Adult orthodontics 2

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Adult orthodontics 2

  1. 1. ADULT ORTHODONTICS www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. -What is adult? - history of adult orthodontics. - Reasons for increase interest of adults in orthodontic treatment. - Indication - Contraindications. - Difference between adult and adolescent patients. www.indiandentalacademy.com
  3. 3. Adult is defined as one who is fully grown,most males 18 and above and most females of 16 and above can be considered to be adult,although residual growth is left. It is however quite impractical to determine the exact time when adulthood begins. www.indiandentalacademy.com
  4. 4. HISTORY: - Kingsley, in 1880,indicated an early awareness regarding orthodontic potential in adult patient. - He stated, “It may be regarded as settled fact that there are hardly any limits to the age when movement of teeth might not succeed.” www.indiandentalacademy.com
  5. 5. Acc. To MacDowell(1901), after the age of 16 years, a complete and permanent change in transition of the occlusion is almost impossible owing to the development of, - adult glenoid fossa, - density of the bones , - muscles of mastication. www.indiandentalacademy.com
  6. 6. In 1921 Calvin Case demonstrated the value of orthodontic therapy for the patient with pyorrhea in the lower anterior area. www.indiandentalacademy.com
  7. 7. Adult orthodontics:- Acc. To Ackerman, “adult orthodontics is concerned with striking a balance between achieving optimal proximal and occlusal contact of the teeth,acceptable dentofacial aesthetics, normal function and reasonable stability.” www.indiandentalacademy.com
  8. 8. Reasons for the increased interest by orthodontists in the adult as a patient and vice versa. 1) Improved appliance placement techniques. www.indiandentalacademy.com
  9. 9. 2) Better management of joint dysfunction. 3) More effective management of skeletal jaw dysplasias with advanced orthognathic surgical techniques. www.indiandentalacademy.com
  10. 10. 4) Increased desire of patients and restorative dentists for treatment of dental mutilation problems using tooth movement and fixed restorations rather than removable prostheses. 5) Reduced vulnerability to periodontal breakdown as a result of improved tooth relationships and occlusal functions. www.indiandentalacademy.com
  11. 11. 6) Role of media, visual as well as print articles in magazines ,news paper as well as community programs have increased patient awareness. 7) A broader understanding of the biology of the tooth movement,esp. with regard to age changes. 8) Ingenious approaches to anchorage management such as implants. www.indiandentalacademy.com
  12. 12. INDICATIONS: (BY RAVINS) 1) Improvement of tooth-periodontal tissue relationship. 2) Establishing an improved plane of occlusion to distribute the forces of occlusion better. 3) Balancing the existing space for better prosthetic replacement. 4) Improve occlusion and coordination between the muscle and TMJ. 5) improve patient esthetic.www.indiandentalacademy.com
  13. 13. CONTRAINDICATIONS: (BY BARRER) 1) Severe skeletal discrepancies. 2) Advanced local or systemic disease. 3) Excessive alveolar bone loss. 4) Poor stability prognosis. 5) Lack of patient motivation. www.indiandentalacademy.com
  14. 14. But mark and cosrn disagree with this list except for systemic disease and lack of patient motivation. www.indiandentalacademy.com
  15. 15. DIFFERENCE B/W ADOLESCENT AND ADULT ORTHODONTIC PATIENT. Acc to levitt, “ in adult patient there is no growth and only tooth movement”. Acc to Barrer “ adult, unlike the child is a relentless patient, who will not cover our deficiencies in skills or our errors in the use of mechanical procedures by helpful settling in post-treatment.”www.indiandentalacademy.com
