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STUDY MODELS

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INDIAN DENTAL ACADEMY

Leader in continuing dental education
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Contents.
Introduction.
Diagnostic Aids.
Study Models (Defn).
History.
Purpose of Making Study Models.
Objectives of Ideal Orthodontic Study Models.
Uses of Study Models.
Steps in fabrication of Study Models.
- Impression Making.
- Disinfection of Impression.
- Taking a Wax Bite.
- Casting.
- ABO requirements for trimming Study Models.
- Trimming Procedure with Finishing.
- Care and Storage of Study Models.

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Model Analysis.
- Ponts Analysis.
- Linder Harth Analysis.
- Korkhaus Analysis.
- Mixed Dentition Analysis.
Moyer's.
Tanaka-Johnston.
Huckaba.
Hixon and Oldfather.
- Sanin-Savara Analysis.
- Careys Analysis.
- Boltons Analysis.
- Peck and Peck Analysis.
- Howes Analysis.

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Methods to determine Asymmetry of Arch dimension and
Tooth Position.
- Using Divider.
- Using Symmetrograph.
Diagnostic Set Up.
Digital Study Models.
- e-models.
- Ora-scanner.
- OrthoCAD.
References.
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Diagnostic Aids.
Comprehensive orthodontic diagnosis is
established by use of certain clinical
implements called DIAGNOSTIC AIDS.
They are of two types:
1) ESSENTIAL DIAGNOSTIC AIDS
2)SUPPLEMENTAL DIAGNOSTIC AIDS.
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ESSENTIAL DIAGNOSTIC
AIDS
SUPPLEMENTAL
DIAGNOSTIC AIDS
1)CASE HISTORY. 1)SPECIALIZED RADIOGRAPHS.
OPG
LATERAL
PA VIEW
2)CLINICAL EXAMINATION. 2)ELECTROMYOGRAPHY.
3)STUDY MODELS. 3)HAND-WRIST RADIOGRAPHS.
4)RADIOGRAPHS.
PERIAPICAL
BITE-WING
PANORAMIC
4)ENDOCRINE TESTS.
5)FACIAL PHOTOGRAPHS. 5)BMR ESTIMATION.
6)OCCLUSOGRAMS.
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STUDY MODELS.
Orthodontic study models are essential
diagnostic records, which are accurate plaster
reproductions of the teeth and their supporting
soft tissues and which help to study the
occlusion and dentition from all the three
dimensions.
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No matter how astute you are, no matter how
carefully you look into your dental mirror,no matter
how you bend your head to get a better view of the
patients mouth as he sits in the dental chair with his
jaws spread apart, you cannot achieve the degree of
accuracy and attain the completeness that an analysis
of study casts will permit. An additional plus is
that you have a time linked, a longitudinal ,three
dimensional record that establishes the status of the
teeth and investing tissues at that particular time.
- GRABER.
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History.
PFAFF IN 1756 FIRST TIME OBTAINED A
NEGATIVE PRODUCED FROM WAX AND
FROM IT A POSITIVE MODEL WAS
OBTAINED THROUGH PLASTER
CASTING.
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Purpose of Making Study
Models.

