Orthodontics principles and practice 2nd edition basavaraj subhashchandra phulari

Visit to download the full and correct content document: https://textbookfull.com/product/orthodontics-principles-and-practice-2nd-edition-basa varaj-subhashchandra-phulari/

More products digital (pdf, epub, mobi) instant download maybe you interests ...

Sustainability Principles and Practice 2nd Edition

Margaret Robertson

https://textbookfull.com/product/sustainability-principles-andpractice-2nd-edition-margaret-robertson/

Forecasting Principles and Practice 2nd Edition Rob J. Hyndman

https://textbookfull.com/product/forecasting-principles-andpractice-2nd-edition-rob-j-hyndman/

Oncologic Emergency Medicine Principles and Practice 2nd Edition Knox H. Todd

https://textbookfull.com/product/oncologic-emergency-medicineprinciples-and-practice-2nd-edition-knox-h-todd/

Principles and Practice of Lacrimal Surgery 2nd Edition Mohammad Javed Ali (Eds.)

https://textbookfull.com/product/principles-and-practice-oflacrimal-surgery-2nd-edition-mohammad-javed-ali-eds/

Brain Based Learning and Education Principles and Practice

2nd Edition Yi-Yuan Tang

https://textbookfull.com/product/brain-based-learning-andeducation-principles-and-practice-2nd-edition-yi-yuan-tang/

Tourism : principles and practice Fletcher

https://textbookfull.com/product/tourism-principles-and-practicefletcher/

Forecasting Principles and Practice Athanasopoulos

https://textbookfull.com/product/forecasting-principles-andpractice-athanasopoulos/

Derivatives principles and practice Das

https://textbookfull.com/product/derivatives-principles-andpractice-das/

Keeping Bees with a Smile Principles and Practice of Natural Beekeeping 2nd Edition Fedor Lazutin

https://textbookfull.com/product/keeping-bees-with-a-smileprinciples-and-practice-of-natural-beekeeping-2nd-edition-fedorlazutin/

ORTHODONTICS PrinciplesandPractice

ORTHODONTICS

Principles and Practice

ORTHODONTICS Principles and Practice

SECOND EDITION

Basavaraj Subhashchandra Phulari BDS MDS (Ortho) FRSH FAGE

Formerly, Faculty of Department of Orthodontics and Dentofacial Orthopedics Mauras College of Dentistry, Hospital and Oral Research Institute Republic of Mauritius

The Health Sciences Publisher

Jaypee Brothers Medical Publishers (P) Ltd

Headquarters

Jaypee Brothers Medical Publishers (P) Ltd.

4838/24, Ansari Road, Daryaganj New Delhi 110 002, India

Phone: +91-11-43574357

Fax: +91-11-43574314

E-mail: jaypee@jaypeebrothers.com

Overseas Offices

J.P. Medical Ltd.

83, Victoria Street, London SW1H 0HW (UK)

Phone: +44-20 3170 8910

Fax: +44(0)20 3008 6180

E-mail: info@jpmedpub.com

Jaypee Brothers Medical Publishers (P) Ltd.

Bhotahity, Kathmandu, Nepal

Phone: +977-9741283608

E-mail: kathmandu@jaypeebrothers.com

Jaypee-Highlights Medical Publishers Inc. City of Knowledge, Bld. 235, 2nd Floor, Clayton

Panama City, Panama

Phone: +1 507-301-0496

Fax: +1 507-301-0499

E-mail: cservice@jphmedical.com

Jaypee Brothers Medical Publishers (P) Ltd. 17/1-B, Babar Road, Block-B, Shaymali Mohammadpur, Dhaka-1207

Bangladesh Mobile: +08801912003485

E-mail: jaypeedhaka@gmail.com

Jaypee Medical Inc.

325 Chestnut Street Suite 412, Philadelphia, PA 19106, USA

Phone: +1 267-519-9789

E-mail: support@jpmedus.com

Website: www.jaypeebrothers.com

Website: www.jaypeedigital.com

© 2017, Jaypee Brothers Medical Publishers

The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.

All rights reserved. No part of this publication and may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.

All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.

This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.

Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.

Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com

Orthodontics: Principles and Practices

First Edition: 2011

Second Edition: 2017

ISBN: 978-93-85999-89-5

Printed at:

Dedicated to My dear parents (Subhashchandra and Shivalingamma Phulari), brothers (Sangamesh, Jagadeesh and Manjunath),

My beloved wife Dr Rashmi GS Phulari, MDS (Oral Pathology & Microbiology) and My dearest sons (Yashas and Vrishank) for their love, support and encouragement

And to Dear (Late) Chandu who is always in our hearts and thoughts...

Aakash Shah BDS MDS (Ortho)

Professor

Department of Orthodontics and Dentofacial Orthopedics Faculty of Dental Sciences

Dharmsinh Desai University Nadiad, Gujarat, India

Aneshwar Rohanlal Bhagwandass BDS (Manipal), DMD (USA) Private Practioner United States of America

Anil Shah BDS Master of ESOLA Academy Vienna University, Austria President, SOLA India Innovate Dental Center Surat, Gujarat, India

Basavaraj Subhashchandra Phulari BDS, MDS(Ortho), FRSH, FAGE Formerly, Faculty

Department of Orthodontics and Dentofacial Orthopedics Mauras College of Dentistry, Hospital and Oral Research Institute Republic of Mauritius

Basti Risi Kino DMD, MDSc, PGDip (PSM) Director of Public Dental Services Ministry of Health and Quality of Life Republic of Mauritius

Desi Moodley

BDS, PDD-Aesthetic Dent (Stell), MSc Dent Sc (Stell), PhD (UWC) Researcher

Oral and Dental Research Institute

University of the Western Cape Cape Town, South Africa

Frank Tsahannerr Dr Med Dent (Munich University)

Implantologist

Perchastr.5

82335 Berg am starnberger see, Germany

Mark Donald Vernon BChD MFDSRCS (England)

Clinical Lecturer

The Barts and The London Dental Institute United Kingdom

Mohan Vakade MDS (Oral and Maxillofacial Surgery)

