Ortho appliances and usage

Basics:

SNA=maxilla to cranial base

SNB=mandible to cranial base
ANB=maxilla to mandible

SNB “80” :
increase-> PRO MAN
decrease-> Retero MAN

SNA “82” :
increase-> PRO MAX
decrease-> RETRO MAX

ANB “2-4 “
Increase = class II
Decry = class III

Cephalometric superimposition
To evaluate the skeletal and dental changes that occur over time due to growth or
treatment

Development of occlusion
Gum pad stage
Form birth to 6 months ending with eruption first primary tooth

Primary dentition stage

From 6 months to 6years ending with a first permanent tooth
Children often have minimal overbite and overjet

Mixed dentition stage

6 years to 12 years ending with last primary tooth extract

Ugly duckling stage

11-12 years
Diastema less 2 bet upper central incisors
Mesial eruption of canine should close the space
Dr.baraah Hamid

Appliances:

1-Posterior crossbite =narwo maxillary deficiency

-should tx early if functional shift
-can treat later if it not functional shift
The mid palatal suture is less interdigitated so it easier to make palatal \
Expansion

(Quad Helix)

(Haas, Hyrax)

2-Anterior crossbite:
• One tooth or a few teeth
Wear and gingival strain
Tx: 2*4 =two brackets in molars and four incisors only one arch or active retainer
with finger spring

• Full underbite due to skeletal class 3

Tx:reverse pull headgear

2
Dr.baraah Hamid

3-severe over-jet:
• increase trauma risk
• Psychosocial concern
Tx: 2*4, headgear

4-anterior open Bite

-Thumb sucking
• narrow maxilla with posterior cross-bite
• Proclined maxillary incisors and retroclined mandibular incisors

-tongue thrust
• pt position tongue anteriorly during swallow
• Proclined incisors with generalized spacing
Tx: habit appliance like rake or blue grass

3
Dr.baraah Hamid

5-palatal impingement: deep bite

Lower incisors are biting in soft tissue of palate
• pain/ discomfort/ trauma gingiva
Tx: maxillary bite plate

Moderate crowding
Equal or More than 4 mm crowding
Tx:lip bumper, The Lingual Holding Appliance (LLHA)

Sever crowding:
Equal or More than 8 mm crowding
Tx:serial extraction(C-D-4)

4
Dr.baraah Hamid

Headgear

Growth modification: only during growth

8-13 for girls
10-15 for boys

Should wear 12-14 hours per day

1-high-pull headgear
For class 2 open bite

2-cervical-pull headgear
For class 2 deep bite

3-J-Hook Headgear
For retraction of canines and incisors

4-Reverse-pull Headgear/facemask/Frankel
For class 3 maxillary deficiency

5-chin cup
For class 3 mandibular excess/ prognathic mandible

5
Dr.baraah Hamid

Functional appliances =removable

Passive tooth born depends on soft tissue and muscles

Modified growth at condylar/ For skeletal Class 2 correctors with mandibular

deficiency
( Bionator-Activator- Twin block appliance)

( Herbst appliance)

(MARA) Mandibular Anterior Repositioning Appliance

6
Dr.baraah Hamid

Twin block=fixed or removable

MARA=fixed
Herbst=Fixed tissue born
Bionator : tooth borne
Frankel class 2-3

Frankel FR – III= class 3

The only tissue borne functional appliance

7
Dr.baraah Hamid

Palatal expanders

*•rapid palatal expansion* :- 0.5 mm per day (two quarter turns of the screw)
*•slow palatal expansion* :- -0.25 mm per day or every other day (rate of less
than2 mm per week).

(Schwartz appliances- W-arch- Quad helix- Hyrax appliance- Hass appliance-

transpalatal arch)

haas expander = Posterior crossbite =narwo maxillary deficiency

The only tissue borne maxillary expansion

1-Schwartz appliances
Removable - jackscrew, dental tipping,
For mild posterior crossbite

2-Hyrax appliance most common

8
Dr.baraah Hamid

Mixed dentition appliances:

Nance appliance-lower lingual holding arch-lip bumper
-Nance appliance:
• Upper arch/space maintainer or close space like anchorage.
Permanent dentition appliances
Aligners-Braces

Elastic recoil:
Allow time for recognization of soft tissues fibres
PDL fibers reorganise in 3-4 months
Gingival fibres 4-6 months
Supracrestal fibres 1 year or more
Superacrestal fiberotomy for teeth that had sever rotation

Hawley retainer
Most common
Acrylic on palate=connector + overbite control
Labial bow= incisor retention
Adams clasps=molar retention

Vacuum formed retainer