an any other group age
Poor oral hygiene among older people has traditionally been manifest in high level of tooth loss, dental caries, and periodontal disease as well as xerostomia and oral cancer
1- Bone:
= Increasing age is associated with progressive reduction in bone mass resulting in osteoporosis
= atrophy of alveolar bone is related mainly to tooth loss and increase by age that resulting in:
- Absence of denture
- Loss of facial height
- Upward and forward posturing of mandible
= loss of alveolar bone occurs more rapidly in mandible than maxilla
= level of cyclo-oxygenase 2(cox2) enzyme, which play essential role in bone repair, decline dramatically with age, this explain the delayed bone healing in older age
2- T M J:
= The main age changes related to remodeling of the articular surface and disc in response to functional changes following tooth loss
= remodeling may result in disc displacement, particularly anterior displacement
= the retrodiscal tissue may show decreased vascularity and cellularity and increased density of collagen
= in severe cases displacement may lead to perforation of the disc resulting in progressive damage
3- Nerve and musculature:
= continued muscle function in a major requirement for the maintenance of speech and mastication, in all patient with advancing age, there is reduction in total muscle mass which occurs through a reduction in the number of muscle fiber rather than a major reduction in muscle fiber size
= by age there is a loss of motor unit specially over 60 age
= manifestations:
- Reduced masticatory force
- Reduce muscle strength
- Lengthening of chewing process
- Changes in chewing behavior
4- Oral mucosa:
= the clinical appearance of the oral mucosa in older patients is indistinguishable from younger one, however changes by time as:
- Mucosal trauma
- Mucosal disease
- Salivary gland hypo-function
Can alter the clinical features and character of oral tissues
= the stratified squamous epithelium become thinner, loss of elasticity and atrophies with age with increased oral disorders
5- Sensory changes:
= it is known that taste and smell sensitives changes throughout life and often decline with aging
= these changes can make the foods become tasteless resulting in reduction in appetite
= diminution of taste results from degeneration of taste buds and reduction of their total numbers
= elderly people cannot detect the pleasantness of food compared with younger people, this can lead to the older people to added more ingredients such as sugar or salts to food stuff that can lead to adverse health effect
6- Salivary glands:
Dry mouth –xerostomia and diminished salivary glands output are common in older age, some cases have decreased salivary output due to high intake of drugs as:
- Anti-depressant
- Anti-hypertensive
- Cytotoxic and anti-parkinsonism
Some cases with neck cancer may exposed to irradiation which cause:
- Severe and permanent salivary hypo-function
- Xerostomia
Some disease as: Diabe
Preventive orthodontic is that part of orthodontic practice that concerned with patient and parents education, supervision and development of dentition and craniofacial structures
preventive and interceptive for general practitioners.docxDr.Mohammed Alruby
Scope of orthodontics
for general practitioner
Prepared by
Dr. M Alruby
Orthodontics: is a branch of science and art of dentistry dealing with prevention, interception, and correction of positional and dimensional dentofacial abnormalities.
Orthodontic treatment could be divided as follow:
1- Preventive orthodontic treatment.
2- Interceptive orthodontic treatment.
3- Corrective orthodontic treatment. a) Early corrective. b) late corrective.
4- Post. Treatment maintenance or retentive and follow up.
Preventive orthodontics:
It is defined as that phase of orthodontics employed to recognize and eliminate potential irregularities and malposition in the developing dentofacial complex. It is directed toward improving environmental conditions to permit future normal development
N: B: the child as a patient: children will accept orthodontic treatment if the purpose for treatment is explained in a simple terms that they can understand. Information concerning treatment aims and procedures should be given to the child without hesitation and under authority; neither gives him a great attention nor neglect him. Be familiar with the child and give him some sympathy.
Most children at preadolescent age are ready to accept orthodontic treatment if the orthodontist was able to establish a sympathetic relationship with the child. The child must not force to treatment but it is better to postpone treatment until the child feels the needs for treatment.
The adolescent patients: the 15 years old patient frequently consider himself as a man and must has a special management. Adolescent patient may deny that his teeth need correction and warning of the appliances. It is very important to know whether the patient came to the office alone, with friends or forced by his parents.
Preventive orthodontics is a long range approach and it is largely a responsibility of the general dentist. Many of the procedures are common in preventive and interceptive orthodontics but the timing are different.
Preventive procedures are undertaken in anticipation of development of a problem. Interception procedures are undertaken when the problem has already manifested. For extraction of supernumerary teeth before they cause displacement of other teeth is a preventive procedure, while their extraction after the signs of malocclusion have appeared is an interceptive procedure.
Preventive procedures:
A- Pre-dental preventive procedure ( parents education):
Instruct the mother to feed her baby from breast and if the baby to be feed by a bottle, the nipple should be long enough to rest on the anterior third of the tongue. It also should contain a small side opening instead of single large end hole, this allows the milk to flow on the dorsum of the tongue and prevent it from being squeezed directly into the pharynx, by this method the tongue is allowed to function properly during swallowing which is very important in general growth of the jaws, al
Cleft palate is a congenital deformity caused by abnormal facial development during gestation. It results from the failure of structures like the lip and palate to fuse properly before birth. Treatment requires a team approach and several surgeries over many years to repair the palate and address issues like feeding difficulties, speech problems, dental abnormalities, and ear infections. The goal of palate repair surgery is to separate the oral and nasal cavities to allow for normal speech and feeding.
Restorative Dentistry For Children PAEDIATRIC DENTISTRYJamil Kifayatullah
This document discusses restorative dentistry for children. It covers the importance of maintaining a dry field for clear vision and preventing contamination during restorative procedures. It describes various methods for achieving a dry field, including cotton rolls, saliva ejectors, and rubber dams. It discusses the aims and general principles of restorative dentistry in primary teeth, including cavity classification, preparation, and choices of restorative materials. It also covers the use of preformed crowns for primary teeth, including stainless steel crowns and strip crowns. Finally, it discusses early childhood caries (ECC), including definitions, prevalence, risk factors, clinical presentations, consequences, and approaches for prevention and treatment.
4 prevention of occlussal abnormalitiesLama K Banna
This document discusses preventive orthodontics and the role of the general dentist. It emphasizes the importance of the dentist understanding normal facial development, recognizing early deviations, and identifying factors that can cause malocclusion. The dentist should monitor patients from age 5 onwards and watch for issues like retained primary teeth, habits like thumb sucking, and ectopic eruption of molars that may require early intervention. The goal is to either address problems preemptively or determine when orthodontic treatment may be needed and refer patients accordingly.
This document provides guidance on managing avulsed permanent anterior teeth in children. It discusses evaluating the injury, immediately replanting or storing the tooth, performing root canals as needed, splinting the tooth, and following up over time. The goal is to replant the tooth promptly and monitor for signs of infection or need for additional treatment like apexification to encourage healing and prevent loss of the tooth. Immediate management and follow up care are important for the best prognosis of a replanted tooth.
Preventive orthodontic is that part of orthodontic practice that concerned with patient and parents education, supervision and development of dentition and craniofacial structures
preventive and interceptive for general practitioners.docxDr.Mohammed Alruby
Scope of orthodontics
for general practitioner
Prepared by
Dr. M Alruby
Orthodontics: is a branch of science and art of dentistry dealing with prevention, interception, and correction of positional and dimensional dentofacial abnormalities.
Orthodontic treatment could be divided as follow:
1- Preventive orthodontic treatment.
2- Interceptive orthodontic treatment.
3- Corrective orthodontic treatment. a) Early corrective. b) late corrective.
4- Post. Treatment maintenance or retentive and follow up.
Preventive orthodontics:
It is defined as that phase of orthodontics employed to recognize and eliminate potential irregularities and malposition in the developing dentofacial complex. It is directed toward improving environmental conditions to permit future normal development
N: B: the child as a patient: children will accept orthodontic treatment if the purpose for treatment is explained in a simple terms that they can understand. Information concerning treatment aims and procedures should be given to the child without hesitation and under authority; neither gives him a great attention nor neglect him. Be familiar with the child and give him some sympathy.
Most children at preadolescent age are ready to accept orthodontic treatment if the orthodontist was able to establish a sympathetic relationship with the child. The child must not force to treatment but it is better to postpone treatment until the child feels the needs for treatment.
The adolescent patients: the 15 years old patient frequently consider himself as a man and must has a special management. Adolescent patient may deny that his teeth need correction and warning of the appliances. It is very important to know whether the patient came to the office alone, with friends or forced by his parents.
Preventive orthodontics is a long range approach and it is largely a responsibility of the general dentist. Many of the procedures are common in preventive and interceptive orthodontics but the timing are different.
Preventive procedures are undertaken in anticipation of development of a problem. Interception procedures are undertaken when the problem has already manifested. For extraction of supernumerary teeth before they cause displacement of other teeth is a preventive procedure, while their extraction after the signs of malocclusion have appeared is an interceptive procedure.
Preventive procedures:
A- Pre-dental preventive procedure ( parents education):
Instruct the mother to feed her baby from breast and if the baby to be feed by a bottle, the nipple should be long enough to rest on the anterior third of the tongue. It also should contain a small side opening instead of single large end hole, this allows the milk to flow on the dorsum of the tongue and prevent it from being squeezed directly into the pharynx, by this method the tongue is allowed to function properly during swallowing which is very important in general growth of the jaws, al
Cleft palate is a congenital deformity caused by abnormal facial development during gestation. It results from the failure of structures like the lip and palate to fuse properly before birth. Treatment requires a team approach and several surgeries over many years to repair the palate and address issues like feeding difficulties, speech problems, dental abnormalities, and ear infections. The goal of palate repair surgery is to separate the oral and nasal cavities to allow for normal speech and feeding.
Restorative Dentistry For Children PAEDIATRIC DENTISTRYJamil Kifayatullah
This document discusses restorative dentistry for children. It covers the importance of maintaining a dry field for clear vision and preventing contamination during restorative procedures. It describes various methods for achieving a dry field, including cotton rolls, saliva ejectors, and rubber dams. It discusses the aims and general principles of restorative dentistry in primary teeth, including cavity classification, preparation, and choices of restorative materials. It also covers the use of preformed crowns for primary teeth, including stainless steel crowns and strip crowns. Finally, it discusses early childhood caries (ECC), including definitions, prevalence, risk factors, clinical presentations, consequences, and approaches for prevention and treatment.
4 prevention of occlussal abnormalitiesLama K Banna
This document discusses preventive orthodontics and the role of the general dentist. It emphasizes the importance of the dentist understanding normal facial development, recognizing early deviations, and identifying factors that can cause malocclusion. The dentist should monitor patients from age 5 onwards and watch for issues like retained primary teeth, habits like thumb sucking, and ectopic eruption of molars that may require early intervention. The goal is to either address problems preemptively or determine when orthodontic treatment may be needed and refer patients accordingly.
This document provides guidance on managing avulsed permanent anterior teeth in children. It discusses evaluating the injury, immediately replanting or storing the tooth, performing root canals as needed, splinting the tooth, and following up over time. The goal is to replant the tooth promptly and monitor for signs of infection or need for additional treatment like apexification to encourage healing and prevent loss of the tooth. Immediate management and follow up care are important for the best prognosis of a replanted tooth.
The document provides information on orthodontic diagnosis and clinical examination. It discusses examining the patient's age, medical history, dental history, chief complaint, and habits which help in diagnosis and treatment planning. The clinical examination evaluates the skeletal, facial, and occlusal characteristics to determine the cause of malocclusion which can be skeletal, dental, soft tissue, or a combination. This includes assessing the anteroposterior, vertical, and transverse jaw relationships to classify the skeletal pattern and guide orthodontic treatment.
The document discusses various oral habits that can interfere with facial growth and cause malocclusion. It describes habits like digit sucking, tongue thrusting, mouth breathing, lip biting, nail biting, cheek biting, bruxism, abnormal posture, and self-mutilation. For each habit, it discusses the causes, effects on dental development and jawbones, diagnosis, and treatment options like counseling, reminders, appliances, and exercises to help correct undesirable oral behaviors.
