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Textbook of Orthodontics
Gurkeerat Singh
SECTION ONE: NORMAL GROWTH
1:
Introduction to Orthodontics
WHAT IS ORTHODONTICS?
BRANCHES OF ORTHODONTICS
PREVENTIVE ORTHODONTICS
INTERCEPTIVE ORTHODONTICS
CORRECTIVE ORTHODONTICS
AIMS OF ORTHODONTIC TREATMENT
FUNCTIONAL EFFICIENCY
STRUCTURAL BALANCE
ESTHETIC HARMONY
SCOPE OF ORTHODONTICS
MOVING TEETH
ORTHOPEDIC CHANGE
ALTERING THE SOFT TISSUE ENVELOP
HISTORY OF ORTHODONTICS
2:
Basic Principles of Growth
INTRODUCTION AND DEFINITION
SOME DEFINITIONS RELATED TO GROWTH
SOME DEFINITIONS RELATED TO DEVELOPMENT
METHODS OF STUDYING PHYSICAL GROWTH
MEASUREMENT APPROACHES
Craniometry
Anthropometry
Cephalometric Radiography
EXPERIMENTAL APPROACHES
Vital Staining
Autoradiography
Radioisotopes
Implant Radiography
METHODS OF COLLECTING GROWTH DATA
LONGITUDINAL STUDIES
CROSS-SECTIONAL STUDIES
Types of Growth Data
BASIC TENETS OF GROWTH—PATTERN, VARIABILITY, TIMING
RHYTHM AND GROWTH SPURTS
CLINICAL SIGNIFICANCE OF THE GROWTH SPURTS
FACTORS AFFECTING PHYSICAL GROWTH
TERMINOLOGY RELATED TO GROWTH
GROWTH FIELDS
GROWTH SITES
GROWTH CENTERS
REMODELING
GROWTH MOVEMENTS
Cortical Drift
Displacement
CHARACTERISTICS OF BONE GROWTH
Intramembranous Ossification
Endochondral Ossification
MODES OF BONE GROWTH (Figs 2.4A to D)
Hypertrophy
Hyperplasia
Extracellular Material
GROWTH CONTROL
THEORIES OF SKULL GROWTH CONTROL
GENETIC THEORY
SUTURAL DOMINANCE THEORY
CARTILAGINOUS THEORY
FUNCTIONAL MATRIX HYPOTHESIS
SERVOSYSTEM THEORY
ARCHITECTURAL ANALYSIS OF THE SKULL
GENERAL PLAN
INTERNAL CONSTRUCTION OF BONE
3:
Prenatal Growth of Cranium, Facial and Oral Structures
PRENATAL GROWTH PHASES
PRENATAL GROWTH PROPER
DEVELOPMENT OF THE SKULL
THE CALVARIA
THE CRANIAL BASE
THE FACIAL SKELETON
THE MAXILLA
THE PALATE
THE MANDIBULAR PROCESSES
THE MANDIBLE
4:
Postnatal Growth of the Craniofacial Complex
INTRODUCTION
THE CRANIAL VAULT
THE CRANIAL BASE
THE NASOMAXILLARY COMPLEX
THE MANDIBLE
5:
Development of Dentition
INTRODUCTION
EVOLUTION
THEORIES OF ORIGIN OF MAMMALIAN TEETH
THEORY OF CONCRESCENCE
THEORY OF TRITUBERCULY
THEORY OF MULTI-TUBERCULY
CHARACTERISTICS OF HUMAN DENTITION
MODE OF ATTACHMENT
NUMBER OF SUCCESSIVE TEETH
SHAPE OF TEETH
DENTAL FORMULA IN HUMANS
PRENATAL DEVELOPMENT OF DENTITION
STAGES OF TOOTH BUD DEVELOPMENT (Fig. 5.1)
DEVELOPMENT OF DENTITION FROM BIRTH TO COMPLETE DECIDUOUS DENTITION (Table 5.1)
MOUTH OF THE NEONATE—0 TO 6 MONTHS
The Gum Pads (Fig. 5.3A)
Neonatal Jaw Relationships
Precociously Erupted Primary Teeth
THE DECIDUOUS DENTITION STAGE
Normal Signs of Primary Dentition
THE MIXED DENTITION STAGE
FIRST TRANSITIONAL PERIOD
Eruption of Permanent First Molars
Incisor Eruption
The Broadbent's Phenomenon—Ugly Duckling Stage (7–14 years)
THE INTER-TRANSITIONAL PERIOD (1.5 YEARS)
THE SECOND TRANSITIONAL PERIOD
THE PERMANENT DENTITION
ERUPTION
PROCESS OF TOOTH ERUPTION
FACTORS DETERMINING TOOTH POSITION DURING ERUPTION
SEQUENCE OF ERUPTION
Dental age 6: First stage of eruption
Dental age 7
Dental age 8
Dental age 9
Dental age 10
Dental age 11
Dental age 12
Dental age 13,14,15
DIMENSIONAL CHANGES INTHE DENTAL ARCHES
DEVELOPMENTAL DISTURBANCESAFFECTING THE TEETH
DISTURBANCES DURINGINITIATION OF TOOTH GERMS
DISTURBANCES DURING MORPHO-DIFFERENTIATION OF TOOTH GERMS
DISTURBANCES DURINGAPPOSITION OF HARD TISSUES
DISTURBANCES DURINGCALCIFICATION OF HARD TISSUE
DISTURBANCES DURING ERUPTION OF TEETH
CONCLUSION
6:
Occlusion in Orthodontics
INTRODUCTION
UNDERSTANDING FREQUENTLY USED TERMS
GNATHOLOGY
DENTAL OCCLUSION
DISOCCLUSION OF TEETH
STAMP CUSPS
SHEARING CUSPS
NORMAL OCCLUSION
IDEAL OCCLUSION
BALANCED OCCLUSION
PHYSIOLOGIC OCCLUSION
TRAUMATIC OCCLUSION
THERAPEUTIC OCCLUSION
CONCEPTS OF OCCLUSION
CLASSIFICATIONS OF OCCLUSION
BASED ON MANDIBULAR POSITION
Centric Occlusion
Eccentric Occlusion
BASED ON RELATIONSHIP OF 1ST PERMANENT MOLAR
BASED ON THE ORGANIZATION OF OCCLUSION
BASED ON PATTERN OF OCCLUSION
RELATING CENTRIC RELATIONTO CENTRIC OCCLUSION
IMPORTANCE OF CENTRICRELATION IN ORTHODONTICS
COMPENSATORY CURVATURES
CURVE OF SPEE
CURVE OF WILSON
CURVE OF MONSON
ANDREWS SIX KEYS TO NORMAL OCCLUSION
KEY I
KEY II
KEY III
KEY IV
KEY V
KEY VI
SECTION TWO: DIAGNOSIS
7:
Diagnostic Aids—Case History and Clinical Examination
INTRODUCTION
ESSENTIAL DIAGNOSTIC AIDS
NONESSENTIAL OR SUPPLEMENTAL DIAGNOSTIC AIDS
CASE HISTORY
PERSONAL DETAILS
Name
Age and Date of Birth
Sex
Address and Occupation
CHIEF COMPLAINT
MEDICAL HISTORY
DENTAL HISTORY
PRENATAL HISTORY
POSTNATAL HISTORY
FAMILY HISTORY
CLINICAL EXAMINATION
GENERAL EXAMINATION
Body Build
Cephalic and Facial Examination
Assessment of Facial Symmetry
Facial Profile
Facial Divergence
ASSESSMENT OF ANTEROPOSTERIOR JAW RELATIONSHIP
ASSESSMENT OF VERTICAL SKELETAL RELATIONSHIP
Examination of the Soft Tissues
NASOLABIAL ANGLE
Chin
INTRAORAL EXAMINATION
Tongue
Lip and Cheek Frena
Gingiva
Palate
Tonsils and Adenoids
Clinical Examination of the Dentition
FUNCTIONAL EXAMINATION
ASSESSMENT OF POSTURAL REST POSITION
Registration of the Rest Position
Evaluation of the Path of Closure
Sagittal Plane
Vertical Plane
Transverse Plane
EXAMINATION OF THE TEMPOROMANDIBULAR JOINT (TMJ)
EXAMINATION OF OROFACIAL DYSFUNCTIONS
Swallowing
Tongue
8:
Orthodontic Study Models
INTRODUCTION
IDEAL REQUIREMENTS OF ORTHODONTIC STUDY MODELS
WHY WE MAKE STUDY MODELS?
