the most commonly used cephalometric analyses originally developed based on Caucasian patients with excellent occlusion.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses the Cervical Vertebral Maturation (CVM) method for assessing optimal treatment timing in dentofacial orthopedics. CVM uses the shape of cervical vertebrae on lateral cephalograms to determine skeletal maturity. There are 6 stages from pre-pubertal to post-pubertal. Treatment effects are greater if timed around pubertal growth spurts - class II treatment works best in CS3-CS4, class III works best before puberty, and vertical issues work best at CS3. Maxillary effects are greater before puberty while mandibular effects are greater during puberty.
Rakosi's analysis is an important diagnostic tool for planning functional appliance therapy. It involves analyzing three divisions: 1) the facial skeleton, 2) the jaw bones, and 3) the dentoalveolar relationship. Key measurements of the facial skeleton include saddle, articular, and gonial angles which provide information about cranial base orientation and mandibular positioning. Measurements of the jaw bones like SNA, SNB, and inclination angle describe the maxillary and mandibular skeletal bases. Dentoalveolar measurements such as upper and lower incisor angles indicate incisor inclinations. Rakosi's analysis provides a comprehensive evaluation of skeletal, dental, and soft tissue structures for orthodontic
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses molar distalization, which is an alternative method for gaining space when treating orthodontic patients with space deficiencies. It provides the history of molar distalization, indications and contraindications for its use, different appliance options, and considerations for appliance selection. Molar distalization involves using orthodontic appliances to distalize or move the molars backwards in the dental arch in order to gain space.
This document discusses orthopedic appliances used for growth modification. It describes three main types of orthopedic appliances: headgears, protraction face masks, and chin cups. Headgears are the most widely used and can be cervical, occipital, or a combination to modify maxillary growth. Protraction face masks apply an anterior protractory force on the maxilla through facial anchorage from the chin and/or forehead. Chin cups provide anchorage from the chin area. The key principles of orthopedic appliance therapy are applying heavy intermittent forces through teeth to modify bone growth at sutures and growth sites.
Class III malocclusion is characterized by the mandible being positioned forward in relation to the maxilla. It can be caused by a skeletal imbalance with a long mandible or forward placement of the mandibular fossa, or pseudoclass III due to habits. Treatment may involve growth modification using reverse headgear or chin cups in growing patients, orthodontic correction, or orthognathic surgery to correct severe skeletal discrepancies. The severity, growth potential, and dentoalveolar compensation must be considered to determine the best treatment approach.
RAPID MAXILLARY EXPANSION VS SLOW MAXILLARY EXPANSIONShehnaz Jahangir
This document provides an overview of rapid maxillary expansion (RME) vs slow maxillary expansion (SME). It discusses the historical perspective of maxillary expansion, articulation and ossification of the midpalatal suture, indications and contraindications for expansion, classifications based on activation and support, examples of RME and SME appliances, activation protocols, and the biomechanical aspects and effects of RME on skeletal and dental structures. Key differences between RME and SME include the rate of activation (rapid vs slow) and appliances used (tooth-borne vs tissue-borne).
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses the correction of Class 3 skeletal problems using reverse pull headgear or facemasks. It begins by describing Class 3 malocclusions that are due to maxillary deficiency or mandibular excess. It then discusses the types and etiology of Class 3 malocclusions. Reasons for treating Class 3 issues are provided. The document focuses on describing reverse pull headgear and facemasks, including their definition, indications, components, types, force parameters, biomechanics, treatment completion indications, advantages, and effects.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Orthodontic tooth movements and biomechanics.Sk Aziz Ikbal
The document discusses biomechanics principles related to orthodontic tooth movement. It covers topics such as:
- Forces applied to teeth can cause movement through bone remodeling.
- Biomechanics refers to mechanics applied to biological systems. Knowledge of forces is needed to control orthodontic treatment.
- Teeth can move through light forces during normal function but heavier sustained forces over 1 second are needed for orthodontic tooth movement.
- Forces have magnitude and direction, while scalars only have magnitude. Resultant forces and moments from multiple applied forces are calculated.
- Different force systems and moment-to-force ratios produce different types of tooth movement such as tipping, translation, rotation, and torque.
This document discusses various fixed appliance techniques for maxillary arch expansion. It begins by classifying expansion appliances based on whether they are fixed or removable, and whether they provide rapid/orthopedic or slow/dentoalveolar expansion. It then describes several common fixed appliances for rapid and slow maxillary expansion, including tooth-borne appliances like Hyrax and tooth/tissue-borne appliances like Haas. The document discusses the effects of rapid maxillary expansion on the maxilla and mandible, as well as indications/contraindications and clinical management of rapid maxillary expansion. It concludes by mentioning bonded rapid palatal expanders as an alternative to banded appliances.
This document summarizes Nance appliances, transpalatal arches, and quad helix appliances. It describes the design, indications, and disadvantages of each appliance. For transpalatal arches, it notes they are used to prevent mesial migration of upper first molars and can provide anchorage, arch width stabilization, and be used as a retainer. Quad helix appliances are used to expand arches and derotate molars through a fan-like sweeping action. Nance appliances maintain posterior tooth positions and can be modified to provide an anterior bite plane.
This document provides information on performing a functional examination as part of an orthodontic diagnosis. It discusses examining the postural rest position and maximum intercuspation, as well as the temporomandibular joint, orofacial dysfunction, and various functional movements. Methods for determining and registering the postural rest position are described. Examination of swallowing, tongue posture, speech, lips, respiration, and craniofacial skeletal relationships are also covered to evaluate orofacial dysfunction. The document emphasizes that a functional examination is important for a complete orthodontic diagnosis beyond just a static evaluation of dental relationships.
This document discusses the management of open bite malocclusions. It begins by defining open bite and classifying it as either skeletal or dental in nature. Skeletal open bite is caused by excessive vertical growth of the jaws while dental open bite is due to reduced incisor height. Common etiologies of open bite include thumb sucking habits, tongue thrusting, and abnormal skeletal growth patterns. The document outlines various treatment approaches for different open bite classifications and etiologies.
Anchorage management is essential in orthodontics to control unwanted tooth movement during treatment. Various classifications and sources of anchorage are discussed. Anchorage planning and different savers like reinforcement, subdivision, tipping, and skeletal anchorage can help minimize anchorage loss. Different appliance systems utilize anchorage differently, like the edgewise appliance relying on distal tipping of posterior teeth to neutralize forces. Maintaining optimal force levels and proper anchorage are key to achieving desired tooth movements.
This document provides information on headgear, including its components, principles of use, types, and applications in orthodontic treatment. Headgear delivers extraoral force from a cranial support to intraoral appliances. It consists of a facebow, force element, and head cap. Forces from headgear can distalize teeth and maxilla through different anchorage points. Types include cervical, occipital, and high pull headgear. Headgear is useful for orthopedic effects, anchorage reinforcement, molar distalization, and space maintenance.
This document describes Dr. Duane Grummons' posteroanterior (PA) cephalometric analysis for evaluating facial asymmetry. The analysis involves constructing reference lines and planes to compare bilateral landmarks and structures. Measurements are made of linear distances, angles, ratios and volumetric comparisons. The comprehensive analysis evaluates multiple structures and parameters while the summary analysis focuses on key dental and skeletal factors. The analysis is useful for orthodontic-surgical treatment planning to determine the extent and location of asymmetries and surgical corrections needed.
