1. The document discusses anterior open bite and high angle cases, defining dental and skeletal open bites. It covers etiology including transitional factors, skeletal factors like genetics and trauma, soft tissue factors like muscles and adenoid size, and habits like digit sucking.
2. Treatment options are discussed ranging from myofunctional therapy and extraoral traction to fixed appliances, molar intrusion, repelling magnets, and orthognathic surgery. Stability, relapse prevention, and difficulties in treatment are also addressed.
3. Key predictors of open bite like Bjork's structural signs, Jarabak ratio, UAFH-LAFH ratio, and decreased overbite depth indicator are summarized. Character
1. Late mandibular incisor crowding is common in modern populations as the mandible continues growing forward while maxillary growth stops, pushing the lower incisors lingually and reducing arch length.
2. Causes include late mandibular growth, increased muscle tone, gingival/occlusal forces, lack of attrition in modern diets, and reduction in intercanine width.
3. Management options for mild crowding include acceptance and monitoring, interproximal stripping for adults, or extracting a lower incisor with fixed appliances and lingual retainers for more severe crowding. Extraction of lower premolars may also be considered.
Management of Open Bite - Dr. Nabil Al-ZubairNabil Al-Zubair
The document discusses the orthodontic management of open bite cases. It covers conditions like long face syndrome, posterior growth rotation, and anterior and posterior open bites. Managing high angle and open bite cases can be difficult as the underlying skeletal issues are not always clear. Open bites can be anterior or posterior and have multiple etiological factors, both hereditary and non-hereditary like thumb sucking and tongue thrusting. Mouth breathing associated with nasal obstruction is a significant cause that can result in skeletal open bites and long face syndrome.
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 discusses two main types of space closure mechanics in orthodontic treatment: closing loop archwires and sliding mechanics. Closing loop archwires involve individually fabricated loops to retract teeth into extraction spaces, while sliding mechanics use elastic chains or coil springs to slide teeth along archwires into spaces. The document provides details on techniques, advantages, and disadvantages of each approach as well as factors influencing effective space closure.
This document discusses Steiner's acceptable compromises for compensating for sagittal discrepancies between the upper and lower jaws. It provides guidelines for adjusting the positions of the upper and lower incisors based on the ANB angle. A case example is used to illustrate how to predict changes to the ANB angle through growth or treatment and adjust incisor positions accordingly. The document also discusses individualizing treatment proposals based on factors like soft tissue function.
This document discusses several orthodontic appliances including the Nance appliance, transpalatal arch, quad helix, lip bumper, and tongue crib. It provides details on the design, indications, mechanisms of action, advantages and disadvantages of each appliance. The document is intended as an educational guide for orthodontic residents, as it is presented by several orthodontists and covers the key aspects of these common fixed functional appliances.
1. The document discusses features, etiology, and treatment of anterior open bite and deep bite. It describes skeletal, dental, soft tissue, and growth features of high and low angle cases.
2. Cephalometric measurements used to assess open bite and deep bite tendencies are described, including overbite depth indicator, Jarabak ratio, and UAFH-LAFH ratio.
3. Causes of open bite discussed include habits, enlarged adenoids, and posterior rotation of the mandible. Deep bite causes include class II skeletal pattern and anterior rotation of the mandible.
Pendulum appliance 2 /certified fixed orthodontic courses by Indian dental ac...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
1. Late mandibular incisor crowding is common in modern populations as the mandible continues growing forward while maxillary growth stops, pushing the lower incisors lingually and reducing arch length.
2. Causes include late mandibular growth, increased muscle tone, gingival/occlusal forces, lack of attrition in modern diets, and reduction in intercanine width.
3. Management options for mild crowding include acceptance and monitoring, interproximal stripping for adults, or extracting a lower incisor with fixed appliances and lingual retainers for more severe crowding. Extraction of lower premolars may also be considered.
Management of Open Bite - Dr. Nabil Al-ZubairNabil Al-Zubair
The document discusses the orthodontic management of open bite cases. It covers conditions like long face syndrome, posterior growth rotation, and anterior and posterior open bites. Managing high angle and open bite cases can be difficult as the underlying skeletal issues are not always clear. Open bites can be anterior or posterior and have multiple etiological factors, both hereditary and non-hereditary like thumb sucking and tongue thrusting. Mouth breathing associated with nasal obstruction is a significant cause that can result in skeletal open bites and long face syndrome.
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 discusses two main types of space closure mechanics in orthodontic treatment: closing loop archwires and sliding mechanics. Closing loop archwires involve individually fabricated loops to retract teeth into extraction spaces, while sliding mechanics use elastic chains or coil springs to slide teeth along archwires into spaces. The document provides details on techniques, advantages, and disadvantages of each approach as well as factors influencing effective space closure.
This document discusses Steiner's acceptable compromises for compensating for sagittal discrepancies between the upper and lower jaws. It provides guidelines for adjusting the positions of the upper and lower incisors based on the ANB angle. A case example is used to illustrate how to predict changes to the ANB angle through growth or treatment and adjust incisor positions accordingly. The document also discusses individualizing treatment proposals based on factors like soft tissue function.
This document discusses several orthodontic appliances including the Nance appliance, transpalatal arch, quad helix, lip bumper, and tongue crib. It provides details on the design, indications, mechanisms of action, advantages and disadvantages of each appliance. The document is intended as an educational guide for orthodontic residents, as it is presented by several orthodontists and covers the key aspects of these common fixed functional appliances.
1. The document discusses features, etiology, and treatment of anterior open bite and deep bite. It describes skeletal, dental, soft tissue, and growth features of high and low angle cases.
2. Cephalometric measurements used to assess open bite and deep bite tendencies are described, including overbite depth indicator, Jarabak ratio, and UAFH-LAFH ratio.
3. Causes of open bite discussed include habits, enlarged adenoids, and posterior rotation of the mandible. Deep bite causes include class II skeletal pattern and anterior rotation of the mandible.
Pendulum appliance 2 /certified fixed orthodontic courses by Indian dental ac...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
Index of Complexity, Outcome and Need (ICON) - Orthodontic IndexDr.Nasir Al-Hamlan
This document provides information on the Index of Complexity, Outcome and Need (ICON) orthodontic index. The ICON assesses orthodontic treatment need and outcome. It contains 5 components that are each scored and weighted: dental aesthetics, upper arch crowding/spacing, anterior vertical relationships, crossbite, and buccal segment relationships. Scoring protocols and examples of using the ICON for a case are also provided. The ICON is described as being simple, quick, and valid for assessing need, complexity, outcome and international use. Some limitations include assuming patient cooperation and dependence on the aesthetic component.
This document discusses the management of transverse discrepancies including crossbites and maxillary expansion. It begins with definitions of key terms and discusses the prevalence, etiology, diagnosis, and classification of posterior crossbites. Treatment options are provided for different crossbite classifications. The rationale, indications, contraindications, effects, and complications of maxillary expansion (RME) are outlined. Various appliances and techniques for rapid and slow maxillary expansion are described. Factors determining the appropriate type and technique of expansion are also discussed.
This document discusses various orthodontic appliances used for intrusion, including the three-piece intrusion arch, Rickets utility arch, K-SIR appliance, and Connecticut Intrusion Arch. It describes how each appliance works and its advantages. The three-piece intrusion arch uses an intrusive cantilever to simultaneously intrude and retract anterior teeth. The Rickets utility arch engages two molars and four incisors to intrude lower incisors. The K-SIR appliance modifies loop mechanics to simultaneously intrude and retract teeth. The Connecticut Intrusion Arch incorporates characteristics of the utility arch and conventional intrusion arch to achieve absolute intrusion of anterior teeth.
This document discusses various methods and appliances for distalizing maxillary molars, including removable and fixed options. Removable appliances discussed include extraoral traction using headgear as well as removable appliances with finger springs or sliding jigs. Fixed appliances discussed include intramaxillary devices like Wilson's 3D appliance as well as intermaxillary appliances like Herbst or Jasper Jumper. Factors like the presence of second molars, skeletal pattern, and growth prognosis must be considered when determining whether molar distalization is indicated.
Rakosi's analysis is an important diagnostic tool for planning functional appliance therapy. It involves analyzing three divisions: 1) the facial skeleton, 2) the jaw bones, and 3) the dentoalveolar relationship. Key measurements of the facial skeleton include saddle, articular, and gonial angles which provide information about cranial base orientation and mandibular positioning. Measurements of the jaw bones like SNA, SNB, and inclination angle describe the maxillary and mandibular skeletal bases. Dentoalveolar measurements such as upper and lower incisor angles indicate incisor inclinations. Rakosi's analysis provides a comprehensive evaluation of skeletal, dental, and soft tissue structures for orthodontic
This document discusses various methods for analyzing space in orthodontic treatment planning. It describes the Royal London Space Analysis method in detail, including its two stages: 1) assessing space requirements and 2) creating or utilizing space through treatment mechanics. The method is considered easy to use, reliable, and valid, but it may overestimate crowding and have limited impact on treatment decisions. Alternative space analysis methods and their advantages/disadvantages are also reviewed.
Orthopedic protraction of the maxilla part 1MaherFouda1
1. The document discusses treatment of Class III malocclusion through maxillary protraction using face masks connected to various intraoral appliances.
2. Common intraoral appliances used include rapid palatal expanders, removable plates, and splints to stabilize the maxilla.
3. Face masks like the Delaire or Petit masks can be used to apply approximately 350-450g of forward force over 12-14 hours per day to correct maxillary deficiency.
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
Canine Impaction and Its Importance in OrthodonticsAnalhaq Shaikh
Canine Impaction, Its Importance in Orthodontics, Etiology, Diagnosis and Management.
by Dr Analhaq Shaikh, 2nd year Postgraduate student, Sharavathi Dental College and Hospital, Shimoga, Karnataka
Canine Impaction can also be termed as Shy Canine.
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
Edward H. Angle was a pioneering orthodontist who developed concepts of occlusion and malocclusion classification in the late 1800s. He opposed extracting teeth for orthodontic treatment. Several orthodontists further developed his ideas, creating new appliances like the Edgewise and Begg appliances to improve control of tooth movement and occlusion. In the 1970s, Larry Andrews identified characteristics of ideal occlusion from studying untreated ideal bites. He developed the preadjusted edgewise appliance and "Six Keys of Occlusion" to achieve optimal occlusion without wire bending. Ronald Roth built on Andrews' work by incorporating the temporomandibular joint.
