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Essentials of Orthodontics
Aravind Sivaraj
CHAPTER 1:
Introduction
INTRODUCTION TO ORTHODONTICS
DEFINITIONS
British Society for Study of Orthodontics (1922)
Proffit (1975)
American Association of Orthodontics (1993)
ORTHODONTIST
Orthodontist (Orthodontic Specialist)
Branches of Orthodontics
Unfavorable Sequelae of Malocclusion
Need for Orthodontic Treatment
Scope of Orthodontic Treatment
HISTORY OF ORTHODONTICS
ORTHODONTICS IN INDIA
EVOLUTION OF ORTHODONTIC APPLIANCES
20th Century before and during World War-I
CHAPTER 2:
Growth and Development
GENERAL PRINCIPLES AND CONCEPTS
DEFINITIONS
Growth
Development
Maturation
Differentiation
FACTORS AFFECTING PHYSICAL GROWTH
Hereditary
Nutrition
Illness
Race
Socioeconomic Factors
Family Size and Birth Order
Secular Trends
Climatic and Seasonal Effects
Psychological Disturbances
Exercise
CONCEPTS OF GROWTH
Concept of Normality
Rhythm of Growth
Growth Spurts
Differential Growth
Growth in Height
Growth in Weight
Indices of Maturity
Biologic Maturity Indicators
Growth Assessment
Growth Predictions
TYPES OF GROWTH DATA
Opinion
Observations
Ratings and Rankings
Quantitative Measurements
METHODS OF GATHERING GROWTH DATA
Longitudinal Studies
Cross-sectional Studies
Semi-longitudinal Studies (Overlapping Studies)
METHODS OF STUDYING GROWTH
Biometric Tests
Vital Staining
Radioisotopes
Implants
Natural Markers
Comparative Anatomy
Radiographic Techniques
Genetic Studies
MECHANISM OF BONE GROWTH
OSTEOGENESIS (MECHANISM OF BONE FORMATION)
Endochondral Bone Formation (Flow chart 2.1)
Intramembranous Bone Formation (Membranous Bone Formation) (Flow chart 2.2)
Bone Deposition and Resorption (Bone Remodeling)
Growth Movements
Directions of Growth
Soft Tissues Associated with Growth
THEORIES OF GROWTH
Genetic Theory
Sutural Theory (Sicher) (Fig. 2.7)
Cartilaginous Theory (James Scott) (Fig. 2.8)
Functional Matrix Theory (Melvin Moss) (Fig. 2.9)
van Limbourgh's Theory
Enlow and Bang's Expanding ‘V’ Principle (Fig. 2.10)
Neurotrophic Process in Orofacial Growth (Neurotrophism)
Hunter-Enlow Growth Equivalents Concept (Enlow's Counterpart Principle)
Petrovic's Servosystem Theory (Flow chart 2.3)
PRENATAL GROWTH AND DEVELOPMENT
PERIOD OF OVUM
PERIOD OF EMBRYO
Development of Branchial Arches (Fig. 2.12)
Development of Perioral Region
Development of Nasal Pits
Development of Cranial Structures
Flexure of the Cranial Base
Uneven Nature of Growth of Cranial Base
PRENATAL DEVELOPMENT OF MAXILLA
DEVELOPMENT OF PALATE
Ossification of Palate
DEVELOPMENT OF MAXILLARY SINUS
DEVELOPMENT OF TONGUE
PRENATAL DEVELOPMENT OF MANDIBLE
MECKEL'S CARTILAGE
ENDOCHONDRAL BONE FORMATION
PRENATAL GROWTH OF TEMPOROMANDIBULAR JOINT
POSTNATAL GROWTH AND DEVELOPMENT
NEONATAL SKELETON
POSTNATAL GROWTH OF THE CRANIAL VAULT
POSTNATAL GROWTH OF THE CRANIAL BASE
Cortical Drift and Remodeling
Elongation of Synchondrosis
POSTNATAL GROWTH OF MAXILLA
Displacement
Growth at Sutures
POSTNATAL GROWTH OF MANDIBLE
Ramus
Body of Mandible
Angle of the Mandible
Lingual Tuberosity
Alveolar Process
Chin
Condyle
Coronoid Process
MANDIBULAR ROTATION
Clockwise rotation (Backward rotation, Posterior rotation) (Fig. 2.20).
Counterclockwise Rotation (Forward Rotation, Anterior Rotation)
Intramatrix Rotation (External Rotation) (Fig. 2.21)
Matrix Rotation (Apparent Rotation)
Total Rotation (True Rotation, Internal Rotation)
POSTNATAL GROWTH OF TMJ (FLOW CHART 2.4)
SUMMARY OF FACIAL GROWTH CHANGES
DEVELOPMENT OF DENTITION AND OCCLUSION
BUD STAGE
CAP STAGE
BELL STAGE
Root Formation
PERIODS OF OCCLUSAL DEVELOPMENT
Predental Period
PREDENTAL PERIOD
Gum Pads
Status of Dentition
DECIDUOUS DENTITION PERIOD
Eruption Age and Sequence of Deciduous Dentition
Spacing in Deciduous Dentition (Physiologic Spaces)
Flush Terminal Plane (Fig. 2.22)
Deep Bite
Variations in the Occlusion of the Primary Dentition
Changes in Incisor Relationship during Deciduous Dentition
MIXED DENTITION PERIOD
First Transitional Period
Intertransitional Period
Second Transitional Period
PERMANENT DENTITION PERIOD
Dimensional Changes
Factors Affecting the Development of the Occlusion
Forces of Mastication
Dental Arch Form
FUNCTIONAL DEVELOPMENT
NORMAL MILESTONES OF DEVELOPMENT
Infancy
Preschool Period
School Period (6–12 years)
PUBERTY AND ADOLESCENCE
MASTICATION
Classic Pattern (Suckle-swallow) is Outlined by Bosma in Infants
Preparatory Phase
DEGLUTITION
Infantile Swallow
Characters of Mature Swallow (Figs 2.31A and B)
Phases of Deglutition or Swallowing
Theories of Deglutition
Triangular Force Concept
RESPIRATION
SPEECH (FIG. 2.32)
Passive Muscle Function
TRAJECTORIES OF FORCE
Trajectories of Maxilla
Trajectories of Mandible
WOLFF'S LAW OF TRANSFORMATION OF BONE
PSYCHOLOGICAL DEVELOPMENT
