abpd05OrthoIV.12.2010...• Lingual Bite Plane/ i.e. an Incline Plane –– Can fabricate on your Can fabricate on your own with composite – Resin on stone modelResin on stone model-

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Orthodontics IV:Orthodontics IV:Management of the Developing OcclusionManagement of the Developing Occlusion--

Problems We Commonly Face & How to Solve Problems We Commonly Face & How to Solve ThemThem

Paul K. Chu, DDSPaul K. Chu, DDSSt. Barnabas HospitalSt. Barnabas Hospital02 December 201002 December 2010

ReviewReview

•• A 3 ½ year old girl A 3 ½ year old girl living in an area living in an area where water is where water is fluoridated at 0 10fluoridated at 0 10fluoridated at 0.10 fluoridated at 0.10 ppm will receive what ppm will receive what strength fluoride strength fluoride supplement? (Halo supplement? (Halo effect effect notwithstanding) notwithstanding)

Review McDonald & AveryReview McDonald & Avery

•• Is milk cariogenic?Is milk cariogenic?•• What type of caries is breast milk What type of caries is breast milk

associated with?associated with?associated with?associated with?•• What is the CERTAIN LETHAL dose of What is the CERTAIN LETHAL dose of

fluoride in children?fluoride in children?

•• Is milk cariogenic? NO (remember casein)Is milk cariogenic? NO (remember casein)•• What type of caries is breast milk What type of caries is breast milk

associated with? (Dentinal)associated with? (Dentinal)associated with? (Dentinal)associated with? (Dentinal)•• What is the CERTAIN LETHAL dose of What is the CERTAIN LETHAL dose of

fluoride in children? (32fluoride in children? (32--64mg/kg)64mg/kg)

Review Lecture Review Lecture

Central Incisor (#a) 14 weeks in utero

First Molar (#d) 15 weeks in uteroFirst Molar (#d) 15 weeks in utero

Lateral Incisor (#b) 16 weeks in utero

Cuspid (#c) 17 weeks in utero

Second Molar (#e) 18 weeks in utero

Sella

Porion Orbitale

Nasion

Lecture 3:Lecture 3:Standard Cephalometric LandmarksStandard Cephalometric Landmarks

Gonion

PNSMenton Gnathion

Pogonion

B Point

A Point

ANSArticulare

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SN Plane

Palatal Plane

Lecture 3: Lecture 3: Frequently Used PlanesFrequently Used Planes

Occlusal Plane

Mandibular Plane

Lecture 3:Lecture 3:Skeletal Assessment Skeletal Assessment -- Wits (AOWits (AO--BO)BO)

Where? Draw a PERPENDICULARline from A point to occlusal plane; B point

l l l

Norm: -1, 0, +1

to occlusal plane

Wits Measures?sagittal discrepancy between the upper and lower jaw

Similar to what?

A- N - B

Lecture 4Lecture 4

•• In order from most common to least In order from most common to least common….name the teeth most common….name the teeth most commonly missing…commonly missing…

Lecture 4Lecture 4

•• Most commonMost common-- 8’s8’s•• 22ndnd: Mandibular 2: Mandibular 2ndnd premolarspremolars•• 33rdrd: Maxillary Laterals: Maxillary Laterals•• 44thth: Maxillary 2: Maxillary 2ndnd premolarspremolars•• 44 : Maxillary 2: Maxillary 2 premolars premolars

Management of the Developing OcclusionManagement of the Developing Occlusion--Problems We Commonly Face & How to Problems We Commonly Face & How to

Solve Them Solve Them CROSSBITESCROSSBITESCROSSBITESCROSSBITES

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Anterior CrossbitesAnterior Crossbites

•• Indicates Indicates skeletal growth skeletal growth problem problem pp

•• Indicates Indicates possible possible developing developing Class III Class III occlusionocclusion

Anterior CrossbitesAnterior Crossbites

•• TRUETRUE--no functional shiftno functional shift--retrusive maxillaretrusive maxilla