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.
Hybrid appliances are specifically and individually tailored to exploit the natural processes of growth and development. Such an approach represents a departure from the practice of adopting a "named" appliance for the treatment of a class of malocclusion
This document discusses utility arches, which are orthodontic appliances used to apply light forces in the dental arch. It provides details on:
- The historical background and development of utility arches based on biomechanical principles.
- Common wire dimensions and materials used, including stainless steel, nickel titanium, and beta titanium alloys.
- The standard design components of utility arches, including molar, vertical, and incisal segments.
- Different types of utility arches like passive arches, intrusion arches, and retraction/protrusion arches and how they are activated to apply specific orthodontic forces.
This document discusses soft tissue analysis in cephalometric evaluations. It begins by explaining the importance of analyzing soft tissue profiles in orthodontic treatment planning. It then outlines various soft tissue landmarks used in cephalometric analysis of the profile, nose, chin, and lips. Specific angular measurements are described to evaluate different regions of the soft tissue facial profile, including nasal angle, nasolabial angle, mentocervical angle, and others. The document provides details on traditional planes of reference and how to assess vertical facial proportions, convexity, and prominence of different soft tissue structures.
The document discusses the Peer Assessment Rating (PAR) index, which is used to evaluate orthodontic treatment outcomes. It was developed through meetings of experienced orthodontists who formulated the index using over 200 pre- and post-treatment cases. The PAR assigns scores to various components like anterior teeth alignment, overjet, overbite, and midline to provide a cumulative score. Treatment results are graded as greatly improved, improved, or no different based on the reduction in PAR scores from pre- to post-treatment. The document then provides detailed descriptions and scoring criteria for each component of the PAR index.
The document discusses orthodontic bracket prescriptions, including:
1) Early edgewise brackets required wire bends to control tooth movement, while contemporary brackets have built-in prescriptions for in-out, tip, and torque adjustments.
2) Lawrence Andrews introduced the pre-adjusted edgewise appliance with customized brackets programmed for specific tooth control without wire bends.
3) Later prescriptions like Roth and MBT incorporated changes like more torque in upper incisors to compensate for bracket limitations, while individual adaptations are often needed for specific cases.
Dr. James McNamara developed a cephalometric analysis method in 1984 to evaluate orthodontic and orthognathic surgery patients. The analysis divides the craniofacial skeleton into five sections - maxilla to cranial base, maxilla to mandible, mandible to cranial base, dentition, and airway. Linear measurements of landmarks and planes are compared to normative standards to assess relationships. Advantages include using primarily linear measurements, being more sensitive to vertical changes, and providing growth guidelines that are easily explained.
This document discusses molar distalization, which is an alternative method for gaining space when treating orthodontic patients with space deficiencies. It provides the history of molar distalization, indications and contraindications for its use, different appliance options, and considerations for appliance selection. Molar distalization involves using orthodontic appliances to distalize or move the molars backwards in the dental arch in order to gain space.
This document discusses Class II Division 2 malocclusion. Key points:
- Class II Division 2 is characterized by retroclined upper incisors and a retropositioned lower first molar. The overjet is usually minimal but may be increased.
- It has a prevalence of 1.5-17.7% and is highly associated with impacted canines.
- The etiology involves genetic and environmental factors like soft tissue pressures retroclining the upper incisors.
- Treatment aims to correct the skeletal and dental relationships, overbite, and achieve a functional occlusion. Options include growth modification, fixed appliances, orthognathic surgery, or a combination. Anchorage is
This document discusses the benefits of orthodontic treatment. It outlines 7 main benefits: 1) psychological benefits such as improved self-esteem, 2) improved masticatory efficiency, 3) improved speech, 4) prevention or cure of temporomandibular joint dysfunction, 5) interceptive benefits such as preventing trauma, 6) dental health benefits like increased resistance to caries and periodontal disease, and 7) being an adjunct to other dental treatments. The summary at the end synthesizes several key studies that evaluated these benefits and the evidence regarding their effectiveness.
Index of Complexity, Outcome and Need (ICON) - Orthodontic IndexDr.Nasir Al-Hamlan
This document provides information on the Index of Complexity, Outcome and Need (ICON) orthodontic index. The ICON assesses orthodontic treatment need and outcome. It contains 5 components that are each scored and weighted: dental aesthetics, upper arch crowding/spacing, anterior vertical relationships, crossbite, and buccal segment relationships. Scoring protocols and examples of using the ICON for a case are also provided. The ICON is described as being simple, quick, and valid for assessing need, complexity, outcome and international use. Some limitations include assuming patient cooperation and dependence on the aesthetic component.
This document discusses the management of transverse discrepancies including crossbites and maxillary expansion. It begins with definitions of key terms and discusses the prevalence, etiology, diagnosis, and classification of posterior crossbites. Treatment options are provided for different crossbite classifications. The rationale, indications, contraindications, effects, and complications of maxillary expansion (RME) are outlined. Various appliances and techniques for rapid and slow maxillary expansion are described. Factors determining the appropriate type and technique of expansion are also discussed.
This document discusses various orthodontic appliances used for intrusion, including the three-piece intrusion arch, Rickets utility arch, K-SIR appliance, and Connecticut Intrusion Arch. It describes how each appliance works and its advantages. The three-piece intrusion arch uses an intrusive cantilever to simultaneously intrude and retract anterior teeth. The Rickets utility arch engages two molars and four incisors to intrude lower incisors. The K-SIR appliance modifies loop mechanics to simultaneously intrude and retract teeth. The Connecticut Intrusion Arch incorporates characteristics of the utility arch and conventional intrusion arch to achieve absolute intrusion of anterior teeth.
This document discusses various methods and appliances for distalizing maxillary molars, including removable and fixed options. Removable appliances discussed include extraoral traction using headgear as well as removable appliances with finger springs or sliding jigs. Fixed appliances discussed include intramaxillary devices like Wilson's 3D appliance as well as intermaxillary appliances like Herbst or Jasper Jumper. Factors like the presence of second molars, skeletal pattern, and growth prognosis must be considered when determining whether molar distalization is indicated.
Rakosi's analysis is an important diagnostic tool for planning functional appliance therapy. It involves analyzing three divisions: 1) the facial skeleton, 2) the jaw bones, and 3) the dentoalveolar relationship. Key measurements of the facial skeleton include saddle, articular, and gonial angles which provide information about cranial base orientation and mandibular positioning. Measurements of the jaw bones like SNA, SNB, and inclination angle describe the maxillary and mandibular skeletal bases. Dentoalveolar measurements such as upper and lower incisor angles indicate incisor inclinations. Rakosi's analysis provides a comprehensive evaluation of skeletal, dental, and soft tissue structures for orthodontic
This document discusses various methods for analyzing space in orthodontic treatment planning. It describes the Royal London Space Analysis method in detail, including its two stages: 1) assessing space requirements and 2) creating or utilizing space through treatment mechanics. The method is considered easy to use, reliable, and valid, but it may overestimate crowding and have limited impact on treatment decisions. Alternative space analysis methods and their advantages/disadvantages are also reviewed.
Orthopedic protraction of the maxilla part 1MaherFouda1
1. The document discusses treatment of Class III malocclusion through maxillary protraction using face masks connected to various intraoral appliances.
2. Common intraoral appliances used include rapid palatal expanders, removable plates, and splints to stabilize the maxilla.
3. Face masks like the Delaire or Petit masks can be used to apply approximately 350-450g of forward force over 12-14 hours per day to correct maxillary deficiency.
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
Canine Impaction and Its Importance in OrthodonticsAnalhaq Shaikh
Canine Impaction, Its Importance in Orthodontics, Etiology, Diagnosis and Management.
by Dr Analhaq Shaikh, 2nd year Postgraduate student, Sharavathi Dental College and Hospital, Shimoga, Karnataka
Canine Impaction can also be termed as Shy Canine.
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
Edward H. Angle was a pioneering orthodontist who developed concepts of occlusion and malocclusion classification in the late 1800s. He opposed extracting teeth for orthodontic treatment. Several orthodontists further developed his ideas, creating new appliances like the Edgewise and Begg appliances to improve control of tooth movement and occlusion. In the 1970s, Larry Andrews identified characteristics of ideal occlusion from studying untreated ideal bites. He developed the preadjusted edgewise appliance and "Six Keys of Occlusion" to achieve optimal occlusion without wire bending. Ronald Roth built on Andrews' work by incorporating the temporomandibular joint.
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.
Hybrid appliances are specifically and individually tailored to exploit the natural processes of growth and development. Such an approach represents a departure from the practice of adopting a "named" appliance for the treatment of a class of malocclusion
This document discusses utility arches, which are orthodontic appliances used to apply light forces in the dental arch. It provides details on:
- The historical background and development of utility arches based on biomechanical principles.
- Common wire dimensions and materials used, including stainless steel, nickel titanium, and beta titanium alloys.
- The standard design components of utility arches, including molar, vertical, and incisal segments.
- Different types of utility arches like passive arches, intrusion arches, and retraction/protrusion arches and how they are activated to apply specific orthodontic forces.
This document discusses soft tissue analysis in cephalometric evaluations. It begins by explaining the importance of analyzing soft tissue profiles in orthodontic treatment planning. It then outlines various soft tissue landmarks used in cephalometric analysis of the profile, nose, chin, and lips. Specific angular measurements are described to evaluate different regions of the soft tissue facial profile, including nasal angle, nasolabial angle, mentocervical angle, and others. The document provides details on traditional planes of reference and how to assess vertical facial proportions, convexity, and prominence of different soft tissue structures.
The document discusses the Peer Assessment Rating (PAR) index, which is used to evaluate orthodontic treatment outcomes. It was developed through meetings of experienced orthodontists who formulated the index using over 200 pre- and post-treatment cases. The PAR assigns scores to various components like anterior teeth alignment, overjet, overbite, and midline to provide a cumulative score. Treatment results are graded as greatly improved, improved, or no different based on the reduction in PAR scores from pre- to post-treatment. The document then provides detailed descriptions and scoring criteria for each component of the PAR index.
