Ortho Techniques

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emm64
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223271
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Ortho Techniques
Updated:
2013-06-10 17:50:06
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ortho
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ortho final
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  1. AP problems
    • skeletal hypo/hyper
    • molar class
    • canin class
    • incisor positions
  2. Tranverse problems
    • Occlusal Plane
    • arch width
    • midline
    • posterior crossbite
    • Curver of Wilson
    • Buccal corridor
  3. Vertical
    • incisal display (smile/rest/gingiva)
    • interlabial gap
    • overbite
    • posterior open bite
    • curve of spee
    • mentalis strain
    • lower face height
  4. AP external
    • profile (slightly convex
    • NasioLabial angle (90-95)
    • LabioMental angle
    • Lip Position (UL 2mm behind E plane, LL on E plane)
    • Labiomental angle (110)
    • Chin-Throat Angle (close to 90)
    • Chin-Throat Length (51-60mm)
    • Mandibular Position(Pogonion forward to perpendicular)
    • Maxillary Position (Subnasale in line with perpendicular
  5. Normal lip position
    • UL 2mm behind E plane
    • LL on E plane
    • E plane: tip of nose to pogonium
  6. Tranverse external
    • Symmetry (glabella, subnasale, pogonium in line, equal 5ths)
    • occlusal cant
    • dental midlines
    • buccal corridor (transverse smile vs. upper arch)
    • incisal display
  7. Vertical external
    • 1/3rds
    • lower facial height
    • facial pattern (brachy, meso, dolicho)
  8. Dolichofacial
    high angle, long face
  9. Intraoral AP
    • dental class (class I U1MB=L1BG, canine cusp=embrasure of mand canine 1stPM, class II=mesial, class III=distal)
    • Overjet
    • anterior crossbite
  10. Intraoral Transverse
    • occlusal plane cant
    • arch width
    • Basal Bone discrepancy
    • arch symmetry
    • posterior crossbite
    • curve of wilson
  11. brodie bite
    entire max arch outside mandible
  12. Mild Molar classifications
    • mesial: end on class II
    • distal: super Class I
  13. Class II div 1 (dental)
    proclined centrals
  14. Class II div 2 (dental)
    retroclined centrals, proclined laterals
  15. deep curve of wilson
    lower molars inclined lingually
  16. Intraoral Vertical
    • Overbite (1-2mm)
    • posterior open bite
  17. Intraoral Alignment
    archlength discrepency (arch(5-5)-tooth widths = + spacing, -crowding)
  18. Leeway (E) space
    • primary molars wider than premolars
    • mx: 1.5/quadrant
    • mn: 2.5/quadrant
  19. Incisor liability
    permanent incisors wider than primary
  20. Moyers mixed dentition analysis
    • predicts 345 width based on MANDIBULAR INCISORS (2112)
    • note 4 incisors but measure 345 of one quadrant
  21. Bolton Discrepancy
    ideal occlusion must be correct ratio of Max to Mandibular Mesio-Distal tooth widths
  22. Bolton Analysis
    • use chart to compare max MD to mand MD
    • OVERALL: Distal 1st to Distal 1st (Max x axis (top of chart), Mand (left y-axis)
    • ANTERIOR: Distal Canine to Distal canine
    • Positive bolton = more overall discrepancy than anterior discrepancy
  23. Bolton vs ALD
    • Bolton relates max and mandible
    • ALD: single arch
    • Bolton may result in ALD, abnormal OB, OJ, class II or III
    • ALD discrepancy = spacing, crowding
  24. Why do kids have ugly duckling diastema?
    canines didn't erupt
  25. Canine impaction frequency
    more mx, palatal
  26. most complicated ankylosed teeth?
