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All ofthe following are advantages ofthe indirect method of bonding

brackets to a tooth over the direct method EXCEPT one.

Which one is the CXCEPIIOM

. Reduced chair-side time

. \Iore precise location ofbrackets possible in the laboratory . Controlled thickness ofthe resin between the tooth .
Less technique sensitive and the bracket interface

. Easier clean-up during bonding and de-bonding

. Better visualization inlab

(especially Jbr lingual brackets)


Coprighr O 2011'2012 Dental Decks


The indirect bonding technique is more complex and technique sensitiv€ and requir€s extra precautions

The procedure involves the following steps: 1. An accumte impression with alginate is tak€n and poured up with orthodontic model stone to be used as a working model. 2. Vertical lines arc draM on the teeth to aid in bracket placement and a separating media is aPplied.
3. The brackets are then loaded with a filled resin paste and cured. 4. After its initial set, individual positioning of a ffay with siiicone is prepared by applying it over the bracketed teeth on plaster model. 5. This whole set-up th€n is placed in warm water to dissolve the separating media 6. Th€ silicone tray is then removed from the plaster model with brackets embedded in it. 7. Brackets are cleaned under running watff making sure that pads have cured resin. 8. Enamel is etched, conditioned and unfilled resin is applied. Unfilled resin is also applied to cued resin on the base of the bracket pads. 9. The silicone tray with embedded brackets is then positioned on the teeth being bonded and held in position till the initial set ofthe unfilled rcsin is reached.

f. The conhol of"tfrsh" (e&ess of resin) not only makes clean up easy but also the controlled
accurately expresses the built-in prescription ofthe appliance. (e.g., linqpal appliance), this technique is almost always employed.


2. Also, in situations where visibility is a problen

lmportent: l. All orthodontic appliances obey Newton's Third Law: There ir in equel and opposite rcaction to every rction. 2. For each appliance, the sum ofthe forces and the sum ofthe moments acting on it sum to zero.
3. T,?es ofappliances

. Equal and opposite forc€s: an elastic band stretched between two brackets produces equal and oppo_ site forces (the sum ofthe forces equals zero). . One.couple applirnces: inserted into a bmcket at one end and tied as a point contact at the other end. A couple is produced only at the engag€d end. The sum of the forces is zero. . Two-couple appliances: inserted into a bracket at each end. Both a couple and a force are produced at each end. The magnihrde ofthe couple is largest at the end closer to the bend in the wire The sum ofthe forces is zero.


All ofthe following are functional appliances trXCfP? one. Which one is the EXCEPTIO-M

. Frankel

. Bionator
. Clark's Twin Block

. Herbst
. Activator

. Quad-Helix


Copyrighr e 201l'2011 - Dentel Decks


1. The photograph shows a

maxillary fixed bilateral space maintain€r. This t)?e space maintainer also is known as a:



Iftroth primary canines were present, which ofthe following

space maintain€r(s)

could be used in plac€ of this appliance that cannot be used in this case?

. Distal shoe . \ance appliance

. Lin-eual holding arch
. Hawley retainer . Band and loop (bilaterul)
coplrlhr 2000-200.1 Unilcriry ol $'x\hngron All nght rc *ncd.Ac.c$ ro IhcAdar ofPc.lirdc Dcnlisrry isaorcmcd by r
licensc. UnaulhoriT.d acccs or toFoducton E fo.b'ddcn wrhout ihc lrnor sntcn Fft'\non ofrhc Unive6ir-v of$xshineton For infomrton. co.ra.r I c.nscalN $ash,n gton cdr




20ll :012

Dcntal D.cks

By keeping lhe lip pressurc away fiom thc lowc.d . Bionator: similar to the activator in function but its design is a himmed-down version ofthe activator to make it more comfortable to wear . this appliposterior cross-bite cases with a digital-sucking habit.d by a lrm.The constant prcssure ofthc lower lip against the front pad of the lip bumpcr exerts a force to gently push thc molar leeth backward. They are used to treat Class II malocclusions. Herbst appliance: it can be fixed or partially removable.Cl^ssified asi . Twin block appliance: the two-piece acrylic appliance postures the mandible forward with help ofocclusally inclined guiding planes and bite blocks. o.iisrry is gotm. an example ofthc bilatoral usc offixcd unilateral band and loop space maintaincrs.9!xOr :ooc?0rx Unilesii_! of Wdhingron. hc.veNq ofwBhingon All ngtu rcsrye'1. Lower lingual arch: may be fixed or rernovable and is effective in maintaining mandibular leeway space while still allowing horizontal and vertical growlh changes jn thc positions ofmolars and incisors. holding it open or open and forward.tu o_TlrodLchon F fortidd.p"iehr 200G200a Un.@?l u *6hingr. LrMurh.las ol P. All nghB rcaded Ac 6 b dr n. Tissu€ borne: The Frankel functional appliance is the only tissue bome functional appliance. This helps to posture the mandible forward and induce growth. For inldmarid. Activator: advances the mandible to an edge-lo-edge position to induce mandibular growth for the correction ofClass ll malocclusion. This improves the deep bite seen in Class II cases. Acc6s to n\.. C.*** ance is used for This frxed appliance. . consists of4 helices (2 onterior and 2 posterior).n edu This photograph shows two band and loop space maintaincrs.Ne{. ads of Pcdiatic Dlrlsy is e@o.ileKny of warhingio. rirhau' dr pnn trn1' adms'on or $. and they often are used bilaterally. The maxillary teeth arc prevented from erupting by the acrylic shelfwhile mandibular posterior teeth are free to erupt. which serves to expand the arch by "padding" against the pressure ofthe lips and cheeks on the teeth and postures the mandible forward and downward. moving teeth and modifying growth. Functional appliances are by definition ones that change the posture ofthe mandible.These arc vcry common types ofunilateml spacc mamtaineis.tu. It postures the mandible forward to induce growth for correction ofClass lI malocclusions. UDseFir-w of wEhingo. Thc Nance applianc€ is used in situations where premature biltt- appliarce. Some clinicians object to the button since it can create tissue irritation. . The lip bumper hamesscs thc nahrml forces ofthe muscles surrounding thc lowcr teeth to broaden and lenglhen thc dcntal arch. The lip bumpcr will gradually "strctch" thc dental arch to makc room for thc crupting adult tccth. in ahis casc a maxillary removable bi laleral spacc maintainer Note: Rcmovablc appli- anccs arc not commonly uscd bccaus€ of problcms *ith thc appliancc not bcing wom and tbc frcquen( incidcncc of breakage and loss. ot se U. Essettially. The vertical separation ofthejaws is also configured by the height ofthe bite blocks. the longuc prcssuro is allowed to gradually move the ftont teeth forward to "unravel" or align the crooked teeth. . Jasper modified the appliance by replacing the tel€scopic apparahrs with a flexible plastic open coil spring. Tooth borne: ..n'ahc Dc. For inroD8rioa Fnk: l. ces Functional Appfian (in biet .riz.lu msh'n8 Other appliances: . .d by ! licN Uuu' T?L a. c. Stretch ofthe muscles and soft tissues creates pressures transmitted to the dental and skeletal struchrres. Note the small acrylic button thatwill restagainst the palatal tissue with thc Nanceappliance.cces or rqlrcdudim is foftiddm without rhe pnn Mftn p. A metal rod and a tube-telescopic apparatus is attached bilaterally to the maxillary first molars and mandibular first premolars.mism. . front teeth. Lip bumper: is a removablc appliancc uscd in growing children to create and save thc space necessary to accommodate the adult teeth without extraction.

Traction .Denral Decfts . Edgewise mechanisms . Light-wire appliances Coplright O 201 1-201 2 . Neither anchorage or traction 1 Coplrighr O 201l-2012 . Anchorage . Lingual archwires .. Palate-separating devices . Both anchorage and traction . Whip-spring appliances . Frankel's appliances .DenlalDecl6 .

th hormone released in lhe early evening . is used to maintain space. it / Not€d. Ideal to place headgear aftcr dinner not before bedtime llagnitude oI Force: . Remember: The 4 basic components of fixed appliance include: bands. Whip-spring appliances are used to de-rotate one or two teeth. Crow.. brackets. . or to rein- Headgear is an orthopedic appliance that allows orthodontists to: . \lobilit-Y ofmolars is normal 100-200 gm per side \ote: One ofthe greatest advantages ofusing extraoral anchomge fl. and auxiliaies (elastics or ligatures to hold the archwire in brackets).*** Anchorage force anchorage. are generally rcstrictcd to tipping teeth. minimum is 8 hours per day . Fixed orthodontic appliances offer controlled tooth movement in all 3 planes ofspace. Vacuum formed appliances 2. Active plates: Schwartz appliance. Examples i[clude: lingual archwire.e. Ideal amount offorce for teeth movement is . writersaI appliance). Tmction is used to create space. Loose removable appliances: functional appliances. Use various designs (cervical pull. *** Frankel's appliancc is a removable functional appliance and is employed in cascs of ab- noll]'j. Normally. . Use with gowing patients Headgear components: . Headstraps: Cervical and high pull a neckstrap for anchorage Optim!l usage of headgear: . Force applied to first molars that are banded via a facebow with a headcap or . face masks. functional jaw orthopedic appliances i ' -. Ideal amount offorce for onlropedic changes is 250450 gm per side . Ex- . . Facebow: Outer bow dillerent lenglhs lnner bow sized. Ilyalinized bone around molars . occlusal splints. retainers .. \losl mo\emenr lhrough intermrnent forces . 3. tv'int'ire appliance.al (h. Extra-oral traction devices: head gears. Control growth of facial structures .e.. Passive appliances .r-peracti|e) soft tissue pattems. must be capable of exerting a torque. palate-separuting devices. Important: Removable orthodontic appliances amples include. light-wire appliances as well as other fixed appliances (i. Headgear is used to modiry growah ofthe maxtlla. awl reverse pull) . headgear) is that it permits posterior mo\ement ofteetb in one arch without adversely disturbing the opposile arch.l. wom rcgularly lor 10-12 hours per day. high pull. '&g 2. 4. straighl pull. Bite planes. archwires. One ofthe easiest mov€ments to accomplish is tipping incisors mesially. or protract maxillary teeth. antedor spring aligners . fixed space maintainen. For an orthodontic appliance to be effective in tmnslating the roots of teeth. orthodontists suggest l4 hours/day . Lip bumpers . the edgewise mechanism. chin cups . Active appliances . connects to the maxillary molars . to dislalize (retracl. Attached removable appliances l.

Dental D€ck . Vitalium 6 coplright @ 20ll-2012. The universal appliance . stainless steel . The edgewise appliance . Beta titanium .. The Begg appliance . Denlal Decks . Nickel-titanium . None of the above 7 Copright O20ll-2012 .

strength. Similarly.. and gives it 4 times the range. Unlike the Edgewise brackets." The dimensions ofthe slot were altered to 0. when lhe diameter of a wire is doubled. excellent resilience) and reasonably Sood formabiliry by a Note: Each of the major elastic properties (i. wires. . . The slot sizes commonly used are 0.JJ md) and 0. or single brackets with extension wings that contact the arch wire to conffol and correct rotations. . Note: Stainless steel exhibits the highest modulus ofelasticiry frltlresr/ and lowest springback. Major steps in the evolution of cdgewise appliances include: . Torque: is accomplished by having the bracket slots inclined to compensate fbr the inclination ofthe facial surface.45 hm). St. Note: In the original edgewise appliance this was accomplishedby applying first-order bends . Areas ofresorption ofboth cemenrum and dentin ofthe root tend to fill in with new cementum so that the original form ofthe root is retained. . The brackets most commonly used are the Edgewise brackets . Horizontal control: this is accomplished by varying the relative thickness ofth€ bracketbase for teeth of differenr thickness. thus the name "edgewise. these Begg brackets can only be used with round cross_seclion archwires. Note: Endodontically treated teeth are more prone to root resorption when orthodontically moved. healy continuour forces have more potential to crcate rcot tesorption than do light forces. Nickel-titanium alloys offer a highly desirable combination of a very low modulus ofelasticity and an extremely wide working range.022 inch 10. R€member: Strength: Stiffness x Range \€r] important: Deleteious €ff€cts oforthodontic forcel the pulp. Loops and helices are incorporated into archwires to increas€ the activation range. Edgewise b. excellent corrosion resistance.The prop€rties ofan ideal wire material for orthodontic purposes can be described largely in terms ofthe following criteria. (r'aning btist in segments ofeach rcctangular arch rire) in the ^rah Brackets are the attachments through which forces are appliedto the teeth and they allow the placement of arch* ire and other accessodes to b ng about the desircd tooth movement.022 x 0. its stifiness by 16 timcs. Note: In the original edgewise appliance this was accomplished by ap- pll ing second-order bends langled bends) rn the arch wire. Pein: usually occurs within a few hours ofinitiation of force application and lasts for 2 to 4 days.liliolitgual bcnd! in the arch wire. stillness/springiness. usually results liom poor oral hygiene. and low cost. Thc Begg bracket has a narrow slot wh€re an archwire is looscly fitted and held in place with a locking pin. Automatic rotNtional controli this is accomplished either by using twin brackets on the labial surface. the material should be weldable or solderatrle. Tissue inflammation. .single and double edgewise. ltlesiodistal tip control: is accomplished by angulating th€ bracket or bracket slot to provide the proper tipping movement lor each tooth. loss ofvitality is very rare but has been seen in teeth that are moved with unusually hearry force.apy.018 inch (0.. . so that hooks or stops can be attached to the wire. The contemporary edgewise appliance has evolved far from the original design while retaining th€ basic principle of a rcctangular wire in a rectangular slot.028 precious metalwire was used. They offer a highly desirable combination ofstrength and springiness (i-e..022 x 0. Tle ry?ical formulation for orthodontic use has l8% chromium and 8% nickel. .\-ote: [n the original edgewise appliance this was accomplished by applying third-order bends \Nie.e. \tobilit! ofteeth: moderate mobility occurs and resolves with the completion of the. and its working range is decreased by half.inless steel wires are very popular because oftheir good mechanical properties.028' and a 0. . makes it I times less stiff.and the Begg brackets. its strength is increased by 8 times. and range) is ^ffected change in the lenglh and cross section ofa wire. Effects on root structure: root resorption is a potential side effect ofonhodontic movement. Beta titanium wires are also known as TMA (tilanium-molybdenum d//o'. with the largest dimension horizontally. These dimensions allowed excellent control of cro"{'n and root position in all three plan€s ofspace. These brackets can also be us€d with round cross-section archwires. Doubling the length of a wire decrease its strength by half. It should possess: (1) High strenglh (2) Low stifliess (3) High working range and (4) High formability In addition. .Thebftcket has tie-wings on opposite sides of the archwire slot for engaging a ligature that is used to bind the archwire to the bracket. Effects on the pulp: light forces should have little ifany effect on To overcome the dcficiencies ofthe bbon arch (trhich was an eotlier Angle appliance) Angle reoriented the slot from vertical to hoizontal and inserted a rectangularwire rotated 90 degr€es to the orientation it had with the ribbon arch. \ote: Only ifthe attack on the root suface produces large def€cls at the apex that ev€ntually bc_ come separated fiom the root surface is repair ofthe damaged root impossible.ackets have an archwire channel which is rectangular in cross-section.

