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
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses the stomatognathic system, which includes the structures and functions involved in chewing, swallowing, breathing, and speaking. It describes the key structures - jaws, teeth, tongue, and muscles. The muscles involved include the temporalis, masseter, medial and lateral pterygoid muscles. It discusses the functions of mastication (chewing), deglutition (swallowing), respiration, and speech. Mastication involves preparing the food, crushing it between teeth, and grinding it using temporal and masseter muscles. Swallowing then moves the crushed food to the pharynx.
=== 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
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
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
Bionator (2) /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.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 document discusses the stomatognathic system, which includes the structures and functions involved in chewing, swallowing, breathing, and speaking. It describes the key structures - jaws, teeth, tongue, and muscles. The muscles involved include the temporalis, masseter, medial and lateral pterygoid muscles. It discusses the functions of mastication (chewing), deglutition (swallowing), respiration, and speech. Mastication involves preparing the food, crushing it between teeth, and grinding it using temporal and masseter muscles. Swallowing then moves the crushed food to the pharynx.
=== 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
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
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
Bionator (2) /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.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
Introduction
Histology of supporting structure
Types of tooth movements
Phases of orthodontic tooth movements
Biological changes by tooth movements
Theories of tissue reactions
Replacement resorption
This case report describes a patient who underwent orofacial myofunctional therapy (OMT) to address temporomandibular joint (TMJ) pain and other issues. The patient had a history of mouth breathing, tongue positioning problems, and sinus infections. OMT involved exercises to improve tongue positioning, swallowing, and jaw function. After two months of weekly OMT sessions, the patient's oral muscle strength and functions improved, her pain was gone, and structural stability was achieved through an interdisciplinary approach including chiropractic. The case suggests that OMT may help treat TMJ and sleep apnea disorders.
This document discusses the muscles of the face and oral cavity that are important for complete dentures. It describes several muscles like the mentalis, orbicularis oris, buccinator, suprahyoid muscles, and tongue and how they can impact denture retention, borders, and contours. Maintaining the functions of these muscles is essential for denture stability and comfort. Recording muscle functions during impressions and jaw relations is important for optimal denture fit.
This document provides an overview of factors affecting the stability of complete dentures. It defines stability and discusses several key factors, including:
- Residual ridge anatomy (height, shape, arch form)
- Denture base adaptation to underlying tissues
- Relationship of denture bases to muscles like the buccinator and mylohyoid
- Opposing occlusal surfaces
- Contours and extensions of denture borders
Stability results from a balance of forces from muscles that can displace dentures and those that resist displacement. Proper consideration of these anatomic and muscular factors during denture fabrication can enhance stability.
The Frankel functional regulator is a removable orthodontic appliance developed by Dr. Rolf Frankel to effect changes in the jaw relationship during mixed and early permanent dentition. It consists of upper buccal shields, lower lip pads, and wires. The shields and pads act to change muscle function and guide jaw growth. Indications include Class II malocclusions with a retruded mandible. Contraindications include severe crowding. The appliance aims to correct jaw positions through muscle adaptation and differential tooth eruption guidance between the arches.
This document discusses concepts of occlusion in fixed partial dentures. It defines key terms like centric relation and occlusion. It describes the requirements for optimal occlusion, including simultaneous bilateral contact of posterior teeth in centric occlusion and forces directed along the long axis of teeth. It also discusses mandibular movements, border movements, and functional movements. The document outlines the diagnosis of occlusion through intraoral exam, radiographs, and mounted casts. It describes planning occlusion and achieving an optimal occlusion.
This document discusses various definitions and factors related to occlusion. It defines static occlusion as the alignment and articulation of teeth within the arches and their relationship to supporting structures. Dynamic occlusion refers to the functioning of the stomatognathic system as a whole, including teeth, supporting structures, TMJ, and muscles. It also discusses ideal occlusion, physiologic occlusion, and therapeutic occlusion. Normal occlusion depends on the position and growth of bones, eruption path and forces on teeth, and forces generated during occlusion. Factors like heredity, trauma, disease and tongue position can influence occlusion development.
---Activator and its modifications[14.9.16=8.29 pm]Sunil Sk
The document discusses functional appliances, specifically the activator appliance. It provides:
1. A brief history of functional appliances and the development of the activator by Andresen in the 1930s to guide mandibular positioning and muscle forces.
2. Two main theories for the activator's mode of action - the myotatic reflex theory proposed by Andresen and Haupl which suggests muscle stimulation and contraction causes skeletal adaptation, and the viscoelastic theory which proposes soft tissue stretching induces adaptation.
3. Key intended effects of the activator including sagittal and vertical skeletal changes through condylar growth modification as well as dentoalveolar guidance of tooth eruption.
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 TREATMENT OF CLASS II, DIVISION 1 MALOCCLUSION WITH FUNCTIONAL CORRECTO...Maen Dawodi
THE TREATMETHE TREATMENT OF CLASS II, DIVISION 1 MALOCCLUSION WITH FUNCTIONAL CORRECTORS
According to Hotz, the adjustment of teeth basically involves a modification of that "natural interplay of forces" which is responsible for the shape of the dentoalveolar arches.
In this article certain problems of Class II, Division 1 cases which arise in connection with the use of skeletal vestibular screens are discussed.
The figure illustrates the Frankel functional appliance that is used in the treatment of Class II cases. The mandible is repositioned in a forward direction to produce the so-called "construction bite," in which the incisors are in an end-to-end relation. The degree to which the buccal shields and the lip pads extend beyond the upper and lower arches corresponds to that of the normal dentition.
This illustrates an occlusal view of a Class II malocclusion. The degree of expansion of the dental arches and of the palatal vault was achieved in this case with the functional appliance in 1 year and 7 months. These casts illustrate not only that good morphologic results can be obtained with functional correctors, but also the manner in which these results are obtained.
The aim at bringing about a new equilibrium between the mechanical forces of the tongue and the cheeks with the aid of oral-seal exercises and a reorientation of the tongue position against the palate. This therapeutic principle corresponds to that applied in general orthopedics.
The first objective is to modify the soft-tissue structures by physiotherapy, and the second is to reeducate motor functions and muscle tone by exercises.
Kinetics of orofacial muscles in c.d. dr barman /orthodontic courses by India...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses the muscles of mastication, including their development, anatomy, functions, and palpation. It then covers several topics relating to the prosthodontic significance of the muscles of mastication, including mandibular movements, the chewing cycle, occlusion, contours of denture bases, centric relation, and how the maximum intercuspal position influences the muscles. Maintaining proper muscle function and coordination through factors like centric relation and balanced occlusion is important for prosthodontic treatment.
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.
Kinetics of orofacial muscles in complete dentures /certified fixed orthodo...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Muscle function & malocclusion /certified fixed orthodontic courses by Indian...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
1) Mastication involves the chewing and grinding of food using the teeth and muscles of mastication. As food is broken down, it is mixed with saliva and prepared for swallowing.
2) The muscles of mastication work in a coordinated manner through opening and closing strokes to crush and grind food between the teeth. Sensory feedback and reflexes help coordinate this chewing cycle.
