Orthodontics scope & introduction

ORTHODONTICS-ORTHODONTICS-
AIMS & SCOPEAIMS & SCOPE
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Ortho= straighten or correctOrtho= straighten or correct
dontics= related to teethdontics= related to teeth
Orthodontics is a branch of dentistry concerned withOrthodontics is a branch of dentistry concerned with
prevention, interception & correction of malocclusion &prevention, interception & correction of malocclusion &
other dentoskeletal abnormalities .other dentoskeletal abnormalities .

DEFINITIONDEFINITION
Orthodontics & dentofacial orthopaedics is that specialty areaOrthodontics & dentofacial orthopaedics is that specialty area
of health science of dentistry concerned with diagnosis,of health science of dentistry concerned with diagnosis,
supervision, guidance & treatment of growing & maturesupervision, guidance & treatment of growing & mature
dentofacial structures including those conditions that requiresdentofacial structures including those conditions that requires
movement of teeth & treatment of malrelationships &movement of teeth & treatment of malrelationships &
malformations of craniofacial complex. It includes themalformations of craniofacial complex. It includes the
correction of relationships between & among teeth & facialcorrection of relationships between & among teeth & facial
bones, application of force, including orthopedic & functionalbones, application of force, including orthopedic & functional
forces & diagnosis & treatment in conjunction withforces & diagnosis & treatment in conjunction with
orthognathic surgery to attain & maintain optimalorthognathic surgery to attain & maintain optimal
physiological health & esthetic harmony of the patient.physiological health & esthetic harmony of the patient.

OCCLUSIONOCCLUSION
 According to Edward Angle,According to Edward Angle, occlusion is the normal relation of theocclusion is the normal relation of the
occlusal surfaces of the teeth when the jaws are closed.occlusal surfaces of the teeth when the jaws are closed.
 The static relationship between the incising or masticatory surfaces ofThe static relationship between the incising or masticatory surfaces of
the maxillary & mandibular teeth or tooth analogues.the maxillary & mandibular teeth or tooth analogues.
 Centric occlusionCentric occlusion is the relation of the opposing occlusal surfaces thatis the relation of the opposing occlusal surfaces that
provides maximum planned contact &/or intercuspation.provides maximum planned contact &/or intercuspation.
 Centric relationCentric relation is the relation of the mandible to the maxilla when theis the relation of the mandible to the maxilla when the
condyles are in their most posterosuperior unstrained position in thecondyles are in their most posterosuperior unstrained position in the
glenoid fossa at an established vertical relation.glenoid fossa at an established vertical relation.

 OVERJETOVERJET- Horizontal overlap of the incisors. (normal 2-3- Horizontal overlap of the incisors. (normal 2-3
mm). It is usually measured parallel to the occlusal plane. Itmm). It is usually measured parallel to the occlusal plane. It
is measured from the labial surface of the lower central incisoris measured from the labial surface of the lower central incisor
to the lingual surface of the upper central incisor at the levelto the lingual surface of the upper central incisor at the level
of the upper incisor edge.of the upper incisor edge.
 OVERBITEOVERBITE- Vertical overlap of- Vertical overlap of
the incisors ( normal 1-2 mm). It isthe incisors ( normal 1-2 mm). It is
usually measured perpendicular tousually measured perpendicular to
the occlusal plane. It is usually thethe occlusal plane. It is usually the
distance between the lower incisor edgedistance between the lower incisor edge
& upper incisor edge.& upper incisor edge.

AIMS OF ORTHODONTICAIMS OF ORTHODONTIC
TREATMENTTREATMENT
Major responsibilities of orthodontic practiceMajor responsibilities of orthodontic practice
include the diagnosis, prevention, interceptioninclude the diagnosis, prevention, interception
& treatment of all forms of malocclusion of& treatment of all forms of malocclusion of
teeth & associated alterations in theirteeth & associated alterations in their
surrounding structures; the design,surrounding structures; the design,
application & control of functional &application & control of functional &
corrective appliances; & the guidance of thecorrective appliances; & the guidance of the
dentition & its supporting structures to attaindentition & its supporting structures to attain
& maintain optimum relations in physiologic && maintain optimum relations in physiologic &
esthetic harmony among facial & cranialesthetic harmony among facial & cranial
structures.structures.