The document discusses various concepts related to mandibular growth rotations proposed by different orthodontic researchers over time. It begins by introducing Arne Bjork who first described growth rotations in 1955. It then covers Enlow's concept of remodeling and displacement rotations. Bjork's 1969 classification of forward and backward mandibular rotations is described, including his identification of three types of forward and two types of backward rotations based on their center of rotation. The document also discusses concepts by Bjork and Skieller on total, matrix, and intramatrix rotations. Fred Schudy's concept relating rotation to the disharmony between vertical, anteroposterior and horizontal growth is summarized. Finally, Dibbets' re
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document summarizes Dr. Pratik Yadav's journal club presentation on Downs WB Analysis of the dento-facial profile. It discusses the 10 parameters in Downs analysis, which includes 5 skeletal and 5 dental measurements. The parameters are measured based on landmarks and reference planes on lateral cephalograms. Downs analysis is one of the most commonly used cephalometric analyses originally developed based on Caucasian patients with excellent occlusion.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses the Cervical Vertebral Maturation (CVM) method for assessing optimal treatment timing in dentofacial orthopedics. CVM uses the shape of cervical vertebrae on lateral cephalograms to determine skeletal maturity. There are 6 stages from pre-pubertal to post-pubertal. Treatment effects are greater if timed around pubertal growth spurts - class II treatment works best in CS3-CS4, class III works best before puberty, and vertical issues work best at CS3. Maxillary effects are greater before puberty while mandibular effects are greater during puberty.
Rakosi's analysis is an important diagnostic tool for planning functional appliance therapy. It involves analyzing three divisions: 1) the facial skeleton, 2) the jaw bones, and 3) the dentoalveolar relationship. Key measurements of the facial skeleton include saddle, articular, and gonial angles which provide information about cranial base orientation and mandibular positioning. Measurements of the jaw bones like SNA, SNB, and inclination angle describe the maxillary and mandibular skeletal bases. Dentoalveolar measurements such as upper and lower incisor angles indicate incisor inclinations. Rakosi's analysis provides a comprehensive evaluation of skeletal, dental, and soft tissue structures for orthodontic
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses molar distalization, which is an alternative method for gaining space when treating orthodontic patients with space deficiencies. It provides the history of molar distalization, indications and contraindications for its use, different appliance options, and considerations for appliance selection. Molar distalization involves using orthodontic appliances to distalize or move the molars backwards in the dental arch in order to gain space.
This document discusses orthopedic appliances used for growth modification. It describes three main types of orthopedic appliances: headgears, protraction face masks, and chin cups. Headgears are the most widely used and can be cervical, occipital, or a combination to modify maxillary growth. Protraction face masks apply an anterior protractory force on the maxilla through facial anchorage from the chin and/or forehead. Chin cups provide anchorage from the chin area. The key principles of orthopedic appliance therapy are applying heavy intermittent forces through teeth to modify bone growth at sutures and growth sites.
Class III malocclusion is characterized by the mandible being positioned forward in relation to the maxilla. It can be caused by a skeletal imbalance with a long mandible or forward placement of the mandibular fossa, or pseudoclass III due to habits. Treatment may involve growth modification using reverse headgear or chin cups in growing patients, orthodontic correction, or orthognathic surgery to correct severe skeletal discrepancies. The severity, growth potential, and dentoalveolar compensation must be considered to determine the best treatment approach.
Myofunctional appliances in orthodonticbilal falahi
This document discusses different types of removable functional appliances used in orthodontic treatment, including activators, bionators, and Frankel function regulators. Activators are loose-fitting appliances that guide muscle forces to correct skeletal discrepancies like retrognathic mandibles. Bionators are less bulky than activators and can be worn full-time, using tongue posture modification to guide growth. Frankel function regulators aim to re-educate muscle balance through controlled orthopedic exercises.
This document provides an overview of functional appliances used in orthodontic treatment. It begins with definitions of functional appliances and a brief history of their development. It then discusses the basis, classification, forces, treatment principles, indications, actions, case selection, and common appliances like the activator, frankel regulator, bionator, twin block, and Herbst appliance. It provides details on their design, indications, mode of action, and advantages. In summary, the document serves as a comprehensive guide to functional appliances, their development and use in orthodontic treatment.
1. Class III malocclusion is characterized by the lower incisors positioned anterior to the upper incisors with a reduced or negative overjet.
2. The main causes are skeletal patterns like mandibular prognathism, maxillary retrognathism, or a combination of both.
3. Treatment depends on the severity and can include growth modification with functional appliances, orthodontic camouflage, or orthognathic surgery.
Molar distalization /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Biomechanics of molar distalization appliance /certified fixed orthodontic c...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Early vs late orthodontic treatment /certified fixed orthodontic courses by I...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Headgear /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
This document discusses functional appliances used in orthodontic treatment. It describes the advantages and disadvantages of functional appliances, how they work to produce orthopedic, dentoalveolar and muscular changes, different types of functional appliances including activators and Frankel regulators, and guidelines for use and patient instruction.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Copy of biomech of head gear /certified fixed orthodontic courses by Indian d...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses various methods and appliances for distalizing maxillary molars, including removable and fixed options. Removable appliances discussed include extraoral traction using headgear as well as removable appliances with finger springs or sliding jigs. Fixed appliances discussed include intramaxillary devices like Wilson's 3D appliance as well as intermaxillary appliances like Herbst or Jasper Jumper. Factors like the presence of second molars, skeletal pattern, and growth prognosis must be considered when determining whether molar distalization is indicated.
This document provides information about molar distalization, including:
- Molar distalization involves moving molars backwards to correct malocclusions.
- Various appliances can be used for molar distalization, including headgear, K-loops, and pendulum appliances.
- Treatment planning for molar distalization generally involves two phases - a space gaining phase followed by a consolidation phase to achieve ideal occlusion.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Molar distalisation /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
This document discusses current trends in molar distalization. It begins by explaining that orthodontic treatment philosophies now aim to avoid extractions and rely less on patient cooperation, leading to development of various appliances for distalizing maxillary molars. Removable appliances include headgear and finger springs, while fixed appliances include intra- and intermaxillary devices like pendulums, magnets, and coils. Factors like second molar eruption and skeletal patterns influence distalization. A proper diagnosis is needed to determine if distalization is indicated based on growth prognosis and sagittal relationships. Contraindications include high mandibular planes and open bites.
1) Mandibular molar protraction is challenging due to the high density of mandibular bone and inadequate anterior dental anchorage. Temporary anchorage devices (TADs) provide skeletal anchorage to protract molars.
2) Various TAD techniques are described for molar protraction, including using a lingual elastic tied from the molar to the archwire to prevent crossbite, and a "push-pull" technique placing a TAD in the edentulous space.
3) Molar protraction through atrophic alveolar ridges carries risks of periodontal complications, so techniques are described to minimize risks and protract molars at their center of resistance.
This document provides an overview of orthopedic appliances used to modify maxillary and mandibular growth. It discusses the principles, types (e.g. headgear, facemask), biomechanics, and clinical applications of these extraoral appliances. Key points covered include the magnitudes, durations, and directions of optimal orthopedic forces; the use of headgears like cervical pull, high pull, and combinations; and the goals of growth modification to alter skeletal relationships and avoid surgery.
Cervical traction is used during active clinical crown height stage of teeth to place the inner bow close to the center of resistance of the first molar, which is near the trifurcation of roots. The inner bow has stops to maintain a 4-6mm space between the bow and incisors. A Kloehn facebow is a cervical headgear used to redirect maxillary growth in class II division 1 malocclusions involving maxillary excess during mixed dentition stage. It utilizes orthopedic forces from the outer bow connected to the tragus to restrain maxillary growth and distalize the dentition.
This document discusses early orthopedic correction of Class III malocclusions using chin cups. It provides context on when chin cup treatment is indicated, effectiveness in young children, necessary forces, wear time, and factors that influence treatment outcome. The document also examines different types of Class III malocclusions, including pseudo-Class III vs skeletal Class III, and outlines diagnostic criteria and assessments used in evaluation and treatment planning.
