Management of Crowding /certified fixed orthodontic courses by Indian dental academy

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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.

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Management of Crowding /certified fixed orthodontic courses by Indian dental academy

  1. 1. Etiology and Management of Crowding www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. Aetiology can be described as the science which deals with the causation or origin of any disease. This can be attributed to any branch of science. Finding the cause is curing half the disease www.indiandentalacademy.com
  4. 4. The Orthodontic Equation CAUSE ACT AT TIMES ON TISSUES PRODUCING RESULTS www.indiandentalacademy.com
  5. 5. Dockrell classification  Heredity  Developmental causes of unknown origin  Trauma  Physical agents  Habits  Disease  Malnutrition www.indiandentalacademy.com
  6. 6. Primary Etiological Sites  NEUROMUSCULAR SYSTEM  BONE  TEETH  SOFT PARTS www.indiandentalacademy.com
  7. 7. TIME  PERIOD DURING WHICH CAUSE OPERATES  AGE AT WHICH IT IS SEEN www.indiandentalacademy.com
  8. 8. THE ORTHODONTIC EQUATION ELABORATED ACT AT CAUSE ON TIMES PRODUCING TISSUES SOME PREDISPOSING 1.CONTINUOUS 1.NEUROMUSCULAR OR SOME EXCITING TISSUE INTERMITTENT 2.TEETH 1.HEREDITY 3.BONE AND 2.MAY ACT AT 2.DEVELOPMENTAL CARTILAGE DIFF. AGE CAUSES OF UNKNOWN 4.SOFT TISSUE LEVELS ORIGIN OTHER THAN 3. TRAUMA MUSCLE 4.PHYSICAL AGENTS 5.HABITS 6.DISEASE 7.MALNUTRITION www.indiandentalacademy.com RESULTS 1.MALFUNCTION 2.MALOCCLUSION 3.OSSEOUS DYSPLASIA
  9. 9.  Dental crowding can be defined as a discrepancy between tooth size and jaw size that results in misalignment of the tooth row • Arch length a measurement of space available in the dental arch for alignment of teeth  Arch length deficiency defined as a negative difference between the space available in the dental arch and space required to align the teeth  Arch length discrepancy a difference between the space available in the dental arch and space required to align the teeth www.indiandentalacademy.com
  10. 10. ETIOLOGY OF CROWDING  Disproportion bw arch size and tooth size or arch length discrepancies  Prolonged retention of deciduous teeth  Altered path of eruption  Premature loss of deciduous teeth  Delayed eruption of permanent teeth  Presence of supernumerary teeth  Trauma  Localized abnormal size and shape of teeth  Late horizontal growth of mandible  Mesial migration of buccal segments www.indiandentalacademy.com
  11. 11. HEREDITY  Child is the product of parents who have dissimilar genetic material. Thus conflicting traits may be inherited from both parents resulting in abnormalities.  Racial, ethnic and regional inter-mixture www.indiandentalacademy.com
  12. 12. According to Lundstrom there exists a number of human traits that are influenced by the genes that include the following • TOOTH SIZE • ARCH DIMENSIONS • CROWDING • ABNORMALITIES OF TOOTH SHAPE • ABNORMALITIES OF TOOTH NUMBER • OVERJET • INTERARCH VARIATIONS • FRENUM www.indiandentalacademy.com
  13. 13. GENETIC INFLUENCES MALOCCLUSION CAN BE INHERITED IN TWO WAYS INHERITED DISPROPORTION BW SIZE OF THE TEETH AND SIZE OF THE JAWS WHICH WOULD CAUSE IMPROPER OCCLUSAL RELATIONSHIP INHERITED DISPROPORTION BW SIZE OR SHAPE OF UPPER AND LOWER JAWS WHICH WOULD CAUSE IMPROPER OCCLUSAL www.indiandentalacademy.com RELATIONSHIPS
  14. 14. PRIMITIVE POPULATION : MALOCCLUSION WAS LESS FREQUENT CHARACTERISTICS OF CIVILIZATIONS STOCKARDS EXPERIMENTS CHUNG ET AL : HAWAIIAN MELTING POT COMPARISON OF MONOZYGOTIC AND DIZYGOTIC TWINS LAUWERYNS ET AL CORRUCINI AND CO WORKERS HARRIS AND JOHNSON IN BOLTON BRUSH GROWTH STUDY www.indiandentalacademy.com
