This document presents two case reports of patients with anterior open bite treated using different approaches based on the patients' tongue posture at rest.
The first case involved a patient with a high tongue posture, treated successfully with a Hawley retainer and crib to restrain the tongue horizontally. Results were stable 32 years later.
The second case had a horizontal tongue posture, treated initially with headgear, expansion screw, and palatal crib to restrain the tongue. Follow up treatment corrected the malocclusion and stable results were seen 10 years later.
The document discusses how determining tongue posture guides open bite treatment, with restraining approaches used for high/horizontal postures and orienting treatment for low/very low post
The term Deep Bite and ways to manage it simplified.
TYPES, MANAGEMENT,
*The illustrative videos used in the presentation may not play.
(refer to YouTube)
This document discusses factors that orthodontists consider when determining whether to extract teeth as part of orthodontic treatment. It outlines general factors like medical conditions, age, and pathology, as well as factors specific to the malocclusion like the skeletal pattern, degree of crowding, overjet, and overbite. Diagnostic elements that can influence the decision for extractions include issues with compliance, the tooth-arch discrepancy, cephalometric measurements and facial profile, growth stage, and dental asymmetries. Sound decision-making relies on evaluating these elements to determine the best treatment approach.
This document discusses the diagnosis and treatment of deep overbites. It begins by defining developmental and acquired deep overbites, and classifying them as dentoalveolar or skeletal. For dentoalveolar deep bites, intrusion of incisors or extrusion of molars may be used to correct the overbite. For skeletal deep bites, functional appliances or extraoral forces can modify jaw growth. Treatment may involve intrusion, extrusion, altering the occlusal plane, or guiding eruption. Deep overbites can be addressed during growth or after using compensation mechanics. The document provides details on various techniques and considerations for deep overbite treatment.
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 ForsusTM FRD is a flexible fixed functional appliance developed by Bill Vogt in 2001 that can be used with a fixed pre-adjusted Edgewise appliance.
- It consists of spring modules, push rods of varying lengths, split crimps, and a measurement gauge.
- The ForsusTM is recommended for Class II cases where patients did not cooperate with class II elastics, and is planned from the beginning of treatment.
This document discusses molar distalization, which is an alternative method for gaining space when treating orthodontic patients with space deficiencies. It provides the history of molar distalization, indications and contraindications for its use, different appliance options, and considerations for appliance selection. Molar distalization involves using orthodontic appliances to distalize or move the molars backwards in the dental arch in order to gain space.
Recent advances in orthodontics include improvements to brackets, bonding materials, wires, software, and appliances. Brackets are now made from stronger materials with coatings to reduce friction and promote oral health. New bonding materials bond more effectively in fewer steps. Wires now come in various alloys and shapes to apply lighter continuous forces. Software includes apps for patients and artificial intelligence to assist with treatment planning. These technological advances have improved orthodontic treatment outcomes.
The term Deep Bite and ways to manage it simplified.
TYPES, MANAGEMENT,
*The illustrative videos used in the presentation may not play.
(refer to YouTube)
This document discusses factors that orthodontists consider when determining whether to extract teeth as part of orthodontic treatment. It outlines general factors like medical conditions, age, and pathology, as well as factors specific to the malocclusion like the skeletal pattern, degree of crowding, overjet, and overbite. Diagnostic elements that can influence the decision for extractions include issues with compliance, the tooth-arch discrepancy, cephalometric measurements and facial profile, growth stage, and dental asymmetries. Sound decision-making relies on evaluating these elements to determine the best treatment approach.
This document discusses the diagnosis and treatment of deep overbites. It begins by defining developmental and acquired deep overbites, and classifying them as dentoalveolar or skeletal. For dentoalveolar deep bites, intrusion of incisors or extrusion of molars may be used to correct the overbite. For skeletal deep bites, functional appliances or extraoral forces can modify jaw growth. Treatment may involve intrusion, extrusion, altering the occlusal plane, or guiding eruption. Deep overbites can be addressed during growth or after using compensation mechanics. The document provides details on various techniques and considerations for deep overbite treatment.
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 ForsusTM FRD is a flexible fixed functional appliance developed by Bill Vogt in 2001 that can be used with a fixed pre-adjusted Edgewise appliance.
- It consists of spring modules, push rods of varying lengths, split crimps, and a measurement gauge.
- The ForsusTM is recommended for Class II cases where patients did not cooperate with class II elastics, and is planned from the beginning of treatment.
This document discusses molar distalization, which is an alternative method for gaining space when treating orthodontic patients with space deficiencies. It provides the history of molar distalization, indications and contraindications for its use, different appliance options, and considerations for appliance selection. Molar distalization involves using orthodontic appliances to distalize or move the molars backwards in the dental arch in order to gain space.
Recent advances in orthodontics include improvements to brackets, bonding materials, wires, software, and appliances. Brackets are now made from stronger materials with coatings to reduce friction and promote oral health. New bonding materials bond more effectively in fewer steps. Wires now come in various alloys and shapes to apply lighter continuous forces. Software includes apps for patients and artificial intelligence to assist with treatment planning. These technological advances have improved orthodontic treatment outcomes.
This document discusses the management of open bite malocclusions. It begins by defining open bite and classifying it as either skeletal or dental in nature. Skeletal open bite is caused by excessive vertical growth of the jaws while dental open bite is due to reduced incisor height. Common etiologies of open bite include thumb sucking habits, tongue thrusting, and abnormal skeletal growth patterns. The document outlines various treatment approaches for different open bite classifications and etiologies.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses various methods and appliances for distalizing maxillary molars, including removable and fixed options. Removable appliances discussed include extraoral traction using headgear as well as removable appliances with finger springs or sliding jigs. Fixed appliances discussed include intramaxillary devices like Wilson's 3D appliance as well as intermaxillary appliances like Herbst or Jasper Jumper. Factors like the presence of second molars, skeletal pattern, and growth prognosis must be considered when determining whether molar distalization is indicated.
The document discusses the history and evolution of lingual orthodontics, describing the development of various lingual bracket systems from the 1970s to present. It covers key topics like patient selection, diagnostic considerations, bonding techniques, biomechanics, and keys to success with lingual therapy. Lingual orthodontics offers aesthetic benefits over labial appliances but also presents certain challenges in terms of treatment complexity and costs.
This document discusses the classification and treatment of open bite malocclusions. It defines open bite as a condition where there is space between the maxillary and mandibular teeth when the jaw is closed. Open bite can be caused by epigenetic factors like tongue size/posture or environmental factors like abnormal tongue function. Treatment approaches include habit correction, growth modification, orthodontic camouflage, or orthognathic surgery. Various orthodontic appliances are discussed that can be used to correct open bite such as tongue cribs, lip bumpers, headgear, and bite blocks.
Functional appliances utilize the natural forces of the orofacial musculature to produce skeletal and dental changes. They are based on Moss's functional matrix theory which proposes that muscles and glands influence bone growth. Functional appliances can be active or passive and produce orthopedic, dentoalveolar, and muscular changes through forces of compression, elimination of restrictive influences, and mandibular repositioning. Common functional appliances discussed in the document include Bionators, Twin-Blocks, Herbst, Frankel Regulator, and Jasper Jumper. They vary in their mode of action, indications, advantages, and disadvantages.
This document discusses the definition, etiology, and management of anterior open bite. It defines anterior open bite as a malocclusion where the maxillary and mandibular incisors do not overlap vertically when the back teeth are in occlusion. Anterior open bite can be caused by skeletal factors like increased lower facial height, habits like digit sucking or tongue thrusting, soft tissue patterns, localized developmental failures, and mouth breathing. Management approaches include removing the underlying cause, using growth modification appliances in children, fixed appliance therapy, and in severe skeletal cases, surgical intervention like maxillary osteotomies.
The document discusses headgear, including:
- A brief history of headgear from the late 1800s to present day.
- The components and assembly of headgear including head caps, neck straps, face bows, molar bands and tubes.
- The types of headgear including high pull, low pull, and combinations.
- The uses of headgear such as for growth modification in class II malocclusions, anchorage reinforcement, molar distalization, and space maintenance.
- Guidelines for headgear force prescription, wear time, and expected tooth movements.
This document discusses anchorage in orthodontics. It defines anchorage as the resistance to unwanted tooth movement. It classifies anchorage according to site (intraoral vs extraoral), number of units (simple vs compound), and arch form (Moyers and Burstone classifications). Biological factors like tooth morphology and muscles affect anchorage. Mechanically, friction influences anchorage. The document reviews anchorage considerations for removable and fixed appliances historically used like edgewise and Begg appliances. It also discusses anchorage preparation and loss.
