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1、Chapter 50Orthodontics,Orthodontics,Specialty of dentistry that diagnoses,prevents,and treats dental and facial irregularities of growing and mature dentofacial structuresAge of orthodontic patient can be as early as age 7,or earlier if neededInterceptive orthodontic treatment allows orthodontist to
2、 intercede or correct problems as they are developing,The Orthodontist,Dental specialist who has completed college and 4 years of dental schoolCompletes an additional 2-to 3-year training program specializing in orthodontics and dentofacial orthopedicsStraightens teeth and aligns the jaw,Responsibil
3、ities of the Orthodontic Assistant,Assisting the orthodontistEducating patients in oral and overall healthTaking diagnostic impressionsTaking radiographs and bite registrationsProviding pre-and postoperative instructions to patientsPerforming sterilization procedures,Expanded Function Orthodontic As
4、sistant,In some states,depending on the dental practice laws,dental assistants may alsoplace arch wiresadjust head gearplace separatorsfabricate vacuum-machine-formed retainersfit orthodontic bands around molars,The Orthodontic Office,Based on“open bay”principleAccommodates and treats many patients
5、at a timePatient care aspect of the office is typically divided into three areasrecords areaarea where radiographs are takenarea where patient care is providedMay also include a laboratory,An Open Bay Design,Occlusion,Relationship between maxillary and mandibular teeth when upper and lower jaws are
6、in fully closed positionNormal occlusion:ideal contact between mandibular and maxillary archesMalocclusion:Any intra-or extra-arch deviations,Angle Classification System,Developed by Dr.Edward H.Angle(1855-1930)Class I occlusion(neutroclusion):mesiobuccal cusp of maxillary first permanent molar occl
7、udes with mesiobuccal groove of mandibular first molarmolar relationship is normal,but presents deviations,such as teeth are crowded in one or more areas within arch,Class II Malocclusion,Said to be in distoclusionMesiobuccal cusp of upper first molar occludes mesial to mesiobuccal groove of mandibu
8、lar first molarClass II,Division Imandibular teeth are behind upper jaw with a protrusion of upper incisors Class II,Division IImandibular teeth are behind upper teeth,with central incisors tipped labially,Class III Malocclusion,Said to be in mesioclusionMesiobuccal cusp of maxillary first molar occ
9、ludes in space between distal cusp of lower permanent first molar and mesial cusp of lower permanent second molarCommonly referred to as an underbite,Class I Occlusion,Class II:Division I and Division II,Class III,Three Categories in Etiology of Malocclusion,GeneticSystemic(environmental)Local(habit
10、s),Genetic Factors,Responsible for deviations within dentition and jaw sizesDental heredity factors include:supernumerary teeth ectopic eruption abnormal eruption of a permanent tooth out of normal alignmentirregularity in jaw sizes and teeth-to-jaw relationshipscongenitally missing teeth,Systemic F
11、actors,Include injuries at birthTypes of injuries include:fetal molding occurs when a limb of a fetus is pressed against another part of the body such as an arm pressed against the mandibletrauma during birth-occurs during the use of forceps in delivery,Dental Trauma,Can lead to the development of m
12、alocclusion in a number of waysDamage to permanent tooth buds when an injury to primary teeth has occurredMovement of a tooth or teeth as a result of the premature loss of a primary toothDirect injury to permanent teeth,Local Habits,Sucking habits of children involving thumb,finger(s),or pacifierCan
13、 have an affect on jaw and tooth development,Problems with Malalignment,Stress and strain on surrounding muscle attachments,tissue,and boneDigestive problems brought on by poorly chewed foodTemporomandibular joint(TMJ)painCompromised oral health and function,Common Problems with Dental Arches,Crowdi
14、ng of one or several teeth is the most common cause of malocclusionOverjet the severe protrusion of the maxillary anterior teeth causes a horizontal space between the mandibular facial surfaces of the lingual aspect of the maxillary anterior teeth Overbite the extreme vertical overlap of the maxilla
15、ry teeth can e so severe that the mandibular anterior cannot be seen at allCross bite one or more maxillary teeth are lingual to the occluding mandibular tooth or teeth when in occlusions Malpositioning of teeth,Overjet and Overbite,Benefits of Orthodontic Treatment,Boosts self-confidence and self-e
16、steemImproved appearanceBrings teeth,lips,and face into proportionCan benefit social and career successImproves a persons general attitude toward lifeAssists with jaw developmentMaintains space,Corrective Orthodontics,Conditions that require correcting mal-relationships and malformations of teeth an
17、d facial bonesCorrective orthodontics includes:fixed appliances(braces)removable appliances for correction or maintenance of orthodontic treatmentorthognathic surgery,Elements of the Initial Orthodontic Visit,Extensive examination of face,jaws,and teethCompletion of dental recordDocumentation of pat
18、ients oral habits or abnormal functionsDetermination of Angle classification of occlusion on both sides of patients faceObtaining patients medical and dental history,Treatment Planning,If patient is a child the parents are involved in the discussion Dental team communicates with both the younger pat
19、ient and parent to ensure understanding of treatment plan Sometimes treatment is delayed until further dental developmentSecond appointment is scheduled for completing patients diagnostic record,Medical History,Taken to evaluate general health of patientSome conditions and medications have an effect
20、 on patients response to treatmentAlthough orthodontic therapy is relatively bloodless,it is possible to cause bleeding For illnesses,such as endocrine problems,rheumatic fever,and prolonged bleeding,medical clearance and recommendations should be made by a physician,Dental History,Provides informat
21、ion concerning dental treatmentOutcome of orthodontic treatment can be affected by whether the patient has received routine dental care or only emergency dental careType of dental care patient has sought out in the past can be indicative of how motivated,dedicated,and enthusiastic patient will be du
22、ring orthodontic care,Consequences of Lack in Growth Hormone,Lag in growth of bones Delay in growth of childs teeth and facial bonesChildren may keep their deciduous teeth 2 to 4 years longer than averageProblems with eruption of the secondary dentitionMissing adult teeth,Diagnostic Records,Assist i
23、n the preparation of a patients individualized treatment planExtraoral and intraoral photographs and diagnostic impressions are taken as part of the initial diagnostic recordPhotographs capture the color,shape,texture,and characteristics of intraoral and extraoral structures,Three Standard Extraoral
24、 Photographs,Taken to evaluate the symmetry and balance of the faceFrontal view with lips in relaxed positionFrontal view with lips in a smileProfile view of patients right side with lips relaxed,Standard Intraoral Photographs,Full frontal view(teeth in occlusion)Bilateral view(teeth in occlusion)ba
25、ck to the first molarMaxillary occlusal view,including palate and all occlusal surfaces,Diagnostic Radiographs,Two types of radiographs are also taken as part of the initial diagnostic record:CephalometricPanoramic,Cephalometric Radiograph,X-ray that provides orthodontist with a lateral view of pati
26、ents head,teeth,and jawsAn analysis of the cephalometric film helps the orthodontist determine the current shape of the face,how the face has grown,and the expected growth,Views Provided by Panoramic Radiographs,Maxillary and mandibular jawsTooth developmentRoots of teethNerve positionsJaw structure
27、s,jointsSupernumerary teethTMJMissing or misplaced teeth,Advantages of Digital Radiology,Ability of cephalometric analysis to be accessible at chairside computer for case presentationReduction in radiationEasy storage,Diagnostic Models,Used for diagnosis,case presentation,and patient identificationO
28、rthodontic assistant generally fabricates study models Provides a positive replication of patients mouth,muscle attachments,and hard palateFinished appearance is a trimmed,polished,and symmetrically correct model,Diagnostic Model,Case Presentation,Typically involves a consultation appointment for on
29、e hour scheduled for patient or guardianPresentation includes initial photographs,radiographs,cephalometric tracings,diagnostic models,and other adjunctive aids the orthodontist deems appropriatePresentation also includes information on approximate length of treatment and costIf treatment is accepte
30、d a consent form is signedConsecutive appointments are then scheduled to begin treatment,Financial Arrangements,Paying in full at start of treatmentMonthly payment plansSemiannual payment planAll financial plans consist of a formal,legally binding contract that states what percentage of the treatmen
31、t is to be paid at the first appointment and what the fixed payment will be Insurance coverage is also considered,Specialized Instruments,Pliers and band pushersOrthodontic scalerLigature directorBand(driver)pusherBite stickBracket forceps(placement tweezers),Orthodontic Scaler,Utilized in bracket p
32、lacement,removal of elastomeric rings,and removal of excess bonding or cement around bands or brackets,Courtesy Hu-Friedy,Ligature Director,Tucks twisted ligature wire ends into interproximal spaces,Courtesy Hu-Friedy,Band(Driver)Pusher,Used to seat and position band on toothCan be used to contour o
33、cclusal aspect of band around toothWorking end has a round serrated tip to prevent slippage,Courtesy Hu-Friedy,Bite Stick,Assists in band seating with aid of patients biting forceHandle and tip is one piece made from autoclave materialTriangular steel working area is placed occlusal on band so patie