USES OF STUDY MODELS
PARTS OF THE STUDY MODELS
STUDY MODEL FABRICATION AND TRIMMING
STEPS IN ART PORTION FABRICATION
The Lower Model
The Upper Model
Finishing the Models
Cast Trimming to Indicate Occlusal Plane Relationships
MODEL ANALYSIS
PONT'S ANALYSIS
Drawback of Pont's Analysis
LINDER HARTH INDEX
KORKHAUS ANALYSIS
ASHLEY HOWE'S ANALYSIS
Definitions
Inference
WAYNE A. BOLTON ANALYSIS
Procedure for doing Bolton Analysis
CAREY'S ANALYSIS
Methodology
MOYER'S MIXED DENTITION ANALYSIS
Procedure
TANAKA AND JOHNSON ANALYSIS
KESLING DIAGNOSTIC SET-UP
9:
Cephalometrics—Landmarks and Analyses
INTRODUCTION
HISTORY OF CEPHALOMETRICS
USES OF CEPHALOMETRICS
OBTAINING THE CEPHALOGRAM
TRACING TECHNIQUE
STEPWISE TRACING TECHNIQUE
Step 1
Step 2
Step 3
Step 4
Step 5
ANATOMIC STRUCTURES IN THE CEPHALOGRAM
POINTS AND LANDMARKS—DEFINITION AND REQUISITES
POINTS AND LANDMARKS—CLASSIFIED
TRUE ANATOMIC POINTS
IMPLANTS
DERIVED POINTS
External Points
Intersection of Edges of Regression as “Points”
Intersection of Constructed Lines
POINTS AND LANDMARKS—DESCRIBED IN THE LATERAL PROJECTION (Fig. 9.9)
UNILATERAL LANDMARKS
Nasion (Na) (Fig. 9.10)
Anterior Nasal Spine (ANS) (Fig. 9.11)
Superior Prosthion (SPr or PR) (Fig. 9.12)
Subspinale (“A” Point) (Fig. 9.13)
Incision Superius (Is) (Fig. 9.14)
Incision Inferius (Ii) (Fig. 9.15)
Infradentale (Id) (Fig. 9.16)
Supramentale (“B” point) (Fig. 9.17)
Pogonion (Pog) (Fig. 9.18)
Menton (Me) (Fig. 9.19)
Gnathion (Gn) (Fig. 9.20)
Basion (Ba) (Fig. 9. 21)
Bolton Point (BO)
Posterior Nasal Spine (PNS) (Fig. 9.22)
Sella(S) (Fig. 9.23)
BILATERAL LANDMARKS
Orbitale (Or) (Fig. 9.24)
Gonion (Go) (Fig. 9.25)
Condylion (Co) (Fig. 9.26)
Articulare (Ar) (Fig. 9.27)
Pterygomaxillary Fissure (Ptm) (Fig. 9.28)
Porion (Po) (Fig. 9.29)
Xi-Point (Fig. 9.30)
R1-Mandible
R2-Mandible
R3-Mandible
R4-Mandible
COMMONLY USED LINES AND PLANES DESCRIBED IN THE LATERAL PROJECTION
Frankfort Horizontal Plane
S-N Line
Bolton's Plane
Palatal Plane
Occlusal Plane (Functional OP, Anatomic OP)
Mandibular Plane
DOWN'S ANALYSIS
INTRODUCTION
Down's Control Group
SKELETAL PARAMETERS
Facial Angle
Angle of Convexity
DENTAL PARAMETERS
Cant of Occlusal Plane
Inter-incisal Angle
Incisor Occlusal Plane Angle
Incisor Mandibular Plane Angle
Protrusion of Maxillary Incisors
STEINER ANALYSIS
THE ANALYSIS
Relating the Maxilla to the Skull
Relating the Mandible to the Skull
Relating the Maxilla to the Mandible
Occlusal Plane Angle
Mandibular Plane Angle
The Dental Analysis
Maxillary Incisor Position
Mandibular Incisor Position
Inter-incisal Angle
Lower Incisor to Chin
THE SOFT TISSUE ANALYSIS
Steiner's S-line
TWEED ANALYSIS
DESCRIPTION
THE WITS APPRAISAL OF JAW DISHARMONY
10:
Diagnostic Radiographs and Photographs
INTRODUCTION
WHY RADIOGRAPHS?
ORTHOPANTOMOGRAM
INTRAORAL RADIOGRAPHS
INTRAORAL PERIAPICAL RADIOGRAPHS
BITEWING RADIOGRAPHS
OCCLUSAL RADIOGRAPHS
FACIAL PHOTOGRAPHS
EXTRAORAL PHOTOGRAPHS
INTRAORAL PHOTOGRAPHS
11:
Maturity Indicators
INTRODUCTION
REQUIREMENTS FOR AN IDEAL MATURITY INDICATOR
CLINICAL IMPORTANCE
LATE AND EARLY DEVELOPMENT
MATURITY INDICATORS
NEURAL AGE
Development Landmarks
MENTAL AGE
PHYSIOLOGICAL AND BIOCHEMICAL AGE
CHRONOLOGICAL AGE
SEXUAL/PUBERTAL AGE
DENTAL AGE
Methods to Determine Dental Age
Age Determination Using Growth Chart
SKELETAL AGE
Anatomical Regions
Anatomy of Hand-Wrist
RADIOLOGICAL METHODS OF ASSESSMENT AND PREDICTION OF SKELETAL GROWTH
GREULICH AND PYLE METHOD
SINGER'S METHOD OF ASSESSMENT
FISHMAN'S SKELETAL MATURITY INDICATORS
SKELETAL MATURATION EVALUATION USING CERVICAL VERTEBRAE OR CERVICAL VERTEBRAE MATURITY INDICATORS (CVMI)
MATURATION ASSESSMENT BY HAGG AND TARANGER AND THE KR (KANSAL AND RAJAGOPAL) MODIFIED MP3 METHOD
Evaluation
BJORK, GRAVE AND BROWN
12:
Computerized Diagnostic Systems
INTRODUCTION
THE DIGITAL IMAGE
IMAGE ARCHIVING / STORAGE
IMAGE DISPLAY
TOTAL DIGITAL RADIOGRAPHY
TELERADIOLOGY
VARIOUS METHODS OF DIGITAL RADIOGRAPHY
PHOTO STIMULABLE PHOSPHOR PLATES
DIRECT RECEPTORS
FLATBED TRANSPARENCY SCANNER
AUTOMATIC IDENTIFICATION OF LANDMARKS
DIGITAL CEPHALOMETRICS
DIGITIZATION
Direct Computer Digitization
Resolution and Accuracy
Indirect Digitization
Direct Digitization
CEPHALOMETRIC ANALYSIS AND TREATMENT PLANNING
Static Function
Dynamic Function
VIDEO-CEPHALOMETRY
PROFILE VIDEO IMAGE MODIFICATION
QUANTIFIED PROFILE MODIFICATION THROUGH EXTRAPOLATION
PHOTO-CEPHALOMETRY
TECHNIQUES OF IMAGE SUPERIMPOSITION UPON CEPHALOGRAM
Direct Digitization
Indirect Digitization
DIGITAL PHOTOGRAPHY
PIXELS AND RESOLUTION
INPUT DEVICES
EXPOSURE
IMAGE RESOLUTION
IMAGE STORAGE FORMAT
PHOTOGRAPHY SOFTWARE
THREE-DIMENSIONAL IMAGING
CRANIOFACIAL IMAGING AND ANIMATION WITH THE LASER SCANNER
METHODS OF 3-D CRANIOFACIAL SKELETAL IMAGING
METHODS OF 3-D INTRAORAL DENTAL IMAGING
METHODS OF CAPTURING MANDIBULAR MOTION IN 3-D
DIGITAL STUDY MODELS
13:
Classification of Malocclusion
INTRODUCTION
INDIVIDUAL TOOTH MALPOSITIONS
MESIAL INCLINATION OR TIPPING
DISTAL INCLINATION OR TIPPING
LINGUAL INCLINATION OR TIPPING
LABIAL/BUCCAL INCLINATION OR TIPPING
INFRA-OCCLUSION
SUPRAOCCLUSION
ROTATIONS
Mesiolingual or Distolabial
Distolingual or Mesiolabial
Transposition
MALRELATION OF DENTAL ARCHES
SAGITTAL PLANE MALOCCLUSIONS
Pre-normal Occlusion
Post-normal Occlusion
VERTICAL PLANE MALOCCLUSIONS
Deep Bite
Open Bite
TRANSVERSE PLANE MALOCCLUSIONS
SKELETAL MALOCCLUSIONS
ANGLE'S CLASSIFICATION OF MALOCCLUSION
CLASS I—MALOCCLUSION (Fig. 13.5)
CLASS II—MALOCCLUSION
Class II—Division 1 (Fig. 13.6)
Class II—Division 2 (Fig. 13.7)
Class II—Subdivision (Fig. 13.8)
CLASS III—MALOCCLUSION (Fig. 13.9)
Pseudo Class III—Malocclusion (Fig. 13.10)
Class III—Subdivision
DEWEY'S MODIFICATION OF ANGLE'S CLASSIFICATION OF MALOCCLUSION
MODIFICATIONS OF ANGLES CLASS I
Type 1
Type 2
Type 3
Type 4
Type 5
DEWEY'S MODIFICATION OF ANGLE'S CLASS III
Type 1
Type 2
Type 3
LISCHER'S MODIFICATION OF THE ANGLE'S CLASSIFICATION OF MALOCCLUSION
NEUTRO-OCCLUSION
DISTO-OCCLUSION
MESIO-OCCLUSION
BENNETTE'S CLASSIFICATION OF MALOCCLUSION
CLASS I
CLASS II
CLASS III
SIMON'S CLASSIFICATION OF MALOCCLUSION
FRANKFORT HORIZONTAL (VERTICALLY)
ORBITAL PLANE (ANTERO-POSTERIORLY)
RAPHE OR MEDIAN SAGITTAL PLANE (TRANSVERSE)
SKELETAL CLASSIFICATION
SKELETAL CLASS I
Division 1
Division 2
Division 3
Division 4
SKELETAL CLASS II
Division 1
Division 2
SKELETAL CLASS III
ACKERMAN-PROFITT SYSTEM OF CLASSIFICATION
CHARACTERISTIC 1—ALIGNMENT
CHARACTERISTIC 2—PROFILE
CHARACTERISTIC 3—TRANSVERSE RELATIONSHIPS
CHARACTERISTIC 4—CLASS
CHARACTERISTIC 5—OVERBITE
INCISOR CLASSIFICATION
CLASS I
CLASS II
Division 1
Division 2
CLASS III
14:
Etiology of Malocclusion—Classifications
INTRODUCTION
WHAT CAUSES A MALOCCLUSION?