Translation 9 Cop)riShr@ 20ll 2012 Dental Decks .Fon For infomarion.produdioi forbidd.cnsc Unaurhorizcd acccs or i. copynsbr 1000 200.s rod'eAdlsof Pcdf r'c tldldry is govmcd by rli.onhd licens@-uqash . What is the most likely type of tooth rnovement produced in this situation? . 't pnor Minen p€mi$ior ordi! Unilen y ol\lish i'. Extrusion .n vahout rh. but the reason is NOT . The statement is corlect. \EITHER the statement NOR the reason is corect An actiye {inger spring of a removable appliance usually touches the tooth with a point contact.The Hawfey retainer (shoren l)elow) is the most common retainer in orthodontics because it can use the palate for anehorage.1 unxcniry of r . Both the statement and the reason are correct and related .nrd Acc.$hriSron An r€hs fs. . The statement is NOT correct.Intrusion . but the reason is correct . Both the statement and the reason are correct but NOT related .

These fingcr springs are attached to a removable appliance. Tooth-moving elements: typically either springs or screws. it has bcen shown that under the properly controlled regimen oftreatment the destruction to the periodontal tissues ofthe teeth is not accentuated to a statistically significant degree as great€r than that which occurs during the same intedm \r'ithout orthodontic therapy.. lndications for removable appliances: . *tt 2. This is usually accomplished with a simple removable appliance. It is inversely propo(ional to the length ofthe spring. 3. '1. Acrylic base-plate). 5. Gronth modification during the mixed dentition \ote: Components ofanchorage can also bing about (desired or undesired) toothmovements. The best example is Adam's crib. Note: When a patrent (young or old) )s in active orthodontic heatment and the gingiva is inflamed. Important: Ma. A framework or baseplate: usually acrylic. The best method for tipping maxillary and mandibular anterior teeth is with linger springs. Retention after comprehensive treatment . Anchorag€ component: resists force ofactive components (e.\illary incisor rotation is not commonly treated during the stage of mixed dentition. r' . -{ctive components or tooth moving components: springs."" generated in the spring is directly proportional to the distance (d) that an orthodontic spring is deflected and the radius (r) ofthe wire.. *** Multiple A Hawley retainer can be made for the upper or lower arch. This design considention is important for ary patient who once had an excessive overbite.. be careful because what commonly occurs is rotation of that tooth instead of actual i. The palatal coverage ofa removable plate like a Hawley retainer makes it possible to incorporate a bite plane lingual to the upper incisors to control the bite depth... The lower retainer is somewhat fragile and may be difficult to insert because ofundercuts in the premolar region.g... it should be corrected as soon as possible (while il is erupling). -. Z-springs can also be used but they deliver excessively heary forces and lack rang€ ofmotion. Tte most common problems associated with these simple removable appliances are lack ofpatient cooperation. Lwhen using buccal coil springs to try and regain space by pushing a tooth mosially or dis- Precisely: Fct d14 l3 Exc€ssile orthodontic force used to move a tooth may: (l) Cause hyalinizatio'l (necrcsis) of the PDL membrane.. Th" fo. Limited tipping movements . .r::.appliances can use the palate for anchorage.iodontal disease dudng orthodontic therapy is preventable and is controllable and in conrinuous studies affer orthodontic therapy has been completed. It may be useful to recommend the use ofwater irrigation devices to help flush food debris away from the brackets. (2) Cause undermining resorption.':: movement. (3) Crush the periodontal ligament Importanti Pe.:Note{ii tally. screws or elastics. llajor components of a remoyable appliance: l. Retentiv€ component: retains the appliance in function: consist olvarious clasps. 2. The true reason that the Hawley retainer is the most common is because ofthe varietv ofbenefits it has and can have when used properly. poor design leading to lack ofretention. This palatal coverage (agylic) is the major source of anchorage in th€ Hawley appliance. Howevet ifthe incisor is in crossbite. Note: Apatient may have difficulty pronouncing linguoalveolar consonants for a few days after receiving a maxillary Hawley appliance until the tongue adapts to the palatal covemge. . This provides anchorage. the dentist should encourage better oral hygiene. It is best teated after all permanent teeth have efl)pted (earll permanent dentition). and improper activation. An undesimble common side effect ofa finger spring is the tendency for the root apex to move in the direction opposite from the crcwn.

nothing . 35-50% unbuffered phosphoric acid. nothing 10 Copyflghr C 20ll 2012 DenlalDecks ORTHODONTICS An example of a maxillary permancnt central incisor in crossbite is shown.. Surgically reposilion the central inclsor . the dentist should do what? copFlhr 1000tr. unnt^fyof !\k!hrigoo For rnromdio. Correct the condition immediately with .Dental Decks .'triry f 3.Tr'lrc.isnon ofl h. 35-50% unbuffered phosphoric acid . Prior to placing bands.hi.q:h . Nothing. . 10-15% unbuffered phosphoric acid. is used as an etching agent.{. In order to treat this condition properly. alrc.r4u. is used as an etching agent...c$orrFroduc troi R forbiddcr $irhoDr lh. Do nothing until all permanent teeth have erupted . Nothingt l0-l5% unbuffered phosphoric acid .04 unircrrq Adas of ol $hsh redrahc D.ORTHODONTICS Prior to direct bonding.on'ad l. Place a a simple appliance maxillary expander 11 Coplaight C 20ll-2012 .ftcn Fm.v!rrd h). prio.is! Umurhoi.

permanent canine).ss I elastics (intramdxillary)r nsed for traction between tceth and groups of teeth within the same arch. a maxillary removable appliance is usually the best mechanism to concct a simple anterior crossbite that requires a tipping movement. Cross-elastics from the maxillary lingual to the mandibular labial can be used to conect a single-tooth crossbite. This situation may be encountered at an old extraction site. the pennanentjirst molar) to a tooth located in the anterior part ofthe mandlble (i..jirst perma' nent molar).ior crossbite situation.e. The tooth surface must not be contaminated with saliva.Vsed to improve the overjet in an edge-to-edge or ante. Corticrl anchoruge: anchor teeth roots are moved into cortical bone whichresorbs more slowly than does medullary bone. Important: Anchorage is the word used in ofihodontics to mean resistance to displacement.e.. for intermaxillary traction. to ligate archwires to brackets. Class III elastics (irtemaxillary)r usually are wom from a tooth in the posterior part ofthe maxilla (i. because tooth movement is slowed to a minimum as the roots encounter cortical bone along the resorbed alveolar ridge. . Crossbite elastics: are wom from the lingual ofonc or more maxillary teeth to the buccal ofone or more teeth in the mandible to helD correct crossbites. Topicalfluoride should not be used before etching because fluoride decreases the solubility ofenamel.*** When placing bands. this anterior crossbite should be corrected before it reached the occlusal plane (vhile il !'as erupting). Stationary anchorage: displacement ofanchor teeth can b€ minimized by ananging the force system so rhat anchorteeth must movebodily (translation) ifat all.l growth problem. the tooth surface should have a frosted appearance. the petlnd ent canine) to a looth located in the posterior part ofthe mandible fi. Implants for rochorrg€: implanls can serve as anchorage for holding or moving teerh. Class II elastics (in termaxillary\: :js]'J. elastic thread. wbile movement teeth are allowed to tip. They are used to move teeth. Dilferent anchorage situations include: . Remember: After etching. . particularly crossbite of the incisors' is mrely found in children rvho do not have a skeletal Class IIIjaw relationship. and for separation. may derelop in a child who has good facial proportions. Elastics are aiways attached to bmckets and archwires. . When elastics are used to move teeth they should be attached directly to the appliance components. Ir is important to evaluate the space situation before attempting to correct any antedor crossbite. however. .e. The cold slab is used for mixing regardless olwhich ofthe two cements is used ("liozen slab technique '). otherwise re-etching is required. This allows the addition ofa greater amount ofpowder into th€ cement liquid and thus produces a stronger cement. Cl. and formed shapes for specific purposes.e. especially in the presence ofscvere crowding. . For teeth that will need both lingual and labial attachment . -{nterior crossbite. The " anchorage vafue" ofany tooth is roughly equivalent to its root surface area fu'hich is the same os its periodontal ligame t area).Usedto correct Class II malocclusion. Tooth surfaces that are incompatible with successful bonding Cementation ofbands: Glass ionomer cements (resin or non-resin based) because oftheir fluoride releasing prcperties and retentive strenglbs are fast replacing Zinc phosphate cement. Not€: Another method for reinforcing anchonge would be to add an exffaoml force such as headgear or interarch elastics. f/ Ideally. never around a naked tooth. Note: The permanent antcrior tooth that is most often atypical in size is the maxillary lateral incisor Elastics are available as rubber bands. eitherglass ionomerorzinc phosphate cements are used and do not require etching.ally are wom from a tooth in the anterior part of the ma. . To provide better anchorage for greaier tooth movement . until bonding is completed. . This approach is called "stationary anchorage. A crossbite relationship ofone or two anterior teeth. extmcting the adjacent primary canines usually leads to spontaneous corection ofthe crossbite. . The implant r/drle/ \r'ill not move because it has no PDL. The maxillary lateral incisors tend to erupt to the linglal and may become trapped in that location. Remember: Anterior crossbite in a primary dentition usually indicates a skelet. The rnost probable etiologic factor for this happening is prolonged retention ofthe primary maxillary incisors. A maxillary removable appliance can also be used.. Reinforced anchorage: is accompl ished by adding additional teeth to the unit to di stribute the force over a larger rcot surface ar€a in the anchorage unit. Note: 37% phosphoric acid is the most commonly used etching agcnt. lndications for using bands instead ofbonded brackets: . If enough space is available to accomplish the movement.. Reciprocal tooth movem€nt: is produced when two teeth or resistance units of equal size are moved against each other and move the same amount toward or away iiom each other." . In this situarion. Teeth with short clinical crowns . which promotes immediate remineralization.{illa (i. it can be almost impossible to close such an extraction site.

righr O 201 l-2012 . The first statement is true. the second statement is true .. Both statements are true . Straight-pull .Dental Decks Which of the following may cause extrusion of the marillary lirst molars which can cause an open bite? . Both statements are false 12 Cop!. Reverse-pull . the second statement is false . The first statement is false.Dental Deck . High-pull headgear 13 CopFight O20ll-2012 . Cervical-pull headgear headgear headgear .