34、nt can bite onto plastic stickBiting force drives band into position,Bracket Forceps,Also called placement tweezersUsed to carry and place bonded bracket on toothDesigned with long-tipped,reverse action,and serrated beaks to secure bracket in place,Bird Beak Pliers(No.139),Used for seating separatin
35、g springs and bending arch wireOpposing beaks are conical and pyramidalAvailable in various lengths,Courtesy Hu-Friedy,Band Contouring Pliers,Recontour and adapt O-band around toothBeaks are tapered with slight bowOne beak tip is concave and one is convex,allowing them to fit together for contouring
36、 orthodontic bands,Courtesy Hu-Friedy,Weingart Ultility Pliers,Used to hold orthodontic arch wire when placing or removing from mouthTwo opposing beaks have serrated tips;they may be pointed,straight,or curved,Courtesy Hu-Friedy,Tweed Loop-Forming Pliers,Have one round and one concave opposing paral
37、lel beaks used to form omega loop and various other loops into an arch wire,Courtesy Hu-Friedy,Posterior Band Remover Pliers,Removes posterior bands with two stainless steel beaksOne beak is cylindrical with replaceable nylon tip;other is curved with carbide insertCylindrical beak is placed onto occ
38、lusal surface with curved beak placed on gingival surface of band,Courtesy Hu-Friedy,Pin and Ligature Cutter,Used to cut thin ligature wireBeaks are tapered with carbide inserts that can be replaced or sharpened when worn,Courtesy Hu-Friedy,Howe(110)Utility Pliers,Used for placing bands,tying ligatu
39、re wire,and holding and adjusting arch wire during placement and removalBeaks are round and tapered with serrated pad tips,Courtesy Hu-Friedy,Arch-Forming Pliers,Place form and contour into arch wiresHave a concave,cylindrical-shaped beak that may be grooved or smooth,Courtesy Hu-Friedy,Coon Ligatur
40、e-Tying Pliers,Used for tying wire ligature ties around brackets and/or bands and arch wireBeaks are fine serrated and narrow to allow ease in ligature tying,Courtesy Hu-Friedy,Distal End Cutter,Cuts and holds(magnetic insert)the distal ends of arch wires that protrude distally from the buccal tube,
41、Courtesy Hu-Friedy,Orthodontic Treatment,More than aligning teethModifies and corrects facial growth using different appliances by placing force,torque,and pressure over a period of timeSome appliances are used to primarily move teeth(orthodontic),whereas others are used“orthopedically”to modify fac
42、ial growthCan begin after case presentation,providing all decayed teeth are restored and dental cleaning is completed,Fixed Appliances/Braces,Exert more pressure than removable appliances and can achieve more complex movementsConsists of small bracketsmolar bandsarch wireAuxiliariesThe teeth are mov
43、ed in 6 directions:mesial,distal,lingual,facial,apical and occlusal,Special Fixed Appliances,Used prior to,during,or after regular orthodontic bracket treatmentCemented in place and have a specific function during a phase(s)of treatmentTypes include lingual arch wire,space maintainer,palatal expansi
44、on appliances,and habit correction appliance,Lingual Arch Wire Appliance,Conforms to lingual aspect of mandibular dental arch,which is attached to molar bands that are cemented around first molarsUsed to promote or prevent tooth movement until permanent eruption takes place,Lingual Arch Wire,Space M
45、aintainer,Fixed appliance worn to prevent adjacent teeth from moving into space left by an unerupted or prematurely lost toothConsists of band and wire loop soldered togetherWire loops provide space to allow permanent tooth to eruptCome in several varieties that adapt to patients needs,Space Maintai
46、ner,Expansion Appliance,Placed to widen narrow upper jaw and correct cross biteUsed to spread midpalatal suture,creating space where new bone cells are generated and mesh togetherMade up of acrylic palatal portion attached to stainless steel frameworkInside acrylic portion a screw-like device is pla
47、cedSpecial key turns screw at precise intervals,which puts pressure onto palateEffectively minimizes or eliminates the need for braces when patient gets older,A Palatal Arch Expander,Orthodontic Treatment Sequence,Application of separatorsPlacement and cementation of posterior bandsPlacement and bon
48、ding of bracketsInsertion of arch wire and application of ligature ties or elastomeric tiesInterval adjustment checksBand and bracket removalPlacement of fixed or removable retention devices,Separators,Provide space and opens the contact points so they properly fit the molar bandsTo achieve their pu
49、rpose,they should stay in place for one weekSeveral typesWireSteel springsElastomeric(elastic)separators,Orthodontic Bands,Stainless steel circular metal strips May have various components welded or soldered Come in various sizes,are anatomically correctDivided into maxillary and mandibular right an
50、d leftOcclusal edge is contoured or rolledGingival edge is straight and smooth,Fitting the Molar Bands,Maxillary and mandibular bands are initially seated on tooth by finger pressure on mesial and distal surfacesAfter initial placement a band pusher is used on mesiobuccal and distolingual edges to s