3) After sufficient mastication, the food is swallowed through a coordinated process of deglutition involving the oral, pharyngeal, and esophageal phases to transport the food bolus to the stomach for further digestion.
orthodontic biology of tooth and supporting structure.docxDr.Mohammed Alruby
Histology of supporting structure
- Periodontal ligament
- Alveolar bone
= types of tooth movement
= classification of force during treatment
= factors affect tooth movement
= hyalinization
= types of root resorption
= factors affect tooth movement according to pressure tension theory
= role of chemical mediators in tooth movement
= role of neurotransmitter in tooth movements
orthodontic biology of tooth and supporting structure.docxDr.Mohammed Alruby
The goal is to examine the relationship between orthodontic biomechanics and the underlying biological process
When orthodontic force is applied to the crown of the tooth it is transmitted through the roots to the periodontal ligament and alveolar bone
Histology of supporting structure:
- Periodontal ligament
- Alveolar bone
I- Periodontal ligament:
A- Cellular component:
• Forming cells:
Osteoblast: bone forming cells
Fibroblast: PDL fibers forming cells
Cementoblast: in layer adjacent to the roots
• Resorptive cells:
Osteoblast: large cell rich acid phosphatase enzyme that demineralize the bone and disintegrate of organic matrix
Fibroblast: disintegrate fibers
Cementoblast: resorb cementum
• Progenitor cells: undifferentiated mesenchymal cells UMC: small cells with closed nucleus and little cytoplasm & monocytes
• Epithelial rest of malassez: arise as a result of breakdown of epithelial root sheath at the time of cementogesis
• Defensive cells: as macrophages & mast cells
B- Periodontal fibers:
1- Collagen fibers:
the main bulk of PDL fibers and found in 5 groups:
- Alveolar crest group: from cervix to alveolar crest
- Horizontal group: from cementum to bone horizontally
- Oblique group: the main attachment that run obliquely from cementum to bone in an apical direction
- Apical group: circumscribed the apex and responsible for resistance to rotation
- Inter-radicular group: inter-mediate plexus, observed midway between bone and root
- Supra-alveolar group:
Dento-gingival
Dento-periosteal
Transeptal
Circular
Alveolo-gingival
2- Oxytalan fibers:
Immediate elastic fibers that resist dissolution by acids unlike collagen
Run from cementum or bone to blood vessels
Play a role in supporting the blood vessels against distortion and compressive strain
c- Ground substances:
organic matrix surrounding the PDL elements, it is chemically composed of CHO linked with protein. CHO- protein complex commonly divided into two groups: proteoglycan and glycoprotein
ground substances of periodontal ligament is in a continuous state of remodeling process
d- Neurovascular elements:
myelinated: pain sensation
non-myelinated: blood vessels wall
PDL functions:
- Supportive
- Nutritive
- Remodeling
- Sensory
II- Alveolar bone:
= in human, marrow spaces are rare in the buccal and lingual plates, these spaces decreased with age
= wider spaces are lined with a layer of fenestrated compact bone when PDL fibers are anchor these fibers is called bundle bone
N: B:
= collagen turn over in PDL is higher 4 times than skin and 2 times than gingiva and this due to the forces in PDL is multi-directional takes vertical and horizontal component
= lake of marrow spaces implies that bone resorption takes more time so that the tooth movement in mesial and distal direction occur more than labial and lingual sides
= the resorptive cells increase as the marrow spaces increase
N: B:
The new deposited tissue during tooth migration have 3 stages:
Stage I osteoid:
is the pr
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
Introduction
Histology of supporting structure
Types of tooth movements
Phases of orthodontic tooth movements
Biological changes by tooth movements
Theories of tissue reactions
Replacement resorption
This case report describes a patient who underwent orofacial myofunctional therapy (OMT) to address temporomandibular joint (TMJ) pain and other issues. The patient had a history of mouth breathing, tongue positioning problems, and sinus infections. OMT involved exercises to improve tongue positioning, swallowing, and jaw function. After two months of weekly OMT sessions, the patient's oral muscle strength and functions improved, her pain was gone, and structural stability was achieved through an interdisciplinary approach including chiropractic. The case suggests that OMT may help treat TMJ and sleep apnea disorders.
This document discusses the muscles of the face and oral cavity that are important for complete dentures. It describes several muscles like the mentalis, orbicularis oris, buccinator, suprahyoid muscles, and tongue and how they can impact denture retention, borders, and contours. Maintaining the functions of these muscles is essential for denture stability and comfort. Recording muscle functions during impressions and jaw relations is important for optimal denture fit.
This document provides an overview of factors affecting the stability of complete dentures. It defines stability and discusses several key factors, including:
- Residual ridge anatomy (height, shape, arch form)
- Denture base adaptation to underlying tissues
- Relationship of denture bases to muscles like the buccinator and mylohyoid
- Opposing occlusal surfaces
- Contours and extensions of denture borders
Stability results from a balance of forces from muscles that can displace dentures and those that resist displacement. Proper consideration of these anatomic and muscular factors during denture fabrication can enhance stability.
The Frankel functional regulator is a removable orthodontic appliance developed by Dr. Rolf Frankel to effect changes in the jaw relationship during mixed and early permanent dentition. It consists of upper buccal shields, lower lip pads, and wires. The shields and pads act to change muscle function and guide jaw growth. Indications include Class II malocclusions with a retruded mandible. Contraindications include severe crowding. The appliance aims to correct jaw positions through muscle adaptation and differential tooth eruption guidance between the arches.
This document discusses concepts of occlusion in fixed partial dentures. It defines key terms like centric relation and occlusion. It describes the requirements for optimal occlusion, including simultaneous bilateral contact of posterior teeth in centric occlusion and forces directed along the long axis of teeth. It also discusses mandibular movements, border movements, and functional movements. The document outlines the diagnosis of occlusion through intraoral exam, radiographs, and mounted casts. It describes planning occlusion and achieving an optimal occlusion.
This document discusses various definitions and factors related to occlusion. It defines static occlusion as the alignment and articulation of teeth within the arches and their relationship to supporting structures. Dynamic occlusion refers to the functioning of the stomatognathic system as a whole, including teeth, supporting structures, TMJ, and muscles. It also discusses ideal occlusion, physiologic occlusion, and therapeutic occlusion. Normal occlusion depends on the position and growth of bones, eruption path and forces on teeth, and forces generated during occlusion. Factors like heredity, trauma, disease and tongue position can influence occlusion development.
---Activator and its modifications[14.9.16=8.29 pm]Sunil Sk
The document discusses functional appliances, specifically the activator appliance. It provides:
1. A brief history of functional appliances and the development of the activator by Andresen in the 1930s to guide mandibular positioning and muscle forces.
2. Two main theories for the activator's mode of action - the myotatic reflex theory proposed by Andresen and Haupl which suggests muscle stimulation and contraction causes skeletal adaptation, and the viscoelastic theory which proposes soft tissue stretching induces adaptation.
3. Key intended effects of the activator including sagittal and vertical skeletal changes through condylar growth modification as well as dentoalveolar guidance of tooth eruption.
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 TREATMENT OF CLASS II, DIVISION 1 MALOCCLUSION WITH FUNCTIONAL CORRECTO...Maen Dawodi
THE TREATMETHE TREATMENT OF CLASS II, DIVISION 1 MALOCCLUSION WITH FUNCTIONAL CORRECTORS
According to Hotz, the adjustment of teeth basically involves a modification of that "natural interplay of forces" which is responsible for the shape of the dentoalveolar arches.
In this article certain problems of Class II, Division 1 cases which arise in connection with the use of skeletal vestibular screens are discussed.
The figure illustrates the Frankel functional appliance that is used in the treatment of Class II cases. The mandible is repositioned in a forward direction to produce the so-called "construction bite," in which the incisors are in an end-to-end relation. The degree to which the buccal shields and the lip pads extend beyond the upper and lower arches corresponds to that of the normal dentition.
This illustrates an occlusal view of a Class II malocclusion. The degree of expansion of the dental arches and of the palatal vault was achieved in this case with the functional appliance in 1 year and 7 months. These casts illustrate not only that good morphologic results can be obtained with functional correctors, but also the manner in which these results are obtained.