Myofunctional appliances -activators /certified fixed orthodontic courses b...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
This document discusses open bite, including definitions, classifications, anterior open bite (AOB), and posterior open bite (POB). It defines open bite as a malocclusion where there is no vertical overlap between the maxillary and mandibular anterior or posterior teeth. AOB is more common than POB and can be caused by factors like thumb sucking, increased vertical facial proportions, tongue posture, mouth breathing, and neurological issues. Diagnosis involves assessing medical history and performing tests like the Overbite Depth Indicator. Treatment aims to correct the underlying causes and close the open bite.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document provides information on headgear, including its components, principles of use, types, and applications in orthodontic treatment. Headgear delivers extraoral force from a cranial support to intraoral appliances. It consists of a facebow, force element, and head cap. Forces from headgear can distalize teeth and maxilla through different anchorage points. Types include cervical, occipital, and high pull headgear. Headgear is useful for orthopedic effects, anchorage reinforcement, molar distalization, and space maintenance.
The document discusses orthodontic triage, which is the process of distinguishing moderate orthodontic treatment problems from complex cases. It outlines five steps for orthodontic triage: examining syndromes and developmental abnormalities, performing facial profile analysis, assessing dental development, analyzing space problems, and identifying other occlusal discrepancies. The document also discusses criteria for selecting growth modification patients and managing various orthodontic issues like crossbites, eruption problems, and space deficiencies.
This document provides an overview of clear aligner biomechanics and why they are less efficient than fixed appliances at moving teeth. It discusses the two primary mechanisms by which aligners move teeth - shape molding and auxiliaries. Simple tipping is the default tooth movement for both aligners and fixed appliances. The document then explores reasons for aligners' lower efficiency, including their inability to direct force through the tooth's center of resistance, lack of control over force delivery, stress relaxation within the material, and limitations of current prediction systems. Overall, the average efficiency of tooth movement with aligners is around 50%.
This document discusses the management of low angle cases (skeletal deep bites). It covers the etiology, which can include hereditary factors and horizontal growth patterns. Clinical features include a short square face, upper teeth hidden behind the lips, and decreased interlabial distance. Diagnostic features include decreased facial angles and a horizontal growth pattern seen on cephalograms. Management options discussed include removable appliances, growth modification, magnets, fixed appliances, implants, lingual appliances, Invisalign, and surgery. Stability and retention are also addressed.
This document discusses various types of dental retention appliances. It begins by defining retention and explaining why it is necessary after orthodontic treatment. It then covers theories of retention, keys to eliminating lower retention, and classifications of retainers. The main types of retainers discussed are removable retainers like Hawley retainers, wrap-around retainers, and Essix retainers. Fixed retainers and principles of different retention times are also summarized.
biomechanics of space closure in orthodonticcs / fixed orthodontics coursesIndian 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.
Functional matrix Hypothesis- RevisitedDr Susna Paul
The document summarizes the functional matrix hypothesis, which proposes that craniofacial bone growth is in response to mechanical stimuli from surrounding soft tissues. It revisits the hypothesis by incorporating recent understandings of mechanotransduction, the connected cellular network of bone cells, and the interplay between genetic and epigenetic factors. Specifically, it describes how mechanical loads are sensed by bone cells and transmitted through the cellular network to regulate gene expression and bone formation. It presents the original genomic thesis of bone development being controlled by genes alone, the epigenetic antithesis of multiple developmental processes, and a resolution synthesizing both genetic and epigenetic influences.
This document discusses the management of open bite malocclusions. It begins by defining open bite and classifying it as either skeletal or dental in nature. Skeletal open bite is caused by excessive vertical growth of the jaws while dental open bite is due to reduced incisor height. Common etiologies of open bite include thumb sucking habits, tongue thrusting, and abnormal skeletal growth patterns. The document outlines various treatment approaches for different open bite classifications and etiologies.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses various methods and appliances for distalizing maxillary molars, including removable and fixed options. Removable appliances discussed include extraoral traction using headgear as well as removable appliances with finger springs or sliding jigs. Fixed appliances discussed include intramaxillary devices like Wilson's 3D appliance as well as intermaxillary appliances like Herbst or Jasper Jumper. Factors like the presence of second molars, skeletal pattern, and growth prognosis must be considered when determining whether molar distalization is indicated.
The document discusses the history and evolution of lingual orthodontics, describing the development of various lingual bracket systems from the 1970s to present. It covers key topics like patient selection, diagnostic considerations, bonding techniques, biomechanics, and keys to success with lingual therapy. Lingual orthodontics offers aesthetic benefits over labial appliances but also presents certain challenges in terms of treatment complexity and costs.
This document discusses the classification and treatment of open bite malocclusions. It defines open bite as a condition where there is space between the maxillary and mandibular teeth when the jaw is closed. Open bite can be caused by epigenetic factors like tongue size/posture or environmental factors like abnormal tongue function. Treatment approaches include habit correction, growth modification, orthodontic camouflage, or orthognathic surgery. Various orthodontic appliances are discussed that can be used to correct open bite such as tongue cribs, lip bumpers, headgear, and bite blocks.
Functional appliances utilize the natural forces of the orofacial musculature to produce skeletal and dental changes. They are based on Moss's functional matrix theory which proposes that muscles and glands influence bone growth. Functional appliances can be active or passive and produce orthopedic, dentoalveolar, and muscular changes through forces of compression, elimination of restrictive influences, and mandibular repositioning. Common functional appliances discussed in the document include Bionators, Twin-Blocks, Herbst, Frankel Regulator, and Jasper Jumper. They vary in their mode of action, indications, advantages, and disadvantages.
This document discusses the definition, etiology, and management of anterior open bite. It defines anterior open bite as a malocclusion where the maxillary and mandibular incisors do not overlap vertically when the back teeth are in occlusion. Anterior open bite can be caused by skeletal factors like increased lower facial height, habits like digit sucking or tongue thrusting, soft tissue patterns, localized developmental failures, and mouth breathing. Management approaches include removing the underlying cause, using growth modification appliances in children, fixed appliance therapy, and in severe skeletal cases, surgical intervention like maxillary osteotomies.
The document discusses headgear, including:
- A brief history of headgear from the late 1800s to present day.
- The components and assembly of headgear including head caps, neck straps, face bows, molar bands and tubes.
- The types of headgear including high pull, low pull, and combinations.
- The uses of headgear such as for growth modification in class II malocclusions, anchorage reinforcement, molar distalization, and space maintenance.
- Guidelines for headgear force prescription, wear time, and expected tooth movements.
This document discusses anchorage in orthodontics. It defines anchorage as the resistance to unwanted tooth movement. It classifies anchorage according to site (intraoral vs extraoral), number of units (simple vs compound), and arch form (Moyers and Burstone classifications). Biological factors like tooth morphology and muscles affect anchorage. Mechanically, friction influences anchorage. The document reviews anchorage considerations for removable and fixed appliances historically used like edgewise and Begg appliances. It also discusses anchorage preparation and loss.
Myofunctional appliances -activators /certified fixed orthodontic courses b...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
This document discusses open bite, including definitions, classifications, anterior open bite (AOB), and posterior open bite (POB). It defines open bite as a malocclusion where there is no vertical overlap between the maxillary and mandibular anterior or posterior teeth. AOB is more common than POB and can be caused by factors like thumb sucking, increased vertical facial proportions, tongue posture, mouth breathing, and neurological issues. Diagnosis involves assessing medical history and performing tests like the Overbite Depth Indicator. Treatment aims to correct the underlying causes and close the open bite.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document provides information on headgear, including its components, principles of use, types, and applications in orthodontic treatment. Headgear delivers extraoral force from a cranial support to intraoral appliances. It consists of a facebow, force element, and head cap. Forces from headgear can distalize teeth and maxilla through different anchorage points. Types include cervical, occipital, and high pull headgear. Headgear is useful for orthopedic effects, anchorage reinforcement, molar distalization, and space maintenance.
The document discusses orthodontic triage, which is the process of distinguishing moderate orthodontic treatment problems from complex cases. It outlines five steps for orthodontic triage: examining syndromes and developmental abnormalities, performing facial profile analysis, assessing dental development, analyzing space problems, and identifying other occlusal discrepancies. The document also discusses criteria for selecting growth modification patients and managing various orthodontic issues like crossbites, eruption problems, and space deficiencies.