The mtio between the net moment and net force on a toolh (M/F ratio) \nith reference to the center ofresistance determines the center ofrotation.st molar attachments.5 years old Side Effects of Headgear: . A graph ofthe M/F ratio plotted againsi lhe c€nter of rotation illusirates the precision rcquired for controlled tooth movement. Since most forces are applied at the bracket. Forces produce eith€r translation (bodib movement). forehead or a combination ofthese structures. cheeks. Note: A force rhrough the center ofr€sistance causes all points ofthe tooth to move the same amount in the same direcdon. Forces can also be divided into components in order to determine effects parallel and perpendicular to the occlusal plane. [n multirooted teeth it isjust apically to the furcation. Treatment: . a force Straight-pull headgear is similar to the cervical-pull headgear. the forces can be combined !o determine a single overall resultant. Forc€: is a load applicd to an object that will tend to move it to a different position in spac€.Orthodontic forces can be treated mathematically as vectors.) and a standard facebow inserting into the headgear tubes of the maxillary first molar aftachments The objeotives of treatment with these types ofheadgear are to rcstrict anterior growth ofthe maxilla and to distalize and erupt maxillary molars.9. forces are r€presented and treated mathemati- cally as vectors. noncoflinear but paralfel forces. . or the long axis ofthe tooth. Therefore. Thc result of applying two forces in lhis \r'ay produces pure rotation without translation.8.5-10. Rotation: occurs when a force is applied away from the center ofresistatce.der to predict tooth mov€ment. In single-rooted teeth. Chin ctp (chin capl ar€ devices to utilize cxtra-oral traction to restrain or alter mandibular growth.Females: . applied by a bmcket that does not act through the center ofresistance. When mor€ than one force is applied to a tooth. Franlfort horizontal. which is two equal and opposite. Note: A force. has an extraoral component that is supported by the chin. Howevet this appliance places in a straight distal direction from the maxillary molar Like cervical-pull headgear. The only force system lhat can produce pure rctation (a mome t *-ith no netforce) is a cottple. . Cervical-pull headgear consists of a cervical oeck strap (as ahchorage. noncol inear but paral lel forces. point ofapplication. the indications are Class II. first molars will move distally and forward growth ofthe maxilla will decrease. Principles of Biomechanics in Fixed Orthodontic Appliancesl .5 years old . Indications: Class lll maloccllJsions (\rhere protraction ofthe maxilla is desirable). . rotation. The objectives oftreatment with these typcs ofheadgear ar€ restriction ofanterior and downward maxillary gowth and/or molar distalization and control ofmaxillary molar eruption. with increased vertical dimension and minimal overbite. and direction. it is necessary to compute equivalent forc€ systems at the center ofresistance in o. Indications: Class II maloccltJsions (due to excessive mandibular powth). [t consists of two pads that rest on the soft tissue ofthese structurcs. Timing ofAny Headgea. which is equal to force magnitude multipliedby the perpendicular distance offhe lin€ ofaction to the center ofresistance.5-11. Division I malocclusions (wlen bite ope i g is undesirable). Likely results include: opening the bite. Negates Class II correction . the center ofresistance is on the long axis ofthe tooth one-third to one-halfthe '!\ ay ftom the alveolai crest to the apex. A major disadvantage of treatment using cervical headgear is possible extrusion of the maxillary molars. C ou ple: is rwo equal and oppos ite. Indications: Class II malocclusions with deep bite High-pull headgear consists ofa high-pull headstrap and a standard facebow inserting into the headgear ofthc maxillary fi. C€nter ofresistance: a point at which aesistance to movement can be concentmted for mathematic analysis. causes rotation ofa tooth.Males . May cause distal tipping ofmolars . Tlris RDe ofmovement is called translation or bodily movement. The tendency to rotat€ is due to the moment ofthe force. or a combination oftranslation and rotation.These types ofheadgear have a more direct effect on the anterior segmcnt ofthe tubes a{ch. Thc potential for rotalion is rermed a moment. The movement of a tooth (or a set of teet ) can be described through the use ofa center ofrotation. Indications: CIass II malocclusions. depending upon the relationship ofthe line ofaction of the force to the center of resistance oftbe tooth. Unwanted extusion forces on maxillary molars f4pically found with cervical headgear) will cause the mandible to move inferiorly and posteriorly . This tendency to rotate is measured in moments and is calledthe momentofthe force.A force has magnitude. Reverse-pull headgearunlike all ofthe otherheadgears above. Side effects include downward and backward rotation of the mandible. These pads are connected to a midline framework and are adjustable. Note: Couples are usually applied by engaging awire in an edgewise bracket slot.

Division I malocclusion . Posterior crossbite after prolonged thumb sucking . Two deciduous molars nearly in crossbite .. Anterior crossbite in mildly prognathic children . Posterior crossbite with a functional shift 14 coplright @ 20ll-20 t2 . Class lI. Deviated midline in the absence ofa functional shift .D€nbl Decks . Mild crowding of lower permanent incisors .Denhl Decks . Ar anterior open bite after prolonged thumb sucking 15 coplright O 201 I -20 12 .

l. not appliances. An omega loop is tlpically included making the appliance useful in rotating and widening the molars. as contrasted with a functional crossbite \ote*. S. W-arch: these consist ofhealy stainless steel wire with fonr (quad-helix) or three (ty arch) hcljces rhat are incorporated to increase the range and flexibility. functional or skeletal origin It is important to correct poste or crossbites (which are related to lhe t|ansverse plane ofrpdcel and mild anterior crossbites in the first stage oftreatment. (y6y thumb sucking). whereas Class II relationships are more commonly found in whites of northern European descent.5 . A true anterior crossbite in the primary dentition is quite rare because mandibular growth lags behind maxillary growth. T*o acrylic pads with a midline jackscrew are connected to the rest ofthe appiiance. . Hyrax appliance: is the most commonly used tlpe ofappliance for rapid expansion /r. 3.lt corsists ofa hymx screw held in place with a wire framework that is attached to several upper ieeth with cemented bands. Maxiilary or palatal expansion appliances are used to correct trrnsverse discrepancies by skeletal expansion ofthe midpalatal suture.Posterior crossbite: . Should be thoroughly diagnosed as to whether it . Remember: A skeletal crossbite. Severe anterior crossbites. sion. are usually not corrected until the second stage ofconventional treatment. [t consists ofbands that are cemented on maxillary first premolars and first molars. . The primary incisors wear down rapidly.4): is a thin wire that goes across the roofofthe mouth from first molar to first molar. Should be corrected as soon as possible . usually demonstmtes a smoolh clo- !ure !o centric occlusion. A corrected anterior crossbite is best retained by the normal incisor relationship that is achieved through treatment (the overbite). Ma) be corrected with nalatal expansion . Reverse overjet. Haas appliatrce: is both tissue and tooth-bome and has an extensive amount ofpalatal acrylic wltich acts on the palatal mucosa. and an anterior shift ofthe mandible to escape occlusal interferences rarely occurs until the permanent incisors begin to erupt. Quad-hefix. Harrley-type removable appliance with a jack screw: can bc uscd for mild poste. 4. . rior crossbite frrarrverse problem). A young child who has a tendency toward a Class III malocclusion will have end-to-end contact ofthe primary incisors. suggesting a Class III malocclusion. which can guide permanent molars. 5. premolars into a crossbite relationship. usually demonstrates a smooth closure to centric occlu'-A::. in contrast. A functional crossbite is usually caused by thumbsucking and does not demonstrate smooth closure into CO. . Prolonged sucking habits often produce a mildly narrow maxillary arch and a tendency toward bitateral crossbite. Class III relationships are more prevalent in Asian populations.25 mm daily forre qudrler turn). . A pattem of anterior displacement of the mandible may develop when the permanent incisors come into contact. Children with this condition usually shift the mandible to one side on closure to gain better function..ior crossbites in children. however' producing an anterior crossbite ftom the shift. . population. even ifthe permanent first molars have not yet cruptod.tnt/dql. 2. Important: The most common rype ofactive toolh movement in the primary dentition is to correct a poste. . TPA is used to maintain expansion in the molars. is much less frequent than Class II in the U. or later. An anatomic crossbite (skeletal). Tlley can be us€d to corect unilateral or bilareral crossbites and for corecting rotated molars. May be associated with a mandibular shift is ofa dental. as contnsted with afunctional crossbite. The screw is activated by at least 0. Appliances to correct crossbites: . Transpalatal arch AP.

Both statements are true . The first statement is false. the second statement is false . The first statement is true. Proclination ofthe maxillary incisors .Dental Decks ..A Class II malocclusion 17 Cop)'righr O 201l-2012 . Both statements are false 't6 Coptrighr O 20ll-2012 'Denial Decks . Crossbite . Anterior open bite . the second statement is true . Expanded maxillary arch . Retroclination of the mandibular incisors .

Class Class II III . retrognathic..Dental D€cks . Class II . Both the statement and the reason are correct but NOT related . . Prognathic. but the reason is correct . The statement is correct. The statement is NOT correct. Class I . prognathic. Both the statement and the reason are correct and related . but the reason is NOT . Retrognathic. Prognathic. prognathic. Retrognathic. Class I . Retrognathic. Prognathic. prognathic. Class II 't9 coplrighr o 20ll-2012 . retrognathic. retrognathic.D€ntal Deks . NEITHER the statement NOR the reason is correct 18 Cop)'right O 20ll-2012 .

Long anterior facial vertical dimensron . Anterior open bite .Dental Deckj .. Dental cast aralysis . Greater maxillary-mandibular plane angle 21 Cop)right O 201| -2012 . Facial profile analysis . Tendency to Class III malocclusion . Photographic analysis .Dental Decks . Full face analysis 20 Coplyighr O 201 I '2012 .

). a long face predisposes the patient to Class II malocclusion. The mandibular plane angle can be visualized clinically by placing a mirror handle or other instrument along the border ofthe mandible. elc. a short face to Class III malocclusion. .*& Z. The angle between the mandibular plane (Go-Me line) and the maxillary plane flN. the former is considered a vital diagnostic technique for primary evaluation.The facial profile analysis delineates the same information as that obtained through lateral cephalometric radiographs. Lip posture (competent/incompetant) and incisor prominence 3.. l. In treatm€nt planning: impacted teeth are usually a high priority. 4. Important: A flat mandibular plane angle correlates with short anterior facial vertical dimensions (height) and anterior deep bite malocclusion. Cephalometric measures in themselves are usually not considered problems.. The greater value indicates a longer anterior face height. all other things being equal.'. There is also an interaction between face height and the anteroposterior position of the mandible. brttxism. Vertical facial proportions 4. i&. 3. They should be used to explain or support a diagnosis based on all the data required to make a diagnosis. interarch relationships usually take priority over intra-arch relationships. however. thumbsucking. should not be used to make a diagnosis./ should also be considered. Important: The most stable area from which to evaluate craniofacial growth is the an- terior cranial base. by themselves. Anteroposterior position/proportion ofthejaws relative to each other 2. The difference lies in the detail obtained through the latter method. but what they indicate m ybe (i. within occlusal problems. small maxilla. habits (i. There is a significant difference in esthetics and cephalometric values among .e.lts normal value is: 27'(+/.e.Jlared incisors. Inclination ofthe mandibular plane angle Note: Within the lower third of anterior face height the mouth should be about one-third ofthe way between the nose and the chin. It is a quick and simple (also cheap) technique which readily gives the following information: 1.Individual cephalometric measures. . elc.'-. No&gf racial and ethnic groups. prognathic mandible.4")..t-PNS line) rs called the maxillary-mandibular plane angle (MMPA).

Adjustment in milliamperage . A soft tissue shield .Denbl Decks . n--J 23 CoDright O 201l-2012 .What is needed so that soft tissues are clearly visible on a lateral cephalometric radiograph? . A hard tissue shield . Adjustment in kilovoltage . Nothing must be done to make soft tissues visible 22 coplright (] 201I ?012 Doral Deck Identify the Frankfurt-Ilorizontal plane and the numbered points it uses for its origin.

The lateral head radiograph (cephalometric x-ray) must be compared with the "normal" lateral radiographs form an accepted norm. Linear and angular measurements are obtained utilizing known anatomical landmarks in the lateral head radiography ofthe patient. These measurements are then compared with those considered within normal limits and in that way enable the orthodontist to assess aberration in the dentition and jaw structures, which result in malocclusion. Aaalysis ofcephalometric radiographs is not limited to the hard structures such as bone and teeth, but also includes measurements of soft tissue structures such as the nose, lips and soft tissue chin. Superimposition in longitudinal cephalometric studies is generally on a reference plane and a registration point. This will best demonstrate the groMh ofstructures furthest from the plane and the point. The most stable area from which to evaluate craniofacial growth is the anterior cranial base because ofits early cessation ofgrowth. Cephalometrics is useful in assessing tooth-to-tooth, bone-to-bone and tooth-to-bone relationships. Serial cephalometric films can show the amount and direction of gro{th.
),Iote: A lateral cephalograph usually shows magnification with up to 7-8olo magnification considered acceptable. The resuldng double shadows are traced and the average is used

for measurements. Cephalometric studies show that, on the average: . The maxilla, during growth, is translated in a downward and forward direction . llandibular growth stops after maxillary gowth
The Frankfort-Horizontal plane is constructed by drawing a line connecting porion (4) and orbitale (8), This has been adopted as the best representation ofthe natural odentation of the skull.


l. Bolton (Bo): highest point in the upward curvature of the retrocondylar fossa ofthe occipital bone. 2.Basion (Ba):,lowest point on the anterior margin olthe foramen magnum, at the base of
the clivus.

3. Articulare (,4r): the intersection of three radiographic shadows, the inferior surface of the cranial base and the posterior surfaces ofthe necks ofthe condyles of the mandible. 4. Porion (Po): midpoint ofthe upper contour ofths metal ear rod ofthe cephalometer. 5. Spheno-occipital synchondrosis (SO): junction between the occipital and basisphenoid bones. 6. Sella /S): midpoint of the cavity ofsella turcica. 7. Pterygomaxillary fissure (Przr): point at base of fissure where anterior and posterior walls meet.
8. Orbitale for: lowest point on the inferior margin ofthe orbit. 9. Anterior nasal spine (lNS): tip ofthe anterior nasal spine. 10. Point A fsabsprrale/: innermost point on contour ofpremaxilla between anterior nasal spine and incisor tooth. Il.PointB (Suplamentqle)| ifi.€rmost point on contour ofmandible between incisor tooth and bony chin. 12. Pogonion fPog): most anterior point ofthe contour ofthe chin. 13. Menton (Me): most inferior point on the mandibular symphysis, the bottom ofthe chin.

