Benefits Risks of no treatment

Improved function Worsening of dental health

Improved Esthetics Enamel decalcification
improve lifestyle Periodontal disease
Better chances for marriage Root resorption
Better career chances TMJ disorders

Risks of orthodontic treatment

Root resorption
Decalcification of enamel
Soft tissue Damage
Periodontal disease
 Two components :
Esthetic component
Dental Health component
 Esthetic component :
Very subjective
Difficult to assess class III malocclusion
Ranked from 1-10 as follows:
1-4 > Little or no need
5-7 >Borderline or moderate need
7-10 > Definite need
 Assessed with MOCDO scale/Ruler :
M > Missing teeth
O > Overjet
C > Crossbite
D > Displacement of contact point
O > Overbite\Openbite
 Cases are ranked as follows :
1 > no need
2 > Little need
3 > Moderate need
4 > Great need
5 > Very Great need
 Skeletal Classification
 Angle Classification
 British Standard incisor classification
 Class 1 :
Normal Relationship between max. & mand.
Skeletal bases
 Class 2 :
Protruded Max . Or retruded Mand. Skeletal
bases
 Class 3 :
Retruded Max. or protruded Mand. Skeletal
bases
 Based on the first molar position as it is the
key of occlusion , followed by Canine Position
 Mesio-buccal cusp of upper 6 occludes in the
buccal groove of lower 6
 The upper canine’s cusp occludes between
lower canine & first premolar
 Angle Class I :
Normal molar & canine relation ,
malocclusion is elsewhere
 Angle Class II div. 1 :
max. protrusion or mand. Retrusion ,
accompanied by increased overjet and
abnormal lip function
 Angle Class II div. 2 :
Max. protrusion or mand. Retrusion ,
accompanied by retroclined central incisors that
are overlapped by the laterals

 N.B : Class I on one side and Class II on the other

> Class II subdivision
 Angle Class III :
Mandibular protrusion or max. retrusion

 N.B : Class I on one side and Class III on the

other > Class III subdivision
 Classifies the incisor relationship , separate
from the molar relationship
 Class I :
lower incisor edge occludes directly below
cingulum / middle part of the upper incisors
 Class II :
Lower incisor edge lies posterior to the
cingulum / middle part of the upper incisor
 Division 1:
inc. overjet & proclined
upper incisor

 Division 2 :
Retroclined upper incisor
 Class III :
Lower incisor edge lies anterior to the middle
part \ cingulum of the upper incisor
 Standardized : 6 feet from tube to patient – 1
feet from patient to film – natural head
position (Cephalostat)
 Uses :
Monitor growth
Research & surgical planning
Diagnosis & monitoring of ttt
Assessment of end result
Localization of unerupted teeth
 Before Tracing , check for pathology as :
1.Inc. size of sella turcica > indicates tumor
2.Shortening of roots > indicates cysts or any
condition causing root resorption
3.Dilacerated roots > indicates trauma and
possible impactions
4.Enlarged adenoids > avoid placing oral
screen so as not to affect patient’s breathing
Point 1 Point 2 Line joining

Sella – S Nasion – N S-N plane

Midpoint of pituitary Most ant. Point on Represents cranial

fossa / sella turcica frontonasal suture base

Point 1 Point 2 Line Joining

Orbitale – Or Porion – Po Frankfurt horizontal

plane - FH
Most inferior anterior Uppermost ,
point on the margin outermost point on
of orbit the bony external
auditory meatus
Point 1 Point 2 Line joining
Anterior nasal spine - Posterior Nasal spine - Maxillary plane - MxPl
ANS PNS
Tip of anterior process Tip of posterior nasal Represents the bone
of maxilla spine of the maxilla of the maxilla

Point 1 Point 2 Line Joining

Gonion – Go Menton – Mn Mandibular plane -
MnPl
Most posterior inferior Lowermost point on Represents the bone
point on the angle of the mandibular of the mandible
the mandible symphisis
 A Point B point Pogonion - Pog
Deepest concavity on Deepest concavity on Most anterior point on
the anterior profile of the anterior profile of mandibular symphisis
the maxilla the mandible

