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
Techniques for anchorage control in lingual orthodonticsParag Deshmukh
various techniques used in lingual orthodontics for anchorage control are described here.. and various cases of lingual orthodontics in which different techniques were used for anchorage control are discussed here..
Techniques for anchorage control in lingual orthodonticsParag Deshmukh
various techniques used in lingual orthodontics for anchorage control are described here.. and various cases of lingual orthodontics in which different techniques were used for anchorage control are discussed here..
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
History:
= In early 1900, George Crozat developed a removable appliance that fabricated from precious metal and consists of:
a- Effective clasp on 1st molars
b- Heavy gold wire as a framework
c- Lighter gold finger springs that produce desired tooth movements
After that the removable appliance developed and continued in Europe but neglected in united state
= in 1900, Monoblock developed by Robin and considered the forerunner of all functional appliance
= in 1920, development of activator by Andreson in Norwegian
Martin Schwarz in Vienna developed variety of split plate which effective in expanding the dental arches
Philip Adams in Belfast modified the arrow head clasp by Schwartz into Adams Crip which become the basis of English removable appliance
= in 1925 to 1965: American orthodontic based on use of fixed appliance that is unknown in Europe which all treatment done by removable
= in 1960: introduction of functional appliances in American by Egil Harvold
General requirements of orthodontic appliances:
1- Should be comfortable to wear and easily accepted by patients
2- Should be able to produce the desired force that cause a well-controlled tooth movement
3- Should be fabricated from bi-compatible material that is well tolerated by oral tissues
4- Should be readily cleansable by the patients so that they do not constitute a hazard to dental or oral health
5- Should be capable of being firmly positioned in the mouth
Mode of action of removable appliances:
There is a variety of movements can be achieved either individually or in group of teeth:
1- Tipping: unlike the fixed appliance which control the tooth in three directions, force by removable appliance is mediated by spring, elastic, piece of acrylic which can make one point of contact.
Directions: mesial, distal, buccal, lingual
2- Overbite reduction: incorporating an anterior bite plate to correct the deep bite by allowing super eruption of posterior segment
3- Anterior cross bite: if space available, anterior teeth pushed by using removable appliance with spring or screw and corrected to normal bite to prevent relapse
4- Posterior cross bite: incorporated expansion screw in midline only make buccal tipping of teeth (bucally)
5- Extrusion: elastic from removable appliance used to extrude the teeth by engaging a fixed attachment by vertical component
Used for impacted central incisors in mixed dentition.
6- Intrusion: by using buccal capping lead to force for intrusion
7- Retention: to maintain the position of teeth (Hawley, vacuum form)
Advantages of removable appliances: Little Wood 2001:
1- Make it possible for patients to maintain oral hygiene during treatment
2- Most of malocclusion require tipping movement so removable appliance can be used
3- Less chair time side of dentist, so dentist can be handle more than one patient
4- Less force needed to move the teeth than in fixed appliances
5- Can be used by general practitioner(GP) dentist
6- Less expensive, can be used b
QUICK REVIEW OF PROSTHODONTICS – TNMGRMU SOLVED B.D.S FINAL YEAR QUESTION PA...Arun Kumar
This book contains solved "Prosthodontics & Crown & Bridge" B.D.S final year question paper. This helps the students in their eleventh hour preparation.
K- Sir loop /certified fixed orthodontic courses by Indian dental academy Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
The scope of fixed prosthodontics treatment can range from the restoration of a single tooth to the rehabilitation of the entire occlusion. Single teeth can be restored to full function, and improvement in
esthetics can be achieved. Missing teeth can be replaced with fixed prostheses that will improve patient comfort and masticatory ability, maintain the health and integrity of the dental arches, and, in many instances, elevate the patient’s self-image.
