Early diagnosis in orthodontics

Early Diagnosis
www.indiandentalacademy.com

Hereditary malocclusion

Abnormal Facial proportions

Deficient maxilla
Prognathic mandiblewww.indiandentalacademy.com

Visual Treatment Objective

Visual Treatment
Objective

Growth Directions
Growth at the Maxillary sutures produces an
increase in distance from Nasion to anterior
nasal spine.
This moves the Maxillary molars and
posterior nasal spine to move away from the
base of the skull.
Growth at the posterior alveolar process
causes the molar teeth to move away from
the palatal plane.
Growth at the mandibular posterior alveolar
process causes the molars to move
occlusally.

Animation

Distal Step

Skeletal Problems
Class II. M.O. can develop due to:-
Prognathic Maxilla with normal
mandible
Retrognathic Mandible with normal
maxilla
Combinations.

GROWTH MODULATION
Growth ModulationGrowth Modulation
Growth Modulation

Management of Maxillary
Prognathism
By extra oral traction- Facebow attached to
splint or upper molar bands.
Head gear force of 450 to 550 gms and
should be worn 14 hrs a day.
Cervical pull head gear:- Indicated in
patients with decreased vertical dimension.
Outer bow lies above plane of occlusion to
direct force through center of resistance
and prevent distal tipping of molars.

Head Gears
High Pull Cervical
Pull
Medium Pull

Bio-Mechanical Principles
of Head Gears

High Pull Head Gear
Indicated in patients with increased
vertical dimension.
Face bow is anchored to an
occipital anchoring unit to produce
vertically directed force.
High pull head gear can decrease
vertical growth of maxilla thus
allowing auto rotation of mandible.

Head Gear (contd)
Mauric Firouz & Ravindra Nanda
have demonstrated,when force is
directed at the level of trifurcation
of maxillary molars significant
distal movement and intrusion of
molars was achieved.
Medium pull head gear is indicated
in average angle cases.

Maxillary
intrusion
splint

Management of Mandibular
Deficiency
Functional appliances forms the main
stay for treatment of mandibular
deficiency in growing children.
Criteria for case selection.
Individuals with growth potential.
Retrognathic mandible.
Deep bite.
Horizontal Growth Pattern.

Removable Functional Appliances
Bite plate-Norman
Kingsley-1879.
Monoblock-Pierre Robin-
1902
Activator-Viggo Anderson-
1908
Bimler appliance-Bimler-
1949
Kinetor-Stockfish-1951
Herren activator-Herren-
1953
Bow activator-Schwarz-
1956
Bionator-Balters-1956
Elastic open activator-
Klammt-1960
Modified activator-
Harvold-Woodside-1963
Cybernator-Schmuth-1963
U’Bow activator-
Karwetsky-1964
F/regulator-Frankel-1966
Palate free activator-
Metzelder-1968
Propulsor-Muhlemamm-
1974
Twin block-Clark-1977
Functional Magnetic
system-1989
Mandibular growth
advancer-Yokata-1993

Activator
Harvold -Woodside
Activator
Klammt’s E.O.A
Hamilton’s Bonded activator

Twin Block
Bionator Functional regulator II
MGAwww.indiandentalacademy.com

Fixed Functional Appliances
Herbst appliance-Emil Herbst-Popularised
by Pancherz-1979.
Herbst with head gear-Shiavoni-1992.
Mars appliance-Clements & Alex
Jacobson 1982.
Jasper jumper-J.J.Jasper-1987.
Saif spring-Armstrong-1957.
The adjustable bite corrector-
Richard.P.West-1995
M.P.A. Coelho Filho-1997.www.indiandentalacademy.com

Eurekha spring-Divencenzo-
1997.
Universal Bite Jumper-Xavier Calvez-
1998.
Churrojumper-Ricardo Castanon-
1998.

Herbst
F.M..S
Jasper
Jumper
Gentle
Jumper
SAIF Spring
Churro Jumperwww.indiandentalacademy.com

MPA Two Piece Corrector
Universal Bite Jumper
Eureka Spring

 Attempted in class II mesially migrated molars with
straight profile.
 Successful before eruption of second molars.
Distalization Devices.
 Magnetic Appliance (Gianelly 1989).
 Modified Nance Arch with niti coils or wire ( Gianelly
1991).
 Molar Distalizing bow ( Jerkel & Rakosi 1991).
 Pendulum Appliance (Hilgers 1992).
 Jones Jig (Jones & White 1992).
 Distal Jet (Carano et al 1996).
 Lokar distalizing appliance.
Molar Distalization (Adjuncts)

Lokar Appliance Magnets
NiTi Coil Springs K - Loopwww.indiandentalacademy.com

Pendulum Appliance
Jones Jig
Distal Jetwww.indiandentalacademy.com

Non extraction treatment -
molar distalisation

Post treatment

Adjuncts- Fixed Functional
Appliances
• Jasper Jumper
• Herbst Appliance
• M.P.1,2,&3
• Fixed Twin Block
• Churro Jumper
• Saif Spring
• Forsus-3M

FIXED FUNCTIONAL - FORSUS

Case Report - 4

Management in adolescent
Period
Camaflouge treatment
Teeth are displaced relative to their
supporting bone to compensate for underlying
jaw discrepancy.
Indications for Class II.
Too old for successful growth modification.
Mild to moderate skeletal class II.
Reasonable good alignment of teeth.
Good vertical facial proportions - neither short
/ long face.

