Surgery /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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Surgery /certified fixed orthodontic courses by Indian dental academy
- 1. Diagnosis & treatment planning in orthognathic surgery INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com 1
- 2. Contents • • • • • • Introduction Indications Collection of records Diagnosis Treatment plan Different surgeries - maxilla - mandible www.indiandentalacadem y.com 2
- 4. Envelope of discrepancy 3 ranges of correction for any kind of malocclusion • Orthodontic tooth movement alone • Tooth movement plus functional or orthopedic treatment • Surgical orthodontics www.indiandentalacadem y.com 4
- 6. Indications A skeletal or dento-facial deformity is so severe that the magnitude of the problem lies outside the envelope of possible correction by orthodontics alone proffit www.indiandentalacadem y.com 6
- 11. Collection of records Interview data Clinical examination Data Data base Diagnostic records www.indiandentalacadem y.com 11
- 12. Collection of records Interview data • Patient’s chief complaint • Interview related to the patient’s social psychological status • Information related to the patient’s physical status www.indiandentalacadem y.com 12
- 13. Collection of records Patient’s chief complaint 2 groups 1. who are concerned about their appearance, oral function 2. Older patients concerned about some specific health related problems www.indiandentalacadem y.com 13
- 14. Collection of records Social psychological status An extension of chief complaint • Motivation • Expectation personality exceptional Personality inadequate no problem pathologic personality www.indiandentalacadem y.com 14
- 15. Psychological considerations in orthognathic surgery “The area around mouth is both emotionally charged and strongly connected with one’s self image” - MACGREGOR The face is the area of one’s body that produces the greatest concern regarding physical attraction A survey of over 100 adults ( Berschied et al ) - The people who are satisfied with their facial features expressed greater self confidence www.indiandentalacadem y.com 15
- 16. Psychological considerations in orthognathic surgery Dento- facial defects are extremely prominent Study done by Richardson (a normal child, a child with crutches and a brace on the legs, 1 child with hand missing, a child in a wheel chair, a child with a facial deformity and an obese child) It is impossible and foolish to treat the patient’s physical condition without adequate understanding and regard for the emotional frame work www.indiandentalacadem y.com 16
- 17. Psychological considerations in orthognathic surgery CONCEPT OF BODY IMAGE ( Individual’s self concept ) 2 COMPONENTS • BODY SENSE – The actual appearance the person sees when viewing himself in a mirror / photograph - SCHILDER & SCHONFELD • BODY CONCEPT - The internal process of how the patient feels about his appearance www.indiandentalacadem y.com 17
- 18. Psychological considerations in orthognathic surgery • Internal motivation – originating within the patient • External motivation - a desire to overcome others The patient motivated by external pressures were very poor candidates compared to the patients responding to internal pressures - EDGERTON & KNOOR www.indiandentalacadem y.com 18
- 19. Psychological considerations in orthognathic surgery Structured interview technique Prevent some of the pitfalls of cosmetic surgery that result in postoperative dissatisfaction Post operative dissatisfaction is usually as a result of lack of understanding between the patient and surgeon www.indiandentalacadem y.com 19
- 20. Psychological considerations in orthognathic surgery Structured interview technique 1. How does the patient perceive the deformity ? 2. How does the deformity affect the patient’s personality ? 3. Why did the patient decide to have the problem corrected ? 4. What does patient expect from surgery ? 5. Has the patientwww.indiandentalacadem ? had previous surgery y.com 20
