/RTHODONTICS
&ARHAD " .AINI
$ALJIT 3 'ILL !SHVIN 3HARMA AND #HRISTOPHER 4REDWIN 4HE !ETIOLOGY $IAGNOSIS AND -ANAGEMENT OF $EEP /VERBITE
!BSTRACT 4HIS ARTICLE GIVES AN ACCOUNT OF THE AETIOLOGY DIAGNOSIS AND CONTEMPORARY TREATMENT METHODS FOR THE CORRECTION OF ANTERIOR DEEP OVERBITE HIGHLIGHTING THE APPROPRIATE METHODS DEPENDING ON THE TYPE OF MALOCCLUSION WITH WHICH A PATIENT MAY PRESENT #LINICAL 2ELEVANCE #ORRECT DIAGNOSIS AND TREATMENT PLANNING SKILLS ARE IMPORTANT IN THE CORRECTION OF ANTERIOR DEEP OVERBITE 5P TO DATE KNOWLEDGE IN THIS FIELD IS OF RELEVANCE TO ORTHODONTISTS PROSTHODONTISTS AND MAXILLOFACIAL SURGEONS $ENT 5PDATE
/VERBITE MAY BE DEFINED AS THE DEGREE THE OVERBITE DEPTH IS n MM ON AVERAGE A OF VERTICAL OVERLAP OF THE MANDIBULAR &IGURE INCISORS BY THE MAXILLARY INCISORS WHEN THE /VERBITE IS DESCRIBED IN TERMS POSTERIOR TEETH ARE IN OCCLUSION /VERBITE OF ITS DEPTH AND INCISOR CONTACT 4HEREFORE DEPTH IS USUALLY MEASURED PERPENDICULAR OVERBITE MAY BE TO THE OCCLUSAL PLANE EITHER IN MILLIMETRES .ORMAL OR AS THE AMOUNTPERCENTAGE OF THE TOTAL 2EDUCED DECREASED OR CROWN LENGTH OF THE MANDIBULAR INCISORS $EEP INCREASED THAT IS OVERLAPPED BY THE MAXILLARY #OMPLETE TO DENTITION OR PALATAL MUCOSA B INCISORS !N AVERAGE OVERBITE OCCURS WHEN OR THE MAXILLARY INCISORS OVERLAP THE INCISAL )NCOMPLETE THIRD OF THE MANDIBULAR INCISOR CROWNS )N ADDITION A DEEP OVERBITE COMPLETE TO )N A #LASS ) INCISOR RELATIONSHIP WHERE THE THE MUCOSA PALATAL TO THE MAXILLARY INCISORS MANDIBULAR INCISOR TIPS OCCLUDE WITH THE KNOWN AS AN IMPINGING OVERBITE &IGURE A CINGULUM PLATEAU OF THE MAXILLARY INCISORS WHEN COMBINED WITH POOR ORAL HYGIENE MAY BECOME TRAUMATIC CAUSING IRRITATION AND DISCOMFORT AND OCCASIONALLY LEADING TO SIGNIFICANT SOFT TISSUE DAMAGE )N SOME #LASS &ARHAD " .AINI "$3 &$3 2#3 -3C )) DIVISION MALOCCLUSIONS WITH MINIMAL C -/RTH 2#3 &$3/RTH 2#3 #ONSULTANT OVERJET THE RETROCLINED MAXILLARY INCISORS /RTHODONTIST 3T 'EORGES (OSPITAL AND MAY IMPINGE ON THE GINGIVAE LABIAL TO THE +INGSTON (OSPITAL $ALJIT 3 'ILL "3C MANDIBULAR INCISORS &IGURE B #OMBINED "$3 &$3 2#3 -3C -/RTH 2#3 &$3/RTH WITH POOR ORAL HYGIENE THIS MAY LEAD TO 2#3 #ONSULTANT /RTHODONTIST %ASTMAN TRAUMATIC GINGIVAL RECESSION $ENTAL (OSPITAL !SHVIN 3HARMA "$3 -3C -&$3 -/RTH -/RTH 2#3 #LINICAL &IGURE A ! #LASS ) INCISOR RELATIONSHIP WITH A ,ECTURER IN /RTHODONTICS 2OYAL ,ONDON !ETIOLOGY NORMAL OVERBITE B 4HE MAXILLARY INCISORS OVERLAP (OSPITAL AND IN PRIVATE PRACTICE AND !NTERIOR DEEP OVERBITE PROBLEMS THE INCISAL THIRD OF THE MANDIBULAR INCISOR CROWNS #HRISTOPHER 4REDWIN "3C "$3 -3C MAY RESULT EITHER FROM AN UPWARD AND C ! DEEP ANTERIOR OVERBITE WITH THE MAXILLARY -&$3 2#3 #LINICAL ,ECTURER IN 2ESTORATIVE FORWARD ROTATION OF THE MANDIBLE DURING INCISORS COVERING OF THE MANDIBULAR INCISOR $ENTISTRY %ASTMAN $ENTAL (OSPITAL 5+ GROWTH OR FROM EXCESSIVE ERUPTION OF CROWNS $ENTAL5PDATE *ULY!UGUST /RTHODONTICS
A A
B
&IGURE A -ANDIBULAR INCISORS IMPINGING ON THE PALATAL MUCOSA B -AXILLARY INCISORS IMPINGING ON THE MANDIBULAR LABIAL GINGIVAE
THE INCISOR TEETH NOTABLY THE MANDIBULAR INCISORS !NTERIOR TEETH GENERALLY ERUPT UNTIL THEY MAKE CONTACT EITHER WITH OPPOSING ANTERIOR TEETH PALATAL MUCOSA OR THE RESTING TONGUE 4HE FACTORS THAT CONTRIBUTE TO AN ANTERIOR DEEP OVERBITE MAY BE CLASSIFIED AS FOLLOWS 3KELETAL 3OFT TISSUE $ENTAL
3KELETAL &ORWARD ROTATION OF THE MANDIBLE IN THE DIRECTION OF MOUTH CLOSING IS DUE TO INCREASED POSTERIOR VERTICAL FACIAL GROWTH COMPARED TO ANTERIOR VERTICAL FACIAL GROWTH &IGURE A "JORK DESCRIBED SEVEN STRUCTURAL SIGNS FOUND ON A LATERAL B CEPHALOMETRIC RADIOGRAPH WHICH MAY GIVE AN INDICATION TO THE PATTERN OF MANDIBULAR GROWTH )N FORWARD GROWTH ROTATORS WHICH CAN GIVE RISE TO AN ANTERIOR DEEP OVERBITE THE FOLLOWING SIGNS MAY BE EVIDENT &IGURE &IGURE A ,ATERAL CEPHALOMETRIC RADIOGRAPH B OF A PATIENT WITH A FORWARD GROWTH ROTATION OF &ORWARD INCLINATION OF THE CONDYLAR HEAD THE MANDIBLE B "JORKS SEVEN STRUCTURAL SIGNS !N INCREASED CURVATURE OF THE INFERIOR INDICATING A FORWARD MANDIBULAR GROWTH ROTATION ALVEOLAR CANAL 2EFER TO NUMBERED LIST IN TEXT !BSENCE OF AN ANTEGONIAL NOTCH &ORWARD INCLINATION OF THE MENTAL SYMPHYSIS IN #LASS )) DIVISION MALOCCLUSION IS A HIGH REFERRED TO AS A STRAP LIKE LOWER LIP )NCREASED INTERINCISAL ANGLE LOWER LIP LINE WHICH IS THOUGHT TO GUIDE THE $EPENDING ON THE VERTICAL LENGTH OF THE )NCREASED INTERMOLAR AND INTERPREMOLAR MAXILLARY AND MANDIBULAR INCISORS TO ERUPT LOWER LIP THIS MAY CAUSE RETROCLINATION OF ANGLE IN A MORE RETROCLINED POSITION THE MANDIBULAR INCISORS OR IF A HIGH LOWER ! REDUCED ANTERIOR LOWER FACIAL HEIGHT 0ATIENTS WITH A REDUCED ANTERIOR LIP POSITION IS ALSO PRESENT BIMAXILLARY LOWER FACE HEIGHT OFTEN DESCRIBED AS RETROCLINATION OF THE MAXILLARY AND 3OFT TISSUE SHORT FACE INDIVIDUALS MAY HAVE INCREASED MANDIBULAR INCISORS !N IMPORTANT AETIOLOGICAL FACTOR MENTALIS MUSCLE ACTIVITY 4HIS IS SOMETIMES )F THERE IS A FORWARD RESTING
