Corticotomy facilitated orthodontics
Although the art and science of orthodontics have progressed significantly over the past 100 years, relatively little has been done to enhance the rate at which tooth movement occur. Many methods have been done to enhance the rate of tooth movement. These methods include the injection of biologically active peptides, the use of magnets and even the application of electric current and corticotomy.
Corticotomy: is slight penetration through the cortical bone and did not be confused with the osteotomy. Or defined as incision made into the cortical bone.
This penetration or incision leads to decrease the resistance of the alveolar and diminish physical alveolar bone contact that accelerates the rate of tooth movement.
Several authors have described rapid tooth in conjunction with corticotomy surgery as movement by bony (Block). Kole6 was the first describe the corticotomy as a surgical procedure in which one tooth or group of teeth with the adjacent bone is repositioned in one step. But others prefer to call this osteo-corticotomy or intra alveolar segmental osteotomy, reserving the term corticotomy for a technique in which cuts are made in the buccal cortical plate of bone. So that the segment to be moved orthodontically is held only by cancellous trabeculea and palatal cortical bone.
Kole in 19596 reported combining orthodontics with corticotomy surgery and complete the active tooth movement in adult orthodontic cases in 6 to 12 weeks.
The inter-proximal corticotomy cuts were extended through the entire thickness of the cortical layer, just barely penetrating the medullary bone.
The vertical cuts were connected beyond the apices of the teeth with horizontal osteotomy cut extending through the entire thickness of the alveolus, essentially creating blocks of bone in which one or more teeth were embedded, using the crowns of the teeth as a handles. Kole believed that he was able to move the blocks of bone some what independly of each other because they were only connected by less-dense medullary bone. He found no incidence of root resorption, no loss of tooth vitality and no pocket formation.
Kole used this surgical technique for correction of some of dento-alveolar problems as:
Protruding of lower incisors: this procedure is indicated in most of cases but should be determined whether a mandibular or dento-alveolar retrusion. Buccally the cortiocotomy is performed between the incisors and canine then horizontal cut is made 1cm. below the incisors, lingual two vertical and one horizontal cut is made fig(1).
Distal displacement of a single tooth or group of teeth: correction necessitates a long period of treatment in adult patients fig(2) .
The retrusion of all six lower anterior teeth: after buccal and ligual corticotomy is perefrmed.
Alignment of rotated teeth.
Correction of spaced teeth: in maxillary and mandibular protrusion with diastemas between the t
Periodontally Accelerated Osteogenic Orthodontics with Piezoelectric Surgery...Abu-Hussein Muhamad
Piezosurgery has been applied in dentistry for many years. This paper reviews specifically the treatment applications that have been used in surgically assisted orthodontic treatment since the last decade. Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a surgical technique which results in an increase in alveolar bone width, shorter treatment time, increase post-treatment stability, and decrease amount of apical root resorption. The aim of this case report is to compare the use of micro-motor and piezoelectric surgery unit during decortication in Periodontally Accelerated Osteogenic Orthodontics technique.
Key words: Piezoelectric surgery, piezosurgery, Periodontal regeneration , accelerated tooth movement
Abstract: Corticotomy-assisted orthodontic treatment is an established and efficient orthodontic technique that has recently been studied in a number of publications. Corticotomy facilitated orthodontics have been employed in various forms over speed up orthodontic treatment It involves selective alveolar decortication in the form of decortication lines and dots performed around the teeth that are to be moved. It is done to induce a state of increased tissue turnover and a transient osteopenia, which is followed by a faster rate of orthodontic tooth movement. This technique has several advantages, including faster tooth movement, shorter treatment time, safer expansion of constricted arches, enhanced post-orthodontic treatment stability and extended envelope of tooth movement. The aim of this article is to present a comprehensive review of the literature, including historical background, contemporary clinical techniques, indications, contraindications, complications and side effects. Keywords: Corticotomy, decortication, review, orthodontic treatment
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Orthodontics has been developing greatly in achieving the desired results both clinically and technically.
Today, it is still very challenging to reduce the duration of orthodontic treatments.
It is one of the common deterents that the orthodontist faces and it causes irritation among adults plus increasing risks of caries, gingival recession, and root resorption.
A number of attempts have been made to create different approaches both preclinically and clinically in order to achieve quicker results, but still there are a lot of uncertainties and unanswered questions towards most of these techniques.
Orthodontic consideration of the old extraction siteAhmed Baattiah
This document discusses alveolar bone resorption after tooth extraction and socket healing. It notes that bone loss is most rapid in the first 3 years after extraction, with 40-60% loss, slowing to 0.25-0.5% annually thereafter. Within 24 hours of extraction, a blood clot forms in the socket, which is later replaced by granulation tissue and then bone deposition over 4-6 months as the socket heals. Methods to preserve sockets during healing include grafting, guided tissue regeneration, immediate implant placement, and platelet rich plasma. Orthodontic tooth movement can also be used to regenerate alveolar bone in areas of previous extractions.
Resective osseous surgery involves reshaping the alveolar bone through additive or subtractive techniques to correct deformities caused by periodontal disease. The goal is to reshape the marginal bone to resemble healthy bone. Key steps include vertical grooving, radicular blending, flattening interproximal bone, and gradualizing marginal bone using instruments like chisels and curettes. This technique is best for early to moderate bone loss up to 3mm and can provide reduced pocket depths and stable tissue contours for long-term maintenance when performed with apically positioned flaps.
Periodontally Accelerated Osteogenic Orthodontics with Piezoelectric Surgery...Abu-Hussein Muhamad
Piezosurgery has been applied in dentistry for many years. This paper reviews specifically the treatment applications that have been used in surgically assisted orthodontic treatment since the last decade. Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a surgical technique which results in an increase in alveolar bone width, shorter treatment time, increase post-treatment stability, and decrease amount of apical root resorption. The aim of this case report is to compare the use of micro-motor and piezoelectric surgery unit during decortication in Periodontally Accelerated Osteogenic Orthodontics technique.
Key words: Piezoelectric surgery, piezosurgery, Periodontal regeneration , accelerated tooth movement
Abstract: Corticotomy-assisted orthodontic treatment is an established and efficient orthodontic technique that has recently been studied in a number of publications. Corticotomy facilitated orthodontics have been employed in various forms over speed up orthodontic treatment It involves selective alveolar decortication in the form of decortication lines and dots performed around the teeth that are to be moved. It is done to induce a state of increased tissue turnover and a transient osteopenia, which is followed by a faster rate of orthodontic tooth movement. This technique has several advantages, including faster tooth movement, shorter treatment time, safer expansion of constricted arches, enhanced post-orthodontic treatment stability and extended envelope of tooth movement. The aim of this article is to present a comprehensive review of the literature, including historical background, contemporary clinical techniques, indications, contraindications, complications and side effects. Keywords: Corticotomy, decortication, review, orthodontic treatment
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Orthodontics has been developing greatly in achieving the desired results both clinically and technically.
Today, it is still very challenging to reduce the duration of orthodontic treatments.
It is one of the common deterents that the orthodontist faces and it causes irritation among adults plus increasing risks of caries, gingival recession, and root resorption.
A number of attempts have been made to create different approaches both preclinically and clinically in order to achieve quicker results, but still there are a lot of uncertainties and unanswered questions towards most of these techniques.
Orthodontic consideration of the old extraction siteAhmed Baattiah
This document discusses alveolar bone resorption after tooth extraction and socket healing. It notes that bone loss is most rapid in the first 3 years after extraction, with 40-60% loss, slowing to 0.25-0.5% annually thereafter. Within 24 hours of extraction, a blood clot forms in the socket, which is later replaced by granulation tissue and then bone deposition over 4-6 months as the socket heals. Methods to preserve sockets during healing include grafting, guided tissue regeneration, immediate implant placement, and platelet rich plasma. Orthodontic tooth movement can also be used to regenerate alveolar bone in areas of previous extractions.
Resective osseous surgery involves reshaping the alveolar bone through additive or subtractive techniques to correct deformities caused by periodontal disease. The goal is to reshape the marginal bone to resemble healthy bone. Key steps include vertical grooving, radicular blending, flattening interproximal bone, and gradualizing marginal bone using instruments like chisels and curettes. This technique is best for early to moderate bone loss up to 3mm and can provide reduced pocket depths and stable tissue contours for long-term maintenance when performed with apically positioned flaps.
Quinidine, Albino rats, Pentylenetetrazole, Gap junctionsiosrjce
This document describes a case study involving periodontally accelerated osteogenic orthodontics (PAOO) to accelerate orthodontic tooth movement. PAOO involves selective alveolar decortications and bone grafting to induce regional acceleratory phenomenon and reduce orthodontic treatment time. The case report describes performing corticotomy and bone grafting to close a 6.5mm space between teeth in a 27-year-old female patient, achieving the space closure in 4 months, which is significantly faster than conventional orthodontic treatment. PAOO provides benefits like reduced treatment time, increased bone volume, and improved post-treatment stability compared to traditional orthodontics.
Periodontally Accelerated Osteogenic Orthodontics: A Surgical Technique and C...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document describes a technique for selectively intruding overerupted molars in adult patients using a combination of selective alveolar corticotomies and a modified full-coverage maxillary splint with nickel-titanium springs. Two case reports are presented where this approach successfully intruded overerupted maxillary molars within 2.5-4 months without side effects. The technique aims to take advantage of the regional acceleratory phenomenon caused by corticotomies to increase orthodontic treatment efficiency for adult patients who require molar intrusion.