•• PSEUDOPSEUDO--functional shiftfunctional shift--normal maxillanormal maxilla

--long mandliblelong mandlible--proclined maxillary proclined maxillary

incisors/retroclined incisors/retroclined mandibular incisorsmandibular incisors

--retroclined maxillary retroclined maxillary incors/proclined incors/proclined mandibular incisorsmandibular incisors

Anterior Crossbite ResultsAnterior Crossbite Results

Stillman’s/Gingival Clefts

Anterior Crossbite CausesAnterior Crossbite Causes

•• Labially positioned supernumary toothLabially positioned supernumary tooth•• Trauma/Caries (necrotic teeth can cause Trauma/Caries (necrotic teeth can cause

deflection)deflection)•• Arch length deficiency causes lingual Arch length deficiency causes lingual

deflection of permanent teeth (esp with deflection of permanent teeth (esp with maxillary laterals)maxillary laterals)

Anterior Cross Bites: SolutionsAnterior Cross Bites: Solutions

•• Tongue BladeTongue Blade–– Must be done with Must be done with

erupting teetherupting teethCooperative ptsCooperative pts–– Cooperative pts Cooperative pts onlyonly

–– Cycle of 5 mins of Cycle of 5 mins of each houreach hour

–– Not always Not always successful due to successful due to noncompliancenoncompliance


•• Lingual Bite Plane/ Lingual Bite Plane/ i.e. an Incline Planei.e. an Incline Plane–– Can fabricate on your Can fabricate on your

own with compositeown with composite–– Resin on stone modelResin on stone model--–– Resin on stone modelResin on stone model--

cover lower incisors cover lower incisors and possibly caninesand possibly canines

–– Only locked in tooth is Only locked in tooth is in contact with planein contact with plane

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•• Palatal Hawley Palatal Hawley with springwith spring–– Indicated when Indicated when

one or 2 teeth are one or 2 teeth are in CBin CBin CBin CB

–– Esp with lateral Esp with lateral incisorsincisors

–– Good to correct Good to correct arch irregularties arch irregularties alsoalso

Posterior CrossbitesPosterior Crossbites

•• Common 1/13 kids (Common 1/13 kids (KutinKutin et al)et al)•• Not self correctingNot self correcting-- primary posterior CB will be primary posterior CB will be

followed by CB in the mixed dentitionfollowed by CB in the mixed dentition•• Left untreated can develop into a true skeletalLeft untreated can develop into a true skeletal•• Left untreated, can develop into a true skeletal Left untreated, can develop into a true skeletal

defectdefect•• Treatment of CB in primary dentition favors Treatment of CB in primary dentition favors

development of normal occlusion in permanent development of normal occlusion in permanent dentitiondentition

Posterior Posterior SKELETALSKELETAL CrossbiteCrossbite

•• Discrepancy in structure of maxilla or Discrepancy in structure of maxilla or mandiblemandiblemandiblemandible

•• Narrow maxilla or wide mandible is often Narrow maxilla or wide mandible is often associated with buccal CBassociated with buccal CB

Posterior Posterior DENTALDENTAL CrossbiteCrossbite

•• Faulty eruption patternFaulty eruption pattern--erupting lingually erupting lingually

•• After eruptionAfter eruption-- occlusion occlusion locks them into placelocks them into placeoc s t e to p aceoc s t e to p ace

•• In mouth breathers, the In mouth breathers, the tongue can assume a tongue can assume a position in the floor of the position in the floor of the mouth, resulting in mouth, resulting in muscle imbalance and muscle imbalance and subsequent CBsubsequent CB

Posterior Posterior FUCTIONALFUCTIONAL CrossbiteCrossbite

•• Results from a shift of the Results from a shift of the mandible into an mandible into an abnormal but more abnormal but more comfortable position comfortable position (shifts to the side of the (shifts to the side of the XB)XB)

Posterior Posterior FUNCTIONALFUNCTIONAL CrossbiteCrossbite

•• Posterior Functional Posterior Functional CrossbiteCrossbite

--teeth are in max teeth are in max i t tii t tiintercuspationintercuspation

--unilateralunilateral--mandmand. midline shifts to . midline shifts to

side of XBside of XB

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Posterior Posterior FUNCTIONALFUNCTIONAL CrossbiteCrossbite

•• Lining up the midlines Lining up the midlines reveals true reveals true inadequacy ainadequacy ainadequacy…a inadequacy…a constricted maxillary constricted maxillary arch!arch!

