Orthodontics clasificacion de Angle Método Herbz

metodos de medicion de arcadas dentarias

1. ORTHODONTICS
Dr. Ebtisam ElHamalawy
MFDS RSC (Edh.), MJDF RSC (Lon.), BDS (Misr International
University)

2. INCISORCLASSIFICATION
BRITISHSLANDEREDINSTITUTECLASSIFICATION
Class I : the lower incisor edge occludes with or lie immediately
below the cingulumplateau of the upper central incisor
Class II: the lower incisor edge lie posterior to the cingulum
plateau of the upper central incisor
1.the upper central incisors are proclinedor of an average
inclination and there is an increased overjet
2.The upper central incisors are retroclined, the overjetin
usually minimum but may be increased
Class III: the lower incisor edge lie anterior to the cingulum
plateau of the upper central incisor. The overjetis reduced or
reversed

3. ANGLESCLASSIFICATION
According to Angle, themesiobuccal cuspof the upper first
molar should align with thebuccal grooveof the mandibular
first molar.
He based his classifications on the relative position of
themaxillary first molar
Class I: NeutrocclusionHere the molar
relationship of the occlusion is normal or as
described for the maxillary first molar, but the other
teeth have problems like spacing, crowding, over or
under eruption, etc.

4. Class II: Distocclusion(retrognathism,overjet) In
this situation, the upper molars are placed not in the
mesiobuccal groove but anteriorly to it. Usually the
mesiobuccal cusp rests in between the first
mandibular molars and second premolars. There
are two subtypes:
Class II Division 1:The molar relationships are like
that of Class II and the anterior teeth are protruded.
Class II Division 2:The molar relationships are class II
but the central are retroclined and the lateral teeth are
seen overlapping the centrals.

5. Class III: Mesiocclusion(prognathism,negative
overjet) In this case the upper molars are placed not
in the mesiobuccalgroove but posteriorly to it. The
mesiobuccalcusp of the maxillary first molar lies
posteriorly to the mesiobuccalgroove of the
mandibular first molar.
seen as when the lower front teeth are more
prominent than the upper front teeth.
In this case the patient very often has a large
mandible or a short maxillary bone.

6. NormalOcclusion

7. Class 1 MO

8. Class 2 MO

9. Class 3 MO

10. UNDESIRABLESEQUELOFORTHODNTIC
FORCE
Pulpal damage
Root resorption
Loss of the alveolar bone height
Pain
mobility

11. ORTHODONTICTOOTHMOVMENT

12. Orthodontic Indices
•ICON -Index of Complexity,Outcome and Need
•IOTN -Index of Orthodontic treatment Need
•PAR -Peer Assessment Rating

13. IOTN

14. IOTN consists of two components:
1. Dental Health Component
2. Aesthetic Component

15. Aesthetic Component
Grade {1, 2,3, 4} no slight/ need for ttt
Grade {5,6,7} slight need
Grade {8,6,7} need
Grades

16. Recording the Aesthetic Component
•Grade the dental attractiveness of the
anterior teeth

17. Aesthetic component

18. Dental Health Component
Grade: { 1/ 2 } no need
Grade: 3 borderline need
Grade 4, 5 : NEED for ttt

19. GRADE 1
Grade 1 (None)
Extremely minor malocclusions including contact
point displacements less than 1 mm.

20. GRADE 2 {SLIGHT}
2•a Increased overjetgreater than 3•5 mm, but less
than or equal to 6 mm with competent lips.
2•b Reverse overjetgreater than 0 mm but less than or
equal to 1 mm.
2•c Anterior or posterior crossbitewith less than or equal to
1 mm discrepancy between retrudedcontact position and
intercuspalposition.
2•d Contact point displacements greater than 1 mm
but less than or equal to 2 mm.
2•e Anterior or posterior open bite greater than 1 mm but
less than or equal to 2 mm.
2•f Increased overbite greater than or equal to 3•5 mm
without gingival contact.
2•g Pre-or post-normal occlusions with no other
anomalies (includes up to half a unit discrepancy).

