Angle's classification method

Class I with severe crowding andlabially erupted canines

Class II molar relationship

Edward Angle, who is considered the father of modern orthodontics, was the first to classify malocclusion. He based his classifications on the relative position of the maxillary first molar.^[2] According to Angle, the mesiobuccal cusp of the upper first molar should align with thebuccal groove of the mandibular first molar. The teeth should all fit on a line of occlusion which is a smooth curve through the central fossae and cingulum of the upper canines, and through the buccal cusp and incisal edges of the mandible. Any variations from this resulted in malocclusion types. It is also possible to have different classes of malocclusion on left and right sides.

§ Class I: Neutrocclusion Here 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.

§ 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.

§ Class III: Mesiocclusion (prognathism, negative overjet) In this case the upper molars are placed not in the mesiobuccal groove but posteriorly to it. The mesiobuccal cusp of the maxillary first molar lies posteriorly to the mesiobuccal groove of the mandibular first molar. Usually 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.

[edit]Crowding of teeth

Crowding of teeth is where there is insufficient room for the normal complement of adult teeth.

[edit]Cause

Extra teeth, lost teeth, impacted teeth, or abnormally shaped teeth have been cited as causes of malocclusion. Ill-fitting dental fillings, crowns, appliances, retainers, or braces as well as misalignment of jaw fractures after a severe injury are other causes. Tumors of the mouth and jaw childhood habits such as thumb sucking, tongue thrusting, pacifier use beyond age 3, and prolonged use of a bottle have also been identified as causes.^[3]

A 2011 paper suggested that "the changes in human skulls are more likely driven by the decreasing bite forces required to chew the processed foods eaten once humans switch to growing different types of cereals, milking and herding animals about 10,000 years ago."^[4]

[edit]Treatment

Crowding of the teeth is treated with orthodontics, often with tooth extraction, dental braces, followed by growth modification in children or jaw surgery (orthognathic surgery) in adults. Surgery may be required on rare occasions. This may include surgical reshaping to lengthen or shorten the jaw (orthognathic surgery). Wires, plates, or screws may be used to secure the jaw bone, in a manner similar to the surgical stabilization of jaw fractures. Very few people have proper teeth alignment. However, most problems are very minor and do not require treatment.^[3]

[edit]Other conditions

Open bite treatment after eight months of braces

Other kinds of malocclusions are due to vertical discrepancies. Long faces may lead to open bite, while short faces can be coupled to adeep bite. However, there are many other more common causes for open bites (such as tongue thrusting and thumb sucking), and likewise for deep bites.

Malocclusions can also be secondary to transverse skeletal discrepancy or to a skeletal asymmetry.

[edit]Etiology

Oral habits and pressure on teeth or the maxilla and mandible are etiological factors in malocclusion.^[5][6]

In the active skeletal growth^[7] mouthbreathing, finger sucking, thumb sucking, pacifier sucking, onychophagia (nail biting), dermatophagia, pen biting, pencil biting, abnormalposture, deglutition disorders and other habits greatly influence the development of the face and dental arches.^{[8][9][10][11][12]}

Pacifier sucking habits are also correlated with otitis media.^[13][14]

Dental caries, periapical inflammation and tooth loss in the deciduous teeth alter the correct permanent teeth eruptions.

[edit]References

1. ^ Gruenbaum, Tamar. Famous Figures in Dentistry Mouth - JASDA 2010;30(1):18

2. ^ "Angle's Classification of Malocclusion". Archived from the original on 2008-02-

SMK- Composite Bridge System

From Wikipedia, the free encyclopedia

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[edit]History

In 1992, the first SMK treatment was performed in the Orthodontic Department of the Pomeranian Medical School in Szczecin, Poland , by dr. C. Turostowski. At the beginning it was treated as a temporary solution. However, after seven years, due to continuing research the SMK method became increasingly used as a permanent option.