WHITE AND GARDINER'S CLASSIFICATION
DENTAL BASE ABNORMALITIES
PRE-ERUPTION ABNORMALITIES
POST-ERUPTION ABNORMALITIES
SALZMANN'S CLASSIFICATION
PRENATAL
POSTNATAL
DEVELOPMENTAL
FUNCTIONAL
ENVIRONMENTAL OR ACQUIRED
MOYER'S CLASSIFICATION
GRABER'S CLASSIFICATION
GENERAL FACTORS
LOCAL FACTORS
15:
Etiology of Malocclusion—General Factors
INTRODUCTION
HEREDITARY
NEUROMUSCULAR SYSTEM
DENTITION
Size and Shape of the Teeth
Number of Teeth
Primary Position of Tooth Germ and the Path of Eruption
Shedding of Deciduous Teeth and Sequence of Eruption
Mineralization of Teeth
SKELETAL STRUCTURES
SOFT TISSUES (OTHER THAN THE NEUROMUSCULATURE)
CONGENITAL FACTORS
MICROGNATHISM
OLIGODONTIA
ANODONTIA
CLEFT LIP AND PALATE
PREDISPOSING METABOLIC CLIMATE AND DISEASE
ENDOCRINE IMBALANCE
METABOLIC DISTURBANCES
INFECTIOUS DISEASES
DIETARY PROBLEMS (NUTRITIONAL DEFICIENCY)
ABNORMAL PRESSURE HABITS AND FUNCTIONAL ABERRATIONS
POSTURE
TRAUMA AND ACCIDENTS
PRENATAL TRAUMA
TRAUMA AT THE TIME OF DELIVERY
POSTNATAL TRAUMA
16:
Etiology of Malocclusion—Local Factors
ANOMALIES OF NUMBER
SUPERNUMERARY TEETH
MISSING TEETH
ANOMALIES OF TOOTH SIZE
ANOMALIES OF TOOTH SHAPE
ABNORMAL LABIAL FRENUM
PREMATURE LOSS OF DECIDUOUS TEETH
PROLONGED RETENTION OF DECIDUOUS TEETH
DELAYED ERUPTION OF PERMANENT TEETH
ABNORMAL ERUPTIVE PATH
ANKYLOSIS
DENTAL CARIES
IMPROPER DENTAL RESTORATIONS
17:
Dental Public Health Aspects of Orthodontics
INTRODUCTION
PREVALENCE OF MALOCCLUSION
ORAL CLEFT LIP AND PALATE
ASSESSMENT OF ORTHODONTIC TREATMENT NEED
ORTHODONTIC INDICES
INDEX OF ORTHODONTIC TREATMENT NEEDS (IOTN)
PEER ASSESSMENT RATING INDEX (PAR)
FACTORS AFFECTING RECEIPT OF ORTHODONTIC TREATMENT
IMPROVEMENTS IN PERSONAL APPEARANCE
SELF-PERCEPTION AND SELF-ESTEEM
GENDER AND AGE
PEER GROUPS
SOCIAL CLASS
GENERAL DENTIST'S ATTITUDES
AVAILABILITY OF RESOURCES
COST OF TREATMENT AND ORTHODONTIST REMUNERATION
TRUST IN THE HEALTH CARE SYSTEM
CONCLUSION
SECTION THREE: TREATMENT PLANNING
18:
Treatment Planning
INTRODUCTION
ORTHODONTIC DIAGNOSIS
FORMULATION OF A PROBLEM LIST
SETTING PRIORITIES FOR THE ORTHODONTIC PROBLEM LIST
PLANNING SPACE REQUIREMENTS
RETRACTION OF PROTRUDED TEETH
CORRECTION OF CROWDING
ALIGNMENT OF ROTATED ANTERIOR TEETH
ALIGNMENT OF ROTATED POSTERIOR TEETH
CORRECTION OF MOLAR RELATIONSHIP
LEVELING THE CURVE OF SPEE
ANCHORAGE
TREATMENT POSSIBILITIES
CHOICE OF MECHANOTHERAPY
PLANNING RETENTION
FACTORS IN THE CHOICE OFA SPECIFIC TREATMENT PLAN
THE TYPE OF TOOTH MOVEMENTS REQUIRED
PATIENT'S EXPECTATIONS
GROWTH POTENTIAL OF THE PATIENT
PATIENT'S ABILITY TO MAINTAIN ORAL HYGIENE
THE COST OF THE TREATMENT
THE SKILLS OF THE TREATING CLINICIAN
DISCUSSION WITH THE PATIENT AND PATIENT CONSENT
19:
Biology of Tooth Movement
INTRODUCTION
THEORIES OF ORTHODONTIC TOOTH MOVEMENT
PRESSURE TENSION THEORY
BLOOD FLOW THEORY / FLUIDDYNAMIC THEORY (Fig. 19.2)
BONE BENDING/PIEZOELECTRIC/BIOELECTRIC THEORY
PIEZOELECTRIC SIGNALS
PHASES OF TOOTH MOVEMENT
INITIAL PHASE
LAG PHASE
POST-LAG PHASE
BONE RESORPTION
DIRECT FRONTAL RESORPTION
UNDERMINING/REARWARD BONE RESORPTION
BONE FORMATION
BIOCHEMICAL CONTROL OF TOOTH MOVEMENT
20:
Mechanics of Tooth Movement
INTRODUCTION
FORCES AS VECTORS
FORCE AND MOVEMENT
CENTER OF RESISTANCE
TYPES OF TOOTH MOVEMENTS
TYPES OF FORCES
CONTINUOUS FORCE
INTERMITTENT FORCES
INTERRUPTED FORCE
21:
Methods of Gaining Space
INTRODUCTION
PROXIMAL STRIPPING (REPROXIMATION)
INDICATION FOR PROXIMAL STRIPPING
CONTRAINDICATIONS FOR PROXIMAL STRIPPING
PROCEDURE
Assessing Space Requirements
Selecting Teeth and the Amount of Enamel to be Stripped
Enamel Stripping
ARCH EXPANSION
RAPID MAXILLARY EXPANSION DEVICES
PHILOSOPHY FOR THE USE OF RME APPLIANCES
ANATOMY OF THE MID-PALATINE SUTURE AND THE MAXILLA
EFFECTS OF THE RME
On the Maxillary Teeth and Alveolar Bone
Maxillary Skeletal Effects
On the Mandible
On the Nasal Cavity and Adjacent Cranial Bones
TYPES OF RAPID MAXILLARY EXPANSION APPLIANCES
Removable RME Appliances
Fixed RME Appliances
ISAACSON RME APPLIANCES
HYRAX RME APPLIANCES
DERICHSWEILER RME APPLIANCES
HASS RME APPLIANCE
ACTIVATION OF THE RME APPLIANCE
Retention Following RME Therapy
SLOW EXPANSION DEVICES
APPLIANCES USED FOR SLOW EXPANSION
Screw Appliances
Coffin Spring
Quad/Tri/Bi-Helix
Ni-Ti Expanders
The Schwarz Appliance
DISTALIZATION OF MOLARS
EXTRAORAL DISTALIZING APPLIANCES
INTRAORAL METHODS OF DISTALIZING MOLARS
Schwartz Plate
Sagittal Appliance
First Class
Veltribilateral and Monolateral Sagittal Screws
Open Coil Springs
Jones Jig
Distal Jet Appliance
Fast Back Appliance
Pendulum Appliance
Intraoral Magnets
Lip Bumper Appliance
UPRIGHTING OF TILTED POSTERIOR TEETH
DEROTATION OF POSTERIOR TEETH
PROCLINATION OF ANTERIOR TEETH
EXTRACTION
HISTORICAL BACKGROUND
THE NEED FOR EXTRACTION
Arch Length—Tooth Material Discrepancy
Correction of Sagittal Interarch Relationship
Extraction for the Relief of Crowding
DIFFERENT EXTRACTION PROCEDURES
Balancing Extractions
Compensating Extractions
Phased Extractions
Enforced Extractions
Wilkinson Extraction
Therapeutic Extractions
CHOICE OF TEETH FOR EXTRACTION
INCISORS
Maxillary Incisors
Mandibular Incisors
CANINES
Indications
FIRST PREMOLARS
Indications
Timing of Extraction
SECOND PREMOLARS
Indications for Extraction
FIRST MOLAR
Indications
Rules for Guidance to the Best Time for Extraction
SECOND MOLAR
Mandibular Second Molar
MAXILLARY SECOND MOLARS
Indications
Contraindications
THIRD MOLARS
22:
Anchorage in Orthodontics
INTRODUCTION
SOURCES OF ANCHORAGE
INTRAORAL SOURCES OF ANCHORAGE
Alveolar Bone
Teeth
Basal Bone
Cortical Bone
Musculature
CLASSIFICATION OF ANCHORAGE
INTRAORAL ANCHORAGE
INTRAMAXILLARY ANCHORAGE
INTERMAXILLARY ANCHORAGE
SIMPLE ANCHORAGE
STATIONARY ANCHORAGE
RECIPROCAL ANCHORAGE