21. GRADE 3 {BORDERLINE NEED}
3•a Increased overjetgreater than 3•5 mm, but less than
or equal to 6 mm with incompetent lips.
3•b Reverse overjetgreater than 1 mm, but less than or
equal to 3•5 mm.
3•c Anterior or posterior crossbiteswith greater than 1
mm, but less than or equal to 2 mm discrepancy
between retrudedcontact position and intercuspal
position.
3•d Contact point displacements greater than 2 mm, but
less than or equal to 4 mm.
3•e Lateral or anterior open bite greater than 2 mm, but
less than or equal to 4 mm.
3•f Deep overbite complete on gingival or palatal tissues,
but no trauma.

22. GRADE 4
4•h Less extensive hypodontiarequiring pre-restorative orthodontics or
orthodontic space closure to obviate the need for a prosthesis.
4•a Increased overjetgreater than 6 mm, but less than or equal to 9 mm.
4•b Reverse overjetgreater than 3•5 mm with no masticatory or speech
difficulties.
4•m Reverse overjetgreater than 1 mm but less than 3•5 mm with
recorded masticatory and speech difficulties.
4•c Anterior or posterior crossbiteswith greater than 2 mm discrepancy
between retrudedcontact position and intercuspalposition.
4•l Posterior lingual crossbitewith no functional occlusal contact in one or
both buccal segments.
4•d Severe contact point displacements greater than 4 mm.
4•e Extreme lateral or anterior open bites greater than 4 mm.
4•f Increased and complete overbite with gingival or palatal trauma.
4•t Partially erupted teeth, tipped and impacted against adjacent teeth.
4•x Presence of supernumerary teeth.

23. GRADE 5
(Need treatment)
5•i Impeded eruption of teeth (except for third molars)
due to crowding, displacement, the presence of
supernumerary teeth, retained deciduous teeth and any
pathological cause.
5•h Extensive hypodontiawith restorative implications
(more than 1 tooth missing in any quadrant) requiring
pre-restorative orthodontics.
5•a Increased overjetgreater than 9 mm.
5•m Reverse overjetgreater than 3•5 mm with reported
masticatory and speech difficulties.
5•p Defects of cleft lip and palate and other craniofacial
anomalies.
5•s Submerged deciduous teeth.

25. Recording the DHC
Examine each subject for:
•Missing teeth
•Overjets
•Crossbites
•Displacement of contact points
•Overbites
= MOCDO

26. Recording the DHC
•Examine the subject using the ‘MOCDO’ scale
•As soon as a definite treatment need threshold is
reached, then the examination is stopped

27. IOTN Ruler

28. Missing Teeth
•Congenital absence/traumatic loss
•Impacted teeth
•Ectopic teeth

29. Missing Teeth
•IMPACTED if 4mm or less space is
available between adjacent teeth &
tooth not erupted.
•Impacted = Need for Treatment

30. Overjet
•Measure to the labial aspect of the most
prominent incisor
•Only record Need for Treatment if the
overjet extends beyond the 6mm line

31. Reverse Overjet
•All four incisors must be in
lingual occlusion

32. Crossbites
•Can be anterior or posterior, but
mostly posterior
•If displacement on closure =
Need for Treatment

33. Displacement of contact points
•Only applies to crowding
between permanent teeth
•Measure between the contact
points of the two most
crowded teeth

34. Overbite
•Deep overbite
•Open bite

35. Deep Overbite
Definite Need for Treatment
When
Overbite causing gingival or
palatal trauma.

36. PEERASSESSMENT RATINGINDEX{PAR}
Used to determine the orthodontic treatment
outcome
Its applied to the pre and post operative study
models
It measures the following features of malocclusion:
1. overjet
2. overbite
3. central line relationship
4. buccal segment relationship
5.upper and lower anterior alignment

37. REQUIREMENTS OFAREFERRALLETTER
All referral letters should include the following
information:
1. Patient demographics
2. Reason for referral i.e. treatment, advice
3. Salient features of patient’s malocclusion
4. History of previous treatment
5. Recent relevant radiographs where available

38. WHENTOREFERINADECIDUOUS
DENTITION??
1. patient with a cleft lip or a cleft palate or
craniofacial anomalies
2. sever maxillary and mandibular
disproportion{parents complain} otherwise delay
until mixed dentition
http://www.bos.org.uk/Resources/British%20Orthodon
tic%20Society/Author%20Content/Documents/PDF/R
eferrals%20July%2009%20%20lo%20res.pdf