  16. 16. Acc to Ackerman. “ In a child ,one occasionally calls on another specialist. On the other hand it is rare adult whom one treats orthodontically without finding it necessary to collaborate with another specialist.” www.indiandentalacademy.com
  17. 17. FOUR MAJOR CATEGORIES IN WHICH ADULT PATIENT SIGNIFICANTLY DIFFER FROM THEIR ADOLESCENT COUNTERPART: 1) The diagnostic process. 2) Treatment plan selection. 3) Acceptance of recommended therapy. 4) Achievement of treatment objectives. www.indiandentalacademy.com
  18. 18. 1) THE DIAGNOSTIC PROCESS. Problem oriented dental record aides in making the appropriate diagnosis, for it requires that the patient’s problems be listed and a plan be developed to manage each problem. www.indiandentalacademy.com
  19. 19. DIAGNOSTIC STEPS:- 1) Collect data accurately. 2) Analyze data base. 3) Develop problem list. 4)Prepare tentative treatment plan. 5) Interact with those who are involved; discus plans and options; clarify sequence, acquire patient acceptance. 6) Create final treatment plan.www.indiandentalacademy.com
  20. 20. Before starting the treatment, the orthodontist needs to be prepared to do the following:- 1) Diagnose different stages of pdl disease and their associated risk factors. 2) Diagnose TMJ dysfunction before, during or after tooth movement. www.indiandentalacademy.com
  21. 21. 3) Determine which cases require surgical management and which one require incisor reangulation to camouflage the skeletal base discrepancy. 4)Work cooperatively with team of other specialists to give the patient the best outcome. www.indiandentalacademy.com
  22. 22. ADULT ORTHODONTIC TREATMENT OBJECTIVES: 1) Dentofacial aesthetics. 2) stomatognathic function. 3) Stability. 4) Achieving class 1 occlusion. www.indiandentalacademy.com
  23. 23. ADDITIONAL ORTHODONTIC TREATMENT OBJECTIVES:- 1) Parallelism of abutment teeth:- - Restoration will have better prognosis. - Allows for a better pdl response. - Allows for better retention. www.indiandentalacademy.com
  24. 24. 2) MOST FAVORABLE DISTRIBTION OF TEETH:- - Teeth should be positioned in such a way that occlusion of natural teeth can be established bilaterally between the arches. www.indiandentalacademy.com
  25. 25. 3) REDISTRIBUTION OF OCCLUSAL AND INCISAL FORCES:- - helpful in case of significant bone loss. 4) ADEQUATE EMBRESURE SPACE AND PROPRE ROOT POSITION:- - Allows for better pdl health. www.indiandentalacademy.com
  26. 26. 5) ACCEPTABLE OCCLUSAL PLANE AND POTENTIAL FOR INCISAL GUIDENCE AT SATISFACTORY VERTICAL DIMENSION. www.indiandentalacademy.com
  27. 27. 6) ADEQUATE OCCLUSAL LANDMARK RELATIONSHIP. 7) BETTER LIP COMPETECY AND SUPPORT:- - Inadequate support may create change in anteroposterior and vertical position of upper lip and increse wrinkling. www.indiandentalacademy.com
  28. 28. 8) IMPROVED CROWN/ROOT RATIO:- In case of individual teeth bone loss we can improve the crown to root ratio by decreasing length of clinical crowns tooth is erupted orthodontically. www.indiandentalacademy.com
  29. 29. 9) IMPROVEMENT OF MUCOGINGIVAL AND OSSEOUS DEFECTS:- - Proper positioning of teeth in arch will improve gingival topography. 10) BETTER SELF MAINTEINANCE OF PDL HEALTH:- - For better periodontal health tooth should be positioned properly over their basal bone support. www.indiandentalacademy.com
  30. 30. 11) ESTHETICS AND FNCTIONAL IMPROVEMENT. www.indiandentalacademy.com
  31. 31. 2) TREATMENT PLAN SELECTION: Factor affecting treatment plan selection:- 1) Existing oral pathology: - dental caries - periodontal disease - faulty restoration - TMJ. 2) Skeletal relationship. www.indiandentalacademy.com
