????? ( Orthodontics )

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?????( Orthodontics )

• ???????????????
• ???????

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??

• ????????????????????,?????????????????
  ???????????
• Orthodontics Dentofacial Orthopedics
• Malocclusion Dentofacial Deformity
• ?????
• ?????(?????)
• ??? (??)
• Orthodontics (?????)

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• ????????
• What is Dentofacial Deformity ?

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Dentofacial deformity

• A malformation of the teeth, jaws and/or face
  characterized by disharmonies of size, form
  and/or function. The term encompasses problems
  such as malocclusion, cleft lip and palate and
  other skeletal or soft tissue anomalies, or
  syndromes that involve the face and the
  dentoalveolar complex.

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??

• ?? ???????
• 1 ?????,??????????
• 2 ??????????
• 3 ????????????

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??

• ??????
• ??????? 60s 29.33 - 48.87
• 2000s 51.84
  72.92
• ????? ( Individual Normal Occlusion)
• ????? ( Ideal Normal Occlusion )
• ?????? ( Incisor Irregularity Index )

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ABCDE Anterior lower incisor crowding
0-1 ideal 2-3 mild crowding 4-6
moderate crowding 7-10 severe crowding gt 10
extreme crowding
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??

• ?????
• 1 ??????
• 2 ????
• 3 ???????
• 4 ?????

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??????????

• Relation between size of overjet and
• prevalence of traumatised anterior teeth
• Overjet (mm) Incidence
• 5 22
• 9 24
• gt9 44

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??

• ?????????
• 1. ???????????
• Andrews ?????????
• ???????????
• ??????????
• ?????Spees??????

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??

• ???????
• 2. ????(Harmony)
• ??(Stable)
• ??(Aesthetic)
• Dr.Graber To improve the patients life by
  enhancing dental and jaw function and
  dentofacial esthetics. ( purpose )

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??

• ?????????
• ?????????????????????????1000???,??????
  ??Etruscan?????????

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??

• 1850?,Norman Kingsley ??Oral
  Deformitis?????????,??19????????????????,????????
  ??????????,?????????????

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??

• ????????????????,???????????,??????????
  ??????

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??

• Edward H Angle???????????????,???????
  ????????,???????????????????????????????????????,?
  ????????????

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??

• 1890?????????????????,????????????,???????????
  ????,????????????????????? ????,?????????????????
  

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??

• ??,?????????????????,?????????????????
  ?,????????????????,????????,????????,?????????????
  

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??

• ???????,??????????????????????????????
  ????,???????????????????20??30???,Tweed
  ?????????????????????,???????????????

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??

• X-?????????????????????????????????????
  ???????????????????????,????????????????,?????????
  ????????

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??

• ??21????,?????????????
• ? ????????????,???????????????

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??

• ? ??????????????????????,????????????,????????
  ?????????

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? ???????????????,???????????????????????????????,
????????????? (Multidisciplinary Treatment )
(Interdisciplinary Treatment )
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??

• ??????????????????????????????,????????
  ?????????????????????????????,????????????????????
  ?Angle??????????????

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??

• ??????????????
• ????????????,???????????????????????????
  ???????????????,????????????????????????????????
  ?????????????

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??

• ???????????
• 1. ?????(Preventive Orthodontics)
• ????
• ??????
• ???????
• ?????
• ????????

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??

• ?????????
• 2. ?????(Interceptive Orthodontics)
• ????
• ????????

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??

• ?????????
• 3. ?????
• ??????
• ?????
• ??????
• Invisalign ???

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????????????
?????????????????
????
??
?????
???
?????
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??

• ?????????
• 4. ??-????
• Orthognthic Surgery
• Surgical Orthodontics
• Distraction Osteogenesis

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????????
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????????
Le Fort I?II?III ???
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????????
??????
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????????
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????????
????? Maxillar Impaction
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????????
??????
??????
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??

• 20??????????(Moorrees)
• Monobloc??????,1920,Pierre
• Edgewise???,1928,Angle
• Begg?Straight-wire?Tipedge
• X-?????,1931,Broadbent
• ???????,1941,Tweed
• ???????????
• ????,????????????????ß?
• ????,Burstone,???????????
• ????
• ???????
• ??????, 80s

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??

• 21?????????
• Craniofacial growth and development
• Biology of tooth movement
• Biomechanics and Materials
• Computer use in orthodontics
• Diagnosis and Treatment
• Interdisciplinary Treatment

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??????Craniofacial Growth and Development

• ?????????????
• ???????

