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Adult orthodontics

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandent...
Adult orthodontics
 Contents

• Introduction
• History
• Comparison b/w adolescents & adults
• Objectives
• Classificatio...
Basic biological concepts
associated with adult orthodontics.
 Periodontal

ligament.

 Bone
 Teeth

.

www.indiandenta...
Periodontal ligament


Fibroblast

•
•
•
•
•
•
•
•

Blood borne origin
Pleuropotential cell
Collagen & proteoglycans
Coll...
 Capillary




bed.

Number of branches found in the vascular bed –
decreases
Amount of blood flow to tissues-decreases...


Bone



Mechanical properties changes
Macroscopically- trabecular bone volume decreases.
Osteoblastic activity-reduces...
 Teeth






More root exposure
Short crown root ratio
CR shift –apically
Diameter of pupal canal reduces
Decreased ...
CEJ–alveolar crest distance

Significant reduction in crest
height with age
0.017mm/year

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Prevalence of PDL pockets

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History








Kingsley(1880)-early awareness of the orthodontic
potential for the adult pts.
Published statements-N...
History

www.indiandentalacademy.com
History
 Lindegaard

et al (1971)-3 factors.
 Reidel & Dougherty (1976)
“orthodontics is total discipline and it
makes n...
Adult practice today

www.indiandentalacademy.com
Scope of procedures
Musich’s (1986)study of 1370 consecutively examined adults

www.indiandentalacademy.com
Why do adults seek orthodontic
Rx










Did not want orthodontic treatment as children
Did not know about ort...
comparison
factors

adolescents

adults

Dental caries

More susceptible

Recurrent decay
restorative failures, root
decay...
Factors

Adolescents

adults

Growth factors

Growth-orthopedic
Stable correction .

No growth
Minimal skeletal adaptabili...
factors

adolescents

adults

Rate of tooth movement rapid

slower

orthopedics

50%

Small percentage

Orthognathic surge...
factors

adolescents

adults

Anchorage Head gear
potential

implants

Missing
teeth

Restorative

Space closure
without p...
factors

adolescents adults

Extraction 4 PMs
controversy

Less
frequently

Strategic
extraction

common

uncommon

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Adult orthodontic treatment
objectives
 Dentofacial

esthetics
 Stomatognathic function
 Stability
 Normal occlusion

...
Additional AOT objectives









Parallelism of abutment teeth
Most favorable distribution of teeth
Redistributi...
Parallelism of abutment teeth







Abutment teeth-parallel
Permit-easy insertion of
replacements
Allow –restoration...
Most favorable distribution of
teeth



Distributed evenly-replacements
To establish normal occlusion.

www.indiandental...
Redistribution of occlusal &
incisal forces.



Cases with significant bone loss(60-70%)
To maintain occlusal vertical d...
Adequate embrasure space
&proper root position.




Better PDL health
Helps in interproximal cleaning
Placement of rest...
Adequate occlusal landmark
relationships



Transverse dimension – difficult to correct
Skeletal crossbite cases-only an...
Better lip competency & support


In case of anterior restoration-retractions



Inadequate support-change in anteropost...
Improved crown/root ration
 In

case of bone loss
 Reduced crown/root ratio
 Can be corrected by reducing the clinical
...
Better self maintenance of PDL
health
Improved self maintainace of PDL
health occurs with proper tooth position

Teeth s...
Esthetic & functional
improvement.
Should provide acceptable dentofacial esthetics
Improved muscle function
Normal spee...
Classification











Graber,Vanarsdall

Physiologic occlusion
Psychological disorientation
Adjunctive orth...
Treatment for adults
 proffit

-

• Younger adults(20-35yrs)
• Older group(40-50yrs)

 Adjunctive

orthodontic treatment...
Adjunctive orthodontic
treatment
 Definition

:tooth movement carried out to
facilitate other dental procedures
necessary...
Goals of AOT
 Facilitate

restorative treatment
 Improve PDL health
 Favorable crown : root
 “Goal of AOT is to provid...
Principles of AOT


Diagnostic & treatment planning.

•
•

Collecting an adequate data base.
Developing a problem list.

...
 Diagnostic

records

• OPG.
• Full mouth IOPAs.
• Lateral ceph
• photographs.
• Dental casts.

www.indiandentalacademy.c...
Biomechanical considerations
 Characteristics

of the orthodontic

appliance.

• Anchorage control
• 22-slot edgewise app...
Removable appliances

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Bracket placement

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Effects of reduced periodontal
support
 Bone

support
 Bone loss-PDL
area decreases
 CR-shifts more
appically

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Timing & sequence of treatment
Active disease
Disease control

Re-evaluate

Establish occlusion

stabilize

Definitive res...
Adjunctive orthodontic Rx
procedure.


