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Trent, Bailey (Class II div I)

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Presentation on theme: "Trent, Bailey (Class II div I)"— Presentation transcript:

1 Trent, Bailey (Class II div I)
3/25/2017

2 Profile is a poor man’s ceph
3/25/2017

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8 Anterior and Posterior Crossbites
Lecture 8 Ingrid Reed DDS, MS Department of Orthodontics & Dentofacial orthopedics 3/25/2017

9 Anterior Crossbite Dental – on or two teeth
Abnormal axial inclination Retained primary tooth Crowding Usually Class I Skeletal - Class III ANB <0° Look at molar relationship Take ceph Pseudo Class III – shift due to interferences when end to end occlusion Check bite in CR vs. CO for interference Pseudo class III - forward shift of the mandible to escape incisor interferences in what really is an end to end relationship. Not a real Class III, eliminate the interferences. Crowding in Class I situation need to differentiate between skeletal and dental class. Pseudo class III patient is biting edge to edge on incisors uncomfortable shift mandible forward appear to have anterior cross bite, can lead to improper growth of the jaws. One tooth in cross bite – 3/25/2017

10 Anterior Cross bite - Dental
Jared Hallier Single tooth crossbite Most common cause of maxillary incisor in crossbite is retained primary tooth Mandibular incisors not moved lingually 3/25/2017

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12 Anterior Crossbite - dental
Retained primary tooth causes deflection in the path of the incisor that start lingual 3/25/2017

13 Anterior Crossbite - Dental
Wearon labial surface gingivalrecession bone loss,want tocorrect these early 3/25/2017

14 Anterior Crossbite - Skeletal
The whole jaw is in cross bite here = skeletal problem 3/25/2017

15 Anterior Crossbite - Skeletal
Severe class IIII referout 3/25/2017

16 Treatment – Dental anterior crossbite
Tongue blade Removable appliance with finger spring Fixed appliances Possible extraction of adjacent deciduous teeth Bite on popsicle stickuse own bite as force to correct this. Crowding may need to 3/25/2017

17 Tongue blade Can move tooth enough force there, many children can do this – do it as early as possible. 3/25/2017

18 Early mixed dentition only centrals want to correct this early – in this case Maxillary Hawley with a finger spring. Finger spring does not bodily move the teeth, but will tip it. Takeimpression make a Hawley, the patien has a deep bite, must open bite in some way when appliance is placed need to put blocks on the molars to disocclude the bite (open the bite Typically use band lock = blue ontheocclusal surface = very soft on top put the white composite, that way can remove the blue material without getting teeth when taking it off. 3/25/2017

19 Hawley with finger spring
Proffit page 401 Removable appliance tipping only Root control is needed for more than 3-4 mm of crown movement Spring fabricated fro wire > but not so heavy that force is too high, springiness obtained by bending helices. Ball clasp retention 3/25/2017

20 Willard, Trixy Wind helix in the direction it was made Acrylic build up on laterals 3/25/2017

21 Hawley with finger spring
Assess space available Alginate impression Pour in yellow stone Fabricate Hawley with clasps and finger spring Bend finger spring so it unwinds in the direction it was wound Build up molars to clear occlusion Deliver appliance Activate spring every few weeks Self retaining Helix – unwind in direction it was wound 3/25/2017

22 se;lf retained now no appliance needed
3/25/2017

23 Dental Anterior Crossbite
Several teeth are Involved and simple tipping of one tooth won’t work. Hawley would be difficult in this case with several teeth in cross bite 3/25/2017

24 Left premaxilla needs to be reshaped.
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25 Brackets can movethe tooth bodily
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27 Change shape of arch, bone- different then just tipping one tooth
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28 Anterior crossbite of lateral incisors
Maxillary laterals usually erupt to the lingual if inadequate space 3/25/2017

29 Retention of Anterior Crossbites
Good overbite relationship Should be self retaining Tipping tooth forward – vertical change in overbite Retention of anterior cross bite – good overbite is selfretaining. 3/25/2017

