Smile architect

Orthodontist – The Smile
Architect
www.indiandentalacademy.com

Department of Orthodontics and
Dentofacial Orthopaedics

More than just beautiful smiles…...

The Forgotten
Triad……

Diagnosis
• Diagnosis is the key to
• However, Diagnosis is no cake walk.
• Diagnostic aids help us to come as close
as possible to a comprehensive diagnosis.

COMPREHENSIVECOMPREHENSIVE
DIAGNOSISDIAGNOSIS

• However, in the field of orthodontics, at
the time of diagnosis, the treatment
objectives are set and the diagnosis, as
such, is considered only tentative until
those treatment objectives are achieved,
because the tissue response and the
duration, direction and magnitude of
growth varies in individual patients.

•
Hence, as a clinician, a thorough knowledge of
the normal is a must in order to recognize any
deviations from the normal.

Primary Spacing

Deep Bite
(Early Deciduous Dentition)
Eruption of first permanent molars
Attrition of Incisors
Forward movement of the mandible
due to growth
Edge-to-edge bite
(Late Deciduous / Early Mixed Dentition)

Incisal Liability
Usage of Primary SpacingIncrease in Inter-canine Width
Increased labial inclination of permanent incisors

Leeway space
1.7mm
0.9mm

Ugly Duckling Stage

Andrew’s Six Keys to
Normal Occlusion
90º
5º
Molar Inter-arch
Relationship
Mesio-distal
Crown Angulation
Labio-lingual
Crown Inclination
90º
90º
16º
-1º
18º
+7º
Occlusal plane
Key 123

Absence of RotationTight Contacts
Curve of Spee
not exceeding
1.5 mm
Andrew’s Six Keys to
Normal Occlusion
456Key

Skeletal DentalCombination

Maxilla Mandible
Combination

Planes

Combinations

Malocclusions in the Saggital Plane

Class II Malocclusion - DentalNormal

Class II Malocclusion - SkeletalNormal

Class III Malocclusion - DentalNormal

Class III Malocclusion - SkeletalNormal

Malocclusions in the Vertical Plane

Open bite

Deep bite

Malocclusions in the
Transverse Plane

Posterior Cross bite

Anterior Cross bite

Orthodontic Treatment
– Age no bar

Orthodontic Treatment
Preventive Interceptive Corrective
Orthodontic Orthognathic
Active Appliance
Therapy
Camouflage Adjunctive Retention

Preventive Orthodontics
“Prevention is better than cure”
So, “Catch ‘em young”
• Preventive orthodontics includes procedures
undertaken prior to the onset of a malocclusion
in anticipation of a developing malocclusion.

• The following are some of the procedures
undertaken in preventive orthodontics:
1. Parent education
2. Caries control
3. Supervision of timely tooth shedding
4. Space maintenance
5. Checkup for oral habits and habit breaking appliance
if necessary
6. Occlusal equilibration if there are any occlusal
prematurities
7. Extraction of supernumerary teeth
8. Management of abnormal frenal attachment

Space Maintenance
• Premature loss of deciduous teeth can cause
drifting of the adjacent teeth into the space.
• This can result in abnormal axial inclination of
teeth, spacing between teeth and sometimes a
shift in the dental midline, i.e. – malocclusion.
• Space maintenance is the maintenance of the
mesio-distal and vertical width of an arch space
created by the loss of deciduous dentition.
• The appliances/devices used or intended to be
used for this space maintenance are called
space maintainers.

Removable Partial Denture Crown and loop
Distal Shoe Lingual Arch

Habits
• A habit is ‘an act that has become fixed
due to repeated performance.’
• Oral habits in children have a definite
bearing on the development of occlusion.
• Frequently, children acquire certain habits
that may either temporarily or permanently
be harmful to dental occlusion and to the
supporting structures.

• However, when the habit is corrected while the
occlusion is still undisturbed and no
malocclusion has set in, it is termed as
preventive orthodontics.
• But, in case the habit has already caused the
onset of a malocclusion, the measures applied
to correct the habit are termed as ‘interceptive
orthodontics’.

Interceptive Orthodontics
“A stitch in time saves nine”
• Interceptive orthodontics includes
procedures that are undertaken at an
early stage of a malocclusion to eliminate
or reduce the severity of the same.

• The procedures undertaken in
interceptive orthodontics include:
1. Serial extraction
2. Correction of developing cross bite
3. Control of abnormal habits
4. Space regaining
5. Muscle exercises
6. Interception of skeletal malrelation

Serial Extraction
• The early mixed dentition is easily prone to
development of irregularities in the dento-facial
complex.
• When such potential irregularities are
recognized and anticipated, the planned
extraction of certain deciduous teeth and later
specific permanent teeth in an orderly sequence
and pre-determined pattern can help in guiding
the erupting permanent teeth into a more
favorable position.

