ORTHOPAEDODONTICS · (Orthopaedics) o My Recommended Age To Start Phase One is at Age 8 o 1’st...

ORTHOPAEDODONTICSPhase 1 - Module 1

Presented by Dr. Bert Botha

Field of Practice: Orthodontics & Early Dental-arch Development

There seem to be two kinds of clinicians;

One professional may be involved in the thinking process of just straightening permanent teeth alone. This leads to a concentration on the model. For that person, treatment planning may be conducted with static thinking or rearranging the teeth as if fixed on an articulator. That orthodontist may rely later on jaw surgery for maxillo-mandibular correction. Treatment to him or her is fraught with remarkable limitation.

A second professional thinks biologically and dynamically. Growth, physiological change, induced skeletal change and biology now occupy the consciousness. A three dimensional view is present, and the fourth dimension- time- enters into concern.

Dr. Robert Ricketts – 1996.

ORTHOPAEDICS + ORTHODONTICS

ORTHOPAEDICS+ORTHODONTICS

ORTHOPAEDICSRTHODONTICS

ORTHOPAEDICTHODONTICS

ORTHOPAEDIHODONTICS

ORTHOPAEDIODONTICS

ORTHOPAEDODONTICS

The medical specialty concerned with the preservation, restoration, and development of form and function of the

musculoskeletal system, extremities, spine, and associated structures by medical, surgical, and physical methods.

(https://medical dictionary)

ORTHOPAEDICS

That branch of dentistry concerned with the correction and prevention of irregularities and malocclusion of the teeth.

(https://medical dictionary)

ORTHODONTICS

The medico-dental specialty concerned with the development and function of the musculoskeletal system, followed by the

correction of irregularities and malocclusion of the teeth.

ORTHOPAEDODONTICS

11 YEARS7 YEARS

12 YEARS7 YEARS

13 YEARS7 YEARS

Prof. M. Thomas Wilcko,Western Reserve University,School of Dental Medicine,Cleveland, Ohio, USA.

According to the American Orthodontic Society as well as the American Dental Association,

every child should visit the Orthodontist at around 7 years of age, regardless if any problems are noticed.

WHO QUALIFIES FOR ORTHOPAEDODONTICS?

- According to Bench et al (J.Clin.Orthodontics 1996) 80% of all ortho patients needs some type of arch expansion.

- “Early cross-bite corrections lead to a stable and normal occlusion pattern, and contribute to symmetrical condyle growth, harmonious TMJ- and overall growth in the mandible” -Kutin & Hawes, Harberson & Meyers, Vadiakas & Roberts, Barenie & Bell et al

WHO QUALIFIES FOR ORTHOPAEDODONTICS?

CONCLUSIONS

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

1’st Growth Spurt

“Young patients should start visiting the orthodontist around 4 years of age…..Waiting until after 9 years can lead to TMJ problems and future relapse”

- BELL R.A, LE COMPTE E.J. American Journal of Orthodontics 1981

Growth (cm/y) 2’nd Growth

Spurt

Phase 1 (Orthopaedics)

o My Recommended Age To Start Phase One is at Age 8

o 1’st Growth Spurt at Age 9 – aim to have a normal mouth at 9.

o 2’nd Growth Spurt between Age 11 and 14 (Boys: 12-16) – use phase 2 to finalize and finish what has been started at 8.

Phase 2(Orthodontics)

Age - years

THE BEST TIME TO START

Eruption space for the remaining

12 permanent teeth should be

present

Dental- and skeletal relation

corrected

Vertical dimension

corrected (deep / open bite)

Habits must be broken

G e t t h e p a t i e n t a s n o r m a l a s p o s s i b l e f o r h i s a g ea s s o o n a s p o s s i b l e

• All the teeth needed for the applicable fixed appliances are present.

• Best growth management results are reached when covering both growth spurts

• 1’st Growth Spurt is at Age 9 – all corrections done after nine tend to relapse easier.

