Orthodontics Chapter 60 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights...

OrthodonticsOrthodontics

Chapter 60Chapter 60

Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.


Lesson 60.1Lesson 60.1


Learning ObjectivesLearning Objectives

Pronounce, define, and spell the Key Terms.Pronounce, define, and spell the Key Terms. Describe the environment of an orthodontic Describe the environment of an orthodontic

practice.practice. Describe the types of malocclusion.Describe the types of malocclusion. Discuss corrective orthodontics and describe Discuss corrective orthodontics and describe

what type of treatment is involved.what type of treatment is involved. List the types of diagnostic records used to List the types of diagnostic records used to

assess orthodontic problems.assess orthodontic problems.


OrthodonticsOrthodontics is the specialty of dentistry is the specialty of dentistry

concerned with the supervision, concerned with the supervision,

guidance, and correction of the growing guidance, and correction of the growing

and mature dentofacial structure.and mature dentofacial structure.

IntroductionIntroduction


Malocclusion is an abnormal or Malocclusion is an abnormal or

malpositioned relationship of the malpositioned relationship of the

maxillary teeth to the mandibular maxillary teeth to the mandibular

teeth when they are in occlusion.teeth when they are in occlusion.

Understanding Malocclusion Understanding Malocclusion


Factors Related to MalocclusionFactors Related to Malocclusion

Developmental causes Developmental causes Congenitally missing teethCongenitally missing teeth Malformed teeth Malformed teeth Supernumerary teeth Supernumerary teeth Interference with eruption Interference with eruption Ectopic eruption Ectopic eruption

(Cont’d)(Cont’d)




Genetic causes Genetic causes Discrepancies in the size of the jaw, teeth, or bothDiscrepancies in the size of the jaw, teeth, or both

Environmental causes Environmental causes Birth injuriesBirth injuries Fetal moldingFetal molding Trauma Trauma





HabitsHabits Tongue thrustingTongue thrusting Tongue-thrust swallowingTongue-thrust swallowing Thumb and finger suckingThumb and finger sucking BruxismBruxism Mouth breathing Mouth breathing


Any deviation from class I occlusion Any deviation from class I occlusion

is considered malocclusion.is considered malocclusion.

MalocclusionMalocclusion


Fig. 60-1 A, Diagram showing class I occlusion. Fig. 60-1 A, Diagram showing class I occlusion. B, Photo showing class I occlusion.B, Photo showing class I occlusion.

(A, From Proffit WR, Fields HW: (A, From Proffit WR, Fields HW: Contemporary orthodonticsContemporary orthodontics, ed 4, St Louis, 2007, Mosby.), ed 4, St Louis, 2007, Mosby.)

B


Class II MalocclusionClass II Malocclusion

This condition is also referred to as istoclusion.This condition is also referred to as istoclusion. The body of the mandible is in an abnormal distal The body of the mandible is in an abnormal distal

relationship to the maxilla.relationship to the maxilla. Class II malocclusion causes the maxillary anterior Class II malocclusion causes the maxillary anterior

teeth to protrude over the mandibular anterior teeth to protrude over the mandibular anterior teeth. teeth.


Fig. 60-2 A, Diagram showing class II malocclusion. Fig. 60-2 A, Diagram showing class II malocclusion. B, Photo showing class II malocclusion.B, Photo showing class II malocclusion.


B


Class III MalocclusionClass III Malocclusion

This condition is also referred to as mesioclusion.This condition is also referred to as mesioclusion. The body of the mandible is in an abnormal mesial The body of the mandible is in an abnormal mesial

relationship to the maxilla.relationship to the maxilla. Class III malocclusion causes the mandibular Class III malocclusion causes the mandibular

anterior teeth to protrude in front of the maxillary anterior teeth to protrude in front of the maxillary anterior teeth. anterior teeth.


Fig. 60-3 A, Diagram showing class III malocclusion. Fig. 60-3 A, Diagram showing class III malocclusion. B, Photo showing class III malocclusion.B, Photo showing class III malocclusion.


