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American journal /certified fixed orthodontic courses by Indian dental academy

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Welcome to Indian Dental Academy …

Welcome to 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 has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

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  • 1. Efficiency of Pendulum Appliance for Molar Distalization Related to Second & Third Molar Eruption Stage  Gero S.M. Kinzinger, Dr med dent et al www.indiandentalacademy.com 1
  • 2. Introduction     Head gear, ACCO, Jones jig, Lokar distalizing apl, distal jet, magnetic modules Pendulum appl – Hilgers, 1992 Snodgrass, Byloff, Favero, Scuzzo et al and Kinzinger et al. Bussick & McNamara, Ghosh & Nanda, Joseph & Butchart – position of second molar is of little if any import. www.indiandentalacademy.com 2
  • 3. Objectives  To assess this hypothesis.  Discussion of early third molar germectomy. www.indiandentalacademy.com 3
  • 4. Material & Methods     Modified Pendulum appl 36 pts – 25 girls, 11 boys Mean age – 12 years 5 months 3 groups according to the stage of second & third molar eruption – patient groups (PG) PG1, PG2, PG3. www.indiandentalacademy.com 4
  • 5. Material & Methods    PG1 – incomplete or no eruption of M2 PG2 – M2 erupted, M3 in budding stage PG3 – M1, M2 erupted, M3 germectomy www.indiandentalacademy.com 5
  • 6. Material & Methods    Pendulum appliance – Pendulum K Activated intraorally by adjusting distal screw Built in straightening activatn & toe-in www.indiandentalacademy.com 6
  • 7. Material & Methods www.indiandentalacademy.com 7
  • 8. Material & Methods   Dental casts – T1 & T2 Transverse arch width and magnitude & direction of molar rotations. www.indiandentalacademy.com 8
  • 9. Material & Methods   Sagittal plane – cephalograms T1 & T2. A. Skeletal angles–      SNA SN-NF RFA Facial PA FMA www.indiandentalacademy.com 9
  • 10. Material & Methods  B. dental angles & distances –           i CEJ/PTV M1-CEJ/PTV M2-CEJ/PTV M1-CEJ/ANS-PNS i/ANS-PNS i/SN M1/ANS-PNS M2/ANS-PNS M1/SN M2/SN www.indiandentalacademy.com 10
  • 11. Results  Dental cast measurements   Pre Rx transverse arch width – M2>M1 Gain M2>M1 www.indiandentalacademy.com 11
  • 12. Results  Mesiobuccal rotations  M1>M2 www.indiandentalacademy.com 12
  • 13. Results  Analysis of Cephalograms    Mean distal tipping: M1 3.07+-4.02 ; M2 5.3+-4.23 Labial tipping of central incisor – 4.51+-3.6 Mean distalization: M1 3.14+-0.92 ; M2 2.56+-0.81 mm. Incisor protrusion 1.33+-0.85    70.25% and 29.75% Time – 0.62 and 0.51mm/month Distal tipping of first molars in PG1 > PG2 & PG3. ( 0.8+-3.4 & 5.36+-3.49) www.indiandentalacademy.com 13
  • 14. Results   Tipping of erupted second molars markedly more in PG2 than PG3. ( 7.55+-5.28 & 2+-2) None of the measured skeletal changes were significant. www.indiandentalacademy.com 14
  • 15. Discussion  In the distalization direction, a tooth bud acts on the mesial neighboring tooth in the same way as fulcrum. www.indiandentalacademy.com 15
  • 16. www.indiandentalacademy.com 16
  • 17. www.indiandentalacademy.com 17
  • 18. Biomechanical analysis www.indiandentalacademy.com 18
  • 19. Horizontal plane Mesiobuccal rotation www.indiandentalacademy.com 19
  • 20. Sagittal plane www.indiandentalacademy.com 21
  • 21. www.indiandentalacademy.com 22
  • 22. www.indiandentalacademy.com 23
  • 23. Conclusions   The best time to start therapy with a pendulum appliance is before the eruption of second molars. In case of simultaneous distalization of 1st and 2nd molars, prior germectomy of 3rd molar is strongly recommended. www.indiandentalacademy.com 24
  • 24. www.indiandentalacademy.com 25
  • 25. Bond Strength of Various Bracket Base Designs  Wei Nan Wang, Chung Hsing & others www.indiandentalacademy.com 26