PSYCHOLOGY (STUDY OF PSYCHE)
THEORIES OF PSYCHOLOGICAL DEVELOPMENT
Psychoanalytical Theory (Sigmund Freud 1856–1931)
Classical Conditioning (Pavlov, 1927)
Maher's Theory (1933)
Psychosocial Theory (Erik Erikson)
Operant Conditioning (Skinner, 1938)
Cognitive Theory (Jean Piaget)
BEHAVIOR IN ORTHODONTICS
Wilson's Classification (1933)
Frankel's Classification (1962)
Lampshire's Classification (1970)
Wright's Classification (1975)
BEHAVIOR DEVELOPMENT
BEHAVIOR MANAGEMENT
Parental Influences on Child's Behavior
Parental Anxiety
BASIC APPROACHES TO CHILD MANAGEMENT IN ORTHODONTICS
EPHEBODONTICS
Introduction
CLINICAL IMPORTANCE OF GROWTH AND DEVELOPMENT IN ORTHODONTICS
INFANCY AND EARLY CHILDHOOD
JUVENILE PERIOD
ADOLESCENT GROWTH
CLINICAL IMPLICATIONS OF REGIONAL DEVELOPMENT
Cranial Vault
Cranial Base
Nasomaxillary Complex
Mandible
Temporomandibular Joint
CONCLUSION
CHAPTER 3:
Occlusion and Malocclusion
OCCLUSION
TERMINOLOGY
TYPES OF CUSPS
ARRANGEMENT OF TEETH IN HUMANS
IMAGINARY OCCLUSAL PLANES AND CURVES
Curve of Spee
Curve of Wilson (Fig. 3.1)
Curve of Monson (Fig. 3.2)
CENTRIC RELATION AND CENTRIC OCCLUSION
CENTRIC CONTACTS
Posterior Centric Contacts
Anterior Centric Contacts
ECCENTRIC OCCLUSION
Functional Occlusion (Working Side Occlusion, Laterocclusion)
Nonfunctional Occlusion (Mediocclusion)
DISCLUSION
Normal and Ideal Occlusion
ANGLE'S CONCEPT OF NORMAL OCCLUSION (FIG. 3.3)
BEGG'S CONCEPT OF NORMAL OCCLUSION (ATTRITIONAL OCCLUSION)
ROTH'S CONCEPT OF FUNCTIONAL OCCLUSION
ANDREWS SIX KEYS TO NORMAL OCCLUSION
Molar Interarch Relationship
Mesiodistal Crown Angulations (Tip)
Labiolingual Crown Inclinations (Torque) (Figs 3.4A and B)
Absence of Rotations
Tight Contacts
Curve of Spee
CLASSIFICATION OF MALOCCLUSION
MALOCCLUSION
CLASSIFICATION
Purpose of Classification
When to Classify
Strang's Steps for Proper Classification
TYPES OF MALOCCLUSION
Intra-arch Malocclusions
Interarch Malocclusion
Skeletal Malocclusions (Figs 3.8A to C)
SYSTEMS OF CLASSIFICATION
History of Malocclusion Classifications
Angle's Classification
Lischer's Classification
Dewey's Classification (Dewey-Anderson's Modification)
Simon's Classification
Bennett's Classification
Ballard's Classification
Incisor Classification: British Standard Classification of Incisor Relationship(Fig. 3.13)
Canine Classification
Ackerman-proffit Classification
Method of Classification
Katz Classification
McCallins Classification of Class III
EPIDEMIOLOGY OF MALOCCLUSION
APPLICATIONS OF EPIDEMIOLOGICAL-PRINCIPLES
STUDY DESIGNS
Descriptive Studies
Analytic Studies
BIAS IN RESEARCH
Internal and External Validity
STATISTICS MEASUREMENT OF DATA
HYPOTHESIS TESTING
Type I Error (a)
Type II Error (p)
Power
Sample Size
Central Limit Theorem
Statistical versus Clinical Significance
INDICES OF MALOCCLUSION
INDEX
Orthodontic Indices
Dental Health Component of Index for orthodontiC Treatment Need
Relationships used in the index (Table 3.5)
ANTHROPOLOGY
ANTHROPOLOGY AND ORTHODONTICS
EARLY PRIMATES
From Shrews to Humans
CONCLUSION
CHAPTER 4:
Etiology
ETIOLOGY OF MALOCCLUSION
CLASSIFICATION OF ETIOLOGIC FACTORS IN MALOCCLUSION
Moyer's Classification
White and Gardiner's Classification
Graber's Classification
General Factors
Local Factors
ETIOLOGY FOR SPECIFIC TYPES OF MALOCCLUSION
HABITS
DEFINITION
CLASSIFICATION OF HABITS
William James Classification (1923)
Kingsley Classification (1956)
Ernest Klien (1971)
Graber
Finn and Sim (1975)
Eric Johnson and Brent Larson Classification of Non-nutritive Sucking
THUMB SUCKING AND FINGER SUCKING
Sucking Reflex
Etiology
Process of Sucking
Phases of Development of Thumb Sucking
Subteleny Graded Thumb Sucking into Four Types (1973)
Diagnosis
Management of Thumb Sucking
Blue Grass Appliance
TONGUE THRUSTING HABIT
Etiology
Classification of Tongue Thrust
Simple Tongue Thrust
Complex Tongue Thrust
Diagnosis
Management of Tongue Thrust
Speech Therapy
Surgical Treatment
MOUTH-BREATHING
Congenital Micrognathia
Etiology
Pathophysiology
Diagnosis
Management
LIP BITING AND LIP SUCKING
Differential Diagnosis
Management
BRUXISM
Etiology
Diagnosis
Management
FINGER NAIL BITING
TONGUE SUCKING
PILLOWING HABITS
NUTRITION IN ORTHODONTICS
EFFECT OF NUTRITIONAL STATUS ON TOOTH MOVEMENT AND TISSUE RESPONSE TO APPLIANCES
DIETARY COUNSELING FOR PLAQUE CONTROL AND GENERAL HEALTH IN THE ORTHODONTIC PATIENT
NUTRITIONAL CONSIDERATIONS IN THE ORTHOGNATHIC SURGICAL PATIENT
NUTRITIONAL FACTORS IN THE ETIOLOGY OF CRANIOFACIAL ANOMALIES
Conclusion
GENETICS IN ORTHODONTICS
HISTORY
MOLECULAR BASIS OF INHERITANCE
Cell
Patterns of Genetic Transmission
Gene Mutations
Chromosomes in Man
Genetic Disorders
GENETICS IN ORTHODONTIC PERSPECTIVE
Methods of Studying Role of Genes
Pedigree Studies
Inbreeding
Age of Onset
