Orthodontics Key Points- By Danesh Kumar || JSMU

Chapter 01 Basics of Orthodontics

• Maxillary line of occlusion= pass through central fossa & Cingulum of anterior, mandibular line
of occlusion= through buccal cusp of posterior & incisal edges of anterior.
• Angle’s classification→ maxillary 1stmolar is key to occlusion. Class 1- incorrect line of
occlusion but normal molar relation , Class2- MB cusp of Max 1st molar ahead/anterior/mesial
to Buccal groove of mandibular molar. Class3- MB cusp behind/ distal to buccal groove.
• Canine classification→ class 1- mesial slope coincide distal slope, class2- mesial slope ahead &
class 3- mesial slope behind distal slope.
• Incisal classification→ class 1- incisal edges of upper incisor at/below Cingulum plateau. Class
2- Incisal edges posterior to Cingulum( Division 1- proclined & division 2- retroclined) ,class3-
Incisal edge anterior to Cingulum plateau.
• Cross bite is transverse discrepancy in buccolingual & labio lingual direction.
• Anterior cross bite ( upper anterior occlude lingual to lower) & posterior cross bite (upper
posterior lingual to lower.)
• Overjet/ horizontal overlapping/ distance between labial of lower incisors & Incisal edge of
uppers. Normal= 2-3mm, mild 3-4, moderate 5-6, severe 7-10mm
• Overjet of 5mm or greater indicates Angle’s class 2 malocclusion.
• Reverse overjet/ negative overjet/anterior cross bite → lower incisors are in front of upper incisor,
normal- O, moderate 1-2, severe 3-4 or greater.
• Overbites/ vertical overlapping→ normal 1-2mm. [open bite/ negative overbite→ no vertical
overlapping, moderate 0-2, severe 3-4 mm].
• Deep bite/increased or severe overbite/ traumatic overbite→ moderate 3-4, Severe 5-7 mm.
• Sunday bite / dual bite— Habitual forward posturing of Mandible into class 1 & severe Class 2.
• Complete bite if Occlusal stop between incisal edges of lower & cingulum of upper incisors.
• Spontaneous correction of diastema if <2mm.
• Ugly duckling stage → self correcting, flared & spaced Maxillary incisors,@ 8-11 years,
unerupted canine lie superior & distal to LI, corrected by eruption of 2° canine.
• Skeletal classification shows anterio posterior direction, [Class1/ straight profile /neutro
occlusion], [class2 / convex/ Maxillary prognathism/disto occlusion], [class 3/concave/ mesio
occlusion/ mandibular prognathism].
• Compensating curves→ curve of spee(anterio posterior, start@ tip of incisal edge to distal cusp
of 3rd molar), curve of Wilson (mesio distal, contact buccal&lingual cusp of molars on both
sides)
• Primate space physiological space, in maxilla(mesial to 1° canine),in Mandible(distal to
deciduous canine).
• Leeway space( combined mesiodistal width of 1° canine, 1st & 2ns molar is > 2° canine, 1st & 2nd
PM, the difference is leeway space, maxilla= 1.5 mm, Mandible= 2.5).
• Andrew’s 06 key of normal occlusion= 1= class 1 molar relationship, 2= correct crown
angulation, 3= correct Crown inclination, 4= no rotations, 5= no space, 6= flat to slight curve of
spee( not deeper than 1.5mm), 7= no tooth size discrepancy ( boltan analysis).
• IOTN( index of treatment needs)→ grade1= no treatment, 2= mild/ little, 3= moderate,4= severe,
5= extreme need.
Chapter 02 Basics of Growth & Development
• Differential growth shown by scammons curve( neural growth complete by 6-7 years, maxilla
follows neural tissue, mandible follows general body growth which slow in childhood & s
shaped@ puberty, lymphoid tissue maximum growth at 10 years, genital tissues -male= 14-15,
female= 11-12 years.
• An important aspect of growth pattern is it’s predictability.

