Evidence based dentofacial orthopedics (2) /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.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call

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Evidence based dentofacial orthopedics (2) /certified fixed orthodontic courses by Indian dental academy

  1. 1. EVIDENCE BASED DENTOFACIAL ORTHOPEDICS www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. CONTENTS Introduction Historical purview History of evidence based health care and evidence based dentistry History of dentofacial orthopedics - Origin and philosophy of functional appliances and growth modification concept Status of functional appliances in Europe and United States www.indiandentalacademy.com
  3. 3. CONTENTS Principles of functional appliances Review of literature Literature regarding treatment of Class II malocclusion Literature regarding treatment of Class III malocclusion Literature regarding treatment of Transverse Maxillary Expansion www.indiandentalacademy.com
  4. 4. CONTENTS Functional appliances and mandibular growth Stepwise advancement of mandible V/s maximal jumping of bite Summary and Conclusions www.indiandentalacademy.com
  5. 5. INTRODUCTION www.indiandentalacademy.com
  6. 6. There is only one disease – malocclusion. The medicine is force, and there are a number of ways to apply that force. Weinstein (1971) www.indiandentalacademy.com
  7. 7. Evidence based treatment Treatment procedures should be chosen on the basis of clear evidence that the selected method is the most successful approach to that particular patient’s problem(s). Better evidence fortifies the decision. www.indiandentalacademy.com
  8. 8. There are trends and fashions, controversies and claims in orthodontics just as in other specialties in medicine. One such controversy is that which is surrounding Functional Jaw Orthopedics. www.indiandentalacademy.com
  9. 9. Functional appliances were always questioned regarding their efficacy to bring about skeletal changes. www.indiandentalacademy.com
  10. 10. HISTORICAL PURVIEW www.indiandentalacademy.com
  11. 11. Evidence-based health care is said to have its origins in the middle of the 19th century in Paris, when young graduates started challenging the validity of clinical decisions based solely upon personal experience. An even earlier origin in China has been suggested. A structured and formal introduction can be traced to McMaster University in Canada (1985). www.indiandentalacademy.com
  12. 12. The American College of Physicians followed suit little later. A formal initiative on the continent was taken by the establishment of Center for Evidence-Based Medicine in Oxford, UK in 1995. The Centre for Evidence-Based Dentistry was not far behind in its establishment. The movement is catching up and has spread to Spain; and now to India (CEBD-i)! www.indiandentalacademy.com
  13. 13. Criticism has ranged from evidence- based medicine being old-hat to it being a dangerous innovation, perpetrated by the arrogant to serve cost-cutters and suppress clinical freedom. The first International Conference on Evidence Based Dentistry was held on November 2003 in Atlanta. www.indiandentalacademy.com
  14. 14. The purpose of using an EB(evidence based) approach in clinical care is to close the gap between what is known and what is practiced, and to improve patient care based upon informed decision-making. www.indiandentalacademy.com
  15. 15. The Age of Expert and the Age of Professionalism was followed by the Age of Science leading to the present, which some now call the Age of Evidence. www.indiandentalacademy.com
  16. 16. HISTORY OF DENTOFACIAL ORTHOPEDICS www.indiandentalacademy.com
  17. 17. Nicolas Andry is credited as the first to coin the term ORTHOPAEDIC. Andry derived the word orthopedie from the Greek words ORTHO (straight) and PED (child) referring to the art of Correcting and Preventing Deformities in Children. www.indiandentalacademy.com
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  19. 19. Bone may be one of the hardest tissues in the human body but it is also one of the most responsive to environmental stimuli. Bone has always been tried to be modified to produce favorable results. www.indiandentalacademy.com
  20. 20. European orthodontists suggested the use of muscular forces to correct the various dentofacial deformities. The original name Andresen used for this type of Treatment was Biomechanical Orthodontics. later, after teaming up with Häupl, was the name changed to Functional Jaw Orthopedics. www.indiandentalacademy.com
  21. 21. Wolff and Roux (1883) - Theories on bone plasticity. Working hypothesis - “shaking of the bones.” In 1880, Kingsley introduced the term and concept of “jumping the bite” for patients with mandibular retrusion. Hotz modified the Kingsley plate and called it “vorbissplatte.” www.indiandentalacademy.com
  22. 22. www.indiandentalacademy.com
  23. 23. In 1900’s, the German physiologist Wolff stated that “the internal architecture of bones represents the stress pattern on them”. Benninghoff made an exhaustive study of the architecture of the cranial and facial skeleton, and of the so called stress trajectories. www.indiandentalacademy.com