The aim at bringing about a new equilibrium between the mechanical forces of the tongue and the cheeks with the aid of oral-seal exercises and a reorientation of the tongue position against the palate. This therapeutic principle corresponds to that applied in general orthopedics.
The first objective is to modify the soft-tissue structures by physiotherapy, and the second is to reeducate motor functions and muscle tone by exercises.
Kinetics of orofacial muscles in c.d. dr barman /orthodontic courses by India...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses the muscles of mastication, including their development, anatomy, functions, and palpation. It then covers several topics relating to the prosthodontic significance of the muscles of mastication, including mandibular movements, the chewing cycle, occlusion, contours of denture bases, centric relation, and how the maximum intercuspal position influences the muscles. Maintaining proper muscle function and coordination through factors like centric relation and balanced occlusion is important for prosthodontic treatment.
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.
Kinetics of orofacial muscles in complete dentures /certified fixed orthodo...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Muscle function & malocclusion /certified fixed orthodontic courses by Indian...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
1) Mastication involves the chewing and grinding of food using the teeth and muscles of mastication. As food is broken down, it is mixed with saliva and prepared for swallowing.
2) The muscles of mastication work in a coordinated manner through opening and closing strokes to crush and grind food between the teeth. Sensory feedback and reflexes help coordinate this chewing cycle.
3) After sufficient mastication, the food is swallowed through a coordinated process of deglutition involving the oral, pharyngeal, and esophageal phases to transport the food bolus to the stomach for further digestion.
orthodontic biology of tooth and supporting structure.docxDr.Mohammed Alruby
Histology of supporting structure
- Periodontal ligament
- Alveolar bone
= types of tooth movement
= classification of force during treatment
= factors affect tooth movement
= hyalinization
= types of root resorption
= factors affect tooth movement according to pressure tension theory
= role of chemical mediators in tooth movement
= role of neurotransmitter in tooth movements
orthodontic biology of tooth and supporting structure.docxDr.Mohammed Alruby
The goal is to examine the relationship between orthodontic biomechanics and the underlying biological process
When orthodontic force is applied to the crown of the tooth it is transmitted through the roots to the periodontal ligament and alveolar bone
Histology of supporting structure:
- Periodontal ligament
- Alveolar bone
I- Periodontal ligament:
A- Cellular component:
• Forming cells:
Osteoblast: bone forming cells
Fibroblast: PDL fibers forming cells
Cementoblast: in layer adjacent to the roots
• Resorptive cells:
Osteoblast: large cell rich acid phosphatase enzyme that demineralize the bone and disintegrate of organic matrix
Fibroblast: disintegrate fibers
Cementoblast: resorb cementum
• Progenitor cells: undifferentiated mesenchymal cells UMC: small cells with closed nucleus and little cytoplasm & monocytes
• Epithelial rest of malassez: arise as a result of breakdown of epithelial root sheath at the time of cementogesis
• Defensive cells: as macrophages & mast cells
B- Periodontal fibers:
1- Collagen fibers:
the main bulk of PDL fibers and found in 5 groups:
- Alveolar crest group: from cervix to alveolar crest
- Horizontal group: from cementum to bone horizontally
- Oblique group: the main attachment that run obliquely from cementum to bone in an apical direction
- Apical group: circumscribed the apex and responsible for resistance to rotation
- Inter-radicular group: inter-mediate plexus, observed midway between bone and root
- Supra-alveolar group:
Dento-gingival
Dento-periosteal
Transeptal
Circular
Alveolo-gingival
2- Oxytalan fibers:
Immediate elastic fibers that resist dissolution by acids unlike collagen
Run from cementum or bone to blood vessels
Play a role in supporting the blood vessels against distortion and compressive strain
c- Ground substances:
organic matrix surrounding the PDL elements, it is chemically composed of CHO linked with protein. CHO- protein complex commonly divided into two groups: proteoglycan and glycoprotein
ground substances of periodontal ligament is in a continuous state of remodeling process
d- Neurovascular elements:
myelinated: pain sensation
non-myelinated: blood vessels wall
PDL functions:
- Supportive
- Nutritive
- Remodeling
- Sensory
II- Alveolar bone:
= in human, marrow spaces are rare in the buccal and lingual plates, these spaces decreased with age
= wider spaces are lined with a layer of fenestrated compact bone when PDL fibers are anchor these fibers is called bundle bone
N: B:
= collagen turn over in PDL is higher 4 times than skin and 2 times than gingiva and this due to the forces in PDL is multi-directional takes vertical and horizontal component
= lake of marrow spaces implies that bone resorption takes more time so that the tooth movement in mesial and distal direction occur more than labial and lingual sides
= the resorptive cells increase as the marrow spaces increase
N: B:
The new deposited tissue during tooth migration have 3 stages:
Stage I osteoid:
is the pr
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 1
Prepare by
Dr. Mohammed Alruby
Histology of muscles
Physiology of muscles
Muscles development
Orofacial muscles
- Facial muscles
- Jaw muscles
- Portal muscles
Methods of studying muscles
Muscle changes during growth
Muscle function and facial development
Histology of muscles
The structural and functional unit of the muscles is the muscle fiber
Muscle fiber: elongated cylinder measure about 10 to 80 microns in thickness and from 1 to 15cm in length
= Each muscle fiber contains an acidophilic granular cytoplasm (sarcoplasm) that rich in:
Glycogen, mitochondria, Golgi apparatus, protein (actin, myosin, tropomyosin),
Large number of myofibrils (sarcostyles) which responsible for muscle contraction
= the muscle fiber is covered by thick membrane called (sarcolemma) and surrounded by CT called (endomysium)
= the muscle fibers are coalescing together to form bundles; each bundles are covered by C T septa called perimysium
= the muscle bundles are coalescing together to the whole muscle which is covered by CT fascia called epimysium, these CT contain: blood vessel, lymph vessel, and nerves, that firmly attach the muscle bundles to each other and attach the whole muscle to its tendon
= the myofibrils (sarcostyles)are the contractile units of the muscle, in skeletal muscle they are transversely striated due to presence of dark and light bands
The dark bands are formed of thick myosin filaments rich in Ca, the light bands are formed of thin actine filaments rich in water, there is a pale line in at the center of dark band called (Henesen’s disk), There is dark line at the center of light bands called (Krauses membrane) or Z line
The distance between the two lines called (sarcomere) which is a contraction unit of the muscle.
During the muscle contraction there the Sarcomere is shortened due to sliding of the light bands over the dark bans. The energy required for contraction is derived from transformation of ATP ------ ADP
Physiology of muscles:
Man has 639 muscles, composed of 6 billion muscle fibers, each fiber has 1000 fibrils, which means that there are 6000 billion fibrils at work at one of time or another.
Elasticity: muscle can be stretched behind its original length and return to the original shape after relaxation (normal muscle can be elongated about 6/10 of its length
Contractility: it is the ability of muscle to shorten its length under nerve impulse, this contraction is stimulated by acetyl choline, glycogen is partially oxidized to provides energy and lactic acid that carried away by blood stream
Excessive accumulation of lactic acid can produce fatigue
Isometric contraction: (stretching): the muscle is simply resisting the external forces without actual shortening
Isotonic contraction: there is an actual shortening of the muscle, the strength of isometric contraction is much greater than that of isotonic contraction as the stre
diagnostic aids part 3, photograph and radiograph.docxDr.Mohammed Alruby
Diagnostic Aids
Part 3
{Radiographs and Photographs}
{BMR and EMG}
Prepared by
Dr. Mohammed Alruby
Radiographs
Means: A procedure that uses a type of high-energy radiation called x-rays to take pictures of areas inside the body. X-rays pass through the body onto film or a computer, where the pictures are made
Types:
Intra-oral radiographs:
Periapical radiographs:
It is necessary for any orthodontic diagnosis for the following reasons:
The pattern and amount of root resorption of deciduous teeth
Presence or absence of permanent teeth, their size, shape, position and relative state of development
Congenital absence of teeth or presence of supernumerary teeth
Character of alveolar bone, lamina dura, and periodontal membrane
Morphology and inclination of permanent teeth roots
Pathological oral condition such as thickened periodontal membrane, periapical infection, root fractures, cysts, retained deciduous teeth
Abnormal path of eruption of permanent teeth
Malposition of individual as: rotation, which requires a larger space on the arch
Very useful in mixed dentition analysis
Recognition of exact position of impacted tooth by using method of parallax: that determine whether the unerupted tooth is located labially or palatally. Two periapical radiograph is taken with the film in the same position in each exposure, but the tube is moved in second exposure about 10cm. if the impacted tooth is moved in the same direction as the tube so the tooth is impacted palatally and the reverse is versa.