Orthodontics Key Points By DANESH KUMAR- JSMU 1

 • Craniometry, anthropometry & ceph are included in measuremental approach & vital staining,
autoradiography, radioisotope, & implant radiography are experimental approaches.
• Craniometry for studying growth by measuring dry skull, cross sectional study &
Anthropometry is longitudinal study.
• Common dyes (alzarin Dye- john hunter, tetracycline & Typhon blue) used for vital staining ,
stain the mineralizing tissue.
• Gamma emitting isotopes for diagnosing cancerous growth.
• Intra membranous ossification→ secretion of matrix, e.g cranial vault, maxilla & body of
Mandible.
• Endochondral ossification→ cartilage to bone, e.g cranial base, condyle of Mandible.
• Rapid cartilaginous skeletal development in 3rd month, in growth of vascular system by 4th
month, epiphyseal plate cartilage lengthen the bone, periosteum inc; thickness & reshape.
• New bone formation from cartilaginous/direct formation within mesenchyme is called modeling.
• Maxilla movement by resorption & remolding is primary displacement, forward movement of
maxilla due to growth of cranial base is secondary displacement.
• Growth sites are locations at which growth occurs e.g condyle, sutures, synchondrosis, ramus.
• Growth centers are locations at which independent/ genetically controlled growth occurs.
• All centers of growth are growth sites, but not all growth sites are growth center.
• 03 theories of growth control,1) bone is primary determinant of growth. 2) cartilage is primary
determinant if bone is secondary. 3) soft tissue matrix is primary determinant while cartilage &
bone are secondary.
• Theories: genetic theory, scott nasal septum theory, sichers’s sutural dominance theory.
• Scott nasal septum theory is rejected because of achondroplasia syndrome.
• Sichers’s sutural dominance theory→ growth at suture is independent of environment factors.
• Moss functional Matrix theory→ face grow in response to functional need.
• Growth of cranial vault is direct response to pressure/ growth of bone.
• Hydrocephaly→ bec of fluid pressure, ICP build up, brain growth impediment lead to
enlargement of cranial vault.
• Major determinant of maxilla & Mandible is enlargement of nasal & oral cavity.
• Mandibular Condylar growth in which no suture is present.
• In microcephaly & hydrocephaly ,the growth @ sutures respond to outside influence.
• Craniofacial complex is divided into 1) cranial vault (flat bones, cover outer & upper surface of
brain, growth at cranial sutures, fontanelle closed postnatally), 2) cranial base( bony floor, center
of ossification is synchondrosis—spheno ethmoidal [complete@ 6-7 years], inter sphenoid
[complete at birth], spheno occipital [ complete in last, 15-18 years], 3) naso maxillary complex
(by intra membranous ossification, grow by apposition of bone@ suture & surface remolding).
 MAXILLARY GROWTH
• Maxilla move downward & forward, frontal surface is remolded, & bone removed from most
anterior portion(resorption) & deposition at back.
• Maxillary growth at suture is primary displacement & push because of cranial base growth is
secondary displacement.
• At 7 years cranial base growth stops, afterwards maxilla come forward only by sutural growth.
• Achondroplasia= abnormal cranial base growth, lead to mid face deficiency.
• Growth order in Maxilla => transverse→ anterio posterior→ vertical
• In transverse Maxillary growth, width end before pubertal spurts, intercanine width doesn’t
change after 12 years & inter molar width increase till eruption of 2nd & 3rd molar, maxillary
midline suture increase 5-6mm of width.
• In anterio posterior growth, Maxilla grow forward & downward in both cranial base growth &
surface remolding.

Orthodontics Key Points By DANESH KUMAR- JSMU 2

 • In last Vertical growth complete in 16 years in girls & longer in boys.
• 6mm vertical growth & 2.5mm anteriorly of incisor between age of 6-25 years.
 MANDIBULAR GROWTH
• Development from Meckel’s cartilage ( it disappear after mandibular growth, remnants convert
into 02 small bones which form conductive ossicles of middle ear, perichondrium persist as
sphenomandibular ligament).
• Intra membranous bone formation start lateral to Meckel’s cartilage & spread posteriorly.
• Condyle cartilage develop as secondary cartilage , initially as separate area of condensation at 08
weeks & fuse with body at 4 months.
• Main role in mandibular growth is by both endochondral & periosteal activity.
• Pattern of growth: cranium as reference ( chin move downward & forward)& by vital staining.
• Ramus remold backward & upward, & Mandible translated downward & forward.
• In vital staining, the sites of mandibular growth are posterior surface of ramus, condyle &
coronoid process.
Chapter:03- Early & late stages of Development
• Premature infants are expected to small@ 1st & 2nd year of life & indistinguishable in 3rd Year.
• Child with Congenital hormones deficiency, heart disease, stress are chronic illness.
• Infantile swallowing→ disappear in first year of life, active muscle contraction, little activity of
tongue & Adult swallowing→ cessation of lip activity, lip relaxed.
• Children move jaw laterally on opening, bring back to midline,& teeth to contact with food is
called juvenile chewing, develop during primary molar eruption.
• The transition of juvenile chewing to adult chewing develop during permanent canine erupt@
12 years.
• First sound are bilabial sounds (m,p,b) & last speech sound is r.
• Teeth present at birth are natal teeth, & teeth erupt within 30 days are neonatal teeth.
• Primary tooth eruption sequence (ABDCE), (Maxillary: Mandibular CI- 10: 8, LI-11:13, canine-
19:20,1st molar- 16:16 & 2nd molar- 29:27months).
• Pre emergent 2° teeth eruption→ small buccal & buccal drift of follicle within bone, resorption
of bone & root of primary teeth & tooth move by propulsive mechanism.
• In cleidocranial dysplasia , improper resorption of root & tooth impedes permanent teeth
eruption.
• Mutation in PTHR-1 lead to defect in propulsive mechanism & primary failure of
eruption(normal bone resorption but teeth don’t follow path).
• Resorption is rate limiting factor for pre emergent eruption.
• Post emergent eruption→ comprised of spurt( tooth penetrate gingiva first time), juvenile
occlusal equilibrium (slow eruption, between 8pm midnight),& adult occlusal equilibrium
(final phase, slow eruption).
• Functional tooth erupt@ rate parallel to rate of vertical growth of mandibular ramus, total
eruption path of 1st permanent molar is 2.5cm.
• Eruption sequence: 6 years (1st molar, lower CI), 7 years (max CI, mand LI), 8 years(max LI), 9
years( no eruption), 10 years (1/2 root of 3,4), 11 years(mand canine&1st PM, max 1st PM), 12
years ( max canine &2nd PM, mand 2nd PM & 2nd molar), 15 years( roots of all teeth except 3rd
molar).
• Nolla stages of tooth development: stage 1-5 duration- 6 years, stage 6-8 duration- 2-3 years,
stage 9-10 duration- 2-3 years.
• Stages: 0-no crypts, 1- crypts, 2-initial calcification, 3- 1/3 of Crown Calcified, 4-2/3 crown
Calcified, 5- complete crown, 6- crown complete ( flat cervical region & start of root formation),
7- 1/3 of root, 8- 2/3 of root, 9- complete root (open apex), 10- closed apex.
• Trauma BEFORE stage 6 cause Turner tooth, trauma AFTER or at stage 6 cause dilaceration.