  32. 32. 3) Biological consideration: - neuromuscular maturity. - periodontal susceptibility. - rate of tooth movement. - growth. 4) Therapeutic approach available: - functional appliances. - orthognathic surgery. - restorative dentistry. www.indiandentalacademy.com
  33. 33. 5) Extraction/nonextraction. 6) Anchorage requirement. 7) Missing teeth. www.indiandentalacademy.com
  34. 34. FACTOR AFFECTING THE PATIENT’S ACCEPTANCE OF THE TREATMENT PLAN:- 1) Sociobehavioral interaction: - Office environment - Staff training and selection - Team coordination 2) Duration of treatment. www.indiandentalacademy.com
  35. 35. 3) Cost of treatment. 4) Perceived risk/benefit ratio. 5) Appliance selection. 6) perceived value orthodontic treatment to dental providers consulted. 7) Negative condition. 8) Positive conditions. www.indiandentalacademy.com
  36. 36. FACTOR AFFECTING THE ACHIVEMENTS OF TREATMENT OBJECTIVES:- 1) Psychosocial behavioral orientation. 2) Previous medical history 3) Dental history. 4) Ability of the orthodontist to interface the treatment plan with those of other dental specialist. 5) skills and knowledge of orthodontist and staff. www.indiandentalacademy.com
  37. 37. 1) Psychosocial behavioral orientation: - patient cooperation with the prescribed therapy. - patient’s adaptation to orthodontic appliance. - Patient acceptance of the duration of the treatment.(fatigue factor) - Cost of the treatment. www.indiandentalacademy.com
  38. 38. 2) Previous medical history:- - Minimize force at TMJ in arthritis patient. - Patient with ulcerative colitis and psoriasis may be taking steroids. - Uncontrolled diabetic patient. - Patient receiving anticoagulant therapy. - Patient with hyperacidity can develop root caries during treatment. - Bacterial and hormonal changeswww.indiandentalacademy.com
  39. 39. - Patient with hyperacidity can develop root caries during treatment. - Bacterial and hormonal changes during 2nd trimester of pregnancy -Bacterial and hormonal changes during 2nd trimester of pregnancy can cause severe inflammation. www.indiandentalacademy.com
  40. 40. * Etiology of adult malocclusion. * Types of adult orthodontic patients. * Types of adult orthodontic treatment. * Adjunctive treatment: - Goals - Biomechanical considerations. - Timing and sequence. - Procedures carried out. www.indiandentalacademy.com
  41. 41. ETIOLOGY OF ADULT TOOTH MALPOSITION:- 1) DENTAL ORIGIN 2) SKELETAL ORIGIN www.indiandentalacademy.com
  42. 42. 1) DENTAL ORIGIN:- a) Faulty eruption from the normal functional position. b) Insufficient arch length. c) Excessive arch length. d) Prolonged retention of primary teeth. e) Ectopic eruption. www.indiandentalacademy.com
  43. 43. g) Prolonged finger and thumb sucking habits. h) Clenching and grinding. i) Improper swallow pattern with tongue thrusting. j) Effects of tongue pressure on the anterior teeth. www.indiandentalacademy.com
  44. 44. k) Macroglossia. l) Premature loss of deciduous teeth. m) Loss of permanent teeth. www.indiandentalacademy.com
  45. 45. 2) SKELETAL ORIGIN:- a) Cleft palate. b) Gross mediolateral disharmony of the craniofacial skeleton. www.indiandentalacademy.com
  46. 46. ADULT PATIENTS WHO NEED ORTHODONTIC TREATMENT CAN BE DIVIDED IN TO 2 GROUPS:- 1) YOUNGER ADULTS.( UNDER 35 OFTEN IN THEIR 20’S) 2) OLDER PATIENT IN THEIR 40’S AND 50’S. www.indiandentalacademy.com
  47. 47. 1) YOUNGER GROUP:- Goal:- Improve quality of life. www.indiandentalacademy.com
  48. 48. Reasons for not receiving orthodontic treatment early:- 1) Reluctant about treatment. 2) Were not aware of orthodontic treatment. 3) Parents could not afford. 4) Were not given proper advise by family dentist. 5) No orthodontist located in the vicinity. www.indiandentalacademy.com
