Accelerated tooth movement in orthodontic is a challenging task to shorten the treatment time
Research in this area confined into the following categories;
1- Biomechanical approach: as self-ligating system
2- Physiological approach: such as direct electric stimuli, or low level Laser therapies (LLLTs)
3- Pharmacological approach: local injection of cytokines or hormones
4- Surgical assisted approach: periodontal ligament distraction, dento-alveolar distraction, selective decortication,
5- Surgery simulated approach: as submucosal injection of platelets rich plasma (PRP)
1- Biomechanical approach: self-ligating bracket system
= 1st self-ligating -------- Russell attachment 1935
= edge lock (oramco) ----- 1972
= mobile lock (Forstadent) ------1980
= speed ---------------- 1980
= active --------------- 1986
Self-ligating brackets has 2 categories, active and passive
Active: bracket have a spring clip that store energy to pass against the arch wire
Passive: bracket have slide that can be closed and does not encroach on slot lumen
Self-ligating bracket enable tooth to slide along an arch wire with lower and more predictable net forces with complete control
Mechanism:
The primary advantage of self-ligating over conventional that occurs because the usual steel or elastomeric ligature not necessary
Passive design generates less friction than active one. Under conventional, the friction / bracket with Niti wire was 41gm in Dentaurum bracket, and 15gm with Damon bracket with stainless steel wire
With reduced friction may become 3.6gm so less force needed to produce movement
Self-ligating bracket produce more physiologically harmonies tooth movement by interrupting periodontal vascular supply so:
- More alveolar bone generation
- Greater amount of expansion
- Less Proclination of anterior segment
- Less need for extraction
** several systematic reviews and studies revealed that self-ligating bracket do not accelerate alignment or space closure in clinical setting, this approach paradox in likely due to the effect of binding because when the teeth tip, rotate or torque, the edges of slot engage the arch wire creating binding so that resistance to sliding increase.
** because the bracket design of self-ligating is narrower than conventional type so the effect of binding is greater resulting in increased resistance to sliding compared with conventional. Less incisor Proclination appear the more advantage of self-ligating bracket
** tooth movement is a metabolic process of alveolar bone resorption and deposition of bone, so acceleration of movement may affect by biological and surgical procedure
2- Physiological approach: direct electric current stimulation:
Beason et al, the 1st that proposed use of electric current for orthodontic tooth movement near to tooth that moved but failed to demonstrate the effect on movement
DavidoVitch et al reported successful results in accelerating orthodontic tooth movement through direct current on gingival tissue as
This document discusses various methods to enhance orthodontic tooth movement. It describes how application of light continuous forces for prolonged periods, as well as intermittent forces, can encourage tooth movement. It also explores how drugs like prostaglandins and relaxin can increase the rate of movement by stimulating bone remodeling processes. Finally, it examines surgical techniques such as corticotomies and alveolar distraction that utilize the body's regional acceleratory phenomenon to speed up orthodontic tooth alignment.
The document discusses various approaches to accelerate orthodontic tooth movement including biomechanical, physiological/mechanical, pharmacological, surgical-assisted, and surgery-simulated approaches. The biomechanical approach examines self-ligating bracket systems. The physiological/mechanical approach explores direct electric current stimulation, enzymatic micro batteries, piezoelectric stimulation, low-level laser therapy, and photobiomodulation. The pharmacological approach investigates prostaglandins, corticosteroids, growth hormone, parathyroid hormone, vitamin D, and relaxin. The surgical-assisted approach examines rapid canine retraction through distraction of the periodontal ligament and dentoalveolar distraction. The surgery-simulated
Biochemical Level btw conventional and rapid movemnt.pptxDeeksha Bhanotia
This study compared biochemical changes between rapid and conventional orthodontic tooth movement. 30 patients undergoing fixed orthodontic treatment were divided into two groups - one receiving conventional treatment and the other receiving micro-osteoperforations to accelerate tooth movement. Gingival crevicular fluid was collected from both groups at various time intervals and analyzed for levels of interleukin-1 and osteocalcin. The results showed significantly higher levels of both biomarkers at the micro-osteoperforated sites, indicating rapid orthodontic tooth movement was achieved through increased biological responses to force application.
Photobiomodulation technique uses low intensity lasers and light in the red to near infrared zone (600 to 1000 nm wavelength) which brings about biological changes at the cellular level thus initiating the bone remodeling. As a result accelerates orthodontic tooth movement without causing any harm to the periodontal tissues
Accelerated Orthodontics, in light of current evidenceMariaShahid29
This document discusses various methods for accelerating orthodontic tooth movement. It begins with an introduction describing how orthodontic treatment involves reorganizing skeletal and dental tissues, but can take 2-3 years, which has drawbacks for patients. It then covers theories of tooth movement and the biology behind orthodontic tooth movement.
The main methods discussed are pharmacological methods using substances like prostaglandins, misoprostol, vitamin D, parathyroid hormone and relaxin. Surgical methods like corticotomy, piezocision, corticision and micro-osteoperforations are also summarized. Physical methods like vibratory stimulus, low level laser therapy and low-intensity pulsed ultrasound are briefly
MECHANICAL METHODS IN ACCELARATING ORTHODONTICS.pptxDr. Genoey George
Mechanical methods can accelerate orthodontic tooth movement by stimulating alveolar bone remodeling. Non-invasive approaches include low-level lasers, electric currents, vibration, and pulsed ultrasound. Low-level lasers increase the proliferation of osteoblasts, osteoclasts, and fibroblasts, accelerating bone remodeling and tooth movement. Vibration and pulsed ultrasound decrease friction and induce bone remodeling through changes in bone metabolism and cellular differentiation. These mechanical methods provide alternatives to accelerate orthodontic treatment while avoiding risks of surgical methods.
Article teixeira effects of micro-osteoperforationCentric Learning
1. The study examined the effect of micro-osteoperforations (MOPs) on the rate of tooth movement in 20 patients undergoing orthodontic treatment.
2. The experimental group received MOPs on one side of the maxilla prior to canine retraction, while the control group did not receive MOPs.
3. MOPs significantly increased the rate of tooth movement by 2.3-fold and increased inflammatory marker levels. Patients did not report significant pain from the procedure.
This document provides an overview of methods used to accelerate orthodontic tooth movement. It begins with an introduction to the topic and discusses the main concerns with traditional orthodontic treatment duration. It then outlines several methods to speed up tooth movement, including pharmacological methods using agents like prostaglandins, surgical methods like corticotomy and piezocision, and physical methods employing vibratory stimulation or low-level laser therapy. For each method, the document discusses the procedure, indications, advantages, disadvantages and relevant studies. It primarily serves to educate on the various techniques available to reduce the length of orthodontic treatment.
This document discusses various methods to enhance orthodontic tooth movement. It describes how application of light continuous forces for prolonged periods, as well as intermittent forces, can encourage tooth movement. It also explores how drugs like prostaglandins and relaxin can increase the rate of movement by stimulating bone remodeling processes. Finally, it examines surgical techniques such as corticotomies and alveolar distraction that utilize the body's regional acceleratory phenomenon to speed up orthodontic tooth alignment.
The document discusses various approaches to accelerate orthodontic tooth movement including biomechanical, physiological/mechanical, pharmacological, surgical-assisted, and surgery-simulated approaches. The biomechanical approach examines self-ligating bracket systems. The physiological/mechanical approach explores direct electric current stimulation, enzymatic micro batteries, piezoelectric stimulation, low-level laser therapy, and photobiomodulation. The pharmacological approach investigates prostaglandins, corticosteroids, growth hormone, parathyroid hormone, vitamin D, and relaxin. The surgical-assisted approach examines rapid canine retraction through distraction of the periodontal ligament and dentoalveolar distraction. The surgery-simulated
Biochemical Level btw conventional and rapid movemnt.pptxDeeksha Bhanotia
This study compared biochemical changes between rapid and conventional orthodontic tooth movement. 30 patients undergoing fixed orthodontic treatment were divided into two groups - one receiving conventional treatment and the other receiving micro-osteoperforations to accelerate tooth movement. Gingival crevicular fluid was collected from both groups at various time intervals and analyzed for levels of interleukin-1 and osteocalcin. The results showed significantly higher levels of both biomarkers at the micro-osteoperforated sites, indicating rapid orthodontic tooth movement was achieved through increased biological responses to force application.
Photobiomodulation technique uses low intensity lasers and light in the red to near infrared zone (600 to 1000 nm wavelength) which brings about biological changes at the cellular level thus initiating the bone remodeling. As a result accelerates orthodontic tooth movement without causing any harm to the periodontal tissues
Accelerated Orthodontics, in light of current evidenceMariaShahid29
This document discusses various methods for accelerating orthodontic tooth movement. It begins with an introduction describing how orthodontic treatment involves reorganizing skeletal and dental tissues, but can take 2-3 years, which has drawbacks for patients. It then covers theories of tooth movement and the biology behind orthodontic tooth movement.
The main methods discussed are pharmacological methods using substances like prostaglandins, misoprostol, vitamin D, parathyroid hormone and relaxin. Surgical methods like corticotomy, piezocision, corticision and micro-osteoperforations are also summarized. Physical methods like vibratory stimulus, low level laser therapy and low-intensity pulsed ultrasound are briefly
MECHANICAL METHODS IN ACCELARATING ORTHODONTICS.pptxDr. Genoey George
Mechanical methods can accelerate orthodontic tooth movement by stimulating alveolar bone remodeling. Non-invasive approaches include low-level lasers, electric currents, vibration, and pulsed ultrasound. Low-level lasers increase the proliferation of osteoblasts, osteoclasts, and fibroblasts, accelerating bone remodeling and tooth movement. Vibration and pulsed ultrasound decrease friction and induce bone remodeling through changes in bone metabolism and cellular differentiation. These mechanical methods provide alternatives to accelerate orthodontic treatment while avoiding risks of surgical methods.
Article teixeira effects of micro-osteoperforationCentric Learning
1. The study examined the effect of micro-osteoperforations (MOPs) on the rate of tooth movement in 20 patients undergoing orthodontic treatment.
2. The experimental group received MOPs on one side of the maxilla prior to canine retraction, while the control group did not receive MOPs.
3. MOPs significantly increased the rate of tooth movement by 2.3-fold and increased inflammatory marker levels. Patients did not report significant pain from the procedure.
This document provides an overview of methods used to accelerate orthodontic tooth movement. It begins with an introduction to the topic and discusses the main concerns with traditional orthodontic treatment duration. It then outlines several methods to speed up tooth movement, including pharmacological methods using agents like prostaglandins, surgical methods like corticotomy and piezocision, and physical methods employing vibratory stimulation or low-level laser therapy. For each method, the document discusses the procedure, indications, advantages, disadvantages and relevant studies. It primarily serves to educate on the various techniques available to reduce the length of orthodontic treatment.