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????????????
???????????
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8 months, 6 y, 8 y and 20 y old
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??????

• ???????????????
• ????
• ????
• ???????

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??????

• ???????????
• 1. ????
• ???? (Craniometry) (??)
• ???? (Anthropometry) (??)
• X-????? (Cephalometry )

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Craniometry
Cephalometry
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• Anthropometry

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Anthropometry

• ?????????????
• ??????
• ????
• ????
• ?????
• ??????????
• ?????????
• ????????

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??????

• ???????????
• 2 ??
• ???? ( Vital staining )
• ?????? (Radioactive Tracer)
• ????? (Implant radiography)
• ?????(Molecular Genetics)

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?????????
???????? ??????
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• General concepts of Growth
• Growth Assessment
• Bone formation and growth control
• Growth of cranial complex

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Growth and Development

• Terminology
• Growth
• Development
• Pattern, Variability, and Timing

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??????

• ??????????
• 1. ??? (Growth Patten)
• ???? ??????????
• ??????????
• ?????
• ?????

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Pattern

• Normal growth pattern
• ex) Changes in overall body proportions
• Cephalocaudal gradient of growth

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Pattern
Scammons Curve
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?????
?????
?????
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??????

• ??????????
• 2. ??? (Variability)
• ??????????,????????????????????????????????????
  ??????????????

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Variability

• Racial and ethnic differences
• Gender
• Sickness
• nutrition
• Timing factor -Late/early maturers
• Problems with growth (hormones or genetics)

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??????

• ??????????
• 3. ??? ( Timing )
• ???????????????,?????????,????????????????????
  
• ??????

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Timing Variation

• Early, average, and late matuerers
• Chronological age vs. Developmental age

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??????
?????????? 4. ???????
??????????????????????????????????,???????????????
???????????????
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Why do we assess growth?

• To determine optimum time for treatment (growth
  modification and surgery)
• to determine the amount of growth left
• to determine type of growth

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??????

• ??????????
• 5. ?????????
• (Growth site and Growth center)
• ?????????,???????????,??????????????

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Growth center

• A location at which independent (genetically
  controlled) growth occurs, as opposed to a growth
  site, which is merely a location at which growth
  occurs. All growth centers also are growth sites,
  whereas the reverse is not true. For example, as
  a result mainly of transplantation studies, it is
  now known that the sutures between the membranous
  bones of the cranium and the maxilla that
  previously were considered as primary growth
  centers, actually are mere sites of growth.

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???

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??????

• ????????????
• 1. ?????
• Bolton - ????
• Frankfort??(????)
• ????

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Bolton - ????, A line connecting points Bolton
and Nasion an alternate representation of the
cranial base.
Frankfort??
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?????(S-N)Representing the anterior cranial base.
A line joining points S and Na.
?????(N Ba) To represent the cranial base more
accurately than the SN line or the Bolton plane.
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??????
???????????? 2. ??????? ? ??????
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??????
???????????? 2. ??????? ?
?????????? ????????? ????
?????? ?????????????????????????,?????
?????
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Reserve zones (RZ) ??? Proliferating zones
(PZ) ??? Prehypertrophic zones (PHZ)
???? Hypertrophic zones (HZ) ???
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Reserve zones (RZ) ??? Proliferating zones
(PZ) ??? Prehypertrophic zones (PHZ)
???? Hypertrophic zones (HZ) ??? Articular
cartilage (AC) Growth cartilage (GC)
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??????
???????????? 3. ??????? A. ??
????? ????? ??????????????
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??????
???????????? 3. ??????? A. ??
??(6-7????90)
????Aperts???
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??????
???????????? 3. ??????? B. ??
??????????? ????????????
(???????????)
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??????
???????????? 3. ??????? B. ??
???????? ,? gt? gt ? ???? ????????1/3?
???
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??????
???????????? 4. ?????? A. ???
(??????) ( Nasomaxillary Complex)
?????????,??????????????????????????
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??????
???????????? 4. ?????? B. ???
?????? ?????? ??? ?? gt
?? gt ??
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???????
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???????????? 5. ???????? A. ????
?????????,?? ???????
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????
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???????????? 5. ???????? B. ????
?????? ??????
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???????????? 5. ???????? B. ????
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??????
???????????? 5. ???????? B. ????
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????????
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• 5. ????????
• C. ????
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• ?????RPE
• ?????????

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??????
???????????? 6. ???????? A.
??????????? ?,?????????? ??????????

