The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Activator- A Functional Appliance. pptxAfaf Mohammed
An activator is a removable functional appliance used to correct skeletal problems in young individuals. It is an orthopedic appliance when used at the right age can prevent skeletal malformations and prevents surgery in the future.
Contents:
Introduction
History of activator
Classification of views
Effect of activator on dentofacial structures
Advantages & Disadvantages
Indications & Contraindications
Principles of activator
Types of forces employed in activator
Effectiveness of activator during sleep
Muscle activity with activator
Case Selection for the treatment with the functional appliance.
Treatment timing
Clinical and laboratory steps in fabrication and treatment of activator
Construction bite
Modifications of Activator
Case report
Conclusion
Bibliography
Activators and its modifications /orthodontic courses by Indian dental academyIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Activator- A Functional Appliance. pptxAfaf Mohammed
An activator is a removable functional appliance used to correct skeletal problems in young individuals. It is an orthopedic appliance when used at the right age can prevent skeletal malformations and prevents surgery in the future.
Contents:
Introduction
History of activator
Classification of views
Effect of activator on dentofacial structures
Advantages & Disadvantages
Indications & Contraindications
Principles of activator
Types of forces employed in activator
Effectiveness of activator during sleep
Muscle activity with activator
Case Selection for the treatment with the functional appliance.
Treatment timing
Clinical and laboratory steps in fabrication and treatment of activator
Construction bite
Modifications of Activator
Case report
Conclusion
Bibliography
Activators and its modifications /orthodontic courses by Indian dental academyIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
=== airway and craniofacial pattern
=== muscle and craniofacial pattern
=== tongue and anterior open bite
=== thumb sucking
=== failure of eruption
=== trauma stability
=== genetics
Treatment:
Thumb sucking
Tongue thrust
Macroglossia
Airway obstruction
Incisor intrusion
Growing patient
Non growing patient
** bonding to second molars
** esthetics and open bite
** ortho-gnathic correction
Frankel appliance /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Activator /certified fixed orthodontic courses by Indian dental academyIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Bionator /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Functional appliances
For general practitioners
Prepared by
Dr. M Alruby
Functional appliances are large category of orthodontic appliances that used primarily to reposition of the mandible in order to alter the muscular forces against the teeth and craniofacial skeleton.
Functional appliances are used for growth modification procedures that are aimed at intercepting and treating jaw discrepancies. They can bring about the following changes:
1- Change the relationship of the jaws.
2- Change the direction of the growth of the jaws.
3- Acceleration of desirable growth.
4- Provide more favorable environments foe developments of dentition through:
a- Modify the muscle function.
b- Relive abnormal muscle function.
c- Selectively alter the eruptive path o the teeth.
5- Selectively inhibit the skeletal growth.
Classification of functional appliances:
1- Myotonic appliances: they are functional appliances that depend on the muscle mass for their action.
2- Myodynamic appliances: they are functional appliances that depend on the muscle activity for their action.
3- Removable functional appliances: they are functional appliances that can remove and inserted into the mouth by the patient for example: activator and bionator.
Uses and indications of functional appliances:
1- When the muscle dysfunction play a role in etiology of malocclusion.
2- Where alteration of muscle function may provides an optimum condition for normal dentofacial development.
Functional appliances may be indicated in the following:
1- Anteroposterior discrepancies on mild disproportional bases as Class II, Class III.
2- Vertical discrepancies on mild disproportional skeletal bases (open bite or deep bite).
Timing of treatment:
All the functional appliances are probably most effective in the growing children to gain maximum benefits from pubertal growth spurt.
Treatment principle:
Functional appliances work on two broad principles:
1- Force application: comprehensive stress and strain act on the structures involved and result in a primary alteration in form with a secondary adaptation in function. Most of the fixed and removable appliances work on this principle.
2- Force elimination: this principle involves the elimination of abnormal and restrictive environmental influences on the dentition thereby allowing optimal development. Thus function is rehabilitated with secondary changes in form. All functional appliances are assemblies of a few simple components. Each component has a desired function and is generally incorporated for a specific purpose. The currently used appliances are made of combination from three basic functional components. They are bite planes, shields or screens and construction of working bites. These components produce skeletal and dentoalveolar changes by acting on the following:
1- Eruption (bite plane).
2- Linguofacial muscle balance (shields or screens).
3- Mandibular repositioning (construction of working bite).
Definition
Types of rotation
Etiology of rotation
Winging and counter winging rotation
Advantages of derotation
Biomechanics of rotation correction
Methods of correction rotation
Management of molar derotation
Retention of rotated tooth
Methods to prevent relapse
Active retention
Torque when, where, how?
Importance of torque
Biomechanics in torque
Torque expression in slot 0.018 and 0.022
Expression of torque
Mode of ligation and torque
Types of torque
- Passive
- Active
Factors affect torque
Torque with different appliances
Torque in base and face
Torque prescription in different techniques
Class II malocclusion and torque
Torque control in different treatment steps
Differential torque
Torque clearance
Intrusion and torque
Torque and intra-oral elastics
More Related Content
Similar to effect of functional appliances on facial growth.docx
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
=== airway and craniofacial pattern
=== muscle and craniofacial pattern
=== tongue and anterior open bite
=== thumb sucking
=== failure of eruption
=== trauma stability
=== genetics
Treatment:
Thumb sucking
Tongue thrust
Macroglossia
Airway obstruction
Incisor intrusion
Growing patient
Non growing patient
** bonding to second molars
** esthetics and open bite
** ortho-gnathic correction
Frankel appliance /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Activator /certified fixed orthodontic courses by Indian dental academyIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Bionator /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Functional appliances
For general practitioners
Prepared by
Dr. M Alruby
Functional appliances are large category of orthodontic appliances that used primarily to reposition of the mandible in order to alter the muscular forces against the teeth and craniofacial skeleton.
Functional appliances are used for growth modification procedures that are aimed at intercepting and treating jaw discrepancies. They can bring about the following changes:
1- Change the relationship of the jaws.
2- Change the direction of the growth of the jaws.
3- Acceleration of desirable growth.
4- Provide more favorable environments foe developments of dentition through:
a- Modify the muscle function.
b- Relive abnormal muscle function.
c- Selectively alter the eruptive path o the teeth.
5- Selectively inhibit the skeletal growth.
Classification of functional appliances:
1- Myotonic appliances: they are functional appliances that depend on the muscle mass for their action.
2- Myodynamic appliances: they are functional appliances that depend on the muscle activity for their action.
3- Removable functional appliances: they are functional appliances that can remove and inserted into the mouth by the patient for example: activator and bionator.
Uses and indications of functional appliances:
1- When the muscle dysfunction play a role in etiology of malocclusion.
2- Where alteration of muscle function may provides an optimum condition for normal dentofacial development.
Functional appliances may be indicated in the following:
1- Anteroposterior discrepancies on mild disproportional bases as Class II, Class III.
2- Vertical discrepancies on mild disproportional skeletal bases (open bite or deep bite).
