The document discusses the classification and treatment of deep bite. It defines deep bite as overbite greater than 3mm and classifies it as true deep bite caused by infraposition of posterior teeth or pseudo deep bite caused by supraocclusion of anterior teeth. Treatment involves intrusion of maxillary incisors, extrusion of premolars or molars, or a combination, and may include removable appliances, fixed appliances, headgear, or orthognathic surgery depending on the severity and skeletal vs. dental factors. Functional analysis is important to determine the correct treatment approach.
This document discusses two main types of space closure mechanics in orthodontic treatment: closing loop archwires and sliding mechanics. Closing loop archwires involve individually fabricated loops to retract teeth into extraction spaces, while sliding mechanics use elastic chains or coil springs to slide teeth along archwires into spaces. The document provides details on techniques, advantages, and disadvantages of each approach as well as factors influencing effective space closure.
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
Dr. James McNamara developed a cephalometric analysis method in 1984 to evaluate orthodontic and orthognathic surgery patients. The analysis divides the craniofacial skeleton into five sections - maxilla to cranial base, maxilla to mandible, mandible to cranial base, dentition, and airway. Linear measurements of landmarks and planes are compared to normative standards to assess relationships. Advantages include using primarily linear measurements, being more sensitive to vertical changes, and providing growth guidelines that are easily explained.
The simplicity of bonding can be misleading. The technique undoubtedly can be misused, not only by an inexperienced clinician but also by more experienced orthodontists who do not perform procedures with care.
Success in bonding requires understanding of and adherence to accepted orthodontic and preventive dentistry principles.
The advantages and disadvantages of bonding versus banding of different teeth must be weighed according to each practitioner’s preferences, skill, and experience.
Bonding should be considered as part of a modern preventive package that also includes a strict oral hygiene program, fluoride supplementation, and the use of simple yet effective appliances. In other words, complicated mechanics with abundant use of coil springs and multilooped arches lends itself less well to bonding and easily can compromise the integrity of tooth enamel and gingival tissues around brackets on small bonding bases.
This document discusses molar distalization, which is an alternative method for gaining space when treating orthodontic patients with space deficiencies. It provides the history of molar distalization, indications and contraindications for its use, different appliance options, and considerations for appliance selection. Molar distalization involves using orthodontic appliances to distalize or move the molars backwards in the dental arch in order to gain space.
This document discusses several orthodontic appliances including the Nance appliance, transpalatal arch, quad helix, lip bumper, and tongue crib. It provides details on the design, indications, mechanisms of action, advantages and disadvantages of each appliance. The document is intended as an educational guide for orthodontic residents, as it is presented by several orthodontists and covers the key aspects of these common fixed functional appliances.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses two main types of space closure mechanics in orthodontic treatment: closing loop archwires and sliding mechanics. Closing loop archwires involve individually fabricated loops to retract teeth into extraction spaces, while sliding mechanics use elastic chains or coil springs to slide teeth along archwires into spaces. The document provides details on techniques, advantages, and disadvantages of each approach as well as factors influencing effective space closure.
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
Dr. James McNamara developed a cephalometric analysis method in 1984 to evaluate orthodontic and orthognathic surgery patients. The analysis divides the craniofacial skeleton into five sections - maxilla to cranial base, maxilla to mandible, mandible to cranial base, dentition, and airway. Linear measurements of landmarks and planes are compared to normative standards to assess relationships. Advantages include using primarily linear measurements, being more sensitive to vertical changes, and providing growth guidelines that are easily explained.
The simplicity of bonding can be misleading. The technique undoubtedly can be misused, not only by an inexperienced clinician but also by more experienced orthodontists who do not perform procedures with care.
Success in bonding requires understanding of and adherence to accepted orthodontic and preventive dentistry principles.
The advantages and disadvantages of bonding versus banding of different teeth must be weighed according to each practitioner’s preferences, skill, and experience.
Bonding should be considered as part of a modern preventive package that also includes a strict oral hygiene program, fluoride supplementation, and the use of simple yet effective appliances. In other words, complicated mechanics with abundant use of coil springs and multilooped arches lends itself less well to bonding and easily can compromise the integrity of tooth enamel and gingival tissues around brackets on small bonding bases.
This document discusses molar distalization, which is an alternative method for gaining space when treating orthodontic patients with space deficiencies. It provides the history of molar distalization, indications and contraindications for its use, different appliance options, and considerations for appliance selection. Molar distalization involves using orthodontic appliances to distalize or move the molars backwards in the dental arch in order to gain space.
This document discusses several orthodontic appliances including the Nance appliance, transpalatal arch, quad helix, lip bumper, and tongue crib. It provides details on the design, indications, mechanisms of action, advantages and disadvantages of each appliance. The document is intended as an educational guide for orthodontic residents, as it is presented by several orthodontists and covers the key aspects of these common fixed functional appliances.
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 Steiner's acceptable compromises for compensating for sagittal discrepancies between the upper and lower jaws. It provides guidelines for adjusting the positions of the upper and lower incisors based on the ANB angle. A case example is used to illustrate how to predict changes to the ANB angle through growth or treatment and adjust incisor positions accordingly. The document also discusses individualizing treatment proposals based on factors like soft tissue function.
The document discusses orthodontic bracket prescriptions, including:
1) Early edgewise brackets required wire bends to control tooth movement, while contemporary brackets have built-in prescriptions for in-out, tip, and torque adjustments.
2) Lawrence Andrews introduced the pre-adjusted edgewise appliance with customized brackets programmed for specific tooth control without wire bends.
3) Later prescriptions like Roth and MBT incorporated changes like more torque in upper incisors to compensate for bracket limitations, while individual adaptations are often needed for specific cases.
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.
This document provides an overview and instructions for Carey's analysis and Lundstrom analysis. Carey's analysis involves measuring the arch length and comparing it to the tooth material to determine if extractions are needed. It can indicate if a premolar extraction or first molar extraction is required based on the discrepancy. Lundstrom analysis divides the dental arch into segments and measures the tooth widths to calculate the net discrepancy. Both methods help assess dental arch perimeter and tooth size to determine appropriate treatment planning.
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 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 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.
1) The document discusses different types of scissor bites (malocclusions where the maxillary teeth are positioned buccal to the mandibular teeth), including definitions, classifications, causes, and treatment options.
2) Scissor bites can be caused by factors like microglossia, abnormal tooth germ position, and skeletal Class II issues. Treatment depends on a patient's age and severity of the scissor bite, ranging from removable appliances to orthodontic devices to orthognathic surgery.
3) The document presents several case studies as examples. One case discusses using a bonded constriction quad-helix appliance to reduce the maxillary arch width in a growing patient with a bilateral scissor
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.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document provides a history and overview of rapid maxillary expansion (RME). It discusses:
- The early history of RME dating back to the 1800s and its reintroduction by Haas in the 1960s.
