This document discusses orthodontic treatment of adolescents. It notes that adolescence presents unique opportunities for orthodontic treatment as growth is still occurring. However, motivating adolescents can be challenging as they are focused on their peers and appearance. Treatment must consider the psychosocial development of adolescents and their desire for independence. Compliance is also a concern given the length of treatment. The document outlines factors influencing an adolescent's decision to undergo treatment and strategies for improving compliance, such as addressing their concerns. It provides an overview of adolescent orthodontic treatment objectives, advantages, difficulties, and considerations.
Body dysmorphic disorder in adult orthodontic patients /certified fixed ortho...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Psychological Outcomes in Cosmetic Surgeryamyhiggins444
Cosmetic surgery can enhance your life as well as your looks, according to industry advertisements and television shows, such as Extreme Makeover and Nip/Tuck. The idea is that a face “lift” will also boost one’s spirits and self-confidence. The problem is that the evidence supporting this assumption is tentative. Research shows that, following cosmetic surgery, patients variously report their mental health has either improved, not changed, or diminished. Psychiatrist David Castle, a leading researcher on the psychological outcomes of cosmetic surgery, is concerned by the “gloss” applied to cosmetic surgery that “suggests you will have a new life”, he says. “But of course, it doesn’t change the person you are on the inside.” David, who is a professor at the University of Melbourne and the Mental Health Research Institute of Victoria, says that some research has shown that cosmetic surgery can enhance self-esteem, which can feed into social confidence, but the evidence for long-term effects on psychological wellbeing is scant and requires further investigation.
Unique Issues...
Differing stages of cognitive development
Hormone fluctuations
Underdeveloped impulse control
Prefrontal cortex not fully developed until age 25 (https://www.urmc.rochester.edu/)
Often cannot change their recovery environment
Resepond differently and/or cannot be prescribed many psychotropics
Going through individualtion and identity development
Often unmotivated for change
Many prefer virtual interaction
24 Hour Bullying
Confidentiality and need for parental consent
Marcy Witherspoon, MSW, LSW of the Health Federation of Philadelphia discussed trauma-informed care with the Philadelphia EMA HIV Integrated Planning Council on November 9, 2018.
This document provides an introduction to and overview of a counselling dilemmas eBook published by the Australian Institute of Professional Counsellors (AIPC). It is divided into three main sections covering Relationship and Family dilemmas, Ethics, Values and Boundaries dilemmas, and Situations of Risk dilemmas. Each dilemma is accompanied by comments from qualified counsellors, psychologists, and mental health professionals. The purpose is to help counsellors develop their knowledge and approach to dealing with complex counselling situations they may encounter. The introduction encourages counsellors to submit their own comments and feedback on the dilemmas.
This document provides information and guidance for promoting healthy relationships in late adolescence and young adulthood. It defines relationship abuse and outlines risk factors. The goals are to educate peers about signs of unhealthy relationships, discuss healthy relationships using safety cards, and learn how to respond if someone discloses abuse. The safety cards are meant to start conversations, provide information on support services, and help victims without pressuring disclosure. Role playing is used to practice skills like introducing a safety card in a way that validates the peer's experiences and plants seeds for the future.
Legal & ethical issues provisions and programmes for elderlypradeepmk8
This document discusses several ethical issues related to research involving elderly subjects. It notes that elderly subjects may be more vulnerable due to physiological and psychological factors. Key issues include obtaining proper informed consent, assessing subjects' ability to make decisions, and evaluating risks and benefits of research for this population. The document calls for more interdisciplinary research on ethical guidelines to properly address these challenges and protect elderly participants.
Presentation for Reflections from the Past BookSusan Stuntzner
This document provides an overview of a book written to help individuals with disabilities and professionals working with them develop resilience. The book covers 10 domains of resilience including locus of control, regulating thoughts and emotions, coping strategies, social support, purpose in life, outlook, functioning/independence, spirituality, personal growth, and family connections. For each domain, the document outlines skills discussed in the book to help build resilience when coping with disability.
Body dysmorphic disorder in adult orthodontic patients /certified fixed ortho...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Psychological Outcomes in Cosmetic Surgeryamyhiggins444
Cosmetic surgery can enhance your life as well as your looks, according to industry advertisements and television shows, such as Extreme Makeover and Nip/Tuck. The idea is that a face “lift” will also boost one’s spirits and self-confidence. The problem is that the evidence supporting this assumption is tentative. Research shows that, following cosmetic surgery, patients variously report their mental health has either improved, not changed, or diminished. Psychiatrist David Castle, a leading researcher on the psychological outcomes of cosmetic surgery, is concerned by the “gloss” applied to cosmetic surgery that “suggests you will have a new life”, he says. “But of course, it doesn’t change the person you are on the inside.” David, who is a professor at the University of Melbourne and the Mental Health Research Institute of Victoria, says that some research has shown that cosmetic surgery can enhance self-esteem, which can feed into social confidence, but the evidence for long-term effects on psychological wellbeing is scant and requires further investigation.
Unique Issues...
Differing stages of cognitive development
Hormone fluctuations
Underdeveloped impulse control
Prefrontal cortex not fully developed until age 25 (https://www.urmc.rochester.edu/)
Often cannot change their recovery environment
Resepond differently and/or cannot be prescribed many psychotropics
Going through individualtion and identity development
Often unmotivated for change
Many prefer virtual interaction
24 Hour Bullying
Confidentiality and need for parental consent
Marcy Witherspoon, MSW, LSW of the Health Federation of Philadelphia discussed trauma-informed care with the Philadelphia EMA HIV Integrated Planning Council on November 9, 2018.
This document provides an introduction to and overview of a counselling dilemmas eBook published by the Australian Institute of Professional Counsellors (AIPC). It is divided into three main sections covering Relationship and Family dilemmas, Ethics, Values and Boundaries dilemmas, and Situations of Risk dilemmas. Each dilemma is accompanied by comments from qualified counsellors, psychologists, and mental health professionals. The purpose is to help counsellors develop their knowledge and approach to dealing with complex counselling situations they may encounter. The introduction encourages counsellors to submit their own comments and feedback on the dilemmas.
This document provides information and guidance for promoting healthy relationships in late adolescence and young adulthood. It defines relationship abuse and outlines risk factors. The goals are to educate peers about signs of unhealthy relationships, discuss healthy relationships using safety cards, and learn how to respond if someone discloses abuse. The safety cards are meant to start conversations, provide information on support services, and help victims without pressuring disclosure. Role playing is used to practice skills like introducing a safety card in a way that validates the peer's experiences and plants seeds for the future.
Legal & ethical issues provisions and programmes for elderlypradeepmk8
This document discusses several ethical issues related to research involving elderly subjects. It notes that elderly subjects may be more vulnerable due to physiological and psychological factors. Key issues include obtaining proper informed consent, assessing subjects' ability to make decisions, and evaluating risks and benefits of research for this population. The document calls for more interdisciplinary research on ethical guidelines to properly address these challenges and protect elderly participants.
Presentation for Reflections from the Past BookSusan Stuntzner
This document provides an overview of a book written to help individuals with disabilities and professionals working with them develop resilience. The book covers 10 domains of resilience including locus of control, regulating thoughts and emotions, coping strategies, social support, purpose in life, outlook, functioning/independence, spirituality, personal growth, and family connections. For each domain, the document outlines skills discussed in the book to help build resilience when coping with disability.
The document discusses the debate around allowing cosmetic surgery for teens. It notes that some parents and doctors argue the benefits of improved self-esteem and appearance outweigh the risks. However, others point out risks like developing body image issues or negative reactions if the outcome is not as expected. Psychologists could play a role in evaluating teens before or after surgery to discuss self-esteem and body image concerns. The procedure is more common among girls due to greater societal pressures related to appearance.
This document discusses the legal and ethical issues related to caring for aged people. It covers topics such as negligence, malpractice, intentional torts like assault and battery, defamation, invasion of privacy, elder abuse and neglect. It also discusses advance directives, restraint use, do not resuscitate orders, withholding treatment, assisted suicide, informed consent, enteral feeding, and patient opposition to placement. The goal is to increase awareness of these issues and ensure the elderly are treated with dignity while protecting their rights and safety.
Kaitlynn kept her ADHD diagnosis a secret in school due to stigma, but was diagnosed at age 8 due to struggles. She faced academic and social difficulties from ADHD and being held back a grade. Now in college, Kaitlynn has learned strategies to manage her ADHD and sees it as part of who she is rather than something to be ashamed of. She hopes to reduce stigma around ADHD by sharing her experience living with the disorder.
Shane Desautels is the director of NewWays learning. He has worked in the field of social services for over 30 years. As a literacy consultant to the South Side Health and Vitality Studies, he has provided expertise in the areas of technology literacy, adult and youth learning, empowerment strategies, and communication with traditionally marginalized groups.
Mental health issues like anxiety, depression, eating disorders, and bipolar disorder are caused by chemical imbalances in the brain. The document discusses several mental disorders and how they affect those suffering from them. It also explores how society and media portrayals influence people's views of these illnesses and their own self-image. While mental health issues are serious, increased awareness and understanding are helping to reduce the stigma around conditions like depression.
The document discusses factors that influence teens to get cosmetic surgery, including wanting to delay aging, change body parts, boost self-confidence, and match seasonal trends due to media portrayal of "perfect" people. It notes that most cosmetic surgeries are received by young girls, who commonly get procedures like breast augmentations and lip enhancements. The document also outlines some benefits of cosmetic surgery for teens, such as improved self-esteem and ability to avoid bullying, but emphasizes the importance of society promoting self-love in teens rather than pointing out flaws.
