ORTHODONTICS 1

MIDTERMS LECTURE

GROWTH IN THE NASOMAXILLARY COMPLEX & MANDIBLE AND EFFECTS ON DENTITION

AND OCCLUSION

GROWTH IN THE NASOMAXILLARY COMPLEX

Maxillary
● Two mechanisms are involved: +4-5mm between 6-16 years of age
○ Growth in cranial base pushes
maxilla forward Intermolar Width

○ Active growth of maxillary structures +2-3 mm between 6-16 years of age

and nose Mandibular

● Bimolar width of the 6’s correlates with:

○ Vertical growth of the maxilla Maxillary
○ Growth in the midpalatal suture Decreases slightly during transition to early
mixed dentition
○ Growth in height +1-2mm with emergence of permanent incisors
–2mm~ with loss of deciduous 1st and 2nd
molars
By late adolescence, dental arch in the maxilla Arch Depth
drifts forward by 5mm in the molar region and Decreases slightly during transition to early
mixed dentition
2.5mm in the incisor region; thus, shortening the Maintains dimension with emergence of
dental arch perimeter permanent incisors
–2-3mm~ with loss of deciduous 1st and 2nd
molars

GROWTH IN THE MANDIBLE Mandibular

● From 7-16 years of age:

Maxillary
○ Ramus height ↑ ~1-2 mm per year +4-5mm during early mixed dentition
○ Body length ↑ ~ 2-3 mm per year –4mm during late mixed dentition

● Variation in mandibular morphology and Arch Perimeter

size contributes significantly to most
+2mm during early mixed dentition
malocclusions than that in the maxilla
–4-6mm during late mixed dentition
● The upper and lower dentitions must adapt –3.5(♂)/4.5mm(♀) between 8-15 yrs
during development if there are significant Mandibular
variations in mandibular morphology
● Typical tooth displacements noted early in
the life help to predict the ultimate molar Leeway space
and incisor relationship
● Different size
Maxillary between primary
+3mm during transition to early mixed molars and
dentition
+2mm with eruption of permanent premolar
changes
Intercanine Width
+3mm during transition to early mixed
dentition
Little to none eruption of permanent
changes
Mandibular
 ● The maxilla is not easily divided into a core of
bone and a series of functional processes
● The maxilla experiences a small and variable
degree of rotation, forward or backward
● At the same time, internal of the maxilla is
occurring, there are varying degrees of modeling
the palate

***forward rotation is the more usual pattern

TIMING OF GROWTH IN THE MAXILLA AND
MANDIBLE
● Completion of growth is achieved in definite
sequences:
1. Width
2. Length
3. Height
normal growth pattern of jaws
● Growth in width of both jaws and the dental
arches is usually completed before adolescent
growth changes
● Growth in length and height of both jaws
continues through period of puberty

ROTATION OF MANDIBLE DURING GROWTH

● The mandible experiences an internal rotation
of 10-15° and is associated with vertical facial
TIMING OF GROWTH IN THE MAXILLA
development
INTERACTION BETWEEN JAW ROTATION AND
TOOTH ERUPTION
● Rotational pattern of jaw growth influences
magnitude, direction and anteroposterior
position of tooth eruption
 ● The molars migrate further mesially during
growth than the incisors
● Because the forward internal rotation of the
mandible is greater than the maxilla, decrease in
mandibular arch length is greater than decrease
in maxillary arch length
Forward rotation in the maxilla:
● Greater or lesser degrees of rotation of the jaws
can occur and result in moderate variation of jaw
orientation even in individuals with normal facial
proportions
● Rotational patterns for growth may be different
for individuals who have “short-face” and
“long-face” types of vertical facial development

SHORT-FACE TYPE (Brachyfacial)

● Short anterior lower
face height
● Excessive forward
rotation of mandible
during growth
● Nearly horizontal
● Tips the incisor forward, increasing their palatal plane
prominence ● Low mandibular
plane angle
Internal rotation in the maxilla: ● Large gonial angle
● Deep bite
malocclusion and
crowded incisors usually seen