Class II division 1 malocclusion features a retrognathic mandible or prognathic maxilla. Clinical findings include a distal step in the deciduous molars and large overjet in mixed/permanent dentition. Cephalometric findings show maxillary protrusion or mandibular retrusion. Early intervention includes addressing habits, using a cervical headgear with facebow to restrain maxillary growth and distalize the upper dentition into a Class I relationship. Treatment effects include reducing maxillary protrusion while allowing normal mandibular growth.
Maxillary protraction /certified fixed orthodontic courses by Indian dental ...Indian dental academy
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This document discusses maxillary protraction, which is a common treatment for Class III malocclusions involving a deficient midface. It involves using headgear to apply forward force on the maxilla to correct the skeletal discrepancy. The document covers the history and development of maxillary protraction appliances, treatment effects, optimal timing, benefits of combining with rapid maxillary expansion, and different appliance designs.
This document discusses class II division 1 malocclusion, including its prevalence, clinical and cephalometric features, and early intervention. Key points include:
- Class II malocclusions are common and involve a distal positioning of the mandible or protrusion of the maxilla.
- Early signs include a distal step of the deciduous molars. Treatment aims to guide normal mandibular growth.
- Kloehn headgear can be used in the early mixed dentition to restrain maxillary growth and correct the class II relationship.
- Class II malocclusion involves a protrusive maxilla and/or retrusive mandible. Kloehn facebow can be used in early mixed dentition to restrain maxillary growth and allow mandibular growth. It improves the skeletal and dental profile through reducing overjet and protrusion.
- Treatment involves cervical headgear worn 12-14 hours per day for 12 months to distalize maxillary molars and inhibit maxillary growth. This is followed by fixed appliance therapy to maintain correction.
This document discusses the classification and management of Class II Division 1 malocclusions. It describes six main horizontal facial types (A through F) and five vertical types based on skeletal patterns. Treatment involves growth modification using functional appliances or headgear in growing patients, camouflage orthodontics using extractions or non-extraction approaches in non-growing patients, or orthognathic surgery for more severe skeletal discrepancies. The goal is to correct the Class II malocclusion through altering jaw positions and modifying facial growth.
Class II malocclusion is characterized by a distal relationship of the mandibular dentition relative to the maxillary dentition. It has several craniofacial and dental features including a retruded mandible, large overjet, and distal step relationship of the deciduous molars. Early intervention with a Kloehn facebow can redirect maxillary growth and correct the class II relationship in growing children. The facebow applies orthopedic forces to restrain maxillary growth while allowing normal mandibular growth.
This document discusses class II division 1 malocclusion, including its prevalence, clinical and cephalometric findings, and early intervention. Class II malocclusion is the second most common malocclusion and is characterized by a distal positioning of the mandibular molars or maxillary protrusion. Clinically, it presents with a large overjet and deep bite. Cephalometrically, it is associated with a retruded mandible. Early intervention focuses on maintaining a class I molar relationship through restoration of caries, habit correction, and the use of headgear in cases of maxillary excess to guide alveolar growth.
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Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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The document discusses Class II division 1 malocclusion, including its prevalence, clinical and cephalometric findings, and interceptive treatment using a Kloehn facebow during the mixed dentition stage to restrain maxillary growth and distalize the upper dentition into a Class I relationship. Cervical headgear with a facebow is recommended from late mixed dentition to beginning of permanent dentition to correct maxillary protrusion and achieve a Class I molar and canine relationship.
This document discusses Class II division 1 malocclusion, including its prevalence, clinical findings, and early intervention. Key points include:
- Class II malocclusion is characterized by a distal step in the deciduous molars and is the second most common malocclusion.
- Clinical findings include overjet, overbite, protrusive midface, and retrusive chin. Cephalometric findings show maxillary protrusion or mandibular retrusion.
- Early intervention involves maintaining dental health, addressing habits, and using cervical headgear to restrain maxillary growth and distalize the upper dentition into a Class I relationship. Headgear is most effective when started in late mixed or early permanent dentition
1. Class II malocclusion is characterized by a distal relationship of the mandibular teeth relative to the maxillary teeth and has a prevalence that varies among populations.
2. Clinical findings may include a distal step relationship between the deciduous molars, large overjet, deep bite, and a retruded mandible.
3. Early intervention for growing maxillary excess can include the use of a Kloehn facebow headgear to redirect maxillary growth and prevent worsening of the class II relationship.
Class III malocclusion occurs when the mandible is positioned forward in relation to the maxilla. It can be caused by maxillary deficiency, mandibular excess, or a combination. Diagnosis involves measuring angles like ANB and Wits appraisal. Treatment depends on the underlying skeletal discrepancy and may involve functional appliances to guide growth, facemasks to protract the maxilla, or chin cups to restrain mandibular growth. For older patients, camouflage options like extractions and orthodontic tooth movement are used. Early treatment is preferred to prevent adverse effects on facial growth and development.
- Class II malocclusion is characterized by a distal relationship between the maxillary and mandibular teeth. It has several craniofacial and skeletal features.
- Early signs in the deciduous and mixed dentitions include a distal step relationship between the second deciduous molars and transverse discrepancy.
- Treatment in the mixed dentition stage involves using a cervical headgear with facebow to restrain maxillary growth and distalize the upper dentition to achieve Class I molar and canine relationships.
This document discusses various treatment approaches for Class III malocclusion. It begins by defining Class III malocclusion and describing its prevalence and causes. It then discusses the controversies surrounding the timing of treatment, summarizing that early treatment is generally best when positive growth factors are present. The document evaluates several appliances that can be used for growth modification in younger patients, such as facemasks and chin cups. For older patients, it discusses camouflage orthodontic treatment using techniques like proclining incisors or extractions, as well as temporary anchorage devices. Finally, it briefly outlines orthognathic surgical options including mandibular osteotomies and maxillary procedures.
- Class II malocclusion is characterized by a distal positioning of the mandibular molars or mandible. It is the second most common malocclusion.
- Clinical findings include a distal step relationship of the deciduous molars, large overjet, deep bite, and procumbent upper incisors.
- Early intervention with a cervical headgear can restrict maxillary growth in growing children exhibiting maxillary excess to redirect their growth into a Class I occlusion.
Similar to Chin cup for treatment of growing class III patient (20)
Growth modification of different types of malocclusionbilal falahi
This document discusses different types of growth modification appliances used to treat malocclusions. It begins by explaining that growth modification uses remaining growth potential to alter jaw size and positioning. Key appliances discussed include the Andresen activator, twin block, and various types of headgear. Factors like timing of treatment, force magnitude, and duration of force application are reviewed. Both passive and active functional appliances are indicated, with considerations for skeletal, dental, and vertical discrepancies.
This document discusses serial extraction, which is an interceptive orthodontic procedure used to correct hereditary tooth-size discrepancies. It describes when serial extraction should be considered, between ages 6-12, and the criteria for determining if a patient is a suitable candidate. Ideal candidates have a Class I malocclusion with a true tooth-size discrepancy of 10mm or more. Contraindications include Class III maloccusions. A thorough examination and diagnostic records including radiographs and models are required to properly diagnose if serial extraction is appropriate.
Zygomatic anchorage ( mini plates ) in orthodontic bilal falahi
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2. Miniplates are surgically placed on the zygomatic bones and used to apply orthodontic forces from elastic threads or coils.
3. Several case reports describe using this technique to correct anterior open bites, close spaces, and intrude supererupted molars.
The document discusses posteroanterior (PA) cephalograms, which provide an effective tool for evaluating craniofacial structures. Key information that can be assessed from PA cephalograms includes facial asymmetries, widths of dental arches, and cant of the occlusal plane. Landmarks are identified and traced on the radiograph to perform analyses. The Grummons analysis is a quantitative method using planes and volumes to assess asymmetries. Overall, PA cephalograms allow for detailed evaluation of the dentofacial and craniofacial structures in the transverse and vertical dimensions.
