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Orthodontics
Introduction
• Orthodontics
– Area of specialty dealing with the
recognition, prevention, and treatment of
malalignment and irregularities of the
teeth, jaws, and face
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The Orthodontic Practice
• Orthodontic office
• Orthodontic team
– Orthodontist
– Reception and business office staff
– Office coordinator
– Laboratory technician
– Orthodontic assistant
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Occlusion and Malocclusion
• Normal (ideal) occlusion describes the
contact relationship of the mandibular
arch with the maxillary arch.
– Mandibular teeth are in maximum contact
with maxillary teeth and spaced normally
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Occlusion and Malocclusion
• Normal (ideal) occlusion
– Maxillary anterior teeth overlap incisal
edge of mandibular anterior teeth by 2 mm
– Maxillary posterior teeth are one cusp
distal to mandibular posterior teeth
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Normal Occlusion
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Occlusion and Malocclusion
• Malocclusion:
– Any deviation from normal occlusion
– Includes misalignment of a single tooth, a
group of teeth, or an entire arch
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Angle’s Classification
• Neutroclusion
– Cusp of the maxillary cuspid (canine)
occludes between the distal of the
mandibular cuspid and the mesial of the
mandibular first bicuspid
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Angle’s Classification
• Distoclusion
– Cusp of the maxillary cuspid (canine) is
moved forward and occludes between the
distal of the mandibular lateral incisor and
the mesial of the mandibular cuspid
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Angle’s Classification
• Mesioclusion
– Cusp of the maxillary cuspid (canine) is
moved back and occludes behind the
mandibular cuspid and in the middle of the
mandibular first molar
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Malposition of Individual Teeth
• Torsiversion
– Tooth is rotated or turned
• Mesioversion
– Tooth is mesial to normal position
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Malposition of Individual Teeth
• Distoversion
– Tooth is distal to normal position
• Linguoversion
– Tooth is lingual to normal position
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Malpositions
of Individual Teeth
• Labioversion or buccoversion
– Tooth is tipped toward the lip or cheek
• Supraversion
– Tooth extends above the normal line of
occlusion
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Malpositions
of Individual Teeth
• Infraversion
– Tooth is positioned below normal line of
occlusion
• Transversion or transposition
– Tooth is in the wrong order in the arch
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Malpositions
of Groups of Teeth
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Anterior cross-bite
Posterior cross-bite
Edge-to-edge bite
End-to-end bite
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Malpositions
of Groups of Teeth
• Open bite
• Overjet
– Horizontal overlap
• Overbite
– Vertical overlap
• Underjet
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Etiology of Malocclusion
• Genetic or heredity
• Systemic
• Local
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Types of
Orthodontic Treatment
• Preventive or interceptive
– Placing restorations
– Space maintainers
– Observations
• Corrective
– Fixed appliances
– Removable appliances
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Process of Tooth Movement
• Resorption
– Process that eliminates tissues no longer
needed in the body, therefore allowing
teeth to be moved
• Deposition
– Retains teeth by creating new deposits or
cells
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Process of Tooth Movement
• Osteoclast
– Cause bone to resorb or break down
• Osteoblasts
– Deposit new bone to hold tooth in new
position
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Preorthodontic Treatment
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Diagnostic records
Medical-dental history
Clinical examination
Radiographs
Photographs
Study models
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Panoramic Radiograph
(Courtesy of Dr. Steven Gregg)
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The Consultation Appointment
• Orthodontist presents patient with
treatment plan
• Responsibilities of patient is reviewed
• If patient accepts the treatment plan
– Consent papers are signed and financial
arrangements made
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Orthodontic Appliances
• Fixed
– Orthodontic
bands
– Brackets
– Arch wires
– Ligature wire and
plastic bags
– Buccal tubes
– Springs
– Elastics
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Orthodontic Appliances
(Courtesy of Rita Johnson, RDH, Professor, MCC,
Lowell, MA; and Dr. Vincent de Angelis, Associate
Professor, Harvard School of Dental Medicine.)
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Special Fixed Appliances
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Lingual braces
Lingual arch wire
Space maintainer
Palatal separating appliance
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Removable Appliances
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Headgear
Functional appliances
Retainers
Tooth positioner
Aesthetic orthodontic aligners
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Orthodontic Instruments
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Coons’ ligature-tying pliers
Mathieu needle holder
Ligature director
Pin and ligature cutter or light wire
cutter
• Howe pliers
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Orthodontic Instruments
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Band seater
Bite stick band seater
Band driver
Posterior band removing pliers
Band contouring pliers
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Orthodontic Instruments
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Bracket forceps
“Bird-beak” pliers
Three-prong pliers
Weingart utility pliers
Tweed-loop pliers
Distal-end cutting pliers
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Orthodontic Treatment
• Application of separators
• Placement of posterior bands
• Placement of anterior brackets
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Orthodontic Treatment
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Placement of arch wire
Oral hygiene instructions
Interval checkups
Completion appointment
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Completion Appointment
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Ligature ties removed
Elastic ties removed
Elastic released
Wire cut
Wire removed from wing
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Completion Appointment
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Arch wire removed from bracket
Anterior brackets removed
Posterior bands are removed
Above process repeated on lingual
surface
• Cement and direct bonding materials
removed
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Completion Appointment
• Rubber cup polish completed
• Alginate impression taken of arches
• Patient reappointed for later that day or
for next day
• Retainer or positioner placed
• Patient given instructions on how to
wear appliance
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