Butler's Field Theory
Principal Polygenic Variation
Eugenics
CHAPTER 5:
Orthodontic Diagnosis
ORTHODONTIC DIAGNOSIS
ESTHETICS IN ORTHODONTICS
Divine Proportions
Fibonacci Numbers
GOLDEN SECTION
Properties of Phi (ϕ)
Golden Rectangle
Pentagon Analysis
Golden Triangle
Genetic Implications of the Logarithmic Spiral and the Golden Section
Facial Analysis with the Golden Proportion
Divine Proportions in the Human Dentition
Association of Divine Relations with Denture and Face
Analysis of the Cephalometric Matrix
Divine Proportions in the Frontal Cephalometric View
Visual Esthetic Examination
DIAGNOSTIC AIDS IN ORTHODONTICS
ESSENTIAL DIAGNOSTIC AIDS
SUPPLEMENTAL DIAGNOSTIC AIDS
CASE HISTORY
Personal Details
Chief Complaints
Medical History
Dental History
Prenatal History
Postnatal History
Family History
CLINICAL AND GENERAL EXAMINATIONS
Height and Weight
Gait
Posture
Body Built (Physique)
Extraoral Examination
Classification
Intraoral Examination
FUNCTIONAL EXAMINATION
Assessment of Postural Rest Position and Interocclusal Clearance
Evaluation of Path of Closure
Smile Analysis (Fig. 5.17)
Assessment of Respiration
Examination of Temporomandibular Joint
Evaluation of Swallowing
Speech
ORTHODONTIC STUDY MODELS (FIGS 5.19A TO D)
Ideal Requirements of an Orthodontic Study Model
Parts of a Study Model
Steps in Construction of Orthodontic Study Models
Gnathostatic Models
Classification
Pont's Analysis
Procedure
Linderharth's Analysis
Korkhau's Analysis
Carey's Analysis
Bolton's Analysis
Moyer's Mixed Dentition Analysis
Mixed Dentition Analysis—Radiographic Method
TOTAL DENTITION SPACE ANALYSIS
Anterior Space Analysis
Midarch Analysis
Posterior Space Analysis
INFERENCE TO DEFICITS AND DECISIONS
RADIOGRAPHS USED IN ORTHODONTIC DIAGNOSIS
Intraoral Radiographs
Extraoral Radiographs
Cephalometric Radiographs
CEPHALOMETRICS
Types of Cephalograms
Uses of Cephalograms
Film Interpretation
Cranium
Paranasal Sinuses
Mastoids
Cervical Spine
Upper Airway and Neck
Dentomaxillofacial Complex
Landmarks
Lines and Planes in Cephalometrics
Cephalometric Tracing Technique
Superimposition of Serial Cephalograms
Sequence of Color Code in Cephalometric Superimposition
Cephalometric Analysis
Down's Analysis (Fig. 5.33)
Skeletal Parameters
Steiner's Analysis
Wits Appraisal (Fig. 5.37)
Tweed Analysis (Fig. 5.38)
Sassouni Analysis
Mcnamara Analysis
Wylie Analysis
Cephalometrics for Orthognathic Surgery (COGS by Burstone)
Posteroanterior Cephalometric Analysis
Cephalometric Superimpositions
FACIAL PHOTOGRAPHS
Uses of Photographs
Photographic Analysis
Profile Examination
Facial Divergence
Frontal Examination
Supplementary Diagnostic Aids
Hand-Wrist Radiographs
Skeletal Maturity Indicators
Hand-Wrist Radiographs
Indications for Hand-wrist Radiographs
Greulich and Pyle Method
Tanner and Whitehouse Method
Taranger Method
Chapman Method
Bjork, Grave and Brown Method
Singer's Method of Assessment
Fishman's Skeletal Maturity Indicators
Maturation Assessment by Hagg and Taranger (Fig. 5.43)
Sesamoid
Skeletal Maturation Evaluation Using Cervical Vertebrae
Tooth Mineralization as an Indicator of Skeletal Maturity
Dual Energy X-ray Absorptiometry
Diagnostic Setup (Fig. 5.46)
Electromyography
Basal Metabolic Rate (BMR)
Physioprint (Fig. 5.47)
Digi-graph
Magnetic Resonance Imaging
Tomography
Conventional Tomography
Computed Tomography
Occlusograms (Fig. 5.50)
Digital Subtraction Radiography
Laser Holography
Photocephalometry
Cine Radiography
Ultrasonography
Principle
COMPUTERS IN ORTHODONTICS
CHARACTERISTICS OF A COMPUTER
Speed
Accuracy and Reliability
Memory
Integrity
Versatility
Components of a Computer System
USES OF COMPUTER IN ORTHODONTICS
Computerized Scheduling
Computerized Dental Patient Record
Practice Management
Practice Education
Case Presentations
Dental Imaging
Continuing Medical Education and Research References
Communications and Entertainment
Computerized Cephalometric Systems
RMO's Jiffy Orthodontic Evaluation
PorDios (Purpose on Request Digitizer Input Output System)
Digi-graph
Computer Aided Diagnosis
Medical Imaging
Conclusion
STERILIZATION IN ORTHODONTICS
STERILIZATION
Disinfection
Clinical Procedures
Inventory
Storage
General Comments
CHAPTER 6:
Orthodontic Treatment Planning
GENERAL FACTORS IN ORTHODONTIC TREATMENT PLANNING
SETTING-UP GOALS
ENLISTING THE TREATMENT OBJECTIVES
Assessment of Growth Potential
Assessment of Etiologic Factors
Planning Space Requirements
Space for Anchor Loss
Planning Anchorage
Selection of Appliance
Patients Expectations
Planning Retention
Re-evaluation
AGE FACTOR IN ORTHODONTICS
Diagnosis and Age
TREATMENT AND AGE
Early Treatment
Late Treatment
TOOTH MOVEMENT AND AGE
Vitality of Tissue
Role of Growth
Role of Apical Foramen
Density of Bone
YOUNG VERSUS ADULT PATIENTS