This finite element analysis compared the biomechanical effects of different corticotomy approaches on tooth movement during maxillary canine retraction. 24 corticotomy models were designed varying the position, distance from the canine, and width of the cuts. The results showed that a distal corticotomy close to the canine resulted in the greatest canine displacement and lowest strain in the periodontal ligament, suggesting it may be the best approach for facilitating canine retraction. As the distance between the corticotomy and canine increased, its biomechanical effects on tooth movement decreased. The width of the cut did not significantly influence the results.
Immediate Implants Placed Into Infected Sockets: Clinical Update with 3-Year ...Abu-Hussein Muhamad
Dental implants can be placed immediately into healthy extraction sites with high success and survival rates. It has been suggested, however, that immediate placement of implants into infected extraction sites is contraindicated due to the pathology interfering with osseointegration resulting in decreased implant survival and success With many potential implant sites presenting with a preexisting periapical or periodontal infection, treatment protocols have been advocated for immediate placement of implants in these infected sites. Advancements in surgical techniques and implant surface technology have made immediate placement of implants a more predictable and accepted treatment option; however, there is still debate about whether infected extraction sites should be used for immediate implant treatment approaches. The purpose of this clinical update is to report on the success and survival of implants placed immediately into infected extraction sites.
This document describes a study on the socket shield technique for tooth replacement with dental implants. The socket shield technique involves retaining part of the facial root when extracting a tooth and immediately placing a dental implant. The study examined 15 patients treated with this technique between 2011-2018. Volumetric analysis using CT scans found that the socket shield technique helped maintain hard and soft tissue volumes compared to traditional immediate implant placement. The technique is described as an effective way to preserve alveolar bone and provide esthetic outcomes for dental implant treatment.
Resective osseous surgery involves removing tooth-supporting alveolar bone to reshape it and eliminate periodontal pockets. It is indicated for inconsistent bone margins, reverse bone architecture, one-wall defects, and other bone irregularities. The surgery involves using burs and chisels to perform vertical grooving of thick bone, blending any bone ledges on tooth roots, flattening interproximal bone in narrow areas, and gradualizing marginal bone. Flaps are closed to cover the new bony margins. Post-operative maintenance like cleaning and antibiotics is needed to allow healing over 2-3 weeks.
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.
full mouth rehabilitation of partially and fully edentulous patient with crow...Merenguita
This case report describes the full mouth rehabilitation of a patient with short clinical crowns in the mandibular anterior teeth and edentulous maxilla. A thorough examination including diagnostic wax-up determined 2mm of additional crown length was needed via crown lengthening surgery. Single crowns were placed on the anterior teeth along with a maxillary complete denture and mandibular removable partial denture with a lingual plate. The treatment aimed to prevent extrusion of the anterior teeth and reduce forces on the maxilla to avoid combination syndrome. A 4 month recall found healthy gingiva and the patient was satisfied with function and esthetics.
This document describes a case study of a 10-year-old boy who fell and fractured three of his upper anterior teeth. One tooth had a fracture below the gingival crest. Rather than extracting the tooth, the clinicians used orthodontic extrusion to bring the remaining root portion above the gumline. This involved cementing a screw post to the root, attaching elastic thread to bring the root out over 6 weeks. After extrusion, the tooth was restored with a post core and crown. At a 2-year follow up the restorations were stable clinically and radiographically. The case demonstrates how an interdisciplinary approach with endodontics, orthodontics and prosthodontics can save a tooth that
A 58-year-old patient visited the clinic seeking treatment for removable dentures. An examination found she was missing teeth in the upper anterior region and had a protruding ridge that could cause discomfort. She also had a fused labial frenulum. The general dentist referred her to oral surgery for preprosthetic surgery. Her general health was normal with no systemic issues.
This document describes a case study of using titanium screw anchorage to successfully treat a 31-year-old female patient with a severe anterior open bite of 7 mm. Mini screws were implanted in the maxilla and mandible to provide anchorage for intruding the upper and lower first molars by 3 mm each over 19 months of active treatment. This led to a counterclockwise rotation of the mandible which corrected the open bite and improved her retrognathic facial profile. The results suggest titanium screws are useful for intruding molars and treating anterior open bites in adult patients.
Rapid canine retraction and orthodontic treatment with dentoalveolar distract...Dr Mujtaba Ashraf
This document presents a study on a new technique called dentoalveolar distraction (DAD) to rapidly retract canines during orthodontic treatment. The study involved 10 patients where the maxillary first premolars were extracted and a distractor device was used to move the canines into the extraction sites at a rate of 0.8 mm per day. Full canine retraction was achieved in an average of 10 days with minimal anchorage loss. The canines tipped and translated distally on average 13 degrees. No complications were observed. The DAD technique reduces orthodontic treatment time by nearly 50% with no adverse effects on surrounding structures.
It restore alveolar bone to the level existing at the time of surgery or slightly more apical to this level. Aim is to achieve positive bony architecture.
STEPS INCLUDE:
1.VERTICAL GROOVING
2. RADICULAR BLENDING
3. FLATTENING INTERPROXIMAL BONE
4. GRADUALIZING MARGINAL BONE
PREFERRED TREATMENT FOR ONE WALLED PERIODONTAL BONE DEFECTS (HEMISEPTUM)
The document discusses treatment options for congenitally missing maxillary lateral incisors, including canine substitution, single-tooth implants, and tooth-supported restorations. It provides details on the benefits and drawbacks of each approach. Space closure through canine substitution is presented as having the advantage of accomplishing treatment in one phase and producing permanent results independent of residual growth. However, achieving high esthetic standards requires restorative work on canines and premolars. A six-step clinical procedure is outlined to close spaces and perform restorations for an optimal esthetic outcome. Risks of biological complications with the implant approach over time are also noted.
Resective osseous surgery aims to eliminate periodontal pockets and create physiological bone contours and gingival architecture to facilitate plaque control. It involves osteoplasty to reshape bone and ostectomy to remove bone. Key principles are using a full-thickness flap, contouring bone to match healthy gingival form, and leaving a positive bone architecture. Techniques are used to modify defects like craters, ledges, and furcations. Studies found minimal bone loss with healing. The main objective is achieving periodontal architecture to enable self-oral hygiene.
This document discusses factors affecting the selection of patients for implant retained prostheses. It outlines that a thorough patient evaluation including medical history, dental evaluation through examination and imaging, and informed consent is required. The dental evaluation assesses bone quality and quantity, occlusion, and adjacent teeth. Indications for implants include missing teeth from congenital defects, trauma, or being edentulous. Contraindications include certain medical conditions, smoking, drugs/alcohol, or inadequate bone. Proper patient selection is key for implant success and satisfying treatment outcomes.
This document discusses factors to consider when selecting patients for implant retained prostheses. It outlines general patient factors like medical history and motivation that should be assessed. A thorough dental evaluation including extraoral and intraoral exams, various radiographs, and bone density assessment is important. Patients should provide informed consent and understand expectations, risks, and commitments. Clinical indications for implants include missing teeth due to congenital defects, trauma, or being edentulous. Contraindications include conditions that could compromise bone healing or the patient's ability to maintain implants. A multidisciplinary approach may be needed for complex cases.
This document summarizes a study on using bone grafts and immediate implant placement in areas of high aesthetic value. It describes using block bone grafts taken from the mandible to augment alveolar ridge deficiencies in the maxilla before placing implants. The goals were to assess success rates of implants placed in grafted bone and determine if this technique is suitable for aesthetic areas. The methodology involved using SPI implants and placing immediate provisional restorations on the implants after grafting and implantation to condition the soft tissues during healing. Success was based on radiographic and clinical assessments during outpatient follow-ups.
Stomatognathic system
- Muscle function
- Form and function of jaws
Trajectories of the jaws
- Trajectories force
- Buttresses
Closed functional system
- Basal arches
- Lip, cheek, tongue morphology
-
Dynamics of mandible
Mastication
- Dynamic of mastication
- Mastication after teeth eruption
- Respiration during mastication
- Masticatory efficiency
Swallowing
- Stages of swallowing
- Tongue thrust and malocclusion
Respiration
Speech
TM articulation
- TM articulation disorders
Effect of different form of malocclusion
Introduction
Significance of proper interproximal contact relation
Factors affecting inter-proximal contact relations
Description of inter-proximal contact
Labio lingual aspect
\Incisal and occlusal aspects
Size of contact
Shape of contact
Benefits of ideal contact
Hazards of faulty reproduction of contact point
Conclusion
Quinidine, Albino rats, Pentylenetetrazole, Gap junctionsiosrjce
This document describes a case study involving periodontally accelerated osteogenic orthodontics (PAOO) to accelerate orthodontic tooth movement. PAOO involves selective alveolar decortications and bone grafting to induce regional acceleratory phenomenon and reduce orthodontic treatment time. The case report describes performing corticotomy and bone grafting to close a 6.5mm space between teeth in a 27-year-old female patient, achieving the space closure in 4 months, which is significantly faster than conventional orthodontic treatment. PAOO provides benefits like reduced treatment time, increased bone volume, and improved post-treatment stability compared to traditional orthodontics.
