PowerPoint Presentation: Class 1 Malocclusion Level 5 2012-2013 Supervisor: Dr. Mohamed Farhan Republic of Yemen University of Sciences & Technology College of Medical Sciences Dentistry College Introduction : Introduction Occlusion is the relationship of the maxillary and mandibular teeth when the jaws are in a fully closed position. Classification of occlusion :- Class I (normal occlusion ). Class I malocclusion. Class II malocclusion. Class III malocclusion. Introduction : Introduction Prevalence of malocclusion :- Class I normal occlusion: 30 %. Class I malocclusion: 50-55 %. Class II malocclusion: 15 %. Class III malocclusion < 1 %. More class II in whites and more class III in Asians . Class III and open bite are more frequent in African than European populations. Class I malocclusion: Class I malocclusion Definition: Definition Angle’s class I malocclusion is also known as neutrocclusion where the molars are in normal class I relationship (Mesiobuccal cusp of the upper first permanent molar lies in the mid buccal groove of the lower first permanent molar) leaving the other teeth in malocclusion (not in normal intercuspation) . Causes of orthodontic class I malocclusion : Causes of orthodontic class I malocclusion Developmental causes : The most encountered developmental disturbances are: Congenitally missing teeth. Malformed teeth. Supernumerary teeth. Impacted teeth. Ectopic eruption. Causes of orthodontic class I malocclusion : Causes of orthodontic class I malocclusion Genetic causes :- Genetics play major role for malocclusion when there is discrepancy between size of the jaws & size of teeth . Causes of orthodontic class I malocclusion : Causes of orthodontic class I malocclusion Environmental causes: It is caused by injures which has two types:- Birth Injures: It comes under two major categories: Fetal molding (when a limb of the fetus presses another part leading to distortion of that part ). Trauma during birth from usage of forceps . Causes of orthodontic class I malocclusion : Causes of orthodontic class I malocclusion Injures throughout life : Trauma to teeth can lead to development of malocclusion in three ways: Damage to permanent tooth bud when primary tooth is traumatized. Premature loss of primary teeth leading to permanent tooth movement. Direct injury to permanent teeth. Note :- both dental and skeletal factors are incorporated in class 1 malocclusion. Diagnosis : Diagnosis History Clinical examination Study models Radiography OPG Periapical X-Ray Lateral cephalometric X-Ray. MANAGEMENT OF CLASS1 MALOCCLUSION: MANAGEMENT OF CLASS1 MALOCCLUSION Treatment aimed at correcting: : Spacing. Crowding. Crossbite. Openbite (anterior). Rotations. Deepbite (anterior). Bimaxillary protrusion. Treatment aimed at correcting: SPACING: SPACING PowerPoint Presentation: Generalized: Eliminate cause Microdontia Eliminate spaces between anteriors, leaving a space between canine and 1 st premolar Prosthesis Spacing with proclination: Labial bow Elastics with fixed or removable appliance Localized spacing with proclination : Labial bow with finger spring Localized spacing with proclination Midline Diastema : Eliminate cause high labial frenum attachment. Removable appliances : Finger spring. Finger spring with labial bow. Split labial bow. Fixed appliances: Pin and tube appliance . Midline Diastema CROWDING: CROWDING CROWDING: Analyze space discrepancy using model analysis. Treatment is planned on the amount of space required. Mild Crowding If the space discrepancy is up to 4mm: Usually resolves without extraction. Proximal stripping. Alignment of teeth by labial bow, finger spring. CROWDING CROWDING: Moderate crowding If space discrepancy is in the range of 5-9mm, treated without extractions by : Arch expansion. Molar anchorage. Enamel reduction. CROWDING CROWDING: Severe crowding Patients with space discrepancy of 10 mm or more: Extract all 1 st premolars. Retract canine by canine retractor. Align anteriors by labial bow. Retention by Hawley’s retainer. CROWDING HAWLEY’S RETAINER: HAWLEY’S RETAINER CROSSBITE: CROSSBITE CROSSBITE: ANTERIOR Z-spring with posterior bite plane Expansion screw with posterior bite plane CROSSBITE CROSSBITE: POSTERIOR Single tooth: Cross-elastics. Unilateral: Unilateral expansion screw. Functional appliance. Bilateral: Maxillary expansion is done to relieve cross bite by: Coffin spring CROSSBITE CROSSBITE: Quad Helix Appliance CROSSBITE CROSSBITE: Hyrax screw for rapid maxillary expansion CROSSBITE OPEN BITE: OPEN BITE OPEN BITE: ANTERIOR: Eliminate habit Thumb sucking. Tongue thrust. Mouth breathing. Skeletal openbite during mixed dentition: Frankel IV or chin cap with high pull headgear. In permanent dentition,before puberty Fixed appliance with box elastics. In permanent dentition after puberty: Surgery. If due to supra-erupted posteriors: Posterior segmental osteotomy. OPEN BITE ROTATIONS: ROTATIONS ROTATIONS: Single Tooth: Removable Appliance: Couple force by flapper spring/ double cantilever spring and labial bow. Semi-fixed Appliance: Whip spring. High labial bow with soldered ‘T’ spring. Multiple rotations: Treated by fixed appliance Overcorrection is done and retention is given for at least 1 year…. ROTATIONS ROTATIONS: High Labial bow T spring ROTATIONS DEEP BITE: DEEP BITE DEEP BITE: DEEP BITE Growing age: With less low facial height : Anterior bite planes DEEP BITE: DEEP BITE Anterior bite planes are contraindicated if patient already has more lower facial height. Intrude anteriors by: Fixed appliance J hooks of vertical pull headgear BIMAXILLARY PROTRUSION: BIMAXILLARY PROTRUSION BIMAXILLARY PROTRUSION: BIMAXILLARY PROTRUSION Extract all 1 st premolars, or 1 st molars. Treatment depends on angulation of canine: Distally inclined canine : Retract canine and align incisors using retainers. Mesially inclined canine: Fixed appliance. BIMAXILLARY PROTRUSION: BIMAXILLARY PROTRUSION Use of anterior subapical osteotomy in conjunction with extraction of a tooth in each quadrant, usually the 1 st premolars . Bone apical to upper 6 anteriors is cut, and the whole segment is pushed back, in conjunction with surgical splints and rigid osteosynthesis (plating). Box and vertical elastics and retainers are used postsurgically to prevent relapse of teeth. BIMAXILLARY PROTRUSION: BIMAXILLARY PROTRUSION THANK : THANK YOU !!