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.

3. #1 Reason most orthodontists perform treatment
Malocclusion

4. #1 Reason people seek orthodontic treatment
Esthetics

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

6. Contraindications for ortho Treatment
Lack of bone support
Rampant caries
Poor general health/mental health
Poor OH/patient cooperation
Lack of interest
Lack of financial support

7. Factors affecting Malocclusions
Overjet
Overbite
Openbite
Crossbite

8. OVERJET EXCESSIVE 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.

9. OVERBITE EXCESSIVE VERTICAL OVERLAPPING
Caused by the Max anterior teeth vertically overlapping the Mand anteriors.
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.

12. Crossbites
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 teeth

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

15. Crowding
Mild
Moderate
Severe

16. Angle’s 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.

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.

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.

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.

22. Causes of Malocclusion
Genetic
Systemic
Local

23. Genetic Causes Congenitally missing teeth Malformed teeth
Supernumerary teeth
Macrognathia
Micrognathia
Macrodontia
Microdontia

24. Congenitally Missing Teeth
Patient missing Upper laterals

25. Malformed teeth
Upper incisors misshapened

26. Supernumerary Teeth
Supernumerary between upper centrals

27. Macrognathia
Large Jaw

28. Micrognathia
Small Jaw

29. Macrodontia
Large Teeth

30. Microdontia
Small Teeth

31. Systemic Causes
Diseases 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.

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

34. Local Causes
Mouth breathing
Bruxim
Nailbiting

35. Phases of Orthodontic treatment
Preventive
Interceptive
Corrective

36. Preventive
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.

38. Treatment for Preventive and Interceptive Phases
Space Maintainers
Restoration to prevent tooth loss
Observing growth patterns
Correcting bad habits
Serial extractions
Recognizing 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.

40. Initial Exam/Initial Consultation
First appointment
Review medical history
Examine the patient
Initial recommendations, review treatment options, and answer questions
Next appointment Records

41. Records Second appointment Montage of patient
Intraoral and extraoral photographs
Study models
Panoramic
Cephalometric
Never 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.

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

44. Panoramic
A wide view of patient’s mouth
Allows insight into placement of impacted teeth, 3rd molar location, and eruption patterns of unerupted teeth

45. Cepholometric
Used for diagnosis of jaw relationships
Tracings 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 patient
How long it will take
What style of braces and or appliances are being used
Cost 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.

49. Bands
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.
Only upper first molar bands have headgear tubes
Come in multiple sizes

50. Banding Appointment Teeth are pumiced
Orthodontic Assistant sizes bands
Orthodontist checks
Assistants prepares cements
Orthodontist seats bands

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

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

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

54. Elastic Ties aka: O’s, A’s, colored ties
Used to hold AW into bracket slots.

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

56. Kobayashi Hooks Placed on Brackets to attach interarch elastics
Interarch 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 held in place by deposition (osteoblasts).
Active Phase=tooth movement
Retention Phase=teeth held in place with retainers, osteogenesis takes 6-12 months
Hawleys, Trutanes, Fixed Retainers

58. Retainers
Hawley
Trutanes
Fixed Retainers

59. Oral Hygiene Special toothbrush and brushing instructions
Floss and floss threaders
Proxibrush
Fluoride rinse
Wax
Food Do’s and Don'ts list
What to do when things break