ORTHODONTICS

Orthodontics deals in correcting the teeth and jaw that are positioned unfittingly. Overlapped teeth or crooked teeth that do not fit together correctly are difficult to keep clean. These also bear the risk of early loss due to tooth decay and cause stress on gums and muscles. These problems often lead to headache, and TMJ syndrome – moreover disfigured teeth also hamper one’s appearance.

Orthodontics is aimed towards correcting these anomalies. The benefits of orthodontics treatment include a more pleasing appearance aesthetically besides, enduring the strength of teeth and mouth.

With the help of diagnostic tools including X-rays and photographs an orthodontist recommend the suitable orthodontics treatment after carefully looking at the dental health history and clinically examination. A treatment plan is thus devised, that’s right just for you!

Scope of orthodontic treatment

  • Alterations in tooth position: Orthodontic treatment is made possible by the fact that teeth can be moved through the bone to ideal location by applying appropriate force on them.
  • Alteration in skeletal pattern:Malocclusion may be associated with skeletal disharmony involving the jaw bone. The orthodontist can bring about changes in all the three planes of space i.e, sagital, transverse and vertical.
    1. • The soft tissues that envelope the dentition are greatly influenced by the placement of the dentition.
    2. • It is possible to bring about favourable changes in the soft tissue pattern by orthodontic treatment.

Need of orthodontic treatment

  • • Poor facial appearance
  • • Psychological disturbance
  • • Risk of caries
  • • Predisposition to periodontal diseases
  • • Risk of trauma
  • • Abnormalities of function
  • • Temperomandibular joint problems

Candidate for orthodontic treatment

You are a candidate for orthodontic treatment if you have any of the following conditions:

  • Buck Teeth: It is also called as “Overbite”. It is a condition where the upper teeth lie too far forward or protruding over the lower teeth.
  • Underbite: This is the reverse of overbite or buck teeth – where the lower teeth are too forward or the upper teeth too far backward.
  • Crossbite: It is a condition where while biting, the upper teeth do not come down fully aligned with lower teeth causing problem in biting.
  • Open bite: when open space appears between the biting surfaces of the front and/or side when the upper and lower teeth bite together.
  • Misplaced midline: it can be defined as a condition when the centres of the upper and lower teeth are not aligned with each other.
  • Crowding: when there are too many teeth at the dental ridge

Different types of components like fixed and removable are used to correct the disfigured teeth and help retain muscles and effect the growth of the jaws. These components might put gentle pressure of the teeth and jaws depending on the severity of your problem.

Fixed components include:

  • Braces: Braces are the most common fixed component, which include wires and/or brackets. Bands are used around teeth to act as anchors and provide strength. On the other hand, brackets are most often bonded at the front of the tooth. Arch wires are passed through the brackets and attached to the bands to create tension on the teeth – making them slowly move to their proper position. Now days, braces have become smaller, lighter and much more convenient to carry. They also come in bright and attractive colours for youth.
  • Special fixed appliances: These are used to control the habits of thumb sucking or tongue thrusting. These components are attached to teeth by bands.
  • Fixed space maintainers: Space maintainers are used to keep the open space formed with the loss of baby tooth intact until the permanent tooth erupts.

Removable appliances include:

  • Aligners: Aligners are a good alternative to braces, which is very effectively used by orthodontics to move teeth in a similar way without using metal wires and brackets. Aligners are virtually invisible and can easily be removed while eating, brushing and flossing.
  • Removable space maintainers: These devices solve the same purpose as that of fixed space maintainers. Made up of acrylic base that fits over the jaw and have plastic braches.
  • Jaw repositioning appliances: These are also called splints, which are used to align jaw to close in a more favourable position.
  • Lip and cheek bumpers: These are designed to help lips and cheeks prevent from bucking over to teeth. These are meant to relieve the pressure lips and cheeks might mount on to the teeth in some cases.
  • Palatal expander: A plastic devise, palatial expander is used to widen the arch of upper jaw. Fitting over the roof of the mouth, it mounts pressure on the joints in the bones exerting them to open lengthwise, widening the palatial area.

    The services offered by orthodontist can be broadly classified as :
  • 1.Preventive orthodontics
  • 2.Interceptive orthodontics
  • 3.Corrective orthodontics
  • 4.Surgical orthodontics

Preventive orthodontics

Preventive orthodontics is that part of orthodontic practice which is concerned with the patient’s and the parents education, supervision of the growth and development of the dentition and the cranio-facial structures, the diagnostic procedures undertaken to predict the appearance of malocclusion and the treatment procedures instituted to prevent the onset of malocclusion

  • • PARENT EDUCATION
  • • CARIES CONTROL
  • • CARE OF
  • • DECIDIOUS DENTITION
  • • MANAGEMENT OF ANKYLOSED TOOTH
  • • MAINTENANCE OF TOOTH SHEDDING TIME TABLE
  • • CHECKUP FOR ORAL HABITS
  • • OCCLUSAL EQUILIBRIATION
  • • PREVENTION OF DAMAGED OCCLUSION
  • • EXTRACTION OF SUPERNUMERARY TEETH
  • • SPACE MAINTENANCE
  • • MANAGEMENT OF DEEPLY LOCKED 1ST PERMANENT MOLAR
  • • MANAGEMENT OF ABNORMAL FRENAL ATTACHEMENTS