SINGLE OR PRIMARY ANCHORAGE
COMPOUND ANCHORAGE
REINFORCED ANCHORAGE
EXTRAORAL ANCHORAGE
MUSCULAR ANCHORAGE
ANCHORAGE PLANNING
CLASSIFYING ANCHORAGE REQUIREMENTS
MAXIMUM ANCHORAGE
MODERATE ANCHORAGE
MINIMUM ANCHORAGE
TWEED'S CLASSIFICATION OF ANCHORAGE PREPARATION
23:
Retention and Relapse in Orthodontics
INTRODUCTION
CAUSES OF RELAPSE
NEED FOR RETENTION
SCHOOLS OF THOUGHT / PHILOSOPHIES
THE OCCLUSION SCHOOL
THE APICAL BASE SCHOOL
THE MANDIBULAR INCISOR SCHOOL
THE MUSCULATURE SCHOOL
RIEDEL'S THEOREMS OF RETENTION
THEOREM 1
THEOREM 2
THEOREM 3
THEOREM 4
THEOREM 5
THEOREM 6
THEOREM 7
THEOREM 8
THEOREM 9
LENGTH OF RETENTION PERIOD
TYPES OF RETAINERS
IDEAL REQUIREMENTSOF RETAINING APPLIANCES
FIXED RETAINERS
Temporary Fixed Intra-coronal Retainers
Temporary Fixed Extra-coronalRetentive Appliances
Flexible Spiral Wire Retainer
Mesh Pad Retainers
REMOVABLE RETAINERS
24:
Surgical Procedures in Orthodontics
INTRODUCTION
SURGICAL AIDS TO ORTHODONTICS
SOFT TISSUE PROCEDURES
LABIAL FRENECTOMY
Indications
Technique (Figs 24.1A to 24.3D)
LINGUAL FRENECTOMY
ANKYLOGLOSSIA
SYMPTOMS
Clinical Features
Treatment
PERICISION
Indications
Technique
EXPOSURE OF IMPACTED TEETH (e.g., canine)
Indications
Technique
HARD TISSUE PROCEDURES
CREATION OF SPACEBY EXTRACTION OF TEETH
Indications
Technique
REMOVAL OF OBSTRUCTION TO ERUPTION (e.g., supernumerary teeth, odontomes)
Indications
Technique
REMOVAL OF IMPACTED TEETH (e.g., canine)
Indications
Technique
PROPHYLACTIC REMOVALOF THIRD MOLAR GERMS
Indications
Technique
CORTICOTOMY
Indications
Technique
TRANSPLANTATION (e.g., canine)
Indications
OSTEOTOMY FOR RAPID PALATAL EXPANSION
Indications
Technique
SERIAL EXTRACTIONS
25:
Orthognathic Surgery
INTRODUCTION
INDICATION FOR ORTHOGNATHIC SURGERY
ABNORMALITIES OF THE MAXILLARY BASE
Maxillary Prognathism (Fig. 25.2)
Maxillary Retrognathism (Fig. 25.3)
Maxillary Asymmetry (Fig. 25.4)
ABNORMALITIES OF THE MANDIBULAR BASE
Mandibular Prognathism (Fig. 25.5)
Mandibular Retrognathism (Fig. 25.6)
Mandibular Asymmetry (Fig. 25.7)
ABNORMALITIES OF THE CHIN
Macrogenia
Microgenia
ABNORMALITIES OFTHE ALVEOLAR PROCESSES
PLANNING ORTHOGNATHIC SURGERY
CLINICAL EXAMINATION
SOCIO-PSYCHOLOGICAL EVALUATION
RADIOLOGICAL EXAMINATION
Photographs
CEPHALOMETRIC EVALUATION
STUDY MODELS
PREDICTION TRACING
MODEL SURGERY
PROCEDURES
ANTEROPOSTERIOR CORRECTION
Maxillary Surgery
Mandibular Surgery
VERTICAL CORRECTION
Maxillary Surgery
Mandibular Surgery
TRANSVERSE CORRECTION
Maxillary Surgery
Mandibular Surgery
SKELETAL OPEN-BITECORRECTION (APERTOGNATHIA)
GENIOPLASTY
MALAR AUGMENTATION
26:
Implants to Mini-Screws
WHAT ARE DENTAL IMPLANTS?
DEFINITION
HISTORY
TYPES OF DENTAL IMPLANTS
ENDO-OSSEOUS IMPLANTS
Root Form—(Also Used in Orthodontics)
Blade Form
Ramus Frame
SUBPERIOSTEAL IMPLANTS
TRANS-OSSEOUS IMPLANTS
BIOS IMPLANT SYSTEM (BIO-RESORBABLE IMPLANT SYSTEM)
MICRO/MINI IMPLANTS
BIOMATERIALS FOR DENTAL IMPLANTS
METALS AND METAL ALLOYS
CERAMICS AND CARBONS
POLYMERS AND COMPOSITES
INDICATIONS FOR DENTAL IMPLANTS
ORTHODONTIC ANCHORAGE
27:
Genetics in Orthodontics
INTRODUCTION
MODE OF TRANSMISSION OF MALOCCLUSION
REPETITIVE TRAITS
DISCONTINUES TRAITS
VARIABLE TRAITS
TRACING THE GENE IN FAMILY PEDIGREE STUDIES
AUTOSOMAL DOMINANT INHERITANCE
AUTOSOMAL RECESSIVE INHERITANCE
SEX-LINKED RECESSIVE INHERITANCE
Characteristics of X-linked Recessive Inheritance
Sex-linked Dominant Inheritance
POLYGENIC DISORDERS AND MULTIFACTORIAL INHERITANCE
PENETRANCE AND EXPRESSIVITY
INBREEDING AND CONSANGUINEOUS MARRIAGES—ITS CONSEQUENCES
DENTAL AND SKELETAL CHARACTERISTICS THAT ARE INHERITED
BUTLER'S FIELD THEORY
POPULATION DIFFERENCES
TWIN STUDIES
FUNCTIONAL COMPONENTS OF THE FACE
CONCLUSION
28:
Cosmetic Contouring in Orthodontics
INTRODUCTION
PROCEDURE
USES AND ADVANTAGES
29:
Detrimental Effects of Orthodontic Treatment
INTRODUCTION
TISSUE DAMAGE DURING TREATMENT
TRAUMATIC ULCERATIONS
PERIODONTAL DISEASE
CARIES
ROOT RESORPTION
PULPAL DAMAGE
INCREASED PREDISPOSITION TO DENTAL DISEASE AND DYSFUNCTION
PERIODONTAL DISEASE
MANDIBULAR DYSFUNCTION
FAILED TREATMENT
SECTION FOUR: ORTHODONTIC MATERIALS
30:
Material Used in Orthodontics—Introduction and Archwire Materials
INTRODUCTION
CLASSIFICATION OF ORTHODONTIC APPLIANCE MATERIALS
ARCHWIRE MATERIALS
SPRINGBACK
STIFFNESS OR LOAD DEFLECTION RATE
FORMABILITY
MODULUS OF RESILIENCE MB
FRICTION
BIOCOMPATIBILITY AND ENVIRONMENTAL STABILITY
CAPABILITY TO BE WELDED OR SOLDERED TO AUXILIARIES AND ATTACHMENTS
CLASSIFICATION OF ARCHWIRE MATERIALS
GOLD
STAINLESS STEEL
Australian Stainless Steel Wires
CHROME-COBALT
NICKEL-TITANIUM
Thermal Ni-Ti Alloy
Elastic Ni-Ti Alloy
Copper Ni-Ti Alloys
BETA TITANIUM OR TMA WIRE OR CNA WIRE (FIG. 30.9)
Weldability of B-titanium Wires
ALPHA TITANIUM
TITANIUM NIOBIUM ALLOY
MULTI-STRANDED ARCHWIRES
Coaxial Archwire
COMPOSITE/COATED WIRES
OPTIFLEX ARCHWIRES
31:
Bracket Material and Auxiliary Force Delivery Systems
BRACKETS
CLASSIFICATION
Material used in Manufacture
Morphology of the Bracket
Technique for Which it is Used
Slot Size of the Bracket
AUSTENITIC STAINLESS STEEL
POLYCARBONATE BRACKETS
FIBER-GLASS REINFORCED BRACKETS
CERAMIC BRACKETS
Classification
METAL REINFORCED CERAMIC BRACKETS
TITANIUM BRACKETS
BRACKET BASES
AUXILIARY FORCE DELIVERY SYSTEMS
ELASTICS AND ELASTIC MODULES
Elastics
SPRINGS
Comparison of Certain Properties of Nickel-Titanium and Stainless Steel Coil Springs
MAGNETS IN ORTHODONTICS
Types of Magnetic Materials Used
32:
Impression Materials
INTRODUCTION
IRREVERSIBLE HYDROCOLLOIDS (ALGINATE)
ADVANTAGES OF ALGINATES
DISADVANTAGES OF ALGINATES
USES OF ALGINATE
COMPOSITION (TABLE 32.1)
Reactor
Accelerator
Retarder
Glycol
Disinfectants
Setting Process
Setting Reaction
