INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
TWEED-MERRIFIELD
DIAG NOSIS

Identification & Classification of
Orthodontic & Orthognathic
disharmonies
www.indiandentalac...
Tweed’s contribution



IMPA:



Tweed treated series of cases first by non extraction,
then by extracting 4’s, if neces...


FMA



Patients were placed in the head holder with head
oriented on FH plane using the forefinger and thumb,
he outli...
Merrifield’s contribution


Merrifield’s diagnostic philosophy outlined follows:



Recognize and treat with the dimensi...
Diagnosis of Orthodontic and
Orthognathic disharmony
should be based on four major
areas

www.indiandentalacademy.com

Fac...
Facial Disharmony







Facial proportion is one of the greatest challenges &
opportunities for clinical orthodontist...










The chin-lip relationship can be defined
And also be related to other elements in face such as
the nose, n...
Dental Disharmony





Teeth, their relationship to each other 7 to the
supporting bones have been the overriding conce...






Orthodontic treatment is a space management
procedure. Space can neither be created nor
destroyed by orthodontist...
Cranial Disharmony






To strive for a harmonious relationship of maxilla &
mandible to the cranial base & to each ot...










Environmental
Disharmony

The most challenging area of orthodontic treatment is to
correct environmental ab...
Classification of
Orthodontic &
Orthognathic
disharmonies


Facial
Horizontal Disharmonies
 Disharmonies of facial conve...


Dental


Arch length disharmonies







Arch Width disharmonies







Mandibular arch space deficit
Mandib...


Cranial
 Horizontal





Mandibular retrognathism
Mandibular prognathism
Maxillary retrognathism
Maxillary prognat...
 Environmental
 Internal



Muscles & other soft tissue disharmonies
Bone & joint disharmonies

 External



Habits...
www.indiandentalacademy.com
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T m diagnosis /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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T m diagnosis /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. TWEED-MERRIFIELD DIAG NOSIS Identification & Classification of Orthodontic & Orthognathic disharmonies www.indiandentalacademy.com
  3. 3. Tweed’s contribution  IMPA:  Tweed treated series of cases first by non extraction, then by extracting 4’s, if necessary. The results of the extraction cases were more gratifying and he was near to his visualization of balance and harmony of the face. In these successfully treated cases he observed that the inclination of the lower incisors to the mandibular plane was in the range of 90 (+5 or –5).  Thus he concluded that normal range of mandibular incisor inclination, when related mandibular plane is 90+ 5. www.indiandentalacademy.com
  4. 4.  FMA  Patients were placed in the head holder with head oriented on FH plane using the forefinger and thumb, he outlined and extended the mandibular plane posteriorly to connect to FHP with the result of this study, be concluded that the normal variation of FMA is 16˚-35 ˚, with average of 25 ˚  FMIA    The sum of all the angles in a triangle is 180˚, if the norm for IMPA is established at 90˚, norm for FMA at 25˚, the third angle FMIA must be 65˚ All the patients with large FMA need compensation of mandibular incisor inclination. Meaning in high angle cases, the lower incisor are slightly proclined. www.indiandentalacademy.com
  5. 5. Merrifield’s contribution  Merrifield’s diagnostic philosophy outlined follows:  Recognize and treat with the dimension of dentition. This means non-expansion of malocclusion when the normal muscular balance exists.  Recognize the dimensions of lower face and treat for the maximal facial harmony and balance.  Recognize and understand the skeletal pattern. Diagnose & treat in harmony with normal growth & development www.indiandentalacademy.com
  6. 6. Diagnosis of Orthodontic and Orthognathic disharmony should be based on four major areas www.indiandentalacademy.com Facial Dental Cranial Environmental
  7. 7. Facial Disharmony     Facial proportion is one of the greatest challenges & opportunities for clinical orthodontist Most patients desire & demand esthetic improvement, which includes beautifying the smile & allowing normal lip postures Merrifield & others have pointed out that the upper & lower lips are very responsive to maxillary incisor tooth movements. Merrifield concluded that 4mm of upper incisor is accompanied by 3mm of upper lip retraction & 1mm of upper lip thickening www.indiandentalacademy.com
  8. 8.       The chin-lip relationship can be defined And also be related to other elements in face such as the nose, naso-labial contour, the smile line etc. Lower facial contour is a responsibility of orthodontic specialty LFH is very responsive to proper tooth repositioning And in extreme cases surgical intervention supervised by orthodontist can achieve necessary balance & harmony of lower face Hence identifying & classifying facial disharmonies must be an integral part of our service to our patients & recognized as one of our first responsibilities www.indiandentalacademy.com
  9. 9. Dental Disharmony    Teeth, their relationship to each other 7 to the supporting bones have been the overriding concern of Orthodontist since Angle. Angle’ s system is considered standard for more than 100 years,. However disharmonies of teeth can be better understood & identified by using a comprehensive space analysis system including all 32 teeth & determining whether a space deficit or space surplus exists as well as analysis of the occlusal relationship of maxillary teeth to the mandibular teeth www.indiandentalacademy.com
  10. 10.    Orthodontic treatment is a space management procedure. Space can neither be created nor destroyed by orthodontist Space management must use the elimination of certain dental units to allow spatial relationship of the remaining dental units. This is not space making, but it is judiciously using the available space It is also crucial to identify the areas of dentition that have space deficit or surplus. In this way the orthodontist can most advantageously use space management to correct the most overriding disharmonies www.indiandentalacademy.com
  11. 11. Cranial Disharmony    To strive for a harmonious relationship of maxilla & mandible to the cranial base & to each other is an important responsibility of the orthodontist Disproportion of these bones or malrelationships with other bones in the cranium can be favorably influenced by dental repositioning during growth period. Orthognathic surgical intervention , supervised by orthodontist, in extreme disharmonies can result in reestablishing a better relationship between maxilla to the mandible and to the surrounding bones of the cranium www.indiandentalacademy.com
  12. 12.      Environmental Disharmony The most challenging area of orthodontic treatment is to correct environmental abnormalities. Hence orthodontist must understand mother nature & knowledge of the functional and static elements associated with dentition, face & cranium. Bones, muscles, blood supply, nerve supply, joints & other soft tissues make-up the environment Functional elements:- Joints, muscles of expression, mastication, deglutition, speech & breathing Static elements:- Bone, cartilage & soft tissue www.indiandentalacademy.com
  13. 13. Classification of Orthodontic & Orthognathic disharmonies  Facial Horizontal Disharmonies  Disharmonies of facial convexity  Disharmonies of facial concavity  Vertical Disharmonies  Excessive facial height  Diminished facial height  www.indiandentalacademy.com
  14. 14.  Dental  Arch length disharmonies      Arch Width disharmonies      Mandibular arch space deficit Mandibular arch space surplus Maxillary arch space deficit Maxillary arch space surplus Mandibular arch width deficit Mandibular arch width excess Maxillary arch width deficit Maxillary arch width excess Occlusal Relation disharmonies   Distal occlusion Mesial occlusions www.indiandentalacademy.com
  15. 15.  Cranial  Horizontal     Mandibular retrognathism Mandibular prognathism Maxillary retrognathism Maxillary prognathism  Vertical   disharmonies disharmonies Hyperdivergent cranial patterns Hypodivergent cranial patterns www.indiandentalacademy.com
  16. 16.  Environmental  Internal   Muscles & other soft tissue disharmonies Bone & joint disharmonies  External   Habits Trauma www.indiandentalacademy.com
  17. 17. www.indiandentalacademy.com

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