Timing of treatment:
All the functional appliances are probably most effective in the growing children to gain maximum benefits from pubertal growth spurt.
Treatment principle:
Functional appliances work on two broad principles:
1- Force application: comprehensive stress and strain act on the structures involved and result in a primary alteration in form with a secondary adaptation in function. Most of the fixed and removable appliances work on this principle.
2- Force elimination: this principle involves the elimination of abnormal and restrictive environmental influences on the dentition thereby allowing optimal development. Thus function is rehabilitated with secondary changes in form. All functional appliances are assemblies of a few simple components. Each component has a desired function and is generally incorporated for a specific purpose. The currently used appliances are made of combination from three basic functional components. They are bite planes, shields or screens and construction of working bites. These components produce skeletal and dentoalveolar changes by acting on the following:
1- Eruption (bite plane).
2- Linguofacial muscle balance (shields or screens).
3- Mandibular repositioning (construction of working bite).
Similar to effect of functional appliances on facial growth.docx (20)
Definition
Types of rotation
Etiology of rotation
Winging and counter winging rotation
Advantages of derotation
Biomechanics of rotation correction
Methods of correction rotation
Management of molar derotation
Retention of rotated tooth
Methods to prevent relapse
Active retention
Torque when, where, how?
Importance of torque
Biomechanics in torque
Torque expression in slot 0.018 and 0.022
Expression of torque
Mode of ligation and torque
Types of torque
- Passive
- Active
Factors affect torque
Torque with different appliances
Torque in base and face
Torque prescription in different techniques
Class II malocclusion and torque
Torque control in different treatment steps
Differential torque
Torque clearance
Intrusion and torque
Torque and intra-oral elastics
Extra-oral forces
And
Appliances
Prepared by:
Dr. Mohammed Alruby
Definition
Philosophy
History and development
Classification of extra-oral forces
Advantages of extra-oral forces
Disadvantages of extra-oral forces
Uses of extra-oral forces
Headgear
Appliance enhanced the action of headgear
Protraction appliances
Types of reversed headgear
Chin cup appliance
Orthopedic correction of class III
Orthopedic correction of open bite
Orthopedic correction of class II
Retention after orthopedic correction
Definition
It is a force derived from an extra-oral appliance that uses the forehead, the top of the head or the back of the neck as anchorage to apply forces to the dental or basal arch. It may be orthodontic force or orthopedic force to move the dentition, or restrict or redirect the growth respectively.
Philosophy:
The philosophy beyond the use of extra-oral force is based upon the old concept that, (the application of appreciable amount of force against the growing bone con modify or alter the direction of bone growth and consequently alter the shape and position of the bone
= the well-known best examples are the induced skull deformation in Colombia –India and feet deformation in Chinese girls
History and development:
Appliances resembling chin cups have been in use since the early 1800's. According to Graber, the early attempts with the chin cup were not successful because of incomplete knowledge of mandibular and facial growth, its use on non-growing patients, and an inadequate understanding of the forces generated by the chin cup.
1802: Cellier and Josef Fox in 1803, utilized chin caps in combination with bite blocks to correct the “underslung chin”
1866: Norman Kingsley introduced extra-oral head cap anchorage or force for maxillary distal movement
1880: Kingsley described an appliance that could influence the position of the dentition in upper jaw with the aid of extra-oral forces
1887: E.H.Angle recommended the use of occipital bandage in treatment of maxillary protrusion
1904: Jackson was first describing the facial mask
1892: headgear appliance was originally designed by Kingsley
1920: Angle and his followers were convinced that class II and class III elastics not only moved teeth but cause a significant skeletal changes: stimulate growth of one and restrain growth for the other so we not need to use any extra-oral force just wait until permanent dentition is completed
1923: Case recommend the use of extra-oral force against maxilla in treatment of class II and class I maxillary protrusion
1947: Kleohn, presented his treatment results with cervical neck strap, subsequent to this report, many other variation of the headgear appliance were presented
1960: Delaire facemask
Classification of extra-oral force appliances according to uses
The extra-oral pull is generally applied bilaterally, for three main purposes:
(1) as a restraining force
(2)
Effects of extra-oral appliances
And
Forces
Prepared by
Dr. Mohammed Alruby
Factors affect extra-oral force
Studies of maxillary protraction force
Results of extra-oral force
Effects of extra-oral appliances
The effects of extra-oral forces on dentofacial structure depend on the following factors:
- Direction of force
- Magnitude of force
- Duration of force
- Growth
- Patient cooperation
1- Direction of force:
Kloehn 1953, Gould 1975, Greenspan 1970, Merrifield and Cross 1970, and Worms et al 1973, all give an adequate description for the direction of force application and their effect on maxillary molar position, tipping, bodily, extrusion, intrusion movement
The direction of force should be adjusted according to the patient needs and objective of treatment as:
- When bodily movement is required, the force should pass through the center of resistance of molars (at the tri-furcation of roots) and the extra-oral tube should be placed gingivally as possible
- When bodily displacement of maxilla is required, the force should pass through the center of maxillary resistance (zygomatic bone)
- When extrusion of molars is required, (in case of deep bite) the force should pass below the center of resistance (below the level of occlusal plane)- cervical headgear is the best choice
- When intrusion is required (open bite cases) the force should pass above the level of occlusal plane
- In occipital headgear, the vector of force may pass through the center of resistance of 1st molar and thus causes: -------------- distal translation of 1st molar
- If the vector of force passes above the center of resistance causing:
a- Distal root torque
b- Mesial crown tipping
c- Intrusion of maxillary 1st molar ---- that, ----- closing the bite and same can occurs in the vertical or high pull headgear
== the direction of force can be determined by adjusting the outer bow in relation to the occlusal plane or center of resistance
== the best method for recording the force direction is the lateral cephalometric radiograph with the appliance in place, then the outer bow is adjusted in relation to the occlusal plane and the center of resistance of tooth or jaw
