.

The Art and Science

The Art and Science

Third Edition
, .
(With over 1250 if!usfraOOnSJ

f}I
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Orthodontics The Art and Scienca

I5IEdilioll : June 1991

2ndEdilioo : J\IIe 1999
l'lI Edition : 0cI0bef 2003
Repmt : Fe\:t1Jary 2004
~ Re~ wi., publsh.

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PubD$hId by :
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H Authors

Dr. Uh:lhlpi Sundaresa Iyyer

_.rly
Qrthodonlisl, Minislry of Healih,
Stale 01 Kuwait

Assistant Professor
Department of ~tics
CoIlegfl ofDootal StJl9ef)'. Mangalore
(A unit of Manipal Acatlemy of Higher Educatloo)

Dr. ~113 Iyyt't llhabljhi

Orthodontist, Miidstry of Health,
State of Kuwait
Formerly
Assistant Professor
Department 01 Orthodontics
College 01 Dental Surgery, MangalorB
(A LIlil of Manipal Academy of Higher Education)

.
.1'" Contributol'~
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 The eagerness an the part of the graduating dentist~ to know more about
Orthodontic5 and the lockof on all encompassing bookw05 the driving force
thol led me to author the fi,,1 edilion of thi' teX) book of Orthodontics . Six
year.>, two editions and numerous reprint5, have encouraged me to come up
with this third ediliOf'l.
Orthodontics is a dynamic fie ld with changes occurrirlg at a rapid
pace Orthodontics is much more than a cosmetic fie ld of DentistJY. Recent
interest in tile biochemicol and cellu lar aspects of tooth movement have
proved beyond doobt that Onhodontics is a specialization that qpplies the
principles 01 b iology as we ll 05 e nginee ring. Orthodontics is o lso kee n to
adapt new technology to aid in imaging, diagnosis and treatment deliveJY.
The new lechnologie, and a brooder understanding of the biological and
mechon ical aspects of toolh movement have removed mony of the limitotions
of orthodontiC tre<1tment. The rap id improvements and odvonces ploce a
tremendous p ressure on the outnors to frequenfly update and revie w lhe
book.lth05 been myendeavor to bring to yo<; some oIlheseodvonces_
The Ihird edition of this book adopts a friendly two color form<>1
followed intcrnolionally by most IJublishers. hl effort has been made to
imprave Ihe overall quality of rhe illustratiOlls which have been pain,takingly
redrawn and enhanced using th" lolest ovoilob le 5Oftwore. We have al50
added 0 number of clinica l photographs 10 enable easy understanding of the
. ubiec/.
I rema in ever grateful 10 my leoclle r Or. '/.Surendra Shelly lor his
valuable guidance over Ihe years. I would also like 10 thonk Mr Sudhir Kumar
kya, the publisher of Ihis book lor hi5 whole hearted support in this endeavor.
I hope thi5 book ;5 accepted and appreciated by the dental community.

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H Contents l::-?-jl~ J I".~ .....4J ;:..!lI
~ I,,:. ~ .;,.. U""::: ';i J
i.b..i-?- t"

Section 1 Introduction

Section 2 Growth and development

Sectloo 3 Occlusion & Malocclusion

Section 4 Diagnosis
Se<:tion 5 Biomechanics

Section 6 Preventive & intarceptiva Orthod ontics

Section 7 Spece Gaining

Section 8 Orthodontic AppI lanc8fI

Section 9 Corrective Orthodont lct

Open Bi\e

of Deep Bile

Section 10 Surgical Orthodontics Be Retention and relapse

Section U Miscellaneous

O
rri,CKiontK:' is Ina! bfOoch of dontW...,
conco rne d with pr" v" M ion ,
in t~ ,c " pt i on ond co rr octlo n of
maloccl"' ior\ ond other o b.norroo liliet of the
denlo-loDol region. The word Mhoo:!ontic, '"
detNod ffOm ... Greek words onhO$ meonirg
coned and odonIos mooning leerh. The Itrm
OrI/Iodoo,!ics WCI' ~m coiroed by Ie Felon.
In 1922, ..... British Soc;e'Y for the Slud, of
OrThodontics no. defi "", d ,n.. specio l,!, 0 ' ,
'Onhocio<1tia ind u"",, the <Iud, of th"ijrowtn ond
cIo-telop"'''''' cJ tho iow, and Ioes pc r!icu"' ~y.
oro the boo:ty 1I"""",lfy o. infl .... ncing the IlOItion
01 rho: Ioelh; tho .judy 01 odion end reader. 01
inte. nol ond ule rnol intluenco, on the
~pment ond th .. p,,,,,,,,,,,on a nd .:onlldO>
01 orTe>led and pe.-led development.'
Men ho. ,,,cog ni.ed II." pre","" of
demolo clol dIllorm i!;". or>d the Mod /.,.. il>
InIOtmont Ctotu,i., 00d<. Crud" oppli oroces !fla t
_ seemi ng ~ oo.igoo<! b rog ukllel TOo Ioeth r.:rve
to
been ~ted b'! I"d>eologi,b from round 11.0
...,..jd ird uding Eg lP/, G,u e. end Me>.i co.
No rme l ol ig nm M t o f t " ~ th no t o nly
con/,ibutes 10 tfle oroI "I!(l fth but also gOM" ~
WOY '" me overoll W(lll bc.ing ond PfI.>oooirty 01
on iodivid...ol. Correct to01h pO$d,on i$ on
im~rton1 loel0' for 8$1he~cs. fvndion ond 10<
"""",II ~lionorres1omlion 01 denial heoI1h.
VIhiIe ""'" moIocdusiono may no! odveroely oIIecr
the he.olth oi an ind ,.id IJCI. t!.ey ne-"'ele$$ o,e
ca poblG of produ cing ~'iro t> . fundic l'l(l l c nd
e,l hetic imbo lonces. Th o fcll owing ole lOme of
the unfavovrcble "",,""Ole of moloed ...""'.
Malocdu$lOfl i$(IIpr;rblo oIodY=eIy ofIectrng !he
Iodal appcorcnar of an ind,,<!uat
RIsk of urI"
Mo loli gn mont of teoth ma ke. o re l h, gic no
moinle ""roce a dilf"rcu lt to .l , thelett,- iroc"",.i ng
F;g I I ~ ... u'" '..to a...J
,",,,,,,to""" , i''-",u'
0'>0 orowd" , ," , k. "" I "1'9 '"
>,00_ to (00<.
th~ ri, k of corie, {fig I) .
PredIsposition to periodontal dluase.
Mo lo<;cI <I$ ion a'-SOCiotW with poo< oro l hyg io oo
;, 0 f,~qve nt cou 'e of p"rioc/onlo l di"," " , e" In
odd;t;on , teeth tho t are ploced in abno rm ol
po, iti o n, can b-o a cou,," for trourna t", occlusion
with ,,," ultant perbdonta l jj"U " da mog e.
P$ycho/ot 'c,,' dIsturbances
Ma l ac d ~, i on th a t a d v"" e ly a Hects th e
nppea rooc. of person leads to p,ycholog ica l
di, turOOnce.. Un ' ;ghtly ap p-co 'aoco of teeth
mole. a P"'''''''' high ly self.co n<Ciou , nnd tum s
him into on in tro \"e n . Thu, tr eatm e nt a f
m<l locd u>ion in , ud, poti . rrls kel ps in imp,ov ir>g
the mental wo ll oong ond confid ence,
Risk of trauma
Teeth tMt oro ",,,,,,,"y p'oclined a re at a hi;J h ,;.,I:
of injury e<peeio lfr- d urng play or by on occidenta l
fa ll (fig 21,
Abnormalities of function
Many mo lo<;o lu ";on , cou,e ab<1om1a lity in th e
flJl"l<:tioning 0/ too ,tomolog r<Jthi c 'ystem , tiC h a.
imp 'op<!< deglv\ition , deled ' in spee-:::h, im prop<: r
r. 'Piro tion, etc.,.
Ro 2 toci' lila' O(o , ~ ..,oc;"", oro 01 0","" ,Ok
01 <- iJrl ..,<I<> boO ... . " n.t~oI ~
~
Tempe ro mandlbul"r JoInt problems
Mo locclu s io n a "oc iat e d w;th occl uo a l
promaturiti e, and deep bite a,e believ. d to be a
Cau l. of TMJ pro ble m uch a s pain a nd
d ysfunction .
AIMS OF ORTHODONTIC TREATMENT
Tf", a im. a nd o bieCtives of o rthodonti c therapy
hove beM su mmor ise d by Jod,on a s tho
Jock""", '$ tri"" , Th e three main o biecti.e. of
orthodonti c treatment 0'-" .
a, Fundio nal efficiency
b. Structurol bo lonce
c, E, theHc; ha ,mony
The orIhodonti. t shOO d . t,"" '0 " ch";ve tf"" .
th ",. mo in obi ed i. es of treatment.
Functlon,,' efficIency
Mony mo locclusionl offect r<>Imol fundion ir>g of
the , to matog f)(J thic system. Th e orthodo nHc
treatm e nt .r.o uld thus a;m o t imp,o. ing th .
funcHo ni ng of the orofocial op pomtus.
Structural balance
The orofrxiol.-eg <>n comi!!. 01 too dentoa ~ '
.yst~m, , f", >keletol ti" ue ond th e soft ti ss ue

Functiona l efficiency
<i'--- - - - Estheti c ha rmor.y
Strudural ba lance
,nclud ing mu.cu la ture . Stob ie orthodontiC
"eatmon t i. be.t ach ieved by ma into ini.,.. a
balo nc .. between the", th ree ti"u" >Y'tem .
Esthe t Ic h a rmo ny
By for the mo,t oommon romon for >""king
orthodontic core i. to impro the oppecmnco 01
the t...,th 0,", Iooe Mony ma locclu. ion> are
=ocioted with un'''ht~ oppecmc.::. oI teeth 0Jnd
mn thu, affect tOe ind i.idl.>O l', ,,,If
image. well
being ood 'lJGCe"" ;"
society Thu. the orthoo::>o nt"
If80tment , hau ld oim at impra.ing the esthetic.
oIthe in di.idua l.
11IE SCOPE OF OR11IODONnc TREATMElWf
Orthodontic treatment in""",,, the three main tis
we 'ystem. cac.::c",ed in dentalacia l develop
ment, name ly the dentitian. tho "'oleton a nd tfle
k>ciol and jaw mU lculature. Orthodonlic treat
ment con brin g about change. in the de nti tion,
!he ""8leto l .yolom and the envelopir\g soIt t~' ue ,
Alle re llon In t ooth pos itIon
Orthodontk treet""' nt i, mod e pO"ibie by the
iod thot leeth con be mo"Cd throvgh the booe to
J
idea l locati ons by opplying op-propriote force on
thom. Ma, t ma loco lu>i on , in.o lving ' he de nta l
' ystem can be effe<:ti.ely trealed by r,..wing !eeth
so a , ta normal i", t.... occlu, ion '.
Alte ra tio n In ske le ta l pa ttern
Ma locc: lu,""" ma y' be os,ociated with ,ke leta l
di..narmony in.0I.in9 the io-: bone. [i . 0 . r!lxillo
and rnc,", ibie) . ,De.i cti o"~ fmm the normal co o
ori ... in si.e. o,ition and reloti ononip i><otwe" n
these . keleto l companent" It i, wilhin the scope
af on orthadont i,t to a p ply a pprop ria te
orthopaedic force, that are ccpol>ie af = tro ining,
promoting ar red irectin g . ke1eto l growlh SO a. to
""rmal i", the .kaleto l ,ystem, The otlhodQflti. t con
bring about chang e, in a ll the three p lane. 01
,~e i.e. wg iltal. tmn"",.., ond verti<;a l
Alte ra tion I n so rt tiss ue pe ttern
TM salt t;;""'" that . ,-,..."Iop the dentition ore ~tly
influ;' c.::ed by the pla ceme nt of the dentition , 11i,
poo, ible to brin9 about Io.ou robl " cha nge. in
lhe sofi tissue pattem by orthodontic treatment,
SERVICES OFFEREO BY fHE
ORTHODONfISf
The service. affered by on orthodonti,t COn be
broodf,- cla S' ified e.'
0, Preventiye ortl.."Jollla
b Interceptiye orthodontiC'
c, Correcti. e arthodonta
d, Surg>co l orthodontic,
Pre ve ntIve orthodOlltlcs
"Pre venti""", Ih", s.oy. "i s be~er tha n cu re'
Prevonti." ortr.odMt ico inc lude. procedu re,
ur>dc rto kon prior to lhe a n t of a molocd usion
,
in anticipation of a de.elop ing malocc lu,ion,
Pre ve nti.e orthodont ic. can be defin ed ' J>,
4 Onhodontiu The: An alld Scle:IICI!

'Actions token 10 presotlV'(! the in~rit, 01 who!

oppeots normal 10. 1001 0ge :

In t . ' ~.pIlY. O't~ odo "II ~.

In!eree o!i"" orthodon!k:, ir>dudes p<'oced.xc, !hot

ere undo r!o' e n o! an ,,,<ly lI09" of a
".",Ioed""on to elimina"" '" ~uce the """",t,
01 the 1ome. By underteklng oepl"Opriote
inle.ceplive procedurss, ij it; possible 10 prevent
estobli .... menr 01 0 lull fledped ".",Ioed",,,,,, ttKJt
moy ~i", lon9 ~ orlhodOMlc ,reotrneon! ot 0
klte-r oge

Correct/Ye Orthedonliu
O~,~C ~u r,,, undeno'en 10 CDrnKt 0
fully e.lobl'>hcd ".",Iocd",ion.
SU' aJul O, t llodontlu
The-t Ore su.gieol procedu.es II-ot ore unde-rtolen
in coniu",';:'" with or os on odiund to orrhodortic
troo!rr>ent.The .\\J rgial l ortr.:.donti:; procedu~ rue
~$UO Il , te rried out 10 romove On eliQlog ie foclo r
'" to 1,,,,,1very """"" denIo1ode1deio<m ilies th:rl
connOI be troaled bv orlIrodonWc "'e,oPy olone.
BAIF HISJORr OF ORTHOOONnCS
Onhocb'~CS is (onside<od the oid,", soeoolity
01 denlillry. h~rrr:'" "'-'9QM11I-ot 0IIem""
were
me de 10 Ire el mo loc cl~ lio n os oor1y o.
1000 S.c. Primitive opp licnr::el to move !6olh
ho_ e bee n fcu nd in Greek ond EI,y ,eon
fIIOCCMltio<rl.
The Gn.ek phyoitian Hippoootes ((60 . 377
S.c.) il believod :0 be !he pio".t in medicoJ
sclonc.e. He """. the till perOO<l 10 esroblish .
rnedicollfQdition booed on JOdI roth.r thon
f(!1>gion Or IonC/_ A number 01 ",I. rene ... on
leeth and jows ore found in h;, writingl.
A,iIlO!1o (384 . 322 B,C.) W(l, 0 G reek
f; V ' fd.o,d ,.. ~ .. "'pl . "Gh., 01 ,,",0 '"
O1I-odon- co
philol-Opher ... ho II""" l"Iediccl 1oO..-ce the ~tsl
IySIem 01 compcrotMr one-rom-;. Anstr;ie W(U the
nm wrilOrwl-ro.vaed f-r..;man ~ end c~red
th em ... il), th olll of <o rious oth". ,peciel ,
The li"t reco rded , ug"oMio, fo, activo
'"tC!mer"<"af moloco''''''''' ....... by kOius Cameli",
Celsus (25 6.C. -AD, 5O) ..no odvocoled ~,e use
of Anger pleuu,," 10 aJ:gn in&gu!o,:ee-:h.
Pierre Fauchord 0 Frenc h denlrll is
cOI"Ol,de<od I"" founder of modern demel~ As
..ar:., '" 1723, he developed whot i. probobfr the
lirl! orlhodonl": opp llor><:6 celOld 0 Borrdelette ,
thot WOI des igroed to . 'pand Iho denial orc h.
No,man King.ley on America" demi5l, was
the ~flt!o:> use emtKlmI force to o::>n1ICt protruding
_ .... He it ni<!~ o. tf,e 010'-' in d~h
palate rreorrnem.
Em,rlOn C. Any .1 (1623 1903) f"t$l
advor:otcd the open:ng <Jtrre mid'POlotallUlv:e,
o P'OCwure wj,ich 1010' cem.!o be knawn '"
"'pi<! """ illcry e' po nsic.n.
W,lIi om E, ....."'9 ill (1823 . 1896) wallhe
Ii"t p~ "O fl to ban d teeth for a criv e tooth
....,...".,...nt,
He n')' A Bok., in 1893 introduced what is
.;alled Bo ker', anchorag e or the u.e of
nerm<lXilla')' ~ .ast ;c. to trec t ma locdu.ion
Edv.o:Jrd H, Ang:" {l855 - I 930) ~ cOflSidered
me ' Fath~ r of Modern Ortnodontico' for hi.
.......,emu. wntributio~. to , hi . ope<:i<l lity (fig 4)
nuough hi, l e ad~"h i p , orthodo~t; e, wos
sepomted fro m other bro fll:he, of denti,t')' to
c.sta blid\ ;" e lf a , c spec ia lit y Ang le "
cont ribution, ind ud e a clou if ication of
"",loOOu,ion and orthodontic appli ance, , ueh
0$ Pin and tube oM the Edg . wi'" applioF)(e ,
Al>gle a lso sta rted a School of Orthodonti cs at
SLlDtJ i., New london, Connoc!'<:ut in wh<:h rr.tJ<1y
of the pion ee r America n orthodonti . t. we r~
wained. Angle ~ieved t,.,<lI the who le cor'flleme,.,.
d leeth cou ld be ,,'t a iood """" yet goco:i ocdu~on
~kI be ochbeved , He thllS a,*"ocated aroh
e>:poMiofl for most patient"
Co l'i" Co,~ 11847 . 1923) beli e,ed thot
Iooal impm"" ment we, a gu ide to orthodontic
5
treotmM t Cale (f;g 5) ol.a claim. to be the fi"t
orthodanti,t to use intermaxi lla ,), ela.ti". Cawin
Co", wos criti o of Mgle o nd oppa",d Ang l.',
ph il o.ophy ci arch expan~on to treat moot 0;0"" .
He orr.ocoted the remova l of certa in teeth to
achieve .table treatment re, ult, o"d to improve
foci<l l ~<!het b.
Martin Dewey (188 1 . 1933) _,on ardent
cham pio n of no~c'troOion , Dewey {fig 6)0 150
modified Angle', d""ifiooti o" of malocc luSion .
In 193 1, Ho lly B,oadbent and Hofofoth
inde pende ntly de.e loped ce pho lometf ic
rooiogropoy which ,t~ndord i sed the po<itioni"9
of the head '" rckltioo ta th e film a"d X r~y $C uree,
TO Me rod iograph. mod e it pa ... ble to viS<Jo li .e
tne oro"iol and facio l , keleton, Thi. ca n be
OO"~dered a ma jor odvoncement in orthodonti o
d<:J9"", i. ~r>d trootm""t plann i" g,
8"""0<= in I 955 inl(odvc&d tOe ~dd etoh
to,h" iq ue . Thi, ena bl ed direct bonding of
orthodontic allachment. to lhe "",ome l which
9 rootly cnr.a " ood o.the\i<;$.
Royrnord Begg of Mira", introduced 0 ~ght
wire Ji"ed opplionce reo:hnIqoe !hot was bosed on
.... ~ddi""' ...iullcn.e. Heclsoodwxcfed
the need iore>:lroChOn of some teeth to ochi_
.table multi.
While me American orthod oe>ti," _te
, ha wing ~ oen in te rell in im proving lioed
orthodontic appl ia",,",. the ir European covnte r
po rt. co ntinue d to deve lop removob le and
fun o;lio",,1 a pplia nce, lor guidOn<;<! 01 growth .
Pi erre Robin in I 902 introduced 0 Monob loc
which prQtruded the mond ible lorword in poIiertI1
wirh 9Iossoptosi!.. ViIlOO Anderson in 1910
d_lopo-drhe ocfi'fO\or which mode V><I 01 "-
IocioI mw;ulotuteto guiclethe ~ oIlho jows.
Rolf Fron kel In 1969 . 1913 proposed rhe
Function Regulator to treot 0 vonr.ty d >keletol
molocd".on ..
lowtence Andr..... intmduood the S/ruight
Wif'll ~pl lonce;" the early _nti e. This was a
pmodfusted oppl iance in which the brod<ell "'"""e
p-te .prcgro rnm ed to occompl i.h the de.ired tooth
moveme nt. !n a ll th o thr pio n.. of , poeo. Tn i.
is corosidered 0 maier r;rlvonce","", in im pro" ing
orthodomic t...,tn-enl re!-IJ Its with mri mo Ipou"ble
wite bendln9.
This discu"ion on rho hi,tory ond evolution
01 ormodomicJ I. by no means complele. There
ho.e beer> nume""", ~.,Ie whou: mntribufiOfll
ho.e gone 0 long way in the improvement of Ihis
IpfICialily. Foro mote COtIl'Iete "",,_!he ....00...
Ote o<Mcl to te~ott- televont litero,"", .

" oloune ..
1, ""'-'01 1:" "'~ ! 0;"".,- 01 orthoJo.\<;co, Am J 0rt'>0d
1990;2062 1J
2, _ t",_. Cr.;"""'o. H""" "'" W..-_
, Ro ... ~ " .. ~ to ...,'<><d,,,,,,,- Am J o.tt.cG
1971 ;1 18
3. 50'..-.00 JA ,
corroo .... 1%6
"""'Ic.
of ~~ AI llpp",""

'. Gtoboo- 1M , O~ooJo ..... ' Pri,q,loo ..! _ .

'NBSO ........ I988

and Development -
Principles and Concepts
The pmdice of onhodon~cs has two baDe
*"'"""'''''. Tho nISI ond Ioremost I'to ~
on intimate ~ of the anolom'/ and growth
01 the h$Od. The second i. to mo.tw II",
ted>niques lor .eguloting tooth pwition. In the
poll,!he i"temet;"" be_ n the .. IWO _ 01
informet"'" "'0. cO<1.id ered 10 be onf,- m;";mo l.
h is now II$tOblishcd that" -.00 ~nowledge of
IIfO"'Ih ...d da.elopment is asentiol b- ,uoceo.Iul
orthodontic t.-.otmen!. ner. or. " """,be, 01
..... ' ... 'tmm ities t"" con rtvJk,lothe g~
'*'tm0fl and the jaw bones. Undtntonding !he
gtOWIh 01 II. ~ Iodal reg.on is viIolly Imporlunl
when planning suell treclr1"1OnT prO<:$duru.
Tn i. chopter .. ill pres ent a
compre .... ns/ve ""'ew 01 ,he booic ConaIprs 01
growth and deveIopmenl os understood today.
h wou ld be our e ndeavor Ie ' Iimu late the yo.J r>g
--.
$lUdent'. mind I<) !I.e! he at" "1..- date can
a>nIributelO ........... rnrnpledi ... oIOOtIio-bdaI
aEFINmcms RELATED ro GROWTH
Gr Dw t b
There i, no "n...""II, occepled definition of
growth. Vorlo~. di";,:,,, .... ho~ do~....d g,owth
in dille,.nt we ). _
"The ..,j/ ""'1~plioJtion oIl;...;.,g substonc.. {J.5.
"wd",
' Ir>CTe05e in Ii,". cho;tn(lll in p<opotl;o" c nd
prog'eSl ive complexily,' [Krogmanl
"/In in.creoM in si ...: (Todd)
"Enti'e " 01 <IIqvenliol anatomic Dnd
phy. iologlc chonge. toking pla ce Irom the
beg inning of Fl"'ootol lile to senility." (Merld ith)
'Qu~osped 01 bioIogicdowelopment per
un~ 01 ~me: (Moyers)
"Cha","o in gny rno'poMg Ogico l paramete r which
i. """""'roble: {Moss)
Though llrowth IIlI"neral~ onoooted
-..iIt. on increose in lize, yet some oondifion.
i""""'ng t1!gf~~';"n 0'" olso conl;defed to tok~
plGce durlng g(~. Fore.:omple, me oImphy
of me "'rmvo glond .
Develo pm e nt
"o.v./opme nl, " according 10 Todd. ' il ~r=
towonn maturity". h cord;,-,g to ~", de>oeIoo.
menl rOlfe .. 10 oil Ihe nOlurolly occurring
uroidirectionol <hemges in !he Ide of on indMd",,1
!.om irs e>:io>enceo.o single cell to irs eIobomtion
0 1 0 MU,"func~o",,' unit to,,"iroting in d""m.
Thvs II enr::O"lXl...e$ 1he nom"IOl ~tiol ew.: nts
between ferrili , otion ond death .
Olfl". ntll,tloll
Dil/erentiotion is It.. change from ge~foliz<od
cal", tiswe to."..,thor il """" .peciol~ed. Thul
diflerenriolion il 0 chonge in Quality or kind .
'ACTORS A"~cnHa PHYSICAL
GROWTH
A num bor of /0 <;\0" oflee th e rele, tim ing and
chorecle' 01 g..,..,.rh. They ir.d ...... '
He ullity
There OHm. to be 0 conSlderobl, genelic
Influence on the ,iltt 01 pOlI1, rete of growth ond
me or.et oj gf<>'Mh . Thege_ her>ce ~ 0 ....,jot
re1e in me """ro ll growth of " perlO" .
Nutrition
Malnulrilion moy oH~cl li,e of pOrlt, body
proportions, Quality orod ladure oIli~sws, and
..- 01 g"""" _. The deds of "..,lnUlrition
ore rev<It"Iible to 0 certoin _fIIOI childre" have
~ne rer;upem~... P"W"". !f me or:fo,.e,.. ,1Iechr
ore noI too _re, tt., growth proom occelerollos
wh en proper nulrilion il p.rovido-d. This il coil ed
colo;h. vp growth .
IIIn e ..
The ul",,1 minor childhood illne" ordinonly
camel be .hewn 10 ha", mu m e!fed On ohyl"col
gto wlh. Pro lo ng ed en d d. bililolin g ill n...
howo_ cO n hove " mo~<o-d effect on 011o:rped.
of """"",.
Rece
Although me DFerer-as in growl!! omC>ng dillerenl
IOCes con be ottributed to 011-.... nutrillonol ond
en-.;ronmenlallocto", Ihe ,~ ..... ml to be SO""
evi denc. th"t race doe, plCl'f a ro le in gro....-t+;
proc .... fo ' .xomp le in Americo n bloc k.,
eoki!ico'ion and erupiOn 01teem occu" olmo:sl
o ylQr &arli., thon ""'ir wh~e covnr.rpOrfS.
Soc/a- ecollomlc '"dotl
Children brought up in oIHuenl ond fo.otable
0000 -<>nomic coMit~. sr.:>w ",rller on.." 01
llrowt~ .""nls. Th...,. al so g' ow 10 0 lotger ~ iie
,ho n Child ,en liv ing in vnlovo roble .oe io
ec:onomic; e<wiro n"""'l.
'emily .'u II~ II birth ordlr
51ud:es hove shown rh", :+"f.tS1 110m bobi.llend
to ...,igh I." ot birth orod have ,,,..,lIer millre
t..rt higherl.G. The ,,,..,lIer the "'mil)- ,iIe, me
bene< would be the numlion and ""- fa..ooroble
cond ilio",.
Seoul.r trend.
Cho"lllt in ain ond mO'urolion in 0 lorge
populolioncon belhowntooccurwilh~"". F",
""",mple, liheen ylQr old boys ore oPF'f..dmme/y
5 rndles toller rhon me ..,me oge group 5O"fICI"
bo ck. Although thore i. no 10lilloclo'1
e>planotion offered regoroing mis finang, ~covld
polSibl, 00 due 10 chong e. in socio. "o nomic;
,o <\dilio n, ond food hobit,.
ClimatIc .. mt s .... s on .. ' .. ffact s
Sec""" o l "o,,, tio n hO" e beo n .hown to offed
adipo5<l tisse", cootent and the weight of ""'" born
bobie>. O irr<ltk cho ngo. oeem to have _ttle d:rect
effect 00 rate of gfowth,
Psyc h o lolllc a l dlsturb .. nces
k i eo n th ot children experienc ing , tre" fu ll
cond itio n, d i' ploy on inhibition of g rowtn
Mr"..,.,e secret"", . f' K rdogk o l d:sturbon co> 01
prolong~d du rotio n con h~ nce ma rked ly r. tord
g rowth,
Ex .. rcls ..
Although oxerd .... mo y be e.sen' ia l for a h",, 'thy
body, , tr""""'" a nd regulo r ,,"," reise. hove root
i:>e< n osm ciored with mo re I<:, "o ro o lo gro wth.
C"rtain c'ped, of growth . uch ." ",,"ei a pmen'
01 some rr.;o'or ,kill . and i""roo .. in ml.lK le rr<l "
is lo und to be infi uer"I<:ed by e. "",ile.
SOME CONCEPTS OF GROWTH
Concept o f no rmll llry
Norma l re:..rs to that whkh ;, u, ua "y ,,",peeted , ;,
ordino ri fy , een cr i. Iypico l. Th e co ncopt of
""""" ,ily must root be eqLJ<lted with th ot of the
idea l. Vlhile idea l c!e r.o:c. l he cenlfo l tendency
10< tha g roup, ()(l(rr<l l refe" to a ran ge,
An other o.peet of =n io-fooio l g rowth
i. thot nOfrr<l1i1'y change. with a ge , Th us whoo t i.
nQrmo lfy . NO n o r i< ,,", pe ered for oo e Oil<' g roup
ma y ~ot be noce,sa ri ly flOrmal for a differ",,' age
llrouP
Rhythm o f gr o wth
Acco rd ir>g to Hooton , HU rr<l n g rawth i, not ~ floI" : I 4 I 6 ye""
.t""eIy a nd uniform voce .. whefein a ll pa rt' of
the. body " ,, 'arge at tne ' a me rate ond th e
increme.ot, of one yeor o re eq ua l to thot of the
prec;eed inQo r . ucceed ir>g yeor,' However there
",e m. 10 be 0 rhythm du ri r>g the gro wth proc ....
This growlh rhythm i. mo" clea rly ,ee~ in sto tu re
or body he ight.
Th. fi" t W<lV1!' of g ro wth i, .ee n in both
",,",e. from birth to In..fifth or ';d h yeor. It;' rr.;o,t
irllense a nd ra pid duri "ll the fi " t two yeors , The re
fo llow. a >lower inc rea,e t" rm ir>ati"ll in boy.
o bo ut the tenth to twe lfth yoo r ond in girl , no
lote r than th e tenth year. TI"", both ,e<" , e nter
upon a noth~ r pe riod of occele roted gfowth
= ponding to odoieoce0C8 wh<:h ~ complet" d
in gi rl. betw~en!he fo urteenth or>:! . id "" nth yeo r,
but "'tend. in boy. th ro ugh the , i. teenth o r
eig hteenth year. FoI lo'-'oi ng th;" a fin ol period 01
, low growth i, .ee n which e nd> between the
eightee nth and twentieth yeo" in f. rr<l le. but
goo , on in boy> until about Ih" tWMIy filth yeo r.
Growth s purts
G rowth doe, not ta ke ploce uniformfy at 011 tir1'le$.
Ther o .e em. 10 be peri od s whe n 0 ",dde n
o cce lero tion 01 g rowth accu rs . Thi$ sudden
increa,e in growth i.tefmed g rowth 'P urt',
The phy.biogi;:o l o llerotion in her"..,.,,,,
\.ecr..,tion i, believed to be lhe cou for . uch
a cce ntuoted growth . The limi r>g of the growth
>pu rt. differ in boY1 and girl .
The fo ll owing a re th e timi"ll' of growth
'P<J rt>.
a . J u,t before birth
b. On e yeof alte r birth
C M;,ed dentitio n g rowlh .purt
Bo,,: 8 -11 yM "
Girl< ' 7 9 )'<'0"
d Pre pu be rta l g rowth ' p.urt
G i ~.: 11 - 13years
G ro wth mod ification by mean . of
!undiorcJ1 and ~c cpp~onc:\!S elici! bette<-
response d"';"g growrh 1J)U1:s . Surgo:cloorredion
~ng lhe "",,"Ila end mandible .hould be
comed ovt 0"'" c~".. c,,"sotio" of t\, . gr'O"lh
<pu rt.
D,fferent,., , ralO'lh
The hllman ~ does no! grow ot t\,. >Ctne role
1tnlugh;>U! life. D~ftefilnt organs grow ot diflertonl
rates, to a differe<,t am ount and 0: differ""t ti mes .
Th" i. termed dif!.'eIlIiOI growt\,.
Here il ....,."Id be best 10 ........man IWO
impo rtont aspects 01 growth, both 01wf,ic h heJp
\II und."lOrod the concep:> of dil'e-ontiol gorowIh
more dearly, The.e are :
I . Scam mon's c:vrve of growth
2, Cepholo..:oudol grad~nt 01 g~
Sca mmo n's Cu...... 01 g rowth The bod y
liuues con be broadly dfJ!.Silied into lou, typM.
They a"' lymphoid hOI"", neural ~ .. ue. geneml
ti ss ue ar>d genital Ti ss ue . Ea ch 01 These Ti .. ""s
grow at diff.... nt times or>d rote, {Iig 1).
L"f"'Voo;,:llitlue adi,""""," """ely In lale
.:h ild hood and "",.:h e, olm o.T 2000/0 of 00u~ ~'"
this" on adaptation 10 protect chi ldren from
infdo~ Of mey are """'" p<Q<1. 10 iT . s., abovt
18 Y""" of oge, Iympko;d Ti" ue uncle ' goe'
irwolution to r!lOch adult ,iu
Nev'a l ti..ue grows "'''1 mpid'" 0<1<1
olm O<l re<><:he. odu lTsile by 67 )'Cors of age.
Vt;y little growth 01 naurol tissue occu" ohtr 6 .
7 yeor.;. This /ooli'otes inlOke d furtl.cw" lrc;w.Iedge
Geneml Ti"u. Of' viscern l ti"u. cono iSl:l of the
muscle>, bone .,nd other organ . These tl$wes
emibit on '5' ,hoped OJ""" with rnpid g'owlh
uplo 2 . 3 )'to" 01 oge foll""",ed by <> >low pho.se
01 growlh between 3 _ 10 yeo .. After the tenth
yeof, a fOaid pho", 01 gf'tMll, ocevrs te rmino~ng
by thi! 1a. 20th )'eO'.
!
i
,
Geni'ol ~_ co"';.,. d the ret)fOoi.dioe
0<;10",. They""" negligible growth ......, pube<:y.
How"Wl r they grow ,ao idly at puberty rllO chi rog
aduk size criter which g"",,", ceo....
Cep~aloc"udol g ro dient of gro wrh ,
Ce onob<ooo'" grodiMl d growth ,;mplr. '"""'"
11-01 thin is on a.:b d incaosecl growth e"<Ierodir.g
from head tC1W<lrds me feet. A co mporiton ohh l
boOt ptOp<:01ion beIwee n pre-norol 0 rod pooIrotal
Ide re.eols thor poSlnolOl g"",,", 01 Algiofll 01
!he bod v thot ore oway from the hypop h".. is is
Th;. growth c<;>n<;epl con be illu<lmted
o. follow.:
.,. The I>oodlokes up obout SO% o! Ihe tDioI
body Ionglfl amund the th,,d month d intro-
uterine lile. /'oJ the time of birth, th~ trunk
ordlhe h.>bi have grown ,.,...",,/honthe heod,
Thereby ...dudng m" head to abouT30% d
body long/h. The oV8m li poH"m of growth
continues with ., pmgre!li ... ~udion in !he
relative size of lhe heod 10 oboul12'l1. in me
odu ll.
b. The lower limbo are rudimentary 0t0U'0d the
2rod mC>llth of in!fa.uteOoe I,fio, They Ia .....
glOW and rep re$O<11cimost 50% 01me bod,
longl" 01ad ulthood .
c. Thi l increosed grod ient of growth il .. id~nt
even withi n the heo<! arod I",,", AI the time
01 birlh, *"cronium is proporlionallv Ial'Qllr
thon thelote. Po.:-natally me Ioee grow<
more rhon the O'Qnium.
MfTHODS OF faTHERING GROWTH DA.TA
The "'r'Io<Jl~" otu.die> can be bIoodly grovpo<:!
~,
O. l0"llitu.dinal sNdies
b. Crou MCtOorool.udie,
c. 5e<n1 _10"llilvdirool studies
lOlll/ltvdl". ' .'"dl..
In thil type of INd " the ob lervorlon ond
mea...,...."., nts pe~oining to ~ are mod. on
o per\Qn or a I1"WP af perSC<'tS 01 reg ular in,,",", l.
0Ytf0 prolonged period 01 'me. Th".longlufroo l
studiel are long t...m sludi ... wher. the some
sample i, .tvdied bv meon, 01 lollow-vp
e><Ominotion.
The lonlliludnol ,'udie. have Ih"
foIfo..,ing ocNanTot,jes :
o. .....the so me wbie<:n ace fallowl up 0'18' 0
long ocrio:>d , th e . pecili e de,.~ I "" m ""tc l
poH"", 01 on individed can be lludiotd and
tom po,ed.
b. VariaTion In developmoor omong inc!..-.d",,~
with,n the K>mpl. con be studiO)(j ,
Th. longiludnol >Iud ie, "aye Ih.
IoIIowing ditod ... nlu!J"l :
o. i.J:>ng1rud....,1 <0..0:1... are comed cui 0Ytf long
pe~ods 01 lima , It often takes yeo,.. or
decodel to com plete 0 .teldy o. the some
so rnp le il.tudied 01,egu la, intervo l.,
I\
b. lonlliludirool,!udief; noqvire maimoroonco of
lobo<cto<y 'esearch pern>noel orod data
.toroge 1\'It1rms for a long period 01 tim e.
Th", they ca n be "xpen.Om ,
L. N,1I-.eso .",,'... Ore perlo.rrned 0-: prolonged
pe<>od. 01 time th.,., i. 0 ri, .
of th. S<lmple
size red~"'" toc.honge of plcxe. or ott....
u~_.
c,,,....::f/o,,., Ittflll
CroU-ut~anol studle. are carried out b~
ob ... "",tion and meow""". nt mode af ditferent
.om pt." or.d stud ied at diffe"'nt ""Moo . Cro...
"",Ii oflO llludlfl off., the lollowi"'ij cdvonlOgn :
o. The", lhx!iel 0" 01 shorr duration .
b. ThlO"f 0" lelt e>.pen'iYe thon Iongitudirool
-SIud,.s os thev ore compl",ed in a ,holle,
spanohr ......
c. H i, pos":ble to get a large somple 01 the
duroHoo oIltud~ i. shorr
d. It is poo~ ble .., '"P"<'t tf>e stud, in COM 01
any flaw, Th~ moy not be ""$Iiblc in "
longilu diroo l . tudy.
Semi _ lonl/' ,w ll'''.' . 'wlll
It i, pauible 10 combine the Cto......dionol aod
lon g itu dinol merhods '0 a. ro de,," h.
a~ clboIh ... JyIIom>clgoIheri"'ij grovo.Ih
dolO .
TYPES OF GROWTH DATA
The physical growth Can be .tudie<! by a numbe-r
01 ways:
OpInion
Opinion is 1M etudelt """,nsol.tudying g...,......
Opinion i, 0 d ..or lIueu of an ....,..,ienctod
pc roon . Thi l method 01 , tu dying growth is ncJj
yet)' ""ientilil; ond $hou ld be ovo<ded when betIer
mer!>ods a'" CMliloble.
Ob.l, n t /ons
An o!h er method of gotherin g growth r. lot""
infom1oTian i. by ob ... rvotign, Th ey a re u... lu l in
I!~ng al l0("""'" pI..n,.,.,.", Iud> as ~
or absence of cori .... pteMnce or absence o! a
Cio. II molar ",lotion, Ire.,.
R. II,,_s 1,,01 R,,,,lrl,,ts
Whenever q",,"t;~cmion 01 a ""rtic~IDr dmo is
dilfk ulT, it is po ..ible 10 ooopt a meThoo af reting
"rod re nki"9.
Rati ng maku ult of . ta ndard,
coo~n~onolly ao::epted sco\eo Iordassi~ oo~on .
Ronklng involves !he o""ngeu,...,,,t 01 do!o in an
orderly ooquenc., bosed on the ""Ive.
Ou . "lIt.II mllUflmlnti
A sc\et1tif" approach to m.iy grow'h i. one that
I. based on accurate me-o lu re m., nts. The
"""". ureme nt. mOO. wn be 01 th ree type .
I . Direc! o"to . Di rect date ore obtained from
""""_",.,,,1> thot a"" tat.&n an living "",",ons
Of coda.er. by meons of sco\eo, """"suring 'Ope.
or calipers.
2. IndirK! 0.,/0 : Thot growth meow,,,,,,,,,"
con also be hod from imog&S or repradVClion of
the p",",on. l.>d1 o. photog",pI. . , radiog"'pl.s or
clenKl I casto,
3, Derived 0.,;, . Tney oro dota thot 0'" defi....,.j
oh comporing "'" "'80.u'emenf1;. Thew"'"
"" of moosu",,",.,,..1s con be 01 d.t!erent ~me
from", Or o/rwo d;H",ent so....,les.
M ETHODS OF STUDYINO OROWTH
Acco rding to Profitt th.r. or. tw o ma in
opprooc he. to lIudy ing o h\'Ska l growth
I. MeO'U'I"'en! oOP'OOC"I.
They comprise 0/ ",eo.",oment techniques thpt
cr. ccrried ovt on Ii.ing in d ividual. . Th. ",
me/hod. do flO' harm the onim a l.
II. E.pe ri", e nla l approach e,
Th e... are desm"cIie teeM"u "".... tt.e a nimol
that i tudi"" i ..,cfiliced. e. pefimeotal
ogprOCI<;h are usually nat carried out on
humo ....
Blml l" c t ur.
lhe-y o re Te,lS in ""jch p;,.yfco l cM ro c<eriltics
.u~ h o. we ight, he ,.hT, .kelelo l maturotioo 000
(l$~fk;atl on 0'"
mM ,ur. d and compe .ed with
JlQndord, based upen th e ="'ino~on o! 10f\/<,
grou!>, of healthy subjed!;.
11/1. ' "linin.
In 1936. Belchi... o(uOOoIoI'y nc>'ed !hot bar>es
of animo~ ",,"0 hoo """en mood ... plants we ...
'Io in ed r"" , So"l>seq uentfy, lhe d\'l' in tne mO<!cler
plant. o li." rin we. identilied ond u.ed 10< bone
-"" Thil !eChniq..... j~ oominilffQtiQn of
certain dvet to !he experimental on,mol which geT
incarpatOted in the bo __ Kis pelf-bf. TO .'udy
the mon.- in which bane is laid dawn. the I~.
of 9rowth, ,.,. ct're<:~cn. dun:mcn and amount of
growrn m dr!lerent .~e. in th . bane, The dyfl
used for Thil pu rpo ... o r. . ...
_...
a. Ai i!e rin R"" S
b. Add Al iIa"n ~""
, l"fPOn llIue
d
leod cc:etcle
Red/ol,otop ..
RodioisolOpe! of certain ."""' nb 01' compound! ,
when iniect.d inTO Tissue g... inco rporated ,n the
de~lop i ng bof'lO ond ad O~ in . ivo mor.er-..
 A ,
These rodioillO!Opm ro n kl"', be de:8Cred by
troc'in g down the ", d iood;"'ity lhey o mit. The
rodio-~tOpel used in c'code:
o. 1ochneri~m . 33 ,
b. CoIcMn . 45
(.. Pctass,um . 32

Imp/lni.
The u,," d implcnIS IQ >Iud-, 00"" grc>w1l1....,. ~m
pnxe .. media l ", the fio;t molor,
introd uced by Bjott in 1969, It in ,.o l,.u the
In co le of The mand ible the implants oro l<lled
impla ntin g of smo ll bit. of biobgico lly inert olloys
as foll owl (fig 2.c):
inIo grcw.1ng bone. Th e... ser;e as rodOgrophic
I. Antoriar 0'P' of ..,.mp/lys.is, in tho miali""
merence pO,nI, for ",riol rod;ogrgphic orlOlv>is.
be:owtho root lip"-
The merollic Imp~(lnIs used lor studying growth
2_ Two pi'" on the right side.x the mandibular
ore uwolly vetylirry. They Or. "round 1.5mm in
body. Ow pin under the fit'51 premolar ana
Ierogrh one! O.Smm in di""...,..rond are mode of
the od>er below the <one! premolar Or row
Tantolum meto l. Th .... implants ore embedded
mO~.
in CarIOin OIWOS at In.. mo,;11c and mandible in
3 Ono pin on !h. e.<wnol aspect of th o rig ht
otd .... ~ >!cod y tho growth of tf>e "u ll.
romul at rhi! 10' 01 of <xc lu.o l surf""o of
'The o'eos wh . r.1he ;mplan!) a'll ploced
moIo.
in Ike mo.,,;I., 0"" Ifig 2.0 & b):
1. Hord polo~ ~ind the deciduous conines Rlldlo"lIp~l c ttcftnlqllu
(prioIlo eruption 01 """inory permonent
Aller Roeonrgon's d~ 01 X "'I'> more thon
incisoll).
100 yeaf'l ago. difletent types 01 raaiographic
2. Below ..... 01'11.,..;0'",,,01.,>0,,
(af!erenJPhOn
Io!d-oique:l lO.tudy <;Ir"""" ond ~opmenl_.
of ma .. llory inciWf1;) .
dcvisod . The most commo nl, used t""hniq!l81
3. Two implants on ",me r side of the 'ygC>mohc
pro<:on 01mo. ill o,
cr. ".pho lometry and hahdwri. t radiograph .,
4. Border between M rd po lotc end ofveoJor Ceph o lometry , It is 0 star>dardiud

rod,ograph ,c techn iq ue of tho cran io-fac iol
region, Mer ito introd\ICtian by Broo d ~ nt in the
yea r 193 1, thi s techniq u~ ho . contribut~ d
.ig nifico ntl y to ou r krlO>M edgc of hum e n cro nio-
laeie l .k~ leto l growth if.. 3_01_ Ce pha lo metry
meke, it polSible to to ke s~fie l ro di og raph, of a
patieflt' , ,ku l in ordef to s!v:fy tn., growth chonge'
Iokir>g place , Net on ly i. thi, tech niqve v.ef~1 in
studyi.... growth, it i, a l. o a va luoble oid in
orthodontic diogno,i . , trea tment plann ing,
eva luation of treotme nt ",. ult, aM lor grawth
p",dK:\ion , IMo ,e de"" I. on ceph<l lometry a ro
given in chopter 121.
Hand.wrist X-ray, , Rad iogrophs of th e hand
wrist "'9io n a", u,ed to , tudy th e biologica l or
. keletol a ge of a pc""" Th e h<lM _wri<t oreo
ha. " nu mbo r 01 <ma ll spo ngy bo nes called
carpel, tha t have 0 defi nite K he du le of
appea rance oM o,,,fication (1.. 3.bl,
Na tYra l ma rke rs
Normol bone ho, c.~ in h ~!olog rn l l""tu,es ....en
a. nutri ent cord" I,,,,,, of a rrested growth ond
ce<to in promi """t tro ~cula . _ The, ,, de"eiop -
Fig 3 Ro" ; og'op~ ic
d-.. """. of ....a,;"Il
bono 0-""'" IJol '--"'''Il
lot. ",1 ". pI-.o"~ " ""
IBI U ~ Ho..o _W,,,
rod.",,,,,,,
"","la l feotu ,.. ci a bone ce n be vsed 0< natura l
markero to .tudy growth bl mean . 01 .eria l
rod iogm ph, . Noturol mark" " CM be u.ed to
stud y bone depos ition , re'o<ption oM bon e
", mode ling ,
C(tm pa ratln ana tomy
Certa in bm ic princip le, of growth that Ore
uf'lr.-efSOl to all spe<:ies can fir" be , tudied on
laborolofy an ima l. ,
MECHANISMS OF BONE GROWTH
Boo-.. ~ a spo<:iolized ti " U" of mesoderma l or" in_
It form, the , trueturol fromewor'< of the body_Bo!1e
i, a calc ified t ~.ue that . upp-ort. the body and
~ ive, poi n~ of otklchment to the mu<cu latu ,. _
Norma l 00 "" contain< betweer> 32 - 36% of
orga ni<: matter.
Bone deposition and resorption
Bone chor>ge. io .oope and ,;ze by two bo, i<:
mech on i' m' , bon e de po . itio n an d bone
resorption . The prcx;e" of bone depos ition aM
r"sorption together i. (a il . d bone remodel ing.
The changes It10t bc:re depos~ion.,....j 1eSOJPI""
O>n prodlJCO ore :
o. Chonge in ....
b. Chang. In shape
Co Change "' propotlion
d. Chong. in ... Ia~on.hip of th. bone with
odjoceMt SlruCN ....
CO.t/OIl' dr'ft
Mo$I bone. grow by inlerplay of bone depos iti""
Cild resorpIicn. A combi...,t.", cJ bone deposil>on
or.d resorplioo rG!u hing In () growth """'omenl
-.",10 the depositIng wrloce is c.olled cOlliml
drill. ~ bone depopionorod ...... 'piion on .. ther
>ide 01 0 bone ore eqool, then tho, thid ....... 01
!he bono remgi", tonlfOnt. Nin case rMr. bone
-
IS deposited on one side end less bone resorbed
orr Iho opposite sidt then the 1i><kness of the bone
D llp'"eoment
~ movement of the ~e bon e {[' a unit.
is /he
Dj.pla e""".nt co n be of two Iyp<!'.
PI;mory Dispioc e ment : II 0 bone g ets
displcc&d '" a ~uh of ~. own 9'c>wth, ~ "ce lled
primary di,plocemem. For lXOmp/e, 91"",/h o!
the mwcillo at the Tuberosity region rewhs in
pv";'ing oI/ho mwcillo ogoit"d1 the croniol bme
which .... uhs in /he di.ploee""",t ol the m.... llo
in 0 fOI'WO,d end downward direction ~ig ~ .0).
Secondary DI,ploce",.,m ; If the bone g.~
displocod 01 e re5U~oIgnw.th and enlargement
of on adjacent bone. ,t ;. c.olled WIU>Odory
di,ploc:ement, fo, e>:<rmpie, the g..,...,n of th,
Clonial bo.. C<lu .... the lO<WQrd and dow""",rd
d i'Pioc""" "m of the """",Ik, (fig 4. b).
DSTEODf'NESIS
lh. procen of bone formotion i, coiled
..,..
~&nas~ So"" Ionnotion 10k.. ploee in two
1. Endcc:hondrol bone formation.
'2. Inttomernbn:.nous bonclorrnotic:n.
E"doo/lond.o' bo ... formatloll
".1he
In !hit I'IPt 01 tWtog ...... bone Iannotion i$
p<Keded by r"""""ti"" of 0 Olrtiloginous model
whic h il subsequently ",p laced by bon t .
Er.dochorrdtc l bo"" b-mation <>CCufS os f<> lows.
o. MCWlCh\'l"l1ol celli becomecQndeowd allhe
l IT. of bo rle fa r""" .",
b. Some ....... nC>ymcl ~e ll s diffe''''''''''te into
c~sI, ond k>vdown h,ol'" w rtUage.
c. lhe C<ltliloQ. luvrroundt'ld by 0 mombro ...
co iled perichondrium. lhi. i. highly vosc:u!..-
 ond CQ'1loim O$l..ogenlc celli.
d. The inter..::ellvlor ,u~nce ........ ounding the
co rtilog e ce llJ becomes co ld li &d dve to th e
inflvo""c of enzyme oll<oli ne phospoolase
,eaot&d by1M carti lo;ll te l ~.
t. Thu. the numlion to II>e cMiloge ~i , i. cut
off leading 10 their cIeol". Thi. r...,,!to in
formotion 01 emP'\' 'p0c8'coiled primOI)'
I.
0 .....
TM blorxl veuek ond O$leOgt<lic cell. I,om
the p"richondrium in.ode the c"k~ied
CM il 09 i,xl1)$ motri, whic h is now ,&d",ed to
be .. or wa ll. du e to ""tin g Owtl y of the
...
CQ lc ified matn... Th i, l oov~1 10';11 e mpty
'PQCO-S betw<:" n rne wall. called seconoo ry
~.
g. The osIeogeniccelll from the perichondrium
becom" o<leablost. ond orron(l& olong rho
wlfo'. 01 rhcoe bel .. 01 CQIciIied motr;"
h. The O$lec:obIo.t. loy down orooid whieJ, I"""
becomes mkifiod to Iorm 0 lamo llo 01 bone.
Now onoth" , layer 01o.~d is secretod and
this goes Of> and Of>. n.v. the CQ Ici!;ed m<J!Tix
01 co,~loge ad. a, 0 'Uppar! for bon"
Iom>otion.
' n l'8""mlllan,"s 11011. 10 ''''8 11011
I" rhi' Iypc! 01 ""ilkotion. rh.lonnotion 01 bone
i. not " ,ac..oed by lo.moti on 01" tQrtiloginou,
mod el. In,tead bon. i. laid dewn dire<:tly in a
~brQ u. membro ....,. Tr.. intromomi::<"onovs bone
il fo.-'med in the following manne,:
a. N ~,e .ite 01 bo"" f"""o~on, mesenct.ymo l
celli b&e<>me ogY"'I/Oted.
b. Some ...... nchy....,1 cell. loy down bundle.
01 co/l"II"n f1>e,.
c. Some ~I cells oroIorge orod OC~'"
o bosophiIic cy!Opi(J:Im a nd form OSleoblosts.
d . The ... e,toobla,t, """..10 0 geioti f"lO<l' "",tr",
co il ed o~d o,ou nd th e co ll ~ n fi bo".
e. Th~ depos~ calcium $Oils ;'110 11-00 ruleoid
leading 10 Con'.,,"'" 01 osleold IfIlo bo""
Icme lkl.
I. Now Ih. o<teab'osT' mo'IO owoy I,orn 1M
10~1oe and " new lore< 01 OIttoo'd ~ I'IO'eIed
..+oich al$O get< cd6~ed .
g. SOl'l'e of Iho o.!eobfa ... get enlrooped
be_n two lomello ... They ore coiled
..-..
THEORIS OF GROWTH
G.."el": Ih eo ry
Th:. tI1eoo:)- $impty .ioles no- ell g<o-M+o it "",traj led
by genehC influence and is pte.plonlled. This i
one 01 ~ eorl'eol theari ... pur forwa,d.
Sulu f Ih.o"
Sicl>er believed!ho! cro~i<>-focial growlh occurs
at the ""tu res. According to him paired poro llol
l utv re, lnal attach fociol orea , to th e I< ull an d
111. era";a l base rog'OI1 P'J,h tl-oo noso-mo,ill a ry
comple. bwa,ds 10 poal it<,~ ";th that of
!he mand,ble. This theol)' also adnowfedges !he
generic Illfluence 01 growth.
A number 01 poi"is _re raised ogo,n.'
thlpheol)'. TM Iollowing ore some ollhem :
1. WMn 0" area 01 rh e w lure i. I,onoplonled
'0 o noth or location. the /i ssue doe. not
continu e ro grow. Thi , cl"",ly ir'ld icate.
""I-: 01 """,te growh fIOI""tioi 01th e SYT",....
2. GIOoOth ta~., pla ce '" unlfeoted ooses of del!
""late even i" the absence 01 wlu ....
3. M,crocepholy and hyd,oeephofy roised
doubq oboulll>e ifl/!"in.ic genetic .~mulu. 01
lui ......
C.. rW fnOIl. th e ory
Thl, Ihool)' wtll put forward by Jam .. Scott .
Acco<ding to him intrin,ic g ,,,,,,,h conlfoiling
/oc!ors oro pr~$ent in cortllo ge 000 periosloum
wim wTure. bei"lj onlj secondo,,!, He.>ewe<!
the oortllogin"" ~o. Inro"llnovt me slcull os
pnmory cen~ 01 goowrn.
Growll. of the molill" i> on"buIed ro the
nasa l "'PTol (ortil <>g . According 10 Scoll, the
nasa l scp'ol ( 0 Ili"9 0 II me pocemo ..... lorgrcwth
of the enrire noso-mO>tillolv comple. . lh.
mondole I. oolUlderec! 0...... diophysis 01 0 long
bone. ban-inTo 0 ho ......,. .hape with OIlip~
rerno"<9d $0 mot there i, oo ~i l og<l consliMi"lj hoM
on epi physe a l 1'1010 OT the e nd . which or.
reprlOnTed by t"" condyl ....
Points in ro.our 01 Thi. theory i",lude ;
1. In mo"l' bones,a:ulIiogo g~ <XCIJ11, wh~.
1>0<1. merely rcpiocel it.
2. Ii 0 port oi on ~pi physeo l pi "", ~ lro napion:ed
10 0 doflo..em tocolion, ~ will continI>\! rogr(>N
in the n...... locotion. nus incf;co1es 11._ innolo
g'owtf, potenTiol ot the cart,loge.
3. NOI<II ""olal coo1;1"9. also shows ,nna'"
growth pot""tio l on be ing tran!.p kmtod To
onoTh., ~Ie.
4. &perim",,1:< on '0bb,4In""lving .elTlO'VOl 01
The nosol .eptol oorliloge demonlTro",d
"lorded mid_toe. developmenT.
Th . '~nct'on el m . t,,~ concept
11>& lurdional mMn. concept 01 Me"in Moss
_lizedthe sud.on g'owth ond dcWIloprnenI
OTO ~""'-"Mn me Sutu",1 grcwth """'ry 01 Sa-
ond C" rtibg inou . g,owth tt..or-,- of Scott we'"
>CYorely " iliCi, ed fa. th eir ino d"'1uacy. Moss
inl,oduced the doctrine allunr;tianol matrix
comphmonk"T to Ine original concepT of
/unct<onal "ernnicl compoo:>..,1 by Van de, Kloovs.
The fun ,~ o n al mot,i. con ce pt a ltompl, 10
comp ,. h. nd Ihe ",k>lions hl p between form (lnd
/unction.
The functiOnal mot,", hypothMi' c.,lm.
tha t tne ofig i", fo rm, posit ion. growt h a nd
moinlenonco 01 011 sl<e~101 ,;"we. orocl a'goOn'
ore olwoy, seconda ry, tomp" n,olory ond
neceuory ",.pon_ To chronologically and
marphologicall, priO<" \MInt. Of proce ..... mOT
oceu' in ,,,,,oOfi co ll , ,. Iated non-okele'o l liu""""
orge n. Of /utXlioni"lllP"c",
A number at relo! ... "ly independent
!unct<ons ~ oorried out in the aonio--bdol "'goon
of ..... humon body. Some 01 me !unctions carried
a ut in d uo.. 'e. >"",lioo, oIloo ioo , >i~o n, hoo ri"lj,
b::lk>"ce, d." ,.Ning, digcslioo, swo llowi"ll. IPC'I'Ch
ond n_u",1 integ,o~on.
Eoch 01 these futX~an. is oorried out by
o fu"chanol c",niol compo .... nT. toch ful\OlOOol
'tanlo l ca mr>en enl ,on, i, t, of oil a f Ir.e li,we.,
o'go " ., . poc and , I. to l pe rl, nocono,..,. 10
cnrryoul a gi."n function. lhe functional crtWI.,1
comp o .... '" i. d",..;dec! into :
1. Fun::lionol mom.
2. S'<e1etal'JO it
Ai lrl, "';nues. Otg on, o nd lundioning
.poxes le\;en "" 0 whole com"ri.., the functionol
motrOc, while the sl<e~1 ~_ leiarod to !hi.
specJ;c /undiorol mori>. oomprise tI>e skeIe",1 una.
AlII~ole!01 ~ .. ue. ang inale, g'ow a nd func~O<l
", mpl. toly embodd<od in their ' e"cro l melric.,.
l iM chong ... in '''.,!halX' ond spatial posiTion
01 all I kelctol "nits including Ihe" .er v
moinlOnonce i. dl>\! 1O!nO operolionol ocil'<lTy of
!hei. .. k>ted /unCfionClI mcma" .
Th e "'.Ielol unil : AII , k. lotc l ti ss ue. ossoc: ""ed
wilt> 0 singl. funCiion 0'. 'o ll~d 'mo I k'~lo l
.....a'. The skeielol un~ moy becomptised 01 bone.
conik>\!8ond tendinous ~ .. ue. V/hen 0 00 ... ..
comprised of ....... rol con~g """, skelelOl uni .... ,
they oro te-rmed 'm >cro-,kolelol "" it". Th . m"" ilk>
and mond ito o.-e eoonprised of (I ......"ber 01 such
micro-skele-tol units. For IIIXOmple, rho mondibie
hos wtth,n a olveolar, ongulor. condylar. gon.cl,
l=t
menial, coronoid ord bosol mic;ro$l:elelol unib_
In cose of !he m.,,;11o ~ i$ mooe uj) 01 orb~ol.
ptIeIIm<lti<:, pablol oed 00",1mlao-"'e~'" unil>
Whe n odi o ining po rt ion$ of 0 nu mbe ' of
Reig hbouri nQ bone. C'. united t<> fu ndo n o. (>
single =nial com"""""t, ...., tc<m mi l O 'macro-
.l:eletol una'. The entire endOCftlnicll"rI",:e of
!he calvori ....... i!I on ""'m~ of 0 mocro-skeletal
una .
T~e IunClionol mom. : The Ivncfioncl molri>
con.i$!3 01 m"$(Ie., glonds, roe ..... vessels. lot,
tee,h o.-.J the funcHoning .poe.... The fu "'tionol
matri. i. divided into two:
I. Periost..,1mot,ix
2. COj)wlo' matn.
1. Perio1;teol Mo!ri= : The periollll matrices
cd d,rectIy and odWely upon their rektted skeletol
unib. Aherotionl in lhei. fUnc1ior1ol dema.-.Js
J)tOCIuce a """"ndo.., compenlQlO.., lro",I"".
motion aI the .i"" oed or lhope of th~r sleolela l
unil>. Such trn ns/ormotions Ore brovg ht obout by
.... ;nterreloted p<o<;e .... ' of bon. depositio<1 ond
resorpIion. The peri05l",,1 motriau indud" the
mutde-s, blood "".... Is, ne"'ft, glond etc.,.
These lissues oct difOCllyon their relo!ed sla.1o.to1
unrts ll>ereby bringing obout 0 lrunslormotion in
!her size and ,""ope. This lron$lormotion d"" It;>
lheodion 01 peri",1eo1 mott'\cM il brou"" about
by bone depooition ond ,.",'pI""'.
2. c-.Ior MotriGes : Tn e cap$ulo' mot,ice,
eel. doodr and pa ...... 1y on their reloIoId .keleto l
unita procfucing a MCOndo.., com pen",,,,..,
11'0........ in opoce. \he$e OllelOltOns in spatial
poWon aI oi>eIo:!r:ll unils are boought obout by
the eopor,.;on d!he oro-Iociol COlllul. within
which Ihe Ior:d bones arise, orow nnd are
molntcined. Theboal sh~1 unils Ore possr.eiy
ond l oco ndo rily.,.......... d in .pece o. th e ir
enveiopi r.g co p.ule .. ,,"pondod. Tn is kind of
tronllo tive lI rowth i. net brouoht obo ut by
deposition and resorption.
The ......."H.oniol copwle and III. oro-
foeie l capw~ en e"" mple. of COPIV;,r f\'\Ctr""'.
EQch of th ele cop. vl. , i. on enve lop which
conla ins 0 .. ,lei of f",dio",,1ortn'oi o:w-nponents
(.1:8.101 un il> ond ",;,ted Wl>::tionoi motrur) .... ic/.
o. a .... o~ a ... "'ndwk.... d in between two
~ forerl. In the neuro<lOriol col)$V~, !he
cove" consll! oIltre .kin and dura mot. wh ....
01 in lIIe 0<0-10001 copwle the slcin ond m...:oso
form !he covering_
Th e neu ro."rnn iol cop:s ule lurrou nds
c nd pro""" the n. uroc",n io l copo u;, r lunc:tiono l
motrix "",\eM il the bro in, loptom..,ir.g end
C.s.f. The ...........,.,roniol cop~ I, mode uj) 01
slc;n, cOf'W"OOldive 1issrJe. opo........,.;c loye., I""",
conn.dIve tiuue Ioyer, I"" iosleum, bose of me
slcull and the 2 loyers aI d"", m01er. The oro
facial cop:sule "'rrounds one' j).otKn the 0<0-
""so-phoryngeol SOOCM .... ic/. constii"'e lhoe oro-
facio l cop:s ulo' moirix. T..... growth of the lodo l
. ku ll i. influenced by th e "o lu mo a nd porerq of
th .... ,~.
"en Llmbor, II '. tll e 0l)'
A rnulrifoctoriollheory was ~ Iorwor<I by on
Limbergh In 1970. Accordi,,!! '" ..", Umboroh
lIIe thr... populo. Ihoc .... alo...,.,...m were f>Ol
."' i.focio'y, yet eoch conioin. element! of
!ig niliccnc:e thai cON>Ol be denied. von umbcrg h
.xplo in$ the proce.. of growth and development
in vi_ !hat combines ell the 11. ....... xisti"ll
theooi ... He wpp::><ts the fundiottcl mo!l'tlr mOOty
dMasa. OC~"""" OIpec1SofSo:::her's
Iheory and '" me ..,me ~"'" doe. n", rule oo.rt
oenetic Involvemenl. van Limborgh has
.' W sledlhe IoIIow;ng !i.e1octot$1hot hoe be~
controll growth:
Int,lnl ic ffe ntlic /octo" , They are t .... g..,,,,i<:
co ntrol of the . <. Ietol unil> the mse lvel.
lo<: o! ep ige ne li c la ctor< 80 rl e growt h i,
detormi" ed by """",tic cantrol ori gino tin g fro m
adjace nt , trvctcres !i kHbroin, eye, etc.,.
Gene"'! ep igenetic /oct"., .
Th . y m e ge netic
!oct"" dotetm ini ng growth from di,lo nt . trudure,
f ,g, 5e> n()ffi10 ne" growth hormcn . "tc, ,,
lo<:ol ~ rlVi!O nm "nto! lactors n .y or. nOn -
91' neti c fectors trom locol ",tema l environment.
f.g . hobil$, mvsde force, etc.,.
c.,,,e roi e nvironm e nt,,1 j"ctor< The y o re
gene",1rl on-9"""''o infl uen c.e, .uch as nd rition,
O'gen etc.,
The views "'f.'l',oed by I'<l n 1m borgh can
be symmoriwd in the 101l 0w irl 9 , ,' point"
I. Chon d roc ro nia l growth i, co ntroll ed ma inly
by the intrin";c gerleti( foci""".
2. De,moc ronia l growt;, i, co ntrolled by 0 few
;ntri n,'o gen. t f""to" ,
3. The Lurti"gioou, pa rt, of the sk ull mu,t be
COfl.ide red os growth centre .
4. Sutu ro l g rowth i. cO rltroiled ma in I, bi
inIIv.r'ICl" 00900ting from the ,~ " I ( ortilnge'
a nd from o th or od i oc~ rlt .lu ll , trvcture,
S, Pc rio <t. a l g rowth larg ely depe nd , up on
g rowth of odiocent <trudure',
6. Sutural and pe r<>sloo l growth ore odd it600 lly
~ bo,- b:;a l non--genet'o cn';rorvne<ltol
i nflu or>:~
OTHER THEORI~S RfLATIW TO CRANIO-
FACIAL GROWTH
Elllow's expandIng 'V' princIple
Mony locia l bo no, or part. of bo ne ho. e 0 V
.hoped pattern of g rowth. The yrowth movcmo nlo
o nd en largem . nt ci th e,e bone, occur to war ds
the wid . ood, of the V o. a re, ul t of di lFere ntial
dopesit" n ~ ",100,," """"""ion of bone Bon.
\~
depo' ition oceu" on the in ner , id. of the wido
.n d 01 th e V' ond 0000 resorption on th o o uter
,ur/ace, Depo~tio n 01"" ta le< ploee at th e erld.
01 th o 2 arm S of the "I res ultin g in g rowth
ma. am"nt toward, th e e r>d,
Th . V potte rn of th e g rowth occu,," in 0
numb<or 01 reg ion< Ifig 5) ,,,,,h "" tne bo ", of the
maoo;ble, end. of long bon~., roondibu" r body,
po late etc ..
Enlo ... ' caunterpa,t principle
The counterpart princip le 01cron ioloeo l growlh
.Iotes that the growth of any gi...n f"".,1 o r cro nia l
port re" le, .IpOC ifoco lly to o th. r , trudurol or>d
goomctr'o co unterpmh in the face and cran iu m.
There are reg io na l rola ti on>hip.
throu ghout the whole fOGe ond cron ium. II eoch
rega rd part 000 it. part'ou"r counterpart enlarge
to th e ",rne ."t. nt. ba la nced growtn occurs -,.7
Irnba laoces in the reg;onol relation$hip, ; ,
a re produced by differeoce, in ,
o. An"",,"", of growth betwee n the cC-U rlte'pa rt"
b. Dr-e:;t"ns d growth between ohc coVnterp:Jrto,
Co Time of g rowth betwee n the cou nt~ rpart' ,
The diff. r. n! port, & tl""r GOuntnrport,
are,
I , Na"""'ID:iII "'l' wmpl~< relate, to the anterior
crania l 10'''' ,
2 Horizont" di mension ofthc phar.,-ngeoI .pace
re lo te. to th e midd le cro niol lo.", .
3 Midd le erun ;,,1fo,,,, and breadth ci ro mu'
ore co unt. rpart.
4 lIA.o>.i llary ond mo ndil>ulor arche, o re mut",,1
counlerparl>
5, Bony maxil lo and COfPU' 01 roond ibl e are
mutua l cO\Jnterpa rt' ,
6, I'-kl<il " ry tu ber"'ily and li r>gual tubero, ily o re
co unte rparts.
 For e>.omple, rh~ presence 01 tos~ bud, ;,
dependent UJICI'" 0" intocl in"",.,o!iQo._ The """"'"
are not onl)o imporlcnl for !I.. sensa",n " f IO~o
b~t th ey a l.e hov e a M urotroph ic .Keol in
, ullOining nO!'O lthy growth 01 th e tolte M . a'"
nearb)o ep~heliol ti .. "", Ii the toste buds ore de
inneMlIed, they become atrophic and 10 also
the neorby epitheli(J1 ~II ..

A Neuromu.culor troohism : fmbr yoni,

~~1 is indepenoo...tof neurollnnervotion
and !fo!1I>" CCW1tfo1. ~pro>im:;llel 01 the ")blast
ltoge of diffe rentiotion, n"'-' ro l inne"'otion i.
estob li,hed with out which fu rther myogeroe. i,
uJUQ ll y co nnot continue ,
B
Ne"f<)-viJcer<>llropi>;", : The $Olivary giard.,
lot filSV' and other Ofgon. are trophlcolly
NI II. ob opllle p'O,,' " In reguloted, ot lea" in ~".
. , ... t. cll ' ,.,owf/!
N eufOlrophism i. a non.lmp ulse Mlnsmilling
oeuro l IUrldion!hot irw<>M.. c>ep lcsmi<; Ir<lnsport Coflg'.~ .....""' , M<Ab,.,." N': C .... h "'"_~
and provide. for long te rm inTeroClion b.etwe. n moo' . Hoc" wH, <0 "" " ",,"0' ''''Iil''og",,,,;,
copt-.o lo ~ 0,," f,M o""t,.,-~ M J Qr,kod 191'<,
"eyro", cnd inn e rvoTe d tiuue, tha t 153 16(l
I>omeooto#colly reg~k>101 the mo,pholcgicol, 2, ~: 1-10 ... boo. cl hdo g-.-t.. we lo.ooIon
Co-.-y. 1981
compositional and "'ridional integrity of"""" 3. &.I"". H"...,.,!d. L>tho ... Mclli--, C"-;""'.... 0'"
Iissws. The """""' 01 neur(llrOp/lic .... b$t(Jl'lCfS rrd 1Io"1<~ : , . .... " h on "",",,01 01 (10.,0100.:01
!he ptOCeSS of their introduc:ljon into the to'<;let ....,..; Nos J Oothod 1911.5095030
~. Grots. TM : Ool ooob .k, : r.nopIos arc! !""OCi".
In.... ore un"""""" 01 pre$e<1l. -..e SO"..... !I18~
. The different typ.es of neurotrophic S, Ma<s Go""""" """,",ov... "'; "" ..."", "'" J
Oothod 19a 1 ;366-375
mechen""", ore: 6, Me.. 0'" ~ . "" : Tlo. pri"",.,."" 01 1"><'1",,, 1
1, Neuro~pilhelio l trop!,ism ""'.~ .. " loOGl """,,",' , Am .' OrtOod 1969 ; 203 1
/, ",- , S",",", ' 0,,", S ~ """''''' Moo.!SO .... i'" ard
2, Neuro .iKern l troph i$n1 Vd.,.OM A. o IlQ..... ,.., ..... . ,~ ,"otle l cl
3. N.,..,.,.musc"lo. trophism """' ...._I!7<>'h Iv.) 00-+"" 19&< ,316-332

N,,"ro~lrh!!'liallrophi.m : Epithelial m~osi.

a. 11...... S"'I. ~ . S<o,""'. ~o, ""'01, ,Y.o .. S.lo, "n.
v........ ........_ : Ivo ollomohl< ......... '"""'"
en! synthe.i. Of<! neun>IrOphicolly a>"Itn:lIlfId. The 010'0.00l000i._ IIm J 0 _ 1943, ~18
9. "'of;~ WIt. C.,......po"' .. Omooo'Ofa. So loo. ..,
no,",ol epithelial growth i. tonIfOlled by reI~ CV",oql~6.
of ce<fOin neurotrophic 1ubslOnces by the ........., 10. ~ E Mojo .. , Hond boot< 01 Ooj ,j, ,;co,"'"
boo .....dicd ..AoI;''-o, ;",,1988,
,yna~ . Ilihi. """ ,otropnic p>u.. i.lodcing 11, !'-W,:O~ o"" C>c<MoI",,, __ .......
0< o'eiici""t, abnorma l " pith . li e l g rowth, 0<0-
il W ~,I9I'3
fociol h,popc.ic and ma ffeo-motion etc., OCCU '.
 ~.- ..
,.

and Development of
and Facial Region

rowln an d de ve lopm en t of on

G
"et/ad 0 1 tb e e mbryo
ind,,;du c l be divid .d ;010 pre-
~c "
This per'.od extends from the fourteenth doy to th.>
notol en d me poll- nolO ' pe<iodl. The
fiity sixth 00,. of intro -uterine lif~ , During th ~ per>od
pro""to l perK><! o f development i. " dYr><lmic
!r.. mo ior pen of the devolopment of the feodol
phose in Ir.. deve lopment of " ""mem be ln ~,
end th e eron,,1region OCOJrs.
Dun,,!! /hi, period, the r..igr" irlCY8OS8!l by " I...,.,
5000 tim ... .,. compored 10 oof,. " m.reefold P,"od "f th e f etus
inc,,,,,... during the post-nolOl period, The pre-
This phm.e e>.!enm betwu" "',fifty .i:<Ih 001 01
noIol Me Con be orb"",ri" dividtd ;"''' """
imro ........ ne IiIe hU billh. In this period, occeboled
~:
grOWlh 01 the oonio-lo<;"1 strvctUflS 0<"'''
1. Period oflhe ovum
r.sulting ,n an il'H;rflo<J!.e in their $jUt. In oddmon,
2. Period 01 theembryo
o chonge in proportion between the variou~
3. Period oIthe Ietu.
structure< 01$0 ,,"urs.
P~,I"" 01 tb, OY"'"
PftNArAL GROWTH OF CRANIAL SASE
This period ~ /0,,, pe"od oIopptO.<imole"
two _ls from !he ~me 01 f.urililalion. During The ""rli... t ~.idence otlormation of th" CR:Iniol
mi, period the d""""ge of the oYum ond the 00$0 i$ __ in the post or Iot~ sornilic ~ (4th
otlachmen, of the ()VM to the InllO-ulOri"o ""1;111 . 8th """'* 01 intra uterine life). Duri"lt thi,lote
<>Ceu". somitic pooriod meserd>ymol tissue d-..d Ifom
2Z Orthodontics The: An and Science

!he pntnItiYe .!reo!:. ....... rol aest and occipital

We.atOhtel cond..,,,,, around tho de-.eloping
btoin. Th .... ,,(opsule is formed around \t.e
broln co llod Ecto m e~ i , o. Ecto menlo geo l
CDPWIe. Th o be",,1portion of thi' copl ule give,
n. Ttl "'" Ivtu,," (ran>ol bos~.
T"'~ developmenl 01 Ihe ,kull crd
100 mctiot. 01 II-e (arfilog'" of "'" cranial base is
degendent upon !he preoenc:e 01 mony arher
........1.trvdvr~' li~~ bruin, =..001 _ and ~I-
e,es. Thu ...... ideo(e 01 .h~1 fatmal;on is _n
<:CIrTIP" r"ti..ly I"., "fI.,..tho pfimo<dio of many
0Iher cronio l5lf\JClur .. ho ... developed.
From OrooM !he fortieTh 00, onwc rd"
'.hs ecIomeninge<l1 copoula is slowly conv.rted
' 'Ill C01~ 01 +0 Cn>"",,1 boo .. , I Hooo' co"",'
~ cor!iIQge. This herakH!he on$Cl of <:mnial 2 I'roopho,cid _to,;,.. J. Oob;o" . "",.....,;d <o"".~ .,
b=selotmotior . Thee",,,,...,., of-.::hymal 4. A:o ... tI""do <...;101/0, 5. 0"<: ",~,,,,, 6. AI
op/oof"ood <erliogo. 7 1btI s,.t..oood_1ogo
aIs inIo comloge o r ChOhdoificolio h OCCV.. in 4

--,
~(I"itIJ:

~ """"""""
< ""'"
~ Ok
-:... chondriIieO!ion ~ """""u OfOUnd the
CNNOI end 01 the notoc ..... d are (:all ed
........:1.... 001 cortiloge<.
-,.".oP"1.. 1
C:rioI !Q the te;minoTianaf,~""rd . (wh ich
... "" le"O'.1of the ora-p/>::o, ogeoI ",-,bra",,]
~ ~hyscol pouch do ." ",f,;,;h gives rise
... Ot1leriotlobe of !he p" t ,;bnd.
On eiIha< sid. 01 the ",;sod.,
1oIem twa
"7PoPhyseol or post spf.... . I cortilog ...
cIeweIop. Th...., cortiloga " - Ioge"",,"ond
bill Iho poot,.;a-port olhbod,oIsp/>e<-OO .
C.c oio l to t h~ pih,Ntofl glond , two
~ "rooid o r trabea.b .... ikyas""""lop
""'it;h fvte toge!h~, ond Ionn !heon"""" part
of bod, of . pn.,no id , AI1tcriooy, tho pre
s ph e no id co rti loge fo rm s 0 ve rt ica l
cart ilag ino u. pla te co iled mes ethm ai d
ccrtiloge ",Mch g ..... rise 10 th~ perpendlrulor
plole of ethmoid ond cri>Ioyolli.
f.iiJ LO!eroilOlhe p~vik"y IIland chondriflCOlion
cen ..... 0'8 ....... which 10m> the le_ Wlnll
(orb~o5flhenoid) and lI",ote, wing (olj .
'P~cnoidl of IphMOid
N/lu l
Initiolfy during d~k>pme nt, 0 cops ule is He n
around the nosol ...,..... orgon, nil capsule
dIord'~res ond fa,"" the mrtilogoesof the n<lril,
....t.Kh fuse wtth thecorti!oges 01 the =niol bose.
Ol/ ~
A r:opsyl. II toen oround the .... T,bvlo-cochleor
,Ml<) o rgan s, TI,i. ccpo'-"e chondrifi et OM lot. r
o .. i~", to give ril<) 10 the mo.lOid ond pet ro u.
pOrti""'s of th e lamparc l bo n~ , The oti" " ",'i "90S
"bo fu "" w'th the wrti!o ge, of the crania l bo""
Tr e initia lly "' pa ro'e cenUe, oK cartiklge
form otion in the cronkl l bo"" fu tog etner into
o single i"<>g ulor and ~"'otly perforated cm~'a l
bo,e, T.... ""rl, e.tabli , hm ent of th e variau,
nerv , bbod ,""sse1, etc" irom aM tothe bra in
.... ult. i ~ nurrerov. p"""rat io ns or forami"" in
the d . ve lop ing c ra nia l base. Th e o" ifyin g
<:h andra-cra~ ' um meets the o" if,iog
de.mocro ri um (cran ial vault) to lor m th e
neurocro niu.11
Cllo ndra -cranlal ossIfication
The cran io l bo ", wh ich is oow in a cartilag inous
100m un wgOO$ oss ii<:a t>on , T"" bone, of the
cro niol b,,,e under90 both cndochondrol 0$ wel l
'" intraroom brano u. o.\ili<ation.
Occip ilci ile ne. The occip ital bo n. shows
both end ochandra l ond intra me mbro nous
o" ilicot,,,,,, Se', en o"iikotion ce nt",. 0 ", ,een,
to intromcmbrono u' ond five endochondra l,
lil The ,upra~ucho l 'qvo mou, port oss iiies
int ramemb ronou , ly Itom one pair of
ossificaiio n ( Ont"" "," ien appear in ,h~ ath
week of intra _uterine lile,
(ii) Tne in f' onue hol 'qu~ rn ou' port ou ilie,
en doc~ ondra ll y from two ce ntre, wh ioh
upp<>a r at the I O:h week 01 intro- uT<lrine life,
(iii) The bo,iI or port os\ili ", en dochondral.y ; rom
a '-rg'e "' edkl n o"ifieci on ce"tr e appeari,,"
in the 11 m woo_ of 'r.tra-utc''". Iii. , Th:$giv,",
ri s.c to tr e ontorior portion of 1M occipita l
co ndy le; and the ante rio r boundory of
faromc ~mog num
(iv) A pa ir of " ndochon dra l oss itieation centr'"
oppoars i~ ' he 12th weak form in g the l at~ra l
bo ur',dary of foram e~ ma gr>um and th e
po" arior ;>ortion of occ ip;ta l co n~ e.,
Temporal Bane Tile temp oral bon . o" ilie.
both . ndochond rol ly ond intra. membranou sly
fro m 11 ce ntre.,
(il Sqc<ortJOus port of the tempora l bone ossifies
from a ' i,," le intrcmemb rcnovo ~entf~ thot
appeo" in the 8th week of infra -ute rin e life,
(ii) Th . tympan i" rin g o ifi es fro m four
intro membfGno u, ce~tre. thot oppeor in the
12th we. k of intra uterine life .
(iii) The petrous po rt of temf>Ora l bone o"ifi el
irom 4 endochor>dra l c""tre. thot appeor in
the 5th month of i n 'm-ut~ ri n e life,
(i \l) The sty lo id proccs> oss ifi e, from 2
en r;b;hondra l ~ent"'s,
Ethmo id Bone Thi , bon e . how. on ly
~ nd oohondro l oss ificotion, It oss ilies fram three
ce ntre, :
(i) O ne centre located (e.-.tra lly toot form. the
median floor of the onterio<' cronkl l fo,,,,
Ii i) Two lotera l Cef'ltr", in th o na,al cap.u le,
Sp he noid Bon e Thi , hon e oifi . s bot h
inlromem bmn ou . 1y and . ndoehondra lly, There
ere at leo,t 15 ouiftcO ' ian ce nt",. ,
Ii) Lee r win g E~dochond ro l oss ificatio n
occu,", The oss iiko ti on ~. ntre i, , eM in the
orb ito.phe noid cartiklge,
(ii) Grect. r wing and latera l pterygoi d plate:
'lwo 'rlra membranou. ru.>ifkation cef1Ire$ are
, . en in tho oli;pher'lOi d eartiiage, A po~ of
the gr""terwing o" iti . , . ndocha ndm il y,.-'
(iii) Me di c i pterygoid pla te O" ifi e,
. ndochord rolly 110m 0 seco ndary cartil ege
i ~ th " "" mu lar proceu ,
(iv) Anteri or part 01 i>ody 01 Sphe noid: Os.if",.
" ndochond rolly from fi", CIl ntrc , (two pa ired
ond one in the midl ine), The ce ntre of
o"';fication i, , . "" in pre.'phe rlCid ca,tiklge.
(v) Po.t.. ri or port 0; body 0 1' phenoH Os,ifia.
endochondra lly fram foo r ~e ntre" The c<nt,.
 01 ossilicotion,,!he p::>sHphenoid comloge.
The cranial bme or~hond..,.c:rtJnium i.
impo<tcnt o. " jvr>dion ~en the c/tlnial 'IClult
and the lode l I. ton, be<r>g , nored by both .
The cronia l bose i. reiati"" fy . table durir>g lI"""",n
compored to Ihe cronicl ycult orod the /0". 1 ~.,.
the croniol base con be Ioken 00 a bollo o""in.l
".f,ic;h the cranial YOult orod lodal skeleII:n con
be compared. The chondro-cronium i. relotivdy
lIa bl, . Thi, aid. in maintaining the earl y
em~ished '81a~oruhip of ~ood ..ssel, an d
_ r u nn ing to ond from th e brain. The cron iol
baM 01 0 newbo rn i. smo ll ....n , n compo red to
the cro nlol 'IClult thot c",......Js be)'(l nd the bose
Io!etolly00><1 poster""",.
Fluu,. at t il, c" nl" Hit
During !he embryon,c ond early fetol period, the
CJUniaI ba ... bo::ome. l\coo:e<I ... the tegion be"-'
the pituitory 10"," " nd the opheno.occipita l
junr;tion. The loce is he nce too<ed un~ r the
acni um. Th i. 11. ,u,. of the cron io l bo. e is
occompanied by 0 correspond in g fl, xure of th e
60 , .Io~ng bn>in!tern. Thu.lhe spi,..,1 chord and
f-e \oro""n mo::g:-...n whch d.ol'"G the eorIy stogI!s
of development ........ dil1lCted batkwon::ls now
become di'ech>d downward. (Iig 2). Thi.
FOg 2 FI, ,, . 01
,.,~I"""
DffO" '.d".'i""
.... d ....""ct'...
10_,. "">II"um
downward diftd1!d /oramen mognum i. "n
odapto~on seen in mon ....no, unl,1<e onimol"
lIen ds erec;!. Thi s fie""", eltlle cro nia l be" old.
in in, 'e(lIl .,.. . n.. ne urocroni ol copo ci!),. A"",n..r
coru'q uen<:e 01the flexure i. the prede minont
dow"""rd ,otn. , then forword displocem,nt 01
the loee during its growth from !he cronlol baM.
N oround tho 10m"""" 01 mtrouIer\nIt
tde, the ~ 01 tho! baM is .mout65' . Th"IIonen,
out a bil at tno "'" 01 birth .
Une ... n n'fUrI or g,owth o( crln'.' ~.se
TM growl n of th e cron io l bose;, highly un""" n.
Th.. i, attributed 1"0 th . unoy"" norur~ 01growlh
seen In !he dil'erem region. of ,n. broin. Tllus tl>e
cranial ba ... growth """",bles th'g'owtn oil""
V1Imrollurioce ollhe overlying brain.
The ontetlor ond JIOItenor pa'" of !he
emniof bote glOWol dilleren' ",!e.. B,~,n th,
10th and the ~Q!!, weeIc. of intro u!e<ine lif, . tne
on!orier cron ial boot in<reo:se< in IMgth ()nd width
by 7 timel wh il e, durin g tile sa me period the
p-OS'''''''''' c,on ial bose ''''''''0.... on fy /r.e fokl .
PRENATAl EMBRYOlOGY OF MA.l('UA
Nound the Iourth _ k 01 'ntrou!erine t.fe, 0
prominent bulge oppeo.. on ,ho ....Ifal aspect
of the embryo c"","""""ding to the ~foplng
bto in . Belew !he bug., 0 si-cI1 r:ffl deprcsI.ion -.+, kh
~ por,,:ls to th . prim itive mouth ~ co iled
,~ . ~fl OOf Of!lie>lcmodeum , bmed
by lhe buccopho ry"9",,1 membrone which
seplrola the Itomodeum /rom the fotegU! .
By oroond the ~'h week of intrauterine
lile. t... branchial orehes form in the region of
Ihe Mure head ond neO:. Eoeh of the.e oreh..
give, ,ise to mu . de . , connecti.e ,151111>
,,"evia t"'e, "'oIctc l compone nt' 00><1 ne uro l
com p:)<1e nts of the fut"", lace. Th. fi'll bra nd1 iof
 _. proce$$
Fronto-nasdI Medial nasal Process

Lateral nasal process Mandibular proces~


--
r'G' c..OO',I_'''' '" ,... """" ,..,...;"'" +. "".001
._ Q_~ ..bl, .law.. - . k '''' , _ 01 +0
orch is <;ClUed the mandibular ordl and pI(Jy1; on
imp::><1Onl role in the d .. velocmeni of the n<lSO-
mo,,;IIo"! region .
The mesod erm c""e ,in g the developi","
lorebro i ~ pro liferotos and f""nYI {] downwo rd
prOi&clion rhol ove rlop. Ih. ~p~' por! of
stomodeum. lhOs o;lownwo,d p'ojodion i,col'ed
Ironto-nosol proceM.
The stomodeum is thus ~rlopped
.uperio.'y by the f,onlo_nol0' proc.... The
mo!)d,bul"r ".ct-.e. of boll> the sides form lhe
Ioterol wall . <i !!le 51omM""rn. Th. mond ib<Jlo r
ord, give. off {] bvd f~o m iT$ dor.s.o l end co iled
me mo~ l k>rv process. Th e moxi llory proce .. g r~
ventra-medic-emn",' To th e moin pori of Ihe
mandibular orch which i. nOw coiled the
mondibulor proe" ... 1hu. 01 thi. "og" Ihe
p"ml!I"" mouth 0< stomodeum ill overlapped !rom
cbove by the Irontol proco", below by lne
mondib<.ok:l. pro cess {]nd on e<1!>ef fide by:he
0'0.,1 1<:,,'1' p!'O("'sel .
Th e e-::tode rm o",",fyir"lg th. lronto,..."ol
P~"" .how. bilalera l loca liud thid<~n i ng,
obcMt!he IIOrnoOeum. TrIe$<: a'O <:;glled rl>e rrnol
plooodn These p'aoodes saon "n~ and form
!he naral oils.
Th e fo,,..CTf,,,, <i thesc o"O:!<li pits ,",0... iN irc<11o.
roos.o l p'ocess into two port .
o. The modiol......,1 p,oc .... end
b. lhe io'e",1 nas.ol P'OCesl
The two mondibula, p,ocesses g'ow
medial'yond !use 10 form !he I".,.,." I,pond lowe,
jaw.'" !he ma .. llary p"""' uroergoe'lIfOWih.
!he m:.nlO..-.oso1 pnxe.. becames narrow '" !hOI
!he t~ nora l pill oome d""". l he line oll\lS ion
0' The Moxilklry p'o<~" and th e med ic i noto l
p,o<e" cor,elpe<1 dl to the n"loiocrim(l 1dlid .
DEVELOPMENT OF PAJ.ATE
The polalO Is '0"""",, by canTriblllian. 0/ the .
o. M(udlary ",ocon.
c. --
b. PalolOl oi>eMo' g;"'n 011 by The maxillary
FronTO nrno l procc",
The I,onto-nora l p,a<;... give, rI$e to t""
premC>.i llo'l' regio~,,"" i", I"" po'olol,he~ lor'"
the rest ol!he po'ol . At!he pablol,he'" grow
med",lIy, thei, union is p,evented by the presence
oIthe longue. Th.JI iniliolly/l,e developng po'atJl
<helve. grow ... rtkolly downwards IOwOrds the
~oo, of me movth (~g 41. Sa""'~m. du~ng the
""",n!h wee!: oli nl",."!",..,,, I:;", " T",,,,leomation
in Th o pot iTl on <i the "" Iota l she l, o, OCcurs. Thel
change from "II1!r1'k:o llo" h",i~o nTo l potilio~.
1M, Irorulormifon i. beleved 10 tcke ow w~~'"
nov,.. Vo,iovo ''''''''''''' ore g;'. " to ....,lain how
!hi... cns!ormation oc:cu". They are :
o. Ak.,chon in b'oohemical o~d phl "ool
consl.",ncy 01 In.. connec:tijve lisSIJO of the
palolal,h.lves.
b. Alte",ti en in ",,~ kl!u'. ond blood SlJpply
TOTh e pa lotol . helv.,.
c. Appea'''." ". 01 on intrin sic . h. lf le,ee.
 d. Rnj:Iid djfle,~ntial mitotic odivily.
e. Muoeulor .........",....,..
I f. Withd<vwl of the ...,.,bryoo" Ioce from '9J i",t
the heOtt pfoml~ence rewh. i~ dight jOw
opening . Tni. ",sulrs in wilhdrowl 01 the
lOng"" from oo-n!he poW .......... and
a id. in ,he elevation of th . polotc l sh. lve.
from " ~col to" noritonkll po .. rlon.
The....., polotol sh.Ives, by 8 In _I:.
of introule~ ..... Me, ore in <;lose opprOJeimalion
wiTh eocI1 etn .... In itio ll , th , two po lot,, 1.h elve,
ore covered by on epitheliol lining. killer join,
rIICI epithelial ce'ls ""O'l' .eoOle. The conned ....
hsS<>e of It,. po/(l'k;>i "'e~ i"'""",;ng le will> "",d>
OTher r. wlling in IM i, I" ..""
Th .,nIl", polote does not contod onet
IU$<: 01 the IIOme ,;"",. Initiolly contoCl OC(urs in
!he ce<1!ro1 ~on d too _ondo'l' pcicJ'e po$ler\or
1Q!he premoxi ll a, From !hi. point, d O$ure O<:wrs
booh o~yond p<><reriorly. The ITIe$loI edges
of the pololal prC>ceUe> /use will. the h. lower
end of """" I se ~tum 000 Inu l .e pero! ... the two
ncsoI coWies fn;.m '>(1m OlhefOnd Itoa 0ItI1 Ctr'rity.
0 . . 1II08 t /01l of ~III I'
0ssiIiccn00 olth. pdr>'e 0<%1'" from the 6Th week
01 inIrn'uterine life. This is on inlromembronous
I'yp8 of ossmc;otion. The- palate "";~e> from"
single unt.e derived from the mO>i11o. The mos!
post........ port 01 t+,e polo", doe. not as~ lr_ Th is
forms the $Ok palot". The ",;d.palolollutu",
osaifies by 12. 1~ yeors.
DEVElO,PMEI'tT Of MAXilLARY SINUS
Tn. mwillary sinus forms """,eli",,, orouod the
3rd month 01 i"lra - ~Io'iM life. It de....q" ~
e.pansioo 01the nl)li mucovo membrane into
II. ....,.;110,., bone. LoI.... rbo .in~s .. nlotg~s ~
-.men ollhe interQOl woll 01 mwillo.
PRE!tArAt EMBRYOLOGY OF MANDIBLE
Abo-vt th e 4th .... ok 01 intraute,ine Iile. t....
de,....loping bro in cnd the peri<.ordium form two
pramin,nt bulges on the w:nlrol ospea 01 the
embryo. These bulg" 0,,, separOled by 1M
primitive oral co,ity 0< 'lOmod""m, Th<r floor 01
!he stomodeum is bmed b,-.... bva:o.phay.geoJ
memboane, .. hich ""POrotes ~ from "" foregut.
Th, ~'Y"IIIIOI ord.es oreloid down on
th.Iot"",1cn.d ,.""ra l Olped. of ,he cranic lmost
pa,t 01 Ihe lo",gul which lin in cia ..
aPl'''''''mollon with Iht fIOmodeum. lnitiollytl-e
ore .i< pJ-,oryng.e<>l e rches, b", the folth ooe .......,I~
di$Qp~" c. soon os iT is ferm ed Iooving only
Ii ...... They e'e sep"",ted bV four bronchial
grooves. The fi"T aro;h Is coiled the mendibulor
crd, end the 5&Ccnd areh, h-yo<l ordt, Th e ethe '
Ormes do nOT hove any specific nemU
Eoch of ~ ~ .... Ort:Ms conlOin ,
l. A cemrol c<>1iloge rod thoIfonn.1he skeleton
of lhe oreh.
2. A m~lculOf component t"med Os
bnrcti""""".
3. A VOSCUIOf component.
4. A neuro l olem""j,
Th. m(md ibuior o od-. Ioo-rnt the 10""'01
woll ofth. SIOmodeum. H~ cH 0 bvd from ~
de,,"cl end Thi. bud is coiled Ih, "'o>illory
process, II grows ventrQ. mediolly, cro nic l te Ih~
moin pa!! of the <>r<;h, ... hkh is now coiled the
"..,ndibuior pnxe... The mondibulor pr<Xes$CI
01 both ,kle, grow lowcrtb eoch ether ond fUll
fn tho midline. They now forrn the lowe< bo rd.,- ol
the <torroodtrum i.~. Ih, IQwor lip and th~ lawe,
....
Me cke l ', c.rtlla;.
The Mocker. atrtiloge is derived from the fi..1
b,~nc hiol orU> c",und!he 4 1st ~ 51h do~ 01

f 'll! :AI ",""Q I . _ 'O'jo (8i I.ltric< .1_ ......
!Cl1~!~""" 01 "" foo:n,;" ,to ... , to "'\001'0 "' ....
inlr()o u ~ne life . It ex!"e<ld> from !r.e cortilog inou.
0IH: 'apS ule to the midline Or l ymph,..., ord
provlo:les 0 lemolo:e for guiding !he g,,,,,,th oi the
mol\d,b\e (fig 5). A maior potIior> 01 the Mlle br!',
"'''ilog<! d,soppeo,," during growth ond the
remoining port develop, Into me following
$llVdVre. :
I. Th e menlol o,.id ..
2. II"'I<: UI OM Molle",
3. Spine ol . pherx>id bon e
4, Anleor"OOI' I'Qo m " n!of mal~
5. ~pheno mandibular ligoment
The firsl ,Iructu,e to d$Velop in Ihe
JlrimOrdium 01 tho, lower jaw il!he mondibulor
d"lYiIion of the trigeminol ""roe. Th .. .. followed
by the mesenchymol <:O<'ldentOtion forming the
finl bf" nc~i o l arch . Neurolrophic IOG!on
prodlKed by th e """,,, il"lduo:e osloogene. ~ in the
ouiIicotion <o nlre" A sing le ossik"li" n , ,,,,Ire
"" eoch fool! 01 th e ",,,,><Iibl.. ortses in the 6th
- " 01 inlrouteri"" Iile in !he ~ion 01 .....
bifurca.ion 01 the inlerio< ohoeolor "",.." inlo
menial orod inO"..., b",nches.
The .,.,ilying membtone is IoatIlIo'M:!
Ie> .... Meckel', corti!","e ond as oa:ompa1:yi"ll
reurtI,,,,,~ ar b<.m dle. From this prima!)' ~~ nlre,
OIoi&c:otM ,~d, be!ow orod """,rod rhe infe,;or
......,Io r nerve ond II, incisive branch o nd
Upwon:ll to form a tmu9~ lor otXommodahng
lloe de""loping loo.h bud . So,,,,,,d 01 .he
iM'omcmb ronou. o,.-fico'i o n do,,,, lly ,,~d
venlral ly fo r... , th e body and romu , of Ih e
"",nd ib'e.
h ouil:e",,,,n conlinu es. Ito e Met<o l',
(ortilcge beeomes ,u=L.irod~ ord in...ded by
Ootle. Ol$'~calion stopo 0: th. site 'ho' wlllioler
beeo..,e the mandibulor li'"1;lulo from ..t.... t""
Mecbrl', conila{18 conhnu ... into the middle eor
and dewllopS no the ocodito<y os*,," i,e, mallev.
& in cvs , The Sj)'"Ie1"IOmond ib ulo' li 'lO menl ..t:~h
e.,end . Iro." Ih e li ~~v l o 01 mand ible 10 Ir.e
'phe neid bocoe 01,0 form. 0 ",,,,,",,,1 ef I""
,v.oc:. ol', ",niloge
n doc llond,el bone fo,met foll
Endochondrol bone form~'io" is I..n oro .,. in 3
areas of the mandible:
1. Thec~o ' ~
2, Thecorc noid process
3, T"" me ntol regOn
Cor-dyiar proc . .. ,' AJ obov! lhe 51h wee\: 01
int,ou'erine Ii'e, on OreO 01 me,,~chy"'ol
e01'ldenlotion con boo seen above m. I'OIntrol pon
01 m. tfe.ielooing mondible . Tnis develop' ir"l) 0
coroe . s""peeI con'lol1'! fig 6) by oboo' 10th
....... ond ' I(IrI$ es,ificolion by I. th week. ~ then
mig rotOI infe<'o<ly and Iu ... wilt1 tre mand ,oo lor
ro "",,, by cbo<J l 4 monl:", Much 0' I.,., cO ne
tropoo co ~, bge .. r",,'oo::1 :,y bono by If.! ,." idd~
<i 10101 1,10 bo.t its "pp"'..,d pe,":sI. ;n"O odu~ j
a(;fi"ll both os 0 gr~ cortilal/O ond on orhcular
co,,;loge.
Coronoid p,oces< : Secondo,., oecellory
cortiloge, appear in the ~ion 01 the COtQnC)id
OfO<;M, by about ri", 101 4 weeO: of intm ..... teritle
1'10. Thit secondo .... cortil ogo of eo ronoid P"OCe ..
i. bIO ieved 10 Q"'" os 0 response 10 ~ dt:YcIopIng
lemporoli. mvs.c le. The ca rOr'>O id occe,,,, ry
cartH age bocom e. incorporate d into th e
ap,,,,ding intram ernbra rl o u. bon .. of th ~ rom u,
.;:ad di$opp&a r; before b i ~ h
Menfoi (egion . In th e menta l (egKln, o n " i tr. ~r
side of the . ymohy:;i" on~ or two ,,,,,,, II cc rti kl go'
a;>po'>C r aoo <>Mifv in the 7th mC<"lh of inlm-uterine
lif" to Iorm vctio blc num be" of me nta l ossicles
in the li brovs ti,," e, 01 the symp hy:; i. Th e. e
o" icle. beco me inco rporoted into th e intro _
m<: mbronou. oo,., e wh en tM , ymphY''' o, ,,fi
co m pletel y d uring the fi" t yeo( of po,t_n atollif .
POST_NATAL GROWTH OF THE

CRANIAL BASE

The maxil!a i. otroched to tne cron ia l b<;J .., by

mecn, 01 0 num be r of . ulu ", . TM maooib'e too

o
i, offoch . d to the " en d ,bose 01 the te mpo ro _
mon dibulot joint, Thu, g rowth p ro~~" e .
oCGu rri ng o t l he crania l bo.., co n offect th e
pkl cement 01 maxil:o OM the moM ibie.
TM cran ia l bo," g rows po. t_nata ll y by
cample.-< int" radi"" belwM n the foll owing three
growth pro<;e"c .
a. Ed"" " ve cortica l d rill o nd re modeling
b. Elongation at syriChoooro.."
c. Sutu ra l grawth

Co,tlca l drift lin d remodellnl

F;g 6 CO<",," ' '''f k>,o " ~ ' ~ P' ' " ,, ~,
orea and tuoeo -.it> t 'l< =
mont" " ."", ,,, ' ;.,. ~J.
" 0 .. ",, 'd ,
) 1>.. ... Mr orrou oo ,he !c ..I;
Re m od e li ng refe rs to a proce" wh ore bone
de r>o. ition ornJ re.orption occu r so 0' to bring
a bo ut eho flge in ' :"", ~a p" on d roloti on. hip of
the 00,., " . The cro ni um i. divid ed into 0 num be r
of co m"" rtm ento by bo ny elevations and ri dg e,
pre nt '" th e crania l bar.e. Th ese elevated ridge,
ood bo ny portitio n' . ho w Ix:oe d"PO'ilion, wh il e
the predom ina nt port of the tkxx , how, bon e
resorption ,;Iig 7i. Ti-i. intrac",n ia l bone "'>Uption
helps in increas ing Ihe intra cran ial 'poce to
ac;cc-mm odo te the gro w;ng brain .
The c,on ia l bo.e i. pe rforated bl the
po.sogo of a numwot ~ood _ods co,d r>e<V<l.
com mun icati ng with th e brain. TM lom mioo thol
a ll ow th e F'<'''tgo of the, . r),,,ve. and blood
V"'S"~ unde rg o d rift ing by oone J epo<il>on a nd
re>Upti<l n . 0 0. 10 con,to ntfy mc into in thl ir proper
rc kllion' hip with the g rowin g ora in,
 one! the occipilol $e{jtnenl1lMn bocCtTl81u1oOd in
the midl,ne oroo by 20 yean 01 ooe .
lh o sphene.occ ipito l l~nchondrQ 'i '
~del 0 press ure orcom~ssion ociot:lled 00""
~, in centres! to the Ion,:"" oclcpled growth
oeen in SIllY,,". This ' I beJuse 110, croniol bo ...
oupport:l m, weight of me bmin ond face ... hich
!:>eo" down "" the synchondn:a;J in me midline
oj tho =noOl bose. I'd endochClf'"d.oI bone grtrwlh
O<;O,tn QI me opheno-ocdpiloIJYfldlondros". me
JahenOid ond the ocdp~ol bonn are moved
aport. Ai the $0"'" ti me new ~f.ordrc l 00""
i. leld dow n in the me<lulkl"l region, ond cort~ 1
bone is formed in the endos!eo l ond periosteo l
regionl. ThUi me ,pneno'd ond occipital bo.->I!.
'~in lengm ond width (Kg a .b).

~IOIl'.tloll . , Ihtl 5Y"ChOlld/O. . . The .1Nc1u~ ol" ..,."d>ond..... illike 2

ep,physeool pIotes posi!io....d bed 10 bod ond
Most oj tho bon ... olth. cnmiol bose 0'" Iorrned
by 0 ~on'leg'oo .... p,ocell. lO1er tho ""tilog ...
"pieced by bene. HOWI!"er cortoin be nds of
cotliklge ra mo in ot tho junction oll'O rious booe,.
The ... c reas c" coiled Synci1orxirQses. Th ey cre
tmpo<lanl growth SitM of the croniol bo .... They
ore primo,., cotliloge1. The important
$Ynchond",..,.lound in the O'OnIOI bo... o~;
o . Spheno--ocdpilol..,...dlordrwi.
b. Spheno-elhmoid ..,..chondrosis
c, In!er.",*""",," .ynd>ondrosil A
d. Intro oOCc ipito l5y r>ehondrosil

Sph~no.occipifal synchondroSiJ , It i. the

comlcginev. iundioo betwMn the lahencid and
thoocdpilol bcncs (fog a.o). The opheno-occipitol
JYflchondrosi. i. bel,........! to be me prindpol
growth cotliloge ol the O'Oniol bo ... during
childhood. It i. contidered 10 be the mo.t
imporTanl g rcwlh sito "I the ere"",1 base. The B
.ph,,,,,,occip itol'yro<:f.ord,,,,I. i. be lieved to be fig e ~.s"r....., =<>'" . )'nd>c......... (15:. 0,_"..
octr.o up 10 the (>;je " f 1215 years. The .p,.ooid s"i>ono oipilO l "".JIC<""",,,. '""'" " ' 'IC.fe(OfO ;,
~ ...... ....rd'" 01 ~ ond """" .. I boo.<
....... olld 1,,0 common zo".,dreeo:ve CO'Ibge.
Tho direc~on 01 growth 01 rto. sphetIo-occipilol
*
~ndrmlill vpwo rd . therelore ~omo. rto.
_rio< po rt of the oroni lJm OOdi!y forward . The
, .owlh 01 the .yn~ond ro.i. continuOI til l tfle
cbIiIeration 01 the lOme by formation of bone
SludieJ I" 'IO,iou. sci.ntist, ho ""own
that th.
closure ol th& synchondrosis occurs on on O'<efOge
Q/ 131 5 yeot1 01 oge.
5plten-o-etllmoi<!" synchondro.;. ; Thl. i, 0
cartilaginou. bond b e _ rtoe 1fI1.""0!d ond
elhmoid bones . It i< b., li . ved to ollily by 525
yeors 01 ege.
In,efoipnenoido l 1("chondro.i. , It I, 0
CDfIiIogirlOUl bond be_" /he 2 porlS oIlhe
ophenoid bone. h Is bet-..d 10 0!Si1y '" ]';nh.
fnlnl-occipirol lynchondnil: Thl. ollilie.
I" 35 \Irs 01 oge.
Suturel ' towth
The cranic l bose ho. a nlJm ber 01 bone. thot 0'.
jginod to one oncth. , by moo n. of .utvres. ~
01 th& lutv,., lret ore pre....,' inc!.>de :
o. Spheno .lronlQl
b. Fronta temporol
C. Spheno . orlvnoid
d. Franta ethm:d
... Fronto rwomo1ic
As the bro in .",lo rg e. dunng growth.
l><:>"'I formOTion <xCv" at lhe .,-,d. 01 the bo ne
[thol il ot .ther""" of th o suture).
Tlm l.. , 01 e'e " I., b.tse ,.o. .tft
o. By blnh. ~6()'J, 01 oduh .It<, is OIIOlnod.
b. By 47 years.. 94% of ooul.,.>c it ollOlnod.
c. By8. 13,...,... 9tmol"duhsifflil o""ined.
)\
POST..fWATAt GROWTH OF MUtUA
The growth of r+,. MJ.omo iOllory comple. ia
produc&d bym. followi ng m.m onism l:
o. Di.pIoC<!ment
b. GfOWTho"ulu~
c. Surf"" J'lmodeli"ll
Ol,ple u"'e n l
Mo>:illo il orroched to the emniol bo... by mea ....
of" numbe, of 1V1u.... Thu. the growth of me
croniol "".. r.o. a dl 'lId bearing on the nolO
rno~ll ory growth.
A po .. ~ or seoond ory di<plo cemont ol
,n., noso-mo..illOl'j cempl... ocwrs ino downwc rd
o,-,d forwa,d di'tdion os It.. oonic>l "".. g .......
Thi. is e _clary type ol di:lploce_nr os/he
"duol enlarge.....1 ol these porlS is not diAtdly
im.>""",,, (fig 9 .b). The nos<Hna.iUory comple.: Is
.impl~ mo,""", onTeriorIy O. the mid<!'" emnlol
fo.,o g,owl in thot directiM . Th e pO III.,.
displacement ah he m,,,iila il on important growth
....
me< hcnism ~ tfle primory denti~en "",rs bvt
bc.romes less impotlont o. growth 01 cronicl bose
In oddilion. 0 primory type 01
disploc,"",enI i. 0110 SOOt1ln " ........,rd d"ed"",
(fig 9.,,). Thil occurs by gr(Mfh of rtoe mG.<illory
.uberosity in 0 posTerior di..."tioo. This re.ulll in
It.. wh ole mcu6 110 be in g ca,ried ont.no.-ly. The
"moont of this forwa,d di. pl<xem&nt equa l. the
omo ,-"" of pos~o' iengthenir>g. This is 0 primgry
type oj displacement Ol lhe be"" is disploced by
its .,...n enlorllemotnr.
The rnaAiUo is connecrod !Q rto. <:roni"", "nd
cmniol bo by 0 n~mber oj l Ulu "'I. The ...
wlU'ft. ir.d ...de:
o. FranTa noKl I .~t~re
 A
b. Fronta - maxilkl ry , ut",e
c. ZygO r:1 oti co terY'lporo l suture
d. l yg omatico - maxi lla ry , uture
e. Ptel)'go po lati ne .uture
These .utu re. oro e ll ob!" uc an d morc
or I,,,, porollel to M e;' clhe-, Thi s a ll ow, th o
downwa rd and iorwo rd re oo, iti on ing of the
moxillo oS growth occ ur< at the'" .vlure . AI
growth of tf>e . urrovr>d ing soft ji,.ue occu rs, th e
ffi(lxil la i. Lorri ~d downward. a nd forward . Thi'
leo d. to o pen in g up of . pa oe at the sutura l
otlochm""ts. N. w bo n. is now formed "" eit"" ,
' ide of the ,uture , Th u. the OY<mJ 1I , i"e of the
boMS on . it"" r 'id~ increo ,e. , HMce '" tens ion
related bo ne form oti o n occurs at the . ulure._
Surface Rem ode ling
In oddition 10 th o growth occurring at tf>e , vlu,""
moss ;v" rem ode ling by bon e depositi on and
reso rption <xcurl to bri r>g abo ut,
o. lnoeo.., in size
b. Cha ng e in , h op~ of bor.e
c. Cha nge in lun c:k>oo l rdotion , hip
Th e fo ll ow ing are the bone remoo eli ng
" hong . , th ot are , een in th e no, o_ma , ilb y
com plex W.. 101:
[11 Resarption occ urs on the latera l , urfo:e cf
the orb ita l rim I"" ding ta lot",ol mov~ ment
ofth e eye bo ll , Ta compensate, -hen:! i, bone
depo~fon 00 the m. diol rirr of th e orb it orod
on the externol ' c,rfoce of tr.. latc'ol ,im
[21 The ~ oor of th" orbit lixe, , upe riorfy, latero'l,
and a ntcrk>r+y, Surfoce depo. itio<1 occurs her~
0"" "" ,.) It, in growth in a , upe rior, lotere l
atod anterio r direction,
[31 Bon e d ~po'iti on occ urs 010 "9 the po. t""ior
margin cf th e mo, ;'I"", tubero,ity. Th i, cause,
len gthen ing of the den ' a l a rch o nd
",,10 rll""""'t of the a nlero =Ie<'or of men.'on
of th e enti", maxilla ry bod y, Thi, help> to
a ccom oocto tftc er.) pting moI a 'l.
':{ , Be ne resa'P'ion occur> on tho latera l wall of
the no, . leading to a n ir o,,,,, , e in ~,e of he
nosa l Ga,ity,
(5 ) Bone r~,orpti o n i, .. en on the fl cor of the
nosa l cavity, To co mpensate the'~ i, bone
deposition o n th ~ po lutel , ide. Thu , Q net
downward shih occur.; lead ing to ino",o"" in
maxilla ry he;ght ,
,:6) The zygomatk box moe. in a po,t. rim
direction. Th i' is a.+eved "I re,o, plion on
the a n-e rior , urfae~ Dod d e po~ti on o n the
po,te rk>< ,u ri(l(O,
(7} The Ieee ~ narg .< in wKJth by b"n" fc.r-r,otio<1
 Growth and DWG:lopmG:nl of Cranial and Facial RG:gion
. ..
-,-, ~ POS TNATAL GROWTH OF M ANDIBLE
'I
" E
on the late ",1 wrioce ci lho '\'\loma lk arch
arid ,eso rpl ion u" it' med ia l ", rface .
(B) The onlerior rosel <pine prorrine<1ce ir.::reo=
due to bone depo'ition. I" add iliorl there i,
resorptio n from Ihe p"riootoo l surface ci Iobo l
cortex. A!; a compensclooy ,neoh"",sm, bone
depo, ition occur; on the " ndo,tea l ,u rface
of lho labia l ~o rtc' and periostea l svrfoce of
the ling ua l (Cortex.
(9) A!; the teeth ,tort e rupti ~g , bo ne depo';tion
occur< at the a lveolo r margin,. Th i. irx;r=
the maxillary he ight arid th e depth of the
polote.
[l O)Tho ""tiro wall of the , inu , CJCccpt the mes., 1
wa ll u,,,,e ,got>' ' Morpliorl , Thi< re, ult, in
inCfeo,e in ";ze ot the mox;lla ry antrum .
'~ 33
f .. 10 lo rt" . w node ' e.g '"""0''' in ,r.. mi d o ,"
~:.Bone ,... x '<i <>!i s,,,'" ",I.. .-;d'OOo1 '"lOon iB & ()
Sor.o ,orn<><I.O~~ '" h . po '" ''''''fig '" ,s oo".-.-d
d;-'!'~ t (I.",] G-owrh of Iloe poklO ,.!>bo .... V"" ..,"
of ~r_' iEI 90". no cnodol"J ai lho l~~ ~."
Of the flX., 1bone., th e mand ible unde rgoe. Ihe
large,t amount of growth po,t- not(] lfy 000 01,0
e,h ib it, the Io'<;le.t variability in morphology
Wh ife tM mo ndibl. appear> in the rxlu lt 0. 0
~ng l e oo.le, it is devobpmo nla lly ond f<JnOior><l 11y
divi.ibla into ",,...-01,kelela l ;ub .unil$. Tr.. bow l
booo o r II. . body of tho mand ible form. orle unit,
to wI1 ich i, attached the afw,a la , proce$$, th e
corono id proce'$, the condy lar prcx;e>s, th e
a ng ular proco,", the ramu" fh:, lingualluberosily
and ,he chin. Thu. the , tudy of po.t. nat(] 1g rowth
cf thc mandib le i. made ea. ie r and mO r~
moo ningfu l wh." each ci the de~ opmenla l a nd
fund iord ports ore con.idemd ..,parotefro {fig 11).
lhe ,amu' move, prog r.""'ely poste rior by 0
CO m binotian of d"po'it i o~ and ,e, orpt iM .

1
A B

) GJ,.,.!
'. --'j
/!
...----/
C o

E F
f'I; "')uo
" I Il Po,' _
..,b! do .. '"""",",
tut-o, ;'1 o"<l I; "~, l o
01 ""''''-... (" & e) Bo""
10) So ,.
"'mOO~;ng
"""'P';"" I.odng" 10"""1",,,
"'""
of
j, m, ndlbl. (Ci
00';, 0",,1noI, h
s.:....
: ~I
,,,,.,d.ro Q. ..,"
"" "; b,.-I,,, Il'0~t"
~

k>I<..;"'l V PO"" " If) (,"'H."oo 01 mm", ....,..,-... bon. ",.,,,,,lel rog
Re.orption <Xc ...... on !he onteOor pert ci the rornlJ:l
while bo M deposition occurs on the posterior
the ramus in 0
reg ion. Thi. re.ult. in a 'drilT' of
po,te rior di rection. The fun d"", of r~ mode ling
01 th e romu ' ore,
1, To occommodot~ th~ incrMs in g maSS 01
mo<ti<:otory muscles inu. rted into it.
2. - Too=modote th . "",Iorged broodthof lhe
pharyngeal .pace.
J. To !ocililo.. the lengthen ing of the mandiooklr
body, wh ich in tu rn accommodates the
eru ptin g mo",,,,,
Co,pu. Or the body of mandible
As oo.."",d "", rl ier, the o nterio r border-cl tne m t
romllS ~ .h i bit, bone r~ $orptioo wh:1 ~ the po, le rOr
bo rd er , how. bon e depos itio n. That is, th ~
displocemertc1the r<lmlJ:l reou'ts in tr.e croveci:>n
of fo rme, romo l Moe into th~ po,",rio r port of
th e body <i maooible, In this manner the body o f

,I
 Growth and 1kv~lopm~nt
A tan be noTiced tho! the Ingval tuberosity pttr!rud",
_II toward. Ihe midlin. of "'e ,omu" The
"" ""'n di ~e lengthen. , T.hu. add iTiooa l 'POce
rnodr! "I'<li",~e boy m.,., ,,, of r"""plion aI the
GI'IIetior border aI the rum..., is mode use aI to
occommoOOle the ""'plirog perrnanem molars.
itntle of th e mane/ltrl,
On ,he lingual side of !he angle aI mondible,
teKIt'P~On to~'" pi""" on "'. posTeno-inf&tior
ospect while dopo,;tion occvrs on the ontoro -
superior ospecr. On thr! buccal ';de.. r'tSOtption
occurs on the ont"rio_superior port wh,l"
deposition 1O~1l1 place 00 th e P<'.tero-lUpo rio r
po" , Th .. resu ~ in Ho,ing ollhe engle 01 th.e
moncfrble as a"'" advance ..
The IIn,uel tuberosity
The ling...,ltuMros ityi." dioo equMllerrt 01 the
mo.QIlary lubet<llity, which k>nns a major s~e aI
g.o..Ih far me lower bony arch , ~ farm. the
of (ra nl.1I and Facial R9ion 35
boundary be, .. " .. , the ramllS & the body;
The linOualluberosity m"""" poo~
i)y depo.iti"" "" it, polt ...iorty fodn g IUriace. It
noricl'lobly in r;r lingual di.ectron <N"od mO! it lies
prominence of th o tuberosity i. increo..d by th e
pnrserrce of a 10'11" resorption field jU! be~ it.
Thi....orption field produ,.. a .izable
dep....,.. ion, "'.I inguol fo..o. The combination
of ' '''''rpTion in th e fono and depositi on"" Ina
medial surloce of the Iubt<ol~1 ilseH occenluol ...
m. prominence aI me l,ng...,lluberotity.
The al.eola, proe ...
Alveolar p'o<:us d.....lop, in reopot'lM 10 the I
pteO<Inc8 me tee'"
01 toolh br.o:f 1'4 e-upllh, .
olveola r pracou d""...ops ond inoeoKII ln !-reight
boy 1>0 .... deposi!>on olme mo.rQins. The 01 .... 0""
bone odd.1O 1M heightand thid<neoJaI ... body
01 !he mondible and is particularly manilflred o.
o l ed9 ~ exte nding linguo l to tho ro mu. to
oc:commodole the 3rd moIors.ln 0:>511 04 ob.ence
of """"" the ol"""Ia, bone feril. to devefop ond a
",."..b. in "'. e"""t 01 toom,ftOdmdion.
The chin
The chin is 0 specifIC human ch::rrocteri.ic ond it;
Iound in ill fulfy de>'Oloped form in re<;lI"It man
on ly. In infancy, th e ch in i. u.""II, und~ r_
d...eloped. As oge gdYonc.. me growth of chin
becomes tigniliconl. k it;~..-.<ed b., -..:rl and
. pedli c """"tic foctors . U,UCl I'y ma les O r~ seM
10 """" prominent dril'll COffipg,ed 10 f,,,,,,I,,,.
Tho mentol proWert:JrrcO fcr<m, by ba>e depouion
do..o1ng dlildhood, Its prom,nence i. OCC4,,,uo!ed
bl bon . re5Ol'Ption thot ~Il in th e o lv",,'ar
region obcMI ~, cr=tW"rg 0 c(:<'lc",.;ty.Tho d - ,
pain! in this concaorty il kncwm <JS "poin! S in
ceph <>Iomorttioo term i""logy,
3S Orthodontics The Art and Science

The co ndyle mo. em ent in tOo V pottorn_ Bri "~y h e ca roooid

The mondibulo r condyle r.o, be. n rocog nb:od 0' procell 1>01 0 prop!! I'. ,.iike ~,t, sa lhat its lingoo l
on impo rtom growth site, Tho head of t" . condyle . ide face, three genera l direction. 011 ot ocoee, i_e
i. cov. red by 0 thin loy"," of corti"9" co ll . d the posteriorly, , upe rio rl , an d mod ia lly_
cond~ ar co rtil ogc , The DfCSCcoeC of the co ndy" r R.. fe re nc .. s
cortilage is a n a da ptoti an to with stend th e
~ornpre .. io n tr.o ! <xcv ... ot the joint, The role of Ayoc b Qrd '1.e,-ato : ,l 'c od ;"" lo' g'Owth, A" J
0 1i-.oJ 1'19".1 ; 255_265
the condy !~ in th~ g ro wth of mo nd ibl. ho , 2 5... noOO or , hi.,.'"" ; T'", ~'''''' h ""to d ,0010,,"
",moined 0 co ntrove ...y, There a re two .choo l. "", ..di ,.." '.i _h , A-n J Ort..od 19?a ; 24_35
3 I\h.o ' r> ~ ; [le.--o.o l A~ \', H;,'o!<>;ll ond 0.>"01 _
of thoug ht reg arding too ro le of tm, condyie , oprr-<>nt, """ ,,"01\/" 0. r.o...>e, " - Doh, 1998
a, It wo. eo rlier belie,, .d thot growth <xcu... at <, 1liOo"' : """'01;", of "",o, ;",h, 9",w,h "" 0; 0',
Ivo J C.i>Od 1969 ;39-53
the s u rloc~ of the condyb- comlcge by mea n. 5 !" , ,,o ~ , Too" uo r, D .,- ;, i;o " , lo'o l,.", 0 "
of bone depoo iti on_ Tiw. the conrlyl~ g row> Go ld,' , ;, MoJol- " loo,;t, o;' ol ""o od ;hulo,
. ,OY.< h, k J C.'h e 198, ; /-0 ,/,6
toword. the oran iol bo.~_ "" tr.. co r.d yle 6 do Sj"" ~ =-,.,.,o , orJ C,,,, O<ro ; 'd l, ,,,, of
pu shes <>g a in !! th e cra niol bose, the entir. G~' ' IP' '" roGoolbcb-lTo-"th, 'om
J Ot ..od I,Y3
;2 69_275
mand ible get. d i, ploced fo rwo rd , o nd
7_ ~ , Iow : )'a,; """'" of i, ,*, g'''''+, WB ,"",..dc~
downward, (I>g 12 _0)_ Coov n,,19 62
8_ G',,,,, TM : Or"=","" , , ~~, """ _ _
b. It is now bc licycd that tho growth of solt
',','8,"" u..!on, l 98.!l
tissue. iocludir.g th~ m= les ar.d co nnedive 9, "t" orJ .At~<6 -n , bl". , ,,,",, """"",,,)0 , g.",*,_
tissue, corrie. the mor.d ib" f"""",rds aWOl Am J O " i-.oJ I "'2 ; 146 _152
10, H........,b.. ~, ,nd P'ofl _And ....'" e ", o;, 1 bo>.
from the cro nio l bO 'e (co rry ow o y \l''''''''- Am J 0 1..od 1<; 94 ; 503512
phe no m e na n), Bo ne g ro wth fo llo ws 11 _ Ko,,; 0""
Am J O+od 1966;
Q
'''''''' "',',, ~ : foc.+>
S66-5~3
c< '0 k>o;o,'
<econdorily ot the condyle to ma inta in 12 k"t, rJK""".., Rdo"""hp:>et_ , ~1eO<"I
con .ro nt contoct with the cra ni a l 00..,. 01 "",,'I ' '( ,- 0 ", <rd (","-o/.,od ~, ., ,bbl
Am J O+<>d 198B ; ~(i1 _ <76
Th . ccn dylo r g rowth rote increo<. 1 at 13 Mi'o, i P,.p , b,,ol ~ ' Qw' h of mon dib, lo'
p<Joorty reoch ing a pe<J k betwee n 12 1/2 - 14 P"'!T'<"'-""', A" J O+<>d 19S 1 ; 5<6-553
j <, MOm, Soto, orJ S,-"""""o ; L", ,vo"'" 01 """.
yeo" , Tho gro wth ceo",s around 20 y""" of oge ..,...".. P"V" t ~'"" ,..., J O rti-.oJ 1993 . 3.l~336

The c arannld p,neess ~<d>e' , " ,,"0, C>"'d >1; 1.,

15 , No "",, 1 "" " ,; ""
",, --Jo bu b \I'",t h a -.J '._.. ",,!.'wla ' do. , 'apcr..-l
co,
The g rowth of the coronoid Drocess fo llows th ~ ., '.\ocoea "", ,,,,,",,,"" J 0+.00 19 69 .- <05-415
enklrgir.g V principle , Viewing, the long itvd ina l 16 ~ id .. " s ",", "" a
>1; 1.. ; No,,,,,, 1 " "; 1'",, cod

<edion of tM coronoid p roc~ss from the poste<io r

"",--Jo"','" IT""""
nod rl ..-t"" f,~ <io...lopmont
., fJoxoco '"'""""', Ivo J o.+x" 1969 .- <05 <15
ooped, it con be seen thot de po<ition occur.! on 17 ~ mf " WIt C",hmpo ''''' O , I, oJo.,t"" S' l""',
CV Ma>by,19M
the ting ",,1{m<>d ia l) . urtocc. of tho Ielt ar.d rig ht 18, lobe" ~ ~~ ; Ib--od book 0' O " i.xlooh, y"",
coronoid P<'OC. ss Altho ugh add~ion~ ta ke. P"~~ book ",.00,1 "" "h i... ,, n.:,I 988,
19 ~""''', lo ""'-d, ond Ho rr~ f"",,,1 " 0"' orJ
on the lir.g ua l. ioo, th e "" rtica l dimen5J on of the "",-.ib..,j". ~~ , "-'n J Ot..od 199 1 ;
coronoid process a l..., ioc,.o"",_ Th i' foll ows th~ 542_5<6
20 ,"" I r'-~ JA _ Pm<;iao ot ~ t ~" JB l-pp;ncctt
V p<i ncip le_V..,wir.g it from the occlu sa l a'pect, (0 _ _ ' ) , 1966
!he de position 011 tho li"'] uol of tM coronoi d 21, "'" ""'" AA 0 ,01 1""1<>"", ; ~n-.eo1 S~ ",,
". '" ond fu-.;t.", C .Y.I~""", It b~ , . 1 9 !lO
proce .. bring. o bout 0 po . terio r g ro wth

I

of Dentition
Occlusion

T
ho omb '1o nic oro l co vity i. lined b, future cl9c.idvoo.,., tooth cnd is co iled the .. ""mel
. t",lilied s.quomo u. e pHhe lium lnown 0' o rGon . Th e e""m e l o rgo n po"e' th,,,ugh "
tf>e o r~ 1 ectoderm. Aro und the 6th week numbe< of . tog e. ultimate ly rorm ing th e teeth.
of intro_utennc lif~. the infe<O loterol border of Boa d O<l the ,,",ope of tt,., "name l oroa n, the
1M me, ill ory O!d! end me , upero-Iolerol bord..- d...... lopmen! oI!oeIh con be drvidcd into th,"
of the mandibulor aleh show loca li z.. d I1OgotS. Th.V 0'. the bud, cop om! the bell.togo.
proliforarion of In. "'GI cooderrn .......,11;09 in tho
/onnahon of (I hc;wse."'oe shope<! bond 01 tiss""
coiled"'" den'ollominCl (/,g I). IN.denial lamroo
plop on impollOnI role ,n Ihe development 01 th~
~. n-. docitIOO\.IJ toeth o..,lormed btd~
protrlerol,,", oIlhc Demellomi..... The pennonent
moIo .. deYok>pOI" .....At of its d~o\ proIilernhon
wh i ~ th e pom>(VMtrl! teeth met ",pbce decidoou.
IOOIh ,"",elop from " InguQ l "~ olthe d.n:oI
Io mino . Thul 011 t~eth originaTe from the dental
10m."".
The ectoderm in certain o reas of th~
dentollom'"o prolilerates and f""", Icnob riLl
,trvcture. thot grow into the und e rl yin'iJ fig I O tol 10 ... ,,..,
"...,..,nch, ,,,,,,. Each of me", knobs "'pteSCm."
BUD STAGE
This is the in ilio l Sloge 01 tooth b-mctioo wh e'e
..... encmel orgcn reoembles 0.",0/1 bud (I", 2 cl.
Outing the bud ,toga, the ItIlcmei orgon oonsisl,
01 peripherally Ioco!ed low column .... c:elis ond
(S'"In)Iy IocoIed poIvgonoI 0lI1.. rroe sumJUoolng
"",... doymcl cel ~ proj i!t.rol<!, ""ic~ "","It in tt.e<,
co ndensat ion in two a,e e . The e,eo ef
condonsotion imm ed lOlely M low the enemel
etgDn is the dentel pa~llo, The ~c:hymoI
COOOltllsation that svrfOUOO< the tooth bud end
the dentol papillo is the dental soc.. The denlOl
popillo os ~I 0 ' me dentol soc a~ nOl-..e1l
defined d...,;"g rt.o bvd SIOge ~ bocame mOre
dclined during the .ubscqll<lnt cop end M il
stoges. The ce ll. of the dentol popilla form the
dentin ond pulp ...,lIe the denkll soc forms
cementum ond pe~odon!ol tlQOmenr.
CAP STAGE
The IOOth bvd continues to proj iferole rewiring in
e CDP shaped enamel orgon (liij2.b). TI,i. il
d ... txJe, illld by 0 shallow invagine'ion on the
....o...wrIoce '" the bud .
The <>ule' cells 01 the m p r;o.erinij the
woweUl. are C1Jboidal end are coiled the <>ute r
enomeI ep1Iheliu m. Th e ce l ~ lini ng th e m nerwity
of ..... COp become lo ll C~ um"", ond orOrefe-rre-d
to OS me inner er\Omel oopithe-lium. The centrol
area d the enamel Of9C1r"1 MI'M" the outer oncI
in_enamel epilhelium which initiall,consind
of polygonol ~Is, occquire """'"' inl1!<"cellulor
fluid ond"'forms 0 cellula, nelwor.: co iled the
. tell o+.. retk ul um. The Itell ote reticu lum .,.>001,
o bo",.mednetworI:ofcels. The~1
cono:lenoation i.e. the denIol popillo ond denlol
_ are poonouno;ed du~ng this <loge 01 dentol
de .IoPIII,"'1.
., ,
BELL STAGE
Due to ca nti nved uneven 1I,,,,,,,h 01the enom . 1
OI"9"n ~ ac'l""" 0 bell,foepe (I", 2.c). The cefl,
0It!-.. inner enamel ""ithelium dill...-entlole prior
10 omelogenelis Into loll cal"mnor cells coiled
ameloblo"'...nich loydown enamel. The cell. al
the in ne, .""mel ep ith elium e, er! 0 . !rang
inli""",e on tho urderlyi ng m ~"' hym<l l ce ll, of
lhe donlo l papillo.
A lew layers atllot squamous cell. are
..... n ben.Mn the inn .... en::omel epi~helium orod
th~ .lello,", "'~culum. This loye' i, coiled the
.trolum int...... edium . Hi> beliorred to be ..-otiol
foe .n<lmellormotion.
The steL'ote relicu""" expands lurtr...-d""
10 c""tinued IXCllmulotion aI inloo.~el"lodluid.
The cells at this areo all sIC' l/Ioped, foeving
10'1l" proce.... that anastomose with those of
cdioo:::enr cell . N th .,...,,,,.,1 formofion .",m,
!he "rctvm n!ticui..." call.apse. to a naffOW lOne
th . reby reducir>g th e dist"",. between tho outer
enamel ond inret ....., me l epitf.!iium.
The cellt 01 lhe ouier .""mel oop;thelium
I\cKcn to form low cubo:oidcl cells. 1he outet encmeI
ehelium Is thrown into folds which are rich in
capillary nel ......... Thi. p,avidM " taurce al
nutriti on lo,!h e .....,,,,,,1<o<gon. Belo ro the inner
e""meI opilhel ium begin, to produce en<l"",I, the
perip,,",al cells of the denIal papilkl dillerent"""
into <>donlable",. They are cuboidal cell< thot
klle, assume a columna, Ionn ond ptOdoce
do:ruin.
The den!ol . ac u~ibi" a ci,cula '
orm ngemenl of 111 fibres cor.d re",mblos a cc p>ule
o~ tne """mel "'II" n. The filns of tho denlol
$<X Ionn the pe,iodonIol li bnn thalspan between
!he";'" and bone. The iundi"" ~ the in ......
enamel "".thelium ond odonloblc.ts ()IJtli_ the
/vtu", der>~",,"enomel iunc~an
 c D

ROOT FORMATION PERIODS OF OCCLUSAL DEVB.OPMENT

Root dcvelopmem begins alter !he d .... M and
_nom,1 formo;rtion nooches the lulure ",menlO-
enomel junctlO<>. The outer and inn .... el'lOmei
epllhelium join and Iorm " ,hooth th", helps In
mckl'ng the lOOP. cI the roo! This She<l lh is
co llod the Hertwig'. epithelia l root ;hC'(lth.
0ed"",1 develop:nenr can be di ... dod into th,
follow; ..... de-oIopmental periods:
I. """ . denlOl period.
'2 Tho deciduous denlman period.
3. nw. mDc&d Oenr~ion period
4. The PI'f""1onent de ntition pMod.