  15. 15. DEVELOPMENTAL DEFECTS OF UNKNOWN ORIGIN These are gross defects of rare type originating in failure of differentiation at a critical period in embryonic development Congenital absence of muscles Micrognathia Facial clefts Oligodontia Anodontia www.indiandentalacademy.com
  16. 16. CONGENITAL DEFECTS SEEN AT TIME OF BIRTH GENERAL LOCAL  ABNORMAL STATE OF MOTHER DURING PREGNANCY  MALNUTRTION  ENDOCRINOPATHIES  INFECTITIOUS DISEASES  METABOLIC/ DISEASES ACCIDENTS AT CHILD BIRTH   MACROGLOSSIA/ MICROGLOSSIA CLEIDOCRANIAL DYOSTOSIS INTRAUTERINE PRESSURE  CLEFTS OF THE FACE AND PALATE   ABNORMALITIES OF JAW DEV. DUE TO INTRAUTERINE PRESSURE  NUTRITIONAL  ACCIDENTAL TRAUMA TO FOETUS BY EXTERNAL FORCES www.indiandentalacademy.com
  17. 17. TRAUMA PRENATAL/ BIRTH INJURIES  HYPOPLASIA OF THE MANDIBLE  VOGELGESICHT  PRESSURE OF KNEE OR LEG  FOETUS HEAD FLEXED AGAINST THE CHEST www.indiandentalacademy.com TIGHTLY
  18. 18. POSTNATAL TRAUMA  FRACTURES OF THE JAW AND TEETH  HABITS MAY PRODUCE MICRO TRAUMA  TRAUMA TO THE TMJ www.indiandentalacademy.com
  19. 19. PHYSICAL AGENTS  PREMATURE EXTRACTION PRIMARY TEETH  NATURE OF FOOD www.indiandentalacademy.com OF
  20. 20. HABITS  DELETRIOUS HABITUAL PATTERNS OF MUSCLE BEHAVIOUR OFTEN ARE ASSOCIATED WITH PERVERTED OR IMPEDED OSSEOUS GROWTH, TOOTH MALPOSITIONS, DISTURBED BREATHING HABITS, DIFFICULTIES IN SPEECH, UPSET BALANCE IN FACIAL MUSCULATURE AND PHYSIOLOGICAL PROBLEMS  THEREFORE ONE CANNOT CORRECT MALOCCLUSION WITHOUT INVOLVMENT IN SUCH REFLEX ACTIVITIES www.indiandentalacademy.com
  21. 21. DISEASE  SYSTEMIC DISEASES FEBRILE DISEASES KNOWN TO UPSET DENTITIONAL DEVELOPMENT TIME TABLE DURING INFANCY AND EARLY CHILDHOOD MORE LIKELY TO AFFECT QUALITY RATHER THAN QUANTITY OF GROWTH MALOCCLUSION SECONDARY TO CERTAIN NEUROPATHIES AND NEUROMUSCULAR DISORDERS SEQUALAE OF TREATMENT OF SUCH PROBLEMS AS SCOLIOSIS BY PROLONGED WEARING OF APPLIANCES TO IMMOBILIZE www.indiandentalacademy.com THE SPINE
  22. 22.  ENDOCRINE DISEASES PRENATALLY Manifest as hypoplasia of teeth POSTNATALLY Retard or hasten the direction of facial growth Rate of ossification of bones Time of suture closure Time of eruption of teeth Rate of resorption of primary teeth www.indiandentalacademy.com
  23. 23.  LOCAL DISEASES 1) NASOPHARYNGEAL DISEASES AND DISTURBED RESPIRATORY FUNCTION 2) GINGIVAL AND PERIODONTAL DISEASES 3) TUMORS 4) CARIES A) PREMATURE LOSS OF PRIMARY TEETH B) DISTURBANCES IN SEQUENCE OF ERUPTION OF PERMANENT TEETH C) LOSS OF PERMANENT TEETH www.indiandentalacademy.com
  24. 24. ETIOLOGY OF LATE LOWER ARCH CROWDING  MARGARET RICHARDSON  Late lower arch crowding: facial growth/ drift ( Eur J Orthod 1979:1; 219-225)  Late lower arch crowding in reln. to primary crowding ( Angle orthod 1982:52;300-312)  Role of the third molar in the cause of late lower arch crowding (AJO-AO 1989:95; 79-83) www.indiandentalacademy.com
  25. 25.  Pressure from the back of the arch because of physiologic mesial drift, the anterior component of the force of occlusion on mesially inclined teeth, mesial vectors of muscular contraction, or the presence of a developing third molar may cause forward movement of the buccal teeth, with shortening of the arch and an increase in crowding. www.indiandentalacademy.com
  26. 26. Pressure from the front of the arch may cause reduction in arch length and depth with resultant crowding. SELMER AND OLSEN R The normal development of the mandibular teeth and the crowding of the incisors as a result of growth and function. Dent Rec 1937;57:465-77. www.indiandentalacademy.com
