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Rene S. Johe, DMD UMDNJ-NJDS
Drift of Teeth
Mesial and occlusal Throughout life Slows down in adults With missing teeth posterior segments tip mesially or supererupt, necessitating molar/premolar uprighting
Permanent incisors erupt lingually compared to their primary counterpart Permanent canines usually erupt buccally compared to their primary counterpart
Know Class I, II, and III malocclusion concepts Class I malocclusion has a well related skeleton, rotated and/or crowded teeth Class II relationship
± Mandibular canines DISTAL to maxillary canines
Sites of Growth
± Maxillary tuberosity ± Mandibular lingual tuberosity (Ramus) ± Alveolar growth
Growth and Deposition / Resorption
± V principle ± Remodeling / Relocation
Class III cases Anterior crossbites ± Correct as soon as possible Skeletal problem Late growth Maxillary crowding probable May be associated with a shift (pseudo-class III occlusion) .
A point.Cephalometric Radiographs Landmarks ± Sella. Menton. etc ANB values ± >5 degrees ± Skeletal Class II ± <0 degrees ± Skeletal Class III Value Norms ± SNA ± 82 deg ± SNB ± 80 deg . B point. Orbitale. Pogonion.
relative maxillary excess ± Ratio MORE than normal .relative mandibular excess .Moyers / Space Analysis Moyers Analysis measures LOWER INCISORS and predicts CANINES and PREMOLARS Bolton Analysis evaluates a tooth size discrepancy ± Ratio LESS than normal .
Molar Uprighting Typically due to missing teeth (premolars) Involves fixed appliances Problems encountered ± Periodontal defects ± Occlusion (open bite problems) ± Long treatment time .
large overjet Class II div II ± Horizontal growth tendency ± Maxillary central incisors retroclined. maxillary laterals proclined ± Deep bite .Class II types Class II div I ± Normal growth tendency ± Maxillary incisors proclined.
Supernumerary teeth Vast majority in the maxilla (90%) Most common is mesiodens. then paramolars Others include ± Maxillary lateral incisors ± Maxillary premolars ± Mandibular premolars Feature of Cleidocranial Dysplasia .
Oligodontia Also called (partial) anodontia. hypodontia Most common missing teeth are ± Third molars ± Maxillary lateral incisors tied with ± Mandibular 2nd premolars Feature of Ectodermal Dysplasia .
Tooth Movement PDL ± Elastic. reactive tissue Biologic Electric theory Pressure Tension theory Movement ± High Force Blood vessels occluded (Hyalinized). Undermining Resorption ± Low Force Blood Vessels not occluded. Frontal Resorption ± Ideal force depends on root area. and other factors . type of movement.
depending on root surface area ± The bone will remodel with ideal light forces Strong forces ± Produces undermining resorption ± Produces hyalinized connective tissue .Orthodontic forces Ideal forces are light ± Different forces are ideal for different teeth.
low load/deflection ratio ± Exhibits hysteresis Deactivation force less than activation force ± Martensite (pseudoelastic) vs Austenite . high load/deflection curve Nickel titanium ± Low stiffness.Properties of Wires Stainless steel ± High stiffness.
Space Maintainers Fixed ± Band and Loop ± Distal Shoe ± Lingual Arch ± Nance Appliance / TPA appliance Removable (some space regaining) ± Lip Bumper ± Headgear .
Lower Incisor crowding Normal in females age 7-11 ± Incisor liabilty Occurs due to mesial drift of teeth and late mandibular growth NOT related to 3rd molar eruption .
Primate spaces Location ± Mesial to maxillary canines. distal to mandibular canines ± Used up by erupting incisors .
Leeway space .
Terminal Plane Relationships in Primary Dentition .
Etiology of Malocclusion Genetics ± Less than 50% cause Epigenic (Epigenetic) ± Habits ± Early primary tooth loss Distal eruption of lateral incisor causing loss of primary canine Loss of primary second molar causing mesial drift of permanent 1st molar ± Trauma .
Appositional bone growth vs Interstitial bone growth Interstitial ± Occurs at sutures two-sided periostial membrane Usually requires cartilage Appositional ± Enlarges the existing portions of bones Does not require cartilage Requires periosteum and endosteum .
little or no genetic control .Endochondral vs Intramembranous ossification Cranial Base ± Endochondral. some genetic control at synchondroses All other facial bones including Maxilla and Mandible ± Intramembranous.