JACKSON’S TRIADJACKSON’S TRIAD
Jackson has summarized the aimsJackson has summarized the aims
& objectives of orthodontic& objectives of orthodontic
treatment as the Jackson’s triadtreatment as the Jackson’s triad
which include-which include-
a. Structural balancea. Structural balance
b. Functional efficiencyb. Functional efficiency
c. Esthetic harmonyc. Esthetic harmony
Soft tissues
Dentoalveolar
system
Skeletal tissues

NEED FOR ORTHODONTICNEED FOR ORTHODONTIC
TREATMENTTREATMENT
 APPEARANCEAPPEARANCE- patients dissatisfied with the irregular appearance of their- patients dissatisfied with the irregular appearance of their
teeth.teeth.
 TO PREVENT TRAUMA TO THE SUPPORTING TISSUES OF THETO PREVENT TRAUMA TO THE SUPPORTING TISSUES OF THE
TEETH-TEETH- eg. A lower incisor which is trapped labial to the upper incisor dueeg. A lower incisor which is trapped labial to the upper incisor due
to traumatic occlusion. The occlusal forces are transmitted along the longto traumatic occlusion. The occlusal forces are transmitted along the long
axis of the tooth which is forced against the labial plate of the alveolaraxis of the tooth which is forced against the labial plate of the alveolar
process. If this is not corrected, the tooth will eventually loosen & will fall off.process. If this is not corrected, the tooth will eventually loosen & will fall off.
With careful occlusal guidance this situation is intercepted & prevented &With careful occlusal guidance this situation is intercepted & prevented &
treated before irreparable damage occurs.treated before irreparable damage occurs.
 TRAUMA TO TEETH-TRAUMA TO TEETH- Due to traumatic occlusion wear facets & attritionDue to traumatic occlusion wear facets & attrition
occurs.occurs.
 TRAUMA TO THE ORAL MUCOSA-TRAUMA TO THE ORAL MUCOSA- Abnormal position of the teeth mayAbnormal position of the teeth may
cause teeth to impinge against the oral mucosa instead of the antagonistcause teeth to impinge against the oral mucosa instead of the antagonist
teeth. This causes mucosal ulcerations & pain.teeth. This causes mucosal ulcerations & pain.
 FRACTURE OF TEETH-FRACTURE OF TEETH- Teeth which project out & are not covered by lipsTeeth which project out & are not covered by lips
are susceptible to fracture. (esp. during contact sports)are susceptible to fracture. (esp. during contact sports)

•DENTAL CARIES-DENTAL CARIES- Malaligned teeth are more susceptibleMalaligned teeth are more susceptible
to plaque accumulation & consequently more prone to caries.to plaque accumulation & consequently more prone to caries.
Due to improper position the self cleansing action of teeth is lostDue to improper position the self cleansing action of teeth is lost..
•PERIODONTAL DISEASE-PERIODONTAL DISEASE- Malaligned teeth with heavy plaqueMalaligned teeth with heavy plaque
accumulation lead to periodontal diseases.accumulation lead to periodontal diseases.
OCCLUSAL INTERFERENCE-OCCLUSAL INTERFERENCE- Malocclusion which producesMalocclusion which produces
deviation in the path of closure of the mandible as a result of occlusaldeviation in the path of closure of the mandible as a result of occlusal
interference may be contributory factor in the development of paininterference may be contributory factor in the development of pain
dysfunction syndrome.dysfunction syndrome.
Irregularities in the position of cusps of opposing teeth may preventIrregularities in the position of cusps of opposing teeth may prevent
mandibular closure in centric relation, & if deviation occurs it means thatmandibular closure in centric relation, & if deviation occurs it means that
asymmetric contraction is induced in muscles of mastication.asymmetric contraction is induced in muscles of mastication.
 EXTRUSION & INTRUSION OF TEETH-EXTRUSION & INTRUSION OF TEETH-