- 21. Psychological considerations in orthognathic surgery • Positive reactors / group I • Neutral reactors / group II • Negative reactors / group III www.indiandentalacadem y.com 21
- 22. Psychological considerations in orthognathic surgery Is the deformity developmental or acquired ? • Greater emotional stability is seen in patients with congenital deformity • No concept of NORMAL • Patients with an acquired deformity will have a distorted image of their former appearance • Clinician should be frank about the possibilities of treatment Age • Adolescents would be expected to have fewer www.indiandentalacadem postoperative emotional problems y.com 22
- 23. Psychological considerations in orthognathic surgery Supportive measures • Explaining the surgical goal - Show the pictures of other patients - encourage the patient - limitations & risks must be explained - should not promise • Anticipating post operative depression • Seeking psychiatric consultation www.indiandentalacadem y.com 23
- 24. Collection of records Physical status • • • • Medical history Dental history Family history Evaluation of the physical growth status chronic conditions are of great concern www.indiandentalacadem y.com 24
- 26. Family history • Hapsburg jaw www.indiandentalacadem y.com 26
- 27. Collection of records Clinical examination data To determine what diagnostic records are required 1. Health of the hard and soft tissues 2. Oral function including TMJ 3. Facial proportions and esthetics www.indiandentalacadem y.com 27
- 28. Collection of records Health of the hard and soft tissues • • • • OPG – overall dentition Bitewing – inter-proximal caries Occlusal - palate & impacted teeth Midline IOPAs ex; diastema www.indiandentalacadem y.com 28
- 29. Collection of records Periodontal health • • • • Bleeding on probing Periodontal breakdown Pockets Adequacy of attached gingiva www.indiandentalacadem y.com 29
- 30. Collection of records Oral function • • • • Speech - lisping Mastication Cheek & lip biting TMJ problems - symptoms - muscle examination - Range of motion www.indiandentalacadem y.com 30
- 31. Collection of records TMJ radiographs 1. Trans-cranial radiographs – lataeral 1/3 of the condyle 2. Tomographs / laminographs - multiple views 3. Computed tomography - anteroposterior and lateral views 4. Arthrography - disk morphology & position 5. Magnetic resonance images ( MRI ) - precise method - hard & soft tissues www.indiandentalacadem y.com 31
- 32. CT scan of right TMJ www.indiandentalacadem y.com 32
- 33. PHOTOGRAPHS FACIAL • Frontal with relaxed lip position • Frontal with smile • Three quarter view • Profile view • Submental view INTRAORAL frontal • Teeth on occlusion right lateral left lateral upper • Occlusal views lower www.indiandentalacadem y.com 33
- 36. Facial keys to orthodontic diagnosis and treatment planning: PART 1 - W. Arnett, T. Bergman AJODO 1993 April • Head orientation - Natural Head position • Condyle position - Centric Relation • Lip posture - Ralaxed Lip Posture www.indiandentalacadem y.com 36
- 37. NATURAL HEAD POSITION • Orientation of the head assumed naturally • 2 degree standard deviation www.indiandentalacadem y.com 37
- 38. CENTRIC RELATION To produce precise function Upper most position - DAWSON www.indiandentalacadem y.com 38
- 39. CENTRIC RELATION • TOMOGRAPHY • BASE PLATE WAX METHOD - Double thickness - guided closure - first tooth contact www.indiandentalacadem y.com 39
- 40. RELAXED LIP POSITION • CASUAL OBSERVATION www.indiandentalacadem y.com 40
- 41. Facial keys to orthodontic diagnosis and treatment planning: PART 2 - W. Arnett, T. Bergman AJODO 1993 MAY I. Frontal view a.. Relaxed lip b. Functional analysis 1. Closed lip 2. Smile II. Profile a. Relaxed lip www.indiandentalacadem y.com 41
