the aim of orthodontic treatments - semmelweis...
TRANSCRIPT
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The aim of orthodontic treatments
To treat esthetic complainsTo solve the functional problems (chewing, speech, TMI)Prevention (Unreal expectations: improvement the quality of life: better job, new relationships, marriage etc. )
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Skeletal and dental anomalies are treated
Angle II. anomalies
Angle classification(based on:anteroposterior relationship of the jaws))
Angle III. anomalies
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Angle I.normocclusio
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Angle II/1 Angle II/2
Angle II. - Distocclusio
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Angle III – progenia - mesiocclusio
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Sceletal and dental anomalies are treated
Vertical problems
Transversal problem
Deep bite and open bite
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Grouping of orthodontic Grouping of orthodontic anomaliesanomalies
Removable appliances
Fixed appliances
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fg magy ex. 1.dia
Removable appliances
- Active plates - Pasive plates
- Functional, bimaxillary appliances
(To improve the relationship between the upper an lower jaw)Frankel-appliance, Hansa-appliance, Bionator, Aktivator
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Functional, bimaxillary appliances
BeforeAfter
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Grouping of plates
Upper passive (retention) plates Upper active plate
PassivePassive ActiveActiveSCREWSCREW
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Active platesscrew !!!!!
The screw is activated in the directionof the arrow (10 days, 2 weeks)
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Elements of removable appliances
• Acrylic base plate• Labial bow• Clasps• Active element
(Hawley) retention plate
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Elements of removable appliances
• Acrylic base plate
• Labial bow
• Clasps
• Active elements
0,7-0,9 mm stainless steele wire
U-loop
U-loop
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Labial arch
0,7 – 0,9 mm stainless steel alloy
Labial arch holds the appliance in the mouthand able to tilt the incisors backword (retrusion)
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Labial archVertical bending: right-angle 90’
by one third of canine (mesial arm)
Flat Nose Plier
or
Classic Universal Plier
Flat Nose Plier
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Labial arch• Bend the loop (Wire bending plier, Round & Concave Plier or Double Rounded Jaw Plier• The mesial and the distal branches of the loop
have to be parallel
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Labial arch Bend the end of the wire palatinally
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Elements of removable appliances
Adams clasp
Adams clasp
Adams clasp
Acrylic base plate
Labial bow
Clasps
Aktív elemek
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Elements of removable appliances
Arrow clasp
Arrow clasp
Acrylic base plate
Labial bow
Clasps
Active elements
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The elements of the platesAcryl basic plateLabial bowClaspsActive elements-springs Free-ended or finger springs
closing opening
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The elements of the plates
Acryl basic plateLabial bowClaspsActive elements
•console-like springs
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Active plates
• Upper typical active plate ( the screw is in the• middle of the appliance
• (
•
Lower typical active plate
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Active plates
Lower atypical active plate
Upper atypical active plate ( the screw is placed assimetrically)
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Active plates
Upper atypical active plate with lateral bite raising
(for the treatment of lateral crossbite)
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Active platesY-plate
• Kiterjesztése• Feladatai elhorgonyzás aktív fogelmozdítás
Lower Y-plateUpper Y-plate
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Bertoni-screw(instead of Y-plate)
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Flat nose plier Wire bending plier
Classic universal plier
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08/10/13 29
Oral screen
Against bad habits
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Grouping of orthodontic Grouping of orthodontic appliancesappliances
Intraoral appliancesIntraoral appliancesExtraoral appliancesExtraoral appliances
Intra-, extraoral appliancesIntra-, extraoral appliances
20080213BiofiztanteaFG
Extraoral appliances:
Chin cap – in progenie (III. class)
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Intra-, Intra-, extraoral applianceextraoral appliance:
Reverse HeadgerFacemask
sagittális expansion of the maxilla
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Inta -, extraoral appliance: headgear
-Distalisation of upper jaw (or upper molars)
- Influence of vertical anomalies
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Elements of fixed appliances
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Fixed appliances
• Multiband appliances• Direct bonding technic Elements:
– Brackets– Bands on the molars ??– Buccal tubes– Archwire– Ligatures
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Elements of fixed appliances(multibond, multibracket appliances
direkt bonding technic)
Bracket Ligatures
Orthodontic archwire
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wingsslotbasis
Coloured dots
The dot is always on the distogingival wing of the bracket.
