1. Introduction to orthodontics. Occlusion and malocclusion.
1. Definition of orthodontics.
• Definitions
• Divisions
2. Definition of ideal occlusion
• Andrews six keys of normal occlusion
3. Positions of the mandible
4. Equilibrium theory
5. Classification of malocclusion
• Angle’s molar classification
• Canine classification
• Incisor classification
• Classification by the severity of crowding
• Classification by the size of overjet in Class 2/3 cases
6. Prevalence of malocclusion
7. Aetiology of malocclusion
• Genetic influence
• Environmental factors
• Physiological factors
• Mouth breathing
• Sucking habits
• Pathology
• Childhood fractures of jaws
• Juvenile rheumatoid arthritis
• Excessive growth hormone
• Periodontal disease
• Dentoalveolar trauma
• Early loss of primary teeth
8. Benefits of orthodontic treatment
9. Risks of orthodontic treatment
2. Growth and development of the craniofacial region
1.Definition
2.Growth pattern
3. Levels of growth of the body
• Cellular level
• Growth of soft tissues
• Interstitial growth
4. Development of the mandible
5. Development of the maxilla
6. development of the cranial vault
7. Mandibular growth rotations
8. Adult craniofacial growth
3.Development of the dentition
1. Postnatal development of the dentition
2. Development of the jaws
3. Deciduous dentition
• Stages of tooth eruption
• Eruption timing
• Characteristics of normal deciduous dentition
4. Mixed dentition
• Stages of eruption
• Explanation of Terminal plane
• Temporary features of the mixed dentition
• The leeway space
• Dental arch length
• Dental arch width
5. Factors affecting tooth position
6. Crowding of mandibular incisors
7. Occlusal changes in the permanent dentition
4.The orthodontic patient examination
Patient examination
1. Chief complaint
2. Medical history
3. Dental history
4. Social and behavioral examination
Evaluation of the facial and dental appearance
1.Extraoral examination
1.1 Frontal
• Horizontal
• Vertical
1.2 Profile
• Horizontal
• Vertical
2. Jaw function
3. Tooth –lip relationship – mini esthetics
3.1 Smile analysis
4. Tongue examination
5. Path of closure of the mandible
6. Evaluation of normal breathing
Cephalometric and soft tissue analysis
1. Orthodontic records
2. Dental photography
3. Radiographs used in orthodontics
3.1 Panoramic radiograph
3.2 Occlusal radiographs
3.3 Periapical radiographs
3.4 Bite-wing radiographs
3.5 Lateral skull radiograph
3.6 Frontal cephalometrics
3.7 Three-dimentional imaging
4. Cephalometric analysis
4.1 growth prediction
4.2 Hard tissue landmarks
4.3 Anatomic planes
4.4 Cephalometric angles
4.5 Dental relationships
4.6 Steiner’s analysis
4.7 Wits appraisal
4.8 Tweed’s analysis
4.9 Facial analysis
4.10 Malocclusions
4.11 Errors in cephalometric analysis
Dental cast analysis
1. Planes of space
2. Deviations in positions of individual teeth
3. Mixed dentition analysis
3.1 Moyers’ analysis
4. Permanent dentition analysis
4.1 Bolton’s analysis
4.2 Pont’s index
4.3 Linderhearth’s analysis
4.4 Carey`s analysis
5. Evaluation of the skeletal and dental relationships
5.1 Transverse plane of space
5.2 Anteroposterior plane of space
5.3 Vertical plane of space
5.Treatment Planning
1.Aims of treatment
1.1 Facial aims
1.2 Occlusal aims
1.3 Need for treatment
Planning to achieve the facial aims of treatment
1.Position the upper incisors in the anteroposterior plane
2. Position of the upper incisors in the vertical plane
3. Lower incisor position
Planning to achieve occlusal aims of treatment
1. Space creation
1.1 Extraction or expansion?
1.2 Guidelines for extraction
1.3 Transverse arch expansion
1.4 Anteroposterior arch lengthening
1.5 Reduction of tooth width
2. Step by step treatment plan
2.1 Planning treatment for moderate problems
2.2 Planning comprehensive orthodontic treatment
2.3 Camouflage treatment
3. Choice of appliance
4. Limiting factors of orthodontic treatment
4.1. Envelop of discrepancy – range of tooth movements.
4.2 Soft tissue limitations
5. Timing of treatment depending on the malocclusion
5.1 Cervical vertebral maturation method
6.Orthodontic tooth movement and biomechanics
Orthodontic tooth movement 1. Role and structure of periodontal ligament
2. Theory of tooth movement
3. Optimal orthodontic force
4. Tissue response to orthodontic force
4.1 Changes in the pressure zone
4.2 Changes in the tension zone
5. Stages of tooth movement
6. Types of force based on magnitude and force decay.
7. Effects on drugs on the response to orthodontic force
Biomechanics of tooth movement
1. Introduction
2. Laws of Newton
3. Definition of force
4. Definition of center of resistance
5. Center of rotation
6. Definition of moment
7. Types of dental movements
7.1 Tipping
7.2 Translation
7.3 Root movement
7.4 Rotation
7.5 Intrusion
7.6 Extrusion
8. Definition of a couple
9. Static equilibrium
10. Action and reaction
11. Deep bite correction
12. Correction of bilateral posterior open bite
13. Correction of anterior cross bite
14. Use of V bend
15. Diastema closure
7.Contemporary removable appliance
1. Types of tooth movements with removable appliance
1. Tipping
2. Overbite reduction
3. Crossbite correction
4. Extrusion
5. Intrusion
2. Components of removable appliance
1.1 Retentive components
1.2 Active components
1.3 Expansion screws
3. Clinical use of removable appliance
4. Treatment with removable appliance
4.1 Flat anterior bite plate therapy
4.2 Posterior bite planes
4.3 Opening and closing spaces with removable appliances.
4.4 Modificated appliances
5. Functional appliances – basic characteristics
5.1 Treatment philosophy
5.2 Clinical effects
5.3 Types of functional appliances
– Removable appliances – Activator, Bionator, Frankel system, Twin block
– Fixed functional appliances – Herbst appliance, Power scope
5.4 Pre-functional stage of treatment
6. Removable appliances used with fixed appliances