*ULY!UGUST $ENTAL5PDATE /RTHODONTICS
2EMOVABLE !NTERIOR BITE PLANE OR CLIP OVER BITE PLANE WITH FIXED MALOCCLUSION THE DEEP OVERBITE IS OFTEN THE APPLIANCES APPLIANCES RESULT OF RETROCLINATION OF THE INCISOR TEETH $AHL APPLIANCE REMOVABLE 4HE MAXILLARY INCISOR CINGULUM PLATEAU IS OFTEN POORLY DEFINED 4HE MAXILLARY INCISORS &UNCTIONAL APPLIANCES "ITE PLANE EFFECT EG WITH ACTIVATOR TYPE APPLIANCES MAY ALSO HAVE A REDUCED CROWNROOT ANGLE SUCH AS THE -EDIUM /PENING !CTIVATOR COLLUM ANGLE )T IS IMPORTANT TO NOTE THAT A DEEP OVERBITE MAY BE PARTLY DUE TO OVER &IXED APPLIANCES 0RE ADJUSTED %DGEWISE 3TRAIGHT 7IRE APPLIANCE ERUPTED MAXILLARY INCISOR TEETH CONTINUOUS ARCH z #ONTINUOUS HEAVY FLAT ARCHWIRES EG X MECHANICS INCH STAINLESS STEEL z 4REATING ON A NON EXTRACTION BASIS IF POSSIBLE )NDICATIONS FOR TREATMENT z "ANDING SECOND MOLARS EARLY IN TREATMENT !NTERIOR DEEP BITE MAY OCCUR z 0LACING AN INCREASED CURVE IN THE UPPER ARCHWIRE IN THE PRIMARY DENTITION )F SO IT IS OFTEN AND A REVERSE CURVE OF 3PEE IN THE LOWER ARCHWIRE ASSOCIATED WITH A RELATIVELY SHORT ANTERIOR z X INCH PREFORMED COUNTERFORCE NICKEL LOWER FACE HEIGHT REDUCED MANDIBULAR TITANIUM ARCHWIRES PLANES ANGLE AND SQUARE GONIAL ANGLES 4HAT 4IP EDGE APPLIANCE IS AT THIS AGE IT IS PRIMARILY SKELETAL IN NATURE z !NCHOR BENDS )F THE PROBLEM IS TREATED IN THE PRIMARY ,INGUAL APPLIANCES DENTITION IT IS LIKELY TO RECUR WHEN THE ACTIVE $AHL APPLIANCE FIXED TREATMENT IS DISCONTINUED 4HEREFORE AT THIS STAGE OF DEVELOPMENT TREATMENT IS RARELY &IXED APPLIANCES INDICATED SEGMENTED ARCH 2ICKETTS UTILITY ARCH )N THE EARLY PERMANENT DENTITION MECHANICS "URSTONE INTRUSION ARCH A DEEP OVERBITE MAY NEED TO BE REDUCED IF CAUSING TRAUMA TO THE SOFT TISSUES PALATAL !UXILIARIES #LASS )) INTERMAXILLARY ELASTICS TO THE MAXILLARY INCISORS OR LABIAL TO THE &IXED BITE PLANES MANDIBULAR INCISORS )T IS IMPORTANT TO z 4URBO PROPS NOTE HOWEVER THAT TRAUMATIC OVERBITES z #OMPOSITE BITE PLANES DIRECT OR INDIRECT ARE ALMOST ALWAYS ASSOCIATED WITH POOR ORAL HYGIENE 4HE )NDEX OF /RTHODONTIC (EADGEAR 7EDGE EFFECT WITH DISTAL MOVEMENT 4REATMENT .EED )/4. IS CURRENTLY USED IN THE HOSPITAL SERVICE TO PRIORITIZE TREATMENT #ERVICAL PULL HEADGEAR TO MAXILLARY FIRST MOLARS BY CLASSIFYING MALOCCLUSIONS ACCORDING TO * HOOK HEADGEAR TO THE UPPER LABIAL SEGMENT TREATMENT NEED /NLY PATIENTS WITH A DEEP OVERBITE CAUSING PALATAL OR GINGIVAL TRAUMA !BSOLUTE ANCHORAGE )MPLANT ANCHORAGE FALL INTO THE TREATMENT NEED CATEGORY )/4. -ICRO SCREW ANCHORAGE F $EEP OVERBITE IS OFTEN /RTHOGNATHIC SURGERY -ANDIBULAR ADVANCEMENT TO POINT LANDING ASSOCIATED WITH AN INCREASED OVERJET $URING ORTHODONTIC TREATMENT AN INCREASED OVERJET 3EGMENTAL SURGERY ,OWER LABIAL SEGMENT SET DOWN OFTEN CANNOT BE ORTHODONTICALLY CORRECTED -ANDIBULOTOMY UNTIL THE OVERBITE HAS BEEN REDUCED 5PPER LABIAL SEGMENT IMPACTION 4ABLE !PPLIANCES AND TECHNIQUES FOR OVERBITE REDUCTION -ETHODS OF OVERBITE REDUCTION 4HE METHOD MOST SUITABLE FOR EACH PATIENT DEPENDS ON THE TREATMENT TONGUE POSITION ANDOR AN ADAPTIVE TONGUE #LASS )) MALOCCLUSION )N #LASS )) DIVISION OBJECTIVES WHICH INCLUDE THE ACHIEVEMENT TO LOWER LIP SWALLOW PATTERN OCCURS THE MALOCCLUSION WITH AN INCREASED OVERJET THE OF A STABLE END RESULT 4HE DENTAL OVERBITE MAY BE DEEP BUT JUST INCOMPLETE MANDIBULAR INCISORS ERUPT UNTIL THEY CONTACT MOVEMENTS REQUIRED TO REDUCE A DEEP TO THE PALATAL MUCOSA THE PALATAL MUCOSA UNLESS THERE IS A FORWARD ANTERIOR OVERBITE MAY INCLUDE ONE OR MORE RESTING TONGUE POSITION ANDOR AN ADAPTIVE OF THE FOLLOWING $ENTAL TONGUE TO LOWER LIP SWALLOW PATTERN AS 2ELATIVE INTRUSION OF THE INCISORS /VER ERUPTION OF THE DISCUSSED IN THE PREVIOUS SECTION !BSOLUTE INTRUSION OF THE INCISORS MANDIBULAR INCISORS OFTEN ACCOMPANIES A )N #LASS )) DIVISION 0ROCLINATION OF THE LABIAL SEGMENTS
$ENTAL5PDATE *ULY!UGUST /RTHODONTICS
&IGURE 4HE @.UDGER APPLIANCE &INGER SPRINGS &IGURE 4HE -EDIUM /PENING !CTIVATOR IN ADDITION TO HEADGEAR AID IN DISTALIZATION OF THE APPLIANCE &REE ERUPTION OF THE MANDIBULAR BUCCAL MAXILLARY FIRST MOLARS SEGMENTS REDUCES THE ANTERIOR OVERBITE
