Dr shabeel pn
http://hidentfinishingschool.blogspot .com/

Orthodontics is a specialty in dentistry that concerned with prevention, interception & correction of the growing and mature Dentofacial structures. (Dentofacial structures are teeth, jaws, & surrounding facial bones).

1. Unattractive facial esthetic. 2. Dysfunction of TMJ. 3. Susceptibility to dental caries. 4. Susceptibility to periodontal disease. 5. Impaired speech caused by malposition of teeth and\or jaws.



3. 4.

Poor oral hygiene and lack of cooperation. Lack of bony support for the dentition. Poor general or mental health. Lack of interest.

Benefits of orthodontic treatment:
Orthodontic treatment may aid in eliminating or reducing three types of adverse effect for the patient: 1. Psychosocial function. 2. Oral function. 3. Dental disease.

Severe malocclusion & dental facial deformities strongly influences child self-esteem and if left untreated it can cause difficulty in psychological and social adjustment as the child matures.

Malocclusion may compromise oral function: 1. Difficulty in chewing. 2. Jaw discrepancy change manner of swallowing. 3. Difficulty for certain speech sounds. 4. TMJ joint pain from minor imperfection in occlusion (clenching & grinding).

Malocclusion can contribute in dental decay & periodontal disease because of difficulty in maintaining good oral hygiene due to lack of normal occlusion and natural cleansing benefits.


Physical conditions: Chronic diseases such as heart problems, asthma, diabetes, or blood disorders. Habits: Prolonged habits over the years can cause changes in Dentofacial structures of the child such as thumb sucking ,tongue thrusting ,& mouth breathing.

Causes of orthodontic problems :
1. 2. 3. 4.

Developmental causes. Genetic causes. Environmental causes. Functional causes. Interaction among these causes give rise to orthodontic problem.

1. Developmental causes :
The most encountered developmental disturbances are:  Congenitally missing teeth.  Malformed teeth.  Supernumerary teeth.  Impacted teeth.  Ectopic eruption.

2. Genetic causes :
Genetics play major role for malocclusion when there is discrepancy between size of the jaws & size of teeth.

3. Environmental causes:
It is caused by injures which has tow types: 1. Birth Injures: It comes under tow major categories:  Fetal molding (when a limb of the fetus
presses another part leading to distortion of that part ). 

Trauma during birth from usage of
forceps .


2. Injures throughout life :
Trauma to teeth can lead to development of malocclusion in three ways:  Damage to permanent tooth bud when primary tooth is traumatized.  Premature loss of primary teeth leading to permanent tooth movement.  Direct injury to permanent teeth.

Management of orthodontic problems
Treatment include interceptive & corrective measures that can be treated by general practitioners & pediatricians, while more sever cases should be referred to the orthodontists.

It allows the dentist to prevent or eliminate irregularities & malposition of the teeth in the developing dentition. It includes:Prevention of primary tooth loss due to caries. Usage of space maintainer to save space for permanent tooth eruption. Correction of oral habits leading to damage of permanent dentition. Early detection of genetic & congenital anomalies. Natural exfoliation of primary teeth (because retained teeth lead to impaction or malposition of permanent teeth). 



It allows the dentist to intercede or correct problems as they are developing. It includes:A. Interceptive treatment. B. Corrective treatment. 

A. Interceptive includes:  


Removal of primary teeth that contribute to Malalignment of permanent teeth. Correction of cross bite. Correction of jaw size discrepancy by fixed or removable appliance. Extraction of primary or permanent teeth to correct over crowding.

B. Corrective include:   

Movement of teeth by applying forces through usage of fixed appliance ,and redirection & stimulation of functional forces within the Dentofacial structure. Removable appliances for correction or maintenance of treatment. Orthognathic surgery in sever cases.


1. 2. 3. 4.

It includes four developmental stages from childhood to adulthood. Pre-dental jaw relationship. Primary dentition. Mixed dentition. Permanent dentition.


Normal occlusion



Normal occlusion :

It is the usual or accepted relationship of the teeth in the same jaw with the teeth in the opposing jaw when they are in centric occlusion.

Deviation from normal occlusion can be given to these characteristics: 

Midline deviation. Over jet & overbite of anterior teeth. Axial position of teeth in each arch. Relationship of all teeth in their normal position. Relationship of dental arches to each other.


According to Angle any deviation from normal occlusion can be a malocclusion.

Class I ,or neutroocclusion.  Class II ,or distoocclusion. Class II div 1. Class II div 2.  Class III ,or mesioocclusion. 

When the jaws are at rest & teeth are in centric relation ,the mandibular arch is in normal mesiodistal relationship to the maxillary arch. Mesiobuccal cusp of maxillary first molar occludes in the buccal groove of the mandibular permanent first molar.


