Orthodontics 2 PDF

THE PROBLEM ORIENTED APPROACH: ORTHODONTICS 2 PREPARED BY: CLAIRE O. DDM  FACIAL & DENTAL APPEARANCE CLINICAL EVALUATION MAIN SUBJECTS MACRO-ESTHETICS MINI-ESTHETICS MICRO-ESTHETICS Facial proportions in all The dentition in The teeth in relation to...

THE PROBLEM ORIENTED APPROACH: ORTHODONTICS 2 PREPARED BY: CLAIRE O. DDM  FACIAL & DENTAL APPEARANCE CLINICAL EVALUATION MAIN SUBJECTS MACRO-ESTHETICS MINI-ESTHETICS MICRO-ESTHETICS Facial proportions in all The dentition in The teeth in relation to 3 planes of space relation to the face one another MACRO-ESTHETICS MACRO-ESTHETICS Facial proportions in all 3 planes of space MACRO-ESTHETICS Proportionate features are generally acceptable even “poor man’s cephalometric if not beautiful analysis” Facial esthetics vs. Profile Analysis facial proportions Assessment of devlelopmental age Frontal Examination Degree of physical Bilateral symmetry in the development over fifths of the face chronologic age MACRO-ESTHETICS An ideally proportional face can FRONTAL EXAMINATION be divided into central, medial & lateral equal fifths. Proportionality of the eyes, nose & mouth MACRO-ESTHETICS Mild asymmetry is the rule, rather FRONTAL EXAMINATION than the exception MACRO-ESTHETICS FRONTAL EXAMINATION The proportional relationship of facial height to width establishes the over-all facial type & basic proportions of the face Established by Renaissance artists, da Vinci & Durer - Hairline to the base of the nose - Base of the nose to the bottom of the nose - Bottom of the nose to the chin SHOULD BE EQUAL MACRO-ESTHETICS Establish jaws proportionately positioned in the AP plane PROFILE ANALYSIS Evaluation of lip posture and “poor man’s cephalometric incisal prominence analysis” Reevaluation of vertical proportions and evaluation of mandibular plane angle MACRO-ESTHETICS PROFILE ANALYSIS Establish jaws proportionately positioned in the AP plane >10° >10° MACRO-ESTHETICS PROFILE ANALYSIS Evaluation of lip posture and incisal prominence MACRO-ESTHETICS PROFILE ANALYSIS Evaluation of lip posture and incisal prominence MACRO-ESTHETICS PROFILE ANALYSIS Evaluation of lip posture and incisal prominence With the mandible in rest position and the lips in repose, the interlabial gap may be between 0 and 3 mm. MACRO-ESTHETICS PROFILE ANALYSIS Evaluation of lip posture and incisal prominence The general guideline that holds for all racial groups is that lip separation at rest should not be more than 4mm MACRO-ESTHETICS PROFILE ANALYSIS Evaluation of lip posture and incisal prominence BIMAXILLARY DENTOALVEOLAR PROTRUSION MACRO-ESTHETICS PROFILE ANALYSIS Evaluation of lip posture and incisal prominence BIMAXILLARY DENTOALVEOLAR PROTRUSION MACRO-ESTHETICS PROFILE ANALYSIS Evaluation of lip posture and incisal prominence BIMAXILLARY DENTOALVEOLAR PROTRUSION 1. Excessive separation of the lips at rest is called lip incompetence 2. Excessive effort to bring the lips into closure creates lip strain and prominence of lips in the profile view 3. Different racial groups and individuals within those groups have different degrees of lip prominence that are independent of tooth position MACRO-ESTHETICS PROFILE ANALYSIS Evaluation of lip posture and incisal prominence Class II MO * The size of the nose and chin must be considered when the position of the incisors and amount of lip support are evaluated MACRO-ESTHETICS PROFILE ANALYSIS Evaluation of lip posture and incisal prominence As we age, the supporting collagen, fat pads, and muscles in and around the lip area steadily diminish, resulting in thinner lips that are more