Orthodontics Key Points By DANESH KUMAR- JSMU 3

 • Difference between amount of space needed & available space for incisors is inciosr liability.
• Slight increase width of arch across canine contribute 2mm of space, proclined incisors create 1-
2 mm additional space.
• Flush terminal plane→ distal surface of deciduous 2nd molar of maxilla & Mandible in same
plane.
• Mesial step→ distal surface of 1° mand 2nd Molar lies mesial to distal surface of max 2nd molar &
may convert to class ½. Distal step→ distal surface of lower molar more distally to upper.
• Radiographic assessment of skeletal age by MP3 staging, hand wrist radiograph, Cervical
vertebral maturation index.
• Most accurate method for growth assessment→ hand wrist radiograph & most common for
assessing craniofacial skeletal growth is CVMI.
• MP3-F stage= onset of puberty growth spurt. MP3-FG= acceleration, MP3-G stage= maximum
growth, MP3-H phase= deceleration, MP3-I = end of pubertal growth.
• Ossification od bone of hand & wrist is standard for skeletal development.
• Pre pubertal growth → diaphysis< epiphysis, 2/3 years before pubertal growth→ diaphysis=
epiphysis, onset of pubertal growth→ sesamoid bone in thumb, pubertal growth complete→
fusion b/w epiphysis, diaphysis & radius( last bone to ossify).
• Trapezoid shape of C3 & C4 indicate least mature, peak of mandibular growth occur 02 years
after CS1( Cervical stage-1).
• PHV( peak height velocity)→ greatest annual increment during puberty or 0.9 to 01 year before
puberty, it’s between C3-C4 stage.
• Minimum→ start→ onset→ PHV→ declaration→ End→ Termination
• Average voice change start 1.8 years after onset, pubertal voice change0.2 years before PHV.
• Bone surround the inferior alveolar nerve is called core, rotation in core is called internal
rotation that move jaw forward & upward , internal rotation have 02 components, 1)Intra
matrix rotation→ within body of mandible, & 2) matrix rotation → rotation around condyle.
• 15° rotation occurs from 4 years, 25% at condyle & 75% from Body of Mandible.
• Surface changes in rate of tooth eruption is external rotation, that move jaw backward &
downward.
• Backward rotation, when growth occurs more anteriorly than posteriorly & gives positive sign.
• Changes in rotation judges by palatal plane & mandibular plane.
• Short face height→ excessive forward mandibular rotation, Horizontal palatal plane, low
mandibular plane angle, deep bite & crowded incisors.
• Long facial height→ palatal plane rotate down posteriorly, excessive backward mandibular
rotation, anterior open bite, inc mandibular plane angle, mandibular deficiency.
• Age changes→ decreased exposure of UI, Lower exposure of LI, thin lip with less vermilion
display, occlusal wear, dec width & height, mesial drift of molar.
• Most common cause of late mandibular incisors crowding is late mandibular growth.
• With age→ decrease in enamel thickness & pulp thickness, inc dentin thickness & crown
exposure.
• Gingival migration of attachment without any eruption is passive eruption.
Chapter 04 Etiology of Malocclusion
Distrubance in EMBRYONIC DEVELOPMENT
• Teratogens= aspirin→ encephalopathy, aspirin+ smoking→cleft lip & palate, dilantin &
mercaptopurine→ cleft palate, CMV- microcephaly, toxoplasma→ hydrocephaly &
microphthalmia, ethyl alcohol→ central midface deficiency, retinoic acid, valium,
thalidomide→ craniofacial microsomia & treacher collin syndrome, rubbela virus→
microphthalmia, cataracts, deafness.
• X ray radiation cause microcephaly & vitamin D excess cause premature suture closure.