Orthodontic tooth movement occurs through the application of mechanical forces that cause the alveolar bone and periodontal ligament to bend or flex. This movement is regulated by various cellular and molecular mechanisms. There are two main theories that describe how orthodontic forces are converted into biological responses: the pressure-tension theory and bioelectric theory. The pressure-tension theory proposes that orthodontic forces alter blood flow in the periodontal ligament, resulting in the formation and release of chemical messengers that stimulate cellular activity and bone remodeling. The bioelectric theory suggests that bending of the alveolar bone generates piezoelectric signals that act as cellular signals to initiate tooth movement. Understanding these biological mechanisms of tooth movement could help
Orthodontics-Periodontics Relationship
ntroduction
Biological basis for orthodontic therapy
Periodontal tissue response to orthodontic force
Effects of orthodontic tooth movement on the periodontium
Orthodontic tooth movement in adults with periodontal tissue breakdown
Specific factors associated with orthodontic tooth movement
Implants and orthodontic therapy
Systematics of combined ortho – perio treatment
Periodontally Accelerated Osteogenic Orthodontics (PAOO)
Minor periodontal surgery and orthodontic treatment
Review of literature
This study evaluated the stability and rate of osseointegration of 33 immediately loaded dental implants in 7 patients that were treated with ultraviolet light photofunctionalization. Photofunctionalization increased the hydrophilicity, cleanliness, and positive charge of the implant surfaces. The average stability of the photofunctionalized implants at 6 weeks was higher than typically reported for untreated implants after 2-6 months of healing. No stability dips were observed for the photofunctionalized implants. Photofunctionalization accelerated osseointegration as shown by higher stability increases per month compared to literature reports on untreated implants. The results suggest photofunctionalization provides benefits for immediate loading by enhancing
Dental extractions in irradiated patientsUjwal Gautam
Dental extractions in patients undergoing radiotherapy carry risks of osteoradionecrosis and impaired wound healing due to radiation damage to vasculature, bone marrow, and fibroblasts. Extraction after radiotherapy requires preventive measures like antibiotics and atraumatic technique. Hyperbaric oxygen therapy has been used preventively for extractions, though its effectiveness is less than 100%. Where possible, extractions in irradiated patients should be avoided or meticulous preventive measures undertaken due to osteoradionecrosis risk.
Introduction
Histology of supporting structure
Types of tooth movements
Phases of orthodontic tooth movements
Biological changes by tooth movements
Theories of tissue reactions
Replacement resorption
Role of polycystin 1 in bone remodeling- orthodontic tooth movement study in ...EdwardHAngle
Objective: To test the hypothesis that polycystin-1 (PC1) is involved in orthodontic tooth movement as a mechanical sensor.
Materials and Methods: The response to force application was compared between three mutant and four wild-type 7-week-old mice. The mutant mice were PC1/Wnt1-cre, lacking PC1 in the craniofacial region. An orthodontic closed coil spring was bonded between the incisor and the left first molar, applying 20 g of force for 4 days. Micro–computed tomography, hematoxylin and eosin staining, and tartrate-resistent acid phosphatase (TRAP) staining were used to study the differences in tooth movement among the groups.
Results: In the wild-type mice the bonded molar moved mesially, and the periodontal ligament (PDL) was compressed in the compression side. The compression side showed a hyalinized zone, and osteoclasts were identified there using TRAP staining. In the mutant mice, the molar did not move, the incisor tipped palatally, and there was slight widening of the PDL in the tension area. Osteoclasts were not seen on the bone surface or on the compression side. Osteoclasts were only observed on the other side of the bone—in the bone marrow.
Conclusions: These results suggest a difference in tooth movement and osteoclast activity between PC1 mutant mice and wild-type mice in response to orthodontic force. The impaired tooth movement and the lack of osteoclasts on the bone surface in the mutant working side may be related to lack of signal from the PDL due to PC1 deficiency.
The document discusses the effects of radiation therapy on osseointegration and implant success. It describes how radiation can damage bone tissue by reducing vasculature, killing osteoblasts and osteocytes. This compromises implant anchorage, remodeling, and the body's response to infection or forces. Animal studies show reduced success rates with higher radiation doses. The risks and benefits of implant placement in irradiated sites are evaluated based on the location, radiation dose/method, and functional goals for the patient.
orthodontic biology of tooth and supporting structure.docxDr.Mohammed Alruby
Histology of supporting structure
- Periodontal ligament
- Alveolar bone
= types of tooth movement
= classification of force during treatment
= factors affect tooth movement
= hyalinization
= types of root resorption
= factors affect tooth movement according to pressure tension theory
= role of chemical mediators in tooth movement
= role of neurotransmitter in tooth movements
orthodontic biology of tooth and supporting structure.docxDr.Mohammed Alruby
The goal is to examine the relationship between orthodontic biomechanics and the underlying biological process
When orthodontic force is applied to the crown of the tooth it is transmitted through the roots to the periodontal ligament and alveolar bone
Histology of supporting structure:
- Periodontal ligament
- Alveolar bone
I- Periodontal ligament:
A- Cellular component:
• Forming cells:
Osteoblast: bone forming cells
Fibroblast: PDL fibers forming cells
Cementoblast: in layer adjacent to the roots
• Resorptive cells:
Osteoblast: large cell rich acid phosphatase enzyme that demineralize the bone and disintegrate of organic matrix
Fibroblast: disintegrate fibers
Cementoblast: resorb cementum
• Progenitor cells: undifferentiated mesenchymal cells UMC: small cells with closed nucleus and little cytoplasm & monocytes
• Epithelial rest of malassez: arise as a result of breakdown of epithelial root sheath at the time of cementogesis
• Defensive cells: as macrophages & mast cells
B- Periodontal fibers:
1- Collagen fibers:
the main bulk of PDL fibers and found in 5 groups:
- Alveolar crest group: from cervix to alveolar crest
- Horizontal group: from cementum to bone horizontally
- Oblique group: the main attachment that run obliquely from cementum to bone in an apical direction
- Apical group: circumscribed the apex and responsible for resistance to rotation
- Inter-radicular group: inter-mediate plexus, observed midway between bone and root
- Supra-alveolar group:
Dento-gingival
Dento-periosteal
Transeptal
Circular
Alveolo-gingival
2- Oxytalan fibers:
Immediate elastic fibers that resist dissolution by acids unlike collagen
Run from cementum or bone to blood vessels
Play a role in supporting the blood vessels against distortion and compressive strain
c- Ground substances:
organic matrix surrounding the PDL elements, it is chemically composed of CHO linked with protein. CHO- protein complex commonly divided into two groups: proteoglycan and glycoprotein
ground substances of periodontal ligament is in a continuous state of remodeling process
d- Neurovascular elements:
myelinated: pain sensation
non-myelinated: blood vessels wall
PDL functions:
- Supportive
- Nutritive
- Remodeling
- Sensory
II- Alveolar bone:
= in human, marrow spaces are rare in the buccal and lingual plates, these spaces decreased with age
= wider spaces are lined with a layer of fenestrated compact bone when PDL fibers are anchor these fibers is called bundle bone
N: B:
= collagen turn over in PDL is higher 4 times than skin and 2 times than gingiva and this due to the forces in PDL is multi-directional takes vertical and horizontal component
= lake of marrow spaces implies that bone resorption takes more time so that the tooth movement in mesial and distal direction occur more than labial and lingual sides
= the resorptive cells increase as the marrow spaces increase
N: B:
The new deposited tissue during tooth migration have 3 stages:
Stage I osteoid:
is the pr
Biologic tissue response to tooth movementCing Sian Dal
1. Orthodontic tooth movement occurs through the biological response of tissues to mechanical forces. When force is applied, pressure and tension zones develop in the periodontal ligament on either side of the tooth root.
2. Light, continuous forces cause frontal bone resorption, facilitating tooth movement. Heavy forces lead to hyalinization and undermining bone resorption, impeding movement.
3. In the pressure zones, force distorts periodontal ligament cells and matrices, altering blood flow and releasing biochemical signals like prostaglandins that stimulate bone-resorbing osteoclasts. This allows the tooth to move through bone remodeling.
1) The document describes a study on the effects of low level laser therapy (LLLT) on human appendicular bone fracture healing.
2) A total of 40 patients with fractures were divided into a laser group (20 patients) who received LLLT, and a control group (20 patients) who did not.
3) Results showed the laser group had better clinical outcomes like less pain and earlier movement, and radiological outcomes like faster/greater callus formation and bone density increases.
4) The study concluded LLLT can accelerate bone union and enhance healing when used as an adjunct to standard fracture treatment.
Corticision is a technique used to accelerate orthodontic tooth movement. This study investigated the effects of Corticision on paradental remodeling in cats undergoing orthodontic tooth movement. The results showed that Corticision led to less hyalinization of periodontal tissue and more direct bone resorption compared to orthodontic force alone. New bone formation was also accelerated with Corticision. Histologically, Corticision sites healed more rapidly with new bone formation filling defects. Quantitatively, Corticision increased the rate and amount of new bone formation up to 3.5 times compared to orthodontic force alone. Therefore, Corticision can be an efficient method to accelerate orthodontic tooth movement and associated al
1) The document discusses how various drugs can influence orthodontic tooth movement, including analgesics like NSAIDs, acetaminophen, bisphosphonates, fluorides, corticosteroids, and vitamin D.
2) NSAIDs and bisphosphonates can reduce the pace of tooth movement by inhibiting prostaglandin synthesis and osteoclast activity. Acetaminophen does not significantly affect tooth movement.
3) Vitamin D, corticosteroids, and fluorides can impact bone metabolism and influence the rate and stability of tooth movement to varying degrees. Corticosteroids in particular may increase short-term movement but decrease long-term stability.
The document discusses the biology of orthodontic tooth movement. It covers the historical perspective of orthodontics, the tooth-supporting structures including the periodontal ligament, gingiva, cementum and alveolar bone. It also discusses the theories of orthodontic tooth movement including the pressure-tension theory, fluid-dynamic theory, and bone bending theory. The document outlines the normal response of tissues to function and different phases of tooth movement seen with light versus heavy orthodontic forces.
The document discusses trauma from occlusion (TFO) and the adaptive capacity of the periodontium. It defines key terms like occlusion, traumatic occlusion, and TFO. It describes the types of forces that can cause TFO as well as the adaptive changes that occur in the periodontium in response to increased occlusal forces. Specifically, it notes that the periodontium can remodel to cushion the impact of excessive forces by widening the PDL space and increasing bone density at the expense of bone loss. However, if forces exceed the tissues' adaptive capacity, injury results.
This document discusses prostaglandins and their role in orthodontic tooth movement. It begins with an introduction to orthodontic tooth movement and the various chemical mediators involved, including prostaglandins. It then discusses how drugs can alter the rate of tooth movement, with prostaglandins and other substances like vitamin D and PTH increasing the rate, while NSAIDs and bisphosphonates decrease it. The document concludes by focusing on prostaglandins and their mechanism of action in accelerating orthodontic tooth movement.