    primary molars (E's)
  27. Porion (Po)
    •  The most superior point of external auditory meatus
  28. Orbitale (Or)
  29. The lowest point on the inferior rim of the orbit
  30. Sella (S)
    •  Point in center of sella turcica
  31. Nasion (N)
    •  Point at junction of frontal and nasal bones
  32. A point (A)
    •  Innermost point on Mx between ANS and incisor
  33. B point (B)
    •  Innermost point on Md between incisor and chin
  34. Pogonion (Pog)
    •  Anteriormost point of chin
  35. Gnathion (Gn)
    •  Constructed point midway between Po and Me
  36. Gonion (Go)
    •  Constructed point on line bisecting angle formed by posterior ramus and Md plane
  37. Frankfort horizontal
    Porion to Orbitale line used for reference
  38. Steiner Skeletal
    • Facial type
    • •  OP - SN (dg)
    • •  GoGn - SN (dg)
    • Skeletal pattern
    • •  ANB (dg)
    • Maxilla
    • •  SNA (dg)
    • Mandible
    • •  SNB (dg)
    • •  Pog - NB (mm)- [Chin]
  39. Steiner Dental
    • Upper incisor
    • •  U1 – NA (mm)
    • •  U1 – NA (dg)
    • Lower incisor
    • •  L1 – NB (mm)
    • •  L1 – NB (dg)
    • Interincisal angle (dg)
  40. Maxillary Protrusion (steiner)
    large SNA (>84)
  41. Mandibular Protrusion
    large SNB (>82)
  42. ANB (Steiner)
    • Skeletal Class II >2
    • Skeletal III < 2
  43. Pog-NB (Steiner)
    Chin protrusion/prominence > 4mm
  44. Occlusal plane (steiner)
    • upper incisor tip to occlusal surface of of 1st extended vs. SN
    • steep if > 14
  45. Mandibular Plane Angle (steiner)
    • Gonion to Pogion vs. SN
    • steep: Dolichofacial > 32
    • shallow: Brachyfacial < 32
  46. Incisor A-P position
    • front surface of incisor vs. NA line (U1-NA) or (L1-NB)
    • Distance not angulation
    • Retruded: less than 4 mm
  47. Incisor Angulation
    • U1 (long axis) vs. NA line
    • retroclined <22
    • L1 vs NB
    • retroclined < 25
  48. Interincisor angle
    • longaxis of U1 vs L1
    • upright greater than normal
    • divergent less than normal (130 degrees)
  49. Steiner example w diagnoses
    • SNA (dg) 82 82 Normal maxilla
    • SNB (dg) 71 80 Retrognathic Mandible
    • ANB (dg) 11 2 Skeletal Class II
    • U1 – NA (mm) 1 4 Retruded U1
    • U1 – NA (dg) 15 22 Retroclined U1
    • L1 – NB (mm) 12 4 Protruded L1
    • L1 – NB (dg) 35 25 Proclined L1
    • Pog – NB (mm) 1 4 Retruded chin
    • OP – SN (dg) 24 14 Steep OP
    • GoGn – SN (dg) 38 32 Dolichofacial
    • Interincisal angle 120 130 Divergent incisors
  50. What problem is always a priority?
    pathology
  51. What is the growth modification order?
    • Maxilla then mandible (males later too)
    • Transverse, AP, Vertical
  52. Growth modification goal: maximize ___ and minimize ___
    maximize skeletal while minimize dental
  53. How? Why? encourage maxillary growth
    • protraction facemask
    • treat class III
  54. Class II elastics
    U3 to L6 to distalze maxillary teeth
  55. Class III elastics
    U6 to L3, mesialization of max, distalization of mand
  56. removable limitations
    • can only tip teeth
    • mild ortho problems
    • compliance
  57. non-extraction space creation
    • distalize molars
    • procline incisors
    • expand palate
    • interproximal reduction
  58. Proffit's extraction guidelines
    • <4mm ALD rare only for severe protrusion or vertical only
    • 5-9mm depends on HT and ST charateristics
    • >10mm almost always required
  59. major indications for extractions
    • dolichofacial
    • proclined incisors
    • protruded lips
    • severe crowding
    • minor:
    • curve of spee, molar, dental anomalies
  60. surgical correction indications
    • severe SKELETAL
    • adult
    • good health
  61. camouflage tx
    • orthodontic hide orthopedic non-growers
    • Class II: U4 extraction or L incisor proclination
    • Class III: L4 extraction or U incisor proclination
    • economical, non-surgical
    • compromised incisor angulation, not much facial improvement
  62. separators for banding are left on how long?
