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ORTHODONTICS Ortho means straight; odont means tooth Chapter 27.

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Presentation on theme: "ORTHODONTICS Ortho means straight; odont means tooth Chapter 27."— Presentation transcript:

1 ORTHODONTICS Ortho means straight; odont means tooth Chapter 27

2 What is orthodontics? Orthodontics is a specialty concerned with the guidance and correction of the dentofacial structure.Orthodontics is a specialty concerned with the guidance and correction of the dentofacial structure.

3 #1 Reason most orthodontists perform treatment MalocclusionMalocclusion

4 #1 Reason people seek orthodontic treatment EstheticsEsthetics

5 Indications for Ortho Treatment Impaired chewing (Mastication)Impaired chewing (Mastication) Crowding (Esthetics)Crowding (Esthetics) TMJ dysfunctionTMJ dysfunction Dental cariesDental caries Impaired speechImpaired speech

6 Contraindications for ortho Treatment Lack of bone supportLack of bone support Rampant cariesRampant caries Poor general health/mental healthPoor general health/mental health Poor OH/patient cooperationPoor OH/patient cooperation Lack of interestLack of interest Lack of financial supportLack of financial support

7 Factors affecting Malocclusions OverjetOverjet OverbiteOverbite OpenbiteOpenbite CrossbiteCrossbite

8 OVERJET EXCESSIVE HORIZONTAL PROTRUSIONEXCESSIVE HORIZONTAL PROTRUSION When the patient bites together, there is an abnormal space between the lingual of the Max incisors & the facial of the Mand incisors. When the patient bites together, there is an abnormal space between the lingual of the Max incisors & the facial of the Mand incisors.

9 OVERBITE EXCESSIVE VERTICAL OVERLAPPINGEXCESSIVE VERTICAL OVERLAPPING Caused by the Max anterior teeth vertically overlapping the Mand anteriors.Caused by the Max anterior teeth vertically overlapping the Mand anteriors. Slight overbite is normal.Slight overbite is normal.

10 OPENBITE Anterior or posterior teeth do not occlude. A space between the teeth.

11 Crossbites Anterior Crossbite: maxillary anterior teeth are positioned lingual to mandibular anterior teeth.Anterior Crossbite: maxillary anterior teeth are positioned lingual to mandibular anterior teeth.

12 Crossbites Posterior crossbites: maxillary posterior teeth are positioned lingual to mandibular teeth.Posterior crossbites: maxillary posterior teeth are positioned lingual to mandibular teeth.

13 Edge to Edge Bite Incisal edges of maxillary anterior teeth occlude on the incisal edges of mandibular anterior teethIncisal edges of maxillary anterior teeth occlude on the incisal edges of mandibular anterior teeth

14 End to End bite Cusp tips of maxillary posterior teeth occlude with cusp tips of mandibular posterior teethCusp tips of maxillary posterior teeth occlude with cusp tips of mandibular posterior teeth

15 Crowding MildMild ModerateModerate SevereSevere

16 Angles Classification Class I (Neutrocclusion): mesial buccal cusp of maxillary first molars is contacting the buccal groove of the mandibular first molars, remaining teeth are considered to be in normal occlusion.Class I (Neutrocclusion): mesial buccal cusp of maxillary first molars is contacting the buccal groove of the mandibular first molars, remaining teeth are considered to be in normal occlusion.

17 Malocclusion Molars are in the same relationship as Class I, however, remaining teeth exhibit deviations from normal occlusion, such as: crowding, crossbite, or openbite.Molars are in the same relationship as Class I, however, remaining teeth exhibit deviations from normal occlusion, such as: crowding, crossbite, or openbite.

18 Class II Malocclusion Class II (Distocclusion): mesial buccal cusp of maxillary first molars is contacting the mesial portion of the mandibular first molars, mesial to buccal groove.Class II (Distocclusion): mesial buccal cusp of maxillary first molars is contacting the mesial portion of the mandibular first molars, mesial to buccal groove.

19 Class II Division I Division I (refers to anterior teeth only): molars are in the same relationship as Class II with maxillary anteriors being flared out to the labial.

20 Class II Division II Division II (refers to anterior teeth only): molar relationship the same as Class II with maxillary centrals are tipped back to the lingual; they are touching the mandibular anterior teeth.