The mandibular arch is in distal relationship to the maxillary arch by half width of the permanent first molar or mesiobuccal cusp width of a premolar. Mesiobuccal cusp of the maxillary first molar occludes in the interdental space between mandibular 2nd premolar & the mesial cusp of the mandibular 1st molar. The maxillary anterior teeth are protruded or retruded over the mandibular anterior teeth.

Class II subdivisions:A . Class II div 1: 

Maxillary incisors are protruded. Lips are usually a part, with lower lip tucked behind the upper incisors & upper lip appears short.

B. Class II div 2 :
Maxillary incisors are Retruded.  Maxillary lateral incisors may tipped labially and mesially. 


Mandibular arch is in mesial relationship to maxillary arch (Protruded mandible). Mesiobuccal cusp of maxillary 1st molar occludes in the interdental space between the distal cusp of mandibular 1st molar & mesial cusp of 2nd molar. The mandibular anterior teeth are protruded over maxillary teeth.

Factors associated with malocclusion :    

Crowded teeth (Most common problem). Over jet , protrusion of maxillary incisors. Overbite ,increased vertical overlap of maxillary incisors. Open bite ,lack of vertical overlap of maxillary incisors.

When force is applied for any period of time causing compression in one side of the periodontal ligament (PDL) & tension on the other side . These forces causes resorption & deposition of bone in the tissues.

Compression of periodontal ligament reduce the vascular supply to the supporting tissues in that area within 48 -72 hours this causes the cells of the PDL to differentiate into osteoclasts and the resorption process starts.


Tension side starts to activate osteoblasts .This resulted on new bone development & deposition. The tooth moves in direction of compression as the resorption takes place . On the opposite side the space created by the tension is filled in by deposition of new bone.

Application of heavy forces is avoided because it may cause excessive tooth destruction and tooth loosening.

1. TIPPING Moving the tooth more upright. 2. BODILY Cause the tooth to migrate slowly in its position in the arch. 3. ROTATION The force will move the tooth to the right or left in its socket.

Orthodontic Records & Treatment Planning
Orthodontic diagnosis & treatment planning is based on certain records that are taken for the patient in the 1st appointment. These information's comes from three major sources:1. Patient interview. 2. Clinical examination. 3. Evaluation of diagnostic records.

I. Interview Information:
1. Medical & dental history: Comprehensive physical condition is necessary to evaluate specific orthodontic concerns. 2. Physical growth evaluation: Evaluation of the child physical growth stage is important to aid in orthodontic treatment. 3. Social & behavioral evaluation: It is important to explore patient reasons for Tx Motivation & cooperation of the child is very essential for Tx success. Adults seek Tx to improve their esthetic & function.

II. Clinical examination:
It s purpose is to document, measure , evaluate facial aspects, occlusal relationship & functional characteristics of the jaws. a. Evaluation of the facial esthetics. b. Evaluation of oral health. c. Evaluation of jaw & occlusal function.

a. Evaluation of facial esthetics:
Orthodontic goal is to improve facial symmetry & profile. A. Frontal evaluation * Bilateral symmetry. * Midline. * Vertical proportion. B. Profile evaluation * Jaws proportion. * lip protrusion due to incisor protrusion. * Vertical facial proportion & mandibular plane angle.

b. Evaluation of oral health:
Hard & soft tissue examination, oral hygiene assessment & prophylaxis, periodontal pocket charting must be examined.  Patient should be referred for Tx before any orthodontic Tx is conducted. 

c. Evaluation of jaw & occlusal function: 

Examination of patient occlusion, TMJ palpation & any mandibular lateral or anterior shifts are important for orthodontic purposes .

III. Diagnostic records:
It includes photographs, radiographs, & diagnostic casts, best done during intra oral examination.  Diagnostic records document tooth angulations ,crowding & presence of unerupted teeth. 


Intra oral & extra oral photographs should be taken. It is useful for patient identification ,Tx planning ,case presentation ,case documentation & patient education. Frontal & profile views are taken with lips in relaxed position . Three intra oral photographs full direct view with teeth in occlusion ,maxillary occlusal view, right buccal view (from distal of the canine to last molar).


Cephalometric radiograph is taken before , during & after Tx to evaluate jaw & tooth position changes. Cephalometric radiograph is important to evaluate malocclusion ,skull ,bones, &soft tissue. Cephalometric analysis is carried out on a tracing paper, or digitized on the computer. Certain land marks are identified on cephalometric radiograph.

C. Diagnostic casts  

It is used to complete the measurement & for case presentation. They are made of plaster rather than stone to provide a more finished product for case presentation.


Case then will be presented to the patient or his guardian to explain Tx plan ,time & how patient should cooperate to have a successful results then patient will sign a consent form. Tx fees also will be discussed .


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