 ORTHODONTIC MOVEMENT OF TEETHORTHODONTIC MOVEMENT OF TEETH
REQUIRED IN CONJUCNTION WITHREQUIRED IN CONJUCNTION WITH
RESTORATIVE DENTISTRY-RESTORATIVE DENTISTRY- When teeth have driftedWhen teeth have drifted
as a result of dental extraction or periodontalas a result of dental extraction or periodontal
disease, it is necessary to reposition them to facilitate restorativedisease, it is necessary to reposition them to facilitate restorative
procedures. The up righting of tilted teeth or closure of spacingprocedures. The up righting of tilted teeth or closure of spacing
before making a partial denture.before making a partial denture.
 AS AN ADJUVANT TO SPEECH THERAPY-AS AN ADJUVANT TO SPEECH THERAPY- eg.eg.
Patients with cleft palate, correction of nasal twang due toPatients with cleft palate, correction of nasal twang due to
improperly placed teeth, lisping etc.improperly placed teeth, lisping etc.
 AS AN ADJUVANT TO SURGICALAS AN ADJUVANT TO SURGICAL
CORRECTIONS BY ORAL SURGEONS ORCORRECTIONS BY ORAL SURGEONS OR
OTOLARGYNEOLOGISTS (ENT SURGEON)OTOLARGYNEOLOGISTS (ENT SURGEON)- eg.- eg.
As in cleft palate patients maxillary expansion brought about afterAs in cleft palate patients maxillary expansion brought about after
surgery.surgery.

MALOCCLUSIONMALOCCLUSION
 Malocclusion : a deviation in intramaxillary &/orMalocclusion : a deviation in intramaxillary &/or
intermaxillary relations of teeth that presents a hazard to theintermaxillary relations of teeth that presents a hazard to the
individual’s well being; often associated with otherindividual’s well being; often associated with other
dentofacial deformitiesdentofacial deformities..
 INTRA ARCH MALOCCLUSIONINTRA ARCH MALOCCLUSION
 INTERARCH MALOCCLUSIONINTERARCH MALOCCLUSION
 SKELETAL MALOCCLUSIONSKELETAL MALOCCLUSION

SEQUELE OF MALOCCLUSIONSEQUELE OF MALOCCLUSION
 Poor facial appearancePoor facial appearance
 Development of cariesDevelopment of caries
 Poor oral hygienePoor oral hygiene
 Periodontal diseasesPeriodontal diseases
 Psychological disturbancesPsychological disturbances
 TraumaTrauma
 Abnormal function (improper deglutition, mouthAbnormal function (improper deglutition, mouth
breathing, improper mastication, speech defects,breathing, improper mastication, speech defects,
abnormal muscle function)abnormal muscle function)
 TMJ abnormalitiesTMJ abnormalities
 Impacted & unerupted teethImpacted & unerupted teeth
 Prosthetic rehabilitation problems…as space problems,Prosthetic rehabilitation problems…as space problems,
teeth tipped & receiving abnormal stress.teeth tipped & receiving abnormal stress.www.indiandentalacademy.comwww.indiandentalacademy.com

CLASSIFICATION OFCLASSIFICATION OF
MALOCCLUSIONMALOCCLUSION
 Edward H. Angle 1890 postulated that theEdward H. Angle 1890 postulated that the
upper first molarupper first molar was the key to occlusion &was the key to occlusion &
the upper & lower molar should be relatedthe upper & lower molar should be related
so that theso that the mesiobuccal cusp of the uppermesiobuccal cusp of the upper
molar occludes in the buccal groove of themolar occludes in the buccal groove of the
lower molarlower molar..

Angle’s Class IAngle’s Class I
 Normal relationship ofNormal relationship of
molars, but line of occlusionmolars, but line of occlusion
incorrect because ofincorrect because of
crowding, spacing,crowding, spacing,
rotations, missing tooth etc.rotations, missing tooth etc.