● Mandibular incisors erupt upward and somewhat

forward

LONG-FACE TYPE (Dolichofacial)

● Excessive lower
anterior face height
● Mandible shows
opposite, backward
● The normal internal rotation of the mandible rotation
alters the eruption of the incisors somewhat ● Palatal plane rotated
posteriorly posteriorly
● Increased mandibular
plane angle
 ● Anterior open bite malocclusion and
mandibular deficiency

Key Points:
● Variations in craniofacial morphology are a
primary source of serious malocclusions
● Natural controlling factors of craniofacial bone
growth include genetics, function, and general
bodily growth
● Nasomaxillary growth mechanisms involve
sutures, endosteal and periosteal surfaces, and
alveolar processes. Alveolar remodeling
contributes significantly to heigh, width, and
length increases correlated with eruption.
● Mandibular growth modes and mechanisms
are mostly intramembranously rather than
endochondrally determined. Areas of muscle
and tooth attachment are important parts of
growth and shape change. The condylar region
plays a special role in mandibular growth and
translation
 POSTNATAL GROWTH OF THE MANDIBLE

THE MANDIBLE
● The mandible undergoes the largest amount
of growth post – natally

LINGUAL TUBEROSITY
● Lingual tuberosity moves posteriorly –
deposition
● Prominence of the tuberosity is increased
by the presence of large resorption field just
below it
● Resorption field produces a sizeable
RAMUS
depression, the lingual fossa
● Ramus moves progressively posterior by a
combination of deposition and resorption

ALVEOLAR PROCESS
ANGLE OF THE MANDIBLE
● Adds to the height and thickness of the
LINGUAL SIDE OF THE MANDIBLE
● Postero – inferior = resorption body of the mandible
● Antero – superior = deposition

BUCCAL SIDE OF THE MANDIBLE

● Antero – superior = resorption
● Postero – inferior = deposition
 CONDYLE
● It was earlier believed that growth occurs at
the surface of condylar cartilage by means
of bone deposition

CORONOID PROCESS
● The growth of the coronoid process follows
the enlarging “V” principle

THE CHIN
● Prominence of metal protuberance is
accentuated by bone resorption that occurs
in the alveolar region above it, creating a
concavity
 WIRE BENDING

INTRODUCTION
● Purpose of an orthodontic appliance
whether it is removable or fixed, is to
produce controlled forces to move teeth
● A controlled force is one that corrects the
amount of force directed to stimulate the
histologic processes that must accompany
tooth movement.

● In a practical stand point, all orthodontic

movement are delivered by the wire
● The wire is the foundation of all orthodontic
appliance
● The wire is just not any wire but must be
properly selected in size and material
● It must be properly bent and tempered to
project the desired force
● The design of a wire in relation to the tooth
movement gives the immediate indication of
its efficiency
● Rod of the exact size in the tube can
revolve without resistance from the tube
thus it can move vertically or horizontally or
tip the tooth

CLASSIFICATION OF WIRE
1. Design or cross section form
2. Diameter
3. Composition
DESIGN
● Viewed at the tip or end wires maybe half
round, oval square or rectangle
● The different design of the wire increases
the efficiency of wires in a certain direction
● In orthodontics – principle of the rod and
tube
● Rod of lesser size in the tube can freely
move in the tube and creates a “play” where
it lessens its influence on the movement of
the tube’s direction
● Change the design of the tube and wire
other than round and if still fit perfectly to
each other, another force us produced
○ TORQUE – a force or system of
forces tending to cause rotation
● By simply changing the design, a more
efficient delivery of force and strength are
 produced because of the squareness of the
design of the wire and tube Stainless Steel (ss):
● Corrosion resistant iron
DIAMETER ● Advantages:
● In orthodontics, the diameter is expressed in 1. Resistant to corrosion in the
thousandth of an inch presence of oral fluids
● The cross-sectional design of the wire 2. Strength in small diameters
indicates the amount of material is used

Elgiloy:
● It is not a stainless steel
● It is a cobalt nickel spring alloy
● It is ductile easily workable
● More corrosion resistant than SS
● Composition:
1. Cobalt - 40% – toughness
2. Chromium - 20% – as mordant (fix
the color)
COMPOSITION 3. Nickel - 15% – hardness, malleability
● There are 5 metals used in orthodontics: and ductility
1. Gold 4. Molybdenum - 7% – hardness
2. Stainless Steel 5. Carbon - 15% – combining element
3. Elgiloy 6. Iron – firmness
4. Nickel Silver
5. Nitinol or Nickel Titanium

Gold:
● In pure state – soft malleable and ductile
● Is not affected by oral fluids
● Combining it to other metals like palladium
(widening the melting range of gold),
platinum (increase hardness and strength,
contributes to resistance to tarnish and oral
fluids)
● Copper and silver in small amounts
 CORRELATION OF THE DEVELOPMENT OF DENTITION AND FACIAL GROWTH
Relationship between the Development of the
Dentition and Facial Growth
1. Predental/Gum Pad Stage
a. Relationship of Upper and Lower Gum
Pads
2. Primary Dentition
a. Situation before transition
3. Mixed Dentition Stage
a. First transitional period
b. Intertransitional period
c. Second transitional period
4. Apical area
a. Enlargement of the Apical Area
b. Anterior section of the apical Area
PREDENTAL/GUM PAD STAGE (0-6 MONTHS)
● Gum pads = alveolar arch at time of birth
● Gum pads get segmented corresponding to
the sites of developing teeth
● Maxillary Gum Pad
○ Maxillary arch is horseshoe-shaped
○ Gum pads extend labially and
buccally beyond those in mandible
○ Develop in two parts:
■ Labiobuccal - grows fast
■ Lingual
● Mandibular Gum Pad
○ U-shaped
○ Lower gum pad is everted
(anteriorly)
○ Divided into 10 segments by
transverse grooves
Relationship of Upper and Lower Gum Pads
● Newborn face and jaws are positioned
distally compared to adult position
○ Change in relationship occurs when
function is initiated
PRIMARY DENTITION (2-6 YEARS OLD)
● Emergence of tooth is highly associated
with height, followed by weight and head
circumference of individuals
Situation before transition
● By the time the deciduous dentition has
erupted fully, the maxilla and the
corresponding part of the mandible are well
and truly filled with developing tooth germs,
which are arranged in a specific order.
● The available space seems to be used to
the best possible advantage. Depending on
the size relationships between the tooth
crowns and the jaws that house them, the
position of the permanent teeth can vary.
● The original narrow ridge-shaped basal
section of the mandible which exists at birth
has, in the meantime, widened and
thickened. The forces generated in biting
and chewing can be withstood. Through the
continued vertical growth of the jaws, the
height available to accommodate the
forming permanent teeth increases
gradually.
MIXED DENTITION STAGE (6-12 YEARS OF
AGE)
First Transitional Period
● is characterized by:
○ The emergence of the first
permanent molars
○ The exchange of the deciduous
incisors with the permanent incisors
● The mesio-distal relation between the distal
surfaces of the upper and lower second
deciduous molars can be of 3 types:
1. Flush Plane
● Occurs during/by:
○ Early shift - Utilization of
physiological spaces and primate
spaces
○ Late shift - leeway space in the
lower arch
○ By differential forward growth of the
mandible
 ○ Both the maxillary and mandibular
planes are at the same level
anteroposterior as seen in figure 2a.
2. Mesial Step
● The maxillary terminal plane is relatively
more posterior than the mandibular terminal
plane that is shown in Figure 2b.
3. Distal Step
● The maxillary terminal plane is relatively
more anterior than the mandibular terminal
plane as seen in figure 2c.
● Ugly Duckling Stage
○ Transient form of malocclusion
where midline diastema is present
between maxillary central incisors
○ Canine impinging on the roots of
lateral incisor
■ Causes lateral incisor to
erupt into oral cavity with
divergence of crown distally
■ Pressure transmitted
central incisors causes
crowns to diverge and roots
to converge towards midline
(midline diastema
temporary)
○ Represents a metamorphosis from
un-aesthetic phase to esthetic phase
Intertransitional Period
● Root formation is not complete
● Apices are wide open and do not close for
at least another year
Second Transitional period - Shorter Duration
● Leeway Space of Nance
○ The combined mesio-distal width of
the permanent canines and
premolars is usually less than that of
the deciduous canine and molars
● Maxillary arch
○ 1.8mm (0.9 mm in each quadrant of
the arch)
● Mandibular arch
○ 3.4mm (1.7mm in each quadrant of
the arch)
● The normal leeway spaces according to
Moyer is 2.6mm in the maxilla and 6.2mm in
to mandible
is
APICAL AREA
● The relationships between the developing
dentition, the growth of the jaws, and the
problems that can originate are easier to
understand if the jaws are taken in subdivisions.
● Extra clarity is gained when the region in which
the teeth were formed initially, and in which the
roots are later located, is given prominence in
such a consideration.
Enlargement of the apical area permitting the regular alignment of
● Characterized by: the permanent incisors
○ Size of apical areas increase in the
first year of life SUMMARY
○ Tooth germs move within growing ● TABLE 1.1: SUMMARY OF EVENTS IN
jawbones DENTAL RELATIONSHIPS FROM BIRTH
○ Increase of apical area in transverse TILL ABOUT 12 YEARS OF AGE
and ventral directions restrictedly
particular in mandible
Predental Stage ● Gum pads features
○ Anterior part of lower border of ● Relationship of gum
mandible increase in bone thickness pads
○ In the maxilla the midpalatal suture
continues to offer a possibility for Primary Dentition ● Generalized spacing
ncrease in width, while in the region (6mos - 6years) ● Primate space
● Shallow overbite
posterior to the canine and first ● Increased overjet
premolar, the maxilla can still be built ● Terminal Plane
outwards by apposition and relationships
resorption.
○ The posterior section of the apical Mixed Dentition ● Eruption of 1st
area in the maxilla and mandible is (6-12ears) molars (early mesial
shift
unlike the two other sections in that, ● Replacement of
from birth to the end of facial growth, incisors
it gradually increases in size and is ● Incisal liability
built up dorsally ● Ugly duckling stage
Anterior section of the apical area
Replacement of ● Leeway space
● Characterized by:
deciduous canine ● Late mesial shift
○ Anterior sections of the apical area and molars
change during development from
newborn to adult. Permanent
○ Initially, the anterior section of the Dentition
apical area in both jaws is occupied
completely by developing teeth. CLINICAL SIGNIFICANCE
○ More space becomes available for ● Teeth continue to migrate and erupt
their successors, after the throughout childhood and adolescence even
emergence of deciduous teeth occlusion is attained
especially as a consequence of the ● Post eruptive movements of teeth are
marked vertical development in the directly related to the spaces created by
related regions of the jaws. growth displacements and movements of
○ The large incisor crowns have other teeth
emerged, the roots of the deciduous
incisors are gone, and only the roots
of the permanent incisors are
present within the alveolar process.
○ The emergence of the permanent
canines makes more space
becomes available in the anterior
sections of the apical area, thus
 INVISALIGN

INTRODUCTION
 REMOVABLE CLEAR PLASTIC RETAINERS

● PROVIDES BETTER ORAL HYGIENE

CLEAR REMOVABLE RETAINERS (MOLDED THAN FIXED RETAINER
RETAINERS) ● SERVES AS A TEMPORARY BRIDGE OR
● Molded to perfectly fit the new position of CROWN FOR MISSING TEETH
the teeth
● ACTS AS NIGHT GUARD FOR BRUXISM
● esthetic, comfortable, and inexpensive
appliance compared with conventional fixed
and removable orthodontic retainers.
● a transparent and thin but strong
vacuum‐formed appliance, that is made up
of polypropylene or polyvinyl chloride (PVC)
material

A retainer keeps your teeth from moving after

they’ve been straightened with braces. It can take
at least four to six months for the new position of
your teeth to become permanent. During that time,
your teeth will try to shift back to their original
position, which is called relapse. When used as
instructed, a retainer prevents this from happening.
HISTORY OF RETAINERS
9 ADVANTAGES OF CLEAR RETAINERS
● MORE ESTHETIC AND LESS VISIBLE
● INEXPENSIVE
● EASE OF FABRICATION
● ABILITY TO PLACE ON THE DAY THE
FIXED APPLIANCE IS DEBONDED
● DECREASED CHAIR TIME
● CAPABLE OF CORRECTING MINOR
TOOTH DISCREPANCIES DUE TO
FLEXIBILITY AND POSITIONER EFFECT
Clear retainer with maxillary right canine denture tooth
5 DISADVANTAGES OF CLEAR RETAINERS
● PRONE TO WEAR AND TEAR NEEDS
REPLACEMENT AT LEAST ANNUALLY
● THEY CANNOT BE READJUSTED OR
REPAIRED; THEY CAN ONLY BE
REPLACED
● IF EXPOSED TO EXCESSIVE HEAT,
CLEAR RETAINERS CAN WARP IN
SHAPE, THEREFORE MAKING IT
IMPOSSIBLE TO FIT YOUR TEETH AGAIN
● OVER TIME, CLEAR ALIGNERS CAN
BECOME DISCOLORED
● IF YOU DON'T ADHERE TO THE
RECOMMENDATIONS FOR PROPER
HYGIENE, THEN THEY CAN EASILY
TRAP LIQUID OR FOODS AND RESULT
IN CAVITIES
FABRICATION, INSERTION AND ADJUSTMENT
FABRICATION
● Steel trays with multiple retention holes and
polyvinyl siloxane are recommended for
impression.
● Die stone is also recommended.
 ● After obtaining a dental cast, interproximal
areas and gingival borders should be
distinct.
● Plastic thermoforming machines are used
for retainer construction.
INSERTION AND ADJUSTMENT
● Clear plastic retainer can be inserted by
seating the retainer with finger pressure
CLEAR PLASTIC RETAINERS AS PREVENTIVE
● Essix retainer is an orthodontic material that
conforms exactly to the contours of the
teeth to aid in the maintenance of tooth
position (retention)
● It is used to maintain a previous orthodontic
result or to simply prevent undesirable
movement of teeth
INDICATIONS FOR CLEAR PLASTIC
RETAINERS
● Removable clear plastic retainers, aka Essix
Retainers, are custom-made orthodontic
appliances used to retain teeth in their
newly-aligned position after orthodontic
treatment.
Some short indications of these retainers include:
● MADE OF CLEAR PLASTIC, MAKING THEM
LESS NOTICEABLE THAN TRADITIONAL
WIRE AND BRACKET RETAINERS.
● THEY ARE REMOVABLE, ALLOWING FOR
EASY CLEANING AND MAINTENANCE OF
ORAL HYGIENE.
● MORE COMFORTABLE TO WEAR THAN
TRADITIONAL WIRE AND BRACKET
RETAINERS.
● CAN BE USED TO TREAT MINOR TOOTH
MOVEMENT, AS WELL AS TO RETAIN TEETH
AFTER ORTHODONTIC TREATMENT.
● REQUIRE REGULAR WEAR TO BE
EFFECTIVE, TYPICALLY FOR 12-22 HOURS A
DAY.
● MAY NEED TO BE REPLACED
PERIODICALLY, AS THEY CAN WEAR DOWN
OR BECOME DISTORTED OVER TIME.
● SHOULD BE STORED PROPERLY WHEN NOT
IN USE TO PREVENT DAMAGE OR
DISTORTION.

CONTRAINDICATIONS FOR CLEAR PLASTIC

RETAINERS
● SWOLLEN INTERPROXIMAL TISSUE
● SEVERE PRETREATMENT DENTAL
ROTATION
● DENTAL ARCH EXPANSION
● PATIENT WITH ANTERIOR OPEN BITE
BEFORE AND AFTER USING RETAINERS

CLEAR REMOVABLE RETAINERS (MOLDED

RETAINERS)
 TRADITIONAL BRACES

● The spring pushes open, applying pressure

METAL BRACES against each of the teeth next to it, helping
● most common type of orthodontic braces widen the gap.
Introduction
● most often made from highgrade stainless
steel
● use brackets and wired to change the shape
of your bite, straighten teeth and remove
gaps between teeth Ligatures
● firmly hold the archwire in the slotted
position on each bracket.
● play a role in guiding tooth structures into
the desired direction

Parts of Traditional Braces

Brackets
Rubber bands
● small, square-shaped appliance bonded
● “Elastics”
directly to the front of your teeth.
● Used to align your bite and are very
● made out of metal or tooth-colored ceramic
important in the bite-fixing phase of
● it has room on the front of the bracket for an
treatment
archwire to fit down into it
● Attached to the brackets and will go from a
lower tooth bracket to an upper tooth
bracket

Archwire
● it is the “U” shaped metal band that spans
the entire width of the upper or lower arch of
teeth.
● clips into the brackets onto them with small
FUNCTION
ligatures
● for dental crowding and straighten teeth
● holds a consistent shape, applying pressure
● correct bite so the front and back teeth meet
across the entire smile to comply with the
evenly
curvature of the wire.
● reduce the chance of damage to prominent
teeth
INDICATIONS & CONTRAINDICATIONS
Efficacy
● Indication
Springs ○ As they are a fixed appliance metal
● small metal springs between the brackets of braces allow for greater control and
the adjacent teeth.
 more precise teeth movement, Cut any hard foods into small, bite-sized pieces.
especially in complex cases. ● yogurt, soft bread, pasta, cooked or canned
● Contraindication
fruit, mashed fruits and vegetables, and
○ Found that metal braces, in
comparison with clear aligners, were scrambled eggs
more effective in treating teeth
rotation, retention after brace
PREVENTIVE OR INTERCEPTIVE
removal, and certain types of
Orthodontic Tooth Movement and Bone
malocclusions.
Remodeling
Dental Health
● Indication
As soon as the force is applied to the tooth, it
○ Another benefit to braces is that they
moves a small amount and compresses the
can improve overall oral health.
periodontal ligament on the left side, and stretches
● Contraindication
the ligament on the
○ Misaligned teeth can cause
right side.
swallowing or chewing issues. It can
also make them harder to clean,
making plaque buildup more likely
and increasing the risk of gum
disease

DO’S & DONT’S

Brushing with braces is crucial to prevent
bone remodeling occurs
plaque buildup and oral diseases such as
○ the bone that the tooth is being
gingivitis.
pushed toward starts to shrink away
● brush at least three times a day
○ the bone that your tooth is moving
● brush at least 1 hour after meals
away from will start to add new bone
● brush above, on, and below the braces
to it, keeping up with the movement
Clean between their teeth with other suitable
of the root.
tools
● a floss threader or interdental brushes.
How do Braces Work?
Children
Should avoid sticky, chewy, or hard foods, as
● The younger a person is, the quicker they
they easily cause damage to the braces.
tend to respond to growth modification and
● popcorn, nuts, hard and chewy sweets, ice,
tooth movement.
chewing gum, whole hard fruits such as
● Mouth (jaw & teeth) still developing
apples, raw vegetables such as carrots,
● may require more extensive treatment
corn, hard bread such as rolls or bagels,
Adult
and ribs.
● jaws are already completely developed.
● require more specialized treatment.
. Development of the Jaw .

-Pressure
-Positions
- Alignment of Jaw
-Facial Structure

Children's bodies are still developing meaning

teeth, gums, jaw bones and muscles are more
malleable to change.

You will achieve the best results with healthy teeth

and gums. As you age, your teeth, gums and
surrounding bone become harder and less
malleable.
 TMJ SPLINT
TEMPOROMANDIBULAR JOINT
● Sliding hinge that connects the jawbone to
your skull
● Joint between condylar head of the
mandible and mandibular fossa of the
temporal bone
● Soft cartilage disk acts as a cushion
between the bones of the joint
TEMPOROMANDIBULAR JOINT DISORDER
● Occurs if the disk erodes and moves out of
its original position
● Multifactorial etiology with; bruxism,
psychological illness, traumatic injuries from
mastication, extreme mouth opening
● Dysfunction can lead to; difficulty in
chewing, clicking sounds,
● Can cause; pain, discomfort, locking of jaw
(Trismus)
TMJ SPLINT
Function:
●To Stabilize jaw and ease muscle tension
○ Prevent you from clenching your jaw
and grinding your teeth that is
responsible for causing muscle pain
and tension
● For treatment of temporomandibular
disorders
○ Acts as a buffer, causing your TMJ
to move into a natural resting
posture. The joint is therefore
"forced" to relax because it isn't fully
engaging. As a result, the tension in
your biting muscles as well as the
muscles around your face, neck, and
shoulders is eased.
How does it work? (mechanism) (point/s must
be relevant to the development of dentition &
facial growth, and how it can help TMJ
disorders):
- A splint acts as a buffer and thereby
moves your TMJ into a natural resting
position. When that happens, the joint isn’t
fully engaging and is “forced” to relax.
Consequently, the muscles around your
face, neck, and shoulders as well as biting
tension is eased.
- Such splints are thought to unload the joint
by disarticulating the dentition and
increasing the vertical dimension of
occlusion. By unloading the joint, there
will be a reduction in both synovitis and
masticatory muscle activity. Therefore,
the result is a reduction in symptoms.
HOW IT IS USED?
Wear it at recommended times:
● Nightguards; the most common
○ These devices are made for
overnight wear, which tends to be
 when jaw tension is severe and
uncontrollable (because you’re Interceptive Dentistry - Recognize and eliminate
sleeping). potential irregularities and malposition in the
● Occlusal guards developing dentofacial complex.
○ Similar to nightguards but worn
during the daytime hours. They are So with that knowledge, what do you think the
often transparent or made of clear Splint is? So since splints are basically designed to
acrylic, covering the biting surfaces support and stabilize joints and muscled to prevent
of all or most of the upper teeth, malocclusion and help relieve jaw pain caused by
preventing full tooth-on-tooth TMJ disorders, then splint is preventive scope of
engagement. dental appliance.
● Minimalist splint designs
○ Only cover a few of the front teeth,
rather than the entire mouth. The
smaller design is preferable to some
people but can make it difficult to
sleep with or keep up with
throughout the day.

NOTE:

TMJ patients should expect to wear a splint for at

least 3 months until the dentist finds their ideal bite.
This is the first stage of TMJ treatment. During the
second stage of treatment, the dentist will make
your ideal bite permanent.

INDICATIONS

● Pain in TMJ area

● Difficulty with opening your mouth
● Myofascial Pain Disorder
● To prevent clenching and grinding or
Bruxism

CONTRAINDICATIONS

Patients who have:

● Soft tissue damage on ligament

● Damage of muscle and nerve in the joint
space

PREVENTIVE OR INTERCEPTIVE

Preventive Dentistry - It is the action taken to

preserve the integrity of what appears to be the
normal occlusion at a specific time.
 PALATAL EXPANDER

INTRODUCTION
●