Gonion (Go): lowest most posterior point on the mandible with the teeth in occlusion. Nasion fNa): anterior point of the inte$ection between the nasal and frontal bones. Important: The most stabl€ point in a growing skull from a cephalometric standpoint is s€lla turcica, the center ofthe pituitary fossa in the cranial base.
14. 15.

mal-r€lstionships in s growing child, the orthodontist can get the most Yduable information from:

. A wrist-hand radiogaph . Height-weight tables . Presence ofsecondary sex characteristics


Stage ofdental development

21 Coprighr O


Denral Decks

The anomaly depicted in the plcture below is called a *** Be as specilic as possible. Abo think about the treatment options for this anomaly.

Uuv.nity of wrd,i.sron Allrisbt r6ded Acc.s b theArlis of Pediadc Dcnhsry $ govemed by a hceGe Un.ulhonrcd.ccs or rcprcdud,m is fd.f iddcn wInoui rhe pno. \riftcn p€mission ofrhe UnikBity of w$hngion. Ior inromatoo. con dd: l'.65.!9u.sa\hington edu
Coptrisht 2000.2004

Cop}{ight O 20ll-2012 'Denlal Decks

Uniydny ofwahin8loD. All nshb D€nriry is eov crn d by.lien$. Ulluiioiz.d @s or rprodxrion is fdbiddm enhour thc pno. widd p.mision offi. uni vdiry of Wshinghn. Fo. inf{lruio'! co.i.cli li Coorieh 20{o

6d.d Aas

lo lh€ Ad,s of Pedi.tic

The physiologic age or developmental age can be judged by finding out the skeletal development. The wrist-hand radiograph offers the best aid for this purpose. By looking at the ossification and development ofthe carpal bones ofthe wrist, the metacarpals ofthe hands and the phalanges ofthe finge$ the orthodontist can have an idea about the cbronology ofskeletal development. Comparing the overall pattem observed in the hand-wrist radiograph, with age standards in a reference atlas, does this. Important: Dental age refers to the state of dental maturation.

Rememb€r: The ulnar sesamoid or hamate bones are considered as landmarks to obtain an estimate ofthe timing ofthe adolescent growth spurl Wrist-hand radiographs in the dental office can be obtained by using a standard cephalometric cassette and dental x-ray.
The state ofphysical maturity or skeletal development co-relates well with the jaw groMh. fthodontists use this information to predict how much jaw growth can be expected. Note: After sexual maturity much less growth is expected and therefore growth modification is not attempted.

Remember: Hand-wrist radiographs are less useful in evaluating whether growth has stopped

or is continuing (patient's position on growth curve). Seial Cephalometric radiographs are used for this pupose.

A midline supemumerury tooth (mesioderu) in the mandibular arch is shown. Mesiodens usually
occur in the maxillary arch. However, you will see them occasionally in the lower arah. Note the crowding of the mandibular permanent incisors. Extraction of the m€siodens is the heatment of choice. Important For the best therapeutic result, orthodontic treatment to close the space may be

A midline supernumerary toolh (mesiodens) is present. Note that the maxillary right permanent cenhal incisor is (slightry rctated, and that the direction ofthe roots ofthe central incisors is more flared. The cerhal incisors most likely were deflected from their normal paths of eruption by the mesioderc. The mesiodens should be extracted. To localize a supemumerary tooth or impacted tooth and its relationship to other teeth, you should take two or rnore periapical x-rays at different angles and an occlusal view film.

CotFghr 2a0G20Ol UnileGiry of Wahinsron. all risht lt3d.d A€s b $. Arla orPrdi.ttc Ddristry ii sovo.d by r licre. U.rutfnizcd aacs or rep'tdcrioD is foi'iddf, wil])out iE prtd qino pmisid ofd. Univm'ty of wGhinclon, Fd infom.rio, co.ilct li.6g@uv8ri4rd.cd!

Conditions associated with multiple supemumerary teeth:

. Gardener's syndrome . Down's syndrome . Cleidocranial dysplasia . Sturge-Weber syndrome
Note: Oligodontiay'absence ofone or more teeth, is more common in females than males. It is often associated with smaller than averaee tooth-size ratio.

Dental Decks . Primary canines . Primary first molars . Upright 27 Cop)'. Permanent first premolars . Primary second molars Cop''righl O 20ll-2012 . Band . Separate .l Drcks .aghr O 201 | '2012 ' Dent. Complete crown lenglhening procedure .. Complete crown preparation and fabrication .

In serial extraction procedures. will A common dental condition that can benefit from orlhodontic treatment prior to prosthetic treatment is the long-term loss ofa rnandibular permanent lirst molar. Irnproves the periodontal environment by elirninating plaque-retentive areas . migration and rotation of the adjacent teeth into the edentulous space. Imoroves crown-to-root ratio . rather than attempting to move the second molar mesially to close the space. It is indicated primarily in severe Class I malocclusion in the mixed dentition that has insullici€nt arch length. Note: After extraction ofthe maxillary first premolar in a serial extraction procedure. concems about eruption sequence are usually related to the eruption pattern of the permanent rnandibular canines and first premolars. due to better force distribution . Remember: Severe arch space deficiency in the p€rmanent dentitton (over l0 mm) almost always require extractions to properly align teeth. it can lead to an increased open bite and loss ofanterior guidance.Serial extraction is the orderly removal of selected primary and permanent teeth in a predetermined sequence. Improves the direction and distribution of occlusal forces . Note: The key to success is extraction ofthe first premolars before the permanent canines erupt. the maxillary canines path of eruption will usually be downward and backward. Stages in serial extraction: The primary canines are the first to be removed. Decreases the amount oftooth reduction required for parallelism ofthe abutrnents . To aid in support and retention during this time. Important: A high mandibular plane angle is one ofthe most significant complications of molar uprighting. The loss ofthe first molar results in tipping. A normal angulation ofa molar is desirable since it: .Increases the durability ofthe restorations. and then the permanent flrst premolars (usually). Improves the alveolar contour . Note: The best way to upright a second molar that had drifted mesially is by tipping its crown distally and opening up space for a pontic to replace the missing first molar. followed by the primary first molars. This is usually followed by full orthodontic treatment. periodontic or more complex prosthodontic procedures . Six to fifteen months is the interval between extractions. because if the molar is uprighted unsuccessfully. This procedure primarily benefits children who demonstrate an arch-length discrepancy. Decreases the possibility of endodontic. a lingual arch should be used in the mandible and a Hawley appliance in the maxilla.

Dental Decks . Pulling . Removable partial denture .. Intrusion . Translation .Dental D€ck . Band and loop on "T" . Extrusion . Torque . Rotation 29 Coplright O 201l-2012 . No space maintenance is needed 20 Cop)'righr @ 201 I '2012 . Tipping . Distal shoe on "T" .

The center of rotation is at the crown of the tooth. the PDL is rich in collagen fibers organized to resist the forces ofmastication. A space maintainer can be removed as soon as the permanent tooth begins to erupt through the gingiva. the best approach is to allow the eruption of the second molar and the mesial drifting to occur naturally. noncolinear but parallel forces. 6. Under normal physiologic conditions.n.l. This Bpe ofmovemcnt is called translrtion orttodily movement. Important: On th€ side toward which the tooth is being moved. always maintain space until the arival of the second nremolar. 3.'Ir^nslsJtioln (bodily movement): a force lhrough the center ofresistance causes all points ofthe tooth to move the same amount in the same directioD. Most readily accomplished with a removable appliance. Ertrusiotr: displacement ofthe tooth from the socket in the direction oferuption. but by force petunit area. Both the amount of force delivered to a tooth and also the area ofthe periodontal ligament overwhich that force is distributed are important.When the primary second molar is lost. Recuning tooth rotations after orthodontic cofiection occur because ofthe persistence of the elastic supracrestal gingival fibers (mainly free gingival and transseptal. This creates one area ofcompression aad one arca of tension. tnor rrittm psmkion or rh. Importsnt: Need adequrte retention to prevent rclapse. l.. Intrusion. Univdi. Torque: controlled root movement labiolingually or mesiodistally while the crown is held relatively stable (mesial-distal root movenlent is also termed "uprightingr. 2. conhd liccns(4u Kshine1on. The most rapid losses in the A-P distance This photograph demonstrates a tooth partially erupting between the wires ofa space maintainer The space maintainer now can be removed. .fr. This will fill in the space most of the time. Very difficult to accomplish. No space maintainer is required if eruption ofthe succedaneous tooth is imminent. This is called the tension side. which is two equal and opposite. Ifa permanent first molar is extracted on a child tlefore the eruption ofthe permanent second molar.c$i d The optimal force levels for orthodontic tooth movement should bejust high enough to partially but not completely occlude blood vessels in the periodontal ligament. The PDL response is determined not by force alone.d a. or pressure. The center ofthe rctation is at the root apex. Very dillicult to accomplish. Types oftooth movement that can be accomplished with orthodontics: L Tipping: the crown moves in one direction while the root tip is displaced in the opposite direction due to rotation or pivoting ofthe tooth around the axis ofresistance or axis of rotalion (localed somewhere in the apical o e-thitd of the root). 5. The most reliable indicator ofreadiness of eruption of a succedaneous tooth (and the need for a space maintainer) is the extent of root development determined by radiographic evaluation. 4.edu ofPcd$tic D. Crown movement occurs when negate the tipping a force is applied at the bracket and a small couple is also applied to panially ofthe crou'n caused by the force. 2. This is called the pressure ot compression side. Very important: ofthe ach is usually due to a mesial tippermanent first molar after rernoval of the primary second ping and rotation of the molar. RotAtion: the only force system that can prcduce pure rot.s!a is goremed by a li. This $eates two areas of compression and tension.fbels). (See picture below).d Acccs to rhc Arld rctoducrion is fodiddcn $nhout !h. Un rhor. Copltght 2000 2001 Untueniit of Wdhlngton All rishts N. Thc periodontal lig|ment is a well-organized connective fibrous tissue andremodels significantly during orthodontic movement. on the side ofthe root from which the tooth moves. Accomplish€d most easily with Nnterior incisor teeth. 2. youwill find "osteoclastic activity" that result in bone rasorption.frs.tion fd moment with no netJbrce) is aotr^ ple. movement into the socket along the long axis ofthe tooth. 3. you will find "osteoblastic activity" that rcsults id bone apposition. Root movement occurs when a forc€ is applied at the bracket and an even larger couple is applied to more than negate the tipping of the crown caused by the force.y orqlshirglon For in fomation.

Both statements are false 30 CoplriSht O 20ll 2012 ' De.talDecks . All ofthe above 31 Coplrighr O 201 I -20 12 . the second statement is false . Minimize changes due to growth .. Maintain teeth in unstable conditions . Allow for reorganization ofthe gingival and periodontal tissues . The first statement is false. the second statement is true .Denral Decks . The first slatement is true. Bolh statements are true .

l. so that the soft tissue pressures constantly produce a tendency for relapse. the next step is to maintain or to modify the soft tissues in the retention phase. The corection ofan anterior crossbite is easily retained after orthodontic correction by the overbite achieved during treatment. and full-time retention is critical during this time. After malposed teeth have been moved into the desired position. Remember: . pulling teeth with them as they go.One of the most importart aspects of orthodontic therapy is retention. The only possibilities are accepting relapse or using permanent retention. However. Significant reorganization ofthe PDL occurs in 3 to 4 months. Retention is necessary in orthodontics for the following reasons: l. gradual withdrawal ofan orthodontic appliance is ofno value. The gingival and periodontal tissues are affected by orthodontic tooth movement and require time for reorganization when the appliances are removed. By cutting the collagen fibers. Important: Most clinicians believe that the collagen fibers in the supra-alveolar tissue are signifrcantly responsible for the relapse oforthodontically rotated teeth as well as the redevelopment ofspaces between orthodontically moved teeth. only the first two reasons apply to most orthodontic patients. they must be mechanically supported until the hard and soft tissues have been thoroughly modified in structure and in function meet the demands of the new position. the fibers stretch like rubber bands to adjust to the new position. two things are accomplished: 1. A simple incision in the sulcus is made to the crest of the bone. 2. When teeth are orthodontically moved. Maintainins the treatment result followins orthodontic treatment is one of the most difficult aspects ofthe entire treatment process. Allow new fibers to form that will help retain the tooth in its new position. The circumferential supracrestal fibrotomy is a minor surgical procedure. 2. Supracrestal fibers are commonly associated with relapse following orthodontic rotation ofteeth. they have a strong tendency to retum to their former position. 3. Eliminate the polential for relapse due to collagen fiber retraction. . \ote: Post-orthodontic circumferential supracrestal fibrotomy is most often performed on a rotated maxillarv lateral incisor. This incises all of the collagen fibers that are inserted into the root ofthe tooth. like rubber bands. -to Remember: Collagen fibers are the primary components ofthe attached gingiva. Fortunately. and maintaining the position of the teeth until remodeling ofthe supporting tissues is completed and growth has essentially ceased allows a stable orthodontic result without further retention. The teeth may be in an inherently unstable position after the treatment. Note: Retention is accomplished with either fixed or removable retainers. Changes produced by growth may alter the orthodontic treatment result. Part-time retention is recommended up to a year and often longer . In the last situation. 2. Once the -both occlusal results are desired achieved and the hard tissues are in normal function.

with . Interstitial grorth only . Endochondral bone formation. without 32 Coplright O 20ll-2012.. Degenerative changes into bony structures Copyright O 201 1-2012 .Denral Decks . Both appositional and interstitial growth . Appositional growth only . with . without . Dental Decks . Both endochondral and intramembranous bone formation. Intramembranous bone formation. Both endochondral and intramembranous bone formation.