PROPERTIES
Working Time
Setting Time
Dimensional Stability
Strength
Water: Powder Ratio
Spatulation Time
RATE OF DEFORMATION
Permanent Deformation
Flexibility
Reproduction of Surface Detail
Viscoelasticity
Disinfection
Compatibility with Gypsum
CLINICAL CONSIDERATIONS
Dispensing
Modified Alginates
MANIPULATION OF ALGINATES
Mixing Alginate Impression Material
Equipment Checklist
Portioning
Add Powder to Bowl
Mixing
Filling Tray and Taking Impression
Compressive Strength of anAlginate Gel as a Function of Gelation Time
Cleanup and Disinfection
Other Applications of Alginate
Duplicating Materials
Troubleshooting
33:
Luting Materials
INTRODUCTION
DENTAL CEMENTS
PHOSPHATE-BASED CEMENTS
ZINC PHOSPHATE CEMENT
Application
Composition
Liquid
Setting Reaction
Manipulation
Factors Affecting Setting Time
Properties
Effects of Solubility
Film Thickness
Biologic Effects
Thermal Properties
Optical Properties
Advantages
Disadvantages
ZINC POLYCARBOXYLATE CEMENTS
Composition
Powder
Liquid
Setting Reaction
Properties (As per ADA Specification No. 96)
Working Time and Setting Time
Biocompatibility
Mechanical Properties
Solubility
Film Thickness
Adhesion
Applications
GLASS IONOMER CEMENTS
Synonym
Application
Types and their Use
Composition
Liquid
Manufacturing
Chemistry of Setting
Structure of the Set Mass
Factors Affecting the Rate of Reaction
Role of Water in Setting Process
Protection
MANIPULATION
PREPARATION OF THE TOOTH SURFACE
PROPORTIONING
Powder Liquid Ratio
PLACEMENT AND PROTECTION OF THE MATERIAL
PROTECTION OF THE CEMENT WHILE SETTING
PROPERTIES
Setting Time
Hardness
Film Thickness
Strength
Fracture Toughness
Solubility
Adhesion
Esthetics
BIOLOGIC EFFECTS
Resin Modified Glass Ionomers
34:
Adhesion Promoters and Bonding Materials
INTRODUCTION
ADHESIVE SCIENCE
DIAGRAM
What can be Done to Bring such Solids Together?
THE RANGE OF ORTHODONTIC ADHESIVES
RESIN-IONOMER HYBRIDS
CLASSIFICATION AND TERMINOLOGY
Resin-Modified Glass Ionomers (RM-GIC)
Compomers (Polyacid-modified Resin Composites)
ENAMEL AND DENTIN BONDING
ACID ETCHING
ACID ETCHING PROCEDURE
IATROGENIC EFFECTS OF ETCHING (Table 34.4)
Alternative Techniques to Acid Etching
Dentin Adhesion
GENERATIONS OF DENTIN BONDING AGENTS
ETCHANT
Function of an Etchant
Method of Application of Etchant
PRIMERS/COUPLING AGENT/DENTIN CONDITIONER
ADHESIVE
First Generation Dentin Bonding Agents
Second Generation Dentin Bonding Agents
Third Generation Dentin Bonding agents
Fourth Generation Dentin Bonding Agents
Fifth Generation Dentin Bonding
Sixth Generation Dentin Bonding Agents (No etch, No rinse, No Cure Technology)
FACTORS AFFECTING THE BONDING OF THE BRACKETS TO THE ENAMEL
ETCHING VS NONETCHING
TYPE AND CONCENTRATION OF ACID
ACID
TIME
EFFECTS OF FLUORIDE
DIFFERENCES AMONG TEETH
OLDER VS YOUNG TEETH
USE OF PUMICE
AIR ABRASION (MICROETCHING)
CRYSTAL-GROWING SOLUTIONS
Advantages
ACIDIC PRIMERS
LASER ETCHING
Mechanism of Action
Laser Used
Disadvantages
MOISTURE RESISTANT PRIMERS
CHLORHEXIDINE
Function
BLEACHING
BOND FAILURES
BONDING FAILURE CAUSES
Possible Causes of Adhesive-enamel Bond Failures
Possible Causes of Adhesive-bracket Bond Failures
COMPOSITE
INTRODUCTION
COMPOSITION AND STRUCTURE
The Resin Matrix
Filler
Coupling Agent
Pigments and Other Components
CLASSIFICATION OF THE COMPOSITES
Macrofilled (Traditional) Composites
Microfilled Resins
Small Particles Composites
Use
Hybrid or Blend Composites
Chemical Cure
Visible Light Cured
NEW COMPOSITE MATERIALS
Flowable Composites (Fig, 34.6D)
Condensable Composites
PROPERTIES
Setting Characteristics (Table 34.7)
Polymerization Shrinkage
Water Sorption
Solubility
Coefficient of Thermal Expansion
Mechanical Properties
Hardness
Wear
Radiopacity
Color Stability
Appearance
BIOCOMPATIBILITY
35:
Orthodontic Instruments
INTRODUCTION
SEPARATING PLIERS
SCISSORS
BAND SEATER
MERSHON BAND PUSHER
BOONE GAUGE
BRACKET POSITIONING HEIGHT GAUGE
DOUBLE BEAK PLIERS
JOHNSON CONTOURING PLIERS
STANDARD LIGHT WIRE PLIERS
JARABAK LIGHT WIRE PLIERS
ANGLE WIRE BENDING PLIERS
TWEED LOOP FORMING PLIERS
NANCE LOOP FORMING PLIERS
DE LA ROSA CONTOURING PLIERS
WEINGART UNIVERSAL PLIERS
ANGLE/TWEED RIBBON ARCH PLIERS
HOWE PLIERS
LIGATOR
MOSQUITO FORCEPS
“MATHIEU” NEEDLE HOLDER
LIGATURE ADJUSTER AND TUCKER
PIN AND LIGATURE CUTTERS
PIN AND LIGATURE CUTTER 45°
HARD WIRE CUTTERS
HEAVY WIRE CUTTERS
DISTAL END CUTTERS
BRACKET REMOVING PLIERS
POSTERIOR BAND REMOVING PLIERS
ANTERIOR BAND REMOVING PLIERS
ADAM'S PLIER
ADAMS’ CLASP BENDING PLIERS
ARROW CLASP FORMER
ARROW CLASP BENDING PLIERS
YOUNG LOOP BENDING PLIERS
FACE BOW BENDING/CUTTING PLIERS
3-PRONG PLIERS
TURRETS
36:
Sterilization in Orthodontics
INTRODUCTION
CRITICAL
SEMI-CRITICAL
LEAST CRITICAL
STEPS IN STERILIZATION/DISINFECTION
METHODS FOR STERILIZATION
METHODS OF DISINFECTION
HAND DISINFECTION
SECTION FIVE: ORTHODONTIC APPLIANCES
37:
Orthodontic Appliances—An Introduction
INTRODUCTION
CLASSIFICATION OF ORTHODONTIC APPLIANCES
REMOVABLE ORTHODONTIC APPLIANCES
SEMI-FIXED ORTHODONTIC APPLIANCES
FIXED ORTHODONTIC APPLIANCES
MECHANICAL ORTHODONTIC APPLIANCES
Removable Appliances
Fixed Appliances
Active Fixed Appliances
Passive Fixed Appliances
FUNCTIONAL ORTHODONTIC APPLIANCES
IDEAL REQUIREMENT OF AN ORTHODONTIC APPLIANCE
BIOLOGIC REQUIREMENTS
MECHANICAL REQUIREMENTS
ESTHETIC REQUIREMENTS
38:
Removable Orthodontic Appliances
INTRODUCTION
ADVANTAGES OF REMOVABLE APPLIANCES
DISADVANTAGES OF REMOVABLE APPLIANCES
GENERAL PRINCIPLES OF REMOVABLE APPLIANCES
APPLIANCE DESIGN
Components of Removable Appliances
ACTIVE COMPONENTS
SPRINGS
Designing a Spring
TYPES OF SPRINGS
Finger Spring
Double Cantilever/Z-Spring
T-Spring
Mattress Spring
Helical Coils Spring
Coffin Spring
CANINE RETRACTORS