Master of ESOLA Laser Academy, Vienna University

Professor and HOD

Department of Oral and Maxillofacial Surgery

Vaidik Dental College Daman, Gujarat, India

Contributors

Naresh Thukral

BDS Master of ESOLA Academy Vienna University, Austria

Founder President, SOLA India Head, Laser Academy and a Faculty Executive Member of Board SOLA-International

Ohana Gabriel Dentiste

7 Ar Gombetta 92400, Courbevoie France

Poorya Naik BDS MDS (Ortho) Reader

Department of Orthodontics and Dentofacial Orthopedics College of Dental Sciences Davangare, Karnataka, India

Rashmi GS BDS MDS (Oral Pathology and Microbiology) Professor

Department of Oral Pathology and Microbiology

Manubhai Patel Dental College and Hospital Vadodara, Gujarat, India

Syed Zakaullah BDS MDS (Oral and Maxillofacial Surgery)

Professor and Vice Principal Department of Oral and Maxillofacial Surgery Al-Badar Dental College and Hospital Gulbarga, Karnataka, India

Valentina Tsipova BDS MDS (Ortho) University of Tartu Estonia

Richard Poavin and Brulet Alain

Graphic Designer

Rich.C.lte’e

Route co^tiere-Trou- Aux-Biches i^le Maurice

Rue Aristide Briand 78700 conflans Ste, Honorine France

Preface to Second Edition

Since the first edition of this book was published in 2011, I have received an overwhelming feedback in the form of numerous email messaged and letters. I am extremely grateful for the positive response the book has received from the faculty in the field of Orthodontics and students alike.

The basic format of the book comprising of 49 chapters grouped under 15 sections is retained in the second edition as well. The book continues to give simple and logical narration of difficult orthodontic concepts in a fluid easy-tounderstand language.

Numerous high-quality clinical photographs and skilfully made graphic illustrations throughout the book make it easier for the students to grasp the subject. Few pictures that lacked good resolution have been replaced in the new edition.

Innovative self-explanatory flowcharts and tables along with good pictures have come to be the hallmark of this title. In addition, summary charts given at the end of each chapter as Chapter Overview come handy during revision of the subject in preparation to exams.

Sample questions in both long question and short note formats are given for each chapter to prepare the students for theory examination. Chapter-wise Multiple Choice Questions (MCQs) are also given to aid students in preparation for viva-voce.

All the efforts have been made to present the subject in concise yet all comprehensive manner. It is hoped that the new edition will continue to be appreciated by students and staff alike.

Basavaraj Subhashchandra Phulari basavarajsp@gmail.com

Preface to First Edition

The fascinating field of Orthodontics has come a long way since the era of finger pressure and crude wires to the more sophisticated, state-of-art techniques and appliances of today. The oldest specialty of dentistry has witnessed immense progress in the last few decades, both in terms of technology as well as patient management. Braces are no more only for children and adolescents. More and more adult patients are seeking orthodontic treatment in the recent years. Thanks to technical advances in the appliance design, there has been increased understanding of cellular responses to orthodontic force and awareness among general public.

The ever-growing field of Orthodontics and Dentofacial Orthopedics as it is called today is fascinating and at the same time complex. Teaching orthodontics to undergraduates had never been more challenging, especially, in the view of vast literature and comparatively minimal exposure to clinical orthodontics, the undergraduate students generally have during their course. This book is a humble step towards meeting this enormous challenge of providing an all comprehensive, yet simple-to-understand text for the students of dentistry. The objective is to narrate the essentials of orthodontics in a simple and logical way, at the same time arouse interest in the minds of undergraduate dental students about this wonderful field. Furthermore, it is also hoped that the book will be of value to postgraduate students as well.

The 49 chapters, encompassing 15 sections have been compiled by an impressive bunch of academicians around the world. The chapter, History of Orthodontics gives a quick glance at the turning events in the evolution of the first speacialty of dentistry. Often asked and considerably difficult concepts such as Cephalometrics and Model Analysis are explained systematically with provision for quick review. Management of different types of malocclusion is narrated in simple manner with complete case records to support the text.

A separate chapter on Preclinical Orthodontics has been included for the first time which deals with rationale, armamentarium and step-by-step wire bending procedures, much required for undergraduate students. A working classification of basic orthodontic instruments is given with their modes of usage in chapter 27—Orthodontic Instruments There is another section that covers the Recent Advances in Orthodontics including implants, invisalign and application of lasers in orthodontics.

Over 2,000 high quality clinical photographs and professionally done graphic illustrations with informative legends in the book make the text easy to grasp. Incorporation of tables, flow charts and boxes throughout the textbook wherever necessary will give the reader a convenient summary of key features and also make reviewing easier.

An accompanying booklet MCQs in Orthodontics features over 2,300 multiple choice questions given chapter-wise with answer keys. Furthermore, in each chapter, the questions follow the same order of points given in that particular chapter, thus can act as a very good means of revision of that topic/chapter and at the same time prepares the student for viva voce as well as PG entrance test and other competitive tests.

I regret any deficiencies and shortcomings that might have crept in despite our best efforts. I would also welcome comments and suggestions from both students and teachers for further improvement of the book.

Basavaraj Subhashchandra Phulari

Acknowledgments

There are several people who have contributed to this project without whose cheerful cooperation the task would have been arduous if not impossible.

With profound sense of gratitude and respect, I express my heartfelt thanks to Dr Rajendrasinh Rathod MDS, Chairman of Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India; Chairman and Dean of Mauras College of Dentistry, Hospital and Oral Research Institute, Republic of Mauritius, for his timely suggestions, critical observations and above all for his inspirational support not only in this endeavor but throughout my academic career. He has been a constant source of encouragement and guidance throughout this project while providing me with all the facilities required for completion of this work. My special thanks to Dr YK Desai, Professor, Prosthodontics for support and comments he provided to this work. I would also like to thank Dr Yashraj Rathod, Trustee, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India for his unstinting support and encouragement during this endeavor.

