Tiêu đề Clinical (Orthodontics).pdf ✅

www.purebasic.com.bd | Dr. Sarwer Biplob Clinical Note 2020 | Orthodontics | Pure Basic 1 Pure Basic Clinical Note 2020 Orthodontics For FCPS Part-1, MS & DDS Admission Preparation Dr. Sarwer Biplob BDS. FCPS (ii). MS (Course) Oral & Maxillofacial Surgery Medical Officer Faculty of Dentistry, BSMMU Founder, Pure Basic www.purebasic.com.bd 0163 888 5050
2 1. Introduction to Orthodontics Aims/Goals of orthodontic treatment (MS-March-10, 09, January- 07) The aims and objectives of orthodontic therapy have been summarized by Jackson as The Jackson's triad. The three main objectives of orthodontic treatment are: a. Esthetic harmony - By far the most common reason for seeking orthodontic care is to improve the appearance of the teeth and face. b. Functional efficiency - Many malocclusions affect normal functioning of the stomatognathic system. The orthodontic treatment should thus aim at improving the functioning of the oro-facial apparatus. c. Structural balance - Stable orthodontic treatment is best achieved by maintaining a balance between these three tissue systems. The orthodontist should strive to achieve these three main objectives of treatment. Roth Williams’s concept of goals of orthodontics. A goal-oriented orthodontic treatment is advised. 1. Functional occlusion 2. Aesthetic 3. Facial harmony 4. Long term stability 5. Patient satisfaction 6. TMJ health 7. Periodontal health Scope of orthodontic treatment Orthodontic treatment involves the three main tissue systems. It can bring about changes/alteration in - 1. Dentition/Tooth position 2. Skeletal pattern 3. Soft tissue pattern Services offered by the orthodontist (scope/division) A. Preventive orthodontics. B. Interceptive orthodontics. C. Corrective orthodontics. D. Surgical orthodontics. 2. Preventive Orthodontic and Interceptive Orthodontics Preventive orthodontic or interceptive orthodontics deals with (MS-March-12, 12, 10, 10, 09 DDS-12) Preventive procedures Interceptive procedures 1. Pre-dental procedure 2. Parents education 3. Care of deciduous dentition, Oral hygiene 4. Caries control, restoration of decayed teeth 5. Space maintenance 6. Removal of supernumerary teeth 7. Prevention of ectopic eruption. 8. Grinding of cusp/Occlusal equilibration if there are any occlusal 9. Management of tongue tie 10. Checkup (recognize) for oral habits and habit breaking appliance & motivation. 11. Management Of ankylosed tooth 12. Extraction of prolong retained deciduous teeth, maintenance of quadrant wise tooth shedding time table 13. Prevention of damage to occlusion e.g. Milwaukee braces 14. Management Of deeply locked first permanent molar 15. Management of abnormal frenal attachments 1. Correction of developing cross bite. 2. Diastema closure 3. Muscle exercises 4. Space regaining (Space regainer), Management of reduction in arch length (perimeter) 5. Serial extraction, Resolution of crowding 6. Disking/Slicing 7. Bruxism management 8. Equilibration of occlusal disharmonies 9. Abnormal habit control (Habit breaking appliance) 10. Early detection and treatment of eruption problems e.g. Removal of soft or hard tissue impediments in the pathway of eruption 11. Interception of skeletal malrelation Space Maintainers Types (MS-March-10) Fixed space maintainers a. Functional type • Crown and bar • Band and bar b. Non-functional type
3 • Band and loop – Most commonly used. • Nance space holding arch/Nance appliance • Transpalatal Arch (TPA) • Lingual holding arch • Bonded space maintainer c. Cantilever type • Distal shoe space maintainer Removable space maintainers: a. Acrylic partial dentures b. Full or complete dentures c. Removable distal shoe space maintainer Prerequisites for Space Maintainers (MS-March-09) There are certain prerequisites for all space maintainers, whether they are fixed or removable. 1. They should maintain horizontal space or, the mesiodistal dimension of the lost tooth. 2. If possible, they should be functional, at least to the extent of preventing the overeruption (vertical space) of the opposing tooth or teeth. 3. They should be as simple and as strong as possible. 4. They must not endanger the remaining teeth by imposing excessive stresses on them. 5. They must be easily cleaned and not serve as traps for debris, which might enhance dental caries and soft- tissue pathology. 6. Their construction must be such that they do not restrict normal growth and developmental processes. 7. They should not interfere with functions, such as mastication, speech or deglutition. 8. They should allow eruption of successor tooth. 9. They should be able to provide mesiodistal opening, if required. Serial extraction Tweed has defined it as tile planned and sequential removal of the deciduous and permanent teeth to intercept and reduce dental crowding problems. Different authors have given different sequences for following guidance of occlusion. Some of the most common and accepted sequences are: a. Tweed's method – DC4 b. Dewel's method – CD4 c. Nance's method – D4C d. Crewe's method. Indication 1. Class I malocclusion with an arch size-tooth size deficiency of 5 mm or more per quadrant, normal eruption sequence as assessed radiographically and a skeletal growth pattern within normal limits. 