ORTHODONTICS-2.pdf

ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024...

ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 ORTHODONTICS 2: − Extractions for crowding or malalignment were frequent HISTORY OF ORTHODONTICS − Primitive orthodontic appliances have been EDWARD H. ANGLE found in both Greek and Etruscan materials − “Father of Modern Orthodontics” − Concept of normal occlusion in the natural dentition − Angle’s classification of malocclusion – important step in the development of orthodontics − Angle’s postulate: The permanent first molars were the key to occlusion The mesiobuccal cusp of the upper molar occludes in the buccal groove of the lower molar ORTHODONTICS − “orthos”= right or correct − As dentistry developed in the 18th and 19th − “odontos” = tooth centuries, a number of devices for the − A branch of dentistry concerned with the “regulation” of the teeth were described by growth of the face, development of occlusion various authors and apparently used and the prevention and correction of sporadically by the dentists of that era. malocclusion or occlusal anomalies/ − After 1850, the first text that systematically abnormalities described orthodontics appeared. − Malocclusion does not in itself represent a disease state, but rather a variation from what is considered ideal NORMAN KINGSLEY − “A Treatise on Oral Deformities as a Branch IDEAL OCCLUSION VS NORMAL OCCLUSION of Mechanical Surgery” − first truly comprehensive textbook about orthodontic problems and treatments − Among the first to use extraoral force to correct protruding teeth − A pioneer in the treatment of cleft palate and related problems − Despite the contributions of Kingsley and his contemporaries, their emphasis in orthodontics remained on the alignment of the teeth and the correction of facial proportion DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 1 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 IDEAL OCCLUSION DYNAMIC OCCLUSION VS STATIC − In static occlusion, the mesiobuccal cusp of OCCLUSION the upper molar occludes in the buccal groove of the lower molar STATIC OCCLUSION − In functional occlusion, there is good cuspal − The form, alignment and articulation of the interdigitation to provide mutual support for teeth within and between the arches, and the the teeth in function relationship of the teeth to the supporting − A hypothetical concept of perfect teeth structures arrangement based on dental anatomy − Refers to the contact between teeth when the − Seen on ideal model casts, typodont and jaw is closed and stationary complete denture − The goal of orthodontic treatment even if it cannot be achieved NORMAL OCCLUSION − Shows some deviation from that of the ideal − Components: o The maxillary and mandibular teeth are arranged on a smoothly curving line of occlusion o The mesiobuccal cusp of the upper molar occludes in the buccal groove of the lower molar LINE OF OCCLUSION − A smooth catenary curve passing through the central fossa of each upper molar and across the cingulum of the upper canine and incisor DYNAMIC OCCLUSION teeth − The function of the stomatognathic system as − The same line runs along the buccal cusps a whole comprising teeth, supporting and incisal edges of the lower teeth structure, temporomandibular joint and neuromuscular system − Contacts between teeth occurring under movement of the mandible DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 2 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 CENTRIC RELATION VS CENTRIC OCCLUSION TRAUMATIC OCCLUSION − An abnormal occlusal stress which is capable CENTRIC RELATION of producing or has produced an injury to the − aka. RETRUDED CONTACT POSITION periodontium − Its reproducibility makes it the most reliable − May coexist with apparent normal occlusion reference position − May be due to the changes in the supporting − Postural position of the mandible independent tissue, or the presence of malposed teeth, of tooth contacts − The relationship of the mandible to the maxilla where the condyle of the mandible is located at its most superior and anterior position, resting on the glenoid fossa against the articular eminence with the articular disc properly interposed LAWRENCE ANDREWS − Redefined the concept of an ideal static occlusion by describing it in terms of six individual keys, CENTRIC OCCLUSION including an updated ideal − aka. INTERCUSPAL POSITION relationship for the first − The relationship of the mandible to the