 Bimaxillary protrusionBimaxillary protrusion
where patient exhibitswhere patient exhibits
normal class I molarnormal class I molar
relationship but therelationship but the
dentition of both thedentition of both the
upper & lower arches areupper & lower arches are
forwardly placed inforwardly placed in
relation to the facialrelation to the facial
profile.profile.

Angle’s Class IIAngle’s Class II
 Class II molar relationshipClass II molar relationship
where the distobuccal cusp ofwhere the distobuccal cusp of
the upper first permanentthe upper first permanent
molar occludes in the buccalmolar occludes in the buccal
groove of the lower firstgroove of the lower first
permanent molar. Angle haspermanent molar. Angle has
subdivided class IIsubdivided class II
malocclusions into 2malocclusions into 2
divisions-divisions-

Angle’s Class IIIAngle’s Class III
 Class III molar relationClass III molar relation
with the mesiobuccalwith the mesiobuccal
cusp of the maxillarycusp of the maxillary
first permanent molarfirst permanent molar
occluding in theoccluding in the
interdental spaceinterdental space
between the mandibularbetween the mandibular
first & second molar.first & second molar.

SCOPE OF ORTHODONTICSCOPE OF ORTHODONTIC
TREATMENTTREATMENT

SCOPE OF ORTHODONTICSCOPE OF ORTHODONTIC
TREATMENTTREATMENT
Orthodontic practice deals directly or indirectly with the following:Orthodontic practice deals directly or indirectly with the following:
1.1. Guidance of occlusal developmentGuidance of occlusal development
2.2. Elimination of impairment of masticatory function caused byElimination of impairment of masticatory function caused by
dental malocclusiondental malocclusion
3.3. Reduction of susceptibility to dental caries caused by dentalReduction of susceptibility to dental caries caused by dental
irregularitiesirregularities
4.4. Correction of dentofacial abnormalities of genetic, congenital &Correction of dentofacial abnormalities of genetic, congenital &
environmental originenvironmental origin
5.5. Improvement of dentofacial estheticsImprovement of dentofacial esthetics
6.6. Elimination of periodontal disease & other conditions of the oralElimination of periodontal disease & other conditions of the oral
tissues resulting from malocclusiontissues resulting from malocclusion
7.7. Correction of shifted teeth prior to the construction of bridges &Correction of shifted teeth prior to the construction of bridges &
partial denturespartial dentures
8.8. Elimination of harmful dentofacial habitsElimination of harmful dentofacial habits
9.9. Correction of temporomandibular joint abnormalities caused byCorrection of temporomandibular joint abnormalities caused by
malocclusionmalocclusion

SURGICAL
ORTHODONTICS
CORRECTIVE
ORTHODONTICS
INTERCEPTIVE
ORTHODONTICS
PREVENTIVE
ORTHODONTICS
ORTHODONTICS

PREVENTIVEPREVENTIVE
ORTHODONTICSORTHODONTICS
Preventive orthodontics is that part of orthodontic practice which is concerned withPreventive orthodontics is that part of orthodontic practice which is concerned with
patient & parent education, supervision of growth & development of the dentition &patient & parent education, supervision of growth & development of the dentition &
the craniofacial structures, the diagnostic procedures undertaken to predict thethe craniofacial structures, the diagnostic procedures undertaken to predict the
appearance of malocclusion & the treatment procedures instituted to prevent theappearance of malocclusion & the treatment procedures instituted to prevent the
onset of malocclusion.onset of malocclusion.
Preventive orthodontics includes procedures undertaken prior to thePreventive orthodontics includes procedures undertaken prior to the
development of malocclusion in anticipation of a developingdevelopment of malocclusion in anticipation of a developing
malocclusion. It is basically the treatment of moderate non skeletalmalocclusion. It is basically the treatment of moderate non skeletal
problems in preadolescent children. It involves moderately severeproblems in preadolescent children. It involves moderately severe
orthodontic problems, or potential problems, that are within theorthodontic problems, or potential problems, that are within the
purview of the dentistpurview of the dentist..
The preventive procedures are planned by looking into the familialThe preventive procedures are planned by looking into the familial
patterns, habits, present dental conditions etc.patterns, habits, present dental conditions etc.

