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Methods of gaining space 1. /certified fixed orthodontic courses by Indian dental academy

Methods of gaining space 1. /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



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  • Articulations became more and more rigid and fused. The teeth were not tipped alone, but teeth in the alveolus together tipped. <br />
  • Small round niti wires should be a niti while larger rectangular ones often perform better if made from m niti.m niti useful in later stages when flexible yet stiffer wires are used <br />
  • Driftodontics. <br />
  • Tma can be activated twice as much as s.steel before it undergoes permanent deformation, but exerts half the force of s.steel. <br />
  • Into a crossbite tendency, this lingual movement is resisted by opening the horiz loop <br />

Methods of gaining space 1. /certified fixed orthodontic courses by Indian dental academy Methods of gaining space 1. /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

  • METHODS OF GAINING SPACE. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com 1
  • Key-stoning procedureHarry G.Barrer JCO Aug 1975 A. Malposed incisors B. interproximal relationship after key stoning Rounded surfaces slip and rotate. www.indiandentalacademy.com 2
  • Key-stoning procedure: www.indiandentalacademy.com 3
  • Nonsurgical rapid maxillary alveolar expansion in adults:a clinical evaluation. Chester S. Handelman, Angle Orthodontist, 1997 vol 67 •Late teens and early 20’s questionable. •Sutures: rigid and fuse. •SA-RME. Non Surgical Maxillary expansion: Pain, swelling, ulceration, flared posterior teeth, bite opening, gingival recession, and perforation of the buccal alveolus. Vanarsdall: in children, gingival recession and dehiscence of bone www.indiandentalacademy.com 4
  • • 5 adults with transverse deficiency- treated nonsurgically using Haas appliance. •RMAE- expansion centered in the alveolar process of maxilla rather than the body.(lateral walls of the palate) •Bilateral/unilateral crossbites, arch constriction. 2 quarter turns/day Haas appliance Later 1 quarter turn/day U 1 no separation. 12 weeks retention. www.indiandentalacademy.com 5
  • Displaces the alveolus with the teeth rather than expanding the teeth through the alveolus. www.indiandentalacademy.com 6
  • bilateral www.indiandentalacademy.com 7
  • Unilateral crossbite – left www.indiandentalacademy.com 8
  • www.indiandentalacademy.com 9
  • www.indiandentalacademy.com 10
  • RMAE acceptable alternative to SA-RME in adults for maxi deficiency. www.indiandentalacademy.com 11
  • Nickel-Titanium Palatal expander. 2 properties: Shape memory & superelasticity. Exists in more than 1 crystal structure. Lower temp-martensite. temp:94degree Transition Higher temp-austenite {phase transition} www.indiandentalacademy.com 12
  • MOLAR DISTALIZATION www.indiandentalacademy.com 13
  • Indications for Molar distalization 1. In a growing child - to relieve mild crowding - causes permanent increase in arch length of about 2mm on each side. 2. Late mixed dentition - When lower E space –utilized for relief of anterior crowding, - Upper molars distalized to get a class I relation www.indiandentalacademy.com 14
  • Indications for Molar distalization 3. Non-growing patient - To regain lost arch length - Blocking out of canines 4. Upper second molar extraction - Lower arch normal www.indiandentalacademy.com 15
  • Indications for Molar distalization   Class I malocclusion- with highly placed canine/impacted canine Lack of space for eruption of premolars due to mesial migration of permanent first molars www.indiandentalacademy.com 16
  • Indications for Molar distalization  Good soft tissue profile  Borderline cases  Mild to moderate space discrepancy with missing 3 rd molars/2 nd molars not yet erupted  End on molar relation with mild to moderate space requirement.  Cases with less than full cusp class II molar relation. www.indiandentalacademy.com 17