maxilla molars when the teeth are in maximum occlusal contact, irrespective of the position or alignment of the condyle-disc assembly SIX KEYS TO NORMAL OCCLUSION: 1.Molar relationship − The distal surface of the distal marginal ridge of the upper 1st permanent molar occludes with the mesial surface of the mesial marginal ridge of the lower 2nd molar − The mesio-buccal cusp of the upper 1st permanent molar falls within the groove between the mesial and middle cusps of the lower first permanent molar DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 3 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 2.CROWN ANGULATION − Mesio-distal tip − The gingival portion of the long axis of each tooth crown is distal to the occlusal portion of that axis. − PREMOLARS have the lowest crown angulation − The degree of tip varies with each tooth 5. Tight contacts There should be an absence of any spacing within the dental arches 6. Occlusal plane 3.Crown Inclination − The curve of Spee should be relatively flat − Labio-lingual or bucco-lingual torque − The mandibular curve of Spee should not be − For the upper incisors, the occlusal portion of deeper than 1.5mm the crown’s labial surface is labial to the − The depth of curve of Spee is measured by the gingival portion. In all other crowns, the perpendicular distance between the deepest occlusal portion of the labial or buccal surface buccal cusp tips and a scale that was laid on is lingual to the gingival portion the top of the mandibular dental cast, touching the incisal edges of the central incisors and the distal cusp tips of the most posterior teeth in the lower arch 4. No rotations − There should be an absence of any tooth rotations within the dental arches DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 4 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 ✓ Distal tipping ✓ Mesial tipping ✓ Lingual tipping ✓ Buccal tipping ✓ Mesial displacement ✓ Distal displacement ✓ Lingual displacement OCCLUSION ✓ Buccal displacement − it is defined as the static contact of upper and ✓ Infraversion lower teeth − May involve four tissue systems: 1) Teeth, 2) ✓ Supraversion Bones, 3) Muscles and 4) Nerves ✓ Rotations − *Any alteration in any of the above systems ✓ Transposition can lead to malocclusion 2) SKELETO-DENTAL DYSPLASIA MALOCCLUSION − This category involves the four tissue systems − A developmental condition with a significant − It describes those malocclusions where the deviation from what is an ideal or normal teeth (whether it be individually or by group) occlusion are in malposition, and where there is an − In most instances, malocclusion and abnormal relationship of the maxilla and dentofacial abnormalities are caused not by mandible to each other or the cranial base some pathologic process, but by moderate − SKELETO-DENTAL DYSPLASIA GROUP (occasionally severe) distortions of normal IRREGULARITIES development. − Malocclusion can occur in three planes of − Malocclusion can be divided into three groups: space o Dental Dysplasia o Skeleto-dental Dysplasia o Skeletal Dysplasia 1) DENTAL DYSPLASIA − A dental malocclusion exist when the individual teeth within one or both of the jaws are abnormally related to each other − Only the tooth system is involved − May be limited to a couple of teeth or involve majority of the teeth present; this includes individual tooth abnormalities DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 5 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 MALOCCLUSION IN TRANSVERSE PLANE CROSSBITE − Lack of vertical overlap between the maxillary and mandibular dentition; ant/post MALOCCLUSION IN VERTICAL PLANE OPEN BITE SCISSOR BITE − Lack of vertical overlap − Excessive vertical between the maxillary overlapping between and mandibular the maxillary and dentition; ant/post mandibular anterior teeth DEEP BITE 3) SKELETAL DYSPLASIA − Excessive vertical − Individual tooth irregularities may or may not overlapping between the be present but the relationship of the maxilla maxillary and mandibular to the mandible and of both the maxilla and the anterior teeth mandible to the cranium have a profound influence on the orthodontic objectives − The defects may be in the size, position or relationship between the jaws. OCCLUSAL RELATIONSHIPS OF THE PRIMARY AND PERMANENT MOLARS A. FLUSH TERMINAL PLANE RELATIONSHIP − Both the maxillary and mandibular planes are at the same level anteroposteriorly − If the distal surface of the maxillary and