B


Malaligned TeethMalaligned Teeth

CrowdingCrowding In this, the most common contributor to In this, the most common contributor to

malocclusion, one or many teeth are involved in malocclusion, one or many teeth are involved in misplacement.misplacement.

OverjetOverjet An excessive protrusion of the maxillary incisors An excessive protrusion of the maxillary incisors

results in space or distance between the facial results in space or distance between the facial surfaces of the mandibular incisors and the lingual surfaces of the mandibular incisors and the lingual surface of the maxillary incisors. surface of the maxillary incisors.



Malaligned TeethMalaligned Teeth


OverbiteOverbite This is an increased vertical overlap of the maxillary This is an increased vertical overlap of the maxillary

incisors. incisors. Open biteOpen bite

A lack of vertical overlap of the maxillary incisors A lack of vertical overlap of the maxillary incisors results in an opening of the anterior teeth when results in an opening of the anterior teeth when occluded. occluded.

Crossbite Crossbite A tooth is not properly aligned with its opposing A tooth is not properly aligned with its opposing

tooth. tooth.


Benefits of Orthodontic TreatmentBenefits of Orthodontic Treatment

PsychosocialPsychosocial

Oral functionOral function

Dental diseaseDental disease


Management of Orthodontic Management of Orthodontic Problems Problems

Preventive orthodonticsPreventive orthodontics To prevent or eliminate irregularities and To prevent or eliminate irregularities and

malpositioning in the developing dentofacial region malpositioning in the developing dentofacial region Interceptive orthodonticsInterceptive orthodontics

To intercede or correct problems as they are To intercede or correct problems as they are developing developing

Corrective orthodonticsCorrective orthodontics To move teeth and correct malocclusion and To move teeth and correct malocclusion and

malformations. malformations.


Medical and dental historyMedical and dental history

Evaluation of physical growthEvaluation of physical growth

Social and behavioral evaluationSocial and behavioral evaluation

Clinical examinationClinical examination

Orthodontic Records Orthodontic Records and Treatment Planningand Treatment Planning


Clinical ExaminationClinical Examination

Used to document, measure, and evaluate Used to document, measure, and evaluate the: the: Facial aspectsFacial aspects Oral healthOral health Jaw and occlusal relationshipJaw and occlusal relationship Functional characteristics of the jaws Functional characteristics of the jaws


Diagnostic Records Diagnostic Records

Photographs are useful as an aid in:Photographs are useful as an aid in: Patient identificationPatient identification Treatment planningTreatment planning Case presentationCase presentation Case documentationCase documentation Patient education Patient education


Fig. 60-9 A and B, Standard extraoral photographs. Fig. 60-9 A and B, Standard extraoral photographs. (From Proffit WR, Fields H, Sarver DM: (From Proffit WR, Fields H, Sarver DM: Contemporary Contemporary

orthodonticsorthodontics, ed 4, St Louis, 2007, Mosby.), ed 4, St Louis, 2007, Mosby.)


Fig. 60-10 A-C Intraoral photographs showing (A) the patient’s Fig. 60-10 A-C Intraoral photographs showing (A) the patient’s front view in occlusion, (B) the maxillary occlusal view, and (C) the right front view in occlusion, (B) the maxillary occlusal view, and (C) the right

buccal view.buccal view.


Radiographs Radiographs

Cephalometric radiographsCephalometric radiographs Extraoral radiographs make it possible to evaluate Extraoral radiographs make it possible to evaluate

the anatomic bases for malocclusion, as well as the anatomic bases for malocclusion, as well as the skull, bones, and soft tissue.the skull, bones, and soft tissue.

Cephalometric analysis Cephalometric analysis Tracing or computerized drawing involving a Tracing or computerized drawing involving a

series of points makes it possible to compute a series of points makes it possible to compute a means of mathematical descriptions and means of mathematical descriptions and measurement of the status of the skull. measurement of the status of the skull.


Fig. 60-11 A and B Cephalometric radiograph and analysis.Fig. 60-11 A and B Cephalometric radiograph and analysis.