Uprighting of posterior teeth

•
•
•
•
•





Uprighting a single molar
Upright...
Uprighting posterior teeth
 Treatment

planning consideration

• Loss of posterior teeth
• If the 3 molar is present?
• U...
Loss of posterior teeth

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Distal crown/ mesial root
movement

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Crown: root length

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Appliances for molar uprighting
 Partial

fixed appliance
 Active & reactive unit
 bonding>banding

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Uprighting a single molar


Distal crown tipping with
occlusal antagonist
• Flexible rectangular wire17x25 NiTi
• Anchora...
Uprighting with minimal
extrusion




Uprighting with no occlusal
antagonist
“T-Loop”-17x25 steel/
19x25 beta Ti

www.in...
Uprighting of lower molars
Birte melsen,JCO 1996
case1
56yrs/M
Missing lower 1st molar

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case1

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Case 2
42/F
Missing 46

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Case 2

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Distal jet

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A simple technique for molar
uprighting –E Capelluto,JCO 1996
“MUST”

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Final positioning of molar & PMs
Compressed coil springs
018 steel

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Uprighting two molars in the
same quadrant.
 Combination

of distal crown & mesial

root
 No bilateral uprighting - same...
Retention
 Fixed

bridge-within 6 weeks
 Short time-19x25 steel /21x25 beta Ti
 >few weeks-intermediate splinting

www....
Forced eruption
 Indications

• Defects in cervical 3 of the root
• Horizontal / vertical #
• Internal/external resorptio...
Forced eruption
 Treatment

planning

• Good periapical radiographs
• Periodontal support
• Root morphology and position
...
Orthodontic technique
 Anchor

teeth –rigid
 Flexible –tooth to be extruded
 With / without the use of orthodontic
brac...
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Alignment of anterior teeth
 Indications

• To improve access & permit placement of
•
•
•

restoration
To permit placemen...
Treatment planning
 Interproximal

stripping
 Diagnostic setup-very helpful

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Orthodontic technique
 Alignment

of crowded, rotated &
displaced incisors

• Edgewise brackets-canine –canine
• Initial ...
Positionining tooth for single
tooth implants


Missing teeth-implants
• Space needed for implant, esthetics& the
occlusi...
Timing of implant placement


Implants to support restorations should not be placed
until all vertical growth has been co...
Case reports





Kenji W Higuchi

48yrs/F
Class II div 1
Deep bite
Missing12,47,46,45,35,36,37

Treatment plan: surgi...
Case 1

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case1

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Case 2
 53yrs/M
 Class

III
 Ant &post crossbites
 spacing
Treatment plan: 2 implants,35&36
Healing period -4 months
I...
Case 3
 64yrs/F
 Class

I
 Impacted canine
 Missing teeth

Treatment plan:

Extrusion of impacted canine
1 implant -16...
Case 3

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Anterior diastema closure


Loss of posterior teeth, abnormally small teeth, loss
of bone support-drifting/spacing.



P...
Diastema closure

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Crossbite correction
Crossbite-functional problem
Ant crossbite -esthetic
Tipped teeth-removable apl
Elastics
Establishing...
Comprehensive
orthodontic treatment.

Adult orthodontics.

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Comprehensive orthodontic
treatment-Adults
 Special

considerations for adults

• Different motivations for seeking ortho...
Comprehensive treatment
 Motivation

for adult treatment

• Psychological
• PDL & restorative needs as motivating factor
...
Psychological considerations






High motivation -self referred for esthetic
reasons
Low motivation -dentist referre...
Periodontal diagnosis



Awareness of risk factors
General factors

•
•
•
•

Family history
General health status
Nutrit...
Periodontal aspects of adult
treatment


Periodontal considerations are increasingly important
as patient become older ,r...
Minimal periodontal involvement
 Hygiene

status

• Special care-adults
• Inter dental aids, proximal brushes

 Level

&...
Moderate PDL-involvement


Disease control

•

Preliminary PDL-treatment

•
•
•

Scaling,curettage,flap surgery etc
Endod...
Severe PDL- involvement


Disease control
• Scaling,curettage,flep surgery, osseous surgery
• Endodontic therapy



Peri...
Temperomandibular dysfunction
 Internal

joint pathology
 Muscle origin

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Temperomandibular dysfunction
•Prevalence of TMD problemsSchiffman et al (1998)
Muscle disorder
Joint disorder
Combination...
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Intrusion


light & continuous force
• With continuous arch wires
• Segmental arch wires



In case of PDL involved-anch...
Intrusion of incisors in adult patients
with marginal bone loss
Birte Melsen, AmJ Orthod 1989





Common problems-adul...


Material & method

•
•
•
•



30 sample
5M/25F
AGE:22-60yrs
PDL preparation

Orthodontic appliance-4 types

•
•
•
•

J...
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 Analysis

applied

• Study casts
• Latral ceph
• Opg
• IOPA-special film holder

Piece of 021x028 elgiloy

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 Results

• True intrusion=0-3.5mm
• Clinical crown length reduction =0.5-2mm
• Root resorption =1-3mm
• Total amount of ...
Upper molar intrusion
Birte melsen JCO 1996





Case 1
38yrs/F
Missing teeth
Chewing difficulty

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4.5mm-intrusion
7.5mm- mesial movement
2mm- reduction of clinical crown ht.
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Case 2
40yrs/F
Missing 15,16,25,27,28,35,37,38,44,45,47,48
Chewing difficulty.

