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
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
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
Description :
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
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.
Frankles appliance Is a myofunctional appliance
Functional appliance are removable or fixed appliances that aim to utilize eliminate or guide the forces arising from muscle function,tooth eruption and growth inorder to alter skeletal and dental relationship
Canine Impaction and Its Importance in OrthodonticsAnalhaq Shaikh
Canine Impaction, Its Importance in Orthodontics, Etiology, Diagnosis and Management.
by Dr Analhaq Shaikh, 2nd year Postgraduate student, Sharavathi Dental College and Hospital, Shimoga, Karnataka
Canine Impaction can also be termed as Shy Canine.
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
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
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
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
Description :
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
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.
Frankles appliance Is a myofunctional appliance
Functional appliance are removable or fixed appliances that aim to utilize eliminate or guide the forces arising from muscle function,tooth eruption and growth inorder to alter skeletal and dental relationship
Canine Impaction and Its Importance in OrthodonticsAnalhaq Shaikh
Canine Impaction, Its Importance in Orthodontics, Etiology, Diagnosis and Management.
by Dr Analhaq Shaikh, 2nd year Postgraduate student, Sharavathi Dental College and Hospital, Shimoga, Karnataka
Canine Impaction can also be termed as Shy Canine.
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
Surgical analysis in orthodontics /certified fixed orthodontic courses by Ind...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
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Skeletal classification /certified fixed orthodontic courses by Indian dental...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
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La cirugía ortognática, a través de dos especialidades médido odontológicas,l la ortodoncia y la Cirugía Maxilofacial.
Más información en: http://www.clinicabenarroch.com/cirugia-ortognatica.html
Lip repositioning surgery for Gummy Smile CorrectionArun1g
Presented modified lip repositioning surgery is a predictable technique for the treatment of excessive gingival display due to hyperactive upper lip, resulting in high level of patient satisfaction. Additional studies are necessary to evaluate the long-term outcomes of this procedure.
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Class 2 MALOCCLUSION /certified fixed orthodontic courses by Indian dental ac...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
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
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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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Class II division 2 malocclusion
It is a type of class II malocclusion, defined by Angle in
1899.
It represents 5 to 10% of all malocclusions ( Sassouni 1971)
3. Class II division 2
According to Angle’s classification:
It is when the buccal groove of the first mandibular molar
occludes distal to the mesiobuccal cusp of the first maxillary
molar, with retroclination of the maxillary central incisors.
4. Class II division 2
British standards classification of incisor relationships:
- The lower incisor edges occlude posterior to the cingulum
plateau of the upper incisors and the lower centrals are
retroclined.
-The overjet is minimal but may be increased.
5. Class II division 2
Von-Der-Linden classified Angle’s class II/2 malocclusion in
to 3 types based on the severity of incisor relationship :
Type A:
Maxillary central incisors and
laterals are retroclined.
Degree of retroclination
is less severe in nature.
6. Von-Der-Linden Classification of class II/2
Type B:
Maxillary lateral incisors are
overlapping the retroclined
maxillary central incisors.
Type C :
Maxillary central and lateral incisors
Are retroclined and are overlapped
By the maxillary canines.
7. General clinical features of Class II division 2
Extra-Oral:
-Shape of the head: brachycephalic
-Facial profile: convex (striaght)
-Chin : Prominent
-Lower Lip: Everted ( lower
lip line is high relative to the
upper incisors)
-Upper Lip: Positioned high
inrespect to the upper anteriors
(Gummy smile)
-Mentolabial sulcus: Deep
-Mentalis : Hyperactive
8. General clinical features of Class II division 2
Intra-Oral:
- Class II molar relation (Distocclusion)
- Class II canine relation
- Retroclined maxillary central (extruded)
- Labialy tipped maxillary lateral incisors
- Deep bite: overclosure (closed bite)
- Decreased overjet
- Accentuated curve of Spee
- Retroclined lower incisors
(Extruded lack of stops)
9. Etiology of Class II division 2
Class II division 2 malocclusions arise from a number of
interrelated dental, skeletal, soft tissue and genetic factors.
Most of class II/2 malocclusions are caused by an underlying
skeletal discrepancy, and few have a normal skeletal jaw
relationship.
Class II div 2
Dental or Skeletal
( combination of both)
10. Dental Class II division 2
Normal maxillo-mandibular skeletal relationship. (Stiener: SNA, SNB,ANB
and McNamara:A/pog to NFH = Norm)
Mainly occurs due to mesial drift of the maxillary first molar. As a
result of:
a) Loss of mesial proximal contact with the primary 2nd molar
-premature extraction/loss of primary 2ndmolar.
