Class i malocclusion and it’s variation and management .

CLASS I MALOCCLUSION AND IT’S VARIATION AND MANAGEMENT in Orthodontics.

1. CLASS I MALOCCLUSION AND IT’S VARIATION AND MANAGEMENT .

2. WELCOME TO THE PRESENTATION OF ORTHODONTICS SEMINER ON CLASS I MALOCCLUSION AND IT’S VARIATION AND MANAGEMENT .

3. P resentation on “Class I malocclusion,it’s variation and management’’ Submitted to : Dr. Anjuman Ara Akhter Dr. AKM Asad Polash Dr. Shahina Shoheli Department of Orthodontics & Dentofacial Orthopedics Dental Unit,Rajshahi Medical College Prepared by: Name: Md. Sharif Hossain Batch: 24 th B.D.S. Roll No. : 02 Session: 2012-13

4. PRESENTATION CONTENT

5. Before going to malocclusion or abnormal occlusion let’s ask first what is occlusion..?? Occlusion: Occlusion of the teeth means the relationship which the teeth of one arch bear to the teeth of other arch when the jaws are closed into maximum cuspal occlusion . Normal occlusion : Normal occlusion is commonly defined as, “An occlusion within the accepted deviation of the ideal.’’

6. Malocclusion Malocclusion may be defined as an irregularities of teeth beyond the accepted range of normal. In modern times, Dr. Edward Angle ,who is considered as father of “Orthodontics’’, gave us the first indices of malocclusion which is based on the mesio -distal relation of the teeth,dental arches and the jaws. Later many classification have been put fourth but till today Angle’s classification is being used widely because of it’s simplicity.

7. Classification of malocclusion Different classes of malocclusion according to E. H Angle are: 1. Class I malocclusion 2. Class II division 1 malocclusion 3. Class II division 2 malocclusion 4. Class II subdivision malocclusion 5 . Class III malocclusion 6. Pseudo-class III malocclusion 7. Class III subdivision malocclusion.

8. Types of malocclusion Malocclusion can be broadly divided into: 1. Intra-arch malocclusions -Mesial inclination -Distal inclination -Lingual inclination - Buccal inclination -Mesial displacement -Distal displacement -Lingual displacement - Buccal displacement

9. Types of malocclusion (continued…) - Infraversion - Supraversion -Rotations . Mesio -lingual or disto-buccal . Disto -lingual or mesio-buccal -Transposition -Imbrication 2. Inter-arch malocclusions -Sagittal plane -Vertical plane -Transverse plane 3. Skeletal malocclusions.

10. Class I malocclusion Angle’s class I malocclusion is characterized by the presence of a normal inter-arch molar relationship. The mesio-buccal cusp of the maxillary first permanent molar occludes in the anterior- buccal groove of mandibular first permanent molar. The patient may exhibit dental irregularities such as crowding,spacing,rotations , missing tooth,etc .

11. Class I malocclusion (continued…) Approximately 60%-70% of all cases of malocclusion fall into this class.

12. FEATURES OF CLASS I MALOCCLUSION

13. Features of class I malocclusion Extra-oral features : 1. Straight profile 2. Competent/incompetent lips 3. Normal/deep/shallow mento -labial sulcus Intra-oral features : 1. Class I molar canine incisor relationship 2. Spacing of teeth 3. Crowding of teeth 4 . Anterior crossbite 5. Posterior crossbite

14. Features of class I malocclusion (continued…) 6. Anterior openbite 7. Proclination 8. Retroclination 9. Rotation of teeth 10. Deep bite 11. Bi-maxillary protrusion

15. Etiology General factors Heredity: this largely dictate the tooth tissue ratio, the general form & relationship of the jaws and the soft tissue pattern Congenital: clefts,birth injury,adverse effects of drugs on foetus etc. Environmental function: functions such as feeding,swallowing,mastication,speech,habit etc. Endocrines: cretinism,acromegali etc. Pathology: osteodystrophies,tumors , trauma,burn etc.

16. Etiology(Continued…) Local factors Mainly inherited factors: 1. Abnormalities in the size & number of teeth . Missing or congenitally absent teeth . Teeth of abnormal shape & size . Superneumerary teeth 2. Abnormal position of crypt & total displacement or transposition of teeth 3. Impaction of upper first permanent molars 4. Abnormal labial frenum

17. Etiology(Continued…) Mainly environmental factors: Premature loss of deciduous teeth Retention of deciduous teeth Loss of permanent teeth Delayed eruption of permanent teeth Failure of teeth to erupt Habit: sucking Trauma Local pathological factors Misplaced teeth causing abnormal path of closure.

18. MANAGEMENT OF CLASS I MALOCCLUSION

19. Management Aims: 1. To improve the aesthetics and function of the teeth and jaw 2. To relieve crowding and align the teeth within the arch 3. If necessary to reduce a deep overbite and improve the inter- incisal angle.

20. Treatment aimed at correcting Spacing Midline diastema Crowding Crossbite Openbite (anterior) Rotations Deepbite (anterior) Bimaxillary protrusion.