visibly lined MACRO-ESTHETICS PROFILE ANALYSIS Evaluation of lip posture and incisal prominence BIMAXILLARY PROTRUSION MACRO-ESTHETICS PROFILE ANALYSIS Reevaluation of vertical facial proportions and evaluation of mandibular plane angle Steep Mandibular Plane = long anterior facial vertical dimensions & a skeletal open bite deficiency Flat Mandibular Plane = short anterior height & deep bite MO MACRO-ESTHETIC CONSIDERATION SKELETAL PROBLEMS 3 possibilities for correcting facial proportions 1. Orthodontic Camouflage 2. Orthognathic and/or plastic surgery 3. Orthodontic growth modification MACRO-ESTHETIC CONSIDERATION ORTHODONTIC CAMOUFLAGE Making facial disproportion disappear without changing the jaw proportions that underlie it MACRO-ESTHETIC CONSIDERATION SURGERY Mandibular Advancement Surgery Genioplasty Rhinoplasty MACRO-ESTHETIC CONSIDERATION SURGERY Mandibular Advancement Surgery Genioplasty Rhinoplasty MACRO-ESTHETIC CONSIDERATION GROWTH MODIFICATION if possible, the best way to correct a jaw discrepancy would be to get the patient to grow out of it. MACRO-ESTHETIC CONSIDERATION GROWTH MODIFICATION Inducing differential growth of the jaw relative to the other, either stimulating one to grow faster or restraining it so the other jaw can catch up 3 important principles to keep in mind for pre-adolescent or adolescent child: 1. TIMING 2. 3 planes of space 3. Compliance MINI-ESTHETICS Tooth-lip Relationship of the dental midline of relationship & each arc to the skeletal midline of the Smile Analysis jaw Vertical relationship of the teeth to the lips at rest & on smile Transverse cant of the occlusal plane MINI-ESTHETICS Tooth-lip relationship & Smile Analysis 2 TYPES OF SMILE SOCIAL SMILE (posed) ENJOYMENT SMILE (Duchenne) MINI-ESTHETICS MINI-ESTHETICS Amount of incisor & gingival display Transverse dimensions of the smile reltaive to the upper arch The Smile Arc MINI-ESTHETICS 1. Acceptable range of tooth display is from minimal tooth coverage of 1mm up to 4mm coverage of the incisor crown 2. 1-2mm maximum acceptable amount of gingival display 3. Overlap by the lip of the cervical margin of the tooth by 1-2mm is ideal MINI-ESTHETICS The width of the maxillary dental arch, as seen on smile, should be proportional to the width of the midface MINI-ESTHETICS BUCCAL CORRIDOR Distance between the maxillary posterior teeth and the inside of the cheek Minimal buccal corridors are favored by most The relationship of the cheeks to the posterior teeth on smile is just another way of evaluating the width of the dental arches MINI-ESTHETICS It is the relationship of the curvature of the lower lip to the curvature of the maxillary incisors MINI-ESTHETIC CONSIDERATION I MPROVI NG THE SMI LE FRAMEWORK the primary goal of mini-esthetic treatment is to enhance the smile by correcting the relationship of the teeth to the surrounding soft tissues on smiling Examination focuses on the 3 aspects of the smile 1. Vertical Tooth-lip Relationships 2. Transverse dimensions of the smile 3. Smile Arc MINI-ESTHETIC CONSIDERATION VERTICAL TOOTH RELATIONSHIPS GENERAL GUIDELINE: at least 75% display of the Central Incisor Related to the age of the patient Peak Incisor display is during adolescence with 85% average display MINI-ESTHETIC CONSIDERATION VERTICAL TOOTH RELATIONSHIPS IF TOOTH DISPLAY IS INADEQUATE: - Elongate the upper teeth - Extrusion with archwires - Class II elastics - Anterior vertical elastics MINI-ESTHETIC CONSIDERATION VERTICAL TOOTH RELATIONSHIPS MINI-ESTHETIC CONSIDERATION VERTICAL TOOTH RELATIONSHIPS MINI-ESTHETIC CONSIDERATION VERTICAL TOOTH RELATIONSHIPS