DIAGNOSIS & TREATMENT PLANNING /fixed orthodontic courses by IDA

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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. Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics, Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call 0091-9248678078

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www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com DIAGNOSIS AND TREATMENT PLANIING IN ORTHODONTICS

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www.indiandentalacademy.com “The first step toward cure is to know what the disease is......”

The Goal of an Orthodontist..........:

www.indiandentalacademy.com The Goal of an Orthodontist.......... To obtain optimal occlusion with in a framework of skeletal bases. With the nerves, muscles surrounding in harmony. Normal function and stability. Without damage to the health of the surrounding tissues (PDL, gingiva, TMJ, etc…). 3

The objectives of orthodontic treatment (Jackson’s Triad)::

www.indiandentalacademy.com The objectives of orthodontic treatment (Jackson’s Triad): Functional stability Structural balance Esthetic harmony

TO be spoken out by sir, No need of this slide, thus delete it before presentation.:

www.indiandentalacademy.com TO be spoken out by sir, No need of this slide, thus delete it before presentation. Although this is definitive, it is obvious that it means different things to different persons, so much so that large segments of orthodontic profession, if presented with single case, would start out in different directions toward different objectives by different orthodontic means. The last should matter little except that orthodontists, being committed to certain appliances with their inherent limitations, are not free to be objective about their objectives. Concepts and standards have been devised which are subservient to appliance limitations. These concepts and resultant orthodontic objectives are as different as black and white. A CRITICAL ANALYSIS OF ORTHODONTIC CONCEPTS AND OBJECTIVES William L. Wilson –AJO-DO 1957

One century back EDWARD. H. ANGLE rightly said::

www.indiandentalacademy.com One century back EDWARD. H. ANGLE rightly said: “In studying a case of malocclusion, give no thought to the methods of treatment or appliances until the case shall have classified and all peculiarities and variation from the normal in type, occlusion and facial lines have been thoroughly comprehended. Then the requirements and proper plan of treatment become apparent”.

The orthodontist must …:

www.indiandentalacademy.com The orthodontist must … Know normal features of occlusion and dentofacial complex. Recognize the various characteristics of the malocclusion & dentofacial deformity. Understand the nature of the problem and the etiology, if possible. Design a treatment plan based on the specific needs of the individual.

Therefore, this presentation is divided into following sections::

www.indiandentalacademy.com Therefore, this presentation is divided into following sections: Know Normal features of occlusion and dentofacial complex. Recognize the Various characteristics of the malocclusion & dentofacial deformity. Understand the Nature of the problem and the etiology , if possible. Design a Treatment plan based on the specific needs of the individual.

The Beginning … :

www.indiandentalacademy.com The Beginning …

1. Normal Features:

1. Normal Features of Occlusion & Dentofacial Complex www.indiandentalacademy.com

Normal Growth:

www.indiandentalacademy.com Normal Growth When the horizontal, vertical and transverse growth components of maxilla and mandible match that of each other, normal growth results. Frontal or lateral view of Occlusion

Cranio-Facial Structures:

www.indiandentalacademy.com Cranio-Facial Structures

2. Diagnosis:

2. Diagnosis Recognizing the various characteristics of the malocclusion & dentofacial deformity. www.indiandentalacademy.com

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www.indiandentalacademy.com Some diagnosis are Easy, Many are difficult and Few are impossible yet all are important , for diagnosis is the trump factor in providing orthodontic care . care. osis tru

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www.indiandentalacademy.com Human head is the most complicated anatomical complex in all creation. Here the interrelationships are infinite and the causes and effects of these relationships are almost imponderable.

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www.indiandentalacademy.com The more our knowledge increases the more our ignorance enfolds . The vast stretches of the unanswered and the unfinished will outstrip our collective comprehension. ? @ ? * k K ? & ? # ? A ? L ? I ? W ? ? ? Q ? F ? % ? ?

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www.indiandentalacademy.com Malocclusion is one such relationship of the components of the human head which has remained enigmatic despite staggering advances in our level of knowledge and comprehension. Our lore on this subject abounds with clinical dogma , with sacred tradition , and even with myth .

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www.indiandentalacademy.com Diagnosis is most neglected by many for various reason: Poor knowledge of basic medical sciences (e.g. anatomy, physiology, …) Poor education / importance to treatment of a case rather than diagnosis Variability and individual perceptions Uniqueness of each individual patient

Problem Oriented and Evidence Based Diagnosis:

www.indiandentalacademy.com Problem Oriented and Evidence Based Diagnosis The goal of the diagnostic process is to produce a complete description of the patient’s problems and make a problem list . To obtain the problem list, a collection of relevant information is required. This collection is called a database .

The Database:

www.indiandentalacademy.com The Database It is obtained from 3 sources. Patient history, & interview data. Clinical (extraoral, functional & intraoral) examination. Analysis of diagnostic records (models, radiographs, cephalograms, photographs etc.).