This document provides an overview of clear aligner biomechanics and why they are less efficient than fixed appliances at moving teeth. It discusses the two primary mechanisms by which aligners move teeth - shape molding and auxiliaries. Simple tipping is the default tooth movement for both aligners and fixed appliances. The document then explores reasons for aligners' lower efficiency, including their inability to direct force through the tooth's center of resistance, lack of control over force delivery, stress relaxation within the material, and limitations of current prediction systems. Overall, the average efficiency of tooth movement with aligners is around 50%.
This document discusses the management of low angle cases (skeletal deep bites). It covers the etiology, which can include hereditary factors and horizontal growth patterns. Clinical features include a short square face, upper teeth hidden behind the lips, and decreased interlabial distance. Diagnostic features include decreased facial angles and a horizontal growth pattern seen on cephalograms. Management options discussed include removable appliances, growth modification, magnets, fixed appliances, implants, lingual appliances, Invisalign, and surgery. Stability and retention are also addressed.
This document discusses various types of dental retention appliances. It begins by defining retention and explaining why it is necessary after orthodontic treatment. It then covers theories of retention, keys to eliminating lower retention, and classifications of retainers. The main types of retainers discussed are removable retainers like Hawley retainers, wrap-around retainers, and Essix retainers. Fixed retainers and principles of different retention times are also summarized.
biomechanics of space closure in orthodonticcs / fixed orthodontics coursesIndian 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.
Functional matrix Hypothesis- RevisitedDr Susna Paul
The document summarizes the functional matrix hypothesis, which proposes that craniofacial bone growth is in response to mechanical stimuli from surrounding soft tissues. It revisits the hypothesis by incorporating recent understandings of mechanotransduction, the connected cellular network of bone cells, and the interplay between genetic and epigenetic factors. Specifically, it describes how mechanical loads are sensed by bone cells and transmitted through the cellular network to regulate gene expression and bone formation. It presents the original genomic thesis of bone development being controlled by genes alone, the epigenetic antithesis of multiple developmental processes, and a resolution synthesizing both genetic and epigenetic influences.
This document discusses various analyses used in dental diagnosis and treatment planning including Bolton analysis, space analysis, and mixed dentition analysis. Bolton analysis examines the balance between the mesiodistal diameters of maxillary and mandibular teeth. Specific ratios are calculated for the overall dentition and anterior teeth. Mixed dentition analysis is used to estimate the size of permanent canines and premolars and the available space in the permanent dentition. Other analyses mentioned include measurements of crowding, spacing, tooth size, arch perimeter, and curve of spee. Huckaba's and Moyer's methods are also referenced for predicting premolar and molar sizes based on primary tooth measurements.
Early vs late orthodontic treatment /certified fixed orthodontic courses by I...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.
Bolton analysis and mixed dentition analysisMasuma Ryzvee
This document summarizes methods for Bolton analysis and mixed dentition analysis. Bolton analysis measures tooth size ratios to determine excess tooth material. Mixed dentition analysis predicts widths of unerupted canines and premolars using methods like radiographs, Moyer's tables, or equations. Radiographic analysis measures primary tooth and unerupted tooth widths on radiographs. Moyer's tables and equations like Tanaka-Johnston predict canine and premolar widths based on measured incisor widths.
The Indian Centre For The Alexander Technique (1)padmini_at
Padmini Menon teaches the Alexander Technique in Bangalore, India. She received her training at the Brighton Alexander Technique College in the UK from 2005-2008. She then founded the Indian Centre for the Alexander Technique in Bangalore. Her students include people from various backgrounds seeking to address musculoskeletal issues or improve overall well-being.
Biomechanics of open bite correction /certified fixed orthodontic courses by ...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 document discusses Alexander Technique, a method developed by Matthias Alexander in 1890 to align the body physically and mentally. It focuses on relaxing tension in the torso to allow free movement and breathing. Alexander Technique is commonly used in singing training to help singers develop proper posture, breathing, and avoid injury. It can also benefit other performers and be used in physical therapy to treat posture and movement issues.
The document discusses the edentulous state and complete dentures. It covers topics like the etiology of tooth loss, prevalence of edentulism, residual ridge resorption over time, forces generated during chewing with natural teeth versus dentures, and the impact of tooth loss on diet and nutrition. The goal of complete denture construction is to minimize forces on supporting tissues and decrease denture movement by achieving good border extension and intimate fit during impression taking and through relines. Masticatory performance is reduced with dentures compared to natural teeth.
- Forward Head Syndrome (FHS) is a constellation of health issues that arise from chronic forward head posture (FHP). FHP places extra pressure on the neck, heart, lungs and digestive system, and can reduce lung function by up to 30%.
- FHS has been linked to a 42% increased risk of cardiovascular disease in men over 50. Even a 3cm loss of height has been associated with this increased risk.
- Prolonged use of laptops, phones and other devices, time spent sitting in cars and chairs, and poor posture habits can all contribute to the development of FHS over time. Simple exercises and posture awareness can help address and prevent FHS.
1. Comprehensive orthodontic treatment involves repositioning nearly all teeth to achieve an ideal occlusion. It is ideally done during adolescence when permanent teeth have erupted but growth remains.
2. Treatment involves 4 stages - alignment and leveling, correction of molar relationship and space closure, finishing, and retention.
3. The first stage, alignment and leveling, aims to align teeth and correct vertical discrepancies. This is done using round nickel-titanium wires which apply light continuous forces.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses various developmental disturbances that can affect teeth. It covers disturbances in size such as microdontia and macrodontia. It also discusses disturbances in number, including hypodontia, oligodontia, and supernumerary teeth. Various morphological disturbances are described, including fusion, gemination, taurodontism, dens evaginatus, and enamel pearls. Genetic conditions that can cause defects in enamel such as amelogenesis imperfecta are also reviewed. The document provides diagnostic criteria and differentiating features for many of the discussed dental abnormalities and developmental disturbances.
This document provides an overview of serial extraction in orthodontic treatment. It discusses the history, definitions, diagnosis, indications, contraindications, advantages, disadvantages, treatment sequence, appliances used, and conclusions regarding serial extraction. Key points covered include using serial extraction to relieve crowding by removing primary and permanent teeth in a planned sequence, the importance of understanding facial growth and development, and balancing the dental, skeletal, and muscular systems when determining case selection and treatment objectives.
This document summarizes information about endocrine disorders, with a focus on diabetes mellitus. It describes the different types of diabetes, including type 1, type 2, gestational diabetes, and maturity-onset diabetes of the young. The clinical features, acute and chronic complications, diagnosis, and management of diabetes are discussed in detail. Treatment involves lifestyle changes, oral medications, insulin administration, and glycemic control monitoring. Dental considerations for diabetic patients are also reviewed.
Cephalometrics is the standardized radiographic analysis of craniofacial structures used in orthodontic diagnosis and treatment planning. Key points:
1) Cephalometric analysis involves identifying anatomical landmarks on lateral skull radiographs, then measuring angular and linear relationships between structures to evaluate the sagittal, vertical, and dental relationships.
2) Common analyses include Downs, Steiner, Tweed, and McNamara which assess the position of maxilla, mandible, and teeth.
3) Sagittal analysis evaluates the skeletal relationship of maxilla to cranial base and mandible. Vertical analysis assesses facial height and inclination. Dental analysis examines tooth positions.
Modelanalysis /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
Serial extraction /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
wick alexander technique of pre adjusted edgewise appliance /certified fixed ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
This document provides an overview of orthognathic surgery and how it is used in conjunction with orthodontics to improve facial balance and alignment. It defines orthognathic surgery as jaw surgery to reposition the jaws and discusses reasons a patient may need it, including for functional issues or aesthetic/social reasons due to a malocclusion. It describes the process of orthognathic treatment, including patient selection, pre-surgical orthodontics, the surgery itself, post-surgical recovery and orthodontic treatment, and finalization of treatment.
Bimaxillary proclination is a condition characterized by protrusive and proclined upper and lower incisors. It is most common in Afro-Caribbean populations and also seen in some Asian and Arab groups. Skeletal, soft tissue, dental, and habit-related factors can all contribute to the development of bimaxillary proclination. Treatment depends on the severity and may involve nonextraction for mild cases or extraction of first premolars with orthodontic alignment in moderate to severe cases. Stability can be improved with permanent retention like bonded lingual retainers.