Initially, SMK treatment was for orthodontic patients with missing lateral incisors. Later, was applied to patients with other missing teeth especially premolars. In some cases SMK was used together with veneers so as to give it a more cosmetic and natural look. Shortly afterwards SMK was introduced as a method for other dental patients not only orthodontics patients.

The SMK (Composite Bridge System) method is a collective name for different variations of the same original method.^[1]

After seven years of extensive research in June, 1999 dr.C. Turostowski completed his Phd - "SMK – composite bridge of own construction applied in the rebuilding of lateral incisors".

In 2003 many dental courses for dentists,^[2] dental workshops at medical schools and orthodontics departments were organised around Poland.

[edit]About SMK method

The SMK (tooth in one day) method is an adhesive restorative prosthedontic solution. The method basically involves the dentist modelling and shaping a tooth from composite materials in the gap between the teeth. In some cases a porcelain veneer is then placed on the new tooth to give it a more natural look. The tooth is attached to the neighbouring teeth also with composite materials. In 2011 over 1000 SMK treatments were performed^[3] mostly lateral incisors.

The main advantage of this method is that there is no grinding of neighbouring teeth. Therefore, the neighbouring teeth are not damaged. This means that the patient can at any time revert back to their natural teeth. This method can also be used in situations where other solutions are not applicable. For example, if there is not enough bone and and implantscannot be inserted, or the grinding and damaging of neighbouring teeth for a normal dental bridge is not accepted by the patient, or the cost of alternative treatments is too high for the patient. The SMK method is the best solution in all these cases. The dentist makes the tooth in the surgery (dental technician is not needed), therefore,the whole treatment only takes 2 hours.

[edit]

Informed Consent for the Orthodontic Patient

As a general rule, positive orthodontic results can be achieved by informed and cooperative patients. Thus, the following information is

routinely supplied to all who are considering orthodontic treatment. While recognizing the benefits of healthy teeth and a pleasing smile,

you should also be aware that orthodontic treatment has limitations and potential risks. These are seldom serious enough to indicate that

treatment should be avoided, but they should be considered in making the decision whether or not to undergo orthodontic treatment.

Orthodontic treatment usually proceeds as planned; however, as in all areas of the healing arts, results cannot be guaranteed, nor can all

consequences be anticipated.

Orthodontics plays an important role in improving one's oral health, and in achieving balance and harmony between the teeth

and face for a beautiful, healthy smile.

Because of individual conditions present and the limitations of treatment imposed by nature, each specific benefit may not be

attainable for every patient. The unknown factor in any orthodontic correction is the response of the patient to the orthodontic

treatment.

Orthodontics strives to improve the bite by helping to direct the forces placed on teeth, thus protecting them from trauma

during ordinary everyday activities, such as chewing. Orthodontics distributes the forces of chewing throughout the mouth to

minimize stress on bones, roots, jaw joints, and gum tissue. Orthodontic treatment may eliminate potential dental problems,

including abnormal tooth wear. It may also reduce tooth decay and future periodontal problems by making it easier to care

for the teeth and gums by aiding good oral hygiene.

Risks

All forms of medical and dental treatment, including orthodontics, have risks and limitations. Fortunately, complications are

infrequent in orthodontics, and when they do occur, they are usually of minor consequence. Nevertheless, they should be

taken into account in dealing whether to undergo orthodontic treatment. Some of the primary concerns involved in

orthodontic treatment may include:

1. Tooth decay, gum disease, or permanent white markings (decalcification) on the teeth can occur, particularly if the

orthodontic patient eats foods containing excessive sugar and/or does not brush his/her teeth frequently and properly. These

same problems can occur without orthodontic treatment, but the risk is greater to an individual wearing braces or appliances.2. In some patients, the roots of some teeth may be shortened during orthodontic treatment. Usually this shortening is

minimal and does not have significant consequences, but on rare occasions it may become a threat to the longevity, stability,

and/or mobility of the teeth involved.