  • Case selection 1. Normal or near normal mandibular arch 2. Late mixed dentition-ideal - Early permanent dentition-growth still left in maxillary tuberosity area.- 16-17 yrs-males 14-15 yrs-females 3. Molars placed normally- buccopalatally. 4. 3rd molars-absent –stacking of upper molars – unsuitable 5. Profile considerations- well developed nose & chin 6. High MPA- contraindicated-wedging effect www.indiandentalacademy.com 18
  • Classification 1. Location of appliance  Extra-oral  Intra-oral 2. Position of appliance in mouth  Buccal  Palatal 3. Type of tooth movement  Bodily movement  Tipping movement www.indiandentalacademy.com 19
  • Classification 4. Compliance needed from patient  Maximum compliance  Minimum or No compliance 5. Type of appliance  Removable  Fixed 6. Arches involved Intra-arch Inter-arch www.indiandentalacademy.com 20
  • Various appliances used for Molar Distalization :           Head gears Pendulum appliance. Coil springs Niti and S.Steel Distal jet K loop Jones Jig Magnet Wilson’s Bimetric loop Use of super elastic NiTi Franzulum appliance. www.indiandentalacademy.com 21
  • Various appliances used for Molar Distalization           ACCO Crozat appliance Crickett appliance Modified Nance lingual appliance Schmuth and Muller double plates Claspring Removable molar distalization splint Fixed piston appliance Using implants Fixed functional appliance www.indiandentalacademy.com 22
  • Distalization using Headgears  Very efficient  Reciprocal forces are not transmitted to other teeth  Molar movements depends on direction of force in relation to the C Res of the molar & magnitude of force www.indiandentalacademy.com 23
  • Biomechanics of Headgears:  C Res  Moments www.indiandentalacademy.com 24
  • Cervical Headgear    Short face Class II maxillary protrusive cases with low MPA & Deepbites Extrusive & distalizing effect Lower anterior facial height is less. www.indiandentalacademy.com 25
  • High pull Headgear     Produces intrusive & Posterior direction of pull Long face class II patients with high MPA Force through C Res – Intrusion & distal movement of molar 6-8 months – class IIclass I www.indiandentalacademy.com 26
  • Straight pull headgear  Class II Malocclusion with no vertical problems  Prevent anterior migration of maxillary teeth, translate them posteriorly Adv-effective, no reciprocal forces Disadv- Patient compliance www.indiandentalacademy.com 27
  • Modification of the Bimetric arch  Class II correction- Distalization + expands caninepremolar area- unlocks the occlusion  A mild-moderate class II div 2 with normal mandibular arch-easily corrected www.indiandentalacademy.com 28
  • Modification of the Bimetric arch Archwire design:  .016”premium wire  Premolars bonded if expansion is required  Teardrop shaped loop  Bite opening bend  Mild toe-in  2mm activation www.indiandentalacademy.com 29
  • Elastic load reduction principle:  Class II elastics – used sequentially T.P Green – 1st week Pink - 2nd week Yellow – next 2-3 weeks  Initial heavy force- to resist forward pushing force of new wire- force transferred distally  Later Molar uprights-mesially directed archwire force decreases- support with light forces.  Extrusive component of class II- kept to a minimum www.indiandentalacademy.com  1mm/month.wire activated for 3 visits.  Borderline cases –Non Ext 30
  • K-Loop molar distalizing appliance Valrun Kalra – JCO 1995  K-loop – forces - .017 x .025 TMA  Nance button – anchorage  8mm long , 1.5 mm wide  Legs- 20 degree bend  Inserted into molar and first premolar tube, marked  Stops bent 1mm distal , 1mm mesial  Stops- 1.5mm long www.indiandentalacademy.com 31
  •  Reactivated by 2mm 6-8 weeks later.  molars move by 4mm, premolars by 1mm  Anchorage can be reinforced by headgear www.indiandentalacademy.com 32