I have much pleasure in acknowledging the help I have received from my students of Mauras College of Dentistry, Hospital and Oral Research Institute, Republic of Mauritius in grueling sessions of spell check, and for familiarizing me with ‘student’s point of view’.

I am indebted to Dr Anil Shah and Dr Aakash Shah for all the help and encouragement I have received from them during the formative stages of this project. I am proud to have them as contributors.

I extend my special thanks to Mr Chitranjan Luchoo for his expert comments and suggestions regarding photography, and Mr Prakash Gopoul for providing crisp, neat line drawings for the book. I will be failing in my duty if I do not mention the affection and support I have received from Dr Goyal and family, Jayantee Raghunandan and family, Ramesh Purgus and family and Gopoul family who have always provided that moral boost much needed during compilation of the book.

I take this opportunity to thank my beloved parents Mr Subhashchandra Phulari and Mrs Shivalingamma Phulari, and brothers Sangamesh, Jagadish, and Manjunath Phulari for their constant support and cooperation during the entire course of this publication. I thank my beloved wife Dr Rashmi GS Phulari MDS (Oral Pathology and Microbiology) for being a constant source of inspiration and support throughout this project, helping me at every step right from checking the flow of text, arrangement of photographs to final proofs. I fondly acknowledge my dearest sons Yashas and Vrishank for their patience and love.

I profusely thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President) and production team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for their enthusiasm, excellent cooperation and constant support in publishing the book.

Most of all, I thank God for all the kindness and mercy showered upon me.

SECTION 5:

SECTION 6: Preventive and Interceptive Orthodontics

SECTION 7: Treatment Planning

SECTION 8: Orthodontic

SECTION 9:

34.

35.

SECTION 10: Orthodontic Appliances

37.

SECTION 11: Corrective Orthodontics

SECTION 12: Surgical Orthodontics

SECTION 13: Retention and Relapse

Introduction

INTRODUCTION

Humans have attempted to straighten the teeth for thousands of years before orthodontics became a dental specialty in the late nineteenth century. Proper alignment of the teeth has long been recognized to be an essential factor for esthetics, function and overall preservation of dental health. Malposed/poorly aligned teeth may predispose to a number of unfavorable sequelae such as poor oral hygiene predisposing to periodontal diseases and dental caries, poor esthetics giving rise to psychosocial problems, increased risk of trauma, abnormalities of function and temporomandibular joint (TMJ) problems (Box 1.1).

Box 1.1: Unfavorable sequelae of malocclusion

 Poor facial appearance

 Poor oral hygiene maintenance

 Risk of dental caries

 Risk of periodontal diseases

 Abnormalities of functions

 Psychosocial problems

 Risk of trauma to the teeth

 TMJ problems.

Orthodontics is the branch of dentistry concerned with the growth of the face, development of occlusion and the prevention and correction of occlusal anomalies/ abnormalities. The term “orthodontics” comes from Greek: “orthos” meaning right or correct and “odontos” meaning tooth (Flowchart 1.1). The term ‘orthodontics’ was first coined by Le Felon in 1839.

DEFINITION

Knowing the definition is often an important initial step in understanding any subject. A number of definitions have been put forward over the years to explain what orthodontics is. Some of the widely followed definitions are given below:

In 1911, Noyes gave the first definition of orthodontics as “The study of the relation of the teeth to the development of the face and the correction of arrested and perverted development.”

Flowchart 1.1: Derivation of the term orthodontics

BS

In 1922, The British Society of Orthodontists proposed that “Orthodontics includes the study of growth and development of jaws and face particularly and the body generally, as influencing the position of the teeth; the study of action and reaction of internal and external influences on the development, and the prevention and correction of arrested and perverted development.”

Later, the American Board of Orthodontics (ABO) and the American Association of Orthodontists (AAO) stated that, “Orthodontics is that specific area of dental practice that has, as its responsibility, the study and supervision of the growth and development of the dentition and its related anatomical structures from birth to dental maturity, including all the preventive and corrective procedures of dental irregularities, requiring the repositioning of teeth by functional or mechanical means to establish normal occlusion and pleasing facial contours.”

WHAT IS MALOCCLUSION?

The term ‘malocclusion’ was first coined by Guilford and it refers to any irregularities in occlusion beyond the accepted range of normal category. Malocclusions are caused by hereditary or environmental factors or more commonly, by both the factors acting together. One of the most common causes of malocclusion is the disproportion in size between the jaw and the teeth or between the maxillary and the mandibular jaws. A child who inherits mother’s small jaw and father’s large teeth, may have teeth that are too big for the jaw, causing crowding in the arch. Abnormal oral habits, such as thumb/digit sucking, lip biting and mouth breathing may also cause malocclusion by adversely affecting the normal occlusal development. Malocclusion can be presented in a number of ways. Some of the common characteristics of malocclusion include:

„ Overcrowded teeth

„ Spacing between the teeth

„ Improper “bite” between maxillary and mandibular teeth

„ Disproportion in the size and the alignment between the maxillary and the mandibular jaws.

It must be appreciated that not all malocclusions need treatment. Treatment of malocclusions that are mildly unesthetic and not detrimental to the health of the teeth and their supporting structures may not be needed and is not justified.

AIMS OF ORTHODONTIC TREATMENT

Although orthodontic treatment improves facial appearance and is occasionally performed for cosmetic reasons, it should be aimed at restoration of overall dental health.

Phulari

Jackson has summarized the aims of orthodontic treatment that are popularly known as Jackson’s Triad (Fig. 1.1). They are:

i. Functional efficiency

ii. Structural balance

iii. Esthetic harmony.

Functional Efficiency

The teeth along with their surrounding structures, are required to perform certain significant functions such as mastication and phonation. Orthodontic treatment should increase the efficiency of the functions performed.

Structural Balance

Orthodontic treatment not only affects teeth but also the soft tissue envelop and the associated skeletal structures. The treatment should maintain a balance between these structures and the correction of one should not affect the health of the other.