Growth to Work With
Diagnosis
Appliance Selection
Periodontal Problems
PHASES OF ORTHODONTIC TREATMENT
Treatment Planning in Primary Dentition
Treatment Planning in Mixed Dentition
Treatment Planning in Permanent Dentition
Treatment planning in postpermanent dentition
LIMITATIONS IN ORTHODONTICS
Factors Related to the Patients
Factors Related to the Dentist
Factors Related to the Nature of Orthodontics
METHODS OF GAINING SPACE
PROXIMAL STRIPPING (REPROXIMIZATION, SLENDERIZATION, DISKING AND PROXIMAL SLICING) (FIGS 6.1A AND B)
Indications for Proximal Stripping
Contraindications
Advantages of Proximal Stripping
Disadvantages of Proximal Stripping
Diagnostic Aids for Proximal Stripping
Fluoride Application
EXPANSION
Rapid Maxillary Expansion
TYPES OF APPLIANCES USED
Removable Appliances
Fixed Appliances
Description of a Typical Expansion Screw
SLOW EXPANSION
Appliances Used for Slow Expansion
Coffin Spring (Fig. 6.5)
Quadhelix (Fig. 6.6)
Wilson's ‘W’ Arch Appliance (Fig. 6.7)
EXTRACTIONS IN ORTHODONTICS
Historical Background
Skeletal Jaw Malrelations
Extraction of Upper Incisors
Extraction of Lower Incisors
Extraction of Canines
Extraction of First Premolars
Extraction of Second Premolars
Extraction of First Molars
Wilkinson Extraction
Extraction of Second Permanent Molars
Extraction of Third Molars
Balancing Extractions
Compensating Extractions
Enforced Extractions
DISTALIZATION
Extraoral Methods
Intraoral Methods
UPRIGHTING OF MOLARS
DEROTATION OF POSTERIOR TEETH (FIG. 6.9)
PROCLINATION OF ANTERIOR TEETH
TREATMENT PLANNING IN CLASS I MALOCCLUSION
CLINICAL FEATURES OF CLASS I MALOCCLUSION
Crowding (Fig. 6.10)
Spacing (Fig. 6.11)
MIDLINE DIASTEMA
Causes of Midline Diastema
Treatment
Rotations
Anterior Openbite (Fig. 6.12)
Posterior Openbite (Figs 6.12A and B)
CROSSBITE
Classification of Crossbite
Anterior Crossbite
Posterior Crossbite
Skeletal Crossbite
Dental Crossbite
Functional Crossbite
Treatment of Anterior Crossbite
Double Cantilever Spring (Z-spring)
Treatment of Posterior Crossbites
Deep Bite
Dental Deep Bite
Removable Appliances
Myofunctional Appliances
IMPACTED TEETH (FIGS 6.14A AND B)
Incidence
Etiology
Diagnosis
Clinical Evaluation
Radiographic Evaluation
Periapical Films
Tube Shift Technique or Clark's Rule (Fig. 6.15)
Buccal Object Rule
Occlusal Films
Panoramic Radiographs
Computed Tomography
Management
Surgical Exposure
Methods of Orthodontic Attachment
Retention
TREATMENT PLANNING IN CLASS II MALOCCLUSION
CLASS II DIVISION 1 MALOCCLUSION
Clinical Features
Skeletal Features
Treatment Objectives
Treatment of Skeletal Class II Malocclusion
Camouflage
Surgical Correction
Role of Extraction
CLASS II DIVISION 2 MALOCCLUSION
Clinical Features
Treatment Objectives
Role of Functional Appliances
TREATMENT PLANNING IN CLASS III MALOCCLUSION
CLINICAL FEATURES OF CLASS III MALOCCLUSION
SKELETAL FEATURES OF CLASS III MALOCCLUSION
Etiology
Diagnosis
Treatment
Interception during Growth
Role of Extractions
DRUGS USED IN ORTHODONTICS
PROPHYLACTIC ANTIBIOTICS FOR PREVENTION OF INFECTIVE ENDOCARDITIS
Regimen A—Penicillin
Regimen B—Penicillin Plus Streptomycin
Fluorides and Orthodontics
Antianxiety Agents
Pharmacologic Agents for Myofascial Pain
SUMMARY AND CONCLUSION
CHAPTER 7:
Biomechanics
MECHANICS OF TOOTH MOVEMENT
NEWTON'S LAWS OF MOTION
Force
Stress and Strain
Couple
Moment
Center of Resistance (Fig. 7.1)
Center of Rotation
TYPES OF TOOTH MOVEMENTS (FIG. 7.2)
Tipping
Bodily Movement (Translation)
Pure Translation
Pure Rotation (Fig. 7.3)
Generalized Rotation
TYPES OF FORCE (Fig. 7.4)
Continuous Force
Intermittent Force
Interrupted Force
BIOLOGY OF TOOTH MOVEMENT
PHYSIOLOGIC TOOTH MOVEMENT
Tooth Eruption
Migration or Drift of Teeth
Tooth Movement during Mastication
TOOTH MOBILITY
Physiologic (Normal) Mobility
Increased Mobility (Hypermobility)
Reduced Mobility (Hypomobility)
HISTOLOGY OF TOOTH MOVEMENT
OPTIMUM ORTHODONTIC FORCE (TABLE 7.1)
HYALINIZATION
THEORIES OF TOOTH MOVEMENT
Pressure Tension Theory
Fluid Dynamic Theory
PHASES OF TOOTH MOVEMENT
Initial Phase
Lag Phase
Postlag Phase
BIOCHEMICAL REACTION TO ORTHODONTIC TOOTH MOVEMENT (FLOW CHART 7.1)
BONE RESORPTION
BONE DEPOSITION
Orthodontic Root Resorption
Effects of Orthodontic Tooth Movement on Dental and Periodontal Tissues
ANCHORAGE IN ORTHODONTICS
DEFINITION (GRABER)
CLASSIFICATION
SOURCES OF ANCHORAGE
Simple Anchorage (Fig. 7.6)
Compound Anchorage
Reinforced Anchorage (Figs 7.7 and 7.8)
Reciprocal Anchorage
Intermaxillary Anchorage
Baker's Anchorage (Figs 7.11 and 7.12)
Intramaxillary Anchorage (Fig. 7.13)
Stationary Anchorage
Prepared Anchorage (Fig. 7.14)
Extraoral Sources (Fig. 7.15)
Factors Affecting Anchorage
Mutual Support
Basal Bone
The Musculature
Anchorage Planning
Maximum, Minimum and Moderate Anchorage