Orthodontics Key Points By DANESH KUMAR- JSMU 4

 • Most common congenital deformity= clubfoot, ( 2nd= cleft lip and palate).
• Fetal alcohol syndrome occurs in germ layer formation stage & initial organization,
encephalopathy during neural tube formation, treacher collin syndrome & craniofacial
microsomia during origin migration & interaction of cell population, crouzen syndrome during
final differentiation.
• FETAL ALCOHOL SYNDROME: during 1st trimester, short palpebral fissures, flat midface,
short nose, indistinct philtrum, thin upper lip, associated factors ( low nasal bridge, epicanthal
canal, micrognathia, minor ear anomalies).
• ANENCEPHALY: most common neural tube defect, absence of large part of Brain, or skull etc.
• TREACHER COLLINS SYNDROME: also called mandibulofacial dysostosis, mutations in
TCOF1 & lack of mesenchymal tissues in lateral part of face. Abnormal development of 1st &
2nd bronchial arches. Features: underdeveloped lateral orbital & zygomatic, small Mandible, ear
deformity, conductive hearing loss, nasal deformity.
• CRANIOFACIAL MICROSOMIA: or hemi facial microsomia,loss od neural crest cell during
migration, features: deformed ear, facial asymmetry, deformed/ absent ramus, Teratology of
fallot.
• CLEFT LIP & PALATE: most common congenital defect involving face & jaw, during 4th
developmental stage, lip cleft bec of failure of fusion between median & lateral nasal process &
Maxillary prominence, which occurs normally in 6th week. Midline cleft of upper lip bec of
failure of fusion of 02 median nasal process, unilateral/ bilateral cleft lip due to failure of fusion
Maxillary & median nasal process, oblique cleft of face because of failure of fusion of
maxillary & lateral nasal process, isolated cleft palate because of failure of fusion of02
palatine shelves.
• CROUZON SYNDROME: autosomal dominant, mutation in FGRR2 on chromosome 10,
deficiency of midface structure, hypertelorism, bulging of eye.
• ASPERT SYNDROME: or acrocephalosyndcatly, autosomal dominant, anomalies of skull, face
& limbs.
Distrubance in FETAL & PERINATAL PERIOD: Intra uterine molding
• PIERRE ROBIN SEQUENCE: molding during head fixed tightly against chest cause
mandibular deficiency, small Mandible, airway obstruction, cleft palate, glossoptosis.
• MIDFACE DEFICIENCY: during arm is pressed across face, severe Maxillary deficiency at
birth.
• STICKLER SYNDROME: defect in cartilage formation, flat mid face, short nose, hearing loss,
facial asymmetry, joint hyper mobility.
Progressive CHILD HOOD deformity:
• UNILATERAL CONDYLAR FRACTURE: cause growth deficiency, scaring, managed by
early mobilization.
• TORTILLAS: excessive contraction of neck muscles on 01 side, affected muscle is
sternocleidomastoid.
• MUSCLE WEAKNESS SYNDROME: increased anterior face height, open bite, excessive
eruption of posterior teeth, narrowing of maxillary arch.
Early ADULT life growth distrubance:
• ACROMEGALY: inc GH by anterior pituitary gland, excessive Mandible, skeletal class -2,
arthritis, inc BP, diabetes. Managed by removal/ irradiation of tumor, after irradiation therapy
sella turcica enlarge & loss of bony definition.
DENTAL distrubance:
• Anodontia- complete absence of tooth, oligodontia→ absence of > 6 teeth, hypodontia →
absence of < 6 teeth, HED→ hypodontia, conical teeth, sparse hairs, no sweat glands,
hyperthermia & lack of development of alveolar process.