mandibular deciduous second molars are in the same vertical plane; then it is called a flush terminal plane − It is usually the most favorable relationship to guide permanent molars into Class I DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 6 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 B. MESIAL STEP RELATIONSHIP − The maxillary terminal plane is relatively more CLASSIFICATION OF MALOCCLUSION posterior than the mandibular terminal plane − VARIATIONS OF CLASSIFICATION OF − The maxillary terminal plane is relatively more MALOCCLUSION: posterior than the mandibular terminal plane o Angle’s Classification − Invariably, this guides the permanent molars o Dewey-Anderson’s Modification into a Class I relationship o Lischer’s Modification o Simon’s Classification o Ackermann-Proffit Classification o Skeletal Classifications ANGLE’S CLASSIFICATION OF MALOCCLUSION ANGLE’S CLASSIFICATION OF C. DISTAL STEP RELATIONSHIP MALOCCLUSION − The maxillary terminal plane is relatively more − Edward Angle described the classes of anterior than the mandibular terminal plane malocclusion based on the occlusal − The maxillary terminal plane is relatively more relationship of the first molars anterior than the mandibular terminal plane − Unfavorable relationship as it guides the permanent molars into distal occlusion CLASSIFICATION DESCRIPTION CLASS I The position of the dental arches is normal, with first molars in normal occlusion CLASS II The relations of the dental arches are abnormal with all the mandibular teeth occluding distal to normal DIVISION 1 The upper incisors are protruding DIVISION 2 The upper incisors are lingually inclined CLASS III The relations of the dental arches are abnormal, with all mandibular teeth occluding mesial to normal DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 7 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 CLASS II DIVISION 1 DIVISION 2 The upper incisors The upper incisors are protruding are lingually inclined ANGLE’S CLASSIFICATION WITH DEWEY- ANDERSON MODIFICATION CLASS II CLASS I − MB cusp of max 6 mesial to MB groove of − MB cusp of max 6 occludes with MB groove of mand 6 mand 6 Type 1 Crowded maxillary anterior teeth; Canines may be abnormally Division 1 Division 2 positioned Maxillary incisors Maxillary incisors are in labioversion are linguoverted Type 2 Proclined or Labioverted maxillary with lateral incisors incisors *Subdivision: Class overlapping the II division 1 central incisors or Type 3 Retroclined maxillary incisors; malocclusion canines overlapping Anterior crossbite present occuring on one the lateral incisors side only Type 4 Posterior crossbite present; *Subdivision: Class Anteriors are in normal relation II division 2 malocclusion occuring on one Type 5 Mesial drifting of molars due to side only early loss of mesial adjacent tooth DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 8 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 LISCHER’S CLASSIFICATION − He substituted the term Class I, Class II, Class III given by Angle with the terms Neutrocclusion, Distocclusion and Mesiocclusion, respectively CLASS III − MB cusp of max 6 distal to MB groove of mand 6 Linguoversion Lingual to normal Type 1 Edge-to-edge bite position in anterior region Labioversion Labial to normal position Type 2 Mandibular incisors Mesioversion Mesial to normal are crowded and in position lingual relation to Distoversion Distal to normal the maxillary position incisors; labioverted Infraversion Inferior or away from maxillary incisors the line of occlusion; intrusion Type 3 The maxillary arch Supraversion Superior or extended is underdeveloped past the line of causing crowding of occlusion; extrusion maxillary incisors Torsiversion Rotated on its long while the axis mandibular arch is Axiversion Axial inclination is well developed and wrong, tipped in normal Transiversion Transposed or alignment; changes in the linguoverted sequence of position maxillary incisors DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 9 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 SIMON’S CLASSIFICATION − Since growth of the face and jaws occurs in the three planes of space (height, width, and depth), abnormalities also occur in any one or more of the foregoing planes − Simon’s craniometric classification relates the dental arches to the face and cranium in the three planes of space o Frankfort horizontal plane (vertically) o Orbital plane (anteroposteriorly) o Raphe