orthopaedodontics · (orthopaedics) o my recommended age to start phase one is at age 8 o 1’st...
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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