Orthodontics MDDr. David Hrňa david.hrna@fnusa.cz ORTHODONTICS Stomatological specialisation dealing with prevention, diagnostics and therapy of irregular tooth position, relationship of dental arches and jawbones [USEMAP] GOALS OF TREATMENT: -Ideal functional occlusion -Ideal soft tissue proportions and adaptation -Ideal jaw, skeletal and dental relationship [USEMAP] ucorrect relationship of molars ucorrect overjet and overbite uCorrect intercuspidation of teeth uPoints of contact are lined in an regular arch uDeciduous dentition is ended either by a small step or the posterior teeth surfaces are aligned u u u u u u u uCorrect dentition has 6 keys of correct occlusion- Andrews u Untitled-1 Untitled-2 P1230007 P1230003 P1230006 [USEMAP] Ideal occlusion Ideal occlusion DSC_5675 DSC_5676 [USEMAP] hloubka skusu a incizální schůdek.png Overjet and overbite [USEMAP] uUpper dental arch covers the lower dental arch in horizontal plane = OVERJET – distance between vestibular plane of lower incisor and incisal edge of the upper incisor uUpper dental arch covers the lower dental arch in vertical plane = OVERBITE – distane between incial edge of lower incisor and incisal edge of the upper incisor Overjet = IS, Overbite = HS okluze ideal 1 1 [USEMAP] Classification of orthodontic anomalies u1. Anomalies of single tooth uInclination – tooth tipping mesially,distally, uvestibular =protrusion, oral=retrusion, vestibular, lingual, palatal eruption uVertical anomalies - supraocclusion, infraocclusion P1230015 [USEMAP] Protrusion x Retrusion Retrusion Obsah obrázku zavřít, zelenina Popis byl vytvořen automaticky Protrusion Supraocclusion Obsah obrázku text Popis byl vytvořen automaticky Infraocclusion Classification of orthodontic anomalies 1.Anomalies of single tooth uNonocclusion – buccal, lingual, palatal uupper teeth are not in contact with lower teeth uTransposition – change of sequence of teeth in one arch, eg. the canine and first premolar or canine and lateral incisor [USEMAP] Classification of orthodontic anomalies u1. Anomalies of single tooth uRotation - mesial, distal uImpacted teeth – the teeth is developed, but not erupted, most often: wisdom teeth, upper canine uAnkylosis, reinclusion uHyperodontia – the number of permanent teeth is higher [supernumerary teeth, most frequently- mesiodens, upper incisors] uHypodontia – 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] Rotation [USEMAP] Obsah obrázku jídlo, omáčka, zelenina Popis byl vytvořen automaticky Hypodontia DSC_5037 [USEMAP] Hyperodontia [USEMAP] Impacted tooth [USEMAP] Palatal eruption [USEMAP] IMG_0515.JPG uPalatal eruption of the upper second premolar Palatal eruption DSC_2394 [USEMAP] Vestibular eruption DSC_8825 DSC_8827 Anomalies of the shape of teeth [USEMAP] Obsah obrázku jídlo, zavřít Popis byl vytvořen automaticky Peg teeth – lateral incisors Classification of orthodontic anomalies u2. Anomalies of groups of teeth -groups of teeth are in irregular position u uProtrusion, retrusion uAnterior cross bite– is in the frontal part – lower tooth is more anteriorly than the upper tooth u P1230020 Protrusion with deep bite DSC_9679 DSC_9680 [USEMAP] Inverted bite DSC_9543 [USEMAP] Classification of orthodontic anomalies u2. Anomalies of groups of teeth uCross bite – in lateral part the buccal cuspids of lower molars are more buccaly than the in the intercuspidal line u u u u uOpen bite - negativ overbite P1230018 P1230016 [USEMAP] Cross bite DSC_9548 [USEMAP] Open bite DSC_6757 [USEMAP] Classification of orthodontic anomalies u2. Anomalies of groups of teeth u uDeep bite – the overbite is increased, the upper incisors cover more than the incisal third of the lower incisors uSpacing, diastema uCrowding – primary, secondary, tertiary u u u [USEMAP] Deep bite DSC_3080 [USEMAP] Crowding [USEMAP] Obsah obrázku horké, osoba, svačina, zavřít Popis byl vytvořen automaticky Classification of orthodontic anomalies u3. Anomalies of the relationship of dental arches = Angles classification uClass I . normoocclusion 1 1 [USEMAP] Angle I DSC_3211 [USEMAP] Classification of orthodontic anomalies uClass II : distal occlusion u - with protrusion of upper incisors u - with retrusion of upper incisors 2 2 [USEMAP] Angle II DSC_1343 [USEMAP] Classification of orthodontic anomalies uClass III : mesial occlusion 3 cun pred [USEMAP] Angle III DSC_3288 [USEMAP] Classification of orthodontic anomalies u4. Anomalies of position, size and relationship of the jaws-bones DSC_0067 [USEMAP] Classification of orthodontic anomalies u4. Anomalies of position, size and relationship of the jaws-bones uSkeletal class I : relationship of jaws without any deviation 1 1 [USEMAP] Classification of orthodontic anomalies uSkeletal 