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Darby Ch. 40 Orthodontic Care (Examples of Common Fixed Orthodontic…
Darby Ch. 40 Orthodontic Care
Orthodontics
dental specialty that deals with the recognition, prevention, and treatment of conditions involving irregularities of the teeth, jaw, and face, and their influence on the physical and mental health of a person
Goal of Orthodontics
establish or maintain a normal functioning occlusion
improve or maintain good facial asthetics
promote long-term stability
establish the best physiologic position of the condyle in the TMJ
establish periodontal health
AAO recommends an orthodontist examine a child by the age of 7, based on three main factors:
posterior occlusion is established when the first permanent molars erupt. It is at this time that basic occlusal relationships can be evaluated
incisors have begun to erupt, leading to identification of crowding, deep or open bites, or other jaw discrepencies
for some, early detection and interceptive treatment can lead to more effective treatment plans
Effects and Treatment Risks
orthodontic force on the Maxilla
force on the teeth and the periodontium
Malocclussion
not a diseased state
deviation from the normal relationship of the maxillary arch or teeth
can occur in the sagittal plane, the transverse plane, or the occlusal plane
Two Origins:
first is founded in genetic discrepancies
can be skeletal or dental
Example of Genetic Discrepancy: overcrowding, supernumerary teeth, narrow jaw, and premature or late exfoliation
Example of strictly Dental malocclusion: individual tooth placement or tipping of teeth within the arch or a posterior crossbite
second is caused by trauma or parafunctional habits
example: thumbsucking, clenching, grinding, and other habits outside of the range of normal speech and mastication that affect normal growth and developmental patterns
Effects of Malocclusion
psychosocial problems caused by poor facial aesthetics, poor word enunciation
increased plaque biofilm, debris, and stain retention contributing to periodontal disease
ex: gingival recession, mucogingival problems, alveolar defects
oral function problems, such as difficulties with chewing, swallowing, and speech
injury cased by trauma to and breakage of malpositioned
temporomandibular dysfuction, a chronic impairment or discomfort of the function of the TMJ
Examples of Common Fixed Orthodontic Appliances
Archwire
held in place by brackets bonded to tooth. Held in place by ligature typically.
Applies pressure
Self-Ligating Brackets
require no additional ligature, therefore reducing friction
holds archwire. no ligature required.
Buccal tube
metal tube welded to the cheek side of a molar band
tube that holds the end of a lip bumper, headgear, or other appliances
Transpalatal Appliance (TPA) / Passive holding device/ or Active with loop
holds upper molars in place to stabilize their position or rotate molars
Ligatures
small ties or rings made of wire or elastic
they fasten the archwire to the bracket
Temporary Anchorage Device
a micro implant inserted through the buccal ridge where elastic band chains can be attached
used to correct mild to moderate anterior open bite and or vertical excess problems. May reduce need for orthognathic surgery.
Bands
bonded to the tooth to securely hold the archwire
usually on molars
Twin Brackets
bonded to th tooth. Metal and Acrylic. May be placed on buccal or lingual surface
holds archwire, requires elastic ligature
Common Fixed Orthodontic Appliances for Jaw Development or Expansion
Nance Holding Appliance (NPA) / Passing holding Device
holds upper molars in place to stabilize their position or rotate molars
maintains maxillary space holding 3 &14. Acrylic button provides additional stability
Palate Expander
can also be removable. requires activation by turning a "key" in an expansion screw
widens the maxilla slowly by stretching the soft cartilage of the palate over the course of the months
Reverse Headgear or Protraction Facemask
used for Class III occlusion correction (deficient growth of maxilla/excess growth of maxilla)
accelerates maxillary growth by using the chin and forehead for support to allow the maxilla to pull ahead of the mandible
Herbst Appliance
a metal tube that connects the mandible and maxilla to create class I occlusion
helps the jaw develop in a forward direction by controlling the mandible's position in relation to the maxilla
can be removable like headgear
Bluegrass, Crib, or Tongue Guard Appliance
Used to block tongue thrusts, trains correct swallow, or arrest thumbsucking habit
Headgear (common removable appliance)
Class II correction (excess growth of maxilla/deficient growth of mandible)
allows extrusion or intrusion of maxillary first molar
Chin Cup (common removable appliance)
normal maxilla. prognathic mandible
restricts mandibular growth
Assessing and Evaluating for Referral for Orthodontic Care
DH must be able to identify features and patterns of normal growth and development versus abnormal
Medical History
medical history can include information related to a potential need for orthodontic referral
medications with orthodontic consideration are antiseizure drugs such as phenytoin that sometimes produce gingival hyperplasia that may slow tooth movement or bisphosphonates that may slow down bone turnover
Intraoral and Extraoral Assessment
occlusion classification and assessment of dentition for malocclusion or alignment occurs during intraoral examination
primary and permanent tooth eruption patterns, primate spaces, or the process in tooth development in which the teeth enter the mouth and become visible
should be evaluated for appropriate or altered sequencing
Photographs
orthodontist or orthodontic dental assistant will take a standard series of intraoral and extraoral photographs of:
full face with lips relaxed
full face smiling
a smiling profile
a nonsmiling profile both left and right
Purpose
to evaluate facial symmetry, profile, and quality and esthetics of smile and gingiva
Lip incompetence
separation of lips by more than 3-4mm
Radiographs
Panoramic Radiography
used to examin the perioral structures for the presence of pathology or for supernumerary, congenitally missing, or impacted teeth
Lateral Cephalometric Radiograph
used to assess the facial and jaw proportions and the skeletal relationship of the jaws to each other and to the base of the cranium, and to determine the need to reposition the anterior teeth
Cone beam computed technology (CBCT)
special type of x-ray equipment used when regular dental or facial x-rays are not sufficient
uses 3D images of the teeth, soft tissues, nerve pathways, and bone in singel scan
Developmental Ages
Skeletal age
development of skeletal system
Chronological Age
patients age in years and months
Dental Age
maturation of the teeth, including clinical errupion
Orthodontic Considerations
size of permanent teeth is accommodated by spacing of the deciduous dentition, growth of the alveolus, and eruption of maxillary incisors
Overretained Primary Teeth
a permanent tooth should erupt when 3/4 of its root is completed
problem usually occurs when the permanent tooth bud develops in a position that is too far lingual to the primary tooth or when a primary molar is still intact and prevents exfoliation
Congenitally Missing Teeth
Early Loss of Primary Teeth
Crowding of Mandibular Incisors
Midline Diastema
more than 2-3mm in size may be caused by:
midline supernumerary tooth
midline soft tissue or intrabony lesion
tooth size discrepancy
missing lateral incisors
low labial frenum attachment