- Classification of RME based on factors like rate of expansion, direction, and type of appliance.
- Indications for RME including dental issues like posterior crossbites and medical issues like poor nasal breathing.
- Contraindications such as single tooth crossbites or severe anteroposterior skeletal discrepancies.
- Examples of RME appliances including the Hyrax expander and bonded expanders, discussing their advantages.
This document discusses deep bite, including its definition, types, etiology, diagnosis, factors, and treatment. A deep bite is defined as excessive vertical overlap of the upper and lower incisors. It can be true, caused by infraocclusion of posterior teeth, or pseudo, with normal posterior eruption. Causes include genetic, acquired, and muscular factors. Diagnosis involves clinical exams, casts, radiographs, and cephalograms. Treatment aims to correct the underlying occlusion and may involve bite planes, fixed appliances, or intrusion/extrusion of teeth to reduce the overbite. Bite ramps are an effective option to help correct a deep bite over time through posterior development.
1) The document discusses various methods for evaluating anteroposterior jaw relationships using cephalometric analysis, including the ANB angle and Wits appraisal.
2) It notes that while the ANB angle is commonly used, it can be unreliable due to factors like cranial base length and jaw rotation.
3) The Wits appraisal was developed to address some of the inconsistencies of the ANB angle by measuring the anteroposterior relationship of points A and B to the occlusal plane.
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 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 various types of intrusion arches used in orthodontics to correct deep overbites. It begins by defining intrusion and describing the biomechanics and principles involved. It then covers 9 specific intrusion arch designs: 1) Rickett's Utility Arch 2) Tipback Springs 3) Burstone's Continuous Intrusion Arch 4) Burstone's Three Piece Intrusion Arch 5) K-SIR 6) Connecticut Intrusion Arch 7) PG Retraction Spring 8) Translation Arch 9) Lingual Arch for intruding lower incisors. For each type, it provides details on materials, design, and mechanics of intrusion.
This document discusses various concepts related to orthodontic tooth movement including:
- Types of tooth movement such as tipping, translation, and torque which are determined by the ratio of moments of force and couples applied.
- Force systems used in orthodontics such as one-couple systems which allow for predictable tooth movement. Segmented springs and anterior intrusion/extrusion arches are examples.
- Applications of anterior intrusion and extrusion arches including intruding/extruding specific teeth, correcting midlines, and preventing excessive tipping during space closure. Factors like wire placement and anchorage can be modified to achieve the desired tooth movement.
Dr. Viken Sassouni developed a cephalometric analysis method based on craniofacial x-rays of 100 children. He identified planes, arcs, and points to analyze facial proportions and classify facial patterns. A well-proportioned face has four planes intersecting at point O and equal upper/lower anterior and posterior facial heights. Sassouni found most faces were Type II patterns. His analysis considered vertical and horizontal relationships and classified occlusions, palates, profiles, and dental axes. He concluded that "normal" is relative and proportions are more important than absolute measurements.
Class II malocclusion features a distal relationship of the mandibular dentition relative to the maxilla. It has a prevalence among Caucasians and involves either maxillary excess, mandibular retrusion, or a combination. Clinical findings include a distal step in the deciduous molars, large overjet, and deep bite. Cephalometric findings show a prognathic maxilla or retrusive mandible. Early intervention via a cervical facebow headgear can restrain maxillary growth, distalize the upper dentition, and correct to a Class I relationship.
1. Class 2 malocclusion is characterized by a distal relationship of the mandibular molars or retrusion of the mandible. It has a high prevalence among certain populations.
2. Clinical findings include a distal step relationship between the deciduous molars, large overjet, deep bite, and a class 2 molar and canine relationship. Cephalometric findings include a prognathic maxilla, retrognathic mandible, or combination of the two.
3. Interception of developing class 2 malocclusion can be done during the mixed dentition stage using a cervical headgear with facebow to restrain maxillary growth and distalize the upper dentition into a class 1
This document discusses Steiner's acceptable compromises for compensating for sagittal discrepancies between the upper and lower jaws. It provides guidelines for adjusting the positions of the upper and lower incisors based on the ANB angle. A case example is used to illustrate how to predict changes to the ANB angle through growth or treatment and adjust incisor positions accordingly. The document also discusses individualizing treatment proposals based on factors like soft tissue function.
The document discusses orthodontic bracket prescriptions, including:
1) Early edgewise brackets required wire bends to control tooth movement, while contemporary brackets have built-in prescriptions for in-out, tip, and torque adjustments.
2) Lawrence Andrews introduced the pre-adjusted edgewise appliance with customized brackets programmed for specific tooth control without wire bends.
3) Later prescriptions like Roth and MBT incorporated changes like more torque in upper incisors to compensate for bracket limitations, while individual adaptations are often needed for specific cases.
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.
This document provides an overview and instructions for Carey's analysis and Lundstrom analysis. Carey's analysis involves measuring the arch length and comparing it to the tooth material to determine if extractions are needed. It can indicate if a premolar extraction or first molar extraction is required based on the discrepancy. Lundstrom analysis divides the dental arch into segments and measures the tooth widths to calculate the net discrepancy. Both methods help assess dental arch perimeter and tooth size to determine appropriate treatment planning.
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 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 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.
1) The document discusses different types of scissor bites (malocclusions where the maxillary teeth are positioned buccal to the mandibular teeth), including definitions, classifications, causes, and treatment options.
2) Scissor bites can be caused by factors like microglossia, abnormal tooth germ position, and skeletal Class II issues. Treatment depends on a patient's age and severity of the scissor bite, ranging from removable appliances to orthodontic devices to orthognathic surgery.
3) The document presents several case studies as examples. One case discusses using a bonded constriction quad-helix appliance to reduce the maxillary arch width in a growing patient with a bilateral scissor
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.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document provides a history and overview of rapid maxillary expansion (RME). It discusses:
- The early history of RME dating back to the 1800s and its reintroduction by Haas in the 1960s.
- Classification of RME based on factors like rate of expansion, direction, and type of appliance.
- Indications for RME including dental issues like posterior crossbites and medical issues like poor nasal breathing.
- Contraindications such as single tooth crossbites or severe anteroposterior skeletal discrepancies.
- Examples of RME appliances including the Hyrax expander and bonded expanders, discussing their advantages.