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3mm-intrusion
8mm-mesial movement of molar.
Lower-implants
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Interproximal stripping for the
treatment of adult crowding-Julia F
Harfin JCO 2001 Nov


Crowding

•
•
•



Thickest en...
Case reports

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Case1
22yrs/F
Moderate crowding

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Case 2
24yrs/F
Severe crowding

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Case 3
21yrs/M
Anterior crossbite
crowding

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Space closure
Old extractions sites -difficult to close
• Resorption
• Remodeling of the bone.
 Such situation-better to ...
Rigid implant anchorage to close a
mandibular first molar extraction siteW.Eugene Roberts, Charles nelson,jco1997
Rigid en...
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Space closure- Removable prosthesis







35yrs/M
Class III
Generalized attrition
Upper midline shift
Asymmetric sm...
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Invisalign


What is invisalign?

- Invisible alignment of the teeth
- An invisible way to align the teeth
• Uses a serie...
Impressions are
made using
Polyvinyl
Siloxane

Impression and
bite send along
with a detailed
treatment plan.

advanced im...
Invisalign

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Invisalign
Patient gets the first aligner 6 weeks
after the 1st visit
 Most treatments require 20 – 60 aligners
 Worn fo...
Invisalign







Limitations
Patients with severe malocclusions
cannot be treated
Children,mixed dentition – growing ...
Invisalign system in adult orthodontics:
mild crowding & space closure cases
Robert L Boyd, R J Miller,JCO 2000 April

Cas...
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Case 2

33yrs/M
Spacing b/w teeth
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case3

35yrs/M
Mild crowding

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Lower incisor extraction treatment
with invisalign system-Ross J Miller
2001 JCO nov
Case report
24yrs/F
Lower incisor cro...
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Rapid orthodontic decrowding with alveolar augmentation: case report

William . M . Wilcko
World Journal Orthodontics 2003...
After 1 wk of bracketing & wire activation-selective Decortications.

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Decorticotomy

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Bone grafting /augmentation

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Post treatment
Total treatment time 6mnths.

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Discussion
 Rapid

decrowding & minimal root
resorption -2 phenomenon

• Increased Regional bone turn over
• osteopenia
S...
Conclusion


Takes shorter treatment time



Pre-existing fenestrations/dehiscence can be
corrected-alveolar augmentatio...
Accelerated Invisalign treatmentAlbert H Owen,JCO 2001 June
Esthetics & speed
Decorticotomy( AOO)
Invisalign therapy
Cla...
After 10 days of corticotomy
Invisalign therapy started.
Aligners changed –every 3 days.
Rx completion-4 months.

www.indi...
Retention & Post treatment
stability in Adults.



“After malposed teeth have been moved into the desired
position, they ...
Retention
Removable appliances & retainers
Hawley retainer
Tooth positioner
Spring retainer
Fixed retainer
Bonded retainer...
Hawley retainer

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Hawley retainer –modified

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Positioner

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Positioner

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Fixed retainer

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Fixed retainer

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QCM-Organic polymer retainer

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Labial fixed retainer

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Labial fixed retainer

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Case reports

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CASE NO-3
D.P 21/F

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34
D.P.21/F

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35
D.P.21/F
SEVERE SKELETAL CLASS II WITH
MATCHING SOFT TISSUES
HYPERDIVERGENT JAW BASES
SEVERE PROCLINATION OF U-ANTERIORS.
...
D.P.21/F
PRESURGICAL PHASE

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37
D.P.21/F
PRESURGICAL PHASE

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38
D.P.21/F
POST SURGICAL PHASE

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39
D.P.21/F
PRE -FINISHING RADIOGRAPHS

SUPERIMPOSITION

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40
D.P.23/F

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40
D.P.23/F

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41
D.P.23/F

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42
D.P.23/F
COMPARISON

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43
D.P.23/F
COMPARISON

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44
Thank you
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
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Adult orthodontics 1 /certified fixed orthodontic courses by Indian dental academy

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  • Transcript of "Adult orthodontics 1 /certified fixed orthodontic courses by Indian dental academy "