- The document discusses various oral habits in children including tongue thrusting, mouth breathing, bruxism, lip biting, nail biting, cheek biting, and self-injurious habits.
- It provides classifications of tongue thrusting by various authors, describes the differences between infantile and adult swallowing patterns, and lists features of simple and complex tongue thrusting.
- Diagnosis methods for tongue thrusting including history, functional examination, and palpatory examination are explained. Treatment considerations and management techniques such as myofunctional exercises and appliances are also outlined.
Management of vertical malocclusions.pptxFongChanyip
This document discusses the management of vertical problems in orthodontics. It defines deep bite as excessive vertical overlap of the incisors and open bite as a lack of overlap. Normal overbite is 1-3 mm. Deep bite can be dental or skeletal in nature, while open bite can be simple (dental) or complex (skeletal). Treatment depends on factors like facial profile, lip competence, and vertical growth pattern. Intrusion or extrusion mechanics may be used to correct deep bite, while habit correction and appliances are used for open bite. Short and long facial patterns present additional challenges and may require orthognathic surgery.
MOUTH BREATHER AND NARROWING OF MAXILLA.pptxmathew mseke
Mouth breathing can be caused by nasal obstruction from allergies, enlarged adenoids, or pollution. It leads to an inferior mandibular position and changes in facial muscle activity, resulting in a long narrow face, high anterior face height, narrow maxilla, open bite, and increased overjet. These anatomical changes occur as the mouth breather adapts their posture to breathe through their mouth by lowering the mandible and tongue and extending the head. Over time, if this posture is maintained, it can interfere with normal jaw and facial growth.
The document discusses the role of the tongue in causing and maintaining malocclusion. It describes tongue anatomy, muscles, development of swallowing patterns from infancy to maturity, and evaluation methods. Abnormal tongue size, posture and function can influence malocclusion, such as a retracted tongue causing crowding. Tongue thrust can cause open bites and other issues. Treatment may involve muscle training and appliances to encourage proper tongue posture and swallowing. The size, function and position of the tongue are closely related to dentofacial development and malocclusion.
This document discusses the management of anterior and posterior open bites. It defines open bites and provides classifications based on location and etiology. For anterior open bites, it discusses evaluating factors like overbite depth indicator and various treatment approaches including no active treatment, habit breakers, removable appliances, fixed appliances, implants, and surgery. For posterior open bites, it notes management includes avoiding extrusion of posterior teeth and intruding molars. Treatment approaches are discussed for growing vs non-growing patients.
1. Oral habits in children such as thumb sucking, pacifier use, and tongue thrusting can cause dental issues like anterior open bite, impacted teeth, and crossbites due to the pressure placed on teeth.
2. The duration and frequency of oral habits plays the biggest role in determining the changes to teeth, with 4-6 hours of force daily usually needed to move teeth.
3. Treatment involves stopping the habit, often through reminders or appliances, as well as correcting any resulting malocclusion through appliances or orthodontics. Non-dental interventions are usually first before using devices.
This document discusses various environmental influences that can contribute to malocclusion, including sucking habits, tongue thrust swallowing, respiratory patterns, and injuries to the soft tissues of the lips and cheeks. While these factors have the potential to impact tooth alignment by altering functional forces, the evidence for their role in causing malocclusion is mixed. For example, sucking habits during primary dentition often have little long-term effect, and the force and duration of tongue thrust swallowing is typically not enough to move teeth. Mouth breathing may slightly change craniofacial posture but does not usually cause severe malocclusion on its own. Overall, environmental influences are best thought of as contributing factors that can combine with genetic predispositions
This document discusses open bite treatment in the permanent dentition using vertical elastics. It begins by differentiating between dentoalveolar and skeletal open bites, noting that skeletal open bites involve greater skeletal involvement and are more difficult to treat. Nonextraction treatment of open bites uses vertical elastics to extrude anterior teeth and close the bite over 18-20 hours per day. Tongue posture must also be addressed through the use of tongue cribs or spurs. Retention involves a maxillary retainer with an orifice to modify tongue posture. Close monitoring is needed to ensure patient compliance with elastic wear.
This document discusses the diagnosis and treatment of open bites in the permanent dentition. It begins by differentiating between dental and skeletal open bites, noting that skeletal open bites tend to be more severe and involve underlying skeletal discrepancies. Treatment options are then outlined, including nonextraction correction through anterior tooth extrusion using vertical elastics. The use of tongue cribs or spurs to modify tongue posture is also described as important for stability. Factors such as incisor display, facial height, and underlying skeletal patterns guide the decision between extrusion or intrusion approaches.
Lecture 8 management of patients with orofacial cleftsLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name management of patients with orofacial clefts
Lecture 8
Al Azhar University Gaza Palestine
Dr. Lama El Banna
This document discusses factors involved in arranging anterior artificial teeth. The objectives of anterior tooth arrangement are primarily esthetics as well as proper lip support, satisfactory phonetics, and function. Key factors discussed include resorption patterns in the maxilla and mandible, basic factors in positioning teeth such as slope and inclination, and how arrangement is influenced by age, sex, personality, and cosmetic goals. Guidelines are provided for arranging individual tooth types in different arch forms.
Tongue & its prosthetic coniderations seminaradifay wan
This document provides an overview of the anatomy of the tongue. It begins with an introduction and then covers the gross anatomy, muscles, blood supply, innervation, taste buds, and histological features of the tongue. It also discusses age-related changes and the applied anatomy of the tongue in relation to prosthodontics. Specifically, it explores how the tongue influences the stability of dentures and the neutral zone. The document concludes with a section on prosthetic considerations for the tongue.
This document presents an orthodontic case presentation for a 13-year-old female patient with the chief complaint of her teeth being too forward. The patient has a class II malocclusion with increased vertical dimension and compromised smile esthetics. The proposed treatment plan is non-extraction with growth modification using high-pull headgear to correct the skeletal discrepancy. The treatment aims to correct the dental and skeletal problems through fixed appliances and stripping of the lower incisors. Retention will involve short-term Hawley retainers and long-term lingual retainers to prevent relapse.
Post insertion problems are common with complete dentures as they act as foreign bodies in the mouth. Common complaints include looseness, pain, difficulty eating and speaking. Causes of problems include poor fit from over-extended or under-extended borders, poor jaw relations, cusp interference, and an uncooperative patient. It is important to thoroughly check dentures before delivery by examining the borders, retention, stability, jaw relations, and other factors to minimize post insertion issues. Proper evaluation and adjustment can help reduce complaints and improve patient satisfaction with their new dentures.
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Anterior Open Bite etiology and differential diagnosisMarwan Mouakeh
This document discusses the etiology and classification of anterior open bite. It defines anterior open bite and discusses its prevalence, which can range from 1.5-11% and varies among races. Anterior open bite is classified as dental, dentoalveolar, or skeletal depending on whether it is restricted to the anterior teeth or involves the underlying skeletal structures. The etiology of anterior open bite is multifactorial, involving genetic, anatomic, and environmental factors. Genetic factors include unfavorable growth patterns and increased tongue size. Environmental factors prominently include non-nutritive sucking habits which can cause dental changes, as well as abnormal tongue function and airway obstructions.
This case report describes the orthodontic treatment of a 24-year-old female patient presenting with an anterior open bite. Treatment objectives were to correct the open bite, spacing, establish a normal overjet and overbite, and improve aesthetics and function. Edgewise brackets were bonded and initial leveling was performed. Canine retraction and incisor approximation were accomplished using power chains and arch wires. Cephalometric analysis revealed the lower incisors were positioned too far forward. Arch coordination and 5mm lower arch contraction were performed to achieve the treatment objectives. Over two years of treatment, a Class I canine and molar relationship with satisfactory interdigitation and correction of the open bite were achieved.
Magnets have been used in orthodontics since the 1970s to provide tooth movement. They provide advantages over conventional appliances like constant force levels without decay, less patient discomfort, and faster tooth movement. Various types of magnets can be used in clinical applications like impacted tooth relocation, diastema closure, extrusion or intrusion of teeth, and malocclusion correction. While magnets offer benefits, they also have disadvantages like corrosion, bulkiness, and thermal sensitivity that limit their routine use in practice.