Bit-wing radiographs:
Is used mainly for detection of proximal cries, but it is of little value in orthodontic diagnosis
Occlusal film:
Occlusal projection is useful to locate the supernumerary teeth at the midline (mesiodens) and to determine accurately the position of impacted maxillary cuspids
Extra-oral radiographs:
Cephalometric radiographs:
Lateral cephalometric radiographs
PA cephalometric radiographs
Lateral oblique cephalogram:
The patient is directed by 45 degree and take the shot
Since dentofacial structure will be superimposed in the true lateral cephalometric projection, the lateral oblique direction is designed to gives a more accurate recording of the actual tooth position in either the left or right buccal segments depending on which side is approximately perpendicular to the central rays
The lateral oblique cephalogram combines most of advantages of the lateral views, intra-oral periapical survey and panoramic radiograph plus a standard cephalometric registration that makes possible measurements of bone size and eruptive movements so it is of particular size in analysis of developing dentition
Submental vertex cephalometric:
Is used to assess mandibular asymmetry in the transverse and anterior-posterior plane. It is an important aid in detecting asymmetry in the symphysis, body, ramus, and condyle of the mandible. In many cases of asymmetry, this view is important for evaluation of mandibular displacemen
Diagnostic Aids
{Study cast, Cast analysis}
Part (2)
Prepared by
Dr. Mohammed Alruby
Study cast
Definition: it is a positive replica of the teeth and their supporting structure, it should be reproducing accurately all the anatomical details of the teeth, alveolar process, mucobuccal folds, palate, frenal attachment as well as the exact relationship of the mandibular to the maxillary dental arch
Good models begin with good impression, orthodontic impression should displace the lips and cheeks, so that, the full depth of mucobuccal sulci is recorded. This over extension of impression is obtained by building up the tray periphery with wax or by using special orthodontic trays
The position of maximum intercuspation should be recorded by getting the patient to bite through softened wax, that is important for:
1- Recording the proper intercuspation specially in cases of poor occlusal fit due to extraction or tongue thrust. So it is wise to check the occlusion in the mouth and compare it to the occluded cast to insure that the model is correctly articulated
2- Trimming of the upper and lower cast together without change in occlusal relationship or fracture of teeth
Occlusal registration of wax bite:
= the position of maximum intercuspation as well as the centric relation must be registered
= a piece of soft wax large enough to cover the occlusal surface of maxillary teeth is shaped to the form of maxillary arch, then gently pressed against the maxillary teeth
= the patient instructed to relax and mandible is guided to most posterior and superior position of condyle within the glenoid fossa, while the teeth come into occlusion
= if there is shifting during closure due to cuspal interference, this mean that the occlusal position is not coincide with centric occlusal position, in this case, in this case two bites are taken one for usual occlusal position, and the other for centric occlusion
Ideal requirements of orthodontic study models:
1- They are symmetrical and pleasing to the eye and so that a symmetrical arch form can be readily recognized
2- The dental occlusion shows by setting the models on their backs
3- Clean, smooth, bubble free, with sharp angles where the cuts meet
4- Glossy in finish.
Trimming of study models:
There are two types of trimming:
a- Angle trimming:
The purpose of angle trimming is to added an appropriate proportional bases to the anatomical portion of dental casts which is important in:
- Registration of centric occlusion by having the posterior and lateral border of both casts on the same plane, so that cast may place on any side without change in its relationship
- Giving an idea about the relationship of the teeth to the alveolar process and basal bone
- Giving harmonizing appearance of the right and left sides of the cast which any a symmetry can be detected
- Detection of occlusion from any side, anterior as well as lateral sides
Principles:
1- The floor of the base is trimmed
diagnostic aids part 1 diagnosis, examination, BMR, EMG.docxDr.Mohammed Alruby
Introduction:
Proper treatment plane depends on prompt diagnosis, good clinician should have a bird’s eyes to first identify the problem and find its etiology
Definitions:
= Grabber and Rackosi: defined diagnosis as:
Recognition and systemic designation of anomalies, the practical synthesis of the finding, permitting therapy to be planned and identification to be determined
=a continuous evaluation process in orthodontics starting right from the first interaction with the patient continuing through different stages till end of treatment and course follow up visits
Goal of orthodontic diagnosis:
Is to produce a comprehensive description of the patient’s problem and then to synthesis the various elements of description into a rational problem list
Diagnostic aids:
Data required for orthodontic diagnosis are derived from routine essential diagnostic aids and also from supplemental aids when needed, Graber categorized the diagnostic aids into essential and supplemental aids
Essential:
- Case history
- Study models
- Certain radiographs: periapical, bite wing, panoramic radiograph
- Facial photographs
- Intra-oral photographs
Supplemental:
- Specialized radiographs: occlusal of maxilla and mandible, lateral cephalogram
- Hand &wrist radiograph
- Electromyography
- Endocrine test
- Basal metabolic rate
Case history:
Complete case history includes all the relevant information derived from the patient and parents and essential for planning
Personal details:
Name:
The patient’s name should be recorded for the purpose of identification and communications
Calling the patient by his/her name not only establishes a good report but also imparts confidence in the patient mind about treatment providers
In case of children, it might help to know their pet problems
Age:
= certain malocclusion occurring during growth period are transient and self-correcting
= growth modification procedures such as functional appliances can be carried out during growth periods
= surgical respective procedures such as orthognathic surgery are best carried out after cessation of growth
= chronological age is important for the maintaining of shedding and eruption time tables as well
Gender:
= recording gender of the patient is important for treatment planning, females are observed to precede males in growth related events such as onset of growth spurt, eruption of the teeth and onset of puberty
= gender may also have a bearing on patient’s compliance toward certain types of orthodontic treatment
Occupation and address:
Occupation of patient / or parents gives an idea about socioeconomic condition which might affect the selection of orthodontic appliances and can give an idea about awareness
Address of patient determine the sociality of the patient and this effect on the treatment because some countries have normally bi-maxillary protrusion and also determine the awareness of patient about treatment and oral hygiene
Patient behavior:
Behavior of patient depend on: patient
Smile: is the most pleasant and wanted expression by each one of us.
