Jaw geometry / /certified fixed orthodontic courses by Indian dental academy

906 views
604 views

Published on





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
00919248678078

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
906
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Jaw geometry / /certified fixed orthodontic courses by Indian dental academy

  1. 1. JAW GEOMETRY INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Lay - out……! Introduction Historical Perspective Mandibular Rotation…! Why? Types of Rotation….! Classification Study Done Aims & Objective Materials & Methods Case Reports Future scope Conclusion www.indiandentalacademy.com
  3. 3. Introduction…. Face is a complex structure that has always challenged the orthodontist for a very long time. The face (Profile) is considered largely during treatment planning, which is determined predominantly by the rotation of mandible. It was “Bjork” (1969) with his studies opened new vistas on understanding the rotation of mandible, which he said that it is a complex phenomena and rightly published an article “Rotation A Puzzle” It was after this eye opener, treatment was focused on the “Face” than the “Base” . In this presentation an effort has be made, not only to understand the the rotation of mandible but also www.indiandentalacademy.com its effects on treatment.
  4. 4. Lay - out……! Introduction Historical Perspective Mandibular Rotation…! Why? Types of Rotation….! Classification Study Done Aims & Objective Materials & Methods Case Reports Future Scope Conclusion www.indiandentalacademy.com
  5. 5. Historical Perspective…. “BELCHIER & DUHAMMEL” (1736 to 1740 ) Investigated bones with the help of “Madder Root Die” & published an article “Root which stains bone Red” Phase of Transition Die to Implant. “DUHAMMEL”(1750) implanted wires to bones. “JOHN HUNTER”(1754) began work on mandible “JOHN HUNTER”(1764) proved mandibular remodeling is www.indiandentalacademy.com possible
  6. 6. Historical Perspective…. 1st implant study by “G.Humphry”,boring hole in the pigs mandible & tying wire to it . This was published in an article “Growth of the Jaws” (1871) www.indiandentalacademy.com
  7. 7. Historical Perspective…. “JOHN HUNTER”(1771) “Natural History of Human Teeth”describing “Ideal Occlusion”&“Mandibular Growth” “LUCE” (1889 – 1900) worked on condyle & termed “HINGE AXIS” “BENNETT” (1908) Gave “ROTATIONAL THEORY” “KEITH & CAMPION”(1922) studied growth of craniofacial www.indiandentalacademy.com structures
  8. 8. Historical Perspective…. An illustration showing the lengthening of the Mandible occurring Dorsally form the published article “The Natural History Of The Human teeth”by “HUNTER” (1771) www.indiandentalacademy.com
  9. 9. Historical Perspective…. “BRASH”(1924) proved condylar hinge movement (1930) Ceph studies were done - not very reliable “BJORK”(1951) started implant studies on the jaws “POSSELT et al” (1952) did studies on Mandibular Motion www.indiandentalacademy.com
  10. 10. Historical Perspective…. “BJORK”(1955) Phrased the term “Growth Rotation” “BJORKS & Co Workers”(1960) Longitudinal studies with implants (1969) Orthodontic Specialty focused attention on “Mandibular Rotations” (1983) SKIELLER & Co Workers gave importance to jaws www.indiandentalacademy.com especially to Mandible during treatment planning
  11. 11. Lay - out……! Introduction Historical Perspective Mandibular Rotation…! Why? Types of Rotation….! Classification Study Done Aims & Objective Materials & Methods Case Reports Future Scope Conclusion www.indiandentalacademy.com
  12. 12. Mandibular rotation …! Why? Normally changes that occur in the facial complex helps the clinician to identify & diagnose a problem correctly so as to provide the optimal treatment. It is therefore essential for us to be aware of, How the face changes ,Where & When it occurs & How it takes place ?. So sound understanding of growth of the Maxilla & Mandible is necessary to understand the rotation of the mandible,which predominantly determines www.indiandentalacademy.com the facial type of an individual.