Torque new /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
Seminar canine-presentation /certified fixed orthodontic courses by Indian de...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Canine retraction /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
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)
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
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
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
History:
= In early 1900, George Crozat developed a removable appliance that fabricated from precious metal and consists of:
a- Effective clasp on 1st molars
b- Heavy gold wire as a framework
c- Lighter gold finger springs that produce desired tooth movements
After that the removable appliance developed and continued in Europe but neglected in united state
= in 1900, Monoblock developed by Robin and considered the forerunner of all functional appliance
= in 1920, development of activator by Andreson in Norwegian
Martin Schwarz in Vienna developed variety of split plate which effective in expanding the dental arches
Philip Adams in Belfast modified the arrow head clasp by Schwartz into Adams Crip which become the basis of English removable appliance
= in 1925 to 1965: American orthodontic based on use of fixed appliance that is unknown in Europe which all treatment done by removable
= in 1960: introduction of functional appliances in American by Egil Harvold
General requirements of orthodontic appliances:
1- Should be comfortable to wear and easily accepted by patients
2- Should be able to produce the desired force that cause a well-controlled tooth movement
3- Should be fabricated from bi-compatible material that is well tolerated by oral tissues
4- Should be readily cleansable by the patients so that they do not constitute a hazard to dental or oral health
5- Should be capable of being firmly positioned in the mouth
Mode of action of removable appliances:
There is a variety of movements can be achieved either individually or in group of teeth:
1- Tipping: unlike the fixed appliance which control the tooth in three directions, force by removable appliance is mediated by spring, elastic, piece of acrylic which can make one point of contact.
Directions: mesial, distal, buccal, lingual
2- Overbite reduction: incorporating an anterior bite plate to correct the deep bite by allowing super eruption of posterior segment
3- Anterior cross bite: if space available, anterior teeth pushed by using removable appliance with spring or screw and corrected to normal bite to prevent relapse
4- Posterior cross bite: incorporated expansion screw in midline only make buccal tipping of teeth (bucally)
5- Extrusion: elastic from removable appliance used to extrude the teeth by engaging a fixed attachment by vertical component
Used for impacted central incisors in mixed dentition.
6- Intrusion: by using buccal capping lead to force for intrusion
7- Retention: to maintain the position of teeth (Hawley, vacuum form)
Advantages of removable appliances: Little Wood 2001:
1- Make it possible for patients to maintain oral hygiene during treatment
2- Most of malocclusion require tipping movement so removable appliance can be used
3- Less chair time side of dentist, so dentist can be handle more than one patient
4- Less force needed to move the teeth than in fixed appliances
5- Can be used by general practitioner(GP) dentist
6- Less expensive, can be used b
QUICK REVIEW OF PROSTHODONTICS – TNMGRMU SOLVED B.D.S FINAL YEAR QUESTION PA...Arun Kumar
This book contains solved "Prosthodontics & Crown & Bridge" B.D.S final year question paper. This helps the students in their eleventh hour preparation.
K- Sir loop /certified fixed orthodontic courses by Indian dental academy Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
The scope of fixed prosthodontics treatment can range from the restoration of a single tooth to the rehabilitation of the entire occlusion. Single teeth can be restored to full function, and improvement in
esthetics can be achieved. Missing teeth can be replaced with fixed prostheses that will improve patient comfort and masticatory ability, maintain the health and integrity of the dental arches, and, in many instances, elevate the patient’s self-image.
Torque new /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
Seminar canine-presentation /certified fixed orthodontic courses by Indian de...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Canine retraction /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
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)
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
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:
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
Orthodontic Diagnosis
For general practitioners
Prepared by Dr. M Alruby
Orthodontic diagnosis deals with recognition of the various characteristics of the malocclusion. It involves collection of data in a systematic manner to help in identifying the nature and cause of the problem. Comprehensive orthodontic diagnosis is established by use of certain clinical implements called diagnostic aids.
Consideration of general health, appearance and attitude:
The first step in any orthodontic examination is to form a general idea of patient's health status, physical appearance and attitude toward orthodontics.
Case history:
Case history involves eliciting and recording of relevant information from the patient and parents to aid in the overall diagnosis of the case. The information is gathered from the patient and parents.
Personal details:
Name: the patient's name should be recorded for the purpose of communication and identification. Most patients like being called by their name. Addressing the patient by his or her name has a beneficial psychological effect as well. In case of children it is wise to record their pet names.
Age: the patient's chronological age should be recorded. Age consideration helps in diagnosis as well as treatment planning. There are certain modalities that are best carried out during the growing age. Growth modification procedures using functional and orthopedic appliances are carried out during the growth period. Surgical respective procedure is best carried out after the cessation of growth.
** Dental age determination: can be determined by two different methods:
- Stage of eruption of teeth.
- Stage of tooth mineralization on radiograph.
