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Long face syndrome   /certified fixed orthodontic courses by Indian dental academy

Long face syndrome /certified fixed orthodontic courses by Indian dental academy




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

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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    Long face syndrome   /certified fixed orthodontic courses by Indian dental academy Long face syndrome /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • LONG FACE SYNDROME www.indiandentalacademy.com
    • ‘A person is always remembered by his face and deeds’. The human face is the area of our interest. The human face has been the subject of study since man could first express himself. Beautiful faces are always eye catching. The terms beauty, attractiveness and harmony are all included under the umbrella of esthetics The law of the equal tripartite, which applies to the entire face, is usually considered first. This guideline requires that the distance from the point trichion to the point glabella, the point glabella to the point subnasal, and the point subnasal to the point menton all be equivalent. www.indiandentalacademy.com
    • Vertical skeletal dysplasia can either be due to increase in vertical dimension or a decrease in vertical dimension. The “Long face syndrome” includes multiple anomalies like open bite, hyperdivergent face, maxillary alveolar hyperplasia, maxillary vertical excess, anterior vertical excess of the lower face level, high angle facial type. www.indiandentalacademy.com
    • Schudy FF (1964) studied that the vertical dimension is the most important dimension to the clinical orthodontist, and that vertical dysplasias are inseparably related to both open and closed bites. It was shown that vertical dysplasias are due to inharmonious vertical growth, that many of these inharmonies are reflected in the SN-MP angle. These dysplasias have a direct bearing on treatment procedures and that they can be pinpointed and measured in millimeters. Morphological types of human face should be based on the angle of facial divergence. Lundstorm A, Woodside DG (1981) based their study on the Burlington and Ann Arbor longitudinal samples, compared selected dentofacial characteristics in cases with predominantly vertical and horizontal growth directions at the chin, the investigation tested a number of hypotheses on possible relationship between the chin growth direction and the dentofacial variations studied. It was found that cases with vertical and horizontal growth differed in several respects, the former showing greater facial height, a more retrognathic chin, a steeper mandibular plane, a larger gonial angle and less skull base flexure than the latter. www.indiandentalacademy.com
    • DEVELOPMENT OF VERTICAL SKELETAL DYSPLASIA NATURE V/S NURTURE Essentially all aspects of normal and abnormal development are in some way a result of the interaction of genetic and environmental factors; thus there is no compelling reason to label a trait or condition as either genetic or environmental. Most of the anomalies have a multi factorial basis of existence, there fore the effects of both the nature and nurture should be considered. www.indiandentalacademy.com
    • Bjork in 1969, in his implant studies showed the 7 structural signs of mandibular growth Characteristics Forward Rotator Backward Rotator Inclination of the condylar head Curves forward and back Straight or slopes up Curvature of the mandibular canal Curved Straight Shape of the mandibular lower border Curved downward Notched Inclination of the symphysis (Anterior aspect just below “B” point) Slopes backward Slopes forward Interincisal angle Vertical or obtuse Acute Interpremolar or intermolar angles Vertical or obtuse Acute Anterior lower face height Short Tall www.indiandentalacademy.com
    • Diagnosis of Long Face Syndrome: Clinical - Dolichofacial face - Increased lower anterior face height and decreased posterior face height - Gummy smile - Incompetent lips - Anterior open bites - Weak musculature www.indiandentalacademy.com Sassouni’s Analysis
    • CEPHLOMETRIC FINDINGS: • High mandibular plane angle & hyperdivergent jaws • Short ramal length • Increased symphyseal height • Antigonial notching • Hypsomaxilla • Hypsogenia • Downward backward rotated mandible • Extruded Molars www.indiandentalacademy.com
    • Effect of Vertical component on Sagittal relation: It has been noted that vertical dimension affects the sagittal relation between the maxilla and the mandible. Eg: A Class III vertical grower will be rotated to Class I and like wise a Class I vertical grower will be rotated to Class II Therefore these compensations should be taken into consideration while planning the treatment for the patient www.indiandentalacademy.com
    • TREATMENT OF LONG FACE SYNDROME Treatment can be divided into : • Early treatment which includes growth modification like head gears, chin cups, bite blocks, vertical holding apliance, TPA etc. • Late treatment which includes mechanotherapy and surgical treatment. Surgical treatment usually done in adults. www.indiandentalacademy.com
    • SKELETAL FACTORS IN THE DEVELOPMENT OF AN OPEN BITE TYPE : The combination of :excessive development of the upper mid-face heights (cranial base to molars) a lack of development of posterior facial heights (S-Go) results in the downward and backward rotation of the mandible. www.indiandentalacademy.com
