ORTHODONTICS MUDR. ALENA BRYŠOVÁ, PH.D. [USEMAP] ORTHODONTICS Stomatological specialisation dealing with prevention, diagnostics and therapy of irregular tooth position, relationship of tooth arches and jawbones [USEMAP] MALOCCLUSION is a manifestation of genetic and environmental interaction on the development of the orofacial region [USEMAP] GOALS OF TREATMENT: -Ideal functional occlusion -Ideal soft tissue proportions and adaptation -Ideal jaw, skeletal and dental relationship [USEMAP] Ideal occlusion correct relationship of molars correct overjet and overbite Correct intercuspidation of teeth Points of contact are lined in an regular arch Deciduous dentition is ended either by a small step or the posterior teeth facets are aligned Correct dentition has 6 keys of correct occlusion- Andrews Untitled-1 Untitled-2 P1230007 P1230003 P1230006 [USEMAP] Ideal occlusion DSC_5675 DSC_5676 [USEMAP] okluze ideal 1 1 [USEMAP] Classification of orthodontic anomalies 1. Anomalies of single tooth Inclination – tooth tipping mesially,distally, vestibular =protrusion, oral=retrusion, vestibular, lingual, palatal eruption Vertical anomalies - supraocclusion, infraocclusion P1230015 [USEMAP] rotation DSC_5451 [USEMAP] Classification of orthodontic anomalies 1.Anomalies of single tooth Nonocclusion – buccal, lingual, palatal upper teeth are not in contact with lower teeth Transposition – change of sequence of teeth in one arch, eg. the canine and first premolar or canine and lateral incisor [USEMAP] Classification of orthodontic anomalies 1. Anomalies of single tooth Rotation - mesial, distal Retention – the teeth is developed, but not erupted, most often: wisdom teeth, upper canine Ankylosis, reinclusion Hyperodontia – the number of permanent teeth is higher [supernumerary teeth, most frequently- mesiodens, upper incisors] Hypodontia – 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] [USEMAP] Hypodontia DSC_5037 [USEMAP] DSC_8825 DSC_8827 [USEMAP] Anomalies of the shape of teeth DSC_6753 [USEMAP] Palatal eruption DSC_8727 [USEMAP] Palatal eruption DSC_2394 [USEMAP] Retention of canine DSC_4121 [USEMAP] Retention of canine DSC_4127 [USEMAP] Classification of orthodontic anomalies 2. Anomalies of groups of teeth -groups of teeth are in irregular position Protrusion, retrussion Inverted bite – is in the frontal part – lower tooth is more anteriorly than the upper tooth P1230020 [USEMAP] Protrusion with deep bite DSC_9679 DSC_9680 [USEMAP] Inverted bite DSC_9543 [USEMAP] Classification of orthodontic anomalies 2. Anomalies of groups of teeth Cross bite – in lateral part the buccal cuspids of lower molars are more buccaly than the in the intercuspidal line Open bite - negativ overbite P1230018 P1230016 [USEMAP] Cross bite DSC_9548 [USEMAP] Open bite DSC_6757 [USEMAP] Classification of orthodontic anomalies 2. Anomalies of groups of teeth Deep bite – the overbite is increased, the upper incisors cover more than the incisal third of the lower incisors Spacing, diastema Crowding – primary, secondary, tertiary [USEMAP] Deep bite DSC_3080 [USEMAP] Crowding DSC_5182 [USEMAP] Classification of orthodontic anomalies 3. Anomalies of the relationship of dental arches = Angles classification Class I . normoocclusion 1 1 [USEMAP] Angle I DSC_3211 [USEMAP] Classification of orthodontic anomalies Class II : distal occlusion - with protrusion of upper incisors - with retrusion of upper incisors 2 2 [USEMAP] Angle