PREVENTIVEPREVENTIVE
ORTHODONTICSORTHODONTICS
Procedures undertaken in preventive orthodontics are-Procedures undertaken in preventive orthodontics are-
1. Parent education1. Parent education
2. Caries control2. Caries control
3. Care of deciduous dentition3. Care of deciduous dentition
4. Management of ankylosed tooth4. Management of ankylosed tooth
5. Tooth shedding pattern assessment5. Tooth shedding pattern assessment
6. Oral habits & habit breaking if necessary6. Oral habits & habit breaking if necessary
7. Occlusal equilibrium if occlusal prematurities are present7. Occlusal equilibrium if occlusal prematurities are present
8. Avoidance of damage to occlusion. Eg. Milwaukee braces8. Avoidance of damage to occlusion. Eg. Milwaukee braces
9. Extraction of supernumerary teeth9. Extraction of supernumerary teeth
10. Space maintenance10. Space maintenance
11. Management of deeply locked first permanent molar11. Management of deeply locked first permanent molar
12. Management of abnormal frenal attachments12. Management of abnormal frenal attachments

Irregular & malaligned teeth in early mixed dentition arise due
to two main causes-
1. Lack of adequate space for alignment , which causes an
erupting tooth to be deflected from its normal position in the
arch.
2. Interference with eruption , which prevents a permanent
tooth from erupting on normal schedule & secondarily lead to
space problems because other teeth drift into their place.
The goal of early treatment is to prevent teeth from drifting &
to create some additional space within the dental arch so that
alignment becomes possible.

ORAL HABBITS & HABBITORAL HABBITS & HABBIT
BREAKINGBREAKING
Habit is the tendency towards an act that has becomeHabit is the tendency towards an act that has become
a repeated performance, relatively fixed, consistent,a repeated performance, relatively fixed, consistent,
easy to perform, and almost automaticeasy to perform, and almost automatic..
 THUMB SUCKINGTHUMB SUCKING
 TONGUE THRUSTTONGUE THRUST
 MOUTH BREATHINGMOUTH BREATHING
 BRUXISMBRUXISM
 LIP BITINGLIP BITING
 NAIL BITINGNAIL BITING
 CLENCHINGCLENCHING

Normal development at age 4 Normal development at age 6.
Normal development at age 10 Normal development at age 12
SPACE MAINTAINENCESPACE MAINTAINENCE
Early loss of primary tooth presents a potentialEarly loss of primary tooth presents a potential
alignment problem because of the drift of permanentalignment problem because of the drift of permanent
& other primary teeth is likely unless prevented by& other primary teeth is likely unless prevented by
space maintenance.space maintenance.

What a Tooth Is Lost Prematurely...
Let's assume that unfortunately child's primary first
molar is lost prematurely at age 6. Without the
stabilizing influence of this tooth, the primary
second molar and the permanent 6-year molar (6)
begin to move forward. When the space left by the
primary first molar is closed, it prevents both
permanent bicuspids (1 & 2) from erupting into
proper position.
In another situation, let's assume that the
primary second molar is prematurely lost.
With nothing to hold it in position, the
permanent 6-year molar (6) migrates forward
and closes up the space. Once again, there
will not be enough room for both permanent
bicuspids (1 & 2) to erupt properly.
PRIMARY SECOND MOLAR MOVES INTO SPACE
PERMANENT 6 YR MOLAR
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Stopping Problems Before They Develop
Treatment for loss of the primary molar is simple, but
critical. It requires construction of a space maintainer, an
appliance that preserves the space left by the prematurely
lost tooth. Later, when it is time for the permanent
bicuspids (1 & 2) to erupt, they will have adequate room.