IMPLANTS AS ANCHORAGE IN ORTHODONTICS
Classification
1. Endosteal Implants
2. Transosteal Implants
3. Subperiosteal Implants
4. Endodontic Stabilizers
5. Intramucosal Inserts
Subperiosteal Implants
Osseous Implants
Interdental Implants (Figs 7.19 and 7.20)
ANCHORAGE LOSS
Signs of Anchorage Loss
CHAPTER 8:
Preventive and Interceptive Orthodontics
PREVENTIVE ORTHODONTICS
DEFINITION
Patients and Parents Education
CARIES CONTROL
Care of Deciduous Dentition
Extraction of Supernumerary Teeth
Eliminating Occlusal Interference
Maintenance of Tooth Shedding Timetable
Management of Ankylosed Teeth
Management of Abnormal Frenal Attachments
ORAL HABITS CHECK-UP AND EDUCATING PATIENTS AND PARENTS
Preventing Milwaukee Brace Damage
Deeply Locked Permanent First Molars
Muscle Exercises
SPACE MAINTAINERS
Classification
Indications of Space Maintainers
Contraindications of Space Maintainers
Removable Space Maintainers
Advantages of Removable Space Maintainers
Disadvantages of Removable Space Maintainers
Indications for Removable Space Maintainers
Contraindications of Removable Space Maintainers
Acrylic Partial Dentures
Complete or Full Dentures
Removable Distal Shoe Space Maintainer
Fixed Space Maintainers
INTERCEPTIVE ORTHODONTICS
DEFINITION
SERIAL EXTRACTIONS (FIGS 8.6A TO D)
Definition
History
Rationale
Indications for Serial Extractions
Contraindications
Advantages of Serial Extractions
Limitations of Serial Extractions
Precautions to be Taken during Serial Extractions
Changes that Occur during Serial Extractions
Objectives
Diagnosis
Procedure
DEVELOPING ANTERIOR CROSSBITE CORRECTION
Dentoalveolar Anterior Crossbite
Functional Anterior Crossbites
PREORTHODONTIC TRAINERS
Indications
Contraindications
Design
Phases of Treatment
CLINICAL MANAGEMENT
Removal of Soft Tissue and Bony Barriers
MUSCLE EXERCISES
Exercise for the Temporalis Muscle
Exercises for the Lips (Circumoral Muscles)
Exercises for Masseter Muscles
Limitations of Muscle exercises
Musical Instruments and Muscle Exercises
CHAPTER 9:
Orthodontic Appliances
REMOVABLE APPLIANCES
INDICATIONS FOR REMOVABLE APPLIANCES
ADVANTAGES OF REMOVABLE APPLIANCES
DISADVANTAGES OF REMOVABLE APPLIANCES
COMPONENTS OF REMOVABLE APPLIANCES
I. Retentive Components
Principles of Retention
Mode of Action of Clasps
Classification of Clasps
Southend Clasp (Fig. 9.7)
Triangular Clasp (Fig. 9.8)
Ball End Clasp (Fig. 9.9)
Eyelet Clasp (Figs 9.10A and B)
Arrow Pin Clasp (Fig. 9.11)
Schwarz Clasp (Fig. 9.12)
Duyzing Clasp (Fig. 9.13)
Visick Clasp (Figs 9.14A and B)
Hand Wrought Roach Clasp (Fig. 9.15)
Crozat Clasp (Fig. 9.16)
Delta Clasp (Fig. 9.17)
Smart Clasp (Modified Adams’ Clasp) (Fig. 9.18)
II. Active Components
Classification of Active Components
1. Bows
2. Springs
Canine Retractors
Reverse Labial Bow (Fig. 9.27)
Mills Retractor (Fig. 9.28)
3. Screws
4. Elastics
III. Base Plate (Fig. 9.30)
Uses of Base Plate
Thickness of Base Plate
Extension of Base Plate
Materials used for Base Plate
Delivery of Removable Appliance
Instructions to the Patient
Problems during Removable Appliance Therapy
FIXED APPLIANCES
ADVANTAGES OF FIXED APPLIANCES
DISADVANTAGES OF FIXED APPLIANCES
Tooth Movement Possible by Fixed Appliances
Method of Fixing Attachments onto the Teeth
BANDING
Indications
Steps in Banding
Types of Bands
BONDING
Types of Bonding
Steps in Bonding
Debonding
Methods of Debonding
COMPONENTS OF FIXED ORTHODONTIC APPLIANCES
I. ACTIVE COMPONENTS
II. PASSIVE COMPONENTS
Bands (Fig. 9.45)
Brackets
Ribbon Arch Brackets
Edgewise Brackets
Weldable and Bondable Brackets
Metallic Brackets
Ceramic Brackets
Plastic Brackets
Buccal Tubes
Lingual Attachments (Fig. 9.46)
Ligature Wires
Lock Pins (Fig. 9.47)
FIXED APPLIANCE TECHNIQUES
Edgewise Appliance (Figs 9.49A and B)
Begg's Technique (Figs 9.50A to D)
Tweed Technique
Combination Techniques
Labiolingual Technique
Lingual Appliance
Universal Appliance
Tip Edge Technique
Straight Wire Appliance (Preadjusted Edgewise Appliance) (Figs 9.51A and B)
ORAL HYGIENE IN FIXED APPLIANCE TREATMENT
Microbiology of Orthodontic Appliances
Caries and Decalcification during Orthodontic Therapy
Periodontal Problems
Traumatic Ulcerations
Oral Hygiene
Tooth Brushing
Mouthwashes
Nickel Hypersensitivity
CHAPTER 10:
Dentofacial Orthopedics
ORTHOPEDIC APPLIANCES
BASIS FOR ORTHOPEDIC APPLIANCES
Amount of Force
Duration of Force
Components of Extraoral Appliance
Concepts of Extraoral Anchorage
Indications for use of Extraoral Force
BIOMECHANICAL CONSIDERATION
I. Teeth
II. Basal Bone
III. Musculature
IV. Site of Anchorage
V. Manner of Force Application
VI. Magnitude of Force
VII. Duration of Force
Determination of Force Magnitude
HEADGEAR
Objective
Biomechanics
Mechanism of Action
Types
Parts
Extraorally