4Q II Orthodontics - ThE Art and SciQnc:1Z

A 8

PRE DENTAL PERIOD

loIerol wku. of the mandibular orch is normally
Thos is me period oller birth during whIch , .... mere do>lol to thot oflh" maJ<illory otdl .
neonor. does not t.:,,,,, any teeth. h usvolly los ... The upper and lower gum pod. "re
for 6 manila ofu:, birth olmoS/limilor to each other. The uPPf""Qum pad
is both wide r (II well os longer than the
Gum ".d, mond ioo lo, gu m pod . Th u. when th e up per ond
lower gum podl are oppro> imoted. the 'e i, 0
The " I, ,,,,.,, p'occn... cllr.e ' ime of biMh c '.
known 01 0"'" pods. T~e gum pod. II ... pi.-.\:. comp/et. """jet 011 orou nd. COnlOcT OCC"'"
b.!lween the upper ond lowe, gum pod. in the
~rm and ore """,red by" do_loyer 01 t.brov.
trsr MOlar ~ion and 0 'PO<'" e><iIlI bet en thorn
perIo$toum. They "'" ho,..sIloe "'oped end
In the o~rior region (fig 4). Thi. in/a"file open
deYelop in two ports (fig 3). They 0 ... the labio-
bite ilcol'llideled normal and a hell'" In suclc/lng.
buccol portion and the lingual pc><Iion. Tho two
pc<Iions oJ"'" 9"'" pads are ~IIXI from each
other by" g""""" co iled th e clentol groCl'ie _Th e
gum pod. ore divided rio Ie<> Mg mont. by cMo in
gl'OOVt!l co iled Iran"",,,,,, QrooI'e., Eoc" cI the ...
segments con.id. of one developing deciduous
-~. -, /I
/
The gingival groo.e oeporo:es the gum
pod from the palate and Rool 01"'" mouth. The
r.ons>erle g''''''''' between the C(lnine Qnd ~ ..I
deciduovo molar S<lgm""t;1 <:oIled the 10t.",1
\ "
subs. The !oterol wk i; a re ",,,lui in judgin g !toe
inter-o re), ",'otion"hip aT" very Ol'O,ly Sloge. The

I
 D.:vdopm.:nt of Ikntition and Occlusion 41

The statu. of dentition

The ne<>n ate i. without teeth fo r ab:>ut 6 mo nths
of lile , AI birth th e gum pad. are not . uificientl y
....;de to cccommodote the develop ing in ci", ...
which ar~ crowded in tMir cryptl. During the
a... t yea r of life tr... Gum pod, grow rap idly
permitting me i ""~c<s to erupt in ~ olign""",t,
Very rore ll t~ "t h a re iound to have
erupted at the time of birth, Svch teeth thot ore
!>",$Mt ot the time of birth ore ca lled nata l teeth,
Someti me. teeth erupt at an ea rly age, Teeth that f,. 5 $poe;.,. ., d"ddvo" ""t;fQ"
erupt during the fi rSt month of "'il e are ca ll ed Spac ing In de cidu ous dentItion
neonata l!eeth, TM nora l and MOnata l teeth a re
Spercing u.ue ll y e..;.t, be~n th ~ decid ucr-u.
mo.tfy laceted in the roorJ ibu lor incisoc region
teeth. These space. art! ca ll ~d phy.iologica l
one! . how a 'fam ilio l tendency.
.poce. or developmen!<]1 <p<lce. (I .. 51 The
THE DECIDUOUS DENT/TION PERIOD pre ... nce of .pace. in the ptimery dentition i.
impo rtant for tOe norroo l development 01 .he
The initi al"", do primery loolh bud, occu" dc ring pe rroo ncnt de ntition, Absence of .pace. in the
the fi" t , i, week. 01 intm-uteri ne lile, The p-imory prima ry dentition i. an in dication tho! crowd ing
leeth beGin to erupl at the o~ of cOOvt 6 month . of teeth moy occur when the klrg er pe rmc"""'t
The eruption of 011 primcry teeth i. completed by teeTh erupt.
:2 1/2 . 3 1!2 yeo ... 0; ag e when the ',",000 Sp<lC ing iovcriob:y i. seen mesial to the
decid uous mo la ... ~ome ioto occlu.ion, me~illary con ine. and di,ta l to ' he ma ndibu la r
co~ i ne, (jig 61. The ... physi<ll<>gicol 'p<l ce. a re
Eruption age lin d u quence of Lo lled primate .pace. or . imion 'poLe, or
dec i d uous den!ltlon
onthropa:d 'pace. 0< they are ",en commo nfy in
The roondibu lar centra l inci.o" are the iir.\! teeth primote,. The ... 'pace! help in pklcern ent of the
10 erupt into the ora l covity, They BrtJp' oround con ine cusp. of the opper;;,... arch ,
6 -7 months of age. The O'/croge 09<' of eruption
01 the de<iduou. dentiti on i. given" Tob-le I. Th.
liming of tooth erupti on i. ~ i gn ly vanable, A
voootioo of 3 month, from the meon cg " hm
bee n o-:;c"pted o. normol. The .equence of
eruptiM of the dc"iduQu, dentition i.: A B D
- C E.
Th. pr imer, don tit ion i. u. ua ll y
e"a blishcd bl 3 yeo" of age OIl erupti on of the
second docid'- """ 'no lo .... Between 3 6 years
01 age, the dentol aree. i. ,elotivefy .!<]blc an d
very few chong'" OCCL'r,
f,. 6 h ;"" .. """. ,

41
Fln ll t.tlll'n .' pll n.
The mHo diml ""o~oo ~ the d i<tal
. uria ... ol!he upper and!cwor oa<;CO'1d dodch"" J'
molo" i. coiled tne termi",,1 pla ne. A normo l
lectu re 01decld uau . denTiTion is c Ilush le rmin el
..
pklno wheno the di,lol ,~ri<" Qltho vpper ond
lewer IKOnd dKiduou. molo .. ore in the some
venicol plane.

D p MI.
A dee!! b~~ may OJr in tho in~iol ,t<>g.' of
develapm(l<1t. The deo p bit." ccce ntvot~d by A
the loci tho! tfoe d.oduQu l inc ilO," ore mor\l
upri ght tf>a n thoir successors. Tre low" in ci",1
edg.. clten conloc! !h. cin~vlum areo 01 the
""""lIory incis<n. Thi. deep bile islale-r redL.'CM
duo to the fdlowi"!l factors.
o. Ervplion of decidllOUS mo'on
b. Attritio<101incisors.
c, Fo.won:l move,,-! of the mandib.'e d .... 10
growth.

THE MIXED DENTITION PERIOD

The nioed dertilion po-ricd begifll at CpD'o,;",o1efv

6 )'eon 01 age with the eru~lan 01 !h8 fjru
petrnOnenr moIa .... During !he mi. ed dsmi!;""
period, the decidvou< teem clong "'ith some
permcnent t.!eth me ~! in lhe 0<01 cavity.
Th e mixed de ntiti on p.riod ca n be
clcSl ifred into tf>ree pho !;e$.
\. Fir'lttrnn sitioM l period
~. Imorjron<itio,mlpe,Kx!
3, s.concl hon.ilioncl period

FIn ' It.n.lllonal p e riod

The R.,t tron,,1iooo1 period is chonxleril.ed by rhe
eme'Qe"'" 01 rh9li"t pe rma~.~t moJo .. and fh.o, f 'g I W (I,,,, ......col .. " . [Si 0;".1 , lOp .... ,.i .. 1
e.chongo 01 the d. cidvo u$ in cisor. ... itf> the pbl. {Q ,1'.. ,I~......"''''' '''''0
permo ne nt incisocs.
Emergence of the lirst permonen! malo ,, :
The mondibulo' lirsl molo, '" lhe ~"I permonenl
1OOIf, 10 . rupl 01 around 6 100" cI age. The
lacalian and relaTionship ol lr.e li rsl perman ent
meMor deper'ld. m"" h upon th l di,ta l , urioce
..btia",hip ~ th" uI'f><'<" Md~ r seoond
dooduoUl molors . Th" ~"t permon",' mola"
oreguided im:>t.. dental m:h by "-distil ",rioce
01 !he MCOI'Id dkiduou. molo". n.. maio-d"dIOl
",Iorion between Ir.e didolsurioces of m. upper
one! lower second .;".; i<;IUOlJ , mole" eM be 01
""" 'YPII.
A Flu. h 'ermina l plane: The d ista l ,u rfo ce
01the vppe r e nd I"""" second docidVQ<,j, moI a "
ere In on .....1Tico1plane (fig 7.a). This 'YPI 01
relohOng,;p is caPe:! flu. h 0' ""ffical terminal
plcno. ThIS is e normol feotu ... 0/ ...... deciduous
domilion. Th..os Ihoeruping ~ .., p"rn'O""Oellt molars
may 01110 be in a flush or "",d on .-..Io!io,,,hip.
f", tn e1rC"' iTioo of wcil on ""d on mole' reb!"",
ro e Cia.. I mo.,r rolotion , t"'lo",o' moIe r he.
ro move forward by cbo ut 3 S mm ... .,Ii to
fig e ~. f.,.,. lOt. 01 "'" . N pI .... I n! ....""""'" 0>0b1
tho uppe r molar (fig S).Thi s OCCIJ" by utiliz:ction
oi the phytiolagic:.pou:s and leeway .poe. in
"" ~ .... ;~I I"II tn. IOri""'t.
,..;b~["" 01 .... - - . ....,.,.
" oco, (511..010 ... ,~ by

!he , - , on;!> and bydille"'n~oI forword grov.th

of the mondiblo.
The shih in low,,, malo, lrom a flush
lerminol plaroo to Q C., <.< I ,. Iolion con oceu' in
Iw<> _ \'S. They or" "",;.gnoled o, lh o CIO rf,- c!"ld
the loteshih.
Ea rly . hih OCCIJ" during the eo...,. mi:<.ed
dcr>~~on pe,iod. The ervpli .... force 01 the f," 1
pcrmonenl malo, is sufficient to pu,h the
doKidUOUl N,,'and <and molors fotword In 1ho
arch to d o.. lhe primarc spoce and tno,.by
"""blosh a 00.. 1moIo, ~otionship. S'nce tnos
occur. eo"" in the mi.ed denl~ion J)eriod ~ i.
ce ll .,.! ..." f,- . hilt.
Mcny chil dren locl the pr ima .. I!XIC.
000 thU' rhe .-upbng permo .... nt mofo,. are
unable 10 mc><I lorword to """bli$h OaM I
~<>Iionship. In thtst C""", when the ';"';ic!uous
second rro:oIo .. e>:foliole the pe rmr;roeot fl<$' moIOIl
d,ift "",~'oI f,- uti irlr"tg the "'-"oy opo:>o>. Th ~ occ",",
.. tho .,te mi><od dentition p.,,;od orICl is 11m ce lled
Iot,,,h i#,
S. Mesial step /ermina! plane : In ,hi. type
o! rlIla~onship rho diSlOI .un"";,, of tno lowe,
_ ond deciduous moIo, is more mesial thon !hot
01 th& Upp!)l" (fig 7.c). Thus tn" permonam mol",.
erupl direcllyiMO AIlglo~ 0 = I ocdUSlon. l h.
type 01 rT'IO$iclltep "","ino l pbne ""'" com monft
oocur> du e to CIO dy forward growth of th e

rnond ibko. Hth o d:flerentd growth cl the mond ibko
in 0 Iorword di rection pe" i. t, . it can leed to on
Ang le'. Cion II I molar relation . If th e lorword
ma nd ibular growth i$ minimol, it con esto b li ,h a
C I"" I moto r relotion . hip.
C. D ista l ste p t ~ rminol pion" TM i, i.
choroLteri, ed by the d i. tol ,urfoce of the lower
m:ond deddOO\J' rr<>Ior be ing more di,1:;l 1to thot
of t he uppe r (Iig 7.b) Th u. the erupti n g
permo nen t mol ar$ mo ybe in Ang le'. C ia .. II
ocdusioo .
The e<chong e of in ci.ors Du ring th e li " t
Iron,ition o l pcriOO th e dec iduous in cisors arc
rep leced by t h o p e rmanent jnc i.or> The
IMnd ibular centro l inci",," ore u'<..<l lly tr..:, li"t to
e rupt. The permon e nt ina """ are com;d e rably
"'rye r th on the dcddlJOu. teeth the y re place _Thi,
diH..",n:::e belw-t!e n th e amount of >(Xlce "" ed ed
10, th e occomodotion o! th e inc;,o ,> oM the
e mount cl spece ovo ilabl e Ior thi$ i$ co il ed ir.:;i",1
lio bility. The ir.c i.cl liablit, i, roug hly about 7
mm in th e maxill ary arch ond obout 5 m"n in th e
mond ibu lar oreh. The inciso l lia bility i, ""e rcom .
by th o lollo",,;ng focto",
A Utihotion 01 jn terd o nfal 'po ce, ,een
in p",."c ..,. den li'ion Tho phy> io log ic 0<" the
dev,"opmento l spece. tho ' "" i,t in ,he p rim ory
dentition oce vtili ,,,,, '0 partly OC( oont for t~e
in c;,a lliobllity, The pe rmo "" nt icc;,ors Ore much
moreeo,ily ocrommexlote-d in normo l o ligr ment
in co,., exhib it' ng odequote inter_de nto l .po:;e.
thon in on Orcn tho! ho, no >(Xlce,
B. In crease in inter - con i,, " width During
th e tron,irion from th e primory inci sors to rM
p" rmor "..-.t incisors an increo se in in"" coni""
w id rh of belth th e moxi llory o. woll 0' th e
mand ibul a r arch. , ho, been ob,""ad , Thi. i.
on importont loetor wh ich o "ow> tho mIXh lo rg or
permo nont inGiron to be acco ", modoted in th e
arch p,e viou$ly occup ied by I.," d eciduous
In","O,",
C Cnong e in in ciso r inc Unation . On e of
~ d'fler.""", between d""dJO u, ond petmo","",
inc i,o" i. t he ir ir.:;li nati"" , TM primory inc isorS
ore morn upright than tM permonent i:"l<; i",,,
Sin ce the p" rmon e n' ir.dsoro ""'pt morn lab ia lly
in cl ined th c, teM to inc reo .e the de<>to l orch
~rimeter_ Thi, i. oroother factO' that he lp. in
oocOrT1moda ting the larg e r pe<mo nent in ci.""
Inter translt/onal period
b thi ' period tM moxil kJry and morxi ibula r arches
con,i.\! of sets 01 dendl1Ou, ond p=na nont teeth
Between th o p" rmOr>(l nt inci.ors and the fi" t
pem1 c""nt mola rs are the de6duou. erda" o nd
canin es_ Th i' pho,o durin g tM mi,od dentiti on
::: $ ;!: ;!: ::: ;!: :E
~;!:;;~:E S~~;;:E
~N"'N'" _~"''''M

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" >" ~"':.o:o~
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o ~",,,,," ' .
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Developmenl of Dentition and Occlusion ' /fJ
48 Orthodontics - 'he: Art and Scic:ncc:
period ill 'elalively stobie 000 no change Oul"I_
Tn e nCD nll transltIDn.' pe,IoII
The s.ocond tron,itio ",, ' period i. cho,()Cteri,ed
t>.,. !he !ilpi()Ceme!11 <i !he deciduovl n"IOiOf$ ond
conine:! by the premolors ond pe'"",,,,,,, cw.pia.
_ _ liYeIy. n.. combined ....:o.d..101 wicl!h 01
the pennonenl <;<;Ini""" ond "",!nolo" IllIIIJolly
len thon Ihm of !he ded duoul conines ond
molo". The IUrpI", <p>O'! il coiled leeway.poc;e
01 None. (!ig 9). The omounl <i Ieewoy 5jXIa i.
9,ea le' in the mond ibulor or<;h Ihon in Ih e
mo. ill o'1orc h. II is oboo! 1.Smm 10.9 mm on
8(lch lide 01lhe orchl in Ihe ""',i ll o!)' arch and
obout JAmm (1 .7mm on 8(lch II~ oIth, o:",fl)
if) the mondibulm mch. Ihil e. " ... poee
o... ilable oller !he exd>::Inge 01 the deciduous
M<J!0" ond conine. i. ufilizecl 10, ....101 drift 01
the mondibv!a, ....,I"" to e>lOblish Clan I ....,lor
!illation.
The ~g ly d ucklin g ' loge 50 m, tim .. a
IrOnl ien' or ,. If correclir,g "", Ioed", icn;, seen
in !he ,,..,.il lary ind.or l8!Iion bc!wMn 8 . 9 1""'''
of oOe. Thi. is 0 porliculars~ootion seen during
!"he eruption 01 !he I18rrnonenl <;<;Inlroes. As the
developing pomICIneni canines ""'pi, !hey d"~
the """"d!he laletol iociooomesio/ly. Tli,-..iR
i. tfQn.milliog 01 the Iota on 10 ,he <oo1s 01 !I.e
~n'rol incitoo; w+.K:!. 01 1(1 ~ d~piac.-d mesial"..
A rcw llonl di.kll dr.-ergo nce of the crowns of th e
lWO c&o'roi inciSOll cou les 0 mid li rlil 5jXIdng .
Ihill~u<rt"'" ...... bun d..cribod by Bo-oodbent
01 the vgly duckling ""ge 01 chlldten lend to
look ugly during this pho.. 01 o:Ievelapm&nt
Patenll ore 0/1.., opp,ehensi ... during !l.i, stoge
ond ",",uk the dentist. This condd"", uwoll,
cofted1 by i!self ... hM tI>e In;...,. erupt ond 1M
prelW,," is IronIhrred from the roofS 10 the coror"<ll
oreo of lho ind .or! .
THE Pf RMIIHEHT DElmnON nR/OO
The ,.....,..,_, cMnt:tion form. .,.,;T!1" the jo-.4 SOO<1
olle r birlh , e.~e pl for the cu.ps of Ine fi ... ,
poI,,,,,,nenl mo la ... which form before birth. The
.,.,.."",nenllrw;i1Ol"1 develop linguol 0, polDlOl1C>
lhe detiduous irw;i1OB ond r>'lII">'e labiolly 01 they
"rup!. n.. p<ern<Jlors ~oo below the d~'lIing
rootsd th. dec:io:fl,OUl mo/ors. TN!TeOn en.I<In
doles of the petmo ...... tdentffior1 ilQiven in Tobl.
" Th e 0l!"U~ sequence of the permonenl
dc<1li!ion rrv:1f exh ibil ""riolion . The frequenllysee n
seque-neM in the "",.illoF)' orch 0"":
61.2.4.J.5-7",
612J-~57 _
In cOle 01 the mondibulor o,eh the
sequence i. :
61.2.3.~.S 70r
6124357
1_ 101-0101'0 $I , Dorool """1Comj; KIIOIogy....:l ()ooooI.
_ t h-,o ... bIo"'~ .-...0 . ...... DoN. 199$
2. ~_E~ : I<cr<:Ilx:x>l."'Ort ' .a, v.."
bIk ",""""I po.b!. ...... 1"><, I 9M.
3 T., >to AA , 0 .... I-""~ : 00;..1op ....... !.t<vc.
..... God f..oc>oo. CV,V."q. $ll<>oio,l98C
'. ""' ...... U.60, , o..-...Ie!><""' 01 ,lot d ~~o .
q'n .......a, 0.,,-, 1M
5 v"" .... l.<>d .... ~~ G .M- <nJ 0ul'01Ioo HI : 0.-.-.,
_ , of 'Oo "'fI"" ~""'Io<1: An 01100 : I,,pe<
G,," '-ow. 1976

T
r..oro.fodo ' regio n rwiomu 0 ""de "logo
of i un ct io n uc h 01 mo stico tio n,
.wollowing, relP j,otion and .peed!. It i.
now on GCcepfed fOCI t!xll form arid function O'll
inl.."..lotO'd , Norm al developtnel1' 01 tr..:. oro-
Joe",1reg ion Os to" io rpe ',lent dependtonl uP'
"",mollun ction.r"" iu",'i cn. of me oro_loxiol
region ;"dude mOllicolion, , "'1)11".. 1"".
re.pi,olion, speech, fociol "P'.";OI'l and
mointononc .. oj mandibulor po,~>on. In thi.
chopte<_ study some DlIh. imporlOnt lurchcrc
oIth. o,o-loc;.,1 r."ion ond thel' rol. on
de..o.!opment
MAS JlCATlON
Maslicolion i. 0 com pie> getly,.." a imed 01
breaking down aod insolivo~on 01 ti.e food,
preparatory 10 $WOIiOWIng. In infant., Ihe food
is token in by sud:.ing 01 th.r diet il mostly
coofined to liquid . Thus mo$lia>~on In lhe fniO
,
Development
se n~e i. nol ple. ",,' in infant . As the infonT
,witd' M on to so li d Or ", mi,oIid food, it quic kly
l..arn. to u,," the lip. to koep the food from be in g
fo::.d out of 1M mouth . The bolus of food i.
mL>:ed v.im", li llO by Ih e oclion of the tong ue and
i.lotced b.ot"'.... n 1M g um po d. <>r lhe ocdusol
surfoe of In. ervpli"ll leelh.
T.. ~>cotion ollood in Q(I odu~ oco..n
in the following oi. pho.e. o.OIIIIincd by Murph, _
",~p .,. to,y ph.s.
Dur'ng mi, ph""" "'" inge<...J iood ;. poomoned
by ,he tong"" Icwold. the chewing ,ide and the
mandible mo_ to the ",me <ide.
This phose ischarodeUwl by a !""""",,,Iory po_
in the mO<lia:dian_During !hi, period, the ""'SOIY
"'tell"''' e""I""le the opP",,"ol ";scosity of lIoe
,ng... ted food and lite probable load on 110 ..
mo$IiCQIO"lopp"mlus.
 "
50 OrthocionliC$ - TIle Art and SciEnce
C,u.h1nl pluue
Tne food is " u.fIed by eq ",,1octr,.jly on both side,
of th o dontol arch. T.... """h;ng .-orts v,im" high
ve bc ity and g ra dva ll y .Jow. down
Tooth contact
Du ri ng thi, pho.e tn..
teeth como in <onto e! and
. ignifie, the e nd o! the crus hi ng pM ,e.
Guldin; ph"u
Dvr;,-,g this prose, th o conteel become. unikoltorol
a nd the re i, tran , g rel<ion of the mo nd ibu lor
molars ocro .. the ma<ill ory count. ,ports
CentrIc occIU"on
The te. lh cOme to" defini~ and distinct <top .
DEGLUTITION
,
Deg l u~lion or ."",110";,,," i. on impo rtc-ct furo:: tbn
carried out by th e 'tomah>g nothiC syste m. Tfle
>wO ll owing po~ in infant' is different from toot
wen in odu lt, _Thu . two mo in ro,;", cl """, llowing
are fOCOil nised, Tney ore the infontil e ....." lIow and
the motu'" , walko",.
Infantile .wallow
The ability to feed from 1M !Yeo,t ~ oresent ., the
new born oh ild , Dw ing the proce" of . u,kling,
the nip ple is drown into tho mouth by negom~
pre" u", from with in. Th e tongue li e; ove r the
I"""" r gem pads a M protnJdcs bctwoon tho nio plo
000 low" r lip.
Th . milk i, dir.cted co nti nVOV$ ly to t he
pr.o rynx by on o utom atic peri,ta ltic move ment of
tho lON;l u ~ 000 m~ ohyoi! mu>ele . During thi,
proce", r" gu lor b reath ing co ntinue. , The milk
pa"e. between the muoio l pillo" ond the lote ro l
cho n.-..ls of tM pmrynx, Any cxce" mi lk in the
mouth dribb le, down th e chin .
Th e chorM'eri,tks of o n in'onti le , wcl low
as o utli ned lrf MO)"!r$ is o s fo ll oW! ,
o . Th e jaw. 0 '" opart ond t M to """,, i. pl<xed
betwee n th e uppe r 000 lowe r gu m po d .
b. Th e roondib l. ~ . tob ili . ed by th e controdion
of the musd e, of th e ""en, h cro nio l ne rve
ond t he interp:>sed tor>g ue ,
c. Th e . wa llow i. gu ided end to a Iorge oxto nt
cont>-<> Ied t>,..."sory iO'ercr.onge bel\veen /""
lio. end tongu e.
As the infant beg in s to eat solid food ,
there i. 0 d~t,-.:t c ho r>ge in The . woI l:Mi ,," pattern
The tong ue i, conto ined with in the d ento l otche,
on d the moOOiblc i. c.o lon ger protruded. Th i.
he rolds the on set of th e mo ture swa llow,
M ature swallo wl~t
Moture =c~ lowing ;, seen oHer 0 yea r o f lile, The
infonti ~ . wo ll ow g raduolly di. cppe crs with the
e ruption of th e bu cca l tee t h in th e primo ')"
d e ntition. The ce$sotion of th e infanti le ,wa llow
on d the o ppeo ro r.:e o f the root" re , wo'iow occur
g ro d uo ll y. Durin g t he troM itio na l peri o d,
d ..mx\e<i,tks d bot+> Nom le 000 motu '" $Wa'iow
con be observed,
Deg lutitio n occurs in four p ho.e. :
\ Th . prepa mtorl"wa ll ow
2. The oro l pho,e
3. The phoryng ea l pho se
4 . The "",op ho geo l phose
Th e pr~po rat0 'Y , wollow , Th e food ofte r
0,
roo , ticotion ;, a.",mbled a <;om pxt bolus on
the dOrSum o f the tong ue. In oroe r ' 0 o<;n ieYe
this the teeth ore parted little and th e ch ec k
muscles cootmct. The meth a re then brou ght in\::)
ocd u, ion 10 $ta bil ize t he jaws ond to clo.., the
o rol covity proporfy and i.olote it from the kl bio l
ve ,tibu le , The fXl"e rior a.poot of the tongu e
p'esse. a go in" the "'# pa late 10 isolate the o<a l
coyit, from th e pho ",n', Th u. a t th is time , the
 f" I p",;.", bb;tooiod to ,-,0," t...oaH " ,
Note th , ' \<mo~;" oi tho m"Hlo 'l 0,0>
pmd ed" . po!ted", "'0" [, le, l"", ol
"opld'lIrom CCCC~ " ""'" be. ood """~"
ij ' ov,1, po","" ,
oml emily lorms a """led unit
The oral plm,e Th e ,oft po lata ;0 rai ,ed to
"""I off the 0000 1covily ,md the po!! ....ior port of
!he""", ,,,, drop< down . These m,,,,,,,,,,,,,, ueate
o ""'ooth poth loc t~ bo lus as it is pu ~ into
!he phory'" by me perisla!t", octi"" of the Io<1glJC.
The pharyng~o l phase The ph ot)'ngeo l
phose beg in. o. soor't 05 the food po"e. throug h
the lo uc", 1 pill orl . h t h ~ food reoche. the
pho ryngeo l wa ll o, thore ;. a ' refle. upward
moveme nt 01 th ~ ""tire phot)'r>(leo l complex.
When the pho ryng ea l wa ll . \ouch the .aft po late
a peri.toltic maveme nt sets up to move the food
00-
The aesop),ay",, 1 phase, Thi . pha,e camm
51
en ce . 0. ,aon as the load poss e, th e
cricophoryngea l ",h ine,"" r. P. ri, toitie ~ctiv ity af
the aellOphogoo lwa ll . occ ur 10 PO" the food into
th~ stomach ,
Th e to<>'] uc and the po"'t. retum ta the ir
ofig iM I positi on to ' tmt th.e next Lj'< le.
RESPIRATION
Re,piration i. an in herent refl e>< activily. The
r>ewbo rn inlont i. bo,;coll y a ,,'''a l breot h~ r.
Breathing i. e""ked 'POnta r>eomly at birth ood ;"
aided by the po.tura of the mandib le ond hy",d
bort.e, Ncrmc l oro .foc",1 d~v elopmer't i, to 0
la(ge extent de pend ""t upoo pre,e" ce of oormo l
re'"P irati on
f; ~ 2 Po'en'
Iow.-.,J r"'V",
~-tho,ky'og "',., 01
po.,,,,, ,,,,. ""_ "ot. +.
In potiMt, I..",ing partio l or tolo l no, o l
o bstruction, ""sol breothing may nat be f>O'>i bl~
Th.,e patie nt, breathe throug h th e mouth, The
olt~ roti on in brMthing patte rn bring , abaut 0
lowered mandib ular and tongue po. ition Thu $
the orolac "'; mu <eulcr bclanco ~ ko,t lead ing to
ob ~ma l deve lopme nt of the dr.nkl l arches,
SPEECH
Speer h i, lorgeiy 0 I"" rn ~d octivity. T~e l i" t
.ound, produced by a ch ild i, often th e baby
crY, The med><rism 01 ( !)'ing i, intimately ",Ioted
10 respirotion with la!)'ngeol and phoryngoo l co -
ordif'<ltion,
Spe;och ~ an ocquired ski ll ll>ot involves
producti on o f ba sic roote. in the Io!)'n< known o s
phonotion, ond modi!>::"t"'" of tho", oounds by
chan ging the . hape of the covilie. in th e mouth,
"oO " <>W "".110"( "'(" (>"0 "',en~ '" .,."(;,,,1<>- ,,,h """ to
no", ond t hroot, wh ich io kroown m a rticu lation .
A lorg o number of mu. cle. a re involvod
in prodvction cJ ~h_ They in dv"" tho mu.d
of the wa ll 01 the to.-.o, re.p;ralo!), troct, the
pI>orynx, the soft parala, too tongue , li p' aoo face.
Speec h doe. not m o~e 9 ro.s dr.monds on th~
pe ri.om l mu ", u l~tur. gOO hone. $peech dr.Jod l
ore rorely 0 cou'" for ma lo<;c lu. ion _
PASSIVE M USCLf FUNCTION
A nu mber cJ mu.de, ~xert fore. on th o developing
1"""_ There he, bee n ob.erved to be 0 .trong
int" r.o..pend " nce betwee n the bane c nd the
mu.cleo. Altf<>vgh too bor1e ~ one ci the harde.t
tissues in th e bod y, it i$ m011 re$po n' ive 10
~ nv i ronment~l locto" indvd ing m",cu loture
The teeth and the , upporti ~ g . trocllJrc.,
or~ blonketed from 01 d irection' by mu",le, Th u,
 !be inroQrity of til. denta l e rche, and the
...!otiONh ip 01 the teeth with eoch other end with
'r'th 01 the oppo>ir>g arch is to 0 lerge ~'*"nt
irWIue""ed by muscle"
'. The dentiti on i, cove<e<l by e conti nuous
lIude bond toot eoorcle, it '~rti ng \'oith the li ber>
cJ!he li p<, the mvsde< run loterolf)' and posIeriwy
c<ourod the comeraf the mouth, foining the fibers
01 bucc irl oto r wh ich ins~ rt into the pte ryga
mcndibulcr rophoe. The"" fibers i ntermin~l e \'oitn
.... Ii!>;" 01 the ""P'''K>r" con5lr>:;tor and conti""",
poste riorl y and m.,dio lly to a ncho< ot the origin
alrlle . uperior can.trictor i,e. at the phoryngeo l
tubercl e The denta a l"eo lo r reg ion i. thus
encircled Irom the bucca l a.pect by thi$ bond of
lIUJ.de. and thi, ph enome non i. referred to ""
!he oocc ino",," mecha ni.m ,
Oppo>i ng the buccinotor mechanism
!rom within i. a very powerfu l mu sc ulor organ,
!he tong ue . The dentition is in 0 con.tant ,tote of
dyno mk equ ilib rium, The re i, 0 be""". 0I1on:e<
fig 3 rrO i" """ 01 fo". ':A) fro"o",,, t b<Jff" "
(SJ Mc lor" co"o '" ", ,,,. ,, (C) Pt" ,,,,,,d b,tt,."
R Mcndbclor ,,,0<"''''
S3
between muod e, t;'<;t is belie"w to influcn<:. the'
pOOtion and <labi lity oflh.. de"loofyeol",d.mp~ .
TRAJECTORIES OF FORCE
,
The tro jcctorio l theory elloree stote! thot the li ne,
01 o ri entation of the bony trobe;;: ulo e conespon'd
to th" poth"""y. 01 moxima l pressu re and ten' ion
and thot 00ne trobecul"" a re thdor;" th'. reg"'"
wh ere the . tre .. i. greo", r,
Sennir>g hoff , tud ied the ""tura l li ne, of
stress in th e skull by pierdng smoli ho le, into a
freoh sku ll. Later as skul ls wer. ~':iei' he obsarved
that the ha l o .. umed 0 linea r form in' the
d n.ct"", afthe bonyl'r'l:lbecukle. ~ wereljled
B. nn ingf>olf's li nes or trajectories which indio""
the d irn<:tian of the fu nctiona l stre$S~'.
Traje cto rIe s af th e muma ..
The tro jeaarie, of th e moxil lo ca n be broodly
clo ss ilied a. ve rticol and horizonta l traje<:tori. s.
The v. rtico l trajectories indlKfe the I""'to na'a l
buttress, the ma lor.zygomatic OOttre.. ond lhe
pterygoid buttress.
',o nlo nasal b~ ttress Thi . I(oiectory
originato. from the inci,or; . amine. an d tho fi~t
maxi llary premo", a nd run. crania ll y aloog th.
sides of the piriform opertu re, too crest ofthe """,I
oono and termi""t in the fronto l bone,
Ma la r zygomatic b~tlress Th i. tra ie cta ry
transm it. tho . tres. from th o buccal ~p of teeth
;n th ree pathwa y<:
o Thro ugh the rygomotic arch to the bose 01
the <lull
b Upi'Ord 10 too frarttai 00ne through the lateral
wa ll . of the orb it.
c. Along the lower orb itol margin 10 bin th e
upper port of th. fronto-nowl buttress ,
M If" Orthodontia Thill: Art and ScienCe!

Pterygoid bll1t1"," : Th;, ""ilctcry transmits I..... rJ tronslormolion 01 bone

!he IIr_from the _and ond Ihlrd mob" to the Thus, no! ""Iy i. !he quon!ily 01 bonoo
boseof th.,h ll , ,;'we Ih . minimum tOOt WO<J~ bo neede-d fO!"
The OOr1l00ta l trojl!'dori., of the moxil lo IVr>elion roq uire<nen". bJT olso il .sIt"\J<:Me ~ .""h
indcode : tho! it is belt . uiTed 10' Ih. IOfcel e.<ertod upot! it.
o. Hard palate 110 long be"" .uch as Ihe lemur 1$ OJT open, i'
b. o.bit<Jl ridge< will be found rhol dense cortical be"" li on :he
c. Zygomatic on:h ... outside and l pi<:uleo of If,., mn<:e10Ul bone wiThin
d. 1'010101 bones are arranged in such 0 WIly thQ11hey wpporl the
e. lesse< .. ing. oI.phenoid <:o~i<:ol bone obng _II defined po!hs 01,1..-
and Wain.
TR AJECTORIES OF THE MANOIBLE
A lioe ol,t",,, extend. from one cOf\dyle to the
t""
oint' pO", ing oloog ')'mph.,..... A 1'MT1"'"
01
,
....,IIOcoltmjec!Qne. ,odiote down below !he roots
of the mandibular teelh.
The bwer bordo, of !he mand,ble Dnd
, 0;;",", OrhodoWi:o. SI Lo";"
the m,lohpd ridges ora Ihe <>!he, prominen! 4.
tv Moobr,19f16.
OO._ .....
110.... E ............ , tto..Jboc< ..
bock _ <01 "'bI........ ;,.,.In&.
r.o,
bun,_ ol"'" mor<libl . 5. SaIz""," .III , """"'_ 01 C,tI t ..... 11 I;...,.,
..... ..,..",. 1%6
WOLFF'S LAW OF TRANSFORMATION
OF BONE

Bone, unlih. olherC<>Mllld;'" ~UlJfl ",.pond. tQ

mad deg-.oIp ..... urc ond """"'n, bychange.
in its /orm. TIIO$IO charges ore oo:omplished by
moon, 01 resorption of I,~ng bone Dnd
doopooitjon 01 new bone. n, .. may lake plo<" on
!he ..,rlOCII 01 the oo.,e un';'" "'. perios!evm, 0(
in th e cose of '<lncelk-x bon. on th e w rl",. 01
the trcbec.J b . or on the "", II . of morrow .po ces
Of 0; ' linu ..... The o..u.itodu,," 01 a bwe i. such
that ~ ton best resist IIIe foo:es which are blough!
10 boor upon a wi'" 1M uMl of 0$ lillie hu ue "..
pOSSible. In !hi. reopect bene il mo.e pIoslic: rhon
any othe. connediVft Ii......... ~ hos been Iound
!hot bone ... 1onncd in juotlhe q""nIir)o and shope
lhe T "'i ll e""bI~ it to withllOnd tile phy.icol
det'l"lOndl mode uon ~, with th e g.eole>! om"" nl
rJ lICOI"1on' l of IlrtKlu.e . Thi. i$ Ih. be.;. of Wo lff'.

- Basic
n I!...dy of ocdt><ion " O~ imporlOn! ~
of donI; "' ",. Tf.e .!<.><fy end proc!iao 01 m~t
bron~ he, of dentIStry . hou ld be bosed on
"SIrong fO\.O"ldot>on 01 It,., krn>Medge of ocd uslon
Ifig I). Ollhodon~cs is 00 ".:cep~on to mi, as
go.,r """'I' changes occur in !he oed......,., duri .....
... ~oodoolric Iheropy; The orthodonlisl $hould know
...+.or >ntt,1uIeI norma' ocdu<ion in order 10 be
""'-!O reo;og"". obnormo l occlusion.
The term 'ocdy,,,,,,,' M$ both SIOli c ond
dy noml c ospect . Stotic' ref." '0 .h. form.
aligM'1e<1! o>\d orticu loti on of teeth witn in ond
b.,,'_~ !he arches, ond!he """'~o".nip oI _h
10 lhel. wpponing <lNelll ... , Oy.ocJmic;' ,of, to
..... funClion of"'. Slomatogn<IIh,c .,..tem os "
......... comprising tedh, wpporling ".veMo,
.. mpo,omondibulor ;oint, ~u""",u""ulo, ond
n~ t'l!i ... ~ 11""ms. The lerm. 'no' mol' ond
,.Iet
'"",Ioo;c;lusi",,' IlS ....ed in orthodontics rooin fy
10 the stoTie O'pe<:T Or th e form of the dentition.
Angte defiMd occlusio n a. the nomIC I
,
inclOncd pi"""" oIthe lee!h
relotiort rJ the occI.aoi
whe n the "'"... cr. cklsed. Th is definitio " \s on
over.simplificaTion of wh.,t it octuolfy (>n$liMes.
0ed"'; "";1,, comp le. ~.~on \~vohl i"1I
!he t_ h, pe<>odoo,t(li ligoment. II>e jowI., the
tempet<>mondibulor lOint, the muxles and II>e
"""OUS$ySltm. Theoim o/thisd>aplor illO Ihrow
lig ht on normol oc:cluoion ond 10 hillhlillhl the
artl-.odonlic; os~ 0/ ocdus;on.
TRMINOLOIJY
Id e al OOciUI;O/! , It i. 0 or,, -oo noai .ad
tIooor"ticol concept of occlusal .tructural &.
lundional relatIOnships Itoot include idealized
principit$&. dIoracleristics Itoat an oed....ion
should hove .
Phy~;o/ollic oce/usion This 'ale,. to on
oed"';on thet OevrOI{J, in one or mar. ways from
idea l yol il i. well oclapled to t hot pot1iculor
e""; rom,.,..... I. is eSlhetic a lld """"'" no polholoQic
man ifestati on , or dj1function.
BoIQnce d ocdu.ion An occ lu.iQn in wh ich
bo lonced and equa l contacts ore moinla i"""
throughooJt th e entire oreh during oil . xcu ,,;cm
of lhe mandible
Funclionoi occius;on ,. It is delin.d 0< an
mmng """,nt of tee1f1 which wi ll prooido the higMot
efficiency during a ll lr.e excurl ive mov. "",,,t, of
tr.e mand i ~ wh"h 0'" r'I<'>Ce''''''Y during Io..notion
ThNapeutic occl u,ion An oec lu. ion thot
M' been mod ifi ed by oppropriate therapeuti c
modo litie. in cmer- to chango a r>OI1 - phy~oIogica l
occ lusion to onc that i, at leo,t physio log ic if not
ideo l.
Trauma tic OCclU5ion Troumatic ocd u, ion i.
an obnorma l occl",ol , tre", wh id , i, eopoble 01
produc ing or ho. produced a n injury to th o
periodontium.
Trauma from ocdu .ion It is defined a,
peridontiol ti~~u " injury ca u.ed by oedu",1!orco.
throvgh abnorma l occlusa l coolocts.
TYPES OF CUSPS
The humon po,te, ,,,, teeth con<titute IwD types of
cusp, _ They are Ir.e cent, ic f>oId ing cusp< and
th e non--- supporting cU'p',
Centric /tDlfl l nt cus ps
The fa cia l c"'p' of mandibular & po lotol cusp~
of maxi lla ry po,tenor teoth are w iled tr.e ce ntr;":
f>oId i"ll cusps. They acc lude into tr.e cMt rol
10",0 . 000 morg ina l ridge, 01 oppo. inQ teeth.
Th ey are 01,0 ca ll . d tho ,lamp ClJ'P"
Non - 5up poTtlng cus ps
The maxil bry buc~o l ~ mandib<.Jor ~'nguo l e<JSpS
0.., ca ll ed r>OI1-.upporting cusps. Tr.ey contoct
ond gui"" 1M mandib le during I c~ 1 "",u rsio,,"
& sheor fe>c<J duri.-.g """ ticotion . Hence they ore
a l", ca ll ed shea ring or guid ing cu<p',
ARRANGEMENT OF TEETH IN HUMANS
Hu ma n dentiti<;," e,h iblt, two type, of ,ooth
arrang e"",nt wr.en the upper ond bwer t...,th
ocdvde with 0"'" anather. Th ey ore '
0 , Cusp- fo,,,, occ lu,;oo
b. (uspembro,wr. occlu,ion
Cusp- rona o cclus ion
In thi< type of cx:d", ion, the <tamp cu<p of 0""
tooth occ lud e. in c .i n ~ le 10'''' of a . ing le
opponent. Tr.e uope< <tamp cusp. fit ;"to " I",cept
tr.e """",110,,,," 01 the lower leeth wh ile the lower
,ta mp cu'p' fit into a ll tho uppe r fo,,,,,, t. pt
the di,to l o ne, af bicu, pid . _ Thi , kind of
ao-angemeri wr.ere conto<:l! occur between single
oppo. i n~ teeth ~ co iled a cu,plo.", occlu .>on
or a tooth to tooth o"ong . ",,, nt
Cus p_e mbras ure occlusio n
Anotr.er type of occl""",,, betw...,n tr.e upper and
lower teeth i, co iled the cu,;p-embrm ure 0<' tooth
to two teeth oc d u~ oo , In ti, type 01 mrungernert,
eoch tooth oco lu"", with two oppo,ing teeth
IMAGINARY OCCWSAL
PLANES'" CURVES
Curve Df Spee
It rele" to the antero_po,te rior curvature of the
occlusal , urfoce, begiming at the ti p of the lower
cu.pid &Io llawing the C"'P ti p" of h" b:cuspid,
& mo lors cont inuin g a. an orc thro ugh th e
~ondyle (fig 1 _aj . ~ the cvrve i<e<te nd od, it woul d
Icxm 0 cird ~ ofobout 4 inch dia meter.
 \
A B
Ti'e wrY" re, ~ lt, from \"o , kltic<l, in axia l
of'llrnnent of tf", lowo,teoth. The b>g ax;' 01 each
lowe, tooth i, a ligned nearly para ll e l to it,
indMduaI orr of coo re around the coo oyk1r axi .
Thi. requ " e, a grad",,1 p<ogrc,,;Ye incrc<"ed
.......,1tilting ofteeln to'""" '" mol",. wh ",h Lr>l<lte:;
the c ure of Spee.
CY'Y8 of WIIso/l
Thi' i, 0 curY" toot contects the bucca l & li ng",, 1
CtI1p tips of the mandibukJ r bJCC(l1teeth if>g 1 b)
The ctJ"e of 'Nikoo is ~k>- klt"ro l on ""cn ~do
01 the oren. It re wlt, from i nw~rd incli nati on of
the lower fX'sterior Iooth. Cu ...... o of WiI "," "" Ips
in lwo wcy"
o. Teeth ore a ligned pora ll cl to , he directi on of
"""" ;01pteryg oid for optim um r "~'t<lr\Ce to
""""Ii co tory force.
b. The c:"""te<! bvcea l cu'>" prey.",! food from
go in, f'O,j Ihe occlvso l toble_
e ll,ve of Mon ~" "
The curve of ".on son i, obtOin. d bye,jMci;ng
the curve of Sp"" & CuOo'" of Wi l,oo to a ll w'o,
&. incisa l edge>,
51
CENTRIC RELATION'" CENTRIC
OCCLUSION
Ccnttic rolotk>n i. the rc lotk>n 01 the mandible to
the mad le wh en the mord ibulor condyl a re in
the """,t . uperior and retruded po~ r ion in the ir
gle noid fo.:;o with tho o'lieuler disc properly
interposed. Cent ric re lat ion i, 0 1,0 ca ll ed
li gam entou. po' iti on Or termitJO l hinge flO;ition.
At ce~tri c rela ti on both the condyle. are
-limulto neoo, ly se<Jtco mo"" ,uperio<ly in th . ir
glenoid 10.:;0. In tryirl9 to oblai n centric relati""
the ma ndible may be lorced toolar bocl, rhu s
the torm 'un,trc ined" appeofS in som e d. tiniti,,'"
C~ntrjc occlusion i. that po' ition of the
mand ibula r condy le whe n Inc t.<;.c th ore in
'f""',i","", i<ltercu' potion. C. "t,<: occlusian is also
ca ll ed intor, ou'po l po, ition or conyenience
ocd u. ion
Centric ",latiC<l a nd centric occ lusion
' lroulJ coirrcide in order 10 he"" perfect oormony
betweo n the teeth , the J.omporon"IQnd ibuklr iOint
ond the r>OOrl1u>cuklr ..... tem. ;.omo , !Lid;". i:?""
,hown thot ma jority 01 the popu lati on ooyC a
ma~;mu m inter- evspoti on 12 mm Io<word of
cent,i c

Ma:.imum interevspation con olso occvr
";!MuI t!>e condyle. being in ~, This i"olled
mo.imum inl",cu,pation , ""bituo l oedvs ion or
o cqu ired oedu li",,_
CENTRIC CON TA CTS
' he:1 0,., oreos '" tho IMIh that contact the
OIlPO'ing ~ (I;g 2). Centric contact. hcrve been
dO$$ified into P<>Iteri", C<lntric tontoct> ond
onle<ior C$I'Imc c""toct.,
The poslerior<enmc contocls consist 01 me toe.,1
rang! 01 co nloe" ond In o li ng uo l rong e of
,0nlO<;Il. Faciol rong. of po:;teriorcem-ic Cor"fOCk
inl'(lfve lhe mondib u.,rfockl l c..sp lip' cc nlc o;lng
the 'MIIOI!ossa. ond m.,;,,1 ",0'~;n<l1 ri~ of
lhe opposing m<ll<i1.,'1 teeln. ling",,1 ",ngll 01
poolerio, centric contoct. invo .... the m,..;l1ory
lingua ""$II ~ps contacr:nglhrt_lloosoeond
.....
di.tol mo.g,nol ridge$ of!he OWOSing mondibvlor
Anl."", " . nt,Ic cont~cI.
Anlerior leeln ne ..... o nl,o oM rong e o f u ntric
,onloell ond ore in line wfrh tho bdol "'''lie of
posterio' IntriI; contoc:l$.
PoSl$'\Qr centric contocts <esuk in 0>:1011,.-
di,eded bl"ClH o. CO"""" CU'l' tips occlude on
on OWOSlng tooth o<eo mot i. ll'O'P'I"dioJJo- to
lhe Ion:e. H~>'e' centric conlocl. oflen ""'"
on incl in es o f po.lerlO(leel~, TMse '''''lads IMI
occu' 'o n in clin e. or. co il ed poded ce nt ric
eonlOd"S. The ,,,,,Ioct, occurring on irdine
houldbe bo.,nced by on "'l",,1 ,ontoCl on on
oppollng Indine 10 reso .... the Iorwo In on o . lal
direction. II me conlod occurs on MO incline"
!he conlecri, tI)fIT>O:! bi-poded conled. Contods
1ho11Xl:N( on 110"", indi"'" a re collod ",.podod
,,,,,Ioc!!.
Cornocts tt-.:;,I <>eo.r r on fou, indine. c r.
co ll od quodr() ' poded co nlocl.
CCNrRIC OCCLUSION
Ecc_1e occlulion rde" 10 contact cI ~ that
OCCuro during movement 01 the mond lble .
Eccenfl,c oed .... ron con be 01 """ typ!l' .
o. Fundrorrol oed .... ion
b. Non-lunc~ o",, 1 oed",ion
h ad/onal occlusIon
fi:o'Ictiono l occlu,ion (al'" co iled worki,.... side
ocdusioo) r.le" to tooth coolOct$ thot OCCur in
"'" s~gment of the arch roward, which tM
=c.ndible mov . Fur.oiono l o<;du siO<1 con be of
..,rype' :
lcIerol /t.;n<;iio.wi occiv, ion . It in cl ude, Tooth
c;DnIacts th or occur 0<1 con ines and po.teri<x teelh
on 1M . >d e IOworck wh ich the mOMib le moyes,
The Ioterol fu nction ol occ lu.:"" con be of !wo
","'
I. Co ni"" g uided occ lu, ion During laterol
...".j ibul"r move ment, the o pposi,.... upper &
b,..e, cani"" of th e wcrl:inQ ."" cont""t the reby
cou$ing disc lu . ioo of a ll posterior t""th on the
worl; ing & bo loneing . id ",_ Co nine gu id ed
ocdu>ion i. u, uolll "", n in young ind ivid uol. with
ooworn dentition. In 0 CM ine gu;d "d occ lu sion,
!he mo ndioo lar cani"" cu'>' tip trad" fTom th e
cenlric oonto<;t po int ot the m.",,1"",rgino l '''g''
lDwa,d, th e o,-"p ti p of the "",xilla')' con ine
2_ Grouped late ral accl usia n : I ~ additian
10 cani"" gu idonce, ~. rtoin
oth er po.te rior t. eth
on the working . ide 0150 contod du ring lot" rol
rMVOOl8I1t aitt.c mon"I;l . S,d 0 type cJ con=!
during latero l movement is co il ed grouped late(ol
ocd u ~ on _
Protru ' ive fu nctianal occlusio n It incl ud es
eccentr", ~o nto<;t. thot oocur wh-o n th e mondibl .
move, forv.u-d, Idoo lfy the si, mo,..J ibular anlorior
'octh co nToC! olong th" lingua l i~d i "'" of th e
max il lo r, anteriar te eth while th e po>!. ri o"
di,occl ude,
Non-funcllona/ occlusIon
They are tooth contoct> thot occu r in the .egme nt
away from wh ioh the mand i b l ~ rnoye , _ Fo r
. , arnp le ii the mo,..Jib" i, mo".d 10 the left . ide.
contact. OCCUf on th e fight ,;d e of the Ofeh.
D/SCWS/ON
The te rm di sclu . ion i. " sed to describe
di,occiu,ion or 'eporotion- of non .functiona l
po!lteriortootn during eccentr", mot"n> af the ,"w,
Di$Clu$ ion of po,te ri o r teeth i. brought oOOut by
condylar gu idon ce ond in ci'Q I ~uidof1Ce
Co~ d y l ar gu idan ce r~le" to the
downword movemeru of both the co,..JyI.. 0 10","
the , lope. of the articu lo r em inence d uring
protru.iye moveme nt. leod in g to , eporotion of
the posterio rs , In ca ... of laterol movem ent,. the
cond yl e on the non.fur.oion ing ; ide tron~at"s
forward olor... the em i",r.:e wh ile the~ . 0<1
th " fundioning "de p;vol5 in ito fo ..o le" ding to
discl",,, n of posteroo 0<1 the non -fu r.:tiono l side.
AI1lenor gu idor.:e refers 10 anteriof Iooth
fun dion$ wh",n .eporore the posteri<x teeth during
ecce ntric motion. of th e jaw. During prot"" iv"
and klterol moveroom of the mondible. the Io-w..,
anterior tMth trock downward fr-om th-oif oree of
c" "tri c Lantoet Toward$ th " inC i'o l e dg ~. " f
maxillary teeth wh il e di,occluding l he non-
functionol po.terio< teeth_
Co ndyl a r guidonc . has its g ree t"d
inll uer.:~ on disdud in g th e mo.t di,tol po.terior
teolh. whil e l he inc isa l g uidance provide ,
di .dud ing effect on ,he more me,,, I I,,,,l h. The
(oneMor gu ida .--.:e i, a fixed a""tom", foctor thot
canl"lOt be controllod by *" """tiMwfti le th-o i""",,1
guidon"" can be control led bv modilying the form
an d arrangement 01 th e anterior teeth ,
ANDREWS ' SIX KEYS TO NORMAL
OCCWS/ON
Andrew. during the 1970', put forwo rd th e . ix
key. to "o(ma l occ lu sion alte r ,tud, ing model.
of 120 po tle nt, with ideo l occ lu . ion, Andrews
con> 'derod !he pre", r>Ce cJ the ... leoTure$ e""ntioI
to ochievo on optima l occl,-" ion . The , lx l ey. to
F ,3 AnO .......... _ Ie ...,"",1 "',._
~ ., 1 W 'dool C..... I ...,.,. . ,..",.:a; Mol"
"_0 "'" eo.. 1
Koy 2 (Q . ........... =""" ~.loiao '00
ID) ~ rd <--" <"~u~. "" ;:1001
Koy 3 () Idool I,bio-lhg..,1 ,,_, cdl ..... .,.,
Koy ~ \1'1 Idod ~"ig"_ cf ",, .... "''''
_f,,", :Gjlob.... .".. "'" "'.. ~ ~ ""'

no<mo l occ lu . ion ore con$idered und or th e
lDIIowing heed ing. :
I. Mo lor inter-oreh reloti on. hip
Me~o -d i sXl I c'own ongv~oti on
labio lin gl)(l l Crown ind inotion
Absence 01 rotation
Tight oontacts
Cu ..... e 01 Spee
Mol8 T Interarch relationship
The me.io-b uccal cuop 01the uppe r firlt moIe r
ohould ood ude in the groov~ between 100 meskl l
oM medkl l Mcol ev.p of tf", lower firSt molo"
The mo.io. li ng",, 1 cu.p of the uppor fi rSt redo r
ohou ld oco lude in th e centro l 10"0 of IowerlirSt
"","o r. Tho crown 01th e upperfirSt moIo r mult be
cngulated .0 th at th e d i.te l margi na l ridge
ocd ude. with the me,ial marg ioo l ridge 01lower
>OJld moler,
Mu/o-d/stal crown angulation
The ,""co nd key mok.s u"" 01 0 li ne tl">ot passe,
along the long a<i, ci the gown througn the moM
f;g 3 AMrew ~ "., normol oo:lu",,"
5 IH) ~ o l .,;,""" 'f'OC; "" :r, S~
Ko \'
don;, ,,,, "". "'tOi,'", ko, 5
Koy 6 1,1) kloo l '''''''' 01 S_
p rom inMt port in th~ cente, 01 too Iobial a-Mcal
sur/oce, Thi. line i, oo ll .d the long o<i, of If",
cli nica l Cfown
Fo r tho occ lu, ion to be cans id oro d
normo l, the g ing iva l pat! 01 the lon g axi s of lhe
crown must be d ista l to th e occlu$Ol pot! of th~
lin e, Diffe,e nt teeth ex hibit differe nt crown
o ngukltion .
lablollngu al crown In~lInation
Tn,. crown inclination" determined from a mesia l
a- dista l view. If t he ging iva l Of"" o f the CrOwn i$
more li,.". uo lfy plocad than !h~ occ lu sa l area, it
i, re/e rre<l to a. po, itive Crown ind iootion , In
ca ... th o lingiva l ""'" cithc crown i, more klbio lfy
or bvc<:o lly ploced tr.on the occ lu sa l area it i.
referred to 0' negative crown indinotion ,
The moxillory i"c;$Or< exh ibit 0 fX"litive
crown i"" li noti on wh il e the mondibular in cisor<
. h<>w a very mild neg ative crown ioclino~on. Th.
maxill ary an d mondil>u lar po,torio rS nove a
""gotivo crOwn in cli notion ,
Normal oedUlicn i. chor"eJerized byaboenc:e 01
DRy n:>Ioticn. Roll:lllod po>feriorteelh 0CCI.pJ mo~
lPOce In the denlOl on::h ... hil~ roI<.>!ed incisors
occupy leu lpace in the oret..

Tllllt contect.
To co",Oj .. on OCc lul ion ". normal, th.", IhovId
be light conklet betw n odiocomt teeth.

Curn, at 5p
A nOllTlol oedu..,1 plone DCCOrdi"lllo iVldrews
shoulel be fbt,...ott. ... o;\JMtoi Spee not~ng
1..5 mm.

1. _ If . r...... 1.y. to..,.....,1 ocd.-... Mo J

O~19n, 6J, 296
2. f ....., Go,,", Omd, ~ .... Uobom>on, 0<d"",1
'-'<10'0 ...,,1. c:w.oo""i= J On ~ 1973
,6II'-6~1
]. _ ... ,: Q "~ , G<.:lt.olo,:" Q...;'"MfIOO
booIJ, 1 ~3
~. m"....,,:
Wdgh 11"/1
..
~ Io' , " .... ;pIo, and ' '''''_'.
5, _ , DMoH. Goo<vo A ' <rb, Go ,.,... E .:0 . ...""
"""'0 l.,.;. :,., .... booIc d o<d", 'OI'. Q .i, ......'I(.
bode" 19M
6 ~1cIH. .d! . F,.. ,..,.",. Otct...,. '0 ..... 0..
_""" . J OI~'col 0rrI>0d1961;32 _ ~1

l
 of

M
o loed u. ion con pre.e nt i15e lf in TYPES OF MA LOCCLUSIONS -
nu me rOuS way . ( Iou ifi ca ti on TERMINOLOGIES
invo lve. the gro upl"," to",,!he, of
N.c locdus ion co n be broodly divided into:
m'>ovs mc locc lusi()(ll into simp~' or !molle,
groups. In order to ho-<o 0 sytIem of ~~""t>on .
i) Inl ro _orch ma loccl u.ion. Ihct indude
tondords s hould be ICI up t~ot roprelont yoriotinn. in indi"';d~ltoo!h pos~ion Mel
mobodusions ofIec1ing 0 group ollecth
nonnolcy lk o;bimio"./rom!he otcepted """'"
should olso b. grovpt'd InlO vofOUI ,molle, wi"'," on o'ch.
ii) InI~Hlrch malocclusion. Ihol comprioe 01
dNision. 0< COIegories.
Th. odvontogOJ 01 cloulfylng 0""""
mol .. kJtion 01 denial 10 on!! onOll-
upon .k.,.le1ol bony 00 ... , which mill
molocdus.ion is a.follows :
o. Clo.>i/icotion hoIps'" d"'gnosisond pIonnorog tham ........ be normal.,.. relored
iii) SkeI"",1 malocduslons whidr involve the
trflOlmenilor th. patient .
unde~ying bony t-...
b. Clessilieation help. In Vi.uDllling ond
under:llanding the pfObiem ost06oted WIth
!hat mob:dusion. Mo\oed""ian. can occur in .., riau.
eambir'l(r~an. lind therefore ~ moy be very
c. CIa.. ifo<:alion helps in cornmunicorinll the
d ifficuk to dos';fy !he molocclu":on inlo inlm-
~"""
d . Comparison oIth. ""rioI/s maloo;:lusionl il o rch. inte,orm and .~"Ie1tr! ma!ocdUllian .
fhe abo,e mentioned caraga,;.r'on of
made easy b-, da ... f.:arion .
 E_ , ~ -'

,,
,

,
1
,
, ,
,
, ~,
" ,
, ....,. ,
~

,,
,,

G : .,: H
'"
. ~

r:
I '. _
,
molocd\llion give< us on ideo of !he posolb'"
I'ypes of molocclVlion mot can occu' in on
ind i"dvol.
INTRA ARCH MAlOCCLUSIONS
A toolh can be obno'molly 'elated 10 it.
neighboring teeth. Such ob_mol..,rio1ions are
called Individual !eelh malposltions. The
inc!iYidvol tef:!h moloOsition con be abnormal
inclination (or tipping) 01 me "'eth 0' abnormal
dl!lloceme n~. ,Il,nom'lOl indi'lO~on invojves the
abnorma l ti lting ci the croom, with the root be ing
in _mo l po. iti on, Bod ify dilplacement invol, ..
obno<mol locolion of Ih e crown 01 well o. th o
roof In the lOme direcfion.
Intra-orch malocdUl1ons con also ind~
condit;on t.ke ,poci~~ing ",,",in lhe
denlOl orcho.-
Some of the commonly Hen indMduol
!H m mol posi~on. 011 (fog 1):
DiSIOI incl inoHon or diSIOI !i~~ln~ Thi ,
"''''"Ie c cond ition where tho c,own of the tooth
is liho-d or inclined didolfy.
Meslo/ inc/;""rion 01 mello/tippin\! : Thi.
il a condition ......... the CtOM'I 01 the tooIh i.
~11Iod 0' Inclined mesially.
UnllvallndiMtian ar lin 9uo l fipping :Th is
i. on abnormo l li ngual or pala!a l tiltin g of th o
tQoIh, Thi. condition is 01", cc li o-d"(l'.5.;;I"I'<ltion;,
8uuol inc/inaHon or buccal Ii~~ing : l hl.
tele"to labial ron cose
of on,*,ior) or buccal
COM 01 posrMi<:.1 tihing crI the !OOIh.Thi$ condrlion
i. 01 ... colled'Fina!io~
Melial displacement: Th" refo" to a tool\,
thor! Or bodily """""" in (I mOSi::ll direclion ~.
th e mld li"",
0;.10/ displace",..n/ : Thi .-elell to a room
rhor I. bodily mov...t in 0 d~tol di_~on aWOl'
from the mid li ne,
Ung ua l di.p lacoma nl : Th is ;1 0 co nditi o n
wnell lhe enti ll tooth i. di.o loced in a ling ua l
dirK~on,
8uccol dilplocem~nl : Thi. d crlbes 0
condi'ionwhere the tooth i, dioplocod bodify In 0
lobiol or buccol diff!mon.
Inf~llion 0<' infro . occlu$ion : The "''''''
inf'eMIr'ion 0< inf",-ocd u ~on roi.. I<> a 1000+, thol
foc s not eruptotd enough comPQred to th e Ofhe r
teeth in the oreh.
$upfovel"5lon or 'u~,a - c(ulion l hl. i.
a tooth thor! hos CIYO'f-o-rvol...t o. compared!O
oth..- teeth in the crch. It is clso coli..! WPfl>.
occlusion.
Ra.<ofians , This ",rm ...:e" to room mOWlmen~
aro..nd its long 0<" .
OISl o lingua l or mesio bucca l ,etc/ion:
This describes a tooth which hos moved oround
ils long 0 ... 10 !hot lhe d"",1 ospeer is moroo
lingually placed.
Mello lin\!uol or di,fo - bu.al roro/ion:
lhil is 0 condition ~ the room ho, fCltc;lted
o><tnd its Ion<;J oxio 10 rhol the mesiol ospec! is
morel lnguolfy p!oad,
Transposition Th i. torm desc ri be. 0 condition
where two tH th h~ ,,-,cfocng.ed ploces.
INTER-ARCH MAlOCCWSIOHS
ron
These malocclusion. cre ,horoel.riled by
oboooorrg ff!bfonsh" between two leri10r group'
of teem 01 one a",h !Q .the Of"or arch. Tho""
inlor-orch mo1ocdvsian. can ocwrin !!Ie ICgi!1ol,
,er1ico l or in the tronsve,se plo"". of .pace.

Satltta/ plane malocc/us/on,
T.... include. condit.",. --+>"''' th e upper ond tke
boer ord, . , are abr.ormoll, reloted to OO(hotr.er
inu oog itla l pion .
i'r~'ma! <xclu ..~> H i, te rm ,efe " to a
mndilion w""'" t""
lowe, arch i. more forwardly
pIoxed whM tne fXltient b<te. "' centric occ lusior1 .
l'b.I,..:!'.S' rmc i oce/v . ion ) Thi. is a cor.o i' ion
J.ere too 1()'WC,arch i, rYlOf. di,t" lly pIoced whon
.... potient bit". in ee~tri c oed","""
V.,t/ca l plane ma/occlu$lons
n....e "",Ioco lu. ""'" "", I,," . deep bit" ond ope n
bioe where a n obnorrnal , ort;co l ",lo tion e,im
belwee n the teeth of the upper and klWe< ,orch
o....p b ite or ;n"re m e d oY~ rbite It is 0
c:ondition where there i. ~''''~i c;o l overlap
~n tn" upper and Ioweranteriors Ifig 2 .01
Ope'!Jl~a . Th;. is (I conditi on wh ..,.e th ",~ is
.",verTu;ol overlap between the uppe r ar>d low ...
100m, Thu . 0 opam moy exi, ! betw..,n th e upper
6'1-
c
o~d lower !eeth when th e petie n! bite. in ce ntric
ocdusion. Tf>e o~e can be in the anlefior
0<" the po,terior reg ion . (f.. 2,bl
Transverl8 plane malOCClUSIons
The tron ..er.... plane inte rarc~ malocclusion
ir>d"de. vor>ou< type. of lftm.b it~ The term
croo.bile rciero to CJbnormai tro",1'()I>e rek;,tkmhiJ<
beiW<len the upper ornJ lower arene.,
SKElETAL MALOCCLUSIONS
Th e y or e moloc d u. ion . oau <ed d ue to
abo nom.., litie. in the "",>i ll" or mornJible. The
def~CI< can t", in <i,e, ",,' ition or relolion,hi p
between the iows. Th . " eletCJI mo locclusi<>n' coo
01,,, CKeur in th e th ree piO M' "f 'poL" oome ly
so~ itta l , . ertioal and tro nsv.". plo n"$. In the
sog itto l piOM, th e fOfWord piCK"ment of a iow i,
re", ,,ed to o. progoothi<rn whil e retrognetlli,rn
rele" Ie Q more bad;word placeme nt of 0 jaw,
Th e ">g ittol abnorma litie, can CKwr in 0""' DC
both the jaw . and can aCCu( in variau .
 I. ,
I
I

A , c

D , F

\' "", J
,

G H

fl<; J o;.,g..MO'ie .. p< .... ..,~ '" ,foo P"",... .. rei",.""

Cbo, , (8) a.m,,, 110 .. pool"""" Ic) BI"",,;l Io'f
oIotoI ..... _ "'''' ', .... , .. ."..,.,,, ... '" '" >0'),, 1 , ', ... ~, .'!o<rr, 1
(0) Mo . l lo'l ,,'I'll""';;'"' 1~I >.\o-J"'/ .. "',ogo"O"""" if)
"""""" I<OIIN'bsm ,od """""..,'., ..."....t.." fG) M.,d .., ... """,,1..,., ,~~ - . . , . ~...t.'I'I I~ !,.~~ ....
_"ON ........... "''' ' ".10< __ ....
 A
c
~. Oiog",_< ..... _, .. ,... '" Ii>o _bIo , ~ "" .. \:riono..,.ps " .... .., .... _ pion. 1"1 Nonnol ..........
.....,."., (&I U . _ ~ (Q 800_1 _.10 (OI1Ivccd ~"_ (fl ~ ..I...........al.......
combif>OliO<1 I . Figure 3 gives you !he possibl e
"""<xcI"si"".,
l<>g iT!(l l lk~l cto l
Sl<eJCJ(l' mcb::clu.ions in the ,,,,,,,,verno
plane are .... uclly " rewll 01 f>Orrowing or
wdening 01 ,..... jOWS. They COn b$ describotd 0.
narrow mo."'o, wide mandible ~ Then
.... ., '". rnolocdu<ion. 0", uouolly relerred to
oscros,bilM (Fig 4).
I~ me ""rtic;al plane abnoonal""na~o'"
in !he vertic;(l l moawrc ment. of the jaws COn aflect
.... ioworlocio l height.
R ,
R o
ANGLE'S SYSTEM OF CLASSIFICATION
Edw<lrd Ao;g l, i"'foduc~" .y>lem 01 d"ss ilyin 9
I
molocd",ion in the yeor 1899. Angle"
d<u<i~COIion is slill in u... ofre, olmosl 100.,.....
01 il. introdu,'ion due 10 ils , ;mplidly In
{]pplication
Angle'. ~Ia ..ifkalion was baled on rhe
mesio-<!jo,o' rololion of I!.~ ,,,,,I\,, denIO' arches
aOO the jaws. Ac;o;o rdirog to Angle, II ... 11\(,,;11 01'1
liro! pc rm<>r>ent mol", i. the key to ocd", ie n. He
co,," ;de,ed In-. t(!(lth 0' f....d oooto micc i po;""
 - .

c o

within !he lows. s.:....:I on the.elation ol the Ie-.-
~1lI pe< ..... nent mclarlo the upperHIlI p"rmorMlt'll
mokl" he douifiod mekuk..ooion> inlo th,.,., mo in
Oanes dtligr'Klted by the Roman num erals I, II ,
and III.
Ant i.'. el... I CIa u I is bimoxi llory proItvsion ~the polien!
Allg1e'1 Closs I molocdu.ion i. chornclerized by
!he.ptesenoI 01" notmcll inlor"..,rdJ moIor ~
The mesio~CQI cusp of !he maxillary ~"t
permanent mclo.occIude. in the buccol gfOOYe
cl maodibul(r~'" pomnonenl """.... /fig 5.0) TlI8
pgliem mOJ ",hibil denlol i"!1Iulori~ wd> os
~ir.g, spocing,_rot,-k>no, milSiJ)g Ioo!h ~c".
Th&se pet....... e.hibil """"" I0I<,.Ie101relation "'"'
I~ IIO , how r>Om"I<lf mu~ nction :i A.nother
mcloo::d usio n ""'I is mos! ofton ",,~,i!i<I und er
e.hibil. a normal CIe .. 1molor ",lcbonln ip OO!
the dentition 01 both the upperond 100000f af'Ches
ore fotw<:nIr pIoad in ~ rollle foooI podl":
,
F"l 6 Pot-ont ho;"" "" 01. '. ( IQ" II ,
om,;,,,, 1 mo"",' :"' Oc n I;.J Bcoccal ~ . w
ot>o-<"\i h . 0 ",,, i mo'" .,\,I"" ,nd
t"" ;""''''''''''-!i~.!ieI (81 1_ 1 ~ ((I
In,,,.,,,, d a" ',<11 "'" p,od le,a' '' ' of
"""'" " ,, ""'''''' (0) , od",, "' ,," 01 " .
"",.,nt, No............ f"""'loo"," of
tho ' '''- 00'''''''.
Angl. 's Class /I
This grou p i, ch Or<lct~ riled by 0 Clo" II mo la,
rek.tion whe,e the d;,tobvcC<l1cu'!' of the upper
fi"t pe rmone nt mo lor ocd lJd., in tho b<xco l
groove c1 the " werfi rst permone nt mola r (fig S.b)_
Ang le has sub-ck",ified Cla,s II mo locdu ,ioI'\s
1nIo 1wC> di. i. ions ,
CI"ss II. ctlvls/on 1
The Cia" II, divis ion 1 molocc lu<ion ;,
choractcrimd by procli ned upper iroc i",,, with a
~l!!w1 incrc<l'" in 0XErht (fig 6) A deep inc;""
H
Classification 01 Maloccilision . 71 ~;
"
over bite Con <XC U' in th o onteri or reg ion . A
cr.orocteri,tic leatu,e of t hi. mo locdu.ion i. the
pre~oe of obno!-mol.m~octivijy, The lIPpe '
l i~ u~llLhypotoni c, . ho rt an d fa il , to fonn 0
oeo::'-
li p The Iow.lr li p cush ion. the palatol O'l>"'t
01 ,~ uppe r tooth, 0 looture typ ical of" Ckm II,
d ivi$ io n I ",f. rred to a. 1i.E....t!:2p'. The tong ue
o ccupi e, 0 lowe r po,t ure t hereby to ili ng to
oo unt~ roct th . b ucCinato r a cti v it y. Th o
unr",t'ain ed bu cci no to ( a otiv ity (e. ul" in
.norro";;ng of the uppe' arch at the premola ( ocd
conin e (cg~ n ' thereby pmdvcing a V_. hoped
upperorr;h. Anoth. r ni u ~l" aberration ~ a hyper
octi ~e/~i. octi~ity, The niUK~ imbalonco i.
Fit! 7 (.'l (lou 1 bimo,j kY, p'O!rclk-n :8) ( ,<" II, oM*, 1 ,"", oe d ",oo !~ 000. I, do"i,,!, 2
.-docd ... Oon (0 ) 0". II ""ot d"""""~ i A-.t. -"" Ope" , .. ,~ ) f'<,11"-;';', ope' b'le ,;G:, ("" .....
:" :''!'''';''')
')-3
 ,
- w
n
I
,
f ,g 9 CI,,, II, d~~ ; ", I "", '""clo"", ,
0000<"'' "''' I"",, -ed ~ I'00I,,......
~'''''' ",,,,,,,,,'OJ 00<00 1",,-.do. ""''"''
co.. "II '00'0"'''0<, c< tho uo_ <>h. ,

produced by " hyperactive bu,cil>Otor and

mentalis and on oh","'" tongue po .. rion that
oc~enlu<l:es Ihe ",,"""';ng of Ihe upper d.... ""
oreh pig 9).

CI ... It, dlY/5lon 2

Al in 00.. II , division 1 mobcdu",,", th" div~ion

f ig 10.00" II , <f~""" 1
2 alto exhib<,.. " 0:", II mola r ~atio~sh i p The

,II
II i Ii
wi1I1 the ", nines I<>b'olfy foppood. The pcl"",! exh ibi!.
a deep a nterior o.. erbite.
The li ng U<l lfy 'n:J ir!ed ~ = Trob gM:s
!he OtI:ha lIqUCI<ish opptlOrt:l<\aI, un..,., .... """""'"
V.shaped arch _n in dM"tion 1. Th& mandibular
Iobool gong"",1 hssue ;s ofIen troumoriz6d by the
_....,." fipped uppct """,,,01 inc;ioors. The
patient e:.hjbils "",mol periorol muscle ",IMIy.
An obr.:>rmol bockward path of closo.n moy "I..,
be present due to 1M e. celSi'lO)ly Ti pped centra l
inc;isqro.
CI . . . /I, SalH1/vl.'on
When 0 Class II molar r"lotion ~llS on one side
and" CIo", I reIorion onthe other, ~ is reIer.ed to
OIPOIS Ii;lubd;"~~ 60sed on whefl>e, IlllO
divi";"n I or divi,ion 2 ~ can b., co ll &d Clou II ,
divilion 1, subdivision or Go .. II, divi sion 2,
,u bd "lIlon.
CI . . . III 1II.'oce/UlloM
lh. rroIocclosion ..... ibib a a"", III moIa, teIoIIon
with the metio-buccal cusp2.-the ma>:illa'!y ~rs1
pemoonem molo, occluding in tho intetdemol
spOc. be!weero I/ie-;;:;c;,diook"tors! ~~
m o lo ~ IIig S,d). c" ..
II I rno locdv:l lon co n ~
~k.~..;fiod inTO T"~.'m IIIond pIMa Oau1!!:

,
 --,
DI'lolon 1
,
DI,it IOll 2

O<oriOl !ncr.. "O

_ CO"'''
4><

,-
Arcb ""'"

140010 actMIj
..Short. h:Ipoie"
V sh~ """""

,
""'._ fI>OI'I:oio and ~
ij sI!apt<I ,.,j ~

Nrmal dopItl
Norml rro,JOCjo actr.;!),

- -""";;".,-_..:'.
Pm til IOsI>' ""!mal Backward

...,;"',..".;. ,..,,',....
low _1>o9'JI ",,""lI '" _
~
................ , .-fl.' 1 ,~
True Clau 11/ onterior reg ion .

Thi' i." skeleta l..Qp...!!!.maloco"""'" of~"tic
origin th a t Can occur due 10 jf>e fo lk>wing "",,"e, '
II. bcessh..e ly lorg e m<"><J ib,,
b. fOtWordly pI<>c. d maoo ib..
C. Sma ller loon nor"",,1ma<illa
d. Retropo,itioned mo.ill a
e. Com binati o n of tr.e above cou,.s
Plead" Class //I
Th~ typo of moloOOusion i1 produced by II f~
movement of the rMr>d ibie during jaw dow'~,
thu, ;1 isolso coll ed 'po~ ra r or-;-r-,bittxll' 0;:;"
III mabedusion . The fr>lowing are some of the
rouse, of p.evdo 00$' II I ma locd", ;on :
o. Preoer>ce oiocciu>o1promaMities may deI1ect
the mand ible !o<word.
b. In ca.a of prematu re los\ of deciduou s
po.terio ro , the ch ild tends 10 010," the
roorldible Iorword to e.labli, h contOCl in th~
c. A ch ild with en larged adenoid, tend. to
mo," tne moOO ible forword in on ,me mpt to
provent th e to"9 ue from contacting Ihe
adenoids_
Clan III, Su/Jd'v'.'on
Thi . i. a co ndition characteri,ed by a Sla .. 'll
ma la r relation o n one side and a Cla ss I relation
on the othe r .id .
-- -
DrBw/Jac/u of Angl,,'. classification
Although Angle" d"ssification 00. been u.cd for
olmos! a hundnxl)'OO" now, it,till ha, a number
01 draw"",,". that inc lude :
c, Angle c,,:nside red mol ocdu.ion on ly in the
anlera-posterior pia .... , He did not con,ider
mo locdu.io n. in tt-.. transverse and vertico l
,""""s,
b, Anllie con>i de.-e<l tt-.. fi rst permo"""t mola rs
os fixed p:>ints in the . k,,1 1. aut tN, i. not
fouOO to be 00_
c. The da"ifica ti on cannot be appli ed if tI",
li"t perman ent mola rs ate extracted or
miing ,
d _ The da.silicatio n car>nOl be app li ed to the

,,
 F;i 11 Clo" III
( ~ ) co ; (8)
.-.0 1",,,1,,:0,.
800 1 oee l" i"" .i .w
, howi' g d o" III "' Dlo'
",r,t", and ""'''''''' , ,,,,,.
b,. " ,d" c,. (C) Ar t.,,,,
."w (D ) lotO'ol
cop o o lo~ ' ,," 01 tOe """
po''''..

d~ddvoo. de ntition . DEWEY'S MODIFICATION OF ANGLE'S

~ Th e d 6" ifico tion do~. not d iff""mti ot~ MALOCCLUSION
betwee n skcletol and denta l malocclusions .
f. Th~ clo.. ifico tio n doe. not high lig ht th~ D. wey propo",d 0 modifi cotion of the Angle'.
etiology of 1M roo locc lu.<ion . d "",it.:ot"", d: mo locdllSio~ . He divided h>rJ~'s
g. Indiidu ol tocth "", Ipo. ition . ho,~ no! b~ en Cia .. I into livo type> ond ,.I.e,g l ~. Clo.. III into
consid ered byAr>g le. three ",p">.
ClaM I modlr'utlOR. 0' o.
. . 1 : Clew I """occiusJon With bvt>Ched 0'
~gnteMcr~t~. ~
. . 2 : Cleu I .... itl1 prct",.ive """ ilia')' ioci",,,.
\ell 3 :CIo~ I moIlXd u",", ~ onltrior';;ronbite.
. ....
. . 4 : Clau I ~or ,.Io~on wi'" pOII<!nor
TjpI5 , The pormonentmolarhos drilled mesially
_10 1IOrt,. eoJrDdioo. d..oond decidUCiUS melar
orsecond pr.moIor.
0.,. III modlflc.. Uons ." D Ter$iv<!rsion : ROiClion of
t,pe 1 : Th<! upper end lower denlo l Orchel w~e n
~ oeporolel, ore in no"",,1 o lign..-t. But
...... the orcl>es ore rood. to occlude lIoe poIient
oioow. 0 .. edge to edg. indiO' olignm.nl,
~'<e 01 0 forwardly moved mondibular
""'a2n:h.
frpe , The mandibular ioolOD ore ~rOY<ded
andore in !irvJa1 relat"", Ie 1100 """,lie"" incisorL
TrPe 3: Th e mo'illery ioc i",,, a,.. o:.rowded and
en in .:!oub iTe in relation to the mendibou le.
-"corso
U SCH.R '. MODIFlCArlDNS OF
ANGLf'S CLAIS''''CATIO''
liKher lubsriMed!he term CIe"I, II ond III given
by Angle wit~ th e te,m . neut,ocdu.)on,
di>tocc luliori end meSioccivsien . In odd iTion to
!he.e, he adde d c few more term . which
dMIgrlQted Ce<1Q in em", ma'ocdvsJons.
N.v/(occluJion , SynonymouJ wltl1 Mgl.,
CIau I merlocdusion.
DistoccIt.s.iot , S,nonymous with Angle's Cia"
maIolusJan.
Mes.Oclusk>rl , Synonymou. wit\, Anglu CI.,..
HI merb;c;lusion.
Buccocc;luricn , Bucwl pJoc....., . nt a f a foath
Q( a group of teeth .
ling<.oocelu.ior> , ungual place .... nt ai a IoaIh
Of a group oIlOe1h. ,. ~
Supr<lOcciuslon : Whirn ., tooth ar 9rooP 01
teeth Mve e-nJpteci boeyon d nor"'9 'I. ,.I.
InfroocdusJon , W'hen c tooIh O!" group of.teeth
loa"" nat e",pied Ie narmll ....... 1.
Me.siowrf;lofI , tkl.iol to tire ",,",,01 potitklro .
~on : Dislalla!he narmol pc:.ulion.
Tmnsv<mion : Trcnlf)O$~ion of two-*' ,
A>i....,sion : AbnOfmal w.iol incliflC)~on 01 CO
,~.
0 tooth coro und ~.
long oxi.
SlMO" '. CLASS/FICAr/ON
Maloedu.ion c:an OCC\Ir. in anl.ro.pas"""r,
~ ond in the Yft1rcal pJones. Simon hod
l'vI farward a croniam.!ri( cla"itica~on of
mokxc;lu5ion!he! reloted tI1~ dentol orchM in 011
tI1e.oe tI1r" plene. Ifig 11). Simon" ')1tem 01
c!o.. ifi<otjon mod<:! U$e 01 tI1r~~ anthropometflC
pJone. i.e., the FfO~ 'farl hon,oole l plone, th o
orb<kll ple .... ond th e m icl$C gi~ol plcne. The
da ..i~co~on of meloedu.ion "",s bosed on
obnarmol deYIOlion. ai the denial ardre. from
,.,_.
the ... normerl potmon i.. reIotioo 10 " - th ....
Frankfort ho"lonla' plane
Thi . is 0 1'101"10 thot conn ects th~ upp&r" mo~in of
the axlemo l o<Jd iTC<Y moet .... to the inlrcarbilel
malgin. Thi. pic ... is used to c:1a ..ilv
mOlocduJionl in ....,;col pJanc. Twa terms ore
used to dMcribe ony obnormol rela~on of the
leetlr to .his plane. When the dental a",h o. pari
ai it is dOH' .h,,.. normerl la the Franl:lar1 plane,
it i. <.aIled onrooion. When tire d""'lel orch Of
pa ri of it i. forther awey f,om 'h, FronlcfQrT
",,'izonte l plol"lO, it iJ cc llod cb,tradion .
 . "'"
," ~;. 78 , Orthodontia The Art and Sc:iUlC:~

Orblt., plill.
Thil plone 11 pe'll en-dicvlof 10 tt.e Fronkfort
honzonlo l plan~. dropped c:Iown from the r::.::.n.,.
orb ilal morgln dlre-::lly urld . rlhe pupi l of II", eye.
A<:cord ing Ie Simen, thi, plone Ihov ld PO$!
II"e"llll me diotol third <i meupper coni .... , Thi,
i. collo<! Simon's Low 01 Conine. This plone il
used to doIoIbe maloc<:iusion in
ontero-poslet'ior diredion.

(ollod proI,ac~on .
close, or rnor4I
th is piane, it is coi led relrodion ,
J
I
Th<! mid'logi!!ol plone i. used to de.cribe
malocc' lISion in "'" r,.........e1Se dll'ec!ion. Wh..,
pori orwhole 01 "'" orch is <rwOJ from ,.. mid
sagi"",1 plene it is coiled di>tnrc~on. Wh,n tt.e
ora. or po~ of ~ .. do,""r 10 the mid 'SO\litlol plon8
ir i. colJed contracti"",

, BENNU'S CLASSIFICATION

Norman Benne! c","died moIocd....,.,., based on

i1setiology.
ac...1 . Ahnormal pmiIion 01""", 0/ more res'"
du''''' ioc<Il 01"-'.
CIoull . .AhnomYr1 fom-.olm <i e pari 01 e,whcje

-
<i ,,;Ihe, er<; Md"" to ""v~opm e nlol defocts of

CIos, III AI:lI'IOfmcl 'okltOon, hi p between vpper

ond lower OtCiIel, 0"'; between eirhe, or<;h o,..j
Ioc:iaI c:o::riOu' ond c~1mr,d cD"" ,,.. I/uo " ..1100,
of eithe< o~h.

ACKEltMANPRORTT SYSTEM OF ClASSI

FICATION
c
'"'" 12 Si"",,,, d,,,~; ,o'on IA) f, H, ~"' IBI o.bOlo l Ado,mon and Profitt in 1960 propOSGd 0
""no 10 JWd.!,.ogitIo 1 ""rIO. dicgrommelic do.';!icolion of mc locckJsjon te
 ,
,
,
'''!'' ' .,
,.tj,If .,.
k;~,: ~ - -.',
,/---....,

'{'ansve' "" Ik~"tion Sag itta! Ik-viati""

Buccal T rarn: Qa.. r
Palatal ' ''giltal CIa II divi.ion 1
Cnilate...J aau II divi ,;on 2
Bilateral Skeletal
Skeletal

S"gitto.
"".tical

,:?+----~V;enic"l D':':":',:o~,"
Concave
,:0:----1
0 1'<''' bi'e anterior
Straight Ope n bite posterior
Anterior Oeep bile anterior
divergent Collapsed b ite posterior
Postenor Skel etal
Int,a""'ct;. divergent Dental
a!ign::IQC1\t

"'"
Crowding
Sp~c1ng

o ve fLom ft the li mi ta t ion. of the Ang le '. Th i, . )'St. m of de .. ilko!io n i, bo,ed 0<1

dcs>ifi oat>on, So lient feoture. of th~ ck,,~f""tion
ro ude :
D. Tran,vcr", o. we ll m "" rticol di;.crep<lrICie,
con be Lon;i d., red in add ition to antero-
poole rio.- roo Irei ot"", . ,
b. Crowd in g and orch asymmetry con be
evol"",ted .
c_ In Ci'or protru ,""" i.lo k"" into account.
the Ve nn wmbolic diagram {fig 131 thot identifies
fj'e roo jor cooraderi,tics to be can,idered and
,",scribed in the class ifica tion .
Step 1 (Alignm e nt)
The fitst slep invol"", C1Ssessment of the alig nment
and Sl"""",try of the donial a rch . ~ i, dossified as
Ideal I crowded I spaa.d.

Stl P 2 (Profile;
II irwol'l8lhe conoiderD~on oI lhe pralil . 1ho
p1:Iiile is described as <X>rWe:</IIrDi!# / .... reo .
The Iociol r:I~"'ce is olto considered i.e.,
on~ "' posterio' divergence .

Step J (Type;
n. t",,,,,,,, ,.e >kaletol arid d. "Jol 'OkllOoNhip i.
"",luoIed. Bucrol ond polotal aoubites ~ 0"1
ore noted. 1ho aoubifl i./vrther .... b-c;lo...fier:/
D. unilo te,ol 0' bUole"'l. In oddirion,
dillnntiotio<> is mode between sIo:le4<Jl ord denl;)l
<roubi." ,

Step" (C/"u;
1hi. invol ...... the o .....,.,enl 01 the oogl"ol
relolion<hip_ k i. douiNed as Angle'. OOH r f
do.. II I CIo .. 1II maloc:duon. Oill~"'n~olion I.
mode between skelOTol oed den.,,1mo locd u~ ,

Step 5 (Bltl dlpt";

Molocdusiord in the ""ni(ol plane ore noted.
They ore descnbed o. onterior Or posterior Open
ooIlopsod bite.
b~, <rIeriorr:leep biI!Iorposfeoioo
'" me ntio<1 is mode who"'" Ihe maloc.:lusiOl1I.
>k~ eto l or dMtOI.

Rlf.rene..

1. G<obo.- r M ,Crt t ,~. : l'rIotip!o. ..... ...-..

1
'M'r Sc.ndon.r9811
"""'" WI:
CI ....Mb"t986,
eo..... _.'l' Oothodoori<s, St l.o<.o'

J, "**' f ~,""'rId boo<. 01 O~ '*"

bod< _ I po bl """ ; ",. l ~e
" 5aizrr"", J.>. Pto<l~. 01 Ort ~ <kt , Jl U_
"""'-'" 1 9~

,

of Malocclusion
h.. o"hodon~c spedolily d~ol, wlm
T
!'ea lmenl of varlou. molocdu,iofl .
Etiology 01 mo locd ul lon i~ the stu dy of
ill 0lV>e 0( co ........ Malocd ......", COn OCWf <Iv.
100 number cJ possible COIMI. Broodly.ptdcing
""'Iocd ....ions tQ ",..-:I by~, """",,c focto ..
Or by e n. irOl'me nta l io ctora,Co mp,.r.e nsive
ortt.odon~' mO""lI"m""t im'd ..... icJe"tificoliO!'l
0/"'" posoible eriologic fodors and a" 01lempl
10 "',minote II>e loO"'''. Ahhough ~ may nat be
pos~ b~ 10 elimiMla th e caus. in most C(I~ 01
mo100:1" , iO<"l. il nftverth . I.... i. of ",Ive in
prue nti . " ond in1<"<:epll ... orthodontic
procadure. ""-e (1 pou,ble mulcxdu.lon iJ
~ 0< imere.pred by limely fMl"",,1 ohl",
~-
~opm""t 01 "ormol dentition end
oc:dusion depends on 0 numberof inlerrelotod
lo<.1ors "'01 include !he demool-.Io, , d<elekll
and It.., n<lV<OI'nusculorfodorl . Thvs loco lil.OTi on
01 t.... poss ible eti olog y may be (1 ""'Y diltio.lt
,,
I
toll A number of clouj~,orionl 01 etiologic
"'ctoro 01 malocclusion oove been put lorword
(referlo!Q bl.o, 1),
Grobe r hOI do .. ili.d In. etiolog,ool
foC1Otl 0.1<><:01 ond lIeneralloaora The local
IoClO" .....""nsibt.lo, moloccluloion p,oduce 0
Ioco liUld oiled conli ned to 0"'" 0' rno<fI a"pce nt
"""""""""11 teel!>. The gene ",1focl:)(S on tho: ot"",
hand a,e thooe that oIied the body OS a whole
and hove a profound efledonthe greete, port 01
the dOXllO-lociol stnxtures.
HEREDITY
In -".Joy life, we come 000<$ quile 0 numoor
01 fami lies wM rc the inmote. hove a lot 01
rooemblonco. Tn ul it is quite log ica l to o"ume
thor offspring. inher~ quite 0 ..... otlributes nom
thei, portH<. He*"" ho. lor long beenanributod
al 0"" 01 the co~s 01 molocclwon.
Th e child i, 0 prcdoct of P'O", nt. woo

A. 0.01 _ .".... "....

I . "', ;
2._
~. ~
I."" ...'._....
...........
...............
- "-'_ _-
.~ -"'
~t.go1Dal_
S. 1...... rtI.rJ
c. I'00I......... otnoro>alI..
I. ~
.
I. 1Jopo .... k>, 01 m -._
1L_~01

B. ~
~--
5. ~" .. "_
__
'OI""~I'"
~. ~/>ILtb
1. _.IIIM i"L jlO>"m 01 do 1.1:1 ..
01"..."
",*. t. """'"
de> ..... ij ""'" II""'
Z. ~MOL'I 2.
3,
_".Im
~ {)(
"'-.0 1ft\!>
!OfIh
potrfLai'JOI1
1 S<.I>orTUT"lOfll')" "'LIl ~ aM _
~ h fol,.

,- --...,,-
GAU!R'S CLASSif iCATION ~1\tsoh"'!t iIbnoI_lft>L(~
GEH&lA ~ 'Acr()RS !l!I!IItn;tI<..f
~ r_ m """""'"'
1. Htrt'Y (!'oJ< ' "it Ib _ _
7. Pon..
1 EmI_OI .7 .......... _
. "..,..."....,
- . ........... I10I000 ......1
1'oII_{lli""....,. _ LOCAL FACTlIRS
..........." ....... ,
.......
11. poIsJ, t u..!.
.."
4. '~_OO"""IM_
"e~ .......... -~ ..-
_",w!bo\>
b, WoIobI:f.c 4 _
e, . , _ """*" Z , ~oI_oi!.
-'."",,010-1
S, 0.0., " ' _ (l'0lt1on11dtf<l&nol) l.,.,.....~d_~
~, A _ ~"'I ~'I . " U>::t._:at>errdooo I. l.to!oI"'lI.I>IoI lrlJU'n' _ I ~.
I. """"""'" ""~ 5.. ~'trol"" 1m ~ ~ 1M&>
~. ~ "Id I\nQI< .~ &, ~ -","01~ I_
e, T"'"9If tIvuoI otld I<W"Q>I ~ ), 00It\'td """""" 01 poor_,_
-
d Li> ." .. I t:I1rLQ
~.~-~
t. ~ .... O<Ii
t,

to.
~ """"" po!tt
t . .IJO<JIc4"
llIoU
'1.~""' __
U""
~ di"' m il ar 9~ Mti c "",ter;"!. Thu. , he child
-rinherit contl kting troit> form both t h~ po rent.
"ISU!Iir>g ., aboonna ~t ... ci too dootobciol regi"'"
"""oth e r rc a . an a ttri buted fo r ge ne ti ca ll y
-.m ined mc bcdu, ion ~ th" ro-::d, elMic and
. no l interm i<tu re whiCh m.. h, ha vo led to
JIIKOord i""too inh eri tanoe of teeth and io'"'"
Accard in g to Lur"id stro m th ere e<i, ,, 0
""",ber of huroo ~ ' ro its that Or6 influer">Coo by
_ge nes thot inc lude '
::. IOoth . i2e . The , iIe of the dentition i. to 0
bye extent determ in ed by ge ne . Abnorma litie,
d lOOth ..;u. .uch a< microdontia a M rno-::rodorWio
<Roffributod to he redity.
:.. Jvch dime nsion, . The denta l a rch IM gth
~ orc h width m~ believ. d to be i""'rited
c.. Cro wd ing I Spacing . C rawd ing and
"!"'dng of teeth are ~ ieved to be of genetic
origin. Mo" of rhe,e coM itioru a r. beli ev. d to
"'" 0 re. ult <>1 uncoord iM ted i nh . ri!anc~ of oreh
'-'glh OM to oth motc ricl .
CL Ab norma ,' itie' of tooth l hope Aoomo lie,
d lOOlh.rq,e 'L'Ch a, the pre",c.:e <>f peg .haped
b ",l< i, onathe r tro it thet ,how. n>g h 9" nctk
;nd i,pa~ tion .
e.. Ab""rmoljti~, 01 /001" number : Pr~$. n ce
oIeilher more or less number of leeth con 01", be
inh~ rM d . Thi' in clu d. , cond i~ on , ud '"
anodontia and ol igodo nti a .
L Overie1: The hOriIoota l ove rla p of tha upper
and towor dentition refe rred to as th e overi'lt i,
believed to be geneti~a l fy i nlluM~.d .
g. Im e r_aroh voriation , . D i , ~ r e panci c,
" """'''''file,sogiffoi ond ""rtkol plane, botweoo
...., upper and low., iow< oon be inh erited .
h. f"",um , The size, po'ition a r>d . hope of tM
frenum i .oid to be 9. n. ti co lfy intl u . n~.d. Thu .
mo bcd usion . uct> o~ mid li ne dia ,tcmo tMt may
be d ue to obnorm oliti o; 01 the I", num o re to 0
lorg e c, tcnt d otermiood ge r>et"'a ll ,.
Accord in g to Ho rri, o nd Jo h n,on 0
n umber 01 cronialociol porom et." . now...o
significon t geneti c influence. The", in clude th .
lal l<W.in g di,:once. : ",1k;J. gnoth ion, ",1k;J - point
A, , 8110 - gonion, M~on _ ont" ri<>r nO$ol !oP ine,
o rficu1me _pogonion, b':ygomotk width, """'ri Of
lodal he .. ht.
At, ' 0 roo ny tro its show 0 ' trong go netic
potto m 0 numbe r of ma locc lu, io n, con b.e p-ortly
Of ",1eIy attribv.ed 10 geneti.c lodor.. These II"""tk
tro ils ~ on be furt oo' infi """",...o by ~", 'ti n g pre _
"" to l or po st riotal envi ronmento l lo clQ " .
CONGENITAL DEFECTS
COrl'(le nita l defect, 0' devel opme ntcl defect. a re
molb-rnot"", \.eM [)j.he tim. 01 birth. They rooy
be cou>ed by 0 vorXlty of !actors iocW ing genetic,
ro diol<>gic , che mico l, e ndocri ne, infectio n. and
me<.h onica l focto".
The cOfl gen iro l obflOfl11olitie. tho! mu ",
roo locd vsion 000 be broacf fy ck;J" ified as genera l
OM loca l c"" gen ita l o bnorm o litie,
Gene,al con,enlfal facto"
o. Aooorma l ,tote 01 mothe, du rin g Pro 9M ncy
b. Mo l""trition
C Erxlooinopothi o.
d . Inl. diou, di =",.
c Metobo l", and nutriti arl of d istu rbon c. ,
I. hddentl during P"'9 "" r>::"Y ond chi ld birth
in
g. Intro _uteri ne ve,,,,ro
h. heidento l trau rooti.at iOrl 01 th e I"tu < bl
oldornollorce.
Local conganltal factor.
o. Abno.rma litie, "I jaw d.ve bp ment d <.>e to
intro _utef'i M po' ition
b. C1eh, o/ th e foce ondpo,, ",
c MCKro and mk rog louio
d. C1eidocronio l d )'$Osto,;,
The fo llowing a re ,orne of th e ' ","geniml
co ndit io n. fre qu e ntl y e ncounte red by the
orthodMti, t.
Cleft. of th e lip and pala ta
Cleft, inv~ "ing tn.. lip or.d po lote or. th e mo. t
COmf1'l<) nfy "'M de"" k>prnenlo l defects Ih:lt occu r
a. o re. ult of non- fulio n between In.. va ri ou,
embryonic proce .... . CI. n potien!> may exh ibit 0
nu mb.. r of de ntal problem, includ ing mi" ing
",eth, mob ile teeth , roto tion. cro" bite , etc.,
{d iocu ..ed " ter o. a . eporote cMpte r) .
CongenItal s yphilis
5y"" ili . of cong enim l orig in i, tro n. mitted from
tn.. infeded moth er 10 th e ch~d . Tn.. ch i'd exhibits
one o r more of In.. fo llowing leatu re<:
a . Hutch in,on' . ind ror>
b. Mul b..rrymolors
c. Enomel d eficiencie,
d. E<1. n~ve dento l dec"l'
e. The maxillo may b.. , ma ile r in . ize re lotive to
tf", mand ible
I. Anterior cro .. bite
Ms t e rnsl rub e " s Infactlon s
~terno l ",b" lIa infedion, during 1""9no ncy i,
be lieve d to COU ," wid p re ad cong e nita l
malformation. in the ch ild . The lo ll owing a re
. ome of the feature that am be , ,,,, no
o. Oenm l hypoplo. ia
b. Relo rdod e rupti on 0/ teeth
C E.ten' ive corie.
Cleldo c rlln/al dysas toal.
Th i. i, a (ong enim l cond iti on charocte rized by
uni,,1imlI u blot"", 1. port", 1o r complete a b<er.:e
of the clovicle . The potient ma y exh ibit the
fo llowing foo t...... :
o. W!oxil lory retM ",n and po .. ibi e mand ibula r
p rotru. iorI
b. Ov. r reta ined d"'iduavs teeth and remrd. d
eruptio n 01 pe rma nont teeth
c. Pre' enc. of ' upe rn um erary teoth
d. Pre, ence of ,hort and thin roots
C. rs brs' palsy
Th i' i, a cond ition whe re in the potient locks
mu sc ular co-ord inati on. It u, ua lly occurs du e to
birth iniu rie .The unco ntro ll ed and a berrant
m=1e odivity upsets t\." musd. bo lonce re,uiti ng
in malocdu. iorI
ENVIRONMENT
Vo riou< pre _nolol ond IX',t-""ml enl'ironmenlo l
faclon can coo.., ma loccl usion .
Pra n a tal ra ctors
Th o foN. is wel l prot~ded ago in, t iniu rio. and
nutritiono l deficiencies during pregnm>C)'. But
the re o re certain fodo", the I""serxe of wh ich
can re" Jlt in a bno.rma l growth of the oro -foc iol
region the r. by predi'posing to molocclu. ion .
Almu ma l feta l po. tvre during ge,totion
is sa id to inte ri. re with ' ym meltic developmer1t 01
the klce. Mo, t 01 the, e deform iti" . ore tempom ry
and " , oo lly d isappear a. "Il e odvo nce .
The othe r pre noto l influence, include
mate rno llib roid,. a"",iotic le.iorI" materna l diet
and metabolism .
Mote rno l infedi"" . uch m Ge rrno n
meo. le. a nd us. of ce rta in d rug. du ri ng
I""gn<l ncy such 0' Tha lidomide can cou, e g ro ..
cong ~n into l deformities inclu d ing deft.
 109 1 (A) God (8l Miod.n.
.....,.;1."'1" _ -.-.. _
1..:-.." "'
how ... .."..
"""" "'" _ood ......,.og ......,q .-.,.
' ho odlo< a",,,,1 ind.~ .
01
Oed"",t
rnd. ~""'" 01 .... to.". oo"",t,

hltn.t., t.ctOtS
Tho foll owi ng are some of the P'>"l ncla llado,"
WI01 c:on c:ovse molocclV$ion:
0. f orGept del,.try con ,e",,11 in injury 10 !he
!empotOmondibukrr join! O'ItO ....ich con
undergo onkylo.i . Such poKenl, >how
~!Otded mondibula, gl(lW!!, ond thus hove
o hypo~O$lic mand ible ,
b. Cereb ra l pal. y i, a con dili on cho rC)(len,tod
by musdo inco ordinati on. Thi . roo ! occur
e. Mifwoukee broce. Ore ~ Ior!reo!me n! 01
scol'o$iJ. Thue brae ... derive .upport f,om
!he mandibl . Prolonged use ol these braces
co n cou mari;ec/ mandibular grOWlh
~rdorion.
AHOMAUES IH HUMBER OF nCTN
In 0,de,Ie oc hievc g<>od occlusion, lroe l'Iormo l

due 10 birth in iuries, The polO,,", ton exh ibit
moI~usion due lO loss c;J muscle balance.
Co Tro..nro!icir1jurie<thr;r!Ol_~frocn.n
con CO<M g...,."m ... ,Otda~on ,,",uhing in
ma.ted Foool mym""""Y.
d. Prnroce 01 ",,,cli=Je ..,do o,ltr<t covsed
by bvrnt or 0$ 0 res ult 01 deft li p ...".. ery rooy
numbe, of !Celh should be fM"e"",'. P'ft!.ence cJ
eXII" 'Hth or obs.ne. 01 one or more !etlh
pnodioposcslc moiocc I"""",.
S"p.,""",.,. r), t ,11
r_h thaI a", . """ to the na,,",,1 complement
CWl! tem'WId supem u""""' ry tceIh. The.c Jeetr hovo

prod uce ma locclu sion d"" ,0 ,h l ir r. stricti .... abn ormo l morp holOllY and do not ''' ..... nb l.
infl uence on growth, normal teeth, E.. ra teeth thot re.., mb! e f"IO(fnO l

&5
reeth o' e co il ed . upplementa l teeth.
A1""1"",,11, seen .~pe,"urr.ero 'f tC>Oln i.
t~e mesiad.n ... hie" occurs in It!e ,",o. illo 'Y
midliflfl(fig 1J. They con occurpngly 0(01 0 pair
ond ore _oily conicol in shope . Unerup,"""
~oMiodeo .. " on. of tho "'''*eI rricfjne spacing.
Supernumerory teeth con olso occu' in the
p<emolo' or third moIor regionl.
Supplemento l_ h ore mo. t olle n . een
in the poremolor ond lotero l ir.cisor reg ion . It i.
noI..,ncom""", to ~cd on tro Iow. r incitoc. The
wpemumero 'f ond .upp!.,,,,e.lIol ~ co"",,
nan-uplion of odjo""" IMth (fog 2jond con
defied ..... erupting odjocem - " in!o obnormol
Iocot"" d. In oddition """" '"'" occupy orch
length intended 10, normol c"",pI_m of _h.
Th","'e-r con rew~ in ~irog cnd rolo!ion. of
odroe"nt _h. Une rupted WP(lrnum oro'f ,... tn
pan risk of 'ysti" Iro",formoti on.
MI"/n, t otetlr
Congen~olly ",i"'ng tee'" ore by for more
ammon thon """",,,u""""ry IeoIh oro:! ron oco.w
in eithe, of the iaws. The following 0... some 0/
the commonly mi";ng _h in de<;l'llOs.ing ord ....
oIlr&Qvency :
o. Thi rd mo""
b. Mel.;I,, 'Y "re.-o l in ";.".,,
r'G 2 1"1 A to JOO' dd ,Io .. ;,~ ~ 'vp't-d
, ........""ro-,<>O+ n tho """' corl..J "'<1_
,....1:>0<'1"11 ,... ...."rOc, rj ,,. '''''01 1", ""
,:5) 1.od "'l rap/1 01 ,ho ",me =,."t
c. Mo,..:IjIl<",,' ,,"cend p "m%r"l
d. Mond,bularino","
e. Mo ...d"ry JlKorocI premoIors
AbMnc. 01 teeth con be IInilote,.,1 a,
so_limn bolate,ol. They moy OCCU' olong w;th
ather anoma l... such 01 ~e of "" 0 leetn.
Ab.e nee of 0 00 or mo<o tccth pred ilPO'e to
opodng in th e dento l oreh. The od joce nt teeth
m;groteond ~Iore cou,," obnolmol loco~on
and 0';01indination of re.=th (~\I 5J. Absence of
a permonent roorh auire often _ulto in .......,.
relOl * de<:.duo... lee"'.
AHOMAUl"S OF TOOTH SIZE
In ordor 10 ~.e """"' 01occlus ion, """" sho uld
be hormony between the tooth . Izo a nd oren
length and a lso ~twee n the mo.i llory a nd
 ,

FiQ 3 W & {B: S............,. 10-..... ..."" (C) ,\ (OJ ~"" .. " ......... ...of> - . .... ~ poIGIoJy
tE)& Ir. S_ ._10-.,,11 ~CIOO< ;G)& :til'-'_ ._ .............. _ n'" ",..1".

J
1';; ~ ~\ & I~) ..... ng""- noI.". lq & -:0\ 1> .... '" ml.."v """"'10...,,1 ; ..;.o~ I~! & If! I j,...,, 1
m ;' .~ ~ k>w" .oeONl ,.....,.010~ tG) & (H) 8< .... .,. m'''''; ' PP'" .. _ Incloo< .
 F'g 5 IAI 0'0 181
U~P" 1. 1, 10,,,.1
;.("., cono;J."~ott
.. ,...ng. Nol. ,n.
",,,,ho,,, .po><i"g .1
lilt """,tbo-,-...en """
"O n ,o in, i n, . r

_.1
po< cnd 10 .... '
,",dlino.. Th
..,.;1Itrr ng.'"
io 01 .... k",doft';c.
ICl ~p/loI""
"' .... pot ;"",

....!ibvlo, tooth 11>&. M irw;reos<> in si.8 01 ANOMALl9 OF TOOTH SHAPE

. . . result. in aowdirog .....10..... o .... .oed IeeIh
z-li. ........ lo 1pOC0"Ig, A co",,,,,,,,,1y seen """"",Iy
...... preseo::e QI . moller si,ed mc,ilklty Iotera l
-Dsots. Ar.omcli tt 01 size con at..o occur in tho
--..I'bulor premolo.... Fusion boolwe"n two
.q.,o..1I1edI> o. be_n 0 tupemu""",,,,'Y tooIh
ond 0 norm al tooth ma~ p,edi.po.e to
~usion. IIcviolio'" in ~'" of IOOlh can aceu'
..big with "".iotion. cJ >hope.
The tile of leelh is 10 a large ed.nt
_rmi .... d gaoehoolly Thu. mo.t of IheJe
gnjition. >how 0 posit",,, family hislory,
Momali of tooth si.e ond .hope 0'. ""'"' oo.,n
inle,,..,klTOO . Abno,mc~v shaped l""lh predispose
10 molocclv>icn. Tho fo llowing Ore $0II"I4I oilhe
o",pl., 01 I'.quentl, ..,en tooth ,hope
onomolier,;
c. The p,.,...,..,e of peg ,hoped """'illo,"! !<rtorol
i!ldsoo-1 is often occompon'.c l.,. ljXICir>g end
mogrotion of led! ~og 6) .
b. Anolh.r onomoly 01 tooth shope i, th.
pre ... n"" 01 on obnormclly lorge Cing ulum
on 0 """illo,.,. irIC"'" (fig 7). The pre<ence

01 o n e 'a gge ra ted ci ngul um prevents
e,la bli. h""",t of normo l overbite ond overiet
The invo lved tooth i, u, ua ll.,. in la biove r>iO<1
dcoe to the lorce. of occl usion .
c. The mO<1diW(>"" =and p-remolo" moy ",,,,I.,.
he. e on odditio nol li "9 ua l cu<p, the roby
ir"ICre<J5ir>g the me.iodi. ta l dimcn>ion 01th e
tooth.
d . Congen ita l s, philis i, oftM Cl$$ocioted with
Fig 6 :AI And IBI Up per lof' latera l In6.or
"",,odo n' k i odO<Oed """" ma,,; , 1 "oJ" ;n
,"",log "' .... .w.I .", . (q Qnd (0) h'<>c.ooon!k
"""Ia" ,0;; oon'mllnd",... E) l"",,, peg Ind.."...
presenc~ of abnorma ltooth form. Pc.:l,roped
Iotero l, and mu lbeHY malo" 0'" d onica l
find ings in , ueh potients.
e . Anoma li o$ of ,hope can occ ur as a ",. ult 01
deve lopmenta l defect, li k~ om . loge n.,i.
impenedo, hypopla \ia 01 teeth, fus ion a nd
gem iootion.
I. Dilace ratio n i, de>c ri bed 01 a conditian
cho rodefitcd by on a l:>normol angulation
between the crown and root of 0 tooIh '"
angulation within th e root. It u. ua ll.,. occurs
dcoe to 0 blow to a cJecld""", tooth which is
transm itted to If-.. ucderlyinll perm"""nt IQol\,
bud . Dilaceroted teeth foil to erupt 10 normal
lovel ond con th us cou,e mokxclu .jon.
---.
JO;,; 1 Ma, lllo'l' c.n ...~1 'noM"

ABHORMA~ LABIAL FRENUM

, j,a~; " g 9<0 ..1"0",

,I,D"""",li!". 0I1he """,iJkl..,. klbiollreovm are

_ o/Ien ouocJolod wi!h a mo:<illo..,. midi; ....
~. Prior 10 he ..... pIionclleelh, Iho mo>ilklry
o::bieIlrenum il oltached to !lie alwtolor ridge
.... same f,bIt1 oouing over linguolly 10 the
~ cl the Incisi"" popilla. As the teeth Ita"
~,al.....alar bone is deposfed and the freno l
=-xnmenT mi~t&. intoo more apica l poSition,
bsIy, a heavy liborovs freowm is louro<;I attached
2:1'- inI.rOenIol popillo regiOfl. This I)<pe cJfrenoI
.......J"""nI ton prevenllhe 1M> ""'><illorycenlrol
- ' - ' from appn;N<il'l'lOling each o!her. lflg 8.0).
ThitcondiOOn is OOgnosed !>va JXISffi""
i:bdI~. When the upperrop issl.-chld foro
~ cl ~ me, a not;c"" bl " bIor.::h "lI or:cvr1' c;;;er
""" interdenlOl papil la. A mid lin e intra.aral
-mpico l radiog roph u<uo lly exhibiT. nOTching
01"" inllrd.rlrcl of..eolo' creslfl .. S.b),
MOdlin. diane"", ""'Y also oc~u, dUll 10
F;g B IN T",d< "", . ~Iorr 1<>1>01 freoom "'0'''11
mid i.... dia l''''''. (81 ~."""oph '""'" a mid i ..
"""'""-J 01 rho ;"'. , .... 01 ,,1...010; w..
ond eruption to oc~upv ils ploce . EorlVloss ol
de6duou.le.m con CO ..... migration 01 odjocen1
1eeIh into th. lpace and con therefore poe..-.I
the eruption olrhe pennanenr .Ucce>sof (~g 9).
P_tvN Io.s oIan rc;""se\dom leads
to malocclu lion. Lon of a dec;d""", <ftC() nd
molor <:on cou,," a marked forward ,hilt of tM
r>e rmO M nI li rsT ma lor thtreby blockirlg th e
ervplion 0I!h. second premolar, ..... 0. either gillS
impeded at i, dellOdG'd 10 on obnotmol posilion.

....
'" n~mber 01 CO" .... inclvding pre",nce 01
~ mesoodel"ll,onornaliesollOQlh ... and

PREMATURE lOSS OF DECIDVOIJS TEETH

The _rIty cl malocclusion coused d....
to ""n/y 10$1 01 <I dodduou$ roorh der>end. on the
following ksdOr"l ;
o. Pre mo l",. Ion of deci d ua .... molon
predi$!X>SO 10 "",loccIusion du e 10 shiffing of
ad jacent Jeerh into the ' pace. Early 10.. of
This rel.1S to IoSI 01 a tooth before il$ permanent
o~teric'l mesl off.,., de rlol p,od...ce cny
senos'''' is I UIfic~v odvoncO'd in de-velopmenl
 Flu? N <nI (II) P>....."
_
... "_
p.omob- ........ pod ~.,~ ..
'" - - . . -...d """'" ........ Ied 1."- m;puioo "' ... I~,
10 ~ o" lpou.
_ _ _,

moloccl .... ion , PROlOHtilE"O RffE"HTlOH OF

b, TM eo rl ier 1M de<:idVOVl _I> are e.xtroc!ed
bel"", 1M . ucc .... iona l leetl1 are reed, to
,,.
""'pt, Ihe grft<lte, i. th" panibility al
malocclusion.
In 0 p"""n hOYing ordllength doIiciency or
crowding the corly Ios.s 01 deciduous leerh
may wo=n the "';'ting maloccl",ion.
''Il 10 o- .. ''''ood "-r dO(idllCOJ' """',,1"","o n
dvo ,,>"""'101 obwnco 01 i" " " ' _ co,,,,,,1"'"""
orclOUOUS TE"HH
Thi, . .1S to 0 condi~on ..... ere me", is und""
"!enrlon 01 decidoous teeth beyond the u,uol
enJption oge 01 meir permo""nI .\ICCeS....... A
deciduovs rooth tho1lail. to undergo l~pI;O"
win pr....ent lhe nonnol OfI)ption of ;ts permanenl
'<lCcelSOr,
Pro lo ng ed re te nti o n 01 dec iduous
onler\o rl uluol ly re, ults. in li nguol Or palota l
eruplion 01 th e ir permonon t 'ueeelSors ,
Prolonged l(I!(Inlion of buccol teeth t1!Wits in
erupllon 01 the permonenlleeth eirh., bua>llyor
linguely or may re"..,in mpodeCi wi"'''!he jaws..
Qu;re oft..n cerIoin pom 0I1he deep roo "
roors ..... Ich ore owoy from ..... polh oIeruplion of
the perm a"" nt leeth Ioil to I)Ot resorbed th ereby
leeving 1m:Jlllrog ments. 01tho root withi n lhe jow
These root lrog ments. co n deflod or bled tM
<Xfiocenl "",piing ,..,11>.
The klliowing 01(1 some of 11>& ....,ton.
lor prolonged """OOon ofdeaduoUJ reell> .
o. Absence 01 underlying pe,,,..,n,,"! _h(Ag
10, 11).
b. Endoe,in o l dis,,"bonce. .uch G.
hypolhyroidi<m
c. An~~ ~ decid uous t..,th thot loillO rosorb
d. Nof, _vito l decidLlOV. t....tl1 thot de nat relOlb
DElAYED ERUPTlOfll OF PERMANENT retain od rOOt frogme nt., 0( formation of " bony
''''' boaier.
n", ma..; ll ory coni ...... deveiOj) 01""",
r_. or\I 0 numbe< of =<0,.. tho! oon dolov!he neaf tI1e AGOrot the Otbit or-.d """"I down 10 lI"if
.,yprlon oi permon",,' ..".,:h . The toflowing Ofe
1:",,1 poomon in ~'e 0,01 cavity. Thus tI1ey are
_oIlhem:
mOSI often found erupling in on obnonnol
<=. Congeoital oboen"" oi It.. permooe01IOO1h.
pooition (~g 12).
b. P'_oco of supernume,ory !oom coo block
!he eNp''''9 pilfmoooni loom.
'" Presoocc of <l heavy ",u ,ow l I;.orrior co n
preve nT Toe perma nenT tooIh fr om emerg i n ~
inTO me 0",1co";!r. A 'Ufgkol incision in
moItcal6$ o<:""fo",." me eruption.
d. Pr,moturc fon ofdedduovsloo/h con resu~
in d elayed lO'Vptron 01 rhe vnderiyinll
pemlOne01 teeth due 10 iormotioro of bo .....
over tile ..... pring pefm,menilOOlh.
.. Endocrinol disordors sum os ~poIhy'oidl$m
co n cc use 0 de la y in erupt io n of the
pe<m<l"'l nT ToeTh .
l Pre_ce of d...:iduoo. (oot frag ments mot
Ofe flOt fe$Orbed can bfock the ervph"ll
petmonerrt teem.
.tBfIIORMAJ. RU"T/U PATH

One ci!he CIM ... of maklcdusion ~ on obnormcl

path ci eru pTiO<1 ..+.k;h co ukJ be doe 10 ord1length
cSeficien, v, prese nce of , upornumerory Teem,
f" f.""..,.." ;,""",.. """ ....
0'
1 2 I", ,,,",ed """ I 00 CO n '""
,.;n
11., "'"~ ..... c........
"""P' po,...",.
ANlCnOSIS
M~"'" i, a cooditjO<1 -
wher.. iM 0 pcrto'...+d ..
of the root .u rface i, di,ectly luoe<! to the bone
wiTn the ob$M<;~ of tn . inte"'o-n in.g perHxio nta l
membtCl ne. This mosl oh..... occurs 01 0 re,u~ of
Troumo to the tooth which perforotu the
periodontol membrun . Ankylosis con 010.0 be
0'"000100 ..;!h cer!oin in/e<;riO<1', endocrinel
dllo,d.,. 0"'"
congenitol dl,otd., .ueh ao
deidocroniaf dy:lostMiI. Oinicalfy, !he.le "",!h
foil 10 ervpl Io!he no ""<:,II.,,., and ore !he refor.
cc lled wbme rged tMth (fig 13). AJ tirTli!' lhe,~
teeln ore !Qtoliy ",bme r~C'd wilnin In e jow cnd
. herefore couse mOgfO!icn of odrocenl ""'"' into
!heopoet.
flg 13 . ... d ..... ... , .... ,....,._ ....... It ...V"ood
~"" tio..... t. i> ,"~" "'"
oj rill 01 '110 " ,.r'Of'.
I, W"""'~_" wtf,
I)E"NTAt CARIES
Con&> con lead 10 P"Imature 10.. 0/ dedducu.
Of perma ne nt ''''''n
ther~ by causing mig",'i on of
COOligucUl teetn, abnormal a>kll in cli r.oTion or">d
su~-eruplion of oppo:! ing teeth.
Pro.cirrd cone. that ro. r.a: been reslored
con COU$O millrotion of !hot odtocent teeth in'<>
!hespoceleading 10 0 ",dUClioo in ordllength.
A. lubs_ol reduction in arch length con be
".peered ff .Ie".,o l odiCJCenl teeth if'"fOive<t by
pro,.;"",1cori,. ore Ief! un reslO-ed.
IMPROP"R D"NTAL R~STORATIONS
ImproGlr dentol restcrotions may prorli.oo:se 10
molocclu.ion . Ove.-contoured otclulol
....1O'OIi0"l couse pn:matu", conlOdS leading to
Iu'ldionol ohm of!he mandible d..ring jaw dOlln.
UncIer-o;)t"tou.od 00::1"",1 """"m""" altl perm~
I.... "!loosing denlmon to ...." ro..up'. P",';mo l
rCl'oroliOOI In ol Ore und . r-conToured invgrlo bly
r.. ult in lou of ord> len gt" d...e to drilling of
od;ocenl leeon tOOCC'-'P'f "'" spoCI . ~ 0"""",,,1
con!oc! 0110 couou lood lodgement ond
periodonlOl weakening ol!he fe.e1h.
PR~DISPOSINO
METABOliC
CUMAU AND DISEASE
A numb-er 01 endOOino l dilO rders, i nl"'t~~,
cond iti on. a nd metabolic dist urb a nce. CO n
predispose 10 "",Ioed ..... "".
""doerl"e '",II.'ence
Ce rf(lln ondocrlnal d,oo(d"(1 ""'1 .81UI1 In
maloccluolon . The following 0[11 tom. of the
.. odocrlool dl.,u, banc~. thaI con cal'",
n\aloct:lutlon ,
Hrp o tnr'o idl lrn Hypotnyr o ldllm I.
cOO fOcteri.ed by the p""$M<;e of one Ot mo<tI 01
. . loIlow.n9 IaoIures:
"'- Ro,otdO!Ion in role of ,olciumd~ilion in
00_ (lnd ~ !h.
to.. IYIarkod delo-y in !o.o!h bud form a!l on ond
ftrupl;OO ofteelh
c.. Dek,yed """",I en d ""iphrseoi ""lcl~oo!lon
=- The deciduo ... reerh Ortt ohlin oYerrelO"'-d
ond rIoo perm:men! ICCIh 0..,.1ow IO.-up!
.. Abnonnol root re>OfPlion
'- I"egulo,it;" in 10011> arrongemen! and
crowdir.g of!cerh con OCOJr
liyptrlhyroid il m Thi . cond iTion 1$
cfto,ac teri,ed by ,nc reo,,, in th e rate of
-.,'otion. ond on i""",,,se in ",elobelic role.
n.. potien! , . hibits prttmoturtt "",anon 01
:iIciduou1 teeth, didurbed root reso,ption 01
.... "'''' ~ ond earlyerupX>rt d F*"'cnenl
....... The DOIienl rnoy I'me <><!!OO- porot.. which
(OIl1fO;,.,;/;.;.,res orthodo n# c "eet"", nI.
Hypoporo! nyrOidi,m , Thi . end oer in gl
dioorder is OS,OCig!ed >Mlh <:hang " in co le um
-OO1:sm. k con COI.I$ed..\:ry in lOOIn 'ruplion,
-.
oIIeted toorh mo,phoi"llY, de:ay'ld e... plion of
dIociduous and permanent teeth and hyPDllIoSlic
Hyperpororfryrojr;/i$m : Hn,."pc'OIhyroidi.m
poduces '""ease ill bloo-d ooleum. 1"",,,;,
Oemi ner"<l lilgTi O<'1 of bon e ond disruplio n of
Iro becu lgr pattern. In g row ing chi ldren ,
onse..... plion of Iooth d...... lopment OXOJrs. The
_rt. may become mobile due 10 lou dcomcal
bone ond 'osorplion of rio" olveolo, pnxeu.
"'tI. II(lII~ dlllll'hR~"
kYle iebMIc di_~ ore beM.ed '0.1ow tIown
.... PO" of ~h pnd ~OjltI\ent. Th~
condiTions mOl cO ule 0 di,turbo"'l In tOOTh
....pliOl1 or-.d &heddi"lj ~rebv il1(:","1o& tI10 riu.
01 molocd",ion .
Oi_SOI oNeditlg "'" oro-Iociol mulodes
con heve g po-oIound eflOCl 0<'1 tne derrlo_of...eoIo r
compl e. predi lpOsi .... to "", I<xclu ,''''''
DIETARY ,"ROSLE"'S (NUTRITIONAL
DEFICIENCY!
Nutrilionol deficienc ... dun"", llrowth mev _"h
in obnormal cIe-eIopmenl, ~ maloccluSIon.
Th"'e di.eo ... ore more common in the
Oove/cpi"ll 'Q<J nlrieo ""'n in!he ~ped world.
Nut rition reloted di' Tu rbor-.cc, w<:h g, ri ckeH' ,
,curvy a nd berib eri con prod uce uvere
mo locclulion and may up, e' the de.n lol
deveiopmer11Q1 hmo IQbI".
P{JsrURE
""""" po"u",1 ~ob'" 0"" >Ofd!O be 0 cou .... 1or
malocd",lon. Alrho"\l h I>O! wt.""nlicted, they
,
ma ~ be a"Q"'oled with gb"""",,1~ .. ure , . gna
mu",,1e imbctklroce tkerebl inenw.ir"\Q 'he (''',k of
I'lXllocdu ~o n .
Childr"" who w pport rhei' b.od ,bv
,.,.,in9 the chin on their Mod ond rhos....+>o
hong ....... heed to\hat the chin "'''' 09""'" the
m..., oreobserved to t....... mendibulordeliciency.
""""" J>OS'I."t C 0 COuse 01 malocclusion oIII-ough
no! P'O'"ed l'lXly ne"" ~hele,, be en ~cc""'uotir>g
melor for other mo locd ",';",.
Ace/DENrs AND TRAUMA
ChIldren ore highly proneto injuries 01 thedenJo.
iac ;o'-.-.gion during the early)'OO" ""ife when
"'".v ,.,r n to crawl, ....I~ or during ploy. h-'toI; 01
Ihe-," Inlurl" 110 unnolicet;i ond mQ y be
rto.ponliblc for 1"10",';101teeth that do JlOI r1lloa rb
ond deflediort of elupTing pom'lQn onj teeth 1010
oboo-rmol positioN .
 ~"Io.l';"' .
A" 1 01iocd 19!9 ; 192199
23. - . ~ """'"" -c,d ~ of O..-.i<t. V_
, 8"' lOi . ~"" .. " , h.'i><>, C ... ,l:o,.'" 0. .... boo<.-..di:a ,,,i>Io... .....
1988,
2', Ro=> j , O'po"",, Odo : -""'-'It" on 1'00101 ["" .
""'..., ....,t+. ~ ; n ,11"1'" :1.1 ;"", ,,'" J Orl od ",,",IChO<t.c.J I?70; '93H7
, ' 9&J : JJ ~ - 3 'O
E1',_. v,......".,...., l'q:i"', ...d S,, ~, T. .....
25 So', m.,.IA ; .'1oc, e, e-:xMi "" 01 ,,,,,,,,,-.01 ..
cf ". ""'.....- . ... -no'~ ,
, , _ , Ot" _r"" 0'"
potCi """..., ~ o-""" ~i ~ JOrt oc' 1995 ;. " \- r...,,,,,,,,,
j "'" Dont ""'" \ ~~3, 3~; )tS) \ ~9C
, m
F.... ~., Wo-,." !.I,d, 00'
.-.0100 o nd ,""",""',,, in ............
rhIno> Vonc.I ...... ,
.on j C othod
26 SoIuno,}A """, ,, oj ::>!--.odo -,tk, . & "W",c"
a>~ 1966
17. $;"", iIco"..--d ~ - ty! '''' ...... or
, " 99" , U7 ~
G<obor - -.... ........ .y_ ~ ..... _n . Io'o~'.nd
...... od..." ... ~ AonJOr1'ood 1991.11 ) )79
26 IMow 6 !kog;.., S , 00-0\I0d0 .. < $0...100 cI
, ""' .... ,."". Am J 0 _ 1943 ; ~1!'50
(;0:,,.. 1M : Or+<x'~"3 ' ""-.oIoia or; OOXioo_
W8 So, 'dt~, I 968
..rnxt ... oi po ... 'n .... f-oo ...... """'JIW-.I
""'" -".. :., 0 1-...1 Soc 1 ~1C. ~ 29,"2
29, -" .... 9-cop'O, cod SI>o, ~ : t-I~ 0' ,h.g;,: Min',.

ood
Yo_.""''''0'" _._ . . . ""','O,
I...... O:};""_,,
0.0 ... !:oj,.:""
, k-. J O,..b o 1993 " 520519
Ho,,,'.' <rod Y~e ,<'Ino<I , ,,,,i""'' 'i 1""", ,,
10 "" "",I ..,.,, '" ....,100 10
, 0rt>00 \1'117; 2~ _ Xl
1"1"00". Wer ..... cnd -".f;,.Id
M"<ho<. fo,o", I'Iah" or .,.,..,1 .... .. 0l0i,1 dowI""" .... , "" j o.+od
1987, 28.29J
:le , T, II . ), Jo.d-,,,..
"''''., "'" '
." ud . '0'''' n ol, ~""' ,; ,
o.- h :l 19!-6 .- &:l l e ~
"co~ I i _ "" j 31 l.I'~, Koo-nl, S....... ~, 51- "",, ... , -" .. Q ........
U,_ 0"""' .....
10<1 ,,,,,,,"oc...
; 523..s32
0-.1 '0001 'onn, A-. J Ort-..d 990

, ,',
19~ ;
..... d.w,g bt-th,; A." J Crt"" '92_ 32. V; , N,Id,,;.-\:w .... Icno,Iolonl ...... .,.,oq,.

,.ho""'" .
__ Am J 0,+""
KI...
~ovr

P, ... u ,,"
0-.:1..,..,. <>' ':d, f'e<rI .
1919 .. 511Sn
hob, .. , ."lol.gl<.1 "'e"''' in
""''occd'''.,.... "'" l 0""<><1 1952, 569-!;81
... J 01'lod 1~81 2~3-2n
33. Wo',"". H,I-/;oIoj ....l Do ..... ........1 0"",,,. ,<n,
pc: ........ hr J 0"MDd
3-<, w"",,-.. H,.loo'.
- ;19 - 34~353
s.oo.,,,. Mo~. Ot"c S<n~
'4:0 ..1
............... 1-0,, '\1 M- J o.+.od 19M ;:259
" ( ......... 1Id D"j,h, _ '. "", .-.d.~01 "'"i m
"""""1" , nO f",}"Jd.;..g ",,",' Ivn J 0 ."., I 1'85 35 W,,,,,,",, I""'"",, r,,,,,,", H 0''', ,00 H,rl . , : Nooo l
,~32,"5 0_) fol '....-, ; ....."" Ib-, e' po","" ~'" j 0.-1-0,,'
". t,~"", <rod Do~ " P~ ... ' 01 .. '0\71 01 ;, hal
""11".....,".... "'bit. Am j 0+.00 1965
........... ood
19fi7, I\ I'l6
36 w" .... Io ' ..,n, ..-.I ~ ; ", ,,,, "",fro', of ,'m,.
; . 31.... 35 ,...., _ , ".....". , -.0+"'1;_ k- J 0rlI0d 198' ;
........ od _ , "'~or _It,,.,.
" 0IId om<i _ .....,.. "'" J Oo+od 1989 ; '32"J8
1972G6
37. _ . _ _ . ...-.d W;;~11 , Roo"",.,. '" ,..,.,1
". ........ _ 80-",",," -r .I ~,.< .:1-;\:1.0' M. J Off..!
19!1O;4e-S9
",,,,- .... oood '" d.o"e. hi _
O~ 1981 ;~S45
"""- A.. J

"'" t<.U RI.". Jooodo<h ~ . <O.jo.""I", a"-'" """<dol V, hr,., 00 .. '1. , Nd ,, 1 1/"0....., 1'0""'1
" -.,,,", ""1'"
"",~Io ... Ioro .... _ _. , 1.......... . ......... <On-

11,0,,,. Ch1'-ood 191],'3 , 2'29

Md II . " " ,,~ lo' lo.lood' .g on,
l !.

)9 Will.... O"~~!Dw 0.._ "',

f..-po""" J ChO<tf..OO 1~9J;129 131
O<'d Oed_I

" ~"" . A... j o.+.od 1988 ,

0(p0.,j, 10''''''' , or.d L; OOM"
I~9 . I SZ
E!Ieo;' 01 , ud;....
"""'" "', W' ; 't, 19'1 3
. 0 W'",,,,, , S, ,,ko t, ",,!fed po"'<11 """"'",,", k-,
" ",to<,.", """,,:0. = "blr . ",.., j 01"" 199. ; 16' _
j 0"1'" 19'1 1.- B5-'l-J
WQ o d,'d .," , d,, ~'o~,~o, t o'o",6"" . ~,
".
0-0.. ~~ U-I_ I. "".._ c.......
.1.
~WI "'" ,,,,,,.ohio, ,.0 """'"'" _ ......

" ,;.., """'G

2OC).111
"",.,,.01 a,. me. A.. j Om..:..! 1983;
d-c~.-..do

"
01 "'-" " ~ _ And 0rl>0<I1991 ; ).

I\Wi, ot>d \.\,~ ,Modoon I . - - 01 ....

