Expansion in orthodontics /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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  • 230-300 gms, continuous forces
  • Only one of the repelling magnets could slide on the pins for activation of the MED. Self-polymerizing acrylic was added every three weeks to re-establish contact between the magnets
  • Expansion in orthodontics /certified fixed orthodontic courses by Indian dental academy

    1. 1. www.indiandentalacademy.com EXPANSION IN ORTHODONTICS
    2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    3. 3. INTRODUCTION The prime objective of expansion is to coordinate the maxillary and mandibular bases www.indiandentalacademy.com
    4. 4. Historical background Hippocrates “Among those individuals where heads are long shaped, some have thick necks, strong members and bones, others have strongly arched palates, their teeth are disposed irregularly crowding one over the other and they are suffering with headaches and ottorrhea”. www.indiandentalacademy.com
    5. 5.  Fauchard 1728  Shange 1841  Bourdet 1757  Robinson 1846  Fox 1803  Tomes 1848  Delabarre 1819  Allen 1850  Cefaulon 1839 to 1841  Whitel and Westcott 1859 www.indiandentalacademy.com
    6. 6.  Emerson Colon Angell 1860, San Francisco  San Francisco Medical Journal and Dental Cosmos  Editor of dental Cosmos: John Deh White www.indiandentalacademy.com
    7. 7.  A.Coleman 1877 described coffin spring  Field: coffin can cause separation of MPS in very young children  Farrar: “separation of superior maxilla at the symphysis”  Supported by Clark L Goddard, E.S.Talbot and A.E.Matteson.1893 www.indiandentalacademy.com
    8. 8.  C.H.Hawley  H.A.Pullen  E.H.Angle  V.H.Jackson  M.Dewey  G.V.I.Brown  Ketchem  Prof. M.H.Cryer  V.E.Barnes  G.H.Write  F.A.Faught  L.W.Dan  W.H.Haskin www.indiandentalacademy.com
    9. 9. Anatomical considerations  MAXILLA www.indiandentalacademy.com
    10. 10. SUTURES  Melsen’s study 1975 www.indiandentalacademy.com
    11. 11. INDICATIONS Marked narrowing of the arches Unilateral or bilateral cross bite Mand prognathism with reduced anterior development of the maxillary base  Steep palate with septal deviation and mouth breathing due to enlarged adenoids  Cleft lip and palate  Mild arch length to tooth material deficiency. (1mm of expansion in post = 0.7 mm increase in arch perimeter)    www.indiandentalacademy.com
    12. 12. CONTRAINDICATIONS  Uncooperative patients  Pts with anterior open bites, and steep mandibular plane angles www.indiandentalacademy.com
    13. 13. CLASSIFICATION OF APPLIANCES  According to the rate of expansion – Slow eg W arch, Quad helix, Coffin spring – Rapid eg Hyrax, Minn, Isaacson – Ultra rapid – Surgically assisted www.indiandentalacademy.com
    14. 14.  According to appliance attachment – Removable eg Active plate and Functional appliances – Fixed: • Tooth borne eg, Biedeiman appliance, Minn expander • Tooth/Tissue borne eg Derichsweiler type, Haas type. www.indiandentalacademy.com
    15. 15.  According to modality employed – Orthodontic expansion – Passive expansion – Orthopedic expansion www.indiandentalacademy.com
    16. 16. REGULATION OF EXPANSION  Rate of expansion  Form of the appliance  Age of the patient www.indiandentalacademy.com
    17. 17. Rapid maxillary expansion  Orthopedic expansion  Force levels of upto 10-20lbs per day  Active phase 2-4 weeks www.indiandentalacademy.com
    18. 18. REQUIREMENTS OF AN RME APPLIANCE  Rigidity  Tooth utilization  Expansion( dilating unit and action)  Economy of time and material  Hygiene www.indiandentalacademy.com
    19. 19. Banded type of appliances  Hass type  Derichsweiler type  Isaacson type  Biedeimann type www.indiandentalacademy.com
    20. 20. Bonded type Mundro et al 1977 www.indiandentalacademy.com
    21. 21. Instructions on how to expand Zeibe in 1930 : 180 degree rotations per day  Upto age of 15 years : the turn 180 degree is given as 90 degree in the morning and 90 degree in the evening.  15-20 years : overall rotation of 180 is possible by splitting the rotation into 4 turns of 45 degree each with approx equal time lapse between them.  Age over 20 years : 45 degree turn in the morning and 45 in the night initially www.indiandentalacademy.com
    22. 22. Zimring and Isaacson in 1965 :  Young or growing patients: two turns each day for the first 4-5 days and one turn each day for remainder of rme treatment.  Adult patients: two turns each day for the first two days and one turn each day for the next 5-7 days and one turn eac other day for the remainder of the rme treatment. www.indiandentalacademy.com