&IGURE 4HE ANTERIOR BITE PLANE WORKS BY ALLOWING ERUPTION OF THE POSTERIOR TEETH INCISORS AND MOLARS )T MUST BE EMPHASIZED INCREASES 4HE ADDITION OF COLD CURE ACRYLIC THAT IN MOST CASES THE PRE TREATMENT TO THE BITE PLANE ALLOWS FURTHER REDUCTION LABIO LINGUAL INCLINATION OF THE INCISORS OF THE OVERBITE DURING TREATMENT ! VERY MUST BE MAINTAINED FOR STABILITY 4HEREFORE USEFUL APPLIANCE IN A #LASS )) DEEP BITE CASE PROCLINATION OF THE INCISORS TO REDUCE AN IS THE 4EN (OEVE APPLIANCE ALSO KNOWN AS A 2ELATIVE INTRUSION OF THE INCISORS OVERBITE MAY ONLY BE USED IN SELECT CASES @.UDGER &IGURE 4HIS APPLIANCE USED IN 4HIS MAY BE ACHIEVED BY 4HE OTHER OPTION IS A COMBINATION WITH HEADGEAR COMBINES THE ERUPTION EXTRUSION OR UPRIGHTING DISTAL COMBINATION OF ORTHODONTICS AND BENEFITS OF AN ANTERIOR BITE PLANE WITH DISTAL TIPPING OF THE PREMOLAR AND MOLAR TEETH ORTHOGNATHIC SURGERY IN ORDER TO REDUCE A MOVEMENT OF THE UPPER FIRST MOLARS TO AID 6ERTICAL FACIAL GROWTH IS REQUIRED IF THE DEEP OVERBITE SURGICALLY IN #LASS )) CORRECTION AND BITE OPENING OVERBITE REDUCTION ACHIEVED IN THIS WAY IS TO REMAIN STABLE -OLAR AND PREMOLAR EXTRUSION MAY EITHER BE PASSIVE EG USING AN ANTERIOR !PPLIANCES AND TECHNIQUES FOR &UNCTIONAL APPLIANCES BITE PLANE OR ACTIVE EG USING VERTICAL OVERBITE REDUCTION 4ABLE 4HESE APPLIANCES ARE PRIMARILY ELASTICS ON FIXED APPLIANCES INDICATED FOR CORRECTION OF ANTERO POSTERIOR 2EMOVABLE APPLIANCES ARCH DISCREPANCIES IN GROWING PATIENTS !NTERIOR BITE PLANE (OWEVER CAPPING OF THE MANDIBULAR !BSOLUTE INTRUSION OF THE INCISORS 4HIS MAY BE USED ON A SIMPLE INCISORS REDUCES MANDIBULAR INCISOR 4HIS CAN BE DIFFICULT TO ACHIEVE UPPER REMOVABLE APPLIANCE AS A PRELIMINARY ERUPTION WHILE PERMITTING BUCCAL SEGMENT AND REQUIRES COMPLEX ORTHODONTIC STAGE OF TREATMENT AND IS IDEALLY FITTED IN A TOOTH ERUPTION THE BITE PLANE EFFECT MECHANICS 4HE MECHANICS TEND TO PIT GROWING PATIENT AS THE PERMANENT DENTITION &IGURE THEREBY FLATTENING AN INCREASED INCISOR INTRUSION AGAINST MOLAR EXTRUSION IS ESTABLISHING #LIP OVER ANTERIOR BITE PLANES CURVE OF 3PEE AND REDUCING A DEEP THEREBY INEVITABLY LEADING TO SOME 0LINT CLIP MAY ALSO BE USED WITH UPPER AND OVERBITE &URTHERMORE THE USE OF FUNCTIONAL EXTRUSION OF THE BUCCAL SEGMENTS AS WELL AS LOWER FIXED APPLIANCES GIVING CLEARANCE APPLIANCES CAUSES AN INCREASE IN THE INCISOR INTRUSION 4HE ONLY WAY TO ACHIEVE FOR PLACEMENT OF LOWER ANTERIOR BRACKETS IN ANTERIOR LOWER FACE HEIGHT TRUE INTRUSION OF INCISORS SOLELY IS WITH THE #LASS )) DIVISION DEEP BITE CASES /VERBITE USE OF IMPLANTS OR BONE SCREWS ABSOLUTE REDUCTION OCCURS BY PREVENTING ERUPTION OF &IXED APPLIANCES CONTINUOUS ARCH MECHANICS ANCHORAGE THE MANDIBULAR INCISOR TEETH BUT ALLOWING ERUPTION OF THE POSTERIOR TEETH &IGURE 0RE ADJUSTED %DGEWISE 3TRAIGHT 7IRE APPLIANCE #ONTINUOUS ARCHWIRES n HEAVY FLAT 0ROCLINATION OF THE LABIAL SEGMENTS 4HE ANTERIOR LOWER FACE HEIGHT ALSO /VERBITE DEPTH REDUCES AS THE INCISOR TEETH ARE PROCLINED ! USEFUL TWO DIMENSIONAL GEOMETRIC MODEL HAS BEEN DESCRIBED STATING THAT THERE IS APPROXIMATELY MM CHANGE IN OVERBITE FOR EVERY DEGREE OF INCISAL ANGULAR CHANGE EG DEGREES PROCLINATION LEADS TO MM REDUCTION IN OVERBITE )N CLINICAL PRACTICE THE ACTUAL CHANGE IN OVERBITE DEPTH CANNOT BE ACCURATELY PREDICTED BY THIS METHOD ALONE OWING TO OTHER CONTRIBUTORY FACTORS NOTABLY THE INTRUSION OR EXTRUSION OF THE &IGURE "ANDING THE MANDIBULAR SECOND MOLARS TO AID IN ARCH LEVELLING
$ENTAL5PDATE *ULY!UGUST /RTHODONTICS
AB@ROCKING CHAIR ARCHWIRES IS THAT THEY CAN CAUSE DISTORTION OF THE ARCHFORM IF USED FOR EXTENDED PERIODS 4HEREFORE THEIR USE REQUIRES CLOSE SUPERVISION
4IP EDGE APPLIANCE 3O CALLED @ANCHOR OR @ANCHORAGE BENDS USED IN THE FIRST STAGE OF THE 4IP EDGE APPLIANCE SYSTEM ARE EXTREMELY USEFUL IN &IGURE A )F THE CANINE TEETH ARE DISTALLY ANGULATED ENGAGEMENT OF THE INCISOR BRACKETS WITH THE OVERBITE REDUCTION &IGURE !N INTRUSIVE INITIAL ARCHWIRE RED DOTTED LINE WILL EXTRUDE THE INCISORS B 4HE ARCH WILL LEVEL AS THE CANINE ANGULATION FORCE IS APPLIED TO THE LABIAL SEGMENTS IS CORRECTED AND AN EXTRUSIVE FORCE TO THE MOLARS 4HE PREMOLAR TEETH ARE NOT INCORPORATED AT THIS STAGE OF TREATMENT 4HEREFORE THE PARTICULARLY DISTALLY ANGULATED MAXILLARY ARCHWIRE ACTS AS A LEVER ARM ALLOWING CANINES WILL CAUSE THE INITIAL ARCHWIRES LIGHT FORCES TO BE USED OVER A RELATIVELY TO EXTRUDE THE INCISORS &IGURE A !S THE LONG RANGE 4HE ARCHWIRE OF CHOICE IS A ANGULATION OR TIP IS EXPRESSED THE INCISORS INCH ROUND