" cial ........... '" .. ",;1 .... 0--",0'1 doooo .... od by
1000< hoIogo<o, ... "'" J Onllod 196~, ''16-~1
x. "01;0 w" ea.....-po"' ... o..I>odoofleo, s lo" ,
CV""" by,19M
" ' ' - f : Tho ""~) 0"<1 ,""""'"'" 01""""""
" ""","" 01 ...", 1''f ~~ ..... """" ... "'" ,~, j
0 ,; , " 91.!! , 35: 138_ 1<6_
c.,..
. ~ogo' ... , !<.bt~"I , Coo ."", 0'1 01 ...... " CI,,, II

O rol hob-Is In child"", ho.,." definite
beefing on th. d.... lopm.", "I
Clcci". ;o " . Frequently, ch il dren
ocqWe artoj" hooil> "'at may .jllt.,
lerr pomrify
or permor>enlly be hormlvl ro dentol oedv."""
ond to lh . !ooth . upporlir>g It rue!u,.,.
A natH! ~" n be deftned o. the ,(!(Id.,~
IDwOrd. on oct 'na' hos bee" ...... " repeated
por/ormon:e. reloIWely 1UocI, cono:.lent Dnd eo..,.
10 perfo rm by an i rodi';du ol ,
HobO!. are Inv. oequi"", 0." "",.H 0;
~Iion. In me initicll.t>ge. Ihe:" is" conscious
e/Io.110 peno,m Ihe oct. loler lite oct become<
leu consdOlJ$ and if repeal ed oftcn Ot'lO<JQ n mO)'
_ _ !he ,,,,,I,,,. of un::ontdousneu. Habits COn
be dosSlfied In (] numb .. , 01 WOY$. One
do .. iIi,aI>on i,lo d",;de f-.obill info p, ....", 00r>
pr~ ...... rc a nd biti ng I", uill, Ho bi!. con 01"" be
douined oJ (ompul.iv(o Clnd non-comp"I..: ...
hobotsor .. mpoyond ",,,,,n,ng/I.j habits !'*'table
I fo r" ""'oiled d", ,,iicoticm).
THUMa AND DIGIT SUCIWWC
Dig it "ding i. defir..d 01 placement of TM thum b
Of OM more finget'llin 'o'Or,ing depth. into Ill..
mouth . Thumb and dig,l suchng is One ol!h,"
<:omma"~ ........ hob~1 t"-:>! most ch;kI'M indulge
in. R<KCN slc;die. f..:,,,, 5hown that thumb . lId<i ng
may be prodiccd CVIIfI during intrau!erin~ lif$.
The p,esen'" of ,hI, hob~ i> c.......idered qu~e
normolt;n Tr.e 090 af 3 Itl 4 )'t'<lrs, "" r~sle"ce
I
of th~ ncb:t beyond thi . a .... con leod to "miou.
ma!occIuslon._
EI/olallY
A numbero! theories ho .... been put fOfWard to
.,n...hy rhumb .uc;king aceu". The fdlowinll
0", ,.".,. ohhe mo,~ occeptad Or'IeS ,
Froodian tneoty , Th i. tr.eo'l we. propo.ed
by Sigmond Frllud in 1Ir, ""Iy po" 01 this ~
He sug"",1ed thot 0 cnlld pos= Inro.gh varioul.
\
di,Tin c! phos.e. 01 p.ychclO9 ical rJoi"elapm em 01
 whidl..,., "",I 0'><1 'ne onol phooes are -, :~

the 1,..1three ..""" a' Ide. In ..... orol ohose,!he

moYtto iJ believ-ed 10 be an """""'tic lOne, The
ch ild has th . tem;ienq to plo,," hi l tirlgC<l or 0 0')'
U" M ".~I"
_.1". Pr ~v. "t;OI1 0+

--...,
ThtM ........ ~. thol are ~ .. oth .... obtOoCt into th . oro l cO'>';tv,

--
_I.rdon ........ """"~ II. ~ 1Or9A, IVCh M oct ill bt! 1~ b re<u lt in """".:;.nol
""'"' ~ in.ecu';I"t' ond po the ,i, l 01 m. child
,.... __ hl,....._ ........
too _.., ... """""" _ _ ..., .. _
diversdy,ng into ath.,
hobin..
0'0/ d"ve 'neory 01 Seo,.. o"d W,se :
""'*""l...... ~ ",-, 5o:<Irsond WI$t! in 1950 propo;ed!hal p!Oianged
.ud<.ling con lead '0 thvmb .ocking.
Be niomin 's 1!",ory ; Be njomi n hOI l u g~"ed
r.,ply ~ .l>Itt
t",t th~mb , uckirlg orosc. from the rootin g o r
Tho!' ... _ tho! .... "" _OI! "'~ "", ... ploo"'9 rcfb A On in 0 11 mo ", molicn inlont.
rOOIeo!
~1IrI 1OOIo n:r
I~ .. _ht_ . . . .
Pl j ~ or-...
'0 .tIOOMg.
RooIirog refI .. is tho ~ at ~ iiont', heod
ond lO"guc ~"..., obje<llouchrog h,.d>oel:.
1'>e obtecr '. ""uo!'y the morl>c,.'. b,..,,,, b", mov

-
01", be 0 flngo' 0' 0 poci/";",. Th,uooMg ",He>.
diooppta .... ,n nomoal inb"" mound 7 . 8 montt"
.....
~.
ThtM __ ~ fI.ItG _ '" t ~ ~
ofoge,
P, ~c,~ o log l co l 0 51'<' 0 5 C hildre n deprived
ill> ~ lingo< 5iJdl"ll W alSO I>r'q.II IW IIing
IIbII ' p,. ..". ~.blt.
of po rento ll O'r'C, co re a nd aHed ;"" 0'" be lieved
.. ....,.,......=""...,.._ .....,,,_Il0l> to "O$OrI'O this ~bi! d"" to 0 feoe long ci ~""
_ 0'tid'I
-.... dhc' loa 0<1, rot." ..
lOlC,ned poll!:!m : According to some ou!nOn,

......
--
jIo. An ........... ""~ ..... "'!IiI ...... tII
Ihvmb SlIcldng .. m..my 0 Ieomed poncm...;th
no underlying co"," 0' P"Jddovocol booonng .
~ _ _ IS """ .. "'l1iIin;, !*'<I ~
..., II> tlrYoj,
f'hase I: IN",m ol ond , ,,bd inoc:o lly sig nifica nti:

_..._ ..__..
Th o first p h~se is .@."d llf ing tho fi ... t m r~e )",0'"
of lile, 1M p<ese<>oc 01 t~um b .... d ,, '9 du,i"9
~. .... "-bitt
thi, p/vJ!C iHoMid.,ed qujje normol orid """,II,
"'"" . . lIMp """'" - .

tot lid _
.......... """* _ ....
Ii> .".". io _
00<1
t __
",,,,,,,,,,,'es uI !he end of p~ ... one

_1IIoioIJ_..... _ .
""'" oceur ......:I _ 11M """, _ .........
.....c:t
PhoSfl /I (C~n'colly .iyni~con! .ud<'ng) . The
""on::! pI'CJOee"'"nd.~J 6 'n .,eorsof
~~ . The D<"C'W<lC" of socking dU""9 thi' peoDd
h_.
Ii... ' <MII'IrItInr IIob!tt is On indie"ti"" Ihu t the ct, i!d i. !lnde . o ' oot
~ .. _ 1101 .. ,""" _ nI troppoo1 .. o n.i llly, T"",tme nt to soJ vc the de ntal probleml
"'_ .......... Y>oold be in ilioted d u,ing th i' ph "",
 f'\l I PI",,,,,,",,,,;" P'"''''
~ ..., ;0;"1, '" th"w"""""
":1 to. o~. 0/9 _.~. 1j).<><1
;C) 1"''''3",1 P"~IQg<O~ ~' (0)
"
ooh'...
- cepIo'O$""" "' .... ""....
"",so. II) , (Intmdab le weking] . My tnum b
sudinQ pe r~,ti" 9 oo~d th.e /o., rth 0( Mtn Ve<l'
<;>I IiI<! ohould alert 11.. den~111O II.~ und~,I ,i~"
pI}ChoIogi.:al aspOOs oI/he habit. Apsyd>oIog."
mighl hoI'(! lo be consulred du,,"9 Ihis ph....,
Elftcu 0 1 thum/) a ile/lin,
Thu rnb a r>d digil , uLkir>g arc be(i ed to cou "" a
.... mber 01 chongeo in tn.. u..nlol oren and rire
l upporting .truLlu..... Th. se rit~ 01 me
",010 od .. ion w....,d by lI.umb tudr:ing dep80 0ds
on the ttident oIloclO'l. They ore:
'II D",o 'ion . Th~ omo~nl oj li m~ ' f>I'nl
indulging in Ih. flabit.
b. FreqLJ<!')(y' Tho "" mbe r of tim ellho fIobit
is odMlted in a dot.
c. Jnletl<ity: The ~igor ",ith ",hich !he hab~
is performed.
The Iolbwing ore some oIlhe ell...:" 01
lh"",b .ud:ing :
o. Lubial tipping of th a ",,,,,il ia,,, a~""ior 1.... lh
"""ti ng in ",adinolion at rna,; I",,,, a rltorio<$ .
b. The <M!<jet;naeoses d..... to pr<>cIinotiofl QI
the n'oIlIOIlcuy ortcriotI Some chilo::Qn n:sl rhnr
hard on /he mondibulor!lfllCfi<n dumlll roo
"""Icing oct In we" child .. " li"9Ul1llipping
F;g ?
,h"
"'' ' YoI'' ~I ""_ ..... i.lIoI\o' hod c ... m .. Jd.. ......... bl <r<! , .,. 0.... ".1..,1 '"'" """')0 ........ -d.i<_ Nooo
d" pOO" ~ ... ,,~ 01 .... _I<.., 01' "" ,h _ '" d ... .., 10_ ., ....... """ .. "" oooOOa'od ......... hot:w-
A I;"'; h hOr """" Of """
.-! to i.. ~ ,110 "'-">" -j, .. ~ "" 01.

ollhe mondibulor In(;.o" , on be expc<:1...! whim predisPO .... 10 pool ...... , u05sb~...
whic:h furthe, I~ /l,e oYCtjel. (fig2) .
d. Anterior open bote (On DCCu' os 0 ","uk 01 t. The ,hild mOV d...,..,1op !CIngue 111",,1 hob,l
re strl' ti on (If inci .ot e ru pllo n and as a "," "II 01th o Ope<1 b<to.
wptC>ef" pti a n 01tho bu cca l teeth Ili g I) . ll. I he upper lip i, g" ",,,,, lfy hypolank: while th o
e. n.. ch""k m",des coniro" during Ihumb lowe, pM allh .. loce .. hib~J hype""c"""
sucking ,asulhn~ In 0 noOTOW marillo,,! otd> memol" ocIIv"y
 A B
l
'-ll<>bil
Hol;.;- ' '''0'"'' . -
w,,",
~ .... "-~ "' _ .-t of ,",-,,0 " " ;"'11 ,nO '(>"."" ,... u" .... ' " Rorr oia, ', ' ,cbi' """'eo" :8)
DAllno. '. d i>cont inue hi' suc kirl g hob it, Thu. th~ po"",t.
- -ep","",k ,ho ukJ be qve,fo ned on the freq ..." q ond the denti, t , ha uld ooek to Ir.oti vo te , he <;~ ikJ _
....ddUfotic<> 01t"" fx, bil, The child '. e motionol Dunlop Dut i"",'ard 0 theory ca ll ed Be'<l
-.n; sho ul d be m se "ed by en quiri ng into !.C eh h, p.o the' i' th o tct~ tho! tho be, t way to break a
-...gs a. : habi t i. by it, con, ciou " purpo,eful repetiti on .
'"- Feeding ha hit. Dunl op >egge,,, thot th e chil d , r.ov ld be a,led
11 ""renta l ca re of the ch il d to '; ' in Iront of a large mirro r 000 a sked to >uc k
::.. Whethert"" po ,oots a re workil'lQ hi . th umb o b,orvi r.g " i m ~ i G' he indu lg e, in
An intr<HJ<ol d inicol . xcminot:on ,,,,,,,,Id the ha bit. Tni. procedu re i, ve ry effec tive il the
...:on:! 011 th. fea tu re! , een . uch os prod inotion, ch il d i. ",ked to do the >a m" ot 0 ti me when h. ~
cgen bite etc." The , hil d', ling . " , ho ul d be invofved i" on en joyo bi e octi' it,_
oocmiood , P' e<er.::e of d eo n oo il, a nd ca ll us 00 Mechanica l o.'ds , T" oy 0'" OO; i, o lly ,"mioo ing
_linger i. commo nly "'5OCioted with thumb Gppl ' o nce. that o, ,,. t the child who ~ willi ng to
srling . quit the hab it but i, not ab le to do "" the "", bi t
ho > ente re d a sub con .c io u. le ve l. Thc.e
a.
Mana eem e nt of thumb sacking
a pp i-a n"e, ","" airy con<~t 0 1 0 crib ~ poIato l
Psych o,' ogical ap prO<lch It i, u.v a lly . a id to th e ma, ill ary in<;i.o" , Hab it breo ke" ca n be
~ enil d,e" Icd inll fXl ,,,,)joi "''''', kw~ a nd of two type. Ifig 3),
allectioo r.!.C rt to thi' hob it , Thu . th e pa re nts 0) Rem O'llob le ha bit b.-ca ler> , They ore po>~ v~
shoo ld bo ca LJn ,., ~ed to pro,:d. the chil d with ren lovab le opp li ance< th ot co n, i<l of cri b
adequate laye and aHecf on . Th o poren!s sho uld a nd i. a n<;ho red to tho ora l co, it, by moon.
a!.., b,., a d,.;",," to d ive rt II", ci)i kj ' , off"" I"', to of cle, p' on th e po,te ri o r !eeth.
.,a,." thin B' , cd, a ' pla \' a nd toys, b) Fixed hG bi! b r~ak. " : Hom-), 9 ""9" ~o in le"
Th. J cc." of " nl ho bit interceptio n ,,!eel wire COI l be des iy ""d to for- In a Itame
~ largdy dcpcrx!o upon the . ubject'> co- thot i> sol dered to bo nd. on the mo lo,,_
operatio n a nd willi ng rl e>s to be he lped to O :OOr a ids that ca n "", u<ed to inte rce pt
.he hobit lndude bond<>ging,'ile rhumb, "nd
bondog ,ng oIlheeibow.
Chemicol Opptooch : Uoeolbi:'ll:rlu!.tingor
foul "",,11,"11 p<epolO'ion p/oced on rhe thumb
.hot is wde<! con mok~ rhe h"b~ di<lO"",lul,
Th" me<!Occm ... '" !h<>l can be used indude,
0, Ptppet (!is:ro ",oo in 0 ..... oli le med ivm
b, Q vini""
C' Asofeli.da
TONOVf' THRVST HABIT
Tongue thrvst " de~,>ed '" a condition in which
tho tongue mok... """""'ct with ony teeth ont-'or
to ..... moIors during .wollawing.
111'/"1/1 " I l enl/" e t~'''5t
FleI,he, hos p,oposed the lollowing 10ClOtS o.
00"'0 the ",,,I.e lor tong"" II,wllir>g,
Ge""lic locrot$ The-! a ' c specific an olomi,
,,", v'om uK ulo , vo ,iolion. in 1M oro.faCiel
(lr'
' eg io" tloot Co n p recip ilale lO<>g ue Ih ",,!. e,g,
Hjportonk Ofb<cula'; .,.-;, o ctivily,
Sometimes the mo",mtion i, delayed ond tnus
infontile swallow pelSi... for '" longer dUr'Olion 01
.~ .
Meehonleol r~,',ic,jo". : The P'elenCe 01
(e!!oin ,ondllion, .ueh o. mocroglollio,
OONItriOed r:Ientol o,dle' end enktroed odenoidt
pred ispooe to Iong ve Ikru<! habit.
Neurolog ica l diSl<J,bo nce Ne u, o logico l
distu rbo nces affecli ng the orah :iol region .vch
a. hypo",n . ;li"" po lo te e,..,j mod..."te moto'
disabilitl con cou'" tong"" rh"'l1 hobit.
CIIf. ,f'c. fl on of t on, we I~,nt
loblo 2 gi_lhe Ja""" and Holt dOS$lficotion 01
tongue /hruOf. The term non-<lelarming in Ih ..
dossificotion imolie. that the int"r-<l:9~otion 01
te-eth ond the f"'OIile ore occeptoble and with'n
normol ronge . Delor mir>g longue Ihrutl i,
osso6c!ed with some o. nlo of...eolor defect,
long"" Ih",,1 <:o n 01.0 be dO'l~fiOO 01
~ rt1 ple tor>g ue th""l and cort1pJ e' tong uo 110",,1.

!.eo-med be""v.o, (nobit) Tongu e th.u .'

T"", I, ~ I><'g!..-_
con be ocq.u"ed o. ",",,1,;,. The following ore T""," , ~_ITq.IO_

oorne oflhe predisposing foct",,!hot ror>leod to s...._t: _ _ _

tongue rhrvsring , s...._2 :_ ..""'....
o. Impropcrbollleleoding ~_3:_~

b. Prolonged lhumb ...d ing '!III II . DrIDrrontt _ ...... _

s...._,, _ _ bOo
c. Proiongcd'onsillar ond upper respin;rla'1lrod
",,*=tion.
Sub_t ,_ior..-
$.01> _ 3' iloop_
d, PtOIong.cd d"'o"on 01 lendemeso 01 gum or T"", 1/, ~ _ ... 1oIor1l1>'9ll_
leelh t<l<1 resu lt in 0 (ha n~ in . wa llowing Sub _
!: _ :nI _____ bile
pone' " to ovoid p re. su re a " Ihe l" r1<le, ll)r\@ Wl _ I ' _ d_toeIt!
Sub _ l _ 10.- __
Jo..\o t<J'o tioto<rl, roo9 uo Ih ' v, 1 con pre.., nl o .
port 01 nO<mO'I (h,klhood boh (J'llio' thaI i, SirnpIt Claullicrion at Tongue ...... '
g'odu,,11y ",ad ,l..d e. the o~ 00"""""". ' he
",1on.1" .....,11ow dlonge< to 0 mo"'", """,,11ow
ence the ~ deci<loo", teeth sItwIenJpllnO
---
~""9"-
 I's~t h ogen i t
lu c lols lon g ue Thru lT CO n Clln/cill feature.
ICIm~t i ", uOCC ur a, c ruu lt o f force d Th ~ lOngu, In'u ,t hab<t con be aWldatcd w.Th
dotonTro.>oIion of oItw hobt.l i ~ thv"..o "'eking . the foIlowin\jleotv<es :
os often .e..o 11>:11 dlild"", ..ho 0"" Iort:ed to o. P,,,,,linohOn of anterior leeth
m.e rhumb ..,din5 hab' ofIen lak, up tongue b. Anterior open bite "
iInnIu'll . c. BimOll-illory ptolrusion
d. Posttrior open bile in co", of 101..,,1 tongue
Simpl e tont ". thrust
.~,

r ... fol low in g fOOlurc. con b<: ob.. rv.d: e, Pos~'ior crollb ,l(o
Q The ' i ~, ,.e ""''li U" thru S1 i, cno ,ooe<ilold by
a """"a l tooth rontoct du,i,,.. the IWOllowillQ
~.
the manogement of to"ll"e 11"",t Invol_e.
b. Presence 01 on on!erior open bITe.
inle. cepr;gn of the hob.! foil""""'" by ~eat~' .... 10
ot. They chibd good intercuopolion of leeth.
co-1'8CI tIw moIocdUllOn.
eL The tong ... 1>1r<usI1"rw",d d<.aing .....,11".;"11
10 hwp 'lIabl"h on onlenor lip....,1 Hobil .nlOlrcOlption ,
It- Ab<>QO'mcl monic Ii, mu<de ocl,",.,. i .->,
L The TongV\! thrull "'/l
be in"" ceplOO I"y use
cf hobT br""k ... II< des<:ribed 10< rhumb
Compl . ~ lonlfu. fhru.t .v< 'i .-.g. floTh f"cd c nd remO\o'Obie crib. or

-.
ru .... "'. "" luoIJlo! a ids i~ b.-eoking the hobit
Tho IoI lowinQ leatures we """" :
2. Tho child is 10ught the COH"'" I~eIl>od oi
" Thi~ kind 0/ tongue thruu i. chafOd ..;...d by
0-" opart >wallow.
3. Voriou> muWe e>.en;;'" of tt... tongue con

ot.
......
o The unl .. "", open bde can be d.Hu'le or

Absence of lempo<ol muode const"c~on

help in l'oi"'''11 it 10 odo pT 10 'he now
."",11o-ng pan&m fRe/er chopTer 20)
<I\",11g ,,,,,, llowing . Treolmenl 01 molocclu->Km " Onc~ Ihe l",b,1
d CO<1 lroction oI lhc d rcu momllT'MJS<;te. duiin~ i, int" rc~j"d the mQ locdusio n o:ssocioled ..,th
,.." lIowin~, tile to"gu ~ Iluust il lreoled ", ing fCmo\o'Ob .. or
It. n,~ ocdvSion oft""th mcy b.. 1>00" f...,..j orihodQ(1tic owlim~ .

10J
MOUTH BREATHING HAB IT Pathophy!I ology

During ora l re'p irat iM, the fo ll owing three

Mov!h breathir>g has been o~ib "1ed cs 0 possi," .
char"\ge, in th e postu re occur
.tiobg ie fa ctor for ma locd usio n. The med . of
o. Loworing of th. mandib le
re.piratOon influence. the po.tum of the iaw, th e
b. Pe,itio ning tho tongue dowrwa rd, and
to r>gue ond to 0 Ie" e r . >Cent tr-e heed . Thu . it
for...ord , .
, eem, 'l,uitc bg ico l :001 mouth b,eatning con
c. Tippin. boc'of thehead .
result in ol-e red iaw ond tong u. po,ture wh ich
Lowering of tho tongu e or.d mand ible
cov ld olter the Orofod ol equilibriu m there by
up,ets th e oro -fe.ci ol equ ilibri um. There is a n
l..oo iog to r:".olocd"" ion. W.ost r.OImo l people
unre!lri<;t. d bJcc ioator od;vity that in:l",,",," , ' ''"
ind ul ge in mouth breathi ng when th ey ore un de.-
pa.iti on of the 'eeth ond ct, o the growth of tN!
phy' i~ol e.e rtion such "' du ri ng stre nu ous
. xere i,. 0< sporll oC'ivit!
,M
CllnlclI / fell tures of mouth brea thing
C/llu lfl ~lI t/o n of mouth breather!
The type of ma locciL, ion mo.t offer a"oc ia :ed
Mouth brM/he" co n b. dOi~fi .d into 3 type.:
I'Ot+- mautn orccthn g ~ cal led long 'oco 'ynd ro "'"
o . Obstruct;""
Dr" the clo" ie ~d o noid focie. . Tho, . pati en"
b Hobituo l
exh ibit tho fe ll ow i"," feate,ceo .
c. A<>otom ic
a. Lorg an d """Ow foce :fig 5 )
Ob5lwaive . .Com plete or po rtiol cb;ttuction
b. Norrow no, . and "",01pa .. og ~
of t~ . no . o l po .. og e can re, ult in mouth
c. Short ond ~o:cid up pe;-- li p
br. othing . 'The 101l0 l'Ong or o." 'e of the wu.e,
d Co ntract"d uppe r arch with poss ibi lity of
of "",a l obstruction:
po.t. rior ero" bite
a . Devioted no,o l septum
e An . xpr. " 'ort!e .. or ,"o n' ' a ce
b. No",1polyp.
f. Increo sed ov. ~et o s 0 re.u lt of fl aring of the
c. Chron ic in~ o m matior, of "";01m""o.o
100'0"
d. Loca li, ed be<lign tumors
g. Anterior morgina l ging"itis con oceur due
e. CongM ito l en!or"em . nt of nod turbi note.
to dryir>g of the ging iva Ui g 6)
AII~rg i c reaction of the """, I muco",
h. l he d"",ess ci the mouth pred~~ to cor",
g. Obstructive a den oid s
Ant~ rior open billl can occu r
Habituo i ,A robitoo l rno<Jth brooh r .. one who
contin ues to brM :he thrcc-g h hi s mouth even Diagn osis of mouth br ea th Ing
thovgh the r..,,,,a l ob, tructi on i, removed. Thu s Hi. tory : A good hi<tory ' :"oC<Jld b-< recorded from
mouth breathing become, a deep rooted hobit the pationt n, we ll m paron".
thot i. po rfor-m~d u fICo ~!<:iO<J'~. C li nicol oxo mi noti on , Loo~ o ut for it. va r"""
A'Xltomic: An a natom ic mou th breoth er ii one cl inica l feat ure . A number 0: , imole te,t, can be
who$~ li p rr.:xphobg,- doo. nat pe rm it complete corried out to d;ogr>Q'. rno<Jth broothing , uch ~,
clo, ure of the moutn, , ueh 0' a patient having the mirrce to,t, wate r te,t ntc. (Refer chaptor 11}
, hort uppe r li p CePha lom etriC' Ce pr., lometric exami notiort

"
Fig 5 _ , .. " ........
... ~ b>g boo a.l _"""I
~-r~ __. _
Ix aoo .....
 Inr9fC'pHon 01 the habit: Mouth b,eathing ,
~on be intercepted by "'" 01 a _fibulor sown.
Alterno!' ly1:rdhe.; tope' co n b. ".ed to
e.tobli .h li p sao l.
Rapid ma'i llcry expo noion , Pa!i . nts .. ,If,
narrow, wnstliClod m:;mlloty a<don benell! ftom
",pOd paioh;ll exp:ln<ion o,aced ...... oi~ 01
WIdening the o<do. Raoid m"",lIoty oonsion
hos been found 10 in(reose the nOSCII oir flow
orod dec,,!o" the nc..,1 0;' re<illonc:e.

8R U){ISM .

B",,o,,,, can be delin ..d a. th e gri nd in g 01 too!n

/0, ""","'nClio..,1 p<J~ (f", 7) Some ou!h:>n
..fer h;I npdumal gri.-.::ling a. btuli..... whil, !he
Ierm btuoomonia il given forgnnding dv<lng n-.;:
dor H.....

Ellolo,y
), P,ycrdog;';ol ond . motionol . t",,, heve
bUrl a ~'i bu'od a. o n. 01 the Co uSOI of
f i; 6 "',",' wi!!. m"",h
" . _ - ?..I ~'"9,;o.,
"''''''' ' '1 ..0 ;' .,Ib ;' ''11 bnJ .;' m,
2. OccIJsol inlorf"",,,,,,,, '" di$ctepOlIC\" between
aonlric: ,el,,~on and cenlric aecluto'on can
h.lps in .'lo bli,hing ' Ih. omount 01 prtdispase h;I grinding.
nosophoo,1 'Yeolspace, lire 01 odenoidl on<! aI.., 3. !'ericoronJtiI, ond ~I poln 1.IOOdIa
kelps '" cIio(,jn",ing the long foc:~ OS>oCioted with "ig9&' b<u>Olm in some ind .. od .... ll.
.
mouth b,eothing.
.
R/I;<>OmOnomefr/, It is tr..
study of ,no..,1 air
Cllnlc.l 'Utu'li
flow'ei)oo ode. i.t". u~ ng ~ CO<1li-1li"ll <J flow o. Ocd\lSO l weo rfocels cOrl be ob.wtrved On!he
l"fIeIe!S; orod 1"'1""'" 1I""{I8o , Th,ne de-.;"" .... p ~.
b. ffoctu .., 01 ~I!. ond ""'1OrO~onl.

_...
'" .. ~motion olairflow lIwough .... .......,1 passoge
rnd nOO/lI .... i<lon~. ~. Mabilolyolleelh.
d, lendliTIHS or,d h"fP"o1rophv 01 mcn~(btoty
M,n.,'IIt'''' 0' Ploltll 11,.. ,11/""
~.jnovo/; 01 ~osof
01 P~Otyhll~ ol ,. MuKI. poir) whon the polisnl wohn wp In
obl1ru~'io": An, ~ollll of pha.,~geol fflo m<>fning,
obSTructi on w>ould btl ~oved b, relarrlng tn o f, TemP"'""""'nd ibuloi' io'nt pain and dl"omIort
patieo1ttaThe E.N,l, 'UraeP'I , . '11M o(CU'.

,,
 01 , ..,,,, help ,n 4iimi""ting oeclu"" i<1lerfe ... nQl,
p,e"ent occiulol WMe M d' breok Ihe
ne urom\IKuklroooplolk>n. "1

OTHER MINOR HABITS

Lip bltln'
lip biting ond ~ ludot'Q "",metim... oppear.
Iorcedd,~cl"'u"mbo.-~ngef~,
lip bi!lng mOil often In.-o""," !he 10...... I,p whch
i. turn ed in.....,rd. and p,e'''''' -i; exerted "" tho
li ng u ~ l lurfocel of the "",.~ lo l)'<J nt..rion, Th.
pot ienl ""' y hl bit lhe following IMlu,.,:
o. Prodi"&<! u _ onlo"o" and ,ejroclinod
lower omerio<1
b. Hypertrophic ond redundom I"""", ~p
c. Gad,nll cJ I,PI
This hoba con be Int~.pled "'in9 Kp
.
b...mpers tt.ot no! only l ..,p tI,., lips m<01, WI oliO
, .
imp ' o\o'!l The ""iol inclinotk>n of ,he onleri,,, I.. th
due to un.... lra inod odion of Ih . 1""9uO.

Nol l Oltln,
Noil bitinll daM no! produce!llO>o> molocdution.
ttisIo<y ond dln,col """mlno~on In """' tote$ I,
Minor Iocol tooth Irnogulorilies sud> OS roIOtCn,
..,Hldenl '0 dlogno.e bru~l.m . Occl .... ol
",lmolu"lIe, con be dlOlinOMd by ule 01 wea' 01 illci"" edlJll ond mll)O' crowding con
occur 0' 0 (fluh of ""il boling. ~Ie in certoin
arTlculOllng pop.", Heeno-m vogrophic
Wlminalio n CO n boe ca rri ed o ut 10 ch ick 10<"
hyperaclivlty of lhe mll",le, of mOITi eoll o",

',u/m , n t
Mony co_ of btuli.m ore o .. ociol.d wil"
omotjooal ond psydIolQgicol djsfurboncOi Thul
opproprlol. p.~hol"Oicol lOOurllellng by 0
psythkllri$l mo,bo InitiOi<><:I . livpnot. reIo.<iog
.... mo.oodmgmgoCQl1he1 p inrat~ m ~
"",sion, ~sol oo i U$lm&<I~ ~VflIO CClmedOVl
10 e l i m l n~!O p rl molu rili~I, Nighl QUOrtn or OTher "*'t
f" a f'Iot itQl, wi .. W !>tic>; " , b i ng trPi<C 1"too
cI ok ..... "~a<td 00110 "",1oIiln"""'"
occMol . "'i" l. ~I ,o.~ Ib a oeduscl.u,fc,o.
~ in middle eo>l """ib~.....t.m;, (oiled the 19. ~!".".., ....., boo,k oi 0 ", lowl<>. "'-
nul noIch which i, 0 wear ol'Hth in !he lor... 01 c boo< ... ed," p..-bI........ i",.1~8
n T",,,,, S"""..,... , SI-, .... ' Efocll of oI~lk. ftt nfil
no1ch, Thi, i. g r.. u ~ cl erod ing open gnd oolin g "" .. .,. .. (>"; ,""-01 (!o,-.'.,.,...,.,.. ... Cot..,..
J
herd ~vl, Usi"ll lh. 'flCi",1edgo of lfl(1 ente rio " 1981, 2 ~ 6 Z'l 3
21, ull " : Ad"". "" " '. fore" Tn," dlog ",,;,
(fig 8), Th~se f>'lt",,1$ moy eJ, ibH mikj irreg..oiorilies ~~ f ,,"01 . .... C "",," 1956, 60'& 1<
and rofO<1 of roctn, 12. U'\G . .:....-~ SI\o,,,,,
S" ",o ";1",,10 , 0...0""
fOod ...p.o,,,
ood hcicl """" , .... Or-f>Od 19~
~21!l2
n . V'll 'io,.,loIfu.. .. ,'o.-lOlxool ......... I g"
""'Jo.+.. ''/8 - ;21.3-17.
1....,11', Sh,p;m. ho,.o, C .... 1.o. ood DosxI, 1'. Woo-reo. Horlie!d. 0-.1 Dolsbr Noool '"-r I....
,y""", 10-+1"" h 011....1< "",._. "'" J 0 ....... ". ..... , ' "'" J 0rl>0:I 1991 3'~353
11'63;3:;"-3<' 15. Wa ....... I1orlol<l ............ ,...... ,,~!.on'"' __
L 91"9<'>, v,..."....,,"" .. 51>:>,""
ond 5j-.p;.o, Ir>- ...... ~ ",,,I _>'G. Am j Qrt.oO l l'U :289.
",o r",..,.", ;, ......,..."". Noll Qrt.oO 19'1S . _I 1 m
m 26, W
,....,.._ 1, T,"""I, H'n.,... '''' H.o >f~" __
3, ';.+d \'1",..-. 3""'. ..... "'" "'p,:
v...".I....,,_ ........, f" .... 'l
""'~ ..., "PO ",", ' "'" J o.+od
~ ..... ,."-""", ,.., odoI _ ~ , A .. j 0d>c<J 11'87.1 11 116
1991,IH.15j 27, W,....." 1000""n, ~'" H'd", : AMI,>rIo 01 "',,,~.
~ G.obo< ,Tho _M'-o~""'rder. _ _ ond ..., U_ oo-y t...oto-,; . ..... )' 0.+"" 19<I~ ,
MoIoe:Io....,.._ A-. J O+ood 1963 . 18-.:;0 972C6
S. G.ooo. t:.Il.r. ..y ....., ho.... _ . fcdot. WoI<'-, 28. w. ,. 1'r"1:If", aod W, U'" _ Rooi ........ ,., ",001
"'. h.., h",,_ 0-.1 _ _III port.....
.... J CWw:.:II99J , SU-519
0.- to ...... '" _"".. , ~ood
0rt<>01981;536-"5 ~
_ .... "'" J

6. H,r ... l ,.,o 0-.1 V!IIn(I_. "od"PO'l"ll 1><"0"> Z'I \\\1_ C...-;n. Shoo. - CoIoodono .. 00<1 o-..:t....
lot ..-..IC<d._ '" '" ,100' 10 _.~ "*'- A... j .. 'noa........ W,V'. 11"i3
O'od 1987, 199JQ3 :;0. Wood.'d ];n," '_~on ' o", lu.d"r~"'. "od
7, 1i""' ..!o-<n1 v,e, enon "'od""" '''J ...;,~., 1.\\\. "". : """'db..b- ,00 """"..., (iWWI'' ' ' '
lot ""'x'''''''' '" " !''''; Io .100', ( ... .. " A-n J
0.. ..... 19a7 , 27'1_303
' " "!Ifd ,...,.., 01 "'""t~ "9 . A" J Crt""" I 9 91 , 1
8 H', ,,,,, War"" ..... Ho; .... : IJ c'"' .. ...".~.
"' ... do.og ~ "'R, .... J (MI.", 1ge6 ; <92_
"
.~
9 Jocoboo" ~ ond ...., ""'.odo.. ' o , _
'-II. "'" J 01iK>d 1979; 511-529
Ie ~ I.I', p,. ..... hob'I>, etio'''II;cal
;n fu,,,, ..
_""''''''''. A-. j CWw:.:II9~, ~9~1
11 I........... Do~"'. "'"""""""
.nd ~ 01 _ I
d... ..,. ood ~"lI"-" d"'R loot' ""'J
0ttI00d 19(15
, ' 31' 35
12. Wrt1Oo1<r!d Ilo'J " , ..... ~' ..o "~,"H;.,I
0..<1' ",, __ ..0 "V,-.,dlng Ioob t , /or, J 0 "",," 1 9a~
;'32.<35
13. Lo;,., ..... !101<_ """_"';01...,',,''''
,.... """"1_,...,,,. "'" j """"" 1989, <J2.~36
I~ ....."", 8<u ...... ~ <>1 '. ",. c/ol'*-. .... J o.1hod
1I'l10 ,.8-59
IS. M..,." o,d H''''.''g , BotrIo1...:L'ng ond
.... Ioa;--., ...... J 0.+"" 19M; 109.152
16. 0p0n!, Lo.""". ond r,i.... : EIIt<. cl ",d<og
'""tot. ....
_~ . ""'J Orrhod 1994 ,161 _

'M
17, r",fln W" (on"",,,,,,,,'1 Cot"oOo"~ " $I l WI,
ev ,.....".".198-6,
18, Rogon 0..0 So b.,.". , (".Odic , r>' .. _ ( '." II
"",Io<d",,,,__ "'" J 0 " ",," 19M; '\ib l\>9


f.- ~ ~'il ..,..J= ~
~ Jl,.:.s.::Jl H"':"'~
~ U;. J
Ofll""""'"
M erry popIJloIk>n lUrveyo ha.e
been corri. ci oul in diff&rent pert! of
the wo rld wit~ th e ob je cti ve o f
...-noting prevel ence of mclocdUl lon ond
omooonilc fl'eOtment need.. P~lence of
.,JocdulOon " estimated to b. hi~h., in
=- ':>ptd c.ountrillJo, compared to dMllopio 'II
. - un!Ie<.de.oe1oped counmes.
A numbe, ol Wd ......... b.n ccrd.cIed
""deI."min . the prevole"". 01 molocdVSion in
dlnn' rovYrios. The prevoio>nce ci rnaloc;duoiol1
...o<>g C hin "l. children wa5 ,"!imeted TO be
cbo~t 61 .82"'in c .tudy done by Peking
lWvetSity.ln OIl epidomiolovi<:al ,u""Yoi 1,028
cWdren COIned out 10 """.. !he p,evoIenc;e of
-*>cclosoon in Nig.no, ~""'S seen !hoi cho1dto'>
S4.0'lI. hod Anglu 0 = I molocdUICn cnd
I~ hod Anglo'. Clo.. II molocclu5en. The
prevo len ce cl mc loedu l ion ~mong Indi an
cftiIdren ha l beM reported to be os io<w en 19.6%
.. Madl"\l ' by Mlg lon i D.C et 01in 1965 and c.
~# "';"/ J~I ~~~
~ .fo!.:l J;~ ~
..:ro ~""':""'I
of
MOll '" 90% in o.lhl t.r Sidhu 5.S. in 1968.
Indian s nibi! c low il'l<;i ~ 01 "" ri c!ion in
molar reloll o n both in the me. ia l and <1 15101
di rection. OI lto-occ lutio n in India i. >'\Iry low in
con\ms!IoUSA (3.4% ... Whilesond 15'1!. ... 8Iocbl
and Europe (29%j.Cla.. 1I1 molacdu"on i. alta
muc h leu ptevOlent in India campared to Us.+..
N ~ .he rland. and Ke nya . Prevalence 01
ma lo cclu.ion in 0 ,o mple 01 Le bone .e
",ooalc ~ildren "",.I"und 10 "" chou! 59.S%. A
stI.dy conduced 10 determi M !f><> p,evoM C' ond
.,,," rily of ma lacclusiOl1 in Ara b urban ", ildren
of 13 to 15 I'OClI1 og e . evoo led!hot 85 ~nt
had Angle aossl molaod.... ian, 8.5 pllfCed had
Angle Cla,. II, OM.ian 1 ma locclu.lon, 1.7
perc .. n. hod Angle Cia.. II, Divi, ion 2
moloccl"';on,ond 1.3 pe~ belonged 10 me
Atlgle Clo .. III C0l1lQOtY. In" 51ud, <10M b, m,
Fed" ,,,1 Univel1ity 01 Rio de ..km"iro, 9""il th e
prevclence of ma locdu.ion in Br<"i l;.,,, childre n
wo o ,,"imetod to be 75.8'"' .
 MA$UREMIIT OF MALOCCUlSfOlI'
M(>locciu,i(>n and dento/ociol dolorm~1 ere
cond it io ns thot canst itule 0 hooo rd to the
mointencne 01 oro l hea lth a nd interlere with th o
Wil li be<ng of the p<!<Son by odWIfH ly olflKti"9
dentolo"jal o~n.,tia, mandibular function Or
..- The meosu,",,,,,,nt 01 malocclusion as a
publil; hoolth problem i. ~eI, d;/f;cult since
most ~nlic treatment il underloken lor
aellketic reo..,,,, end ~ i. ~ diflicuh to esrim cle
th l ""I nt 10 which rTKl lp<><ed teeth orde nle.lociel
anoma li e. co n, mut. a p.vchoIog lca l helO rd.
Molocdvsion r.o. pro""" to be a diff.:u lt e ntity to
det-ne becau$/> indi";dual per<;ept;ons 01 ...+.at
consliMes a malocdusion problem d,flerwideiy.
.... a .elult, no generally accopled epi-
demiologicol ndeo.-01 malocclusion 110. yeI been
de..;sed.
According to R",,,,, ,,. on 11Id", i. delir>ed
os 'a nu menca l ", Iu. de""ribing tf>e relati<) statu.
01 a population on " gmduofed scoIe with definit.
uppero:rr-,d lower lim''' "",do is designed 10 pe<m it
and foolilate comporiooo with other populations
do";~.d by the "'''''' criteria and metl>cx:l..:
Jamison H.D. (and McMillon R.S. ho:r...
proposed a 1m 01 requirement' 10< (an ideol
or1~odon~c index that can be uHd in the
epidemiolog ic st""i" 01 orthodontic problem
ol loll ows :
I. Tf>e index sho uk! be .imell, o=rote, rejo ble
and reprod oob"'.
2. The inde.. .hoold be obiectMo in nalu", and
r\eId quo~dcnowhlch II'IOJ be onaIped
by currenl.lotisIicol method..
3. Th, ind.. mu.t be .0 designed as to
<ffIeo .. ,tio:f.e bolweon hor.jicopp'ng ond nOf>-
hon<kopp ing molocclulions:
~, Th o o""m iMtion r",!uired mu . t be one that
con be performed quiddy by eJ<OfT1inon e--.
without special inslrudion in onhodontic
dog""",.
5. The inde. m ou ld len d itse ll to mod ilicotlor>
for the co llection 01 opid emi otog ico i doto,
regordi~g me locd us i o~ o th er than
1""'<'Q1tor-, incidence, --.my e g. 1Teq.......-q
01 molposillor>ing of indjiduol teerh. .
6. The inde..hould be usoble .,-theron patients
01 on study models.
7. 1he inde. should measure lhe dog," 01
handi cap, il eny and avoid cfost ilying
'melocd u.ion '.
HAHDICAPPIII'G lABIOl/HGUAL
OEYIAnOIl' III'DEX (HlD INDEX)
The 'Hondia>pping Lob;g.lroguol Devoab"" Ind",'"
(HLD Indo WOJ developed by Harry l. Droker In
"". Tho HlD inde, was proposod Ie l-eleCf
s';'jeds with ....... re or f-.:;,,..;f;;oppng ""Iocdusion
end dento loc ic l o nom c liB'. Th o indo> i l
opplico~e on ly 10 tho ".,,""'''"''! d.nti~o~ . HLD
indo>< "'tIl!he ~ ... t orthodon~c inde< de"g~ed 10
meet the odrrtinitlrnli ..... needs 01 prog,am
plann .... ,
Method
Th . th ree pia",," com mon ly um lor orthoOontic
ori entation i. e. Ihe $OgiHa l " lone, tr.. Frankie"
h<>ri""'IOI ple no end the orb ita l plane are th ~
OOS<1 for the HLD j~de.< ......... ure rneris, The ma in
intention of !he HLD inde>< is 10 measure the
presence Or absence and the degree 01 Ihe
hondcapcau$8d by the com~"'!he rndo..
The HlD inde.< il bosed on _en rompoo .... b.
All mOOluremen!> ere mode with a Baley g.oug"
sccled in milli mete ... The ..,von compone nt
co nditio n. 01 th e HLD ind e.>: a re ",plo in ed es

-
hJlIIalio <Ioviation.
... 000fliI0 in ......
IIn\b.4I ~ ill nn
..--
~biIo" nn
Ec>:P: orupiorc IJ(IItliorl
.-"'~
...,.. "
Cc..c/ilio n If. 1_ Ckft P%ro' Thi, cond ition
.. de<cnbed 0' rnolocel v. ion, re,u lting from
......... . trudurol deIormities in'OMng growth and
;;eweIo.pment of the mondib le ond maxi llo. The
_nc~ of cleft palate is indicated by on ..... in
_ ,eoord in g e""ri.
Corn/ition II Z - Trauma/ic D.wietion, ,Tho
-..motie deviotion. ref"aed to ore, lor e.g. 10,.
gl" prema<iilo oegmlIDl by burn' or by occident,
1"!/! resc lls c1 osteomyeliti' or o..... r ~ potr.ology.
The pre",nce 01 a lroumahc de.ioti"n i, 0 1.0
nIicoted by on '~ in the recording chort.
Condition # 3 . O""~riel , Th i. "ond ition i,
....,.u red;,i!h the patient in centric relationship.
The meo ...-emenl con be awli"; 10 a prolrud ing
Jingle tooth a. we ll 0' to the whol. arch. The
.....,.uremnnt i. read ~nd ro<Jnded off 10 lhe
-.,,,,t milli met...- a,"" reco<ded.
Condition # 4 . O"" ..rhle , Th i. me~,urem e nt
.01<0 rou,"" . d off t<> the neore.t mil li meter and
II I
r~"o rded . Re'~rSe o.~rbit. may e.xi'l in .am.
cond iti on, and ,hou ld bo me o.ur.d and
<ecorded .
Condition II 5 . Mandibular Protru,ion
TN, " mao. ur"" from th o labia l of th e lower
incisor to the lab.io l of the upper inciSC<". The
mea.ur""",,", in mi ll imeters i. re.cOtded. A r.,,'eM
ove rbite if pr~ 'Mt , hou ld be .hown und~ r
'overbite' .
Co"dition II- 6 . Open bite Thi. condition
is defin od a. 'the ab,ence of oed"",1cantad in
the onteric< reg ion' It i. m~,ur"" from edge to
edl}<' in millimeters and recorded.
Condition 11 7 . Labio lingual ,pread : To
moo.ure Jabio- li ngua l ,preod, the Boley gauge
CiS""
i. to dete rmin e tf>e extM t 01 d. violion from
a no<TTla l oreh . The toto l di, tonce between th e
mo . t prottuded and th e fingua lfy d i.ploeed
anterior i, mea,ured .
In th o e.ent 01 mu lti ple anto-rior teeth
crowding. ~II doviotion. f'om the normal arch
.houId be moo.ured for "bio-lingua l 'p<Md, but
only the mo,t ",ve re individua l meo.uremenl
' hould be ent.red on lhe i,Jo . Th i, is don~ to
g..... the potlentthe benefit o/the grectest deviotion .
Th e obov~ e.xpioined HLD inde< .y.tem
i, c modifioation 01 a~ ea rlier u.ed HLD ;nde.
Th " HLD inde< u$!Od prior to th o new HLD i,Je.x
i.e. before 1960', made use 01 weighting fado"
developed by tria l end ~ rror, Th i. i,J~x ')"$tem
hod nine componenl cond ition, mea. ured . The
candition, observed ond scares assigned are ,;ven
inTable II.
A '''ore of 13 Itentotive) end Over
constitute. a 'physica l handicap'.
T..... fol lowing rode, ore u.oo in the HLD
index.
o Condition ob"' nt
X Condition present
M Miud dentition (10 be indlo:ned a J . Open bile

A
,-IClinical ow",,,,,1
. """"
5. TOOIh disploce....,.,t
D : a i~ical di>OPP'O"o l 6. Congon itolft miuing teeth
, 7. U,*"pted (;fI nt", 1incisors
ORTHODONTIC TREATMENT a. Marod ibuia'p'OIlnoth iom
PRIORITY INDEX (TPIJ 9. Monclibuia, retrogr>e!hitm ond
10. l'bsIerior cn:ossbire
The Orthodontic 1,,,,,10,,,,,,. Priorily Ind. (Tl'g ".lO TI'l I, bo..! on a scoIe 01 '010 3', '4 10 6'
d_'opo.H,y Gl(linge' R.M. in 1967. Tho Tl'1 and '.,..6', The TPl h!ridsrogMllm(nnomitl1inl
VItI$ 0 I'lt"i" on/modificnlion mode by Grainger
percenloge of pr8'IOience, relalille to oge .
..- "'" eooi"" dev.!1oped 'Maloa;lusiOl1 Severity TPI t<Xirel con be _sed in!he ronges
Estimcre'. Tl'1 i ~ bo d on tI>e study of inter
of :
relo!ionsh ips of 10 mcn iles!ction. of mclocdusion.
0 2.5 - l~
TPI inc lud ........, synd'Orl'le$ ord que>ntifie. orll l
2.5 4.5 Middle
lro!er -<&IotOnshipJ in '" rons d!he _ sync!rorrc. 000.. 4,5 High
The 10 mon~es1otio ... d molocclusion lTI8(l!.u~ Tl'1_ os a guide Iorepidemiclogio;o)
in TPI 0 ... :
our.eys 01 pcpulaliono 0'0 wdl 0' on 1""",_
BOmola, nolotionohip for SCfMning. TPI has been u..! in notional
2. Moxilla<yoverjet
slvdifl of ormooontic need. of children .

liIa.It! . .. f ronkfl (te l) CI:mI tr. r!.ImbIr c Ie8tt dosfiad .. 1OII:Id

'I$l;1!1 i dW~UrlllWliooilq P ' "
(II or nono).

baIl~n"""''''''' i _od.Tc:dl'''' '

<leIned~ . 1,5mnor, 1.!<rm. TDC(tI,*b1111Cn1d
<:pJar/i11l"ely ,.45'
or >45'

Handbpplr1g ~o Ungual ~ i'Ick.o:iI dIIt_ ( .. or ilCill), I"a.maIC

Dt'tlllion Indtl hy DfIklI. (1t&CI) dMCi:oos I.... roo:w.). CYIIjIt {~~ (!)Y1't). man:lW
~!tmI).""' qlII\t:ilt l~ard~1P'wI
(1I'DAWWIIIi1d"~' illrrwn).

MeasIn_iIQoII"'riIri:r~CU!P
i"lfVi"''' WIIbI~"~OIWjIt

I' I
MoIoc;cIuolon Sevtrby EsUm"~ by
~~j~l)
Sf..., ~1<Idd6"ned meMIIMmOIIIJ:
1. Overjtt2.~. 3. ArteriH open ti;te ~. CongenlaI~
~ ma>:IIIar! irdsofl S. FilII pe!rnar.oo! rr<i<o" ,ei,.......rtp
6.l'<I$ItIbrtrwl:1itil 7. Toc<h~ 1Id.J;i.oo
poIe!'I ~.

Six mJfoccIlISiOIIljllldromu WI" deflfltd :

1.PosJijyf~jt! ilIld.rniiH open bile.

...
2.1'<1$11\'e o.erjet, jlO$iiYo 0I'$f bi: <fsIi,i nn'a' rQal:O:lrohip
.,..; pos!efoI Ci"OSSbIti wM1 ~ twIl OOWII> rroo:IiII<iar

3.Nega1ve overje!. rt.esial molar reIa:~, ilIld ~teIior

crossbi:e1fliltima:<lll.ryl9ij\!f1irQtJall>~teeft
~ .Co.varitaly rt1ss;ng maritaJy 1r1dJo(s.
S.Too1I1~
61'i!nlliIIl:>:ltl ~a:::errm.
HIM W8lg/lted and df/iMd IIlIIISUI'!IIIMts :
I . Molar (iii,.; oo~. 0Yerbi!~ 3, CNe1iet~. Poo!o;rior crO&Sb.te
5,Post.rioroponbite 6. Tooth~ 7.MidIioe
relation 8. ~>:irny media~dWtiITla 9. CorlQri.o4y ~
marllary r..:lsor.;.

S .." lMIoCduJion IjIIIdromu doI/mJd,

tOverjel ilIld (Ij.>lf1 tie.
2.0:sIai rmIar rdaloo, O'/fl/jtI,~, ~crossbito,
!!die <iastema, Q>;j (I'IicInI dIMaion.
3,CoogenI8lly ~ ow.iIal)'iI'Idoora.
~.TooIttOspillcamen!IIIGtIJaI:ropolria/).
5.1'<1s1er1or opoo bile.
6.MeslaI molar re/ali):l.~, O'/wbiIe.postfI/iot' aossbI:e, mana
~andJTidlinede>ia!ion
7~ """" ,reldoo."'>9<1 d\l<tib::rl ~ Ip>IonIialI:>ofl
<l$pI~). aOOl;<lII1~ nt

-
Otklrl!<t $COI'Ir"G schemes &IQrrns lor dlferOli slago.l!; 01 derlaI
~,:~~1IixOOdIn'ion.&potrnant<t.

Trutrnenl Prknhy IndeX by Grillnger!I961j II "aigJIooind<i.llrro~,

\. LWararteriorseg!!I')IIC overjet
2..u.... ~noroegnent<Mllj<!l
3. o...tie of~ w ...a_1IItIOrI:)(
4,~C!J<!I1bi1ti
~.~~ oIMsors
6. OisWm;.Iijr fIaIion
7. Me!;iaI mol", reiati::rl

1\7
 ,
Seven maIoccI:Isbn IYfldromel were defined ,
1, Ma.J"'l'"'~ .yrd-orno
VJlertite
l~
4.~-lII\btt
5P~
6.118xt1aJy coI!apsIi syll<Yornfi
7. ~ rrissingio::isr>rs

Handlelpplng Malocclusion Asse .. ment w~ """""',MIMI! C(I"ISi$t <t llYn pall! :

AtcOOl by Salzmllnn(19118) ! , ~:':-M:h~"..,....teen.~ rl)jajon,
'&p;ojv. ,
2. 'rlIi.! rarch de>'la1on. overjet<MItite, crosl~, <!piJ\ i)M,
~dtv'i:n
J.SO: ~deiWJ1a::1a1 deforrriIies.
1, FIIdal IJ>j"a' ~
2.l!lwa1 ip palatallO maalali' incisoo
lOo::lusa!~
4, FlrtIctiJrWj8'II'imbloo
5. Facial asymmetry
6:Speech~,

ThislWlcanrxiybe as~Otlllvt paJ_,

 " -. ,
t. I ..

Diagnosis

O
rthodontk d iagnosis de a l. wit h CompreMn~ ve o.rthodn n!ic d iogno,is is
recogn it i on of t he va riou s e,,,, b lish. d by uo" oJ ce rta in cl inical impi e", ""j,
chorO<:leristic. oj the mal occlus ion . co il ed diegne. tic a id., Orthodonti c diog no,ti c
It ;ovolvo, coll ectio n of pertinent data i ~ a oid . o re 01 two type. n ",y o re the e"enti ol
~t<I" motic ,,", nner to ;",Ip in identifying the natu r~ dio 9"",.tic a id, c nd th ~ , upp iem e nto l d iog no. tic
and OJ use a lthe proble m. a.Mdortic di Qgr'IOO~ okis.
sho uld be bo,ed on >our>d SCiM!i!;c kF'lOwi edge
comb ined at time. with d inko l e' perience a nd nSE'mA~ DIAGNOSTIC AIDS
com mon "",..,_
They are cl inica l a id, that ar~ con. ide,ed ' e ry
Oiogoo, ;' invo lves deve lopm ent of a
importont io ' a ll co"'._ They o re >imp le o nd do
COOlIlrer..n.;ve doto bo.., c1 pertinerit inforrnoti<>n .
not '<>qu i", . ' pe nsi ve equ ip me nt. The fo ll ow ing
The data is derived from case hi, tory, d;n ~o l
ore the " ,,,,,,tia l d iagnoMic o id.
exom ination a nd other d iagno>lic aid, >uen as
1. Case h ~tary
stvdy ca . t" ra diograp h, and photog rap h. A
2 Clinicol examination
lofnotOoopproo<;h to the e>om ination j, _ tie l
3. Study model ,
10 . n, ure thet ""thi ng i. ov...-lo:>otcd. The p<J rpo5e
4. Cer1<l in rad iograph<
01 th is coo pte, j, to desc ribe a nd illu stra te
oj Pe,io p ico l radiogroph ,
funda me ntal, of gotheri "ll o nd in torpreti ng
bJ Bite wing
d ir>ical inform<l tkm yi elded from <I diagnostic
cJ Pano ramic
""erOse
5 Facia l photograph,

\\1)
I
SUPPLEMENTAL DIAGNOSTIC AI DS
They ore c;e rtoin aid, wI1ich are not ..... ~ti<ll in
all 00 ..... They rn<l l req uire spec"lized .-q uirrnent
lhol on overoge denli st mcry ""I po..... The
,upoplemen!(ll diog no.tic oid. include .
1. Sp"ciolized rod>ogrophs e g o
G. Cepho lo melfic radiogroph.
b. Oeeiu.o l intro oro l fil m.
C. Selected !otero l jaw .iew.
d. Cone . hilt techniql1f>
2. Eledromy"..,roph ic .xami"" tio n 01 mu.d e
octivity
3. Hor>d.wrist md iogroph. to o.. e .. oon e ag e
o r matu rotion ag e
4. Endocri ne te. t.
5. Eslimatio n o f 00'0' mernooli c rote
6. Di09""'& ..,tup
7. OOO uK'grarm
CASE HISTORY
Co ... hi.tory in.ol"". elicitir>g or>d record ir>g o f
rele,"" nt inforrn<l lion from the patie nt "r>d pa re nt
to oid in the 0."", 11 diagno";, of th e co.e. Th e
inforrn<ltio n i. g<llh~ red from the pati ent or>d
pa rents .
Person,,' de tails
Nome , The pati ent'. no me . hould be recorded
for t he purpos e o f eommunico tio n ond
id ontifi cotio n. Moot patie nt, li ke oo in g ca lled by
the ir ""me . Add,e" ing 0 poti Mt by hi. or her
"" me ho, 0 benefici{]1 p,ychalogico l cffoct os
well. It gets the patient to think tho t tt.e clinicion
il int~ r~~t~d in hi~ "", II be in g. In cos~ of chikJren
it i. wi,e to record thei' pet nome. ,
~ ~: Th~ pati ont' , chronologica l G(Ie sOOukJ
b. re cord ed, ,
Ago co~. id erat i o n h ~ l p. in
diogr\O.is o. _ II o. treotm ent plon ninQ , The r.
ore certoin tron. iont conditions thot ocelli" durir>g
develo pme nt toot are con ,.;dered normo l for that
age. Th u. krmwi ng th e age helps in identilying
and anticipating t hese condition . In odd ition,
there are certoin t"",tment modo litie, thot ore best
corried ovt d lll"in g the growin g age. G rowth
mod ificati o n procedvre. u";ng Iv r>etionol and
orthopaedic opp lio.-.:e, are co rried 00 1 durir>g
th e growth pe riod . Surgioo l re o i"" p roced ure.
ore beo! carried out oft. r th e "",,,,lion of growth.
Sex : Th . potien/', $.' shovld be record ed in th~
ca se hi,taf)'. Thi. i, im portant in ploM ing
treotme nt os tr., timin g of g rowth e.ento s",," os
g rowth sp urt. is dilfe rent in mo l~. OM lemole"
Forna'", "''''''f(
prec.d~ male. in onslOt d growth
spurt>, pvb.erty ond term i"",tiO<1 of g rowth .
Address ond occupotion R~ cord in g 01 t he
addrc" and occupatio n help. in """I""tion of
tt.e ,oc io ,,<;onomic ,totu. 01 th o potient ond
po ren!" This he lps in s!l.di(ln (If an appropriato
opp liance, The add re .. o lso h ~ l p, in l utu,.
corrc.pondero::e.....ch G. to intimate appointment,.
ChIef complaint
Tr., potient", chd compaint '00u'd be recoroed
in hi, or r.,r own wo rds , This h. lp, tt.e dinicion
in identilyir>g the priorities an d de. ire, of the
potien!. Most potient> ....,k orthodo ntic co ,~ lor
reaso n. of e ither estheti cs or impoired fvnction ,
M edIc'" history
Before orthodontic treotmen! i, ur>den:J kon. a full
med icol history i, recorded . Fortuootely.ery lew
medica l co~d itio n , co ntm indicote the u.e of
orthodonti c ""pl","c." Moo! of the ... oond ition.
rna l requi' . certoin p recovtiO""f)' me",ures to
be token pior to or dvrir>g the orthodontk: thempy.
It is odvi",ble to deley orthodontic treatm ont in
potie<1t, . vl/ering from epilepsy until it is controlled
Patien" witf> hi.tory 01 blood dyscrm'" rMy need
speci a l rn<l""'gem. nt if e<lrodions ore pla nn ed,
 LL~
Sex !M! !F! fileNo

Phone Number
---------- ------~~

DIIntal Hlllory

Extraora) EumlllBllon

foclalOivergence Sh,peolFace

F I ~l'o~'" I S<rllio,tl
II jRwild 10ViI

facill Symmetry
l II AS)'IM'IOI<Ioal
... "'""
~E"'nt6 II
S1u oc ,;,oI
I- I- I
N..oI.biai AJljlI, Mentoll blal 9uk;ul

INormal I ~ 1tou1O IObtu .. II INormai i .. fllalloW II

>$.,-"