  49. 49. 6) Improper ortho treatment when young or were uncooperative. 7) Had ortho treatment but relapse occurred. 8) More conscious of appearance with age. 9) Anterior teeth started to crowd or minor crowding becomes worse. www.indiandentalacademy.com
  50. 50. 2) OLDER PATIENTS:- Goal:- - Maintain proper dental health. - For the restorative purpose. www.indiandentalacademy.com
  51. 51.  Older patient mainly need treatment for:- 1) Malposed teeth contributing to pdl disease. 2) Increased difficulties in mastication. 3) Anterior space enlarging or developing. 4) For better tooth positioning prior to prosthetic preparation. 5) Tooth interference that may causes TMJ problems.www.indiandentalacademy.com
  52. 52. ACCORDING TO PROFFIT ADULT ORTHODONTIC TREATMENT IS DIVIDED IN TO 3 PARTS:- 1) ADJUNCTIVE TREATMENT. 2) COMPREHENSIVE TREATMENT FOR ADULTS. 3) SURGICAL TREATMENT. www.indiandentalacademy.com
  53. 53. DIFFERENCE BETWEEN ADJUNCTIVE TREATMENT AND COMPREHENSIVE TREAMTMENT IS INDISTINCT,AS ANY TREAMENT WHICH REQUIRE MORE THAN 6 MONTHS IS CALLED AS COMPREHENSIVE TREATMENT. www.indiandentalacademy.com
  54. 54. 1) ADJUNCTIVE TREATMENT:- “ Tooth movement carried out to facilitate other dental procedures necessary to control disease and restore function.” www.indiandentalacademy.com
  55. 55. GOALS :- 1) Facilitates restorative treatment by positioning the teeth. 2) Improve periodontal health by removing plaque harboring areas . 3) Establishing favourable crown to root ratio and position of the teeth. www.indiandentalacademy.com
  56. 56. BIOMECHANICAL CONSIDERATIONS:- - Control of anchorage requires that anchor teeth should not be allowed to tip. - Fixed appliance is necessary. www.indiandentalacademy.com
  57. 57. -Adult patients demand for removable appliance but they are not useful in adjunctive treatment. - But in case of multiple missing teeth removable appliance is useful. www.indiandentalacademy.com
  58. 58. Placement of brackets www.indiandentalacademy.com
  59. 59. - In case of reduce periodontal support and bone loss , lighter forces and relatively larger movements are needed. www.indiandentalacademy.com
  60. 60. TIMING AND SEQUENCE OF TREATMENT:- - Before any type of tooth movement any caries or pulpal pathology should be eliminated. - Larger restoration require detail occlusal anatomy should be carried out after orthodontic treatment is over. www.indiandentalacademy.com
  61. 61. - Periodontal disease should be controlled before any tooth movement. - Scaling, curettage and gingival graft should be carried out before treatment. - Surgical pocket elimination and osseous surgery should be carried out after orthodontic treatment. www.indiandentalacademy.com
  62. 62.  PROCEDURES CARRIED OUT IN ADJUNCTIVE TREATMENT : - 1) UPRIGHTING POSTERIOR TEETH. 2) FORCED ERUPTION. 3) ALIGNMENT OF ANTERIOR TEETH. 4) CROSSBITE CORRECTION. www.indiandentalacademy.com
  63. 63. UPRIGHTING POSTERIOR TEETH:- www.indiandentalacademy.com
  64. 64. 1) If third molar is present , whether both second and third molar should be uprighted. 2) Whether to upright tipped teeth by distal crown tipping or by mesial root movement. www.indiandentalacademy.com
  65. 65. www.indiandentalacademy.com
  66. 66. 3) Whether we need slight extrusion or maintain occlusal height during uprighting. 4) Whether premolar should be repositioned or not. www.indiandentalacademy.com
  67. 67. APPLIANCE FOR MOLAR UPRIGHTING:- - Partial fixed appliance. - Anchorage. - Placement of brackets on canine and premolars. www.indiandentalacademy.com
  68. 68. www.indiandentalacademy.com