HIGH TENSILE STAINLESS WILL REINTRUDE AND THE ARCH WILL LEVEL &IGURE STEEL ARCHWIRE 4HE USE OF #LASS )) ELASTICS B 4HIS IS KNOWN AS VERTICAL @ROUND TRIPPING IN THE 4IP EDGE SYSTEM GREATLY FACILITATES 4O COUNTER THIS PHENOMENON IT IS POSSIBLE THE BITE OPENING EFFECT OF THE ANCHOR TO USE REDUCED TIP MAXILLARY CANINE BRACKETS BENDS OR TO BY PASS THE INCISORS INITIALLY IN PATIENTS &IGURE #OUNTERFORCE NICKEL TITANIUM ARCHWIRES WITH VERY DISTALLY ANGULATED CANINE TEETH ,INGUAL APPLIANCE 0LACING CURVES IN ARCHWIRES n IT IS POSSIBLE 4HE BRACKETS IN THIS APPLIANCE TO SWEEP A REVERSE CURVE OF 3PEE INTO SYSTEM ARE BONDED TO THE LINGUAL ASPECT A LOWER STAINLESS STEEL ARCHWIRE AND AN OF THE TEETH MAKING THE APPLIANCE EXAGGERATED CURVE IN AN UPPER ARCHWIRE MORE AESTHETIC THAN CONVENTIONAL FIXED 4HIS ALLOWS EXTRUSION OF THE BUCCAL APPLIANCES 4HE ANTERIOR BRACKETS MAY SEGMENTS ESPECIALLY THE PREMOLARS AND HAVE A FLAT SURFACE THAT OCCLUDES WITH THE SOME INTRUSION OF THE LABIAL SEGMENTS &IGURE 4HE USE OF @ANCHOR BENDS IN THE 4IP MANDIBULAR INCISORS ACTING AS AN ANTERIOR (OWEVER AS THE AREA OF FORCE APPLICATION EDGE APPLIANCE PLACES AN INTRUSIVE FORCE ON THE BITE PLANE IN DEEP BITE CASES &IGURE IN THE BRACKETS IS ANTERIOR TO THE CENTRE OF INCISOR AND CANINE TEETH 4HE ANCHOR BENDS MAY A 4HE POINT OF FORCE APPLICATION IS ALSO RESISTANCE OF THE MANDIBULAR INCISORS THERE BE SEEN IN THE ARCHWIRES JUST MESIAL TO THE FIRST DIFFERENT FROM CONVENTIONAL APPLIANCES MOLAR BANDS WILL BE AN OFTEN UNWANTED TENDENCY FOR !N INTRUSIVE FORCE DIRECTED THROUGH A PROCLINATION OF THESE TEETH LINGUAL BRACKET IN A NORMALLY INCLINED #OUNTERFORCE .I4I ARCHWIRES n THESE TOOTH WILL PASS CLOSER TO BOTH THE CENTRE RECTANGULAR NICKEL TITANIUM ARCHWIRES HAVE STAINLESS STEEL ARCHWIRES MAY BE USED TO OF RESISTANCE AND THE LONG AXIS OF THE BUILT IN PRONOUNCED CURVES OF 3PEE &IGURE LEVEL THE OCCLUSAL PLANE BY A COMBINATION TOOTH THEREBY THEORETICALLY PRODUCING 4HE DISADVANTAGE WITH THESE SO CALLED OF MAINLY EXTRUSION OF POSTERIOR TEETH AND INTRUSION WITH LESS PROCLINATION THAN TO A LESSER EXTENT INTRUSION OF ANTERIOR TEETH LABIALLY POSITIONED BRACKETS &IGURE B 4HE INCORPORATION OF THE SECOND MOLAR TEETH EARLY IN TREATMENT WILL AID IN ARCH AB LEVELLING BUT CARE MUST BE TAKEN TO KEEP THE TUBES RELATIVELY OCCLUSALLY POSITIONED ON THE MOLAR TEETH FOR THE MAXIMUM MECHANICAL ADVANTAGE &IGURE 4HIS ALLOWS FOR EXTRUSION OF THE FIRST MOLARS AND PREMOLARS AS WELL AS AIDING INCISOR INTRUSION 3OME PATIENCE ON THE PART OF THE OPERATOR IS REQUIRED IN ALLOWING ADEQUATE TIME FOR LEVELLING TO OCCUR 7HEN USING PRE ADJUSTED EDGEWISE BRACKET SYSTEMS IT IS ALSO &IGURE A ,INGUAL BRACKETS WITH RED ARROWS AND WITHOUT BITE PLANES B $IAGRAM TO ILLUSTRATE THE RELATIONSHIP BETWEEN AN INTRUSIVE FORCE TO THE CENTRE OF RESISTANCE AND LONG AXIS OF A TOOTH "LUE LINGUAL IMPORTANT TO REMEMBER THAT THE ANGULATION FORCE 'REEN LABIAL FORCE TIP BUILT INTO THE CANINE BRACKETS *ULY!UGUST $ENTAL5PDATE /RTHODONTICS
DISTORTION DURING MASTICATION 4O REDUCE ANY 4URBO PROPS AND COMPOSITE BITE PLANES EXTRUSION OF THE MOLAR TEETH DOUBLE BUCCAL 4URBO PROPS ALSO KNOWN AS BITE TUBES ARE USED ON THE FIRST MOLAR BANDS IN TURBOS ARE BONDED TO THE PALATAL ASPECT ORDER TO ALLOW USE OF A SECTIONAL ARCHWIRE OF THE MAXILLARY INCISORS 4HEY HAVE A BITE LINKING THE BUCCAL SEGMENTS AS WELL AS THE PLANE INCORPORATED &IGURE 4HESE AS UTILITY ARCH )N ORDER TO LIMIT PROCLINATION OF WELL AS COMPOSITE BITE PLANES MAY BE USED THE MANDIBULAR INCISOR TEETH LINGUAL CROWN WITH CONVENTIONAL FIXED APPLIANCES GIVING &IGURE 2ICKETTS UTILITY ARCH TORQUE MUST BE BUILT INTO THE RECTANGULAR THE ADVANTAGE OF ALLOWING THE PLACEMENT OF ARCHWIRES USED /NCE THE OVERBITE HAS BEEN UPPER AND LOWER FIXED APPLIANCES FROM THE REDUCED THE CANINES ARE PROGRESSIVELY START OF TREATMENT #OMPOSITE BITE PLANES LIGATED TO THE ARCHWIRE AND THEREBY MAY BE MADE INDIRECTLY INTRUDED