This document presents a case report on the orthodontic treatment of a 16-year-old female patient named Pinki who presented with crowding in both dental arches. She had previously undergone unsuccessful treatment with a removable appliance by an underground student. The current treatment involved fixed appliance therapy including initial leveling and alignment with round wires followed by use of rectangular wires to correct minor irregularities and achieve arch contraction. Interdigitation was improved with elastics. Post-treatment intraoral photographs show significant improvement in crowding and occlusion.
This document provides instructions for making alginate impressions. It describes positioning the patient upright for maxillary and mandibular impressions. Stock trays should be selected to leave 6mm of space between the tray and mucosa. Trays may need modification by adding wax. For maxillary impressions, alginate is loaded into the tray and pressed upward and backward. For mandibular impressions, alginate is placed in the retromolar area before inserting the loaded tray. Proper mixing, border molding, and quick removal of the impression is important. Impressions should be disinfected and poured within an hour to prevent syneresis. Modifications are described for patients with gagging, salivation issues, or hyper
A bite registration is made by having the patient bite into softened baseplate wax or modeling wax in order to record how their teeth come together. The wax is softened and placed over the teeth, and the patient is instructed to bite down normally until the wax hardens. This bite registration is then used to articulate study models to accurately reproduce the patient's occlusion.
This document provides instructions for making alginate impressions. It describes preparing the patient and selecting a stock tray, modifying the tray if needed, and taking impressions of the maxilla and mandible. Key steps include adjusting the patient's position, applying alginate to the tray and palate, inserting and seating the tray, and doing border molding before removal. The proper mixing of alginate and preventing syneresis after removal are also outlined. Modifications for patients with gagging or excess salivation are provided.
A bite registration is used to record how the upper and lower teeth fit together. It involves placing soft wax between the dental arches and having the patient bite down to make an impression. This impression is then used to position study models accurately relative to one another. Specifically, baseplate wax or modeling wax is softened and placed in the mouth to capture the occlusal surfaces. The patient bites down firmly until the wax hardens, and then it is removed and disinfected for use in articulating dental models.
This document discusses strategies for reducing overjet in orthodontic treatment. It presents four examples of patients requiring overjet reduction and proposes treatment plans for each. The key points covered are the four main ways to reduce overjet: moving the lower incisors forward, moving the upper incisors back, moving the mandible forward, and limiting maxillary growth. Factors like molar relationship, amount of extraction, and facial angle are considered for determining the best mechanics in each case.
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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
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.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
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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
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
2. Orthodontic treatment of dental open
Presented by:
Dr. Md. Ishtiaq Hasan
BDS, FCPS-II Trainee,
Dept. of Orthodontics, DDCH
Supervisor:
Prof. Dr. Md. Zakir Hossain
BDS, PhD(Japan)
Prof. & Head,
Dept. of Orthodontics,
DDCH.
bite: A case report
3. HISTORY AND DIAGNOSIS
• 35 years old female came to the department of
Orthodontics and Dentofacial Orthopedics, Dhaka
Dental College and Hospital with the chief compliant of
unpleasant aesthetic look due to spacing and
proclination of upper jaw.
• The patient was in the permanent dentition.
• She had no relevant dental, medical or family history
• No history of previous orthodontic treatment.
4. extra oral examination
Facial photo-Right view Facial photo-Frontal view Facial photo-Left view
A convex profile
Lips are incompetent at rest showing 75% of the upper central incisors
Lower midline shifted 2 mm right side
She had obtuse labiomental angle
She had increased lower facial height
5. Intraoral examination
Facial photo-Right view Facial photo-Frontal view Facial photo-Left view
She had an anterior open bite from right sided lateral incisor to left sided lateral incisor
Missing
Grossly carious
6 56
5
Canine relationship class-II on right side and class-I on left side
Overjet. 9 mm
6. Radiological Examination
Panoramic radiographs revealed that missing right sided
second premolar, first molar and left sided first molar.
Grossly carious right sided first premolar
Generalized bone loss.
There was no bony pathology
9. • Cephalometric evaluation showed—
Variables Values Bangladeshi norm Clinical norms Differences
SNA 79.1° 83° 80.0..89.0° -2
SNB 72.1° 81° 75.0..82.0° -9
ANB 7.0° 2° 2.0..4.0° +5
SND 69.0° 79° 76.0..77.0° -10
IIA 96.6° 117° 130.0..150.0° -21
SN-OcP 21.4° 13° 14.0° +8
SN-GoGn 46.4° 25° 30.0° +21
Max1-NA 33.5° 29° 22.0° +4
Max1-SN 112.7° 108.0° +4.7
Mand1-NB 42.9° 30° 25.0° +12
1u-NA 6mm 8mm 4mm +2
1l-NB 6mm 8mm 4mm +2
Holdaway Ratio 8mm 0..2mm +6
S-L 14mm 59mm 51mm -45
S-E 11mm 23mm 22mm -12
ANB angle is more than normal and IIA is less than normal. So, it is a case of skeletal class 2 div I.
MPA angle is more than normal (+21), so patient is hyperdivergent.
10. Aetiology
• Patient history revealed that she had thumb
sucking habit, suggesting that anterior open
bite etiology was related to thumb sucking.
• No respiratory problems were noted.
11. WHAT ARE THE CAUSES OF ANTERIOR
OPEN BITE AND WHY RELAPSE OCCUR
• Teeth & alveolar bones are
balanced by the forces of lips,
cheeks and tongue. If this balance
is altered, changes occur.
• Based on this idea of balance,
several etiological factors are
associated with AOB.
12. • The severity of AOB and sucking habits of fingers
and pacifiers have been well established.
• In such cases, AOB self-corrects consistently after
removal of habits, provided that no other
secondary dysfunctions have set in.
• The secondary dysfunctions may developed from
maxillary incisor protrusion generated by the
sucking habit, thereby breaking the lip seal
required for swallowing and causing the tongue
to be abnormally positioned, especially at rest.
13. • Hypertrophic lymphoid and tonsils are the most
common cause of nasal obstruction and
consequently may force the tongue to remain lower
to allow breathing to occur through the
oropharyngeal rather than nasopharyngeal space.
14. In 1964, Subtelus and Sakuda published an article on the diagnosis and
treatment of AOB. They try to find out an explanation for the existence of
persistency of open bite after removal of the causes. They found that in
case of persistent open bite, the following significant differences were
found---
• Greater eruption of upper molars
• Extrusion of upper incisors
• Increased mandibular plane and gonial angle
They named this facial pattern as ‘skeletal open bite’.
Its primary etiological factor is an unfavorable growth pattern with divergent
basal bones and therefore no contact between the incisors.
These etiological factors are associated with growth and not function and can
thus be defined as skeletal factors.
15. • Over the years, vertical facial pattern was ultimately considered as the
main risk factor for AOB and treatment stability. However, other studies
have reported that most hyperdivergent pts exhibit a normal or deepbite
while pt with normal facial patterns display a persistent open bite.
So, skeletal pattern cannot be the cause of AOB.
16. • Denison et al. assessed the stability of surgical
treatment in 66 adult pts followed up for at least
1 year after surgery. They found 42.9% of open
bite cases recurred and the relapse was due to
dentoalveolar changes and not for the skeletal
changes.
• Once hyperdivergency is successfully eliminated
with orthognathic surgery, it cannot be blamed as
an etiological factor for open bite relapse,
because these pts were adult, & exhibit no
growth.
17. • Therefore, it is believed that causes of relapse in
AOB are due to dentoalveolar origin, generated
by oral disorders, overlooked in the pretreatment
phase.
• Most investigations of AOB etiology agree on the
existence of secondary dysfunction, which remain
after the correction of etiology , such as stop
thumb sucking or removal of adenoids and
tonsils. This secondary dysfunction is poor tongue
posture at rest.
18. • Lower tongue posture at rest exert a long lasting
pressure on teeth, prevent eruption of incisors, thereby
causing and maintaining AOB.
• In addition, a low tongue posture may encourage the
eruption of posterior teeth and constrict the upper
arch since the tongue does not touch the palate.
• This etiological factor may not been studied enough
and is generally overlooked during AOB treatment.
• Failure to eliminate this factor may be the key reason
of AOB relapse.
19. Different types of the tongue at rest:
• The normal position of tongue is it rest on the
incisal papilla and its back lies along the
palate, keeping the anterior teeth in balance
while preserving the transverse dimension of
the upper arch.
• Tongue shows 4 types of abnormal resting
posture—high, horizontal,low and very low.
20. High posture:
• High posture of the tongue at rest is
associated with slightly protruded upper
incisors and AOB may exhibit vertical
overlap and positive horizontal overlap.