Smile: is amused facial expression with the corner of mouth turned up and exposed front teeth
Facial expression, postures of lips, occlusion and arrangement of teeth, buccal corridor, shape of teeth, gingival color, texture, contour and other several aspects constitute component of smile
Most of patients come to us to improve their smiles, the orthodontic studies stress on skeletal structure than soft tissue structure, and the smile still receives relatively little attention
Nature of smile:
1- Posed smile: voluntary, static, sustained, social smile not elicited by an emotion
2- Un-posed smile: spontaneous, involuntary, dynamic, natural, and not sustained characterized by greater lip elevation
Smile types: smile styles:
1- Commissures smile: the corner of the mouth turned upward called Monalisa smile
2- Cuspid smile: the upper lip is elevated, the entire lip rises like a window shade
3- Complex smile: the upper lip moves superiorly as in cuspid smile and lower lip moves inferiorly
Evaluation of posed smile:
variables Normal smile Not good smile
Smile arc Consonant Non consonant
Smile index Average Increased / decreased
Morley’s ratio 75 – 100% (normal) Disturbed
Buccal corridor Average Obliterated / excessive
Smile line Average High / low
Occlusal plane No canting Canting occlusal plane
Important definitions:
Smile arc:
the curvature formed by an imaginary line tangent to the incisal edges of the teeth, modified in varying degree of curvature in relationship to the lower lip
Range: from no curvature to an accentuated curvature was in relation to the lower lip, so quantification differed for each model
Buccal corridor:
the amount of dark space displayed between the facial surfaces of the posterior teeth and the corner of the mouth, calculated as the total dark space on both sides of the mouth as a percentage of the total smile width
Range: from 6% to 26.5 in approximately 0.5% increments
Maxillary gingival display or gummy smile:
The amount of gingival show above the central incisor crown and below the center of the upper lip. Negative number indicate gingival exposure. Positive number indicate tooth overlap by the lip
Range: from 1mm of gingival display (-1) to almost 7mm of tooth coverage for the female models, and approximately 2mm of gingival display (-2) to 6mm tooth coverage for male models
The variation between the models was due to differences in sizes and coordinating the images for different faces
Maxillary midline to face:
The relationship of maxillary dental midline (measured between the central incisors) to the midline of the face, defined by the center of the philtrum and the facial midline
Range: the maxillary midline was moved to the left of the face in approximately 0.25 mm increments. The right and left buccal corridor was maintained throughout the movement of the dentition. The maximum deviation show is 6mm
Maxillary to mandibular mid
Successful infection prevention program
A successful infection prevention program depends on:
1-Developing standard operating procedures.
2- Evaluating practices and providing feedback to dental health care personnel (DHCP).
3- Routinely documenting adverse outcomes (e.g., occupational exposures to blood) and work-related illnesses in DHCP.
4- Monitoring health care associated infections in patients.
Standard Precautions
Standard Precautions: are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients.
Standard Precautions include:
1- Hand hygiene.
2- Use of personal protective equipment (e.g., gloves, masks, eyewear).
3- Respiratory hygiene / cough etiquette.
4- Sharps safety.
5- Safe injection practices (i.e., aseptic technique for parenteral medications).
6- Sterile instruments and devices.
7- Clean and disinfected environmental surfaces.
Each element of Standard Precautions is described in the following sections. Education and training are critical elements of Standard Precautions, because they help DHCP make appropriate decisions and comply with recommended practices.
1- HAND HYGIENE:
1- Perform hand hygiene.
a. When hands are visibly soiled.
b. After bare hand touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions.
C. Before and after treating each patient.
d. Before putting on gloves and again immediately after removing gloves.
2. Use soap and water when hands are visibly soiled (e.g., blood, body fluids); otherwise, an alcohol-based hand rub may be used.
2- PERSONAL PROTECTIVE EQUIPMENT (PPE):
1- Provide sufficient and appropriate PPE and ensure it is accessible to DHCP.
2- Educate all DHCP on proper selection and use of PPE.
3- Wear gloves whenever there is potential for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment.
a- Do not wear the same pair of gloves for the care of more than one patient.
b- Do not wash gloves. Gloves cannot be reused.
c- Perform hand hygiene immediately after removing gloves.
4- Wear protective clothing that covers skin and personal clothing during procedures or activities where contact with blood, saliva, or OPIM (other potential infectious materials) is anticipated.
5- Wear mouth, nose, and eye protection during procedures that are likely to generate splashes or spattering of blood or other body fluids.
6- Remove PPE before leaving the work area.
3- RESPIRATORY HYGIENE / COUGH ETIQUETTE:
1- Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and conti
The way to infection control in dental clinics
Introduction:
The unique nature of dental procedures, instrumentation and patient care settings require specific strategies directed to the prevention of transmission of diseases among dental health care workers and their patients.
Disease: impairment of normal functioning, manifested by signs and symptoms.
Infection: state produced by an infected agent in or on a suitable host, host may be or may not have signs or symptoms.
Carrier: individual harbors the agent but does not have symptoms (person can infect others).
Factors that allow or aid infection:
= The presence of pathogenic micro-organisms.
= There must be a portal of entry via which the organisms invade and colonize the susceptible host.
Medical history
A thorough medical history should be taken and up-dated at subsequent examinations. Medical history screening is essential in alerting the clinician to medical problems that could, in conjunction with dental treatment, adversely affect the patient.
Protective measures
Protection can be achieved by a combination of immunization procedures, use of barrier techniques and strict adherence to routine infection control procedures.
(a) Immunization:
All dental health care workers are advised to be immunized against HBV unless immunity from natural infection or previous immunization had been documented
(b) Protective coverings:
=Uniforms:
Uniforms should be changed regularly and whenever soiled. Gowns or aprons should be worn during procedures that are likely to cause spattering or splashing of blood.
=Hand protection:
Gloves must be worn for procedures involving contact with blood, saliva or mucous membrane. A new pair of gloves should be used for each patient.
If a gloves damaged, it must be replaced immediately. Hands should be washed thoroughly with a proprietary disinfectant liquid soap prior to and immediately after the use of gloves.
Disposable paper towels are recommended for drying of hands.
Any cuts o abrasions on the hands or wrists should be covered with adhesive waterproof dressings at all times.
=Protective glasses, masks or face shields Protective:
Glasses, masks or face shields should be worn by operators and close-support dental surgery assistants to protect the eyes against the spatter and aerosols which may occur during cavity preparation, scaling and the cleaning of instruments.
(c) Sharp instruments and needles:
Sharp instruments and needle should be handled with great care to prevent unintentional injury. Needles should never be recapped by using both hands indirect contact or by any other technique that involves moving the point of a used needle towards any part of the body. The needle can be recapped by laying the cap on the tray, placing the cap in a re-sheathing device or holding the cap with forceps before guiding the needle into the cap.
(d) First aid and inoculation injuries:
preventive and interceptive for general practitioners.docxDr.Mohammed Alruby
Scope of orthodontics
for general practitioner
Prepared by
Dr. M Alruby
Orthodontics: is a branch of science and art of dentistry dealing with prevention, interception, and correction of positional and dimensional dentofacial abnormalities.
Orthodontic treatment could be divided as follow:
1- Preventive orthodontic treatment.
2- Interceptive orthodontic treatment.
3- Corrective orthodontic treatment. a) Early corrective. b) late corrective.
4- Post. Treatment maintenance or retentive and follow up.
Preventive orthodontics:
It is defined as that phase of orthodontics employed to recognize and eliminate potential irregularities and malposition in the developing dentofacial complex. It is directed toward improving environmental conditions to permit future normal development
N: B: the child as a patient: children will accept orthodontic treatment if the purpose for treatment is explained in a simple terms that they can understand. Information concerning treatment aims and procedures should be given to the child without hesitation and under authority; neither gives him a great attention nor neglect him. Be familiar with the child and give him some sympathy.
Most children at preadolescent age are ready to accept orthodontic treatment if the orthodontist was able to establish a sympathetic relationship with the child. The child must not force to treatment but it is better to postpone treatment until the child feels the needs for treatment.
The adolescent patients: the 15 years old patient frequently consider himself as a man and must has a special management. Adolescent patient may deny that his teeth need correction and warning of the appliances. It is very important to know whether the patient came to the office alone, with friends or forced by his parents.