- 42. Frontal view Outline form & symmetry Height : width • Females – 1.3 : 1 • Males - 1.35 : 1 Asymmetry Common sites – chin, gonial angles, & cheek bones www.indiandentalacadem y.com 42
- 43. Facial level • • • • Pupil plane Upper dental arch Lower dental arch Chin- jaw line constructed frontal horizontal reference line www.indiandentalacadem y.com 43
- 44. Midline arrangements Uppermost condyle position and first tooth contact Soft tissue landmarks • Nasal bridge • Nasal tip • Philtrum • Chin point Dental land marks • Upper incisor midline • Lower incisor midline www.indiandentalacadem y.com 44
- 45. Frontal vertical facial relations Facial one thirds www.indiandentalacadem y.com 45
- 46. Long face problems Vertical maxillary excess www.indiandentalacadem y.com 46
- 47. Long face problems Increased chin height www.indiandentalacadem y.com 47
- 48. Short face problems Short vertical chin height www.indiandentalacadem y.com 48
- 49. Lower one third evaluation Relaxed position Upper lip : lower lip = 1:2 Upper lip 19 – 22mm Short upper lip ( 18mm or less ) • Increased interlabial gap • Incisor exposure Lower lip 38 – 44mm • Anatomic short lower lip – class II malocclusions • Secondary to posture www.indiandentalacadem y.com • Anatomic long lower lip – class III malocclusions 49
- 50. Lower one third evaluation Upper tooth to lip relation Normal range is 1-5mm women show more within this range Disharmony is due to 1. 2. 3. 4. Upper lip length Lower lip length Thickness of the lips The angle of the view www.indiandentalacadem y.com 50
- 51. Incisor to lip relations Interlabial gap Lip incompetence • Short philtrum/anatomic short upper lip • Vertical maxillary excess • Excessive overjet – upper lip blocks the lower lip www.indiandentalacadem y.com 51
- 52. Lower one third evaluation Closed lip position Mentalis contraction, lip strain, alar base narrowing www.indiandentalacadem y.com 52
- 53. Smile position with lip level • 2mm of gingival exposure • If the patient has normal crown exposure at repose and gummy smile maxilla should not be impacted • The gingival smile is never treated to ideal at the expense of underexposing the incisors in the relaxed lip position www.indiandentalacadem y.com 53
- 54. Incisor to lip relations Anesthetic reverse resting maxillary lip line www.indiandentalacadem y.com 54
- 55. Incisor to lip relations Commissure height A line connected from the alar bases through subspinale is perpendicular to the commissural Line Drooping of commissures - ageing, facial jowling www.indiandentalacadem y.com 55
- 56. Incisor to lip relations Maxillary lip to upper incisor at rest Age differentials Excess incisor show at rest • • • • Short upper lip Vertical maxillary excess Excessive crown height Detorqued max. incisors www.indiandentalacadem y.com 56
- 57. Incisor to lip relations Inadequate incisor show at rest • • • • Excessive upper lip height Vertical max. deficiency Inadequate crown height Flared maxillary incisors Dental characteristic of ageing is to show less upper incisor exposure and more lower incisor exposure www.indiandentalacadem y.com 57
- 58. Inadequate incisor show in growing patient www.indiandentalacadem y.com 58
- 59. Incisor to lip relations Gingival display on smile Gummy smile • • • • • Short philtrum Vertical max. excess Excessive curtain on smile Gingival hyperplasia Upright max.incisors www.indiandentalacadem y.com 59
- 60. Incisor to lip relations Crown length Vertical height of max. central incisors Adults Children - 9-12mm (males ) 9.5mm (females ) 4.5 mm www.indiandentalacadem y.com 60
- 61. Incisor to lip relations Lip incompetence in children www.indiandentalacadem y.com 61
- 62. Incisor to lip relations Periodontal contribution in adolescents - kokich Gingival margin is 1mm coronal to the Cemento-enamel junction www.indiandentalacadem y.com 62
- 63. Incisor to lip relations Excessive smile curtain www.indiandentalacadem y.com 63