• It is cool to have braces at 8AGE - 8 YEARS – USUALLY STILL 12 PRIMARY TEETH PRESENT

• All the teeth needed for the applicable fixed appliances are present.

• Best growth management results are reached when covering both growth spurts

• 1’st Growth Spurt is at Age 9 – all corrections done after nine tend to relapse easier.

• It is cool to have braces at 8AGE - 8 YEARS

• All the teeth needed for the applicable fixed appliances are present.

• Best growth management results are reached when covering both growth spurts

• 1’st Growth Spurt is at Age 9 – all corrections done after nine tend to relapse easier.

• It is cool to have braces at 8AGE - 8 YEARS

• All the teeth needed for the applicable fixed appliances are present.

• Best growth management results are reached when covering both growth spurts

• 1’st Growth Spurt is at Age 9 – all corrections done after nine tend to relapse easier.

• It is cool to have braces at 8AGE - 8 YEARS

THE 4 DIMENSIONS

1

1 - TRANSVERSE

2

2 -LONGITUDINAL

THE 4 DIMENSIONS

33 - VERTICAL

THE 4 DIMENSIONS

4 - TIME

THE 4 DIMENSIONS

Eleven of the 22 Cranial Sutures are connected to the Maxilla

Basion

Sella Tursica

MidpalatalSuture

Nasion

Olfactory bulb

SERIOUS COMPLICATIONS OF INSUFFICENT GROWTH

The base of the skull expands with the Maxilla.

Basion

Sella Tursica

MidpalatalSuture

Nasion

Olfactory bulb

SERIOUS COMPLICATIONS OF INSUFFICENT GROWTH

age - 8 years – USUALLY STILL 12 PRIMARY TEETH PRESENT

The amount of nasal mucosa is programmed for the surface of your normal Maxilla.

age - 8 years – USUALLY STILL 12 PRIMARY TEETH PRESENT

If the maxilla is narrowed, the Olfactory nerve endings are buried under the greater amount of mucosa.

age - 8 years – USUALLY STILL 12 PRIMARY TEETH PRESENT

The development of the Pituitary gland gets enhanced as the Sella Tursica expands with the palate.

COMPROMISED BREATHING:

UNDERDEVELOPED UPPER ARCH :

8 WEEKS INTO TREATMENT:

IMPROVEMENT AFTER 8 WEEKS:

JUMPING THE BITE AS SOON AS POSSIBLE:

After only 3 months she could smell things she couldn’t smell before in her life

PERMANENT COMPLICATION:

The mouth breather who develops a narrow upper arch and skeletal open bite can be cured from all abovementioned complications EXCEPT this one.

PERMANENT COMPLICATION:

The mouth breather who develops a narrow upper arch and skeletal open bite can be cured from all abovementioned complications EXCEPT this one.

THE VICIOUS CYCLE OF NEGLECTBIRTH

BIRTH

MOUTH BREATHING

Allergies/malnutrition

THE VICIOUS CYCLE OF NEGLECT

BIRTH

MOUTH BREATHING

Allergies/malnutrition

NO BREAST FEEDING

NARROWED MIDFACE(MX COMPLEX)

MOUTH BREATHINGLACK OF N2O

TEMPORALISCHEWING

Intercept this tragic sequence

8Y

THE VICIOUS CYCLE OF NEGLECT

BIRTH

MOUTH BREATHING

Allergies/malnutrition

NO BREAST FEEDING

NARROWED MIDFACE(MX COMPLEX)

MOUTH BREATHINGLACK OF N2O

TEMPORALISCHEWING

Intercept this tragic sequence

8Y

VERTICALGROWTH

SOFT DIET

THE VICIOUS CYCLE OF NEGLECT

BIRTH

MOUTH BREATHING

Allergies/malnutrition

NO BREAST FEEDING

NARROWED MIDFACE(MX COMPLEX)