- congenitally missing primary 2nd molar.
b) Inter-arch tooth size discrepancy:
-small or congenitally missing maxillary permanent teeth ( 2nd premolar)
results in a class II molar relation.
c) Maxillary canine or 2nd premolar impaction or displacment out of the arch
- inadequate space in the dental arch class II molar
( unilateral/subdivision or bilateral)
11. Skeletal Class II division 2 malocclusion
Results from a discrepancy in the maxillary-mandibular skeletal
relationship.
It might be either due to:
1) Mandibular deficiency
2) Maxillary excess
3) or a combination of both
12. Skeletal Class II division 2
The skeletal class II relation is associated with a class II dental
malocclusion as a result of natural dental compensation to
make the skeletal disharmony less severe.
In class II/2 :
- Retroclined and extruded lower incisors.
( due to lack of lower lip support and absence of insical stops)
- Retroclined and extruded upper centrals high lipline of the lower lip,
(covering the upper incisors)
- Decreased overjet ,deepbite , deep curve of Spee.
( overclosure of the mandible in severe cases)
13. Skeletal Class II division2 Mandibular deficiency
It is a skeletal class II relationship resulting from a
mandible that is either small or retruded relative to the
maxilla.
Mandibular Deficiency
Size or Position
(small mandible) (Retrusion of a normal sized mandible)
(Combination of both in severe cases)
14. Skeletal Class II division 2 Mandibular deficiency
Class II div 2 with a small mandiblethe decreased size is localized more to the
mandibular body (Mandibular Ramus is of normal lenght)
Cephalometrically:
1) Flat mandibular plane
2) Increasesd posterior facial height
3) Short lower anterior facial height
( resulting in both upper and lower lip
having a more everted position at rest)
4) Mandibular length
measured from Ar-Gn-Pog may appear
normal because of the excessive
chin projection.
5) SNA: normal
SNB: decreased
ANB: increased (Stiener)
15. Skeletal Class II division 2 Mandibular deficiency
Mandibular deficiency may result from the retrusion (distal positioning) of a
normal-sized mandible.
Cephalometrically:
SNA: Normal
SNB: Decreased
ANB: Increased (Stiener)
-Distinguishing characteristics:
a)The cranial base defined by
(S-N-Basion) is more obtuse
b)Gleniod fossa in a relatively
posterior in position.
c)Normal size of mandibular
ramus and body
d) normal lower facial height
16. Skeletal Class II division 2 Maxillary excess
Maxillary excess
Vertical dimension or Anterior-posterior dimension
Posterior Overall vertical
excess excess
( Combination of both)
17. Skeletal Class II division 2 Maxillary excess
Vertical Maxillary excess may be localized only to the posterior area Open
bite and incompetent lips ( normal vertical display of maxillary incisors in
repose and during smiling.)
Overall maxillary excess includes both the anterior and the posterior area
resulting in an excessive vertical display of the maxillary incisors in repose and
during smiling (high smile line) Gummy smile. (classII/2) and incompetent
lips.
In these 2 conditions of maxillary excess Mandible is rotated downward
and posteriorly (clockwise) resulting in a class II skeletal relationship.
18. Skeletal Class II division 2 Maxillary excess
Class II/2 with an overall vertical maxillary excess:
Cephalometrically:
-SNA: Normal
-SNB: Decreased
-ANB: Increased (Stiener)
-Increased lower anterior
facial height
-Steeper mandibular plane
-More inferior position of the
maxillary molars relative
to palatal plane.
-Clockwise rotation
of the mandible
19. Skeletal Class II div 2 Maxillary excess
Maxillary excess in Ant-Post Dimension is characterized by a
protrusion of the entire midface including :
1) Nose
2) infraorbital area
3) Upper lip
Cephalometrically:
SNA: increased
SNB: Normal
ANB: Increased
-Increased face convexity.
-Overjet: excessive
-Over eruption of mandibular incisors
-Excessive overbite.
--If midface protrusion is severe
The lower lip will be positioned lingual
to maxillary incisors encouraging
there protrusion.
20. Skeletal Class II division 2
Skeletal Class II division 2 might be a combination of both mandibular
deficiency and maxillary excess.
Which will add to the severity of the Ant-post skeletal problem.
A patient with maxillary vertical excess
and mandibular deficiency.
21. Diagnosis : Problem-Oriented approach
Decision making in orthodontics requires the establishment of a problem list before
considering the treatment options. ( 3D = Soft tissue, Dento-alveolar ,Skeletal)
-And this problem list becomes the “Diagnosis”
Therefore to establish a proper diagnosis, we should create an adequate database
(Data collection)
Questionnaire/interview
Clinical exam Database Problem Listing = Diagnosis
Diagnostic records
(the diagram shows how the problem list derived from the database)
22. Diagnosis: Problem-Oriented approach
Database is derived from 3 major sources:
1) Patient questioning (interview)
-chief compliant: to fined what is important to the patient.