In contrast to the cranial vault. L The growth ofthe cranial vault occurs almost entirely in response to growth ofthe brain.In the cranial vault. 8. 6. Endochondral ossification \otcs . between the sphenoid and ethmoid bones. Growth ofthe cnnial base is primarily the result ofendochondral growth and bony rcplac€ment at the synchondroses.The condyle ofthe mandible grows by proliferation of cartilage. but periosteal activity also changes both the inner and outer Jurfaces ofthese plateJike bones. the head is 30% ofthe body. . These important growth sites are the synchondrosis between the sphenoid and occipital bones. thcre is a tendency for bone to be removed from the inner surface ofthe cranial vault. *** :. Bone formation begins in the embryo whete mesenchymal cells differentiatc into either fibrous membrane or cartilage. or spheno-occipital slnchondrosis. The greatest period ofcranial growth occurs between birth and 5 years ofagc. 6.'-._.Eventually.. Growth in the condyle in- anterior-posteior (downward and fo' **(td patlern ofg|orlr. Intramembranous ossification is so called becausc it takcs place in mcmbranes of connective tissue. ond occipitdl rores/ ofthe cranial b. while at the same time new bone is added on the exterior surface. bands ofcartilage called synchondroses remain between the centcrs ofossification. Note: The cthmoid. the head repres€nts about ofthese changes.s on both endosteal and periosteal surlbces. 3.. After a tooth has bcen moved from one position to another. 4. Remember: The bones ofthc cranial base are not affccted to a great degree by growth ofthebruilr' lsince thqt are endochondral bones). ln fetal life .1. 8. Note: The bones ofthe cranial base are not affected to a great degree by growth ofthe brain (siace lhey are endochondral bones). these synchondroses bccome inactive. sphenoid and occipitalbones lbones of the cranial base) form this way. In the adult.. This type ofossification is principally rcsponsible for the formation ofshort and long bones. 2. 2. organic matrix is laid down and calcium and phosphate are deposited. . the head takes up almost 50% ofthe total body length. \ote: The maxilla and mandible as well as the cranial vault are lbrmed lhis way is how the remainder ofthe skeleton fornrs and takes place within hvaline cartilage modef. at about the third month. which are part ofthe normal growth l2% ofthe total body lenglh -all pattem. and the sphenoethmoidal synchondrosis..-. the greatest increase in size ofthe mandiblc occurs distal to the lirst molars. Arch lengrh space for the eruption of pemanent mandibular second and third molars is created by resorption at the anterior border ofthe ramus. Remodeling ofbone rcsults in the histologic structurcs called osteo[s. the growth process is entirely the resuit ofp€riosteal activity at the surfaces ofthe bones. The chief factor in thc formation ofthe alveolar process is the eruption of teeth' . Although the majority ofgrowth in the cranial vault occu^ at the sutures. 5. which have independent growth potential." 5.. In determining a patient's skeletal growth pattem. the most important factor is hereditv. the bones (i. At birth..e. Deposition and resorption may not occur in cqual amounts. After age 6. As ossification procc€ds. sphenoid.t!{ote{t 1. 3. Remodeling and growth occur primarily at the pcriosteumlincd contact areas between skull bones. between the two parts ofthe sphenoid bone. thc resulting bone is transitional bone. Grow1h ofthe cranial base generally precedes growth ofthejaws. Which is grorvth by the addition ofnew layers on those previously formed. Osteoprogenitor cells in the membrane differentiate into osteoblasts: a collagen matrix is lbrmed which undergoes ossification. elhmoid. At birth the greatest dimension ofthe face is width. Important: Mandibular growth creeses lhe is in the downward and forward directions. Cartilage cells are replaccd by bone cells (osleocytes rcplace choha drocr 1es.. Remodcling ofbone occu... 7. the skeletal sutures. This leads to two paths ofbone development: 1.. The dependencc oftooth development and tooth eruption upon growth ofbone and bones is considerable. dimension ofthc mandible. retlect the "cephalocaudal gradient of gro\ryth. . 7. the intersphenoid synchondrosis.se are formed initially in cartilage and are later transformed by endochondral ossi{ication to bone.

The statement is NOT correct. Both the statement and th€ reason are correct and related . Endosteal remodeling 31 Coplrishr O 20ll-2012 .Denral Dect! . The statement is correct. but the reason is NOT .. Sutural expansion . Interstitial growth .D€nbl Decks . Both the statement and the reason are correct but NOT related . NEITHER the statement NOR the reason is correct Coplright @ 201l-2012 . but the reason is correct . Apposition .

hlperplasia. The soft lissue matrix in which the skeletal elem€nts are embedded is the primary determinant of grow1h. hypenropht and endochondral replacem€nt do occur there. whilc bone responds passively to being displaced. Progressive posterior remodeling creates space for the second primary molar and then for the sequential eruption ofthe permanent molar teeth. Grow'th ofthe mandible occurs by both endochondml proliferation at the condyle and apposition and resomlion ofbone at surfaces. Growth of bone: is avascular .Periosteum consists ofa fibrcus out€r layerand a cellular inner layer ofosteoblasts. . Appositional by the recruitment of ftesh cells. this growth ceases before enough space has been created for eruprion oflhe third permanent molat which becomes impacted in the ramus. the alveolus resorbs after the extmction until finally the alveolar ridge completely atrophies. To summarize the growth ol the maxilla and mandible: 1. 4. The second theoryor cartilage theory suggests that genetic control is expressed in the cartilagc. The space betwe€n the jaws into wbich the teeth erupt is gene. Bone foms by cither endochondral ossification or intmmembranous ossifi cation. nasal septum and spheno-occipital synchondrosis. The mandible is translated in space by the g.ally considered to be provided by growth at th€ mandibular condyles (especially the moldlt. Note: This theory is kno\Mr as the functional matrix theory. while bone responds secondarily and passively J. which Iay down bone. chondrcblasts. Note: The perichondrium consists ofa fibrous outer layer and chondroblastic inner layer 2.. and ifa tooth is extracted.th ofthe mandible occurs at the mandibular condyle and along lhe postedor sudace ofthe ramus. Importanti Cartilagc tissue is pressure tolerant and able to providc flexible suppon b€cause it and contains an intacellular matrix ofproteoglycans. Remember: Gro\\. in the form ofnutritional status. is the primary determinant ofits own growth2. In infancy. but it can also be significantly allectcd by the environment. and deposition ofmore matrix around. while condylar growth fills in thc resultant space to maintain contact with the base ofthe skull. Ifa tooth fails to erupt. degee ofphysical activity. alveolar bone never forms irl that area. Akhough this cartilage is not like rhe cartilage at an epiphyseal plate or a synchondrosis.Grofih ofcartilage occurs in two ways: l. Bccause ofits rigid structure. Many arguments have been made about the condyles function in mandibular gron'ih. Thre€ major theories havc atlcmpted to explain the determinants ofcraniofacial growth: l. and therefore its locus should be the periosteum.Appositionat below the covering periosieal layerofbone.e. This indirect control is called epig€netic' The third theory assumes gcnetic control is mediated to a large extent outside the skeletal system and occurs only in response to e srsnal from other tissues. and new bone fills in at the sutures. health or illness. Note: After age 6. . Cartilage covcrs the surface ofthe mandibular condyl€ at the TMJ. Growth ofthe surrounding soft tissues s€ens to be important. Tte body ofthe mandible grows longerby periosteal apposition ofbone on its posterior surface. The condyle is a major site of vertical growth in the mandible. All other ar€as ofthe mandible are formed and grow by direct surface appos! Irnportlnt: tion and remod€ling. In contrast to the maxilla both endochondral and periosteal aclivity are important in growth of tbe mandible. T}e major difference in the theories is the location at which genetic control is expressed. More often than not. 2. the greatelt increese in size ofthe mandibl€ occurs distal to the first molars. however. while rhe ramus grows higher by €ndochondral replacement at the condyle accompanicd by surfac€ remodeling lon the onterior surface oflhe ramus). and both bone and cartilage are secondary followers. The bone ofthe alveolar prccess exists only to support the teeth. The maxilla is translated downward and forward as the face grows. Examples ofsites that gow by interslitial growth include the mandibular condyle. *** It is a truism that grollth is strongly influenced by gcnetic factors. from perichon&al stem cells and the addition ofnew matrix to the surface. chondrocytes already established in lhe cartilage. Notei The "V" principle ofgrowth is illustrated by the maDdibular condyle. '. likc othcr tissues. Cartilagc is the primary determinanr ofskeletal growrh. the ramus is located at about the spot wh€re the primary fir$ molar will erupt. Growth ofrhe maxilla and its associated structurcs occurs from a combination of growth at sutures and direci remodeling ofthe surfaces ofthe bone. The first theory implics rhar gcnetic control is expressed directly at the level ofthe bone. rda. interstitial growth is not possible. Most authoriiies agree that sofFtissue development carries the mandible forward and downward. Do not confus€ bone growth with bone formrtion. and a number of similar factors. . 3. Interstitial by the mitotic division of.owth ofmuscles andother adjacent soft tissues and fiat addition of new bone at the condyle is in response to the soft tissue changes. Bone.

D€ntal D€. Palate .D€ntal Drcks .. Incisor . An oral habit he must have Cop'. Maxillary tooth-size excess . Pressure from third molars . Late mandibular growth . Trauma .ks .right O 201l-2012 . Zygomatic 36 CoplriShr O 201 | '2012 . Tuberosity .

. Remember: The mandibl€ can and does undergo more -the gro$th in rhe late teens than does the maxilla. The neural tissues reach about 90% oftheir adult attainment at roughly 9 yeaN ofage and tinall) at age 20 are at adult attainment. Girls will generally start growth sooner.. opening up space at its supedor and postedor sutural attachments. . 2. the whole maxilla is simultaneously carried anteriorly. The amount of forward displacement exactly equals the amount of posterior lenglhening. for boys it is around age 14. Resorption occurs on the opposite side ofthe same cortical plate. l$ote$j migrates downward and forward away from the cranial base and undergoes significant surfac€ remodeling. Scammon's gronth curves point out four major tissue systems ofthe body and a percentage ofadult arainmenr at :0 years ofage. 3. The curve for lymphoid tissue which reaches 200olo ofadult attainment until they reach 100% in adulrhood. and downward migration is augmented by inferior apposition ofbone. growth occurs in two ways: (l) by apposition ofbone at the sutues that connect the maxilla to the cranium and cranial base and (2) by surface re- modeling. ar or around age twelve. Much ofthe anterior movement ofthe maxilla is negatedby anterior resorption. . jt is not surprising that the mandible. This surface remodeling includes resorption of bone anteriorly and apposition of bone inferioriy. more consistent level in childhood. tends to gro$ more than the maxilla. chronologic age often is not a good indicator dividual's crowth status. move distally relative to thc body ofthe mandible late in mandibular growth. The The The The nasomaxillary complex anterior cranial fossa palate body ofthe mandible Thc cunent concept is that late incisor crowding develops as thc mandibular incisors. 5. Cephalocaudal gradient of growthi simply means that there is an axis of increased growth extending from the head toward the feet. being further away from the brain.. which is closer.. Because of time and variability. 4. which is the inside surface ofthe maxilla within the maxillary sinus. The mandible grows later and follows a pattem closer to that ofgenital tissues. ofthe in- . and will grow less than boys. 4. The maxilla 'k. new bone is added on both sides ofthe sutur€s. lmportant: The maxilla develops postnatally entirely by intramembranous ossification.Noteql' *' -- The average peak growth for girls is around age 12. . and perhaps the entirc mandibular dentition. 2. . l . 3. General body tissue growth follows a direct line to age twenty and t-inally the getrital tissues begin their growth at puberty which is around agc fourteen. the shorter the duration ofthe growth . When the facial growth pattem is vierved against the perspective ofthc cephalocaudal gradient. The counterparts to the bony maxillary arch development include: . G.The bony maxillary arch lengthens horizontally in a posterior direction. follows a pattem closer to that or neural tissues than does the mandiblc. . Growth accelerates again around puberty before slowing and vifually stopping at maturiry Key point: The timing of $owth spurts is important in orthodontics.o$th velocity cunes a : - . Since there is no cartilage replacement. 2. As growth of sunounding soft tissues translates the maxilla downward and forward. The lymphoid tissues then undergo a decrease in size Important: L The maxilla. Generally speaking. the earlier the growth spurt. show that groMh in height is very rapid after birth but decelerates quickly to louer. and so the presence ofthesc teeth is not a c tical variable extent oflate mandibular growth is a critical variable. Bone has been deposited on the posterior-facing cortical surface ofthe maxillary tuberosity.. Late incisor crowding does occur in individuals with no third molars at all.lun and the less overall the grourh will be.-'-. As the maxillary tuberosity grows and lengthens posteriorly. grow for a shorter amorult of time.. l.