Periodontally Accelerated Osteogenic Orthodontics: A Surgical Technique and C...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document describes a technique for selectively intruding overerupted molars in adult patients using a combination of selective alveolar corticotomies and a modified full-coverage maxillary splint with nickel-titanium springs. Two case reports are presented where this approach successfully intruded overerupted maxillary molars within 2.5-4 months without side effects. The technique aims to take advantage of the regional acceleratory phenomenon caused by corticotomies to increase orthodontic treatment efficiency for adult patients who require molar intrusion.
This finite element analysis compared the biomechanical effects of different corticotomy approaches on tooth movement during maxillary canine retraction. 24 corticotomy models were designed varying the position, distance from the canine, and width of the cuts. The results showed that a distal corticotomy close to the canine resulted in the greatest canine displacement and lowest strain in the periodontal ligament, suggesting it may be the best approach for facilitating canine retraction. As the distance between the corticotomy and canine increased, its biomechanical effects on tooth movement decreased. The width of the cut did not significantly influence the results.
Immediate Implants Placed Into Infected Sockets: Clinical Update with 3-Year ...Abu-Hussein Muhamad
Dental implants can be placed immediately into healthy extraction sites with high success and survival rates. It has been suggested, however, that immediate placement of implants into infected extraction sites is contraindicated due to the pathology interfering with osseointegration resulting in decreased implant survival and success With many potential implant sites presenting with a preexisting periapical or periodontal infection, treatment protocols have been advocated for immediate placement of implants in these infected sites. Advancements in surgical techniques and implant surface technology have made immediate placement of implants a more predictable and accepted treatment option; however, there is still debate about whether infected extraction sites should be used for immediate implant treatment approaches. The purpose of this clinical update is to report on the success and survival of implants placed immediately into infected extraction sites.
This document describes a study on the socket shield technique for tooth replacement with dental implants. The socket shield technique involves retaining part of the facial root when extracting a tooth and immediately placing a dental implant. The study examined 15 patients treated with this technique between 2011-2018. Volumetric analysis using CT scans found that the socket shield technique helped maintain hard and soft tissue volumes compared to traditional immediate implant placement. The technique is described as an effective way to preserve alveolar bone and provide esthetic outcomes for dental implant treatment.
Resective osseous surgery involves removing tooth-supporting alveolar bone to reshape it and eliminate periodontal pockets. It is indicated for inconsistent bone margins, reverse bone architecture, one-wall defects, and other bone irregularities. The surgery involves using burs and chisels to perform vertical grooving of thick bone, blending any bone ledges on tooth roots, flattening interproximal bone in narrow areas, and gradualizing marginal bone. Flaps are closed to cover the new bony margins. Post-operative maintenance like cleaning and antibiotics is needed to allow healing over 2-3 weeks.
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.
full mouth rehabilitation of partially and fully edentulous patient with crow...Merenguita
This case report describes the full mouth rehabilitation of a patient with short clinical crowns in the mandibular anterior teeth and edentulous maxilla. A thorough examination including diagnostic wax-up determined 2mm of additional crown length was needed via crown lengthening surgery. Single crowns were placed on the anterior teeth along with a maxillary complete denture and mandibular removable partial denture with a lingual plate. The treatment aimed to prevent extrusion of the anterior teeth and reduce forces on the maxilla to avoid combination syndrome. A 4 month recall found healthy gingiva and the patient was satisfied with function and esthetics.
This document describes a case study of a 10-year-old boy who fell and fractured three of his upper anterior teeth. One tooth had a fracture below the gingival crest. Rather than extracting the tooth, the clinicians used orthodontic extrusion to bring the remaining root portion above the gumline. This involved cementing a screw post to the root, attaching elastic thread to bring the root out over 6 weeks. After extrusion, the tooth was restored with a post core and crown. At a 2-year follow up the restorations were stable clinically and radiographically. The case demonstrates how an interdisciplinary approach with endodontics, orthodontics and prosthodontics can save a tooth that
A 58-year-old patient visited the clinic seeking treatment for removable dentures. An examination found she was missing teeth in the upper anterior region and had a protruding ridge that could cause discomfort. She also had a fused labial frenulum. The general dentist referred her to oral surgery for preprosthetic surgery. Her general health was normal with no systemic issues.
This document describes a case study of using titanium screw anchorage to successfully treat a 31-year-old female patient with a severe anterior open bite of 7 mm. Mini screws were implanted in the maxilla and mandible to provide anchorage for intruding the upper and lower first molars by 3 mm each over 19 months of active treatment. This led to a counterclockwise rotation of the mandible which corrected the open bite and improved her retrognathic facial profile. The results suggest titanium screws are useful for intruding molars and treating anterior open bites in adult patients.
Rapid canine retraction and orthodontic treatment with dentoalveolar distract...Dr Mujtaba Ashraf
This document presents a study on a new technique called dentoalveolar distraction (DAD) to rapidly retract canines during orthodontic treatment. The study involved 10 patients where the maxillary first premolars were extracted and a distractor device was used to move the canines into the extraction sites at a rate of 0.8 mm per day. Full canine retraction was achieved in an average of 10 days with minimal anchorage loss. The canines tipped and translated distally on average 13 degrees. No complications were observed. The DAD technique reduces orthodontic treatment time by nearly 50% with no adverse effects on surrounding structures.
It restore alveolar bone to the level existing at the time of surgery or slightly more apical to this level. Aim is to achieve positive bony architecture.
STEPS INCLUDE:
1.VERTICAL GROOVING
2. RADICULAR BLENDING
3. FLATTENING INTERPROXIMAL BONE
4. GRADUALIZING MARGINAL BONE
PREFERRED TREATMENT FOR ONE WALLED PERIODONTAL BONE DEFECTS (HEMISEPTUM)
The document discusses treatment options for congenitally missing maxillary lateral incisors, including canine substitution, single-tooth implants, and tooth-supported restorations. It provides details on the benefits and drawbacks of each approach. Space closure through canine substitution is presented as having the advantage of accomplishing treatment in one phase and producing permanent results independent of residual growth. However, achieving high esthetic standards requires restorative work on canines and premolars. A six-step clinical procedure is outlined to close spaces and perform restorations for an optimal esthetic outcome. Risks of biological complications with the implant approach over time are also noted.
Resective osseous surgery aims to eliminate periodontal pockets and create physiological bone contours and gingival architecture to facilitate plaque control. It involves osteoplasty to reshape bone and ostectomy to remove bone. Key principles are using a full-thickness flap, contouring bone to match healthy gingival form, and leaving a positive bone architecture. Techniques are used to modify defects like craters, ledges, and furcations. Studies found minimal bone loss with healing. The main objective is achieving periodontal architecture to enable self-oral hygiene.
This document discusses factors affecting the selection of patients for implant retained prostheses. It outlines that a thorough patient evaluation including medical history, dental evaluation through examination and imaging, and informed consent is required. The dental evaluation assesses bone quality and quantity, occlusion, and adjacent teeth. Indications for implants include missing teeth from congenital defects, trauma, or being edentulous. Contraindications include certain medical conditions, smoking, drugs/alcohol, or inadequate bone. Proper patient selection is key for implant success and satisfying treatment outcomes.
This document discusses factors to consider when selecting patients for implant retained prostheses. It outlines general patient factors like medical history and motivation that should be assessed. A thorough dental evaluation including extraoral and intraoral exams, various radiographs, and bone density assessment is important. Patients should provide informed consent and understand expectations, risks, and commitments. Clinical indications for implants include missing teeth due to congenital defects, trauma, or being edentulous. Contraindications include conditions that could compromise bone healing or the patient's ability to maintain implants. A multidisciplinary approach may be needed for complex cases.
This document summarizes a study on using bone grafts and immediate implant placement in areas of high aesthetic value. It describes using block bone grafts taken from the mandible to augment alveolar ridge deficiencies in the maxilla before placing implants. The goals were to assess success rates of implants placed in grafted bone and determine if this technique is suitable for aesthetic areas. The methodology involved using SPI implants and placing immediate provisional restorations on the implants after grafting and implantation to condition the soft tissues during healing. Success was based on radiographic and clinical assessments during outpatient follow-ups.