- Medical and dental history
-Physical growth status (Age & Sex) = Growing or non-growing
-Motivation and expectation
2) Clinical examination : to evaluate facial, occlusal , and functional characteristics
(Extra-oral and intra-oral)
Proper evaluation of the face , smile , and profile to define the esthetic problem list
3) Evaluation of diagnostic records:
a) Diagnostic casts
b) Radiographic records: Lateral ceph. /panoramic
c) Photographs : frontal/ frontal dynamic : posed smile,
-close-up image of posed smile/ ¾ view / profile etc..
23. Treatment planning : Problem-Oriented approach
After evaluation of the collected database and
establishment of a prioritized problem list we should
start thinking about the potential solutions of these
problems (Treatment Planning)
The treatment plan describes the procedures meant to
correct each problem on the list.
24. What do we mean by problem-oriented approach?
For example:
Problem is identified : growing patient was diagnosed with a skeletal class II malocclusion
due to a maxillary excess ( Priority on a problem list)
a solution to this problem is considered
One of the treatment options for solving this problem in a growing patient is through
“restraining” the maxillary growth.
Treatment plan is established : in this case is to apply an orthopedic force to the maxilla
via maxillary teeth best applied in posterior and superior direction
Biomechanical consideration are identified
Mechanotherapy is selected to full fill these considerations
(High pull headgear or skeletal anchorage)
25. Treatment options for Class II division 2
For any characteristics of malocclusion 3 ranges of correction exists:
1) A range of correction that can be accomplished by orthodontic tooth
movement alone.
2) A larger amount that can be accomplished by orthodontics tooth movement
aided by absolute anchorage
3) Additional amount that can be achieved by functional and orthopedic
treatment. (growth modification)
4) A larger range of correction that requires surgery as a part of treatment plan.
26. The range of tooth movement for a patient is determined by the
1) Severity of malocclusion
2) Age of the patient ( growing or non-growing)
3) Facial esthetics
These 3 main features will determine the treatment option that is
suitable for the patient.
27. Limitations of orthodontic treatment
Epker Envelope of discrepancy:
Represents the maximum amount of tooth movement possible by 3 different
means of treatment: (Orthodontic / Orthopedic / Orthognathic)
It has 3 envelopes the perimeter of each envelope gives the maximum range of
movements possible by different methods of treatment .
29. Treatment of class II division 2 malocclusion
7mm maxillary incisors retraction (within the range of ortho tooth movment)
12 mm maxillary incisor retraction : ( orthopedic and orthodontic tooth movment)
15 mm maxillary incisor retraction : Requires orthognathic surgey
30. The orthodontic treatment with or without orthopedic treatment can create
a larger A-P correction then in Transverse and Vertical dimension.
Greater amount of maxillary retraction then mandibular can be established
(due to anatomic and physiologic limits)
31. Soft tissue limitations:
The soft tissues will largely determine the limitation of orthodontic treatment
from the perspective of:
1) Functional stability.
2) Facial esthetics.
32. Limitations in orthodontic treatment related to the soft
tissue:
1) Pressure exerted on teeth from lips, cheeks, and tongue
2) Peridontal attachment
3) Neuro-muscular influence on mandibular position
4) Contours of the soft tissue facial mask
5) Lip-Tooth relationship ( Anterior tooth display during facial animation)
33. Timing of the treatment: is an important factor in the
amount of change that can be produced
Optimum time for growth modification Pre-pubertal
growth spurt
therefore proper diagnosis of the patient at early age
and the use of correct functional appliances will cause
the patient to aviod surgery
34. Treatment of Class II Division 2
Class II Div 2 malocclusion Dental or Skeletal
Dental Class II div 2 Orthodontic treatment ( extraction or non extraction)
Skeletal Class II div 2
1) Growth modification (Growing patient)
2) Dental camouflage ( extraction vs non extraction)
(mild to moderate skeletal class II)
3) Orthognathic surgey + with orthodontic treatment
(moderate to severe Class II)
35. Treatment options for dental Class II dvision 2
For a dental Class II/2 malocclusion:
Extraction or non-extraction treatment. depending on the severity of
mesial drift of the maxillary 1st molar.
-slight mesial drift ( mesial crown tipping) + minimal crowding
Nonextraction + distalization of maxillary 1st molar
- severe mesial drift (roots and crown are mesially positioned) extraction
is indicated to obtain space.
36. Treatment options for skeletal Class II division 2
Three treatment approaches are available :
1) Growth modification
2) Dental camouflage
3) Orthognathic surgery (with orthodontic treatment)
37. Treatment of skeletal Class II division 2 malocclusion
Growth modification for class II skeletal problem: (Orthopedic treatment)
- the goal of growth modification is to enhance the unacceptable skeletal relationship
by modifying remaining facial growth pattern of the jaws.