Rampant caries is a severe form of dental caries characterized by the sudden appearance of widespread and rapidly progressing cavities affecting many or all erupted teeth. It most commonly affects children between ages 4-8 and 11-19. Successful management requires a coordinated team approach between pediatricians, pediatric dentists, parents, and the child. Initial treatment involves provisional restorations, dietary counseling to reduce sugar intake, oral hygiene instructions, and both home and professional fluoride therapy. Long term management may also include comprehensive restorative dental work and extractions, with the goal of preventing further progression of dental caries.
Rampant caries is a severe form of dental caries characterized by sudden and widespread tooth decay. It most commonly affects the primary dentition of children ages 4-8. Successful management requires a team approach involving dietary counseling to reduce sugar intake, oral hygiene instruction, topical fluoride treatment, and restorative dental work. With advances in preventing and treating dental caries, rampant caries can now be controlled through early intervention, patient education, and ongoing dental care.
Introduction to pediatric dentistry 2009(new)drferas2
1. Pediatric dentistry is concerned with dental care and treatment of children, with objectives including relieving pain, restoring function, preventing disease, and modifying child behavior.
2. Common dental diseases in children include baby bottle caries, thumb sucking, trauma, and malocclusion. Treatment involves restorative procedures like fillings, stainless steel crowns, pulpotomy, and extractions when teeth are non-restorable.
3. Elements of comprehensive pediatric dental care include patient records, behavior management, guidance of developing occlusion, and preventive methods like fluoride, sealants, and dietary counseling.
The document discusses the importance of preventive and interceptive orthodontics, which aims to recognize and address potential orthodontic issues early on through procedures like parent education on oral hygiene and diet, caries control methods, management of conditions affecting tooth eruption, and early treatment of oral habits that could interfere with proper occlusion development. It emphasizes starting orthodontic prevention from the prenatal period through childhood by examining the dentition regularly and addressing any emerging problems to minimize the need for future comprehensive treatment.
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
This document discusses oral habits including digit sucking, bruxism, mouth breathing, lip biting, and tongue thrusting. It provides definitions, etiologies, effects, and treatment approaches for each habit. It also discusses prevention of traumatic dental injuries through early orthodontic treatment and use of mouth guards. Finally, it outlines the role of dental professionals in detecting and preventing oral cancer through recognition of risk factors, examination of lesions, and simple diagnostic tests like oral cytology and Toluidine blue staining.
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
AGE FACTORS IN ORTHODONTICS
An important consideration in orthodontic diagnosis and treatment planning is the age of the patient. In addition age factors influence the treatment mechanics and prognosis.
There are certain features which are normal to a child, however if present in an adult would constitute malocclusion. These malocclusions need no treatment at that age as they get corrected automatically as the age advances.
The chronological age may sometimes be misleading and may not reflect the exact growth status. Thus skeletal and dental ages of the patient should be ascertained for a more accurate diagnosis.
This document discusses preventive orthodontics and measures taken to prevent malocclusion in children. It focuses on caries control, periodontal health, and preventing malocclusion. Key aspects include periodic oral examinations of children to detect early problems, preservation of arch length, replacement of lost primary teeth with space maintainers, and intercepting potential irregularities to facilitate future treatment. Conditions that can cause orthodontic problems include crowding, mismatch of tooth and jaw size, breathing issues, and thumb sucking. The general factors influencing malocclusion with premature tooth loss include abnormal oral muscles, oral habits, existing malocclusion, and erupting teeth adjacent to space left by loss.
The document discusses various oral habits in children such as thumb/finger sucking, pacifier use, lip habits, and tongue thrusting/mouthbreathing and their effects on dental development. It notes that the duration of the habit plays the biggest role in tooth movement, with 4-6 hours of force per day necessary to cause changes. Treatment approaches include reminder therapy, reward therapy, and appliance therapy if the first two fail. Common appliances described are removable plates and fixed appliances like palatal cribs or the Bluegrass appliance.
This document discusses the examination and diagnosis of complete denture patients. It emphasizes the importance of a thorough case history and physical examination. The case history should explore the patient's dental history, medical history, habits, expectations and mental attitude. The physical examination involves both extraoral and intraoral assessment including facial form, profile, symmetry, complexion and lip support. A systematic examination allows for an accurate diagnosis, prognosis, and treatment plan.
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.
The document discusses various oral habits in children such as thumb sucking, finger sucking, pacifier use, lip biting, tongue thrusting, mouth breathing, nail biting, bruxism, and self-mutilation. It describes the potential dental effects of each habit including anterior open bite, maxillary constriction, and labial-lingual movement of the incisors. Treatment options discussed include reminder therapy, reward therapy, and appliance therapy. Common appliances mentioned are palatal cribs, tongue cribs, and the Bluegrass appliance.
This document contains the objectives and content from an interhospital case presentation on early childhood caries. The presentation includes two case studies of children with dental caries, a review of dental anatomy and development, and a discussion of early childhood caries. It emphasizes the role of pediatricians in the prevention, early diagnosis, and management of early childhood caries.
Nursing bottle caries is a pattern of early childhood dental decay seen in young children due to prolonged and improper feeding habits like unrestricted bottle feeding. It is caused by fermentable carbohydrates like milk, fruit juice and honey interacting with the bacteria Streptococcus mutans in the mouth over long periods without saliva flow to wash them away, such as during sleep with a bottle. This leads to acid production and demineralization of tooth enamel. Management involves treating decay, counseling parents on proper feeding and oral hygiene, and preventing recurrence through dietary control and fluoride therapy. Complications can include pain, malocclusion and speech problems if left untreated.
This document discusses various common oral habits including lip biting, tongue thrusting, bruxism, nail biting, thumb sucking, and mouth breathing. It describes the dental effects of these habits, which vary depending on the intensity, duration, and frequency of the habit. For habits lasting 4-6 hours per day, tooth movement can occur. The document outlines different treatment approaches for habits, including reminder therapy, reward therapy, and appliance therapy. Duration is identified as playing the most critical role in causing tooth movement. The goal of treatment is to interrupt the habit before permanent teeth erupt.
This document discusses various common oral habits including lip biting, tongue thrusting, bruxism, nail biting, thumb sucking, and mouth breathing. It explains the dental effects of these habits, which vary depending on the intensity, duration, and frequency of the habit. Duration is identified as playing the most critical role in tooth movement, requiring 4-6 hours of force per day. The document outlines different treatment approaches for habits, including reminder therapy, reward therapy, and appliance therapy. Removable and fixed appliances are described for treating habits. The dental effects and treatments for specific habits like thumb sucking, pacifier use, and tongue thrusting are also summarized.
Definition
Types of rotation
Etiology of rotation
Winging and counter winging rotation
Advantages of derotation
Biomechanics of rotation correction
Methods of correction rotation
Management of molar derotation
Retention of rotated tooth
Methods to prevent relapse
Active retention
Torque when, where, how?
Importance of torque
Biomechanics in torque
Torque expression in slot 0.018 and 0.022
Expression of torque
Mode of ligation and torque
Types of torque
- Passive
- Active
Factors affect torque
Torque with different appliances
Torque in base and face
Torque prescription in different techniques
Class II malocclusion and torque
Torque control in different treatment steps
Differential torque
Torque clearance
Intrusion and torque
Torque and intra-oral elastics
The document provides information on orthodontic diagnosis and clinical examination. It discusses examining the patient's age, medical history, dental history, chief complaint, and habits which help in diagnosis and treatment planning. The clinical examination evaluates the skeletal, facial, and occlusal characteristics to determine the cause of malocclusion which can be skeletal, dental, soft tissue, or a combination. This includes assessing the anteroposterior, vertical, and transverse jaw relationships to classify the skeletal pattern and guide orthodontic treatment.
The document discusses various oral habits that can interfere with facial growth and cause malocclusion. It describes habits like digit sucking, tongue thrusting, mouth breathing, lip biting, nail biting, cheek biting, bruxism, abnormal posture, and self-mutilation. For each habit, it discusses the causes, effects on dental development and jawbones, diagnosis, and treatment options like counseling, reminders, appliances, and exercises to help correct undesirable oral behaviors.
Rampant caries is a severe form of dental caries characterized by the sudden appearance of widespread and rapidly progressing cavities affecting many or all erupted teeth. It most commonly affects children between ages 4-8 and 11-19. Successful management requires a coordinated team approach between pediatricians, pediatric dentists, parents, and the child. Initial treatment involves provisional restorations, dietary counseling to reduce sugar intake, oral hygiene instructions, and both home and professional fluoride therapy. Long term management may also include comprehensive restorative dental work and extractions, with the goal of preventing further progression of dental caries.
Rampant caries is a severe form of dental caries characterized by sudden and widespread tooth decay. It most commonly affects the primary dentition of children ages 4-8. Successful management requires a team approach involving dietary counseling to reduce sugar intake, oral hygiene instruction, topical fluoride treatment, and restorative dental work. With advances in preventing and treating dental caries, rampant caries can now be controlled through early intervention, patient education, and ongoing dental care.
Introduction to pediatric dentistry 2009(new)drferas2
1. Pediatric dentistry is concerned with dental care and treatment of children, with objectives including relieving pain, restoring function, preventing disease, and modifying child behavior.
2. Common dental diseases in children include baby bottle caries, thumb sucking, trauma, and malocclusion. Treatment involves restorative procedures like fillings, stainless steel crowns, pulpotomy, and extractions when teeth are non-restorable.
3. Elements of comprehensive pediatric dental care include patient records, behavior management, guidance of developing occlusion, and preventive methods like fluoride, sealants, and dietary counseling.
The document discusses the importance of preventive and interceptive orthodontics, which aims to recognize and address potential orthodontic issues early on through procedures like parent education on oral hygiene and diet, caries control methods, management of conditions affecting tooth eruption, and early treatment of oral habits that could interfere with proper occlusion development. It emphasizes starting orthodontic prevention from the prenatal period through childhood by examining the dentition regularly and addressing any emerging problems to minimize the need for future comprehensive treatment.
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
This document discusses oral habits including digit sucking, bruxism, mouth breathing, lip biting, and tongue thrusting. It provides definitions, etiologies, effects, and treatment approaches for each habit. It also discusses prevention of traumatic dental injuries through early orthodontic treatment and use of mouth guards. Finally, it outlines the role of dental professionals in detecting and preventing oral cancer through recognition of risk factors, examination of lesions, and simple diagnostic tests like oral cytology and Toluidine blue staining.
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
AGE FACTORS IN ORTHODONTICS
An important consideration in orthodontic diagnosis and treatment planning is the age of the patient. In addition age factors influence the treatment mechanics and prognosis.
There are certain features which are normal to a child, however if present in an adult would constitute malocclusion. These malocclusions need no treatment at that age as they get corrected automatically as the age advances.
The chronological age may sometimes be misleading and may not reflect the exact growth status. Thus skeletal and dental ages of the patient should be ascertained for a more accurate diagnosis.
This document discusses preventive orthodontics and measures taken to prevent malocclusion in children. It focuses on caries control, periodontal health, and preventing malocclusion. Key aspects include periodic oral examinations of children to detect early problems, preservation of arch length, replacement of lost primary teeth with space maintainers, and intercepting potential irregularities to facilitate future treatment. Conditions that can cause orthodontic problems include crowding, mismatch of tooth and jaw size, breathing issues, and thumb sucking. The general factors influencing malocclusion with premature tooth loss include abnormal oral muscles, oral habits, existing malocclusion, and erupting teeth adjacent to space left by loss.
The document discusses various oral habits in children such as thumb/finger sucking, pacifier use, lip habits, and tongue thrusting/mouthbreathing and their effects on dental development. It notes that the duration of the habit plays the biggest role in tooth movement, with 4-6 hours of force per day necessary to cause changes. Treatment approaches include reminder therapy, reward therapy, and appliance therapy if the first two fail. Common appliances described are removable plates and fixed appliances like palatal cribs or the Bluegrass appliance.