21 Class III Malocclusion Class III (Mesiocclusion): Mesial cusp on maxillary first molars are touching distal of the buccal groove on the mandibular first molar.Class III (Mesiocclusion): Mesial cusp on maxillary first molars are touching distal of the buccal groove on the mandibular first molar.

22 Causes of Malocclusion GeneticGenetic SystemicSystemic LocalLocal

23 Genetic Causes Congenitally missing teethCongenitally missing teeth Malformed teethMalformed teeth Supernumerary teethSupernumerary teeth MacrognathiaMacrognathia MicrognathiaMicrognathia MacrodontiaMacrodontia MicrodontiaMicrodontia

24 Congenitally Missing Teeth Patient missing Upper lateralsPatient missing Upper laterals

25 Malformed teeth Upper incisors misshapenedUpper incisors misshapened

26 Supernumerary Teeth Supernumerary between upper centralsSupernumerary between upper centrals

27 Macrognathia Large JawLarge Jaw

28 Micrognathia Small JawSmall Jaw

29 Macrodontia Large TeethLarge Teeth

30 Microdontia Small TeethSmall Teeth

31 Systemic Causes Diseases and nutritional disturbances that upset the normal schedule of dentition development during infancy and early childhoodDiseases and nutritional disturbances that upset the normal schedule of dentition development during infancy and early childhood

32 Local Causes Trauma/injury to permanent tooth buds, premature loss of primary teeth, and direct injury to permanent teeth.Trauma/injury to permanent tooth buds, premature loss of primary teeth, and direct injury to permanent teeth.

33 Local Causes Thumb sucking/ can cause openbite and/or overjetThumb sucking/ can cause openbite and/or overjet Tongue thrusting/ can cause openbiteTongue thrusting/ can cause openbite

34 Local Causes Mouth breathingMouth breathing BruximBruxim NailbitingNailbiting

35 Phases of Orthodontic treatment PreventivePreventive InterceptiveInterceptive CorrectiveCorrective

36 Preventive Orthodontic treatment designed to correct problems, that if not stopped, will contribute to more serious problems in the future.Orthodontic treatment designed to correct problems, that if not stopped, will contribute to more serious problems in the future.

37 Interceptive Orthodontic treatment involving the correction of problems as they are developing.Orthodontic treatment involving the correction of problems as they are developing.

38 Treatment for Preventive and Interceptive Phases Space MaintainersSpace Maintainers Restoration to prevent tooth lossRestoration to prevent tooth loss Observing growth patternsObserving growth patterns Correcting bad habitsCorrecting bad habits Serial extractionsSerial extractions Recognizing deviation from normal developmentRecognizing deviation from normal development

39 Corrective Orthodontic treatment performed when the problems have already occurred and there were no steps taken to correct them previously.Orthodontic treatment performed when the problems have already occurred and there were no steps taken to correct them previously.

40 Initial Exam/Initial Consultation First appointmentFirst appointment Review medical historyReview medical history Examine the patientExamine the patient Initial recommendations, review treatment options, and answer questionsInitial recommendations, review treatment options, and answer questions Next appointment RecordsNext appointment Records

41 Records Second appointmentSecond appointment Montage of patientMontage of patient –Intraoral and extraoral photographs –Study models –Panoramic –Cephalometric Never review financial information at this appointmentNever review financial information at this appointment

42 Montage Photographs A series of usually eight photographs to allow the doctor a clear view of the patient mouth.A series of usually eight photographs to allow the doctor a clear view of the patient mouth.

43 Study Models An exact replica of patients teeth and surrounding tissuesAn exact replica of patients teeth and surrounding tissues Allows the doctor to view all aspects of patients teeth without patient having to be thereAllows the doctor to view all aspects of patients teeth without patient having to be there

44 Panoramic A wide view of patients mouthA wide view of patients mouth Allows insight into placement of impacted teeth, 3 rd molar location, and eruption patterns of unerupted teethAllows insight into placement of impacted teeth, 3 rd molar location, and eruption patterns of unerupted teeth

45 Cepholometric Used for diagnosis of jaw relationshipsUsed for diagnosis of jaw relationships Tracings are designed to show how the jaw relates to certain landmarks in the skullTracings are designed to show how the jaw relates to certain landmarks in the skull

46 Consultation/Case Presentation A detailed outline of the treatment for the patientA detailed outline of the treatment for the patient How long it will takeHow long it will take What style of braces and or appliances are being usedWhat style of braces and or appliances are being used Cost of treatmentCost of treatment

47 Palmer Numbering System

48 Separators Elastic, circular shaped item placed between teeth to open contact between teeth to allow orthodontic band to fit around teeth.Elastic, circular shaped item placed between teeth to open contact between teeth to allow orthodontic band to fit around teeth.