Functional occlusal plane - FOP

Line drawn between cusp tips of permanent
premolars & molars
 Divided into :
Antero-posterior (Skeletal pattern relation)
Vertical (Facial Proportions)
Dental (Incisor angulations to planes)
Angle Normal Value Standard Represents
Deviation
SNA 81 +/- 3 Cranium to maxilla
SNB 78 +/- 3 Cranium to mandible
ANB 3 +/- 2 Maxilla to Mandible
• ANB 2- 4 … Class I
• ANB > 4 … Class II
• ANB < 2 … Class III
Angle Value Standard Represents
Deviation
Frankfurt 28 +/- 4 Lower anterior facial height
Mandibular plane • >32 .. Inc. LAFH
angle (FMPA) • <24 .. Dec. LAFH
Maxillary 27 +/- 4 Lower anterior facial height
Mandibular Plane • >31 .. Inc. LAFH
Angle (MMPA) .. • <23 .. Dec. LAFH
More commonly
used
Angle Value Standard Represents
Deviation
Upper incisor / 108 +/- 6 Proclination / retroclination
Maxillary plane angle of upper anteriors
(U1/MxPl)
Lower incisor / 90 +/- 6 Proclination / retroclination
Mandibular plane of lower anteriors
angle (L1/MnPl)
Interincisal angle 135 +/- 10 Relation between upper &
(I/I) lower anteriors
 Drop perpendicular from A point to FOP - AO
 Drop perpendicular from B point to FOP - BO
 Measure horizontal distance From AO to BO
 BO should be ahead of AO by:
1 +/- 1.9 in males
0 +/- 1.7 in females
 Space Analysis
 Measure tooth size ( using caliber on the cast)
 Measure Arch Length (Using a piece of ligature wire
)
 Crowding=tooth size – arch length
Mild > 1-2 mm per quadrant
moderate >3-5 mm per quadrant
Severe > more than 6 mm per quadrant
 Tipping : movement of crown , with little or
no root movement
 Rotation : requires less force than tipping ,
but force couple is required (Two forces in
opposite directions)
 Bodily movement : Movement of crown and
root for equal distances , done only with
fixed appliances
 Torque : opposite of tipping , movement of
root with no crown movement , more difficult
than tipping
 Vertical :
1. Extrusion : induces tension resulting in
bone deposition
2. Intrusion : induces pressure resulting in
bone resorption
 Fixed Appliance : made of brackets , wires ,
tubes , bands & elastics
 Removable appliance: can be removed at the
patient’s will , results in intermittent force
 Functional appliance : uses muscle
movements to move the teeth
Advantages
1. Used for tipping movement
2. Can be removed (More
comfortable to the patient &
more esthetically pleasing)
3. Can be made by general
practioner
4. Inexpensive
5. Lab made , therfore less chair
time and more patients can be
treated
Disadvantages
1. Can only treat simple
malocclusion
2. Cannot treat multiple rotations
3. Poor patient compliance
4. Prolonged treatment duration
5. Lower appliances are not well
tolerated
Appliance Wire Use

Labial bow 0.7 mm • Minor overjet

reduction or
incisor
alignment
• retention

Long labial bow 0.7 mm • Close space

bet. Canine &
premolar
• Severe
proclination
• retention

Double cantilever 0.5 – Used to procline

/ Z spring 0.6 mm the incisors
Appliance Wire Uses

T spring 0.5 mm Buccal movement

of premolars &
molars

Canine retractor 0.7 mm Buccally displaced

canine moved
palatally and
distally

Palatal screw • Palatal

expansion
• Used to procline
incisors
 Robert’s Retractor :
◦ 0.5 or 0.7 mm
◦ Retracts incisors
Appliance Uses

Herbst Class II mandibular

deficiency ,brings lower jaw
forward to inc. growth

Bionator • Class II
• Maxillary arch expansion
(By holding the cheeks
away from the teeth)

Medium One piece appliance ,

opening corrects deep bite
activator
Appliance Uses

Ant. / post. Bite plane Lifts the occlusion to

intrude / extrude the
anteriors

Andresen Activator Ttt of Deep bite –

(Modification :Harvold) proclination of upper
&retroclination of lower
incisors

Twin Block Class II

 Affects neutral zone of bone
Appliance uses

Frankel I • Class I
• Class II
division 1
Frankel II Class II
division 2

Frankel III Class III

Frankel IV • Open bites

• Bimaxillary
protrusion
 Lingual orthodontics : difficult , irritates the
tongue
 Ceramic brackets : expensive , causes tooth
wear
 Clear aligner therapy : Expensive , time
consuming , limited to mild to moderate
crowding , intrusion of teeth , limited control
 Periodontal disease must be managed first
 Use light force
 Strict oral hygiene methods
 Permanent retention required