= in Kloehn’s face bow, the direction of force is 25 – 30 degree below the occlusal plane so that, the vector of force is far away from the center of resistance of 1st molars, thus cervical headgear causes distal tipping and extrusion of 1st molars and open bite
The direction of force depends upon the following variables:
I- Vertical position of the outer bow relative to the center of resistance:
= force applied by oblique headgear passing through the center of resistance will cause translation of the tooth and make intrusion at the same time
= force applied by oblique headgear passing above the occlusal plane
but below the center of resistance will cause:
a- Distal crown tipping, mesial root torque
b- Extrusion of mesial marginal ri
Characteristic of light
History
Laser physics and properties
Component of laser
Classification of laser
Biological effect of laser
Laser effect on dental tissues
Laser safety in dental practice
General application of laser
Personal protective equipment
Types of laser intensity in orthodontics
Uses of laser in orthodontics
Effect of laser in orthodontics
Introduction
History
Classification of maxillary fractured Lefort
Special consideration for orthognathic surgery
- Patient selection:
Age of patient
Assessment of patient motivation and expectation
The nature and severity of skeletal dysplasia
Systemic evaluation
- Patient evaluation:
(1) General evaluation
(2) Esthetic evaluation
(3) Functional evaluation
(4) Radiographic evaluation
a- Ceph ---
PA
Lateral: ------ soft and hard
b- Panorama
c- CBCT
d- Periapical
Protocol for basic orthognathic record collection
Treatment planning
- Time of treatment
- Objective of orthodontic treatment
Pre-surgical
Post-surgical
- Sequence of treatment:
Pre-surgical phase
Orthodontic in theatre
Post-surgical treatment
Surgery without orthodontics
Stability and clinical success
complications
Medical glossary
Prepared by:
Dr. Mohammed Alruby
Medical glossary
Aberrancy: occurring or developing away from the normal situation
Acantholysis: loss of coherence between epithelial cells due to degeneration of desmosomes (intercellular bridge) this will lead to the formation of intra-epithelial clefts, vesicle and bullae
Acanthosis: epithelial hyperplasia, mainly of the stratum spinosum, leading to increase thickness of the stratum granulosum due to increased number of cell layers of prickle cells
Achondroplasia: an autosomally inherited disorder characterized by abnormality of conversion cartilage into bone predominantly affecting the epiphyses of long bones, leading to retarded growth at the epiphyses and resulting in dwarfism with short extremities but normal trunk
Acidogenic: referring to organisms capable of producing acid
Aciduric: referring to organisms capable of surviving and metabolizing under highly acidic conditions
Acquired: a term used to describe a condition, habit or other characteristic which is not present at birth, which developed in the individuals by reaction to some environmental factor (to acquire is to obtain)
Agenesis: failure of formation leading to absence of a part or organ
Aglossia: failure of formation leading to absence of the tongue
Agnathia: absence of the jaw, usually the lower jaw, usually accompanied by approximation of the ears
Amyloid: pertaining of starch, having the characteristic of starch. A protein compound of albumin and chondroitin sulphate which resembles starch in appearance and may be pathologically deposited in certain tissues
Anaplasia: atypical differentiation or lack of differentiation of epithelial cells occurring in the malignant disease. Anaplastic cells have large, hyperchromatic, irregularly shaped nuclei and frequently show a typical mitosis.
Aneuploidy: an abnormal number of chromosomes in a nucleus. This usually arise from failure of paired chromosomes or sister chromatids to disjoin at anaphase of cell division
Aneurysm: circumscribed dilatation of an artery
Aneurysmal: relating to an aneurysm. The term applied to a type of cyst that produce bony expansion simulating the expansion of an artery produced by a vascular aneurysm
Angiogenesis: development of blood vessels
Angioma: a swelling or mass due to proliferation with or without dilatation of vascular channels
Anhydrosis: absence of sweating due to absence of sweat glands
Ankyloglossia: tongue tie, usually due to a short lingual frenum or one attached too near the tip of the tongue, may be due to failure of separation of tongue from the floor of the mouth during embryogenesis
Ankylosis: stiffening or fixation of a joint as a result of a disease process
Anodontia: absence of teeth
Anomaly: deviation from the normal, anything structurally unusual or irregular
Antigen: a substance that can induce an antibody response
Antimongoloid slant: an obliquity of the palpebral fissures laterally
Muscles
Part 3
Prepared by
DR. Mohammed Alruby
Development of oropharyngeal function
Neuromuscular regulation of jaw positions and functions
Muscles controlling mandibular postures
- Muscles of mastication
- Submandibular muscles
- Extensor and flexor muscles of neck
Positions of mandible
Some clinical implications
Development of oropharyngeal function
1- Prenatal maturation:
= During prenatal life, the neuromuscular system does not mature evenly, it is not accidentally that the orofacial region matures a head of limb region
= In human fetus, by about the 8 week, generalized uniform reflex movement of entire body can be elicited by tactile stimulation
Diffuse spontaneous movements in response to as yet unidentified stimuli have been observed as early as 9.5 weeks
Localized specific and more peripheral responses cannot be produced before 11 weeks, and at this time, stimulation of the nose-mouth region causes lateral body flexion
By 14 weeks, the movements have become much more individualized. Stimulation of the mouth area, the general bodily movements no longer are seen but instead facial and orbicular muscle response are produced
Stimulation of the upper lip causes the mouth to close and often deglutition occurs
Respiratory movements of the chest and abdomen are seen first at about 16 week
The gag reflex has been demonstrated in human fetus of 18.5 weeks. By 25v weeks, respiration is shallow but may support life for few hours
Stimulation of the mouth at 29 weeks’ menstrual age has elicited sucking through complete suckling and swallowing is not thought to be developed until at least 32 week
2- Neonatal oral functions:
a- The mouth as sensory instrument:
= At birth, the orofacial region is a very active perceptual system, the infant finds the mouth nipple = more tactile than the visual sensation
At birth, the tactile sense already is more highly developed in the lips and mouth than in the fingers
= The neonate’s slobbers, drools, chew his toe, sucks his thumb and discovers the gurgling sounds can be made with his mouth
= oral function of the neonate is guided primarily by local tactile stimuli, particularly those from the lips and anterior part of the tongue
= the posture’s of neonate’s tongue is between the gum pads and often for enough forward to rest between the lips, where it can perform its role of sensory guidance more easily
= the mouth of infant is used for many purpose, the perceptual functions of the tongue, lips, and facial skin are mingled with the sensory function of taste, smell and jaw position.