    1. 1. Adult orthodontics INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2. Adult orthodontics  Contents • Introduction • History • Comparison b/w adolescents & adults • Objectives • Classifications • Adjunctive orthodontics • Comprehensive orthodontics • Retention www.indiandentalacademy.com
    3. 3. Basic biological concepts associated with adult orthodontics.  Periodontal ligament.  Bone  Teeth . www.indiandentalacademy.com
    4. 4. Periodontal ligament  Fibroblast • • • • • • • • Blood borne origin Pleuropotential cell Collagen & proteoglycans Collagen turnover in PDL- 2.5-6.5 day Aging-imbalance. Proteoglycans-withstand the forces. Retains water-changes with age. PGs-prostaglandins & leukokines-resorption of bone. www.indiandentalacademy.com
    5. 5.  Capillary   bed. Number of branches found in the vascular bed – decreases Amount of blood flow to tissues-decreases  Nerve tissue  Changes in number of neuro receptor  Age related decrease in sensory responsiveness. www.indiandentalacademy.com
    6. 6.  Bone  Mechanical properties changes Macroscopically- trabecular bone volume decreases. Osteoblastic activity-reduces Imbalance b/w resorption & replacement Sinus size-increases Bone density decreases &porosity increases with age.      www.indiandentalacademy.com
    7. 7.  Teeth      More root exposure Short crown root ratio CR shift –apically Diameter of pupal canal reduces Decreased vascularity&innervation -pulp recovery. www.indiandentalacademy.com
    8. 8. CEJ–alveolar crest distance Significant reduction in crest height with age 0.017mm/year www.indiandentalacademy.com
    9. 9. Prevalence of PDL pockets www.indiandentalacademy.com
    10. 10. History      Kingsley(1880)-early awareness of the orthodontic potential for the adult pts. Published statements-Negative. MacDowell(1901)- Impossible age. Lischer(1912)-optimal age for treatment. • Golden age of treatment Case (1921)-value of adult 0rthodontic therapy www.indiandentalacademy.com
    11. 11. History www.indiandentalacademy.com
    12. 12. History  Lindegaard et al (1971)-3 factors.  Reidel & Dougherty (1976) “orthodontics is total discipline and it makes no difference whether the patient is young or old” www.indiandentalacademy.com
    13. 13. Adult practice today www.indiandentalacademy.com
    14. 14. Scope of procedures Musich’s (1986)study of 1370 consecutively examined adults www.indiandentalacademy.com
    15. 15. Why do adults seek orthodontic Rx          Did not want orthodontic treatment as children Did not know about orthodontics as children Parents couldn't afford orthodontic treatment as children. No orthodontist located in their vicinity when younger Incomplete orthodontic treatment as children, non cooperative Had orthodontic treatment as children but relapsed. More conscious of appearance with age Malpositioned teeth contributing to PDL disease Spaces b/w anterior teeth enlarging ,new spaces opening up. www.indiandentalacademy.com
    16. 16. comparison factors adolescents adults Dental caries More susceptible Recurrent decay restorative failures, root decay& pulpal pathosis PDL disease Resistance to bone loss Susceptible to gingival inflammation Susceptible to bone loss TMJ adaptability high Symptoms with dysfunction Occlusal awareness Infrequent Increased enamel wear with adverse change in supporting tissue. www.indiandentalacademy.com
    17. 17. Factors Adolescents adults Growth factors Growth-orthopedic Stable correction . No growth Minimal skeletal adaptability. Surgical option Dentofacial esthetics Reasonable concern Concern occasionally disproportionate to degree of existing problem www.indiandentalacademy.com
    18. 18. factors adolescents adults Rate of tooth movement rapid slower orthopedics 50% Small percentage Orthognathic surgery 1-5% 10-20% Restorative dentistry Smaller percentage frequently Combination treatment uncommon 80% www.indiandentalacademy.com
    19. 19. factors adolescents adults Anchorage Head gear potential implants Missing teeth Restorative Space closure without prosthesis www.indiandentalacademy.com
    20. 20. factors adolescents adults Extraction 4 PMs controversy Less frequently Strategic extraction common uncommon www.indiandentalacademy.com
    21. 21. Adult orthodontic treatment objectives  Dentofacial esthetics  Stomatognathic function  Stability  Normal occlusion www.indiandentalacademy.com
    22. 22. Additional AOT objectives         Parallelism of abutment teeth Most favorable distribution of teeth Redistribution of occlusal & incisal forces Adequate embrasure space & proper tooth position Adequate occlusal landmark relationships Better lip competency & support Improved crown/root ratio Improved self-maintenance of periodontal health. www.indiandentalacademy.com
    23. 23. Parallelism of abutment teeth      Abutment teeth-parallel Permit-easy insertion of replacements Allow –restorations Better prognosis Better PDL response. www.indiandentalacademy.com
    24. 24. Most favorable distribution of teeth   Distributed evenly-replacements To establish normal occlusion. www.indiandentalacademy.com
    25. 25. Redistribution of occlusal & incisal forces.   Cases with significant bone loss(60-70%) To maintain occlusal vertical dimension www.indiandentalacademy.com
    26. 26. Adequate embrasure space &proper root position.    Better PDL health Helps in interproximal cleaning Placement of restorative material. www.indiandentalacademy.com
