ORTHODONTICS Stomatological specialisation dealing with prevention, diagnostics and therapy of irregular tooth position, relationship of tooth arches and jawbones MUDr. Alena Bryšová, Ph.D. nMALOCCLUSION is a manifestation of genetic and environmental interaction on the development of the orofacial region GOALS OF TREATMENT: -Ideal functional occlusion -Ideal soft tissue proportions and adaptation -Ideal jaw, skeletal and dental relationship Ideal occlusion ncorrect relationship of molars ncorrect overjet and overbite nCorrect intercuspidation of teeth nPoints of contact are lined in an regular arch nDeciduous dentition is ended either by a small step or the posterior teeth facets are aligned n n n n n n n nCorrect dentition has 6 keys of correct occlusion- Andrews n Untitled-1 Untitled-2 P1230007 P1230003 P1230006 Ideal occlusion DSC_5675 DSC_5676 okluze ideal 1 1 Ideal occlusion Classification of orthodontic anomalies n1. Anomalies of single tooth nInclination – tooth tipping mesially,distally, nvestibular =protrusion, oral=retrusion, vestibular, lingual, palatal eruption nVertical anomalies - supraocclusion, infraocclusion P1230015 rotation DSC_5451 Classification of orthodontic anomalies 1.Anomalies of single tooth nNonocclusion – buccal, lingual, palatal nupper teeth are not in contact with lower teeth nTransposition – change of sequence of teeth in one arch, eg. the canine and first premolar or canine and lateral incisor Classification of orthodontic anomalies n1. Anomalies of single tooth nRotation - mesial, distal nRetention – the teeth is developed, but not erupted, most often: wisdom teeth, upper canine nAnkylosis, reinclusion nHyperodontia – the number of permanent teeth is higher [supernumerary teeth, most frequently- mesiodens, upper incisors] nHypodontia – the correct number of teeth is reduced because some teeth are absent due to agenesis of their germs [most frequently- upper lateral incisors, third permanent molars, premolars] Hypodontia DSC_5037 DSC_8825 DSC_8827 Anomalies of the shape of teeth DSC_6753 Palatal eruption DSC_8727 Palatal eruption DSC_2394 Retention of canine DSC_4121 Retention of canine DSC_4127 Infraocclusion n DSC_3243 Buccal nonocclusion DSC_9679 Classification of orthodontic anomalies n2. Anomalies of groups of teeth -groups of teeth are in irregular position n nProtrusion, retrussion n nInverted bite – is in the frontal part – lower tooth is more anteriorly than the upper tooth n P1230020 Inverted bite DSC_9543 Classification of orthodontic anomalies n2. Anomalies of groups of teeth nCross bite – in lateral part the buccal cuspids of lower molars are more buccaly than the in the intercuspidal line n n nOpen bite - negativ overbite P1230018 P1230016 Cross bite DSC_9548 Open bite DSC_6757 Classification of orthodontic anomalies n2. Anomalies of groups of teeth n nDeep bite – the overbite is increased, the upper incisors cover more than the incisal third of the lower incisors nSpacing, diastema nCrowding – primary, secondary, tertiary n n n Deep bite DSC_3080 Crowding DSC_5182 Classification of orthodontic anomalies n3. Anomalies of the relationship of dental arches = Angles classification nClass I . normoocclusion 1 1 Angle I DSC_3211 Classification of orthodontic anomalies nClass II : distal occlusion n - with protrusion of upper incisors n - with retrusion of upper incisors 2 2 Angle II DSC_1343 Classification of orthodontic anomalies nClass III : mesial occlusion 3 cun pred Angle III DSC_3288 Classification of orthodontic anomalies n4. Anomalies of position, size and relationship of the jaws-bones DSC_0067 