Diagnosis & treatment planing /certified fixed orthodontic courses by Indian dental academy

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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.

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Diagnosis & treatment planing /certified fixed orthodontic courses by Indian dental academy

  1. 1. DIAGNOSIS AND TREATMENT PLANIING IN ORTHODONTICS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. “The first step toward cure is to know what the disease is......” www.indiandentalacademy.com
  3. 3. The Goal of an Orthodontist.......... 1. 2. 3. To obtain optimal occlusion with in a framework of skeletal bases. With the nerves, muscles surrounding in harmony. Normal function and stability. Without damage to the health of the surrounding tissues (PDL, gingiva, TMJ, etc…). www.indiandentalacademy.com 3
  4. 4. The objectives of orthodontic treatment (Jackson’s Triad):    Functional stability Structural balance Esthetic harmony www.indiandentalacademy.com
  5. 5. TO be spoken out by sir, No need of this slide, thus delete it before presentation.     Although this is definitive, it is obvious that it means different things to different persons, so much so that large segments of orthodontic profession, if presented with single case, would start out in different directions toward different objectives by different orthodontic means. The last should matter little except that orthodontists, being committed to certain appliances with their inherent limitations, are not free to be objective about their objectives. Concepts and standards have been devised which are subservient to appliance limitations. These concepts and resultant orthodontic objectives are as different as black and white. A CRITICAL ANALYSIS OF ORTHODONTIC CONCEPTS AND OBJECTIVES William L. Wilson –AJO-DO 1957 www.indiandentalacademy.com
  6. 6. One century back EDWARD. H. ANGLE rightly said: “In studying a case of malocclusion, give no thought to the   methods of treatment or appliances until the case shall have classified and all peculiarities and variation from the normal in    type, occlusion and facial lines have been thoroughly comprehended. Then the requirements and proper plan of treatment become apparent”. www.indiandentalacademy.com
  7. 7. The orthodontist must … 1. Know normal features of occlusion and dentofacial complex. 2. Recognize the various characteristics of the malocclusion & dentofacial deformity. 3. Understand the nature of the problem and the etiology, if possible. 4. Design a treatment plan based on the specific needs of the individual. www.indiandentalacademy.com
  8. 8. Therefore, this presentation is divided into following sections: 1. Know Normal features of occlusion and dentofacial complex. 2. Recognize the Various characteristics of the malocclusion & dentofacial deformity. 3. Understand the Nature of the problem and the etiology, if possible. 4. Design a Treatment plan based on the specific needs of the individual. www.indiandentalacademy.com
  9. 9. The Beginning … www.indiandentalacademy.com
  10. 10. 1. Normal Features of Occlusion & Dentofacial Complex www.indiandentalacademy.com
  11. 11. Normal Growth  When the horizontal, vertical and transverse growth components of maxilla and mandible match that of each other, normal growth results. Frontal or lateral view of Occlusion www.indiandentalacademy.com
  12. 12. Cranio-Facial Structures www.indiandentalacademy.com
  13. 13. 2. Diagnosis Recognizing the various characteristics of the malocclusion & dentofacial deformity. www.indiandentalacademy.com
  14. 14. Some diagnosis are osis    Easy, Many are difficult and Few are impossible yet all are important , for diagnosis is the trump tru factor in providing orthodontic care. care. www.indiandentalacademy.com
  15. 15.   Human head is the most complicated anatomical complex in all creation. Here the interrelationships are infinite and the causes and effects of these relationships are almost imponderable. www.indiandentalacademy.com
  16. 16.   The more our knowledge increases the more our ignorance enfolds. enfolds The vast stretches of the unanswered and the unfinished will outstrip our collective comprehension. ? @ ? * kK ? & ? #?A?L?I? W???Q?F?% ?? www.indiandentalacademy.com
  17. 17.   Malocclusion is one such relationship of the components of the human head which has remained enigmatic despite staggering advances in our level of knowledge and comprehension. Our lore on this subject abounds with clinical dogma, with sacred tradition, and even with myth. www.indiandentalacademy.com
  18. 18.  Diagnosis is most neglected by many for various reason: 1. 2. 3. 4. Poor knowledge of basic medical sciences (e.g. anatomy, physiology, …) Poor education / importance to treatment of a case rather than diagnosis Variability and individual perceptions Uniqueness of each individual patient www.indiandentalacademy.com
  19. 19. Problem Oriented and Evidence Based Diagnosis   The goal of the diagnostic process is to produce a complete description of the patient’s problems and make a problem list. To obtain the problem list, a collection of relevant information is required. This collection is called a database. www.indiandentalacademy.com