or Midsagittal plane (transverse) FRANKFORT HORIZONTAL PLANE ORBITAL PLANE − The eye-ear plane is determined by drawing a − Perpendicular to the FHP at the margin of the straight line through the margin of the bony bony orbit directly under the pupil of the eye orbit directly under the pupil of the eye, to the − This plane is used to determine sagittal or upper margin of the auditory meatus (the anteroposterior deviations of the dental arches notch above the tragus of the ear) and the axial inclination of the teeth to the face − This plane is used to determine deviations in and the cranium the height of the dental arches and teeth in − This angle should pass through the distal third relation to the face and cranium of the canine – Simon’s Law of Canine − Deviations: − Deviations: o Attraction o Protraction ▪ The distance between the occlusal ▪ The teeth, one or both dental plane and the FHP is comparatively arches, and or jaws are too far shorter than normal. forward. The orbital plane passes o Abstraction too far posteriorly to the canines. ▪ The distance between the occlusal o Retraction plane and the FHP is comparatively ▪ The teeth, one or both dental longer than normal arches and or jaws are too far retruded. The orbital plane passes too far anteriorly to the canines. DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 10 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 MIDSAGITTAL PLANE − This plane is perpendicular to the FH plane Antero-posterior, transverse and vertical − This plane is used to determine the deviations discrepancies are considered in the general form and width of the dental Crowding and arch asymmetry can be arches and the axial inclination of the teeth in evaluated relation to the midline of the palate and the Incisor protrusion is taken into account head − Deviations: o Contraction ▪ A part or all of the dental arch is contracted toward the raphe median plane. The abnormality may be mandibular, alveolar, dental, anterior, posterior, unilateral or bilateral. o Distraction ▪ A part or all of the dental arch is wider than usual from the raphe median plane 1) DENTOFACIAL APPEARANCE PROFILE CONVEX PROFILE − The two lines form an angle with concavity facing ACKERMAN-PROFFIT CLASSIFICATION OF the tissue MALOCCLUSION − Profile that is indicative of excessive maxillary − Ackerman and Profitt, in 1960, proposed a growth or prognathic diagrammatic classification of malocclusion to maxilla with retrognathic overcome the limitations of the Angle’s mandible classification of malocclusion. − Common in patients with − This includes Angle’s classification and five Class II division 1 characteristics of malocclusion within a Venn malocclusion diagram − Salient features of the classification include: − DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 11 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 CONCAVE PROFILE − The two lines form an TEETH / ARCH FORM angle with convexity towards the tissue − Profile that is indicative of prognathic mandible or retrognathic maxilla − Common in patients with Class III malocclusion TRANSVERSE − The transverse skeletal and dental relationship is evaluated STRAIGHT PROFILE − The buccal and palatal crossbites are noted − Profile with harmonious growth of jaws; the − Unilateral or bilateral crossbite? two reference lines form nearly a straight line − Skeletal or dental crossbite? o Anteriorly divergent ▪ A line drawn between the forehead and the chin is inclined anteriorly o Posteriorly divergent ▪ A line drawn between the forehead and chin slants posteriorly SAGITTAL (A-P) DENTOFACIAL APPEARANCE LIPS DENTOFACIAL APPEARANCE INCISORS DISPLAY DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 12 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 VERTICAL 2. PITCH, ROLL & YAW − The introduction of rotational axes into systematic description of dentofacial traits significantly improves the precision of the description and thereby facilitates development of the problem list. − Particularly useful way to evaluate the relationship of the teeth to the soft tissues that frame their display PITCH TWO ADDITIONS TO THE FIVE − The vertical CHARACTERISTICS CLASSIFICATION relationship of the SYSTEM teeth to the lips and cheeks can 1. ESTHETIC LINE OF DENTITION be conventionally − Angle's concept was that if the buccal occlusal described as up- line of the mandibular dental arch was down deviations coincident with the central fossae line of the around the