2. Arch length deficiency as compared to the tooth material is the most important indication for serial extraction, which could be unilateral or bilateral, is indicated by: a. Non-pathoiogic i. Absence of physiologic spacing ii. Markedly irregular or crowded upper and lower anteriors iii. Midline shift of mandibular incisors due to displaced lateral incisors. Malpositioned or impacted lateral incisors that erupt palatally out of the arch. iv. Premature unilateral or bilateral premature loss of deciduous canines with midline shift. v. Abnormal canine root resorption. vi. Canine being blocked out labially. vii. Mandibular and maxillary anterior teeth that are proclined (bimaxillary protrusion), could be associated with crowding. viii. Gingival recession on the labial aspect of mandibular anterior. ix. Ectopic eruption. x. Mesial migration of buccal segment. xi. Abnormal eruption pattern & sequence. xii. Lower anterior flaring. b. Pathologic i. Extensive proximal caries and subsequent mesial migration of the teeth distal to the carious lesion. ii. Premature loss of deciduous tooth and lack of subsequent space maintenance. iii. Deleterious oral habits. iv. Improper proximal restorations. v. Tooth ankylosis. 3. Where growth is not enough to overcome the discrepancy between tooth material and basal bone. 4. Patients with straight profile and pleasing appearance. Contraindication (MS-March 10)
4 1. Mild to moderate crowding-tooth size arch length deficiency < 5 mm per quadrant 2. Class II division 2 and Class III and Class III malocclusions with skeletal abnormalities. 3. Spaced dentition. 4. Congenital absence-anodontia/oligodontia. 5. Extensive caries or heavily filled first permanent molars, which cannot be conserved. 6. Open bite and deep bite, which should be corrected first. 7. Midline diastema 8. Class I malocclusions with minimal space deficiency 9. Unerupted malformed teeth e.g. dilacerations 10. Mild disproportion between arch length and tooth material that can be treated by proximal stripping 11. In cleft lip and palate cases Oral Hygiene Parents and children should be taught oral hygiene measures. The recommended oral hygiene measures for different age groups are- • Infants (0–1-year-old): Plaque removal activity or brushing should start with the eruption of first primary teeth. Parents should do the cleaning act. Moistened gauze or wash cloth can be used to gently massage the gums and clean the teeth. • Toddlers (1–3 years old): Toothbrush should be introduced. Non-fluoridated pastes are advised, since the child may ingest the toothpaste. Parents should brush for the child. • Preschoolers (3–6 years old): Children should brush under parental care. Fluoride toothpaste is introduced. • School aged (6–12 years old): Proper brushing technique and regular brushing by the child. • 3. Development of Dentition and Occlusion Periods of occlusal development: 1. Predental period 2. The deciduous dentition period 3. The mixed dentition period 4. The Permanent dentition period Deciduous dentition Characteristics: The initiation of primary tooth buds occurs during the first six weeks of intra-uterine life. The primary teeth begin to erupt at the age of about 6 months. The eruption of all primary teeth is completed by 21⁄2- 31⁄2 years of age when the second deciduous molars come into occlusion. Root formation of all deciduous teeth is completed by 3 years of age. Signs of normal deciduous dentition are- 1. Flash/Straight terminal plane - The mesio - distal relation between the distal surfaces of the upper and lower second deciduous molars is called the terminal plane. A normal feature of deciduous dentition is a flush terminal plane where the distal surfaces of the upper and lower second deciduous molars are in the same vertical plane. 2. Deep bite: may occur in the initial stage of deciduous dentition. 3. Shallow overjet, almost vertical inclination or Upright inclination of incisors 4. Ovoid arch form 5. Spacing in deciduous dentition - a. Interdental spaces (Spaced anteriors) - also called physiological spaces and developmental spaces. These spaces are important for normal development of permanent dentition. No spacing between the primary incisors guarantees insufficient room for the permanent incisors to erupt which resulting in severe crowding in permanent dentition. b. Primate spaces or, anthropid or, siman space - is present in the primary dentition in both maxillary and mandibular arches. In the maxillary arch primate space is present between the deciduous lateral incisors and canine. In the mandibular arch, it is present between the primary canine and primary first molar. Primate spaces are used in early mesial shift in the mandibular arch. Mixed dentition Begin around 6 years of age with the eruption of the first permanent molars Mixed dentition = deciduous teeth + permanent teeth Divided into 3 phases: • 1st transitional period • Inter-transitional period