Diagnosis & Treatment Planning - Steps:

www.indiandentalacademy.com Mechano- therapy Diagnosis & Treatment Planning - Steps Patient History Clinical Examination Analysis of Diagnostic Records Classification Problem List = Diagnosis Treat pathology (caries, gingivitis etc.) Problems in priority order A B C D Possible solution to individual problems Optimal Treatment Plan 18 Data Base A B C D

How to recognize the various characteristics of the malocclusion? :

www.indiandentalacademy.com How to recognize the various characteristics of the malocclusion? Class I malocclusion Class II malocclusion Class III malocclusion

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www.indiandentalacademy.com Class I malocclusion could be a result of normal growth of all structures, or It could be a product of various diverse growth of the various structures of the dentofacial complex, compensating each other, to create a balanced face.

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www.indiandentalacademy.com Take a slide from Ali’s seminar on “Dentoalveolar compensation and anatomical basis for malocclusion” Where a Negroid face which is of dolicofacial pattern gets compensated by extra-wide ramus. This makes the chin more prominent.

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www.indiandentalacademy.com Class II Malocclusion

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www.indiandentalacademy.com One such malocclusion is Class II malocclusion. Since Class II malocclusion is recognized easily by health professionals as well as by patients and their families, especially in cases of excessive over jet, the correction of class II problems may constitute more than half of the treatment protocol in a typical orthodontic practice.

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www.indiandentalacademy.com It is interesting to note that the process of evolution in orthodontic diagnosis and treatment planning has been gradual. Now, let us trace through history , the changing perceptions on the etiology of class II malocclusion .

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www.indiandentalacademy.com For decades together class II was erroneously considered a purely sagittal problem. Pioneered by Dr. Angle’s classification of malocclusion based on anteroposterior relationship of first molar, probably thousands of class II of all hues and varities were treated as basically sagittal discrepancies, often with disastrous results.

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www.indiandentalacademy.com One such malocclusion is Class II malocclusion. Since Class II malocclusion is recognized easily by health professionals as well as by patients and their families, especially in cases of excessive over jet, the correction of class II problems may constitute more than half of the treatment protocol in a typical orthodontic practice.

PowerPoint Presentation:

www.indiandentalacademy.com It is interesting to note that the process of evolution in orthodontic diagnosis and treatment planning has been gradual. Now, let us trace through history , the changing perceptions on the etiology of class II malocclusion .

PowerPoint Presentation:

www.indiandentalacademy.com For decades together class II was erroneously considered a purely sagittal problem. Pioneered by Dr. Angle’s classification of malocclusion based on anteroposterior relationship of first molar, probably thousands of class II of all hues and varities were treated as basically sagittal discrepancies, often with disastrous results.

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www.indiandentalacademy.com It was not the orthodontists alone who were guilty of nescience, but even the surgeons jumped onto the bandwagon and restricted themselves to sagittal correction of what was actually a problem involving more than one plane.

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www.indiandentalacademy.com The Angle system of classification still remains at the core of orthodontic diagnosis a century after its development , even though this classification scheme is not sensitive to imbalances in the vertical and transverse dimensions.

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www.indiandentalacademy.com First now let us see, how malocclusions such as Class II develop as sagittal discrepancy.

SAGITTAL PLANE:

www.indiandentalacademy.com SAGITTAL PLANE Prognathic Maxilla Retrognathic Mandible Combination of the two A N I M A T I O N

Normal Mandible, Prognathic Maxilla:

www.indiandentalacademy.com 2 Normal Mandible, Prognathic Maxilla

Prognathic Maxillary Dentition:

www.indiandentalacademy.com 2 Prognathic Maxillary Dentition

Normal Maxilla, Retrognathic Mandible.:

www.indiandentalacademy.com Normal Maxilla, Retrognathic Mandible .

Prognathic maxilla, Retrognathic mandible.:

www.indiandentalacademy.com 2 Prognathic maxilla, Retrognathic mandible .

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www.indiandentalacademy.com Can also be because of decreased cranial flexure , the posterior positioning of glenoid fossa which neutralizes the horizontal growth of mandible ending up in Class II.

Case 01 :

www.indiandentalacademy.com Case 01 

VERTICAL DISCREPANCY:

www.indiandentalacademy.com VERTICAL DISCREPANCY With the passage of time, inevitably there was gain of knowledge and wisdom and the focus now began to shift towards other etiologic possibilities of class II malocclusion It was schudy in 1964, who brought into focus the vertical dysplasia causing and affecting the class II malocclusion. Until then investigators had never explored the vertical dimension of the posterior aspect of the face. But here were the secrets to be found.

Vertical Discrepancies :

2 Vertical Discrepancies Discrepancies in the vertical dimension occur in the form of a long face or a short face syndrome. www.indiandentalacademy.com

Rotations of Mandible:

Rotations of Mandible The rotation of the mandible due to vertical growth discrepancies also has to be distinguished. 3 M O R P H I N G S H & V G R O W T H www.indiandentalacademy.com

Vertical Maxillary Excess:

www.indiandentalacademy.com Vertical Maxillary Excess Vertical maxillary excess brings about a clockwise rotation of the mandible and a class II situation.