Determination of the dental age from observation has been the only method available for long time. In certain cases however, the accuracy of the method is limited.
When determining the dental age radiographically according to the stage of germination, the degree of development of individual teeth is compared to a fixed scale.
** Skeletal age evaluation: assessment of the skeletal age is often made with the help of a hand radiograph which can be considered the biologic clock. For the analysis of skeletal maturity the stage of mineralization of the carpal bones must be determined thereafter the development of the metacarpal bones and phalanges should be evaluated. For the evaluation of the hand radiograph various indicators regarding the development and maturity are established which occur regularly in a definite sequence during skeletal development.
Sex: the patient sex should be recorded in the case history. This is important in planning treatment, as the timing of growth events such as growth spurts is different in males and females. Females usually precede males in onset of growth spurts, puberty and termination of growth.
Address and occupation: this help in evaluation of socio-economic status of the patients and parents. Some countries
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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2. 2
Rotation in Orthodontics Dr. Mohammed Alruby
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
Definition:
3. 3
Rotation in Orthodontics Dr. Mohammed Alruby
Observable mesio-lingual or disto-lingual intra-alveolar displacement of the teeth around its
longitudinal axis
Types:
1- Centric rotation: only rotation around the long axis in which the angulation of the long axis
of the tooth is unaltered
2- Eccentric rotation with tipping of the tooth
If the body rotates about its center of resistance, it is called pure rotation
Types:
Mesio-lingual, disto-lingual, mesio-labial, disto-labial
Possible etiology of rotation:
- Severe crowding
- Supernumerary tooth or odontoma
- Typical class II div 2 malocclusion where upper central lingually inclined, leaving
insufficient space in dental arch
- Unilateral cleft where usually teeth lateral to cleft is rotated
- Over retained deciduous tooth
- Ectopic canine
- Unerupted teeth at base of root of the completely erupted teeth
- Scare tissue from trauma
- Spacing different type of force acting on the teeth such as: masticatory force, force from
the tongue, lip biting, thumb sucking
Winging and counter winging:
Dehlberg, stated that:
if the distal margins of the central incisors are rotated in labial direction -------- winning
if the distal margin of central incisors are rotated in lingual direction ----------- counter winning
the most common rotated teeth are L5 followed by L4 and U1 with the same prevalence
4. 4
Rotation in Orthodontics Dr. Mohammed Alruby
advantages of de-rotation:
1- Rotated posterior teeth occupy more space than normally placed teeth, derotation of these
teeth provide some amount of arch length
2- Absence of rotation is one of the keys to normal occlusion
3- Non rotated teeth have tight contact with its adjacent teeth
4- Derotation is essential for proper maxilla to mandible relation and proper intercuspation
5- Derotation is essential for equal distribution of occlusal forces
N: B:
Force required for derotation is 30 – 60gm or 60 – 100gm depending from case to case
Optimum force similar to tipping force
Alignment of rotated anterior teeth Alignment of rotated posterior teeth
Broader mesiodistally Broader labio-lingually
Occupy less space when they are rotated Occupy more space when they are rotated
Alignment of such teeth require space Alignment of such teeth creates space
For every millimeter of rotation required the same
amount of space required for aligning of teeth
Space created depend on the tooth (molar
, premolar and amount of rotation present
Biomechanics for rotation correction:
Rotation can achieve by two ways:
1- Using couple of force
2- Using single force and slop
Couple of force: two parallel forces equal in magnitude but in opposite direction separated by
distance that act upon a tooth are required
This is the only force system couple of producing pure rotation of body around its center of
resistance and the longitudinal axis of the tooth from occlusal view
In this case, the tooth maintains its position because both forces act at the same distances
perpendicular to the center of resistance leaving only pure moment to occur (pure rotation)
N: B:
When crowded and rotated maxillary incisors are corrected orthodontically in adults, there is a
black triangle left after correction specially if sever crowding was present
For that reason: black triangle must be noted and prepared patient during examinations for
reshaping of the teeth to minimize this esthetic problem
5. 5
Rotation in Orthodontics Dr. Mohammed Alruby
Methods for correction of rotation in orthodontic appliances
1- Ligation:
To achieve orthodontic tooth movement, arch wires must be tied to the bracket slot by metal or
plastic ligation
The traditional elastics O ties often failed to correct severe rotation because of inability to fully
seat the arch wire into bracket slot
a- Double over tie (figure 8):
In which the o –ring criss - crosses over the bracket
Twist the o – ring in this manner increases its elastic tension which help seat the arch wire
b- Modified figure 8 ties:
The force level of the o – rings are symmetrical they may still be in adequate to fully seat
the wire
This modification creates a symmetrical force to help fully seat the arch into the bracket
slot
c- Anti-rotational ties:
d- Double ligation:
In which the wire is ligated firstly the bracket under the wire and then over the same wire
6. 6
Rotation in Orthodontics Dr. Mohammed Alruby
e- Single tie (isolated tie):
Firm ties are made to the bracket farther from the arch wire, use of finger or an
instrument to press the arch wire as flush as possible against the bracket to be filled an
elastomeric ligature or rotation wedge or even left empty
f- Modified rotation tie:
Rotation tie was modified by using elastic modules or elastic chain with steel ligature wire,
the chain is attached to the prominent side of bracket passes inter-proximally then ligature
wire is attached to main arch wire on other side
g- Circumferential tie:
Similar to modified rotation tie but is done with stst ligature wire. In case of posterior teeth
and canine, small retention area can be molded with composite resin or an auxiliary can be
placed or soldered onto the lingual palatine surface to prevent displacement of the ligature
wire
N: B:
Anti-rotational tying of the canine during canine retraction or the 1st
premolar in case where the
2nd
premolar have been extracted is a useful way of preventing such rotation
In cases of the wings of the dental bracket alone should be tied to prevent it from moving away
from the arch wire during retraction
During the tying procedure the tip of clinical probe is inserted between the bracket and ligation
threads allowing slight amount of slack to ensure freedom of movement to reduce friction
ALSO: anti-rotational tying of teeth neighboring to open coil to guard against rotation
7. 7
Rotation in Orthodontics Dr. Mohammed Alruby
2- Auxiliaries:
a- Rotational wedge:
It acts as fulcrum between the wire and bracket, it is ligated to the tie wing of the bracket
closest to the wire available in different color
b- Steiner ligature rotation wedge:
Round elastomeric wedge easily attaches
to the bracket under the arch wire,
supplied on perforated ligature wire
c- Button:
Can be used to produce a couple of force by bonding buttons to buccal and palatal surface
of the rotated tooth and use elastic chain between them and the neighboring teeth or
anchorage devices
d- Monkey hook:
S shaped auxiliary with an open loop on
each end for the attachment of intra-oral
elastics or elastomeric chain
8. 8
Rotation in Orthodontics Dr. Mohammed Alruby
e- Double loop derotation:
In case of severe rotation, it is very
difficult to bond attachment for proper
of couple force due to inaccessibility to
surface or area of attachment
In such case multiple repositioning of bonded
attachment will be required during derotation
f- Rotating spring:
= Provide simple and effective means of de-rotating teeth without the removal of arch wire,
= used for Begg and Tip Edge brackets
= can do clockwise or anticlockwise movement
= not effective in de-rotating posterior teeth
= exert light continuous force that can align rotated tooth within several weeks
3- Derotation with NiTi wire:
In the pre-adjusted edgewise system, use highly resilient super-elastic NiTi wire for initial
alignment and final engagement of rectangular wire in brackets and rotated teeth
Disadvantage: can cause undesirable force for neighboring tooth lead to unwanted movement
4- Sectional technique:
De-rotation of upper incisors with sectional 0.018 Niti and diastema closure with partial
derotation and finally placed 0.017 x 0.025 stst wire
Complete derotation was achieved after 10 weeks and then start retention phase