The document discusses orthodontic bracket prescriptions, including:
1) Early edgewise brackets required wire bends to control tooth movement, while contemporary brackets have built-in prescriptions for in-out, tip, and torque adjustments.
2) Lawrence Andrews introduced the pre-adjusted edgewise appliance with customized brackets programmed for specific tooth control without wire bends.
3) Later prescriptions like Roth and MBT incorporated changes like more torque in upper incisors to compensate for bracket limitations, while individual adaptations are often needed for specific cases.
Dr. James McNamara developed a cephalometric analysis method in 1984 to evaluate orthodontic and orthognathic surgery patients. The analysis divides the craniofacial skeleton into five sections - maxilla to cranial base, maxilla to mandible, mandible to cranial base, dentition, and airway. Linear measurements of landmarks and planes are compared to normative standards to assess relationships. Advantages include using primarily linear measurements, being more sensitive to vertical changes, and providing growth guidelines that are easily explained.
This document discusses molar distalization, which is an alternative method for gaining space when treating orthodontic patients with space deficiencies. It provides the history of molar distalization, indications and contraindications for its use, different appliance options, and considerations for appliance selection. Molar distalization involves using orthodontic appliances to distalize or move the molars backwards in the dental arch in order to gain space.
This document discusses Class II Division 2 malocclusion. Key points:
- Class II Division 2 is characterized by retroclined upper incisors and a retropositioned lower first molar. The overjet is usually minimal but may be increased.
- It has a prevalence of 1.5-17.7% and is highly associated with impacted canines.
- The etiology involves genetic and environmental factors like soft tissue pressures retroclining the upper incisors.
- Treatment aims to correct the skeletal and dental relationships, overbite, and achieve a functional occlusion. Options include growth modification, fixed appliances, orthognathic surgery, or a combination. Anchorage is
This document discusses the benefits of orthodontic treatment. It outlines 7 main benefits: 1) psychological benefits such as improved self-esteem, 2) improved masticatory efficiency, 3) improved speech, 4) prevention or cure of temporomandibular joint dysfunction, 5) interceptive benefits such as preventing trauma, 6) dental health benefits like increased resistance to caries and periodontal disease, and 7) being an adjunct to other dental treatments. The summary at the end synthesizes several key studies that evaluated these benefits and the evidence regarding their effectiveness.
The document discusses arch form and width in orthodontic treatment. It defines arch form as the shape formed by the buccal and facial surfaces of teeth when viewed from above. Factors like ethnicity, malocclusion type, musculature, environment, and treatment influence arch form. Implications of arch form for treatment include aesthetics, periodontal health, treatment planning, mechanics, and stability. Common arch forms described include Bonwill-Hawley, catenary curve, Brader ellipse, conic sections, Andrews, and individualized forms. Arch width changes naturally with growth but appliances can stably expand the arch to a limited degree depending on factors like age and extractions.
This document discusses Class II and Class III subdivision malocclusions. It describes two types of Class II subdivisions - Type 1 where the mandibular midline is deviated and Type 2 where the maxillary midline is deviated. Treatment depends on the type and severity of crowding but may involve single or multiple premolar extractions or interarch mechanics. Class III subdivisions can be treated similarly though studies are lacking, and extraction of a mandibular incisor is another option. Early intervention can address asymmetries from early tooth loss or crossbites.
This document discusses the management of facial and dental asymmetry. It defines asymmetry and outlines its prevalence in the general population and among orthodontic patients. Asymmetry can be caused by skeletal, functional, muscular, local dental factors or a combination. Diagnosis involves taking a thorough history and conducting examinations of the soft tissues, dentition, occlusion and skeletal structures to determine the underlying causes and classify the type of asymmetry present. Treatment aims to address the specific causes and may involve orthodontics, orthognathic surgery, or both to improve function, occlusion and aesthetics.
This document discusses the aetiology of malocclusion. It states that malocclusion can be caused by both genetic and environmental factors. Genetic factors that may influence malocclusion include homeobox genes, growth factors, and genes related to specific dental anomalies. Evidence for a genetic role comes from twin studies and familial occurrences of certain malocclusions. Environmental factors like soft tissues, habits, and local dental factors can also influence malocclusion development. The interaction between genetics and environment determines the phenotype.
1. Bimaxillary proclination is a malocclusion where the maxillary and mandibular incisors are positioned forward in relation to their dental bases.
2. It is most common in Afro-Caribbean and some Asian populations and can be caused by skeletal, soft tissue, dental, or habitual factors.
3. Treatment depends on the severity and may include space creation through extraction or alignment and retraction of the incisors using techniques like temporary anchorage devices. Stability of results can be challenging.
Arch Form in orthodontics /certified fixed orthodontic courses by Indian dent...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
Class III malocclusion is characterized by the mandible being positioned forward in relation to the maxilla. It can be due to maxillary deficiency, mandibular excess, or a combination. Treatment depends on the patient's age, skeletal maturity, and severity of the malocclusion. Early treatment options include a face mask or chin cup to guide growth, while later options include dental camouflage if mild or orthognathic surgery if more severe. Careful monitoring of mandibular growth is important for determining the best long-term treatment approach.
This document discusses biomechanics in orthodontics. It covers physical variables like Newton's laws of motion and terminology used in orthodontics such as vectors, forces, moments, and centers of resistance and rotation. It also discusses forces related variables including magnitude and direction of forces, root surface area, duration of forces, and how drugs can affect the response to orthodontic forces. The relationship between force magnitude, duration, and type of tooth movement is explained. Maintaining an optimal force leads to more efficient movement while excessive forces can damage tissues.
This document defines orthodontic anchorage (OA) and discusses its early understanding and assessment. It describes factors that influence anchorage demand and different classifications of OA. Theories of optimal force levels and differential anchorage are explained. Various methods to reinforce anchorage are outlined, including using compound anchorage units, anchor bends, tipping and uprighting teeth, extraoral anchorage, and musculature forces. The evidence for the differential force theory is discussed.
This document provides an overview of adult orthodontics. It discusses special considerations for orthodontic treatment in adults, including medical history, psychological factors, lack of growth, and periodontal disease. It also describes recent advances in adult orthodontics, such as ceramic brackets, lingual appliances, and Invisalign, which aim to improve aesthetics. The document is a reference list for adult orthodontics written by Mohammed Almuzian at the University of Glasgow in 2013.
This document contains a diagnostic summary, clinical examination, radiographic findings, problem list, treatment aims and objectives, cephalometric interpretation, and treatment plan for an orthodontic patient. Key details include that the patient presented with a Class I incisor relationship on a Class II skeletal base with vertical proportions. Clinical findings show good oral hygiene and tooth quality with no pathology. The treatment plan is to use a functional appliance to improve the skeletal relationship, followed by fixed appliances to detail the occlusion. Retention will involve upper and lower retainers.
The document discusses impacted maxillary canines, including:
- Unerupted canines is a common clinical problem, with prevalence ranging from 0.8-2.8%.
- Normal development involves calcification starting at age 1 and eruption around 11-12 years old.
- Factors that can cause impaction include crowding, prolonged retention of primary canines, abnormal position of tooth buds, and genetic factors.
- Diagnosis involves inspection for delayed/asymmetric eruption, palpation of buds, and diagnostic imaging to determine location, development stage, and other anatomical details of unerupted canines.
1. The document describes the Begg orthodontic appliance and treatment methodology. It discusses the history and philosophy of Begg, the features of the appliance, and outlines the objectives and mechanics of the three stages of Begg treatment.
2. Stage I focuses on intra-arch alignment and leveling as well as overcorrection of overbite and overjet. Light class II elastics are used. Stage II aims to maintain stage I results while closing extraction spaces and correcting dental asymmetries using heavier elastics.
3. Stage III involves uprighting and torquing springs to correct tipping and torque. Uprighting springs may be needed to prevent opening of extraction spaces during torqueing. Finishing
This document discusses Class 2 Division 1 malocclusion. Key points include:
- It has a prevalence of 27% and is characterized by a distal relationship between the maxillary and mandibular teeth.
- Treatment options include orthodontic camouflage using appliances like upper removable appliances, functional appliances to modify growth, or orthognathic surgery.
- The choice of treatment depends on factors like the patient's age, skeletal pattern, dental development, soft tissue profile, and compliance. Camouflage is generally considered for mild cases, while surgery is used for more severe skeletal discrepancies.
- Outcomes and stability vary depending on the treatment approach and individual patient factors. Early intervention
This document provides an overview of extraoral orthodontic appliances. It defines extraoral appliances as those that apply forces from an external source. The document then summarizes the main types of extraoral appliances - headgear with facebow, J hook facebow, asymmetric headgear, and combinations with functional appliances. It also briefly outlines the history, uses, and studies on the effects of headgear, including dental and skeletal effects.
This document discusses the orthodontic management of hypodontia, which is tooth agenesis excluding third molars. It begins by defining hypodontia and classifying it based on the number of missing teeth and inheritance patterns. It then discusses the prevalence of hypodontia based on factors like ethnicity, gender, tooth type, and location. The etiology and clinical presentation are described. Management involves a multidisciplinary team and factors like age, severity, facial profile, and dental relationships are considered. Treatment options include space opening/closure and different appliances used. Challenges in treatment and restoration options to replace missing teeth are also covered.
This document discusses different types of tooth extractions performed in orthodontic treatment. It begins by explaining the history of extractions from Angle's philosophy of non-extraction to Tweed and Begg incorporating extractions. Evidence is presented on the effects of extractions on factors like profile, smile width, vertical dimension, and relapse. Types of extractions covered include lower incisors, upper incisors, canines, premolars, and molars. Serial extractions are defined as the timed extraction of primary and secondary teeth to interceptively manage crowding. Factors affecting extraction decisions and guidelines for different malocclusion types are also summarized.
This document discusses the orthodontic management of deep overbites. It begins with definitions and classifications of overbites. It then covers the prevalence, aetiology, indications for treatment, and principles of overbite reduction. Various treatment methods are described in detail, including removable appliances, fixed appliances, functional appliances, and auxiliary devices. Factors to consider for treatment method selection and mechanics for overbite reduction are also outlined. The document provides a comprehensive overview of deep overbite orthodontic management.