This document discusses the examination and diagnosis of complete denture patients. It emphasizes the importance of a thorough case history and physical examination. The case history should explore the patient's dental history, medical history, habits, expectations and mental attitude. The physical examination involves both extraoral and intraoral assessment including facial form, profile, symmetry, complexion and lip support. A systematic examination allows for an accurate diagnosis, prognosis, and treatment plan.
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.
The document discusses various oral habits in children such as thumb sucking, finger sucking, pacifier use, lip biting, tongue thrusting, mouth breathing, nail biting, bruxism, and self-mutilation. It describes the potential dental effects of each habit including anterior open bite, maxillary constriction, and labial-lingual movement of the incisors. Treatment options discussed include reminder therapy, reward therapy, and appliance therapy. Common appliances mentioned are palatal cribs, tongue cribs, and the Bluegrass appliance.
This document contains the objectives and content from an interhospital case presentation on early childhood caries. The presentation includes two case studies of children with dental caries, a review of dental anatomy and development, and a discussion of early childhood caries. It emphasizes the role of pediatricians in the prevention, early diagnosis, and management of early childhood caries.
Nursing bottle caries is a pattern of early childhood dental decay seen in young children due to prolonged and improper feeding habits like unrestricted bottle feeding. It is caused by fermentable carbohydrates like milk, fruit juice and honey interacting with the bacteria Streptococcus mutans in the mouth over long periods without saliva flow to wash them away, such as during sleep with a bottle. This leads to acid production and demineralization of tooth enamel. Management involves treating decay, counseling parents on proper feeding and oral hygiene, and preventing recurrence through dietary control and fluoride therapy. Complications can include pain, malocclusion and speech problems if left untreated.
This document discusses various common oral habits including lip biting, tongue thrusting, bruxism, nail biting, thumb sucking, and mouth breathing. It describes the dental effects of these habits, which vary depending on the intensity, duration, and frequency of the habit. For habits lasting 4-6 hours per day, tooth movement can occur. The document outlines different treatment approaches for habits, including reminder therapy, reward therapy, and appliance therapy. Duration is identified as playing the most critical role in causing tooth movement. The goal of treatment is to interrupt the habit before permanent teeth erupt.
This document discusses various common oral habits including lip biting, tongue thrusting, bruxism, nail biting, thumb sucking, and mouth breathing. It explains the dental effects of these habits, which vary depending on the intensity, duration, and frequency of the habit. Duration is identified as playing the most critical role in tooth movement, requiring 4-6 hours of force per day. The document outlines different treatment approaches for habits, including reminder therapy, reward therapy, and appliance therapy. Removable and fixed appliances are described for treating habits. The dental effects and treatments for specific habits like thumb sucking, pacifier use, and tongue thrusting are also summarized.
Definition
Types of rotation
Etiology of rotation
Winging and counter winging rotation
Advantages of derotation
Biomechanics of rotation correction
Methods of correction rotation
Management of molar derotation
Retention of rotated tooth
Methods to prevent relapse
Active retention
Torque when, where, how?
Importance of torque
Biomechanics in torque
Torque expression in slot 0.018 and 0.022
Expression of torque
Mode of ligation and torque
Types of torque
- Passive
- Active
Factors affect torque
Torque with different appliances
Torque in base and face
Torque prescription in different techniques
Class II malocclusion and torque
Torque control in different treatment steps
Differential torque
Torque clearance
Intrusion and torque
Torque and intra-oral elastics
Extra-oral forces
And
Appliances
Prepared by:
Dr. Mohammed Alruby
Definition
Philosophy
History and development
Classification of extra-oral forces
Advantages of extra-oral forces
Disadvantages of extra-oral forces
Uses of extra-oral forces
Headgear
Appliance enhanced the action of headgear
Protraction appliances
Types of reversed headgear
Chin cup appliance
Orthopedic correction of class III
Orthopedic correction of open bite
Orthopedic correction of class II
Retention after orthopedic correction
Definition
It is a force derived from an extra-oral appliance that uses the forehead, the top of the head or the back of the neck as anchorage to apply forces to the dental or basal arch. It may be orthodontic force or orthopedic force to move the dentition, or restrict or redirect the growth respectively.
Philosophy:
The philosophy beyond the use of extra-oral force is based upon the old concept that, (the application of appreciable amount of force against the growing bone con modify or alter the direction of bone growth and consequently alter the shape and position of the bone
= the well-known best examples are the induced skull deformation in Colombia –India and feet deformation in Chinese girls
History and development:
Appliances resembling chin cups have been in use since the early 1800's. According to Graber, the early attempts with the chin cup were not successful because of incomplete knowledge of mandibular and facial growth, its use on non-growing patients, and an inadequate understanding of the forces generated by the chin cup.
1802: Cellier and Josef Fox in 1803, utilized chin caps in combination with bite blocks to correct the “underslung chin”
1866: Norman Kingsley introduced extra-oral head cap anchorage or force for maxillary distal movement
1880: Kingsley described an appliance that could influence the position of the dentition in upper jaw with the aid of extra-oral forces
1887: E.H.Angle recommended the use of occipital bandage in treatment of maxillary protrusion
1904: Jackson was first describing the facial mask
1892: headgear appliance was originally designed by Kingsley
1920: Angle and his followers were convinced that class II and class III elastics not only moved teeth but cause a significant skeletal changes: stimulate growth of one and restrain growth for the other so we not need to use any extra-oral force just wait until permanent dentition is completed
1923: Case recommend the use of extra-oral force against maxilla in treatment of class II and class I maxillary protrusion
1947: Kleohn, presented his treatment results with cervical neck strap, subsequent to this report, many other variation of the headgear appliance were presented
1960: Delaire facemask
Classification of extra-oral force appliances according to uses
The extra-oral pull is generally applied bilaterally, for three main purposes:
(1) as a restraining force
(2)
Effects of extra-oral appliances
And
Forces
Prepared by
Dr. Mohammed Alruby
Factors affect extra-oral force
Studies of maxillary protraction force
Results of extra-oral force
Effects of extra-oral appliances
The effects of extra-oral forces on dentofacial structure depend on the following factors:
- Direction of force
- Magnitude of force
- Duration of force
- Growth
- Patient cooperation
1- Direction of force:
Kloehn 1953, Gould 1975, Greenspan 1970, Merrifield and Cross 1970, and Worms et al 1973, all give an adequate description for the direction of force application and their effect on maxillary molar position, tipping, bodily, extrusion, intrusion movement
The direction of force should be adjusted according to the patient needs and objective of treatment as:
- When bodily movement is required, the force should pass through the center of resistance of molars (at the tri-furcation of roots) and the extra-oral tube should be placed gingivally as possible
- When bodily displacement of maxilla is required, the force should pass through the center of maxillary resistance (zygomatic bone)
- When extrusion of molars is required, (in case of deep bite) the force should pass below the center of resistance (below the level of occlusal plane)- cervical headgear is the best choice
- When intrusion is required (open bite cases) the force should pass above the level of occlusal plane
- In occipital headgear, the vector of force may pass through the center of resistance of 1st molar and thus causes: -------------- distal translation of 1st molar
- If the vector of force passes above the center of resistance causing:
a- Distal root torque
b- Mesial crown tipping
c- Intrusion of maxillary 1st molar ---- that, ----- closing the bite and same can occurs in the vertical or high pull headgear
== the direction of force can be determined by adjusting the outer bow in relation to the occlusal plane or center of resistance
== the best method for recording the force direction is the lateral cephalometric radiograph with the appliance in place, then the outer bow is adjusted in relation to the occlusal plane and the center of resistance of tooth or jaw
= in Kloehn’s face bow, the direction of force is 25 – 30 degree below the occlusal plane so that, the vector of force is far away from the center of resistance of 1st molars, thus cervical headgear causes distal tipping and extrusion of 1st molars and open bite
The direction of force depends upon the following variables:
I- Vertical position of the outer bow relative to the center of resistance:
= force applied by oblique headgear passing through the center of resistance will cause translation of the tooth and make intrusion at the same time
= force applied by oblique headgear passing above the occlusal plane
but below the center of resistance will cause:
a- Distal crown tipping, mesial root torque
b- Extrusion of mesial marginal ri
Characteristic of light
History
Laser physics and properties
Component of laser
Classification of laser
Biological effect of laser
Laser effect on dental tissues
Laser safety in dental practice
General application of laser
Personal protective equipment
Types of laser intensity in orthodontics
Uses of laser in orthodontics
Effect of laser in orthodontics
Introduction
History
Classification of maxillary fractured Lefort
Special consideration for orthognathic surgery
- Patient selection:
Age of patient
Assessment of patient motivation and expectation
The nature and severity of skeletal dysplasia
Systemic evaluation
- Patient evaluation:
(1) General evaluation
(2) Esthetic evaluation
(3) Functional evaluation
(4) Radiographic evaluation
a- Ceph ---
PA
Lateral: ------ soft and hard
b- Panorama
c- CBCT
d- Periapical
Protocol for basic orthognathic record collection
Treatment planning
- Time of treatment
- Objective of orthodontic treatment
Pre-surgical
Post-surgical
- Sequence of treatment:
Pre-surgical phase
Orthodontic in theatre
Post-surgical treatment
Surgery without orthodontics
Stability and clinical success
complications
Medical glossary
Prepared by:
Dr. Mohammed Alruby
Medical glossary
Aberrancy: occurring or developing away from the normal situation
Acantholysis: loss of coherence between epithelial cells due to degeneration of desmosomes (intercellular bridge) this will lead to the formation of intra-epithelial clefts, vesicle and bullae
Acanthosis: epithelial hyperplasia, mainly of the stratum spinosum, leading to increase thickness of the stratum granulosum due to increased number of cell layers of prickle cells
Achondroplasia: an autosomally inherited disorder characterized by abnormality of conversion cartilage into bone predominantly affecting the epiphyses of long bones, leading to retarded growth at the epiphyses and resulting in dwarfism with short extremities but normal trunk
Acidogenic: referring to organisms capable of producing acid
Aciduric: referring to organisms capable of surviving and metabolizing under highly acidic conditions
Acquired: a term used to describe a condition, habit or other characteristic which is not present at birth, which developed in the individuals by reaction to some environmental factor (to acquire is to obtain)
Agenesis: failure of formation leading to absence of a part or organ
Aglossia: failure of formation leading to absence of the tongue
Agnathia: absence of the jaw, usually the lower jaw, usually accompanied by approximation of the ears
Amyloid: pertaining of starch, having the characteristic of starch. A protein compound of albumin and chondroitin sulphate which resembles starch in appearance and may be pathologically deposited in certain tissues
Anaplasia: atypical differentiation or lack of differentiation of epithelial cells occurring in the malignant disease. Anaplastic cells have large, hyperchromatic, irregularly shaped nuclei and frequently show a typical mitosis.