30 Cleft Palate Bays Ties in with anterior cross bite most patients with cleft palate have an anterior cross bite. Generally orthodontic needs for these patients will be tied in with treatment. Dental problems on maxilla from cleft palate. Lower arch usually well developed, no problems Occlusion and development of maxilla – are of cleft problem with eruption of canine. 3/25/2017

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32 Bays 3/25/2017

33 Cleft palate treatment sequence
TIME PROCEDURE 2-4 weeks Lip closure 12-18 months Palate closure 7-8 years Alignment of maxillary incisors, expansion of maxilla, as preparation for alveolar graft 7-9 years Alveolar bone graft (before eruption of lateral incisor, if present, or canine) Adolescence Comprehensive orthodontics Lip /nose revision Late adolescence Orthognathic surgery? 3/25/2017

34 Cleft palate – orthodontic problems
Problems from repair –not cleft itself Lip repair – constriction across anterior of maxilla – anterior crossbite Palate repair – constriction laterally – posterior crossbite Problems from cleft Maxillary incisors erupt rotated and in crossbite Lateral incisor and/or canine in area of cleft missing or impacted Cleft area doesn’t have bone for eruption – alveolar graft needed Scartissue not as pliable as lip causes constriction of tissue,correction of palate constricts laterally =posterior cross bite Bone grafts are usually necessary 3/25/2017

35 Early permanent dentition treatment
Correct maxillary incisors Rotations Crossbite Position Expand maxilla Alveolar bone graft Alveolar bone graft Stabilizes the cleft area Creates healthy environment for the permanent teeth Ideally permanent laterals and canines should erupt through the graft Graft between 7 and 10 years 3/25/2017

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37 Unrepaired cleft - TG 1-24-03
Rarity – seen in grad ortho, patient with unrepaired cleft this is very rare. Anterior crossbite with cleft And posterior crossbite 3/25/2017

38 TG Unrepaired cleft and severe constriction of maxilla 3/25/2017

39 TG 3/25/2017

40 TG Schwartz appliance on the lower gently pushes the teeth apart and stretches the bone a little =removable appliance activated only once a week. Not like a rapid palatal expander on maxilla 3/25/2017

41 TG 08 fairly wellformed maxilla,cleftisstill in place willstill need surgery for lateral incisor and missing bone 3/25/2017

42 TG 3/25/2017

43 3/25/2017 Mandiblearch is wellshaped,
Stillhas a defect thatneedscorrected got a greatresult. 3/25/2017

44 TG 3/25/2017

45 Early Permanent Dentition Treatment
Canine & premolar on cleft side – malaligned Close spaces if missing teeth Position teeth as need for prosthetics Dental implants are not appropriate for cleft areas 3/25/2017

46 Orthognathic surgery - cleft palate patients
Males > females Growth – return of anterior and/or lateral crossbites Usually deficient maxillary growth Normal mandibular growth Males usually more than females because of deficient maxillary growth 3/25/2017

47 Posterior Crossbites Skeletal dental 3/25/2017
Diagnose early!!!! Patient yesterday that has been seen atschool 16.5 years old severe posterior crossbite that will be difficult 3/25/2017

48 Posterior Crossbite Posterior crossbite – position of maxillary molars
Bilateral maxillary lingual crossbite Unilateral maxillary lingual crossbite Asymmetric maxillary arch Unilateral mandibular buccal crossbite Normal maxilla Asymmetric mandible Maxillary buccal crossbite Unilateral is very rare most of the time have bilateral cross bite with a shift Usually due to narrow maxilla - 3/25/2017

49 Why does this crossbite exist?
Bilateral maxillary palatal crossbite Maxilla narrow - skeletal basis Dental arch narrowed – skeletal width correct Proffit page 225 Dental related to tooth that came in wrong way 3/25/2017