This document summarizes the results of several randomized controlled trials (RCTs) testing various dental implant procedures and materials. It finds that: 1) Short implants are more effective than bone grafts for atrophic mandibles. 2) Bone substitutes like Bio-Oss may be sufficient for sinus lifts with <5mm bone. 3) Vertical bone augmentation is possible but complications are common and effectiveness is unclear. 4) The need for and best technique for bone grafts in extraction sockets and around implants is unclear.
1. Orthodontic tooth movement occurs through remodeling of the alveolar bone in response to prolonged mechanical forces on teeth. Bone resorbs on the pressure side and forms on the tension side of the periodontal ligament.
2. There are three phases of tooth movement: initial rapid movement, a lag phase where little movement occurs as hyalinized tissue forms, and a post-lag phase where movement resumes as the hyalinized tissue is removed.
3. The rate of tooth movement can be increased by using drugs that enhance bone resorption like prostaglandins, or decreased by using drugs that suppress bone resorption like NSAIDs. Local drug delivery could help enhance anchorage during orth
Definition
Types of rotation
Etiology of rotation
Winging and counter winging rotation
Advantages of derotation
Biomechanics of rotation correction
Methods of correction rotation
Management of molar derotation
Retention of rotated tooth
Methods to prevent relapse
Active retention
Torque when, where, how?
Importance of torque
Biomechanics in torque
Torque expression in slot 0.018 and 0.022
Expression of torque
Mode of ligation and torque
Types of torque
- Passive
- Active
Factors affect torque
Torque with different appliances
Torque in base and face
Torque prescription in different techniques
Class II malocclusion and torque
Torque control in different treatment steps
Differential torque
Torque clearance
Intrusion and torque
Torque and intra-oral elastics
More Related Content
Similar to accelerated orthodontic tooth movments.docx
Orthodontic tooth movement occurs through the application of mechanical forces that cause the alveolar bone and periodontal ligament to bend or flex. This movement is regulated by various cellular and molecular mechanisms. There are two main theories that describe how orthodontic forces are converted into biological responses: the pressure-tension theory and bioelectric theory. The pressure-tension theory proposes that orthodontic forces alter blood flow in the periodontal ligament, resulting in the formation and release of chemical messengers that stimulate cellular activity and bone remodeling. The bioelectric theory suggests that bending of the alveolar bone generates piezoelectric signals that act as cellular signals to initiate tooth movement. Understanding these biological mechanisms of tooth movement could help
Orthodontics-Periodontics Relationship
ntroduction
Biological basis for orthodontic therapy
Periodontal tissue response to orthodontic force
Effects of orthodontic tooth movement on the periodontium
Orthodontic tooth movement in adults with periodontal tissue breakdown
Specific factors associated with orthodontic tooth movement
Implants and orthodontic therapy
Systematics of combined ortho – perio treatment
Periodontally Accelerated Osteogenic Orthodontics (PAOO)
Minor periodontal surgery and orthodontic treatment
Review of literature
This study evaluated the stability and rate of osseointegration of 33 immediately loaded dental implants in 7 patients that were treated with ultraviolet light photofunctionalization. Photofunctionalization increased the hydrophilicity, cleanliness, and positive charge of the implant surfaces. The average stability of the photofunctionalized implants at 6 weeks was higher than typically reported for untreated implants after 2-6 months of healing. No stability dips were observed for the photofunctionalized implants. Photofunctionalization accelerated osseointegration as shown by higher stability increases per month compared to literature reports on untreated implants. The results suggest photofunctionalization provides benefits for immediate loading by enhancing
Dental extractions in irradiated patientsUjwal Gautam
Dental extractions in patients undergoing radiotherapy carry risks of osteoradionecrosis and impaired wound healing due to radiation damage to vasculature, bone marrow, and fibroblasts. Extraction after radiotherapy requires preventive measures like antibiotics and atraumatic technique. Hyperbaric oxygen therapy has been used preventively for extractions, though its effectiveness is less than 100%. Where possible, extractions in irradiated patients should be avoided or meticulous preventive measures undertaken due to osteoradionecrosis risk.
Introduction
Histology of supporting structure
Types of tooth movements
Phases of orthodontic tooth movements
Biological changes by tooth movements
Theories of tissue reactions
Replacement resorption
Role of polycystin 1 in bone remodeling- orthodontic tooth movement study in ...EdwardHAngle
Objective: To test the hypothesis that polycystin-1 (PC1) is involved in orthodontic tooth movement as a mechanical sensor.
Materials and Methods: The response to force application was compared between three mutant and four wild-type 7-week-old mice. The mutant mice were PC1/Wnt1-cre, lacking PC1 in the craniofacial region. An orthodontic closed coil spring was bonded between the incisor and the left first molar, applying 20 g of force for 4 days. Micro–computed tomography, hematoxylin and eosin staining, and tartrate-resistent acid phosphatase (TRAP) staining were used to study the differences in tooth movement among the groups.
Results: In the wild-type mice the bonded molar moved mesially, and the periodontal ligament (PDL) was compressed in the compression side. The compression side showed a hyalinized zone, and osteoclasts were identified there using TRAP staining. In the mutant mice, the molar did not move, the incisor tipped palatally, and there was slight widening of the PDL in the tension area. Osteoclasts were not seen on the bone surface or on the compression side. Osteoclasts were only observed on the other side of the bone—in the bone marrow.
Conclusions: These results suggest a difference in tooth movement and osteoclast activity between PC1 mutant mice and wild-type mice in response to orthodontic force. The impaired tooth movement and the lack of osteoclasts on the bone surface in the mutant working side may be related to lack of signal from the PDL due to PC1 deficiency.
The document discusses the effects of radiation therapy on osseointegration and implant success. It describes how radiation can damage bone tissue by reducing vasculature, killing osteoblasts and osteocytes. This compromises implant anchorage, remodeling, and the body's response to infection or forces. Animal studies show reduced success rates with higher radiation doses. The risks and benefits of implant placement in irradiated sites are evaluated based on the location, radiation dose/method, and functional goals for the patient.
orthodontic biology of tooth and supporting structure.docxDr.Mohammed Alruby
Histology of supporting structure
- Periodontal ligament
- Alveolar bone
= types of tooth movement
= classification of force during treatment
= factors affect tooth movement
= hyalinization
= types of root resorption
= factors affect tooth movement according to pressure tension theory
= role of chemical mediators in tooth movement
= role of neurotransmitter in tooth movements
orthodontic biology of tooth and supporting structure.docxDr.Mohammed Alruby
The goal is to examine the relationship between orthodontic biomechanics and the underlying biological process
When orthodontic force is applied to the crown of the tooth it is transmitted through the roots to the periodontal ligament and alveolar bone
Histology of supporting structure:
- Periodontal ligament
- Alveolar bone
I- Periodontal ligament:
A- Cellular component:
• Forming cells:
Osteoblast: bone forming cells
Fibroblast: PDL fibers forming cells
Cementoblast: in layer adjacent to the roots
• Resorptive cells:
Osteoblast: large cell rich acid phosphatase enzyme that demineralize the bone and disintegrate of organic matrix
Fibroblast: disintegrate fibers
Cementoblast: resorb cementum
• Progenitor cells: undifferentiated mesenchymal cells UMC: small cells with closed nucleus and little cytoplasm & monocytes
• Epithelial rest of malassez: arise as a result of breakdown of epithelial root sheath at the time of cementogesis
• Defensive cells: as macrophages & mast cells
B- Periodontal fibers:
1- Collagen fibers:
the main bulk of PDL fibers and found in 5 groups:
- Alveolar crest group: from cervix to alveolar crest
- Horizontal group: from cementum to bone horizontally
- Oblique group: the main attachment that run obliquely from cementum to bone in an apical direction
- Apical group: circumscribed the apex and responsible for resistance to rotation
- Inter-radicular group: inter-mediate plexus, observed midway between bone and root
- Supra-alveolar group:
Dento-gingival
Dento-periosteal
Transeptal
Circular
Alveolo-gingival
2- Oxytalan fibers:
Immediate elastic fibers that resist dissolution by acids unlike collagen
Run from cementum or bone to blood vessels
Play a role in supporting the blood vessels against distortion and compressive strain
c- Ground substances:
organic matrix surrounding the PDL elements, it is chemically composed of CHO linked with protein. CHO- protein complex commonly divided into two groups: proteoglycan and glycoprotein
ground substances of periodontal ligament is in a continuous state of remodeling process
d- Neurovascular elements:
myelinated: pain sensation
non-myelinated: blood vessels wall
PDL functions:
- Supportive
- Nutritive
- Remodeling
- Sensory
II- Alveolar bone:
= in human, marrow spaces are rare in the buccal and lingual plates, these spaces decreased with age
= wider spaces are lined with a layer of fenestrated compact bone when PDL fibers are anchor these fibers is called bundle bone
N: B:
= collagen turn over in PDL is higher 4 times than skin and 2 times than gingiva and this due to the forces in PDL is multi-directional takes vertical and horizontal component
= lake of marrow spaces implies that bone resorption takes more time so that the tooth movement in mesial and distal direction occur more than labial and lingual sides
= the resorptive cells increase as the marrow spaces increase
N: B:
The new deposited tissue during tooth migration have 3 stages:
Stage I osteoid:
is the pr
Biologic tissue response to tooth movementCing Sian Dal
1. Orthodontic tooth movement occurs through the biological response of tissues to mechanical forces. When force is applied, pressure and tension zones develop in the periodontal ligament on either side of the tooth root.
2. Light, continuous forces cause frontal bone resorption, facilitating tooth movement. Heavy forces lead to hyalinization and undermining bone resorption, impeding movement.
3. In the pressure zones, force distorts periodontal ligament cells and matrices, altering blood flow and releasing biochemical signals like prostaglandins that stimulate bone-resorbing osteoclasts. This allows the tooth to move through bone remodeling.
1) The document describes a study on the effects of low level laser therapy (LLLT) on human appendicular bone fracture healing.
2) A total of 40 patients with fractures were divided into a laser group (20 patients) who received LLLT, and a control group (20 patients) who did not.
3) Results showed the laser group had better clinical outcomes like less pain and earlier movement, and radiological outcomes like faster/greater callus formation and bone density increases.
4) The study concluded LLLT can accelerate bone union and enhance healing when used as an adjunct to standard fracture treatment.
Corticision is a technique used to accelerate orthodontic tooth movement. This study investigated the effects of Corticision on paradental remodeling in cats undergoing orthodontic tooth movement. The results showed that Corticision led to less hyalinization of periodontal tissue and more direct bone resorption compared to orthodontic force alone. New bone formation was also accelerated with Corticision. Histologically, Corticision sites healed more rapidly with new bone formation filling defects. Quantitatively, Corticision increased the rate and amount of new bone formation up to 3.5 times compared to orthodontic force alone. Therefore, Corticision can be an efficient method to accelerate orthodontic tooth movement and associated al
1) The document discusses how various drugs can influence orthodontic tooth movement, including analgesics like NSAIDs, acetaminophen, bisphosphonates, fluorides, corticosteroids, and vitamin D.
