Orthodontics an overview

ORTHODONTICS- -AN OVERVIEW
www.indiandentalacademy.comwww.indiandentalacademy.com

Small minds discuss people
Big minds discuss events
Great minds discuss ideas
Extraordinary minds act in silence

CLASS

Sardar was writing something very slowly.

Friend asked:" Why r u writing so slowly?

Sardar: "I'm writing to my 6 yr old son, he
can't read very fast.

What is Orthodontics?
1911, In Noyes defined orthodontics
as”the study of the relation of the teeth to
the development of the face ,and the
correction of arrested and perverted
development.
www.indiandentalacademy.com

In 1922 British society ofIn 1922 British society of orthodontics orthodontics
proposed that”orthodontics includes the proposed that”orthodontics includes the
study of growth & development of the jaws study of growth & development of the jaws
and face particularly ,and the body and face particularly ,and the body
generally,as influencing the position of the generally,as influencing the position of the
teeth;the study of action and reaction of teeth;the study of action and reaction of
internal and external influences on the internal and external influences on the
development,and the prevention and development,and the prevention and
correction of arrested and perverted correction of arrested and perverted
development.”development.”

Orthodontics-Defined by -AAOOrthodontics-Defined by -AAO
• Area of dentistry concerned with the
supervision,guidance and correction of the growing
and mature Dentofacial structures,including those
conditions that require movement of teeth or
correction of malrelationships and malformations of
related structures,by the adjustment of relationships
between and among teeth and facial bones by the
application of forces and /or the stimulation and
redirection of the functional forces within the
craniofacial complex.

PIONEERS IN ORTHODONTICS

A man:
"Sardarji, tell me,
why Manmohan
Singh goes for a walk
in the evening not in
the morning?"
Sardarji:
''Arey bhai
Manmohan is PM not
AM''.

Norman. W.Kingsley
Bust of CHRISTSelf-Portrait

KINGSLEY SERVED AS DEAN OF THE SCHOOL
OF DENTISTRY AT NEWYORK UNIVERSITY
FATHER OF ORTHODONTICS

Edward Hartley Angle
Father of Modern Orthodontics

Edward Hartley Angle-(1855-1930)
Father of modern Orthodontics-Born on 1st
june
1855,in Herrick,Pennsylvania.
In 1900 in-St.Louis-started his first school of
orthodontics.
American society of orthodontists was founded
in 1901-under angles leadership.
Introduced-most universally used classification
of malocclusion.
Developed a number of appliances-
‘E’arch,Pin & tube, Ribbon arch (bracket
refurbished & revamped & now it is an integral
part of begg technique).

Sardar found the answer
to the most difficult
question ever –
What will come first,
Chicken or egg?
O Yaar, what ever U
order first, will come
first.

SO WHY DO PEOPLE
SEEK ORTHODONTIC
TREATMENT ??

Facial Appearance :-The most
important characteristic in
relation to self image and self
esteem
People Dissatisfied with Facial
appearance express more
dissatisfaction with teeth than
any other feature !!

Structural Balance
Functional Efficiency Aesthetic Harmony
AIMS OF ORTHODONTIC TREATMENT
JACKSON’S TRIAD

LIVING DANGEROUSLY

SIX KEYS OF NORMAL OCCLUSION
1.MOLAR INTER-ARCHRELATIONSHIP
2.MESIODISTAL CROWN ANGULATION
3.LABIOLINGUAL CROWN INCLINATION
4.ABSENCE OF ROTATION
5.TIGHT CONTACTS
6.CURVE OF SPEE

Smart student
During an examination this guy was
not able to answer the question so he
copied the answer from another good
student, The answer to the problem
was 'log(1+x)'.
But as he did not want to make it
obvious that he was cheating, so he
changed the answer slightly, to
'timber(1+x)'

WHY TO CLASSIFY?

REASONS FOR CLASSIFYING
TO GROUP CERTAIN MALOCCLUSIONS
TOGETHER WHICH MAY OR MAY NOT
HAVE THE SAME ETIOLOGY.
EASE OF REFERENCE, COMPARISON AND
COMMUNICATION.
THINKING OF THE POSSIBLE TREATMENT
MODALITIES THAT MAY BE NEEDED IN A
PARTICULAR CASE.