21. Diagnosis History Clinical examination Study models Radiography -OPG -Intra-oral periapical -Lateral cephalogram .

22. Spacing of teeth 1. Removal of the etiology 2. Use of removable appliance If the spacing is associated with proclination of teeth,we can manage the case with an appliance having labial bow 3 . Use of fixed appliance Elastic chain or elastic thread for correction of generalised spacing.

23. Spacing of teeth (Continued…) 4. When there is a localized space in the presence of proclination , -labial bow with palatal finger spring 5. Use of crown & prosthesis If space is large enough to be replaced by a tooth of suitable size,the space is regained and prosthesis can be advised to manage the space.

24. Midline diastema 1. Removal of cause i.e. -high frenum attachment -Habit should be eliminated - Frenectomy 2. Active treatment (a) Removable appliance -Palatal finger spring -Palatal finger spring with labial bow -Split labial bow

25. Midline diastema (Continued…) (b) Fixed appliance -Elastic or spring between two central incisors. 3. Retention -Long term retention using suitable retainer such as lingual bonded retainer, Hawley’s retainer.

26. Before & after treatment Fig: Midline diastema Fig: Spacing

27. Crowding of teeth 1.Mild crowding : If the space discrepancy is upto 4mm, -Usually resolves without extraction -Proximal stripping -Retract canine by canine retractor -Alignment of anteriors using labial bow.

28. Crowding of teeth 2. Moderate crowding : If the space discrepancy is in the range of 5-9mm,treated without extractions by: -Arch expansion -Molar anchorage or -Enamel reduction.

29. Crowding of teeth (Continued…) 3. Severe crowding : Patients with space discrepancy of 10mm or more, -Extraction of all first premolars -Retract canine by canine retractor -Align anteriors by labial bow -Retention by Hawley’s retainer.

30. Anterior crossbite 1. Pre-adolescent age group: a. Tongue blade therapy b. Catalan’s appliance or lower anterior inclined plane c. Double cantilever spring or Z-spring

31. Anterior crossbite (Continued…) 2. Adolescents and adults a. Double cantilever spring with posterior bite plane b. Telescopic expansion screw with posterior bite plane c. Segmental expansion screw with posterior bite plane.

32. Posterior crossbite For single tooth : A. Cross elastic B. Sectional fixed appliance C. Expansion screw Unilateral crossbite : A. Using unilateral expansion screw B. Using fixed appliance

33. Posterior crossbite (Continued…) Bilateral crossbite : A. Symmetrical expansion screw B. Coffin spring C. Quad helix appliance D. The RME appliance E. Ni-Ti expanders.

34. Openbite Anterior openbite A. Elimination of abnormal habit -Thumb sucking -Tongue thrust -Mouth breathing B. Myofunctional appliance -Frankel IV appliance C. Oral screen can also be used.

35. Openbite (Continued…) Skeletal anterior openbite 1. During mixed dentition , - frankel IV appliance or modified activator 2. In permanent dentition mild to moderate cases, -fixed appliance with box elastics 3. In permanent dentition with severe cases, -surgery i.e. segmental osteotomy.

36. Openbite (Continued…) Posterior openbite 1. If it is due to lateral tongue thrust habit,use of lateral tongue spike either fixed or incorporated in a removable appliance 2. Vertical elastic can be used along with fixed appliance 3. If due to infra occlusion of ankylosed tooth, crown on the tooth to restore normal occlusion.

37. Rotation Single tooth 1. Can be corrected by removable appliance -Couple force by flapper spring/double cantilever spring and labial bow 2. Semi-fixed appliance can be used -Whip spring -High labial bow with soldered ‘T’ spring . Multiple rotations -Treated by fixed appliance.

38. Retention of rotation Long term retention is required to achieve stability of the treatment. Retention can be given by either removable or fixed appliances. Pericision or circumferential supracrestal fibrotomy is an adjunctive surgical procedure where the gingival fibres are incised to prevent relapse.

39. Fig: Supracrestal fibrotomy

40. Deep bite 1. Removable appliance -Anterior bite plane 2. Myofunctional appliance -Activator can be used 3. Fixed appliance -Anchorage bend/Tip back bend -Arch wire with reverse curve of Spee -Arch wire with ‘U’ or ‘L’ loop 4. Surgery -segmental surgery.

41. Bi-maxillary protrusion 1. Extract all 1 st premolars 2. Treatment depends on angulation of canine - Distally inclined canine Retract canine by canine retractor Alignment of anteriors using labial bow - Mesially inclined canine Fixed appliance.

42. Retention after active orthodontic treatment Retainers are passive orthodontic appliances that help in maintaining & stabilizing the position of teeth long enough to permit rearrangement and remodelling of the supporting structures after the active phase of orthodontic treatment. Retention can be given by- Removable retainers Fixed retainers.

43. Retention after active orthodontic treatment Normally retention is given for at least 6 months to 1 year to prevent relapse. Removable retainers -Hawley’s appliance - Begg retainer -Spring aligner Fixed retainers -Band & spur retainer.

44. THANK YOU

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