= the sensitivity of tongue and lips is greater than other area of the body and the sensory guidance for oral functioning, including jaw movements is from remarkably large area
b- Infant suckling and swallowing:
= Infant suckling and swallowing have been the subjects of much research due to the effectiveness of these activities is a good indication of the neurologic ma
Muscles
Part 2
Prepared by:
Dr. Mohammed Alruby
Muscle function and malocclusion
Muscle development and skull form in relation to function
Facial balance, muscle balance, and orthodontic therapy
EMG response of muscles
Myofunctional therapy
Basic concepts of neuromuscular physiology
Muscle function and malocclusion
Muscle function is a factor in shaping the dental arches and is important in maintaining the stability of the teeth following orthodontic treatment
Muscle fibers contract in response to change in electrical potential of its investing membrane, proprioceptors located in the muscles and the periodontal membrane make possible a high degree of accuracy in bringing the teeth in contact
Class II malocclusion:
The muscle function is usually normal in class I malocclusion with the exception of class I Openbite
In class I cases, the teeth are in state of balance with environmental force, although the actual measurements of tongue and lip forces showed that, they are not equal at any area during particular function
Class I openbite:
= Usually caused by thumb sucking, retained infantile tongue swallowing or both, the child begins with finger habits of sufficient intensity and duration to deform the maxillary anterior segment forcing the incisors labially and allowing the tongue to move farther in forward direction
= the tongue continues to thrust instead of entering the transitional phase, a large part of this activity may be compensatory or adaptive to produce anterior seal with lower lip during swallowing
=such activity accentuates the openbite, prevent complete eruption of incisors and increase the overjet to the extent that the lower lip may cushion behind the maxillary incisors during rest and functional movements
- The upper lip become more hypotonic
- The lower lip become hyperactive
- Chin puckering can see with each swallowing
= the hyperactive mentalis muscle, retroclined, imprecate and flatten the mandibular anterior segment
= the tongue drop downward and mouth breathing become a dominate pattern, as the tongue thrust forward, it elongates in shape thus alter the balance with buccinator mechanism resulting in:
- Collapse of posterior segment
- V-shaped palate
- Buccal cross bite
This occurs also as a result of molding effect of the tongue upon the hard palate
Mouth breathing:
Is the good explain for these changes a result of underdeveloped nasopharyngeal structures and subsequently maxillary deficiency
Class II division 1 malocclusion:
= In contrast to class I class II div 1 involve an abnormal muscle function from beginning
= As abnormal muscle function in class II div 1 is a compensatory or adaptive and is secondary to skeletal relationship
= Because of large overjet, there is lack of the lip seal during rest and various functions so, mouth breathing is developed
= Some individuals translate the mandible forward to effect lip seal and to improv
Muscles
Part 1
Prepare by
Dr. Mohammed Alruby
Histology of muscles
Physiology of muscles
Muscles development
Orofacial muscles
- Facial muscles
- Jaw muscles
- Portal muscles
Methods of studying muscles
Muscle changes during growth
Muscle function and facial development
Histology of muscles
The structural and functional unit of the muscles is the muscle fiber
Muscle fiber: elongated cylinder measure about 10 to 80 microns in thickness and from 1 to 15cm in length
= Each muscle fiber contains an acidophilic granular cytoplasm (sarcoplasm) that rich in:
Glycogen, mitochondria, Golgi apparatus, protein (actin, myosin, tropomyosin),
Large number of myofibrils (sarcostyles) which responsible for muscle contraction
= the muscle fiber is covered by thick membrane called (sarcolemma) and surrounded by CT called (endomysium)
= the muscle fibers are coalescing together to form bundles; each bundles are covered by C T septa called perimysium
= the muscle bundles are coalescing together to the whole muscle which is covered by CT fascia called epimysium, these CT contain: blood vessel, lymph vessel, and nerves, that firmly attach the muscle bundles to each other and attach the whole muscle to its tendon
= the myofibrils (sarcostyles)are the contractile units of the muscle, in skeletal muscle they are transversely striated due to presence of dark and light bands
The dark bands are formed of thick myosin filaments rich in Ca, the light bands are formed of thin actine filaments rich in water, there is a pale line in at the center of dark band called (Henesen’s disk), There is dark line at the center of light bands called (Krauses membrane) or Z line
The distance between the two lines called (sarcomere) which is a contraction unit of the muscle.
During the muscle contraction there the Sarcomere is shortened due to sliding of the light bands over the dark bans. The energy required for contraction is derived from transformation of ATP ------ ADP
Physiology of muscles:
Man has 639 muscles, composed of 6 billion muscle fibers, each fiber has 1000 fibrils, which means that there are 6000 billion fibrils at work at one of time or another.
Elasticity: muscle can be stretched behind its original length and return to the original shape after relaxation (normal muscle can be elongated about 6/10 of its length
Contractility: it is the ability of muscle to shorten its length under nerve impulse, this contraction is stimulated by acetyl choline, glycogen is partially oxidized to provides energy and lactic acid that carried away by blood stream
Excessive accumulation of lactic acid can produce fatigue
Isometric contraction: (stretching): the muscle is simply resisting the external forces without actual shortening
Isotonic contraction: there is an actual shortening of the muscle, the strength of isometric contraction is much greater than that of isotonic contraction as the stre
diagnostic aids part 3, photograph and radiograph.docxDr.Mohammed Alruby
Diagnostic Aids
Part 3
{Radiographs and Photographs}
{BMR and EMG}
Prepared by
Dr. Mohammed Alruby
Radiographs
Means: A procedure that uses a type of high-energy radiation called x-rays to take pictures of areas inside the body. X-rays pass through the body onto film or a computer, where the pictures are made
Types:
Intra-oral radiographs:
Periapical radiographs:
It is necessary for any orthodontic diagnosis for the following reasons:
The pattern and amount of root resorption of deciduous teeth
Presence or absence of permanent teeth, their size, shape, position and relative state of development
Congenital absence of teeth or presence of supernumerary teeth
Character of alveolar bone, lamina dura, and periodontal membrane
Morphology and inclination of permanent teeth roots
Pathological oral condition such as thickened periodontal membrane, periapical infection, root fractures, cysts, retained deciduous teeth
Abnormal path of eruption of permanent teeth
Malposition of individual as: rotation, which requires a larger space on the arch
Very useful in mixed dentition analysis
Recognition of exact position of impacted tooth by using method of parallax: that determine whether the unerupted tooth is located labially or palatally. Two periapical radiograph is taken with the film in the same position in each exposure, but the tube is moved in second exposure about 10cm. if the impacted tooth is moved in the same direction as the tube so the tooth is impacted palatally and the reverse is versa.
Bit-wing radiographs:
Is used mainly for detection of proximal cries, but it is of little value in orthodontic diagnosis
Occlusal film:
Occlusal projection is useful to locate the supernumerary teeth at the midline (mesiodens) and to determine accurately the position of impacted maxillary cuspids
Extra-oral radiographs:
Cephalometric radiographs:
Lateral cephalometric radiographs
PA cephalometric radiographs
Lateral oblique cephalogram:
The patient is directed by 45 degree and take the shot
Since dentofacial structure will be superimposed in the true lateral cephalometric projection, the lateral oblique direction is designed to gives a more accurate recording of the actual tooth position in either the left or right buccal segments depending on which side is approximately perpendicular to the central rays
The lateral oblique cephalogram combines most of advantages of the lateral views, intra-oral periapical survey and panoramic radiograph plus a standard cephalometric registration that makes possible measurements of bone size and eruptive movements so it is of particular size in analysis of developing dentition
Submental vertex cephalometric:
Is used to assess mandibular asymmetry in the transverse and anterior-posterior plane. It is an important aid in detecting asymmetry in the symphysis, body, ramus, and condyle of the mandible. In many cases of asymmetry, this view is important for evaluation of mandibular displacemen
Diagnostic Aids
{Study cast, Cast analysis}
Part (2)
Prepared by
Dr. Mohammed Alruby
Study cast
Definition: it is a positive replica of the teeth and their supporting structure, it should be reproducing accurately all the anatomical details of the teeth, alveolar process, mucobuccal folds, palate, frenal attachment as well as the exact relationship of the mandibular to the maxillary dental arch
Good models begin with good impression, orthodontic impression should displace the lips and cheeks, so that, the full depth of mucobuccal sulci is recorded. This over extension of impression is obtained by building up the tray periphery with wax or by using special orthodontic trays
The position of maximum intercuspation should be recorded by getting the patient to bite through softened wax, that is important for:
1- Recording the proper intercuspation specially in cases of poor occlusal fit due to extraction or tongue thrust. So it is wise to check the occlusion in the mouth and compare it to the occluded cast to insure that the model is correctly articulated
2- Trimming of the upper and lower cast together without change in occlusal relationship or fracture of teeth
Occlusal registration of wax bite:
= the position of maximum intercuspation as well as the centric relation must be registered
= a piece of soft wax large enough to cover the occlusal surface of maxillary teeth is shaped to the form of maxillary arch, then gently pressed against the maxillary teeth
= the patient instructed to relax and mandible is guided to most posterior and superior position of condyle within the glenoid fossa, while the teeth come into occlusion
= if there is shifting during closure due to cuspal interference, this mean that the occlusal position is not coincide with centric occlusal position, in this case, in this case two bites are taken one for usual occlusal position, and the other for centric occlusion
Ideal requirements of orthodontic study models:
1- They are symmetrical and pleasing to the eye and so that a symmetrical arch form can be readily recognized
2- The dental occlusion shows by setting the models on their backs
3- Clean, smooth, bubble free, with sharp angles where the cuts meet
4- Glossy in finish.
