©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontics Chapter 27

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Introduction Orthodontics –Area of specialty dealing with recognition, prevention, and treatment of malalignment and irregularities of teeth, jaws, and face

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Practice Orthodontic office Orthodontic team –Orthodontist –Reception and business office staff –Office coordinator –Laboratory technician –Orthodontic assistant

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Occlusion and Malocclusion Normal (ideal) occlusion –Describes contact relationship of mandibular arch with maxillary arch

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Occlusion and Malocclusion Normal (ideal) occlusion –Mandibular teeth are in maximum contact with maxillary teeth and spaced normally –Maxillary anterior teeth overlap incisal edge of mandibular anterior teeth by 2 mm –Maxillary posterior teeth are one cusp distal to mandibular posterior teeth

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Normal Occlusion © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Occlusion and Malocclusion Malocclusion: –Any deviation from normal occlusion Includes misalignment of single tooth, group of teeth, or entire arch

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Angle’s Classification Neutroclusion –Cusp of maxillary cuspid (canine) occludes between distal of mandibular cuspid and mesial of mandibular first bicuspid

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Angle’s Classification Distoclusion –Cusp of maxillary cuspid (canine) is moved forward and occludes between distal of mandibular lateral incisor and mesial of mandibular cuspid

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Angle’s Classification Mesioclusion –Cusp of maxillary cuspid (canine) is moved back and occludes behind mandibular cuspid and in middle of mandibular first molar

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Malposition of Individual Teeth Torsiversion –Tooth is rotated or turned Mesioversion –Tooth is mesial to normal position

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Malposition of Individual Teeth Distoversion –Tooth is distal to normal position Linguoversion –Tooth is lingual to normal position

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Malposition of Individual Teeth Labioversion or buccoversion –Tooth is tipped toward lip or cheek Supraversion –Tooth extends above normal line of occlusion

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Malposition of Individual Teeth Infraversion –Tooth is positioned below normal line of occlusion Transversion or transposition –Tooth is in wrong order in arch

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Malpositions of Groups of Teeth Anterior cross-bite Posterior cross-bite Edge-to-edge bite End-to-end bite

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Malpositions of Groups of Teeth Open bite Overjet –Horizontal overlap Overbite –Vertical overlap Underjet

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Etiology of Malocclusion Genetic or heredity Systemic Local

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check What are some local factors that may contribute to malocclusion? –Thumb sucking, tongue thrusting, tongue sucking, mouth breathing, bruxism, or nail biting

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Types of Orthodontic Treatment Preventive or interceptive –Restorations –Space maintainers –Observations Corrective –Fixed appliances –Removable appliances

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Process of Tooth Movement Resorption –Process that eliminates tissues no longer needed in body Allows teeth to be moved Deposition –Retains teeth by creating new deposits or cells

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Process of Tooth Movement Osteoclast –Cause bone to resorb or break down Osteoblasts –Deposit new bone to hold tooth in new position

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Preorthodontic Treatment Diagnostic records Medical-dental history Clinical examination Radiographs Photographs Study models © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Panoramic Radiograph Courtesy of Dr. Steve Gregg

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Consultation Appointment Orthodontist presents patient with treatment plan Responsibilities of patient reviewed If patient accepts treatment plan: –Consent papers signed –Financial arrangements made

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Appliances Fixed –Orthodontic bands –Brackets –Arch wires –Ligature wire and plastic bags –Buccal tubes –Springs –Elastics

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Appliances BracketsBands © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Arch Wire Materials: –Stainless steel –Nickel-titanium alloy –Beta-titanium Variety of thickness Changed several times during treatment process © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Appliances (Courtesy of Rita Johnson, RDH, Professor, MCC, Lowell, MA; and Dr. Vincent DeAngelis, Associate Professor, Harvard School of Dental Medicine.)

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Special Fixed Appliances Lingual braces Lingual arch wire Space maintainer Palatal expanding appliance © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Removable Appliances Headgear Functional appliances Retainers Tooth positioner Aesthetic orthodontic aligners Bionater Herbst Frankel

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check What does the Herbst appliance address? –It improves overbite by encouraging lower jaw growth

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Imaging Treatment Allows treatment through non-traditional means Hand-held scanner Treatment planning software Robotic production of shape-memory alloy archwire Less pain and shorter overall treatment

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Instruments Coon ligature-tying pliers Mathieu needle holder Ligature director Pin and ligature cutter or light wire cutter Howe pliers

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Instruments Coon ligature-tying pliers Mathieu needle holder © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Instruments Ligature directorPin and ligature cutter © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Instruments Howe pliersBand seater © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Instruments Bite block with band seater Band driver © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Instruments Posterior band- removing pliers Band-contouring pliers © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Instruments Bracket forcepsWire bending pliers © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Instruments Three-prong pliersWeingart utility pliers © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Instruments Tweed loop pliersDistal end-cutting pliers © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Treatment Application of separators –Elastic –Steel spring Placement and removal of brass wire © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Treatment Placement of bands Placement of brackets © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Treatment Placement of arch wire © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthodontic Treatment Oral hygiene instructions Interval checkups Completion appointment

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Completion Appointment Ligature ties removed Elastic ties removed Elastic released Wire cut Wire removed from wing © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Completion Appointment Arch wire removed from bracket Anterior brackets removed Posterior bands removed Above process repeated on lingual surface Cement and direct bonding materials removed

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Completion Appointment Rubber cup polish completed Alginate impression taken of arches Patient reappointed for later that day or next day Retainer or positioner placed Patient given instructions on how to wear appliance

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check What procedure is being completed in the image? –Cementation of brackets (Courtesy of Rita Johnson, RDH, Professor, MCC, Lowell, MA; and Dr. Vincent DeAngelis, Associate Professor, Harvard School of Dental Medicine.)