II DSC_1343 [USEMAP] Classification of orthodontic anomalies Class III : mesial occlusion 3 cun pred [USEMAP] Angle III DSC_3288 [USEMAP] Classification of orthodontic anomalies 4. Anomalies of position, size and relationship of the jaws-bones DSC_0067 [USEMAP] Classification of orthodontic anomalies 4. Anomalies of position, size and relationship of the jaws-bones Skeletal class I : relationship of jaws without any deviation 1 1 [USEMAP] Classification of orthodontic anomalies Skeletal class II : the lower jaw is more distally to the upper jaw (small lower jaw, large upper jaw) 2 [USEMAP] Hrdličková%20fron Hrdličková%20p Hrdličková%20l Hrdličková%20is Hrdličková%20obl Hrdličková%20us Hrdličková%20prof%20l [USEMAP] Classification of orthodontic anomalies Skeletal class III : the lower jaw is ventral to the upper jaw (progenia – large mandible,pseudoprogenia – small maxilla) 3 [USEMAP] Classification of orthodontic anomalies DSC_0068 [USEMAP] [USEMAP] Diagnostic examination 1. ANAMNESIS a] Family anamnesis - dental problems of parents - orthodontic anomalies of parents - genetic health problems [USEMAP] Diagnostic examination 1. ANAMNESIS b] health anamnesis of the patient - medicaments - allergy - facial and dental injury - contagious disease [USEMAP] Diagnostic examination 1. ANAMNESIS c] special anamnesis of the patient - frenulectomy - adenotomy - habits - mouth breathing [USEMAP] Diagnostic examination 2. CLINICAL EXAMINATION a] extraoral examination -profile [convex, concave, straight] -face symmetry -temporomandibular joints [USEMAP] Diagnostic examination 2. CLINICAL EXAMINATION b] intraoral examination -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 [USEMAP] Diagnostic examination 3. MODEL EXAMINATION - space analysis, discrepancy -arch form -dental anatomy -intercuspidation [USEMAP] Diagnostic examination 4. RADIOGRAPHS a] 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 [USEMAP] [USEMAP] [USEMAP] Diagnostic examination 4. RADIOGRAPHS b] 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 [USEMAP] [USEMAP] body na TLR.JPG N - nasion (1) S – sella (2) a – articulare (3) Me – menton (6) Po – pogonion (7) SpA – spina nasalis ant. (9) SpP – spina nasalis post. (10) A – bod A (11) Is´- apex (12) Is – incisale superius (13) Ii – incisale inferius (14) Ii´- apex (15) B – bod B (17) Go – gonion (kontr. bod: 1. a-4, 2. ML) Gn – gnation (konstr. bod: 1. N-Po, 2. ML) [USEMAP] Cephalometric analysis [USEMAP] DSC_1033 [USEMAP] skeletal analysis DSC_1035.JPG ANB (-1° to +5°) WITS (-2 to +2mm) DSC_1036.JPG [USEMAP] Skeletal class I hrudová2.JPG [USEMAP] Skeletal class II with protrusion of incisors 2.tř. 1.odd..JPG with retrusion of upper incisors 2.tř. 2.odd..JPG [USEMAP] Skeletal class III III.sk.tř..JPG [USEMAP] Diagnostic examination 4. RADIOGRAPHS c] 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 [USEMAP] _ERM_K_PAVEL_CT3 _ERM_K_PAVEL_CT4 _ERM_K_PAVEL_CT6 _ERM_K_PAVEL_SSD4 Čerm sk1 _ERM_K_PAVEL_4D2 [USEMAP] Kudynkova Kristyna-bočníkef Kudynkova Kristyna-zadopř Kudynkova Kristyna-bočníLS Kudynkova Kristyna-bočníPS [USEMAP] Kudynkova Kristyna-3D7 Kudynkova%20Kristyna-3D1 Kudynkova%20Kristyna-3D2 Kudynkova%20Kristyna-3D3 Kudynkova%20Kristyna-3D6 [USEMAP] Diagnostic examination 5. PHOTOGRAPHS - extraoral photographs - frontal - profile - smile -Intaoral photographs - frontal teeth - right and left side - upper and lower arch [USEMAP] DSC_1143 DSC_1144 DSC_1145 DSC_1147 DSC_1148 [USEMAP] DSC_1151 DSC_1149 DSC_1150 [USEMAP] Etiology of orthodontic anomalies Ideal set of teeth can be seen in aprox. 