SPACE MAINTAINERSSPACE MAINTAINERS

INTERCEPTIVE ORTHODONTICSINTERCEPTIVE ORTHODONTICS
Interceptive orthodontics is that phase of the science &Interceptive orthodontics is that phase of the science &
art of orthodontics employed to recognize & eliminateart of orthodontics employed to recognize & eliminate
potential irregularities & malpositions in thepotential irregularities & malpositions in the
developing dentofacial complexdeveloping dentofacial complex..
It refers to the measures undertaken to prevent aIt refers to the measures undertaken to prevent a
potential malocclusion from progressing into a morepotential malocclusion from progressing into a more
severe one. These procedures are carried out when thesevere one. These procedures are carried out when the
signs & symptoms of malocclusion have appeared. Thesigns & symptoms of malocclusion have appeared. The
malocclusion may develop because of hereditary patternmalocclusion may develop because of hereditary pattern
or extrinsic or intrinsic factors.or extrinsic or intrinsic factors.

INTERCEPTIVE ORTHODONTICSINTERCEPTIVE ORTHODONTICS
Procedures undertaken in interceptiveProcedures undertaken in interceptive
orthodontics include:orthodontics include:
1.1. Serial extractionsSerial extractions
2.2. Correction of developing crossbiteCorrection of developing crossbite
3.3. Control of abnormal habitsControl of abnormal habits
4.4. Space regainingSpace regaining
5.5. Muscle exercisesMuscle exercises
6.6. Interception of skeletal malrelationInterception of skeletal malrelation
7.7. Removal of soft tissue & bony barrier to enableRemoval of soft tissue & bony barrier to enable
eruption of teetheruption of teeth

SERIAL EXTRACTIONS-The plannedSERIAL EXTRACTIONS-The planned
sequence of tooth removal involving thesequence of tooth removal involving the
extraction of selected primary teeth &extraction of selected primary teeth &
ultimately permanent teeth to relieveultimately permanent teeth to relieve
crowding & irregularity during thecrowding & irregularity during the
transition from primary to permanenttransition from primary to permanent
dentition .dentition .

CORRECTIVE ORTHODONTICSCORRECTIVE ORTHODONTICS
Corrective orthodontics is that branch of orthodonticsCorrective orthodontics is that branch of orthodontics
that recognizes the existance of malocclusion & thethat recognizes the existance of malocclusion & the
need for employing certain technical procedures toneed for employing certain technical procedures to
reduce or eliminate the problem & the attendantreduce or eliminate the problem & the attendant
sequelaesequelae..

THE ORTHODONTICTHE ORTHODONTIC
PROBLEMSPROBLEMS
ORTHODONTIC PROBLEMS
DENTAL ORIGIN SKELETAL ORIGIN COMBINATION

 Correction of commonCorrection of common
malocclusions-malocclusions-
- management of- management of
midline diastemamidline diastema
- alignment of- alignment of
crowded, spacedcrowded, spaced
teethteeth
- correction of rotated- correction of rotated
teethteeth
 DIASTEMA- A space betweenDIASTEMA- A space between
adjacent teeth. Most common isadjacent teeth. Most common is
maxillary midline diastema.maxillary midline diastema.
SPACING
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 SPACINGSPACING
 Spaces can result from a disharmonySpaces can result from a disharmony
between tooth-size and jaw-size or bybetween tooth-size and jaw-size or by
abnormal tongue thrusting activity.abnormal tongue thrusting activity.
 Spaces between the teeth can lookSpaces between the teeth can look
unattractive and can interfere with speech.unattractive and can interfere with speech.
 Orthodontic treatment usually involves theOrthodontic treatment usually involves the
use of braces to align the teeth and touse of braces to align the teeth and to
close the spaces.close the spaces.
 Abnormal tongue activity must beAbnormal tongue activity must be
eliminated or the spacing is likely to recureliminated or the spacing is likely to recur
 CROWDINGCROWDING
 A disharmony between tooth-size and jaw-A disharmony between tooth-size and jaw-
size can result in crowded, irregular teeth.size can result in crowded, irregular teeth.
 Crowded teeth can look unattractive andCrowded teeth can look unattractive and
can be more difficult to clean.can be more difficult to clean.
 Orthodontic treatment usually involves theOrthodontic treatment usually involves the
use of braces which are the most efficientuse of braces which are the most efficient
and accurate way of aligning teeth.and accurate way of aligning teeth.
 Sometimes it is necessary to extract teethSometimes it is necessary to extract teeth
to provide sufficient space to allow theto provide sufficient space to allow the
teeth to be aligned in a stable andteeth to be aligned in a stable and
harmonious position within the jaws andharmonious position within the jaws and
face.face.

