1. 27 Orthodontics

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

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

4. 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. 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. 6 Normal Occlusion

7. 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. 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. 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. 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. 11 Malposition of Individual Teeth Torsiversion –Tooth is rotated or turned Mesioversion –Tooth is mesial to normal position

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

13. 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. 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. 15 Malpositions of Groups of Teeth Anterior cross-bite Posterior cross-bite Edge-to-edge bite End-to-end bite

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

17. 17 Etiology of Malocclusion Genetic or heredity Systemic Local

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

19. 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. 20 Process of Tooth Movement Osteoclast –Cause bone to resorb or break down Osteoblasts –Deposit new bone to hold tooth in new position

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

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

23. 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. 24 Orthodontic Appliances Fixed –Orthodontic bands –Brackets –Arch wires –Ligature wire and plastic bags –Buccal tubes –Springs –Elastics

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

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

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

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

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

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

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

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

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

34. 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. 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