MOUTH BREATHINGLACK OF N2O

TEMPORALISCHEWING

Intercept this tragic sequence

8Y

VERTICALGROWTH

SOFT DIETTMJ

MALFORMATION + DISFUNCTION

ReducedOLFACTORYFUNCTION

THE VICIOUS CYCLE OF NEGLECT

BIRTH

MOUTH BREATHING

Allergies/malnutrition

NO BREAST FEEDING

NARROWED MIDFACE(MX COMPLEX)

MOUTH BREATHINGLACK OF N2O

TEMPORALISCHEWING

Intercept this tragic sequence

8Y

VERTICALGROWTH

SOFT DIETTMJ

MALFORMATION + DISFUNCTION

ReducedOLFACTORYFUNCTION

ReducedPITUITARYFUNCTION

POSTURALDEVIATION

THE VICIOUS CYCLE OF NEGLECT

BIRTH

MOUTH BREATHING

Allergies/malnutrition

NO BREAST FEEDING

NARROWED MIDFACE(MX COMPLEX)

MOUTH BREATHINGLACK OF N2O

TEMPORALISCHEWING

Intercept this tragic sequence

8Y

VERTICALGROWTH

SOFT DIETTMJ

MALFORMATION + DISFUNCTION

ReducedOLFACTORYFUNCTION

ReducedPITUITARYFUNCTION

POSTURALDEVIATION

DISTURBEDCSF FLOW

COMPROMISEDHEALTH AND

EARLYDEATH ?

THE VICIOUS CYCLE OF NEGLECT

About dr. Weston A. PriceTHE ROLE OF NUTRITION IN FACIAL GROWTH

For over ten years, he traveled to isolated parts of the globe to study the health of populations untouched by western civilization.

His goal was to discover the factors responsible for good dental health. His studies revealed that dental caries and deformed

dental arches resulting in crowded, crooked teeth are the result of nutritional deficiencies, not inherited genetic defects. The

groups Price studied included remote villages in Switzerland, Gaelic communities in the Outer Hebrides, indigenous peoples of

North and South America, Melanesian and Polynesian South Sea Islanders, African tribes, Australian Aborigines and New Zealand

Maori. Wherever he went, Dr. Price found that beautiful straight teeth, freedom from decay, good physiques, resistance to

disease and fine characters were typical of native groups on their traditional diets, rich in essential nutrients.

When Dr. Price analyzed the foods used by isolated peoples he found that, in comparison to the American diet of his day, they provided at least four times the water-

soluble vitamins, calcium and other minerals, and at least TEN times the fat-soluble vitamins, from animal foods such as butter, fish eggs, shellfish, organ meats,

eggs and animal fats—the very cholesterol-rich foods now shunned by the American public as unhealthful.

The isolated people Price photographed—with their fine bodies, ease of reproduction, emotional stability and freedom from degenerative ills—stand in sharp

contrast to civilized moderns subsisting on the “displacing foods of modern commerce,” including sugar, white flour, pasteurized milk, lowfat foods, vegetable oils

and convenience items filled with extenders and additives. The discoveries and conclusions of Dr. Price are presented in his classic volume, Nutrition and Physical

Degeneration. The book contains striking photographs of handsome, healthy, primitive people that illustrate in an unforgettable way the physical degeneration that

occurs when human groups abandon nourishing traditional diets in favor of modern convenience foods.

The photographs of Dr. Weston Price illustrate the difference in facial structure between those on native diets and those whose parents had adopted the “civilized” diets of

devitalized processed foods. The “primitive” Seminole girl (left) has a wide, normal face with plenty of room for the

dental arches. The “modernized” Seminole girl (right), born to parents who had abandoned their traditional diets, has a narrowed face, crowded teeth and a reduced

immunity to disease.

He also studied the influence of the maxillary position and width on the total well being of the body and the structures around it.In his classic book “Nutrition and Physical Degeneration” in the chapter ‘’Mental and Moral Deterioration’’ he investigated the abnormalities of arches.

He concluded: “In the processes that are involved in the production of facial and dental arch deformities, it is helpful to think of the face as, constituting the floor of the anterior part of the brain”.

One of his most interesting cases was a 16 year old boy.