1) Invaluable in planning treatment as they are three-
dimensional records of patients dentition.
2)Occlusion can be visualized from all aspects.
3) Provide a permanent record of the intermaxillary
relationships and the occlusion at the start of
therapy;this is necessary for medico-legal
considerations.
4) Help us to monitor changes taking place during
tooth movements.
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Contd.
5)Helps to motivate the patients as they can visualize
the treatment progress.
6)They are needed for comparison purposes at the
end of treatment and act as a reference for post
treatment changes.
7) Serve as a reminder for the parent and the patient
of the condition present at the start of treatment.
8)In case the patient has to be transferred to another
clinician ,study models are an important record.
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Objectives of Ideal Orthodontic
Study Models.
1)Models accurately reproduce the teeth and their
surrounding soft tissues. Soft tissues must not be
altered.
2)Models are to be trimmed so that they are
symmetrical and pleasing to the eye and so that an
asymmetrical arch form can be easily recognized.
3)Models are to be trimmed in such a way that the
dental occlusion shows by setting the models on their
backs.
4)Models are to be trimmed so that they meet the
measurements and angles as proposed for trimming
them.
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Contd.
5)Models are to have a clean, smooth, bubble
free surfaces with sharp angles where the cuts
meet.
6)The finished models will be treated with a
soap solution to give it a glassy, mar-proof
finish.
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Uses of Study Models.
1)To assess and record the dental anatomy.
2)To assess and record the intercuspation.
3)To assess and record the arch form.
4)To carry out various space analysis.
5)To assess and record the curves of occlusion.
6)To evaluate occlusion with the aid of articulators.
7)To measure progress during treatment.
8)To detect abnormalities. (eg: localized
enlargements,distortion of arch form)
9)To provide a record before ,immediately after, and
several years following treatment for the purpose of
studying treatment procedures.
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Parts of the Study Models.
ANATOMIC portion.
ARTISTIC portion.
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Anatomic portion.
Anatomic portion is that part of the study
model which is the actual impression of the
dental arch and its surrounding structures.
Usually made of stone plaster.
Must be preserved while trimming the model.
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Artistic portion.
The artistic portion of study model is a plaster
base that supports the anatomic portion.
Helps in depicting the actual orientation and
the occlusion of study models.
Gives a pleasing and symmetrical appearance
to the models.
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In a well fabricated set of study models
the ratio of the anatomic portion to
artistic portion should be 3:1.
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Steps in construction of study
models.
Impression making.
Taking a wax bite.
Disinfection of the impression.
Casting the impression.
Basing and trimming.
Finishing and polishing.
Care of the study models.
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Impression making.
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Impression making.
Irreversible hydrocolloids(alginate) are widely used.

Advantages of alginate:
1)easy to manipulate.
2)comfortable for the patient.
3)relatively inexpensive as it does not require elaborate
equipment.
4)has pleasant taste.
5)able to displace blood and saliva.
6)they are hydrophilic.
7)they are compatible with stone so it is easy to pour and
retrieve the cast.
8)they can be used with stock trays.
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Orthodontic impression trays.

Orthodontic trays are used as their rim in labial
region is about inch (20 mm) and their edges are
beaded.
Strips of soft utility wax or mortem can be added to
tray periphery.
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Disinfecting the impression.
First rinse with water.
Immerse it in a disinfectant solution approved
by O.S.H.A such as Biocide or Chlorhexidine.
Be sure to rinse it again with water to remove
the residual disinfectant solution.
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Taking a wax bite.
It should always be taken as it helps the dentist
to relate the upper and lower casts in
occlusion.
Also helps to hold the casts flushed with each
other while trimming.
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Taking a wax bite.
Phillip Adams:
Wax bite should consist of only a bar of
moderately softened wax across the premolar
region.
Graber:
Two layers of soft base-plate wax roughly
shaped to arch form and warmed in water may
be used.
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Casting the model.
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Casting the model.
The models may be cast in
Plain dental plaster.
Stone plaster.
Mixture of plain plaster and stone plaster.
Or the anatomic portion may be cast in stone
plaster and and bases in plain plaster.
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RUBBER MOULD BASE
FORMERS.
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Cross Section of Plaster Casts in Rubber
Mould Base Formers:
Occlusal plane should
be parallel with top and
bottom cast surfaces.
The back surfaces of the
casts should be related
in exactly the same
plane ,perpendicular to
top and bottom cast
surfaces.
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Broussard cast former.
(Rocky Mountain Dental Products Co.)
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(Lawson)
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American Board of Orthodontics
requirements for study models.
(American Board of Orthodontics: Specific Instructions for
Candidates, St Louis,1998, The Board)
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American Board of Orthodontics
requirements for study models