5.1 Headgear
5.2 Facemask
5.3 Chin cup
6. Clear aligner therapy
8.Functional appliances
1. Definition for functional appliance
2. History of the appliances
3. Classification
4. Effects of functional appliances
4.1 Dentoalveolar changes
4.2 Skeletal changes
4.3 Growth stimulation and acceleration
4.4 Soft tissue changes
5. Ideal requirements of functional appliances
6. Advantages and limitations
7. Indications for functional therapy
7.1 Skeletal criteria
7.2 Dental criteria
7.3 Soft-tissue criteria
7.4 Functional criteria
8. Appliances
8.1 Upper anterior flat bite plane
– Bite plane with labial bow
– Sved bite plane
8.2 Upper anterior inclined plane
8.3 Lower inclined plane
8.4 Vestibular screens
8.5 Hotz oral screen
8.6 Lip bumper
8.7 Andersen activator
– Advantages
– Disadvantages
– Steps in construction
– Bite registration
– Teeth movements with activator
– Treatment effects
8.8 Bionator
– Types of Bionator
– Objectives of treatment
– Standard appliance components and construction
– Indications and contraindications
– Class III Bionator
8.9 Frankel appliance
– Philosophy and uses
– Different appliances indications
– Appliance construction
– Treatment with Frankel appliance
8.10 Twin Block
– Types
– Parts of the appliance
– Treatment with twin block
8.11 Fixed functional appliances
– Classification
– Herbst appliance
– Jasper jumper
– PowerScope
9.Extraoral appliances
1. Introduction
2. Indications for use of extraoral force
3. Location of Center of Resistance of the Dentomaxillary Complex
4. Components of Headgear
4.1. Face-bow. – outer and inner
4.2. Anchorage source or headgear strap
4.3. Force element. Earlier elastic bands/straps
5. Types of Headgear
5.1 Cervical Headgear
5.2 High-Pull Headgear
5.3 Straight-Pull Headgear
5.4 Vertical-Pull Headgear
5.5 Headgears for incisor retraction
6. Uses of Headgear
7. Patient instructions and disadvantages of Headgear therapy
8. Reverse-pull Headgear/Face mask
9. Indications for Face Mask
10. Components of face mask
10.1 Intraoral Device
10.2 Elastic Traction
11. Protraction headgear
12. Chin cup
10.Contemporary fixed appliances
1. Advantages and limitations of fixed appliances
2. History of fixed appliance
2.1 Edgewise appliance
2.2 Light wire appliance
2.3 The readjusted appliance
• Roth
• MBT
• Lingual appliances
3. Components of the fixed appliances
4. Types of brackets
4.1. Metal brackets
• Stainless steel brackets
• Cobalt chromium brackets
• Titanium Brackets
• Plastic Brackets
• Ceramic Brackets
• Individually Customized Brackets
5. Part of a bracket
5.1 Bracket slot
5.2 Type of bends for threedimensional tooth movements
• First order bends
• Second order bends
• Third order bends
5.3 Modification of slot dimension
• Advantages and disadvantages of 0.022 slot
• Advantages and disadvantages of 0.018 slot
6. Morphology of the brackets
6.1 Single slot brackets
6.2 . Twin bracket
7. Slot modifications to reduce friction
8. Ligation of the brackets
8.1 Self-ligating brackets
8.2 Tie lings of the brackets
9. Auxiliary features
9.1 Power arms
9.2 Accessary slots
10. Archwires
10.1 Physical properties of an archwire
10.2 Archwire materials
10.3 Other auxiliaries
10.4 Palatal and lingual arches
11. Fixed expansion arches
11.1 Quad Helix
11.2 Hyrax
12. Fixed Appliance for distalization
12.1 Pendulum
12.2 Distal Jet
12.3 Veltri distalizer
12.4 Belussi Distalizer
11.Decision on bracket type and system
1. Evolution of treatment mechanics and contemporary appliance design
1.1 Edgewise appliance
• First, second, third order bends
1.2 Straight wire appliance
• Mechanics with the SWA
• Canine retraction
• Methods of space closure
• Appliance compensation
2. Roth Prescription
• Justification on modifications
• Mechanotherapy
3. McLaughlin Bennett Trevisi prescription
• Space closure
• Appliance compensation
• Class II div 1 growth modification
• Class II camouflage
• Class II Surgical cases
• Class II div 2
• Class III camouflage
• Class III surgical cases
• Palatally placed upper lateral incisors
• Lingually placed lower incisor
• Maxillary lateral incisor Substitution
• Palatally impacted Maxillary canines
• Buccally displaced maxillary canines
4. Alexander orthodontic philosophy
4.1 Alexander principles
4.2 Treatment philosophy
• Diagnosis and treatment palning
• bracket selection and prescription
• Arch shape
• Treatment mechanics
• Bracket selection
• Non extraction treatment
• Extra oral forces application
• Proper timing with class ii elastics
• Finishing and retention procedures in alexander discipline
5. Damon system
5.1 The Damon Philosophy
5.2 Bracket Design
5.3 Treatment Planning
5.4 Bracket Selection
5.5 Treatment Phases
5.6 Managing Severely Displaced or Rotated Teeth
5.7 Retention
12.Bonding in orthodontics
1. Bonding Procedure
1.1 Cleaning
1.2 Enamel conditioning
1.3 Sealing
1.4 Positioning
1.5 Bonding
1.6 Banding of molars
1.7 Bonding to crowns
1.8 Bonding to amalgam
1.9 Bonding to composite restorations
2. Indirect Bonding
3. Instruments used in orthodontics
4. Bracket positioning chart
5. Ideal arch form
5.1 The tapered arch form
5.2 The square arch form
5.3 The ovoid arch form
6. Tips on placing brackets in different cases
7. Treatment stages
7.1 Stage 1: Leveling and Aligning
7.2 Stage 2: Working Stage
7.3 Stage 3: Finishing Stage
13.Anchorage
1.Definition for anchorage
2. Classification of anchorage
2.1 Intraoral or extraoral
2.2 Intramaxillary and intermaxillary
2.3 Type A, Type B, Type C
3. Intramaxillary anchorage
• Anchorage preparation
• Soft tissue anchorage
• Free anchorage
4. Intermaxillary anchorage
5. Extraoral anchorage
6. Indications for anchorage
7. Factors to consider determining the type of anchorage
8. Tips to reinforce posterosuperior anchorage
9. Tips to reinforce anteroinferior anchorage
10. Types of anchorage
10.1.1. Minimal Anchorage.
• Stops.