2) NSAIDs and bisphosphonates can reduce the pace of tooth movement by inhibiting prostaglandin synthesis and osteoclast activity. Acetaminophen does not significantly affect tooth movement.
3) Vitamin D, corticosteroids, and fluorides can impact bone metabolism and influence the rate and stability of tooth movement to varying degrees. Corticosteroids in particular may increase short-term movement but decrease long-term stability.
The document discusses the biology of orthodontic tooth movement. It covers the historical perspective of orthodontics, the tooth-supporting structures including the periodontal ligament, gingiva, cementum and alveolar bone. It also discusses the theories of orthodontic tooth movement including the pressure-tension theory, fluid-dynamic theory, and bone bending theory. The document outlines the normal response of tissues to function and different phases of tooth movement seen with light versus heavy orthodontic forces.
The document discusses trauma from occlusion (TFO) and the adaptive capacity of the periodontium. It defines key terms like occlusion, traumatic occlusion, and TFO. It describes the types of forces that can cause TFO as well as the adaptive changes that occur in the periodontium in response to increased occlusal forces. Specifically, it notes that the periodontium can remodel to cushion the impact of excessive forces by widening the PDL space and increasing bone density at the expense of bone loss. However, if forces exceed the tissues' adaptive capacity, injury results.
This document discusses prostaglandins and their role in orthodontic tooth movement. It begins with an introduction to orthodontic tooth movement and the various chemical mediators involved, including prostaglandins. It then discusses how drugs can alter the rate of tooth movement, with prostaglandins and other substances like vitamin D and PTH increasing the rate, while NSAIDs and bisphosphonates decrease it. The document concludes by focusing on prostaglandins and their mechanism of action in accelerating orthodontic tooth movement.
This document summarizes the results of several randomized controlled trials (RCTs) testing various dental implant procedures and materials. It finds that: 1) Short implants are more effective than bone grafts for atrophic mandibles. 2) Bone substitutes like Bio-Oss may be sufficient for sinus lifts with <5mm bone. 3) Vertical bone augmentation is possible but complications are common and effectiveness is unclear. 4) The need for and best technique for bone grafts in extraction sockets and around implants is unclear.
1. Orthodontic tooth movement occurs through remodeling of the alveolar bone in response to prolonged mechanical forces on teeth. Bone resorbs on the pressure side and forms on the tension side of the periodontal ligament.
2. There are three phases of tooth movement: initial rapid movement, a lag phase where little movement occurs as hyalinized tissue forms, and a post-lag phase where movement resumes as the hyalinized tissue is removed.
3. The rate of tooth movement can be increased by using drugs that enhance bone resorption like prostaglandins, or decreased by using drugs that suppress bone resorption like NSAIDs. Local drug delivery could help enhance anchorage during orth
Similar to accelerated orthodontic tooth movments.docx (20)
Definition
Types of rotation
Etiology of rotation
Winging and counter winging rotation
Advantages of derotation
Biomechanics of rotation correction
Methods of correction rotation
Management of molar derotation
Retention of rotated tooth
Methods to prevent relapse
Active retention
Torque when, where, how?
Importance of torque
Biomechanics in torque
Torque expression in slot 0.018 and 0.022
Expression of torque
Mode of ligation and torque
Types of torque
- Passive
- Active
Factors affect torque
Torque with different appliances
Torque in base and face
Torque prescription in different techniques
Class II malocclusion and torque
Torque control in different treatment steps
Differential torque
Torque clearance
Intrusion and torque
Torque and intra-oral elastics
Extra-oral forces
And
Appliances
Prepared by:
Dr. Mohammed Alruby
Definition
Philosophy
History and development
Classification of extra-oral forces
Advantages of extra-oral forces
Disadvantages of extra-oral forces
Uses of extra-oral forces
Headgear
Appliance enhanced the action of headgear
Protraction appliances
Types of reversed headgear
Chin cup appliance
Orthopedic correction of class III
Orthopedic correction of open bite
Orthopedic correction of class II
Retention after orthopedic correction
Definition
It is a force derived from an extra-oral appliance that uses the forehead, the top of the head or the back of the neck as anchorage to apply forces to the dental or basal arch. It may be orthodontic force or orthopedic force to move the dentition, or restrict or redirect the growth respectively.
Philosophy:
The philosophy beyond the use of extra-oral force is based upon the old concept that, (the application of appreciable amount of force against the growing bone con modify or alter the direction of bone growth and consequently alter the shape and position of the bone
= the well-known best examples are the induced skull deformation in Colombia –India and feet deformation in Chinese girls
History and development:
Appliances resembling chin cups have been in use since the early 1800's. According to Graber, the early attempts with the chin cup were not successful because of incomplete knowledge of mandibular and facial growth, its use on non-growing patients, and an inadequate understanding of the forces generated by the chin cup.
1802: Cellier and Josef Fox in 1803, utilized chin caps in combination with bite blocks to correct the “underslung chin”
1866: Norman Kingsley introduced extra-oral head cap anchorage or force for maxillary distal movement
1880: Kingsley described an appliance that could influence the position of the dentition in upper jaw with the aid of extra-oral forces
1887: E.H.Angle recommended the use of occipital bandage in treatment of maxillary protrusion
1904: Jackson was first describing the facial mask
1892: headgear appliance was originally designed by Kingsley
1920: Angle and his followers were convinced that class II and class III elastics not only moved teeth but cause a significant skeletal changes: stimulate growth of one and restrain growth for the other so we not need to use any extra-oral force just wait until permanent dentition is completed
1923: Case recommend the use of extra-oral force against maxilla in treatment of class II and class I maxillary protrusion
1947: Kleohn, presented his treatment results with cervical neck strap, subsequent to this report, many other variation of the headgear appliance were presented
1960: Delaire facemask
Classification of extra-oral force appliances according to uses
The extra-oral pull is generally applied bilaterally, for three main purposes:
(1) as a restraining force
(2)
Effects of extra-oral appliances
And
Forces
Prepared by
Dr. Mohammed Alruby
Factors affect extra-oral force
Studies of maxillary protraction force
Results of extra-oral force
Effects of extra-oral appliances
The effects of extra-oral forces on dentofacial structure depend on the following factors:
- Direction of force
- Magnitude of force
- Duration of force
- Growth
- Patient cooperation
1- Direction of force:
Kloehn 1953, Gould 1975, Greenspan 1970, Merrifield and Cross 1970, and Worms et al 1973, all give an adequate description for the direction of force application and their effect on maxillary molar position, tipping, bodily, extrusion, intrusion movement
The direction of force should be adjusted according to the patient needs and objective of treatment as:
- When bodily movement is required, the force should pass through the center of resistance of molars (at the tri-furcation of roots) and the extra-oral tube should be placed gingivally as possible
- When bodily displacement of maxilla is required, the force should pass through the center of maxillary resistance (zygomatic bone)
- When extrusion of molars is required, (in case of deep bite) the force should pass below the center of resistance (below the level of occlusal plane)- cervical headgear is the best choice
- When intrusion is required (open bite cases) the force should pass above the level of occlusal plane
- In occipital headgear, the vector of force may pass through the center of resistance of 1st molar and thus causes: -------------- distal translation of 1st molar
- If the vector of force passes above the center of resistance causing:
a- Distal root torque
b- Mesial crown tipping
c- Intrusion of maxillary 1st molar ---- that, ----- closing the bite and same can occurs in the vertical or high pull headgear
== the direction of force can be determined by adjusting the outer bow in relation to the occlusal plane or center of resistance
== the best method for recording the force direction is the lateral cephalometric radiograph with the appliance in place, then the outer bow is adjusted in relation to the occlusal plane and the center of resistance of tooth or jaw
= in Kloehn’s face bow, the direction of force is 25 – 30 degree below the occlusal plane so that, the vector of force is far away from the center of resistance of 1st molars, thus cervical headgear causes distal tipping and extrusion of 1st molars and open bite
The direction of force depends upon the following variables:
I- Vertical position of the outer bow relative to the center of resistance:
= force applied by oblique headgear passing through the center of resistance will cause translation of the tooth and make intrusion at the same time
= force applied by oblique headgear passing above the occlusal plane
but below the center of resistance will cause:
a- Distal crown tipping, mesial root torque
b- Extrusion of mesial marginal ri
Characteristic of light
History
Laser physics and properties
Component of laser
Classification of laser
Biological effect of laser
Laser effect on dental tissues
Laser safety in dental practice
General application of laser
Personal protective equipment
Types of laser intensity in orthodontics
Uses of laser in orthodontics
Effect of laser in orthodontics
Introduction
History
Classification of maxillary fractured Lefort
Special consideration for orthognathic surgery
- Patient selection:
Age of patient
Assessment of patient motivation and expectation
The nature and severity of skeletal dysplasia
Systemic evaluation
- Patient evaluation:
(1) General evaluation
(2) Esthetic evaluation
(3) Functional evaluation
(4) Radiographic evaluation
a- Ceph ---
PA
Lateral: ------ soft and hard
b- Panorama
c- CBCT
d- Periapical
Protocol for basic orthognathic record collection
Treatment planning
- Time of treatment
- Objective of orthodontic treatment
Pre-surgical
Post-surgical
- Sequence of treatment:
Pre-surgical phase
Orthodontic in theatre
Post-surgical treatment
Surgery without orthodontics
Stability and clinical success
complications
Medical glossary
Prepared by:
Dr. Mohammed Alruby
Medical glossary
Aberrancy: occurring or developing away from the normal situation
Acantholysis: loss of coherence between epithelial cells due to degeneration of desmosomes (intercellular bridge) this will lead to the formation of intra-epithelial clefts, vesicle and bullae
Acanthosis: epithelial hyperplasia, mainly of the stratum spinosum, leading to increase thickness of the stratum granulosum due to increased number of cell layers of prickle cells
Achondroplasia: an autosomally inherited disorder characterized by abnormality of conversion cartilage into bone predominantly affecting the epiphyses of long bones, leading to retarded growth at the epiphyses and resulting in dwarfism with short extremities but normal trunk
Acidogenic: referring to organisms capable of producing acid
Aciduric: referring to organisms capable of surviving and metabolizing under highly acidic conditions
Acquired: a term used to describe a condition, habit or other characteristic which is not present at birth, which developed in the individuals by reaction to some environmental factor (to acquire is to obtain)
Agenesis: failure of formation leading to absence of a part or organ
Aglossia: failure of formation leading to absence of the tongue
Agnathia: absence of the jaw, usually the lower jaw, usually accompanied by approximation of the ears
Amyloid: pertaining of starch, having the characteristic of starch. A protein compound of albumin and chondroitin sulphate which resembles starch in appearance and may be pathologically deposited in certain tissues
Anaplasia: atypical differentiation or lack of differentiation of epithelial cells occurring in the malignant disease. Anaplastic cells have large, hyperchromatic, irregularly shaped nuclei and frequently show a typical mitosis.