  • 26. Purpose of the study   Size & design of bracket base Two designs :    A single piece casting with retention grooves on the base. Mesh or circular,concave form that is laser welded with silver directly to the bracket body. To determine the bond strength and debonding interface distributions of 6 types of brackets. www.indiandentalacademy.com 27
  • 27. Material & Methods  The brackets were –       Dynalock (Unitek, US) Accuarch appliance Formula –R (Tomy,Japan) Ultratrimm (Dentaurum, Germany) Minidiagonali Roth (Leone, Italy) Tip-edge Rx-1 (TP Orthodontics, ) Mini Diamond (Ormco) www.indiandentalacademy.com 28
  • 28. Material & Methods www.indiandentalacademy.com 29
  • 29. Material & Methods    120 maxillary premolars fm pts 9-16yrs Criteria for tooth selection – a. crown with no defect. b. tooth has never been pretreated with a chemical agent such as H2O2 or formalin. c. contour of labial crown surface was adapted to the base of the bracket before bonding. 6 groups of 20 teeth each. www.indiandentalacademy.com 30
  • 30.        Polished with pumice for 10 sec Etched for 15 sec with 30% phosphoric acid Outline demarcated with pencil Surface outside coated with red nail polish Bonding agent – Concise, 3M Specimen incubated in 37* water bath for 24 hrs. Tested on Instron universal machine www.indiandentalacademy.com 31
  • 31. Results www.indiandentalacademy.com 32
  • 32. www.indiandentalacademy.com 33
  • 33. www.indiandentalacademy.com 34
  • 34. Discussion  Tomy bracket  Dentaurum bracket  Mesh spacing -5.1 www.indiandentalacademy.com 35
  • 35.  Mini mesh – 2.9 www.indiandentalacademy.com 36
  • 36. Conclusions    The size & design of a bracket base affects bond strength. Tomy bracket with circular concave design produced greater bond strength. Among brackets with mesh type bases, the larger the mesh spacing, greater the bond strength. www.indiandentalacademy.com 37
  • 37. www.indiandentalacademy.com 38
  • 38. Distal Movement of Mandibular Molars in Adult Pts with the Skeletal Anchorage System  Junji Sugawara, Takayoshi daimaruya et al www.indiandentalacademy.com 39
  • 39. Introduction     One of the most difficult to achieve treatment objectives in Orthodontics. Headgear, lip bumper, distal extension lingual arch, Jones jig, Franzulum appliance, multiloop edgewise archwire. Skeletal Anchorage System ( SAS ). Distalization of molars enables the clinician to correct ant crossbites, crowding & dental asymmetry without extracting premolars. www.indiandentalacademy.com 40
  • 40. Aims    To measure the average amt of distalization of mandibular molars. To evaluate the type of tooth movement that occurs. To determine the stability of the distalized molars 1 year posttreatment. www.indiandentalacademy.com 41
  • 41. Material & Methods   15 adult pts ( 12 women & 3 men ) Criteria –       Having no severe skeletal disharmonies Sufficient space behind the second molar Treated by distalization of mandibular first molar Followed for at least 1 yr posttreatment. Average age – 26.9 yrs, 16.1 - 43.5 yrs Average t/t time 28.9 months, 21 – 39 mnths www.indiandentalacademy.com 42
  • 42. Material & Methods www.indiandentalacademy.com 43
  • 43. Material & Methods    Anchor plates ( Leibinger, Germany) – pure titanium Monocortical screws – pure titanium – diameter – 2.0 mm, length – 5.0 mm. Placed behind second molars under local anaesthesia. www.indiandentalacademy.com 44
  • 44. Material & Methods www.indiandentalacademy.com 45
  • 45. www.indiandentalacademy.com 46
  • 46. Methods of Distalization  Single molar distalization www.indiandentalacademy.com 47
  • 47.  En masse distalization of entire buccal segments www.indiandentalacademy.com 48
  • 48.     Retention – LBR – 0.0175-in multistranted flexible wire. Records – Lat. Ceph, OPG, dental casts & photographs – pre Rx, at debonding, 1 yr after debonding. Occlusograms – 1.06 X Tipping ratio - root movement / crown mov   < 25% - tipping >25% - translation www.indiandentalacademy.com 49