• Tip back.
• Arch wire tie back.
• Toe-in, Toe-Out.
• Retro-ligature.
• Intermaxillary elastics.
• Lip Bumper.
10.2. Moderate Anchorage.
• Nance Button.
• Transpalatine Arch (TPA).
• Lingual Arch
10.3. Maximum or Severe Anchorage.
• Chromosome arch.
• Transpalanance
10.4. Absolut Anchorage
14.Management of the developing dentition
1. Space management in the transitional dentition
1.1 Prediction of tooth emergence
1.2 Factors influencing time of eruption
1.3 Factors influencing mesial or distal drift
2. Planning for Space Management
2.1 Space evaluation and size prediction
• Nance analysis
• Moyers analysis
• Bolton analysis
2.2 General eruption pattern and problems of eruption
3. Treatment Options for Space Management
3.1 Space maintenance
3.1.1 Nonfunctional fixed unilateral space maintainers – band and loop, distal shoe
3.1.2 Nonfunctional fixed bilateral space maintainers – Lower arch, Active holding arch, transpalatal arch, Nance arch
3.1.3 Functional fixed space maintainers – Band and occlusal bar, Band and pontic, Crown and bar, Crown and pontic, Anterior provisional fixed partial denture
3.1.4 Removable space maintainers
3.2. Space regaining
3.2.1 Fixed unilateral and bilateral regainers
• Molar distalizer with Nance anchorage
• Sliding loop and lingual arch
• Pendulum appliance
• Distal jet appliance
• 2 × 4 bonding
• Removable space regainers
3.3 Space creation
• Tooth extraction
• Sequential selective enamel stripping
• Sagittal expansion – lip bumper,pendulum appliance, active lingual arch, removable distalizer, headgear.
• Transverse expansion – W arch, quad –helix, has expander, hyrax expander, removable expanders
3.4 Space closure
3.5 Space supervision
15.Management of incisor crowding
1. Classification of incisor crowding
2. Treatment of minor crowding
3. Treatment of moderate crowding
3.1 Preservation of E space
3.2 Space creation
4. Treatment of severe crowding
4.1 Serial extraction
4.2 Treatment planning
4.3 Timing of serial extraction
4.4 Sequence of serial extraction
4.5 Serial extraction in patients with Class II division 1 malocclusions
4.6 Serial extraction in patients with Class II division 2 malocclusions
4.7 Serial extraction in patients with open bite
4.8 Serial extraction in patients with Class III malocclusions
5. Mandibular Incisor Crowding Caused by Bolton Discrepancy
16.Management of oral habits
1. Non-Nutritive Sucking
1.1 Ethiology
1.2 Effects on occlusion
1.3 Time of treatment
2. Thumb or Finger Sucking
2.1 Ethiology
2.2 Effects on occlusion
2.3 Treatment
• Behavioral modification
• Removable habit breakers
• Fixed habit breakers
3. Pacifier Habits
3.1 Еffects on occlusion
4. Tongue Thrust
4.1 Classification
4.2 Clinical examination
4.3 Treatment
5. Lip sucking or lip interposition habit
5.1 Effects on occlusion
5.2 Treatment
6. Mouth Breathing
6.1 Effects on occlusion
6.2 Etiology
6.3 Clinical examination
6.4 Treatment
6.5 Muscular extras ices
7. Speech problems
8. Bruxism
9. Nail biting habit
17.Orthodontic management of hypodontia
1. Definitions
2. Etiology
2.1 Genetic factors
2.2 Environmental factors:
• Allergy
• Facial trauma
• Maternal medications during pregnancy
• Endocrine disturbances
• Maternal health during pregnancy
• Maternal rubella (German measles) during pregnancy
• Evolutionary dental changes
• Localized inflammation and infection during the initial stage of tooth formation
• Systemic conditions (rickets, syphilis)
• Dysplastic syndromes (ectodermal dysplasia) and abnormalities of the ectodermal structures (discussed later in this chapter)
• Chemotherapy and irradiation
2.3 Association of Hypodontia with Dental Anomalies
3. Effects of hypodontia on occlusion
4. Treatment
4.1 Management of Missing Lateral Incisors
• Space closure by canine substitution
• Space creation and alignment for a prosthesis
• Autotransplantation
4.2 Management of Missing Mandibular Second Premolars
• Space opening
• Space closure
18.Orthodontic management of supernumerary teeth
1. Prevalence
2. Etiology
3. Odontoma
4. Dentigerous Cyst
5. Classification of Supernumerary Teeth
6. Ectopic Eruption of Supernumerary Teeth
7. Late Development of Supernumerary Teeth
8. Effect of Hyperdontia on Occlusion
9. Management
9.1 Early detection and removal
9.2 Early detection and observation
9.3 Late detection and management
9.4 Late development of new supernumerary teeth
19.Diagnosis and management of abnormal frenulum attachments
1. Prevalence
2. Etiology of Midline Diastema
2.1 Lateral incisor hypodontia
2.2 Microdontia of maxillary lateral incisors (peg-shaped lateral incisors)
2.3 Presence of mesiodens or odontoma
2.4 Deleterious oral habits
2.5 Muscle imbalance (lip dysfunction)
2.6 Impinging deep bite
2.7 Anterior Bolton discrepancy
2.8 Pathologic tooth migration
3. Effects of Abnormal Frenum Attachment on Occlusion
4. Differential Diagnosis of Abnormal Frenum
5. Clinical and radiographic signs of true abnormal frenum
6. Management in adults