• Since the tongue rests on the palatal
surface of the incisors, beneath the
incisal papilla, upper incisors are
positioned above the occlusal plane.
• Leveling of the mandibular arch is
unaffected and display a single occlusal
plane.
• Posterior crossbites are not present as
the back of the tongue rests on the
palate while maintaining the transverse
dimension of the upper arch.
21. High posture of the tongue at rest, associated with a mild
AOB; may exhibit vertical overlap.
The maxillary incisors are protruded and lower arch leveling
is unchanged.
No posterior crossbite was observed.
The arrows represent the direction of the force exerted by the
tongue.
22. Horizontal position:
• In the horizontal posture
of the tongue at rest, the
tongue appears lower than
in the high position,
although with greater
protrusion, resting on the
palatal surface of the upper
incisors and on the incisal
edges of the lower incisors.
23. • The major effect in this case can
only be seen in the upper arch,
where protrusion of maxillary
incisors was more prominent, which
prevented their extrusion, thereby
causing AOB.
• Also due to the greater
protrusion of the incisors, a positive
and increased horizontal overlap was
noted.
• As the tongue positions itself
lower, its back turns away from the
palate allowing transverse changes
to occur in the maxillary arch, which
may cause posterior crossbites.
24. Horizontal posture of the tongue at rest, associated with a
moderate AOB; may exhibit vertical overlap.
The maxillary incisors are markedly protruded and above
the occlusal plane.
Lower arch leveling is unchanged.
Due to the distance between the back of the tongue and the
palate, posterior crossbites may emerge.
25. Lower position:
• As the tongue assumes a lower
position, pressure begins to be
exerted on mandibular teeth.
• In the low posture of the
tongue, it rests on the lingual
surface of the crowns of
mandibular incisors, thereby
protruding these teeth and
preventing their eruption,
which establishes a moderate
open bite.
26. • Due to protrusion in the lower
incisors, horizontal overlap may be
zero or negative.
• A gap can be seen between the
occlusal surfaces of posterior teeth
and the incisal surfaces of anterior
teeth in the lower arch only, with
lower incisors positioned below
the occlusal level.
• Posterior crossbites may be
present for the same reason
mentioned above.
27. Low posture of the tongue at rest, associated with a
moderate AOB. The mandibular incisors display a
pronounced protrusion.
Lower arch leveling is changed, with mandibular incisors
positioned below the occlusal level.
Due to the distance between the back of the tongue and the
palate, posterior crossbites may emerge.
The arrows represent the direction of the force exerted by the
tongue.
28. Very low position:
• A very low tongue posture occurs when the
tongue rests below the crowns of the mandibular
incisors in the lingual region of the lower
alveolar ridge.
• The direction of tongue pressure produces
retroclination of mandibular incisors and
prevents their eruption, positioning them below
the occlusal level.
• The open bite is more severe and associated
with posterior crossbite due to the fact that the
tongue moves away from the palate.
• The tongue sprawls across the mouth floor,
expanding the lower arch in the transverse
direction.
29. Very low posture of the tongue at rest, associated with a
severe AOB.
The mandibular incisors appear uprighted or retroclined.
Lower arch leveling is changed, with mandibular incisors
well below the occlusal level.
Due to the distance between the back of the tongue and the
palate, posterior crossbites are bound to emerge.
The arrows represent the direction of the force exerted by
the tongue.
30. High Upper procline
Lower no change (IMPA normal)
Vertical overlap present
No cross bite
Horizontal Upper more procline
Lower no change (IMPA normal)
Vertical overlap present
Post cross bite
Low Lower procline
No overlap
Lower incisors present below occlusal level
Post cross bite
Very low Lower retrocline
Lower incisors present below occlusal level
Post cross bite
31. Treatment choices based on tongue position at rest :
• High and horizontal tongue postures are positioned very close to normal
posture and require control in the horizontal direction only.
• It is suggested that blocking mechanisms such as cribs are sufficient to
produce this tongue retraction and adapt it to its correct posture at rest. This
type of treatment will be referred to as restraining treatment.
• However, in the low and very low tongue postures, the tongue is not only
protruded but it is positioned below its correct position and needs to be
retracted and elevated.
• This process is difficult to learn and automate, requiring educating devices
which force the direction of the tongue, such as spurs. This type of treatment
will be referred to as orienting treatment.
33. Case 1: high posture of tongue at rest
8 years old female pt
Mixed dentition stage
Angle class I malocclusion with AOB
Slightly increased overjet
Protruded maxillary incisors
Interincisal diastema in the upper
arch
The lower arch was normal
Face was symmetrical with slightly
convex profile
34. • Patient history did not reveal sucking habits, indicating
that AOB was caused by an abnormal posture of the
tongue at rest.
• AOB morphological characteristics indicated that the
patient had a high tongue posture as it did not change
the occlusal plane in the lower arch.
• However, the maxillary incisors were protruded and
positioned above the occlusal plane.
• Since the treatment goal was to restrain the tongue in
the horizontal direction, placing it further back,
restraining treatment was pre- ferred and a Hawley
retainer was therefore used, combined with a crib.
• The retainer was used for a period of two years until
the patient was in the final stage of mixed dentition.
35. • She was monitored until the permanent dentition
phase. The AOB was closed, overjet and interincisal
diastemas reduced. No other treatment was performed
on this patient, who achieved a stable result as can be
seen from the records obtained 32 years after
treatment.
• It was only thanks to the removal of a poor tongue
posture that establishing a normal hori- zontal overlap
became possible and, more im- portantly, the AOB
etiological factor was elim- inated, thus ensuring a
stable result for many years.
36. Hawley retainer with crib used to
treat patients for a two year period
until a normal overbite was attained.
Extraoral and intraoral photographs 32 years after treatment
37. Case 2:Horizontal Posture of tongue at rest
9 yrs old female pt
Mixed dentition
Angle class II div 1 malocclusion
8 mm overjet
Crossbite present
AOB
Midline shifted to the right less than 2 mm
Symmetric face
Convex profile
Skeletal pattern class II (SNA =88,
SNB=78, ANB= 10)
Mandibular plane angle normal (MPA 34)
38. • Patient history revealed that she had no
sucking habits, suggesting that AOB
etiology was related to abnormal tongue
posture.
• To determine what sort of tongue posture
the patient had it was observed that
lower arch leveling was normal while the
upper incisors were protruded and
positioned above the occlusal level. These
features suggest a horizontal posture of
the tongue associated with marked
overjet. Therefore, restraining treatment
would be indicated in this case.
39. • It was decided to use head gear (As incisors are
proclined), expansion screw (for crossbite) and palatal
crib (For AOB), which was worn for six months.
• After this period, an Angle Class I molar relationship
was attained with 3 mm overjet, the crossbite was
corrected as well as the AOB and there was improvement
in the skeletal relationship (SNA=83°, SNB=78° and
ANB=5°). The face remained symmetrical and the profile
slightly convex . The appliance was then worn only at
night for another six months for retention purposes.
• At age 12, the second phase of treatment was initiated
with the placement of a fixed metallic orthodontic
appliance.
40. headgear used in the first
treatment phase containing a
posterior maxillary splint with an
expansion screw, lingual crib and
Hawley clasp.
Extraoral photographs, cephalometric radiograph and intraoral
photographs at the end of the first treatment phase.
41. Extraoral and intraoral photographs at the end of the second treatment phase.
In this case, AOB correction occurred, thanks to a spontaneous extrusion
of the incisors after using a palatal crib and correcting the tongue posture.
The results were stable as can be seen in the follow-up photographs 10 years
after treatment.
Stability of AOB correction was accomplished because the etiological factor
was eliminated.
43. Case 3: High Posture of tongue at rest
7 years old female
Mixed dentition
Class I molar relationship
Tendency toward posterior crossbite
AOB
The face was balanced with no apparent asymmetries
Lip incompetence
Convex profile
Skeletal class I (SNA=78, SNB=77, ANB=1)
44. • No sucking habit was reported.
• The morphological features of this AOB
included slightly protruded maxillary
incisors with deficiently erupted and
protruded mandibular incisors
(IMPA=100°)
• These effects in the lower arch suggest
a low posture of the tongue at rest.
• Since this tongue had to be retracted and
elevated, it was decided to conduct
orienting treatment with spurs on the
lingual arch.
45. • The spurs were worn for a period of two
years and the patient monitored for
another two years until the permanent
dentition stage.