Correction of developing cross bite
Pre treatment Post treatment

Interception of Habits
• Interception of the habit will cause interception of
the developing malocclusion effected by the
habit.
• Some of the common oral habits:
– Thumb sucking
– Tongue thrusting
– Mouth breathing
– Bruxism
– Lip biting
– Nail biting

Buccinator Mechanism
Thumb sucking

Thumb sucking

Tongue Thrusting

Mouth Breathing
Oral Screen

Space Regaining

Interception of Developing
Skeletal Malrelationship

Interception of developing skeletal
class II

Interception of developing skeletal
class III

Corrective Orthodontics
“Better late than never”
Corrective orthodontics includes
procedures undertaken to correct a fully
established malocclusion.
These corrective procedures may be:
 Orthodontic
 Orthognathic (Surgical)

Orthodontics
alone
Growth modulation &
orthodontics
Orthodontics and orthognathic
surgery
7
4
2
2
12
6
5
5 15
10
10
Envelope of discrepancy

Orthodontic Corrective
Measures
• It includes the following:
Active Appliance Therapy
Camouflage
Adjunctive Orthodontics
Retention

Active Appliance Therapy

Case 1

Pre Treatment – Extra Oral

Pre Treatment – Intra Oral

Pre Treatment - Occlusal

With Appliance

Post Treatment - Extraoral

Post Treatment- Intraoral

Post Treatment- Occlusal

Case 2

Post Treatment – Extra Oral

Post Treatment – Intra Oral

Case 3

Pre Treatment – Occlusal

Post Treatment – Occlusal

Case 4

Pre Treatment - Extra Oral

Pre Treatment Radiograph – Lateral Cephalogram

Post Expansion – Intra Oral

Post Expansion - Occlusal

Post Treatment - Occlusal

Post Treatment – Lateral Cephalogram

Case 5

Pre Treatment – Lateral Cephalogram

TREATMENT PLAN:
• Growth still remaining, hence reverse pull
headgear
• RME for expansion of narrow maxilla
• Fixed therapy with PEA mechanics

Mid Treatment – Reverse Pull Head Gear

Mid Treatment – Intra Oral

Mid Treatment – RME

End of Orthopaedic Phase – Extra Oral

End of Orthopaedic Phase – Intra Oral

End of Orthopaedic Phase – Occlusal

Mid Treatment – Fixed Therapy

Fixed Therapy – Intra Oral

Fixed Therapy – Occlusal

Fixed Therapy – Lateral Cephalogram

Pre treatment Present Status

Orthognathic
• Orthognathic surgeries are major surgical
procedures carried out along with
orthodontic therapy to correct dento-facial
deformities or severe oro-facial
disproportions involving the maxilla, the
mandible or both in combination.

• Steps involved in orthognathic surgery:
1. Diagnosis (pre operative evaluation)
2. Pre-surgical orthodontics (reverse
orthodontics)
3. Mock surgery
4. Surgery and stabilization
5. Post-surgical orthodontics

Pre Treatment - Intra Oral

Pre Treatment Lateral Cephalogram

Pre Surgical (After decompensation) – Extra Oral

Pre Surgical (After decompensation) – Intra Oral

Pre Surgical (After decompensation) - Occlusal

Pre Surgical (After decompensation) – Lateral
Cephalogram

Occlusal Splint

Post Surgical – Extra Oral

Post Surgical – Intra Oral

Post Surgical – Lateral Cephalogram

Pre Treatment Pre Surgical Post Surgical

Pre Surgical

Present Status – Intra Oral

Present Status – Occlusal

Pre Surgical – Lateral Cephalogram

Post Surgical - Occlusal

Post Surgical - Lateral Cephalogram

Present Status – Extra Oral

Present Status - Occlusal

Present Status - Lateral Cephalogram

Camouflage
• ‘Disguise of guns, ships etc effected by
obscuring outlines with splashes of
various colours.’
- Oxford Dictionary
• ‘To deceive observation, or plan as a false
front.’
- Webster’s Dictionary

• The orthodontist uses ‘camouflage’ treatment in
cases where the ideal treatment protocol was/is
not possible due to some reason or the other, to
try and improve the dental occlusion and facial
esthetics.
• The term ‘camouflage’ is chosen to emphasize
that successful treatment must produce
“acceptable” facial esthetics as well as
“acceptable” dental occlusion.

Mid Treatment

Post Treatment - Extra Oral

Post Treatment - Intra Oral

Post Treatment - Lateral Cephalogram

Adjunctive Orthodontics
• Adjunctive orthodontic treatment is tooth
movement carried out to facilitate other
dental procedures necessary to control
disease and restore function.

Case 1
Increasing pontic space

Case 2
Correcting traumatic occlusion

Retention
“It’s not over till it’s over”
“I will give you half my fees if you can retain what I
have achieved”
• Retention is the phase following active
orthodontic treatment aimed at stabilization of
achieved orthodontic correction or holding of the
teeth in ideal functional esthetic occlusion.

Retention is necessary for three reasons:
The gingival and periodontal tissues are affected by
orthodontic tooth movements and require time for
reorganization, when an active appliance is removed.
After treatment, the teeth are in unstable condition.
So the soft tissue pressures constantly produce
relapse tendency.
Growth changes can alter orthodontic results.

• Aids to retention:
 Natural Aids
 Surgical Aids
 Mechanical Aids

A beautiful smile…
… is your choice.www.indiandentalacademy.com

A is contagious -
Lets start an epidemic!
Thank you

Smile architect

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Editor's Notes