This document discusses various considerations and approaches for treatment planning in orthodontics. It addresses topics such as developing a problem list, involving patients in decision making, decisions around arch expansion versus extraction for crowding, growth modification versus camouflage for skeletal problems, and specific approaches for treating Class II and Class III malocclusions. Key points covered include contemporary guidelines for extraction, factors in rapid versus slow palatal expansion, limitations of tooth movement alone to correct skeletal issues, and caveats of different treatment strategies.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
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
Salivary gland imaging and sialochemistry (radiological and biochemistry)Coco Mathew
A through guide in understanding salivary gland disorders, it radiographic interpretation and components of saliva, its function along with treatment aspects.
indications and contraindications of rapid maxillary arch expansion,appliances used and effects of rapid maxillary arch expansion/ comparison between rapid and slow expansion
EXODONTIA CAN BE DEFINED AS THE PAINLESS REMOVAL OF THE WHOLE TOOTH OR A TOOTH ROOT WITHOUT TRAUMA TO THE INVESTING TISSUES, SO THAT THE WOUND HEALS UNEVENTFULLY AND NO POST OPERATIVE PROSTHETIC PROBLEM IS CREATED.
How to gain space
For General practitioners
Prepared by
Dr. M Alruby
The correction of many malocclusions requires space in order to move teeth into more ideal locations. Space required for correction of: crowding, retraction of proclined teeth, leveling of steep curve of spee, derotation of anterior teeth and for correction of unstable molar relation, the orthodontist is often faced with the dilemma of how to obtain space for these corrections. Planning space is an important aspect of treatment planning.
Methods for gaining space:
1-Proximal stripping.
2-Expansion.
3-Extraction.
4-Uprighting of the molars.
5-Derotation of posterior teeth.
6-Proclination of anterior teeth.
7- Distalization.
1- Proximal stripping:
Proximal stripping is a method by which the proximal surfaces of the teeth are sliced in order to reduce the mesio-distal width of the teeth. It also known by the synonyms, reproximation, slenderization, disking and proximal slicing. Although this procedure is routinely carried out on the lower incisors it can also be done on the upper anterior and buccal segments of upper and lower arches.
Indication for proximal stripping:
1- Proximal stripping is usually indicated when the space required is minimal (about 2.5 mm) in these cases, it is possible to avoid extraction of the teeth by performing reproximation.
2- If the Bolton's analysis show mild tooth material excess in either of the arches, it is possible to reduce the tooth material by proximal stripping.
Contra indication for proximal stripping:
1- Proximal stripping is not carried out in young patients, as they possess large pulp chamber, which increase the risk of pulpal exposure.
2- Patients who are susceptible to caries or those have high caries index.
Advantage of proximal stripping:
1- It is possible to avoid extraction in borderline cases where space requirement is minimal.
2- A more favorable over bite and over jet relation can be established by eliminating tooth material excess in either of the arches.
3- More stable results can be established by broadening the contact area thereby eliminating small contact points, which can slip and cause rotation of the teeth.
Disadvantage of proximal stripping:
1- The stripping procedure creates roughened proximal surface that attracts plaque.
2- Caries susceptibility is increased as a part of the enamel is removed, leaving behind a roughened area.
3- Patients may experience sensitivity of the teeth.
4- Improper procedure at the hands of the inexperienced operators can result in alteration of morphology of the teeth, creating an unnatural appearance of the teeth.
5- Loss of contact between adjacent teeth may result in food impaction.
Diagnostic aids for proximal stripping:
Arch perimeter analysis: showing tooth material excess about 2.5 mm over the arch length is a diagnostic criteria favoring reproximation.
Bolton's analysis: Bolton's analysis revealing an excess of tooth material in either of th
Mouth preparation refers to procedures that must be accomplished before fixed prosthodontic treatment can be properly performed.
Rarely are crowns or fixed prosthodontic treatment provided without initial therapy because what causes the need for the fixed prosthesis also promote other pathological processes (caries and periodontal disease are the most common).
Failure of fixed prosthesis often results from inadequate or incomplete mouth preparation.
