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INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com

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CEPHALOMETRIC APPRAISAL OF TREATMENT CHANGES WITH BEGG www.indiandentalacademy.com


INTRODUCTION 

Changes take place in teeth & bones due to ortho trt

Clearer picture obtained with ceph

Begg technique - unique ceph response

Begg did not demonstrate it cephalometrically

However, orthodontists of this era rely heavily on ceph making ceph appraisal a necessity www.indiandentalacademy.com


ď Ź

Selection of sample Effects of trt mechanics on ceph parameters investigated by: Comparison of pre & post trt ceph of same patient Comparison of ceph of patients treated with diff techniques Comparison of ceph of treated sample with control untreated sample www.indiandentalacademy.com


Control sample should gave characteristics like facial type, malocclusion, age, sex & race similar to treated sample.

If changes are common to both groups, effects attributed to growth

Best method to differentiate growth from trt effectsUse of non-growing treated & untreated samples www.indiandentalacademy.com


ď Ź

Method of evaluation of ceph changesDirect measurements from pre & post trt tracings Superimposition of pre & post trt tracings

Different superimposition methods Todd Krogman Broadbent Bjork Brodie Steiner

P-N Plane S-N Plane

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Broadbent- reg at R & // to B-N  DeCoster –cribriform line  Ricketts- ref line is Ba-N & reg at CC- mandible reg at N - maxilla ref line is palatal plane & reg at ANS- molar & incisor eruption 

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Characteristic Responses of pats.who have undergone 1st pm extn correction 

Apical base relation

PayneDecrease in ANB present & accomplished by posterior movement of pt. A Preidmore Redn of 3.07 from a pretrt ANB of 6.88 Posterior movement of pt. A www.indiandentalacademy.com


Kimmon Further decrease in ANB occurs in stage 3 due to rotation of max incisors about axis of torque

Williams Posttrt.decrease in N-S-GoGn Forward movement of pt.B Decrease in ANB

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Lower incisor 

Moved bodily lingually in alveolar process Stage 1-

labial surface descends &

Stage 2-

apex moved posteriorly uprighting on the apex

L1 brought to APog in stage 3 by Forward movement of pt.P Expenditure of L/anchorage Position is imp for optimum U&L/lip balance www.indiandentalacademy.com


ď ľ Change of molar relation from Cl II to Cl I Tipping of U/molars distally L/molar anchorage expenditure Favourable growth trend of mandible

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 Anchorage loss  Grafton -

∴ In

observed % of extn. space closed by forward movement of anchor teeth

Class I

47.5% of max. extn space 51.5% of mandible extn space

Class II

23.4% of max. extn. Space 97.2% of mand. extn space

class I -

max. & mand. Anchor teeth play similar roles mand molar anchor loss  correction to class II .. www.indiandentalacademy.com

Class II -


 Allen - Investigated forward movement of max .

teeth due to torquing of incisors & uprighting of canines Correlation was low between forward movement of max.1st molar and

 1 to SN  3 to SN  Trt time of 3rd stage  Duration of torque application www.indiandentalacademy.com


Mandibular plane angle Swain & Ackermann -

Overbite correction - molar extrusion & incisor intrusion

If growth is favourable no change in FMA

If growth in unfavourable

↑ in FMA

-

during treatment

↓ in FMA

-

during retention relapse of overbite

Similar findings by Philips, James & O’Reilly www.indiandentalacademy.com


 Cant of Occlusal plane Philip’s, Broussard’s, Harber’s • Clockwise rotation of OP in relation to SN, PP & MP • Extrusion of UI & LM and intrusion of LI •. Greater change than FMA & less tendency to return

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ď ľ Root resorption Guy-

Greatest amount during tipping of incisors No correlation between root resorption & Time or extent of tipping or torquing of incisors

ď ľ Alveolar crest height of 2nd premolars Libby-

No sig. difference between sites adjacent to www.indiandentalacademy.com & away from extraction site


 PP-MP Decreased for both experimental & control samples

 N -S-B Increased for both experimental & control samples

 L/ant’r face height , U/ant’r face site, S-Gn, UMT ⊥ PP, Or’- PP & Ar-Gn Increased for both but less for experimental sample www.indiandentalacademy.com


ď ľ N - S- Gn Increased for experimental sample

- non sig.

Decreased for control sample

- sig.

ď ľ SE - PNS Increased for both experimental & control samples

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Characteristic Responses of pats.who have undergone non extn correction  

ANB Meistrell et al↓ in SNA & ↑in SNB ↓ in ANB of 1.27 -

Statistically non sig. Statistically sig.

Cohen

↓ in ANB Sig. distal movement of Pt. A & slight distal movement of Pt. B

Hans

↓ in ANB Sig. distal movement of Pt. A www.indiandentalacademy.com


 UI to SN 

Meistrell et al-

In Div 1

-

5.03 reduction

- Sig.

In Div 2

-

9.25

Sig.

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Increase


LI to MP/ Angular rel’n to mand. plane Increase of 0.67 Increase of 8.5

sig. sig.(Edler)

LI to APOg/Spacial rel’n to APo Increase of of sig. Increase of 1.6 mm (Edler)

Interincisal angle Statistically sig. in Div 2 Decrease of 11.95 %

Mand. Incisors were consistently proclined Could have been decreased by labial root torque

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ď ľ Mandibular Plane Angle Decrease of 0.08

-

In Div. I

increase of 1.2

-

not sig.

Not sig., but care should be taken in high angle cases - Class II elastic force with in 1-2 ounces - All interference from cusps & brackets eliminated

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 Cant of Occlusal plane Meistrell ↓ of 0.37 not sig. Stability during treatment Hoecever Stage III rotated OP downwards anteriorly & upward posteriorly Countered by U ant’r anchor bends & pos’r check elastics www.indiandentalacademy.com


ď ľ Upper & lower 1st molars Vertical change U/molar Meistrell et al

Extrusioin of 2.1 mm

Riolo et al

Extrusion of 1.8 mm

L/molars Meistrell et al Riolo et al Menzes

Extrusion of 2.6 mm Extrusion of 2.6 mm Extrusion of 2.87 mm

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ď ľ Forward shift U/molar Small forward shift of 22 mm

non sig

Anchor bend & Cl II elastic force insufficient to distally drive the molar L/molar 1.2 mm forward movement

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SUMMARY  LI

bodily repositioned lingually

 LI

fall on/near APog line producing

harmonious soft tissue balance Angulation has no relation  Apical

base difference reduced www.indiandentalacademy.com


ď ś Mandibular

& occlusal plane angles become

steeper during first two stages Revert to original cant or even lesser in 3 rd stage ď ś Overbite

correction stable because of adequate

torquing of UI www.indiandentalacademy.com


 Largest

amount of tooth movement with

min. anchor loss occur in 1st & 2nd stages  Preoccupation

with intermediate dental

features to be avoided  Significant

& desirable changes occur even

after active trt. Is over www.indiandentalacademy.com


Stage I

Stage II

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Post - Trt.

StageIII III Stage

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CONCLUSION ď ś Cephalometric

appraisal increases our

understanding of changes taking place in dentoskeletal apparatus. ď ś Therefore,

it serves an important tool for

learning & refining the technique, according to individual needs, to produce the best results. www.indiandentalacademy.com


www.indiandentalacademy.com Leader in continuing dental education

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Cephalometric apprasial/ dental implant courses by Indian dental academy