    27. 27. Adequate occlusal landmark relationships   Transverse dimension – difficult to correct Skeletal crossbite cases-only anterior crossbite can be corrected. www.indiandentalacademy.com
    28. 28. Better lip competency & support  In case of anterior restoration-retractions  Inadequate support-change in anteroposterior &vertical position of upper lip & increase in wrinkling. www.indiandentalacademy.com
    29. 29. Improved crown/root ration  In case of bone loss  Reduced crown/root ratio  Can be corrected by reducing the clinical crown. www.indiandentalacademy.com
    30. 30. Better self maintenance of PDL health Improved self maintainace of PDL health occurs with proper tooth position Teeth should be positioned properly over basal bone www.indiandentalacademy.com
    31. 31. Esthetic & functional improvement. Should provide acceptable dentofacial esthetics Improved muscle function Normal speech & masticatory function www.indiandentalacademy.com
    32. 32. Classification           Graber,Vanarsdall Physiologic occlusion Psychological disorientation Adjunctive orthodontics Corrective orthodontics Orthognathic surgery Periodontally susceptible TMJ-dysfunction Enamel wear beyond that expected for chronologic age Dental mutilation Combination Borderline surgical case www.indiandentalacademy.com
    33. 33. Treatment for adults  proffit - • Younger adults(20-35yrs) • Older group(40-50yrs)  Adjunctive orthodontic treatment  Comprehensive orthodontic treatment www.indiandentalacademy.com
    34. 34. Adjunctive orthodontic treatment  Definition :tooth movement carried out to facilitate other dental procedures necessary to control disease & restore function.  Uprighting of posterior teeth  Forced eruption  Alignment of anterior teeth  Crossbite correction www.indiandentalacademy.com
    35. 35. Goals of AOT  Facilitate restorative treatment  Improve PDL health  Favorable crown : root  “Goal of AOT is to provide a physiologic occlusion & facilitate other dental treatment & has little to do with Angle’s concept of an ideal tooth relationships.” www.indiandentalacademy.com
    36. 36. Principles of AOT  Diagnostic & treatment planning. • • Collecting an adequate data base. Developing a problem list. www.indiandentalacademy.com
    37. 37.  Diagnostic records • OPG. • Full mouth IOPAs. • Lateral ceph • photographs. • Dental casts. www.indiandentalacademy.com
    38. 38. Biomechanical considerations  Characteristics of the orthodontic appliance. • Anchorage control • 22-slot edgewise appliance with twin brackets • Removable/Fixed appliance. • Bracket placement-ideal-tooth to be moved. www.indiandentalacademy.com
    39. 39. Removable appliances www.indiandentalacademy.com
    40. 40. Bracket placement www.indiandentalacademy.com
    41. 41. Effects of reduced periodontal support  Bone support  Bone loss-PDL area decreases  CR-shifts more appically www.indiandentalacademy.com
    42. 42. Timing & sequence of treatment Active disease Disease control Re-evaluate Establish occlusion stabilize Definitive restorative Rx maintenance www.indiandentalacademy.com
    43. 43. Adjunctive orthodontic Rx procedure.  Uprighting of posterior teeth • • • • •    Uprighting a single molar Uprighting with minimal extrusion Final positioning of molar & PM Uprighting two molars in the same quadrant Retention Forced eruption Alignment of anterior teeth Crossbite correction www.indiandentalacademy.com
    44. 44. Uprighting posterior teeth  Treatment planning consideration • Loss of posterior teeth • If the 3 molar is present? • Uprighting by distal crown/ mesial root rd • movement? Slight extrusion of tipped molar is permissible? www.indiandentalacademy.com
    45. 45. Loss of posterior teeth www.indiandentalacademy.com
    46. 46. Distal crown/ mesial root movement www.indiandentalacademy.com
    47. 47. Crown: root length www.indiandentalacademy.com
    48. 48. Appliances for molar uprighting  Partial fixed appliance  Active & reactive unit  bonding>banding www.indiandentalacademy.com
    49. 49. Uprighting a single molar  Distal crown tipping with occlusal antagonist • Flexible rectangular wire17x25 NiTi • Anchorage unit-19x25 steel • 17x25 beta-Ti www.indiandentalacademy.com
    50. 50. Uprighting with minimal extrusion   Uprighting with no occlusal antagonist “T-Loop”-17x25 steel/ 19x25 beta Ti www.indiandentalacademy.com
    51. 51. Uprighting of lower molars Birte melsen,JCO 1996 case1 56yrs/M Missing lower 1st molar www.indiandentalacademy.com
    52. 52. case1 www.indiandentalacademy.com
    53. 53. Case 2 42/F Missing 46 www.indiandentalacademy.com
    54. 54. Case 2 www.indiandentalacademy.com
    55. 55. Distal jet www.indiandentalacademy.com
    56. 56. A simple technique for molar uprighting –E Capelluto,JCO 1996 “MUST” www.indiandentalacademy.com
    57. 57. www.indiandentalacademy.com
    58. 58. Final positioning of molar & PMs Compressed coil springs 018 steel www.indiandentalacademy.com
    59. 59. Uprighting two molars in the same quadrant.  Combination of distal crown & mesial root  No bilateral uprighting - same time  17x25 Niti www.indiandentalacademy.com
    60. 60. Retention  Fixed bridge-within 6 weeks  Short time-19x25 steel /21x25 beta Ti  >few weeks-intermediate splinting www.indiandentalacademy.com