Based on their Location
Based on Design
Based on Mode of Action
LABIAL BOWS
Short Labial Bow
Long Labial Bow
Split Labial Bow
Robert's Retractor
Reverse Labial Bow
Mill's Retractor
High Labial Bow with Apron Springs
Fitted Labial Bow
SCREWS
Advantage of Screw Over Springs
ELASTICS
Advantage
RETENTIVE COMPONENTS (FIXATION)
CLASPS
Mode of Action of Clasps
DIFFERENT TYPES OF CLASPS
Circumferential / C-clasp
Jacksons / Full Clasp
Schwarz Clasp
Adams’ Clasp
Southend Clasp
Triangular Clasp
Ball-End Clasp
Crozat's Clasp
FRAMEWORK/BASE PLATE
USES OF BASE PLATE
THICKNESS OF BASE PLATE
EXTENSION OF BASE PLATE
Modification of Base Plate
DELIVERY OF REMOVABLE APPLIANCE
INSTRUCTIONS TO THE PATIENT
COMMON FAILURES FOR NO TOOTH MOVEMENT
ANTEROPOSTERIOR MOVEMENT
Reduction in Overjet
Vertical
Transverse Movement
Patient Compliance
PROBLEMS ENCOUNTERED IN REMOVABLE APPLIANCE THERAPY
39:
Fixed Orthodontic Appliances
INTRODUCTION
ADVANTAGES OF FIXED ORTHODONTIC APPLIANCES
DISADVANTAGES OF FIXED ORTHODONTIC APPLIANCES
INDICATIONS OF FIXED APPLIANCES
CONTRAINDICATIONS TO FIXED ORTHODONTIC APPLIANCES
COMPONENTS OF FIXED ORTHODONTIC APPLIANCES
ACTIVE COMPONENTS
Separators
Archwires
Elastics
Elastomerics
Springs
Magnets
PASSIVE COMPONENTS
Bands
Brackets
Buccal Tubes
Lingual Attachments
Lock Pins
Ligature Wires
40:
The Edgewise Appliance
INTRODUCTION
TREATMENT STEPS
BRACKET SPECIFICATIONS
BRACKET POSITION
ARCHWIRE FABRICATION
FIRST ORDER BENDS
SECOND ORDER BENDS
THIRD ORDER BENDS
41:
The Begg Appliance
INTRODUCTION
COMPONENTS USED IN THE BEGG TECHNIQUE
MODIFIED RIBBONARCH BRACKETS (Figs 41.1A to F)
LOCK PINS
MOLAR TUBES
ARCHWIRE
ELASTICS
ROTATING SPRINGS
UPRIGHTENING SPRINGS
TORQUING SPRINGS
DIAGNOSIS IN THE BEGG TECHNIQUE
THREE STAGES OF BEGG TECHNIQUE
OBJECTIVES OF STAGE I
Characteristic Archwires and Elastics of Stage I
OBJECTIVES OF STAGE II
Characteristic Archwire and Elastics of Stage II
OBJECTIVES OF STAGE III
Characteristic Archwire and Elastics of Stage III
42:
The Pre-Adjusted Edgewise Appliance
INTRODUCTION
ANCHORAGE CONTROL
LEVELING AND ALIGNING
OVERBITE CONTROL
OVERJET REDUCTION AND SPACE CLOSURES
FINISHING AND DETAILING
43:
The Tip Edge Appliance
INTRODUCTION
TIP EDGE BRACKET DESIGN
ADVANTAGES OF THE TIP EDGE BRACKETS
PLACEMENT OF TIP EDGE ATTACHMENTS
AUXILIARIES
TREATMENT STAGES
44:
Lingual Orthodontics
INTRODUCTION
HISTORY
DIFFICULTIES ENCOUNTERED DURING THE DEVELOPMENT OF LINGUAL ORTHODONTIC THERAPY AND THEIR CURRENT SOLUTIONS
INDICATIONS FOR LINGUAL APPLIANCES
TREATMENT STAGES OF THE PRE-ADJUSTED EDGEWISE LINGUAL APPLIANCE
Stage I: Diagnosis and Treatment Planning
Stage II: Alignment and Consolidation of Spaces
Stage III: Finishing and Detailing
Stage IV: Retention
Treatment Stages of the light wire lingual appliance
Stage I: Diagnosis and Treatment Planning
Stage 2: Alignment and Consolidation of Space
Stage 3: Torquing and Uprightening
Stage 4: Retention
45:
Orthopedic Appliances
INTRODUCTION
THE PHILOSOPHY OF EXTRAORAL FORCE
BASIS FOR ORTHOPEDIC APPLIANCES
ORTHOPEDIC APPLIANCES
HEADGEAR
Components
Face Bow
Force Generating Unit
Anchor Unit
Cervical Headgear
Principles of Force Application in Headgear Therapy
Biomechanics of Headgear
Treatment Effects
Skeletal Effect
Uses of Headgears
Limitations of Headgear Therapy
FACEMASK
Indications
Parts of a Facemask (Fig. 45.9)
Biomechanical Considerations
Types of Reverse Pull Headgear
CHIN CUP
Philosophy of Chin Cup Therapy
Basic Chin Cup Appliance Design
Duration of Wear
Effects of Chin cup
Types of Chin Cup
46:
Functional Appliances
INTRODUCTION
BASIS FOR FUNCTIONAL APPLIANCES
CLASSIFICATION OF FUNCTIONAL APPLIANCES
CEPHALOMETRIC DIAGNOSIS FOR FUNCTIONAL APPLIANCE THERAPY
ANALYSIS OF FACIAL SKELETON
Saddle Angle (N-S-Ar) (Fig. 46.1)
Articular Angle (S-Ar-Go) (Fig. 46.2)
Gonial Angle (Ar-Go-Me) (Fig. 46.3)
Anterior and Posterior Face Height (Fig. 46.4)
Cranial Base Length (Fig. 46.5)
ANALYSIS OF JAW BONES
SNA (Fig. 46.6)
SNB (Fig. 46.7)
Base Plane Angle (Pal-Mp) (Fig. 46.8)
Inclination Angle (Fig. 46.9)
Rotation of Jaw Bases (Figs 46.10A to D)
EVALUATION OF THE LENGTH OF JAW BASES
Mandibular Base (Fig. 46.11)
Maxillary Base (Fig. 46.11)
Ascending Ramus (Fig. 46.12)
Morphology of the Mandible
ANALYSIS OF DENTOALVEOLAR RELATIONSHIPS
Axial Inclination of the Incisors (Fig 46.14)
VISUAL TREATMENT OBJECTIVE (VTO) (FIG. 46.14D)
ACTIVATOR (FIGS 46.15A TO C)
INDICATIONS
CONTRAINDICATIONS
ADVANTAGES
DISADVANTAGES
PHILOSOPHY OF ACTIVATOR
COMPONENTS OF THE ACTIVATOR
CONSTRUCTION BITE
FABRICATION
MANAGEMENT OF THE APPLIANCE
BIONATOR (FIGS 46.16A AND B)
INTRODUCTION
PHILOSOPHY OF BIONATOR
BIONATOR TYPES
Standard Appliance (Figs 46.16A to C)
Open Bite Appliance
Class III or Reverse Bionator
INDICATIONS FOR BIONATOR THERAPY
CONTRAINDICATIONS
ADVANTAGES OF BIONATOR
DISADVANTAGE OF APPLIANCE
THE FRANKEL FUNCTION REGULATOR
FRANKEL PHILOSOPHY
MODE OF ACTION OF FR
ORAL EXERCISES WITH FRANKEL
TYPES OF FUNCTION REGULATORS
FABRICATION OF FUNCTION REGULATOR
PARTS OF THE APPLIANCE (FIGS 46.17A,B AND F TO I)
IMPRESSIONS
WORKING MODEL POURING AND TRIMMING
TRIMMING FOR LIP PADS
TRIMMING FOR BUCCAL SHIELD
CONSTRUCTION BITE (FIG. 46.17J)
WAX RELIEF (FIGS 46.17K TO M)
WIRE COMPONENTS (FR Ib) (FIGS 46.17A,B AND F TO I)
Lower Lingual Support Wire
Lower Lingual Springs
Lower Labial Wires
Palatal Bow (Figs 46.17K and M)
Labial Bow
Canine Loops (For FR Ia)
Canine Loops (For FR II)
Upper Lingual Wire (Protrusion Bow)
ACRYLIC PARTS
COMPONENTS OF VARIOUS FR APPLIANCES
FR Ia
FR Ic
FR II
FR III (Figs 46.17C to E)
FR IV
FR V
TREATMENT TIMING
TWIN-BLOCK
EVOLUTION OF TWIN-BLOCK
Introduction
DEVELOPMENT OF TWIN-BLOCK
CASE SELECTIONFOR TWIN-BLOCK APPLIANCE
APPLIANCE DESIGN AND CONSTRUCTION