Trimming of study models:
There are two types of trimming:
a- Angle trimming:
The purpose of angle trimming is to added an appropriate proportional bases to the anatomical portion of dental casts which is important in:
- Registration of centric occlusion by having the posterior and lateral border of both casts on the same plane, so that cast may place on any side without change in its relationship
- Giving an idea about the relationship of the teeth to the alveolar process and basal bone
- Giving harmonizing appearance of the right and left sides of the cast which any a symmetry can be detected
- Detection of occlusion from any side, anterior as well as lateral sides
Principles:
1- The floor of the base is trimmed
diagnostic aids part 1 diagnosis, examination, BMR, EMG.docxDr.Mohammed Alruby
Introduction:
Proper treatment plane depends on prompt diagnosis, good clinician should have a bird’s eyes to first identify the problem and find its etiology
Definitions:
= Grabber and Rackosi: defined diagnosis as:
Recognition and systemic designation of anomalies, the practical synthesis of the finding, permitting therapy to be planned and identification to be determined
=a continuous evaluation process in orthodontics starting right from the first interaction with the patient continuing through different stages till end of treatment and course follow up visits
Goal of orthodontic diagnosis:
Is to produce a comprehensive description of the patient’s problem and then to synthesis the various elements of description into a rational problem list
Diagnostic aids:
Data required for orthodontic diagnosis are derived from routine essential diagnostic aids and also from supplemental aids when needed, Graber categorized the diagnostic aids into essential and supplemental aids
Essential:
- Case history
- Study models
- Certain radiographs: periapical, bite wing, panoramic radiograph
- Facial photographs
- Intra-oral photographs
Supplemental:
- Specialized radiographs: occlusal of maxilla and mandible, lateral cephalogram
- Hand &wrist radiograph
- Electromyography
- Endocrine test
- Basal metabolic rate
Case history:
Complete case history includes all the relevant information derived from the patient and parents and essential for planning
Personal details:
Name:
The patient’s name should be recorded for the purpose of identification and communications
Calling the patient by his/her name not only establishes a good report but also imparts confidence in the patient mind about treatment providers
In case of children, it might help to know their pet problems
Age:
= certain malocclusion occurring during growth period are transient and self-correcting
= growth modification procedures such as functional appliances can be carried out during growth periods
= surgical respective procedures such as orthognathic surgery are best carried out after cessation of growth
= chronological age is important for the maintaining of shedding and eruption time tables as well
Gender:
= recording gender of the patient is important for treatment planning, females are observed to precede males in growth related events such as onset of growth spurt, eruption of the teeth and onset of puberty
= gender may also have a bearing on patient’s compliance toward certain types of orthodontic treatment
Occupation and address:
Occupation of patient / or parents gives an idea about socioeconomic condition which might affect the selection of orthodontic appliances and can give an idea about awareness
Address of patient determine the sociality of the patient and this effect on the treatment because some countries have normally bi-maxillary protrusion and also determine the awareness of patient about treatment and oral hygiene
Patient behavior:
Behavior of patient depend on: patient
Smile: is the most pleasant and wanted expression by each one of us.
Smile: is amused facial expression with the corner of mouth turned up and exposed front teeth
Facial expression, postures of lips, occlusion and arrangement of teeth, buccal corridor, shape of teeth, gingival color, texture, contour and other several aspects constitute component of smile
Most of patients come to us to improve their smiles, the orthodontic studies stress on skeletal structure than soft tissue structure, and the smile still receives relatively little attention
Nature of smile:
1- Posed smile: voluntary, static, sustained, social smile not elicited by an emotion
2- Un-posed smile: spontaneous, involuntary, dynamic, natural, and not sustained characterized by greater lip elevation
Smile types: smile styles:
1- Commissures smile: the corner of the mouth turned upward called Monalisa smile
2- Cuspid smile: the upper lip is elevated, the entire lip rises like a window shade
3- Complex smile: the upper lip moves superiorly as in cuspid smile and lower lip moves inferiorly
Evaluation of posed smile:
variables Normal smile Not good smile
Smile arc Consonant Non consonant
Smile index Average Increased / decreased
Morley’s ratio 75 – 100% (normal) Disturbed
Buccal corridor Average Obliterated / excessive
Smile line Average High / low
Occlusal plane No canting Canting occlusal plane
Important definitions:
Smile arc:
the curvature formed by an imaginary line tangent to the incisal edges of the teeth, modified in varying degree of curvature in relationship to the lower lip
Range: from no curvature to an accentuated curvature was in relation to the lower lip, so quantification differed for each model
Buccal corridor:
the amount of dark space displayed between the facial surfaces of the posterior teeth and the corner of the mouth, calculated as the total dark space on both sides of the mouth as a percentage of the total smile width
Range: from 6% to 26.5 in approximately 0.5% increments
Maxillary gingival display or gummy smile:
The amount of gingival show above the central incisor crown and below the center of the upper lip. Negative number indicate gingival exposure. Positive number indicate tooth overlap by the lip
Range: from 1mm of gingival display (-1) to almost 7mm of tooth coverage for the female models, and approximately 2mm of gingival display (-2) to 6mm tooth coverage for male models
The variation between the models was due to differences in sizes and coordinating the images for different faces
Maxillary midline to face:
The relationship of maxillary dental midline (measured between the central incisors) to the midline of the face, defined by the center of the philtrum and the facial midline
Range: the maxillary midline was moved to the left of the face in approximately 0.25 mm increments. The right and left buccal corridor was maintained throughout the movement of the dentition. The maximum deviation show is 6mm
Maxillary to mandibular mid
orthodontic biology of tooth and supporting structure.docxDr.Mohammed Alruby
The goal is to examine the relationship between orthodontic biomechanics and the underlying biological process
When orthodontic force is applied to the crown of the tooth it is transmitted through the roots to the periodontal ligament and alveolar bone
Histology of supporting structure:
- Periodontal ligament
- Alveolar bone
I- Periodontal ligament:
A- Cellular component:
• Forming cells:
Osteoblast: bone forming cells
Fibroblast: PDL fibers forming cells
Cementoblast: in layer adjacent to the roots
• Resorptive cells:
Osteoblast: large cell rich acid phosphatase enzyme that demineralize the bone and disintegrate of organic matrix
Fibroblast: disintegrate fibers
Cementoblast: resorb cementum
