Ch 50 Orthodontics IntelliTec Classweb.ppt

chapter50orthodontics,orthodontics,specialtyofdentistrythatdiagnoses,prevents,andtreatsdentalandfacialirregularitiesofgrowingandmaturedentofacialstructuresageoforthodonticpatientcanbeasearlyasage7,orearlierifneededinterceptiveorthodontictreatmentallowsorthodontisttointercedeorcorrectproblemsastheyaredeveloping,theorthodontist,dentalspecialistwhohascompletedcollegeand4yearsofdentalschoolcompletesanadditional2-to3-yeartrainingprogramspecializinginorthodonticsanddentofacialorthopedicsstraightensteethandalignsthejaw,responsibilitiesoftheorthodonticassistant,assistingtheorthodontisteducatingpatientsinoralandoverallhealthtakingdiagnosticimpressionstakingradiographsandbiteregistrationsprovidingpre-andpostoperativeinstructionstopatientsperformingsterilizationprocedures,expandedfunctionorthodonticassistant,insomestates,dependingonthedentalpracticelaws,dentalassistantsmayalsoplacearchwiresadjustheadgearplaceseparatorsfabricatevacuum-machine-formedretainersfitorthodonticbandsaroundmolars,theorthodonticoffice,basedon“openbay”principleaccommodatesandtreatsmanypatientsatatimepatientcareaspectoftheofficeistypicallydividedintothreeareasrecordsareaareawhereradiographsaretakenareawherepatientcareisprovidedmayalsoincludealaboratory,anopenbaydesign,occlusion,relationshipbetweenmaxillaryandmandibularteethwhenupperandlowerjawsareinfullyclosedpositionnormalocclusion:idealcontactbetweenmandibularandmaxillaryarchesmalocclusion:anyintra-orextra-archdeviations,angleclassificationsystem,developedbydr.edwardh.angle(1855-1930)classiocclusion(neutroclusion):mesiobuccalcuspofmaxillaryfirstpermanentmolaroccludeswithmesiobuccalgrooveofmandibularfirstmolarmolarrelationshipisnormal,butpresentsdeviations,suchasteetharecrowdedinoneormoreareaswithinarch,classiimalocclusion,saidtobeindistoclusionmesiobuccalcuspofupperfirstmolaroccludesmesialtomesiobuccalgrooveofmandibularfirstmolarclassii,divisionimandibularteetharebehindupperjawwithaprotrusionofupperincisorsclassii,divisioniimandibularteetharebehindupperteeth,withcentralincisorstippedlabially,classiiimalocclusion,saidtobeinmesioclusionmesiobuccalcuspofmaxillaryfirstmolaroccludesinspacebetweendistalcuspoflowerpermanentfirstmolarandmesialcuspoflowerpermanentsecondmolarcommonlyreferredtoasanunderbite,classiocclusion,classii:divisionianddivisionii,classiii,threecategoriesinetiologyofmalocclusion,geneticsystemic(environmental)local(habits),geneticfactors,responsiblefordeviationswithindentitionandjawsizesdentalheredityfactorsinclude:supernumeraryteethectopiceruptionabnormaleruptionofapermanenttoothoutofnormalalignmentirregularityinjawsizesandteeth-to-jawrelationshipscongenitallymissingteeth,systemicfactors,includeinjuriesatbirthtypesofinjuriesinclude:fetalmoldingoccurswhenalimbofafetusispressedagainstanotherpartofthebodysuchasanarmpressedagainstthemandibletraumaduringbirth-occursduringtheuseofforcepsindelivery,dentaltrauma,canleadtothedevelopmentofmalocclusioninanumberofwaysdamagetopermanenttoothbudswhenaninjurytoprimaryteethhasoccurredmovementofatoothorteethasaresultoftheprematurelossofaprimarytoothdirectinjurytopermanentteeth,localhabits,suckinghabitsofchildreninvolvingthumb,finger(s),orpacifiercanhaveanaffectonjawandtoothdevelopment,problemswithmalalignment,stressandstrainonsurroundingmuscleattachments,tissue,andbonedigestiveproblemsbroughtonbypoorlychewedfoodtemporomandibularjoint(tmj)paincompromisedoralhealthandfunction,commonproblemswithdentalarches,crowdingofoneorseveralteethisthemostcommoncauseofmalocclusionoverjetthesevereprotrusionofthemaxillaryanteriorteethcausesahorizontalspacebetweenthemandibularfacialsurfacesofthelingualaspectofthemaxillaryanteriorteethoverbitetheextremeverticaloverlapofthemaxillaryteethcanesoseverethatthemandibularanteriorcannotbeseenatallcrossbiteoneormoremaxillaryteetharelingualtotheoccludingmandibulartoothorteethwheninocclusionsmalpositioningofteeth,overjetandoverbite,benefitsoforthodontictreatment,boostsself-confidenceandself-esteemimprovedappearancebringsteeth,lips,andfaceintoproportioncanbenefitsocialandcareersuccessimprovesapersonsgeneralattitudetowardlifeassistswithjawdevelopmentmaintainsspace,correctiveorthodontics,conditionsthatrequirecorrectingmal-relationshipsandmalformationsofteethandfacialbonescorrectiveorthodonticsincludes:fixedappliances(braces)removableappliancesforcorrectionormaintenanceoforthodontictreatmentorthognathicsurgery,elementsoftheinitialorthodonticvisit,extensiveexaminationofface,jaws,andteethcompletionofdentalrecorddocumentationofpatientsoralhabitsorabnormalfunctionsdeterminationofangleclassificationofocclusiononbothsidesofpatientsfaceobtainingpatientsmedicalanddentalhistory,treatmentplanning,ifpatientisachildtheparentsareinvolvedinthediscussiondentalteamcommunicateswithboththeyoungerpatientandparenttoensureunderstandingoftreatmentplansometimestreatmentisdelayeduntilfurtherdentaldevelopmentsecondappointmentisscheduledforcompletingpatientsdiagnosticrecord,medicalhistory,takentoevaluategeneralhealthofpatientsomeconditionsandmedicationshaveaneffectonpatientsresponsetotreatmentalthoughorthodontictherapyisrelativelybloodless,itispossibletocausebleedingforillnesses,suchasendocrineproblems,rheumaticfever,andprolongedbleeding,medicalclearanceandrecommendationsshouldbemadebyaphysician,dentalhistory,providesinformationconcerningdentaltreatmentoutcomeoforthodontictreatmentcanbeaffectedbywhetherthepatienthasreceivedroutinedentalcareoronlyemergencydentalcaretypeofdentalcarepatienthassoughtoutinthepastcanbeindicativeofhowmotivated,dedicated,andenthusiasticpatientwillbeduringorthodonticcare,consequencesoflackingrowthhormone,lagingrowthofbonesdelayingrowthofchildsteethandfacialboneschildrenmaykeeptheirdeciduousteeth2to4yearslongerthanaverageproblemswitheruptionofthesecondarydentitionmissingadultteeth,diagnosticrecords,assistinthepreparationofapatientsindividualizedtreatmentplanextraoralandintraoralphotographsanddiagnosticimpressionsaretakenaspartoftheinitialdiagnosticrecordphotographscapturethecolor,shape,texture,andcharacteristicsofintraoralandextraoralstructures,threestandardextraoralphotographs,takentoevaluatethesymmetryandbalanceofthefacefrontalviewwithlipsinrelaxedpositionfrontalviewwithlipsinasmileprofileviewofpatientsrightsidewithlipsrelaxed,standardintraoralphotographs,fullfrontalview(teethinocclusion)bilateralview(teethinocclusion)backtothefirstmolarmaxillaryocclusalview,includingpalateandallocclusalsurfaces,diagnosticradiographs,twotypesofradiographsarealsotakenaspartoftheinitialdiagnosticrecord:cephalometricpanoramic,cephalometricradiograph,x-raythatprovidesorthodontistwithalateralviewofpatientshead,teeth,andjawsananalysisofthecephalometricfilmhelpstheorthodontistdeterminethecurrentshapeoftheface,howthefacehasgrown,andtheexpectedgrowth,viewsprovidedbypanoramicradiographs,maxillaryandmandibularjawstoothdevelopmentrootsofteethnervepositionsjawstructures,jointssupernumeraryteethtmjmissingormisplacedteeth,advantagesofdigitalradiology,abilityofcephalometricanalysistobeaccessibleatchairsidecomputerforcasepresentationreductioninradiationeasystorage,diagnosticmodels,usedfordiagnosis,casepresentation,andpatientidentificationorthodonticassistantgenerallyfabricatesstudymodelsprovidesapositivereplicationofpatientsmouth,muscleattachments,andhardpalatefinishedappearanceisatrimmed,polished,andsymmetricallycorrectmodel,diagnosticmodel,casepresentation,typicallyinvolvesaconsultationappointmentforonehourscheduledforpatientorguardianpresentationincludesinitialphotographs,radiographs,cephalometrictracings,diagnosticmodels,andotheradjunctiveaidstheorthodontistdeemsappropriatepresentationalsoincludesinformationonapproximatelengthoftreatmentandcostiftreatmentisacceptedaconsentformissignedconsecutiveappointmentsarethenscheduledtobegintreatment,financialarrangements,payinginfullatstartoftreatmentmonthlypaymentplanssemiannualpaymentplanallfinancialplansconsistofaformal,legallybindingcontractthatstateswhatpercentageofthetreatmentistobepaidatthefirstappointmentandwhatthefixedpaymentwillbeinsurancecoverageisalsoconsidered,specializedinstruments,pliersandbandpushersorthodonticscalerligaturedirectorband(driver)pusherbitestickbracketforceps(placementtweezers),orthodonticscaler,utilizedinbracketplacement,removalofelastomericrings,andremovalofexcessbondingorcementaroundbandsorbrackets,courtesyhu-friedy,ligaturedirector,tuckstwistedligaturewireendsintointerproximalspaces,courtesyhu-friedy,band(driver)pusher,usedtoseatandpositionbandontoothcanbeusedtocontourocclusalaspectofbandaroundtoothworkingendhasaroundserratedtiptopreventslippage,courtesyhu-friedy,bitestick,assistsinbandseatingwithaidofpatientsbitingforcehandleandtipisonepiecemadefromautoclavematerialtriangularsteelworkingareaisplacedocclusalonbandsopatientcanbiteontoplasticstickbitingforcedrivesbandintoposition,bracketforceps,alsocalledplacementtweezersusedtocarryandplacebondedbracketontoothdesignedwithlong-tipped,reverseaction,andserratedbeakstosecurebracketinplace,birdbeakpliers(no.139),usedforseatingseparatingspringsandbendingarchwireopposingbeaksareconicalandpyramidalavailableinvariouslengths,courtesyhu-friedy,bandcontouringpliers,recontourandadapto-bandaroundtoothbeaksaretaperedwithslightbowonebeaktipisconcaveandoneisconvex,allowingthemtofittogetherforcontouringorthodonticbands,courtesyhu-friedy,weingartultilitypliers,usedtoholdorthodonticarchwirewhenplacingorremovingfrommouthtwoopposingbeakshaveserratedtips;theymaybepointed,straight,orcurved,courtesyhu-friedy,tweedloop-formingpliers,haveoneroundandoneconcaveopposingparallelbeaksusedtoformomegaloopandvariousotherloopsintoanarchwire,courtesyhu-friedy,posteriorbandremoverpliers,removesposteriorbandswithtwostainlesssteelbeaksonebeakiscylindricalwithreplaceablenylontip;otheriscurvedwithcarbideinsertcylindricalbeakisplacedontoocclusalsurfacewithcurvedbeakplacedongingivalsurfaceofband,courtesyhu-friedy,pinandligaturecutter,usedtocutthinligaturewirebeaksaretaperedwithcarbideinsertsthatcanbereplacedorsharpenedwhenworn,courtesyhu-friedy,howe(110)utilitypliers,usedforplacingbands,tyingligaturewire,andholdingandadjustingarchwireduringplacementandremovalbeaksareroundandtaperedwithserratedpadtips,courtesyhu-friedy,arch-formingpliers,placeformandcontourintoarchwireshaveaconcave,cylindrical-shapedbeakthatmaybegroovedorsmooth,courtesyhu-friedy,coonligature-tyingpliers,usedfortyingwireligaturetiesaroundbracketsand/orbandsandarchwirebeaksarefineserratedandnarrowtoalloweaseinligaturetying,courtesyhu-friedy,distalendcutter,cutsandholds(magneticinsert)thedistalendsofarchwiresthatprotrudedistallyfromthebuccaltube,courtesyhu-friedy,orthodontictreatment,morethanaligningteethmodifiesandcorrectsfacialgrowthusingdifferentappliancesbyplacingforce,torque,andpressureoveraperiodoftimesomeappliancesareusedtoprimarilymoveteeth(orthodontic),whereasothersareused“orthopedically”tomodifyfacialgrowthcanbeginaftercasepresentation,providingalldecayedteetharerestoredanddentalcleaningiscompleted,fixedappliances/braces,exertmorepressurethanremovableappliancesandcanachievemorecomplexmovementsconsistsofsmallbracketsmolarbandsarchwireauxiliariestheteetharemovedin6directions:mesial,distal,lingual,facial,apicalandocclusal,specialfixedappliances,usedpriorto,during,orafterregularorthodonticbrackettreatmentcementedinplaceandhaveaspecificfunctionduringaphase(s)oftreatmenttypesincludelingualarchwire,spacemaintainer,palatalexpansionappliances,andhabitcorrectionappliance,lingualarchwireappliance,conformstolingualaspectofmandibulardentalarch,whichisattachedtomolarbandsthatarecementedaroundfirstmolarsusedtopromoteorpreventtoothmovementuntilpermanenteruptiontakesplace,lingualarchwire,spacemaintainer,fixedapplianceworntopreventadjacentteethfrommovingintospaceleftbyanuneruptedorprematurelylosttoothconsistsofbandandwireloopsolderedtogetherwireloopsprovidespacetoallowpermanenttoothtoeruptcomeinseveralvarietiesthatadapttopatientsneeds,spacemaintainer,expansionappliance,placedtowidennarrowupperjawandcorrectcrossbiteusedtospreadmidpalatalsuture,creatingspacewherenewbonecellsaregeneratedandmeshtogethermadeupofacrylicpalatalportionattachedtostainlesssteelframeworkinsideacrylicportionascrew-likedeviceisplacedspecialkeyturnsscrewatpreciseintervals,whichputspressureontopalateeffectivelyminimizesoreliminatestheneedforbraceswhenpatientgetsolder,apalatalarchexpander,orthodontictreatmentsequence,applicationofseparatorsplacementandcementationofposteriorbandsplacementandbondingofbracketsinsertionofarchwireandapplicationofligaturetiesorelastomerictiesintervaladjustmentchecksbandandbracketremovalplacementoffixedorremovableretentiondevices,separators,providespaceandopensthecontactpointssotheyproperlyfitthemolarbandstoachievetheirpurpose,theyshouldstayinplaceforoneweekseveraltypeswiresteelspringselastomeric(elastic)separators,orthodonticbands,stainlesssteelcircularmetalstripsmayhavevariouscomponentsweldedorsolderedcomeinvarioussizes,areanatomicallycorrectdividedintomaxillaryandmandibularrightandleftocclusaledgeiscontouredorrolledgingivaledgeisstraightandsmooth,fittingthemolarbands,maxillaryandmandibularbandsareinitiallyseatedontoothbyfingerpressureonmesialanddistalsurfacesafterinitialplacementabandpusherisusedonmesiobuccalanddistolingualedgestoseatbandbandisplacedclosetoheightofcontourbitestickisthenplacedonbuccalmarginsoftheband,abandpusher,cementationoforthodonticbands,cementshouldhavestrengthandreleasefluoridetopreventdecayunderthebandexamplesofcementsincludeglassionomer,polycarboxylate,andzincphosphatecementshouldbethick,withalongsettingtimeforsettingtime,itisimportanttocloselyfollowmanufacturersdirections,bondedbrackets,mostcommontypeofattachmentforfixedappliancesattachedtomeshstainlesssteelbackingpadthatisbondedtoenameloftoothbondedontofacialsurfaceofallanteriorteethdesignedwithfourtiewingssoarchwirecanbeplacedintohorizontalslotandbracketcanbeligated,bondedbrackets,small,lowprofile,andeasytokeepcleansopatienthasbettercontrolofgoodoralhealthmaybemadeofstainlesssteel,ceramic,oracrylic,bondeddirectlytoteethavailableinsilver,gold,andtooth-coloredbracketsbondedusingcompositeresin,self-ligatingbracket,alternatestyle“self-ligatingbrackets”havedoor-and-hingesystemwheredoorcoversslotofarchwirewhenplacedadvantagesofthissystemarethattheycauselessfrictionwithinthearchwireguideslot,enablingtheteethtoslideandmovefaster;theyareaestheticallypleasing;theypromoteefficientoralhygienebecausetheydonotuseauxiliaryties;andlesstimeisrequiredtomakearchwirechangesateachappointment,brackets,courtesyamericanassociationoforthodontics,auxiliaryattachments,maybeattachedtomolarbandsorsinglebracketscanbepurchasedpresolderedontobracketormolarbandorthodontistcanweldthemontobandintheofficeinclude:headgeartubes,edgewisetubes,labialhooks,andbuttonsorbrackets,archwires,directteethintodesiredpositionplacedintohorizontalslotsofbracketsandtubesinmolarbandsheldinthispositionbyligatureorelastomerictieproduceforcethatguidesteethintomovementavailableinseveralshapesandsizes,placementofarchwire,typesofarchwires,nickeltitaniumwirestainlesssteelwirebetatitanium(tma)wireoptiflexwire,shapeofarchwires,usageofroundwiresusedinbeginningstagesoforthodontictreatment;exertgentleforcelevelthearchandalignteethinanuprightpositionopenabiteandslideteethtoclosespacesusageofrectangularorsquarearchwiresusedinfinalstagesoftreatmentpositionthecrownuprightoralignrootoftoothusedforstabilityandgeneratemoreforce,elastomericties,afterarchwirehasbeenselected,measured,andplacedintoslotsofbrackets,itmustbetiedorligatedmadeofplasticorrubber-likematerialstretchedaroundbrackettoholdarchwireinplacetheuseofelastomerictiesresultsinlesstimebeingrequiredforanarchwirechange,placingandremovingelastomericties,ligaturewires,thinwiresthataretwistedaroundbrackettoholdarchwireinplaceare.01-gaugestainlesssteelthatmaybetiedintwowayscaneitherbetiedaroundonetoothorseveralteeth,formingafigure8someligaturetieshavehookscalledkobyashihooksthathavebeensolderedtothem,placementofligaturewire,powerproducts,elasticchaintiescontinuousosthatformachainapplygentlecontinualforceonteethtoclosespacesorcorrectrotatedteethelasticsorrubberbandsplacedfromonetoothtoanotherinsamearchorfromonetoothtoanotherinanopposingarchclosespacebetweenteethandcorrectocclusalrelationshipsbetweendentalarches,headgear,orthodonticappliancethatactivelyguidesgrowthanddevelopmentofjawusedtotreataclassii,divisionimalocclusion(increasedoverjet)aloneorwithfixedbracestheheadgearisattachedtothemolarbandsandisanchoredfromthebackoftheheadorneck.itspurposeistostoptheupperjawfromgrowing,hence,preventingorcorrectinganoverjet,adjustmentvisits,scheduledatspecificintervalsduringtreatmentarchwiresarechangedloosebandsarerecementedbrokenbracketsarereplacedimportantforcheckingprogressandevaluatingoralhygiene,oralhygieneanddietaryinstructions,providedbyorthodonticassistantincludesdemonstrationonhowtobrushanduseaflossthreaderotheradjunctiveoralhygieneaidsthatcanbedemonstratedincludeanend-tuftedbrush,proxybrush,rubber-tipstimulator,andwaterpikpatientshouldbeinstructedtocutfruitsandvegetablesintosmall,bite-sizepiecesandtoavoidcertainfoods,brushingwithfixedappliances,flossingwithflossthreader,imagecourtesyinstructionalmater