  27. 27. LATE MANDIBULAR GROWTH  CAN LEAD TO INCREASED PRESSURE FRONT OF THE MOUTH IN Growth behaviour of the human bony facial profile as revealed by serial cephs Angle Orthod 1952;22:78-90.  LANDE  BJORK AND PALLING, HUMER FELT AND SLAGSVOLD AND SIATOWSKI www.indiandentalacademy.com
  28. 28. A study of the correlation between mandibular growth direction and changes in incisor inclination, overjet, overbite and crowding. Eur Orthod Soc Trans 1975:131-40.  LUNDSTROME www.indiandentalacademy.com
  29. 29. SKELETAL STRUCTURE/ COMPLEX GROWTH PATTERNS  CROWDING INCREASED DUE TO PARTICULAR TYPE OF SKELETON/ SPECIFIC TYPE OF GROWTH PATTERN (SAKUDA ET AL)  INCREASED LOWER ARCH CROWDING WAS SEEN TO BE ASSOCIATED WITH INCREASED MANDIBULAR PLANE ANGLE, LARGE OVERJET, RETROGNATHIC FACE AND INCREASED OVERBITE (MENG ET AL)  EXTREME DEGREES OF MANDIBULAR GROWTH www.indiandentalacademy.com INCREASED CROWDING (BJORK)
  30. 30. SOFT TISSUE MATURATION  DENTOALVEOLAR STRUCTURES ARE RESPONSIVE TO SOFT TISSUE PRESSURES AND ADAPT TO A POSITION OF BALANCE OF LIPS CHEEKS AND TONGUE  FRANKEL /LOFFLER  WOODSIDE /LINDER ARONSON www.indiandentalacademy.com
  31. 31. PERIODONTAL FORCES  TEETH ARE JOINED TOGETHER UNDER TENSION BY THE TRANS SEPTAL FIBRES (PICTON AND MOSS)  ANY IMBALANCE CREATED BY THE TONGUE ON ONE SIDE AND THE CHEEK AND LIPS ON THE OTHER ARE COUNTER ACTED BY FORCES IN THE PDL BY ACTIVE METABOLISM (PROFITT)  CONTINUOUS FORCE ON THE MANDIBULAR DENTITION TO MAINTAIN PROXIMAL CONTACTS IN A STATE OF COMPRESSION. FORCE INCREASED DURING OCCLUSAL LOADING (SOUTHARD) www.indiandentalacademy.com
  32. 32. TOOTH STRUCTURE  PECK AND PECK  SMITH ET AL/ PUNEKY ET AL/ GLEN ET AL/ GILMORE AND LITTLE www.indiandentalacademy.com
  33. 33. OCCLUSAL FORCES  ALTERATION IN FUNCTION MAY PRODUCE A DIFFERENT PATTERN OF MASTICATORY FORCES OR AN OCCLUSION WITH PREMATURE CONTACTS www.indiandentalacademy.com
  34. 34. CONNECTIVE TISSUE CHANGES  BONE LOSS AS A RESULT OF AGING OR PERIODONTAL DISEASE MAY ALLOW TEETH TO MOVE UNDER PRESSURE  THEY LIFE CAUSE CROWDING IN LATER www.indiandentalacademy.com
  35. 35. Diagnosis  Classification  According to amount of crowding in mixed dentition (Hotz 1980)     of crowding First degree Second degree Third degree According to etiology of malocclusion    Primary = heriditary Secondary = acquired anomaly Tertiary www.indiandentalacademy.com
  36. 36. What is supporting zone? www.indiandentalacademy.com
  37. 37. www.indiandentalacademy.com
  38. 38. Second degree Third degree www.indiandentalacademy.com
  39. 39. www.indiandentalacademy.com Primary crowding
  40. 40. Secondary crowding www.indiandentalacademy.com
  41. 41. Coronal and apical crowding www.indiandentalacademy.com
  42. 42. Odontometry  PREDICTION OF UNERUPTED TOOTH SIZE ( MIXED DENTITION ANALYSIS LIKE MOYERS, NANCE, BALLARD, STAHLLE AND HIXON)  ASSESSMENT OF TOOTH SIZE- ARCH SIZE COMPATABILITY WITHIN THE SAME ARCH (NANCE, HOWES, CAREY, REEZ AND BEAZLEY)  ASSESSMENT OF TOOTH SIZE COMPATABILITY BW 2 ARCHES (LUNSTROM www.indiandentalacademy.com
  43. 43. BOLTONS TOOTH RATIO ANALYSIS www.indiandentalacademy.com
  44. 44. SANIN- SAVARA TOOTH SIZE ANALYSIS www.indiandentalacademy.com
  45. 45. www.indiandentalacademy.com
  46. 46. HOWES ANALYSIS www.indiandentalacademy.com
  47. 47. PONTS ANALYSIS      Determination of sum of incisors Determination of measured premolar value Determination of measured molar value Determination of calculated premolar value S.I x 100/ 80 Determination of calculated molar S.I x 100/64 www.indiandentalacademy.com
  48. 48. CAREYS ANALYSIS  DETERMINATION  DETERMINATION OF ARCH LENGTH OF TOOTH MATERIAL  DETERMINATION OF DISCREPANCY www.indiandentalacademy.com