Ilf
 TOrlgllll ~ TongUi Aellvltv

!No'mol Ism' i'- I I IN()r)QI ~ TOI1$lf I'IcII!Iir!ol

T.M.J. Frellllm

!Nor~. II Pain I C!l$~ I I IN orJ1lol i Abno

'''-

Poln 01 c!osurl BrNthlng

INO/flo! .
1.1-" 1 1 0J,41l'l ~ I lOr. , ~ N. w 1"-' I I
Intraoral examinatIon
,

@@@@@@@@I@@@@@@@@
t:: . 8 7 6 5 4 3. 2 .1 11 2 3. 4 5 6 7 .8
'i, @@@@@@@@@@@@@@@@
'

~~~~I ~~~~~
@@@@@@@@@@

, OVerjet Ov trb ~ e
- - - -- -
UolarrttMlon .- '-_ _ _ _ __

.;.
Delalls 01 m~~.Wsion present

O cro".I"g o~ blto W Rotollono

O S~lClngl
"" .;i.e., "i(j"c" ..""" ,,"
o Dttp,1011< 0
c, ' ",

. ,,,,..:. """""/.",,,,:.;.
,;,~~:-
i'rQclln. lIo"
,'-'--"~,,,,,--~
0 Po. ltrtor "",-"bilo
"""- =-~
, 'I
 ...- ....
DOco'"". n~I""'" O I'I ".h1 rU h. 0 . . . . . . D ...... . .
OI'gIlotli

.
rr_t Obttetl'tlll

,-""

I CMWllIIl th! IrNlIDIflt p/In dHaibed abcWf by my CWhodoIII/$/

Iftd "'.. twn nDIified 0111 P'"s"*' ... .n.ru Ind ~

120 ' Orthodontics The Art and Science
O",beoc p<ltients am <JI'odergo orthodooticlhera py
;f il i, under conlr~, Polien!> Oovi"9 rheu molic
lever or cardioc onomo li e. requ iro ontibiotic
co veroge , Ch il dren who Ore s. vere ly
ha ndicappoed e ith...- mental ", or phy>ica ll v moy
requi'e specie l roo nagem ent.
Th e med ico l hi,ta,), .hould inc lud e
inforrootion on dru g u.ago. The use 01 cetta in
drug. like asp irin mO)' impede orthodontic tooth
movement. fulients who are wlferi ng from ocllle,
debilitati ng coOOitio ns such a, .jral fove' shou ld
be olk>wed to rec:OIIC' ;:oiorlo inili<>lin-g orthodontic
treotment,
Dental hll!ory
Tn., dental hiMc:<y of tr.., poti~ nt ,hould jnc lu de
info rmal ion on th e age of er"pl ion of the
d ~dd u ous ond permorHmt t~~t h, hi, to ry of
""Iractioo, decoy, reslorations 000 trauroo to tm.
dentition, The post denta l hi, to,), help, in
"""""tion of potienls arid p<l rerh attitude towa rds
treotmer>t.
P,. -n.t.1 hl.tory
The pre-nolO l hislOf)' $hovId i ndud~ inlormotion
on the cond ition of the mothe r dcn1ng pn>g1>Jncy
and lhe type 01 deJive ry, The use of cettai" drugs
like t/lo~domide or affectation with some infeclion.
durir>g p-regnorq li k!. Ge,man ~Ies CO " ""v/t
in co ngeroikll deform ilie, of Ihe child,
1"lormotion shoul d be goth . red On the
tvPi' of do live,)" Forcep, del",.".,- pred ispose fo
lempororr.and ibula r jo in l injurie' which ca"
mon ile'l os marked mand ibu lar growt r.
retordatioo .
Pos t natal hIstory
The post - nolo l hi,klry i ~c l ude. inlorroolioo 00
the type of llOed i"ll ' presence of hobib 000 on *""
mil estone, of nomHll <lev.,lopment
k
': ,
Family hlsto,y
M;m y malocc lusion, .vch a. ,ke leta l 00.. Ii,
CIo.. 1I1 roolocdlJSio-ns aoo cOfJ9<'nito l COrId~ions
.uch o. dell$ d lip and po",te ore inheriled . Th u.
Ihe fomi ly histol) .hou ld r~cord deto ilo 01
mo locdu, io n ~xi"i ng in ofher members of the
fom ify.
Gf;HERAL EXAMIHAnON
The generol el<Ominotio n comprises 01 lhe general
"".",ment of the patient. AI1 obser.-""I c lin icio~
u."" lly begi n. hi' genero l "<"minotion O. SOOI1
'" the pati ent enters the cli nic,
H. 'ght a nd weIght
Tho height and weightof!he patient are rec.orOOd.
They provide a due 10 Ihe phy> ico l growth ond
maturotion of the pationt which may he.e denio_
1<>::",1corn, lotioo ,
Ga It
it is the way 0 perron walk" Abnorma lilies 01 (jOit
ore u, uo lly ossociotcd with neuromu,cu lor
dii order-s wh ich may ho." a dentol correiotion,
Pa.tu,,,
Post"re refers to Ihe woy 0 pe"on . tond .
Abno,mo l po,tu re, con pre dispose to
malocclus ion due to olterotion in mo<j ll o-
rnO rid ibuIo r ," lotion, hip,
Body build (phys Ique)
It i. possible to do\,;iy the physique into one of
tn., 1oI100000g th"", tvp"s :
o. Ae,lh etic: They hove 0 thin phv>ique and
u:!Uolfy pa"~' no"ow de nta l orches.
b. Pletonc: Th,,"! ore person. who oro abo ....
They genera lly MV" lorge, 'q"ar" dental
arch~"
,
 OHhodontic Diagnosis IZI

c. AJhletic : They lin! considen!d normolly bo,.;l., da"'~ca~on to dosli/y lace into II", following
being ... ilhe' Ihin no, obe..._ They he.. IIY=rn- :
nonnol Wed denial ora-. a . Me>optOSOpic : ~ il an aver_ or normal
SheJdon hos dO$<iI>ed the oe ... rol body Iocelorm.
oo ild lnlo Ihr" types : b. Eurvl>rosop>e : This type 01lex" i. broad one!
o. Edomorp/1lc: Tol l ond th in phl"'iqve
b. Me>omorp/1ic: ........,"'ge physiq ue
Co Endomorpt,lc : Short an d <>be ... p/1ys;que
c. '''"
L"Ptoprosopic : It il 0 long o nd no rrow face
f~

EXTRA ORAL EXAMINATION A.se .. ", eltt of (.e/., .y",metry

$/1.". or t". hu d
Tho heed CQn be dcl$if"oed rio one olthe /oIo..;I'Ig
three types: Ilig I)
o. MeKx:e-phclic ....~ .ho pe of heod , 1he1
pos .... nonnol denlo l ormes.
b. Oolicocephollc : leng ond norrow heocl.
They hove _rowdentol ordI ....
c. B~phollc : Broodendsho"heod,
he.. brood detIIol c",hes..
Tho poIieni', Iodel symmeh"y is .....mlned to
determine dispropa<bO/ls 01 the lece in 1roRM!<1e
and . eo1icol plones. In mos' people .he 'Oglrt end
Ie~ .ide. ore not idenlical (fog 2)_ nu.... ome
deg ree 01 o$)'mm etry Is co nSidered norm al .
kl""melriel .hol ore g'o .. a nd ore
dclWl eosily sl>ould be reconJed _Gf'tlS$ 10001
a",mmelries con occural a ..... ul. 01 :
0_ CangMiloldeltcb
They
b. Heml-Iocia l OIroph, I hypertrophy
Co Un1olero1 co,qlo,onlcyloois end IIyperpbsio

FIe/II ro,m
Alimple "'elY 01deKnbing the Io<:e is Ie dalli/y it
os either,.".""d, ".,,1 or sq uare. A more Id t ntilic
F.CI.' PIOtl/.
TM Iaciol prolHe is """"'ined by """"in9 tM potient
fro m Ih e , ide, The foc iol profi le heip i in

\ ~\
 A 8
dk>gnosing gro.<. d~vi a tian . in th .. ma.i llo_
mcndilwJlor rc!otion,hip. The profil e i, o!Se $$e d
by join ing 'f.e followir>glwo refe re n~e li M.:
I. A Ii "" pning the forer..oo and the soft Ii..""
point A [deepest point in curvoture of upper
lip).
2. A Ii"" iOin in g po int A and trw, soh Ii",,,,
pogooioo (mo. t anterior point of th e ch in).
Bo>ed on the relationship between the$e
two Ii""', three type. of pro/il e. 8xi. t.
A 8
i
Straight p rofile - The two line. fo<m a nee rl y
$lro ight Ii"'! Ifig 3_0)
Convex pro/ile . The two line, form on or.g le
with th e concavity Iodng th o ~"ue. Thi. ki nd 01
profile occurs a. a (e, ul t 01 a pr"9rloth ic moxill o
or a retrogr>Othi, rroor>d ible o ..,en in 0 Cia.. II,
Division 1 mc locduoion {f;g3.bj.
Con.::ove profile: The two refere",," li_ form
an m'9l . with the convoo,ity toward, th e Ii """
c
 Th j. type o f profi le i ."societe<! with 0 prognothic
maoo ible ora ",trognathic maxilk, c. in 0 C ia ...
III malocdu,ion {fig 3.e).

FIO clll t diverg enc e

Focio l d ivergooce i. defined os a n anterior or

posledor inc li nation 01 the lower foce r. lotive to
the fc:>reheod . Fad,,1divergence can be of th ree
type. :

AIlterior diYerQent : A line drawn between the

A fore head QOO chi n i. ind in "" ont~ ri o rl y toword.
Ihe ch in {fig 4.0).
Po,l ~r ior d ;v~ rgenl , A li ne d rawn betwM n
the for.heod oed chin , Iant, posteriorly toword.
ch in (fig 4.bl_
I '" Stra ight Dr orthognafh ic . Th e lin e betwee n

~
'. ' ,L \ th .. foren""d oed ch in is sIroight or perpe<ldi::uklr
to the floor Ifig 4.c).
The Iociol diverg Mce ;$ to 0 "''9<'
extent
infl <JM,~d by the potlen!'s ethn;,; ond ro ciol
,
" bodground,
,
Auenm e nt of antero - po. ferlo,
B ' e I8tlon. hlp
JIJW

Th .. ont"ro .po <!e.-ior ", Ioti on,h ip Mtween t""

c of tke forefi nger or the hond pam downward.IRg
f".g 4 f<>do l d~.,~""". (AI "",,,,:or D'.erg."". 15)
,.,....'" o.... 'Ii''''. (q o,,""ol nalhO;
upper and lower jow c""' M ossessed to a C>! rtoin
.<I~ nt dinica lf,-. Id"" lIy tho maxillary .keletol booe
is 2 . 3 mm lorwa rd 01tho mandibu lar skeleta l
bo~" whe n the teeth are in <xc lu.ian. E>limotion
i. done by plocement of the index Clnd the midd/ ..
fing ers at the .olt t'''uo point A and point a
re.pectivefy, This can a l", be done in the some
wa~ af" r retrocti ng th e lips,- In skeletol 00 .. II
patients, the inde;( finger" anteriorlo the midd le
fi nger orthe flond points upword. lfig 5.b). In 0
skelelo l a"" IUpotienltke middle finger ~ ahead
S_c) _In 0 potient with Cla,,1 ,ke leto l pot" fn 1""
hand i. ot on even leve l.lfig 5_0)
 A B

.... """_<h.,
f>;l 3 As .. ,,,,,",,, 01 ""' .. 0 _Ierior
b, pIac.monr 01 tho
;..de.. 0<Id .... m<ldle li "ll<" '" th.
wit Ii,,,," ""'"f A ond ,,,,,OJ e W
CI"" I ... W ",,,,, ... hond ~ 01
00 __ ~ . IS: In C.", I po';."" ,
... kGnd po;nt. ,..,..."d . ~ 1 1n e lm.
I I poh""' ' "" ~ point, """,""",d,

plan e. m ~et b~ l<>nd the occ ipi ta l re gion, it

indkote." low cng " ",," Or a fIDrironlC l growing
c foc." If the two pic".,. meet enter\:)( tothe occipita l
'. gion iTind icate. 0 high angle co c< 0 vertical
A.uum,n! 01 ve,t/csl sk. l"t.1 growirog Ioce
rel.!lons"/p
Notmo IlV, the di. kmce from 0 point beJwe&n the
eyeixows to th 8 [un ctiOil of the ""se with upper
lip wi ll boo equol to th o di , !o",," f,om the lotter
point to the uOOe r side of the oh in . A mcrkedly
....duced Io"""dodal ..... ight i. a>SOCicted wiln deep
bit ... wh ile i ~ oreo d lower fociol height is
cuodcted with onteriC>( open bite .
The vertial l .keletal ~Iotion$ hip Can olse
be 0,",,""" I>y .!odying the ongko brmed ""tween
!he bwerborderof the mondiblo ond the fronklort
horizoolcl plene 10 li ne between the most wperior
po ;"n! of externa l cud itory ";"",IU I ond inferior
border 01 orbit) [fig 61 _Normally th e two pl.",,,.
int~r'$ect 01 th e occi pital " 'Il ion. In co,,, the Iw<>
EvaluatIon of fa e/al proportIons norrno l lip, th at /o il to form a lip ,ea l duc 10
A~ I proportioned face con be divide<! into th ree procli ned upper ind >orl_
eq uo l ," ~ico l th ird. u' ing fo ur hori,ontol p lohe. Eyerted lips - They oro hype rtrophied lip. with
ot the leve l of the hoir liM, th uproorbito l ridg~,
weo~ mu>cu lo rtO<1ocity (fig 8,c),
the ba", of the nose and the inferior border of
m n_ Within the bwerface, the vp po('\,xc up ;e,
o third of th . d istonc. while the thin ",,~ pieS the
"" t of the .po:;o {fig 71_

Examlnlltlon of lips

Normolfy the upper li p COve r$ the e n/ir. Iobiol

.u rlocc of upper anterior> except the incisol 2 -3
mm , The low. r li p co,. " th . erttire Iobio l surfOC"
of tho """"' r onte rio" ond 2 . 3 mm of the in<;i",1
edge 01 the upper o nte r""" Up. con be do"ifi...:!
into the fo ll owing four type. :

Competent lip. ; The lip' ore in ~ ight conted

",11 M t he mu oc ulcture i< relaxed (fig 8_al _

Incompetent lips They are morp ho logica lfy

short li p, which do no! fo rm 0 li p _ I in 0 reloxed
sla te , The li p sea l con on ly be och ieve-d by oct,,"
controct ion of th . pe rioro l and m o nto li .
mu>cles (fi g 8,bl ,
f ip S A" ..,mot of tf . I P' IA: Compo ",," ;P'
Potentiolly incompetent lip . " Th ~ y ore :,1 1""""0.,''''"'
lip. (C: ~"...., I'p'

1%
 ....,Iocclu.iord while ,ecessive chins er,. common
in 0 .... II ",erlocdusion

Nuol.bl., "nt'.
It i. the ongle formed belwee n the low8'/' bard" of
til. nose ond 0 line ~ !I.e inlersection 01
no ... ond upper lip with th, tip oIth,lip (lobtaie
wperiuo) (fog 10). This ongle i. normally 11 0 , k
.""'ucel in polienls hovin" proclined upper
o nl.riQrl 0' P'OIInothic mOKiIIo_ ~ increases in
patient! witII rel!Oljoothic moxiller or ret,ocIined
f -a 9 ",," ,ID/,b 01 " I", m""i llory ontenor. .
"",'n,,"on of th" no..
n... <\01810 a ""Il'" e>l"onl conlri b<.J'es 10 h, esThe!k INTRA.(IRAL EXAMINATION

,
. <Joe_
oppecuO'lCO<r.<J "
Nwe size : Noomolly Ihft now is one thi~-6I .,. .. I""tlol> o f t Ol>gue
IIlolOkOlfaool heg,. ,.".... h:!w r.... '" 10.- bonier ~Ime. oIlheloogue con Upoe1lhe _ _
rJ chin) . balonce ond equilibrium Ieoding 10 molocdvsion.
/<Ioi(11 to/l!o~t , 1he shope 01 the con be
r>OH Pra..,nce 01 on e.ce..i.e ly le'ge 10nll'" il
, trc i;nl, Cc nVil. or crooked a , 0 re,u ll of 00>01 irldiceted ~ Ih. prt'sen<:e 01 imprints ol!l.e teeth
inju ries. on th e 10t"",1 me rgi ns 01 th e toog ua g);lng it 0
sc.alloped oppeorc nce.
NosIri/1 , Tiley ore oval and .hould be b4iol.rol~
fY'I'metricol . Stenosi, olthe nosmi,....,yindia>lft
imp<>i,ed nasal b""""ing.

E.. mlut/o" 01 ehln

WoenlOlobial ,ulcu< . The """'lo-lob~1 WIcUI i<"
conco:rvily see<> below In. lower lip (f'll 9). Do.ep
mento lobiol Ivkv. il oeM in CIo II II , Dil'i' '''n
1 ma l occlu ~oo ...n il e it i .no ll ow io bima>J ll ery
p(QfrU~en.

Menterlis erd;v;ty , No rmolly th" m"ntoli.

muscle doe. not.how ony conlrodion at...st_
Hy~rodi'" mentolis octivity is - . in oem.
molocduslon< ouch o. Clo.. II, d",isloo 1 coses.
~ cause. puoo" ing 01 the chin.

Chin po<;I;on and prominence, Prom inent

c hin i . u.uo ll , " " oe ia ted with C lo" III

., ,.
 A patient whose Iongu .. con nood'I It.
I:,;~~,:::~~',::'~,:: :::~:
10"11&d10"9"".
frenum .rto uld be exomin Th&
lor longue
potian!. n(N in g to ngu e ti ~ The re il on
",tion in !he re.Tir.g tOl1g ue po~~O" o. wel l
... impoltment of Tong .... m(r>'em .nt.
I ".,,',,''', of ,,,. po/alt
~ polole should be ..... ml...d 10, the
VCI,iolion in polo tal dept h occu" in
o ..ociotior1 wilI1 ""notiO" of loc;,1fom,. /oI,ost
doli colooo l potien!> hove deep IXIloTc.
!:L Prese nce of swel ling in th e polot" co n be
indica""" of on impeded tooth, P"'""na! oi
cysts oror ..... bony pathologies.
Co MutOSOl ul~ion and indttntation. ore 0
"""".. oIlrOumoli<: deep bite_
o:!.. Presence 01 cW!. in the ~""" 0'" OIKCioIed
with diKon!;"".., 01 the pIllet. _
... The third ",,"oe is ,," uo lfy in Ii"" with the
conine., Th i. is u.efu l in the " .... ,ment of
maxill ary onterio , prod;""!i"".
... mlullon of ,,",/yo
;;", gingiYu >hould be ....,mined lor inRommation.
~nion and othe' mucogingivol I."ons_
"':0"' """ d pOol' orol h,g....... is vwolty osaocioted
gerlll",lizod me'g inol 9'ng ;';,,,. ~ Is ." ry
O!Imn>O<1 to fi nd o nlO!'rior rTXlrgin ol g in g ivitis in
...,.,th breoth .. rl d .... to dry""" of th e movTn
a:wJ>ed by tn~ ope n lip pos,""'. Presence of
~~c oc;du.ion i. indicot...::t bV Iocollrod
;.ngiYol recession . Abnormolly hype,plo.tic
gingiva is __ in patients using <:enoin dn.og,
Me [);lonlln.
um/nu/on 0 1 Ir. n.1 attacltmeJlt.
The "",,,xill ary lab", 1frenum con ot lime, be tnid ,
Sbn:>J. cnd attaehed rej oti""ly low. s...o, an
ottochrnent prevents the two moxill0'Y ,emn;ol
incise .. from oppowi",OIino eod> oiher theteby
pred i>pOSino to Mid li ne d'ru!emo
Abno rma l fre no l otiacnm onts ar",
dkl gnosed by " bkJnch te.Tw;"'", tne vope r li p i
. tretched upw<lrd. ond outward. lo r a period of
fimo. The presence of blo~.chin~ in the region <:Ii
!he inhor.den'ol pap illa i. diognostic of on
obnonnol frenum.
An abnormally high attachment of the
mondibulor lob.,1 fref' ..... ton couse rocesoion of
the gir>g i.-o in thot creo.
Exam/nat/on of f onalla and "deno/If,
The .i..,and degree <:I infl am mctioo ilon , <:I tI>e
1011$01$ <hcmld be emmined. Abnormally inflamed
1011",1...,,,,,, olte,ation in long"" and jow po$IUre
thereby up<elling tne oro-mOoI bolo,...,,,Ieod,r.g
10 molocclusion .
AS5usm.nt 01 fit. If.nfltlon
The dc nto l.yolem is el\Om ined an d th~ following
detail , ,,'" recorded ,
o. Teeth present In"de tne 0'01 c6vity
b. Teeth u"""",ted
c. Tedh,rllS$ing
d. Slolus of the d.."litioh i.. of IotIh thet hovoe
erupted ond ,"", "'" erupted.
ft. Pr e.ence of car ie . . ro.lorotion.,
ma lformaTio n., hypop las ia, wear o~d
discdoT<lllon . '-
I. The pcliontil o1ked 1000..."", jcrwo in CII<1tnc
occlusion and the molar , ,, Iol ion is
determined. Thi, is c\e$cnbed as Angles
Class I, II or III.
g. The overjet ond o-erbiT"e which "'p"'''n1 II-e
horizonlol ond ""~icol....,rlop 01 tho up"",,
end k>wer 100m ore recorded. Vo~otlon
uch o. ir>C",,"ed OV(l ri "I, deep bi ttl open
bite or>d O"QSI bile $Mo uld be re<:orded.
h, Tran5Ye"," rn<l lrelat.,,,,,,svcn as cross biltl ond
.h ift in the uppe r or lower midli ne. <hou ld be
boked lor.
In dividua l tooth i rr~ gu l or i t i e< 'ue n D'
rototi on., d i.p lao e ment., in tru. ion ond
extru,"", O r~ noted,
I. Th e upper ond lower orcM. oro exom iMd
indi, iduoll y to ,tudy the ir arch form and
'ymm etry, Arch fc.rm, con be rmrmo l, n",row
01rhlped) or squ are.
FUNCTIONAL EXAMINATION
It i, now e<tob li,hed tlxlt M-rmo l fUr"ICtion of the
.torn<ltognothi c .y<lOO1 promote. norrn<l l growth
and deyelopment 01 the orolaeio l comp lex.
Improper IU rOoring 01 the storoo~ 'YO"'"
can re.ult in "",iou. ma locdvs ion .
Orthodonti c diagnos is . hou ld not be
ro<lriclOO to .tOli<: eya l""tion 01 the teeth aM their
supporting structures but .hov ld i""lude the
exam'ootian of tile ""riou. lundior>a l un its of the
, tomc tognc thio . y, tom. n o lunct ion al
exo mi noti<ln .hau ld irlClud" H-.e loI lowi,.... :
D, kse,,..,.,,-t of post"",1",ot po~tion CJr"Id intor-
oce lu so lopoc .
b, Patholdowre
c , A.." .. mont olro.piroti on
d. bam ir>Otion ofTMJ
". Exam irl otion 01 ,wa llowi,....
f. Exom inotionol .peech
Assessm ent of postural r est posit/ on
lind Inter - O '~/USIII ~/earan,e
The po,tura l (e.t position ;, the pos ition of th e
moM i" . ot whk h the mu.dc. that 01= the fow>
OM those hot """" them ore , in a .\:;lte of mini"",1
oontroction to ma into in the post ure of the
mandjbio . At the po>!u ra l re" po";ti on, a .poc.
exi. t, between the uppe r ar>d lower jow" Thi.
space i. ca lled tM int ....-occ lu$0 1d eoror"l<" 0<
tM freeway .poce. ">emo"" ,",
3 mm in the con ine reg ion.
f,=~,,",. '''I
TMr. a re voriou. metr.oc. of o .. e .. ing
the po.turo l re,t po. it""" , During e.ominotjon,
the potlent <hou ld be ,,,,,t,,,, up<,"ht, with tM bod:
un. upport. d OM ",k. d to look . troig ht ohead .
The fo llow ing are some of the metOOds u.ed to
r""ord th e po,turol ro, t po,jjion .
Phone tic me thod , The patie nt i. o.k. d to
repeet """'" eon,onant, li k. 'M' or 'C' or repeat
a word like Mi" i"'pp< '. The mand ible retu rn , to
the po,tura l re.t po. it"", ) ,2 ..,conds oft", the
e, e rci.." Th e poti~ nt i. told rwt to change the
fow, li p or toogue pos ition alter the phonoti on,
0, the de nt.,t port. the li p. to .tudy tho ;ntor
oco lu.o l.pocc.
CommQM method, The poti ent osked to
perform cerla in fUr"l<tio<1 u::h as """ Ibwir>;l, The
mor>dible tend. to return to rest po.iti on /oI lowhg
thi. oot.
Non -command merhod Th e poti e nt i.
ob",,,,ed 0. he >peaks or 'W<lllows , The poti""t
i, not owore that he i, b-o in g exam ined . Th i. i,
u. uo lly oo rried out by ta lking aoout topics
unreloted to the potient ..+.ile cor~ ful f,- ob,. rving
him or he"
Thero Or" vor;OU. method. e mployed 10
mom ur. the jn te' occlu . ol c loarance. The
foll owing Ofe .O<M of them.
Direct intra - oro l piocedure , Vernie r co lipe"
con be u.ed dired ly in the poti ont', mouth in tM
conine or i'he incise, ~ion to meo>U rc the f""""""Y
.poce.
Direct extra ora l procedure Two marb
are ploced one on the no.n end ooolher 00 the
chi n in the mid. sog itto l plan e. The di, tance
between these two po in t, is mee.ured ofte r
mtruding th~ poti""t to <e me in at r~'t po.ition .
leier the potient i. asked to occ looe the t~eth end
:!Je di. tm>:;e between the two point' i. o9O in
~. ured. Th e diffe ronco betwe en the two
-eodings is the Ireewo y spoee.
"dired extra orol proce dure Th" inte r
ocd usol.poee i. d~te rm i ned in 0 rod iograph or
i;!y Kine,k>g rophy. Two lot. rol cephalogra m., at
~ po, itian and athe, in centric occlu.ion con
I:.elp ~.tob li'" the frM woy .poce.
Euluatlon of pllth of clo.ure
The pot h of do.ure i. the mO>e mMt of the
"lO!>dible from relt po.ition to hobitua l o:civsio n.
Abnormaliti e. of the poth of clo.u re are ,een in
......, form. of me lo:d V$ion
l'otw<:J,d path of clo,vre . A forward poth of
m.ure OCc ur1 in potient. with mi ld . ke l"ta l
"",norme lcy or edge to edg e incisOf co ntoct. In
..rn potient., th e mand ib l~ is gvid . d to a more
bward position to a llow th e mendibuklr incisor.
.. go labial to th e uppe' in<: i.orS
3cd<word path of closure Clo .. II, division
2m,e. ",hibit premeture incism contad due to
"'I!'Iroclined maxilimy ino",,,. Th~s th~ mond ib1e
.guided poste rio ri y to e.tobli sh occ lusion.
iJ::!eroJ path of clo.ure lateral deviat ion of
~ mond i b l ~ to th e left o r the right side i.
"""", iot"d with ocdu",1 prematuriti o, and a
~ me'i lloryorch.
,Assenmllnt 'of ,,,.pl ratlon
Human. mey exhibit th ree type. of br~oth i ng
""", I. ora l and oro """, 1.
A num ber of ' imple te, t, exi5t thot con
Oe em plO)'ed to diagoore!he mOOe of respmlion .
~ test ,' A doo"e . ided mirror is he ld
~en the no,e and the mouth. Fogg ing on
th e nasa l . id e of th e mirror in dica te, na .o l
breathing wh il e fogg ing toword$ th e """ I . ide
i n dicot~. ora l breo lhinll:
Cotlon te.t,' A b<JHerffy .hoped piece of cotton
i, p ieced over th e up per lip below tr.e nostril . . If
th e cotton flutters down it indic ete, nasa l
breath i"," Thi. te.t ,on be vsed to det.rm ine
unilatera l nasa l bockege .
Wot", tel! " The potien t i$ o.ked to fill hi. mouth
with wowond retein it for a period of ti me. Wh ile
n0501br. otherS occompl ish tr,;. with ""'. , mouth
breothers find the to., dilfk ult.
ObselYO tioo In nasa l bi-ootf"", the extemo l
nore, di la te during in , piroti on. In mouth
breothers, there is eithcr no cho ng<! in the eld" r",,1
nare. or they may con,trict during in", iration.
Exam Ina tIon of T.M.}.
Th e functio nal e>a mi notion .hould rovtine ly
include au,cultatio n and ""I"" ti on of the
temporo.mendi b<Jla r io<nt ond th e mU5Culatur"
o<socklted with mer><!ibulor open ir>g.
The potient i$ examined fo< .ym ptom. of
te mporo ma ndi bu lar joint prob lem. such a.
dding, ~pitu'$, po in of the meslicotory muscle. ,
li m itatioo of jew movement, hyper. mo/'< Iity or><!
morpho/og imlobnormaliti. , .
The max imum mout h op e ning i,
d~mi ned by meo,uring the d~tan<:. between
tho me.illory and mend ib<Jlo r inci",1edg with
the mo uth wid e o pe n. The norme l inter in<:i",1
distance is 4045 mm .
. Eva lulltlon or SWill/owing
In" new bo rn, th~ toogU " is r" lotivefy Jorge or><!
protrude, betw"",n the gum po ds or><! toke. po rt
in e,toL li .hing th e lip lea l. Th i. kind af .wo ll ow
i, ca lled inlanti le~wa ll aw and i " en till 1 1!2 to
2 y""r$ of ag e . Infanti le .wa ll ow i. rep lemd by
,h. matu re .wo ll ow 0' t..... bucca l teeth , tort
e rup ting Th e p e "iste ~Le of the infa ntile
swa lbwhg con bea cau~lormo:OC.dJsion . Thvs
Inc ,wa llowing p.c ttem o f th e iM ivid",, 1 should
be e""miood. Th e pe<>istrnl~. of infonh1 . swol ow
is in d icated by t roe presence of the 'o ll ow in g
f~:
a . Protru. ion of the tip of the tong ue
b. Contract io n o f per iora l mu scl e. d u ~ ng
,,,,,, ,Io..;ng
c. No co ntact at the mo lar reg ion during
swa llo>'>ing

Speech
Cena in ma locclu.ion, rr.ay cau," d. fecr. in
spoech due to interfe re "". with movement of th o
tong "" OM lip. Thi s ,hou ld be oo.. rved whi le
co nve rSing >'>ith th e patient. The poti ern co n be
asked to roo d out from a beak or asked to cavnt
from 1 _20 whil . ab IVin g the speech . Pot.,nt.
hov,"'Il to ng ue th",-" habit ",nd to lisp wh il e del!
palate patients may h a~ a "",,,, I tor.e
ORTHODONTIC STUDY MODElS
O rthodonti c study mod els are occurote plaster
reproductio n. of . he teeth arod lhe ir . vrro un d ing
saft ti ss ue,. They Ore an e .... ntkl l dklgroosti c a id
t"",t make, it passible to ,tudy the arrangement
of teeth and the "", Iu sioo from a ll dire-:::tiOn .
(fig 111.
u,", of study model. in clud e :
1. They ena ble th e stud-)' of I"" ""d u, ion from
a ll o'pe<:ts.
2. They ena ble accurote meas urement. to be
mad e in a denta l meh. They help in
mea.u"",,,, nt o f arch length, orch ,," dth and
tooth size .
3. TOOy he'p in os,.,. smerl ohre<:Jtmen. prog ress
by Ihe dentist as we ll as lhe pati ent
4 . They help in a,,,,,,,ng tho oatu ,," arid ",. erity
of ma locd u, ion
5. Th ey are he lpfu l in motiva tion of !he patien!
crod to exp la in th e trea tment plan 0' we ll os
prog""ss to th e potient and po ," nts.
6. II make, it possibl e to ~mulate tr~alme<1t
proced u," , 00 the cast .ueh a. mock surgery.
7. Stud}- models ore useful to tron: f. r r!!Cords in
co,. the potient i. to be treated by aoother
clini ck,"
Detoi l. on t he req uiremen l, of
C<fnodo~tic !Iud-,- models and ther fabr<:otion are
g i.en in cha pter 39.
Gnathostat/c models
ihcy are orthodontic study mod. l, where tn., bose
of t r., maxillary em! i, trimmed to corresporld to
tho Fra nkfort horizo nta l pia,""
DIAGNOSTIC SET UP
TI, e dia~no'tic ""tup was firSt proposed by H.D.
Ke, li "'ll . Th~ dKlgMstic "t up is made from an
. xtro ,~t of trimmed arid pd ished stud-)' models.
The ind i.id u<Ji teeth and thei r as,ociated alveolar
 B

C D

I
7U 1
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IJI

0 :fr'/
~ -:/
E F

f;o 12 D" ~ "" " ;' ,.t". (.'. _81 f" h"'" blodo "" d t o """,00 ;" o; ~d" ~1 ,..,1, (CDI Inc ;,; " ," tW o .., ;" "'"
I!'-Hl C<;<nplolod ... ""
 '{r l 5!!) XOM p<'J
00,,0 U,,!'!,OO POl !'''!' UI 10':>;0 41~ol I""P'A' PU '
"'11 '4_ IDflp IAIp.; 1"'11 ~IOJod<>< 01 apDW am
' In ) 1""I\Jo/\ -u!5mw 100l 6uI6 "'11 '" IO",_d D UJLJL
t "pow'j jn~ IDIU DZlJ04 If 'yj~a j IDflp IAl f" JL <>yj
aIDJOOa, 01 apo)q MO<I"'J !lu!<n In , ' ! l'Oj ~ 41
"Jnp"OOJd
do 10' 0)0 ruO" W "1 pal!l 0 n ~A "9
uo:> ...ptJOOaDS!P 415u~ 1 'PJO ~ '" 41001
l>Oj "YI uo <OJnp.;:<o.Jd ;oAlp<;WO' 'OO!"lA.'11
6 U!IOIOW " '9 pajoAljolJJ "9 u o~ IUal lod a'11 'l
u"! "'P"'" "Yl uo
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dn I"S 0/lsou/l,,/P JO usn
" I""~OO
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G41 5u!IOln w!. U! ,d l" 4 sn41 do la, c'<'I'O UOO !P
r . 41 -'UO!I"OO p ~J !< Q P ~ 41 U! o,oq l ~pcW
OLII uo pa'''Id~J p.;o jJO P"",O II"'" '"'0 "',,a;>o.>:j

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1'''''''1 1j>1 iO! "r'0J ~,o:rJ
10JO OJIUI -".'A 10101
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a,IQI!'S pUl! I.JV aql - 5:)!IUOpoqIJO ZIti

FACIAL PHOTOGRAPHS AS A
DIAGNOSTIC AID
facial photogro~ offer a lot of info..maticn on
"" wit ti nue morphology orod f"cie l ~xpres.ion,
PhcIogroph ho uld be tel"" in 0 slonoord ized
monne' SO t!>ot they cen modHy be COInpored
with .. mile, pholograph~ 1cken duritIQ Or after
"" ~eo1ll1e"'.
80th "',e-oral os """II o. Inr'eoro!
phorogropllt ore one!ul OOgl>Oslic f8CO'do. Three
"""" ."",I.Iew> aff! ,0uliMl~ lokon Iflg' 13):
a. fronte l view
b. Profil Iew
c.. Ot>11q..... fc.,;ol .iew
Thee>:lro-eral pMlogroohse", IoI<en by
gositioo ."g !he poIi""t in ouch e monne< thelthe
FJi pIone II perallelto the Hoor.
The infrl>o<:o'Ol phoiog,oph.!hot 0", IOkero
indde'
e. telt o,..j rigftt 10te", l. i"",
b. Frontal view
Co Maxi ll ary end mc,..j ibvlo r ""eluse lview
U.. of p ~ a tatr.p ~ .
1. They 0", ulel,,1 in o ..,.. menl 01 Ioelol
..,mm~. /ociol type ond prdile.
2- They _ .,. diogno"ic recortb.
J. They help in .,.......ng the prog .... 01 the
treetment.
ElECTROMYOGRAPHY
ElectromY09rophv i. proaod"ftI u.ed lor
feCOrdltIQ !he electricol oclivity 01 the mu.;"".
the 'e>/itIQ potentiol 01 0 m...cte hber is 85 . 90
rrN. \QtUnIOry muscles co".;'" 01 """'t' controditIQ
5btes supplied by J*lpherol """'" lerminol . The
membra"," of eo<;h fibre;' electrica l", charged
with polilive chaf{lO outside ond negativity 0185
- 90 mV ;nskle . Upon ,ece;';ng I; mul ... , ~
;, a r.....e<$Ol 01 tM. potontiol;1y r.,u~ing in m",,1e
co ntro ction, Thl, ~ ce ll ed ""'tion pot8ntiol ond
dM ote, the m&chen ico l oetivity e f tM mu " le,
The eI..o.omyog"Cph is a morn i"" ...t.irn i. vsod
to """';"", e"llt.!yend record !he action p:nntial
during IT>JII;/. 0(;IMty. 8edmmyogram i,e ~
oI:mf>ed by sucho plOClllin. 1heodion poIenIial
;, pc\cd up by eledrod ...t.kh e", 01 twotypes:
5"rioce elewcdeJ : lhese elecrrocie:! e,e vsod
whe n the mu scle .. ,upernc"oo l", pi"",ed just be.,.,.
tl-oe skin .
N.-li. eledfooO$ To . y Or" ",,,d ...hen me
muscle ;1 ploc;ed deep inside e.g. l'Ie"loo;d
mu..:!!!$.
HaVIng peked up the eelion pmenrial
w;th surioee 0' ,,*1. ele<:trodeo, ~ ;s rordtd
,.,ther with the helD 01 a mov;"II pen in the lorm
of 0 groph or roccrQed;n m. l""" 01 "",nd with
th e holp 010 mog netlc tooe recorder,
EMG il uted '0 cIotect obno<mol mu,,1e
ect;.;ty auoc;a ted wah cerro;n ferm. 01
,...,Ioed.,,;on.
0_ In _~ Cia .. II, 1Ii.,;,;"n 1 molocdU100n
the uppe' lip is hypo-lunctionol. Thus during
.....,lIc".."9. the lower lip"""'rods Upto<lrd.ord
forwordl to /0.00 the mo ,i llD lebielly end e
,trong menlOl;1 oct .... ily ...een. EMG con
00 V1o<l to Itu dy l uch 0 co nd;tion.
b Abnorma l MCinotO!' oct;vi"" ;n OCII II ,
dili,"" 1.
c. Ove,de.u", ef joWl ;. o.><>doted w;th
ocuontuated lempo,olis muscle odMty.
d. Ch;ld",n with cereb,ol poloy.
e. EMG ~ be corned out efte, erthodontic
thero"," 10 see ~ musd~ bolo;lr'oU! I, achieved,
RADIOGRAPHS USED IN
ORTHODONTIC DIAGNOSIS
t. To ...... ~ dt>olop!>tnl of lilt dtrloJ>.
Willia m Conrad Rcentgen di,covered X-ray, in ~. _ otKl $tal. of orupIaI" tJo __
1895. Th" re i, no ",._ 1of the medica l field thot
2. To "1O ~~h 11>0 p, ... oc. or Ila.nc. 01
is not infl uenced by th is discovery. OrThodontb
is no ~xceplion . Rod iographs hov. e.tobi i,hed
'"'*"'''''1Wy tNII>.
3. To dOlor .. no th . " t.". oj <001 rosorP"" oj
them,e lve. o. 0 .o lvob l. too l in orthodontic
r!o<iduorJ$ Ietfl.
diogno<i. Tobl~ I gi,e' the u.,,' of ra diog raph.
,,..
T~oWj 11>0..,.,. .. >OI\:JrmI.Jor\oHI"J. pormano[t

._d
in orthodootk; prootke .
Radiogra ph. routinely used fO<" dio9""'i. ~. To CMlirm tJo po--..:n:/ ~
in ortf.odontk;s OJn 100 dos, ifi ~d into two group" ~ ",,,,,..lie eor<iit"",.
Intra oro l radiograph, ~. To ~Uly tho ctwldrr oI,_lDlo.
2. Extraoro l radiograph.
1. T~'y ;jl" '~uab lo 11<1 In <ra.nio -d on lo-ll oi,1

INTRA ORAL RADIOGRAPHS Ilf\a~'''_

Thr~~ Iy p~. 01 intro -o,ol rod ioQroph. a re
commonly u d. They Ore th e periapica l, bite
wing ond occ lu . ol projection .
Intra orlll perlllplclIl radiographs
(I.D.P.A.)
They Ofe rod iog raph. that ore used to view the
teeth and th eir svppotling structure. (fig 14). TW<l
intm-oral proiedion techniq ue. are u.ed lor
pe rio pica l radiography. They a fe :
t _ To ""'*'"
tJo .... iroS"1tt(,n .. tJo ""'" .. -..
9. To ...... ."e\h t.aI .or. ~ .t>oorrJ,ll.
1. Para lleling tochniq ""
2. Bi,eding ang le technique
ibrelld in9 te;;ilnique . Thi. techniqu e i. 01.0
co il ed rillht ong l. o r long COO/l tedmiqu e. In
th i, ted"'iqu e, the X. roy film i, plOlCed porel"l to
the long axis of th e teeth end tr.e central roy 01
the X ray beo m i. directod ot ,;g ht ongle, to the
teeth ond film . TN, method is be neved to redlJCe
g<>orneIric distortions ort<! i. th. reio", the preferred
to-ch~ique .

Bisecting ong le technique , In thi s technique,

the centra l roy i. directed o t ,.. hl ang le, to 0
pkln e bi,octin g the ong le betwee n th~ long oxi.
01 th e teetn ond the film.

Uses of intra -o rol periap ical radiograp h"

Fu ll mouth intra -orol periopial l radiogroph, ore
routine ly tokc n prior to initiation of ortnadootic
t'Mt",ent. The following a re .orne of the u.es 01
")PA
1 lO co nlirmth e presen<:eofobsence olteeth.
2. To estobii,h the pfesence or ob.e nce of
 "'pernu""",,,,'Y I"""'.
to ouest me <lent 01 wldlico1ion ard root
lormclien of teeth.
10 confirm th e .....""' co ond ""'"" the elIlenl
01po rie~ce l palh olog yand root froc;l~re,.
5. Ta Iludy The elveo lor bone and periodonlil l
ligament .pao;e.
6. Ta t!\Jdy the height and contour of alveolar
bonecreSl. "Ig t5 e.,. wI'>g n>d~",<h
7. To a'>e .. 1he a>.lcl indinoli<:n 01 roott.
olveolar bon .
8. Ta deted re!oillOd rootfrogmenll ond ,oo!
tu mpt. C 10 deled _ondo" oor;es beb.. re<!lorrfio"" .
d. To de'eCI <:MI'hcng ing pra. imo l re.lomlioroo.
9. 10 determ ine The >i,e and 'ha pe ()I unenJpted
teelh . c. To det",1 perlodo nlol change .
I. To detect i"Ie'proximo l eo l"" .....
OdodvonlCgal ()f IOPA : The l()fl()..,i"9 are
_"'!he ,hxl.""bges ()f infro..,..,f perigplo;of Oce/anl ,. d/o' rlp~ .

Intm oral ocdusol "'drogropht .noble ';ewing

Ao.>essment oft. entire denim"" .-.qui,. 100 of 0 relolNelylarge ... gmenl ol-he denIol on:;h,
monv rodiogropht. including lhe Dolo'. or floor of the mouth.
2 Ch ildren may net oil""" plo(e.....,! 01 inlro Oed"",1 rodiog",ph. e,. elsa u.. I,,1 in polienll
oro llil "". who or. un cb l. to open The rr.oum wid e er.o<Jg h
3. They cc nnol be used in pali""l. having high
10' p" 'io jOicol radlog-c ph . It i. po"'bI. !O cillo in
gag refl ond ttisrmn.
oed"",1 p"Q)ec~on of 110 0 VWO' a ......11a$ the
nlollel 01 IOPA : A1thou<;Ih the ICPA lowe, orche. (fog 16). The foliowinQ ore the u....
roph, hove a number 01 drowbockl they of ocduool radiog",phs :
some advorrtoges III _II :
... \.owrodiotiondw:.
IL Posslble 10 obloin Irxoliz<:d views of the 0_
oIin_Sl.
c. They olfe r e.ee llenT clon!y 01 t th and the ir
1Upporting Itrudur .

, . . . wIn, rI<1/0" .plls

I;~~~~~~;;~~"~lhecoronol olong with their

portol
(~II 15). The 10U"""ing ore
uses 01 bit. wing radiographs ,
10 dekl<:t pro.imo l w rie .
10 study Ihe height ard (ootour of inlerdenlal
1, b I""n te impacted Of c"","upled leet h,
2, To Iocnte ; uperr1um . rory teeth.
3, To Iocat. In ro ign bod ie; in the jaw, aM
,10,,<,$ in sa livory d uct,
2.
4 To st""" DULCe li ngua l expYlSioos 01 cort>::a l
plole du " to palho:ogy of th o j ~w , 3.
5, To diagno,e the pre,ence ond oxt""t of 4.
lraClure<.
6. Th&y nre u""lu l in MhOOonti", to ,tudv the 5.
efled' of ord> . xpan';"" p"xedu ," , .
6,
EXTRA ORAL RADIOGRAPHS
deve lopme nt by . tu dying dodd""u, foot
re,oro ti on and raot deye lapmerl t a f
permo""nt teeth
They can be used ta y~w on.vlosed and
im pcx;1ed teeth
To . tudy the path of eruption of teeth .
To diogrlc ,e the pr",enc" ond extent of
pat~ogy and frac tu re, m the jOws,
To diogno,e th ~ prn,e,"". or ob.ence of
mu lti ple su pemumerory teetl"
They o, e u,elul oid. in ' '' riol . ,troction
procedure> to . tcdy the .tatus d OOJ pti ng teeth,

E,traoro l ro diog raph. i" dcx:J., all viaws moo e of

the oro.fa.::ia l rog ior1 ">ith the film pa' itioned e,tra
ora ll y, Th oy or~ ",.leA whenever lorge ore",
the foce aM ,.u ll are to be visua lized .
Panoramic radlolraphs
Panoromic roo iograph$ e n-ob" ,;e">ing 01 both
maxillory and the rnand ibulor " fehe, with tl...-,
.uppartin g .tfUcture. Ifig 171. Thu. 0 . in gle
imo!l~ coy~ " 0 mo jor part 01 tl", focia l regian,
Uses 01 Panora mi c radiograph ioclu de,:' "
I. Th.y or. u;eful in 0,,""i"9 Ihe dental
7. They ore c-..,Iul in the mixed de ntiti"" period
to >i'vdy the ,tatu. of u,",rupted teelh.
m
Th e odvontag e. at panoromic
radiograph ioclu ",,:
1 A brO<ld onatom ic; mea can be ';, ua limd.
2, The potient rodia li on exposu re i, low.
3, II can be ur.ed in patient, who ore ur>ObI~ to
to~te intro ~1 ~Im . or unable to open the
rrlO<Jth,
The followin g are the disad-.-antoge al
panoromic rodiogro.oh,'
 I Dillortio<l" mog nificotioos and """ rl appir.g
01 lilt .!ructums ocwr.
2. The ~h and lilt wpporting p""odoorol
$l\'Vdur.,. a"' not as dear as in perioPcol
"~
.l. Inclino ti\>n of a nte ri o , te etn co n no t be
'fiwali.ed _
-.I Require. "'Iviprnenllhat i. e:<pen"ve.
5. Whe_ derail. ol a particular area art
neododthey htNeto be .... p~ byother
mdiog roph.
C.pll8lomlll,lc ,.dlo, '"P ~S
are lope<ialized "",vII rodiogrophs in wh,dI
head is po$ilioned In 0 'pe<ially des"ogned
'!!rOd holde r ca lled cellhabsklt by me(ln, 01 eCr
__ Tnu. it i. 0 . to nOOrd i,ed tocim iq ue ",he ,o
... ..., head;$ held in a ptIetermined poIiticn.
C....,llogrom. are allO V$Od lor <;<>mparilOr'l at
..,....(>1md iog mph , .
Cephalametric radiographs are af twa
"."
1. Lottrol CllphologrOM ~ig 18.a)
2. Pwerc onterior cep""lagmm {fig IS.b)
The usc d oep""lome!n c rodiogm~ !or
a<thodootic d"(/"'OSII II diKY ...d in ""Ioill~ !he
IoIlowing chol*<'_
OTHER RADIO GRAPHS
H...d . ..,1.1 ,.dlo, plts
RlJdiagrophs of 1M hand and wrill ore ulllfulin
eslirroting 1M skeletal age 01 0 perso<l. The hond
m.o wrist ragion have a nvrnbo r ol."",11bone.
who"" cppea rance and prog ress of os. ili~ctio<l
oe<:~' in a ~idablo Mqve<1ce. Tni . enables
o.MHmtOi 01 the skeletal age 01 0 polienl. Thay
ore .....,/vI in OJOeSSing growm /or p~~~ing growth
modilic:o!ion proeed\lf$f and wrgl~al resecIi ..
procedures.
RECENT ADVANCES IN D.AGNO$f.C A.DS
o.tt.odorrrcsiso ",podly growing I,e ld w"h
develop",.,,. occ.uring almost avery cloy. 1~
improve""''' bosiCDli" Ou' in 1WO oreal. 1~
lill' IS on improvemen! in !he molerloll ond
technique. u... d while iIle other " odvonces in
lhediagnos.:coids.. Re<ft"f r.-oIionsln medl<;ol
imaging lias be.> oooplOd '" denlrllry and ~nd
>ome opplico!ioos in orIhodon~a os ~II. Somo
of the ... ,.;eeRIly evol.ed dlogl\O'l~c aids 0(1
di$omed in brief.
)C ero .ad lo, . ap hy
Xe:m-Jogoph-; il a com;rlele", dr)-, non-cl-remcd
prcx:e" whi ch mo\:e. ule of !he c lectrellol ic
proce.. '" in )(oro. modline . It .. 01 invon!cd by
Chester F. CO~'OI1 in 1937 . ho rtly before !h e II
Worl d Wer.
Xerorad iog rap hy makes un of on
aluminiu m pia!' rhar I. cooted wifh 0 loy" 01
,;!recu> """" iu m. Tr.e Hlen....." portil;les ore g;,.en
a un~o'm eloc!tO$l<mc: d!crge. 1 .... chorood p~e
" ploced in 0 I",hl righI, o.rt"rll'" (OMl!I. Wr.en
tire him ..... po.ed ~ tou .... a ... lecbve disdlO'lle
01 !he ..,"'n,um depending upon !he ornovnl 01
rtxliolion used ond re~_ de..."., 01,,,. obioc'
This po!Iem 01 elec1ri~ dlloChorg& on ill, plOIe i,
coiled Iotonl imog&.
Thltlolenlimoge i, then co~ iNDO
", ..bIo.,mo!il" br 0 pmc.asI coiled development In
o un~ called proceuor. The plole il ... po"d 10
charged pollicle< coiled tone . The ... poflldeo
odhe.e 10 ,he chorged o,eol in omoun"
pn;>pO<1ronal 10 the quonhly of charge ~t.
This image io now !fO... fermd on 100 speCIal kind
0/ pope' ccl ~ :rr...m.. opoq"" poper.
The unlq .... leo!ure oI.e,orocliography is
thol iI I, possible 10 llaoe bolh pO)ilive ond
n~olive imoge. Once Ihe 10lenl imoge io
co~rted 10 0 mol imoge on 10 0 pope, the
"I.nj"", plole can be discharged, deo'""'!'l and
uMld ogain. h can be ~ os mony 00 1000
fima.
..,,,
x.,,,,,,,diogrophic imoge dilleR Irom
convenlionol rodiog.oph. in Ihe followir>g
1. It """ibi!! high edge cantro.' due to 0
phenomenon coiled edge enhancement
Th',lacifmtes pero!iptian of <>'lQt(Jmic dda1..
2. n.. ...IOfOdog",phcimagei.1onpoperOf"d
., vie.....d in reHeded light . Thy Ono .pedal
illumino~on i. nMded I<>r viewing.
J. Cf>oiot of positi.e Of nc~o~ve Imag e is
p<~ble.
Tn.:. od.ontoge. of Xe<crod iogmphy 0.6 .
1. Red u ctionin ex~ou re time
2. Eo"" in mO rl ipu lation. No nec d of do,.
"'0"'1 fO<" cleve!opir>g.
3. Eo ... 01 "'e"';ng . No >pe<:icl lig ht SO>.Jrce i.
requ ired.
~. EOQe...na~eIIed.Boondcry~
lIruclure. i. dear
5. Cepholomel.ic ID~d ma.ks ore eeoil y
idenlili&d.
6. Recono1n.rclicn oI!he cepholomelric: plo_
o nd points con be made direc~y on pope<.
DI" G,apl>
The O,gi Gmph is 0 oyn1hesis o/",deo imoging,
com""",,' Iedvdogy and sonic O'llitiring. The
Oigi g",ph wad: 1k>Iicn "'1""'' ' "'
m..... u.... 5' ~
J 7 . The moin cobin.t contoino the electronic
circuilry. The Oigi G",ph enable. the dinicion 10
perform noninmo;'e and non rtxl iDl!rophic
o:phoiometri:;; ~ . Cepholometrk; lomlmorl<S
are digitized by ~g~tfr' Iood ling the soo k; dig itil ir>g
pobco to a point on the pot""I, ,!:in correspor><Wrlg
lIoit. Th i. e mit. a lOund , ",.-h ioh i. then re o~
!o,-the mioropho ne Md monito red o,X, Yond l
ct>-erd inotes,
7he sy<tem a ll ows ce pholom otri:;; evo lootion ond
ftC tment progre .. os often as nemssa"" withaut
...tiotiOi"l exposu re , Feotures of Dig i G ra ph .ystem
irdvdo,
1. A londmork con be ide ntified os 0 point in
three dimensions.
2. A cepholometriC ono ly, i' co n be mo d"
indepo nd ontly o f heod po. iti on .
3. Pa ra llel ism of X-roy in mid - ootg itta l pla ne
and , ymm et"" o f onoto mi o morpholog y
betw~ n left o nd right sides is no! ""c~,o"".
Th e Dig i Groph wo rk , lotion'. flordwo r.
end softwore e nobl e th e pe rfo rman ce o f
<2I:Ihc:1om "tnCOrlO fy<e$, tre oi rig, , uperim pol iti a n
...d .;. ",,1treatment obiective., TM progromme
.a>p<lble 0114 an alyse . Meosureme nts foro ny
.t..:Ied orlO ly<is con be d isployed on the monitor
ordthe ob.erved vo luo, o re . flown o long with
patient tnml adjusted for oge, ,ex, roce and
fIIII:d siz<o inelu<ling.to ndord deviotions , Optio",,1
~,,"I> inel",," ,
A eon. vItotion vnit: ~tron.port. info rmoti on
into th e op e rot o ry, d oc tor' s o ff ic e /
consvltotion o ree, thus ol~ viewing and
compo r i. on of in fo rmot ion o nd t he
development of vi. uo l treotme nt o b jectiv .
A high - re,olution video come ro 'with 0
lelephoto len. for toling inlro_ o rol .iew. by
m.eze from ing the video ima ge ,
A lig hl box for X ra)'$ a nd 0 study model
hoIder for _ideo imaging tflot will be included
~ th.. floppy d i, k,
eome ro ond video p ri nte r fo r p rod "" ing
CDJ>ie' o f . id eo mon ilar informa tion ,
The Digi G rop h o ll ows all po tie nt'.
mode l" fed iog ro ph l , photograph . , cepha lo -
grom$ and troLings to be stored on on e '"'0 11
di,k , thereby reducing sto rag e requi re-monl>.
Fu rthefmorn it i, 0 ""Ioob le too l fo r improving
wmmunicot"" a mong din ki"" pot""t ond stoff.
MRI (Magnetic Res on lln ce Imlll lnl)
Mttg Mtic R. so""""e Imag ing mak. , u... of two
fundem ento l pro ~ rt ie' o f proton. , i.e . pin ond
smo ll mogn etic mOyeme nt. , Th e pfoto n of
hyd'''Il " n ion which i, in wot...- (wole r t:.. in g the
ma jo r compon ent of body) is utili ,ed in M.R.1.
The praton , behove li ke ,mo ll opi,..,ir>g mog neto
and ",.-h en ploced in 0 mogn . ti Cfield they teod to
mo"" poro ll el to the fiel d, Beeou .. of the sp in the
p ro ton , '. 'po nd diffe re ntly with in the if o' i,
p r"ll ross ing obo~t the d ir. ction o f the magnetic
field , If a coil i, f'>O W wound oround a volum e of
p ro t-on. , they nOw p rogreSl ot 90 dog,..., a ro und
tn., mo gnetic field at the , o rne freq uency a nd
ind uce a minute cu" . nt in the coil wh ich when
a mp lified co n be d i. play.d over o n o.o ll o>cope,
Th i, energy i, utili , ed in the >conn ing procedure ,
Th. advonto ge, of mag netk:. rCIO""""e
imag ing ore :
1, MRI d oes rlOt flov. flo , ard. a . it u.' " non
ionio ir>g . Iectromo g netic rodiofon.
2, Anotomiccl dote il , me '" good e . in c.T.
.oon .
3, G reate r tiss ue choroole ri. oti on i$ po,<ib l .
4, Ima g ing o f blood ve" . I$, bloo d flo w,
vi, uo li",ti on of thrombus i, po"ibie,
Th e d i", dvontoge' of MRI indooe :
I , Ti"", to ken i, mo re.
2 Not u",d in patient. with co rd iac pace ma ker,
3, No n vj.uo liootion o f bone mo k it u, . I. "
in bony Ie. io ns,
To",o 'rl pll~ Cornpvled 10mogrophy: II is olso o;olled C.t
COIWen!;oool rodiagrop'" ate i~el in which Of 0.1 ~uted oxicltomCVOphyj. C. t. ..",......
011 ob;ectJ between the X-,~ oo urce crl<l/ilm are are moi~~ complex imaging 'yotems which u...
lu~ r imposed, Thus th e <;ioriry of a .peei/;(: thi n booms oi X roy that move in Q IvncNonous
mdOClrophic find in g depends Ct> betn it. Joccrtio" mo.....,..with on a rroy of ~~1c<:10<1 which colc:vlole
ond the de;_ to wt.kh a. donsity d iff." from and ottln~QIlIhe Xrol booms ot diff... nt angles
If>ot of """,unding obj..:!$. In 10...... Ii!uo~o", end in diff.nnt planes. Thi. dolO i. led inlO 0
N~rimpo$ifi(lr'l 01 obtect. inlilri'eres wim on compute. ~h per/orrno ro.omerou. <XJlculollono
o~ obility to cl .... rIy d~r the object 01 a. per the program and comlruCII aocuralil
inleres1. In 11...... imtoncestomography con be ima"", In me eo<onol and oxicl pIonol-
uMld to .... uoll$. (I <&Clion 0/' ,Iici oltM ob;e.u The od""nloge, of c.T. ICon ore :
ond T~ c limi nate cmd.,i'cbJ . overlcp. I. Accurate viouo li setion 01 On aree 01 interes!
Tornog rophk co n be eo nventiOllO I Or il pouible ,
compuTed tCrn<>;lrop hy. , 2. The co mput . r progra mming mok it
, poslibll to view the imagn In diff"'"fIl
Con....enlional Tomography: fnj!; II 0 pro",,,
thodes ond densilles. This helpo di/fe,entiole
by which 0 Ioyer of on imoge wi"'i" me body i.
bt ond blood.
produced ""'~e the images oI'Jn.lC7ures above
ond below tho1 Ir;>yer Ore mode invi'ibl .. by O""'", o"lml
blurring . Blurring 01 imOO\! ovtslde lfoe pia"" of
~;, 0 tracing 01 a phologro ph 0/' a p/lolocapy 01
in",," is occo mp li shed b~ s imu llaneou.
o denlel o.ch, Ocd usog.oml Or. used 10. Ih.
mc ..... ",,1 of lhe X-roy tub\! ond fil m during the
foll .,....l .... PU'PO$OS:
"poI ure. The tu be cnd li lm orl co nnoccd so
o To e"imOIa ocdvoa l relotior-r$h ipo
thol rT"OCYemen!< occur oround a point 0/' ft.kn..m
b. To l$limote orch lenogth & width
N the dislonc.. fram 11... point of rol<llion
incseoilel, the omount 01 image blurring olso
c . TOel~male!he toorh rYIOYtI_ requi...d In
0113 plo ..... o[ spoc:e
illO'l_. Th .... obj_ dose 1<1 the point 01
d. To IIl'mote spacing & crowding
rotation Ore mor.. shcrp cnd objeds lorthesl or..
I . Toeslimote onchoroge requi""",,,,,,
blurred. '" the cny~ between Ihe source I folm
Occlw.ogrcms con be obleined;., two
ond tissue increases the th id<noss 01th e imoge i.
wop:
reducod, Tn ", Tn . greato,t blurring il soon in the
I. Th e oceluse l sur/a ce. of the uPperOM lowe r
pe'ipr.e.y wh il o the !harpest image is seen ot tile
oo..to lo;olt! Ore photographed in 0 I :1 rotio ood
cenlfol 0''''' near the fulcrum of .o"'"on. o 1I'Od..g of the photograph is mode.
The principles of tomography con be
2. The COI/Sore photocopied on 0 >BfOIC mcodlino
mothonicolly implemented rn Iwo WOp :
and !he oo::lusol photocopy II used 10 oblOIn 0
1.TheX-toylubeond ~Im cun ....,..., oync/n>nousIy
trocinll
in oppooile ditflOCfions in porol", plo_.
2.Th. X-ray tu be ond ~Im con n"OYfI syrdIrooovsIy DI,lt,1 SuOtr. et/on R.d/o"lplly
ond in oppos ite directions in po.olle l p'.one, but
In co nventi ono l rad iog raph . the beckground
with motion . other th a n straig ht lin . i. drcular.
.t ructures sud1 0. a lveo la r bone and od ioc.e nt
spiro l, ele.,.
e:th moy drow the exom;"" " vis ion OW<ly from
."" d i09no,t;c inlo rmo tion the reby mo ~ ;n g
Oe!ection of poth olO<;lk chonge. diffi cu lt. Th e
..!.o nc. "", nt 01 carie. from On in cipiMt Ie, ion
bwgh th e de ntino enom el ivnoti on i. ofte n
~v lt to deted. Li<. wi,. th e o,,,,,,,,,,,nt of 0
"!etlli ng or expond ing le. ion afte r root wna l
fo.m py i, 0 cho llenge becov,. of tho , ubi le
c!>rmg o' in th o den' ity of the Ie. ion thot may not
:ledetodabJe with the uoo ided eye.
The deted io n af initiol ,o uooring a r
bmalioo of anguklr del""t, oro und impklnt< is
~diffk:v~ to vio...., lize on radiographs . Moceove<
"".pread of bone 10"' 010119 the thread of lhe
-cdform implont i, olton obsoured by th o ..harp
_ .t between th e bone and im pla nt ,urfoce,
s.btrodion rOO iOllrophy odd", .. e, many 01 tho,
IftIotions in the detedion of the.e rad;,:,grooh ic
etonge< by decrMsir>g tho omount of diSlrooting
=cd<grovnd informo~on orm by olWng t"" eya
."b;v, on the odua l ohonge that ho. ocov r. d
!tt!Iween two imoge . By subtracting 011 onolom ic
ure. that have not cha nged between
oJog rophk e>:c:rn inations, cro oges in d'ogr>O.llic
""""""tion ore eo, ie r for the "",derlo ",e.
Tochnica lfy thio i. an ;moge "" hon cement
~ tMI removn. the , tnxtured noise from
;.noges, The re, ult is tr.e oree of cho"9" cI "arfy
~ eith"' o~n.t 0 nevtro lgrey bock,gfO\Jnd
. fi .v..., rim posed on tho ori gioo l radiogroph
_The , ublrm;tion of origina l two rad iographs
lermed an imoge ratke< lho n 0 rad iogrtlp h
~ it doe, r>OI d ireot~ "" ult fram e<po,u re
... radiog raph io film .
Th e d ig ilo l . ubt ro ction te ohnique
~I y enhonco, th e diffe rences be\weM two
"""'9"' . Im og . r. gi. trati on howev...-;. fou nd to
,,"0 I!d1 nica l problem, It is im possible to ""h:oeve
-'eel registration of imog "' durir>g digiti"'lion
~ of imperfections in th e ra do'ograo hic and
~ _ _ _ _ _--'i
olignm. nt procedurel . The lorger th e differences
in r ~ g;,trotion , the more th e vi,,,",, 1noise pre",nt
;n th e ,ubtro cted imoge
LB$ er HoloerBphy
Ho logra phy i. a photograph ic technique for
recordir>g and reco n.ll ructing imoge. in such 0
way lhot tho 3 dim,..-" ione l ospect of on ob j. d
can be obtoined . Th . r. co rd ed im oge i, co il ed 0
holog ram, Laser i. light ampliHcotior1 by stimuklted
em i5,ion of rad ioti on .
Holography io a W<lve front feC<:>rWNdioo
process in which two coherent beom. oonve rge
to prod uce 0 constr u,,!i,e and de,!ru,,!ivo
inte rferen<:e potte, n wh ich i, record . d on fil m,
Orth odontic opp li cotion, of loser hol ogrophy
incl ude :
1 Storag . of , tudy mod . 1irrKlge,.
2 Meo.ureme nt of in "i>o r iot"" ion .
3, Stud y th e effects of high pu ll neodgeor
troeti on in oh il dren , . kull .
4, Tooth po,ition meo'ureme nh On d. ntol
casts,
5. To otudy th e eff"",! of ma.illmy e. po"'''''' on
fada l. keleton.
6. To .tudy th o efle<t of Ckl .. II ..Josti" on bone
dispklce", ent.
7. To , tudy tho effedof oervioo l pu ll hoodgMr
o n rrKl>i llo,
8. 10 delermiM the certres of rotot"", produced
by orthodontic lorces,
9 Low"r ino i>o r 'poe. one l)"> i, .
10. 10 ass",,!he fa<:ial ond dento l arch ')'TMl etry,
Photoc e ph .. lometry
Altho<J1> the .tondord kllerol ond onlero-posterior
oephologro m, revea l.orn e ospeol! of .off ti ssue,
th ey nevorthele .. do not 9;"'" odeq""" t~ >oft ti ,we
deta il " In 0 lotero1 cephaiogrom only the profi le
4\ i, """" wh ile in on onte ropo,terior oepho log rom
' J
J
the loltrol o.ofI bsue ""'rgins ore .een.
1ho""" In 1978 de loped pholo-
cephc lOtl\etry tQ bet~ r "."",Ii Ih . soft lim.",. '"
!he PGlitont.
Th"", mdb.oppqo '" mn;olc "",rkefswith
holes ore pIocedoo Ihe poIiMf. sk>1 with ~~
ond . Ia nda rd lole re l o nd on' e re "",'. ri or
cep/IoIog"""", ore toI<en.Using !he same positioo
101en>1 ond lronlol photogoophs ore Ioken. 1he
r>holog"lpN ar. porin!ed 10 1M same . i,e os tho
rad;ograp h. oM o r upe rim poJ.&d ove r Ihe
rodi<>glOphic treeing tolinglhe _lie "",rle,.
os the guide.

This i, boskolly 0 radiogrophic mOlion

picture. The .ubie<;t i. oriented properly ond
"ab ili lad in a mod ified ee pho lotlOI. AI1 X ray
motion pidute i. obtoined using 0 one COmOfO
which run, DI 240 from .... per MCon<l. This
diog n.wic a id is I.O:MId to .jlUaliz\! 1M .wallowing
fXltl&rn ofth . fXllienl . Th . Xroy mOli on pielu " Is
studied ",iflg 0 ~ projedot'.

I. Dooono WI! ' ......... d "'" .w.,b<lol pro/; M(jo

0t>0d 1956;'26 191
~
,,,,
_.,..W.6 , OIrwxIo<n< DitJo_..... w.irJo. BOlIO\.

~.
c.._.
J,eo b,o ,

a.
.....c:Ioop
"" 0" " ;0' 10 Rod iOIl'Op" C
1.00 tv'd r~. PIo'"d.h""'. 1~5
V.I ................. : ~"'" ..!nod.....
~...,.,""'" KDJ 1998. 21>. 5155
5 "'01 .. WIt c:..-_tIO'I'Y Ot '. oodo<.~ . So l ... . . C'I
Motb,-. I 9\l6
o ~ t Ma-rt" : Hond boo, oJ O"I>odoo",~ ~ y_
boo, <"10<1<01 ...hi........ ;fOC,I9M.
1. _"''' , Ho~ ' .Oj I ......... J<:W>Od
1995. H3-4~1
a. ~oI .. a, \101",..,., ""'i"", . I",,, """';"'''''''
KOJ 1996. 18: 1\69 1171
9
fia 0.0_
TlIomooM~._" l _ . ,~
prirodploo and Iodroaco,- /Aooby __
booIIlo<,I99_
10 .,.,.." , 1oWI~ 01 b-.d .... h;, <oop/>o"""""
'""~ P"'" N9< 0rtI0d 1960 ,3035
 ,
....,."..!J ..r"' .~ ~ . . . 1.,Ja,.1"~
~ ~ ~ ';;';-';1 .,.... ~
~.,i,:.Q ~ ,. ~ ~ ~ ..l!.i:!o !""
\,j"""": 'i J
~ \0:. ~ jo

T
he a.se"me nT of cro nio'/o cio l llruCTurc,
fQ<m." pa rt 01 ofIf\odooTo;: diag"OS< . The
ea,I,,,.1 moth".! u.ed to cnl1. lodo l
proportion, wo, by ",h.he .Tondord, w,th
Ie"""",. ,ym,,*'Y ond!:>eo"", '" key poi""_
Croni ome!ry co n be ..,id to be tho fororll""'" of
np no lo me tr y. Cran iomet ry iM(> lve d
""IIlw!'tt"",n!> of croniclodDI dimens;"M of
oIwlb of dead peI$OtIS. Thi. ""'Ihod wos' not
pocIicol in living ind,ot'd""l. due to .... soItliss...e
orMIop whd mode dired rI"Ie<l wremen\l dl!k,)t
ond fo r Ie .. reli obJ e.
Th" d iscO"ery 01 X"oy, In 1895 by
IIoeoligen revolulionOD!Id dcn~.try. It p..,.,.;ded (I
motors/rom t""X roy rube. In 193 1 Boa ,dbenT
irlU,SA ond Hoiroth in GemHJnY ' imu ltOne<)Vl fy
p-nd " sIondardizec:l oephoIomet'ic technique
",Ing "high ~ "-roy "'''',hi.... ond 0 .....d
holde, coiled Cepholo.lol. ' The fe,m
cepha lomet,i os i. u!<!d 10 deoc'i be th e aoolysi.
ond m""", uremMts mode o n th~ cep holomet';'"
ro::Uogmpt..
TrPES OF CI!"PHA.t 06RA.MS
Cotjl!xl logra m. can be of Iw<;l type. :
o. ,""1e,,,1cephalogrum . TIbs pro_id a lateral
";ew of !he ol<ull (~g I oj. k is laken with the

....!hod of obTaining me in"", cronio-/ociOI '"-d in 0 .1onda,,:1"1ZlIId ",produ6bie poIilion

"'8Oturcm. m. with qll~e" b~ of occuroq Or.;! 01 0 $peCilie<l dio!onceln:m ,..,., source oIlhe
_od ucib;lily. In 1922 Po.::<:ini , tor.do rcliled the X""
OI;ICIjogrophic he"d images by pos#ioning the b. fran to l ce ph o logr<lm Th i, prov ide. o n
lUbiecl>ogoinsl (I Mm CODe"" at a diSlOnce 01 2 on!efQ.posl<lrior_;o.- of the ,lull (~g I .b) .
USES OF CEPHALOGRAMS
Cep/loloM(l"ie. 1>0. 6Ilobliohed ~se!1 os OM 01
i"
the pila15 of Wi .1 .. uNa orIhodonhc dOg.,.,....
k i. also a YQI...,bie rooI in """""en! plonnirog
ond /ollow up 01 pot:ents undergoing orthodontic
tre(JImenl. n" /oUQwing Die .ome of th.
opplauionl oi apholomerria in orthodonhcs.
c. Ctlpholomelrics hell" in <><troodonlic 0/;09""'"
b~ aMbling 11"1& $I""v01 olcelelol. denIal ond
.aft lissve IIo\O:Ic.o"eJ of the efOnio-lociol ~ iOr"l.
b. II helps in dC,.. ilicellon of the , Ielo l and
denlol abnorma lit i and 0 1,0 he lp, in
.tfobl isn i.... lccie l tV P"
c. Cepholomelrb he lp:! in pkl,.., inE 1r=lme<\'
10' on indi.ill...,l .
d. h l-.elpt in evaluation 0I1he !reotmen! re ..... h.
by qvo ntil,ing the chon"", bro.:ght olx"" by
treot""",t.
Cephobrnolric. helps ;" p,edOcfirog the ~
t.
re!o1ed chongoo ood chonges....oooted ..;Ih
lu'glcol t.-.ol..-...
L C.pholom""ks is 0 ... Iuoble oid in nISeOrch
worI<. irwo!ving the cn::mic>- denio Iacial region.
TeCHNICAl ASPEeJS
The cepl>olometrk mdiogroph. ero ta~en \/:Sing
on oppcrotu. thot """'~Is 01 an X.m~ lO urco cnd
" heod holdir>g device co iled cepha l",lat. The
eepho lostot lfog 2.b)COf1, itf, 01two &a , r"Q(1, TrooT
pre.eM th e mave mer>t 01 the head In The
h",i:ronlOl pIor>e. Verlicol ,1ob'liroloo of Ih head
is brougl-( about by on o,bml pain\ef!hal COflICldI
 5 feet

f'll2 IN Sao ... ".10:1 IGOF<I pia..

d ..... ,; 5 k.r. (6) Co ............
..-:I .. ""w...... ~ood ..-.:t he p
i. d.~ 'I,g ..... ~ .o .
0' '",.~O'

Iholowerbotder-ohhe lehorbit. The upper port

d the loa. illuppo<ted ~ the ~hood domp
p:nllionod obove the region 01 the ""...1bridge.
The distonce bel '"'. the X-ray ,ourc. ond the
rnidsoginol pklne 01 the potier>! It'll 2.0) i, f"ed
015 foet (I 52.4 em). Thus tho eq<J ipmenr ~ps in
Dandc ,di,ing Ih e mdiogmph, by v.e 01 co,,""' nl
heed palmon and source film dillon SO tr.:,1
..not ... diog",pn~ ""n be compared .
CEPHAlOMETRIC LAI'I'DMARK$
Cepi>olomelrics mokes use oj , ,,noln klndmalh
or poin" on the skutt which o'e used 10'
~ nlitoti.-c onofysio and m""' u'omenTl.
The cepha lomelric I"rod"""" Ifig 3) co n bo of
IIn. tomlc I./ldm. rill
These londmorh repre..,nt oduol OrlOtomic
strWu'es 01 the . \utt.
Derived I"ndme rk.
These ore landmorb Ti>ot have boon ool~ ined
secondorily Irom onotomic ,true"'r!! ' in 0
cephologrom.
The londmorh thot or. used In
""pholometries should /uNitt """'in ""''''nrments..
o. h should be 00"1,..,.,,, in 0 rod'og'oph.
b h .hoo.,ld be unl!c<-m in ovtli". ond .hoo.!1d be
'op,od",ibi..

I ~S-
f~ 3(1) ""pot\I:>"'l kt" , 1 '''''''' ...-....~
INS _ _ opno . " . Poi"" B Poi'" B. Pog.
110 _~ po;", Iv ~-. ,' . _.!'TM. """ po;.o.
c.. The landmc:ub shoJd pennhalid quonlilatie
_urem."" ol li_ ond ang .... ptOjecled
"""....".
The Ia.-.:l""" h u...d in cepl>olometrb
can be dO$~f~ 0' f,ard lin"" 0"" ",It ti,,,,,,
landmark s. Th e fol low ing Or& so me of th e
imporla nt ~ Iom etric 10M""'''''
Hown : The rrIO$fan\orio, ~nt midway be_
.....
fie fnJnlOl ond ""sal 00_ on the r..",to....,sal
0rbiI01e , Th. lowest point on the inlerior bony
""''lIin 0/ the D rb~_
fbnon , The hig ht oo.,y poi nt on the up p.e r
""''lIin 01 Ie,,,,, 1eL>d itory """,tVl .
"'lid ......" , N Na,-"'"
S _ Solo, o Otbioolo . I-NS _ ""IOIIO!' """'" ...... .
'-'On. Go - Goo... ., ..... .....,,'<)n. Go - Gooo" ~. 900... .
Sello , The point .eprwwnling the midpoint of
tIvt piluilcrybsa or ... lIoturcica. Hiso constru<Ied
point in rho mid- sogiftol plane_
Poin' A " ~ .. Ih . cleepesl po inl in the midli ile
betwe~n lhe a nl. ,io. nasa l .p ine and 01.8010'
crest betwee n th ~ two ce ntre l ina """ . II i. e lsa
wiled ..............,1.
Poinl B : k is the deepeot point in the .mdline
bet .. ee .. the olveola. oat of "",ndibl. ond rho
mentol proce>s. His 01", coiled supramentale.
Btuion : It i. the med",n point of the onl'~or
ffiOrgin of the loro.".., mcognvm.
Bolloo point .' Th e h i 9 h ~.t point ot the post
conoMar notch o f t hoo ",ap ita l bone .
Mter!or nasa l sp in e; It i. the a nterior ti p o f
tM , harp bony pr",e" of th e mo," l" in th e
midline of the low.r margin of anterior "",a l
opMing ,
Gonion' It is a con,tructed point at tr., juncti on
01 ""ma l pia ..... and the mandibdar pia,""
PogO""", . It is ,h.. mo. t onterior po int of t he
bony chin in th e med ian plane .
Me nton: It i. th o mo,t inf",ior mid li ne point on
the mand ibulo r .ymphysi. ,
Gnathion It il ,h.. most antoro_inl.,riQr po int
on the ,ymphysis oi th e ch in . IT is con,tructed by
int. rsecti ng 0 line drown perpend icu lar'o tho line
connocti"il menton o.--.d PO!?""K>n ,
AtTicu/ore , It i. 0 po int at th e ju nction of th e
po,te rior border of ram u. OM tM infe rior border
of the ba. ilo r port o f t hoo ",ap ital bon o.
Condylion ; Th . mo,t ,uperior po int on tne
heed of the condyle ,
Pra,thioo , The lowe>! and mo.t onteriar po int
on the alveo lar b.one in tho md line, be:w.on the
uppef centro I inci.ors . It i. 0100 coiled
ruprodentoie.
/nfradentole The highe,t and most antefiar
po int on!he o"edor process, in the rned" n pi"""
be~""n tr., mandibular centra l indsors,
The key ridge ; The "wer most point on th e
contour of the anterior wa ll of the infra .tempora l
fo=.
po, teri<x no,oi ,pine The intersection o f a
co ntinuotion of tr., a nte rior wa ll of the pterygo-
polatine 1"'$0 and thoo floor of the no",. marking
the di.ta llimit of th e moxi ll a,
Broadbent reg isrrol ion point It ii th .
midpoint of the perpeM icular from the center of
.0 11 0 tursica to the Bolton pla n .
!'1m point. : It is the intersection of the inleriol
bc:.-der 01 th . fo reman rotu ndum with th. posterior
wa ll of tM pterygo_mo<il lory l i.w,," ,
G,labe/,'a ' It i. ,he mo.t p rominent po int o f the
forehead in the mid.agiHal plane.
Chelioo: Ir i. rhe laterol t. rminu. 01the ora l slit
on t he outer corne r of th o mouth
Suilnose,l e . The po int where the lowe.t bord . r
of the ""... meet. the outer contour of th o upper
lip,
LINES AND PLANES IN CEPHALOM ETRieS
C.phk>metrks moke. u;e 01 c~ricin Ii"", or pi""",
(Iig 4), The'e I'ne. are obta ined by connecting
two leMmor'<>, Ba,ed on the ir orie ntotion th.
line. or plc ne, Can be clossilied into OOrimnta l
end vertica l ploroe"
Horizontal planes
SJ,'. plan e' It is rhe cfo~ial lin e between the
center 01 se l" tu"icc (selk,) co:f rhe a nterior po<nt
of the Ironta""", 1.utu,," (nmion), ~ repre'ent<
the anterior "Mia l bo,e.
Frankfort horizonral plene Thi. plan e
wnned, the lowe.t poi nt 01 the orbir 10rbilo l ~1
and th e superior po int af lhe externa l aud itory
o>eatu. (PC<-" ",I.
CXd",a / plon~' It i. a denture plone bisecti ng
the po.torior ",c lu";oo of rhe permanent molars
and prem olo rs lor d eciduous maiars in mixed
oonl ;t;or.) OM e.tend, onteriorly
1'010101 plone . It i. a li ne linki"il the onterior
no", 1.pine of th o m("i ll o and the po.te rior no", 1
'pine of rhe IX'latiroe bo ne .
Mondi/xilor plan e : Severo l mand ibular plan .,
are uoed in , . rho lom "tri ". bo ... d on the anof,tsi.
 A

c D

being done . The mo,t commooly used one. o re Ver!lc. ' plane

o. Tongent to the lower oore;- of the mcnd ib" A Pog Line ; It i. " line from po int A on th.
('-0. moxi ll a to pogO<1 ion on the mo ndibl .

b. A line connect ing Qonion cnd gn<l tl1 ion Focial plane It is " li ne from th e onterior
1St. ,,,,,,] point of the Ironto-n ow' . uture (nn'ion] to th e
Co A line connec ti ng gon ion and menton mo,t ont"""" f>O int ci the morxi ible (pogonion).
(Down') Focio l od, A li ne from Plm point to
lIo>ion No,ion plane' It i, " Ii"" conneding cepr.o lometric gnathion
If>" be, ion cnd no.ion. It repr~,en" the mmio l E. Plcne' ortf", "'the!ic plcne is" line between
..". the mo, t ante rior po<nt of 1M ",It tim ... nose ami
Bohon', pi""" Thi. i. " pkm e 1M! (o",,,,e\< solt ti""" chi n.
Ihe Bo lto n', poi n" postorior to the occipita l
mnd~e, and "",ion.
 E

~u '--/,
G

o o

~u ~u
I ~~ J---=::='
f ;g 4 ( . ph,I""",; , " I""es (oot;oo.o . i ~ : "\ono.,",., plun . if i 8u",," . No , ;or, pta", (G:, E,,",,;( pl"no
lH) A - Pcv><""" ""''''' l~' f'ciol ~. I',oc;ol <>.0 ,
 DOWNS ANALYSIS
One of the moot f,eq......,1Iy .......d cepholo ..."'ric
atlOlyoi, i,!h. [)own$onoip io. Downs hod bosed
hi. f,r>di"9' on 20 Coucosien inc!i.;duols 0.11 2 .
17 yea" ago ~roup belong i"ll to both the ...,e .
Down. OtlO~ .. CO<1lkts of 10 p"'rometers oI ;o,t,kh
live ore ske!.,;,f ond ~ve c ... dental.
Fce lcl ongle , It i. the iMide inferior 0"91.
fom1ed by tn.. interloectio<\ of r'''''on oogo nion
pIone ond!he F.H . plane (~g 50). Theo ... roge
-.oh... io 87.8" whUe!h. ronlil" io 82 ta 95' This
ongl. gives UI en indicofon o! rh. On1eto
posterior poo itionl "9 01 !h. mondible in relation
10 the upper f""o. Th e mogn itvd . of thi' ", 'ue
;nc,ea,e. in co,u of 1~.1 "'01 Clo$l III ",it!.
prominerl chin -..h1e ~decreo..,. i"I skeletal Class
'ro~
kgie 01 <;o.""".ily , Thi . 0.... 1. i. Icrtrled by
"" int&r1e-::tion of a Ii", from ,"","on to poo int A
and 0 lin. fmm point A to pogonion (~g S.b).
Thi. ongl. """'Dis the convexity or conc:a.;ty of
!toe . kelelol profile.
i n.. ove<Olje ", I"" .. 0" while the fOr.ge
is be""ee n . 8.5 to 10". A po'itiVl) ong le Or on
increooed O"9le ""\IgeoT$ 0 p,ominent mo,o lla ry
denture 00'" relOhve ta mandible . A decreoocd
ontie oI~ityoro ~ engle io;"a!COlive
01 ~gnothic prolil .
A-B pia,.., ong le, Thi . 0"9 1. i, formed betwe""
a line CO<1nechng poOn! A ond point B ond 0 line
joining tIO>ion 10 pogonion (laciol planej(fl\l S.c) .
The mean ",fue i, -~ .6 while !he ronge is 9 to
cr. l his engl. i, indicOlive 01 the mo..ilb-
ma ndib ular relation ship in r. lation to the foc ", '
plane. It is " .""lIy <>egot""' in ", Iu. since point
8 is positioned behind point A In COMO of Ooss
III m olocc l u~ on . a pos iti". orog l. moy be fo und.
Mandi~k., plane angle : Th. mandiula, plane
angle is 1o'<""1od by the int'''l!(Cfon 01 the
rrond,bu!a, plane with !he F.H .pla ... fog 5.d} .
lhe 'neon ""u ~ is 2 1.9" wh ir. the fOnge is 17 10
29'. M ; ncre~ mond ibv lor plo .... ang le is
wgge.!Noo 01 <I ... rIicol gro..er ";!h hypef'diwlrger-t
fociol """,,m.
Y 0J<i$ ~9~ Q>os) : This ongl. is obIoined
by ioini ng It.e oeIlagno!h ioo Ii .... ";!h!he F. H.
plon e (fi g 5 .e). iI..,e mean va lu. is 59" with a
roftlil" 0/5 3 to66'. The o"\lle i" orgo' in Closs
II fociol oo>tems thon in pollen!> ... nibmng Closs
III potie'n. In oddition. the Y oxi. indicolOo th.
g'owth potle rn 01 the ind:viduol. ~ tI,. ong'" is
greote , tha n "","mo l, it ind icates greoter ve rtica l
g!'OW!ll 0' mandible. 1/ me ang l. is ,,"o lle, than
tIO'mCIl, it indicctes g'eoter horilontol growth of
rrondible.
D,n l.1 Pllrllmete,.
COM 01 occ!<'$O} p lo~ , This ongle i, f~ed
betwoecn !he acclusol plane ond tho F.H. pie""
(fig 5.~ . Down. constructed the 00:1,,",,1 plane
by b._ling the occl.,>ion 0I1he lit PI'man ...."
moklr1 orod the in osa l overbite . Th ."-,,o n ", 'ue
i. 9.3' whi le the ronge i. 1.5 to 14' . Thi s ang lo
gr.es u. 0 memure of !he dope of .... olusal
pkl ... relo:ive to "'" F.H. plone.
Inter.inCi<ol "ngl. : lhi, angl. i, fo,med
be_ n the Ioog ex of the upper ond lower
irodsor1 lfi~ 5 .g) The cvero~ =din g i, 135.4"
while the rung. i. between 130 to 150.5' . The
engie is de<n=ed i"I Class I bim(D01lary proIMion
ond Closs II, divi>ion 1 molocclusion whe'eD' ~
i. in c;reo",d in" Closs II , divi sion 2 cose.
InCi50 r oedu.ol p lane ang le : 1hl5 il th e
intide infenOf angle formed by the itltertedion
\$1
 )

c~

, :
 G H

~ ~ 0--.. .oo ...... .",.;.uod , (Gl ............ ' ~Io

t( U_ - . .. A - Pl>Il rr.o
!I'll'' ' ' ' ' <:><d .... 010 ... ooglo to 'nQior _10, 01
betwMn the long "',.. oIlO'1O'e< CO""'" inc....". one! UPP'" ind.o, ,0 A . PO!) ';n" This i. 0
... otdvsol plcm .. and is 'ld 01., pIvs Of m;"", I)"""" meosureme nt !:>I=tw.,.,n the irw;iJOI edg.e 01
0..;.,1.", from c right "":lie (fig S.h). The oYerQge ,h o mc'ilia ry ce nlro l indS<)!" aod the li r>e jo ining
... ~ " 14.5' wh ile 1M rong" i. bei'w&en3.5 to po int A to pogon ion [li ~ S_il . This distonce is on
N. An in<;reC$<O in th i, ong l. is .ug~'li~ of on o~eog. 2.7 mm j.ong o : 110 5 mml . The
.",eaMd ~incisof prodinalion. m.... uremenll' mO<e in patients pn>oenting with
hOsor mol><l,bu~ pia"., ang~ : Thil ongl upper inci_ prodi,..,Kon.
"""'eeI bv interJedion 01 the long 0 '" 01 the
STEINER ANALYSIS
r.:....trr inc,.." and lhe mondibuk" plone (Gg
5.o1.The mO<ln o"llOJlation i, l .4''''''il. the t'Cl"lle
Cecil. C. Steiner in !he yeor 1930 o.,..."k>ped "'"
be'-r1 . 8.$ 10 7". M i ncre<l<e in thiSong le is
ono ty.i. with th e ideo 01 provid ing mo.lmo l
ondicoli of lowe, inc i. or proc ii noti on.
cli nic,, ' informeTion with th o leos! n ~",b!lr of

\53
 S.N.& ongle; H i, the ongle ~ the S.N..

--
11.1*1 ,
~Ia .... ord 0 I;"., joining nooian to pol'" 8(1'11

.-
6 .bJ . This ongle indical ... the aruel"O-poolel'ior
positioning ol Ihe mandible in ,elallan to the
acn",1 bel.... "''''''''''ge ",I"" is 80". M Increase
In mi, ang~ indicates 0 p'ognathic mandible
ftoiluq. 11,t(~1 S2 - ~ (Cloll llI) whe rOOI " Ie .. 1Il0n normol ongle
.6,5 -I O(dog) l uggO-!l,o 'etM iv@mo""' ib le(Oau lI) .
~,;it ~ <:OI1"'Oti 0(de,)1

~B p(InII ongII " ,&(dtg) t1i<loQ) A.N,e. ang le Thil angle il form ed by 'he
inlersecti on oI li """ jci ning nolio n 10 poi'" A ond
~'~ongII 2\.,'O(1It9) !l.2Miilo;li
,., SU(cIes;) SUS(dog)
""lion 10 poi'" B(Iig b,e), II deno, .. !he reO;.live
pas";O" of the rnaxilaond menclible Ioeodlorher.
The meon vollHl i, "Z'. An ir.creo ... in Ihis angle

.
~.
I, Ind,corive 01 0 Cle .. II ""'1eIa1 tendency ... hile
on ongle thol i. less tnon roormol 0' 0 negotr.e
en (II _ _ 1M"
" \.5 1~00;J
angle I vgg .. .,i... 01 0 .keletol Cloll III

1 ~"""""_JNno 14r.:doQ} 3..!i-a~)

Low.- biIor .......4tW, pIoN lol{:Io!<)

,.iohonsh,p.
",IW Mondlbvlo' plo~e a~gl" . It il 'he ong l,
"_1090 I~'I~) \\51:~)ag1 Iormed belW<!t!n S,N, plane arid me mandib<Jlo'

~ ""*" .. A PO; U II M ., . S nn
pklne Ifill b ,d}, Th e mandibu la r' pla"" uled in
,hil ona ly$i . .. 0 Ii"" cgnnodin~ gonion and
gnathion, The 0" '09" ,o lue i. 32". Th i, angle
gi,,, on incliec!ion c l the 9,owth potlern ol (In
individvol. A b-e r ongle .. indicofive of a
m....uren_. hori.ontal ~r>g loce ... hile on increased angle
The Sieoner onoty.;. in divided in:01l-.rM l"IIgellS a verlkol g,.,.,.;ng i""'ivid""l.
pens. They ore III, skMial <rooIpi<, denial Qnoty... Ocdusol plone ongle : The occlusol plone
ord tile "'" ~ .. ue onlysi> ongle 1110rmed be-. the <XcIv",1 plan, ord

5~el't., In.'y'" lhe S.N. plone (lig 6.e). In Ihi> onolys .. me

S,NA OrlgJe , It i, the angle fanned by the
intfl.-..c:~"" 01 S,N, Pia .... and a Ii"" ioiniog
r"ICd-ion and po int A Ifill 6.0) , Thi. ongle indi;:at...
the relotive onte ro,polt. rio< po< ition ing of th e
. me.i lkl in ro kltion to th~ eroni,, 1base. 11... me,,,,
",I"" i. 82', A kl~,.r.. n ...,,,,,,,1volue ;.-,d><ot..
,1>01 Ihe """,aio .. p<Ogno!~k 10= II) while a
.smaller Y(lllHI I, luw ...,i.e 01 a I~,ognothic.
""",;110 (Oon II~ .
ocduool plane ff:pr..-o" {] line possing IIlfOUgh
me "",rlopping cv>po 01 ~'"'! ;nmolors ond f,,",
mota .. , It has {] m oon ""Iue 0114.5". Thi , angle
i,,,k{]les !ne ~otion 01 the oedu ",,1pia"" to ,he
cran ium and loc@ , It obo ind icat tho g rowth
pa~e rn 01o n ind ivid ""r,
Oe/llal An.'y",
Uppe' in("iS<:>" 10 NA (o"!1iel : ~ i. !he angle
forme-d by the inlelSe(:fion 01 the long (I' is of the
 , J

A B

flo 6 $IoOot, 0"""' "" I,N"" "'11 10 r~ s, ~. e, oog ie \'C) A.N.~ . ogIo (0) .......... Jo , pb- ..... ~ (E) Oed .........
--;. (FI U",* ~" N _A :onc lol

!55
G

f; ~ 6 Sr. ;"" , """I,,;,

,ont ~ u.d , (GI lIppo< ;",;<e<
'0 N_II (Iinoo,) (Hi Low"
;n<; "" " N- 6Ior.g lol \' J ~
;",;"", 10 N_S \' ~ II, Int.. -
;"',> on.;llo (Kl s r""
.~

:'
 ind icoles proclOnation of lowe<" incisors whe rea< 0
decreased .o lue irn,iioot. , upright or retrodir>ed
Vorl, bl.
lower incisor:!,
"'" " ..I..
Lo we r incisor 10 N -B (lin ear) It i. the
Sb l, tal
lineo r dista""e between the labio l . urioce <i lowe r

.. .,.
SNA ...-.gio

~-
S2i<!091
8Il :dtli)

02{deg)
;
,
<
ce ntrol incisor ond the Ii "" ioini ng rro~ on to po int
B (Iig 6.i],Th i. "",,,,,suremen t help, in a,,",~ ng
th e lowe r incim r inclirro!>on , An increa se in th is
meClS ure-me nt ind ioate. prod ined lower incisors.
The no rma l vo lue i. 4 mm,
();oIJooI ~.. W\iO " 5Idogl
_ pIont a;Io Inler-inci, or ang le ' Tni$ i$ the ongl" formed
32ldog)
between t)"o, long oxi. of the uppe r and lowe r
Donl. 1 ce ntra l inci'Of> (fig 6_i). A reduced inter-i ", i. or
lIppor _ Il w. 1""9'<) 22(dog) ong l" i, e.",d eted with a Clo.. II , dii$ion 1
_ _ ., w. (InoaI) ma locclu. ion or 0 Clo .. I bimo, _A lorger tha n
' I'' '')
. . . . . """.I'l. norma l a ng le ;, se en in C lass II , di vi. io n 2

- ...
NB (oogIo) 250:deg)
ma locd usion_ The meon vo lve i. 130 10 131 '
lowor _ to NBlhor) 'I ~ "I
Saft tIss ue am. lysIs
131{dog)
5 Ii"., . Accord ing to Steir>er the lip. in a well
bobnced fo.::e sno ukJ toc<:h a line extending fmm
ropper <;e<1trol i",i$of1 orld the Ii "" p ning rro sion . oh t;,su ~ co ntour of the chin to the middle of on
'" "" int A Ifi g 6.~ , The "",,,,,, I 0"010 i,22"_ 'S' formed by the lowe<" bo,d er of tf.e "" (fog
ilIis orlgle iOOicales th~ relotive irl d irroti on of the 6 .l ] If the lip. Ore located bcYOf1 d this Ii "" thcn
roppe r i ~ci",rs. An increased 0",,10 is , een in th. lip. e r. be lie"ed to be prot, u, ive o nd i<
::rr:5ents who hove proclined uppe r inci",,, os in interp reted o. 0 conYe, profile, If the lip' are
00.. 11, Di.;, ion 1 ma locdu. ian .
~, in cisor to N-A (linear) It is 0 linoor
~urem ent between the lo bio l , u rfoo~ 01 the
roppe r centra l inci,or 000 the li ne joining ""si an
b JIOint A [fig 6 ,g], Th is mom uremcnt a lso helps
.."Ietermring the uppe r inciso r P"SitiM , I\Ionoo I
,.
"""-'e is 4mm_ It i"'rea$es in coses with procI ined
roppe'ind""".
be, indsor 10 NB (angle) This o ngle is
bmed betwMn the N-B pla ne oM th e 10 "" o<is
o/1he "'- r incisor Ilig 6_h) . This ong le ind icot"'
the ind irrotion 01 th ~ lowe, co ntro l i"" isor ond
lrm 0 mM n vol"" 0125". An i",r""sed .o lu"
 c. long ","$ of Ia-r inO<Ot
I
v.~_ M...._ R."~, f ii

--
F r _~

....
. . . ,ngIo
.....
I F ~P.IJ
"'.oJ 11-lS(d+\l1 "nd e>'Olvc:l!ion of p rogrosi. of a COlt,
form .d by ,~" lh ....., pklne. Ore:

..... --.
. . . . . 0101.""1

_"'(f1oU) "'. .-
behind !hl$ line Ihey affl ..,id to boo .......sive and
F,."kfo,t
( FiliPA'
m"nllibw/., pi"""
It II 1M ongle formed by the inlr:>fl4dion 01 ....
f'nlnWort hari>ntal plane with 1M mandibular
1M pollen! m(Jy have a OOflCO'o'e profile. pIone. Th, mean ""I"" is 25'.

TWEED ANAlYSIS /n~',o' m"nll/bul., pl.". a"" . (IMP-A.'

TM Tweed an~. mo."" use of "''" po,n tlig
7) lhot farm Q diognC>$lioc ffiQ~",
!IMd or"
o. fronk/all horizontal pia,...
b. Mand,bular pia,...
It is the a,... le '-ormed by th e int.'....,tian 01 the
n.. pi" ..... Ioro" aoOl of the "'-' inci$orwilh "" mondibulor
pia,.... ~ indiCQIes!he ind,""lion oIlhe lower
incioor. Th, meon ""''''' i. 90".
F'''n~'ort ",."dlbll'a, IIIc1IO' an" a
{FMIA }
It i.the 0.,..1, farmed by tM interoec~O!1 of tM
long oxi, of th e lower incisor with The F.H.plcne.
The mean volue is 65',

Til , Wit. app,.lul

The _ appn:o ....1is 0 meosUffl 01 the """'" to
willa. the mo>Olla ond !he mandible ore ",lated

--
/0 eodo OIher in the anfem.poslOriar Or aogillol
pIone. Th, wil$ oppr<>isol is used in 00... """"
th e ANB a...g le i, co nsidered nor"" reliable due
10 Ioda" wch '" posirion of ""sicn cnd rololion
cllhe JOWl>.
A IlIfIdionol oalusol pion. io drown
through the ~ping cusps 01 /list premola"
oncI ~"'1 rnoIa", !fillS). Perpend"oculors or. drown
to "" oed..,..,1 plonro from pain .. A and B. The
poi,,!! of contoe! 01 the ... perpendicvlaro OIl me
ccdvsol poIone 0'" ter"",d AO end ao. The
disk"". between poin!! AO "nd BO gi.eo the
ontotrOpost&rl", ",)mion between Tr.e TwI:l iOwa. In
L RodlogtOPWo projocIIon orro"

.-
A. MI!ln_ ' ,,",,"',
~ oI. rf"70:nont "
tt"" etIoi>rr+l'l:
Uog(jI"..,., 0<f0I>" 0..:0. .... X...,. b..", By U!"J ~ 1><10, ob.oct <kIw't.
"'!'<'IpnIIoI "t.. ~ Ofeo W:. ot ,.,;. '"""""",oct "" dIolo\O.
By "'f o! ..~~ ",*,1Ja<,'-o
tr:e .. ,_ _

~, OisM"",' ho lli on.tIl

ld~~ tP.o ~~
r:JqJICJ." .. . a_
dtptJ! Of Joioj, TI';$ Mt ""til
indi>brfoos ,
I.O ..... ...,;

"u . _~"radiog"",),
."oJ<:lTn"'"
,,*d ~ ....
~,<koQ ......... ",""" -o<rJ my
....
TtIo ' 'f'O<'' 'Y' OvI>:Omf t l
r1"","~'g'" no>: po ,,,,,fN !II<

F\o\tlo: n 01 '" p . .rt, 1<.:1';, 01'/ ~,.". or By """.-o." d IIoIlil or.,.." nooin;)
>pOOl" 1'10 ,,'Op/JJIonill""Y ~ h ... t-d . .. rod",1tIOil_, ll'Kl brofMj
"1I*"""ocro_ ~

t &rot. ,"m "'" _Uriny .,......

Ef'Q:> ...,. o<w!o '" w,,,,, ""'" nor OO!~ ;" ~ to r..:ln!liI'KI 1M Ill. o! " ~ :il:>oi oIol .. ~ hi
.......",.,.,.. ot'" ,.m", "" ....,...,... dl;ill4"''' d\lllzt nilOid.m-1<> ','d
Ino .. M:l no ........ " Cq o ~ "" .no. it."..-.j
r:>!"""'mni>. WQ<lII' -""""'" ~.. provo<! '~
1>0"..".. ~..-.:l 00_"'-
l &rot. In londrnorl; Itlorlli_on

A. rlJafI, 0/ ~4i'I< ~
Po doltlion or ~~"'!U'f O<CII' tiuo" Ro" ..,:>d<O j"".. ~ "" .. ,...;"
"'" o\!oSI iOrII nI,~nIl'yin;) " ""'" IIToo'JgI. Moi<! WI' (Io1rilOl'td>;i '!J!l t.
.... r>:ftalood<l,."_ '
"',...,,,,,'" of ....
GUO """'" l>i>'.
,*"' _ ".... """ioi lIio coobo tvDlded .,. , lIbilill'llo<l ' f
f>(! o~ I.I:>i nI,. b By
in<fo~ '" ru"TOr<, ~ . _
'"'" it ~. !>JI ~ ho
po~liIf 01 moIQ.\ bb', ' ",
~ ~'Ph ....,. """" OS trr "'" Of ~'kf''-
,1..,_
of tit
,..,.!on ~.I>:I' N
Itn
IOU: Tho ' '''' .. rWL<.o

Po<:<rorNt otlinroarfrll/o;, - . . . . , GoodO ",.... . ,_~J~

-
"..... 0 .. )<00 .. ..",.,..._ g<'O<I .... ."j,," of ",oq'" K,
_( Ti>o I/gh ~v , """'ln_

B. _
doWiott..-.:l
_
oflonjl\ft<
100"",
~ 01
01 ._
E""" '""" """"'N - . . . . "" d<Inoll
i\O.,.ly. 11*; <II./U.O<ri4i;n lI iIIertIco!oo
1.O ...... .
doh~ ,
Jw." .. _~
c.!IO<\l:Wrow ~J:/ 1Oq<n
~COi'kfrlohl " "'nt~
_ bo ""1)" ~_O',
_
h110"'''''_.i<w'd ..... _ fl'cuI ~ de."" Good q...,. "d(.g~ .... \ISO 01
. L.d! .. pOr\:l~ _~ .,ole" """I'OJIJ;*
_...,. oI f1o . - lwJd:nn
v..'o:lll o _lIoen _ "' I;n>-NrI. 110 ..1'\0"'" !or flo .."" porw!"
~"" tIolwo'" _~ 1:1"", rod mo 1<1 ~iM""""" ..
~"o+rlll '"~~-.
n.. _ I S v:pocmIOhI , "" ...,. ., ~ Of TI'iO ""';,. 0-'> "" I'!' rr<IolritIrq
.... YNuo. flo _ ","_ nil rod bj"
~ . ~ """" Ilfn:j.ut,- pdln\

\S~
cooo 01 motel point BO Is ohood 01 AD br I mm,
wIIilo in cose ~ r,.mgies th. points AD ond 80
COIncide. In cooe 01 skeletal 0= II tendency 80
il ..... ",,11y behind AO ( ,,,,,d CJ:I 0 p<>s_
reading)
while in .~eletol Closs III poll"'" ..... poin' 80 il
locol!id oneod 01 AO (...00 os " "egatr.e reading)

ERRORS IN CEPHALOMETRY

A t1 umber 01 pos~ ble error> moy creep in during

copho lomo'rv 01 il i"'>'O"e. 0 numoo.. 01 oIep
.... ch til ob!oi"ing g llood ,,,dk>gmph, ... "" 01
geometrio 'O"",,,otion. ond onolyoi. ond
inlerptOlOlion olthe Yl>1~ ... obrained wilhouJ O"l'
obse..., bios. Tobie ~ lIives 0 .ummory althe
sourc.eS 0/ errOr in <:epholometry. Allhough
convemionol pholom<!1lV mov be osoo6trted
with 0 nvmber 01 wurc.e. 01 erro<s, a .hll oIIe ..
viItIl inlofl1"l(1\;Qf1 f<xme orthodontist in d~nosil
and lreo'meM pionning.

1. Down. WS . "'"'0 .... I f lO d.,*",, 1,,0110 . fflg lo

Ot!000 1956 ;26 ,191
2 Do-..... WB , n,. "'"
Ii "phobmer~ i. 0rlI00000
,,<OM oro .......... d~ , Am) O+>od I~Z
,. ,162
1 G_I"' , ~<>''''''''''''"",_.
WSSa.._.198a
4. )o<o"on ""od'ctlon to Rodiog'.p' '''
~"" 1.00 ood ~ Phlod.\>h ... 19M
!>. Prdio Wl. Coo ... """' .... ClrtIooo'.....-. Sf too ..
01 ..... 1946.
6. I\obor1 f """'" 110""I.,.:,. aI Orhxlrrii<>, y."
boo!< " ...fcolll'All ........ ind96a.
7. _ _JA. , ""'eta 01 o.&o:odoMc>. Jl lW"""
So'"",,"
1
~
8. h_CC : Co;rIdcw' ...... b-""' ....... .....,l
O~nod l 9~3,39;n9
9. Sr, ... CC : ~~ 1, d ln~oI P''''~' , "",.
;~ Q"nod 1959:29; 8
10. loIoo ... CC . n..... 01 C""""""'"''' '" 0' 0.0 i.
""'"' ... '''" 0"""",,
omoa1960 ' .;721
""...donI" __",.., J
II , _ M o..bo-< J!ob<,11 .,..,,,,,,..,,1 0rt/00000 .
,," ".. _ ".0;.10.
and ' odW ... .... Mad,. pO'
boot "" , 1994
12 v...~ 1doJo . ....... _oIlo~in ....... _
"d ....... ,.....omoa 1~;lO--35
 Maturity
~r<ko"'andin; of ;fCI'Wl~ _IS i. of
A
fI~MOry impono"". in th e proctlco "f
.,.1.
!i nieo l orthodontic' , B<>Iogi<; 0;<1,
ellal age. be"" alii", ond , k. l. tol moly'OTlon or.
<:eorl.,. .ynonvmous lern" .ned 10 deKribe the
IIIOget of moturotion 01" person . 0.... to ina'
oiduol ~tk>n$ in 1Wn;"g, durotion ond velocity
dgrowlh, . keletal age o_"""nI ; _ialln
bmuloling ..;obi. otthodonlic tfeoIment plan .
MaturoCI<IOl llOtvs con hove considerable in~y.
once on diaQnosis, treotmont goo ls, Tr&Ot~ nt
~ng, and the ",,,,,tu'" outcome of Ofthod".,.
jc !reQlment. Oink<l l dec:~ ions ,ego rdil'lg use 01
_,,,I trodion forces, lunctional opplione..,
Gf!'OCIjon .ersul non- extrocfion treo~nt O.
cw:hognolhic surgery ""', at leas! porljolly, boHId
an growth COtItid.roIio..... Prediclion 01 borh rhe
.... ond the omount ofoClive 9fO"''h, peciolly
... IM croroiolociol compie<, would be _wi kI
fie orthoclo<1tist.
In . lel'l of the importo nce of growt h in
161
ortOOdont;c ,,,,,,/menl, oojedil"e " .... um.nl 01
moturation is im porta nt. The d1 rOl1o logico l o~
ba.ed on Th e dote of bi rth oHe" liltl. insight in
determining th e d ~ Iopmer>!0 1 slog e 0< somal>':
m<;lvrfly 01 "porson. Thu. the moturily iroditolors
provide on obioc~~ diognos~< evaluotion 01
sIoge o! mOlurily In on ind;"iduoL
lhe boSl' for sleIe/ol age ouess..-l
by r<Jdiogroph, it mo. me di ff"",n' ouif;co~on
centres awoo' ond motu", at dilf!lfl!t\' ~met,The
ord . r, rote, time of appeorar.ce a nd pr<>g rcu of
o ssificati on in Tne >'O ,io u' oss ificatio n co ntre. oc-
curs in 0 ..-odOdobio SIlquen(e ,
II """,t>e, 01 "'..t~ ",. ovoiloble 10
.,.....,..lhe .Ulek>1 maturity 01 on individuol. These
nh,ode:
A u.e of hand ... ri" ",diogroph._
8 , e..::.IUOtion of 1~letof maturot"", u,;.,g c<o"' ..
col..., rtobrae,
C Ao ... ll rMnTo f ""' turity by clinica l and rodlo-
graphic ,"o mina tion o f diffe rent .to~. o f
 tooth d evdcpmel'lT, whil e t he radi us i< on the d isto l o.p.ct, The ro-
AlThougn 0 n um i>e r o f met~ d.le l- diu> ond the ulroo g ive r~e to 0 dista l p(o~t iOl\
eTa I mOMity d elefmin oT"", ho,e been descri bed, on the ir respecti" . id .., Th e", o re ca lled the
Th e uoe o f hond_wri . Trodiogroph . ho. bee n The uln o .oid ond th o ro dKo I . tyk>;d.
roost ",dely occevoo meThod ,
Th e carpal.
HAND -WRIST RADIOGRAPHS They COf1s i, t oi e ight '010 11, irreg ulo rly .hoped
benes arrc,," ed in two rows , 0 proxima l r'Yl< o od
1r.e M nd _wrist reg ion ~ mo de up 01nume rou'
a di. tal row, The bonel 01th o proximol raw ore
. mo ll bone" Th e,e bone how 0 prod ieTo blo
sco phoid, lunote , trlq uetro l and pil iform, Trw.
ond ",hodul"" pott" rn of opp"orcn c" , o ss ifico -
dil tal (Ow 01 bo ne. include tro pezium , troperoid,
Tion on d unk>n fro m birth To moTuriTy. Thu , by
capitote, on d hamot. _Eoch of the .. eig ht carpal
mere:y coml"'rin g a !'Oti Mt" ho "d wr~t rad io
bone. ouifies from 0"" primary cente r, ",.-hich
g ro ph with 'Tanda rd rod iogroph, thot "' pre,,,,,t
o ppeor. in 0 pred icroble !'Ottern
d ill",MT, le leto l age" w. will i>e able to dete r
mine t ho , l . letol mot uroti o n . totv. of thot ind io The m e tacarpal.
vidual.
They are 5 miniature big be""s fo.-mi ng tho .kel.
A number of method s 1>0" been d.
. tol fromeworf d the !'O lm of the hand. Theyore
>- scribed to as", ... the ""eleTa I maturity cosirog ho<>:J
numbe red I 5 from II", thumb to th" littl e fi n
wri,t rad iogroph> _ Th e fo ll owin g or" tl", mo<t
g...-_ Eoeh metaoarpa l ossifie, from one primo r;
comrrt<::.-llv used method"
ce nte r li n its shoft) and a ""'Of1da r; center 0f1 the
A. Alio. Method by G ", ulich and P~ e
d i.Ta I e nd ("-'C"pt fo r tho first meloo(Jfpal whe re ~
B, Bpr-f , G rove ond Brown Method
op pea rs ot the p roxim al e nd ).
C. Fi. hm an's Skeleta l Maturity Indicators
D, H<>g g and To ron ge' Method, The phalange$

ANATOMY OF HAND WRIST They ore sma ll bone. forming the linge ", They
are th ree in nu", ber in co cn fin ge(. exce pt tho
The ha ndwri,t region ;' mad e u p 01 the loI k>w thum b ...-h ieh ho. on ly two pholo nges ,
in g lou< group, 01 bones (fi g 1), Tho three b:>nes o re referred to o. tho
I, Dista l endo 01lo ng bo "'" olforM rm p roximol, midd le (o b,""t in thumb) and the d is
2, Corpok 101pha longe., The pholange, " ss ify in J .Ioge.
3. Mctocorpo~ (fig 2),
4. PIlola nges STAGE I The e piphysi s an d
d iop!1v>i . ore equo l.
DIUal end. of long bonn or forearm STAGE 2, The e p iphys is CO P' t he
The d i,to l erd. of rod iu, ond ulna , wh ic h a re d iaph ys i< by ,u rroundin g
lQng bone. o f the fo rco rm, form the l i"t grovp 01 it like 0 cap,
bo""" In tho ar>atom ico l po'ition with the !'O lm STAGE 3: f v, ion OCcurs betwee n
focin 9 th e front tho ulna i. 0f1 the med ia l a'pect t he ep iphys is ol'ld
diaphy>i.

,,
 ~
~
p B g
<V'

=7

9"'"
M
M

I. ROOiu.
2. LJlno
3. Di,tal Eplphysi, of Radiu,
4. Di,tal Ep iphysi, of UI""
5. Tmpezi"",
6. Tmpeloid
7, Capitate
8. Komulor pro<:en 01 Hamate
9, Homote
10. Tr\quetrn l
11. Pi,iform
12.lvrlOte
13.5<:ophold
14.Sesomoid
M '" MeIoeorpo l
P '" """1011<

163
 >/$"

GREULICH AND PYlE METHDD

2,
_.m::f::'
00tt<0'Iinl!ti:>n 01 ~!'I'IOIJo1f ~ 1'' ' ~._.
G r. uli ch ond Pyj. pub li shed '::'::;,~~::':'::";:
ideo l ,ke letol oge piLlur. , 01 th o .t
difie re nt ch ro nologicol oge, 900 lor..oeh .\e>-
<>In: d I~ ~.~odJsioo ':;C"'" .., loW Eoch photogra ph in the otlo , is repre.entoti\le 01
(;Ws II '" Cla>< Iii I3ID;duIio>1
o porti;:ulo r ok. "",,1oge. Th. potierit'. ro diogra ph
3, T~ _ It Ii<oIolII ogo '" I PI'ionC . """, ~
;0 ""'>d t>!' ~"""'"" t at \ ...,,,,,,,,_
i. motohed on on ove roll OO, i, ..;th 0"" of the
photogra ph, in the otlo s,
,j Ol1$,

4. Sor'" .......... " oj _01 "" "'fig tw<t...,ist

BJDRK, GRAVE AND BROWN
~ ~ r CJIt! ., .... ~ I1f ~"""
01 '" ~ br.l: 0/$0 ~ prO<Ic! ~I.>' ... _
They no". divided ,leleta l deyelopm Mt in to 9
rnolJralon flIto l roo' O\OIJ$
5 "pro;jcl tI\O fAlbtlI {lIOW11\ !pIX!, , tages , Eac h of these stages r. pre,ent, a leve l of
,keletal moturity Ifi g 3 ). Apprapriote chrono logi .
S, 'U _oid it>- ~""<Il """'.~'"
r ~' 0I 1te~. "",.;,,,,,,,,,,,,j, r>JH OO.-". , on 111< co l oge lor eoch of the ,toge, wa. given by ScOOp!
_:01 ......."'" pll'lo!~ in 1978.
1, It ~ ~ " j>I."io(.!S ..t1 "",tot rnaIoct'uoion Sfage 1 (males 10.6 y, le males 8.1y) :
~1gorarlii<_, I~ W-O Th . epiphysis 000 d iaphysis of the proximo l pha.
,~ . 20 t..... .., os "' ....... tI\O~, "..., . lan, 01in dex fi"9" r are equal. II occur-, opprw:i
The uumolct bon e moteiy tlu-eo Y""'' bel"", the peal 01 pu berta l
~{owth 'P'Jrt.
Tn. "",""",oid bc....e ~ 0 ,mo l nod ulor bo"" most
often pre,ent embedded in tendon. in tn . region Stag e 2 (mo le s 12.0 y, lemole , 8. 1 y ):
01 th o thum b. The ep iphysi, and diap-hysi' 01 the middle pho
lam 01 th o middl . li ","er are eqLJ<ll,

SIa ge 3 (male . 12,6 y, le mal ". 9.6 y):

Thi, Slog" ~ c"" roeIM=' by pr. se""" of 3 ar"",
oio.s ilicotiQn :
o. The hamulo r proco" oft n.. nomate
e, hibits ossification .
b. Ossificoti on of pi' ilorm.
C Th e epip-hysi. ond diaphys is 01 radius
are eq ual.
Stog" 4 (moles 13.0 y, fema les 10 ,6 y) :
Th i' stage mo rk, the beginni ng 01 th o pubertal
growth 'purt. It is cno ro cteri.cd by :
o . Initio l mine ra lization of the ulnor
A B c
sesamoid of th e thumb.
F;g 2~, in o..;loot"" 01 pI" " "'iI<' ~TI ",~'
ond . :oph),>,'""
(qf",,," be ....""
1"',,,,,h,.
"
lBiT"- op~ GOp> h 0"",*", ;'
..-.J ,,,,, .,,..
b, locreased ouificotion 0111.; no mulo r
flo 3 (.'.,' S"" . one - ~ O i pt, ,, ~ ...... ' iOP "I,i, 01 .... fig 3 IB) ~ ...,. _ . Tho ..."""" ,nd ... ""' .. 01 to
_",,01 pOol,,, of ,"",,, liV ' 0-' eqvc l. ", W e phd" , cf to. n#J. 1'"'1''''''' 'VO l

c D E

F
fo; 3 (1') Sb}<> bx _ I ~tiof .,.".mf.",,,, 01 .... " ""' .. """""" cf tho h mo ':C; I I ~ ",.h"too 01 t . "" """"
""""" 01 .... homo .. t>on .

\6.5
 H J
f'" 3 (HI $'>gO roo Copp;ng 01 o;o physi> by to. <po...,.,.. ~ ,",, " miJd ~ ,*"kx'~ 01 '"" ",oJ t"ll"' 81 Pro,_ 1photono
'" 'ho ""'"" I;'. Rod"

F.. 3 :10 S_\~ Uo "'; ~"",,,,,,,,. ,00 ~"." f .. 3 iW s,ov< .. _ . ~."oo 01 "oph,... ond d<>phyo;..
01;" "'.. ""'*""
01 .... '"~ f "ll"'_ """""n.. of ' "" 1.,10 ,1 _ ,
01 tfoe ." ,,,,,,,, 1

D
[J~
f"
n
3 Wl YO,. f;g. Fe""" be!wetn tOe ,>,;pO', .., ,nO
""ph,... oftho ,,-,;,jJ ~ """ .... 01 . ", .... <kk f ~ .. ,

,
 proce .. of the ha mote bOM .
Stage 5 (ma les ]4 ,Oy, lema les 1.0 y) ,
Thi, sIoge he", ld, th e peal 01the p...b:rto l growth
s;>url. Ca ppir>g 01 diaph)'>i , by tn., e pip hy> i. i.
_ n ,n :
a Mid dle pha lanx of the third fin ger
b. Proxima l pha lanx of the thumb
0, Ra diu.
Sla ge 6 (mol e, 15.0 y , lema/es 13,0 y/ ;
Thi. stC!Qe signifie. the end of the pU""' rtal growt"
<purl. It i. c""", de rit "d by union b.etwM n epi-
phys i. a nd diaphysis of th e dioto l phakmx of the
midd le finger.
Sloge 1 (mo le . 15,9 y, female, 13,3 y),
Un ion 01ep iphy>i, and diaphy>i' of the proximo l
ph<;.la nx of the little fing er OCCurS
Slo ge 8 (mo le. 15. 9 y , females 13.9 y!;
This Sfage .naws fusion between tf>. epiphysi, and
diop h)'$ is of the midd le phalanx of the middle
Gr>g er,
Slo ge 9 (mo le. 18. 5 y , lemale. 160 y! ;
Thi. i, tf>. lost sla ll" ond it signilie. the end of
~ k e l etal growlh, It is choraderi, ed by lusion of
epiph)'$i, ar>d diop hysis of th e rad iu. ,
SINGER 'S M ETHOD OF ASSESSMENT
.k.li.J n Si nger in 1980 poropo<ed a sysIem 01 hond o
wri. t rad iog raph o.. essment that would e nab le
the cl inicion to rapidly and wilh "'me degree of
re lio bility he lp determine the moturat;ona l , totu,
of the patient. Six sto ge. 01 hondwn. t de,.., iop .
ment ore desoribed . The st"ll'" and thoir charac-
teri.tic, are:
Stase one (Ea ,'y)
Thi. stage is charocteril oo by a bsen ce of the pisi_
form, a b, ence 01 hook of the hamote a nd ""P i-
\ 61-
phys i' 01proxima l pha lanx of . econd finge r be-
ing n,mower thon it. di o~ hY' i .
Stage two (P,e pub e ,ta l)
Sloge two i. choroctori, . d by initio I OSsification 01
hook of the ho mote, initio l o" ificat;;'" of th o pi. i.
form and proxima l phakln' of .e~o n d fin ger I;.e-
ing eqvo l to it. epip hysis , Stag e 2 re pee' '''''ts tha t
period prio< to the odo le.oent growth $p ur: duro
ing whi ch .ign ifica nt amount. of ma ndibu lar
growth a ~ poss ible. l\.Ioxil ko ry orthodontic thera py
in oOf1 juction with mOM ib ular ~ rowth might a id
correoti on of a Closs II relotion. hip with con, id -
e rob ie , pood and eo ...
St.,e th,ee (Pub e rtal onu t)
This .tog e i, characte ri,ed by I;.eginn ing of cob .
ficotion of ulna r ,esomo id, i"""""sed width of
e pip hys is of proxima l p"" lonx 01 the ' eGOM fin-
ger and ;,-,:""".ed <Xl lcifi co!ion of hook of ho"",t.
OM pi siform,
Stage four (Pube rtl/)
5io9. fovr i. ~r.o rocteriled by <Xl lcilied ulna r ",so-
moid and <Xlpping 01tho dia phys is of the mi dd le
pho la n, of third fing er by it. e piphys is.
St~ge flye (P~b eral deceleratIon)
Thi . >tag " i. cho rocte ri , e-d by fully ca lcified uln a r
",,,,maid, fu, ;on of ep iphysis of disla l pha lanx 01
third fing er with it' ,hoff, and epip hyte, of rod iu.
ar>d ulna not fu lly fused with re, pective shafts.
Stag e 5 rep""ent. tM t period of growlh when
ortr.orlontic treatment might I;.e completed or>d
the potiMt is in rete ntion tr.erapy.
Steg .. . ,)( (Growth comple tion)
No remo:ning growth .ites.eM.

aMJ. l : The ttd~pro:ximII pha ~J; sh:JIoo1
equal wdl:h01 epiphysis and ~ysis,
.
S,I.U 2, W' !ltlolepip'rysistlqU3ll:lflal ol cb
~ in hi rr.<!dipllliw of ilia ....
.
S,M. I J , 1'fIdI:1":.jepipl\~ (l(wall:l lllaH"
~ in 100 . - pilaIanx ol fllll m
S .M,I.~ , ~< ...::tGtm.:tormrroo:JoI loo
S,IA.I. ~ : "'"
eawn.oIopiphysisseenn<lstalpha-
no/lTdir1ger,
S,U,16: CW>.l ol ~seon "rricde!>;la-
Itnc o/til! ~,
StU 7' ~oI~seen " mildIepha
t<ru of IlM-oer,
S.M,I. S: Fusil101W>!s~a"Id<i.l!tlYsisin lhe
cistaI~of M rllger.
S.loI.l 9: fusion of epiphysis and <'iaph~"
prn>:ina1 ~xollTdq"r,
S.IA,LtC, fusionol~and(\ap'\y$i$inthe
mid<tophano/ ttd~.
S.M,!. 11 ' Fusion ol opiphyslsand daphysisseen
irl thelooo...,
FISHMAN'S SKELETA L MATURITY
INDICATORS
A1)'<1"'" IOf "vo lu iltio-n ci '"'.!..ta l moturutiorl ""m
""oposed bl Leooord S. Fil hroon in 1982. Thi.
.y.tom of ~ y a luating ha nd,wri , t rod io graph;
roo ke. u.e of aoolom ica l . ite, located on th e
thumb, thrd finger, fihh ling er aed ",diu . Eleven
diocrcte <>do ",,,,,. n! ske letol moturity in di<;olor>
(S.M,I ,'sj covering the e ntire period of odolescent
developmem hov<: boon ,bcribcd. The Fioffi,on'.
' y, t. m of interpretatioo use, four .Ioge. of bone
matu rotiorl , Th ey ore:
1j Epiphysis equo l in width to diophys i.
2) AppM ronce 01 odd uctor 'e>o moid of tho
th um b,
3) Copp ingol ep hiphysi.
4) Fu';on 01 ep iphy,~
Tabl e 2 give. the el' '''' n . keletol rooturity in
d>ookl r (fig 41. Table 3 giy", u. th o opp(oxiroote
00'
dvonolog ical age t:lI"Jd percMlOg " 01 gr-o...th that
i. com pleted corro.pond ing to """h of the eI""""
.skeleta l rootu,ity ied icotot1 .
MATURATION ASSESSMENT BY HAGG
AND TARANGER
Sk. letal (i<!YelopmMt in the hend oed wrist il
Qr\O I)"Led from orlO uc l reo-ogrep"" lalen botwoen
the age. of 6 end 18 yeors, by a ...... ment ofthe
ossili<;otion of the ul oo r ."",moid of th e "",laC,
arpopha lo"," e<ll faint of the lirst fir-.ger IS) oed
<:em in .pecified 'lOge, of th ree epiph)Oe<li bonos:
tho middle oed di>tc l phakmge. of the third fin
ger IMP3 and DP3) and the distal . piphysis of
th e rOO iu. IRl Ifi ~ 51.
Seumold
Se50 mo ;,; i. u,ua lfy ottain od during the occel-
eroti on pe riod o! the p...obeoc l growth >-p.K! (on ... t
of Peok height volocity).
ThI,d fln,e, middle phalanx
MP3-F , Th . epiphyo i. i. a. wide 0. th,o, meta
physi" Thi5 .toge i. atta ined bofore onset of P.H.V.
b, about 40 perc""t of the . ubject< oed a t PHY
by many Qlhet1.
MP3FG. The ep iphy;i. i. 05 wide a. th e meta
phys is ond the r. is di!linct medio l ond/ or loterol
bo rd er of the ep iphy';, forming a Ii"" of demar-
cotion at right ong lol to th o di, tol borde r. Th i,
stoge i. atta ined 1 year before or ot ~ H.V
Female
SMI No. Ag. 1n Y.... P.re.nlllg. of Adolescent % <If MIX Growth % ol Mand.
growth complel<ld Compl' !-.I ,~"
Completed
9.9. tll.98
, , 2.2
,
10.58 ;00 .88 16.7 14.7

' O.88tll.9S 22.5 18.5 25.0

, 32.1 ~., ~. ,

, ".22 ,,1.1'
".64 O.90 39 .8 28.6 38.3

12 06 O.96 51.1 49.7 47.0

, '< .34 tO.90 7305 g.O ~,

'3 .10ioO.87 00. 83. 0 n .'

'3 .90tll.OO 91.9 89.S M.'
00.'
'" '4.17 to.96 00' 921

'00% '00%
"
Male
1.O71.25
'""
SMI No. Age In Years Percenllll!<' of Adolescent % 01 Max Growth "" of Mand .
growth eompletod Completed Growth
Compt.ted
, 11.01 1.22
, 16.7 15.9
,
11 .68 1.06
12.121.00
"
2\.6 18 .5 19.~

,
12.33 11.09 28.9 ~, ~,

12.98 ~ 1 . 12 M' 28.6 00.

.'
,
13.751.oe
14 .38 1.OS
526
7 .3
49.7

69.0
~,

00'
'5 .11 1.03 87.3 83.0 nJ

,-
15 . 50~1 . 0 7 920 89.6 M.'
95.3 92.7 91 .5
'" 16.40~I . OO

\1.37~,.2!;
,

" '00% '00%

\ &9
- '
 MPJ.G , The oicIeo 01 the epiph)'Si1 ~ thld-
ened ond obocop'" melophysis,lorming 0 sharp
edge "i""I'V at one or both .ides, Thlo ""~;,
gjloined at ar 1 yeo r afte r P.H.V
MP3H, FulliO!1 01 the epipn y<i. ar>d metaphy.
lis ~as begun and;' ol1cined after PHV wtbe
btl! end of~......th spurt by ptOCtically 011 boys
end obout 90 pe<ant cJ the gi,".
""'3-J, Is onaiMll before or 01 end 01 ~......th
tpUII in 011 subjO'Cb ""'epI a ' - girls.
ntl,1I tlnte, dllflll plrlllinx
OP3~ , FUlion of the e pip~\,>i s and metophYSil
_completed . Tfli. mile >ignifies the fUllon of the
~\'Ils or>d metaphysis a nd il attoined during
f'e deaolefotion pMod cJ the pube<tal grov.th 1PJff
. end 01 P.H.V.) by all wbjec1s..
&l, f",ion 01 the epiphysis and metcphysis fIas
!legun. TI.i l,to",, ;1 Olto ined 1 yeor belore a ' at
too end of growth .purl by about 80% of th e lIi~.
-'obout 90% of the boys ,
au, Fuslan is almost complelfld but there is
a .mall gap at One 0 ' both ma'~lnl.
"1, is chorocterized by ""ion 01 thl e,l'physis
end metoplr,sis.
These IfOOM _'" not <llli?ined beIonI end cJ
&t.V. by CW\"f IIJbjecl.
.sKElETAL MATURATION EVALUATION
.sING CERVICAL VERTEBRAE
~ ond Forman developed a ryWm of $kel.
"""""'lion determinotk>n using the ClMcol
.........oe. The shapes aI the cervical ","".broe
-.. seen 10 diller 01 each ,''''''' aI skeletol dlMll
-"",t Ifig 6). This provided a mean. ta cleter.
Dne the Iok.leta l mOluo"ily aI a per>on end t~reby
*",rm in e whethe r the poss ibility of potentia l
11-1
g,.,.,m ....sIed.
The shapes 01 the ~,;ebn>1 bodies 01 C3 and
C~ changed from som-f""......!ge .hoped, 10
reckmgu lor,lcJlcwed by .quare ,f>op<! .ln odd i.
tiao1 They become tolle, a. , k. l. tal maturity pro
Qre,~ TI.e inferior O1!r1ebm l bo ,d .... we<ellot
when immoture, ond they _'" ca~ when
m"",,,,. The CUrvaluto:s 0/ the inferior- wrtebtol
borders were _n 10 oppear ..-ql.l<lntially Irom
C2 10 C3 to C ~ 01 !hot skeleton motured. The
conc""me. become mar. distinct '" the person
motured.
He ..,,1 a nd Fortro:l n hovo put lorwcrd th o
foll owing Ii>. slogel in vetrib<-c l d"""lcpment,
Ste,e 1
This $loge called initiation, corresponds to be-
9irWng oIado-.m gn:>wthwith 80%10 1()()%
aI oool_en! g'owth expected. Im..nor borders
01 C2, CJ, ond C~ ,..,'" flat at Ini< Iloge, The
""rteb"", were ~. lhopod. ond the ,uperior
vertebral bord"" we"' to~ lrom ~iortQ
anterior.
St"ge 2
The second 1Io~ Is called acceIemtian. Growth
6S"
Dr;<;..Ierution beglr. at thi< 1IIage, with 10 8$"
01 adoles<::ent growth e>,pOCJod. Concovmes-.r
develcp i"ll in tI>e i"lerior borders 01 Cl end CJ,
The infe,.ior border 01 C4 we.flot, The bod ies of
CJ and C4 were nll<lr+, rectang ul ar in , f>o pe,
Ste,e 3
The third lloge coiled transition, COITI!SJ'O' w:loed to
oeletorion 0/9rowth toword, peak heighl _
Iocity ,.;th 25" to 65'l1oal adolescent growth ..
peeled. Diolinct cancovilies ""re ..,..., in the in/e.
rior borde" of C1 and CJ. II COf'>C:OViIy wei t>e.
ginn ing to develop in the inferior bord er 01 C4,
The bodies of C3 ond C4 were rocton",",Io, In
 B
fl
THE DISTAL PHA-
LANX OF TH E I
F G H I
FINGER
THE MIDDLE PHALANX OF THE THIRD

ULNAR
SESAMO ID

h. r:: ::'I "-

IJ J
 Initiation Acceleration Transition

Completion Maturation Deceleration

o f (3 and C4 we r~ nearly 'qvore to >quore in

Stage 4
This ' toge called deceleration, GOrrc'pon<:h ta
dec. leration 01 odole"'Mt growth .p.urt -.iti> 10%
10 25% a f odolesce nt growth expected. Oi. tind
cnncov iti~. w~re ,"M in th ~ inf. rior b.orden of
0 , C3 , aM C4 . The "crtcbra l txxiios 01(3 and
C4 were becoming mOr~ .qvo r. in <hope.
Stage 5
The lillh .<loge i. co ll~d moturn lion . Finol motu
tOIion of the ",rtebroe tool poce c;l.ing this 'l:ojJe,
.il!1 5% to 10% of Od01eSCM t growth expect. d.
More aooe<>tuoted cO<1cavitie. were ' '''''' in the
inferior b.o rder.; of C2, C3, ond C4. Thc txxiie,
, hope.
5t.. , ~ 8
Thi ' 5109c called co mpleti o n corre.pond . to
co mpl etion 01 growth . Little or no adole,e6nt
growth co ukJ be c<pectoo . Deep COOCCNw.e. we'"
. eM in the i n f~ ri or bo rden 01 (2, (3, ond (4.
The txxii~' 01 (3 aM (4 we ro 'Qvore o r we re
greater in vertK:o l d imen'ion thon in horizonta l
d ime""ion.
TOOTH MINERALIZATION AS AN INDICA
TOR OF SKELETAL MATURITY
The ca lcificati o n pottern. ond ' t"lj e of miner-ol
iIati on o f th e teoth i. b~ li "ved to no"" 0 do,"

1'1-3
 "
'" ,

,elcli.,""'ip w~r. the . ', ...1<>1 rrot\",,~on 01 on

ind",;duol. Stymour Chcrt',ow has desc.ribed 0
"""1,,,.1 01 clelennin,"iI +. skeletal "'OMi!f boood
on Ihe min.,oliloHon 01 Ihe lower c"n,re.
Dcrni~c'" Gold " and lon ... hcJ.... desc.ribtd
a "m- :Orm.l~od.

L 0."""" _ ......., _ GO O. I'd"""," oi

!\Ie po.booI<4 , ....t. """"'" f; J 0.+"" 1~60,"" ,
1';_91
2.
rno <d<f;<a co "';tOO cod
o.-hod I9'i'J ; .". ,1 611~
._1. . .
c......;+o, a...:...... , and MIndo. y,,"~.,..., <0-
'1' "'"_
:L 0. ...1.... 8."""'' ' ' b-q. <r<; ,...... , ........ .
I<~""".;'" o,"",og MO(Uo,.'" 01......,,< ...... . IOt
de<r<1, tr"' ........ -.;~, "'" J 0riI0d 1~5; .... '
'J:J-~~
~, 0. ..... ..... 6_'" SI.oIoOOl ""~ en> oeoloo
_ 'i'-"""" ,1,.. J Ortloo 1976,"",69-113.
~, ~I;rj <rd 1Oro_ : y", .. ""," I'd"", cod ,n.
,...boo'" ~ ' '''''I, ""'~ ,,'" J OriIod i 962;"" m
m
~ r ", .. I"nO f ...", : \ ....,1 """"""0' ...... , .
'en. Am j Ort"lOd I 9'i'5;;oj : 58-(,6
7. ), 10 ' S; r ~ : ~,., olo~ I ' Nml .... 0: O" I'''''''i,
.""" -,,..:,., ,.. ... Or,,,,,",,, 19M: >'01: J22333
6. ......en..;~. ond Ck..o :S,~" , I OQO .... """'
,,;-h I; nr. "'ood, . , ' ,h.o fi ' ~"', ..: n J Crthod
1i'!ll."" ... n . 9S.
9 toon'" \.fi"""," Rod!o&'OF"'C .",, 10";0' g;
S.. . '" ,....,.1\ ....... Q.!'!Odo.,. \ 9&2; "'". 6'l
10 ,"''",con,. ,,_ ",d 0..&010, J.I< ...........' 0 .,. 0',"
"""Kit. ... 11'0</11., "'.) 01>0<1 \990] ,001 ' 33

"
II. "... ~ ... 0 r ,T'or ' f",,1.orion 01 oul;.:o+io, ol
"-;' I'O~I""' ....... J Ort ... IWoi. 0<' 288
=
12. ~...,.. ... L"'ml><,O,.,," 110M" fr<>rt<1 "." -.J
""'""'0" .. .,-"......"" A... ) 0""",,1991;
"" , 542S<1\.
 ,

Analysis

S IIIdV cosll or. essert!;.,1 d"'l)I"IO'tic OH;lI. The

STudy mode~ provide (I th ree dimensio<"lal
view of tho ""'xi'lory t>r><l m::md lbular 00<1101
on:het. ~ 0'1011"" invoJ,., the .tudy of 1M
""",ilia", and mandib...l",dentd ardon I" oi llhe
!hree plone. of >P0""' (""gittol, vertical and
lftln .... rse plones) and il " voluobl. tool in
orthodontic diagnosis ond Ireotrnent plannIng.
CAREY'S ANALYSIS
Mony ma locc lUSio n. occu r o. 0 result of
dnc repancy between arch length and Tooth
....,~I. Co'ey'~ a"" I ~, hel~ in de~rminif\Q
""e _ <J !he diKteponCV. k i. pet/ormed on
~ lowe< cosl. The same analysis on rile upper
cost" coiled Arch Peri""" Analy.il
Det.,mllll t /an af " reh len-. th
The arch ~""ilTh onte<i<;<- 10 the fi rst permane nt
molar il meas ured ". ing a $Oft brtm wire. The
wi", is ploced eonIOC~"9 the meoiol ,w""c. of
the ~ .. t permonent mola r done lide arid ls
po s.ed over the buccal <:us ps of 1M premolars
cind olong the antO!<ion and i, co ntin ued o n the
opposite IH;le In me ..,me wr:rr uplo rile mesial
.unuca of the opposite ~m pefTTKl""'" moIo', In
""" of procllned O~B, !he wi", ill poued
along the cingulum oj anlllria' .eeth. II !he
om ........ _h a'8 retrodj,..."j, the b'a" wi", in
the anterio' .egmerl! ~ klbiollo the teeth. ~
th e IInterior IoeIh ore ... 011 a ligned th e w1ro po$$e'
av"" th e in C~III edge of ont .... ion.
Doot e rm lll . t lD n Dr fOD th mat e . '.'
The meiiD-dislol..;drh oj rh. teerh onl$'\Or to rhe
firs! melon ~ ptemolor 10 second pNmOI""
i. """' .... red ond ",mmed up.
Det. r m/neflon of th e dls c r. p .IIC"l
The dilcreponcy referll tho difference bctwoon
the a rc.h i""'llth e nd tC<lth moto ri a l.
 OI.orop,noy Int,,,",,
o. 2.5 " 11 PrO" "'" ""W""
2.S . 5 "11 E'N:>o' ~ ~ prornola-o
E,_"" ~ I '~ 1'_'
Infsrence

0, Hthe di.CfOporq i. Oto 2 .5 rTlrTl, it indicate.

mirlimo l tOOl" mC'erial ro:ce", In . uc:h case"
pro,imal . tri pp ir.g ,an be carried out to
red uce the tooth mat.,.-",,!.
b, 11 th" di ", re ponq i. botwMn 2 ,510 5 mm , it
indicete. th e need to e>ctroct the .""o nd
premoklr>,
c A discrepancy 01 more than 5 mm ind icote.
th o noed to e>ctract th e lir\! premokl r>,

ASHlFI' HOWE'S ANALYSIS

Ashley Howe LOf\~dered tooth cr""," iog to be due

10 defkioncy in arch v.idth rathe.- th an orch length,
He found a ,elo tion. hip betw""~ the tota l width
of the 12 teet"anteriof 10 toe ... cond moIer> a rid
the mdth of the de ntol arch in the first premo lor
region.

De!erm/natlan af tatal tooth

material (T. T.M.)
The me.io-<i i.ta l widtn of 011tir e teeth me>ia l to
the '''''000 pe rma ""nt mota " i. moe, ur.d "" ilh
tnc hclp of divkJ e" 'Jig I ,oJ and a ll t"" vol.,.,.
are w mrr.od up. Tni. ",, 'u. i, c~lI ed tlr" tota llooth
material,

Oet6rmlnatlon of premolar
dlam .. t .. , (P.M.D.)

The f>rOO1oklr diameter refo " to the ar ch wicith fg l A ~ e l lj o .' e " , ,,,, , ,,~ , IA: ,':.,,,,,,,m,,' cf ....
frcm the rp of th o M ool C"'P of one first p",moIa r """, 0' ; ;'''' ".;do, "'.,. !octo , I ... "'00 0' m '~ ," ","
cC '''cu ' (3) ",',e " " om.,1 of p""'ol,, 0;0", . 1.,
tothe tip of bucco l cu ' p of th e o.opor.ite fi rst prom"""
( ~ i " 00>.....,- . .. of """, I 0,,1, wdth, I",., ~ ,ow ,
,-moJar(f;g I .b), he "'""" ~ I to '''' "" ~ ... oro,,-; _ oo
 ~~ R-
PWUW '"
31 " 1+1.
~It ......

_fot . W~
I .-p../
~ 1"'-'
\1
" ,,,-
I, . .
V ' 01
~I.:'I
r,.. _ , b) "''''' W ~ on -t
~
". ~ \ A

"'" 9o<00r:.........
)-) 8
Oe ' e tmlne!ltm of prlmo/.r bU.'
. ,eII w ldl ll ( P.M .B.A.W.} ,-
i-)
The conine 10..0 i, found di'lo l 10 conine
"",inere". The meo-...me<ll 01 the .width Irom
conir>e fOSSIl of 0"" .ide to lfoe oIfoer give! ul lh e
f", 2 .",." o">Of". tAl I,ropro.,.,"" ~'id-ro
1:
IS;, "'.~
""tn 01the dento l arc;h at the oe iee l ~ ... or th e "",k. , ~dr+r

ju ndian betwee n Tn. 00",,1 bo n. end c~ lo,

p"xeu. II Ihe canine /0"0 i. nol dearly
diotinguishoble rho mea .... ,., ... "'" i, mode from a
paint ""', i, 8 mm below the e,.," of m. in.'.. ,.
dental papilla diSlOIIo:he conine(fig l .c)
The P.M.B.A.W cnd th e P.M. D. ere compared.
th. P.M .B.AW. i, grecle,lhen Ih. P.M.D . then it
is en IrldicaTion lhol ard> e>:p<lnl ion il pou ible .
If on lhe Dlher harld rhe P.M.BAW. i, leIS lhan
P.M.O. then orc;h expo""ion is not pouible.
AccordIng to Ashley Howe. to o<h_
nannal ot;C!ution with a full complement of IeeIh
tI-re bosel orch ",idth CI !he prernoio, regl"" """'Id
be """ the .~m of mio-di"", width, a! all the
fecth ",.,00110 Th e se-cooo permon" nt molar (10101
tooth mOI. ri ol) Thi , ro ~ o (cxp'ou~ 01 %)
be'-"r!he op;"ol boo. width 01 t+.e plemola r
need 1<>, e .!faction,
b_ If ~M.8.A.W. '" is HlI. or".."..., 1Ir. CO ...
con ""","bf, be 1r'I!O~ withcAA exrrt>:ting a""
c. "'"
K ~M. B.A.W. ~ i. 37 44%. the co ... i.
referred '0 01 0 bo,derli"" (0'"' ,
~
PONTS ANALYSIS
Ponti in 1909 presentod a 'Y'te m ..... ~~!l.e
meo, .. "."ent of tho fou' mo.iflory inclloO"
ou","o'icoIiV "IObtl$hed the ",idth ollheo",h in
the p"'molo, ond molo, 'egion,. Pont, onolyo:s
helps in :
0 _ [We,miningwhelherrho derrolorrn il f'IO!1QW
or i. roormo l.
b_ Determin ing tho need for lote rol o re h
""PO n ~on,

region and rho tt>to l 1QoIh motorial i, 00110::1Il-00 c _ De......ining how mud> expon<ion" ~sibje
Jl"!rlola' bosol ord! width percorrloge. It i. at the oremolorond ... 0/", region!.
<Ie""mlned using lhe lormulo :
OetOlm/na lJon 0' 111m
IncllOrI (S. I .}
p,
PM.BAW. '" - PM.8AW. . 100
1.lM. The """io-dillOl width of me 4 maxi l'",\, inO..,...
is m.", ured ond th e vo lues .u mmod up. This
o. II P.M .B.A.W. % i. 37% or less . it ind ieote. 0 .-o lu& il ca lled l um of in cioon (S.I,).
Detarm/nat!oll of mOllSu,e d
premola, valu .. (M.P. V.)
The width of tf><, orch in th~ p r~ mo klr region from
th o di stal pit of 00" upper ; irst premoklr to '''''
t""
d ~ta l pit of ClQite first pr<moier i. rMtlSUred ,
~ ;, ~olled the meas ured premo lar "" Iue.
Dete,m/llatioll or melllu,ed
molar value (M.M.V.)
The widrh of th e oren in the ",,::i o r regi o n from
too me>i~ 1 p it of 00 0 upper first mo klrto !he me,,,, 1
pit of tf..", oppas it" first mo la r i. meo. ure d, Thi'
voic e i$ coiled th e meawred molarvolve
Dete rm/llatloll Df ealcillated
premolar value (C.P.V.)
Ca lculated pr=o lor volu e Or tM expected areh
width in the prerrm!ar regio n i$ OOlermined by th o
formula : 5,1, x 100 ;' 80
Dotorm/llat/on of ea/eu/lltod
mo/a, Ylllue (C.M.V.)
Calcukllad meklr "" I"" crt"" o<pe<:tOO arch width
in the mol", {egk:<> i. determ in ed by t"" form uh
S.I., )oo / 64
/nforence
If mea.u",d vol"" i.le" tha n cakul ated va lu e, it
indicate, th e .... ed for oxpon sio". Thu s it i.
poss ible to delermin . how much e<p<msion i.
needed in lhe moJar and the premoklr reg ions.
LINDER HARTH INDEX
TM a",,~i$ i. very ~mj ar to Po nls ana lys;, ",copt
tho t <I new formula has been propo <ed to
determ ine th e calc ulated premoklr and mol",
, olue.
The calcu late d p re mo lor va lue i.
delermi""" u';"9I"" formula : 5.1 ,100 1 85
The cokulaled moIar"" l...., i$ determined
u,ing tho ;o rmulo: 5.1 ,100 1 64
KORKHAUS ANALYSIS
Th i. onofy. i~ i. a lso . imil a r to Po-rtl~ ono l\,>i' h
make. u.e of th e lindo r HOffh'. iormulo to
dele rmin e tn.. ideo l w!'h widtn in th e premolar
"""'" mo!ar "'9ion, In odd it"". thii ono~i. utili""
o meosurem Mt mod e from the midpo<nt of the
inter_premo"" lin8 to Q point in betweo n the:wo
mo.illo .... inc i,""rl , Ac~ord i n9 to Korkhou., for 0
9 i~en width of uppe r inci sors a .pedfi c ~ol"" of
the di.kl nce betwee n th e midpoi nt of inter-
jnrnOor f ne 10 he po<nt betwcoo he two mexi lo,,"
inci so rs .ho uld e.iot . An increase in thi s
mcos ureme nt denotes proclin ed upper onte~or
'e~th whi le a decraa ,e in thi s 'a lue de note.
"'''oc li ned Upp"" o nterio " .
BOLTON 'S ANALYSIS
Tooth . ize i. on im portant fodo< to be tokon into
oon.ideration in orthodont iC dia gnosis and
trea tme nt plann ing AcoO<"d in g to Bo lton, lhe re
,,",iot. a ratio between the me. iod i. tal width$ of
max ill ary and man dibu lar te eth, Many
me lo<:clu~on. occu r as a re, uh of obnommlitie.
in tooth . i,e. The Bo llon'. analy,i, help. in
daterminhg disjyop;;>rtk>n in ~ze between m:i1.,'Y
a nd mand ibu larteelh,
Sum of malld/bula, 12
The mesio- d~tal width 01 all the teet h me,,,, 1to
the mandioolar co nd pe rmo" ent mola rs is
",eo",red and !Ummed up.
Slim of maxillary 12
Th e me,kJ-dioto l wklth of a ll t"" !eeth m<O>kJ l to
th e mox illary . e cand perma n."t molarS is
meoMed and J.Umm..d up_ O"e ,,,,,,," lIoII of a liter/or ,. tlo
Th um 01 """"a-distol widtn cJ the mandibulo,
Sum of mlnd/bul 6
onterio," $hou ld be 77.2 % 0' tM me. io-di,tol
The """, l od i .~ 1 width of 011th o teeth mOliol to width of the ""'l,o ll o"! onte<io r. _The on'arto r rOlio
!he mond ibu la, /i.. Tp,emola .. i, measured an d i, dot"""hed ulie.g 'he le li owi nQformul o
... mmed up.
sum 01 rtomfbulo. 6 100
S~m of ," u llll " 6 Anterio. mtio -

The meuo-dlllOl .,jdth 01 011 The leeTh mefol To

tI-te mo>Jllory ~"I pn,moIOr1 il mea,ured end Kthe "nterio, rofo is less Incn 77.2% ~
"""me<! up. indiccles rtQXillory on!erio<" "",eso. Tho omoun:
01 mcnillo"! onl.rier ""''''' I. determined b.,. rhe
Oetl,mlnatlon of "we,,,11 ,.t/o foll owing woy:
According 10 Bo lT on, TOO . um of m".io-d illc l Mond ibo.i la , 6 x 100
Maxillary 6 .
widTh, of lhe mand ibular ~Th OnTOnO' 10 tt-.e 77.2
second permanent mola .. is 91.3" .... """Ia I'Theo~mlio is morett.:1n 77.2%.
d"1STo1 width 01 Th" m<Jl<il!ory """" meuol 10 the il indicate. mand,bulor onl"rio, ".... The
RCOnd mole ... The o..,mll milo i$ ~rmined OrtOUnl 01 ... ondibulo, onte,ior ."ceu I.
using The fo,mulo : dete,m,ned "'Ing .... Iormulo :
Mo,;ll ary 6 . 77.2
Ove. 011 mTio _ ' um 01 "",,,,, ibula, 12 100
,um 01 me,ili o ,,! 12 100

MOYRS MIJ(f"O OfNnTION ANALYSIS

If oYemU milo is I.ss Thon 91.3%, il
indicofel: mo, lllery tooth moterial pee. The The "UruoH 01 0 mixed dosntiion "ntllpi' is ro
_un! of maullory = i. de1ermired u.. fIg """ IUCI~ The omount 01 <pO'" """lloble in the
.... Iormulo arch fo, the ervptle.g perrronent (onines ond
Mo""ibulo, 12 . 100 premolo". I" this onol, .i. the .ize 01 The
Me,ollo"! 12 u,""""pled pe r""'l nent cw.pido a..J premolo rs are
91.3
predided frcrn he kn owledge ofth e ~"" of cerlo",
permanent toelh already erupted in the mouTh .
If ............011mtio is mom Thon 91.3%. The "'~'I miJcod dentition onolr'" prl!(kls Th,
t ;"dlootes morodibul...- tooTh mo!o:wiol '"""""'" The combined """iO-d,JIOI widTh c:J 3, ~ ond 5 booed
~ of mondObularexcesscan bode1erm,ned
on the sum 01 The width. of the Io.!, lowe,
bJ II-oe Iormulo , penno,..,..,. inci"" ..
ll>ct mesio-distol widTh 01 tholo.!, lowe,
Maxi lla,,! 12.91 .3 indoors 0" meotured and .ummoo up. Th.
Mcndibu lo, 12 . amount of spo<:e "va ilab le for the 3, 4 arod 5
100
oiIe<- ir.::isor oI ignrne<11~ clcletm inetl by nteO liJ rie.g
 .-
.. ......,-
,-., .,.. .. ... .... ....",-.. .,.. .. .. .'
. , .,
ta the dillOrtiO<1 mot o::m <XOJc. It il P<lllible

., '" dete rm inemo
"

"
...
"' '" :t:
"'
"' "'
"
'
"' "'

",
" .,
"' .,.,:1 "' "' .,, , "'
"'.
"'

... .' , ".. .... .,.. .. . .. .' ..

.,

., " "'
.,
" "'
"'
"'
"'
.,
.,
.....," "
lIud ,i ng the teoth thot
in 0 rodi<>groph 000 on 0 cosio The

.... .', -..' .,.. .. .'.. ., .."' .'.,.,

"'"' "
., "'
,
"'
"' "' "' "' ., "'"' "' "' "'
., "'"' "'"'
"' formulo II used :
-
:j
"' " "' "'
., "-" .,.. .,"' Y1 XI ."
" ., .,
., "' "'"' .,
" ., "' "' "' "''
.. .. .' ,., "',
.. .,.'., "'"'.."' "
.. . .. - :"' "',"' .... .' .' .'...." "',."'
., "' "' " " "' "'"'
, .'

.. ...
"' ..h.", :
"' " :1 "' "'" "'
" "' ., "' ,"' "' ~ "'
"' "' "' " Y1 - width of une",p~ I<><>th ..hose

,'-'---
"'
.. ....., .." " ""' .." :1 ..,.."'"," ..", .'., ....
..
.'.,...... ........ ".
moe""t,ment i, fa be determin ed,

.. .."'"'., ....." .."'" r:: .'., .," , .. .'.'.. ...

, " "'
"' width af v_upted tooth on tho

..
.... ... ..
'"
.. .. .,.." ,.. .."' ... .'..
'" r..d iog r<lph .

.... ..."'"'
'"
.. :: , ..
' "'
,

"'"' "
"
"'
"' .. .. .. "'"'
,'
"' "' "' "
X1 - width of a toot\, t\,at fm c<upred,
moelUred on the <wI.

, "'.. .... ..... .... = .... ..::.. -.,' ...."'.. .... .."'..
" "
"' ..
., ". width 01 a tooth that hw ,"",pled,

...."' ....""'..
' "' "' "' "'
"'
"'
" "' ".."' "' .. "'.. "'.. .. "'.. "'
"'
"" "'"' .. .... "' "' .
"' "' "' "'
"'
"'
.,
meosu,ec! on tne rod;ogruph,

," .."' .. . .. "'

"' "' "' "'
" "' "' "' , "',
"'
"'" "'
" "
"
", "
the di. ton cR bMw""" the di.kl l surfoce of lotero l , ~ W~ : e>;. .............,- ;, .,.,., ... 0t>4 i. '010...
in cisor urld th e mMial. urf<xe of To"t po rm<lne<1t "' .... O "'~'" "" tho tot01"""t 01 maio<cJvo.on.
mol., , ~Io
~""
O<tood 19!>a , 2a: I 13
w" . Tho ",*,,1 ~ k<rioo> 0/ 0 _ , ....
f Bosod on the mesio-gl$lolwidth of the
lour maooibuf" , incisors, the e;opedtd width 01 , ~
_
"'" J 0>+.00' 1962 ; 48 05GoO
At , A poI,gon F\rto,I cI """"",I 0t>4 boooI
ad> d ......_ .. ft ho hoo.oonoI ..... "'" J 0rt'I0d
the conine" fi,st ond I<'lCOnd p,emolo" 0'"
1 9Sol : ~O . 8 1 1 .
ptediCled by ",\erring rhe probabil,ry chon (Tobie
3). Wh,ledoing 00, rhe 75%1_1 of p'obob01iry ""_ s , .ow_ 01 ""."", of ",""'<IoOQ <d
lPOcng cf ... , ......... Don! ai" No"'" "'" 1918,
is cons id ered rejia~e. 563578.
Th o pr. dicf. d tooth oi.. <>f 3,.1 000 5 i, ; ""ndopo OR, ~>odo 1 1O\ ,",,,,,,,. ~W : ~ "" I...... :
O' ,, ~ 01 ....... "" ...... 10 OnbJ 197Q : ~o : 1 12
compered with th o md1leogth avo ilcble for them
00 os 100.1er""" the ofsatopancv. ~the pr8(IOr;Iod
P.clln W~: C""t, rn,,,,,'1' O"t""I0"."", !.o tOJ I ,
cY II""",,, 1966.
.0100 i, g,~ol'" lhem the ovailable orch l..-.gth, RoI>orI
" r.-Io f ~ : .....,. k<>l of Or'
k<>l...d ..1 poJ>I ....... ;nc.19M.

,;,a. y_
~;ng ol-mr;on bc e>poded.

MrXED DCHnflON .tHAU'Srs

11M. _
............ 010</ "".... ...-..1 ._0. I.
.. I~, Tho ooor!""" 0/ ..... 40001

1"""" 0 _ _ < Ibp..lo ___ f """ 0.-. "'-

Q_'
RADIOGRAPHIC MEftlOD 19H,88 . 19lI

This leCiWqllt mo keo u,," <>f a rod iog rop/1 os w. 11

os 0 Ity"," co,t to de'erm ine th e width <i th e


of Tooth

~h odonTic tre<ltm . nt i, mode iX'Sl ible

O by the Io ct thot teeth ~c n iJ.e mo.&d

rivough "'" c~arbone by oP!)1yitog
Oppf<>Priole fotces. Orlhodontic tooIh """""",,,nj
is 0 unique process ... ......, a solid object (room) is
moM 10 move thrQl,lgh o..,rod medium ~)_
a
~ oblliry independent mDement of the IHIh
is IInOq"" 10 hllm"", in I"lrticulor end mammals
in generc l. T ~ eo rli...-p 'im~"'" onlme ll, "d> 0>
~~i le. hod t... th that ..., re onkylosed OI" fw,.d Ie
th" oo ne, Tn i. did not all ow independe nt
lTlO"'!!ment 01 the 1eoeIh. During the procen of
eYOIlffion, the periodonlal l;goment oppoorod
be" " .. the tooth OM !he alveolar ooclcat. Th ..
oppoorora 01 this period"""'l ri_ enoblod
ioodepeo.cienttoolh I'I"W:M':m.......
OrmodOOlic 'rec!"""nt " pouib~ due 10
rile fo:::t that~r a pI~onge<llo1'C" is apphd
on (I tooth, bone remod eli ng <xCCufS orovnd
tf>e tooth res ulting in iTI move meflt. ~ (I rule of
!hllmb it eM be lO id!hoTbone ,ubled 10 ~ ..ure
""" ~U~ of ComQreUOf1 of ~ocJo<,~ ligcme<1t
reoo<bs""+'1e bone forms liMe' tensile force OHI
","uk of ,!retdIing of !he periodonlolli9"menl.
The oim 01 ~ ~ chapter i$ 10 study the
"'lrioul bioIogocollssue changes that oo:ur 6.oing
100'" """"""". nt.
PHYSIOLOGIC TOOTH MO VEMEN T
PhysiolO<;lk too," movement. 0'. nowrolly
ocwrring tooIh .........emen,,!hat lake plooe during
one! o~r tooth eruptton. Physiologl' tooth
"""",,,,,,,,," Ind!.de :
o. TocIh erul"'on
b. M'gration or dt~! of !.... tII
c. Chcnge-s in lOO!n ,:>OSition duri ng mosti<;cti on

. 18 1
Tootll er uption
Tooth er\Jption io the axia l "'ove"' ent of t~~ tooth
from it. deyelo;>menkl l po.ition in the jow to it.
ro",, 1 "".ition in tOe o r~1 COyity. A nv", b.. r 01
tneo ri M hov~ been put forwo rd to exploin how
the er\Jption proce .. take. P.,ce The f~lowing
ore .ome oft~e theories :
A) Blood preu ure the ory Acco rd ing
to t~i, tneory. the ti...", orour.d the devoloping
end of th e root i, highly vo sevlor. Th i, vo ""vlo r
preuure i. believed 10 c~ u ,e th . oxOo I movement
oIthe tM th.
8) Roo! growth: Accordi,," to th e pro"" nent,
oIthis theory, the o pico l growth of root, r. "" lt. in
on oxiolly directed force thot bring, "boot tho
e",pli"" of t~e teeth , Thi. theory ho. not been
oecepted for 0 ""mber of re<Jrom. T..,th "'0"" 0
greoterdi$ltlr'lCe during eruption thon tM ir>eroose
in root length . In oddi!ion, the ()flset of roo!
g rowlh or>d ertJ ption do I"lOl .eem to coioot/e,
Tee'" thot o re mo lfe<med and lock roots also ...-upt
in 0 nu",ber of co", .
C) Hommock ligament, Accord ing to $icher,
o bond of fibrous ti ,sue e<i$t$ bl:1ow th e root ape.<
.panning f' om one >ide of the al">o" r wo li lo
the other, Th i. fibroo. tissue opp.eo" to form 0
netwooi below the de,.I"pi,,"" root ond i. r>:;h in
fluid droplet, . The deve lop ing ,00/ forces ilse lf
ogo in<l tfli. bond of tissue, which in tum appl ie.
on occiu,o lf.,- direded force on ~he tooth .
D) Pedodonto l ligam en t lro dion This
theory >tot"~ that the periodonto lligornarot is rich
in fibroblo st< that ( """'in controctil . ti.,...., . The
controction of the .. !>"riodo!1t'" fiber:! (mainly the
oblique grou p of fi bers) re, ult. in oxi'" """'oment
of th e tooth.
, .
Migration or drift of t .... tll
Migrotion refe" to the minor chonges in \ooIh
pos ition ob""rved alter eruption 01 teeth. It is.
ge ne ro ll, belei.ed thot the direction of toolh
migro tion va rie, from 'P"Cie. to .pecie. Tn.,
humen deriition .r.ow.a rIOtu",1 t. nder>cy 10 """'"
in a me. Oo I ond acel"",1dirodic<1 , Thi. i. lorQely
t, ue in co,e 01 the moxill ory dentition . Howe"",
the lower jow covId .how cortain ",natio"" Tooth
migrotion i. u s u~ l fy 0 re. ult of prO><imo l a nd
acelu,a l wea r of teeth, As the leeth und e'1l"
oedu", ' and proxim~ 1 woo r, !hey ma,e in 0 mesiol
ond occluso l direction to mo into in intor. proximal
000 occ lusa l contoc:t ,
Tooth move ment durIng mast/catIon
D~r i ng masti cation, the tceth or>d periodo<1tol
irudures O r~ ""bjeded 10 int~rmiffent hemy fo =
wh ich OO;U' in cycl e, of one second or Ie .. and
moy ronge from 1 . SO kilogram, booed on th e
type of food be in g mo,ticoted, A toolh s~ bieded
to tnese he~.-y forces, ~xhib it. ~ight me,. """ nt
within il$ ,odet a nd .ub,oqvontl y return. to ill
o' ;g inol ",,'ition as $OO n as lhe load is remo,ed .
Wh en 0 tooth i. ""b j&ct. d 10 ,uc h r.eavy
forces, the tissUfl fluid pre,enl in the periodonto l
'pace, bei r>g ir\Comp re.seble, preve nt. mo jor
disp laceme nt of Ihe looth wilh in the ,ocket,
Therefore the fore"" are tron>m itted through the
tissue flu ids 10 the od j~coot ol,wI", bo!1e , Recent
. twi e, ho, f.own tf.o t the olveolo r bone con
bend in ""1>0"'" to heo.-y mo.ticatory force, .
Wheneve r the forc. , 01 mo. ti cction ore
$u'klined end a,e more tllOn tl ... usua l o ne
... cond cycle. the periodontal fl uid is sq ueezed
o ut 000 0 pa in i. felt a. the the tooth is di.placed
into the pe ri odo ntallig ornent 'poe<! ,
HISTO t OGY OF tOOTH MOVEMENT
Who~ lore. '" cppl>d o~ 0 looth 10 bri"9 obe'"
onn.ooe nll c mevo."O""I, if ro"" lh in fo,.mcl;O/1 ef
0 ' ''''' 01 ~ , ...u'" 000 ..,ns ion o'oufld Ih 'lOalh.
AtO<l' 01 preSlu,," Oro f"""ed in:l.e d irodion o f
If..e tooIh m~m~nt, ...Me o'eo~ of '-"siO/1 form
in rh. ooposi~ direcfu<1.
601le is fiing Iissoe ... hich roocl$ 10
0 d~rinQ "",-men
pressure ond "",,'on in 0 certoin de'ined morne,.
Bone luriocellbjeded 10 ~UIl'e =".I;oy belle
l'MO'plicol whi lo bona wbilKled lo -..rn.>on !>"bits
deposilicH1.
W h. n 0 Too Th i, mo.eel du e to
oppko~on <:J on O<!hodon~c fomt.iI>o", i. bo.,..
IMOrp~on on the o"' .. u'" .ide ond n.... bon.
io<mation on rh :de 01 ten,ion.
The h'~" chongoesseen during Iooth
t'IOYe'Ment (fig 1) """I occording 10 Tils omount
one! du,a~o~ oI!oree oppl-ed. The hiro\ogic
cM nges 'see n during looth movoment co n be
SlOJCfied undo , TwO head;,..., m :
1) Chonges fo lbwi ng o p pli<XllicH1 01 mil d force.
2) Change. foIb,,; r.g oppli<Xl~on 01 ."'",m.
.~.
Clt, " t .. follo"""t . ppll.,.II()f) ()I
mild lo,ce
Wh.~ 0 lore. is opplied m 0 IOOIh, 0'00' 0/
preIS U'Oond Tension O'C prodIKed.
C"" nge, on P"''' u", side' The period onto l
figomen t in the direction of the toorh moyorr.ert
gels compressed 10 olmost 1f;lrd 01 its o.-iginol
!hidne... A morked i"""""",, in !he ""lCulo,a,-
<:J periodol'llolljgoment on !his .id.
is obse""Old
due Io ;~ in OJpillo'V blood IoUpply; Th"
~ ... in blood "'wly helps in mob,lizotion of
cells such o. fib,oblosl' end ",teodastl.
Ostecxlosto a re be"" reso~ng cel ls Tr.oT
Ii"" up eiot1g the wet wo ll on the Pf..su,e ."de.
They Iif! .mhln .""lIow ce"",Iono in belle OJ"ed
Howship', lacuna . " c~ng<> in orifInte~en 01
th e bc-.-y trc becukle il s->..",..,.,I w..,ls e~er
contin ued orl hodcntic 1"0::8 ap piicoti O/1. TM
tro b..cvkl e whl c/1 0'.
u,,"o lly nero ll . 1to the la ng
0 ';'of tf-e teeth becom. 1>OOro nlol:y ori""ted i.o.
perollel m rh, di'tdion <:J orl!.odo~tic force. The
trobeaJlo' oct1em !eworlI boc~ 10 n""",,1 PO~em
phO$ft <:J!he /reo_'l1.
The ol1eoc1clts !hallie witH" HOWIhip'1
Iccunae ",OM ' .. olbing bone. Vlhe~ the fertes
applied '"' .mhin p/- ySio'ogk li rMs, he resore~
i, !.eM in th e ofveokl , ploTe im rnediotefy c dice""T
10 Ih .l igo", ,,,, t, Th is l<it'ld 0' "'$O<ot;O/1 i, <Xliled
fron<ol 'e,orc~on.
a.cnS"'s o.~ ",n l,on side: Th. oree 01 the
"oOIh opposite 10 ,"" d irect:on 01101"" .. eo lltd
-he tension .. de, 0... oWliwtion ot enhoc!on-k
'0=. the poo'odonlol membrone on the ,en"en
sKle gelf " re' ched. Thu. th e ci,te"'. between
th . o'.eo lar process erld tM tooth i. wider:od.
In cdd itioo 10 I'rtTchif-o;.l of th e periodontal
libe", ""sed vtlKuicrity i........ on the ten lion
,ic\e i~ ,t 0 1 on rh, pmuure ,ide_ TM "'isod
""",,ularity eou"" ,.,obilito~on of cell. IUch 0,
~brob\onond osteobIosts in th$oroo. In _pen ..
. te r!>. trocllon, O$Ieoid i,laid down bv osleOblon
in the J>'!"'ooenlollogoment i,.,modiotely oapcenl
to the lami na duro. This lig htfy colc~ittd bone In
dve CC<J~ 01 ti me motu,6S 10 form wo ..., bon .
Seco.odary re"'Cl(/e.ling ch enge s Wne ne ,
o fo,,,,,
i. o~pl ;ed 10 mo.o 'eetn, the bone
immediotely adjacent .hO'> osteOclastic. end
.w.eobla,Nc o erlva,- on , .... """"u'" ond tension
.id. ""ped'vely In oddiion, bony chonges oIso
toke ploc 1.....1>0,. to' maintain the width or
thic~ n ... 01 tho af.teolor bon._ The", cho"Oel
or. co il ed iK!CO/1do ry re~ in g ch"""9M ~,g 2),
Foe . ' ampie, if 0 lOath is oo; ng mo.ed in " le biol
 Orthodontic II'"
force

Pressure
Side

Application of extreme forces

Periodontal Ligament 0 Dellti n

mIl Cerner.lum Bone resorpb:m Bone dep:>Sition

- .
f;g 2 (.<I s.c"""",., ,.m",,"""11
s.c..-.,. .._ n g cf..ogoo _
d>o"~ ... __ 1,.1.,..;,; th o op~liwt"'" ~f 0 bo<f;~ fo. i, I; ,guo l octlon
fdl:noing ....." " _ 0' 0 'Fo-ng "'"" .. 0 II-qool d _

~on the<e is compensatory dooposilion 01 """"
bone on me 0tMr,,;00 of tho Icbiol oIveoIar bar".
:*lie end e l", a compMsotO'1 reso'ption on th e
~\IO l l i de 01 tro.. Ii~ uo l elveolc, bot1 e Ifig 21 .
~ ccmpen"',,"", sIrucV:"oI ol!iltatiom "'" i"""-n
Ihid<1>MS cl the suppotling 0"->10' proce ..
- . though the IooIh mOl' be I\"\/7<O:Id <>WIt' 0
::!isIonce ........,1 ~mes grooief thon the thickn~
ohhe ofve%' ~ pIotel ,
a.nlln fallawlnlt .pplle.tlon of
..-tr.m. foren
W! .. '~e.treme """80 are opplied to tooth. ~
in ~ru""ng or I0I01 compression of Ih&
=-iodon!ollivomenl. On the pro ....." side. the
1Il001 c l o~ ly epp ro'i me !es !h. lam ino du",.
-"prIlltel Tho pe ri odonto l ligorM'lT 000 Iood.
ID occlus<on oi llIe blood ",ssell. The ligorM'l!
hence deprived of its flI.fIrffior1ol supply leadirog
IDtegnwi", chonges coiled hyolinllDlion.
In thi' case, the bone connot rewrb in
..... 1ron101 ~rt;or, edice",,! 10 the leeth. Rath.,
ISj
bone resorption otCUrs in !he odjocent morrow
IpoGC ... end in tho olvealc, "'ot. bel"",. behind
ond ebove tr.. hyolini,ed '''''''. , Thi , ki nd of
",sorpti"" i, C<l 1I.d "OOermi ning Of reol'WOrd
,MOo"'ioo.
On the tension lide, the petioclonlol
lig(m.n!ge\s~'-sl,eid>ed leading to ....... i"ll 01
!he blood -.s<!ls ond ischemio.
Th", wh", e.xTremo foo:e is cpp tled ther&
il 0 ne t increon In oSTooe lolt ie activiTy Os
compored to boo, /ormation with tM ,"S<J ~ tt.ct
the tooth becom ... IDOMI oed in its socket.
In odd~ion. ~in ond hyperemia 0I1he
gi"9"" moy occur duelo application 01 e.Jreme
Ion: ... during oo1'hodor ,'" loom mo..""....." .
OPTIMUM ORTHOO ONTIC FORCE
Op~m"," orthodontic force is Doe which _ _
iee!h most fOp;.!ly I... the desired direction, with
the I....' peuible domoge 10 Imu8 ond ",iIh
min,,,,,,,,, petien! d;scomlor!.
 Oppenh ~i m and Schwafl ia llaw ing
ext"",ive ,tw i., . tate that the optimvm lorce i,
eq uivolMt to th o cop ill ary pu l.. pre .. ure "..h icn
is 2026 gml sq. cm of r<X>t ,vrroce aree , From 0
clinico l po int of vi"w, optimum orthodontic force
no, the fo ll ow ing cha racte ristb :
a. Produce, ra pid tOOlh mooement
b. Mini"", 1potie nt diKomfort
c. The log rJ>o'" of tooth roovement i, mirimol
d. No marl<ed mob lity of the tee'" beirlll rooved
From a histologic point of view the v,e
of optimum orthodontk; force ho, th e fo ll owing
cf\o ract.,,;,tico .
o. The vita lity of the tooth and , upporting
periodonm lli gornent i. "", inm ined
b. Initiote. mo,imum cellula r response
c. Prod""es direct or franto l re.orption
HYALINIZATION
Hvo liniZOlion i. a klrm of ti.we de-generation
cho racteri=, by/ormation of a deo " eo~ nophiko
homoge-nau vb.tance. Th., hya li nization COn
occur in organ. such a< kidneY', lun gs, etc. "
Hyo lruotion of the periOOooro l ~gament cJe,,01es
o comp r.. ,ed and loca lly d e generot e d
pe riodonta ll 'tlamcnt.
The co,we ntiona l patholog ic proce" of
hya lin i' atian is on irr.ve" ib le on e, howeve r,
hvo li nimtion of the periodonta l ligoment i. a
reversible process .
Exp e rime nla l evider\ ce, ,how tha t
hvo li nimtion of the periodo nta ll igamenl on th~
pre"u", side OCOIJl'1 in >orne 0 """ durirlll a lroo,t
a ll forms of orthodontic tooth movement. But the
m""s O r\! wOe<-when the fa r<;<! applied ~ e,"reme.
The marllles ob"'l'/ed during formatio n
of hy<.tinized zone. are as kl ilows :
I} There is a grad",, 1' hrinkage af pe riodo nta l
liga ment fioo.-..
2} The ce ll ula r structure, beoom e indi, tin c!.
Some nuclei bewtne sma ller (pyLnot;,:)
.arne nuc le i di;app=r.
3} Thecompr ..." d oo liagenou. fi borsg rod
un ite inta a mOre Or Ie" cell free rna ...
4) i
ground , ubstonce .
5} Th. re ~ 0 o w ''''_o,,~ "o<>d ,"",""'"
leading to 'p; llin g of tileir con te nt .
6)
, ,
cmeocloot.ore fo rrn odin
a period of 20..30 hoofS.
The prese nce of 0
tnerefore bone re>orption
" canno! occu ,
i, hence not oopobl ~ of fvrth.,- roovome nt
tM loca l damaged tissue he, b" " , ,""',,' I
The odjocent af.,..d ar bone wol l re.o rb< .
The e limi roation of hYQ lini,ed ti"ue
OCCVr$ by two mec hanilm,.
1) Re;a'ption of the af.-eolar bone by """cd",,,
d iffere ntiat ing in the pe ri phe ra l inta ct
periodontal membrane and i ~ ad joccnt
marrOw $pO".'.
2) Inva.ion af ce lls en d blood ,e,,,,~ from tr..
pe riphe ry of tho com pressod zo '"' by ",hi,),
th e necrotic li,,""e i. ,emoyed . The invcd irlll
c. ll , pe""tro to the hya linized lis<ue a nd
e lim ina te th e unwo nted fibrous ti" u. by
enzymati c odion nod phogaq to'i'
Greater tn.. forces, th e wider is the a ree
of h)<l li nizotion. Thu. klrger Or"'" cfthe 190""",t
become furxt"""", tOO.-eD! .<h""";rIIlla rge 0 """
of n""ward resorption . If lighterforee, are used,
!he hyo li nized lOOes are """ lIer <>r>d a larger area
of functi oning ligament i. ova il obl . T~i. fronl<ll
ore uMd.
,
re,orption predamioo"', in case 'li.i/hter force,
The locoti on a nd Ihe exte nt of the
hyclinized tilS"" lorg ly dep~r>d. upo n the nature
of tooth movement (fi g 3). In co.., ohip ping tooth
 A B
.,.,..,mom, Th o hyol inj'oti on ,"ovid be d ose TO
",. ol""o iar cre.t ..n ile in co,," of bod ily TOOTh
o " ",,,I it """,Id be c;lo.., rlo t+.., middle porlion
d. ..""",. ~eo::essive loro!sofO appted
~. ., Npping tooth move""",t, il can teSuk in
. . onoas 01 h,ol,nimlion. one in!h, apicol "'5)I0Il
=ICI1he omM in Ihe morginal 0_.
The lorm cnd ovtIine oil... odjocenl
~r bone olso plays <I rol . in locati on of
Oiled Q r~.lveas of b:>ny promine nce, 01'
Ie. ulvo lly ",s uit in OTem of hyo linitation ,
ie. hove shown Ihol looth movement
~'through th .... *'II'" (~9 ~). Bul'SlOne
="'qorie11he .toll" o. :
<:.. Initial ~ase
~ log phose
Posllag pr.a se
c
Inltla' ph" ..
Du ri ng th e inlti ol phe.e . ve ry rooi d tooth
m"""men! is obser.oed ~ <I ,1-.:>.1 d ~ta rIQI ""'leh
then stop . This movement 'epre.ent,
di.plocemenl c4 rho tooth in the periodontal
"",mb"me .pace ond- probably bending 01
bor>e 10 0 ceotoin exlent !:>h...:lies 1\0""
01 .... 010.
,hown thot both 100h! ond heovy I<><tM dlsploce
the tooth to the soma O>:lent dIoing !hil initiol prose
of tooth mo"""" n!.
The toolh movement in the initio l phe se
i. boetwooIn 0.4 to 0.9 mm and ",,,,,11y OQ;UI'I I.. 0
...,.,Ie',; ~me.
til, JIbe
Ou";"!! thi> ~hOM. lilli, or no tooth movemerU
<>Cc u". Thi, ~hose "ckoroeten,ed bv lormot>o"
of hro lin il~ tl m.'11 in th e P<' riodonto l lig orr\Offit
wnich ho, to be feso,kd before fvrther tooth
 -..
Front.

IniIioI ph ... L. gph'" Post log phn.

moveme nt "on OCCur. Th~ duration 01 the log oroo resulting "' direct reC<ption 01 bony su rfo ce
phc.. depelld. on th ~ ~mo u nl 01 lorc~ uoed to la cing th e periodonla lli gamenl.
mov~ the tooth. ~ light Iorce. ~re uoed , th " or""
01 hy<l linizotion i ma ll and lronta l re.orption THORIES OF TOOTH MOVEMENT
OCCUr1. If heavy fon:e. are u.ed , If", orea 01
hyali niwtion i. klrg e. Re.orption in thi s co", i. Th e mechanism 01 movement of a tooth by on
ort~tic force i, a . ubiect c1 or>JCing rcsoo rch
rearward ~Ild " longe r log period OCClJ(5 to
for decode .. Numerou. theories have heM put
elimi""te tf", n)'<ll,n iled tissue .
forwo rd to expklin th e SOm<!. The theories th ot
The log phase <J$u~11y e.tend. lor 23
a re accepted and have .toad the te. t of lime are
week:. but moy attime. be '" lon g as 10 week.
The duration of the log phc.e depend. """n a
varied number 01 factors indvding th e den sity of I} Pre"u re ten.ion theory by Se hworz.
2) Blood fl ow tf-.eory by Bie n
olveolo r bone, age of th e ""tient and the extent
3] 1k>ne bend ing pietoe lectri:: th eory
01 th e hy<llinized li.",e.
Pressure !en51Dn theDry
Pod lag phase
Oppenr.e<m in 1911 wostheli... t pe rson to study
After th ~ lag pho.." tooth movement prog r"e.
Ih e ti " u" cha ng e, in th e bon e in Cide nt to
rapidly os th e hyo li rlized tOn e i. removed and
orthodo ntic tooth movem ont. Schworz. (1 932) i,
bone undergoes resorption . Du ring thi s ""sI log
said to be th e author of thi , theory. According to
period, o,teodasa are found over" lorge surfoce
 Sdrwo r:, wh eneve r a tooth i ubjeoted to on
octhodo ntic fo rce, it resull> in a rea, 01 pre" ur.
and lens ion , Th e orea of th e pe tiodootium in th e
&ectio n 01 tooth movement i. ~n der p,. "u re
..t.iIe the ore<> of pe ri::>donti um oppooito the Iooth
........em""t i. und er ten. ion . Accord ing to him,
:he a rea. of pre",u", .<h ow bone ",.orption wh ile
::reo. 01 le n. io n . how bon e depo.itio n.
F1~ld dynamIc th eo,y
'Jio theory i. a lw ca ll ed the blood flow th eo ry a .
cropo.ed by Bien, koord ing to this theo ry, tooth
..,.,.,.. ment occu'" o. 0 resu lt of a lteration . in fl uid
~a m i c. in the periodon ta l li g a m ~nt. Th e
~to lligament occupie, th e pe riodonta l
~ wh ich il confined between two horn ti , ....... ,
.."".,Iy th e tooth and the a lveol ar <ocket, The
:.eriodonto l spoxe conta in, a flvid 'Y'tem mod e
~ 01 into",tit",1 fluid, cell ular el"", ent. , bl ood
::-:;" ~;: ,"seou. ground .ub<ta nce in add itio n
, pe ri od onta l fi ber! . It:i. a confin ed ' poxe
~ the polsage of fl uid in a nd o ut of thi, 'POX"
.. r. mited , Th e content, of th e pe riodonto l
igament thu , creote. a uniq ue hydrodynamic
andmon ",.. mb ling a hydrav' c mec"" n ~m and
...hock ab50rne r. When th e focce" remo ved ,
:be Ruid is replenished by d iffusio n fro m co piflo ry
.... U, and = iroulotio n of the intorstitia l flui d,
'When th e locce appli ed " of short durotion , uch
c::sduri r>g m::l<ticotion, the fluid in the periodontal
EIDO!! i, r6 p1e n i , h~d m ' 000 os the fo rce i.
~d , But when a lo ro. ofg reate r mog nituoo
::nJ d urotion ~ oppUed '''''h os durng orIMdontic
lDoth move ment, the inte"titio l fluid in th e
:lfriado nto l $pace get, sq ueewd out mld move.
-.ord, the o pex o nd ""lYiral m::l'lin, a nd ,.. ull>
n decrea,ed Iooth mov"m~ nt, This i, ca lled the
_ ,e fil m elfect' by Bien
W he n an orthodonti o IIXUJ ~ o p pHod, ;t
~ in con'll"'''"''' oi the p" ri::id crlol ligornent.
Siood v. " . I. of th e pe riodonta l li Qo me nt get
tro pped between th e princi po l fibe rs and thi'
re, ull> in their . Ie""" i, . The v.... 1 abov~ the
, teno, i. th en bo ll oon. re, ulting in la rmation 01
an a ne urysm The , e an euf)', m< Ore minute
flexible wa ll ed sac, of fll>id .
Bien WWe. t that the r~ i, On a lteration in
the chem ica l e nv iro nment a t the , it. al the
"" se" or steno! i. d"" to a decreased oxygen leel
in t..... comp re .. ed areo. a. compared to the
ten,ion >ide. Th e fo rmation of the<e a ne ury:s m<
a nd a<cu lar 5I" no, i, cou blood go,.,
to
eKOpe into the interstitio illuid thereby creating a
laora bl e loco l environ me nt foe ,.,orpti on.
B<ln e ~ e ndln g a nd pa lzoe/e ct,/c thea_
,Ies of t ooth moveme nt
A ce nt ury ag o , f arrar 118 76) li" t no te d
deforma tion Of ~ nd ing of int"",e pto l ol. e<> lo r
wa ll .. H. wa. the fir'$! to , ugg e51 that boM
bend ir>g m::lyr,., 0 po" ible mec",",i.m lor bringing
about tooth movement,
Pie zoel e ct ric ity i, a ph'e nomen on
o bserved in ma ny cry>to lline maleria l. in which 0
deforma tio n of th e crysto lstrudure prod uces 0
f"", c) el ectric w r rent a. a re, ult 01 d i$plocem ent
01electro ns lrom o ne po rt 01the C/)'$ta l loHice to
the o ther, A ,ma ll e lectrk current i. ge ne rated
when bon e i. mecha nica ll y defo rm ed . The
po"ibi e ,ou ree. of the electrio CUrTe nt ore:
a . Collagen ; In bone , col lo 9.o exi. t. in a
crysta ll ize<! , tate ond am thus be a wu ree of
piezoe lectricity when deformed .
b , Hydro xyapatite ' It 01.0 i, ory,tol lino in
form and therelore can produce electricity
when deformed,
c, Co JJogcn -h ydro <yop alite inre rfa oe
Th . junction betw. en the col lage n a nd
hydroxyopom. cry>ta l. when bent con be 0
 1O<Jr"Ce of piezoelectricity,
d, The mucopo ly. acch a ride frocti"" of th e
g round .ub.mnce a lt f,ovgh oot crysta lline
moy a lso P'>'''' .. ..., ability to geno rale electric
ccorr""t when OOfooned.
When a c')'>to l , trudure is defooned,
el"'tro n, migro !e from o ne kxation 10 onath er
resu lting in an . Iedr'" ch arge. h bng o. the
force i. maintained, th e cry>to l. trudu r. ito bl~
and 00 further electric elf",t i. ob,erved. Wh M
the force ~ relea>ed the c')'s to~ retum to the ir
ori g irKllsholl" and a reverse flow of electrons is
ob.e rved. Thi. rhythmic actN ity produ,e. a
constant interploy of electr", sig[\o l. woorea,
occa , ianal app li cation and re lease of force
produces occa.ioM l eledric si gna l"
Pi e zo e le ct ri , . igno l. ha . e two un u.ua l
charocteristic. ,
a. Quick decoy rote: \o'Ihen a force i, app lied , a
piezoel..ctric signo l i, produced . Thi ' elodric
chorge qu iokft d i oway to ze ro even fho.ugh the
fC<"ce is ma intai ned,
b, Wh en the force is re lea>ed, e ledron flo w in
the OppOS ite diredian i ..,en
On opplication of 0 force On 0 tooth ,
the odjoCM t a lvM lor bon<o be nd,. ArM. of
co nco.ity in bo,", are assocklted >M!h neg atil"e
charge. and e.oke bon e ",",pos ition. Area. of
corwexily ore associated with positi.e cha rge, and
e.ak. bone re:;orption
When 0 force is appl ied , compre,sian of
th e af...edar wall occurs ",. ulting in the a l.eo lar
and medu llary cortim l plat!!> of booo being moved
dooeo" t"9"rher In thi. manner, tf>e bone become.
Ie .. ooocove and @ electric sig nal associated
>Mlh r o rp!ion is e,tob li shed
BONE DEPOSmON
Bone forma ti'e cho nge, ore obse",.d o n
ten, ion .ide. h a foreru nne r to th e r
bone deposition, there ",om. to be on i
in the numbe(oIos~Ia<to which
forming cel l,. Theloreovoid II
q toplo,m ond have an ova l n"" le u.
ag o in, t the ba M . urfoee whe r~ ad ive
tormatian i. in progress I. e, " ' ' ''''"'' ,1
e nda.t" um and help in th ~ formation of t
, I ,
minera l solts. o,teob lo.ts increo", in nu moor by
pro liforation of tfleir precu rsor cell. (fig 5 )
The ",t . ab la.h oro de rived fro m
pa rava. cu lar con nective ti;; ue cel l" I
associated v.ith the blood ,,,,,,,1, _
cel ~ undergo mim. ond DNA .yntOO'" and larm
the commit.J a.t~oprog enitor cell . , \Nhe""ver
tf>ere i. a . tre.. or , train due to orthodontic lore.,
the", osteOP'Ogenito r oe ll. undergo inc rease in
n ud e ar 'o lume ond fo rm the G l .t ag e
preo.<teobio'!1 , With lurther DNA 'Inthe~. the G I
. toge preo,teobla. ts tra nsform into G2 , tage
preo, teoblo,t. A, a final , tep the G2 'lOge
proosteobia.t; undergo mita. i, and fo rm the
osteobla,,, C<" bone farm ing cell. ,
The bone formed pa ..es tlvougfl Ihree
. tog "'_Th ey are th o a.teaid, bund lo bone and
Ihe la mellated bone. The new bone fa rmed by
the a<tea blo. t, i, th e a>teold whid! i. lig htly
cokified , A> """" and mare oslooid i. formed
the deeper layers unde rgo ma'" cobfioolion and
form too bundle 00ne. The fiber. of r., periodorlol
oppara tu. 01$0 get attached to lhe bundle bone.
When the bunnd le bo ne reoch .. a certain
moftJrity, pa rt. 01 it get reorgonizcd into moture
la mellated bone,
Osteoid ti swe, deposited on the ten,ion
.<ide, get. ca lcified rewltirr g in the form oti on of
 ---~ Commlntd
O.t.<Iprog. nitor
..II.

- -.-
Pom, ,,,"lar
p"",,"o. e, lls
1 ~

G1 $1' 80
P"o.ttoIll ..1I

G2s. gt
_tool>l_, 11

-
OsttoblU1.

19 1
00"" l am~ I Ole. TOe periodontc l liber:! readapt ta
the new po.i!k;.n 01 the tooth by prcliferation 01
th e inte"ned",telOne,
BONE RESORPTION
!>on o r orptian i. brought about by ce ll. ca lled
o. teod"s!., They me mu ljin""leated g.,nt c. ll,
and moy h(l'l" 12 or mOre nude;, Q,teod",ts
O r~ irregu larfy (1'101or club .foopcd "'ifh bronch ing
p.-oc:e"e" They occur in booy li ke depressions in
l>one ca ll e d How.hip'. lacu na e and hov e
,em inent m itocllond ria, l)'>OSorres and vocuoIes.
Each of their n""loi "'" a . ing le nucl eolus, The
part of th e osteod:"t in contoet with tr.. resom ing
oone ha, 0 ruffl ed OO rde.-, The osteoclost, are
derived from,
c . Acti va ti on 0; pre. ious ly pre,ent inactive
OIItr'!Od asb,
b. Migration lrom adioce<>t bon .
c. Formation of new o,teoda,t. Irom loco l
mOOf<>pfooge. of per;odontolligoment,
d. Inll", 01monocyte. Irom blood ves""ls,
During bone resorption three proce,,,,.
occur in m::>re or Ie" rapid wcc.,,""'. They are :
I) Decokifi cotbn
2) DegradetiO<1 of "",tnx
3) Tran,part 01 sol u ble products to th e
.. troce ll ular fl~id Of blood vo>culor .y.tem,
Orgon ic acid . ,uch as citric (Kid, ond
IoclO: odd and hydrogen ion, are secreted by the
(uffled b-order 01 th e o.leoda>t> whi ch increo,es
th e .olub ility of hydro xyapa tite I ~ ading to
decolcilicotion.
The degradation of the motn< i. brought about
by the activity of Cathep.in B \ {II>o10mo l acid
protease), Fi""Ifr-, the breokdown products d bone
ar. tronsported 10 tr.. extrace lkkr ~uid orld blood
vasculo r 'y.t(!ffi.
BIOCHEM ICAL REACTION TO OR'"" "~
TIC TOOTH M OVEM ENT
It i, known th<lt b-one cell';;"h:;:::~k::~~:
osteob lasts re.pond to an
prolife ration in ord e r to bring abaul
deposition 0'""re",rption, Ho""",","", ,~:~:~:::
that occur at the ce llul ar le\'"e l in '"
fore. are r\Ot tota lly und erstood .
Wh M a force is applied onto : ': : ;
(e.u lt. in a number 01 biophyoica l events
compress ion of pe ri odonta l li gament,
de1ormotion and Ii"u e inju ry. The.e biophy<i<d
events in turn lea d ta ce rl ain
r""ction. ot 0 ce ll ular le"e l wh ich bring
b-or-.e remode ling , Th"" a process 01 tra n.<d lldiaa.J
occurs where m",horlica l energy (orthodO<'l ic
form) i. converte d into a ce ll ular re'pon se .
80n~ deformation and CO rTlp-ression 01
th e periodO<1la l ligame nt lead. to tM roloo ," 01
some cxtro-c~ lu"'( silT""~ng molecul e< ca led ~
m ....--.gers. Tf>ey i,dude hormone uch a. PTH.
bea l che rnica l med",tars such os prmtag landins
and oourotran smitters . uch a ub.tance P o rod
va.oadive inte, ti na l po lypeptid e (VIP).
The first me .... ngers bind ta receptors
present on th e cell surfoce of target cell , a '""
initiote a ..-oc"" 01 intro c&l lulor ~gr"l<l li ng, The
intra cell uler sig nallin g re,u lts in lormalion of
,eco,"" """,.", ng"" . which i,-,d ude cydie omp.
cyc lic gmp a,"" cokiu m.
The formation of ,,,,end messengers
inside the cel~ i. believed to initlote forma tion of
bone cell. nl;lfJl ~ y o.teoda,t. 0,"" o,teoblo,,,
which are respo nsible lor bone remodel ing.
An o ltorna tive bio lOjl ic pothway fo r
orlOOdontic tooth movement he. been wgge,tcd
by..ome wnrkers A:cordin g to them, ottOOdontic
force res ults in cer\l in amount 01 ti ssue injury.
Sub,equently. hydroic e<>zym e. ore relea$ed
Summary or 810cbemlcal Reac.tlons
Orthodontic Force

-.:,..-
n >
o "
=""<

~g

,.",........,--1- ~
1
Orthodontic Tooth Movement
which oct""t. enzyme coIbger.o.. thot contrWe.
to bone resorpt;oo ,

Bo,.,.,,"'.\ ' A ~""""""ion d ' ho P""P""'I of '"

P""" " >on"', ">,..,..,,,", "" J O"M 1969 " 5"
, 122
Iloi , SM fl,", [)rna"" _fOO"", .,+,;ci, ,"" ,.
Ioto ""' .. """,..,..tri, I<r<h 0r0 1 8~ ) 1966 ,' 2 ,
173.301.
i~' P, Rr<J. r , rf.o ""01 pho .. 01 Oo+.odontk
""'.. """'"r:>oo "'ideM", I",,, 00."',,""" ,f ',e
_ <>doni" ,,,0"""'. E,m J Orthod 1993; IS
, ~~9 26J
Col lett A ~. Soo",,, Ag E;, o lO'''' ;o, p h)~ ok>g)
updo'. 000 o,'M,,"'~ ;mpl:,,,,;on,. ""~ Orthod
J I99 I ; 12, 116l n
Do~",, '<h . Z, fkoI< N.....oI""""&'>, ~ ok; "",
ood tO e ,on' m l of 0 ~ 1o, 00 ", ", mo<lolli, ~ '"
(),t~ . . o.o10 " NQrth "" 1988;32,' 11.
m
, o",;do~'<h.l , r "" ",od,d;"" of C,d ~ Om p b,
crl'->odcrl~ k<....Am J O+ood 1973; 64 , 31~ 3 1 6
f,.. Gw, , Bono <><>fJOing 0 "",,0 of Omodonl <
Tw,h "",",,-t. " " J OrtM 1972; 62 :l8~ 393
G; " ,," I ~ M , 0<>1,,,,,, " 1M B<oko-gko l Oo'~ 01
Ortkodontti. PhWolp",o, loa 000 !'.bi"" 197T
Galdmoo HM , G"' ,...! ly M H;" o"'l1'1 01 IootO
,oo-,.,,,,,,nt, [)",--,t, a n 0 ; fIO<,h An""'," 1972 ; 16 ,
439,'48
10 ."'='" RJ, l noo-.-" 5J, o.ov'OO'oitch.M 'On ""'"
"""''''''''. A,og" O"M 1993;63 ,305 XI\'
I I , Jocoooon A , Orthodonlk> _ I 0' ~ ;.
", I obio<'~ ....... J Orthod 19 73; 6, ,1 16
I ~, ~,80"" """"""tfl\l , e.. i Orl.xf 1991 ; 172
m
I3 PfOt~ \''R, eon .. moo=r o.-tt-.odarl~. , St lou;', co
,1'oob" Im ,
I ., ~ obt~ E!,'""",,: Ho,," book 01 0rl>0d0nI ~ " yoo,
"""" rtM!>d~~1 puo~.""" "",1988,
15. So ... , JR Too" ."""ion
000 Ortf",d-,,,fI;< ",,,,.,.
"".-., Bolio!> Do<.' J 199:1 ; 1< 1. 1<9.
16. Schudy fF, Som. OioIou~oI (00("''' ''
Orthodoo.
'"", ,,", J O~M 1973; 63 , 376 ,' 06 ,
17. yo,' i'o,o DK B'x ' o m;,o l p, in<;iplo. of Tooth
~,ont Dont. O n. Of "" .. h ","-,, 0 1981;25,
19~6

of Thoth
ve"f bo<Iy conti n"", in it. ~te of rest 01'
E
of u niform motion in 0 <fre ight line, urness
It " compe lled to cn""ll" thot . tole bot force,
"'p re"ed upon it [S ir 1100:: Newlon) and teeth
are no exception.
Phy~c" Math . mo tia and Er>g ineerir>g
are 3 important di,cip li ne. tho! co n effectively b..
ap pli ed to the 'Iu dy of orthodontic loath
~.
Mechan ic. i. defin ed a, that bronch of
engineeri ng . d enee that describe. tM effect of
m e on a body. A d ear un derstaooi ..... of the
t.eofie. of mocho nios have potentio l oppli::otior\.
in 3 crecs:
I. Prod .., opplic<Jlion of fore""
2. A bette r und . "tond ing of cli nica l and
hi,tologica l respo n>e to voriou, roognitlKie.
off0(' .
3. I mp rov in g t he d . , ig n of ort hodo nti c
appiionc.s.
Tho, ""po n, " of a tooth to a n app lied
,
force ca n be at 3 level. i.e. d inico l, ce ll ular arod
stress-slre;n level of octil'ity within the in,. >iir>g
ti>,ue' which is tr.e Ioost un der>tood . Th ere ex;<!
no . lre,,.,lrein \IO<JQ~$ , ot ,..""",t. whk h am be
ploced with in the periodonti um to evo luote the
, tre_$Ir(l in activity. Therefore. the importo nce ci
th e .t udy of mec ha nic . connot be o" e r-
"""pho';'ed as olmast 011 th e a .. umptior1, m<Jde
a bo ut the ,tre,,-stra in octivity in the periodo ntium
are bo$ed on several moth ."""tica l fa<mu lotiom
000 canc lusian,
For a better unoor>lardng of mecho nk$
one ,",au", be lam il", r with the term inology u,ed.
FORCE
Force can be defined a. on oct upon a body that
cM nge' or tends to chonge the stote of rest or of
unifa<m moti on of tMt!>od l.
Be in 9 a vedor, force r.os a definite """gnitude, a
specific direction and 0 point of appli cation. In
cli nice l prodke it is .. thor a 'pu'n' or Q 'Pu ll . In
Ihe metric ' l.tem the un it of '<xce' ~ e'P re"ed in
'gram<.
Orthodont ic cor:ection i. based o~
oppi icoti ", of opprcpr",le fo rce on lhe leeth.T ne
f<xce, are ""ne rated by a variety of ortnodontic
oppi iOr"lCes.
STRESS AND STRAIN
Sire" i. I"" force applied per unit area while , trQin
000 be defin ed os th o interne l di, tortion pe r un it
0=
Sire" and ,tra in are in ..,, relaled term.
as , tre" i, an exte rnal force actin g upon a baeiy
wh il e , trai" is lhe ,..,s ultant of , h .., on that body.
Siroi n Can be ~ <p;eed in h e form ofa chong o
in eithe , the e"",om l di "e n, ion or inrer",,1ooe r91
of th e body.
50 Grams
A th o L~ ntr~ of r.,i.ra nco li e. betwCM the ' oot" ,_
r" 1 (A) ( <>- pie . '"'" Ic<GO! 01 "'"'" ,,,,,,,"'tJ<!e. p<Y<J~
'" ooc~ ot-.. , a"od ""' rig i, """"".. J red or, . :3) O n cd
o'eI ~""'" d. 0 =" . ,o>a'
io ' '''' ....... ct or<
COUPLE
Coopie i, c poir of conce ntrated force. ho""
eqcol m"9n itu de ond oppo>ite dir",tion .....
pora lle l but noncollin ear li ne of action (fig 1).
A couple when CCling upon c boJ, 'm,,11
oboe t pure rototi on.
CENTRE OF RESISTANCE
Eyery body <X free obioa "e have, 0. ii it. me" io
cor.::entrotod O' 0 . ingle poi~t 00 whic h it con be
aerfectly "" lanGed. For phy~ca l coku lation, this
point can be tok e n ~. the po int where th e whole
body wa>]h ' is cor>Centrated and co n be term ed
centre of gmvity.
Howe,ar, teeth cannot rr\O'>'e in a f_
man Mr withi n th e foW$ , Th ey o'e re"ricted by
the in'e, ting ,i.."e, a ra un d ''''' ir roo". In , uch
a ' ituoticn, 0 "" int 01"10 1090U' to tne contre 0 1
gro,"'Y i, me de v, a of 000 is called tt." cffitr. 01
re~lIooc " .
Centre of re, ille nce of a too,h Ca rl be
deiined as thot point 00 th e toot;' wh on 0 si"il le
force i. pos>cd through it, woul d brin g abovt its
tra n,lation a lon g the line of <><:tion of tne forc.
G~n~ro l ~ th e contre of res ista nce of 0
tooth ~ con,tont. In a . ingle-rooted tooth it lie.
belwe< n <:<1 . third end one ha lf of the roar, opkal
to th e a l,eolar crest while in a ,nu lti . roored too:i>
2 mm apico l to ,he lu reotion (fig 21. Th. Ce ntro of
re, i,!{l nce e,i,,, lor ' ing l. tootn, un it. of tooth,
th o ~ nti re dentol arch an d the fow" Knowin g the
bcati<:<1 of tr.e ce ntre of re.i, taflCc is thu , ,ery
im portont in p lan ning app rop r i Q t ~
mecoonotheropy_
Two factors which can ch an ge th e
",,' itio n "of the centre of "" i, to nce or~ the root
length ond olv<x>lar booe Coeight. LC<"'J9"<the r~,
the centre of r~. i sto n c" wi ll be placed mare
 spec ifi c OJis. Orthodontic force . o re mo. !
commonly op plied 01 the leve l of the crow,," of
the teeth . Th~tefc.r" the force. ,""..,00n appl ied
through th " eM !'" of r~' i '~nce of the crowns.

Thu, th ese fo rce , not on ly prodvce 0 lineor
motio n, they 01.0 prod " c~ a rotation .
mom ent of the force i. the refore the tend oncy for
Tn"
o Iorc~ to prodvce rokl tion ,
,Vtomerl = ~og ni",,"* ci fc.rce x di\tance
(perpend ic ulor di , tanc e fro m ' he , entre 0;
re.i.tonce of t+Je body to , h" Ii "" ci oct"'" of the
forcel_ The unit ci """"urem ent ci mom ent ;.
gro m milimet. " . The IWO vo r>ob.les thot cieterrr;ne
the mo ment of f""e oro the mCl\ln itu <i<o of force

~ , . '"
floj 2 C.,.", ~, ,.,;",,,,,. of ", v',;,,,,,,," ond "' g'. ond the di. lo nce from the centre of re, i5la """ {fig
4), Either o ne of the.e two va ria ble. can be
mC>1 ipJloted 10 proo....ce the de.'red force .\'>leml

A B c
_ ho,," 0'" ".i
"" 3 Cort", o! .,,,,, o-Iluencod by 1M " ,oe k,
,... "",1 I, ,.,." . No""" 01_ " ,
[Al
bono (BI ",-,,,,,,, ton. lo" ",,,''' ;0 Q '~", " 01 <00"'"
rJ. ~,tr>c. , !O ,"'" ""'"""'" oeJ ok.r" ~ "Il "'''' ' , ;.,
_ c"""",1 cont", 01 " . ;'-onao
f .. 4 .....",.,.,. " ,01 ," ~ by ","r ipl ~ng he ""","~ ..ode
oi I""", 0,. t ... por,......~
to .... , ,," ~e 01
.... ,dO"" " , oi tho
"";'b><e
I ~. cI """""
opicoll.,.. l i' ow i if the olveolor crest j, highe r,
fie centr~ of r~sistanc e wil l M p l ()C~ d rr.or~
o>m "" ll y (Ii g 3 ) Simil arly th o morpho logy on d CENTRE OF ROTAnON
!he numb<!<- of roots alro inf l""""e tre location c<
Centre of rotot"", is a po int, obout whkh 0 body
foe ce ntre of re,;, jm ><;e
ap pea rs !{) ha ve raloled , o. determ in . d from it>
MOMENT initia l and fin a l po' itions,
The Cef1tr. of rotatio n ~ 0 vuricb lo point
Moment can t>e defin ed 0 ' 1M measure of and ch an ge. accord ing to the tv .... of tooth
rotol;ol\a l po", ntiol of a lorc" with re",,~d to " moveme nt. It Ca n b.. ot ony positi on "" or oli

In
 l ./
.l. ..',
i
i

L-...
'.'
'""..,

\../ ,...
A 8 c
'It ~ c.- 01 ">"01.,., W'" "" hoI",1
~~~;,p~H' ... _o_
clo'ng ,""' .... Iod ,.".ng (Q ......" 100..,
.... 0._
~
_ ..-.uri"""
... '-"..-"..10<11 "'*'II
d.n-.g ...... _.,.
............

I~e loolh [fig S).

E.g- In Co.., dconlro ll~ crown lipping,
the cem'e 01 ",lotion will be 01 the roOI OJ!"" whi~
in cose 01 0 perIed translolion ~ "'ill be at in~nily.
In dinical p'adfce, me tooth """,11y
IoIlowson ~porh 10 rfIOd1 lis fonol position,
D
thus changr,g """"""" al raIoIla1 _",I fimes.

. / TYPES OF TOOTH MOVEMENT 4. E,:ruiion

Tr.e ptime moli.e o f o rtf>:x!onlic lrealmonl i, 10
ma.-ethe I..,m;,-to more fo.'OIUble and con'ecleo'
position., In the psO<e!S oj oc:hieving mi. gool,
th81eefh undergo 0 variety oj rTIO'iefI1tm, in all
!he 3 planes d $pOO!: i.e. 00II11101, coronal and
tfan.-.e. TooIh """"""'"' ........ n theorol cavity
<;On be lilleo' as follow>:
I. Tipping
2, Bod ily """,. men!
3. Inlrulion
S. ~g
6 Up'ighti.-.g
TI,,1"4
Tippirlg is 0 ''''pletype 01 tooth ~ ..here
o single 10"" I,opplilld 10 the CrtIW!1whic:h......,1ts
in o'nO'<emGnt d!he crown in the dif8dion 01 tne
fon:e ord the root ;" rl~ "P\X>SI'Io dreclioo. i <pping
is coniide red 10 be th e ii mplesl a mong Iflo Tooth
""",.menTo, II co n be o f two Iype. :
Conlroll~d Tipping: Contro ll ed tipp irog of
looth occurs whe n tooth tip ! obout centre of
rototi on ot it, ope<. Here th ere is 0 li rog"o l
mo.em.nt of the crown with mini mol mo.-me nt
<>I th e root in lobiol direction
Uncontrolle d lipping : Uncontro ll ~ d tip pin g
<>1 0 tooth de"ribe. 1h. mo.ement ci a tooth that
occu" about a centre of rototi"" opicol to ond
....ry d os e to th~ c~ntr~ of , i, ton c. . It is
chorode<ized by tr.. crown mo,;r>g in one dired""
while the root mov~. in the c-ppo. ite dir. ction
Bodily movement
" the line of oction of an opplied forc~ pos.e.
hough the centre of re, i. tor.::e of tooth, all the
points on the tooth will move on eqvo l distonce
in th e , orne di rect ion . ig nifyin g
bodi ly
tf"plgcement. Th is i. ca ll ed tron. lotion .
InUIt.'on
" tnJ";on i. the bod ify disp"cem ent 01 0 tooth
0lon9 it. 1""9 oxi. in on opicg l direction .
E1tru. lon
Dfrusion i. the bodify displocement of tooth
olonQ its long o<i, in on ocdu,o l d ir~dion .
Rot.tlon
~Iolion. ore lob iol Or ling uo l mo.ements of 0
IooIh o.ound it, long a,i.
TorquIng
lOrq ui ng con b., considered o. a rev~ rse lipping
ct.o rodNi,ed by li ngoo l mO.em""t 01 th e root.
Uprlghtlng
Ourir>g Ot'f-odo!1t<: trealmMt, tho Crow"" cicertoin
teeth will be lipped in 0 me,io-dr.10 1dirodion with
f..e ro-:::ts ti ppe.J in the oppooite ""'1'. Tippi ng the.e
roots bock ~ get poro ll "1orie ntation i. termed
uprig hli ng .
Althoug h th ~ . e ore t h ~ commonl y
MCounlered mo.-menl, with in th e oro l covity, in
o mort! """,tif", opp rooch the Iooth mo.ement,
CM be do"ifi ed bo. ica lly inlo Ihree .
1. Puretron,,,tioo
2. Pu re Rolali on
3. Ge ne ro li>.,.j Rolction
Pitre tr.n.'et'on
It occurs when 011 po ints on the tooth move on
eq",, 1 d~tance in the .orne dirodion . Thi. is
broughl oOOu! when lhe li M of ocli"" of en
ap pli ed fore . passe. throu gh tho cont, . of
re. i. len e. d a tooth Pure lran .lolioo con be of
three type, :
1 Inl""""
2. E><Irvs""
3. Bod il y mo ve me nt im e'io d i, tol, lob io
li ng""l)
Pura ,ot.llon
A di . p"c~m~ n t of lhe body, p, odu ced by a
couple, charoc:teri,ed by the centre of rotoli on
co in cid in g with the centre of re,;, to rocc i.e. th e
moveme nl of po inl. of lhe loolh along the area
of a d rcle . with th o cc ntre of resi,ta nce OOing th o
centre of Ih e cirde. Pu re rotation. con be divided
inlo 2 tyll"s :
Tron"~ ,,e Rolali on : TI,o.e looth di"" lacem enhl
durin 9 wh ich th e loog -ax;. orie ntation c,,"nge"
E.g. Tippi ng ond torquing
L009 oxi. rolali on . Hen: Ih e an~ukJt"" of the
Ior>g -oxis" 001 altered. E.g . Rotation of a tooth
orour>d ii, long ox i.
Generll/ud 'otatlon
Any movemMt Ihal i, 001 pure fro",,,lion or
.olotion co n be dosc. ibed 0' 0 combin ation of
 :....
~"'"
\. ....
\" ...
"
....
'

i-' "."
... ....... ".......

~"'"
\0 A B -
\ ...

..... .....
\'" .
--
"
...
,
\ :'~
,,
,,
, .,:.,,.
"

\ ....... " ..
.. , .-- ' , \
, D
VE F
"',

\ \"
,
"

t
H

"'" 6 'i..... of 1000, """"""'0' '" U, ~o '. "' led \ vf ~~ :3) C()O!mlleO ,.,..-.... i~ T",." ,'of"" ID'/ T()fq ~ fI\l '~i Ur:<i\l h-;'l\l
IF! ROIot or. iGi "'",,-on II~ En""",

,
 Interrupted Force
- -

Duration

&o!h tronslolion ond rofuIion o.-d con b. t~"ned
~n1ed roIotion. This type of N\OYe.-.-tco~
~ seen dvring rovtine din ica l prodice .
,. is woIl.~ by the pio".,.,,, in the JUbtec. a
..,.,Iocdulion is !he diocos<t in onhodoo llic:s,me
deM~et, il$ medicine. It i. the,b, ...,.,
.-.po~o'" lor the di,,;oOt"l to use hi, knowled(llt
0"Id c:<.pener.ce '" del"""in,ng the l, pe . omou'"
en! di reenon of force required to b<ing o bovt
Jlicie<,t treatment resu la.
80sed ",, !he duroti,.., d a~ icot;on.
!oru COn be di .. ded into ;
1.Cent..,,,,,,,,,IofQO
2..lnrermille'" force
J . lnterrupted torte
Canth,u".., ta,e,
is on octi ve orthodo ntic fore&thot deCfOOJOJ
.RIle in mog nitude beiw. e<1 appo intment period l.
E.g. light wire oJ)plronce.
Fo ' on opplionce to deii . .... conlinuOOI
face. If-.. o~io """ ccmponenls should be f-i,*"
fl exibl. ond the OClivoti on must be don e 10 0
,elo~' ely low fo ,ee le' . 1. Thi. i. b-eccIV Wl
<:on~noovo force1 oro .. ped'ed to bn"Q obout
diHld resorption of !he root soc'<et. They should
hence not ocd..de mont th:m 0 .moll pan:entoge
of blood """,I. with,n the per;odor>tolligornenl
o.-d not 1ubslonliolly ~ ...-ith tho;, nutrmo",,1
wvrtt Mo reo-..... th e co",;"oous fon:e cycle
indu de. no ,e.t po,ico' OM little int" ri" r~nce with
norm a l biologic IUnc!ior>i"Q within the ~ft Ii ...,e
"a" be t~ eroted.
f"t"",lIte" t to,,,e
k i. an odive otIhodontic: force that detIJYS 10
",0 mognitvd, or neorfy so ~ to the ne.I
oppoi"'me"'. E.g. RemCM:Ible oct..... plotes.
f o' on opp liQr"l(;f: to de live, inl&rmittent
Ion;~. the oppl icn::e cCt"np""""" o.ho<.Jld f>o-<e high
. tifln e" ond the in itiol <>d,,,,,tion . hould be tw'o
 th e expected corre'ponding ,oft. ti ss ue
d. formot""" Due to 0 reiotively high octi"oti on,
a greater force ~ exerted on tn., !eeth. Thi ' lea",
to ur'ldorm ining r. '""ption aM corre~ing
tOOlh movement. Orxe the toom ha, moved, 3 "0<0''''
th e fo,ce will decoy conidero~1 so that repo ir oi IOo!" "",...". nt ,

tho nec rooed .oHtinue ond resumption of ~O<XJ

. upply occu" within the periodontium
<
I<m j Ort--.:.d 19a4
Md-." ,l R "''''''0," . :".,;;,,2;
Be Do-:;<.Or Inc 'l-.OodeI,:"io , 1990
, ,~'o,,~ ..
5 P.d.H Wit eonlO..-.""",,, O.-thodontb," ' -'" "I
,.,." ....,' 98-6
lnterrllpte rj fore. 6 Rob. " J N;, ol" 8 oo ng " dn 'Q:;',::::~
O"'odon ' ;, ,I'.oc., on ;<. l, " ~
It i:I on orthodontic or orthopoodk force that i:I Ph "., ',"" " 1985
inoct ive ior interva l. of time be twoen 7, of tooth rno-.-e.,-,.,,-,l ,
Sm ; "",!<.~ ()1"", ,I'.~t-.on ~ .
j Orthod 19S<; B5, 2,5_3():)
appointm ento. lt ofton e,hibito, C)'Cli c, 1000g.term 8, T'.omo. hi G<o,..-, Robe" l VOM"""I , o-t-.o

''' '<pri''' ....

mognitc,Oeti me pottern. e ,g , force exe rted by en d-:mk> ocn1 ood """" ...... , "''''''''" . -
_ extra -ora l epp li ooce warn on ll o' night. b<>ok .... ,
For on interrupted force to t>e do livored,
the pro_req ui'ite. includ e ,
0_ It should de li, ... hea\')' force"
b. There ,hovld not be ony forco decoy
c, Tr.ere .hou ld be a ,pecific mognilude-time
pol1<lrn fer e,omple, 200 300 gm. of force
10 .14hovrsadoy,
d, Tn.. inactive pe riod 01 each day mu,t be
' ufiic""'t to keep the periodontcl li geme nt
hea lthy CNIY tn., tota l pe riod af ti me of use of
th e epp li o",""
Th in king in the normo l "101, it might
ocCur to u' that a conti""""" forco moy !;.-ing
about a continl.'OVO moveme nt Or on in creased
force moy Ieod to on increased tooth movem""t
Sut, the.e e.. umpti on, ore furfro m roolily both
in tl", clini ca l and ce llul ar context. The rat.. of
Iooth mOVOme<1t i$ high ly d. p" noont urx>'! the
complex biologic re'ponse, to the voriov. types
of force, which 0(0 yot b be d eo rty "",".rstO<XJ,

Note TI,. ""rm iolerrvpled and inIe<'",'n"", 10<,0'

a '" ifile<pceled '" d<'I!0<,,,,~ WIlt' b)- o';I{"""", a LIIho,-,.,
The obov.. ,_~io.->ed d"""iphoo j, ba=i C<l Rob<.t
1. Nikaioi', descr,'phoo 0.' the ~".<>o.\oW
T ooth """",,,,",,,1 during <>r1hxIontic thernpy
il b<oo ght OOOvTby lorce. lI"~roted by
tne ad .... com_I< 01 an orlhodonlic
~1ICCl- The Iort:e <.-:110m""" teoih;, derived
SOURCES OF ANCHORAGE

Anchorage during onhodontic th . ,OIl'/ is mainly

obtained from two~.
~I'I'I certoin onotomic o ren, which oct o. I) InIm-OfOI K>UA:e.
ancI>ors, kcordir>g 10 Newlon', th ird law of Z) E.I",o ro l sovrce.
lOIOIion, for every oction the re i~ o n eQ1Xl 1 and
DPJIC>S'1e ,""""".,. In occOl<>nce "",/h thl' Iaw, Intra _or.' IOP'e..
foe 100:.. used to move tee'"
may Induce on The inmIoml SOuR;eI of oncho",1I" ind<.d ......
~ gnd _ _ len;. on the anchorage unit<
I""', alveolar bone, ..... 00..,1 iow bore, and
-..di"d 10 <:OuSe t~i' mo.....ment which il no! ..... m"Kukttv~,

.....,.
dairobIe. The ""'>!once!ho'r th., onc:f>otoge cno.
. 'o!hes.. lI!1""'"te<l IOOth move"","" is wiled

Gto~r hOI deFined onchoroge in

The teeth : ~e '
orll>odorl~Ollly,
Klm e 1""lh ore moved
..... remaining leeth d the oml
COI'iry con oct ,,. onchoroge or ",..-.!once utlits.
c.thodontics 01 the natu." ond del/ree 01 "", is dve 10 "'" Iocr IhaIlhe teeth IIlemselves
~G to dispbcernorvollored by on onoTomk
con resi,t """",me~! . n.. c nci>orog e poIent",1
r i lorthe pvrpose of effec:ting tooth fI\OWIm enT. of_ h depend. on 0 numbe roflodo<1 $u ~h o.
Accotding to White and Gordin'f, 'Anchotoge i. lOOt 10m>, root .i""
number 01 (ooto, JOf!eng!+>
"'" tile ol deli ... ry from which 0 10101 it e><etted.' one! root indhrtiotl.
I. Roo< form,' Tn., andlorog e patentic l oJ a tooth
deper>d . I<><g oly on its root fom> Crass section.
of root, can be 01 th "", type.; rov r>d, fIot ar>d
trk"'gular, ~our>d root, 0 ' "'." in bku.pids ar>d
pa la tal root 01 mO<il lory molars can re,i.t
horiI ontally d irected forces in any direction . Flat
root., for example th o,e 01 mand ibular inc ~ors
or>d """A" or>d th e
buccal root. 01 maxi llary
moIa", can fe,ist movement, in the me~od i stol
direction but have liHle re~,tance to movement
on the thin ed~, lound on the ir bucoa l and
li ngual . id , Triangu lar root. 01 conin e, OM
maJi llary central and lateral ind. "" a Her tn .
m",imum r." i, to,,(" to di.piocemoot compa red
to rooM or flot rool lorm s,
2. Size ond numu r of roots . MultirO<lted teeth
with IOfge rooto nave a greater ability 10 with. Ii;...id
tress than . in gle rooled teeth .
3, Rool knglh " In phy. iaiog io caM i!ian" the
,oot longth indicate, the depth to which th e tacth
" embedded in bon o. The longe r the root, t he
dee".,r it is . ", bedded in bone and the greater i,
H, re>i.tor>ee to displace men!
4. Inclinotion of Iooth , The axic l ind ination 01 a
\::lot, is imporlo"lnt in a .... ssing its vo l"" a . a sou rClO
01 anchorag e A gre ot . r re , iMan ce to
di,plocem ent i, offered when the force e><erted 10
move tMth i. oppa' ite to that 01 t he ir axial
i", linatioo,
5, Ankyio,ed teeth ; Ank~o.ed teeth are directly
l i,ed to too alveolar bone and h. nce la c~ a
periodooto ll igOO1ent, Orthodootk movem ent 01
weh teeth is no! po"ible and th ey can therefore
, erve a, """,,. IIM t oocho" when""er po"ib le,
Alveolar bone; Th e a lve o lar bon e that
, ufroond, a tooth offe rs resi,tance to tooth
move ment uplo a certo in amount o f Ioree. I'Io\-,en
the force opplied exceed. a certain lim it, the
alvoolor bone pe rmits tooth movem. nt by bone
remodel ing
Ba,,,1 bon e : Cer"klin Orea, of the bo.ol
bon o, a re availab le in trao<a lfy 0' sou rce.
ancr.orage . Th . ", orea , ioc lud o tho hard pa la>r
and the li ng",, 1 , u rlaee 01 tM mondible in t
region of tM root., The ... i,""~m l "" d '''~''i '
!xl",1borw: can be vsed to ovgm ent m-amaxillo<r
or inter-maxil lary anchorage ,
Muscu/alure , The normal tonu , of th o loc:iaI
an d ma,ticatory mU$CIe. pi"y' on important rot.
in tM norma l development of donta l arch ...
Aooormo l hypotooic mu,eulature cau,es Il anng
ami 'pac in g of teeth wh il e hypo rfonk mU$Cleo
""ert restrictive forces in a lingual d irection . Denial
ondmrag . ma y be ino-eased by making u... oi
hypertonic lab ia l musculoture o. in tho co.. of 0
lip bumpo r.
Cerkl in . xtrooru l area' ~On be utilil..d 0, 5OUrLe>
01 or>eMrag e to bring about orthodontic or
ortr.op:,ed o:: chClO""J9"S' They a re mainl , used when
adequate re, istanoe con,..,t be obta in ed from
intraora l ,oure", lor th o purpose 01an chorag .
Th e e<traora l 5OUrce. 01 anchora ge includ e the
w Hli um, the back 01 th e ned: or>d the focial
bo~,
Cranium (occipilal or parielal anchorag e);
b t rooral anchorag e can be obtained by using
hea d gears tMt derive anchorage Iro m th e
oc~i pito l ar parietal reg ion of the cra niu m. The,.
d. vi<;e. or. used o long with 0 foco bow to "" trkt
max illa ry growth or to move t ne d."tition o r
maxilla ry bane di,to ll y,
Ba~k 01 Ihe neck (c ervi~ol a nchorag e):
Eidraornl or.chorage C<ln alternatively be oCton od
from 1M ned: orce rvica l region, Such a typo 01
hea d gear " ca ll . d cerviw l rn.e>d gear.
 .,,

TYPES ' OF ANCHORAGE

tho ""' """ 01 lor<. 'ppll'lIlon , Slmpl .. ""<lho'.,..