Esthetic Harmony

The orthodontic treatment should enhance the overall esthetic appeal of the individual. This might just require the alignment of certain teeth or movement of the complete dental arch, including its basal bone. The aim is to get results which go well with the patient’s personality and make him or her look more esthetically appealing.

BRANCHES OF ORTHODONTICS

The general field of orthodontics can be divided into the following three categories based on the nature and time of intervention:

„ Preventive orthodontics

„ Interceptive orthodontics

„ Corrective orthodontics.

Preventive Orthodontics

Preventive orthodontics is defined as “Action taken to preserve the integrity of what appears to be the normal occlusion at a specific time.” As the name implies,

preventive orthodontics includes actions undertaken prior to the onset of a malocclusion, so as to prevent the anticipated development of a malocclusion.

Preventive orthodontics encompasses all those procedures that attempt to ward off untoward environmental attacks or anything that would change the normal course of events. They include the care of deciduous dentition with restoration of carious lesions that might change the arch length; monitoring of eruption and shedding timetable of teeth; early recognition and elimination of oral habits that might interfere with the normal development of the teeth and jaws; removal of retained deciduous teeth and supernumeraries, which may impede eruption of permanent teeth and maintenance of space following premature loss of deciduous teeth to allow proper eruption of their successors.

Interceptive Orthodontics

Interceptive orthodontics implies that an abnormal situation (malocclusion) already exists when the action is taken. Certain interceptive procedures are undertaken during the early manifestation of malocclusion to lessen the severity of malocclusion and, sometimes, to eliminate the cause.

Interceptive orthodontics is defined by the American Association of Orthodontists as “That phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions in the developing dentofacial complex.”

Interceptive procedures include serial extraction, correction of developing anterior crossbite, control of abnormal oral habits, removal of supernumeraries and ankylosed teeth and elimination of bony or tissue barriers to erupting teeth.

Certain procedures undertaken may be common to both preventive and interceptive orthodontics. However, the timing of the services rendered is different. Preventive orthodontic procedures are carried out before the manifestation of a malocclusion, while the goal of interceptive orthodontics is to intercept a malocclusion that has already been developed or is developing, so as to restore a normal occlusion.

Corrective Orthodontics

Corrective orthodontics, like interceptive orthodontics, is also undertaken after the manifestation of a malocclusion. It employs certain technical procedures to reduce or correct the malocclusion and to eliminate the possible sequelae of malocclusion.

Corrective surgical procedures may require removable or fixed mechanotherapy, functional or orthopedic appliances, or in some cases, an orthognathic/surgical approach.

ORTHODONTIC APPLIANCES

Today orthodontists have a wide array of appliances in their armamentarium to treat malocclusions. Success of orthodontic treatment depends on the appropriate

Fig. 1.1: Aims of orthodontic treatment (Jackson’s triad)

selection of the appliances, the timing of the treatment, the type of tooth movement and/or skeletal changes desired, age of the patient and other factors. There are basically four types of orthodontic appliances, which can either be used individually or in combination to treat malocclusions.

i. Removable orthodontic appliances

ii. Fixed orthodontic appliances

iii. Functional appliances

iv. Orthopedic appliances/Extra-oral force appliances

Removable Orthodontic Appliances

Removable orthodontic appliances are so called because they can be removed and fitted back into the mouth by the patient (Fig. 1.2)

Use of removable appliances requires careful case selection for the success of the treatment. They are ideally used when simple tipping movement of teeth is sufficient to correct a certain type of malocclusion. The range of malocclusions that can be treated with removable appliances alone is limited. They can also be used as passive appliances to maintain the teeth in their corrected positions after active phase of orthodontic therapy, e.g. retainers. Removable orthodontic appliances can be used in conjunction with fixed mechanotherapy.

Fixed Orthodontic Appliances

Fixed orthodontic appliances are so called because they are fixed to the teeth and cannot be removed by the patient. Fixed orthodontic therapy involves fixation of attachments (brackets) to the teeth and application of forces by arch wires or auxiliaries via these attachments (Fig. 1.3). Fixed appliances are indicated when multiple tooth movements are required for correction of malocclusion, such as rotations and bodily movement of the teeth. Fixed mechanotherapy allows fine finishing and settling of occlusion. There are a number of fixed orthodontic techniques such as: Begg’s, Edgewise, pre-adjusted Edgewise, straight wire and lingual techniques.

Functional Appliances

Functional appliances/myofunctional appliances are those appliances that utilize the forces of the circumoral musculature for their action to effect the desired changes (Fig. 1.4). They act principally by holding the mandible away from the normal resting position to effect growth modification of the mandible.

Orthopedic Appliances/Extraoral Force Appliances

Orthopedic appliances use extraoral forces of high magnitude (>400 g/side) to bring about skeletal changes. Intermittent application of such high forces in the growth period aids in correction of skeletal malocclusions by growth modification. Orthopedic appliances like functional appliances require good patient compliance for their success, e.g. headgears and chin cup (Fig. 1.5)

TIMING OF ORTHODONTIC INTERVENTION

Appropriate timing of orthodontic treatment is essential to accomplish the desired treatment outcome and its long-term stability. Timing of orthodontic intervention is related to the stage of dentition.

Deciduous Dentition

Orthodontic treatment during this stage mainly includes the following:

„ Parental education

„ Care of deciduous dentition

„ Space maintenance

„ Elimination of abnormal oral habits.

Early Mixed Dentition

Orthodontic treatment during this stage includes the monitoring of shedding timetable, serial extraction, space maintenance and control of abnormal oral habit. Although most corrective orthodontic procedures are performed in older children and adolescents, it may be advantageous in some cases to begin the treatment early before all the permanent teeth have erupted and facial growth is complete.

Fig. 1.2: Removable orthodontic appliance

Fig. 1.3: Fixed orthodontic appliance

Advantages of early orthodontic treatment include:

„ Correction of bite problems by guiding jaw growth and controlling the width of the upper and lower dental arches.

„ Reduction or elimination of abnormal swallowing or speech problems.

„ Growth modification using functional and orthopedic appliances is best done in this period where significant growth is taking place.

„ Shortening and simplification of later orthodontic treatment.

