NormocclusionLocal and general anomalies

Dr.Káldy Adrienn

Semmelweis Egyetem

Gyermekfogászati és Fogszabályozási Klinika

Angle classification system

For malocclusions proposed by Angle is widely used and serves as an excellent means of general description that has facilitated the communication about different malocclusions within the profession

The system basically describes anteroposterior relationships of the upper and lower first molars

Angle classification system

Angle Class I.

A Class I malocclusion is associated with a normal maxillomandibular relationship in the saggital plane

All ideal occlusions are Class I, however not all the Class I occlusions are ideal

Class I. malocclusions

Local anomalies

Single teeth: variations in the positions of single teeth-tilting,mesial, distal,labial, lingual,infra,supra position, rotation-ectopic eruption of the first molars-median diastema-anterior crossbite-impacted teeth-numerical deviations

General anomalies

Vertical plane:-Deep bite-Openbite

Transversal plane:-crowding-crossbite

Local anomalies

-tilting ( apical base in place)-incorrect position( apical base not in the right place)-combination of these

Etiology-lack of space-functional problems-hereditary factors-trauma-early extaction of the primary tooth

Axial deviation of the single teeth

Labial, buccal, palatinal, lingual, mesial, distal tilting of the teeth

Labial tilting of the upper incisors: - genetic- bad oral habits (thumb sucking, pacifying)

Palatinal tilting of the upper incisors:-lack of place-deepbite, coverbite

Therapy:

Elimination of cause factors (disfunctions, persistent milk teeth)

Removable appliances, fixed appliances

Ectopic upper canine

Lack of place

Therapy:

Creating place -Expansion: -removable expander plate („Y” plate) -fixed appliance

-Extraction

Maxillary midline diastema

Early mixed dentition

Diagnostic:Oral observation, X-ray

Etiology:Supernumerary teeth, congenital missing teeth, strong fraenum, hereditary factors

Consequences:Esthetical and phonetical problems

Median diastema

Therapy:Elimination of the trigger factors

-Frenulectomy -Extraction of the supernumerary tooth

Space closing -with fixed or removable appliance

Retention phase!

Anterior cross-bite

Diagnostic

Oral observation, X-ray

Etiology -Unfavourable axial inclination -Crowding -Hereditary factors -Trauma

Consequences -Traumatically occlusion -Gingival irritation -Periodontal problems -Tooth lost

Anterior cross-bite

Therapy

Elimination of cause factors -Creating space with fixed or removable appliance

-Alignement of the tooth

Impacted teeth

DiagnosticOral observation, X-ray from two direction

Etiology

-Unfavourable axial deviation or postion of the germ -Crowding -Hereditary factors -Trauma -Early extraction of deciduous tooth -Supernumerary teeth

Consequences -Follicular cyst -Root resorptoin of neighbouring teeth

Freuency -8,3,5,1

Treatment of impacted teeth

-Orthodontic treatment with spontaneous eruption

-Surgical-orthodontic treatment without extraction

-Orthodontic treatment after surgical intervention and extraction of the impacted tooth

-Direct surgical reposition

Impacted canine

Prognosis

-Palato-buccal position -Abnormality of teeth axial inclination ( 45o ) -Space discrepancy -Patient age

Possible sideffects of the treatmentLoss of anchorage, loss of attachmentIntrusion of the neighbouringRoot resorption

Numerical deviations

DiagnosticOral observation, X ray

Etiology-Hereditary factors-Trauma-Intrauterine injuries-Cariological problems

Consequences-Agenesia Diasthema, -Supernumerary: crowding,follicular cyst, -Periodontal problems

Frequency -Agenesia: 8,2,5,1 -Supernumerary: mainly in the front area

Treatment of numerical deviations

-Orthodontic-Orthodontic and prosthetic-Prosthetic-Surgical-Orthodontic-Implantologic

Important factors:Other orthodontic anomalies, oral hygiene, age

Treatment of Angle class I.General anomalies

Outline

Deep bite Open bite Transversal anomalies Lateral cross bite, Scissor bite,

Crowding

Deep bite

Dento alveolarOver eruption of incisorsLack of laterals eruption Multiple extraction

SkeletalUsually together with Angle II/2

Analysis of the cephalogram

ML-NL angle ML-NSL angle NL-NSL angle Gonion angle

Treatment of deep bite

Intrusion of incisors Extrusion of molars Appliances:Multiband or removable

appliance

Utility ív

Treatment with fixed appliance

Deep bite (Angle II/2)

Passive plate with bite raising block in the front

Open bite

Anterior LateralUnilateral Bilateral

Dento alveolarHabitual dysfunction

SkeletalVertical development of the

mandible

Analysis of the cephalogram

ML-NL angle ML-NSL angle NL-NSL angle Gonion angle

Typical skeletal and dentoalveolar open bite

Treatment of open bite

Elimination of the causes

Correction of the vertical relation between the upper and lower jaws

Appliances:Oral screenActivatorFixed appliance with

intermaxillary elastics

oral screen

ORAL SCREEN

Az aktivátor

Andresen Häupl—funkciós

állcsontortopédia

Merev akrilátblokk Labiálív Öntött kapcsok

Aktiválás

vertikális irányú becsiszolás

Dentoalveolar open bite due to habitual dysfunction Treatment with tongue cribs

Tongue trust swallowing

Treatment of the open bite with fixed appliance

Treatment of the open bite with fixed appliance

Tongue trust swallowing

Utility arch

Transversal anomalies Lateral cross bite Unilateral Bilateral Dentoalveolar Skeletal

Lateral scissorsLateral cross bite

Analysis of the model

Measurement of the indexes

Analysis of the relation between the apical and the coronal base

Pont- and the Schmuth- index

Treatment alternatives of lateral cross bite In the deciduas

dentition grinding and functional training (bite exercise)

Functional appliance with screw

Frankel I Active plate Quad-helix Hyrax screw

Hasund-féle Hansa készülék:

--felső lemezrész tágító csavarral, torqueáló-rugóval, Adams-kapoccsal

Alsó lemezke -- speciális rugóval, -- ajakráccsal

--Buccális pajzs --pelották --transzpalatinális ív --segédrugók

Periosteum viszkoelasztikus elhúzódása

Frankel appliance

Upper and lower active plates

Unilateral cross biteforced bite

Transversal widening

Treatment of scissors bite

Closing the upper arch

Expanding the lower arch

Appliances: multiband, activator (with screw) active plate

Transversal anomalies Crowding

Primer: Size of tooth arch Size of

teeth Secounder: Early deciduous extraction and its

consequence Tertier: Eruption of the wisdom

Crowding

Primary ⇐ Jaw size ⇒ Tooth dimension Secondary ⇐ Early extraction of deciduous Tertiary ⇐ Third molar

Treatment of crowding

Prevention Space creation

Transversal and or sagittal widening (help: Pont index )

Tooth material reduction

extraction or stripping of enamel(help: Bolton analysis)

Stripping of enamel

Hyrax

Treatment of crowding

Prevention Provision of space

Pont index sagittal and or transversal expansion)

Reduction of tooth material (extraction

stripping)

Non extraction treatment

Crowding Large scale deep

bite (Angle II/1.)

persistant decidous

After the treatment

After the treatment

Extraction treatment Consideration : Expansion ⇔ extraction The measure of the narrow: 0-5mm, 5-10mm,

10- Consideration of the protrusion Consideration of the vertical relation

systemic extraction

Extraction of deciduous canines

Extraction of first deciduous molars

Extraction of first premolar