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Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
Open bite sem [recovered] /certified fixed orthodontic courses by Indian dental academy
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Open bite sem [recovered] /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
0091-9248678078

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  • 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. Open bite www.indiandentalacademy.com
  • 3. DEFINITIONS CLASSIFICATIONS ETIOLOGY DIAGNOSIS TREATMENT FINISHING & RETENTION www.indiandentalacademy.com
  • 4. INTRODUCTION; Open bite mal occlusion has long held fascination in orthodontics. It is difficult to treat and relapse tendencies are strong. - Young H. Kim AO 1987 www.indiandentalacademy.com
  • 5. DEFINITIONS; Normal bite: It is defined as vertical overlap of the incisors. The lower incisal edges in relation to the lingual surface of the upper incisors present at or above the cingulam (normally there is 1-2 mm overbite) www.indiandentalacademy.com
  • 6. OPEN BITE; www.indiandentalacademy.com
  • 7. ANTERIOR OPEN BITE; www.indiandentalacademy.com
  • 8. POSTERIOR OPEN BITE; www.indiandentalacademy.com
  • 9. SIMPLE OPEN BITE; www.indiandentalacademy.com
  • 10. COMPLEX OPEN BITE; www.indiandentalacademy.com
  • 11. COMPOUND OPEN BITE; www.indiandentalacademy.com
  • 12. IATROGENIC OPEN BITE; Open bite as a consequence of orthodontic treatment. www.indiandentalacademy.com
  • 13. Classificaton; It used to visualize the problem, diagnosis and treatment plan. www.indiandentalacademy.com
  • 14. Classified on developmental; Primary; Mixed; Gum pads Temporary www.indiandentalacademy.com Permanent; Persistent habits
  • 15. Depend on site; Anterior open bite; Posterior open bite; www.indiandentalacademy.com
  • 16. Depend on position; Intra arch The tooth itself is malpositioned within arch creating open bite - infraversion / inclination abnormally without root. www.indiandentalacademy.com
  • 17. Inter arch; -No vertical overlap -abnormality in upper/lower or both - Ant/post segment www.indiandentalacademy.com
  • 18. Ankerman profit; vertical relation Anterior open bite dental Posterior open bite skeletal www.indiandentalacademy.com dental
  • 19. Depend on etiology; Lateral open bite Compound open bite www.indiandentalacademy.com Iatrogenic open bite
  • 20. ETIOLOGY OF OPEN BITE; WHY OPEN BITE ? - EPIGENETIC FACTORS - ENVIRONMENTAL FACTORS - HABITS www.indiandentalacademy.com
  • 21. Pre – disposing factors; maxilla Skeletal Mandible Dental Excess eruption of posteriors Decreased eruption of anteriors www.indiandentalacademy.com
  • 22. Various factors influencing open bite; a) Disturbances in embryonic development; 1) Muscle dysfunction 2) Hemi mandibular hypertrophy www.indiandentalacademy.com
  • 23. 1) Muscle dysfunction; Kiliaridis s, mejersjo c - Etiology; - Ejo 1989 - defect in the uterus. - Pathology - affect the particular muscle Bone formation in the origin of muscle Loss of musculature www.indiandentalacademy.com
  • 24. Underdevelopment of face www.indiandentalacademy.com
  • 25. Muscular dystropy. & Muscle weakness syndrome. Muscle tonicity Open bite www.indiandentalacademy.com
  • 26. Mandible drops downwards away from maxilla www.indiandentalacademy.com
  • 27. Anterior open bite due to increased eruption of posterior teeth. www.indiandentalacademy.com
  • 28. 2) Hemi mandibular hypertrophy Bilateral www.indiandentalacademy.com
  • 29. - unilateral www.indiandentalacademy.com
  • 30. b) Genetic influence; - A strong influence of inheritence on facial features is obvious at a glance. - mal occlusion produced by inherited characteristic in 2 ways; What it has to do with open bite ? www.indiandentalacademy.com