This document discusses deep bite, including its definition, types, etiology, diagnosis, factors, and treatment. A deep bite is defined as excessive vertical overlap of the upper and lower incisors. It can be true, caused by infraocclusion of posterior teeth, or pseudo, with normal posterior eruption. Causes include genetic, acquired, and muscular factors. Diagnosis involves clinical exams, casts, radiographs, and cephalograms. Treatment aims to correct the underlying occlusion and may involve bite planes, fixed appliances, or intrusion/extrusion of teeth to reduce the overbite. Bite ramps are an effective option to help correct a deep bite over time through posterior development.
1) The document discusses various methods for evaluating anteroposterior jaw relationships using cephalometric analysis, including the ANB angle and Wits appraisal.
2) It notes that while the ANB angle is commonly used, it can be unreliable due to factors like cranial base length and jaw rotation.
3) The Wits appraisal was developed to address some of the inconsistencies of the ANB angle by measuring the anteroposterior relationship of points A and B to the occlusal plane.
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 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 various types of intrusion arches used in orthodontics to correct deep overbites. It begins by defining intrusion and describing the biomechanics and principles involved. It then covers 9 specific intrusion arch designs: 1) Rickett's Utility Arch 2) Tipback Springs 3) Burstone's Continuous Intrusion Arch 4) Burstone's Three Piece Intrusion Arch 5) K-SIR 6) Connecticut Intrusion Arch 7) PG Retraction Spring 8) Translation Arch 9) Lingual Arch for intruding lower incisors. For each type, it provides details on materials, design, and mechanics of intrusion.
This document discusses various concepts related to orthodontic tooth movement including:
- Types of tooth movement such as tipping, translation, and torque which are determined by the ratio of moments of force and couples applied.
- Force systems used in orthodontics such as one-couple systems which allow for predictable tooth movement. Segmented springs and anterior intrusion/extrusion arches are examples.
- Applications of anterior intrusion and extrusion arches including intruding/extruding specific teeth, correcting midlines, and preventing excessive tipping during space closure. Factors like wire placement and anchorage can be modified to achieve the desired tooth movement.
Dr. Viken Sassouni developed a cephalometric analysis method based on craniofacial x-rays of 100 children. He identified planes, arcs, and points to analyze facial proportions and classify facial patterns. A well-proportioned face has four planes intersecting at point O and equal upper/lower anterior and posterior facial heights. Sassouni found most faces were Type II patterns. His analysis considered vertical and horizontal relationships and classified occlusions, palates, profiles, and dental axes. He concluded that "normal" is relative and proportions are more important than absolute measurements.
Class II malocclusion features a distal relationship of the mandibular dentition relative to the maxilla. It has a prevalence among Caucasians and involves either maxillary excess, mandibular retrusion, or a combination. Clinical findings include a distal step in the deciduous molars, large overjet, and deep bite. Cephalometric findings show a prognathic maxilla or retrusive mandible. Early intervention via a cervical facebow headgear can restrain maxillary growth, distalize the upper dentition, and correct to a Class I relationship.
1. Class 2 malocclusion is characterized by a distal relationship of the mandibular molars or retrusion of the mandible. It has a high prevalence among certain populations.
2. Clinical findings include a distal step relationship between the deciduous molars, large overjet, deep bite, and a class 2 molar and canine relationship. Cephalometric findings include a prognathic maxilla, retrognathic mandible, or combination of the two.
3. Interception of developing class 2 malocclusion can be done during the mixed dentition stage using a cervical headgear with facebow to restrain maxillary growth and distalize the upper dentition into a class 1
1) A 12-year-old patient presented with mucosal trauma from a deep overbite.
2) Traumatic deep overbites can be classified based on their skeletal and dental characteristics.
3) Treatment aims to relieve pain, correct vertical and anteroposterior discrepancies, and ensure stability.
The document discusses class II malocclusion and early intervention using a Kloehn facebow. Key points include:
- Class II malocclusion is characterized by a distal relationship of the mandibular dentition to the maxillary dentition. It involves maxillary excess, mandibular deficiency, or a combination.
- A Kloehn facebow applies cervical traction to restrain maxillary growth while allowing normal mandibular growth. It consists of inner and outer bows connected to maxillary first molar bands.
- Treatment with a Kloehn facebow in the late mixed/early permanent dentition redirects maxillary growth, distalizes maxillary molars, and can guide the mandible
The document discusses class II malocclusion, early intervention, and the use of Kloehn facebows. It notes that class II malocclusion is characterized by a distal relationship of the mandibular dentition and is commonly treated using cervical headgear to restrain maxillary growth. The Kloehn facebow applies orthopedic forces to the maxilla via an outer bow connected to the ear and an inner bow fitted into bands on the maxillary first molars. When used for 12-18 months in the mixed dentition, it can correct class II malocclusions by distalizing the maxillary dentition and allowing normal mandibular growth.
The document discusses class II malocclusion and early intervention using a Kloehn facebow. Key points include:
- Class II malocclusion is characterized by a distal relationship of the mandibular dentition to the maxillary dentition. It involves maxillary excess, mandibular deficiency, or a combination.
- A Kloehn facebow applies cervical traction to restrain maxillary growth while allowing normal mandibular growth. It consists of inner and outer bows connected to maxillary first molar bands.
- Treatment with a Kloehn facebow in the late mixed/early permanent dentition redirects maxillary growth, distalizes maxillary molars, and can guide the dentition
1. Class II malocclusion features a distal position of the lower molar or mandible, or protrusion of the maxilla and maxillary teeth.
2. Early intervention with a Kloehn facebow cervical headgear can help intercept growing maxillary excess in the mixed dentition stage.
3. Treatment involves applying orthopaedic forces with the headgear to restrain maxillary growth and distalize the upper dentition into a Class I relationship.
This document discusses class II malocclusion and the use of Kloehn facebows in early intervention. It provides details on the components and mechanics of Kloehn facebows, noting they apply orthopaedic forces to restrain maxillary growth. Treatment is aimed at distalizing the maxillary dentition to achieve class I occlusion. The document outlines craniofacial features of class II malocclusion and effects of facebow therapy, including reduction of maxillary protrusion while allowing normal mandibular growth. Facebows are most effective when started in late mixed/early permanent dentition to coincide with facial growth spurts.
Class II malocclusion features growing maxillary excess and can be intercepted early. It has high prevalence and clinical signs include distal molar relationship, overjet, and maxillary protrusion. Cephalometric findings show maxillary protrusion or mandibular retrusion. Kloehn facebow with cervical headgear restrains maxillary growth from ages 7-9 to correct the class II relationship and distalize upper molars in 12 months, allowing normal mandibular growth.
Class II malocclusion features a distal position of the lower molar or mandible, or protrusion of the maxilla and maxillary teeth. It is characterized by a protrusive mid-face or retrusive chin. Early intervention with a cervical headgear can restrain maxillary growth, guiding it into a class I relationship. The headgear applies orthopedic forces to distalize the maxillary dentition over 12-18 months, allowing the mandible to grow forward into a class I occlusion.