I )~~
It i, defined 05 d ~ n t o l o""~o,,,ge ;n w~ ; ch the
21 SllltionarJ rdrr,lO
3\~ .~ago
roonner & ClPpl icotior1 of force i. >uch lhal il "nd.
A,oordlnl 10 J..... l"oI>.d : to oho nge Ihe o'iol incli rlOti<ln of the tooth or
IJ lojr ......aary Ie.lh Ihot form tM orKhorogo un it in th ~ pi """, of
l) ~'-t"'Y 'PO e.. in which lhe force is being applied, Th u.
A,oo"l1"" 10 I~ ,II' ot . n,IW'IO; the "" isla nce of tho oncholOge un il to li pp ing i<
1)1n'''''1I
ulilized to mave another tooth or teeth,
l) ~ 'U """ ,
A, Cer;lcaI
Simplo an ohorog e i. obloin. d by engo ging
S, 1Joc\:III_ --.ilh lhe a ppliarKe a gmator numbe r "il..elh Ihon
C. er,.,ia are to 00 mo.om within the >a me donto l orch (fig

,- D. Fld'"

A.,ording 10 t ~ numb" of . n, ho"I' ",its:

1J. The combin ed root , urfooe orea of lhe teeth
farm ing tho onchoro ge un it mvot be double that
of the IMth to be mo.ed . Thu. the re>i.to""e
I) So.,;. or prirIwy iO'd!"'J"
l:i Co~ .nchor,lO
Offered l:.,. It,;,' a r)Choroge un it is greater tf>on tf>ot
3) MIJIipIo
a""hor>gol
or ,_
..
off",ed by too tooth or tc\if.'be:;ng mo.ed k,
,"
e,omple of <impl e an d'K,ragc ' i, give,n in fig 5/,
.
where a po lotoliy placed promo., r 'I pu< h ~ "
N1cia J bon es Th e fronta l bone and th e bllC(Jlly --.ith lhe ",\I oftOO leelh in tr.. denta l arch "
..,.",.jibvlor.~ ofFe, c:.-.choroge c:l.oing I:xe al Ihe or'IChor unit"
'Ox'" the rapy in order to proIroct the moxillo ,
He<l d geo", Ihol mokes u, e of onchorog e from
!he foreh eod and d, in a re ca ll ed ,eye " e It is defir>ed a5 de nta l onohoro~e in wI1K:h the

~ ma nnor & opp li calion of forc~ lendo to dispklce

Ihe ancho-roge unit bOO ily in tho pla no ci .poce
;~ wh ioh Iho foro~ i, be ing opp li ed. The
anchorage provid ed by 0 tooth "" i, li r>g bOO ily
move me nl i$ co nside rab ly greate r t""n one
resiotir>g tipping forco.

R."lp,a".1 .""ha,.g.
Th . lerm gen erolly refers ta the '. l ish:...::e offered
by two mo lposed uo it, when the di .. ipotion of
equa l ond oppo,ile forces ,,!"ids 10 move each
.{,i;il lowo rds 0 more """"01 ocdu .ion. H. re two
le,",h or two grOlJp' of I.elh of equol anchoroge
F" 1 Y",pIo O"""""l" - """"""bIo ,ppI_.
'''''''''''OJ.... 0 ",," W fo, b"",01 "'''''''"''''' 01 0 va lue ore roode to move in OI'po, ite di",ctions,
,do"" pI"od P"""'''' E",mplel of reciproca l OI"I<:MlOQ e indude closure
 A

D
flg 2 loci"""aI ~ : W c..._ of ..-.r...
d"-.. "" "II .100-;:., aJ) fOlgoof"";"II' osod to doot
Mldlno d...."'" Ie, C,,,..,,,,,, ""'~I 10< "","""," 01 '-"<I~ ~ pao>ooIor ere...~ . (0) "'"do.,..,....O<I"WQ.
, , _ '. _'ionco "'''''''''"'''110 Coli" "P'''II

of 0 mid line dia,te"", b m",, 'ng the Iw<l ce ntro l

inc:ioon toward. ~ ~. The use ci cross!>!.
etoS/a and dental o",h tl>IP<Insion ore ort.,..-
e>omples of AKiprocol onchoroge (hg 2).
A
I~ft ,., clter. ,.
AndIcroge i" w~ich all the .... illonC. IIn it, orc
, ;t<JaTOI'd wiThin the oro l cavity il t,""cd inTrno rol
c n ct>oro~ , The teeth to b.. moved 000 the
"""tom le a reas IIlat oIfera~ ore a ll within
me orol covrty. Voriou. in!roOfol anatomic unil:!
rho! moybe employed ore the teem, polcrte end
lingual oMooiar bon.. r:J "",ndible.
~.d,.o,.1 a/lello,.,.
Atlchoroge in wh ien I ..... ' .. istonee unill "re
siruotod QVtI ide the ami (.(lvity isTe<med ell",,, ,,,1
anchorage. Va riov. ex!", orol Or"IQ10m ic unit.
f" 3 !" .,, ~In of ...""",, 1<>XI""O(jO '~ r.co """"',,,
~"'''.';1;." . f mo,HIo o'","'=<j. ~""'.". , .... on<
0<; . III) 0<W1oI """" _ """""_ f""" tlooo CII'ok.<A

used os >ilea of ttilIIOnCII Ore ocdpul. bock of
foe ned, CIOnlun and /ace. E", m?Ies of cd"oorul
cnd>o'oge in dude The vse of heod gea" IMT
deri~ a..a.oroge from The ,,,,,,\col or crcn i<l l
region. end lace me ... TnoTden,,,, """ho", 9"
!rom the lodo l bonet (fi g 3).
Museu/., .nehor.,e
.. cenoin co,"" !he pe.ioral mU1Culotu re i,
emploved o. 'esilionce unito . Muoculor
.. ocho.og~ mok ... use ollorres "", ..oled by
......d... 10 o;d In the movem.nt of teeIh. M
e.omple of mVKllIo, ondIc>"'9" is the use of 0
Ip bumpe, 10 diSlOlilll moIofll~" 4).
Int.emumary .nchorag.
When 011 the unil' offering relislo""e are siluoled
within Ih e IQ me jaw The onchoroge is dewiiJ.ed
'" intro mexille ry. In th il lype of onchorag e the
fttI! 10 be fnO'o'ed ond lf1e e""I>o",1I" ""its ore
oII.ituo\ed ,i!her entirely ",the mo .. llary Of the
mordibuio. o..:he..
A
B
f'll 5 1IoQ,-' o.<~ , (Al Clo .. " _ ...... " 0 ..
~ III C... Ie Honn<n<ikr, """",,-.
Inl.,multl. ry .""ho,.g,
Ancho'09t In which the .... Wonce un~. s~uO!ed
ifI 0"" jaw ere use;:! 10 elfed tooth m""",,*,' in
Ih, oppos ing je w i. ca ll ed in le rmo.i ll or)'
enchoroge . It il 01K> lerm ed Bok~ l, """h,, 'oge.
C le s. iI elcrsli c I,oelion (fig 5.0) ap pli ed b-elw<x! n
lhe \ow&!" ~a r ond uppe< e nleriofS o. we ll 0$
Cless III el:nti<:~ op!>ied beIwee<1 1M uppe<
molor o<1d ~ onleno .. (fig 5.b) ore types of
intenno>lill""'10n.:horoge
 ReInforce d Or multlpl .. anchorage

An c horag e in which .no" ,han one

"" i,tanc~ un it i. u,jli zed i. termedI ;,~;:'::~: 11
anchorog e. Rei "for~" d anrha-ag e "
augm entation of anchorage by .ariou. m OO ",
such as extraoro l app li ance>, uppe r on reriOf
inc li M d pkme o r 0 tronspatO'<l ) arch con .-.eding
the tv.'o maxi ll ary molar> ,
Afx!ra o ra l' loree , to Qligment anc horage:
,, Force, 9" ".rated from e>traora l arem , uch 0>
,, cra ni um, back 0; the nock and loee ca n be u<ed
,
I to rci nforceo ro<:ho.-ag e.

B Upp e r (Interior inclined plane A

A remo{Jb le app ia nce irl ccrporotmg an Uppel
a nterior ;r.:;li nod pkJn e re.uit, in fQIWard g lide of
the morid ib le du ring da.u re o f th o jaw (ti g 6 .a).
Thi' re, ult, in ,tret~h i r>J of tho re tra do.- muscle.
af the mond:b'e ",""cn wbseq u"ntfy controcl> and
tocco. th o mand ible against the uppe r indi ned
p la " e . Th us 0 di' tol force i. opp l;ed o~ the
maxill ary tooth rnorohy rcinfo rci<>g ma dl ory
ordlo rage, A mod ific()!jo rl O'f the <Y1teria" in di ~
pa ne ~ the S.ed appliance thm ho, "" odd it"",a\
uppe r incisol ca pp in g (fig 6 .b) ,
C. Transpa iota i ofch Tn i. is 0 wire that
B
spa ns th e pola te in a t"'n"e",~ d irooion 10" '.
f .. 6 ~"'~ oi ,.....""'. 0 0"""",- ("1 Uppo< 0 ~"'.,.
",d "od '*"" WI oW....,.
",-oJ

S Ingle or primary ancho,age

Co,"" wr.xc in the ",.i>l<)l)(;e plU':OOd by 0 , iogie
Iod!, with greate.-o lveo:1lr <upport i. u>ed to m Ove
anothe, tooth with IQ"er !.Uppc.>rt j, telered to as
sing le or prima ry anchoro ~

Compound an c hor" g~

~ v.-r.c ,c the rc,~taoce provided by mo re

tho n 0""' tooth with groote' , uppo rt i, u>cd to
""""e tooth v.itil 'm." support ~ ce ll "" co r~ "d
or0>o roge.
connoding *'" G", perrnor.en. mo'o" 01 eother
side [fig 7) .They Ote used in fi>.ed med>ono

ANCHORAGE PLANNING

~e ploMing i, of vtmQo! impOr<lnc.Io'

_ .UCC<IS. of Otlhodonl;,: ...eatmo ..... P~or to
i~
initiol"'" 01 OfIl-o:xIonlic thefOP\". ~ is e _ a! to
(Orefu'ly ouess the onchOfOQe demoods 01 00
indMdvaf cose SO thol oppropriate treol,.,....,t
...adol;!;... con be e. ecvtttd . The O"'"01"ooe
A
a numbor of foCIo"

I. Numbor 01 l ee rh being moved, The

gte<J'efthe number of ~th be,ng mOWJd, 'he
greoie' ;' the demand on the onmomge.
2. Jype 01 rHIf> ""ing "'~ ; The moYetnent ~
.....lender OnlOn.:.-1o>e1h oI!= ~ .. ro,n on the ,I
~e thon robuot mul!irooteo' '"tho
J . Typ e 0 1 /oo rn m Ol-ern e", Whene ver
@I
,
':''-' ,
.. .. ~'.

>
bod,,"," t<>Oth movome nt i. req uir ed, the .. is 0 . ;....-

cr-oltr Itroin on IhG ar><horoge . In COf't'~" ,

Wng loot+> movement. oK.... a "lali.oly lome,
-.oin on rhe anchorogo unih.

4 . Durotion 01 tootn """,eme,,1 ; Treorment
.... 0 prcIon!;lttd du<o1ion ploc ... on undue o!to,n
an !he onchofoge.

Booed on the abo~e menr~ foctors, The

onchorage demand 01 a parti cular poti lffit i.
dc!ermined Case. that ho"" 0 high oncho'<l(lO
mquiftll"ent need neinloro:ment oIlhe anchOt'l:Jge
bran. o. mc<e of the voriovs mean$ rnentioattd
eorl;e,. In $pile of tho pr=>utionto'<en in p'onrirg
oncho' oge, 0 certoin omoun! 01 unwonted c
lIIO'I'eme nt ollho cnchor teeth inlfOrkobf.,o occur>
during orthodo nti c tr""tment. Such uowonT""
f, 6 Cbc"~orIo ' <>' _-c,. &~ , W ""'-'""~ '"
0" ' 0' 00' II I ,v.oOoo , on<," oro iCi Mi, "'"'"
lIIO'I'emenTSof oncror '''''Ih i, co il ed 'anchorage ~,~
.....Based on the oncho, age fa .. thai i.
peftrl lnibl" rhe andM:m'!!" de ma nd g/ on
eodnldionca.. <;an be oI ....... 1'1Pf'S i.e. """';mum
onciloroge, modenJte onchofIJ~ and minimum
ol\Chora~ cose (~g 9).

M.xlmllm '~C"O'"'. cUeI

101 <;DieS where !he onchoro~e demor.d is very
high, rl()t more Inc. .. 1/. '" of the e:drodion lpoee
shou'd be lOll by Iorword ~ 01 Ite anchor
t... th. n. onchoJ<)9" in tt- pol;.".,,. ......,Id be
ougrnenled too_oid u......,nted movemem oIlhe
onchottetlh.

Mod. , . ,. 8/1cllo ,_ " .....s

-.
In these <;0$01, "'" ondIor ....... can be permitted
to m~ Iorwordlnro ''''lI to InoFlIoe e>S>oclio"

Mlllimum enc hor.,_ "8105

In these CO""', th o ancho ro "," deroorod is .ery
low. Mo'e lMn hoI! the &xlroctlon spoce con be
lost by The onchot tMth m<wing mesiolfr.