Posterior Posterior FUCTIONALFUCTIONAL CrossbiteCrossbite•• May be corrected May be corrected

by simple canine by simple canine incisal or inclined incisal or inclined plane adjustmentplane adjustmentplane adjustmentplane adjustment

•• Best to treat during Best to treat during mixed dentitionmixed dentition

Posterior Crossbite Treatment Posterior Crossbite Treatment --DENTALDENTAL

•• WW--Arch ExpanderArch Expander•• i.ei.e Porter AppliancePorter Appliance•• You can expand the arm to You can expand the arm to

also tip also tip anteriorsanteriors for XBfor XB•• Opened 3Opened 3--4 mm wider than 4 mm wider than

passive widthpassive widthpass e dtpass e dt•• Tipping onlyTipping only•• Usually require 2Usually require 2--3 3 mosmos of of

active treatment and 3 active treatment and 3 mosmos of of retentionretention


•• Un equal WUn equal W--Arch ExpanderArch Expander•• Longer arm is the bracing Longer arm is the bracing

armarmarmarm

•• Shorter arm is in CBShorter arm is in CB


•• Quad helixQuad helix•• Extra wire gives this greater Extra wire gives this greater

range of action than w archrange of action than w arch--but equivalent force to w archbut equivalent force to w arch

•• Anterior helices can stop Anterior helices can stop thumb habitthumb habit

•• Weakened anterior segmentWeakened anterior segment--kids can break or distortkids can break or distort

•• Widen appliance 3Widen appliance 3--8 mm8 mm

Posterior Crossbite TreatmentPosterior Crossbite Treatment--DENTALDENTAL

•• Crossbite ElasticsCrossbite Elastics•• Link lingual clasp of Link lingual clasp of

maxillary molar tomaxillary molar tomaxillary molar to maxillary molar to buccal tube on buccal tube on mandibular molarmandibular molar

•• Tipping onlyTipping only

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Posterior Crossbite TreatmentPosterior Crossbite Treatment--SKELETALSKELETAL

•• RPERPE•• Rapid Palatal ExpanderRapid Palatal Expander•• i.e: Haas, Hyrax, Minne i.e: Haas, Hyrax, Minne

Expander, Cap Splint Expander, Cap Splint •• T kT k•• Turn key as per Turn key as per

orthodontists Rxorthodontists Rx

Posterior Crossbite TreatmentPosterior Crossbite Treatment

•• RPERPE•• KeyKey•• Make sure pt keeps Make sure pt keeps

up hygiene!up hygiene!up hygiene!up hygiene!


•• Headache is Headache is commoncommon

•• Suture will openSuture will openSuture will open Suture will open freely within 2freely within 2--3 3 weeksweeks


•• CondylarCondylar position & position & length of length of mandibularmandibularskeletal structures skeletal structures different bilaterally in different bilaterally in children with XB. children with XB.

•• Compensatory growth Compensatory growth occurred after expansion occurred after expansion treatment.treatment.

•• Treatment eliminated Treatment eliminated assymetriesassymetries observed observed before treatment!before treatment!

REMEMBER TO DOCUMENT & REMEMBER TO DOCUMENT & REFER (or TREAT) CROSSBITES!!!REFER (or TREAT) CROSSBITES!!!

