Orthodontics

1. 27 Orthodontics

2. Introduction • Orthodontics • Area of specialty dealing with the recognition, prevention, and treatment of malalignment and irregularities of the teeth, jaws, and face

3. The Orthodontic Practice • Orthodontic office • Orthodontic team • Orthodontist • Reception and business office staff • Office coordinator • Laboratory technician • Orthodontic assistant

4. Occlusion and Malocclusion • Normal (ideal) occlusion describes the contact relationship of the mandibular arch with the maxillary arch. • Mandibular teeth are in maximum contact with maxillary teeth and spaced normally

5. Occlusion and Malocclusion • Normal (ideal) occlusion • Maxillary anterior teeth overlap incisal edge of mandibular anterior teeth by 2 mm • Maxillary posterior teeth are one cusp distal to mandibular posterior teeth

6. Normal Occlusion

7. Occlusion and Malocclusion • Malocclusion: • Any deviation from normal occlusion • Includes misalignment of a single tooth, a group of teeth, or an entire arch

8. Angle’s Classification • Neutroclusion • Cusp of the maxillary cuspid (canine) occludes between the distal of the mandibular cuspid and the mesial of the mandibular first bicuspid

9. Angle’s Classification • Distoclusion • Cusp of the maxillary cuspid (canine) is moved forward and occludes between the distal of the mandibular lateral incisor and the mesial of the mandibular cuspid

10. Angle’s Classification • Mesioclusion • Cusp of the maxillary cuspid (canine) is moved back and occludes behind the mandibular cuspid and in the middle of the mandibular first molar

11. Malposition of Individual Teeth • Torsiversion • Tooth is rotated or turned • Mesioversion • Tooth is mesial to normal position

12. Malposition of Individual Teeth • Distoversion • Tooth is distal to normal position • Linguoversion • Tooth is lingual to normal position

13. Malpositions of Individual Teeth • Labioversion or buccoversion • Tooth is tipped toward the lip or cheek • Supraversion • Tooth extends above the normal line of occlusion

14. Malpositions of Individual Teeth • Infraversion • Tooth is positioned below normal line of occlusion • Transversion or transposition • Tooth is in the wrong order in the arch

15. Malpositions of Groups of Teeth • Anterior cross-bite • Posterior cross-bite • Edge-to-edge bite • End-to-end bite

16. Malpositions of Groups of Teeth • Open bite • Overjet • Horizontal overlap • Overbite • Vertical overlap • Underjet

17. Etiology of Malocclusion • Genetic or heredity • Systemic • Local

18. Types of Orthodontic Treatment • Preventive or interceptive • Placing restorations • Space maintainers • Observations • Corrective • Fixed appliances • Removable appliances

19. Process of Tooth Movement • Resorption • Process that eliminates tissues no longer needed in the body, therefore allowing teeth to be moved • Deposition • Retains teeth by creating new deposits or cells

20. Process of Tooth Movement • Osteoclast • Cause bone to resorb or break down • Osteoblasts • Deposit new bone to hold tooth in new position

21. Preorthodontic Treatment • Diagnostic records • Medical-dental history • Clinical examination • Radiographs • Photographs • Study models

22. (Courtesy of Dr. Steven Gregg) Panoramic Radiograph

23. The Consultation Appointment • Orthodontist presents patient with treatment plan • Responsibilities of patient is reviewed • If patient accepts the treatment plan • Consent papers are signed and financial arrangements made

24. Fixed Orthodontic bands Brackets Arch wires Ligature wire and plastic bags Buccal tubes Springs Elastics Orthodontic Appliances

25. (Courtesy of Rita Johnson, RDH, Professor, MCC, Lowell, MA; and Dr. Vincent de Angelis, Associate Professor, Harvard School of Dental Medicine.) Orthodontic Appliances

26. Special Fixed Appliances • Lingual braces • Lingual arch wire • Space maintainer • Palatal separating appliance

27. Removable Appliances • Headgear • Functional appliances • Retainers • Tooth positioner • Aesthetic orthodontic aligners

28. Orthodontic Instruments • Coons’ ligature-tying pliers • Mathieu needle holder • Ligature director • Pin and ligature cutter or light wire cutter • Howe pliers

29. Orthodontic Instruments • Band seater • Bite stick band seater • Band driver • Posterior band removing pliers • Band contouring pliers

30. Orthodontic Instruments • Bracket forceps • “Bird-beak” pliers • Three-prong pliers • Weingart utility pliers • Tweed-loop pliers • Distal-end cutting pliers

31. Orthodontic Treatment • Application of separators • Placement of posterior bands • Placement of anterior brackets

32. Orthodontic Treatment • Placement of arch wire • Oral hygiene instructions • Interval checkups • Completion appointment

33. Completion Appointment • Ligature ties removed • Elastic ties removed • Elastic released • Wire cut • Wire removed from wing

34. Completion Appointment • Arch wire removed from bracket • Anterior brackets removed • Posterior bands are removed • Above process repeated on lingual surface • Cement and direct bonding materials removed

35. Completion Appointment • Rubber cup polish completed • Alginate impression taken of arches • Patient reappointed for later that day or for next day • Retainer or positioner placed • Patient given instructions on how to wear appliance