78% ' . The first slatement is false. Both statements are false Coplaighr O 201l-2012 . the . Both statements are true . the second statement is false second statement is true . 98o/o 49Yo .. Less than 25% 38 CoDriglt @ 201| -2012 .Dedtal Decks .D€nlal Decks . The first statement is true.

The soft tissues ofthe brain expand thus pacing growth ofthe flat bones of the skull 6. Clefts ofthe lip are more frequent in malcs. reorientto palate is more frequent in females. nrim . Bone is responsive to soft tissue . \oL3. making i! the most common craniofacial birth defect.The grand design of the human face is the result of remodeling and displacement which interact to produce the final result. Also. Clcft position.-4ry . 5.palat€ begin to develop at four to five w€eks gestational age.re ic . 3. A tooth-size discrepancy . Thc palatal shelvcs fuse with one another andwith the primarypalate anteriorlt which. An abnormal frenum attachment .The secondary palate develops at approximately nine weeks dev€lopmental age. Note: lfthe space is 2 mm or less and the maxillary laterals are in a good position. . it is best to align the teeth orthodontically and then do Usually this is not done until the permanenl caoines erupt. A mesiodens .. Tle paired palatal shelves arise from the iDtraoral maxillary processes. The greater the amount ofspacing.I srnr a Halrley appliance with finger springs .*** It is prevalent in 49% of l1-year-old children. A normal stage ofdevelopment The spaces tend to close as the permanent canines erupt. The growth in width ofthejaws is generally completed before the adoles- cent growth spurt begins. 7. --. during active tooth eruption there is apposition ofbone on all surfaces \ot€ 2. Cleft lip involvement is more frequent on the left side than the right. The lip and primarJ. whereas the sum of the M-D diameter of the mandibular permanent teeth is approximately 126 mm. 3. The reason is the sum ofthe M-D diameter ofthe maxillary permanent teeth is approximately 128 mm. Using a lingual arch with finger springs . originally in a vertical 1. Failure ofthis fusion rcsults in clcft lip. while total closure of a diastema initially g€arer than 2 mm is unlikely. a horizontal position as the tongue assumes a more inferior position. ' _ '-' clefting ofthe lip and/or palate occurs in I of 700 . The two medial nasal swellings and the maxillary s$'ellings fuse io form the upper lip. Using cemcntcd orthodontic bands with inter-tooth traction \ote: Space closure is least likely to occur following early loss ofa primary maxillary central incisor. Failure of fusion results in a cleft palatc. the less the likeIihood that a maxillary central diastema will totally close on its own. The cause ofa median diastema could be anv ofthe followins: . Ifit is caused by an rbnormal frenum. As a general guideline. 2.000 bifihs. The functional matrix theory (the 3rcl theory o the back oJ card #34) holds that: r Qnft ticc. Deglrtrtion (mandibular function) influences mandibular growth . l. it is most likely the result ofa normal developmental proccss. a maxillary central diastema of 2 mm or less will probably close spontaneously. Displacement and remodeling can occur in opposite directions.Permanent teeth move occlusally and buccally while erupting. 4. Rememb€r: The maxillary arch is slightly longer in length compared to the mandibular arch. . In rhe United States.. These shelves.I. The growth in length ofthe jaws continues through the growth spurt. Accepted methods ofclosing a diastema: a frenectomy. in tum arises from the fusion ofmaxillary and mandibular processes.

A brass wire placed between the primary second molar and permanent first molar . Disking the distal of the primary first molar . The first statement is false.. Extraction ofthe Drimarv second molar 41 Coplrighl O 2011-2012 . the second statement is true . The first statement is true.Denhl Decks .An appliance incorporating a finger spring to move the primary second molar mesially . Both statements are false 40 Cop)'dght O 20ll-2012 Denta! Decks . the second statement is false . Both statements are true .

It is seen in about 2-6Yo of the population and spontaneously corrects about 60olo ofcases. the permanent molar is unable to erupl and the root of the primary molar may be damaged. The resultant space can then be maintained as part of orthodontic treatment. flaps should be reflected so that the tooth is ultimately pulled into the arch through keratinized tissue. three principles should be followed: l. A poor eruption direction of the canine. The distal aspect ol the root of lateral incisors suides the eruotion ofcanines. 3. sometimes leading to impaction. there is an increasing risk that the impacted tooth has become ankylosed. is observed often but usually is due to the eruption path being altered by a lack ofspace. Ectopic eruption occurs when a tooth erupts in the wrong place. extract the adjacent primary second molar immediately. If it shows signs ofcaries. may lead to transposition ofthe lateral incisor and canine. 2. In treatrnent planning for an impacted tooth. An impacted canine or other tooth in a teenage patient can usually be brought into the arch by orthodontic traction after being surgically exposed. The mesial position of the permanent molar means that the arch will be crorvded unless the child receives treatment. which occurs more frequently than mandibular first molars. This separating device (brass wire) will cause the permanent first molar to be tipped distally. The prognosis should be based on the extent of displac€ment and the surgical trauma required for exposure. During surgical exposure. not through alveolar mucosa. Even adolescents have a risk that surgical exposure ofa tooth will lead to ankylosis.*** The maxillary canine is the most commonly impacted tooth. Remember: This mesially inclined position ofthe permanent molar makes it susceptible to decay. Ectopic eruption of mandibular lateral incisors. to occur is much Class II itself in Ifthe eruption path ofthe maxillary lirst molar carries far too mesially at an early stage. It is most likely in the eruption of maxillary first molars and mandibular incisors. Failure ofa permanent tooth to erupt may cause damage to roots of other teeth and also create a severe orthodontic problem. Its occurrence more common in the ma"rilla and is often associated with a developing skeletal pattern. Ad€quate space should be provided in the arch before attempting to pull the impacted tooth into position. . In older patients. It{ote: Research suggests the association of impacted canines with missing lateral inci sors or shortened roots oflateral incisors. Orthodontic consultation is indicated when first observed on an x-ray.

The time required to stabilize the molar can vary from: . l-2 months . Normal occlusion Class I malocclusion Class II malocclusion Class III malocclusion Cop)riShr O 20ll-2012 .1. 2-3 years 42 Coplrighl aq 201l-2012 Denial Decks ORTHODONTICS Match the dental rrch relationships on the left with the correct d€piction ofthe relationship on the right.Dental Decks . 6-12 months . 2-3 weeks . 2-6 rnonths . The time required to upright a molar can vary from: 2.

grafts. but limits the wire sizes available. Normal occlusion = C The triangular ridge ofthe mesiobuccal cusp ofthe maxillary first molar articulates in the buccal groove ofthe mandibular first permanent molar. A severely lingually tipped mandibular molar is more difficult to control and upright proP€rly. Class II malocclusion = A Class II malocclusion has the mandibular molar placed behind or posterior to the maxillary molar. . which can also upright the molar. which will remove bone from the area adjacent to compression ofthe PDL. Retention (slabilization) can be provided by an appliance or by a well-fitting provisional restoration. When this occun an inevitable delay in tooth movement occurs. stebilization should lasi until the lamin{ durr and PDL reorganize. Classlmalocclusion=D Class I malocclusion has the normal molar relationship but the incorrect line ofocclusion. . Note: It is best to Nvoid excessive orthodontic force. This will allow for reorganization ofthe PDL. which will stabilize the tooth positions.) and " hyalinization" (blood supplv is lost and results in "undermining resorptionn(osleoclasts atlackthe lanina dura ftom the underside ofthe lamina dura). activify is critical.018 inch. A fixed edgewise orthodontic appliance is usually used for molar uprighting. etc. Osteoblasts also must form newbone on the tension side. \ote: When an orthodontic forc€ is applied lo is heavy or light: Slow progess in molar uprighting in an adult patient is most likely due to occlusal int€rf€rences. -Secondary period oftooth movement fdfer lhe above happens)t lhe PDL heals and there is secondary tooth movement. . Heavy force: . osteoclastic cells must be formed.022 inch allows a wide mnge of wire sizes to be used. . t\do scena os can develop depending on whether the force . Class III rnalocclusion = B Class III malocclusion has the mandibular molar olaced forward or anterior to the maxillary molar. a tooth. . Light force: the use ofliglt forces causes smooth continuous tooth movement without formation ofa sig_ nificamly hyalinized zone in the PDL. but the timing of osteoclestiq not osteoblaslic. As a result teeth start to move earlier and in a more physiologic way than do teeth subjected to hea\y forces. Facts about molar uprighting: .). Important: For a tooth to move. removing bone in the process of"fiontal resorption" which begins tooth movement.*** A severely tipped molar or one that requires mesial movemmt to shorten the pontic space requires a longer treatment time.lniti^l peiiod (from secoruls to weeks)t causes n?crosis. The bracket slot size of0. Osteoclasts attack the adjacent lamina dura. The tipped second molar should be banded because ofthe considerable posterior masticatory forces produced can easily shear offbonded brackets. The altemate slot size is 0. This ranges ftom approximately 2 months (simple uprightind to 6 monrhs (uprighting plus osseous s rgery. Molar uprighting treatment in high angl€s cases will tend to result in excessive bite opening (increases vertic a I d imens i on of occ lusion).

Class II.6s dr rcpbdu. Class I .right O 201l-2012 . All iights tlld.tal D€cks .. *iihour rhe prior vndm pemi$ion ofn\e Uniwniiy of washingror For infomation.nrisb) F CNemcd by a hcmse. .De. l'cosd4u ahinebn. Crowding ofpermanent incisors in mixed dentition . Lack of spacing in primary dentition .diaric D. Unourhonz. cm..2012 .ertu 45 Copyrighr e 201 I .d e.. Class III kr Copynghr 2000-2004 Unrvsitv of Wasbingio.id is foibidd. Division I Class II. .d Aees to rhe Arlas of P. Premature loss ofmandibular primary canines Larger than normal primary teeth 44 Cop).Dental Decks . Division 2 ..

malformed teeth.The significance of the lack of sp. .There may be a dispropo.. during eruption.l growth problem. and essentially non-existent in the mandible. about 6 mm narrower mesio- di\rally rhan lheir successors. Division I = maxillary incisors (centrqls qnd laterals) are in extreme labioversion. 2.. Supemumerary teeth. The premature loss ofthe primary canines. Arch perimeter does increase after eruption ofthe incisors. When the canine is shed. Therefore. the alveolarprocesses are covered by gum pads. Division 2 is a malocclusion in which the body of the mandible and its superimposed dental arch are also in distat relationship to the maxilla. Anterior teeth are most likely to be fractured in children with this n ne of mixed dentition malocclusion. The age at which it is treated depends on the problem involved. . The maxillary anterior primary teeth are about 7570 ofthe sizc oftheir permanent successors.r primary canine reflects insuflicient arch size in the anterior region. l. on average. Less fiequent causes ofmalocclusion include habits such as thr-rmb sucking or tongue thrusting- Signs of incipient malocclusion: . 4. the mandibular arch is posterior to the maxillary arch when the pads contact. The maxillary arch is horseshoe-shaped and the gums rend !o extend buccally and labially beyond those in the mandible. impingc on the roots ofthe primary canines causing them to resorb. As such. 5. the midIine will shift in thc direction ofthe lost tooth. and the maxillary canines occlude mesial to the mandibular canines. impacted or lost teeth and teeth that eiupt in an abnormal direction may contribute to malocclusion. II. furthermore. Malocclusions are more identifiable in children 7 to 9 years old because the eruption of permanent incisors reveals tooth-arch length discrepancies. The lack ofinterdental spacing in the primary dentition . Howeveq it is a small increase rn the maxilla. I . 3. '.The premature loss ofthe mandibul. The crowding ofthe permanent incisors in the mixed dentition . Division I type. The big difference between Division I and Division II is in Division II the maxillary laterals have tipped labially and mesially. and the molar and canine occlusion are the same as Class II.I . 2. You will have lateral and lingual migration of the mandibular incisors.tion between the size ofthe maxilla and mandible or between the jaws and tooth size resulting in overcrowding ofteeth or i1r abnormal bite pattems. particularly in the mandibular arch /Noae*lil .. Rememberi An anterior crossbite in a primary dentition usually indicates a skelet. At birth. There is no set rule as to when a malocclusion should be treated. which soon are segmented to indicate the sites of lhe developing teeth (called gum pad stage). the minimal arch grofih does not usually contribute to further dental alignment. the crowns ofthe lateral incisors. Class Remember: Class II. The mandibular anterior primary teeth are.cing relates to the increased mesiodistal width of the Permanentteeth. The distobuccal cusp ofthe maxillary first molar occludes in the buccal developmental groove ofthe mandibular first molar.

Dental Decks . Skeletal cross bite 46 Coplright C 201l-2012. Dental open bite . 70. 45 . 35 . ?5 47 Coplrighr O 201 1-201 2 . Dental Decks \ .. Dental cross bite . 5n. Skeletal open bite .60.