The treatment of Class II Division 2 malocclusions involves three main steps:
1. Unlocking the malocclusion using appliances like the Quad-Helix or utility arch.
2. Torque control and intrusion of the upper incisors using a maxillary utility arch with activations. Stabilizing the molars is important during intrusion.
3. Intrusion of the lower incisors and cuspids using lower utility arches with activations to provide intrusive forces.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
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Public Health Lecture 4 Social Sciences and Public Health
Chin cup for treatment of growing class III patient
1. The Orthopedic Chin Cap
Prof. Maher fouda
Prepared by
Bilal A. Mohammed
Faculty of dentistry-
Mansoura university - Egypt
2. Background
A number of appliances are available for the treatment of Class III
malocclusion. Among them, chin cup holds a premium position as a
traditional appliance for the early orthopedic treatment of Class III
malocclusion. However, a thorough and in-depth investigation of the
literature reveals controversies and contradictions regarding both its
appropriate use and its clinical effectiveness.
3. Clinical results achieved with the chin cup also constitute a matter of
debate. Retardation or even sometimes restriction of mandibular growth is
supported by some authors (Proffit 2000, Bishara 2001 and Chang HP
2005), while such effects are questioned by others (Mc Namara
2005,Sugauara 2005, Oppenheim 1944, Thilander 1965).
Since no standard protocol has been followed from various clinicians, it is
evident that the effectiveness of the chin cup varies according to the exact
and individualized way of use and it ranges substantially between
investigators from minimal to great.
5. • The oldest of the orthopedic approaches to the treatment of
Class III malocclusion.
• - much of the research conducted on Asian populations due to
the higher incidences of Class III malocclusion in these groups.
6. - there are a wide variety of chin cup designs available commercially.
- in general these appliances can be divided into two types:-
1- The occipital-pull chin cup is used in instances of mandibular
prognathism.
2- the vertical-pull chin cup is used in patients with steep mandibular plane
angles and excessive lower anterior facial height.
7. occipital-pull chin cup
- indicated for use in patients with mild to moderate mandibular
prognathism.
- Success is greatest in those patients in the deciduous and
mixed dentition who can bring their incisors close to an edge to
edge position when in centric relation.
- useful particularly in patients who begin treatment with a short
lower anterior facial height, because this type of treatment can
lead to an increase in this dimension.
Soft elastic appliance. The direction of force is
determined by the position of the head cap
9. Force Magnitude and Direction
- Chin cups are divided into two types: the occipital-pull chin cup that is
used for patients with mandibular protrusion and the vertical-pull chin cup
that is used in patients presenting with a steep mandibular plane angle
and excessive anterior facial height.
- Most of the reported studies recommended an orthopedic force of 300-
500 grams per side. Patients are instructed to wear the appliance for 14
hrs/day.
10. Proffit recommended a force of approximately 16 ounces (450 gram) per
side through the head of the condyle or a somewhat lighter force below the
condyle. Once it is accepted that mandibular rotation is the major treatment
effect, lighter force oriented to produce greater rotation makes more sense.
From this perspective, it is apparent that more Asian than Caucasian
children can benefit from chin-cup treatment because of their generally
shorter face height and greater prevalence of lower incisor protrusion, not
because of a difference in the treatment response.
11. -
Once the anterior crossbite was corrected, the patient was
instructed to wear the chin cup at least 10 hours per day until
slight Class II canine and molar relationships were established.
12. Direction of force
- If the pull directed below the condyle, the force of the
may lead to a downward and backward rotation of the
mandible.
- If no opening of the mandibular plane angle is desired, the
should be directed through the condyle to help restrict
mandibular growth.
13. Hickam-type headgear. Used as anchorage for a hard chin cup. The direction of pull can
be adjusted according to the placement of the elastics.
14. - If no increase in lower anterior facial height is desired, the vertical-pull
chin cup can be used.
15. The use of a Hickham-type headcap combined with a hard chin
cup allows for variable vectors of force to be produced on the
lower jaw.
The direction of pull can be adjusted according to the placement of the elastics.
16. A study by Schulz and co-workers that compared the vertical-pull chin cup
combined with the bonded acrylic splint expander to the bonded expander
used alone in high-angle patients indicated that a modest improvement can
be obtained in the mandibular plane angle and in lower anterior facial height
with the use of the vertical-pull chin cup.
17. - One of the easiest of the vertically directed chin cups to manipulate
clinically is shown in the figure below.
- A spring mechanism is activated by pulling the tab inferiorly and
attaching the tab to a hook on the hard chin cup.
The vertical-pull chin cup. A, Unitek design. A spring force design is used to create a vertical direction of
pull.
18. - Another type of chin cup
- produces a vertical direction of force.
- incorporates a cloth headcap that curves around the crown of the head.
- secured posteriorly with two horizontal straps.
- This particular design is useful in those patients in whom anchorage in
the cranial region is difficult to achieve.
B, Summit Orthodontics design. A cloth head cap curves around the crown of the
head and is secured posteriorly with two horizontal straps. The force is produced
by the stretch of the elastic material. In both of these examples, a hard chin cup is
shown.
19. Best patient for Chin cup therapy
Ko et al (2004)
1. Mild Skeletal III, ability to achieve edge to edge incisors
2. Short vertical facial height (.Chincup cause clockwise rotation of the mandible.
3. Proclined or upright LLS (Chincup cause lingual tipping of the lower incisors
(Thilander 1963)
4. Absence of severe facial and dental asymmetry.
20. 5- The earlier the problem is addressed, the more successful treatment
appears to be.
6- Multiple “stages” of active chin cup home wear are often required in order
to be successful in the case of moderate prognathism.
7- The “corrected” patients need to be monitored at 4- to 6-month intervals
until major growth has ceased.
21. 8- The best age is before canine and premolar erupt (CS2-CS3
maturity) this is the first growth spurt of mandible, the second one
when 7 and 8 erupt CS4-CS6 (Bacceti, 2005).
22. - Patients with mandibular excess can usually be recognized in the primary
dentition despite the fact that the mandible appears retrognathic in the
early years for most children.
- There is evidence that treatment to reduce mandibular protrusion is more
successful when it is started in the primary or early mixed dentition. The
treatment time varies from one year to as long as 4 years depending on
the severity of the original malocclusion.
23.
24.
25. (Thilander 1963) and Peter W. Ngan 2014
Retardation of mandibular growth. Effective at reducing mandibular prognathism
before puberty but this is then lost with continual growth, Sugawara et al., 1990
Remodelling of the condyle and glenoid fossa
Backward rotation of the mandible
Closure of the gonial angle
Result in lingual tipping of LIS,
26. The effects of chincup therapy
whether the growth of the mandible can be retarded through wearing a
chin cup?
- Sakamoto and co-workers and Wendell and co-workers have noted
decreases in mandibular growth during treatment.
- Wendell and associates noted that the mandibular length increases in
the treated group were only about two-thirds of those observed in the
control group of mixed dentition individuals.
-Mitani and Fukazawa,however, noted no differences in mandibular length
in Class III individuals who began treatment during the adolescent growth
period in comparison with control values.
27. - Graber reported that, in a sample of young Class III patients, the
predominantly horizontal mandibular growth pattern was redirected more
vertically, indicating that the orthopedic chin cup can produce an increase in
lower anterior facial height while correcting the anteroposterior
malrelationship.
- The idea of this appliance is that because the condyle is a growth site, the
growth impeded by extra-oral force (Graber, 1977).
28. - Sugawara and Mitani noted that such treatment seldom alters the
inherited prognathic characteristics of skeletal Class III profiles over the
long term.
- Despite success in animal experiments, most human studies have found
little difference in mandibular dimensions between treated and untreated
subjects (Sugawara et al, 1990).
- Chincup appliances greatly improve the skeletal profile in the short
term, such changes are however rarely maintained during the pubertal
growth spurt.
