Appliances in presurgical orthognathic surgery /certified fixed orthodontic courses by Indian dental academy

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Appliances in presurgical orthognathic surgery /certified fixed orthodontic courses by Indian dental academy

  1. 1. Appliances in Presurgical Orthodontics INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Introduction • Orthodontic treatment prior to and after surgical correction of malocclusion is considered vital to the stability of the achieved result • Pre surgical orthodontics helps the oral surgeon to align the skeletal bases on the operating table www.indiandentalacademy.com
  3. 3. Review • Bracket systems • First generation Andrews 1972 • Second generation Ronald Roth 1980’s • Third generation 1990’s MBT www.indiandentalacademy.com
  4. 4. Slot dimension • .022 versus .018 • The slot dimension preferred and widely used by the orthodontist for a surgical case is .022 slot, the stability is better as it allows the use of stiffer wires. www.indiandentalacademy.com
  5. 5. Friction /frictionless mechanics Frictionless mechanics Anterior segment Vs posterior segment Friction mechanics Anterior segment Vs posterior segment + Friction Increased anchorage demands www.indiandentalacademy.com
  6. 6. Tip • Inbuilt tip VS expressed tip • Inbuilt tip - The tip built into the bracket • Expressed tip – on insertion of wire – the change in the mesio distal inclination of tooth • The effect of the inbuilt tip and expressed tip on the mesiodistal inclination of teeth is very minimal. www.indiandentalacademy.com
  7. 7. Torque • Inbuilt torque and expressed torque • loss of torque – cardinal rule For every 0.001” play there is loss of 40 loss of torque PAE is highly inefficient in regaining lost torque www.indiandentalacademy.com
  8. 8. Comparison of upper tip 7 6 5 4 Roth 00 00 00 00 MBT 00 00 00 00 3 2 1 Roth +130 +90 +50 MBT +80 +80 +40 www.indiandentalacademy.com
  9. 9. Comparison of upper torque 7 6 5 4 Roth -140 -140 -70 -70 MBT -140 -140 -70 -70 3 2 1 Roth -20 +80 +120 MBT -70,00, +70 +100 +170 www.indiandentalacademy.com
  10. 10. Comparison of lower tip Tip 7 6 5 4 Roth -10 -10 -10 -10 MBT 00 00 +20 +20 3 2 1 Roth +70 +20 +20 MBT +30 +00 +00 www.indiandentalacademy.com
  11. 11. Comparison of lower torque 7 6 5 4 Roth -300 -300 -220 -170 MBT -100 -200 -170 -120 3 2 1 Roth -110 -10 -10 MBT +6,0,-60, -60 -60 www.indiandentalacademy.com
  12. 12. Bends in the rectangular wire Palatal root torque on the anterior and posterior region Anterior region – desirable Posterior region - undesirable Distal to the www.indiandentalacademy.com root torque laterals – buccal
  13. 13. Detorqueing Posterior Anterior www.indiandentalacademy.com
  14. 14. Decompensation Skeletal mal- relationship Teeth compensate to mask the skeletal discrepancy Pre- surgical orthodontics Eliminate the dental compensation that has occurred with respect to the skeletal base www.indiandentalacademy.com
  15. 15. Class II decompensation  Objectives  Co-ordinate the arches in transverse dimension Leveling Class II molar and canine relation ship Obtain sufficient over jet  Treatment plan  Mechanotherapy  Anchorage preparation www.indiandentalacademy.com
  16. 16. Pretreatment oral www.indiandentalacademy.com extra
  17. 17. Pretreatment oral www.indiandentalacademy.com intra
  18. 18. www.indiandentalacademy.com
  19. 19. During treatment intraoral www.indiandentalacademy.com
  20. 20. Post treatment oral www.indiandentalacademy.com extra
  21. 21. Post treatment oral www.indiandentalacademy.com intra
  22. 22. Class III decompensation • Objectives – To coordinate the arches in transverse dimension – Leveling – Class III molar and canine relationship – Reverse overjet& • Treatment plan • Mechanotherapy • Anchorage preparation www.indiandentalacademy.com
  23. 23. Anterior segmental osteotomy • Objectives – Coordinate arches in the transverse dimension – Leveling – Divergence of roots at the planned osteotomy site • Treatment plan • Mechanotherapy • Anchorage preparation www.indiandentalacademy.com
  24. 24. Segmental /Continuous mechanics • Segmental mechanics are more Bioefficient with less adverse effects • Statically determinate system – thus possible to know the exact amount of forces and moments in the system • Though continuous mechanics is a statically indeterminate system, it has been widely preferred by the orthodontist due to the easy cookbook approach. www.indiandentalacademy.com
  25. 25. Creating step at osteotomy site • Aligning by a segmental approach at the osteotomy site – most beneficial • Altering the height of the bracket positioning to achieve the extrusion of the to be intruded segment • Use of a stainless steel or a TMA spring to create a step at the osteotomy site which TMA is preferable – Achieve stabilization of posterior segment with stainless arch wire – Insert the spring into the auxiliary tube www.indiandentalacademy.com
  26. 26. Segmental mechanics www.indiandentalacademy.com
  27. 27. Bonding modification www.indiandentalacademy.com
  28. 28. Pretreatment oral www.indiandentalacademy.com extra
  29. 29. Pretreatment oral www.indiandentalacademy.com intra
  30. 30. During treatment oral www.indiandentalacademy.com intra
  31. 31. Post treatment oral www.indiandentalacademy.com extra
  32. 32. Cleft patients www.indiandentalacademy.com
  33. 33. Problems in finishing • Tip • Torque • Mesio distal diameter (Bolton’s ratio) • Curve of spee www.indiandentalacademy.com
  34. 34. Ideal finish •Consistency •Accuracy •Predictability •Convenience www.indiandentalacademy.com
  35. 35. Tip Change in tip alters the mesio distal diameter occupied www.indiandentalacademy.com
  36. 36. Torque Space closure Lower arch the complete space closure achieved Inability of complete space closure in the upper arch Loss of torque www.indiandentalacademy.com
  37. 37. Mesio distal diameter www.indiandentalacademy.com
  38. 38. Proximal stripping www.indiandentalacademy.com
  39. 39. Post treatment intraoral www.indiandentalacademy.com
  40. 40. Curve of spee www.indiandentalacademy.com
  41. 41. Conclusion • Learn to appreciate the concept of inbuilt tip and torque versus expressed tip and torque • Develop individual orthodontic sense instead of blindly following prescription and bracket systems • Having a thorough knowledge of biomechanics involved will help the orthodontist to supplement any deficiency present in the system that is being used www.indiandentalacademy.com
  42. 42. Acknowledgement Dr. Munirathinam Naidu Principal Dr.PJaykumar Vice Principal and HOD Staff and students Department of Orthodontics Meenakshi Ammal Dental College, Chennai www.indiandentalacademy.com
  43. 43. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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