3. The bone and gum tissue which support the teeth may be affected by orthodontic tooth movement if an unhealthy

conditions already exists and in some rare cases where it doesn't. In general, however, orthodontic treatment lessens the

possibility of tooth loss or gum infection due to misalignment of the teeth or jaws. Inflammation of the gum tissue and loss of

supporting bone can occur particularly if bacterial plaque is not removed daily through good oral hygiene.

4. Teeth may have a tendency to change their positions after treatment. Proper wearing of retainers should reduce this

tendency. Throughout life the bite can change adversely from various causes, such as eruption of wisdom teeth, genetic

influences which control the size of the tongue, the teeth and the jaws, growth and/or maturational changes, mouth breathing,

playing of musical instruments and other oral habits – all of which may be beyond the control of the orthodontist. There are

times when tooth and/or jaw position may change adversely following treatment to a degree that additional treatment is

recommended. The length of further treatment would depend on, among other things, the nature of the problem and might

involve a variety of potential treatment modalities including the replacement of braces.

5. Occasionally problems may occur in the jaw joints, i.e., temporomandibular joints (TMJ), causing pain, headaches or ear

problems. These problems may occur with or without orthodontic treatment. Any of the above noted symptoms should be

promptly reported to the orthodontist.

6. Development and eruption of teeth is a complex process. Occasionally, primary teeth become fused to the bone

(ankylosis) and will not move. This is particularly true when there is no permanent successor (tooth underneath). The fused

primary tooth then remains lower than the rest of the teeth which continue to erupt during normal development. This problem

can also occur with permanent teeth.

7. A tooth/teeth may have been traumatized by an accident or a tooth may have large fillings that can cause damage to the

nerve of the tooth. Orthodontic tooth movement may, in some cases, aggravate this condition and in some instances

necessitate root canal treatment.

8. Orthodontic appliances are composed of very small parts connected together. They could be accidentally swallowed,

aspirated, or could irritate or damage the oral tissues. Cheeks and lips may be scratched or irritated by loose or broken

appliances or by blows to the mouth. Post adjustment tenderness should be expected, and the period of tenderness or

sensitivity varies with individuals and with the procedure performed. (Typical post-adjustment tenderness may last 24-48

hours.) You should inform your orthodontist of any unusual symptoms or of any broken/loose appliances, as soon as they

are noted.

9. Patients may inadvertently get scratched, poked or receive an injury to a tooth with potential damage to or soreness of

oral structures. Abnormal wear of the teeth is also possible if a patient grinds the teeth excessively.

10. Oral surgery, tooth removal or orthognathic surgery (surgical realignment of jaws) may be necessary in conjunction with

orthodontic treatment, especially to correct crowding or severe jaw imbalances. You should discuss the risks involved with

treatment and anesthesia with your general dentist or oral surgeon before making your decision to proceed with this

procedure.

11. Atypical formation of teeth or abnormal changes in the growth of the jaws may limit our ability to achieve the desired

results. At times, changes after treatment require additional treatment or, in some cases, surgery. Growth disharmony and

unusual tooth formations are biological processes beyond the orthodontist's control. Growth changes that occur after active

orthodontic treatment may adversely alter the treatment results.12. The total time required to complete treatment may exceed the estimate. Excessive or deficient bone growth, poor

cooperation in wearing the appliances or elastics that require hours per day, poor oral hygiene, broken appliances, missed

appointments and other factors can lengthen the treatment time and can adversely affect the quality of the end result.

13. Orthodontic appliances (braces) are selected to provide a specific therapeutic result. The type of appliance, construction

and material content may vary. Some patients may have allergies to component materials that may result in adverse

reactions and require alteration or cessation of orthodontic treatment with corresponding limits on success of therapy.

Although exceedingly rare, medical management of dental material allergies may be required.