This document discusses class II malocclusion featuring maxillary excess. Key points include:
1. Prevalence and clinical findings of class II malocclusion during mixed dentition.
2. Cephalometric and occlusal characteristics including a retruded mandible.
3. Early intervention using cervical headgear with a facebow to guide maxillary growth and distalize the upper dentition can help address class II division 1 malocclusion caused by maxillary excess.
This document discusses the management of deep bite. It begins by defining deep bite and classifying it as skeletal, dental, true or pseudo. It then describes the morphological features of skeletal deep bite and discusses the interaction between jaw rotation and tooth eruption. It outlines different types of dento-alveolar deep bite and their characteristics. Factors related to the development of deep bite and strategies for correcting deep bite are also summarized.
This document discusses types and treatment of deep bites. It describes skeletal vs dentoalveolar deep bites and factors that can cause acquired deep bites. The main treatment strategies discussed are extruding posterior teeth, flaring anterior teeth, and intruding incisors. Soft tissue considerations and their impact on treatment plan selection are also covered. Risks like apical root resorption from incisor intrusion are addressed.
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.
This document discusses Class II division 1 malocclusion, including its prevalence, clinical findings, and early intervention. Key points include:
- Class II malocclusion is characterized by a distal step in the deciduous molars and is the second most common malocclusion.
- Clinical findings include overjet, overbite, protrusive midface, and retrusive chin. Cephalometric findings show maxillary protrusion or mandibular retrusion.
- Early intervention involves maintaining dental health, addressing habits, and using cervical headgear to restrain maxillary growth and distalize the upper dentition into a Class I relationship. Headgear is most effective when started in late mixed or early permanent dentition
This document discusses Class II division 1 malocclusion, including its prevalence, clinical findings, and early intervention. Key points include:
- Class II malocclusion is characterized by a distal step in the deciduous molars and is the second most common malocclusion.
- Clinical findings include a protrusive maxilla, retrusive mandible, large overjet, and deep bite.
- Early intervention can be done during the mixed dentition stage using a cervical facebow headgear to restrain maxillary growth and distalize the upper dentition.
- Treatment typically takes 12-18 months to achieve a Class I molar relationship and correct the malocclusion.
Class II malocclusion is characterized by maxillary excess and/or mandibular deficiency. During the mixed dentition stage, interceptive treatment using a Kloehn facebow headgear can guide maxillary growth and distalize the upper dentition to achieve a Class I relationship. The facebow applies orthopedic forces to restrain forward growth of the maxilla while permitting normal mandibular development. Compliance is important for achieving successful outcomes with this appliance.
Class II malocclusion features a protrusive maxilla and/or retrusive mandible. It commonly presents with a distal step in the deciduous dentition and large overjet in mixed/permanent dentition. Cephalometric findings include a protrusive maxilla and/or retrusive mandible. Early intervention can involve restoring caries, treating habits, and using a cervical facebow and headgear to distalize the maxilla in growing children with maxillary excess, helping to guide the mandible into a class I relationship.
1. Class II malocclusion is characterized by a distal relationship of the mandibular teeth relative to the maxillary teeth and has a prevalence that varies among populations.
2. Clinical findings may include a distal step relationship between the deciduous molars, large overjet, deep bite, and a retruded mandible.
3. Early intervention for growing maxillary excess can include the use of a Kloehn facebow headgear to redirect maxillary growth and prevent worsening of the class II relationship.
1. Class II malocclusion is characterized by maxillary excess, mandibular deficiency, or a combination. Early signs include a distal step in the deciduous molars.
2. Interceptive treatment during mixed dentition involves maintaining arch length and using cervical headgear to restrain maxillary growth and distalize the upper molars.
3. Headgear treatment for 12-18 months reduces maxillary protrusion, allows normal mandibular growth, and improves the sagittal and transverse relationships.
Class II malocclusion features growing maxillary excess and can be intercepted early. It has high prevalence and clinical signs include distal molar relationship, overjet, and maxillary protrusion. Cephalometric findings show maxillary protrusion or mandibular retrusion. Kloehn facebow with cervical headgear restrains maxillary growth from ages 7-9 to correct the class II relationship and distalize upper molars in 12 months, allowing normal mandibular growth.
This document discusses class II malocclusion, including its prevalence, clinical and cephalometric features, and interceptive treatment during mixed dentition. Class II malocclusions are common and involve a maxillary protrusion, mandibular retrusion, or combination. During mixed dentition, a cervical facebow can be used to restrain maxillary growth in class II division 1 cases, allowing the mandible to grow forward into a class I relationship. The facebow applies distalizing forces on the maxillary molars over 12 months, improving the overjet and potentially guiding favorable craniofacial development. Early intervention may help reduce the need for future orthodontic treatment.
Class II malocclusion is characterized by maxillary excess or mandibular deficiency. Early intervention using cervical headgear can redirect maxillary growth, improving the skeletal and dental relationships. The Kloehn facebow applies distalizing forces to the maxillary molars and inhibits anterior maxillary growth, allowing the mandible to grow forward into a class I relationship. Treatment usually takes 12-18 months and results in a sustained correction of the class II malocclusion.
- Class II malocclusion is characterized by maxillary excess or mandibular deficiency and involves a distal molar relationship.
- Early intervention using cervical headgear with a facebow can distalize the maxillary dentition and control maxillary growth, guiding the mandible into a Class I relationship.
- Treatment usually begins in late mixed dentition and involves wearing headgear 12-14 hours per day for around 12 months to correct the Class II malocclusion before beginning fixed appliance therapy.
- Class II malocclusion is characterized by maxillary excess or mandibular deficiency and involves a distal molar relationship.
- Early intervention using cervical headgear with a facebow can distalize the maxillary dentition and control maxillary growth, guiding the mandible into a normal relationship during the mixed dentition period.
- Treatment usually takes 12-18 months to achieve a Class I molar and canine relationship through restraint of maxillary growth and distalization of upper molars.
This document discusses intercepting growing class II malocclusions through the use of cervical headgear. It describes how a Kloehn facebow can be used in the mixed dentition stage to restrain maxillary growth and distalize the upper dentition when there is maxillary excess. The facebow is fitted to bands on the maxillary first molars and extends to an outer bow at the ear. Wearing it 12-14 hours per day can help achieve a class I molar relationship in about 12 months. Long-term follow up shows maintenance of arch expansion and reduced need for extraction treatment.
The document discusses intercepting growing class II malocclusions through the use of cervical headgear with a facebow during mixed dentition. Specifically, it describes how a Kloehn facebow can guide maxillary growth in class II division 1 cases by restraining the maxilla and distalizing the upper dentition. The facebow is fitted to maxillary first molar bands and uses cervical traction to correct maxillary excess compared to the mandible. Proper use of the appliance requires compliance and can effectively treat class II malocclusions if worn as directed.
Class II malocclusion can be intercepted during mixed dentition using a Kloehn facebow headgear to apply orthopedic forces to restrain excessive forward growth of the maxilla while allowing normal mandibular growth, reducing overjet and correcting the molar relationship. The facebow headgear distalizes the maxillary dentition and inhibits downward and forward rotation of the palatal plane. Early intervention with a facebow has long-term benefits in maintaining arch dimensions and reducing need for future orthodontic treatment.
This document discusses class II division 1 malocclusion, including its prevalence, clinical and cephalometric features, and early intervention. Key points include:
- Class II malocclusions are common and involve a distal positioning of the mandible or protrusion of the maxilla.
- Early signs include a distal step of the deciduous molars. Treatment aims to guide normal mandibular growth.
- Kloehn headgear can be used in the early mixed dentition to restrain maxillary growth and correct the class II relationship.
- Class II malocclusion involves a protrusive maxilla and/or retrusive mandible. Kloehn facebow can be used in early mixed dentition to restrain maxillary growth and allow mandibular growth. It improves the skeletal and dental profile through reducing overjet and protrusion.
- Treatment involves cervical headgear worn 12-14 hours per day for 12 months to distalize maxillary molars and inhibit maxillary growth. This is followed by fixed appliance therapy to maintain correction.
Similar to Anterior open bite / for orthodontists by Almuzian (20)
This document provides an overview of the book "Planets of Orthodontics Volume 2: Diagnosis and Treatment Planning" which covers topics related to orthodontic diagnosis and treatment planning. It lists the authors and contributors to the book and provides information on the book's contents, preface, and table of contents. The table of contents indicates that the book will cover topics such as facial and smile analysis, imaging techniques in orthodontics, cephalometric analysis, and diagnosis and treatment planning. It aims to answer questions about various aspects of orthodontics through aggregating knowledge from experienced orthodontists.
This document provides an overview of the book "Planets of Orthodontics Volume III: Biomechanics and Tooth Movement". It lists the authors and contributors to the book. The preface states that the book aims to answer questions covering the breadth and depth of orthodontics. It will cover topics related to tooth movement and biomechanics. The table of contents provides an outline of the chapters to be included.
Orthodontic treatment provides several benefits, though some claims lack strong evidence:
1. It can improve self-esteem in patients with Class II malocclusions in the short-term, but does not affect long-term psychological well-being.
2. While it may improve mastication in open bite cases, compensation occurs in most malocclusions without functional issues.
3. It can help speech issues related to specific traits, but cannot ensure resolution without speech therapy.
4. It does not reduce TMD risk or symptoms, though may temporarily relieve symptoms during treatment.
5. Interceptive treatment can prevent trauma and loss of primary teeth but does not necessarily reduce trauma risk.
6.
This document provides an overview of orthodontic appliances and includes the following key points:
1. It describes different types of fixed appliances used in orthodontics including metal brackets, self-ligating brackets, and aesthetic brackets. It also discusses removable appliances, clear aligner therapy, and extraoral appliances.
2. Components and characteristics of common orthodontic appliances are defined, such as types of bracket bases and configurations. Appliance indications, advantages, and limitations are outlined.
3. The document is intended as a reference for orthodontic trainees and includes chapters on specific appliances like the Begg appliance, removable appliances, clear aligners, headgear, and facemasks. Each chapter provides a brief overview
This document provides an overview of craniofacial development from embryology through growth and development of the dentition and occlusion. It is authored by several specialists in orthodontics and contains 13 chapters on topics ranging from embryology and prenatal development to theories of craniofacial growth and anomalies affecting tooth and bone development. The goal is to establish the essential components of orthodontics by covering growth, development and research foundations. It acknowledges contributors and aims to answer questions across the breadth of orthodontics.