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 uSkeletal 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 u1. ANAMNESIS ua] Family anamnesis u - dental problems of parents u - orthodontic anomalies of parents u - genetic health problems [USEMAP] Diagnostic examination u1. ANAMNESIS ub] health anamnesis of the patient u - medicaments u - allergies u - facial and dental injury u - contagious disease [USEMAP] Diagnostic examination u1. ANAMNESIS uc] special anamnesis of the patient u - frenulectomy u - adenotomy u - habits u - mouth breathing u u [USEMAP] Diagnostic examination u2. CLINICAL EXAMINATION ua] extraoral examination -profile [convex, concave, straight] -face symmetry -temporomandibular joints [USEMAP] Diagnostic examination u2. CLINICAL EXAMINATION ub] intraoral examination u -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 u3. MODEL EXAMINATION u - space analysis, discrepancy -arch form -dental anatomy -intercuspidation u [USEMAP] Diagnostic examination u4. RADIOGRAPHS u ua] 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 u u [USEMAP] [USEMAP]OPG.jpg [USEMAP]Marván Timotej_OPG_18012020.jpg Diagnostic examination u u4. RADIOGRAPHS u ub] 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 uN - nasion (1) uS – sella (2) ua – articulare (3) uMe – menton (6) uPo – pogonion (7) uSpA – spina nasalis ant. (9) uSpP – spina nasalis post. (10) uA – bod A (11) uIs´- apex (12) uIs – incisale superius (13) uIi – incisale inferius (14) uIi´- apex (15) uB – bod B (17) uGo – gonion (kontr. bod: 1. a-4, 2. ML) uGn – gnation (konstr. bod: 1. N-Po, 2. ML) [USEMAP] Cephalometric analysis [USEMAP] DSC_1033 [USEMAP] skeletal analysis DSC_1035.JPG u u uANB (-1° to +5°) u u uWITS (-2 to +2mm) DSC_1036.JPG [USEMAP] Skeletal class I hrudová2.JPG [USEMAP] Skeletal class II u with protrusion of incisors 2.tř. 1.odd..JPG uwith retrusion of upper incisors 2.tř. 2.odd..JPG [USEMAP] Skeletal class III III.sk.tř..JPG [USEMAP] Diagnostic examination u4. RADIOGRAPHS uc] 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 u5. PHOTOGRAPHS u - extraoral photographs - frontal u - profile u - smile -Intaoral photographs - frontal teeth u - right and left side u - 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 uIdeal set of teeth can be seen in aprox. 25% of population u40% need treatment Holmanová Š [USEMAP] Etiology of orthodontic anomalies uMalocclusion 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 u uThe etiological factors: u u 1. genetic influences u 2. prenatal factors u 3. postnatal, environmental influences u [USEMAP] Etiology of orthodontic anomalies uHereditary 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 uMainly 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 uMainly hereditary anomalies- mandibular prognatism in the Hapsburg family FILIP II rudolfII [USEMAP] Etiology of orthodontic anomalies uMainly hereditary anomalies – skeletal class III Malá Barbora fr Malá Barbora l Malá Barbora prof [USEMAP] Etiology of orthodontic anomalies u Flodrová Jolana l Flodrová Jolana fr [USEMAP] Etiology of orthodontic anomalies uMainly hereditary anomalies – skeletal deep bite Dvořák Jan fr Dvořák Jan l [USEMAP] Etiology of orthodontic anomalies uMainly hereditary anomalies- skeletal open bite 6 7 8 [USEMAP] Etiology of orthodontic anomalies uMainly hereditary anomalies – primary crowding Gladiš Martin fr Gladiš Martin l Míchal Jakub fr Staňková Dominika fr [USEMAP] Etiology of orthodontic anomalies uMainly 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 u2. Prenatal factors uA.- teratogens u influence of physical, chemical and infectionals effects during gravidity- if acting in critical time [USEMAP] Etiology of orthodontic anomalies uA.- teratogens affecting dentofacial development u uTeratogens Effect u uAspirin, Valium cleft lip and palate uCigarette smoke[hypoxia] cleft lip and palate uCytomegalovirus microcephaly, hydrocephaly uEthyl alcohol central mid-face deficiency u6-Mercaptopurin cleft palate uRubella virus microftalmia, cataracts uThalidomide hemifacial microsomia uToxoplasma microcephaly, Hydrocephaly uX-radiation microcephaly uVitamin D excess premature suture closure u u [USEMAP] Etiology of orthodontic anomalies uClefts lip and palate rozstep2 rozstep1 rozstep3 993855-995535-968 [USEMAP] Etiology of orthodontic anomalies u3. 