29. In theory, extraoral force directed against the mandibular condyle would
restrain growth at that location, but there is little or no evidence that this
occurs in humans. What chin-cup therapy does accomplish is a change in
the direction of mandibular growth, rotating the chin down and back, which
makes it less prominent but increases anterior face height. The data seem
to indicate a transitory restraint of growth that is likely to be overwhelmed by
subsequent growth.
Contemporary Orthodontics, 5th Edition proffit
30. In essence, the treatment becomes a trade-off between decreasing the
anteroposterior prominence of the chin and increasing face height. In
addition, lingual tipping of the lower incisors occurs as a result of the
pressure of the appliance on the lower lip and dentition, which often is
undesirable.
Contemporary Orthodontics, 5th
Edition proffit
31. Unfortunately, the majority of Caucasian children with excessive mandibular
growth have normal or excessive face height, so that only small amounts of
mandibular rotation are possible without producing a long-face deformity.
Many of these children ultimately need surgery, and the chin-cup treatment
is essentially transient camouflage. For that reason, it has limited
application.
32. A typical response to chin-cup treatment. A, Pretreatment profile.
B, Posttreatment profile. This treatment reduces mandibular protrusion
primarily by increasing anterior face height, very similar to the effect of Class III
functional appliances.
33. For chin-cup treatment, a hard plastic cup fitted to a cast of the patient's
chin or a soft cup made from an athletic helmet chinstrap can be used. The
more the chin cup or strap migrates up toward the lower lip during appliance
wear, the more lingual movement of the lower incisors will be produced, so
soft cups produce more incisor uprighting than hard ones. The headcap that
includes the spring mechanism can be the same one used for high-pull
headgear.
34. Effects on Maxillary Growth Peter W. Ngan 2014
- Some studies have indicated that a chin cup appliance has no effect on
the anteroposterior growth of the maxilla.
- Uner et al. showed that early correction of anterior crossbite with chin
cup appliance prevents retarded anteroposterior maxillary growth.
- Sugawara et al. compared the growth changes of patients after chin cup
treatment with control subjects and reported that at age17, the midface is
more deficient in patients of the control groups than in those of the
treatment groups.
Orthodontic Treatment of Class III Malocclusion
Editors Peter W. Ngan & Eugene W. Roberts 2014 Bentham Science Publishers Ltd.
35. Stability of Treatment
- The stability of chin cup treatment remains unclear.
- Several investigators reported stability in horizontal maxillary and
mandibular changes associated with chin cup treatment.
- few studies reported a tendency to return to the original growth pattern
after the chin cup is discontinued.
- Sugarwara and colleagues published a report on the long-term effects of
chin cup therapy on three groups of Japanese girls who started chin cup
treatment at 7, 9, and 11 years. All 63 patients were followed with serial
lateral headfilms taken at the ages of 7, 9, 11, 14, and 17 years.
- the skeletal profile was greatly improved during the initial stages of chin
cup therapy, but these changes were not usually maintained.
36. Reverse chin cup therapy
• Developed in Germany in 2012 by Rahman 2012 show similar result when
the reverse chin cup therapy compared to face mask therapy involving 42 samples
at age of 8-9 years.
• Reverse chin cup therapy is able to produce forward movement of the
maxilla in the growing child associated with lingual tipping of the lower incisors
and labial tipping of the uppers.
37. • The point of application of protraction elastics from the upper
removable appliances was similar for both groups. All patients received
the same protraction force of 500 g per side with a 30 degree
downwards pull.
• The proposed advantages of the new reverse chin cup design were
that it was smaller and less bulky than other protraction appliances,
therefore encouraging children to wear it.
39. for growing patients presenting Class III malocclusion and/or open
bite, could chin cup, as compared with no treatment at all, be
beneficial for the improvement of their facial, skeletal and
dentoalveolar characteristics in the short and long term?????
40. Although the initial plan was to investigate the short and long-term effects
of both the occipital and the vertical pull chin cup, due to the limited data
provided from the included articles, only the short-term occipital pull chin
cup effects were finally examined. Consequently, where the term ‘chin cup’
is used thereafter, it is referred to the occipital pull chin cup, and where the
term ‘clinical effects’ is used, it is limited to the short-term ones.
41. Soft tissue, model cast and perioral muscular electromyography data
analyses were also not possible to be performed because no such data
could be retrieved as appropriate for inclusion and analysis in the present
study. Thus, treatment effect comparisons between the experimental groups
were considered just for skeletal and dentoalveolar alterations as measured
on lateral cephalometric radiographs.
42. Effectiveness of chin cup treatment
The common cephalometric variables retrieved from the seven included
treated groups and possible to be examined in current MA were the
following: (a) skeletal variables in the sagittal plane: SNA (°), SNB (°), ANB
(°), Wits appraisal (mm) and Co-Gn (mm); (b) skeletal variables in the
vertical plane: SN-ML (°), gonial angle (°), N-Me (mm), UFH (mm), LAFH
(mm) and Co-Go (mm) and (c) dentoalveolar variables: overjet (mm) and
overbite (mm).
43. The contribution of the original studies to the investigation of each
individual cephalometric variable is presented in this Table.
44. Meta-analyses were performed for the variables SNA, SNB, ANB, Wits
appraisal, SN-ML and gonial angle, where data from five or more treated
groups derived from the included studies contributed in the analysis. For the
rest of the variables, namely Co-Gn, N-Me, UFH, LAFH, Co-Go, overjet and
overbite, where data from four or less treated groups contributed in the
analysis, exploratory analyses were performed.
45. With regard to the skeletal cephalometric changes in the sagittal plane, it
was revealed that there was statistically significant reduction in the SNB
angle of the patients treated with the chin cup in comparison to the
untreated individuals (SDM = −1.97, CI = −3.09 to −0.84, P = 0.001),
indicating a restriction effect on mandibular growth.
46. In addition, Class III malocclusion of treated patients was significantly
improved since there was a statistically significant increase following chin
cup use in comparison to untreated individuals to (a) the ANB angle (SDM
= 2.48, CI = 1.36 to 3.61, P = 0.000) and (b) the Wits appraisal (SDM =
3.62, CI = 1.32 to 5.92, P = 0.002).
However, for all these three variables, the observed data heterogeneity as
well as the between-studies variance was high.
47. With regard to the skeletal cephalometric changes in the vertical plane, the
results of the MA revealed that the SN-ML angle increased significantly
whereas the gonial angle decreased significantly in the patients treated
with the chin cup as compared with the untreated individuals (SDM = 1.17,
CI = 0.48 to 1.86, P = 0.001 and SDM = −0.80, CI = −1.52 to −0.08, P =
0.030, respectively), indicating a tendency towards an increase of the
vertical growth pattern and/ or posterior rotation of the mandible.
48. However, data heterogeneity of the included studies was moderate to
high, and the between-studies variance was moderate.
The tendency towards increase of the anterior face height is further
supported by the statistically significant increase of the linear variable N-Me
according to the exploratory analysis performed (SDM = 1.39, CI = 0.59 to
2.18, P = 0.001). Moderate data heterogeneity of the included studies and
small between studies variance were also observed here.
49. As far as the dentoalveolar changes are concerned, the results of the
exploratory analysis revealed that there was a statistically significant
increase of overjet in the patients treated with the chin cup in comparison
to the untreated individuals (SDM = 2.62, CI = 1.06 to 4.19, P = 0.001),
indicating an improvement of the antero-posterior relations of the maxillary
and mandibular incisors. Yet, data heterogeneity observed in the included
studies, as well as the between studies variance, was high.
50. For the rest of the variables, namely SNA, Co-Gn, UFH, LAFH, Co-Go and
overbite, no statistically significant differences were derived.
Finally, due to the limited data provided from the included articles, no long-
term effects following the use of the occipital chin cup, as well as no short-
and long-term effects of the vertical pull chin cup, could be investigated.
