Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
The Dental VTO: An Analysis ofThe Dental VTO: An Analysis of
Orthodontic Tooth MovementOrthodontic Tooth Movement
RICHARD ...
Most cephalometric analyses measure
Maxillary and mandibular skeletal
relationships in the vertical and horizontal
planes,...
But when were are rendering treatment to theBut when were are rendering treatment to the
patient we are more bothered abou...
• We must remember that we as orthodontist notWe must remember that we as orthodontist not
only correct jaw bases are also...
Few orthodontic analyses, however, provideFew orthodontic analyses, however, provide
information about the direction and a...
The dental analysis presented in this articleThe dental analysis presented in this article
——in effect, a dental Visualize...
Progress can be checked by referring to the
dental VTO at the patient’s regular adjustment
appointments.
www.indiandentala...
Without this information,the orthodontist
can lose sight of the anchorage
requirements of a case and thus
underestimate th...
Method
www.indiandentalacademy.com
The dental VTO consists of three charts:
Chart 1 records the initial midline and first
molar positions with the mandible i...
www.indiandentalacademy.com
www.indiandentalacademy.com
Chart 2 measures the lower arch discrepancy.
The four primary factors in each case are:
1. Space required for relief of cr...
3. Space required for leveling the curve of Spee,
measured as the deepest point on a line
extending from the distal cusps ...
Four secondary factors that can sometimes
provide additional space are listed, if applicable,
below the primary chart:
1. ...
3. Additional space from buccal uprighting of
mandibular canines and posterior teeth.
4. Additional leeway or “E” space.
w...
According to Moorrees, the leeway space,
or the difference in size between the deciduous
canines, first molars, and second...
E space, or the difference
in size between the
primary second molar and
the permanent second
premolar, is an average of
2....
www.indiandentalacademy.com
www.indiandentalacademy.com
Chart 3 records the anticipated treatment change in terms
of dental movements of the first molars, canines, and
midline.
w...
According to the authors There are four possibleAccording to the authors There are four possible
methods of Class II molar...
c.c. Limiting forward maxillary skeletalLimiting forward maxillary skeletal
development, or retracting the maxilladevelopm...
d.d. Forward mandibular rotation.Forward mandibular rotation. This can occur in twoThis can occur in two
ways:ways:
1)1) M...
2)2) Limiting vertical maxillary development.Limiting vertical maxillary development.
difficult to significantly influence...
If favorable mandibular growth occurred in any ofIf favorable mandibular growth occurred in any of
the ways listed above, ...
www.indiandentalacademy.com
• 12-year-old male
•ClassII skeletal pattern
•slightly high angle
•slightly long lower
•facial height.
www.indiandentalaca...
www.indiandentalacademy.com
The mandibular arch showed
3mm of crowding on the right
side, all mesial to the right
canine.
On the left side, there was ...
The curve of Spee was about
2mm at its deepest point.
Leveling a 2mm curve of
Spee would advance the
incisors 1mm, thus re...
The mandibular incisors were inclinedThe mandibular incisors were inclined
forward (97° to the mandibular plane)forward (9...
The space-gaining procedures of interproximalThe space-gaining procedures of interproximal
reduction, molar uprighting, an...
www.indiandentalacademy.com
Anticipated treatment changesAnticipated treatment changes
were recorded in Chart 3 using thewere recorded in Chart 3 usin...
.Because the total lower.Because the total lower
arch discrepancyarch discrepancy
from canine to midline wasfrom canine to...
The mandibular midlineThe mandibular midline
needed to be movedneeded to be moved
1mm to the right, as1mm to the right, as...
3. The mandibular molars could3. The mandibular molars could
therefore only be moved 2mm totherefore only be moved 2mm to
...
the molar relationship on the rightthe molar relationship on the right
side was 4mm Class II, and sinceside was 4mm Class ...
A palatal bar and a combination high-pullA palatal bar and a combination high-pull
and cervical-pull headgear were used to...
A functional appliance could also haveA functional appliance could also have
been considered before fixed appliance therap...
2mm distal movement2mm distal movement
of the maxillary rightof the maxillary right
molar and the 1.5mmmolar and the 1.5mm...
•A female patient age 8A female patient age 8
years and 4 monthsyears and 4 months
• Class II skeletal patternClass II ske...
The patient’s molarThe patient’s molar
relationship was 4.5mmrelationship was 4.5mm
Class II on the rightClass II on the r...