9. 9
Rotation in Orthodontics Dr. Mohammed Alruby
5- 2 x 4 appliance:
Band cemented or bond on both upper 1st
permanent
molars and bracket bonded onto the upper incisors, by
sequence of wires the correction of rotation may
occur through several weeks and then start retention
phase
6- Piggy back technique:
Main arch wire with open coil to open adequate space to permit the rotation correction, the piggy
back wire was fully engaged into the rotated nonaligned teeth / tooth and then ligated to the main
arch with the adjacent teeth
7- Loops:
a- Double vertical loop:
It is contoured on either side of the tooth, when tied into the bracket of the rotated tooth, the loop
of one side of the tooth will be displaced lingually and the loop on the other side will be displaced
labially causing a reciprocal rotation actually on the bracket
b- Box loop:
Composed of series of vertical and horizontal levers contoured in such manner to provide a short
section of arch wire that is freely movable in all planes of space and usually is contoured to the
width of a single tooth
8- Anghileri appliance (ANG):
= Invented by Dr. Matias Anghileri from Argantena
= Place the initial arch wire and bond button on the buccal surface of rotated tooth
= Insert a passive spring between the two teeth surround the rotated tooth
= use ligature wire from the button to compress the spring approximately a third of its original
length, an easy way to do this by placing the ligature through the 1st
or second coil
= the spring can exert its force in the same direction to which the tooth must be rotated
= the spring works continuously to de-rotate the tooth without adjusting the ligature
10. 10
Rotation in Orthodontics Dr. Mohammed Alruby
== the tooth where the spring is going to be anchored must have a greater anchorage than rotated
one to avoid an unwanted rotation
9- Whip appliance:
Introduced by Huston and Isaacson in 1980
Single rotated tooth in patient with otherwise acceptable occlusion acceptable occlusion may be
rotated with Whip appliance where there is adequate space SINCE: Whip itself provide no labio-
lingual control, labial bow should be adjusted to touch the labially placed surface of rotated tooth
/ teeth
Components:
a- Oval molar tube: (mandibular 1st
molar tube): is bonded or banded directly to the labial
surface of the rotated tooth / teeth
Bonded edgewise bracket can also be used, but it can exert unnecessary torque during
rotation
b- Whip spring: is fabricated of 0.016 heat treated Australian wire
= the recurved end of whip is inserted into the oval molar tube while the other end is formed
into a hook to be engaged onto the labial bow
This design is serve more in case of mesio-labial rotation of incisors
Whip itself provides no labio-lingual control – labial bow should be adjusted to touch the
labially placed surface of rotated tooth
c- Removable appliance part: simple removable plates with adequate retention using Adams
clasp and labial bow made up of thicker gauge stst wire (19 / 20) gauge.
Advantages:
1. Offering a solution in the mixed dentition period, relatively in a short time
2. Providing increased vertical and horizontal anchorage due to palatal coverage
3. Anchorage control is less critical
4. Force system is relatively simple when this appliance is used
5. Management of oral hygiene is easier
6. Patient compliance is less critical, because when removing the appliance, the damage of mucosa
by wire leads to patient
discomfort
7. Whip appliance can be used in emergency situations in the mixed dentition, such as traumatic
occlusion of central incisors.
Clinical drawbacks:
= Much attention should be considered not to activate Whip appliance in vertical plane otherwise
unwanted mesio-distal crown and root movement may be produced extrusion and labial tipping of
maxillary incisors might occur during treatment
= Furthermore, Whip spring can wound the mucosa if not adjusted carefully
= Debonding of bracket and distortion of the spring. However, these problems can be minimized
through satisfactory compliance
11. 11
Rotation in Orthodontics Dr. Mohammed Alruby
10-Hooked appliance:
Removable appliance with hooks soldered or incorporated in acrylic, the rotated tooth is bonded
or banded with attachment to correct the rotation with elastic or power chain between the
attachment and hook
11-Removable appliance:
Advantages:
- Simplified and coast effective treatment for successful derotation of anterior teeth in
mixed dentition
- Reactive forces are less, so there is no particular problem with anchorage