51. Conclusions
Although the aim of this investigation was to assess the short- and long-
term effects of both the occipital and the vertical pull chin cup, due to the
lack of appropriate data of the included articles, only the short-term occipital
pull chin cup effects were possible to be assessed. In addition, soft tissue,
model cast and perioral muscular electromyography data analyses were
also not possible to be performed for the same reasons.
52. Thus, according to the results of this investigation, it can be concluded that
following the use of occipital pull chin cup for the short-term management of
growing patients with Class III malocclusion before pubertal spurt, an overall
significant improvement of the skeletal and dentoalveolar relationships
takes place in comparison to untreated individuals. In detail, data
elaboration leaded to the following conclusions:
- The skeletal Class III sagittal relationships of the maxilla and mandible are
improved.
- The skeletal Class III vertical relationships are also affected towards an
increase of the vertical growth pattern, an increase of the anterior face
height, and/ or posterior rotation of the mandible.
- The antero-posterior relations of the maxillary and mandibular incisors, as
indicated by the increase of overjet, are improved.
53. Nevertheless, the limited number of included studies, the high heterogeneity
observed in most of the variables and the linear manner of many of them
suggest some precaution in the interpretation of these conclusions. It
seems that there is not enough evidence-based data to make definitive
recommendations about the chin cup treatment.
More high-quality evidence-based clinical trials with proper design, sample
size, appliance use and measurements nare needed in the future in order to
reach more reliable results concerning the chin cup treatment of Class III
malocclusion in the short and the long term.
55. A comparison of chincap and maxillary protraction
appliances in the treatment of skeletal Class III malocclusions
56. Material and methods
Lateral ccphalomctric radiographs o f 168 previously treated skeletal Class III
malocclusion patients wrre traced an d digitized. They were evaluated with the JOE
program (Rocky Mountain Orthodontics JO E Version S.O'Denver. USA ). This
program makes considerations about the malocclusion type and its origin by
analysis of several ccphalomctric parameters. Sagittal considerations made by this
program are based on facial depth (NPg/frankfort horizontal), maxillary
depth (NA/Frankfort horizontal) and corpus length (Xi-Pg). After the evaluation o f
the 168 cases, the considerations in the program showed that only 24 cases had a
skeletal Class III malocclusion with a combination of maxillary retrusion and
mandibular protrusion. Others were either maxillary retrusion or mandibular
protrusion cases.
57. When the treatment types of the 24 skeletal Class III cases with a
combination o f maxillary retrusion and mandibular protrusion were
investigated.
it was found that 12 subjects were treated with chincap appliances and 12
with a maxillary protraction appliance.
The first group o f 12 patients (six girls and six boys) with a mean age o f
11.03 years were treated with a chincap an d mandibular occlusal bite plate.
58. 'Ihe chincap applied a total force of 600g. The patients were instructed to wear the
appliance for at least 14-16 hours a day.
The second group comprised 12 children (seven girts and five boys) with a mean
age 10.72 years Maxillary protraction therapy was applied in this group. They were
treated by using Dclairc type orthopaedic faccnusk and a removableintra-oral
appliance with an anterior point application.
59. The total force applied was 600 g and the patients were instructed to wear
the appliance for approximately 16 hours a day. When a normal dental
relationship was obtained with a 2-3 mm overjet. lateral ccphalometric
radiographs were taken in both groups The treatment time was 10.0 months
for the chincap group and 11.7 months foe the maxillary protraction group.
Results
The statistical comparison of the pre – treatment values be tween the groups sho we
dsignificant differences in upper incisor/N A relations ( degree -mm )
60. C hine cap group
SNB and facial axis showe dsignificant d ecreases in the chin cap group .
There was astatistically significant increase in this group in Co –A, ramus
height , ANB , lower face height and anterior and posterior face heights .
Evaluation of dental relationships during chincap therapy showed
Significant increases in upper incisor -NA (mm ) and over jet Angular and
dimensional parameters For lower incisor -NB and molar relationship
showed a significant decrease in this group. Soft tissue analysis
demonstrated a significant increase in upper lip length an d a significant
decrease in nasolabial length.
61. Face mask group
S-N length. SNA. C o -A. SMGoGn. Ramus height. Co-Gn. ANB. lower face
height, and anterior and posterior face heights showed a significant
increase at the en d o f the orthopaedic face mask therapy. Significant
decreases were observed in SNB. facial depth, facial axis, and maxllo-
mandibular differential. The inter-incisal
angle significantly decreased. There was a significant increase in overjet.
and significant decreases in overbite and molar relationship in the
maxillary protraction group. Evaluation of the soft tissues demonstrated a
significant increase in upper lip length.
62. Comparison o f chincap and face mask therapy
The SNA angle increased significantly more in the maxillary
protraction group compared with the chincap group. Angular and
dimensional
parameters for lower incisor-NB showed significant differences
between the groups. There was a significantly greater increase in
the molar relationship in the maxillary protraction group than in
the chincap group. While the nasolabial angle significantly
decreased in the chincap group, there was a non-significant
increase in the maxillary protraction group and the difference
between the groups was statistically significant.
63. Chin cup treatment for class III maloclussions: little evidence
to assess impact on temporomandibular joint
Posted by
Derek Richards
64. Methods
Searches were conducted in Medline/PubMed, Embase, the Cochrane Oral
Health Group’s Trials Register, CENTRAL, ClinicalTrials.gov, the National
Research Register, and Pro-Quest Dissertation Abstracts and Thesis
database. Prospective and retrospective studies, including randomized
clinical trials(RCTs), controlled clinical trials, and other observational
studies were considered in this review. Studies with or without auxiliaries,
such as lingual arches or other intraoral mechanotherapies that had
outcomes including morphological adaptations of the TMJ, changes of
the condylar configuration, dysfunctions caused by the chin-cup therapy,
and incidence and types of TMD were included. Study selection, data
abstraction a quality assessment was carried out independently by two
reviewers.
65. Results
• 12 studies were included
• 8 were prospective, 4 retrospective. There were no RCTs.
• One of the prospective studies was considered to be at low risk of
bias.
• 5 studies considered chin-cup influence on craniofacial structures and
condylar shape
• 7 studies considered chin-cup influence on TMD
• A qualitative summary of the studies was presented. This suggests
that:-
o chin-cup therapy affects the condylar growth pattern, even though
two studies reported no significance changes in disc position and arthrosis
configuration
o chin-cup therapy constitutes no risk factor for TMD.
66. Conclusions
The authors concluded
Based on the available evidence, chin-cup therapy for Class III orthodontic
anomaly seems to induce craniofacial adaptations. Nevertheless, there are
insufficient or low-quality data in the orthodontic literature to allow the
formulation of clear statements regarding the influence of chin-cup
treatment on the temporomandibular joint.
67. Chin Cup Therapy: An Effective Tool for the Correction of
Class III Malocclusion in Mixed and Late Deciduous
Dentitions
The Journal of Indian Orthodontic Society,
October-December 2010;44(4):109-114
68. In Class III malocclusion, it is the treatment objective to restrain all possible
horizontal mandibular growth, or at least redirect it into a more vertical vector as
the maxilla continues to grow downward and forward. Since Class III faces tend to
become more prognathic, and cause unfavorable muscle and tooth adjustments, it is
good interceptive dentofacial orthopedics to place appliances early where there is
Class III malocclusion.
Therapy should eliminate the malrelationship in any event. Many pseudo Class III
cases have a tendency to become full blown Class III later on during the growth
period unless treated.