7. Early treatment procedures
8. Management during the primary dentition
9. Management in infants
10. Frenectomy procedure
11. Ankyloglossia (Tongue-Tie)
20.Early detection and treatment of eruption problems
1. Phases of Tooth Eruption
2. Mechanisms of Eruptive Tooth Movement
3. Permanent teeth eruption
• Factors That Can Disturb Tooth Eruption
4.Types of Eruption Disturbance
4.1 Disruptions in timing
• Delayed tooth eruption
– Etiology
– Diagnosis
– Treatment
• Early exfoliation of primary teeth and premature eruption of permanent teeth
– Etiology
• Failure of eruption (PFE and secondary failure of eruption)
– Etiology
– Treatment
• Retarded tooth development
• Abnormal sequence of eruption
– Eruption of the second molars before the premolars
– Eruption of the maxillary canines before the premolars
– Eruption of the mandibular first premolars before the canines
– Eruption of the maxillary canines before the first premolars
– Eruption of the maxillary second molars before the mandibular second molars
– Eruption of the maxillary lateral incisors before the central incisors
– Asymmetric eruption in the left and right sides of the arch
4.2 Disruptions in position are:
• Ectopic eruption
– Prevalence
– Etiology
– Treatment
– Distalization appliances
• Transposition
– Classification
– Incindence
– Etiology
– Diagnosis
– Treatment
• Impaction
Maxillary canine impactation
• Incidence
• Ethiology
• Diagnosis
• Treatment
Mandibular canine impactation
• Ankylosis
• Incidence
• Etiology
• Diagnosis
• Treatment
21.Orthodontic treatment of dentoskeletal problems
1. Strategies of early treatment
2. Class II malocclusion
2.1 Characteristics
2.2 Diagnostic procedures
2.3 Advantages
2.4 Treatment options
2.4.1 Camouflage treatment
2.4.2 Orthognathic surgery
2.4.3 Growth modification and occlusal guidance
• Functional appliances
• Extraoral traction
• Lip bumper
• Hawley appliance
2.4.4 Two-phase strategy for Class II division 1 malocclusion
2.4.5 One-phase strategy for Class II division 1 malocclusion
2.4.6 Strategy for Class II division 2 malocclusion
3. Anterior Dental Crossbite and Class III Malocclusion
3.1 . Simple dental crossbite
• Classification
• Etiology
• Treatment
3.2. Pseudo-Class III malocclusion (functional crossbite)
• Etiology
• Treatment
3.3 Skeletal Class III and potential Class III malocclusion
• Treatment – Face mask, Modified Tandem
22.Management of transverse problems
1. Posterior crossbite
1.1 Characteristics
1.2 Etiology
1.3 Consequence of delayed treatment
1.4 Advantages of early treatment
1.5 Classification
• Functional crossbite
• Buccal crossbite
• Lingual crossbite
• Palatal crossbite
• Scissors bite
• Brodie syndrome
1.6 Diagnosis
1.7 Early Treatment Strategies
• W- arch
• Quad helix expander
• Haas expander
• Hyrax expander.
• Bonded expander
• Removable expanders
23.Management of vertical problems
1. Open bite
1.1 Etiology
• Finger sucking
• Tongue force
• Mouth breathing
• Genetics
1.2 Characteristics
1.3 Dental open bite
1.3.1 Type I simple dental open bite
1.3.2 Type II combined dental open bite
1.3.3 Type III dentoskeletal open bite
1.3.4 Treatment
• Treatment in the primary dentition
• Treatment in the mixed dentition
1.4 Skeletal open bite
2. Deep bite
2.1 Etiology
2.2 Characteristics
2.3 Dental deep bite
2.4 Skeletal deep bite
2.5 Factors influencing the extent of overbite
2.6 Treatment
2.6.1 Early Treatment Strategies for Deep Bite
2.6.2 Treatment of skeletal deep bite
• Treatment in primary dentition
• Treatment in mixed dentition
24.Orthodontic treatment in the early permanent dentition
1.Space Gaining Procedures
1.1 Extraction as a Method to Gain Space
1.2 Extraction versus Nonextraction Controversy
1.3 Extraction Choice
1.4 Interproximal Enamel Reduction
• Indications and Contraindications
• Steps Involved in Interproximal Reduction
• Techniques for Enamel Reduction
1.5 Derotation of Posterior Teeth
1.6 Uprighting of Tilted Posterior Teeth
1.7 Proclination of Anterior Teeth
1.8 Arch Expansion
1.9 Molar Distalization
• Upper Molar Position
• Influence of Second Molar on Molar Distalization
• Indications and Contraindications
• Complications of Molar Distalization
2.Treatment of Class I Malocclusions
2.1 Arch Length Deficiency
2.2 Expansion
2.3 Extractions
2.4 Treatment Sequence for Class I Malocclusion Correction
• Alignment
• Correction of crossbites
• Alignment of impacted tooth
• Closure of diastema or anterior spacing
• Leveling
• Space closure
• Detailing and final settling followed by retention.
25.Development of a vertical problem
1. Diagnosis of vertical discrepancies
1.1 Long face patients
1.2 Short face patients
1.3 Cephalometric characteristics
1.4 Vertical Class II type
1.5 Treatment planning
2. Deep bite
2.1 Types of deep bite.
2.2 Possible treatment options to open a deep bite
• Anterior bite plane
• Anterior bite plane with intermaxillary elastics
• Bite ramps
• Individual bypass
• Incisal bracket bonding.
