ORTHODONTICSOrtho means straight; odont means tooth

Chapter 27

What is orthodontics?

• Orthodontics is a specialty concerned with the guidance and correction of the dentofacial structure.

#1 Reason most orthodontists perform

treatment

•Malocclusion

#1 Reason people seek orthodontic treatment

•Esthetics

Indications for Ortho Treatment

• Impaired chewing (Mastication)• Crowding (Esthetics)• TMJ dysfunction• Dental caries• Impaired speech

Contraindications for ortho Treatment

• Lack of bone support• Rampant caries• Poor general health/mental health• Poor OH/patient cooperation• Lack of interest• Lack of financial support

Factors affecting Malocclusions

• Overjet

• Overbite

• Openbite

• Crossbite

OVERJET• EXCESSIVE

HORIZONTAL PROTRUSION

When the patient bites together, there is an abnormal space between the lingual of the Max incisors & the facial of the Mand incisors.

OVERBITE

• EXCESSIVE VERTICAL OVERLAPPING

• Caused by the Max anterior teeth vertically overlapping the Mand anteriors.

• Slight overbite is normal.

OPENBITE

Anterior or posterior teeth do not occlude. A space between the teeth.

Crossbites

• Anterior Crossbite: maxillary anterior teeth are positioned lingual to mandibular anterior teeth.

Crossbites

• Posterior crossbites: maxillary posterior teeth are positioned lingual to mandibular teeth.

Edge to Edge Bite

• Incisal edges of maxillary anterior teeth occlude on the incisal edges of mandibular anterior teeth

End to End bite

• Cusp tips of maxillary posterior teeth occlude with cusp tips of mandibular posterior teeth

Crowding

• Mild• Moderate• Severe

Angle’s Classification

• Class I (Neutrocclusion): mesial buccal cusp of maxillary first molars is contacting the buccal groove of the mandibular first molars, remaining teeth are considered to be in normal occlusion.

Malocclusion

• Molars are in the same relationship as Class I, however, remaining teeth exhibit deviations from normal occlusion, such as: crowding, crossbite, or openbite.

Class II Malocclusion

• Class II (Distocclusion): mesial buccal cusp of maxillary first molars is contacting the mesial portion of the mandibular first molars, mesial to buccal groove.

Class II Division I

• Division I (refers to anterior teeth only): molars are in the same relationship as Class II with maxillary anteriors being flared out to the labial.

Class II Division II

• Division II (refers to anterior teeth only): molar relationship the same as Class II with maxillary centrals are tipped back to the lingual; they are touching the mandibular anterior teeth.

Class III Malocclusion

• Class III (Mesiocclusion): Mesial cusp on maxillary first molars are touching distal of the buccal groove on the mandibular first molar.

Causes of Malocclusion

•Genetic •Systemic•Local

Genetic Causes

• Congenitally missing teeth• Malformed teeth• Supernumerary teeth• Macrognathia• Micrognathia• Macrodontia• Microdontia

Congenitally Missing Teeth

• Patient missing Upper laterals

Malformed teeth

• Upper incisors misshapened

Supernumerary Teeth

• Supernumerary between upper centrals

Macrognathia

•Large Jaw

Micrognathia

•Small Jaw

Macrodontia

•Large Teeth

Microdontia

•Small Teeth

Systemic Causes

• Diseases and nutritional disturbances that upset the normal schedule of dentition development during infancy and early childhood

Local Causes

• Trauma/injury to permanent tooth buds, premature loss of primary teeth, and direct injury to permanent teeth.

Local Causes

• Thumb sucking/ can cause openbite and/or overjet

• Tongue thrusting/ can cause openbite

Local Causes

• Mouth breathing

• Bruxim

• Nailbiting

Phases of Orthodontic treatment

• Preventive

• Interceptive

• Corrective

Preventive

• Orthodontic treatment designed to correct problems, that if not stopped, will contribute to more serious problems in the future.

Interceptive

• Orthodontic treatment involving the correction of problems as they are developing.

Treatment for Preventive and Interceptive Phases

• Space Maintainers• Restoration to prevent tooth loss• Observing growth patterns• Correcting bad habits• Serial extractions• Recognizing deviation from normal

development

Corrective

• Orthodontic treatment performed when the problems have already occurred and there were no steps taken to correct them previously.

Initial Exam/Initial Consultation

• First appointment• Review medical history• Examine the patient• Initial recommendations, review

treatment options, and answer questions

• Next appointment Records

Records

• Second appointment• Montage of patient

– Intraoral and extraoral photographs– Study models– Panoramic– Cephalometric

• Never review financial information at this appointment

Montage

Photographs• A series of usually eight photographs

to allow the doctor a clear view of the patient mouth.

Study Models• An exact replica of patients teeth

and surrounding tissues• Allows the doctor to view all aspects

of patient’s teeth without patient having to be there

Panoramic• A wide view of patient’s mouth • Allows insight into placement of

impacted teeth, 3rd molar location, and eruption patterns of unerupted teeth

Cepholometric• Used for diagnosis of jaw

relationships• Tracings are designed to show how

the jaw relates to certain landmarks in the skull

Consultation/Case Presentation

• A detailed outline of the treatment for the patient

• How long it will take• What style of braces and or

appliances are being used• Cost of treatment

Palmer Numbering System

Separators

• Elastic, circular shaped item placed between teeth to open contact between teeth to allow orthodontic band to fit around teeth.

Bands

• Orthodontic bands are placed on first molars, to act as an anchor in orthodontic treatment and to help stabilize the archwire.

• Brackets are soldered on the band, have tubes to hold archwire.

• Only upper first molar bands have headgear tubes

• Come in multiple sizes

Banding Appointment

• Teeth are pumiced• Orthodontic Assistant sizes bands• Orthodontist checks• Assistants prepares cements• Orthodontist seats bands

Brackets• Bonded to buccal/facial portion of

teeth, transmits force of archwire to move teeth

• Can be silver, clear or gold in color• Each bracket is specific to a tooth• Archwire slot has a specific torque

and tip to bring teeth into ideal occlusion

• May have wings for tying or doors

Bonding Appointment

• Pumice teeth to remove salvia and debris

• Acid etch teeth for 30 seconds• Apply bonding agent• Apply cement to back of each

bracket• Place bracket on tooth• Orthodontist positions bracket to

precise location on tooth• Light cure bracket to teeth or allow

to self cure

Archwires

• Placed into bracket slot to control movement of teeth.

• Held in place by elastic ligature ties or stainless steel ties.

Elastic Tiesaka: O’s, A’s, colored ties

• Used to hold AW into bracket slots.

Stainless Steel Ligature Ties

• Used to hold arch firmly into archwire slot

• Can be preformed with pigtail or long

• Used to tie individual teeth or multiple teeth together.

Kobayashi Hooks

• Placed on Brackets to attach interarch elastics

• Interarch elastics, used to correct Class II and Class III occlusion

Tooth Movement

• Teeth are allowed to move through the bone by resorption (osteoclasts).

• Teeth are held in place by deposition (osteoblasts).

• Active Phase=tooth movement• Retention Phase=teeth held in place

with retainers, osteogenesis takes 6-12 months– Hawleys, Trutanes, Fixed Retainers

Retainers

• Hawley

• Trutanes

• Fixed Retainers

Oral Hygiene

• Special toothbrush and brushing instructions

• Floss and floss threaders• Proxibrush• Fluoride rinse• Wax• Food Do’s and Don'ts list• What to do when things break