Stomatognathic system
- Muscle function
- Form and function of jaws
Trajectories of the jaws
- Trajectories force
- Buttresses
Closed functional system
- Basal arches
- Lip, cheek, tongue morphology
-
Dynamics of mandible
Mastication
- Dynamic of mastication
- Mastication after teeth eruption
- Respiration during mastication
- Masticatory efficiency
Swallowing
- Stages of swallowing
- Tongue thrust and malocclusion
Respiration
Speech
TM articulation
- TM articulation disorders
Effect of different form of malocclusion
Introduction
Significance of proper interproximal contact relation
Factors affecting inter-proximal contact relations
Description of inter-proximal contact
Labio lingual aspect
\Incisal and occlusal aspects
Size of contact
Shape of contact
Benefits of ideal contact
Hazards of faulty reproduction of contact point
Conclusion
Factors affect Development of Occlusion and its Stability.pdfDr.Mohammed Alruby
Factors affect Development of
Occlusion
And
Its
Stability
Prepared by:
Dr. Mohammed Alruby
Factors affect development of occlusion
1- Factors determine tooth position during eruption
2- Dimensional changes in dental arches:
- Width
- Length
- Arch circumference
Factors affect occlusal stability and tooth position:
1- Force act against the teeth
Force of occlusion
2- Drifting of teeth
3- Facial growth
Factors affect development of occlusion
1- Factors determining tooth position during eruption:
The tooth passes through 4 distinct stages during its eruption, the tooth position during each is affected by several factors
a- Stage 1: tooth germ, the position of tooth germ is greatly determined by genetics
b- Stage 2: during intra-bony eruption, the tooth position is affected by:
- Presence or absence of adjacent teeth
- Rate of resorption of primary roots
- Localized pathologic lesion
- Any other factors that alter growth of alveolar process
N: B:
The teeth have mesial shifting tendency even before they appear in the oral cavity
c- Stage 3: intra-oral or pre-occlusion stage of eruption, the position of the tooth at this stage is affected by:
- Lip, tongue and c, tongue and cheek musculature
- External objects brought into the mouth as thumb and pencil
- Tooth can be moved mesially into spaces created by inter-proximal caries or extraction
d- Stage 4: this stage is affected by most complicated system of force:
1- Musculature:
= Muscles of deglutition, expression and mastication have direct effect on the dento-alveolar structure
= The tongue exerts very powerful anterior and lateral force on the dentition which resist and balanced the inward force of orbicularis oris muscle and buccinator mechanism, in addition to its molding effect on the palate
= Lip and cheek musculatures
= Masseter, temporalis, and medial pterygoid muscles: support the mandible against gravity and downward pull of submandibular muscles
2- Proximal contact: also the transeptal fibers
The proximal contact of adult’s dentition is maintained by:
- The tendency of posterior teeth to move forward by anterior component force and this force become active by the eruption of 1st molars
- Distal and lingual forces: which act upon the teeth and produced by muscles of lips, orbicularis oris, caninus, zygomaticus, mentalis and buccinators
- The inter-action between these two opposite forces will guided by the proximal contact between the teeth
2-Dimensional changes in the dental arches:
The usual arch dimensions measured are:
- Width: at canine region – at premolar region – at 1st molar region
- Length of the arch
- Circumference of dental arch
a- Width:
At canine region:
It is the distance of anterior region of the dental arch from canine to canine, the significant increase in intercanine width occurs during eruption of permanent incisors and movement of primary canine distally into primate space
Delayed
Tooth
Eruption
Prepared by:
Dr. Mohammed Alruby
Delayed tooth eruption
Definition DTE:
It is the emergence of a tooth into the oral cavity at a time that deviates significantly from norms established for different races, ethnicities, and sexes
Eruption:
The developmental process responsible for moving a tooth from its crypt position through the alveolar process into the oral cavity to its final position of occlusion with its antagonists.
Physiologic process that strongly influences the normal development of the craniofacial complex.
Its dynamic process that encompasses:
1- Completion of root development.
2- Establishment of the periodontium.
3- Maintenance of the functional occlusion.
Factors influencing tooth eruption:
- Broad chronologic age range.
- Race
- Sex
- Ethnic
- Individual variation
Emergence (Moment of eruption):
The moment of appearance of any part of the cusp or crown
through the gingiva.
Impacted teeth:
Teeth prevented from erupting by some physical barrier path.
Etiology:
1- Lack of space Due to crowding of the dental arches or premature loss of deciduous teeth
2- Rotation or other positional deviation of the tooth buds.
Results in teeth that are “aimed” in the wrong direction, leading to impaction.
Primary retention:
- Cessation of eruption of a normally placed and developed tooth germ before emergence.
- No physical barrier.
Pseudo-anodontia
Clinical but not radiographic absence of teeth that should normally be present in the patient’s dental and chronologic age.
the deciduous teeth have been shed, but the permanent ones failed to erupt.
Primary or idiopathic failure of eruption :(Proffit and Vig):
Non-ankylosed teeth fail to erupt fully or partially
- Because of malfunction of eruption mechanism.
- No barrier to eruption.
- Primary defect in in the eruptive process.
Arrested eruption or non-eruption:
- Ankylosis
- Impaction
- Idiopathic failure of eruption
Embedded teeth:
Unerupted due to lack of eruptive force.
No obvious physical obstruction.
Submerged teeth and inclusion/re-inclusion of teeth:
- After eruption, teeth become ankylosed.
- Lose their ability to maintain the continuous eruptive potential as the jaws grow.
- Lose contact with their antagonists.
- Might re-include in the oral tissue.
Eruption is normal according to chronologic and biologic parameters (root formation), BUT the process was haltered.
Controversy between the terms:
“delayed”, “late”, “retarded”, “depressed” and “impaired”
a- Root development as a basis for distinguishing some of these terms (Gron,1962):
Under normal circumstances, tooth eruption begins when ¾ of its final root length is established.
- Mandibular canines and second molars root development > ¾of final root length.
- Mandibular central incisors and first molars root development < ¾ final root length.
b- Root Development alone should be the basis for defining the expected time of eruption for diff
Curve of Spee
Prepared by:
Dr. Mohammed Alruby
Curve of spee
In anatomy, the Curve of Spee is defined as the curvature of the mandibular occlusal plane beginning at the tip of the lower cuspid and following the buccal cusps of the posterior teeth, continuing to the terminal molar.
It is named for the German embryologist Ferdinand Graf von Spee (1855–1937), who was first to describe the anatomic relations of human teeth in the sagittal plane
According to another definition the Curve of Spee is an anatomic curvature of the occlusal alignment of the teeth, beginning at the tip of the lower canine, following the buccal cusps of the natural premolars and molars and continuing to the anterior border of the ramus
Assess the depth of curve from premolar cusps to a flat plane on distal cusps of first molars and incisors. Only one
value is given for the arch, and only if the premolars have not been assessed separately as crowded. Allow 1 mm
space for 3 mm depth of curve, 1.5 mm for 4 mm depth, and 2 mm space for a 5 mm curve (usually no allowance
is necessary).
Exaggerated curve of Spee is frequently observed in dental malocclusions with deep overbites. Such excessive curve of Spee alters the muscle imbalance, ultimately leading to the improper functional occlusion.
It has been proposed that an imbalance between the anterior and the posterior components of occlusal force can cause the lower incisors to over erupt, the premolars to infra-erupt, and the lower molars to be mesially inclined.
This altered condition requires specialized skills for the practitioner. It would be useful if we have a thorough knowledge of how and when this curve of Spee develops, so that it will aid us in our treatment.
In humans, an increased curve of Spee is often seen in brachycephalic facial patterns and associated with short mandibular bodies
According to Root and Fidler et al when a skeletal open bite is not present, the curve of Spee in Class II malocclusions is deeper than in other malocclusions
Andrews noted that the occlusal planes in 120 non-orthodontically treated and having normal occlusions varied from being generally flat to a slight curve of Spee.
This finding led him to believe that the presence of a curve of Spee could be associated with post-orthodontic treatment relapse.
Andrews concluded, “even though not all of the orthodontic normal had flat planes of occlusion, I believe that a flat plane should be a treatment goal as a form of overtreatment.”
A deep curve of Spee may make it almost impossible to achieve a Class I canine relationship, though it may also result in occlusal interferences that will manifest during mandibular function.
Curve of spee from flat to mild:
It has been suggested that the deciduous dentition has a curve of Spee ranging from flat to mild, whereas the adult curve of Spee is more pronounced. The findings were supported by Ash.
Its greatest increase occurs in the early mixed d
Definition
Types of rotation
Etiology of rotation
Winging and counter winging rotation
Advantages of derotation
Biomechanics of rotation correction
Methods of correction rotation
Management of molar derotation
Retention of rotated tooth
Methods to prevent relapse
Active retention
Torque when, where, how?
Importance of torque
Biomechanics in torque
Torque expression in slot 0.018 and 0.022
Expression of torque
Mode of ligation and torque
Types of torque
- Passive
- Active
Factors affect torque
Torque with different appliances
Torque in base and face
Torque prescription in different techniques
Class II malocclusion and torque
Torque control in different treatment steps
Differential torque
Torque clearance
Intrusion and torque
Torque and intra-oral elastics
Extra-oral forces
And
Appliances
Prepared by:
Dr. Mohammed Alruby
Definition
Philosophy
History and development
Classification of extra-oral forces
Advantages of extra-oral forces
Disadvantages of extra-oral forces
Uses of extra-oral forces
Headgear
Appliance enhanced the action of headgear
Protraction appliances
Types of reversed headgear
Chin cup appliance
Orthopedic correction of class III
Orthopedic correction of open bite
Orthopedic correction of class II
Retention after orthopedic correction
Definition
It is a force derived from an extra-oral appliance that uses the forehead, the top of the head or the back of the neck as anchorage to apply forces to the dental or basal arch. It may be orthodontic force or orthopedic force to move the dentition, or restrict or redirect the growth respectively.
Philosophy:
The philosophy beyond the use of extra-oral force is based upon the old concept that, (the application of appreciable amount of force against the growing bone con modify or alter the direction of bone growth and consequently alter the shape and position of the bone
= the well-known best examples are the induced skull deformation in Colombia –India and feet deformation in Chinese girls
History and development:
Appliances resembling chin cups have been in use since the early 1800's. According to Graber, the early attempts with the chin cup were not successful because of incomplete knowledge of mandibular and facial growth, its use on non-growing patients, and an inadequate understanding of the forces generated by the chin cup.