  • K- loop Appliance www.indiandentalacademy.com 33
  • Distalization of Molars with Repelling Magnets Gianelley etal JCO 1988  Anchorage – Modified Nance appliance  Wire extending from 1st premolars  Acrylic button anteriorly contacting the incisors  Auxiliary wire with a loop at its end soldered - premolars bands www.indiandentalacademy.com 34
  • Distalization of Molars with Repelling Magnets  Incisor brackets – passive sectional wire- maintain incisor alignment  Repelling surfaces of magnets brought into contact by passing an .014 ligature through the loop, then tying back a washer anterior to the magnets  Force- 200-225 gms , dropped as space opened  3mm in 7 weeks  Anchor loss – 1mm www.indiandentalacademy.com 35
  • Molar distalization with Superelastic NiTi wire Gianelly JCO 1992  100gm Neosentalloy upper archwire  3 markings  Stops crimped, hook added  Insert wire such that posterior stop abuts mesial end of molar tube, anterior stop abuts distal of premolar.Xs wire deflected gi  Anchorage reinforced by class II, or Nance appliance www.indiandentalacademy.com 100g 36
  • Molar distalization with Superelastic NiTi wire Case report :  12 yr / F  Unilateral class II  Class II elastic against upper 1st premolar  Overcorrected- 4 months www.indiandentalacademy.com 37
  • NiTi Double Loop system for simultaneous distalization of first and second molars Giancotti JCO 1998  Mandibular molars and 2nd premolars banded, other teeth bonded  Lip bumper- prevent extrusion  Maxillary molars and bicuspids – banded, aligned  80 gm Neosentalloy – maxillary archwire placed – marked 1. Distal to 1st premolar 2. 5mm distal to 1st molar tube  Stops crimped on markings www.indiandentalacademy.com 38
  • NiTi Double Loop system for simultaneous distalization of first and second molars  2 Sectional NiTi archwires – crimp stops 1. Mesial and distal to 2nd premolar 2. 5mm distal to 2nd molar tube  Uprighting springs on 1st bicuspids  Class II elastics  Simultaneous, bodily movement www.indiandentalacademy.com 39
  • 24yr/f, class II div I 5months- overcorrected www.indiandentalacademy.com 40
  • NiTi Double Loop system for simultaneous distalization of first and second molars  Useful technique – Class II div I  Minimal patient co-operation  Ideal for simultaneous distalization U7 easier ‘.’ anatomy.  Due to stretching of transeptal fibers, 1 st molars can be distalized using lighter 80 gm force  Anchorage easily controlled , without need for TPA/Nance’.’light forces www.indiandentalacademy.com 41
  • NiTi Open Coil Springs Dia 0.012” Lumen 0.030 www.indiandentalacademy.com 42
  • Pendulum Appliance for class II noncompliance therapy JAMES J.HILGERS,JCO 1992  Nance button for anchorage  .032” sTMA springs-light continuous forces  Broad swinging arc (Pendulum) of force from midline of palate to upper molars www.indiandentalacademy.com 43
  • Pendulum Appliance Fabrication : Pendulum springs consist Recurved molar insertion wire 1. Horizontal adjustment loop 2. Closed helix 3. Loop for retention in acrylic button  Springs- close to center of Nance button www.indiandentalacademy.com 44
  • Springs close to center of palatal button:to maxi range of action, easy insertion. Retaining wire is soldered to the U4 and extended into acrylic. www.indiandentalacademy.com 45
  • Pendulum Appliance  Nance button- extend to about 5mm from teeth  Anterior retention loops fixed on model, later soldered to bicuspid bands  Acrylic pressed against the palatal vault  Pendulum springs inserted www.indiandentalacademy.com 46
  • Pendulum Appliance Pend-X Expansion needed: Jack-screw-One-quarter turn every 3 days www.indiandentalacademy.com 47
  • Pre activation and placement After cementation,before activation: Springs prefabricated to lie parallel to midsagittal plane, Which produces 60* of activation after insertion. As the molar distalizes it moves on an arc towards midline-counteracted by opening horizontal loop www.indiandentalacademy.com 48