Indications for Use of Headgear for Cervical Pull
High Pull (Fig. 10.2)
Protraction Headgear
Cervical Attachment or Neck Strap (Fig. 10.3)
Occipital Attachment or Headcap (Fig. 10.4)
Combination Headgear (Fig. 10.5)
Selection of Headgear
Selection of Headgear Attachment to the Dentition
Selection of Required Movement
Selection of Magnitude of Extraoral Force
Selection of Duration
Selection of Direction
Selection of Timing
Limitations
PROTRACTION FACE MASK THERAPY (Fig. 10.8)
Indications
Types
Clinical Response to Maxillary Protraction
FACTORS GOVERNING VARIABILITY IN CLINICAL RESPONSE
Age of the Patient
Design of Anchorage System
Force Level, Direction and Point of Application
CHIN CUP THERAPY (Fig. 10.9)
Objective
Indication
Types
Force Magnitude and Direction
Treatment Timing and Duration
FUNCTIONAL APPLIANCES
DEFINITION
CLASSIFICATION OF FUNCTIONAL APPLIANCES
Bite Planes
Shields or Screens
Construction or Working Bite
ADVANTAGES OF FUNCTIONAL APPLIANCES
LIMITATIONS OF FUNCTIONAL APPLIANCES
ACTION OF FUNCTIONAL APPLIANCES
VISUAL TREATMENT OBJECTIVE
VESTIBULAR SCREEN (ORAL SCREEN)
Principle
Indications
Clinical Management of the Appliance
Lip Bumper (Lip Plumber) (Fig. 10.10)
Appliance Design
ACTIVATOR
Indications
Contraindications
Advantages
Disadvantages
Mode of Action of Activator
Construction Bite
Fabrication of Activator
MANAGEMENT OF THE APPLIANCE
Trimming of Activator
Trimming of the Activator for Transverse Control
WUNDERER'S MODIFICATION
THE REDUCED ACTIVATOR OR CYBERNATOR OF SCHMUTH
PROPULSOR
Cutout or Palate-Free Activator
KARWETZKY MODIFICATION
HERREN'S MODIFICATION OF THE ACTIVATOR
FUNCTION REGULATOR (FRANKEL APPLIANCE)
Frankel Philosophy
Mode of Action of Frankel Appliance
Types of Function Regulators
Components of Frankel Appliance (Fig. 10.11)
Construction Bite
Clinical Handling of the Frankel Appliance and Potential Management
Treatment Timing
BIONATOR (Fig. 10.12)
Class III Appliance (Reverse Bionator)
Bite Registration
TWIN BLOCK APPLIANCE (FIGS 10.13A TO C)
Bite Registration
Orthopedic Traction
Fixed Twin Blocks
Patient Acceptance
HERBST APPLIANCE (FIG. 10.14)
Indications
Description
Types of Herbst Appliance
Treatment Effects
Advantages
Disadvantages
Jasper Jumper (Fig. 10.15)
CHAPTER 11:
Retention and Relapse
RETENTION
SCHOOLS OF RETENTION
THEOREMS OF RETENTION
RALEIGH WILLIAMS SIX KEYS FOR RETENTION
THEORIES OF RETENTION
Group I: No Retention
Group II: Standard or Limited Retention
Group III: Prolonged Retention
Group IV: Permanent Retention
METHODS OF RETENTION: RETAINERS
Classification of Retainers
Removable Retainers
Hawley's Retainer (Figs 11.2A and B)
van der Linden's Retainer (Figs 11.4A and B)
Begg's Retainer (Fig. 11.5)
Clip on Retainer (Spring Aligner)
Wrap Around Retainer
Kesling Tooth Positioner (Fig. 11.6)
Invisible Retainers (Figs 11.7A and B)
Fixed Retainers
Fixed Appliance Retainers
Band and Spur Retainer
Banded Canine-to-Canine Retainer
Bonded Lingual Retainers (Figs 11.8A and B)
Essix Retainer
Spring Retainer (Barrer Retainer) (Figs 11.9A and B)
Adjuvants to Retention
RELAPSE
Causes of Relapse
Periodontal Ligament Traction
Relapse due to Growth Related Changes
Bone Adaptation
Muscular Forces
Failure to Eliminate the Original Cause
Role of Third Molars
Role of Occlusion
FAILURES IN ORTHODONTICS
Orthodontic Goals
Limitations of Treatment
Growth
Growth Patterns
Anteroposterior Discrepancies
Vertical Dimension
Posterior Facial Height
Bite Opening
Molar Displacement
Freeway Space
Tooth-to-Bone Discrepancies
Tooth Size Discrepancies
Dental Drift
Third Molars
Musculature
Iatrogenic Problems
SUMMARY
CHAPTER 12:
Surgical Orthodontics
MINOR SURGICAL PROCEDURES
EXTRACTIONS
Therapeutic Extractions
Serial Extractions
Extraction of Supernumerary Impacted and Ankylosed Teeth
SURGICAL EXPOSURE OF IMPACTED TEETH
Location of the Tooth
Evaluation of Favorability
Evaluation of Space Adequacy
Surgical Excision and Bone Removal
Fixing Orthodontic Attachments
FRENECTOMY
PERICISION (CIRCUMFERENTIAL SUPRACRESTAL FIBROTOMY OR CSF PROCEDURE)
CORTICOTOMY
ORTHODONTIC IMPLANTS
Classification of Implants
Application of Implants in Orthodontics
Method of Placement
ORTHOGNATHIC SURGERY
ETIOLOGY OF DENTOFACIAL DEFORMITIES
Specific Causes
Hereditary
Environmental
ORTHOGNATHIC SURGERY
Diagnosis (Preoperative e valuation)
Envelope of Discrepancy (Figs 12.2A and B)
PRESURGICAL ORTHODONTICS
Mock Surgery
Orthognathic Surgery and Stabilization
MAXILLARY
Surgeries
Complete Maxillary Osteotomy
Küfner Osteotomy
Multiple-piece Maxillary Osteotomy (Fig. 12.6)
MANDIBULAR SURGERIES
Bilateral Sagittal Split Osteotomy (BSSO) (Figs 12.1, 12.7 and 12.8)
Transoral Vertical Ramus Osteotomy (TOVRO), Intraoral Vertical Ramus Osteotomy (IVRO)
Genioplasty (Fig. 12.9)
Postsurgical Orthodontics