4 Alarming Ways That Neglecting Your Eyes Can Impact Your Health, Wealth & Ha...Monicagayle8688
Master Eye Associates commissioned a research study to investigate the link between health, wealth, and happiness. The study found that neglecting one's eyes can negatively impact quality of life, career, and income in several ways. Poor vision leads to poor job performance and lower income potential due to decreased attractiveness. It can also cause depression and anxiety. Early detection of eye diseases is important as some major causes of blindness like glaucoma and macular degeneration have no symptoms in early stages, resulting in irreversible vision loss. Regular eye exams are recommended to monitor eye health and vision.
Geropsychology is the study of aging and provision of clinical services for older adults. As researchers, geropsychologists expand knowledge of aging and design interventions to address common problems. As practitioners, they help older persons and families overcome issues to enhance well-being. Common problems for the elderly include physical/cognitive decline, loneliness, poverty, health issues, and discrimination. Depression and anxiety are also prevalent, sometimes triggered by life changes. Psychotherapies like relaxation techniques, cognitive behavioral therapy, reminiscence therapy, and family therapy can help address mental health issues facing the elderly.
This document discusses screening and assessment tools for alcohol use. It recommends the Alcohol Use Disorders Identification Test (AUDIT) as the main screening tool for non-specialists to evaluate if someone would benefit from reducing their alcohol consumption. It also discusses screening vulnerable groups like pregnant women, younger people, older adults, and minorities. Brief assessment tools like the Fast Alcohol Screening Test (FAST) can check hazardous drinking levels. More detailed assessments tools are recommended if harm has been established or for specialist practitioners.
Mybodyistemple.com is a website dedicated to promoting health and wellness. It provides tips and advice on nutrition, exercise, stress management, and living a balanced lifestyle. The site encourages visitors to treat their body as a temple by making small positive changes to diet and daily routine.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Angle of wire entry in orthodontic treatmentjimprit
1) The angle of wire entry into the bracket slot, known as the angle of entry, determines the moment of force and can have significant clinical implications.
2) A large angle of entry, such as from a distally tipped canine, can cause unwanted intrusion or extrusion of teeth due to the moment of the couple.
3) Bracket positioning can be used to compensate for unwanted moments and forces from the angle of entry, such as placing anterior brackets more gingivally to prevent bite opening.
Việc đánh giá tương quan của hàm trên với hàm dưới có ý nghĩa quan trọng trong chỉnh hình răng mặt, nó đóng vai trò quyết định trong việc chẩn đoán, lên kế hoạch điều trị và tiên lượng kết quả sau điều trị. Chính vì vậy, rất nhiều tác giả trên thế giới đã cố gắng nghiên cứu để tìm ra phương pháp nhằm đánh giá chính xác mối tương quan này và phim chụp tele từ xa sọ nghiêng (phim cephalometric) là một công cụ không thể thiếu để đánh giá sọ mặt theo chiều trước sau.
Phim cephalometric bắt đầu được giới thiệu và sử dụng trên lâm sàng bởi B. H. Broadbent [1] từ sau đại chiến thế giới lần thứ nhất, kể từ đó nhiều phân tích như Bjork [2], Down [3], Steiner [4], Ricketts [5]…đã được đưa ra để trợ giúp các nhà lâm sàng. Tất cả các phân tích này đã được tạo ra để phân tích đặc điểm về cấu trúc xương, răng và mô mềm. Một trong những phương pháp được sử dụng rộng rãi nhất và đơn giản nhất để xác định tương quan theo chiều trước sau của xương hàm trên và xương hàm dưới là góc ANB.
Góc ANB được đề ra bởi Riedel [6] năm 1952 và được sử dụng trong phân tích của Steiner [4], đây là một trong những số đo trên phim cephalometric được sử dụng phổ biến nhất và đơn giản nhất trong việc đánh giá tương quan giữa xương hàm trên và xương hàm dưới theo chiều trước sau. Tuy nhiên góc này lại bị ảnh hưởng bởi nhiều yếu tố như: vị trí theo chiều trước sau của điểm Nasion, đường S-N, và tác động xoay của xương hàm… [7],[8]. Chính vì vậy, trong nhiều trường hợp, góc ANB không đánh giá được chính xác tương quan xương hàm trên và xương hàm dưới. Jacobson [9] đã nhận ra điều này và đã phát triển một phân tích để vượt qua hạn chế của góc ANB, đó là khoảng cách AO-BO hay còn gọi là phân tích Wits. Kể từ đó, nhiều nghiên cứu đã được thực hiện để đánh giá hiệu quả của phân tích Wits trong chẩn đoán ban đầu và sau khi điều trị, cũng như để thiết lập giá trị Wits ở các chủng tộc người khác nhau. Tuy nhiên, ở Việt Nam hiện nay chưa có nghiên cứu nào được thực hiện để đánh giá hiệu quả của phân tích này. Vì vậy chúng tôi đã tiến hành thực hiện đề tài: “Nhận xét đặc điểm góc ANB và khoảng cách AO-BO ở bệnh nhân lệch lạc khớp cắn theo chiều trước - sau tuổi từ 18-25” với hai mục tiêu sau:
1. Nhận xét đặc điểm của góc ANB và khoảng cách AO-BO ở bệnh nhân lệch lạc khớp cắn theo chi
Diagnosis & treatment planing /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The document provides information about the MBT bracket system. Some key points:
- MBT was developed by Dr. Richard McLaughlin, Dr. John Bennett, and Dr. Hugo Trevisi to address limitations of previous pre-adjusted edgewise appliances.
- MBT utilizes light, continuous forces with sliding mechanics principles. Torque is incorporated fully into the bracket bases.
- Bracket tip and torque specifications are designed to achieve ideal tooth positions and occlusion. Canine torque values were modified from original straight wire appliance prescriptions.
- MBT treatment philosophy emphasizes accuracy of bracket placement, group tooth movement, anchorage control, and awareness of tooth size discrepancies.
This document discusses the treatment of deep bite malocclusions. It defines deep bite and provides descriptions from Graber and Nanda. It then discusses the prevalence based on racial groups. Treatment involves intrusion of incisors, extrusion of molars, and proclination of incisors. Stability depends on factors like growth, muscle strength, and retention. Extraction of premolars is generally not recommended for deep bites. The conclusion emphasizes early treatment and long-term retention for stability.
Class 2 division 2 malocclusion /certified fixed orthodontic courses by India...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
MBT Technique /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This document provides an overview of orthodontic treatment mechanics using the McLaughlin, Bennett and Trevisi (MBT) bracket system. It discusses the history and development of the MBT system, variations in appliance specifications including bracket selection and torque specifications. It also covers important aspects of treatment including bracket positioning, arch forms, anchorage control, archwire sequences and finishing the case.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses the debate around allowing cosmetic surgery for teens. It notes that some parents and doctors argue the benefits of improved self-esteem and appearance outweigh the risks. However, others point out risks like developing body image issues or negative reactions if the outcome is not as expected. Psychologists could play a role in evaluating teens before or after surgery to discuss self-esteem and body image concerns. The procedure is more common among girls due to greater societal pressures related to appearance.
This document discusses the legal and ethical issues related to caring for aged people. It covers topics such as negligence, malpractice, intentional torts like assault and battery, defamation, invasion of privacy, elder abuse and neglect. It also discusses advance directives, restraint use, do not resuscitate orders, withholding treatment, assisted suicide, informed consent, enteral feeding, and patient opposition to placement. The goal is to increase awareness of these issues and ensure the elderly are treated with dignity while protecting their rights and safety.
Kaitlynn kept her ADHD diagnosis a secret in school due to stigma, but was diagnosed at age 8 due to struggles. She faced academic and social difficulties from ADHD and being held back a grade. Now in college, Kaitlynn has learned strategies to manage her ADHD and sees it as part of who she is rather than something to be ashamed of. She hopes to reduce stigma around ADHD by sharing her experience living with the disorder.
Shane Desautels is the director of NewWays learning. He has worked in the field of social services for over 30 years. As a literacy consultant to the South Side Health and Vitality Studies, he has provided expertise in the areas of technology literacy, adult and youth learning, empowerment strategies, and communication with traditionally marginalized groups.
Mental health issues like anxiety, depression, eating disorders, and bipolar disorder are caused by chemical imbalances in the brain. The document discusses several mental disorders and how they affect those suffering from them. It also explores how society and media portrayals influence people's views of these illnesses and their own self-image. While mental health issues are serious, increased awareness and understanding are helping to reduce the stigma around conditions like depression.
The document discusses factors that influence teens to get cosmetic surgery, including wanting to delay aging, change body parts, boost self-confidence, and match seasonal trends due to media portrayal of "perfect" people. It notes that most cosmetic surgeries are received by young girls, who commonly get procedures like breast augmentations and lip enhancements. The document also outlines some benefits of cosmetic surgery for teens, such as improved self-esteem and ability to avoid bullying, but emphasizes the importance of society promoting self-love in teens rather than pointing out flaws.