A B


Diagnostic Models Diagnostic Models

Diagnostic modelsDiagnostic models DiagnosisDiagnosis Case presentation Case presentation



Lesson 60.2Lesson 60.2



Describe the components of the fixed appliance.Describe the components of the fixed appliance. Place and remove brass wire separators.Place and remove brass wire separators. Place and remove steel separating springs.Place and remove steel separating springs. Place and remove elastomeric ring separators.Place and remove elastomeric ring separators. Assist in the fitting and cementation of Assist in the fitting and cementation of

orthodontic bands.orthodontic bands. Assist in the direct bonding of orthodontic Assist in the direct bonding of orthodontic

brackets.brackets.(Cont’d)(Cont’d)




Place an arch wire.Place an arch wire. Place and remove ligature ties.Place and remove ligature ties. Place and remove elastomeric ties.Place and remove elastomeric ties. Describe the use and function of headgear.Describe the use and function of headgear. Describe ways to convey to the patient the Describe ways to convey to the patient the

importance of good dietary and oral hygiene importance of good dietary and oral hygiene habits in orthodontic treatment.habits in orthodontic treatment.


Specialized Instruments and Specialized Instruments and Accessories Accessories

Intraoral instrumentsIntraoral instruments Orthodontic scalerOrthodontic scaler

• Used in bracket placement, removal of elastomeric rings, Used in bracket placement, removal of elastomeric rings, and removal of excess cement or bonding materialand removal of excess cement or bonding material

Ligature director Ligature director • Used to guide the elastic or wire ligature tie around the Used to guide the elastic or wire ligature tie around the

bracket and to tuck the twisted bracket and to tuck the twisted and cut ligature tie under the arch wireand cut ligature tie under the arch wire



Specialized Instruments and Specialized Instruments and AccessoriesAccessories


Band pluggerBand plugger Used to help seat a molar band for a fixed Used to help seat a molar band for a fixed

appliance appliance Bite stick Bite stick

Used to help seat a molar band for a fixed Used to help seat a molar band for a fixed appliance appliance

Bracket-placement tweezers Bracket-placement tweezers Used to carry and place the bonded bracket on the Used to carry and place the bonded bracket on the

tooth tooth (Cont’d)(Cont’d)


Fig. 60-13 A to E, Intraoral instruments.Fig. 60-13 A to E, Intraoral instruments. (From Boyd L: (From Boyd L: Dental instruments, a pocket guideDental instruments, a pocket guide, ed 3, St Louis, 2009, Saunders.), ed 3, St Louis, 2009, Saunders.)

A

B

C

D

E




PliersPliers Bird‑beak pliersBird‑beak pliers

• Used to form and bend wiresUsed to form and bend wires

Contouring pliersContouring pliers• Used in fitting bands Used in fitting bands

Weingart utility pliersWeingart utility pliers• Used in placing arch wiresUsed in placing arch wires

Three‑prong pliersThree‑prong pliers• Used to close and adjust claspsUsed to close and adjust clasps



Specialized Instruments and Specialized Instruments and Accessories Accessories


Posterior band–remover pliersPosterior band–remover pliers Used to remove bandsUsed to remove bands

Pin and ligature cutterPin and ligature cutter Cuts the ligature wire for removalCuts the ligature wire for removal

Howe (110) pliersHowe (110) pliers Allows placement and removal of, and the making Allows placement and removal of, and the making

of adjustment bends in, the arch wireof adjustment bends in, the arch wire(Cont’d)(Cont’d)




Wire-bending pliersWire-bending pliers Used to hold, bend, and adjust arch wires to Used to hold, bend, and adjust arch wires to

create movementcreate movement Ligature‑tying pliersLigature‑tying pliers

Used for ease in ligature tying Used for ease in ligature tying


Fig. 60-14 A to I, Orthodontic pliers.Fig. 60-14 A to I, Orthodontic pliers. (Courtesy of Miltex, Inc, York, Pa.)(Courtesy of Miltex, Inc, York, Pa.)


Fixed appliances, also referred to as Fixed appliances, also referred to as

braces, are a combination of bands, braces, are a combination of bands,

brackets, and auxiliaries that can be brackets, and auxiliaries that can be

used to move a tooth in six directions: used to move a tooth in six directions:

mesially, distally, lingually, facially, mesially, distally, lingually, facially,

apically, and occlusally.apically, and occlusally.