This document discusses Class II malocclusion, specifically Class II division 1 malocclusion. It describes the features of Class II division 1 malocclusion as maxillary excess with an excessive labial proclination and forward position of the maxillary anterior teeth. It recommends using a cervical headgear with a face bow to restrain maxillary growth and distalize the upper dentition during the mixed dentition stage to intercept developing Class II malocclusion. The face bow fits into headgear tubes bonded to the maxillary first molar bands. Treatment usually takes about 12 months to achieve a Class I molar relationship.
1. Class II malocclusion is characterized by a distal relationship of the mandibular dentition to the maxillary dentition and is caused by maxillary protrusion, mandibular retrusion, or a combination of both.
2. Early intervention with a cervical facebow headgear can help restrain maxillary growth and distalize the maxillary dentition during the mixed dentition stage to correct a developing Class II malocclusion.
3. Treatment typically involves wearing a cervical headgear with facebow for 12-18 months to reduce maxillary protrusion and correct the molar and canine relationships before proceeding with fixed appliance therapy.
The document discusses class II division 1 malocclusion, including its features such as a protrusive maxilla and retrusive mandible. Early intervention for growing maxillary excess includes using a Kloehn facebow headgear to restrain maxillary growth and distalize the upper dentition into a class I relationship. The headgear is effective in correcting maxillary protrusion while allowing normal mandibular growth.
Cervical traction is used during active clinical crown height stage of teeth to place the inner bow close to the center of resistance of the first molar, which is near the trifurcation of roots. The inner bow has stops to maintain a 4-6mm space between the bow and incisors. A Kloehn facebow is a cervical headgear used to redirect maxillary growth in class II division 1 malocclusions involving maxillary excess during mixed dentition stage. It utilizes orthopedic forces from the outer bow connected to the tragus to restrain maxillary growth and distalize the dentition.
This document discusses class II division 1 malocclusion, which is characterized by a maxillary excess. Early intervention is important to intercept the forward growth of the maxilla. A Kloehn facebow with cervical headgear can be used in the mixed dentition stage once the permanent maxillary first molars have erupted. It works by restraining maxillary growth and distalizing the upper dentition. Treatment usually lasts 12 months to achieve a class I molar relationship before proceeding with fixed appliance therapy. The document outlines the components and mechanics of the Kloehn facebow for effective orthopedic correction of growing maxillary excess.
The document discusses the features, prevalence, and early intervention of class II division 1 malocclusion involving maxillary excess. It describes the clinical and cephalometric characteristics of class II malocclusion and the use of cervical headgear with a Kloehn facebow to restrain maxillary growth and distalize the upper dentition during the mixed dentition stage to intercept the developing malocclusion. The headgear application is aimed at maintaining a class I molar and canine relationship through orthopedic modification of the maxilla.
- Class II malocclusion is characterized by a distal position of the lower molars or mandible, or protrusion of the maxilla and maxillary teeth.
- A key finding is excessive labial proclination and forward positioning of the maxillary anterior teeth. The maxillary first molar is often mesially positioned as well.
- Early intervention using a cervical headgear with facebow can help restrain maxillary growth and distalize the upper dentition to achieve a Class I relationship. The facebow is fitted to the maxillary first molar bands.
- Class II malocclusion is characterized by a distal position of the lower molars or mandible, or protrusion of the maxilla and maxillary teeth.
- A key finding is excessive labial proclination and forward positioning of the maxillary anterior teeth. The maxillary first molar is often mesially positioned as well.
- Early intervention using a cervical headgear with facebow can help restrain maxillary growth and distalize the upper dentition to achieve a Class I relationship. Treatment typically begins in late mixed or early permanent dentition to coincide with the facial growth spurt.
- Class II malocclusion is characterized by a distal position of the lower molars or mandible, or protrusion of the maxilla and maxillary teeth.
- A key finding is excessive labial proclination and forward positioning of the maxillary anterior teeth. The maxillary first molar is often mesially positioned as well.
- Early intervention using a cervical headgear with facebow can help restrain maxillary growth and distalize the upper dentition to achieve a Class I relationship. Treatment typically begins in late mixed or early permanent dentition to coincide with the facial growth spurt.
1. Class II malocclusions are caused by maxillary protrusion, mandibular retrusion, or a combination of both. Early headgear treatment reduces maxillary protrusion while allowing normal mandibular growth.
2. The effects of headgear include distalizing maxillary molars, inhibiting maxillary growth, and expanding both arches. These changes reduce the need for future extraction treatment and produce stable results.
3. Kloehn facebows can also be used in early mixed dentition to guide maxillary growth backward and downward, preventing worsening of class II malocclusions. Patient compliance is important for success with these orthodontic appliances.
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This document discusses orthodontic archwire selection during the alignment stage of treatment with preadjusted appliances. It provides details on different types of archwires used for alignment including multi-strand stainless steel, conventional and superelastic nickel-titanium (NiTi), and heat-activated NiTi wires. Superelastic NiTi wires are preferred for alignment due to their low stiffness, high springback, and ability to deliver nearly constant light forces during tooth movement. The document discusses various archwire sequences used during alignment and leveling, noting that there is no set sequence but heat-activated NiTi can replace multiple stainless steel wires to reduce visits and discomfort.
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3. Zones of
overbite: 5% to
25% is normal
(yellow), 25% to
40% is increased
overbite
(orange), and
>40% excessive
(deep) overbite
(red)
4. Classification
1. According to its origin;
a) Dental deep bites (Simple).
b) Skeletal deep bite (Complex).
2. According to functional classification;
a) True deep bite.
b) Pseudo deep bite.
3. Depending on the extent of deep bite
incomplete over bite
complete over bite
4. According to dentition;
a) Primary dentition deep bite.
b) Mixed dentition deep bite.
c) Permanent dentition deep bite.
5. A 4-year, 6-month old boy WITH
CLASS II division 1 with deep
overbite
6. Class II division 1 with deep overbite in the
mixed dentition with deep overbite
8. Example of cover bite
malocclusion. Note that the
lower incisors are completely
concealed by the upper
incisors
9. The treatment
of deep bite
can be
performed in
the late mixed
dentition, in
the
permanent
dentition, and
in adulthood.
Class II div 1
CLASS II DIV 2
11. Correction of class II division 1 DEEP BITE IN THE
PERMANENT DENTITION WITH HIGH PULL HEADGEAR
12. Ten-year-old boy with
6 mm deep overbite,
headaches,
Temporomandibular
Dysfunction. B, Deep
overbite, Class II
malocclusion, condyles
posteriorly displaced,
overjet 4 mm. C, Normal
overbite, normal
overjet, Rick-A-Nator,
composite buildups,
eliminate TM
dysfunction.