antero- maxillary dental arch and the teeth were well- posterior axes aligned, ideal occlusion would result. − Evaluated clinically and from cephalometric − This line follows the facial edges of the radiographs maxillary anterior and posterior teeth. − Inadequate, sufficient or excessive gingival display? DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 13 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 ROLL − Describes the difference in the vertical position of the teeth on the right and left side − Viewed as up-down deviations around the transverse axis − The relationship to the facial soft tissues is evaluated clinically with the intercommissure line as a reference. − Presence of cant or none? YAW − Rotation of the jaw or dentition to one side or the other, around a vertical axes − Produces a skeletal or LECTURE 3: INCIDENCE & RECOGNITION OF dental midline MALOCCLUSION discrepancy − Viewed as left-right MALOCCLUSION & RACE deviations around the RACE MALOCCLUSION vertical axes Western Incisor alignment irregularity; Greater incidence of mandibular − Midline on or off? retrusion and fewer cases of mandibular prognathism Caucasians Highest incidence of dental and SKELETAL CLASSIFICATION skeletal malocclusion; increased Facial skeletal patterns are divided into: overbite and Class II pattern; greatest occlusal anomalies in o Class 1, in which the profile is the incisor region orthognathic Africans/ Anterior open bite o Class 2, where the mandible is Carribeans retrognathic East Class III pattern, crowding o Class 3, in which the mandible is Asians prognathic Filipinos Bimaxillary protrusion MALOCCLUSION & FACIAL PROFILE − Facial profile is determined by drawing 2 lines o GLABELLA to soft tissue SUBNASALE (base of nose) o Soft tissue SUBNASALE to soft tissue POGONION (chin) DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 14 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 − Facial type assessment is in many aspects crucial for the planning and prognosis of orthodontic treatment. − Facial morphology is related to factors such as: volume and shape of pharyngeal airspace anatomy of masticatory muscles dentoalveolar anatomy occlusion type MALOCCLUSION & FACIAL PROFILE direction of craniofacial complex growth CONVEX − Indicative of protrusive maxilla or a retrusive MALOCCLUSION & PATTERN: mandible CRANIAL INDEX CONCAVE − calculated using the ratio between the − Indicative of excessive growth of mandible or maximum width and length of the head a retrusive maxilla STRAIGHT − Harmonious growth of both jaws BRACHYCEPHALIC − Cranial Width > Cranial Length Short & broad MESOCEPHALIC − Cranial width = Cranial width Average DOLICHOCEPHALIC − Cranial width < Cranial length Long & narrow STRAIGHT − Anterior Divergent o Straight with anterior inclination; Class II* − Posterior Divergent o Straight with posterior inclination; Class III* DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 15 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 3. LEPTOPROSOPIC − DOLICHOFACIAL − Increased facial height relative to the width − Features a long, narrow face with a high mandibular plane angle, convex profile, poor chin development and an anterior-posterior face height imbalance NOTE: − A number of developmental anomalies can MALOCCLUSION &TYPE: affect both the deciduous and permanent dentition 1. EURYPROSOPIC − These include variations in the number of − BRACHYFACIAL teeth or their individual morphology, the − The facial width is position they attain within the dental arches greater than their facial and the composition of their constituent hard height exhibiting a tissues broad, short and − The etiological basis of these abnormalities globular face can be genetic, environmental or − Features a broad square multifactorial, but they all impact upon the face with a strong chin, developing occlusion, either directly or flat lip posture, low indirectly mandibular plane angle and straight profile EARLY LOSS OF DECIDUOUS TEETH 2. MESOPROSOPIC − It is usually the result of extraction due to − MESOFACIAL caries or trauma − Features average width − This can have implications on the future space and height facial distribution and symmetry within the affected proportions dental arch − With well-balanced − The degree of space loss and potential features occlusal disruption will be influenced primarily − Tend to have an ovoid by the following: arch form AGE The earlier the deciduous tooth is lost, the more potential for