  13. 13. Mandibular rotation …! Why? Maxillary Growth www.indiandentalacademy.com
  14. 14. Mandibular rotation …! Why? Mandibular Growth www.indiandentalacademy.com
  15. 15. Mandibular rotation …! Why? Total Growth Effect www.indiandentalacademy.com
  16. 16. Possible Maxilo-Mandibular Skeletal Combinations www.indiandentalacademy.com
  17. 17. Lay - out……! Introduction Historical Perspective Mandibular Rotation…! Why? Types of Rotation….! Classification Study Done Aims & Objective Materials & Methods Case Reports Future Scope Conclusion www.indiandentalacademy.com
  18. 18. Types Of Rotation……! Classification It is mandatory that growth follows “Cephalocaudal Growth” trend & hence it is inevitable for the mandible to compensate more than the maxilla to derive at an acceptable compromised profile. The compensation of the mandible is more because it is the only mobile bone in the entire Cranio Facial Complex. The basic movements of the mandible are Upwards & Forwards (Anti Clockwise) Downwards & Backwards (Clockwise) Lateral Excursions www.indiandentalacademy.com
  19. 19. Classification….! Mandibular Rotation can be broadly classified into: During Growth  During Treatment During growth:1. “PROFFIT”  Internal Rotation  Total Rotation  External Rotation Total Rotation = Internal Rotation – External rotation www.indiandentalacademy.com
  20. 20. Classification….! 2. “SOLOW & HUSTON”  True Rotation  Apparent Rotation  Angular remodeling of lower border Apparent Rotation = Total Rotation – Angular Remodeling Of Lower Border 3. “SHUDDY”  Clockwise rotation  Counterclockwise Rotation www.indiandentalacademy.com
  21. 21. Classification….! 4. “BJORK” Forward Rotation Type - I - around the condyle. Type - II - around the incisors. Type - III - around the premolars. I II III www.indiandentalacademy.com
  22. 22. Classification….! Backward Rotation Type - I - around the condyle. Type - II - around the most distally occluding molar I II www.indiandentalacademy.com
  23. 23. Classification….! 5. “BJORK & SKIELLER” Matrix Rotation – around the condyle (A) Intra Matrix Rotation – centered within the body (B) Total Rotation Total rotation = Matrix rotation + intra matrix rotation A B www.indiandentalacademy.com
  24. 24. Classification….! During Treatment:Treatment mechanics inevitably changes the position of the mandible. These Mechanics can be either “SKELETAL or DENTAL” SKELETAL During Growth Period:- Head Gear Therapy Myo functional Therapy…..ect ! www.indiandentalacademy.com
  25. 25. Classification….! After Growth Period:- Lefort surgeries Upward Impaction I II High Lefort Downward Impaction DENTAL Distalization Mesialisation Molar extrusion Molar www.indiandentalacademy.com Intrusion
  26. 26. Schematic Explanation…! www.indiandentalacademy.com
  27. 27. Schematic Explanation…! = Low Angle = Normal Angle = High Angle www.indiandentalacademy.com
  28. 28. Thus any treatment change alters the position of the mandible which in turn alters the profile ( long or short face). Alterations in the position of the mandible due to treatment usually takes place around the condyl ..i.e., rotation takes place as a mandible as a whole. This concept of rotation of the mandible during treatment is used for the study conducted in our department to calculate the rotation of the mandible. www.indiandentalacademy.com
  29. 29. www.indiandentalacademy.com
  30. 30. Lay - out……! Introduction Historical Perspective Mandibular Rotation…! Why? Types of Rotation….! Classification Study Done Aims & Objective Materials & Methods Case Reports Future Scope Conclusion www.indiandentalacademy.com
  31. 31. Aims & Objective of the study…..! To assess the rotation of the mandible for every 1 mm of movement of the molar. To derive on a “Calculated approach” to assess the rotation with the help of “Cephalometric & O.P.G “ analysis. To apply this calculated approach,during the planning phase of pre - surgical orthodontics , so as to predict the rotation of the mandible accurately. To use the calculated value for the fabrication of surgical splint to aid the surgeon in easy & timely surgery. www.indiandentalacademy.com
  32. 32. Lay - out……! Introduction Historical Perspective Mandibular Rotation…! Why? Types of Rotation….! Classification Study Done Aims & Objective Materials & Methods Case Reports Future Scope Conclusion www.indiandentalacademy.com
  33. 33. Materials & Methods….! 20 Cases undergoing Begg mechanotherapy were Selected. Both Males & Females between the age group of 15yrs to 25yrs were considered. All the patients had Bimaxillary Dental Proclinaiton & underwent all1st Bicuspids extraction. Begg stage - I arch wires were placed with 35 to 40 degrees of anchor bend & 2 to 21/2 Oz of force used. At the end of stage - I OPG & Lateral Cephalogram were taken. www.indiandentalacademy.com
  34. 34. Materials & Methods….! Pre treatment & End of stage - I OPG & Cephalometric X- rays were assessed for the following land marks, OPG land marks:- [WEBER.J.S.URSI.et all,JCO - 1990 - March (166 - 173) Right 6 to orbital plane Left 6 to orbital plane Right 6 to mandibular plane Left 6 to mandibular plane www.indiandentalacademy.com
  35. 35. OPG - Land Marks . . . www.indiandentalacademy.com .