1802: Cellier and Josef Fox in 1803, utilized chin caps in combination with bite blocks to correct the “underslung chin”
1866: Norman Kingsley introduced extra-oral head cap anchorage or force for maxillary distal movement
1880: Kingsley described an appliance that could influence the position of the dentition in upper jaw with the aid of extra-oral forces
1887: E.H.Angle recommended the use of occipital bandage in treatment of maxillary protrusion
1904: Jackson was first describing the facial mask
1892: headgear appliance was originally designed by Kingsley
1920: Angle and his followers were convinced that class II and class III elastics not only moved teeth but cause a significant skeletal changes: stimulate growth of one and restrain growth for the other so we not need to use any extra-oral force just wait until permanent dentition is completed
1923: Case recommend the use of extra-oral force against maxilla in treatment of class II and class I maxillary protrusion
1947: Kleohn, presented his treatment results with cervical neck strap, subsequent to this report, many other variation of the headgear appliance were presented
1960: Delaire facemask
Classification of extra-oral force appliances according to uses
The extra-oral pull is generally applied bilaterally, for three main purposes:
(1) as a restraining force
(2)
Effects of extra-oral appliances
And
Forces
Prepared by
Dr. Mohammed Alruby
Factors affect extra-oral force
Studies of maxillary protraction force
Results of extra-oral force
Effects of extra-oral appliances
The effects of extra-oral forces on dentofacial structure depend on the following factors:
- Direction of force
- Magnitude of force
- Duration of force
- Growth
- Patient cooperation
1- Direction of force:
Kloehn 1953, Gould 1975, Greenspan 1970, Merrifield and Cross 1970, and Worms et al 1973, all give an adequate description for the direction of force application and their effect on maxillary molar position, tipping, bodily, extrusion, intrusion movement
The direction of force should be adjusted according to the patient needs and objective of treatment as:
- When bodily movement is required, the force should pass through the center of resistance of molars (at the tri-furcation of roots) and the extra-oral tube should be placed gingivally as possible
- When bodily displacement of maxilla is required, the force should pass through the center of maxillary resistance (zygomatic bone)
- When extrusion of molars is required, (in case of deep bite) the force should pass below the center of resistance (below the level of occlusal plane)- cervical headgear is the best choice
- When intrusion is required (open bite cases) the force should pass above the level of occlusal plane
- In occipital headgear, the vector of force may pass through the center of resistance of 1st molar and thus causes: -------------- distal translation of 1st molar
- If the vector of force passes above the center of resistance causing:
a- Distal root torque
b- Mesial crown tipping
c- Intrusion of maxillary 1st molar ---- that, ----- closing the bite and same can occurs in the vertical or high pull headgear
== the direction of force can be determined by adjusting the outer bow in relation to the occlusal plane or center of resistance
== the best method for recording the force direction is the lateral cephalometric radiograph with the appliance in place, then the outer bow is adjusted in relation to the occlusal plane and the center of resistance of tooth or jaw
= in Kloehn’s face bow, the direction of force is 25 – 30 degree below the occlusal plane so that, the vector of force is far away from the center of resistance of 1st molars, thus cervical headgear causes distal tipping and extrusion of 1st molars and open bite
The direction of force depends upon the following variables:
I- Vertical position of the outer bow relative to the center of resistance:
= force applied by oblique headgear passing through the center of resistance will cause translation of the tooth and make intrusion at the same time
= force applied by oblique headgear passing above the occlusal plane
but below the center of resistance will cause:
a- Distal crown tipping, mesial root torque
b- Extrusion of mesial marginal ri
Characteristic of light
History
Laser physics and properties
Component of laser
Classification of laser
Biological effect of laser
Laser effect on dental tissues
Laser safety in dental practice
General application of laser
Personal protective equipment
Types of laser intensity in orthodontics
Uses of laser in orthodontics
Effect of laser in orthodontics
Introduction
History
Classification of maxillary fractured Lefort
Special consideration for orthognathic surgery
- Patient selection:
Age of patient
Assessment of patient motivation and expectation
The nature and severity of skeletal dysplasia
Systemic evaluation
- Patient evaluation:
(1) General evaluation
(2) Esthetic evaluation
(3) Functional evaluation
(4) Radiographic evaluation
a- Ceph ---
PA
Lateral: ------ soft and hard
b- Panorama
c- CBCT
d- Periapical
Protocol for basic orthognathic record collection
Treatment planning
- Time of treatment
- Objective of orthodontic treatment
Pre-surgical
Post-surgical
- Sequence of treatment:
Pre-surgical phase
Orthodontic in theatre
Post-surgical treatment
Surgery without orthodontics
Stability and clinical success
complications
Medical glossary
Prepared by:
Dr. Mohammed Alruby
Medical glossary
Aberrancy: occurring or developing away from the normal situation
Acantholysis: loss of coherence between epithelial cells due to degeneration of desmosomes (intercellular bridge) this will lead to the formation of intra-epithelial clefts, vesicle and bullae
Acanthosis: epithelial hyperplasia, mainly of the stratum spinosum, leading to increase thickness of the stratum granulosum due to increased number of cell layers of prickle cells
Achondroplasia: an autosomally inherited disorder characterized by abnormality of conversion cartilage into bone predominantly affecting the epiphyses of long bones, leading to retarded growth at the epiphyses and resulting in dwarfism with short extremities but normal trunk
Acidogenic: referring to organisms capable of producing acid
Aciduric: referring to organisms capable of surviving and metabolizing under highly acidic conditions
Acquired: a term used to describe a condition, habit or other characteristic which is not present at birth, which developed in the individuals by reaction to some environmental factor (to acquire is to obtain)
Agenesis: failure of formation leading to absence of a part or organ
Aglossia: failure of formation leading to absence of the tongue
Agnathia: absence of the jaw, usually the lower jaw, usually accompanied by approximation of the ears
Amyloid: pertaining of starch, having the characteristic of starch. A protein compound of albumin and chondroitin sulphate which resembles starch in appearance and may be pathologically deposited in certain tissues
Anaplasia: atypical differentiation or lack of differentiation of epithelial cells occurring in the malignant disease. Anaplastic cells have large, hyperchromatic, irregularly shaped nuclei and frequently show a typical mitosis.
Aneuploidy: an abnormal number of chromosomes in a nucleus. This usually arise from failure of paired chromosomes or sister chromatids to disjoin at anaphase of cell division
Aneurysm: circumscribed dilatation of an artery
Aneurysmal: relating to an aneurysm. The term applied to a type of cyst that produce bony expansion simulating the expansion of an artery produced by a vascular aneurysm
Angiogenesis: development of blood vessels
Angioma: a swelling or mass due to proliferation with or without dilatation of vascular channels
Anhydrosis: absence of sweating due to absence of sweat glands
Ankyloglossia: tongue tie, usually due to a short lingual frenum or one attached too near the tip of the tongue, may be due to failure of separation of tongue from the floor of the mouth during embryogenesis
Ankylosis: stiffening or fixation of a joint as a result of a disease process
Anodontia: absence of teeth
Anomaly: deviation from the normal, anything structurally unusual or irregular
Antigen: a substance that can induce an antibody response
Antimongoloid slant: an obliquity of the palpebral fissures laterally
Muscles
Part 3
Prepared by
DR. Mohammed Alruby
Development of oropharyngeal function
Neuromuscular regulation of jaw positions and functions
Muscles controlling mandibular postures
- Muscles of mastication
- Submandibular muscles
- Extensor and flexor muscles of neck
Positions of mandible
Some clinical implications
Development of oropharyngeal function
1- Prenatal maturation:
= During prenatal life, the neuromuscular system does not mature evenly, it is not accidentally that the orofacial region matures a head of limb region
= In human fetus, by about the 8 week, generalized uniform reflex movement of entire body can be elicited by tactile stimulation
Diffuse spontaneous movements in response to as yet unidentified stimuli have been observed as early as 9.5 weeks
Localized specific and more peripheral responses cannot be produced before 11 weeks, and at this time, stimulation of the nose-mouth region causes lateral body flexion
By 14 weeks, the movements have become much more individualized. Stimulation of the mouth area, the general bodily movements no longer are seen but instead facial and orbicular muscle response are produced
Stimulation of the upper lip causes the mouth to close and often deglutition occurs
Respiratory movements of the chest and abdomen are seen first at about 16 week
The gag reflex has been demonstrated in human fetus of 18.5 weeks. By 25v weeks, respiration is shallow but may support life for few hours
Stimulation of the mouth at 29 weeks’ menstrual age has elicited sucking through complete suckling and swallowing is not thought to be developed until at least 32 week
2- Neonatal oral functions:
a- The mouth as sensory instrument:
= At birth, the orofacial region is a very active perceptual system, the infant finds the mouth nipple = more tactile than the visual sensation
At birth, the tactile sense already is more highly developed in the lips and mouth than in the fingers
= The neonate’s slobbers, drools, chew his toe, sucks his thumb and discovers the gurgling sounds can be made with his mouth
= oral function of the neonate is guided primarily by local tactile stimuli, particularly those from the lips and anterior part of the tongue
= the posture’s of neonate’s tongue is between the gum pads and often for enough forward to rest between the lips, where it can perform its role of sensory guidance more easily
= the mouth of infant is used for many purpose, the perceptual functions of the tongue, lips, and facial skin are mingled with the sensory function of taste, smell and jaw position.
