Outline Outline

••Orthodontic directionsOrthodontic directions

••Medical and dental Medical and dental

historyhistory••

Klinical examination Klinical examination ••

Model analysisModel analysis••

Angle diagnostic Angle diagnostic systemsystem

Extraoral examination

Orthodontic directions Orthodontic directions

Orthodontic directionsOrthodontic directions

Sagittal (mesial-distal)Sagittal (mesial-distal)

Vertical (deep bite, open bite)Vertical (deep bite, open bite)

Transversal (narrow)Transversal (narrow)

Angle Class I.Angle Class I.

Class I. Cuspid

Angle II.Angle II.

Angle II/1Angle II/1

Overjet

Distocclusion

Deep bite 70-80 %

Mouth breathing (often)

Incomplett lip closure

Acquired anomalies

DistoocclusionOverbite (always)Retrusion of upper incisors

Angle II./2 rendellenességek Angle II./2 rendellenességek jellemzőijellemzői

Hereditary anomalyHereditary anomaly Excessive function of Excessive function of

the upper lipthe upper lip Pronounced sulcus Pronounced sulcus

mentolabialis (deep mentolabialis (deep bite)bite)

Nose breathingNose breathing „„Forced distooclusion”Forced distooclusion”

Angle III – progenie - mesiocclusionAngle III – progenie - mesiocclusion

CLASS III MALOCCLUSION

LATE MIXED DENTITIONCLASS III MALOCCLUSIONANTERIOR CROSSBITE

CLASS III MALOCCLUSION

DEEP OVERBITEMAXIMUM INTERCUSPATION

Sceletal or dentoalveolar anomalies –

Vertical anomalies

Deep bite Open bite

Deep bite

The six keys of occlusion (by Andrews) are:

Molar inter-arch relationship Mesio-distal crown angulation Labio-lingual crown inclination Absence of rotation Tight contacts Curve of spee

Asymetrical forms Asymetrical forms

By narrowing of the archesBy narrowing of the arches

the lateral cusps forces thethe lateral cusps forces the

mandible to lateral directionmandible to lateral direction

Sceletal assimetrySceletal assimetry

Angle Angle subdivion -subdivion - if the occlusion on the right side and if the occlusion on the right side and left side are differentleft side are different

III Class

Tongue –thrust swallowingTongue –thrust swallowing

Lip-pressure swallowing Lip-pressure swallowing

Thumb suckingThumb sucking

23.04.21.23.04.21. 4040

-Consequences of thumb sucking

-Open bite-Protrusion of upper incisors-Retrusion of lower incisors- Distalocclusion

Mouth breathingMouth breathingthe nasal cavity is usually (nasal gland, polyp etc.)the nasal cavity is usually (nasal gland, polyp etc.)

Upper incisors are protrudedOpen biteInflammated marginal gingiva

Mouth breathing Mouth breathing Oral breathing

Deviation

Maximum mouth opening

Place analysisPlace analysis

The lower jaw is more important, because The lower jaw is more important, because we are not able to increase the size of the we are not able to increase the size of the mandible !!!mandible !!!

Leeway space

The primary molars are smaller than the premolars

Curve of spee.

Measurements Measurements

Arch perimeter analysis (place analysis)Arch perimeter analysis (place analysis) Pont- indexPont- index Schmuth- indexSchmuth- index Moyers- indexMoyers- index Bolton analysis (77,2%)Bolton analysis (77,2%)

ISD 75.5%-78,9%ISD 75.5%-78,9%

or extraction

Steiner analysisSteiner analysisWidth of 3,4,5Width of 3,4,5 Width of 2,1,1,2

Measured valueMeasured value

Measured value

Calculated value =

Measured valueCalculated valueDifference

Sum of differences

Pont- and Schmuth- index Pont- and Schmuth- index

Pont-indexPont-index

Pont-Index

If the difference between the optimal premolar, molar distance and the measured premolar, molar distance is less then 5 mm EXPANSION

If the difference between the optimal premolar, molar distance and the measured premolar, molar distance is more then 8 mm EXTRACTION

Between 5-8 mm BORDERLINE CASE

ModellanalysisSchmuth - indexSIpremol.: SI + 8 mmmol.: SI + 8 + 8 mmmag.: SI / 2

Anterior length of the dental arch

Distance between the premolarsLength of the arch (12 teeth mesiodistal width)

Moyers- index Moyers- index

7272

Orthodontic treatment in primary dentition

1.Progenia appliance: chin cap 2.Bad habits: thumb sucking, appl.: oral screen 3.Cleft lip and cleft palate 4.Loss of primary teeth appl.: space maintenier 5.Crossbite appl.: inclined plane

Orthodontic treatment in mixed dentition

1.Crossbite appl.: inclined plane 2.Early loss of primary teeth appl.: space maintener 3.Functional jaw orthopedic Sagittal anomalies: Angle II. – distalocclusion Angle III. – mesialocclusion Vertical anomalies: open bite deep bite appl.: bimaxillary functional appliances activator, bionator, Frankel-appl., Hansa-appl. etc. 4.Diasthema medianum appl.: removable appliance with springs brackets 5.Crowding with or without lateral crossbite appl.: expansion of the dental arch with activ removable plates or quad-helix 6. Timing of first molar’s extraction ( reason: gangrena, periostitis, periodontitis etc. ) 7.Hotz serial extractio

–primary canines–primary first molars–permanent first premolars

1. Treatment with fixed appliances - multiband, multibond - lingual and palatinal arches - Hyrax 2. Orthodontic treatment with extraction ( most

frequently: first premolars ) reason: crowding or overjet 3. Orthodontic treatment with surgical

intervention f.e.: impacted teeth 4. Treatment with missing teeth space closure or preprosthetic orthodontic

treatment -reason: aplasia, accidents, caries 5. Dysgnathia operations ( age: 18 ) progenia, prognathia, open bite 6. Orthodontic treatment in periodontal deseases 7. Problems with wisdom teeth