• By then the patient had developed a Class
I molar relationship, severe lack of space in
both arches, posterior crossbite on the
right side, and normal overbite.
• The mandibular incisors were uprighted
and extruded through the use of spurs
(IMPA=92°).
• The skeletal Class I relationship was
maintained (ANB=1°). Corrective
treatment was then initiated with
extraction of first premolars.
Panoramic radiograph of
patient with spurs in place,
reorienting the tongue
backwards and upwards.
46. Extraoral photographs, cephalometric radiograph and intraoral photographs after
use of spurs in permanent dentition. uprighting and
extrusion were
attained in the lower
incisors with the use
of spurs alone, and
the stable outcome
was monitored over 5
years.
47. Extra oral and intraoral photographs at the end of corrective treatment
after 7 years of spur use, showing stability of AOB correction.
48. Case 4: Very low Posture of tongue at rest
9 years old female patient
Severe AOB and severe lack of space in lower arch
She was a mouth breather and undergo speech therapy
Skeletal class III (ANB= -1)
Vertical growth pattern and MPA=49
49. • According to the morphological characteristics of the open
bite, the patient had a very low position of the tongue at
rest, clearly characterized by retroclination of mandibular
incisors (IMPA=70°) and posterior crossbite.
• To perform the correction it would be necessary to move
the tongue upward and backward with orienting treatment.
• The appliance of choice was a lower lingual arch with
spurs.
• Firstly, a single spur was placed in the midline region,
then other spurs were gradually inserted in the canine-to-canine
region.
50. • Use of lingual arch with spurs was suspended four years later. At
this time a significant improvement in vertical overlap was
observed as well as the presence of diastemas in the mandibular
incisor region due to the protrusion of these teeth. The profile
remained balanced and the face symmetrical . At this stage, it was
decided to place a fixed orthodontic appliance in the mandibular
arch in order to close spaces.
• The upper arch received no appliances and was monitored for a
period of one year to assess stability of AOB correction. Should
the AOB have relapsed it would have meant that the tongue
posture had not been corrected. An adequate vertical overlap was
achieved and the posterior crossbite corrected.
51. Spurs used on lingual arch,
start- ing with one spur at arch
center (A) and in- creasing
number and size of spurs (B) in
order to reorient tongue
posture backwards and
No expansion was performed in the uuppwpaerdr. arch
and crossbite was corrected by positioning the
tongue higher, thus changing the transverse
dimension of the arch.
The face remained symmetrical with a balanced
facial profile. At this stage, fixed appliances were
installed in the upper jaw to finish the case.
52. • Correction of this AOB was achieved mostly by a significant
extrusion of the mandibular incisors The backward and
up- ward change in tongue posture allowed eruption of the
incisors, thereby lengthening the alveolar process , as
reported by Meyer-Marcotty et al. The skeletal features of
this face would have one believe that the cause of the AOB
might be an unfavorable growth pat- tern. However, this
case suggests that AOB oc- curs — even in hyperdivergent
faces — when the eruptive process is hampered by a
mechanical obstruction (in this case the tongue), and thus,
skeletal pattern would not play an etiological role in AOB.
53. Extraoral and intraoral photographs after 4 years of spur use.
intraoral photographs after placement of appliance in the lower arch.
54. cephalometric x-rays comparing
initial and final treatment
phases. Radiographs shows
protrusion and marked
extrusion of incisors obtained
with the use of spurs only.
Removal of the causative agent of this AOB ensured
outcome stability 10 years after treatment. Treatment of
these cases requires patience and the long-term use of
spurs, which in this case lasted for 4 years. Due to AOB
severity, the amount of extrusion required for incisors to
attain vertical overlap is considerable . Moreover, the
process of automating tongue posture is slow, demanding
time for neuromuscular restructuring.
56. Palatal or lingual crib:
• They are aimed to correct
AOB by preventing the tongue
from resting on the teeth.
• They must be long to prevent
the tongue from positioning
itself below them but it fails
to re-educate the tongue.
• In this case, the tongue
return to its original position
when it is removed, thus
leading to AOB relapse.
57. Palatal or lingual spur:
• It was described by Rogers in 1927 in the treatment of 3 open
bite cases.
• Spurs induce a change in the resting position of the tongue, thus
allowing tooth eruption and openbite closure.
• This change in tongue position alters sensory perception by the
brain, thereby producing a new motor response. This response
can be imprint permanently in the brain, which explains the
permanent change in tongue posture produced by spurs. This is
the main factors responsible for AOB treatment stability.
• Crib without spur simply restrain and does not retrain the
tongue, while spur discourage the tongue from resting against
them. A spur appliance is more effective in arresting finger
habits and correcting AOB than crib without spur.
• Huang et al. evaluated AOB treatment stability using spurs in 33
patients divided into 2 groups, one with and one without growth
and they found that AOB correction occurred in both cases.
58. Clinical recommendations:
• Spur appliance should be non-removable.
• It should remain in the mouth at least 6 months after the
AOB has ceased.
• Spur is constructed with .045 inch ss wire (similar to a
mandibular lingual arch) to which eight short, sharpened
0.026 inch spurs, 3 mm in length, are soldered from canine
to canine.
• The spurs are positioned 3 mm away from the cingulum of
the incisors and are directed at an angle (downward &
backward) to encourage correct tongue posture, with the
tip of the tongue behind the upper central incisor papilla.
59. • The AOB usually takes 6-8 months to close after appliance cementation but
may take a longer time for some patient.
• At the end of active orthodontic treatment without bonded spur appliance,
a removable appliance with spurs will not be successful. In that cases, fixed
spurs should be given because patient cannot wear removable spur
appliance full time and part time wearing of a removable spur appliance is
not effective in closing open bites. It takes 2-3 weeks for patients to adopt to
speaking, swallowing and eating with cemented spurs. Therefore , it is
reasonable to expect patients who have never used fixed spurs to wear a
removable spur appliance full time until the bite closes.
• To avoid making patient afraid, Dr. Roberto Justus advised to refer the spur
appliance as ‘the reminding appliance’ in front of the patient.
60. • A mandibular spur appliance is as effective as maxillary one, except
that it is visible and patient might find it objectionable since they
should be continuously asked about the appliance.
• Haryett et al. concluded that spur appliance do not cause
psychological problems and there are no reports of pain or injury to
the tongue and no marks or bruises can be seen on the tongue when
using spurs.
• When cementing the spur appliance, the family should be informed
that there will be some initial difficulty speaking, eating, and
swallowing. All of these problems will be resolved in 2 to 3 weeks.
During this period, patients are asked to cover their spurs with cotton.
The tongue is thus protected and can gradually adapt to the spurs.
• The patients should also be advised to pay particular attention to
hygiene on the lingual aspect of the maxillary incisors because the
spur appliance makes brushing this area more difficult.
61.
62. When an orthodontist is faced with an anterior open bite
relapse, Dr. Roberto Justus recommends the following-----
• Explain to the family the possibility that the relapse is due
to an anterior tongue rest posture problem.
• Determine whether orthognathic surgery is indicated or
not.
• If surgery is not advisable, recommend a cemented
reminding appliance with spurs.
• Encourage the family by giving them a copy of an article
that shows cases successfully treated with the spur
appliance.
63. • A mandibular canine to canine fixed retainer or a
removable lower retainer is given to avoid incisor
crowding.
• Bond a upper canine to canine retainer to ensure that
the maxillary incisor alignment is maintained.
• Allow the spur appliance to remain in the mouth for at
least 1 year, even though the bite may have closed in 6
to 8 months.
• Do not expect the bite to close immediately.
64.
65.
66. Contra-indications of spur appliance---
• Diminished muscular control.
• Abnormally large tongue.
• Maxillary lateral incisors have not yet erupted (indicating that closing a
transitional anterior open bite).
• Stressful periods in patient/parents lives (illness, divorce, school exams, etc).
• Immaturity (lack of understanding treatment goals).
• Increased nasal resistance, allergic rhinitis, or enlarged tonsils and/or
adenoids (particularly during an acute episode).
• Ongoing speech therapy. Speech therapy should preferably be instituted after
the bite has closed because the speech therapist can work more effectively
with a child who does not have an anterior open bite.
• Bad oral hygiene.
• Severe skeletal dysplasia (need orthognathic surgery).
67. Orthodondic or surgical treatment of
AOB?