69. The ideal patient for chin cup or functional appliance treatment of excessive
mandibular growth has:
1. A mild skeletal problem with the ability to bring the incisors end-to-end or
nearly so
2. Short vertical face height
3. Normally positioned or protrusive, but not retrusive lower incisors.
70. What chin cup therapy does accomplish is lingual tipping of the lower incisors as a
result of the pressure of the appliance on the lower lip and dentition and a change in
the direction of mandibular growth, rotating the chin down and back. Children who
have increased lower anterior face height and are treated with chin cups may end up
with skeletal open bites after treatment. Chin cups are divided into two types:
1. The occipital-pull chin cup, more frequently used in cases of mandibular
prognathism and,
2. Vertical-pull chin cup that is used in cases of steep mandibular plane angle and
excessive anterior facial height, the so-called “backward rotator” patient with
openbite.
71. The time duration of chin cup wear depends on the age when the appliance is
placed and the magnitude of the malocclusion as well as the amount and direction
of growth at the time.
After the correction of a pre-existing anterior crossbite has been accomplished, the
patient wears the appliance during the night only as a retention appliance.
72. CASE REPORTS
Case 1
A female patient aged 7 years reported to the Department of Orthodontics and
Dentofacial Orthopedics with a chief complaint of forwardly placed lower front
teeth.
On examination, she was brachyfacial, had a concave profile, an everted lower lip
with a deep mentolabial sulcus.
73. Intraorally, she had a mesial step terminal plane on right and left side. The overjet
was 1 mm and overbite was also 1 mm with a posterior crossbite on right side.
74. Cephalometric analysis showed a Class III skeletal tendency, a horizontal growth
pattern, a decreased lower anterior facial height and proclined upper and lower
incisors.
The patient was treated with a chin cup therapywith a slow maxillary expansion
(SME) screw to correct right side posterior crossbite along with Z spring to procline
the left central incisor for the correction of anterior crossbite.
75. After 11 months of treatment, forward growth of maxilla was observed with
restricted growth of mandible and a normal interarch relationship with increased
lower anterior facial height obtained. We have a follow-up of almost 2 years post-
treatment.
Post-treatment extraoral (case 1)
76.
77.
78. Presently, the patient is wearing chin cup only at night time for retention. Fixed
mechnotherapy will be initiated after eruption of all permanent teeth, if required.
79. Case 2
A male patient aged 10 years reported to the Department of Orthodontics and
Dentofacial Orthopedics with a chief complaint of forwardly placed lower front
teeth.
On examination, he was found mesofacial, had a concave profile, an everted
lower lip with a deep mentolabial sulcus.
80. Intraorally, he had a mesial step terminal plane on right and left side. The overjet
was 1 mm and overbite was 2 mm with mildly crowded lower anterior teeth
81. Cephalometric analysis showed a Class III skeletal tendency, a horizontal growth
pattern, a decreased lower anterior facial height and proclinated upper and lower
incisors. The patient was treated with a chin cup therapy.
82. After 13 months of treatment, forward growth of maxilla was observed with
restricted growth of mandible and a normal interarch relationship with increased
lower anterior facial height obtained.
83. for retention the patient worn the chin cup only at night time. Fixed mechnotherapy
will be initiated after eruption of all permanent teeth.
84. The question concerning the ability to alter the mandibular growth pattern with a
chin cup should be regarded in the light of all the variables that may influence
growth. Previous studies on the effects of the chin cup force on growing human
mandibles have reported various results. There have been a number of clinical
studies that have evaluated the treatment effects produced by chin cup therapy.1-4
These studies have shown treatment effects that are somewhat distinct from those
discussed earlier regarding the orthopedic facial mask and the FR-3 of Frankel.
85. One of the substantive concerns, particularly in the treatment of the patient with
mandibular prognathism, is whether the growth of the mandible can be retarded
during treatment.
Wendell2 et al (1985) have noted decrease in mandibular growth during treatment.
Wendell2 et al when examining a group of Class III patients treated in the mixed
dentition noted that mandibular length increased for the treated group were only 60
to 68% of the control group. Mitani and Fukazawa3 (1976) noted no differences in
mandibular length in Class III patients who began treatment during the adolescent
growth period. These findings support the observations of Sakamoto1 (1981) and
Sugawara4 et al (1990) who advocate the use of the occipitalpull chin cup as early as
is practical. Whether the ultimate length of the mandible can be influenced by chin
cup therapy still remains unclear.
86. The Effects of Chin Cup Therapy on the Mandible:
A Longitudinal Study
Peter D. Wendell
University of Connecticut School of Dental Medicine,
Farmington, Conn , 1983
Am. j. Orthod.
Februry 1984
87. This study was conducted to evaluate the effects of chin cup therapy on the
mandible and its dentition in skeletal Class III patients. The patients
selected for this study were Japanese females treated only with the
extraoral chin cup appliance. Both the control and treatment samples were
obtained from Japanese universities, where these longitudinal data were
gathered. Lateral cephalometric radiographs were taken on the average
every 6 months for the treatment group and every year for the control group.
88. Ten treated patients and seven control subjects were studied. The duration
of chin cup therapy was variable but averaged 3 years 1 month. The
cephalograms were digitized on an electronic screen, and a cephalometric
analysis was recorded from a computer program. A Cartesian coordinate
system was used to enable measurement relative to given x and y
reference lines. Subsequent cephalograms for a patient were
superimposed, using detailed cranial base structures. The cephalometric
measurements were plotted against the patient’s chronologic age in order to
obtain a rate-of-change value from a regression line.
89.
90.
91. The rate-of-change values were then
compared with the control group to yield
comparison of changes in mandibular growth
rate, direction, and pattern in the treatment
group. Active and posttreatment effects were
evaluated: (1) All measurements for the rate
of change of absolute mandibular length
(ramal length, body length, and total
mandibular length) were reduced by 60% to
68% from the control rate of growth during
therapy. These parameters continued to
show a decrease of 55% to 61% following
active treatment. (2) The mandible exhibited
less downward displacement.
relative to cranial base, during treatment.
92.
93. (3) The mandibular plane angle and the gonial angle closed with growth in
the Class III control sample but were variable in the treatment group. (4)
The skeletal profile was improved with treatment. (5) Dental changes
indicated that an orthopedic correction occurred so that the dentition
exhibited a more normal migratory displacement into a favorable Class I
occlusion. This study indicates that the chin cup may be a viable mode of
treatment for preadolescent and adolescent mandibular prognathism
patients.
94. Chin Cap Force to a Growing Mandible
Lone-term clinical reports
95. The cases reported in this study were three Japanese females who had
undergone several years o f chin cap treatment.
The sample includes different types of prognathic skeletal patterns in
terms of the relative size or position o f maxilla and mandible.
A chin cap was applied to the mandible with a force o f 500-600gm at
the chin during the treatment period. The applied force was directed
toward the condylar head o f the mandible
within a small range of variation. The design
o f the chin cap is shown in Fig. 1.
96. The type of chin cap appliance
used by the patients in this
study. The cup was pulled up
by on rubber elastic on each
side, with ends attached on
different straps. Average force
level at the chin ranged
from 500-600gm.
97. Measurements used in this study. The long axis of the condyle is drawn
through the midpoints of the widest and narrowest parts o f the head and
neck.The condyle point, Cd, is located by the intersection of the long
axis with the condyle surface. Linear measurements are made between the
established points. The gonial angle is centered on Go and measured to the
tangent lines.
98. The investigation is based on serial lateral cephalometric radiographs
taken at three-month intervals, along with semiannual records o f
standing height and wristhand radiographs. Each subject maintained
time tables in which every hour of chin cap use was recorded.
Two o f these cases were treated with a chin cap as an adjunct to an
intraoral appliance for several years, and one was treated solely with a
chin cap. Since two cases were treated orthodontically along with a
chin cap, the changes in the face may include treatment effects other
than those produced by the chin cap therapy. However, the study was
based on the area where orthodontic therapy is thought to be least
effective.