  • 31. Long face pattern; King L, Harris EF, Tolley EA - AJO 1993 Long face syndrome; www.indiandentalacademy.com
  • 32. Ackerman, Isacson, Shapiro - AJO 1970 Genetic inheritence Skeletal influence Dental influence Open bite www.indiandentalacademy.com
  • 33. c) Environmental influence; The open bite can be produced by 1) equilibrium forces 2) Functional forces www.indiandentalacademy.com
  • 34. 1) Equilibrium forces; It states that object subject to unequal forces will be accelerated and there by move to different space. Proffit WR; AO 1978 Hence the equilibrium has to be maintained. www.indiandentalacademy.com
  • 35. Altered equilibrium due to increased tonque pressure. www.indiandentalacademy.com
  • 36. a) Juvenile equilibrium; The teeth that are in function parallels the rate of vertical growth of mandibular ramus www.indiandentalacademy.com
  • 37. The rate of eruption is controlled by forces opposing direction, not those promoting it. www.indiandentalacademy.com
  • 38. 2) Functional forces; Biting force and eruption Downward growth of mandible Open bite Masticatory muscle gains strength at puberty. www.indiandentalacademy.com
  • 39. HABITS Definition; It is the tendency towards an act of repeated performance relatively fixed or consistent and ease to perform by an individual. We are just beginning to realize how common and varied the vicious habits of lip and tongue, and how power full and persist to overcome - Angle. www.indiandentalacademy.com
  • 40. Earliest writings; - causes of irregularities through habits that pushes teeth forward. - Lefoulon 1839 - balance of force to retain teeth in position. - Desirabode 1843 - “lateral pressure theory” - Bridgeman 1859 - “Sim Wallace theory” - Bennett www.indiandentalacademy.com
  • 41. Classify; 1) useful Tongue thrusting harmful 2) When persists Pressure Sucking ( lip, thumb) Non pressure Mouth breathing www.indiandentalacademy.com
  • 42. Thumb sucking; Definition; It is defined as the placement of thumb or one/more fingers in varying depths into the mouth. Klein AJO 1979 www.indiandentalacademy.com
  • 43. Physiological condition; -It is considered normal till 3 – 4 yrs. - It is an non nutritive sucking habit - Recent studies indicate that thumb sucking is practised even during the intra – uterine life. www.indiandentalacademy.com
  • 44. Pathological condition; & Clinical features It occurs through altered equilibrium not just pressure through fingers. www.indiandentalacademy.com Open bite
  • 45. Sucking habits; www.indiandentalacademy.com
  • 46. Theories; 1) Freudan theory; 1- 3 years – oral and anal phase. 2) Oral drive theory of sears and wise; 1950 Prolonged habit leads to thumbsucking. 3) Benjamins theory; Thumbsucking develops in infants due to the rooting reflex/placing reflex. www.indiandentalacademy.com
  • 47. 4) Psychological aspects; Children develop this habit as a feeling of insecurity, when they are deprived of love, care and affection. www.indiandentalacademy.com
  • 48. Phases of thumbsucking; Phase – 1; - First three years of life. - sub clinically significant. Phase - 2; - 3 – 6 yrs of life. - clinically significant. www.indiandentalacademy.com
  • 49. Phase - 3; - beyond 5 – yrs. - intractable sucking. - Its an alert to an dentist. www.indiandentalacademy.com
  • 50. DIAGNOSIS; - Check for childs emotional status. - feeding habits - Intra – oral examination; - incissors - open bite - Clean nails www.indiandentalacademy.com
  • 51. TREATMENT; 1) Psychological approach; Beta hypothesis theory by Dunlop Consious purposeful repeatation. 2) Mechanical aids; Basically reminders 3) Chemical approach; www.indiandentalacademy.com
  • 52. TONGUE THRUSTING DEFINITION; It is defined as the forward movement of the tongue tip between the teeth to meet the lower lip in deglutition and in sounds of speech so that the tongue becomes interdental. Tulley www.indiandentalacademy.com AJO 1969
  • 53. Classification; According to moyers; Simple complex - To establish lip seal - Anterior open bite - Contraction of circum – oral muscles. - abnormal mentalis - diffuse open bite. - poor occlusion. www.indiandentalacademy.com
  • 54. Simple tongue thrust. www.indiandentalacademy.com
  • 55. According to James s. Braner and holt Type 1 - Non deforming tongue thrust. Type 2 – Deforming anterior tongue thrust. Type 3 – Deforming lateral tongue thrust Type 4 – Deforming ant; & lat; tongue thrust www.indiandentalacademy.com
  • 56. Etiology ; According to fletcher; 1) Genetic factors; Neuromuscular variations in oro facial region. 2) Learned behaviour; Prolonged action & gum tenderness. 3) maturational; Age – swallow pattern. www.indiandentalacademy.com
  • 57. 4) Mechanical restrictions; - macroglossia. - arch constricted. 5) Neurological disturbances; - motor disability 6) Psychogenic factor; - discontinuation of other habits. www.indiandentalacademy.com
  • 58. DIAGNOSIS; - Size of the tongue - posture of the tongue - Structure of the tongue - Function of the tongue www.indiandentalacademy.com
  • 59. 1) Size of the tongue; Variations in tongue size , Reaches its adult size by the age of 8 years. Why asses the variations ? True macroglossia Pseudo macroglossia www.indiandentalacademy.com
  • 60. Macroglossia; The whole oral cavity is filled with the tongue mass, presence of indentations on the periphery. www.indiandentalacademy.com
  • 61. Etiological factors; congenital Acquired - muscular hypertrophy - Acromegaly - glandular hyperplasia - myxedema - amyloidosis - lymphangioma - Downs syndrome - tertiary syphylis Cyst/tumors involving tongue. www.indiandentalacademy.com
  • 62. Pseudo macroglossia; Forward posture of tongue - Low palatal vault www.indiandentalacademy.com
  • 63. Etiological factors; - habitual posturing of the tongue. - hypertropied tonsils and adenoid tissue. - arch deficiency in all dimensions. - severe mandibular deficiency. - cyts/tumors that displaces the tongue www.indiandentalacademy.com
  • 64. Clinical assessment; 1) macroglossia. 2) microglossia. - Tulley AJO 1969. www.indiandentalacademy.com
  • 65. MACROGLOSSIA; Signs and symptoms. - Open bite (ant/post) - Diastema (mx/md) - Accentuated curve of spee in maxillary arch - Reverse curve of spee in mandibular arch. - difficulty in swallowing - mandibular prognathism. - Larry M. WOLFORD, AJO 1996 www.indiandentalacademy.com
  • 66. Cephalometric & Radiographic assessment. - over angulation of upper and lower anteriors. - Dispropotionately excessive mandibular growth. - increased gonial angle. - increased occlusal and mandibular plane angle. - David A. AJO 1996. www.indiandentalacademy.com
  • 67. Cephalometric evaluation; Lateral ceph with sufficient exposure to evaluate the soft tissue. Reference lines; I,V,M,O. www.indiandentalacademy.com
  • 68. Criteria for evaluation; - The greatest possible area of tongue should be above reference line. - The base line is independent of skeletal structures. - The tongue should not change with position of the mandible. www.indiandentalacademy.com
  • 69. Menstrual data through template; www.indiandentalacademy.com
  • 70. Template evaluation; www.indiandentalacademy.com
  • 71. 2) Posture of tongue; The posture is evaluated for various open bite tendencies. It can be flat/arched, protracted/retracted, narrow/long. www.indiandentalacademy.com
  • 72. ANTERIOR POSTURE; www.indiandentalacademy.com
  • 73. LATERAL POSTURE; www.indiandentalacademy.com
  • 74. STRUCTURE OF TONGUE; In infancy the extrinsic suspensory muscles attach the tongue to various osseous structures largely resposible for gross movements in horrizontal plane. - It has the property of elasticity & contractility ----- tongue thrust. Acts through all / none law. www.indiandentalacademy.com
  • 75. FUNCTION OF TONGUE; DEGLUTATION www.indiandentalacademy.com
  • 76. According to moyers; Depend on the characteristic; 1) Infantile swallow ---- 12 - 18 mnths. 2) Mature swallow ----2 - 4 yrs www.indiandentalacademy.com
  • 77. INFANTILE SWALLOW; www.indiandentalacademy.com
  • 78. Central furrow & gum pads. www.indiandentalacademy.com
  • 79. MATURE SWALLLOW; www.indiandentalacademy.com
  • 80. SHALLOW TONGUE; www.indiandentalacademy.com
  • 81. Do tongue thrust cause open bite ? Pressure on teeth by swallow - 1 secs Individual swallow – 800/dy - & few in sleep. Total 1000/dy www.indiandentalacademy.com
  • 82. Treatment; Defect in posture; - habit breaking appliance. - muscle exercise through elastics. Defect in size; - Glossectomy.. - surgical correction. www.indiandentalacademy.com
  • 83. Glossectomy; Pseudo macroglossia True macroglossia Procedures; - Midline wedge resection with base in the anterior tongue. - Midline elliptical excision. - Marginal excision. - “Keyhole” or combined technique. www.indiandentalacademy.com
  • 84. Keyhole technique; Anterior wedge resection Midline elliptical incision www.indiandentalacademy.com - AJO -96
  • 85. SEQUENCE OF PROCEDURES; STAGE I : GLOSSECTOMY ORTHOGNATHIC SURGERY - Psychological approach. - No IMF - No air way obstruction. www.indiandentalacademy.com
  • 86. STAGE 2 : ORTHOGNATHIC SURGERY. GLOSSECTOMY - If occlusal stability is a concern. www.indiandentalacademy.com
  • 87. STAGE 3 : COMBINED - Both the procedures combined together at a same surgical stage. www.indiandentalacademy.com
  • 88. MOUTH BREATHING; Definition; It is defined as the the pattern of breathing totally / partially through oral cavity due to anatomical / functional variations. www.indiandentalacademy.com
  • 89. Classify; a) Obstructive. b) Habitual. c) Anatomical. www.indiandentalacademy.com
  • 90. ETIOLOGY; Mouth breathing primarily has effect on - posture of jaws. - Position of tongue - posture of head. Altered equilibrium Growth Tooth position www.indiandentalacademy.com
  • 91. Mouth breathing Mandible lowered LFH Tilted head lowered tongue Change of 5 degree cranio vertebral angle Mandible rotated Open bite www.indiandentalacademy.com Obstruction relieved
  • 92. Mandible lowered; Ant; open bite. www.indiandentalacademy.com
  • 93. Change in cranio vertebral angle; www.indiandentalacademy.com
  • 94. Physiological variations; All humans are some mouth breathers. Average breathing air flow ------ 20 – 25/L/mnt Partial mouth breathing --------- 40 – 45 L/mnt Transitional stage ----------- 80 Mintz S, Shepard RJ. www.indiandentalacademy.com
  • 95. Pathological variations; It becomes a habit when the breathing persists even when the obstruction is removed. Opposing principles; Total nasal obstruction Increased LFH Battgel J BJO - 1996 www.indiandentalacademy.com
  • 96. Clinical features; Malocclusion associated with the mouth breathing. Long face syndrome/classical adenoid facies; www.indiandentalacademy.com
  • 97. DIAGNOSIS; - Nasal obstruction. - Adenoids. - hyoid triangle analysis. www.indiandentalacademy.com
  • 98. NASAL OBSTRUCTION - AJO 1998 www.indiandentalacademy.com
  • 99. Choanal atresia & treacher collins syndrome in infants ----- tracheostomy www.indiandentalacademy.com
  • 100. How much obstruction has to occur for effect on growth ? - It depends on location of the obstruction. Anterior Middle portion posterior - nasal function www.indiandentalacademy.com
  • 101. Methods in assessing the nasal obstruction. - Cross sectional area. - Peak nasal air flow - Nasal resistance. - Respiratory mode (oral/nasal air flow ratio) -AJO 1998 www.indiandentalacademy.com
  • 102. Rhinomanometric studies; Study of air flow with flow meters, and pressure gauges. Cleft lip and palate patients increase tendency of mouth breathing ? - AJO 1998 Posterior nasal obstruction by pharyngeal flaps. www.indiandentalacademy.com
  • 103. ADENOIDS; Enlargement of adenoids relation to mouth breathing. www.indiandentalacademy.com
  • 104. Hyoid bone position; - AJO 1984. In 1981 Bibby and Preston. Hyoid bone is not fixed to a space by any bony articulations. Hyoid bone is determined by muscles and ligaments attached to structures above and below it. www.indiandentalacademy.com
  • 105. - It is influenced by the tongue posture and mandibular position. it signifies www.indiandentalacademy.com
  • 106. TREATMENT; - Removal of the cause. - Interception of the habit. - Rapid maxillary expansion. - orthodontic + surgery www.indiandentalacademy.com
  • 107. Nasal obstruction; - AJO 1998 - vertically repositioning of maxilla predictably reduce the nasal resistance. Not nasal air flow Breathing mode is behavioral determined than structurally determination The highest correlation between these parameters are 0.24 %---- 0.74% www.indiandentalacademy.com
  • 108. Adenoids; - AJO -94 - Adenoidectomy. Ten yr old www.indiandentalacademy.com
  • 109. No change in breathing pattern; www.indiandentalacademy.com
  • 110. Rapid maxillary expansion; For maxillary deficiency Increase nasal air flow Reduction in nasal resistance was frequently measured. Rhinometric studies; No change in breathing mode. www.indiandentalacademy.com
  • 111. DIAGNOSIS; Early detection of symptoms is recommended, so that treatment can be provided in time whatever the cause may be. - Subtenly, AO 1954 - Ricketts, AO 1968 www.indiandentalacademy.com
  • 112. How to decide for open bite ? It is the ability to recognize vertical growth in routine treatment mechanics. Commonly clinicians evaluate Mandibular plane for open bite. www.indiandentalacademy.com
  • 113. DIAGNOSIS; - SKELETAL OPEN BITE - DENTAL OPEN BITE. - ANTERIOR OPEN BITE. - POSTERIOR OPEN BITE. www.indiandentalacademy.com
  • 114. Skeletal open bite; www.indiandentalacademy.com
  • 115. Posterior open bite; - Failure of posterior tooth to erupt fully in occlusion producing lateral open bite. Mechanical interference. Disturbance of eruption mechanism. www.indiandentalacademy.com
  • 116. GROWTH PATTERN ; Its purpose was to assess skeletal factors associated with development of vertical facial disproportions. Horrizontal facial planes tends to be steeper and more divergent with lower facial height. www.indiandentalacademy.com
  • 117. Steeper planes; www.indiandentalacademy.com
  • 118. 1) Mandibular plane; Favoured --- Nanda. Not favoured --- Skiller/Bjork. 2) Gonial angle; Enlow - Angle. 3) Palatal plane; Posterior dips 4) Occlusal plane; Bjork –no change Steeper 5) Cranial base; Larger cranial base and corresponding positional deviations of mandible associated with open bite. www.indiandentalacademy.com
  • 119. CEPHALOMETRIC EVALUATION; There are six specific cephalometric angular measurements for identifying the vertical dysplasia. www.indiandentalacademy.com
  • 120. 1) SN --- (ANS – PNS); www.indiandentalacademy.com
  • 121. 2) SN --- MANDIBULAR PLANE; www.indiandentalacademy.com
  • 122. 3) GONIAL ANGLE; www.indiandentalacademy.com Resultant uprighting of the ramus.
  • 123. 4) PALATOMANDIBULAR ANGLE; Bimler used this angle for describing facial types. www.indiandentalacademy.com
  • 124. 5) SN --- OCCLUSAL PLANE; www.indiandentalacademy.com
  • 125. 6) CRANIAL BASE ANGLE; www.indiandentalacademy.com
  • 126. LINEAR PARAMETERS; GROUP 1; PFH/AFH ----- Sum of angle -Jarabak GROUP 2; UFH/LFH Average --- 0.810 Open bite ---0.686 www.indiandentalacademy.com
  • 127. OBJECTIVE OF OPEN BITE; 1) Creating sufficient overlap with molar relation; Incisal overlap 0.5 --- 4.0 mm Average – 2.8mm - Kim 1974 - AO 1998 www.indiandentalacademy.com
  • 128. Central incisor relative to lip line; www.indiandentalacademy.com
  • 129. The dentition is placed in proper three dimensional perspective to ensure stability. - Antero – posterior aspect. - Vertical aspect. - Transverse aspect. www.indiandentalacademy.com
  • 130. Axial inclination; ------ open bite www.indiandentalacademy.com
  • 131. Axial inclination ----- deep bite. www.indiandentalacademy.com
  • 132. Eliminate Blocks: In order to eliminate blocks the molar are distally tipped. Extraction ( 1/2/3) molar www.indiandentalacademy.com Non extraction
  • 133. TREATMENT; It depends on etiology and location - Dento alveolar open bite. - skeletal open bite. TIMING OF TREATMENT; Not too early not too late www.indiandentalacademy.com
  • 134. TREATMENT DURING PRIMARY DENTITION; Dental open bite; - Habits ---- after 3 yrs. Screening therapy. Skeletal open bite; - Habit control secondary. - Growth modification not indicated www.indiandentalacademy.com
  • 135. TREATMENT ON EARLY MIXED DENTITION; Dento alveolar open bite; - Screening therapy - Behavior modification. www.indiandentalacademy.com
  • 136. Screening appliances; Vestibular screen ------------ digit sucking Vestibular screen ------ Its modifications. Tongue crib ------ tongue thrust. Posterior tongue crib -------- lateral tongue thrust Activator ----------- Tongue thrust and finger sucking ( work as a interceptor). www.indiandentalacademy.com
  • 137. BEHAVIOR MODIFICATION; COUNSELLING; A straight forward discussion with the child during eruption of permanent incisors. REWARD; For not engaging in the habit. www.indiandentalacademy.com
  • 138. REMINDER; For the child who wants to quit. www.indiandentalacademy.com
  • 139. QUAD HELIX; Maxillary lingual arch with crib; www.indiandentalacademy.com
  • 140. OPEN BITE IN LATE MIXED DENTITION; Skeletal parameters; - Major diagnostic criteria is either, maxilla or both Palatal plane mandible Ramus “ KEY “ www.indiandentalacademy.com
  • 141. GROWTH MODIFICATION; It varies depends on horrizontal/vertical growth; www.indiandentalacademy.com
  • 142. www.indiandentalacademy.com
  • 143. High pull head gear to molars; www.indiandentalacademy.com
  • 144. High pull head gear with maxillary splint; www.indiandentalacademy.com
  • 145. Bite blocks with functional appliance; www.indiandentalacademy.com
  • 146. Head gear with functional appliance and bite blocks; www.indiandentalacademy.com
  • 147. Functional appliance; Head gear with activator www.indiandentalacademy.com
  • 148. Bite registration; www.indiandentalacademy.com
  • 149. TREATMENT IN ADULT; Correction of vertical relation mandible maxilla Vertical excess anterior www.indiandentalacademy.com posterior excess
  • 150. Maxillary excess; Le Forte I Reduce the nasal septum www.indiandentalacademy.com
  • 151. Anterior open bite; Anterior segment is moved more than posterior www.indiandentalacademy.com
  • 152. Posterior open bite; www.indiandentalacademy.com Segmental osteotomy
  • 153. Mandibular surgery; Surgery in the ramal part is done only to the secondary aspect to the maxillary osteotomy for the auto rotation of the mandible. Advancement genioplasty www.indiandentalacademy.com
  • 154. GENIOPLASTY; Long face pts has excess eruption of lower anterior which is flared and unstable Poor chin balance Bony cut is given upward and forward angulated to advance it. www.indiandentalacademy.com
  • 155. PRE – SURGICAL ORTHODONTICS; allignment levelling Antero posterior incisor position www.indiandentalacademy.com
  • 156. LEVELLING; MAY OR MAY NOT BE DONE; - Depend on facial type. Stabilizing arch wire; 18 slot ------- 17 x 25 22 slot ------ 21 x 25 www.indiandentalacademy.com
  • 157. POST SURGICAL ORTHODONTICS; Until stabilizing arch wire is removed the teeth are held in tight position. - four weeks Light vertical elastics www.indiandentalacademy.com
  • 158. RETENTION Removable Appliance with high pull head gear www.indiandentalacademy.com
  • 159. Appliance with the bite block. www.indiandentalacademy.com
  • 160. Force Amplified Retention 1997 JCO Sheridan Low profile lingual caplin Canine to canine hooks www.indiandentalacademy.com intra oral elastics.
  • 161. Conclusion; www.indiandentalacademy.com
  • 162. THANK www.indiandentalacademy.com U

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