13. D, Rick-A-
Nator, fixed
appliance to
correct deep
overbite and
move lower jaw
forward. Two
molar bands,
.045 S.S
connector wires,
incisal ramp
(indexed).
14. F, Normal overbite, normal
overjet, Rick-A-Nator,
composite buildups, eliminate
TM dysfunction. G, Lower jaw
comes forward because of
Rick-A-Nator. The patient
occludes in front of the incisal
ramp. Composite buildups are
created on lower primary
molars to help patient chew.
Lower first molars passively
erupted to correct deep
overbite, 3 mm in 3 months.
15. . H, Class II skeletal
malocclusion, normal
maxilla, retrognathic
mandible, TMD
headaches,
retrognathic
profile. I, Rick-A-Nator
after 6 months. Class I
skeletal malocclusion,
normal maxilla, normal
mandible, no
headaches, straight
profil
18. Sweep archwires,
base arches, and NiTi
intrusion mechanics
can be used for the
young permanent
dentition in the
maxilla and mandible,
but
segmented intrusion
mechanics come to
the fore in adulthood.
22. In patients who
are growing,
deep bite can
be treated with
removable
appliances
such as
occlusal plates
and bimaxillary
appliances
Bite Plane to Correct deep Overbite
(Transverse Expansion 1 - 2 Turns a Week)
23. . (A–C) Pretreatment intraoral
photographs of a 9-year-old girl.
Note severe depth of overbite and
severe overjet. Imprint of
mandibular incisors on palatal
mucosa because of impinging
incisors. (D and E) Frontal and lateral
view of maxillary removable retainer
with anterior bite plate disocclusing
the posterior teeth to allow their
eruption. Note hooks on labial bow
used by the patient to stretch
elastics for retraction of maxillary
incisors and overjet reduction.
24. (F) Occlusal view illustrates
amount of retraction of
incisors in one month,
between the prior anterior
position of the labial bow and
the facial surfaces of the
incisors. The acrylic touching
the incisors was cut to allow
their retraction. (G) Frontal
occlusal view at the end of
early treatment (phase 1). The
retainer was worn
subsequently for retention.
25. The natural growth
of the alveolar
process can be
specifically
managed at this
stage. This is
usually done by
managing
the vertical
eruption of the
teeth.
three-piece base arch delivering
simultaneous intrusion and
retraction of the maxillary anterior
segment of teeth.
27. The effectiveness
of removable
devices can be
increased
by combining the
removable
appliance with fixed
elements such
as headgear and /
or two-by-four
mechanics.
29. Low pull headgear adjusted for class II treatment: a) en face view:
position of face bow: it does not lean against lips, b) lateral view -
external arms of the face bow bent up, c) external arms of the
face bow bent down; note the direction of force line ( ) and
moment (M) rotating molar.
30. Typical course of comprehensive mixed dentition treatment. (A) cervical
headgear; (B and C) maxillary 2 3 4 appliance; (D and E) before and 6 months after
placing a mandibular lingual arch after extracting the primary first molar
31. Headgear combined with fixed appliances: intermaxillary class
III traction forces lower canine distally
33. Various fixed
mechanics
are used for the
orthodontic
correction of dental
deep
bite : sweep
archwires. overlay
technique, two-by-
four mechanics,
tip-back mechanics,
and segmented
intrusion mechanics
35. Bite blocks play an
important role in
the orthodontic
treatment of deep
bite. They provide
targeted
support for the
desired effects :
intrusion of the
anterior teeth
and/or extrusion of
the posterior teeth.
36. 278 Deep bite with
traumatic bite
pattern
Deep bite with
traumatic bite
pattern can be of
dental or skeletal
origin . Depending
on the etiology of
this anomaly, there
are various
therapeutic
approaches.
37. 278 Deep bite with
traumatic bite
pattern
Intrusion of the
anterior teeth and/or
extrusion of
the posterior teeth can be
performed
using orthodontics. Skeletal
deep bite can be partially
compensated;
in severe cases,
orthognathic
surgery is indicated .
38. Orthodontic Problems of
Deep Bite
In the treatment of
deep bite, an
etiological
distinction must be
drawn between
dental deep bite,
skeletal deep bite,
and a combination
of dental and
skeletal deep bite.
39. Orthodontic Problems of
Deep Bite
Depending on the
additional
functional diagnosis, dental
deep bite can be treated in
both the mixed dentition
and adulthood. The major
advantage of
treatment in the mixed
dentition is undoubtedly
the broader
range of treatment options.
40. Functionally, however,
it is essential to note
the position of the
incisal edge in
relation to the lip or
lip closure line.
Patients with
a pronounced deep
bite often display
hypertonicity of the
perioral
musculature .
41. When the position
of the
upper lip to the
lower lip in
relation to the
incisors is correct,
the
incisal edge of the
maxillary incisors
should lie in the
region of
the lip closure line
43. In patients
with a deep
bite, there is
frequently a
deviation in
the position
of the
maxillary and
mandibular
incisors.
44. In this group of
patients, the
incisal edge of
the maxillary
incisors
is well below the
lip closure line
with the mouth
closed and
relaxed
closure of the
lips.
46. When the
overbite is
correct, the
incisal edge is
in the area of
the lip closure
line when the
lips are closed
in a
relaxed manner
and a rest
position is
adopted .
47. Maxillary and
mandibula r
incisors are in a
harmonious sagittal
relationship to the
musculature, soft
tissue, and position
of the tongue.
This position must
be achieved for
reasons of stability
in the treatment
of deep bite.
48. Position of the
incisal edge in
patients with deep
bite
The position of the
incisal edge of
the maxillary
incisors is often
below
the lip closure line
in patients with a
deep bite.
49. Position of the incisal
edge in
patients with deep bite
As a result, an additional
unfavorable force vector
is applied to
the incisors via the
sagittal pressure
of the lower lip , in
particular when
there is hypertonicity in
the perioral
musculature.
50. To do this, the patient
closes the lips
in a relaxed manner
and adopts a rest
position. The
clinician
marks the patient's
lip closure line on the
labial surface of the
maxillary incisors
with a probe.
52. Orthodontic
intrusion of the
incisors results
in a more
favorable
relationship
between function
and the
position of the
teeth in relation to
musculature and
soft tissue.
(a) intrusion with mini-implants. (b)
intrusion with mandibular utility arch
54. Apart from
orthodontic intrusion,
the application of
torque is also
available for axial
improvement
in deep bite patients.
As a rule, this
involves a palatal root
torque of the
maxillary incisors.