    61. 61. Forced eruption  Indications • Defects in cervical 3 of the root • Horizontal / vertical # • Internal/external resorption • Decay • PDL – disease • To obtain good access for endodontic and rd restorative process www.indiandentalacademy.com
    62. 62. Forced eruption  Treatment planning • Good periapical radiographs • Periodontal support • Root morphology and position • Endodontic therapy should be completed www.indiandentalacademy.com
    63. 63. Orthodontic technique  Anchor teeth –rigid  Flexible –tooth to be extruded  With / without the use of orthodontic bracket www.indiandentalacademy.com
    64. 64. www.indiandentalacademy.com
    65. 65. Alignment of anterior teeth  Indications • To improve access & permit placement of • • • restoration To permit placement of crowns & pontics To reposition the closely approximated roots To place implants. www.indiandentalacademy.com
    66. 66. Treatment planning  Interproximal stripping  Diagnostic setup-very helpful www.indiandentalacademy.com
    67. 67. Orthodontic technique  Alignment of crowded, rotated & displaced incisors • Edgewise brackets-canine –canine • Initial wire-light & flexible • 016 Niti • Crown reduction www.indiandentalacademy.com
    68. 68. Positionining tooth for single tooth implants  Missing teeth-implants • Space needed for implant, esthetics& the occlusion  Space needed for implants • Narrowest – 4mm • 1mm –in b/w implants  Contralareral & adjacent teeth –size of the implant www.indiandentalacademy.com
    69. 69. Timing of implant placement  Implants to support restorations should not be placed until all vertical growth has been completed.  Boys-20yrs  Girls-15-17yrs.  For adults-soon after –minimizes bone loss. www.indiandentalacademy.com
    70. 70. Case reports     Kenji W Higuchi 48yrs/F Class II div 1 Deep bite Missing12,47,46,45,35,36,37 Treatment plan: surgical correction 6 implants on 37,26,25,47,46,45 Healing period -4 months Implant-supported FPD Uprighting of 3rd molar + alignment Same implants-abutments. www.indiandentalacademy.com
    71. 71. Case 1 www.indiandentalacademy.com
    72. 72. case1 www.indiandentalacademy.com
    73. 73. Case 2  53yrs/M  Class III  Ant &post crossbites  spacing Treatment plan: 2 implants,35&36 Healing period -4 months Implant-supported FPD www.indiandentalacademy.com
    74. 74. Case 3  64yrs/F  Class I  Impacted canine  Missing teeth Treatment plan: Extrusion of impacted canine 1 implant -16 Healing period-6 months Implant supported FPD-anchorage Same implant-abutment www.indiandentalacademy.com
    75. 75. Case 3 www.indiandentalacademy.com
    76. 76. Anterior diastema closure  Loss of posterior teeth, abnormally small teeth, loss of bone support-drifting/spacing.  Partial closure-composite build ups-permanent retention  Smaller diastema-removable appliance  016 niti,018 steel with coil springs. www.indiandentalacademy.com
    77. 77. Diastema closure www.indiandentalacademy.com
    78. 78. Crossbite correction Crossbite-functional problem Ant crossbite -esthetic Tipped teeth-removable apl Elastics Establishing a good overbite relationship is the key to maintaining crossbite correction. www.indiandentalacademy.com
    79. 79. Comprehensive orthodontic treatment. Adult orthodontics. www.indiandentalacademy.com
    80. 80. Comprehensive orthodontic treatment-Adults  Special considerations for adults • Different motivations for seeking orthodontic • • treatment & different psychological differences to it. Heightened susceptibility to periodontal disease. Lack of growth. www.indiandentalacademy.com
    81. 81. Comprehensive treatment  Motivation for adult treatment • Psychological • PDL & restorative needs as motivating factor • TMJ dysfunction as motivating factor  Periodontal aspects of adult treatment  Special aspects of orthodontic appliance therapy. www.indiandentalacademy.com
    82. 82. Psychological considerations     High motivation -self referred for esthetic reasons Low motivation -dentist referred for adjunctive correction Turned off -unaesthetic appliances, fear of pain, extended treatment time, personal inconvenience & cost Adults are less tolerant of discomfort & more likely to complain about difficulties in speech, eating & tissue adaptation. www.indiandentalacademy.com
    83. 83. Periodontal diagnosis   Awareness of risk factors General factors • • • • Family history General health status Nutritional status Current stress factors • Local factors Plaque indices Crown root ratio Habits Restorative status www.indiandentalacademy.com
    84. 84. Periodontal aspects of adult treatment  Periodontal considerations are increasingly important as patient become older ,regardless of whether periodontal problems were a motivating factor.  Minimal PDL involvement Moderate PDL involvement Severe PDL involvement   www.indiandentalacademy.com
    85. 85. Minimal periodontal involvement  Hygiene status • Special care-adults • Inter dental aids, proximal brushes  Level & condition of attached gingiva  Gingival recession  Gingival grafts www.indiandentalacademy.com
    86. 86. Moderate PDL-involvement  Disease control • Preliminary PDL-treatment • • • Scaling,curettage,flap surgery etc Endodontic treatment Cast restorations should be delayed  Period of observations  PDL-maintenance • • • • Full arch bonding> banding Steel ligature > elastomeric rings maintenance = 2-4 months Hygiene maintenance- electric tooth brushes, mouthwashes www.indiandentalacademy.com