Untreated cross bite can lead to:Untreated cross bite can lead to:

--gingival inflammation and recession of the investing gingival inflammation and recession of the investing tissues surrounding the maltissues surrounding the mal--opposed teeth opposed teeth

--occlusal traumaocclusal trauma--enamel abrasion or fractures enamel abrasion or fractures --development of abnormal chewing an swallowing development of abnormal chewing an swallowing

problemsproblems--abnormal growth of the maxilla and the mandibleabnormal growth of the maxilla and the mandible--the development of a permanent Class III dentofacial the development of a permanent Class III dentofacial

abnormalityabnormality--asymmetric growth of the mandibleasymmetric growth of the mandible--temporomandibular joint dysfunction temporomandibular joint dysfunction

PROBLEMS WITH ERUPTIONPROBLEMS WITH ERUPTIONand how to handle themand how to handle them

1st Permanent Molars1st Permanent Molars22ndnd Permanent MolarsPermanent MolarsPermanent LateralsPermanent Laterals

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PROBLEMS WITH ERUPTION OF PROBLEMS WITH ERUPTION OF TEETHTEETH-- PERMANENT FIRST MOLARSPERMANENT FIRST MOLARS

•• Ectopically Erupting Ectopically Erupting Teeth:Teeth:

•• Most common 3% ofMost common 3% ofMost common 3% of Most common 3% of the timethe time

•• Molars= self correct Molars= self correct 66% of the time66% of the time


•• HaltermanHalterman•• Distalizes Distalizes

ectopic ectopic permanent permanent molarmolar

•• Change power Change power chain every 2chain every 2--3 weeks3 weeks





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PROBLEMS WITH ERUPTION OF PROBLEMS WITH ERUPTION OF TEETHTEETH-- SECOND PERMANENT SECOND PERMANENT

MOLARSMOLARS•• DeDe--ImpactorImpactor•• Distalizes ectopic Distalizes ectopic

permanent molarpermanent molar

Activate

PROBLEMS WITH ERUPTION OF TEETHPROBLEMS WITH ERUPTION OF TEETH--PERMANENT LATERAL INCISORSPERMANENT LATERAL INCISORS

•• Ectopic Ectopic EruptionEruption-- due due to excessive to excessive mass ormass ormass or mass or inadequate inadequate arch lengtharch length

•• Be prepared if Be prepared if early loss of early loss of canine occurs!canine occurs!


•• Ectopic Ectopic eruption of eruption of laterallateral-- causing causing exfolliation ofexfolliation ofexfolliation of exfolliation of primary canine primary canine & 1& 1stst molar molar may cause may cause transposition transposition of canine! of canine!


•• If ectopic erution If ectopic erution occurs with lateral, occurs with lateral, and no midline shift is and no midline shift is seen, place LLHA seen, place LLHA , p, pwith spurwith spur to prevent to prevent midline shiftmidline shift


•• If ectopic If ectopic erution occurs erution occurs with lateral, with lateral, and midlineand midlineand midline and midline shift IS seen, shift IS seen, extract extract contralateral contralateral primary canine primary canine to prevent to prevent midline shift! midline shift!

PROBLEMS WITH ERUPTION OF TEETHPROBLEMS WITH ERUPTION OF TEETH--PERMANENT CANINESPERMANENT CANINES

Normal Eruption of Normal Eruption of CanineCanine

•• It starts out lingual to the arch It starts out lingual to the arch and mesially directedand mesially directed

•• Changes to a more verticalChanges to a more verticalChanges to a more vertical Changes to a more vertical orientation when it engages orientation when it engages the distal aspect of the lateral the distal aspect of the lateral incisor rootincisor root

•• Continues to erupt into the Continues to erupt into the oral cavity labial to the oral cavity labial to the resorbing deciduous cuspidresorbing deciduous cuspid

•• Often see simultaneous closure Often see simultaneous closure of a maxillary central incisor of a maxillary central incisor diastemadiastema

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•• 33rdrd Molars Molars most most commonly commonly impactedimpacted-- thenthenimpactedimpacted then then caninescanines

•• Why?Why?


