Ten golden rules

tenten
rules
www.indiandentalacademy.com

INTRODUCTIONINTRODUCTION
This paper highlights on, the
ten golden rules to remember
before examining and treating
an orthodontic patient.

HOLISTIC APPROACHHOLISTIC APPROACH
A thorough clinical examination is
mandatory:
Examine face not just dentition –
correlate with the age
Abnormal facial proportions
Asymmetry
Physiologic versus malocclusion :
- developmental spacing
- ugly duckling stagewww.indiandentalacademy.com

Abnormal FacialAbnormal Facial
ProportionsProportions

Asymmetric faceAsymmetric face

Ugly duckling stageUgly duckling stage

CONSIDER ETIOLOGYCONSIDER ETIOLOGY
Abnormal muscle function –
mentalis,lip trap,
Habits
Large tongue
Abnormal deglutition
Hereditary type of growth- skeletal
Hereditary arch length discrepancy

HabitsHabits
EARLY
DIAGNOSIS
AND
PREVENTION

HabitsHabits (Lip Biting)

Large Tongue

Hereditary malocclusionHereditary malocclusion

OPG can reveal:
Periodontal support
Supernumerary / missing
teeth
Periapical pathology
Unerupted / impacted
teeth
Morphology of condyles
ADVISE OPG FOR ALL
ORTHODONTIC CASES REGULARLY

Radiograph showing Bone LossRadiograph showing Bone Loss

Supernumerary teethSupernumerary teeth

Hypoplastic CondyleHypoplastic Condyle

INFER FROM CEPH ANDINFER FROM CEPH AND
STUDY CAST ANALYSISSTUDY CAST ANALYSIS
 Diagnose whether skeletal or
dental
Growth patterns – vertical or
horizontal
Arch length / tooth size
discrepancywww.indiandentalacademy.com

CephalogramCephalogram

PREVENTION FIRSTPREVENTION FIRST
 Proximal caries
Space maintainers
Occlusal prematurities – heading
to functional shifts
Developing anterior cross bite
Habit breaking appliances

Space MaintainersSpace Maintainers

Developing cross bite - ICPDeveloping cross bite - ICP

INTERCEPTINTERCEPT
MALOCCLUSIONMALOCCLUSION
 SERIAL EXTRACTION
Do not attempt extraction in severe
skeletal discrepancy, deep / open
bite, minimal crowding
 SKELETAL DISCREPANCIES
Growth modification

Severe crowding - SerialSevere crowding - Serial
ExtractionExtraction

Maxillary
intrusion
splint

Pre - treatmentPre - treatment
Class III -Class III - Max. Def.Max. Def.

Pre & During treatmentPre & During treatment
(Reverse Pull Head Gear)(Reverse Pull Head Gear)

CONTEMPORARY APPROACHCONTEMPORARY APPROACH
TO TREATMENTTO TREATMENT
Not all orthodontic patients need
premolar extractions
 Growth modifications to change
profiles
 Newer non extraction strategies
- molar distalisation
 Never extract canines without
specialist opinion

Impacted caninesImpacted canines

EXAMINE TMJEXAMINE TMJ
 A badly treated malocclusion – can
lead to serious TMJ problems
 Occlusal prematurities, functional
shifts lead to TMJ problems –
orthodontic treatment mandatory
 Temperomandibular dysfunctions –
need functional appliances

Occlusal Prematurities - TMJOcclusal Prematurities - TMJ
ProblemsProblems

T
w
i
n
B
l
o
c
k

Non extraction treatment - molarNon extraction treatment - molar
distalisationdistalisation

Post treatmentPost treatment

Do Not Defer Treatment For AdultsDo Not Defer Treatment For Adults
 Bone support can be improved by
advanced periodontal treatment
procedures
 Newer wires permit use of lighter
forces
 Esthetic advances :ceramic/silicon
brackets,lingual orthodontics
 Surgical orthodontics.

Ceramic brackets With flexibleCeramic brackets With flexible
wireswires

CorticotomyCorticotomy

Pre treatment - Class IIIPre treatment - Class III

Presurgical orthodonticsPresurgical orthodontics

Post surgical orthodonticsPost surgical orthodontics

Post treatment - Class IIIPost treatment - Class III

Lingual OrthodonticsLingual Orthodontics

CHOOSE THE RIGHTCHOOSE THE RIGHT
RETAINERRETAINER
 TRADITIONAL UHA RETAINER – do
not activate in retention period
 LINGUAL BONDED RETAINERS – for
crowding, spacing, diastemas
 ESSIX RETAINERS- invisible retainers
made of vacuum pressure moulding
 PERICISION- for rotated teeth
 Appliances with guide planes & habit
reminders for specific caseswww.indiandentalacademy.com

Invisible retainersInvisible retainers

RetainersRetainers

 HOLISTIC APPROACH
 CONSIDER ETIOLOGY
 ADVICE OPG FOR ALL CASES
 INFER FROM CEPH AND STUDY CAST
ANALYSIS
 PREVENTION FIRST
 INTERCEPT MALOCCLUSION
 CONTEMPORARY APPROACH
TO TREATMENT
 CONSIDER TMJ
 DO NOT DEFER TREATMENT FOR ADULTS
 CHOOSE THE RIGHT RETAINERwww.indiandentalacademy.com

Ten golden rules

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