Preventive orthodontics is a long range approach and it is largely a responsibility of the general dentist. Many of the procedures are common in preventive and interceptive orthodontics but the timing are different.
Preventive procedures are undertaken in anticipation of development of a problem. Interception procedures are undertaken when the problem has already manifested. For extraction of supernumerary teeth before they cause displacement of other teeth is a preventive procedure, while their extraction after the signs of malocclusion have appeared is an interceptive procedure.
Preventive procedures:
A- Pre-dental preventive procedure ( parents education):
Instruct the mother to feed her baby from breast and if the baby to be feed by a bottle, the nipple should be long enough to rest on the anterior third of the tongue. It also should contain a small side opening instead of single large end hole, this allows the milk to flow on the dorsum of the tongue and prevent it from being squeezed directly into the pharynx, by this method the tongue is allowed to function properly during swallowing which is very important in general growth of the jaws, al
Orthodontic Diagnosis
For general practitioners
Prepared by Dr. M Alruby
Orthodontic diagnosis deals with recognition of the various characteristics of the malocclusion. It involves collection of data in a systematic manner to help in identifying the nature and cause of the problem. Comprehensive orthodontic diagnosis is established by use of certain clinical implements called diagnostic aids.
Consideration of general health, appearance and attitude:
The first step in any orthodontic examination is to form a general idea of patient's health status, physical appearance and attitude toward orthodontics.
Case history:
Case history involves eliciting and recording of relevant information from the patient and parents to aid in the overall diagnosis of the case. The information is gathered from the patient and parents.
Personal details:
Name: the patient's name should be recorded for the purpose of communication and identification. Most patients like being called by their name. Addressing the patient by his or her name has a beneficial psychological effect as well. In case of children it is wise to record their pet names.
Age: the patient's chronological age should be recorded. Age consideration helps in diagnosis as well as treatment planning. There are certain modalities that are best carried out during the growing age. Growth modification procedures using functional and orthopedic appliances are carried out during the growth period. Surgical respective procedure is best carried out after the cessation of growth.
** Dental age determination: can be determined by two different methods:
- Stage of eruption of teeth.
- Stage of tooth mineralization on radiograph.
Determination of the dental age from observation has been the only method available for long time. In certain cases however, the accuracy of the method is limited.
When determining the dental age radiographically according to the stage of germination, the degree of development of individual teeth is compared to a fixed scale.
** Skeletal age evaluation: assessment of the skeletal age is often made with the help of a hand radiograph which can be considered the biologic clock. For the analysis of skeletal maturity the stage of mineralization of the carpal bones must be determined thereafter the development of the metacarpal bones and phalanges should be evaluated. For the evaluation of the hand radiograph various indicators regarding the development and maturity are established which occur regularly in a definite sequence during skeletal development.
Sex: the patient sex should be recorded in the case history. This is important in planning treatment, as the timing of growth events such as growth spurts is different in males and females. Females usually precede males in onset of growth spurts, puberty and termination of growth.
Address and occupation: this help in evaluation of socio-economic status of the patients and parents. Some countries
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
2. 2
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
3. 3
Dr. Mohammed Alruby
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 improve the facial
profile, so the condyles become outside the fossa (Sunday bite) and the persons being as who
wearing activator
= the lower lip cushion to the lingual surface of maxillary incisors in both rest and during function
4. 4
Dr. Mohammed Alruby
= lower lip sucking may develop and lip become hypertrophied
= the upper incisors move farther forward resisted by the hypotonic and relatively functionless
upper lip
The lower anterior teeth are flattened by continuous pressure of mentalis muscle, the curve of spee
increased
Class II division 2 malocclusion:
The precise role of musculature in class II div 2 is more difficult to establish, Activity of cheek and
lip muscles are normal in contrast to div 1. Some authors have suggested that the tongue behavior
tend to exaggerate the curve of spee by occupying the intra-occlusal space and interfering with
eruption of posterior teeth so that, the inter-occlusal space in class II div 2 is large
= the lingual inclination of maxillary incisors combined with excessive inter-occlusal space may
produce a functional guidance in the mandibular closure and forced retrusion of the mandible
By EMG: studies have shown an increased activity of masseter and posterior fibers of temporalis
from the point of initial contact to the position of habitual occlusion
== some authors related the type of malocclusion to the hyperactivity of the mandibular elevator
muscles which permit adequate eruption of posterior teeth and may also contribute to relapse after
retention
Class III malocclusion:
There is a strong hereditary pattern in class III malocclusion and it is thought that abnormal
muscular activity in this class is adaptive one
The upper lip is relatively short but not necessarily hypotonic. The lower lip is hypertrophied and
appear passive during deglutition cycle
Muscle development and skull form in relation to function
The relation of Muscle function to the structure and form of the skull can be summarized as follow:
1- Certain internal elements of the skull, especially in the base of the cranium, are entirely
independent of muscle growth and function
2- Some of the structure and form of the skull is related to muscle function through polygenetic
development and appear to be independent to some degree of the development or function
of the individual muscles
3- The degree of muscle function generally determines much of the quantity, quality, structure
and form of the face
4- Muscles can change their location and extent through change their attachment or through
change in position due to new attachments and new function which can produced also
change in the morphology of the facial skeleton
5- The masseter, temporalis, temporal bone ridges and zygomatic arches show strong
developmental increase.
6- The pterygoid plate grow wider and the tuberosity become well developed
7- The mandible shows an everted border and bi-gonial width show an increase
5. 5
Dr. Mohammed Alruby
Facial balance, muscle balance and orthodontic therapy
Facial balance in orthodontic refers to the orthognathic appearance of the face as evidenced in
the soft tissue profile, since the force exerted by:
- Tongue
- Circum-oral musculature
- The buccinator
- The muscles of mastication
Is not equal in amount, it indicates that there are other factors in addition to muscle balance
responsible for the stability of the dentition
Regardless to orthodontic therapy, the following factors are important in establishing facial
muscle posture:
1- Axial position of the teeth
2- Kinesthetic of the dentition which are developed by the proprioceptors
3- Quantity and quality of the functional force exerted in the movement of the mandible
4- Atmospheric pressure
5- Pressure developed in breathing and swallowing
= muscle posture and functional balance of mimetic and masticatory muscles are important in
maintaining the stability of orthodontically obtained results
Presence or absence of muscle balance is an important reason why orthodontic therapy is
successful in some cases but is followed by relapse in other similar
Scott studied fetal muscle and bone configuration, and found that muscles can adapt to new
functional pattern and growth changes.
The ability of muscles to change their insertion is recognized as being responsible for dento-facial
morphologic change brought about by orthodontic therapy
Under retention, the muscles can adapt themselves to the changes functional pattern brought about
by change in the occlusion of the teeth
If muscle balance is not achieved because of insufficient retention, orthodontic therapy is followed
by relapse
Early treatment in young children is advantageous for stability of orthodontic results because the
muscles are in state of active growth, during which their origins and insertions are changing and
can be more easily influenced in a direction favorable to the achievement of state of balance
N: B:
There is a compensatory changes occur in:
- Functional pattern
- Muscle behavior
- Actual extent and manner of muscle insertion
- Change in periodontal ligament
- Change in the inter-dental fibers
Some if not all of these changes take longer for their adjustment than it takes to move the tooth into
their new position. Therefore, retention of moved teeth is required until equilibrium is stablished
6. 6
Dr. Mohammed Alruby
EMG response of muscles
EMG: a method of studying the physiologic basis of mastication, deglutition and speech.