This one sentence document provides a link to up-to-date orthodontic notes created by Almuzian. Clicking the link will access Almuzian's Orthodontic Notes hosted on the orthodonticacademy.co.uk domain.
Surgically assisted rapid maxillary expansion (SARME) is a surgical technique used to widen the maxilla. It involves performing corticotomies through the zygomatic buttress and releasing other resistant structures like the midpalatal suture and pterygoid plates. An expander is placed preoperatively and activated starting 5 days post-op at 0.5mm/day. SARME allows for greater expansion than orthodontics alone and has better stability than segmental osteotomies. It is used to treat transverse deficiencies over 5mm and failed orthodontic expansion in adults. Risks include periodontal damage, root damage, and nasal complications.
1. There are several methods for predicting outcomes of orthognathic surgery, including manual tracings, computer programs, and 3D modeling.
2. Accuracy of prediction varies depending on the method and software used, with 3D modeling generally providing the most accurate predictions but manual methods still common.
3. Studies have found most software to be reasonably accurate for hard tissue predictions but with more variability for soft tissues like lips and less ability to account for individual patient differences.
This document discusses psychological assessment of patients undergoing orthognathic surgery. It notes that all patients should be assessed by a psychologist to evaluate their motives and determine if surgical goals are realistic. It also discusses body dysmorphic disorder, noting that some patients have a distorted body image and unrealistic expectations about how surgery can change their appearance. The document provides criteria for diagnosing body dysmorphic disorder and recommends that surgery only be considered if there is a physical defect and the patient receives psychological support. It offers guidance for surgeons on how to approach patients showing signs of body dysmorphic disorder.
This document discusses effective communication with orthognathic patients regarding their diagnosis and treatment options. It is important to discuss the patient's case outside of their presence using clear language and involve the patient in discussions. Providing information through multiple methods like verbal, written and audiovisual aids can help patients better understand and retain information about their often complex treatment. Clinicians must clearly explain the patient's diagnosis, what may happen without treatment, and available treatment options with benefits and risks to gain informed consent.
This document summarizes distraction osteogenesis (DO), which is a process where new bone is formed between bone segments that are gradually separated. DO involves three phases: a latency phase, distraction phase where the bone is slowly separated, and consolidation phase where the new bone mineralizes. It discusses the history and applications of DO, including for lengthening of long bones and the mandible. Key advantages are that it allows for larger movements than traditional bone grafts and avoids prolonged fixation. Potential complications include non-compliance, pain, premature consolidation, and neurological damage.
Treacher Collins Syndrome (TCS) is a rare genetic disorder characterized by deformities of the face, eyes, ears and jaw. It is caused by mutations in the TCOF1 gene. Clinical features include downward slanting eyes, ear abnormalities, cleft palate and a recessed chin. Treatment involves surgery to reconstruct facial structures and manage airway issues in infancy. Further reconstructive surgeries are often needed as the child grows. Prognosis is good with treatment, though facial differences typically remain.
In 1976, Paul Tessier published a classification system for facial clefts based on their anatomical position. The Tessier classification system categorizes 15 types of clefts into four groups: midline clefts, paramedian clefts, orbital clefts, and lateral clefts. It describes clefts at both the soft tissue and bone levels. The midline clefts run vertically along the facial midline, the paramedian clefts are similar but further from the midline, the orbital clefts involve the orbit, and the lateral clefts run horizontally on the face. The classification system provides a standardized way to describe different types of facial clefts.
1. Solitary Median Maxillary Central Incisor Syndrome (SMMCI) is characterized by the presence of a single tooth in the middle of the upper jaw where two central incisors would normally be.
2. Diagnostic criteria for SMMCI include a solitary central incisor tooth in the maxilla, a V-shaped palate, nasal obstruction in over 90% of cases, and potential issues like cleft lip/palate or holoprosencephaly.
3. Management of SMMCI involves treating any nasal airway issues at birth, regular dental care, and eventual orthodontic treatment to make space for an artificial tooth on one side during permanent dentition.
Pierre Robin Sequence (PRS) is a rare condition characterized by the triad of micrognathia, glossoptosis, and cleft palate. It occurs due to restricted growth of the mandible in utero, which causes the tongue to obstruct palatal fusion and the airway. Management requires a multidisciplinary approach and may include interventions like nasopharyngeal intubation, mandibular advancement, or tracheostomy to address airway and feeding issues. Long term care involves monitoring for catch-up mandibular growth and treating dentofacial abnormalities, with some studies finding persistence of mandibular deficiencies in PRS versus isolated cleft palate. Genetic assessment is also important as PR
Parry–Romberg syndrome (PRS) is a rare developmental disorder characterized by the progressive shrinking of tissues on one side of the face. It typically begins with a patch of hardened skin on the forehead that leads to an indentation resembling a sword wound on the affected side of the face. In addition to facial atrophy, it can cause neurological and eye problems. While the cause is unknown, genetic and autoimmune factors may play a role. Treatment aims to stop further progression and repair facial deformities through immunosuppressants or reconstructive procedures once stabilization is achieved.
Oro-facial-digital syndromes are a rare group of genetic disorders that affect around 1 in 50,000 people and have similar features. They are caused by mutations in different genes and are classified into eight types. Common signs include digital anomalies of the hands and feet, facial abnormalities such as frontal bossing and wide-set eyes, and oral features like cleft lip and high arched palate.
This document discusses four neuro-cutaneous syndromes:
1. Hypomelanosis of Ito, which causes pigmentation abnormalities and limb/facial asymmetry. Management involves tissue expansion and reconstruction.
2. Tuberous sclerosis, a genetic disease causing benign tumors in organs. Symptoms include seizures and intellectual disability.
3. Neurofibromatosis type 1 causes tumors along nerves and skin abnormalities. Symptoms include café au lait spots and neurofibromas.
4. Encephalotrigeminal angiomatosis is not genetic but a vascular development anomaly causing facial angiomas and cerebral calcifications.
Nager syndrome is similar to HFM but also includes preaxial limb anomalies such as hypoplastic or aplastic thumbs and radial hypoplasia. It also involves agenesis of the soft palate, known as the "sign post" sign, as well as ear defects and TMJ ankyloses.
Marfan syndrome is a genetic disorder of connective tissue that affects the heart, eyes, bones and other tissues. It is caused by mutations in the FBN1 gene and is inherited in an autosomal dominant pattern. Diagnosis is based on the Ghent criteria, which looks for major and minor clinical features in different organ systems. Common signs and symptoms include elongated limbs, scoliosis, eye problems like retinal detachment, heart issues like mitral valve prolapse and aortic aneurysm, and skeletal issues like joint hypermobility and pain. While there is no cure, treatment focuses on managing heart and eye complications through medication and surgery.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
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Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
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Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
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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.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
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5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
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Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
2. Table of Contents
Definition........................................................................................................................................ 3
Incidence ......................................................................................................................................... 3
True rotation, matrix rotation & apparent total rotation as described by Bjork 1969 .................... 5
Predictors of skeletal open bite ....................................................................................................... 6
Features of high angle or long face syndrome ................................................................................ 8
Overbite and Open bite ................................................................................................................. 10
Indication of treatment.................................................................................................................. 10
The etiology can be classified into................................................................................................ 10
Treatment is dependent on the ...................................................................................................... 13
Methods of treatment .................................................................................................................... 13
In details........................................................................................................................................ 14
1. For sucking habit ................................................................................................................... 14
Prevention of digit-sucking sucking habits, BOS guidelines 2000.......................................... 15
Treatment of digit-sucking habits, BOS guidelines 2000 ........................................................ 15
Correction of Problems Caused by Habit................................................................................. 16
2. For mouth breather ................................................................................................................ 16
3. For tongue thrust.................................................................................................................... 16
4. Myofunctional Therapy ......................................................................................................... 16
5. Extraoral Traction.................................................................................................................. 18
6. Fixed Appliances ................................................................................................................... 19
8. Molar intrusion using skeletal anchorage .............................................................................. 20
9. Repelling magnets ................................................................................................................. 21
10. Orthognathic Surgery......................................................................................................... 22
11. Adjunctive procedure......................................................................................................... 22
3. Stability of AOB ........................................................................................................................... 23
Management of relapse ................................................................................................................. 23
Difficulty associated with the treatment of AOB, Burford 2003 Sandler 2011............................ 24
Posterior open bite ........................................................................................................................ 24
Caused by...................................................................................................................................... 24
Treatment ...................................................................................................................................... 25
Summary of the evidences ............................................................................................................ 25
Anterior open bite & high angle case
4. Definition
Dental AOB: It is present when there is no incisor contact and no vertical overlap of the lower
incisors by the uppers (Houston, 1996). The severity varies, from almost an edge-to-edge
relationship to a severe handicapping open bite.
The skeletal AOB is mainly due to growth problem that is associated with un-balanced growth
between the AFH and PFH leading to posterior growth rotation and AOB. It characterized by
increased in AFH, shortened PFH, steep MP, divergent facial profile and antegonial notch.
Classification (worms 1971)
Pseudo pen bite which means that there is positive vertical overlap between U and L incisors
with no contact.
True open bite: loss of vertical overlap
Incidence
In children is 4% at age 9 years, falling to 2% by the early teenagers (O’Brien, 1993).
One measure of the importance of the inherited characteristics is the incidence of AOB in
black and white individuals in the USA.
Blacks are 8 times more likely to have an AOB.
Worms 1971 showed 50% reduction from age of 7 till 12 (from 13.5% to 3.7%)
Type of growth of the mandible
Nielsenet al 1991
1. Normally
A. The direction of condylar growth is vertical, with some anterior component,
B. Always there is a balance between APH and PFH growth to achieve normal FH. If this is
lost then either long or short face might develop
C. AFH depend on the
1. Eruption of the maxillary and mandibular posterior teeth
2. Growth at the posterior dentoalveolar area
5. 3. The amount of sutural lowering of the maxilla.