  49. 49. MIXED DENTITION ANALYSIS  CAN BE DIVIDED INTO 2 CATEGORIES THOSE IN WHICH THE SIZES OF UNERUPTED CUSPIDS AND PREMOLARS ARE ESTIMATED FROM MEASUREMENTS OF THE RADIOGRAPHIC IMAGE THOSE IN WHICH THE SIZES ARE DERIVED FROM KNOWLEDGE OF THE SIZES OF PERMANENT TEETH ALREADY ERUPTED IN THE MOUTH www.indiandentalacademy.com
  50. 50. www.indiandentalacademy.com
  51. 51. Peck and Peck analysis www.indiandentalacademy.com
  52. 52. www.indiandentalacademy.com
  53. 53. Conventional method 4 mandibular incisors measured with a boleys gauge  Unerupted canines and premolars are obtained by measuring the greatest M-D crown diameter on radiographic images  Reduce radiographic enlargement by using Huckabas formula x = y x’/ y’ www.indiandentalacademy.com
  54. 54.  Space required = sum of incisors + values of canines and premolars  Space available measured using brass wire from M-B cusp of first permanent molar to opposite molar  Amount of discrepancy = space requiredspace available www.indiandentalacademy.com
  55. 55. Tweed method  relations of axial inclinations of mand incisors and basal bone made on lateral cephs  FMA is bw 21º – 29 º FMIA should be 68 º º  FMA ≥ 30 º FMIA 65  FMA ≤ 20 º IMPA should not exceed 92 º www.indiandentalacademy.com
  56. 56.  Dist bw the objective line and the line that passed through the actual axial inclinations of mand incisors was measured with vernier calipers  Measured value x 2 to include both right and left sides www.indiandentalacademy.com
  57. 57. Total space analysis  Method is divided into three areas  Anterior Tooth measurement = sum of mand incisors + radiographic image of canines  Cephalometric correction  Soft tissue modification  Z angle is measured  Z angle + cephalometric correction  Upper lip thickness  Total chin thickness  Anterior deficit = Measured value – total space required www.indiandentalacademy.com
  58. 58.  Middle area  Tooth measurement = crown widths of first permanent mandibular molars + values of premolars obtained from radiographs  Curve of occlusion right side + left side/ 2 + 0.5  Space available M-B cusp of primary first molar to D-B of permanent first molars www.indiandentalacademy.com
  59. 59.  Posterior area sum of M-D widths of 2nd and 3rd molars which are unerupted permanent mandibular molars were substituted for primary second molar third molars not visible – wheelers measurement of molar was used www.indiandentalacademy.com
  60. 60. X = y – x’/ y’  Space presently available + estimated increase or prediction = space available www.indiandentalacademy.com
  61. 61. Littles irregularity index  Labiolingual displacements of the digitized anatomic contact points of anterior teeth measured perpendicular to the arch form from the mesial of left canine to mesial of right canine ( AM J ORTH 75; 68:554- 63) www.indiandentalacademy.com
  62. 62. Treatment modalities BEGGS VERTICAL LOOPS www.indiandentalacademy.com
  63. 63. REFINED BEGGS www.indiandentalacademy.com
  64. 64. HIGHLY PLACED CANINES OPEN BITE CASES www.indiandentalacademy.com
  65. 65. AMOUNT OF CANINE DISTALIZATION NEEDED TO CREATE SPACE FOR RELIEVING CROWDING www.indiandentalacademy.com
  66. 66. V BENDS www.indiandentalacademy.com
  67. 67. www.indiandentalacademy.com
  68. 68. SINGLE LOOP www.indiandentalacademy.com
  69. 69. PEA  FORCES SHOULD BE KEPT LIGHT  SAGITTAL, VERTICAL ANCHORAGE NEEDS IDENTIFIED  LACE AND LATERAL SHOULD BE BACKS AND BEND BACKS USED  POSTERIOR SEGMENTS SHOULD BE SUPPORTED WITH HEAD GEAR/ TPA IN MAX ANCHORAGE CASES www.indiandentalacademy.com
  70. 70. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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