In patient with normal occlusion (Perry and Harris) found by EMG tests that the temporal muscles
and masseter act in synchronized manner, although the temporal muscles become active before the
masseter muscles
In class II div 1 malocclusion they found electrical activity to appear in masseter muscle before
temporal muscles, the temporal muscle is rapid in action and relatively weaker than the masseter
muscle in power
= According to Moyers the external pterygoid proceeds the digastric muscle action in mandibular
depression
= Ralston, states that at present: EMG is capable of assessing:
- time only,
- duration,
- phasic relationship of muscle contraction,
but not measuring such function as:
- Force
- Speed of contraction
- Work produced
At rest position:
- There is an equilibrium between all the forces operating on the mandible
- The elevator and depressor muscle of mandible exhibit their minimal electrical activity
Shpuntoff, found that:
- General posture
- Pain
- Fatigue
- central nervous system excitation
were major factors affecting the constancy of the physiologic rest position
Myofunctional therapy
1935 – 1951 – Rogers, related the normal development of the face, jaw and dentition to the
normal functional balance of the facial muscles.
Rogers suggested, that muscle exercise be used as an adjunct to mechanical correction of
malocclusion
He also was careful to point out that although muscle exercise elsewhere in the body generally
used to increase the size or strength of the muscles in the circumoral region
He proposed certain exercise to establish proper tonicity and function of facial muscles
Purpose: myotherapy is used to:
1- guide the development of the occlusion
2- give the growth pattern an optimal chance to express itself
3- provide the best retention possible for mechanically treated cases
7. 7
Dr. Mohammed Alruby
limitations:
= muscle exercise will not greatly alter the bony growth pattern or perform heronic tooth
movements
= clinician have that myofunctional appliances are generally more useful than exercise alone
Principles:
1- study the possible role of muscle dysfunction in the etiology and maintenance of the
malocclusion
2- remove, if possible such etiologic factor as deleterious habits (tonsils and adenoids)
3- remove by occlusal equilibration any interference in the primary dentition
4- establish early with minimal mechanotherapy, the proper arch form and occlusal
relationship
5- begin appropriate myofunctional therapy
6- be certain of occlusal functional harmony during reflex activities before ceasing appliance
therapy
Types of muscle exercise therapy:
1- Pterygoid muscle exercise:
indicated for the treatment of disto-occlusion as the weakness of this muscle can be responsible for
this type of malocclusion
= bringing the mandible in forward position so that, the mandibular incisors are held anterior to
the maxillary one, provided the maxillary incisors are in normal position
= then the patient is instructing to relax the pterygoid muscle and allow the mandible to recede to
the point where the dental arch is in their relatively mesiodistal relationship
= when the maxillary incisors are in extreme protrusion, the mandibular incisors should be
protruded to the limit forward direction but not anterior to the maxillary incisors
This exercise accomplishes the followings:
a- Enhance the ability of the patient to maintain correct mesiodistal relationship of the dental
arches without strain when an inclined plane is employed
b- The habit of keeping the mandible in the correct position in gradually developed
= when the dental arches are brought to correct form and normal mesiodistal relationship, the
patient is provided with an appliance as activator or inclined plane to ensure the maintenance of
the position of mechanical advantages
2- Masseter, temporalis muscles exercises:
= they assist in the correction of infra-occlusion and disto-occlusion
= this exercise should not be performed if the patient is unable to place the mandible in its correct
position
= the exercise consists of the contraction and relaxation of the masseter group of muscles with the
mandible in normal position
= the patient should be instructed when learning this exercise to place the tip of the forefinger over
the masseter muscles near the angle of the mandible to enable him to feel the contracting and
relaxing movements
8. 8
Dr. Mohammed Alruby
3- Tongue exercise:
= is an adjunct to the masseter temporalis exercise
= the patient is instructing to place the tongue against the mucous membrane directly behind the
mandibular incisors with each contraction of the masseter- temporal group of muscles to press the
tongue against the anterior section
= at the same time, by widening the tongue to force it against the lateral sides of the alveolar
process
= this exercise trains the tongue to remain in its proper position and has a tendency to prevent the
narrowing of the mandibular arch, facilitating the earlier removal of retentive appliance
4- Mentalis muscle exercise:
= include the development of the orbicularis oris and the associated muscles
= the exercises should be started as soon as the protrusion has been reduced to the extent, that it
is possible for the patient to close the lips without stretching them
Three exercises are recommended:
a- Exercise developed for the upper lip:
Developed by L, S, Lourie:
- Grape the chin firmly between the thumb and index finger with the lip relaxed
- Hold the lower lip down
- Close the lips
- Relax and repeat from 10 to 50 times at a specified time, as before meals
Note: when the lower lip is held down as the lips are closed, the upper lip must come down to meet
the lower lip
b- The exercise for enunciation of the letter P:
- The sound should be made forcibly
- It should be made in front of mirror
- The patient should be instructing how to make the sound
- Whether the mentalis muscle show excessive muscular activity at the beginning of the sound
must be noted
- Two exercises periods of 5 to 10 minutes each must be observed daily
c- Whistling:
= is an exceptionally fine exercise for orbicularis oris muscle, mentalis and the associated muscles
= the muscular activity is much more vigorous and powerful than that used in making the sound
P, the higher the note, the greater the muscular activity
= closer the lips in the presence of an overdeveloped mentalis muscle usually is accomplished by
an upward movement of the lower lip but slight, if any downward movement of the upper lip
= when the lips are closed, there is usually dimpling in the chin and tautness of mentalis muscle S
5- Orbicularis oris and facial muscle exercise:
a- Orbicularis oris exercise:
Is best performed with the aid of an exerciser designer, so that it is difficult to keep it within the
mouth (oral orifice) unless the orbicularis oris muscle is contracted properly
= the exercise is made of:
- Two curved bars of acrylic or stainless steel and united near their center by joint to which
handle at right angle is attached
- There are notches at one end of the bar, to which the elastic bands are attached so that,
there is a resistance to approximate the free ends of the bars
- The free ends are shaped to engage the angle of the mouth
9. 9
Dr. Mohammed Alruby
- This exercise is continued with one elastics during the 18th
week or two, and contraction
are increased daily until reach 50 to 60 a day
b- General tonic exercise:
Influenced not only the orbicularis oris, but also the muscles which work with the orbicularis oris
= it consists in taking a generous mouthful of warm saline solution, at a temperature which is
breakable to the mucous membrane of the mouth
= teeth held in firm occlusion
= the solution is forced through:
- Interproximal space
- Buccal cavity
- Lingual space
= the exercise is performed morning and night
= the exercise is continued until muscle fatigue is occur
= it is good for: tonic activity, mouth hygiene
10. 10
Dr. Mohammed Alruby
Basic concept of neuromuscular physiology
Introduction:
When the muscle is stretched the tension within the muscle is increase
Active tension: tension result from contraction of muscle tissue. All the mandibular elevator
muscles possess spindle so it has stretch reflexes but the facial muscles possess no spindle so the
stretching of this muscles not elicit stretched reflexes
Passive tension: tension result from the physical properties of the tissue. In many muscles,
elongation will result in an increase in both active and passive tension, and the sum of the tension
called total tension
1- Physiology of skeletal musculature:
= When the muscle is stimulated, it contracts usually causing its origin and insertion to approach
each other
= Muscle are not contractile but also are elastic, after repeated contraction or stretching, they
return to their original or resting length and maintain this length without further contraction
= Impulses run continually from the spindle of the muscles to the midbrain where connection is
made with motor pathways and the muscles are kept in a constant state of reflex determined
contraction called tonus. Tonus serve to maintain body posture
= when muscles are completely relaxed, there is no electro-myographic evidence of motor unit
activity
Clem Mensen: has suggested that resting muscle tone is due to passive elastic tension within
the muscle that is quite independent of the reflex stimulation through a motor nerve
Josef et al: have shown that the muscles of mastication nerve completely rest, due to the
continuing force of gravity
When the motor nerve to muscle is cut, the muscles undergoes atrophy when the muscle is
not used, disuse atrophy is set in. the process of atrophy is slower than the atrophy result
from nerve section.