  69. 69. UPRIGHTING A SINGLE MOLAR:- Moderately tipped molar:- - 17x25 braided s.s - 17x25 Ni-Ti  Severely tipped molar:- -19x25 s.s - Uprighting spring ( 17x25 beta- Ti) www.indiandentalacademy.com
  70. 70. • “ T-loop” - 17x25 s.s - 19x25 beta-Ti • Activation of T-loop. www.indiandentalacademy.com
  71. 71. • Severely tipped teeth:- - Use of modified T- loop. www.indiandentalacademy.com
  72. 72. • Final position of molars and premolars. • Use of open coil spring - steel - A Ni-Ti • Occlusion should be checked carefully. www.indiandentalacademy.com
  73. 73. RETENTION • For shorter period • For a longer period. - Intracoronal wire splint www.indiandentalacademy.com
  74. 74. www.indiandentalacademy.com
  75. 75. FORCED ERUPTION:- Indications:- - Defects in cervical third . www.indiandentalacademy.com
  76. 76. TREATMENT PLANING:- - Periapical radiograph. - Single tapering and flared and divergent root morphology. - Endodontic therapy. www.indiandentalacademy.com
  77. 77. How much tooth should be extruded can be determine by 3 factors:- 1) Location of the defect.(fracture line) 2) Space to place margin of the restoration.(1 mm) 3) An allowance for the biological width of the gingival attachment.(2 mm)www.indiandentalacademy.com
  78. 78.  Duration:- - 1mm/week without damaging pdl. - 3 to 6 week. www.indiandentalacademy.com
  79. 79. TECHANIQUE • Continuous flexible wire is contraindicated. www.indiandentalacademy.com
  80. 80. 2 METHODS • With orthodontic bracket. • Without orthodontic bracket. www.indiandentalacademy.com
  81. 81. • Brackets are placed more occlusally on anchor teeth than its ideal position. • T-loop, - 17x25 s.s - 19x25 beta-Ti www.indiandentalacademy.com
  82. 82. RETENTION:- - By passively fitting rectangular arch wire.(3 to 6 week). www.indiandentalacademy.com
  83. 83. ALIGNMENT OF ANTERIOR TEETH Indications:- 1) To improve access and permit placement of well contoured restorations. 2) To permit placement of crowns and pontics . www.indiandentalacademy.com
  84. 84. 3) To reposition closely approximated roots and to improve the amount of interradicular bone. 4) To position teeth so that implants can be placed to support restorations. www.indiandentalacademy.com
  85. 85. * Alignment of crowed, rotated and displaced incisors. * Separation of approximated teeth. www.indiandentalacademy.com
  86. 86. • Position teeth for single tooth implant:- - Minimum 6mm of space is require. - Apices of adjacent teeth. www.indiandentalacademy.com
  87. 87. Anterior diastema closure and space redistribution:- Causes:- - Loss of posterior teeth. - Small teeth. .- Loss of bone support. www.indiandentalacademy.com
  88. 88. TREATMENT:- - With Removable appliance. - With fixed appliance. www.indiandentalacademy.com
  89. 89. CROSSBITE CORRECTION:- - It can cause functional problem and occlusal trauma. - Single tooth crossbite. - Group of teeth in crossbite.(part of skeletal problem). www.indiandentalacademy.com
  90. 90. - Correction with removable appliances.(anterior segment) - Correction with the “through the bite” elastics.(posterior segment). www.indiandentalacademy.com
  91. 91. www.indiandentalacademy.com
  92. 92. SUMMARY:- There is wide variety of etiology that can cause an adult malocclusion. Also each patient’s need for treatment are different so treatment should be carried out taking his/her needs in consideration. Adjunctive treatment helps by facilitating other dental procedures to control disease and restore function. www.indiandentalacademy.com
  93. 93. PERIODONTAL ASPECT OF ADULT TREATMENT:- 1) Minimal periodontal involvement. 2) Moderate periodontal involvement. 3) Severe periodontal involvement. www.indiandentalacademy.com