Orthodontics Key Points By DANESH KUMAR- JSMU 5

 • Supernumerary teeth & malformed teeth during Morpho differencial stage, most common
variability in size, most variable is Maxillary lateral incisors.
• Most common supernumerary tooth is mesiodens.
• Cleidocranial dysplasia→ mutation in RUNX2 , features: partial or complete loss of clavicle,
narrow arched palate, retained primary teeth, dentigerous cyst.
• Turner tooth→ trauma when crown is forming, dilaceration occurs after crown completion.
• Achondroplasia→ abnormal endochondral ossification, retrusion of midface, short limbs.
• Effects of thumb sucking→ Flared & space Maxillary incisor,Lingually positioned lower
inciosr, narrow Maxillary arch, anterior open bite, Quad helix is given.
• Effects of tongue thrusting→ increased overjet, narrow Maxillary arch, Open bite , incisors
protrusion.
• Effects of mouth breathing→ increased facial height, supra eruption of posterior teeth,
increased overjet, anterior open bite.
• Adenoids faces→ narrow width dimensions, protusion, flatted teeth, short upper lip, forward
head posture.
Chapter 05- Orthodontic Diagnosis
MACRO ESTHETIC→ facial view/ symmetry( apply rule of 5th & 3rd) & profile analysis( jaw, lip
posture, inciosr prominence, lip competence, Mandible plane angle etc).
• Rule of 5th → eye separation by Central 5th, eye width by medial 5th, nose & chin within central
5th, interpupillary distance must be equal the width of mouth.
• Rule of 3rd→ upper 3rd from hair line to mid brow, middle 3rd from mid brow to sub nasale, lower
3rd from sub nasale to soft tissue menton.
• Facial index→ relationship of height to width.
• Class 1 skeletal / soft tissue→ straight profile, class 2- convex profile, class3- concave profile.
• Lip prominence ( retrusive or everted, prominent or protusive), lip competence (competent=
upper & lower lip meet @ rest, in competent= lips separated by 3-4 mm, potentially
incompetent= lips have ability to meet but due to some factors,they are separated).
• Bi Maxillary dentoalveolar protusion→ proclined both upper & lower teeth & prominent lips.
• Lip prominence > 2mm in presence of lip in competence indicate dentoalveolar protusion.
• Mandibular plane angle/ lower facial height= visualized by finger/ mirror handle, steep Angle
indicate long anterior facial height & skeletal open bite. Flat angle indicate short anterior
facial height & deep bite malocclusion.
MINI ESTHETIC→ tooth lip relationship ( dental Midline, inciosr stomion, occlusal cant), smile
analysis ( teeth & gum display, buccal corridors, smile arc).
• Incisor stomion is inciosr display at rest, excessive due to long lower 3rd of face, short upper lip.
• Transverse cant→transverse rotation of dentition at smile or at rest.
• Social smile/ posed smile is focus of ortho diagnosis.
• Display of 75% of incisors is minimum for excellent esthetic, up to 4mm lip coverage & 4mm
gingival display is acceptable. { Decrease in incisors exposure with age}.
• Buccal corridors/ negative space→ distance between max posterior & inside of cheek.
• Smile arc—contour of Incisal edges of max anterior relative to curvature of lower lip.
• Broad smile is more esthetic than narrow smile, flattened smile arc/ non consonant is less
attractive .
MICRO ESTHETIC→ Dental appearance ( tooth height, gingival shape, contour, embrasures, shade).
• Width of tooth should be about 80% of it’s height.
• Golden proportion→ width of LI should be 62% of CI, canine width should be 62% of LI, &
PM width should be 62% of canine width.
• CI have highest gingival level, max CI & canine have elliptical & LI have oval gingival shape.

Orthodontics Key Points By DANESH KUMAR- JSMU 6

 •Interdental contact area ,move apically from CI to molar is called connector, most apical point on
gingival tissue gingival zenith.
• Triangular shape area present incisal & gingival & apical to contact area→ called embrasures ,
gingival area don’t filled with interdental papilla is called black triangle.
• Black triangle due to loss of gingiva, severe crowding and corrected by IPR.
• Maxillary Central incisor are the brightest while the canine are the dullest in the arch.
DENTAL CAST ANALYSIS
• Symmetry – by placing transparent ruled grid over dental cast, so that dental grid axis is in the
midline, make it easier to spot asymmetries in arch form.
• Space analysis : steps→ 1) calculate space available from mesial of 1st molar to contralateral side.
2) calculate amount of space required by teeth.
• Methods for mixed dentition analysis→ radiographic, proportionality table( tanaka & Johnston
method & Moyer’s method.)
• Tanaka & Johnston analysis→ use width of Lower incisors to predict the size of unerupted canine
and pre-molar, sum of LI ( width) is divided by 2 & add 10.5mm for Mandible & 11 for Maxilla.
• Lateral incisors are used because of variation & first eruption.
• Mayor’s method→ use sum of lower incisors to correlate the value in table, instrument used→
cast, bolys gauge, probability chart.
• Bolton analysis/ tooth size analysis→ According to Bolton there exist a ratio between the
mesiodistal width of maxillary and mandibular teeth.
CEPHALOMETRIC ANALYSIS
• Distance from X-ray source to subject mid sagittal plane is 5 feet & from mid sagittal plane to
plane should be 15cm.
• Landmarks: Anterior point of intersection b/w nasal & frontal bone is NASION(Na), midpoint
of concavity of sella turcica is SELLA, lowest point on inferior margin of orbit is ORBITALE
mid point of upper contour of EOC is PORION(Po), tip of anterior nasal spine of premaxilla is
ANS, tip of posterior nasal spine of palatine bone @ junction of hard & soft palate is PNS, point
at which base of fissure where anterior & posterior wall meet is Ptm.
• Lowest point on anterior margin is called Basion(Ba), innermost point on contour of pre maxilla
between ANS & incisors is point A, innermost point on contour of mandible between the incisor
tooth and the bony chin is called point B, most anterior point on contour of chin is pogonion(
Pog), most inferior point on Mandible symphysis is menton(Mn), midpoint of contour
connecting ramus & body of mandible is gonion(,Go), center of inferior point on mandibular
symphysis (gnathion- Gn).