Aneuploidy: an abnormal number of chromosomes in a nucleus. This usually arise from failure of paired chromosomes or sister chromatids to disjoin at anaphase of cell division
Aneurysm: circumscribed dilatation of an artery
Aneurysmal: relating to an aneurysm. The term applied to a type of cyst that produce bony expansion simulating the expansion of an artery produced by a vascular aneurysm
Angiogenesis: development of blood vessels
Angioma: a swelling or mass due to proliferation with or without dilatation of vascular channels
Anhydrosis: absence of sweating due to absence of sweat glands
Ankyloglossia: tongue tie, usually due to a short lingual frenum or one attached too near the tip of the tongue, may be due to failure of separation of tongue from the floor of the mouth during embryogenesis
Ankylosis: stiffening or fixation of a joint as a result of a disease process
Anodontia: absence of teeth
Anomaly: deviation from the normal, anything structurally unusual or irregular
Antigen: a substance that can induce an antibody response
Antimongoloid slant: an obliquity of the palpebral fissures laterally
Muscles
Part 3
Prepared by
DR. Mohammed Alruby
Development of oropharyngeal function
Neuromuscular regulation of jaw positions and functions
Muscles controlling mandibular postures
- Muscles of mastication
- Submandibular muscles
- Extensor and flexor muscles of neck
Positions of mandible
Some clinical implications
Development of oropharyngeal function
1- Prenatal maturation:
= During prenatal life, the neuromuscular system does not mature evenly, it is not accidentally that the orofacial region matures a head of limb region
= In human fetus, by about the 8 week, generalized uniform reflex movement of entire body can be elicited by tactile stimulation
Diffuse spontaneous movements in response to as yet unidentified stimuli have been observed as early as 9.5 weeks
Localized specific and more peripheral responses cannot be produced before 11 weeks, and at this time, stimulation of the nose-mouth region causes lateral body flexion
By 14 weeks, the movements have become much more individualized. Stimulation of the mouth area, the general bodily movements no longer are seen but instead facial and orbicular muscle response are produced
Stimulation of the upper lip causes the mouth to close and often deglutition occurs
Respiratory movements of the chest and abdomen are seen first at about 16 week
The gag reflex has been demonstrated in human fetus of 18.5 weeks. By 25v weeks, respiration is shallow but may support life for few hours
Stimulation of the mouth at 29 weeks’ menstrual age has elicited sucking through complete suckling and swallowing is not thought to be developed until at least 32 week
2- Neonatal oral functions:
a- The mouth as sensory instrument:
= At birth, the orofacial region is a very active perceptual system, the infant finds the mouth nipple = more tactile than the visual sensation
At birth, the tactile sense already is more highly developed in the lips and mouth than in the fingers
= The neonate’s slobbers, drools, chew his toe, sucks his thumb and discovers the gurgling sounds can be made with his mouth
= oral function of the neonate is guided primarily by local tactile stimuli, particularly those from the lips and anterior part of the tongue
= the posture’s of neonate’s tongue is between the gum pads and often for enough forward to rest between the lips, where it can perform its role of sensory guidance more easily
= the mouth of infant is used for many purpose, the perceptual functions of the tongue, lips, and facial skin are mingled with the sensory function of taste, smell and jaw position.
= the sensitivity of tongue and lips is greater than other area of the body and the sensory guidance for oral functioning, including jaw movements is from remarkably large area
b- Infant suckling and swallowing:
= Infant suckling and swallowing have been the subjects of much research due to the effectiveness of these activities is a good indication of the neurologic ma
Muscles
Part 2
Prepared by:
Dr. Mohammed Alruby
Muscle function and malocclusion
Muscle development and skull form in relation to function
Facial balance, muscle balance, and orthodontic therapy
EMG response of muscles
Myofunctional therapy
Basic concepts of neuromuscular physiology
Muscle function and malocclusion
Muscle function is a factor in shaping the dental arches and is important in maintaining the stability of the teeth following orthodontic treatment
Muscle fibers contract in response to change in electrical potential of its investing membrane, proprioceptors located in the muscles and the periodontal membrane make possible a high degree of accuracy in bringing the teeth in contact
Class II malocclusion:
The muscle function is usually normal in class I malocclusion with the exception of class I Openbite
In class I cases, the teeth are in state of balance with environmental force, although the actual measurements of tongue and lip forces showed that, they are not equal at any area during particular function
Class I openbite:
= Usually caused by thumb sucking, retained infantile tongue swallowing or both, the child begins with finger habits of sufficient intensity and duration to deform the maxillary anterior segment forcing the incisors labially and allowing the tongue to move farther in forward direction
= the tongue continues to thrust instead of entering the transitional phase, a large part of this activity may be compensatory or adaptive to produce anterior seal with lower lip during swallowing
=such activity accentuates the openbite, prevent complete eruption of incisors and increase the overjet to the extent that the lower lip may cushion behind the maxillary incisors during rest and functional movements
- The upper lip become more hypotonic
- The lower lip become hyperactive
- Chin puckering can see with each swallowing
= the hyperactive mentalis muscle, retroclined, imprecate and flatten the mandibular anterior segment
= the tongue drop downward and mouth breathing become a dominate pattern, as the tongue thrust forward, it elongates in shape thus alter the balance with buccinator mechanism resulting in:
- Collapse of posterior segment
- V-shaped palate
- Buccal cross bite
This occurs also as a result of molding effect of the tongue upon the hard palate
Mouth breathing:
Is the good explain for these changes a result of underdeveloped nasopharyngeal structures and subsequently maxillary deficiency
Class II division 1 malocclusion:
= In contrast to class I class II div 1 involve an abnormal muscle function from beginning
= As abnormal muscle function in class II div 1 is a compensatory or adaptive and is secondary to skeletal relationship
= Because of large overjet, there is lack of the lip seal during rest and various functions so, mouth breathing is developed
= Some individuals translate the mandible forward to effect lip seal and to improv
Muscles
Part 1
Prepare by
Dr. Mohammed Alruby
Histology of muscles
Physiology of muscles
Muscles development
Orofacial muscles
- Facial muscles
- Jaw muscles
- Portal muscles
Methods of studying muscles
Muscle changes during growth
Muscle function and facial development
Histology of muscles
The structural and functional unit of the muscles is the muscle fiber
Muscle fiber: elongated cylinder measure about 10 to 80 microns in thickness and from 1 to 15cm in length
= Each muscle fiber contains an acidophilic granular cytoplasm (sarcoplasm) that rich in:
Glycogen, mitochondria, Golgi apparatus, protein (actin, myosin, tropomyosin),
Large number of myofibrils (sarcostyles) which responsible for muscle contraction
= the muscle fiber is covered by thick membrane called (sarcolemma) and surrounded by CT called (endomysium)
= the muscle fibers are coalescing together to form bundles; each bundles are covered by C T septa called perimysium
= the muscle bundles are coalescing together to the whole muscle which is covered by CT fascia called epimysium, these CT contain: blood vessel, lymph vessel, and nerves, that firmly attach the muscle bundles to each other and attach the whole muscle to its tendon
= the myofibrils (sarcostyles)are the contractile units of the muscle, in skeletal muscle they are transversely striated due to presence of dark and light bands
The dark bands are formed of thick myosin filaments rich in Ca, the light bands are formed of thin actine filaments rich in water, there is a pale line in at the center of dark band called (Henesen’s disk), There is dark line at the center of light bands called (Krauses membrane) or Z line
The distance between the two lines called (sarcomere) which is a contraction unit of the muscle.
During the muscle contraction there the Sarcomere is shortened due to sliding of the light bands over the dark bans. The energy required for contraction is derived from transformation of ATP ------ ADP
Physiology of muscles:
Man has 639 muscles, composed of 6 billion muscle fibers, each fiber has 1000 fibrils, which means that there are 6000 billion fibrils at work at one of time or another.
Elasticity: muscle can be stretched behind its original length and return to the original shape after relaxation (normal muscle can be elongated about 6/10 of its length
Contractility: it is the ability of muscle to shorten its length under nerve impulse, this contraction is stimulated by acetyl choline, glycogen is partially oxidized to provides energy and lactic acid that carried away by blood stream
Excessive accumulation of lactic acid can produce fatigue
Isometric contraction: (stretching): the muscle is simply resisting the external forces without actual shortening
Isotonic contraction: there is an actual shortening of the muscle, the strength of isometric contraction is much greater than that of isotonic contraction as the stre
diagnostic aids part 3, photograph and radiograph.docxDr.Mohammed Alruby
Diagnostic Aids
Part 3
{Radiographs and Photographs}
{BMR and EMG}
Prepared by
Dr. Mohammed Alruby
Radiographs
Means: A procedure that uses a type of high-energy radiation called x-rays to take pictures of areas inside the body. X-rays pass through the body onto film or a computer, where the pictures are made
Types:
Intra-oral radiographs:
Periapical radiographs:
It is necessary for any orthodontic diagnosis for the following reasons:
The pattern and amount of root resorption of deciduous teeth
Presence or absence of permanent teeth, their size, shape, position and relative state of development
Congenital absence of teeth or presence of supernumerary teeth
Character of alveolar bone, lamina dura, and periodontal membrane
Morphology and inclination of permanent teeth roots
Pathological oral condition such as thickened periodontal membrane, periapical infection, root fractures, cysts, retained deciduous teeth
Abnormal path of eruption of permanent teeth
Malposition of individual as: rotation, which requires a larger space on the arch
Very useful in mixed dentition analysis
Recognition of exact position of impacted tooth by using method of parallax: that determine whether the unerupted tooth is located labially or palatally. Two periapical radiograph is taken with the film in the same position in each exposure, but the tube is moved in second exposure about 10cm. if the impacted tooth is moved in the same direction as the tube so the tooth is impacted palatally and the reverse is versa.