Chronic tonsillitis . Deviated nasal septum Note: The earliest possible diagnosis ofthis open bite is essential because the condition is not self-correcting and usually worsens with time. The triangular ridge ofthe mesiobuccal cusp ofthe maxillary first molar articulates with the buccal groove ofthe mandibular first molar. Maxillary canine lies between the mandibular canine and first premolar. The mandibular incisors occlude even more posterior to the maxillary incisors so they may not touch at all. The maxillary central incisors overlap the mandibulars. It is most commonly caused by a discrepancy between tooth structure and the amount ofsupporting bone length. Class I is associated rvith an orthognathic (straigh) facial profrle where the nose. Maxillary canine is mesial lo mandibular canine. . and chin are harmoniously related. Class II: less common (about 25 %r'). The maxillary canine is distal to mandibular canine. Anterior open bites can be classified as a form of apertognathism (which neans open bite deJbrmity) Classification of Human Occlusion (Angleb): . Narrow oropharyngeal space . Class III is associated with a prognathtc (concave) facial profile. (the buccal groove ofthe mandibularfrst molar articulotes qnteiorly to the mesiobuccal cusp ofthe marillaryfrst molar) The chin may also protrude like a bulldog's does. . it should be perpendicular or slightly obtuse. Narrow face . The mandibular incisors overlap anterior to the ma"\illary incisors. The mesiobuccal cusp ofthe maxillary first molar falls approximately between the mandibular first molar and second molar. Cfass I: most common (about 70 o% of the populatior). . The mesiol:uccal cusp of the maxillary first molar falls approximately b€tween the mandibular first molar and the second premolar (the buccal groove of the mandibular first molar articulates posteriorly to the mesiobucctl cusp of the maillary Jirst molar).The following factors are associated with chronic rrouth breathing: . The lowerjaw and chin may also appear small and withdrawn. Class ll is associated with a retrognathic (convex) facial profile. Allergies . lips. Class III: the least common (less than 5 Zo). Note: The nasolabial angle is the angle between the base of the nose and the upper lip. Chronic rhinitis: inflammation ofthe mucous membranes ofthe nose .

Denral Decks . The first statement is false. Both statements are true . SNA angle of> 84o .. D€ntal Decks . the second statement is true . the second statement is false . The first statement is true. ANB angle of < 4' . SNB angle of< 78' . None ofthe above 4A Cop)'righl O 201l-2012. Both statements are false 49 Copyrigh O 20:l-2012 .

. There may be difficulty in masticating ifonly a few teeth meet. The mandibular incisors will most likely be tipped forward. As children mature their profiles become less convex. *** A concave . This is often indicative of of a Class III malocclusion. The maxillary incisors will most likely be tipped lingually. Referral to a speech therapist is helpful because both patient and parents are likely to benefit from the counseling. swallowing and mastication). lips and chin are harmoniously related. Severe mdocclusion may compromise all aspects oforal function. swallowing and speech. profile is also termed prognathic. An orthognathic profile is one in which the nose. Even less severe malocclusions tend to affect mastication. A r€trognathic profile is one in which there is a protruding upper lip or the appearance of a recessive mandible and chin. Note: The ANB angle describes the relation of the maxillary and mandibular denture bases. It can be difEcult or impossible to produce certain sounds in the presence of severe malocclusion. 5. . A prognathic profile is one in which rhe mandible is markedly forward the maxilla giving a concave midfacial appearance. when no clarification is given these tenns refer to the mandible. \otes 1. This relationship is usually accompanied by a Class I dental 2.e. For example. An SNB angle of < 78' indicates mandibular retrognathism and an ANB angle of < 4' indicates a harmonious skeletal profile. 4. severe lip strain @eeded to bring the lips into closure). Important: A bimaxillary dentoalveolar protrusion means that in both jaws the teeth protrude. The convexity is due to the relative prominence of the maxilla compared to the mandible. not so much by making the function impossible as by requiring physiologic compensation for the anatomic deformity. 3. This condition is seen in facial appearances in 3 ways: excessive separation of the lips at rest (rnco mpelence).**x Remernber: An SNA Algle of> 84' indicates maxillary prognathism. andjaw discrepancies may force adaptive alterations in swallowing. and speech therapy may require some preliminary orthodontic treatment. Speech is affected in severe malocclusions along with other oral fturctions (i. patienls with a skeletal Class III malocclusion sometimes have difficulty pronouncing "f' and "v" soutds. This relationship is usually accompanied by a Class II malocclusion. or convex profile. Although the maxilla can be termed prognathic and/or retrognathic. and prominence of lips in the profile view.

Class Class II malocclusion III malocclusion . Underbite or prognathism 50 Copright O 201l-2012 . Class I malocclusion .D€nhl Deck . Overbite or retrognathism . Normal occlusion 51 CoplriSht O 201l-2012 . Underbite only .. Retrognathism only . . Overbite only .Dental Dects .

The protruded maxillary incisors (centrals and laterals). . Ectopic eruption of maxillary central incisors . Class III subdivision is a Class III relationship of the teeth on one side Class $ ith a Class I relationship on the other side. The mandibular incisors are usually tipped lingually and forward to the maxillary incisors. . the patient has the ability to bring the mandible back $ithout strain so that the mandibular incisors can touch the maxillary incisors (this ability is ofren considered diagt?o. however. Minor transverse maxillary discrepancy Notei It has also been suggested that these sequelae occur more frequently in subjects with a prognathic mandible (ptimary cause) and the mandibular shift can be considered a functional (envi . Division 2: a distal relationship ofthe buccal groove ofthe mandibular first permanent molar to the mesiobuccal cusp ofthe maxillary first permanent molar along with the maxillary laterals being tipped labially and mesially (sometimes actually overlapping the centrals).ttlc). Class II.o mehtal) factor. maxillary overjet. Also characteristic ofthe "true" Class lll malocclusion is the prognathic mandible. while the maxillary canine is an exaggerated distal relationship to the mandibular canine.Those malocclusions in which there is a illa make up Class II. This type is therefore a milder form ofthe "true" Class Ill malocclusion and more amenable to conservative orthodontic novement than the "true" Class lll malocclusion u. The maxillary first molar therefore occludes distal to the mandibular first molar. The maxillary centrals are usually retruded somewhat. the unilateral distoclusion is referred to as a subdivision of its division. "distal" relationshio ofthe mandible to the max- Divisions of Class II malocclusions are as follows: . Class II. For example: . therefore the postnatal causative factors may not be the pnmary cause.hich often requires sugrcal corection. Prenrature loss of deciduous molars Functional factors: . Division l: a distal relationship ofthe buccal groove ofthe mandibular first permanent molar to lhe mesiobuccal cusp ofthe maxillary first permanent molar along with the maxillary incisors (centrals and laterals) tn extreme labiovenion @rchuded). pseudo-class III malocclusion is one in which the mandibular incisors are forward ofthe maxincisors when in centric occlusion. are usually confined to one side ofthe maxillary arch. *** Subdivisions: when the distoclusion occurs on one side ofthe dental arch only. and other anterior aberrations. Anomalies in tongue position . Class II. Division I Subdivision: one side of the maxillary arch is in a Class II relationship with its occluding mandibular quadmnt while the other side is in a Class I relationship. III malocclusions arc those in which the body ofthe mandible and its superimposed dental arch are in a mesial relationship to the skull base and maxilla. Naso-respintory or airway problems Skeletal factors: . --\ illao Different etiological factors have been suggested in pseudo-Class Dental factors: lll malocclusion: . Neuromuscular features .

orric De isq is golemcd by a liccM.20 12 .gron AU nelb t*ryed Ae csrorheAilN orP. . *inh p€misio. Class I 1 Class II.cdr 52 CoplriSht O 201 I. Division 2 . Class II. Dmtal Decks . "Pseudo" Class III malocclusions .Dental Decks . "Sunday bite" . Division .icuiry oiwshington. is fodiddm wirhour rhc pno. All ofthe above Coplright O 201l-2012 .. Unau tlorird redr d ig'odudio. For infmrion. con@r li 6sc(4u. oarhc U. Class III Coplttlt 2mG2004 Univmity ofwahi.d.wshins1m. "True" Class III malocclusions .

the incidence of malocclusion in a homogeneous population generally is lower. The first t. Remember: Class II. hich is forward to normal. crowding) canbe superimposed upon In most cases Class II. functional or apparent). Mandibular incisors are forward of maxillary incisors in centric occlusion bul the patient can bring the mandible back without strain so that the mandibular inciso$ touch the \r \ote: In order to ayoid maxillary incisors.?e is considered to be a positional form. Division I Subdivision includes malocclusions. while the other side is in a Class I relationship. various abenations in the individual alignment ofthe teeth (for example. Avoiding the risk ofperiodontal problems to mandibular incisors caused by the traumatic occlusion due to the crossbite. . such as bruxism that can develop from antenor or posterior interferences ." In most cases they have an edge-to-edge bitc. which have one side ofthe maxillary arch in a Class II relationship with its occluding mandibular quadrant. this class. Division 1 malocclusions. . T}le benefits attributed to the treatment ofpseudo-Class are: lll malocclusion in the mixed dentition . Preventing functional posterior crossbite \ote: The "Sunday bite" is a term given to the forward postural position ofthe mandible which is adopted by people with Class II profiles in an effort to improve their esthetics. Besides the labial axial inclination ofthe maxillary incisors (overjet). the relationship ofthe maxillary first molars and canines to their mandibular counterparts is such that the distobuccal cusp ofthe maxillary first molar occludes in the buccal developmental groove ofthe mandibular first molar and the maxillary canines occlude mesial to the mandibular canines. as a result of a mesial displacement ofthe mandible into an anterior position and has been named in a different ways (pseudo. Gaining space for eruption ofcanines (lack of space could be catsed by retro-inclination of upper incisors frequentlyfound in pseudo or Class III malocclusion) .the body ofthe mandible and its superimposed dental arch are in a distal relationship to the maxilla and the ma. III malocclusion) is an anteroposterior dentoalveolar relationship characmore anterior position ofthe mandibular dentition compared to the maxillary dentition. Preventing unfavorable growth ofskeletal components (infact. This may look like a Class III position in the absence ofa true skeletal Class lll relationship. Hence termed 'pseudo Class lll malocclusion.rillary incisors are usually in a labial axial inclination. The maxillary overjet or other anterior aberrations are usually confined to one side ofthe maxillary arch.{ote: Relative to a heterogeneous population. Mesio-occlusion 1Class a terized by the interference of teeth. In addition. there are two types of mesio-occlusion. a patient Inay adopt a jaw position on closure.The other form of mesio-occlusion is a truc skeletal Class lIL Thc characteristics ofthis malocclusion result from a combination ofskclelal and dentoalveolar features. ). Clinically. early treatment ofanterior crossbite can help lo ninimize adaptations that ate often seen in seyere late adolescent maloc- ch6iotl) and habits.

Discrepancy between tooth size and supporting bone 51 Cop)right O 201 I -20 l2 .righr O 20ll-2012 . Down's slndrome . Rickets .Dentaltr€cks .. Al abnormal flenum .. Hlperparathyroidism Cop.Dental Deck . Mandibular incisor crowding . Hereditary gingival fibromatosis . Uneven growth of the arches .

maxilla. Physiologic occlusion: although not necessarily an ideal or Class I occlusion. insulficient alveolar qrch length to qccommodate all teeth in ideol alignment qnd in q good sqgittql position). Abnormal position ofthe crypt . diagnosed in a 5 year old child. However.:. A space deficiency exc€eding 4mm usually indicates extraction for correction of the malocclusion . l. Th€ patient should be ref€rred to the orthodontist for this analysis. . When a diagnosis is made that crowding does exist and this crowding exceeds 4 mm in the mandibular arch. The most common cause ofClass I malocclusion is a discrepancy between tooth structue and the amount of supporting bone (length). Supemumerary teeth . Pathologic occlusion: cannot function without contributing to it's own destruction. Congenital absence . Lack of space in the arch (crowding) . pulpal changes ranging from pulpitis to necrosis and periodontal changes. it l{oted. *** This condition can result in the premature exfoliation of primary teeth The generalized eruption failure or "primary failure of eruption" is caused by the failure ofthe eruption mechanism itself. It may manifest itselfby any combination of: excessive wear ofthe teeth without sufficient compensatory mechanisms.. extractions are often required to attain an excellent.. In general: when the space lacking is less than 4mm.). etc. the alveolus resorbs after the extraction until finally the alveolar ridge completely atrophies. 2. Bone resorption proceeds normally. the decision whether to exftact teeth depends greatly on a space analysis performed on the mandible. primarily affects the growth of *** The bone the alveolar bone fas opposed to the midface. Tooth movement caused by pathologic conditions is termed pathologic tooth movement. The involved teeth do not erupt spontaneously and are not amenable to any orthodonlic recourse.l nitely. Dilacerated roots Remember: Anodontia. in most cases it can be obtained by carefully stripping some interproximal enamel from each ofthe antedor teeth . is an occlusion that adapts to the stress of function and can be maintained indefi.The cephalometric analysis ofthe Class I occlusion would indicate an ANB angle ofless than 4 degrees signif ing a harmonious skeletal prohle and sagittal harmony between the maxillary and mandibular dental arches. 3. This condition is rare. and ifa tooth is extracted. The localized causes of failure of eruption or the delayed eruption of the teeth include: . or mandible.TMJ problems. Perhaps the most prevalent characteristic ofClass I malocclusion is crowding (i. alveolar bone never forms in that area..e. stable result. Ifa tooth fails to erupt. ofthe alveolar process exists only to support the teeth. but involved teeth simply do not follow the path that has been cleared.

the primate space is located between the lateral incisors and . In the maxillary lareral incisors arch. the primate space is located between the canines and first molars the mandibular arch.Denral Declis "Primate spaces" in the primary dentition are found in which TIYO locstions? . Negative pressure created within the mouth during sucking is not considered constriction of the maxillary arch .Atl ofthe following statements regarding the effect ofenvironmental influences during growth and development ofthe face. Patients who have excessive overbite or anterior open bite usually have posterior teeth that are infra. jaws and teeth are true EXCEPT ongWhich one is the EXCEPTIOM . the primate space is located between the lateral incisors and canines Coplright C 201l-?012 DenralDecks . cannot be indicted with certainty as an etiologic agent ofa long-face pattem ofmalocclusion because studies show that the majority ofthe long-face population have no nasal obstruction 56 CoDrjght aq 20 I I 20 I 2 .In . In the maxillary canines arch. "Tongue thrust swallowing" leads to an open bite a cause of . the primate space is located between the central incisors and .or supra-erupted respectively . "Adenoids" which lead to mouth breathing.ln the mandibular arch. A non-nutritive sucking habit leads to malocclusion only if it continues during the mixed dentition stage .

