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ORTHODONTICS- -AN OVERVIEW




  INDIAN DENTAL ACADEMY
Leader in continuing dental education



          www.indiandentalacademy.com
Small minds discuss people

  Big minds discuss events


 Great minds discuss ideas


Extraordinary minds act in silence

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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.



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

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PIONEERS IN ORTHODONTICS




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Self-Portrait                    Bust of CHRIST


  Norman. W.Kingsley
           www.indiandentalacademy.com
FATHER OF ORTHODONTICS



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


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Edward Hartley Angle
Father of Modern Orthodontics
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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).
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SO WHY DO PEOPLE
SEEK ORTHODONTIC
  TREATMENT ??




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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 !!

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AIMS OF ORTHODONTIC TREATMENT

          JACKSON’S TRIAD
               Structural Balance




Functional Efficiency                   Aesthetic Harmony
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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
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WHY TO CLASSIFY?



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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.
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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 CLASSIFICATION
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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 MOLAR
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www.indiandentalacademy.com
CLASS II
    DIVISION I
    DIVISION II
                      TYPE A
                      TYPE B
                      TYPE C
CLASS II SUB DIV

                          TRUE
CLASS III
                        PSUEDO


CLASS III SUB DIV
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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
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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




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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

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www.indiandentalacademy.com
www.indiandentalacademy.com
Class II subdivision
 » Class II molar relation on one side and class I on
   other




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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
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Class III MALOCCLUSION




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www.indiandentalacademy.com
TRUE CLASS III
• Class III molar relation

• LOWER INCISORS LINGUALLY
  INCLINED

• LOWER TONGUE POSTURE- NARROW
  UPPER ARCH

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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
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Purpose of Cephalometrics
•Study craniofacial growth
•Diagnosis
•Planning orthodontic treatment
•Evaluation of treated cases

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

                     www.indiandentalacademy.com
Cephalostat

                                60"
                                 60"                        15"
                                                             15"
                                                                         Film Plane
                                                                          Film Plane
                Source Plane
                 Source Plane




X-ray Source
 X-ray Source
                                                                         X-ray Film in
                                                                          X-ray Film in
                     Mid-saggital Plane
                     Mid-saggital Plane                                    Cassette
                                                                            Cassette
                                          Patient in Head Positioning
                                           Patient in Head Positioning
                                                     Device
                                                      Device

                          www.indiandentalacademy.com
Cephalostat




  www.indiandentalacademy.com
Cephalostat




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Standard Cephalometric
       Landmarks
             Sella                                           Nasion

Porion                                                       Orbitale

Articulare                                                    ANS
                                                             A Point
                                                            B Point
         Gonion                                       Pogonion
                     PNS
                                Menton           Gnathion
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Radiographic Landmarks




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Frequently Used Planes
       SN Plane

        Frankfort Plane
            Palatal Plane

       Occlusal Plane

        Mandibular Plane




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Orthodontic
tooth movement
is not the only
type of tooth
movement.
Types of Tooth Movement

    Eruption
      Active
      Passive
    Lateral drifts
      Physiological
      Due to loss of adjacent teeth
    Orthodontic tooth movement
Types of Tooth Movement

          Intrusion
          Extrusion
          Tipping
          Translation
          Rotation
Orthodontics  an overview  /certified fixed orthodontic courses by Indian dental academy
Orthodontics  an overview  /certified fixed orthodontic courses by Indian dental academy
Orthodontics  an overview  /certified fixed orthodontic courses by Indian dental academy
Mechanisms of Tooth Movement



         Piezoelectric theory.
Orthodontics  an overview  /certified fixed orthodontic courses by Indian dental academy
Mechanisms of Tooth Movement



         Pressure-tension theory.
Orthodontics  an overview  /certified fixed orthodontic courses by Indian dental academy
Orthodontics  an overview  /certified fixed orthodontic courses by Indian dental academy
Orthodontics  an overview  /certified fixed orthodontic courses by Indian dental academy
Orthodontics  an overview  /certified fixed orthodontic courses by Indian dental academy
The Optimal Force

“High enough to stimulate cellular activity
without completely occluding blood vessels in
the PDL” (Proffit et al. 2000).
Actively being investigated in a scientific field
known as mechanotransduction.
Orthodontics  an overview  /certified fixed orthodontic courses by Indian dental academy
Orthodontic tooth movement cannot
occur unless cells are at work.
Force --- fluid flow --- cell-level strain
Deformation of cell membrane leading to cytoskeletal changes
Second messenger pathways
Gene upregulation in fibroblasts, osteoblasts and osteoclasts
Effects of LIGHT forces on the
periodontium

Light, continuous forces
  Osteoclasts formed
  Removing lamina dura
  Tooth movement begins
  This process is called “FRONTAL RESORPTION”.
“Frontal resorption” because it occurs
between the root and the lamina dura.
LIGHT forces leading to FRONTAL RESORPTION

  Phase 1 – Mechanical compression and tension of the periodontium
  Phase 2 --- Mechanically induced cellular and genetic responses; no tooth
  movement
  Phase 3 --- Accelerated tooth movement due to frontal bone resorption