(EADGEAR "URSTONE INTRUSION ARCH 4HE DIRECTION OF PULL OF THE 4HIS APPLIANCE HAS BEEN SAID TO HEADGEAR LARGELY DEPENDS ON THE PATIENTS PRODUCE FOUR TIMES MORE INCISOR INTRUSION FACIAL GROWTH PATTERN ! COMBINATION PULL &IGURE "URSTONE INTRUSION ARCH THAN MOLAR EXTRUSION AND IS THEREFORE HEADGEAR OR AN )NTERLANDI TYPE HEADGEAR CLAIMED TO BE THE APPLIANCE OF CHOICE MAY BE USED TO PROVIDE STRAIGHTFORWARD IN ADULT PATIENTS WHERE AN INCREASE IN DISTAL MOVEMENT OF THE MAXILLARY MOLAR FACE HEIGHT IS NOT DESIRED &IGURE TEETH CAUSING THE ANTERIOR BITE TO OPEN 4HE ANTERIOR CANINE TO CANINE REGION IS 4HIS IS CALLED THE @WEDGE EFFECT AS THE MOLAR ALIGNED SEGMENTALLY 4HE POSTERIOR MOLAR IS MOVED DISTALLY AND THEREFORE CLOSER AND PREMOLAR TEETH ARE ALSO ALIGNED AS A TO THE CONDYLAR HINGE AXIS #ERVICAL PULL SEGMENT AND RECTANGULAR ARCHWIRES AS HEADGEAR HAS AN ADDITIONAL EXTRUSIVE FORCE WELL AS RIGID PALATAL AND LINGUAL ARCHES ARE ON THE MAXILLARY MOLARS AND IS THEREFORE PLACED PROVIDING STABLE POSTERIOR VERTICAL IDEAL FOR USE IN LOW ANGLE DEEP BITE #LASS )) &IGURE 4URBO PROPS BITE TURBOS ARE BONDED TO ANCHOR UNITS 4HE ACCESSORY ARCHWIRE IS MALOCCLUSION )N CASES WHERE THE MAXILLARY THE PALATAL ASPECT OF THE MAXILLARY INCISORS VERTICALLY ACTIVATED FOR LABIAL SEGMENT INCISORS HAVE OVER ERUPTED A * HOOK INTRUSION BY PLACING TIP BACK BENDS MESIAL HEADGEAR MAY BE ATTACHED TO THE ANTERIOR TO THE MOLAR TUBES )T IS PLACED IN THE ASPECT OF THE MAXILLARY ARCHWIRE TO PROVIDE ADDITIONAL BUCCAL TUBES ON THE FIRST MOLAR AN INTRUSIVE FORCE 4HIS HAS THE BENEFIT $AHL APPLIANCE TEETH AND LIGATED TO THE CANINE REGION OF OF HELPING TO REDUCE EXCESSIVE GINGIVAL 7ORKS ALONG THE SAME PRINCIPLE THE ANTERIOR SEGMENT ARCHWIRE EXPOSURE HOWEVER THERE ARE NO SAFETY AS THE ANTERIOR BITE PLANE AND IS OFTEN FEATURES WITH THIS TYPE OF HEADGEAR AND IT USED TO GIVE OCCLUSAL CLEARANCE FOR ANTERIOR MAY ALSO PLACE UNDESIRABLY HIGH INTRUSIVE !UXILIARIES RESTORATIONS IN PROSTHODONTICS FORCES ON THE MAXILLARY INCISOR TEETH #LASS )) INTERMAXILLARY ELASTICS 4HESE ARE USED BILATERALLY &IXED APPLIANCES SEGMENTED ARCH MECHANICS FROM THE ANTERIOR MAXILLARY DENTAL ARCH !BSOLUTE ANCHORAGE ! RECENT SYSTEMATIC REVIEW TO THE MANDIBULAR FIRST MOLAR TEETH !BSOLUTE VERTICAL ANCHORAGE MAY AND META ANALYSIS OF TRUE INCISOR INTRUSION 4HEY ARE USED IN THE CORRECTION OF #LASS BE USED TO PRODUCE TRUE INTRUSION OF INCISOR ATTAINED DURING ORTHODONTIC TREATMENT )) MALOCCLUSION AND THE REDUCTION OF TEETH )F RIGID ENDOSSEOUS DENTAL IMPLANTS CONCLUDED THAT IN NON GROWING PATIENTS OVERJET !N OFTEN UNWANTED EFFECT IS THE HAVE BEEN PLACED FOR FUTURE RESTORATION OF MM OF TRUE MAXILLARY INCISOR INTRUSION RESULTANT VERTICAL FORCES ON THE MANDIBULAR MISSING TEETH THEY CAN BE INCORPORATED INTO AND MM OF TRUE MANDIBULAR INCISOR MOLAR TEETH (OWEVER IN LOW ANGLE A FIXED APPLIANCE TO ALLOW INTRUSIVE FORCES TO INTRUSION WAS ATTAINABLE WITH THE DEEP BITE MALOCCLUSION THE EXTRUSION BE PLACED ON SURROUNDING TEETH (OWEVER SEGMENTED ARCH TECHNIQUE OF THE MANDIBULAR MOLARS IS BENEFICIAL THESE IMPLANTS CANNOT BE PLACED UNTIL THE IN HELPING TO REDUCE THE ANTERIOR DEEP END OF ACTIVE FACIAL GROWTH 4HEY ALSO NEED 2ICKETTS UTILITY ARCH BITE !N INCREASED CURVE MAY BE PLACED TO BE PLACED IN EXACTLY THE CORRECT POSITION 4HIS TECHNIQUE IS VERY VALUABLE IN THE UPPER ARCHWIRE TO HELP REDUCE THE FOR THE PLACEMENT OF FUTURE PROSTHESES IN ALLOWING TRUE INTRUSION OF THE INCISOR UNWANTED MAXILLARY INCISOR EXTRUSION FROM 4HEREFORE THEIR USE IS RESTRICTED TO SKELETALLY SEGMENT 4HE @UTILITY ARCHWIRE ONLY ENGAGES THE ELASTIC FORCE (OWEVER THE NET EFFECT OF MATURE ADULT PATIENTS AND REQUIRES VERY THE MOLAR AND INCISOR TEETH &IGURE )T #LASS )) ELASTICS WILL BE OVERBITE REDUCTION PRECISE JOINT PLANNING BETWEEN THE IS STEPPED AWAY FROM THE BUCCAL SEGMENT AS THE MANDIBULAR MOLARS ARE CLOSER TO ORTHODONTIST AND PROSTHODONTIST TEETH ALLOWING BETTER LOAD DEFLECTION THE CONDYLAR HINGE AXIS THAN THE MAXILLARY -ICRO SCREW ANCHORAGE ON THE PROPERTIES AND REDUCED RISK OF ARCHWIRE INCISORS OTHER HAND HAS A NUMBER OF ADVANTAGES
$ENTAL5PDATE *ULY!UGUST /RTHODONTICS
AB C
&IGURE -ICROSCREW ANCHORAGE ! MICROSCREW PLACED IN THE MAXILLARY LEFT FIRST PREMOLAR REGION IS USED TO PROVIDE ABSOLUTE ANCHORAGE TO INTRUDE THE OVER ERUPTED MAXILLARY CANINE AND INCISORS A PRE TREATMENT B START OF TREATMENT C END OF TREATMENT
OVER DENTAL IMPLANTS IN THAT THEY ARE EASIER ADVANTAGE THAT NO INCREASE IN ARCH LENGTH TO PLACE CAUSE MINIMAL PATIENT TRAUMA AND IS REQUIRED (OWEVER CARE MUST BE TAKEN MAY BE LOADED IMMEDIATELY /WING TO TO DIVERGE THE ROOTS OF THE TEETH WHERE THE THEIR SMALL SIZE THEY MAY BE INSERTED INTO A SURGICAL CUTS ARE TO BE MADE )F THE ANTERIOR NUMBER OF LOCATIONS ALLOWING FORCES TO BE LOWER FACE HEIGHT IS TO BE MAINTAINED A USED IN THE REQUIRED DIRECTIONS 3EGMENTS OF SUBAPICAL OSTEOTOMY IS UNDERTAKEN TO SET TEETH MAY THEREFORE BE INTRUDED &IGURE DOWN THE LOWER LABIAL SEGMENT &IGURE )F THE FACE HEIGHT IS TO BE INCREASED A SEGMENTAL OSTEOTOMY INCLUDING THE LOWER /RTHOGNATHIC SURGERY BORDER IS UNDERTAKEN OFTEN REFERRED TO AS A 0ATIENTS WITH A #LASS )) DIVISION MANDIBULOTOMY &IGURE &IGURE ,OWER LABIAL SEGMENT SUBAPICAL MALOCCLUSION OFTEN HAVE AN EXCESSIVE !N ANTERIOR SUBAPICAL MAXILLARY SETDOWN OSTEOTOMY CURVE OF 3PEE )N PATIENTS WITH SHORT FACES SEGMENTAL OSTEOTOMY MAY BE UNDERTAKEN WHERE AN INCREASE IN THE ANTERIOR LOWER TO REPOSITION THE UPPER LABIAL SEGMENT FACE HEIGHT IS DESIRED THE CURVE OF 3PEE SUPERIORLY PARTICULARLY IN CASES OF ANTERIOR MUST BE MAINTAINED PRIOR TO SURGERY BY VERTICAL MAXILLARY EXCESS PLACING AN INCREASED CURVE OF 3PEE IN THE MANDIBULAR ARCHWIRES 7HEN THE MANDIBLE IS ADVANCED AT SURGERY THERE WILL BE A THREE #ONSERVATIVE MANAGEMENT POINT CONTACT WITH THE MAXILLARY ARCH IN THE 3OME OLDER PATIENTS PRESENTING INCISOR REGION AND BILATERALLY IN THE TERMINAL WITH DEEP OVERBITES AND RECURRENT PALATAL MOLAR REGION 4HIS IS KNOWN AS A THREE POINT TRAUMA MAY NOT BE GOOD CANDIDATES FOR LANDING 4HE LOWER ARCH IS THEN LEVELLED ORTHODONTICS OR ORTHOGNATHIC SURGERY 4HESE POST SURGERY BY EXTRUSION OF THE PREMOLARS PATIENTS MAY BE MANAGED CONSERVATIVELY &IGURE -ANDIBULOTOMY )T IS IMPORTANT TO NOTE THAT ADDITIONAL ARCH BY IMPROVEMENT OF THEIR ORAL HYGIENE LENGTH IS REQUIRED FOR POST SURGICAL LEVELLING PARTICULARLY PALATAL TO THE MAXILLARY INCISORS 4HIS MAY BE OBTAINED BY EITHER MAINTAINING AND POSSIBLY THE PROVISION OF A BASEPLATE SOME SPACE IN THE LOWER ARCH PRE SURGERY OR WHICH THEY CAN WEAR AS NEEDED USUALLY AT ALLOWING FOR SOME PROCLINATION OF THE LOWER NIGHT INCISORS POST SURGERY #ONSIDERATIONS IN TREATMENT 3EGMENTAL SURGERY PLANNING 4HIS MAY BE CONSIDERED FOR ADULT PATIENTS WHERE LEVELLING THE CURVE OF 3PEE !GE BY ORTHODONTIC MECHANICS IS NOT ACHIEVABLE ! PATIENT WITH A DEEP TRAUMATIC )N CASES WHERE A NATURAL STEP EXISTS IN THE OVERBITE IS BEST TREATED WHILE STILL GROWING MANDIBULAR ARCH THE ARCH MAY BE ALIGNED WHEN CORRECTION MAY BE RELATIVELY AND LEVELLED IN SEGMENTS USUALLY WITH AN STRAIGHTFORWARD AND BEFORE ANY LONG &IGURE )NCISOR EDGE CENTROID RELATIONSHIP 4HE ANTERIOR SEGMENT FROM CANINE TO CANINE TERM PERIODONTAL DAMAGE OCCURS 'ROWTH DOT IN THE MAXILLARY INCISOR ROOT IS THE CENTROID AND TWO POSTERIOR SEGMENTS 4HE ARCH MAY MODIFICATION USING VARIOUS FUNCTIONAL CENTRE OF RESISTANCE THEN BE LEVELLED SURGICALLY 4HIS HAS THE APPLIANCES WITH CAPPING OF THE MANDIBULAR
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INCISORS OR A SIMPLE UPPER REMOVABLE OVERBITE THAT WILL PREVENT RELAPSE AT THE END TEETH SHOULD ALSO BE MAINTAINED WITHIN THE APPLIANCE WITH AN ANTERIOR BITE PLANE MAY OF TREATMENT ZONE OF SOFT TISSUE EQUILIBRIUM BETWEEN THE BE USED MUSCULATURE OF THE TONGUE AND THE LIPS )N NON GROWING PATIENTS ANY !N INTERESTING PROPOSITION IS THAT IN #LASS )) 6ERTICAL SKELETAL DISCREPANCY EXTRUSION OF THE BUCCAL SEGMENTS TENDS TO DIVISION MALOCCLUSIONS IT MAY BE POSSIBLE 3HORT FACE LOW ANGLE CASES IN GROWING BE UNSTABLE AS A RESULT OF STRETCHING OF THE TO INTRUDE AND TORQUE THE MAXILLARY INCISOR PATIENTS ATTEMPT TO ENCOURAGE EXTRUSION PTERYGO MASSETERIC SLING 4HEREFORE TRUE ROOTS PALATALLY ALLOWING THE MANDIBULAR OF THE BUCCAL SEGMENTS USING ANTERIOR INTRUSION OF THE INCISOR TEETH IS REQUIRED INCISOR CROWNS TO BE PROCLINED AND HENCE BITE PLANES FUNCTIONAL APPLIANCES CERVICAL AND POSSIBLY SURGICAL CORRECTION USING A OCCUPY THE POSITION PREVIOUSLY OCCUPIED PULL HEADGEAR OR THE 4IP EDGE APPLIANCE )N COMBINED ORTHODONTIC AND ORTHOGNATHIC BY THE MAXILLARY INCISOR CROWNS THUS THIS WAY THE INCREASE IN ANTERIOR LOWER FACE APPROACH MAINTAINING THE INCISOR COMPLEX WITHIN THE HEIGHT WILL IMPROVE THE FACIAL PROFILE AS WELL ZONE OF SOFT TISSUE EQUILIBRIUM AS HELPING TO REDUCE THE OVERBITE !VOID CHANGE IN INTERMAXILLARY HEIGHT 5PPER LIP TO MAXILLARY INCISOR RELATIONSHIP ,ONG FACE HIGH ANGLE CASES WITH DEEP IN NON GROWING PATIENTS 4HE EXTRUSION OF 4HE AMOUNT OF MAXILLARY INCISOR BITE IT IS IMPORTANT TO AVOID EXTRUSIVE MOLARS IN NON GROWING PATIENTS IS UNSTABLE EXPOSURE IN RELATION TO THE UPPER LIP AT MECHANICS TO THE POSTERIOR TEETH IN ORDER TO AS THE MUSCULAR FORCES FROM THE PTERYGO REST SHOULD BE ABOUT n MM )N PATIENTS AVOID ANY FURTHER INCREASE IN FACE HEIGHT MASSETERIC SLING WILL RE INTRUDE THE MOLARS WITH REDUCED INCISOR SHOW AT REST IT MAY IF THE POSTERIOR VERTICAL FACE HEIGHT HAS NOT BE PRUDENT TO INTRUDE THE MANDIBULAR ACCOMMODATED THEIR EXTRUSION INCISORS RATHER THAN THE MAXILLARY IN ORDER 3TABILITY OF OVERBITE CORRECTION 0ROCLINATION OF THE LOWER LABIAL SEGMENT TO PREVENT AN AGED APPEARANCE TO THE 4HE STABILITY OF OVERBITE IN #LASS )) CASES