Aneuploidy: an abnormal number of chromosomes in a nucleus. This usually arise from failure of paired chromosomes or sister chromatids to disjoin at anaphase of cell division
Aneurysm: circumscribed dilatation of an artery
Aneurysmal: relating to an aneurysm. The term applied to a type of cyst that produce bony expansion simulating the expansion of an artery produced by a vascular aneurysm
Angiogenesis: development of blood vessels
Angioma: a swelling or mass due to proliferation with or without dilatation of vascular channels
Anhydrosis: absence of sweating due to absence of sweat glands
Ankyloglossia: tongue tie, usually due to a short lingual frenum or one attached too near the tip of the tongue, may be due to failure of separation of tongue from the floor of the mouth during embryogenesis
Ankylosis: stiffening or fixation of a joint as a result of a disease process
Anodontia: absence of teeth
Anomaly: deviation from the normal, anything structurally unusual or irregular
Antigen: a substance that can induce an antibody response
Antimongoloid slant: an obliquity of the palpebral fissures laterally
Muscles
Part 3
Prepared by
DR. Mohammed Alruby
Development of oropharyngeal function
Neuromuscular regulation of jaw positions and functions
Muscles controlling mandibular postures
- Muscles of mastication
- Submandibular muscles
- Extensor and flexor muscles of neck
Positions of mandible
Some clinical implications
Development of oropharyngeal function
1- Prenatal maturation:
= During prenatal life, the neuromuscular system does not mature evenly, it is not accidentally that the orofacial region matures a head of limb region
= In human fetus, by about the 8 week, generalized uniform reflex movement of entire body can be elicited by tactile stimulation
Diffuse spontaneous movements in response to as yet unidentified stimuli have been observed as early as 9.5 weeks
Localized specific and more peripheral responses cannot be produced before 11 weeks, and at this time, stimulation of the nose-mouth region causes lateral body flexion
By 14 weeks, the movements have become much more individualized. Stimulation of the mouth area, the general bodily movements no longer are seen but instead facial and orbicular muscle response are produced
Stimulation of the upper lip causes the mouth to close and often deglutition occurs
Respiratory movements of the chest and abdomen are seen first at about 16 week
The gag reflex has been demonstrated in human fetus of 18.5 weeks. By 25v weeks, respiration is shallow but may support life for few hours
Stimulation of the mouth at 29 weeks’ menstrual age has elicited sucking through complete suckling and swallowing is not thought to be developed until at least 32 week
2- Neonatal oral functions:
a- The mouth as sensory instrument:
= At birth, the orofacial region is a very active perceptual system, the infant finds the mouth nipple = more tactile than the visual sensation
At birth, the tactile sense already is more highly developed in the lips and mouth than in the fingers
= The neonate’s slobbers, drools, chew his toe, sucks his thumb and discovers the gurgling sounds can be made with his mouth
= oral function of the neonate is guided primarily by local tactile stimuli, particularly those from the lips and anterior part of the tongue
= the posture’s of neonate’s tongue is between the gum pads and often for enough forward to rest between the lips, where it can perform its role of sensory guidance more easily
= the mouth of infant is used for many purpose, the perceptual functions of the tongue, lips, and facial skin are mingled with the sensory function of taste, smell and jaw position.
= the sensitivity of tongue and lips is greater than other area of the body and the sensory guidance for oral functioning, including jaw movements is from remarkably large area
b- Infant suckling and swallowing:
= Infant suckling and swallowing have been the subjects of much research due to the effectiveness of these activities is a good indication of the neurologic ma
Muscles
Part 2
Prepared by:
Dr. Mohammed Alruby
Muscle function and malocclusion
Muscle development and skull form in relation to function
Facial balance, muscle balance, and orthodontic therapy
EMG response of muscles
Myofunctional therapy
Basic concepts of neuromuscular physiology
Muscle function and malocclusion
Muscle function is a factor in shaping the dental arches and is important in maintaining the stability of the teeth following orthodontic treatment
Muscle fibers contract in response to change in electrical potential of its investing membrane, proprioceptors located in the muscles and the periodontal membrane make possible a high degree of accuracy in bringing the teeth in contact
Class II malocclusion:
The muscle function is usually normal in class I malocclusion with the exception of class I Openbite
In class I cases, the teeth are in state of balance with environmental force, although the actual measurements of tongue and lip forces showed that, they are not equal at any area during particular function
Class I openbite:
= Usually caused by thumb sucking, retained infantile tongue swallowing or both, the child begins with finger habits of sufficient intensity and duration to deform the maxillary anterior segment forcing the incisors labially and allowing the tongue to move farther in forward direction
= the tongue continues to thrust instead of entering the transitional phase, a large part of this activity may be compensatory or adaptive to produce anterior seal with lower lip during swallowing
=such activity accentuates the openbite, prevent complete eruption of incisors and increase the overjet to the extent that the lower lip may cushion behind the maxillary incisors during rest and functional movements
- The upper lip become more hypotonic
- The lower lip become hyperactive
- Chin puckering can see with each swallowing
= the hyperactive mentalis muscle, retroclined, imprecate and flatten the mandibular anterior segment
= the tongue drop downward and mouth breathing become a dominate pattern, as the tongue thrust forward, it elongates in shape thus alter the balance with buccinator mechanism resulting in:
- Collapse of posterior segment
- V-shaped palate
- Buccal cross bite
This occurs also as a result of molding effect of the tongue upon the hard palate
Mouth breathing:
Is the good explain for these changes a result of underdeveloped nasopharyngeal structures and subsequently maxillary deficiency
Class II division 1 malocclusion:
= In contrast to class I class II div 1 involve an abnormal muscle function from beginning
= As abnormal muscle function in class II div 1 is a compensatory or adaptive and is secondary to skeletal relationship
= Because of large overjet, there is lack of the lip seal during rest and various functions so, mouth breathing is developed
= Some individuals translate the mandible forward to effect lip seal and to improv
Muscles
Part 1
Prepare by
Dr. Mohammed Alruby
Histology of muscles
Physiology of muscles
Muscles development
Orofacial muscles
- Facial muscles
- Jaw muscles
- Portal muscles
Methods of studying muscles
Muscle changes during growth
Muscle function and facial development
Histology of muscles
The structural and functional unit of the muscles is the muscle fiber
Muscle fiber: elongated cylinder measure about 10 to 80 microns in thickness and from 1 to 15cm in length
= Each muscle fiber contains an acidophilic granular cytoplasm (sarcoplasm) that rich in:
Glycogen, mitochondria, Golgi apparatus, protein (actin, myosin, tropomyosin),
Large number of myofibrils (sarcostyles) which responsible for muscle contraction
= the muscle fiber is covered by thick membrane called (sarcolemma) and surrounded by CT called (endomysium)
= the muscle fibers are coalescing together to form bundles; each bundles are covered by C T septa called perimysium
= the muscle bundles are coalescing together to the whole muscle which is covered by CT fascia called epimysium, these CT contain: blood vessel, lymph vessel, and nerves, that firmly attach the muscle bundles to each other and attach the whole muscle to its tendon
= the myofibrils (sarcostyles)are the contractile units of the muscle, in skeletal muscle they are transversely striated due to presence of dark and light bands
The dark bands are formed of thick myosin filaments rich in Ca, the light bands are formed of thin actine filaments rich in water, there is a pale line in at the center of dark band called (Henesen’s disk), There is dark line at the center of light bands called (Krauses membrane) or Z line
The distance between the two lines called (sarcomere) which is a contraction unit of the muscle.
During the muscle contraction there the Sarcomere is shortened due to sliding of the light bands over the dark bans. The energy required for contraction is derived from transformation of ATP ------ ADP
Physiology of muscles:
Man has 639 muscles, composed of 6 billion muscle fibers, each fiber has 1000 fibrils, which means that there are 6000 billion fibrils at work at one of time or another.
Elasticity: muscle can be stretched behind its original length and return to the original shape after relaxation (normal muscle can be elongated about 6/10 of its length
Contractility: it is the ability of muscle to shorten its length under nerve impulse, this contraction is stimulated by acetyl choline, glycogen is partially oxidized to provides energy and lactic acid that carried away by blood stream
Excessive accumulation of lactic acid can produce fatigue
Isometric contraction: (stretching): the muscle is simply resisting the external forces without actual shortening
Isotonic contraction: there is an actual shortening of the muscle, the strength of isometric contraction is much greater than that of isotonic contraction as the stre
diagnostic aids part 3, photograph and radiograph.docxDr.Mohammed Alruby
Diagnostic Aids
Part 3
{Radiographs and Photographs}
{BMR and EMG}
Prepared by
Dr. Mohammed Alruby
Radiographs
Means: A procedure that uses a type of high-energy radiation called x-rays to take pictures of areas inside the body. X-rays pass through the body onto film or a computer, where the pictures are made
Types:
Intra-oral radiographs:
Periapical radiographs:
It is necessary for any orthodontic diagnosis for the following reasons:
The pattern and amount of root resorption of deciduous teeth
Presence or absence of permanent teeth, their size, shape, position and relative state of development
Congenital absence of teeth or presence of supernumerary teeth
Character of alveolar bone, lamina dura, and periodontal membrane
Morphology and inclination of permanent teeth roots
Pathological oral condition such as thickened periodontal membrane, periapical infection, root fractures, cysts, retained deciduous teeth
Abnormal path of eruption of permanent teeth
Malposition of individual as: rotation, which requires a larger space on the arch
Very useful in mixed dentition analysis
Recognition of exact position of impacted tooth by using method of parallax: that determine whether the unerupted tooth is located labially or palatally. Two periapical radiograph is taken with the film in the same position in each exposure, but the tube is moved in second exposure about 10cm. if the impacted tooth is moved in the same direction as the tube so the tooth is impacted palatally and the reverse is versa.
Bit-wing radiographs:
Is used mainly for detection of proximal cries, but it is of little value in orthodontic diagnosis
Occlusal film:
Occlusal projection is useful to locate the supernumerary teeth at the midline (mesiodens) and to determine accurately the position of impacted maxillary cuspids
Extra-oral radiographs:
Cephalometric radiographs:
Lateral cephalometric radiographs
PA cephalometric radiographs
Lateral oblique cephalogram:
The patient is directed by 45 degree and take the shot
Since dentofacial structure will be superimposed in the true lateral cephalometric projection, the lateral oblique direction is designed to gives a more accurate recording of the actual tooth position in either the left or right buccal segments depending on which side is approximately perpendicular to the central rays
The lateral oblique cephalogram combines most of advantages of the lateral views, intra-oral periapical survey and panoramic radiograph plus a standard cephalometric registration that makes possible measurements of bone size and eruptive movements so it is of particular size in analysis of developing dentition
Submental vertex cephalometric:
Is used to assess mandibular asymmetry in the transverse and anterior-posterior plane. It is an important aid in detecting asymmetry in the symphysis, body, ramus, and condyle of the mandible. In many cases of asymmetry, this view is important for evaluation of mandibular displacemen
Diagnostic Aids
{Study cast, Cast analysis}
Part (2)
Prepared by
Dr. Mohammed Alruby
Study cast
Definition: it is a positive replica of the teeth and their supporting structure, it should be reproducing accurately all the anatomical details of the teeth, alveolar process, mucobuccal folds, palate, frenal attachment as well as the exact relationship of the mandibular to the maxillary dental arch
Good models begin with good impression, orthodontic impression should displace the lips and cheeks, so that, the full depth of mucobuccal sulci is recorded. This over extension of impression is obtained by building up the tray periphery with wax or by using special orthodontic trays
The position of maximum intercuspation should be recorded by getting the patient to bite through softened wax, that is important for:
1- Recording the proper intercuspation specially in cases of poor occlusal fit due to extraction or tongue thrust. So it is wise to check the occlusion in the mouth and compare it to the occluded cast to insure that the model is correctly articulated
2- Trimming of the upper and lower cast together without change in occlusal relationship or fracture of teeth
Occlusal registration of wax bite:
= the position of maximum intercuspation as well as the centric relation must be registered
= a piece of soft wax large enough to cover the occlusal surface of maxillary teeth is shaped to the form of maxillary arch, then gently pressed against the maxillary teeth
= the patient instructed to relax and mandible is guided to most posterior and superior position of condyle within the glenoid fossa, while the teeth come into occlusion
= if there is shifting during closure due to cuspal interference, this mean that the occlusal position is not coincide with centric occlusal position, in this case, in this case two bites are taken one for usual occlusal position, and the other for centric occlusion
Ideal requirements of orthodontic study models:
1- They are symmetrical and pleasing to the eye and so that a symmetrical arch form can be readily recognized
2- The dental occlusion shows by setting the models on their backs
3- Clean, smooth, bubble free, with sharp angles where the cuts meet
4- Glossy in finish.