  20. 20. The Database It is obtained from 3 sources. 1. Patient history, & interview data. 2. Clinical (extraoral, functional & intraoral) examination. 3. Analysis of diagnostic records (models, radiographs, cephalograms, photographs etc.). www.indiandentalacademy.com
  21. 21. Diagnosis & Treatment Planning Steps Patient History Clinical Examination Analysis of Diagnostic Records Data Base Classification Problem List = Diagnosis Treat pathology Treat pathology (caries, gingivitis etc.) (caries, gingivitis etc.) Problems in priority order A B C D Possible solution to individual problems A B C D Optimal Treatment Plan www.indiandentalacademy.com Mechanotherapy
  22. 22. How to recognize the various characteristics of the malocclusion? Class I malocclusion  Class II malocclusion  Class III malocclusion  www.indiandentalacademy.com
  23. 23.   Class I malocclusion could be a result of normal growth of all structures, or It could be a product of various diverse growth of the various structures of the dentofacial complex, compensating each other, to create a balanced face. www.indiandentalacademy.com
  24. 24. Take a slide from Ali’s seminar on “Dentoalveolar compensation and anatomical basis for malocclusion” Where a Negroid face which is of dolicofacial pattern gets compensated by extra-wide ramus. This makes the chin more prominent. www.indiandentalacademy.com
  25. 25.  Class II Malocclusion www.indiandentalacademy.com
  26. 26.   One such malocclusion is Class II malocclusion. Since Class II malocclusion is recognized easily by health professionals as well as by patients and their families, especially in cases of excessive over jet, the correction of class II problems may constitute more than half of the treatment protocol in a typical orthodontic practice. www.indiandentalacademy.com
  27. 27. It is interesting to note that the process of evolution in orthodontic diagnosis and treatment planning has been gradual.  Now, let us trace through history, the history changing perceptions on the etiology of class II malocclusion.  www.indiandentalacademy.com
  28. 28.   For decades together class II was erroneously considered a purely sagittal problem. Pioneered by Dr. Angle’s classification of malocclusion based on anteroposterior relationship of first molar, probably thousands of class II of all hues and varities were treated as basically sagittal discrepancies, often with disastrous results. www.indiandentalacademy.com
  29. 29.   One such malocclusion is Class II malocclusion. Since Class II malocclusion is recognized easily by health professionals as well as by patients and their families, especially in cases of excessive over jet, the correction of class II problems may constitute more than half of the treatment protocol in a typical orthodontic practice. www.indiandentalacademy.com
  30. 30. It is interesting to note that the process of evolution in orthodontic diagnosis and treatment planning has been gradual.  Now, let us trace through history, the history changing perceptions on the etiology of class II malocclusion.  www.indiandentalacademy.com
  31. 31.   For decades together class II was erroneously considered a purely sagittal problem. Pioneered by Dr. Angle’s classification of malocclusion based on anteroposterior relationship of first molar, probably thousands of class II of all hues and varities were treated as basically sagittal discrepancies, often with disastrous results. www.indiandentalacademy.com
  32. 32.  It was not the orthodontists alone who were guilty of nescience, but even the surgeons jumped onto the bandwagon and restricted themselves to sagittal correction of what was actually a problem involving more than one plane. www.indiandentalacademy.com
  33. 33.  The Angle system of classification still remains at the core of orthodontic diagnosis a century after its development, even though this classification scheme is not sensitive to imbalances in the vertical and transverse dimensions. www.indiandentalacademy.com
  34. 34.  First now let us see, how malocclusions such as Class II develop as sagittal discrepancy. www.indiandentalacademy.com
  35. 35. SAGITTAL PLANE Prognathic Maxilla Retrognathic Mandible Combination of the two A N I MA TI O N www.indiandentalacademy.com
  36. 36. Normal Mandible, Prognathic Maxilla 2 www.indiandentalacademy.com
  37. 37. Prognathic Maxillary Dentition 2 www.indiandentalacademy.com
  38. 38. Normal Maxilla, Retrognathic Mandible. www.indiandentalacademy.com
  39. 39. Prognathic maxilla, Retrognathic mandible. 2 www.indiandentalacademy.com
  40. 40.  Can also be because of decreased cranial flexure, the posterior positioning of glenoid fossa which neutralizes the horizontal growth of mandible ending up in Class II. www.indiandentalacademy.com
  41. 41. Case 01  www.indiandentalacademy.com
  42. 42. VERTICAL DISCREPANCY    With the passage of time, inevitably there was gain of knowledge and wisdom and the focus now began to shift towards other etiologic possibilities of class II malocclusion It was schudy in 1964, who brought into focus the vertical dysplasia causing and affecting the class II malocclusion. Until then investigators had never explored the vertical dimension of the posterior aspect of the face. But here were the secrets to be found. www.indiandentalacademy.com
  43. 43. Vertical Discrepancies  2 Discrepancies in the vertical dimension occur in the form of a long face or a short face syndrome. www.indiandentalacademy.com