EVOLUTION OF THE APPLIANCE DESIGN (FIGS 46.18A TO C)
DELTA CLASPS (FIG. 46.18D)
LABIAL BOW
BASE PLATE (FIGS 46.18E i AND ii)
OCCLUSAL BITE BLOCKS WITH INCLINED PLANES (FIG. 46.18F)
ANGULATION OF THE INCLINED PLANES (FIG. 46.18F)
CONSTRUCTION BITE
BITE REGISTRATION FOR CONSTRUCTION OF TWIN-BLOCKS FOR CLASS II DIVISION 1 MALOCCLUSION
ESTABLISHING THE CORRECT VERTICAL DIMENSIONS—THE INTERGINGIVAL HEIGHT
FITTING TWIN-BLOCKS:INSTRUCTIONS TO PATIENT
Stages of Treatment (Figs 46.19A and B)
RETENTION
FIXED FUNCTIONAL APPLIANCES
HERBST APPLIANCE (FIGS 46.20A AND B)
Indications
Contraindications
Disadvantages
JASPER JUMPER (FIGS 46.21A AND B)
Indications
Contraindications
Advantages
Disadvantages (Figs 46.21C and D)
THE MANDIBULAR ANTERIOR REPOSITIONING APPLIANCE (MARA) (FIG. 46.22)
Indication
Contraindications
BIOPEDIC APPLIANCE (FIG. 46.23)
EUREKA SPRING (FIG. 46.24)
Advantages
Disadvantages
SAIF SPRING (FIG. 46.25)
Disadvantage
THE KLAPPER SUPER SPRING (FIG. 46.26)
Advantages
Disadvantages
FORSUS FATIGUE RESISTANT DEVICE (FIGS 46.27A AND B)
Advantages
SABBAGH UNIVERSAL SPRING (SUS) (FIGS 46.28A TO C)
Disadvantages
CONCLUSION
SECTION SIX: MANAGEMENT OF MALOCCLUSION
47:
Preventive Orthodontic Procedures
INTRODUCTION
PREVENTIVE MEASURES UNDERTAKEN
CARIES CONTROL
PARENTAL COUNSELING
Prenatal Counseling
Postnatal Counseling
SPACE MAINTENANCE
EXFOLIATION OF DECIDUOUS TEETH
ABNORMAL FRENAL ATTACHMENTS
LOCKED PERMANENT FIRST MOLARS
ABNORMAL ORAL MUSCULATURE
SPACE MAINTENANCE (IN THE DECIDUOUS AND THE MIXED DENTITION)
FACTORS TO BE CONSIDERED FOR SPACE MAINTENANCE
IDEAL REQUIREMENTS OF SPACE MAINTAINERS
CLASSIFICATION OF SPACE MAINTAINERS
SPACE Maintenance FOR PREMATURELOSS OF DECIDUOUS FIRST MOLAR
Sequelae
NANCE PALATAL HOLDING ARCH
Advantages
Disadvantages
TRANSPALATAL ARCH
Advantages
Disadvantages
LINGUAL ARCH
Advantages
Disadvantages
SPACE MAINTENANCE FOR PREMATURELOSS OF DECIDUOUS SECOND MOLARS
Sequelae
SPACE MAINTENANCE ON PREMATURE LOSS OF DECIDUOUS SECOND MOLARS BUT PRIOR TO Eruption OF PERMANENT FIRST MOLARS
Disadvantages
SPACE MAINTENANCE FOR PREMATURELOSS OF DECIDUOUS INCISORS
Advantages
Disadvantages
SPACE MAINTENANCE FOR PREMATURELOSS OF DECIDUOUS CANINES
Sequelae
REMOVABLE PARTIAL DENTURES
Advantages
Disadvantages
48:
Interceptive Orthodontic Procedures
INTRODUCTION
SPACE REGAINING
ESTIMATION OF SPACE LOST
TIMING OF DISTALIZATION OF 6 YEARS MOLARS
Fixed Appliances
Removable Space Maintainer
CORRECTION OF ANTERIOR AND POSTERIOR CROSS BITES
ELIMINATION OF ORAL HABITS LEADING TO INTERCEPTION
MUSCLE EXERCISES
USES
EXERCISES
Exercises of the Tongue
Exercises of Masseter Muscles
Exercises of Pterygoid Muscles
Limitations of Muscle Exercises
REMOVAL OF SOFT or HARD TISSUE IMPEDIMENTS in THE PATHWAY OF ERUPTION
RESOLUTION OF CROWDING
MANAGEMENT OF CROWDING
SERIAL EXTRACTION AND GUIDANCE OF ERUPTION
DEFINITION
HISTORICAL REVIEW
RATIONALE
INDICATIONS
CONTRAINDICATIONS
DIAGNOSIS AND TREATMENT PLANNING
DIAGNOSIS
Study Models
Radiographs
Photographs
PROCEDURE
TWEED'S METHOD (1966)
DEWEL'S METHOD (1978)
NANCE'S METHOD
GREWE's METHOD
Advantages
Disadvantages
INTERCEPTION OF DEVELOPING SKELETAL MALOCCLUSIONS
CLASSIFICATION
INTERCEPTION OF CLASS II MALOCCLUSION
INTERCEPTION OF CLASS III MALOCCLUSION
CAD/CAM MYOFUNCTIONAL APPLIANCES
DESIGN
Indications
Contraindications
49:
Oral Habits and their Management
INTRODUCTION
DEFINITIONS OF HABITS
CLASSIFICATION OF HABITS
WILLIAM JAMES (1923)
Useful Habits
Harmful Habits
KINGSLEY (1956)
EARNEST KLEIN (1971)
Intentional/Meaningful Habits
Unintentional/Empty Habits
GRABER (1976)
FINN AND SIM (1975)
Habits
JOHNSON AND LARSON (1993)
Classification of Non-nutritive Sucking (NNS) Habits
HABITS CAN BE CLASSIFIED ACCORDING TO THE CAUSE OF THE HABIT
Physiologic Habits
Pathologic Habits
CLASSIFICATION BASED ONTHE ORIGIN OF THE HABIT
Retained Habits
Cultivated Habits
CLASSIFICATION BASED ON THE PATIENT AWARENESS TO THE HABIT
Unconscious Habits
Conscious Habits
MATURATION OF ORAL FUNCTIONS
FETAL LIFE
SUCKLING
DEVELOPMENT OF A HABIT
ETIOLOGICAL AGENTS IN THE DEVELOPMENT OF ORAL HABITS
ANATOMICAL
MECHANICAL INTERFERENCES
PATHOLOGICAL
EMOTIONAL
IMITATION
RANDOM BEHAVIOR
EQUILIBRIUM THEORY
TREATMENT PHILOSOPHY AND CONSIDERATIONS
RESTRAINING HABIT
Psychologic Methods/Approach
Extra-oral Methods
Intra-oral Methods
DIGIT-SUCKING HABIT (THUMB/FINGER-SUCKING—Fig. 49.8)
DEFINITIONS
SUCKING REFLEX
Anatomy and Physiology of Sucking
PSYCHOLOGY OF NON-NUTRITIVE DIGITAL-SUCKING (NNS)
CLASSIFICATION OF THUMB SUCKING
Subtleny et al (1973)
CLINICAL ASPECTS OF DIGIT-SUCKING
Phase I
Phase II
Phase III
INCIDENCE OF FINGER-SUCKING HABIT
EFFECT OF DIGIT-SUCKING
Effects on Maxilla (Fig. 49.11)
Effects on Mandible (Fig. 49.11A)
Inter-arch Relationship (Fig. 49.11B)
EFFECT ON LIP PLACEMENT AND FUNCTION
EFFECT ON TONGUE PLACEMENT AND FUNCTION
Other Effects
DIAGNOSIS
History of Digit Sucking
Extra-oral Examination
Intraoral Examination
TREATMENT OF DIGIT SUCKING
Pretreatment Screening
Dental Consultation
Clinical Treatment
Psychologic Approach
Reminder Therapy: Appliance
Reminder Therapy: Non-appliance
TONGUE THRUSTING HABIT
ETIOLOGY OF TONGUE THRUSTING
Genetic Factors
Learned Behavior
Maturational Factors
Mechanical Restriction
Neurological Disturbances
Psychogenic Factors
CLASSIFICATION OF TONGUE THRUST
Backlund 1963
Pickett's 1966
Moyers, 1970
James Braner and Holt
CLINICAL FEATURES/ EFFECTS OF TONGUE THRUST ON DENTO-FACIAL STRUCTURES (Figs 49.19A and B)
DIAGNOSIS
Extra-oral Examination
Examination of Tongue
Differential Diagnosis
RETAINED INFANTILE SWALLOW
CLINICAL FEATURES
MANAGEMENT OF TONGUE THRUSTING
MANAGEMENT OF SIMPLE TONGUE THRUST
Cognitive Approach
Reflective Approach