  94. 94. 1) MINIMAL PERIODONTAL INVOVEMENT: - CHILDREN AND ADOLESCENT ARE LESS SUSEPTIBLE TO PERIODONTAL DISEASE THAN ADULTS. www.indiandentalacademy.com
  95. 95. 2) MODERATE PERIODONTAL INVOVEMENT: - All periodontal disease should be controlled before tooth movement. Fully bonded orthodontic appliance is preferred in periodontally involve adult patient. www.indiandentalacademy.com
  96. 96. Steel ligatures or self legating brackets are preferred. Periodontal maintenance therapy at 2-4 month interval. www.indiandentalacademy.com
  97. 97. 3) SEVERE PERIODONTAL INVOVEMENT: - Periodontal maintenance should be scheduled at more frequent intervals. Orthodontic goals and mechnics should be modified to keep force value minimum. www.indiandentalacademy.com
  98. 98. SPACE CLOSURE VS. PROSTHETIC REPLACEMENT: - Old extraction site: - Space closure is difficult in adult. The involvement of cortical bone tend to produce reciprocal space closure. Implant in the ramus can be use to provide necessary anchorage.www.indiandentalacademy.com
  99. 99. TOOTH LOST DUE TO PERIODONTAL DISEASE: - Unwise to move a teeth in area where bone is destroyed because of periodontal disease. www.indiandentalacademy.com
  100. 100. SURGICAL TREATMENT: - - orthognathic basically involves planned fracturing of the facial skeletal parts and reposition them as desired. - Moderate to severe skeletal discrepancy. - Patient education. www.indiandentalacademy.com
  101. 101. SURGICAL PROCEDURES: - 1) Correction of anteroposterior relationship: - both maxilla and mandible can be moved forward or backward for correction of jaw discrepancy. www.indiandentalacademy.com
  102. 102. A) MAXILLARY SURGERY: - The LeFort 1 downfracture procedure is used to reposition the maxilla. www.indiandentalacademy.com
  103. 103. www.indiandentalacademy.com
  104. 104. B) MANDIBULAR ADVANCEMENT:- - Bilateral saggital split osteotomy(BSSO) of the mandibular ramus. - stretching and retraction of the inferior alveolar nerve. www.indiandentalacademy.com
  105. 105. www.indiandentalacademy.com
  106. 106. C) MANDIBULAR SETBACK: - - BSSO. - The transoral vertical oblique ramus osteotomy(TOVRO). www.indiandentalacademy.com
  107. 107. 2) CORRECTION IN VERTICAL PLANE: - a) Maxillary surgery: - - LeFort 1 downfracture of the maxilla, with superior reposition of the maxilla. - In downward movement of the maxilla rigid fixation are used.(synthetic hydroxyapatite) www.indiandentalacademy.com
  108. 108. www.indiandentalacademy.com
  109. 109. b) Mandibular surgery: - mandibular ramus surgery in open bite cases avoided. Short face(skeletal deep bite) best treated by saggital split mandibular ramus surgery. www.indiandentalacademy.com
  110. 110. 3) CORRECTION OF TRANSVERSE RELATIONSHIP: - easy to move maxilla in transverse direction then mandible. www.indiandentalacademy.com
  111. 111. A) MAXILLARY EXPANTION: - Constriction or expantion done during course of Lefort 1 downfracture procedure. www.indiandentalacademy.com
  112. 112. GENIOPLASTY www.indiandentalacademy.com
  113. 113. RETENTION: - - More difficult in adult then in adolescent patient , - slower tissue turn over rate. - Normal functional adaptation occurs more when growth has been completed. - Reduce height of periodontium. www.indiandentalacademy.com
  114. 114. -Hawley retainer. - Hawley retained with tongue cribs. - fixed bonded retainer(max. and mand. Anterior segments) www.indiandentalacademy.com
  115. 115. Restorative retainers: - - composite restoration. - amalgam, inlay or onlay. - pontics (fixed/removable). www.indiandentalacademy.com
  116. 116. Periodontal surgical retention procedure: - Fibrotomy. - gingivectomy. www.indiandentalacademy.com