Bit-wing radiographs:
Is used mainly for detection of proximal cries, but it is of little value in orthodontic diagnosis
Occlusal film:
Occlusal projection is useful to locate the supernumerary teeth at the midline (mesiodens) and to determine accurately the position of impacted maxillary cuspids
Extra-oral radiographs:
Cephalometric radiographs:
Lateral cephalometric radiographs
PA cephalometric radiographs
Lateral oblique cephalogram:
The patient is directed by 45 degree and take the shot
Since dentofacial structure will be superimposed in the true lateral cephalometric projection, the lateral oblique direction is designed to gives a more accurate recording of the actual tooth position in either the left or right buccal segments depending on which side is approximately perpendicular to the central rays
The lateral oblique cephalogram combines most of advantages of the lateral views, intra-oral periapical survey and panoramic radiograph plus a standard cephalometric registration that makes possible measurements of bone size and eruptive movements so it is of particular size in analysis of developing dentition
Submental vertex cephalometric:
Is used to assess mandibular asymmetry in the transverse and anterior-posterior plane. It is an important aid in detecting asymmetry in the symphysis, body, ramus, and condyle of the mandible. In many cases of asymmetry, this view is important for evaluation of mandibular displacemen
Diagnostic Aids
{Study cast, Cast analysis}
Part (2)
Prepared by
Dr. Mohammed Alruby
Study cast
Definition: it is a positive replica of the teeth and their supporting structure, it should be reproducing accurately all the anatomical details of the teeth, alveolar process, mucobuccal folds, palate, frenal attachment as well as the exact relationship of the mandibular to the maxillary dental arch
Good models begin with good impression, orthodontic impression should displace the lips and cheeks, so that, the full depth of mucobuccal sulci is recorded. This over extension of impression is obtained by building up the tray periphery with wax or by using special orthodontic trays
The position of maximum intercuspation should be recorded by getting the patient to bite through softened wax, that is important for:
1- Recording the proper intercuspation specially in cases of poor occlusal fit due to extraction or tongue thrust. So it is wise to check the occlusion in the mouth and compare it to the occluded cast to insure that the model is correctly articulated
2- Trimming of the upper and lower cast together without change in occlusal relationship or fracture of teeth
Occlusal registration of wax bite:
= the position of maximum intercuspation as well as the centric relation must be registered
= a piece of soft wax large enough to cover the occlusal surface of maxillary teeth is shaped to the form of maxillary arch, then gently pressed against the maxillary teeth
= the patient instructed to relax and mandible is guided to most posterior and superior position of condyle within the glenoid fossa, while the teeth come into occlusion
= if there is shifting during closure due to cuspal interference, this mean that the occlusal position is not coincide with centric occlusal position, in this case, in this case two bites are taken one for usual occlusal position, and the other for centric occlusion
Ideal requirements of orthodontic study models:
1- They are symmetrical and pleasing to the eye and so that a symmetrical arch form can be readily recognized
2- The dental occlusion shows by setting the models on their backs
3- Clean, smooth, bubble free, with sharp angles where the cuts meet
4- Glossy in finish.
Trimming of study models:
There are two types of trimming:
a- Angle trimming:
The purpose of angle trimming is to added an appropriate proportional bases to the anatomical portion of dental casts which is important in:
- Registration of centric occlusion by having the posterior and lateral border of both casts on the same plane, so that cast may place on any side without change in its relationship
- Giving an idea about the relationship of the teeth to the alveolar process and basal bone
- Giving harmonizing appearance of the right and left sides of the cast which any a symmetry can be detected
- Detection of occlusion from any side, anterior as well as lateral sides
Principles:
1- The floor of the base is trimmed
diagnostic aids part 1 diagnosis, examination, BMR, EMG.docxDr.Mohammed Alruby
Introduction:
Proper treatment plane depends on prompt diagnosis, good clinician should have a bird’s eyes to first identify the problem and find its etiology
Definitions:
= Grabber and Rackosi: defined diagnosis as:
Recognition and systemic designation of anomalies, the practical synthesis of the finding, permitting therapy to be planned and identification to be determined
=a continuous evaluation process in orthodontics starting right from the first interaction with the patient continuing through different stages till end of treatment and course follow up visits
Goal of orthodontic diagnosis:
Is to produce a comprehensive description of the patient’s problem and then to synthesis the various elements of description into a rational problem list
Diagnostic aids:
Data required for orthodontic diagnosis are derived from routine essential diagnostic aids and also from supplemental aids when needed, Graber categorized the diagnostic aids into essential and supplemental aids
Essential:
- Case history
- Study models
- Certain radiographs: periapical, bite wing, panoramic radiograph
- Facial photographs
- Intra-oral photographs
Supplemental:
- Specialized radiographs: occlusal of maxilla and mandible, lateral cephalogram
- Hand &wrist radiograph
- Electromyography
- Endocrine test
- Basal metabolic rate
Case history:
Complete case history includes all the relevant information derived from the patient and parents and essential for planning
Personal details:
Name:
The patient’s name should be recorded for the purpose of identification and communications
Calling the patient by his/her name not only establishes a good report but also imparts confidence in the patient mind about treatment providers
In case of children, it might help to know their pet problems
Age:
= certain malocclusion occurring during growth period are transient and self-correcting
= growth modification procedures such as functional appliances can be carried out during growth periods
= surgical respective procedures such as orthognathic surgery are best carried out after cessation of growth
= chronological age is important for the maintaining of shedding and eruption time tables as well
Gender:
= recording gender of the patient is important for treatment planning, females are observed to precede males in growth related events such as onset of growth spurt, eruption of the teeth and onset of puberty
= gender may also have a bearing on patient’s compliance toward certain types of orthodontic treatment
Occupation and address:
Occupation of patient / or parents gives an idea about socioeconomic condition which might affect the selection of orthodontic appliances and can give an idea about awareness
Address of patient determine the sociality of the patient and this effect on the treatment because some countries have normally bi-maxillary protrusion and also determine the awareness of patient about treatment and oral hygiene
Patient behavior:
Behavior of patient depend on: patient
Smile: is the most pleasant and wanted expression by each one of us.
Smile: is amused facial expression with the corner of mouth turned up and exposed front teeth
Facial expression, postures of lips, occlusion and arrangement of teeth, buccal corridor, shape of teeth, gingival color, texture, contour and other several aspects constitute component of smile
Most of patients come to us to improve their smiles, the orthodontic studies stress on skeletal structure than soft tissue structure, and the smile still receives relatively little attention
Nature of smile:
1- Posed smile: voluntary, static, sustained, social smile not elicited by an emotion
2- Un-posed smile: spontaneous, involuntary, dynamic, natural, and not sustained characterized by greater lip elevation
Smile types: smile styles:
1- Commissures smile: the corner of the mouth turned upward called Monalisa smile
2- Cuspid smile: the upper lip is elevated, the entire lip rises like a window shade
3- Complex smile: the upper lip moves superiorly as in cuspid smile and lower lip moves inferiorly
Evaluation of posed smile:
variables Normal smile Not good smile
Smile arc Consonant Non consonant
Smile index Average Increased / decreased
Morley’s ratio 75 – 100% (normal) Disturbed
Buccal corridor Average Obliterated / excessive
Smile line Average High / low
Occlusal plane No canting Canting occlusal plane
Important definitions:
Smile arc:
the curvature formed by an imaginary line tangent to the incisal edges of the teeth, modified in varying degree of curvature in relationship to the lower lip
Range: from no curvature to an accentuated curvature was in relation to the lower lip, so quantification differed for each model
Buccal corridor:
the amount of dark space displayed between the facial surfaces of the posterior teeth and the corner of the mouth, calculated as the total dark space on both sides of the mouth as a percentage of the total smile width
Range: from 6% to 26.5 in approximately 0.5% increments
Maxillary gingival display or gummy smile:
The amount of gingival show above the central incisor crown and below the center of the upper lip. Negative number indicate gingival exposure. Positive number indicate tooth overlap by the lip
Range: from 1mm of gingival display (-1) to almost 7mm of tooth coverage for the female models, and approximately 2mm of gingival display (-2) to 6mm tooth coverage for male models
The variation between the models was due to differences in sizes and coordinating the images for different faces
Maxillary midline to face:
The relationship of maxillary dental midline (measured between the central incisors) to the midline of the face, defined by the center of the philtrum and the facial midline
Range: the maxillary midline was moved to the left of the face in approximately 0.25 mm increments. The right and left buccal corridor was maintained throughout the movement of the dentition. The maximum deviation show is 6mm
Maxillary to mandibular mid
Successful infection prevention program
A successful infection prevention program depends on:
1-Developing standard operating procedures.
2- Evaluating practices and providing feedback to dental health care personnel (DHCP).
3- Routinely documenting adverse outcomes (e.g., occupational exposures to blood) and work-related illnesses in DHCP.
4- Monitoring health care associated infections in patients.
Standard Precautions
Standard Precautions: are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients.
Standard Precautions include:
1- Hand hygiene.
2- Use of personal protective equipment (e.g., gloves, masks, eyewear).
3- Respiratory hygiene / cough etiquette.
4- Sharps safety.
5- Safe injection practices (i.e., aseptic technique for parenteral medications).
6- Sterile instruments and devices.
7- Clean and disinfected environmental surfaces.
Each element of Standard Precautions is described in the following sections. Education and training are critical elements of Standard Precautions, because they help DHCP make appropriate decisions and comply with recommended practices.
1- HAND HYGIENE:
1- Perform hand hygiene.
a. When hands are visibly soiled.
b. After bare hand touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions.
C. Before and after treating each patient.
d. Before putting on gloves and again immediately after removing gloves.
2. Use soap and water when hands are visibly soiled (e.g., blood, body fluids); otherwise, an alcohol-based hand rub may be used.
2- PERSONAL PROTECTIVE EQUIPMENT (PPE):
1- Provide sufficient and appropriate PPE and ensure it is accessible to DHCP.
2- Educate all DHCP on proper selection and use of PPE.
3- Wear gloves whenever there is potential for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment.
a- Do not wear the same pair of gloves for the care of more than one patient.
b- Do not wash gloves. Gloves cannot be reused.
c- Perform hand hygiene immediately after removing gloves.
4- Wear protective clothing that covers skin and personal clothing during procedures or activities where contact with blood, saliva, or OPIM (other potential infectious materials) is anticipated.
5- Wear mouth, nose, and eye protection during procedures that are likely to generate splashes or spattering of blood or other body fluids.
6- Remove PPE before leaving the work area.
3- RESPIRATORY HYGIENE / COUGH ETIQUETTE:
1- Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and conti
The way to infection control in dental clinics
Introduction:
The unique nature of dental procedures, instrumentation and patient care settings require specific strategies directed to the prevention of transmission of diseases among dental health care workers and their patients.
Disease: impairment of normal functioning, manifested by signs and symptoms.
Infection: state produced by an infected agent in or on a suitable host, host may be or may not have signs or symptoms.
Carrier: individual harbors the agent but does not have symptoms (person can infect others).
Factors that allow or aid infection:
= The presence of pathogenic micro-organisms.
= There must be a portal of entry via which the organisms invade and colonize the susceptible host.
Medical history
A thorough medical history should be taken and up-dated at subsequent examinations. Medical history screening is essential in alerting the clinician to medical problems that could, in conjunction with dental treatment, adversely affect the patient.
Protective measures
Protection can be achieved by a combination of immunization procedures, use of barrier techniques and strict adherence to routine infection control procedures.
(a) Immunization:
All dental health care workers are advised to be immunized against HBV unless immunity from natural infection or previous immunization had been documented
(b) Protective coverings:
=Uniforms:
Uniforms should be changed regularly and whenever soiled. Gowns or aprons should be worn during procedures that are likely to cause spattering or splashing of blood.
=Hand protection:
Gloves must be worn for procedures involving contact with blood, saliva or mucous membrane. A new pair of gloves should be used for each patient.
If a gloves damaged, it must be replaced immediately. Hands should be washed thoroughly with a proprietary disinfectant liquid soap prior to and immediately after the use of gloves.
Disposable paper towels are recommended for drying of hands.