Cosmetic Surgeries
DISTRACTION OSTEOGENESIS
DEFINITION
HISTORICAL PERSPECTIVE
INDICATIONS
ADVANTAGES
DISADVANTAGES
PREOPERATIVE CLINICAL EXAMINATION
Vectors of Distraction Osteogenesis
Distraction Device Characteristics
Orthodontic Management
GROWTH AND STABILITY AFTER DISTRACTION
Dental Distraction (Fig. 12.12)
Future Directions
CONCLUSION
CHAPTER 13:
Multidisciplinary Orthodontics
ADULT ORTHODONTICS
REASONS FOR INCREASE IN ADULT PATIENTS
Difference between Adult and Adolescent Patients
Indications for Adult Orthodontic Treatment
Contraindications for Adult Orthodontics
BIOMECHANICAL CONSIDERATIONS
Mechanics and Treatment
Age-related Changes in the Periodontal Ligament
Age-related Bone Changes
Local Age Changes
DIAGNOSIS AND ADULT ORTHODONTICS
Periodontal Considerations in Diagnosis
Multidisciplinary Approach
TREATMENT ASPECTS IN ADULT ORTHODONTICS
1. Adjunctive Orthodontic Treatment
2. Comprehensive Treatment for Adults
Invisalign® Technology (Fig. 13.2)
3. Surgical Orthodontic Treatment
Retention in Adult Orthodontics
ORTHODONTICS IN MULTISPECIALTY APPROACH
MULTISPECIALTY ORTHODONTIC TREATMENT
Sequence of Treatment in Orthodontics
Conservative Management of Malocclusion
Orthodontic Management of Ankylosed Teeth
ORTHODONTIC-PERIODONTIC INTERRELATIONSHIP
Stage I: Diagnosis
Recognition of Individual Patient Response
Identification of the Susceptible Patients
Stage II: Treatment Planning
Migration as a cause of Disease
Stage III: Treatment
Periodontal Care during Orthodontic Therapy
Orthodontic Care for the Periodontally Involved Patient
Stage IV: Post-treatment
Orthodontic Therapy in Patients with Juvenile Periodontitis
Conclusion
ORTHODONTIC MANAGEMENT OF TMJ AND OCCLUSAL DISORDERS
BIOMECHANICS
TEMPOROMANDIBULAR JOINT PATHOLOGY
SIGNS AND SYMPTOMS OF TMJ DISORDERS
Pain
ORTHOPEDIC DYSFUNCTION
Joint Sounds
Altered Mandibular Movements
Muscular Dysfunction
Neurovascular Dysfunction
Homeostatic Dysfunction
DIAGNOSIS
History
Clinical Examination
Radiography
MANAGEMENT
Symptomatic Treatment
Definitive Treatment
Conclusion
ORTHODONTIC MANAGEMENT OF CLEFT LIP AND PALATE
INCIDENCE
EMBRYOLOGICAL BACKGROUND
Etiology of Cleft Lip and Palate
Heredity
Environment
Multifactorial Etiology
Predisposing Factors
Classification of Cleft lip and palate
Rare Facial Clefts
Esthetic Problems
Hearing and Speech
Psychological Problems
Management of Cleft Lip and Palate
Presurgical Orthopedics
Surgical Lip Closure
Surgical Palate Closure
Retention in Cleft Lip and Palate
FAMILY COUNSELING
ORTHODONTIC MANAGEMENT OF CRANIOFACIAL SYNDROMES
ORTHODONTIC MANAGEMENT OF CLEIDOCRANIAL DYSPLASIA
Clinical Features
Management
ORTHODONTIC MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA SYNDROME
ORTHODONTIC AND TEMPOROMANDIBULAR JOINT CONSIDERATIONS IN TREATMENT OF PATIENTS WITH EHLERS-DANLOS SYNDROME
Orthodontic Considerations
ORTHODONTIC MANAGEMENT OF MEDICALLY COMPROMISED PATIENTS
MANAGEMENT OF PHYSICALLY HANDICAPPED CHILD
Management of Handicapped Child during Dental Treatment
Management of Deaf Child
Management of Blind Child
MANAGEMENT OF ORTHODONTIC PATIENTS WITH A HISTORY OF RHEUMATIC FEVER OR CONGENITAL HEART DISEASE
ORTHODONTIC MANAGEMENT OF PATIENTS WITH BLEEDING DISORDERS
Special Orthodontic Considerations
ORTHODONTIC MANAGEMENT OF PATIENTS WITH HEMATOLOGIC MALIGNANCIES
Role of the Orthodontist
ORTHODONTIC MANAGEMENT OF PATIENTS WITH ENDOCRINE DISORDERS
ORTHODONTIC MANAGEMENT OF PATIENTS WITH DIABETES
Orthodontic Considerations
ORTHODONTIC MANAGEMENT OF PATIENTS WITH CYSTIC FIBROSIS
Orthodontic Considerations
ORTHODONTIC MANAGEMENT OF PATIENTS WITH JUVENILE RHEUMATOID ARTHRITIS
Orthodontic Considerations
ORTHODONTIC MANAGEMENT OF PATIENTS WITH RENAL FAILURE
Orthodontic Considerations
FORENSIC ORTHODONTICS
FORENSIC DENTISTRY
Definitions
Major Fields of Forensic Odontology
ROLE OF ORTHODONTIST
DERMATOGLYPHICS
CHAPTER 14:
Community Orthodontics
ORTHODONTIC PRACTICE
IDEAL ORTHODONTIC SERVICES
TYPICAL ORTHODONTIC PRACTICE ORGANIZATION
Typical Orthodontic Management Style
Key to a Better Way
Nature of Participation
Delegating Authority with Responsibility
ORTHODONTIC WORK ENVIRONMENT
Communicating with Patients
Proper Case Presentation
Patient Communication during Treatment
Management by Exception
Conclusion
MEDICOLEGAL CONSIDERATIONS IN ORTHODONTICS
LEGAL PRECEDENTS
Contracts and Statutes of Limitations
Negligent Treatment
Misdiagnosis
State Dental Regulations
CONCLUSION
CHAPTER 15:
Materials Used in Orthodontics
ORTHODONTIC MATERIALS
CLASSIFICATION OF ORTHODONTIC APPLIANCE MATERIALS (FIG. 15.1)
Arch Wire Materials
Bracket and Attachment Materials
Bonding Materials
Orthodontic Cements
Sealants and Adhesion Promoters
Conditioning and Crystal Growth Systems
Force Delivery Systems