50 Patient exhibits a shift, so instead of being a unilateral posterior crossbite, you have a bilaterally constricted maxilla with a shift Cross bite right side –these are rare look again on closuer has unilateral cross bite onone sidethen lookatmidlines – they are not coincident. Noreason for this have correct number of teeth should be no shift of change, be suspicious ofbilateralconstricted maxillawith a shift one sidein cross bite the other looks noraml. 3/25/2017

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52 Hand articulatpatientcasts with midlines lined up, willsee they hit on cusp tips they shift mandible getting appearance of a cross bite. 3/25/2017

53 Rapid Palatal Expander
Proffit page 284 Hyrax expander with jackscrew 0.5mm per day Maxilla opens as if on a hinge, with its apex at the bridge of the nose Suture opens on a hinge anteroposteriorly, separating more anteriorly than posteriorly. Rapid palatal expander to open the palate out and spread the teeth out to correct and get midlines almost lined up 3/25/2017

54 Posterior Crossbites 3/25/2017

55 Occlusion is much more classone and the molar position has not changed
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56 Dental Posterior Crossbite
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57 Occasionally there will be a dental cross bite central and lateral incisors no deciduous teeth. First molar too far to the lingual. Bands on upper and lower sodera lingual buttondorrectas a single tooth cross bite. 3/25/2017

58 Oral habits – disruptive to occlusion
Thumb sucking Finger sucking Tongue thrust Nail biting Lip biting Lip sucking Other things that are disruptive to the occlusion tongue thrust nail biting any force to the teeth 3/25/2017

59 Thumb (finger) sucking - phases
Phase I Birth to 3 years Normal , especially associated with weaning. Usually self eliminated. Phase II 3 to 6 or 7 years 3-4 years: mild displacement of primary teeth; normal lip & cheek pressure will restore teeth to usual position if sucking stops After eruption of permanent incisors: if sucking persists, stop habit and start orthodontic treatment to correct tooth displacement. Constricted maxilla: least likely to correct spontaneously Phase III Thumb sucking may be a sign of psychological problems Talk to child Appliance to help child Moyers – page 731 Thumb sucking - definition “Repeated forceful sucking of the thumb with associated strong buccal and lip contractions.” Most likely to cause malocllusion. Usually selfcorrected kids usually stop Can move the maxilla and reshape entire maxilla by thumb sucking. Year old. Child needs to wanttostop. Little kids a good way to get them to stop. Wear socks on hands at night buy cute socks. Appliances can be used this is like punishment find way to work with the child 3/25/2017

60 Thumb (finger sucking)
Threshold duration is about 6 hours or more per day for the force to have an effect. Changes the equilibrium of the mouth. Detrimental effect on the occlusion, if child stops young, this will self correct, force of thumb is reshaping the maxilla creating an open bite. 3/25/2017

61 Effects of thumb sucking
Tongue lowered to accommodate thumb Cheek pressure Greatest at corners of mouth More constriction at canines V- shaped palate Lingual movement of maxillary molars Mandibular molars unchanged Anterior teeth and premaxilla can be moved V-shaped palate sucking – cheeks are pushing in on everything cheeks are also a force.lingual movementof teeth anterior teeth move causing an open bite. 3/25/2017

62 Cheek Tongue 3/25/2017

63 Malocclusion due to sucking habit
Lower incisors Lingual displacement Upper incisors Labial displacement Maxillary arch Narrow Interarch relation Anterior open bite 3/25/2017

64 Treatment Convince child that they want to stop, appliance called anterior crib can remind child the thumb cannot go into the mouth here., Crib 3/25/2017

65 Treatment – palatal expander
Palatal expander – more dental expansion Proffit page 401 Activate ¼ turn (.025 mm ) every other day (page286) ratio of expansion is 1:1 dental to skeletal expansion Note retention from Adam’s clasps and ball clasps Bone fills in in 3 -4 months and self retaining after that 3/25/2017

66 Reference Contemporary Orthodontics, 4th Edition William R. Proffit
Henry W. Fields Jr. David M. Sarver Pages: 68, , , , , , , 622 3/25/2017


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