- 64. Incisor to lip relations “Smile arc” Consonant smile arc Nonconsonent smile arc www.indiandentalacadem y.com 64
- 65. Incisor to lip relations Flattening of the smile due to attrition of incisors www.indiandentalacadem y.com 65
- 66. Incisor to lip relations Inadequate incisor show on smile • Long philtrum height • Vertical max. deficiancy • Inadequate smile curtain • Flared max. incisors • Diminished dento alveolar development Secondary to thumb sucking habit www.indiandentalacadem y.com 66
- 67. Incisor to lip relations Diminished lip mobility due to low frenal attachment www.indiandentalacadem y.com 67
- 68. Incisor to lip relations Assessment of “negative space” www.indiandentalacadem y.com 68
- 70. Soft tissue Profile angle General harmony of the forehead, mid face, and lower face Class I occlusion – 1650 to 1750 Extremes of the angle are usually due to skeletal disharmony www.indiandentalacadem y.com 70
- 71. Lower face analysis on profile view www.indiandentalacadem y.com 71
- 72. Profile view Nasolabial angle • Range is 850 – 1050 ( 1000) • Females show more obtuse angle • Indicate the position of the maxillary teeth and the contour of the lower border of the nose www.indiandentalacadem y.com 72
- 74. Profile view Factors to be considered in treatment plan • • • • • • Existing angle Estimation of the lip tension Antero-posterior lip thickness Magnitude of the mandibular retrusion Extraction versus non-extraction Surgical movement of the maxilla Maxillary setback – nasal elongation, alar base depression, opening of the nasolabial angle ( premature ageing ) www.indiandentalacadem y.com 74
- 75. Profile view Maxillary sulcus contour • Gently curved • upper lip tension www.indiandentalacadem y.com 75
- 76. Profile view Mandibular sulcus contour Deeply curved - class II, vertical maxillary deficiancy www.indiandentalacadem y.com 76
- 77. Profile view Orbital rim • Anteroro-posterior indicator of Maxillary position • The globe is positioned 2-4mm anterior to the orbital rim www.indiandentalacadem y.com 77
- 78. Cheek bone contour Deficient in combination with maxillary retrusion www.indiandentalacadem y.com 78
- 79. Profile view Nasal base lip contour Mand. Protrusion Max.Retrusion www.indiandentalacadem y.com 79
- 80. Nasal & paranasal relations www.indiandentalacadem y.com 80
- 81. Profile view Nasal projection Subnasale to nasal tip Normal is 16-20mm Important in contemplating anterior movement of the maxilla www.indiandentalacadem y.com 81
- 82. Profile view Throat length & contour Neck throat junction soft tissue menton Mandibular setback is contraindicated in case of a short, sagging neck www.indiandentalacadem y.com 82
- 83. Lower face analysis on profile view Chin neck angle www.indiandentalacadem y.com 83
- 84. Lower face analysis on profile view Labiomental sulcus www.indiandentalacadem y.com 84
- 85. Profile view Subnasale –pogonion line - Burstone Upper lip – 3.5+/- 1.4mm Lower lip - 2.2+/- 1.6mm www.indiandentalacadem y.com 85
- 86. Transverse facial & dental proportions Rule of fifths Middle fifth of the face www.indiandentalacadem y.com 86
- 87. Transverse facial & dental proportions The middle fifth of the face The distance between 2 inner canthi of the eye www.indiandentalacadem y.com 87
- 88. Transverse facial & dental proportions The medial fifths of the face A line from outer canthus of the eyes should be coincident with the gonial angles of the mandible www.indiandentalacadem y.com 88
- 90. Transverse facial & dental proportions The outer fifth of the face outer canthus of the eye to the helix of the ear www.indiandentalacadem y.com 90
- 92. Transverse facial & dental proportions Transverse nasal proportions 3 major categories of nasal features - Forman & Bell 1. Leptorrhine 2. Mesorrhine 3. Platyrrhine www.indiandentalacadem y.com 92
- 93. Transverse facial & dental proportions Leptorrhine – Long narrow nose ( whites ) www.indiandentalacadem y.com 93