55. Definition of Deep Bite
Deep bite is classified
by the degree of
overbite. We refer to
deep
bite when the overbite
is 3 mm . Aesthetics
and masticatory
function may be
impaired as a result.
(a) A Class I incisor relationship with a
normal overbite. (b) The maxillary
incisors overlap the incisal third of the
mandibular incisor crowns. (c) A deep
anterior overbite with the maxillary
incisors covering 100% of the
mandibular incisor crowns
56. Definition of Deep Bite
If
deep bite is combined
with retroclination of
the maxillary incisors,
a retral forced bite may
also be present in
functional terms.
In adulthood, this can
lead to a compressed
joint and the associated
problems .
57. Definition of Deep Bite
In addition, a
deep bite with
gingival and/or
gingival trauma-
related
impingement
may be present
and this may result
in periodontal
problems.
(a) Mandibular incisors impinging
on the palatal mucosa. (b)
Maxillary incisors impinging on
the mandibular labial gingivae
58. Definition of Deep Bite
According to
Hotz ( 1 954), a
deep bite must
be divided
diagnostically
into a true deep
bite and a
pseudo deep
bite . true deep bite
59. Definition of Deep Bite
A true deep bite
exists when there
is large
interocclusal
clearance in the
rest position. In
such cases, the
posterior
teeth are in a so-
called infraposition.
60. Definition of Deep Bite
A pseudo deep bite
exists in the case of
limited and/or normal
interocclusal
clearance.
The anterior teeth are
consequently in a
supraocclusion
and are the cause of
the deep bite.
61. Definition of Deep Bite
A
differential
diagnosis is
made based
on the
functional
diagnosis .
62. Definition of deep bite
Left: A correct
overbite exists when
the incisal edges of
the maxillary
and mandbulra
nterior teeth overlap
by 2 mm .
A deep bite can be
diagnosed when
the overbite is <! 3
mm.
63. Definition of Deep Bite
The deep
bite m ay be
dentally
supported
(center) or
gingivally
traumatized
( right). A true
deep bite must
be distinguished
from a pseudo
deep bite.
64. Definition of Deep Bite
True deep bite
A true deep bite is caused
by the infra
position of the posterior
teeth.
The incisors a re correctly
positioned.
This can be diagnosed by
determining
the freeway space in the
functional
analysis.
65. Definition of Deep Bite
True deep bite
The posterior alveolar
process is not sufficiently
developed
vertically. The freeway space is
enlarged
(4 mm ) . The therapeutic
approach
is to promote development
of the alveolar process by
managing
eruption of the teeth .
66. Definition of Deep Bite
Pseudo deep bite
The cause of
pseudo deep bite
is the
supraocclusion
of the incisors.
These
project vertically
over the occlusal
plane.
67. Definition of Deep Bite
Pseudo deep bite
The posterior relation
is vertically
correct and the
freeway space is
within the normal
range (2 mm ) .
The required treatment
involves vertical
reduction of the
anterior alveolar
process.
68. Therapy of Deep Bite
Bite raising
and
correction
of overbite
are the
aims of
deep bite
therapy.
69. Therapy of Deep Bite
Intrusion of the
incisors in the
maxilla and
mandible,
extrusion of the
premolars, and/or
extrusion of the
molars can be
performed to correct
the deep bite.
70. (A and B)Pretreatment
extraoral and intraoral
photographs.Note
severe depth of overbite,
despite normal lower
face height. The lip line
during smile under
scores indication for
extrusion of posterior
teeth
Class II division 2
71. (C)In the first step, only the
maxillary arch and
mandibular posterior teeth
were banded/bonded . An
anterior bite plate
disoccluded the posterior
teeth while vertical elastics
helped extrude the
mandibular teeth, which were
joined with segmental
archwires. (D and
E)Posttreatment smile and
occlusal photographs
72. (F) Another alternative of
bite opening by extrusion
of posterior teeth: the “bite
plate” is provided through
platforms bonded on the
palatal surfaces of the
maxillary incisors. Elatics
between the maxillary and
mandibular posterior teeth
facilitate their extrusion.
74. A 9-year-old
girl .Note
severe depth
of overbite and
severe overjet.
Imprint of mandibular
incisors on palatal
mucosa because of
impinging incisors.
75. Maxillary removable
retainer with anterior
bite plate
disocclusing the
posterior teeth to
allow their eruption.
Note hooks on labial
bow used by the
patient to stretch
elastics for retraction
of maxillary incisors
and overjet reduction.
77. At the end of early
treatment(phase 1)
retainer was worn
subsequently for
retention.
78. (A) Class II, division 2
malocclusion with
supracluded maxillary
central incisors.(B)
Intrusive archwire
anchored in the permanent
first molars resulted in
intrusion of the central
incisors (note change in
cervical level of central
versus lateral incisors and
in amount of overbite).
79. Correction of a deep
curve of Spee during
alignment using the early
vertical correction (EVC).
A, B, C) The flattening of
the curve of Spee is
managed with two 0.017 x
0.025-in stainless steel
cantilevers while the
flexible 0.014-in NiTi
archwire allows proper
alignment.
80. D, E, F) Two-month
progress photographs of
the improved vertical
relationship. The
correction of the curve of
Spee occurred faster than
the alignment of the teeth,
which is still incomplete.
The absence of change in
the AP relationship points
towards no extrusion of
the molars.
81. A base archwire
can be tied over the
main archwire
instead of being
inserted to the
brackets. In this
case, the force
system is
determined and
more predictable.
82. Two 0.017 x
0.025-in beta-
titanium
intrusion base
archwires can be
inserted into the
slots of the
brackets over a
flexible archwire
to assist
leveling.
83. Because the force
system in
indeterminate, they
might not produce
intrusion if an
incorrect activation is
placed, e.g., an
anterior bend
intending to cause
intrusion of the
incisors might
actually cause
extrusion.
84. The rationale
of a reversde
curve NiTi
archwire used
for vertical
correction.
The green
line depicts
an estimated
3-mm placed,
activation
when a flat
archwire is
placed
85. whereas the
yellow line shows
the increased
vertical activation
caused if a
reverse curve is
placed to the
archwire. The
reverse curve
would produce
twice the
intrusive force of
the flat wire.
88. TRUE DEEP BITE
This type of deep
bite is caused by
an infraocclusion
of posterior
segments. It is
usually seen in
class II division 2
malocclusions.
89. PSEUDO DEEP BITE
Pseudo deep bite is
caused by over
eruption of the
anterior teeth in
relation to the
normally erupted
posterior segment of
teeth. It is
usually seen in class II
division I
malocclusions.
90. Intrusion of the
incisors is the
main focus of
orthodontic
treatment
for a pseudo
deep bite
caused by
supraocclusion
of the
anterior teeth.