1. Gtot.. 1M , ~ . IITD,... -t pnx!Ioo.

W8!.o ....... ,988
2. _ Wl: Coo,_ary OrIhodonlo, !II loud,
CV-."t986.
3. ",.,... f - . Hond boo!. 01 0 - . _
boaI< _ , p"bIo~ 10<,1 988.
. 1lIoMoo M GtoM. ..... ~ \Ianondo l .~.
Iia'w,'" p<ft:ipi.. ond ~ '''' Mo1Or)'OOr
boo< IIIC, 199.
 -';.,...!.:I ..,.:...~ ~ ~,.,..,. ~
~ ~ ";"'40- ';;;-~ I .,.:.:. ~ys.
~jl~ J ?';':- '-4-3 ~I J,.;,.. t'"
~~~';""I.:"""';~ J

Factor in
ontics

;mpottant cons'deroffM in ~,!it c. IWsI dee!! bite

Af; diollnos;' and treatm ent ,H a nning Is the

of the potient. In cddifon ege fodor'S
duence !he '..at""",! mechonio end porogr\OSi$.
DlAGHOSIS AND AGE
D;allnosi, 10""1 " vital part of luc"..ful
CIfIhodOl'ltic th.mev. In "rd." to diognoM
cb>otmclitiIH C>f , ... de nlofoci,,1 Impl .... the
O<1hodonti,t sho uld know wh eT CMilit,,!
<'C)tn'I(l 1<;y. Normo lcv in the d. ntorociQl regior1
c5!!en /rom oga 10 "~. There ore certa;" Ieotu~
dille deYeIopi"9 denb-Iociol compkoo wl>ich "re
~oI ln "child, however d ~lln on odull
........IdCCO'lllilute malocclusion. These en ~
b OS seIf-<;""ecting rnalocdusionl or tr(Insient
..,,,loedul;on,. Some o f the I,on,ienl
"",1oGdvolono oro :
o . Open bile _ " in the gum peds
b. Spo.;ing in d &<:iduou, de ntition
d Flush IIIrmin,,1 plone
e. U g~ du ckli ng . tog e
I. 5econd deep b'1e
These malocclusions ere consid~d
nr::nnollo. !hOI oge end need no Ire<JlJ'n8nt o.
!hey gel COfreded oVlomaticol1y o. th. 011"
odvonces.
The chronological age of!he pOtienl mOl'
sometimes be misleod ir>g <nl may not ",lied tI1.
exod growt" .Iotus. n.....
sl::elelo l end cIertaI o~
01 In., patient IhQ~kI be osc~ rtoin .d for 0 more
occvrota diQ gnos il. ' foe , k. tetot 0"," or borIe
oge o. II it someli..- coiled i. determined by
studying 0 horodwri" n:xIiogroph. The hondo
wrist region hos 0 numbol, 01 corpel borIes. The
"..i!1ar1icrn ond union cJ ........ <keiel<ll centen
foIlow<l delinl'" "me ",bl~ ond p<>Kem. Thus by
ooo.";o;n i,,.. !tie #crIvs ol!!.e>e ossiko!icn ten!en
ond compo,i".. them with .tondord, I", di!leret\!
... letot ~I, one con ~rm .... 1he e:<oC! ,l<eIelc t

?1'
meturity ,letu. ci o n ind i';duo l. Th e dento l oge
of on ind i,idw l is de'Ofmin ed bya"e .. ing .he
, tog o 01 cobkotion o nd root de, olopme nt.
Considering the foertho\ orthodo rtt<: 0I""Jd
dMtofocio l orthope&d io oppl ian oe. are ma"
eHed ie during g"""""', the ""essme nt of .Ik.leta l
mat urot ion in you n~ patie nts il 01 utmo. t
impOrto nce fc-r th e <ucce" 01 the therapy.
TREATMENT AND AGE
Early trea tm e nt
Mast orthodon" ,. be! i. e in !he concept 01 'co'Lh
th em young'. Treoting a potient ot a n ea rly ego
when OOr.toloekJ l growth i. od ;y. ha . num erOUS
benelilS .
Scope for growth mod ification Sleleta l
me loeclu<ion that oecurs a, a rewlt 0; a ltered
growth direction and amount co n be int~ r"" p'ed
by modu lating further growth . The ... pfocedJre,
that modify growth ohou ld be initkJted at on ea rly
age befate cranio.foekJ l growth coo", .
Scope for preventio n and inte rce ption
One of th ~ odvon"'9"' that early trootment oIlo"
i. the poss ibility of preventing 0< intercepting 0
me!o.cclu,ion. Even if t..... mo locolu";"" COMOt
be toto ll y e li minated, iT> ,evo rily oan be red ucM
<0 thot comp lex o rthodo ntic treolment in\lohi ng
e>t(action ond . urga ry am be min imized
Hom e<s in g natural growth force. Th .
human dentiti on hos a noturo l tertdency to trIOye
in a me,kJI orld oedusa l direction . The", ""turo l
terdend"" ( 00 be c.oo 10 g ukle the orupting teelh
to more icvo'Ob le po.ition .
Mjni mi,e p,ycho log ical dishes< Tfe atm ent
co rried out o t ar' earfy "ge ovoi d, p,ycho log ica l
disturba nce, as a re.ult of coping with 0 full
A..d!led mIl loccl u ~M.
l . te trsa tment
Role of growth . O ~hodonti c t". "",. ,,,,,,":,:
out du ri "," odo le.cenoe or . til!
Ctlr'ln'" mille use ci the growth
werking with g rowth potent;,,1 has
odva ntog e' o. M li sted eo ri ier,
mo locc lusions ore be,t t", o ,.d oft.r
co m pletion. Mo 't . ke leta l
indkotad fe< e<thogncti-io sl.'l"g<!ty o re 10 be treated
otter growth comp leli on '0 a . to oojd roCUrTelOt
growth d""'gc. a"ociated with oontinuati on oi
aooormll i growth pattern.
limjted tre o!m e nt option> In a growi n;
pOtient, the orthodonti, t ho . a number of options
in hi' a rmam a nta riu m ,hot inc lud e g rowth
modu lotion, gc;oonce of eruption. use of nofural
iorce, otc.,. Howeyer, in on odult potient the
treolment options or~ li mited to moving tMt;, cmd
surgery.
Compromi'e on trM !m e ni obi ect iy ", In
on adu lt po!lent in whom growth hoI ce",ed, ~
may not be po,"ible to achi eve 011the oo jectiYes
of fun ctio n, .,!hetics ond . ta bi lity !hot rep rc..,nt
idoa l dentition a nd occ lu, ion . In mony ad ult
pOlients compromise, might ho,o to be mod e in
the Ireatment. V/hile sertin g treatment objectives
!or odvh patients !he orthed anti, t should set goa l.
thot are rooli'li c, ottoi""ble o nd which <Iril . the
be.t possible ba lar>ee in IV rKtioo, esthetic, and
treotme nt ltob ility.
TOOTH MOVEMENT AND AGE
Vituiiiy 01 tissue . Orthodontic tooth mo .... ment
is most eifecti'ely co(ficd o ut in YOVl"lQ peti ent,.
YOO l"lQ pot;""ts exh ibit in oroo.cd ya<culority ond
cel lulority 01the pe riodc nto l me mbrorle 0I""Jd bo ne
'" compcred 10 older potie nts . fune nts of yo<Jr>g&"
age 0'" hence more re'PO"s i' e'o orthodontic
!orcon wh ich ""'<os is pos~bIe to move lei,,"1000e r.
Role of gro wth , MOlt ortnodont ic ond
onhoooedic correctiOf'll 0", dfedively corned out
durillg Ihe II"""'" pried. This is due 10 tM foCI
tnO! ~o~ ng er growing poti ent. reoct "'Ore
""",, rob fy to or\hodorItie. e nd orthopoedi<; le rce .
Although it i, dfliroble to cor<)" ""t
o.thodenl'c """,,"enl o! 0 younger ogoo, it i.
_nnel ... pou' l;.I. to mov. '"'" in oId.r
polient3 by olleri"ll the forte mogn~ude om!
durotion,
Role of apica/Ioramen . In an adu 't pa~ ..... t
the opicol foramen II norrow. Fon:e OpS)licotion
during Ire<:Itment moy pose a grealer cho~c. ol
IIO/l."rn lity, ,oo! reso'~on and anlcylOClis olteetf,
occ",ing. In a I"' ur>g potient, the a pleel b-tl men
......
.. wider Itou. Ito , .. Is 1M"" chonce 01 py lpol
Denldy 01 bor-II , AJ. odults ....nlbit "reoter
del'lS ity 01 bor., o"~ontic tooth mQ"o"e:"<1ent i.
mvc:h slowo'-
roVlfG VERSUS AOtIl T PATIENTS
In recent ~mel *'e", hoI ~ on inc''''$(! in Ihe
numbe.- 01 odu lt potienfl who de. ir. o ~hodontk
co rrection of th. i, mol<xclu.i on. Numerous
d,IIe",,,,,,,. "-<ill berween oduk o~f-oocIorI~a ond
oModontics Ior-Ihe young child. The IoIl""'in9
" " lQtre 01 the importont 0""'" where tho
d,Herenc.
, i. ""'"'
GrOWlh to ... 01" witn , 0"" 01 tho im po rtant
d;~ol in t<eating 0 child arid an adu~ i. Ito .
Da rhol in 0 child tho or.hodonliol hoi growth to
><OrIc with. .\Awt onhodonlic ond orthopaedrc
treoT"'c nt is efficiently corried olll "'Ongt!>e g,<M"II-,
pote nti a l cI the potie nt. In co mpo ri so n, on odu lt
ItxI:s gr<>wtt. . Th", Itoe orthooonti <l ""'~I (Qlio.
on IOOth """",menlorlurge"..
D ia~f\O' ;$ ' Most of Ih e routine dio9nosll c a i",
oon ~ us.ed in both )'O<1ng a . well o. ad ult
pa!ients. An oduk pohent JI,,,,,,, yreote, ",,",bil;ry
of dormant ocll-ooll. impaction, periodontal
problem., wee' of dentltion,louliy "'Itorotion,
bone los. , 10.. of tn tk d ue to decc1, etc" . The
diagnostic e, erci!! In an odult should hence
wn,ider Ito ..... ~ a. some of ,hem mo ,
ha .. 011' 11-0 ....JCCelol oIlhe o<ll-adorr"ic !herop.,-.
Applionce ... Ie,fian , Younge' po~ent. who,
Ore growing con benefit from ortl>oaa&dk ond
mVCh",d'onc l oPf' lla""e< tMt he lp mOOu lo!e
growlh in ca ... cJ obnormalgrowm amounland
dirtlC!JOn. In on oduk pa~er-' *'e options 0 ...
,estricted to orthodont:c tocrl> 1I"IOI'"_nt ond
.""'"
It i, a fo e: IMI yo un 5l<" poli .... fI 1~"""'le
rna" appfianCfl ard Off! nat bothered by It-.e
Oppeclfl::rnce al'he appliOr"Ke . In caMl ci adulb,
Ihe opplionce toleranc. I. much le.-Ihon 0
ch ild. Adu k, ore aket1 bothe red by the loolu 01
thi! op.p lio",,&, In Iwen potie nt., removab le
oppf:ances ond fixed opplionco, Itoot are mOr.
est/IeIic;orinca-.sp;CllCUlo.., a~ ..............
feosble.
Perloaon IO,' problem. Presence 01
pe ri odOl1la l invo lvefl'lflnt a nd bone loS! i. more
wm ... on in on aduk pa~ent. PofiodonlaU ,
..........
rnoolYed ....,., move more readily ond offe, POO'
Pollen l ma/iva/ion and coop efolion : Mo.t
odu lt pot"",t. _l:ing Mhodo nti:: th alOP'!' Or. _I I
motiYoled 0< compared to child,...,. ThuI the
onhodoo ,tis! oon ...ped mo.., co--ooerotion in on
oduh patient.
n ,we v;' a li ly , Th . tiSl ue \l ilo lil1 a nd
respon~,-.",,,., 10 Ion:e il mvch greow in 0 child
thon in an oouhpotient. Thil il beoou .. of
reduced V<loou lority ond cc ll ulorily in an odult
pot;"nt.

Treatm e nt obie c/iye, In a~ ad"lt pot ie nt,

mony COrl1;::<"omi... might hove to be mode. The
3 a!:;cct"'" allvnctian, ~,theti c, 0"'"
.tobilily rMy
not be achieved in on odu lt patie nt cnd the
o rtf.odantill.hou ld thu s .tri ke the be.t possible
bo laoce betw""n tho vorious objecti><e"
Tr~o lm Ml OPP' f!oC;otion Ad" lt patient. o re
more oppredotive of tho treotmcnt resu lt. thon 0
ch ild potient.

a...0Mol"""
2. 0..; 1?9 1 "'"~_ i, ~""''''
_ _",,0, c"''''"'
3_ ~ ... ),'.oI.. n on M ~' o.+.odoot,, :)(;O lo- o "'~",:
630_6. 1, l'iSS
. _ C""Id" I'.e<ixo , Ro!<h)lf. "" Xh>,"" ,
Compori-
" ado,.',
"'" 01 '"'Il''Y ..-.J <oj .odoo,~, "tx.dorl .... '
,A!,O, ~55 . 70 , 1993
5 Coocw ond COot ,""',,,: A.clcl, OrthO<Jon' '',
J_o;,,;,;ol ort>Od .5H72 , 1972
6. Go I_ , MJ' 0"0 "" opo<' 1;;10 , AJ.O , 522_526,
,m
7, Gio"",,,', No " i~i o " Modw", 0,0 Arono\'<,11
Con""",,"i.......1"" 1 oohodooi c o,u lt 'opi<! po"-
"" """"""', , AJ .O , 20/ _213, 198.
S, Ho<v.-, L, levit : MV1 Ort->odort~" h i""" """"'"
, 130-155, 1971
9 ~,,,,, 1 H.Mo,", H" ",ooCo,", Allu, d Mu lt
O .thodorl~ " loa ,,,, f obti _ ' 19B9
10 i'.oJ'ndo" Ro""w o"~I<, AJ,O , .6J .~ 71, 1990
11 , SpWol Co o ~" 'o t; on , 10' Ad,1t Orthodont ~ . -
Jdnko l ""hod, 5355.5, 1976
12_"1'" Mu ' " oti"""', ~ MOOd"", ~ ,o..-opy :
'\',J.0 : J05 -31 5, 1981
13, Thoo-r,o. ){" GrOOo< '''"
1995
"'*"'' l 1Ionor>do .1, Moot,- ,
.
)4 , \10":0 0'" (;o,o>o -Co""",' "' po", d ""OOdon'~,
oo o,U ' >d" ' ~ ' AJ ,O, I ~2 I .6 , 1<;95
15, Wa ,," Hom Jo ' O"",,",,"x Off~ . Oo,ogn o..;go.
log Mu , koo> : J.<I _ I """"" 1m , J55360

,
,,


Orthodontics

P '''''eniiv" o""aclontic. i. th(JI porl 0/

oflflodontic proctice which il <""",e rn ed
with th e poTienl. and IX'renlS' education,
~Msion of ..... growth and development d!he
m::Ilocdusion

""'......Tn.,
hove appeared is on inle<l:epl ....

fdlowing ore some d .... ~ures

underto~.n in I>f'e"'!"tr.e orthodontia ,
I. Ibrent tduwiion
dentihon onc! the c;n;Inio-lociol slnJdures, the
<5ognos~< procedvres undenoken 10 pre<fod the 2_ Conn control
oppeoro nce 01 "",I<>cel usian and th o treotmont 3. Core of d"ddcoou l denTiTion
procedure. inltiMed 10 pMYent tn. on",,1 of 4. Monog"""nt Qf onk~cned tooth
""",,"1uUon. 5. MointenaOOll of quodront ",;,.. tooth lheddo-.g
Preventive oothodonlict I, (I long mnos fi ..... lable
appro<>ch cnd it il k>'lleiy (I responsibi lity oithe 6. Checkup lor "", I ""b~1 end hobit brea king
Plf'IIra l d. nti.t. Man~ of In., procedtJ r. s ore cpp l i<ln~e il necessc ry
COmmon in p.e~.ntiy .. and Intercep ti"., 7. Ocduiol equilibrlorion il there ore "ny
OIIhodonlics but rho liminogl or. diK" r.nt . occlusol premotvrities
Prev.nliv .. proceduru Of' undertaken in 8. P''''''''''ion 01 domoge 10 ocduliot! e.g.
""ticipotion of deve lop ment of (I pro blem, Milwcuk ... broces
h!n:eptMo> ~ ore unci..""""" ..nen Ihe 9. E.!mci0<1 ofwpemurnen;.r;~
;on;>blem has olroody manit.,Ied , For ".'01. 10. Spoce moinlenanoe
.... I.... ,d~"te.o:thbelcnlheyct>JM 11. Monog""""nI of deeply Iocb .:Hnt .... """ .. ~
~pl <>C.m enj 01 ct h. , teeth i. 0 pre.entive =0'
crocedure , ..... 1. tn.i, e.odrocti:)n olter Ihe sign. cJ 12. Monoge""",t of oMormoI frMOl ettcchlTle<lts

.-
"If W u_.,..., ""';.,. h doodoj""", ....Ii.....
-noI"",,, ..... ~od .... ,.., ,0<>0"".. MCOIId "'""" '""'"~~ ....:01, rio t. 'PO co: (II: i'I"
EDIJCATION OF THE PARENTS
Pre,,*,1MI dentis!<y >hovkl ideall , begin much
belore the bm. 0I1he child. The ...PKling mother-
should be educoted on moH ...... uch 01 nvtrifion
10 p<O>'ide on ideol errvironmern Ioc tho de.eioP"9
letul. Soon oIt., birth. th. moth.r .hould be
ed...:olOd on ..,ope< nu "'ng one' COllI cI the cJ. ikl.
In ccoe trw. ,hi ld ~ boin.;l boIIl. fed th . moth er,.
ad-.ised on Ih. u'"" ci phys<o logic nipp;" orod nol
the Oln-.tiorol niWo. The Ol"",,"tmoj niW e.
ore nonpIo"";olog'c ond do nOI pennil wclding
bI' mCMlrllent of lne tong"" ond the lower jaw.
They rother COuse sudcing 01 lne mnk which m"l'
I""d to 'IOt'iou.orthodontic pn:>bI .... oIth.l8eIh.
The pIoysiologic nipple. on the OIM' hond e,..,
clel.lgned 10 po ' ,,".i! ' L>C~ir>g cI 1M mi. whir:h more
0' lell resemb le. the normal fUneTi","o l OCTil'ity
OS in breasTfeedi ng. Th o moth ... l. 01 .0 odviced
agolnst!he p",'oogt'd uSf! 01 poci~C<"I ...+-.ich con
have 0 detrimentol eKllCt on the deMlion. r""
young mothers 0.., 0100 ocfy,ced on moHers
penoining 10 prevention 01 nUfllng bottle
Jyndromo.
Th. poren!> .hould at", be educated on
th e need lor .... oinleining good oro l hrgillne . The
po re nts shovld be taught th e co rre<:t melf.od of
b<-uth ir>g llIe child , teeth .
W"> ~ 10 "'" .,. ... :10 Ionvt. Nolo
CA.RIES CONTROl
IMIh if nor relrorod
_ment 0/ edjO,ent teetn i
1~ Sur:h Iossol o,ch
01 IMth con
oreh tenglh ond JOolh rr<!l.,...,1
p"rrnc nont Teem erupt into tho oro l co.ity.
. hould be OOIOCTod l>y dinko l
proper IIlllOrchOn oIrheoflected teeth should be
unde~ol:en immediately 10 prevent loss 01 ord.
I.ngth.
CARE OF DECIDUOUS OENTITION
Pre. e nti \0"8 o rth odo nt ic. incl ud o, core of the
de<:idVOVl den'ition by =1 of p'.~"~OM 000
timely r1HIoro!;on olcorious l!!cIh. The dccid..r<>u$
...,th ore eroceIlcnt natu",1 opace moi""" ....... ~nIif
tnedeveloprng permon.m!eril on: tIlOdv lOen.rpr
""" .... orol aMty. Thu."n..&rt,.hovId be token
10 preIo"8nt torly 1000 ollhe dociduow ... th . .s'mple
pre-;enTive procedu r. , ....d> 01 Dpp l,cation of
topi co l ~ u o ,i de a nd p;t arod I~"". _ len" Ifi g
\ .b) h ~p in prevc<>tin ~ ~ori ",.
fig 2 O'l ;",.j (BI P,e>ef>(' 01 ,,,,,,'''",,,,''Y ,eel,
h<>< " .... ,ed " deloy ;, ... JfY'" of tiMo ,"", ,;b cr ;oci>on ;c: , nd IDi
~ "'" " , .... ..., j' ''''' ... b. .... 0' tho do,.I opng door;.;,," . it ; ,nd 1 1 s.. ~>O<" 10" '01 ;0( "'"

EXTRACTION OF tMth to e rupt in abrx>rma l p<l, iti an,_ Pre>e""e ai

SUPERNUM ERARY TEETH
I'=;ence 01 ,up<rnumera ry and , upp lemental
,...th can interfecc ;<,ith th e e",pt"", of nearby
mrmo l t..eth (:ig 2) . Th"y con defl ~ct cxJ jacMt
a n uneru p' ed me , iod e n, prev" n" the two
ma<i!ary cont",1i ""~or' from approximating ooch
other. Tnu, , upe rn Ur1e rary teoth . " ou ld be
ide ntifi ed end e ' trocted belore they caw
d i ,o klc.em~ nt of ohe , teeth
H/M/NATINO OCCLUSAL INTEHFERENCE MANAGEMENT OF ANKYLOSED TEETH

All hondlonal prematurities .I>ould be .Iiminated M l<ylof;it I. 0 codilion cho rcderind by obseoc.t
01 Ihrt COn leoti to de.ialionl;n .he mondib..lof 01"'. pe...odclf.",1 "",mbro_ in " .mall ""'" ""
poIh 01 dosu~ and obo ~ilj)OS1t to bruKiom.
Using orIiculohng poper, 1h8 premo!ure conio<J
()<lit deleCled 000 oeIKti ... grinding is corried
0lIl. Some!imes abnormal onabnOcolfectule$like
eno~ 1 peori l, rn<r; cou"" poromcture corb:!o n..,.
shou ld be eliminoted by grind ing.

MAINTENANCE OF TOOTH
SHEOOINfl "ME TABLE

The,. should not b. mo,. thon 3 months

dilfe,.r.:e in shedding 01 d..dduous IMIh ond
.rv~jon 01 permanent j",,1h in on .. Quod,,,nt as
compclred Ie <>lher quodrants. O. loy in _"'Ption
may be d..e Ie """ 01 the Iollowi .... IoClOo'$ ;
o. P",,,,,,ce 01 O"'.,,-rcloined deciduovt t... th Fi. I~I
M.i<I ... " " -
~ dvo '0 ""c ~
_110<-, ..........
b. P' .....nee 01 unres"rbed deciduous root
.,..-. (II) Rod'cog'oPo
.ho. l ~e
_ ....Ibo ..
c. SupemumerorytoCllh Ifig2)
d. C)'IIS ond !umo"
e. o.er.oonging reslOrotion ;n o:Iecid""", teeth
"-~
f. Fi brosis 01 gingiva
g. Mkyiosedprimor;t.... th

fle wtde d tM root ",rioce, Anl)'iooed deO~
.... th do ""t get ""orbed and the refore either
j)I'l!v~nt the permo ne nt tooth from eru pting (fig 3)
.,.. defl ect th em to erupt in ob narmol locotions ,
The,e onk0o,cd teeth should be diognosed ond
!Il.O'gicoly """"""'" at o n appropriote t:me 10 petm ~
!!'Ie pemXln ont teeth to enJp/:
M ANAGEMENT OF ABNORMAl FR ENAl
ATTA CHMENTS
The pre,ence 0/ a thid: o nd ~ e,J,y "",xil lory Iobio l
h num IMt i. ottocOOd ~otiv"y low pre""," the
maxi110 ry rentrol io::i>ors fro m 0 ppmximo!i ng e<:><:h
other produCing mid line dio,te"",. Th i' kiM 0/
c bnorma l Ire nol o ttochme nt in mo,t patient> is
m u.ed d ue to hered itory lo ctor!. Th ey . hou ld
hence be diagnosed ond treoted ot on ea rly ag o_
" ble nch test h. lp. in dio9"". ing a thid: Ire num .
~ add ition ""tching of interdentol ben e in 0
--,
peri0rHco l rod i09roph confi rm. 0 thick I' M ol
Presence of Mk0oglo"ia or tongue tie
~ 4 _b) prevent> nor"", 1fun ctbnol development
due to lowered "". ition of t"" tongue on,d
a bnorma litie, in speech and , wa ll owing , This
cond ition .mold be . urg ico ll y treated to prevent
/ull.fl odged "", Ioccluoion,_
ORAl HABITS CHECK-UP AND EDUCATING
PATIENTS AND PARENTS
Habit. ,veh o. fi nge r 000 th "",b . ucki ",", ne il
biti ng, tM9ue thru.ting and lip biting .hovId be
identifi ed ond stopped. Prev""'ion starl. "";th
p'o pe' nurs ing and u.e of a phys io log ica lly
de'ig ned nurs ing nippl. ond pacifie r to """"" nee
norma l functiono l and d.glutoti on-ol octivity,
PREVENTI NG MILWAUKEE
BRACE DAMAGE
Mi f...ovkee bro<:e is on orthopoock OW 10 nee vsed
lor t.. corredion of scol'o::>$;" Thi~ oPrHionce exerts
tremendous lorce on the mandibfe ond th e
develorHng ocdu .ion leoo ing to rlOtorootion of
mondibvlo r growth ond po" ible de fo rmitie .
Whe""v,,", .uch on opplionce i< u<ed, occ lusion
.mold be !,<,o tected u, ing l urictiorXl l oprH io",
or positioners mode of .oft motoriol, _
OEEPLY LOCKEO PER MANENT
FIRST MOLARS
Th e deddVOlJ' ,ec".,d molors occO$iono lly hove
a p'o m i ""~t di. tol bulge wh ich prevent' the
eruption of the first permo n""t mo lors, Sli cing
the dista l s urfoc~ of the , econd deciduous molor
h. lps in guiding the eruptio<1 oI the Rrst permo nent
mole",
SPACE M AINTENANCE
Premoture 10" of dedduovs t""th con cou,e
drifting of the od joc. nt teeth into the .pace. It
con re. ult in oooormo l oxiol indination 01 t~~th,
spIlLing between teeth ond . hift in the denkll
midli ne_ Pre mot"re 10" of deciduou. ante riors
lead. to very liHl e orthodontic cMnge' . II the
deciduooJ, fi rst m<>klrs ore lost premotun: f" loteml
 A nllRg 10 IIikI'ICad :
, ,
, ,.', 3 It .hou ld be .:rro l. in con.t,ucti-on,
Rt_ u.. ~ r~~ 01 ""j.!O;M
2 WI\ biw$ or '~ tlfn:ll 4, It sho uld be stroog eno ugh 10 ",ithsterld
) l'>I'<!W",,,,,, L_ "-,nct'>OnOllo.-a:<.
_~I'UI.' f 5 . It .nou ld nOI e . erl e <cc .. ivII "reI'
~ Co<IU..,............. _
oojoinUl9 IoWn.
6. K mU~T aoe'm~ maintenance 01 oTol
7. It "'ul1 nol T.<I,iLl neTmol
! A..m.bf~
2 Ct;oo" .<1\ 10k. pl ec~ d ut ing 'ha !,e t\l il ion
~ 'W'I 1I'tIr d ox:idJOVl1O perma n"n! den' iti o n,
b'JO"1i >r"'''''~~
3, ~~
8 The .~cce ", a inta i,, " , <l1 ou ld"", ' ." " . '
the WOI 01 0",...- ",nc~on .

ItEMOVA8U SPACE MAllI'rAlII'ERS

.... ,
"Nd .... ....u.-.

,'H:)r>.I.ock"->I ,~
They OT. spcce mo,mo;""" which con be ,""""'"'II
ond <einse<led inro the 0'01 cavily by the JX>!>ent
~ &r !)'pO
~omO"Obk! rooce ""'intai""" con be <;III",fied
i 1 l.>orr tIPt
U$ fun Cti ona l o nd no n l un ctillno l spoc.
~i f",, ~ \)'1'"
<: P'l'IK!)'pI mointoin.". Fu ncl;ona l 'pa ce mainta ;ne"
'~~~!p i""o'po<o~ _n 10 aid io mosli,olion, speech
a..i ' ~$1t~""IIl"<l ' ond ~lhciCl whereas non -fu",,~onal ,poce

1 ""
FIoncvooio "IW<" ..........
oloyI" plOt. dookl'M
mo,n/o,ne" ho"", only an acrylic exlensioll " -
the od~nI~""" 0_ to prevenl .pace cbou,e.

Advan fat u 01 mo . .. blll . pace

sI,iII 01 onl(:fio" ,, ~'" piece. In co,," of 0,.",,,1,,,, m .. lnt.ln ...
10 .. 01 dec iduo us seccod mo lo,s, tft. fitst
L Th . y " " . o . y to cle an o "d pe ,m il
pe< n"O"eN moo-. "' '"'010 me. d fy +..reby 1oa;; ''9
ma'nto.roonce of p,ooe, oro l hvg iono.
'n.uflidenl .pa ce fo' th" c'~plin9 .e:o" d
2. They mo.Main 0' (e .lo,. Ine ~e(lieol
p'emoiors ,..k'-en can gel impoeted ",ithin il'e iow
(/;-'"n,"on.
or gel den.cted a~d erupl In on obno",ml
3. They con hi! wo,n po,1 ,im. ollow,ng
!oca~on 500ce mainlo~'" 0 ..... ce used CO
ei,eviollOtl 01!hot blood 10 the ,ofr ~Auas.
molnloln the 'p"oe "",,100 by the 0$' 01 0
4. They SOt"'" other imporlont lunchO,,", Ike
dec:1d~oullooth.
mos!,e(l! on, '$Iheto end phoneoics.
A 'p"ce moinlo' ne r Iho....ld l,,~ill iI'.e
5 Oo nte l ched< up 10' co rie' d eteClion I" bt
lo llowing reou;rcmcnt"
vnde rto ~e n oo, ily,
I . It .s/1ou 'd me'nto i" ti", e nii (e mes iod i, to l
 Roo m ~o n be mode fo r permo n. nt _ th to
orupl wil no ut cha ng ing tn o ~ p pl io n ~e .
T~ lIim.Aote e flJp'"", 01 p"'moM nl leeth.
8o~d (O"ltrud""" roo! _(lnOl)'.
lhey help in p<""en~ng d....... lopmem 01
tongue thrusl hab~ in!o!he "'1rOC1io~ IpOKe.
, ,
INudy."I.tu of 'emo~.b/. 'pIC.
Tney may be 1011 or b-oken by th e paTlont.
U""ooperct:. o paTients m c~ no! wea r the
apo lklnce.
lo1erol iew gn:>Wlh moybe 'eslric:led, ~ clasps
ore inc:.orporo1ed.
lher may couse irri1uToon 01 the underlying
oo!thU .....
Removo bl. "" nlures are ind ico t. d wne"
oellr.olks il of imporlonce
i. In COle the obulmenl """h <ofY'lCt suppo<1 0
Ii.ed oJ)Plionce ~ i<. recom"",roded 10 uMl 0
remO">Ob.ie space mointoine,.
l. In deh pokrte polienl'lwho requi~ obruro1lon
of lhe palo!ol deled.
In co.., tl\(! radiog ra ph revea ll thOT the
"""Ii
.I
uno<upled pe rmo """,t 'oolh i. not to
Of\Jpt in lo u Tn o n Ii mont". tim e , a
,~ movobl . !J)(lce mointo ine r co n be given.
5 litho p" rm(mcnt looM r """ oo!lulfy......,:>1ed
;1 moybe d.flic,,~ 10 oOOp! bonds. Thus ~ io
odvisable 10 use , e movoble spoce
mo;r::a,,,,,,.
6. Mulhole lots of ded duous leel!> which !T'OY
,equ; .... lunc:lio<"ol ~Ioce_ in the 101m of
e ither iX' ~iol or com p'e donluro.
Cont,.'nd'c"tlon . of remoy"b/e Irp8
of sp~c . ma/nlal"et$
1. lock of IX'Ii~M Co-opltro,""'.
2. In pore n's who ore oll~ry;c 10 acrylk
malI!rioll.
J. Ep;lepfc PC"ents who have unconll'Olied
seilU<es.
Some commo"'y us-d , ,,movable
.p~ce m.lnt.ln . ,.
Acyl.c P",lia! o..nlu,e. Acryl ic perTiol
deMur ... hove beton...sed <uCc~'<'ully ;n paliems
wno hove urde'90ne mulliplo e>:!mc1ions (fig 5).
1,.. opoliance ( On be readily odjuoter:110 ollow
!h" enrPllOn of~. The indusion of oo1mcial
'OOlh in !he den!u~ ,eolr:rtfl "",,,,,,,to"l functiotl.
CI",p' ccn be la bri cot.d o n doOduou. con inOI
ond mo k'" fc' ' OTcnt "", .
 B

fit 6 s-I ....,. loop '"""'" ... _ ..

Full or Complete d,mhm" , Som.limes oil into position wfoen ,he decKlUQIJS _and
1M porimoryteeil1 01 c pore.schooI cMd may req uire il bot .hort1v befo re th o ' f\J~tion 01 the
oxlroction due to ro mpO nt corles of Ie"'"
thot pen''fI(ment molar. Tr.. tooth to
c:omoI be - . d . Mhough .nil procedvro woo owoy from the stone model and a
mono common in ...... pno.fluoridorion ero. ~n cut into the stone model to allow the
todoy lome dlild,,,,, moy req uire ~omple'e 0/ the ooyIic "".osion. The acrylic will
e.troction of their dec Kluou, _~. These cese.
into the ofvoo!", aIIo, the ;,:;:::.~.:,:::
c re mooaged by"'" use of 0 complete denture. tooth. Th e ,,!(!nJion may""
The!.e de<1too"esnol ody resbre mGII~ fun.::tion eruption 01 the peffl'll""",tioolh .
ond estheli<;$, but 01<0 guide the Hrst permanent
moIors inlo the" coned position. The pos'erior flXEO SPACE MAJlltfAJlltERS
border o f the dint",. ""ould be plo~ed OYer tho
Oreo op porOXirnoting the me>ic l surice. 01 the Spec. mcirrloinell whkh oro fixed 0' I" ~' >~ ':
.,,-.erupted fi"t pelm o,..,nt II"clar. The denture
tr.. toeth ore ce ll ed lim.P'X" rnolnto in.....
-..;If hove to be odj",ted and 0 portion of it cut
owoy <1$ ' foe I)e'rnoncnt inr:i!.ors erupt, ond the
posterior bord., ~OrrlOll(ed to Guido the fi"t
poerm o n&nt mQ lolI into po . ition. When tM
perm cnent inOlOI"I ond fi"t poe'rnonenl mo""
hove erwted, 0 portIol d enture spo::A moincainer
con be lINd until ...... remaining permonentltHlth
''''pl.
R.movcbl, Dillol Shoe .poee Maintainer:
At-,'i m""""iolG' cerylic pO~io l denture with on
acrylic dislal Ih"" lOKIenlion ha. be..... u.ed
fig 7 &<.:I ond loop -"" _ ..... .
we<:es<fully to guide the S,-,I perrnooenl malor
Ad nt.'eI of fI" ..d sp.c
... Int.ln ....
I. Bonds and crown. ore ~ which ffICIuire
minimum Of notooth preparation.
2 Thor,. r;Io r>OI ;rueofere with pO$.$'" eruption 01
obutmem leeln.
3. JowgrowthiJ.nOl hJ mpered .
~. Thesuccedo neoo'pMn""""IlooIhcre free
to e"'pTinTctho o rol covily.
5. ~ Oln be vsM in UI'CO-open:rt~ paTienl!.
6. MostOOlIO<y fI..-.::~on .. ~1OrtId ~ panNa are
"O<Od
DI d ..... t..' .., of ""ed ,~C.
"""lIln
1. Elclx>roTo insr",menlotkm with exper1 !kill iJ.
...dod.
2- Th . y mol fewlt in decok ifocctlorl of TOOTh
ma t"nal unde,!he baM .
l. SVpro ...... plian 01 opp<><ing _h can IOke
ploce ~ ponlio are not.......:l.
Kpon!laore .....,d ~ Oln io """ "".with
vertical
oruption 01 I .... obutrMm looth ond moy
~m e",pI>odc/ ~bcr.g P"""CO .,1 teelh
if the potie~t fu il, I" r.pan.
Band and loop space maintainer : 80nd
aM loop space mointoine", ore 0"'" of rhe mOil
common SpeKe >mrolling ooplienee> VlfItd in
denlOl proc~c". The tooth dis",1 to the""">CIlorl
space i!. bonded and 0 loop c! Iho, Itoinleloil
""",I wire II scHde,od to it with ilS mes10 1 end
toochi"ll tke tooth mu icl to The "'Irodio n space
(fig 6 .\ 71. It Is 0 unil otero l fixed appliance
in:Jicoted fo< space moinle,..;mce in !he poslafior
""9rMnh when a .Inglo toorh ;,Iost.
Crown and loop opplionce , Crown ond
loop oppllo",u 0'. <lm~or to baM OM loop
spoco moinlai ..... in 011 respe<;b en:.pt thot 0
.to irl .... sloe! c;rown is used fo,the <>b...tmonIlocfh.
The crown il used in p rof. renee to the bond whe<'I
tM obutmont tooth i. hi g hly ca rio u., hi bit,
mo.ted nypaplo.io Ofi, pu lpotomized.
rhe I;nguol orch 'poce mo;ntoine.: The
lingual orch iI the mO>! eI'fec1j..., oppt.,,,,o fat
spaco moin!enonce In Ihe lowe. ord>. The
<1o.<l0l1 mondibulor lingual orch 'OI'distl alrwo
bonm (_led on the fir!! permonen! rN>Ioft Or
on tM ""ond de<;iduovs rrroIc ... ~ 0'" foir>ed
by a <\o inl .., ,tM I wire contocting the ling oo l
.unoce of the foor mat"J<fibu lo< inc~o" [fig 8.0).
The oppl i"""" i, u'va lly in dicat. d to p<e"' "," tM
"PO'''' created by rmffip " lo" of p<ima')' molars.
II oo lp' in maintaining too arch peri rooter by
pmvcntin g bo, h me~o l drittin g of tho mo",rs ond
a lso ling ual co ll ap,,, of the a nlerior teeth.
PaJalal arch appliance,' Thoy arc , imilor
to too ling",, 1 orch de,cribed abo~a. Pa latal
arche, or. de>igned to prevent m . ~o l migration
of the ma.;:!a ')' rrdars. They are conotruc\ed "sing
0.036 inc h d",met", hord .m in .." '~~::;,:.:;:I
Nance hold ing arch i. a maxilla ')' I
that d"", not conlact tho ante rior teeth.
op>,"o, iroote. th e a nterior pa late [fog S.b).
incorporate. an a c')'li c button in the anterior
region that oonloo. too palatal tissue.
Tronspa iotoi arch More rec e nt ly, the
tran"PO latol arch has been recommended foI
stobilil inQ the maxi lla')' fi",t perman ent mo lo",
wh en the primary mo la ", re quire extraction
[fig 9).100 tro'lSpalale l ~rch con~,l$ of a thid;
stain le .. , teo l wire thot spon. the p<l lote
conMCting the lir51 perma nent molar of one .ide
I'>ith the other. The best i""ketion for tro nopo lotol
arch ~ when one "de of the erch i$ intaot, or.d
>e"erol primlJC( todh on t"" other ~oo are missing.
Disto ,' shoe 'pace maintoin er Di, tol "'''''
"PPI",nce i$ath. ""ise kr>O'Wf1 0$ the intro-cOiedor
"PP1"""e [I1 Q10). The di.to l.....rtoce oltha second
primory molor guid the unerupted first
permo ne nt molar. When th o ' ""ond primo')'
molar i, removed prior to th e e ruption of the fi rst
permanent mo lar, the inlro_oOieolar applianoe
pro'IKJe, greater contr" of the poth of e<uption of
the unerupted tooth ond prevent, und e' ira ble
me, io l migration. The opp lioncc which is " sed
in practic~ now i. Roche', disto l ,hoe or it,
f"IOdi~cotiolU u.. ng croom 000 bond oppl;onces
wilh 0 d~tal iotr<)'g ingr.o l e,ten sion.
fJ ln..1ic ontarlor .pace maini oiner. II
-0$ de.cribed by Slelfion. Miller and John ..... in
1971 . Its metnod ci tonsln.dion i,,' mple 000
elsa pt<>"<MI,." on MII>ctic component . The spoce
moinlc in er con";li"! ci a pI",tic tooth li.<ed onlo "
......
1ing",,1orch which, in tu rn , is otlc ched 10 mo lor
Sand and Bar i")Ipe space mamlainer ,
This is a ~...d space moin!oinf!t in which the
abutm""t leeth on eitne r side 01 !he troclion
tpCu arc bon ded and connected to eoch o th er
by a bor (~g II . 01 . Altema~ ""lv 'lOinleu"~
r;ro..ns am be voed on the abutments. Thi'trPe
ci space moinloiner is colledcroom tn:I barspooo
mo inta in er (f>g n.b).
PLANNING FOR SPACE MAINTANANCE
The following foQon:.ho..Ad be considorod when
'9Oce moinkli ...... is ploone<! lollowing the e<lrIy
..... of p<imoyte<lth.
I. Time elapsed since fa" of loom : It i ,
UllJallyad.iscJble 10 ploce" space moiolOirer",
lOOn a. the primary toe'" ""' """oved. Stud...
;.-.Iicet. thot Ih e ,.,..".imum loss 01 spoc. occurs
withir1 6 nx><1th. 01""trodion of the teeth. It would
be a good ideo to labtica1e the appliance prior
ro e<lmo:tion of Ihe primory toolh arod in...., the',
appliance won "'* the droction.
2. Dan lal og e a lIne pa ti ent : Th. de ntol
<>g" 01 th e poti . nl ohovld " Iways be c"".id. r..d
roltlerlhon the d..-onoi<>gioJl age. This i. beco ......
too m..och V<riJ6on In eruption ci teeth .. observed.
h I, ,""uolly obseroed Ihot the pMmOnem reeth
.,upt once 3/. 1h of their root developmen' is
co mp lete. Thi. c,ilorio con be ",ed to prcdkt th e
oge ci .... p!k>n of th" permonent teeth.
Early I"" citeem con ClIU$8 " delay io
.rvpfion oJ the successor. For """mple eorfy loss
of me d ecid""", molo'l belore 7)'M1rs of 09"
re. ull. i ~ a deloy in .rupli o n 01 Ih e p remolor.
3. Thickne.. 01 bo"" covotlng Ine
""""'*O '-lit: The mOre the bone coYering
m. unerupted iooIh, the more.....,..,ld be the lim"
it .. ovid tok~ to .rupt, orod ther.lore .poee
mo inlono nce i. i!~ i col.d. Norm a lly pre""," ""
loke 4 5 """,tlti 10 o",pt t+, roogh 0 bone 01 I
mm.
4 . St,q"" nc~ 01 ecuplirn 01 ~jh Wh . n .Y~ r
a >po ee maintain e r i, pla nn e d, a dequate
consid. rati on shovkJ 00 given to 100 a diCc""t
developi ng ond ""-'PIing toeth. The "'!i~ting
dentition ca n g reo tfy influe "". tho cb , ure 01 tho
extr<>dion spoc . Forc.xompc ~ the ded~,,"
,econd mo ",r i, lo,t ea rly, we ,hou ld study the
de"eJoprn ent ci the perm"""nt """"d rnoklro nd
the . ucc . .. o ry "",DOd premolar. In co,. too
,,,,<x,d mo", r i$a heod 01 the =cod pre molorin
it, e ruptiOf1, it i. likel y to exert a me, iol fOfce 00
the first moklr which con move me'ic lly. Thi, rooy
relIJ lt in irlS"#icierl \pIXe for the oecond premokl r.
5. Co ngenita l a b,ence of permonent
IooIh , ~ perm ,,"",nt teeth arc cooge nita lfr m '~ n g,
Ihe denti,t ,hou ld doc<J" il he is go ing to reta in
lh. 'poee until a repklc"", ent , an be givM or
ol low the othe r " rupti,... teet h to drih and cia,"
the .poce.

 Interceptive Orthodontics
T hereore 0 num bercl prooodure. thclccn
be undertaken by the or1hodotl~sI, 10 01
to inte,~ept " malocclusion thO)! i
deve loping . Unlike pre"entive orthodon!\c
ptI::I<:Iod"",,1hct ~ a imed at elim iMlion 01 lOde"
lhat may lead to malocclusion, inlercepw.e
OIIhodontlc:s I, ......derloken 01 a fi"", ...... n the
mclocclu l lo n ho. o lrlody developild or i.
deve loping, Thu. interce pTive orthodonti<s
bosirnl y m/e" 10 rreasu"," ~ 10 pravenI
o ~iol molco:lu.ion I.om pt09f<I$li"ll irtlQo
more _ I l l one.
The !tim" p" ...,..Uiw! ond intoo"?'!''''''
OO'Ihodonlia ore oometi.... used ..,.,onymou~
But ~ should be UMetl!ood th<>l ~ .... entiVe
OItr.odonJi~ E!!X=ed ....... ~un<ieflake n whfrn the
_Idol and oo::Iusion ore perlodly nomd, ..... i'"
!he i~ pnxedura are carriood out when
!he ''9'" end symptom. 01 0 rnolood",ion h.....
- -~
Qj)peC~, Som e dIke proced ures co rried 001 in
pnrm"tNe olthodonfia can also be <;Qmed oul
......
in inten:epllYo orthodonlics bullhe ffmi"lls ore
Inte reG pl; ". orthodon tics ho. been
de~ned o. thot phOM of the sdeno;o end Qrt of
orthodontia .~IO reo;Qg.'Iire end .rminote
~I.n!iol irrog"kl riti ., ofld molposi#on. 01 th e
deW!lopir.g donto -.,C;01comp lex.
The ~ underto""" in inleoa.pli..
orthodontics inc:ludo. :
' I Se<ial extraction
2. Con-oclion of developing cr=bi!e
3. Control oIobnonncli hobil$
I ~. Space regoinin-g
S. Mvsde e.>:ercisc,
6. Inllneprion "'. keletol rnolrekrtiotl
7. RemoYOl 01 oofr tiswe or bony borrier to
.,.,ob~ eru ption 01 teeth
 SEltlAL UTltACnON

SeMol e.<lrodion i. on inte rc<!ptiWl oflhodontic Indlc e ll on.

p roced ~re u. uo ll, initiot..d in The oKl rl, mi.. d Serio l $l<I'I'O::tioo is ind>::aled in the foi loYoing co_
denTiTion wh en ooe con recog r"li,. end o nti~ iO<l'" l . C ia ," I mc lcodu . io n . nowing hgrmo,",
pooler'l'"lC l irregoJorities in the cIonte fodo l CC<"r1 p1e. be_ skeie!a i and museu io, S)'SIIm.
ond il ~00y1ed by 0 proce<lut1t rIxIt inch.od the 2. MhIe!1g.h tle~cien<y os ~ompoore<l to_
olon* to<!tOdion 01 """"'in dec io;!lJOIil ,NIh ond ,ocIh m<>'eriai is the mosI impar1cntind~
Ioter .pecl~c permanent teeth in on ord.".ly
sequence ond pre-d""""'inecl ponem 10 guide
lor serIol e>dIOChon. Ardr "",m, d,',,_.
is indiOlled by the ~ of ono o r _
the e"'P'!1g pem1CI r. "" teeIh inlOo '""'" ~bIe <Ji m, lol"""ng koatvres:
politioo. o . AI>sr.c, of ~h \'S iolog i c fjXl cing
b. Unilatera l or bilate ra l promotu ro
Hillo ry
dec iduous ca nin ";th mid line , hilt
~ ;e l lgren in 1929 u,ed the t. rm 5e'I'<>1~'''Q~tion c. """lporiI ~ion ed or impedcO loterol incison
to describe 0 procedure whl!<ll some deddvou< !hot erupt palatonl' out 01 the orch
IeeIh IoIIcwer::I by perm,,,,,,, teeth wer'l!Jdroclt>d d. Morkedly l""IIula, or CIOWded uppe' and
\
10 guide !he reo! 0I1rle iee1h into normal occlusion. lowe, onleriM
None, during th~ 1940's populoriled mi, . Local,zed gingival re"", ..ion in the 10'Wt0'
techniq<ll in th. Unilr::d Sto leS 01 Americo and anterior region i. a coor'oderi.ti~ feollr~ cI
t.".,., od it ,.o nned '" prog reu i..... e.ohoct;on'. Hotz or"" 1<If\glh defi ciency
in 1970 ca ll e d ' uen a proced ure activ e f. EClOpic . rupti on of teeth
ou ,:>e "'ili c n of teoth by e>trocti on. g. 1vIes",1migrction ci bucca l legmen,
n. l\b.-.ao-maleflJPtion pollo m &. sequence
Retlonele
I. L_,om";o.Rc.ing
Seriol e>droction is bo<ed on two boo", principia. I. Al>kylo ... of ooe or mare INIh
Arch length - loolh male riol dose,.paney: 3. Wh ...... grovoth iJ '""" e nough 10 o.et co"",
Whe_ ther. is on e><au of tooIh mottuiol a , the dlwepancy berw.:en IOOth material ond
compared 10 the a d , length, ~ is ad-isoble ", basal ben.
reduce the i0oi+1 "",-em l in arderlO "", ... . lO ble 4. PoTien .. ";111 lI,eig h, profi lo arid pleasing
rO.ultl. Thi l principle i. utilized in ... ri ol e,troctioo "" peo '" f'IGG
proced ure. whe r. tooth mote-riCll iJ reduced by
Con tr. lndlu t lon. of se,,,.1 . "" . ctIOd
",lac,"", eotroc~on 01teeth.., thor the rest 01 th.
'ee,h con be guided to normol occJusion.
ScVd e>i.WJd ....... '"' wntro~nd"taIlod In r'OJmber
of condiriotl$"";"ir;h indude :
Physlologle roolh mo;'-.men! , Human
o. Clan II &. III malocclusion with .kele",1
denlolion shows a pn,..ialogic. ~ncv to move
abnol'ft'Cll ......
low<I,dJ an e"',oc~on spoce. Thul by "'Iect.....
b . Spaced dentition
refTlO'o'Cl of $O rne teeth tt,.
rest of the teeth whid1
c. Anodon,", /oHg-oOOntio
c in the p-roco" of e fIJpti on or. guided by th e

d. Ope<> bile ond deep bile
I!. Midll .... diostemo
to" .. I molexciu';oc . wilh mi nim,, 1 .poce
d.fideo"l<;y
g. Urervpled mo llofmed tee!h e.g. d iloceroli o o
h. Exl,n,lv, co ri or heavily lilled lil"ll
pennanen! mol....
Mild di.proporlion b.rtween archl.ngth ond
rOOIh fI'OIeriollh.- can be I<oJaIed ~ proIimol
stripping
Advlnfl,,, "f urlll exltletlan
SeMI . "'rocli o n corried out duri ng Ike mi.ed
dentlli o n and ea rly permo ne nt de nli"'" pel'"".
foes 0 nymber 0 1 "tMlntog ... :
c.. TrClOlment is mot!! ~ogk a. ~ I....,""'.
guidance of teeth inta normol posttions
moldng use oIlhe physiologic /arteS.
t>. P,ychological Troumo o1$odoled ..-ilh
moloc;dulion Can be (rOided b-,. trOO!mon!
01 Ir.e ma locclus ion 01o n ""rty age,
" II e llminale. o r reduce. Ir.e du rali o n 0 1
""-"tibonded I~ lreolmMI.
Ii Better oral h ygiene i. pOllible thereby
red\ICing the risk of carie .
I!. Health of in.en"llli.. ue. il po .... ",ed.
t l .... relenlion period is indicated at the
ccrnple!lon 01 tr-""n!.
g. Mart lIoble ~ .... fb me """ieved OS tho IOO!h
"",1"""" "n d arm lenglh are in he rmon y.
Oludvlnt. ,.. 01 terlal utrae!lon
G. Serialextraction requi .... dinio:Jl jcod(/l':'Mnl.
There il no linlil. opproach that oon be
uniYersolly applied ta oil pollenI'! . foch
patienl has 10 be ~ ond a ... iloble
ilJ<t<OCI>cn limo table plonn&<!.
b. Trealmenl li me i. prolong ed o. tho treat",",,1
il oo rrled ovt in stagas IP"!"d over 23 yeo r.
e. It req ui re, lhe flOlienl 10 . isit Ihe dentist ofte n.
,
Thul patienl co,opemlion is.......oed.
d. AI e.droCl;.,n .poell Qr. r:reoTed that close
g/oduQ IIy. thl potie nt he>< a lendo""" of
d e""lop ln g lOng u. Ihru.1
e E"" odio n o f th e bvcca l I""th co n ",. ull in
deepening ol th l bit..
f. If Ihe po:edytelo~ not oorried ovtproperly
Ihn II 0 risk of 0'Ch Iengrh redr.ci->g ~ """,iol
migra!'on 01 the b\lCCOl segrr..-.t. Th ... a
pac:rl,o..ecvled ,...;ol .... rodion PIOIIromrne
ron be worse Ihon "one at 011.
g. Di!chir>g 0< ~oee co n e, il l belwee n the
con in e on d nco OO pre molar
h. The O><bI""' inalion "Ilee'!- al *'"
I<o:ml nalio n
01II-.. serial e>drOdion pr<;>ce<lure mov ~yi",
eotnIClion . Thi. n.. ce .. i!oleS .hort Ie"'" fUoed
aoplionce therooy.
DI",nn. lI~ p'KfllufI
The diognm/ic OlOorI:ise prior 10 IrOO!Ment should
i ~ compreher'lli.e o""" menl 01 the cIer1lO l,
$kelelo l 000 soft tiU\ie$ . A tooth "","" iol. "rc h
le nglh d iw-e""o"I<;y mulT id"" ll y e>.i ll . kcord lr-.g
ta most ovthOf$, <;tn orcn length defi.:;iency 01 not
len Ihon 5 . 7 mm 'hould exist ta undenako this
procedure. Snxly model o""lyoio should be
corried out to determine th" orch length
di1Creponcy. Corey', onalyoi< in the lower orch
o nd o!'Ch perimellr ooolysi. in tho UPPlf orch
. hould be ,Qtried ""I. Mi,. d d"", tllio n o nolysis
he lps in dete ,mini r\9 Ike . pace req ui,OO for Ih e
e rupling b\lCCOl tOOlh. Tho, e ",pli o n .toN. of ~1O
dentition is evoloo!ed from on O.P.G.
Th. I~elela! ~.. ue o ...... ment l hovld
inyolye comprehensive c e phalomet riC
e>omination to !Iud.,. the underlying ,kolotlol
",lotion. !.ericl &J4tOCfion pmJvces the best ....,h,
in 0 CIo" I.,kelolal palrtm. P,."M ce olo a~1
II 0< <;I C lou III . ke l" IOI poll e rn ore
conlroin tlc"li o n. fo r serio l ""'mction procedvre.
 Ie-
\D I,
,"- {)
y
1

G te.
V

c D
""".J", '"S1tp01oa...".,11
f"~ I Dowel', ~ oi _ - , 1 . . - W !.Iop ."... - " ......... 01 ....,... .. , ' ....... 10 """Ie
oj .... I~. (B'i ho ' - . _ _ 01 doc.J.ou,I .., ...ob, 10 _ _ a ...... u._ cl fV.o ","""""".JCj _ .
_ .. 01 .... ..... "'" \ ... ....-do.,. "' . ........ pot""" .... ""'"_ ......,.. IDi!,o;.! ",.""",,, ~
 ~ ,

A B

F.; 2 T_.,...,.i-Iod 01.., .. ",~ocl ,," ~\ S'op 0"" . ' ''me;''', 0' "",'''''00,' ' Im,-.olo. iBl .IIop two . ""'OC'"," of
_ ""'" ,or.... ..." f..,~,
Th . ,olt ti"ue ossessment by dini<:ol .poce for the olignment 01 the ir>Cirors. Th is S"'P
~m i Mtion and cepho logra m, he lp in the i, ~m.,.ied 001 ot 89 Y""' '' of o[/" . A yeo, lotef, th~
diag no sis . Ser ia l c,tr()oti on i, gene ro il y deciduous Ii ,,! mo lo... ore erirocled .0 tho! the
.....Jerlok. n in poti onJ> e<h ibiti ng h(lrmoniov< .oft eruption of fi ~t premo )" " is occe le roted. Th ;. i.
Issue pottem. fol lowed by the ".traction of the . ",pling fi rst
p:emdOr> to p".,.,., itthe pem'<lnentconrn lo erupl
~,a" edure
in th eir place.
Anumbe, of method. or "'que",," of exlroction In .ome ca,e. 0 mod ified Dewe l' ,
~ beM d~ ,cri b" d, Three of th e popular techn iqvo i, fo llowed wherein the fir$t pre molors
aelhods ore: ore en udeoded ot th" time of e.troction of the
f", t dOOdoou. mo""". Th ~ i, freq ue ntf,< MC~''''i)'
D~wel ',method

Twoed... method
Nance metOOd
in the moooibu lar arch where th., con in". otten
enJpt before th., fir$! pr~ moIo".
Tweed' , method Thi. method invo lve. the
1'.Iewe1', method Dewe l 00. proposed a 3 e' trocti on 0/ the decidUOV$ fi"t moIors oround 8
".,., ... rio l edroction pr<Xedur~ (fig 1). 111 th e first yeo rs of age. Thi' i. fo l ~ by th., e>ctrodion of
R? the deciduous <:I:m i"". ore e<troded 10 creot. the first premolors ond the deci d uous can ine,

23 1
F'J 3 InlM.,l oo of <x>1Cri{)( "o"b...
" ",," t .... "" "''''0. T,,, a )'0<>"
01d "",,,,,,, wo' "."\oJ b'" 2!~
oppI """, 'oot 'i'l a'ld (tl;, ",,,,,,,,,.,,...,
pho'~, (q 0"," :0: ~o""
~.," "ro lio "", ).
IF! ooJ IG) """
-'eo'''' ''! """""copho,
sim u l ~ neou.ly (fi g 2).
No n c~ melhod , This il li r,,; I~ r to the lweed's
techn iq ue a nd involve. the " , tracti o n 01 th o
ded duo u. n"t mo lo" foll owed by th e ex/roction
01the li"t prM-d o r, and the decidvoul con ine, .
Po. t 18" 111 ex tractIon f lxlld t h erapy
Mo.t eo.e. of . e riol extraction n. ed iixe d
op plio "". th" ropy fo r th" co rrection of o' io l
ind ir"lOtion ond deto il ing of the occ lusion
DEVEL OPING A NTERIOR CROSSa/TE
Anterior Cfm ,t, ite i." conditi o n cf.o rocteri'Od bl
le\'er:!e Oyeriet where in one or mo re mo, ill ory
c nte rior teeth a re in li ng uol rolotio n to th"
"", nd ibu" r tMth.
h1terior=.. bite, sho ukJ be interc"l'!ed
ami treated ot a n early . tag e .o '" to preven t 0
minor orthod ontic problem from prog re .. i,.,. into
a lOO f:>rderto-Iada l a noroof(. M old orthod C<"l!ic
""" im .mt The be, t ti me to treat 0 ("",t,ite i.
!he first time it is . eer> ."
M terior crossb'te .houkJ be treated "" rly
Ior th e l~ l owi n g rea"",. :
o. Thi' type 01 molOGdu sion is ",If' perpetuati ng
i. e. il the ero .. bite i. pre ,"nt in the decid lJOOJ <
dentiti o n, it lOOy ma nile,t in th" mixed ond
pe rmo ne<>t dontition a. we ll.
b. Simple oote-rior ero .. bile< thot a re not lre<>ted
"" rly hove the pote nt ia l 01 g ro wi ng into
. l el eto l mo lo ce lu. io n that lo te r need
cornp I Gated 0 rthodontk trootme!1t co mbined,
at time" with ,u rgica l procedu re.,
Ante rio r ero" bite. ca n broa dly M
d onified ", .
o. Dentoolveo lar ontorio r cro" bites
b. Sk ~ e tol antefior ( ",,,bit.
c. Functio nol o nt..,.;oc " ",. bite,
De nto . o ln olor o nte riof c roB bile ,
Mte<ior , ro .. bite in which 000 or more maxilla ry
an te rio r teeth o re in lin gua l ft lotion to the
mand ibula r anterior> i, tefmed de ntoowe lolo r
ont. rio r , ,,,,,bite. Thi. kind 0/ o nterior ( ",,,bile
i. often man if." ted o. , i,.,. le !oCth ero.$b ite a nd
v. uolf( OCCVf$ d ue to ove r. reto ined decid uou s
teeth th ot dellett the erupting pem" "'...., t. eth inlQ
a po'crto l po. ition . The .. dentoa fveolcr crossbiles
, on b.. effeclively treated u. i,.,. to ngue bled es,
Cotolon'. o ppl"'rKe and dooble 'ontikwcf spring .
with po. terior bite plate (Refer chaptef 34 ).
functio nal on te rio! cra"bite , So me ante rio r
OfOSl bite' 0'" refe rred to '" lun cliona l "'0"
bite. Th ~ type 01=bite is tr.. so ,oiled poevdo
Cia .. III ma locd v.ion wh crt! th o mo nd ibr.. i,
co mpelled to close in 0 po. ition lorward 01 it.
true centric relation . FUr>diono l ero .. bite, occu r
o. a resu lt of ocull.l$O l pre maturitie, th ot co u.e a
defie<;lion 01 the mand ible into 0 fc.rw<lrd position
d urin g , Io. ure . The, . a re to be trt!o ted by
e li mino>i"ll the ocd vso l p",,"otuMtie .
Skeletal anterior
c ro"b ite . o r. usua ll y a r uit of sl e leto l
dis<reper.:ie. in [TOWIh 0/ maxilo or ..... mandi ble.
Anterio r ero"b ite, Con be a r. ,ult 01 maxillory
. ke leto l , etrog no t hi, m 0( hJ' Pop lo sia o r
ma ndi bu lar prognathi. m. Th 0 ," be,t treated
d uring ~"'wth by growth modifkati on proced u",.
b)' Ule 01 myolu r>dOno I ororthopoedic opplionc",
INTERCEPTION Of HABITS
Ho bi!> in the orthodonti c .., n", refer to , ertoin
a cti on . involving the teeth o nd other o rol or
perio ra l ,trveturc , whic h a re ",peoted often
enoug h by some potierns to hove profound 0"'"
deloteriou, effect on the po, iti o ns 01 teeth end
oce lu. ;on. So me 01tile ho~" thot con alleet the
ora l . trvcture< o r~ thumb sv cking, tongu e
thrusting and mouth breathin g.
Tlrumb suck/nt
One of th e hobits th", is most frequeotly practiced
by ch il dr .n ond is capable of p roduC in g
"""""il i,.. efIocts "'" the ';"nto_al""oIor 1trvclutes
i, the thumb suckin g hobit. Th. presenoe of thi ,
ho bit upto 2 III _ 3 yM" of oga is c"",>d.red
qu ite r<>rma l. Persi,te<>:e of this hob't beyond 3
In 4 yeo ... of ag o Lon haye 0 darooging
infl uence on the dento-or.eoIor struoture' and
shovld hence be intercepted (Rofer Lhape r 9).
Thvmb ".od,ing i. intercepted by use of hab't
breaker.; tr.at cO<Jld be of rema~able typo or one
that is fixoo (fig 4).
Tontue tlrrust
Ta,..ve thru>! i, defin ed os 0 co ndition in whOoh
th o Iongoe mo kes co ntact with any tooth o nterio r
to the mola " during ,wa llowi ng. Th i. i. a
deleter.ovs hobit tllOt LO n clinically present with
open bite and anle<ior prodinotion.
The ton gue thru.t habit shou ld be
intercepted by u,;"9 hobit brook.r.;. The potic nt
shovld be tro in ed and ed ucated on the cor",d
tech nique of .wo ll owing
M outlr breI/tiline
Mouth breath ing hobit ""s a profound elf""
on the dento _fo eio l reg ion . It Can be ob<trUC!;'"
or ha bitua l in nature. Ob.trvot i~e mo uth
breothing i, v. uolly a r~.ult of nasa l ob,truction
such o. nasa l polyps, "",sa l turnc."S, chronic no""
inflam ma tory oonditi on. arn! d ~via t.d na ",1
septum. Habih.oa l moulh breotf>ing i, ""'. whe",
ora l breathing peroi"'" DO a hobit ofi~rthe removo!
of th . no,o l obstruction .
Mouth breathing affects th e o ro-fociol
equi librium due to lowe red mand ibular aod
tor1gu~ "",tu re and Can lherefo", prodc.oce sev.'"
moloc:dvsion.
Int. rceptiv. proced ure, .hou ld invo"e
identification and ...",..".,.a ci the cause. Pe<.i>lera
of hob'tuol oral brM thing i. an indication to use
a ve.tibu lar scre~ n to intero'>f)t lhe ""b it
SPACE REGA.INING
If 0 P!i,:,:,;ory mol~r i. lost early and 'p<lce
m<l i ~lo i ........ orc not ".ed. 0 r~uoti o n in orch
~ ~y mesiol mO'lOO1ent of the firs! molo r can
be expeoted . In .uoh polient. th e .po<:e 10.1 by
"""liel !!!QYM,Mt of the mQ lqr can be rega ined
by di,tal roo,.ement of the first molar.
 A

Not a ll potient. who My" lost orch at on oorly <>go prk>c to the .ruptio<1 of t\.., ~
le ngth by mesia l mo lor ""'",me nt ore ideol malo ,. Th. fo llo wing a re <em e of th~ commor>ly
ca nd idot. , lo r . poc e regaini ng. Th e .poco used .p<lOe ~o i n . ".
"'[rl ining procedure, a re p~robly unde rtokM
i'* _
Gerber 'p.ee regalner
A seo ml"" o rtnooonti c bond or 0 crown"
,elected for the Iooth to be disto lized . Tni pace
regOin" r eon.ist. 01 a 'U shaped hollow tub ing
ond a 'U ' .hoped rod thot e nt. " the tu bin g. The
tube i. ,oIde red orwe ld..d on the me.iol Q.f>OCt
01 the li" t rnoIor to be mov~d di.tolfy. TM 'U'
shaped wi re or rod is fitted into the ' ube, in , ueh
c.woy tho' the bos" of the ' U' ,00 conta cts ' M
tooth me.ia l to th e edentul au. Qre<J. Of>On coi l
.pring. of r;.deq""te IMgth are placed around
the f,ee ..-d. 01 tne 'U' ..ho ped rod ond iN~ rted
into tr.e tubing ossembfy. The lore"" generated by
th&COmpr8SsOO open coil ", ring. bring about 0
di.to l mo"m",,' ofthe firs! molar.
SpIce re,alners using Jack screw.
Spocco regoining co~ be r.rovght about u>ir.g j",k
!<:roW' placed in weh c way ,hat an i ~\Cf~'" in
oren ~~i s_o btoi nedj)y_d 'ltQlilOtion 01 ,he
!!!S!lw-,The opplklnce con~ 't' 01 a ", lit ac~ic
pklte with a jackscrew in relation to tho edentJ ous
'pace cOO i. rctcined using Adorn's do<ps.
Space reltalnlnlt u51nlt cantilever Iprlng
The molar con be di.taliz~d to regc in .pace by
using ",meoble opplklrxcs ' hot irlCo rporn te
' impl e fing er sp ring$.
MUSCLE EXERCISES
The dentol tis""" are blankctOO from 011 direction>
by muscles. Normol occ lusol developmen t
depends upon the pre ... rtee 01 '""""'01 oro lac;o l
mu.dc /u~ction Mu sc le exe rcises he lp in
im provin g aberrant m",de funck."
EJ(erclse for the matlerer mUIele
An exerose to .rrengthe n the mo "ete r musd e
involve, the de n( hing 01 !eeth by the poti.nt while
oountin g ' 0 ten. The poti en' i. c,xed to "' ~
tn;, for .ome duration of ' ime .
Eurclse for the lips (clrcum.orel
mUlelas)
A numbe r of exe rc/ . " , hc" bee~ ,",,,,.dI,. '
T.... li p oM 01-": mu ",Ie .
a. Stretch in g of 100 upper li p to
"",I I ,;,~:~::,;~::::;':: I:~'~:::::
i. an
potients hovin g ",crt hypotonic lip~.
in tM , tretchin g. the poti cnt i. o,~ed to hoI<l
o pioce of pape r between the lip .
b Pati""t< Om be o, ked to strekh the upf>O' lip
in a downwo,d di rection tOW<l rd . th e chin.
o. Hoking and pumping ofwater I;.;.;k 000 Jonj,
be hi"" the lips.
d Mo<;.og ing of the lips.
e. &!ttonpull excrd ,e : Aoo"onor ll t2 ind>
diometer is token and a thread pos~
through the bvtton Ix>e . The patient;' asked
to piece the button beh in d ,h. li ps ond puB
th e threa d, whil e "" tricti"ll it from being
pu lled ou t by "'ing li p prew)(e.
/. Tug of war .'.,.-oi", : Th;, is , imilor to the
betton pull exo r~ise. Tni, involVe< u' . of two
beffon>, with "'.. pbced behm tile li p> wh ile
th o oIOOr bvffon is ","d by oooth.r person to
pull the tn reexL
Exercises for the tongue
One elastic .wo llow Hi . exe ro i,e i, u,ed
for c",reetion 01 impro per po,itionin~ of the
tong u . A 5/ 16 in ch intraoro l e klsti( is placed
on the tip 01 the tong "" and tho pati ent i. c,xed
to roi se the tong ue ond hold the elo, tio ogcin ,t
th o ruga e area and , wallow.
Tongue "ok! ~x...-ci' e : A 5/ 16 il"lCh . Iastic is
po, itioned oer th e ' ortg ue in a desigootcd 'POI
foro pn:",ri ~ pe<iod of ti me with the li ps dosed .
The potient is then o,ked to , wallow with ela>tio
 ''' T ~R CE,.nON OF SIIUETAL
MALRELATIONS

-_.
Ske~elo lmalocc lu sion if dic>gno>ed at on eorly
" oge co n be i nt"~~ 10 o. kl red uce th e severity
of the molocdu~Oo" thOl ""'l' occur. Tf>ese growth
modvlotion pnxeclul'e$ ore aimed m normo1izi"l:l
....... D.
the >bIelal ,e lotion';'i".
~-

--" 0_-
,oIrDQO ......
lll'.te. p tlo/! at C'a .. /I ",,,'ocelll,IoR.
~nfoln&I~, d05' II $hI,klfmcleod...."'" <1:Iwllvoccurso, ,,
re, ult 0 1 eitner ... ce!l ive maxil lary g rowTh,
1I'0\<f! "",,, ~1IdOnr 10
1W1i<:! f1'~ xl!a'y I '~" defi o..f'oCy in mond ibulor grooM" oro combi ne!.,.,
of both. ",",'i llo"" grOWlh (o n be ,,,,trioled by " $0
d boo, bo..,..it1 fIoodgoeor. elms limolocd"""'"
due 10 dejicient monc:libulor II..-th .. u_lIy
Ireo!cd by mp/urdionol opplionces.
In te, ceptloll o r eln. 11/ m .. l...,c l.... ,oII.

Cia .. III malocclusion oa:u ... as " resul! 01

StaoIrJj Qus I I ~~ I' ma nd ibulor prognotn ism, ma xilia ry reTro
_UO pI"""" .w"r,
groo'IO gna nthi$ m or a co mbination of both. Ch in cup
"'~ I", '"'" f..,. """" !':+IIIPI'
\li,*~ \'oit" hood g.ea r helps in ",.Iric~o n 01 mar>dibu klr
growth ..ni~ FR III orfoce mesic thernpy is used
k:o- co,.,. 01 m(Jl6l1ory dejicifn<:y.
SIIIIIa' CltSlIII
_DO

--
"UIWy
M<91111Mo ..,
REMOVAl OF SOFT TlSSVE ANO BONY
BARR IERS

WIle""""" 0 pcm10ne<1t toot!, f"i's to ft nJpI 01

... ploce orld lip' O~".
J..o e!a~lic ."",11ow ; Two 5/16 j""h elosHe.
"'" ploced O'I'er ,he k:ngue, one in the mkl!l""
end the 0Ih.. on the tip and II-. patient is asked
II> .....,11"", with the ~Iasha in pOoilion .
The 00Id puI! e-osc : Th .. lip of the tong~\!
and the midpo int ,,'" mod~ to c""Io <;l the poloTe
and Th e mand ible i, groouo ll y ope ned. This
oen:ise helps in . tret<;hir>g the li "!!,,,,1frenum.
appropriate time, il1 o'uption may ~ stimuloto-d
by wrg ica lfy ei<pOSing Ihe crown. o,...-relO in o-d
me
primory I""th, onkyloso-d primary leelh anc:l
wpemvme-rory teeth Ore oil'- pc=ible <:DUOOt of
non-eruplion 0/ .. cadcneous!edl>. whid>""""1d
~ rulod out prior to this pnxe<iu",.
The "''11"",1 ptI)<:'Idu ... ;"""'_ eocition
of the solr !il1Uf! and "lmo",,! of o ny bone
",",rlying Ille crown of the une nJpto-d tooIh. Tile
extent of timlt! remova l shou ld ~ such thot the
gmates! d",meler of tf-.e crown of If-.e tooTh ..
e,poosed . In othe r words th e Iv rll~ l ly ;"ooted
OJ)ening in tt..!iuve i Iign~, lo~er !loa n me
greole$t dim..,.OO of !he 1ooH>. The surgical
wound i.given 0 cement d..,..,ing let 0 ~riod ol
2_1:..
Re le re n c e ,

_ II. 1'roIf, WI! , " - _ """ ~

0", I .... : loIror>g """" _ I DtOG""..ng.
00h0d 1980;!IO , 75_116_
2. Mo. l """" ...... , P]: (0.,01 o/I;owq 01 _
.. f ............... 01 d.... b:>nJoo opoc. """ "" ........ J
DortChO.j 1983 ,!)(l , 1 97 .<'O~
3. [)ewoj: ~;,"' i ' ,...;., 1. >:I_. No J Qo-1,,,,,
19.W;879l
'. o.w.I, ~ _ " " " ....h",k"I,,., 1.... """",-
"bi'""''''
(),ft,d19~
"M "00""0.' ,,<od~,.,.
.-9Oc;.9'16
Am J

5. Edwo JG : no ~,' ....o. HI. ',,"om, I

f""""""",, : OlrCoi <>A. Am j Q" iIod 1~n ; 71 ,
'89_501!
6. Gn;.t-IM . Ootl>odoo"" _........,.... ....... d o,
W8Soundo ... I~68
1. t\o;ob ,GO.OdO'IO:O 01 ......- _ _1 _.
,... J Odhod 1970 ;120
a. HoM. ~.,. <rd 0'C0M0< 0...-.1 o-OMl
"" 0'" '" """',,""';, '" """" oI, ,.J 0 "" d.
".,.",:on . A", J Ort.od 1\'63 . Jt.331J
9. ~'11 E. 11oI':>1I\I J , _~ ,,"' .... 01 ~--.._

"""1,,,_
I .. o'm. n' QIOMi"1 "''''
010010 ... _
.leo
... J 0- o.ld 1919;
'"'P' ,.
!I..
~ ,300.306
10. NortDnA. _ .. w..GoII . ....!: Spoc. ""' __
...-. '" _ do""-"". J 0- o.Id 1975; '"
112 _ll a
I I. ProIi# WR, COO" "" ""'.., o.+' odon,;: . S' l OJ" ,
CI "'...... 1986,
12. - . ~ "'\'0" . Ho:r.O boo&< of Or+odoef,,- v."
bool ",",,1<01 ~..o"""" c.1~8fI
13. ~_ -"' : _
..
01 01nOdo.ob,.e Uo,,'-'-'
~19M
l~. Sit"""" 5.tId II ..... oi ,""I....", (8"" 10 Ion ,,,,,,,,
'" "9"1. Anl J Q.-t-.:,d 19<8 . 969979
15. T"""" M c;..bof, "' '''''" l \10 ...... . : 0rl00C",,
t;c, am,., ...
_ I-.:
1""ipI.. 0.' '.".... 0" ... Mo>I>v,..."

16. Vig, _.",.b.

191'<
I_..-.f Kow<IIoId o.....t"" 01
"'"""""'" ___ ..... <rd _ _ '"
"'") 0rI'-00d 1990 ; <~51
17. Wr;g.\, (;l, ~ 00, ~oc .... r"fI" ,.. " ..........
0'" "'-'<!d cMnr;'''"'_
0." ( I" NotI, 0"' 1918 ;
22,519.1>01

of
Space
T he correction of menv ma locc lus ion.
r. q ui"" 'po<;e in orcJ<,r to move teeth Into
more ;dea l locotion,. Spo<e" req "". d for
"",~cti on of crowd in g. retradi"" of prod ined
leeth, leve li ng a , jeep (U"'8 0; Speo! , derototion
d o nt"rior reeth and for correcti on o f un,tob le
IIIOIa r ,,"olion. The O<thodM' ~t is oH" n Io::M wilh
'he d il . ma 01 how to o bto in 'f'O oe req ui",d for
i>e>e corecf,on, . Planning .poce;, an imf>'!1On l
GIIJl"d of treotment pl ~n nin g
Some o f the method, of g<lin ing 'poee
incIud" ,
Prp, imo l. t ripp ing
E.pon''''n
< E<tra ctk>n
< D i<tolirotio n
,< Upr>ghtin g of ma la"
OerO'ation c< poster>:xtffih
> Prodination of o nterio"
PROX IMAL STRIPPING
r rox;f'1o l stripping
proxi mo l .urf""~$
ro reduc~
j, a metW by whi t h the
of the IM !h Ore ,lie"" in order
Ih e me,io-dislo l width of the toeth. It is
01,0 known by the .ynonym" reofO, imcti on,
, I "" d~ri lati "" , di,bng and prox imo l sli ci ng ,
Although thi, p ro~ o d u ro i, rou tin oly ~arr",d o ut
on the lower on w io rs it can 01,0 be do,,", on tho
uf'IO"r a nteriors and b.x~a l "'llmef'll'> 01 the upper
and lowerarche.,
Indlcll t/ons for proximal strIpping
1, P'o,i ma l 'tripp in g i. vs uo lfy indicoted when
th o ,poeo req uired ~ mi nima l i.~ . , 0 2.5
mm, In these cases , it i, po"ible to a'oid
e , tr a cti on 0 1 to" th by p. rlarming
mproximati on,
2. II th o BaltM' s ana lys is ,how m ild toot h


moIenal "CIH$ ,n e<th~r oi tho otdl ..., ~ ;s

pouible 10 ,,,auce the 100'" moleficl by
plO,;mol ,rrippi~g.
3. ~ COn be undenalcen in the lower enterio.
..,
0"" 0

region OS on 0'<1 10 ,elention

Amount of p,oxlmel st"pp'nt
COn!" Indl"atlon, fo, proximal . trlp-
pint
1, PfO>< imo l stripp in ~ i, not ca rri ed out in young
pctie nts OS Th e, pos.se" lorge pu lp chomber
bo "':ood3:,~~:;0;,"::.: 'm:o:';",;";0:":' ' ;:'~.~:::;~
repro.irnotion
orcn, il
I, ur>d erlaken in

wh'<: h ir'IC'",,_ tho ril k ci pu lpal .'po''''. 011rho. teoth,

2. Pt.!ilffilt "'no or., ",",sceplible Iornn., '" thooe
who nove" high cori", irnlc>. DI.. d.,e ~t.t of p,oxlm ol . f" pp/nt

Ad~.nl.'.' of p,ox/",. I . 'ripplng

1. ~ il possible 10 ovood _,1Ion in bordorline
co .... ""'~ space reqJiremenl i. minimal.
2. A rroor. lo.ouroble &me bite ond Oefjet
cOn be e.~bli!hed br .Iimina~r.g
""'Q~OI1
loom moterio1eKCeU in either of rt.e orcl>es.
3. Moo! Ilobl~ 'ew lts con be e, toi;Ji,h.,d by
broode r1jr1 g th e co ntoct o reo Th e ro by
. el imir\(l,jr>g , moll co nto d point; which con
. Iip and couoe rolotion of ' eeth,
Dt. tno. t/c "Id, la , p,ox/mal st" ppl",
kh pe-nmeJe, a"alysls ; Arch perime1 .. , 01
Co,...,~onoly$;" lhowing 0 looIh malenal tru:e5$
01 0 _25 mm c.oenh. ordller>gIh is a diognostic
crilDrio fo.,Qring r.prDJ<imolion.
Hollon's o~a!ysls . Bokon's onalysis """",ling
an fI>Q!$' 01 room mo~~ol in ",!her of ,he orchu
is on indiroti on 1<) rwVOl loom malerio l in mo l
o ren, Minimo l inl &ro rc h to ot h mote rio l
di!.Crep<l ncie' con c lso be <:e rroded by proxi ma l
. trlp pir,g. (li g 21
Inl10 0'01 p~riopico l radiograph. It i,
oo:Msoble to cor.lull,. ono:Jyu. .... DCcurate/y tok ....
Inl,o-orol perloplcol rodlogroph 01 lho '''9100.
o. The strippong pnxedu,," create< .""~", ,
prD>imol surface mat otlro!;ts plaque.
b. co~.s sUKep/ibOl,ty is inaea sed os ;>0'"''
rho 0110"",1 is r"".",..~d, Ie<r<ing behir>d
lOugf..e<,ed 01] ,
c, fIor ients moy ~xperien<;:e ..,,,, iliviry 01t... th.
d, Imp ro po' proc e dure at the ho nd o 01
inexp e rie nced ope ra ta" con r8l ~ l r in
Dhrotionol morphobgy dthe roe*" creo'Ong
on unnolu,ol oppeoronce 01 the _h.
D. Lou 01 contod be""""'n cdjocent k>Oth moy
rewh In Iood impaction.
P,oc. d .. , . 01 p"'~/mal .trlpp/..,
PrD>imol ,tripping is carried out in one of !hot
foIl"","ng WO)'S (fig I) ,
I . U... 01 "","'lIie ohm""" drip.
2, Sote "dad ro ,bon.rndum di",.
J, long min tOp<l red li " u, ,, bur<
Fluo,ltle e ppllc.tlon
Th e in(reoud ca rie . 'u.c e ptibilil~ "Iter
sleno:le,izotion i. "","eg ed by" c<>mprehensive
fluoride PlOIIrcm"", Iollowingihe p,ocedure.
 ,;~ I P'Q, ;", o l " '; 'P-"'l " ' ;' 0
+" 'epeo-od
'I 'l lc 'lg i"".. t. , ~
':S! Solo,;dod " """" .... m d-""
iq "~1<lIk at "",,,,, " ri p>

' ''' 2 (.<.j p""""t",. nt r*o1Ogo"o, '

of 0 po ' ;, nt ' O ,-;" ~ ,.- o"Jl b" la r
Bo llo" " " . too" "'0"..'01. IB)
P' o>l ",, 1 .,.; .... n; """ _ ",mod to
"'""" . ... "","o.ibo.rla- 0">" "" o..d
h ooJ";t, h od owl """" (q ~ .
tOO'."..t , "",.~ """" a'9>m"'"
<J ""- ........ "'"
EXPANSION AS A METHOD OF (lAINING coni,onting prob lem (crowd ing
SPACE
(fig ~J.ln oddi~ on. the lowtion of
e,ponsion is orwt of lI1e non.I""'l~V<I memod. of the a.et. il luch rhat ~'" "",,<:8 goined b)-
goining spoa (~9 3). k i. u....ally unci_ken in
pa.ients he",ing conslriCled ~lIary a,ch a, in
P"' ielllS with uni!oterol Or bilol_1 CIOM bile.
Expan.ion ron be skele,ol 0' cknto-ol,eol" .
5kelekll bpem."'" i",.,.,l,o. ", IIHi ng of !h-e mid-
poloTO I l ulu re wh il e dento-{lfveolo r e'pc>n<ion
prod", 0 denlo l oxpo",ion with no , k. leTol
chenge. Expon""" is b,ou gnt about by '>'(l';"us
0Pllliarn:es IMl ircotpon::r!e ;ad:. screws Otby u...
"'Ipringl. A more detailed occoum 01 .-oriou'
upOtd"'" procedu ... and dc,.,.;oos i. giver> ;" ....

enwing chapreo-.

UTRAcnON AS A MfiHOO OF GAINING

SPACE

me
One 01 frequent!; """lied mctnods to gaining
Ipolal for orthodoo~c purpooe. is b)- e><l1O<:tian 01
one Of mono """rh_ Extrodan thol it undortoltm
a. a pan of arthodonlk " ealmenl is coiled
t!>emptUllc _cOOn.
P,emalo'S are lh, mOIl hequently
e.JroclCd ' eel h as pOrt oi orthodontic '.-.o!"",m f;~ .. (.0.: e""",;o., 01 "' .... '"Ih ,',ocI ~ goin
e,.rodian of ane premolo rl'om noch quod"'nt ..,.,. 'n '.,gt'~ .....of+",,,,,
,0 on', "''' io ' "'" orld
<'ow;; "". iBI p"", H,""o, I. 01,0 "" i""'"""' I",
"' .... jaw p'.,.idc ulk""'t .peKe t() cOt,ed ,;", <.rod Of' 'eel,
....... , ,.
 ~.,o;~~.' b. lllilired lor correction in both
... onlO<ior os _II os Ih~ p<>:!lerior 100m."" 01
II " r'\O! u""om mon 10 exira , ! mo lo" c.r
ind."rs during ortho don tic th e rapy.
"'~_. 8J(!roClion of conO n end Uppe<' indson
lIusvoU1ovo;ded.
TheO..-rIo!he lI'J'!'Iion of ......ch teeth
tI_c;tltra pottenI should be based on" lOund
l i.""~" Mo .. dlf1<>ilo on/heropeuhc: e:<Il'IXIOm
gWen in chopl .... 23.
., recent timel is di.toli,alia" f molOI"1 .
Distolirorion procedures Ole aimed '" mO'Oing the
""""'" In " di.,.,1 di"""';on so '" 10 goin 100"'.
This opprooch i, becoming populor dve 10 1M
~>:.:::~:;. DiSloli.01ion
: fie
;::::~,::;;O~~',
il moI"r o .. ume> ';g n~N:u!'t! .alvi in
t~tm. nt 01 mild to modorote DCII II moio ,
I" ';~O >~" '~ ,.IIih a """"CJI ""," dible . rr.."
br di, tolilin g"'" mooi ll ory mola rs in these C01{l'.
edroction of teelh COn be O\IQided. The ideal
IcrdislallZ<lllon is during iN mOoed denlition
!!Mod prior to the .",plion of the .Icond
;>em><>....m molo .
D<l!olizolion ,on be brought about by
t..foJ lowing me!hods
1. E.Tro oro l method.
2. Inlra ore l metr.oo.
Eo'' , . or.' motlloa's
tfMd geot1 detWing o.-cl>otoge from rh. cer.i<;al
... ""niol fell"'" con be used It) diO!011l8 MOIors.
The heod gea, assembly consists 01 0 Ioce bow
which il mode 01 on in,...,- ond on ouler bow. The
_, b-ow Is Io.od 10 bucca l tubes pre-' 0f1 th e
1'1010.... The o uter bow i. atlOch$d 10 the ortra
.....,1 hood (OP 0' node . tra p. The vse of ortra
orollon:el lor r:!"lSIoliWfion h", the loI\o..i"9
disodvontogtt ,
1. Ptrlien! coope-ot;oo;, essent",1 b-timely weor
of th e op~lon~e:
2. The opp iion ce. o rO u.u o lly no t worn
conti n~y. Thus!hey 0'" int" rmi!lent ., the ...
oction re,..,~ing In prolonged !reotm""t ~me.
In order to"""reomethe dtowbodcs 01 ""'ra-orol
opplionce., vo,ious illlro orol applionce l to
d i. tol i, . mo lo" were introduc ed. Tne se
opp l",,,,, o re li.1td on 10 !he t... th a nd therefore
p-rodoco 0 conti n""". effect. The loIJo.,,;r,g 0"
some of t+.e intruorol de,;, .. u~
Sagjltal rrpplJonce : Molrr' d istoli,a tion con
be brought obout b y removable opplionc
' 'coo po",t;, ",Iock..:rews. The opplicroc:e consilii
ol 0 ,~~ ocryloc plale iOined t~ether by 0 iock
."...... lfi; 5) The oc:rylic: plalo is ...done<! in sud>
o wa y thot the tooth th ot is to be d i"" liz&d i.
isol oted, while th o ... " 01th o arch i. u..,d lo r the
purposoo 01 oncilorc~.
The.. gpplianceo ore retained ullng
Adom', clolPS on !he mc>Ia .. .....! premolan .
The jade scr~ 0.. po$moned in such "vtrTf lItot
their ""'9
0 ... is perollello ,.... oc:duscrl pI"ne OS
"""los the bvt:colsurloce of the mol,,~ This
f'O! Sog ;,,, 1 app li onco i""o"x"o,""O" .<row for
00101;,, ';.,
f,. 6
(Vj p,.
('oj oM :, )P" 0'"'
coo ,..".
pool d;~, b,! ...,
d ' ~o r, ,,,, o
ibJotecol) """" ",, I ~"ph> ot 0 ,.,r, ... "oc<od
,;,d 'IO<at' .xcl,.., 1 "r "", ,,,,*,, of 0 ,.,roo' !,,,,,Ied "' ~..
, ~<:<>i ' pri"",
p. ...c', lm 00""'''''''
(C) _

Iyp~ ai opp iior><;e <;on be u .... d for di"" iizoti on of

only or.e tooth ot 0 time to o<oid und ue .<Ire in on
the onchorage .
Distoholion u. ing intra _ o ro l mag n ~ ).
Intre -ore l repe ll ;ng magn et. con be uoed to
dista lire makJrS, TM'" devices cons,,) of repe lling
mag""ts placed 00 the moklr to be di.<lO:i,od ond
th o tooIh onterior to it. Th~ O111erior onchoroge
c@bere inforced u. ing a Nan CD hokJ ir>g arch,
U,e of op e n cojf s pring s 10 disla lize
rT>01'ors, Moklr d i ~ lizotion con be brovght obc<.Jt
u:\ing Op"" co. ndel titClrium 'pri ng compressed
bel.... ee n , he molar and the a nterior "'9""",1. The
onterior onch aroge is reinforced by us. of 0 Na nce
button tflo t r~<t' ogo in<t th~ ont",Oo, port of the
po lote . (fig 8)
Pendu lum orr/ ianc e It i. o n introo ro i
fogS 0". .. '<il "";,,go ,...0 ,. ,h".! ........ ~. 5I>oom ..... -, on o='i<F.<, ,oIrod)o<lo' 9 """ "CO'pooY" G 0_ CO!
~.nd. Nor b.,.1on 1", onto.;,.- "",,,~.

ch!ci.c1io<1 tIfl!lIiance!l'lCll incorpotOlss 0 mod ilied

i I ....\ \1( \\ ~..i ;, .'i: !. iJf.')
Nonce bulton fo, purpo'" of onchoro9t.IM
oddi~on ~ coruish ofo stainless ~ .,;'" wi!h 0
.$
heli<. !he distol end of which inserted ink> "
*eYe on !h.t palatal osped of !he molO<$ 10 be
, '., oJ." .".j 'i ~i'" (

"""Ii.ed (tg l). D.""I.roIion io p<o<Ivced by ,I "----,1

., I
oponino me helDc a nd lorcelul~ e1>9oging !he '--,-'- - -'.--'
&.w I &ncK inlO !he .Iee, ",.

UPRIQHTINQ OF MOlARS
-
f'mnotv", 10$$ 01 0 oocond deciduau. moIa, Of
ec'rOdion of a _ond premolar can couse mesial
tppit>o oIlhe lil$! permr:rnenl malo . A. mesially
<wed molar (>Ccup'e; rno,~ . poee !hoMOn
upigh! moIo' (Iig 9)- 1hu, by uprighting me..
Ippe<I rno lors. ce rta in "moun! 01.!Ce con 00
_ red. IvI<:>OI$ <;g n be uprighl<>d ul ing Ma r f>g 9 A ,~~ ' 00;' 0'" , ,, ""'" .,," """. ,ho, ""
"P< {Ii" """
 R. f.r"nc".

2 ' ~+ffl)'ci H ,..",10 "' M Co ,"" 0.,

E, 'fa """ " 'M """",;ro<;'''''
:;, c.,,,,, ~ ,.."',. "" i, ,..-,1.';eo<t""
1969;U_93
~ D~',.", ., ""'"''"''''''"'o ,''"",,
ob;oct ...., "" "',t-.- .co<od~ .. _ k-, J
195 . ; 'i06-92~
5 Gm,., TM , Or'hoo'"" , co
'Hi! S-;~"" " , 1 %8

6 H, " , Po I"o l ..
, .-.toIo,;,,1 c"ho,"""'. , A,-, ',';~:;~': ;:: ~!.:
"",,;on'
I '"
Hat. Ro , 'o . ",,, ..,-,,,, of '" "", ,,j l<l ~ <l<noI .....
'"0 -no no",,1 m, j,.,. by ope n; ", ". , m; ; """,..
"""'0, ",'" I. o,,-,.,d 196 1, ] I 73_90
S, Huo" l",>c '''' m oo~ h ,,-m..-' ,"01",,",, " of ~
r .. 1 ~ A 'o",.d ""'.... "" t~, 0''''';'' """ =- , "k>1OI ""'0 "';"" , A"Ii ~ e<lhoo' 1980; 50 , 189-
-1.0 , """"0 1c oo ? 17.
9 Hal, Tn,o,," "" 01 "",,i " ) _'_"1 by ~
+0 ".. "" , 101 ''''"''', AVe O"hoo' 1965; 65 , 21)3.
2 17_
10, "-<l', - Go..;J.; ,>(e 01 ... " ,,,", .., .... , .. "" ,,,,,,,.
DERDTATION OF POSTERIOR TEETH ie" , Am J Orl- od 197a; I _ ~
II .vn ., SI- ,..;oc.,-. : A" Roto : S'r~ Uoda-" Am J
O,.bo 1987; 78 1_7&l
ko:ated p",terior t. eth accupy rnore ' O<l ce tha n
"",rr.o ll l p'o "ed po<terior teeth O. rototi on of
12. .....oo Ph '" " ~ ,' -'I.oJ ,J ,,,,,,.j ~~ ct "", 100

wred"' , ,J Ad " A<d,_ .,,,,h 0. "''''''-''1' Am J

these teeth hence prol'i de, rome Orr>O\lnt ci arch Onl.oJ 1"91 ; 484_<09
length (fig 1O),Derototio" i. b. ,t a ch ieved with I] P",jiH WR: CO"t. ", ,,,,,, Ort" ~t"" S' l"", ..
Ci ,,,,,,.t.,, I 906
fixed c pp iooxc. iOXOfpototing .pring. Of e lDStb
14 Rcbo., ' """'" ' ' ..... d Oook 01 O"hoo'oo""", Yeo<
"" in ~ a fore" coop le boo:< ,.-,.,j ',, 1 pvhI;,ho~ , inc 1986
I S So , ,," , n .A : ' "",ti(e 0' CM-oc'<x" " , JB l W""""
PROCLlNATlON OF ANTERIOR TEETH ,,,,",,,.,,-, 1 ~6t

Prod inolio<1 o f a retruded c nte rior tooth re. ult, in

ga in o f o rd\ le ngth , Thi , i. c$LJ<l 11y ind icoted in
co whe<-e th e teeth o re retrodned or ,n tflo..,
Case' where protr<x:tJ\g the cnlefro v,ill r.c< affcd
the . oh ti,.ue protil e of ' k po tie nt

\
 Expansion

A e;'~ ~~~~
oppore<1tly complex yet re!otiely ,.;mpl e

0 L\
proced ure in o rthodontic . j . pa latol
<pa n. ion. II> v. " oti lity i, un iqu e l o r (,d\(' ;\'-'
~pite th e mony (M l rOve" i", su rroundin g
Oe$irab le r. , ull$ are och ie.ed when used in th e
it,
L,n ~
n)
,
cpp ropri ate , tuation lrr a skilled clinidan .
Expon,"" of the polote """ fir>! ""h ...,ed
:;; I :3 I
i:-
'" Emerson C. Ange ll in 1860. Po'otal .>PO"'' ' ' (
be carrled out in dilie r. n! way> whic h are
CJ:ln
boood ly ck",ifoed 0' rap id & , low, c
RAPID MAXILLARY EXPANSION (R.M .E.)

tepid mo,i li o,), " 'po", ;o n i, 01, 0 kroown by t he
.....,. ro p-d P<l loto l expan, io n o r ",lit po latc . It is
.. <ke leta l :ype of e <pan,"o" tho! involves Ihe
RJIO",tion of th e mid pa lota l suture a nd
~ nt of!he maxil ,,!)' .holve, away from """h
the fin t time in 1860, ",ed 0 iClC k , crew type of
device be/weerl the maJ;llary prnmola", in a 14
yea r old g irl and ach."ed an increase in oreh
>Mdth by I /. inch in I 4 ooy. (fig I). Wolter Coffin
in 1877 introdoced 0 ,o rin g co il ed Coffin .pring

""". Erne"on C. Ang e ll is (o noide re d Ih.

/orthe pu rpo>e of ~ ng t!>eorch. Th,:"" . Hoo,
kowe'er were not a~cepted by t he orthodonti c
id>er of rap"d mo,i li o,,! c xpon ,ion. Aoge ll , for commu nity ot that time.
 It was the 0101 'U'!learn ond E.N.T. Tht sphenoid and the zygomatic
surgeo .... who popularized this l<Khniq ..... during hove a bvII.....ing diod .... '.. 'ng mid po
the ecw1y POri o/th"oentury. E.N.T. s...geon. used .uture opening.
thi. 1echnique In lfWlment 01 nasal ,nsulf"o::ienct
and coruIrided r"OlKI-mo>illa..,. <:Or'I1pie.. with g=> I/IIOICATIONS fOR R.III. E.
I UCCfl .
!!.op;d mo,jll ory e>:pon ,ion no. beet> corried "..
KomkoU I ond Md r. .. Has< during tn..
1950'1 reintrod uc&d rupid maxi l"''''' expor"l$ion!O
for dentol o. _ II o. med ica l purpose . n..
foll owing ore lOme of the in dicction. for rcpod
tho C<1hodontlc com mun ity. Tf>ey pop<Jklriu>d tn..
c.",cllpt .. ith s.ce llent 1."'01ci1 publication, on rnc.ilkl ryoxpon"on:
crimoll ond hu mcros u~r.g 0 """""r ofle<:Miq~ (II Posterior erOl!l bito ~i;l21 oosocicled wah rool
01 ",~ti .. mD.<illory deficiencie . A ....
ond methodl.
mo>.lllory defiOency ;$ os.sodcltd with ""
APPliED ANATOMV undoroi.ed / nO((OW mo .. illo . Roloti ...
rro::odlory r:IeIiciency i1 ~rized bot J"IDIn"d
Tht ITOOIdIIo IOge1herwith thoo polatine bonelorms maxi lla but OeBized mondible.
the hord pola.., floor and g...,..... port ol the lot.
erol woll. ci the 1"(1$01 <:nvity. 1ne m:uilla is a
po iltld bone thot cwoiOJiats. ,.;th '" owooiIe """""
ber aoo .arioY l oIhor hone. indcding tm....tal.
e!h""" d. """,I. lacrima l. "om ..... ,ygomoric orod
the per loti.... bones. Moot of too . utum l oHoch
me nt. of tn.. rT>Q,ill a to tn.. "" ioinin g bone. cre
a t it5 posterior and superior ""pe<:1s IflO .ing th o
anterior and inial,,="" ""ped' free, wh"h ma kes i!
~ul .... ,obl& Ioo-Ioterol d;splac<!t<nent.
Jhs ....... ....,.;Iory and the ime' "PtIlatine
.utu,e1 or. collKt",* coiled the mid -polatol
.uture. !!.opld maxillary expansion should be
i'iIioled prioIlO"'ossi/icotion 01 the m d . poIotoI
. uJure . Voriou. studies hove been done to
~In !heoooo, ... hio;h the md - paiolol "'''''''
..... fiel. Meloon ~tholthe Ifon.""",,,,rowIh
of the mid . pa loto l wtur~ c""~ nu ed uplt> 16
yeo " in girl, and 18 yoo" in boys . Most.tU<J iol
repo rt a brood ru ngo of ",..fkation ti metabl e i.e.
berween 15 . 27 yeo" Tf>c dinidon !hovld
honce OKcrIOin thallhe .ulure i. nol oss ified t>t
using appropriate diagnostic oido to b.
described Ioter in th," eMptor. --
r", 2 ~""'1001<>0- <K><> W. l!l 000""" .....
 A ,
12} Clou III roo l<>cclu",," 01 <lenkll or skeleTal
o;IU"". ImpfO'o'emenl i$ see" in boI+I antflrior
os _II os posterior crossbi,-,
(3] a.h polo!e potie"" with collapsed m",clilary
0"". "",olclherupy, R.M.E.
I~l In coses requiri"llfoce
" used olong with Ioce moll< 10 00sen me
mO"i 110 ry IvlWJl ol't<w;h,,-,. ,., os to foc;. ilete
pro t'llction.
{S) The medicol indicotions lor ra pid mc"ollary
eJ<POnlion indud.. 00",1 n'.:"osb, poornOKlI
oilWOJ', seplol deformities, reculNl'l eeIr and
nosal ~on, allergic minili$, O.N.S" e.t.c.,-
DIA.GNOSTIC ""OS
The rQ<ltin e diognosTic aid . sud> o. co,. hi, k>ry,
d inico l exominati cn and study models ore usefu l
in dklgnosil. The mid - po loto llvtu rtl con
oiluol i.ed in a !TIO>iloyocdu""l.;ew rod"oogroph,
These ~~ 1$0"'0100 uoe/oJ dumg hEd" ... oI
10 chK~ for mid - palatal spliT ond 01.0 to
ntimm" !he amount of "'''''illary e>ponsion
achieved. f'A cephologmm i. ono/het volvoble
dklgnoslic oid in rapid m<illory ", pan,ion
~ u res 10 . >li"",'" the omount of eJ<ponslon
11>01 hen lek..., pioce.
THE EFFECTS OF R. M.E.
Though R.M .E. i. e..en~Qlly 0 dentofa<;ial
ortnopaec!;,: opolion<:e used by orthodooli$h. it
finds oppllcofion In other ~"lds such 0$ 0'01
su'9""1. E.N.l orod plosfic surgery.
Mo. il/ary .hletol ellee' , The mo.illary
poo~ d o r teeth ore VS<Jd o. hor><lle. 10 apply a
t,,:msye 'le re-d p rocc l force so 0,10 opoen th e mid
. pakJtol , uture. Since th . lerce e~ioyed for 1M
pfOCedvre i. vy high, no! mud. of ort\1odQo otic
chonge. con be obse.....d. The oppiianUl otI
odMniotl compre ..... the peiiodo"lOllil/Omenl
and bonck the olweoio. prt>CI!SS bucollyond .JawIy
opens the mid palatal suh"", The oJ*'ing 01
the mid pakJlOl '''I\l10 ~ ~",.noped C<'tri''''9ukn
with m,,,imvm ope ning ot the incisor "lgiotl and
grodvo ll , diminishing IOwa rds th e po,te rio r po rt
boe
of p""'t~ (fig 3 0). This cOn be oP P'ftCiated in 0
po" R.M.E . ocdvsol rodiogroph . Similar Ion .
shaped 0< "",,"p"rallel opening i, OllO Men in
the superio-inlerlo' dirodion. The me" mum
opening i, toward. th" 0.01 covi ty wllh
r:<~ less operi"lltowords .... nosol ospect
(fig 3 b).
Accord in g TO Kreb the two ha lves 01
the maxi lla rotote in The S<lgi~al and corono l
p'"".,.. I" m., toroncl p/1;>IIe!he two"'~ of the
"",..11" tOIOIo owoyfrcm.eel> other. n.. point CI
.,.,.;el> tho n>kIIic:nlokes ploD! i. """,nd .... Iron\o-
"""""Of\' _""'fe. In mucgillel plone, m, "..,.;110
i. /"".-.:1 to ,ClCle in 0 down .... rd ond Iorword
diradion.
Nno",," 01 e:<pCnJlIln er:n-d . An irw::,ecse
in m~.irorywdth 01 u~ 1Omm COfl be ochie"OllCl
by~d "..,.;11a<y e.pCInliar>. rnertn oIe<pc,,"s"on
is oocutO.2 toO.Smm perdcy.
E~d on olve%, bone , The 01"",,1a. bone
in the a ..... adja<;ent to the anc;ha' .... th bend.
.Iigh~v. This i, due to !he reli l....1nOlure af the
al..:olo. 00f>e. vV
Elfea an m!l~illary enreriar IOlel!-r .. The
appearon<:oe al c midline .s;>acing be_n "'" two
ma.ilia!)" ce ntrol ineisen il th e mOl! reliobje
d inieol evide",,, 01,.,..., me, il la!)" ... po",ti o~, The
incisor ... """,tOO i. coout 00 11 of lhe d~tonee
lhe KrOWi. opened. By InlO(! 10 I;,,~ monlhl. Ih e B
midli"" dio l'Gmo clo ... , o. 0 rel uir 01 Ih e Iron,
,. pro l fb r. trection . f"
Il l)
,,~""""""
6<.:co~)
","0 1 " """",," " ... 0 """""
lipped C>"IChor"",",,,
rrdar>

Effect on ma. iUory posterior ,n Ih , Th e

""" iliaf)' pOSlo rlor lee!h ore ~scd 01 ono:hor1
du.ing rcpid "'.0..0;10",. .. pc""cn. These leern
.how brx;c.,1 lipping (#g . ) ond 0'. 0110 bel>eved
to ,,>.In.od. te a lirrrired e>.!ent.
fHecr on mcmdible , Me" outhe" ha . "
abse......:! a down"""rd and I:..d :.... ,d 'CletlOn cI
me mandible 10110..109 ,aPld expon.""" . Th" i.
accompanied by a ,light Int'CO" In the
mandibular plane angle. The .......,n attributed
10. the ma.-.:libvlc' I'OtotOO "!he 8>JMien ond
buccal bpplng oIthe m"",llary mala ..
Eff",t on odja,ent eran;ol bone. and
""'.... : twpid mC>.lllery ... penSlan nal anlv
..... uits In apening 01 the mid pcrlorol wrure but
allO hal fa, '''''''nlng elleas on ad'",,,,", eran",1
IIrveIvre<. In odd""" 10 the effeds on those bor.eo
d irHy orticu<mng with the mo:rilla, b<mes ci lhe
t"'nivm .urn o. "",Ielol .,nd ",cip;,.,1 olso w=
found ro be displD<cd.
f lkd. of R.M.f. en n"".1 'oYiIy : Fall"";ng
ftlpid "",,"lIory expoOlian an increos.e '" inlr ...
nosal space occurs due ta the ouIeo' .rob 0/I'l0$(l1
cavity moving oparl. Thi. incr"", ... in nDlaI caWty
width i. """';mum in the ime,ia, "'9ion 01 the
noIOl ccrmy and grodually decrea .... Iowa,ds the
superia. Olp&d. Sim~a, grodM:nt isalso Iound in
en anhlfio.po<lenor di.ection with the 11 _ _
inc""" ... being '" the a nterior "'9ian .
Air Haw ,esi.lonce is belie'<'ed to reduce
by 45 60 %, lhe.eby iml"""ing ""~ b=!hing.

\
TYPES OF APPLIANCE USEO

Numerou. appli a r>Ce. nove bee n used lor rap id

m'''ilory .'pon~on. Br<:<Xily!f.ey co n be d" .. ~ied
0' :
1, Remova ble op pl;" nce.
2. Fi<ed Applian ce,
o. Toolh b<lrn e
b, Toolh and li.. ue borne

REMOVABLE APPLIANCES

The relia bllily of the,e o p plian ce, in produc ing

~elol expansion i. hig hly qve>tionable. jlJthough
~ i.poss ibl e to ,plit the . utu re. v. ing re movabl~
pkrte" it neverth eles, is unpred;;lob'e. Treotment
during tn.. dedduou . or early mixed de ntition i,
conS ide red more fa vo rob le in pro duc ing
opp re<:;iable . "oleto l eff"",",
A removab le Iyp e of rapid maxil la ry
.. pa n";an device con";,t. of a .pl it ocrylic plate
with a mid line $Crew. The appli o r>Co i, retoi ned
u. in g c la.p, o n th e po.te ri o r tHth. The
d i' ''''vonto ge. of a ,..,movoble ro pid e<pansio n
opp li orx:e is th e need lor potiM t co.o pe ration
a nd the d ifficully in reta ining tho plate inside the
mouth .
FIXED APPLIANCES
Ap pl in""". that Or. fixed onto the teeth a re mo re
,..,Iiable an d fo\J nd to produce con.ist""t skel..to l
effect> . Th e,e fixed rap id c>pa nd ers ca n bc
do";!ied into tooth ond ti.. u. borne a W ';"r>ee,
and Iooth borne ClPplior.::",. Two of!he com"'o nly
u'ed tooth and Ii" ue borne applio nce, ore :
1. De rich,wei1er type
2. Ho,.lype
Examp le, of tooth borne o ppl ia r>Ce.
ir.::lud e '
I, looo<:$o n type
2, Hyraxtype
f~ 5 RM'o-u" appiia'lCo irKorcoratng ioe' !C""
for ,r<;" "'f'O"'""
De, lchs welle , type
The firS! premolars C>'"Jd too fi rst molar> C>"e bar-d<>d .
Wi re tag. are soldered onto the pa loto l a.ped of
the ba nd. Th O,. wire to9' get inMrted into a
. pl it pa lota l acrylic plate ir>eorporatin Qa sc rcw at
its cc ntor (fig 6 .o)
Hau ty pe
The first premo lor ond moIo r of either ,ide ore
bond ed, A thic . ,ta inl." steel wire of 1, 2 mm
d iam","' i. 5OIde rod on th e bucca l ond lirog uo l
o,pech con nectin g the premo lar a nd mofo'
bond . T,,,, li ng ua l wire i ept lo nger so 0' to
exte nd p.o,t the bond. both o nteriorly and
po,tefk>rly. The,e e<ten. io n. o ro bo n! palatally to
get embedded in the po lo!o l a o"yi iG, The .plit
pa loto l ac~;c flo . a mid line . crew. The plote
doe, not extend o,er th e rugoo 0"'0 (fig 6. b) .
Isaacson type
Th~ is a tooth oornc a oplion co ,""tho ut On')" a c,,!i'c
pa latol coveri ng , Thi ' des ig n make, use of a
,
f ..
,
6 (.'l
c
o..d>o...a...,.,.... of " "',,.'" ~~ lSI H"" ,.,.... 04 ",""",,,"on
o
oppI O>n<;o Ie) I,.,.,,,on ~."" 01 "PC"_
appli<c. ' ''-og Ik ..... "p" odo, ID) Hr= ''''' of " po"" OO """ ""'"

.pring bod..d screw ca lled a MINNE exponder Hyra" type

[deyeloped ot t""
Uni"""ity of Mi nn o>Ota, Deffll l Th;, type of appliance ma kes u... 01 a 'P"Ciol
"""", Th e Ii ,,! premolor. nnd mo la" are
type of KreW ~o ll"d HYRAX (Hyg iM ic Ropid
par><ierj . The screw> f'Kwn heovy gougo w ire ",.
Ex

ba nded . Meta l fl ange, cr. wld ered onto th~
band, on the buo, ol ond li rlg<J01 $irle" The
~xpa n der consi, t. of 0 coi l spring hov;,... 0 nut
wh ich can compre .. tho spring. Th i' coi l sprir>g
i, mooe to exleoo betwoon the li"9lJO l metal
flcnge. tf..:,t hClVe i>een <o1d ~r"d. The e>paooer ~
activoted by do' ;"" th . nut $0 that the sprir>g
get, co mpressed [fig 6 .0)
tM.ions that are adapted to fo llow the po lokll
cooloor and are soldered to bands 00 prem o lars
ond mole" [fig 6.d) .
Bonded R.M.E
Most of the rapid roo<illary expansioo apr" i<>nees
oo1Cl'ibed earl ier are bancled app lklflCe . They
;flCorporote bond, 00 th e first premolars and
'iG 1 ~' it<mo_ . oppio"", "'OO'' ' ' ' ;'''' pod "' .... I... ..,.. ..........."" ,:e:, ftrm< ..."........
="'" ""'"""'tVO.,
...,.j
10, to "," ~ ... -"" IC:-&ID) P" ..... m.... "" ; pool_''''' ... . ,.
....,,..,., :!) & If) P" . to"' .... tv'd ~H"'h " -<9"'"' 0101tho. i>C,..",
10 """
....,.od -.;" "" " , .,;d
pol;""!
mok", . M a lternotiye design a f tho op~ ia n~e
woukj be to ,",ye c sPir/ CO'ieriog vaOObl. numbe<
of teeth on oithe. ,id o 10 wh ich tM i"de .crew is
ott""hed. S~ ints cen t>e ~I two types:
I. CaslCep $p li nn
2. ACl)iic 5~ints
The cost C<lp .p li nn are moo . ol . il vo,
copper a ll oy. Th e c cryli c splint' Ore mod e of
poIymeth)f.methoc~ate. A wire framewo rk may
be adopted around tho teeth to reinforce the
acrylic. The, e .pli nn ore I>onded to teeth u>i<>;l A
e ithe r ~Io" ionom . r oe oth . r bond ing adhe,ives,
offer odequate etrnir>g.

DESCRIPTION OF A TYPICAL
EXPANSION SCREW

A typica l ""pan. ion screw con .ist. of on oblong

bc-dy divided inta two ho lv. , . E""h ho lf ho, 0
f" 8 IN T, p;,o l . ' pon,;"" ,crow I! ) Ko,
"''''''''' d tho oppl;.,."","
"'0. 10'

threaded in"" r , id e thot reC<! i..,. ooe erid of 0 Schedule by ZImrln, and laa8cl on
double ended suew. The screw ha. a centra l
In you ng grow ing patient., lhey reco rnrnen d two
I>o"ing with four hole. The ... hole. r""e ive a
tum. eac h day for 4 . 5 day. orid Ioter one turn
key which i. used to tum the screw Ifig 8). The
pe r day till the de. ired eXfXlnoion i. achieved . In
tur~ i ng of the sc rew by 90 degree {I. e. one turn )
ca. ~ of non growing adu lt f><l ti ents, tner
bring' cbov!a li near movement of O.18 mm . Th e
recommend two tum' ""ch dO)' far fi" t two do)",
pattem of thread ing on eith er ~de i. of oppos ite
one tum per day foe tho next S 7 da)" and one
direction. Tn..... tvming the screw withdraw; ~ Irom
tum e'er)' a ile mate day till de'ired e'fXlnsiofl is
both . id e, oimu llon eousiy.
cch ie'ed
ACTIVATION SCHEDULE
TREATMENT EVALUATION
Veriou. authors hoye adyocoted d iffe rent DURING R.M . E.
ClCIivotion sched ule, te achieve !he desired ",w its.
O inko lly, the mo<t noti<;eobl . 1ernure dvring ropid
Schedule by Timms moxillar)' e'f><lnsion is th e oppeorance of 0
midi i"" dia stema. S!vdies by various ",-*<>" show
for palient, of "pte 15 yeo" of age, 9Cr' rolation
that Ihe amo unl of inci,,,, ,epa ralion i, rough ly
in the morn ing and """ ning . In palienl. over 15
ho ll the an"lOUf'll 01 jock SCfew separalion . But
yeo". Timm, recommend. 45" odivatioo "timos
tho QnYl<J m of diastema .no ukj not be taken d. 0
a day.
reliab le foeto r in e<timoti ng tn . amo unt of
""pa nSiOn. Mo.<illory occ lu.a l radiograph and
fA ceph a log ro m ore more ~ i abl~ in estimati ng
~ amount of """ illo ry exponsion ,
CONTRA/NO/CATIONS OF R.M.E.
Some coses whe re R,M, E, i. co ntrOind icoted
~ ,
1. Sin gle tooth cro.,b ite..
2. In potie nt. who o re u n ~oope ra 'i'e, R,M.E.
i. contra indicated a s the a ppl KlnCe req ui re,
lreq uent activation and rYXl intcrooce a; good
ora l hygiene ,
J.. Rop id rooxillory expo nsio n i. tool co rri ed o ut
afte r o lSification of the mid po loto l , uture
un le .. it i. occompon ied by odj unctivc
, ur~ica l proced ures.
~. Sk.,jeto l o.ymmetry 01 ma<ill a an d mandib le
a nd o du lt ca",s with seve re ontero pa~terior
sk~eto l d i, crepa ncie .
5. Vertka l growers with siM p "" ndibuJo r piOn!!
ong le o r. u, ualfy a contra ind ication ,
6. h tr., p"'lefiof teeth o re lIsed a ' oncho " to
mov~ tho bone. o po rt. tf><, proced ure is not
ind icated in 0 pe ri odo nto lly wea k dentitio,,-
RffE NTION FOLLOWING R.M. E.
fnilure 10 reklin the c<ponsi an r~'u lt, in relop,~ ,
Most autr.o.. reco mme nd a ",tontion pe riod of
DOl Ie" tho n 3 . 6 month. Isaa cso n reco mmends
'he use 01 tho R,M,E, o pp lion c~ it. elf 10<" the
""'l'os e 01 rete ntio n Tho , crow ,hou ld be
... mobi lized u, in g co ld Cure a crylic (fig 9) .
~notiv.,jy, .,;ther a remO\la bi e o r fi<ed retainer
!e.g. TPA) can b.. u,cd.
potients Over 16 yeo" of O\l e o nd mo l. potients
over 18 yeo", of O\le in whom the mid paJoto l
su"' re 1>0. ou ilied. Surg ka l .epo rotion mcy 01.0
be re-qv ired in po tia n" exhibi ting it'ICr8osed
circum ."".;lk"" rig id ity "' " r~sul t of oging .
Maxill ary e<pon, ian co n be brou g ht
obouj by . urgery o lo ne o r by $urg~ry o lon g with
o rapid exp o n, io n o ppli once . Th e , urgico l
procedu res u,oo ll y co rned out ore ,
o Poloto lostectomy
b, Lotero l mo><:ill ory osteotomy
c. ""'terior maxill o')' osteotomy
CLIN/CAL T/PS FOR R.M . E.
O ro l hyg iene in!ilru ctions sf>w kJ be gillen to
th e pot ien t ond re info rce d d uring the
proeed u,"
2. Orthod ontK move ment of th e onchor teeth
ohov kf be ovoid . d prior kl ropid moxil lory
expcm , io n, o. mobi le teeth do not o ffer
adequa te an c hora ge fo r pel lato l , piit,
Recentfy moved teeth tend to tip.
3 The pelt" nt ohou ki 00 troi....m to uw the key,
The k~y . ho uld be jied to 0 string ond the
free e nd .hou ld 00 secured arou nd the
patie nt', wr~t to ovoid ocodMla l , wa!owing.
4, Moxi llary ocd,-,"a l ra d iograph, shou ld be

,SURGERY AS AN ADJUNCT

f'otients who o,h ibit unu sual r~s i 't ance to

oeporofon of the poloti"", OOne' moy requ i",
..... k al inle,wmtion, This ,,"oo lfy <xcu" in lomale
 10k.... 01 regulo, inlarYQl, 10 man~at
oxpanoion.
5. The pos! ibl. immedial. aI/em eI p"maTvre
opp t(l(lC. """""" Iir"Idu de diU r. ,. , pnm ur<!
01 Ihe bridge o f no .. , p"". ure unde r eyes,
b'ondoing of oon lissLM$ ~"' tfle eyot, etc.,
The" oyrnp tom. mot OCCU' an remOoI 01
.... CfIIltCl"lO!! fa, "'poi, at Ii",. n" lui".,. The
pallentl should tho,,*" be kept seated and
o, ked nol 10 .Iond immediolel, oH.,
opproonce ,."""",,1
SLOW '''PANSION
Accord ing to the ~11 01 slow e'p" ruion.
the .....,its a~ """'" slable ...hen the """,,110,., orch
i, ~panded slawly 01 a mre 01 0 .51 mm pe'
week. T.... ~gen~bysuchpmcedu,
I, much !owe, ;.". 24 paund,a.ogoinsf 10.20
pound. gene,ote d du,ing 'opid ma. illa"
expc"lio n. Unlike in 'opid "",," li a r)' expon";on
wkare tM treatment i. compJ ct<:-d in 12 we.ks,
~ow ex;:oansio n moy tcke as mlJci, 0. 25 mor-r.h:. .
Slow . "",,, sian has !>"od,~onolly beM
""",ed demHIM.oiorexpansion, although some
, k,letol c;hang con be obMrved. T....,.1ower
e..ponlion Ikhniq...,. haveoloo been 0I0S0d0!ed
the """",n";on, produong 9",01., .labil:ty ond
,010pl' pottn' iol rhen in 'apld """'~
procedures.
APPltANCIiS USED FOR SLOW " . .~
SION
"""" 10' slow e' p<l",rn (~g 10).
' P'&Od o ut octi ""ti"n . chedule. r .... $C 'Ow' u
kn lowcxpontio n I
",ed in R.M.E.
Coffl" ,p,,"t
Ti". appliance wo> desogned by We"'" CoIIo'
oroo..nd the beginnIng 01 rhi> .:emu,., (h g II ).
is 0 ,."..,...,b'.e oppliQI"IC. CQp<lble oIllow o:IenI.>
olv.o lo , expO"lio n. The appJi(m ce consiSlS cI
a n cmeg<l .haped wir e o f 1.2 5 mm thi d",. ,,"
pJocod in the m id.po loto l reg iM. The Ir ue.nck
al tne orr.ego .,.;", '''~ emb~dded in oc<)foc
covenng !he I~ 01 the polole. The IPring it.
cdM;rrod by pulling tn. """ ..des Qpon MQn..,a,.:
h con 0100 be octJ.oted by ",in9 rh..., p'ong

- ....
WIth a more pIr;>ioIogic ad;~_ 10 me """"Icry pi .. , . Collin spring i> belioMld 10 bring abo'" 0

fll'''' S'ow. ,p. nsi," RI p," .. , on, 'on

TY!)II 04 _~'" .... "ly rIIIt.li1 '

- ".
,--
_no....,
!WIoI.~
TjIlt "' ...... _ "'"
....
...... ,",,",\>(lit

~oI_ ..

......
tror_",,.....
T rpo O\~
, ~-

~-
,~

Ei:Ioer ~"" OJ ~
M, .~
--
- 1.IO.1y ~"" I",fit>:t
Bri<>:t Mol> 0( ~Wj ~I.tt
U.,,' ~ of (~_ !.lor. <:".iIQ of .......

- ,
 10 1"1 ~.m,.ob" m"rI,,, ,low ,",'00"0 " oppi"' " "
_ " " kilO pbe.
G",to. clv~cr exponsicn , However u of thi'
q>plkmc:e in younger potient, i< b" lieved I:> bring
cbovt .orne omovnt of .... eleta l 6xpo nsian.
opp lianc~. used to o'pond 0 normw
;( i. the quod he lix (fi g 12). It i. ,a id to
....... e evolved Irom the origina l Coffin loop, Th e
....,., heli' incorporate, four helice, toot increose
f>ewi", longth, The ",iore the flexib~ity and ron ge
.... oction of th i' app lionce is more. The opplionce
is co nstru cted u. ir>g 0,038 inch wire 0"" i.
so ldoroo to ba~d. O,n the n"t molm. ,
The quad he lix coo, ist, of a po i' of
o ntenor heli ce, and 0 po ir of po,te rior h. lice,.
The pOOioo d wire between the two a,tmior helice,
i, GOliad the anterio<' bridge. The wire between
th e onterio<' and po,t.,.,lor he lice, i, GOliad tM
polotol bridge, The free wire end:! OO jlXMI I:> the
f>O,terior "elices m e ca lled wte r arm, . Thev re,t
a ga in' t the li"9,-",,1 ,u rfoce of the buccol teet"
o nd Ore soldered on to l he li"9uo l "' peLt of Ih e
mol or band
The quad helix can be ""00 10 ""per><! a
narmw arch a. _ II a , I:> brir>g a bovl rololi on of
molar<, II can be pre.aclivoted by <lrelching Ih e
two moI"r band, "po rt prlor to ceme nlotio<1 oc by
""ing lhree prong 1'100 afte-rcemcntation (fig 13).
The quad he li x bri ng' oboul 0 . Iow
denlo-a l"eolor expo nsion . But whe n it i, u,ed in
childre n during the deciduous and eo rly mixed
denlilioo period" 0 , kelekll mid -po latol , pii" ing
con be och i. ""d.
Arch uplln. 'Qn u.'nt fIxed IIppllllnce~
Arch expo nsion can b" ochieved in a palienl who
i. und e rgoi ng li>e d mec hanothe ropy_ Mil d
expon .i o n con be brought about by us ing
e<ponded orch wire,_ In odditio<1 opplionces ,ltCh
 I, _Nl,NO""",ondC"~'... , ""'"
011 "'1'"
paklto '
,19'199
"FX>''
00 , Am

f ig 12 Q"", ".. 1,

,
os !he q""d ...Ii>< or the Ironspolo101 orch con be
used olong with fixed machonotheropy.


\0 Ho., , 1'010,., ~ ,.,.. " . O" J.. " ... beg;,,"'11
.~ o~hc _h "'" J C!.+<>O 1970;21"-

)), _:'" ~.<pO """" oI i \o",,~ ""~" ," I _

00..... ",wi <om, b,. _ I' g " , mid pakooj
....... Iv{ioC!.+<>O 1961;31 73-90
11 _ ~ _ pall , .............. ~ rI ....
"'.......... _ , . Ar!)lo ""bod 1930, !oO le9.

'"mopa\ofl "'_IvY-
13. , ...
ito
cl_u-, _ _..,
, _ _ ... br 0_
0I+Qd 1965; ~ 2(1).

A '" ,...I """""""' "'"

I( 10<>0 ; Con,,,,1 of 11-. . ""n,.. ,.. "'_"" ...
""11"'"1 Am 1 (MJ.od I 980 , 2 SO
X..
15, la,O\i" '" : ~oct '"""po'"" .ri"
,I o ~" RM : . Am J o...hod 1 9~1,
"'''''>g
""" J71 .317
f,om

B
f ig 13 I~ G..oJ n.r.oC"O<Oti""!a."."j,, . _,~""
,~"" " '" '''' .... ~_ (Ill Q.<>d 001 10 o<"><IIion fo'
01"""",, ' and <o ,,,..~ c. ,.. ''''''' 0'0"Il .......

j i
.,.,.;!h orIhodon~( ,regImen! .. root fleW.
E.to bli shm e nt of no rmo1 functi on a l
bola""" with supporting .t<udure.
Most e.Troctiono are perlo rmod en po rt
use 01 on I)pplionce . The nature 01
:::::::~:,~;;~decidingoI 1'11e
in
age po ,;"n! "'0')' be
v.+.ether o r no! to
10 e.lroClion. Erlrodions in orthodon~o
. ",;,,1 ~rlroction corried out 01 On
com odout a .
To extract 01 not to 8>1'0<1 hOI always
a nd will olwoys remain a contr<)Ve rs, in
, The g reat exl>"odlon conlfO'>WtJ oI
"",s based on two school. 01 thought
th@ philo>o p'hv Qf lWo pion.eer. in
onhodon~a namely. Edward Angl. ond hi,
IIII.dem CoMn Case. The larmer OOvocot.ng ,..",.
""''''''lion ""'"" the klttet rocomm . ~ e.lroc!1on.
Edwtrd A"g ie be loe-ed that en ind Mdv::.1
VWl. wpoble 01 having 32 ",,,th in nonnol
occlu.>on one! orthodonjjc ~Imo n! lor nery
poTi ent invo'-'ed e><pa n.iQf> 01 orche1.
CoMn Case o"ilved If'OI~h arches
could "Iwoys be expanded lOthoI Meth could be
ploced i~ ol'g"me nl, ....-the< e$lhe!ic. no, stability
would bo $Oli lloclo ,), in th e long t.,...,., for many
patient>, He "'us odvocoted extmdion of teeth.
By the late 1940', ".I,oetion wol
", introd'-""'<i inte c.1~t>C1 by C,""rles Tweed
.. ho o ~ thot tr.. !X>II-troolment ocd\Jsion
'0001 rroore ""bit ... potiena ~ ... tII 8Jd'Od .....
ollou, ~rst p<emolo ... By the eorfy 1960', "..""
InOn ha ll 01 th e orth oda ntiC potitnts ho d
_clions ohome teet~, ~wo l~ but """olways
~rsr p""",,olors.
fig
d""-",,, III 10."""
THE NEEO FOR EXTRACTION
oi.,.. __ .. on'
1 room '"""""'" i. _ _ '" odo lot>gIh <Ou_ ....... "'11 01 _ . W_ ........ "I1 oLo It> _
There ore number 01 d rcums10nc., thot
necessi101e C<In>dion of teeth os portol routine
orIhodon1lc ~lm ent. They ore listed 05 follows .
Arch l.nt/" tooth mflterl.1 dUe,.,.ne,
Ideol1y1f>o ordt lenglh ond IOO1h m"""",1 $hould
be in ha!monVwi\h eod1 0"-. The ,ize 01 !he
dentiti on and arch lengtn ore u."" lIy gem,ticolly
determined. Tn e p'cloence of tooth moteriol in
_ess 01 the orch length <;On _uk in crowding
01 teeth 0' prociination of onlerio" (fig 1I.
In many <Oloe. tne tooth materia l. o,d1
lenst " d i, proportion con not b.e t,eo ted by
inueosing the arch length. Hence redllClion of
tooth morerial it the only ohemotiw>. uhoc:rior .
of one 01"""" 100110 is resorted 10 in case of...-...
tooth moterle l . oren I. ngtn discrepancy.
Corrutl.a 0' gnu, "". ,arcft
,.'.110"'.',.
Ab""""tJi oog ittcl mo lrelaticn,n ip.s ouch os 00..
II or Ciou III mo locdusion fI'IO'\' requ ire exlrceJk>n
01 teerI> 10 oct.i"'. nonnol JOQinol inw_ch
... lalion. The """"clion 01 tee'" in sudl <;Oloe.
1,..','. in ~:'obl ist.ing normol i",i lO ' and m~at
'0.. of.do Itogio _q
relotion'h ip.
-'<01 ~,_.
k .. (1 lnOW" /ocl thet exlrodion oft.
ImpoirS the /or.oord devdopm ..'11 01 the oJ"nt,II
arches ond .... 01..."." pnxflI. ~." :''::''~
of " lta in teeth in Angle'. Clall II ond CIo" II
I
ma locc lu sion , imp",.e,"''' oogiHo l 'e lolioosllip
not only br tooth JTI(IYtIfTIent bul o*, br sei..ar..
Iorword w<1h impairment.
Angle " Cla n I : The.e pol iMts 0"
o:no rcct.ti1ed by 0 norma l ~ itl(ll inle ,orc!>
relotion. Thus ~ is not od.isDble 10 discourog.
me deoeioprrMonr 01 one denlOl of'l:h more !han
!he otto.r. Hence in Arogl.'. CIon I COSel, it i,
,..-e/erob le to "><Iroct in botn tr.e arche .
NrQIII', Oou II , In most Cia$> II cw.es. the
uppcrr dentolordl "Iorwordly pIocod the lower
ora. ploced ba ck. Th .... br W<lfa(:ting only in me
"PP'" Old! it i. pc"ible to redu ce Ih~ ob normal
upper prodinolion ond a tso 10 discourage the
forward development 01 the uppe' ordl.
In Angle', 00 It casel, ....nere !her. is
lower orcn crowding orme m~a " 0'0 not in f,, 11
0"" II ocd,,",on, ~ may b.e neceuo ry 10 exJrOCI
In boll> the upper 01 _II 0. me lower arch .. to
ochieve proper inter.orm ~ation ond IoCOrTed
ttoe crowd in g.
 A B
c
kg/e'. Cion 1/1 It i, beneficia l to avoid
_ ction in the upf>er oem a. it moy affect th e
bwc rd d.weiopment 01 th e mox il lg , ~ I . '.
Oou III co..,s are preI.r<>bfy treoted byextroction
cnIy in the ""wer orch or by . xtra ction in both
,"",
AlIne.nUII,'n and form of teet"
7ee!h thot are obnormo l in ,i,. or form mol
':!ea!SSitate their exlfOction in order to r;lCh i. ve
Elisfud"'Y occlu.ion . Such onomo lie. induoo
~crodo nti o, .e ver. ly hypop lastic teeth,
dilDceratio n 000 abnormal CCOWn morpho logy_
fig 2. (/oj In "","" " elm, I, _ ,
it ~ Mmob"10 OXI""" ;, boo,;,.
"",ho, '" +0, +. ,,,,,,*, """" -
0'
t" jow. I, ",o;"o ;"d IBI In
~"; I . '. Cia" II, "p'" Q""
" ' ",,,Ho", hoI p "' d ; ",,,w"'l ; " ~
tho forword ~ rowIh of mmi llo (0
10 An;'. ', CI,,, III, low", " "'"
" ",,,,10." holp '" di>co,"og i' g
,.,. '""", rd g """';' of mond;blo
Skeletal Jaw mal,. lilt/on.
Sovoro "o lelol mo lre lctionship of the jaw. moy
not be .otisfoctori ly treoted u<ing orthodonti c
appliances a lo ne . Surg ico l resecti'e procMure,
obng with ",tril<:tion moybe roqu irod in ,ueh
case"
THE CHOICE OF TEETH FOR EXTRACTION
T.... deci. ion to ",trod teeth d urir>g orthodontic
th " ropy should be 00.00 on 0 .ovnd diog no'tic
e<crci.e , Premo"'" are the mo.t co mmonl,
extroct"d teoth 0' port of orthodontic treotm ont
Fig J i"l, 1<><,'*'''0 i,,,,;,,,, inoo1eJ I", "~"", ,,,, r!i ,od ""~ of ' '''' "''' "'. "'"
~ci.", ndkatod h . ,,=100
EXTRACTION OF UPPER INCISORS
T.... ffic><illa ry incisor> ore rorcfy e1trocted m a
p<>rt of orthodontic theroPI. Ho_ver, tr.ere or.
ce.1o in condit""" wheo one Dr more of t.... upper
inci,,,,, mal oo\"e to be , acrifi<ed .The f" lowing
Or~ "'m~ oltr.em
c . An unkl\"arab ll impacted upper i nc ~or too .
cannot be brou ght to norma l a lig nment .
b. A bucca ll y / lingva lly bkx;lod GU ' ia t~ m l
iociS<:<" with good contact between tM centm l
inci'Dr 000 con i,.., ca n be c, troctcd.
c. II on e 01 the lateml ioci",,", i, C0!19M ita ily
mi ing, th o oppo~te lot. ro l fficry hov~ to be
eidroC!ed in orde r to ma intol<1 Ofch .ymmetry.
d. A grossly carious inc i"" that con not be
restored may ha'e to be ,acriked.
:C! o..J ID) Scpplomonbl ,,_
~. Mo llormoti o", of indS<:<" crown, thot caronOl
be re.tored by pro.the' i" moy noc",,;tol<
tr.eir extrocti on Ifig 3.0) .
I Trouma Of" itTllpct roble damage to ioci. ol1 by
frocture may ioo icale their remove l
9 An inc isor with d iiaceroted root ca "not be
efficiently moved by orthodontic thero py. It i.
he""" prelcrob le to c,troct them.
EXTRACTION OF LOWER INCISORS
Extraction of lowe r inc i",,, $hou ld os for o.
po"ibl .. be ovoided . Th e eidroction of 0 lower
incisor to ~ ieve kJwcr anteriar crowd ing ~ otte n
foll owed b, ' M oo rrowi"9 of l ow~ r intercon in e
wid th, retrod inotion of lowe r ind""", , deep bite
and re-{Jppeo r ortC~ do crowd ing _ This Ieod, to 0
co llop,. of the lowor orch.

The reduction in lower intcr_w nino wkith
often leads to a secondary mductk>n in uppe r
..te r< a"ine width relvitifl 9 in upp-. r ont" ,io,
crowd ing . The extraction of a lowe, anterio r ' " ""
"'" fx;,,,,, for r= hing conseq,"""e, ~t o re be,t
"",,00d.
f'; ~ v,...... 10''''0 1 ;,<;oc r -0' 1, bIoG"j I'ng-JO I, w;h
)0""" be,~eec to. ""-.,,,1i "" ", or" ,", i" , Sec,
- .1. mar be . " ",,;.d
f ;g (AI t (!r,low.' 10",,,,1
",,;.or ;mpocted. n.. poo;<on
'" tf . ,,~'" ind "" i, deop
'"" ;, ,,10'" ",.0 1. for
,"""""I."" "" lof '""",,, by
ort,oOO"' ;; ' ''''H mont
,(0 Rw""" ,,",,, 0' tfoe 10""><
"".,,"'-
r""", a re howeve.-rome conditiro, wh" n
a lower inci. or moy hO'ie to be "xtrocted
a_ If one of the inci,,,,, i, comp l~t ~ ly out of the
o<ch with good inter_denia l co ntoct betweM
the re,t of the teeth (fig 5)
b. A lower ind, or that we. trau ma tized, 0<"
", hibiling sev~ re carie., ging iva l reco" ian
or bo,", 10" may hove 0 poor p-r<>goo,i. _
c_ p"",,,,, ce of severe arch length delkicnc:y is
often charocte<i<ed by tr.., p"'.er><;e a f lon _
shoped flaring 001 of th e lower n d.c.-crown._
In the", CaseS it ma l nat be po"ible Ia flatten
the lower a~tcrior regno nt by extracting teelh
furthe r distolfy in l he arch. Thus one of the
i", iso" may have ta be ext' ooted so o. to
improve the crowd ing c:o<>od axial inolinati onol
rest of tho inoi,o,,_
d. In mil d Ck", III ca.., with Iowo r irodsoc
 crowdirlg, one 01 the bwer indKn may be
6<II0dIId to od>ieve nonnal overjet, """,rbile
UJltAeTIOif OF CANINES
ond to relieve crowding.
CGnines Gte " ' " frequen~1 emoctecl 01 0 pOll 01
orthodo<1lic ",,,,,Im""I. The exl'rndion 01 <;(1"'_
II .o ld TO <;O UI. flott""i,," of foce , olte<ed focial
bo lo"" orld ch ong e in focio l 8.>:."",,, ion. In
od ditio n th e contoct produ ce d between The
premolar orld lote'ol indw, il rcref,- scti,focloly.
Som. ol th. c<><>dilior IInder ",Mch
con"", moy h(M'! to be e.troded ore :
o. The coni"",.r...1op for owayhom theirfloal
Iocorion. In oddilion they no.e 0 long poth
01 eruption /rom their liIe 01 development to
their ~nol posaion in the 0I'tI1 CO\Iity. ThUi
the <;(In,n", 0'" highly ,ufCephbie to ectopic
eruption ond impachon (fig 6 Qnd 7). Such
""foYOfO\w,. impa cted can;"", or conines thai
fw:tve erupt&d in unu;uol locoTioo1l m()y hove
10 be ",",o v,.d.
b. A co nln . tr.ot i. completef,- ouT of th e o" h
with .-.osoroo bf,- gQod conl<lct betwet n 1M
lo te,ol inc" o, end fi"t premo lo ' I, on
fie 7 ~ /; .... \o.o .... b ~ ....., .... ..w<' ... ,..-0. "".
boo .......... ",";0 .M'c.o.to .. , ~ .. ~ _ _ ..-. Gr~" Indkol>on lor its extrcction.
...., _oic: ......"... (l!I ~n cl .... _ _ c. PrerTOl\lre shedding 01 0 dec.id\lOOJ1 conine

rOIl 8 ~ E>:!t"""'" of rr>! ''"'''''''''' g;"'" goo .... ,.,~"'io<
"'"'<Iion. \'8) "","'<I,,' of ,,>C"'"~ pr>mcior ",<un h Ie" 00<",,",- pon"'+,- ,,," ... .. "'. +. PO' ''no~ ""'""
1o<v.<J ,"<!,. T' ", I ,,_~... ;, '''' lobi. ;", .,., ..,. ,,"",,",n
U''''' ))1 ind icot" 1 th o extrr;ICtio n of ito fe llow
on the o ppo, ite ' ide of th e oreh to re\tOre
.ymm etry.
d. In C lass II ca,e, if the low ~ r dec idu ou,
conine. or h. d eorfy, the up.,. r deciduou.
conic"" shov kJ 01 ,0 be removed '0 0' to
o,oid wor!<' ninll of the po.t. normaq (Closs
II tender-ql.
e. In Cl ol, II I co if Ih. upper deddvou5
co nin e. a re . hed ea rly, it moy oecess,late the
",troctio n of the low~ r decid uou. conin to
""oid wo"e ni nQ of the pre-n o rmoky lei,,,,
III tendencyl
t DeddUOl.>! COn ine5 moy be ",trocted os 0
port of se, i<ll exlroction procedure,
EXTRACTION OF FIRST PREMOLARS
Th e first p'e mo laf5 ore the mo,t commo-n ll
extracmd tnnth 0' port of o rtr.odor>tic Ireolmef1t.
The reason lor their e>dra d io n i, o.lolkJw, ,
O. Thoir localion in the oreh i, ,ueh that th e
'poce go ined by the ir e<traction ca n be
ulili,ed fo r correction ooth in lhe a nte rio r o.
we ll 0' th~ po, terior reg io n.
b. The conloct th ot re.u lto ootwcen the con ine
o nd ,econd premolo r i, soti,fado ry
""""""'Q' .,,,,,,,,,, """" """'.
~ O'>'Q Iohlo fo! 0 _
c The oxlrodio n of the I,,,t premo lo r leuves
be hi nd 0 po,t erior , e gm ent tho t of/ef5
adeqvote ancho roge forthe retracti on 01the
. ix o nte ri o r teeth,
The fo llowing 0'" """ e 01th e indcot"".
for fi,,! pmmolo r extrocti on ,
o They ore tho t th of choic" fo r "xtroctio n to
relieve moderate to severe onterior crowd i,..
oilhe up.,. r or lowe r oreh (fi g 9.01
b, The firs! prom olors oro eldracted forcorrect""
of moderato to ' evere o nterior proc linoti o n
a5 in a Clo .. II . divis ion 1 rn o locclini<ln oro
00$$ I b<dent~ 1 protM ion {fig 9 . b &cl.
EX TRACTION OF SECOND PREMOLARS
The ind ication for oldroctio n ci second premol"",
,.
Q. The extroc\ion of ,ecood premolo" in,teod
of the fi r>! premolor< r". ult. in the Q~e
of the o nte ri o r "'gm"",t be in g , tre"llthened
{fig 8). Th u. o n e.wirorvnen t i, ( rooted thot
favo" me",, 1movemertof the pooterior ieeth,
Th e second pre MO" Ore u, uolly extracted
to treat mild o nterior crowding . The remo ining
$pOce con be clo,ed by cantrolled "",. iol
moement of tfle molo".
b The <eCOM premokl" are usua lly e>d roct.d
wh en 45 mm 0 1 onchorog . 10 .. 15
de liberately des ired,
c Wh e ne v. r the .econd pr e mo lor> are
wfavorobly impocted , it ~ preferred 10 extroct
th.om mth.or tMn the li"t pr~ moIo" [fig 1 O. a
& b).
d_ If e>trCldions ere to l>< U"" . rtokM in ope n
bile roses, ~ i. prefe rable to e>dract tM "",ond
premol ars 0$ th. ir ed m elion """o um g'"
deepening 01the bite_
e. In case 01 grossly cerious or deeply li lled
.ecO<1 d premokl " , it i. wi.c to edmct th em
""" preserve th~ li "t premo lo,,_
I, Eo, ly 10" of a dedd lJOU. mol ar moy cou ...
forward movement 01 tM li" t permon en'
mol or leovir.g in odequote 'pac" for the
...,cand premokl r to e rupt. In . uch ca..." , fig 9 l oJ~ot"" foe f'T ",,""k>, ''''''''''''l-'J s.--.
tfle -",cord bicv'pid erupt< completely out of
om' " "'l ;, usuo: ~ -...clod'1.,-"""""" 0' f, premoIo<
(I)! o,d Ie : a;"", I1 ", P''''''''''" " , 01", """,od br
tn.. on::h_ Such 0 tooth moy be indicoted lor o,~""' ''" of f,-" "'-''' '''''''
e>iro ction (fig 1 O. CI> d ).
b. Th e e,traction of the fi"t molor re, ull> in
EXTRACT/O,. OF FIRST MOLARS deepening of the bite.
c The ,econ d p<emokl r OM mo"'r moy ti p into
Th e li " t molo.-. or. r>OI commonly e,trocted in the extroctio n 'POCO ,
(O<1 junction with orthodontk tMr0PY. E.troction d. MaslkotiO<1 may b.. affected,
01 th~ fi" t pe,mo nen! moIo" i, ovoide d fo r the Th e indi catio n' io.- fi" t molor e>1mctiO<1
following reosons: arc 0' foll ow. :
o The ~>d=ti Of'l of the fir<t moIor doI" oot g ive 0 _ Min ima l.po-ce'req uiremc nt for co,nxtion of
a dequotc >pOe" in th o indoo r region mil d antorior crowding or mikJ p<oc linotion,
fiv 10 I"'oor "" k>< ,,,,,ono:! p'.,.,. oio' ""mo." ('0,1 0"<1 (~: eo>or ~ >e<ond 0" ,"""", t::) ,"<1 iO) ,ocone ",...,. oio tot
""",,,,,,,,,t
"", ... , blocb.J ~", ,",,, ~, TI;, cc," "'''' ~ 0"" ' D 001) " .. a' doc"""",,, "",o..J roo or ",." ..... 'n!he ", '"
.."." drif<ng "," ,,," ~, Tho _or<! p'",*, ;n >oXh ", .. , """ ""''P' I"eg '., ~ .;.. '" ;...oo.q-"", 01 ,ooeo

"- Gros,f,- docayc<l mol", or heel"'1-; fi lled teeth, Wi l'in ,or,". extractia n ho . 0 nu mber of
e. Open bite coses con MMfitfr<>m "'tr""tion drowb"" k" The fofbwir'lg are ,ome of th em :
of firlt md or 0' there is a tenoo rq for th ~ a . Th . e<teaction a! first molors off"" li mited
bite to deepen offe, e<trocti Ofl of first mO "" r$_ <pO L ~ to reli eye crowd in g,

b_ Th . ,econd bi cv<pid, OM second mola"

WilkInson ext,ectlon rotot. a nd moy tip into the exteadk>1 ,poco,
WiIkin", n odvocoted e, tro d k>1 of 011 the foo r forst <;_ Th~ rem ovo l of the fir.t molars d" p<iv~s the
""""anent moIors M!ween the og o 'of 8 1/2 " orthadont~t of adequate otlCf.orage f", any

9 1/2 yeors , The 00 ";, for svch e<teaction. i. th e orthodonti c a ppi ia""o
fact that the first pe rmonent molars are highly
"",,, ptihl e to <;o fie, _ The oth er be nefil> of
e<!r<;T<;tin g the fi" t mo""rs ot on eorl-y oge ore , EXTRAcnOH OF SECOND
... The.. "'<!rodi"" prov>de. add i~o",, 1 .pace fo r PERMA NENT MOLARS
eOJption of the third mo"" rs , Thu ' impoction
Tho o.tro ction of ,econd permonont molar>
of th ird mo lors Can be "","de<:!.
afthoug h not com mon, is ad.,>coted Ioro number
b. fn go""",f, cr~ in g oflhc arch ~ mini mized ,
of rea.o n>, os folbw"
Thvs the othorteeth hove a lower ri<k of corie<
A. To prevent third molor impaenon : The
removo l of cond mokl ... oos been advoco!ed
fo r the prev""tion of lowerthird mola r imp<lctic<1 _
The ca,", thot benefit from >lJc h e<troctions ore
tho ," wh ere the thi rd molo ... are uplight or not
ti pped mesia lly more thon 30", Upper s.""",d
mo., r extmdic<1 if a mi ed oot plior to the eruption
01 the third malo ... , re,u lt, in "'Ii,factory th ird
moklrpo,jjioo ,
S_ To re lieve im pa ction 0/ .econd
premo/a", The premature loss of se cond
decid uoo . molors i. u.ua lly followed by fo rward
d rift of th e fir51 permon e nt molors loov ing
inad equote 'p<lce to< the ,",eond bkusp'id. to
eru pt. The e.tra ction of seco nd mo lar:s in such
Co,e' may a ll ow the di,ta l mOvem ent of th e fi r:st
permonenl moIa ... t..ereby olf. rng .uffidt >pOc.
for the second premolor:s to .rupt.
C. lower indoor crowding: Very mild
crowd ing in the cnterior port of th e crch con be
rei ie,-.,d by e:dmctic<1 01 the secood moIa,,_ Some
a utoor:s suggest thot ",traction of seco nd mok",
min im ize. anterior imbricati on or>d crowd ir>g.
D. To . nobl" dls!oll:o!ion of /ir51 malo,. :
In co.e. where the fi " t permon ont molars are to
be dista liled, the extroct"'" of secood mala" ca n
benefit the procedure ,
E. Open bite eo.e. : The extraction of th e
second molars deepens .1", bit" _ Thu s they can
be eO<1,idereo in ope n bito co,e._
2XTRACTION OF THIRD MOLARS
E<trocl ion of third mdar:s during orthodontic
tre ot"",,,t does not y"id ' fl'O'e tf>ot can be uoed
Iordocr~ i r>g or redoctic<1 d proci irlatic<1, Third
mala" ore . >dract. d for orner reo5Ofl, os !clIo,",,'
a, Gro,sty irrp:>ded thimrr.>Iars toot are uoob/e
to erupt into id ",, 1 po, ition o r. u. uo lly
e>drocled ,
b. Th e e rupt ing t hir~ mo l ~" have
im plicated to be the couse for lot.
ant" rior crowd in g, Altnoug h _;;:~::::;,,:::
not be"" confirmed it ne,erthe!ess
some rol e in lowe r anterior crowdi"ll.
c, Ma lform ed third mol ar. thot interfere
notmo l occlusion ,
BALANCING: EXTRACTIONS
R"moo l of a tooth fro m one . id & of 0 dera
arch resu lts in 0 tende rq for t"" rest of the _
to move towords the e>troction >pOee. The 1_
distal to the extradio n.poe. move into the sp<XZ
while the teeth me. io l to th o extraction .poce alii
01 . 0 move di.ta lty into the 'poce, Thus rt.t
mid li nes of the orch moy shift to tf", . id e of If.
extrocliO<1 spooe , To ovoi d , uch unesthetic ~ hil:s
of tf>e dento l arch , OO lo""in g extroctions are
OOvooO!e<J _Babndr>g I!)(\roction refers to rerr>::>.d
of onoth er tooth on the oppooite >ide of the same
arch.
COMPENSATING EXTRACTIONS
Compensa ting extraction rde" to e>droetion cJ
teet/, in opposite fows_Compensotin g extradioos
are carried out to pres.",. t"o buccal occlu sal
re lo tion,hip_ In a CIo" I re lation it i. u.uo lly
adviso bJe to extroct in both the orch.:s to preserve
th e M Lal ""d"",1 rclotrc.->o hi p,
EXTRACTIONS OF PERMANENT TEETH
WITHOUT APPLIANCE. THERAPY
/0ost thernpeutic e>tmctions "'" followed by <dive
opp li once th e rapy, However the re may be
in,tooces when ", traction of a permo nent tooth
not be followw by orthodontic th eropy for voried
reo<on. such o. non oai lobility 01 . peciol;'t,
 potien! un .u ito~ . for~>:ed oppl''''''. theropy el:;;
Tooth hove a natura l terxlencyto drift into
~. e,troctiO<1 'flOc . The eidont of th ;, tipping vo""'.
from po t" n! to pati onj or><! d e pend . on variou .
""-
~~
A.llnl. """,""",,~
II . Totally _ buoolly O(~ lectors such 0. the extent of croWding and oge of
C. Ir.ca$O_la!ertOlio~
~. flo

O__
, G"*'Y~
oiI>ot ",.,."._
10"- .i<mIetrY
_ \hfIt_bII
,
> !he pot""!. Tho Ior>g tt: rm effod folbwing exlrodlon
01perma nent teeth i$ th e mesia l migration of the
p",tcrior tccth. the me,ia l drift ~ ",,,,,, II , rapid in
, _ ..tI!prnotI'Ioolo
loong age when the teeth am ,til l in a , tate of
"

---
f, lliaeorOCod ~
IlCtive e nJption and the ioW5 are , ti ll growing.
Extra cti on. of tho lower lirst premcHOr is
A. T""""' _bu<dy"'~
II. s.-!y " " " " - . ~
otton a,sociated "..;th .po ntoneo<J' decrowding 01

_long" do!t<;;onc,"'h
~ '" bono 10 .. the Ioweranlotiors. Such sponlane<>JS de<:rowding

-.
C. s...-
by drifting aile. th, relerred to '" driltodontics ore
,
f....,;"g ~lowe"..,temn
le.s freqU<!nt in the upp~ r orch
A. Ett>pioary ""-'P!tO or
~jmp<IcIod While cono idering . uch extraction. it i<
II,ToIati_ bocdyor ingu>!y always (KMsabi. to .xtroct in a ba lorICe<l manner
C.~oamo . _ ..
I'M of ..r i a I _ >0 0$ to preserve the inlegrity c1 the orch , EdrodOi1
of 0 permo n."t tooth on 0"" . id e of the orch
To_~to_

--- - __._i>
~- ~or>1~ wookJ re, ult in ,h iltin 9 of the teeth toward. the
extraction.pace Jeoding to non-coirlCidence c1
~ , To rtIIol>O noOI; ~ ton<l
the mid li nes and o.ymrnet"l, Another Iodor is
~
!he ooccal occlusa l relotionohip_ Mc~oI m';lroti on
B.lIn"VOIJIo!>!y~
C. In opoo II!Ioo. rilty .,. ~~ tendMc;e, moy often upse! th e ooccal o-ccfu",1
", .. Irs! (lftIrnoIar> .. ~01
bI!.i$~.
D. ff ~ t\ocoyIor n..'1oo'ge
, reloti on.h ip of the dentition . In ord<or to pr. ", rve
the re lationsh ip, e>drodiono may ""ve to be done

~-
--
~ "'" QUtOtlontbit progrmIo.
IMn ti1oy 'ro OXlIOOCod lo_ot:l\'$t

A._~~t '"
<Om<! itIId ~ '" proc~..i..,
II. GroiI>Iy ~dor 1>0....,
I\IIO~
in both the orche. vnie .. unw., migration co-tocth
mov""'''"t is requ ired in 0 f>Orticu la r oreh .

Refeten ce.

--
C. fn",,",, ~ .. t l1olr~
_ <IeepenirI; Of tlh,
Book <>rod H ",,~, h~noI op;co l roc< "" ","00. Mo
J o.1-ood 199~ ; 350361
2 So", "';, Eo-".",o H, "-"11 10 ,.,..., Cot.; , S, Co ..
A. TO _l/'IO>lmolar<npeclion hI""""", -.'" """O>drnct"", An. J a"Oed )992 ;
B_ To_trIpac1looofM<Ond 4M HO

-
-- -,-
~~lbIt <kIeIiutlon 0Ir...t

p!.OIIOMI. May tit."_for """'"

N<JI exttaclod fill' " " _
",,,,,,,,,0UCh .. _ _ '"
., j

- '~
3,

~,

5
8i<ho.o o'ld Ardoooon Th;,d
1983 , I J 1 I3 1
Bi<ho.o ord ~ ; 5e-coM molar
art'>od 19116 ;' 1 5 _ ~2.
,..,k",. Am J OrtOod
"'''''''ions. ''''''
so,ho.o, Co m"' "" """ Jo,,*-, : ~ ~ "''''
Ie< .,.""""n
J

doe<:"""'- .... J o.1-ood 1995 ; 129135

o. 0 ',,",," So<;o,.,o 0,.,0 tINed molo,,, n ... , roIo i,
J. - ~" - 0"",
orthc<Jon '~ ...... hn J C'>o+OO 1961 ; <98520
1 tt..ooI_"'-.... I._ ... _ . . ..... JOrhxI
196'1,8193
8. DeoooI, !>o-o;ol ..-.:on 'ft """cdc oicao Indoo< "'~
,~jl"_ c..! ~""' .... ,' 1"0<0< ..... Am J Ort-.od
195-<, i"O.! 9:l6
9. Clot.:!. ",d "" do< w.... . E""""" . ot't-.:xb.~
_ _ t, ond CM). "'" J 0 ,11 ... 1 9~ I , 2 102; 9
Ie, flo .. ,G~; ,,,,,, oi ""ploO<'oI ..... , .. ,;,1 .~ , oc
, ,", """ J Ort-.od '970; '.,~
II I<lowo< No",''''. _"",,", 0,"" ~l - Ei.c-.
o/ .... " .... ..-d,~ _..., ... or ___
001"0''''''' J 0.+"", 1991, _25 _30
12 LI!!Io, Wollon, 0;,1 Rodel , .y..,"",b,lo, """'CI
.1~"_ h'
I""mekor _ _ ..... _led to,.

...... 001-"",,,,, '" ..... _ 0""""
19a1 ;3_9-.165
13. ProIIr l\'l, co..-po",,, C ~ _o"'''. S' !L..l.,
0< ," """ T9'81>
U "'.... E MOl.... Hood booI 01 Ot!ho<lo","", "'-
Ix>oI< modl ,, 1 pcbh/-", ", Inc , I 9BB ,
15, 5k>do" Se."" . o..! Dob--.... <I : C f " ~al ,,.,. ,; .
""" ,,"111 "" mO,," ",II1oc1oo'iGl,~" j O.-+.od
19&9,453--4.\1
16. ~I<>ja." , f ... ...-""',, . ~ .,..to, !<ro j Crtd
11'94; 19_24
11. Vtg. _ ..... 1>. - . ..-.:I Koooo "" ~-"" '"
""I I ... '.-.ro. '" .... ..-.:I ......,., """"'"....
..... J Ort-..d 1990; 4 ~-51
18. Wei_b, V9< _ ' . ond 0:-0 .... . o..'><>doo.
"'... ~ ...... ..... J 0ri>00 1989; '62_. ...
 Appliances -
Concepts

rtl>odomic lI1!O""*'t(Ji"',otim~

O the est heti c. and function of the

or%do l reg ion . Mo, t of Ih~,e
2. Mro/v"ctioncl appiionQIs
o. Re moVllb le ~pl ionce
b. Ftxed opp li(Jno;

Msc;honkal appliances ne,t mild

~U,.. on {] """It. oro group 01 ~Ih ond theoir
O rthxlon~ c opp liance. oro dt vleu by '""pamog ,"""""" '" c pre.del.rm ir>ed direcri""
f il moy be app lied to ";Th The help ,j odiwl cOil1~....nich ore po rt
cobeTh or group ollOClh on<! thei. suppotling oi"., oJ)pl",,"",", iI>eII. Theocm.. ~ rncry
re,$O", to briog obout necessorych"'9'S include springs, elO$lics. SCleW', etc." Tl>e1e
. rhe bc.-.e-..hich....1l allow tooth rrlOWI_. appliances con be Mther dossiliod a. ~bIe
and fi)ced opplionces.
CLASS' I"' CAT/ON 0" ORTHODONTIC MvofurxTiona i cpp lkltx c, ore loose lit.
APPLIANCES ling 0( JIOSIMl oppl.",e8O thot ,,"mess the nGlu-
",11orce. 01 the oro-foc;oI muswloture wI'ich are
Inlnsm/nod 10 !he leelhand olYeob bone IhfQllOll
the medium 01 the appliance. n,.,.., cppHance.
Opp l. lr'ICS3
e ithe<" tron,mit, elim inotc or guide the noturo l
0. R...,., ovoblo opp/io nce .,o'ic>'oi mv.de Ion:es OtIlOlhe d" nli~o~ . Un li ke
b. Fi~ oppl"'nce mechanical opplioncH Ihe rnyo/vndionol oppli.
 ADVANW1Eil Of UWOVABLE API'U.l.NCE5 mSADVANTAGES OF ~EWOVULE

.""l.IA1< C'ES
1) Tho I.... tie ....... too ~ _ 1 - - ' " 1><1ho
_ " . . . . . ~ "" JiKjIorio ""'""'
~1ho ..........
"'_1MiICII'. ~
lot w.>l_Ii!' N""'"
1) .... "'" ;opoIiara can lot
pan ......... _, il.wr~
_>td,

~ 1) J.1ooI ~b:d , "" ,oep.;r'ng 1\lPin!I ~ 0I1>Il _ .... 10< ... _ 011110 \'111_

-
bo IUdiir otl!iocI O~ ...... _ 'obit ~ 21 ~<l>Io ~ . . eIDIibIt ..

-
, l) Uln'/ WQtjo ~_.., .. It<t 'Wi,,", 'I""", I~ tlil boo Gill! ~ """" ~ 1loio ~
INi>< U.. to.tk>I< 01 , _....
l) 1\onmIoIoo~"1IInad"1I1O_-,odO<Q_
_ sid!' ... 011110 0tI_,'" 3) ~ orUtpIt_ .... _
.1101iO_ ..... _too_
, 5) Nl ..... ~ ... ItoI<fW ... _ .... ,,' I .....
!IOtdo "'" ~ " poIlOr1t, 0.. OIl I~. TIl"'''' VIOIIIIIIM
. ~l Rwoo~ ~ bI~ oboI.o! ! ~ _ _ lM ~ ~ prok>ngod 11 east 01_
_1>rooo .... _ _ .... _Io<I:Ji:odif _ _ _ ....1\

... 1IlI:*~ .. _ ... W

"""' ... _ _ ;o_ II ,li,
IW!oio ......... 4"'" ., _

1) _
"'""".......,.,..
............""""'*
...... lot _ ty ,,",II <*Mal po><tOoioeo. $)
WIiIIQ_ ; ; 5 _
'" _ ~ odJaQiot\, I .. ...,
_......., ..,.. n ..... fIU ...... ;o poAtoIio 100 QIIQo~
... opo<iIIotIlO _ ... on __ <U'ioJl _ _T._
cb ....011d.oaI <PICO
P"I*ior __ toy

al Tho !-.:.ion '" _~ IW ~ flOOd IMlriYtn'ory, 71 AI til oppIn:oo In """"'"""', roort

9) Tlrt1 ",. rMr:~o/J 10M t""""", Nn lotd ~ . Io.~~m"....~
10) All _ _ '"'" as w.. _ <Ni''' tno ,... ... Ii!' lor
...____ .... ............
Iot_..........nr
_
.. ~a.n.
P.... _ 0I0N0I .......... ..

..-
_~....,
$)
_~_io.la9ro_oI
. . . - 0IIci ' ' - .... Ipplian<e
nl ~ ~iotao lI. 10.. eorospboou> "'"" IlIJhto. ""td
I) -~-Ii _ _
T/ify .....,e too _

121 ~ ~ l'1li OW! LtidesiiItW \:IrQOIon bo "'""""""

Ii!' ... ~iont,
-,
~I$f l

~
,I Cia .. Ii l1l<I CIIU UI
..,, -""obIo '1_

aoces do not U$oolly oonIOln octive COmponenl$.
F...-odioool oppliQl\C.,. en used lor growth modi
ficaTion p"xedures lhol " re a imed al inlen::epl.
ing and 'realing iaw dilCIe porodes,
60th mochanoa:>l and !he rnyofundKloal
appliances can be d asoofoed as remoYObi. and
fuoed DpplioncllL Rcm(MIble oppliorQ1 as Woe
ser1fId into ond lemo.i'>d hom the orol covify bf
' he pali"";. ~emovcble cppl i<>n<;a "fie,,,
nu m-
ber of odYcnlag e$ i " dlJd i ~g lhe obi lily TO moi ...
;oin "",I hyge ine ond Ihe nood fOl" 1&.. cha ir ,ide
~mc _ The mo,n drowboc:k of ........ oppliances is
tt... need Jorporilnl CDDPC'<JIion ord rhe inobiliry
)0 pcrl""" compte. IooIh movemenl$. ReIer Ie

nome suggests are opplllJOC.es which can be In loble 1101" odl'Onlo{ll!S and di".,a,.,.,nIoges of ....
'V 0
1 01"':>do,' < oppi "" o. W II".,!..,. o,, ~o <>oo "; !h I "P''''g. - """""b~ _'0,,,01Ofrl , ,,," ,:ill A """ """ ole
-"oo~QI . ppI , oao ioc<Hpom' ng 0 .'".., fo, (>" , ~"" (q & 10:, f ;,0<1 _,,, ~01 opp b ", () fir'''' """,do.
s b.d _ho, ~01 oppI &<:. , ,.,j fo, ... ~.,I """,..ion (1') Quod ~~ _ 0 , ..d m,", ho,~o' oppI&<:. fo, "V''''''''
""",o~ . app li ances , Remoobl" ep pi im>c. , are
offe' bette' control end a),o to c la,ge ", tOOl
0;IN(l1 ~ used for 'imple tocth mQv. ment, thot co n
remae the n"d f", poti" nt compliance, Table 2
be brought about by tipping. gie, the cdvontoge' end di.a dvantage; of fi, .d
Fixed opplieroces are tho,e that are fit- app li onc. " Fi<cd a pp li ance, can bring abo ut
led anto the tooth . urfoce and con only be reo variou, tI P~' of tooth ""'' ' mont in dud ing tip .
...,.,ed onlv by the op " mtor_ These appliance, p i n ~, bod il y movemont, rototi on" intrv. ion and
"'" '<e r$O lite and offer 0 numb"r of ad...o nto ge' ext""",,,.
~ th. nmlOV<lble oppli<n:e' _Th. ... appliance.
 AgV.l/fTAGES OFtFIU C Al'J>UlNC~ ~
OISADVANTAGES Of f iXED lPPLJANCES
\ '
1) P~~ ;' ~~~ "
" '.' -,
Mboog, ~,td

""",n... !\&VI ....- of ""~ _to 10
I "'~ . , rt', n! in !Ii< _ ,j li, od> ",_<bit appliMuo. tho, _erlholm lIlI" L.<IIbor 01 _~

~ Tho O(t~ doo. '""

dspfnd "') ~ p'1""1 lot tr..ly ..... I) lI!o ",,01 ioIporWC _ntogo oI.li:<ed ~ ~ QI'~ ~

~"" .r<I ~l oI""'~, ~ whi:tl1lo<ornot """. <>#i;UI. ~;o,j J:<j dubrio 101>:1
2) ~ lopo$PJlf io l<~ o/;JoIJ!-..olypoo sa _ ~ It10 _Ills oM do~ oI lto't1 ~

01 toot> ", o ".~on" . suo!> .. ~ nnrt ,u n I;Jr tho po,liorri ' " '" !hoi" W1Up<rIOI\\ iI/'OIJI\d "" """""
auct<nom .
."- . ' ,- -~
",wiG!\.'
31 ~.
.
IOOtII fI"IOYtm9I1lO ... ~
- takoUPfll()f'~"''''''_
.1' U~.noou .ly,
~ .. A, '"'"1
~ ."" ...,.

:c. ti.,. 1~' rr ..lm,!'I( ", rOli" io e 01>-

\0<>/1\ iobli::olod II( Iho ~,
3) Fixod oppIiaIIoo ro <IMI~'

UnIo ... _.,,, 10011\ ""for M

YIan ,..."._
.wo.",,,,, ;n u.. ~,
~ _

i .y rNJ ",I be
.\OjoroljJ d<!>d. '.~

~) ),(' " prociH !O<>t ~ mo,.mo<lt, on, .J ~,td _1ic~ lIqJf't"pociai u....... 01 fit op&r*'< W

-',- _"II
...-
~I occIJsI,o i> paoliNo osi"l lI. ~ , ~ ~"-I>f .poo:;llltd " 1..... _
, thai 0Wj _td Ioroos _ be ,_
~ 1.>;"; oppkr,oos. ~I o.n.g.d~"""'

J' ~.C ~,
. 5) 1'; ,.,f oppliOJ'lCOO _ 110 iMd .., ....
mOo, ...1o<,IJ.I"". 1rI~ udil'\1 . ,,' ~) ThO ~ 1m 10 >id ~ _ at rogtJ .. _ .

o~_, 7) Fl>od~ or, rr_ .

by ~ _ ,""",,_~.

S) fl<ed '""""'"" otior _ _ t ~_

~I ~oot"'"'" iI, """" "" . - "PO'OIOt ""'" has ~);ainocI
-..
iJrOo .. flo
10 w.. roed tppIIonoos. the" iI gr_ ~ of ~ _$0
tOOll1 """,rnortl.

Paul ve anI! ac!/Y" a pplia nce. be class ified a. rem ovable a nd fixed a ppli ance.
O rthodontic ap~ i ance, can a lsa be classifi ed a,
IDEAl. REQUIREMENTS OF AN ORTHODON-
OCIive <l nd PO''"'''' oppiiance . Acti"" a pp lia rlO"
TIC APPliANCE
exert a force on too teet h or the . uPportin 9
, trud u, e' to b. irr9 a bout the n~c" ..ary tooth App lian ce, whid a re u, " d lor orthodontic
move ment. Pa .. ivo app li aoce. are ma. tty u.ed purpases should fulfill certa in re'N ir"".,nts. The""
to ",!<l in teeth wh ich hav~ been ma ved ta i""a l ",qurromonlo C<l n be discu.sod underthe foI loMog
locati on . k tiv. an d pass;ve appli ance, can 01,0 lour hea ding. :
F,; 2 Orl'>odon,~ _ i oO<H W Son, .. "",.,,, . 0 f...d "",_ o~ "'",. (8) Bo"ldod ""o i_ . 0 ~ .... """ ....
""""~fI:t tel H<>wioy> _., "' . 0 ,..,..,...,,1>10 """'" .~'"o. IDI Ko."" O""~O"," . Ii""'; ,",,,,f...-.c''''''''1 owl ...... "
~ "-<,,,,,too". a _ , ",,,,Vet.. ...,. aW"'"'- (Fl ......... ;,,,..,.. 0 !i,.j .""",,,"01OWeo""

1. ~obgi<; ""lui,.,."""t< b. The O<t+.odon!ic oppl" ,,><. sMuld not poodlK'l

2. Mochoniwl """,i",,,,,,,,,, polhobgic chonge. ouch 0$ root ...-.o<pIion,
J. E.",,,,",, <equi"''''''''ts peo ic>b ,ul domoge or non .;tolity "'!he teeth.
~ . Hygienic requin:ments c. The opplior.:e should nol interfo:n, with normal
9""""h.
81010"," req .. I,.m.nl d. ~ .hould nol i<ltern.re ... ;Ih nom", IIvr.dion.
o. The opopiionce V>o uld bring a bout tfle desirod ". 1M oppliance should no! bring aboul ...ode n
lOO!h movem ent. cho"9('s.

J-l-5
I. ~ ,hould 1\01 bring about unwonled looIh
_ment.
,
,. The mcnoriol used in '" fabrirnlion should be
biocompatible and should not produce to.c
....... I.
.,
" TI\e oPj)liance should not di"nlegrale in otO l ."
fiuids.

Moeft . nl e.1 ,. qul,.ment
c. Tn.. opplio 'ICo lho<J ld hi! .im ple to fabricate.
b. ~ ihou ld rIO! be bY l..,.. The potien! shoo ld be
comforloblo ""'"0 th ......
c. Th. opplionc hauld be o/,ong """"911 10
Yl'ilhslOnd m(:GlicolO<y Iorccs.
d. The opplionce ......... ,d be able to delive,
f;Qml"lI.d fon:e. ft shook! apply" Ion:e of
desired inlenlity. direcrio<l and du",j;"" .
e. The oppllonc hould be univ"r>"li y
oWllcobie i.e. ~ mu.t be able to handl,
vcriovs molocdvsi On$_

Hytln/e ,equl,.m,nf
TM o rtnodontic opp!iorxe ,,,,,,,Id ;d."al' , be self.
c~ruing, III'ICII it ohoo ld be ""'Y
to ,leen them.
The applionce ,hovkl nol ''''''rier. wilh or,,1
Iwi.ne maim,...,nce.

1I;. llId'e '~ ul"""nI

The orthodonlC opplI(Jnce should be eslhehcally

oo:eplobl . " " de.iroble to ho .... an ow1ionce
thot i. <II inconopicuoul <I. possible.

I, Ad.1M , """",,,,010 """ .. "'., ,...I0<<I0, ""'"' ..,.,.,.,.

Am I 0. ..... , 969 , ~Ir.'.~ I a
2. "-doom, C,", T.... do.g n ....d '''''~'x l ,," of ,,"""",
,or. O ~ kocIo" " , ""~ l lono . , , 5t' od ;t",",W''G h!,
a.;~ .. , 198~
J, f""" It) II " .. boo . .. C'-'t~., !!Iodwoil
!cIom';;, Owl", 1m,
~. Govibef,i. _.d Zjb.<"",. : c;.-,g;.... _p""" '"
"m-.,lo o""odoo~, ,,~ ..;.,,<.._ Am J 0""0<1

&mQVOble orth<xklntic app li onc~$, os th o
R j .... m >"gge,t., are d. vice. that con b.. in
",!led into arod removed from the orol COy
ity by the potionJ at wil l. Remc>vob l. applia nces
_'" u'"Q rou~ nely in In.. 19th century. However
!hey were crude ClI'>d ,.,.,'" mode of ~"dO<J' metol
wi",. ",,-h ich I"" ked the mecMn ica l advontoge of
tf,e modern wire" The developm ent of the modi-
fied ormw heod dosp byAdom. in 1950 broug ht
goo u!" .ee chang e in th ~ way the ",movab le
cppi i""" _ ro looked at, The mod~ rn <loy ap-
plia nce. are fobri<ot~d u, ing . te inle ... teel and
ouylic and are more efficient th an lnei r pred . _
== A1tfooo~ rernQ'iobie applion<:e< can be
effectively used to treot a nu mbe r of mino r mal -
d u<ion., they me offen ignored and th~ rnoce
com pl., n,ed app lionce. used in'teod. However
...." oyob l~ applionce. continue ~ b~ the app li.
-
Appliances
once 01 choice in hoti ng cerla i ~ condition . R&_
movab le a ppliances can 01,0 b" u,"d in con
jundion with fixed oppli ancu orld for retention
olt~rtreatme nt with fixed op>" ionce,.
In Am en"" the term removobl. c"" li-
once, ge""ro~y meo n.fundionc l opplionceo that
u o~ the o rofccic l musou lotu,," , In the f ura peon
<oontrie" rem ovc~ e applionce, ore con<idered
to be of two kirldo, The fi rst col<lgory indude,
a"" li ance, whi ch ore clo,p ed to the teeth c nd
c r. referred to 00 fixed >"ote" The other cotogory
includ e, removo~e oppli o",eo, whi<;h li ~ loosely
in the mouth ond prodvce their . ffed by mod ify-
ing the pattern of cdivity of the orofociol muscu
lotu re cnd he"," th e pr."u r.o produoed on the
teeth by the,e adi. itie" In thi' chopter we limit
ou r di.cu u ion to the clooped mOKho nico l appl i-
ance. tho! 0"" ",ed to bring abo ut .oriou, tooth
mo",", men!. The app lio", th at make "s. of
 mUlci. lo,ce, ore discussed lepe'olely o.
~fio",,1 opplio""...
Remoruble orthoOon~c appliance. 01.
fer 0 num ber of advan log.es indoo ing h,e abi lity
to mai nta in a ro l ;'ygi. no cnQ Ihc r,ee-d for I."
choi, ~e 'ime . Th . moin disod.anlog, of ",.
mO'fObl. oppl""ces is lhe t'IMd for pofienr co
opero~on. failure 10 od~ 10 prescribed ",,,..,..
able cppl.mca wea, schedule. ..... 11 '~ulr in ei-
IfIIt' .Iaw !reotm.", respense 0' no reopen'" 01
011. Tobia 1 ...,mmofi>.,I.... odlfOnlo{lOS ond th.
disodvonlogeo of th e removable applionul.
ACT/Olit OF REMOVABLE APPLlIlIitCES
Ranovoble oppl .. nces....,,!.; by applving 0 siollle
lore.. on 10 the crovm altho ,",h. Thu. remo...
obit oppliances ad by Npping ma tooth oround
'I> centre 01 "''''!once. npplng con b. brollghl
obour in the ,,..,."o-<Ii>101 or bvc;r;o.linguol dire<:
lion. Tn. k. y pcir.1' 0 be con'IiOe,td is 'h e pesi.
lion of ,ho rool a pex befote the begin ing of treot.
m." I. TH ,h th ol na vo Iheir apo. ot tho corrod
pet ilion ore idea ll y . vi ,"'" lor IrllOlment with reo
movoble cppl"nce..ln .ud! patients 1M l""9v.
10nry;1 ulUolly due 10 rhe Crown being lipped
from its c","ect po"tion and the'tfore respond
welilo "pping 100Ih movemt m, possible using 0
remo""bIe orthodontic opplloroa.
hmo\lcb .. op pli o""., ore gen"rol fy
conl i cl~u"", i""fled i. e in bring ing ooo ul oodily
trcnslcliot1, demtcli on an d uPlig htin g o/I""th due
10 me single point of conloctol *_ opp liar=>.
Inm"ion. ond extrusions .... nll reR'o'fObie appli.
ances cnoflon medic""", vW>g rho Ioroct oterup-
lion and oo:lus.ion . In oddilion me acrylic bose
plOIt of m. appl"""eo oko COn be design.,.! by
Incorporoliing bito"",",,, mol COn aid I~ ..,Iee
Ii.e cXlru sion or intru. ion.of th e tooth. The bite
pkm indooe Ihe cnlerior orld Ihe posteri or bile
plcnos.
COMPONtlflS OF
REMOVABlE Af>f>UAlltCE$
R&mO'>'Qbl. app lia nce, are madt oool'h,,, I~ I I
lic compone nT .
o . Re'llnl;"'<:Ompor>eoll
b. Ac~"" components
c. Bose pic:.
RtrENT/VE COMPOIfENJS
"Or'Y 0.. compone"" ,hoI help in kU pi"lllM
opp li o""t in plo<:. and reli " di.plocemo nl of 1M
a ppl"""e. Th o . uccess of a .. "',wo bl. a pplj..
arICt ;110 a 10rl1" ''''e nl depende nt upo n good
'"t"'~on 01 me oppli~r"ICO! . Applion<;et thot Ore
loostIy ~lIinll and do not ........ odequolrt inlft>clr1:ll
oncno...:,90 connol bring obo..rl !he necesKlry
IOOIh lTIOYWrIenlS. Adequate ,".. m;on 01 0 ,e-
",,,,,,,bI. opplior"lCO! is achieved by incorpolOling
cerloin wire compon"":, lhot ""IIOQII uncle..:"",
o n th e .... th. Th.,. wire com ponerrts lhot a id i"
relenlia n of 0 removable op pl ian co oro co iled
dOlps.
MOIJe 01 .,I/on of dups
ClolPl oct by engrogin\l c_in conJlrioed 0'_
oflh. I."'" thOl a"' c.alled underwlS. Whtn
dOJPI ore labrico:ed. me wire is moOe 10 ~
the", unclen:uIl s.o Ihot Ih~ i r disp~c.men! 1I pre-
' e<1too . There are two type. of unde<cuts Ih ot ore
foun d in ~otu", 1 dontition.
01 8uocol ond 11 "9 001 ",,,"co l undclOJts (fig
1.0/.
bl Mesial ond distal proximal undtlOJts fog
l.b &. c).
Buccal I lif/llvol "",ic,,1 undercu'S : lhe
buc<:ol ond ling",,1 surfoc., 01 moiol1 h",. Q
di.li",1 undGfC ul cl th e co,,"col mc rgin . These
ccn boo ,een from th e mesic l C' poKI of 0 molor.

A 2]
\ in tke pr ..enoe 01 , h<l llow unde rout. ,
F'II , ("l C.... 'col ,~" t (8) ~ (CI 1.1.,.01 ond ",-01
"",~mo l ",d " M
Example. of ci<l'P' tho! engoge these buccel ond
linguo l ce<vicol lJl"derc ut. ore th e ci rcumf. rer.::io l
dc.p an d Jock,on', clo.p. The,. underc ut. ere
cvo ilob1e for ck"p fob rication only in tf>o," toeth
thot are fully . ",pted.
M~' iol and d isto l proximol undercut, ,
The molO <$ Ore widest m"<ie.diste ll, at the coo-
Ioct f'O int and grod uoll)- Ioper towords the co",j
C()I morg in. Th ese $urfoces slop ping from 1m.
",",iol cnd di. jol conlod areo . !OW<lrd. In., neck
01 rt., teeth ore co il ed th e me,;ol OM di,to l pro,;-
m<l l urnJerovt., n",y con be , een when th e mo -
lor ~ , i"wed from the 000001a.peel. The,.proxi.
ma l unde rcut. are more pro nounced thon the
ce rvico l unde rcut. ond the refo re offe, more re
tention . Em mpl of ,Io.p.
th ot . n~O!le these
undercut! are Ir.. Adorn. do.p cnd Croro! do.p .
Recr~lr.m"nt$ of an Idul ,,"up
1) It shou ld offe r ocieqvote retention ,
It , h<lu ld pe rmi t u.".. " in both l ully e",pled
as wo ll 0' portiolly erupted t""th.
3] It shou ld oller oo equote retentio n even
4) They sho w", rIO! by tkem " '" opply any ac-
tive loroe th ot wou ld bring obout u nde, ir-
ob le tooth movem . nn 01 the onchoroge
teeth .
S) It, hou ldb" eo.ytofobricote.
6) It . hould not impinge on the ,oH ti .. u .
71 It shou", rIO! interle", wit\, normol ocd u ~on ,
Clrcpmfe,en!l,.1 chup
Tke circumfe rential ola.p i, 01>0 ,n own by tke
term. th ree_quarter d o.., or 'C' 010.1' . Th ey ore
' imple do.p. thot ore d .. igMd to engoge tke
buooo -c. rYic<l 1undercut Ifig 2]. Wire i, engaged
from on e proxima l und ercut o long th e cerY;(Of
morgin tken corried over the oed"", ' .mb ro,u r.
to end ". 0 . ing le retent",. Orm on the li nguol
o , peet thot g et, embedd ed in th e ocryllc bo
, ~.
Advontog e of thi s 010.1' i. it. ~mp li oity
of de, ig n and fob riootion, Oi.odvantage of th i.
 A
dos p i. tnot it w nnot be uS6d in P'OI1io lly e rupted
teeTh wherein Ifle ce", ",o l undercut il not o,o il
able 10< d",p IQbricoti on.
JlcI"D" " c/np
Tho. closp wo. introduced by Jo~ in th. year
1906. It iJ 0100 wllcd lull clasp orV d'lfp. l his
do.p engage ...... b<x:co<ervi~al undeow! and
QI~ tile M"'iol 0$ ..,,11o. d~tol ptC>.imol u~r:ler.
c uT. llig 3). Wi re i. odopted c lc " g tile buoco -
c...... lco l m' lrQin ond both The pro. I"",1 under-
cut" I""" """ied ove , both the occlusa l embro-
Wlfll0 end g, ,. tenliv<: Orms OIl boll> ,io:le$ 01
the moigr. 1M odvonloge ollhi.closp is !hot ~ is
,imple to con<lruct and olkn odequate relen-
han. The di",dvorrtoge of .laduon'. clasp is thor
it olfl!<'S inor:ioquo\e retcntioo In pomolly ,,,,pted
T"",",
The Atlo"" d o,!> wo> t.nt dewibed by p~
f'hillipAdomo. II .. moo known OS li pocI d <z\p,
un~, ...1dO>p ond modi~.d a,""""'eod do>p.
~ ~perly construcllld Ihis dolp ofFen; mo'"
mum .-enlion. Tho:t dOJ1p is conllrvCled u';ng
0,7mm hord to<...d slcinlcu Iteel lOire.
The Adams clasp is mad . of t+.e follow-
ing PO'" :
o)lWo (Jfrowheod.
b) Bridg.
e) lWo retenti.e omu
1he rwo ~"owheod. G"IIog.II thG me"",
ond me dillOl pr'QJl.imol underclllJ (1''9 4). The
om>wheods ore connec1ed 10 each 0Ihe< by c
bridge -..hich IS at 45" to !he long QlII oIms 1ooIh..
The Mgms dosp olIoqo nurnbe<of ad
....:mklees .",f,ich are li.ted below :
I) It i. ri gid a"" o ff..... exce ll ent re te ntion .
2) It con ~ fabricatod on decid..ou. a. we ll a.
-.
perm'ment toeth.
J) They COn ~ used on porti~ .... fully "ijl'ed
4) k con be used an moIors, premolors ond on
inc:i50Il.
51 No spec;oIi<ed instrument is needed 10 fgb<l.
cote Tn. clc.p. YounQ" un i""rsa l ~I i." the!
i. uoed ro utine ly for most wire be""l".. ca n
be used.
6) "~Imo l l
cnd ocOJ p",s minimum I.p<Ice.
7] rhe clOIP con be mod"Oed in 0 number 01
ways ~ig 8)
Tn.
Adc.m. d asp con be mod~oed in
number of woyJ. The ... modificotions perm~ ad
di~onal""",,,,, enhcncedrele<1~on . Thefallow
ing ore oeme of th e mooifications 01 Adc.m l
dO!ojlI :
f" 5",' Tho10.,,, of +0 "dgo .. dew", "ed by "",";ng 'he ",0,' ",, 1 ""''''"'' 1~15 1c) T"" ,;gN ong ~
b.r d, 0" modo., icy", !he "OJgO ID)&I[) r:", j " t ",,,,,,hoe d is ton,...d If) Tho o~""". ood I. ", , _ od
,~g""'o ""'" tke ( "'",," wid .. , oIo~",,+..od tGl Tf . ,oe"'" ",'OOhood ' c ... . od IHI n",f;,.. "~~
-, O""ttoa ... , lool.5 <1og.... to tho bri'"
F" 6 Mo" >\l'" Moffl<cioop ,o"' noed~ Tho _""" ",,,,,,,,,,,,,d. 0100 b.nt~Sdo>') '" ., .... ~~ to _t
to. ,""mwhood, """ .... p=; "", end""" ,,_(Il) Tn_""lot 0," ' 0/'0< "nowl....d ~ lo,.. 90 ~'''' 01" I0.oI
11",;. Mlf to. r..q., of to. 1Y<lgo. Tho.,;" ,;",..J" po D'<M t"" omb"""", ........ ... do,!, ~ ~b-" ;,
'''''''''" pO<lOOo KI ,10WElllo. "",., 0'<01 "'co ;, boot., 1"'" 0'''"'' oed= 1om """,,"_ If) Tho """ ""'"
.,; '" ~ ,t.,ppoO down "'" beyond to. p""" mQ! ,orlod tGl ".moll .Iop ~ modo i , ;,. "Ion"'" ""'" '" "" "'""
11., ""kl ~ ""'I.... ~'V"" It~ TO. _ .... togo",. ~ t "'t"".ndot,,_"'........ 0""'_

1',""".Wilh "ogle arrowhead Th e Adam .
con be mod;fied to ho ., ,, 'i"llie arrow-
head. Th i. type 01 do'P is indicated in " porti" lfi
~pted tooth wh ich usuolly i, the 10,1 erupted
=olo r. The sing le orrow~d is mooe to engoge
ho me.;';' . proximo l unde",ut of the lo,t e rupted
rna"', The bridge i, mod ified to er>drde tho to<;>:h
d i, joll}- and e nd. on t he p<llota l "'peet as a re-
te ntive orm (fig 8. a) .
Adorns with J I>ook ,A J hook Can be 501.
dered M to the bridge of th e Ado rns dow These
hoo" a re u.eful in . ngog i n ~ e lo , ti cs (fig 8. bl _
Adorn, ",Ah inco rpora te d he lix A h. li x
'(In be ir><:orporated into the bridge of th o Adorn.
.
do.p. Th i. a lso he lp. in engog ing ,",o,tic, [fig 8 .
)
Adorn s wiln oddilionol arrowhead, Adam .
do. p can be con . truded with an odd i!i",,",1 or-
~. Theodditioo al orrowheod engog"Sthe
prox imo l unOercut of the "diocen! tooth and i.
,old. ,ed Or! to the bridg e of the Adorn . Tn ;,
type 01 closp off.. " odditiono l retention (fi g g,d)
Adorns with so ldered bucca! tube, A buc-
ca l tube ca n be lo ldered on to th ~ bridg e of the
Adorn. cio .p. Thi. rnodifkatian permit. u,e of
e<lra-oro l onchorage u. irlll foce bow - head gea r
a"emb ly (fig 8 . ),
Adam. with disla! extens ion : Th e Adam ,
olo. p oon be mod ified . o thot tho di.te l arrow-
heod ho, 0 ,mo ll e<lension incorporoted di, to lly,
Thi. d io/a l exlen. ion help. in e ng"ll ing eloo/ ic.
{fi gS ,n
Adorns on indSOr> and premolars: Ada m.
cio'p co n be fobrico ted on th o ind.ors and
pfemolar> when rete ntion in tho,e Oreos Ore re
q uired, Th . y coo be cOMlruded to span a .i ng l.
tooth Of lwo teeth (fig e ,g),
Southend clas p
The So uthend da.p i, u,ed when retM tion i, (e
quired in the onteric." region. The wire i, ado~d
o long th o cervical margin o f both the,oe ntra l in_
 A 8

c o

E F

'Ig a Modfi<o,"" 01 M,"" cI.", ~ ~"Ii. "'~ 1<10 "" do", II) MIl"" ,"'0 J foooI< ~I _~;,""'" (Ill
Adom. '"" <Odd."""' 1 ,.."""he<>d ((') Ad.m .,;," >iderod bu<;<ol tub. If) hIo m. wi'" di~ol ",""'.on I~ Mom. on
',dlO'l.
 A B

c o

fly 9 ("1 w>,"'" oIo.p ~) So il. '" do'P

(Ci T,;org,klr d"r (D) Cc<>!at c!o. p IE)
1.o"t. ", d o",

Om" , The d;,tot " nds are carried over the oe_
d u.,,1emb rasures to e nd a . rete ntive crm, on
the po loto l . ide Ilig 9_.1_
Trlangul/l' cl8!P
They are sm,,11triongu lor .hop"'d oia'P' toot are
u<ed between two oo io(enl posterior teeth. Thus
!hey "nlJ'lge the proximo l un der<;ut. of two " dio -
..,nj t. eth. Trian gu lar clasp' a re indicated WhM
odd itiono l retMtion is nMded (fig 9 0) ,
8all e nd clasp
This clasp i. fa bnc:oted using , toinle.. , teol wi,.,
ooving " krob ex" bolille strvdure on one end
{fig 9 BJ. The ba ll can be made at the end 01 th e
wire usir>g . ilver ""Ider. Preformed wires h<";rIg
"bo ll atone end are " I,,, oV<lilob le .
Tr.e bo ll engoge. the proximol undercut
 bet.. .... n two gdiOXlln! ""., .... io' teeth ttl in a fri Bo ws
or>gulo, cloop. rhe dntol end 01 the wi,. il Cor
ned 0... .... the occlusol embraSure 10 end on the 10' inciso, re lroction. There cre YO,ioUI typa.
""Iotol o.pect ttl 0 nllent.,. orm. The boll.-d bows fOUIinelv used bi the orthodomiol. The
claop .. indi""..d when odd~",nol retention .. lowing i. a li,l 01 SOme 01
requ"ed. labial b0w..-
l. Sho .. labial bow
S"".II'~ c/"'P
2. long labial bow
The Sdlworz clOIP or the or<OWl>eod ciolp eon 3. Sptd labial bow
bcr soid to bcr!he prerle. oflheldom', dosp. 4. Rc.e .... lobiolbaw
The clasp il designed in wch 0 wavthot anum 5. Robert'srerrada,
bet oIo......t.eodl engage the Interpn:l>!imol ...... 6. Mill, retmdar
de,cu" between the malo,. and be tween ,. High labial bow "';!h ap"""'poi" ...
prcrrookr.. ond mola .. (fog 9 0) . Thi' Clalp I, not 8. Fi~ labial bow
, used rourinel , d"" 10 0 numbe, of dro..bod. ,
II Nood pedol c,ro..h""d forming pi ..", to Short '"bl., bow
fabricale. Th~ type of lab;ol bow is con!irude:l ,, ~rog 0.7 ....
2) Oro.op ie. a la,9" amounl ai 'POet In the hord round .Iain l. .. " 001",i,e. The . hert 1cbia1
,", cca l ~"i,", l e. baw ca n.i,t, of a bow thot make. conro et.n:..
3) Tho ",~do co n injtn the inl.rdenlal soft Ih ~ moll rmm in enl labial leeth and two U IooJa
li.sue. Ih at ~d 0' ,. tenti ve o,m, di ,to l to th o CQ ni """
4) It i. diffi cult and lime coos um ing 10 fob 'i. (fig 10). Tn~ Iype of klbiol bow is ve'l' ,tiff and
"" e. exhib il. 1ow fl . ><ib'lity. Thu. they 0'. indicated ."..,
in case. of minor oV"fie' reduction 000 onlericw
Crout c/up
'poc. dosu,e. The short Icbiol baw ca n also be
Thi. cla sp resembles a lu ll ckllp bu' no. on cd uJed for "",pose of rele ntion 01fhe ferm;""''''''
ditle",,1 piece ai ",ire soIde,ed .,Mel> tongCOl'I into 01 fi...d orin odontic there py.
lhe mesiol and distol ptO>I.Imol ""den:utL 11"" ~ l he sho~ labial 00.. io octo.oted by com-
all ... bcr"er ,ete"';';" tho" the 1,,11 dOlP~'9 9 ell pr""';ng the U loop'. The oc~votion .hould b.
,uch that th" lobiol bow is disploced polatoll, bi
ACTlVf COMPO/ltflilT$ OF REMOVABLE
Imm.
ORTHODONTIC ..,."lIMCn

They 0'. coonponents allIl. opplioro:e which lOll'

or! /oru,s to bring about the neceoo'l' IOOIh "."...

"....
ment. The oC!i compon."" Include .

2) Springl
3)xROW"O
4) f lo.,;o f~ 10 S!.art I.bool bow

fOj I I l.""IJ 1oIM,I boo.-
' e Ole' bo ...
;; bow
8 ><18 "'" f'on, on . fi "l premolc, 10
T"" di.tal arm. ollne
odepled """, the ocdulOl embro
" 11 ).
The indicaliono ollong lobial bowo~ .
Minor onterior IIp<Ice c",,"ur.
Minor overie' red uction
Oosu'. 01spoco disto! 10 co nioe
G" iclcnce of (enioe during cenioe ,elroc
lOon ",in" 1>010101 'elredo,
As " """in,n9 deYice ol the end 01 filed orth.
odontIc "eo1rr .. ~
The adi.oIio" is simile, 10 !hal desoibed
... short lebiof bow. A rnodified form el lhe long
labial bow Can be mode by .ekl"";ng I"" d,.tal
crm 01the U loopl on to Ir.e bridg e of In . Adoml
. i, 0 Ioblal bow thot i pI~ in the middle.
This IMUIb ;" two sepom18 buccal a,m. ho..,ng a
Ioop.ach (rog 13.0). This type 01101>101 bow
~ Inc"",ted Auibility o. compo,..! 10 ,""
_nt'o(",1 Ji,ort fob iol bows.
The ", Iii Iob iol bow i. used farcnte rie r
1._'" A modilied bm oJ.pJ il lob .. 1bowCXl n
be used Io.-dOluffl 01 midline dia<tema llig 1J .b).
In Ihi. korm, the !tee end of the buccal 0",,' Off!
mod ~ Ie haa~ <11110 I!.e di.t.,! .u.fcce 01 1M O!l'
pOl ite cMtre l inc i", r,
Tho split lob .. 1 bow i. activoted by cem
pre<,"rog tho U loop ).2mm 010 tim e.
Rowolto Id lel ItO ...
This is 01.., called ""e,.. loop lobio! bow. Her_
tho U loops Off! pieced dislol to 1M canine ood
the ~ee""ds d the U loops o:reodaple<;l ~
be_" th o Ii", premola r c nd conine (fog 1J,c),
h " Ionge.- .pa n 01wi", i:I irrccrporolod, th e bow
ex hi bit. incr.csed Ile. ibl lity. Indication. for use
0" . imila, Ie !hot al.horl lob io l bow. n", O(;li.
A
+- - - ..
t~.
B
f'\l 12 ken ... labal boo.- o;:tftolod by -""" ....
loop. n......I-0 ... ~"" aI +. boo. or"", ."i'oJ,. (It
C"..."...OOIOty bond g .... to ...,""n proper 10-..1 01
~
vo~on 01 Ihil lobiol bow is dooe in two .tOflS.
f irSt th o U loop is opened. Thi. ",.u lts in lawe '
irog of lho leb .. 1bow in #'" inci<e r region. Acom
p!!rr$Otory bend i:I thon gr.en or lro. bru" 01 the U
loop to "",imoin !>,ope' I~ 01 fro. bow (/ig 12) .
This;' 0 lobial bow mode 01 thin gouge stainless
_I..,;,., having 0 coil 013 mm irrtemol ditJrnew
me.iol to t""conine, The y.., ofl!. in 0.5 mm
dia mete, "';re a long wil!. increo.ed "';1lI1ength
due to the in<;o'poro lion 01 c coil ma ke. The
 A B

E F
fig 13 \"l Spit 10,101 bow lor ,, ~O<,.., of 0' '"''''' (B) Sp." 0.1:;0 1boo< r", doov<. of md ~ m,..,., Ie) ~ ....... Iobd
..... IDI Robe,, , "''''''''''1~1 M ~ 1o " ' ' ' - (F) Hy. ...... 1",,", w;;" ... on_,,"Ii
Iobiol bow highly ~exiblft (ffg 13.d). ~tol""" 4 Mm. A:; I.... bow is highly ~e>
k --, Ihi" wifS is used for its fobriw- ,bIe ~ generotes lightco- forces. n..... "'"
am bo
~on. the bow is fwghlyllexibl, ond Iocksodoquole used in oduh po;rtie.m; in whom lighler Ioo'ces Ore
wb;lity in the -.tical pI<>ne. Thul til. dislol port ,*,roble.
ollhe ",oclor is supopoo1ed in a stainless ,lee!
tub<n9 01 0.5 mm intern()1diome!er.
The Robert's retrodor II irldio:lted in po - Thi s is 0 la t>ial bow having exl. "';"" IocFling (Tog
tient. no'; .,.. ..,vere ont..nor procHnoTion with , 3.e) 0/ the wire '" os to increosolne fle,dbHity
 M II II'I!f!X1or ,,, ex!endftd IeOOoI bow CIS
,." ,~."" ,~, ",,11<><1 i. ird ioaled in poTi onT. with
"largo a"oriel. The d iS<l dYo n lc ~s 01 Tn. Mi ll,
ir'ldudo dill"" l!)' in corutru.;liQn and
~"nt oc~plor.co d"" 10 1M complex d.
ollhe bow.

lalllal flow wlllt Itp, .... $p,I",. flg 1~ fitood IoIM.t bow
010 heoa"Y "';ro bow of 0.9 or mm
. t
!hot ~nd. into !he buocal ~STibu l l
1 3.~. Apron ,prin g mod " 010:4 mm wil'l is Ideal , equlslte. ot a ,p" '"
~ed to tM hi gh 1"",,1bow. The apron j,pr1ng
Sprir.g. !ool 0 .... designed la bring a bo ut various
designed lOt .... trGdion 01 one Ot me ...
tooIh .................hwld possess certoin ideol reoq.
ui.~es. They ore lisled below:
coses 01 largo 0Yerje1. As .... ry
o . The >pring should be simple 10 fabricate.
a... geneRJted by them they con be
b. It should be eosily ocljustobie.
in odult pori""". c . It should ~tinkllhe o..,llable '1'0"" ..,;lhoul
The oP"'" IiIlfi"'il is 1M adive compo-
dis<:cmfo.t to !h I potllnt.
wnt thaTil OCTi>'tlTed by b", nd i n ~ it toward. the
d. It .hould be OClly to el"" n.
" . . As it il hig nlv flexible, octi'votion 01uplo 3
c. It , nould apply IOI'I:! of req uired megnitude
ot a lime Ca n be done. Th o d ilOdv<l nTogl$
arld d i~t i on.
otdude dllficully' in con.lrvdion 0.-.1 rhk ot soil
I. ~ should 1\01 .Iip or di. lodge ..Mn ploced
<;>"leI' 0 .topor.g IQOII, .urloce.

g. hhould be robust.
h. k should nlmoin ocUve <;>"IeI'O long period 01
10 !hI to<ItoUrI of 1M 101>01 ",!foee (11g """e.
TM U loop il \I:I uolll sm oll. The lit~d 10 Fllelo rs ta fi e con,/"e'e" /n "e'/lInlnll
bow ca nna! be used to bnnll abouTocti've , sp,lnll

I
::::;=::~~ Thev 0 .... u<ed '" ,. toint ... ot D"mcl<,or 01 Wire, TM flulbilitv 01 lhe s~ng
of IOted o~ lhel'Oj))< 10 0 10rf1'l _ depend. UpOn the rliomeler 01
wi"" used. Thu. the force 9"' ... oted is

F = O
adontic o~QO"''' that a... used to ofleet..,riouI L' j where,
, F _ Fo.ce
TM .... are 0 number 01 wo " by ,. ni eh o _ Dio metre of wi re
....." "" bo,II . ",",d,. Te bl. 1 give, The V(Tri. L - Length 01 wire
 o:weoond

...... .. IM " . _ or _ . , _IN)' CO" "" masllOOlIl mo.e""",l.

110 ..... Hled ., ;

.. Sf'o9Io - 0'l1\oUt '*" Folienl com/Olf , Th. , pri ng . hou ld

on l potiont diKO mfor! by woy of its

._.
... ~ w, " , _
,
'" the lo,ce it gon"""t"" ' The

......... I110 ................. "...., . . bt ~'pos.iIiOOl 00 '" to bring cboullh

: toooh movement .
o. IIoUI ~ .".... "'" Di'llC!ion 01 loc'" move men' , The dir
~. ~ SponQo . - .."., ~cn oIloo!h mo.ernMI i. e n irnporlOn! co ........
OIion in de~ gnin~ " opring. Tho di' Belior> eI_
a. . ..... I/le rIOt .... ., .I,bUIIy of llIo .prlng Ihoy mo' ement i. determined by Ih. ~ I nl 01eenToa
. .. boo tI"'~1od n , be"-n tle spring ond!he~. Palatl:ll, pjo<.t
.. SolI ~ ~ . TN!' ... ...,. ...... 01
_ _ ..;.. Ilullll)' coo """"' ..... 000II - ,.
II. ~ IP'ivo . n., ... _ 01 ..... 01'9' !he room is Ie be moved polol""'ond In 0
.... ord .... Ia<:I. . . . . ~_ ~ ...... 01 d'lIol d"llfion .
tt. IPring ....... U<ll~ ...... ,~ ~ I. P ~
F/n4er ' pr/nll
~i~
The fin ger spring i. 0100 co,"',.",,1"'""'-1
Thlckllf wires when u.ed, decreole th e fle>.ib ility ....ing as Of1 e er>d i,I" .<I i ~ cuy lic or>d th e
01 th. Ipring or\d OW IV0 ~reole, fo,ce OOllne .r>d il free. IT il COf1.lnJctcd using 0 . " mm .,,'",
too!h. B, doubling !he diom.*< !he /0"", in mm !>ord round ""'inl"", lice! wi~.
creoses b-rolmO>! 16 times. Thvs by deaeosing The Ii
Ihe doo..-Iholo"", cppliee! iJ lesser one! """"- ",I m""emen! 01 teeIh. Hcon
lore m
."ring "","cino more fle. ible cnd cclive
""..- c longer ~riod oIlim o. IingllOl direction i,e., T.... I""1h .hould be
th o 'i';' of Th o ard. ,
lenglh 01 ",i,~ For<:. ee n bo dec.,,,,,,
d by
inc,eol in g tf>e !englh of lhe wiro. Thus 'P'ir>g' ' :'.;' :':~:I
rhe lillg . r . pring co n,i,t :':
e rm 01 12 15 mm length which il
Thot a,e Ic ng ll< aft more fl.>dble and remain oe
~ .. ue, a nej i. 01 3 mm into"",1 diomet..-or>d
'"'" ",""a long w.olion 01 tim., Helicas one! loops
con be inCOfJXlroted inro .pring. 10 make them from the ri_ and
more ocfi...... By doubling Ihe lenglh /he foru
(Iig 15.0).
con be ...:Iuce<! by 8 fim .
The~ngersprin9s~
force 10 be a pplied The 10". 1'-01 sr.ould in such 0 way mc!1he ceil I
1 'be gfI"",gted by the spring I. ce ~" ' ct.d bc.ed long 0.1, eI the tooI h to be m<wod ,
en the numberof teeth to be moved, tOOt l urio,e 10, te the dirK !i e n ef movement (f>g )

I
 moved . This it done G. dose to the coil "" POI-
fible. ~on 01 uplO 3 mm is <:o,,..~ ,,*,1
"""" O.S mm ";f1I i, used fe r it, fubricoTion.
/he"" , 0.6 mm wire hOI bM n u.ed tho <>d i
votion .hou ld be f.o lf 01thot.

C'lI nlre d ~/nl" Cl nWenr .prln,

Thi> spring COI'ISlr'uc\ed ...!h 0.5 mm hord .Ioin
A less s,eeI oriN .. used to move teeth labiolly (~g
16.0). Tho . ptlng (;OnPsf1; of" coil, close to its

FA """"\I"nuo from m. bose plate . T.... e<><1 helps ;n

inorC<l, ing thl f1e.:lbi lity of the $prir.g by ir.:::'801-
'0V in g the 1""9lh of the wire. Th, . prin g i, oron kld
to ~M p it de", of the 011,." ," .th . The coi l is 10
doli9nod thCl th, ",,'ing i. ndivoled by unwirw;!.
ing the coil.

Z .prln,
Tho '1' .pring ;. ,,10o called double con~~
B Sj)nng The Z spring Is used lor lobiol mOe'
"""', 01 incisoro. TMy wn oIso be vsed fo.- bring.
ing about mino r rotction o f inc iroo ro ,
to!'txlt 0/ ;"lended T"" Z .pring i, moo. of 0,5 mm herd
Prior I ",v"; stoin~ "eel wi",. Tho sprir>g con be mod"
.ot""t~ lot ma...mem ol " ,'ngle incisor "r two inc isors
on 'Ken belo."", the rnucoso and (~g 16.bl. The spring consist. 01 two coil, oI . ery
sman internal diameter. The ,pring should be per-
pendi""l.,< to me palotollUrfoce of the tooth.
~ has 0 relent;wo 0"" of 10 12 mm !eng!!. !\lOT
 ~g 17 T ' pd .....
get. embedded in acrylic. Z ,porin g shou ld be
box"" in wo< prior to ""ry litotion,
The Z ' pring is activated by oporing bol\1
the he li ce. by abou t 23 mm at Q time, In co ...
of minOf rol<l r>on oorredio n, on e of the heli ces is
opened ,
T . ptlnt
Buece l movement of porem<>a" and ,ometim e,
con in e. C<ln be broug ht about usiog e T 'poring ,
II i, mode of 0,5mm ~rd round , to in l... steel
wire. The ,pring oo""isl< of 0 T , hop.ed arm who.e
end. are embedd ed in o cryl ic (fig 17) . loop. OJn
be incorp<lro ted in boIh th e arm. of tM Tso tnat
as the tooth move, b\JC<ll~ the M od of th e T C<ln
be mod . to ,e moin in contoct with the crown by
, li ghtly opening the loop"
Th pring i. octivoted by pu lling th e free
end of th e T toword, th" in te nded direction of
tooth movement,
Coffin spr/nil
nu, i, 0 removab le type 0/ orohexp<l"'ion sp, ing
thot was introduced by Wolter Coffin (fig 1 8) . It is
used to bring obout .low d . ~to .olveol[)f arch ex
/l<lr\$ ion in potienb where the uppe' arch is coo
, ttide<J Of th ere i, 0 unilote rol oros$bite
Th o Co/fjn , pring i, mod . of 1 2
hord rw OO skl in .. " ,...,1
wire , "",::o~;,;,.o~~l
or o""'go , hop"" wi re plo-:;cd in t
from Adom, dasp, 00 the first mol ors and
fir'il poremo lors Or deciduou s molo".
Th e Coffin ' pring co n be oetivOleG
monw lly by ~ding both the 6 nd . at the reg;;.
of the clasp. ond pu llin g the . id o. gentl y opM.
Ad ivation of 12 mm at a tim e i, conside red a,..
propriote.
CanIne retracto,.
ConiM r~ " '"'' <pring. IMt ore used 1:0 .,..,.
con in e. in a di.!al d irection . The can",,, retroc
torS CO n be da .. ~ied bl 0 num ber of way, f';lbl.
3),
U loop canine retractor
It i$ mod e of 0 .6 mm Or 0.7 mm wire It con, ill>
of a U loop, an active arm and a retentive o rm
which i, d islal, Th . bo of the U loop , houkJ be
2 3 mm below the oe"'icol marg in (f,. 19), The
mes io l a rm of th e U loop i. boot ot right ong le.
and adopted around the con ine be low it. me,iaI
contoct point. ","""ho nico l ~ it jo 100<1 effodive m-.l
 au.d on I~ of, 1... l1on 10.., ean lot <It,O!fIod
. he -
"' ,~ _ ' toiur)' ~
'tI, Poo'""oi 9O!oIoI)' p!oc!<I

So...! on tho pnura oll!ollx ",_loop 1M, ,on

be , ... tllled t . ,
c..rn roraotor wI:'ll'lob
tol arm i, octiv. ar>d i$ bent 01 right or>gle, to
1>. c.,;". !tt:'l<;lor "'tliOCfl
er>goge th . con ine below th " heig ht of contou r.
Tfle co il i, ploced 34 mm be low th e gingivo l
h .. d.n thl l, modo 01 OOllon tnlY .on bt
marg in (fig 20) . The he ight of the coi l can be
.... .. ffed ,,' ,
i odjusted bo , . d on th~ >e,tibulor height,
" PY$h t)po "': It is oct",ated by open ing the he li' by 1
~_M~
~" ',~ mm or by cvHing 1 mm of th e fr end ond reo
is used whe n mini mo l retrocti on of 1 2 mm i< odoptin g it o round the ca~ine , It i. ir>di<:oled in
req ui red, It i, octivot. d bycio, ir>g the loop. by 1 potiM t' with ,ho llow .tJ lcus, ond .pe<:i<l lly i~ th "
2 mm 0.- cutlir>g lhe IrM """ of tile octiv~ orm by mondibu lar orch,
2 mm ond reodoptin ~ it. ""hantoge. of thi s re-
Palatal canine . e tractor
""do.- are ea,e in Iobricot ion or>d Ie" bu lk_
It is mode up of 0,6 mm ,toi nle" ste.1 wire, It
con, i,!, of 0 coil of 3 mm diomete r, an active
orm and 0 guide Orm (fig 21)_ Tfle octive orm i,
ploced mesio l10 canine, The hei i> i. ploced a long
the long o.i. of the oonine It i, ind icoted in r~
i --

f;g 19 U 1000<0 0.... ,"".,""

Helical canine retractor

~ is olsa"" lied reverse loop con ine retroctor ond
is mod e of 0 ,6 mm wi "" It con, ist> of 0 co il of 3
mm diameter, an octi.e orm (toward, tfle ti"ve)
""d 0 retentive orm _Th e mesio l Orm (rete ntive
crm) i, gdopted between the premo lgrs , The dis-
 A B
"~22 8"",, " .... "'"""", WS"oootod ",,",no
' " ' """.. 0<1 ~ no """"-'" """'" 01 ," d" QC" ~. ~ re ro '" """" i"':f
t,oc!;"" 01 co nine> th ot ore pcloTOII , ~OCQ<! , N -
....
.i,Olion I. done by opening tho flel .. 2 mm oj <>
allce. 1 ce "llle .e l,. ,lo,
It i$ ,ndict:Jted in co'" 01 buoolly ploo:ed coni_
ond C(l~;"'" pla ced high in ft. .. ,,,,,t,bul . Th&y
are uMod ! mO"" the ccn ine in 0 dilla l a. woll o.
pc loto l dir.ctio n. It , on, il'S of 0 coil of 3 mm
diameter, on o criy~ Orm (CIW<lI f,om ''''' Ii......,)
ond 0 ",'~n!~ mm.lhe coil il ploced di51011O
the long "";,. ol con;",,_ The Mool conine . .
lIoc;IOr con be ot two types. supported ond sell
IUppo~ed. Th .. ..,K .upported co"ine ~
al. made oIlhid<ecgovgo wire {0.7mm1 $0 tho!
the I p.;ng CO n w p port ;'ocK, ~ig 22.b1The wp-
~ ~ i "" mlrocIor> or& mode ci thi<Y>ergc uge
", ire (0 .5m ml . Thus th. y ore me", fl. , iblo c nd
tfletelo.e mc<;hon icoll y effkiil'r1!. Th40 wppoo1ed
coni .... tetrndors lock the ""bil~1 and ore tho'e-
fo,e enc;1osed in 0 .IDin""" >lHllubing OS $hov.n
in Ih.ligu ... ~ig 22_oj. The leN suppo<tod ~ni ....
"'kodorl Oft! adiYated by ("*"II rhe hdiK I mm
ot 0 ~m,. while rhe supported (onine ,.,1n:H:tOn
C<ln be ocH"Oled uplo 2 m m 01 0 time.
,..m,,,,,, ....... nQ g ."i"Io.. ,~ d..... 'o~;"'....,_ {II) ....
Scre w,
SC, ..... 0'" oc;~"" wmpooenrs thot 000 be inco<.
po,(J!ed In 0 ",,,,,,,,,,bie opplie"", . Sc,~ COlO
be used 10 br'ng obout m""'l 'I'P'OS cI tooth....,....
ments. Th, screws ore odi",Md by Iho po!ient<;.:
regular inte"",l, u.. ng 0 I<:ey ,hoI is lupplied 100-
!!-.i, po..o'pOM. Thvs oP!'l ian<.et; inc<:wJX>tO~ng ~
uro a vo luoble o id in polienl. who cc nn ot vi",
1M denti,t tro q\l&!1tty tor rea ctivation of Iho appli-
onee.
RemoYObie OppliotKo. having screws
usually con ...t 01 a splij ocrylic plate and Adoms
OOIP' on rhe po$lfIrior ""'=Ih. The wew if, placed
(OMecr,ng the 'PItt ocryIic plate. Thole oppli.
onces can bring 000...1 'fO!lous types of tooth
mo_non'" 1xI...d o n rhe locction of a~ic 'Pli!.
!he Ioo:lTi on of 1Iw:> 5<"""' aed !he ....." be, of 1(: .......
used in The app li an ce.
B,eodty 1110 removable opplionce. rhg,
moke use of se' ..... OJn bring abo .... Th'N types
of tooth m_ems.
o. E.opon1ion 01 oreh (fig 23.oj.
b. Movement of one or a g'oup of t-";" e
buccol 0<" labiol d;'<'dion (~ 23.b).
c. Movem",t 01 0""' 0' more teeth in a d"tol Of
melio l d irectio n (fig 2 3 4
 A
Elastin
EIa.tics 0$ octiVi) CO<'r1po<1ent. o re ,,, ld om uled
o1oog .,;111 'em<)'>ab\e ap~iances, Thevcnomosri't'
used in coniunc~on wi!" liKed oWlio"'.... Re
........,bI.. opPionc:es U$ing eI"...,.loranlenor",
lrocIion """,,'ol~ molee use 01" lobiol bow,"""
hooks plato=<! d;'tollotne canines. Lolol:< eI",~CJ
""" strelched between them and lie twet llle 'rod-
s,,'" (fig 2~ ). TM diloQvonlc ge. 01 ,L>Ch on op
pI;"' nco inc lude. th o ris' of the ela. t;c , Ii ppir>g
g i"Q iv<llfy ond cauJJng g irlg iva r tm um" ond the
n,l 01 the a,ch fofl\'1 goetIing Aon~ _
B
BASE purE

Th~ bulk 01 the removable oppliu.-.:e is mode 01

the acrylic 110... plale. 1 M prime fund"'" o/lhe
bo se plote lI. to IrlCC ' pornte al l th . componentl
(octive e nd ",te nti,..) tog eth er lnto a . in gle fun e_
tiorxl l urlit. The bo ... plole 01.0 help in rete ntio."
of opplie>nal and lor anchoroge.
The following " ... !he u""ofboM pIoIon
in relllCMlble oppllOnces.
o. The 110M! pIoIe unile$ all the cnmp:>-nents of
c the appliance into one unit.
f ig 23 ~._o. l. oW l,""", . '"""_0""," 0<,,'" b. Helps in onchorl"lllho "PIl lio",,, in pIoc .
I'l Aoo' ........ for ,f(t, ~ (f.I """"onco 10< bucaoI c. It P"O"ides support lort"" wire wm_1s
"""',,,.,.,... 01 ","evp of '" '' Ie) "",,"""" " !of <t,'OI d. Help. i~ di. trib uti r>g th~ lorce. 0. "'0 l o '~
_ .... "" ...h
 o E F

G H

- J K
fill 25 Q.!'"CI<!oMc .Ioop '.... C"'..-t. ..""'1 <100. (8) Joctton~ _ !O Sc~, da.p ~ T,i<w>&'''' cloot>
l

11) AIbr. <,"p '~1 Mo"" d"., ..; ~ J hod ~),ow,.,. "' .. "" hoi. Iii) .......... ,.;Ih ,.ouoI ',I>o ~: Ado ... ,.;t, """I
_ . :.1)5;.,111 . .. ,........ 0.0.10 ..... :<I.o.b-.o ...... <><Id _o~ (l! _"'"O";otioon

 A B

o E f

J , l

Po; 26 ~"'l' ond Bows ~, A"9"' ""~ 16: Z '9""" :c) T " ''''Ii (OJ !on. klI>'o l ' - (El LDng ..... 1bow ~ 1i>I"' ,,00>1
boo. iG) Robo-r, ... _
(t) l.o b;oj boo. "'
;H i ,W~ relOXIO'
od to Ado"" dao.
I'
HV ' 1. "'1 bow Vl f ;tIot<I 10..,' bow lq P..... "" Iobio l bow

,~ .
e. 8oteplo_con bejpcorpomtedintolheplate
10 11001 spocilk orthodonli<: problowns.
T1)8 bose plote should be of minimum
l!oickntU to help In po~enl <>=!pk>nce. Thick
plat o re nor tolerated bo,. potients. Bose plato>
0< 1.52 mm thld<nen offe r odeqLKlle ,trengtn
end ot th e "'''''0lime 0.... to le ro ted well by po-
tients,
Th. "",.ill a')' bose plole u,,,,,lly <ove rs
t"" emire polote I,ll the diolol 01 th.li.. moklf.
!
FIg 26 Pt.... "" boto .....
Thl, !vII co.. mge helps in 9aining odeQIICIIo
",eng,h. Narrow """,;llory be ... pIoles _
bling " ho .... hoo ore less sloble and are IOltIl
to get dislodged during """"""",nil 01 the tong<&
The mOMibul", bose p1o ... it ..,..,..
shollow to ovoid 'mic tion to the lingual"J!a.5.
To compen..,te I", !l.is il should be mod. ilia.
10 In crooso the strenglh . TIr" bo.., pklte J.hoyklk
.nug ly oround th e neck. of teeth that o r. no! bo-
irlg n"IO'>'ed, Th is hulpo in ovo>dir>g food aceu"""
i<>ling unde .."" bose plate.
Th. bo ... plolo i. mode 01 cold ""'"
oeryl", Or heot cur. ocrylic. Cold c",. ocrylic:;'
more freq ....... 1Iy used OS ~ is less ti""" <:Or'$uming
and >imp_ to use. The .r<sodvonrages 01 cold
cure ocryIic (ne rha. there is """'" dlg",* 01 po-
<Oldy and d os not 0> stobie os heat OJA! ...:.,tie.
During co,wflJdion of !he appliano: OOte sho.JoJ
(, {on
,\t",
. .. I
,,,..l
I,
\jJ
be ", ken to block ou ' undercut, '0 thot i n '~rti on
a nd removo l cl th . opp li o""e will not be 0 pro b.
lem, Thi. is moro w in ca , e 01 ooon dib ulm opp li .
o""e"
Bite pio"". con be i"",orpomted into the
bo plate. Th e, e bite plonel help in di""90g -
ing the ocd u. ion, The onterior bite plan es a ,",
Iob riC<l~ by thickening th e bose plo!ebe/1 ind the
"",xill ory onterioro [Ii ~ 27), Anterior bite plone ,
0,", u. olu l in trM ' ment 01 d""p oyer bite' by .
lerti"e eruptuion of tho po,te rior teeth re!ati, e to
th o ontenoro. Po, teri or bite plo ne or. lormed by
e<len ding tho bose plo te '0 cover the ocd u,o l
' uroc. of the t.,., h [fig 28), Th~y ore gen oroll y
u,ed in th e trMlm ent 01 cro" bi!e, a. they help in
remoing the in'ert. ", ,,,,e 01oppo. ing teeth,
CLINICAL MANAG EMENT OF REMOVABLE
APPLIANCES
DeUvIJ'Y of th e applia nce
The re ore 0 num ber ol locto" that , hou ld be
looked into ot the time of op pl io nce de live ry,
I, Th e jj .. ue , urfoce of the ap plian ce "hould
not have ony . hmp areo , or nod ule . Rv n
roor ling. " over: he t~. u e . urface of the ap-
pli o""e to f"~ 1 fOf ony , ho rp oreal tho! oooy
inj ure the ti.. ue" They should b~ trim med to
ovoid ti " ve. irritoti on .
2. The ba,e plote moy ne. d l ome trim ming to
h. lp in <K"y i"",rtion and removol of the op _
pi io ""e , Th i' i, mootly. o in ca,e of unde r-
~u" being pre ... nt.
3. The cl asp f.oo ld be exom ined for ad eq uale
retenti on. If not they , hou ld be od ju. te-d to
engog. the u n der~u t, $0 o. to increa," re o
tention.
~ . The od ive compone nt, "h ou ld re<t ot the de
, ired locotion . Tr.ey should no' impi nge on
tr.e 9in 9i0, . ulcu s o r me fr. num,
5, Th~ pati ent w",,1d be ed ucate-d o n how to
iMert ond r~ "' ove the oppli o""e , It ~ 0 good
>dec 10 "how the app lkmce '0 th e patient ond
domon. trote to them the aL' ion of tho va ri
oul co mpa nont. 01 the appliance . They
, hou ld be ir,. trt.J eted nat to di. tort Ir.e vori
ous act ive component. of the a ppl ionce ,
6. Th e octi, . compa nent. co n be octivot"d of
te, few doy. onLe the poti . n, get' u. " d to
tr., applio nce ,
Ins truction s to th e patie nt
Th . pati . nt i. giv. n in, tructi on , b<o'ore he leave.
the denlo l ofice on th e u,e ond ~o re of the app li .
0"". Simpl. verba l in, tnx tiOfl ' oIIon rve the
purpo' . How~e r printed in<trJCtion "hee' lorfu
tur" refe rence cor bo give n to tho patient. The
fo ll owing a re . om e of tr., in,tru dioo. given ,
I , Patie" t , hould b. in. tn.:d ed on the n lJ," b~ r
of hou rs of we or, Mo. t ap olion ce. ore to be
worn both doy an d night i,e , 24 hou rs,ft i.
recom mended thotthey be worn duriog the
mea l ti me a. we ll.
2. The op pli anc e ond th e teeth , hould be
cl eo""d otter ev. "" mea l. Th ey shov ld 01. 0
be d ear"ied before r. tiring to ~ "" p,
3 T h~ pa ti. nt i, o. ked '0 d ea n th e applia nce
u. ing detergen' ~ utiOfl an d 0 br". h. l'I'hile
deo ning the opp lio nLe. Core "h ould be to~en
not to be nd or dislodge ony of the compo-
"" nt. of the a ppfionce
4, In co.o of removab le ap plion ce tool inco r-
parole screws, th e patient 000 pa "'';'' shOtJ ld
b. give n cl. or in, trud io n. on now 10 octi -
vote the app li<l nce ,
5. Th o pa tient. are in stru c!o-d to report imm'ed i_
otel! to the eli n;": in co,e of opplio nLe da m_
oge Of any other problem wh ile wearing them.
6. Th o patie nt w ou ld be in,ttlKted not to lea ""
 !I.e opp!ianc:e out of !he """"*'
10, a loog 6. fui;tt W)1:,
CVMo.o,.,19!6.
C......,.""",,, 0""""'","01. So to..,
period 01 time CIS it lrocreoses th e ris k of lOll
o nd dor'n"9 ".
l Robo 1 E ""1"' : tf,"d b-: 01 OrthaGo,'"._
"""" ., ... co l ",bI.hm. ;""., 958.
a 0;.,; ...... JA , "..,~. cI ~ .13 u _
P' ollieme e"",ollnte, e" In , emonOI. a:om",,~ 1966
. ppl,."",. ''''''P), 9. 10"" a-d 'No' : ham .... oh: ....... ol "",",,-
,",,0001 ..,.. Am I Cldood 1990 ; S50SS6
0'0/ "ygiene maifl/e"once : Pati.nt who
fail k> cI.., ~ the appliance and te.1II pose the
,ilk of ging ival inflom mc ti on ond hyporp lo.io.
$Qit li., ue i,,;lalion , R,movable plote. thot
nte not trimmed ond poIl.hood properly con htod
10 fiMue irritolioo ond ultel~on. Car hould
be tal<en 10 ovoid ,horp nodul.. ond i.regulari.
~ .. in t+>e applia"' . In add ilion W;te compo-
nent, that exte nd dee,l 1n1O the ves,ibul . offe, '~ k
of ve. tibulo, in-itctio n a nd in jury.
COli.. : Improper oral hygiene can re..,~ in
ca,ie.. The cpplionce ,I\ould be donigned In
,uck a way lIIot orea! oIlood llagnafion do nOf
~,

l'Din E~c. " iv' force. a pplied by th e cdi"e

compo ne nt. con ca u", rend, ,,,,,,, 0' even p<lln
clth.tee!h being mcved.
TOOII> mobiliJy : Presence 01 tmumatic occJu-
lion orlhe use oIeoceuive 10= during thetopy
o;on 0;0""'
obnormal ma~lily of Ito. teeth.

"".... : _bIo appt_.....""'*'r ""~ """'"

Am J Orh;>d 1969 ; 20'l_218
2. Ado ... (p, Tno~. ~ ..... _ 01 ........
~~. Orthodo""" OII~I .. """,, 5" ..d~iO . Wri~",
tolld. 1i1l-l.
3. r...... TO , ~ t . " boo ~ 01 O"hodo,"" . 610<. ..011
s.c""'k 0.100:1 . 1982.
~. Go uW ;, ~od LIM."." : (;<..,,,,, 1,,_... 10
""","",bio ,,,._.,,,,,, OII.lio ...... Am J 00"1l>o<I
19112: 141 149
5. 0 _ 1M. "'"" ___ , ~_bIO OothodOfthC
,""",i:w>aI .. WI So"od ..... fIoblol ...... 1i1l-l.

~ ",..:.lI-?-, .~ ~ ~ """"I"\S
~ la..:.o..o .....~ ~""'':I I ....... '."JS.
~jl~ .J I"~""'4J,;...!:I ~~ ~
~ Ii;. ~ .:r I.O~ ':I J

Appliances

n importont ~<pe<:t 01 j'e<)tment ploMing

A
The _ ""'porIO<!Idioo<M>~ 01 oli.ed
i. ehoosir,g an opprop.i"", op,"ic nc;e f0r- oppl."",. i. oro l hygi ene mo intMoroco wI1kt1
e pcrtic ula r pot;" n! , VoriOU' ty ~1 01 becom e, more d ifficult, Plaq uo mod food debris
app li ances are ava il ob l. from which the tend 10 oocumulo!e crovr.:J *'"
ottocl1r'f'le<1t. wNdI
D<Ihod""~,, ha. to ,.Ied !I.. one lIoot i. mo.t mol:e. dooning cf tMt~ diflio~lt for tho ",,~ont,
IUi!od /orm, poIlent, Most .....locdusioN feClU; ... In cddi~on. "'0
filed appliance, are man! time
....... form 01 f....d therapy lor their correC1ion. oon.uming to fl. ond odjust ond require
AppIionc.. 1hot 0.. fixed or fiHed omo!h, reeth .peoolilf!d nMC," 01 on OrthodonliSl. ReI""",
by the operator and (Dnno! ,.mooed
be by /he chopt ... 1~ for _ deloil. on the odvontoges
~r;.."t (II ..;11 (Ire co lle<ll"'ed opp lionces.F'ctt>&m 0..0 di""d..,~toge. of I ",~d and removabl.
~ t;o n i. dispensed ", ith too lorg, e.tent In app l"n ce .
tie USO 01 fi>.ed ClPp lklr.::c. . Tn. orthodonti l! doe.
I\CIt deperod on the potient for tim el, "'lor ond TOOTH MOVEMENTS POSSIBLE USING
""'''''go'''O'l! 01 the owlioco:;.e Unl .... remOWlb!e FIXED APPlIANCn
appIionce. thot ore copable of onlv ~pping type
01100'" ma...menls, Iued oppliances con bring A 9""" oa..ontage 01 filed applionCM is their
chou! YOrious OIher types 01 !ooth movemenlS obility '" bring 000'" more tho .. a"" type cJ tooth
movemMl 01 me lOme ~me unlike remoYObie
Cd...ding bod,I, movemem, ,Dlttlion, Hppinl!.
... tru,ion . 1"",.>On ami """" root ".,...,mom .
oW1ioroc., mol CO~ a~ly per/ofm . impo1e tooth
""""",,",n\l, The wrioJ.looth ~n\l poso;bie
fi.:ed opP!iOr1<:U 0"" the refore very ~rJ,(lTil e and
u' in9Ii.~d opp li orocu 0'. :
can boo uled to treoTmOlt ma loccl U' ion"
 r\
I'
i
/
I

,- c
".. ~
\

... ,
D E f
f~ I TO." ",.",-..,,1, ~, 'b l , " ;' i i;, o;j . p~ I ""''' , .-) nPII "\I of "0'" I.) &O, H, "' .vo mont IC) T"'q.io;
(D) ~'M "" tEl E>;!o..' on (f ) M..'o-di>l, 1 "",..,.h
.
TIp pi n, Or, capable 0/ bodily move'll''''
TIppi"'ll is the "mplest type oIloo1h movoment, T~r qu /n'
prod LJClld by.he app licatiO<1 of a . ingle force on
1M . tooth o;rown , At. 0 ,0"" It, th e crovrr\ ", ,,,,eo in ~ ui"ll im piies root mo>'ements in the ",bell o<
the dif'8CJQn 01"'" force o"""nd a fulcrvm in the lingual dj,ec::IioIl. It i. possible 10 mDYe the 100II
opiml f'fIgOt1a ""'mol.
Tho roolcpceooperionces in 0 ("bioi or I,ngua l d irection using
appi ionces .
~>.e<I

a ~ount'f'_O~ O" end ~ in 111 , oWO' i!"

di.... ction , Ti pp ing typ o 01 tooth moveme nt con
be used 10!reo! oNy cerIOln malocdusionl. Mo.l
Iiaed opploonoos Ole capable 01 pro<i.cing bppi"ll.
Howeve~ ........ mrelycan 0 mo\oodus;on be ffrolo<!
e ntirely by tipp ing mo"' me nts.
S a d llt 1II 0~.m' "1
80dil y tooth mov"ment implic. on 8<lyn(
movem on' of b.otil the crown a. ,,&II ". the reot
in!hoI S<lme di roct.,n, Cenoin /",ed cpp/io n,,,.
IJpt" htln,
Upr'ghring"fItS to me>io-diW( mOWlment 01 ....
roots . Fine, de!<;liling of ,oots by moving them
mes io -distall , CO n be! brought abo ut b, Ii.ed
opp IOonce.
lito l a t/o,..
Tee*, that ore rctatod oro<md th el' 10"9 o. e. ca n
i)e defoloted vlirog Ilxed o.,pli::mc",. The d"ll'"
cI fOIOIionol conrrd poaihl!! with fu.ed opplicnc;as
is "'" pos.ible using ",m"",ble opplioncel.
Ext,u don a nd In!".. IOl n
&!rvtion orod Intr\t~M ,ew to verti<;o l rT'IQ\Ie/T1, n!s
01 teeth cion; th eir b-Ig (!)li. Et!rusicn 0...1 to 0
Iess,r ""IeM iMllnlon ol ~th Olr group' of tnth
is po.sibl. uling fixed opplione ....
MEflfODS OF FIXING ATTACHMENTS ON
TO THE TfETH
The vorioul ottochments that ore u.ed in li.ee!
opplionce thero py . ueh 0 . bro cketl crxf molor
IIJb.. co n be li d dire<:ll y o nlo lhe Iftlh with
composite odh... ive. 0( con be otloc;hed to
meIollie bonds thot 0'" ""m.mted OlntOl the leeth.
The method 01 lilting the oI1achments direcrly to
"" IoeIh il coiled !:wono"'!!. ~~!he onodl
ments ore fi ..d to borxf, ;,hich ore almenl:i
oround the tHlh, the techni qve i. " ferred 10 01
bond ing.
BAND/N O
Banding irwo""" the "'. 01 thin SIOinleu 11ee1
strips ""ied bonds Ihm 0'" pinched tightly OfOUnd
"" teeth ond then co""",ted to !he teeth. The
OMinIM"M "'p" i. "",iloble in dif\e",nt width.
ond Ihid<nesset to suit d if!.,,,nl I" th . While the
mo lor bond mo torio l is wider ond Itiller, th e
ontoriO( bo nd moteriol i. r. lotively Ihinner orxf
"""ower in ",;din. The out..... urloca 01 th e boa...l
moteriolll smooth ond 9'=y while the Inr>er
.....ioce i, comporiti...,ly rough orod dull, 10 os 10
oid in ~on of !he cement .
IndlutlDn. fOl r ba ndlnf
The f<>ll owi~g are >Om. 01 the situo~on. who",
bond ing il od"1lntogeou<.
1) Bonding iJ prefer"'d ..... r bonding;" coM of
pos:erior teett.. The bonded ollachrnents 0"
be~", copol:Oe of ,..isting oedu..,1f<>fCao th""
bonded oHochment. In odd ition, bonding
need. th oroug h mo i. tu", conlrol which il
d i Hi~u " in th e pe.terior teet+. .
2) hi' preferoblo to bond 0 tooth thot requi<H
buccol o. wel l O. lin9VOI oIIochments.
3) Bondi ore bel.,,, likely to ""ill heovy Ion:...
os in the COM of """,orol de';"", luch 01
head geo".
4) Althoogh il il poll ible to bond ollochments
o n teeth tha t have po rc e loin Or gold
re.torolionl or crown., banding is p",/erred
in th ese eCUel,
5) I! il prel.robl, 10 bond teeth thot .how
recl.ll'len1 brookage allhe bonded oIIoChnenb
d..... to bond !oilu".
6) II i. pr.lotobl. to uM banded _,hmenlt
wh enever thoy ore likely to c<>nl~ct Ihe
Of'posing derlti~on ...+.en the jaws are dosed.
Step s In bandlnf
a. Sol"'rotion of tHlh
b. Seledion 0/ bond mot..,;.,1
'" Pinching o/Ihe bond
d. f ixing tt.. onodlmenrs
e . Cemenlt>~on of the bond
s..porolio n 0/ teellr, Due to tt,.., p"'Sl nr;e 01
t.. ht interdentol COO"lI:>ct between the teeth, il moy
r>::>I be pelSibra to Ion:e tho bond I"' otlhe contoo;!
or>. " is not O<:tviKll:Oe 10 Iorce the bond thtough
a fight i""",denIol con!<>ct 01 ~ i. uoO(Or.Jorioblo
for the potient ond olso difliwl! lor the OI>IrO"lO<.
ToghtconIadSlhould hence boo broken usin; Iodh
..."orotorl prior to band pinching . The voriou,
I'f!>e:s of seporotO<1 ore discus....:! later in the
&.opt...
Moil ,.peroto" h<we 10 be lefl in lhe
mouth for 24 hOIHi or mer. to bri ng obouT
..... Woe il nT MPO ,oti on of the in<er-dMtol contc ct.
s.,"crlon r>I bond mal.riol . Bose<! on ..t>;d,
tooth " bein\! banded, 1M bond OIoIMol r>I
approprio-e thick,*", ond width i. oeIeded.
Pmehin\! of ,ht bond: Bond male,ial of
adequale length is token and the two end. 0 ...
welded I....... The bond i. now po.....! through
IhuepoJ1ed inloll< .,,:;11 """kid a"",nd Ihe toolh
kI be banded. U,ing band pind1ing plie .. , the
bond i, !i ~~~y d",,,,,, a round th ~ tootn to lorm 0
ring . The nod: of the bond i, 'POt ""ded to reto01
the tight fit. The ..c... bond motooo l i, th en cut
off and th e ano. ore ooo ptod clo.< Tothe bond
The ben, IX'~~ is lfXII welded 000 too gingi'vol
mO'1lins of the bond are Irimmed to conform to
the cantOVI' at the gin"..,1 margin. Thewtld <pats
ond rou gh mo 'g in. or< then ,mooT""'led and
po lishod,
Fixing Ih' oll<>cnmenl. Once the bond
pinching i. completed, rhe appropriate
Machmenl, (ue ~xed onto the bond. The
oIIcchmenls include brod<n lor the anterior teem
and buccol or moIa, tubes for !he pOsleria, INIh.
Thew oIrachmcn" are fi.<&d 10 the band by .par
welding or by wlOOring.
CemenloUon ollh~ bond: The finol Itflp
I n~"'ll ceme ntaT ion of m e bcr>d arovnd th e
tooth, The inn...-.urf""" of the bo nd i. rough in
ord"rlo oid in ,. I""tion. Aw. 11 pinched bo nd il
0t\C Th ot hoi OOeq uoie retention e'en wiTh OUTTh e
use 01 eemont. Ne.e" hc l.,.., oemontulion i,
roqulred 10 ,I"",nolfl the <poce between !he borod
ond!OOlh into..t>ic;h coriogenic molerio! moyseep
 A

c D

E F

,""c nd , !"," ncte. , in c po ly-carbo,y lote, zinc ~o,pnate, gle n

(h,ring cemeo\;Jtion, odeqwto m o ~t" '" ienamor-=-t etc.,_ I'",bmed """", less barld.
conlrol i. nece..,,"t' by mean. of soli.a eieC!On 0'' now o..ailoblG in "lriou. >I,e,. They hc~
cn:lcollon!dls. c-m. """am b..........J indvdo elinin~ !he need to pinch custom rrode Ixn:h.
f~ ~ EIKI", " """"'_ 1_ 01 ...,,,,.1,,",mol o..d odd .. """mol W N<.<rol ......... 1
<;hod "'OQI' I!~a''""
, !oOO
""'I>";!''''''' , 1500 IQ ." hod OM """ mag ~l~a',," 500 (0) kid 01<;0..' .';" ",, 1""'1/' 11 co' ....
iii No<mo l .., 'nO! ,,<;d
,~
BONOING
The method d li>.i"ll oll'oc~...-I. dirKflvover!t.e
eoom.1u, 'n g cdke. i,.., r" ~n. i. co il ed ho ndi"ll'
The .limlM lio n of bo nd . greolly e nhences
estheIi<;s ond ore l hro i"". "", inle""n .. and "".
*I to itt populorily over bonding. This ptOCedure
oIdireo;tonoo;~menI on the tooth ,unoc. requl(fl$
pe!'CIOII,oemolenorrd. Enamel ron be p'eheOiod
b,voriou. mofhods. The mosl occepted me:hod
isthe p'OIffIO!menI by acid e\ching *""I~. This
ledriq"" WOI inl,ocicKed in 1955 by SuO<X>COI'e.
The prcllOOTmenl of ."" mel by "cod etch !eCh n,.""
""'p. in the 101i 0w;nl/ ways'
I. Enhance. I~e .urloc" Meroy , The
~;ng of the enamel helps in ",mo';ng .urface
~1S ond orgonic; moteriois that ore found on
f,e.....faced the leeth. ~oIso ilK".leOS8$ the "'~
_~y the,.by enhen.ing the well(1b!ljIy 01 the
-,
2. Enhance. Ih" ,ulOce 0'''' and P(I""II)':
the .!ching of the .""m.1 incrl!(!se< I~' .urfac.