  117. 117. TREATMENT CONSIDERATIONS IN PATIENTS WITH TEMPOROMANDIBULAR DYSFUNTION www.indiandentalacademy.com
  118. 118. TMD as motivating factor for adult patient. Orthodontic treatment helps patient with TMD problems. www.indiandentalacademy.com
  119. 119. TMD symptoms can be divided in 2 groups: - - Internal joint pathology.(Arthritis) - Symptoms of muscle origin caused by spasm and fatigue of the muscle. www.indiandentalacademy.com
  120. 120. TEMPOROMANDIBULAR JOINT DISORDERS: - - Deviation in form. - Disk displacement. - TMJ hypermobility. - Dislocation. - Synovitis. - Capsulitis. www.indiandentalacademy.com
  121. 121. - Osteoarthritis. - Ankylosis. www.indiandentalacademy.com
  122. 122. ETIOLOGY Normal function + An event > Physiologic tolerance TMD symptoms www.indiandentalacademy.com
  123. 123. EVENTS: - 1) Local events: - - History of bruxism. - Trauma - Poorly aligned teeth. - Placement of improperly occluding crown. - Loss of posterior teeth.www.indiandentalacademy.com
  124. 124. Systemic events: - - Emotional stress. - Acc. To Han Selye “ Stress is a non specific response of the body to any demand made upon it.” Physiologic tolerance. www.indiandentalacademy.com
  125. 125. Clinical presentation: - - Pain at preauricular area or temple area or at ear when chewing or opening the mouth. - Pain may radiate to head, face or eye. www.indiandentalacademy.com
  126. 126. Behavioral changes like, - Avoiding wide opening of the mouth. - Patient prefers softer food. www.indiandentalacademy.com
  127. 127. OCCLUSAL STABILITY www.indiandentalacademy.com
  128. 128. HISTORY AND EXAMINATION FOR TMD - Questionnaire. - Orofacial pain history. www.indiandentalacademy.com
  129. 129. CLINICAL EXAMINATION • Nonmasticatory examination. • Masticatory examination. www.indiandentalacademy.com
  130. 130. Nonmasticatory examination • Cranial nerve examination. • Eye examination. • Ear examination. • Cervical examination. www.indiandentalacademy.com
  131. 131. Examination of optic nerve and oculomotor, trochlear and abducent nerve. www.indiandentalacademy.com
  132. 132. www.indiandentalacademy.com
  133. 133. www.indiandentalacademy.com
  134. 134. CERVICAL EXAMINATION www.indiandentalacademy.com
  135. 135. Masticatory examination • Muscle examination. • TMJ examination. • Dental examination. www.indiandentalacademy.com
  136. 136. MUSCLE EXAMINATION www.indiandentalacademy.com
  137. 137. www.indiandentalacademy.com
  138. 138. MASSETER MUSCLE EXAMINATION www.indiandentalacademy.com
  139. 139. STERNOCLIEDOMASTOID MUSCLE www.indiandentalacademy.com
  140. 140. PALPATION OF TMJ www.indiandentalacademy.com
  141. 141. www.indiandentalacademy.com
  142. 142. • Maximum interincisal distance. • Lateral and protrusive movement. • Opening pathway of mandible. www.indiandentalacademy.com
  143. 143. www.indiandentalacademy.com
  144. 144. TREATMENT OF TMD • Control of myofacial pain. • Treatment of TMJ. www.indiandentalacademy.com
  145. 145. Three approaches to control myofascial pain: - 1) Reducing the amount of stress. 2) Reducing the patient’s reaction to the stress. 3) Improving the occlusal relationship.www.indiandentalacademy.com
  146. 146. Treatment of TMJ disorders: - 1) Definitive treatment. 2) Supportive treatment. www.indiandentalacademy.com
  147. 147. Definitive treatment: - 1) Occlusal therapy: - - Reversible occlusal therapy. - Irreversible occlusal therapy. 2) Emotional stress therapy. www.indiandentalacademy.com
  148. 148. 2) Supportive therapy: - a) Pharmacological therapy: - - Analgesics - NSAIDs - Corticosteroids - Muscle relaxants - Local anesthetics. www.indiandentalacademy.com