= the sensitivity of tongue and lips is greater than other area of the body and the sensory guidance for oral functioning, including jaw movements is from remarkably large area
b- Infant suckling and swallowing:
= Infant suckling and swallowing have been the subjects of much research due to the effectiveness of these activities is a good indication of the neurologic ma
Muscles
Part 2
Prepared by:
Dr. Mohammed Alruby
Muscle function and malocclusion
Muscle development and skull form in relation to function
Facial balance, muscle balance, and orthodontic therapy
EMG response of muscles
Myofunctional therapy
Basic concepts of neuromuscular physiology
Muscle function and malocclusion
Muscle function is a factor in shaping the dental arches and is important in maintaining the stability of the teeth following orthodontic treatment
Muscle fibers contract in response to change in electrical potential of its investing membrane, proprioceptors located in the muscles and the periodontal membrane make possible a high degree of accuracy in bringing the teeth in contact
Class II malocclusion:
The muscle function is usually normal in class I malocclusion with the exception of class I Openbite
In class I cases, the teeth are in state of balance with environmental force, although the actual measurements of tongue and lip forces showed that, they are not equal at any area during particular function
Class I openbite:
= Usually caused by thumb sucking, retained infantile tongue swallowing or both, the child begins with finger habits of sufficient intensity and duration to deform the maxillary anterior segment forcing the incisors labially and allowing the tongue to move farther in forward direction
= the tongue continues to thrust instead of entering the transitional phase, a large part of this activity may be compensatory or adaptive to produce anterior seal with lower lip during swallowing
=such activity accentuates the openbite, prevent complete eruption of incisors and increase the overjet to the extent that the lower lip may cushion behind the maxillary incisors during rest and functional movements
- The upper lip become more hypotonic
- The lower lip become hyperactive
- Chin puckering can see with each swallowing
= the hyperactive mentalis muscle, retroclined, imprecate and flatten the mandibular anterior segment
= the tongue drop downward and mouth breathing become a dominate pattern, as the tongue thrust forward, it elongates in shape thus alter the balance with buccinator mechanism resulting in:
- Collapse of posterior segment
- V-shaped palate
- Buccal cross bite
This occurs also as a result of molding effect of the tongue upon the hard palate
Mouth breathing:
Is the good explain for these changes a result of underdeveloped nasopharyngeal structures and subsequently maxillary deficiency
Class II division 1 malocclusion:
= In contrast to class I class II div 1 involve an abnormal muscle function from beginning
= As abnormal muscle function in class II div 1 is a compensatory or adaptive and is secondary to skeletal relationship
= Because of large overjet, there is lack of the lip seal during rest and various functions so, mouth breathing is developed
= Some individuals translate the mandible forward to effect lip seal and to improv
Muscles
Part 1
Prepare by
Dr. Mohammed Alruby
Histology of muscles
Physiology of muscles
Muscles development
Orofacial muscles
- Facial muscles
- Jaw muscles
- Portal muscles
Methods of studying muscles
Muscle changes during growth
Muscle function and facial development
Histology of muscles
The structural and functional unit of the muscles is the muscle fiber
Muscle fiber: elongated cylinder measure about 10 to 80 microns in thickness and from 1 to 15cm in length
= Each muscle fiber contains an acidophilic granular cytoplasm (sarcoplasm) that rich in:
Glycogen, mitochondria, Golgi apparatus, protein (actin, myosin, tropomyosin),
Large number of myofibrils (sarcostyles) which responsible for muscle contraction
= the muscle fiber is covered by thick membrane called (sarcolemma) and surrounded by CT called (endomysium)
= the muscle fibers are coalescing together to form bundles; each bundles are covered by C T septa called perimysium
= the muscle bundles are coalescing together to the whole muscle which is covered by CT fascia called epimysium, these CT contain: blood vessel, lymph vessel, and nerves, that firmly attach the muscle bundles to each other and attach the whole muscle to its tendon
= the myofibrils (sarcostyles)are the contractile units of the muscle, in skeletal muscle they are transversely striated due to presence of dark and light bands
The dark bands are formed of thick myosin filaments rich in Ca, the light bands are formed of thin actine filaments rich in water, there is a pale line in at the center of dark band called (Henesen’s disk), There is dark line at the center of light bands called (Krauses membrane) or Z line
The distance between the two lines called (sarcomere) which is a contraction unit of the muscle.
During the muscle contraction there the Sarcomere is shortened due to sliding of the light bands over the dark bans. The energy required for contraction is derived from transformation of ATP ------ ADP
Physiology of muscles:
Man has 639 muscles, composed of 6 billion muscle fibers, each fiber has 1000 fibrils, which means that there are 6000 billion fibrils at work at one of time or another.
Elasticity: muscle can be stretched behind its original length and return to the original shape after relaxation (normal muscle can be elongated about 6/10 of its length
Contractility: it is the ability of muscle to shorten its length under nerve impulse, this contraction is stimulated by acetyl choline, glycogen is partially oxidized to provides energy and lactic acid that carried away by blood stream
Excessive accumulation of lactic acid can produce fatigue
Isometric contraction: (stretching): the muscle is simply resisting the external forces without actual shortening
Isotonic contraction: there is an actual shortening of the muscle, the strength of isometric contraction is much greater than that of isotonic contraction as the stre
diagnostic aids part 3, photograph and radiograph.docxDr.Mohammed Alruby
Diagnostic Aids
Part 3
{Radiographs and Photographs}
{BMR and EMG}
Prepared by
Dr. Mohammed Alruby
Radiographs
Means: A procedure that uses a type of high-energy radiation called x-rays to take pictures of areas inside the body. X-rays pass through the body onto film or a computer, where the pictures are made
Types:
Intra-oral radiographs:
Periapical radiographs:
It is necessary for any orthodontic diagnosis for the following reasons:
The pattern and amount of root resorption of deciduous teeth
Presence or absence of permanent teeth, their size, shape, position and relative state of development
Congenital absence of teeth or presence of supernumerary teeth
Character of alveolar bone, lamina dura, and periodontal membrane
Morphology and inclination of permanent teeth roots
Pathological oral condition such as thickened periodontal membrane, periapical infection, root fractures, cysts, retained deciduous teeth
Abnormal path of eruption of permanent teeth
Malposition of individual as: rotation, which requires a larger space on the arch
Very useful in mixed dentition analysis
Recognition of exact position of impacted tooth by using method of parallax: that determine whether the unerupted tooth is located labially or palatally. Two periapical radiograph is taken with the film in the same position in each exposure, but the tube is moved in second exposure about 10cm. if the impacted tooth is moved in the same direction as the tube so the tooth is impacted palatally and the reverse is versa.
Bit-wing radiographs:
Is used mainly for detection of proximal cries, but it is of little value in orthodontic diagnosis
Occlusal film:
Occlusal projection is useful to locate the supernumerary teeth at the midline (mesiodens) and to determine accurately the position of impacted maxillary cuspids
Extra-oral radiographs:
Cephalometric radiographs:
Lateral cephalometric radiographs
PA cephalometric radiographs
Lateral oblique cephalogram:
The patient is directed by 45 degree and take the shot
Since dentofacial structure will be superimposed in the true lateral cephalometric projection, the lateral oblique direction is designed to gives a more accurate recording of the actual tooth position in either the left or right buccal segments depending on which side is approximately perpendicular to the central rays
The lateral oblique cephalogram combines most of advantages of the lateral views, intra-oral periapical survey and panoramic radiograph plus a standard cephalometric registration that makes possible measurements of bone size and eruptive movements so it is of particular size in analysis of developing dentition
Submental vertex cephalometric:
Is used to assess mandibular asymmetry in the transverse and anterior-posterior plane. It is an important aid in detecting asymmetry in the symphysis, body, ramus, and condyle of the mandible. In many cases of asymmetry, this view is important for evaluation of mandibular displacemen
Diagnostic Aids
{Study cast, Cast analysis}
Part (2)
Prepared by
Dr. Mohammed Alruby
Study cast
Definition: it is a positive replica of the teeth and their supporting structure, it should be reproducing accurately all the anatomical details of the teeth, alveolar process, mucobuccal folds, palate, frenal attachment as well as the exact relationship of the mandibular to the maxillary dental arch
Good models begin with good impression, orthodontic impression should displace the lips and cheeks, so that, the full depth of mucobuccal sulci is recorded. This over extension of impression is obtained by building up the tray periphery with wax or by using special orthodontic trays
The position of maximum intercuspation should be recorded by getting the patient to bite through softened wax, that is important for:
1- Recording the proper intercuspation specially in cases of poor occlusal fit due to extraction or tongue thrust. So it is wise to check the occlusion in the mouth and compare it to the occluded cast to insure that the model is correctly articulated
2- Trimming of the upper and lower cast together without change in occlusal relationship or fracture of teeth
Occlusal registration of wax bite:
= the position of maximum intercuspation as well as the centric relation must be registered
= a piece of soft wax large enough to cover the occlusal surface of maxillary teeth is shaped to the form of maxillary arch, then gently pressed against the maxillary teeth
= the patient instructed to relax and mandible is guided to most posterior and superior position of condyle within the glenoid fossa, while the teeth come into occlusion
= if there is shifting during closure due to cuspal interference, this mean that the occlusal position is not coincide with centric occlusal position, in this case, in this case two bites are taken one for usual occlusal position, and the other for centric occlusion
Ideal requirements of orthodontic study models:
1- They are symmetrical and pleasing to the eye and so that a symmetrical arch form can be readily recognized
2- The dental occlusion shows by setting the models on their backs
3- Clean, smooth, bubble free, with sharp angles where the cuts meet
4- Glossy in finish.
