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I Skeletal Class I Malocclusion Orthopedic appliance Dr. K. Ravi, MDS, Prof , HOD &Dean , Department of Orthodontics, SRM Dental College. Contents of the lecture • Definition of Orthopaedic appliance • Difference between orthopaedic & orthodontic appliance • Types of orthopaedic appliance • Indications an overview • Head gears • Reverse pull Head gear • Chin cup Orthopaedic appliance • Orthopaedic appliances are appliances that exert orthopaedic force and bring about bony changes . • They are growth modification appliances given in the growing stage of the individuals with skeletal malocclusion. • There are three type of orthopaedic appliances – Head gear – Reverse pull head gear ( Face mask ) – Chin cup Difference between Orthopaedic appliance & Orthodontic appliance Orthopaedic appliance Orthodontic appliance Exert orthopaedic force Exert orthodontic force Heavy intermittent force Low continuous force Greater than 400gms Lesser than 400gms Skeletal changes Dental changes Head gear Hawley's appliance Face mask or Reverse pull HG Begg appliance Chin Cup Straight wire appliance Malocclusion Skeletal Dental Growth Surgical Camouflage Hawley's appliance ,Begg modification in intervention in Appliance & Straight wire growing patients Less severe adults appliance Skeletal Class II Head gear – Maxillary prognathism Functional appliance – Mandibular retrognathism Skelatal Class III Reverse pull HG or face mask for maxillary retrognathism chin cup for mandibular prognathism Constricted maxilla Rapid maxillary expansion appliance Head gear – Maxillary prognathism (Skeletal class II Malocclusion) . Head gears are used in skeletal class II Cases with maxillary prognathism Indications . Restriction of maxillary growth . With a maxillary acrylic splint . With functional appliances . Treating gummy smile . Fixed appliance for preserving anchorage in the upper arch Mechanism of action . Head gears restrict the growth of maxilla by restricting the suture at circummaxillary sutures. Types of head gear Head gear Face bow assembly Head strap Face bow – Standard Force module • Head strap is used to obtain anchorage from the cranial bones ( Extra oral skeletal anchorage ) • Safety release module or force Module • It is the force element of the head gear face bow assembly • It is encaged to the loop in the Head strap at one end and Other end is attached to the outerbow of the face bow Standard Face bow • Parts • Inner bow – attached intra oral component • Outer bow – attached to Force module • Soldered joint Inner bow - Molar tube of FA Headgear tube embedded in acrylic embedded in acrylic of the maxillary splint Cervical pull head gear . In patients with low mandibular plane angle Reduced lower facial height True Deep bite . Anchorage - Nape of the neck . Mechanism of action prevents forward growth of maxilla increase vertical facial height through extrusion of posterior teeth. High pull head gear . In patients with High mandibular plane angle Increased lower facial height Vertical maxillary excess High pull head gear . Anchorage - Parietal bone . Mechanism of action prevents forward growth of maxilla Vertical growth of maxilla Promotes intrusion of maxillary posterior teeth Anticlockwise rotation of mandible Reduction in facial height is achieved Combipull head gear . In patients with Average mandibular plane angle . Anchorage - occipital bone . Mechanism of action prevents forward growth of maxilla Force Magnitude , Duration & direction . Magnitude - 400-500gms per side Centre of resistance Maxillary molar – 2mm above furcation Maxillary dentition – between roots of premolars Maxillae postero superior aspect of zygomatico maxillary suture . Force duration Intermittent force (12-16 hrs per day) J Hook Face bow • Anterior retraction • J hook is anchored to the stop soldered between incisors • closer to centre of resistance • restricted to 50-150gms when away from centre of resistance Concorde face bow for intermaxillary elastics Suggested time frame for Dentofacial orthopaedics • CS1- CS2- Maxillary expansion & protraction • Maxillary growth restriction – until CS4 • Mandibular growth promotion – CS3-CS4 • Mandibular growth restriction – Highly variable Chin cup – mandibular prognathism (Skeletal class III Malocclusion) Chin cup • Head strap • Derives anchorage from skull • Force element • Elastic strap or a force module • Chin cup • Supports the chin • Transmits the force to the chin • Force • Direction –through the condyle • Magnitude - less than 1000gms • Duration – 10 -12 hrs a day • Indication • skeletal class III cases due to mandibular prognathism • Action of appliance • Restricts the growth of condyle Reverse pull Head gear – Maxillary retrognathism (Skeletal class III Malocclusion) Reverse pull head gear or face mask • Indication – skeletal class III cases due to maxillary retrognathism • Types Delaire’s Face mask Petit face mask Tubinger type Extra oral component Components & function . Fore head pad – rests on the fore head , Derives anchorage from fore head, Extraoral anchorage , skeletal anchorage . Vertical rod – connects all the components . Horizontal rod – point of attachment for Extraoral elastics . Chin cup – rests on the chin , Derives anchorage from chin, Extraoral anchorage , skeletal anchorage Active component . Extraoral elastics . Runs between the hook in the maxillary splint to the horizontal rod in the extra oral component Intra oral component – . maxillary acrylic splint or . acrylic splint with hyrax . maxillary constriction & crossbite present . Activates circum maxillary sutures . with soldered hooks in between the deciduous molars or premolars Force • Direction – 15 degrees downward to occlusal plane , pulls maxilla downward & forward • Magnitude - less than 1000gms ,500 gms on each side • Duration – 10 -12 hrs a day (interrupted force ) .
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