• Intrusion bend
• Tip back
• Use of a reverse curve
• Utility Arch
• CIA (Connecticut Intrusion Arch)
• Intrusive arch with loops
• Headgear
3. Open bite
3.1 Etiology
• Local Factors
• General Factors
3.2 Types of open bite
3.3 Clinical characteristics
3.4 Treatment Options
• In block extrusion bend
• Second order or individual extrusion bend
• Reverse curve
• Individual bypass
• In block bypass
• Inverted tip back
• Posterior bite block
• Posterior intrusion block with TMA wire
• High Pull Headgear
• TPA or Chromosome arch with acrylic button
• intermaxillary elastics
• Bracket bonding closer to the gingival margin
• Maxillary surgery
• Glossectomy
26.Transverce discrepancies
1. Development of crossbite
1.1 Classification
2. Posterior cross bite
2.1 Etiology of posterior cross bites
2.1.1Genetic factors
2.1.2 Habits
• Mouth breathing
• Finger sucking
• Infantile deglutition
• Lingual interposition
2.1.3 Interferences and occlusal factors
• Trauma
• Other causes
2.2 Types of posterior cross bites
• Functional cross bite
• Dentoalveolar cross bite
• Skeletal cross bite
• Scissors bite
2.3 Diagnosis for posterior cross bite
2.4 Variables that can have influence in the correction of posterior cross bites
• Teeth inclination
• Lateral functional displacement during mandible closure
• Estimation of the necessary expansion
• Age of the patient
• Vertical changes
2.5 Reasons and timing of treatment of posterior cross bites
3 Disjunction
3.1 Effects of disjunction
3.2 Effects on the maxillary complex
3.3 Effects on the alveolar process
3.4 Dental effects
3.5 Effects on the mandible
3.6 Effects on the adjacent facial structures
3.7 Disjunction indications and Counter indications
4. Treatment for posterior cross bite
• Quad Helix
• Transpalatal arch with an extension arm
• Inverted NiTi arch
• Overlay
• Crossed elastics or “Z” elastics
• Hass
• Hyrax
• Surgical disjunction
27.Treatment of sagittal discrepancies
1. Development of a sagittal problem
2. Diagnosis of sagittal discrepancies
3. Class II malocclusion
3.1 Clinical examination and functional assessment
3.2 Morphologic characteristics
3.3 Treatment planning
3.3.1 Dentoalveolar Class II malocclusions
– Maxillary distalization
Fixed distalizers – open coil spring, elastic NiTi wires or Dr Richard Vlock’s technique, sliding hooks, Pendulum appliance, Distal jet
Removable disalizers – Cetlin plate, Veltri distalizer, Belussi Distalizer
– Non extraction headgear treatment
3.3.2 Functional Class II with distally forced bite
3.3.3 Skeletal Class II with maxillary prognathism
• Extraction treatment
• Management of the extraction space
• Indications and contraindications
• Extraction pattern in class II cases
• Extraction space closure biomechanics by
1. Elastics,
2. Coils,
3. Loops:
• The open ”I” loop.
• The closed ”I” loop.
• The closed helicoid ”I” loop,
• Ricketts loop.
• Bull or Keyhole loop,
• The “T” loop,
• The segmented “T” loop,
• The utility retraction loop.
• The DKL (Double Key Loops).
4. Retroligature
3.3.4 Skeletal Class II with prognathism and anteinclination of maxilla
3.3.5 . Skeletal Class II with retrognathic mandible
4. Class III malocclusion
4.1Treatment Problems
4.2 Anterior cross bite
• Etiology
• Clinical evaluation
• Classification – Dental anterior cross bite, Functional anterior cross bite, skeletal anterior cross bite