                          Tooth movement (mm)



                                                                    Phase 3
                                                          Phase 2
                                                Phase 1



                                                   Time (Arbitrary Unit)
Effects of HEAVY forces on the
periodontium

Heavy, continuous forces
  Blood supply to PDL occluded
  Aseptic necrosis
  PDL becomes “hyalinized” – “HYALINIZATION”
  This process is called “UNDERMINING
  RESORPTION”.
“Undermining resorption” because it occurs on the underside of
  lamina dura, not between lamina dura and the root.
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 other soft tissues),
biomechanics, biometrics, material science, clinical skills and practice
management in addition to interpersonal skills.
W study tooth movement?
 hy
Up to 80% of the U.S. population have malocclusion that
warrants orthodontic correction.
Currently, 36% of the U.S. population seeks orthodontic
treatment (Brunelle et al., 1996).
SKELETAL MATURITY INDICATORS




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




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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.

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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



                  www.indiandentalacademy.com
Etiology
   Prenatal
   Hereditary
   environmental




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The various classification proposed
are:

   White and Gardiner
   Salzmann’s classification
   Moyer’s classification
   Graber’s classification

                www.indiandentalacademy.com
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


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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

                    www.indiandentalacademy.com
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

               www.indiandentalacademy.com
   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

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




                    www.indiandentalacademy.com
Indications for
  orthognathic surgery
     • Facial imbalances or
           asymmetries
 – Long lower face, gummy smile
• Limitations of tooth movements
• Relapse potential of orthodontic
            treatment
            www.indiandentalacademy.com
Contraindications
 Minor skeletal problem
 Patients with only dentoalveolar

  problems
 Uncontrolled systemic disease

 Unstable patients with poor personality

  or pathologic personality


                www.indiandentalacademy.com
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.)



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THANK YOU
  INDIAN DENTAL ACADEMY
Leader in continuing dental education


             www.indiandentalacademy.com

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Orthodontics an overview /certified fixed orthodontic courses by Indian dental academy