Trimming of study models:
There are two types of trimming:
a- Angle trimming:
The purpose of angle trimming is to added an appropriate proportional bases to the anatomical portion of dental casts which is important in:
- Registration of centric occlusion by having the posterior and lateral border of both casts on the same plane, so that cast may place on any side without change in its relationship
- Giving an idea about the relationship of the teeth to the alveolar process and basal bone
- Giving harmonizing appearance of the right and left sides of the cast which any a symmetry can be detected
- Detection of occlusion from any side, anterior as well as lateral sides
Principles:
1- The floor of the base is trimmed
diagnostic aids part 1 diagnosis, examination, BMR, EMG.docxDr.Mohammed Alruby
Introduction:
Proper treatment plane depends on prompt diagnosis, good clinician should have a bird’s eyes to first identify the problem and find its etiology
Definitions:
= Grabber and Rackosi: defined diagnosis as:
Recognition and systemic designation of anomalies, the practical synthesis of the finding, permitting therapy to be planned and identification to be determined
=a continuous evaluation process in orthodontics starting right from the first interaction with the patient continuing through different stages till end of treatment and course follow up visits
Goal of orthodontic diagnosis:
Is to produce a comprehensive description of the patient’s problem and then to synthesis the various elements of description into a rational problem list
Diagnostic aids:
Data required for orthodontic diagnosis are derived from routine essential diagnostic aids and also from supplemental aids when needed, Graber categorized the diagnostic aids into essential and supplemental aids
Essential:
- Case history
- Study models
- Certain radiographs: periapical, bite wing, panoramic radiograph
- Facial photographs
- Intra-oral photographs
Supplemental:
- Specialized radiographs: occlusal of maxilla and mandible, lateral cephalogram
- Hand &wrist radiograph
- Electromyography
- Endocrine test
- Basal metabolic rate
Case history:
Complete case history includes all the relevant information derived from the patient and parents and essential for planning
Personal details:
Name:
The patient’s name should be recorded for the purpose of identification and communications
Calling the patient by his/her name not only establishes a good report but also imparts confidence in the patient mind about treatment providers
In case of children, it might help to know their pet problems
Age:
= certain malocclusion occurring during growth period are transient and self-correcting
= growth modification procedures such as functional appliances can be carried out during growth periods
= surgical respective procedures such as orthognathic surgery are best carried out after cessation of growth
= chronological age is important for the maintaining of shedding and eruption time tables as well
Gender:
= recording gender of the patient is important for treatment planning, females are observed to precede males in growth related events such as onset of growth spurt, eruption of the teeth and onset of puberty
= gender may also have a bearing on patient’s compliance toward certain types of orthodontic treatment
Occupation and address:
Occupation of patient / or parents gives an idea about socioeconomic condition which might affect the selection of orthodontic appliances and can give an idea about awareness
Address of patient determine the sociality of the patient and this effect on the treatment because some countries have normally bi-maxillary protrusion and also determine the awareness of patient about treatment and oral hygiene
Patient behavior:
Behavior of patient depend on: patient
Smile: is the most pleasant and wanted expression by each one of us.
Smile: is amused facial expression with the corner of mouth turned up and exposed front teeth
Facial expression, postures of lips, occlusion and arrangement of teeth, buccal corridor, shape of teeth, gingival color, texture, contour and other several aspects constitute component of smile
Most of patients come to us to improve their smiles, the orthodontic studies stress on skeletal structure than soft tissue structure, and the smile still receives relatively little attention
Nature of smile:
1- Posed smile: voluntary, static, sustained, social smile not elicited by an emotion
2- Un-posed smile: spontaneous, involuntary, dynamic, natural, and not sustained characterized by greater lip elevation
Smile types: smile styles:
1- Commissures smile: the corner of the mouth turned upward called Monalisa smile
2- Cuspid smile: the upper lip is elevated, the entire lip rises like a window shade
3- Complex smile: the upper lip moves superiorly as in cuspid smile and lower lip moves inferiorly
Evaluation of posed smile:
variables Normal smile Not good smile
Smile arc Consonant Non consonant
Smile index Average Increased / decreased
Morley’s ratio 75 – 100% (normal) Disturbed
Buccal corridor Average Obliterated / excessive
Smile line Average High / low
Occlusal plane No canting Canting occlusal plane
Important definitions:
Smile arc:
the curvature formed by an imaginary line tangent to the incisal edges of the teeth, modified in varying degree of curvature in relationship to the lower lip
Range: from no curvature to an accentuated curvature was in relation to the lower lip, so quantification differed for each model
Buccal corridor:
the amount of dark space displayed between the facial surfaces of the posterior teeth and the corner of the mouth, calculated as the total dark space on both sides of the mouth as a percentage of the total smile width
Range: from 6% to 26.5 in approximately 0.5% increments
Maxillary gingival display or gummy smile:
The amount of gingival show above the central incisor crown and below the center of the upper lip. Negative number indicate gingival exposure. Positive number indicate tooth overlap by the lip
Range: from 1mm of gingival display (-1) to almost 7mm of tooth coverage for the female models, and approximately 2mm of gingival display (-2) to 6mm tooth coverage for male models
The variation between the models was due to differences in sizes and coordinating the images for different faces
Maxillary midline to face:
The relationship of maxillary dental midline (measured between the central incisors) to the midline of the face, defined by the center of the philtrum and the facial midline
Range: the maxillary midline was moved to the left of the face in approximately 0.25 mm increments. The right and left buccal corridor was maintained throughout the movement of the dentition. The maximum deviation show is 6mm
Maxillary to mandibular mid
orthodontic biology of tooth and supporting structure.docxDr.Mohammed Alruby
The goal is to examine the relationship between orthodontic biomechanics and the underlying biological process
When orthodontic force is applied to the crown of the tooth it is transmitted through the roots to the periodontal ligament and alveolar bone
Histology of supporting structure:
- Periodontal ligament
- Alveolar bone
I- Periodontal ligament:
A- Cellular component:
• Forming cells:
Osteoblast: bone forming cells
Fibroblast: PDL fibers forming cells
Cementoblast: in layer adjacent to the roots
• Resorptive cells:
Osteoblast: large cell rich acid phosphatase enzyme that demineralize the bone and disintegrate of organic matrix
Fibroblast: disintegrate fibers
Cementoblast: resorb cementum
• Progenitor cells: undifferentiated mesenchymal cells UMC: small cells with closed nucleus and little cytoplasm & monocytes
• Epithelial rest of malassez: arise as a result of breakdown of epithelial root sheath at the time of cementogesis
• Defensive cells: as macrophages & mast cells
B- Periodontal fibers:
1- Collagen fibers:
the main bulk of PDL fibers and found in 5 groups:
- Alveolar crest group: from cervix to alveolar crest
- Horizontal group: from cementum to bone horizontally
- Oblique group: the main attachment that run obliquely from cementum to bone in an apical direction
- Apical group: circumscribed the apex and responsible for resistance to rotation
- Inter-radicular group: inter-mediate plexus, observed midway between bone and root
- Supra-alveolar group:
Dento-gingival
Dento-periosteal
Transeptal
Circular
Alveolo-gingival
2- Oxytalan fibers:
Immediate elastic fibers that resist dissolution by acids unlike collagen
Run from cementum or bone to blood vessels
Play a role in supporting the blood vessels against distortion and compressive strain
c- Ground substances:
organic matrix surrounding the PDL elements, it is chemically composed of CHO linked with protein. CHO- protein complex commonly divided into two groups: proteoglycan and glycoprotein
ground substances of periodontal ligament is in a continuous state of remodeling process
d- Neurovascular elements:
myelinated: pain sensation
non-myelinated: blood vessels wall
PDL functions:
- Supportive
- Nutritive
- Remodeling
- Sensory
II- Alveolar bone:
= in human, marrow spaces are rare in the buccal and lingual plates, these spaces decreased with age
= wider spaces are lined with a layer of fenestrated compact bone when PDL fibers are anchor these fibers is called bundle bone
N: B:
= collagen turn over in PDL is higher 4 times than skin and 2 times than gingiva and this due to the forces in PDL is multi-directional takes vertical and horizontal component
= lake of marrow spaces implies that bone resorption takes more time so that the tooth movement in mesial and distal direction occur more than labial and lingual sides
= the resorptive cells increase as the marrow spaces increase
N: B:
The new deposited tissue during tooth migration have 3 stages:
Stage I osteoid:
is the pr
Successful infection prevention program
A successful infection prevention program depends on:
1-Developing standard operating procedures.
2- Evaluating practices and providing feedback to dental health care personnel (DHCP).
3- Routinely documenting adverse outcomes (e.g., occupational exposures to blood) and work-related illnesses in DHCP.
4- Monitoring health care associated infections in patients.
Standard Precautions
Standard Precautions: are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients.
Standard Precautions include:
1- Hand hygiene.
2- Use of personal protective equipment (e.g., gloves, masks, eyewear).
3- Respiratory hygiene / cough etiquette.
4- Sharps safety.
5- Safe injection practices (i.e., aseptic technique for parenteral medications).
6- Sterile instruments and devices.
7- Clean and disinfected environmental surfaces.
Each element of Standard Precautions is described in the following sections. Education and training are critical elements of Standard Precautions, because they help DHCP make appropriate decisions and comply with recommended practices.
1- HAND HYGIENE:
1- Perform hand hygiene.
a. When hands are visibly soiled.
b. After bare hand touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions.
C. Before and after treating each patient.
d. Before putting on gloves and again immediately after removing gloves.
2. Use soap and water when hands are visibly soiled (e.g., blood, body fluids); otherwise, an alcohol-based hand rub may be used.
2- PERSONAL PROTECTIVE EQUIPMENT (PPE):
1- Provide sufficient and appropriate PPE and ensure it is accessible to DHCP.
2- Educate all DHCP on proper selection and use of PPE.
3- Wear gloves whenever there is potential for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment.
a- Do not wear the same pair of gloves for the care of more than one patient.
b- Do not wash gloves. Gloves cannot be reused.
c- Perform hand hygiene immediately after removing gloves.
4- Wear protective clothing that covers skin and personal clothing during procedures or activities where contact with blood, saliva, or OPIM (other potential infectious materials) is anticipated.
5- Wear mouth, nose, and eye protection during procedures that are likely to generate splashes or spattering of blood or other body fluids.
6- Remove PPE before leaving the work area.
3- RESPIRATORY HYGIENE / COUGH ETIQUETTE:
1- Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and conti
The way to infection control in dental clinics
Introduction:
The unique nature of dental procedures, instrumentation and patient care settings require specific strategies directed to the prevention of transmission of diseases among dental health care workers and their patients.
Disease: impairment of normal functioning, manifested by signs and symptoms.
Infection: state produced by an infected agent in or on a suitable host, host may be or may not have signs or symptoms.
Carrier: individual harbors the agent but does not have symptoms (person can infect others).
Factors that allow or aid infection:
= The presence of pathogenic micro-organisms.
= There must be a portal of entry via which the organisms invade and colonize the susceptible host.
Medical history
A thorough medical history should be taken and up-dated at subsequent examinations. Medical history screening is essential in alerting the clinician to medical problems that could, in conjunction with dental treatment, adversely affect the patient.
Protective measures
Protection can be achieved by a combination of immunization procedures, use of barrier techniques and strict adherence to routine infection control procedures.
(a) Immunization:
All dental health care workers are advised to be immunized against HBV unless immunity from natural infection or previous immunization had been documented
(b) Protective coverings:
=Uniforms:
Uniforms should be changed regularly and whenever soiled. Gowns or aprons should be worn during procedures that are likely to cause spattering or splashing of blood.
=Hand protection:
Gloves must be worn for procedures involving contact with blood, saliva or mucous membrane. A new pair of gloves should be used for each patient.
If a gloves damaged, it must be replaced immediately. Hands should be washed thoroughly with a proprietary disinfectant liquid soap prior to and immediately after the use of gloves.
Disposable paper towels are recommended for drying of hands.
Any cuts o abrasions on the hands or wrists should be covered with adhesive waterproof dressings at all times.
=Protective glasses, masks or face shields Protective:
Glasses, masks or face shields should be worn by operators and close-support dental surgery assistants to protect the eyes against the spatter and aerosols which may occur during cavity preparation, scaling and the cleaning of instruments.