    87. 87. Severe PDL- involvement  Disease control • Scaling,curettage,flep surgery, osseous surgery • Endodontic therapy  Period of observation  PDL- maintenance • More frequent intervals,4-6 weeks Very light forces should be used.  www.indiandentalacademy.com
    88. 88. Temperomandibular dysfunction  Internal joint pathology  Muscle origin www.indiandentalacademy.com
    89. 89. Temperomandibular dysfunction •Prevalence of TMD problemsSchiffman et al (1998) Muscle disorder Joint disorder Combination Normal 23% 19% 27% 31%  Diagnostic records • • • • Full TMJ series x-rays Opg Muscle examination Stress evaluation www.indiandentalacademy.com
    90. 90. www.indiandentalacademy.com
    91. 91. Intrusion  light & continuous force • With continuous arch wires • Segmental arch wires  In case of PDL involved-anchorage compromised.  Intrusion should never be attempted without excellent control of inflammation. www.indiandentalacademy.com
    92. 92. Intrusion of incisors in adult patients with marginal bone loss Birte Melsen, AmJ Orthod 1989    Common problems-adults-PDL disease • Migration, spacing, elongation of incisors Progressive bone loss-CR shifts appically Aim :to intrude elongated teeth with varying degrees of PDL damage & thus evaluating the influence of treatment on pdl status. www.indiandentalacademy.com
    93. 93.  Material & method • • • •  30 sample 5M/25F AGE:22-60yrs PDL preparation Orthodontic appliance-4 types • • • • J hook for intrusion Ricketts utility arch-016x016 steel Intrusion bend into loops of full arch-017x025 steel Burstone’s continuous intrusion arch www.indiandentalacademy.com
    94. 94. www.indiandentalacademy.com
    95. 95.  Analysis applied • Study casts • Latral ceph • Opg • IOPA-special film holder Piece of 021x028 elgiloy www.indiandentalacademy.com
    96. 96. www.indiandentalacademy.com
    97. 97.  Results • True intrusion=0-3.5mm • Clinical crown length reduction =0.5-2mm • Root resorption =1-3mm • Total amount of alveolar support=unaltered/increased  Utility & Burstone’s base arch -largest intrusion &largest gain in bony support. www.indiandentalacademy.com
    98. 98. Upper molar intrusion Birte melsen JCO 1996     Case 1 38yrs/F Missing teeth Chewing difficulty www.indiandentalacademy.com
    99. 99. www.indiandentalacademy.com
    100. 100. www.indiandentalacademy.com
    101. 101. 4.5mm-intrusion 7.5mm- mesial movement 2mm- reduction of clinical crown ht. www.indiandentalacademy.com
    102. 102. Case 2 40yrs/F Missing 15,16,25,27,28,35,37,38,44,45,47,48 Chewing difficulty. www.indiandentalacademy.com
    103. 103. www.indiandentalacademy.com
    104. 104. 3mm-intrusion 8mm-mesial movement of molar. Lower-implants www.indiandentalacademy.com
    105. 105. Interproximal stripping for the treatment of adult crowding-Julia F Harfin JCO 2001 Nov  Crowding • • •  Thickest enamel -maxillary arch • •  Mild- less than 3mm Moderate- 3-5mm Severe -more than 5 mm M & D surfaces of cuspids Distal surface of central incisors Mandibular arch • • M & D surfaces of cuspids Distal surface of the lateral incisor www.indiandentalacademy.com
    106. 106. Case reports www.indiandentalacademy.com
    107. 107. Case1 22yrs/F Moderate crowding www.indiandentalacademy.com
    108. 108. www.indiandentalacademy.com
    109. 109. Case 2 24yrs/F Severe crowding www.indiandentalacademy.com
    110. 110. www.indiandentalacademy.com
    111. 111. Case 3 21yrs/M Anterior crossbite crowding www.indiandentalacademy.com
    112. 112. www.indiandentalacademy.com
    113. 113. Space closure Old extractions sites -difficult to close • Resorption • Remodeling of the bone.  Such situation-better to use prosthesis or Implants.  Temporary implants in the ramus - to protract the molars  www.indiandentalacademy.com
    114. 114. Rigid implant anchorage to close a mandibular first molar extraction siteW.Eugene Roberts, Charles nelson,jco1997 Rigid endoesseous implants are a reliable source of orthopedic anchorage For managing malocclusions that are the usual scope of orthodontic practice Case report 45yrs/M Missing lower molar www.indiandentalacademy.com
    115. 115. www.indiandentalacademy.com
    116. 116. www.indiandentalacademy.com
    117. 117. www.indiandentalacademy.com
    118. 118. Space closure- Removable prosthesis       35yrs/M Class III Generalized attrition Upper midline shift Asymmetric smile Missing teeth Treatment plan: Comprehensive orthodontic therapy Definitive implant & PDL therapy www.indiandentalacademy.com
    119. 119. www.indiandentalacademy.com
    120. 120. Invisalign  What is invisalign? - Invisible alignment of the teeth - An invisible way to align the teeth • Uses a series of clear removable aligners to straighten teeth without metal wires or brackets. • Developed by Align Technology,CA www.indiandentalacademy.com
    121. 121. Impressions are made using Polyvinyl Siloxane Impression and bite send along with a detailed treatment plan. advanced imaging technology transforms plaster models into a highly accurate 3-D digital image. A computerized movie called ClinCheck® depicting the movement of teeth from the beginning to the final position is created. Procedure After wearing all of the aligners in the series, customized set of aligners are made from these models, sent to the doctor, and given to the patient. Pt to wear each aligner for about two weeks. From the approved file, laser scanning to build a set Invisalign® uses of actual models that reflect each stage of the treatment plan. www.indiandentalacademy.com Using the Internet, the doctor reviews the ClinCheck file - if necessary, adjustments to the depicted plan are made.