This slacing is most frequently caused by the growth ofthe dental arches. IDterproximal cavities. The negative pressure created within the mouth during sucking is not what causes the maxillary constriction. sucking habits. mefl the termiral plane is straight until the arival ofth€ first permanent mola$. Space closure occun mpidly whether spacing is present or not prior to the loss. The mandibular second primary molar usually is somewhat wider mesiodistally than the maxillary giving dse. that does. 2. Primary dentition strge: . Starts with the eruption of the primary teeth and lasts until the first permanent tooth erupts . to a flush terminal pleDe at the end ofthe primary dentition stage. The tendency to place the tongue forward between the teeth (in cases ofanterior open bite) appears to originate from the need to attain an oral seal during swallowing. Remember: One ofthe most common cruses of malocclusion is inadequate space management following the early loss of primary teeth. So. but become somewhat larger as the child gtows and the alveo_ lar processes expand. Space maintenance would be indicated. the for- ward position ofthe tongue during swallowing is due to the arterior open bite. not the cause. These primale spaces are normally present from the time the teeth erupt. Tle mesiolingual cups ofthe maxillary molars occludes in the central fossae ofthe mandibular molars. It is the force from the buccinator muscles 1.Recent studies indicate that "tongue tbrust swallowing" can not be blamed for an open bite as it was shown that there is no tongue-force on the teeth during swallowing even though the tip ofthe tongue is placed forward. Boys prccede girls in total number of teeth erupted until I 5 months. if there is no spacing present and the primary anterior teeth were in contact before the loss. . and the incisors are vertical. with minimal overbite and overjet. . a collapse in the arch after the loss ofone ofthe primary incisors is almost certain. then girls surpass boys and r€main ahead throughout completion of the primary dentition . If spacing is present. Dist l step: the mandibular terminal plane is distal to the maxillary termidal plane . Generalized spacing ofthe primary teeth is a requireme[t for proper alignment ofthe permanent incisors. typically. the latter are usually guided into aD ideal end-to-€nd relationship considered "nomal" for whites in North America. r** Spacing is normal throughout the anterior part ofthe primary dentition. Developmental spaces between the incisors arc often present from the beginniDg. there is a possibility that dritting ofthe adjacent teeth will occur if there is a loss of a primary incisor. but is most noticeable in these t$o locations. the reverse is not true tongue thrust swallow therefore should be considered the result -"A ofdisplaced incisors." A sucking habit that is stopped prior to mixed dentition has not been shown to lead to malocclusion. However. lmportrnt: This is not true in the case ofa lost permanent incisor. or the skeleial pattem may Foduce a 'step" mther than a flush termiDalplane . Mesial step: the mandibular terminal plane is mesial to the maxillary terminal plane .

Dental Decks . Tooth #22 is erupting distally . Tooth #22 is erupting lingually . Primitive relationships . . Tooth #22 is erupting mesially . Tooth #22 is erupting facially CoplYiSh O 201 I 59 '2012 .. Occlusion relationships 58 Coplrighi O 201 I -20 12 .Dental Deck . Class relationships Step relationships .

The primary molar relationship shown in the figure above is a mesial-step relationship. but usually they are displaced labially ifthere is not enough room to accommodate them within the arch. the first permanent molars are in a Class Il relationship. This figure demonstrates the fl ush-terminal-plane relationship for primary molars.the fiIst permanent molars do not erupt immediately into normal relationship. l. However. Both the mesial-step and flush-terminal-plane relationships usually result in the development of a Class I permanent molar occlusion. 2. the permanent incisor tooth buds lie lingual as well as apical (inferior) to the primary incisors. Note that the permanent nolars are in a normal Class I occlusion. In both the maxillary and mandibular arches. This is termed a distal-step relationship. 4. As you can see. these teeth can be displaced either lingually or labially. lmportant: The terminal plane relationship ofprimary second molars detennines the future anteroposterior positions ofpermaneot firct molars. The Class II relationship usually is temporary until the second pdmary molars are lost and the permanent nolars move into a Class I relationship. Permanent teeth normally move occlusally and buccally while erupting. The mesial inclined plane ofthe primary maxillary canine articulates with the . This occurs at approximately age ten or eleven and is called the late mesial shift. This is the normal rela'*aii' tionship. . a Sometimes the permanent mandibular canines erupt facially relative to th€ primary canines. Ifthere are problems in eruption. This occurs even in children who have normal dental arches and normal spacing within the arches. In these cases (ie/ashlerminal-plane). although the flush-terminalplane relationship can result in a Class ll relationship ifthe late mesial shift does not occur Another stcp relationship involves a situation where the distal suface of the mandibular primary second molar is located to the distal ofthe distal surface ofthe maxillary primary second molar. often they are right in line with the primary canines.\oto* distal inclined plane of the primary mandibular canine.. The result is a tendency for the mandibular permanent incisors to erupt somewhat lingually and in a slightly inegular position. 3. The mesial-step molar relationship allows for the first permanent molars to erupt into a normal occlusion immediately on eruption. The distal surfaces of the maxillary and mandibular second primary molan are in an end-to-end relationshio. In these cases. . Remember: The maxillary arch is sli glttly longer (approximately 128 mm) than the mandibular arch (approximqteu 126 mm )- . the permanent molars erupt into a Class ll relationship. as the distal surface of the lower second primary molar is mesial to the distal surface ofthe upper second primary molar.

Both statements are false 60 Copyright () 2011. Denial Decks .. the second statement is true . the second statement is false . She is mixing up overbite and open bite She is mixing up overbite and negative ovedet She is mixing up her cartoon characters 6t Cop)'rigbt O20ll-2012 .201?. Both statements are true .Dental Decks . . . She is mixing up overbite and ovefet . The first statement is false. The first statement is true.

Urmity of w.ch sid€. and finally glowth in height. Note: This is referred to as "the late mesial shift ofa permanent first molar. For the maxilla and mandible: Crowth in the width is completed first. The important factor is that some space will be avaihble in the posterior palt ofthe mouth. a maxillary central diastema of2 mm or less close spontaneously. of rh. codrc!: lr- Overjet is the horizontal projection ofthe maxillary anterior teeth beyond the mandibular anterior teeth (labial axial inclination of the maxillary incisors). 3. 4.tiiry is govmed by a I'cea. Maxillary and mandibular arch widths increase and this is completed before the adolescent growth spurt 5. the spaces often will will probably close.1 U. then growth in length. 2. All A116 of PediaEic Dr. conbd. ImportsDt: l.5 mm on e. Normal overjet is 23 mm. Unau Overjet thdiad &c6s d repiodnc ton is foibiddo wilhour thc pnor xit6 tcmhsio. the permanent first molars generally move mesially into the leeway space after the primary second molars are shed. li Overbite is the vertical overlapping ofthe maxillary anterior teeth over the mandibular anterior teeth. non is fodiddcn wirhoui ihc pnor wntm pc6i. while total closure ofa diastema initially geater than 2 mm is unlikely. During the canine-premolar transition period. Overbite is generally is 10ok to 2jo/"but can vary up to 50olo. the mesial drift tendency ofthe posterior teeth in general. ..N3 ro ihc Arhs ofrediaEic Dentisry is govmed by.i vasiq or wxhintton All Overbite (deep bite) ndts rs. The diff€rence is called the leeway space. liccNe Unlu rhorized rcc6s or rarcdu.ion or $e Unirsiq ofwnhinEm For intbmdiom. The dental arch perimeter (length) decreases a surprising amount during the late adolescent and young adult periods due to the late mesial shift ofthe permanent molan into the leeway space. *** This size di{ference has clinical significance.srq. and the lingual positioning of the incisors. With the eruption of the permanent canines.*** There is typically more leeway space in the mandibular arch. The permanent dentition stage begins when the last primary tooth is lost. 2. Overjet rvhereas overbite is in the vertical direction. Cop)ri8hr 2000-2004 Un! ve6i9 of washi.5 mm on esch side while the maxillary leeway space averages about 1. the permanent incisors "spread out" due to spacing. *** This is a common la)?erson mistake. The primary anterior teeth (ihcisots ahd canines) are narrower than their permanent successors mesiodistally. As a g€neral guideline. is in the anterior-posterior dimension. 6. Coprrighr 2000 200. The mandibular l€eway space avemges about 2.d. This is referred to as the "ugly duckling stage"of development. Increases in the vertical height ofthe jaws and face continue until 17 or l8 in girls and in the earlv twenties in bovs. which are generally larger than the primary canines. The primary molars are wider than their permanent successors mesiodistally.shinEon For infomnim." l On occasion. thus causing a loss in arch length. Ac. This leeway space serves to at least accommodate the permanent canines.

Mandibular first molars .2012 . study models and a prediction table . It . Maxillary incisors Copldght O 201 I -20 12 . space required the permanent teeth erupt .Dental Decks . Analysis is done for each quadrant Coplriglft O 201 1. Maxillary first molars .. It is performed during the mixed dentition is performed with a boley gauge. It determines space available vs. It is used to predict the amount ofcrowding after . The analysis is based on a correlation oftooth size .Dental Deck . Mandibular incisors .

A negative number = crowding . there are two very important aspects to the mixed dentition period: L The utilization ofthe arch perimeter The adaptive changes in occlusion that occur during the transition from one dentition to another. . . Follow the same steps as described for mandibular teeth. orthodontic inter\'ention. Therefore. proximal contacts are tight. The total leeway space is the important clinical consideration and the method leeway space is the key factor in th€ transitional dentition. . The number for the right canine and premolar crowding or excess space . since they show too much variability in size. a negative number indicates crowding *** At this point. Subtract #5 from #4 on each side """ Once again. The analysis is based on a cofielation oftooth size. From a clinical point ofview. ofutilization ofthe *** This is false. the earliest indication ofa mixed dentition consists ofthe prirnary dentition and the permanent mandibular first molars. Supervision ofa child's development ofocclusion is most critical during this mixed dentition stage.e (nesiodistal \|idth) ofthe mandibular incisors that have already erupted into the mouth early in the mixed dentition. thc most appropriate approach to management is to take study models and perform an arch length analysis. The maxillary incisors are not used in any ofthe predictive procedures. . That period during which primary and permanent teeth are in the mouth together. The number for the left canine and premolar crowding or excess space *** Add the three numbers: . . The number for incisor crowding or excess space . it is an ideal time for most majo. A positive number = space Note: For the maxillary arch. one may measure a tooth or a group ofteeth and predict accurately the size ofthe other teeth in the same mouth. as well as mandibular pos- lf mandibular antcrior crowding is notcd during thc mixcd dcntition phase. Calculate ftom the prediction table the size olthe canine and premolars 6. :. Mired dentition stage: . . Procedure for rnixed dentition analysis: L \4easure the mesial-distal diameter ofthe mandibular incisors and add them together 2. Subract # I from #2 *** A negative number indicates crowding in the incisor region -1. Veasure the space available for the rrandibular incisors 3. \ormal characteristics ofthe mixed dentition stage: molar and canine relationships are Class l. there will be 3 numbers: . The elveolar process is one ofthe most actively adaptable areas ofbone growth during the period of Eansition between the dentitions. analysis is done for each arch. use the mandibular incisors to predict the size ofthe max- illary canines and premolars. This mandibular incisor crowding usually results from a tooth size-arch length discrepancy. \leasure the space available lor the canine and premolars on each side ofthe arch 5. In thc Moyers' mixed dentition analysis. well-aligned incisors or up to moderate crowding ofthe incisors. the size ofthe unerupted canines and premoJars is predicted from knowledge ofthe siz. lec$ay space is present. Notei The mandibular incisors are measured to predict the size ofmaxillary terior teeth.A mixed dentition an^lysis (transitional dentition analysis) detemines space available versus space required.

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