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NormocclusionLocal and general anomalies
Dr.Káldy Adrienn
Semmelweis Egyetem
Gyermekfogászati és Fogszabályozási Klinika
Angle classification system
For malocclusions proposed by Angle is widely used and serves as an excellent means of general description that has facilitated the communication about different malocclusions within the profession
The system basically describes anteroposterior relationships of the upper and lower first molars
Angle classification system
Angle Class I.
A Class I malocclusion is associated with a normal maxillomandibular relationship in the saggital plane
All ideal occlusions are Class I, however not all the Class I occlusions are ideal
Class I. malocclusions
Local anomalies
Single teeth: variations in the positions of single teeth-tilting,mesial, distal,labial, lingual,infra,supra position, rotation-ectopic eruption of the first molars-median diastema-anterior crossbite-impacted teeth-numerical deviations
General anomalies
Vertical plane:-Deep bite-Openbite
Transversal plane:-crowding-crossbite
Local anomalies
-tilting ( apical base in place)-incorrect position( apical base not in the right place)-combination of these
Etiology-lack of space-functional problems-hereditary factors-trauma-early extaction of the primary tooth
Axial deviation of the single teeth
Labial, buccal, palatinal, lingual, mesial, distal tilting of the teeth
Labial tilting of the upper incisors: - genetic- bad oral habits (thumb sucking, pacifying)
Palatinal tilting of the upper incisors:-lack of place-deepbite, coverbite
Therapy:
Elimination of cause factors (disfunctions, persistent milk teeth)
Removable appliances, fixed appliances
Ectopic upper canine
Lack of place
Therapy:
Creating place -Expansion: -removable expander plate („Y” plate) -fixed appliance
-Extraction
Maxillary midline diastema
Early mixed dentition
Diagnostic:Oral observation, X-ray
Etiology:Supernumerary teeth, congenital missing teeth, strong fraenum, hereditary factors
Consequences:Esthetical and phonetical problems
Median diastema
Therapy:Elimination of the trigger factors
-Frenulectomy -Extraction of the supernumerary tooth
Space closing -with fixed or removable appliance
Retention phase!
Anterior cross-bite
Diagnostic
Oral observation, X-ray
Etiology -Unfavourable axial inclination -Crowding -Hereditary factors -Trauma
Consequences -Traumatically occlusion -Gingival irritation -Periodontal problems -Tooth lost
Anterior cross-bite
Therapy
Elimination of cause factors -Creating space with fixed or removable appliance
-Alignement of the tooth
Impacted teeth
DiagnosticOral observation, X-ray from two direction
Etiology
-Unfavourable axial deviation or postion of the germ -Crowding -Hereditary factors -Trauma -Early extraction of deciduous tooth -Supernumerary teeth
Consequences -Follicular cyst -Root resorptoin of neighbouring teeth
Freuency -8,3,5,1
Treatment of impacted teeth
-Orthodontic treatment with spontaneous eruption
-Surgical-orthodontic treatment without extraction
-Orthodontic treatment after surgical intervention and extraction of the impacted tooth
-Direct surgical reposition
Impacted canine
Prognosis
-Palato-buccal position -Abnormality of teeth axial inclination ( 45o ) -Space discrepancy -Patient age
Possible sideffects of the treatmentLoss of anchorage, loss of attachmentIntrusion of the neighbouringRoot resorption
Numerical deviations
DiagnosticOral observation, X ray
Etiology-Hereditary factors-Trauma-Intrauterine injuries-Cariological problems
Consequences-Agenesia Diasthema, -Supernumerary: crowding,follicular cyst, -Periodontal problems
Frequency -Agenesia: 8,2,5,1 -Supernumerary: mainly in the front area
Treatment of numerical deviations
-Orthodontic-Orthodontic and prosthetic-Prosthetic-Surgical-Orthodontic-Implantologic
Important factors:Other orthodontic anomalies, oral hygiene, age
Treatment of Angle class I.General anomalies
Outline
Deep bite Open bite Transversal anomalies Lateral cross bite, Scissor bite,
Crowding
Deep bite
Dento alveolarOver eruption of incisorsLack of laterals eruption Multiple extraction
SkeletalUsually together with Angle II/2
Analysis of the cephalogram
ML-NL angle ML-NSL angle NL-NSL angle Gonion angle
Treatment of deep bite
Intrusion of incisors Extrusion of molars Appliances:Multiband or removable
appliance
Utility ív
Treatment with fixed appliance
Deep bite (Angle II/2)
Passive plate with bite raising block in the front
Open bite
Anterior LateralUnilateral Bilateral
Dento alveolarHabitual dysfunction
SkeletalVertical development of the
mandible
Analysis of the cephalogram
ML-NL angle ML-NSL angle NL-NSL angle Gonion angle
Typical skeletal and dentoalveolar open bite
Treatment of open bite
Elimination of the causes
Correction of the vertical relation between the upper and lower jaws
Appliances:Oral screenActivatorFixed appliance with
intermaxillary elastics
oral screen
ORAL SCREEN
Az aktivátor
Andresen Häupl—funkciós
állcsontortopédia
Merev akrilátblokk Labiálív Öntött kapcsok
Aktiválás
vertikális irányú becsiszolás
Dentoalveolar open bite due to habitual dysfunction Treatment with tongue cribs
Tongue trust swallowing
Treatment of the open bite with fixed appliance
Treatment of the open bite with fixed appliance
Tongue trust swallowing
Utility arch
Transversal anomalies Lateral cross bite Unilateral Bilateral Dentoalveolar Skeletal
Lateral scissorsLateral cross bite
Analysis of the model
Measurement of the indexes
Analysis of the relation between the apical and the coronal base
Pont- and the Schmuth- index
Treatment alternatives of lateral cross bite In the deciduas
dentition grinding and functional training (bite exercise)
Functional appliance with screw
Frankel I Active plate Quad-helix Hyrax screw
Hasund-féle Hansa készülék:
--felső lemezrész tágító csavarral, torqueáló-rugóval, Adams-kapoccsal
Alsó lemezke -- speciális rugóval, -- ajakráccsal
--Buccális pajzs --pelották --transzpalatinális ív --segédrugók
Periosteum viszkoelasztikus elhúzódása
Frankel appliance
Upper and lower active plates
Unilateral cross biteforced bite
Transversal widening
Treatment of scissors bite
Closing the upper arch
Expanding the lower arch
Appliances: multiband, activator (with screw) active plate
Transversal anomalies Crowding
Primer: Size of tooth arch Size of
teeth Secounder: Early deciduous extraction and its
consequence Tertier: Eruption of the wisdom
Crowding
Primary ⇐ Jaw size ⇒ Tooth dimension Secondary ⇐ Early extraction of deciduous Tertiary ⇐ Third molar
Treatment of crowding
Prevention Space creation
Transversal and or sagittal widening (help: Pont index )
Tooth material reduction
extraction or stripping of enamel(help: Bolton analysis)
Stripping of enamel
Hyrax
Treatment of crowding
Prevention Provision of space
Pont index sagittal and or transversal expansion)
Reduction of tooth material (extraction
stripping)
Non extraction treatment
Crowding Large scale deep
bite (Angle II/1.)
persistant decidous
After the treatment
After the treatment
Extraction treatment Consideration : Expansion ⇔ extraction The measure of the narrow: 0-5mm, 5-10mm,
10- Consideration of the protrusion Consideration of the vertical relation
systemic extraction
Extraction of deciduous canines
Extraction of first deciduous molars
Extraction of first premolar