- 94. Transverse facial & dental proportions Mesorrhine – lack of columellar support & dorsal height ( Asians ) www.indiandentalacadem y.com 94
- 95. Transverse facial & dental proportions Platyrrhine – Broad, flat nose ( blacks ) www.indiandentalacadem y.com 95
- 96. Asymmetry – facial and dental Etiologies • • • • • • Congenital malformations Environmental factors Functional Tumours of hard & soft tissues Condylar pathology Masseteric hypertrophy www.indiandentalacadem y.com 96
- 97. Systematic evaluation of dental & facial asymmetry • Nasal tip to midsagittal plane • Maxillary dental midline to midsagittal plane • Max.dental midline to mand.dental midline • Mand. Dental midline to midsymphysis • Midsymphysis to mid sagittal plane www.indiandentalacadem y.com 97
- 98. Systematic evaluation of dental & facial asymmetry Nasal tip to midsagittal plane The position of the nasal tip is best evaluated by having the patient elevate the head slightly and visualizing the position of the tip to the midsagittal plane Maxillary dental midline to midsagital plane Deviations of the maxillary dental midline from the midsagittal plane www.indiandentalacadem y.com 98
- 99. Maxillary dental midline to mid sagittal plane • Dental midline discrepancy • Max. rotation www.indiandentalacadem y.com 99
- 100. A METHOD TO CHECK MAXILLOMANDIBULER ASYMMETRY www.indiandentalacadem y.com 100
- 101. Maxillary dental midline to mandibular dental midline Midsymphysis to midsagittal plane • True mandibular asymmetry • Functional shift & mandibular asymmetry Lateral shift is not indicative of true mandibular asymmetry but the transverse maxillary deficiency www.indiandentalacadem y.com 101
- 102. Maxillo- madibular asymmetry Transverse cant of the maxilla – canine show www.indiandentalacadem y.com 102
- 104. Chin asymmetry Measurement of the midsymphysis to the midsagittal plane www.indiandentalacadem y.com 104
- 106. Radiographic analysis • Hand wrist radiographs • Lateral cephalograms • Postero- anterior / frontal cephalograms • TMJ radiographs www.indiandentalacadem y.com 106
- 107. Analysis of hand wrist radiograph • To estimate the patient’s skeletal age • poor correlation with jaw growth www.indiandentalacadem y.com 107
- 108. Radiographic analysis Lateral cephalograms • Relationship of the jaws to the cranium • Relationship of the both the jaws • Relationship of the teeth to the jaw bases www.indiandentalacadem y.com 108
- 109. Radiographic analysis Postero-anterior films Vertical lines – transverse asymmetries Horizontal planes - vertical position of structures Different analyses • Rickett’s analysis • Grummons analysis • Grayson’s analysis • Hewittt’ analysis • Chierici’ method www.indiandentalacadem y.com 109
- 111. Cast analysis Casts in occlusion • Antero-posterior • Vertical • Transverse Class I canine relation www.indiandentalacadem y.com 111
- 112. Special considerations • Surgical possibilities • Logical sequence in planning surgical orthodontic treatment • Techniques of prediction www.indiandentalacadem y.com 112
- 113. Treatment planning Surgical possibilities – transverse plane changes in the width of the maxilla I0 mm of average changes www.indiandentalacadem y.com 113
- 114. Surgically assisted orthopedic expansion • RME screw should be placed immeadiately after osteotomy to enhance the orthopedic force • Osteotomy through the lateral maxilla, including the separation at pterigomaxillary region www.indiandentalacadem y.com 114
- 115. Mandible 2 major limitations 1. Soft tissue envelope 2. Temporo-mandibular joint www.indiandentalacadem y.com 115
- 116. Antero-posterior & vertical changes of the maxilla Forward movement – 10mm Upward movement – 10 to 15mm www.indiandentalacadem y.com 116
- 117. Limitations of forward Movement 1.Upper lip 2.Velopharyngeal Closure Upward movement www.indiandentalacadem y.com 117