• Progenitor cells: undifferentiated mesenchymal cells UMC: small cells with closed nucleus and little cytoplasm & monocytes
• Epithelial rest of malassez: arise as a result of breakdown of epithelial root sheath at the time of cementogesis
• Defensive cells: as macrophages & mast cells
B- Periodontal fibers:
1- Collagen fibers:
the main bulk of PDL fibers and found in 5 groups:
- Alveolar crest group: from cervix to alveolar crest
- Horizontal group: from cementum to bone horizontally
- Oblique group: the main attachment that run obliquely from cementum to bone in an apical direction
- Apical group: circumscribed the apex and responsible for resistance to rotation
- Inter-radicular group: inter-mediate plexus, observed midway between bone and root
- Supra-alveolar group:
Dento-gingival
Dento-periosteal
Transeptal
Circular
Alveolo-gingival
2- Oxytalan fibers:
Immediate elastic fibers that resist dissolution by acids unlike collagen
Run from cementum or bone to blood vessels
Play a role in supporting the blood vessels against distortion and compressive strain
c- Ground substances:
organic matrix surrounding the PDL elements, it is chemically composed of CHO linked with protein. CHO- protein complex commonly divided into two groups: proteoglycan and glycoprotein
ground substances of periodontal ligament is in a continuous state of remodeling process
d- Neurovascular elements:
myelinated: pain sensation
non-myelinated: blood vessels wall
PDL functions:
- Supportive
- Nutritive
- Remodeling
- Sensory
II- Alveolar bone:
= in human, marrow spaces are rare in the buccal and lingual plates, these spaces decreased with age
= wider spaces are lined with a layer of fenestrated compact bone when PDL fibers are anchor these fibers is called bundle bone
N: B:
= collagen turn over in PDL is higher 4 times than skin and 2 times than gingiva and this due to the forces in PDL is multi-directional takes vertical and horizontal component
= lake of marrow spaces implies that bone resorption takes more time so that the tooth movement in mesial and distal direction occur more than labial and lingual sides
= the resorptive cells increase as the marrow spaces increase
N: B:
The new deposited tissue during tooth migration have 3 stages:
Stage I osteoid:
is the pr
Successful infection prevention program
A successful infection prevention program depends on:
1-Developing standard operating procedures.
2- Evaluating practices and providing feedback to dental health care personnel (DHCP).
3- Routinely documenting adverse outcomes (e.g., occupational exposures to blood) and work-related illnesses in DHCP.
4- Monitoring health care associated infections in patients.
Standard Precautions
Standard Precautions: are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients.
Standard Precautions include:
1- Hand hygiene.
2- Use of personal protective equipment (e.g., gloves, masks, eyewear).
3- Respiratory hygiene / cough etiquette.
4- Sharps safety.
5- Safe injection practices (i.e., aseptic technique for parenteral medications).
6- Sterile instruments and devices.
7- Clean and disinfected environmental surfaces.
Each element of Standard Precautions is described in the following sections. Education and training are critical elements of Standard Precautions, because they help DHCP make appropriate decisions and comply with recommended practices.
1- HAND HYGIENE:
1- Perform hand hygiene.
a. When hands are visibly soiled.
b. After bare hand touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions.
C. Before and after treating each patient.
d. Before putting on gloves and again immediately after removing gloves.
2. Use soap and water when hands are visibly soiled (e.g., blood, body fluids); otherwise, an alcohol-based hand rub may be used.
2- PERSONAL PROTECTIVE EQUIPMENT (PPE):
1- Provide sufficient and appropriate PPE and ensure it is accessible to DHCP.
2- Educate all DHCP on proper selection and use of PPE.
3- Wear gloves whenever there is potential for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment.
a- Do not wear the same pair of gloves for the care of more than one patient.
b- Do not wash gloves. Gloves cannot be reused.
c- Perform hand hygiene immediately after removing gloves.
4- Wear protective clothing that covers skin and personal clothing during procedures or activities where contact with blood, saliva, or OPIM (other potential infectious materials) is anticipated.
5- Wear mouth, nose, and eye protection during procedures that are likely to generate splashes or spattering of blood or other body fluids.
6- Remove PPE before leaving the work area.
3- RESPIRATORY HYGIENE / COUGH ETIQUETTE:
1- Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and conti
The way to infection control in dental clinics
Introduction:
The unique nature of dental procedures, instrumentation and patient care settings require specific strategies directed to the prevention of transmission of diseases among dental health care workers and their patients.
Disease: impairment of normal functioning, manifested by signs and symptoms.
Infection: state produced by an infected agent in or on a suitable host, host may be or may not have signs or symptoms.
Carrier: individual harbors the agent but does not have symptoms (person can infect others).
Factors that allow or aid infection:
= The presence of pathogenic micro-organisms.
= There must be a portal of entry via which the organisms invade and colonize the susceptible host.
Medical history
A thorough medical history should be taken and up-dated at subsequent examinations. Medical history screening is essential in alerting the clinician to medical problems that could, in conjunction with dental treatment, adversely affect the patient.
Protective measures
Protection can be achieved by a combination of immunization procedures, use of barrier techniques and strict adherence to routine infection control procedures.
(a) Immunization:
All dental health care workers are advised to be immunized against HBV unless immunity from natural infection or previous immunization had been documented
(b) Protective coverings:
=Uniforms:
Uniforms should be changed regularly and whenever soiled. Gowns or aprons should be worn during procedures that are likely to cause spattering or splashing of blood.
=Hand protection:
Gloves must be worn for procedures involving contact with blood, saliva or mucous membrane. A new pair of gloves should be used for each patient.
If a gloves damaged, it must be replaced immediately. Hands should be washed thoroughly with a proprietary disinfectant liquid soap prior to and immediately after the use of gloves.
Disposable paper towels are recommended for drying of hands.
Any cuts o abrasions on the hands or wrists should be covered with adhesive waterproof dressings at all times.
=Protective glasses, masks or face shields Protective:
Glasses, masks or face shields should be worn by operators and close-support dental surgery assistants to protect the eyes against the spatter and aerosols which may occur during cavity preparation, scaling and the cleaning of instruments.
(c) Sharp instruments and needles:
Sharp instruments and needle should be handled with great care to prevent unintentional injury. Needles should never be recapped by using both hands indirect contact or by any other technique that involves moving the point of a used needle towards any part of the body. The needle can be recapped by laying the cap on the tray, placing the cap in a re-sheathing device or holding the cap with forceps before guiding the needle into the cap.