(c) Sharp instruments and needles:
Sharp instruments and needle should be handled with great care to prevent unintentional injury. Needles should never be recapped by using both hands indirect contact or by any other technique that involves moving the point of a used needle towards any part of the body. The needle can be recapped by laying the cap on the tray, placing the cap in a re-sheathing device or holding the cap with forceps before guiding the needle into the cap.
(d) First aid and inoculation injuries:
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1. 1
Dr. Mohammed Alruby
Preventive orthodontics
Prepared by:
Dr Mohammed Alruby
صواب علي دائما انفسهم يرون اشخاص مع نتعايش ان الصعب من
2. 2
Dr. Mohammed Alruby
Orthodontics: is a branch of science and art of dentistry dealing with prevention, interception and
correction of positional or dimensional dentofacial abnormalities
It has the responsibility to study and supervise the dentofacial growth and development from birth until
maturity
Orthodontic treatment could be divided as follow:
1- Preventive orthodontic treatment
2- Interceptive orthodontic treatment
3- Corrective orthodontic treatment
- Early corrective
- Late corrective
4- Post treatment maintenance or retention and follow up
= Preventive orthodontics may be defined as that phase of orthodontics that employed in recognition and
elimination of potential malocclusions
= Effective preventive measures must be applied as early as possible in the life of child (deciduous and
early mixed dentition)
= Note that prevention of malocclusion in early life din not necessarily prevent development of
malocclusion in later life
= Periodic mouth examination and full diagnostic records are necessary at least every 6 months during
the early mixed dentition because it is very critical phase during which many changes are observed as the
child transformed from deciduous to mixed dentition
Preventive measures consist mainly of the following:
1- Recognition of early deviations from the normal, this requires:
- Accurate diagnosis aided by clinical examination and full diagnostic records done at periodic
interval of 6 months
- High clinical experience and basic knowledge to differentiate between the normal occlusion
and potential malocclusion and predict the growth of dentofacial complex
2- Recognize predisposing factors of malocclusion
3- Recognize the harmful dentofacial habits
4- Classify the malocclusion and advise the needs for orthodontic care
5- Promote and maintain the normal occlusion by:
- Extraction of over retained deciduous teeth, remaining roots and supernumerary teeth
- Using space maintainer when indicated
- Caries control and restoration of caries teeth
- Control of periodontal disease and maintenance of good oral hygiene
6- Refer the child to medical specialist for diagnosis and treatment of systemic conditions
7- Refer the child with cleft palate for maxillofacial surgeon
8- Refer the patient to psychiatric when needed
The child as a patient
= children will accept orthodontic treatment if the purpose for treatment is explained in a simple term that
can understand. Information concerning treatment aims and procedures should be given to the child
without hesitation and under authority, neither give him a great attention nor neglect him
= be familiar with the child and give him some sympathy
= Most children at pre-adolescent age are ready to accept orthodontic treatment, if the orthodontist was
able to establish a sympathetic relationship with the child. The child must not force to treatment but it is
better to postpone treatment until the child feels the needs for treatment
3. 3
Dr. Mohammed Alruby
The adolescent patients
15 years old patient frequently consider himself as a man and must has a special management, adolescent
patient may deny, that his teeth needs correction of his teeth and wearing of the appliance. It is very
important to know whether the patient came the office alone, or with friend or forced by his parents
Psycho-dynamics of dentofacial, malformation
= Dentofacial malformation frequently have a psychological impact especially in adolescent patients, this
because of the constant preoccupation with their facial deformity. The psychological disturbances
associated with dentofacial deformity may have more marked effect on patient than that caused by hand
capping of the deformity itself. So the patient must be reassumed from time to time his deformity is being
corrected.
= the psychological disturbance of facially malformed children not only due to reaction of their friends at
school or when playing but also due to the reaction of his family
Families of malformed children react in different ways:
1- They either reject the child or over protect him, both condition will cause an abnormal
psychological behavior
2- The parents may blame each other on the occurrence of malformation
Results: the child also react in different ways:
1- Withdraw himself from the social contact, tend to be alone and usually accept an inferior position
in the society which usually accorded him
2- Other children may use their facial deformity as protective mechanism to get sympathy for other
people. They feel that they must have a special management because of their hand cap
= unfortunately, both behavior may not stop after correction of deformity
= when possible, correction should be done before the school age the dentist should not extract the tooth
without permission of the child, otherwise the child may lose confidence in is dentist and become
uncooperative. If refused extraction refer him to family dentist
Timing of treatment
Timing of preventive orthodontic treatment depends primarily on the presence of conditions that
require an immediate intervention regardless the age of patient however the preventive treatment is usually
carried out during deciduous and early mixed dentition
= serial examination and diagnostic record should be obtained at the following intervals:
1- Before permanent mandibular incisors begins to erupt ---- at 5 years
2- After permanent maxillary incisors begin to erupt --- at 6.5 years
3- After permanent maxillary lateral incisors begins to erupt ---- at 7.5 to 8 years
= the size of the dental arches increases rapidly in females than in males, but the time span of such increase
is shorter in females than males
= Morrees found that, the changes in the arch length and intercanine width are small between 3 and 5
years, as the permanent incisors erupt between 6: 8, the inter-canine width increase about 3mm
= from 4:6 years the arch length is stable, it is gradually increase between 6 and 10 years as a result of
eruption and increase proclination of incisors.
Between 10 and 14 years, the arch length decrease by about 1.5mm in maxilla and 2.5mm in mandible
because the mesial shifting of U and L 6 occupying the leeway space
= shorter after 10 years, the maxillary intercanine width increase by about 2mm due to eruption of U3,
while the mandibular intercanine width decrease slightly
Both arch length and intercanine width may shows slight increase after 14 years
4. 4
Dr. Mohammed Alruby
When treatment is recommended:
= potential malocclusion should be treated as early as possible when the condition is observed to interface
with normal growth, development and function or endanger the health of oral tissues
= certain types of malocclusion are self-corrected and require no treatment
Preventive procedures
- Without appliances
- With appliances
A- Preventive procedure without appliances
1- Pre-dental preventive procedures
2- Dental preventive procedures
1- Pre-dental preventive procedures:
Instruct the mother to feed his baby from breast, if the baby feed by bottle the nipple should be long enough
to rest on anterior 1/3 of the tongue. It also should contain small side opening instead of single end hole,
this allow the milk to flow on the dorsum of the tongue and prevent it from being squeezed directly into the
pharynx. By this method the tongue is allowed to functions properly during swallowing which is very
important in normal growth of the jaws, also less air will be swallowed with milk.
2- Dental preventive procedures:
1- Dental caries
= Dental caries makes possible tipping and crowding of adjacent teeth, over eruption of opposing teeth,
decrease in arch length and possible loss of the teeth. Caries should be restored to normal contour.
= Inter-proximal cavities should be prepared and permanently filled in one visit especially in mixed
dentition period, because the rapid loss of space by mesial shifting of the teeth. Permanent teeth lost due
to caries or any other reasons, should be replaced in children as early as possible if malocclusion to be
avoided. Malocclusion can be initiated due to caries or loss of the teeth as the child favor one side for
mastication to avoid chewing on painful caries tooth or hand capping by the lost teeth.
Technique for fluoride application:
The following technique is described by Knutson:
- Clean the teeth thoroughly (only the 1st
application is proceeding by dental prophylaxis)
- Isolate the teeth with cotton rolls
- Dry the teeth with compressed air
- Wet the crown surface with 2 % sodium fluoride solution using cotton applicator
- Allow the teeth to dry for 4 minutes
- Rinse the mouth with water if desired
- The 2nd
, 3rd
, fourth application are made at approximately one-week interval, Solzman found
that malocclusion is more frequent among non-fluorinated ones, this would attribute to the high
caries index and early loss of 6 in children living in areas with non- fluorinated water supply
2- Loss of the teeth and supernumerary:
Loss of teeth:
Space loss following loss of teeth are common in maxilla than in mandible and in poorly developed arch
than in well-developed arch. Well- developed arch shows a little or no space loss after extraction. Lost
teeth should be replaced as early as possible in children if malocclusion to be avoided to prevent the child
from developing an abnormal mandibular posture (bite of accommodation) or bad habits. The space of lost
teeth can be opened or closed according to the condition
Supernumerary teeth:
May cause an abnormal eruption path, malposition, ectopic eruption or even impaction of permanent teeth.
Mesiodens is one cause of median diastema, supernumerary teeth should be removed as early as possible
when detected to allow normal eruption of permanent teeth
5. 5
Dr. Mohammed Alruby
3- Infection:
Infected deciduous tooth should not keep in month for the purpose of space retention. The pressure of
inflammatory exudate can deflect the permanent tooth bud causing ectopic eruption or impaction of
permanent teeth.
Shiere et al found that complete exfoliation of permanent tooth bud may result from local inflammation
and suppuration caused by infected deciduous tooth
4- Ankylosed deciduous molars:
Ankylosed deciduous molars should be extracted when permanent successors are present, but when
permanent successors are congenitally absent, the decision in such case depend upon the condition:
- If the arch length is abundant and can accommodate all permanent teeth in a good alignment,
the tooth should be kept
- If the arch length is deficient, the ankylosed tooth should be extracted and the space is utilized
for aligning the teeth
5- Extraction of 1st
permanent molars:
If 1st
permanent molar was caries beyond repair, it may be extracted and the space is utilized for correction
of anterior crowding
The extraction is better done before eruption of 2nd
molar because there will be a great chance for 2nd
molar to erupt forward closing the space of extracted 1st
molar
6- Ectopic eruption:
Orthodontic correction of ectopically erupted teeth is too difficult, so that the prevention of ectopic eruption
is better and easy task, prevention of ectopic eruption can be achieved by:
- Removal of supernumerary teeth
- Correction of malposed teeth
- Closure of spaces of missing teeth either by orthodontic or prosthetic means
- Removal of over retained deciduous teeth
7- Premature contact:
Grinding of the incisal tip of primary canines is useful to permit free lateral excursion of the mandible, to
prevent interference with forward movement of the mandible and to correct the early cross bite
8- Over retained deciduous teeth:
Extraction of over retained deciduous teeth should be performed as indicated by the developmental status
of permanent successors
Panoramic and periapical radiograph are diagnostic
9- Deeply locked 1st
permanent molar:
= may cause resorption of the distal roots and cervical portion of 2nd
primary molars, this can treat either
by disking the distal surface of E to free the 6 or by extraction of E and maintenance the space for 5
= slightly locked 1st
permanent molar:
May freed itself automatically without active treatment or may be treated by separation with brass wire
that pass inter-dentally between E and 6 then twisted and tightened, when become loose it should be twisted
again until complete eruption of 6 takes place.
= locking of 1st
permanent molar under the cervical portion of E is usually associated with general lock
of growth of basal bone and crowding of the teeth.
10- Mouth breathing:
= Preventive measures consisted of elimination of naso-pharyngeal obstruction and construction of oral
screen. It is important to ascertain that the child can breathe through his nose before construction of oral
screen.