Classification of orthodontic anomalies n4. Anomalies of position, size and relationship of the jaws-bones nSkeletal class I : relationship of jaws without any deviation 1 1 Classification of orthodontic anomalies nSkeletal class II : the lower jaw is more distally to the upper jaw (small lower jaw, large upper jaw) 2 Angle II DSC_6251 Classification of orthodontic anomalies nSkeletal class III : the lower jaw is ventral to the upper jaw (progenia – large mandible,pseudoprogenia – small maxilla) 3 Angle III - TLR DSC_6922 Classification of orthodontic anomalies DSC_0068 Deep bite Protrusion , skeletal class II Inverted bite, skeletal class III Skeletal, dental open bite Skeletal open bite, class III. Deep bite, skeletal class II Diagnostic examination n1. ANAMNESIS na] Family anamnesis n - dental problems of parents n - orthodontic anomalies of parents n - genetic health problems Diagnostic examination n1. ANAMNESIS nb] health anamnesis of the patient n - medicaments n - allergy n - facial and dental injury n - contagious disease Diagnostic examination n1. ANAMNESIS nc] special anamnesis of the patient n - frenulectomy n - adenotomy n - habits n - mouth breathing n n Diagnostic examination n2. CLINICAL EXAMINATION na] extraoral examination -profile [convex, concave, straight] -face symmetry -temporomandibular joints Diagnostic examination n2. CLINICAL EXAMINATION nb] intraoral examination n -Status of dentition, caries, fillings -Anomalies of the relationship of dental arches – Angles classification -Overjet, overbite -Status of oral soft tissues, frenulum -Functional examination, centric occlusion -hygiene Diagnostic examination n3. MODEL EXAMINATION n - space analysis, discrepancy -arch form -dental anatomy -intercuspidation n Diagnostic examination n4. RADIOGRAPHS n na] Panoramic -detection of congenital absences of teeth -detection of supernumerary teeth -evaluation of the dental health of the permanent teeth -assessment of trauma to the teeth after injury -determination of dental age of the patient -calculation of root resorption -condyles n n Diagnostic examination n n4. RADIOGRAPHS n nb] Cephalometric radiographs -evaluation of craniofaciodental relationship -assessment of the soft tissue matrix -determination of mandibular position -prediction of growth and development -detection of skeletal age Cephalometric analysis body na TLR.JPG nN - nasion (1) nS – sella (2) na – articulare (3) nMe – menton (6) nPo – pogonion (7) nSpA – spina nasalis ant. (9) nSpP – spina nasalis post. (10) nA – bod A (11) nIs´- apex horního středního řezáku (12) nIs – incisale superius (13) nIi – incisale inferius (14) nIi´- apex dolního řezáku (15) nB – bod B (17) nGo – gonion (kontr. bod: 1. a-4, 2. ML) nGn – gnation (konstr. bod: 1. N-Po, 2. ML) nML – mandibulární linie (Me-5) nFOL – funkční okluzální linie DSC_1033 skeletal analysis DSC_1035.JPG n n nANB (-1 to +5 degree) n nWITS (-2 to +2 mm) DSC_1036.JPG DSC_1030.JPG Skeletal class I hrudová2.JPG Skeletal Class II nWith protrusion of upper incisors 2.tř. 1.odd..JPG nWith retrusion of upper incisors 2.tř. 2.odd..JPG Skeletal Class III. III.sk.tř..JPG Diagnostic examination n4. RADIOGRAPHS nc] Other radiographs -Bitewing – caries detection -Hand wrist – detection of skeletal age -Computer tomography –CT scan [impacted tooth, ankylosed tooth, difficult skeletal anomalies -Digital imaging – computer generated model reconstructed from the initial imaging data _ERM_K_PAVEL_CT3 _ERM_K_PAVEL_CT4 _ERM_K_PAVEL_CT6 _ERM_K_PAVEL_SSD4 Čerm sk1 _ERM_K_PAVEL_4D2 Kudynkova Kristyna-zadopř Kudynkova Kristyna-bočníkef Kudynkova Kristyna-bočníLS Kudynkova Kristyna-bočníPS Kudynkova Kristyna-3D7 Kudynkova%20Kristyna-3D1 Kudynkova%20Kristyna-3D2 Kudynkova%20Kristyna-3D3 Kudynkova%20Kristyna-3D6 Diagnostic examination n5. PHOTOGRAPHS n - extraoral photographs - frontal n - profile n - smile -Intaoral photographs - frontal teeth n - right and left side n - upper and lower arch Etiology of orthodontic anomalies nIdeal set of teeth can be seen in aprox. 