VARIOUS SYSTEMS OF CLASSIFICATION
ANGLE SYSTEM AND ITS MODIFICATIONS
SIMONS SYSTEM
AETIOLOGICAL CLASSIFICATION
BAUME CLASSIFICATION OF PRIMARY TEETH
ACKERMANN AND PROFITT CLASSIFICATION
BALLARDS CLASSIFICATION
WHO CLASSIFICATIONwww.indiandentalacademy.com

ANGLE SYSTEM
BY EDWARD HARTLEY
ANGLE
WAS CONSIDERED THE
FATHER OF MODERN
ORTHODONTICS
BASED ON THE ANTERO
POSTERIOR RELATIONSHIP
OF THE
JAWS WITH EACH OTHER
CONSIDERS MAXILLARY
FIRST PERMANENT MOLARwww.indiandentalacademy.com

CLASS II
DIVISION I
DIVISION II
TYPE A
TYPE B
TYPE C
CLASS III
TRUE
PSUEDO
CLASS II SUB DIV
CLASS III SUB DIV

Angle’s classification of
malocclusion
• It was given by Edward Angle in 1899
• Based on the mesio-distal relation of the
teeth, dental arches and jaws
• Maxillary 1st
permanent molar- key to
occlusion

Class I malocclusion
Class I molar relationship
Mesiobuccal cusp of the maxillary first
molar occludes in the buccal groove of
the mandibular 1st
permanent molar

INDIANS ON THE MOON

Class II div 2
• Class II molar relation
• Lingually inclined upper central incisors
• Labially tipped lateral incisors overlapping
the centrals
• Normal perioral muscle activity
• Abnormal backward path of closure

Class II subdivision
» Class II molar relation on one side and class I on
other

Class III MALOCCLUSION
CLASS III MOLAR RELATIONSHIP-
MESIOBUCCAL CUSP OF MAXILLARY FIRST
MOLAR OCCLUDES IN THE INTERDENTAL
SPACE BETWEEN THE DISTAL CUSP OF
MANDIBULAR FIRST MOLAR AND SECOND
MOLAR.
• CLASSIFIED INTO-
TRUE CLASS III
PSEUDO CLASS III

Class III MALOCCLUSION

TRUE CLASS III
• Class III molar relation
• LOWER INCISORS LINGUALLY
INCLINED
• LOWER TONGUE POSTURE- NARROW
UPPER ARCH

PSEUDO CLASS III
• CAUSED BY FORWARD MOVEMENT OF THE
MANDIBLE- POSTURAL OR HABITUAL
CLASS III
• CAUSES OF PSEUDO CLASS III:-
OCCLUSAL PREMATURITY
LOSS OF DECIDUOUS MOLARS
LARGE ADENOIDS

POPOYE
THE
DENTIST

FIND THE WORDS????

Cephalometrics is a technique
employing oriented radiographs
for the purpose of making head
measurements.
Purpose of CephalometricsPurpose of Cephalometrics
•Study craniofacial growthStudy craniofacial growth
•DiagnosisDiagnosis
•Planning orthodontic treatmentPlanning orthodontic treatment
•Evaluation of treated casesEvaluation of treated cases

Cephalometrics is a technique employing
oriented radiographs for the purpose of
making head measurements.
Purpose of Cephalometrics
• Study craniofacial growth
• Diagnosis
• Planning orthodontic treatment
• Evaluation of treated cases

15"15"60"60"
Source PlaneSource Plane
X-ray SourceX-ray Source
Patient in Head Positioning
Device
Patient in Head Positioning
Device
Mid-saggital PlaneMid-saggital Plane
Film PlaneFilm Plane
X-ray Film in
Cassette
X-ray Film in
Cassette
Cephalostat

Cephalostat

WHY_MEN_DIE_BEFORE_WOMEN

Sella
Porion
Gonion
PNS
Menton Gnathion
Pogonion
B Point
A Point
ANS
Orbitale
Nasion
Articulare
Standard Cephalometric
Landmarks

Radiographic Landmarks

SN Plane
Frankfort Plane
Palatal Plane
Occlusal Plane
Mandibular Plane
Frequently Used Planes

MASSAGING
POINTS FOR
GOOD HEALTH

Orthodontic
tooth movement
is not the only
type of tooth
movement.

EruptionEruption
ActiveActive
PassivePassive
Lateral driftsLateral drifts
PhysiologicalPhysiological
Due to loss of adjacent teethDue to loss of adjacent teeth
Orthodontic tooth movementOrthodontic tooth movement
Types of Tooth Movement

Types of Tooth Movement
IntrusionIntrusion
ExtrusionExtrusion
TippingTipping
TranslationTranslation
RotationRotation

Mechanisms of Tooth Movement
Piezoelectric theory.Piezoelectric theory.

Mechanisms of Tooth Movement
Pressure-tension theory.Pressure-tension theory.

The Optimal Force
““High enough to stimulate cellular activityHigh enough to stimulate cellular activity
without completely occluding blood vessels inwithout completely occluding blood vessels in
the PDL” (Proffit et al. 2000).the PDL” (Proffit et al. 2000).
Actively being investigated in a scientific fieldActively being investigated in a scientific field
known as mechanotransduction.known as mechanotransduction.