2- Reflexes:
The basic unit of all integrated neural activity is the reflex arc. Each reflex arc has:
= receptor = afferent neuron = efferent neuron
= effector organ = one or more synapse
In both monosynaptic and polysynaptic reflexes but specially in polysynaptic reflexes activity is
modified by facilitation and inhibition
a- Conditioned reflexes: is an automatic response to stimulus that previously did not elicit the
response. The reflex is acquired by repeatedly pairing the neutral stimulus with another
stimulus that normally does produce the response
Example: in Pavlov’s classic experiments, there are two stimuli in dog brain, surrounding
bell and meat. It is possible to produce salivation by surrounding bell alone
b- Unconditioned reflexes: at the time of birth, the neonate’s central nervous system has
already matured sufficiently to perform many integrative processes
= the baby has appropriate integrative centers in the medulla sufficiently matured to control
reflex: blood pressure, respiration, protective reflex of cough and sneezing
As the child grows, the nervous system continuous to developed anatomically and to mature
physiologically
11. 11
Dr. Mohammed Alruby
3- Muscle learning:
= During fetal life, motor performance capability appears before sensory control, gradually, the
primitive motor system comes under sensory control of basic functions that must be operable before
birth
= Muscle learning is largely a process of acquiring new conditioned reflexes, in this manner, the
various pathways through the brain are gradually developed and imprinted as the body grows
through infancy, childhood into adulthood
= These pathways constitute muscle memory thoughts themselves are the result of complex reflex
in the central nervous system
= The brain gradually accumulates memory traces from both thought and motor activity as a part
of learning process
= any time a person decides to master a new motor skill; the learning process involves the three
important stages:
a- The brain must have a clear mental image of the task to be mastered
b- New pathways must be established and the conditioned reflex reinforced by repeated
practice of the new skill
c- Control of execution of the new skill must pass, the great extent from the higher centers of
the brain to the: midbrain, brain stem, and spinal cord.
4- Classes of neuro-muscular activities:
a- Unconditioned reflexes:
Unconditioned reflexes are present at birth, having appeared as normal part of the prenatal
maturation of the neuromuscular system
A process that does not involve any conditioning or learning. If such maturation has not occurred
by birth, the infant may not survive
Among the unconditioned reflexes operable in the oro-pharyngeal region of the neonate, are those
of: respiration, infantile swallow, suckling, cough, sneezing
Vomiting, gagging, tongue posture, mandibular posture
Unconditioned reflex requires minimal reinforcement and are very difficult to alter or change by
usual conditioning procedure
b- Conditioning reflex:
Include all reflexes that have been learned, including unwanted bad habits: tongue thrust, thumb
sucking.
c- Voluntary effort:
Willful acts are under cortical control rather than the lower centers, which reflexes activities are
integrated
The infantile swallow of the neonate is an example of an unconditioned reflex, the mature teeth
together swallow, which appear during the first year of life is an example of reflex appearing with
normal growth and development.
The learned teeth together a part swallow caused by painful tooth is an example of conditioned
reflex swallow, and of course, voluntary swallows as possible as well
d- Reflexes appearing with normal growth and development:
Obviously, no conditioned is capable of being learned until all the necessary units in the central
nervous system and musculature have matured sufficiently to make possible that learning
a- Mastication:
12. 12
Dr. Mohammed Alruby
Mastication is a complex pattern of jaw movements which are used to prepare the food for
swallowing. Pre-masticatory movements of the jaw can be seen before eruption of the teeth
= These movements are at first mainly in the vertical plane (simple hinge axis movements):
- Protrusive movements become evident with eruption of deciduous canines
- Lateral movements become evident with the eruption of deciduous molars
= The pattern of chewing become well defined by the end of the 1st
year, the chewing pattern
become comparatively mature
= Masticatory function is influenced by the eruption of primary teeth. the muscles controlling
mandibular position are stimulated by the fits occlusal contact of newly erupted incisors
= the sensory guidance of masticatory movements is provided by receptors present in TMJ, tongue,
muscles, oral mucosa
The lips become elongated and more selectively the tongue mobility is developed in various
movements independent of the lips and mandibular movements, the lips form anterior seal during
mastication, so that, the foods are not lost
b- Mature swallowing:
= As the deciduous teeth erupt, the mouth become divided into the oral cavity proper and the oral
vestibules. The alveolar bone and teeth now form the anterior and lateral rigid support to the
tongue during swallowing.
= Rix and Whillis have suggested, that, the significance difference between infant and adult
swallowing is the firm occlusion of the teeth at the moment of transfer of foods into the oropharynx.
The transition from infantile to mature swallowing takes place over several months aided by:
- Complete eruption of primary teeth
- Stabilization of the mandible
- Neuro-muscular regulation
- Appearance of upright head posture
N: B: change to achieve mature swallowing between 12 and 15 months
Swallowing can be divided into three phases:
1- Intra-oral phase: (voluntary)
= This phase includes mechanisms by which the food is transferred from anterior to posterior part
of tongue, in this phase, the food is taken into the mouth by the tongue and present in the depression
of the central portion of the tongue, the groove is obliterated from backward by contraction of
transverse group of muscles, (intrinsic muscles of tongue)
= As the result of that, the bolus of food is moved backward to the posterior aspect of the dorsal
surface of the tongue, then inter the 2nd
stage
2- Second or mylohyoid phase: (voluntary):
= the teeth are brought into firm occlusion to fix the mandible allowing a firm contraction of
mylohyoid muscle to evaluate the floor of the mouth and tongue
= the tongue is compressed against the hard palate
= the lips and cheek play no actual part
= with semisolid foods, there is definite grooving and squirting actions of the tongue as described
in swallowing fluids.
3- Third phase:
= this phase includes the movements of bolus of food down to esophagus
= as the food enter the pharynx, the muscular activity is no longer under voluntary control
= two protective mechanisms come into play:
13. 13
Dr. Mohammed Alruby
1- Nasopharyngeal closure by contraction of the pharyngeal musculature and elevation of the
soft palate
2- Closing the larynx by epiglottis
Characteristic features of mature swallowing:
a- The teeth are brought together into centric occlusion with the exception of swallowing
liquids from a cup
b- The mandible is elevated and stabilized by the mandibular elevators
c- The tongue tip is held against the rouge area of the hard palate just behind the maxillary
incisors
d- Minimal role of the buccinator and lips
e- No contraction of muscles of facial expression
c- Speech:
Speech is a conditioned reflex which performed on background of stabilized and learned position
of the mandible, pharynx and tongue. Speech consists of four parts:
- Language
- Voice: produced by air passed between the vibrating vocal cords of the larynx
- Articulation: the movement of speech organs: lips, teeth, palate, tongue, mandible, to
produce sounds
- Rhythm: variation in the quality, length, timing and stress of sound if no disturbance in
hearing or oral sensation
The child will learn to speck by imitation
All speech function takes place within border movement of the mandible
d- Facial expression:
In the new born infant, the facial musculatures, particularly that of the middle third of the face are
rather flaccid
Only the lower lip is active
The lips may either together or slightly parted at this time and this is not related to their future
posture
The initial expression of the child face may be in the form of discomfort or displeasure, and time,
the facial expression become meaningful
Facial expression depends on:
- The morphology and configuration of soft tissue covering the face
- Neuro-muscular maturation
- Type of external stimuli
Facial expression is a conditioned reflex which can be learned by imitation