ORTHOPEDICS IN BIOPROGRESSIVE

ORTHOPEDICS

• Definition – orthopedics implies any manipulation that alters the skeletal system and associated motor organs

• Method of evaluation by using the superimpositional areas

ANALYSIS OF AN ORTHOPEDIC PROBLEM

• Bimler described the classical severe convexity problem as a micro rhino dysplasia(negative factor four)

• Normally the palatal line is parallel or slightly canted downward to the FH plane.

• In microrhino dysplasia –an upward,outward tip with the ANS tipped toward FH at least 4 degrees or more

• Sufficient maxillary overjet

• Hyperactive lower lip

• Restrictive vault space

• Protrusive upper incisors

CLASSICAL RESPONSES

• Generalized orthopedic response with cervical headgear alone:

- direction of force

- Rotational effect- Effect in dolichofacial and brachyfacial types

• Generalized orthodontic response with cervical headgear: - downward and backward effect - factors that dictate response - effect on the upper and lower incisors and lower molars • The reverse response: - in combination with lower utility arch - effect on the upper and lower molar

MAXILLARY CENTER OF ROTATION

REVERSE RESPONSE

•

• Expansive responses: - the class 2 pose - expansion of the midpalatal suture

• Considerations for expansion

- reciprocal expansion of the lower arch

- preventing impacted second molars

SOFT TISSUE CHANGES

• Normal growth• Growth following orthopedic alteration of the maxilla

• Lip and chin changes

• Tongue posture

SOFT TISSUE CHANGES

ORTHOPEDIC VS ORTHODONTIC MOVEMENT

• Force differentiation: - magnitude

- duration - site of application• Growth restrictive forces and rotational forces

• Nature of bone surrounding dentition - sinus development - distal root tip - stacking factors - sutural freedom

• Mechanical application of cervical head gear:

- force level - intermittent wear - outer bow length and position- expansion , rotation - freedom of movement of maxillae

• Factors causing excessive mandibular rotation(during cervical head gear therapy)

- weak muscular pattern - not retarding effective eruption of the lower molars - severe tipping of upper molars

- full arch therapy without freeing anterior occlusion-incisal trauma

- full time cervical head gear therapy

FACTORS IN HEADGEAR TYPE SELECTION Indicators for strong functional response

1.2.3.4.5.

Mandibular plane 25 degrees and underFacial axis 90 degrees and aboveLower facial height 45 degrees and belowMandibular arc 25 degrees and above Condylar growth pattern upward and forward