25% of population 40% need treatment Holmanová Š [USEMAP] Etiology of orthodontic anomalies Malocclusion is a manifestation of genetic and environmental interaction on the development of orofacial region Soukeník Ondřej p Staňková Dominika fr Němcová Hana fr [USEMAP] Etiology of orthodontic anomalies The etiological factors: 1. genetic influences 2. prenatal factors 3. postnatal, environmental influences [USEMAP] Etiology of orthodontic anomalies Hereditary are mainly: -Shape and size of tooth -Teeth number -Shape and size of jawbones -Time of teeth eruption -Time and type growing jawbones [USEMAP] Etiology of orthodontic anomalies Mainly 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 [USEMAP] Etiology of orthodontic anomalies Mainly hereditary anomalies- mandibular prognatism in the Hapsburg family FILIP II rudolfII [USEMAP] Etiology of orthodontic anomalies Mainly hereditary anomalies – skeletal class III Malá Barbora fr Malá Barbora l Malá Barbora prof [USEMAP] Etiology of orthodontic anomalies Flodrová Jolana l Flodrová Jolana fr [USEMAP] Etiology of orthodontic anomalies Mainly hereditary anomalies – skeletal deep bite Dvořák Jan fr Dvořák Jan l [USEMAP] Etiology of orthodontic anomalies Mainly hereditary anomalies- skeletal open bite 6 7 8 [USEMAP] Etiology of orthodontic anomalies Mainly hereditary anomalies – primary crowding Gladiš Martin fr Gladiš Martin l Míchal Jakub fr Staňková Dominika fr [USEMAP] Etiology of orthodontic anomalies Mainly hereditary anomalies- hypodontia Kern Tomáš l Kern Tomáš fr supernumerary teeth [USEMAP] Etiology of orthodontic anomalies Mainly hereditary anomalies- hyperodontia _ERM_K_PAVEL_CT4 _ERM_K_PAVEL_CT6 Čerm sk1 _ERM_K_PAVEL_4D2 [USEMAP] Etiology of orthodontic anomalies hyperodontia [USEMAP] Etiology of orthodontic anomalies 2. Prenatal factors A.- teratogens influence of physical, chemical and infectionals effects during gravidity- if acting in critical time [USEMAP] Etiology of orthodontic anomalies A.- teratogens affecting dentofacial development Teratogens Effect Aspirin, Valium cleft lip and palate Cigarette smoke[hypoxia] cleft lip and palate Cytomegalovirus microcephaly, hydrocephaly Ethyl alcohol central mid-face deficiency 6-Mercaptopurin cleft palate Rubella virus microftalmia, cataracts Thalidomide hemifacial microsomia Toxoplasma microcephaly, Hydrocephaly X-radiation microcephaly Vitamin D excess premature suture closure [USEMAP] Etiology of orthodontic anomalies Clefts lip and palt rozstep2 rozstep1 rozstep3 993855-995535-968 [USEMAP] Etiology of orthodontic anomalies Syndromes – Pierre Robin syndrome texte_alt_jlemtp00110_gr20 BatemanJacob3 [USEMAP] Etiology of orthodontic anomalies 3. 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 [USEMAP] Orthodontic treatment Objectives of orthodontic treatment Aesthetics Treatment of impacted teeth Prevention of dental injuries Before prosthetic treatment Decay prevention Prevention and treatment of chewing malfunction and jaw joint disorders [USEMAP] Methods of orthodontic treatment Orthodontics movement of teeth Orthopedic movement – effects of growth Myofunctional therapy Serial extraction, controlled extraction Ortho – prosthetic treatment Ortho – surgical treatment [USEMAP] Orthodontic treatment 1. Orthodontic treatment by infants - clefts - syndromes and defects that complicate nutrition and breathing We use - individual removable plates [USEMAP] Orthodontic treatment 2. Deciduous teeth We treat - bite defects inverted bite cross bite - bad habits We use – removable appliances C:\Users\User\Desktop\DSC_6576.JPG [USEMAP] Orthodontic treatment 3. 