crowding will exist CROWDING The more inherent crowding present within the dental arch, the more potential space loss will occur TOOTH The position of the affected TYPE tooth within the dental arch will influence subsequent space distribution DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 16 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 DECIDUOUS EFFECT TOOTH TYPE Incisors Rarely affects space in the permanent dentition unless lost very early Canines Can lead to midline shift towards the affected side in unilateral cases PROLONGED RETENTION OF DECIDUOUS TEETH 1st molars Can lead to midline shift − May be caused by towards the affected side in o Crowding unilateral cases; space loss o Ectopic position of succedaneous tooth through mesialization of o Ankylosis of succedaneous tooth posterior teeth; accentuates o Congenital absence of the permanent premolar crowding successor 2nd molars Has less effect on the midline shift; influences the position of first permanent molars; space loss and premolar crowding. − Treatment options: o Extraction to facilitate successful eruption of permanent succedaneous tooth (in favorable position) o Extraction of deciduous tooth and orthodontic traction of succedaneous tooth o Extraction for prosthetic replacement PROLONGED RETENTION OF DECIDUOUS TEETH − The presence of marked asymmetry in the retention of deciduous teeth should be check radiographically − Occasionally, a permanent successor will erupt having failed to resorb the roots of the overlying deciduous teeth DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 17 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 HYPODONTIA DENTAL EFFECT − The congenital absence of one or more teeth PROBLEM is a relatively common anomaly in human Failure of Can prevent the eruption and populations tooth impaction of a permanent eruption tooth; − May be due to genetic influence, developmental anomalies, and environmental Crowding Can cause displacement or factors rotations of adjacent erupted − Most common permanent teeth to be teeth congenitally missing are: o Maxillary third molar Spacing Can produce spacing o Mandibular third molar between erupted teeth, o Mandibular 2nd premolar particularly a mesiodens o Mandibular lateral incisor producing a maxillary o Maxillary lateral incisor diastema between central o Maxillary 2nd premolar incisors − Mild forms of hypodontia can usually be managed by orthodontic treatment Cystic Follicular enlargement and formation cystic formation on − Management: unerupted/impacted o Space closure permanent tooth o Maintenance or opening of space followed by prosthetic replacement VARIATIONS ON TOOTH SIZE − Little is known about the etiology of tooth size variation but it is almost certainly genetic − Teeth either larger or smaller than the normal population range for dimensions are usually referred to as MACRODONT or MICRODONT. − These variations in tooth size can affect either the crown or root in isolation, or the whole tooth. MACRODONTIA SUPERNUMERARY TEETH − Most frequently affects the maxillary − May occur individually or in groups, permanent incisors or mandibular second unilaterally or bilaterally premolars and is often symmetrical. − These teeth are found most frequently in the − These teeth can be differentiated from double anterior maxilla, but may be seen in the teeth by the absence of coronal notching and premolar and molar region presence of normal pulpal morphology. − In the permanent dentition, the majority fail to − Extraction is often indicated, particularly with erupt and are asymptomatic (routine maxillary central incisors due to poor radiographic screening) aesthetics. o Lateral incisors can be approximated and adjusted restoratively to look like central incisors o Space is maintained for prosthetic replacement DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 18 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 VARIATIONS ON TOOTH FORM − These conditions are generally rare, occurring with prevalence well below 5% of Caucasians. − The generally affect the permanent dentition more commonly than the deciduous teeth MICRODONTIA − Commonly associated with hypodontia and can affect the whole dentition or individual teeth. − Frequently affects the permanent MAXILLARY LATERAL INCISOR – peg- shaped morphology. o Has causal association with maxillary canine impaction − May be retained or extracted o Retained – the crown will require restorative buildup o Extraction – necessitates fixed orthodontic appliance to create space for prosthetic replacement FUSION − results from the union of two embryologically separate adjacent tooth germs of developing teeth resulting in the formation of a single larger tooth GEMINATION SEX-LINKED − an anomaly caused by a single tooth germ that − Males would have bigger teeth attempted to divide during its development, − In a masculine smile, the teeth are large resulting in a bifid crown and square in shape, with little if any rounding or tapering. − In a feminine smile, the teeth are more rounded and may be more tapered. − Not correlated with stature/ height − Not correlated with jaw size − Teeth don’t change in size after eruption DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 19 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 DILACERATION − abnormal deviation or bend in the linear relationship of a tooth CONCRESCENCE crown to its root − uncommon developmental condition of teeth where the cementum overlying the roots of at least two teeth fuse together without the involvement of dentin DENS EVAGINATUS DOUBLE TOOTH − out-pouching of the − Most commonly seen on the anterior region of enamel organ the mandibular deciduous dentition − there is formation of an − Permanent teeth may be managed extra cusp or tubercle restoratively if the coronal portion is too large on the occlusal surface − Those with deviant anatomy may require of a posterior tooth or extraction followed by space closure of lingual aspect of the prosthetic replacement anterior tooth DENS INVAGINATUS − dens in dente or tooth within a tooth − there is invagination or the infolding of the enamel surface into the interior aspect of the tooth. TAURODONT − enlargement of the pulp chamber and apical displacement of the floor of the pulp chamber in multi-rooted teeth, most commonly the molars; tooth with a large pulp chamber, small root canals, and shorter roots DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 20 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 ETIOLOGY OF MALOCCLUSION HEREDITARY − Characteristics are inherited from the parents − Causes → Times → Tissues → Results − Familial and racial characteristics repeat − Size of the jaw, teeth, facial features, timing of CAUSES: development − Differences may be due to climatic, nutritional, − Hereditary and socioeconomic differences − Developmental causes of unknown origin − Other aspects are attributed to racial gene − Trauma pool − Physical agents − Example: African American teeth erupt 1 year − Habits earlier than Caucasian Americans − Diseases − Malnutrition TIMES: − Prenatal − Postnatal − Continuous − Congenital deformities – cleft lip/ palate/ − Intermittent alveolar process − May act on different age levels TISSUES − Some primary − Some secondary − NM tissues − Teeth − Facial asymmetry − Bone and cartilage − Width & length of the arch – macrognathia/ − Soft tissues micrognathia − Tooth size – macrodontia/microdontia RESULTS − Tooth number – oligodontia/ hypodontia/ − Malfunction anodontia − Malocclusion − Tooth shape variations – peg-shaped − Osseous dysplasia laterals, Carabelli’s cusp, mamelons − Palatal depth − Crowding/spacing Classification of Etiologic Factors − Diastema caused by frenal attachment − General Factors − Excessive overbite/overjet − Local Factors − Tooth rotations − Retrognathic mandible − Prognathic mandible General Etiologic Factors − Position and conformation of perioral musculature to the tongue size and shape − Hereditary − Soft tissue peculiarities – character and − Congenital Defects texture of mucosa; frenum size, shape, and − Environmental position DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 21 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 CONGENITAL DEFECTS STAGES OF EMBRYONIC CRANIOFACIAL − Cleft lip and palate DEVELOPMENT − Veau’s Classification: Stage Time Related (humans) syndromes o Class I – soft palate (post- o Class II – hard and soft palate fertilization) o Class III – unilateral lip-jaw-palate cleft Germ layer Day 17 Fetal alcohol o Class IV – bilateral lip-jaw-palate cleft formation syndrome − Surgical repair offers partial correction and initial (FAS) organization of structures Neural tube Day 18-23 Anencephaly formation Origin, Day 19-28 Hemifacial migration, microsomia and interaction of Mandibular cell dysostosis populations (treacher collins syndrome) Limb abnormalities Formation of organ systems: Primary Day 28-38 Cleft lip and/or