MAY STILL BE UNSTABLE SMILE #ONVERSELY IN PATIENTS WITH INCREASED REDUCTION DEPENDS ON A NUMBER OF FACTORS LONG TERM OWING TO PRESSURE FROM THE GINGIVAL EXPOSURE @GUMMY SMILE IT IS WHICH MUST BE TAKEN INTO ACCOUNT FROM THE LOWER LIP 4HEREFORE LONG TERM RETENTION BETTER TO INTRUDE THE MAXILLARY INCISORS TREATMENT PLANNING STAGE MAY BE REQUIRED IN SUCH CASES AND MUST 'OOD INTER INCISAL ANGLE n THE INTER INCISAL BE DISCUSSED WITH THE PATIENT PRIOR TO ANGLE MUST BE CORRECTED AVERAGE )NCISOR RELATIONSHIP TREATMENT DEGREES IN ADDITION TO THE OVERBITE BEING #LASS )) DIVISION MALOCCLUSION A 6ERTICAL FACIAL GROWTH CONTINUES WELL REDUCED IN ORDER TO PREVENT RE ERUPTION OF SIGNIFICANT #LASS )) SKELETAL PATTERN INTO THE LATE TEENAGE YEARS !S THE PATTERN THE INCISORS POST TREATMENT DEPENDING ON AGE REQUIRES GROWTH OF FACIAL GROWTH DOES NOT TEND TO CHANGE #ORRECT MANDIBULAR INCISOR EDGE CENTROID MODIFICATION OR MANDIBULAR ADVANCEMENT FOLLOWING TREATMENT IT IS PRUDENT TO PLACE RELATIONSHIP n POSSIBLY THE MOST IMPORTANT SURGERY (OWEVER IF THE #LASS )) DIVISION A BITE PLANE ON THE MAXILLARY REMOVABLE FACTOR IN OVERBITE STABILITY IN ALL TREATED INCISOR RELATIONSHIP IS ON A #LASS ) OR MILD RETAINER AFTER THE COMPLETION OF ORTHODONTIC CASES IS CORRECTION OF THE RELATIONSHIP #LASS )) SKELETAL PATTERN THEN TREATMENT WILL TREATMENT 4HIS MAY BE WORN ON A PART TIME BETWEEN THE MANDIBULAR INCISOR EDGE AND INVOLVE ORTHODONTIC MECHANICS TO CORRECT BASIS IN ORDER TO MAINTAIN THE CORRECTED THE MAXILLARY INCISOR ROOT CENTROID &IGURE THE INCLINATIONS AND VERTICAL POSITION OF THE OVERBITE UNTIL VERTICAL FACIAL GROWTH HAS 4HIS IS MEASURED AS THE DISTANCE INCISOR TEETH SUBSIDED BETWEEN THE PERPENDICULAR PROJECTIONS #LASS )) DIVISION MALOCCLUSION IF THE OF THESE TWO POINTS ON THE MAXILLARY SKELETAL PATTERN IS #LASS ) OR MILD #LASS )) PLANE MM 4HIS MAY BE ACHIEVED BY AS IS OFTEN THE CASE TREATMENT WILL CENTRE #ONCLUSION EITHER RETRACTION OF THE MAXILLARY INCISOR ON LEVELLING THE LOWER ARCH AND INTRUSION 7HEN FACED WITH THE CORRECTION ROOT CENTROID USING FIXED APPLIANCES WITH AND PALATAL ROOT TORQUE OF THE MAXILLARY OF AN ANTERIOR DEEP OVERBITE THE CLINICIAN PALATAL ROOT TORQUE OR PROCLINATION OF INCISORS )F THE SKELETAL PATTERN IS A MODERATE MUST FOLLOW A THOROUGH DIAGNOSTIC PROCESS THE MANDIBULAR INCISORS TO ADVANCE THEIR TO SEVERE #LASS )) THE INCISOR RELATIONSHIP WHICH MUST BE WORKED THROUGH IN ORDER EDGES 4HE DECISION DEPENDS ON A NUMBER MAY BE CONVERTED TO A #LASS )) DIVISION TO REACH THE CORRECT TREATMENT GOAL 4HE OF FACTORS INCLUDING THE FACIAL PROFILE MALOCCLUSION BY PROCLINING THE UPPER LABIAL PATIENTS AGE PATTERN OF FACIAL GROWTH AND GROWTH POTENTIAL )F A PATIENT HAS A SEGMENT AND THEN DEPENDING ON AGE TYPE OF MALOCCLUSION AND THE RESPECTIVE RETROGNATHIC MANDIBLE IT IS POSSIBLE TO REQUIRES GROWTH MODIFICATION OR SURGERY CLINICIANS SKILL ARE ALL FACTORS THAT MUST BE PROCLINE THE MAXILLARY INCISORS AND EITHER #LASS ))) MALOCCLUSION SUFFICIENT OVERBITE TAKEN INTO ACCOUNT +NOWLEDGE OF THE SKILLS TO ADVANCE THE MANDIBLE SURGICALLY OR IS REQUIRED AT THE END OF TREATMENT TO OF THE ORTHODONTISTS PROSTHODONTIC AND IN A GROWING PATIENT TO USE A FUNCTIONAL MAINTAIN A STABLE INCISOR RELATIONSHIP SURGICAL COLLEAGUES IS ALSO VITAL IF PATIENTS APPLIANCE TO HELP ADVANCE THE MANDIBULAR %XAMPLES INCLUDE COMPENSATING FOR AN ARE TO RECEIVE OPTIMUM TREATMENT INCISORS )N A PATIENT WITH GOOD FACIAL UNDERLYING MILD #LASS ))) MALOCCLUSION BY BALANCE THE TREATMENT MAY BE CARRIED OUT RETROCLINING THE MANDIBULAR INCISORS AND WITH FIXED APPLIANCES ALONE SO LONG AS THE 2EFERENCES PROCLINING THE MAXILLARY INCISORS AND ALSO PALATAL ALVEOLAR PROCESS IS THICK ENOUGH "JORK ! &ACIAL GROWTH IN MAN STUDIED IN CASES WHERE A MAXILLARY INCISOR IS TO TO ALLOW RETRACTION OF THE MAXILLARY INCISOR WITH THE AID OF METALLIC IMPLANTS !CTA BE MOVED LABIALLY TO CORRECT AN ANTERIOR ROOT CENTROID 4HE CROWNS OF THE INCISOR /DONTOL 3CAND n CROSSBITE )T IS THE PRESENCE OF A POSITIVE
