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ORTHODONTICS
Ortho means straight; odont means tooth
Chapter 27
What is orthodontics?
• Orthodontics is a specialty concerned with the
guidance and correction of the dentofacial
structure.
#1 Reason most orthodontists
perform treatment
•Malocclusion
#1 Reason people seek orthodontic
treatment
•Esthetics
Indications for Ortho Treatment
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Impaired chewing (Mastication)
Crowding (Esthetics)
TMJ dysfunction
Dental caries
Impaired speech
Contraindications for ortho
Treatment
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Lack of bone support
Rampant caries
Poor general health/mental health
Poor OH/patient cooperation
Lack of interest
Lack of financial support
Factors affecting Malocclusions
• Overjet
• Overbite
• Openbite
• Crossbite
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.
OVERBITE
• EXCESSIVE
VERTICAL
OVERLAPPING
• Caused by the Max
anterior teeth vertically
overlapping the Mand
anteriors.
• Slight overbite is normal.
OPENBITE
Anterior or posterior teeth do not
occlude. A space between the
teeth.
Crossbites
• Anterior Crossbite: maxillary anterior teeth are
positioned lingual to mandibular anterior teeth.
Crossbites
• Posterior crossbites: maxillary posterior teeth
are positioned lingual to mandibular teeth.
Edge to Edge Bite
• Incisal edges of maxillary anterior teeth occlude
on the incisal edges of mandibular anterior teeth
End to End bite
• Cusp tips of maxillary posterior teeth occlude
with cusp tips of mandibular posterior teeth
Crowding
• Mild
• Moderate
• Severe
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.
Malocclusion
• Molars are in the same relationship as Class I,
however, remaining teeth exhibit deviations
from normal occlusion, such as: crowding,
crossbite, or openbite.
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.
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.
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.
Class III Malocclusion
• Class III (Mesiocclusion): Mesial cusp on
maxillary first molars are touching distal of the
buccal groove on the mandibular first molar.
Causes of Malocclusion
•Genetic
•Systemic
•Local
Genetic Causes
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Congenitally missing teeth
Malformed teeth
Supernumerary teeth
Macrognathia
Micrognathia
Macrodontia
Microdontia
Congenitally Missing Teeth
• Patient missing Upper laterals
Malformed teeth
• Upper incisors misshapened
Supernumerary Teeth
• Supernumerary between upper centrals
Macrognathia
•Large Jaw
Micrognathia
•Small Jaw
Macrodontia
•Large Teeth
Microdontia
•Small Teeth
Systemic Causes
• Diseases and nutritional disturbances that upset
the normal schedule of dentition development
during infancy and early childhood
Local Causes
• Trauma/injury to permanent tooth buds,
premature loss of primary teeth, and direct
injury to permanent teeth.
Local Causes
• Thumb sucking/ can cause openbite and/or
overjet
• Tongue thrusting/ can cause openbite
Local Causes
• Mouth breathing
• Bruxim
• Nailbiting
Phases of Orthodontic treatment
• Preventive
• Interceptive
• Corrective
Preventive
• Orthodontic treatment designed to correct
problems, that if not stopped, will contribute to
more serious problems in the future.
Interceptive
• Orthodontic treatment involving the correction
of problems as they are developing.
Treatment for Preventive and
Interceptive Phases
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Space Maintainers
Restoration to prevent tooth loss
Observing growth patterns
Correcting bad habits
Serial extractions
Recognizing deviation from normal
development
Corrective
• Orthodontic treatment performed when the
problems have already occurred and there were
no steps taken to correct them previously.
Initial Exam/Initial Consultation
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First appointment
Review medical history
Examine the patient
Initial recommendations, review treatment
options, and answer questions
• Next appointment Records
Records
• Second appointment
• Montage of patient
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Intraoral and extraoral photographs
Study models
Panoramic
Cephalometric
• Never review financial information at this
appointment
Montage
Photographs
• A series of usually eight photographs to allow
the doctor a clear view of the patient mouth.
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
Panoramic
• A wide view of patient’s mouth
• Allows insight into placement of impacted teeth,
3rd molar location, and eruption patterns of
unerupted teeth
Cepholometric
• Used for diagnosis of jaw relationships
• Tracings are designed to show how the jaw
relates to certain landmarks in the skull
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
Palmer Numbering System
Separators
• Elastic, circular shaped item placed between
teeth to open contact between teeth to allow
orthodontic band to fit around teeth.
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
Banding Appointment
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Teeth are pumiced
Orthodontic Assistant sizes bands
Orthodontist checks
Assistants prepares cements
Orthodontist seats bands
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
Bonding Appointment
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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
Archwires
• Placed into bracket slot to control movement of
teeth.
• Held in place by elastic ligature ties or stainless
steel ties.
Elastic Ties
aka: O’s, A’s, colored ties
• Used to hold AW into bracket slots.
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.
Kobayashi Hooks
• Placed on Brackets to attach interarch elastics
• Interarch elastics, used to correct Class II and
Class III occlusion
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
Retainers
• Hawley
• Trutanes
• Fixed Retainers
Oral Hygiene
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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