    122. 122. Invisalign www.indiandentalacademy.com
    123. 123. Invisalign Patient gets the first aligner 6 weeks after the 1st visit  Most treatments require 20 – 60 aligners  Worn for 2 weeks each  Should be taken off only for eating and brushing  www.indiandentalacademy.com
    124. 124. Invisalign     Limitations Patients with severe malocclusions cannot be treated Children,mixed dentition – growing jaws and erupting teeth too complicated for the computer to model No precise control over root movements www.indiandentalacademy.com
    125. 125. Invisalign system in adult orthodontics: mild crowding & space closure cases Robert L Boyd, R J Miller,JCO 2000 April Case 1 23yrs/F Spacing b/w teeth www.indiandentalacademy.com
    126. 126. www.indiandentalacademy.com
    127. 127. Case 2 33yrs/M Spacing b/w teeth www.indiandentalacademy.com
    128. 128. www.indiandentalacademy.com
    129. 129. case3 35yrs/M Mild crowding www.indiandentalacademy.com
    130. 130. www.indiandentalacademy.com
    131. 131. Lower incisor extraction treatment with invisalign system-Ross J Miller 2001 JCO nov Case report 24yrs/F Lower incisor crowding Class I molar reln Midline shift-3mm Rt side  www.indiandentalacademy.com
    132. 132. www.indiandentalacademy.com
    133. 133. www.indiandentalacademy.com
    134. 134. www.indiandentalacademy.com
    135. 135. www.indiandentalacademy.com
    136. 136. Rapid orthodontic decrowding with alveolar augmentation: case report William . M . Wilcko World Journal Orthodontics 2003:4:197-205 Thomas . Wilcko Demonstrates a New orthodontic method that provides shortened treatment times. Case report 27yrs/F Class I with moderate crowding www.indiandentalacademy.com
    137. 137. After 1 wk of bracketing & wire activation-selective Decortications. www.indiandentalacademy.com
    138. 138. Decorticotomy www.indiandentalacademy.com
    139. 139. Bone grafting /augmentation www.indiandentalacademy.com
    140. 140. Post treatment Total treatment time 6mnths. www.indiandentalacademy.com
    141. 141. Discussion  Rapid decrowding & minimal root resorption -2 phenomenon • Increased Regional bone turn over • osteopenia Selective decortications. www.indiandentalacademy.com
    142. 142. Conclusion  Takes shorter treatment time  Pre-existing fenestrations/dehiscence can be corrected-alveolar augmentation.  Lip support can be achieved-alveolar augmentation. www.indiandentalacademy.com
    143. 143. Accelerated Invisalign treatmentAlbert H Owen,JCO 2001 June Esthetics & speed Decorticotomy( AOO) Invisalign therapy Class I Occlusion Mild crowding in lower arch Lower midline shift Only lower canine-canine decorticotomy. www.indiandentalacademy.com
    144. 144. After 10 days of corticotomy Invisalign therapy started. Aligners changed –every 3 days. Rx completion-4 months. www.indiandentalacademy.com
    145. 145. Retention & Post treatment stability in Adults.  “After malposed teeth have been moved into the desired position, they may be mechanically supported until all of the tissue involved in their support & maintenance in their new positions shall have become thoroughly modified , both in their structure & function to meet new requirements.” -E H Angle www.indiandentalacademy.com
    146. 146. Retention Removable appliances & retainers Hawley retainer Tooth positioner Spring retainer Fixed retainer Bonded retainer Banded retainer www.indiandentalacademy.com
    147. 147. Hawley retainer www.indiandentalacademy.com
    148. 148. Hawley retainer –modified www.indiandentalacademy.com
    149. 149. Positioner www.indiandentalacademy.com
    150. 150. Positioner www.indiandentalacademy.com
    151. 151. Fixed retainer www.indiandentalacademy.com
    152. 152. Fixed retainer www.indiandentalacademy.com
    153. 153. QCM-Organic polymer retainer www.indiandentalacademy.com
    154. 154. Labial fixed retainer www.indiandentalacademy.com
    155. 155. Labial fixed retainer www.indiandentalacademy.com
    156. 156. Case reports www.indiandentalacademy.com
    157. 157. www.indiandentalacademy.com
    158. 158. www.indiandentalacademy.com
    159. 159. www.indiandentalacademy.com
    160. 160. CASE NO-3 D.P 21/F www.indiandentalacademy.com 34
    161. 161. D.P.21/F www.indiandentalacademy.com 35
    162. 162. D.P.21/F SEVERE SKELETAL CLASS II WITH MATCHING SOFT TISSUES HYPERDIVERGENT JAW BASES SEVERE PROCLINATION OF U-ANTERIORS. www.indiandentalacademy.com 36
    163. 163. D.P.21/F PRESURGICAL PHASE www.indiandentalacademy.com 37
    164. 164. D.P.21/F PRESURGICAL PHASE www.indiandentalacademy.com 38
    165. 165. D.P.21/F POST SURGICAL PHASE www.indiandentalacademy.com 39
    166. 166. D.P.21/F PRE -FINISHING RADIOGRAPHS SUPERIMPOSITION www.indiandentalacademy.com 40
    167. 167. D.P.23/F www.indiandentalacademy.com 40
    168. 168. D.P.23/F www.indiandentalacademy.com 41
    169. 169. D.P.23/F www.indiandentalacademy.com 42
    170. 170. D.P.23/F COMPARISON www.indiandentalacademy.com 43
    171. 171. D.P.23/F COMPARISON www.indiandentalacademy.com 44
    172. 172. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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