Deep bite- The vertical overlapping of upper teeth overDeep bite- The vertical overlapping of upper teeth over
lower teeth, usually measured perpendicular to to thelower teeth, usually measured perpendicular to to the
occlusal planeocclusal plane..
The upper and/or lower front teeth can overupt toThe upper and/or lower front teeth can overupt to
produce a deep bite.produce a deep bite.
In severe cases, the upper teeth can cover the lowerIn severe cases, the upper teeth can cover the lower
teeth completely.teeth completely.
A deep bite can cause excessive wear of the front teethA deep bite can cause excessive wear of the front teeth
and can damage the gum behind the upper front teeth.and can damage the gum behind the upper front teeth.
Deep bites can exert excessive strain on the jaw jointDeep bites can exert excessive strain on the jaw joint
resulting in tempero-mandibular joint problems.resulting in tempero-mandibular joint problems.

Open bite- A malformation in which the anterior do not
occlude in any mandibular position.
•An open-bite exists when opposing teeth don't meet.
An open-bite can cause eating problems and excessive
wear of those teeth which do make contact. An open-
bite can be unattractive and can be associated with
speech problems.
•Open-bites are often caused by abnormal tongue
habits and, although the open-bite can be closed with
braces, unless the abnormal tongue habits are
corrected, the open bite is likely to recur.

 If the lower incisors are in front of theIf the lower incisors are in front of the
upper incisors, the condition is calledupper incisors, the condition is called
reverse overjet or anteriorreverse overjet or anterior
crossbitecrossbite..
 Posterior crossbite exists when thePosterior crossbite exists when the
maxillary posterior teeth are linguallymaxillary posterior teeth are lingually
positioned relative to the mandibularpositioned relative to the mandibular
teeth.teeth.
 Anterior crossbites can cause unevenAnterior crossbites can cause uneven
wear of the teeth and can interfere withwear of the teeth and can interfere with
normal jaw closure, placing extra strainnormal jaw closure, placing extra strain
on the jaw joint which can result inon the jaw joint which can result in
tempero-mandibular joint problems.tempero-mandibular joint problems.
 Orthodontic treatment involves the use ofOrthodontic treatment involves the use of
a fixed or removable appliance to movea fixed or removable appliance to move
the offending tooth (or teeth) forward intothe offending tooth (or teeth) forward into
a normal position.a normal position.
 Sometimes deciduous teeth must beSometimes deciduous teeth must be
extracted to provided sufficient space.extracted to provided sufficient space.
 As a general rule, anterior crossbitesAs a general rule, anterior crossbites
should be corrected as soon as they areshould be corrected as soon as they are
detected.detected.

SURGICAL ORTHODONTICSSURGICAL ORTHODONTICS
Surgical orthodontics is the branch of orthodontics that includes surgicalSurgical orthodontics is the branch of orthodontics that includes surgical
procedures carried out as an adjunct to or in conjunction withprocedures carried out as an adjunct to or in conjunction with
orthodontic treatment to correct severe dentoskeletal anormalitiesorthodontic treatment to correct severe dentoskeletal anormalities
These surgical procedures are usually carried out toThese surgical procedures are usually carried out to
eliminate an etiologic factor or to correct severeeliminate an etiologic factor or to correct severe
dentofacial abnormalities that cannot be satisfactorilydentofacial abnormalities that cannot be satisfactorily
treated by growth modification procedures or orthodontictreated by growth modification procedures or orthodontic
camouflage.camouflage.
The surgical procedures are broadly classified as major orThe surgical procedures are broadly classified as major or
minor surgical procedures. Major surgeries aim atminor surgical procedures. Major surgeries aim at
correction of severe skeletal malocclusioncorrection of severe skeletal malocclusion