„ Prevention of later tooth extractions.

„ Improvements in appearance and self-esteem.

„ Parental education.

Late Mixed Dentition/Early Permanent Dentition

Most corrective orthodontic treatments are carried out in late mixed dentition or early permanent dentition stage.

Late Treatment

„ Many types of orthodontic treatments are feasible after adolescence. However, growth modification procedures to correct skeletal malocclusion may not be feasible due to cessation of growth.

„ Surgical treatment involving orthognathic surgeries are best carried out in late teens/early adulthood after the cessation of growth.

SCOPE OF ORTHODONTICS

From the era of finger pressure application to invisalign treatment, the field of orthodontics has witnessed profound development in the form of newer appliance designs and techniques, which have only increased the scope of orthodontics.

Monitoring and Assessment of Developing Dentition

„ Shedding and eruption schedule is closely monitored to ensure the normal course of events.

„ Space maintainers are given in case of premature loss of primary teeth to facilitate the eruption of successor teeth.

„ Habit breaking appliances are given to eliminate deleterious oral habits, such as thumb/digit-sucking and lip-biting, which can adversely affect the development of dentofacial structures.

„ Planned extraction of certain deciduous and/or permanent teeth (serial extraction) done in selected cases can prevent future development of crowding by providing adequate space for the remaining teeth to erupt.

Correcting Malocclusions of Dental Origin

Malocclusions of dental origin include abnormalities of intra-arch alignment and inter-arch relationship of teeth. They can be managed by removable or fixed orthodontic appliances.

Correcting Malocclusions of Skeletal Origin

Skeletal malocclusions include conditions where the upper and lower jaws are abnormally related to each other.

„ Growth modification: Skeletal malocclusions can be treated successfully by modifying the growth of jaws during active growth period using functional or orthopedic appliances.

„ Surgical correction: Severe skeletal malocclusion in adults can be corrected by orthognathic/surgical approach.

Adult Orthodontics

Better understanding of bone cell reactions to orthodontic forces and improvements in appliance design has made orthodontic treatment feasible in adult age as well. Orthodontic treatment in adults may involve the following:

„ Adjunctive orthodontic procedures: They refer to limited orthodontic treatment carried out to facilitate other dental procedures. Adjunctive orthodontic

Fig. 1.4: Activator, a myofunctional orthodontic appliance

Fig. 1.5: Orthopedic appliance

procedures include uprighting of tilted abutment teeth prior to bridge work, space gaining for placement of implants, etc.

„ Comprehensive orthodontic treatment: It is usually carried out in young adults and involves full-fledged orthodontic treatment with or without extraction of teeth.

Guards

„ Mouthguard/Sportsguard: Mouthguards are often used during contact sports, such as boxing to prevent trauma to the teeth.

„ Night guards: Night guards can be given in bruxism to prevent further loss of tooth structures by clenching of teeth.

Management of Dentofacial Anomalies

Dentofacial anomalies such as cleft lip and cleft palate are usually associated with impaired facial appearance, speech, hearing, mastication, deglutition, and dental occlusion. Thus, management of such patients often requires a multidisciplinary approach with a long-term treatment plan and individualized rehabilitation program designed to address the treatment needs. Malocclusion is usually present and orthodontic therapy with or without corrective jaw surgery is frequently indicated.

BENEFITS OF ORTHODONTIC TREATMENT

„ Improved confidence

„ Well-aligned teeth that are easier to keep clean and

EXAM-ORIENTED QUESTIONS

Long Essays or Long Questions

1. Define orthodontics. Describe aims and scope of orthodontics.

healthy.

„ Ideally positioned teeth, which lessen the chance of gingivitis and advanced gum disease.

„ Closed spaces to avoid the need for a bridge or denture.

„ Better chewing and food digestion.

BIBLIOGRAPHY

1. Ackerman JL, Profitt WR. The characteristics of malocclusion: A modern approach to classification and diagnosis. Am J Orthod 1969;56:443-54.

2. Eveleth PB, Tanner JM. World-wide variation in human growth (2nd edn), Cambridge, Mass. Cambridge University Press, 1990.

3. Foster TD. A Textbook of Orthodontics, St Louis, Blackwell Scientific Publications, 1982.

4. Graber TM, Neumann B. Removable Orthodontic Appliances. Philadelphia. WB Saunders, 1984.

5. Graber TM, Vanarsdall RL, et al. Orthodontics, Current Principles and Techniques. Diagnosis and Treatment Planning in Orthodontics. Mosby, 2000.

6. Graber TM. Orthodontics: Principles and Practice. WB Saunders, 1998.

7. Krogman WM. Child Growth Ann Arbor, Mich. The University of Michigan Press, 1972.

8. Moorrees CFA. The dentition of the growing child, Cambridge, Harvard University Press, 1959.

9. Proffit WR. Concepts of growth and development. In: Contemporary Orthodontics, 2nd edn. St Louis: Mosby Yearbook, 1999;24-62.

10. Profitt WR, Ackerman JL. Rating the characteristics of malocclusion: A systematic approach for planning treatment, Am J Orthod 1973;64(3):258-69.

11. Tanner JM, Whitehouse RH, Takaishi M. Standards from birth to maturity for height, weight, height velocity and weight velocity in British children. Arch Dis Child. 1966;41:454-71.

2. Describe briefly the aims, objectives, scope and limitations of orthodontic treatment.

3. What is orthodontia? Describe various sequelae of malocclusion of teeth.

Long Note or Short Essay

1. Aims of orthodontics and scope of orthodontics

Short Notes

1. Jackson’s traid or aims of orthodontics

2. Branches of orthodontics

3. Benefits of orthodontic treatment

4. Unfavourable sequelae of malocclusion.

Aims of orthodontic treatment

Functional efficiency

Structural balance

Esthetic harmony

Branches of orthodontics

Preventive orthodontics

Interceptive orthodontics

Corrective orthodontics

CHAPTER OVERVIEW

Fundamentals of orthodontics

Orthodontic appliances

Removable orthodontic appliances

Fixed orthodontic appliances

Functional appliances

Orthopaedic appliance

Timing of orthodontic intervention

Deciduous dentition

Early mixed dentition

Late mixed dentition

Early permanent dentition

Scope of orthodontics

Monitoring and assessment of developing dentition

Correcting malocclusions of dental origin

Correcting malocclusions of skeletal origin

Adult orthodontics

Guards

Management of dentofacial anomalies

Since the beginning of human history, human beings have understood at a very basic level that without a proper bite, survival is very difficult. If you cannot chew well, you cannot eat well. The remains of the ancient Egyptians, Romanians and the Etruscans show that these societies used various kinds of metal and wires to straighten or adjust the teeth.