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"JORK ! 0REDICTION OF MANDIBULAR TREATMENT A SYSTEMATIC REVIEW AND 3CHUDY && 4HE CONTROL OF VERTICAL GROWTH ROTATION !M * /RTHOD META ANALYSIS !M * /RTHOD $ENTOFACIAL OVERBITE IN CLINICAL ORTHODONTICS !NGLE n /RTHOP n /RTHOD n %BERHART "" +UFTINEC -- "AKER )- 4HE 2ICKETTS 27 "IOPROGRESSIVE 4HERAPY (OUSTON 7*" )NCISOR EDGE CENTROID RELATIONSHIP BETWEEN BITE DEPTH AND $ENVER 2OCKY -OUNTAIN /RTHODONTICS RELATIONSHIPS AND OVERBITE DEPTH %UR * INCISOR ANGULAR CHANGE !NGLE /RTHOD /RTHOD n n "URSTONE #* $EEP OVERBITE CORRECTION 0ROFFIT 72 %QUILIBRIUM THEORY REVISITED #ETLIN .- 4EN (OEVE ! .ONEXTRACTION BY INTRUSION !M * /RTHOD !NGLE /RTHOD n TREATMENT * #LIN /RTHOD n 3ELWYN "ARNETT "* #LASS )) DIVISION n 0HILIPPE * 4REATMENT OF DEEP BITE WITH MALOCCLUSION A METHOD OF PLANNING 3CUZZO ' 4AKEMOTO + "IOMECHANICS BONDED BITEPLANES * #LIN /RTHOD AND TREATMENT "R * /RTHOD AND COMPARATIVE BIOMECHANICS n n )N )NVISIBLE /RTHODONTICS 'ERMANY "AE 3- 0ARK (3 +YUNG (- +WON /7 -ILLS *2% 4HE STABILITY OF THE LOWER 1UINTESSENCE "OOKS PPn 3UNG *( #LINICAL APPLICATION OF MICRO LABIAL SEGMENT 4RANS "R 3OC 3TUDY $AHL ", +ROGSTAD / +ARLSEN + !N IMPLANT ANCHORAGE * #LIN /RTHOD /RTHOD n ALTERNATIVE TREATMENT IN CASES WITH n .ANDA 23 .ANDA 3+ #ONSIDERATIONS ADVANCED LOCALIZED ATTRITION * /RAL +OLE ( 3URGICAL OPERATIONS ON THE OF DENTOFACIAL GROWTH IN LONG TERM 2EHABIL n ALVEOLAR RIDGE TO CORRECT OCCLUSAL RETENTION AND STABILITY IS ACTIVE .G * -AJOR 07 &LORES -IR # 4RUE INCISOR ABNORMALITIES /RAL 3URG n RETENTION NEEDED !M * /RTHOD INTRUSION ATTAINED DURING ORTHODONTIC $ENTOFACIAL /RTHOP n
"OOK 2EVIEW 4REATMENT 0LANNING FOR THE $EVELOPING BOXES FOR THE UTMOST CLARITY 4REATMENT 0LANNING GUIDELINES OUTLINED WITHIN THIS BOOK SHOULD $ENTITION "Y (ELEN 2ODD AND !LYSON 7RAY FOR THE $EVELOPING $ENTITION REMAINS TRUE TO PROVE TO BE OF VALUE ,ONDON 1UINTESSENCE 0UBLISHING #O ,TD THE 1UINT%SSENTIALS FORMAT AND ADDITIONALLY 4REATMENT 0LANNING FOR THE PP a HB )3". PROVIDES SAMPLE SCENARIOS TO REINFORCE THE $EVELOPING $ENTITION WAS COMPOSED TO @EXPLAIN PRINCIPLES COVERED WITHIN ITS TEXT THE BASIC PRINCIPLES BEHIND GOOD DECISION 4REATMENT 0LANNING FOR THE 4HIS PARTICULAR VOLUME CONTAINS MAKING )T HAS DONE SO IN A BALANCED AND $EVELOPING $ENTITION IS A RECENT ADDITION SIX CHAPTERS THE FIRST VISIT AND INFORMATION INFORMATIVE MANNER WITHOUT UNDERVALUING TO THE 1UINT%SSENTIALS 0AEDIATRIC $ENTISTRY GATHERING INTERCEPTIVE ORTHODONTICS THE EXPERIENCE SO NECESSARY FOR A VERSATILE AND /RTHODONTICS SERIES 4HIS HARDBACK PUBLICATION PREVENTION THE RESTORATIVE PHASE MANAGEMENT EFFECTIVE CLINICIAN 4HIS PUBLICATION IS IDEAL FOR IS PAGES LONG CONTAINING COLOUR OF THE DENTAL EMERGENCY AND PATIENT RECALL THE UNDERGRADUATE DENTISTTHERAPIST OR GENERAL PHOTOGRAPHS RADIOGRAPHIC IMAGES AND #HAPTER ONE COVERS A BROAD RANGE DENTAL PRACTITIONER WISHING TO CONSOLIDATE TABLES AND DIAGRAMS )N TRUE 1UINT%SSENTIAL OF TOPICS RELATED TO @FIRST CONTACT AND PATIENT HISHER KNOWLEDGE AND PROMOTES AN STYLE THIS BOOK IS EASY ON THE EYE VERY @READABLE EXAMINATION #OMMONLY OVERLOOKED POINTS LIKE UNDERSTANDING IN PAEDIATRIC DENTAL TREATMENT AND YET REPLETE WITH CURRENT INFORMATION AND THE PRACTICE ENVIRONMENT AND FAMILY DYNAMICS PLANNING )T COMES HIGHLY RECOMMENDED PRACTICAL GUIDANCE ON ITS SUBJECT ARE INCLUDED ALONG WITH HISTORY EXAMINATION +RISTIAN 3 #OOMARASWAMY &ROM THE OUTSET 4REATMENT AND RISK ASSESSMENT "IRMINGHAM $ENTAL 3CHOOL 0LANNING FOR THE $EVELOPING $ENTITION 4HE SECOND CHAPTER ON INTERCEPTIVE ENDEAVOURS NOT TO LAY DOWN RIGID AND DETAILED ORTHODONTIC TREATMENT IS KEPT SIMPLE YET INSTRUCTION TO ENCOMPASS EVERY CLINICAL SCENARIO MANAGES TO ILLUSTRATE THE IMPORTANCE OF AND CONDITION )T INSTEAD WAS WRITTEN TO PROVIDE ORTHODONTIC TIMING AND INTERVENTION EFFECTIVELY A BASIC YET SOUND GUIDANCE TO PAEDIATRIC AND PROVIDES A BASIC SCREENING TOOL TO IDENTIFY DENTAL TREATMENT PLANNING WHICH IT HAS DONE DEVELOPING OCCLUSAL PROBLEMS 0REVENTION SUCCESSFULLY ,! ADMINISTRATION DENTAL RESTORATION AND &OR THOSE READERS UNACCUSTOMED PROSTHESES BLEACHING AND PULP THERAPY ARE TO THE STYLE OF THE VOLUMES WITHIN THE DISCUSSED IN SUBSEQUENT CHAPTERS 4REATMENT 1UINT%SSENTIALS SERIES EACH BOOK USES SHORT PRINCIPLES MATERIALSMEDICAMENTS AND MODES PARAGRAPHS BOLD TEXT BULLET POINTS FIGURES OF PATIENT DELIVERY ARE THOUGHTFULLY EXPLAINED AND TABLES TO CONVEY INFORMATION TO THE READER AND INTERRELATED CONCISELY YET EFFECTIVELY IN A VERY @DIGESTABLE 4HE FINAL CHAPTERS ENCOMPASS THE MANNER #HAPTERS ALL OUTLINE AN AIM LEARNING ASSESSMENT AND MANAGEMENT OF ACUTE DENTAL OUTCOMESOBJECTIVES AND INTRODUCTION CLOSING EMERGENCIES AND EXPLAIN A BASIS TO PAEDIATRIC WITH A LIST OF FURTHER RECOMMENDED READING RECALL SCHEDULES IN GENERAL DENTAL PRACTICE 4HE TO COMPLEMENT THE TEXT -OREOVER KEY POINTS APPROACH TO THESE AREAS IN PARTICULAR VARIES AND PRACTICAL TIPS ARE PRESENTED IN HIGHLIGHTED BETWEEN PRACTITIONERS THUS THE EVIDENCE BASED
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