Why?Why?•• Tooth has longest period of Tooth has longest period of

developmentdevelopment•• Follows dubious course of Follows dubious course of

developmentdevelopmentdevelopmentdevelopment•• Occupies several Occupies several

developmental positions in developmental positions in successionsuccession


Treatment optionsTreatment options•• Extract primary canines Extract primary canines •• Refer to ortho for chain/ button Refer to ortho for chain/ button

placement by OMFSplacement by OMFS

SPACE REGAININGSPACE REGAINING


Halterman ApplianceHalterman ApplianceR b !!R b !!•• Remember!!Remember!!


Penguin/ Penguin/ PendulumPendulum

•• RegainRegain•• Regain Regain maxillary spacemaxillary space

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Distal JetDistal JetR iR i•• Regain Regain maxillary maxillary spacespace


Williams Williams ApplianceApplianceApplianceAppliance

•• Mandibular Mandibular ExpansionExpansion

SERIAL EXTRACTIONSERIAL EXTRACTION

SERIAL EXTRACTIONSERIAL EXTRACTION

•• INDICATIONSINDICATIONS•• --only when dental arches are structurally only when dental arches are structurally

inadequate for developing teethinadequate for developing teethinadequate for developing teethinadequate for developing teeth•• --little of no hope of attaining little of no hope of attaining •• --**CLASS I DENTITION ONLY!!!!!!!** **CLASS I DENTITION ONLY!!!!!!!**

SERIAL EXTRACTIONSERIAL EXTRACTION SERIAL EXTRACTIONSERIAL EXTRACTION•• FIRST: Extract Primary Canine (wait 6 FIRST: Extract Primary Canine (wait 6 mosmos, ,

then..)then..)-- usually incisors will self correctusually incisors will self correct•• SECOND: Extract Primary First Molar (wait 6 SECOND: Extract Primary First Molar (wait 6

mosmos, then…), then…)•• THIRD: Extract Permanent 1THIRD: Extract Permanent 1stst Premolar (Premolar (whochwhoch

allows for normal canine eruption)allows for normal canine eruption)

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Functional AppliancesFunctional Appliances

Functional AppliancesFunctional Appliances•• AOA: AOA: “Functional appliances are designed to “Functional appliances are designed to

alleviate skeletal and neuromuscular imbalances. “alleviate skeletal and neuromuscular imbalances. “•• Ideal placement: Early Mixed DentitionIdeal placement: Early Mixed Dentition•• Via changing jaw position, or muscular forces.Via changing jaw position, or muscular forces.

Functional AppliancesFunctional Appliances

•• Class II: Bionator I & 2; Herbst; Frankel; Class II: Bionator I & 2; Herbst; Frankel; T i Bl kT i Bl kTwin BlockTwin Block

•• Class III: Twin Block; FrankelClass III: Twin Block; Frankel

AppliancesAppliances-- FrankelFrankel

The Frankel appliances are removable designs invented by Professor Rolf Frankel.

The Frankel philosophy uses the vestibules to enhance favorable growth in developing dentition and restrict undesireable muscle forces.

AppliancesAppliances-- BionatorBionator

•• Class II correction (growth and Class II correction (growth and forward movement of forward movement of mandible) mandible)

•• Wax bite is usually taken Wax bite is usually taken forward in a Class I position (if forward in a Class I position (if comfortable for patient) with comfortable for patient) with co o tab e o pat e t) tco o tab e o pat e t) t22--3mm vertical opening 3mm vertical opening between posterior teeth. between posterior teeth.

•• Initially, the appliance is used Initially, the appliance is used to encourage forward growth to encourage forward growth or advancement of the or advancement of the mandible. Later, the appliance mandible. Later, the appliance can be further utilized to open can be further utilized to open the bite by removing the the bite by removing the posterior bite pads; or, by posterior bite pads; or, by removing the anterior cap, it removing the anterior cap, it can close the bite. can close the bite.