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American Board of Orthodontics
requirements for study models
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Study model trimming
Accurate detailed
impressions are essential to
the production of high
quality study models.
Before the mandibular cast
is poured the tongue space
must be filled in with
alginate.
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Study model trimming
Casting material is carefully
proportioned according to
the manufacturers
instructions.generally , the
ratio of 30 ml of water to
100g of stone will be
sufficient to pour one
model. This should be
spatulated for 20 to 30
seconds by a vacuum mixer
to produce a smooth, dense,
bubble free mix.
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Study model trimming
Vibrate the mix into the
impression so that it flows
slowly from one posterior
end around to the anterior
and then the other posterior
end. Avoid incorporating air
bubbles. Fill its base in a
like manner. Carefully
invert the impression onto
its base and add stone to the
heel areas so that they
extend smoothly into the
model base surface. Repeat
this procedure for the
opposing model.
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Study model trimming
Cast are allowed to dry
thoroughly .
Now one electric plaster-
trimming machine with a
medium grit,carborundum
wheel,grit no. 60 is used for
trimming.
Trimmer has dual wheels.
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Study model trimming
A template(or degree
plate) on the model
trimmer platform is
used as a reference for
holding the casts at a
proper angle while
trimming.
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Study model trimming
In addition to no.600
wet and dry sand
paper,small and medium
scrapers,lab knife and
some special equipment
will be used.
Angle guide.
Squaring tool.
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Study model trimming
Allow the models to dry
for one hour after
pouring.remove the base
formers and then the
impression.
Inspect.
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Study model trimming
The casts are soaked in
water for atleast 10
minutes before they are
trimmed. Never attempt
to trim a dry model.
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Study model trimming
Trim the maxillary cast first.
Remove excess stone from
the heel areas so that the
incisors and terminal molar
cusp tips will be able to
touch the flat plane of the
squaring tool
simultaneously.
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Study model trimming
Position the occlusal
plane against the
squaring tool .
Check to be sure proper
contact is being made.
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Study model trimming
Turn on the water supply before
switching on the model trimmer.
While holding the occlusal plane
of the cast firmly against the
squaring tool, slide the whole unit
toward the rough cut wheel. Trim
away the excess base material so
that the remaining base portion is
about one third the total cast
height.
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Study model trimming
Draw a line over the
median palatine raphe.
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Study model trimming
A perpendicular line is
drawn, about inch distal
to the hamular notches.trim
the back of cast to this line.
The back of the cast forms
right angles with the median
palatine raphe.
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Study model trimming
The buccal segments are
trimmed at a 70 degree
angle to the back of the cast.
To accomplish this, rotate
the degree plate and slide
the angle guide into place.
Press the cast against the
angle guide and trim to
about 5mm from the buccal
surfaces of teeth
Reset the degree plate to
trim the other side.
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Study model trimming
Use even, steady
pressure against the
wheel,but let the model
trimmer do the work.
Both buccal segments
have been trimmed at a
70 degree angle.
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Study model trimming
Change the degree plate
to indicate a 30-degree
setting and reposition
the angle guide.
Trim the maxillary
anterior portion.
Carefully preserve the
mucobuccal fold area.
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Study model trimming
Both anterior angles are
complete.
Note that each angle
begins at a point at the
middle of the canine.
The two angles intersect
at a point that is an
extension of the median
palatine raphe line.
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Study model trimming
The maxillary posterior
segments are trimmed at
130-135 degrees angle.
They should be about
to 5/8 inches wide.
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Study model trimming
Occlude the maxillary and
mandibular casts, trimming
excess stone from the
mandibular heels if
needed.
The wax bite registration
wafer should be in place
when trimming occluded
models because the
vibration may abrade the
tooth surfaces.
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Study model trimming
Use the squaring tool to
trim the mandibular
base so that it is parallel
to the maxillary base.
The height of the base
should be about 1/3 rd
the total height of the
cast.