Fixed AppliancesFixed Appliances


Fig. 60-15 Full braces.Fig. 60-15 Full braces.


Sequence of Appointments Sequence of Appointments for Fixed Appliances for Fixed Appliances

Placement of separators Placement of separators Cementation of molar bands Cementation of molar bands Bonding of brackets Bonding of brackets Insertion of arch wire and tying in with ligature Insertion of arch wire and tying in with ligature

ties or elastomeric ties ties or elastomeric ties Adjustment checks Adjustment checks Removal of applianceRemoval of appliance Retention of teeth Retention of teeth


SeparatorsSeparators

Teeth are separated before fitting and the Teeth are separated before fitting and the placement of the molar bands. placement of the molar bands. Brass-wire separatorsBrass-wire separators Steel separating springsSteel separating springs Elastomeric separators Elastomeric separators


Orthodontic Bands Orthodontic Bands

Preformed stainless steel bands are fitted and Preformed stainless steel bands are fitted and cemented to molar teeth. cemented to molar teeth. Buttons, tubes, and cleats are attached for the Buttons, tubes, and cleats are attached for the

arch wire and power products. arch wire and power products.


Fig. 60-16 Varying sizes of bands.Fig. 60-16 Varying sizes of bands.


Bonded Brackets Bonded Brackets

On the bonded bracket, the arch wire is On the bonded bracket, the arch wire is placed horizontally through the wings of the placed horizontally through the wings of the bracket and then ligated in place. bracket and then ligated in place. This stabilization initiates tooth movement by This stabilization initiates tooth movement by

allowing the forces from the arch wire to be allowing the forces from the arch wire to be transmitted to the tooth. transmitted to the tooth.


Fig. 60-18 Bracket ready for placement.Fig. 60-18 Bracket ready for placement.


Auxiliary Attachments Auxiliary Attachments

Headgear tubes Headgear tubes These round tubes, routinely placed on maxillary These round tubes, routinely placed on maxillary

first molar bands, are used for the insertion of the first molar bands, are used for the insertion of the inner bow of a facebow appliance.inner bow of a facebow appliance.

Edgewise tubes Edgewise tubes Rectangular tubes are placed on the buccal Rectangular tubes are placed on the buccal

surfaces of the upper and lower first molar bands surfaces of the upper and lower first molar bands to receive the arch wire. to receive the arch wire.



Auxiliary AttachmentsAuxiliary Attachments


Labial hooksLabial hooks Located on the facial surfaces of the first and Located on the facial surfaces of the first and

second molar bands for both arches, these hooks second molar bands for both arches, these hooks hold the interarch elastics.hold the interarch elastics.

Lingual arch attachmentLingual arch attachment This button or bracket, located on the lingual This button or bracket, located on the lingual

portion of the bands, stabilizes the arch and portion of the bands, stabilizes the arch and reinforces anchorage and tooth movement. reinforces anchorage and tooth movement.


Preformed thin wire is placed within the Preformed thin wire is placed within the

bracket to provide a pattern for the bracket to provide a pattern for the

dental arch to take its shape from and dental arch to take its shape from and

to guide the teeth in movement.to guide the teeth in movement.

Arch WireArch Wire

(Cont’d)


Arch WireArch Wire


Types of arch wires Types of arch wires Nickel-titanium Nickel-titanium

• For movement because of its flexibility For movement because of its flexibility

Stainless-steel wire Stainless-steel wire • Stiffer and stronger Stiffer and stronger

Beta titanium (TMA) Beta titanium (TMA) • Provides a combination of strength, flexibility, and Provides a combination of strength, flexibility, and

memorymemory

Optiflex Optiflex • Used for light force and its aestheticsUsed for light force and its aesthetics



Arch WireArch Wire


Shapes of arch wiresShapes of arch wires Round wires are used in the initial and Round wires are used in the initial and

intermediate stages of treatment to correct intermediate stages of treatment to correct crowding, level the arch, open a bite, and close crowding, level the arch, open a bite, and close spaces.spaces.

