Orthodontics DDA 214: DR Shabeel PN

ORTHODONTICS
DDA 214
Dr shabeel pn
http://hi-
dentfinishingschool.blogspot
.com
/
DEFINATION:
Orthodontics is a specialty in dentistry
that concerned with prevention,
interception & correction of the growing
and mature Dentofacial structures.
(Dentofacial structures are teeth, jaws, &
surrounding facial bones).
INDICATIONS FOR
ORTHODONTIC TRETMENT:
1. Unattractive facial esthetic.
2. Dysfunction of TMJ.
3. Susceptibility to dental caries.
4. Susceptibility to periodontal
disease.
5. Impaired speech caused by
malposition of
teeth and\or jaws.
CONTRAINDICATIONS OF
ORTHODONTIC TREATMENT:
1. Poor oral hygiene and lack of
cooperation.
2. Lack of bony support for the
dentition.
3. Poor general or mental health.
4. Lack of interest.
Benefits of orthodontic
treatment:
Orthodontic treatment may aid in
eliminating or reducing three
types of adverse effect for the
patient:
1. Psychosocial function.
2. Oral function.
3. Dental disease.
1. PSYCHOSOCIAL FUNCTION:
Severe malocclusion & dental facial

deformities strongly influences child
self-esteem and if left untreated it
can cause difficulty in psychological
and social adjustment as the child
matures.
2. ORAL FUNCTION:
Malocclusion may compromise oral
function:
1. Difficulty in chewing.
2. Jaw discrepancy change manner of
swallowing.
3. Difficulty for certain speech sounds.
4. TMJ joint pain from minor imperfection
in occlusion (clenching & grinding).
3. DENTAL DISEASE:
Malocclusion can contribute in
dental decay & periodontal disease
because of difficulty in maintaining
good oral hygiene due to lack of
normal occlusion and natural
cleansing benefits.
VARIABLES AFFECTING
ORTHODONTIC TREATMENT:
 Physical conditions:
Chronic diseases such as heart problems,
asthma, diabetes, or blood disorders.
 Habits:
Prolonged habits over the years can
cause changes in Dentofacial structures
of the child such as thumb sucking
,tongue thrusting ,& mouth breathing.
Causes of orthodontic
problems :
1. Developmental causes.
2. Genetic causes.
3. Environmental causes.
4. Functional causes.
Interaction among these causes
give rise to orthodontic problem.
1. Developmental causes :
The most encountered
developmental disturbances are:
 Congenitally missing teeth.
 Malformed teeth.
 Supernumerary teeth.
 Impacted teeth.
 Ectopic eruption.
2. Genetic causes :
Genetics play major role for

malocclusion when there is
discrepancy between size
of the jaws & size of teeth.
3. Environmental causes:
It is caused by injures which has tow
types:
1. Birth Injures:
It comes under tow major categories:
 Fetal molding (when a limb of the fetus
presses another part leading to distortion

of that part ).
 Trauma during birth from usage of forceps
.
Continue
;
2. Injures throughout life :
Trauma to teeth can lead to development of