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Study model trimming
With the casts occluded,
trim the back of the
mandibular cast so that it is
parallel and flush with the
maxillary cast.
This will allow the casts to
remain in occlusion when
placed on their backs on a
flat surface.
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Study model trimming
The backs of the
maxillary and
mandibular casts are
trimmed evenly.
The mandibular
posterior corner
segments are trimmed to
130-135 degree
angles,flushed with their
maxillary counterparts.

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Study model trimming
The buccal segments are
trimmed at 65-degree
angles to the deepest
part of the buccal
vestibule.
Do not trim closer than
5mm from the buccal
surfaces of the teeth.
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Study model trimming
Make a semicircular
mark from the center of
one canine to the center
of the other. This will
indicate the anterior
trim line.
It should be no closer
than 5mm from the
labial tooth surfaces.
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Study model trimming
Carefully trim the
anterior segment to the
mark.
It should have a
smooth,symmetrical
shape.
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Study model trimming
Gently carve any excess
material from sulcus
areas.
Use a laboratory knife
and scraper to remove
blebs and define detail.
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Study model trimming
Use extra-fine no.600
sandpaper to smooth
sulcus areas by hand.
The tongue area must
also be sanded smooth.
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Study model trimming
Use the fine sanding
wheel on the model
trimmer to smooth
scratches left by the
rough wheel.
Fill any small voids in
the models with a thin
mix of orthodontic
stone.
Lightly sand again if
necessary.
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Study model trimming
Allow the models to dry
for 24 hours before putting
them in finishing soap
solution. They should be
soaked for about 20
minutes but not more than
30, or the models will
dissolve.
Rinse off the excess soap
and buff with a soft cotton
cloth.
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Study model trimming
After the models have
dried they must be
labelled.
Use an indelible marker
to print the patients
name and the date the
impressions were taken.
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Study model trimming
The study model set is
complete.
Note the sharp,
symmetric angles.
The surfaces are sanded
and polished to a
smooth,attractive luster.
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Study model trimming
The base of each model
is parallel and flush with
the base of the other.
The set will remain in
occlusion when resting
on the heels, or on the
right or left posterior
corners.
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Cast trimming to indicate the
occlusal plane relationships.
Gnathostatic technique.
Simon in 1926.
Reproduces the inclination of the occlusal
plane with reference to FH-plane.
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Care of study models. (White and Gardiner)
Record casts should be kept in boxes holding
5-6 sets of models,each pair held together by a
light elastic band.
A square of thin plastic foam should be kept
between the occlusal surfaces of the teeth.
The wax bite should not be left between the
teeth, however it should be stored as it will be
of help in finding the occlusal relationship at a
later date.
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Orthodontic model boxes.
(J. of Cl. Ortho.,1991).
Orthodontic model boxes can be used for systematic
storage, identification and coding of study models.
BARGER model box: lid style. Stores 8 models per
box.
FUNT model box: drawer style. Stores 4 models per
drawer, 8 models per box.
ARTICULATED model box: drawer style. For tall
mounted models.
Space maintainer lab, Indiana.
North Western paper box company,Washington.
The Board foot, Texas: Model display cabinets.

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Model Analysis.
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Ponts analysis.
In 1909, Pont devised a method of
predetermining an idealarch width based on
the mesiodistal widths of the crowns of the
maxillary incisors.
Pont suggested that the ratio of combined
incisor to transverse arch width was ideally
0.8 in the bicuspid area and 0.64 in the first
molar area.
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1)Sum of mesio-distal widths of incisors.
2)Measured premolar value.
3)Measured molar value.



