This document discusses orthodontic treatment and malocclusion. It begins by explaining that both children and adults seek orthodontic treatment to correct malocclusion (improper bite) and crooked or misaligned teeth to improve appearance. It then classifies different types of malocclusion and provides examples such as overbite, overjet, underbite, crossbite, open bite, and midline shift. The document continues by discussing causes of malocclusion, when treatment is best, and the use of space maintainers when teeth are lost prematurely. It concludes by explaining how braces work to gradually move teeth into proper position and the importance of proper home care and dental checkups for orthodontic patients.

1. Orthodontics
Dr.Saurabh Goel
06/13/14 15:37 1

2. Who Needs Orthodontic Treatment?
• Adults and children both seek orthodontic treatment for:
• Malocclusion (incorrect bite)
• Tooth alignment (crooked teeth)
• Improvement of overall appearance, including gaps between teeth
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3. Classification of Occlusion
Class I Class II Class III
Upper and Lower
molars align
properly, but teeth
are crooked. 72%
of ortho cases.
Upper molars are
positioned too far
forward (anterior)
compared to the
lower molars. 22%
of ortho cases.
The upper first
molar is
positioned behind
the lower first
molar. 6% of
ortho cases.
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4. Examples of Malocclusion
• Overbite – The upper front teeth cover too much (more than 30%) of
the lower front teeth. Also called a deep bite. This may be seen in a
Class I or II malocclusion.
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5. Examples of Malocclusion (contd.)
• Overjet – causes “buckteeth”. The upper front teeth are
positioned too far forward (normal distance between upper
and lower front teeth is 1-3 mm). This is typical in Class II
maloclussion.
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6. Examples of Malocclusion (contd.)
• Underbite – causes a “bulldog” appearance. The lower front teeth are
positioned in front of the upper front teeth. This is seen in Cass III
malocclusions.
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7. Examples of Malocclusion (contd.)
• Crossbite – The upper teeth should overlap the lower teeth slightly
when the jaws are closed. When this does not occur, it is called a
crossbite. May occur in any class of malocclusion.
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8. Examples of Malocclusion (contd.)
• Open bite – open space exists between upper and lower teeth when
jaws are closed. Often caused by thumbsucking, seen in all classes of
malocclusion.
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9. Examples of Malocclusion (contd.)
• Midline shift – the center of the upper front teeth is not aligned with
the center of the lower front teeth. Can be seen in all classes of
malocclusion.
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10. What causes malocclusion?
• Genetics - You may inherit a small mouth from mom and large teeth
from dad ie lineage association might be there.
• Tooth loss - If a tooth is lost from an injury, cavities, or gum disease,
the remaining teeth may shift. Tendency of a tooth to move towards
and empty space.
• Bad habits such as thumbsucking can shift teeth or cause them to
erupt improperly.
• Malnutrition – Nutritional deficits can restrict the growth of jaws and
teeth thereby resulting in malocclusions.
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11. When is the best time to seek treatment?
• The jaws of pre-teens and teens are still growing. Therefore, it
is easier to shift teeth at this stage.
• Sometime, two separate phases of braces are necessary for
treatment.
• Phase I – when patients are 6 to 7 years old, to make room
for the permanent teeth to erupt properly
• Phase II – at age 12 (or when permanent teeth have
erupted) a second round of braces are applied to straighten
teeth and correct bite.
It is becoming more common for adults to seek orthodontic
treatment. Their treatment may take longer to complete.
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12. Space Maintainers
• When a primary, or deciduous, tooth (commonly called “Baby/Milk”
tooth) is lost too early, the space needs to be held open until the
permanent tooth is ready to erupt else space is lost, hence a space
“maintainer is required.
• Question : Why are deciduous teeth called as milk teeth even though
we do drink milk in adulthood as well ?
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13. Answer
• The answer to the last question is that there is marked similarity in
the refractive index of milk and deciduous teeth , thereby earning a
tag of being “ Milk teeth” where as the this refractive index similarity
is lost in permanent teeth , making it devoid of any substantial tags.
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14. Space Maintainers
• A space maintainer is an appliance made of metal or plastic and may
be removable or cemented onto neighboring teeth.
Removable space maintainer Band and loop maintainer Lower lingual holding arch
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15. Why does malocclusion need corrected?
• An incorrect bite can have long-term effects including:
• Interference with normal growth and development of jaws
• Difficulty swallowing
• Impaired chewing
• Speech defects
• Susceptibility to cavities and gum disease
• Poor aesthetics
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16. How do braces work?
Teeth can be GRADUALLY moved into proper position by
applying pressure in certain directions using bands, wires,
and elastics.
Bone remodeling occurs which help teeth to move in a
particular direction.
standard
braces
lingual
braces
“Clear”
braces
virtually
invisible
Invisalign trays06/13/14 15:37 16

17. How do braces work? (contd.)
• Removeable appliances may also be used such as:
• Palatal expander to widen the arch
• Jaw repositioning appliance, or splint, to retrain the jaw to
close properly
• Headgear- involves a strap that wraps around the head and
attaches to a wire or face bow in the front. used to slow the
growth of the upper jaw and move front teeth towards the
back.
palatal expander Jaw repositioning
appliance
Headgear
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18. How do braces work?(contd.)
• Treatment typically lasts 1 to 2 years. After braces are
removed, retainers are used to hold the teeth in their new
position.
• Typically, retainers are worn 24 hours a day for the first six
months and then worn only at night thereafter. Permanent
retainers, bonded to the back side of front teeth, may also be
used.
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19. Home care for ortho patients
• Braces collect food and plaque very easily.
• Often, ortho patients are children or teenagers who do not
have optimum brushing and flossing habits.
• If braces are not kept clean, tooth decay and gum inflammation
easily occur.
• Orthodontists may decide to remove braces prematurely if the
patients hygiene is poor.
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20. Home care for ortho patients (contd.)
• Brushing
• Special orthodontic toothbrushes or battery toothbrushes
may be useful.
• Patients need to brush both above and below the
brackets, paying special attention to the space between
the gumline and the brackets.
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21. Home care for ortho patients (contd.)
• Flossing
• Flossing around braces is time consuming. Superfloss
(strands of floss with stiff ends) or floss threaders are used
to floss beneath the wires.
• Interdental brushes can be used between the wire and the
tooth, between brackets.
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22. Home care for ortho patients(contd.)
•A fluoride mouthwash, either over-the-counter or prescription,
is usually recommended to help prevent tooth decay around
the brackets and to reduce decalcification.
•A oral irrigator such as a Waterpik, may be used to flush debris
from the brackets.
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23. Dental Check-ups
• An orthodontic patient needs to visit his or her general
dentist at least every 6 months for a cleaning and check-up
to monitor the health of the teeth and gums, ensuring great
results when treatment is complete!
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