Square or rectangular wires are used during the Square or rectangular wires are used during the final stages of treatment to position the crown and final stages of treatment to position the crown and root in the correct maxillary and mandibular root in the correct maxillary and mandibular relationship.relationship.


Ligature Ties Ligature Ties

Stainless steelStainless steel A 0.010-gauge stainless-steel wire ligature is used A 0.010-gauge stainless-steel wire ligature is used

to “tie” in arch wires.to “tie” in arch wires. Kobayashi hooksKobayashi hooks

Ligature ties that have been spot welded at the tip Ligature ties that have been spot welded at the tip form hooks for the attachment of elastics.form hooks for the attachment of elastics.


Elastomeric TiesElastomeric Ties

A small elastic ring stretched around a A small elastic ring stretched around a bracket is used to hold the arch wire in place. bracket is used to hold the arch wire in place. Elastomeric ties are available in a variety of colors. Elastomeric ties are available in a variety of colors.


Power ProductsPower Products

Elastic chain tiesElastic chain ties These ties, continuous O’s that form a chain, are These ties, continuous O’s that form a chain, are

used to close space between teeth or correct used to close space between teeth or correct rotated teeth. rotated teeth.

ElasticsElastics Commonly referred to as rubber bands, elastics Commonly referred to as rubber bands, elastics

are placed from one tooth to another in the same are placed from one tooth to another in the same arch or from one tooth to another tooth in the arch or from one tooth to another tooth in the opposing arch. Elastics help close spaces opposing arch. Elastics help close spaces between teeth and correct occlusal relationships. between teeth and correct occlusal relationships.



Power ProductsPower Products


Elastic thread is a type of tubing used to Elastic thread is a type of tubing used to close space or aid in the eruption of impacted close space or aid in the eruption of impacted teeth. teeth.

Comfort tubing aids in patient comfort by Comfort tubing aids in patient comfort by covering an arch wire that may be causing covering an arch wire that may be causing discomfort. discomfort.


Headgear Headgear

Headgear is an orthopedic device used to Headgear is an orthopedic device used to control growth and tooth movement.control growth and tooth movement. FacebowFacebow Used to stabilize or move the maxillary first molar Used to stabilize or move the maxillary first molar

distally and create more room in the arch.distally and create more room in the arch. Traction deviceTraction device Used to apply the extraoral force necessary to Used to apply the extraoral force necessary to

achieve the desired treatment resultsachieve the desired treatment results


Fig. 60-23 Four types of traction.Fig. 60-23 Four types of traction.


Oral-Hygiene Instructions Oral-Hygiene Instructions

Toothbrushing instructionsToothbrushing instructions Floss your teeth, using a floss threader for easy Floss your teeth, using a floss threader for easy

application.application. Brush your teeth at least once every day.Brush your teeth at least once every day. After brushing, rinse and swish water around to After brushing, rinse and swish water around to

remove any debris.remove any debris. Inspect your teeth and braces carefully to make Inspect your teeth and braces carefully to make

sure that they are spotless. sure that they are spotless.


Table 60-2 Dietary Habits and OrthodonticsTable 60-2 Dietary Habits and Orthodontics


RetentionRetention

Orthodontic positionerOrthodontic positioner Retains the teeth in their desired positionsRetains the teeth in their desired positions Permits the alveolus to rebuild support around the Permits the alveolus to rebuild support around the

teeth before the patient wears a retainer teeth before the patient wears a retainer Massages the gingivaMassages the gingiva



RetentionRetention

Hawley retainer Hawley retainer This removable retainer is worn to passively retain This removable retainer is worn to passively retain

the teeth in their new position. the teeth in their new position. Lingual retainerLingual retainer

A fixed lingual wire bonded canine to canine on A fixed lingual wire bonded canine to canine on the lingual surfaces provides lower-incisor position the lingual surfaces provides lower-incisor position during late growth. during late growth.


Orthodontics Chapter 60 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights...

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Transcript of Orthodontics Chapter 60 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights...