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Dr shabeel pn

Orthodontics: Current Concepts in Diagnosis and Treatment Planning. Dr shabeel pn. 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)

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Dr shabeel pn

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  1. Orthodontics: Current Concepts in Diagnosis and Treatment Planning Dr shabeel pn

  2. 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

  3. Orthodontist are Responsible for; • Monitoring growth and development • Correcting problems associated with growth and development • Syndromes – Down’s, Apert’s, Crouzon’s, 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

  4. 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

  5. PART II. What to look for… • Age <6 (primary) • Age 6-8 (early mixed) • Age 9-11 (mixed) • Age 11 - Adult (late mixed-permanent)

  6. Part III:Diagnosis and the Extraction/Non-Extraction Situation Depends on Time…. May start with this next time

  7. 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

  8. What are the potential problems? • Abnormal Wear of the teeth • Abfraction/Abrasion • Failure of restored teeth/crowns/bridges

  9. Abnormal Wear Abfraction Abrasion

  10. 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

  11. 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

  12. 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

  13. 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

  14. Midlines in good alignment

  15. Overbite ~15% (1.5-2mm), No black triangles at incisal embrasures

  16. Angulation of the anterior teeth increases from the midline

  17. Reasonably Level Curve of Spee

  18. Angulation of Posterior segment near vertical from Buccal View

  19. FACIAL PROPORTIONSandSOFT TISSUE SUPPORT

  20. 1/3 1/3 Upper Facial Height = Lower Facial Height

  21. 1/3 2/3 Upper Lip Length = ½ Lower Lip Length

  22. A YOUTHFUL smile shows all of the upper incisor length (and some gingival tissue)

  23. Lips touching a line connecting center nose to chin point

  24. PART II. What to look for… • Age <6 (primary) • Age 6-8 (early mixed) • Age 9-11 (mixed) • Age 11 - Adult (late mixed-permanent)

  25. Age <6 (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

  26. Age 6-8 Fact: If the molars are a full step Class II they will NOT correct to a class I • Eruption of: • 1st Molars • Dental-Class I, II, III • Central Incisors • Adequate room • Rotations/crossbite • Diastema • Lateral Incisors • Adequate room • Rotations/crossbite • 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

  27. 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’

  28. Class II, Div I MB cusp of Maxillary 1st molars in B Groove of Mandibular 1st molars What is the most probable cause of the flaring and space?

  29. Class II, Div I The Lower Lip

  30. Class II, Div 2 Deep Bite Always Present Both arches tend to be crowded, with blocked out teeth

  31. 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

  32. Age 7 Narrow Upper Arch 1.5mm diastema Crowding of laterals

  33. AGE 7

  34. 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

  35. Tongue Thrust

  36. 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

  37. E-Space 1 1 2 2 3 A B 3 C 4 4 D 5 E 6 E- Space ~1.3 mm/side 6

  38. 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

  39. Crowding/Blocked out Canines

  40. Impacted Canines

  41. Age 11 - Adult • Determine • Dental-Class (molars and canines) • Skeletal-Class • OJ/OB • Alignment • Space/Crowding • Canine guidance (FUNCTION!!!)

  42. 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

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