Appliances in Presurgical Orthognathic Surgery-OrTHO / Orthodontic Courses by Indian Dental Academy

Appliances in Presurgical
Orthodontics
Leader in continuing dental education
www.indiandentalacademy.com
INDIAN DENTAL
ACADEMY
Introduction
Orthodontic treatment prior to and after surgical
correction of malocclusion is considered vital to
the stability of the achieved result
Pre surgical orthodontics helps the oral surgeon
to align the skeletal bases on the operating
table
Review
Bracket systems

First generation Andrews 1972

Second generation Ronald Roth 1980s

Third generation MBT 1990s
Slot dimension
.022 versus .018
The slot dimension preferred and widely used
by the orthodontist for a surgical case is .022
slot, the stability is better as it allows the use of
stiffer wires.
Friction /frictionless mechanics
Frictionless mechanics
Anterior segment
Vs posterior
segment
Friction mechanics
Anterior segment
Vs posterior
segment +
Friction
Increased anchorage
demands
Tip
Inbuilt tip VS expressed tip
Inbuilt tip - The tip built into the bracket
Expressed tip on insertion of wire the
change in the mesio distal inclination of tooth
The effect of the inbuilt tip and expressed tip on
the mesiodistal inclination of teeth is very
minimal.
Torque
Inbuilt torque and expressed torque
loss of torque cardinal rule
For every 0.001 play there
is loss of 4
0
loss of torque
PAE is highly inefficient in regaining
lost torque
Comparison of upper tip

7 6 5 4
Roth 0
0
0
0
0
0
0
0
MBT 0
0
0
0
0
0
0
0
3 2 1
Roth +13
0
+9
0
+5
0
MBT +8
0
+8
0
+4
0

Comparison of upper torque

7 6 5 4
Roth -14
0
-14
0
-7
0
-7
0
MBT -14
0
-14
0
-7
0
-7
0
3 2 1
Roth -2
0
+8
0
+12
0
MBT -7
0
,0
0
, +7
0
+10
0
+17
0

Comparison of lower tip

Tip 7 6 5 4
Roth -1
0
-1
0
-1
0
-1
0
MBT 0
0
0
0
+2
0
+2
0
3 2 1
Roth +7
0
+2
0
+2
0
MBT +3
0
+0
0
+0
0

Comparison of lower torque
7 6 5 4
Roth -30
0
-30
0
-22
0
-17
0
MBT -10
0
-20
0
-17
0
-12
0
3 2 1
Roth -11
0
-1
0
-1
0
MBT +6,0,-6
0,
-6
0
-6
0
Bends in the rectangular wire

Palatal root torque on
the anterior and
posterior region
Distal to the laterals buccal root torque
Anterior region desirable
Posterior region - undesirable
Detorqueing

Posterior
Anterior
Decompensation
Skeletal mal- relationship
Teeth compensate to mask the skeletal
discrepancy
Pre- surgical orthodontics
Eliminate the dental compensation that has
occurred with respect to the skeletal base
Class II decompensation
Objectives
Co-ordinate the arches in transverse dimension
Leveling
Class II molar and canine relation ship
Obtain sufficient over jet
Treatment plan
Mechanotherapy
Anchorage preparation

Pretreatment extra oral
Pretreatment intra oral
During treatment intraoral

Post treatment extra oral
Post treatment intra oral
Class III decompensation
Objectives
To coordinate the arches in transverse
dimension
Leveling
Class III molar and canine relationship
Reverse overjet&
Treatment plan
Mechanotherapy
Anterior segmental osteotomy
Objectives
Coordinate arches in the transverse dimension
Leveling
Divergence of roots at the planned osteotomy
site
Treatment plan
Mechanotherapy
Segmental /Continuous mechanics
Segmental mechanics are more Bioefficient
with less adverse effects
Statically determinate system thus possible
to know the exact amount of forces and
moments in the system
Though continuous mechanics is a statically
indeterminate system, it has been widely
preferred by the orthodontist due to the easy
cookbook approach.
Creating step at osteotomy site
Aligning by a segmental approach at the
osteotomy site most beneficial
Altering the height of the bracket positioning to
achieve the extrusion of the to be intruded
segment
Use of a stainless steel or a TMA spring to
create a step at the osteotomy site which TMA
is preferable
Achieve stabilization of posterior segment with
stainless arch wire
Insert the spring into the auxiliary tube
Segmental mechanics

Bonding modification
Pretreatment extra oral

Pretreatment intra oral
During treatment intra oral
Post treatment extra oral
Cleft patients

Problems in finishing
Tip
Torque
Mesio distal diameter (Boltons ratio)
Curve of spee
Ideal finish
Consistency
Accuracy
Predictability
Convenience
Tip

Change in tip alters the mesio distal
diameter occupied
Torque
Loss of torque
Inability of
complete space
closure in the
upper arch
Space closure
Lower arch the
complete space
closure
achieved
Mesio distal diameter
Proximal stripping

Post treatment intraoral
Curve of spee

Conclusion
Learn to appreciate the concept of inbuilt tip
and torque versus expressed tip and torque
Develop individual orthodontic sense instead of
blindly following prescription and bracket
systems
Having a thorough knowledge of biomechanics
involved will help the orthodontist to supplement
any deficiency present in the system that is
being used
Acknowledgement
Dr. Munirathinam Naidu
Principal
Dr.PJaykumar
Vice Principal and HOD
Staff and students
Department of Orthodontics

Meenakshi Ammal Dental College, Chennai

Thank you
Leader in continuing dental education

Appliances in Presurgical Orthognathic Surgery-OrTHO / Orthodontic Courses by Indian Dental Academy

Transféré par

Informations du document

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Appliances in Presurgical Orthognathic Surgery-OrTHO / Orthodontic Courses by Indian Dental Academy

Transféré par

Droits d'auteur :

Formats disponibles

Appliances in Presurgical

Vous aimerez peut-être aussi