  36. 36. Materials & Methods….! Cephalometric land Marks (Angular) FMA GoGnSn ArGoGn Upper Go Lower Go Occl Plane to Sn Cephalometric Land Marks (Linear) N Ans Ans Gn Cd towww.indiandentalacademy.com Ptm
  37. 37. CEPH - Land Marks Linear Cd to Ptm NAns AnsGn Angular FMA GoGnSn ArGoGn UGo www.indiandentalacademy.com LGo
  38. 38. Materials & Methods….! The X - Rays of the 20 patients were analyzed for the land marks mentioned & tabulated as follows: Patient Name: I.D.No: Protocol Pre Rx End of Stage I Inference F.M.A GoGnSn ArGoGn U.Go L.Go Rt 6 to Orbital plane Lt 6 to Orbital Plane Rt 6 to Mand Plane Lt 6 to Mand Plane Cd to Ptm N Ans www.indiandentalacademy.com Ans Gn
  39. 39. Materials & Methods….! The readings obtained from the tabulated values were analyzed & related as follows, Every 1 mm of Molar Extrusion [OPG] {Mo Ex} Increase in Lower Anterior Facial Height {LAFH}. Downward Backward Rotation Of Mandible {Ro Mad}. Change in the condylar position {Cd Ptm} The readings were statistically deduced & were given in a Ratio Format.i.e.. www.indiandentalacademy.com MoEx : LAFH : Ro Mad :Cd Ptm.
  40. 40. Materials & Methods….! The ratio thus deduced was used in a “Reverse Logical Sequence” to predict the auto rotation of the mandible. Cases having “Vertical Maxillary Excess”were selected after necessary investigations were done (Ceph, Model analysis.etc). 10 patients both Males & Females were selected, between the age group of 20 to 28 yrs. All selected cases were discussed with the oral surgeons & presurgical orthodontics were done . www.indiandentalacademy.com
  41. 41. Materials & Methods….! The cases selected were treated with 0.022’ Roth prescription for necessary decompensations. At the end of the pre surgical phase X-Rays (Ceph & OPG) were taken & the prediction of the autorotation was done to obtain a “Predicted Value”. After face bow transfer, the cast was mounted on the articulator (HANAU) & the “Predicted Value” was used to do the mock surgery for the preparation of the splint. The splint thus made i.e. “Predicted Splint”is used during surgery for easy & timely surgery. After 3 wks of the surgery a Lateral Ceph was taken to check www.indiandentalacademy.com the efficacy of the prediction
  42. 42. Lay - out……! Introduction Historical Perspective Mandibular Rotation…! Why? Types of Rotation….! Classification Study Done Aims & Objective Materials & Methods Case Reports Future Scope Conclusion www.indiandentalacademy.com
  43. 43. www.indiandentalacademy.com
  44. 44. Case Report Begg….! Boopathy 20 Yrs Male Teeth Placed in the Front Ectomorphic Body Type, Dolico cephalic Head, Leptoprosophic Face. Symmetrical Face , Average Clinical FMA , Convex Profile,Incompetent Lip , Acute Nasolabial Angle & Deep Mento labial Sulcus Class- I Molar & Canine , Plroclined Upper & Lower Incisors,Over Jet of 10mm &Over Bite of 4.5mm. All Four Ist Bicuspids Extraction was planed & www.indiandentalacademy.com strapped Up with Beggs.
  45. 45. PRE - Rx - INTRA ORAL & EXTRA ORAL www.indiandentalacademy.com
  46. 46. PRE Rx - OPG & LATERAL CEPHALOGRAM www.indiandentalacademy.com
  47. 47. END OF STAGE - I- INTRA ORAL www.indiandentalacademy.com
  48. 48. END OF STAGE -I- OPG & LATERAL CEPHALOGRAM www.indiandentalacademy.com
  49. 49. SUPERIMPOSITION…! Pre Stage- I www.indiandentalacademy.com
  50. 50. Patient Name: Bhoopathy 20/M I.D.No: 60857 Protocol Pre Rx End of Stage I Inference F.M.A 23 26 >3 GoGnSn 30 33 >3 ArGoGn 125 127 >2 U.Go 52 52 0 L.Go 73 75 >2 Rt 6 to Orbital plane 28 31 >3 Lt 6 to Orbital Plane 29 31 >2 Rt 6 to Mand Plane 32 35 >3 Lt 6 to Mand Plane 33 36 >3 Cd to Ptm 28 25 <3 N Ans 49 49 0 Ans Gn 67www.indiandentalacademy.com 70 >3
  51. 51. The values thus obtained from the tabulation were analyzed statistically and the following ratio was obtained. 3mm of molar extrusion 3mm increased Lower anterior Facial height. 2Deg Increase in Mandibular rotation. 3mm Reduction From Condyle to Pterygo Maxillary Fissure Point MoEx : LAFH : Ro Mad : Cd Ptm = 3 : 3 : 1 : 3 (2deg = 1mm) www.indiandentalacademy.com
  52. 52. www.indiandentalacademy.com
  53. 53. Case Report Orthognathic….! Sundari 23 Yrs Female Teeth Placed in the Front Ectomorphic Body Type, Mesocephalic Head, Leptoprosophic Face. Symmetrical Face , High Clinical FMA , Convex Profile,Incompetent Lip , & Posterior Divergent Class- II Molar & Canine , Plroclined Upper & Lower Incisors,6mm incisor exposure, Gummy Smile Over Jet of 6mm & Over Bite of 3mm. Reverse Orthodontics (15,25,34 & 44)extn & strapped Up with PAE Roth .022’& Lefort I 5mm www.indiandentalacademy.com of Upward Impaction.