= many clinical tests are available, refer the child to an otolaryngologist to remove hypertrophied tissue
before any interceptive measures is taken
11- Recurrent subluxation of the mandible:
May causes occlusal and TMJ disorders when the mandible is easy dislocated as evidenced by recurrent
subluxation, the mouth opening should limit either by interdental elastics applied to fixed appliance or by
using chin cup and occlusal anchorage
6. 6
Dr. Mohammed Alruby
12- Abnormal labial Frenum:
Abnormal labial Frenum is one of the causes of median diastema, it should surgically excise before
correction of diastema
13- Tongue tie:
Congenital inferior ankyloglossia is caused by thickened abnormally attached genioglossus muscle which
fix the tongue to the floor of the mouth. Tongue tie causing feeling difficulties in infant, abnormal tongue
function and speech defect ((the sound S and R are affected)) this due to limitation of tongue movements
Healing after surgical removal of tongue tie often leaves an extensive scar which may immobilize the
tongue, so that the operation should be avoided until there is gross functional disturbance. Tongue tie may
disappear after 4 years ago, so that the operation must be carried before this age
14- Orthodontic for hemophiliacs:
= Extraction of the teeth in hemophilic patients is contraindicated when it can be avoided, but if to be done
the child should be hospitalized, multiple extractions of deciduous is done under general anesthesia, blood
transfusion is necessary to supply the child with lacking coagulating factors, if oozing occurs after loss of
deciduous teeth, ice packs, pressure, adrenaline and liquid thrombin should be applied locally
= Removable appliances are the treatment of choice for hemophilic child, impression should be taken in
hospital or in the presence of physician if fixed appliance to be used, avoiding pushing or bands against
gingiva avoiding leaving any sharp edges of the wire. Sticky wax should use to cover any sharp points in
the appliance, it preferable to use ligating elastic ring instead of ligature wire, direct bond instead of bands
B- Preventive procedures with appliance:
1- Mouth protectors:
Should be wear by children playing contact sports to avoid accidental fracture of the teeth and injuries of
soft tissues
Requirements of mouth protectors:
- Should not interfere with normal functions
- Should give maximum protection of the teeth
- Should have minimum and maximum strength
- Should be fit properly over the entire dental arch
- Should occupies little space as possible
- Should be light and easily adjusted
- Should not impinge the soft tissues
- Should not disturb the muscle function
- Should not expensive
Construction of mouth guard:
= an alginate impression material is taken and the cast is poured, a wax bite is taken with the teeth in full
occlusion.
= the appliance is fabricated from rubber with thermoplastic lining, latex or acrylic shelf with soft lining,
the appliance is worn on maxillary arch
= fixed orthodontic appliance should not remove from construction of the mouth protector, but impression
is taken with fixed appliance on place and mouth protector is constructed to fit the appliance, so it will
provide a double protection for the teeth and fixed appliance
2- Treatment of injured teeth:
Accidental traumatic injuries of maxillary anterior teeth is common and frequently occurs with protruding,
the prognosis is more favorable when the root is not completely formed
Direct blow may cause fracture of the crown while indirect blow is abler to causes fractures of the root
especially when completely formed.
Sequelae:
a- The crown may fracture with or without pulp exposure
b- Root may be fractured longitudinally or transversely with or without fracture of alveolar process
7. 7
Dr. Mohammed Alruby
c- Devitalization of the teeth is a common sequela but there may be a chance for pulp survival
especially when the root is not completely formed. So that the tooth should be kept under periodic
observation for any change of the color
d- Internal or external root resorption especially when the root is completely formed
e- Infections
f- Looseness of the teeth
g- Ankylosis
Treatment:
a- Crown fracture without pulp exposure ---- jacket crown
b- Crown fracture with pulp exposure ------- pulp capping or pulpotomy or pulpectomy and jacket
crown
c- Root fracture: usually heals by cemental deposition
Fracture of apical third with pulp devitalization --– apicectomy + endodontic treatment + jacket crown
d- Fracture of alveolar process; manual reduction and immobilization for at least six weeks
e- Looseness of the teeth ------ immobilization by acrylic splint. Self-cure acrylic splint is made directly
over the teeth including the sound teeth on both sides, the patient is asked to bring the teeth into
full occlusion with the splint in place. Then the splint is removed, allowed to set, trimmed and
polished, the cemented on maxillary teeth for 6 weeks at least.
Wiring of the loose teeth is not effective and may causes and may causes undesirable tooth
movements
Space control in deciduous and mixed dentition
= diagnosis of space deficiency problem: mixed dentition analysis
= diagnostic aids:
study cast
panoramic radiograph
periapical radiograph
bitewing radiograph
= premature loss of deciduous teeth, can causes malocclusion of permanent teeth, the deciduous teeth act
to preserve the mesio-distal and vertical spaces for their permanent successor. In determining the need for
space maintainer, careful prediction of growth and development of dentition and basal bones is necessary.
= abnormal resorption pattern of deciduous teeth may be an indication for arch length inadequacy and
future crowding
= an important part of preventive orthodontics is the correct handling of space created by premature loss
of deciduous teeth and to know whether this space should be maintained or allowed to close
= as a general rule, whenever the loss of deciduous teeth predisposes the patient to develop malocclusion,
space maintainer should be inserted.
= actually there are no hard rules for determining whether or not the premature loss of deciduous teeth
could result in malocclusion, but there are some guiding principles that must be followed carefully before
making such decision.
= when a deciduous tooth has been lost prematurely, the dentist must ask himself the following question:
1- Has the balance been disturbed?
The question is too difficult and cannot be easily answered, the teeth in the neutral zone are usually in a
state of balance under different forces acting upon them, the teeth themselves are an essential key in
maintaining this balance through their proper contact. When proximal contact is destructed by loss of
tooth, adjacent teeth will have the tendency to migrate into the edentulous space and closing it and thus
the balance disturbed
= this is not particularly true for all cases; some exception exists among which for example:
a- Well-developed dental arches and proper intercuspation; in such cases premature loss of deciduous
teeth not followed by shifting and space closure in most cases
8. 8
Dr. Mohammed Alruby
b- State of growth: the loss of the teeth in growing medium may be different from the teeth loss after
growth is completed, the chance of space closure is less in the latter case
c- Generalized spacing of the teeth: in such cases the premature loss of one of maxillary or mandibular
incisors is not followed by shifting or space closure and the construction of space maintainer
become primarily for esthetic reasons
d- The site of lost tooth: premature loss of primary mandibular molars is often requiring space
maintainer because the balance is more likely to be disturbed in this area
= if your decision is not to retain the space, it is important to check it periodically. If there is any
evidence of space closure, space maintainer should immediately inserted
2- Will the structures adapt to the space loss favorable or unfavorable?
One of the interesting properties of human organism is the ability to accommodate itself to environmental
stimuli, actually both favorable and unfavorable adaptation may occur as a results of premature loss, for
example:
a- When one of the primary molars is lost prematurely, lateral tongue thrust may occurs an adaptive
mechanism to close this space.
Actually this has favorable sequelae which is preservation of the space for permanent successors i.e.
The tongue provides some sort of dynamic space maintainers, also has favorable sequelae which is
the development of abnormal tongue habit which might cause open bite at this area.
b- Another example is the mucosa at the extraction site which when irritated by the action of mastication
and the food bolus it will become more fibrous and the underlying bone become more resistant which
considered as a favorable adaptive mechanism, however this may prevent eruption or causes
malposition of permanent tooth which unfavorable sequelae
3- Is the loss of deciduous tooth stimuli abnormal muscle function or habits?
Not all muscles react favorable to the tooth loss, for example, the loss of one of mandibular incisors in
cases of hyperactive mentalis muscles may followed by shifting of the teeth and midline toward the
extraction space, flattening of anterior segment and collapse of the dental arch.
Sometime premature loss may result in an abnormal muscle function as tongue thrust adaptive mechanism,
abnormal chewing habits also lip biting thumb sucking are more likely to develop especially when
premature loss in the anterior segment in such cases space maintainer is indicated.
4- Will the occlusion be sufficient to prevent migration of the teeth?
Proper intercuspation of the teeth may actually prevent migration of the teeth and space closure. This is
particularly true for the 1st
permanent molars when present good intercuspation, but if show cusp to cusp
relationship this will be largely wishful thinking because the intercuspation is poor, this would be applied
to primary teeth because the poorly defined occlusal table.
5- What does the premature loss of deciduous teeth effect the eruption time of its successor?
Premature loss of deciduous tooth may accelerate or identify retard the eruption of its permanent
successors, this depends on the developmental status and the amount of bone covering the permanent tooth
at the time loss of its predecessor. Periapical radiograph is important to evaluate the condition:
a- When more than 1/3 of the root is already formed and there is no thick bulk of covering bone,
accelerate eruption may occur
b- When less than 1/3 of the root is formed and there is thick bulk of covering bone and the gum may
become more fibrous and the eruption may be retarded indefinitely.
Do not surprise when see premolar erupt at 7 years and other in other case erupt at 15 years of
age
6- If the malocclusion is already present, will it has any effect on the space created by premature loss?
The answer depends on the type of malocclusion, as;
9. 9
Dr. Mohammed Alruby
a- In class II div 1 with hyperactive mentalis muscle, the loss of one of lower primary molars may result
in collapse of lower dental arch and increase the severity of class II
b- In case of crowding and arch length deficiency, premature loss of deciduous tooth is followed by
rapid space closure
c- In cases of large tongue and generalized spacing, space loss does not frequently occur and space
maintainers would not be necessary
7- If the space maintainer has to be placed, what kind of appliance should be used?
This depend on many factors including:
- Type of the tooth lost
- Type of malocclusion
- Patient cooperation
- Health of remaining teeth
- Age of patient
Factors influencing development of malocclusion following premature loss of deciduous teeth:
a- Abnormalities of oral musculatures, tongue thrust, hyperactive mentalis muscle
b- Presence of oral habits, thumb sucking, finger nail biting
c- Presence of incipient malocclusion; potential class II and class III and poor intercuspation and
arch length inadequacy
d- Sequence of eruption, age of patient, state of occlusal development, premature loss occurs before
or after eruption of 6
Space maintainers
Indications:
As a general rule, whenever the loss of deciduous teeth predisposes the patient to malocclusion, space
maintainer is indicated. Thus indication of space maintainer can be summarized as follows:
1- When disturbance in balance and shifting of the teeth is expected, this actually true for the
premature loss of one of primary mandibular molars
2- When abnormal muscle function is expected following premature loss as: premature loss of
mandibular incisors associated with hyperactive mentalis muscle
3- When premature loss of deciduous teeth can stimulate an abnormal habit as: tongue thrust, thumb
sucking
4- Poor intercuspation and expected shifting
5- Presence of potential malocclusion which might become more sever after premature loss, for
example: arch length inadequacy and expected crowding
6- When the arch length is sufficient to accommodate all permanent teeth anterior to 1st
permanent
molars in a good alignment and no further treatment will require at latter age.
7- When periapical radiographs reveals:
a- Abnormal sequence of eruption, when ectopic eruption is expected
b- Delayed eruption of permanent teeth due to either:
- Less than 1/3 of the root is formed
- Appreciable amount of alveolar bone covering the tooth
c- Uneven resorption of deciduous teeth roots and arch length deficiency is expected
8- When the space supervision reveals sign of closure
9- If retention of space will aid in prevention of further complicated treatment at later age.
Contraindication of space maintainer:
1- When tooth eruption is expected within few weeks as evidenced by:
- Formation of more the 1/3 of the roots
- No or little amount of covering alveolar bone.
2- Generalized spacing and large tongue
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Dr. Mohammed Alruby
3- When space required for permanent teeth is in excess as evidenced by actual analysis of x-ray and
cast
4- When the space retention will be complicated the condition as arch length inadequacy, the space is
allowed to close
5- When the permanent successor is congenitally missing and there is arch length inadequacy
6- Well-developed dental arches and proper intercuspation.
Requirement of space maintainer:
1- Should maintain the mesio-distal as well as the vertical dimension of lost tooth
2- If possible it should be functional at least to prevent over eruption of opposing tooth
3- Should be simple and easily fabricated
4- Should be storage enough to acts over the required periods
5- Should not endanger the remaining teeth or soft tissues
6- Should not interfere the normal growth and function
7- Should be hygienic and easily cleaned
Types of space maintainer:
I- a- functional: maintain the mesio-distal as well as vertical dimension of the teeth, in addition
restore normal functions (mastication and speech) and esthetics
b-non-functional: maintain the mesio-distal width only
II- a- fixed: band or chrome steel crown and loop maintainer, fixed lingual arch cantilever and
space regainers
b-semifixed: cantilever maintainer
c-removable: acrylic partial denture
III- a-active: space regainer
b-passive: band and loop space maintainer.
Factors affecting the type of space maintainers
Selection of space maintainer depends upon the following:
1- the tooth or teeth lost
2- the age of the patient, the sex of the patient
3- the health of the remaining teeth
4- the type of occlusion
5- possible speech involvement
6- patient cooperation
7- performance of the operator.