25% of population n40% need treatment Holmanová Š Etiology of orthodontic anomalies nMalocclusion is a manifestation of genetic and environmental interaction on the development of orofacial region Soukeník Ondřej p Staňková Dominika fr Němcová Hana fr Etiology of orthodontic anomalies n nThe etiological factors: n n 1. genetic influences n 2. prenatal factors n 3. postnatal, environmental influences n Etiology of orthodontic anomalies nHereditary are mainly: -Shape and size of tooth -Teeth number -Shape and size of jawbones -Time of teeth eruption -Time and type growing jawbones Etiology of orthodontic anomalies nMainly hereditary anomalies: -True mandibular progenia -Skeletal open bite -Skeletal deep bite -Primary crowding -Skeletal class II and III -Hypodontia, hyperodontia -Deep bite with retrusion of incisors -Retention or impaction of teeth -clefts Etiology of orthodontic anomalies n2. Prenatal factors nA.- teratogens n influence of physical, chemical and infectionals effects during gravidity- if acting in critical time Etiology of orthodontic anomalies nA.- teratogens affecting dentofacial development n nTeratogens Effect n nAspirin, Valium cleft lip and palate nCigarette smoke[hypoxia] cleft lip and palate nCytomegalovirus microcephaly, hydrocephaly nEthyl alcohol central mid-face deficiency n6-Mercaptopurin cleft palate nRubella virus microftalmia, cataracts nThalidomide hemifacial microsomia nToxoplasma microcephaly, Hydrocephaly nX-radiation microcephaly nVitamin D excess premature suture closure n n Etiology of orthodontic anomalies nAnomalie -Developmental defects - amelogenesis n Developmental defects hypocalcified-e1279283930356 Etiology of orthodontic anomalies nClefts lip and palt rozstep2 rozstep1 rozstep3 993855-995535-968 nSyndromes – Pierre Robin syndrome texte_alt_jlemtp00110_gr20 BatemanJacob3 Etiology of orthodontic anomalies Etiology of orthodontic anomalies n3. Postnatal influences -Trauma – undiagnosed fractures of the mandibular condyles can cause disorders of the growth of the mandibular ramus =asymmetry - Hormonal disorders – growth hormone deficiency, thyroid hormone deficiency – can contribute to the origin of acquired anomalies n n n Orthodontic treatment Objectives of orthodontic treatment nAesthetics nTreatment of impacted teeth nPrevention of dental injuries nBefore prosthetic treatment nDecay prevention nPrevention and treatment of chewing malfunction and jaw joint disorders n n Methods of orthodontic treatment nOrthodontics movement of teeth nOrthopedic movement – effects of growth nMyofunctional therapy nSerial extraction, controlled extraction nOrtho – prosthetic treatment nOrtho – surgical treatment Orthodontic treatment n1. Orthodontic treatment by infants n - clefts n - syndromes and defects that complicate nutrition and breathing n nWe use - individual removable plates n n Orthodontic treatment n2. Deciduous teeth n nWe treat - bite defects n inverted bite n cross bite n - bad habits nWe use – removable appliances n n C:\Users\User\Desktop\DSC_6576.JPG Orthodontic treatment n3. 