Trimming of study models:
There are two types of trimming:
a- Angle trimming:
The purpose of angle trimming is to added an appropriate proportional bases to the anatomical portion of dental casts which is important in:
- Registration of centric occlusion by having the posterior and lateral border of both casts on the same plane, so that cast may place on any side without change in its relationship
- Giving an idea about the relationship of the teeth to the alveolar process and basal bone
- Giving harmonizing appearance of the right and left sides of the cast which any a symmetry can be detected
- Detection of occlusion from any side, anterior as well as lateral sides
Principles:
1- The floor of the base is trimmed
diagnostic aids part 1 diagnosis, examination, BMR, EMG.docxDr.Mohammed Alruby
Introduction:
Proper treatment plane depends on prompt diagnosis, good clinician should have a bird’s eyes to first identify the problem and find its etiology
Definitions:
= Grabber and Rackosi: defined diagnosis as:
Recognition and systemic designation of anomalies, the practical synthesis of the finding, permitting therapy to be planned and identification to be determined
=a continuous evaluation process in orthodontics starting right from the first interaction with the patient continuing through different stages till end of treatment and course follow up visits
Goal of orthodontic diagnosis:
Is to produce a comprehensive description of the patient’s problem and then to synthesis the various elements of description into a rational problem list
Diagnostic aids:
Data required for orthodontic diagnosis are derived from routine essential diagnostic aids and also from supplemental aids when needed, Graber categorized the diagnostic aids into essential and supplemental aids
Essential:
- Case history
- Study models
- Certain radiographs: periapical, bite wing, panoramic radiograph
- Facial photographs
- Intra-oral photographs
Supplemental:
- Specialized radiographs: occlusal of maxilla and mandible, lateral cephalogram
- Hand &wrist radiograph
- Electromyography
- Endocrine test
- Basal metabolic rate
Case history:
Complete case history includes all the relevant information derived from the patient and parents and essential for planning
Personal details:
Name:
The patient’s name should be recorded for the purpose of identification and communications
Calling the patient by his/her name not only establishes a good report but also imparts confidence in the patient mind about treatment providers
In case of children, it might help to know their pet problems
Age:
= certain malocclusion occurring during growth period are transient and self-correcting
= growth modification procedures such as functional appliances can be carried out during growth periods
= surgical respective procedures such as orthognathic surgery are best carried out after cessation of growth
= chronological age is important for the maintaining of shedding and eruption time tables as well
Gender:
= recording gender of the patient is important for treatment planning, females are observed to precede males in growth related events such as onset of growth spurt, eruption of the teeth and onset of puberty
= gender may also have a bearing on patient’s compliance toward certain types of orthodontic treatment
Occupation and address:
Occupation of patient / or parents gives an idea about socioeconomic condition which might affect the selection of orthodontic appliances and can give an idea about awareness
Address of patient determine the sociality of the patient and this effect on the treatment because some countries have normally bi-maxillary protrusion and also determine the awareness of patient about treatment and oral hygiene
Patient behavior:
Behavior of patient depend on: patient
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COLOUR CODING IN THE PERIOPERATIVE NURSING PRACTICE.SamboGlo
COLOUR CODING IN THE PERIOPERATIVE ENVIRONMENT HAS COME TO STAY ,SOME SENCE OF HUMOUR WILL BE APPRECIATED AT THE RIGHT TIME BY THE PATIENT AND OTHER SURGICAL TEAM MEMBERS.
CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
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NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
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2. Dr. Mohammed Alruby
2
Corticotomy facilitated orthodontics
Although the art and science of orthodontics have progressed significantly over the past
100 years, relatively little has been done to enhance the rate at which tooth movement occur.
Many methods have been done to enhance the rate of tooth movement. These methods include the
injection of biologically active peptides, the use of magnets and even the application of electric
current and corticotomy.
Corticotomy: is slight penetration through the cortical bone and did not be confused with the
osteotomy. Or defined as incision made into the cortical bone.
This penetration or incision leads to decrease the resistance of the alveolar and diminish
physical alveolar bone contact that accelerates the rate of tooth movement.
Several authors have described rapid tooth in conjunction with corticotomy surgery as
movement by bony (Block). Kole6
was the first describe the corticotomy as a surgical procedure
in which one tooth or group of teeth with the adjacent bone is repositioned in one step. But others
prefer to call this osteo-corticotomy or intra alveolar segmental osteotomy, reserving the term
corticotomy for a technique in which cuts are made in the buccal cortical plate of bone. So that
the segment to be moved orthodontically is held only by cancellous trabeculea and palatal
cortical bone.
Kole in 19596
reported combining orthodontics with corticotomy surgery and complete
the active tooth movement in adult orthodontic cases in 6 to 12 weeks.
The inter-proximal corticotomy cuts were extended through the entire thickness of the cortical
layer, just barely penetrating the medullary bone.
The vertical cuts were connected beyond the apices of the teeth with horizontal osteotomy cut
extending through the entire thickness of the alveolus, essentially creating blocks of bone in
which one or more teeth were embedded, using the crowns of the teeth as a handles. Kole
believed that he was able to move the blocks of bone some what independly of each other because
they were only connected by less-dense medullary bone. He found no incidence of root resorption,
no loss of tooth vitality and no pocket formation.
Kole used this surgical technique for correction of some of dento-alveolar problems as:
Protruding of lower incisors: this procedure is indicated in most of cases but should be
determined whether a mandibular or dento-alveolar retrusion. Buccally the cortiocotomy is
performed between the incisors and canine then horizontal cut is made 1cm. below the incisors,
lingual two vertical and one horizontal cut is made fig(1).
Distal displacement of a single tooth or group of teeth: correction necessitates a long period of
treatment in adult patients fig(2) .
The retrusion of all six lower anterior teeth: after buccal and ligual corticotomy is perefrmed.
Alignment of rotated teeth.
Correction of spaced teeth: in maxillary and mandibular protrusion with diastemas between the
teeth, the corticotomy is performed on the buccal and lingual as well as on the mesial and distal
aspects of each tooth fig (3).
Linguversion of posterior teeth with compression of the alveola process, very good results are
obtained with corticotomy.
Correction of contracted maxilla, by the same method as for the mandible fig (4).
3. Dr. Mohammed Alruby
3
Correction of too wide maxilla: an adequate strip of bone is removed on the palate, the
treatment is analogous to the extension of the maxilla but the extension screw is inserted wide
open and activated by screwing it tight.
Suya reported surgical orthodontic treatment of 39 adult Japanese patient with an
improved surgical procedure that referred to as (corticotomy facilitated orthodontics)
Suya’surgical technique differ from Kole with the substitution of the supra apical horizontal
corticotomy cut in place of the horizontal osteotomy cut beyond the apices of the teeth. Like Kole.
Suyra did not report luxating any of the coticotomized blocks of bone. He completed most of
cases in less then 12 months and showed examples of cases completed in 6 months. He like Kole.
Believed that the tooth movements were made by moving blocks of bone using the crowns of the
teeth as a handles. He recommended completing the major active tooth movement in 3 to 4
months, after which time that the edges of blocks of bone would begin to fuse together 11
.
Gantes et al reported treating five adult patient 21 to 32 years of age using Suyra’
corticotomy facilitated orthodontic procedure. The cases include some difficult space closing.
Mean treatment time was 14.8 month for test group and 28.3 for the control group. Some apical
root resorption was observed, no loss of tooth vitality, no adverse periodontal effect were
clinically noticeable, no attachment loss of clinical significance, inter-dental papilla were
preserved resulting in good esthetic results, and only minimal gingival recession3
.
Hajji studied the effect of eliminating mandibular dental arch crowding by comparing non
extraction ( 30 ) extraction (34) and corticotomy facilitated orthodontics non extraction (20)
cases by using casts and lateral cephalometric radiograph and he concluded that, there is no
post treatment differences between non extraction cases and corticotomy facilitated orthodontic.
In contrast, mean active treatment time for the corticotomy group was 6.1 months, versus 18
months for the non extraction orthodontics and 26.6 months for the extraction therapy11
.
Wilcko et al use the Suyra surgical technique to resolve dental arch crowding and achieve
decrease treatment, no loss of tooth vitality, no significant apical root resorption, and no
periodontal pocketing. Comparison of pretreatment and post treatment computed tomography
(CT) scans, however indicated a demineralization of the alveolar bone over the root of moved
tooth. CT scan analysis after 2 years of treatment indicated varying degrees of remineralization
of the alveolar bone. The demineralization / remineralization finding strongly suggest the rapid
tooth movement was because of rapid accelerating phenomena not bony (block) movement.