14. Due to the wide variation in the size and shape of teeth, or missing teeth, achievement of an ideal result (for example,

complete closure of space) may require restorative dental treatment. The most common types of dental treatment are

cosmetic bonding, crown and bridge restoration and/or periodontal therapy. You are encouraged to ask questions about

adjunctive dental and medical care.

15. General medical problems, such as bone, blood or endocrine disorders, can affect orthodontic treatment. You should

keep your orthodontist informed of any changes in your health.

POSSIBLE ALTERNATIVES

For the vast majority of patients, orthodontic treatment is an elective procedure. One possible alternative to orthodontic

treatment is no treatment at all. You could choose to accept your present oral condition and decide to live without orthodontic

correction or improvement. Alternatives to orthodontic treatment for any particular patient depends on the specific nature of

the individual's orthodontic problem, the size, shape and health of the teeth, the physical characteristics of the supporting

structure and the patient's aesthetic considerations.

Alternatives could include, but not be limited to:

1. Extraction versus treatment without extraction;

2. Orthognathic surgery versus treatment without orthognathic surgery;

3. Possible prosthetic solutions; and

4. Possible compromised approaches.

If the treatment plan presented by your orthodontist includes surgical movement of the jaws as well as orthodontics, the

following items should be considered in making the decision to proceed with treatment.

1. Movement of teeth with orthodontic appliances prior to the orthognathic surgery is done to position them in their respective

jaws, not to correct the bite in the present jaw position. The appearance and bite may actually worsen during this phase of

treatment.

2. Changing the treatment plan at the patient's request from a surgical to a non-surgical treatment can cause increased

treatment time and/or a compromise in the treatment results.

3. A change in treatment plan should also be discussed with your family dentist and oral surgeon.

4. Orthognathic surgery can create financial concerns. A consultation with an oral and maxillofacial surgeon before

treatment begins is helpful in making the decision whether or not to proceed with the proposed treatment plan.ACKNOWLEDGEMENT OF INFORMED CONSENT

I, [Firstname] [Lastname], hereby acknowledge that the major treatment considerations and potential risks of orthodontic

treatment have been presented to me. I have read and understand this form and also understand that there may be other

problems that occur less frequently or are less severe, and that the actual results may be different from the anticipated

results.

The orthodontic treatment plan has been fully discussed with me, and I have been given the opportunity to ask all questions I

have about the proposed treatment and information contained in this form.

CONSENT TO UNDERGO ORTHODONTIC TREATMENT

I hereby consent to the making of diagnostic records, including x-rays, before, during and following orthodontic treatment,

and to the above doctor providing orthodontic treatment described by him/her for the above individual. I fully understand all

of the risks associated with the treatment.

AUTHORIZATION FOR RELEASE OF PATIENT INFORMATION

I hereby authorize the above doctor to provide other health care providers with information regarding the above individual's

orthodontic care as deemed appropriate by the above doctor. I understand that once released, the above doctor has no

responsibility for any further release by the individual receiving this information.

SURGICAL SUPPLEMENT

If the orthodontic treatment plan includes correction of the malocclusion by orthodontic appliance (braces) therapy in

conjunction with orthognathic (corrective jaw) surgery, I understand that oral surgery is necessary in conjunction with the

above patient's orthodontic treatment. I authorize the office of the above doctor to communicate with the surgeon and

release information from the above patient's treatment record to the designated surgeon. I acknowledge that expenses

incurred from the surgery are separate from orthodontic treatment expenses, and I will be responsible to the surgeon and

hospital for all such expenses.

I understand that if I do not complete the surgical component of the treatment plan that I may have a compromised treatment

result and other complications. I hereby agree not to hold the above doctor liable for any compromised treatment resulting

from my failure for any reason to follow the treatment plan.

CONSENT TO USE OF RECORDS

I hereby give my permission for the use of orthodontic records, including photographs, made in the process of examinations,

treatment, and retention for purposes of professional consultations, research, education, or publication in professional

journals.

_________________________________________ _____________________

Date: 2015-12-11; view: 802