- 118. Backward movement • Very limited movement ( 3-5mm ) Downward movement • Technically possible but anatomically less stable • Interpositional bone grafts provide mechanical stability • Stretch of the soft tissues www.indiandentalacadem y.com 118
- 119. Mandible • Any movements but not downward movements at Gonial region • Mandibular plane changes • Soft tissue stretch • Condylar position in the fossa www.indiandentalacadem y.com 119
- 120. Implications of incomplete growth • Growth following surgery • Need for second surgery • Early surgery is contraindicated for excess growth www.indiandentalacadem y.com 120
- 121. Logical sequence of treatment planning • Pathologic versus developmental problems • Pathologic - chronic systemic diseases - local conditions - psychologic conditions www.indiandentalacadem y.com 121
- 122. • Prioritizing the developmental problem list • Orthodontic risks • Surgical risks - Predictable sequelae - Unanticipated complications - Catastrophic events www.indiandentalacadem y.com 122
- 123. CEPHALOMETRIC PREDICTION Manual prediction • Tracing overlay method • Moving templates Computer prediction www.indiandentalacadem y.com 123
- 124. Tracing overlay method • Simplest way to simulate the effects of the mandibular surgery • Limited to surgery that does not affect the vertical position of the maxilla www.indiandentalacadem y.com 124
- 127. Template method • Intermediate tracings • Used for any kind of prediction • Time consuming www.indiandentalacadem y.com 127
- 134. Advantages • Patient counseling • Comparison of diff. Treatment plan options • Less risk of post operative dissatisfaction Disadvantages • Dental relations are unknown • Distortions with some soft wares www.indiandentalacadem y.com 134
- 136. Classification • Ramus osteotomies vertical subsigmoidal osteotomy sagittal split oteotomy inverted ‘L’ & ‘C’ osteotomies condylectomy • Osteotomies of the body of the mandible • Segmental procedures • Genioplasties www.indiandentalacadem y.com 136
- 137. Ramus osteotomies • To move the whole arch • Best for large movements • Both extraoral & intraoral approaches www.indiandentalacadem y.com 137
- 138. Ramus osteotomies Vertical subsigmoid osteotomy www.indiandentalacadem y.com 138
- 139. Ramus osteotomies Sagittal split osteotomy www.indiandentalacadem y.com 139
- 140. Ramus osteotomies Inverted ‘L’ osteotomy www.indiandentalacadem y.com 140
- 143. Body osteotomies • In cases where satisfactory dental relations are to be established • Short bodies, Asymmetries, Open bite • Changes in arch width www.indiandentalacadem y.com 143
- 144. Segmental & symphyseal osteotomies Total subapical osteotomy www.indiandentalacadem y.com 144
- 148. Segmental surgery Single tooth osteotomies www.indiandentalacadem y.com 148
- 152. In open bite cases www.indiandentalacadem y.com 152
- 156. Mandibular deficiency - Short face Extra-oral • • • • • Well developed chin button Low mandibular plane angle Square gonial angles Lack of prominence of lips Curled or elevated lower lip Intra-oral • • • • Class II molar & canine relation Increased overjet Anterior deep bite Excessive curve of spee www.indiandentalacadem y.com 156
- 157. Mandibular deficiencyTreatment planning • Preadolescents with growth potential - Bite opening - Functional jaw orthopedics - Eruption of the posterior teeth • Adolescents - Camouflage - Fixed functional appliance www.indiandentalacadem y.com 157
- 158. TREATMENT PLANNING FOR ADULTS • Camouflage • Surgery Short face – Subapical osteotomy - Ramus osteotomy www.indiandentalacadem y.com 158
- 159. TREATMENT PLANNING FOR ADULTS Mandibular vertical & antero-posterior deficiency www.indiandentalacadem y.com 159
- 160. TREATMENT PLANNING FOR ADULTS Chin prominence – Genioplasty with angulated osteotomy www.indiandentalacadem y.com 160
- 161. MANDIBULAR DEFICIENCY- LONG FACE Extra-oral • • • • Excessive ant.face height Lip incompetence Skeletal class II malocclusion Hypo-plastic upper lip Intra oral • • • • • • Class II malocclusion Crowding in the lower Over eruption of posterior teeth Tendency towards ant.open bite Narrow maxilla & posterior cross bite www.indiandentalacadem Tipping of palatal plane down posteriorly y.com 161