AppliancesAppliances-- Twin BlockTwin Block•• Indicated for : Class II Division Indicated for : Class II Division

I; Class II Division 2; Class I I; Class II Division 2; Class I open bites; Class I closed bites; open bites; Class I closed bites; Class III occlusions.Class III occlusions.

•• Unlike bulky, oneUnlike bulky, one--piece piece functional appliances, the Twin functional appliances, the Twin Block has separate, unattached Block has separate, unattached upper and lower bite blockupper and lower bite blockupper and lower bite block upper and lower bite block components components -- actually two actually two appliances which work together appliances which work together as one. as one.

•• In function, these two In function, these two appliances interlock at the 70 appliances interlock at the 70 degree angle set into the bite degree angle set into the bite blocks and posture the mandible blocks and posture the mandible forward into the ideal Class I forward into the ideal Class I position preset by your wax position preset by your wax registration.registration.

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AppliancesAppliances-- HerbstHerbst

The Herbst appliance-positions mandible anteriorly

Headgear AppliancesHeadgear Appliances

From Lecture 3From Lecture 3

•• Clockwise & Clockwise & Counterclockwise Counterclockwise mandibular rotation mandibular rotation

Class II Openbite= Clockwise

Class III= Counterclockwise


•• High Pull HeadgearHigh Pull Headgear•• Will deepen biteWill deepen bite-- for for

use in clockwise use in clockwise rotating patientsrotating patientsrotating patients rotating patients (i.e. Class II (i.e. Class II openbite)openbite)


•• Cervical Pull HeadgearCervical Pull Headgear•• Will open biteWill open bite-- for use for use

in counterclockwise in counterclockwise t ti ti t (it ti ti t (irotating patients (i.e. rotating patients (i.e.

Class III deepbite)Class III deepbite)


•• CombiCombi-- HeadgearHeadgear--maximizes molar maximizes molar

retraction while retraction while controlling molar controlling molar extrusionextrusion

--for Class II molars w/ for Class II molars w/ favorable chin favorable chin position position

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•• Reverse Pull Reverse Pull Headgear/ FacemaskHeadgear/ Facemask

--for Class III Occlusionfor Class III OcclusionRemember, patient compliance is Remember, patient compliance is

key in headgear success!key in headgear success!key in headgear success!key in headgear success!

Ok so what do we do with all this Ok so what do we do with all this knowledge???knowledge???knowledge???knowledge???

OrhtodonticsOrhtodontics-- when?when?

•• Best to get a screening by Age 7 (AAO)Best to get a screening by Age 7 (AAO)

OrhtodonticsOrhtodontics-- early treatment early treatment indications? (indications? (DugoniDugoni 1995)1995)

•• Dental/skeletal Class Dental/skeletal Class II or IIIII or III

•• Ant/Post XBAnt/Post XB

•• Periodontal Periodontal compromisecompromise

•• Ant OB > 3mmAnt OB > 3mm•• More than 6mm OJMore than 6mm OJ•• Max midface defMax midface def•• Mod incisor crowdingMod incisor crowding•• Ectopic erutpionsEctopic erutpions

•• Severe deepbite w/ Severe deepbite w/ palatal impingmentpalatal impingment

•• Harmful oral habitsHarmful oral habits•• Craniofacial anomaliesCraniofacial anomalies

OrhtodonticsOrhtodontics-- early treatment early treatment benefits? (benefits? (DugoniDugoni-- 1995)1995)

•• Reduced PM exosReduced PM exos•• Decreased time or no Decreased time or no

Phase II tx Phase II tx •• Reduced need for surgicalReduced need for surgical

•• Increased stability of Increased stability of lower incisor segmentlower incisor segment