99. The cephalometric points, planes and diagram for angular and linear
measurements employed in this study are shown below. These include overall
mandibular length (Cd-Pog), mandibular body length (Go-Pog), mandibular
ramus length (Cd-Go), and the gonial angle. Measurements were made every six
months. The individual growth data for each point was then combined on a
graph to describe the semiannual incremental changes.
100. Case report
a female, with X first records taken at eight years and four months o f
age. The lateral cephalometric diagram shows an evident depression o
f the middle face as well as a remarkable protrusion o f the chin when
compared with the normal pattern for this age. It also indicated a
procumbent mandibular plane and some upward and forward
rotation o f the mandible. Mandibular movements to all functional
positions were felt to be smooth and normal, but a forward
positioning of the mandible was noted during occlusion.
From the rest to occlusal position, the central incisors showed a
premature contact. The mandible then shifted forward to gain buccal
occlusion. Airway was clear and showed no pathological breathing
problem.
101. Case 1 (age 8yr 4mo), cephalometric diagram. Broken line outlines
average female face at age 7yr 7mo ± 18mo. Superimposition is on
Nasion, oriented on Frankfort horizontal. Black indicates patient
outside the average outline, shading indicates patient inside the
average outline.
102. Dental occlusion shows crossbite o f the incisors, deep overbite and
noticeable underjet. This patient was treated with a chin cap and
intraoral appliance. The figure below shows the occlusion on the final
record taken at the age o f 17 years and 4 months. The cephalometric
diagram shows the size and position o f the mandible to be fairly well
balanced, yet the middle face is still retarded in relation to the normal
pattern.
103.
104.
105. Superimposition o f the radiographs on the anterior cranial base
structures during wear o f a chin cap shows a dramatic change in
mandibular position.
This change occurred through correction of the functional forward
positioning o f the mandible. After the change o f the position,
forward growth o f the chin was more inhibited, and the chin was
displaced downward. Superimposition after discontinuation o f the
chin cap shows almost no skeletal change. The changes accomplished
during chin cap wear seemed to be retained well.
106.
107.
108. Superimposition o f the mandible on the mandibular plane at menton shows
peculiar change during the active chin cap period, with growth at the
condyle as well as the posterior border of the ramus, and a decrease in the gonial
angle.
109. Chin cup effects using two different force magnitudes
in the management of Class III malocclusions
Yasser L. Abdelnabya; Essam A. Nassarb
110. Fifty growing patients were selected for this study (26 boys and 24 girls).
They were selected according to the following criteria: skeletal Class III
pattern (ANB angle , 1 degree) and protrusive mandible (SNB angle . 80
degrees). All patients had anterior crossbite.
Hand-wrist radiographs were obtained for each patient to assess skeletal
maturation.
All patients had not passed the peak of pubertal growth spurt, as shown by
the epiphysis of the middle phalanx of the third finger having capped its
diaphysis. The patients were randomly divided into three groups. Group 1
consisted of 20 patients (10 boys and 10 girls), group 2 consisted of 20
patients (11 girls and 9 boys), and group 3 consisted of 10 patients (5 boys
and 5 girls).
The mean ages at the start of treatment were 9.6, 10.1, and 9.2 years for
groups 1, 2, and 3, respectively.
111. Patients in groups 1 and 2 were treated with an occipital pull chin cup
(Dentaurum, Ispringen, Germany) and an acrylic occlusal bite plane with a
thickness that just freed the occlusion anteriorly. The chin cup used was
soft not acrylic. The force magnitude exerted by the chin cup was 600 g per
side in group 1 and 300 g per side in group 2. A force gauge (Somfy tec,
France) was utilized to determine the applied force. The patients were
instructed to wear the appliances for 14 hours each day. In group 3, the
patients did not receive any orthodontic or orthopedic treatment during the
study period.
112. Lateral cephalogram films were taken for all patients at two stages: before
the start of treatment and after 1 year. All films were traced by one
investigator. Measurements obtained were corrected for standard
magnification. The cephalometric films were retraced and the method error
was determined with Dalhberg’s formula; the error was less than 1 mm and
1 degree.
113. Clinically the anterior crossbite was corrected in all patients in the two
treatment groups (Figures 1and 2).
In general, there were significant differencesin the changes in
cephalometric measurements between the two treatment groups and the
control group regarding mandibular position (SNB angle), the
maxillomandibular relationship (ANB angle and Wits appraisal), ramus
height (Ar-Go), vertical measurements (N-Me and SN-MP angle), and
inclination of the mandibular incisors (1-MP). In the treatment groups, the
SNB angle, ramus height, and mandibular incisor inclinations were
significantly decreased in comparison to the control group. The ANB angle,
Wits appraisal, SN-MP angle, and anterior facial height were significantly
increased in the two treatment groups.
RESULTS
114. Figure 1. Pre and posttreatment intraoral photographs of patient utilized
chin cup with 600 grams of force per side.
115. Figure 2. Pre and posttreatment intraoral photographs of patient
utilized chin cup with 300 grams of force per side.
116. Regarding the differences in the changes in cephalometric measurements
between the two treatment groups utilizing either force magnitude (600 vs
300 g per side), no significant differences were found except in ramus
height (Ar-Go). The reduction in ramus height was more pronounced with
the utilization of 600 g of force per side than the use of 300 g of force
per side.
117. Chin cup therapy for mandibular prognathism
lee W. Graber, D.D.S., M.S., MS.
Am. .J. O&hod. July 1977 volume 72 no.1
118.
119. Thirty patients with skeletal Class III malocclusion under treatment
with the chin cup appliance, averaging 6 years of age at the start of
treatment, were followed longitudinally for a 3-year period. This treatment
sample was compared cephalometrically with an analogous untreated Class
III sample.
The following significant craniofacial alterations were noted in the sample
that underwent orthopedic chin cup therapy:
1. A retardation of vertical ramus growth.
2. A retardation of vertical development in the posterior aspect of the
mandibular body.
3. A retardation
120. 3. A retardation of vertical development in the posterior maxilla.
4. A closure of the gonial angle.
5. A distal rotation of the mandibular complex.
6. A decreased amount of anteroposterior anterior cranial base growth.
7. A redirection of the predominantly horizontal mandibular growth
pattern to a more vertical direction.
8. A reduction of the maxillomandibu1a.r malrelationship toward
normative values.
9. A production of an Angle Class I dental relationship following the
establishment of normal maxillomandibular relations.
10. A lack of detectable localized effect on the symphyseal region or
incisor position as a direct result of chin cup placement and pressure.
11. Development of soft-tissue profile changes in harmony with underlying
skeletal changes.
While all of the listed
121. gain increased importance when considered together. With orthopedic chin
cup therapy, there is a change in craniofacial pattern leading to the
observed resolution of the Angle skeletal Class III malocclusion. This study
thus provides strong support for the use of the orthopedic-force chin cup
appliance in the clinical management of young patients with skeletal
mandibular prognathism.
122. Major contributions to correction of the Class III skeletal malocclusion. 1, The mandible
rotated posteriorly, placing the ramus in a more vertical orientation to the cranial
base; 2, the gonial angle was decreased, re-establishing the mandibular plane by
overcoming changes introduced by posterior mandibular rotation; 3, vertical condylar
growth was restricted; 4, the maxilla rotated slightly in a “clockwise” direction.
124. A chin cup was initially thought to reduce the growth of a prognathic
mandible.
Although animal studies indicated the possibility of altering condylar growth
(Petrovic, Stutzmann & Oudet 1975 ; Copray, Jansen & Duterloo 1985 ;
Vardimon et al. 1994 ), clinical research reveals initial changes within the
skeleton that were rarely maintained during pubertal growth (Sugawara &
Mitani 1993 ). The separate effect of the chin cup versus maxillary
protraction is not known and would be difficult to determine. The chin cup
may have an additive influence, maximizing the effect of the protraction,
and/or mandibular rotation.