49 Bands Orthodontic bands are placed on first molars, to act as an anchor in orthodontic treatment and to help stabilize the archwire.Orthodontic bands are placed on first molars, to act as an anchor in orthodontic treatment and to help stabilize the archwire. Brackets are soldered on the band, have tubes to hold archwire.Brackets are soldered on the band, have tubes to hold archwire. Only upper first molar bands have headgear tubesOnly upper first molar bands have headgear tubes Come in multiple sizesCome in multiple sizes

50 Banding Appointment Teeth are pumicedTeeth are pumiced Orthodontic Assistant sizes bandsOrthodontic Assistant sizes bands Orthodontist checksOrthodontist checks Assistants prepares cementsAssistants prepares cements Orthodontist seats bandsOrthodontist seats bands

51 Brackets Bonded to buccal/facial portion of teeth, transmits force of archwire to move teethBonded to buccal/facial portion of teeth, transmits force of archwire to move teeth Can be silver, clear or gold in colorCan be silver, clear or gold in color Each bracket is specific to a toothEach bracket is specific to a tooth Archwire slot has a specific torque and tip to bring teeth into ideal occlusionArchwire slot has a specific torque and tip to bring teeth into ideal occlusion May have wings for tying or doorsMay have wings for tying or doors

52 Bonding Appointment Pumice teeth to remove salvia and debrisPumice teeth to remove salvia and debris Acid etch teeth for 30 secondsAcid etch teeth for 30 seconds Apply bonding agentApply bonding agent Apply cement to back of each bracketApply cement to back of each bracket Place bracket on toothPlace bracket on tooth Orthodontist positions bracket to precise location on toothOrthodontist positions bracket to precise location on tooth Light cure bracket to teeth or allow to self cureLight cure bracket to teeth or allow to self cure

53 Archwires Placed into bracket slot to control movement of teeth.Placed into bracket slot to control movement of teeth. Held in place by elastic ligature ties or stainless steel ties.Held in place by elastic ligature ties or stainless steel ties.

54 Elastic Ties aka: Os, As, colored ties Used to hold AW into bracket slots.Used to hold AW into bracket slots.

55 Stainless Steel Ligature Ties Used to hold arch firmly into archwire slotUsed to hold arch firmly into archwire slot Can be preformed with pigtail or longCan be preformed with pigtail or long Used to tie individual teeth or multiple teeth together.Used to tie individual teeth or multiple teeth together.

56 Kobayashi Hooks Placed on Brackets to attach interarch elasticsPlaced on Brackets to attach interarch elastics Interarch elastics, used to correct Class II and Class III occlusionInterarch elastics, used to correct Class II and Class III occlusion

57 Tooth Movement Teeth are allowed to move through the bone by resorption (osteoclasts).Teeth are allowed to move through the bone by resorption (osteoclasts). Teeth are held in place by deposition (osteoblasts).Teeth are held in place by deposition (osteoblasts). Active Phase=tooth movementActive Phase=tooth movement Retention Phase=teeth held in place with retainers, osteogenesis takes 6-12 monthsRetention Phase=teeth held in place with retainers, osteogenesis takes 6-12 months –Hawleys, Trutanes, Fixed Retainers

58 Retainers HawleyHawley TrutanesTrutanes Fixed RetainersFixed Retainers

59 Oral Hygiene Special toothbrush and brushing instructionsSpecial toothbrush and brushing instructions Floss and floss threadersFloss and floss threaders ProxibrushProxibrush Fluoride rinseFluoride rinse WaxWax Food Dos and Don'ts listFood Dos and Don'ts list What to do when things breakWhat to do when things break


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