6-9 years [ 1. phase of mixed dentition] n nThe best time for treatment : n - cross bite n - inverted bite n - impacted incisors n - diastema more than 3 mm n - big primary crowding n nWe use : removable appliances n small fixed appliances n face mask for inverted bite by class III Face mask Orthodontic treatment n 4. 9-12 year [second phase of mixed dentition] n -Large forming ability of the tissues -We can use and influence the growth -Growth mandible from the joints n nWe treat: - previous untreated anomalies n - crowding n - Angle class II – div. 1 and 2 n - overjet more than 5 mm n - deep bite n - movements teeth after the early loss of teeth and anodontia n - Controlled tooth eruption n - Suspected retention of canines, premolars n nThe best time for functional appliances n - removable appliances - - Small fixed appliances - - Headgear appliance - n n n headgear n Řezáč Jan zev tah Orthodontic treatment n5. Permanent teeth n nWe treat: -All anomalies, previous untreated anomalies, -Angle class III -Crowding -Open bite, deep bite -Impacted tooth -Skeletal anomalies - nAdult therapy – periodontics problems, preprosthetic therapy n - problems with TMJ n - bruxism n nWe use : fixed appliances n extraction n surgical treatment by big skeletal anomalies - - n Othodontic treatment nRemovable appliances: 1.Active 2.Passive 3.Functional n Therapy of ortodontical anomalies nConservativ northodontical appliances : n removable n fixed n nSurgical nextraction of teeth nsurgical expositions of crowns of retined tooth nsurgical movements of maxila, mandible nActive removable appliances n n-Treatment of anomalous position of teeth [inclination, rotation of incisors] n-Treatment the dental arch shape n -Individual resin plates -Active elements : springs, screws, wire bows Removable active appliances P1250006 P1250008 P1250009 P1250007 Removable appliances - active n C:\Users\User\Desktop\DSC_6585.JPG Functional appliances nmodifiyng extent and direction of orofacial growth nexploit muscular activity and soft tissue stretch to stimulate dental and bone n changes noperates at the time of maximum growth of orofacial region = 9-12 years old children nWe need construction bite nType of functional appliances : n Bionator, Klampt, Maxilator – class II and open bite n Fränkel appliance – class III Removable functional appliances P1250001 P1250005 P1250004 P1250003 Removable appliances-passive n C:\Users\User\Desktop\DSC_6580.JPG Fixed appliances -History multiband%20appliance%20po%20uprave%202 nidcr1 multiband%20appliance%20po%20uprave%202 nidcr1 Orthodontics brackets n Stainless steel brackets n n n n n n nAdvantages Disadvantages: n - strong, do not crack - Aesthetic - smooth, low profile - recyclable - low friction - price kovove_zamky_151940 rovnatka42 rovnatka39 rovnatka41 Stainless steel brackets metal bra Orthodontics brackets nCeramic brackets n n n n n n n n n n nAdvantages: Disadvantages: n - Aesthetics - repeated bonding problem - robust - crack - higher friction (avoid metal slot) - price srovnani rovnatka lr_keramicke_zamky_toothc Ceramic brackets srovnani rovnatka mouth Orthodontics brackets nSapphire brackets n n n n n n n n n n n nAdvantages Disadvantages: n- aesthetic - repeated bonding problem - robust - crack - higher friction (avoid metal slot) - price mouth Radiance1 Orthodontics brackets nGold-coated brackets n n n n n n n n n n nAdvantages: Disadvantages: n- suitable for allergy sufferers - price - strong, do not crack - smooth, low profile - recyclable - Low friction - Aesthetics gold-braces lr_kovove_zamky_goldbrac n zlato fr zlato l zlato p Orthodontics brackets nSelfligating brackets – metal and ceramic n n n n n n nAdvantages: Disadvantages: n - not suitable for all - minimum friction types of defects - low power - faster treatment n - Fewer office visits DSC_5636 str 7_4 Selfligating stainless steel brackets DSC_5636 Orthodontics brackets nLingual brackets – 2D,3D n n n n n n n n n nAdvantages: Disadvantages: n- Aesthetics - unsuitable for all types of defects - Difficulty hygiene - (patient discomfort) image_lingual-brackets Janačková nasaz P2 pospisilova prub P3 Lingual bracket Janačková nasaz P2 pospisilova prub P3 Žáková Jitka P2 Žáková ling Cizkova zac P1 Cizkova prub P2 Orthodontics brackets nDecorative brackets n WildSmileBrackets closeup C:\Users\brysova\Desktop\il plocha.png neviditelná rovnátka Invisalign http://cdn-img.health.com/sites/default/files/wp_migrated_images/9df14376_invisalign-2.xxxlarge_2x. jpg Fixed lingual retainer retainer nDirect bonding n1.cleaning 2. etching n n3.rinse 4. drying > > > > nDirect bonding n5. primer 6. bonding n n n n n7. remove excess 8. light or chemically cured n > > > DSC_0026 Indirect bonding neprime lepeni Case 1 : vestibular eruption 11, crowding, supernumerary 11 Case 1 : vestibular eruption 11, crowding, supernumerary 11 Case 1 : vestibular eruption 11, crowding, supernumerary 11 Case 1 : vestibular eruption 11, crowding, supernumerary 11 - Treatment nTreatment time – 11 months Case 1 : vestibular eruption 11, crowding, supernumerary 11 - Treatment Case 2 : retention 11,21 , crowding, supernumerary 11, 21 Case 2 : retention 11,21 , crowding, supernumerary 11, 21 _ERM_K_TELE_RTG Case 2 : retention 11,21 , crowding, supernumerary 11, 21 _ERM_K_PAVEL_CT3 _ERM_K_PAVEL_CT4 _ERM_K_PAVEL_CT6 _ERM_K_PAVEL_SSD4 Čerm sk1 _ERM_K_PAVEL_4D2 Case 2 : retention 11,21 , crowding, supernumerary 11, 21 CBCT 10 09 11 Case 2 : retention 11,21 , crowding, supernumerary 11, 21 Treatment - Extraction of the supernumerary 11,12 DSC_6109 Case 2 : retention 11,21 , crowding, supernumerary 11, 21 Treatment Case 2 : retention 11,21 , crowding, supernumerary 11, 21 Treatment DSC_6106 DSC_6085 – kopie DSC_6085 Case 2 : retention 11,21 , crowding, supernumerary 11, 21 After Treatment nTreatment time 16 months DSC_6108 DSC_6106 Case 2 : retention 11,21 , crowding, supernumerary 11, 21 Hlo z p hlo p Hlo l Case 3 : Crowding, deep bite hlo po pred Hlo z po p Hlo po z l Case 3 : Crowding, deep bite After Treatment with a fixed orthodontic appliance Treatment time – 1,5 years cun pred cun p cun l Case 4 : Crowding, inverted bite, vestibular eruption 13 cun po z cunpo z p cun po z l Case 4 : Crowding, inverted bite, vestibular eruption 13 Treatment – fixed appliance - expansion, leveling, bite correction Treatment time – 1,8 years lli11 li8 li9 li13 li 12 Case 5 : retention 25, no space for 25 eruption Treatment – fixed appliance - expansion, open space for 25 leveling li6 li 4 li 5 Case 5 : retention 25, no space for 25 eruption Treatment – fixed appliance - expansion, open space for 25 leveling Treatment time – 2 years 3 1 9 4 20 19 Case 6 : retention 23, no space for 23 eruption, crowding Treatment – fixed appliance - expansion, open space for 23, leveling Treatment time – 2 years kol 1 kolm kol2 14 12 11 10 Case 7 : retention 13,23, no space for 13,23 eruption, crowding Treatment – fixed appliance – extraction 14,24,34 44, leveling, bite correction Treatment time – 2 years Orthodontic – surgery treatment - by skeletal Class III. case Before treatment After treatment Lingual appliance 2D – crowding treatment Cizk zac P1 Ciz prub P2 n n n n n n n n n n n n n n n n ciz posej P3 ret AN zač1 AN prub AN pos 2 Thank You four Your attention n n n n n n n n n n n n n n n n n n