Binet test showed mentality of a four year old. Roëntgenograms of his hands showed that the epiphytical bones did not unite. He played on the floor with blocks and rattles like a small child.His interests were that of a child. Another outstanding facial characteristic was his maxillary arch which was so much smaller than the mandibular arch, that it fitted inside the lower arch. The genitals were those of a boy of 8 years old.

In order to give him a chewing surface and with the hope of helping him physically and mentally dr. Price widened the maxillary arch by moving the maxillary bones one-half inch apart with his FIXED EXPANDING APPLIANCE.

An important fact of this case study was that the left nostril was entirely occluded all his life until this expansion took place.

(A Rhinologist tried to shrink the tissue with no success.)

• He grew three inches in four months.

• His moustache started to grow.

• In twelve weeks his genitals developed to that of a man.

• His mental change was even more significant.

• He could breathe freely.

• The expansion of the maxilla, applies pressure on the

temporal bones that produced a force downwards on the

floor of the anterior part of the brain, stimulating functions of

the pituitary gland.

The result of this maxillary expansion:

The OLS TracingsLateral Cephalograph - (Longitudinal and Vertical)

GROWTH FROM THE CRANIaL CENTRE

On the Ba-Na line, where the posterior periphery of the Pterion meets the Ba-Na line, is the Cranial Centre.

GROWTH FROM THE CRANIaL CENTRE

On the Ba-Na line, where the posterior periphery of the Pterion meets the Ba-Na line, is the Cranial Centre.

2,5 mm growth per year takes place between age 5 and 18 directly away from CC in the direction of the Mentum and approximately 1,3 mm per year in the Maxilla in the direction of the A-point.

Lateral Cephalograph - (Longitudinal and Vertical)

The OLS Tracings

MANDIBULAR GROWTH

Xi = The mandibular center situated at the Inferior Alveolar Foramen.

The mandibula grows radiant from this point and in the same ratio as the cranium.

Lateral Cephalograph - (Longitudinal and Vertical)

The OLS Tracings

(A) NAM = 175-180 degrees

The OLS Tracings

(A) NAM = 175-180 degrees(B) MXI = 115 degrees

The OLS Tracings

(A) NAM = 175-180 degrees(B) MXI = 115 degrees(C) NBM = 60

The OLS Tracings

(A) NAM = 175-180 degrees(B) MXI = 115 degrees(C) NBM = 60(1) BNA = 63

The OLS Tracings

(A) NAM = 175-180 degrees(B) MXI = 115 degrees(C) NBM = 60(1) BNA = 63

The OLS Tracings

(A) NAM = 175-180 degrees(B) MXI = 115 degrees(C) NBM = 60(1) BNA = 63(2) BCCM = 90-100 (Age dependent)

The OLS Tracings

A lateral Ceph tracing ONLY reveals 2 dimensions of growth .

LONGITUDINAL- AND VERTICAL (In other words the Saggital Plane)

The OLS Tracings

Always focus on correcting the Dental Occlusion especially during phase 1 treatment

The OLS Tracings

zz

Z-Z Line

AP - Tracing

Z-Z LineT-T Line

AP - Tracing

zz

tt

AP - Tracing

Z-Z LineT-T LineG-G Line zz

tt

g g

AP - Tracing

T-T/Z-Z = 0,5T-T/G-G= 0,75

zz

tt

g g

zz

tt

g g

AP - Tracing

ZZG = 33 deg

IDEAL

zz

tt

g g

AP - Tracing

ZZG = <33 deg (30)

BRACHIOFACIAL

zz

tt

g

AP - Tracing

ZZG = >33 deg (37)

DOLIGOFACIAL

g

zz

tt

g

FACIAL GROWTH DYNAMICS

AP - ANALYSISN

M

AP - Tracing

Z-Z LineT-T LineG-G LineT-T/Z-Z = 0.5TT/G-G= 0,75SYMMETRY (N-M)N-M LINE - CROSS

g

Patient Transformation Lies In Your Hands.

End of Module 1