- Optimum timing : Pre-pubertal growth spurt (active growth period)
Two types of orthopedic appliances used in skeletal class II div 2:
I) Headgear ( extra-oral force)
2) Functional appliances ( Removable and fixed )
38. Treatment of skeletal class II division 2 malocclusion
Headgear:
it delivers an extra-oral orthopedic force to compress the maxillary sutures
and modify the pattern of bone apposition at these sites.
2 TYPES
Facebow J-Hooks
(maxillary excess ) ( Maxillary anterior retraction)
and intrusion
39. Treatment of skeletal class II division 2 malocclusion
(cervical)
-Distal and extrusive forces on maxillary mollars . (occipital)
-posterior and inferior extra-oral force -Distal and intrusive forces on the maxillary molar
- extra-oral force is directed superior and posterior
-Increases vertical dimension -A-P and Vertical maxillary excess ( decreases V.D)
- used in A-P maxillary excess with flat mand,plane
40. Treatment of skeletal Class II division 2 malocclusion
Functional appliances: Class II functional appliances are designed to
position the mandible in a downward and forward to enhance its mandibular
growth pattern.
Indication: Mandibular deficiency
Removable Functional: Fixed Functional:
-Activator -Herbst
- Bionator -Jasper jumper
-Twin bloc
- Frankyl II
41. Treatment of a skeletal class II division 2 malocclusion
42. Treatment of skeletal class II division 2 malocclusion
Dental Camouflage:
It is a treatment that seeks to create a dental compensation to hide the skeletal discrepancy
Maxillary Retroclination and Mandibular Protraction.
Indicated:
1) Adults
2) Mild to Moderate skeletal Class II cases
3) Minimal dental crowding .
4) Acceptable facial esthetics
5) Usually requires extraction
Dental camouflage without extraction is rare in case of skeletal class II
-Mild skeletal class II cases
- Mild excessive overjet
- Adequate space available
- Max Molar distalization
43. Treatment of Skeletal Class II division 2 malocclusion
Orthognathic surgery:
A combination of orthodontic therapy and Orthognathic surgery for the
correction of moderate to severe skeletal class II malocclusion
(Adults, no growth potential)
Indicated:
1) Moderate to Severe skeletal discrepancy
2) Facial imbalances or asymmetries: long lower face , Gummy smile
3) Limitations of tooth movement : Upright on basal bone
4) Relapse potential of orthodontic treatment.
5) Severe crowding and protrusion in the dental arches with skeletal
class II malocclusion (extraction space is not sufficient to correct buccal occlusion)
44. Treatment of skeletal class II division 2 malocclusion
Surgical correction includes:
1) Mandibular Advancment:
Indicated: skeletal class II cases with mandibular deficiency
The intraoral sagittal split ramus osteotomy is the most popular technique for
surgical mandibular advancment.
45. Treatment of skeletal class II division 2 malocclusion
Maxillary Impaction: ( Le Fort 1 maxillary osteotomy )
Indicated: Vertical Maxillary excess
Maxillary Impaction may include
1)Total maxillary osteotomy ( maxillary excess ant. and post.)
2) Bilateral posterior segmental maxillary osteotomy ( excess localized posterior)
46. Treatment of skeletal class II division 2 malocclusion
Vertical maxillary excess in the
anterior and posterior region of maxilla
Requires maxillary impaction
by a total maxillary ostoetomy .
To correct the:
1) Gummy smile
2) excessive lower facial height
3) incompetent lips
4) mandible will rotate anti-clock wise
47. Treatment of skeletal class II division 2 malocclusion
- Anterior Maxillary sub-apical setback
Indicated: Maxillary excess is in A-P dimension/ Mid-face protrusion (
No vertical excess)
- Combined Surgical approaches :
Indicated: Maxillary excess (vertical or A-P) combined with
mandibular deficiency.
48. Treatment of skeletal class II division 2 malocclusion
Moderate class II division 2 malooclusion are usually
associated with mandibular deficiency or maxillary excess.
Resulting in a compromised facial esthetics.
The choice between orthognathic surgery or orthodontics
as a treatment option might be confusing to the
orthodontist in borderline cases.
49. Strong consideration of surgical correction of a class II div 2 with skeletal
discrepancy should be based on the following questions:
1) Do the patient's goals for treatment place a high priority on improvement in
facial esthetics?
2) Are the orthodontic movements required in excess of the envelope of
discrepancy so that adequate orthodontic correction may not be achieved?
3) Are the risks of surgery within acceptable levels?
4) Are the benefits of surgical treatment, as previously described, obvious?
50. References
Text Book of Orthodontics ( Samir E. Bishara)
Orthodontics contemporary ( William R. Proffit)
Orthodontics current principles and techniques 5th edition (Graber)
Hand book of Orthodontics (Robert Moyers)
Pubmed
1995 May Orthognathic surgery versus orthodontic camouflage in the treatment of
mandibular deficiency