• Differential diagnosis between true and Pseudo Class III malocclusion
• Treatments for anterior cross bites
1. Dentoalveolar Class III
– Extraction treatment
– Forward arch
– Bite block
– Lingually placed bracket
2. Functional Class III malocclusion (with pseudo-forced bite or anterior displacement)
3. Class III malocclusion with retruded maxilla
– Face mask treatment
– Orthognathic surgery
4. Class III malocclusion with mandibular prognathism
– Orthognathic surgery
5. Class III malocclusion with a combination of maxillary retrognathism and mandibular prognathism
28.Adult Orthodontics
1 Potential Adult Orthodontic Patients
2 Diagnosis: Chief Complaint and Problem List
2.1 Problem list
2.2 General health
2.3 Clinical examination
• Extraoral examination
• Extraoral photographs
• Function of the masticatory system
• Intraoral analysis
• Occlusal analysis
• Cephalometric analysis
• Final problem list
2.4 Aetiology of malocclusion
2.5 Age-related changes in the skeleton
2.6 Age-related changes in the craniofacial skeleton
2.7Age-related changes in the local environment
2.8 Consequences of deterioration of the dentition
3. Interdisciplinary Versus Multidisciplinary Treatments 3.1Treatment sequence
• Essential and optional treatment procedures
3.2 Orthodontist related factors
3.3 Patient related factors
4. Treatment of adult patients
4.2 Sequencing the treatment into phases
4.3 Anchorage
4.4 Appliance selection and design
• Removable appliance
• Fixed appliance
• Continuous archwires
• Segmented mechanics
• Loops
• Power arms
• Cantilevers
5. Anchorage
5.1 Classification of anchorage
5.2 Intramaxillary anchorage
5.3 Soft tissue anchorage
5.4 Free anchorage
5.5 Intermaxillary anchorage
5.6 Extraoral anchorage
5.7 Skeletal anchorage
• Temporary anchorage devices
6. Material-related Adverse Reactions in Orthodontics
6.1 Nickel allergy
6.2 Chromium allergy
6.3 Elastics and latex products
7. Patients with Periodontal Problems
7.1 Indications for orthodontic treatment in periodontally involved patients
7.2 Treatment of patients with flared and extruded upper incisors
7.3 Tissue reaction to intrusion of teeth with horizontal bone loss
7.4 Treatment of patients with vertical bone defects
7.5 Periodontal limits for orthodontic tooth movement
7.6 Sequence of treatment in periodontally involved patients
8. Systematic Approach to the Orthodontic Treatment of Periodontally Involved Anterior Teeth
8.1 Etiology
8.2Amount of keratinized gingiva
8.3 Gingival recession and proclination of lower incisors
8.4 Progressive spacing of incisors
8.5 Management
9. Interdisciplinary Collaboration Between Orthodontics and Periodontics
9.1 Periodontal diagnosis
9.2 Local factors predisposing to periodontal therapy
9.3 Timing of ortho-perio treatment
9.4 Periodontal therapy
9.5 Surgical therapy
• Mucogingival and aesthetic surgery
• Supportive periodontal treatment
29.Finishing the orthodontic case
1. Adjustment of individual tooth position
1.1 Initial bracket positioning
1.2 Primary expression of bracket prescription and position
1.3 Reset evaluation
1.4 Reset appointment
1.5 Secondary expression and finishing
2. Incisor torque
3. Correction of vertical incisor relationships
4. Excessive Overbite
5. Anterior open bite
6. Midline discrepancies
7. Final “settling” of teeth
8. Positioners
9. Debonding
9.1. Mechanical debonding
• Base method
• Wing method
• Debonding by bracket removing plier
• Debonding by ligature cutter plier
• Debonding by Weingard plier
• Howe plier
• Lift-off Debonding Instrument (LODI
• Bracket and adhesive removing plier
• Self – ligating bracket removing
• Lingual bracket debonding
• Debonding of esthetic brackets
9.2 Debonding by solvents
9.3. Debonding by Notching
9.4. Ultrasonic debonding
• Choice of tip
9.5. Impulse debonding
9.6. Thermal debonding
• Effects on enamel
• Effects on pulp
10. Removal of adhesive
10.1 Hand instrumentation for adhesive removal
10.2 Adhesive removing pliers
10.3 Ligature wire cutters
10.4 Hand Scalers
10.5 Burs
• Carbide burs
• Diamond burs
11. Finishing and polishing
12. Special finishing procedures to avoid relapse
• Control of unfavorable growth
• Control of Soft Tissue Rebound
• Crossbite Correction
• Adjunctive Periodontal Surgery
30.Combined Orthodontic and Prosthetic treatment
1. Introduction
2. Edentulousness and space management
2.1 The mesiodistal dimension
• Unilateral agenesis of the maxillary lateral incisors
• Bilateral agenesis of the maxillary lateral incisors
• Bonded prosthetic solution
• Implant solution
2.2 The vertical dimension
• Uprighting the dental axes
• Orthodontic extrusion in implant site
• Orthodontic Forces Necessary for Tooth Extrusion
• Stabilization After Tooth Extrusion
• Contraindications and limitations of tooth extrusion
• Orthodontic Tooth Extrusion Technique
3. Orthodontics, periodontal disease and prosthetic splinting
31.Minor Tooth Movement
1. Definition
2. The tilted posterior tooth
2.1 Etiology
2.2 Clinical symptoms
• Tilting of molar
• Tilting of premolar
• Space loss
2.3 Prevention
2.4 Treatment
• Removable appliance
• Open coil spring
• Helical uprighting spring
• Single T-Ioop appliance
• Double T-Ioop appliance
• Box spring appliance
• Uprighting molars using miniscrew anchorage
2.5 Retention
3. Orthodontic intrusion of teeth
3.1 Intruding a single maxillary tooth with a removable device
3.2 Maxillary molar intrusion with temporary anchorage devices
32.Cleft Lip and Palate
1. Definitions
2. Prenatal development of lip and palate
2.1 Development of the nose
2.2 Development of the secondary palate
3. Cleft Lip with/without Cleft Palate (CL and CLP)
3.1 Anatomy and function in cleft situations
• Lip
• Nose
• Upper alveolus
• Mandible
• Hard palate
• Soft palate
3.2 Classification
3.3 Etiology
3.4 Dental development with clefts
3.5 Development of the occlusion
3.6 Prenatal diagnosis
4. Treatment
4.1 Presurgical Maxillary Orthopaedics
4.2 Early Orthodontics (5–8 Years Old)
4.3 Conventional Orthodontics (11–15 Years Old)
4.4 Late and Retreatment Adult Orthodontics
33.Summary of Treatment Planning for Different Malocclusions
1.Management of Intra-Arch Problems
● Crowding
● Spacing
● Median Diastema/Midline Diastema
● Transposition
● Rotation
2. Management of Transverse Malocclusions
2.1 Types of Crossbites
● Anterior Crossbite
● Posterior Crossbite
● Facial Asymmetry
3. Management of Vertical Malocclusions
3.1 Deep Bite
3.2 Open Bite