    • The posterior half of the palate is tipped downward, carrying the molars further downward. This gives rise to a large palatomandibular plane angle. www.indiandentalacademy.com
    • Because of the short ramus and the lower palate, the pharyngeal space is constricted. In order to breathe, these persons keep their tongues forward. Further enhanced by the dental open-bite, there is a tonguethrusting tendencies. www.indiandentalacademy.com
    • When enlarged tonsils are present, the tongue is further confined anteriorly. As the narrow palatal vault reduces the necessary space, there is a tendency towards tongue protrusion. This, in turn, may be a factor in the creation of bi-dental protrusion www.indiandentalacademy.com
    • In vertical growth pattern the dentoalveolar symptoms include a protrusion in the upper anterior teeth with lingual inclination of the lower incisors. www.indiandentalacademy.com
    • Extractions Wedge Principle Coupled With The Extraction Of Teeth Two major approaches of applying the wedge principle by extraction of teeth to control the vertical dimensions. 1. Loss of posterior anchorage so that the anchor teeth move mesially and are located farther anteriorly in the arch in an area of greater vertical dimension. 2. Extraction of first or second molars in both arches to decrease the posterior dentoalveolar height.    Pearson stated that after the extraction of premolar teeth, there is some mesial drift of the posterior teeth (out of the wedge) and this permits the mandible to hinge closed. Yamaguchi and Nanda concluded that the changes in horizontal and vertical position of the molars were dependent on the type of force application and not on the extraction or non-extraction strategy Recent studies have shown and the evidence has proven that extraction does not www.indiandentalacademy.com help in reducing the mandibular plane angle
    • High pull headgear Centre of resistance of dentition Direction of force passing through the resistance of the maxilla Centre of resistance of Maxilla www.indiandentalacademy.com
    • Vertical Pull Chin cup Four possible mechanisms of (action at work) a) maxillary sutures are pressure sensitive and some intrusion of the maxilla could occur. b) The posterior teeth tend to move forward mesially. c) A slight change in the shape of the condylar neck, with many tending to be curved more forward than previously. d) A retardation of eruptionwww.indiandentalacademy.com of the posterior teeth.
    • MANDIBULAR BITE BLOCK THERAPY WITH VERTICAL PULL CHIN CUP THERAPY Similar effect to vertical pull chin cup, it brings about intrusion of posteriors www.indiandentalacademy.com
    • MAGNETIC BITE BLOCKS Although we get rapid results, two difficulties arise with bite blocks:Extreme mouth opening and patience to tolerate the appliance. Lateral movement of the mandible, that can cause some temporomandibualr joint strain. www.indiandentalacademy.com
    • SURGICAL MODIFICATION OF LONG FACE PROBLEMS When the severity of vertical deformity is so great that reasonable correction cannot be obtained by growth modification or camouflage, the combination of orthodontic And orthognathic surgery may provide the only viable treatment option. Careful planning involving both the orthodontist and the oral maxillofacial Surgeon now provide patients with an option that result in both desirable esthetics and occlusion.   One method of surgical correction is to extract second and/or third molars if they are the only source of centric contacts. Glossectomies have been used to correct open bite problems associated with abnormal tongue habits. Their effectiveness in closing anterior or posterior open bite problems has not been substantiated. www.indiandentalacademy.com
    • IMPACTION The most common indication for maxillary surgery is vertical skeletal dysplasia The maxilla can be moved upwards by 10 – 15 mm with excellent stability www.indiandentalacademy.com
    • COGS analysis indications include:Increased upper and lower facial height (N-ANS & ANS-Gn) Increased mandibular plane angle (MP-HP) Increased posterior facial height (N-PNS ) Increased gonial angle (Ar-Go-Gn) Increased facial height ratio (N-ANS/ANS-Gn) Divergent occlusal planes Clinical presentation:Increased lip to tooth relation Increased gingival display Increased inter labial gap relation Relative mandibular deficiency Anterior openwww.indiandentalacademy.com bite (may be compensated by hyper eruption of teeth)
    • Biomechanical factors Minimize orthodontic extrusion –occurs rapidly with mechanics such as the placement of low modulus continuous archwires Segmented arch mechanics are an excellent way to predictably control the point of force application and the magnitude of force applied When divergent occ. planes exist the treatment occ. plane must be selected first , then appropriate force system designed .(typically a functional occlusal plane is drawn) www.indiandentalacademy.com
    • CONCLUSION Diagnosis of the long face syndrome is a complex problem. The orthodontic clinician must make a careful differential diagnosis for each patient who seeks his or her care. The diagnosis must analyze all three components of malocclusion- facial, dental and skeletal. Each component must be carefully studied and understood so that the proper questions are asked and the correct diagnostic decisions are made to lead to an effective treatment plan. Though it must be remembered that the treatment of long face syndrome will always remain a challenge for the orthodontist. www.indiandentalacademy.com
    • www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com