Many advances in dentistry and some pioneering efforts in teeth straightening began in the eighteenth century, but it was really in the nineteenth century that orthodontics became a science of its own.

Many inventors have significantly contributed to the fascinating science of orthodontics. The person given the most credit for pioneering modern orthodontics is Dr Edward H Angle, who is rightly honored as the “Father of Modern Orthodontics.” Publication of Angle’s classification system of malocclusion in 1899 marked a turning point in the history of orthodontics, paving way to establishment of the oldest specialty of dentistry.

The history of orthodontics is interesting and at the same time complex. It is the oldest specialty of dentistry. It would be wise to follow the development of this exciting field of science right from the era of ancient civilization to the current times. Prior to 1900s, the specialty of orthodontics was referred as “Regulation of Teeth” and as “Orthodontia” up to 1930s. The term “Orthodontics” has been used up to 1970s and currently the speciality is addressed as “Orthodontics and Dentofacial Orthopedics” (Table 2.1).

ANCIENT CIVILIZATION

The history of orthodontics has been intimately interwoven with the history of dentistry for more than 2,000 years. Dentistry in turn, has its origins as a part of medicine (Table 2.2).

The Greek physician, Hippocrates (460–377 BC), was the first to separate medicine from fancy or religion. He established a medical tradition based on facts and the collected information was gathered into a text known as the “Corpus Hippocraticum.” This text of the pre-Christian era contains many references to the teeth and to the tissues

Table 2.1: Evolution of term orthodontics

ƒ Orthodontics

ƒ Regulation prior to 1900s

ƒ Orthodontia up to 1930s (“ia” referred to a medial condition)

ƒ Orthodontics up to 1970s

ƒ Currently orthodontics and dentofacial orthopedics

of the jaws as part of the medical text, which includes descriptions of irregularity and crowding of teeth.

Aristotle (384–322 BC), the Greek philosopher, was the first writer who studied the teeth in a broad manner. In his work entitled, “De Partibus Animalium” (On the Parts of Animals), he compared various dentitions of the known species of animals of that time.

Aulus Cornelius Celsus (25 BC–50 AD), the prominent Roman author of the first century, described finger pressure to move teeth in his work “De Re Medicina” (On Medicine).

“When in a child a permanent tooth appears before the fall of the milk tooth, it is necessary to dissect the gum all around the latter and extract it. The other tooth must then be pushed with the finger, day by day, towards the place that was occupied by the one extracted and this is to be continued until it reaches its proper position.”

MIDDLE AGES THROUGH SEVENTEENTH CENTURY

There is little reference to dentition during this period. An Arabic physician, Paul of Aegina (Paulus Aeginata, 625–690) wrote about irregularities in the dental arches caused by supernumerary teeth. He advised extraction of such teeth.

Ambrose Paré (1517–1590), a French surgeon, paid specific attention to the cleft palate. He was the first surgeon to devise an obturator for the treatment of cleft palate.

EIGHTEENTH CENTURY

Eighteenth century witnessed major events in the development of dental science dentistry. France was the leader in dentistry throughout the world in this century. This was mainly due to one person named Pierre Fauchard. No one person exerted a stronger influence on the development of the profession than he did. In fact, he is referred to as the “Founder of Modern Dentistry.” He created order out of chaos, developed a profession

Table 2.2: Ancient civilization

Authors Contributions to orthodontics

Hippocrates Description of irregularity of teeth in “Corpus Hippocraticum”.

Aristotle Comparison of various Dentitions of different species of animals in his work “De Partibus Animalium”. 25 BC–

AD Aulius Cornelius Celsus

Described finger pressure to move teeth in his work “De Re Medicina.”

Phulari BS

out of a craft and gave to this new branch of medicine a scientific and sound basis for the future. He published his two-volume book entitled “The surgeon dentist, a treatize on the teeth”, which had an entire chapter on ways to straighten teeth. With reference to orthodontics, as early as 1723, he developed what is probably the first orthodontic appliance. It was called Bandelette (Fig. 2.1). It was designed to expand the arch, particularly the anterior teeth and was the forerunner of the expansion arch of modern times (Table 2.3).

John Hunter (1728–1793), an English surgeon and a great teacher of anatomy, published his book “The Natural History of the Human Teeth” in 1771. He demonstrated the growth, development and articulation of the maxilla and the mandible and outlined the internal structure of the teeth and bone and their separate functions. He gave the basic nomenclature of dentistry incisors, bicuspids and molars.

The art of modern dentistry based on scientific foundation was first developed in Europe. It then came to the United States through the European-trained “Operators for the teeth” who came to America seeking fresh opportunities. Many native practitioners of America then began to “regulate” teeth. Malocclusion was called “irregularities” and their correction “regulation” during this period.

NINETEENTH CENTURY

Foundations were laid in the nineteenth century to the oldest specialty of dentistry—Orthodontics. It was in the latter part of the nineteenth (1880s) century that the specialty began to emerge (Table 2.4).

By the mid-nineteenth century, basic concepts of diagnosis and treatment had begun. It was a time when each practitioner attempted treatment by devising their own method based on purely mechanical principles. At that time, orthodontics was part of prosthetic dentistry and the literature on the subject described orthodontics in the area of partial or total replacement of missing teeth.