Any cuts o abrasions on the hands or wrists should be covered with adhesive waterproof dressings at all times.
=Protective glasses, masks or face shields Protective:
Glasses, masks or face shields should be worn by operators and close-support dental surgery assistants to protect the eyes against the spatter and aerosols which may occur during cavity preparation, scaling and the cleaning of instruments.
(c) Sharp instruments and needles:
Sharp instruments and needle should be handled with great care to prevent unintentional injury. Needles should never be recapped by using both hands indirect contact or by any other technique that involves moving the point of a used needle towards any part of the body. The needle can be recapped by laying the cap on the tray, placing the cap in a re-sheathing device or holding the cap with forceps before guiding the needle into the cap.
(d) First aid and inoculation injuries:
preventive and interceptive for general practitioners.docxDr.Mohammed Alruby
Scope of orthodontics
for general practitioner
Prepared by
Dr. M Alruby
Orthodontics: is a branch of science and art of dentistry dealing with prevention, interception, and correction of positional and dimensional dentofacial abnormalities.
Orthodontic treatment could be divided as follow:
1- Preventive orthodontic treatment.
2- Interceptive orthodontic treatment.
3- Corrective orthodontic treatment. a) Early corrective. b) late corrective.
4- Post. Treatment maintenance or retentive and follow up.
Preventive orthodontics:
It is defined as that phase of orthodontics employed to recognize and eliminate potential irregularities and malposition in the developing dentofacial complex. It is directed toward improving environmental conditions to permit future normal development
N: B: the child as a patient: children will accept orthodontic treatment if the purpose for treatment is explained in a simple terms that they can understand. Information concerning treatment aims and procedures should be given to the child without hesitation and under authority; neither gives him a great attention nor neglect him. Be familiar with the child and give him some sympathy.
Most children at preadolescent age are ready to accept orthodontic treatment if the orthodontist was able to establish a sympathetic relationship with the child. The child must not force to treatment but it is better to postpone treatment until the child feels the needs for treatment.
The adolescent patients: the 15 years old patient frequently consider himself as a man and must has a special management. Adolescent patient may deny that his teeth need correction and warning of the appliances. It is very important to know whether the patient came to the office alone, with friends or forced by his parents.
Preventive orthodontics is a long range approach and it is largely a responsibility of the general dentist. Many of the procedures are common in preventive and interceptive orthodontics but the timing are different.
Preventive procedures are undertaken in anticipation of development of a problem. Interception procedures are undertaken when the problem has already manifested. For extraction of supernumerary teeth before they cause displacement of other teeth is a preventive procedure, while their extraction after the signs of malocclusion have appeared is an interceptive procedure.
Preventive procedures:
A- Pre-dental preventive procedure ( parents education):
Instruct the mother to feed her baby from breast and if the baby to be feed by a bottle, the nipple should be long enough to rest on the anterior third of the tongue. It also should contain a small side opening instead of single large end hole, this allows the milk to flow on the dorsum of the tongue and prevent it from being squeezed directly into the pharynx, by this method the tongue is allowed to function properly during swallowing which is very important in general growth of the jaws, al
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1. 1
Dr. Mohammed Alruby
Accelerated orthodontic tooth movement
Prepared by:
Dr Mohammed Alruby
هللا من اطلب ولكن سهله حياه يعطيك ان هللا من تطلب ال
الصعبه الحياه مواجهة علي القوه يعطيك ان
2. 2
Dr. Mohammed Alruby
Accelerated tooth movement in orthodontic is a challenging task to shorten the treatment time
Research in this area confined into the following categories;
1- Biomechanical approach: as self-ligating system
2- Physiological approach: such as direct electric stimuli, or low level Laser therapies
(LLLTs)
3- Pharmacological approach: local injection of cytokines or hormones
4- Surgical assisted approach: periodontal ligament distraction, dento-alveolar distraction,
selective decortication,
5- Surgery simulated approach: as submucosal injection of platelets rich plasma (PRP)
1- Biomechanical approach: self-ligating bracket system
= 1st
self-ligating -------- Russell attachment 1935
= edge lock (oramco) ----- 1972
= mobile lock (Forstadent) ------1980
= speed ---------------- 1980
= active --------------- 1986
Self-ligating brackets has 2 categories, active and passive
Active: bracket have a spring clip that store energy to pass against the arch wire
Passive: bracket have slide that can be closed and does not encroach on slot lumen
Self-ligating bracket enable tooth to slide along an arch wire with lower and more predictable net
forces with complete control
Mechanism:
The primary advantage of self-ligating over conventional that occurs because the usual steel or
elastomeric ligature not necessary
Passive design generates less friction than active one. Under conventional, the friction / bracket
with Niti wire was 41gm in Dentaurum bracket, and 15gm with Damon bracket with stainless steel
wire
With reduced friction may become 3.6gm so less force needed to produce movement
Self-ligating bracket produce more physiologically harmonies tooth movement by interrupting
periodontal vascular supply so:
- More alveolar bone generation
- Greater amount of expansion
- Less Proclination of anterior segment
- Less need for extraction
** several systematic reviews and studies revealed that self-ligating bracket do not accelerate
alignment or space closure in clinical setting, this approach paradox in likely due to the effect of
binding because when the teeth tip, rotate or torque, the edges of slot engage the arch wire creating
binding so that resistance to sliding increase.
** because the bracket design of self-ligating is narrower than conventional type so the effect of
binding is greater resulting in increased resistance to sliding compared with conventional. Less
incisor Proclination appear the more advantage of self-ligating bracket
** tooth movement is a metabolic process of alveolar bone resorption and deposition of bone, so
acceleration of movement may affect by biological and surgical procedure
2- Physiological approach: direct electric current stimulation:
Beason et al, the 1st
that proposed use of electric current for orthodontic tooth movement near to
tooth that moved but failed to demonstrate the effect on movement
3. 3
Dr. Mohammed Alruby
DavidoVitch et al reported successful results in accelerating orthodontic tooth movement through
direct current on gingival tissue as near as possible to the moving teeth
Mechanism:
Direct electric current was 7 volt and 15 microamperes, and was placed on pressure side and
cathode on tension side, the bone formation and resorption is higher than the teeth with orthodontic
alone :
- Increase osteoblast
- Increase PDL
- Increase osteoclast
The use of electric current is used on cats, no clinical application has been reported because the
device was too cumbersome and bulky to used clinically
In 2007 Sony announced the development of a bio battery that generate electricity from
carbohydrate (sugar) and other one using glucose and immobilize enzymes as catalyst. Because of
very small size of these enzymes batteries, the procedure can deliver them into human body with
minimum injury, these enzyme batteries have two major problems: short life time, and poor power
density
Endogenous Piezoelectric stimulation:
** Electrical potential can be created by applying a force to a tooth which result the generation of
piezoelectric charges
These force should not be continuous because the Piezoelectric charges are created when stress to
the bone is applied and released.
** Nishimura et al found approximately 15% more of tooth movement when using resonance
vibration within 21 days for 8 minutes / day when compared with control group with static force
(in animal)
** the 1st
report involving human subjects had patient use vibrational appliance for 20 minutes /
day and report promising rate of tooth movement (Kav 2009)
2 –3 mm movement appear to be impressive, it must be remembered that this was a reduction in
little irregularity index and not a transitional movement
** a prospective RCT (randomized clinical trial) examined 45 subjects require extraction of 1st
premolar for crowding. Patient randomized to use acceledent appliance or sham appliance that
deliver 250gm force for 20 minutes / day
Nickel titanium coil spring attached from canine to TSAD and every 4 weeks the distance is
measured to assess the rate of space closure. Results: 39% of subjects was 38% faster in
acceledent when compared with control group
N: B:
Electromagnetic: Electrical field suggested enhancing tooth movements rate by altering the
shape of PDL cells and their membrane polarization.
Ultrasound: Ortho accel’s technology is predicated on the application of pulsating low
magnitude forces (cyclic forces) to the teeth and surrounding bones.
The application is done through a splint in which patient bites, while motor produce through the
splint vibrational low force to the whole dentition
Its uses constricted only during closing spaces or long periods movement of treatment.
Side effect: increase salivary secretion, increase patient comfort
4. 4
Dr. Mohammed Alruby
Low –level laser therapy LLLT:
Gallium, Aluminum, arsenide, laser irradiation was most frequently use LLLT, that is applied on
buccal mucosa, distal, palatal of tested teeth,
Wave length: ----630 – to 860nm
Energy: 4.5 to 6.0 J/cm
Mechanism;
= increase alveolar turn over
= significant histologic changes in alveolar bone
= increase number and differentiation of osteoclast ---- increase bone resorption
= increase secretion and proliferation of fibroblast
= increasing collagen matrix deposition
= increase number of osteoblast on tension side
Studies:
Some studies reported positive results from use LLLT
Some studies report no effect
Some studies reported retarded tooth movement
== the key factor in the effect is energy not wave length for acceleration. Limpanickhul et al 2006
in clinical study found that 25 j/ cm of LLLT at the surface level too low to express either
stimulatory or inhibitory effect on rate of orthodontic tooth movement (canine retraction)
== in double blinded study on dogs, Goulart et al demonstrate the effect of LLLT 5.25J/cm dosage
accelerate tooth movement in the 1st
observation of 21 days, but 35J/cm demonstrate retard
orthodontic tooth movement compared with control group
N: B:
Blind experiment: is an experiment in which information about the test is masked from the
participant to reduce the bias until trail outcome are known
Double blind: both tester and subject are blinded
3- Pharmacological approach:
In attempt to accelerate tooth movement, cytokines and hormones are tested and tried including:
corticosteroids, prostaglandin, parathyroid hormone, growth hormone, relaxine
All these agents tested experimentally because of their adverse effect except prostaglandin and
relaxin which tested clinically without adverse or systemic effect
Prostaglandins:
Chemical messengers belonging to family hormones called (eicosanoids) they are paracrine
hormone. The effect of prostaglandins is:
- Stimulate contraction of smooth muscle of uterus
- Affect blood flow, sleep cycle and response to hormone like adrenaline
- Significant increase tooth movement
= it has been suggested that cytokines and other inflammatory mediators such as prostaglandin
E2 may activate bone remodeling characterized by bone resorption at pressure side and bone
formation at tension side
= pressure causes changes in PDL blood circulation that allow release chemical mediators that
play role in formation of cells in PDL.
= Yamaski et al and Harel et al: reported that the application of orthodontic force increase
synthesis of prostaglandins (PG) which stimulate osteoclast activity and bone resorption, also
Indomethacin inhibit the appearance of osteoclast and bone so use of non-steroidal anti-
inflammatory drugs slower tooth movement injection of PGE1, PGE2 into gingival tissue near the
maxillary molar stimulate osteoclast and increase rate of tooth movement
5. 5
Dr. Mohammed Alruby
Studies:
Following local anesthesia 0.1ml of 0.01% PGE1 Solution in saline was injected submucosaly or
under mucoperiosteium in pressure side of tooth movement was 2 to 3 times faster than control.