39. WHENTOREFERINTHEMIXEDDENTITION:
ANTERIORORPOSTERIORCROSSBITESWITH associated
mandibular displacement
MALOCCLUSION IN THE MIXED DENTITION
MALOCCLUSIONWHERETHEREIS an underlying skeletal II
pattern.
Most functional appliances are easiest to wear when upper 4|4 are
fully erupted. Such a patient entering his or her pubertal growth
spurt should be seen without delay
SEVERELY HYPOPLASTIC CARIOUS First MOLARS OF poor
long-term prognosis
LACK OF PALPABLE CANINE BULGES BUCCALLY AT 10-12
years indicating palatal impaction of canines
(HYPODONTIA// SUPERNUMERARY teeth SUBMERGED
DECIDUOUSMOLARS // IMPACTED first permanent molars

40. Cephalometrics

41. Cephalometrics

42. Cephalometrics

43. Cephlandmarks

44. ORTHODONTICPLANES
Frankfort plane: Po-Or
Facial plane: N-POG indicates the general
orientation of the facial profile
Maxillary plane: ANS-PNS indicates the orientation
of the maxilla
Mandibular plane:G0-Me indicates the orientation of
the mandible
Occlusal plane: is the line following the occlusion of
the premolar and the molar

45. SNA =81(±3)
SNB =79(±3)
ANB =3(±2)
MMPA (max/mand planes angle) 27(±4)
1 -Mx -Upper incisor to Maxilla angle -109(±6)
1 -Mn -Lower incisor to Mandible angle -93 (±6)
Eastman Analysis

46. ANB 2-4 deg = Class I skeletal pattern
ANB > 4 deg = Class II skeletal pattern
ANB < 2 deg = Class Ill skeletal pattern
Eastman Analysis

47. REMOVABLE APPLIANCE
Anterior bite plane:
1. overbite reduction
2. removal of occlusal interference for bite reduction
Posterior bite plane:
1. remove occlusal interference and an overbite
reduction is unecessary
Anterior cross bite:
{T spring: 0.5mmm / z-spring}

48. REMOVABLEAPPLIANCES
Active components:
1.Springs {t / z springs}
2.screws: {maxillary expander} base plates are
moved apart 0.25mm quarter turn activation
3.Elastics
Retention components:
Adam clasps: {posterior retention} molars= 0.7mm /
0.6mm for premolar and primary molars

49. •RETENTIONCOMPONENTS:
1. ADAMCLASPS: {POSTERIOR
RETENTION} MOLARS= 0.7MM/ 0.6MM
FORPREMOLARANDPRIMARYMOLARS

50. RETENTIONCOMPONENTS:
0.7MMCLASPISRECOMMENDED ANTERIORLYWITHTHEU-LOOP
ENGAGINGTHEUNDERCUTBETWEENTHEINCISORS
Long labial bow:
0.7mm , prevents the buccal and labial drifting of the
teeth

51. REMOVABLEORTHODONTIC APPLIANCE
Types of headgears
1.Reverse pull headgear
2.High pull headgear: occipital pull
2.Cervical headgear.
{forces applied –extraoraltraction 500gms 14-16
hours per day.
Extra oral anchorage 250 gms10 hours.

52. REVERSEPULLHEADGEAR
Facemask or reverse-pull headgear is
anorthodonticappliance typically used in growing
patients to correctunderbites(technically
termedClass-III orthodontic problems) by pulling
forward and assisting the growth of the upper jaw
(maxilla), allowing it tocatch upto the size of the
lower jaw (mandible)

53. HIGHPULLHEADGEAR-
reduces overbite by intrusion of the incisors.

54. CERVICALHEADGEAR
reduces overbite by extrusion of the molars.

55. TWIN-BLOCKAPPLIANCE:
FUNCTIONALAPPLIANCE
1. THECONSTRUCTION BITEISMADEATANEDGE
TOEDGEPOSITION

56. HERBSTAPPLIANCE
Fixed-functional appliance
Splints cemented to the upper and lower buccal
segment connected by a rigid arm to reposition the
mandible more forward

57. •BIONATOR;
THEYAREUSEDTOEXPANDTHEPALATEANDCREATE
SPACEFORINCOMINGTEET

58. THUMB SUCKING HABBIT EFFET
a. Labial tipping of maxillary anterior.
b. Overjetincreases.
c. Anterior open bite.
d. Lingual tipping of mandibular incisors.
e. Narrow maxi arch.
f. Posterior cross bite.