6-9 years [ 1. phase of mixed dentition] The best time for treatment : - cross bite - inverted bite - impacted incisors - diastema more than 3 mm - big primary crowding We use : removable appliances small fixed appliances face mask for inverted bite by class III [USEMAP] Face mask [USEMAP] Orthodontic treatment 4. 9-12 year [second phase of mixed dentition] -Large forming ability of the tissues -We can use and influence the growth -Growth mandible from the joints We treat: - previous untreated anomalies - crowding - Angle class II – div. 1 and 2 - overjet more than 5 mm - deep bite - movements teeth after the early loss of teeth and anodontia - Controlled tooth eruption - Suspected retention of canines, premolars The best time for functional appliances - removable appliances - - Small fixed appliances - - Headgear appliance - [USEMAP] headgear Řezáč Jan zev tah [USEMAP] Orthodontic treatment 5. Permanent teeth We treat: -All anomalies, previous untreated anomalies, -Angle class III -Crowding -Open bite, deep bite -Impacted tooth -Skeletal anomalies - Adult therapy – periodontics problems, preprosthetic therapy - problems with TMJ - bruxism We use : fixed appliances extraction surgical treatment by big skeletal anomalies - - [USEMAP] Othodontic treatment Removable appliances: 1.Active 2.Passive 3.Functional [USEMAP] Therapy of ortodontical anomalies Conservativ orthodontical appliances : removable fixed Surgical extraction of teeth surgical expositions of crowns of retined tooth surgical movements of maxila, mandible [USEMAP] Active removable appliances -Treatment of anomalous position of teeth [inclination, rotation of incisors] -Treatment the dental arch shape -Individual resin plates -Active elements : springs, screws, wire bows [USEMAP] Removable active appliances P1250006 P1250008 P1250009 P1250007 [USEMAP] Removable appliances - active C:\Users\User\Desktop\DSC_6585.JPG [USEMAP] Removable functional appliances P1250001 P1250005 P1250004 P1250003 [USEMAP] Removable appliances-passive C:\Users\User\Desktop\DSC_6580.JPG [USEMAP] Fixed appliances -History multiband%20appliance%20po%20uprave%202 nidcr1 multiband%20appliance%20po%20uprave%202 nidcr1 [USEMAP] Orthodontics brackets Stainless steel brackets Advantages Disadvantages: - strong, do not crack - Aesthetic - smooth, low profile - recyclable - low friction - price kovove_zamky_151940 rovnatka42 rovnatka39 rovnatka41 [USEMAP] Stainless steel brackets metal bra [USEMAP] Orthodontics brackets Ceramic brackets Advantages: Disadvantages: - Aesthetics - repeated bonding problem - robust - crack - higher friction (avoid metal slot) - price srovnani rovnatka lr_keramicke_zamky_toothc [USEMAP] Ceramic brackets keram [USEMAP] Ceramic brackets [USEMAP] Orthodontics brackets Sapphire brackets Advantages Disadvantages: - aesthetic - repeated bonding problem - robust - crack - higher friction (avoid metal slot) - price mouth Radiance1 [USEMAP] Orthodontics brackets Gold-coated brackets Advantages: Disadvantages: - suitable for allergy sufferers - price - strong, do not crack - smooth, low profile - recyclable - Low