Injection repeated weakly interval
There is no evidence for pathologic change. Movement was varied individually.
Relaxin:
Is in insulin / relaxin family of structural related hormone
Can be found in many tissues in males and females’ rats: kidney, heart, liver, lung, skin
Mechanism:
- Increase turnover of extracellular fibrous connective tissue
- Increased collagen deposition in response to tensional forces
- Decrease type I collagen in response to compression forces
- Affect osteoclastic behavior so increase bone resorption through increase turnover necrosis
factor and interleukin 1B secretion
- Increase collagen synthesis in compression side.
Local injection of human relaxin reduced relapse rotation after orthodontic tooth movement
compared with control group
Other studies; relaxin do not accelerate tooth movement in rats, it reduces the level of PDL
organization, increase tooth mobility at early time
4- Surgically assisted approach:
This approach includes techniques of rapid canine retraction through distraction of PDL:
a- Rapid canine retraction through distraction of PDL:
This technique is useful in adults because the time factor is important and movement is slower than
adolescent.
Tooth movement rats based on: cellular activity, strength of PDL, bony resistance of alveolar bone
Stiffness of PDL is higher in adult than adolescent and produce reduction in the biologic response
of PDL leading to delay in tooth movement at early stage.
The rate of tooth movement depends on the state of alveolar bone resistance; it is faster in bone
with loose bony trabeculae
Mechanism:
Surgical procedure in the inter-septal bone at the extraction side distal to canine to reduce the
resistance at pressure side
- Bond and band perform extraction
- 1st
molar and 2nd
premolar was anchor unit
- Niti arch wire placed on anterior segment for initial activation
- Length of canine can obtain from CBCT
- Socket of 1st
premolar is deepened to the same depth of canine with 4mm carbide surgical
bur
- Cylinder carbide bur used to reduce thickness of inter-septal bone 1 to 1.5mm thickness
- 1mm carbide fissure bur used to make two vertical grooves from bottom of socket to the
alveolar crest
- The two grooves joined obliquely toward the base
- Custom made distraction intra-oral device is used immediately after extraction and surgical
procedure
- Activation 0.5mm / day until canine in extraction side
- Patient seen a weak during procedure
6. 6
Dr. Mohammed Alruby
b- Rapid canine retraction through distraction of dento-alveolus:
It is a modified method similar distraction through PDL
Technique:
- Muco-periosteal flap is reflected
- Cortical hole is made by small round carbide bur in the alveolar bone from canine to second
molar
- Holes curved apically 3 to 5mm from the apex
- Thin tapered fissure bur is used to connect the holes around the root
- 1st
premolar extracted and the buccal bone removed between the outline bone cut at distal
canine region anteriorly and second premolar posteriorly
- Full mobilize the surrounding spongy bone around canine root
- Apical bone near the sinus removed leaving sinus membrane intact to avoid interference
during distraction process
- Osteotomy along the anterior aspect of canine are used to split the surrounding bone around
root from palatal and lingual cortex and neighboring teeth
- Leaving an intact lingual or palatal cortical plate and bone around the apex of canine
- Distraction is initiated within 3 days after surgery, activated twice / day – one at morning
and other at night ------- 0.8mm / day
= rapid canine retraction through PDL or dentoalveolar has minimal loss of anchorage
= anchorage loss reported 0.1 to 0.2mm, this because the retraction of canine was completed
while 1st
molar is still in lag period
= this method allow acceleration for only one tooth so it is used only on extraction case
= the distraction is more bulk and the process is more extensive aggressive and complicated
c- Selective alveolar decortication:
It is international injury of alveolar cortical bone to accelerate orthodontic tooth movement.
1892: 1st
described
1959; surgical approach to correct malocclusion with incision to the cortical alveolar bone while
leaving spongiosa intact to splint teeth into new position
1978: Generson et al describe rapid orthodontic treatment for open bite malocclusion using
alveolar decortication without subapical osteotomy
1991: treatment of large group adult patient with modified surgical procedure (Corticotomy
facilitated orthodontics)
Wilcko et al: accelerated osteogenic orthodontic AOO
Or: periodically accelerated osteogenic orthodontic PAOO by adding bio-absorbable grafting
material
RAP: regional accelerating phenomena:
Regional refer to demineralization of both the cut site and adjacent bone
Accelerating: exaggerated bone response in cuts that extend to marrow ((injury of alveolar bone
during active orthodontic tooth movement)).
== the authors suggested that RPA in human begins within few days of surgery, peaks in the 1st
or
2nd
month, and 6 to more than 24 months to subside
In the initial phase of RPA there is an increase in the cortical bone porosity because of increased
osteoclastic activity and speculated that bone dehiscence might occur after periodontal surgery in
an area which cortical bone thin
7. 7
Dr. Mohammed Alruby
== they summarized that RPA might be a contributing factor to increase mobility of teeth after
periodontal surgery
Technique of AOO / PAOO:
= full thickness flaps are reflected labially and lingually using sulcular releasing incision till level
of gingival attachment
= flaps reflected carefully beyond the apices of the teeth to avoid damaging of neurovascular
complex
= selective alveolar decortication is performed in form of cuts 0.5mm depth
= decortication in form of dots or lines or both
= placement of bio-absorbable grafting material over injured bone, this to compensate the increase
in osteoclastic activity at the initial phase of treatment.
= flaps are repositioned and sutured into place for minimum 2 weeks
= tooth movement should start 1 or 2 weeks after surgery
= after PAOO the activation of orthodontic force occur each 2 weeks until the end of treatment
Corticotomy-assisted orthodontics effective in reducing clinical orthodontic treatment time by:
1- Resolving anterior crowding
2- Retracting canine after premolar extraction
3- Facilitating eruption of impacted teeth
4- Facilitating slow expansion of maxilla
5- Intruding molars and correction of open bite
6- Decompensation for augmentation of mandibular anterior teeth ridge before orthognathic
surgery
Advantage of this technique:
1- Faster tooth movement
2- Shorter treatment time
3- Safer expansion of constricted arches
4- Enhanced post orthodontic treatment stability as compared with conventional orthodontic
Draw backs:
1- Invasive
2- Aggressive
3- Increasing post-operative discomfort
4- Risk of complication
5- Patient have to see every 2 weeks and this means that the duration of the increase in alveolar
turn-over that caused by decortication not long enough for necessary orthodontic
adjustment on monthly visits
There are several modification as: single sided partial Corticotomy, Piezocision, corticision, that
developed to reduce the invasive nature
Piezocision: minimal invasive flapless procedure combining micro incision and piezoelectric
incision
d- Corticision:
Corticision: accelerate both anabolic and catabolic alveolar remodeling activity while not
decrease the bone density
= accelerated tooth movement with minimal surgical intervention
8. 8
Dr. Mohammed Alruby
Based on: muco-periosteal flap reflection without any decortication resulting in widening of PDL
space and tooth mobility without any force application but: reduce the complication of crestal bone
resorption
Technique:
= use reinforced scalpel to separate the inter-proximal cortices trans-mucosal without reflecting
a flap
= blade is positioned on the intra-radicular attached gingiva at an inclination of 45 to 60 degrees
to the long axis of anterior teeth, inserted gradually into the bone marrow
= incision kept 2mm apically away from the papillary gingival margin and 1mm beyond muco-
gingival junction
= corticision has recently advanced into piezo-puncture, the surgical blade is replaced by piezo-
electric puncture, puncture rather than the incision penetrating the overlying gingiva and cortical
bone
5-Suegery simulated approach:
Submucosal injection of platelets rich plasma (PRP)
= the local injection of cytokines / hormones has similar effect as that of bone surgery, but it is not
clinically practical because of its systematic effects and need for frequent injection
= platelets are the initiator of both soft and hard tissue wound healing process
= platelets contain growth factors such as:
- Platelets derived growth factor PDGF
- Transforming growth factor TGF
- Endothelial growth factor
These growth factors are critical in:
- Regulation and stimulation of wound healing process
- Regulation of cellular process such as; chemotaxis, mitogensis, metabolism.
= peripheral blood contains: 94% red blood cells, 6% platelets, less than 1% white blood cells
= platelets rich plasma PRP: 5% red blood cells, 1% white blood cells, 94% platelets that
accelerate healing
PRP: applied on dental implantology to enhance osseointegration of dental implant and augment
alveolar bone height in maxillary sinus elevation
Methods of application:
1- PRP applied through flap operation and mixed and activated by CaCl2 and thrombin, but
surgery is aggressive
2- An innovative approach: by injection of PRP submucosal without mixing CaCl2 and
thrombin
= platelets adhere and aggregate layer by layer on surface of collagen
= generate thrombin
= platelets clot laydown on periosteum, then growth factor released and infiltrate
periosteum gradually
Technique:
= single dose injection after 0.9ml of local anesthesia on labial and lingual mucosa of
anterior teeth for pain control
= 0.7ml of PRP injected in labial and lingual attached gingiva and oral mucosa from canine
to canine at the same appointment of bracket bonded
= 500mg acetaminophen post injection pain control. 85% of patients report 6 -12 hours
after injection discomfort like itching reported moderate pain, 15% reported severe pain
Results:
9. 9
Dr. Mohammed Alruby
Tooth movement was accelerated in pt compared with pt with no injection of PRP
Tooth movements variable in the maxilla and mandible in all pts
Future concepts and feasibility
= The major problem of surgical approach is the invasive nature of surgery
= the non-surgical approach is not reliable because of individual variability
= the individual differences that affect the rate of accelerated tooth movement: alveolar bone
density and base line bone metabolism
Alveolar bone density in situ
And base line bone metabolism:
One way to differentiate the impact of base line bone metabolism and bone density on the rate of
orthodontic tooth movement is to compare the rate of tooth movement between the maxillary and
mandibular anterior teeth in the same individual
Liou et al, illustrated that the rate of orthodontic tooth alignment in maxillary teeth is faster than
in mandible because the alveolar bone density is lower in maxillary anterior teeth than in mandible
By assessing the ALP alkaline phosphatase and C- terminal of type I collagen I collagen ICTP
markers for base line osteoblastic and osteoclastic activity, Liou et al illustrated that base line
metabolism is correlated with the rate of orthodontic tooth movement
Bone metabolism- density guided orthodontics:
Root surface is another factor that affect the rate of orthodontic tooth movement as it is slow or
fast, So reinforced techniques can used to affect the rate of tooth movement As: submucosal
injection PRP, Corticotomy, corticision, piezoelectric or even gene-therapy
Summary points:
1- Self-ligating bracket do not perform faster alignment or space closure in a clinical setting
than conventional brackets
2- Direct electric current for accelerating orthodontic tooth movement was applied only
experimentally
3- Effect of LLLT on accelerating orthodontic tooth movement is still controversial both
experimentally and clinically
4- Effect relaxin in tooth movement is still dispute
5- Surgical assisted accelerated tooth movement is more effective either in PDL or alveolus
6- Submucosal injection of PRP accelerate tooth movement