The mandibular arch showed 2.5mmThe mandibular arch showed 2.5mm
of crowding from the canines to theof crowding from the c...
Mandibular incisors were 4mmMandibular incisors were 4mm
behind the APog line and at 87° to thebehind the APog line and at...
Adding all these factorsAdding all these factors
together, there was a totaltogether, there was a total
lower arch discrep...
The mandibular canines couldThe mandibular canines could
advanced 1mm per side, and theadvanced 1mm per side, and the
mola...
ConclusionConclusion
This simple analysis to be most helpful as a diagnosticThis simple analysis to be most helpful as a d...
www.indiandentalacademy.com
Upcoming SlideShare
Loading in …5
×

Dental VTO


The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com

  • Be the first to comment

Dental VTO

  1. 1. The Dental VTO: An Analysis ofThe Dental VTO: An Analysis of Orthodontic Tooth MovementOrthodontic Tooth Movement RICHARD P. McLAUGHLIN, DDSRICHARD P. McLAUGHLIN, DDS JOHN C. BENNETT, LDS, DOrthJOHN C. BENNETT, LDS, DOrth www.indiandentalacademy.com
  2. 2. Most cephalometric analyses measure Maxillary and mandibular skeletal relationships in the vertical and horizontal planes, along with the position and angulation of the incisors www.indiandentalacademy.com
  3. 3. But when were are rendering treatment to theBut when were are rendering treatment to the patient we are more bothered about the amountpatient we are more bothered about the amount and and direction of growth of the skeletal basesand and direction of growth of the skeletal bases that we are altering .that we are altering . www.indiandentalacademy.com
  4. 4. • We must remember that we as orthodontist notWe must remember that we as orthodontist not only correct jaw bases are also mainly involvedonly correct jaw bases are also mainly involved in the movment and correction ot the invidualin the movment and correction ot the invidual teeth.teeth. • For seketal correction we usually make a detailedFor seketal correction we usually make a detailed plan about the direction and amount of ofplan about the direction and amount of of growth to be madegrowth to be made www.indiandentalacademy.com
  5. 5. Few orthodontic analyses, however, provideFew orthodontic analyses, however, provide information about the direction and amount ofinformation about the direction and amount of dental movements required during treatmentdental movements required during treatment within the maxillary and mandibular archeswithin the maxillary and mandibular arches www.indiandentalacademy.com
  6. 6. The dental analysis presented in this articleThe dental analysis presented in this article ——in effect, a dental Visualized Treatmentin effect, a dental Visualized Treatment Objective—was designed to provide organizedObjective—was designed to provide organized and simplified information to help in diagnosis,and simplified information to help in diagnosis, treatment planning, and the extraction/nonextractiontreatment planning, and the extraction/nonextraction decision. It should be used as an adjunctdecision. It should be used as an adjunct to, but not a substitute for, conventional cephalometricto, but not a substitute for, conventional cephalometric analyses.analyses. www.indiandentalacademy.com
  7. 7. Progress can be checked by referring to the dental VTO at the patient’s regular adjustment appointments. www.indiandentalacademy.com
  8. 8. Without this information,the orthodontist can lose sight of the anchorage requirements of a case and thus underestimate the amount of patient cooperation and anchorage needed to reach treatment objectives. www.indiandentalacademy.com
  9. 9. Method www.indiandentalacademy.com
  10. 10. The dental VTO consists of three charts: Chart 1 records the initial midline and first molar positions with the mandible in centric relation. Chart 2 measures the lower arch discrepancy, Chart 3 records the anticipated treatment change in terms of dental movements of the first molars, canines, and midlineswww.indiandentalacademy.com
  11. 11. www.indiandentalacademy.com
  12. 12. www.indiandentalacademy.com
  13. 13. Chart 2 measures the lower arch discrepancy. The four primary factors in each case are: 1. Space required for relief of crowding, measured from canine to midline and from first molar to midline on each side. 2. Space required for the desired correction of protrusion or retrusion of the mandibular incisors. www.indiandentalacademy.com
  14. 14. 3. Space required for leveling the curve of Spee, measured as the deepest point on a line extending from the distal cusps of the second molars to the incisal edges of the central incisors on each side; this point is normally found in the premolar region . 4. Space required for midline correction. www.indiandentalacademy.com
  15. 15. Four secondary factors that can sometimes provide additional space are listed, if applicable, below the primary chart: 1. Additional space from interproximal enamel reduction. 2. Additional space from uprighting or distal movement of mandibular first molars. www.indiandentalacademy.com