friction - Aesthetics gold-braces lr_kovove_zamky_goldbrac [USEMAP] zlato fr zlato l zlato p [USEMAP] Orthodontics brackets Selfligating brackets – metal and ceramic Advantages: Disadvantages: - not suitable for all - minimum friction types of defects - low power - faster treatment - Fewer office visits DSC_5636 str 7_4 [USEMAP] Orthodontics brackets Lingual brackets – 2D,3D Advantages: Disadvantages: - Aesthetics - unsuitable for all types of defects - Difficulty hygiene - (patient discomfort) image_lingual-brackets Janačková nasaz P2 pospisilova prub P3 [USEMAP] Lingual bracket Janačková nasaz P2 pospisilova prub P3 [USEMAP] Orthodontics brackets Decorative brackets WildSmileBrackets closeup [USEMAP] 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 [USEMAP] Fixed lingual retainer retainer [USEMAP] Case 1 – hyperodontia - supernumerrary incisor, cowding [USEMAP] [USEMAP] [USEMAP] [USEMAP] Case 1 before after treatment Treatment – fixed appliance – 11 months Retention – removable appliance [USEMAP] Case 2 – hyperodontia – supernumerrary 2 incisors [USEMAP] [USEMAP] _ERM_K_TELE_RTG [USEMAP] _ERM_K_PAVEL_CT3 _ERM_K_PAVEL_CT4 _ERM_K_PAVEL_CT6 _ERM_K_PAVEL_SSD4 Čerm sk1 _ERM_K_PAVEL_4D2 CBCT [USEMAP] 10 09 11 Extraction of the supernumerrary incisors [USEMAP] DSC_6109 [USEMAP] [USEMAP] DSC_6095 DSC_6106 DSC_6085 – kopie DSC_6085 [USEMAP] treatment – 16 months DSC_6108 DSC_6106 Case 2 - before after treatment [USEMAP] Hlo z p hlo p Hlo l Hlo pred obl Hloz pred prof Case 3 – deep bite, crowding [USEMAP] hlo po pred Hlo z po p Hlo po z l Hlo po obl 1 HLO po us 1 Hlo po prof1 Case 3 – deep bite, crowding – after treatment with fixed appliance – 1,5 year [USEMAP] cun pred cun p cun l Cun obl cun us Cund prof Case 4 – inverted bite, crowding, vestibular eruption canine [USEMAP] cun po z cunpo z p cun po z l cud obl2 cun us2 cun prof 2 Case 4 – inverted bite, crowding, vestibular eruption canine – after treatment with fixed appliance – no extraction, 2 years [USEMAP] lli11 li8 li9 li 7 li15 li13 li 12 Case 5 – retention of second premolars no space for eruption [USEMAP] li6 li 4 li 5 li2 lis po u li3 Case 5 – retention of second premolars no space for eruption – after treatment – epanzion, no extraction – 2 years [USEMAP] 7 8 3 1 9 Case 6 – retention of canine, palatal eruption [USEMAP] 4 20 19 13 15 Case 6 – after treatment – expanzion, alignment canine [USEMAP] 14 10 11 12 9 13 Case 7 - retention of upper anf lower canines, no space for eruptoin [USEMAP] kol 1 kolm kol2 k komack kol3 Case 7 - retention of upper and lower canines, no space for eruptoin – after treatment with extraction of 4 first premolars, canines on place [USEMAP] Case – orthodontic treatment with surgery correction – mandibular progenia, skeletal class III, open bite, crowding [USEMAP] Before treatment After treatment Case – orthodontic treatment with surgery correction – mandibular progenia, skeletal class III, open bite, crowding [USEMAP] jan zac P 1 Jana nasaz P2 jan pos Orthodontic treatment with lingual appliance [USEMAP] Orthodontic treatment with lingual appliance Cizk zac P1 Ciz prub P2 n n n n n n n n ciz posej P3 ret Fixed retainer after treatment [USEMAP] Treatment - crowding - with lingual appliance AN zač1 AN prub AN pos 2 [USEMAP] Thank You four Your attention Questions – email – alena.brysova@fnusa.cz Consultation – Orthodontic department - St. Anne's Hospital, building D2b – Thursday 1-2 p.m. [USEMAP]