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  25. 25. The hard palate, the walls of the orbits, the zygomatic bones, the palatine bones and the lesser wings of the sphenoid act as crossbeams and buttresses of the face. www.indiandentalacademy.com
  26. 26. In 1902, Pierre Robin of France used a monobloc to posture the mandible forward when it was underdeveloped or retruded. The activator as known today was devised by a Dane, Viggo Andresen. www.indiandentalacademy.com
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  28. 28. Repetition of the new mandibular closure pattern induced a musculoskeletal adaptation and resulted in the re-education of the orofacial musculature. Described as an exercise appliance. www.indiandentalacademy.com
  29. 29. Tooth-moving force produced due not to the kinetic energy of muscle function but to the potential energy of stretched tissues. Woodside et al were to refer to this later as the “visco-elastic” properties of the tissue. AJO 1983 www.indiandentalacademy.com
  30. 30. Numerous authors modified the activator appliance like Karwetsky, Wünderer, Harvold, Woodside, Herren, Muhlemann to name a few. The bulkiness of the activator and its limitations to nighttime wear caused the development of many similar appliances. E.g. Bimler’s appliance in 1946; Bionator by Balters in 1960; Functional Regulator of Rolf Fränkel in 1967; Twin Block Appliance by William J. Clark in 1977 . www.indiandentalacademy.com
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  33. 33. www.indiandentalacademy.com
  34. 34. In Berlin in 1909, Emil Herbst presented a fixed Bite-jumping appliance Called the Scharnier, or joint. The Herbst Appliance continuously keeps the mandible in a protruded position both when the jaws close and the teeth are not in occlusion. Jasper jumper, FOMA, MARA, Forsus, etc. www.indiandentalacademy.com
  35. 35. Extraoral force to the maxilla (headgear) was utilized by the pioneer American orthodontists of the late 1800s, who found it reasonably effective. Although headgear was reintroduced in 1940s and came to be widely used in Class II treatment, it was seen primarily as a tooth-moving device . www.indiandentalacademy.com
  36. 36. American orthodontists were slow to recognize the idea that mandibular as well as maxillary growth could be manipulated clinically. www.indiandentalacademy.com
  37. 37. One of the oldest orthodontic appliances is the palatal expansion apparatus. www.indiandentalacademy.com
  38. 38. Isaacson and Ingram (1964) showed that single activations produce forces ranging from 3 to 10 pounds and that multiple daily activations, as commonly practiced, can cause cumulative residual loads of up to 20 or more pounds. AJO 1978 www.indiandentalacademy.com
  40. 40. The philosophical outlook of orthodontists was determined by which side of the Atlantic Ocean they lived and practiced on. American orthodontists had been slower to realize the benefits of removable and functional appliances www.indiandentalacademy.com
  41. 41. Functional appliances were introduced to North American orthodontics in the mid 1950s primarily under the influence of Dr. Egil Harvold. These alternating phases of reciprocal influence or swing of the pendulum have a time interval of about 15 years between Europe and the USA. www.indiandentalacademy.com
  42. 42. Sem-2 www.indiandentalacademy.com
  43. 43. PRINCIPLES OF FUNCTIONAL APPLIANCES www.indiandentalacademy.com
  44. 44. In 1918, Alfred P. Rogers recommended "exercises for the development of the muscles of the face, with a view to increase their functional activity." www.indiandentalacademy.com
  45. 45. Functional appliances are considered by most authorities to be primarily an orthopedic tool to influence the facial skeleton of the growing child in the condylar and sutural areas. These appliances also exert orthodontic effects on the dentoalveolar area. www.indiandentalacademy.com
  46. 46. Functional appliances don’t act on the teeth in a similar manner to conventional appliances, which use mechanical elements It rather harness, transmit, eliminate, and guide natural forces (e.g., muscle activity, growth, and tooth eruption). www.indiandentalacademy.com
  47. 47. The goal of dentofacial orthopedics is to use this functional stimulus, channeling it to the greatest extent the tissues, jaws, condyles and teeth allow. Force deprivation also plays a role in functional appliance (FA) therapy, particularly with the Fränkel and Balters appliances. www.indiandentalacademy.com
  48. 48. Appliance systems that rely on muscle mass and resting pressure are termed "myotonic" and those using muscle activity or movement are called as "myodynamic" appliances. www.indiandentalacademy.com
  49. 49. The adaptations in the functional pattern caused by the activator also include and affect the condyles. Condylar adaptation to the anterior repositioning of the mandible consists of growth in an upward and backward direction to maintain the integrity of the TMJ structures. www.indiandentalacademy.com
  50. 50. Myotatic (stretch) reflex activity is stimulated, causing isometric muscle contractions. This muscle force transmitted by the appliance moves the teeth. Selmer-olsen interpreted the activator action as a stretching of the muscles, fascial sheets, and ligaments when the mandible was opened beyond postural resting position. www.indiandentalacademy.com
  51. 51. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com