  16. 16. 3. Additional space from buccal uprighting of mandibular canines and posterior teeth. 4. Additional leeway or “E” space. www.indiandentalacademy.com
  17. 17. According to Moorrees, the leeway space, or the difference in size between the deciduous canines, first molars, and second molars and the permanent canines, first premolars, and second premolars, is an average of 1.5mm per side in the mandibular arch and 0.9mm per side in the maxillary arch. www.indiandentalacademy.com
  18. 18. E space, or the difference in size between the primary second molar and the permanent second premolar, is an average of 2.5mm per side in the mandibular arch and 2.3mm per side in the maxillary arch . www.indiandentalacademy.com
  19. 19. www.indiandentalacademy.com
  20. 20. www.indiandentalacademy.com
  21. 21. Chart 3 records the anticipated treatment change in terms of dental movements of the first molars, canines, and midline. www.indiandentalacademy.com
  22. 22. According to the authors There are four possibleAccording to the authors There are four possible methods of Class II molar correction in themethods of Class II molar correction in the growing patient:growing patient: a.a. Mesial movement of the mandibular firstMesial movement of the mandibular first molars .molars . b.b. Distal movement of the maxillary firstDistal movement of the maxillary first molars.molars. This is difficult in the presence ofThis is difficult in the presence of developing maxillary second and third molars, butdeveloping maxillary second and third molars, but it can be achievedit can be achieved.. www.indiandentalacademy.com
  23. 23. c.c. Limiting forward maxillary skeletalLimiting forward maxillary skeletal development, or retracting the maxilladevelopment, or retracting the maxilla.. Because such changes are difficult to isolate, it isBecause such changes are difficult to isolate, it is debatable how much is skeletal (above the palataldebatable how much is skeletal (above the palatal plane) and how much is dentoalveolar (belowplane) and how much is dentoalveolar (below thepalatal plane).thepalatal plane). Nasion normally grows forward about 1mm a yearNasion normally grows forward about 1mm a year relative to sella, while A point may be maintained orrelative to sella, while A point may be maintained or retracted relative to its original position.retracted relative to its original position. www.indiandentalacademy.com
  24. 24. d.d. Forward mandibular rotation.Forward mandibular rotation. This can occur in twoThis can occur in two ways:ways: 1)1) Mandibular growth. The direction of overall facialMandibular growth. The direction of overall facial growth is critical to the “expression” of mandibulargrowth is critical to the “expression” of mandibular growth.growth. With more vertical patterns, there is less forwardWith more vertical patterns, there is less forward expression of mandibular growth and hence lessexpression of mandibular growth and hence less interarch dental change.interarch dental change. With less vertical facial growth, mandibular growth isWith less vertical facial growth, mandibular growth is expressed in a more forward direction, resulting inexpressed in a more forward direction, resulting in greater interarch dental change.greater interarch dental change. www.indiandentalacademy.com
  25. 25. 2)2) Limiting vertical maxillary development.Limiting vertical maxillary development. difficult to significantly influence the normaldifficult to significantly influence the normal vertical development of the facial complex.vertical development of the facial complex. As with forward maxillary development, verticalAs with forward maxillary development, vertical development is hard to measure in isolation anddevelopment is hard to measure in isolation and therefore hard to categorize as skeletal ortherefore hard to categorize as skeletal or dentoalveolar. Nevertheless, even a smalldentoalveolar. Nevertheless, even a small limitation can greatly enhance a Class IIlimitation can greatly enhance a Class II correction.correction. www.indiandentalacademy.com
  26. 26. If favorable mandibular growth occurred in any ofIf favorable mandibular growth occurred in any of the ways listed above, maxillary anchorage controlthe ways listed above, maxillary anchorage control could be reduced or eliminated, allowing thecould be reduced or eliminated, allowing the maxillary molars to move more mesially.maxillary molars to move more mesially. www.indiandentalacademy.com
  27. 27. www.indiandentalacademy.com
  28. 28. • 12-year-old male •ClassII skeletal pattern •slightly high angle •slightly long lower •facial height. www.indiandentalacademy.com
  29. 29. www.indiandentalacademy.com
  30. 30. The mandibular arch showed 3mm of crowding on the right side, all mesial to the right canine. On the left side, there was only 1mm of crowding, also between the canine and the midline. www.indiandentalacademy.com
  31. 31. The curve of Spee was about 2mm at its deepest point. Leveling a 2mm curve of Spee would advance the incisors 1mm, thus requiring 1mm of space per side for the leveling process. The lower midline was deviated 1mm to the right, the midline correction would require 1mm of space on the left side and provide 1mm of space on the right.www.indiandentalacademy.com
  32. 32. The mandibular incisors were inclinedThe mandibular incisors were inclined forward (97° to the mandibular plane)forward (97° to the mandibular plane) and were 6mm in front of the APoand were 6mm in front of the APo line.line. Without extractions, the incisorsWithout extractions, the incisors would either remain in this position or,would either remain in this position or, more likely, be advanced farther.more likely, be advanced farther. With extractions, the incisors could beWith extractions, the incisors could be retracted.retracted. Therefore, the decision was made toTherefore, the decision was made to extract the four first premolars andextract the four first premolars and retract the mandibular incisors 2mm.retract the mandibular incisors 2mm. www.indiandentalacademy.com
  33. 33. The space-gaining procedures of interproximalThe space-gaining procedures of interproximal reduction, molar uprighting, and buccalreduction, molar uprighting, and buccal uprighting of posterior teeth were not needed inuprighting of posterior teeth were not needed in this case and were therefore not recorded inthis case and were therefore not recorded in Chart 2.Chart 2. There was no leeway or “E” space available, sinceThere was no leeway or “E” space available, since no primary teeth were present.no primary teeth were present. www.indiandentalacademy.com
  34. 34. www.indiandentalacademy.com
  35. 35. Anticipated treatment changesAnticipated treatment changes were recorded in Chart 3 using thewere recorded in Chart 3 using the following process:following process: 1. Extraction of the four first1. Extraction of the four first premolars produced 7mm ofpremolars produced 7mm of space in each quadrant, sincespace in each quadrant, since there was no crowding betweenthere was no crowding between the canines and first molars inthe canines and first molars in either arch. This was indicated byeither arch. This was indicated by writing “(7)” in each quadrant.writing “(7)” in each quadrant. www.indiandentalacademy.com
  36. 36. .Because the total lower.Because the total lower arch discrepancyarch discrepancy from canine to midline wasfrom canine to midline was 5mm per side, the5mm per side, the mandibular canines neededmandibular canines needed to be retracted 5mmto be retracted 5mm into the extraction sites.into the extraction sites. This was recorded on theThis was recorded on the bottom of the chart, withbottom of the chart, with arrows showing thearrows showing the direction of movement.direction of movement. www.indiandentalacademy.com
  37. 37. The mandibular midlineThe mandibular midline needed to be movedneeded to be moved 1mm to the right, as1mm to the right, as shown by the arrow onshown by the arrow on the bottom of the chart.the bottom of the chart. www.indiandentalacademy.com
  38. 38. 3. The mandibular molars could3. The mandibular molars could therefore only be moved 2mm totherefore only be moved 2mm to close the remainder of theclose the remainder of the 7mm extraction spaces—also7mm extraction spaces—also indicated withindicated with arrows on the bottom of thearrows on the bottom of the chart.chart. This demonstratedThis demonstrated a need for moderate anchoragea need for moderate anchorage control in the mandibular archcontrol in the mandibular arch A mandibular lingual arch,A mandibular lingual arch, for example, could be consideredfor example, could be considered during the first 3mm of canineduring the first 3mm of canine retraction.retraction. www.indiandentalacademy.com
  39. 39. the molar relationship on the rightthe molar relationship on the right side was 4mm Class II, and sinceside was 4mm Class II, and since 2mm could be corrected by mesial2mm could be corrected by mesial movement of the mandibular molar,movement of the mandibular molar, an additional 2mm of correctionan additional 2mm of correction was required.was required. On the left side, an additional 1.5mmOn the left side, an additional 1.5mm of correction was needed.of correction was needed. These amounts were recorded onThese amounts were recorded on the top of Chart 3 with distal arrows.the top of Chart 3 with distal arrows. www.indiandentalacademy.com
  40. 40. A palatal bar and a combination high-pullA palatal bar and a combination high-pull and cervical-pull headgear were used to preserveand cervical-pull headgear were used to preserve maxillary anchorage in this case.maxillary anchorage in this case. www.indiandentalacademy.com