Table 2.3: Contribution to orthodontics in 18th century

Year

Authors Contributions to orthodontics

1723 Pierre Fauchard ƒ Father of modern dentistry

ƒ He published his two-volume book entitled “The Surgeon Dentist, A Treatise on the Teeth”

ƒ Developed first expansion appliance called “Bandelette”

1728–1793 John Hunter ƒ Natural history of teeth

ƒ Growth and development of jaws

ƒ Internal structure of teeth

ƒ Functions of teeth

Table 2.4: Contribution to orthodontics in 19th century

Year

Authors Contributions to orthodontics

1841 William Lintott Introduced the use of screws

1840 JS Gunnell Introduced chin strap

1860 Emerson C Angel ƒ First to introduce Arch Expansion by opening midpalatal suture

ƒ Father of expansion appliances

1871 William and Magill Developed molar bands

1888 and 1889 John Nutting Farrar

ƒ “Father of American orthodontics”

ƒ Wrote “Irregularities of the Teeth and Their Correction”

ƒ Textbook was the first great work devoted exclusively to orthodontics

ƒ Laid the foundation for “Scientific orthodontics” (intermittent forces, limits to amount of tooth movements)

1829–1913 Norman N Kingsley

ƒ Treatise on oral deformities “worked on correction of cleft palate”

ƒ Extraoral traction.

1893 Henry A Baker Baker’s anchorage Intermaxillary elastics)

Fig. 2.1: Bandelette designed by Pierre Fauchard to expand dental arches

Fig. 2.2: Expansion appliance developed by Emerson C Angel

As early as in 1841, William Lintott introduced the use of screws in his work “On the teeth.” He described premature loss of deciduous teeth as a cause of malocclusion, recommended that treatment be begun between the age of 14 and 25 years and also described a bite opening appliance.

JS Gunnell, in 1840, introduced the chin strap as occipital anchorage for the treatment of mandibular protrusion, the principle of which is used even today.

Emerson C Angel (1823–1903), in 1860, was the first to advocate the opening of the median suture to provide space in the maxillary arch, since he strongly opposed extraction (Fig. 2.2). This began the use of arch expansion in orthodontics.

William and Magill developed molar bands on the teeth as early as in 1871.

It was not until the latter part of the nineteenth century, when a few dedicated dentists gave special attention and importance to this phase of dentistry, that orthodontics began to emerge as a specialty science. It was known at that time as ‘Orthodontia’, the suffix ‘ia’ referred to a medical condition. In the last three decades of nineteenth century, some great contributors were made to the specialty by the following dentists.

John Nutting Farrar (1839–1913) is often referred as the “Father of American Orthodontics”. It was he who gave impetus to the scientific investigations that permitted the understanding of the theory and practice of orthodontics. During his studies, he investigated the physiologic and pathologic changes occurring in animals as the result of orthodontically induced tooth movement.

He published two volumes entitled “Irregularities of the Teeth and Their Correction” in 1888 and 1889. The textbook was the first great work devoted exclusively to orthodontics. Farrar was good at designing brace appliances and was the first to suggest the use of mild force at timed intervals to move teeth “in regulating the teeth, the traction must be intermittent and must not exceed certain fixed limits.” He was also the first to recommend root or bodily movement of the teeth.

Another man who also deserves much credit during this period of time is Norman N Kingsley (1829–1913),

a prominent dentist, artist/sculptor and orthodontist (Fig. 2.3). He is known for his works on “Correction of cleft palate”. As early as in 1866, he devised a technique called “Jumping the bite” with the use of a bite plane. He used vulcanite on conjunction with ligatures, elastic bands made of rubber, jackscrews and the chin cap.

Henry A Baker is remembered for the introduction of the so called Baker’s anchorage or the use of the intermaxillary elastics with rubber bands in 1893 (Fig. 2.4).

TWENTIETH CENTURY

Angle’s Contribution to Orthodontics

One of the most dominant, dynamic and influential figures in the specialty of Orthodontics was Edward Hartley Angle (1855–1930) (Fig. 2.5). He is rightly regarded as the “Father of Modern Orthodontics.” (Table 2.5)

Edward H Angle was born on June 1, 1855, in Herrick, Pennsylvania. He completed DDS degree from Pennsylvania College of Dental Surgery in 1878. He joined the faculty of the Dental Department of the University of Minnesota in 1886. In the year 1892, He resigned from the University of Minnesota and moved to Chicago and then he became the first professor of Orthodontics at Northwestern University School of Dentistry. In 1895, Angle completed his MD degree from Marion Sims College. He moved to St. Louis, assuming the professor post first at Marion Sims College of Medicine and shortly afterwards at Washington University Dental School. It was then that he started his first orthodontic case, on his preceptor’s son. Experiences in various schools led him to the conviction that orthodontia could not be properly

Table 2.5: Angle’s contribution to orthodontics

Text book “Irregularities of the Teeth” 1887 (1st edition)

Fig. 2.3: Norman N Kingsley (1829–1913); Fig. 2.4: Intermaxillary elastics: Fig. 2.5: Edward Hartley Angle (1855–1930)

taught in a dental college. He started the first school of orthodontia in 1900, named as “The Angle School of Orthodontia” at St. Louis.

Edward H Angle organized the first orthodontic society and called it as “The Society of Orthodontists.”

In 1935, the Society adopted the name it bears today: The American Association of Orthodontists (AAO). They also established the magazine, a quarterly titled The American Orthodontist, which we read today as the American Journal of Orthodontics.

1903 — Dr. Anna Hopkins was elected the Society’s first Secretary. She completed one of the early Angle courses, but was never to practice orthodontia. In 1906 she became Mrs Edward Hartley Angle.

Appliances Contributed by Angle

„ In 1900, Edward H Angle developed his first orthodontic appliance, the “E” (expansion)-arch appliance. It is also referred to as Edward Angle’s E-arch. E-arch appliance consists of bands which are placed on molar teeth on either side of the arch of a heavy labial arch wire extended around the arch. The ends of labial extended arch wire threaded to the buccal aspect of the molar bands allowed the arch wire to be advanced so that the arch perimeter is increased. Individual teeth were ligated with the heavy labial extended arch wire with ligature wire of 0.010”.