Auxillary Force Delivery Systems
Soldering and Welding
Other Dental Materials
ORTHODONTIC ARCH WIRE MATERIALS
General Properties of Orthodontic Wires
Elastic Properties of Orthodontic Wires
Gold Alloys
Stainless Steel
Cold Working
Heat Treatment
Annealing
Grain Growth
Hardening Heat Treatment
Types
Composition
Sensitization
Stabilization
Mechanical Properties
Braided and Twisted Wires
Solders for Stainless Steel
Fluxes
Australian Wire
Duplex Steels
Teflon (PTFE, Polytetrafluoroethylene) Coated Stainless Steels
Chrome Cobalt Alloys (Elgiloy)
Nickel Titanium Alloys (NiTi)
Copper NiTi Alloy (CuNiTi)
Titanium Molybdenum Alloys (TMA)
Alpha Titanium
Titanium-Niobium
BRACKET AND ATTACHMENT MATERIALS
Stainless Steel
Titanium
Polycarbonate and Fiber Glass Reinforces Esthetic Brackets
Ceramic Brackets
BONDING MATERIALS
Classification
Classification Based on Bonding Systems
Acrylic Resins
Epoxy Resins
Composite Resins
Chemically Activated Systems
Light Activated System
TEGDMA
Cyanoacrylates
ORTHODONTIC CEMENTS
Zinc Phosphate Cements
Zinc Silicophosphate
Zinc Polycarboxylate Cements
Glass Ionomer-based Cements
Resin-modified Cements
Resins
Polyacid-modified Composite Resins (Compomers)
Summary
SEALANTS AND ADHESION PROMOTERS
Adhesion Promoters for Gold
Adhesion Promoters for Porcelain
Acidic Primers
Moisture Resistant Primers
CONDITIONING AND CRYSTAL GROWTH SYSTEMS
Etchants
Air Abrasion (Microetching)
Laser Etching
Crystal Growth Systems
ELASTICS AND ELASTOMERICS
MAGNETS IN ORTHODONTICS
SOLDERING AND WELDING
Welding
Brazing and Soldering
Solder
Ideal Requirements of a Dental Solder
Types of Solders (Brazing Filler Metal)
Applications
Composition
Properties of Dental Solders
Surface Tension of Solder
Fluxes
Oven Brazing (Furnace Brazing)
Technique of Soldering
Steps in Soldering Procedure
Hydrosoldering Units
Antiflux
Pitted Solder Joints
Welding
Laser and Plasma Welding
OTHER DENTAL MATERIALS
Impression Materials
Alginate Impression Materials
Hydrocolloid
Gel Structure
Manipulation
Imbibition and Syneresis
Impression Trays
Impression Tray Selection
Impression Technique in Orthodontics
Impression Technique for Cleft l ip and Palate Cases
Facial Impression Techniques
Duplicating Materials
Elastomeric Impression Materials
Bite Registration Waxes
Gypsum Products
Proportioning
Mixing
Mixing Time
Working Time
Setting Time
Accelerators and Retarders
Setting Reactions
Care of the Cast
Infection Control
ACRYLIC MATERIALS
IDEAL REQUIREMENTS FOR DENTAL RESIN
ACRYLIC RESINS
Uses of Acrylic Resins in Orthodontics
Self-cure Acrylic Resins
Heat Cure Acrylic Resins
Separating Media
Light Cure Acrylic Resins
Orthodontic Appliance Cleaners
Infection Control
Silicone Rubber Materials
FINISHING AND POLISHING MATERIALS
COMMONLY USED ABRASIVES
IMPLANT MATERIALS IN ORTHODONTICS
HISTORY
METALS AND ALLOYS
Titanium and Titanium-6 Aluminum-4 Vanadium (Ti-6Al-4V)
Cobalt-Chromium-Molybdenum-based Alloy
Iron-Chromium-Nickel-based Alloys
OTHER METALS AND ALLOYS
Ceramics and Carbon
Polymers and Composites
Bone Augmentation and Replacement
ENDOSTEAL AND SUBPERIOSTEAL IMPLANTS
Advantages and Disadvantages
ORTHODONTIC INSTRUMENTS
ADAM'S PLIERS (UNIVERSAL PLIERS)
ARCH-FORMING PLIERS (ARCH-CONTOURING PLIERS, DE LA ROSSA PLIERS) (FIG. 15.8)
BAND BURNISHER (BEAVER-TAIL BURNISHER) (FIG. 15.9)
BAND-CONTOURING PLIERS (FIG. 15.10)
BAND PUSHER (MERSHON BAND PUSHER) (Fig. 15.11)
BAND-REMOVING (DEBANDING) PLIERS, ANTERIOR (FIG. 15.12)
BAND-REMOVING (DEBANDING) PLIERS, POSTERIOR (FIG. 15.13)
BAND SEATER (BAND BITER) (FIG. 15.14)
BIRD-BEAK (NO. 139) PLIERS (FIG. 15.15)
BRACKET-POSITIONING INSTRUMENT (BRACKET-HEIGHT GAUGE, BOONE'S GAUGE) (FIG. 15.16)
BRACKET-REMOVING PLIERS (DEBONDING PLIERS) (FIG. 15.17)
CONVERSION INSTRUMENT
COON LIGATURE-TYING PLIERS (FIG. 15.18)
DISTAL-END CUTTER (FIG. 15.19)
ELASTIC SEPARATOR PLIERS (SEPARATOR PLIERS) (FIG. 15.20)
FACEBOW-ADJUSTING PLIERS (FIG. 15.21)
HARD WIRE CUTTER
HEMOSTAT (MOSQUITO PLIERS) (FIG. 15.22)
HOWES UTILITY PLIERS (FIG. 15.23)
LIGATURE DIRECTOR (PITCHFORK INSTRUMENT, TIE IN TUCKER) (FIG. 15.24)
LIGHT-WIRE PLIERS (FIG. 15.25)
MATHIEU-STYLE LIGATURE-TYING PLIERS (FIG. 15.26)
PARALLEL-ACTION PLIERS WITH CUTTER (SARGENT'S HEAVY-DUTY PLIERS) (FIG. 15.27)
PIN AND LIGATURE WIRE CUTTER (FIG. 15.28)
SERRATED BAND PLUGGER (SERRATED AMALGAM PLUGGER) (FIG. 15.29)
STEINER LIGATURE-TYING PLIERS (FIG. 15.30)
TORQUING KEY (FIG. 15.31)
TRIPLE-BEAKED PLIERS (THREE PRONG PLIERS, THREE JAW PLIERS, CLASP-ADJUSTING PLIERS) (FIG. 15.32)
TURRET (FIG. 15.33)
TWEED ARCH-ADJUSTING (NO. 142) PLIERS (FIG. 15.34)
TWEED LOOP-FORMING PLIERS (OMEGA PLIERS, OPTICAL PLIERS) (FIG. 15.35)
WEINGART UTILITY PLIERS (FIG. 15.36)
Bibliography
INDEX
TOC
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