malocclusion in three ways:
 Damage to permanent tooth bud when
primary tooth is traumatized.
 Premature loss of primary teeth leading
to permanent tooth movement.
 Direct injury to permanent teeth.
Management of
orthodontic problems
Treatment include interceptive &
corrective measures that can be
treated by general practitioners &
pediatricians, while more sever cases
should be referred to the
orthodontists.
1. PREVENTIVE
ORTHODONTICS:
It allows the dentist to prevent or eliminate irregularities &
malposition of the teeth in the developing dentition.
It includes:-
 Prevention of primary tooth loss due to caries.
 Usage of space maintainer to save space for permanent
tooth eruption.
 Correction of oral habits leading to damage of permanent
dentition.
 Early detection of genetic & congenital anomalies.
 Natural exfoliation of primary teeth (because retained
teeth lead to impaction or malposition of permanent
teeth).
2. INTERCEPTIVE
ORTHODONTICS :
 It allows the dentist to intercede or
correct problems as they are
developing.
 It includes:-
A. Interceptive treatment.
B. Corrective treatment.
A. Interceptive includes:
 Removal of primary teeth that
contribute to Malalignment of
permanent teeth.
 Correction of cross bite.
 Correction of jaw size discrepancy
by fixed or removable appliance.
 Extraction of primary or permanent
teeth to correct over crowding.
B. Corrective include:
 Movement of teeth by applying forces
through usage of fixed appliance ,and
redirection & stimulation of functional
forces within the Dentofacial structure.
 Removable appliances for correction or
maintenance of treatment.
 Orthognathic surgery in sever cases.
OCCLUSAL DEVELOPMENT:
 It includes four developmental
stages from childhood to
adulthood.
1. Pre-dental jaw relationship.
2. Primary dentition.
3. Mixed dentition.
4. Permanent dentition.
OCCLUSION CAN BE
CLACCIFIED INTO:-
 Normal occlusion
or
 Malocclusion
Normal occlusion :-
 It is the usual or accepted
relationship of the teeth in
the same jaw with the teeth
in the opposing jaw when
they are in centric occlusion.
Deviation from normal occlusion
can be given to these
characteristics:
 Midline deviation.
 Over jet & overbite of anterior teeth.
 Axial position of teeth in each arch.
 Relationship of all teeth in their
normal position.
 Relationship of dental arches to each
other.
MALOCCLUSION :-

According to Angle any deviation from
normal occlusion can be a malocclusion.
 Class I ,or neutroocclusion.
 Class II ,or distoocclusion.
Class II div 1.
Class II div 2.
 Class III ,or mesioocclusion.
1. CLASS I (NEUTROOCCLUSION) :
When the jaws are at rest & teeth are in

centric relation ,the mandibular arch is in
normal mesiodistal relationship to the
maxillary arch.
Mesiobuccal cusp of maxillary first molar
occludes in the buccal groove of the
mandibular permanent first molar.
2. CLASS II (DISTOOCCLUSION) :
 The mandibular arch is in distal relationship to the
maxillary arch by half width of the permanent first
molar or mesiobuccal cusp width of a premolar.
 Mesiobuccal cusp of the maxillary first molar
occludes in the interdental space between mandibular
2nd premolar & the mesial cusp of the mandibular 1st
molar.
 The maxillary anterior teeth are protruded or
retruded over the mandibular anterior teeth.
Class II subdivisions:-
A . Class II div 1:
 Maxillary incisors are protruded.

 Lips are usually a part, with lower
lip tucked behind the upper incisors
& upper lip appears short.
B. Class II div 2 :
 Maxillary incisors are Retruded.

 Maxillary lateral incisors may
tipped labially and mesially.