 HORIZONTAL PLANES:
• SN Plane→ from sella to nasion, oriented at 6-7° upward anteriorly to Frankfort plane.

Orthodontics Key Points By DANESH KUMAR- JSMU 7

 • Frankfort plane→ porion to orbitale.
• Palatal or Maxillary plane→ from ANS to PNS.
• Occlusal plane→ line bisecting the distal cusps of molars & pre molars.
• Mandibular plane→ gonion to Menton.
• If planes intersect close to face & diverge quickly→ facial proportion= long anteriorly & short
posteriorly & skeletal Open bite.
• If planes intersect nearly parallel & converge far behind & diverge slowly, it indicate skeletal
deep bite.
 SKELETAL ANALYSIS(1- SAGITTAL ANALYSIS)
• SNA angle→it shows the Maxillary positioning wrt cranial base, normal= 80-84,< 80 –
retrognathic maxilla & > 84—prognothic maxilla.
• SNB → show mandibular position→normal= 78-82° , retrognathic Mandible if < 78, prognathic
Mandible if > 82°.
• ANB → difference between SNA & SNB, show jaw discrepancy, normal= 2-4° , Less than 2°
indicate skeletal class 3, & greater than 4° indicate class2. ANB angle os affected by vertical
height & lower facial height & anterio posterior position of nasion.
• SN – MX angle→ Angle between Maxillary plane to sella nasion, indicate vertical growth of
Maxilla, normal value= 4-11°. ( < 4= decreased vertical growth, > 11° = increase vertical growth
of Maxilla).
• Wit’s analysis→ difference between point A & Point B on functional occlusal plane, indicate jaw
discrepancy, normal ( normal -1 to 0mm, <-1= skeletal Class 3, > 0 indicate class2).
• Wit’s more reliable because of --- ANB affected by facial height, position of nasion, jaw
rotations.
• Facial angle→ Angle formed between sella nasion to pogonion. Indicate chin position relative to
upper face, normal= 91-83°, retrusive chin if less than 83, prominent chin if > 91.
 VERTICAL ANALYSIS
• SN -MP( sella nasion to mandibular plane)→ indicate vertical mandibular position,N= 36-28°.
• FH -MP( Frankfort horizontal to mandibular plane)→ normal= 29-21°.
• MMA( Maxillary to mandibular plane)→ relative position of Maxilla to Mandible, normal=29-
21, less than 21 indicate short anterior facial height, greater than 29 indicate long anterior facial
height.
• Y – axis—angle formed from point sella in SN plane to gnathion. Normal= 64- 56°.
• Facial axis—between line from Basion to nasion intersected with line from PTM to gnathion,
indicate vertical development of face, normal= 90°.
 DENTAL ANALYSIS
• UI/ LI( inter incisal angle)→ indicate inclination of inciosr to each other, N= 131-135°, if less
than 131 indicate protusion of inciosr, & > 135 indicate retrusion of inciors.
• UI/ NA( nasion to point A)→ normal= 22°, >22= class 2, division 1, < 22= class 2, division 2.
• UI- NA distance= indicate anterio posterior position relative to NA line, Normal= 4mm, > 4mm
shows concave profile, common in bi Maxillary protusion & class 2/1, , < 4mm shows concave
profile in class2/2.
• UI/ SN → normal= 97-107°, indicate inclination of upper incisor. <97= retroclined, > 107° =
proclined.
• IMPA( incisors mandibular plane angle)→ angle at intersection of long axis of LI & mandibular
plane. Normal= 94- 86°, <86= retroclined incisors, > 94°= proclined LI.
• LI/ NB angle→ normal= 25°, indicate inclination of LI relative to NB line.
• LI/NB distance= indicate anterio posterior position to Mand Inciosr to NB line.
 SOFT TISSUE ANALYSIS
• Z line→ from soft tissue pogonion to most prominent lip extending to Frankfort plane.

Orthodontics Key Points By DANESH KUMAR- JSMU 8

 • Z angle→ Angle formed by intersection between Z line & Frankfort plane, indicate prominence
of soft tissues chin, normal= 80-76. <76= depressed chin & > 8O= prominent chin.
• Nasolabial angle→ angle by joining tip of nose, sub nasale & upper lip. Normal= 90-110°, less
than 90° indicate dentoalveolar protusion of Maxilla & obstuse angle indicate upper
dentoalveolar retrusion.
• Rickett’s E Line→ line joining from soft tissue to chin to tip of nose, distance between E line &
upper & lower lip, shows prominence of both lips, normal= Lower lip 0-4mm, upper lip 1-5mm.
• Steiner’s line→ line from sPog to middle of S formed by lower border of nose, in normal Face
,both lips should touch the S line. Normal= 0-2mm.