This new orthodontic method includes the advantage of corticotomy and alveolar
augmentation. An evaluation of this method in non extraction orthodontics for decrowding with
normal orthodontic forces demonstrated dramatic decrease in the treatment time and increases
the thickness of bone. This method not only safe but has made it possible to help to maintain and
even thicken the layer of pre treatment over the prominence root. Fenestration can be covered;
there is still vital root surface. The corticotomies was made in bucaal and lingual as vertical cut
and horizontal and after that augmentation occur by using resorbable material. This study
indicated that, good preservation of the inter dental papillae, no loss of tooth vitality, no
significant reduction in the radiographic height of crestal bone, no radiographic evidence of any
significant apical root resorption11
.
Lars Goldson and jack Van Reck used surgical technique to allow correction of
malposed cuspids through vertical cut on both sides of the tooth and this cut not pass through the
4. Dr. Mohammed Alruby
4
palatal side of the root and also supra apical osteotomy is made at least 7 mm. above the apex,
and then complete the orthodontic procedure to position the tooth7
fig 5, 6.
Chung et al2
conclude that the corticotomy procedures can promote efficient posterior
intrusion and rapid anterior retraction:
Posterior intrusion: in cases of vertical problems and anterior open bite preferable to intrude the
molar teeth with headgear but in adult patient who have completed bone maturity, this approach
will be ineffective, and a corticotomy- assisted technique should be considered. The corticotomy
is carried out first on the palatal side thentwo weeks later on the buccal side, the vertical cuts
2mm. away from the inter dental alveolar margin and should be coincident with the desired
direction of intrusion of the posterior segment, the horizontal cut is made 2mm. away from the
apices of the teeth to be moved. The depth of bone cut should be limited to the cortical bone, and
then high pull headgear is applied.
Anterior retraction: in patients with severe anterior protrusion need maximum retraction of
anterior teeth into the premolar extraction sites. The corticotomy is performed first on the palatal
side and two weeks later on the buccal side. In palatal side the cortical bone is removed across
both premolar extraction sites, the buccal corticotomy involves a vertical bony cut beginning at
the extraction site and extending to the long axis of the canine. A connecting horizontal bony cut
is then made; at least 5mm. above the root apices, the depth of bony cut should be limited to
cortical bone. Then complete the retraction procedures fig 7,8
Hwang and Lee5
although posterior tooth intrusion in an adult patient is difficult
procedure it can be achieved without extending the adjacent teeth by performing corticotomy and
using magnets. The corticotomy procedure was performed as: a vertical cut begun 2 to 3mm.
below the alveolar crest and extended 2 to 3mm. beyond the apex on both buccal and lingual side,
and then horizontal cut was made 2 to 3mm. below the apex to connect the two vertical cuts. This
resection was 3 to 4mm. wide to facilitate molar intrusion. To obtain the desired tooth movement
before the bone heal completely, it is necessary to apply orthodontic force immediately after
corticotomy, otherwise it lose effectiveness.
Mostafa et al have suggested that the use of surgery as corticotomy before the application
of orthodontic force on the over erupted molars can over come the limitation fore the movement.
They made cutting around the tooth from the buccal side only and the incision ended before
reaching the crestal bone to preserve the bone and to minimize possible future periodontal
problems9
.
Generson et al, suggested use of corticotomy to allow treatment of anterior open bite by
orthodontic approach. Four vertical cuts was made between the roots for the labial and palatal
aspect, the vertical cuts were connected by supraapical horizontal cuts on both surfaces. For the
mandibular one, there is no vertical cut made in lingual area between the central incisors
because of difficult access and possibility to damage the teeth4
.
Cheng et al, use the corticotomy procedure for treatment of ankylosed tooth1
fig 9
Owen 2001 makes combination treatment, invisaline and corticotomy technique to allow
rapid tooth movement and he decided to treat himself first using this technique. He had class 1
occlusion with minor crowding on the mandibular arch with acceptable over jet and over bite
and after eight weeks later the crowding was corrected and over jet remain the same,
radiographically there is no evidence of root resorption10
.
5. Dr. Mohammed Alruby
5
Liou and Huang reduce the resistance of the socket through decortication of it to allow
the rapid canine retraction through distraction of the periodontal ligament. Immediately after 1st
premolar extraction, the interseptal bone distal to the canine is undermined and reduced in
thickness. Because the 1st
premolar socket depth is always less than the canine the bone located
distal to canine root apex would resist tooth movement during distraction, therefore the 1st
premolar extraction socket must be extended to the same depth as the canine socket using round
bur, the bur is held parallel to the long axis of canine, the interseptal bone is reduced to a
thickness 1 to 1.5mm. Priapical film is taken to ensure that the socket has been adequately
deepened and the interseptal bone sufficiently reduced. Two vertical grooves performed from the
inferior to superior aspect of the socket on both mesiobuccal and mesiolingual line angle of the
extraction socket, the two grooves are connected at its base then the distraction device is used to
allow retraction of the canine8
.
How can explain the rapid tooth movement
The conventional view of orthodontic tooth movement is that of cell-mediated process
within the periodontal ligament (PDL). Sustained force on the tooth translates into PDL cell
population where in poleomorphic fibroblasts are converted to osteoblasts. And osteocalsts are
derived from the blood borne monocytes. The lamina dura undergoes osteoclasis in the area of
PDL (pressure) and bone apposition occurs in the area of tension.
Brezniak and Wasstern discussed the multitude of factors affecting root resorption, they
pointed out that in the older individuals the PDL becomes less vascular a plastic and narrow, the
bone become denser, a vascular and a plastic. They speculated that these changes are reflected
in a higher susptability to root resorption in adult11
.
Harold Frost recognized that surgical wounding of osseous hard tissue results in striking
recognized activity adjacent to the site of injury in osseous and / or soft tissue surgery. He
collectively termed this cascade of physiologic healing events the regional accelerating
phenomena (RAP). RAP is a complex physiologic process with dominating features involving
accelerated bone turn over and decrease in regional bone densities. RAP does not provide new
healing process but rather explain the acceleration of normal healing events, the greater the
insult the more accelerated and intense the regional response. RAP begins within a few days of
insult and typically peeks at 1 to months, but may take as long as 2 years to subside11
.
The authors suggested that RAP in human being within a few days of surgery, typically
peaks at 1 to 2 months, and may take from 6 to 24 months to subsided, they characterized the
initial phase of RAP as an increase in the cortical bone porosity because of increased
osteoclastic activity. They surmised that RAP might be contributing factor to increase mobility of
the teeth after surgery.
The damaged bone manifested by increase cellular activity, initially manifesting with
demineralization but resolving with re-mineralization. It was later shown that protein extracts
from the decalcified bone matrix are responsible for the new bone formation. A key factor in
bone morphogenesis appear to be bone morphogenetic protein (BMP), which influence primitive
stem cells to become the more specific cell type that participate in bone formation. More recently,
recombinant human morphogenetic protein-2 (rh BMP-2) has been shown to induce new bone
formation11
.
6. Dr. Mohammed Alruby
6
Trauma to the cortical bone has been shown to be apotentiating factor in producing a
localized osteoporosis, surgery invokes an RAP when both hard and soft tissue reorganization is
potentiated, and leading to a transient osteoporosis means increased mobilization of calcium,
decrease bone density and increased bone turn over11
.
All of which would facilitate more rapid tooth movement, so that the dynamics of the
physiologic tooth movement described as a demineralization / remineralization process, rather
than bony block movement or resorption / apposition. Following cessation of active tooth
movement, this growth protein component may assist in stimulating an increase in osteoblastic
activity, resulting in remineralization of soft tissue matrix.
7. Dr. Mohammed Alruby
7
References
Cheng C Y, Zen E C, Su C P: Surgical orthodontic treatment of ankylosis. J Clin Orhod, 1997,
31:375-77.
Chung K R, Oh M Y, Jin S: Corticotomy assisted orthodontics. J Clin orthod 2001.35:331-9
.
Gantes B, Ralhbun W E, Anholm M: Effect on periodontium following corticotomy facilitated
orthodontics- case reports. J Periodontol 1991, 61:234-8.
Generson R M, Porter J M, Stratigos G T: combined surgical and orthodontic management of
anterior open-bite using corticotomy J oral surgery 1978,36 : 216-19
.
Hwang H S, Lee K H: Intrusion of over erupted molars by corticotomy and magnets. Am J
Dentofacial Orthop 2001, 120: 209- 16.
Kole H: surgical operation on the alveolar ridge to correct occlusal abnormalities Oral surgery
Oral medicine Oral pathology 1959, 12:515- 29.
Lars Goldson, Jack van Reck: Sirgical orthodontic treatment of malposed cuspids J Clin Orthod
2001, 35: 331- 9.
Lio FGW, Huang C S: Rapid canine retraction through distraction of periodontal ligament Am J
Orthod Dentofacial Ortrhop 1998, 114: 372- 81.
Mostafa Y A, Tawfik K M, Elmangoury N H: surgical orthodontic treatment for over erupted
maxillary molars J Clin Orthod 1985, 19: 350-1.
Owen A h: Accelerated invisaline treatment J Clin Orthod 2001, 35: 381- 5.
Wilcko W M, Wilcko T, Ferguson D J: Rapid orthodontics with alveolar reshaping: two case
reports of crowding Int J Periodontics Restorative Det 2001, 21:9-19.
With my best wishes