Decreased Condylar Growth:

www.indiandentalacademy.com Decreased Condylar Growth Decreased condylar growth and decreased ramal height swings the mandible backward.

Excess Condylar Growth:

www.indiandentalacademy.com Excess Condylar Growth Excessive condylar growth causes forward rotation of the mandible leading to a class II deep bite situation.

:

www.indiandentalacademy.com During the 1940s and 50s even class II due to vertical maxillary excess were treated with cervical pull headgear . This accentuated the problem rather than solve it.

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www.indiandentalacademy.com The disastrous results obtained led to the realization that the traditional cookbook approach of treating all class II malocclusions with either A bite jumping appliance or a kloehn’s cervical headgear might not be the right approach after all.

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www.indiandentalacademy.com Now the concept changed such that when facial morphology indicated that vertical growth had been excessive or that condylar growth had been deficient, the plan was to inhibit the downward growth of the maxillary molars. When it is determined that vertical growth is deficient, the choice is to stimulate the vertical growth of the alveolar processes.

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www.indiandentalacademy.com This quantum shift in knowledge about the causative factors of class II malocclusion brought into light an entirely new gamut of treatment possibilities .

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www.indiandentalacademy.com Now let us look at some class II cases with predominant vertical discrepancy and their treatment options.

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www.indiandentalacademy.com

TRANSVERSE DISCREPANCY:

www.indiandentalacademy.com TRANSVERSE DISCREPANCY It has only been during the last two decades or so that the role of transverse dimension has been a topic of interest to the typical practicing orthodontist.

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www.indiandentalacademy.com Infact, the skeletal imbalances in the transverse dimension often are ignored or simply not recognized , and thus the treatment options for such patients by necessity are more limited than if these transverse skeletal problems were recognized.

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www.indiandentalacademy.com Many class II malocclusions, when evaluated clinically have no obvious maxillary constriction .

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www.indiandentalacademy.com When a set of study models of the patient are “hand articulated", how-ever, it becomes obvious that when the dental casts are placed with the posterior dentition in a Class I relationship , a unilateral or a bilateral cross bite is produced. This indicates the presence of maxillary constriction as a component of class II malocclusion.

FOOT AND SHOE MECHANISM:

www.indiandentalacademy.com FOOT AND SHOE MECHANISM Richen Bach and Taatz in 1971 used the example of a foot and a shoe, with the foot representing the mandible and the shoe representing the maxilla . If the shoe is too narrow, it is impossible for the foot to slide fully into the shoe. By widening the shoe, the foot slides forward into its usual position.

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www.indiandentalacademy.com When treating in the mixed dentition, the first step in the treatment of mild to moderate Class II malocclusions characterized, at least in part, by mild mandibular skeletal retraction and maxillary constriction may be expansion of maxilla.

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www.indiandentalacademy.com The patients can be left in a over expanded position with contacts still being maintained between the upper lingual cusps and lower buccal cusps of the posterior teeth.

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www.indiandentalacademy.com Widening the maxilla often leads to a spontaneous forward posturing of the mandible during the retention period. After 6 to 12 months, the spontaneous correction of the class II relationship can be seen in many mild to moderate class II patients.

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www.indiandentalacademy.com The net result of this change in outlook has been a reduction in the number of functional jaw orthopedic appliances that now are used in the treatment of mild to moderate class II malocclusion.

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www.indiandentalacademy.com

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3. The Etiology:

3. The Etiology The Nature of the Problem (If Possible) www.indiandentalacademy.com

Deep Mento-Labial Sulcus:

Deep Mento-Labial Sulcus www.indiandentalacademy.com

Mouth Breathing:

Mouth Breathing www.indiandentalacademy.com

Enlarged Tonsils:

Enlarged Tonsils www.indiandentalacademy.com

Infantile swallow:

Infantile swallow www.indiandentalacademy.com

Tongue thrust swallow:

Tongue thrust swallow www.indiandentalacademy.com

Hyperactive mentalis:

Hyperactive mentalis www.indiandentalacademy.com

FUNCTIONAL ANALYSIS:

FUNCTIONAL ANALYSIS www.indiandentalacademy.com

FUNCTIONAL ANALYSIS:

FUNCTIONAL ANALYSIS www.indiandentalacademy.com

Normal Closure (Without Shift):

Normal Closure (Without Shift) www.indiandentalacademy.com

Posterior shift of Mandible:

7 8 7 8 Posterior shift of Mandible 7 7 8 8 8 www.indiandentalacademy.com

VERTICAL RELATIONSHIP:

VERTICAL RELATIONSHIP TRUE DEEP BITE PSEUDO DEEP BITE www.indiandentalacademy.com

LATEROGNATHY:

LATEROGNATHY www.indiandentalacademy.com

LATEROCCLUSION:

LATEROCCLUSION www.indiandentalacademy.com

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www.indiandentalacademy.com Thank You www.indiandentalacademy.com Leader in continuing dental education

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