Dr.

baraah Hamid
2021

Orthodontics

CLASS I: " is when the mesiobuccal cusp of the upper first molar aligns with
the buccal groove of the lower first molar, the upper canine is slightly distal to
lower canine

CLASS II: is when the mesiobuccal cusp of the upper first molar mesial to the
buccal groove of the lower first molar, the upper canine is slightly mesial to
lower canine

CLASS III: is when the mesiobuccal cusp of the upper first molar distal to the
buccal groove of the lower first molar, the upper canine is very distal to lower
canine

Overjet: class 2 div 1 flat 

Horizontal overlap/ labial surface to labial surface 
Normal space=2-3 
Reverse overjet class 3 

Overbite or deep bite class 2 div 2 steep 

Vertical overlap/  normal is 1-2mm 
Open bite 

Crossbite 
Anterior crossbite=cl3  
Maxillary anterior teeth are lingual to mandibular teeth 

Posterior crossbite  cl 3 
Maxillary posterior teeth are lingual to mandibular teeth 

Scissor bite
Maxillary posterior teeth are buccal to mandibular teeth 

Bolton analysis: 
Measure tooth size discrepancy by comparing upper and lower teeth 
Teeth that are too large=IPR 
Dr.baraah Hamid

Teeth that are too small=buildups 

Skeletal classification: 
Class 1 
Jaws well-related to naso-vertical 
Class 2 
Prognathic or protrusive maxilla 
Class3 
Prognathic or protrusive mandible 

Facial convexity: 
Facial plane formed by glabella, subnasale, and soft tissue or chin point 
Straight=calss 1
Convex=Class 2 
Concave=class 3 

Facial divergence 
Inclination of lower face relative to forehead 
Straight=class 1
Posterior divergent=class 2
Anterior divergent=Class 3 ‫ا‬

Profile angles 
Nasolabial angle 
Bet nose and upper lip=90 

Mentolabial angle 
Bet lower lip and chin=120 

Cervicomental angle 
Bet chin and neck=90-120 

Posture lip 
Competent or incompetent
3-4 separation at rest 

Incisal display 
At rest=2-4 mm incisor show ideal 
On smile=all teeth with 1-2 mm gingival show is ideal 

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Dr.baraah Hamid

Buccal corridors 
Dark space bet maxillary posterior teeth and corner of mouth upon smile 
Narrow arch more corridors 
Large arch less corridors 

Cephalometrics analysis 
To evaluate the relationship of the jaws and dental units to each other 

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 

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Dr.baraah Hamid

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

Phase 1 treatment: 
During mixed dentition 
-improve the oral environment 
-correct problem that easier to fix early 
-reduce the complexity of tx in the per men dentition 

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

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 

5-palatal impingement: deep bite 

Lower incisors are biting in soft tissue of palate 

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Dr.baraah Hamid

 pain/ discomfort/ trauma gingiva 

Tx: maxillary bite plate 

Moderate crowding 
Equal or More than 4 mm crowding 
Tx:lip bumper,LLHA 

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

Growth modification: only during growth 

8-13 for girls
10-15 for boys 

Headgear
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 

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- Herbst appliance- Twin block appliance- MARA) 

Twin block=fixed or removable 

MARA=fixed 
Herbst=Fixed tissue born 

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Dr.baraah Hamid

Bionator : tooth borne

Frankel class 2-3 

Frankel FR – III= class 3  

The only tissue borne functional appliance
The only tissue borne maxillary expansion = haas expander 
Palatal expanders
(Schwartz appliances- W-arch- Quad helix- Hyrax appliance- Hass appliance- transpalatal
arch) 

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

*•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).

2-Hyrax appliance most common 

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 

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Vacuum formed retainer 

Primary dentation  more common to have decreased overbite 

Class 3 elastic are use for mesial and extrusive 

Class 2 elastic are use for mesial and extrusive 

Sequence extraction for treat crowding 

CD4 

Two methods or tec. 

Dewel > CD4
Tweed> D4C
Nance>same tweel 
Meyers>BCD4 

Synchondroses close last: spheno-occipital 

Pt has nickel allergy= beta-titanium TMA 

 Frankelfort plan = from porion to orbital

A child with thumb suck dental problem=Early habit-breaking appliance 

Space between pt and cephalometric? 

15 cm=5 feet 
Space bet dr and X-ray? 
6 feet 

The first pharyngeal arch will form: mandible than maxilla 

Root resorption in ortho is due to magnitude force 

Tooth development: 
-initiation stage: 6 weeks in utero (oral epithelium, dental lamina) 
Defects=congenitally missing or supernumerary teeth 

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Dr.baraah Hamid

-Bud stage: 8 weeks in utero (dental placode)

Defects=congenitally missing or supernumerary teeth 

All primary teeth and permanent molars arise from dental lamina
All permanent incisors, canines, premolars from the predecessor 

-Cap stage: 9 weeks In utero (enamel) 

Defects=odontoma, gemination, fusion, dens in dens 

Bell stage: 11 weeks in utero 

-Histodifferentiation: tissue(ameloblasts, odontoblasts) 
Defects=amelogenesis imperfect, dentinogenesis imperfecta 
-Morphodifferentiatuon:shape and zise of crown is determined during this process 
Defects=peg lateral and microdontia 

-Apposition: 14 weeks in utero 

Defects=enamel hypoplasia, enamel pearls, concrescence 

-Maturation:+14 weeks in utero until 8 

Final deposition of enamel and dentine
Take 2 years to complete for primary crown 
4-5 permanent tooth crown 

Defects: enamel hypomineralization, fluorosis, tetracycline= second trimester through

eight years old 
Fluorosis=enamel 
Tetracycline=dentine