4. Surface remodelling at the anterior region of the mandible
D. PFH depend on the
1. Downward growth of posterior cranial fossa
2. Lowering of the temporomandibular fossae
3. Condylar growth.
4. Surface remodeling at the posterior region of the mandible
2. In anterior or forward rotation
If the incisor occlusion is stable, the overbite remains unchanged during the
growth period & the fulcruming point is located at the front teeth.
If the incisor occlusion is unstable, the fulcruming point is located further back
along the occlusal plane. In this situation the bite normally becomes increasingly deep
over time as the result of greater posterior face height increase in combination with lack
of anterior tooth contact. This deterioration of the occlusion is most pronounced during
puberty when growth intensity is at its greatest, but continues throughout the growth
period. Patients with a pronounced tendency to anterior growth rotation and a deep bite
should therefore be treated early and the occlusion supported throughout the growth
period. Retention, especially in the mandibular arch, must also be maintained until
mandibular growth is completed.
The erupting dentition in this type of mandibular growth characteristically
undergoes a considerable amount of mesial migration of both the maxillary and
mandibular teeth with some degree of proclination of the mandibular incisors. Where the
amount of mesial migration of the lower posterior teeth does not equal the advancement
of the incisors by proclination (due to trapping behind upper incisors), secondary
crowding of the front teeth frequently develops.
3. In posterior rotation of the mandible
6. If dentoalveolar growth is greater than vertical condylar growth, the resulting
change in mandibular position is back ward or posterior rotation of the mandible. The
increase in AFH is greater than in PFH, the mandible rotates posteriorly with the fulcrum
at the condyle.
This posterior growth rotation may result in an anterior open bite, depending on
the extent of vertical dentoalveolar compensation.
The associated dental eruption pattern of the posterior teeth is generally distal &
vertical and in some instances the anterior teeth may even become more retroclined with
time. Late crowding is common finding in this pattern of growth due to soft tissue
maturation.
Because the centre for the growth rotation is located near the mandibular
condyles, treatment should be postponed until after puberty or at least until the potential
for backward or posterior rotation is reduced. The reason for late treatment is that
A. The tendency to extrude the posterior teeth decreases when there is less active growth.
B. In addition when treated orthodontically these patients are at increased risk for further
mechanically induced posterior rotation by acceleration of their molar eruption and
require careful control.
C. The increased risk of extrusion in these patients is associated with their weaker
masticatory musculature making vertical control an important consideration.
True rotation, matrix rotation & apparent total rotation as described by Bjork 1969
The actual rotation or total rotation in humans is generally masked on average by
50% surface modelling within the jaws.
In a recent study of non-human primates, it was found that this modelling or
intramatrix rotation in the Rhesus monkey masked the rotations by about 75% in the
maxilla and 90% in the mandible.
7. This surface modelling causes, in most instances, the lower border of the
mandible to appear almost unchanged in its inclination to the cranial base and has led to
misinterpretations of the actual growth changes and tooth movements in humans.
An example of this is seen in Figure below
where the change in mandibular lower border
inclination over time, the so-called matrix rotation,
was -7.3° whereas the actual, or true rotation, was
as much as -16.4° anteriorly
Predictors of skeletal open bite
A. Bjork's structural signs (Bjork, 1969)
B. PFH:AFH ratio (Jarabak ratio)
C. UAFH-LAFH ratio : Nahoum (1975)
D. Molar and incisor dentoalveolar (Neilsen, 1991).
E. Dung and Smith technique
F. The degree of dentoalveolar compensation or dysplatic compensation Bjork 1969
A. Bjork's structural signs help to predict type of growth rotation , (Skieller and Bjork, 1969)
1. A backward inclination of the condyles;
2. A flat mandibular canal;
3. A lower border that is thinner anteriorly and convex, due to minimal remodelling along the lower
border of the mandible and bony deposition at the posterior border of the ramus;
4. The symphysis is inclined backward within the face and the chin is receding;
5. The interincisor angle decreased
6. Interpremolar and intermolar angles are all decreased;
7. The lower anterior face height is increased and there is an anterior open bite.
8. The authors reported that a combination of four variables ccounted for 86% of the variability
observed.
B. PFH:AFH ratio (Jarabak ratio)
Jarabak, 1972
PFH:AFH, 59 – 63% is normal;
if 64 low angle case, deep OB;
58 high angle case, reduced OB
C. UAFH-LAFH ratio: Nahoum (1975) believed that patients with a dental open bite and a UAFH-
LAFH ratio of less than 65% (normally they are equal) are considered to be poor risks for
conventional orthodontic treatment alone.
D. Increased dentoalveolar height in molar region and reduced dentoalveolar height in incisor
region due to strong muscle allowing molar eruption. (Neilsen, 1991).
E. Dung and Smith
Dung and Smith’s sample (1988).
SN/MP angle 40º or greater
OP/MP angle 22º or greater
MxP/MnP angle 32º or greater
AOB negative overbite
PFH/AFH (Jarabak ratio 58% or less
UFH/LFH (Nahoum ratio) 0.65 or less
A seventh measurement was used, namely, the overbite depth
indicator (ODI)
68
This was described by Kim in 1974, and is described as the angle the A-B plane makes with the
mandibular plane combined with the angle of the palatal plane to the Frankfort horizontal. PP-
FH is positive it is added this value from AB-MP and vice versa. A value of less than 68º is said
9. to indicate an open bite tendency. The value of this analysis is that it
proposes to identify those patients who have an open bite tendency
and identifies open bite patients who have a good potential for
orthodontic correction.
The only measurements that were statistically significant were the
overbite depth indicator (ODI) and the presence of an open bite at
the start of treatment.
F. The degree of dentoalveolar compensation or dysplatic
compensation
First described by Bjork 1969 and later discussed by Solow. These
can be measured through the following:
In the maxilla, the maxillary zone, measured as the angle between
the palatal plane (ANS-PNS) and the maxillary occlusal plane (mean
10°±3 ), describes the extent of compensatory or dysplastic development.
In the mandible, the mandibular zone, measured between the mandibular plane (GO-GN)
and the mandibular occlusal plane (mean 20°±4°), similarly describes possible
compensation.
If one or both of these measurements are increased in a patient with an increased vertical
jaw relation, favorable dentoalveolar compensation is indicated.
On the other hand, if these measurements are normal or reduced in the same patient,
either no compensation or dysplastic development has taken place.
This will help in determine the type of treatment. Eg. If the high angle case has no
compensation or has dysplastic development, then treatment can be achieved through
orthodontic treatment to initiate this compensation, but if the compensation is already
present then the case is surgical.
Features of anterior open bite angle and/or long face syndrome
A. Skeletal feature
10. 1. Tapered facial type.
2. Long lower third of the face,
3. Long maxilla
4. Short mandible
5. Short ramus
6. Class II skeletal relationship
B. Cephalometric feature.
1. Enlarged adenoid seeing in the ceph
2. Increased dentoalveolar height in molar region and reduced dentoalveolar height in incisor
region due to weak muscle allowing molar eruption. (Neilsen, 1991)
3. Bjork’s seven features of posterior growth rotation (Bjork, 1969)
4. Jarabak ratio: 58 high angle case, reduced OB
5. UAFH-LAFH ratio: less than 65%
6. The overbite depth indicator (ODI) less than 68 degree
C. Soft tissue features
1. Long lower third of the face,
2. Narrow nose
3. Narrow alar bases
4. Decreased nasolabial angle
5. Incompetent lip
6. VME & excessive exposure of maxillary anterior teeth and gingiva at rest and smiling which is
due to dentoalveolar compensation of the anterior part of the maxilla to compensate for AOB.
7. Retruded chin
D. Intraoral features
1. Open bite
2. Class 2 tendency
3. Increased overjet
4. Narrow upper arch
5. Crowded LLS
E. Growth feature
Usually posterior growth rotation
11. F. Path of closure
Usually normal or may be associated with unilateral cross bite and mandibular displacement
G. IOTN and OB
Overbite measured from any of the lateral or central incisors with the largest
vertical discrepancy is recorded.
Overbite and Open bite
Overbite Open bite
Grade and
qualifier
Grade and
qualifier
2f Increased greater Than Or equal to 3.5
mm
2e Anterior or posterior open
bite 0-2mm
3f Deep overbite complete on labial or
palatal 'issues but no Trauma
3e Anterior or posterior open
bite 2.1 mm — 4 mm
4f Increased and complete overbite with
labial or palatal trauma
4e Extreme lateral open bites
greater than 4 mm
Indication of treatment
1. Difficulty with incision of food
2. Speech problems like lisping
3. Dental and facial appearance
The etiology can be classified into
1. Transitional physiological factors
2. Skeletal factors
3. Soft tissue factors
Muscle of mastication
Neurological disturbances
12. Chronic nasal obstruction
Adenoids
4. Habits,
Digit Sucking Habits.
Endogenous (primary) thrust
5. Pathology
Inflammatory
Hormonal
6. Traumatic
7. Local Dental factors
8. Iatrogenic factors
9. Combination
In details
1. Transitional physiological causes, as the permanent incisors are erupting
2. Skeletal factors
A. Genetic
Vertical growth pattern more genetically correlated than horizontal one; if you had the long face
in one generation then chances are high that you would have a long face in the next generation.
(Hunter 1968)
B. Environmental which subdivided into:
I. Inflammatory: Juvenile rheumatoid arthritis An inflammatory arthritis occurring before the age
of 16 years and involving the temporomandibular joints can result in the development of a severe
class II malocclusion and AOB due to restricted growth of the mandible
II. Hormonal: Excessive growth hormone Overproduction of growth hormone from an anterior
pituitary tumour causes gigantism in children and acromegaly in adults. In both circumstances,
the patient presents with a worsening class III malocclusion characterized by mandibular excess
and AOB.
III. Traumatic:The condyle is the commonest site of fracture in the mandible during childhood and
many go undiagnosed. In severe cases with bilateral fracture and dislocation from the glenoid
13. fossa, an anterior open bite can be one of the presenting features due to a loss in ramus height. A
long-term sequelae of early trauma to the mandibular condyle can be asymmetry, with an
ipsilateral decrease in ramus height and deviation of the chin point to the affected side.The
severity of outcome is in part related to the age at the time of injury. However, a high percentage
of children sustaining a condylar fracture have normal mandibular growth due to the reparative
capacity of the condyle, even when displaced from the glenoid fossa.
