Dr shabeel pn

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Orthodontics Current Concepts in Diagnosis and
Treatment Planning

• Dr shabeel pn

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Questions that make ya go.uhhhh
Which teeth should be the main tooth in contact
during function? What dimension of the face/head
is the first to stop growing? Antero-Posterior?
(Front to back) Width? (Side to Side) Vertical?
(Length) At what age, when looking at a Panoramic
Radiograph, if the 3rd molars are not present
will they not be there in the future? If a tooth
is missing or extracted at what age can they
proceed with implant replacement? What
dimension of the face has to be completely done
growing before the implant is placed? What X-Ray
gives us growth information?
CANINES
15 Yrs
18-19 girls, 19-20 boys
VERTICAL
HAND-WRIST
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Orthodontist are Responsible for

• Monitoring growth and development
• Correcting problems associated with growth and
  development
• Syndromes Downs, Aperts, Crouzons,
  Hemifacial Microsomia, etc
• Cleft Lip and Palate
• Congentially missing teeth
• Jaw growth issues (genetic or environmental)
• Eruption problems
• Correcting functional relationships of the teeth
• Improving Esthetics

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PART I. Touching the Surface ?

• Orthodontics Necessary or Not?
• Eruption timing of the teeth
• Defining Ideal GEOMETRIC Relationships of the
  permanent dentition
• (Lines/planes/angles)

All Patient Photos Used With Permission
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PART II. What to look for

• Age lt6 (primary)
• Age 6-8 (early mixed)
• Age 9-11 (mixed)
• Age 11 - Adult (late mixed-permanent)

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Part IIIDiagnosis and the Extraction/Non-Extrac
tion Situation
Depends on Time. May start with this next time
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Orthodontics Necessary or Not?

• Need to identify and inform if there is anything
  outside the envelope of ideal
  alignment/function.
• It is up to them to take the next step to seek
  out their options, but relieves you from
  responsibility of not informing them of the
  potential problems associated with a less-than
  ideal functional bite

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What are the potential problems?

• Abnormal Wear of the teeth
• Abfraction/Abrasion
• Failure of restored teeth/crowns/bridges

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Abnormal Wear
Abfraction
Abrasion
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What are the potential problems?

• Abnormal Wear of the teeth
• Abfraction/Abrasion
• Failure of restored teeth/crowns/bridges
• Loss of periodontal support
• TM joint problems associated with abnormal jaw
  posturing during function

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What are the potential problems?

• Abnormal Wear of the teeth
• Abfraction/Abrasion
• Failure of restored teeth/crowns/bridges
• Loss of periodontal support
• TM joint problems associated with abnormal jaw
  posturing during function
• Inability to clean teeth

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Defining Ideal

• Geometric tooth relationships
• Static - at rest when all the teeth are in
  contact
• Function not able to touch this today
• Dynamic during chewing
• If we understand the IDEAL adult goal it will be
  easier to identify problems during growth

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Geometric relationships (static)

• Positive Overjet Anterior and Posterior
• Near Level Curve of Spee
• Sufficient canine vertical overlap to ensure
  canine guidance
• Overbite dictated by protrusive disclusion
• Cusps of Molars on a PLANE

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(No Transcript)
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Midlines in good alignment
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Overbite 15 (1.5-2mm), No black triangles at
incisal embrasures
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Angulation of the anterior teeth increases from
the midline
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Reasonably Level Curve of Spee
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Angulation of Posterior segment near vertical
from Buccal View
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FACIAL PROPORTIONSandSOFT TISSUE SUPPORT
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1/3
1/3
Upper Facial Height Lower Facial Height
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1/3
2/3
Upper Lip Length ½ Lower Lip Length
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A YOUTHFUL smile shows all of the upper incisor
length (and some gingival tissue)
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Lips touching a line connecting center nose to
chin point
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PART II. What to look for

• Age lt6 (primary)
• Age 6-8 (early mixed)
• Age 9-11 (mixed)
• Age 11 - Adult (late mixed-permanent)

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Age lt6 (Primary Dentition)

• Skeletal/Dental Class III
• (Midface deficient/Mand excess)
• Crossbite Anterior/Posterior
• Functional shift
• Habits (tongue thrust/thumb sucking)
• Open bite
• No space at age 5-6 Crowding 100 of the time

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Age 6-8

• Eruption of
• 1st Molars
• Dental-Class I, II, III
• Central Incisors
• Adequate room
• Rotations/crossbite
• Diastema
• Lateral Incisors
• Adequate room
• Rotations/crossbite

Fact If the molars are a full step Class II
they will NOT correct to a class I

• Result Will have either
• Class II Div 1 with increased Overjet, possible
  spacing
• Or
• Class II Div 2 with maxillary crowding, deep bite
  and blocked out teeth

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Class II, Div I

• Gl

Facial Angle (Glabella-A-Pg) in a Class I
profile is 168 degrees. with a reasonable
variation Deficient Mandibular Body Length (She
also has an advanced soft tissue A Point due to
flaring of incisors)

• A

• Pg

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Class II, Div I
What is the most probable cause of the flaring
and space?
MB cusp of Maxillary 1st molars in B Groove of
Mandibular 1st molars
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Class II, Div I
The Lower Lip
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Class II, Div 2
Deep Bite Always Present
Both arches tend to be crowded, with blocked out
teeth
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Age 6-8 Continued

• Width
• Positive overjet in all dimensions
• Anterior or posterior crossbites present?
• Functional shifts?
• Anterior-Posterior Jaw Relationships
• Overjet (-/)
• Deficient Maxilla/Excessive Mandible
  (Skeletal-Class III)
• Excessive Maxilla/Deficient Mandible
  (Skeletal-Class II)
• Habits
• Thumb/finger sucking, Tongue thrust

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Age 7
Narrow Upper Arch
1.5mm diastema
Crowding of laterals
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AGE 7
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Functional Shift - Lateral
Shift to the Right

• Lower midline off in the same direction as shift
• Shift is ALWAYS to the crossbite side when
  unilateral crossbite present

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Tongue Thrust
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Age 9-11

• Eruption of
• Mandibular canines (age 9)
• Space available
• Max/Mand 1st Premolars (age 10)
• Space available
• Max/Mand 2nd Premolars (age 11 )
• E-Space!!! very useful for uncrowding and
  correcting Molar class

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E-Space
1
1
2
2
A
3
B
3
C
4
4
D
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E
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E- Space 1.3 mm/side
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Age 11 -12

• Eruption of
• Maxillary canines
• Space available
• High Incidence of Impaction
• 2nd Molars
• Impacted/Ectopic Eruption
• Significant cause for functional interferences in
  adult dentition

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Crowding/Blocked out Canines
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Impacted Canines
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Age 11 - Adult

• Determine
• Dental-Class (molars and canines)
• Skeletal-Class
• OJ/OB
• Alignment
• Space/Crowding
• Canine guidance (FUNCTION!!!)

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Adult

• Vertical Facial Development
• Excessive/deficient tooth display on smiling
• Gummy smile
• Bite Tend to Deepen With Age (OB)
• Lower Anterior Crowding (not caused by 3rds)
• Bruxism
• TMJ Disorders
• Interferences
• Third molar issues