  • 1. ORTHODONTICS- -AN OVERVIEW INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  • 2. Small minds discuss people Big minds discuss events Great minds discuss ideas Extraordinary minds act in silence www.indiandentalacademy.com
  • 3. 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
  • 4. In 1922 British society of orthodontics proposed that”orthodontics includes the study of growth & development of the jaws and face particularly ,and the body generally,as influencing the position of the teeth;the study of action and reaction of internal and external influences on the development,and the prevention and correction of arrested and perverted development.” www.indiandentalacademy.com
  • 5. Orthodontics-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. www.indiandentalacademy.com
  • 6. PIONEERS IN ORTHODONTICS www.indiandentalacademy.com
  • 7. Self-Portrait Bust of CHRIST Norman. W.Kingsley www.indiandentalacademy.com
  • 8. FATHER OF ORTHODONTICS KINGSLEY SERVED AS DEAN OF THE SCHOOL OF DENTISTRY AT NEWYORK UNIVERSITY www.indiandentalacademy.com
  • 9. Edward Hartley Angle Father of Modern Orthodontics www.indiandentalacademy.com
  • 10. 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). www.indiandentalacademy.com
  • 11. SO WHY DO PEOPLE SEEK ORTHODONTIC TREATMENT ?? www.indiandentalacademy.com
  • 12. 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 !! www.indiandentalacademy.com
  • 13. AIMS OF ORTHODONTIC TREATMENT JACKSON’S TRIAD Structural Balance Functional Efficiency Aesthetic Harmony www.indiandentalacademy.com
  • 14. 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 www.indiandentalacademy.com
  • 15. WHY TO CLASSIFY? www.indiandentalacademy.com
  • 16. 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. www.indiandentalacademy.com
  • 17. 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 CLASSIFICATION www.indiandentalacademy.com
  • 18. 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 MOLAR www.indiandentalacademy.com
  • 20. CLASS II DIVISION I DIVISION II TYPE A TYPE B TYPE C CLASS II SUB DIV TRUE CLASS III PSUEDO CLASS III SUB DIV www.indiandentalacademy.com
  • 21. 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 www.indiandentalacademy.com
  • 22. 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 www.indiandentalacademy.com
  • 24. 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 www.indiandentalacademy.com
  • 27. Class II subdivision » Class II molar relation on one side and class I on other www.indiandentalacademy.com
  • 28. 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 www.indiandentalacademy.com
  • 29. Class III MALOCCLUSION www.indiandentalacademy.com
  • 31. TRUE CLASS III • Class III molar relation • LOWER INCISORS LINGUALLY INCLINED • LOWER TONGUE POSTURE- NARROW UPPER ARCH www.indiandentalacademy.com
  • 32. 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 www.indiandentalacademy.com
  • 33. Purpose of Cephalometrics •Study craniofacial growth •Diagnosis •Planning orthodontic treatment •Evaluation of treated cases Cephalometrics is a technique employing oriented radiographs for the purpose of making head measurements. www.indiandentalacademy.com
  • 34. Purpose of Cephalometrics • Study craniofacial growth • Diagnosis • Planning orthodontic treatment • Evaluation of treated cases Cephalometrics is a technique employing oriented radiographs for the purpose of making head measurements. www.indiandentalacademy.com
  • 35. Cephalostat 60" 60" 15" 15" Film Plane Film Plane Source Plane Source Plane X-ray Source X-ray Source X-ray Film in X-ray Film in Mid-saggital Plane Mid-saggital Plane Cassette Cassette Patient in Head Positioning Patient in Head Positioning Device Device www.indiandentalacademy.com
  • 38. Standard Cephalometric Landmarks Sella Nasion Porion Orbitale Articulare ANS A Point B Point Gonion Pogonion PNS Menton Gnathion www.indiandentalacademy.com
  • 39. Radiographic Landmarks www.indiandentalacademy.com
  • 40. Frequently Used Planes SN Plane Frankfort Plane Palatal Plane Occlusal Plane Mandibular Plane www.indiandentalacademy.com
  • 41. Orthodontic tooth movement is not the only type of tooth movement.
  • 42. Types of Tooth Movement Eruption Active Passive Lateral drifts Physiological Due to loss of adjacent teeth Orthodontic tooth movement
  • 43. Types of Tooth Movement Intrusion Extrusion Tipping Translation Rotation
  • 47. Mechanisms of Tooth Movement Piezoelectric theory.
  • 49. Mechanisms of Tooth Movement Pressure-tension theory.
  • 54. The Optimal Force “High enough to stimulate cellular activity without completely occluding blood vessels in the PDL” (Proffit et al. 2000). Actively being investigated in a scientific field known as mechanotransduction.
  • 56. Orthodontic tooth movement cannot occur unless cells are at work.
  • 57. Force --- fluid flow --- cell-level strain Deformation of cell membrane leading to cytoskeletal changes Second messenger pathways Gene upregulation in fibroblasts, osteoblasts and osteoclasts
  • 58. Effects of LIGHT forces on the periodontium Light, continuous forces Osteoclasts formed Removing lamina dura Tooth movement begins This process is called “FRONTAL RESORPTION”.
  • 59. “Frontal resorption” because it occurs between the root and the lamina dura.
  • 60. LIGHT forces leading to FRONTAL RESORPTION Phase 1 – Mechanical compression and tension of the periodontium Phase 2 --- Mechanically induced cellular and genetic responses; no tooth movement Phase 3 --- Accelerated tooth movement due to frontal bone resorption Tooth movement (mm) Phase 3 Phase 2 Phase 1 Time (Arbitrary Unit)
  • 61. Effects of HEAVY forces on the periodontium Heavy, continuous forces Blood supply to PDL occluded Aseptic necrosis PDL becomes “hyalinized” – “HYALINIZATION” This process is called “UNDERMINING RESORPTION”.
  • 62. “Undermining resorption” because it occurs on the underside of lamina dura, not between lamina dura and the root.
  • 63. Orthodontic tooth movement remains one of the most successful procedures with predictable outcome in medicine and dentistry.
  • 64. Orthodontics and dentofacial orthopedics requires thorough knowledge in biology (of bone, cartilage, teeth, muscles, nerves and other soft tissues), biomechanics, biometrics, material science, clinical skills and practice management in addition to interpersonal skills.
  • 65. W study tooth movement? hy Up to 80% of the U.S. population have malocclusion that warrants orthodontic correction. Currently, 36% of the U.S. population seeks orthodontic treatment (Brunelle et al., 1996).
  • 66. SKELETAL MATURITY INDICATORS www.indiandentalacademy.com
  • 67. 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. www.indiandentalacademy.com
  • 68. SKELETAL MATURITY INDICATORS PROVIDE AN OBJECTIVE DIAGNOSTIC EVALUATION OF STAGE OF MATURITY IN AN INDIVIDUAL www.indiandentalacademy.com
  • 69. 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. www.indiandentalacademy.com
  • 70. 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 www.indiandentalacademy.com
  • 71. Etiology  Prenatal  Hereditary  environmental www.indiandentalacademy.com
  • 72. The various classification proposed are:  White and Gardiner  Salzmann’s classification  Moyer’s classification  Graber’s classification www.indiandentalacademy.com
  • 73. 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 www.indiandentalacademy.com
  • 74. 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 www.indiandentalacademy.com
  • 75. 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 www.indiandentalacademy.com
  • 76. 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 www.indiandentalacademy.com
  • 78. Indications for Orthognathic Surgery  Severity of skeletal and dental malocclusion  When growth modification can not be achieved  Esthetic and psychosocial considerations www.indiandentalacademy.com
  • 79. Indications for orthognathic surgery • Facial imbalances or asymmetries – Long lower face, gummy smile • Limitations of tooth movements • Relapse potential of orthodontic treatment www.indiandentalacademy.com
  • 80. Contraindications  Minor skeletal problem  Patients with only dentoalveolar problems  Uncontrolled systemic disease  Unstable patients with poor personality or pathologic personality www.indiandentalacademy.com
  • 81. 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.) www.indiandentalacademy.com
  • 82. THANK YOU INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com

Editor's Notes

  1. In 1922