Space maintainer in maxillary and mandibular anterior segments
In maxillary anterior segment:
= space maintainers are not usually required even with drifting of the teeth because the inter-canine width
will increase by normal growth, however in very young children, space maintainer for this segment is
required to prevent lisping and speech defects as well as for esthetic and psychological reasons. In such
cases, removable partial denture is the appliance of choice if the child is quite cooperative.
In mandibular anterior segment:
= the construction of space maintainer for this area is controversial. You must sure that the musculature,
functional forces, growth and developmental pattern will work together to overcome the effect of tooth loss,
otherwise space maintainer must be inserted because the lower arch is the contained arch and is more
likely to collapse after premature loss. Also as the permanent mandibular incisors erupt they will need
every available bite of space to achieve normal position
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Dr. Mohammed Alruby
Fixed space maintainer as: metal crown with cantilever pontic, canine to canine or molar to molar fixed
lingual arch are the appliance of choice for this segment, removable space maintainer is undesirable in
this region because of:
- poor retention
- possible removal at meal time
- may be lost
- may interfere with normal eruption of permanent mandibular incisors which usually erupt
lingually and then uprighted by action of the tongue (festoons of removable space maintainer
prevent this movement)
space maintainers in the buccal segments:
careful space analysis is required, age, sex of the patient and the time at which premature loss occurs must
take into consideration before taking decision
diagnostic aids:
- full periapical radiograph using, long cone technique
- study casts
- panoramic radiograph
- Moyers mixed dentition analysis chart if possible
Information required:
- Lee way space
- Pattern of deciduous teeth roots resorption
- State of development of permanent teeth
- Sequence of eruption of permanent teeth
- The position of erupting permanent teeth
- Character of alveolar bone
- Type of malocclusion: normal or abnormal
- Growth pattern
- Age of patient
- Sex of patients: teeth of girls erupt 1.5:2 years earlier than boys
- The presence of abnormal muscle function
- The presence of abnormal habits
= all this information is required to know whether or not you must retain the space
= among the common mistakes is the space retention in the deciduous canine region where serial extraction
is indicated.
This depend on the degree of arch length deficiency
= slight deficiency ------- space maintainer
= severe deficiency --------serial extraction
= when the operator decides not to retain the space, a periodic supervision at 2 months’ intervals is
necessary
Space maintainer for the 1st
primary molars area
In the maxillary arch:
Most investigator feel that the loss of 1st
primary molars is less critical than loss of 2nd
primary molars and
is not followed by space closure in most cases for 2 reasons:
- The 1st
premolars erupt before canines.
- The 2nd
premolars seems to resist the unwanted shifting of 1st
permanent molars
In the mandibular arch:
The loss of 1st
primary molars is more critical and often require space maintainer
The effect of premature loss of 1st
primary molar also depends on the stage of development of
Occlusion at the time of loss:
- If loss occurs during the active eruption of 6 a strong mesial force will be exerted on E which
accordingly tip to close the space
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Dr. Mohammed Alruby
- If the loss occurs during active eruption of lateral incisors, the primary canine will drift distally
and close the space
In such cases space maintainer should be placed if another consideration permits or if serial extraction is
not indicated, when you decide to retain the space in this region, the fixed type as band or crown with loop
are the appliance of choice.
Space maintainer for 2nd
primary molars area:
= the 1st
permanent molars will shift mesially closing the space created by premature loss of 2nd
primary
molars, resulting in impaction of 2nd
premolars.
= the degree of mesial shifting of 6 depends upon the time at which the 2nd
primary molar is lost:
- If the second primary molar is lost before eruption of 6 it will erupt far mesially closing the
most of space. Band or chrome steel crown and loop with distal tissue extension may guide 6 to
normal eruption, however in some cases it may interfere with normal eruption of 6
- If 2nd
primary molar is lost after eruption of 6 the 6 may be tipped slightly or excessively
depending on the type of occlusion, intercuspation, muscle factor and he presence of arch length
deficiency and other factors. The condition will be more critical in the lower arch than in upper.
Band or chrome steel crown and loop maintainer are the appliance of choice in this region
Space maintainer for primary canine region:
= this depend on the degree of arch length inadequacy and whether serial extraction is indicated or not
= in sever arch length inadequacy, the extraction of primary canine will be a part of the planned program
of serial extraction and the space of primary canines is utilized for aligning of incisors
= in mild arch length deficiency which can solved by other means rather than extraction or in cases of
arch length sufficiency, the space of prematurely lost primary canine should be retained, otherwise
permanent canine may be blocked labially or lingually
Space maintainer for areas of multiple teeth loss:
Acrylic partial denture or full denture for children, canine to canine, molar to molar rigid lingual arch 0.7
or 0.8 stst wire are available according the case.
Fixed space maintainers
A- Functional space maintainers:
1- Fixed bridge:
= fixed bridge is very rarely used for the following reasons:
- Exert a tolerable load upon abutment teeth
- Require much chair time and much laboratory work and much adjustment
- Require reduction of abutment teeth
= it can be constructed for the anterior region by ¾ crown preparation on abutment teeth with the least
possible reduction.
= full veneer metal crown for posterior segment, an acrylic pontic is constructed and attached to the
abutment by metal bar soldered to the crown
2- Crown and bar or band and bar maintainers:
This is the simplest functional space maintainer, if not the most desirable bar is soldered to the tooth ends
of abutment teeth crown or bands. Crown is preferable than bands because of less caries susceptibility and
less likely to require re-cementation later
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Dr. Mohammed Alruby
3- Stress breaker functional space maintainer:
It is one of the most successful types of functional retainer, it is consisting of two crowns or two bands L
shape stst or nickel chrome and round vertical tube. The L shape bar is soldered on the mesial surface of
the crown of one abutment and other end fit vertical tube soldered on the distal surface of the crown of
other abutment
Band or crown, bar and sleeve retainer allows vertical movement of abutment under-functional forces, so
that, it prevent un-tolerable loads being thrust upon the supporting teeth.
B- Non-functional fixed maintainers:
1- Band and loop or chrome steel crown and loop maintainer
Advantages:
- Easily constructed
- Non expensive
- Provides rooms for erupting permanent teeth
Disadvantages:
Cannot restore the vertical dimension
- Will not restore the masticatory function
- It will not prevent over eruption of opposing teeth
Steps of construction:
- Selection of an orthodontic band or crown to fit the tooth (usually distal to the space)
- A compound impression is taken with band or crown in place
- The band or crown is removed from the tooth and replace securely in the compound impression
- The cast is poured
- A loop of 0.7 stst wire is contoured to rest on the tissue so that its mesial end is contact the
mesial abutment and its distal end is soldered to the mesial surface of distal abutment band or
crown
The loop should be wide enough to permit eruption of permanent tooth
- The maintainer is removed from the models, finished and polished and cemented in the mouth
**** this type can be made directly in the mouth by adapting and contouring the loop directly in the mouth
of the patients, the point of contact between the loop and distal abutment is marked by marking pen. Then
the band is removed and the loop is welded at this point by spot welding. Re-check again in the mouth until
desired position of the loop is obtained.
Then the loop is soldered to the band by silver and flux, finished and cemented in place.
2- Band or crown and loop with distal shoe tissue extension:
This type is indicated when 2nd
primary molar is prematurely lost before eruption of 1st
permanent molar,
the distal tissue extension may help to guide the 1st
permanent molar into normal eruption, on the other
hand it may interfere with its eruption
Steps in construction:
- A band or crown is soldered for the 1st
primary molar
- A compound impression is taken
- The band is removed and replaced in the impression and the stone cast is poured
- If the 2nd
primary molar is planned for extraction but still not, it should be cut off the model.
- A hole is made in the model in the area of disto-buccal root of 2nd
primary molar using drill,
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Dr. Mohammed Alruby
The exact length of the hole should be determined by X-ray measurement of the disto-buccal root
length of 2nd
primary molar
- The loop is made and contoured on the tissues and its mesial end is soldered to the distal surface
of 1st
primary molar band or crown and its distal end is soldered to the gold extension in the
hole
- The appliance is finished and polished, the gold extension is sharpened by carborundum stone
- Try the appliance in the mouth before cementation, X-ray film is essential to see the relation of
the gold tissue extension to the erupting 1st
permanent molar
When good relation is present, the appliance is cemented in place, it was found that the tissue
can tolerate the gold extension very well
3- Passive lingual arch:
It is the space maintainer of choice following the multiple loss of the teeth in maxillary or mandibular arch.
Although it does not restore function or prevent over-eruption of opposing teeth, it has many advantages:
- Eliminate the problem of patient cooperation
- No problem of breakage or loss
- Less caries susceptibility
Steps of construction:
= orthodontic bands are adapted on 1st
permanent molars or the most posterior teeth on the arch on both
sides
= Compound impression is taken with bands in place, the bands are removed and placed in impression
accurately in place
= The stone cast is poured
= 0.8 stst wire is contoured from the band on one side to the band on the other side of the arch and should
touch the cingulum of anterior teeth just above the gingival margin
= the free ends are soldered to the middle of lingual surface of the molars bands on both sides
Vertical loops may incorporate in the wire just mesial to the molar bands if space requiring is indicated
= the appliance is finished and polished then cemented.
4- Gerber space maintainer:
This type may be fabricated directly in the mouth during one relatively short appointment and requires no
lab work.
- Orthodontic band or crown is selected to fit the abutment tooth
- The mesial surface of the band is marked for placement of U- shaped assembly which may be
welded or soldered in place
- The u shaped assembly is fit a u shaped tube which should be adjusted until contact the surface
of mesial abutment. A marking pen is used to mark the proper position, then the U wire is welded
in the U tube in this position, occlusal rest can be added to the U tube selection to minimize the
cantilever effect
- If the appliance is used as space regainer the U wire should not welded in the U tube but instead
of open coil spring is placed between the tube and U wire selection
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Dr. Mohammed Alruby
5- Mayne space maintainer:
= impression is taken with bands on 1st
permanent molars
= the bands are removed and placed accurately in the impression then the cast is poured
= 0.036 inch stst wire is soldered on the buccal surface of molar bands then adapted to the buccal aspect
of the edentulous area, then bent lingually at the distal surface of the 1st
bicuspid and adapted to this
surface
= this wire can be activated to move first bicuspid mesially to regain space for erupting 2nd
bicuspid
This design is introduced by Dr. W R Mayne.
6- Cantilever space maintainer:
= similar to band and loop with distal shoe extension
= it is formed of casted crown with a bar rest on the tissue at edentulous area at the end of which vertical
flat arm is made to inter the tissues just mesial to the erupting 1st
molar
= careful radiographic assessment is required
= the space maintainer should be modified after eruption of 1st
permanent molars
=== the term cantilever refers to any appliance or restoration that have an extended wire that carries a
pontic or modified to perform function
Removable space maintainer
Advantage:
1- Tissue born impose less stress on adjacent teeth.
2- They can be restoring masticatory function, prevent over eruption of opposing teeth, aids in normal
speech, provide accepted esthetics
3- Easily fabricated and non-expensive
4- More hygienic and easily cleaned
5- Stimulate the tissue beneath them and thus accelerate eruption of permanent teeth
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Dr. Mohammed Alruby
Disadvantages:
1- Demand patient cooperation, so it can be lost or broken
Removable space maintainers are indicated in areas of multiple teeth loss or bilateral teeth loss
It is the appliance of choice in the maxillary arch, but the problem of retention in the mandibular arch may
restrict their use, so passive lingual arch in mandible is superior to it
Removable space maintainer can be:
- Removable partial denture
- Full denture for children
Fixed removable space maintainer
= this type may be indicated to overcome the problem of retention in removable partial denture
The use of partial or full crowns with lugs to assist in retention usually increase efficiency of removable
space maintainers
Fixed removable lingual arch
In which the vertical tubes are soldered on the lingual surface of molar bands to which the lingual arch is
fitted. This method permits the dentist to remove and adjust the lingual arch if necessary.