 Minor surgeriesMinor surgeries
1.1. Extractions & serialExtractions & serial
extractionsextractions
2.2. Surgical uncovering ofSurgical uncovering of
teeth & operculectomyteeth & operculectomy
3.3. FrenectomyFrenectomy
4.4. PericisionPericision
5.5. Transplantation of teethTransplantation of teeth
6.6. CorticotomyCorticotomy
7.7. GingivoplastyGingivoplasty
8.8. Cosmetic contouring ofCosmetic contouring of
marginal gingivamarginal gingiva
 Major surgeriesMajor surgeries
1.1. Orthognathic surgeriesOrthognathic surgeries
2.2. Cosmetic surgeriesCosmetic surgeries
3.3. Surgical correction ofSurgical correction of
cleft lip & palatecleft lip & palate
4.4. Surgically assisted rapidSurgically assisted rapid
maxillary expansionmaxillary expansion
5.5. Placement of dentalPlacement of dental
implantsimplants

INDEX OF ORTHODONTICINDEX OF ORTHODONTIC
TREATMENT NEEDTREATMENT NEED
 IOTN was developed to helpIOTN was developed to help
determine the likely impact of adetermine the likely impact of a
malocclusion on an individual’s dentalmalocclusion on an individual’s dental
health & psychosocial wellbeing. Ithealth & psychosocial wellbeing. It
comprises of 2 elements-comprises of 2 elements-
1.1. Dental health componentDental health component
2.2. Aesthetic componentAesthetic component

IOTN TREATMENT GRADESIOTN TREATMENT GRADES
Dental componentDental component
 GRADE 1- No need for treatmentGRADE 1- No need for treatment
 GRADE 2- Mild or little needGRADE 2- Mild or little need
 GRADE 3- Moderate or borderline needGRADE 3- Moderate or borderline need
 GRADE 4- Severe or need for treatmentGRADE 4- Severe or need for treatment
 GRADE 5- Extreme or need treatmentGRADE 5- Extreme or need treatment

Aesthetic componentAesthetic component
This is to assess the aestheticThis is to assess the aesthetic
handicap posed by malocclusion &handicap posed by malocclusion &
thus the likely psychosocial impactthus the likely psychosocial impact
upon the patient.It consists of sets ofupon the patient.It consists of sets of
10 standard photographs which are10 standard photographs which are
graded from 1- most pleasing to 10-graded from 1- most pleasing to 10-
least aesthetically pleasingleast aesthetically pleasing..
 Score 1or 2 – noneScore 1or 2 – none
 Score 3 or 4 – slightScore 3 or 4 – slight
 Score 5,6 or 7 – moderateScore 5,6 or 7 – moderate
 Score 8,9 or 10 – definiteScore 8,9 or 10 – definite
The average score can be taken ofThe average score can be taken of
the 2 components. But the dentalthe 2 components. But the dental
health component is more widelyhealth component is more widely
usedused

PEER ASSESSMENTPEER ASSESSMENT
RATING(PAR)RATING(PAR)
 Measures the success of treatmentMeasures the success of treatment
 The features recorded are-The features recorded are-
1.1. Crowding by contact point displacementCrowding by contact point displacement
2.2. Buccal segment relationship in the anteroposterior,Buccal segment relationship in the anteroposterior,
vertical & trasverse planesvertical & trasverse planes
3.3. OverjetOverjet
4.4. OverbiteOverbite
5.5. Centre-linesCentre-lines
The difference between the PAR scores at the start &The difference between the PAR scores at the start &
on completion of treatment can be calculated & fromon completion of treatment can be calculated & from
this the percentage change in PAR score which is athis the percentage change in PAR score which is a
reflection of the success of the treatment is derived.reflection of the success of the treatment is derived.

THANK YOUTHANK YOU

Orthodontics scope & introduction

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