Multiband
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Elements of fixed appliances
Bottom of thebracket
Huge surface for the bonding material
hook
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Metal brackets• Stainless steele• Titan• Gold
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Ceramic or plastic brackets
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Ceramic brackets
• Disadvantages: - expensive - it’s no possible to renew - fragile - difficult to remove - more difficult to set the ligatures
Advantage: - esthetic
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Signs on the brackets• Arrow in the long-axis of
the brackets• The arrow shows the gingival part of the bracket• Dot on the distogingivalwing (by upper incisors and canines)
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Bonding brackets
• Steps• 1. Mechanical cleaning (metal burs, rubbers)• 2. isolation : lip
retractor, cotton rolls, saliva retractor 3. Drying with bensin or alcohol
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• 3. etching: -- phosphoric acid -- gel -- 30 seconds• 4. washing: -- 30 seconds with water -- isolation again -- drying again 5. Bonding (etch-bond)• 6. Placing of brackets• 7. remove of the overflown of
bonding material• 8. polymerisation
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Positioning of the brackets
• In the middle of the crown• -- vertically• -- horizontally• -- brackets positioners are used
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- 1 mm-1 mm+ 1 mm + 1 mm
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Bonding materials• composites• glasionomer cements
• two components, mix– Paste-paste– Powder-liquid• no-mix materials
• light curing komposite and glasionomer bonding materials
• self curing „glue”
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Separator Plier:
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Direct bonding tubes
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Ligatures
• Elastic• Metal
• Single
• Continous
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Single ligaturesElastic ligature (sologumi) Metal ligature (szöcske = grasshopper)
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Single elastic ligature
Needle holder
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Single elastic ligature
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Metal ligature
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Metal ligatures
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Self-ligating brackets
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Continous elastic ligature(to close gaps)
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Continous elastic ligature(to close diasthema)
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Continous elastic ligature(to close gaps)
Elastic chain
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Continous metal ligature
Main function is fixing of the teeth
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Indirectbonding
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Indirekt bonding
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or rubbers
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Quad-helix
in mixed and permanentdenture
Hyrax rapid palatinal expansion
(ripping of midpalatal suture)
Fixed expanders
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Hyrax(rapid palatinal expansion- 3 weeks)
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Fixed appliances for the treatment of II. class anomalies
• Herbst-appliance• Jusper Jumper• Forsus spring stb.
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Orthodontic ImplantsAnchorage
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Orthodontic ImplantsAnchorage
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Inclined plane against frontal crossbite
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Weingart plier Ligature Cutter
Laboratory Wire CutterDistalend Cutter
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Weingart-Plier:- universal plier: with it we set and take out the arhwires to 6from its
place, activate MB appliances’ accessorical appliances ( QH, TP-arch… ), remove brackets and activate removable appliances:labial arch, clasps,
springs
Needle-holder
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Nikkel-titanium wire1. Leveling phase
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Twist-flex or coaxial wire1. Leveling phase
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2. Leading phase– 2. Leading phase– the movement of lateral teeththe movement of lateral teeth
Wire: quadrangular stainless steele wire
Force : rubbers. Ligatures, loops
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Leading phase– Leading phase– the movement of lateral teeththe movement of lateral teeth
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Orthodontic implantsAnchorage
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Orthodontic implantsAnchorage
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Transpalatinal archAnchorage
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Nance-appliance
Anchorage
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HeadgearAnchorage
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Lingual-arch
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Lipbumper Anchorage
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3. Contraction phasefor setting of incisors
loop
Elastic chainIntermaxillary rubbers
Wire: stainless steele
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Utility wire
• Connection between molars and incisors• For the treatment of deep bite, open bite protrusion, retrusion
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Utility wire(inactive)
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Activation by deep bite
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Activation by open bite
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Activation for retrusion(tilting backward)
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Activation for sagittal expansion of the front
(tilting forward)
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Steps of bending
• De La Rosa-Plier:- for forming the archwires- for ideal-arch forming
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Steps of bending
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Nance –plier (steps on the nose)
Tweed - plier
Pliers bending utility wire
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4. Correction phase
- perfectioning of the occlusion- correction of teeth’ axis
- treatment of remaining problems(gaps, rotation, tilting stb.)
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5. Retention
• There is only one way to completely avoid relapse. At the end of treatment, remove the braces, polish the teeth, make study models and take photographs. And then take the patient out the back door of the office and shoot him. (Dr. Tom Graber DMD, South African Dental Congress. August 1992.)
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• Fixed appliance: 1-3 (4-5) years
• A retention should be twice longer than the active treatment
1 year > 2 years
Length of retention
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Fixed retainers
Twist-flex wire
Thin stanless steele wireReadsy-made retainer
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RetainersResins
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Retainers– Essix retainer
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Retainers- Positioner
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Retainers - Barrer-retainer
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Lingual technic
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4 premolars extraction
PERMANENT DENTITIONCLASS II SUBDIVISION RIGHTMODERATE OVERJET
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4 premolars extraction
UPPER ARCH LOWER ARCH
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4 premolars extraction
POST-TREATMENT
Purpose: I. class occlusion
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2 premolars extractionCanines always have to be in normal occlusion !!
Angle II./2
Purpose : canines I. class, molars II. class
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Extraction of 1 lower incisorExtraction of 1 lower incisor
In lower crowding
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Removing of wisdom teethRemoving of wisdom teeth
To avoid relapse and late crowding
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Köszönöm a figyelmet !Thank you for your attention !