    23. 23. How much to expand  Stanely et al in 1985 +1.6mm (male) and 1.2mm (females) www.indiandentalacademy.com
    24. 24. HAZARDS OF RME  Oral hygiene  Length of fixation  Dislodgement and breakage  Tissue damage  Infection  Failure of suture to open www.indiandentalacademy.com
    25. 25. Reaction to expansion  IN BONE  SUTURES  DENTAL CHANGES www.indiandentalacademy.com
    26. 26. Relapse and Retention  The object of retention is to hold the expansion while all other forces generated by the expansion have decayed away.  It is essential for the fixed appliance to act as the retention appl in the first three months.  Wertz observed that some relapse is seen in the forward and downward movement of the max. www.indiandentalacademy.com
    27. 27. SLOW MAXILLARY EXPANSION Story and Ekstrom: Slow expansion allows physiologic adjustments and reconstitution of sutural elements over a period of about 30 days.  2-4 lbs of force, a little higher for older patients.  1 mm expansion per week. S. E. has also been associated with more physiologic stability and less potential for relapse than with R. M.E. www.indiandentalacademy.com
    28. 28. www.indiandentalacademy.com
    29. 29. Appliances used for S. M. E.  Jackscrews www.indiandentalacademy.com
    30. 30. TYPES OF SCREW     Broad classification: Encased type Skeleton type Special screw Eccentric screws www.indiandentalacademy.com
    31. 31. www.indiandentalacademy.com
    32. 32.  Coffin spring www.indiandentalacademy.com
    33. 33.  W - Arch www.indiandentalacademy.com
    34. 34.  Quad helix www.indiandentalacademy.com
    35. 35. OTHER METHODS OF EXPANSION  ULTRA RAPID EXPANSION  NITI AND OTHER ARCH WIRES  MAGNETS  TRANSPALATAL ARCH  SURGICALLY ASSISTED EXPANSION www.indiandentalacademy.com
    36. 36. Ultra-rapid maxillary expansion of Chatellier  The procedure involves local anesthesia and results are obtained within 1 to 3 days  As a rule, the ultra-rapid method is performed over a period of 3 appointments www.indiandentalacademy.com
    37. 37. Niti expander Wendell Arndt www.indiandentalacademy.com
    38. 38. Functional appliances www.indiandentalacademy.com
    39. 39. Magnets  M. ALI DARENDELILER  Two repelling samarium cobalt magnets Pins and tubes were placed to guide the separation of the palate.  The midpalatal magnets (each 10mm×5mm×5mm) produced 500g of force, which declined to 250g during the three weeks between activations  www.indiandentalacademy.com
    40. 40. Transpalatal Arches  An important auxiliary used in fixed appliance therapy with several indications one of which is expansion or constriction but of small measures of upto 1-2 mm. www.indiandentalacademy.com
    41. 41. Surgically assisted maxillary expansion The resistance in the maxilla separation can be due to either of the following reasons:  mid palatal synostosis  mid palatal interlocking  circum maxillary rigidity www.indiandentalacademy.com
    42. 42. The tech has been described in 3 stages:  Stage 1 A and B  Stage 2 A and B  Stage 3 A and B www.indiandentalacademy.com
    43. 43. Stage 1 www.indiandentalacademy.com
    44. 44. Stage 2 (over the age of 30) www.indiandentalacademy.com
    45. 45. Stage 3 (over the age of 40) www.indiandentalacademy.com
    46. 46. Expansion of cleft palate cases  Excessive anterior collapse coupled to little or no posterior collapse  More fan wise expansion needed to restrict posterior Expansion. Screws of longer thread of upto 18mm expansion  More difficult to retain due to clinical crowns not developed properly  Unilateral expansion both cap splints and bands can be used  Formation of fistula could be a complication www.indiandentalacademy.com
    47. 47. Expansion of the mandibular arch  Stable expansion is difficult to attain in the lower arch  Present studies state that expanding the upper arch allows for spontaneous expansion of the lower arch. www.indiandentalacademy.com
    48. 48. CONCLUSION Expansion of the arches has seen its ups and downs in the past. More and more documentation of the effects and stability of this procedure has thrown a new light on its clinical application. Whether it is slow, rapid or ultra rapid expansion, proper diagnosis and case assessment is very essential to ensure consistent results. As more and more cases are being treated without extractions due to profile considerations, expansion of the arches forms a valuable adjunct to treat a wide variety of clinical presentations. www.indiandentalacademy.com
    49. 49. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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