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??????
???????????? 6. ???????? B. ????
????? ???
????
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??????
???????????? 6. ???????? B. ????
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???????????? 6. ???????? C. ???????
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??????
???????????? 6. ???????? C. ???????
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??????
???????????? 6. ???????? C. ???????
?????????? ????????,????
??????,???????
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??????
???????????? 6. ???????? D. ??
???????????????
,??????????? ??? 140 - 160? ??? 125? ???
??
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??????
???????????? 6. ???????? D. ??
???? ???? ??? 35 100 ???
65 100 ?? ????????????
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??????
???????????? 6. ???????? E. ????
??????????????? ????????,??????? ?,???????????
?? ?????? 1.5?,??????, ??????????????
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??????
???????????? 6. ???????? F. ????
???????? ??????
??????
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??????

• V??????
• Enlow??? V????
• ?????????V??????,??????V?????,????
  ????,???V??????????????,?????????????

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V????? ??????
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When things go wrong

• Congenital craniofacial malformations cleft
  lip/palate, syndromes (Apert, Crouzon, etc..),
  craniosynostosis
• Non-syndromic craniosynostosis
• Trauma
• Ankylosis
• Juvenile rheumatoid arthritis

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When things go wrong

• Blow to one side of the mandible may fracture the
  condylar process on the opposite side
• pull of the lateral pterygoid muscle distracts
  the condylar fragment including all the cartilage
  resorption occurs

Trauma
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• ????????
• ???????????????,??????????????????????
  ??????????????,??????????????????????,????????????
  ????????????????????

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??????

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• ????????????????,???????

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??????

• ??????
• ?????????????,?????????????,???????????
  ??????(Epigenetic)?

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??????

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• 20?? 60??Moss??????????,????????????????
  ??????,?????????????,???????????????
• ??????????????????????????????????????
  

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??????
??????????? (?). ????? 1
????????? 2 ?????????,????? ????????
3 ????????????
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??????
??????????? (?). ????? 4
???????? ????????? 6 - 8????
?????????? 2 -3? ??????????? ??
I II IV III V
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??????
??????????? (?). ?????? 5
???? ?????????????? ????? ??? 60 -
70 ???? ???
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Classification of Occlusion of the Primary Second
Molar

• Look at the distal aspect of the 2nd molar
• Flush terminal plane
• Mesial step
• Mesio step
• Disto step

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Flush Terminal Plane
Distal
Mesial
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Mesial Step
Distal
Mesial
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Mesio Step
Mesial
Distal
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Disto Step
Distal
Mesial
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??????
??????????? (?). ?????? 1
???? 2 ????? 3 ???,??? 4
?????????????? ?????????
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No Primary Spacing
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??????
??????????? (?). ????(?????) 1
???????????? ???,???????
????????,????? ??,???????? ??????????,??
????
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??????
??????????? (?)????(?????) 1
????? ????????????? ?????35 -
40 ??70?????50 ?????50
?????25 - 30
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??????
??????????? (?). ????(?????) 2
???????? ?? 6 ? 12? ???? 6 1 2 4
3 5 7 6 1 2 4 5 3 7 ??
6 1 2 3 4 5 7 6 1 2 4 3 5 7
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??????
??????????? (?). ????(?????) 3
????????? ??????68.2 ??????74.0 ??????
61.8 ??????64.4
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• 3 ?????????
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• (?). ????(?????)
• 3 ?????????
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• ??? ??????????
• ?? gt ?????

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????????
??????????
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??????
??????????? (?)????(?????) 3
????????? ??????? Leeway
Space(????) ?? 0.9 - 1.0 mm/? ?? 1.7 -
2.0 mm/?
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??????
??????????? (?)????(?????) 4
????????????? ?????????????? ??a ????????
gt ? b ?????????? ?????????????????????
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??????

• ???????????
• (?)????(?????)
• 5 ?????????
• ???????
• ?????????????
• ???(?????)?????
• ?????????(????)
• ?????? (????)

150
7 years old
9 years old
14 years old
Changes in the axial inclination due to the
eruption of the maxillary anterior teeth
(Broadbent, 1957).
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????????

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• Summary
• Growth way of craniofacial bones
• cellular level
• Hypertrophy
• Hyperplasia
• Increased production of extracellular matrix
• Growth of the Cranial Vault and Base
• Growth of Maxilla (Nasomaxillary Complex)
  Resorption ?Apposition
• Growth of Mandible (Length?Width?Height)
• Theories of Growth Control
• Bone
• Cartilage
• The soft tissue matrix in which the skeletal
  elements are embedded - 60s Functional Matrix
  Theory by Moss
• Growth of Occlusion

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