Early treatment: Is the treatment during the most active growth period
Indications:
1- Elimination of bad habits which interfere with normal dento-facial growth
2- Gross mal-relationship of the dental arches (severe class II, III, malocclusion) to utilize growth in treatment of the case, if these deformities remain untreated it is very difficult to be corrected by orthodontic means alone in adults
3- Gross malformation in the dental arches as, cross bite, open bite, and excessive overbite
4- Labioversion or torso-version of permanent incisors especially when crowding is expected because correction of these malposition is followed by great relapse tendency when treated in later age
= tooth movement in deciduous dentition and early mixed dentition if necessary should be carried out after complete root formation and before beginning of root resorption
Contraindications to early treatment:
1- Minor malocclusion in the deciduous teeth which may be self-corrected by growth and development
For example:
= Abnormal diastema and spacing of maxillary incisors are corrected with complete eruption of the permanent canines
= some rotations of the teeth are self-corrected by complete formation of their roots, protrusion of maxillary incisors without compression of cheeks may be self-corrected by upper lip, also unilateral cross bite, edge to edge bite in deciduous dentition are self-corrected by the action of the tongue
2- Presence of rampant caries and oral sepsis which should be treated before orthodontic treatment is under-taken
3- Nasal obstruction, enlarged tonsils and adenoid which should be surgically removed first
4- Psychologically ill, highly emotional and uncooperative children
5- Disturbances in general health which would interfere with continuity of orthodontic treatment
6- Slight irregularities of individual teeth which would not interferes with normal function, should not be treated in either deciduous or mixed dentition periods
Age factor in diagnosis and treatment:
= age of the patient is not a primary factor in deciding when corrective treatment should be started, this decision depend on the presence of conditions which if remain would interferes with normal growth and development of dento-facial complex, in such cases treated should be under-taken regardless the age of patient
The child has many ages including, chronological age, dental age and developmental or bone age. The various ages may or may not coincide with chronological age of the same patient
Therefore, it is important to correlate these ages with standard normal individuals to achieve proper diagnosis
= Angle, the 1st who advised treatment as early as possible after appearance of dentofacial deviations
= if treatment is started at an early age, the patient should be kept under periodic observations under permanent dentition is completed and growth ceases
= early treatment of gross malocclusion gives raise better esthetic, functional and more stable results
Eby divided o
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
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How many patients does case series should have In comparison to case reports.pdfpubrica101
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Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
2. TREATMENT PLANNING CONCEPTS
& GOALS
Comprehensive list of patient’s problems = Orthodontic Diagnosis
Pathological & Developmental problems separated
Objective = To design a strategy using best clinical judgement to address
the problems while maximizing benefit and minimizing cost & risk
Develop treatment plan in collaboration with patient
“Do not jump to conclusions” !!!!
3. MAJOR ISSUES IN PLANNING
TREATMENT
PATIENT INPUT
Modern planning = Interactive process
Doctor cannot decide in a paternalistic way
Patients & Parents must be involved in decision making process
Ethically, patients have right to control
“Treatment is something done for them….Not to them”
Informed concent
4. DENTAL CROWDING : TO EXPAND or
EXTRACT
Two controversial aspects of current orthodontic treatment planning
The extent to which Arch Expansion versus Extraction is indicated as
solution for Crowding in Dental Arches
The extent to which Growth Modification versus Extraction for Camouflage
or Orthognathic Surgery should be considered as solution for Skeletal
Problems
5. From beginning of Specialty, Debate on Limits of Expansion of Dental
Arches & advantages of Extraction of some Teeth to provide space for
others outweigh the Disadvantages
With Extraction, Loss of Tooth/Teeth is Disadvantage
Greater Stability of result is an Advantage
Maybe Positive or Negative effects on Facial Esthetics
Contemporary View : Majority of Orthodontic Patients should be treated
without removal of Teeth
Extraction to compensate for Crowding, Incisor Protrusion or Jaw
Discrepancy
6. ESTHETIC CONSIDERATIONS
Major factors in Extraction Decisions = Stability & Esthetics
Expansion of arches moves the patient in direction of more prominent
teeth, while extraction tends to reduce prominence
Prominence of Incisors = Excessive Lip separation at rest
Nose - Chin relationship
For Best Esthetics = Lower Lip should be as prominent as chin
7. STABILITY CONSIDERATIONS
For stable results how much arches have to be expanded ?
Lower arch is more constrained than the upper
Limitations for stable expansion maybe tighter than the upper
2mm Limitation for forward movement of Lower Incisors, as Lip pressure
increases 2mm out into space
Incisors Tipped Lingually away from Lip can be moved farther than Upright
Incisors
8.
9. More opportunity to expand Transversely than Anteroposteriorly – but
only distal to canines
Reports show that Expansion across the canines is never maintained,
especially in Lower Arch
Intercanine Dimensions decrease with age = Lip Pressure at corner of
Mouth
Expansion across Premolars & Molars is likely to be maintained = Low
Cheek Pressures
10. One approach to Upper Arch Expansion is by Opening the Midpalatal
Suture, if base is narrow !
Theory (with no supporting Evidence), upper arch expansion, creating
Temporary Crossbite, Lower Arch follows Lead !!
Excessive Expansion carries Risk of Fenestration of Premolar & Molar Roots
through the Alveolar Bone
Increased Risk of Fenestration = Beyond 3mm of Transverse Tooth
movement
11. Soft Tissue Limitation
Fenestration of Alveolar Bone & Stripping of Gingiva
Amount of Attached Gingiva = Critical Variable
Pre-treatment with Periodontist
12. CONTEMPORARY EXTRACTION
GUIDELINES
Contemporary orthodontic extraction guidelines in Class I Crowding
LESS THAN 4mm ARCH LENGTH DISCREPANCY:
Extraction rarely Indicated
Only if there is severe Incisor Protrusion
Severe Vertical Discrepancy
Some cases can be managed without Arch Expansion by slightly reducing
width of selected Teeth
13. ARCH LENGTH DISCREPANCY 5 to 9 mm :
Non Extraction or Extraction Treatment possible
Decision depends on both Hard & Soft Tissue Characteristics
Any of several Teeth can be chosen for Extraction
Non Extraction Treatment = Transverse Expansion across Premolars &
Molars
Additional Time if Posterior Teeth are to be moved Distally to increase
Arch Length
14. ARCH LENGTH DISCREPANCY 10 mm OR more :
Extraction almost always required
Amount of Crowding equals the amount of Tooth Mass being Removed =
No effect on Lip support & Facial Appearance
Extraction choice is Four 1st Premolars or Upper 1st Premolars &
Mandibular Lateral Incisors
2nd Premolar or Molar Extraction rarely is satisfactory = No space near
crowded Anterior Teeth or Options to correct Midline
15. Presence of Protrusion along with Crowding complicates the Extraction
decision
Retracting the Incisors to reduce Lip Prominence requires Space within the
Dental Arch
General Rule : Lips will move 2/3rd of distance that Incisors are retracted
16. Retrospective Studies of Ex vs Non Ex cases = Highly variable changes
The idea that Extraction will lead to narrow Arch and Incisor Retraction & that Non
Extraction leads to Incisor Protrusion and Wider Arches is NOT WELL SUPPORTED
Final Set of Guidelines :
The more you can expand without moving Incisors forward = Satisfactory Treatment
The more you can Close Extraction spaces without over Retracting Incisors =
Satisfactory Treatment
Oral Health = Excessive Expansion increases risk of Mucogingival problems
Masticatory Function = Expansion or Extraction makes no difference
17. SKELETAL PROBLEMS : GROWTH
MODIFICATION vs CAMOUFLAGE
If it were possible, Best way to correct Jaw Discrepancy is to get the patient to grow out of
it
Pattern of Facial Growth is established early in Life and it rarely changes
Important Q’s = Extent to which Growth can be Modified ?
How advantageous it is to start treatment before Adolescence?
Data from Randomized Clinical Trials for Class II Treatment outcomes are available
Skeletal Problems in other Planes of Space remain Controversial
18. TRANSVERSE MAXILLARY
DEFICIENCY
Close Relationship with Ex vs Non Ex decision
Child with Crowded teeth, a Diagnosis of Maxillary Deficiency can be a
convenient Rationale for Transverse Expansion to align teeth
Width of Maxillary Premolar teeth and Width of Palate = Methods to
Diagnose Maxillary Deficiency
Midpalatal Suture becomes more Tortous and Interdigitated with
increasing Age
19. In a Child age 9, any Expansion Device (Lingual Arch), will separate the
Midpalatal Suture, also move the molar teeth
Adolescence, Heavy force from a rigid Jackscrew Device used for separation
(Microfracture
Maxilla opens like a Hinge superiorly, at base of Nose, also opens more
Anteriorly than Posteriorly
Heavy forces and Rapid Expansion should not be used in school children =
Risk of producing undesirable changes in nose at that age
After Adolescence = Bony spicule Interlocked Suture = Surgery
20. In Adolescents, Expansion across the Suture can be done in 3 ways :
I. RAPID EXPANSION with jackscrew attached to Posterior Maxillary
Teeth, at rate of 0.5 to 1 mm/day
II. SLOW EXPANSION with same Device at rate of 1 mm per week
III. EXPANSION with a Device attached to Bone Screws or Implants
21. RAPID PALATAL EXPANSION
Goal of Growth Modification = Maximize skeletal changes and Minimize the Dental Changes produced by Treatment
THEORY : Rapid Force application to Posterior Teeth = Not enough Time for Tooth Movement = Force will be
Transferred to Suture = Suture will open while Teeth move Minimally
RPE at rate of 0.5 to 1 mm/day
1 cm or more Expansion is obtained in 2 – 3 weeks
Most of movement being separation of two halves of Maxilla, Midline Diastema
Expansion device left in pace for 3 – 4 months for Stability
10 mm of Total Expansion = 8 mm of Skeletal Expansion & 2 mm of Dental Movement
After 4 Months ( 10 mm Total Expansion ) = 5 mm of Skeletal Expansion & 5 mm Tooth Movement
22. SLOW PALATAL EXPANSION
0.5 mm per week
1 quarter turn of screw ( 0.25 mm ) every other day
Ratio of Dental to Skeletal Expansion is 1:1
Large Midline Diastema never appears
10 mm of Expansion over 10 week period = 5 mm of Dental & 5 mm of Skeletal Expansion
Overall result of Rapid vs Slow Expansion is similar
With SPE a more Physiologic Response is obtained
23. CLASS II PROBLEMS
In 1990’s two major projects using clinical randomized trial methodology
were carried out in University of North Carolina & University of Florida,
both were supported by NIDCR
Data from Trials show 3 important things :
Children treated prior to Adolescence, had significant improvement in their
Jaw Relationships
Changes in Skeletal Relationships created during early treatment could be
reversed by Latter Compensatory Growth
At the end of comprehensive treatment during adolescence, no differences
between early patients and previously untreated controls
24. CAMOUFLAGE BY TOOTH
MOVEMENT
Tooth Movement alone cannot correct Skeletal Malocclusion
If malocclusion is corrected and Facial Appearance is acceptable
then treatment outcome can be satisfactory, this is called
ORTHODONTIC CAMOUFLAGE
Camouflage : Dental Occlusion + Facial Appearance
Camouflage means that Jaw Discrepancy is no longer apparent
25. Following 3 patterns of Tooth Movement can be used to correct Class II
malocclusion
Combination of retraction of Upper teeth and forward movement of Lower
Teeth, without Extractions
Retraction of Maxillary Incisors into a Premolar Extraction Space
Distal Movement of Maxillary Molars and eventually the Entire Upper
Dental Arch
26. NON EXTRACTION TREATMENT
WITH CLASS II ELASTICS
If Forward movement of Lower Arch can be accepted = Class II Malocclusion
can corrected using Class II Elastics
Almost always, Class II patients have Lower teeth normally positioned on the
mandible or Proclined to some extent
Result of Class II Elastics = Convex Profile with Protrusive Lower Incisors &
Prominent Lower Lip ==RELAPSE WAITING TO OCCUR
After Treatment Lip Pressure moves Lower Incisors Lingually = Incisor
Crowding
Return of Overjet and Overbite
27. RETRACTION OF UPPER INCISORS
INTO PREMOLAR EXTRACTION SPACE
Straightforward way to correct Excessive Overjet = Retract Protruding Incisors
in to Space created by Maxillary Premolar Extractions
Without Lower Extractions the patient would have a Class II molar relationship,
but normal Overjet and Canine relationship at the End
Temporary Skeletal Anchorage
If Mandibular 1st or 2nd Premolars are also Extracted = Class II Elastics can be
used to bring the Lower Molars Forward & Retract the upper Incisors,
correcting both Molar relationship and Overjet
Class II Malocclusion due to Mandibular Deficiency ??
TMJ Dysfunction ?
28. DISTAL MOVEMENT OF UPPER
TEETH
If Upper Molars moved Posteriorly = correct a Class II Molar Relationship and
provide space into which other Maxillary Teeth could be Retracted
More Often Maxillary 1st Molars are Rotated Mesiolingually when a Class II
Molar relationship exists
Tipping the crowns Distally to gain space is difficult, and Bodily Movement is
Difficult Still
Until recently the Anchorage by Transpalatal Lingual Arch is accepted as the
Best way to undertake Distalization
Can be done Theoretically with a HEAD GEAR = Time Consuming & Excellent
patient compliance
29. Palatal Anchorage for Molar Movement can be created by
Splinting the Maxillary Premolars & including an Acrylic
Pad in splint so it contacts the Palatal Mucosa
2/3rd of space which opens between Molar & Premolars is
from Distal movement of Molars
Tend to come forward again as rest of Maxillary Teeth are
Retracted so more than a half – cusp Molar correction
cannot be expected
Ideal Patient = Minimum Growth potential + Good Jaw
Relationship
30. Temporary Skeletal Anchorage = Greatly improves Distal movement of
Maxillary Dentition
Space in Tuberosity region = Remove 3rd Molars
Bone Anchors placed Bilaterally in base of Zygomatic Arch or in the Palate,
Nickel Titanium spring generates force needed for Distalization
Bone Screws between Teeth prevent Distal Movement of Roots Mesial to
the screw
In some patients = 6 mm of Distal Movement of 1st & 2nd Molars
In addition the Premolars move back along with Molars ( Due to
SUPRACRESTAL FIBERS )
31. THE CAVEAT : (warning, Limitation)
If Class II Malocclusion is due to Maxillary Dental Protrusion,
moving upper teeth back is logical approach
But if there is Mandibular Deficiency, Retraction of Maxillary
Incisors after Distal movement of Molars & Premolars have same
Potential Problem as that with 1st Premolar Extraction
32. SUMMARY
In the Absence of Favorable Growth, treating Class II is Difficult
Compromises have to be accepted in order to correct occlusion
Fortunately, even though Growth Modification cannot be expected to totally
correct an Adolescent Class II problem
Some Forward Movement of Mandible relative to Maxilla does contribute to
successful treatment
Rest of correction = Combination of Upper Incisor Retraction + Forward
movement of lower arch
When No Growth expected = Orthognathic Surgery
33. CLASS III PROBLEMS
Growth Modification is just reverse of Class II
Differential growth of maxilla relative to Mandible
Edward Angle’s concept = Class III exclusively due to Excess Mandibular
growth
Any combination of Maxillary deficiency or Mandibular Excess
Maxillary Deficiency frequent occurrence = Promotion of Maxillary growth
34. HORIZONTAL – VERTICAL
MAXILLARY DEFICIENCY
If Headgear force = compressing Maxillary Sutures = Inhibition of Growth
Reverse Pull Headgear = separating the sutures = Stimulate Growth
Delaire & coworkers in France showed effects of reverse head gear
RESULTS = Successful Forward repositioning of Maxilla can be
accomplished before age 8, afterwards the Orthodontic Tooth movement
overwhelms the skeletal change
35. Even in young patients, 2 side effects are almost inevitable :
Forward movement of Maxillary Teeth relative to Maxilla
Downward & Backward Rotation of Mandible
IDEAL PATIENTS FOR THIS TREATMENT :
Normally positioned or Retrussive, but not Protrussive Maxillary Teeth
Normal or Short, but not Long, Anterior Facial Vertical Dimensions
36. MANDIBULAR EXCESS
Condylar Growth in response to Translation as surrounding Tissues grow
Results from CHIN CUP THERAPY are discouraging (Lower Incisors Tipped
Lingually )
DeClerk : Light but Full Time force from Class III elastics is used from
Skeletal Anchors in Maxilla to Skeletal Anchors in Mandible, effects on
both the jaws are observed
37. CLASS III CAMOUFLAGE
Moderately Severe Class III = Proclining the Upper Incisors & Retracting
the Lower Incisors into Extraction space
Unfortunately this illustrates as Camouflage Failure
Failure especially likely = Large & Prominent Mandible
Retracting the Mandibular Teeth = makes the chin more Prominent
Improving Dental Occlusion while making Jaw Discrepency more Obvious
is not successful teatment
38. Candidate for Class III camouflage :
Reverse Overjet due to Protrussive mandibular incisors & Retrussive
Maxillary Incisors
Short Anterior Face Height so that a downward – Backward rotation of
Mandible would improve both anterior and posterior Vertical Facial
Proportions
39. VERTICAL PROBLEMS
Skeletal vertical problems do not lend themselves to camouflage by tooth movement
For Short Face Patients = Growth modification involves down and back rotation of mandible
without creating anteroposterior mandibular deficiency
Which is why a short face Class III problem is more treatable than a long face one
Long Face pattern of growth is difficult to modify & elongating anterior teeth to close off
accompanying open bite is Antithesis of camouflage
Makes Facial appearance worse
Orthognathic Surgery : Vertically Reposition the Maxilla
Bone Anchors = Intrude Posterior Teeth
40. TREATMENT PLANNING IN SPECIAL
CIRCUMSTANCES
DENTAL DISEASE PROBLEMS
Concern that Endodontically treated teeth cannot be moved
As long as PDL is normal Endo treated teeth respond in same manner
Hemisection !!
In General, Prior Endo treatment does not Contraindicate Orthodontic Tooth
Movement
Pre Ortho Periodontal Procedures
Free Gingival Grafts
41. SYSTEMIC DISEASE PROBLEMS
Systemic Diseases = Greater risk for complications
Successful Orthodontic Treatment = Systemic Disease under control
Most common is Diabetes Mellitus (DM)
Diabetes under control = Good Periodontal response to Orthodontic Force
Alveolar Bone Loss !!
Diabetes not controlled = Real risk of Periodontal Breakdown and Bone Loss
Prolonged Orthodontic treatment should be avoided
42. Juvenile Rheumatoid Arthritis (JRA) = Severe Mandibular Deficiency
Adult onset Rheumatoid Arthritis destroys condylar process
Reduced mandibular growth reported in cases with steroid injections into TM
Joint for JRA treatment
Long Term Steroid use = Periodontal Problems during Orthodontics
Children on steroids also take BISPHONATES = Ortho impossible
Prolonged Treatment avoided
43. Orthodontic Treatment can be carried out in PREGNANCY, but there are risks
involved
Gingival Hyperplasia, Hormonal Fluctuations
Bone Turn Over issues = Alveolar bone loss & Root Resorption
Radiographs to check status of bone = not permissible during pregnancy
Treatment should be deferred until completion of pregnancy
If patients becomes Pregnant during Treatment = Place her treatment in a
Holding Pattern during Last Trimester
44. ANOMALIES & JAW INJURIES
MAXILLARY INJURIES
Fortunately, Injuries to maxilla in children are rare
If displaced by Trauma = Immediately repositioned
Protraction force from a face mask before Fractures have
completely Healed can Reposition it
45. ASYMMETRIC MANDIBULAR DEFICIENCY
In planning treatment, its important to evaluate the condyle to see if its
translating properly
Functional Appliance should be tried first
Asymmetry with deficient growth on one side and normal on other side
HYBRID FUNCTIONAL APPLIANCE
Requirements will be different for both sides
Restriction of condyle = reduced growth on affected side
Oral & Maxillofacial Surgery = Goal
46. HEMIMANDIBULAR HYPERTROPHY
Facial asymmetry can also be caused by excessive growth at one
condyle
Escape of growing tissues on one side from normal regulatory control
Never Symmetric, Late Teens, Frequently in Girls
Body of mandible affected = Bowing downward
Old name = Condylar Hyperplasia
Treatment = Ramal Osteotomy or Condylectomy