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27 Orthodontics Introduction • Orthodontics – Area of specialty dealing with the recognition, prevention, and treatment of malalignment and irregularities of the teeth, jaws, and face 2 The Orthodontic Practice • Orthodontic office • Orthodontic team – Orthodontist – Reception and business office staff – Office coordinator – Laboratory technician – Orthodontic assistant 3 Occlusion and Malocclusion • Normal (ideal) occlusion describes the contact relationship of the mandibular arch with the maxillary arch. – Mandibular teeth are in maximum contact with maxillary teeth and spaced normally 4 Occlusion and Malocclusion • Normal (ideal) occlusion – Maxillary anterior teeth overlap incisal edge of mandibular anterior teeth by 2 mm – Maxillary posterior teeth are one cusp distal to mandibular posterior teeth 5 Normal Occlusion 6 Occlusion and Malocclusion • Malocclusion: – Any deviation from normal occlusion – Includes misalignment of a single tooth, a group of teeth, or an entire arch 7 Angle’s Classification • Neutroclusion – Cusp of the maxillary cuspid (canine) occludes between the distal of the mandibular cuspid and the mesial of the mandibular first bicuspid 8 Angle’s Classification • Distoclusion – Cusp of the maxillary cuspid (canine) is moved forward and occludes between the distal of the mandibular lateral incisor and the mesial of the mandibular cuspid 9 Angle’s Classification • Mesioclusion – Cusp of the maxillary cuspid (canine) is moved back and occludes behind the mandibular cuspid and in the middle of the mandibular first molar 10 Malposition of Individual Teeth • Torsiversion – Tooth is rotated or turned • Mesioversion – Tooth is mesial to normal position 11 Malposition of Individual Teeth • Distoversion – Tooth is distal to normal position • Linguoversion – Tooth is lingual to normal position 12 Malpositions of Individual Teeth • Labioversion or buccoversion – Tooth is tipped toward the lip or cheek • Supraversion – Tooth extends above the normal line of occlusion 13 Malpositions of Individual Teeth • Infraversion – Tooth is positioned below normal line of occlusion • Transversion or transposition – Tooth is in the wrong order in the arch 14 Malpositions of Groups of Teeth • • • • Anterior cross-bite Posterior cross-bite Edge-to-edge bite End-to-end bite 15 Malpositions of Groups of Teeth • Open bite • Overjet – Horizontal overlap • Overbite – Vertical overlap • Underjet 16 Etiology of Malocclusion • Genetic or heredity • Systemic • Local 17 Types of Orthodontic Treatment • Preventive or interceptive – Placing restorations – Space maintainers – Observations • Corrective – Fixed appliances – Removable appliances 18 Process of Tooth Movement • Resorption – Process that eliminates tissues no longer needed in the body, therefore allowing teeth to be moved • Deposition – Retains teeth by creating new deposits or cells 19 Process of Tooth Movement • Osteoclast – Cause bone to resorb or break down • Osteoblasts – Deposit new bone to hold tooth in new position 20 Preorthodontic Treatment • • • • • • Diagnostic records Medical-dental history Clinical examination Radiographs Photographs Study models 21 Panoramic Radiograph (Courtesy of Dr. Steven Gregg) 22 The Consultation Appointment • Orthodontist presents patient with treatment plan • Responsibilities of patient is reviewed • If patient accepts the treatment plan – Consent papers are signed and financial arrangements made 23 Orthodontic Appliances • Fixed – Orthodontic bands – Brackets – Arch wires – Ligature wire and plastic bags – Buccal tubes – Springs – Elastics 24 Orthodontic Appliances (Courtesy of Rita Johnson, RDH, Professor, MCC, Lowell, MA; and Dr. Vincent de Angelis, Associate Professor, Harvard School of Dental Medicine.) 25 Special Fixed Appliances • • • • Lingual braces Lingual arch wire Space maintainer Palatal separating appliance 26 Removable Appliances • • • • • Headgear Functional appliances Retainers Tooth positioner Aesthetic orthodontic aligners 27 Orthodontic Instruments • • • • Coons’ ligature-tying pliers Mathieu needle holder Ligature director Pin and ligature cutter or light wire cutter • Howe pliers 28 Orthodontic Instruments • • • • • Band seater Bite stick band seater Band driver Posterior band removing pliers Band contouring pliers 29 Orthodontic Instruments • • • • • • Bracket forceps “Bird-beak” pliers Three-prong pliers Weingart utility pliers Tweed-loop pliers Distal-end cutting pliers 30 Orthodontic Treatment • Application of separators • Placement of posterior bands • Placement of anterior brackets 31 Orthodontic Treatment • • • • Placement of arch wire Oral hygiene instructions Interval checkups Completion appointment 32 Completion Appointment • • • • • Ligature ties removed Elastic ties removed Elastic released Wire cut Wire removed from wing 33 Completion Appointment • • • • Arch wire removed from bracket Anterior brackets removed Posterior bands are removed Above process repeated on lingual surface • Cement and direct bonding materials removed 34 Completion Appointment • Rubber cup polish completed • Alginate impression taken of arches • Patient reappointed for later that day or for next day • Retainer or positioner placed • Patient given instructions on how to wear appliance 35