    1-2 weeks
  63. brackets are preadjusted for ____
    • tip and torque
    • tip: mesial/distal angulation
    • torque: buccal/lingual
  64. dots on bracket are where?
    distal, gingival
  65. bracket positioning elements
    • base adaptation
    • rotational
    • vertical
    • slot angulation
  66. canine and premolar brackets should be aligned?
    in line w/ labial cusp tips
  67. molar brackets aligned with:
    buccal groove
  68. vertical bracket alignment posteriors:
    equidistant marginal ridges
  69. Upper incisor brackets should be positioned in such a way that they can:
    establish proper gingival and incisal edge relationships
  70. Position the lower incisor brackets at equal distances from the incisal edges and ____than the neighboring canines
    slightly more incisal
  71. Slot angulation
    • wire slot perpendicular to long axis
    • parallel to occlusal surface
  72. bracket position exceptions
    • max lateral incisors (.5mm closer to incisal)
    • mandibular canines (gingivally placed to extrude)
  73. NiTi
    • •  Has shape memory
    • •  Extremely flexible = Superelastic
    • •  Provides low sustained force
    • •  Lacks formability (unless heated first)
  74. Thermoelastic NiTi
    • •  aka Copper NiTi
    • •  At cold temperatures: Can be deformed very easily.
    • •  At higher temperatures: Return to its pre-determined shape
  75. SS wires used:
    • after level and aligning is complete
    • rigidity to maintain the arch mvmt
  76. Stainless steel has lower friction than NiTi.
    True
  77. Stages of fixed ortho
    • •  Stage 1: level and align
    • allow a straight arch wire to be engaged in ideally positioned brackets
    • Loosens the PDL to facilitate tooth movement
    • Levelling: correct vertical, level Spee and marginal ridges
    • •  Stage 2: active tooth movement
    • •  Stage 3: finishing and detailing
  78. Deep bite commonly associated with
    excess curve of Spee
  79. Open bite commonly has ___ curve of spee
    Reverse
  80. levelling tends to ___ the bite
    • open
    • (extrusion easy, intrusion hard)
  81. Stage II objectives
    • •  Molar correction
    • •  Overbite correction
    • •  Overjet correction
    • •  Space opening
    • •  Space closure & canine correction
    • •  Stage II takes longest to complete
    • •  Requires a thorough understanding of biomechanics
  82. Stage II Methods of molar correction
    • •  Differential growth of maxilla and mandible
    • •  Molar distalization
    • •  Differential AP tooth movement - using extraction spaces
    • •  Interarch elastics
  83. MOLAR CORRECTION Differential AP tooth movement (full cusp cl II)
    Extraction of upper 4’s and lower 5’s
  84. MOLAR CORRECTION •  Differential AP tooth movement (super cl I)
    Extraction of upper 5’s and lower 4’s
  85. MOLAR CORRECTION
    • •  Differential AP tooth movement (full cusp cl II)
    • Extraction of upper 4’s
  86. STAGE III:
    • FINISHING AND DETAILING
    • •  Stage III objectives
    • •  Parallel roots
    • •  Finalize tooth position
    • •  Correct Bolton discrepancies
  87. most common relapse
    lower anterior crowding
  88. PERIODONTAL REORGANIZATION
    • • PDL: 4 months after treatment
    • • Gingival fibers: 12 months after treatment
    • • Alveolar bone: 2~3 years
  89. Retention timing
    • All patients who had fixed orthodontic appliances to
    • correct intra-arch irregularities
    • • Full time for the first 3-4 months
    • • Exception: while eating
    • • Unless periodontal bone loss or other special circumstances require permanent
    • splinting
    • • Part time for at least 12 months
    • • To allow time for remodeling of gingival tissues
    • • If significant growth remains, continued part-time until the completion of growth

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