  149. 149. b) Physical therapy: - - Thermotherapy. - Coolant therapy. - Ultrasound therapy. - Iontophoresis. - Electrogalvenic stimulation therapy. www.indiandentalacademy.com
  150. 150. -Transcuteneous electrical nerve stimulation. - Acupuncture. www.indiandentalacademy.com
  151. 151. OCCLUSAL APPLIANCE THERAPY • It is a removable device, usually made up of hard acrylic that fits over the occlusal and incisal surfaces of the teeth in one arch , creating precise occlusal contact with the teeth of the opposing arch. www.indiandentalacademy.com
  152. 152. www.indiandentalacademy.com
  153. 153. TYPE OF OCCLUSAL APPLIANCES • STABILIZATION APPLIANCE • ANTERIOR POSITIONING APPLIANCE • ANTERIOR BITE PLANE • POSTERIOR BITE PLANE • PIVOTING APPLIANCE • SOFT OR RESILIENT APPLIANCE www.indiandentalacademy.com
  154. 154. STABILIZATION APPLIANCE • Muscle relaxation appliance • Fabricated on maxillary arch • Indicated in patient with muscle hyperactivity. e.g. bruxism www.indiandentalacademy.com
  155. 155. - Fabrication of appliance. - Locating the musculoskeletally stable position. - Developing occlusion. www.indiandentalacademy.com
  156. 156. www.indiandentalacademy.com
  157. 157. www.indiandentalacademy.com
  158. 158. www.indiandentalacademy.com
  159. 159. FINAL CRITERIA FOR STABILIZATION APPLIANCE • Appliance must accurately fit the maxillary teeth. • In centric relation all posterior mandibular buccal cusp must contact on flat surface with even force. • In any lateral movement only mandibular canines should exhibit contact on the appliance. • It should polished.www.indiandentalacademy.com
  160. 160. ANTERIOR REPOSITIONING APPLIANCE • It is an interocclusal devise that encourages the mandible to assume a position more anterior then the intercuspal position. • Mainly used to treat disc derangement disorders. www.indiandentalacademy.com
  161. 161. Locating the correct anterior position • Anterior stop is constructed. • Joint symptoms are evaluated. www.indiandentalacademy.com
  162. 162. www.indiandentalacademy.com
  163. 163. Sometime orthodontic treatment becomes more complicated by previous splint therapy for TMD problems. www.indiandentalacademy.com
  164. 164. The moment of truth for TMD symptoms comes after orthodontic treatment is completed, when clenching and grinding that originally caused the problem tend to recur. www.indiandentalacademy.com
  165. 165. LIMITATION IN ADULT ORTHODONTIC TREATMENT: - 1) INTRINSIC. 2) EXTRNSIC. www.indiandentalacademy.com
  166. 166. 1) INRINSIC: - - Adults are no longer growing. - PDL status. www.indiandentalacademy.com
  167. 167. ACCORDING TO CHASENS, ORTHODONTIC TREATMENT SHOULD BE AVOIDED IN FOLLOWING CLINICAL SITUATIONS: - 1) Incontrolled inefection and inflammation. 2) Inadequate retention is present. www.indiandentalacademy.com
  168. 168. 3) Lack of patient motivation and cooperation. 4) Systemic problems which cannot be treated or difficult to control. www.indiandentalacademy.com
  169. 169. SUMMARY:- There is wide variety of etiology that can cause an adult malocclusion. Also each patient’s need for treatment are different so treatment should be carried out taking his/her needs in consideration. Adjunctive treatment helps by facilitating other dental procedures to control disease and restore function. www.indiandentalacademy.com
  170. 170. TMD serves as one of the motivating factors for adult patient to visit orthodontist. Relief of pain by providing adequate TMJ therapy motivates patient to undergo the remaining restorative or orthodontic treatment. www.indiandentalacademy.com
  171. 171. THANK YOU www.indiandentalacademy.com For more details please visit www.indiandentalacademy.com

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