Pseudo Deep Bite
91. As a result of
vertically reduced
attachment,
intrusion
mechanics vary i
n adults and
young patients.
NiTi intrusion
mechanics can be
employed i n both
adults and
Young people .
Pseudo Deep Bite
92. If, in addition to
intrusion, palatal root
torque is
necessary, intrusion
may also be
performed with a
pretorqued
archwire ( compound
archwire ).
93. In adult patients,
we use
segmented
intrusion
mechanics to
correct the deep
bite. This is
particularly
indicated for
greater intrusion
distances.
94. All in all,
the
orthodontic
treatment of
deep bite in
adult
patients is
limited
as the lower
face cannot
be
enlarged.
Two middle-aged cases of deep overbite without molar
support treated by orthognathic surgery
International Journal of Surgery Case Reports
97. Therapy of
deep bite is
dependent
on etiology,
type (true
or pseudo
deep bite),
and the age
of the
patient.
98. For intrusion of the
incisors, NTi
intrusion
mechanics or
overlay techniques
are used in young
patients
and segmented
intrusion
mechanics
with segmented
archwires in adult
patients.
101. The extrusion of
molars and
premolars
is mainly
performed in
young
patients.
Removable or
fixed
orthodontic
appliances can
be used for this.
102. True Deep Bite
If a true deep bite with
infraposition of the
posterior teeth is
present, an extrusion
movement of
premolars and molars
in the
maxilla and mandible
is indicated.
103. A limiting factor here is
that
patients with a
horizontal skull
structure exhibit strong
masticatory
forces and patients with
a vertical skull structure
exhibit
rather weaker
masticatory forces.
104. The risk of a
recurrence is therefore
likely to be
higher in patients with
deep bite and
simultaneous skeletal
components
( horizontal skull
structure ) because of
muscular function
and masticatory force.
106. To correct the incisor
relationship, the
overbite should first
be reduced. An
effective way of doing
this in a growing
patient is the use of an
anterior bite plane. A
removable appliance
incorporating a flat
anterior bite plane was
therefore placed
initially.
107. Treatment Plan
•Use of headgear and
removable appliance to correct
the buccal segment
relationship to class I while
commencing overbite
reduction
•Upper and lower pre-adjusted
edgewise fixed appliances to
level and align arches and
correct the incisor relationship
•Exposure and bonding of the
UR3 to allow mechanical
traction to align UR3
•Long-term retention
108. The removable appliance
also had palatal finger
springs placed mesial to
the maxillary first molars
to aid in their
distalization. A Southend
clasp on the upper
central incisors was also
added for retention. The
design is a modification
of the Acrylic Cervical-
Occipital (ACCO)
appliance popularized by
Cetlin and Ten Hoeve
(1983)
109. What Are the Principles
of Providing a Patient
with Headgear?
As well as
direction of pull,
the other
important
principles when
using headgear
are duration of
wear, level of force
and safety.
110. What Are the Principles
of Providing a Patient
with Headgear?
For anchorage
support when no
movement of the
molars is desirable,
the patient should be
instructed to wear
the headgear for 10–
12 hours a day with a
force of between 250
and 350 g applied
bilaterally.
111. What Are the Principles of
Providing a Patient with
Headgear?
To distalize upper molars,
as in this case, or to
restrict maxillary growth,
the force should be
increased above 400 g and
the headgear worn for at
least 14 hours a day. As
such, the main limitation
of headgear is
compliance, as success is
reliant on a highly co-
operative patient.
112. The class II maxillary
protrusive patient is best
treated by headgear
therapy to restrict or
redirect maxillary
growth. A, This patient is
being treated with cervical
headgear that places a
distal and extrusive force
on both maxillary skeletal
and dental structures. The
force is provided by a neck
strap attached to the outer
bows of the headgear.
113. B, The molar relationship
is beginning to approach a
class III dental
position. C, Space is
beginning to open up
between the second
primary molar and the first
permanent molar. This type
of change is not apparent
for every patient because
the amount of growth and
the amount of cooperation
can vary from patient to
patient
114. What Are the
Principles of Overbite
Reduction in Class II
Division 2
Malocclusions?
Class II division 2
malocclusions
require a reduction
of the inter-incisal
angle, to achieve a
class I incisor
relationship and
stable overbite
reduction..
115. What Are the Principles
of Overbite Reduction
in Class II Division 2
Malocclusions?
A key element in this
is the relationship
between the lower
incisor tip and what
is known as the
centroid of the upper
incisor root (a
constructed point
half-way along the
root)..
116. What Are the
Principles of
Overbite Reduction
in Class II Division 2
Malocclusions?
If the lower
incisor tip is
placed anteriorly
to the centroid of
the upper incisor,
it should lead to
greater stability of
overbite reduction
(Houston, 1989).
117. What Are the Principles of
Overbite Reduction in Class
II Division 2 Malocclusions?
To achieve this, the
maxillary incisor roots
require palatal root torque,
necessitating fixed
appliances and space as
retroclined teeth result in a
shorter arch length than
teeth with appropriate
torque. In this case, space
was created with headgear
and distal movement of the
maxillary buccal segments.
118. Activator therapy is
particularly
suitable for the treatment
of true deep bite in the
early
mixed dentition and the
transition to late mixed
dentition because
adaptation of the
musculature can still be
achieved by
functional orthodontic
treatment.
Utility arch for uprighting
the incisors in Class II,
Division 2 cases. The
fixed appliance is used in
conjunction with the
skeletonized activator
for posturing the
mandible forward and
downward in the Class II,
Division 2 malocclusion.
Lingual view of the
skeletonized
activator used with
the utility arch for
functional therapy
of the condylar
fracture and of the
Class II, Division 2
malocclusion.
120. (a–k) A classic Class II division 2 type
malocclusion with increased overbite and
proclined
maxillary lateral incisors with half unit
Class II molar relationship in the mixed
dentition
(a–c). A ten Hoeve-type appliance was
fitted for full-time wear with a flat anterior
bite plane.
Retention was provided by anterior
clasping with a Southend clasp as well as
an Adams’ crib on
the maxillary first premolars (d, e).
Diligent wear resulted in overbite
reduction allied to distal
movement of the first permanent molars
producing molar correction over a 6-
month period (f–h).
121. A removable appliance
(nudger appliance) can
be used for maxillary
molar distalization.
Either palatal finger
springs (0.6 mm wire)
or screws can be used
as the active
component. A
Southend clasp on the
incisors and Adams
clasps for the molars
and premolars aid with
appliance fixation.