o,1!(! ond ,.ore.ily of the .....,,,,,,1 th<J. incr.o.ing
lhe bond ,trtongth. The ."""",1 "etdoed to (I depth
012025 miCfOIIl.
Bonding olfe.. numerous odven!og o~r
bonding wh"" con be lisled os :
1) II iuotftet,rolty IUpeno..
2) It i. los"" 10 bond thon 10 pinch bone!. around
theteeth,
3) It ""cb~, m(l int.""""" 01better 0101 hygiene.
4) It i. pO lS ible 10 bond on teeth thot "","
aberron! ,nope. or lorm . . II might b.
impos"bl. to bond IUch teeth .
5} H i. _ Ie, to bond thon bond in co," 01
,.omalty enopled and fro<lured 1o:eIh.
6) 1M risk 01 cories und", loose bonds i.
fiil 5 60""-01 <~. I;'l... :t._
"~"II , .... i<o ~~ & (q 3O-~0lIi ~k
.... " ... to .t", .", m, 1 (DI Etoho " I,

owe""" ~'Ih "''''' lEI ..." '" d .... "'''II

' (1'1Soo00bnt I,'pp ~d (GJ & IIf) 1001 . ", &
adOo ... """..0 0" , ,,,,,, """"" o! b.<>c~ ..
"" .... Ir, 5><, .. , ... eJ " ' ," ()I h ....
110" of .;~,,~ . ,. mo .. ; IKI eooo,"1
<0...,1' ... "" 0 I joelh
7) Int e' prox ima l a rea. a re a cce" ible fo r
re,terotio n and pro, i"",,1,tri pping ,". ',-'
~ ~II.. OO,"po.. nt.
DIsadvantages of bondIng
, t , Arch .,;,-"

,
11 Bo nd ed aHochm Mt. a re we<l ker thon bo,-,d,o,d 2Spti"lo>
U: ~

,-
atte<;hm ent> and hence a rc more prone to
bo nd io ilure , ~, Sop/;ator.
21 Bondin g in vo lve, erchi"," of th e ena me l witn PlOtt .. """'po.. nt.
a n oc id whi<: h """y lead to enamel 10" a nd
o n il"l< reo .ed ri.k of demine ra lization .
2".SrOd.:otl
J, IltJ.;:c;j tubol
31 Ena md frocture can ocwr durir.g dabor.ding ,
~, t:.Vj/) O!i3ctmrQ
Ste ps In bondIng
Bo nd i"," i, done in the fo ll ow ing <tep ' [fi g 41 :
11 The cro wn, of the Meth to be bond ed o ro
cl eon ed u, ing pumice an d bri,tle bru oh 00 a. 61 The bond i. a ll owed to ' tren gthM for , o me
to remo,e plaqu e a nd ot he r o rgo nic debris time before placing the arch wire,.
pre.ent on the ename l , urface
2) Aher tho roog h cleacoinq. the tceth a rc' washed BA NOS

a nd d ried, During the b-o nding proced ure,

Band , m" pm,"ve components that r..tp in fixing
a d eq ua te m o i, tu m c o ntro l , hou ld be
th e ,orio u, attochment. onto the tecth . Theyo r.
ma inta ined by th e u.e of >o livo e joctor> and
ava ilab lo in o riov. , ize. to <vit diffe",,,t teeth.
co tton ro ll s, It is od' isable to " ,e a chee k
Th ey a re mod e of . oft . toin le", ., teo l, Th.
retracto r to ' ee p the lip. an d cheeh away
attochmenh like molor tube. a rid brocket. are
from the teetn to be bo nded,
. oldered o r we l d~d ove r thc," bo rld . which o ro
31 3050'Jb pho",horic ocid in gel or liq uid form
ceme nted in positio n orovnd the teeth, Th e u, e
i. v.ed to atch ena mel. Tn;, et, hin g i. u. uo lly
of preform ed band . o r ,ea ml. .. bo nd . i.
do ne fo r 45 60 cond., oHef ",.n ich the
beco mi"," po pulo r, The, e bo nd , a re o,o ilobl. in
etcho nt i, we, hed off with weter. The toeth o re
then dried aoo o rx.e aga in isa klted usirtg fresh
cotton rail. The oppeamnce ci etched """mel
,
i, desc ribed 0' motte, d ull whiti, h 000 lightly , -' e.OII TMo~.O$" Bono WI<Ith
frosted _
41 Seolo nt i, ap plied onto the etched e r>;]m el
"~, In.d.o,.
~
-
~no""1

,~
(Ino",.f

D,l ts
,
,
:~, ':C.,.,.
,c-rfoce.
Q,OOl 0.100
51 Adeq""te qu antity of bon ding adhosive i.
pl oced On the be ", ofth . broO:ol> . Th . bra<;kot ~' Pi~ M I)4 ~ . 1 51I
,
i. plooed o n the tooth a nd i. firmly presscd
into po, iti"" , Exce,sive od he, i, e thot o ppeo"
~

,,~""
OM
'M
~ .1 80
~, I M
"
0' flo, h i. "'m oved using a . cale r.
-', "- , ,

"'lriO\,jlli<e . Th e ortnodonti ll ckooles th o bell
liHing be nd or", cem l nl> them d iro(:tly on the
tooth . Th l u.., of the.., bond. thu l rl d lKe. t he
choiroidl time bv el im;ooti "llth, t""io~1 t(Uk of
pln.;:hlng the bond . Thoy ar. 01.0 more
comfortable lor the pot;"t (Fig 6) .
BRACKTS
Broc.klllI cet (U oondle. to trQnsm~ tt.o Icrc. from
the octive co mpooent. to tM tH th . erQ ~ke" "av.
one or more .$JOf1 thot <>c~&pt the orch wi ... The<.
aft a number of b<acht dlligns o-o iloble _
8<ackeh can be do .. ilied in 0 n~mber of """)':1 _
Ed w,.. type of lI,u ll
8<adc.... .-d in the Edgoorw" ond Stroigh! Wtre
I labiol.,.
''If 7 "'I (41'"'' "po o! """'... III ~bboo ord11ypo"
>=",
re(10ngulo, (,oss -.ection .. ith Ih, 10';'-
dimln.ion being hori<onlol. Theu broc
proYicle grect&r <:0011,01 "". , tooth rTIO'Iement o!c
do not pormillipping of Icclh.
RIbbo n .,," b"cker.
They Ore brockeh whim posses. 0 "''''cal .lot
focing m. oed_lor ginoiYal direction (~g 7.
The slo1 i, also norm..- mesio.dislOlly. lh. kind
brocket" vud wrlh round wi .... Ie> bring o~
tipping 01 tH!n i~ lobi<>~i"iluol as W(! II 01 mesir>
di.kl! dire<;ti Qn. Ribbon oreh bro(~ell are uoed"
the Begg li.ed c~ l iof\Ce ,
We/d.llia an" lIon".III. lI,ach t.
"".n"mo,,"" in the IKIrlierOlion oIth. ~
the brockels con be either bonded d.rectly_
lhe 1eeth using bonding odhasi_ or they COIl
be -...,/dod onto bond. which inlVtn are OIII ... iIed
a r""",d the teem. e",delo thoi-o", bonded ~
.,......th. enamel are coiled bondabl. btockels,
......l$!hoM thoIore -.elded orsolder.d _bond>
ore called .....&dable brndteb_ 1he under.urface
01 bondobfe brockeI. ho.o mc.h """r\: or l i _
to help in interlocking with th~ oo:lhesloe IIill 8).
Weldabl e brOC kot' ho"" a mete l Il ong~ thot ca ~
be weld.d to tr.e bond.
MIt.llle ,o r. ehtl
MOlt brock et. in curre nt use Ore 01the metoll ic
....netv. 0 1Ihcso, sr~ I::m::l<.ts "'" most CQmmo<1l;
lMd. The advantag ... of metal bmckets include,
o. They con be =yded.
b. They con be ."'rililed.
Co They resttl deformation ond Imclure.
d. They .... t.t 1M leasr lridion ol the wir.bmckel
int.riote.
e. Th.y ore not ve ry ""pM,"ve.
The diJOdO nlogo. of molo l broc'OfS ore,
o. They c re ...!t.e!blil y "'" pleasing . The >'Ctient
ter.dpo hove 0 metollic ""ile.
b. They COn eo,ode a.-.I couse .Ioining of teeth.
el,.",'e b,.ell. "
C&m,..;c bmckeb we,. inlreduced 10 o,;hcdoillia
.. th. Ict. 1980' ,. Theyore mod. 01 c luminum
"'ide or ,i rconiu m o.ide . rr.. adva ntoges of
u rom ic brlX keTSOr. :
o. They 0,. dimensionally stobl. ond do not
diston in the 0fIl1 cavity.
b. Thoy ore duroblc ond resiST .mlnlng In Ihe
orolellVlronmen1.
The disodvonlog.es of efOrOmie brockets
indvd. :
o. Th ey ore ve ry brittle ond therefore frocTu re or
croek when undue forces c re op.p lied .
b. To compens<lte for th. i, brinl. ne.. ~ tf>eir ,i.., I,
incroosod which Tond, to if'IC roose their ool~ ,
C. Th ey """bit greeTor IriClion oT the wirebrocket
interlace tl.an metal lic brocket! .
PI.ttle ,o,.e,,",.
,1,10.' of the plo,lie brockel. Of. mod. of
polycorb ona t. or 0 modified fo,m of
po lyccrb-onote . TM,. plo.tic brocket. were
introdu ced to impro'" Th e .sth etic vol uo 01the
opplianc . P!csti<:: brecht. c r. "", ilcbl. in tClOlh
colored or I<ttnopareill looms.
The ditod-.ontage. of plostic bra<;~
=
o. They tend 10 diSColor parlieulorly in po1~""
who smole. 0' d'ink ,off..,.
b. They 011&1" poor dimeruklnc l sta bi lity.
c. Thoir slot tendo te distort
d. Thclridion ~ plastic: mrletsond metoI
arm wi~ ~..,..., nigh.
BUCCAL TUBES
Brackets ore usuall, !"ad on It.. onlerior 1eeth
000 premolo". The OIIOchmenl that is generolly
u,ed on moIers is!,," buccci !UM '" tlo. mololr
tube (fig 10) . The buccel tuM con be weldoble
i. . _ Ided to bondl w~i<: h c r. cemontod around

f .. I I l" , oo l 0_0""',"
b Jlt"" ;() Bal l ..." """" :0: ; ,dot
ff ,'I O 3x," !..be,
:A: l e,uo l d ..,- i6; I ~ ." I
,
~I S ~ ,1e i!1 Do.." (c: Tr;p e
the teeth Or th ol Can b. """',bI , , , " ""'..
direct ly to teath by ", ing bonding ad,.,.,'i . .....
B UCLU I tub~1 Can be ro und
'.dong u"r in cro<' oeoio<'1. Tn.. b"coo ' ... ..;
som eti me' hay" do uble Or tripl. tub. .
additiona l t it'
for foce bow i"'ertio n.
UNGUAL ATTACHIlfEIfTS
Brockets and bucca l tubes a re attached o n "-
klbio l or bl!C~a l a'ped of t n~ teeth. Sometime..
rnav be necessary to hove ottac"mc~t, o~ "-
li nguo l , i d ~ c< well Th e , e Of" va rious
olttlchm . "" Qyailab le tOO l can be fixed on "-
li ,,"oo l a.poet and are colle<! li oglKl l ottoc rrneros..
They Ore u<uo ll l r~qui r"d for engag ing ekwics..
Exompi of ling oo l oi'l""hment> indude
lin." ol button. (fig 1 I ,bl, lioguo l deal. (fig 11_0
e)'elet> [~g II ,d) ond boll .nd hoo~ [fig 11 4
LIGATURE WIRES
The;- are .oo stainb ,cool wires ot 0.009 to 00 11
inc"", d ia~te r and Ore uled to ,ecure th e arm
wire to the b racket. {fig 12), Th;. prace " 01
"",uring the arc~ wire to tne brao~~t. i, coiled
li gation , Ligation i. u.",, 11 1 ne""",a"" in edgowise
type a t bracket, th at ho~e 0 lob ia ll l farin9 .Iot.
The li gature wire. ore (lVo a"b lc in long lengthl
or o re preformed into , mo illi gatur., . Th e m en
wire; CM a lso be sec ured to Ihe broc ket " , ing
" k"tic ligatu r" ring, Th e. e ring . are ava ila ble
m va riov, ca la " far the poti en' ta chao,e fm m,
LOCK PINS
They are ,ma ll pin , that a rc u,ed to , ec<" o the
a rch wiro to brocket, with ,"" rtica l , lot, , uch a,
ri bbon orch brocleh {fig 13) Th e Io<: l pi n, a re
u, ,,,,11y modo of bro s>,
F;g IJ Lcd 0" ,oed ", ,.ow" """ ;, i,,,,," ""'" """
of """,01
ARCH WIRES
Arch wire, a re o ne of the octive co mponena of
fi,"d ep plio nce" They can brin g obo ut ,"o riolJ,
tooth movement. thrO'J ~h the med ium cJ l>roclel$
end bucce l tube, whi ch ed o. ""nd le, en ' he
teeth.
In ea rly doy' {pri o r to 19401, pu re ge ld
a rch wi, ., wore u, " d. The ir hig h CO'l o nd
medm ni<e l iMflicier"lC)' led to th e u" 01 'k>inless
, te"1orchwire, . In the 70', an d 80 '> a number
of tito nium Ixl ..d orch ""; re, we re intrOduced into
o rth odontics . The, . o rch wirel exhibit , upe rio r
"katie propertie" A number of multi-slror.ded orc:h
wi"" are 0100 bei ng u..d effectively.
 BI.. d 0/1 """orl,1 un.
....... Stiff""" . The presence of 0 low ' tiff""ss p~
t"" ab il ity to op ply lower fore" , and a .".,..
con,TO nl foroe over tim . _
I) (loIHI'dp>oJio) .
:J Stirto" .:.~ focmohilJy , The orthodooTic oreh wire moterd
:I) N.<i<ot Ulriu", ~ll1' sh<x! ld e,hibit high formobility . 0 o. to bend tiw
4)
~t
~I
BttI.~
c,c,~ t
Ql:U., .r~ . ."
oh:l<"I'i<.<n nidoI aio>r!

80M;; 0" "oSo -.. ,Uon (1~ 14)

arcn wire into d., ired config uration .coc h """,,, <
loo p. , etc ., withovt ffo<; turin g th o wire .

Re, i/ieoce ; Re. ;I "nce is the amount of 10'<2

t he wire co n with, tond b efore pe rm on e nl
I) Round
deformo tion . Arch wire, .oou ld exhibit h;gil
Z) $quaro
re, ili . nce 50 0 < to ir><; r. o se th e worki"9 rO "g e d
:Ii ROCIi~
41 M~.1'Idod .he opp li ar><:e.
t..~ ...___,~~_ ""~
Sjocompotab;i i ty and eny ironmenJof
Id"a/ requIrements of orthodo~t/c
,tab ility. Orthoc:lontic arch wire hou ld e,hj ~
arch wIres
re. i. toflC. 10 to rni.h and corro. ion ond shoule!
Spring back , It ~ Ir.e meaS"'6 of how for a b e "",, toxic. Tho mo te ri a l . hou ld mo intoin i:.
wire am be dell . d e<! with out cousi<>g permanent d~$i rabl . properties for ""ended periods 01 Ii"",
deformation . It i< 01$0 cal led e kl,tic defleOion . afl.... monufacture.
The oreh wire , haul d ideolft p::l"e>l high $.p rj"," Joinabll;ty . Th . wire , hould b. om ~""b1e 10
bod, wh kh re . u lt. in on ir.::rea.e in its rong e o f salde rir>g ond weldi rlg .
oction.
F6d ion Many l oot h movements 0'.
A accompa nied by . Ii dir>g of the arch wire o,,,, the
tmKlet , Iol>. Prc",nce 01 e>ce,sive fridion ol !he
wirebrocket interface re. ults in undue . trQ in on
th e anchorog . and limilotio" 01 !Oath movement.
B
The wire shou ld therefore p ro.ide Iea.t fri dk:<> " ,
tho wire b ro cke t inte rfeee.

c Gold ""d told "lIoy.

D co,t in,ol,ed I. d to the i n.~nti oo of gold 01 10, .
E
F;g " em.,_>KI'" of a,cffl,;'" W Roc , .:3)
,'C) Roc"'''lio (0)""'100 I ~i Caarn l
Prior to 1940, go ld was exte n' i'ely used in the
monufaCl\Jrc 01 anhodont ic arch wires . Th . high
in which other meta l. like coppe r, .iI. cr o nd
poIIorfvm were ad dod and !he perrentage of gold
reducod _Go ld and gold olloy arch wire< exhibit
celle nt lor mabi litj, erwironmenlol stabil ity a nd
b iocompata bi lity_ The drQwbocks of the, e arch
~ oo ", wire. indvd.low 'F'<"i" 9 back 000 high co,!.
Sta lnlen , tel'l
Au.ten itic oIo inle" . tee l wh ich i ometim ",
referred to o. 18/8 ,ta inl ." . t",,1~ vsed to make
M hodontic orch wire,. Stoin le" oIee l orch wire.
exhibit edequate ,t rM 9, h, r. , ilie"". , formobili ..,.
ond adequate 'pring bocl. In odd ition Ihey are
biocompoti ble and economica l.
NIckel m anlum alloy.
Nicke l titon ium Dil Dy 01.0 ca ll ed NitiMi (N iclel
Titon ium Nava l Ord inance labora tory) was
inv. nted by Wi lliam R, Buch le r at the Naval
O rdina""e laborator)', Th i. a lloy exhibit uper-
eioolicily """,!hope me"",,,r)', Th ey were introdxed
to the orthodontic commu nity by And.""n in
197 1, Nitinol orch wire.hibit hOgh "Pring bock,
high wor'<in g range and low .tiffn e", Thu. th e.e
arch wire. on activot>o-n produce lower-a nd more
,o n, ton t fore. on th o teeth. The di.odvontage.
of Ni tinol or. that it i. re.i.tant to to~ing a bend,
h. li ce, or loop. conroot M made on them Dnd
they cannot M soldered or welded.
Beta titanIum
Seta titanium wa. introd uced by Jon Go ldberg
and CL BUf$tCOl.: . ~ is ovo i\oble by th o m>d e,..,,,, .
of T. M.A. wire . The,e wires hib it a h i ~h rong e
of acti on and , pring bocL Th.y 01,0 p.rmit
moki".. of loops and helice. dCJe to the ir high
formabi lity. An add ed feotur. of th e, e wir., i.
that they can be we lded.
Cobalt ohromlum nIcke l alloy'
Cobalt ch rom iu m nick. 1a ll oy. drown into wire.
con be used suc,, ", s/ u"y in orthodo nti c
app li ance . The,e al loy, oro ava il ab l.
com me rcia lly as Elgiloy, Th e;e arch wire; e, hi bit
ed equat" . pr ing bod, form ab ility and a re
biocampatible.
Optlflex arch wIres
It i. 0 new type of orch wire developed by M.F,
Telo .. in 1992 The.e e r,h wire , ar. med . of
deorop>col fiber C>o"">d ore !herefore h'll hf,- e.the"
In "ddition, they exhi bit hig h re. ilie nce , Th e
drawback of tni' wire i. tho t it oannot aooept a
.harp be nd
M~I!I Sfr~n ded arch wires
/
The,~ arch wire. are mad e up of a nu mber of
thinn er wi re . Th e.e wi re. con be eith er twi,ted Or
,oo'io l in form (fig 1~ ) , Th e odWlnt<lge of th ese
multi , tranded wir., i, that they exhi bit ir>ereo,ed
flexibility,
ELASTICS AND HASTOMERICS
Ek,,' b or. rout;"" f,- u,ed o. o<:live.,ompone nl$
oi fi,ed orthodont ic applience" The ela,tic
pro dud's u,ed in orthodonti c> inc lud e . imp le
elo.t;<1, . Io,tic cha in. , elastic thread and . Ia, tic
modu les,
EI"s tlo.
Th ey are e lasti c> thot r..emble 0 rubber bond,
They are mo de of latex rubber and are eva ilab le
in voriou, diometef$. The force oppl ied by thes~
elo,t ics depend. upo n their diameter, They ar~
O,,"or cod ed for ""'y identi liLction,
Ela. tie, ere u.ed in orthodontics for a
num ber of purpo' " <uch 0' dosure 01 'pace, to
correct open bites, treotmcnt of aD" bite, Dnd to
corred inter a rch r. lation<hip. The.following ore
some of the app li oati""" of """ ti os ,
000, I e la'tics . They are intra -arch e lo,tics
, trNchcd between the mo lars and on te rio rs (fig
15.a), Th ey are geM rolly u.ed fo r dosur& of
spooo and retracti on of teeth
,
,

''Ii IS EI," opp~"'"" WOo .. r .,"'" lal Clo ..

1101<>1", (Q 0.... II , '" ,-b (D\ b ka,o. (E) C_"""
,10.>;"
Clou I'.IoSl,,, : They '''~ ;n,,,,,,,,,,.;lIory ,IOllin
lI,e,doad bet-.Ihe lowe, mola .. 0.-.::1 .... UPI*
o .... ,ien (hg IS.b), Tney 0"' .....d in !he 1nIoO""*,,
a. CI<;In II malocdu.ion. They bring about
"dvctio<\ of Upptlf ont<orio.- prod;nQ~on and
m...:ol moYemen' of the I.,.".,. molars,
Closs III . Iolti" They are intermax illory
c!olicI th ot ora .!<etched between th e UPPl"
mo lors ond th ~ lower ante rio," (Iig 15.c). Tne,
c r. used in treaTment '" Cia" II I molocdLJIkln 10
brino;l obout me,,,,1 movement of upper bu=1
_h and retrodion 01 100000J on\erioJO.
inler.m"",lIory elo,I'e. u.ed 10 no' molor avoilable in 0 ,pool. It i. Cu 10 desired Ier-gth
CfOllbiles (f", 12.e)_ They e:<!encI between Ihe OM Ii..! be_""" teeth or lwO group. of-"
polo"!>1 ,u~cce of the upper moIor orro' the b...ccol 10 dose spece. They Con 01", be usod '" d.rctoIo
'u~oce of lowe r mo lar or ""'~ VefOO. o too,h . (fig 17)
80. alasf;'; . Th i. fo rm of . Ig" ic i, used to
Ehutlt modulu
~o~orop"nbi1eS. Iv> . losticilltre!dIed
between !he upper OM ~ o~lfIriolllik. a boo The." 0'" mode 0; t..o elo.~c rings sepornled by 0
(fig 12.<1). The open bite gek corrected by forced v<rriobl.. di,IO"" . Eloflic ",OOul., ",e oOiloble
ervpIion ofJhe upper or.d lower on!trio~. in verrio .....as ba,..! on the inter-ring diotonce.
They ore gl1l'OtOlly used to do,,", space ond 10'
ffutlc clulln (f Clrllln} d"""'tJlion of leeth.
They o re ~OS'OcI mo gr" ovoao bj . os bog d1oi",
ugatlng fln, '
n,.,y a
of int .... co no .ded ring s. r" uw oll y mode
of , ynth , ti c po ly"u ryh"M mOl. ri ol and a ... Ar<;hooi .... cOn b, secu~ '0 m" brodee.. u ~"'Q

<milo~e in dille ....110' ....' ba>Od on ~ di'llInce small . ,,","OmIIric rings celled li(IQting Mgt. Tho1
between lno rinO$ (.... 16J_ Echoin i. uoed in me 0 ... overiloble in OriOu. colO<1_ AIr ol~"'o-e WO)'

do,u ... of "POce between leelh by o,..!Ching me "!> oecure me arc ..... '" 10 -he brod el i< ,he use of
I",,,,,, ... wi .... thot wes deKribed earlier in the
(hop.....

'0 It> !""', 0-0'"

Ellll lie th,ud
Ek" tic threod il modo 01 a core of Iole. rubbe r,
surrounded by 0 'lee' e 01 wov.n . il ~ o rld i,

SPRINGS

Spri<"og< 0'" the otheroctiw: cornponenb """con

be u"""to bring obou- .."iou. toorh-~lTICnIS.
The Iollowing ,prlng. Ore used in orthodonfia :

Up,I,hllnl .prln,.
The, or. lP'ingl wh ich mOve the root in 0 mel iol
ordi, lol directi.,., (fig 19).
TorquIng .prlngs
They o re .pri ng> whic h mo"o 1M roof in 0 lin91J0 1
or po loto l dirO'lCtion.

Open coli s prings

They a re ", riog' th at are oompr.ssed betw .... n
two teeth to open up ' po<:e be,..",en them [fig 21
ond 22).

Cloud coli s prIng

They ore , tretohed between teoth to cl o,. >poco
(fig 20 a nd 22).

(
c o
SEPARATORS
In mon, poIienli the Pf"'S""C" 01 0 lighl IOlIer-
o..nle l conled tellJ ll$ in difficu lties du~ .... bcrxling.
\'/n ile oIIemp!ing 10 poss 0 bo nd th rovgl1 If>!! inter_
denta l conlOCI. lhe bo nd tends to "", dislofted, In
Md-.-on, !he patient !My . """",,.,. someo/flOUf'f
01 di.cocnforl. The hoe!h should IhereiOf. be
oeporoted 10 b_k the light inter~101 oonIOct.
This i, """"tty achieved ""ing variOUI Iype. 01
<epOroIOo'I available.
So/! boo .. "';re of 0.5 0.- 06 m m dio m<!ler ~ passed
orovnd the COl1tod ond Ihe ends on twisled ~gMr
B
togelhoor. The end is cut shor1 and is I\d:ed
between the teeth {flg 23.t1
Rlnt up., e totl
Th ey ore ,mo ll ,, " ' Ii<; ring. thot o re iXllled
thro~gh the con taCT us in g special p liers
(applica'otj. The 51retthed .Io!lie ring endn:le.
the i"",<den101 contoct and o. a conln:lCls. th.
teeth are oeparooed (~g 23.0) .
Du mll,,11 ' .p. ,. lor.
II is " dumbell .....ped piece 01 ek,,#c Iho! I.
streich"" and poised Throug h tke- int&rdento l
contod Ifig 23. b) . The . jrelched .epareto.- Iri

torega in;" orig inol ler>;lth and in d<>r.g "" b ri r>;l'
about ",pa ro ' "" of tee!n,
Ke s lIng's sp ring lepe r,, /or
Th i. ~ a spring oeporotor tnOt effectively "'fXl ro:e.
th~ conla ct, The spring com i.ts of a co il and 10
arm, . The , ho <te r arm af the .po ..... i. pa".d
b~klW the contact while the bngor arm relt! above
the contoct. When the "P'ing ~ oklced in pos ition
the co< l open. up thvs octi "oti ng the 'p ri..... . A:;
th o 10 a mlS try to come bock to po. itl"" they
brook/he co ntOCl (Iig 23, 0),
Pi.fee Fouc ha rd in 1 728 dev i,ed ' he li," t
o rthodontic appl iance to e.<fXln d IDe dento l arch~
The concept of fi.ing orthodontic ottac hments to
teeth took a deiinite '''"PO in th e lote ni neteenth
ce ntu ry. Edward H. Ar>;l le introdoced the E Arch
or the e, pon. ion eteh in the kl ... 1800'. :fig 24).
Th e appli ance vsed bond, on tho mol a r> with on
expon, ion oren throod . d to the b ucca l o.p-oa ci
,he molar bond>.
In 1912, Edward H. An~ 1e intfoouceC
!he pin oM h..-be oppi icnc~ (fig 25). The appi", ,,,",
(OO,;, too of bond. with a verticaf ' ube placed on
a ll teeth. The erch wire corriod wkJ. red pin' lher
in.crted into th e ve rticol tube . TO<lth movem."
wa< nch i. ved by a ltering the p lt.c ~ ment of lhe",
pin "
fn 1925, Edwa rd H. Angle introou(ed
the -i bboi1 mch appliance (fi g 26). Thi , wa, th..
firSt app li ooce TO use a true bracket f"winQ a
vertica l . Iot foci ..... ocdvoolfr Ang k; v.cd ~oId
arch wir", and lock pin. wilh thi' tech niq ue. The
ribbon arch t. chniq ue encb l. d rotation control
a. well a> bucca- li nguo l ond incisog ir>;lMl I toolf>
mov e me nt . How eve r mel io d i, toi tipp ing
moveme ntl wefe co n. idered d ifficu lt ,,; ,h tlli.
tochn>qu " .
O"e r The 'CO" 0 number o f ; ixed
o ppi itlr"l<;e tecnniq""" h,we evof..ed . It i. nol within
th e s<op-o of th il book to d io.cuu ;0 de'a il 'he
",r>Ol Io<;t..,;qu", 0 ' no..;merou. ph ibwphi", <>nd
mocncn ico l pr;nciplel a re invo lved ,Thu, tne
d i,cu"ion i, limit. d to few o f the more p<lo ulor
te-ch n>q c;e, that ,,"vo been wi d~ y used by the
proctiti onerS
EDGEWISE APPLIANCE 3. Inc","",ed friction ootwee<l the orchwire ond
-~ the I:rodcet
A"\l lc s la.<! wntrib<Jtian to ortr.ooo~ tic . wa. the 4 . The need lor exlmorolfore for oncf.xoge
introd uction of th e .d gewise tec hni que i~ 1928. S. Difficu lty toope nd ee pbM' ,
He o.,viced 0 metol brocket hoving a reclongvlo r Cho rles H, Twood modified th ~ t",hnique
,k>! of 0,022 ' ,0,028' d;m en ~ on foci "\l lobkl lly, a nd od-.-oca'ed ~"" oItMth " oeIecl!!d co. e.
The slot recei .d 0 rectongu lor orch wire of for b~H"r .:ab;lity, He 01,0 introduced the con
0,022 '.0,028" dimension. The wire i, in serted ce pt of anchorag e prepo rotion wherein the ter-
into the brocket w;th It,., narrow dimen."'" ploc.d mina l mala" W<lre ini~o l fy ti pped di.toll y 10 ""Her
occ lusog i"\l ivolfy. Thi. mode of i~.e rti O<1 of the ",,;.t the troction fore thot W<l .... u...d in the loter
wire i, co iled ~dgewi.e OM the refore the tech .toge' , o,.erthe yeo" 0 num "" r of mod ification '
niq"" wo. called edgewi", tochniq"". Th. vn'q.... hove been propo,ed in th i' t""hn iqve ,
f. atvr. of hO'o'i"\l 0 redongular or,h wire in a
r",tongvla r . Iot ......,b!.d CO<1tro l of tooth move
ment in 011 the thr"" plo ne< of 'p<lce , For thi '
PlJ rpa'. Ang le de.oil;.ed the u'"" d an idea l arch
w;re thot incorporoted ce rto in bend, co ll.d the
Grst, =O<1d and third order bend.,
The first order bend. or in-oot bend, ore
pI.:;x;.d 10 com pe<1 ",te lor d;f!e<"nc.. in 1!-oe buc;eo
lin g",, 1 prom ir>e<\Ce of the teeth, They comp ri se
of tho latero l in.", the em';"" olbet and the mo -
la r off,et , The ,,,,,on d ord er bend, a re ploced to
oeh eive eo"""t me. io-di .!ol o.io l ind i""t"'" of
teeI'!1 , They comprise 01 the tipoock bend. ploc..d
in the po,terior segme nt" Th. third orde r oo nd.
or torque ore placed to get correct bucco. li ng ua l
po. iti on by movin g the foot" Th ey oro ploced by
twist ing thc arc h wire.
Th e odva ntag o, 01 tn., . dgew;, e reo h.
niqlJO in clude:
Ab ility to move teeth in all ' he thro~ plane.
oispace
2, Good contrd o,"r tooth movem""t
3 Bod ily tooth movement ;, p<J"ible ,
4, Pr""i, ,, lin i, hing i. po"ibl .
Too d isodYortage, of the edgewise leeh-
nique includ e
1. Th . noed to oppfy he<lvyfQ<Ce"
2, The nood for comple, wire bend ing, ..
F" 27 (. I~_
,~
C
""* i>>J iBi S<=nd 010< bo<.j ICITh;,d
8EOO APPLIANCE
Roymond Segg rGceived fti' troining in
orIftodontics from "'" Angle School during t""
eorlr 1900s. He IaIer retum.,;hoAl$olo in 1925
ond pnIdiood!he ...Jge..i.. lecMiq"". 1n tho mean
lime 8egg modified lhe Angle's ribOOn <Heft
lochniq uo orod inlroduc..d ,he 1I0gg lighT wire
,iiff~renTio l force toc hniq"" {ftg 26.0 OM bl. This
oppHance u..w the concepl of differenTi al 10=
and lipping 01 teeth rolher Ihon bodily
moYement.The SC9g oppliance used high
~ !.IOinless.!eeI wires olong wilh 0 number
ol oUlllllori ond "Pring. 10 oc.h,_ I"" desirod
tooth m""""""".
Th. TreoTm enl us in g lIegg app-lior.ce i.
co rned oul in three dill""""l IIOQ<!'. 5tc>g e one i.
concerned wiTh ol" n""nl, <X>rTKIion 01 c~ i..,...,
"'''''''''",,'.00' I
rol:ltion <;OfT'edion, close re
ad>ieo.ing "" edge loedge onterlor ~It, In r.og.
two, ,he rernoining eodmction spoeeo are dosed
whrle _,nlo,","11
ond lOr'quiog is corried oul 10
axiollncl,,,,,lion of ,he I.elh.
Tir o cdycntc>ge. of Ih o Begg cpp lior>ar
i""lude :
1_ Th, use el l"-h! forces ...t.id> arc ",;min!he
phyoiologic limit<_
2. RelOtNely conNnUOUllora opplicotion
3. Minirnol lriclion between the wore ond the
brocket ...
4. Rop;d alignme,)/ ond ",er bilt correction.
5. The ClPplionca docs "'" >Ira... mo oroc;ho<oge.
6. Go""," 01 fon:es were rool required 10 con_
orochorog I.
STRAIGHT WIRE APPLIANCE

T~ e I tra ignt wi re t ~ c n n i qu ~ i. a re ce nt
mod'ncotion ci tM edpewise opp l:mo. introducro
by lawren ce F. Andrew, in the 1970', bo,,,d on
.i,
hi> k"y> to = 1occlusion. The bark coocept
""'" to prog ram me the brocket to hove the first,
>CCC<ld and third order comp"oo nt, ' 0 tOOt the
";re <>eed not hove any complex bend ing a,
""Iui red in edge"M '" oppl io""e. He""e it io co iled
P"",dju ,ted edgewi,e opp l"""e. Thi ' te< hniq ""
mode it po"ibl" to ,ub,tonti a lly redu ce the wire
beoo ing req uired "'"" a lso """bled goaJ fin ~hing
01 Co'e' [Iig 2B.c and d)

UNGUAL TECHNIQUE

The ling uo l ortflodonti< rechniqve wo> introduced

in 1976 by Craven KUrl. In /h i. t<>ehniquo tf>.,

brad:et, are pklced on th e po lotol and linguo l

o'ped. 01 the teeth. Both 1M edgewise and th e
Begg I""in cip l" . can be e mployed in treotme nt.
Ung uo1 applian ce, aro highly e.llMtic bul oove
the disodvontog e' of poo r <>cc. " and diffic oltr
"' ,peec~ and ma intaini"'J ara l hygiene ,
STAGES IN TREATMENT
le velling and aUInment
Le-velli ng "'"" o l ~ . ignilies bmcketa lignm<rl
in both verti ca l and hori zonta l plaMs of .poee
~ig 29) , In add ition during th ~ poo ", ci treatment
a n rottrtions 0"' corrected, l"",el' ng coo a~goment
a re tM mojor treatmert aIliedi"" during the eorly
stoge ci treotme nt. Acnlevement of obiectives
during this stage wo uld he lp in lotu", tooth
movem . nt, a nd od iu .tment>.
The initi a l levell ing and oli gn me nt i.
ochieved by u," of light round a rchwires . uch a.
f;g 29 lo"l i"9 ond oi ;g o..-.on' (>.) M " , to " ignn',"'
:81 Ai"'o r.,.. merl
nde l titoniv m Or braid ed ' toinles\ steel orchwire
al tf>ey apply ge ntl e lorce, . Progre" i"" 'y lorge,
dOr""I,,,,'; res'" pi oced to o<:f>e ive the object"""
01 levell i"," and align me nt.
Ove , bIte ,eduatlon
Correction 01deep O'Ier bte should be ""de~ken
,oon after the al ig nment phos e , Overbite
red uction , ho uld precede ove riet ",d udion
in orde r to have a .mooth move ment of teeth in
the norirontal plane. D<>ep ""er bite ore correded
by intrus ion 01 the on!",,,,,,, or by extrusion of the
po.t...-ior leeth. th e crx.ce shou ld be bo",d On a
num be, 01 lo cto rs in clu din g the . keletal and
dento l growth pottern of the ind ividual, li p
CC<1ligvrotion 000 the inier-<>cdu sol c~e [10'
m"", deroil, ..,e th o cha pte' on mano gement of
dM p bite), In c;,ors eo n be intruded by ".ing
 c D

intrvsio~ utility crcf, e$ or>d orcn wires wit+, onti I Friction or sHd ing mechoni" , On"
ev"",, of Spe.e in the mandibvlorond e>:oge,ote<i Ihe broci<cl Ilo~ IY;.v., olligr.ed d ollowes !he
cuMl of Spec in !he mOJOliory ofch. Posterior ott.hwu. 10 .I,de Ihrough !he posltln". bnxI<eI
""",,,ion con be achieved by ,,$0 01 bote plan ... sloe. Thlc;lo rec;langualcr ..,in"'" , IMI WIres tueh
and wrli<:ol ..1a.1io _ OJ .01 8" x .025 Ot .019' .025 ",,".......d /o,!he
P'-"JXIM 01 om.,,,,, ,e!<Odior\. Hooks ore IOIdeoed
O~"J. t ,ed uct/on 'lnd . pael clo.",.
One of t~ m<lPor"obiod"., of treotrnenl ";Th fixed
app lion ce . i, to ob. a in a normo l "v. rj e'
,.lot>o<1lhip be!wee<1 t+, . vwerond lowe< Ofd,e.
and tooblain" Closs I <XInine fdoricmhip. Added
10 lIlil we have on odddionol objediYe of dooing
O*>f . .iducl >pace .pKially in coteS ..... eR! some
1801h hove bee" ""''''ct"d lor o..madontic
pu r _ .

Th or. a re two typel 01 "'edlCni" "",d

IQ, a nterior retroction . Th ey or., the friction and
the frictionlo .. mechon ic;,
f; ; 32 01'1. ,. ... fu od oppb ", .. ~\ & I~ ~ u<tood od i m .. oW ;"' ' <:O<'O m', " ' - ((I & (Cl Prooodi ,,,",,
~ .. oppl; .fIQO _ "","'k ~ ':E: & If:, Seg; ~<ra {~& :H:' T~ """'""".
r.~ 33 Coo<poo .... , of f...J ,ppI"'<OI I'll !.tockoI, 0 1o..J. Ie) to.,.~ "",,1'-1 iO: lJ,go..ll>o. "" (f)
UI>'I\I"'..., .... ~ (f)lia<rl ... .... :G) l... ..,...,.d . . _ (HI 60.=1 '''''' ., : led 1'... >IJ 0,:- 00;1 ,.nOQ
(K) lia<rl '. ~ ,' "~, (U 11000, cI-.,"
 loopmeGh o~b co n be do ne by lWo woy'
1 En m,m retroeiio n : He re the e ntiro anto"""
, e9m ,;nl"" is re tracted .Th is 'i nd o f retro<:ti o n is
more tox ing 00 th ~ o nchornge,
2 , Can"'" retradion followed by incisor retradia n;
The con ines are f,rsj rctracled follow.:d by th~
retra cj;on o f t he inci,ors .Th is enho n<~' the
po,te<ior crl choroge control dvri ng >poce closure.

Fln ,,1 t ooth positioning

B
Thi, p hase involve. treatme nt aimed o t lini, hing
and o<:elu",1d~tailin g . Thi s is th us 0 line ru ning
of th e toot h pos i!;on in te rm, o f !h ~ oxiol
c ind ;no!icm a nd on gu klt;ons o nd ro o ptim;.c the

All 3. l""fl' v...J I", onle<"" "" ct"", W Q'" w,.

,,;'h ..." ""'" """ 18i .. , ""' . I""" (C: T ""'" ~ ""'"\>"
~,

on to tho archwirc cilho, me, io l Of d i, ta l to tho

m nine ond e la stic< or nitico il ' pring' are aopl i ~d
lrom thi, po. ! to the hoo ks prosont o n t he mo la r
bo nd. (fig 31). Th i. ,,,, ult, in r. treeiion of the
anterior teeth by the orchwire >Iidi r>g through tho
$lot. of t"" po~ ri or bracke:$ _ Core , houl d be
fo h n to a d~q uat" l y ' e inforc" the po, te ri o r
anch orage .
'2. fric rio nlc5S o r loop mecho ni C5 thi,
type of mechon ic, rel i~ ' en spring a nd bo p
der.ig n, a im.w 0 1 p rOOvcing a contro lled forc~
syste m thot con be modu lot"" for onte r;",
",!ro:;tion 0<" po~ prclro<;tio n de~n g upon
!he aochofOge ceed of !he pol;""!. I'Oriou. designs
o f loop. ore ""a il abl e ,,)Ch 0' T loop, o mego
loop , key ho le loop a nd teo, d rop loop (fig 3 4j .
f ;g 3~ f',;,, ~ o 0,0 dOb '; ... .....,. ~ " ;,. m""" ""'"
".""_" .., f'~ """"0 '" ".d 01. Not, how +,
M loti or retroctk>r1 citror by fri ction or the ocd,,,,,,,, ;, tl." r:<~a 'eo ; , ~ Oy m ~ ",bo ";'
;0 +. ",,,, w,,"
32fI Orthodontics TbQ Art and Sc:iuC:Q

oc:dusion. During thi> phose 01 """Imen! omaller

dio"'"let wi ..... sud-. os .0 16 Iro:hes lfOinless ,!eel
or .-.clO ng\Jkl, bern monium e,. used ... they ere
more fl e..i~ e c nd ellow p!lIC ~e finisning. Mi"",
ere n lire ber<l. in fi rst, _ ""d o r tnird o rder
may be "", ,-" red for ""toili ng of loom <,~Iion,
~col $COming elastics " ,. "Iso uled In this phooe
lot MIlling of the occlu.ion.

1, 8ov; .~, Ke.i"ll PC ' Bow 0,,1 t -ric ''-'!- 0,,"

1ochnItq .... , T ~ rd _ , Pt>_""-,,, WE ltoonden
Co, 1971.
2, '''M~ chl.i: T.... u .~...., 1 O<+todo.,;c d , ~, PUll '
~'" WE 5,, , 1""" Co, 19n.
3, l.i-4oo'" JT : Tho t~.. """ionoo, .. c...o..TM,
So.oi. Sf, 0<111<><1"",." , C.,,,,,, ~.< t P Io. ,,<><I
_<1"",-, SIt.:-.. CJ Moobr. 198$, S6S~
~. I'roh WR: ~.,O+,d,.""St ......... CJ
"...,..,.,1986.
~ ....... f ~ , lion.! bo>ol .. Ollhodoo,;c.. v..
bed. mod~'" oJol",-, :":'1988.
6. 1""""""" WJ, M<xio.. hW , A <..... _ . '"
""tg ~' >0<" _ I "", ...d ~ ., Go_
TM, Swo" flf, OrthoJo<rOco , C... ' .... pri~ .....
TiI, ....... , 51 too" CI """""', 1985, 717]H9
1,

~.
_,m
n.. _ RC : E~ .. 0<+"""""<:,, 51 Lou. , CI
l_Ol,C_IOtI ! ' ~, 2~""" . 5,w.....
ClMoob,; 1966
 F
un(tional appl iances Of myo.fund iorlOl
a ppliarx:e. a. they ore sometime. referred
to ore appliorlC6' thot depend upon the
orofc.:iol mu <culotu re forth. ir odion. In contro!!
", active removo ble opplio nce, thot make l1:Ie of
live components liko springs, clo,ti,. a nd
screw" tho fo rce compo ne nt of fundio na l
cpp lionc~ , ore d " ri v~ d from th. o ro-facia l
musculo!u ,,", Tho ... oppl ian ce, eithe r tron ."., it,
eJimit'Kl te or g uid e the notura l force. of the
,"u",coIo!u ",.
Funct iona l app lia nce. o re ", ed for
growth mod ilicotion pr"""dure, th ot are oimed
at interce pting and treating jaw di.crepa ncie"
The, COn bring obout the 1,,"low ing cr.onges :
1. An i""rea,e o r oocrco,o in jaw ~,~
2. A chong<: in .potiol r~ lo!io n.hip of th~ i"""
3. C"""ge in direelion of growth of the jaw'
4. keel. rolion of de,iroble growth
Functional a pp lioro.:c. arc defin ed a.
Io<m, fitti ng or pes<;'" opp lior><:es whic h homess
noture l forces of th c oro -foeio l mUKvlotv r~ thot
oro trons mitted to th~ t~eth OM ol, eokl r oo,.,e
tnfo"llh th~ med ium of th e oppliance.
The th eo r~ti cal ba. is of fundi ona l
t"",tment in genera l is th e princi ple that 0 'new
IX'ttern cI fun ction' dictoted by the appliance,
lcod. 10 the dev.,lopmMI of 0 eorrespordfig 'new
m<::<"pl-dogk poff~m , The neWpoffern clhmet""
can ",f. r to diffe",n t fu rlCtio nol component. of
tr.e orofockl l slem, lor ",o mpi e, the tong ue, !r.e
lips, the fO Cia l a nd masticatory musc les, the
ligerne n!! , <>nd the periost~ u m_ Depending on the
type of opp li on ee , it< proponent puts mo re
emphasis on 0"" 01 thes~ dill. r. nt fun ctiono l
compo"" nto. The 'new morpholo gic pottefn'
iocl""" 0 diffe",nt orrongffi1entolthe lee'"
within
the jo ws, on impfoveme nt of the occlusion, and
an oltered ",lotion of the jaw>_ It 01.0 in dud ",
cho nge. in th e omoun! an d diredion of g rowth
of th e jaw> and differeoces in th e foeiolsi,e 000
proportion .
,
C1AS5/F/CAf/ON OF FUNCTIONAL
APPU ANCES

Fur>chonal oppliontos ron be doulhed in 0 , TOOII blmo ..... .......

numberof wars (toble 1): I .... bomo _ Wi _
Toorh oome pO'uive O'ppl;on""" Th" , ore nw.. bomo poum ~
tocm bomooll!)lionces ""'tr.cr... rQ ;,.rn"';c le>ree
gcl\Oltlrng ton,pc """.. . cd> '" spings 0( ICt1!ws. ~ ,-~

Th ey ""porod Of' the .soft r~<u . >!retch a rd """,,,UKl r M)'Od)'n ;ort: appIian" .
ocr .... ill 10 prod uce th e oo. i,ed t,,,,,trllMt ,." ul",
Da mple. oi too," bo rne pc " ivc op,""' r>Ceo
~1IiIIo Itr<:tW ~

FQd '~~
ind...!.. ClCt...,tor, bioi 0\01 or><! He rb.! appi","""
roo,,, borne OCI>ve opp/;onet>< : They indooe 0., ' -
mod~OCO!lon. 01 octivoto. olld bionator thot
include expon,ion >Clew, O. oth octiv"
components like.ptings to ptOYide intrin"<: Ion:.
i"" "0....... oronl.,o.post..riO' dtO'''IIe .
... "
Gr<qt II """'""""
', ;, "_.
to rhe leelh fo<!I.o purpose of <:<>rrtlClion 01
D.sue born .. pO''';'''' opplionce . ; Tiuu" mcllocdvsion. Emmp/eo include a,al "'eer>
end
born" oPllliont'" ore "'o" lv 10000led il> the incli<'l8d plane .
,"",slibule ord h""" lim e 0( 00 ",, !>IOCI wilh !l.o G roup /I a ppl;a nce . The opplia nc.
"""',tico. Ex"", ple 01. uc+. o n "Ppli ar<:e in dvde. r&pO&ition the mo .,.j i~ e and ,he re. ullont force.
the Fur.:li orl ol Reguio'or 01 fran le I. t",nl m i ~&d to lhe leeth aod othe r . t""' U....
Myolo nlc Oppliorlces Th ey a.e fU f>cT iono l Example. indu de aeti",for ood biono!Of.
op pl iaT>Ce. #l OT depend on I.... mu,,1e moO! 10'
Grwp /11 owlionee. , These a ppliance, oho
thei' oction.
~onthe maodible but tho.o.., of ()pefOIiom
Myodyoomic app/iQns : They "," lu"':fion,,1 I, rhe -'buloJ, oubide the denIol arch. &amp&.
""P/i"hCOS !hot d.pend on tfllt mu>de Ot&.ril)r lor Include Fronkel oppl",flCe ood _fibula, IIO'fIIIO\.
!heir Iu...:bon.
R"movab/. lunChanal applianc". , Th"y TREATMENT PflINCllttn
ON fI'IIOlurdcnd appiioroceo thot can be relllOYOd
Functional o ppl;onoe. WQf~ on two b,ood
and i" ... ned into the mo",h by the pOIio!>t.
princip1fl :
f..omples indcode a,~voIo' and biorotOf.
1. Force application
Fixed fun Cll o no l upp li oncc. Th ey" . " 2. Fa rc~ ~ li mi""lion
lunctiono l applio n c~. thot ore fitted on the leeth
b, th e apoo r"ta r ond COM ot be re moved by Ih e Fote, .ppllclI tlan
potit nt Ulwill, Compressi-e . Ir.... end srrn ill oct on the stro.CuleS
G,a~p I O'pp/II"" .. : The y 'on,i~t of I,,~ and IGSU" in 0 ~""'ry a~e'~lion in lorm
appl,ances tho. lronsIM the muscle lo,ee di""tIy wrth a -.dory OOoptotion in h.ondIon. Moot 01
the fi.ed and rOmQlla bi e lunctiona l appli arICes
worl< 00 Ihi s ptincple.
Fot"" " lIm/na llon
Thl$ principle involvn the .liminaHon 01
abnorma l ond ren'o:;t~ environ menlo l ;"11 _c,,,
o n Iho denti ti o n th e reby a ll owin g optim a l
development. Thon fundion is rehobiliToted wilh
a w;.onda'Y change In form .
All /uncI'ono1 appl",nces 0" o..embr...
cf a lew simple compone n! . Eoch componen!
),as a des ired functi on a nd is ""..... ro ll y incorpo.
f01Ieod fo< a speO~C pU!'pO$<l. The w'",ntly used
opptOOr'lCe>O'" made of combinations fram Ih"",
booic: /o..nctionoI <:Or' ifX)O "" ilL They 0", bole pia ......
shields 0< "" r""", end cons!r\K~on or worl<ir.g
bito, Tr..",~s prodJe .k"'elalend de n-
roaNeoj", changes by odir.g on the Igjl"";ng :
I. Erupt;on (b~e plonesl
2. Unguolociol muscle bolon~e (lhields
screens)
J, Ma nd ib-ulo , 'opositioning Iconst''''tion or
w<><king bite)
The detail. oI ,hese components .....,
Quolilotively ond quoOliTolively os does me Con-
Rgurorion oflhe connecting "lem""" ond ~e
me ove roll eppe<lro roa. lend ""mel of the a pp li-
.~
BII" plan. .
i3<1e planes may be Hoi Of inclined, arw;l antetio,
or pooli'>rior, whch contod "r.g " Of mu~i ~ _n.
Aht-.:Jug h Ih ..... or" usually tI-ovg ht 01 01 bloc;l< of
ocryloc: resin. mey m"., in lood be mode of wi ... 0'
Of'IJother suiklble moleriol. Rec;em """",n;h inO~
cotes that ,elolMlIy low Ioree., ~ oppl;ed "'her
conlinuou>iy or inl<! rmiHentfy. are capable of im
ped ing the e<\Jpllon of I~h Apico ll y diroded
~ may the'elore be ""pected to impede 0<
0trMI eruption. other /oou. m<ryprodOJal tippr.g
or c-rvptive deflection from the $!orling o.iol ineli-
nation,
ARot onlariat biI.. pIone 01 sulfiDenl di
men"ono to disocdo..de!he po<:uioo Ieeth may
be expected to hove sevoeml eIieds.. n- ef!ects
may compri... s.ome or all of !he 1oIIo..;'Ig.
I. Diffe<e<1tio l er~plion of po.luioo Iee!h
2. Nonenoplion. relotive o. obsolute inINsoon
of incis.ors
3. lrod"" overb~e ,tdoxlion
4, Oiwcd",1on witt1 rem.,.,..,t 01 intemnpation
may well be r&~ ible Ior-ony odclifional
in~~nts 01 mond ilNlo. growth
5. Uni~posteriofloolhen.Pon~oho
tesuh in 0 downwa,d ond bockwotd mon-
dibvle, rotalian mol t.."", to increase on~
ri(nerlico l lower foc", 1height end redoxes
me progncl+>ism of me mo nd ibl e
Indinod pIona may be dMigned 10 pm-
Of
..eIe guide pier ..... for ..... lerb"'linguol mec:hani-
cal 'ruphve di,placement 01 incisors or the
~orn~ deflection of ~ng poIIerior teeth.
It .hould be remernbe<-ed t""t 01 upper
posterior leem erupt, may mig",1<1 not only in 0
""'001 but 0100 in on a nterior diredion . Thr:-re.
lore. imped,ng or sleclMly o,re5ling the ~
of ma.illory mole" nO! onfy pe<mits t,", co,,,,,, j
inO'eO$e of mord ibv lo, dentocrl,..da, height. but
olso resuft1; in a reiO""'1y gfOOter-mMiol or onle
rio, """"""eOl 01 the lowe, buocol segments, boIh
through eruption ond olso t>r thei' forword rron..-
lotion , ""' icr, is prod\Qd by ""rmol mondibulc,
growth. Wilh In.. dimi nilohed o r e,"" ted eruption
of ..... moxillerry molafl. mis romblnotion 01 ef-
fects arn be apected 10 .... uk in rhe improve_
ment of 0 00.. 11mole, relationship. Cor,~,
~ tile lower post.,io' t&e!h e re =troil'led from
erupting while In.. uppers do so unimpeded. the
eotpOded rewlt woold be on im ~nt in 0
Ooss III moIa, rdo~onthip.
'f D
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~ C ;;' i:
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3 <>" ...
!i ~ c..
, I " !i'~i!~l ~~ 1 1 ~.rl.t!.l
itt.l.
'" "g "..
dHP!i~ ' . J:I q: !P linnn
il"!i"
if'" ~ <T

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n

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" a.j:r- - ~" ~ ~i[igt~
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0= S 0 0. 'g. _. :> , , 0. ;;I

". .
~ 2.. .I'" Ipn~iHo!H
,a..II . .i" iLIi' nHHifH
 region,
2. Th ey Con bring obout re model ing of tho
gle,..,id Io"a.
3. Thoy can b-o de>igned ta hove 0 re,trictivo
influence on the growth of the jaw.
4. Th oy con <11ong o the direction of growth 01
the )OW>,
Dento-elve oler chll nge,
Th oy con bring obo ut de<>k> olveolor chong os in
the ""gittol, tra,",verre ond the vertk<l l direct"".,
Most IUrx;lional app lio nce. a ll ow the upper
on!et"iors to tip paloto lly ond lowe r onterior< to tip
lobio lly. In the Iran"", ,,,, direct"", they can bring
obout ex po n. ion 01 the dento l orc he, by
incorporating .crews in them Of by .hi~ d i ng th ~
bucco l mu<d . 1oway from the de ntol oreh . In tho
..... .tica l .,lone , they can boe de. igned to a ll aw
.. leeti"" eruption af te-eth.
Mu scular chllnt"s
Fund""",1opp li anc~, con improve the tonoc ity
01 the oro/ado l mu>culolure .
CASE SElECTION
The troditio"" lview thotfuncfoono l oppli"",.. ore
only . uited to troo! Cia" II . di"';~oo \ rrokxci!.lSion
with une rowded lower orch .. i.lo rgely discorded
in r~ c. nt yeo" . A wide r rongo of co,e, i. being
treated in recent yeor< vsing fundio",, 1opplionce.
01 mo.t 01 the co,., moy require ,ome lorm of
fini, hing with lixed opp lionce .
!we, The growth mod ificotion therapy !.IS ing
lunet"""" opplklnce. i. po.sibl. only in a growing
patient. The optimum time fo r myofuodiotXl l
therapy according to rooot outhor< in betweon 10
yeo" 01 age ond puberta l growth ph""e ,
Sacial can,iderotian . : A to t. d by
hldre.en, functiOr"l<l l opp lior>ee. och ieve lhe ir
""ullo with minimum .upervision and un li ke fixed
opp lionce. can be WQfn >afely for long period.
witr.oot .upervision, Unfortvnotely al CO""' conrd
be treated with lur>dio nol opp liance. a l o n ~
Poti ont, who I;"'~ lor owey lrom the dinic Oftho.~
otterd".-.g boarding ",hoo may benefit frn the.e
app li ance., p.ovided they fulfil a ll other crileno.
fo r cO$e lelection. HOW<!ver luch f'Otienll .hou ld
exhibil ~igh deg ree of motivation ~ tf..: lurx;tiorKll
th erapy i. to boe .<xc."fu;'
Den tol con.ide rotion> . An id eal CO$e for
functional oppl iar>ee theropy i. one thot i. d"""id
of gro .. loca l irreg uloriti e. like rotation. and
crowding. On ly in Cll"lCrowded ome. ;. it I;kety
that a ma locdu.ion con be treated wti./actorily
by functio na l ap p lionce clon e . Th e local
;m>guiorities me trootoo pficrto m att.r runet""",)
t""ropy with fix~d cpp l ionc~.,
Skeicta l conskierolion. : Moderate to ' ''''e re
.ke letal Ckl,, 11 molocc lu.ion. a re idea ll y suited
for funotiono l appl ionoe treatme nt, C lo" II,
divi, ion 1 mo locc lu. ion exh ibiting 0 Clos$ II
skeleta l tendency due to a . hart or retrogtXlthk
mondib le cen be con'id~r~d lor lunct iona l
tf>eropy.
Low ang le celS" !i.e .horizonta l growers)
re.pond we ll o. mo,t funcl ional opp lionce.
neou ro-ge vertical devdop me nt 01"""terio. teeth.
High an gle [v.rtico l gro"",,,) CIo,. II co",. or.
u,,,,, I'y <i two cotegorie,: tho$e with incrlOO.~d
"".rbite CJnd tho,e with.rom. degree of open bite.
The deep ove r bite ty pe 01 high ongle ca.e. a re
successfu ll y treoted using functionol applkmce.
wh il . the open bite type of ce,e,,..,.., a .pecial
ptOblem, Most fuod"""" opplionc.. oIlow I'Orlicol
deve lopment 01 th e pe.t~r;a r dentoa lveo lor
.truetures which moy induce unwonled boc\:wo rd
rototion of the mandible .
. CI"". It divi.ion 2 type <i mo locclu."'"
mey be trIOOted with functional app liance. alter


Fig 1 ~ hod_ ~J_ I (Ij) - . . (Q H..too .".,1 ... "" lD! nIp,,, ......"'"
:;::v..'lb"O" IUWO If~ ~ _or
correctin g the o.ia l i"" li noti on. of the rooxillery
on/eriOr1,
Mild C ia .. II I ma locclu. ion" wh ich
pre.ent with a rev" rS~ o",", ri"t and an averoge
OYerbitc (;On be ",gordO><! '" pote ntioll y t"",tobie
with func!iona l applia nces. Th e,e i. 0$ yet ""
slrcng dinico l eVOenC" of bereficio l skelelo l effect
in the uSe of 00" III lu "'tionol applia",es and
most reported cases have demon,trot..d onfy
dento_alveoler chong<>.
VIS UAL TREATMENT OBJECTIVE
Thi. is on important diagno,tic te,t undertoken
before mo ki"9 0 decision to u,e a lu""tiono l
oppli o",,~ . Thi. te,t enoble. u. to vi$uo li,e how
the potient's prolil e wou ld be aftedur>etioool ap-
plio ",e therapy. It i. performed by osking th e
poti""t to bring the mandibl e lorward. An im -
prOVoment in profile i. con~de r"d a po'itive in-
dialtion lorth<! u"" 01 a functiona l appia", . In
cose tho profil e 1'10"""", then othe r Jteatment
moda lities hoy" to be con,id ered . P'hot"'ilccph.
of the potient tak"" with forword roond ibvlor po.-
ture a re a vo lu obl e a id in motivating the potient
and porent. (fi g 2).
VESTIBUlAR SCREEN
Th o ve.ti bu lo r sc reen i. a ' imp le functiona l
oppiance that to ke. tho form of 0 cvrv..d shield
of ocr,' lic plec..d in the labia l ye,tibul o (fi g 3).
Th ~ mrofC<'<:tion al oppiianc. \"lOS li " t introduced
by Newe ll in the year 1912,
PrIncIple
Th . ve.tibu la , .creen co~ be usod either to apply
the fore", of the circumoral mu;culeture to cerl<lill
teeth or to re lieye those force, from the teelh
1hereby a ll owing the m to mO"'"' d ue to fo rces
e>:erted by the to","u e. Thu> the "".ti bula r.creef!
work. on tf,." prir><ipi e, 01 both force application
 F;g 3 V.,ibc lar "".,
as we ll a, farce e limination .
Indications
Th e following are the in dwtkm. for the us. of
ve!tibul or <Cf~M:
1. The, e applkl nce, have been u.ed mo,tly ta
intefcept mouth breatlling flobi!. Tr..y con
a l. o boo "... d for inte rception of hobit, . uch
0' thum b . ud:i ng, tongue thfu ,tin g. lip
biting and cheek bitin g.
2 Mil d di<lOocciu' io ns con be treated "'ing
th e ve, ti bulo r scree n.
3. Tr..y C<ln be used 10 perfarm rrmde exercises
to help in correcti on of hypotonic lip ond
cheek mu"Ie.
4. The ve,tibular "",en (on be u... d to correct
mild anteo"io< proclir>ation .
Fabrication
1. Upper aM lower impre,sio n. are made aM
tho woriJng mode~ poured. Tfw, OJst< should
reproduce the dep:h, altho "",tib ulof .uku.
2 The uppe r and klwer co,t, a re ocdcoded in
f")Ormal in!er<:u>p<ltiC<1 Qnd the rnodd. = 100
together u,i ng plo,ter. In OJ ... the opplkl nce
F;g .j Add ,"' ."f "'_ " i, pk>;od on ,1>0 I"r_,, 1 o,~
of ., . 'to!,
i, being u.ed for corred ;on of di.t<>--
occ IU ' io n, 0 con.tructi on bitD .no ul d be
ta ken to mfvonce the ma ndibl e.
3. Th . vesti bv!ar .creen >hou ld ",teoo into !he
.uku. to th e point where th e mucow l ti. .....
reflect. oulw<lrd . CQ re Ihould be token nor
to im pirlge on the frenum 000 the mu sdoo
otklcf-..n . nts.
4. Po,terioriy tr.. appi ior">Ce >hould "'""00 vplo
the di,tol marg in of th. la,t &r1Jptoo molat.
5. The model, a re covered with 23 mm 01
wo< over th e lobia l .un"". of the teeth ood
the a lveolar ".-oce.. _ In w.e of prod i"""
teelf, wheh r>eed to be ",traded the wox relie!
il removed to expo'" th o ;r">Ci>o 1or>ethi rd 01
the t.,.,th.
6. The oppliorxc " fabricated "l in g eithe r ",II
rure O r heot Cure oCr,O ic r~ <i n
7. The a ppl<:Jnce is smoothened using sand
poperand poIi. hed.
Management of the applian ce
The poli""t sho uld 00 asked to ...t",,!he oppikl r-o::e
ot nig ht arid 23 hours during th e daytime . The
potient i, in ~ru cted to ma inta in li p . eoL During
 Myofunctional Appliance:s 337

the fi rst lew dayS th~ ""tie nt may . how certain

area. of irrii<ltion in th e .u leuk" a nd the frene l
oreo . Such orees 01 the opj> lionce .ha ul d be
(orefull y trimrred to ovoid ti,.u . irritoti on .

Modlf/cat/ona or the vestibular scre " n

A num ber 01 modifkotion, of the vellibu 10r screen
c re po.!i b l~. The fo llowing are . a me of them:
o. Hot, mod ikotion: The oro l screen can be
fabricated with a meta l ri ng pro jecting
between the up~r ond the lower li p. , Thi.
ring co n be u.ed 10 carry out various mUKIe
6-"i'e>.
b. In po tient. who hove tongu e thru $! "" bit on
odditi o nol ", rM n i. placed on the linguo l
""ped of the teeth . This odd itionol ",reM ;.
attoch ed to th ! ve$libulor 'Cree<" by mea ns
01 a thi d< wire t""t run. through the bite in
th~ latera l ir>e i.or reg ion (Iig ~ I ,
c, In co ,," 01 movth b reoth~ " th e ve&ibu lar
,creM ,,,,,u ld be fobricated with 0 numbe r
of Im l thot arc g rad ua ll y clo.ed in 0
pono,ed noonner,
LIP BUMPER
The lip bu mpe r or lip plumber 0' it i. som etime.
w iled i. 0 corrAlioed r~movobie - lixed oppiance,
The li p bernpe r con be w lied a mod ified v"'tibulor
scree n tho! i. used lor muscular force appicoti o n
o r forca eli minoti on . Th e appl ionce con be u.ed
in both tr.e moxi llo and th~ mand ib l~ to sheil d
the lip. away fram the teeth.
Usn or lip bumper
I, They are ",ed in potien" exh ibitir>g low.... lip
""b it uch as li p ,uckir>g. The lip bu mpe r
.h i ~l d. tM low", lipoway
2. They are a lso ""cd in patient, exhi biti ng
hyp eractive menta li. oetiY ity th at co u ,
\
Fg ~ Lip b,,,,. '
flot!"ening or crowding 0' the low., onteriors.
Th u. li p bump.". o r. mo.tl, u d in the
rr<lcd ibvlor arch end ",,,,Iy in tho max illmy
arch. By removir>g th o soft ti l''''' force. from
the labo l aspect of the low"r o~t. ri o" it may
prod uce forward tilti ng of thes~ teetn ~nder
tr.e nfluento of the tong ue p..."sure, Th", lhe-y
incroooo the oreh length, redeC" crowrlng ond
deere,,,. th ~ excessive overiet
3 , Lip bump " " c~n b~ u,. d to augm e nt
or-.:horoQ " , The ""-"",--,,,,Iorce tror.sm itted on
to the ma la" in a di, tol d i r~ "ti on wo ul d
diocourag " the lorword movoment of t h~
malo""
4, Di.tolitoti M of the first malo" ca n be ochiel'ed
by use of lip bumpeis . ' Th ~ degree of di, ta l
movement can be very li mited, ","ocia ll y
whero the ,econd molars ore ","upled,
5, Th~ li p bump"" can be u, . d 0> .pace
rego i""" ~ the lowor molors hove drifted
",""a lly du e to early loss of deciduo", moIor<.
Applia nce des ig n
The app lior>C<l is made of thick ,toinie" ,tee l wire
extend ing from on e mola r ta the oppa, ite moIor.
The wire i1 mode to lie awoy from the antorior
IooIh so that the li p, ore kept owoy from tho teeth
The li p bvmpcc i, in",rtod into rex",d molo r tube.
of O.93mm diameter so ldered to bond, On the
3a8 Orlhodonlics The Art and Science

IMlutl"".
t 01 .. f , OIr.lion 1 ~tOon
I. 0.... I. 0Mti00 2 moIo<dutOon
CIo# I~ "'_"..,
'. OIM I..,.. ..............
OIM I ""p _ ... _ _

Ii".. mo lo.... The ont",iO' po rtion of the wi,.., I,om

,
.
..
.............. _ _ ...... ra.6
.pplr.OCf tl>orapy 1.1orIp( ..... ...cOllI)lw
~

F 1>011_-'
~ .. ....M lido: 01
no'_
. Mb/ do~ 1 In
con ine 10 coni"" am be reinlO'l:&d with ~ ic _11!(IOI~ t
(fog 51 CO"\JlI '~ I ... loni
Alrhough lip bumpe" 0.. mostly u..d I. n. oppNra io nat_1o _ _ 01 CIIM
,n the mondibulararc",,", they ca~ 0100 be used I PtOlIIt ... 01 OOOIdoci Iftlh ...... .., Dr
In me mOJcillary aod>. Such an opplionce I'limilar .w, ..., _ _ oizI W jHlI/It,
in design ond it coiled Denholtz appl",,,,e, 2. Tho &wI& .... Ia ........i>cb.1I<I I. _OIl
Tfle lip bumper can be CUllom mc>de WIt" "'.... _ lacW ~t I~ 1'....
uling 0.9 mm nord round $to inl ess $tu l ""; ,.., or
"'"~ mio"J<IWar gro1I,
0,.., ,..,ad il y """, il cbl. in vo riouo ,i>e .
j, Tho I\IIPlOI>OIIo ftOl lIH<l ., _ " ,"",,51
tow... ~ "" _ 111 p!~,
ACTIVATOR
4. Tho . . ."'" _ be.,.., ~ -..,.
Kirog.!erin 1879 devi<ed a w/caM. palatal plate MOIl ..... <IOood "' ......... ~
..... Iht ....... _ _ .....
10 be <IUd i~ patients hcving refnldKl mondible.
Thi, ""leone plare ca ....is:edal onanl."e, ,rclne
5. lIIt~ .... _ .r,.. t,.~_

!hel gui<:icd the m,,,,di b~ 10" Ic~rd pcs~i"n V'.-.v _ioluoIa.

whe n lhe poli . ntclo d en H.
HOTz o"loiwd a 'Vc<b'.~ .:mD which woo
o mcdihd form 01Kin ~""'$pk:lle, This wo.wed
to !reot fGttog""thiom oncc;iated wim deep bite.
KWOt aloo used to treal 'fllrognorhism osscriated
willi t.ngually indinod I........ , indoon;,
Pie,,,, Robin devioed on OppiiallOl coiled
Mord>loc modo upr:J" '""gle blade of ... Iconm..
He uS&d il te position the m(tnd i b~ I.::>r..crd in
polient3 .".;!h ~ Io"o~ , ond _ro mond ibc l",
retrog nathio.m , By po . itiOl' ing th e rM ndible
IOrw(lrd IT reduced lhe risk oft>irwO'y ob,t,uo;T!on.
Vi ggc And ,~..,n in 1908 In DenrMrl
dev..1opod 0 loose tlni"ll "ppHona """"~ flO! finor
oMd en h.daugh!e<, He made 0 modified Hawley
typo of ~ine' en the """,,11a'Varth 10 oohkh fle
odded e lowe, lingual horse :shce...hopcd flonge
which ha/pad I~ po.itioning Ihe mandlblelo<wo.d
(fog 6). He mode mi. appliance on hi. dauGhler
who """I going on" 3 month >'<>lticrl, Oro fle,
re!v rn 3 month . lete.., he found" mo rl<ed K\ginol
cCll"Cdicrl and improve """,t of the focia l porcf,~.
""""",,,,n ca lled it biomechmica l wortirIQ relo i,.......
Loter""""~ mowed <:I"'f to N~ and t<><llTl<ld
up wirh Karl Houpl ond bcovght about lot of
chorIQ "' in hi' d ovi<;o. They co iled it Function a l
.low Qrtho poedic"
At, And r~,en and H"""I wor. in Norwoy
wfllc d.webping the app ionc~,
, it beco me known
o. Norweg ion opp lio nco. Thoy later call ed it the
octivotordue to it, abill!)' to activala mllSCle force"
Indlcatlont of act/v;Jtor
It is pfimorily u..,d in octively growing ind ividua ls
w<lh layorobl e g""",,"h pattern . Th o moxillory and
mandibular teeth . hould be well o lign.d, The
mondibular inc i.ors should b. upright avef the
bo", 1 bone . Relor to tob l" 3 for the ind ications
and controi ndic.otion, 01 adivator.
Advant~g "s of actlv ..tor thft ... py
I. It u.e. e,i. ting growth of th e ja"",.
2. During treotm ent th e potient e<porie nce.
minimol orol hyg ien ~'problem s
3, The intervol. betwee n oppointment. i.long,
4 The appointm ent. are "sua lly short d ue to
need lor minimol tld ju . tment..
5 DV<! to the above r",,,o", th~y ar~ mO r ~
"",onamico!.
D/s;Jdvantages of ftetlvato. th ft rapy
1 Requ ire. very good pa tient co operati o n.
2. Th ~ activator ca n""t produce a preci,e
detoilin g ond finishing 01 the o"du.ion. Th".
post.!re<ltment fixed 0 pP ",nce therapy trICl"fbe
needed fa, detailing 01 the oeduo ion .
3. It may produce mo derate mandibular
rolation ( Qnt~ riorly downword . ). Thu .
[lCtiV<ltors o r. rool u>Cd in c,,"es c1 ex"""i....,
10WOl' Ioce height,
Mad e of action af activator
Acco,ding to Anderl en ond Haup!, th e activotor
i ndu~ ", mu . culo,l " l ~ to l adaptat ion by
introd<.'Cing a new paff" rn c1 mand ibulor cIo.ure .
Th . oppl iance loo,ely Ii" into the mOU' h. The
potien' hoi to "",v" the mond ibl~ lorward, to
e ngag e the opp li or.:~ . Thi$ result. in stretch in g
of lhe e"",tor muscles of mo.ticalion wh ich . torlo
cont",ding thereby ."ffirIQ up a myo"'ctic reflex,
Thi s gene",tes lin etic energ y which causes:
0, Preve ntion 01 lurther fO!WOrd growlh c1 t""
mo<illory dento-olvwo r proc~ ...
b, Moy~m ent 01 the moxillo.')" dento-alveoklr
proce" di.."lly,
c , A reaproca l lo rwa rd force on the roond ible ,
In addition 19 tni. myotocti c refl ox. 0
condykl r ""optati on by bockwo rd ond upward
growlh occu.-.,
A ihird fo<"Or ~ the lore" gerwated while
.wa llawing and du ri ng r.leepirIQ . According to
Harvo!d, Wood~de ond Herren pa""e ten sion
coused by >!relcMinQ of musdes, .olt lissu o.
tendiMu, tiSlu e, ~tc" are respon' ib le lor the
achon . They co iled it th o vi$co~ lo.ti c property'.
COII.t.uction bite
The c"""" trvdi,,,,", bite i, a n in"'fma,ill o!), wax
record used to r. lo", the mond ible to the mo<ilkl
in the th ree d im on';on' of . poce . They aro u.~d
to reP'>~tion the mondible in orde r to im provo
th " .k " l~ta l i n t~(' iaw r~ l ationsh i p . Tne bite
reg;,trotian invof...e, ",po,itian in g t"" mond ible
in 0 forward d ir"d iM tIS w~ 1 tIS opening the bite
...., rtieolly (fig 71, In moot eo.e . the rno ndibl e is
adV<lnced by 45 mm and th~ b it~ o pened to the
extenl of 2 -3 mm beyood lhe rrecw<lppace , The
general con.idemti on, for c""",,truction bit~ ore:
1, In eo oe thc ovcfjet is 100 lorge, th~ /orward
 po>itioning i, oo.., ,, . tep wise in 23 pha,e .
2. In co,e of fo(wo rd po' i li on i n~ 01 th~
mand ible by 7-6 mm, tr.., v~ rtico l open ing
,houid be $li9ht 1<> madero' .. Le . 24 mm ,
3, If Ifle lorword position in g i. not mo ro tMn
3.5 mm, lhen the ,""ico l open ing con be
46 mm
Lo w cons truct ion h ile with marked
ma ndibu lar forward positioning Th i. ki nd
01 con,truetion bite i. dta rocteriled by marked
10rw<lrd po'it;oni~g 01 the mo n dib l~ hut minima l
v~rtica l openi,',g . As a r\J ke 01 thumb tfle anteri<lr
odvoncement sf.oulO rd exceoo m:>re 1f'Of13 mm
poste rior t,o the most protru~"" position Vertica lly
tfle open ing is minima l ond is withi n the li mi" of
!he inleroccJu>o 1deero ne<! , Th~ kirJ of octil'Olor
oon.trucled wilh mor'<ed >ogilid odvonceme,' oot
mini mo l vertical opening i, ooll...d on 'H adivotol
The Hocti.-otor is irdkotoo in a potient with 00"
II, divisi<ln 1 malocclusion h"" ing a hori,onta l
growth pottern .
High' con, truclion bile wjth sljg h.
ma ndibular forword po,it ionjng , Th"
mo....,J ibi e i. po,itioned a nte(iorIy by 3-5 mm only
and the bit. i. opened verticolly by 46 mm or c
maximum of 4 mm beyond t.... re.tin 9 po.itio n.
Tni. kind of octivotor ccmtrxted with minimal
>OQ ittol qd""r><MT>eCt bvt morked verticnl opening
il co ll "d a 'V odiv<ltor , Tr.., V type of octiv<ltor ;,
indicoted in a DOl. II, d ivi.ion 1 mo loccl u>ion
hoving a , . rtic<>1 growlh potlern.
Cons lruction b ite withoul mandibular
fo rward positioning So me ti m.. 0
oon.trvction bit~ wit"",,1 forwcrd po>iti o ni ng of
th. mond ible i, moo e in CaSeS Ivch o. deep bile
and open bite .
Construclion bite with op e n,"g and
po.t ~ rior pos ition inQ o f the mand ible In
Clo.. 111 mo locclU$io n, the bile;' ta ken alte r
retn.Jdi ng tho maooib le 10 a more po.le rior
posilion , In add ition, the bilo il ope""" ,u!fieiontly
. to deor the bile. In general a ~I opecning 01
5 mm ond 0 ~'erior pwmoning ol about 2 mm
is reqvired.
Fitb,'caf'on of ee llwittar
Impr...ian. , Impre.. ion . of tne upper ond
to-- arches alll mod. to constn/ct 2 pai" of
models
1. ~modeI.
2. Working models
BU. "IIIIIrOllo n ,
1.The omo unl of ,o~ i tta l and ,.ttica l
adYcncement 01 the mor>:i ible is planne-d.
2. A horteJhoe . hoped WOK block is I"'P"red .
for InHnion bclwee" the upper and bwer
teeth. k mould be 23 mm thider than the
planned..rticolopening.
J. The palien! is mode 10 .~ in on upright
rel axed and nanslrn iMd pos ition.
~. The mor>:ib !. i. guided to the de.lred sogitlOl
position. The operotorsh ould mn yguide
!he m...,dibi. w n~ tt.c tn umbar>:i fote~nger.
He should not""" Pf"'Sure or boa.
S. Th. porierll is asked 10 prodioe pla,,,ment
01 mandible at the d""n:od ><>gillol position
o lewfimeJ before "'(IislroIion 01 the b~ .
6. The ho"" . J>oe "'oped WID. bb:~ is ploced
ewe r lhe occl uso l .u rfOC" of lhe lower co.t
and i. gently p"'ued <0 o. to form Ih"
ind"'lOlions 01 the lower buo llooth.
7. The _ block i, pi"""" on the lawe,;ow
and the potient i.asked to bile atthe dMored
sogiltol position.
8. h Is then ~ ar>:i placed on the modoI,
and checked.
9, ~ Iov<-id all n'got, ~ "chi lled and once ag.c in
tried on Iho ",.1. T.... e'ce.. W(l' I, trimm ed
'"
10. The hordened _ . block iI. agoin trle-d In
the pori,n!'. mouth.
N Hcu lotlon 01 II>. mo de l Th , "'0' bite
reg i,tration i. ploced on the o<:o lu so l surfoc.
<:.et-n the uppe' and lowe , m"",," s. The mode~
ore tn." ameuloted in a ~ "" direction <0 tnat
the anlerior!Nth foe" the hi"ll .... Thi' Iond of
articulotion ...u.... sulfciont access 10 the pabIol
surfoce of the upper and lingual surfoce 01 lower
model. duri"9lhe Iobricotion 01 the opplionce.
Pre pa ration 0/ the wire e le meM5 The
ulua l dosjg n r. qui re. on upper lo bia l bow. The
Iob,,1bow i. mod . with O.B or 0.9 mm wire and
consi ol$ of c hO ri zontal.edf"" with 2 ve~ica l
loops. The ,"ds 0/ the ""mcolloops en~. the
acrylic body between !he C<lnine and dedduoul
~rst molar(or~flI premolar). The Iab,,1 bowc:on
be oct-.... 01" IX"si",
Fa b'icallan 0/ Ihe ac.ylic po,lian , The
oppl ian ce c"",islS of 3 po rls.
o. Mo<i llory po n
b. Mond iboJ llo. oo n
c. Int ...ocdvlOl part
The oppf.c:nce con be fob-icoted by usi"9
eitlw heat cure r.,in 01" cold eu.e ""in. In COH
01 he01 cure resin the models 0'"' r. ... wo:<ed ord
then theyore floslo:ed.
Mana geme nl olll> e opplianc e ,
1. The poti ent should be l ulficiMtfy cO""inced
oOO ut th e beMfi!s he i. go ing to derive by
u'i"9 the OCIivtlIO'. In tni. ' .opect 0 good
pationl-doctarrela~qn is ...... ntiol. The clem"
con make .... of ideo tape<, boofdeto ,re.,
It> mofivole the patient.
2. The pat~n11s o!s.o tought hc>w 10 use, pIcK"
"nd remove the oppiionce by himself.
3, U.""lfy the patient i. a. k.ed to woo' The
opp lionce for 23 houro " day dUri"9 the
 doy tim e for t"" f..,t wee K. Durir>g the "ond
week the potient ~ asked to wea; it fe<" 3 hou"
duri"\l the <loy o. w~ 11 05 ""'ij., , Ieeping. In
Cole the potie nt hOI difficulty in u, ing it th e
whol. n.. ht, more doy timo u i. p<e"~W
until the poti""t con use it for trn. e ntire ni;l ht.
4. Afum ir>;l pion sf>oJd be d. , .. oped bo...d
00 th e individuo l r>e<>d, of the potient. Som "
orthodonti. t. prefer- tho oppl,,= to be worn
for 0 week withou t any grind ing so thot th e
potie nt am get u>ed to it.
Trimm ing of the activator, Afte( fobri cotion
of the activo\o( it s usua lfy fe>und to fit tightl y c.
ocry! ic i<inWposed between th e up-pe r ond lower
ocd uw lluriocc . Picnne<! trimming of the ap-
plia nce in tooth co ntact areo i, cc rned out to
bring 0 bcu d. nlo-clveo kl( CM "\les so o. to g udo
the teeth inm good relotion in 011the 3 pio n of
speco.
Sel. d i,e trimm in g of ""t'l li c i. done in
the di....ction of tooth movemont. The ocryli c .u.-
foce, thot tmn"" it the de, ire-d force by ~ontoct
with the teeth are co il ed gu iding planeo. The or
eal of cery lic Thot centoct tM teeth become po l-
i, hed .
Approxirt1<lte trimmi"\l can be done on
the pia,ter ca,t. Howeve., fino l trimmi ",. shou ld
be done gt the cho ir , ide.
T,lmmlllg of pct/vato,
Trimming of a ct ivato r for vorti eo l cont.o l
Selective trimming of the octivotor can be dO<1e
to intru de or ""'trude the teeth.
fn/wSion of tee th Intru . ion of th e in cisor,
Ore ""h iev"," by lcoding th e ioci",1 edge of the",
teeTh with oct'l lic. Irl Cos. Iobiol bow. are u",d,
they ohauid be pkxed below the aroo of g,,,,,,t.st
cenvoxiTy i. e. inciso lll, to oid in the intru""on (fi g
8 .01
In case intru sion of posteriors ~ """""'"
th Or! ooly th e cusp tip. are bod"d wiTh oClJk.
The 10.,.,., ond fISsu res"", free of oC')'I" (fig 8~
Thi. cpp lie. a vertica l intrusive force on the m:>-
'"
b/rt;S ion of teel": In co, e of extrusion 01 ...
incisor> , the lin guel.urloce i, loaded obo.en
area of g(eotest convexity in the maxi lla ond be-
low tM areo of greott cenvexilj in tho ITlOl>-
dibj.,. The e<lrus i,e movemenl con be enh or"\C.OlO
by ploc ing 0 ", bio i bowobove the orca of g ' -
est co nve,ilj i.e. in 1M 9in 9,,01 1/3 '" ' he lobO
.urloce (fig 8.cl
In eme of molo rs , e<lrusion i, brougl.
obout by lcod ing Iho li rlguols urfu ce obove ~
oreo of greotesl eoov""it, in moxillo a nd beta..
the OreO of gr"ote.t conv,,",iTy in mor"ld ible (!;g
S.d l.
Trimming of the a e li~otor fa og itto l
con t.ol
Se lective trimmi"\l of the octivoto( can be done
to protrude O( rettude the anterior-teeth and 0100
to impm,. the mola r re klti on of the bucca llcotl...
Protrusion of in cisor>' In Co Se th e ir'ldsorS .ne>ulci
be protruded, linguolourioo" of tM teeth is Iooded
with """fli C ond a PO"" Iobie l bow is given
thot i. kept awo y f.om teeth to pr.ve nt pe ' iorol
,oI! tiss ue. co nto<:lin-g the teeth (fig 8.e). This
o",," ic loading of thn Ii"\luo l ",naco ca n be '"
Iwoljpe.
o. E~tire lin gue l . urla ce is l09ded . Since the
orea of co nlact i. mo re the lorce fm
prociirlati O<1 i, olso low.
b. Onfy the incisol portion of the lingua l su(-
lace is Ioad.d . As acr;iic contoct i, ","oil
greoter deg ree of force is genemted to tip
thc inci",,, lobio ll y.
Retrusion of incisor1 : The ocry! ic is trimm .d oway
from the li n-gcoo l ,urlrxc and on active lo biol bow
 A B c

o E F

G
fis 8 r..."'""l 01 o<I!\<otot 1"1 foo-I..- ............
II foo-I_II")<I_ (f) foo- ,_ _ _ lGl
01 .... """". ,.... Tho _
r._
_Ilod_
(II foo- """'"

do> 00 "'" I0I>;01 ..-boo 01 "'"

H
(Q , '" ....... """""'" (OJ foo- moh. _ _
foo- "......... .....,...:.,.. 01 h G<d'< iJ'II f ", " ' . . - "".""',,".
kb;ol _
 A B
c surioce. of th e teeth to be moved ,mn, versefr' (fig
js used to l;.-i"9 about retrusion of the irx iso "
{fig 8 .~ .
Movement of f>O>terior teeth in sag itto l "one :
Tr.e teeth in tke bucca l ,eQment con boo moved
me.jo lly and di<to ll y to he lp in treatir>g ck", II
and 00" III mal occ lusi on . In 00",1 1ma locclu-
sion, th o ma,ilia ry moJor< or" allowed to ,nove
f" 9 In Cia " II mo l occ l"~ an, th o
m,,, j"'v mo:o~ oro o ~ od to ""'"
di"oI l, whO, tho mand i" ,k>, mok",
Q 'O a l lo~'e d to moo me. iall , b,
Ioad i, . "'" mo,HIo" m".o.Hn ij",, 1
.... ""'" 0 .. .. """"'",10 , o :"o. i "') "ol
'" '' '.
dista lly whi le the mandibula r mola" are allowed
to move "",";olfy by loading the maxillary me,;o.
lingual .utfa ce a nd mandibu lar di.to -li ng uo l
wrfoce ,(fig 9)
Movem e nt 01 te eth in tro nsve rse plone
It is p" .. ible to trim th & oct;yotor to stimul ote ex-
po nsion of the buccel ""gment. Tn ;. i. done by
allowing the contact of the oc ryk on the lingual
8.g ). But better expan,ion i. poO>ible by plooing
a lock $CreW in the activotoc.
Mod/f/catlona of actlv9tor
Ove r the years a number of modification. of tho
d aMicol activator have boon d",",'ibed.
Th ~ bow activator of AM . Schwa r, Th.
 f;g 10 Sow oc' YO'"'" oi A.M_ $<0""",,-

bow edivato r i. a horilO<1ta lly .plit activotor hov_
ing a mo, ill ory portion or>d a mond iboJlor por_
tion oonneded tog ethe r by on elostic bow Ifig 10)_
This kind of modifiootioo a lb.. step wi.., >tJ\l ittal
odvor><:"rnent of the mond ible by ad justment of
the bow. In addition this delign oll om mrklin
emou n' of tro n$ve " e mobHity 01 the "",nd ible_
The w.deper>dent mtW'lr>ry OM !he "",n-
dibulor portions con hove a ",,,,w incorpo rated
10 oll ow arch o,,,,,n. io n.
Wundere r, modjlicotion . Th i. i. an act iva_
tor mod iliootion that i, mo.tly \J.ed in treatmont
oICkm III mob:c lu sion , Th il type 01ad;"'ator i.
chorocterizod by mo' illorycr>d mond iboJlorpor_
ISons conn eded by on onterior $C"'W. Byopening
"" screw th e maxillory portior1 is moved onte ri _
orfy, with a ret:iproce l bod:""rd thrvst on the
mond iboJ lo r "" rtioo II ig 1 1)
The red~ced oerivotor or cybemalo r of
Sdtmufh , Th is modification 01 the activotor i$
pro posed by Prafe""r G ,P.F. Schm<JIh _Th i. op -
plionce ",... mble, a bioMtor wit), tM ac~ic por_
lion 01 the octivotor redvced from the maxill ary
ante ri or area leav ing c 'smo ll flang e of oc~ i c on
the po lotol.lopes _The two ha"'e, may be coo-
nected by on Omeg<l shoped polotol wire . imil or
to bionotor.
The pfopulsar , This i. on activator modifica _
tion conceived by Muhlema nn a nd ",r,,,,,d by
Holt_Thi. opp liof"lCe can be said to be a hybrid
appl iance thot combin e. the ~tlJl"e. ci both the
monobloc oed ,he o rol screen, Tn., propu llor i.
devoid of a ny wi", components a nd con' ist~ 01
acryl ic thot covers the mo.illory bucoo l portion
like on "", I " ",e n_ Thi, acryl ic portion ",,!e r>ds
inta II-.. inter-o::dusa l oreo oed oliO oS 0 lin 9ual
flange that he lp. po, ition the mar>dible lorward,
Cutout Of palo te Iree octiyofor Th i, i. 0
modifi cation propo.ed byMct,elderto comb iM
tn., advo ntage. of bionator and tn., Ar>d""en'.
""tiYator, Th e mandibular portion of the app li-
ance "" e mbl. s on adiYotor wh il e the mo,l ll ory
portion h01 acryl ic cove rin g on ly the po lo"' l 01_
peel 01 the bucca l teeth and 0 lmo ll port of the
adjoining ging iYo . The polot<> thus remoin. lre-e
of acryl ic lhereby moking tn., oppliCII"ICe mo", con-
fig 12 Ile ond pool _..,.'" ~ 01 G oa'ioo' _toO ..... - . . . . !AI '" _ , photog"""", (II ~pho
c/ -""""" ;., ... """"" iQ "", _ "",*,"rnpN.
wo n;"nl fo.r polienl, to wem Ih " app licoce for
k>nger hovr>. Due to the Wea1er orn ou"t 01 ,." "".
ing time , ' uCCe'" , hou ld be greater with th e po l_
ot" free oc!ivotor. At::oord;,-.g to Dr Kk:t..... MetuM~r
tf,C a ppliance is excellent in mond ibulor po~ti on .
ing in TMJ dvsfunction w,e.,
Th e 'Korwetzky modifi ca liDn Th i, con, i, t.
01 r'n<lxi lloO)' oM mandi bula r plo,,", ~r>ed by 0
U bow in the tl'jj;"n of the li" t permn rmnt molc r.
The mo;.:illor,- ond mondi bJ lor pI.ote. not onf,CQ"IO!r
the ling ua l Ii""." and li ng",,1os ped 01 t"",th, it
0 1", extend, over the 0<;01"", 1ospoct of 0 11 t"" th,
Th i, Iypil of octivotor a llow, <le pwi'"
oovo<l(ement 01 th e mon di!>l. by ad i".tment of
the U loop
The U loop ho. " la rger OM 0 .horte r
orm . Base<! on thei, p klc~"' . nt poffern "" can
""V~ three type' of Korwetzky a otMJtors
Fype I ,T~i. i. u,ed in th e t'ootm ent 01 Closs II,
divl,ion I, In thi ' ",od ificoti on , th e Io rg er lo"" r
leg i, placed posteriorly, Th ", WhM the two orm.
of the U bow m" sqvee,od the low<l r pklte """""
",g itolly fOlWafds, (fog I 3,0)
Type II . Thi s i, u,.d for the treatment of CIo"
III "",!occlusion, In thi , applionce the lo rge , ~,
leg;, pice"" ont<'ri>rf,. Thv. when the U bow i.
"1 u"""", the r'n<lMibJlor pIole moves di,to lly (fig
13.bl.
1Ype II! ; They ar~ u""" in bri ng in g ooo ut o,ym -
metrk odvancemMk of th" r'n<l ndi bi . The U bow
is offcx;h"" a nterior+,- on one , ide OM posterio rly
on the ot~~r ,id e to a ll ow a ' lm melri, sogito l
movement of the mandibl0. (fi g 13" & dl
Th ~ octiv<Jtor a llows mobilil'j of lhe me n
dib!<. ond therebre "",1:e.1he """""tor more wm-
fortoble to weor, The ape li n""" olkl"" grodva l
and , eq""ntia l lorward pos ition1 ng 01 tho lC>W<l r
,W f,. 1.3 Ko.w.~h- mod l ~"'"", W for Cia.. ! "",Iocci.o "
(1\1... d o" II ""ok>cc!,,",,, lei & (01 fo.. o ,""""~ "'11;'\01
He rren 's modificatio n of Ihe adivotD" ," 0,",","'
 He""n mod ifi ed the acti vator in Iwo waY' '
1. By o, ...com""""'ti r>g the ventra l po.iti o n of
the ma ndi bl e in the con,truction wa, bite,
2. By 'r'lOtir>g lhe appliance fi rm ly agoin. t th e
mo<i ll o')' de nta l mch by mean< of d o'P' (ar.
rowheod. t'iorog ulm or Ja ck'on',)
Th e construction bite is ta ken in a , trorog
mandibu lar p'otr~. i on . Herren reco mm end,
maxim um forward pos itio ni .-.g 01 the mandiblo
,eachir>g rometi mo. the fea ,,;ble mo< imum . Th i<
advooced po. ition of tl", mand ib le cau"", the
rctroc!or muscle. to t')'to bri ng the ma nd ible lxxk
to a(igioo l po' ition , Th i. cau se, 0 backwa rdly
di rected lofce on the upper teeth and a mesia l
directed fmce on the lowe, teeth, Accon:li ng to
HerrM, with evo')' 1 mm inoM"" 01 fc.rw.:,rd posi.
tion of the ma ndib~, the sog irto l force on the
jaw> will i", rea by 1 00 gm. The oma unt af for
word I"'<it""ing of the mand ible i, 3 4 mm boo
yond the ,,",utral ocdvskJ n i.e . in ca,e 01 C\o" II
molm reloti o n th e mond ible i, broug ht iO<W<l rd
to CI"" I moklr plu< on odd itiC<\o I 34 mm for
word, A vertica l af>"nir.g 01 2 4 mm i, recom
mended,
Trionguklr Q( Joc kson', ckl .p, arc !.>Sod
to fi rmly ""ot the opp li on,-" to tf,., maxilla')' den
ti tion, Expon' io n Ic rews can be u.e d for
e<pon.ion .Mob ility of tM mand ible i, re! ri ded
by exiending the li ngual fklnge pf th e a elNa!o' 0>
fo' a. poosib le toward. th.lIoor 01 th " rMuth,
FUNCTION REGULATOR
TM fur>dion Correcto r or Fu nction RogukltQ( i.
, a myofr..ox:liorol appl",rx;e d"""lo ped by Profe,sor
Rolf Fra nkel of Ge rmany. This opplio~co i, 01.0
ca lled Fronk"! appl iance, ve" ihula r appli a nce
and Q(a l gymnastic app iance,
The Fr<ln'e l oppl", nce he, two main
treatment effect" fi"t it ,erve> as a template
aga inst which tf,., craniofaaol muscles fund""'-
The from ework of the appliance provlde< ....
ottificiol baklndng of the environm ent thefCbto
prcmo!ing more oorrno l potlem 01 muscle <><:I ......
Secoc.dfy, the oppiionce ",mo...,,, tM muscle fortl5
in the lab", 1ond boccal area< thot restrd <kelelcl
g rowth th er..by pro.Kl ing on " n"ironme nt whido
enable, skeletal growth .
The Frankel philosophy
Fro rlkel 00s hosed ,., appl",nce 00 the f" lo"';"II
prindple. :
Ve,tib ula r o,eno of operation Accord ing
to f ranke l. the de~tition i. infl venced by petiord
musc le fUr\ctian . Abno rt1\of periora l mu,de
f~",tion ""'lte. a barTle r for th e optimol growth
of the de ntaol.eolar campi"",,, Thu, the Fro nl<el
appli ance i, de'ig ned to fdd a way the mvsde>
(b ucca l and l abio~ from tf,., dentition, so thet the
dontool"cl"", ,tru ctu re, are free to dt,.,,!op . In
odditi"", tM Fra nke l "Pp l",rx;e acts as an e,e(c;'"
device or on orol gy""'csti<; oovico thet oid, in
co rr ..clion of the obno rmol perio,o l mv.de
fu nction,
SOQ itla ! co rrect jon vja too th bame
mo<illary an choroge : The F"",~" I O!>p lian""
;1 anchored firm ly in the mo.illa')' arch by mean.
01 groove, in the mo kl r and can ine reg ioos. The
mand ible is po. itia ned an!er"iorfy by mea", of an
~ i c pod thet contaCl$ the a"'..01", bone beh ind
the Iowo r anterior segme nt. Th ~ lower l;"goo l pod
oel. mor" 0' 0 prop'Kx;eptive tTigg erior po.rura l
ma inlena nce of the mo .-.d ible,
Diller" ntiof ew~ljon guidance Th o Fronk,,1
opp lia "'e i. free of the mo.-.d ibul or teeth. Thi.
a roOW'l selecti"" ~rup'on d the lowe r poster"" teelh
whkh a id, in co rreaion of the discrepo~cy in the
ve rtka l dimeno io n a nd 0 1$0 he lp. i ~ .agittol
<';(:O'redicn 01 Clo.. II "",Iocdusion by ollowing
upwG,d ond lo ....",d m"""menl 01 onl, the
mandibvklr l&o!h,
Minima l maxillary bo,,,1 e ffecl " I, he. bee n
no!od Ihe! In mOlT (i.,,," II "", Ioccl usio nl, Ih~
"",xillo')' posi~"" is d"", 10 nonncl ...+.ile Ine
moodible II.-uded_The Frankel oPIIlionce ho>
...1atWe1r t;nle retrusie sogiml eRed on .... moJitkl
.. c:on',.,11 10 the morkf>d prot,,,,... chonll'" in
monctoble,
Perio!)"oi p~1I by bucco l 'hielcls and lip
pod. , The bu ccol , hie ld. ond lip peds are
e.!endod 10 bring obou! ou!word periolloo l pu ll.
Th il oids In bone Io<-motiO<1 ot ~ apico l bose,
Made a f Ict/on a f Frllnhl Ippllinee
The following are the effects of the F"'n~el
opplionce on the dento-ol..dor srrut!Ures.
Increon In "on,ver,e and .ogmo! Inl,O_
oroi spo'Ce' The buccol .nieldl ond li p ped.
ploV en impo rtant ro le in e limino li ng the
abnonnc l torc~ <>eting 0<1 th e dento-oiveo lc,
;/Ndvres from !I.e poriol"01 "'Ilion ond 01 .... some
ime "-u,baesarnng from within .... oraIlXI-ity
poe. IO..gUO) , In oddiliorr, the buccol,hrelds ond
lip pod$ ",,,,.1 co"''''''' o","""rd pull on the
1XI........:hYe iii"'" and muodeo....!-;ch is lron"nillO<!
Ie the unclertying borte by me<>n. ol libf... "-'to<!
into the peri03lium 01the bone. Thi l l;,l"" pull
0<1 .... poriostium co use< bo,..., formoti"" and 01",
oid$ in 10ieroi mO.....,., e<11 01 th e d.nlo..., l.-eokl r
""'II,
Incr8018 In vemc" ! 'poc,, : No InCRlOJe
in vertical inlfo-orol 'poce i. poo.sible 0' the
frankel OPIIlioru is kept hee f,om the poIleno,
teeth, The poste'fior teeth me lree 10 e rupl.
Man dibu lar prolmclion Th e lin guo l pod
gu icles tile mond ible 10 a mo r" mesio l pclilio<\ ,
Thu. the pot.Irion 01 thor mond,ble is changed in
d"" cou'U of lime by grod""lfy .,.,in'''II the
prolrodor/relrocror m~,de. or><! by tondvlo,
oooplOli on. \I\'herIe.e, I"" mo ndi bl e i. bfoughl
bock, tho li nguol ""d. oppJv p"'.. ure on tr.e
lingoo l o'-eokl r proce$I . Thi1,mmediot~v~
the PfOt<octor mVKIe. to pos~ion the mond ible
meoicrllv
Mu,cI. "mc"on odoptoIJon , Th" Fronk,}
oppJionce helOJ In ","ercomi~g the obnonnol
periorol mUloCle oc:ri .. itv orod 'ehobil~oles Ihe
mu se l", thot ore cousing th e problem, The lip
pod, or><! "" .. d. co u." oo rio' leo l mU lde pu ll
leod i"ll to oone fo,motion . TI .. pod . and . hie ld .
mo!S([ge the toIt ~nue-s orxl imp''''''' blood
ci-t;vlation. The,.."Ids I""""" up the right muw:leo
and imo ........ muscle tone. The 'ip pods pteYetlt
hyperacti"'" 01 th" m"",.,li. muloCies, ,Iimln"'e
lip lrop a...d help in e.lebli"'ing proper lip MOl.
Fronkel hO$ re.:;ommertded C.rIOin orol
ex""" i"" called ora l gymnm'ie. Some of the
e". rd .... ".,o",m. rxl ed are:
0, To k""" th . li ~ d",od 01011 times This ca n
be oided by o,king the potient to keep
pOer;" 01 paper between the 'ip"_
b_ Swallowing. speoIci..g etc., bern"", rrootecrr
Ie.. on ... .....,oM wNn the oppJia nte ia used.
Typu of fu"etl on.I rellulato "
FR I ,Thev er" usod I<> r lreatm enl of CIoIS I
acd CIo IS II , di.;'ion ' melocdu.;."n, Th e FRI i.
divid ed inte the IcOlowirog th"", type. :
FR io _used fo, Ckl.. 1maloa:lusion Io'*"!here
i. minor to rncx:Ierote-oc-:ti"ll_ It i1also used lor
00... Ideep bite co .....
FlI:lb - us.ed 10, Cklss II. If.....ion 1 malocdusio<\
......... OV<t'iel do.. IlOl """eM 5 mm,
FR 1c _ uoed 10' Clou II, divi,;."n I molocclv:llr:>n
in which Ih e """ ri et il more Ih on 7 mm .
 fR2. tt..,- 0'" ...sed for "",,'1r*Il 01 Cia.. II.
d;.,;...,., 1 ond di";>ion 2 .
f RJ , t hoy e re used lor tr""''''''~! ef Clo .. III
FR4 , Th.t!y e,," ulod for tn)Otmont 01 0j)6<l bil<l
and bi""""lIimy prol,u5ion.
FHS lhey Or" iU "Clionol '09 ,,10'0," thot
incOfport>le hood 9""r. Tn"Yo'" indk:O!ed in long
foce pcIicI\.. hovi"ll 0 high mandibula r plone
angle and WOIfj>1 ma.;lIa'1 e>ce...
, .... FR2 oIFronb!l .. 1he "..,.tcommonly
UHd ~pI"nce ond """,Id tht/(I!are be dil<:uued
ind.'e il .
F~nctl(ln . 1 'ftg~I"to, 2 of F,ank"
They oro UHd lor trootm en! of Cia.. II, dr.i>.>on \
(lnd dr.-Won 2 molocclw.ion .
11. fR 2 U>nIis"ol ocryli' oro:! wile rompo_
(~g 14). TN> acrylic components include '
a. Buccal shields
b. Lppod$
c Lowcdillguol pod
Tho wire {ompo nent. i""lude :
0 f\Jloloi bo..
b. Lohiol bow
<. Coni"" --.ion,
d. Upp." lingool .....,
ling",,1 ~,wire
f. 5 up po ~ wi", for li p pod.
t.ow. r linguoll pringl
T.... k;w.-", lip pods o'e olso colt..d
Pallo',. The lip pod, help in elimlroo~an of
abnormal perioral mlJldo, oc:h.rrty I.e. hyperactive
n_toIio mu.d.. octjyity. ~ h,lp" In ellm'rool'ng
Iow.-lip Imp whidl wU$O$ Of occ.nIUGIeS the
p!ooino''''' of ~p"r inciooro. tn odd".",. the I;p
pods oa u... peria>!oo l pu ll ..r.ich res ults in bo""
growth . In Co", 01 FR III, rrn. lip pods o'~ place d
in the mOlOllcryvestibula' "'Ilion.
8ucco1 ohields : The buccal shield. 0"
to ll ed
"'" mod ,hoe to e>cte-nd a.
"1Wibvlar mield ~:!'~~~~~
l i
deeply
a. pO$l ibie within ,he confine. 01
crnd ti ...... e~ ocnmenl. Th ....
from the dc!",itiot\ ond 00501 olveo\", 100...
hoIps ,n un~ted deow""""""",r de.III0p0,....
In odd,rion they obo couse periO$t(l(l1 ~
depotitiatl.
1'o,,"lof!>ow, Tho polol<ll bow has ilS _.~.,'
focing di>!oIly. The palo.,1bow ohoo ld JloneI " -
01th o po lota l ti" ue. Th e latera l ""t. n ~on 01.
bow 0"0156$ the ocdlJ$(l l.unoce in The omt.ras..
mesicl to the f"~1 permone nt maio, and ......
tho OO""jIic bllCCol.hield. 1"" rocv....n oneil ti
the polotal bo..'''''''i ...... o. ocdusol ..... on ...
a.;<;lusol wrioce 01 the hm permanent rnaIc:n
"""._ the mosia-b<K.Ol1ond d1>labuccal a-.
Th e~ <xd~aal '$>1. p,,,,,,,,t th .. opplicrw::, f"""
be in Q t.! i. lodged .up. ri arly a nd 0 110 pr.". ..
"'P roeruphon 01 ,he fi ... t perollonent mala ....
Conin, loop. : Th e conine loop. ac! a.
e.<I .... ~ 01 the vestibulo, sh;dd, ond 0" k"fII
2-3 mm _ , from the buccol .urloct 01 "-
con;"'. Theyo,,"aisocolledcon,neguords n..,
help in ,lf mlnO'ion of the ",wk!l... muw.
Iu-.dion I\.o-oOyho~"'g in !ron'_... deYoI~
in the conine ' <>glen
labial bow , The upope< labia l bow crig il\Ote.
from Ir.. _ ti bvlor . hi elds. T.... wi" ,un, In tfle
middle 3td 01 .ho lobial.u";"c. of the mo>.ilbry
inO$Ol'1. h 11.1l'1"li gingi.,,11y at nghl angles ollho
d..",1 margin 01 the lotero! inci$Ol'1. n. labial
bow .h""ld be ben' in on ideal contou, and noI
in the contour 01 m:>lpo<itioned -'>. This bow 1$
po ....... in noture. In case olfR III m..lobicl bow
i, adapted on th e lobial w rfOC& of ,I>e Iowo'
onlefiorl.
fog I . Com_~ 01 r",,*~ " ""<nco , W l<IbIol~, 1111 C...... """', P U_ ~I ";'t, (Oll..... uol uos_
......
.... ill s...- .....
I<J< Ip,.,.Jo,.'" Il0.<<<01 o!-er.lo. 101 ('_1"'>':1>. (Hl """,.,1_, \!lib- ~ ....... ..... , ~ l.<Joo<o 1"Q'o.OOI

lingllO! Jlobl/izing bow ; Th wile il olso
m/lltd upper l;"guol wire 01 po'oIn.ot'on bow, ~
originotn 1'0m Ihe _lib"l", .......w. ond pou.eo
be_lt>~ u;>pe!" c" ninc. and lirst dodd ........
molars ond curve. along 1M li nguolau rioce 01
!he uppo. Incl sora a t the ':"ve l 01 the clngu l ~m .
This w;." preventslhe ~ng~ ~w'ng 01 !I.e indso<s
dJring tI"eotmenl,
lDo.er IInguol springs; The ... wire compo-
_ _ ogoin" the lingu(ll.urloce oIthe lower
onteriors. The moin uses oIlho! linguol lporitIg.
ore 00 follows :
Q. To preven! supra e ruption 01 tfle lowe r
indSOfl,
b. To SO"een !he lOngue """",re from "'-"
indoors.
c. To p'celi"" rho lower incioors octM!~ Thil il
dooe wl>en thll"j Ore ,e!rocii..,o,
The 'P"i"ll' "'" embodied in tl>e liI"Igooi
~d
Lnll""l CIQ$~ wire , Thio to mede of 1,25
""" <lainl_ I!eeI wire. k follows tho contour 01
the lingual mucoso 3.4 mm below the IIngool
g ingival mOlgin of the lower indoors. It il plated
1-2 nm"""'1 from the ......:om. Thit wire OO$MS
the ocdo.soI s...bee belweenlhe ded<1oous rnolors
ond """ embodded i~ !n.. buccal , hicido,
Labjal suppo.1 wl're. Thi. i, mod& 01 0,9
mm wire. They oIiet ,upp<::<1lor m, lip pod . Thi'
wire Ihoufd be oil"",,! 7 mm below !he gin9",,1
m...... in: 1he ("",!'ol .,.i'a .. i"'lt!olted 'V" ,fleped 10
occommodo!o !he Iow. r Iob",1f,,",,um. Another
";re amerges from the lip pod ond ~tJ "",bedded
in the buccol .h i ~d>.
F~ ,,, "o,,.' ,.,,,,.ro, 1 of F, . ,,~.I
The FR 1 01 frankel fIe,3 moclincoliOrll.
o . FRlo
b. FRI b
c. fR I c
FRI c." fR l a i, used in Cion I mo loc:cl u. ion.
", im mild te> mooernt. ~ing. It i. o lse> used
fa< (I'm I deep bite <008$. All 01j)eCl1 of fR I
O. . limilor ta fR "2 CI<O:pt!hat a 1ac4<s !he lingual
sh;..ld,ling",,1 spings,,,,,,,,,,,1 COQSWYer wire, and
!he upper Iong",,1 bcNtRen in FR 2. n.appl;.".ce
COn,;"1 01 ooyIic "",rI. ond wire COtllpor"lenl>.
Tho ocryl;,: pe rt. indud.:
0 ."2 ve.tibular .~ields
b. 2 li p pad .
Tho ",ile com,"""onts include:
o. !'ulotal bow
b. lobiol bow
c. lobiol >uppor! wire
d. Ungual Bow
e. Coni"" loops
W k.... fR"2 a nd 1 b, "" ir>gual ocrylic
p"d i. absent . A ling ual bow i. p"''''nt tnat helps
in fcrwo<d positi on ing of the mand ible .
The fR I haJ 0 <onine loop 1I10t po ....,
'hrough 'he emb'Olure meliol '0 'he fi",
docduo..s molar. This helps to ~ !he_piing
conio&.
FR 1 b : The FR I b;. used 10 .,"'" Cia.. II, di .. I
mQlocdu:s",n .. he,a Ih. ~! dou no1 "",ceed
5""". ~ d,flm from FR l oin tI-ot it "",111-\.. ling",, 1
ocryl~ ~ . Among 1he wi re co mpo ". nt, the
lower lin gua l 'pO.,..'
are added.
FRlc : lI'a Hl c is u d in Cia.. II, d ... I
moIoccIuooon where the '"""'i01 in..-.;ore mon 7ftm..
In FRI, 1he t.u",,1 ' hield, 0"" .pii! hcri,oruat,
end v.r'~o l ly into "2 part . Th . antero- in ferio<
port",n conto i", the wira. for !he lin gLJQ I ccrPc-
p"d c!'d lip pad . Thi. permits .he 1000000ard
~ oIthe ...-ior->eOion of ","cpplou.
The spoce cr.a!l .. hUed .,jm ",K OM ~
Thus Hie i. u.ed wh&n muhiple .Ioge
advancement il needed.
\
F~n ctIOIl" " i~" !o, J of F,."Ie"
Th e FR 3. lf ig 16) i , ind icated in ( laniU
molocch,sion. ct.a roderized by mQJci lla ry ~.Ied
relrulion and nct mc"dibulaf p,ogfl()lI1i'~' n..
cppliance thould be used during deciduouo,.
mi.d and eorly P8rrnoreffl den1irion.
fR 3 hOI two upptlt" lip pods. 1he lip
pocI. o,.largerond more~ rhon!he lower
poa. QI FR 2. 1he "",do epP'K" ~n:I,op """peel
in sog i~Q I MCIiOO. Tr..,. should I", in tho! depth 0/
!h !i bylor ,y leu . pore ll . 1to th e olvea luJ. Tho
purpose af 111. li p pod . 0,,"'
I. loell!Tlinole me resM<:Ii..., P"'""'" of Ihe upper
lip on the underde...,1cfIed mo . illo
2. TO ....11 len$iQn on ....., tissue. Qnd II'rio,""""
nnochmtfl1l in "'" deph 0/....., "..".;by sulcus
10 .timulole bone growth.
3. Toh'll"sm~!he "PP8' lipbu 10"'" mQndib"
th'aug h tho!lOW<! r lobial e,u, I.,.. a ,ot, ",;",
, !in\~ I U I. Sc m. of th o fore .. or. el .a
transmitted ';a 111 &~e<libular shield,.
Tho buccol ,hiek!. ""nd owoy ffom lI1e
mo<iUooy ~ric, dentoalwoalor IkUClufes by
obolll 3mm. The buccol shields Cle In COn1OCf
wiIh Ihe mondibula, ap;col 00:... lftey _ to
,Iiminore!he bu"ifl()l0< mUKI.1o<ce Qnd alse>
ccu'" a perios_1 p" llleoding la bone grawlh.
labial lUppOrt wires COI'noct!he li p ~I
tog.thor cnd 10 th o b...:co l l h~ds . The Icb;.o l bow
 f l ~ l~ ~ ,. ond po".
,,.. ............."'''''''',h. 01 0
po"'"' ",,'h mQno ;b,lo,
~"" ;., .., _led ,"jo, fR
II opp<:",," 'll p. .,,,,,,,,,...
i>O"'''I1'''''' I~: &
,,..,_J iC) ",,,.
p/ooOooJ""h<

c
i, placed in the 10- ofCh I'rom.Jsion bow is
- ' behind the upptfindoofs 10 sIi~ Iorwotd
mew .. nent of I+>e$e teeth, Th .. palaTal bow lie.
sJightfy ~ from n,. moxooo lo p"'ent O1iIoTion .
It croo .., ri,. PO""" beMld the ." TerupIIXI mokl,
F"nctlon.1 ,.,,,'uo, 4 of F,ankel
The FR 4 ;. used fo, co,rec!""" 01 ope" bit ... ,,00
10 0 \os$el exlem blrnc>J<lllory proIrusion. II> u'" i.
"'rnosI e>o:IuliYely ~ 10 tho nUed donTiTior>.
The FR 4 ho ..... 10m. VGTibulo, coodiguroTion
o. FR 1 ond 2. k locks conine loop> ood
pro1tu$Ion bowl. k consi. 01 4 oedu ........1> on
the r"toCIIIilloryint moIc:nond Intdeddo"" .. moIon
10 pre"""t tippo'rog of me appiio!lCe. The palotol
bow 1,l ik,l" FR J placed di>lallo los! molar.
Functional ,.,ul.to, 5 of F,anlcel
They ore fvndiono l reg ul ator. that ir><;orporoTe
nood gOOf, n",y are iOOicoted in patients ";Ih
long frxe syndrome ho.inll 0 high moOOibulor
piono anglo ond ""rlieol mlll<illory e.cess.
' .... opplionc. eonoilllsol ~oayIic
bite bb;ko ""'t
p<event rrdoreruplion due to .....
ocIiorr 01 "-'1Or.......des of mandible, Heod (IeOf
"'oos are in<:orp::l<oted rhol om ust:d for extroo rol
t,oClIO<,.
Con'trucf/on bIte
For rnir>O< oogftto l porablem., the conslr ...ction bile
i. I(lk.., In on 0<1118 10 edge ind",1 relali"rW>ip
mokio'll """ there;' naol:Nious slmin of the foclol
...usclo. Fmnal hos r""<>rOmend...:! Ihot I....
eonWVClion bile should not """'" the mandiblo
~/vrtheo''''''n 2.51<>3 rTrn. He....:orm>ends
0 ...... verlicol opening that is only I~ enough
to petlI"oit tho Q'OSS()e("';"" to PO" lh<O<lllh the
1"""-occlulOl Orll<), In proc~ce!here musl be at
Ieost2,5 mm to 3.5 mmcleorance in thobval
.. gments 10 a ll ow the cro.sovor wi,... ',0 pm.
Th mugh,
FoIfR 3 th . bite regi.tralion i. Ioke"
"';Ih f", pallenl . rrcrdible in lhe tr'IOOl ccmforloble
rerrvded posffion. In gener,,1 the _icoI opening
i. lop! 10 0 minimum 10 ollow t'J> dooure .... ~h
minimol Wain.
 -~
Sep .." t/o n end tln, ,rollv"
BeIore "", king !I-.e impressions. st-poo ob1 (he<:r.)o
.lasri<:: ... poootors) or.. placed in "'"' moxillory
con .... -lifS1 deOduous molan,n'lbto:lu<e OM in
!he cledd oovi 2nd """ or.Ii,,,! pe rmonenTmc lor
...,btowre.lI'Ot ~re ilcorrled QuIto proy;o.
~c;irrt room In !he .,mbfOl,u",1or the MOlin;
01 me cro'Js<M<"";res, Hthe sepoomoo does "'"
CI'!<lte enoug~ . poco iT il """.".w ry 10 . li ce the
dis",1 <""lOCI 01 the upper ",",ond deciduous
molar as ~I 0:1 ..... docidUOU'l canine 000 h...
decidoou:s ~"',
w , t im.
1" lew -'<1. 2~ hourtldoy (day ~""')
Aft" r 3 """' : 46 hov<lIOoy (dOT' ~mel
AIr., 3rd vllil (2 monlhl) : Full time wear.
The pnIi"'" is ...ked to perlann oml
gormnoslicsl.". talking, reociing, !i<;lhtt., II""'!>'"
the a pplionc:~ in Ihe "".tibul .
SIONATOR
The biof"(lt", woo de.. 01, F>B<l by Bollen du~ng the
eorly 1950',. It 00d rno..oc.h in common with 1f>G
odi.alor. Ito ..,. .... i dille<ed from Iha CO .... ,1000 ",I
octHo1or in lhal a """,less bullyond moreelastic.
The,. "re II""" type. of 0;",,,,10< ,
0. $lcOOcrd opplian:e
b. 00", III oppliona
c. The "l*'bileoppl;on.:.,
S t llml"d ' .1'.1' 1/,,,,
This is used for the _ent cl Om II. diYi<ion
1 and <Jon I moIo<:dusicln. h::Mr>g Mf\'"OW den,."
ord"", The , tand ord opp liance consist. 0/ "
rei","",,, oIencier ooyljc body lined 10 1h,liroguol
""peds 01"'" mClfodibulo, 0"", and port 01 the
moxilto ,,! oren Ifig 17). The oc~ic e.<!..,ds vptO
 A

th e di . tol 01 th e fir>t permon ent mola rS . The
maxillory plate Go'ers on ly the molo r> ond the
premolor> wilh th e enterio r regio n r.mo in ing
uClCo>e red , The oerylic exten d, 2 mOl boe low the
ging ivo l morgin . The intemedu",1 "P" CO cJ 5OrT'Ie
of th o bv,c~f teeth i, fil led with ocryii, e,t""d in Q
over helf of the occ lu ,o l , urfoce of the teeth to
S!<lbilizo th e opplia nce .
The wire component> of th e bionator ore
the pa lotal arch ond the vestibul ar wire , The
polotol oreh is made cJ 1.2 mm dio rneterwi re, It
"m"'!les opposite tho mddle of tho first premolo"
ood foll ow. th o cOl1tourol th e polate forming 0
mand ibular coni "" where it i, bent to reoch tho
up per conine. _ It form. 0 mirror image "" tn.,
oppo. ite . ide . The ve. li bvlo r wi", i. kept owoy
fmm th e surface of in cisorS by the l hickn~" 01 0
<h oet 01 pop"r. Th~ Iotoro l portion. of tt... wire ore
. uHide-ntlv owov from the teeth to ollow expo n.jon
of the erer.
Class 11/ appliance
Th is i. used in mand ibulor prognathi,m. The
ocryiic p;w1o ore similo( to the slecd<l rd oppliooco.
Th . pololo l o.-ch il pb::ed in the oppoo ite diroction
$0 that tho round ed arch is ploced onteriorly. Tho

evrve tho t reoch e, th e di. tol surfoce of fi rst
pe rmonent molo". The pololo l oreh i, kept 1 mm
oWO)' from the "",CO"" The .""tibunwire is mode
up of 0, 9 """ .roi nless oIeo l wire , It 0"""11'" from
the ~c'i'lic below tho co nto e! p~ inl betw~M th e
upper co nine. ood promolor> . It ri ' erti co ll y
Md i. bent ot right on9le. to QO di ,tolly olong
th o midd le of th e uwer p r~ molo r Cmwn, . Mesia l
to the moillr, Il mu nded bend i, mode $0 that th e
wire ",no at the 1.,,.1 of the lower popWa upto the
vesti bvlOf I'oi re ",no over tho lower incl"", ."tead
of torminating ot the lower canine'lfig 18.0).
The open bl!e appliance
Thi. is u.ed in OpM bite cose., The 1'010101 oreh
ond the v<tibulor wire. ore $Ome~ . tt... , t""""rd
opp~"",o , The moxilby ocrylic portioo is rood ified
$0 thot ""en tho onterior oreo il covered [fiQ l 8, b).
It> purpose is to Pffl"ent tho toogue from thrusting
between the teeth 0. the tong ue i, respom ibie in
mOSl co_ for the open bir.!.

Bllo ,0,11I'l lIon

Bi", 'lIIliWotion iI dono in the some way '" lor

the oclivolot. In moot co ... on edge 10 edge bile
.. de';'oble. If the ..... 'iet is 100 m..,u, a ,Iep..,.;.e
e<J"" ncement il "",Iorred.

Ind/cotlon. or Il/on.fo,
I. In a Clan II, di . 1 moloc:c l".ion hoving
IoIlc:><wing feoMU:
o. Well aligned den!!>1 oll;he> .
b. Retruded mondible
c. Nat very _ oI<eIetal discnoponcy
d. Lobiol ripping of upper ind2orl.
2. 00.. 1" molocdusion where _ biorotot
(CIa .. III biotlotorj COn be us..d.
fig )9 I..... block 00"'''''''.
3. Oll'lnbi ... COlt . .."". <>poln b~e bionmo,
con be Vied. pre-molat. 1'" Iovre. molars ore kepI I'ee to h~p
in their eruption il n ded . The up-per <lnd ktw ...
TWIN BlOCK APPliA NC E bile bl ockl lnte~od at (I 45" 0,,"1. ,

The twin block Tecnn iqve effod".\Y comb ine.
incJ ined plon n"";t), int .... ""'. illo')' and . 'tmorol
!fOC~M. Theowlic~"","'",ofan y~,and
o Iowerplote r-.:r.;ng oc:d.....,llyindined bile planes
tha t indue. fovou-tobty di~ ocdusol forces
by coutW1g 0 functlOrol mondbula.dispfocemenl
(fig 19).
The upper pia ... is rejoined by modified
0""'" I>ood closp'. n .. ,Ialp (an incarporolfl a
tvboo lor aflochmenl aI 0 foce bow. 1he upper
pia,," CI>" tIbo hove c joc k K row in co.., maxi lktry
"rch expoOr"lSion is t"OC<u ir&d . Th. up-per oppl.,nce
con .I,t, 01 c bite block thoT (ov.r< the lingua l
,""PI 01 the up per poOlterio. teeth , . xt. ndi ng
omerioriy ti" the mesic l r;Og. cJ the uppe< seco nd
pt"Imolac The bwer plale i, retained by in!eo"de<.kll
ball cla,pt. The ~ bile block 10<1..-.:1, dimity
upkr The distol morgiflOl ridge of the ><ICond
BIt. tOIl /lt,. tlOII
Th. Twin blad< ap pliance .. con,tr\.octed oft., c
bite rllllil!rotion procedure m d "OCfi bed fo'
O(rivoto" The mondible i, IQg;klUy odvonced by
5.7 mm. v..n;~lly the bile i,opened by 3-5mm
in the pre-molar region_
O,fIl Op.o"lc " .etlo..
In to ... with...-e .leIeIol discreponcy_ "",I
tro~~on il used. lhe twin
bIodc applionce uses 0
Cancon:le loce bow that combines the t.""",1
tro c:tlor1 with inter"",.illory T"""ion .T""
lace !:>ow
is vn lqveol it ho, a curved Iab., 1hook , Tho face
bow is a~cched to th e moxi lla')' mo lor, I nte~.
",a.<i llcry .1a1T1~. ~a n b.. used fmm th l curv.d
labial hoo~ of the lace bow to the mondible,
Eot,,,,,,,,1 TfOCfion 01 200 g roms each sic:f. for
8- I 0 hours 0 day is I> - ' bed _Irtlermmillary Iort:lII
 A

B
o
f;y 2'0 Ho.\ooI ~ , !AI s;do._ 1111 Plo.g ...... u.. (Q lobO ..... .:.:du1aI _ (Dj "'b'w:Iobodoo <Xci. .... __

of 1SO gm. i. ""piled from Iow.r opp lian ce to
!he labial hook oj , ... Concoulloce 00...
Flud '''''n IIloell.
The ""in block cpp lio""" mGOy 0. des ignoC lor
dirwcl&.otion 10 !he IaeIh by bonc:Wog k.......,bIa:
o Herb.! ""pI;onc ",bstituq oo;d"..,1 indil'oOd
p%nH fortelescopk tubes, !o l/uide the roondible
into 0 pre!",... . p<l5ition.
,..r'II.. I ."". pla"""
Tm. oppi i""". h(H ..,. good ~;ent accoplora
d"" 10 mlfollowing....,."...,.
o. The bi~ planes offe, !I' COIe< i,.,.."jom of
"'_"", in onleric, end !cleml e.cursion
thon 011;.,. Ivndi<>M 1o~"'i(mc""
b. They oIIe. Itu interference with normol
function.
c. S;g niliconl chong .. in patient'. appeorance
;."""" in 23 mo nth>.
HI!'ItS5T A"PUANCE
Ho rbst ;. 0 liMId Ivndiooal opplionce Thel we.
d_loped by Emil H.. rbsr in Ihe etlrIy 1900',. h
wo. In.troduted to the denlOl pmfe.,ion 01 II...
Inlomoti onol Dentol Congreu in Berj in in 19O5.
Thi' OppliMCI 10'0. ><>OIl Io,gotten end ~ """
,.,ntroduced in 1979 by Honsl'onchen who
P<l!3"I",,=! iIJ .......
Indication s for use o~ Herbst appliance
1, The He rb, t applian ce is ind icated in
correctiOr'l of Cia," II ma locdu.ian, d<Je to
retrognothi c mand ibl e.
2. They Gan be <JSed 00 on onte<ior r.po~tion i ng
,p int in patiMll r.aving temporO!Y'.::md ibvla r
ja int di,orders,
Th. IoI lowing ore the specilic indica,,,,,,,
01 the He rb,t app li ance:
Po$! ada le scen, patients: Trea tm e nt with
He.mt ma\'be c:omp~ within 68 months. Thu,
it i, po" i b l~ to u ,~ th e re, idua l growth loft in
th ..e pa tient.
Maulh breolhers; He rb. t appl ia nce con be
u,ed in movth breotf>e r\ unli ke athe r r"",avab;"
lur>diono loppliance,.
Un co-opero tive parent" It i. 0 li'ed appl iance
ond i, wom 24 hourS 0 cloy, Thu , it can be u,~d
in uncaoperotie patients.
Oescrlptlon of th e appliance
Th e appi iance can bo compared to o n a rtificial
jo int worling between the moxilla and mand ibl e.
A bilateral te le>capic mechani$m keep' the
mandible mechanica lly in cooti noou. anterior
po,iti an. TM device oon~'t> al a !vb. into which
th e plunge' (that ,e,e mble, a rod) li t>. Thetube
i. fi<ed to tM di, tol end 01 the moxill o!)' mo lars
while the rod i, fixed to tho lowor lirst pr.,.."o larS
(fi g 20)
Typ es of Herbat appliance
Broodly the H~ rb, t opplionce can be cla," ilied
into two type, :
o. Bonded Herbst
b, Bonded Herb>!
Bande d He r/' . r . Upp ~ r ond lowe r fi rM
premolars end lim molars are banded. Tho tu be,
are li<ed to pivot, .aldered to th e di, to buccal
a'ped 01 ,h~ upper first mdor bar",!,. The .holt.
or rod , are lixed to pivot, .o ld ~red to tf>e lower
lirsT premolor ban d. ,
Banded Herb,' Tne bo.~ed tiP" of H. rb. t
app lia nce is a wire rcinforo..d o~,"," ic .pii nt that
cove ... tho o<;d u,o l o nd port 01 the bucoa l and
lin goo l . urfOO~$ of a ll tee' h exc~pt the onte ri ors,
Tf>e pivots ore lix..d to the wire fromework at the
d i ,tobvc~a l a'pect of 'h o up p" r fi rSt molars an d
the mo, ,,,10'P'!d of th o """" fir.ll promoiOfl . The
tu be i, fitted onto too pillot, in tf>e maxillary rn<:>iar
orM wh il e the ,holt i, fi<ed to pi,,'. in th e
mon dib ul or premdar rcQion.
Trea tment e ffects
The followin g effect, oro , een w""" the Herb,t
opp li ance i, used lor th e treo tm ent 01 a IIC"'''
mobcd u' iDrl :
1, Clo .. I molar relation or over correoted
Cia .. I malarrelation,
2. An inc rea,e in mand ibul a r g rowth,
3. A oerto in amovnt of di, tol driving of the
"",.;I lary molo... that he lp, in the correction
of mda r relation.
4. Overjet rcd uctio<1 by in crease in mandibu lar
le ngth a nd prac linati on of mand ibu lar
incio"",.
5. It ho. an in hibito!)' influ,e<1ce on th e 'ag itlol
ma,il lary g rowth.
6. We i ~onde, , ugg e,t, 'J bie oontour of th e
g lMoid lo,"a in d ica ti ng anter ior
tran,lormot"'" 01 the glenaOil 10 ..0.
8, Irxrea ... in SNBongl~ ond decrea,e in SNA
ang le.
Advantage..
Th e foll owing are the advantage, 01 the He,,,,1
opplkmoe '
1, As it i, 0 fi ,..d lu ndiono l appli ance that i.
,
nat r~mov.d by the patie nt, the o.dion it
 c
f\o 21 Pr. and po>I-,O(tmor' p/dog""i1l of 0 pelion! w," m".,.jbck" " '"",00"';;'" ...,,'ed ' ''fig
Ho,;,,, ..... "..c. (Al Pm_,,,,,,,! ,i>o>og 'cph. :Ell Ph"'''II'''.ho of """ ..,,'" in 1"-0 ""OJ;' iq Po>~t"",t ",,"t
''''''<>\Yo ph"
 prodcoces is continuous ,
2, The treotme nt du",tion is ,hort d"" to the
conti nuous noture of oction,
3 Le .. patient co_ope",tion is needed os it is c
fi.ed oppliance.
4 It Can be u..,d ,coccessf"11y in pal;"nts who
o re at lhe e nd c4 tfleir growth.
5, Herbst opp l;., nce COn be vsed in potients
who 00,,", mooJIh breall'ing oob~ due to nosol
oirwayob.truction ,
D/sa d van t atet
1, li 'e crt)' other funcliono l opp li<n:e ~ req uires
, p(ltiMt cO'op<mlti o n, a, init;.,1di,.;omfort i,
u. uol ly pte.ont.
2 It con cou.e minor func ti onol disturbo nce,
in the mosticolor)' 'fllem which ore lemporo ry
on d g rodoo ll y disappoor.
3, Them i, on irx;reosed ri.Hor!he deveioprnont
c4 a duol bite, with d)'lfuncti on 'ympl<x'ns of
the TMJ o. 0 poss ible con'equence ,
4, Repeated brea koge ond loo"'nirtg of the
app li once occur:!, e'pecio lly in lhe Iow. r
pre rrdorareo .
5 Ploqu e occumu lot ion ond "nom~ 1
decolcificotion occur, . specia lly in the ",lint
type of'app liance,
6 Te nd . ncy for po.le rio r opon bite at the
termi notion of therapy,
JASPER JUMPER
The Jo<pe r Ju mper i, a relotively '""'w typo of
fie<ible, li<OO, tooth ix>rn<o lund;"no l opplia nce
thot "",. introdu<ed by J.J , Jo. per in the yeo r
1980 . II> odions ore . imilo r to Hetbot appl iance.
but Ioc" the rig idity,
Applianc e d es Ign
The applianco u",s a mod ulo r ')'Item commonly
known 0' Jospor Jum per, wh ich con be o~ oeh ed
to fixed appliance, thot ore plOC<!d on the upper
ond low e r arc he . This Jospe r m o dul~ i,
analogous to the tu be ond plung ~r of Herbst
a ppliance but i, more ne.x'b\e , The Jo.per jumper
is constructed c4 stainless steel coillhot is onoched
ot both the e Cld, to .toinle.. , te,;1end co ps . Th.:
module in given o n opoque poIy.Jretoone W"Iemg
fo r purpo<o of hygiene ond comfort. The Jos.per
module. 0'" ovo iloble in "". en sim. "'''ling fro m
26mmt038 mm in length
The end cap' a re clklchod to the fi.ed
oppliance ot the mo xi llory posl e rio r ond
mondibu lo r anterior reg ion. The force modoJle is
attochOO poste ri o rly to th e mcxillol)' o rch by 0
bol l pi" tr.:.t po,ses throog h the foce bow tube of
the moxill a ,,! li r:!t molo r, Ante ri orly the module i,
onchored to the lower orch wire di,toi 10 lhe
mondibulor mnin e by a .mo ll bayonet beCld oCld
o Iexon beod.
Since th ~ focce module is ot!ochod to
previously pieced fixed opplionces, GO '" shou ld
to ta ke n to hove odeqootely thick a rch wire~.
IndIcation s for Ja.per Jumpa,
They ore bo.i<;olly ind icoted in .'~letol Oa.. II
mo locclu. ion with m a .illory uee .. cnd
mondib ulor deficiency,
Mac ha nls m or act/on
The focce modu le i, .el..oed by meosunng the
di,tonce betvreo n the mesial aspect of l he upper
loco: bow tube cnd the di.tol ooped of!he le. on
bo ll d~"' 1 to ..... mondiWor c""ne, To this length,
12 mm i. added 10 get t h ~ required length 0/ the
fo ra: modu le.
Thu. when the teeth """'" into oed",",",
the fo rce modu le being longe r tendl to cv,,",
th e reby producing 0 me. ic l fo rce o n the
ma ndibu la r o rch ond 0 di.tol force o n the
mc.illoryorch.

Efr.ell of Ja.pa, Jumper
Accotding to Rankin, Pm\w ond 91ockwood rh~
Josper jumper brings obour both l kelml 0<Id
denIO>OIveolDl changers .... the ,Olio 01 40 :60
The ,k.ltlal ell""" .nd....Je :
1) Hoi';' and di.lphcel the mo>Jllo di!!o l~.
2) A ,roo ll shih of point Adi, toffy.
3) Clodw'$('! ro!otion of moooible.
4) C~. """""lorward .
The den191 ch ange. of Jasper jvmper ole:
I) Posteri", ~pping and int'Ulion 01 upper
md~.
...
"2) 8ock"",rd tipping olmo>.illo..,. inc""".
J) Anterior ""' ...Io!..... MdtippWJ 01 mandibular
, J) AIIowsg....mr ..... reedmandibu lo,lreedom
4) IntM io n of mooo ibu l", in ci.o ...
Jaspe r stOles tMt 000' IIcom>ction wiTh
mi. oppjion i$ b rO~ QhT obovT b.,. :
2O'JI. M,,.illo..,. .keletoi '''''''' .... ing
20% . 8oc1cwo<d dento-ot.eolo<_mont
01_...110
20% Fo"""rd dento_ ol. eolc,,_metIt
01 ,,",cmdible
20% . Coro:hiartTimuloTion and
2Ql6 Dow"''Iard aoo lO!ward 'emodellng
01 glenoid 10..0.
Advaltta," ot Jupa, Jumper
1) 1'rQduc;fl1 continuous Iorce<.
2) Does not ,eq ....... po1ient compjO::lIlal by-
WO'f oIlimefy .....",.
," on Herbs! app l",r.::..
4) 0 '01hvg itno i. "".ierto maintain .
f9 23 Pre ofld OOOM,,,,-. """,..do oj. par;.." ,,,,,,ood ",,,.10<,,,,, j," -. W Pro...., ..... ".~ phorograpt..
(811'1- ""' ....... ,, _ oI>o~ph. iCl P"ho1Ogt".pho of opoia-... ;, rho rt"IO\J;' (01 ""',,,.. _ ... room!
OM ;oh .... 1 ~.ph,.

AI"" " ft, Owon (1;,;,"1 Mo'og,m ont oj " .
F,aok. 1 FR II AWHo" . J Oi, O ,tl>od )983;
573_WJ
24_ Po.-.;i.on, Clo .. II ",n dian " H.,bst oo plioK.
,,.,,'m. AmJOrirod I932; 1()4_IIJ
25. f'a-><hon, Ck, I ,..",.. """ Ko<h,tI,..,. ............
J Orthod 199 1, 220_233

_t
005_618 26, PQ oohoor! M,>< 10 adi' ity "' CI"" II, 0;-,-;.00 1
2, WeI< ""'" "'" d... Undo, f,,,,,"""' I opp-lacao' molocd.. ..",. "oo.od b-r b;1O i '-' ~ "'" ... _
""""' col <>doo, ,.." J Ortf.od 1987; 162 168 ~_ Am j O" hod 1 ~ : 32 1_321
3 Co,. h ood ,0, 5' .Mborgh. ' Cha,~ . , i, 27, Paoxl>ec.l, Tho .."..1"""'_ '"" J OrtOod 191!.';
... ",,,,,,,,,"," , ,.II.,.,;,., "",,,.1er ~ d,""'J .or , 1_20
fvoctioM l i""
1986,.10.19
o"'<>POd'" "oo'men', Am J OrthoO 2S Paox"", <>nd """"", . ~ , ~ oH.o 01
... Kt<o.t oppi;o",,"_ Am J W>od 1993; 5 10-.S2D
4. ~ ond -">=boon 1", w.RS o~. "'" 21 """""' .. P. HOW<!, .100\'" A. Ma>o"",,,, : CI....J
j CMhod 1982, 4'5~55 . ~ " of ,h. _dod H.,bs, lIpp ~ o", . 1
5. C'"""""'" """'~ """ ' frtlnktl oppOoooo ,t-opy. G o 00-0I><>d 1931; 'S/,,' 03
Nto J O .. f.od 1983; 89_ 100 30 R. mm. r, Mamo"" ,o" "'0'.', ood WOI
6_ C... k""", <>-.d Ro<Jne-r' F"~ .."..I""""" '""""". C. phol omolr'" ch"ogo, o'>o<i",d ,"'0 """_
Am J Q .. f.od 1983; 89108 FfI'!r>ltl .."..1 '0"". , ond I,od " o-pl;anc. . Am J Ootl..!
7, 1'0", o , ~ F.. , koi , E!I.e, or f,loo k. 1 "" ~ ...... ., 19M,361372
ho''''''n' o! maod ibul.. ,,',,~o, . Am J O,'hOO J I . Rob<""", ' T""" ",.", chango, in """ ,,., It......
1989; 33.)-,4 1 '"., f""",oo ",""",,,,, of fi-~~ . Am J Orlnod 19!Q;
a, f,-On'" """ ~001 , A ",<>indo,,..,, J CMId 1981; 299_3 10
43-1.436 12. $0,*,WooJ.;Oo, Boo",,", c;..",a, Powoil, V~
9, """"'10 """ I<o,~ , Moo-~~ "'''P'''''' '" ""'''''''', aod """ : ,~" +"""iaoo l oppt;o".,.
..."..,.,"" ,,,,,,,,"",,,. /o,m J 0.-;,00 19 71; 478 ~9O on .. ..- mu,do OC'I,...,. Am J 0trI>0J 1990; 212 230
10 1"11"""" ood n-.u.r, M<lKIo oct"'" I.", """
<L-;,-,g
or oct"",,, _ , ..."'.Am j O"ho<J 1\'9 1, 36 1-308
33_ hoi< Z"; '; "- Fi..a_Ro< ,."obIo _
a" Ortho<J 1.99', "" , 2'6 - ~48
,~1

11, La.,- '/I, '101-;". ' Corron! Ho<o.t ~. ~, J 3 ....., G. Cl.d.;,-,g... ~~ ..,;<o B;op"",, _ _
0 , onr.;.J 1994; 216_309 ~""'" J Clio 0nI\00 1 ~89; 606-617
12_ l ..doc, , ,,*,,I ,..oliIo """",,,' ,oIo1cd " '"" poI- 35_ Vak." and Si""k. i, T,,,,,,," ,,, .ff..,,, of Ho"",
,.,,,. 01 oct""", oHoa. ,.." j Orthod 1982; 390 0"",""", . Am J o.tt..d 1989: d 13B_I 47
""'~ ood Karo-old . """"'toe
"'
13. Mom<>-.d""..-.J Alloo "",,,j;l,';,,, ' . """' '"
ort, odoot" "..,,,,,,,,,,,,;th ''''
Si"""",, op p~''''''' ,
36,

3/,
Oothod wa~; 2'2 2~ 1
000"-" ". "'" 1

Wi"l" d" I",,,,,,i .. '" atmoo' ,.' 0,. Cia " I

Am J Q-tx.d 1990, I 13 120
1._ Mon; H. C""""" O O>k:o I Aid , Mot"".....
""*"'~, . -;.. '" Oeadg<.or Ko<t>.t oppI-. ..
"",~ .,.; ,odd.mt i _,AmJo.ti-.od 1964; 1 13
fa""., J 0 , Orthod 1984 ; 265285
15, !J.<NQ"""O 0,," H_ F"""' .....
fo-"" lol

'0Il""'' '
[fR-JI
38,' W;'-,io, Oeo- to' g."rm , ffoo' of ' ro olmOO' ,.;,o,
hoadg. "'_ .... b!I .."..I;""",, " oooly ,,-;,.0 0..... """
o! f ..... ~ . "-,,, J O+-.,d 1985; 4()9_ ~2' Am J Oothod 1193; 3 19_329
16, M,NQmoco 000 H"~. Th. h6"' ~ oPOlio ",o 39, W;.-,Jm;IIo, ~ 'a loo'iD' of a ",-I;"_. plin! tfo,b..
IfR.2. /o,m J Q-tx.d 1981; 418_495 """",,nco, No J o.t.xI 1993; 73 84
17 ~o, 1k-oI,,,.n, 0"" ...
~ hnH", Skokm l ~ Wood',"" """"". and ","no , W"""o 01 """.
ood d.... 01 <"""Il"' follo,,;,~ f"KI>"", 1
1ho.gP" ,.." J o.ftod 1985; ~ I
"Q'"''''' "",0 1 opp l; anco ' h.'oP I 0' ~ 1' OQ id iO"G
romodoI ' ",. "'" J Q .. hod 1981; IS' , I 98
IS MoNam,,",, H""., and ()W; ~ , Camp..i<oo1 01
Ko<h ~ and fcookol.."..l ioo<.Ol, /o,m J 0rlI-><:>d 1990;
13-1 .1"
19 M;,hoI MIoric : Tedriqve ai, ,,: Th . """lotmod
Hh" AppIOo""". J Oin CMhod 1995; 173_173
20_ Nol,,,", , Ho"""" , an d H" bi,,,,, , Mood ib"ior
oi>o"QO' ... "~ f"""""""' l .."..I""", ' '"'I'mo'''' Am
J o.t-.od l993; 153_161
2 1. _0, To""",, and ""udo _ ~. ~ f""" "'-
"""" l.,. ad;"'",, ~ ,.." J C>-1had 1994; 169_179
22_ 0.-.,., : 1o.\c<phobJ ~ ~ . , ,, '~ d ___
-,,,,,, .. ,,,, f"...,..i .."..Iia """_ Am J Orthod 1983,
200_217
23 0.-: _phoIagi<; a...-- in tho """"" 4>nen-
""" -... ,ho "",,*.1~"I<O. Am lo-t-.o<J 1981 ;

I
n ortMdontic prodice, force, em ployed o,e
basica ll y of two types, One i. on orthodontic
Ion;o thot rna_ teeth efficientf,- and the othe r
on orthopo edic force toot offect. the deepe r
cronic.fa cio l "'ru ctures , Orthodontic /o,ce. a re
tho that are oppH..d to tr.., teeth by m<Kln, of
wire. or><! other rxtive <;QI11O"l on" of 0 rernovobl "
",fixed oppi iooce . Th e force. ptOduced by th . ..
app li ance. m. li ght and " mg . jrom 50 100
g rom. _The orthopaedic forces"" the other horxi
ore lleoV)' force. of o_er 400 grom. thot brir>g
about 0 change in the >keleta l ti "",,.
BASIS FOR ORTHOPAEDIC APPLIANCES
Force. applied to If", tM!h hme the potentiol to
'od ioj~outword. orod offoct the n""rby , ' . Iota l
, trvdure' . For sueh , ke leto l chor>g e. to occu r,
the force, employed ,hould be ove r 400 gram .
Thvs th e orth0 p""d iC0r>P1ion ce, utili le the teeth
o. hondle. to lro n, mit the force. to the adio'''''!
Appliances
, ke leta l strudu re" In ord er to produ,e s'e leta l
chor>ges, can. ideration shook] 00 given to the
o mo unt of bee a ppHed ond the dvrof<>n of be~_
Am o wnt of fo r ce
Heavy Ior-ce. of o ver 400 gram. totolly enpre"
Ihe pe riodonto l li gome nt 00 the pre"" ,,, side
ond co w.. h\'<llin i, otion wh ich prevent. Ioot~
movem ent . Th "," heovy force. ore oor>d ucted to
In" ,koleto l . trvctur to prod uce en ortn0f>Oedic
"'"
Dura tion of force
Interm iHMt force. rong ing from 12_14 hours 0
oov are b<! lie.ed k> bring obout min imum tooth
move""",t 001 maximum ,le1e\c1 chong~, Th us
mo.t e<tra-ora l orthopoed ic appliarlCe. ore worn
12_14 hOUr:! 0 day. Increo... in th ~ durati o n 01
weor re.ul!> in an inc",o.e in the dcn\cl cfloo .
H,e commonly .... eeI orthopceelk applic nce. 0 "'
heod gwr, foce mask and chin cup.
HEA.D GEAR

H~cd 9ee" Cr~ th e mo.t co m""", ly u. ed extro -

oro l otthopaed<: oppklnw., They ore",..,..j duriN;l
the growth period to intercept or correLl certain
skeleta l O1 a locd ", ion. ". well a , ' o di1!o li ze . he
rnaxill o"" de ntition or maxilla itse lf , Heod (IOOrs
olso form One of the i01partMt oo jund. to contro l
or ga in ar,d,orage. They der",e aochora[1O from
tho ce rvkol or the cronkll rogio<lS
The r.ead 900r - foce OOw m .." mbl y ho.
The jun ction i. the rigid jOint of in""r
th"", me in compo"" nt.,
or>d w te r bow. It Can be .impl~ .0kJcmd , wire
1, Face OOW
wropped ,olde red or a we lded joint . ,It is placed
2, The force el ement
at th e midli ne 0; the bow" Wr..n asymmetric
3 T"" hoo d cop orc"",ico l . trop
~~; are needed, t"" jo int Con be .hilted from

Fa ce bow the midli ne.

Th e face OOW i. a metoll ie oompo<1ent thot help.
in trorum ittin g the e<lro -oro l fore'" on to the
po.t~ ri o r teeih, The foce bow con,;,;t, of outer
bow, inne r bow and the jundion (fig 1)
The outor bow ;' made of 1.5 mm , tiff
ro-und wire and is co ntoured to fit arou nd the
Ioell. The outer bow can be ' 0001, medium or
lorog.
Short _ Oute r bow is leMe r in len9th too n inr>er
bow.
Med ium _ Outer oow length ;' equa l to
bow.
Long . Oute r bow i, long"," thon inroe' bow.
T"" di, tol ern:! of the wte r bow i. ClINed
to form 0 hook tho l gi'e, atrachmentto the Ion:e
element.
n", iro"'Je( bow" mode of I ,25 mm round
ste inle .. ,tee l ..ire ond contou red mound the
dental arch arn:! molars, Th. ;,-....,,- bow;, inserted
into the bvcOl I tube, fixed on the maxilla"" first
molars . Stop< a re placed on the inner bow me,.;01
to the mo lar tube. to ~>r.w. nt the inn er bow from
"id in9 toa for thro-ugh the tuoo.,
The torce e lemen t
It i, that po rt 01the ossc mbly which prmkJes the
force to bri f19 aoout the desired effect. Thi; mO l
oomprise of .pring . , el o:.!b0"" other stretchable
materia ls. Tha fOfce element conn ed. the lace
bow ta the heo d cop or rwx k ' trop.
TIr.. Iraad cap or c .. rvlcal strap
The opplianoe Io ke. anohoroge from the ' igid
bone. af the ,L..II orfrom the bock a f the neck by
in "",
meon, of 0 heod ca p or ne ck ' trap or 0
combin otion of te., two . The se l~ dian of thi.
depe nd, Upo<1 the ind ividua l potient need,.
P, lnclple. In the use of helld li!ears
Heed g""" he, ,, the ob ility to rllOve the dMtition
and the rnaxi llo in a ll the three plo r\ft' of space.
The followin g Iodors mou ld be considered "," on
planning the"", 01 hoo d goors
C",da, 01 ,esi,tortce of the denti tion
The....,,,, bow of ..... 1oce bow" generolf,- alb::hed
to the mex illo')' first perrna nent. malo " through
 A B
C This is Iocoted bel ",!he
bo.omIl lUbes"" ........ teeth. Thus Ihe~oding
on the moI"rs lends 10 di<p/0c8 them. Adecision
shovld be mode w towhorther bodilV"'OVomenl
or lippirIQ 01 1M leeth is ''''1,,;,0<1. T~ ce n!re 01
....... tonce for " mo "" is ,,"uolf)' 01 the midrool
reg ion. Force. appl ied th,ough the ce ntre of
"""tane<! of the molOf> re", lts in the ir Oodi fr
mo-.ement (~II 2J.1I the force i. applied below
!he antr. of ,....!once. it cou,," 0 diSlQ1 crown
fipp;ng while ~ Kis obovethe ce~ 01 resi$IQnce
~ cau .... d,Of<)I rQOllil'Ping.
Cenl,.. 01 resiSlo:mce 01 maxilla: lhe cenl",
cI "" iof<lnce 01 the "" " il k> " . " wn.oie . hould
0100 be CQ(I~de red when po, nnng lor f>eod gee ,",
It ~ beleiV$d to "'; 01 ot If>" posl~ p&r1 o r a5Pl!'d
f ig 2 RoIo' ,," '" h . 0'."'" ,oJ ,he """"
<J ...""""_ 01 t . """fo 'l' .,.oL-\4,I/ I"" 01
10."""""og ~ +0 """ .... 01 "' ... ,,_
00""" o.od II' '" ,_, e! to nolo. (8: L.;"o
_=-
0/ """" ~ _ _ tho ____ - d _ _
01 to _ _ _ .idol """!W"II (Q L...,
0110-<. po";og _ ........... ,,;
01 . . . . 0&0. ~ d"",' eft,..,. _ ' "
01 I ygomO liCO'M <ilkl'Y . utu,. (fig 4). Und<'l r
cl inical cor>d iti "". the ~entr" of r~" <!'O n ce of tr.e
den!ol o(,h 01" ... ~e .ho<.Jld be CO<1lideted.
""""or the p..".,...,l"",
Fora """"nglhrough Ihe cent ... d ..... wnte
oflhe mOlClllo pnxIute lro",lcfion oIlhe mwJllo
in 0 diwl d"Klion while Ior<:es posoing obove
or bekY,.,o Ihi, poin! co"'" ,oto!>o n oI th, rna. lllo.
Th e ~oint 01 O'i g in of the lo'ce , Hee d
gea rs deriV(l orochO<Q ge from the =i pi~ 1 region
oI !l.e cr<:r>ium Ihe CONica l '<>;l ion (bad< oIlhe
nedcJ. O:<:lplaf head gears p:.::/uc.. 0 superior
ond dislaf /oft:e on the teeth ond moxillo, while
c.eticol heod geors pnxIuce on inlerioronddistol
lore .. on the toeth ond mo. illo . Thus on
oppropriOle point 01 origin (or site 01 onchotogeJ
,),ould b. seleclOd i:>::od on who! type oIlOO1h
oM mo.il lary ~ ment WO\JId be bene/ieiol for
o gi, "" pollenT.
 f ig 3 n. I ., ~ t" ood
o",)ulo' oo 01 tho 0 ","
bow <c." offoct'" ,.,.
c1 fo", . A, S, .... C
""" ..,,'" "'")ing long""
and on ; "oti"'" of tho
0" .. bow. !OJ! 0 11 tho
""" d ...." ,.,oo...c. 0
rO(<.O f><t pO'_
...... 01
" 'O" ~ " th . nt" of
""'' ' ' '-'< of !he ""'" ......
-"'

Point of of tach men I 01 force The point of 1)pe5 of head lears

oHochm. n! rders to the flook presenton the di.tot Base<! on the site of onchor<>ge, head ge<l" con
....d of th e ooler bow to wt,;cn the force element is be olth re~ type. :
ottoched. It is possible to olte r th e direction of tf><,
I. Cervica l h""d g"""
foro, to the mo.illo 0'"'the maxillary dentition by 2. Occipikll f>eod gea rs
c lte<<->g the po"! of ottochment. This C<ln be done 3. Comb<notioo head 9"ar<
by ""rying the length of too outer bow,"" by ""eying
the angie between the inn or cnd outer bow (fig 3, Cer.ico l head gears These head gears
6, 7) . obtain oncflorog o from the nape 01 th e neck (fig
5.0). C"",icol hea d 9""" CO"<o e.xtrvo io n of the
moxillory mok", lea ding to on ;ox.-..o.., in lhe
Iow.dacial heig ht, They 01,0 mOve the maxi llary
de ntition and th ~ maxillo in a dista l diredioo,
These head geOr1 are g enera lly in di::ated in low
mandibular angle CO",,,, a. an ;"crea,e in lower
fadol ~eig~t would be benefiCial in '''''h potient"
I! i. im portant I<> con.ider lhe relation 01
the lin e of forcoto t~ . centre of re, istance of the
mmdllc and the upper denl<> l arc~ , If the li ne of
fi.g c...... 01 ",""'nc. of he ""'~., onO tho ...,'"
loo:~ PO" '" t~h Ihe ce ntre 01 re, i. Ian ce o f
0"'
 -
;.

A
Oedp;lol head gears These head gear<
denye Or'ICOOrn ~ from the bock of the hood [Iig
S_bl _ Th il type of heod gea r produce. (I di",,1
and wperiorly directed lort:. on the moxillory ",elh
and the mo, ;II",
(omb inotion head gears In th is type of
heod gea r, ""opilol and ,,,,,,>col onchoroge are
combined {Iig 5.cl, 'Nhen the force. exerted by
boll, are eqoo l, (I d;.to l and ' li ght upward force
i. e, erted 00 th e maxi li ar)' dentit ion or><! the
""" ili a . By vorring If", proportion! of the I0I01
force deri.. ed from the hood cap and the ne<: k
.trop, tho "" ulto nt Ioree direction o:m be a ltered.

Uses of hea d gellf$

B Orlhopo<ldiC elleCl " Forc'" oP?li ed onto tn"

F~ 5 (.'l C.....1o:01 heod goo. (8) O<d"", 1'-d ~ rrKlxil lo can_be u.ed to re>trlc! its downward ond
IC) Com"cd,,, h.od ~, forword growth. The disto l force in such 0 co,,"
.<I>ovId be opp ' od tlv-ough 1M centre of resislonc:e
the maxill o, r>O rotati on of the max ill o occurs of the moxil lo. It MS bee n 'IJgse,ted tho! Io<-ces
However ....n en th e li ne of force p"'se. be low lhe in the ron l}<' of 350450 gms on eoch ' ide lor 0
(Mtre of ",,;<tonce of the moxillo "" om expe<:f minimum of 12 1 ~ hrs/doy ore requ ired _
(I dockwi," roration of th e """ ili o. Simil ar Orthopo.,dK; effed> from e:>ct",_om llorres are best
(l>n<iderotions apply to the dentol arch . topped in the p,e-oooiescent yeors.
i

A B
fi l 6 ~n 0110<'" _0(-",10 (t"T of "',.-'''''' ~. """ """" I 0000 ow' "'. "'''.W Tho ''''' 01100;' po"" bolow '"
",'" 01 ",~.1O"><. of 0,,10 tho mo,;b 0'" rh. ",,-jt "" T" , prod"" .. 01"' ..... ""'"'''' 01 "",0 to "'0,:110 ooJ +..
' .... '''0 , ':Ili T'>e h. of I""", f<" '" """,,.~ t . " 0"" 01 "" C"" 01 .... """h a"od coo .. 100- 01 t.. don"ilon, Th.
prod..:., ,Oxfw'" m''''''' 0' """ ; .. ond ."doc;""';" ",-.. "," 0' tho <1..-.10","

Anchorage augm entatjon E, jra-o rol force\
or. used to rei nfO<'<;~ anc horage wf\en tho se
obta ined from intra-orol """'<:c,
ore in,uliici ol'l !
The h""d 9"<>'" sho uld be wern for approximatcf,-
10 hrs/day iot thi' purpose and force 'o lu", of
300 gm';~ de a re usud l, !.Ufiicierlt. In til . m"",lI o,
aOCMfOJe ",,,,<..KemenTj> och'""ed bot restricting
,f" me~a l mov~n'Ie<\t of molar<,
Distalim/ion of mola,. Di. tol mov o," "" ' of
upper mola" ma, "", req uired for correction of
molar relation or to goin 'P" ce for correction of
crowd ing or retrodion of ante,"""" E.lra-ofo l
force. cen effectivefy be uI. d fer Ih;; pu rpose
when w<Yn f<Ya minimum of 14 h" pcrday_
Un il otero l distolizoti on of molorS ca n be
ochiev. d u-li r>g "'trn_o rol force by 'aryi r-.g too
length of tho ooter bow_ The Iorgerrn. i. applied
on th e side of the long~r 001'1_ Alymmetric head
gears used for the obove purposo ore Gcr-.era ll l
c. rvice l or comb inatio n typ" .
MoJor rototion In ord . r to dero1Cte 0 moJor,
th . mola r hes to be oonded with the bucca l tube
ploccd dis ta l I)" on d th 6n subseque nt ll
,eposf;oood. Cor,..;lion ~ ocnieved by ad just"",nt
of In" inner bow , 0 thot it prod""". 0 rctotiono l
forco on tho moJ ar, A> soo n a. the cornxtion io
ochkwed , the face bow ,hoold be rooo ju,tod to
opplya direct distol force,
$p<lo~ moinrenarx;e, A mml .HeO;' e metf.od
of mo intoinin g arch length i, by tM vse of extra -
0",1force,_ Th e mesio l movome nt of molar> i,
pre,,,,,led an d tM face oow doe, not interiere
with "ruptin g toeIh, In thi, . itvation, do;\Y woo r of
oppro,imately 8 hrs i ulfiden' ,
 _.-,-
A
<_
F'IIl ~ ......... _ . , <40'100' 01 ....... _ ..... ~
_
o! ....,",. <i bdIt",. """11o ... d ..... dor,;>ioo, IH f06..oc .. dc<; ....... """''''' 01 bco" "'" ,.,.". and ,to
... , 181 " . I',. 01 1",,;. "",_ bote.. '" c...... of ,..",.,<>co "' ......
"""'e.. c!oclc" .. ,"'''''''' 01 """,I., ""d o"l"doci<W..
Head geo<'1 0f1I gen.. roll , .....d forme purpose of
flI;nlorcement of onchoroge or for moxillary
distol"o';on . However, when on onl.r ;o.
proTlOCfOO, fore, i, ""Iuir..d, <> protroction head
geor ;. .......d. Fodol rna'" Ihe<opy has ~ined
""Plllarl!)' in the kaT decode. The priO'l(ipie Ii
pv lli ng Io,ee on In" mo,ili ory "","" wre. with
re.; iproco l pu.h i n~ force on th e fo rer.eo d Or
"",.,.j ,b/e t!1,ough !cool anchorage I, ~mp4e aOO
mechanlcallv sound enough to be vsed OS "
lheropeulic proced..oe lor- _ e n t cI ptOgnathic
syndrome., moxlilary ,.. 'ruslonl, clells ond
mordibvlar progOO!hi>m.
Hidchom 11972) doim, he ..011110 firs!
10 C'MO rGYCrM hood 11""''- ~r. tt, ,,modc lil'\'
wo o mode ~u lar by Delai," around In.. scme
ti me.
"-"<1_".,... ' -.W 1~. ' .... 01 ","" po .... bo _ +.
~,.110 ond , ...... hi 01 t . ....-Ko<>. I~.
/0',.." .; .... """';",
A r rn pul l hea d g"'" bOl ico l' ,
c<:<'tI .... of" rigid OlIIrooml frn~ .... icIo takat
onchotoge from tile chin 0< fo",heod Of bor~ fo,
Ihe anlerior rroction of the mc.<illa U'ling ""n;I.
arc! elaslicwl'lidl ~ Ia<geamo.,..,.dlan:e
upta 1kg or more.
1, It con be u d ;n a g ro wing pot;""t """"II
a
pragnotff" mOl'o::MN . and a r~tru~ve mo.<illo,
It aid. in pulling tno ma,illa"" .trucrurfl
farw(l(d and pushing the mandibulo(
struclura bod:warcl.
2. "oon be uted lor bending the candylo(neck
lor .~muloting temporo mondibuLor joint
odoplotions to ~terior di<pLocement 01 the
chin,
3, It con ot,o be \JSed for ..led"", roo,yoroge""""'t
of the palata l shelve. in deft DOtien!.
4, It con be u. ed in co". erion of po,t_. urgicol
r. lops. ofte r o<teotom ie. lor uo"Kontroi led
po. Hurg icol "OO pt" ti"n.)
5 It cOn be u d to treot c. rioi n occessc ry
problem. a ssodated with "".., morpho logy
such o. lote rol deviotion . ,
Sites of a/lchoraga
Mchoroge lorthe pou""",. <i moxillery retrection
con be obtoin ed Irom loreheod , ch in or Irom
foreheod &chin,
Ancho ro ge Irom ch in In th is typ e 01
prctroction heed geor which i. common ly used
in Britoin, ch in cup with PO"" oro emp loyed , A:;
the andwroge i. cbtoin ed roIely from th e chin ,
the focce i, tron;m iiied to the condylar cartilege
000 tr.. re by hos 0 di; odvontoge cf oltering the
growth of th e rnoOO ible ,
Anchorage from skul! Ce rtoin lo rm , 01
reveroe pull heed gee'" obtoi n o",horog ' on l,
from th e foreheod. Th . disod-<ontoge. ind ude
potiont di scomfort whil e sleepi ng, coS! and timo
requ ired in Iob ri cation ond fixin g,
Anchoroge from ch in & forehMd Th is
Ioce rno .k make; use of onchoroge from both
the fore heed """ ch in. Arx:r.oroge ~ . pceod ClVeK"
a lerger orea . Thu. no exce.. ive force ;, exe rted
on to th e Qrowth corti lo g e . How eyor, the
disodvantoge. with this opplio ",~ ore diffICult;' in
speech ""d comprom ise in ",,;thek. o nd c:omlor'l
du o to it. ";,e,
Blome chan/cal con51d e retlon5
!'moonl 01 force, The omount <i force req ui red
to bring cbout . keleto l changes i. aboot 1 jX>Imd
lor450 g m.) perside
Diredion of force, Mo.t outh o" recom mend
a 1520" downword pull to th e ",du",1plo "" to
produce 0 poure Iorword tron. lolo!y motion 01 the
"",xi lle , II the li roe <i foree ~ poro lJeIto the ocdu...t
plene, "lorw<Jrd tr<l nslotion os well o. on upward
rotation tok pi",,",
DurOlion of force , The ti"", to'en to ",hi ...
des ired re.ul ts i. prcportiona l to the omount of
force utilized , lowlo"e. 1250 gmJ.id ej toke 13
month. to prod uce desired re.ults, However. ve"l
high fo rce yo lu e. like 16003 000 grns reduced
tfootment time to 4 . 21 day. ,
rre-que o"Y 01 use , Mo.t outhOf' recommeM
1214 hou"oIweorodoy_
Partl of a reVerSe pull bead gear
Tr.. reverse pouI l heod geor CONJsts ofm. ~bwir>g
~.
Chin cup , Mo.t ptotrodion heed gw", obto in
OI"ICr.oroge from tr.. chin a. wel l o. tr.. loreh eod.
Th e ch in cup is u. ed to to ke ancho rage from the
enn Ofeel . It i. u.uolly conr>ected to !r.. re.t 01 the
fooo, mosk o.sembly by me<>tl. of meto l rods, The
chin cup con be reedy-mode Of Can be labrialted
from on impression ofth . potient's gen,,1 re~ ion.
rorehood cop , The lorehead suppor1 or cop
Or . trop i. u.ed to der;-..-e onehoroge from the
foreheod_
f lnstie, ' EIe . tie force i< ",ed to opp1y 0 forword
tra ction on the upper oreh . Vertica l posts of the
chin cup Ore u.ed to ortoch the e le.tics onto the
mole r tu be. or hooks .o ldered on th e orch ;o,;re,
Thi s so rt of trodion i. poufely for tooth movement,
InlrQ_Of,,1 appliance, The mc.t common type
of prdroc!ion devi ce i, 0 rnultibor>ded o pp l"",e
with rig id ;o,;re . Tr<l ction hooks ore ploccd e ith er
in the molar or pre molar region . McNamara
odvocote, 0 bonded R. M,E . olo ng with the
~tro ction deY-':e wh ich more or Ie .. re,emb les
th e booo ed He rb,t oppl i,,""" _
 f ............,
.1<:1"

- ;'
. )"

f;g 8 ~ CoN-ee l , ",," v-

III Comb;not;o, ..... 1 ..... _
(q Oc<.""'bI ..... 11"'" \OI!loIoO'
1000 _ , (1') 0'" """ _ hood
; .., (fl Me' pia.......... ....
~,o/ to. """ bow;, - .
1ht1... (G: lIo<>d_lIi'I F-.
....... '" ~:Sfot>do ... Ioce_
314 Orthodontia The Art ilnd Science:
Metal 1m",. : The mil'" cornpo ... 01 cl 0 wee
rrIOlk ouemblyi,1M """"llrome. hCQl'"t\e01 Ihe
""~Cl\J I C<>m pon<!<l" wen '" IN. chin cup ond
lo,e-h""" cop . II ,,1.0 hOi pro.:. lo n To rf:c~ i"e
~ lo sticJ from ,he introorn l op~;c, n ce. Tr.e de.ign
01 th e melal fro me dilfe" hosed on lf1e Iype '"
fog, ""' .....
r)"/MS 0' , . ... 's. ",dl " d . . .,
PrOllocrion head geor by Hidloo:rm
Developed in the eorly 60, . Inkl op~;c,nce V$eS
lhe c hin ond lop 01 tho hood lor ofIChoroll". The
forco dilTri but<>n i. m follows I S')6 heod. B5%
chin. It co n,i,t, ot tw<> . ho rt or"" in front o f th e
mouth to.-.ga~ m.",1Jo,.,. pfQlrocrion e\allic . It
01", hal 0 <:hin cup !rom wnich ong,nales two
long onn . The two long o.ms run porollol to the
lOWe, border 01 the "",ndible ond go ""nicolly
"p from the angle", mondible ond end behind
the eors. An eI",,~c "rop i. oltDChed k) 1M end 01
the long orms 10 encirde tr.e hoo d.
The odvantago. ci th e oppl io nce :o-.:ivde
r(tlcti .... fy ben ... ellhelic. and comlon Th an O!her..
fig 10 'ulOngoo- 01 iaoo moo!<
wdh II>e oplion 01 un~oIertll fo,ee opplioobil"".
Byoddin" 0 rvbber cvohion und.r """ o.m, foral
to.hot .;0. e<>n be a ltered .
Fcco mos!: 01 0.. 10;", . Thi . 1'101 popu lcri,ed
by Deloi ,. in the 60', cnd o lso ....... the chin and
f~ lot I'JWQIf(1ig 9) . Theappl"""""" mode
up cl a rigid ...;..., rromewo.l which il IqUO,w,
and kepi aWOl' I",m the Iooe, h hOI 0 forehead
cop ond 0 chin evp with 0 wire running In /,0t'lI
'" the mouth used /or ei(J$fiC oIIochmenl.
T"binge' model, Th i, i, 0 modified ty pe 01
De loire loco mo,'
It co",i", 01 c chin cup from
whic.h o .ig inote. two tod. th ot run in tl>e mid li n&
and i5 lixlpod 10 cvoid th~ interference of noM.
The superio< ends d!he "'" rods t.w.e 0 fa, eheod
cop !rom which cioslics cncilde !he head. In
oddrion, 0 ClOSS ba, ",,"',lOis In from cl the mc::o.rrh
""hidl con be UI<!,J to "n9"11e elo.fica. The
foreheod cop 000 cross ba, con be odjunecl by
..tidi"fj along rh ~ rod t ram . wo rle 10 I U,T I....
in d .... iduc l patient. [fig 10)
 Occipi tol p ~ 11 ch in cup Thi. type of chin
cvo d eriv~. onchoroge from th e occipital reg ion
of tr., head (fi ~ 6.01 . Thi. i. the mo.t com mon ly
u''''' type of ch in cup. II;' u..,d in Clo>$ III
mo locc l u~on. ossocioted with mi ld 10 mod erote
n"IOndibulor prognoth~m. They 0 '" ""'Y wcco" fu l
in patie nt. who co n boring their inci.or:! do,. to

f\!tilly~ of foe" mosk ; Tn i. i. 01.0 a mod ifi""

form of Delo ire foce mo,k {I.. I I]. It can';"" of a
chin cup and 0 loreneod cop with a .ing le rod
n.mning in the mid line from foreh..ad alp to chin
cup. Aero" bo r ottf>e lev.1of If>e mOOl h il u.ed A
to e ng"," e . Io,tie, . TM advontoge of th;, mode l
i. thot th~ Ioreheod cop, chin cup 000 th~ cro ..
bor can be odj",ted to ,u it the patient.

CHIN CUP

Th~ chin cup or Ih" ch in cop o. it;, .ometime.

ref. red to i. a n e<lro-ora l orthopaedic devke thot
co.ers th e ch in ond i. connected to 0 head g eor.
It i, used to re,trict th . fotword ond down""rd
growth of tM n"IOnd i bl ~. The ch in cup .foce bow
",,~ mbly con,i.t, of 0 ch in cup thot covers tho
chin.o head cop 000 o n od i",tabl . ~ Io.ti c .trop
thot co nnects lhe ch in cup with the h..ad cap.

Types of chin cups B

Ch in cup, 0'" of fwo type, . Th oy are the occipita l
pu ll chin cup and too vertica l pu ll chin cup.
f'~ I I N e'" '"" (B! V...~01 po' <,..,
O<';P'''''- pun
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 Planning
T
rentment pion il on outli"" of 011 Ike
mea, ure, thot can be best i n ,titu~ for a
pot;""!.,, os 10 of'e, mOXimUm, Ioog tefm
benefit>_
Potien! ..,e~ orthodontic treatment for 0
YO,;"tv of roo>o n" TM O<thooonti,t ,f.oo ld plcn
cut 0 treatm""t modo li!y bo , ed on thorou g h
exominotion """ rovr>d dio gr>O>i, in 0 ')'>'emolic
fo. hion . A, no ' imp le formula cook boo .
opproo ch e, i, ls, e""h co. e . hou ld be on eS'''''
cnd Q custom ized l reatmefl\ pion formu loted to
. uit the individu al pot;"",-
SETTING UP GOALS
From Q patient'. p:>nl ci Ioi ew, th e boo k need for
orthodontic tre<llm ont i. impro' omern i~ e. th" tics
o nd fun ctio n, Tho orthodontist, has an added
goo l in th e form of t,.-ol mM t stobili ty_ Th e
o rthodo nti.t ,\'\Q uid e im 01 pro'l id ing qua lity
treotmMt tho! wi~ remDin ,ci ativ.fr' intoctfc.r mony
yeo" to co me " b.r th e th . ro py -, GO Mp.,t. d .
~"" t pat ie nt. ore , ali d ied on ce th e
a nterio r "'eth Ore stre ighteMd . But it i. th e
respo n, ibi lity of the orth od o nti. t to .dvcote the
potiont on the impori<mce of mo.ing tc eth to
po. ition, toot stond for , tob ility. The orthodontist
,ho uld not . ucc umb to th e te mpta ti on of
termiootir.g the trc<l tment o. Soon 0< the anteri o r
leeth a re . tro ight. """ o. ,vch treotment inva r",hIy
re, ull. in unsto ble dentaf po';tio n, thot tend to
~ apse.
In ma ny ,0"'" oc;hie,;ng 011 the tf><""
goo l, i. . , ",thetie., fUrKti o n and . tabil ity moy
be qu ite d ifficult. The orth odontil t sho uld <trike 0
l>alon ce in fu lfilli ng the ma jo r esth etic de,ire. of
th e patient within the bo und. of keys that stand
fo r <lo bility.
ENLISTING TNE TR ~ TM ENT OBJECTIVES
Tf", orthodonti, t . hould . nli, t the probl . n" that
hove to be attended to in a decreosir'lg order of
prionl)'. Th . problem li,t he lp, in .etti r>g up
ooiectiye, and po .. ible solution, to th e problem .
Wh il e setti ng up th e obiectiyeS, the
potie nt' , chi.,.! compko int and po ronml d i""
shou ld be given ooeqV<l te we ightoge . Most
potie nts .eek treatm ent to improve .,th etic. or
function. li the orthodontist con~de r$ certo in other
obi . d ive. more importon!, foron ov.ro ll so lutierl
to tf", prob le m Or to achieve "ng term stabil ity,
the n adeqV<lte "'planotion ,hoo" be ~iven to
the potient.
Th e ortr.odonti,t mUlt be ",a li,tic in
,.,tIin g up ob j. d;"'., Th oy should reflect the
pat ie nt' . need., the doctor ' . own lev.1 of
co mpetence, pati. nt co o pe ra tion, etc., .
A.SSESSMENT OF GROWTH POTENTIAL
The g""""h .totu. 01 on ind iv idual i. on importMt
fOClor thot should be con.idered while pann ir>g
treotment.
A patie nt who is still growing pre.ents
the orti'OOontist with ru merau, apliom thot ""-j>Ioit!
the in dividual'. growrh pote ntial. The orthodontist
co n modu late growth of the dentofociol
. tructure . <:<In gui de teeth into more fa,auroble
pO ' ilion, ond con undertake therapeutic
p ro coduro. to pro,.nt and in tercept
malocdus io ns . In an od ult, the t,eat""",' opl"""
ore li mit ed to mo, ing teeth and .u rgica l
c~ i on
The growth ,totus of .... oovidua l snood
thu, be determined prior to treatment pkmn ing
' 0 a, to carry ou t appropria te tre a tment
proced ures.
ASSESS M ENT OF rnOLOGIC FACTORS
Th . eti o l o~ i c facto" reoponlib le for th.
malocc lu. ion .h ou ld b. do ter mi ned a ~d
adeq uate ste p' , hou ld be planned for their
eliminotion . Th e conti nu"", pre.e n,e a f th.e
etiologic f<,<:tors can cooslitute a "'vere li mitotior>
to the COO'I'edive proced ure, to be ur>dertoken ord
moy 01,0 predi.po.e to re lap,e of 0 t{eoted
mal oc du . ion. Compr.hensive orthodo~tic
tf",ropy should thu. involve reme",, 1of the cou\e.
Wnile this is pouible in ca,e. whe", the etiolow
i. obviOUS, it ""'Y not be possible if the co u... ..
. Iu;;v" or unkr'lOWn.
PLANNING THE FINAL INTERINC/SAL RE-
LATIONSHIP
Eltobl il hme nt of an ideal intori nciwl reiatiOll--
, hip i, one of tho prime obiedive, thot .r.:,."ld be
pkm""d .
Clan I Inclsar r eletlonshlp
In 0 potient pre,enting with 0 Cia" I "", Iocd.,.
,lon, th e inte ri rlCi.a l relation i. usua ll y soti.foe-
tory. Thu , provil ion shou ld be "",de in the treat
ment pkon to pre ..."'e the integ rity.of th i' relo_
liom hip (fig 1.0)
Clau II, dlvl51an 1 Incisor r elationship
In a polient pre'"r>tin g with 000$ II, divi."'" 2
mo locci u, ion, tho ... verity of the pre,enting sk. l-
etol dj.creponcy uwa lfy determ ine. the choice 01
treotment and mechanics. If the ... patient! pre ... nt
with a underlying 00" I skeletal pattern. tf",n
retnx lin ati on of the mo. illory inci."", moy be
.u/ident to produce a r.ormo l interinciso l ref<,
tioosnip (fi g l .b). In co of a mil d Oa.. ll . kol
e tol pattern , a ca mo uf log e tre atm e nt by
 A B c

,/I
~",...!:J
o E
''II 1 ~"'"~'"'II ,k. n.ol 1",.'~ncI ...1
7 .. b'Ic>t> W A. .. I ..."1"".... ....,....
,,",,,,OJ "" ", .. "", ,,00 151 MHo 0 ....
...,.00.., ""'I,,,,"'" rJ
~'Y .\ ,_lod b, ,,,,,,,,l0-00I100 """
uppoo' ' .........
!CI CIo" I
'. (o1s.-. CIon II _100!..,
>od ll , ",o.. m. o! of UPP" '''''''''"
~

.. ) .~ .. ''''V'''"' lEI Mid I.

dO. 2 ..,ood br ""_ """ _
a....
01
_.Wo!oI
"0I>0t lod .... (FJ a .... It 01;. 1 ......
<lao lo-.'wd br",ocf,' ..
.... "_ ............ 101_ byg ........
/ mod""""'" '" -vooY IGl a... II .....
a..-d J>Cf> 01 - . . '"""""'" ....100
0000"",_ <J 'PI><' """"'" (H) Moo.
....... c.... II ""'" - . ; " ptOGI .....""
01 uPr>O< '"' ''''' 0..0 ,._ 1.."..., rJ
io- ",,1It<\on,
G H
retrodinotion ex bod ily ling uol mmem . nt of the
ma'i llory indoors using iixed appi ionoe, mo'/ pro.
duce setisfectory res ults (fig 14 Th is rna y often
' eq uire .,troction of ,ome toeth to produoe
",ti,loeterey re,u lts. Seve r. Ck", II sk.ie!<l l pot.
terns olten requ ire growth mod ilko tio n (in the
growing) or . urgical treatment (in ca,e of non
grow ing odu lts Ifig 1.cI). Growth mod ificetion is
do.... by v:le ef myolundioo al app lior>ees slK.h
a. oeti,ator, b>or>ator, herb.\! oppiianoe, etc.,
Clan II, dM$lon 2 Incl.o elatlonshlp
In (1",\ II , dil'i.ioo 2 ce,e. thot pre,ent with a
Class Ior mild Closs II skek.ta l pattem, uprignting
the moxi lkJry inci. o" by oppi iootion of 0 paloto l
root torque rna, prodv<e the desired interinci",1
relotion (fi g l.e) Howeve r in Co '" of 0 un derly-
ing ,,,,,ere Oass ll ,ke letoi poffern, it may be ad
viwbJe to prod i.... tne moxi ll ary ir>eiw f5 to pro.
dv<~ 0 Clos< II, diyi<ie n 1 poffe"" fo ll owed by
~rowth mod iJkotion (f," 1.n. In 0"" 01 "",,g row
in g indr.-idua l, surgery may be required.
Cleu //I Ipclso "Iatlonahlp
Clo .. IIIpotienl'> who present with a 1000am poth
of dosuro u,,,,, lly preoont 0 oottc' prog""' .... In
the", potie nt" ,,,ferred to a, po" urol Of pseodo
Clo .. II I ,ek,tionoh ip, remoyo l of the occ lu ",1in
terfe rMce by proc lin otion of th e ",'''illory ioci-
oors woold oken prodvce 0 $Ot~loctory n-eri r>eiso l
r~ l ati en (fi g I .g). When the urlderfyir.g Cia .. III
pattorn i. "ory ,cve re , 0 , tob le interinciw l relo
tion ;, oflen ochei.ed by IYoo iootion 01 maxillary
incisors orid retrocli nation of the roor>d iook, r in
cison; Ifig 1.h). Howeve r noture l c"''' per,,,,tion,
thot might hO'ie occured (Le . retrodinotion c1
lower ir.c isors or>d procI ;ned upper incisors) roo,
offect the prog"",~ . I ~ very .evere (10 .. III c<l$e'
,urg ico l eo rrecti<ln may he"" to be conside roo .
PLANNING SPACE REQUIREMENTS
Mo.t malocc lu ~on. require spoe<! to moyo 'eeoh
ta more idea l pa~ lion, . 1M following ore """"
oIthe conditio", thot roqviro spoce for cmredion.
Corre ct ion of crowd ing Corr ft c t i o ~ of
crowded teeth r,;qu ir. , 'p<JCe . The ",\e of thumb
i$ that for every mm of crowding, a mm of a,ch
length (' poLe) i, ,~qu ired .
Rolotion" Rolotad anterior teeth occupy lesser
a rch length. Hence . poee i, re qui , ed for
derototi ng the, e teeth which io ca lcv loted bt
.ublrocti.-.g the di,tooce between the prox imal
ourfoce, of od jocent teeth fro", the 100a i mesi<>-
di<lo l width of the rototed teeth.
Le >'d iing th e ourve 01 Spe e On e of Ihe
common featu , e, assoc ia ted with ;ke letnj
moiocd u,ion io on increo.ed cu,,"e of Speo! . A
flot oreh occup ie, more ' paoe then one with on
e<ee"iv. cut'lle of Spee. Some pro.ision sl;oold
' hu . be roode in tl", t,eatrn Mt pion to pro'o'ide
'pooe for leyelling. Foilure to do 00 rew ll' in
procli r>ation thot i. unotobl e.
Correction 01 prodi nal ion Retraction 01
procli ned leeth require, 'pace. I ~ co," of .poced
dentition, tho e<i,tir.g opace, can be mOOe \ISe 01
to correct th e proc li notion. II the dentition i. not
,paced, then a lter""le ""'I" 01 ga ining spoce
.nouid be planned . For tN""! one mm ci r""'-'ctlan
in prod jootion two mm 01 space i, requ ired .
MoIO{ correction Pre"' n c~ of on un<tabl"
molar rc lotioo at th e end of treatment is a cou'"
of i",tobility. Th e molors . hou ld be moved to
ochi ...... a good i ~ ....cuspat;oo .
Spa ce for anchorage 10' " Mo5t to oth
movemen" are occomp l ~Md by e>ppi iar.ces tho!
"""hot on 10 CMe", ather teeth in the denlol orO>.
So me amount of movement of th e anchoc teeth
.hau ld be "'p"'oed. While tryi ng to retro et !ne
anterior teeth , the mo lo ... a l. o in. ariably move
fo rward to a cet1(lin extent. Tn i. 10" of . pace i,
coi led on<: horag e 10" . Sted ie, hove . hown that
in exlroction CO 'C'. a lmo,t 4(;i1;, of the . pace i,
Io.t by me. iol mOYl'Oment of the posterior aochor
~,h
T"" orthodonti!l ,rou",
' urn up the :;poee
'~ uired tocorrect!he mo locc lu.\Jon . Once th e
tom l .paw reqUire me nt i, known, th e diffe<e<>t
""en"", to aeq"re the needed "P"ee should the n
00 c<plored . Some of th e method, of ga inin g
space ind ed . :
0 U.e of e, i, ti"," ,pac ing
b. Proximo l, tripp ing
, Expansion
d. E:<traction
, Di, toli,ati on
I. Uprighting of mola ...
0 Demtatioo of pa!le<ior t""th
h Procli natio n of onteriors
(For more detail . on aequiri ..... spoee
refer to cMpter 2 1I
PLANNING EXTRACTIONS
Extroction of tooth M$ be<:ome on int"llra l pa ri of
romp,e"",,,;," ortho<:Jo<,!ie procedure . Teooth are
often extracted whenever the<e i, orch " ","thtooth
matena l discrepande. re,u lting in crowd ing Or
proclination. In add ition teeth are 01.0 extracted
to correct inte r_areh reio!ion' hip.
Whene .,.. ext roction< are planned in a
Clo," I . kelem l Or denlo l pattern, i! i, vito lly im-
portan! th at e>troctions a re done in both th e up -
per and the lower arehos sa os to mDinta in the
bvCCDI occlu",1relotionsh ip (fig 20 and bl.
In mo. t 00" II CO"" , the upper denta l
arch i, forword ly placed ort"" lower a rch placed
bad< . Th", by oxtrocti ..... only in the uppe r areh it
i. po" ib le to red uce the obnorma l upper
proc li netion 0"'" ako to disco urage the foewa,d
deve lopme nt of the up pe r orch. V/henever ex-
traction, 0 .... done on ly in the maxillary ore h. we
would h""e ot the . nd 01 th e treatme nt a 00$, II
~ar re latia n and 0 Ck", I conine rekltioo (fi g
2.c and d;,. In co,e of klw.,- mch crowd ing or
when the me'a" 0 .... not in full Closs II occ lu. ion ,
it moy be necessory to ",troct in both the up~r
o. well os!"" lower arc "", . I ~ the", patient>. 0
Clo\, I rrdor ond con in" rekltion $hou ld be
och ievcd at tho end of the treatm...,t (fi g 2.e
000 n
In Ang le'. Clo.. III, it i, beneficia l to
ovo id extroctioo in th e upp. r orch 0< it may re_
tord the forward deve lopm en" of tne mod 10_
Angle', 00'" III emes ore preferab:y treat.d by
extraction only in the lower orch or b, extroction
in both arc"",. In ca", on l, Iow.,- teeth Ore e, _
troctro, at th e cnd of !reo!m.,,-.! a Ckl" III molor
re!o tian and 0 CIo" I can ine re kltion i, och'.. ed
ffig 2.g Clr"J<J h). Ho_ if ",t rodion, a '"" pklnned
in both the uppe r 0< well o. the lowe r ore"";; we
r.houkJ have a Ckl" I mokl rand cani"" relatian
ot the end of the treatme nt (fi g 2 _i and D-
PLANNING ANCHORAGE
Ard,oroge considerotion form, an important part
of the treatm"nt plonni ..... e>.,..c i",. All efforts
should be token to minimile unwonted tooth
mo~eme<lt>_ foilu re 10 pion anchorage in"':;riably
rosu lh in fai lure of !reo!"""'t mechanics.
The an-:;homge demand !or anindivicixl
patient depends on tr.e fo llowing fador:! ,
Num ber of t~e th being moved, The gfco te r
tho numoor of teeth 00;"9 moved, Ihe greeter
woukJ be th e demand 0<1 anchorag e_
~
,-Y
'"'
,
V\)u ~
c

, F
 I ~
t
~Nh\r
~
l
Iv!
J\ 1\ I

G H

.A

.\ ~ r
1:.
l
I'-'
11\
J
'" 2 PIcno~ _ I" .... 1111 ... a... , _ " _ .... ".""" boo d"". in bot. .... up.,.. 0-.1 lowe,
"""-, 100"" (0) ,. 0C0U1l ....1oo:do_ ~ _<>->0 .. _ .,. ~ ,..... _0"",. _ """,d _ . 0000 ' '''...
. - one! 0 00 .. " "",lor """'''''' .. tho .... ol _ _ . IE)""'; (f)'" Cbo, II _<l.oi"", ~ .. ,,,,kA.0" """"
,. bot, ,ppeI and _."h<>,_ """',.. """'. Cleo. I ,or;"" <rid MO'., ..... "'... ""' ...... '" ,_ ....... , IGl ond Iii)'"
00 .. II ...... "'~-.. ,I Q.-Iy bNo, ...., . .. ,Ir<I<\od. _ """,kj ho", . CI... I "" , ' ,.10,,,,, G"" 0 a... II ...,ro,
""'<on '" tho ond " rr..,....,.,... (' ond~) In 0- III m<>Io<dvsr"", 'I ,,:1'001<><-, 0" <loroo ... bot> '-'PP'" ond 1-.. ..cl>o
.... mid _ 0 C"" I co";.,. ond "'..,...- 0..... ond 01 ,.... _ ...

Type of!gelh , Too'" """"""ftni j.....,tv;ng mvl~
rooted posIerioo greoler"stro" on 0. ochoooge
thon tooth n>Oement inYoI-.ing omoIle< 1HIh.
Typ~ 01 100,1> move m"n' : Tipp ing toolh
~I Q'" leu detn<n:ir>g on !he cnd>o<ooe
thon bodily loolh rTlO'< ome nll.
D~ ralio" of Tre atment : Comp lica ted
o<It.odontO: 1feO!Menlol ~ durotlon strain
"'" ",..,hew tee"', mulling in greoloor onchoro911
10..
Onar Iha 0.-.:110"'911 demand iI. known
~ .. J'O'sibJe; 10 Clo"~ the co ... 0. m,,, lmum,
modertlle 0' Mir'limym gr>d>o",ge d.monel cose.
In 00.0 01 mc.imum an chorag o demand,
odoequo~ reinforcemenTof If,." "o::norooe shou ld
be pla nn ed I.ee crooptcr 17).
SELECnON OF APPLIANCE
The noxt 'lop in tr90tment pI<>rlring i. the >election
of oppl"'nce, wh icn i$ t>o,ed on a num ber of
"""
Growth Po!eMial Graw ing pat ie nt. wha
~xfti b it $keleta l ma locdu. ion .hoo fd be tre<:)ted
with app l"'n::e. tha r mod ul ate the growth'" thot
the e.x i. ti.og oke letol problem i 01vOO or at lea. t
oot wor>er>ed ,
Type of 10011> mOVem e nt Remoab le
appl ;"' nce, can be ".ed in patients req uiring
. ir"Ple ti pp ing movemont. W~er bod1y tooth
movemen t, are requi red, fixed olThodantic
a pp li a<>ee, sho ul d M used. Patient< requ iring
cOrT1ol>::atedtoo" movem onts indud ing retat.,."
root move ment" a,ia l mo.-me nt' (intrlJO ian ar
extru,;anl are best trooted with fixed opp liorxe .
Oral Hyg ie rl ~ . Ma intena nce of good ora l
hyg iene i$ on e" enti a l po rt of orthodontic
treatment , However fi,ed appli ance, ploce an
odd itioroo l demand a. they po>e greate r (iok of
ca rie', deca !cificatian , plaque accumu la ti on,
etc.,.
Co,l, Removab le app liance. are by far Ie ..
e'pen.r.-e tOon fixed app l"'rxe. c . they take Ie ..
cha ir 'id~ time and u<e li mited mal~ ri o l to
fab ricato
PLANNING RETNTlON
It ~ 00"1 accepted that teeth once moved , terld to
go t>o d to their in itia l po,ition . The potent",1for
relapse i. in croosW by the pre,e""" of certoin
fa cta" wh ich ale li ,ted 0' f~low' ,
Stre tch ed periodanloi ligomen t The
. tretched gi rl gi",,1fi b r~' are a frequM t Cov.., of
(8Iop ... i ~ case of rotated t~ eth, , inee the.e ~b<e.
toke a long time to reo rgan ize around their " -
po, ition. Thus adcq uate rete ntia n far on
awopr",te period ,hould be plonned depending
on the type of malac:cl u,ion ,
Un'fable occiv, ian , Teelh plo<;ed in un,toble
pasition ot th~ Md of orthodo-ntic therapy terld 10
", k,ps<o.
Cantinuo tian of growth poHern
CQ<1t.....,tio n olthe ~h pottern thot Ms coLJSed
a skel eto l malac:clu.ian otter orthodonti c therapy
r. ",lt, in "," urfocing 01 the "", Iocc lu"on oft...
treatment.
Thu . rete nti on ,h ou ld be plann ed
keeping in mirld a ll th~ foctarslhot rnoy prediopose
to relop.e. In addition to the u.e of retai ners
,om e od i unctiv~ procedure mig ht hove to be
ca r1"i~d aut.o e, to a id in retention,
RE-VALUTION
Th e tre<ltment plan . hou ld be re.~a l uateJ ot
(egu lor interva l. during th e active pho ," of
treatment SO a. to confi,m whethe r th e objecti. ...
thot were set up 0'" being fulfilled , Chong'" might
hovo to be "",de in the tr""t""'nt plan il the
de'ired chang e, c re not tak ing place ar if
ur>fo", c n proble ms arise.
I, Grobe.- TM Ort!.h""" , Pri ~ or><! P"X'~"
we "'u""'~,I96S
2 Ho,,,,,,,WJB , 0"00 000'; ' Diag"".i" W'''l hl.
B....d, I982
3, P",fi" W' : Con""""""o" O~""'i<;l, It (OU" ,
ev Moot" 1 ~ 86
"'".., ~ ~ : Ho.-.d book. of Onh<k>nl<!, y""
book m.,;;", 1 pvbI ...... " , inc. 19M,
5, S.""w WC , Orlhodo ,ti< ..-J Oed",",ol mo",,~ .
m."t, Wri ~ O t, t993
6 Thomo. M Grober, W>ert l Vono ,>dcII , o.t-.odon.
,~. 0"'.... ",ooplo, "'" """"""., Mo.by .,,,,,
book h;; , 199'

of Some
Malocclusions
Gi."" in thi, chapter i, th .
m' ''' ''gement of "
number of co mmon ma lottlu.;o n. incl uding
mid li ne dic ste mo , ' l?Ocin gs, crowd ing and
rotati"" ofteeth .
MANACEIlfEHT OF M I DWWE DIASTEMA
Midline diostemo ",letS 10 on anterior midline
spacing be. ".., Ihe two ITKI><illcuy"""""" incisoB.
~ is"", d Ihe ....,., /requentlr_ rrolocdusio ...
!hal il conoid&t-ed emy tO!rool bu1 o/Ien dil!icu~
To retoin. The midline IpocinO con be " fcsuk 01
"""mbe,alea_s.
Cau.eI "f mlll'lIne d/.. ramll
TroMie M maloccluSio n: Mid li ne d io,tomo
con OCOJ< du e to " v<>rieIy 0 1 cau ...., k i, very
olI. n see n 01 on ir.;lpient n>:;Ilrxd",;on tI10t i.
seH COI'eCting. A midli"" spaCing con <><:oJ,os
o pall of !he ~Iited spoci"ll ..... n in !he dft-
ddu ou. o.. nti tior1 . n .. """"c;n9' seen in the de -
ciduo us dent iTi on i, norma l and helps In
o"omod oti n ~ the Iorge r shed pe r"", ,,,,,,' toeth .
A mid li r.) 5fXl~ing con occu r during m~ mj,od
denti"on pe(ood o..oci<lted with !he c<vpti"" 01
!he pem>anent<;an'nes i.e. the ug!yd",ktng sIogo
(fig I). IV. the developing permanent coni __
et\JpI, II>ey di,plcx:e the roots 01 th" lolerol incl.
to" me ..olly. This .... ull$ in Imnsrnitting 01 the
lo.ce on 10 the rools 01 tI.., ~I inciscn wNc.h
oh,o gel displaced ~iolly. A ","ullon' di.tal di-
ve~nce of the """""'. 01 the two <"",1'01 incilO"
wu"" 0 midline ' pOCing. T~" condition ulV
oily corre<;!s by i",,11wh en con i"". erupt end tt.e
prenure il Tron lferred lrom Th e root> to the <oro
no l ereo 01th e iOOOO<1 .
Tooth mO T~fiol . orc~ lengl~ di.cre poncy,
A di.pom,. in ..... ich the or<:h length exceed .n.
tOOIh II'IOterial can resu~in midline diastema. Thi.
A; 1 WI .... 01,.1 .... >I0\IO '" &. iClT"' ''' . ...
pOtlo "
", ;.I",
include. cenditi ens l uch ". mi .. ing teeth,
m;c,odcmtill, moc:"'Ilnothic cod exlrcc1icm with
"""uftcm d,ifrin\l 04 odiocenl leeth.
AbnOlmol lrenlll o,,,,chm..,,': The I>rMenct
01 0 thld< ond ~hy lobiol ",,",urn con \live n...
to 0 midline diOOleme. This kind 0I1nrn::r1 olllXh.
mem p,_nr, !he two cenlml ir-.:isors from op
pro.<i""9lil"lQ each e .... due to the ~b<ou. r:on--
nedi.ve ~s_ inl,",posed be,.,.".", them.
~15u" IIoblrJ: Hobit ud> liS thumb sud<-
ing, tongue IhNstir>g etc., olso p red~pose to mid-
Ii"" diaSlemo.These pation" [Jenero lly present
with ,.",.:rinotion er><! 9"nero li,ed c nter"" 'pOC'
iog.
MidJiI)l! pelhoJogy, Spocing in the midline CIIn
be comod bv ~ liuv. ond hord tissue poIholo-
gi .. ....:h o. cpls. lurrcrs crd odontornes. P...
~'_ '" ".~t '" ...upl"" "' ~""'. 18i .&. ([)) ~'""'~ 01 ....
er>g! den """"'J'led mesiOOens between tho rootI
04 !he Iw!I centrol neW. ,,~prdspose III mod
r"" doo...""o.
Iatrogenic: Midline dio.Ie"",. con OCC\H when
cen"", therapeutic: pt<><edu ..... ore undenolen.
The oppooronce 01 0 midline "",dog il on im
potto." p.ogn<Hric sign du,ing ropid rno:olUory
.,,;ponsion ond it indimle> the opening of lhe in
termO>iIIc<y ",ture (~g 3).
~aclol p.-edi5flo.irio~. Th" pre.., nce o f mid
line spccing e lso hos" ",cio l ar><! !emiliel bcl;k.
gro und. Th e Negro<d "'c~ showt the greetell
incid&nce el midli "" dia.tema .
A preper hi,III' 1 & clinicel e. ominotion il
'-'Dry 01 in onyolher molcr:clusion. Ablonch
,..1 il pet/or".."j 10 dioynose 0 IIahy lo!,;ol
 A

,
fig' !AI & (B! "".............., do."O 0"'<1; _ I ... I..... ,,......... _ ......... dow,.. , noI<!oO.a __
...... poooIopi<o\ ~.",..."" ((l & !OI M'd!".. d ..... ..., d"" I ....... '0 ' - 0 1 _ II) & (Fl"""""
d"" .. "", d .. '0 "..., _

. cpod madlor, _on.
"''\1 3 Md... d.,-.. __ ; po ..... "oJ.'90 .....
............ k isdot>e t.,. puling 1net.We< Ipool\<oofds.
Prew-ce d ,,!hock and ftlllhy frenum i, con/irmed
by Ifle bla nching 01 tne lis,,,,, in the ir><;ilrve
popJllo region palatal to the two Qlntml incisors.
Presence,of" ,ddi. lOin me m..oenlal ,,'->10,
bon e 01 ,u n 011 " ,,, clOgraph is 0110 diag nosti c
of a ....ck and Hoshy~. M <k.e. rodiogRlph$
"re " yoluobl .. aid in diagno,;n\! midline
PQthology1hat_wse~ , Tcoor. materiol..,rch
length di$crepOncies COn be determined using
model "ool)'lll.
n u tment of midlIn e d/ute"'e
The lreCllmen! of midr.... d;o.!omo i. done i"bee
~-
I. Rem"",r 01 Cou se
2. Acl;...o Ire<Itment
3. Rt.Iention
The fI'l! pho in."",os r'tImo""r 01 the
e/iob\lY. HobO!. ,hovld be climinated using liJood
"r ,emovobl" hob,t b,.ok.". Unerupted
nwiodonl tI>ovk! be e>;jroctf!d, Frer!edomy sho<.Od
be petfotmed to odie " thid: Rashf fnonym. Arrr
midline poIhoIogy should b& II'eOIld "" indicoled.
The second prose consis4 01 ~ treaTment.
~ ctM'I be dono u.. ng ren'lOY(lbj" OPpUO""", Ot
fixed oppl;,nces.
Removabl e app lianc el to treat
midline d.aslemo; Simpl.. remOY<lble oppli.
0"'''' incorporoting li"9'" ,pring. (fig.) or Q
, pJ it lab iol bow (fi g 5) Can be .-d 10 clo$<O a
...dI;"" spco:ing. Fingerspmg,: c;on be giYendisial
!o !h.!w() cen!rol incisors. Ar. c~emo!ive-...)IJ1d
be ta uM 0 spl it Iob<o l bow moo . of a O.7mm
hard sIoinless sIeeI wI!fI. The IobiaI bowsOtO """'"
10extMd up'" th~ diltal aspec! d th e cppooit~
Inlm'inc:ioor.
F...,d appl,once, to treat
midli ne dio$!emo: Fixed applianc~1 incor.
poroting .Ios~cs Of' "pong< brtng aoout the rr.<t
ropid co,redicn d mH;lline d"-"a . Elosria con
be . trelch ed betwee n th e twc centrol incisors in

r~ 6 T... tmont of m;oi,... ""',""'0 ,,1'1 (~td app l"". (."'1 Cio,od ,,.1 " ,I'i I!I Ek",,,, ICI EI."" , ",,10
(O! M .kapod """ ....
Otdet to close !he ~'" {Fig 6.b, cI. elomc thread
orelCJS1k: chain ron bot used between Ihe Jwo un-
"'" irc.iI.o,slor!he >orne purpo>e. An all,,,nofiw;
"lotlrelCh a cIosod wo1 spring (f,~ 6.a) be_
th. two '''''',01ioo sors . 'M' .hoped sprin gs ;".
' OfPO!"Oting th ," ~ i oe. lfi<;l6.d) Ca~ be Inse rted
i~to the two ce ntre l ;00<0' brodcets.Thi llfl 'in 9 i.
ad"oted by do",,\! th, .... Iices.
n.., third pho.., d h'eoImm i"""'- _inr.g
Ihe~ mob:xlu<ion. Mdinedioslsno isallen
C<ln$ide~ eo~ 10_ but difficvh 10 l'Otoin.n..
I:;ey lo is succeWvI.......,ge .....",,,!he elrninalion
rJ tl>e etiologic ladors i~. Most orrhodonfl!l$
'ecomm&nd k.ng term retenti on using wikl ble
r<!kl ine .... Since prolonged retenlion i. indicated,
B
o
~ is od.ioQbIe to use lingual bonded relOO'ler"J If"og
7.d) . The other relcine"lhatoon be used irr;ItJde
bonded teIolners, Ho..ley', ' elci"",", etc.,.
Role 01 ,osme,ic ,estorol;ooo; E.thetlc cam
posite resin. Or<! 1I"""""lIy U:led kl close mid lin e
d;o.<l..,."o espocia lfy in odu h poti en" . It ,equ;,.,
Qroduo l co mpo, ite ""ikJ up "" th e mesiol Sur
fa ce an d stripping d lhe distal ,u rfoce ll;g 8) 01
"""Iroh and "'.....,1. in om"r to ocni_ a natu
ml shope and site 0I111e teeth.
Pt.,.,he,;, I CfOWrl : P,esen<:e 01 peg shaped
lale,a ," a' '"'" ..;Ih orhe< onomollC1 01 shOll"
ond sil. l"MIVire ptCthetic: ......, bil~"'ian. Miss
ing teeth oho.J ld be reploced with fixed or~
able prolihe, i. (fog 91
 A

f ;" e C"",,,,,,.I< ",,"".,."'" of

a m ;d Hn. 0 ;0 . 10 "," IA)
CQmp<>. '" bu<lo up 00 tho
", " ;01 ".p."
of ,h. <""" a l
I, d,,,,. o od ,t, 'P P' "~ of 'h"
0;>'0 1 . v ~ O<: . IS) Comp",;"
""oId"p "' ... ...... 1 o<pOd of
thO Jat.o l ;..;""" onO "'W"Il
of tb. 0 ;"0 1 " d ace (e )
Com"",.". b, ild "P 0" tho
me"'l a,pod of ti>o , ""'-
SPACINO
The .. e . . ,.,e of , pacirtg belw<!en ," !I1 I. 0"" of
!11, commonly ..... n mon~ionJ 01 0 Ooss I
moloc;dusion. The PO """" ~ of spodng I. 0 nor
mal feoJvre in deciduous dentition ond is con
oiclertod 01 0 positive prognostic .ign. In the pe'.
manent r;lentition ~e 01 lpaclrtg ~n
the ,etIh is ebnerrnc l. The spo ce ca n bot in 0
loca lized oreo 0 ' ,he entire arch ce n emibit . pox-
ing .
The following 0,," ""me of the co ...... 01 spocing:
o. Gentroliled opoxing uwoIiy occurs OS 0 re-
sui! cl dioproporlion , * -n arch length oro:!
IocIh me'''''''I. 1'resef>C.\! 01 inc 'O<l sed orch
length or 0 red uctio n in tooIh maTeria l Ca n
" , ult in.pace between th e lee!h. Co ndi_
tlo-n . suen a. oli godontia cr>d miaodontio
.... eloo e lead to spoxing.
b. Spacing con occur os 0 nmoh 01 oherolion
in IOOIh morpl-dogy. AbnonnoilOOlh Iorm
such o. peg shoped la1erol! con predilp<e
to .pacing.
<. o.."'te ,,,,us om l hobi" ,ud> o. lhu mb w<: k.
I".. cnd tong ue ,h,usti ng con Co"" &pOe
ing in lhe o.rlt<lrior '''Il ion.
d. The poesenee of a n cbn C<TT>:l lfr- lorg e lOng ue,
a e<> nd iti on termed m e ,c~los. ia con pre .
di spose to ,poOr,\! .
e. PfUlenQI 01 u""",,oled ,,,,,,,,,numen;,,.,. teeth
uclhe,pathoiogy and qsliclesions ba_
the loe1h e<>n <;II"'" opaong.
L Pr..-.o1urel_oI pemKJneruteelnconcoult
opacing.
O/ t no' "
Th. ro<,I~n e ol1t.odcntic dioQr>:>Stic oids ,"""Id
be ""'pioyed /0, d iagnostic p<JrpoItS. Model
trdyJi. con yIIIId wNoble in\omw;m::)n obovr orch
lenglh-too!l1mo1ericl dilO'epOncy. I'.odiogrophic
"""minolion .hould bot corried out 10 d"ocgflOSe
bony poIhoiOOl' or """""pte<! teeth Ph:>t rrt01 COl""
spoxing.
Trea t men t
RemOV<lI of !he etiok>gy : Th . cous. lor troe
spocing .hould be aocgnooed ond cOequo1e SIepS
token to ellmlnole the ... me. In co ... 01 spxIng
OJ 0 result of obnonnol pressure hobits, hob"
b"",1:ers m . employed 10 intercept the hob~ .
In co ... 01 p,..enc. 01 bony ~y o' cyllic
~ ions. lh ey .r.culd be "'imino''''''.
Us. 01 re movab l. e nd fixed opp liance.
Mi", ,""""", bi & epplior>:;es in<;ofj>C<"Oting Ia biol
bows con be used 10 close 'poces thol ocCur il'>
(Onjuncrb'r wiIh prodinolion. f i>:ed appliorl(es
along wiIh eIovic chal .... 0/ .Iomc thread 0'" rnosl
eIiodi... In do", .. of ~e ... raliu:d spocing.
u.e of Crawn, o",J PTo,IIr",i, : SP<lcin~
thol oxo,o ... 0.0 .... vlt of mic:rodootio con be
tr.o~ uling su ileble CfOW ..... A (Ondilion lOOt it
qu iTOfreqvemly onoou nTerod involving /he mo.il
lo ry IOklfCl l inciso rl oro pog ohoped 0/ , mo ll !eeIh
with rel-U llent .pacing betwee<1 the res! ol/he teeth
d.,. 10 drilTing, In .uch co .... the .\pOco lor tr.e
loterol inelio' can be ~irred ", ing a,.,,,,,,,,
oble oppl'o:lnce ineo'porotir.g linget springs O.
IJ.ed opptronces "'corporoting Dr> open coil spring.
1lre.p<JCOI .ogolned ton be used 10. 0 prosth"'ic:
a"""" on the loterol ind.o .
A .Imilo. conditiorr i, the absencr. '"
leeth, ~h os "",. illory loten:Il inciso .... In ouch
co_ tho ....1of .ho teeth con 00 co<uoli<Ia!oed
IOgettoer ond 0 /i!Xlcolok in rhe lo!<! ml inO""
reg ion whi ch con be 'eplaced ~ a lixed or re
m ova~e pa rtio l prosthes iS.
CftOWOINO
Crcwd",ng Ii onorh., common ITIOn~esto!ion 01"
Cion I "",locd",;On. Crowding ",uolly oc"''''
os 0 resuh 01 disproportion belwee<r IooIh sin!
and arch length. A relom.. deoc:reo .. in arch
length or on increooe in \ooIh moleriol (On rewIr
In crowd,n~.
El lo lotr
Tho following Of0 some of the COU$CS of CtOWd
ing :
o.AI'" I ~rh . \ooIt, mate,;ol diocreporrdol due
10 decreased arch le ngth 0' on increa.e in tooth
mot. ,iol.
b,Prelo&nC' 01 supe rnumerory or extro leelh con
, ..,11 in 0 crowded orrangemer1t 01 teeTh .
c. P'olongod ",I.mion 01 dodduoll.l _h con
feSuh in ervp~on oI"'.i. suec"""",, in on obno<
molloamon. Th. pre""nce 01 an ove.reta,ned
deciduous tooth olong with ils permanent C.....,..
IerporI COn cou" aowding.
d. Abnormalili ... in ,1m ond shope 01 teeth con
IOGd to 0 ~ arch. Teoolh rhol oro ob_
molly Iorge con prod i""""" 10 crowding.
e. Premotvro foI.s 01 0 deciduous tooth irworiobly
rnultl in d'illing 01 oo jocent t""tn Into the e.
'poe".
tro<;tion An exam pl e of ivch a CO ndiTiM
is lhe oorly lou ol ...cord dedduovt mo io r1. In
1M.. co,." the lir>! permanent molo< dr~1s inlo
the emodlon $pOce. Thu, the <ocond ~moIor1
do not h""" ad""""", spoce to e,upt ond may
do 110 In on obno<mal po>mon predisposing 10
F;g II p" onO pwt'~me<"1 pho!O\;""*,, "" ",, __ 1 ..-', ,""""""v I'"",," ..-" 1;,.0 "'*'<><lorl~ "ppkn<:< W""'''Il
","<>if"" O! .... fo,.,, ;rsr """,,,,,"-. {AI ,;81,,00 Ie) p" ho''''ed ~<O"" (Oi '~ I coO '~ I poll .,.",.,,1 """""",."

crowd irtg. Tr eatmen t

D/egnos/s Gojnjng <poce Crowded t"eth requ ire spcce

fo r thoir normo l oli g nment. On on ove>ge for
Clini col e,om inotion , ho ul d be corri. d out to
ev-e ry 1 mm of crowd ing, an equal omount of
determine Ih " ~xtent ond loootion of crowd in g.
'f'O"" i, ~y i red for corroelion. Thu. lhe orneu"1
Mod el o,.., ll"i. con be of use in determining the
of crowd ing ~ I d be ceku lated ond the means
omoonl of orch !engl h . tooth motenal di.crcp-
of obto ining thi:l .poc~ sho uld be determined .
oncy. The po"ibi " COy," Iorthe crowding ,hooJ ld
Th e vo ri ou, meth od. 01 gaining .poce indlJde
0 1$0 be detnrnlir>ed ,
f ig 12 Pro 0"" v>!I'Y8CI_ ' ~pho oi 0 P""'"' "'.;,. <,ooodi ... " 10..0 wi" fOod o"oodomc oppI:onoo fo b.InIJ
,<lro""" 01 "'" .< f," ",,,,,,01;1<. ~' (I) "". ;'Cl ,,..,eo......... phoI~ (DI(E) 0<'Id If) f ...... .",.<r.tt pIo.:od ond
nHnoI ",_"..0 1<:< ,I i"""'" ol ~ ...... (Gl!Hl ."d j1) """ ......"*' ~pI>o

prooimol >hipping, "'po",lon, ..rrodion, mol,,,

disoorlZOhon. o.rolotion ond uprighting 01 pwte.-
rio. IMIh ond p-odinotion 01 omorion. n... in RoIOIionJ OrO tOOIh _me"" !hot occ .... orourd
dicotion lor eoch 01 these method. t'OI bHn di .. the" long IWIS. Two types 01 rolotien' oro pes.
CIJuec:I in o.loi l in o n ""rI~, chclptcr. ' ib\e ,
e. Me, ie. ling..., 1or di.lo bucco l raloticn
Use o f fd mo vab lc appli a nce, O nce th e
b. Oillo ling uo l or mesio bucca l rototion
p<O'loi.iot1 fO( $pO ce i. mode. teeth con be moved
MMo:io<" IeeIh Ihct ore roIcted OCCJP'I' less
10 normol non<rowd . d P05<liQnI by us<ng ",.
'P<I<;<I and f\1er~fo(~ (equiro oddi~onol >p<ICe for
mo'<QbIe appliances thaI incooJXl' A"" coa spMg:s.
!heirderotolioo. Po.terior IeeIh occuP'l' _lpIXfI
c;onine ,efrDdors.lobiol.",." etc.,.

Use 01 f"r>:M/ opplione" : F"ed appliances

con be used to treat aowdi"lll' fiood oppl,o"".,.
tf.o! mak. u>c 01 m<J~i looped orchwiret Or ",oil.
lent nide l - tiklniu m wires ore 'cry efk<:tive in
correction ef crowdiog.
""*" !hey are """""". Thu pooe "\JOined when
....-oIHthorederotorcd.
Trea tm ent
Spece mo nOQomcnl, Treatme nt of onle rior
tooth roiclion req uire. $pOee. Provi sion Ihoo ld
f ig 13 PO'e!""', ',oJ bi~1 ",.,,1Od """ Ibry I ~' """"""'""' ~! I
PI 9& _ 0;." of "",,;10 ..,. ," ,-ro! ;n.;;',,,,_
sea '0""'" cf ....".j ~ ..,. ,t"' ",,<Yod 1"""'' "'"" (0 ocd

~~ , ~ T"""",,,, of ,'''','''os
(AI Roo''"'.->;,o,
used "' )"OC' '01;)'", IB! Mild ,"1;)''''", ,a , ""
,,,,,,1Od by ""'" ... j"",
arch w'", 0"; onga~ "" to
""'" ..... ,"I;) 1>. t,-oc".. ,10> (0 Ekl"', !'<ood uoed
'0 d.>.-oo" ".-.",oIer. It I, a''acned to " . 1.-., ,,, 1
"""""".,.-t ond ~ 0''''''''" +. 1OC"In (Y'o(! l ed
10 ,h. arc"""' . (0) A ( ~v>J to ~OO! ,,"o'k-n by
'''''"'''''' oIa,,~ ,,,.ad. be*' ,,"cor, ..... I", ,,,,' ~_
f~ 15 ~ ~ .. ~.~od ... ......;. lot _ 1 oIot ...... _ . Tho, .... 1Iri"ll """"~ ...... It......
_ Ib 1Dr'II _.

t..nc. be "",do. in the fre(ltmen! p!em lor oblair>-
ing the .-eq ui....d space.
Use 01 rG mcvQbJe opplio ne'5 , Mil d fotO
tion.:an be """"ted !ISing a "!nO"<O~e awl;
Cf"Q!hot incarpORltMa dau~,.:anrd6ver spring
IZ spring) along with a labial bow.
Use 0/ /"'N oppliance. , Whenev.r mul
tipl. rcloticnl c1 lee1h ore preser>1. tile owl",nc:e
cI choice shcukJ be 0 r",ed appliance. Derolohon
oe n be don . by 0 number of W<J"fJ. Rotation
we~es ere Cl>"oi lable th ot co n be wedged be
'"-' "'earch.,;",....-.d .... toom~g 14.o).Mld
tOIO~O<1I_ eI!ediYelv """lOcI bt- u.. of ...... Iien!
orch wires .uch os nickel ~lQnium. Their ,uper
eJO$TkiTy 01"-' engoge".",m 0I1h, WI'" into the
Rel",,!ien 01 rclO!ion. : I! il uwclly &Cid thai
rote'iont ere ooly to treol. but diffi ou lt to r. toin.
They hc.e e ve ry hig h risk of ", Io pse du . to Ihe
. tretdling of me . uprco l""" lor end trcnseptcl
gingovo( ~b(lu which ,,,,, dapt .. ry dowIy 10 !he
newposirion. "JhuI;long ""'" ~n"required
to ochieYe IIObiliTy oI_menl. Perid~ orar
cu.merermal ...",,,,,,,,101 ~brobny i. on odIUnc:.
fi. e lUfQicol p,oced",e where !he glngfvol fibre.
Qre iroclsed IQ proven! "'lop ....
!. GooI>o< TM : ~ia, """"~ ..,,j I>fOdi<e.
we SO...... 1988
.. , o.~.~~~.... ();.voooi .. wn.,. .... - .
2.

3.
".,
_

P<Oi.tr W~ Con_tr 0rth0d0trII<0. St louo ..

tv Moobo.l P86.
broc:ktt "'01. This bring> obout ol,gn.....rn ond ' . Robon f ..."... , I"b>d booIr ... ~ _
boo!. _col ,M.I .......... i"", 1938-
derctot'c" c1 !f", IOoth ~'Il 14 .bl. Eloslic llvecd 5. ~ we , Otrho<lonloc <Y"<i 0.:00>01 _ __
ce n be used to rotale tile tooth o'ound il< long W,";<.1\>93
o.i,. Th ll)' Ore engaged 10 li"guo l olloc hmenl. 6 Ih:<no. M Q,obor. R""-" l l'Mo..dol l , O~~
tOa ,,,ront ~,oo;.lo. <>">oJ t.a. nqwr. Moob-, __
ond ore wrapped around the toolh in the dire<:. booIr I-c. 1\>9.
lion of "'. derc1<Jlion ond ~ed to ,he ald>.,;",
bu.:ally (Iig 144 A couple force '. 0100 effect;.e
in , _ 01" rototed 1OOIh. This II brought
oboul by UIO of ,,"'.,;,: !hr..oo. both bl>COlly ond
Ioroguolly 01 loo..n in fig 14.d.
In C<l'" 01Mcketl thot hCl>"' 0 .. " ""I
slct, derot01ioo ~. oah QWr1 in fig u'. I S CM
be u l~d fc ' domtcti<>n of the tooth .

N
Ord in g to Ang le', ,k", ifial!ion, Cit",
II mo locc lu. io n ind ica te . thot the
ondibulararch is in" di,tel relotion to
that of the max il la Ci"," II mol""c lu. ion i.
dlOrQC!eriIed bot" c",,, II rooIar relctionship where
/he dislo-bllCcol cusp of the "pope' lim pemmnent
molar occlude. in the bucca l groove of th e lower
li" t permon ent ffi-"o r (fig 1 & 2). It can occu r in
two moin form., Cia", II, division 1 a nd division
2. The onfy sim ilori!y thot both the,e form. exhibit
is the Closs II mola r reloti on.
CLASS II, DIVISION 1 MALOCCLUSION
Ck", II, div i. ion 1 molo.cc lu .ion i,,, cord i!k>n
exh ibiting em. II mok" "'''tion.h;p wi!/, pcoclined
m"';Ilory anterior teeth,
FEATURES
1, The polien! exh ibit>" CIo" II mola r relotion,
The mola r reiotion con VO"l from on e nd on
of Class II
molar!o one thot i. a fuli lledged Ckm II.
2 The cI"S$ico lleoture of " Ck", II, divi, ion 1
ma locc lu sion is the ~'enc" of prodined
maxi lla!)' anterio" with re.u llOnt increosed
overjet.
3. Tf>e potiMt exh ibits a convex profil e.
4. Due to prodined "we' ante""". the lower
ant.... ;., ' teeth foil to ma ke cont<Jd with the
po loto l.urfe>::e of tf>e upper ante,io" . Thu.
they are free to ervpl leading 10 on increose<:!
ovc,bite a nd cxcess ive cu rve of Spc<!.
S. The iX'tie nt may hove a sf-ort hypotonic upper
li p. In oddition the potient may ploce the
10_' lip ag ai nst tf,,; po lotal surface of the
uppe r incisors . Th i. i. ca ll ed lip Imp. Th ~
prese ,"", 01 0 ,hart upper lip 01on9 with lip
trap increases If,,; lend"nq for 1m. uwe'
anterior; 10 p,od ine.
6. Patients ok~n lock on onte,io, lip se<J1 due to
the short uppe' li p. Restoration 01 """"01 lip
s",, 1is e" entiol to mointoin the teeth in their
 Ai I A." II, <1;",,,,, I "",Ixd.oioo
:AI (Jj o'>d (q '0""""" "'0,,1and
.. ..00:01 ..... No...... " " " " _ 01
... ",0.11 ., _ ... 101 ow ....(
...... _ . , ... _-.,. ct . . <I'd!
d.. 10 _ _ 1:..0<6_ Cltlioo (f)
Up l'Op ood ~yp."a'~_ ..... ,al
ad"';" 0 .. l,pc.1 01 u...~,-'"
I .. olocd .. ",

corrected po>ifion. common fInding in Clou II, dl"i,lon 1

,. MOf! Clo.. II, divifion I "'fe' u h,bil
obnormol mu>(le ocli.;1y, The, uhibi!
obnormol buccinolo! oeli....,. Jeoding 10 0
co nWieted , narrOw upper arch wh ich
prad i,po,", to pOSler ior ero" bil o. A
h,po rOClive me nlo li s ocli . il, is anoth e r
malocclusion.
S. Clos. II, di.i.ion 1 molocclu.lo n con
~. boo DSIoCioIedwilh p<OCIl<I6d Ioww
antorOO. ni l is a ""Iura l co mponSOlion
tnat hos to ken ploce to red uce the o.eriel.
SKElETAL FEATUR fS
A Cia.. II malacdu.ion may be camplicoted by
1M presero::e of oboormal.l:elelol ",Ia!ionsl'lip d:
the mexill a and th e mand ible. The ob ne'''''' '
skele!()ll. ol\Jre, mOJ! oIten Iwnd ore Ilig 2) :
I . Mo. ala.., prot"" ......
2. Mond;bulm rerrvsian
J . Ma...11a<y pmlnIsian and mordb..oIQf flItrusion
ETIOLOGY
Class II malocclusian con OCCUr due to a ."riery
aI OOUW!l. Broodl, the efimagic fadoo con btl
dOlSit.ed as :
1. Preno lc llc C\Of1
2. Naralfa<lo<s
J . fbstnotaiIodOD
",ecIUI '.ct a ..
Heredilc f}' : The , i:e, ~ ition c nd ,eloti e n, hip
d:~ ~ CrO10 e 1a'O!' .-:Ionj d. """'ined i)y rhe
genel. Thu. (1"" II malacdusian . ohib;!ing
.keletal anamalies .uc;h a. a pmgnarhl( molliia
or 0 teifi)~nothic mondible can be due te
hered itary catJ.e.
Terologer>e.sio : Admlnlst.ation of ce<tain d'uG'
during p~nonc, Can rHull in pe,...rted or
abo.",."..,1 d_lopmenl. The dl1Jgs thor ore
copable aI.uch en oiled are wiled terorogeo'''.
Inooiotion : Expasu.e 01 a preynont womon 10
rodio~on iso~CQYMl of al~ red """""pmen!
01the ()entofa oo l complex.
!nlro ute rine lelol pOllur. One of th o
le<;tOD thaI ..... ms 10 plo, a rol. in molding the
croniofaci<rl ~ion i. Ih. intraufe.in. I.rol
post"'"" Ahoormal pollute lVch as hand. ocrou
tM foce i, fou nd 10 affect mond ib\Jla r growth .
NIUI ' . ctors
Trauma COn >om<!llim.. be induced by impraper
~ps opplimfian dunng d"';.",..y. Thl. rewlt.
in trau me to th e cond ylcr reg ion. Th e
temperom ondi bular jOint in . uch CoSOI con get
onk,lo d Or fib,ol.d leadinG ta under .
de.ttlapmentol the man~ble.
"ottn.t., ' .ctor.
The'. c re 0 nu mb . r of <o ndilion. Ih<l t ca n
infl...ence lhe normal doe-o-Iopm...,1 allhe denio
10001 romplex. The following 0 SOITI$ 01 them:
o. 1.aumalic inlury to the mandible and
te mperoma od ibula r iaint.
b. Long te .m i.rodialion th . ",PV of lhe . k. l. to l
cronicfacial reg"",.
c. Imec~ous cond~ionI wdr a. rheomotcid
arthritis con influence moodibulor G.owfl,.
 ._....
...."". ........I
I
_.ISt . ...

_.. - I

_.-
0' l OW<:!
n o:<oIlarJ
~,.""

d. Alln o'mol fvrcion , uch 01 ora l re,p<ro~o~ . 0. Red udion of """'iet

obno",,,;11 ~wQllowing and hobo" <uch os b. RMucrion of ~
....... b....:kO'lg pr8Yem normal rn..osde actMty. c. Corrac;tiotla o;mv.ding cn:IlocoI ~larilies
n...... poIlenl. oove 0 low 10"11"" posilion d. eo.fec~on 01 unoloble molD, relotionohip
lea d ing to un res tra ined oCT i . i !~ 01 th e e. C,,""rediorl of pool erior t.on bileS if err)'
bUCCin ator group of mu .d",. !, No ' mo li.i"9 the muscu loture

TREArMIIIIr OBJECTIVES TREATMENT OF SKELETAL ClASS "

MAlOCCUISlON
In CIo .. II, dlvitlOo 1 mo kxd",lan, the moior
!roo.tn>ent ob jecTive. oro to r. li o, ,, crowding and basic <>pp rooche& 10 the Ifeotmom
There 0"" Ih,,,,,
irreg ul"r;1y o f tne leelh ond to establis h otob le of 001, 11 , division 1 ma l ocd~lion, Th. y cr. ,
indoot-ond moIa. Nlolionship. The fdl."...;..,g 0'., 1. Growth modiNCOIion
the"eol,,-, objecliYes : \ 2. Comouflo~
 "'' ' ',..."oJ"
f 'G 3 VIl .... (5i Sl.oIoI, 1 0", II ...~ '0 "',.,.j ....I>.
o.,.j (0) \1010"01 Cl<>u II no. to """, 'be,,' ""rO\I"O'~""
"<''''''' t_tod "'". ~''''''~ F'O'W by
" 1"" 00 """ iE) orld IF,
f 6
(Xf _ .
0;
oPf>! .... " (0
1",",,1 c ... , II O~
to ... ,.,.jW:J. " .ogn<l t ~"" tr<,1Od '.... Joopeo- I ~'

J. SU'9,eol Wffediot1 fundionol ond orthodop<ledi~ opplia~ to

GroWl/! I'IOd/f/".lfon
Clou II, division 1 "",Ioulu.ions 0'"
oh .. "
complicOled bym~ p=er-.:e cl undert,ng sl:.elelol
obno'mo li';el , Mool o~.n ",,,,,il ,,'Y progn<>mi:sm
"" mond ,bc ll)(def"",,,CI' exc u', l hcloll obnOl"mol
5l~"to l pol':tlml Co n be in!<ore.pled by mea ,,. of.
reau<e me seve,..., of me
.keletol ",Io~on,hlp"
The ... IrtIOlmenl procedu,"" 0 ... ",uoUy con'ed
ov1 during me mi>O!'d "" eorly peomonent denMion
period pno. to me cessolOon 01 growth.
An ImOrtOnl p,e'fequ;' ile fo' !h~ ..
growth modili co,;on proce<J ure, is 10 IXcu ,ole ll
d"'gno,. th e und er lying "e leto l diSCf~po nC'f'
Anol}'111 of lot~,al c~phalagroml can help
e.",blioh 11,.. >kdelol "",1~""on"'lp.
CO"",'; on of man d ;bluio, deficien cy
Clo sl lilnoio<:c l"" ion compl icolOd by "", nd i"" l",
deficlon<;y or r.. tro ~""th i.m il Ireoted during tr..
mlrcCKI d.nt iti"" pe<iod bp". of myolul'>dio",,1
oopl;.,,,c,", lueh as ocfivelO' (fill 3 . c.b) or
ivlldio",,1 ragulo'Or. In case the po~enl is crt the
end of the glowth period. /u,d luntllonal
owlion"" I,le Herbst appllanar (fig 3 . c.ell or
lalfl"r Jumper {fig :3 e,l) i. indicated.
Correclle n of madlc ry progno,hi.m; C le "
II melocc lulion ""h i.c iting "",.<il lory P'OII""this m
con be inten:e pled by Ille lIS. 01 luce bow with
heod(leOl 10 ,,,,,ria furthe, "",. illory g,""""",.
In some pa~enb, Cion II molocdOJiion
is campfi(.ated by the presence of both moxilkrry
prag"",h,,," c. _II o. mondibulor defi(.iency.
In such patien" an awlionar ","eh a. ocrivo>or
w;lhheadg"'" is u..,d to rellti<:l maxill ory growth
orod pro!TIol<> ma nd ibul ar growth .
C. moull.to
In polienl. who are b~voM oro"",,", it i. not
pouible 10 underlo ko lI'owlh modification
pro<:edure. . Thu. me und .. rly,ng .kel"tol
dis~nC'f' COn be comauflaged by artnodantic
!Oem II"IO'<ement. This is often done byerdfOCnon
of ,.""in teem on d mo>"i og th o ' 01' of th" leeln
in lOthe spoce creo led .
Wi,h "xIre ction of teeth i' is po" ib!e to
obtain co'rect malo, orn:l inciser relolionship
de.p~. th .. fact tnot !he underlying sk.. letal
diK"ponr:y is not addressed. Tnu. tho concept
'mplie. ,hat majar . kele:ol chong.. atll not
po... bl, o/oer me c<>sooNon oIl1roo-m ond ,hat
the orthadonti.t achieve. tne best po"ible
oxo;l!,r~"" uncler the lI "" n li mlrot~ns of tne skele>1
i<l .... relo!ion . The reJX>$ioion ir>g of tne te<lth is likely
1. Pdttlt IQc old fa" s.x::=s1Ji grow1\ 1I'IQdiI~lktI
~~~
_......
2. Wd~rnr;otra! ..i'' 'let"'aa.. RfnlDxI.ioo
3. A' idy .... iIlrgrodteeCtl .o...Hh..mo
loOn IPD iiMilolble b _flIra kif
" GlOd...-.c.lfalal ~wihllliNroeep
1:*",_\1:10
to "" va0 fO>'O<J robi e elie<:t on tfre !Qcio l.,th , tics
of Ih" ind r';dual.
.spoce requirement in the upper orcJ, is
...... ntrolly 10 reduce the OYeIjel. O'I.rb~e ond to
corre<;l_1ocaI inegukrriliesal-n. Eocrtodion
in me lo_r arch mOl' be "",enory 10 carred
unstable molor ... krtian, cone""," 01 crowding,
~ brt.. a nd mi nor.locol i""'" uJa ri ti....
Tho k>cth thotore me!! freq uently e..-oocd
OrG th e first prij~ o " . In , o.e ot 0 wel l olig ned
lowe, o'cn with a Class II mOta, ,"lotion with
... cellent inrcr-CUIj>QNon, ~ is ponible to reduao
the ooe~t1 0"Id obtain stcble ,,,"uh$ by ..,roering
firsl premolars on.ly in Ihe upp .. r on:h (Frg 5). In
case .poaris~in thel~on:h 100;0"110
unliable end ()fI molar <dotion 0< " ' - crowdi "'it ,
rotations or ..ee" i"" p,od inolio n, both vpper
c nd 101"&1' first pre m% r, orc to be extra cted.
In minim um or>ehOlO\le co .... whor" the
spoce requrrement i. not much. th .. ncorn:l
prr>rn<>lars o;on be e:droCled 10 .,,>courag" ,,-iel
mo.-emenl 01 th .. buccal >egmrmt.
0tth0cI0ntic: alll.,1kII!e may also be dar-.
in IIO<TI. potientl by di",,1 d'i .. n9 01 me mo,;llory
molars. This is dane in mild Oossll malocdu~on
ptiO' to enJptlon of the """ond maIors.
f;g p" 0 .... poo'.''''''''''' "''''cvo,''' of 0 pc"'" fO~' ma...d;Oub. " '1"!looh"" ~OO'ed "'-.... Ho m" ,ppI "" oo
.:>.: P",,'oo"' ,'I' 'M"," " ph, rei ~~, cI .... oppI &<:. ;, '"" """," KI Po"_',oo","'" PM","'o""