palate palate, other facial clefts Secondary Day 42-55 Cleft palate palate Final Day 50-birth Achondroplasia differentiation of tissues Syntosis syndromes (Crouzon’s, Apert’s, etc) DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 22 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 CONGENITAL DEFECTS − Hemifacial microsomia o characterized by a lack of tissue on the − Cerebral palsy affected side of the face, the external ear o Paralysis/lack of is deformed and both the ramus of the muscular coordination mandible and associated soft tissues due to intracranial lesion (muscle, fascia) are deficient or missing o Movement disorder: ▪ poor coordination, stiff muscles, weak muscles, and tremors. ▪ problems with sensation, vision, hearing, swallowing and speaking − Pierre-Robin Syndrome o rare congenital birth defect characterized − Brain damage in the areas that control by an underdeveloped jaw, backward balance and posture displacement of the tongue and upper airway obstruction. − torticollis/Wry Neck o Cleft palate is also commonly present in o Foreshortening of the children with Pierre Robin sequence SCM o Effects: bone growth restriction on the affected side of the face, facial asymmetry − Cleidocranial Dysostosis o Partial/Complete, unilateral/bilateral loss of clavicle o genetic condition caused by abnormal growth and development of certain parts of the skeletal system, including the skull, bones and teeth. o may have distinct physical characteristics like underdeveloped collarbones, short stature, unique facial characteristics and delayed tooth − Treacher-Collins syndrome development. o rare genetic disorder characterized by distinctive features of the head and face. o Tends to involve underdevelopment of the facial skeleton, cheekbones, jaws, palate and mouth which can lead to breathing and feeding difficulties o Affected individuals may have downward slant of the opening between the upper and lower eyelids (palpebral fissures) and anomalies of external and middle ear structures, which may result in hearing loss. DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 23 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 o Brain and behavioral anomalies such as a small head (microcephaly) and psychomotor delay have also been ENVIRONMENTAL DEFECTS occasionally reported as part of the − Prenatal condition. o Role of prenatal influence on malocclusion is minimal o The following have been related to occurrence of malocclusion: ▪ Uterine posture ▪ Fibroids of the mother ▪ Amniotic lesions ▪ Maternal diet ▪ Metabolism ▪ Drug-induced deformities ▪ Possible injury/trauma ▪ German measles − Postnatal o Birth injury – delivery-induced deformation of the jaws o Fall – fractures (example: cervical vertebrae) o Extensive scar tissue − Congenital Syphilis o caused by transmission of the spirochete Treponema pallidum from mother to fetus, resulting in diverse clinical presentations o Hutchinson’s incisor o Mulberry molar o Conjunctivitis o Otitis media − Predisposing metabolic climate and disease o Endocrine imbalance/endocrinopathies ▪ Exanthematous fever and febrile disease ▪ Temperature slows down the pace of growth and development DISCLAIMER: The unauthorized distribution or sale of my notes or transcripts is NATIONAL UNIVERSITY-MOA COLLEGE OF DENTISTRY strictly prohibited and will be subject to appropriate penalties. These materials may only be shared or distributed with explicit permission from the author/creator. Any 24 unauthorized use or dissemination of these materials is a violation of my intellectual DOCTOR OF MEDICINE IN DENTISTRY property rights and may result in disciplinary action or legal consequences.  ORTHODONTICS ORTHODONTICS 1 1&&2 2 FERDINAND N. PADILLA JR ORTHODONTICS 1 and 2 Lecture DMD4-DEN218 Dr. Lauren D. Yniguez-Astudillo, Dip. Ortho 1ST TERM A.Y 2023-2024 − Cretinism/Hypothyroidism/Dwarfism o a condition of abnormal mental and physical development resulting from a deficiency of thyroid hormone in fetal or early life, typically characterized by intellectual disability, small stature, and Habit Correction thickening of the facial Thumbsucking Palatal crib/rake features. Tongue thrusting Tongue crib o Thick neck, short extremities, large face Lip biting Lip bumper Mouth breathing Oral screen and head, thick lips, and large protruding Bruxism Night/occlusal guard tongue, Cheek biting Buccal shield o Delayed development of dentition, Retained deciduous teeth, Individually malposed teeth,