122. A removable appliance (nudger
appliance) can be used for maxillary
molar distalization. Either palatal
finger springs (0.6 mm wire) or
screws can be used as the active
component. A Southend clasp on
the incisors and Adams clasps for
the molars and premolars aid with
appliance fixation. An anterior or
posterior biteplate may be required
to disengage the occlusion and
permit uprighting of the tilted
permanent molar (as well
as reduction of an increased overbite).
Anchorage loss normally manifests as an
increase in the overjet.
123. An upper removable appliance
(nudger appliance) with two
screws to distalize the upper
right buccal segment and to
counteract the potential
crossbite
A nudger appliance and headgear in
combination can be used for maxillary
molar distalization to achieve bodily tooth
movement. The combination system
consists of an upper removable appliance
(URA) with palatal finger springs
(activation of 2−3 mm) that act to tip the
crown of the molar distally. High-pull
headgear worn at night, directed above
the centre of rotation of the molar, acts to
distalize the root and hold the crown
movement achieved during the daytime
wear of the URA.24 In addition, the
headgear provides a method of reinforcing
the anchorage during subsequent
retraction of the anterior teeth.
125. This capacity
for adaptation
only exists to a
limited degree
in adult
patients. Thus,
mechanics
such as
sweeps in NiTi
or steel
archwires can
be used in the
orthodontic
treatment of
young patients.
(a–e) A 0.019 × 0.025-in. reverse curve NiTi wire. The magnitude of the
reverse curve is
clear (a–e). The latter complicates engagement slightly. The wire can be
introduced into the first
molar tube using the fingers in the usual way; however, insertion in the
second molar tubes requires
use of a pliers such as a Weingarts (b, c) with stabilisation of the wire
anteriorly in order to facilitate
anterior engagement minimising soft tissue trauma (b)
126. These
orthodontic
mechanics
are only
indicated to
a limited
extent for
adult
patients .
(a–f) A 0.019 × 0.025-in.
stainless steel wire (a, b)
with reverse curve of Spee
of 3–4 mm
in depth in the premolar
region (c–e). The depth of
curve can be estimated
from the incisal tips to
the distal of the occlusal
surface of the first molars.
The wire is inserted in a
similar manner to the
reverse curve NiTi with
anterior engagement
initially to afford sufficient
flexibility (f)
127. Therapy of Deep Bite in M ixed Dentition
Deep bite therapy in the
mixed dentition should
take place before
eruption of the support
zones, between the age of
8 and 9
years. At this stage of
development, there is
usually still enough
orthopaedically useable
potential for growth.
128. Therapy of Deep Bite in M ixed Dentition
At the same time,
dental use can be made of
the vertical development
of the posterior
alveolar process by
managing the eruption of
the posterior
teeth . Orthopaedic deep
bite therapy is therefore
indicated for
true deep bite with large
interocclusal clearance in
the posterior
region.
129. Therapy of Deep Bite in M ixed Dentition
The aim is to influence the
mandible vertically in a
clockwise
direction, where possible,
and at the same time, to
establish
a new vertical position by
means of eruption
management in the
region of the support zones
and the molars.
130. Therapy of Deep Bite in M ixed Dentition
Extrusion of the posterior
teeth and vertical development
of the lower face can be
achieved
very well with Angle Class I and
Angle Class 11/2 (Table 285 )
since
grinding measures with the
activator specifically move the
teeth
into the desired position. This
can only be done to this
extent
with bimaxillary appliances.
131. Therapy of Deep Bite in M ixed Dentition
The bionator is not used to
correct deep bite as
grinding can
only take place selectively.
Another option is to
further enhance
the vertical effect of the
activator in the region of
the first molar
by the nighttime use of
headgear.
Standard Bionator.
activator
132. Therapy of Deep Bite in M ixed Dentition
Treatment in the
mixed dentition is
successful only if
the support zones
have been
retained. The aim of
functional
orthodontic therapy
is enlargement,
especially of the
lower face.
133. Therapy of Deep Bite in
Mixed Dentition
In addition,
the effect of
the
activator with
respect to
retroclination
of the maxilla
is
counteracted.
134. Therapy of Deep Bite in
Mixed Dentition
An occlusal
plate with an
anterior bite
block and low-
pull
headgear can be
used as an
alternative to the
activator.
Occlusal view of the
upper plate (ACCO)
Activation of distalizing arms of
upper plate (first molar area).
135. The modified Teuscher
appliance is a
monobloc attached to
the upper jaw by the
acrylic
edentations and by a
facebow fitted into
tubes that are placed in
the region of second
bicuspid
or second deciduous
molar. A highpull
headgear is attached to
the outer facebow.
136. Therapy of Deep Bite in Mixed Dentition
The headgear
brings about dental
extrusion of the molar
and consequently
clockwise rotation of
the mandible. This
effect is enhanced by
the anterior bite block
and results in
enlargement of the
lower
face.
The Activator
140. Therapy of Deep Bite in M ixed Dentition
Depending on
the angulation
and external
arm length of
the
headgear, a
vertical
orthopaedic
impact on the
maxilla can be
achieved.
141. Therapy of Deep Bite in M ixed Dentition
When treating Angle
Class I combined with a
deep bite in the
late mixed dentition, a
two-by-four appliance is
preferable as the
effects of functional
orthodontic and
removable therapy are
too
limited.
142. Therapy of Deep Bite in M ixed Dentition
Maxillary splint headgear: A, occlusal aspect; B, arrow
indicates the direction of high-pull extraoral traction
143. Therapy of Deep Bite in M ixed Dentition
Deep bite in the mixed dentition can
be treated using functional orthodontic
appliances shortly before the
s u p port zones change. With a true
deep bite, a good clinical effect can
be achieved by extruding the posterior
teeth.
144. Therapy of Deep Bite in M ixed Dentition
In this situation, the activator
is the appliance of choice. In
view of the possibility of influencing
the maxillary basal plane vertically
( N L) , the Sander II appliance is particularly suitable for
correction of a
skeletal deep bite.
145. Therapy of Deep Bite in M ixed Dentition
Through additional use of the headgear, this
orthopaedic
effect can be enhanced by
counterclockwise rotation of the
maxilla . In contrast, correction of
deep bite with Angle Class Ill is done
with fixed a ppllances.
146. Angle Class I
If a deep bite is
combined with an
Angle Class I,
eruption of the
teeth and their
vertical
development can
be managed via the
activator
before the support
zones change .
147. Angle Class I
Extrusion and
vertical
development of
the alveolar
process
can be achieved,
especially in the
premolar region,
by specific
grinding
measures .
148.
149. For an extrusive movement,
the guide planes of the
activator are ground out so
that there is only one contact
line belowthe tooth
equaterand the occlusal
direction of movement
remains clear (a)
Dental arch expansion
takes place via the tooth
guide planes contoured as
inclined planes ,an
occlusion rim remains
occlusally (b)