 MALOCCLUSION
• Angle’s classification, Dewey’s modification, licher modification ( class-1= neutro occlusion,
class-2= disto occlusion, class3= mesio occlusion).
• Akerman & proffit classification→ include esthetic line of occlusion (it follows the facial edge of
maxillary anterior & posterior teeth) & rotational axis( pitch , roll & yaw).
• Roll is the vertical positioning of teeth, when this is different on right & left side OR it’s upward
& downward deviation around transverse axis.
• Yaw is rotation of jaw or dentition to one side around the vertical axis, produce skeletal/ dental
Midline shift. Mostly associated with unilateral class 2 or 3 & asymptomatic posterior cross bite.
CHAPTER-06 ORTHODONTIC TOOTH MOVEMENT
• Ortho movement require light & continuous forces.
• Components of PDL= cell, nerve fibers, blood supply, collagen fibers & PDL fluid.
• Space occupied by PDL is approximately 0.5mm width.
• Principles of movement→ tooth move as bone remold, tooth move through PDL as socket
migrate, movement is primarily PDL phenomena.
• Upon wide opening , distance between mandibular molar decreased by 2-3mm.
• Bone remolding in response to normal function generate piezoelectric current, which act as a
stimulant for skeletal regeneration & repair.
• Force < 1sec= PDL fluid incompressible, bone bends, & piezoelectric current generate.
• Force for 1-2 sec= PDL fluid expressed, tooth move within PDL space.
• Force for 3-5 sec= immediate pain, fluid squeeze out.
• Frontal Resorption→ when light forces applied to tooth, blood flow is partially occluded,
painless, smooth progression pf tooth.
• Undermining Resorption→ heavy forces, painful, blood flow cut off, cell death, step wise
fashion of tooth movement.
• In ortho, produce tooth movement as much as possible by frontal Resorption.
• Piezoelectric theory→ electric signals alter bone metabolism, deformation of crystal structure,
quick decay rate, when force is released, crystal return to original shape.

Orthodontics Key Points By DANESH KUMAR- JSMU 9

 • Pressure tension theory→ relies on chemical signals, after applying force, tooth shift position
within PDL space, compress ligament on one side & tension on other side. Steps: initial
compression & altered blood flow→ release of chemical messenger→ activation of cells.
• Compression side→ decreased blood flow, decreased oxygen level, increased CO2 level,
osteoclastic activity & bone resorption.
• Tension side→ increased blood flow, increased oxygen level, decreased CO2 level, osteoblastic
activity & bone remolding.
• If appliances work < 4-6 hr/ day, it will produce no orthodontic effect, threshold of force
duration is 4-8 hours.
• Concentration of prostaglandins E is important mediator of cellular response.
• Concentration of RANKL & osteoprotegern (OPG) increase in GCF.
• Heavy forces produce undermining Resorption & light & continuous forces produce frontal
Resorption.
• Hyalinization area is a narcotic area or a vascular area in PDL, it’s histological appearance,
cause delay in tooth movement.
• Physiological tooth movement are eruption, migration, drifting, change in position in mastication.
• Pathological tooth movement are because of trauma, periodontitis, extraction.
• Tipping= simplest tooth movement, force kept LOW, crown/ root move oppositely, controlled
tipping if center of rotation at apex, uncontrolled tipping when center of rotation is very close to
center of resistance.
• Bodily movement→ during applying 02 forces simultaneously to crown, apex of root & Crown
move in same direction, Force kept MORE than topping.
• Rotation→ tooth rotate around long axis , some tipping movement occurs , equal & opposite
force is required.
• Extrusion→ when tooth move in Occlusal direction, tipping may occur, require equal forces.
• Intrusion→ tooth move towards apical direction, if tooth submerged in bone, light forces are
required, heavy forces can cause bleeding .
• Root uprighting→ mesio distal movement particularly in root, require couple force, fulcrum line
within crown.
• Forces required for movements (in gm)=> tipping, rotation & extrusion = 35-60, bodily
movement= 70-120[HIGHEST], root uprighting= 50-100, intrusion,= 10-20[LOWEST].
• Point at which rotation occurs is called center of rotation, point at which resistance to movement
can be contacted is called center of resistance , at the midpoint of root.
• Center of resistance is affected by number of roots, degree of bone loss & root resorption.
• Continues forces→ Force maintained at some appreciable fraction of original from one patient
visit to next, heavy continues forces are destructive. E g fixed appliances & springs.
• Interrupting forces→ Force level decline to zero between activation, e.g fixed appliances.
• Intermittent forces→ Force level decline abruptly to zero intermittently. Eg Removal plates.
• Drugs increase tooth movement= prostaglandins, relaxin & vitamin D.
• Drugs decrease tooth movement= prostaglandins inhibitor (indomethacin), corticosteroids,
NSAID, bisphosphonates, TCA, anti arrhythmic, anti malarial, phenytoin.
• Tooth mobility due to PDL space widening & disorganization of ligaments.
• Pain is due to heavy pressure, hyalinized area, mild pulpitis.
• Pain last for 2-4 days, pain associated with initial activation is more severe.
• Acetaminophen is DOC for orthodontic pain relief.
• Root resorption , most common in maxillary incisors.
• Allergy most because of NiTi, alternative= titanium
• Loss of alveolar bone usually between 0.5- 1mm.