REINFORCEMENT OF NEW REFLEX
TREATMENT OF COMPLEX TONGUE—THRUST
MOUTH BREATHING HABIT
ORAL VEGETATIVE RESPIRATION
DEFINITIONS
CLASSIFICATION OF MOUTH BREATHING
SIM and FINN
FUNCTIONS OF NASAL BREATHING
ETIOLOGY OF MOUTH BREATHING
Nasal Obstruction
Facial Type
RESPIRATORY PATTERN (PROFFIT)
EFFECTS OF MOUTH BREATHING
On Face (Fig. 49.23)
EFFECT ON OCCLUSION OF TEETH
Hypertrophic Mouth Breathing Gingivitis
Non-hypertrophic Mouth Breathing Gingivitis
DIAGNOSIS OF MOUTH BREATHING
Subjective Symptoms
Objective Symptoms
Methods of Examination
Other Tests
MANAGEMENT
ORAL SCREEN/VESTIBULAR SCREEN/ORAL SHIELD
Rapid Maxillary Expansion
BRUXISM
DEFINITIONS
ETIOLOGY OF BRUXISM
Local Factors
Systemic Factors
Psychological Factors
Occupational Factors
NEUROPHYSIOLOGY OF BRUXISM
SIGNS AND SYMPTOMS
On Teeth (Figs 49.25A and B)
Musculature and TMJ
TMJ
Diagnosis of Nocturnal Bruxism
MANAGEMENT
LIP HABITS
LIP-SUCKING
Mentalis Muscle Habit
MANAGEMENT
LIP-WETTING
LIP-BITING
CHEEK-BITING
ETIOLOGY
TREATMENT
FRENUM-THRUSTING
Treatment
MASOCHISTIC HABIT
ORGANIC
FUNCTIONAL
POSTURAL HABIT
CHIN-PROPPING HABIT
FACE LEANING
ABNORMAL PILLOWING/HABITUAL SLEEPING ON RIGHT OR LEFT SIDE OF FACE
50:
Etiology and Management of Class I Malocclusion
INTRODUCTION
ASSOCIATED PROBLEMS
FEATURES OF CLASS I MALOCCLUSION (TABLE 50.1)
CORRECTION OF CLASS I MALOCCLUSION
51:
Etiology and Management of Class II Malocclusion
INTRODUCTION
CLASSIFICATION OF CLASS II MALOCCLUSION
CLINICAL FEATURES OF CLASS II MALOCCLUSION
ETIOLOGICAL CONSIDERATIONS OF CLASS II MALOCCLUSION
FUNCTIONAL ASPECT AS A CONTRIBUTING FACTOR FOR CLASS II MALOCCLUSION
MANAGEMENT OF CLASS II MALOCCLUSION
MANAGEMENT OF FUNCTIONAL DISTURBANCES
Mouth Breathing
Abnormal Tongue Position and Swallowing Patterns
Lip Posture and Activity
Management of Abnormal Habits like Thumb Sucking and Finger Sucking Habits
MANAGEMENT OF CLASS II MALOCCLUSION DURING MIXED DENTITION PERIOD (TAKING ADVANTAGE OF THE GROWTH)
MANAGEMENT OF CLASS II MALOCCLUSION WITH MAXILLARY PROGNATHISM WITH NORMAL MANDIBLE
MANAGEMENT OF MANDIBULAR DEFICIENCY
MANAGEMENT OF DENTOALVEOLAR CLASS II MALOCCLUSION WITH NORMAL SKELETAL RELATIONSHIP
MANAGEMENT OF CLASS II MALOCCLUSION IN ADULTS
MANAGEMENT OF CLASS II MALOCCLUSION BY ORTHOGNATHIC SURGERY
SURGICAL APPROACH FOR MANDIBULAR RETROGNATHISM
MANAGEMENT OF CLASS II DIV. 2 CASES
52:
Etiology and Management of Class III Malocclusion
INTRODUCTION
CLINICAL FEATURES
ETIOLOGIC CONSIDERATIONS
CORRECTION OF THE CLASS III MALOCCLUSION
TREATMENT OF THE PRE-ADOLESCENT CHILD
FRANKEL III APPLIANCE
THE CHIN CUP
ANTERIOR FACEMASK
RME WITH ANTERIOR FACEMASK
3-D SCREWS
TREATMENT OF THE ADOLESCENT CHILD
TREATMENT DURING ADULTHOOD
53:
Correction of Midline Diastema
INTRODUCTION
ETIOLOGY
DIAGNOSIS
TREATMENT PLANNING
USE OF REMOVABLE APPLIANCES
HAWLEY'S APPLIANCEINCORPORATING FINGER SPRINGS
FIXED ORTHODONTIC APPLIANCES
ROLE OF COSMETIC RESTORATIONS/PROSTHESIS
RETENTION
54:
Management of Open Bite
INTRODUCTION
CLASSIFICATION OF OPEN BITE
ETIOLOGY OF ANTERIOR OPEN BITE
ANTERIOR OPEN BITE
CORRECTION OF ANTERIOR OPEN BITE
POSTERIOR OPEN BITE
CORRECTION OF POSTERIOR OPEN BITE
55:
Management of Cross Bite
INTRODUCTION
CLASSIFICATION OF CROSS BITES
CORRECTION OF ANTERIOR CROSS BITES
CORRECTION OF ANTERIOR CROSS BITE IN THE PREADOLESCENT AGE GROUP
CATALANS APPLIANCE OR LOWER ANTERIOR INCLINED PLANE
DOUBLE CANTILEVER SPRING/‘Z’ SPRING
Screw Appliances
CORRECTION OF ANTERIOR CROSS BITES IN ADOLESCENTS AND ADULTS
Screw Appliances
Fixed Appliances
CORRECTION OF POSTERIOR CROSS BITES
Screw Appliances
Coffin Spring
Quad Helix Appliance
The RME Appliance
NiTi Expanders
Fixed Orthodontic Appliances
56:
Orthodontics for Adults
INTRODUCTION
INDICATIONS FOR ORTHODONTIC TREATMENT IN ADULTS
PROSTHODONTIC INDICATIONS FOR ORTHODONTIC TREATMENT OF ADULTS
PERIODONTAL INDICATIONS FORORTHODONTIC TREATMENT IN ADULTS
TEMPOROMANDIBULAR JOINT DYSFUNCTION
ESTHETICS
CONTRAINDICATIONS FOR ORTHODONTIC TREATMENT IN ADULTS
DIFFERENCE BETWEEN ADOLESCENTS AND ADULTS (TABLE 56.3)
BIOMECHANICAL CONSIDERATIONSWHEN TREATING ADULTS
CHANGES IN THE TOOTH STRUCTURE
Occlusal Facets
Dental Caries
Restorative Failures
CHANGES IN THE ‘U’
MISSING TEETH
Premature Loss
TEMPOROMANDIBULAR JOINT (TMJ)
TYPES OF TREATMENT IN ADULTS
ADJUNCTIVE ORTHODONTIC TREATMENT
COMPREHENSIVE ORTHODONTIC TREATMENT FOR ADULTS
SURGICAL ORTHODONTIC TREATMENT IN ADULTS
RETENTION AND RELAPSE IN ADULTS
57:
Management of Cleft Lip and Palate
INTRODUCTION
HISTORICAL REVIEW
INCIDENCE
FACTOR INFLUENCING INCIDENCE
SEX
RACE
BIRTH WEIGHT
PARENTAL AGE
SOCIAL STATUS
BIRTH RANK
ETIOLOGY
HEREDITARY
MULTIFACTORIAL THRESHOLD HYPOTHESIS
CONGENITAL
Infections
Drugs
Radiation
Diets
EMBRYOLOGICAL BACKGROUND
POSSIBLE MECHANISM FOR FORMATION OF ISOLATED CLEFT PALATE
CLASSIFICATIONS
DAVIS AND RITCHIE'S CLASSIFICATION (1922)
Group I
Group II
Group III
VEAU'S CLASSIFICATION (1931)
Group I
Group II
Group III
Group IV
CLASSIFICATION BY FOGH ANDERSON (1942)
Group I
Group II
Group III
SCHUCHARDT AND PFEIFER'S SYMBOLIC CLASSIFICATION
KERNAHAN AND STARK CLASSIFICATION (1958)
KERNAHAN'S STRIPED ‘Y’ CLASSIFICATION
MILLARD'S MODIFICATION OF THE KERNAHAN'S STRIPED “Y” CLASSIFICATION (FIG. 57.4)
ELSAHY'S MODIFICATION OF THE KERNAHAN'S STRIPED “Y” CLASSIFICATION (FIG. 57.5)
LAHSHAL CLASSIFICATION
AMERICAN CLEFT PALATE ASSOCIATION'S CLASSIFICATION (1962)
INTERNATIONAL CONFEDERATION FOR PLASTIC AND RECONSTRUCTIVE SURGERY CLASSIFICATION (1968)
Group I
Group II
Group III
PROBLEMS ASSOCIATED WITH CLEFT LIP AND PALATE
PSYCHOLOGICAL
DENTAL (FIG. 57.6)
ESTHETIC (Fig. 57.7)
SPEECH AND HEARING
MANAGEMENT OF CLEFT LIP AND PALATE
INDEX
TOC
Index
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