Orthodontic tooth movement cannot
occurunless cells are at work.

Force --- fluid flow --- cell-level strainForce --- fluid flow --- cell-level strain
Deformation of cell membrane leading to cytoskeletal changesDeformation of cell membrane leading to cytoskeletal changes
Second messenger pathwaysSecond messenger pathways
Gene upregulation in fibroblasts, osteoblasts and osteoclastsGene upregulation in fibroblasts, osteoblasts and osteoclasts

Effects of LIGHT forces on the
periodontium
Light, continuous forcesLight, continuous forces
OsteoOsteocclasts formedlasts formed
Removing lamina duraRemoving lamina dura
Tooth movement beginsTooth movement begins
This process is called “This process is called “FRONTAL RESORPTIONFRONTAL RESORPTION”.”.

““Frontal resorptionFrontal resorption” because it occurs” because it occurs
between the root and the lamina dura.between the root and the lamina dura.

Phase 1
Phase 3
Phase 2
Toothmovement(mm)
Time (Arbitrary Unit)
LIGHT forces leading to FRONTAL RESORPTION
Phase 1 – Mechanical compression and tension of the periodontiumPhase 1 – Mechanical compression and tension of the periodontium
Phase 2 --- Mechanically induced cellular and genetic responses; no toothPhase 2 --- Mechanically induced cellular and genetic responses; no tooth
movementmovement
Phase 3 --- Accelerated tooth movement due toPhase 3 --- Accelerated tooth movement due to frontalfrontal bone resorptionbone resorption

Effects of HEAVY forces on the
periodontium
Heavy, continuous forcesHeavy, continuous forces
Blood supply to PDL occludedBlood supply to PDL occluded
Aseptic necrosisAseptic necrosis
PDL becomes “hyalinized” – “PDL becomes “hyalinized” – “HYALINIZATIONHYALINIZATION””
This process is called “This process is called “UNDERMININGUNDERMINING
RESORPTIONRESORPTION”.”.

““Undermining resorptionUndermining resorption” because it occurs on the underside of” because it occurs on the underside of
lamina dura, not between lamina dura and the root.lamina dura, not between lamina dura and the root.

Teacher: " Where were U born?
Sardar : In Tiruvanantapuram.
Teacher: Spell it?
Sardar : (after thinking) I think I was born in GOA.
Thought for the Day!!!
If you call your mother as MUM..
What will you call Mother's younger
sis and elder sis?

Answer :
MINIMUM & MAXIMUM

Orthodontic tooth movement
remains one of the most
successful procedures with
predictable outcome in
medicine and dentistry.

Orthodontics and dentofacial orthopedics requires thorough knowledge in
biology (of bone, cartilage, teeth, muscles, nerves and othersoft tissues),
biomechanics, biometrics, material science, clinical skills and practice
management in addition to interpersonal skills.

Why study tooth movement?
Up to 80% of the U.S. population have malocclusion thatUp to 80% of the U.S. population have malocclusion that
warrants orthodontic correction.warrants orthodontic correction.
Currently, 36% of the U.S. population seeks orthodonticCurrently, 36% of the U.S. population seeks orthodontic
treatment (Brunelle et al., 1996).treatment (Brunelle et al., 1996).

SKELETAL MATURITY INDICATORS

Introduction
 Chronological age is often not sufficient for
assessing the developmental stage and
somatic maturity of the patient.
 The biological age is determined from the
skeletal, dental and morphologic age and
the onset of puberty.
 Due to individual variations in timing, duration
and velocity of growth, skeletal age
assessment is essential in formulating viable
orthodontic treatment plans.

SKELETAL MATURITY
INDICATORS PROVIDE
AN OBJECTIVE
DIAGNOSTIC
EVALUATION OF
STAGE OF MATURITY
IN AN INDIVIDUAL

METHODS AVAILABLE TO ASSESS THE
SKELETALMATURITY OF AN INDIVIDUAL--
1.USE OF HAND WRIST X-RAYS
2.EVALUATION OF SKELETAL
MATURATION
USING CERVICAL VERTEBRAE
3.ASSESMENT OF MATURITY BY
CLINICAL AND RADIOGRAPHIC
EXAMINATION OF DIFFERENT
STAGES OF TOOTH DEVELOPMENT.