    EDUCATION OF THE PARENTS
  • • Parents should be educated for maintaining good oral hygiene
  • • Parents should be taught the correct method of brushing the child teeth
  • • Mother is also advised against the prolonged use of pacifiers that can have a detrimental effect on the dentition
  • • Young’s mother also advised on matters pertaining to prevention of nursing bottle syndrome
    CARIES CONTROL
  • • Caries involving the proximal surfaces of the deciduous teeth is not restored leads to loss of arch length
  • • Loss of arch length can result in discrepancies b/w the arch length and tooth material when the bigger teeth erupts
  • • Bitewing radiographs are valuable aid in detection of caries. Once caries is detected proper restoration of affected tooth is done
    CARE OF DECIDUOUS DENTITION
  • • Preventive orthodontics include care of the deciduous dentition by way of prevention and timely restoration of carious teeth
  • • The deciduous teeth are excellent natural space maintainers until developing permanent teeth erupts
  • • Some preventive procedures such as application of topical fluorides and pit and fissure sealants help in preventing caries

    EXTRACTION OF SUPERNUMERARY TEETH
  • • Presence of supernumerary and supplemental teeth can interfere with eruption of nearby normal teeth
  • • Presence of unerupted mesiodens prevents two maxillary centre incisors from approximating each other.

    ELIMINATING OCCLUSAL INTERFERENCE
  • • All functional prematurities should be eliminated as they lead to deviations in mandibular path of closures and predispose to bruxism

    MAINTENANCE OF TOOTH SHEDDING TIME TABLE
  • • There should not be more than 3 months difference in shedding of deciduous teeth and eruption of permanent teeth.

MANAGEMENT OF ABNORMAL FRENAL ATTACHMENTS

  • • The presence of a thick anf fleshy maxillary labial frenum that is attached relatively low prevents the maxillary central incisiors from approximating each other producing a midline diastema.
  • • Presence of ankyloglossia or tongue tie prevents normal functional development due to lowered position of the tongue and abnormalities in speech and swallowing.
    DEEPLY LOCKED PERMANENT 1ST MOLARS
  • • The deciduous second molars occasionally have a prominent distal bulge that prevents eruption of first permanent molars.
  • • Slicing the distal surface of the second deciduous molar helps in guiding the eruption of the first permanent molars.

    Causes of space loss
  • • Premature loss of primary teeth
  • • Unrestored proximal carious lesions
  • • Loss of permanent incisors due to trauma
  • • Congenitally missing teeth
  • • Ectopic eruption of permanent teeth
  • • Dental malformation

    Indications of Space Maintainers
  • • After premature loss of deciduous teeth if space shows signs of closing
  • • Use of space maintainer will make future orthodontic treatment less involved
  • • To improve phonetics, esthetics and mastication
  • • To avoid supraeruption of opposing teeth

    Contraindications of SpaceMaintainers
  • • Congenital absence of permanent teeth
  • • Two third root completion of the erupting permanent teeth
  • • More space available than required to accommodate the permanent successor
  • • Un co-operative patient
  • • Patient with poor oral hygiene


Types

    Types
  • Acrylic partial dentures with clasps
  • Full or complete dentures
  • Removable distal shoe space maintainer

    Indications
  • 1. Aesthetics
  • 2. Lack of abutment
  • 3. Cleft palate patients – obturation of defect
  • 4. Permanent teeth not fully erupted – difficult to adapt bands
  • 5. Multiple loss of deciduous teeth

    Contraindications
  • 1. Lack of cooperation
  • 2. Epileptic patients
  • 3. Allergy to acrylic

    Advantages
  • 1. Easy to clean , esthetic
  • 2. less chairside time
  • 3. Maintain vertical dimension
  • 4. Tissue born – less strain on abutment
  • 5. Tissue stimulation – accelerate eruption of teeth

    Disadvantages
  • 1. Chances of breakage
  • 2. Difficult to adapt due to bulk
  • 3. Lateral jaw growth may be restricted if clasps are incorporated
  • 4. Tissue irritation

    Fixed space maintainers
  • Functional
  • 1. Band and bar space maintainer
    • Unilateral space loss
    • Bilateral space loss with unerupted incisors
  • 2.Crown and bar space maintainer
    • Distal shoe space maintainer Non functional space maintainer

    Band and loop space maintainer
  • Crown and loop space maintainer
  • Fixed Lingual arch
  • Fixed removable type lingual arch

    BONDED SPACE MAINTAINERS
  • Nance holding arch
  • Transpalatal arch

INTERCEPTIVE ORTHODONTICS

Interceptive orthodontics has been defined as phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions of the developing dento-facial complex.