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Ponts analysis, contd..
Expected arch width at premolar region:
sum of incisors * 100
80
Expected arch width at molar region:
sum of incisors * 100
64

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Ponts analysis contd..
Ponts also suggested that maxillary arch
should be expanded 1-2mm more during
treatment than his value to allow for relapse.
Thus, amount of expansion that can be done on
molar and premolar region is estimated.
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Drawbacks of Ponts analysis:
Researchers at University of Washington (Dent
Clin North Am 1978) found very poor correlation
between combined maxillary incisor widths
and the ultimate arch width in the bicuspid and
molar areas.
Does not take skeletal mal-relation into
consideration.
Analysis is derived solely from casts of French
population,so it cant be applied globally.
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Linder Harth index.
Similar to Ponts analysis.
Variation in formula to determine the expected arch
widths at molar and premolar regions.
Expected arch widths at premolar region:
Sum of incisors * 100.
85
Expected arch width at molar region:
Sum of incisors * 100.
65
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Korkhaus analysis.
It makes use of Linder Harth
formula to determine the ideal
arch width in the premolar and
molar region.
A measurement is also made from
the midpoint of inter-premolar
line to a point in between two
maxillary incisors.
According to Korkhaus For a
given width of upper incisors, a specific
value of the distance between the
midpoint of inter-premolar line to the
point between the two maxillary
incisors should exist.
An increase in this measurement
indicates proclined upper incisors
while a decrease in this value
indicate retroclined upper incisors.

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Sanin-Savara tooth size analysis.
(Am J Orthod 1971)
Scholars at University of Oregon devised a
simple and indigenous procedure to identify
individual and group tooth size
disharmonies.
It makes use of precise mesio-distal
measurements of the crown size of each
tooth,appropriate tables of tooth size
distribution in the population, and a chart for
plotting the patients measurements.
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Howes analysis.
(Am J Orthod 1954, Am J Orthod 1960)
Ashley Howe devised the formula to determine
whether the apical bases could accommodate the
patients teeth.
He considered tooth crowding to be due to deficiency
in arch width rather than arch length.
Determination of total tooth material.(TM)
Determination of premolar diameter(PMD)
Determination of premolar basal arch
width(PMBAW)
Determination of BAL.
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HOWES ANALYSIS.
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Howes analysis, contd..
If PMBAW is greater than PMD, arch expansion is possible.
Howes believed that the PMBAW should equal approximately
44%of the TTM if it is sufficiently large to accommodate all
the teeth.
When the ratio between PMBAW and TTM is less than
37%,Howe considered this to be a basal arch deficiency
necessitating extraction of premolars.
Howes analysis is useful in planning treatment of problems
with suspected apical base deficiencies and deciding whether
to;
1)extract teeth.
2)widen the dental arch, or
3)expand rapidly the palate.
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Bolton tooth ratio analysis.
(Angle Orthod 1958, Am J Orthod 1962)
Bolton studied the interarch effects of discrepancies
in tooth size to devise a procedure for determining the
ratio of total mandibular versus maxillary tooth size
and anterior mandibular versus maxillary tooth size.
Study of these ratios help in
1)estimating the overjet and overbite relationships that
will likely obtain after the treatment is finished.
2)estimating the effects of contemplated extractions
on posterior occlusion and incisor relationships,and
3)the identification of occlusal misfit produced by
interarch tooth size incompatibilities.
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Procedure.
Sum of mandibular 12.
Sum of maxillary 12.
Sum of mandibular 6.
Sum of maxillary 6.
are measured.
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Determination of Overall ratio:
According to Bolton, a mean ratio of 91.3 will
result in ideal overjet-overbite relationships, as
well as posterior occlusion.
Overall ratio=sum of mandibular12*100.
sum of maxillary12.
If it is less than 91.3%,it indicates maxillary
tooth material excess and it indicates
mandibular tooth material excess if it is more
than 91.3%.
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Contd..
Amount of maxillary excess:
sum of maxillary12- sum of mand.12*100.
91.3.
Amount of mandibular excess:
sum of mandib.12- sum of max.12*100.
91.3.