(d) First aid and inoculation injuries:
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
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effect of functional appliances on facial growth.docx
1. 1
Dr. Mohammed Alruby
Effects of functional appliances
on facial growth
Prepared by:
Dr Mohammed Alruby
بال عاش من
كرامه
شرف بال مات
2. 2
Dr. Mohammed Alruby
Definition:
Functional appliances are large category of orthodontic appliances that used primarily to
reposition the bone in order to alter the muscular forces against the teeth and craniofacial skeleton.
Development and philosophy: Rogers
= One of the oldest concept in orthodontic is (the importance of muscles in the etiology and
treatment of malocclusion)
= The leaders of the functional theory are: Bannet, Walkjoff, Paker, Moss, Vander, among others
have been stated that (function dictates form)
= As the bone is the last unit to exert its influence, its form is completely controlled by other
elements which called according to Moss terminology (the functional matrix)
= Kingsley 1880 introduced a bite jumping appliance to alter mandible position and consequently
alter the muscular environment
= Robin 1902 developed a Monoblock that used primarily in treatment of tongue thrust and
glossoptosis.
= Andreson 1908, based upon the above appliance, he introduced appliance that used at the first
as temporary retainer for his daughter after complete correction of class II malocclusion, after his
daughter come from her summer vacation, he noticed unexpected improvement in malocclusion,
then he uses the appliance in other cases and report a similar success
In his explanation, he stated that, activator activate the masticatory system which in turn
produced the favorable changes
Later on Andreson and Hauple worked extensively for many years (1939 – 1945) in the
development of activator. Their idea was to create not only a new appliance but an entirely a new
explanation of orthodontic tooth movement. They laid down the (shaking theory) that based upon
the functional adaptation hypothesis of Willian Roux. This theory stated that ((the muscular stimuli
are adequate influences, creating an adaptation changes in the periodontal tissue and alveolar
bone))
= an extensive research was taking place in Europe to investigate and modify the Andreson
appliance
These efforts led to the appearance of many modifications such as: Harvold, Balter, Frakel
= American orthodontist were not interested in the functional appliances until 1951, when Harvold
joined the staff at university of Foronto and started to teach them the principles of functional jaw
orthopedics
Mode of action of appliances
The original appliance is made to be loose, so that by constantly falling down, it raised
reflexly by the tongue which activates the muscles of mastication to posture the mandible upward
and forward
= Shwartz among others, attributed the changes produced by the appliance to the stretching of
muscles which undergo reflex contraction in an attempt to return to their resting tone. This
concentration creates an inter-maxillary reciprocal force that tend to move upper teeth backward
and lower teeth forward,
So the functional appliances act by transmitting the force of orofacial musculatures to the teeth
and preventing unwanted forces from adversely affecting the teeth.
3. 3
Dr. Mohammed Alruby
Effect of functional appliances
= There are great controversy regarding the effect of functional appliances on facial growth
= Andreson and Fischer among others claim that, functional appliances can alter the environment
of the growing facial skeleton to bring a significant change in growth pattern
= This concept has been rejected by mainly other investigation who suggest that: growth of
craniofacial skeleton is under close genetic control and therefore, the orthodontic appliances can
have a little effect other than to move the teeth within alveolar bone
= one concept is now clear: functional appliances only work well in growing children and have
their greatest effect when growth is most rapid
= Janson, Harvold and Petrovic among others proved that, significant skeletal changes in the
basal bone of maxilla, mandible and glenoid fossa ((maxilla retracted backward, proliferative
activity clearly demonstrated in condyle and glenoid fossa translated forward and downward))
But this studies in human has great limitation for the following:
1- The craniofacial morphology of animals is different from that of human, therefore, the
response will be differing
2- The appliance used with primate experiment were fixed, unlike the appliances commonly
used in human which is removable and worn only part time
3- In animals, the functional forces are applied to produce an abnormal condition, while in
human, we wish to use these appliances to correct abnormal condition. This make the result
of animals studies not comparable with human and if applied, great caution should be taken
= On the other hand, the results of clinical studies were varying conflicting and most of these
studies have not been drawn a clear conclusion, this may be due to the following reasons:
1- Limitation in methodology: for example, precise measurements of bony changes and
studying histological changes can do in experimental animals after scarifying them,
while the only method available in human is the radiographic cephalometry which has
the following limitation:
- Errors inherent in the technique itself such as magnification, blurring, and distortion
- Errors in landmarks identification
- Errors in landmarks reproducibility for superimposition purpose
2- Standardization of all variables is possible in animals but not possible in human such as
cooperation
3- Improper selection of patient: most studies have only included patients who have
achieved successful results, while very few also looked for those patient in whom
treatment failed
4- Great emphasis on case report
5- Small sample size
6- Most of clinical studies did not take into account, the amount of normal growth, which
needs to be differentiated from treatment changes. This can only do by having a control
group of patient with similar age, sex, and malocclusion who will accept to remain
without treatment while exposing regularly to a doses of x-ray.
4. 4
Dr. Mohammed Alruby
= at the present time, the evidence derived from the better scientific studies suggest the
following changes:
I- Modification of muscular environment:
a- Effects on masticatory functions:
Ahlgren reported that activator therapy helps in normalization of masticatory functions, this view
is supported by Sander who recommended the use of activator until adaptation to the normal
chewing pattern
b- Effects on swallowing pattern:
The original appliance in made loose, so that, constantly fallen down. Thus caused a reflex
elevation of the tongue and contraction of mandibular elevators, which also the same
neuromuscular pattern occurs during normal swallowing. In addition, the appliance provides a
screening effect which is very helpful in correction of abnormal pressure habits
II- Dento-alveolar effects:
a- Vertical:
Functional appliances have the ability to control the vertical height of the teeth, stopping some
teeth while permitting other to develop vertically through the selective relief, built in the appliance.
This hypothesis aids in levelling occlusal plane, correcting deep bite cases, correcting open bite
cases, and was supported by Scheldt 1938 and Frankel, Harvold
b- Anterior posterior:
Functional appliances move the maxillary dentition against the mandibular dentition utilizing
reciprocal inter-maxillary anchorage and thus brought about dento-alveolar remodeling in
anterior posterior direction, which is very helpful in the correction of class II and class III,
providing excellent results when skeletal bases permit
= Janson observed that, with Bionator therapy, most of class II correction is gained through dento-
alveolar remodeling when craniofacial skeleton shows anterior posterior harmony.
She also observed that, with this appliance, the teeth eruption is guided into more distal and buccal
directions, which is very helpful in correction of buccal cross bite and some space deficiency
problem
III- Skeletal effects:
The skeletal effects of functional appliances are still a matter of controversy, occlusion from
clinical studies can be divide to the following:
1- Stimulation of mandibular growth:
This concept was first proposed by Fischer 1938 and supported by MacNamara and Owen. But
rejected by others.