Orthodontics Key Points By DANESH KUMAR- JSMU 10

 •Physiologic response to light pressure: if F for < 1sec= incompressible PDL fluid, current
generation, for 1-2 sec= fluid express & tooth move within PDL space, for 3 sec= partial blood
occlusion, dilation on tension side, distortion of PDL Fibes & cell mechanism, if F for minutes=
altered blood flow, release of cytokine & prostaglandins. If F for hours= metabolic Changes, 4
hours= increased cAMP, 2 days= tooth movement / frontal Resorption.
• Physiologic response to heavy forces: if < 1 sec= incompressible fluid & current, 1-2 sec= fluid
expressed & tooth movement in PDL space, 3-5 sec= blood vessels occluded, minutes= cut off
blood flow, hours= necrosis, 3-5 days= cell differentiation, 7-5 days= tooth
movement/undermining Resorption.
CHAPTER 07 – ANCHORAGE
• Anchorage is resistance to un wanted tooth movement & provided by tooth, palate, extra oral
structures, screw etc.
• Ortho treatment= maximize tooth movement & minimize undesirable side effects.
• Factors affecting anchorage= root area, alveolar bone density, direction of force, muscle pressure,
type of tooth movement.
• Simple anchorage→ active movement of single tooth VS several anchor tooth.
• Single/ primary anchorage→ tooth to be moved is pitted against a tooth with a greeter alveolar
support.
• Compound anchorage→ teeth of greater resistance to movement are utilized as anchorage for
translation of teeth which are less resistance to movement.
• Stationary anchorage→ obtained by putting bodily movement on 01 group of teeth against
tipping of other. E.g retracting incisors by tipping them posteriorly.
• Reciprocal tooth movement→ force applied to teeth & to arch segment are equal & so is the
force distribution in PDL. E.g midline diastema closure, cross bite elastics, Maxillary expansion
screws.
• Reinforced anchorage→ reinforcing resistance area either by adding more resistant unit. E g use
of headgear, retract anterior, extra oral & intra arch anchorage, use of trans palatal arch, banding
of 2nd molar.
• Cortical anchorage→ more resistance, slow tooth movement.
• Skeletal anchorage→ anchorage by structures other than tooth, e g intra oral screw, implant,
extra oral headgear, facemask.
• Absolute anchorage→ 100% retraction of incisors.
• Maximum anchorage→ 80% retraction of incisors,20% forward molar movement.
• Moderate anchorage→ 50% retraction of incisors,50% forward movement of molar or 60%
incisors retraction & 40% forward molar movement.
• Minimum anchorage→ 20% retraction of incisors & 80% forward molar movement.
• Anchorage control is lost when heavy force is applied.
CHAPTER- 08 MECHANISM OF ORTHODONTIC FORCES
• Orthodontic require light & continuous forces.
• Stress is internal distortion or F/A, strain is internal distortion or deflection/L.
• Elastic limit is point at which any permanent deformation is 1st observed.
• Range is distance that wire will bend elastically before permanent deformation occurs.
• Yield point is point at which 0.1% permanent deformation occurs.
• Proportional limit is highest point where stress & stain still have linear relationship/ Hook’s law.
• Strength is greatest force a wire can sustain or deliver without undergoing change.
• Stiffness is force required to bend a material to a definite distance & inversely proportional to
springiness, horizontal slop= springiness & Vertical slope= stiffness.
• Formability is amount of permanent deformation that a wire can withstand before it break.
• Resilience is total energy absorbed by wire without any permanent deformation.

Orthodontics Key Points By DANESH KUMAR- JSMU 11

 • Ultimate tensile strength is maximum load the wire can sustain.
• Shape memory is ability to material to members it’s original shape after being plastically
deformed.
• Super elasticity is very large reversible strain that certain NiTi wire can withstand due to
martensite – austenite phase transition.
• Ideal properties of wire→ high strength, high range, high formability, low stiffness.
• Additional properties→ weldable, solderable & reasonable cast.
• Materials for orthodontic wires→ stain less steel, cobalt chromium alloy, NiTi & beta titanium.
• Other materials used for tooth movement→ rubber & plastic strain,

Orthodontics Key Points By DANESH KUMAR- JSMU 12