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Contd..
A similar ratio is computed for six anterior teeth.
An anterior ratio of 77.2 will provide ideal overjet
and overbite relationships if the angulations of
incisors are correct and if the labio-lingual thickness
of the incisal edge is not excessive.
If anterior ratio exceeds 77.2,there is excessive
mandibular tooth material and if it is less than
77.2,there is excess maxillary tooth material.
Bolton analysis predictions do not take into account
the sexual dimorphism in maxillary cuspid widths.
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Careys analysis
.
Determination of arch length.
Determination of tooth material.
Determination of discrepancy.
Inference;
1)If discrepancy is 0-2.5mm,proximal
stripping.
2)If discrepancy is between 2.5-5
mm,extract the second premolars.
3)If discrepancy is more than 5mm,
extract first premolars.

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Peck and Peck Index.
It is done in lower arch.
Peck and Peck suggested certain clinical
guidelines on the basis of observation that
:Persons with ideal incisal arrangement had
smaller mesio-distal width and comparatively
larger labio-lingual width than in persons with
incisal crowding.
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Procedure:
Measure the mesio-distal width(M.D) and the labio-
lingual width(L.D) of each of mandibular incisors.
Calculate the proportion of the mesiodistal width of
each tooth to the labio-lingual width of the tooth by
using the formula:
M.D. *100.
L.L/F.L
Mean value for lower central incisor should be 88-
92%.
Mean value for lower lateral incisor should be 90-
95%.
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Inference.

If the value for a given case is more than the
mean value then, mesio-distal width of the
tooth is more than the labio-lingual width and
hence proximal stripping is indicated in such
cases.
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Mixed Dentition Analysis.
The purpose of mixed dentition analysis is to evaluate
the amount of space available in the arch for
succeeding permanent teeth and necessary occlusal
adjustments.
This analysis helps one estimate the amount of
spacing or crowding which would exist for the patient
if all the primary teeth were replaced by their
successors.
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Contd..
Methods fall in two categories:
1)sizes of un-erupted cuspids and premolars are estimated from
measurements of the radiographic image.
2)sizes of un-erupted cuspids and premolars are derived from
knowledge of the sizes of permanent teeth already erupted in
the mouth.
Moyer's advocated type 2 because:
1)it has minimal systematic error and range of such errors is
known.
2)it can be done with equal reliability by beginners and expert, as
it does not presume sophisticated clinical judgment.
3)it is not time consuming.
4)it does not require special equipments for radiographic
projections.
The mandibular incisors have been chosen for measuring.
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Procedure in the mandibular
arch:
Measure with a tooth measuring guage or a pointed
Boley guage, the greatest m-d width of each of the
mandibular incisors.

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Mixed dentition analysis..
Determine the
space needed for
alignment of
incisors.
Compute the amount
of space available
after incisor
alignment.


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Mixed dentition analysis..
Now,predict the size of the combined widths
of cuspid, first bicuspid, and second bicuspids.
Long method-(Moyer's)
Prediction of the combined widths of
cuspid,first bicuspid and second bicuspidis
done by use of probability charts.
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Mixed dentition analysis..
No one figure can indicate the precise cuspid-
bicuspid sum for all people, since there is a
range of posterior tooth widths seen even when
the incisors are identical.
The value at 75% is chosen as the estimate.
Theoretically, one should use the 50% level of
probability, since any errors would then
distribute equally.
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Mixed dentition analysis..
Short method :(Tanaka and Johnston, J Am Dent Assoc
1974).
Add the widths of mandibular incisors and divide
by 2.
To the value obtained add 10.5 mm to predict
the combined widths of the mandibular cuspid
and bicuspids and 11.0 mm to predict the
combined widths of maxillary cuspid and
bicuspids.
This is a less precise method which does not
allow for sexual dimorphisms with equal
accuracy.
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Mixed dentition analysis..
Now, compute the amount of space left in the
arch for molar adjustment by subtracting the
estimated cuspid and bicuspid size from the
measured space available in the arch after
alignment of incisors.
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Procedure for maxillary arch:
Similar to that of lower arch with two
exceptions:
1) a different probability chart is used for
predicting the upper cuspid and bicuspid sum.
2) allowance must be made for overjet
correction when measuring the space to be
occupied by the aligned incisors.
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Problems:
A problem arises when considering the space left for
molar adjustment.
Perhaps the most severe limitation of Mixed
Dentition analysis is their inability to reflect the
position of the incisors with respect to the skeletal
profile.
A problem is imposed when the occlusal curve is
assumed to be a flat plane. Here it becomes obvious
that mixed dentition analysis is a two-dimensional
visualization of a complex three-dimensional
problem.