Extractions in class II
Extractions of upper bicuspids only with lower
non-extraction.
Extractions of upper bicuspids and lower
second bicuspids.
Extraction of upper bicuspids and lower
bicuspids with severe lower crowding.
Distalization of molars with extraction of
second molars.
Upto 4mm of distal movement of 1st molar is
possible by extraction of 2nd molars. ( Witzig
& Sphal).

Case Report - 6

Case Report - 7

FIXED FUNCTIONAL - TWIN BLOCK

Average changes brought about by
functional appliance therapy
Condylar growth amounts to 1 to 3 mms
mandiblle outgrows maxilla by 1+/- 0.5 mm.
Fossa growth and adaptation-0.5 to 1 mm.
Eliminating functional retrusion-0.5 to 1 mm.
More favourable growth direction (trabecular
angle) 0.5 to 1 mm.
With holding of downward and forward maxillary
arch movement 1 to 2 mm.
Differential upward and forward eruption of
buccal segments 1.5 to 2.5 mm.
Head gear effect 1 to 2 mm.(Woodside &
Altuna ). www.indiandentalacademy.com

Studies on Functional appliances
Vangeral and Harvold (1985) conducted a
study on the effects of activator and found:-
Inhibition of forward growth of maxilla.
Inhibition of mesial migration of maxillary
teeth.
Inhibition of maxillary alveolar height
increase.
Increased growth of the mandible.
Anterior relocation of glenoid fossa.
Mesial movement of mandibular teeth.
Combination of effects.
Uprighting of maxillary incisors.

Studies On Functional appliance
(contd)
Frank weiland, Bergt Ingerval et al
compared the effects of Herren activator,
Activator head gear and Jasper jumper and
demonstrated higher percentage of success
with Jasper jumper (1997).
Frankel studied the effect of Frankel
appliance and found(1987).
It is a suitable orthopedic exercise device.
It produces an undisturbed dento alveolar
development in the critical period of
eruption.

Case Report - 1

Case Report - 2

Case Report - 3

Treatment effects of Twin block
Christine Mills (1998) compared the effects of
twin block appliance with untreated control
and found .
Mandibular growth to be 4.2 mm greater than
control.
Condylion to Gnathion inreased by 6.5 mm
compared to control which was 2.5 only.
Ramus increased by2/3rd and body length
inreased by 1/3rd.
S.N.to mandibular plane angle- no statistical
significance was found.
Dento alveolar effect contributed to overjet
reduction.

Treatment Plan
In Skeletal Problems During Growth Phase
Phase I:-
•To promote growth of maxilla in
Sagittal and transverse planes if
maxilla is deficient.
•To restrict or redirect growth of
mandible if prognathic.
Phase II:-To establish proper occlusion with
aesthetic and functional balance.www.indiandentalacademy.com

Appliances used in correction of
early class III

Reverse Twin block

CASE REPORT I
Pre treatment

INTRA ORAL APPLIANCE

REVERSE PULL HEAD GEAR
De laire’s Face Mask
Force applied through
orthopedic elastics:-
450 to 500 grams for 12 to
14 hours / day.

END OF PHASE I

Pre and Post FJO

II - Phase

Case Report II

PHASE II

N per.Pt.A- -5mm
N per. Pog-0 mm
FMA- 16
0
PP-SN- 3
0
N-ANS- 43 mm
N-PNS – 45mm
N per.Pt.A- -5mm
N per. Pog- -9 mm
FMA- 25
0
PP-SN- 7
0
N-ANS- 46 mm
N-PNS – 45mmwww.indiandentalacademy.com

Clinical Examination
Frontal ExaminationVertical
•Proportions - vertical thirds
•Facial heights
Excessive upper face
Excessive lower
face
Short lower face
Nasal - Excessive
*Vertical max. excess
*Excessive chin height
*Vertical max. def.
*Short chin height
Facial width: Facial Ht =88% Up Lip Lt : Lo Lip Lt=1:2

Excessive Lower
Facial Height
Reduced Lower Facial
Height

Frontal Examination
Transverse
• Facial Width
• Width of nose at ala=
• Width of the eyes
• Interpupillary dist:
• Width of the mouth= 1:1

Frontal Examination
Symmetry
Coordination-dental / facial
•Maxillary
•Mandibular
•Occlusal Cant
•Chin
Incisor to lip relation in vertical plane
•Lip incompetence - Short philtrum
•Excessive / Insufficient upper incisor show at rest and smile

Profile Examination
Mid and upper face
Nose -
•Radix,
•Dorsum,
•Tip,
• Columella,
•Nasolabial angle.
Lower face
•Lip projection,
• Labiomental sulcus,
• Lip-chin-throat angle 90 deg / length,
•Chin Neck angle 105 to 120 deg
A
B
C
D

Cephalometrics as an aid in
diagnosis

Video Imaging helps to
• Educate the patient
• Project the treatment outcome with varied
treatment objectives
• Visualize Facial effects of treatment before
final decisions are made
• Permit quantification of the planned dental
and osseous movement & reduces guess
work

Graphic Imaging - Treatment simulations
Initial Record
High pull H. G
4’s
Extraction
Growth Forecast
Mandibular
Advancementwww.indiandentalacademy.com

Graphic Simulation

Thank You

Early diagnosis in orthodontics

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