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Review of orthodontic principles


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Review of orthodontic principles

  1. 1. 1st Principle • The same brackets, bands, and wires may (and probably will) result in different treatment responses in different patients • Most of the differences in response center on vertical changes • It is possible (and, in fact necessary) to predict the treatment response
  2. 2. Case 1-Mario age 14
  3. 3. Case 1, continued
  4. 4. Case 2- Oscar age 14
  5. 5. Case 2, continued
  6. 6. Comparison
  7. 7. Comparison
  8. 8. Example #2 Case 1
  9. 9. Case #1 Ceph
  10. 10. Example #2 Case 2
  11. 11. Case #2 Ceph
  12. 12. Comparison
  13. 13. Ceph comparison
  14. 14. Back to #1 • The same brackets, bands, and wires may (and probably will) result in different treatment responses in different patients • Most of the differences in response center on vertical changes • It is possible (and, in fact necessary) to predict the treatment response
  15. 15. Conclusion • Even though molar relationship and crowding are similar, every aspect of treatment should be different in these cases. -bracket positioning - extraction/non-extraction decision - arch wires and mechanics - retention
  16. 16. 2nd Principle • The worst mistake an orthodontic practitioner can make is to cause excessive bite opening in open bite patients • Not treating open bite patients make it impossible to violate this rule -Case selection
  17. 17. Look at this 12 year old patient
  18. 18. Questions • What will happen during initial leveling and aligning?
  19. 19. Month 2
  20. 20. Questions • What will happen during initial leveling and aligning? • Could anything have been done to prevent this?
  21. 21. 3rd Principle • Every treatment decision you make is based on the vertical needs of the patient -Bracket position, what teeth are bracketed, what wires to use, extraction vs. non-extraction, mechanics used, and retainers used are all greatly influenced by a patient’s vertical needs.
  22. 22. What is different? • Extraction case • Non-extraction case
  23. 23. What is different? • Bracket positioning -gingival in anterior -occlusal in posterior • Bracket positioning -incisal in anterior -gingival in posterior
  24. 24. What is different? • 7’s not bracketed • 7’s probably bracketed
  25. 25. What is different? • Retention - clear plastic full coverage retainers (Essix) • Retention • Hawley with a bite plane
  26. 26. Which is more difficult?
  27. 27. This one. Why?
  28. 28. This one. Why?
  29. 29. Which is tougher. This…
  30. 30. Strong or weak muscled?
  31. 31. Strong or weak muscled?
  32. 32. 4th Principle • Decalcification is the number one reason orthodontic practitioners get sued. Make sure all your patients have excellent oral hygiene. If hygiene is not up to par, consider early removal of the braces.
  33. 33. Now look at this.
  34. 34. Now look at this.
  35. 35. Prevention • Good brushing • Oral hygiene instruction and monitoring • Fluoride mouth rinse • Early braces removal
  36. 36. Special situations-white spot lesions • Studies show up to a third of all ortho patients have some white spot lesions • About half of all lesions remineralize in 6mo without any specific treatment
  37. 37. What NOT to do • High concentration fluoride treatment • This arrests remineralization
  38. 38. What to do • Polish with casein calcium phosphate materials (CPP) -CPP is thought to stabilize and localize calcium, fluoride, and phosphate at the tooth surface in a slow-release amorphous form, thus enhancing deeper remineralization of white spot lesions
  39. 39. GC America 1-800-323-7063 • MI Paste™ and MI Paste Plus™ Calcium, Phosphate and Fluoride Tooth Treatment
  40. 40. GC America-MI Paste • MI Paste with RECALDENT™ (CPP-ACP) has a proven clinical success record for patients with increased caries risk and white spot lesions. These include orthodontic appliances, bleaching, consumption of sports drinks and medical therapies causing low salivary flow or xerostomia.
  41. 41. 5th Principle • Check your patient’s molar relationship at every appointment. This is the first thing done at every orthodontic appointment. • If the patient does not have a Class I molar relationship, know how you are going to get there, or have a reason why the case will not finish with Class I molars.
  42. 42. Class II Malocclusion : Class II malocclusion occurs when the mesio-buccal cusp of the upper first permanent molar interdigitates mesial to the buccal groove or fossa of the lower first permanent molar. Ideal Occlusion
  43. 43. Look at this 12 year old • She is a growing patient. Will she finish in Class I?
  44. 44. Yes
  45. 45. Look at this18 year old
  46. 46. Continued
  47. 47. Comments • Full Cusp (8mm) Class II • Non-grower • Significant lower arch crowding
  48. 48. Post treatment Treatment time was 20 months
  49. 49. Why are the molars ClassII? • Upper bicuspid extractions
  50. 50. Why was this treated this way? • It is tough to fight molar relationship in a non-grower. • That is the “good reason” not to finish with Class I molars.
  51. 51. 6th Principle • Before initiating orthodontic treatment, each patient should have a complete set of records and a signed informed consent.
  52. 52. Records • Models (digital is acceptable) • Photos • Panorex or full mouth series • Ceph
  53. 53. 7th Principle • The most important mechanical considerations in all cases are proper bracket positioning and proper arch width control.
  54. 54. 8th Principle • Overbite correction precedes overjet correction.
  55. 55. Look at this11 year old patient
  56. 56. Diagnosis • 7mm Class II • Deep bite • Moderate (4mm) lower arch crowding
  57. 57. 4 Months of Treatment
  58. 58. Waiting for permanent teeth to erupt. Class II still 7mm.
  59. 59. 1 Year Later- Mechanics • Bite not opened enough to begin Class II correction • Discrepancy may be too great for Class II elastics
  60. 60. Remember, do not attempt overjet correction until overbite is adequate.
  61. 61. Removal
  62. 62. Comments • Not enough finishing – Poor interdigitation • Midline discrepancy – Left side still in Class II • Bite still too deep – Not handled properly during wire progression • Poor anterior torque control – Side effects of excessive Class II elastics
  63. 63. Removal, Continued
  64. 64. Before/After
  65. 65. 6 Months Later
  66. 66. Why? • Poor torque control – Interincisal contact does not aid retention • Overjet, midline discrepancy allow rotation • Overbite problem was never resolved
  67. 67. 9th Principle • Make sure all teeth are aligned before progressing out of nickel titanium arch wires.
  68. 68. 10th Principle • Standard of care dictates that a panorex should be done on every patient 6-9 months into treatment. This x-ray is used to check for root resorption. Failure to discover root resorption is the 2nd most common reason that orthodontic practitioners get sued.