4 Alarming Ways That Neglecting Your Eyes Can Impact Your Health, Wealth & Ha...Monicagayle8688
Master Eye Associates commissioned a research study to investigate the link between health, wealth, and happiness. The study found that neglecting one's eyes can negatively impact quality of life, career, and income in several ways. Poor vision leads to poor job performance and lower income potential due to decreased attractiveness. It can also cause depression and anxiety. Early detection of eye diseases is important as some major causes of blindness like glaucoma and macular degeneration have no symptoms in early stages, resulting in irreversible vision loss. Regular eye exams are recommended to monitor eye health and vision.
Geropsychology is the study of aging and provision of clinical services for older adults. As researchers, geropsychologists expand knowledge of aging and design interventions to address common problems. As practitioners, they help older persons and families overcome issues to enhance well-being. Common problems for the elderly include physical/cognitive decline, loneliness, poverty, health issues, and discrimination. Depression and anxiety are also prevalent, sometimes triggered by life changes. Psychotherapies like relaxation techniques, cognitive behavioral therapy, reminiscence therapy, and family therapy can help address mental health issues facing the elderly.
This document discusses screening and assessment tools for alcohol use. It recommends the Alcohol Use Disorders Identification Test (AUDIT) as the main screening tool for non-specialists to evaluate if someone would benefit from reducing their alcohol consumption. It also discusses screening vulnerable groups like pregnant women, younger people, older adults, and minorities. Brief assessment tools like the Fast Alcohol Screening Test (FAST) can check hazardous drinking levels. More detailed assessments tools are recommended if harm has been established or for specialist practitioners.
Mybodyistemple.com is a website dedicated to promoting health and wellness. It provides tips and advice on nutrition, exercise, stress management, and living a balanced lifestyle. The site encourages visitors to treat their body as a temple by making small positive changes to diet and daily routine.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Angle of wire entry in orthodontic treatmentjimprit
1) The angle of wire entry into the bracket slot, known as the angle of entry, determines the moment of force and can have significant clinical implications.
2) A large angle of entry, such as from a distally tipped canine, can cause unwanted intrusion or extrusion of teeth due to the moment of the couple.
3) Bracket positioning can be used to compensate for unwanted moments and forces from the angle of entry, such as placing anterior brackets more gingivally to prevent bite opening.
Việc đánh giá tương quan của hàm trên với hàm dưới có ý nghĩa quan trọng trong chỉnh hình răng mặt, nó đóng vai trò quyết định trong việc chẩn đoán, lên kế hoạch điều trị và tiên lượng kết quả sau điều trị. Chính vì vậy, rất nhiều tác giả trên thế giới đã cố gắng nghiên cứu để tìm ra phương pháp nhằm đánh giá chính xác mối tương quan này và phim chụp tele từ xa sọ nghiêng (phim cephalometric) là một công cụ không thể thiếu để đánh giá sọ mặt theo chiều trước sau.
Phim cephalometric bắt đầu được giới thiệu và sử dụng trên lâm sàng bởi B. H. Broadbent [1] từ sau đại chiến thế giới lần thứ nhất, kể từ đó nhiều phân tích như Bjork [2], Down [3], Steiner [4], Ricketts [5]…đã được đưa ra để trợ giúp các nhà lâm sàng. Tất cả các phân tích này đã được tạo ra để phân tích đặc điểm về cấu trúc xương, răng và mô mềm. Một trong những phương pháp được sử dụng rộng rãi nhất và đơn giản nhất để xác định tương quan theo chiều trước sau của xương hàm trên và xương hàm dưới là góc ANB.
Góc ANB được đề ra bởi Riedel [6] năm 1952 và được sử dụng trong phân tích của Steiner [4], đây là một trong những số đo trên phim cephalometric được sử dụng phổ biến nhất và đơn giản nhất trong việc đánh giá tương quan giữa xương hàm trên và xương hàm dưới theo chiều trước sau. Tuy nhiên góc này lại bị ảnh hưởng bởi nhiều yếu tố như: vị trí theo chiều trước sau của điểm Nasion, đường S-N, và tác động xoay của xương hàm… [7],[8]. Chính vì vậy, trong nhiều trường hợp, góc ANB không đánh giá được chính xác tương quan xương hàm trên và xương hàm dưới. Jacobson [9] đã nhận ra điều này và đã phát triển một phân tích để vượt qua hạn chế của góc ANB, đó là khoảng cách AO-BO hay còn gọi là phân tích Wits. Kể từ đó, nhiều nghiên cứu đã được thực hiện để đánh giá hiệu quả của phân tích Wits trong chẩn đoán ban đầu và sau khi điều trị, cũng như để thiết lập giá trị Wits ở các chủng tộc người khác nhau. Tuy nhiên, ở Việt Nam hiện nay chưa có nghiên cứu nào được thực hiện để đánh giá hiệu quả của phân tích này. Vì vậy chúng tôi đã tiến hành thực hiện đề tài: “Nhận xét đặc điểm góc ANB và khoảng cách AO-BO ở bệnh nhân lệch lạc khớp cắn theo chiều trước - sau tuổi từ 18-25” với hai mục tiêu sau:
1. Nhận xét đặc điểm của góc ANB và khoảng cách AO-BO ở bệnh nhân lệch lạc khớp cắn theo chi
Diagnosis & treatment planing /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The document provides information about the MBT bracket system. Some key points:
- MBT was developed by Dr. Richard McLaughlin, Dr. John Bennett, and Dr. Hugo Trevisi to address limitations of previous pre-adjusted edgewise appliances.
- MBT utilizes light, continuous forces with sliding mechanics principles. Torque is incorporated fully into the bracket bases.
- Bracket tip and torque specifications are designed to achieve ideal tooth positions and occlusion. Canine torque values were modified from original straight wire appliance prescriptions.
- MBT treatment philosophy emphasizes accuracy of bracket placement, group tooth movement, anchorage control, and awareness of tooth size discrepancies.
This document discusses the treatment of deep bite malocclusions. It defines deep bite and provides descriptions from Graber and Nanda. It then discusses the prevalence based on racial groups. Treatment involves intrusion of incisors, extrusion of molars, and proclination of incisors. Stability depends on factors like growth, muscle strength, and retention. Extraction of premolars is generally not recommended for deep bites. The conclusion emphasizes early treatment and long-term retention for stability.
Class 2 division 2 malocclusion /certified fixed orthodontic courses by India...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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MBT Technique /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This document provides an overview of orthodontic treatment mechanics using the McLaughlin, Bennett and Trevisi (MBT) bracket system. It discusses the history and development of the MBT system, variations in appliance specifications including bracket selection and torque specifications. It also covers important aspects of treatment including bracket positioning, arch forms, anchorage control, archwire sequences and finishing the case.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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orthodontic Bracket materials /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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1. Deep overbites, or vertical overlap of the mandibular incisors by the maxillary incisors greater than 3 mm, are common malocclusions. They can be classified as skeletal, dental, or soft tissue in nature.
2. Deep overbites require correction to prevent trauma, excessive wear, and abnormal jaw development if left untreated. They are associated with risks such as temporomandibular joint disorders.
3. Diagnosis of deep overbites involves analysis of dental relationships, facial proportions, and cephalometric measurements to determine the underlying skeletal, dental, or soft tissue etiology in each case. Correction may involve orthodontic treatment with or without orthogn
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise stimulates the production of endorphins in the brain which elevate mood and reduce stress levels.
Treatment of Class 2 malocclusions /certified fixed orthodontic courses by In...Indian dental academy
Class 2 malocclusions have several etiological factors and classifications. They are classified according to Angle, Ballard, and Moyers. Angle's classification divides them into Class I, Class II, and subclasses. Class II is further divided into Division 1 and Division 2. Division 1 is characterized by proclined upper incisors and lip trap while Division 2 shows lingually inclined maxillary incisors. Treatment depends on whether the malocclusion is skeletal, dentoalveolar, or functional in nature.
Management of Deepbite /certified fixed orthodontic courses by Indian dental ...Indian dental academy
This document provides information on the management of deep bite malocclusions. It begins by defining deep bite and classifying it as skeletal, dental, true, or pseudo. It then discusses factors related to the development of deep bite such as incisor angulation and mandibular growth patterns. Treatment strategies for correcting deep bite are also outlined, including intrusion of incisors and extrusion of posterior teeth. Considerations for treatment planning such as soft tissues, smile line, and skeletal factors are also reviewed. Orthodontic biomechanics for intruding incisors using intrusion arches are described in detail.
Orthodontic brackets are components bonded to teeth to apply corrective forces from archwires. There are various bracket types including those made of metal, plastic, and ceramics. Metal brackets are commonly made from stainless steel and have demonstrated clinical success but can stain teeth. Plastic and ceramic brackets are esthetic alternatives but plastic brackets can distort and ceramics are brittle. Proper material selection considers strength, esthetics, and clinical performance.
Materials in orthodontics /certified fixed orthodontic courses by Indian den...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Psychosocial factos /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Psychosocial factos /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Psychosocial factos /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Psychological management /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Psycological managemnt /certified fixed orthodontic courses by Indian dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Psycological management of orthodontic patients /certified fixed orthodontic...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document appears to be part of a health education program for 8th grade students. It provides an agenda and goals for 8 lessons on topics like relationships, decision making, abstinence and contraception, STIs, empathy, and refusal skills. It introduces the program directors and health educators leading the lessons. It also includes activities, discussions, role plays, and factual information to educate students on these health topics in an age-appropriate manner.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document provides an introduction to pediatric dentistry. It discusses how the field has shifted from extraction-focused to prevention-focused. Pediatric dentistry is still developing in India, with outdated views that baby teeth don't need care. The increasing number of pediatric dentists may help change these views. Key aspects of pediatric dentistry include prevention, early diagnosis/treatment, space maintenance, and managing children with special needs. The importance of primary teeth and the "pedodontic triangle" relationship between the child, parent and dentist are also explained. The document outlines the scope and challenges of pediatric dentistry in areas like prevention, behavior guidance, and caring for disabled children.
The document discusses the effects of unrestricted freedom among teenagers, including drug abuse, teenage pregnancy, and underage driving. It argues that providing teenagers with complete freedom could lead them to make poor decisions like abusing drugs, engaging in unprotected sex and becoming pregnant, or driving recklessly due to peer pressure. Such behaviors could significantly harm their health, education prospects, and development into mature adults. Therefore, the document concludes that some restrictions on teenage freedom are necessary to protect them from harmful outcomes.
Adolescence is a difficult time. They go through a lot of changes in their lives, from their bodies to their surroundings to nearly everything. It is a time when kids try to try as many new things as they can. It is critical to monitor the activities and whereabouts of youngsters.
It is also necessary to keep and confirm your values, but it is also important to establish boundaries that cannot be crossed, and guardians must inform them about the numerous hazards that may lurk on the journey of adulthood and how de-addiction treatment in Mumbai may help.
This document discusses some of the negative effects that can result from children maturing early in life, such as teenage pregnancy, drug abuse, and social exclusion. Teenage pregnancy can delay education and reduce future job opportunities as young mothers may need to leave school. Drug abuse can lead to addiction and involvement in criminal activities. Children who mature early are also more susceptible to social exclusion, which can cause feelings of depression and aggression if they feel isolated from their peers. Parents and community support are important to help guide teens and address any issues.
Similar to Adolescent orthodontic treatment /certified fixed orthodontic courses by Indian dental academy (20)
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
Eligibility / requirements-
1. An International English Language Testing System (IELTS) certificate
at the appropriate level.(Within 2 yrs of application date )
2: A recent primary dental qualification that has been taught and examined in English..(Within 2 yrs of application date )
3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
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1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
I –Aligners are made with FDA approved transparent thermoplastic materials using 3D scanning, 3D Printing and finally Trays with Pressure vacuum formers.
Dear Doctor,
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Course includes:
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Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
skype:indiandentalacademy
+919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Properties of Denture base materials /rotary endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
This document discusses dental occlusion concepts and philosophies for complete dentures. It introduces key terms like physiologic occlusion and defines different occlusion schemes like balanced articulation and monoplane articulation. The document discusses advantages and disadvantages of using anatomic versus non-anatomic teeth for complete dentures. It also outlines requirements for maintaining denture stability, such as balanced occlusal contacts and control of horizontal forces. The goal of occlusion for complete dentures is to re-establish the homeostasis of the masticatory system disrupted by edentulism.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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This document discusses dental casting investment materials. It describes the three main types of investments - gypsum bonded, phosphate bonded, and ethyl silicate bonded investments. For gypsum bonded investments specifically, it details their classification, composition including the roles of gypsum, silica, and modifiers, setting time, normal and hygroscopic setting expansion, and thermal expansion. It provides information on how the properties of gypsum bonded investments are affected by their composition. The document serves as a comprehensive overview of dental casting investment materials.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
2. Introduction
Adolescence is the transitional period
between childhood & adult years.
It is a time of awakening, aspirations,
rebellion, learning to drive.
Often characterized using terms such as
‘tumultuous & turbulent’.
www.indiandentalacademy.com
3.
This complex intersection of accelerated
physical growth & dynamic hormonal change is
accompanied by intensified self awareness &
conflicting forces of acculturation to demands of
society.
Orthodontic treatment of the adolescent patient
presents many unique opportunities that may
not be possible for adults.
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4. It is important , as far as understanding
the possible stresses faced by the
orthodontist, to recognize that the
adolescent age is frequently the optimum
time for treatment.
Even though orthodontic correction is
indicated & time is opportune, the patient
may not be enthusiastic.
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5. Reason is obvious. Orthodontic
appliances imply a deformity, and at the
very least are no asset to a young
adolescent who is unsure of his/her
attractiveness.
The prospective patient cannot always
accept what seems as further mutilation,
despite the fact that the treatment is of
importance for future attractiveness.
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6. Most likely motivation for any patient to
seek care stems from the patient’s desire
to improve smile; however there may be
factors influencing the adolescent patient's
decision to undergo orthodontic treatment.
Trulsson et al ( J.O.2002 ) interviewed
adolescent patients in an effort to analyze
the factors affecting their decision to
undergo orthodontics.
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7. The teenagers in study believed that they
would make the final decision to initiate
orthodontic treatment, but this decision
was heavily influenced by “ the norm in
their actual or desired reference group &
by the surrounding world including the
media's ideal body image”.
Teenagers wanted orthodontic care so
that they could ‘be like everyone else’ & ‘to
obey social norms’.
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8. In addition teenagers thought that a “nice
appearance would lead to a high self
esteem”.
Investigators noted that teenagers in study
were not aware of the factors influencing
their decision to undergo orthodontics.
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9. Another concern is compliance of patient
due to length of time required to treat the
patient.
Lack of compliance can impact the final
treatment result. Can result in the patient
being worse after treatment than before
treatment.
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10.
Adolescence is also the stage in psychosocial
development in which a unique personal identity
is acquired.
Includes both a feeling of belonging to larger
group & a realization that one can exist outside
the family.
According to Erikson adolescence age (12 to17)
is where there is development of personal
identity.
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11. Requires a partial withdrawal from
the
family, peer group increases still further in
importance.
Members of peer group become role
model, and the values & tastes of parents
& other authority figure is being rejected.
So a poor psychological situation is
created by orthodontic treatment if it is
being carried out primarily because
parents want , not child.
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12. Motivation for treatment can be divided
into external and internal.
External motivation – Pressure from
others.
Internal motivation – Individual’s own
desire for treatment to correct a defect that
he perceives in himself.
Approval of the peer group is extremely
important.
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13.
It is extremely important for an adolescent to actively
desire the treatment as something being done ‘for’, not
‘to’ him/her.
According to Jean Piaget cognitive development theory,
when an adolescence consider what others are thinking
about, he assumes that others are thinking about the
same thing he is thinking about, namely himself.
They feel as though they are constantly “on stage”, being
observed & criticized by those around them. This
phenomenon has been called the “imaginary audience”
by Elkind.
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14. As a result of ‘imaginary audience’ a
second phenomenon emerges , Elkind
called it “ personal fable”. It makes
adolescents thing that nothing could
happen to them as they are unique.
Imaginary audience depending on what
adolescent believes , may influence to
accept or reject treatment, and to wear or
not wear appliance.
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15.
The personal fable may make a patient ignore
threats to health, such as decalcification of teeth
from poor oral hygiene during orthodontic
therapy.
Orthodontist should not force upon the patient to
wear a particular appliance if he is concerned
about what others will think.
A more useful approach that does not deny the
point of view of the patient is to agree with him,
that he may be right, but ask him to try for a
specified time.
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16.
Encouraging a reluctant teenager to try it & judge his
peers response is much likely to get him to wear the
elastics than telling him every body else does it so he
should do.
Cooper & Shapiro(1996) suggested taking time to
identify an adolescent's concern & then to treat them as
individuals, recognizing their values & issues.
This approach reduces compliance barriers.
Orthodontists should understand that adolescents are
not influenced strongly by health specific goals
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17.
Grewal K, Sunny JP, Valiathan A (2003)
A questionnaire study done at Manipal between April
2003 & June 2003 regarding patients expectations and
perceptions towards orthodontic treatment . Mean age –
19.54yrs.
67%- Believed that their self confidence may be
positively enhanced
42%- Felt that improved facial appearance
would not be an advantage as far as their career
opportunities are concerned.
More than half of the total respondents felt that, to attain
straight teeth was the first motivating factor to undergo
treatment.
Only 31.8% - felt that improvement in dental
appearance may lead to enhanced facial appearance
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18.
Orthodontic treatment of teenagers can be very
rewarding, but some deeper issues of health care might
be missed by the unprepared professional. This patient
group is often viewed as inherently healthy, and
important signs and symptoms of disease can be missed
simply because of a biased outlook.
A particularly vital portion of the care of teenagers is
monitoring for depression and other psychosocial
disorders, including substance abuse. This period of life
is a time of great psychological, social, and physical
changes.
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19.
Tobacco: cigarettes and smokeless tobacco :
May have poor brushing habits ,Association with
risky behaviors and antisocial personality types.
Alcohol : Antisocial behavior, Missed
appointments ,Risky behaviors, Increased risk of
hard drug use.
Opiates including heroin : Antisocial behavior
Risky sexual behavior, Multi drug use,
particularly with cocaine, Missed appointments
Very poor oral hygiene.
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20.
Steroids : Missed appointments, Aggressive behavior,
Poor self esteem, Premature cessation of growth at
epiphyseal plates.
The orthodontist is in a unique position to monitor
adolescents for substance abuse.
Typical orthodontic treatment involves frequent
appointments over several years.
By carefully noting intraoral and extraoral physical
changes, the practitioner can monitor patients for signs
of drug and alcohol abuse
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21.
Treatment for most disorders centers on a
combination of counseling and
pharmacotherapy. Although it is not within an
orthodontist’s practice to treat substance-abuse
disorders, it is important to appropriately make a
referral if a problem is detected.
It is of the utmost importance to respect the
patient’s privacy in these instances and discuss
substance abuse in a private consultation.
Careful questioning of both the child and the
parent can lead to a better understanding of the
situation and an easy decision on referral .
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22.
Teens often undergo significant peer pressure to
try drugs and alcohol. It has been shown that
orthodontic patients who use tobacco are at risk
for other high-risk behaviors.
Suicidal behavior and substance abuse have
been clearly linked, as have substance use and
depression.
Because many orthodontic practices have been
touched by suicide, it is important to be aware of
some significant risk factors for this undesirable
outcome
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23. General Characteristics of
Adolescent Malocclusion
a) Dentition and occlusal relationships are
established!
b) Skeletal growth may be mostly over and
decelerating.
c) Muscle function is matured. .
d) Functional malocclusions are less
frequent since they have largely been
accommodated by dentoalveolar, skeletal,
and/or mandibular joint adaptations.
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24. e) Temporomandibular dysfunction is
more frequent since dental, skeletal, and
joint adaptability have diminished.
i) Psychological aspects are more
significant than at younger ages.
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25. Irfan Dawoodbhoy & Ashima Valiathan
(JICD 1993) have listed following
treatment objectives for adolescent
patients 1) Dentofacial esthetics
2) Stomatognathic system
3) Stability
4) Static & dynamic class I occlusion.
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26. Advantages of Adolescent Treatment
a) Control of all permanent teeth, except third molars, is
now possible.
b) It is beneficial to treat when bone turnover rates are
still high though adult dimensions are nearly achieved.
Repair and remodeling occur readily in response to
orthodontic forces though the basic craniofacial
morphology is largely established.
c) Motivation for treatment is high, especially when facial
esthetics are affected.
d) Treatment goals can be more surely defined, does not
have to counter, as much as earlier, the dynamics of
growth.
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27. Difficulties in Adolescent Treatment
a) The best opportunities for control and manipulation
severe skeletal dysplasia are past.
b) Sports and social activities, so important to
adolescents, often compete with plans for orthodontic
treatment.
c) The time necessary for treatment may be longer for
certain malocclusions.
d) Tooth positioning is often more difficult when
occlusion is fully established and root formation is
complete than tooth guidance was during eruption.
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28. Since precise tooth positioning is the
principal strategy in adolescent treatment,
cephalometric analysis for treatment
planning is essential and many analyses
have been designed solely to , determine
the placement of teeth within particular
skeletal morphologic patterns.
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29. Moyers
group treatment goals for
discussion, quantification, and planning as
follows: (I) skeletal; (2) dental; (3) occlusal
and functional; (4) soft-tissue and facial
esthetics; and (5) compromises.
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30.
I. Skeletal
Improvement in the craniofacial skeleton by
orthodontic treatment is still possible in
adolescence, although the greatest opportunities
for so doing may be over by this age. A primary
aim of some clinicians is to predict the time of
the adolescent of maturity
When maxillo-mandibular relationships are
altered , it is important to ascertain whether
maxilla or mandible, or both are to be changed
and to quantify the change sought in each jaw
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31.
Although mandibular impedence or
enhancement is more difficult after pubescence,
midface changes are possible with intensive
orthodontic forces.
Vertical change is most apt to occur within
dentoalveolar process or by rotation of the
mandible following dentoalveolar changes
Planned horizontal and vertical skeletal
changes ,should be quantified and monitored
regularly by cephalometric analysis.
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32.
2. Dental
a) Axial Inclinations : The roots of posterior teeth should
be approximately parallel to one another, especially
those roots adjacent to extraction sites. Artistic
positioning of the crowns of anterior teeth usually results
in a slight divergence of the roots.
The root angulation of the anterior teeth is lingual and an
interincisal angle of 130 degrees may serve as a rough
guide.
However, the percentage of the 130 degrees contributed
by upper incisors and lower incisors varies greatly with
the maxillo-mandibular relationship and the steepness of
the mandibular and occlusal lines .
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33.
b) Incisal Relations
Ideally the overbite should be approximately one-third of
the lower incisal crown.
The overjet which is determined by a) the axial
inclination of incisors, b) the skeletal relationship, c) the
relation of the widths of upper to lower teeth (Bolton
Index) , and d) the labiolingual thickness of the crowns
should provide incisal centric stops in the intercuspal
(usual occlusal) position.
c) Midlines
The dental midlines should coincide with each other and
with the mid-sagittal plane of the craniofacial skeleton.
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34.
d) Arch Form
The arch forms should be symmetric and coordinated
with each other and should, as much as possible, be
concordant with the forms of their skeletal bases.
The mandibular intercanine diameter should rarely
increase during adolescent treatment, since such an
increase has been shown repeatedly to be unstable
irrespective of the appliance use
e) Spacing
Ideally, all teeth in both arches should have firm
interproximal contacts and there should be neither
crowding nor rotations of the teeth. However, the Bolton
Index may reveal that such perfect results are
impossible and that some spacing or crowding is
inevitable
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35.
3. Occlusal and Functional.
The desired occlusal pattern (group function or cuspid
rise) should be determined at the start and brackets
placed accordingly.
The treated occlusion should display no deflective
interferences during mandibular occlusal movements or
in the retruded contact position (centric relation).
There should be no balancing interferences and the
posterior teeth should disclude during protrusive
movements.
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36.
4. Soft Tissue Profile and Esthetics
It is harder to quantify esthetic goals of treatment and
personal tastes vary , yet there are some commonly
accepted standards. The incisor positions should not
strain the lip musculature and the incisal overlap should
be harmonious with the lip line.
Little display of the gingivae during smiling is desirable.
The lips should be without strain at rest and in function.
The incisors should not be retracted excessively lest the
lip drape at rest will give an aged or edentulous
appearance to the soft-tissue profile.
Excessive retraction of the incisors also robs the lips of
proper participation in facial expressions.
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37.
5. Compromises
When defining goals for adolescent treatment, one
begins with the ideals, listed above, accepting
compromises only when the conditions of the case force
one to do so. In adult treatment, one often is forced to
begin with compromise .
In adolescent treatment every necessary compromise in
the treatment plan should be quantified in terms of the
skeletal profile and tooth positions, and all of the "tradeoffs" and consequences of compromise should be noted
and understood at the start.
Often a hastily, casually, or unwittingly accepted
compromise at the beginning has serious consequences
later. Adolescent treatment should aim for idealism.
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38.
When adolescent treatment is progressing in an
unsatisfactory manner or an unsatisfactory result
is observed at the "end" of treatment there are
no easy alternatives.
Poor treatment does not stabilize or improve
with time. Retreatment to the standards to be
described is really the only satisfactory solution.
For this reason adolescent treatment must be
accompanied not only by meticulously designed
original goals but also by persistent monitoring
throughout treatment.
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39. Treatment planning
a) Congenitally Missing Teeth
I. Maxillary Lateral Incisors.If a bridge or bridges are to be placed, the goals of
treatment must include attentive detail to the positioning
of the central incisors and cuspids which may be
abutment teeth.
When the cuspid and all other maxillary posterior teeth
are to be moved mesially, obviating the need for a
bridge, then the principal new goal is the meticulous
placement of the cuspid root to parallel the central
incisor. The first bicuspid and all posterior teeth are
moved forward into a Class II relationship.
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42.
Moving the first bicuspid forward into the cuspid
region usually creates balancing interferences;
therefore, its lingual cusp must be reduced
gradually during its mesial movement.
If a cuspid rise occlusion is desired, the bracket
height on bicuspid must be placed atypically to
guarantee its extrusion.
Particular attention must be paid to the
positioning of the molars and they must be
equilibrated by occlusal grinding to secure the
occlusal result.
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43.
Mandibular Second Premolars.- The goals of
treatment obviate the need for a bridge, secure
a more correct intercuspation, and guarantee
the height and health of the alveolar bone on
mesial aspect of the mesial root of the first
molar.
If a primary second molar is retained unduly, this
usually results in an undesirable relationship of
the alveolar septum between the second primar y
molar's root and the first permanent molar
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44.
Treatment of congenitally missing mandibular
second bicuspids by mesial movement of all
posterior teeth is not a difficult technical problem
for anyone skilled in precision bracketed
appliance therapy.
While the problem is best treated earlier it can
still be treated well in adolescence with
bracketed appliances. Its treatment with
removable appliances is not recommended
since ultimate parallelism of the roots is
essential for a stable result.
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45.
Eruption Problems.
Failure of a permanent tooth to erupt creates a
severe orthodontic problem.
A localized problem is typically created either by
displacement of a permanent tooth from its
normal eruption path so that the tooth becomes
impacted (usually a maxillary canine) or by
trauma that leads to ankylosis (usually a
maxillary incisor) .
A generalized problem implies an abnormality in
the eruption mechanism.
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46.
Impacted Teeth. An impacted canine or other tooth in a
teenage patient can usually be brought into the arch by
orthodontic traction after being surgically exposed. In
older patients, there is an increasing risk that the
impacted tooth has become ankylosed. Even
adolescents have a risk that surgical exposure of a tooth
will lead to ankylosis. (Becker A, 1998) .
In planning treatment for an impacted permanent tooth,
three principles should be followed: (1) The prognosis
should be based on the extent of displacement and the
surgical trauma required for exposure. As a rule, the
greater the displacement and the greater the trauma, the
poorer the prognosis.
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47.
Extraction of a severely impacted tooth and
orthodontic space closure or prosthetic
replacement may be better judgment than heroic
efforts to bring the tooth into the arch.
(2) During surgical exposure, flaps should be
reflected so that the tooth is ultimately pulled
into the arch through keratinized tissue, not
through alveolar mucosa.
(3) Adequate space should be provided in the
arch before attempting to pull the impacted tooth
into position.
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48.
Diagnostic factors of interest include the position of both
crown and apex, the space available to accommodate
the cuspid in the arch, and the position and health of
adjacent teeth especially the roots of the lateral incisor,
the intactness of the labial cortical plate of bone, the
willingness of the patient to undergo prolonged
orthodontic treatment, and the relationship of the
condition to other orthodontic treatment needed.
All require a meticulous radiographic perspective.
The size of an impacted cuspid may be determined by
measuring the antimere.
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49.
If both cuspids are impacted, measure the crown width
of the maxillary first and second premolars and estimate
the size of the cuspid crown by referring to appropriate
tooth size charts .
Do not forget that sexual dimorphism in crown size is
more obvious in the maxillary cuspid than any other
tooth.
Measurement of crown size of impacted cuspids in the
radiograph is flawed by distortion due to the angulation
and the curvature of the film. Study carefully, in the
radiograph, the health and morphology of the cuspid's
root as well as its position
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50.
If a tooth is severely impacted, surgical transplantation is
a possible treatment approach. This involves removing
the tooth, creating a socket at the appropriate site in the
arch, and replanting the tooth in its correct position.
External root resorption often ensues after
transplantation and is the major cause of failure.
Approximately two thirds of transplanted teeth are
functional for 5 rears, but only about one third are
retained for 10 years.( Moss, 1972).
Orthodontic movement is preferable if it is possible.
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51.
Generalized Eruption Failure. An eruption delay that
affects several teeth in an adolescent patient is an
ominous sign. If the problem is a mechanical
interference with eruption the obvious treatment plan is
to remove the interference and proceed with orthodontic
therapy.
The condition called "primary failure of eruption”, results
from a failure of the eruption mechanism itself.
Unfortunately, not only do the involved teeth not erupt
spontaneously, they do not respond to orthodontic force
and cannot be pulled into the arch. Since prosthetic
replacement is the only practical solution, it is fortunate
that the condition is rare.
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52.
Hemisection: one large step toward management of
congenitally missing lower second premolars.
( Angle 2004)
Northway W.
When the primary molar cannot be retained in cases of
agenesis of the lower second premolar (CML5), there is
the possibility of alveolar atrophy, and space closure
might have a negative impact on facial fullness.
Bearing these in mind, the removal of the distal half of
the second primary molar might allow closure in stages.
Subsequent removal of the mesial half can be followed
by space closure. Using this hemisection approach,
space closure can be continued with ease improving
treatment results.
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53.
In order to test the amount of anchorage loss
resulting from this approach, the pitchfork
analysis was used to compare a group of 23
consecutively treated patients, each treated by
hemisection, with two groups of 30 patients,
each of whom was treated with the extraction of
four premolars.
One group had four first premolars removed
and the second group had second premolars
removed.
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54.
The CML5 group was divided into those which
had upper teeth extracted in order to facilitate
the correction and those who were treated
without extraction in the upper.
The hemisection groups showed statistically
significant diminished distal movement of the
upper incisor as well as the upper and lower lip.
Lower molar protraction and molar relation was
significantly increased. The process facilitates
the keeping of upper premolars, which further
enhances facial fullness.
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55.
Ankylosis – First molars, maxillary cuspids, maxillary
incisors are the permanent teeth most likely to be
ankylosed.
Etiology – unclear. History of trauma associated with
incisor ankylosis.
The goal of treatment in adolescence is to establish, if
possible, proper occlusion: three methods are used:
surgical, orthodontic, and restorative.
The tooth should first be surgically exposed, carefully
luxated, and splinted into an improved position. Subsequent orthodontic movements to an ideal position
should then be attempted, though ankylosis usually
reappears.
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56.
If ankylosis recurs and the tooth is to be retained
consider building it up to occlusion with
composite until growth is apparently over and a
permanent restoration can be placed.
There is a danger in retaining ankylosed teeth,
namely localized cessation of alveolar growth
which may bare the roots of adjacent teeth and
predisposes to periodontal difficulties
If an ankylosed molar must be extracted, do not
overlook the possibility of orthodontic closure of
the edentulous space
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58. Variations in shape & size of teeth
a) "Large Teeth"
This problem is really that of simple crowding
b) Small Teeth . Esthetics are more critical at
this age than during childhood and "permanent"
treatment combining orthodontics and
restorative dentistry can be quite successful.
The introduction of composites, laminates, and
porcelain veneered crowns offers esthetic and
functional success previously not possible.
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59.
c) Anomalies of Tooth Shape
A more permanent treatment of crown
anomalies is possible when started in
adolescence.
Moreover, problems handled earlier often may be
treated again, advantageously, to an esthetic
result which was not possible earlier.
Anomalies in root length and morphology are
more obvious in adolescence and often play an
important role in treatment planning (e.g. ,
deciding whether to remove first or second
bicuspids in extraction cases) .
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60. Alignment Problems
When there is crowding in the early permanent
dentition, an accurate space analysis can be
carried out directly, without the necessity for
predicting the size of unerupted teeth.
In this age group, however, it remains true that it
is necessary to evaluate the amount of
protrusion as well as the amount of crowding to
totally evaluate the space situation.
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61.
The diagnostic setup, a cephalometric analysis,
and judgment of facial esthetics and the lip
musculature are critical in defining a simple
crowding case and planning its treatment.
One may advance and reposition the incisors in
the cephalometric tracing to visualize twodimensionally and statically how such
repositioning encroaches on the lip muscles.
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62.
A significant difference between mixed dentition and
early permanent dentition patients is that the simple
appliances that can be used to solve space problems in
the mixed dentition are no longer effective after the
permanent teeth have erupted.
Whether a patient in the early permanent dentition is to
be treated by arch expansion or by extraction, a bonded
or banded fixed appliance is needed to position the teeth
correctly.
Removable appliances of all types, along with lingual
arches and other round wire or partially fixed appliances,
are effective only for tipping teeth to new positions..
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63. Extraction of first premolars provides the
greatest flexibility in terms of closing
space which of course is a major reason
for this being the most frequent extraction.
In contrast, little useful space for either
purpose is provided by second molar
extraction.
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64.
Tooth Size Discrepancies –
A tooth size discrepancy of less than 1.5 mm is usually
insignificant, but larger discrepancies create a problem
that must be solved in the development of a treatment
plan.
There are five possible approaches:
(1) compensate for a small size differential by changing
the inclination of the incisors;
(2) reduce the width of some teeth by interproximal
stripping of enamel;
(3) build up the width of an anomalously small tooth or
teeth by adding composite resin or a crown;
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65. (4) alter the normal extraction plan to
compensate for size discrepancies (for instance,
by extracting anomalously large lower second
premolars rather than first premolars in what
would otherwise be a first premolar extraction
case);
(5) accept a small space in one of the arches,
usually distal to the lateral incisors.
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66.
Before one of the possible plans is accepted, it is
important to determine whether the discrepancy is
caused by a variation in one of the teeth or a generalized
size difference between upper and lower teeth. This
determination can be accomplished by Bolton analysis .
The usual culprits in tooth size problems are the upper
lateral incisors, but second premolars in both arches also
vary in size. Reducing or building up lateral incisors, if
these are the source of the discrepancy, is the best
approach. It is less easy to alter the width of premolars,
and one of the other solutions may be required.
A diagnostic setup is usually needed to verify that a
proposed treatment plan for tooth size discrepancy can
succeed.
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67.
If the permanent teeth have been allowed to
erupt completely while still malaligned, it is rare
that a satisfactory result can be obtained without
using an orthodontic appliance that can change
root positions. Just tipping the crowns to a new
location is not enough.
If extraction is required to provide enough space,
root movement is required to satisfactorily close
the space
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68. Transverse Problems
Transverse problems in the adolescent age
group, as in younger patients, are most likely the
result of a narrow maxillary arch.
The necessary maxillary expansion may be
approached either skeletally or dentally,
depending on the anatomic basis of the
problem.
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69.
Single tooth crossbites or true unilateral
asymmetries of the dental arch are usually best
corrected by cross elastics in the affected area ,
provided that there is not a skeletal vertical
problem that the elastics could aggravate.
Reciprocal tooth movement will result if one
tooth is pitted against another.
Differential unilateral maxillary expansion can be
achieved by placing a lower fixed appliance and
using cross elastics from the stabilized lower
arch to the maxillary teeth on the affected side
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71.
Skeletal asymmetries - Posteroanterior
cephalograms in the postural and occlusal
positions are necessary for one to identify and
differentiate both mediolateral and vertical
skeletal asymmetry.
Mandibular landmarks which change between
the two vertical positions are evidence of
residual neuromuscular occlusal dysfunction.
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72. TMJ region should be searched for
evidence of condylar or fossa asymmetry
of either shape or position.
PA, lateral & oblique cephalograms,
panoramic or special radiographic
projections of TMJ may be necessary.
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73.
True skeletal asymmetries in the adolescent age
group pose an extremely difficult problem.
Treatment include RME, gradual expansion with
a Quad Helix appliance.
Functional jaw orthopedic appliances can be
used, but best time for their use is past.
If orthognathic surgery is necessary it usually is
done later.
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74. Sagittal Problems
The preferred treatment for skeletal problems,
whatever the plane of space, is always growth
modification. For greatest success, growth
modification treatment should begin before the
adolescent growth spurt, and the amount of
remaining growth must be evaluated carefully
before treatment is planned for an adolescent.
Girls mature earlier than boys, and it is possible
that by the time a girl's permanent teeth have
erupted, it is too late for effective growth
modification.
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75. A second plan for correcting
anteroposterior discrepancies is to
camouflage them by differential movement
of upper and lower incisors.
If the problem is severe, a third option is
surgical repositioning of the jaws.
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76. Class II malocclusion
Even in more favorable circumstances it is
unlikely that more than half of the changes
needed to correct class II malocclusion in
adolescent would be gained by differential
jaw growth.( max. 3 – 4mm ).
If a functional appliance is desired for
adolescent treatment, often a fixed
functional appliance is preferred.
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77. Distal driving of maxillary first molars
becomes difficult .
Extraction of maxillary second molars &
distal movement of remaining upper teeth
can successfully correct moderate class II
malocclusion. Here also one should not
expect more than 4mm distal movement.
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78.
Premolar extraction can produce excellent
occlusion.
Can also use class II elastics without
extractions. However moving the lower incisors
anteriorly more than 2mm lead to instability &
relapse.
Prolonged use of class II elastics can result in
convex profile with protrusive lower incisors & a
prominent lower lip. This is best described as
relapse waiting to occur.
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79. Vertical growth is
needed when inter arch
elastics are used, to prevent rotating the
mandible down & back as lower molars
are elongated, and even then the elastics
may produce an unesthetic elongation of
the upper incisors.
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80.
Skeletal, dental and soft-tissue changes
induced by the Jasper Jumper appliance in
late adolescence.
( Angle 2005)
Nalbantgil D, Arun T, Sayinsu K, Fulya I.
The purpose of this study was to evaluate the
skeletal, dental, and soft-tissue changes in lateadolescent patients treated with Jasper Jumper
applied with sectional arches. The study sample
consisted of 30 subjects (15 treated, 15
untreated) with skeletal and dental Class II
malocclusion.
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81. The results revealed that, in late-
adolescent patients, the Jasper Jumper
corrected Class II discrepancies mostly
through dentoalveolar changes. It is
suggested that this treatment method
could be an alternative to orthognathic
surgery in borderline Class II cases.
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82. Class III malocclusion
Primary reason of treating class III malocclusion
in adolescents is that, if postponed, the
probabilities of needing orthognathic surgery
combined with orthodontic therapy are greatly
increased.
One can rationalize the treatment of class III in
girls during adolescence is easier than that of
boys, because treatment in girls is less apt to be
thwarted by pubescent growth spurting & they
are nearer adult dimensions than boys at each
chronologic age.
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83. Strategies for treatment in adolescence
include – 1) Ventral displacement of the
midface.
2) Inhibition of mandibular growth.
3) Redirection of mandibular growth.
4) Dental & alveolar process repositioning.
Facemask is used in cases of midface
deficiency.
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89. Mandibular prognathism
is a more severe
problem in adolescence than midface
deficiency, particularly when the mandible
is already hyperplastic prior to the
adolescent growth spurt.
Chin cup treatment can be used in milder
cases of mandibular prognathism.
Combining functional appliance with fully
bracketed appliances in both arches is
also useful in treatment.
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90.
One must be prepared to accept defeat in some
cases of mandibular prognathism, particularly in
boys, whose dramatic growth during treatment
may be a problem.
In such instances, secure cephalometric & cast
records, remove the appliances, place retainers
to maintain the arch. Monitor the case
cephalometrically until such time as orthognathic
surgery is indicated.
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91.
Postpubertal assessment of treatment timing for
maxillary expansion and protraction therapy
followed by fixed appliances.
( AJO 2004)
Franchi L, Baccetti T, McNamara JA.
In this cephalometric investigation, authors evaluated the
correction of Class III malocclusion in subjects who had
attained postpubertal skeletal maturity and considered
whether treatment timing influenced favorable
craniofacial modifications. All subjects (n = 50) were
treated with an initial phase of rapid maxillary expansion
and protraction facemask therapy, followed by a second
phase of preadjusted edgewise therapy.
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92.
The treated sample was divided into an early
treated group (early mixed or late deciduous
dentition, 33 subjects) and a late treated group
(late mixed dentition, 17 subjects). Mean
treatment duration times were 7 years 2 months
for the early treatment group and 4 years 5
months for the late treatment group.
The findings showed that orthopedic treatment
of Class III malocclusion was more effective
when it was initiated at an early developmental
phase of the dentition (early mixed or late
deciduous) rather than during later stages with
respect to untreated Class III control groups.
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93.
Patients treated with rapid maxillary expansion
and facemask therapy in the late mixed
dentition, however, still benefited from the
treatment, but to a lesser degree.
Early treatment produced significant favorable
postpubertal modifications in both maxillary and
mandibular structures, whereas late treatment
induced only a significant restriction of
mandibular growth.
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94. Vertical problems
The major vertical problems of adolescents are
anterior open bite and anterior deep bite, both of
which are likely to be seen in combination with
some anteroposterior problem.
As a child becomes older, it is more and more
likely that malocclusion in the vertical plane of
space, as in the anteroposterior plane of space,
is related to skeletal jaw proportions and not just
to displacement of the teeth.
Eruption problems are also likely to be more
serious in this age group.
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95.
Anterior Open Bite. The skeletal indications of anterior
open bite are increased anterior face height and a steep
mandibular plane, both of which reflect excessive vertical
growth of the maxilla and rotation of the mandible; and
excessive eruption of posterior teeth.
Because of the downward and backward rotation of the
mandible, the patient is likely to have a Class II jaw
relationship in addition to the vertical problem.
Growth modification treatment, focuses on controlling
both the vertical maxillary growth and eruption in both
arches.
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96.
The treatment of simple open bite in adolescence
consists of identifying and controlling localized etiologic
factors first, then bracketing teeth and coordinating arch
forms. In a few cases, these steps alone may be
sufficient
Vertical elastic traction is necessary to acquire full
centric stops on all teeth. Check the occlusion carefully
with articulation paper to determine that each tooth has
been seated fully into occlusion.
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97.
Allow the patient to wear the banded appliances
for the initial period of retention, but do not
remove them until normal swallowing and lip
function obtain at all times.
Persistent hyperactive mentalis muscle activity
may be treated with a modified vestibular shield.
For posterior simple open bite, a Hawley
retainer with extended lingual flanges vertically
is useful to control the tongue during retention.
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98.
Complex open bite typically is difficult to treat
orthodontically. In moderate cases, one attempts
to achieve some esthetic cover-up of the
skeletal dysplasia by alveolar process
compensation.
Extractions may be necessary , even when
simple crowding is absent, to provide space for
tooth positioning and alveolar remodeling.
If initial orthodontic treatment does not succeed
in more severe cases, surgery at a later age
may be indicated.
Growth tends to aggravate, not obscure, all
cases of complex open bite.
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99.
By the time adolescence is reached,
environmental causes of anterior open bite have
become less important than skeletal factors . It
is rare for anterior open bite in an adolescent to
be due solely to some habit, or for the open bite
to correct spontaneously at this age after a habit
has been corrected.
In the past, tongue thrust swallowing was
blamed for many anterior open bites in this age
group, and efforts at training the patient to
swallow correctly were used in an attempt to
control anterior open bite problems.
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100. Contemporary
research, however, makes
it clear that tongue thrust swallow is more
an adaptation to the open bite than the
cause of it .
Myofunctional therapy for tongue
thrusting, for that reason, is ineffectual and
not recommended.
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101.
Deep Overbite. Anterior deep bite problems may result
from an upward and forward rotation of the mandible, or
from excessive eruption of mandibular incisor teeth.
Supra-eruption of lower incisors often accompanies a
Class II malocclusion, because when there is excessive
overjet, the lower incisors tend to erupt until they contact
the palatal mucosa.
In comprehensive orthodontic treatment, usually it is
necessary to correct this elongation of the lower incisors,
by leveling out an excessive curve of Spee in the lower
arch.
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102.
In an adolescent whose face height is still
increasing, it is only necessary to prevent further
eruption of the lower incisors as vertical growth
continues to achieve a relative intrusion.
Continuous arch mechanics are appropriate. In
the absence of growth, however, absolute
intrusion is required, and segmented arch
mechanics must be used to achieve this
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103.
Correction of skeletal deep bite problems
requires rotating the mandible downward,
thereby increasing the mandibular plane angle
and anterior face height.
Keep in mind that in a patient with short anterior
facial dimensions and a skeletal deep bite,
rotating the mandible downward to correct the
deep bite will reveal a skeletal mandibular
deficiency.
Thus the growth modification techniques
necessary to deal with this problem are typically
those for correction of mandibular deficiency.
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104. Severe cases of deep bite combined with
severe AP skeletal dysplasia. may require
orthognathic surgery later.
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105. Temporomandibular Joint Dysfunction
Temporomandibular dysfunction and associated signs
and symptoms are more frequently seen in adolescence
than in childhood. The origins are important to an
understanding of the clinical problem in adolescence.
A history of facial trauma or temporomandibular joint
trauma is often found.
Temporomandibular joint dysfunction may be seen with
a variety of malocclusions in adolescence, although it is
most frequently associated with Class II, deep bite, open
bite, and skeletal asymmetry .
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106.
Of particular importance are those cases with occlusal
dysfunction such as an abnormal distance between the
retruded contact and intercuspal positions and markedly
deviant or erratic paths of mandibular closure.
A meticulous examination of the joints and associated
musculature is essential for every adolescent
malocclusion .
Many adolescents are unaware of myalgia or pain in
tendons and the joint region because the condition has
appeared so gradually that they have accommodated
through time. Precise palpation may elicit points of
tenderness of diagnostic significance.
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107.
Treatment consists of correcting the malocclusion to the
finest and most precise functional occlusal results, giving
particular attention to the joints.
Detailed attention to tooth positioning, occlusal
equilibration, and precise occlusal coordination are
essential. Intermaxillary elastic traction during treatment
is contraindicated in patients with TMJ symptoms.
Retention should not be started until perfect occlusal
coordination is seen, but occlusal equilibration may be
begun while the bracketed appliances are still in place.
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108.
References have been made in the literature implicating
adolescent orthodontic treatment as a causative factor in
adult temporomandibular dysfunction,
but sound long-term clinical studies by Sadowsky &
Begole ( AJO 1980 ) clearly show orthodontic treatment
is not a significant etiologic factor on a population basis.
Any poor occlusal treatment at any age can contribute to
temporomandibular pain or joint derangement.
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109. Orthodontic treatment significantly
reduces the prevalence of
temporomandibular joint disrders in
adolescents, for the condition is more
prevalent in malocclusions before their
treatment
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110. Current Trends
A recent trend is the use of invisible removable
aligners for minor tooth movement.
For adolescent orthodontic patients in whom
growth/ orthopedic effects are deemed
unnecessary, possibility exists for use of implant
assisted orthodontics.
Carano ( JCO 2005) however, caution against
the use of orthodontic implants for girls younger
than 16yrs & boys younger than 18yrs.
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111. ASSESSMENT OF RESULTS OF
ADOLESCENT TREATMENT
Evaluation of orthodontic treatments must be
done precisely and with caution for there are
many variables which determine the quality of a
treated result.
Unless one knows exactly the conditions under
which a case was treated, it is wise and
professionally prudent to be cautious in
conclusion and discreet in comment .
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112.
Poor treatment does not stabilize or improve
with time.
Retreatment to the standards to be described is
really the only satisfactory solution.
For this reason adolescent treatment must be
accompanied not only by meticulously designed
original goals but also by persistent monitoring
throughout treatment.
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113.
Occlusion
a) Occlusal Plan. If a cuspid rise occlusion was
chosen, then the entire occlusion should be
consonant with that theory .If group function was
the plan, then the occlusion should be judged by
the principles of that approach.
b) Molar Relationships
Much orthodontic treatment focuses only on first
molar occlusion, but the occlusal relations of all
molars and bicuspids should be studied carefully
and the lingual molar occlusion is particularly
revealing.
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114.
c) Cuspid Occlusion While the cuspid occlusion
is as important as the molars, it is not always
possible to have equally good molar and cuspid
reIationships if there are tooth size
disharmonies.
More compromises in cuspid occlusion and
overbite and overjet are necessary in men and
boys because of the sexual dimorphism in
maxillary cuspid size.
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115.
d) Incisor Position Incisors must be placed well
over the basal bone in each arch and well
related to one another. Careful root positioning
determines incisal stability and esthetics.
e) Functional Occlusal Relations :The occlusion
must be studied in the retruded contact position
(Centric relation) and in the intercuspal position
(centric occlusion).
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116. There should be no occlusal interferences
in retruded contact position nor any
between the retruded contact and
intercuspal positions.
It is especially important that there be
balancing interferences . In protrusive
occlusion the incisors should contact
symmetrically and there must be complete
posterior disclusion.
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117.
f) Root Positions : In extraction cases, it is
important that the roots be parallel directly
beneath the crowns to avoid loss of
interproximal contact. In treated crossbite cases,
root positions must agree with correction.
g) Alignment : Crown size disharmonies may still
be present at the end of treatment when there is
a Bolton discrepancy. Disharmonies of tooth size
and the adaptation of occlusal function to
continuing growth may deny perfect alignment in
some cases.
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118.
Soft Tissues
Facial and tongue musculature play an
important role in stabilizing orthodontically
treated cases, and the facial soft tissues
determine, to a great extent, esthetic results.
The time of treatment and the time of the
evaluation are important since there are
significant soft tissue growth changes during
childhood and adolescence.
One must also decide whether or not any
adaptive functions which accompanied the
malocclusion are still present after treatment.
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119. Gingiva: Gingival health after orthodontic
treatment reflects not only oral hygiene but also
the positions of the teeth achieved at the end of
orthodontic therapy.
Especially vulnerable is the gingival height of
mandibular incisors and the gingival relationship
to maxillary molar and bicuspid roots after
palatal expansion.
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120.
Facial Esthetics
Because each face is unique, it is impossible to
produce identical results for all patients; rather,
orthodontic treatment should enhance the
patient's individual esthetic features.
Special care must be taken in evaluating the
child patient for there is a tendency to apply
adult standards of facial esthetics
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121.
The most common problems in facial esthetics involve
extraction. In some cases choosing not to extract strains
the limits of the alveolar process to achieve alignment,
yet time, growth, occlusal function, etc. , may improve
the eventual facial esthetics.
In other instances, unfortunately, the same factors
produce crowding and malalignment.
Extractions which produce adult faces in young
adolescents are to be deplored. for those same faces a
few years later may look almost edentulous.
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122.
No formulas are infallible when planning
treatment and it is always easier to secondguess treatments after the fact.
Criticism comes easier than craftsmanship.
Facial esthetics is a matter of personal
judgment, so one's own opinions about esthetics
should be imposed with caution on colleagues
who saw the patient at another time.
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123. CONCLUSION
Some malocclusion are best treated in
adolescence and a few are singular to this stage
of development.
More malocclusions are probably treated in
adolescence than any other period, not because
it is always best time for therapy, but rather
because this is the time at which patient &
parent often become aware of this problem
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124.
There are really very few proper clinical research
reports on the effects of adolescent orthodontic
treatment. Most other clinical writing at this
time , reveal more personal clinical experiences
& perceptions.
Therefore proper treatment planning for an
adolescent case as well as highly developed
clinical judgement & skill in use of fixed
appliances are required.
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125. References
Amanpreet Kaur Grewal, James Sunny P, Valiathan A.
Expectations and perceptions of patients towards
orthodontic treatment in Manipal . J Pierre Fauchard
Academy 2003;19:83-88.
Sachdeva Sunil & Valiathan Ashima: "Whose mouth is
it anyway?". Journal of Indian Orthodontic Society,
1994; 22(3): 105-108.
Sunil Sachdeva & Valiathan Ashima: Co-operation in
orthodontics. Nepal Dental Journal 1999 :2(1)21-26.
Irfan Dawoodbhoy, Valiathan Ashima: Age &
Orthodontics. Journal of International College of
Dentist. 1993; 34: 20-25
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Nalbantgil D, Arun T, Sayinsu K, Fulya I : Skeletal,
dental and soft-tissue changes induced by the Jasper
Jumper appliance in late adolescence . Angle Orthod.
2005 May;75(3):426-36.
Franchi L, Baccetti T, McNamara JA. :Postpubertal
assessment of treatment timing for maxillary expansion
and protraction therapy followed by fixed appliances .
AJODO. 2004 Nov;126(5):555-68
Northway W. : Hemisection: one large step toward
management of congenitally missing lower second
premolars. Angle Orthod. 2004 Dec;74(6):792-9.
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127.
Carano A, Velo S, Leone P : Clinical application
of the mini screw anchorage system. JCO 2005;
39 (1) 9-24.
Sadowsky C, Begole EA : Long term effects of
TMJ function & functional occlusion after
orthodontic treatment. AJO 1981; 78;201-212.
Trulsson U, StrandmarkM, Mohlin B : A
qualitative study of teenager’s decision to
undergo orthodontic treatment with fixed
appliances. J Orthod 2002; 29 (3) : 197-204.
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Daniel J Rinchuse, Donald J Rinchuse : Developmental
Occlusion, Orthodontic Interventions, and Orthognathic
surgery for adolescents. DCNA 2006,(50); 69- 86.
Cooper ML, Shapiro ML: Motivations for health
behaviors among adolescents. In Mcnamara JA,
Trotman CF (eds) : Creating the compliant patient, Ann
Arbor, Mich, 1996.
Robert E Moyers : Handbook of orthodontics. 4th edtn,
Year book medical publishers, INC, Chicago, 1988. Pg432-471.
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Samir E Bishara : Textbook of orthodontics.2nd
Reprint 2003, Elsevier , New Delhi. Pg – 454460.
William R Proffit : Contemporary Orthodontics .
3rd edtn, St.Louis, Mosby. Pg - 56-61, 229233,272-275.
Wendell W. Neeley, G. Thomas Kluemper ,Lon
R. Hays : Psychiatry in orthodontics. Part 2:
Substance abuse among adolescents and its
relevance to orthodontic practice. AJODO 2006,
129 ( 2 ) ; 168-174.
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