3. Soft tissue factors
I. Muscle of mastication: Hunt 1997 & Benington 1999 showed large muscle fibres in deep bite
and small size muscle fibres in AOB. This again is classified under the genetic effect
II. Neurological disturbances and Muscle weakness
III. Chronic nasal obstruction (Solow & Tallgren 1976)
IV. Adenoids (Aronson, 1979). However, Vig (1985) that “ the magnitude of the morphological
difference attributed to adenoid removal was far too small to be of any clinical significance”
4. Habits,
I. Digit Sucking Habits.
The incidence of digit sucking is around 30% at 1 year of age, reducing to 12% at 9 years and
2% by 12 years. Most persistent suckers are female (Brenchely, 1992).
The severity of the malocclusion depends on the age of the patient, the intensity, frequency and
duration of the habit. Larsson, 1987
II. Long term pacifier (Larsson 1987)
III. Endogenous (primary) thrust
Very rare & affects 1% of population
Usually associated with lack of neuromuscular control e.g. Downs syndrome
May cause AOB which is difficult to close
Usually associated with a lisp, bimaxillary proclination, reverse COS in the lower and deep COS
in the upper. The diagnosis is therapeutic which means the high tendency to relapse after
treatment.
5. Local Dental factors
Localized failure of development of anterior teeth
Over eruption of posterior teeth
14. Proclination of incisors
6. Idiopathic factors Idiopathic like idiopathic condylar resorption
7. Combination
Treatment is dependent on the
1. Age
2. Family history
3. Medical condition
4. Growth
5. Concerns
6. Profile
7. Etiology
8. Severity
9. Intra and intermamaxillary relationship
10. Compliance
11. Clinician philosophy
Methods of treatment
For sucking habit
For mouth breather
For tongue thrust
Myofunctional Therapy Muscle exercise
Vertical holding appliance
Spring-loaded bite block
Passive posterior bite-blocks
The functional regulator appliance (FR IV)
Myofunctional+EOA
combination Therapy
Teuscher activator
BIS
MIS
Concorde appliance
15. Van Beek appliance
Twin block appliance modifications including:
1. TB with high-pull headgear inserted in the flying spring
2. Thick Twin block appliance
3. TB with occlusal stopper
4. Avoid trimming the appliance
Extraoral Traction Vertical pull chin-cup
High-pull headgear
Fixed Appliances Extraction of terminal molars
Bracket set up
Wire bending
Tongue timer which act as a tongue thrust breaker
Vertical intermaxillary elastics
Segmental arch mechanics
Kim mechanics
Modified Kim mechanics
Molar intrusion using skeletal anchorage
Repelling magnets
Orthognathic Surgery
Adjunctive procedure
In details
1. For sucking habit
Please refer to my summary about Digit sucking & dummy-sucking habit
16. Prevention of digit-sucking sucking habits, BOS guidelines 2000
1. If a dummy is provided, there appear to be fewer problems in the long-term, because the majority
of dummy sucking habits are self-limiting and stop before eruption of the permanent teeth. Any
persistent dummy sucking habit is easily broken by removal of the dummy.
2. It has been suggested that if a digit-sucking habit is noticed, a dummy should be given to the
child.
3. If a dummy is used, it must not be sweetened. After the age of 2, to prevent problems with
speech development, it should be used as little as possible during the day
Treatment of digit-sucking habits, BOS guidelines 2000
1. The child must want to stop otherwise any approach is likely to be unsuccessful.
2. A child who is undergoing severe psychological trauma is unlikely to respond to habit breaking.
A psychologist’s input may be required
3. The use of orthodontic pacifiers which is oval shape and has a vent to reduce the effect of
dummies.
4. The following methods for breaking the habit are listed in the order in which they should be
used:
A. Non-physical methods
Explanation
Reward
Habit reversal
Teach the child to carry out alternative activities when they have the urge to suck the digit
B. Physical methods
Reminder therapy like finger bandage, finger paint or thermoplastic finger post
C. Intra-oral appliances
These deterrent appliances have been shown to be effective within 10 months.
They must be fitted with the full understanding and co-operation of the child and must not
compromise compliance with any future orthodontic treatment.
Fixed appliance like palatal appliance with crib or Blue grass appliance (Huang 1990)
Removable appliance
Functional appliance can stop habit
17. Correction of Problems Caused by Habit
Active orthodontic treatment should not be attempted until the habit is broken. Fortunately, most
of the problems created by the habit are reversible once the habit is eliminated. It has been
suggested that digit-sucking beyond the age of 7 has been associated with an increased risk of
root resorption during orthodontic treatment
2. For mouth breather
Although prolonged mouth breathing may be a contributory factor for malocclusion, it is not
necessarily the main etiological factor. Therefore, adenoidectomy or tonsillectomy is not
recommended in the prevention of malocclusion and should be done for medical purposes only.
Another justification for not performing elective adenoidectomy in mouth breather is the high
risk of prion disease transmission.
3. For tongue thrust
Parker (1971) used spurs soldered to upper central incisor bands to produce dramatic changes in
anterior open bite and posterior crossbite by altering tongue posture. The suggestion is that
anterior tongue posture is responsible for anterior open bites in cases of normal skeletal
proportions with no history of a digit sucking habit. The tongue spurs should be placed
approximately 3-4 mm behind the upper incisors and should be angled backwards and
downwards so that they establish a positive overlap with the lower incisors. Tongue spurs might
cause psychological problems Haryett et al (1967, 1970). Careful explanation of the purpose of
tongue spurs is therefore essential before embarking on treatment. Huang et al (1990) showed a
similar results. Tongue cribs or spurs should be worn for six months after a positive over bite is
achieved; careful patient motivation is required and sharpened spurs are preferred to smooth
ones. The spurs may be carried over to the retainer if desired.
Sometime for primary tongue thrust glossotomy is recommended.
4. Myofunctional Therapy
1. Muscle exercise described by Laurie Park 2007 (Patients were instructed to clench their teeth
together as hard as possible for 15 seconds and to repeat this process at least four times for a total
18. of one minute; this one-minute exercise was to be performed as often as possible throughout the
day).
2. Vertical holding appliance (TPA with acrylic pad that kept away from palate and rely on the
tongue force to intrude the posterior teeth.
3. Spring-loaded bite block, the spring-loaded bite block has helical springs that are placed both
lingually and buccally between the first premolar region and the last molar region. The ends of
the springs are embedded occlusally in the molar regions of the acrylic part of the device. The
upper and lower acrylic occlusal blocks are connected by palatal and lingual wires, which are
activated to a force of 450 g bilaterally. Patients are instructed to use the appliance for an average
of 16 h daily
4. Passive posterior bite-blocks are functional appliances that are used to open the bite 3–4 mm
beyond the rest position. In growing patients, this inhibits the increase in height of the buccal
dentoalveolar processes, thus preventing a downwards and backwards rotation of the mandible. It
also allows differential eruption to occur as the labial segments can erupt unhindered, hence
closing the AOB.
5. The functional regulator appliance (FR IV) It works by allowing vertical eruption of upper and
lower incisors and retraction of the maxillary incisors, and may also encourage upward and
forward mandibular rotation. Cochrane review, by Oliveira , 2007 showed that there is weak
evidence that the interventions FR-4 with lip-seal training and palatal crib associated with high-
pull chin cup are able to correct anterior open bite. Given that the trials included have potential
bias, these results must be viewed with caution.
6. Teuscher activator
7. BIS
8. MIS
19. 9. Concorde appliance
10. Van Beek appliance
11. Twin block appliance modifications including:
TB with high-pull headgear inserted in the flying spring can be utilized to correct the
anteroposterior discrepancy while controlling the vertical dimension. Park 2001
Thick Twin block appliance: The ramps measure 5 mm to 8 mm in thickness in the premolar
region. This impinges on the patient's freeway space, which, in turn, results in increased masseter
tension. This tension not only restricts vertical descent of the maxillary posterior teeth, but also
produces a relative intrusion of the posterior aspect of the maxilla in growing patients." This
phenomenon, which is called the bite-block effect, provides excellent vertical control. Although
long-term studies documenting the results of this treatment are not yet available, the early results
are promising. Clark 2010
TB with occlusal stopper
Avoid trimming the appliance
5. Extraoral Traction
1. Vertical pull chin-cup therapy has been used to limit excessive vertical growth and has been
shown to close AOBs when combined with premolar extractions and fixed appliances as well as
palatal crib
2. High-pull headgear applied to the maxillary molar teeth worn for 14 hours per day has been
used to inhibit eruption of the posterior teeth and hence limit vertical growth. Many strategies
available including:
High pull headgear to a maxillary splint.
High pull headgear to buccal splint.
Headgear can be applied directly to the upper molar bands of a fixed appliance .
Cochrane review, by Oliveira , 2007 showed that there is weak evidence that the interventions
FR-4 with lip-seal training and palatal crib associated with high-pull chin cup are able to correct
anterior open bite. Given that the trials included have potential bias, these results must be viewed
with caution.
20. 6. Fixed Appliances
Anterior open bites can be closed using fixed appliances with
A. Extraction of terminal molars
B. Bracket set up (more gingival at anterior teeth, reduced canine tipping)
C. Wire bending to allow incisor extrusion
D. Tongue timer which act as a tongue thrust breaker
E. Vertical intermaxillary elastics to extrude the anterior teeth. Use of anterior elastics may be
successful in patients in whom a digit sucking habit has artificially inhibited eruption, but should
not be used if the etiology is primarily skeletal.
F. Segmental arch mechanics using 17*17 elgioalloy to extrude the incisor similar to Rickets
mechanics.
G. Kim mechanics
Also, it has been noted that one of the features of a skeletal
anterior open bite is mesial tipping of the molars, resulting
in rotation of the occlusal plane (Kim, 1987).
Therefore, by uprighting the molars the anterior open bite
can be closed. This can be achieved using multi-loop
archwires or curved nickel– titanium wires, creating an
increased curve of Spee in the maxillary arch and a reduced curve of Spee in the mandibular arch
combined with anterior elastics.
To help upright and distalize the buccal dentition again, loss of the terminal molar is
recommended.
Using a multiloop edgewise archwire appliance in conjunction with heavy anterior elastics has
been shown to achieve molar intrusion and simultaneous incisor extrusion in the closure of
anterior open bites.