- Better maintenance oral hygiene
Limitation:
- Ideal case selection is required as it may be indicated early in the case of rotated
maxillary central incisors
- Probably correct early mixed rotation less than 45 degree
- Has high risk of relapse and because patient compliance is needed
- Need for accurate adjustment of the labial bow, palatal spring and acrylic baseplate
1- Double cantilever Z spring:
Construction:
- 0.5mm hard round stst wire
- 2 helices of small internal diameter
- Spring is positioned perpendicular to the palatal surface of the tooth with a long
retentive arm (placed away from the tissue) 12mm in length
Activation:
- Only one helix may be activated to correct mild rotation
Uses:
- To correct of anterior teeth cross bite / rotation where the overlap is less than the
freeway space. The spring is effective only when there is enough space for aligning
12. 12
Rotation in Orthodontics Dr. Mohammed Alruby
2- Labial bow with vertical M loop:
Function:
Alignment of canine, if it is labially positioned, the M loop moves the tooth primarily in a lingual
direction. Depending on the location of the counterpart of the loop, the tooth can be rotated
= the loop should be only lie on the most prominent part of the crown avoiding contact with gingiva
3- Labial bow with retractive canine loop:
Alignment of labially rotated canine
To optimize the point of force application, the loop should embrace the tooth surface as far as
possible
This loop can tip the canine distally as well as lingually
12-Invisalign:
Teeth with rotation may require a combination of attachment and elastics
Correction of rotation with vertical rectangular attachment on the rotated teeth
The location of attachment on the tooth can be changed during the course of treatment to ensure
complete rotation correction
Management of molar derotation
Maxillary molars may be rotated as a result of premature loss of 2nd
deciduous molars and mesial
shifting of 1st
molars which is usually accompanied by mesio-palatal rotation taking palatal root
as a fulcrum for this movement
Rotation of upper 1st
molars may also occur as a minimum anchorage unit or due to poor appliance
design and anchorage loss during treatment
Rotation of upper 1st
molars has deleterious sequel on occlusion and may complicate treatment
due to encourage on the space requirement {rotated upper 1st
molars occupy more space than
normal), also may result in cusp to cusp or even class II occlusion
13. 13
Rotation in Orthodontics Dr. Mohammed Alruby
Causes:
1- Premature loss of 2nd
deciduous molars
2- Use of U6 as minimum anchorage
3- Poor appliance design
4- Anchorage loss during treatment
Sequelae:
1- Occupy more space
2- Cusp to cusp relations
3- Class II occlusion
Diagnosis:
Clinical:
According to McNamara 1993 for evaluation of U6 position: the buccal surface of U6 on both
right and left sides should be parallel when viewed from the anterior area
Cephalometry:
lateral cephalometry:
There are number of cephalometric methods that used to assess the anterior posterior position of
U6:
- U6 ---- to ----- NA line ------ 27 -+3 ------------------------------------- Steiner
- U6 ---- to------ pt vertical ----- age of patient +3 -+3 ----------------- Rickett
- U6 ---- to----- key ridge
- U6 ---- to----- temporal curve of Sassoni ---------- pass through mesio-buccal root
- U6 long axis to ---------- SN ------------------------ Sassoni
- U6 long axis to ---------- pp -------------------------Sassoni
- U6 long axis to --------- occlusal plane ------------Sassoni
- U6 long axis to mandibular plane ----------------- Proffit
In anterior posterior cephalometry:
- Line tangent mesial surface of U6
- Line tangent mesial surface of L6
And measure space between these two lines: 2mm
Cast:
1- Henry 1956:
Measured the angle between median palatine raphe and line through cusps of U6
2- Friel 1959:
Use median palatine raphe as a reference line angle between the raphe and line through mesio-
buccal and mesio-palatal cusp of U6
3- Foresman 1964:
- Measured angle between line passing through mesio-buccal cusp and disto-palatal cusp
and median palatine raphe: 60 degree
- Line passing through mesio-buccal cusp and mesio-palatal cusp to median palatine raphe
each 3 degree rotation will be increase the width of space of 1st
molar width by 0.25mm
4- Orton 1966:
14. 14
Rotation in Orthodontics Dr. Mohammed Alruby
Measured angle between line tangent of buccal surface of U45 and line tangent buccal surface of
U6
5- Rickets 1969:
Describe line passing through the disto-buccal and mesio-palatal cusps of U6.