„ Pin and tube appliance was developed in 1901. In this pin and tube appliance, all teeth are banded. Vertical tubes were welded to the bands on the labial surface in the center of the crown for all teeth in the arch. Arch wires were secured with soldered pins that inserted into the vertical tubes. Tooth movement was achieved by altering the placement of these pins.

„ Angle developed Ribbon arch appliance in 1910. It is a modification of pin and tube appliance. Ribbon arch was the first appliance to use a true bracket. The bracket has a vertical slot facing occlusally. The brackets were attached to the bands at the center of labial surface of teeth.

„ Edgewise appliance was developed and introduced to orthodontics by Edward H Angle in the year 1925 which formed the basis of all fixed orthodontic techniques in use today. In order to overcome the deficiencies encountered with his previous techniques Angle developed the edgewise bracket that could give a better control over individual tooth movement (Fig. 2.6). The unique feature of rectangular arch wire in a rectangular slot of the edgewise bracket enabled control of tooth movement in all three planes of space. Subsequent development of various fixed orthodontic appliances such as Straight wire appliance, pre adjusted edgewise appliance are actually modifications of the standard edgewise appliance of Angle.

Edward H Angle’s Publications and Presentations

„ Angle presented his first scientific paper at the Ninth International Medical Congress in 1887.

„ Published the first edition of his textbook 1887 which would go through seven editions under the following titles:

1. Irregularities of the Teeth, 1887.

2. A System of Appliances for Correcting Irregularities of the Teeth, 1890.

3. The Angle System of Regulating and Retention of the Teeth, 1892.

4. The Angle System of Regulation and Retention of the Teeth—with an Addition of Treatment of Fractures of the Maxillae, 1895.

5. Angle System of Regulation and Retention of the Teeth and Treatment of Fractures of the Maxillae, 1899.

6. Malocclusion of the Teeth and Fractures of the Maxillae, 1900.

7. Treatment of Malocclusion of the Teeth, 1907.

„ Angle published his famous article “The Classification of Malocclusion” in the Dental Cosmos, 1899. His classification provided an intelligent and easily understood means of communication among members of the dental profession. Angle believed that the maxillary first molars were the key to occlusion and his system of classification divides malocclusions in anteroposterior/sagittal plane only. Despite this drawback, Angle’s classification system has stood the test of time and is still the most commonly used method of classifying malocclusions, more than 100 years since he first proposed it. Though Angle died in 1930 (August 11th), his influence is still felt strongly in orthodontics. His concept of normal occlusion and establishment orthodontia as a specialty science will remain Angle’s greatest monument. Characteristic of the man was a remark made shortly before he died: “I have finished my work. It is as perfect as I can make it.”

Another distinguished orthodontist was Calvin S Case (1847–1923) (Fig. 2.7). He developed a classification of malocclusion that included 26 divisions. Case published his major work “A practical treatise on the techniques and Fig. 2.6: Edgewise appliance

principle of dental orthopedic and prosthetic correction of the cleft palate.” Case was a strong advocate of the relationship of malocclusion to facial improvement. Facial improvement was a guide to treatment. He was also a strong proponent of extraction theory in orthodontics.

Charles A Hawley (1861–1929) used a celluloid sheet containing a geometric figure that when adapted to a model determined the extent of proposed tooth movement (1905) and introduced the retainer appliance that bears his name (1908) (Fig. 2.8)

HD Kesling (1945) introduced his philosophy of tooth movement by using a rubber tooth positioning device in which the teeth were moved into a more ideal cuspal relationship after major correction has been accomplished.

History of Cephalometrics

Ever since God created man in His image, man has been trying to change man into his image. Attempts to change facial appearance are recounted throughout recorded history. The question of what is a normal face, as that of what constitutes beauty, will probably never be answered in a free society. (Table 2.6)

Orthodontists, in their attempts to change facio-orodental deviations from accepted norms, have adopted cephalometric measurement, a method long employed in physical anthropology. With the introduction of roentgenography, it was inevitable that this procedure should be employed as a medium for the purpose of roentgenographic cephalometrics.

Cephalometric radiography was introduced to orthodontics during the 1930s.

Cephalometry had its beginnings in craniometry. Craniometry is defined in the Edinburgh encyclopedia of 1813 as “the art of measuring skulls of animals so as to discover their specific differences”. For many years anatomists and anthropologists were confined to measuring craniofacial dimensions using the skull of dead individuals. Although precise measurements were possible craniometry has the disadvantage for growth studies.

Cephalometry is concerned with measuring the head inclusive of soft tissues, be it living or dead. However, this procedure had its limitations owing to the inaccuracies that resulted from having to measure skulls through varying thickness of soft tissues.

With the discovery of X-rays by Roentgen in 1895, radiographic cephalometry came in to being. It was defined as the measurement of head from bony and soft tissue land marks on the radiographic image (Krogman and Sassouni 1957). This approach combines the advantages of craniometry and anthropometry. The disadvantage is that it produces two-dimensional image of a three-dimensional structure.

In 1895, Professor Wilhelm Conrad Roentgen made a remarkable contribution to the field of science with the discovery of X-rays. On December 28, 1895, he submitted a paper “On A New Kind of Rays, A Preliminary Communication” to the Wurzburg Physical Medical Society for publication in its journal.

Professor Wilhem Koening and Dr Otto Walkhoff simultaneously made the first dental radiograph in 1896. It was clear that the use of X-rays provided the means of obtaining a different perspective on the arrangement

Year Authors Contributions to orthodontics

1899–1996 William B Downs ƒ Cephalometric appraisal of orthodontic results

ƒ Down’s analysis

1900–1984 Herbert I Margolis Tweeds triangle 1913–1966 Wendell L Wylie Analysis based on dividing dimensions along the Frankfort plane into contributing linear components

1922–1994 Richard A Riedel ANB angle

1967 Alexander Jacobson The Wit’s analysis

Table 2.6: Cephalometry

Fig. 2.8: Hawley’s retainer introduced by Charles A Hawley

Fig. 2.7: Calvin S Case (1847–1923)