MINI-ESTHETIC CONSIDERATION VERTICAL TOOTH RELATIONSHIPS EXCESSIVE DISPLAY OF MAXILLARY GINGIVA ON SMILE: - Intrusion of the maxillary incisors using segmented arch mechanics - Intrusion using TADS - Orthognathic surgery to move the maxilla up MINI-ESTHETIC CONSIDERATION TRANSVERSE DIMENSIONS OF THE SMILE “BROAD, WELCOMING SMILE” Transverse expansion of the maxillary arch to decrease buccal corridor MINI-ESTHETIC CONSIDERATION THE SMILE ARC The single, most important thing in smile esthetics MINI-ESTHETIC CONSIDERATION THE SMILE ARC SMILE SYMMETRY Repositioning of the teeth or changing the gingival contours should be included in the treatment plan MICRO-ESTHETICS Close-up dental appearance MICRO-ESTHETICS Toot h proport i ons Width should be 80% of its height Height-Width relationships Several possible causes of short height: >Incomplete eruption >Attrition >Excessive gingival height >Inherent distortion of crown form MICRO-ESTHETICS Toot h proport i ons Connectors & Embrasures The connector (interdental contact area) is where adjacent teeth appear to touch and may extend apically or occlusally from the actual contact point MICRO-ESTHETICS Toot h proport i ons Connectors & Embrasures “Black Triangles” – triangular spaces incisal and gingival to the contact areas MICRO-ESTHETICS Toot h proport i ons Gingival Height, Shape & Contour Proportional gingival heights are needed to produce a normal and attractive dental appearance Gingival zenith - highest point of curvature Gingival shape refers to the curvature of the gingiva at the margin of the tooth Lateral teeth is not on the occlusal plane MICRO-ESTHETICS Toot h proport i ons Tooth Shade and Color A normal progression of shade change from the midline posteriorly is an important contributor to an attractive and natural appearing smile  MICRO-ESTHETIC CONSIDERATION ENHANCI NG THE APPEARANCE OF THE TEETH Reshaping the teeth to change tooth proportions - Easier done BEFORE the beginning of fixed appliance treatment Changing tooth proportions = substituting the Maxillary Canines for congenitally missing Maxillary Lateral Incisors MICRO-ESTHETIC CONSIDERATION ENHANCI NG THE APPEARANCE OF THE TEETH Reshaping the teeth to change tooth proportions - Easier done BEFORE the beginning of fixed appliance treatment Correcting BLACK TRIANGLES  EXTRACTION OR NON-EXTRACTION CASE Dental Crowding: Expand or Extract FACTORS TO CONSIDER: Soft tissue is the key ESTHETIC CONSIDERATIONS Size of the nose and chin Well-defined labio-mentla sulcus Consider the position of the lower incisors in relation to the lips 2mm limitation for forward movement of the incisors STABILITY CONSIDERATIONS Consequences of moving beyond normal Expansion across canines is almost never maintained EXPAND or EXTRACT Est het i c c onsi dera t i ons Expansion = more prominent teeth Extraction = reduce prominence of teeth When the prominence of the incisors creates excessive lip separation at rest so that the patient must strain to bring the lips together, the teeth are too protrusive and retracting the incisors improves the facial appearance EXPAND or EXTRACT Est het i c c onsi dera t i on The size of the nose and chin has a profound effect on relative lip prominence EXPAND or EXTRACT St a bi l i t y c onsi dera t i ons Lower arch is more constrained, the limits of expansion for stability seem to be tighter compared to the maxillary arch EXPAND or EXTRACT St a bi l i t y c onsi dera t i ons Fenestration of the alveolar bone and stripping of the gingiva become increasingly likely as the incisors are advanced CONTEMPORARY EXTRACTION GUIDELINES