3.3 Short Face/Low Angle Cases/Hypodivergent Face
3.4 Long Face/Hyperdivergent Face/Features of High Angle Case
4.Management of Sagittal Malocclusions
4.1 Class II Division 1 Malocclusion
4.2 Incisor Edge–Centroid Relationship/Edge–Centroid Relationship
4.3 Class II Division 2 Malocclusion
4.4 Class III Malocclusion
4.5 Pseudo-Class III Malocclusion
4.6 Bimaxillary Protrusion
34.Patients with Temporomandibular Disorders
1. Incidence
2. Patient Examination
2.1 Chief complaint
2.2 Medical history
2.3 Dental history
2.4 Clinical examination
• General inspection of the head and neck
• Masticatory and cervical muscle evaluation
• Neurovascular evaluation
• Intraoral evaluation
3. Classification of TMD
4. Joint disorders
4.1 Congenital or developmental disorders
4.2 Disk derangement disorders
4.3 Temporomandibular joint dislocation
5. Inflammatory conditions
5.1 Synovitis
5.2 Osteoarthritis
6. Ankylosis
7. Fracture
8. Masticatory muscle disorders
8.1 Myofascial pain
8.2 Fibromyalgia,
8.3 Myositis
8.4 Myospasm
8.5 Myofibrotic contracture
8.6 Neoplasm
8.7 Local myalgia – unclassified
9. Diagnosis
9.1 Intracranial and vascular pain disorders
9.2 Neurogenic pain
9.3 Migraine headaches
9.4 Tension-type headaches
9.5 Extracranial pain disorders
9.6 Mental health disorders
10. Connection between malocclusion and TMD
11. Costen syndrome
12. Connection between orthodontic treatment and TMD
13. Treatment
13.1 Patient education
13.2 Cognitive behavioral intervention
13.3 Pharmacotherapy
13.4 Physical medicine
13.5 Orthopedic appliance therapy
13.6 Occlusal therapy
13.7 Surgery
35.Orthodontic treatment of impacted teeth
1. Diagnosis of impacted teeth
2. Localization of the Bony Crypts of the Maxillary Permanent Teeth
2.1 Incisors
2.2 Canines
3. Intraosseous Eruptive Pathways
4. Relationship of Malpositioned Tooth Buds to Anatomic Structures
5. Orthodontic and radiographic assessment of impacted teeth
5.1 Orthodontic Assessment
• Examination
• Radiographic assessment
• Preventive Treatment of Impactions
• Supernumerary Teeth and Odontomas
6. Impacted Maxillary Canines
6.1 Diagnosis
6.2 Assessment
6.3 Interceptive treatment
• Extraction of primary canines
• Expansion of the anterior maxilla
• Distalization of the buccal segments
• Extraction of permanent teeth
6.4 Criteria for Choosing Orthodontic and Surgical Protocol
• Surgical Approaches to Impacted Teeth
6.5 Stages of Orthodontic Treatment
• Opening space in the dental arch
• Preparing anchorage and the active unit
• Preoperative protocol for bonding the attachment
• Moving the impacted tooth – Ballista spring
• Final detailing and retention
7. Labially impacted maxillary canines
7.1 Etiology
7.2 Interceptive Treatment
7.3 Surgical uncovering techniques
7.4 Biomechanics
7.5 Important considerations
8. Palatally impacted canines
8.1 Surgical uncovering techniques
• Simple impactations
• Complex impactations
• Adult impactations
9. Impacted mandibular canine
9.1 Vertically Impacted Canines
9.2 Horizontally impacted canines
10. Impacted maxillary central incisors
10.1 etiology
10.2 Surgical uncovering techniques
10.3 Postoperative orthodontics
11. Impacted premolars
11.1 Surgical uncovering techniques
11.2 Postoperative orthodontics
12. Impacted mandibular molars
12.1 First molars
12.2 Second Molars
36.Orthodontic Mini implants
1. Skeletal anchorage
1.1 Basic components of the screw
1.2 Biological aspects of implantation
1.3 Stability of orthodontic mini-implants
1.4 Specifications of mini implants
1.5 Orthodontic loading
1.6 Insertion sites
• Buccal alveolus
• Posterior palatal alveolus
• Midpalatal suture
• Anterior nasal spine and anterior alveolus
• Anterior rugae
• Infrazygomatic crest
• Maxillary tuberosity
• Buccal alveolus
• Edentulous area
• Retromolar area
• Anterior and lingual alveolus
1.7 Surgical procedures
• Self drilling
• Predriling type
2. Anterior –posterior treatment
2.1 Anterior retraction
• Treatment planning, biomechanics, and mechanics
• Treatment options
• Biomechanical principles
• Posterior mini-implant clinical steps
2.2 Posterior distalization
• Treatment planning, biomechanics, and mechanics
• Treatment options
• Biomechanical principles
• Clinical steps for mandibular distalization
• Clinical steps for palatal alveolar distalization
• Clinical steps for a mid-palatal distalizer
2.3 Molar protraction
• Treatment planning, biomechanics, and mechanics
• Treatment options
• Biomechanical principles
• Clinical steps for molar protraction using alveolar site anchorage
• Clinical steps for mid-palate (indirect) anchorage
3. Vertical control
3.1 Anterior intrusion
• Treatment planning, biomechanics, and mechanics
• Treatment options
• Biomechanical principles
• Clinical steps for Anterior intrusion
3.2 Anterior extrusion
• Treatment planning, biomechanics, and mechanics
• Treatment options
• Biomechanical principles
3.3 Posterior molar intrusion
• Treatment planning, biomechanics, and mechanics
• Strategies for intrusion of the maxillary dentition
• Strategies for intrusion of the mandibular dentition
• Biomechanical principles
• Clinical steps for maxillary molar intrusion
4. Maxillary transverse expansion
4.1 Bone anchored Rapid palatal expansion
4.2 Surgically Assisted RPE (SARPE) with Bone-Anchored Expander
5. Asymmetric transverse control
• Treatment planning, biomechanics, and mechanics
• Biomechanical principles
• Clinical steps for centerline correction
6. Unilateral intrusion (vertical asymmetry correction)
• Treatment planning, biomechanics, and mechanics
• Treatment options
• Biomechanical principles
• Clinical steps for unilateral intrusion
7. Transverse correction of ectopic teeth
• Treatment options
• Biomechanical principles
• Clinical steps for ectopic tooth alignment
37.Self ligation in orthodontics
1. Evolution of Ligation and Appliances
1.1 Begg pins
1.2 Self ligation
• Edgelok brackets
• SPEED brackets
• Mobil-Lock brackets
• Activa brackets
• Time2 bracket
• Damon SL brackets
• Damon 2 brackets
• Damon 3 and Damon 3 MX brackets
• System R brackets
• Quick brackets
• SmartClip bracket
2. The self ligating bracket
2.1 Bracket body
2.2 Slot
2.3 Auxiliary Slots
3. Active and passive systems
4. Properties of an Ideal Ligation System
5. Friction and self ligation
6. Torque expression of self-ligating brackets
6.1 Torque expression
6.2 Torque loss
7. Treatment with self ligating brackets
7.1 Archwire Sequence
7.2 Auxiliaries
7.3 Ligation of Archwires