  44. 44. Rotations of Mandible  The rotation of the mandible due to vertical growth discrepancies also has to be distinguished. H & V G R O WTH MO R PHI N G S 3 www.indiandentalacademy.com
  45. 45. Vertical Maxillary Excess  Vertical maxillary excess brings about a clockwise rotation of the mandible and a class II situation. www.indiandentalacademy.com
  46. 46. Decreased Condylar Growth  Decreased condylar growth and decreased ramal height swings the mandible backward. www.indiandentalacademy.com
  47. 47. Excess Condylar Growth  Excessive condylar growth causes forward rotation of the mandible leading to a class II deep bite situation. www.indiandentalacademy.com
  48. 48.   During the 1940s and 50s even class II due to vertical maxillary excess were treated with cervical pull headgear. This accentuated the problem rather than solve it. Flash Player Movie www.indiandentalacademy.com
  49. 49.  The disastrous results obtained led to the realization that the traditional cookbook approach of treating all class II malocclusions with either   A bite jumping appliance or a kloehn’s cervical headgear might not be the right approach after all. www.indiandentalacademy.com
  50. 50.   Now the concept changed such that when facial morphology indicated that vertical growth had been excessive or that condylar growth had been deficient, the plan was to inhibit the downward growth of the maxillary molars. When it is determined that vertical growth is deficient, the choice is to stimulate the vertical growth of the alveolar processes. www.indiandentalacademy.com
  51. 51.  This quantum shift in knowledge about the causative factors of class II malocclusion brought into light an entirely new gamut of treatment possibilities. www.indiandentalacademy.com
  52. 52.  Now let us look at some class II cases with predominant vertical discrepancy and their treatment options. www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. TRANSVERSE  DISCREPANCY It has only been during the last two decades or so that the role of transverse dimension has been a topic of interest to the typical practicing orthodontist. www.indiandentalacademy.com
  55. 55.  Infact, the skeletal imbalances in the transverse dimension often are ignored or simply not recognized, and thus the treatment options for such patients by necessity are more limited than if these transverse skeletal problems were recognized. www.indiandentalacademy.com
  56. 56.  Many class II malocclusions, when evaluated clinically have no obvious maxillary constriction. www.indiandentalacademy.com
  57. 57.   When a set of study models of the patient are “hand articulated", how-ever, it becomes obvious that when the dental casts are placed with the posterior dentition in a Class I relationship, a unilateral or a bilateral cross bite is produced. This indicates the presence of maxillary constriction as a component of class II malocclusion. www.indiandentalacademy.com
  58. 58. FOOT AND SHOE MECHANISM   Richen Bach and Taatz in 1971 used the example of a foot and a shoe, with the foot representing the mandible and the shoe representing the maxilla. If the shoe is too narrow, it is impossible for the foot to slide fully into the shoe. By widening the shoe, the foot slides forward into its usual position. Flash Player Mov ie www.indiandentalacademy.com
  59. 59.  When treating in the mixed dentition, the first step in the treatment of mild to moderate Class II malocclusions characterized, at least in part, by mild mandibular skeletal retraction and maxillary constriction may be expansion of maxilla. www.indiandentalacademy.com
  60. 60.  The patients can be left in a over expanded position with contacts still being maintained between the upper lingual cusps and lower buccal cusps of the posterior teeth. www.indiandentalacademy.com
  61. 61.   Widening the maxilla often leads to a spontaneous forward posturing of the mandible during the retention period. After 6 to 12 months, the spontaneous correction of the class II relationship can be seen in many mild to moderate class II patients. www.indiandentalacademy.com
  62. 62.  The net result of this change in outlook has been a reduction in the number of functional jaw orthopedic appliances that now are used in the treatment of mild to moderate class II malocclusion. www.indiandentalacademy.com
  63. 63. www.indiandentalacademy.com
  64. 64. www.indiandentalacademy.com
  65. 65. 3. The Etiology The Nature of the Problem (If Possible) www.indiandentalacademy.com
  66. 66. Deep Mento-Labial Sulcus www.indiandentalacademy.com
  67. 67. Mouth Breathing www.indiandentalacademy.com
  68. 68. Enlarged Tonsils www.indiandentalacademy.com
  69. 69. Infantile swallow www.indiandentalacademy.com
  70. 70. Tongue thrust swallow www.indiandentalacademy.com
  71. 71. Hyperactive mentalis www.indiandentalacademy.com
  72. 72. FUNCTIONAL ANALYSIS www.indiandentalacademy.com
  73. 73. FUNCTIONAL ANALYSIS www.indiandentalacademy.com
  74. 74. Normal Closure (Without Shift) www.indiandentalacademy.com
  75. 75. Posterior shift of Mandible 8 8 7 7 7 www.indiandentalacademy.com 7 8 88
  76. 76. VERTICAL RELATIONSHIP TRUE DEEP BITE PSEUDO DEEP BITE www.indiandentalacademy.com
  77. 77. LATEROGNATHY www.indiandentalacademy.com
  78. 78. LATEROCCLUSION www.indiandentalacademy.com
  79. 79. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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