If this line bisects the distal half of canine on the contra-lateral side so U6 is in correct position
6- Farahat 2012:
T: ------------ cusp tip of maxillary permanent canine
DB: ----------disto-buccal cusp tip of maxillary 1st
permanent molar
ML: ----------mesio-lingual cusp tip of maxillary 1st
permanent molar
Line a: ------line extended from disto-buccal cusp tip and mesio-lingual cusp tip of U6 right side
and extended to opposite side of arch
line b: -----line drawn through ditto-buccal cusp tip and mesio-lingual cusp tip of left side of U6
and extended to opposite side of arch
line a1: ---- perpendicular line drawn from cusp tip of left canine to line a
line b1: ----- perpendicular from cusp tip of right canine to line b
- length of a1 and b1 is measured
- Line a1 represent right side U6 rotation: --- 7.89mm
- Line b1 represent left side U6 rotation: ---- 6.41mm
N: B:
In class II:
a1: ---- 8.0mm
b1: --- 6.2mm
In class III:
a1: ---- 8.3mm
b1: ---10.16mm
Methods for correcting molar rotation:
1- Toe in bends within successive arches
2- Transpalatal arch (Carlson and Hoeu)
This method is especially favorable when the need for de-rotation is the same on both sides
of the arch
3- Extra-oral force: bayonet bend is placed at the distal end of the intra-oral bow which acts
as stop to direct the full force of headgear against U6
4- Denholz appliance: muscular anchorage system: an appliance is similar to lip bumper, it
consists of :
- Two molar bands with buccal tubes
- Base arch of 0.036 inch stst to fit buccal tube
- Vestibular screen
- Coil spring are inserted into the base arch to dissipate the force of vestibular screen into
U6
5- Sliding jigs together with class Ii elastics
6- Modified Nance with Quad helix
7- Nitinol coil spring
8- Jon’s Jig
9- Distalizing Jet
15. 15
Rotation in Orthodontics Dr. Mohammed Alruby
Retention of rotated tooth
Rotation are easy to treat but is very difficult to retention
When the tooth is rotated around its long axis, the supra- alveolar tissue remains under tension
SO rotation have very high risk of relapse due to elastic recoil of the stretched supra-alveolar and
transeptal fibers
Methods to prevent relapse of rotation:
1- Early correction of rotated teeth:
It is advisable that all rotation to be corrected to labial or slightly over-corrected positions in the
early stages of treatment
The longer the rotated teeth are held in correct position, the greater the chance for stability
Exp: the mesio-labial rotation of U2 in class II div 2 malocclusion should be slightly overcorrected
because its relapse very easily
2- Circumferential supra-crestal fibrotomy CSF:
Advocated for release of soft tissue tension and attachment of fibers after orthodontic correction
of tooth rotation
These procedures are done at the end of finishing phase of treatment before appliance removal
and beginning of retention phase (supra-crestal fibers are sectioned and allowed to heal and orient
while the teeth are held in the proper position)
After supra-crestal fibrotomy, there is some dental mobility that is due to the incision of the
transeptal fibers that bound the teeth with other teeth, this gradually diminishes in 2 -4 weeks
Procedures:
a- Edward technique:
= under local anesthesia no 11 knife is passed through the gingival sulcus up to crest of alveolar
bone
= interproximal cuts were made on each side of the rotated tooth and along the labial and gingival
margin
= no need for periodontal pack
= this surgery is not indicated for patient with crowding without rotation
16. 16
Rotation in Orthodontics Dr. Mohammed Alruby
b- Papilla split: alternative to CSF:
Procedure:
Vertical cuts are made in the gingival papilla without separating the gingival margin and papilla
tip
Advantages:
a- Reduce the possibility that the height of gingival attachment will be reduced after surgery,
and it is particularly indicated for esthetically sensitive area
b- Easier and perform with an orthodontic appliance and arch wire in place
c- Form the point of view of improved stability after orthodontic treatment, the surgical
procedure appears to be equivalent
c- Bonded retainer:
= Multistrand wire individually adjusted and bonded to each tooth in the desired arch segment for
long term retention
= Recommended removable plate to be used with bonded lingual retainer for severely rotated
maxillary anterior teeth with different type of malocclusion
= The labial wire of this acrylic plate extend distal to the bonded retainer to avoid the risk of
retainer wire fracture
= The acrylic of the plate can be ground away from the teeth involved in the bonded retainer
Active retention:
1- Spring aligner:
Use to maintain the anterior teeth aligned and / or to correct small rebounds
Construction:
Like the circumferential or wrap around retainer, but the main difference is that it only includes
the six anterior teeth meanwhile the wrap around retainer includes all the erupted teeth
17. 17
Rotation in Orthodontics Dr. Mohammed Alruby
Place and take off technique:
For the correction of rotated teeth, we must apply pink wax or block out over the aspect of the
tooth in plaster that we want to rotate and on the contra-lateral aspect, we must wear off the model,
in these cases we recommend to place fixed retainer
2- Essix retainer: esthetic retainer
Retention is based on acetate or plastic plates