• Surgical treatment is indicated for extremely
severe cases with MPA above 50
• In orthognathic surgery cases, spur appliance
should be considered post-surgically and only
if an open bite begins to relapse.
68. TREATMENT OBJECTIVES
Considering the above findings the objectives of
orthodontic treatment of this patient were to –
• Correction of anterior open bite.
• Correction of median diastema.
• Reduce lip procumbancy and lip incompetency.
• Retrocline upper and lower incisors.
• Establish normal overjet and overbite.
• Establish normal interincisal angle.
• Correction of midline.
• Improve gingival condition.
• Improve profile
• Establish and maintain occlusal harmony and
interdigitation for improved aesthetics and proper
function.
69. TREATMENT PLAN AND PROGRESS
• Due to badly destruction of lower right first
premolar, it was decided to extract the
tooth.
• The treatment plan was to extract both
upper first bicuspids to retrocline upper
incisors and reduce lip incompetency and
distal movement of lower right canine and
left premolars.
• But patient refused to extract teeth as
because she already lost so many teeth.
• So we try to retract upper incisors and
reduce lip incompetency as much as possible
by utilizing the space available between the
upper incisors.
70. • Edgewise bracket was bonded 1 mm gingival to the centre
of the crown of upper and lower incisors to extrude them
and to reduce anterior open bite.
• Initial leveling and alignment was done with the use of
0.014 ss multiloop arch wires.
• Upper spacing were closed by power chains with 0.016 ss
round wire.
• Upper arch contraction was done by 0.016x 0.022 inch
rectangular ss arch wires with tear drop contraction loops .
• At the end of treatment, elastics was used for better
interdigitation.
71. Fig: Initial leveling and alignment by
0.014 ss round wire with multi-loop.
Fig: closing space between central incisors
by 0.016 ss round wire with power chain.
72. Fig: Arch contraction – right side
Fig: Arch contraction by .016*.022 ss
rectangular wire with tear drop loop.
81. DISCUSSION AND RESULTS:
• Total treatment time was 24 months.
• The result was slightly compromised in that
there on right side, canine relationship was not
class I and lip procumbancy was not fully
corrected as because the patient refused to
extract teeth.
• However, the patient was happy with his
appearance and reduced lip incompetency.
83. ——— Initial
——— Post Treatment
Cephalometric superimposition
Cephalometric radiography
superimposition comparing
before and after showed that
the open bite problem was
corrected by---
•The upper incisors tipped
backward and retracted
•The lower incisors extruded
due to positioning of
brackets 1 mm gingival to
the centre of the crown.
•Upper and lower molars
were not extruded; Extrusion
of molars are not advisable in
open bite cases as because of
relapse tendency.
85. At the end of treatment---
• Facial photographs
show an improved
profile.
• Lip procumbency was
reduced.
86. At the end of treatment---
• Ideal overjet and
overbite were achieved.
87. At the end of treatment---
• Proper alignment and
nice gingival contour
were attained.
88.
89. Tooth loss due to periodontal disease--
• When a tooth lost due to periodontal disease, that space is
very difficult to close.
• As a general rule, it is better to move teeth away from such
an area, in preparation for a prosthetic replacement,
because of the risk that normal bone formation will not
occur as the tooth moves into the defect.
• In older pt who has lost a tooth due to periodontal disease,
it is not a good judgment to attempt to close the space.
--------PROFFIT
90.
91. • It is important to explore and understand various aspects of
orthodontic treatment where adults need special
considerations in contrast to adolescents.
• Adult orthodontics is basically same as adolescent
orthodontics for tissue changes associated with tooth
movement, stages of treatment and goal of treatment.
• But there are certain differences in several aspects namely
psychosocial, biological and mechanical aspects where
adults need special consideration for behavioral and clinical
management
92. Psychosocial factors
• Adult patients have high treatment expectations.
• They are more serious about the detail of the treatment as treatment time,
complexity of treatment, number of visits, likelihood of correction etc.
• They have been shown to have more discomfort from appliances.
• They are more co-operative in following the instructions from orthodontists
such as elastic wear, hygiene maintenance, keeping their appointments etc.
but they don’t commit to long-term treatment .
• In other words, adults demand best treatment results in a short time.
• Therefore, it is quite important to apprise these patients about the limitations
& complexity of the treatment, increased treatment time & high relapse
potential.
• Adult patients may have hesitation in accepting visibility of orthodontic
appliances. They may demand esthetic appliance e.g. esthetic brackets,
lingual appliance, invisalign etc irrespective of their limitations .
93. Periodontal susceptibility
• Adolescents more resistant to bone loss as a
result of periodontal disease but highly
susceptible to gingival inflammation.
• Adults Higher degree of susceptibility to bone
loss as a result of periodontal disease.
94. The bone level
• The minimum amount of bone support necessary for teeth
to withstand orthodontic forces in a plaque-controlled
environment has yet not been established. Reduced bone
support is not a contraindication to orthodontic therapy.
• The ideal alveolar bone for closing first molar space is 6 mm
in mesio-distal direction and 7 mm in bucco-lingual
direction. If the pt does not fit these characteristics, one
can start guided bone regeneration technique, which is
widely used for orthodontic movement in areas with bone
defects.
95. CONSIDERATIONS REGARDING
EXTRACTION
• Extraction choice may be affected by
periorestorative status of dentition or already
extracted tooth complicating the treatment plan.
• In adults, closing an old extraction site is difficult.
When there is a dense cortical layer of bone
formed within the alveolar process of a
previously (long ago) extrated tooth, it become
very difficult to close the space.
96. • Tooth movement is slowed to a minimal when the root encounters
cortical bone along the resorbed side of alveolar ridge.
• Tooth movement is also greatly slowed & root resorption more
likely when a tooth is faced against a cortical plate.
• Maintenance of closed spaces is also very difficult (difficult to close
and keep it closed).
• It may need uprighting to open the space mesially to receive
prosthesis rather than attempting space closure.
• Existing occlusion is maintained when occlusal difficulties are not
present. Lower incisor extraction & proximal stripping are preferred
over bicuspid extraction to relieve crowding.
97. CONSIDERATIONS REGARDING APPLIANCE PLACEMENT
• While bonding, special considerations may be
required due to presence of restorations such
as porcelain and metallic surfaces.
98. BIOMECHANICAL CONSIDERATIONS
Adult bone is less reactive to mechanical forces .
Loss of attachment leads to apical shift of centre
of resistance, thereby increasing distance from
centre of resistance to point of force application in
turn leading to increased tipping moment
produced by the given force.
Therefore greater countervailing moment is
required to balance this greater tipping moment
to translate periodontally compromised tooth .
When bone has been lost, same amount of force
produces greater pressure in PDL of a
compromised tooth than a normally supported
one.
99. Considerations Regarding Tooth movements
• To correct deep bite in young patients, posterior extrusion is
allowed because of compensation made by vertical growth. But
overbite correction in adults should be carried out by intrusion of
anterior teeth, not by extrusion of posterior teeth.
• Palatal expansion is carefully done to avoid buccal tipping due to
extrusion associated with it.
• Most mechanotherapy has extrusive component. Retraction force
has a larger extrusive force component if the bone loss is most
pronounced. Hence, light continuous intrusive force should be
maintained during retraction.
• In adult patients, segmented arch mechanics is preferred because
light force is required for adults.
100. CONSIDERATIONS REGARDING VULNERABILITY TO
ROOT RESORPTION
• Adult patients must be informed about the
risk of root resorption and thoroughly
evaluated for the susceptibility to root
resorption . All measures should be taken to
manage root resorption.
101. CONSIDERATIONS REGARDING
VULNERABILITY TO TMD
• There is a higher risk of developing TMD in
adults than adolescents, which may not be
related to orthodontic treatment.
• Hence, adult patients need a thorough check
up for the signs of TMD before initiation of
orthodontic treatment.
102. CONSIDERATIONS REGARDING TREATMENT TIME
• Tissue remodeling associated with tooth movement is slow leading
to slow rate of tooth movement making the treatment time longer.
• Activation in adults usually in 50’s and onwards is required to be
done after longer period i.e. 3-6 weeks as against 2-4 weeks
required in adolescents.
• Initiation of tooth movement takes longer time as compared to
adolescents. The delayed response to mechanical stimulus, is
suggested to be caused by insufficient source of preosteoblasts as a
result of reduced vascularization with increasing age.
• After delayed initial tissue reaction, rate of tooth movement in
adults is not that much different as compared to that in
adolescents.