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Hixon and Oldfathers method.
(Am J Orthod 1980)
The mesio-distal width of the mandibular central and
lateral incisor is obtained from the casts.
Determine the width of the un-erupted premolars
from the intra-oral peri-apical radiographs made
using long cone technique.
Add the width of central and lateral incisors with the
width of un-erupted premolars of that particular side.
The estimated sum total width of the cuspids and
bicuspids of that particular side can be obtained from
the given chart.
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Hixon and
Oldfather
values.
Every measured sum
width of incisors and
bicuspids has a
corresponding sum
width of the cuspids and
bicuspids in the chart.
Measured values in
mm.
Estimated tooth
size in mm.
23 18.4
24 19.0
25 19.7
26 20.3
27 21.0
28 21.6
29 22.3
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A revision of the Hixon and Oldfather
mixed-dentition prediction method.
By Robert Staley and
Paul Kerber.
Graph shows
relationship between
size of lower incisors
measured from cast plus
lower first and second
premolars measured
from radiographs (x-
axis) and size of canine
plus premolars. (y-axis).

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Huckabas analysis.
(Dent Clin North Am 1964)
Both study models as well as radiographs are
used for determining the width of un-erupted
tooth.
With radiograph, it is necessary to compensate
for the enlargement of the radiographic image.
This can be done by measuring an object that
can be seen both on radiograph and and on the
study model, such as a primary molar tooth.


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Contd..
After the measurement, a proportional relationship can then be
established as follows:

Actual width of primary molar(X1) =
Apparent width of primary molar(X2)
Actual width of unerupted premolar(Y1)
Apparent width of unerupted premolar(Y2)

Or Y1= X1-Y2.
X2

This technique can be used for all ethnic groups.
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Functional analysis and
Equilibration of Occlusion.
Study of patterns of attrition and facets of
wear.
A functional mandibular displacement can be
discovered by looking at the inclined planes
and cusps of the teeth on the casts.
Return to the mouth to check for prematurities,
tooth guidance,
cuspal interference
and possible trauma.
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Contd
Study casts enable the dentist to study these
things much more clearly and to correct them.

One of the most valuable service the dentist
can render is equilibration of patients
occlusion . Without a set of study casts this is a
hazardous procedure.
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Methods to determine
Asymmetries of arch dimension
and tooth position.
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Method of using dividers to measure from
the median raphe to estimate asymmetries
of the dental arches. (Graber)
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Use of a symmetrograph to determine
asymmetry in the dental arch. (Graber)
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Diagnostic set up.
Proposed by H.D.Kesling.
A popular practical technique for visualizing space
problems in three dimensions in the permanent
dentition is that of cutting of teeth from a set of casts
and resseting them in a more desirable positions is
called a Diagnostic or Prognastic set up.
Record casts are not used, since they must be used for
comparison with the diagnostic set up and with
progressive record casts.
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Technique.
Obtain an accurate wax bite. Trim the posterior
portion of the bases of the casts with the wax bite
interposed so the bases are flush.
Drill a hole through the alveolar portion of the casts
well below the gingival margin of teeth.
Insert a fine saw blade through the hole and cut to the
crest of gingival margin between two teeth. Repeat
this for all the teeth to be cut off the cast.
Align the teeth and wax them into the desired
positions. It is best not to cut all the teeth so that the
bite relationship can be kept.