•• Reduces incidents of root Reduces incidents of root resporptionresporption•• Reduced need for surgical Reduced need for surgical

orthodonticsorthodontics•• Increased stability of Increased stability of

transverese & AP transverese & AP dimension changes with dimension changes with Phase I txPhase I tx

espo pt oespo pt o•• Reduces mucogingival Reduces mucogingival

problemsproblems•• Reduced incidents of Reduced incidents of

ectopic eruptionsectopic eruptions•• Better patient cooperationBetter patient cooperation

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3 major Developmental Stages3 major Developmental Stages

•• Primary DentitionPrimary Dentition•• Mixed DentitionMixed Dentition•• Early Permanent DentitionEarly Permanent Dentition

3 Planes of Space3 Planes of Space

•• TransverseTransverse•• Anterior PosteriorAnterior Posterior•• VerticalVertical TRANSVERSE

ANTERIOR/ POSTERIOR

VERTICAL

Orhtodontic AppliancesOrhtodontic Appliances-- Primary Primary DentitionDentition

•• Very ControversialVery Controversial•• Functionsl problems Functionsl problems

usually treatedusually treated•• Trasnverse XBTrasnverse XB•• Trasnverse XBTrasnverse XB•• A/P A/P –– ant XBant XB•• Vertical Deep/open Vertical Deep/open

bitesbites--HeadgearHeadgear--Bite PlanesBite Planes

Orhtodontic AppliancesOrhtodontic Appliances--Mixed Dentition Phase IMixed Dentition Phase I

•• Purpose: To establish Purpose: To establish normal, vertical, normal, vertical, transverse, & sagittal transverse, & sagittal dental & skeletaldental & skeletaldental & skeletal dental & skeletal relationships relationships –– NOT NOT necessarily to prevent necessarily to prevent the need for full, fixed the need for full, fixed appliances. appliances.

Mixed Dentition Phase IMixed Dentition Phase I--Treatment ApproachesTreatment Approaches

•• Active or Passive Active or Passive Space MaintenanceSpace Maintenance

•• Fi ed o emo ableFi ed o emo able•• Fixed or removable Fixed or removable expansionexpansion

•• Fixed Archwires (2x4) Fixed Archwires (2x4) HeadgearHeadgear

•• Functional Appliances Functional Appliances

2 x 42 x 4

•• banded molars & bracketed banded molars & bracketed incisorsincisors-- allows for molar allows for molar derotation/uprighting/incisor derotation/uprighting/incisor levelling, alignment, & levelling, alignment, & g gg gintrusionintrusion

•• creates a more normal creates a more normal relationship between the lips, relationship between the lips, teeth, tongue, and jaws, as teeth, tongue, and jaws, as well as reduces the risk of well as reduces the risk of fracturing the upper incisors fracturing the upper incisors

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2 x 42 x 4•• banded molars & bracketed banded molars & bracketed

incisorsincisors-- allows for molar allows for molar derotation/uprighting/incisor derotation/uprighting/incisor levelling, alignment, & levelling, alignment, & intrusionintrusion

•• A: arch wire is free to slide A: arch wire is free to slide through molar tubethrough molar tube incisorsincisorsthrough molar tubethrough molar tube-- incisors incisors tip anteriorly and extrudetip anteriorly and extrude--corrects anterior XBcorrects anterior XB

•• B: arch wire cinchedB: arch wire cinched--wire wire doesn’t slidedoesn’t slide-- extrudes incisors extrudes incisors due to lingual torque due to lingual torque –– mesial mesial force on molarforce on molar

Mixed Dentition Phase IIMixed Dentition Phase II--Treatment ApproachTreatment Approach

•• Purpose: to accomplish 6 Purpose: to accomplish 6 keys of occlusionkeys of occlusion

•• Includes both orthopedic Includes both orthopedic (headgear/functional) & (headgear/functional) & ( eadgea / u ct o a ) &( eadgea / u ct o a ) &orthodontic (full, fixed orthodontic (full, fixed edgewise) edgewise)

•• If Phase I completedIf Phase I completed-- 1212--18 mos18 mos

Mixed Dentition Phase IIMixed Dentition Phase II--Treatment ApproachesTreatment Approaches

Mixed Dentition Phase IIMixed Dentition Phase II--Treatment ApproachTreatment Approach

1)1) Space consolidationSpace consolidation2)2) Sagittal Arch Sagittal Arch

Coo dinationCoo dinationCoordinationCoordination3)3) Root ParallelismRoot Parallelism4)4) Finishing & DetailingFinishing & Detailing5)5) RetentionRetention

Mixed Dentition Phase IIMixed Dentition Phase II--RetentionRetention

•• Max/Mand Hawley Max/Mand Hawley retainers must be worn retainers must be worn 24hrs/day first 4 mos 24hrs/day first 4 mos yyafter debracketing.after debracketing.

•• Then next 8 mos at Then next 8 mos at nightnight

•• After 1 yearAfter 1 year-- 11--2 nights 2 nights per week.per week.

Complications of Orthodontic Complications of Orthodontic TherapyTherapy

•• DecalcificationDecalcification•• CariesCaries•• Periodontal problemsPeriodontal problems

N it l t thN it l t th•• Nonvital teethNonvital teeth•• Root resorptionRoot resorption•• Relapse (2/3 relapse Relapse (2/3 relapse

without some form without some form of retention)***of retention)***

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Does TMD develop with Does TMD develop with orthdontics?orthdontics?

•• May occur coincidentally with May occur coincidentally with t t tt t t b t NOT llb t NOT lltreatmenttreatment-- but NOT usually but NOT usually because of tx.because of tx.

•• No relation has been found No relation has been found between malocclusion & between malocclusion & TMD.TMD.

Do 3Do 3rdrd Molars contribute to Molars contribute to crowding?crowding?

•• No difference in incisor crowding No difference in incisor crowding in pts with impacted, erupted, in pts with impacted, erupted, missing, or extracted 8’s.missing, or extracted 8’s.

•• Indications for exo? Pathology, Indications for exo? Pathology, external root resorption, external root resorption, pericornitis, caries.pericornitis, caries.

•• Predict impaction? If distance Predict impaction? If distance from distal of 7 to anterior from distal of 7 to anterior border of the ramus is greater border of the ramus is greater or equal to length of developing or equal to length of developing 33rdrd molar crown there is a 70% molar crown there is a 70% chance of eruption. chance of eruption.

Journal of Pediatric DentistryJournal of Pediatric Dentistry--Nov/Dec 2005 Nov/Dec 2005

•• Parents’ satisfaction with their child’s Orthodontic Care: A Parents’ satisfaction with their child’s Orthodontic Care: A comparison of Orthodontists & Pediatric Dentistscomparison of Orthodontists & Pediatric Dentists

•• Found parents equally happy with both doctors delivering Found parents equally happy with both doctors delivering treatmenttreatmenttreatment.treatment.

•• Pediatric dentists treated cases 9 mos earlier than Pediatric dentists treated cases 9 mos earlier than orthodontists.orthodontists.

•• Patients treated by the pediatric dentist were more racially Patients treated by the pediatric dentist were more racially diverse.diverse.

•• Orthodontists 3x more likely to extract primary teeth than Orthodontists 3x more likely to extract primary teeth than pediatric dentist.pediatric dentist.

•• Orhtodontists 14x more likely to treat Phase II cases. Orhtodontists 14x more likely to treat Phase II cases.

So, if you are interested in So, if you are interested in Ortho.. PURSUE IT!Ortho.. PURSUE IT!

To doTo do-- Holiday party (gift, small food Holiday party (gift, small food item) if you have time cook item) if you have time cook somethingsomething--Greg’s Greg’s bdaybday-- TannenTannen leaving leaving earlyearly--5:305:30--66

Documents

abpd05OrthoIV.12.2010...• Lingual Bite Plane/ i.e. an Incline Plane –– Can fabricate on your Can fabricate on your own with composite – Resin on stone modelResin on stone model-