  • 49. Crown movement – occlusograms  Root – ceph tracing  www.indiandentalacademy.com 50
  • 50. Results www.indiandentalacademy.com 51
  • 51. Results       Mean distal movement : 3.5 +- 1.4 mm at the crown level. Max – 7.1 mm , min – 1.0 mm Root movement – 1.8 mm Relapse – 0.3 mm , 9% Max relapse – 0.8 mm No correlation betn relapse rate & amount of tooth movement. www.indiandentalacademy.com 52
  • 52. Case 3    36 yr Japanese woman 36 months of active treatment Distal movement – Lt- 7.1 mm, Rt- 5.5 mm www.indiandentalacademy.com 53
  • 53.  Post treatment www.indiandentalacademy.com 54
  • 54. www.indiandentalacademy.com 55
  • 55. www.indiandentalacademy.com 56
  • 56. Discussion    Previous modalities disadvantages – pt compliance, tipping movement, anchorage loss, incisor flaring. Endosseous implants – disturbed tooth movement, became loose because of heavy force. SAS – provides rigid anchorage, doesn’t interfere with tooth movement. www.indiandentalacademy.com 57
  • 57.  Two distinct advantages of SAS –    It is possible to intrude mand molars En masse distalization of mandibular buccal segments or the entire dentition is possible, thus reducing t/t time. SAS might recquire orthodontists to reconsider their thinking regarding arch length discrepency, space analysis & extraction criteria. www.indiandentalacademy.com 58
  • 58. Conclusions     SAS is a viable modality for distalizing mandibular molars. It enables en masse movement with only a minor surgery to place the anchor plates. Effective in correcting class III malocclusions, mand incisor crowding & dental asymmetries. Premolar extraction can be avoided. www.indiandentalacademy.com 59
  • 59. www.indiandentalacademy.com 60
  • 60. www.indiandentalacademy.com 61
  • 61. Eruption of Third Molars : Relationship to Inclination of Adjacent Molars  Jackie Badawi Fayad, J C Levy, et al www.indiandentalacademy.com 62
  • 62. Introduction    Most often impacted Impaction related to available space – pterygoid vertical & distal border of first molar. Recent studies have questioned significance of this available space as a predictor for eruption or impaction. www.indiandentalacademy.com 63
  • 63. Purpose  To determine the relationship between maxillary molars’ sagittal inclination and the eruption of third molars with CT scans www.indiandentalacademy.com 64
  • 64. Material and Methods   60 subjects ( 30 men, 30 women) with complete normal permanent dentitions. 2 groups –   First group – 28 subjects, mean age 33.3 yrs, range 16-50 yrs. With erupting or erupted third molars. Second group – 32, mean age – 27.6 yrs, range 16-50 yrs. With impacted right and left third molars. www.indiandentalacademy.com 65
  • 65. Material and Methods  Analysis using 2D multiplanar reconstructions www.indiandentalacademy.com 66
  • 66.  Sagittal inclinations of 1st & 2nd molars were measured by posteroinferior angle formed by the molar axis ( intercuspid groove bifurcation) and the palatal plane. www.indiandentalacademy.com 67
  • 67. Results   Rt & Lt 1st & 2nd molars were more mesially inclined in the group with erupting or erupted third molars than in the second group. Inclination of 1st molar was a predictor of eruption of 3rd molar. www.indiandentalacademy.com 68
  • 68. www.indiandentalacademy.com 69
  • 69. Discussion     Sagittal inclination of M1 & M2 was more in subjects with erupted M3 than in those with impacted. Cross sectional study Effect of age on sagittal inclinations Measurements on panoramic radiographs not reliable www.indiandentalacademy.com 70
  • 70. Conclusions   The vertical position of the 1st maxillary molar in the sagittal plane is a predictor of the eruption of the adjacent third molar. The sagittal inclinations of maxillary molars increase with age : it could be the effect of mesial drift. www.indiandentalacademy.com 71
  • 71. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com 72