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The Diagnostic Set Up.
(before and after)
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Uses of Diagnostic set up.
Useful in difficult space management problems to
ascertain ,before orthodontic treatment is begun ,
precisely the amount and direction each tooth must be
moved.
When extractions are contemplated as part of the
orthodontic treatment ,the diagnostic set up will
demonstrate vividly the amount of space created by
extractions and the tooth movements necessary to
close the space.
Will also aid in choosing which teeth to extract.
Useful in patient motivation.
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Obtaining a 3-d study cast image.
Standard dental impressions of upper and lower
arches using a Thixotropic Vinyl Polysiloxane crown
and bridge material.
Impression scanning with an Ora-scanner.
Create an e-model Digital Orthodontic Model using
proprietary technology available from Geodigm
Corporation.
The laser sensor accuracy is 0.01mm , which
result in an e-model 3D surface accuracy of
0.1mm with a Polygonal Mesh size of 30,000
polygons per jaw.
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Ora-scanner.
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OrthoCAD software( ).
Capable of capturing and presenting 3-D study
models.
With OrthoCAD digital models clinicians can
easily store, retrieve, diagnose and
communicate cases electronically, saving all
the hassles associated with plaster casts.
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Contd..
Take alginate impressions of maxillary and
mandibular dentition and a bite registration.
Send these to an OrthoCAD processing facility
and within few hours,3-D study models are
downloaded to orthodontic office.
The process requires an Internet connection, a
download utility, and analyzing software.
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OrthoCAD allows for various
views of study casts for diagnostic
purposes.
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Diagnostic tools included with
OrthoCAD.
Measurement analysis:
recorded and saved.
Midline analysis: study
models can be virtually
split.
Overjet and overbite
analysis.

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Diagnostic tools contd..
Occlusogram.
Magnification.

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Diagnostic tools contd..
Antero-posterior and
transverse adjustments.
Notes.

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OrthoCAD.
In addition to diagnostic tools, software provides the
orthodontist the ability to print various views, and to
e-mail files to other practitioners directly from the
program.
Efficient magnetic and optical storage.
200 3-D study models can be stored on a CD-
ROM with 650 MB storage space.
A 30 gigabyte hard drive can store 10,000 3-D
study models.
Cost effective.
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At last an advice:
GRABER- Take study casts of every patient; learn to look
for the variations of the normal and the departures from the
normal. Make a check list so that you dont miss anything.
On each subsequent visit, take out the study casts and
compare the present status of the mouth with that of the
study casts taken earlier.
What changes have occurred?
Are they favourable or unfavourable?
Is there any drifting, over-eruption, prematurities, abnormal
facets of wear, overbite problems?
Catch these before they develop.
This is dentistry at its best- a preventive and
interceptive service.
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References.
Graber TM, Swain BF: Orthodontics; Current
Principles and Techniques, Mosby, 1985.
Proffit WR: Contemporary Orthodontics, Mosby,
1986.
Graber, Vandersdall: Orthodontics; Current
Principles and Techniques, Mosby, 1994.
White TC, Gardiner JH, Leighton BC : Orthodontics
for Dental Students, 1985.
Moyers : Handbook of Orthodontics.
Lawsons: Bench Top Orthodontics.
Phillip Adams, John Kerr : The Design, Construction
and Use of Removable Orthodontic Appliances.



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Bolton WA: Disharmony in tooth size and its relation
to the analysis and treatment of malocclusion. Angle
Orthod 1958;28:113.
Howes AE: A polygon portrayal of coronal and basal
arch dimensions in the horizontal plane. Am J Orthod
1954;40:811.
Sanin C, Savara BS : Analysis of permanent
mesiodistal crown size. Am J Orthod 1971; 59:488.
OrthoCAD : Seminars in Orthodontics, 1997.
Orthodontic Model Boxes, J Cl Orthod, 1991.


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