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 u u u [USEMAP] Orthodontic treatment Objectives of orthodontic treatment uAesthetics uTreatment of impacted teeth uPrevention of dental injuries uBefore prosthetic treatment uDecay prevention uPrevention and treatment of chewing malfunction and jaw joint disorders u u [USEMAP] Methods of orthodontic treatment uOrthodontics movement of teeth uOrthopedic movement – effects of growth uMyofunctional therapy uSerial extraction, controlled extraction uOrtho – prosthetic treatment uOrtho – surgical treatment [USEMAP] Orthodontic treatment u1. Orthodontic treatment by infants u - clefts u - syndromes and defects that complicate nutrition and breathing u uWe use - individual removable plates u u [USEMAP] Orthodontic treatment u2. Deciduous teeth u uWe treat - bite defects u inverted bite u cross bite u - bad habits uWe use – removable appliances u u C:\Users\User\Desktop\DSC_6576.JPG [USEMAP] Orthodontic treatment u3. 6-9 years [ 1. phase of mixed dentition] u uThe best time for treatment : u - cross bite u - inverted bite u - impacted incisors u - diastema more than 3 mm u - big primary crowding u uWe use : removable appliances u small fixed appliances u face mask for inverted bite by class III [USEMAP] Face mask [USEMAP] Orthodontic treatment u 4. 9-12 year [second phase of mixed dentition] u -Large forming ability of the tissues -We can use and influence the growth -Growth mandible from the joints u uWe treat: - previous untreated anomalies u - crowding u - Angle class II – div. 1 and 2 u - overjet more than 5 mm u - deep bite u - movements teeth after the early loss of teeth and anodontia u - Controlled tooth eruption u - Suspected retention of canines, premolars uThe best time for functional appliances u - removable appliances - - Small fixed appliances - - Headgear appliance - u u u [USEMAP] Orthodontic treatment u5. Permanent teeth u uWe treat: -All anomalies, previous untreated anomalies, -Angle class III -Crowding -Open bite, deep bite -Impacted tooth -Skeletal anomalies - uAdult therapy – periodontics problems, preprosthetic therapy u - problems with TMJ u - bruxism u uWe use : fixed appliances u extraction u surgical treatment by big skeletal anomalies - - u [USEMAP] Othodontic treatment uRemovable appliances: 1.Active 2.Passive 3.Functional u [USEMAP] Therapy of ortodontical anomalies uConservativ uorthodontical appliances : u removable u fixed u uSurgical uextraction of teeth usurgical expositions of crowns of retined tooth usurgical movements of maxila, mandible [USEMAP] uActive removable appliances u u-Treatment of anomalous position of teeth [inclination, rotation of incisors] u-Treatment the dental arch shape u -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 u Stainless steel brackets u u u u u u uAdvantages Disadvantages: u - 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 uCeramic brackets u u u u u u u u uAdvantages: Disadvantages: u - 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 uSapphire brackets u u u u u u u u u u u uAdvantages Disadvantages: u- aesthetic - repeated bonding problem - robust - crack - higher friction (avoid metal slot) - price mouth Radiance1 [USEMAP] Orthodontics brackets uGold-coated brackets u u u u u u u u u u uAdvantages: Disadvantages: u- 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 uSelfligating brackets – metal and ceramic u u u u u u uAdvantages: Disadvantages: u - not suitable for all - minimum friction types of defects - low power - faster treatment u - Fewer office visits DSC_5636 str 7_4 [USEMAP] Orthodontics brackets uLingual brackets – 2D,3D u u u u u u u u u uAdvantages: Disadvantages: u- 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 uDecorative brackets u 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 [USEMAP] Obsah obrázku jídlo, zavřít, kukuřice Popis byl vytvořen automaticky Case 1 – hyperodontia - supernumerrary incisor, cowding [USEMAP] [USEMAP] [USEMAP] [USEMAP] Case 1 before after treatment uTreatment – fixed appliance – 11 months uRetention – 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_6106 DSC_6085 – kopie DSC_6085 [USEMAP] utreatment – 16 months DSC_6108 DSC_6106 Case 2 - before after treatment [USEMAP] Hlo z p hlo p Hlo l Case 3 – deep bite, crowding [USEMAP] hlo po pred Hlo z po p Hlo po z l 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] Case – orthodontic treatment with surgery correction – mandibular progenia, skeletal class III, open bite, crowding [USEMAP] u Before treatment After treatment Case – orthodontic treatment with surgery correction – mandibular progenia, skeletal class III, open bite, crowding [USEMAP] jan zac P 1 u u Jana nasaz P2 jan pos Orthodontic treatment with lingual appliance [USEMAP] Orthodontic treatment with lingual appliance u u u u u u u u 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 u AN zač1 AN prub AN pos 2 [USEMAP] Thank You four Your attention u u u u u u u u u u u u u u u u u u u Questions – email – alena.brysova@fnusa.cz Consultation – Orthodontic department - St. Anne's Hospital, building D2b – Thursday 1-2 p.m. [USEMAP]