GDA ortho

Norman Kingsley

Edward Angle (1855-1930)

best balance, harmony, proportions of mouth in relation to other features require full complement of teeth that occupy normal position

• Charles Tweed
• modifying via techniques

• Broadbent
• (post WWII)
• skeletal problems
• functional jaw orthopedics

• emphasis on dental/facial esthetics (including soft tissues)
• more pt involement in tx planning
• more adults (multidisciplinary care)

create best balance or occlusion, esthetics, stability, long term maintenence and restoration of dentition

supervision, guidance, and correction of the growing and mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of related structures by the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of the functional forces within the craniofacial complex

• ANGLE
• Primary goal: ideal occlusion
• secondary goal: ideal jaw rltn
• Hard/soft tissue rltn: ideal hard tissue -> ideal soft tissue
• Diagnostic: dental casts, ceplometric
• Tx approach: obtain ideal dental and skeletal rltn, assume soft tissues OK
• Function emphasis: TMJ relation to occlusion
• Stability: related to occlusion

• SOFT TISSUE
• Primary goal: normal soft tissue proportions and adaptations
• secondary goal: functional occlusion
• Hard/soft tissue rltn: ideal soft tissue -> ideal hard tissue
• Diagnostic: clinical examination of intra-oral and facial soft tissues
• Tx approach: Plan ideal soft tissue rltionships then place teeth and jaws as needed
• Function emphasis: soft tissue movement in relation to display of teeth
• Stability: related to soft tissue pressure/equilibrium

To track the developing dentition and occlusion to provide interceptive therapy

To address esthetic and functional desires of the fully dentate patient

• To provide the highest quality comprehensive care to the partially edentulous
• patient

• elastic supracrestal fibers
• connect teeth together, stretch and will close diastema

no, only point contacts, only tipping no translation

translation

apposition

inhibit apposition

remodeling of affected skeletal components

• cranial base and nasal septum not susceptible to modification (nasal septum theory
• periosteal & condylar cartilage may be (remodeling)
• sutural surfaces are susceptible (sutural)
• change in function promotes condylar remodeling (functional matrix-> soft tissue GC)

• increase traverse maxilla
• encourage/discourage AP growth of mand or max

• force: heavy (500-1000 g much more than teeth)
• duration 12 hrs, 12-18 months
• protraction: 1000 g force, 12-24 hrs 9-12 months

heavy force needed 24 hurs a day 6 years+

• functional matrix (form follows function)
• holding in protrusion or opening stimulates condylar growth
• via pressures from muscles and soft tissues

• mandibular growth modification
• not used much anymore

2 removable to position mandible for growth modification

mandibular anterior re-positioning appliance

heavy, 24 hrs 12-18 months

rotation(ligation), torque(edgewise insertion square wire), tip/angulation

• in-out bends: buccal lingual position, rotational
• variation in bracket base thickness

• MD tip: slot angulation
• crown root angulation: long axis angulation

• buccal lingual torque, slots of brackets different angles
• crown-root angulation

torque, angulation, in-out(thickness), off-sets (rotation)

• arch-wire to incisal edge
• shorter is intrusion
• longer is extrusion (typically canine)
• too high: intrusion and lingual root movement
• too low: extrusion and buccal root movement

line scribe line with long axis of tooth

• stainless steel: stiff, remembers form used later), correcting molar relationship and space closure (rectangular stainless steel)
• beta titanium
• nitinol (thermally active cold shaped): more flexible doesn't have shape memory, leveling and aligning

• rectangualr stainless steel
• translation

• NiTi
• tip, rotate, extrusion, intrusion

• stainless steel
• root uprighting, rotation extrusion, intrusion

3-4 months post appliance removal

• collagenous: 4-6 months
• elastic supracrestal fibers: 1 year

mesial drift, entropy, gravity and poor growth persistence

• standard retainer
• acrylic, bow, clasp

adams clasp, c clasp

• 24 hrs 8-12 months
• taper off
• one night a week

tipping 3-4 mm

• minor crowding or relaps
• simple crown tipping, no root angulation
• simple rotations

buccal tipping

send models to lab, lab cutos teeth out and places in ideal position and builds spring retainer to fit that position

• retenetive clasps
• body wire, lingual extensions
• minor tooth movement, arch development or molar rotation
• not used much anymore

• clear aligner material (suck down stent)
• rigid to resist deformation
• flexible to provide ortho force
• multi-point contact
• need accurate PVS impression
• cannot be used for skeletal issues

• FRONTAL RESPORTPITON
• sec: compress pressure, dilate tension
• min: dec blood flow, cytokines
• hours: metabolic, cellualr changes
• 4 hours: PDL differenctation cAMP
• days: remodel bony socket (frontal)

• sec: vessel occlude
• min: no blood
• hours: cell death
• days: differention in marrow undermining
• 7-14 UNDERMINING RESORPTION removes lamina dura by compressed PDL

• translate
• root upright
• tip
• rotation
• extrusion
• intrusion