This is usually achieved using multiloop edgewise archwires made from 0.016 x 0.022 stainless
steel archwires. Kim recommends an 0.018” slot and standard edgewise brackets for reasons that
are obscure.
Use of the technique with an 0.022” straight-wire appliance system has produced no problems.
21. The archwires are an ideal shape with five L-lopps on each side starting from between the lateral
incisors and canine and working distally until between 6s and 7s.
The vertical dimensions of the loops should be 2-3 mm and the horizontal dimensions 5 mm
except in the molar region where it is increased to 8 mm. Tip backs of 3-5º are placed on each
loop.
This effectively produces a curve of Spee in the upper arch and a reverse curve of Spee in the
lower arch.
These are counteracted by placing 3/16” heavy elastics vertically between the most anterior
loops in the maxilla and mandible.
This transfers all the active force in the archwire to the posterior segments thus intruding and
uprighting the posterior buccal segments.
When the terminal molars are out of contact and no further reduction of the anterior open bite
occurs; at this stage, flat 0.016” x 0.022” archwires are placed to upright the molars while
continuing the anterior elastics.
H. Modified Kim mechanics
For some years clinicians have used reverse curve nickel-titanium archwires instead of multiloop
wires and they seem to work well. Enacar et al (1996) and (Harradine and Birnie, 2000).
Hooks are provided by using crimpable hooks.
7. Molar intrusion using skeletal anchorage
Like Dental implants, mini-plates, mini-screws , ankylosed teeth (Cousely 2008 use TPA with
two palatal TAD for posterior teeth intrusion, while Etilita et al 2012 use TPA with two buccal
TAD). Park et al (2008).
This technique showed that the pd is improved as the crestal bone is moved more coronal and
thus improving the crown root ratio. Byani 2012
The following points should be considered:
Consider the skeletal relationship including the vertical, transverse, and anterior-posterior
relations. For example, a skeletal class 2 open bite with a long anterior facial height can be
22. treated successfully by the intrusion of the posterior teeth as this would produce a closing
counterclockwise rotation of the mandible with a shortening of the anterior facial height and a
correction of the open bite. Sugawara et al (2002) reported that during intrusion of the molars
with a skeletal anchorage system, the anterior lower facial height, mandibular plane angle, and
ANB difference reduced significantly, whereas the overbite and Wits appraisal increased
significantly. Hence, the intrusion of the molars is best suited to skeletal open bite patients who
show long face types with class 1 or mild class 2 skeletal patterns whereas in class 3 open bites,
the class 3 malocclusion would get worse as the anterior open bite closed
Incisor exposure at rest and smile are important objectives to consider before treatment. Patients
who do not show sufficient incisor exposure should not be treated by molar intrusion, making the
more conventional method of incisor extrusion a more suitable option for open bite correction
Periodontal condition should be carefully considered.
For patients with a dual occlusal plane, segmental intrusion of the posterior buccal segments is
indicated. However, during the active intrusion phase, careful monitoring of the first, second,
and third order relationship of the intruded molars should be monitored.
This can be achieved by
a. placing miniscrews on both the buccal and palatal,
b. using a transpalatal bar or a splint
c. An alternative design of splint
8. Repelling magnets (Kiliaridis, 1990)
Kalra, Burstone and Nanda (1989) have suggested that magnets may be beneficial in treating
anterior open bites by:
• intruding upper and lower posterior teeth so as to allow mandibular autorotation
• distracting the condyle downwards and forwards to allow compensatory condylar growth which
would again favour mandibular autorotation
23. 9. Orthognathic Surgery
Where there is an obvious step in the occlusal plane, two piece maxilla
No step, one piece maxilla.
Subapical osteotomy of the anterior (Kole technique) or posterior segment (Schuchart
technique)depend on the etiology
Recently Bisase 2009 recommend anticlockwise rotation of BSSO with rigid fixtion.
10. Adjunctive procedure
Glossectomies. Their effectiveness in closing anterior or posterior open bite problems has not
been substantiated (Proffit, 1990).
Surgical procedures to improve the patency of the airway
Occlusal equilibration (Janson 2008)
Corticotomy assisted molar intrusion (Akay 2009)
24. Stability of AOB
1. In general: AOBs treatment is stable in approximately 80% of treated cases with slightly better
with surgical treatment than non-surgical (5% differences).(Huang, 2002). Lopez-Gavito 1985
showed that 1/3 is lost.
2. Extraction: There is also evidence of greater stability of open bite correction when orthodontic
treatment is undertaken with extractions (Janson et al., 2006).
3. Extrusion or intrusion: In treatment resulting in molars intrusion, the rate of relapse ranges
from 17 to 30%: whilst in treatments with incisor extrusion, relapse may be even greater,
reaching sometimes 40% of treated cases. (Suguwara 2011)
Causes of relapse
Continued unfavorable posterior mandibular growth rotation
Unfavorable tongue position
Continued habit
Excessive extrusion of incisors
Relapse after surgery
Management of relapse
Overcorrection is recommended to compensate for any relapse.
Elimination of the habit
Using headgear attached to a URA with a high pull direction of force untile growth cessed.
Retainer with passive bite blocks, which supposedly place intrusive forces on the posterior
teeth, could be used &should be continued until facial growth has almost ceased and this is often
well into late teens.
Some recommend lip and tongue muscle exercises once a day, which was supervised once a
week by a speech and language therapist
Daytime wraparound retention with modified contour,
in which the wire is engaged in the CEJ to counteract the
intrusion relapse of anterior teeth, usually this is used at
25. day time while at night a different appliance is used but with tongue crib.
PFR can be used as removable retainer with posterior bite plane. If the tongue play a role in
the open bite then holes or spur in the palate can help to minimize the relapse.
Fixed Modified Nance-Hyrake appliance to train the tongue
Difficulty associatedwiththe treatment of AOB, Burford 2003 Sandler
2011
1. Tendency to vertical growth rotation which worsens the class 2 and makes the use of
functional appliance challenging
2. Most of the orthodontic treatment are extrusive which make the treatment worse
3. Quick loss of the extraction space for two reasons: the masticatory muscles restrict the
posterior mandibular teeth more than their maxillary counterparts; and the thin cortices and
trabecular bone of the maxilla provide less resistance to movement than the thick cortices and
more dense trabeculae of the mandible
4. Poor soft tissue compliance that make stability poor
Posterior open bite
Caused by
1. Failure of eruption
2. Tongue interfere with eruption
3. Trauma and Ankylosis
4. Hemimandibualr hyperplasia when the vertical compensation is not sufficient
26. Treatment
1. Habit breaker posteriorly
2. Composite build up
3. Orthodontic extrusion by FA or TAD
4. Segemental dentoalveolar osteotomy
5. Segemental maxillary or mandibular surgery
Summary of the evidences
Definition: Dental AOB: It is present when there is no incisor contact and no vertical overlap of
the lower incisors by the uppers (Houston, 1996).
Incidence: In U children is 4% at age 9 years, falling to 2% by the early teenagers (O’Brien,
1993).
Type of growth of the mandible: Nielsen et al 1991
True rotation, matrix rotation & apparent total rotation as described by Bjork 1969
Bjork's structural signs help to predict type of growth rotation , (Bjork, 1969)
PFH:AFH ratio (Jarabak ratio) Jarabak, 1972, 58 high angle case, reduced OB
UAFH-LAFH ratio: Nahoum (1975) believed that patients with a dental open bite and a UAFH-
LAFH ratio of less than 65% (normally they are equal) are considered to be poor risks for
conventional orthodontic treatment alone.
Increased dentoalveolar height in molar region and reduced dentoalveolar height in incisor
region due to strong muscle allowing molar eruption. (Neilsen, 1991).
Dung and Smith (1988).
Overbite depth indicator (ODI) Kim in 1974
Skeletal factors: Mainly genetically in origin. Vertical growth pattern more genetically correlated
than horizontal one; if you had the long face in one generation then chances are that you would
have a long face in the next generation. (Hunter 1968)
Soft tissue factors : Muscle of mastication: Hunt 1997 & Benington 1999 showed large muscle
fibres in deep bite and small size muscle fibres in AOB
Chronic nasal obstruction (Solow & Tallgren 1976)
27. Adenoids (Aronson, 1979).
Digit Sucking Habits: The incidence of digit sucking is around 30% at 1 year of age, reducing to
12% at 9 years and 2% by 12 years. Most persistent suckers are female (Brenchely, 1992).
The severity of the malocclusion depends on the age of the patient, the intensity, frequency and
duration of the habit. Larsson, 1987
Prevention of digit-sucking sucking habits, BOS guidelines 2000
Myofunctional Therapy : Muscle exercise described by Laurie Park 2007
The functional regulator appliance (FR IV) Cochrane review, by Oliveira , 2007 showed that
there is weak evidence that the interventions FR-4 with lip-seal training and palatal crib
associated with high-pull chin cup are able to correct anterior open bite. Given that the trials
included have potential bias, these results must be viewed with caution.
TB with high-pull headgear inserted in the flying spring can be utilized to correct the
anteroposterior discrepancy while controlling the vertical dimension. Park 2001
Thick Twin block appliance: This phenomenon, which is called the bite-block effect, provides
excellent vertical control. Although long-term studies documenting the results of this treatment
are not yet available, the early results are promising. Clark 2010
Kim mechanics, (Kim, 1987).
Modified Kim mechanics, for some years clinicians have used reverse curve nickel-titanium
arch-wires instead of multiloope wires and they seem to work well (Harradine and Birnie, 2000).
Molar intrusion using skeletal anchorage: Like Dental implants, mini-plates, mini-screws ,
ankylosed teeth (Cousely 2008 use TPA with two palatal TAD for posterior teeth intrusion,
while Etilita et al 2012 use TPA with two buccal TAD)
In general: AOBs tend to relapse in approximately 20% of treated cases.(Huang, 2002)
Extraction: There is also evidence of greater stability of open bite correction when orthodontic
treatment is undertaken with extractions (Janson et al., 2006).
Extrusion or intrusion: In treatment resulting in molars intrusion, the rate of relapse ranges from
17 to 30%: whilst in treatments with incisor extrusion, relapse may be even greater, reaching
some-times 40% of treated cases. (Suguwara 2011)