> = prognathic ANB ± 2 degrees < rel max retrognathia or mand prognathia < rel mand retrognathia or max prognathia .Steiner Values SNA ± 82 degrees < = retrognathic. > = prognathic SNB ± 80 degrees < = retrognathic.
Overbite vs Overjet Overbite ± Can be Deep or Negative (Openbite) ± Changes with craniofacial growth ± Mandibular incisors touch palate ± Impinging overbite Overjet ± Can be due to Incisor proclination or retroclination Skeletal discepancy Negative overjet = crossbite .
Chronological vs Dental Age Can vary by a significant amount It is possible for: ± A 9 year old to have a full complement of permanent teeth ± A 14 year old to have 12 primary teeth remaining Different races display different dental ages at set chronological ages. .
Fixed vs Removable Appliances Removable Appliances ± ± ± ± ± ± ± ± head gear lip bumper face mask Schwartz Standard Edgewise Straight Wire Hyrax. Haas expanders Crozat appliance Fixed Appliances .
Hawley Retainer Most commonly utilized retainer Advantages ± Anterior tooth control ± Allows some settling of occlusion ± Easy to adjust Disadvantages ± Canine control ± Occlusal interferences ± Extraction treatment relapse concerns with clasps .
thumb sucking) .Dental Spacing Can be normal ± Mixed dentition in maxillary arch Can be due to ± Small teeth (tooth size discrepancy) ± Frenum ± Habits (tongue thrust.
Causes of Open Bites Skeletal ± Vertical growth can be due to genetics. mouth breathing Habits ± Tongue thrust ± Thumb sucking .
.Serial Extraction A planned sequence of tooth removal that can reduce crowding and irregularity during the transition from the primary to the permanent dentition. Used in severe crowding cases where transverse expansion in the mixed dentition will likely be unsuccessful.
Indications for Serial Extraction 1) No skeletal problem exists 2) Large space discrepancy 3) Normal overbite .
Impactions Most common ± Maxillary canines ± Mandibular third molars Less common ± Incisors ± Mandibular canines ± Premolars Usually require exposure Tooth may become ankylosed .
Headgear Types + Effects Cervical and High Pull Headgear Straight Pull is a combination of both .
.Fixed appliances Brackets are bonded to the teeth. Ties (metal or rubber) hold the archwires into the brackets. Archwires are wires that connect all the teeth in one arch.
Alignment and leveling Goals ± Bring teeth into alignment ± Correct vertical discrepancies ± Derotate teeth where necessary ± Establish a more ideal arch shape .
Correction of molar relationship and space closure Goals ± Correction to Class I molar relationship if 4 bicuspids were extracted or non-extraction treatment ± Correction to Class I canine relationship ± Close (extraction) spaces if present ± Correct overjet relationship .
Finishing Goals ± Parallel tooth roots ± Align tooth marginal ridges ± Idealize occlusion ± Idealize esthetics and function ± Utilize elastics as necessary .
Types of tooth Movements Intrusion Extrusion Tip Rotation Torque .
etc) ± Screws (expansion.Removable Appliances Clasps ± Adams. mattress. Ball clasps ± Labial bow ± Springs (finger. C clasps. mini) .
Posterior Crossbites Skeletal ± Narrow maxilla ± Molars not tipped palatally Dental ± Normal maxillary base ± Molars tipped palatally ± Associated with habits / soft tissue .
not active Transseptal and Supracrestal fibers Intercanine width Overcorrection Relapse is not predictable Third molars do not cause incisor crowding .Retention Growth throughout life Reactive and passive.
Soft tissue Appearance of Skeletal Problems Class III ± Scleral Display ± Lack of Zygoma ± Midface deficiency ± Vertical Growth Class II ± Small mandible (90%) ± Horizontal Growth .
Transseptal and supracrestal Fibers Attached to cementum Elastic fibers Are difficult to remodel Increase risk of relapse Necessitates either: ± Overcorrection ± Fiberotomy .
Their etiology can be different.Speech Effects Several malocclusion characteristics can have speech effects. The most common are: ± Open bites ± Spacing ± Incisor irregularity .
Iatrogenic Orthodontic Problems All orthodontics is intrusive and can therefore have iatrogenic side effects such as: ± Irritation ± Pain ± Plaque problems ± Allergic reactions .
Elastics Utilized to: ± Correct molar/canine relationship ± Intercuspate occlusion ± Different types for different malocclusions Class I Class II Class III .
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