Trajectories and rotations /certified fixed orthodontic courses by Indian dental academy


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Trajectories and rotations /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Growth & Development of Nasomaxillary Complex Stress trajectories of force Maxillary rotations Clinical Implications of G & D of Nasomaxillary Complex
  3. 3. Stress Trajectories of Force “Function can influence the overall pattern and relationship of the structures”. Effect of function on bone was first noted in femur .
  4. 4. Stress Trajectories of Force In 1867 an anatomist named Meyer with the help of the mathematician Culmann propounded Trajectorial theory of Bone formation. Julius Wolff –1870 “Trabecular alignment in the bone was primarily due to functional forces”. ROUX-Law of transformation of bone.
  5. 5. Stress Trajectories of Force A change in the intensity and direction of these forces would produce a change in the internal architecture and external form of the bone. Change in the functional forces produce measurable changes in bony architecture.
  6. 6. Stress Trajectories of Force Benninghoff made an exhaustive study of the architecture of the cranial &facial skeleton and so called “Stress Trajectories” or “Lines of force” evolved.
  7. 7. 3 main vertical pillars of stress trajectories can be seen in the nasomaxillary region. a.Canine pillar b. Zygomatic pillar. c.Pterygoid pillar
  8. 8. Maxillary rotations Implant studies of jaw rotations were mainly carried out by Bjork & Skeiller in 1960’s Tantalum metallic pins were used Rotations are classified into Internal Rotation External Rotation
  9. 9. Maxillary rotations  Lateral implants:4yrs of age -inserted laterally in the zygomatic process of the maxilla.  Anterior implants:10-11yrs of age -inserted below the anterior nasal spine.
  10. 10. Lateral View
  11. 11. MAXILLARY ROTATIONS 1. Transverse Plane 2. Vertical Plane
  12. 12. Maxillary rotations Transverse mutual rotation of the two maxilla:-
  13. 13. Maxillary rotations Increase in width of the midpalatal suture is not same between anterior and posterior regions.As a result the two maxillae rotate in relation to each other in transverse plane.
  15. 15. Maxillary rotations Vertical rotation of the maxillary complex:-. -Downward and forward displacement of maxilla during growth are associated with vertical rotation Bjork & Skeiller.
  16. 16.
  17. 17. “Interaction between Jaw growth & Tooth eruption.” Translocation True Eruption
  18. 18. Clinical Implications of Maxillary Growth. Cessation of growth of maxilla is in the following order:-Transverse direction -Anteroposterior plane -Vertical direction.
  19. 19. Transverse Growth of Maxilla Growth in width is the first one to drop to the adult levels [by onset of puberty]. Deficiency in the transverse growth of maxilla causes decrease in the width of palate leading to crossbite.
  20. 20. Crossbites Skeletal Dental
  21. 21. . RAPID MAXILLARY EXPANSION Circummaxillary sutures. 1. Nasomaxillary Suture 2. Frontomaxillary Suture 3. Zygomaticomaxillary Suture 4. Lacrimomaxillary Suture 5. Ethmoidomaxillary Suture 6. Vomeromaxillary Suture
  22. 22. Structure of the suture at different ages: Infancy Juvenile Adulthood
  23. 23. Activation of RME. Upto 15yrs of age 1800 (2 turns daily) 15-20yrs. of age 1800 (4 turns daily) Over 20yrs. 900 (2 turns daily)
  24. 24. How much to Expand? Palatal cusps of upper maxillary teeth should occlude with the lingual inclines of the buccal cusps of the lower mandibular teeth.
  25. 25. Effects of RME:-Midpalatal suture opens anteroinferiorly. -Midline diastema. -Buccal flaring of posteriors.
  26. 26. Frontal View
  27. 27. Ideal patients for RME treatment.  Full cusp cross bite with a skeletal component  Some degree of dental as well as skeletal constriction initially  No pre-existing dental expansion.
  28. 28. Adverse effects of RME:Nasal hump & paranasal swelling. Pain. Buccal tipping of posteriors. Root resorption.
  29. 29.
  30. 30. Rapid maxillary expansion Vs slow expansion
  31. 31. Dental cross bites are corrected by -Quad helix -W arch -Arch wire
  32. 32. Anteroposterior growth of maxilla. Maxillary excess:-For restriction of maxillary growth in growing individuals appliances like 1.Headgear 2.Functional appliances
  33. 33.
  34. 34. Types of Head Gears:Cervical head gear: used in patients with horizontal growth pattern with reduced lower facial height.
  35. 35. Types of head gear’s Occipital pull Head gear:Used in long face patients with high mandibular plane angle.
  36. 36. Functional Appliances They are of two types:-Removable -Fixed Appliances.
  37. 37. Removable Appliances: Bionator Activator Twin Block
  38. 38. Fixed Appliances:- Herbst Appliance Jasper Jumper
  39. 39. Dental camouflage can be done for mild to moderate skeletal problems. For adult patients where growth is no longer present surgical correction should be done.
  40. 40. Maxillary Deficiency:-Growth modulation in sagittal plane can be done by 1.face mask 2.reverse functional appliances.
  41. 41. Face mask Therapy Delaire Facemask
  42. 42. Face mask Therapy Petit Face mask
  43. 43.
  44. 44.
  45. 45. Reverse Functional appliances: Twin Block Functional Regulator
  46. 46. Vertical growth of maxilla Vertical excess of maxilla can be controlled by inhibiting the descent of maxilla and eruption of posterior teeth.
  47. 47. Frequent respiratory infection Nasal Septal deviation Swollen Nasal Mucosa Enlarged adenoids Contracted Maxillary arch Reduced Nasal breathing Decrease in Nasal width Mouth breathing Lowered tongue position Extended head posture Lowered Mandibular Posture
  48. 48. Hierarchy of effectiveness in long-face class II treatment HP headgear to functional appliance ht Bite blocks on functional appliance High-pull headgear to maxillary splint High-pull headgear to molars.
  49. 49. -Highpull headgear to a maxillary splint
  50. 50. Highpull headgear to a functional appliance.
  51. 51. Functional appliance with increased height of the bite blocks
  52. 52. Bibliography:Contemporary orthodontics -William Proffit Orthodontic principles &practice -T.M.Graber Essentials of facial growth - Enlow Factors affecting the growth of mid face - James Mc Namara Rapid maxillary expansion - Donald J. Timms
  53. 53. Thank you For more details please visit