  • Intra oral reactivation: Center of helix held with bird beak plier while, spring is pushed distally & reinsert. Stabilization: •Nance button •Upper utility arch- anterior segment- anchorage. •Full arch bonding:continuous wire with omega loop. •Head gears ? www.indiandentalacademy.com 49
  • Pendulum Appliance  Unilateral correction www.indiandentalacademy.com 50
  • Pendulum Appliance Conclusion :  Excellent patient tolerance  Upto 5mm distalization in 4 months  Distalization + Expansion  Patient compliance not needed www.indiandentalacademy.com 51
  • Franzulum appliance Friedrich Byloff et al  Anterior anchorage : acrylic button-5mm wide  Rests on canine and premolars - .032”S.Steel wire  Tube from acrylic button to receive active component  NiTi coil springs-100200g/side  JCO2000 sep J-shaped wire inserted into tube www.indiandentalacademy.com 52
  • Franzulum appliance: Niti spring over J shaped wire Inserted into tube of anterior anchorage unit •Anchor unit bonded with composite. •Close to CR of molarpure bodily movement. compressed Tied into lingual sheath www.indiandentalacademy.com 53
  • Case report  11yrs 10mts / M        end on molar relationship Space deficiency in both the arches Premolars blocked out Fixed appliance with cervical headgear and Cl II elastics End of treatment; Class I molar relation, no significant change in facial profile U6:3mm,L6:6mm Lower incisors proclined. Extrusion of U&L 6 Long term stability???? www.indiandentalacademy.com 54
  • Distal jet Appliance Aldo Carano, Mauro Testa JCO 1996  Lingual molar distalizing appliance  Appliance design : Wire extending from acrylic through tube ends in a bayonet bend-inserted into lingual sheath   Coil spring clamped on tube  Clamp  Anchor wire to 2nd premolar www.indiandentalacademy.com .036” int dia 55
  • Distal jet Appliance  Reactivation- sliding clamp closer to first molar,once a month.  After distalization – - clamp-spring assemblyacrylic, - premolar arms cut off. www.indiandentalacademy.com 56
  • Distal jet Appliance Case report  18/F, Class II div I  No skeletal abnormalities  Non-extraction therapy (3rd molars removed)  Distal jet  4 months- Class I ,2mm-L, 3mm-R www.indiandentalacademy.com 57
  • Distal jet Appliance Advantages :  Bodily movement  Easy insertion  Well tolerated  Esthetic  Unilateral, Bilateral  Permits simultaneous use of full bonded appliances. www.indiandentalacademy.com 58
  • Open Coil Jig Jones, White –JCO 1992 Oct NiTi springs 70-75g Nance button attached to U5 Assembly tied in place www.indiandentalacademy.com 59
  • Open Coil Jig 3 1. Fixed Sheath 4. Hook 5. Sliding Sheath 6. 5 Light wire 3. 6 Heavy round wire 2. 4 1 Open coil spring 4-5mm of distal movement. 2 www.indiandentalacademy.com 60
  • Conclusion      Borderline cases Space gaining procedures Simplicity Clinical effectiveness Patient compliance factor www.indiandentalacademy.com 61
  • Distraction Osteogenesis:      New bone formation b/w the surfaces of bone segments gradually separated by incremental traction. Tension-stimulates new bone parallel to vector of distraction. tension in surrounding soft tissues, initiating a sequence of adaptive changes termed as distraction histogenesis. Skin, fascia, bl vessels, nerves, muscles, cartilage, periosteum. Illizarov. www.indiandentalacademy.com 62
  • Mandibular Sympyseal distraction.         Mandibular symphyseal distraction- space gaining. Intra oral mandibular distraction device. More stable results. Corticotomy. Latent period.5-7days.(fibro vascular bridge) Activation.optimum rate: 1mm/day(0.5mm-premature ossification,2mm-fibrous CT , ischemia) Consolidation (remodeling) concomitant soft tissue expansion. Retention. www.indiandentalacademy.com 63
  • Thank you For more details please visit www.indiandentalacademy.com