The procedures undertaken in interceptive orthodontics include
  • 1. Serial extraction
  • 2. Correction of developing crossbite
  • 3. Control of abnormal habits
  • 4. Space regaining
  • 5. Muscle exercises
  • 6. Interception of skeletal malrelation
  • 7. Removal of soft tissue or bony barrier to enable eruption of teeth


Serial extraction

  • 1. This method involves planned extraction of certain deciduous teeth and later specific permanent teeth in an orderly sequence and predetermined pattern to guide the erupting permanent teeth into a more favorable position.

  • 2. Serial extraction is an interceptive orthodontic procedure when one can recognize and anticipate potential irregularities in the developing dentofacial complex.

Rationale

  • Arch length-tooth material discrepancy

  • Physiologic tooth movement

Indications

  • Class-I Malocclusion

  • Patients with straight profile and pleasing appearance.

  • Arch length deficiency- absence of physiologic spacing

  • Ectopic eruption of teeth

  • Mesial migration of buccal segment

  • Crowded upper and lower anteriors

  • Ankylosis of one or more teeth

  • Lower anterior flaring

Contraindications

  • Spaced dentition

  • Open bite and deep bite

  • Midline diastema

  • Class II and class III malocclusion

  • Dilaceration

  • Extensive caries

  • Mild dispropotion

Advantages

  • Reduces duration of multibanded fixed treatment.

  • Better oral hygiene.

  • More physiologic

  • More stable

  • Lesser retention period

Disadvantages

  • It requires clinical judgment.

  • Takes 2-3years.

  • Patient cooperation is needed.

  • Ditching exist.

  • Tendency of developing tongue thrust.


DEVELOPING ANTERIOR CROSSBITE

  • It should be treated at an early age so as to prevent minor orthodontic problem progressing into dentofacial anomaly.

  • It can be of three types

  • 1) Dentoalveolar anterior crossbite
  • 2) Skeltal anterior crossbite
  • 3) Functional crossbite

Interception of habits

Habits that affects oral structure are :

  • Thumb sucking

  • Tongue thrusting

  • Mouth breathing

Thumb sucking

  • This is considered normal up to 2 and half to 3 years of age.

  • Persistence of this habit beyond3and half to 4 years of age have a damaging influence.

  • It is interceptive by use of habit breakers.

Tongue thrust

  • Tongue thrust :- It is defined as a condition in which tongue make contact with any teeth anterior to molars during swallowing.

  • This is treated by use of habit breakers.

Mouth breathing

  • Mouth breathing :-has a profound effect on dento -facial region.

  • Obstructive mouth breathing is the result of nasal polyps, nasal tumors and deviated nasal septum.

  • Vestibular screen is used to intercept habit.

SPACE REGAINING

  • If a primary molar is lost early and space maintainers are not used , a reduction in arch length by mesial movement of the first molar occurs.

  • The space lost can be regained by distal movement of the first molar.

  • The space regaining procedures are undertaken at an early age prior to the eruption of the second molar.


MYOFUNCTIONAL APPLIANCES

It is defined as an appliance that employs muscle forces derived from the orofacial musculature using growth potential.


    INDICATIONS
  • During pubertal growth spurt 9-12yrs(females) 11-14yrs(males)
  • For any skeletal discrepancies -class 2,class 3,open-bite cases
    BITE PLANES
  • Bite planes are extensions of acrylic base frame work. They can be flat or inclined bite planes.
  • LOWER INCLINED PLANE/INCISAL CAPPING/CATLAN’S APPLIANCE
  • introduced by CATALAN
  • used for correction of cross bite

    ORAL SCREEN/VESTIBULAR SCREEN Indications
  • 1.Mouth breathing
  • 2.Thumb sucking
  • 3.Lip biting
  • 4.Tongue thrust
  • 5.Mild disto occlusions with pre maxillary protrusion & open bite in deciduous % mixed dentition
  • 6.In the presence of flaccid,hypotonic,orofacial musculature as muscle exerciser
  • 7.For the correction of proclined upper anterior teeth

    ACTIVATOR INDICATIONS:
  • 1.CLASS 2 DIV 1
  • 2.CLASS 2 DIV 2
  • 3.CLASS 3
  • 4.OPEN BITE
    ACHIEVES THE FOLLOWING CORRECTIONS
  • 1.Expands the upper arch
  • 2.Positions the mandible forward & corrects class 2 molar relation to a class 1 molar relation/skeletal discrepancy
  • 3.Retracts upper incisors
  • 4.Corrects deep bite
  • 5.Corrects lower incisor crowding or proclination which ever present

TWIN BLOCK APPLIANCE

  • effectively combines inclined planes with intramaxillary & extra oral traction
  • The appliance consists of an upper & a lower plate having occlusally inclined bite planes that induce favorably directed occlusal forces by causing a functional mandibular displacement.
  • The upper & lower bite blocks interlock at a 45 degree angle


    INDICATIONS
  • 1.Correction of class 2 malocclusions due to retrognathic mandible
  • 2.Used as an anterior repositioning splint in patients having tmj disorders

    SPECIFIC INDICATIONS
  • 1.Post adolescent patients
  • 2.Mouth breathers
  • 3.Un co-operative patients