Presentation12 /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 ,or call

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Presentation12 /certified fixed orthodontic courses by Indian dental academy

  1. 1. WHY ORTHOGNATHIC SURGERY? INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3.
  4. 4. ORTHOGNATHIC SURGERY  Orthognathic surgery is a process in which dentofacial deformities and malocclusions are corrected with orthodontic treatment and surgical operation of facial skeleton ,sometimes combined with various soft tissue procedures.
  6. 6.  Orthognathic surgery mainly used for correction of dentofacial deformities and various malocclusions.
  7. 7.  Dentofacial deformities:Dentofacial deformities refers to deviation from normal facial proportion and dental relationship that are severe enough to be handicapping.
  8. 8.  The affected individual are handicapped in two ways: 1)compromised jaw function. 2)discrimination in social interaction because of dental and facial appearance.
  9. 9.  Dentofacial deformities are:Various de A)facial syndrome and congenital anomalies:a)Fetal alcohol syndrome. b)Hemifacial microsomnia. c)Facial clefting syndrome. d)Achodroplasia. e)Maxillary and mandibular trauma.
  10. 10.  Various malocclusions are: Anteroposterior direction: Anteroposterior discrepancy- A))classl B) classll- a)div1 b)div2 C) classlll
  11. 11. 2)vertical discrepancy: a)open bite b)deep bite 3)Transverse discrepancy: a)narrowing of jaws b)widening of jaws
  12. 12.  Various dentofacial deformities and malocclusions are associated with underlying skeletal discrepancy.
  13. 13.  Question arises: who is a candidate for surgery in addition to orthodontics?
  14. 14.  Is that surgery will be needed if there is severe skeletal or very severe dentoalveolar problem ,too severe to correct with orthodontics alone?.
  15. 15.  The answer to second question is:what makes a problem too severe for orthodontics alone??
  16. 16.  If the jaw relationship is correct ,crowded and malaligned teeth nearly always can be corrected by orthodontic tooth movement.however there are limits to how far a tooth can be moved.
  17. 17.  For this reason ,surgery to reposition the jaw often is required for successful treatment,and soft tissue surgical procedure may also be needed. Orthodontic treatment even if successful in bringing the teeth into proper relationship,may not correct the underlying skeletal problem well enough to overcome psychological handicap.
  18. 18.  If a discrepancy In the size and position of the jaw contribute to the malocclusion and it is reflected in improper facial proportion there are only 3 possible treatment:
  19. 19. 2)Orthodontic camouflage. 3)surgical repositioning of the jaws. 1)modification of growth
  21. 21.  Dental compensation prevents correction of skeletal discrepancy introduce an element of camouflage
  22. 22.  Mature patient correction of malocclusion orthodontic camouflage
  23. 23.  Dental camouflage mild discrepancy exist and no potential for future growth.  Repositioning of the teeth to compensate for skeletal discrepancy.
  24. 24.  Example:classll malocclusion with underdeveloped lower jaw and proclined upper incisor.  Camouflage should be abandoned when it has the potential to correct malocclusion at the expense of facial esthetics.
  25. 25.  Essence of camouflage Improve facial improve relationship dental relationship
  26. 26.  After the growth has ceased surgery is the only alternative
  27. 27.  Reverse orthodontics:Making the malocclusion worse for the orthognathic surgery.
  28. 28.  When is a problem too severe for orthodontic treatment only?
  29. 29.  Tremendous advance in the area of orthognathic surgery since 1970.  Major role of orthgnathic surgery in treating patient successfully who has aesthetically unacceptable and unstable results after orthodontic camouflage.
  30. 30.  Need for orthognathic surgery- 1)impaired mastication. 2)tempromandibular pain and dysfunction. 3)susceptibility to caries and periodontal disease. 4)psychological effect resulting from the unaesthetic appearance from the dentofacial deformities .
  31. 31.  Soft tissue limitation –1)pressure exerted by soft tissue lips,cheeks and tongue which are the primary determinant of stability.  2)the periodontal attachment apparatus  3)tempromandibular and soft tissue components.
  32. 32.  4)soft tissue integument of the entire face which determines esthetics.
  33. 33.  Aesthetic guidelines given by Ackerman and proffit:  1)protraction of incisors would be more favorable in a patient with large nose or chin providing there would not be excessive deepening of mentolabial fold.
  34. 34.  2)orthodontics alone can rarely correct severe midface deficiency or mandibular prognathism because these 2 conditions are always accompanied by unaesthetic lip position and neck form.
  35. 35.  3)moderate amount of mandibular deficiency are often acceptable to patients although the orthodontist might more prominence of the lower face.  4)maxillary incisor should never retracted to the point that the inclination of the upper lip becomes negative to a true vertical line.
  36. 36.  5)short lower facial height or protrusion of the teeth may create an ill defined labiomental sulcus as a result of the necessity to strain the lips in an efforts to gain a lip seal.
  37. 37.  6)overretraction of the maxillary incisor often tilts the occlusal plane down anteriorly creating an excessive display of gingiva which is considered unesthetic .patient do not mind if only moderate amount of gingiva shows on smile.
  38. 38.  7)when the lower lip is trapped under the maxillary incisor or when the mandibular incisor have been excessively proclined the resulting lip position is unacceptable.
  39. 39.  8)Lack of a vermilion border is not desirable tooth movement that proclined the incisors would create an aesthetically fuller lip.  9)Extreme bilabial protrusion is generally perceived as unacceptable regardless of the racial or ethnic group.
  40. 40.  Proffit and colleagues(1992) –guidelines For predicting successful outcome when the choise between surgery and orthodontic correction Sample size-40 patients
  41. 41.  Conclusion-surgery is likely to be needed for adolescents beyond the growth spurts with a classll malocclusion when  1)overjet greater then 10 mm  2)pogonion to nasion perpendicular is greater then 18mm
  42. 42.  3)mandibular body length less then 70 mm  4)face height is greater than 125mm.
  43. 43.  Envelop of discrepancy:introduced by Proffit and Ackerman
  44. 44.
  45. 45.
  46. 46.
  47. 47.  Orthognathic surgery is required for Psychological Better esthetic improved satisfaction and function jaw discrepancy
  48. 48.  Evaluation before orthognathic surgery: 1)psychological 2) soft tissue 3) jaw evaluation evaluation discrepancy evaluation
  49. 49.  Psychological evaluation: Dentofacial deformities and malocclusion Handicapping malocclusion Social discrimination Functional abnormalities
  50. 50.  Not so long ago the patient thoughts and patient perception were considered soft data ,less important than what could be physically measured during a clinical examination or analysis of diagnostic images.
  51. 51.  From 1990 changed occur and treatment plan inclined more towards patients facial esthetics.  Evaluation of patients feeling and perception has become necessary.
  52. 52.  Involvement of patient and parents is necessary in treatment plan.  Ackerman and Proffit –Clinician influenced by objective findings  Patients influenced by subjective findings
  53. 53.  psychological impact of dentofacial deformities Reaction to Effects of Facial appearance dentofacial deformities
  54. 54.  Orthognathic surgery-challenge the patients capacity to adapt.  Studies also reported 2 main reasons for which patients are seeking for treatment:1)esthetic improvement 2)functional improvement
  55. 55.  Edgerton and Knorr(1971): 1)external motivation 2)internal motivation Helm(1985)-Adult with deep bite,severe crowding,extreme overjet causes unfavorable self perception.
  56. 56.  Gerzenic (2002)-studied the psychological profile of 100 classll and classlll patients preoperatively and postoperatively.  Results-preoperatively classlll patient felt less attractive then classll patient.
  57. 57.  Attractiveness and self-confidence has increased more in classlll patients after surgery.  Esthetic improvement was the driven force behind classlll patients to seek treatment.
  58. 58.  Ceib Phillip-people with dentofacial disharmony may encounter psychological distress directly from teasing or indirectly from sociocultural percepts. -Individual with dentofacial disharmonies who are seeking treatment are experiencing a level of psychological distress that warrants intervention.
  59. 59.  Soft tissue evaluation:shift towards soft tissue paradigm.
  60. 60.  Nose Lip Facial profile Chin
  61. 61.
  62. 62.  Evaluation of facial proportion and symmetry:
  63. 63. Evaluation of nose Evaluation of lip:Lip thickness Lip fullness Evaluation of chin:
  64. 64.
  65. 65.  Growth modification  Orthodontic camouflage  Surgical repositioning of the jaws
  66. 66.  Envelop of discrepency
  67. 67.  Psychological aspect of Dentofacial deformities
  68. 68. Thank you For more details please visit