Orthognathic surgery
 Orthognathic surgeries
 are surgical procedures carried out along
with orthodontic treatment to correct
dento facial deformities of severe
orofacial disproportions, involving
maxilla,the mandible or both in
combination

Etiology
 Prenatal
 Hereditary
 environmental

The various classification proposed
are:
 White and Gardiner
 Salzmann’s classification
 Moyer’s classification
 Graber’s classification

Local factors
 1. Anomalies in number of teeth
 2. Anomalies of tooth size
 3. Anomalies of tooth shape
 4. Abnormal labial frenum
 5 Premature loss of deciduous teeth
 6. Prolonged retention of deciduous teeth
 7. Delayed eruption
 8. Abnormal eruptive pathway
 9. Ankylosis
 10.Dental caries
 11.Improper dental restorations

General factors
 Heredity: It includes factors that result in
malocclusion and are inherited from the
parents by the off springs. These factors can
influence-
 Neuromuscular system
 Dentition
 Skeletal structures
 Soft tissues

Environmental factors
Prenatal factors
 Abnormal fetal posture : -
-Interferes with symmetric development
of face
-Not directly associated with
malocclusion but may be associated
with abnormal pressure or imbalance.
-Most of the deformities are temporary
and disappears with time

 Maternal infections such as German measles and
use of certain drugs during pregnancy like
thalidomide can cause congenital deformities like
cleft
 Post natal factors
- Trauma
- Forceps delivery can result in injury to the TMJ area
which can undergo ankylosis retarded mandibular
growth

Indications for Orthognathic
Surgery
 Severity of skeletal and dental malocclusion
 When growth modification can not be
achieved
 Esthetic and psychosocial considerations

Indications for
orthognathic surgery
• Facial imbalances or
asymmetries
– Long lower face, gummy smile
• Limitations of tooth movements
• Relapse potential of orthodontic
treatment

Contraindications
 Minor skeletal problem
 Patients with only dentoalveolar
problems
 Uncontrolled systemic disease
 Unstable patients with poor personality
or pathologic personality

Aims of orthognathic surgery
 Optimum facial aesthetics
 Optimum dental aesthetics
 Functional occlusionsss
 Future health of oro-facial structures
 Rapid treatment
 A stable result
 Minimum morbidity(unhealthy, sick, sickly,
gruesome, ghastly, macabre, dreadful.)

LASERS IN ORTHODONTICS

ORTHOPHASER
One of the latest commercially available argon
laser welder
Bigger than the conventional spot welder
Strong weld and biocompatible
All metals including titanium can also be welded.
Consist of working microscope with integrated eye
protection, a flexible hand piece and a compact control
with pre-programmed parameters

ORTHOPHASER

Laser welding of commercially pure titanium
 Used in dentistry for crowns, bridges and partial
denture framework.
 Highly reactive metal in air
 Oxide layer formed on this converts it from an active to
a passive state.
 At temperatures used for soldering procedures, the
thickness of the titanium oxide layer increases thereby
debonding from the parent metal.

 Hence conventional soldering not employed.
 Laser welding in an argon gas atmosphere is
done to join the titanium components
 Advantage using this method is that the metal is
subjected to very minimal heat influence and
hence the welded joint will be composed of
same pure titanium as the substrate
components

TITANIUM TITANIUM

Advantages of laser welding
 Processes high alloy metals without difficulty
 can be used in open air
 Can be transmitted over long distances with a minimal
loss of power
 Narrow heat affected zone
 Low total thermal input
 Welds dissimilar metals
 No filler metals necessary
 No secondary finishing necessary
 Extremely accurate
 Welds high alloy metals without difficulty

 Rapid cooling rate may cause cracking in certain
metals
 High cost
 Optical surfaces easily damaged
 High maintenance cost
Disadvantages of laser welding

Fully Automated Laser Welder
Developed specifically for joining orthodontic brackets to
their pads, customized weld spot sizes
INTERNAL ASSEMBLY
AUTOMATED LASER WELDER

Intra Oral Laser Micro welding
Leigh & Bevis ( Oct 1978)
Source - Internet
The laser micro welder used in this study was a
high power industrial neodymium laser capable of
delivering 20 joules/pulse for a maximum of 6
milliseconds at a wavelength of 1.06 microns. A
four inch focal length lens was used ,which yields
an effective spot diameter of .010 to .015 inch

Rapid and repeatable actions of neodymium laser intra orally
is safe and creates no damage to dental tissues
Intra oral micro welding in the placement of space
maintainers, retainers, orthodontic splint, periodontal splints,
archwire brackets to existing bands and auxiliaries
It eliminates time consuming procedures like ligature tying of
archwire, eliminates the need of painful intra oral soldering,
and aids or eliminates the process of crimping and clamping

JOKE- FALL IN LOVE!!!!!!!!!!!!

EDMUND
WUERPEL

“The mind of a child is as tender and as lovely as the
petals of a full blown rose.Beware how you touch it!!
meet it with all the reverence of your being.Use it with
gentle respect and fill it with the honey of love,the
perfume of faith and the tenderness of tolerance.Thus
shall you fulfill the mission of your life”
Edmund.H.wuerpel a great artist
and friend of angle has
told……………….

THANK YOU
GOOD LUCK

Orthodontics an overview

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