  41. 41. A functional appliance could also haveA functional appliance could also have been considered before fixed appliance therapy.been considered before fixed appliance therapy. A good response to the functional applianceA good response to the functional appliance might have reduced the amount of maxillarymight have reduced the amount of maxillary anchorage support needed later. Extractionsanchorage support needed later. Extractions would still have been required after the functionalwould still have been required after the functional phase, assuming incisor retraction was still aphase, assuming incisor retraction was still a treatment objective.treatment objective. www.indiandentalacademy.com
  42. 42. 2mm distal movement2mm distal movement of the maxillary rightof the maxillary right molar and the 1.5mmmolar and the 1.5mm distal movement of thedistal movement of the maxillary left molarmaxillary left molar , the canines would have, the canines would have to be moved 9mm on theto be moved 9mm on the right andright and 8.5mm on the left to close8.5mm on the left to close the extraction spaces.the extraction spaces. www.indiandentalacademy.com
  43. 43. •A female patient age 8A female patient age 8 years and 4 monthsyears and 4 months • Class II skeletal patternClass II skeletal pattern •a low-angle patient witha low-angle patient with a normal lower faciala normal lower facial height.height. •no crossbites,no crossbites, www.indiandentalacademy.com
  44. 44. The patient’s molarThe patient’s molar relationship was 4.5mmrelationship was 4.5mm Class II on the rightClass II on the right side and 2.5mm Classside and 2.5mm Class II on the left (Chart 1).II on the left (Chart 1). The dental midlinesThe dental midlines were properly alignedwere properly aligned www.indiandentalacademy.com
  45. 45. The mandibular arch showed 2.5mmThe mandibular arch showed 2.5mm of crowding from the canines to theof crowding from the canines to the midline on each side .midline on each side . The leeway space in the mandibularThe leeway space in the mandibular arch, due to the presence of thearch, due to the presence of the primary canines and the first andprimary canines and the first and second molars, was 1.5mm per side.second molars, was 1.5mm per side. The loss of these teeth wouldThe loss of these teeth would leave a total of only 1mm of crowdingleave a total of only 1mm of crowding per side in the mandibular arch.per side in the mandibular arch. www.indiandentalacademy.com
  46. 46. Mandibular incisors were 4mmMandibular incisors were 4mm behind the APog line and at 87° to thebehind the APog line and at 87° to the mandibular plane, the decision wasmandibular plane, the decision was made to advance them 4mm, providingmade to advance them 4mm, providing 4mm of space per side.4mm of space per side. The curve of Spee was about 1mmThe curve of Spee was about 1mm deep bilaterally, requiring 0.5mm ofdeep bilaterally, requiring 0.5mm of space per side for leveling.space per side for leveling. No midline correction was needed.No midline correction was needed. www.indiandentalacademy.com
  47. 47. Adding all these factorsAdding all these factors together, there was a totaltogether, there was a total lower arch discrepancy oflower arch discrepancy of +1mm per side from+1mm per side from canine to midline andcanine to midline and +2.5mm per side from first+2.5mm per side from first molar to midline.molar to midline. www.indiandentalacademy.com
  48. 48. The mandibular canines couldThe mandibular canines could advanced 1mm per side, and theadvanced 1mm per side, and the molars could bea dvanced 2.5mmmolars could bea dvanced 2.5mm per side (Chart 3).per side (Chart 3). Thus, 2.5mm of the 4.5mm ClassThus, 2.5mm of the 4.5mm Class II correction on the right sideII correction on the right side could be achieved by mesialcould be achieved by mesial movement of the mandibular firstmovement of the mandibular first molar. The remaing space bymolar. The remaing space by other methodsother methods On the left side, the entire 2.5mmOn the left side, the entire 2.5mm Class II correction could byClass II correction could by achieved by moving theachieved by moving the mandibular first molar forward.mandibular first molar forward. www.indiandentalacademy.com
  49. 49. ConclusionConclusion This simple analysis to be most helpful as a diagnosticThis simple analysis to be most helpful as a diagnostic and treatment-planning aid and as a reference throughoutand treatment-planning aid and as a reference throughout treatment.treatment. It is also useful in making the extraction/nonextractionIt is also useful in making the extraction/nonextraction decision.decision. It can even been applied in some mutilated-dentitionIt can even been applied in some mutilated-dentition cases, and in patients where second molars werecases, and in patients where second molars were substituted for first molars, or premolars for canines.substituted for first molars, or premolars for canines. www.indiandentalacademy.com
  50. 50. www.indiandentalacademy.com

×