2- The changes were in the direction of growth and in mandibular position, but the total
volume of mandible is not affected (Frankel)
3- Rotation of mandible with occlusal plane changes
4- Restraining forward maxillary growth: correction of class II is achieved mainly by
inhibition of maxillary growth rather than stimulation of mandibular growth (Bjork,
Harvold)
5- Backward translation of maxilla: (Nielsen and Owen)
6- Forward translation of glenoid fossa.
N: B:
30% --- 40%: orthopedic changes, 60% -- 70% dento-alveolar changes: by functional appliances
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Dr. Mohammed Alruby
A- Effects on maxilla:
= Nielsen observed significant effect on maxillary growth with FR2 appliance, several patients
showed a backward rotation of maxilla, so that, the maxilla was more retrognathic at the end of
treatment period.
= these finding were in agreement with the finding of Owen, but dis-agreed with McNamara and
Dellinger
= on the other hand, some investigator stated that, these appliances only restrict the forward
maxillary growth.
= Jacobson reported that ANS and A points were prevented from moving forward by about 1.1mm
and 0.7mm respectively with activator III supported by Bjork and Harvold, and rejected by:
McNamara and Dellinger
B- Effects on mandible:
= Several investigators have reported that FR2 promotes forward growth of mandible
= according to Frankel, the major effect of appliance is redirection of mandibular growth at
condyles
= McNamara reported an acceleration of mandibular growth in patients treated by FR2 this
observation is also suggested by Owen.
= At contrast, Nielsen found no evidence to support this view in children treated with FR2 or
Harvold activator, he stated that, either appliances were not capable of altering the size of the
mandible
N: B:
The conflicting viewpoints may be due to:
1- Variation in the appliance design and the amount of forward positioning and amount of
vertical opening
2- Individual variation in the treatment response.
** changes in the vertical relationship:
- With both activator and FR2: these was increase in LAFH and TAFH.
- Country et al suggested that larger increase in LAFH and TAFH with Harvold
activator is attributed to greater bite opening (1.5mm) with this appliance but in
other appliances the bite opening (2-3mm)
- Nielson et al claimed that increase in ALFH and TAFH was due to vertical eruption
of mandibular molars that lead to ------------- downward rotation of mandible
because both appliances have extension to prevent eruption of maxillary teeth
** changes in horizontal relationship:
- Country and Dellinger among others reported that, overjet is reduced by tipping of
maxillary incisors palatally and mandibular incisors labially
- The apices of maxillary incisors tipped labially from 0.5mm to 1mm
- Excessive proclination of mandibular incisors is the major cause for overjet relapse
C- Changes in glenoid fossa:
= remodeling of glenoid fossa in more anterior dentition seen in experimental animals and there
is some evidence that it may occurs in human if it happens, the TMJ and mandible will become
translated in more forward
Limitation of functional appliances
a- Functional appliances are typically associated with mandibular and maxillary molar
extrusion that help for eliminate deep over bite.
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Dr. Mohammed Alruby
So: functional appliances are contraindicated in backward rotation of the mandible with
minimal over bite
b- The results depend on patient cooperation
c- Limited correction of growing persons only
d- Difficulty in tooth movement
Effects of activator therapy
1- On mandible: Melan and Trep 1984
Condylar growth during 10 months of activator treatment increased 1.1mm and was redirected
12-degree in more posterior direction
= Forward displacement of glenoid fossa, 1.1mm increase in AFH and 2.5-degree increase in
mandibular plane angle
= Pancherz 1984: the magnitude of mandibular growth was not affected by activator treatment
2- On maxilla:
Melsen demonstrated an increase posterior vertical height that lead to backward rotation of
mandible
= Foesberg: significant decrease in SNA
= Harvold: activator inhibit the horizontal growth of maxilla by 2mm but Pancherz that inhibit by
1.7mm
3- On dentition:
Harvold appliance caused 1.4mm maxillary lingually tipping and 0.5mm incisors lower labial
tipping
4- On soft tissue:
Forsberg: observe upper lip retrusion, nose showed equal forward growth
Effect of functional regulators
1- On mandible:
= Frankel reported forward displacement of pogonion and B point:
4mm / year in 6 – 9 year of age
6mm / year in 9 – 13 year of age
= McNamara: by FR result in mandibular growth by 1 – 2mm / year
= Rigbellis: by FR result in mandibular growth by 1 – 8mm / year
2- On maxilla:
Righellis: no significant horizontal effect on maxilla in patient treated by FR as compared with
untreated
3- On dentition:
Nielsen: FR not induce any proclination in mandibular incisors relative to cranial base
McNamara: improve placement of lower labial pads either too far occlusally or labially would
result in lip bumper effect rather than restriction of mentalis activity.
N: B:
63% dental change, 37% skeletal change ----------------- overjet correction
4- On soft tissue profiles:
Nielsen examined 10 cases Class II div 1 patient treated with FR, all patient showed an
improvement in their soft tissue profile because of an improved lip position
5- McNamara and McDougall: significant amount of expansion by FR, less expansion in lower
arch
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Dr. Mohammed Alruby
Biomechanics of functional appliances by Nanda
1- Glenoid fossa
Causing stimulation of growth at mandibular condyle and remodeling at glenoid fossa
Condylar growth favorable (backward) or unfavorable (upward)
2- Maxillary inhibition:
Inter-maxillary force delivered by labial bow and sometimes by acrylic cap deliver orthopedic
force that inhibit downward and forward growth of maxilla this allow correction for class II
3- Posterior bite plate effect:
When large bite opening is used, inhibit the eruption of teeth that minimize the backward rotation
of mandible
The amount of positioning mandible in forward direction allow stretch of muscles that create
traction of mandible
Myodynamic: mandible postured 5 – 6mm opened 2 – 3mm beyond rest position
Myotonic: mandible postured or open vertically by greater amount more than Myodynamic
4- Guidance of eruption:
= By selective using of occlusal stops or facets in anterior or posterior segment that guide the teeth
to levelled and corrected its relationship
= using posterior bite blocks prevent continued eruption of posterior teeth while allowing incisors
for eruption
= to guide eruption and correct sagittal discrepancy, the upper molar should have occlusal stops
and not on lower molar because the upper molars tend to erupt in mesial and occlusal direction
but lower tend to erupt in vertical direction only, this allow correction of molar relationship
5- Stimulation of bone deposition in areas where the periosteum is stretched:
When using Frankel appliance, the buccal shields extended well into buccal sulci around point A
that lead to stretching periosteum and promotes bone deposition that allow relocation of muscle
attachment at that area.
6- Altering soft tissue forces:
Teeth in its position are in balance between the lips and tongue anteriorly and check and tongue
posteriorly
Cam change the effect of muscle from any side allow other change in the dental arches as:
- Eliminate the pressure from lips and check allow expansion of arches
- Eliminate the position of tongue from resting on the teeth that allow eruption
enhancement
- Anterior lingual shield prevent tongue to become in forward position in cases of
anterior open bite