7.4 Reduction of Overall Treatment Time
7.5 Retention
7.6 Longer Intervals between Adjustments
8. Cost and Treatment Efficiency
38.Pain, Lesions and Emergencies during Orthodontic Treatment
1. Introduction
2. Pain in orthodontics
2.1 Antipyretic analgesics
• Acetaminophen
• Sodium dipyrone-Metamizol
2.2 Non steroidal anti-inflammatory drugs (NSAID)
• Propionic acid derivates
• Carboxylic acid derivates
• Acetic acid derivates
• Oxicam derivates
• Non-acidic derivates
2.3 Vibrating stimuli
2.4. Laser therapy in pain reduction
3. Lesions and urgencies during orthodontic treatment
3.1 External apical root resorption (EARR)
3.2 Oral lesions
3.3 Gingival inflammation
3.4 Orthodontic movements
3.5 Poorly adapted molar bands
3.6 Lesions caused by elastic chain
3.7 Lesions caused by fixed or removable appliances
39.Clear Aligner Treatment
1. Introduction
2. History of clear aligners
3. Tooth movement biomechanics
4. Biomechanics with aligners
5. Attachments
• Bonding of attachments
• Ellipsoidal attachments
• Vertical rectangular attachments
• Horizontal rectangular attachments
• Beveled rectangular attachments
• Optimized Attachments
6. Advantages of aligner treatment
7. Disadvantages of the aligner Treatment
8. Steps in aligner treatment
8.1 Taking the impression
8.2 Photographs
8.3 Radiographs
8.4 Treatment options
• Full treatment
• 3–3 treatment
• Express treatment
8.5 Resolving of crowding
• Teeth proclination
• Arch expansion
• Extraction
• IPR
9. Treatment of open bite
10. Treatment of deep bite
11. Space Closure
12. Treatment of cross bite
13. Class II Correction
14. Class III correction
40.Lingual Orthodontics
1. Historical Perspective
1.1 Difficulties during the development
2. Advantages and Disadvantages of Lingual Therapy
2.1 Intrusion of anterior teeth.
2.2 Maxillary arch expansion.
2.3 Combining mandibular repositioning therapy with orthodontic movements.
2.4 Distalization of maxillary molars
3. Bracket positioning
3.1 Laboratory Procedures
3.2 Indirect Bonding procedure
4. Methods of Ligation
5. Archwire sequence
6. Instruments used in lingual orthodontics
7. Anchorage Control
7.1 Anchorage control in the Upper Arch
• Maximum anchorage
• Moderate anchorage
• Minimum anchorage
7.2 Anchorage in the Lower Arch
• Maximum anchorage
• Moderate anchorage
• Minimum anchorage
8. Use of Quad Helix in Lingual Orthodontics
9. Partial Canine Retraction
10. Use of Coil Springs
11. Use of Elastics
12. Interproximal Enamel Reduction in Lingual Orthodontics
13. Correction of deep bite
14. Correction of open bite
15. Distalization Treatment
16. Space closing loops
17. Finishing the case
18. Lingual Orthodontics in Pediatric Patients
41.Retention in orthodontics
1. The need for retention
1.1 Reorganization of periodontal ligament
1.2 Occlusal Changes Related to Growth
2. Retention After Class II Correction
3. Retention After Class III Correction
4. Retention After Deep Bite Correction
5. Retention After Anterior Open Bite Correction
6. Retention of Lower Incisor Alignment
7. Timing of Retention
8. Removable retainers
8.1 Hawley retainer
8.2 Wrap around retainer
8.3 Elastic wrap around retainer
8.4 Van der Linden retainer
8.5 Sarhan all wire retainer
8.6 Spring aligner
8.7 Osamu retainer
8.8 Essix
8.9 Reinforced Essix
9. Fixed retainers
9.1 Prefabricated
9.2 Adapted on the patient (made to fit
10. Removable retainers vs. fixed retainers.
11. Correction of Occlusal Discrepancies
11.1 Modified Functional Appliances as Active Retainers
42.Sleep Apnea
1. Introduction
2. Signs and symptoms
3. Physical examination of the patient
3.1 Adult apneic event
3.2 Pediatric apneic event
4. Effect of anatomy on respiration
5. OSA in children
5.1 Diagnosis
5.2 Orthodontic management
• Treatment involving the maxilla
• Treatment involving the mandible
6. OSA in adults
6.1 Diagnosis
6.2 Cephalometrics
6.3 Examination of the tongue, soft palate, and tonsils
6.4 Management
• Non – surgical treatment – mandibular advancement
• Orthognathic surgery management
7. Questionnaire and treatment planning for the OSA patient.
43.Treatment of dilacerated teeth
1. Dilacerated teeth
1.1 Definition
1.2 Ethiology
1.3 Epidemiology
1.4 Clinical features of dilacerations
1.5 Radiologic features of dilacerations
1.6 Prognosis
1.7 Treatment
2. Ankylosed teeth
2.1 Definition
2.2 Ethiology
2.3 Diagnosis
2.4 Treatment
• Ankylosed deciduous molars
• Ankylosed permanent molars
3. Tooth transposition
3.1 Prevalence
3.2 Etiology
3.3 Classification
3.4 Treatment
44.Treatment of patients with asymmetry
1. Introduction
2. Classification of asymmetry
3. Etiology and diagnosis
3.1 Skeletal asymmetry
3.2 Dental asymmetry
4. Treatment
4.1 Correction of Unilateral Molar Rotation
4.2 Treatment of the Class II Subdivision Malocclusion
• Unilateral class II elastics wear
• Unilateral tip-back bends incorporated in 2 × 4 appliances
• Jasper jumper appliance
• Asymmetric headgear
• Unilateral Tip-Back Mechanics
4.3 Treatment of diverging occlusal planes
• Canted anterior occlusal plane
• Canted posterior occlusal plane
4.4 Unilateral dental crossbite
4.5 Asymmetric dental arch form
45.Minor Surgical Procedures
1. Minor surgical procedures
1.1 Frenectomy
• Diagnosis
• Treatment
1.2 Gingival enlargement during orthodontic tooth movement
1.3 Circumferential fiberotomy
1.4 Supracrestal Fiberotomy
1.5 Autotransplantation
2. Orthognathic surgery
2.1 Malocclusions indicated for surgery
2.2 Esthetic and Psychosocial Considerations
2.3 Contraindications to surgery
2.4 Orthodontic camouflage versus surgery
2.5 Diagnosis and treatment planning
• Evaluation of Face
• Smile analysis
2.6 Diagnostic Features of Common Dentofacial Deformity
2.7 Surgical procedures
2.7.1 Mandibular Surgery
• The sagittal split osteotomy
• Vertical subsigmoid osteotomy
• Genioplasty
• Anterior subapical osteotomy
2.7.2 Maxillary Surgery
• The LeFort I osteotomy
• Segmental osteotomy
2.7.3 Dentoalveolar Surgery
• Distraction Osteogenesis
2.7.4 Adjunctive Facial Procedures
• Chin Augmentation or Reduction
• Rhinoplasty
• Implants for Facial Soft Tissue Contours
• Submental Procedures
2.8 Timing of Surgery
2.9 Presurgical objectives
• Intra-arch objectives
• Anteroposterior (sagittal) objectives
• Transverse objectives
• Vertical objectives
2.10 Objectives during surgery, fixation, and immediately postfixation
2.11 Postsurgical and retention objectives
2.12 Postsurgical Stability and Clinical Success
2.13 Risks of orthognathic surgery