- 162. .Treatment planning – adults Decreasing the lower face height • Superior positioning of the maxilla ( LeFort I total / Segmental osteotomy ) • Mandibular surgery ( Ramus osteotomy ) • Superior repositioning of the chin ( Inferior border osteotomy ) www.indiandentalacadem y.com 162
- 166. Class III problems • More mand. Growth than normal • Growth continues after adolescence longer than Normal Heavy forces for longtime wear – Restrict maxillary growth Shorter periods of wear - Rotation the mandible down & back www.indiandentalacadem y.com 166
- 167. Class III problems Maxillary deficiency – Face mask therapy Age- 8 yrs or children Patients with transverse discrepancy - RME www.indiandentalacadem y.com 167
- 168. Class III problems Surgical camouflage - Reduction genioplasty • Increase the face height • Flassidity of soft tissue www.indiandentalacadem y.com 168
- 169. Class III problems Onlay grafts • Mid face deficiencies • Grafts in the paranasal, alar base and zygomatic areas www.indiandentalacadem y.com 169
- 170. Class III problems Maxillary versus maxillary surgery • Volume of the oral cavity • Unesthetic “Turkey gobbler” appearance Suction lipectomy www.indiandentalacadem y.com 170
- 171. Class III problems Timing of orthognathic surgery Excess mandibular growth Relapse tendencies Maxillary deficiency • Favorable maxillary growth • Prolonged mandibular growth www.indiandentalacadem y.com 171
- 173. Class III problems- cleft patients Bone grafts Timing of the graft – before the eruption of the tooth • To establish bone continuity • Acts as a matrix www.indiandentalacadem y.com 173
- 174. Class III problems - cleft patients Comprehensive orthodontics Secondary esthetic procedures 1. Nose-lip revision 2. Pharyngeal surgery • Compensation from lat. Pharyngeal wall • Enlarged tonsils www.indiandentalacadem y.com 174
- 175. Class III problems - cleft patients Orthognathic surgery After conclusion of active growth Maxillary surgery • Lip scars • Palatal scar • Cleft palate speech www.indiandentalacadem y.com 175
- 177. Dento facial asymmetry In preadolescent children Growth modification with asymmetric functional appliances ( hybrid appliances ) www.indiandentalacadem y.com 177
- 178. Dento facial asymmetry In adolescents Avoid surgery until adolescent growth spurt ends Ankylosed condyle Release of condyle from glenoid fossa www.indiandentalacadem y.com 178
- 179. Dento facial asymmetry In adults Can not be managed orthodontically or orthopedically • Ramus osteotomy • Maxillary surgery / asymmetric onlay grafts • Inferior border osteotomy www.indiandentalacadem y.com 179
- 180. References • Surgical orthodontic treatment - R.P.WHITE & W.R.PROFFIT • Esthetic orthodontics & orthognathic surgery - DAVID.M.SARVER • Surgical correction of dentofacial deformities – W.H.BELL, W.R.WHITE & R.P.PROFFIT • Orthodontics ; current principles & techniques – T.M.GRABER & R.I.VANARSDALL.Jr • Dentofacial deformities ; integrated orthodontic & surgical correction – B.N.EPKER & L.C.FISH www.indiandentalacadem • Contemporary orthodontics y.com PROFFIT – W.R. 180
- 181. References • Contemporary treatment of dentofacial deformity - R.P.WHITE.W.R.PROFFIT & DAVID.M.SARVER • A text book of oral surgery - MOORE • Introduction to orthognathic surgery – color atlas - J.P.REYNEKE & W.G.EVANS • LEE HELDT & ERNEST A.HAFFKE –The psychological and social aspects of orthognathic surgery - AMJ.ORTHOD vol.82, 1992 • G.W.ARNETT & ROBERT.T.BERGMAN – Facial keys to orthodontic diagnosis ; Part I - AJODO April, 1993 • G.W.ARNETT & ROBERT.T.BERGMAN – Facial keys to www.indiandentalacadem orthodontic diagnosis ; Part II – AJODO MAY, 1993 y.com 181
- 182. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacadem y.com 182