  54. 54. PRE Rx PHOTOS www.indiandentalacademy.com
  55. 55. PRE TREATMENT OPG & CEPH www.indiandentalacademy.com
  56. 56. PRE SURGICAL www.indiandentalacademy.com
  57. 57. PRE SURGICAL CEPH & OPG www.indiandentalacademy.com
  58. 58. PREDICTED CEPH Maxilla & Molar moved up by 5mm. Red Predicted Face. Blue Pre surgical www.indiandentalacademy.com
  59. 59. FACE BOW TRANSFER MOCK SURGERY & PREDICTED SPLINT www.indiandentalacademy.com
  60. 60. DURING SURGERY www.indiandentalacademy.com
  61. 61. IMMEDIATE POST - OP www.indiandentalacademy.com
  62. 62. POST SURGICAL CEPH & OPG www.indiandentalacademy.com
  63. 63. POST - OP SETELLING www.indiandentalacademy.com
  64. 64. FACE PREDICTION (with ratio obtained) www.indiandentalacademy.com
  65. 65. PROFILE-COMPARISION www.indiandentalacademy.com
  66. 66. Lay - out……! Introduction Historical Perspective Mandibular Rotation…! Why? Types of Rotation….! Classification Study Done Aims & Objective Materials & Methods Case Reports Future Scope Conclusion www.indiandentalacademy.com
  67. 67. Future Scope…! This study should be conducted on large group to check for its “Reliability Constant”. The muscle structures around the mandible plays a major role in its movement & hence it should be considered ( For which a study is in progress to assess the muscles function of the mandible with the help of Ultrsonography). TMJ especially condyle is a complex structure & so are is its movements ,hence a MRI & C.T will be more essential to check its study function. Once these Diagnostic aids become reachable for the common man it would be easy for every body to opt for prediction results, which in turn would increase the efficacy of the orthodontist www.indiandentalacademy.com
  68. 68. USG - -Study…! www.indiandentalacademy.com
  69. 69. Left Lateral Pterygoid - Protrusion www.indiandentalacademy.com
  70. 70. Right Lateral Pterygoid -Protrusion www.indiandentalacademy.com
  71. 71. Left Lateral Pterygoid - Excursion www.indiandentalacademy.com
  72. 72. Right Lateral Pterygoid-Excursion www.indiandentalacademy.com
  73. 73. Left Temporalis - Clenching www.indiandentalacademy.com
  74. 74. Right Temporalis - Clenching www.indiandentalacademy.com
  75. 75. Left Masseter- Clenching www.indiandentalacademy.com
  76. 76. Right Masseter- Clenching www.indiandentalacademy.com
  77. 77. CT SCAN….! www.indiandentalacademy.com
  78. 78. TMJ - CT…! www.indiandentalacademy.com
  79. 79. 3-D RECONSTRUCTION…! www.indiandentalacademy.com
  80. 80. MRI - TMJ…! www.indiandentalacademy.com
  81. 81. MRI-SCAN…! www.indiandentalacademy.com
  82. 82. MRI-SCAN Land Marks…! www.indiandentalacademy.com
  83. 83. Close up view of TMJ Different Positions www.indiandentalacademy.com
  84. 84. Close up view of TMJ Different Positions www.indiandentalacademy.com
  85. 85. Close up view of TMJ Different Positions www.indiandentalacademy.com
  86. 86. Lay - out……! Introduction Historical Perspective Mandibular Rotation…! Why? Types of Rotation….! Classification Study Done Aims & Objective Materials & Methods Case Reports Future Scope Conclusion www.indiandentalacademy.com
  87. 87. Conclusion…! With this study the clinicians is able to accurately predict the “Mandibular Rotation”. The results of this study can be used effectively during treatment planning of surgical cases where pre surgical orthodontics is necessary. The “ Truth Of Future Orthodontics” is to use this easy calculated value, for “Nature Gave You The Face , But you Have To provide the Expression” www.indiandentalacademy.com
  88. 88. Before I Conclude…..! A patriot is a man working for his country's future instead of boasting of its past. www.indiandentalacademy.com
  89. 89. According To Me….! An orthodontist is a man working for his fraternity’s future instead of boasting of its past. www.indiandentalacademy.com
  90. 90. www.indiandentalacademy.com

×