3. CLASS III
(MESIOOCCLUSION):
 Mandibular arch is in mesial relationship to
maxillary arch (Protruded mandible).
 Mesiobuccal cusp of maxillary 1st molar
occludes in the interdental space between
the distal cusp of mandibular 1st molar &
mesial cusp of 2nd molar.
 The mandibular anterior teeth are
protruded over maxillary teeth.
Factors associated with
malocclusion :
 Crowded teeth (Most common
problem).
 Over jet , protrusion of maxillary
incisors.
 Overbite ,increased vertical overlap
of maxillary incisors.
 Open bite ,lack of vertical overlap of
maxillary incisors.
PRINCIPLES OF ROOT
RESORPTION
When force is applied for any period
of time causing compression in one
side of the periodontal ligament
(PDL) & tension on the other side .
These forces causes resorption &
deposition of bone in the tissues.
RESORPTION
Compression of periodontal ligament
reduce the vascular supply to the
supporting tissues in that area within
48 -72 hours this causes the cells of
the PDL to differentiate into
osteoclasts and the resorption
process starts.
DEPOSITION
 Tension side starts to activate
osteoblasts .This resulted on new bone
development & deposition.
 The tooth moves in direction of
compression as the resorption takes
place .
 On the opposite side the space created
by the tension is filled in by deposition
of new bone.
THE FORCES OF MOVEMENT
Application of heavy forces is
avoided because it may cause
excessive tooth destruction and
tooth loosening.
TYPES OF TOOTH MOVEMENT:
1. TIPPING
Moving the tooth more upright.
2. BODILY
Cause the tooth to migrate slowly in
its position in the arch.
3. ROTATION
The force will move the tooth to the
right or left in its socket.
Orthodontic Records &
Treatment Planning
Orthodontic diagnosis & treatment
planning is based on certain records that
are taken for the patient in the 1st
appointment.
These information's comes from three
major sources:-
1. Patient interview.
2. Clinical examination.
3. Evaluation of diagnostic records.
I. Interview Information:
1. Medical & dental history:
Comprehensive physical condition is necessary to
evaluate specific orthodontic concerns.
2. Physical growth evaluation:
Evaluation of the child physical growth stage is
important to aid in orthodontic treatment.
3. Social & behavioral evaluation:
It is important to explore patient reasons for Tx
Motivation & cooperation of the child is very
essential for Tx success.
Adults seek Tx to improve their esthetic & function.
II. Clinical examination:
It’s purpose is to document, measure ,
evaluate facial aspects, occlusal
relationship & functional characteristics of
the jaws.
a. Evaluation of the facial esthetics.
b. Evaluation of oral health.
c. Evaluation of jaw & occlusal
function.
a. Evaluation of facial esthetics:
Orthodontic goal is to improve facial symmetry &
profile.
A. Frontal evaluation
* Bilateral symmetry.
* Midline.
* Vertical proportion.
B. Profile evaluation
* Jaws proportion.
* lip protrusion due to incisor protrusion.
* Vertical facial proportion & mandibular plane angle.
b. Evaluation of oral health:
 Hard & soft tissue examination,
oral hygiene assessment &
prophylaxis, periodontal pocket
charting must be examined.
 Patient should be referred for Tx
before any orthodontic Tx is
conducted.
c. Evaluation of jaw &
occlusal function:
Examination of patient
occlusion, TMJ palpation & any
mandibular lateral or anterior
shifts are important for
orthodontic purposes .
III. Diagnostic records:
 It includes photographs,
radiographs, & diagnostic casts,
best done during intra oral
examination.
 Diagnostic records document
tooth angulations ,crowding &
presence of unerupted teeth.
A. PHOTOGRAPHS
 Intra oral & extra oral photographs should be taken.
 It is useful for patient identification ,Tx planning
,case presentation ,case documentation & patient
education.
 Frontal & profile views are taken with lips in relaxed
position .
 Three intra oral photographs full direct view with
teeth in occlusion ,maxillary occlusal view, right
buccal view (from distal of the canine to last molar).
B. RADIOGRAPHS
 Cephalometric radiograph is taken before , during
& after Tx to evaluate jaw & tooth position
changes.
 Cephalometric radiograph is important to evaluate
malocclusion ,skull ,bones, &soft tissue.
 Cephalometric analysis is carried out on a tracing
paper, or digitized on the computer.
 Certain land marks are identified on cephalometric
radiograph.
C. Diagnostic casts
 It is used to complete the
measurement & for case
presentation.
 They are made of plaster rather
than stone to provide a more
finished product for case
presentation.
CASE PRESENTATION
 Case then will be presented to the
patient or his guardian to explain Tx
plan ,time & how patient should
cooperate to have a successful
results then patient will sign a
consent form.
 Tx fees also will be discussed .
THANK YOU

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ORTHODONTICS

Severe malocclusion & dental facial

Genetics play major role for

presses another part leading to distortion

2. Injures throughout life :

Trauma to teeth can lead to development of

When the jaws are at rest & teeth are in

 Maxillary incisors are protruded.

 Maxillary incisors are Retruded.

tipped labially and mesially.

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