i
J
,I

~
I
Yo;'
- r
' If
(I

!I
," I-
"
H" ,
!~
,,}"
II
L
~I
q

'~

Pi
 S" ,. I"., cltro. cliltll
In poHenll nhibitinll 'e_ere I kelolol
.,..,h",roonoh ip, .urge<)' ""'~ be the k/ecllrecl"er1
rnodcl lity. Sos.ed an lh . vrxle<!ying ,\010101po~
a rno:JJory tel b:>d oro mond i""Io, od-.-oncemon'
i, undonahn afto,-I!.. campl.Han 01 growl!..
Ca"'"I/OA 0' d u p 11111 .nd c roUlllte
CIa.. II malocclulion can be OSSOClOfed wilh
oMorio' deep b~e. Thi, can be ,eoled in I!.e
lollowing WOY' :
o. U" of remo'ob le onl. ,ior bile plol"l(Jl 10
.noouroge , ,, ri ico l deve lop""n l of Ihe
pollorio< ~e-nlO"'~Of segMe<1ts.
b. By USlflg fixed oppUcn:... 10 In!rude me upper
ond I_onteriot"s.
Crcosbite:s are a CJ:>i ,.,.,., Jeo".." 01 00..
n, d".icwo 1 malocdusion. TheyOCC\.O" os a resu~
oil!., foIlowinglodOB :
o. Abno'm(ll bvccinc!ior muscl. OCl"~1 due 10
Iow,red jaw ond long "" potlu" con co u,'
conllrklion of the mo<ilkHY arches.
b. If 11;, mand ible i. brou ghl forwo rd by ulO of
, functional oppl,o",... lhe bl'OOcHI' tegmen!
01 rh, mandible is made 10 ocdvd, with !he
iUtDWOf "",,,,,,to!ol the ono:oo"lo", ~ \eod"" 9
10 a po .. ,"", c",.,b;IoI .
C,o..b .. ". or. _0><1 U''"9 opplionc ...
ir.:O'porol in g Icrew. or ,prir.g' that pond lhe
mO' ill ol")' e,ch.
Tho co "",lion of d""P bile and cro"bile
no," been di.eu..ed in de!e il in me fo ll ow in g
ch:oplet1i.
CLASS If. OIVISION 2 M AlOCCtUSION
The Ciou II. divilicro 2 moIocd"'ion if " concilion
CM'OC1e<"i,"" I:rt a Orm II molar relation"'ip ...irh
r.I,oc li ned upper c""lta l. thol orc ove rlapped by
the klla"<l l inci"", (fi g 61. Vo,,,tion' of !he d011ico1
)"pe indc.o. ...,oclin! ce nlro's o. well 01 ioto-rol
inci<Col end "C<)' roreIv ind...doe relrod ined ccrines
o.we ll.
Retrocl:~olo" 01 upper ir.;:iootJ I, 0 Ciou
II, d"i"on 2 malocclu1ion is u.",11y 0 natural
dento-<:olveoia, cOhlpe"... lio" Ioro Closs II lke1'lOl
pO'fern in order 10 deCRlO>e!l-e ov.jet.
fea turu af CI... II. O I~15 ' an :I
Mild io,,,,, 01 Clo " II, divi,io:"\ 2 ma locclul ion
,.,oy be perfeClly acceptabl e wih r&go ,d to
Iu <"I<lion (1$ well 0' fodo l opp"oronce. In s.eve ..
~o ...., tire bl"e II often .... '" deep and poses lIle
risk of penodontal ""urno in Inc upce, pOlolol
and lowe, Iobial al pec:.. The IoIlowi"9 are /he
leotu ... 01 Clo.. lI. d"jojon 2 molocduslon :
o . ,Voolo" In dillo-ocdu.ion
b ~rodired cenlrolir.;:i"", at<! ",rely 01 athe,
ontoriors 01 we ll.
c Oeep over bile
d. 1'Ieo1inllltroigh , profilo
. Bnxld squore Ioc.
f. fkx;kword path 01 closure
g. Deep menlOlobiol sulcus
h. Aboenc:. 01 obnorrr.ol muscl" octMly
Th e treotmenl ob icCli.., 'nclud e :
0_ Relief of gingiva l troumo 6 fd IC, ","," , .Ioo"<loph , ood l<t;' , Ro q, .. 0' Cio<>
~ , D ~" I , Am j Ori>od 1995; 276 _285
b.
c.
Corroction of i ~c~o r rekltion.h ip
Reliel of crowd ir.g ond b col irreg ularit;".
~. G , o,, ~ ~, r-.~'" 0'" BoRa , C ,,"d~o ' po ....", a<>d
Cio" II doo ", ;", ,o_o, ..jot mokxd Jl" ", A" J
Ortrod 1989 ; 428 _432
d_ Correction of bvcooo l S<'Qmen ' rekltion.h ip S 0.obo, TM Ort..odo" ", , Pr- ~ , ; , ~ , oo->d p' , er ~.,
The rol . of extract"m in the troot"", nt aM
9,
WE '"""d..-" 198-9
Ho,,, h,o ,f Clo" II 01,;,10 " 2 mol""",,;on
corr. cti an of the buccol"' Qme~t re lotion. hip is "" "", ..oct."" . ..., j Or+-.od I 'i9(l ; 37' .3W
esse ntia ll y tha .ame o. wo. de.cribed for Ck", 10_ H;,,;' SU'll-,oI hoot"""" of C"" II, 0" """ 2
II, divi . ion 1 molocc lu.ion. The de" p ont" rior mokx<>",."", A", j Oohoo 1989 ; 185_1 91
11_ Ko" <>c,,; H"~ ( ,,,,,,,10.; .. ,ho"" " ri >l ~' of "' ..
overbite cnd retroc li naticn thot i, cl>a rocte ri . tic foCI- w," ,,,,-,,,,I "d poI,"",rrd "",to*'"'.
Am j
of divi. ion 2 m<l lexc lu ' iOo i\ tr. ot. d by ' 00h0<i 19 67 ; 207212
12 " ~ i>"'. 1, C,",~Ie, ;, 1.0"." 0... eo'''''''''''s:''' '
o. Rod",tion in inci.o l overbite and No,","o,,; o, io,g 101""n' of Cion II
b. Alteration of incisol i", li nation "", kx<Jo. 0o>, AOl j 0,,,..,. 1986 , 28 6_21'5

The deep over bite is reduced by use of

13 ~ Q' , """"Q',
>Iud" 01
'loft, 0"" G, __
(I,,, II, OM""" I treotmen1. Am
, bo , ~, C<!*,iometi~
j 0"000
aoterior b it~ pla ne or fi,ed app li a nc es 1992 ;276 280
I. P" d-.. " , Act~ - t, of;,. t,onpora l and m,,,",,
incorpo rotir.g cnchor bond. or reverse CUtvO of ~. ; o ( 10" II, 0""", 1 "",kx<"' '''''''' Am J
Spee . Th e incisor i", liM tion ofton ne<:M.itat.. OrtOOO 19a~ ; 619_68 B
15 Po,d-",,, _ ),'",>d . od;, ;1)' ;' CI", II , o;" ; ~oo 1
the u.e of torquing .p ring l to move tho uppe r
mol ""I us-i-o ... t "",t<;j Oy "'10 """ pi >g wit> m. Ko.b>I
inciso r rc-ots li ngu a lly ond th e crown. bucm ll y. Am j Ortk-d 19aO . 32 I _329
o ,, ~ an-:: .
16 Po",,,,,,, , S<oI .. , 1",d ..",., 1doaoge, cOn1'l b, -iog
Rol. of fUllctional appli. nces ., ("0" ~ (",~'k>n "
Ort..oo 1984 ; 125_13.
ott"""" hootmon'. Am J

17 /or-,"" No";", ""; ( ,,''''' , "'""re .... of 0"" ' ''to

During the mi""d dontition period , it is pon ib lo moIQ" I" , ;oo , ha ,g." Am j OrtMd 1995 ;
3S2 391
to proc li ne th o mo' ill ory inciso," th. reb y Ie PI.;ffc.- ,.,; G,o"",, , Comb ~," ""hopod~ . """,,"
conv e rti ng 0 Cia," II, divi s ion 2 into 0 da.,,, ~oaI mor1 . Am J Ortooo I 982 , 185-201
19. P,of" W~ ; Cc , tomporo..,- Qot-.;.J.o oia, St L""~.
mo locd ", ion that resemble, Ck", II , divi<ion 1. CVMc>t-"I98o.
Thi$ Con r,.., fo ll owed by the u$e of functi ona l ,0 R'Q<ln ond .svu,'" Co,OO<;I"o 01..--. ( I, ,, .
"" k=I",'oo. Am j C>1.00d )989; 192.199
app li ance. m described for O ms II, division 1
21_ " ""~ EMoyo~ , Hoo"" l<>oIo. of O"' od<.,. ~" y""
mobcdusion . boo~ "',"ee l pcbl""' ,,, 10<,1 9118
n R"" rt>a" , Tooatm.... oho ..... , ;0 " jdr"" '" aled
Refere nc es ~ , ;, (,nc1l00'. " gol ,,", of r",,01 _ Am j Ort"""
1983;299_310
2J Ru_ 0"; W. ' (0 " ",'''" of Ckl .. II , DM""" 2
I_ k.y~", N ",*,~odoo ~"'- m ont of '""''" Ck", II, makxd o, ion, ,I"oo " h ,ho USo of tho llio ,ot",
D~ ; ~ o, 2 ",olced,, ;o.,. . Am j Ortl>oo 1990 ; u"pl",.,,_~O"o " of t~ o '0"'. Am j Orthoj
5 1052 1 191'0. 106_11 2
2_ """."" Non"',,',,, ,.""".,. ... cf 0;" I, 0,';' 24 *~ , T.. , t_ t 0' ([""dod 0;" II mo kxd."""
"',' 1 m, ~",,_ Am j Ort..oo 1985 ; 38()'395 ,0,." j Orth d ) 99J , 298_303
3_ """. ," ""_,oct.on notmort of .. ,," 0;", I, 25 ~.." G<a o.., a'Jd M" ~ '" Pu~pI", ry ",>", 1 I,-.,.,I>oid
0 " ;0;0,2 mo le,d",o,,,_ Am j Ort, o; 199 1 !,'"'' I, au.. I ",xl Ckl" II ""ioa;!v, oo, . Am j
Ootlood 1982 , 299_309
4, OoI i;o"', - Vark"ia, In morpW"," , ,; """II a', 26 T''''''''.Yo 0.0",,'. ~oo. " LY,oa 'ldo'l , O "lJioo _
,, ""oi In"'o," fou"d ;, CI.n II, 0;, ;,;0' 2 r" ' '-<eO' ",-;"''''''
0',J ,"", .. , ,.0, ),'.o, b, \'OC ,
.,.",Ico;;"':",,,_hn j Orthod 1980 ; 'J.8 " ~3 l<>oIo. t-.t, I 9 94
5, o.""><h, >-9< "0 1, 000 1h ::'" , " "" , I" or oh"b:o- 27 W, .. , "q;' Co., i , O"i>ion 1 """"d ... oo . Am
moo' ;n (Ie" I, D ; ~, ; o o 2 mol o<o u,;o' Am j j 011"," 1994 42 S_433
O"hoo 1992 ; 50'1_5 I8

,oc;dLll.iOn!hat i. ~ .... "110 IdIl'l1!iIy
N bul is ofren diffi<u~ to!rea! is ,"" 00.. 111
Iocclulion. Th;, cond ilio n represenTI
"pra.normaq ",hen! It>e mandibje" in" mesial
1IIIoti0l11o the upper a.m. Aording toAngI" "
00,,111 mol". ,elotion"'p relet! to "cond,tion
",he", the mu<,, ooccol onp of th e upper firsT
~tJf oodvde. between the mO<'ld ioo lor li m and
second melon. Although lhilde~nilion ,ep,_
g Iypicol CIo", III ... lotion!.h,p,1ho """"'" molar
CO<1 be in " rnMiol ",lafurohip Ie" ""ryir>g do.grtle.
This kiM of mc l ocd u~on finds h" he,t indMnce
in Japan and I(oreo.
FEATURES OF CLASS 1/1 MAlOCCLUSION
The folio,.; ..... 0'. th e feoturO I of " C ion III
malocclusion :
o. The paliem h(Jf" <lou III molor r.,!alio",hip
Ilig I)
b. The ir><; ioorl may be in o n edge to edge
of Class III
c.
reloIio,w"p or on onl"';o, cro..bite Ir-OY
oa:vr. ~ i. not unconmon to ~"d" normol
Inc ilOl re lationsh ip
The ~pe<orch i,~,.,. """"'" and ,no~
..nile "'" lowe, ""'" is brood. n..... posIetio<
0'0J.!.b~e> 0",,, common ieoIvre of (I"" III
mc locd",ion. Th i. t..o.rq i, e.<ag""",ted
due TOthe IMf,,1sagitta l reloti ons.hip of th e
lowe, arch dvo to ....,ch Ihe broader part of
the mondibuJor ord> Opp<4ft$ the I\CI1"QW pan
of TM upper arch,
d. IT is Com mo n for Th e uppe r TeeTh to be
c~ os the a.do is ""flOW and sho<1
while. the mandibular arch if; ahen spaced.
e. The oot"nl hM a COrl'OV<' profile d"" Ta the
pre..,,,,,e of 0 promi ne nt chi n,
Vet1<coI g""""'r1 em ibi~ ng an irlCfOOSC<l inlet
mO<in",y Might may h..... on ontetiot open
bile . In $Orne DOTOenT> 0 deep <Mt<bite m<ry
occur.
g, A type of em, III mo locclusion referred To as
----------------- A----------------

B
 pseudo Cla n III molocdVlion il
"",,<><;tented bor tn . preSM<:e of occluIOI
prematuritieo; resulbng in 0 hobit",,1 ~rd
f TIOtOOr
pos;.\oning oh'" mandibl . These pot;onts
""'I .n ibit 0 forword potn of elosu r . 1",. Ocss III mo'oo:IV\lio<l !hot exh ibits u.-.derlying
si<elolol imoo ia "Ce i. usuo ll l inheoited , CIo S! III
SJ(ElETAt FEAJVRfS OF CLASS 11/ molacdUliono ore lOid 10 hovoe 0 '<eI'l' slrong
MAlOCClUSION g " netic 00';'" The QIh.r co ....... 01. pre-nc>rTT>OIcy
inc lud e "ob itua l forwa rd pO'itioni ng of the
0= III makxcl",ions 0<0 quite o~"" ouoOrned
mandblo We ta acd_1 promoturitie! Of '" .bgeo'
with underlying .... Iotol malrelationships. The
following ore 10"'" 01 Ill. commonly -.-. .>Ietal
odenoids.
!.:atu, (fig J),
DIAGNOSIS
c. A .hort Ot~ogno"'ic mad lo
b. A long 0, prognanth" mandiblo The diagnostic; procedure .hou ld help in
c A combinolion of me o~ determining the type 01 Closs III mokxdusicn i.e.
 A A A

Cla.s III malcx:clusion

I
, Growlog Pi titflt

,.

I
,I b, ~9
DertaI CIaS$ Ii

I
-""'.
i I
Skeletal Class IU

....-
r.I M~ r.Iand<b<i"
WI.gnd'.m pr~'~*'<l 1""",,-
",,,,larl

'f",.
I
~.,
I
F"".lMI~
IcIlow l~ b!" ct\irI "'~
;
,I
""'" "....
~~.

.
m.. ~. ~ ,
.....,~ .

--.,.
",,,,it.,
grO'oill
"'"
" .~
, ...-,.:;ii_
-,--
fo; ' Pe' '"ot w," .".,,; 100 ..,. d..k""", ,oct .. ..;;, b oo .,..,,\ W, I!I & -:<:) I'r" ... ..,. . .. ... """' ...... ~. IE) & if!
PI:> __ ........ rno.,..'apI-
 ,
F.. 5 N P"natmont ;>I""OIl"'''''' oi a paI;"'1 """"I """ lay '"''''IF'''t~<m 1"000"'" w,' loco mo>I. r~J Tho pal",,_,
_ri"\l tho appi"'''''"
t(! Tho 1, -"",,, 1 .p~t ..ii , ~I'E '" aid ;n mh ~
 fI<j 5 (01 P.. , o-nr.,- oh>"OQ'.""'.
denkll or ,keletol, !rue or p ... udo. The d,nical
....,mlnot;"" should indud.: oMervollon 01 path
of closur . In odditio n, .lud, mod.l. ond
radiographs should also be Io ken. A 100ero~
cepl-oolog rom ofrom ""I"obl. infornoo!ion On t~ e ,
slcele!ol nature of t"" mo locd usion,

TREATMENt

Cia.. ill mo","fusion .!.ould b. recognized and

_ed early due to the following reosons :
o. Reor;ognizing It,. molocdo osion 01 on eo~, age
mokes it possible to inlen:epl the obnormal
..ketolal ponern so 0' to redvce the 1eYerII, of
t""clcva lopi ng ma loccl usion ,
b. Th e Clo .. III ma locclusion cho roct&ri.ed b,
onteriOf cross!>t... allen ......, Its In r"rorded
mo";lla,,, g~ due kllocking ol!he ma:.illa
..;thln the mondibto.
,
c. The ol .. sol lore ... on the mandibular
Indsors exe<Io:d by the mo. illo", incisors in /"t"cepllon (I"./nll lI. owlh
c""ll;~e enco<>roge 1M (O"'inved fotwOn:I a .,.. III molO<:du';on "'ith on und"'!ring ....tolal
Ii.""""h of mandbl. Ivrt>er wo"",,,ing the pre mol.. '.,t.,nst-Ip requ' re eo rI,. t~ '" to In~p!
normolcy, the develop in g I k~l"rol molo" luSiM, Th e
~. !SO t ~>~r~
' -w~~~.

414 " Orthodontics - Thllt Art and Scilltncllt

following ore !-O rne of the growth mo-dulotion procedure., Oa.. III due to moxillor)' delic.ie nq
procodure. tho' con ~ corned out, i. treated by maxilicry o-dvm><:ement procedu res
o. Frenkel III, 0 myofur>diooa l opplic""o con sud> 0.10 Fort I ostectomy. 00.. 111mclocdu~ OfU
be uo.ed during growth to intercept 0 Ciou II I thot ar~ 0 ",. ult of mondibu lar P"Ollnoth i..-n o re
due to mo dlory skele!O l retrusion. t'ected by mand ibulof . et bock procedu res ,
b, Reverse octivator,
Treatment of pnudo Clan III
C, Ch in rup with high pull hood gear " u.ed to
int~ rce pt Clo " III molocclu.ion due to Pseudo Clo ," III mc locd u$ion th ot O-CC~rS o. 0
mandibu la r P"Ollr>Clthi..-n . re. uIt of oa:lusal prematurily im prove. on ",,,,,,,,,,I
d, Sever.. Ciou II ImabcduJ.ionI thot ore 0 resJ;t of the couse .
of maxi lla ry retru. ion cen be treeted by
r.ve" e heod gea r {or foce ma,k) 10 protrcd R. f. re nc es
the mcxillo (fi 9 4 & 5),
(",btl , Dil'"".. , 1 d ~ 0,," ''OC'_ '
pIon-
"'fig 01 ,,,,,, ~aI onI>odor< ~ 0 o" III "",Io<.<M'on,
Trestment of snterio, c,ou bite Am J O <thcdl~a l ; 42. _. 36
Mild onterioruobite. cen be trected u<lng lower 2 CO= ~ , ~_omI """"" 0.-.;1 C"'. III 'ceo""""
Am J Oot><:>d 1981 ; 638-650
<Jnteno.- irn:li ned pio ne, or rern<lvcoble appi ior><:e.
3, W, <>">i IkN""", ,,, : C~ "" 01 oo ~ t Ckl"
incorporo tinQ >crews des igne d for o nterior III ooo" _olto "",!oed,,, ,,,, Am J Orihoo 1984 ,
.'po","'" 277-'190
4, Grober TM , o,.OOdon'''' , P."" l p ~ , 0'" prn<tk.
Treetmen! of poste,'or c'ou bIte W8 So urdo..,19BS
5 loN I, Mo.llo, To:-..;h;, ond No'om,", , Maxflo')'
CIo,. III ma locc lu';c"", ore ofton """ompo nied ~ 0'" "" ", p OppiofICO " ~I Clo ..
by po,te rior Cross lHte , The posterior em,. bite II aloe, Am J Q.\hod 1967 ; 30-\ 312
6 N.,"' . mc, k"' ",,", No'o." o"d -';'", ' om , H. _
con be treated by ropid mexi llory oxpon. k>n
reo:iilOr/ 10<.", ,, <roniob:d mpholog,- of C" ..

Role of extractions
11 0'" C"" II "", bod", ..... _Am J om-.:.d 1961 ,
150_1 56
Clas, III ma loccu on chorccteli""d by lower orch 7 N<;w-.;., ond1.10<' 11 , CophoIom, " " 0" 0""""" of
><9' 01 ", UI<:NNp , Am J O<th-od 1994; 328 34 4
le ngth defic ie r>Cy ond onte rior ero,. bite can be 6 P",fIH WR, (",'om""",,,, o,.'m" "",, 51 'w"
treoted by extrocting tho lower first premolo r> CI Mo.I>,, 1986
fellowed by fixed mechc r'>Otheropy, CIo" III inter- 9, Re-bon E ~ , -.d book 01 O"k4oon1k:s, y""
book mod;toI ,rt.I 0h0 ", loe, 1988_
ma,i ll oty e lo , ti "" shovld ~ u.ed to retro ct th~ 10 n-.on-... M G ..boo-, Rot-! l Yo,,,,,dol , Orlh;.don-
10_ , anterior. (fig 6) . In case 01 ofch length .J ' "'" oc>".,' ori ""lpio, ond "<,, ~,, Mo,by >"
deficiency in voi "i"ll both the o,che., the lirst book It!c , 19\14
1 1 ToIIoro, _ I, 0'" fro ";'; , ~<rlr k.>"",ono l , _ _
premolors "lOU ld be extracted in both th e up~r
ond low..-arc:he. ,
"""" of ao.. II "...ocd..o;oo, Am J o..t.:.d 19\15 ;
525_532
12 0 ...... 000 fl",! 1 Eff o<" 01 f""l. r, f R_J _ Am J
Treatment of ,eve,e CIa .. 11/ O.thod 1994 ; 561_~67
Mta, g,owth
Se"e,. C ia " III moloeclu . ion ofte r growth
compietion, i. ttlXlted byourgico l ond correctiv~

M
aloc;d",ion con DC;tIIf in three planes
,,/.poce i.e. $<I9 illo l, t'''''''''''<e
and
in the _ ica l plon e. Open bite i,,,
malocdV$ion """ oce,,,,, in I/,e oemwl plane.
dIo~led by lod dvertiQol oYericJp belween
l~e mexillary and mandibull)l' demi!ion. Open
biTes COn occu' in the onl.ria' and Ihe "",slo ri o.
reg ion ornl "ro coiled anterior ~n bite end
POSlorio<open bil40 .... pedivefy.
The diogrosi., Ireoh'rlent, and succe$Slul
,.' e nlion 01 jrOl<lted o pt! n bite molocclu.icn
continue to be" c hollange 10 cl ini cia ns. Mony
poten~ol etiologic fucto .. a~ Implicated OS
couses 01 open bile including urr/a.on:,bIe ~
patlern., digil-Suding hoblt., tongue and
oroloc io l mUlc le activity, he red iTy, ofofa<:io l
lun<:~oool matrices, imbolontel belween jow
potlure, oed""" and eNp/iYe bus and hllOd
posiIion. A deloiled un.w.to nd,ng of ... etiology
and d. velopm enta l ponx . .. i. tflvt es...,'." in ill
m(a,., ge"""" .
of
ANTERJOR 01'" BItE
Ant",ior OJ"' n bilf: i." co ndition whe ro Thoxo is
no .. rtico l O'>"!!flop 1>0,,-> the upper and lower
onteriotl (F;g 1). Anleri", open bit are
~ty U"""ItI~ particularly during speoch
when the tong ue i ..-essed belweon tM tcel\1 on:!
l i ~,
Oossificotioo, of a"l$'Ior<>pen bite
"""'-riar apen bile ,an be dossil,ed ... :
a. sqlelOl a nteria, open bile
b. DenIOI "nt~rior-open bite ,.
El/olOlt 0' .",.rio, op." bit"
Tho etioIog, oj onterlor oponbite is ....,~ifOClorioI.
No sing le Ioct<x con C>C;CQO,j nt lor- most ope n b it~.,
Anteri", <>pen bite. ,on <)(:C,,. d"" 10 " YOrie". of
~Ilcrry or><I non . he-litory fodorI. The
following Ore .ome oj the ~llologic loclors
re'j>O nJiblcr !.o, ome'",' ope n bites :
II P,olonged !numbwc kir.g habit mi ght be 0
 A

c
~ 3 SbIoIOl <" _ _ .... W 00. 10 _ ......~ .-10..,....,.,..,., (11 0...., docI<w... """"' ..... _
iC1 Out .. com!.;",,~ 01 A&.8 ,':1: Duo '" .. rtitol """I...,. _ . ..

likely ""lJ>e cJ ope~ bile. T~ poofVre 01 rl>vmb

posi~oning. th& inle .... itt. and Ihotlrtoquency
01 ,..,.;king, 01 "-on inAuenceon!he notu'"
and ", .... oty of It.e open bite.
ii) Tongue trnv$Ti""il il OilO impli caTed forlome
cose.oIopenbile .
iii) Of 011 the pouibl. elOoIogic fodors tho! hove
been sIuded, perhaps"'" weoImt i'npooltl ooe
focv.e. on nOlophofvngeo l <;I;''''O V
~ cOO ossodotod mouth breo~
iv) Inh~ri!ed !<>etCrI . "" h ". inc:,,,,,sed longue
site, end obngrmol ,~Ietol growth poI*n
cA th& mcnillo and mandible (On obo be
1''''11'' ' " , .kel. t., 1t,,'e.lo, "/M" bite
A patient h<r.Ong " sI<e\etol onleriof open bite may
reveo lln.. fo llowing fectur lfig 2),
o. Inc,,,,,,,,,, Iowo, on~'iot 1"",,1 Might
b. Dec""""" uppotr omena. 1or;"lheigh!
c. Increosed anterior and decreased pOIlerior
!ocial .... gnt
d. A $!&ep rnondib<Jlor plnne angle
e. Sma ll mondibvlorbod,. and remus
l. The pot .. nt ".." hove <I .hort uppot, lip with
....:=ivo> rno.illory Inti..". I!)I- poaIN
f, The P("ie~t often ~'''' 0 long o nd norrow foce
g, Diverge nt cepho lometri<; plane;
h Steep anterior crania l base
Cepholometrk; cxomi"" tion ""'y a ,."",,1
downwa rd o nd forward roto tio n o f th e
mond ible. In $om e patient" on upward
tipping of tloe maxill ary , keletal ba co n be
ob,e rved, Anoth . r cam mon fea lure i, a
ertical rrm>ill ary irxreo,e Ili g 3),
F"aru,,,s of dental ant. rlor open bite
[)er,ta l anterior open bite, do not p re>en' ,..;th the
ske:elO l comp li cation. mentioned oboe. The
fol lowing are l h" fea lu're, of de nta l ope n bi t<! '
0, Proc li ncd uppe rante rio rt"eth.
b, The uppe r and lower onto rio " foil to overlap
eoch otherre,v lting in a .pace between the
maxil lory and mand ib ul ar onte rio".
0, If," patient moy have a rKl rr OW """il lary arch
due to IDWtlfCd tongue ~ d"" to a hab.l,
Treatment of ant.rior ope n bit"
Removal of th e ,aust' , O pen bite; tfla t ho"
been d iagr1Osed ' d"" to fla bit. ~ uch o. ln umb
. ud in g or tangu e thru st in g, requ ire th e ir
inte rcept io rl u, ing pa .. ivc habi t bfe o ki ng
appl"'nc ... . Th. "-obit breok .... con be e ither 0
rcmoOi>Ie C< 0 fixt.d 'Ype cJ crib (fig 4). Per.;j,\eOCe
o f tn., a>u>e will offer 0 seve re limitotion in 1M
correct;"e procoocore"
Myofundional Ih"fOPY Skeleta l onteria t
Ope n bite. can be t"",ted du ring g rowth u. ing
functional app liar.;:es such as F,R.IV ora mod ified
aoti vato r. Tf>t"e opp li o nce. incafpora' e bile
b\od.. inte<po<ed between the po!lerior teelh, HlOl
have an intru, ive action on the uppe<or>d lower
po,ter"'" teeth, Pati ents exhibil ing 0 downward
and backward rQtot io n of th e mo nd ible with
in::"""ed vertico l growth. benefit from therapy
u.. ng a vortko l pu ll. hcod gea r with chin cup ~
tr. ated du rirl g the mi.oo dmtiti on peri<xJ ,
O rtixxX>ntic lheropy . Mil d to ~ro te open
biles con be successfull, ""'naged u,ing fixoo
mechanothcraP\' in con iunct"", with box do ," ".
Thi. fo rm of "Jaolic opp li cation can .. ,t. of an
e lm ' K: tha t is , tre,ch . d to exte" d betw",," the
uppe r an d k;,w...- antc rio ", Thi , brings obovt
e'tnr ~o n af tho upper OM lower anterior,. It mOf
not be o disabie to resart to tni' form of thera py
in .ove r keleto l o pe n bite .
SU fgkol correction Slelc' o l open bite. in
--,.o du lts o r~ besr trootoo by .u rg i<:a l procedure,
in "0" in 9 tM moxilla and the mand ible,
f" 5 V>I. !C:
!J) .,...j P.............
phoog, h, (>1 0 p.m " w ,h
...-'" 0 _ biIo,!OI A f-,"'bO
......... """ ...0" ~_opI '''''i''''
......... " 'h', PO'~" i~i, IA orod 10 )
P",,og'Opio. of ,h. "''''' po''''''
"""' ~ i compiol;o' of ,,...,,,,,",
Ull Orthodontits - Th~ Art and Stiente

f .. <I "", ... 10< ."" , b'" ~ ..Itd "it> fc<oo _"'''' .od 0,1......," '" ' W" """ I"".. ,,,,,,," o.omol,,,, . W & Ie)
p _ _ ,....,.,....."", iCl & iDl "... ...u ... F>b:. !f: & 1'1 _; ~ ~ ~ _ .....,

POSTERIOR'pPEH S ITE Ce U'''5 of po. terlo , op,n bl' e

, TIIe ~ ore two poss ibl .. cov~ of post" rio r open
Pmt... ior open bite .. 0 condilion c~roCl ... ize<J b..,
by I""k 01 contecl beIwe.> the po>Ietiors wh"" {I) """,hanical fflrierellC1l WIth eruplion, eith ..,

!he IIIeIh ate in oonmc occlllSion. Kn>O$IIyoccurs beftn ex 0[1",- .... 10011. emo<ges from IIw: oIvIoIot
in 0 >e9""",1.of!he posl. riOf -m .
bonu, Of
(2) le Hu re e f th e e ruptive m""non;,m ol lrte fOOth
$0 thot the expe;:!ed a mount of e rupl\or1 d~ no!
=,
,' M!JchonioJl in"' ...."'nce with flflJpIion
may be coused by onkylooi< of the tooth to the
olveolar bone, whicn con occur .ponlOneouoly
or o. 0 rew h <i Houma , or by ob>lode. in tn .
""'tn 01 th e e rupTi ng T""tn Exam plel of .I<J~ h
obstrUCTion. prio r to eme rgence ore
wpemumelO'Y IeeIh ond ""n=otbrog dedduoul
tooIn rooT1 or ot.eolor bone. Aker the tooth
emerges I.om !he bone, !""""",fn:,m $Ok N_
int~rpo:M>d bet ... , the teeth [c~, lOngue,
~ ... ge') con be obstocle. to eruption [fig 7).
ArI\;yIooe<!teem "'" ",,"oil, in infroocduWon ond
arc .." id te be '\Jbm . r~ lfi g 8) .
The IOCO ne! po." ble co u,," of eruptio n
!<ifu... is 0 dill\!<ballOll 01t+., on.opt'.on mec/Ionism
ih<!K. TheN potlen!> hcr.e no oth ........cognimble
diso<d .. r. ond no mech:mirot interferentef with
f og 8 ""'_.""'...,., bi .. i. Q paIion1
........ og or 001)'10-' " P'" .. ~ r ,,'
""''''''- ....,'.,
Qlt Orthodontics The An .and Science

OI\lP~O~ ..,~m to ... is!. Th. <;ond it"" may be "'"

CO U$e of po.torio r o~bi '" wh ich doc. not
,e.po nd 10 ortr.odonlic treo!ment

Tho prima'Yoim oIlIeoImentshould be to """""'"

tho Iu .... Lo"",,1 tong..,. .pi..... o,~ Q ..,I~obl"
aid in 'ontrol of IoTerol tong u. thru,T. Or.c. me
ho bit i. intercepted, a lpo nt<lnoous improvemont
often follows. The pollerioa alll be forcefu lly
"",ud&<!. In m~ 01 pos~rio' open b~e d.... 10
im..,-<:>cch....,., 01 onkylOMdI....." ~ i. bcol treoted

...
by <;fQWnS on poote,ion to n:s~ normal ocx:I....,1
,.
" . f.fe"c es

1. 80>., 001",-', coe,"_"

cl d..........,..1 <It-
"""-" ." 0101 .... 0 ... II ~ ......... con-
~on ..... ~ """- ",", J OoI"", 1983 ;
.~~
2. r.. ..... ood ." 5'-'" : f...o,~1 ~ 00 _ .
,..,.." .. ,l. 1otoI _ b... Am J o.tI.,d 1983 ;
S~;.s
l. ""'_ TM , Ortfro!i<>r,o.a : """" .0'..
or-J ".-a<t ~ .
WI! s.. .......... 19!1l
lopn.G:!vlo, ""'~o'" LII,. 0,," ~ : _.,.
.,.,,, . b-,. mo'<><d.,loo. Am J O~"..! 19U ;
17S-186
~ Nond" Ib'"..... 01 .......1 growth ... 'or:.o. 1m J
Q.,hod 198a; 1Q.3.116
6, """'" 'Nit, Coo, u,,,, ., 0rfI,~. S, Lo._,
CV~ ' 9"66,
), Roi-,;" 80,.., VI<>."", : S-'"'l~" _ _ , oJ ... ~ ...
O nl.'~ "v", b," d. l",m;'i., wi'" , ig d ;",,,,,,, 1
h.,ion '" mo..dblt, Am I C " hod 19K> , 5257
8. lobo<! E Mc,e", I1orod -..,! Ori>odor<~ .. "'"".
bod mod~ .AII~"". <><.1988.
,. _'.-~ )ol;1~
__ _
a..! WM..., 11.. ...--",, _
...t.i. and On 1 ..... Or.,....,..
1m
J Oo+oo 19!r2;22'1135
e...... :
'0, So~_" ond
198J ;4755
O.. " -h; ~ _ ,0.", 1 o.o~od
,.
II , $o ~ ..... JA , Poxfct 01 O"~ , j) Up.p;"ct "
'""PO '1.1 96.
12. r...."." II< Gt.,b,o'. Oobo~ l 1IonoOO<J1 , o...IIocIon-
'''' ".,." eI.'"
~
book n.;. 199-'
onl ,0<10 .......... Moob).-'
 '.

2. Demolcto.sb ~.

C
'05mite i, " term uM<! 10 desoib..
cboormc l ocd",;"n in t~ Irons.""" 3. FunCli ooo l "".. bile
pio ne. Th. Ierm is oIso <ned t() d&so:ri be
Ante,lo, e ,c u Olt.
reverse OV1I ~ tt of o ne or more cnleriQr teeth .
Grabe, has defin.. d c!"Onblte 01 " An .. rior crollbil. it d.fine<;i 0>" mobcdU l;on
condition ...... '" one or more tee'"
may be .......,hing from the lingo..<ll
posmon of !he mOleilla,..,.
obnonnolly malpo<ed bvcolly Of lingually Or ,,""'rior tee'" in ",Iotionshi" with /h" m'Jndibulo,

-
lobiolly ..;th ~,,,nce 10 It... opllO'ing tooIh "r

C US SIFICATION OF CROSSSITE

Crossb ite con be da";t;OO booed 011 loco!;"" 01:

o nlerio<' letlll. Moll 01 the co .... reported In "'"
lit""""... invot.e permon.." Ie,""" nc...e-.lhi.
rro'ocdJSion i. welt docu ...,. nled in !he doQd""",
d entiti on, !OO, All onle ri or , .o.sb ite con irWoivG
" . ;n gic tooth "r on e<1tir. s~ment of tflo "rd!.

". AIlI"';o< crosobi,., Post erlo, ,"ouOlt"

1_Singl .. toolh
This ~ 10 on obnoonallmRSYet>e rekJhonthip
2. Seg"""';,
be_1he uppe' ond I"""" posIeriorleerh. In
b. Poslerior cr=bite
' hi> condihon, insleod 01 the mondibulo' bua:ol
1. Unilolerol ~;g 1.b}
cu.p. occluding in th.o cenlrol lonoe 01 tho
2 , 8<101erol (f9 1.eI m oxi llo'l' posl",,,,. , ,h, I""" occIud. bucco llO
Booed on the ""tur. of th e eronbikl 01: tho "",><1 10'1' Meal ''''PO. Thus posI<>rior CfOllsO'"
1, SkeleTal cro ..b ite
,
oce u," c . 0 res ull of I", . 01 coord inolio n in lhe
42:4 Orthodontics The Art and Sc.ience

A B

c D

f;g I c'O""' .. , ;, .... t'",,, .,. ,". "" ,I\: No,m, 1 ~'"''' .... ,''',"" i8i V, j'" ,,," ,,,"''' bit. O:Ci 8.1oloro l " 0,. ." ,
':0: Bo,,, 1 n<>" oedu.oon :,1 l ~ iUO I """ oeolu"" ,

Io""Q I d:mcmion between the upper oed tfee bwe.-
orclt e, .
Posle';or era .. bite. con be uni lo"' rol
in.oI.-ing One side oil n.. ard, or biktlero l which
in.oIves ooth . ioos
Buccal nan occlus ian Th is i. 0 form 01
pa,terio r cro .. b'te where th e maxill ary posteriors
ocdude entire ly an tr.e bucca l a'pect af tr.e
mandibulorpasterio,,(fi g I dJ. Thi$cond ition is
01$0 co il ed as $C''"O'' bile,
Linguol nor> - occlus ion , Th is is a form of
pasteriu cra"b'le where the maxillary paslerio"
occlude e ntir. ly on th.e lin guo l o'pe<t of th.e
mondibu lo( pa.leriars (fi g l ,ej,
Skeletal cross bite
Skelela l erosibte is as.so;:iated with a disc(eporq
in th o $izo of the maxilla and th.e mand ible, Thi.
kind of cras,bite is usua ll , inherited Or roo, resu lt
from d. f.dive embryciog ica l cJ.,vek>pment. The,
""" pre",nf~ith er in th o ontcrior or th e pa,t.rior
region . Sk. letol onterior cro" bit., ore u.ua ll,
os a res ult ai ",lorded ma:Jlary g,,,,,,,,,h u a rooxi lkl
that i< bockward ly po.ihoned (fig 21. It com a ir.<>
occu r os 0 re.u lt of exc."rve m<mdibular 9r""""h.
Ske letal po"eri", era" b ite, are usua lI,
characterized by a "'rYaw upper arch.
 A B c
f ;g 2 >k~ . ", "".hi.., -c 'n, 0'"' ''' _<00...'' pi " . ~ on .... "" ""'''''.. dvo '" "",, 110" o""" ""th ',,, :11 0"""'"
''''''''-' 0... ., ""," iI,,)" - pmgnct, -.... iCi 0"""-""........ do... ., ,..",d,.,. -''roIl'"'''''''' ond "",",; b..b< p~at.k"
Denta l cronblte ETIOLOGY OF CROSS BITE
o..~to l
cr= bit. , o re vs...., lfy Ioco lized cor.d iti on.
Cro,", bites of th o a ntorio r or posterior "'9"'" .c on
where o ne o r more teeth o re o bnorm o l' v r~ "ted
Clcc ur O. 0 re. ult of 0 num berof eou'" ''
10 that of the o p posing arch . A variety 01 fo ctor>
1 Pe,si sle-nce of a dodduou. tooth often re.u lt,
r.ovc boon reported to CO U," a denta l a ntorior
in po loto l d"r ""t"", of i~ erupling w eee"or
cro<\b it~, ir.: lu ding 0 lingvo l ","upt>:>,., path of
cau ~ r,g . ing lc tooth a nte rio r cro"bile.
th o rrt(l,ill ory ant",iors , tra uma to the dedd LJOl'S
2. Crowd ing ""d a bnorma l displacement of one
d ontiti o n in whiCh there i, di. pla cem. nl of tho
or rnare teeth a. 0 rew lt of oK h lengthtooth
tooth buds , dela yed e ruption of rhe decidLJOu.
motorio l d i .creponci~s rnoy ea u s~ den to l
derlition <>nd "' po rnu merary toe11 . Tooth motoria l
ero" bite .
arch - IO"llth d;"'rop<lnde. can resu lt in crowd ing
3. Pre$. n e~ 01 hobils <uen a s thu mb <ud;ing
an d linguo l p", jtio ning 01 uppe' t~eth I~ading to
o M mouth breathin g con ca u. e l owe r~d
o denlo l crossbite .
lo ng ue po,ilio n. Th u. lhe lo ngue no lo ng'"
Func!lonal c, ou blte ba lance. the force, exerted o n the te. th by
Ihe bucca l g ro up of mu sc u l at ur~ . Thi .
Pre.., noe of ocd v;ol interf. rence, ca n "" ult in
disha rmony between tn., e' lem ol an d inte"",1
d"';otion of !he """""ible during tow cb<.ur". Thi,
mu s<;~ forc~s ca n r~su ll in na rrowing of llle
con pre,ent a, a un;kJtora l posterior cro"b ite.
uppe r arch leo:f in g to po. tenor cro"bi!e
Ha bitua l forward positio ning of the mo n di bl ~
4. Relo rd ed deve bpment of moxil lo in "'g;Ho l
Ip se vdo Cbss II Q """I lecd 10 on onl!<ior cros.bite.
a. we ll a . tro n.v",,~ d ired ion co n Cou S~
P",lJdo Closs III resul" from o n eo rl y denta l
ero" bites in t" e a nte<io r or poslerior reg io n.
interfe= ce tnot fo rces the mo ndi ble to move
S. Narrow uppe r oreh re. ulting from d""re<lsed
forwa rd to o bXl in rnaximu,n inte u>palion . An
growth slimu lo,,,,,, in the mi d po lota l . uturc .
accq uired mu. eulo r refi e, pollern d uring d o. ure
6. Ca ll o pse of mo <ll iory arch a s seen in
of the mo nd ib lo is In ,o l" . d in fun ct io no l
cor>;l<l'"ital defed. soc" OS deh. cJ the polote
ero .. bil"".
 'oct'
F;~ 3 (r"" .li'" Ij>l & ':8) ,.,..... io , ,-,.io ",ouli .. !O ~ (DI ,wI'"" ><9"'orlol <"'...... ,. (~i &(FI PO>I...io,
"o"b-.. :GI <I. (HI An", <Ior ood po~", ,, , ,,,,,,Olo
 B
Fill .~ <loti,,,,
ond " "', . .... , ""," 0' ....'" ... ..,1
1128 ",- Orlhodonlics - Tfle Art and Science

con be u,ed in 00"" there i, ,uf/icient 'poe" for

th o tooth to be brouQhtaut. The tong ue blod ~ i.
o flat wooden . tid; r~..,m bli"9 on ic:e aco m ,td .
It i, placed inside the rrmvrh cMtoding the polota l
ospectol th~ tootf, in cro" ba" If,. 5), The blod .
i. made to re,t on tr.e mon dib vlo r tooth in
c(o"," 'e whic: h ecl:< a, e f<Jlcrum ond ,he potient
i, e . k. d to rotate the oral port efthe blode
upwerdo end fo rword._
Thi, i. continued for 1 2 MUr< for obout
2 wee k" Mo. t deye loping 0(0" bite, thot o re
rocog nized by the denti.t et on oorl , ,taQ" can be
,u cee"fu ll , trected by thi> form of t!-.e ropy.

C6tl~m'. appliance or lower ante,lo, In

clined plane
Indi ne<! p., nc. canstruoted OIl ,he lower enterior
teeth can be u,ed to treat "",' il lory 'eeth in
cro...bitc (fi g 61.The indi""d pla ne can be mod .
01 ecryj ic or COlt metol or><! can 6.. d igned ta

f ;, 5 To ", ", bk,; , " "" to ,,,"' d,,, k>p;, . on .... k"
""" .'0
7, Sog irto l discreporn:ie. 01 the jOW$ .ueh o. 0
forword ll po~t>oned rn"nd ible r~sul " in th e
wide, port " f th o mo ndiiJ.ulor on;h occ ludi ng
with a n<lrr"w", port of tke maxi lla ry arch.
B Unilatorol hypo O f hype rpia, tk: grow:n of ony
01 th e iaw. can cau se cr"""bite .

TREATM ENT OF ANTERIOR CROSSBITE

Use of tongue blade

Developing sing le tooth a~teriar ero .. bile, con
r .. 6 iA) (, tI , o', o,pI""o (Bi \ <10 , :.,.. c+ Coe","',
be . ucoe" fulfy treated ur.ing 0 tongu e blad e_ I, , p,I """,
 bile plone 10 helo in jumping the b~t . The ut.e o!
Z .pring .. indiCO!ed onlywhon thor ... oclec!uole
lpo et 10' loblo lizoti o n of the ~t~ in "onb ito.

I rr ... !ml nt of . ke/etal ant. ,lo, Crall lilt.

du,'n, ,rowtlt pe,Iod
Sl<eletal an~oubit.. that occur1 01 0 result
0' 0 retro-posmoned n",,.;no .hould be tlWled
~ternliflOlion "'''''''''' b,using 0 prOhoa;on
loe .. ...,tJ,: (_rw ~eod 9""'1 (fig 1O).Thet.e 'ace
"",oI<s hell i" o.otrodion 01 tho ,.,Qxillo thoreb,
~""_! ~ __ ,' I,,,,,,,',
~ 7 R ..,.",U. wi .." . ;""'POfIri~
-. ''''''.....
Z.".... 10"
n o rmc lil lr.g the 5~e~ 1 O"O""b ite.
EXCtll ivt mcndibuklr growth lead ir.g to
tree! a sin g le tooth in erou.b it. or c seg me nt of
",," otol ""teriof 0"0" bot .. ""auld be in!tlrce ptod
the vppeorcn;h in cro..bite. The lrod ln ed ~ c"" i.
designed fa no-... c 45 o ngulo~on which IOKes by u... af c/oi" cap.
th_ "",. ;Uory Iee!h in crossb;te to Q more lobiol
Fixed .ppll",CI' for ' rI.tment of '"Ie
pooihon.
hit jndo<nled """'" odeovore .poc..n"
,'"r CIOII "'"
DortoI omorio' c;roubite irN<>ling <>nil 0< Iwo teeth
in tl>e o.wlo< tho alignment 01 the mO>.lllorylKlh
,",," be j,,,,,'eeI with fi..d oppl","," V!ling multi
in "o..bit&. Thay ore to boo ~d onft in those
k>oped orc hwi reo.
cOIU where The cro"b;te ;, du e to 0) Jl<l loto lfy
d;,pla<:ed maxill a"," inci <o r.
TREATM ENT OF POSTERIOR CROSSSITE
Th . lowe r anterior ,<>dined plan. r.a. 0
""m~' of d;!ICIlMlntog .. which include :
1. The patient encounters problems In speech
during the !hemp,. Single tooth CtO$$bite involving the molor1 con
2. The polio", ho. 10 put up with d,olory be - . d using eloslic> hI! ,",:O'rIIICher:I between
restridions.
3. Hmecpplion;e io vse<l lormcn tr.c n 6 .......1:>
it , an re,"" in oo! ..i<:<"opeon blto dye to "'pro.
" uplion of the poste ri ors.
4, Th. appl ia nc e ma y need frequent
_lion.

V,. 01 dOllb'. caRll/e Wet Jp,'''' (Z

so,/nIlJ
Am.,;." c;roos biles imoo!ving one or IWO N'IOXillory
tC<lth co n be lreot. d " ' ir>g " doub le conlile"" ,
>p rin g Ilig 7) . In "",a of 0) deep O V"' bit. th e
SIlrl ng lhoold be g ivon o long wjth 0 posto,jo r
the maxi lklt)' polatal surfa". ond mandibular
buccal , urio c. (fi l) 8 ).Th e,e e lastio. e<lcnd
throvg h the bite and ore in clKated if suifici""t
>poce exi$t. for movir>g the tooth into the arch.
The,e ela>tics are to b. wom 00, and
night. Too treatment .houkJ not be oo ntinved for
more th a n si' wee k. 0$ the .I0$ti<:1 co n e>trude
the teeth.
Coffin spring
TM Coffin 'prin g wa. de.:gr.ed by Wa lter Co ffin.
It i. a romovab'" applian~. thot co n ~st' of a n
omega shaped wire of I .25mm d"melar pkloe<i
in t..... mi d po lota l reg ion. The free .nds of the
omega are embedded in on acryli o plate trot
COV6rs th o slo pes of th o pO!oto. The >p ring brings
about d ontoa lveolo r expoos ion . Howeve r. it i,
cOpO"o of . kolctal changc. when u.ed in youn g
potient .
Quad helix
The qua d hel i. is a 'pring tmt con,i.t. 01 lO'J r
OO lie (ttg 9 8) . The q uod h. li, i. capob!e 01
0,
dento alyeolor ",p,m.>on of the moklr wel l en
pre mdor reg iM. It ca n brir>g a bout , keleto l
e>pon",on whe n used in you ng er poti ont.
Rapid maxillary expansion
Bi'ow skeletal cro .bite cmraocri,od by 0 deep
po klte, no",1ob>lructiOl"l and narrow moxilkl Con
be treated by rapid maxillary expo", i"" whe<e in
too midpol atol .u lure is .p lit. Thi. i. done by
u.ing app l"nco$ th ~t incorporato >crew. thot are
to be octivated 0 1 reg ul a, inte",ot. .(fig 9 A)
Removable plate.
Unilateral em .. bi te, can be treated using
removo" o o!'Pi inncel incc<pcroting fock s.crews
Th e a ppl ia nce con~'t. of a , plil ocry li c pklte, a
jad, KreW and Ada m' . da.p. o n th e po,terior
teeth to retain t"" pklte. A .,bio l bow con 01<0 be
in.:;orporat.d into th e app lianco lor mi nor . poce
cklsure and retraction .
Tro, dc~ rcd dfoct ~ och'cvod by secOOn 01g
tl", pklte in wd, 0 wafthoto srno ll .. gment an d
la rge r >cgme<l' arc formed . Th e 'NO segment.
are coonected b, or.e or more iock K rews. Too
sma ll er $. grrr erlt of th o pklte adfoir"l$ the alllO in
crass.bite wh~re",
, the kl rger .. gment i. vsed for
anchorage'
Fixed appl!ance5
Unikltero l era " bil~' can also be trooted by u~ng
fixed appl kmcc . A.ymmctricolll expanded
 i I)

f;;, 10~.;!I)...d(C) p,. ....,......, ~ .. ~ <>I. _ ..... 0 .... .., =- bOo _toO ..... "-' OO+:d: ~,
oppI ' oo. 'll\. ~I u-.l1) .... ' .".,. .... ,...,.ogro"'" d ... ..,.... .........
43t Onhodontia . ThlZ Atl and ScilZnu

I, BotI, W",,:It.r, ."po","", i, ,..,,"" 10 '010 01 0<'

'po n~"" cod pa';onh og.o, Am J O"hod 1982 ;

_A.
3237
2, 901: M<>xlb-i.~ """110 C.Qd.,,", oppl
orooo, 11m J Ort00.:l11'8 1 .. 152 1'1
3. l1ooo. Co~ So.... , AAO!: .. p-:... ~ ood ~
JOr+.od 1991 , 171.1 19
.. , _ ond ~ .);eI : ffiec" ." _llorr ~h . 1;.,
.oplio'coo _"''''' on ..pholo_< - . . " , .
........ "'" J 0ri-00<I 1981 ; 31&.3119
~ Otobot 1M , Or.I>odonJcs , "o.;IoIoo.od .",,,'n.
W8 J.o...!on.l\>68
6. O,_bo"",,.od ZoorrioIoo , E/IocI." ooldol ..
_ t ""'~ Am j OtOed 1 9~2: 122 1
7. _ , . x.:O ~_ : D.. "",",.w J , i O n O oOed
1913 ,2 21 2~5
B. ~o, : ' 010,,1 ...... ""." J," '""" Dog I"ln i of
d."olo<,o' ",,"0'' '' 00 ...... j o..t.od 1970:
219255
9. tal , ................... ." .... _IIooy_ ..t.
0...... "",.1 "",;tv by ."'"'11 tho ,.,,;,) .. I.tot
_ h9a0l+0cl1961; 3 1 "3-90
10. _ ,. 10011 '""" '"'" _ _ Io.of"" ol "'...
pol.,.1 pons;" . AnglO 0'*'011 1980; S<I ,
189217
11, _ , I....m..". 01 """"10<, cIoII.<Io<>qo b, ~
,h . ",;opo l,I< 1 " '"'' >.ng. 0 "",,," 1965. 65 ,
200-2 17
12, H..... : PoIo,, 1 ..,",Io n , . ng a bo<tde<l Ofl~"
...... "'" J 0ri-00<I 196""2 ,'6<</18
13. P.. ~" "'. : Con""""",,,,, 0" .... _ ... It I<>o~,
Ci .""""'" 1986.
" . _ f - . . . ' Hand '""'" 01 Oo~ , j ,;0" ",-",

' 'Yo_"
boo...... .". p..bI ...... '0<.1938.
1~ n..:...- M Grnba-, _ I o"t,od""o
tI<o ........ ""nd.1oo _ h....... M<>obr _,
booIo; I",. 11"1.
16, 1.I<W.1o' . 11m"""" ".~. Z_n, "".",., '"
..... l>ooo ~'-1 o! q,.,.,....
~ _-.on", 11m J
Ortt.od 1'1&3; 31 13 16

,
bite
ko mo.,IIo ')' demel orck ~I"" IO'9otrlhon
T th e ITI<lnd ibulo r orch oilOW! th o m,;,.illory
onte ri oro to over lop the mandi bu lar
cn&riors. This ~pping cO!I..o mardiOJor_h
occurs in bolll!he horizontal 05 well 01 '''1111,,,,1
ollKliorl. The hcriwntal ~p is<XIlied Oe~et
while rhe ..rtico! overlap is rermed """~. Thus
_ degree 01 """;0;01 OY'IIrIopping or """rbile
i.o r.otmOIleotvre 01 ............. deru~ion. H _ .
SO"" potienls present with """".,;.. o.erb ite.
Such 0 co nditi on wh. ,. there " On ."Iuive
"'l rtico l cmo rl opping of th e ma nd ibular ont...-iofl
by ma.lliory ootorio<1 is cal led dM!l bote,
Deep 1><111 is one oIl+.e hquen~, seen
moloo:lu';on, Ihm am occur olong with orller
oS$OCiolOO malocclusions. II is $Oid 10 be one 01
the mo.1 dgmoging malocclu. lon. whe n
<:.OI'SIo:\e<ed lrom tho view point oItho fvt..,,,, heofth
01the moslicalory of>P'l"'l'" on.d the oJ.ot,lO l un ilS.
Gre b. r ho. def ined deep bite e. 0
CtYId itiorl of e..ce"r.e "". rb'te. whem the vertica l
of
meo,uremenl beh n th e mo . ill o,,/ ond
m ondibvlor in cisa l me rgin . is . ,c...i when the
mand ible I, brovg ht into ""bilu'll Of" centric
occ lu"'on. Oeejl.:we, bile con be of two ',pe. :
incomple!<l ...... bm. and camplete OWl' b<te.
Incampler. ave, bile i. an intioor relafio"nship In
which !he lowe, incilOr<1aiI toacdude,..jlh eithe,
the upper inci..... or the mucosa allhe polole
when the IMth are acdudo,d (~g I .b) . Complete
"""'" bile on I"" 0Ihe< fiend .. " reI(I!ionship in
""'kh Ih e I.,......" incisor> conl:;x;tlh. p<!lalc l ou.foce
of th e vppe-r ioo sars 0' the po latal tiSlue when
t+"., 1..,11> ore in centric ocd vsien 11'g l.cl.Thi.
kind of deep bite allon re",1ts in Imuma of !he
mUCOOCl pol,,1011o the ma ullary incilOt1.
CLA SSI FICATION
Deep bit. con be broodf,o c\ossifi..:! >nIo1wo typeS.
I . Shl&te l deep bite
2. De ntol d..,p bite
 . '.~
434 " Orthodonlic~ - The Art and Science:
A B
Skeletal deep bIte
S k~eto l deep bit~. are u.vall, of 9"""ti o origin
Thi , ki oo of deep bit. i. cau,. d b, upward an d
forward rotation of the mandible, The deep bit"
con be furth .r won .n.d by 0 downword an d
iorword indi notio-n of tM rooxill a (fig 3), The..,
,k" letol deep bite. ore chomcte rizo d by tloe
pre,""". of th e foll ow ing feature, :
a . Patie nt, " ,hibit 0 hor;",,,to l growth pattern .
b. Th. onteriorfocol height is reduoed.
c. A redoced inlar-occlu,",,1 deom n"" (freewo y
'P"ce).
d. A cephalom etric . xo rnin ation revea l, th ot
mc<t of the oc.rizo ntal cep halometric pia ne.
, uch a. maoo ibul or plane, F,H, plane, SN
plo ne etL., or~ paro lle l to e-och otr.cr.
Dental deep bite
Th is kind of deep bite is chom c:e rizod by tfle
ab.ence of any , k. l. tol comp li coti"9 footure.
wh ich are ",e n irl ,keletol deep bite, Dente l
c
deep bites OCCur due to ove.-e ruplion of onter"'"
or infra -ocd u.i<>n of moio rs ,
Dee p bite due to over.erup lion of
anterior, , Denta l dee p bit. a .. ociated with
ov. r_. rvptio-n 01 lower inc i,or> ;' u, ,,,, lly ",n ;n
C lo" II ma locc lu.ion . The p' e.ence of on
irlCieOsed overjet a llow. the iow", inc""" to """ r_
eru pt until they meet the palota l mucoso. Th.",
patient. henc. ",h,bit on exr:e$SNe CUNe 01 Spee .
The i~lar-ocd ",a l cl earance i. u.""lly normal ",
th6 molo .. ore fully enJ pted.
Deep bite du o to infra- o oclu , ion 01
mc/afS ' Deep bile< can oceu ( due to infra-
occ l", ,,,,, of the molo ... The presence of a Iot. ral
to ngve po. tur e o( lalera l tong ue thrust moy
prey""t the molars from e,uplinG 10 thair norrool
-.-OCcluoo llevd . It can 01;0 occur due to premo!vre
los. of poslor>or teeth . Deep bile. caused by ;Ma_
oee lu . >:>" of mola " are characterized by the
presence of pa rt., lfy e(upted rrdon (Le. reduoe<!
crown f,.,ight) ond Io rge inter-oedu",, 1deom0C0,

DIAGNOSIS'
Th e rovtin e diogno$ti c a ids such as cli niccl
uaminatian, stud y madels ond lote rol
cepholog",m '"' """" It>< 1M OOgnoslic e..erdiG,
The onhodonful.hauld be able to d,fiet...,hatoo
skelelal deep bite from denllli deep bite. Loterol
te9holomelric o ...:d,..is 01 tI-e 1ke1otal pattem helps
in dkl""""r>g a !.kelrnl deep bite. n.es. potienlo
$how a reduced mondibvlor plane angle 01 ....,11
01 a red""ed a nt..nor focio l height.
FACTDRS TO BE CONSIDERED IN TREAT
MENT OF DUP IJlff
Deep bitel C>I1I ",ually correded by in!rusion at
the anterior _h or by <'O<Iru<ion 01 the po$teriar
teeth, The Ofthodonrisl should de<:ide wII>ch 01
tr... IWO modaliTies i. ind icored for a gi""n potient,
The", or. Cerloin factors that help in deciding
wheth er to Intrude th e e nterio", QI exlnJde the
'""'-
Up , . ' . 11( 1). 111"
Pntients w;th deep bite who exhibit a shorr upper
lia 01 a gu,.,..".,.. smile """"'Id be treatod by intrwion
of the anter""'. In pot" nt. exhibitir>g normal
u ppor lip with on ly 2 . 3 mm of moxil lary incise l
edge expos.ed, iTil ideo llO extrude the mokl Ol.
 A B

D
,_ ,dand
fig 3 \""",, 1 dc<p ... ~\ N""""I .... :.,01 """""Mho IBi $,01",01 ' ''''."''''''''' '" _cd "",,\.., of f>o
moedibl. (C) SkcI",,1 de bilO ..... 10 OOW""",. 0 ,0 f"",,,," ""olion 01 th o "",, ;1:0 10) 5"'1.t0l d boo d" '"
,,,,,,,,,,,,too of B~ C

Conslderat/on of vertltal fllc/al inte,occiu101 <poce i, on j"" icolion that the

re'~tlons"'p
Eldru.ion 01 one or mOre f>O,te(lOI" leeth usualfy
results in down_rd OM bockwo rd rotation of
th.e mondible. Tf>us an ;""reose in onteriorfo<;iol
heig hlOCCllfS. Thi. ca n be 0 ber>elit in !rootin g
sLeletal deep bile> with =~ssi"" OOrilOOlal growth
and upwo,d rotation of mandible
Cons/d.,aflon of Inter-ocelullIl splice
The average inkl'-<>cclusal 'P<' ce i. 2 4 mm in
th e premola r ,. giO<l. p""~ ,,,," of an inc,,,,,,,,d
molars o,e 001 fully "",pted. In soch potient. the
dM P bite con b. trMted by extru sion of In..
posterior toeth
The ortOOdooti.! should 001 ,ed uce 0
oo.-mo l inte r-oedusol deoronce by extf ur.iO<l of
mo",,, c < it Can ""u lt in fotig ue of the m".d"s of
ma't~)ion wh ioh I,I<lt stretohed end predi spose
to ", Iop.e . The r><esence of a normo l inter
ood u. el dee re "'. i. therefore 011 indicoti on for
intrusio n of the inci""", rothe r tho" e;:tr" ' io,, of
molars.
 A B
F~ 4 km"" bi .. , lono ~A ,I.otronc. 01 ' .5 1 m" >I>oold ", ~o ,'" OPP<' cod lower ""'",.", ..,.' ,(B) An'"",
"'to pIo ...
TR EATMENT OF DEEP BITE Myofunct/onal appllancas
De ep bite ca.e, diCJgno , "d to "" du e to infro
Deep bite. <Xln be treoted uo in<j r,,,,,oV<lble, ft<~ d
o::-::Iuoion c< mol"" con "" treeled by an cx:tivo!or
or myofundionol opplionce,
de .igned and trim med to a llow the extrusion of
Removable appllllntn tke.e teeth . Th e inter.o::-::lu,a l oc~ic is trimmed
grCldua lly to " ""O""'g " the e rupt ion of th e
Anterio, bite plone i. th ~ most commonfy "' "0
po.te,iQ r teeth. BiQnator ca~ a lso be used for a
re movabl e opplionce for treatm ent of deep bite
. imilo r purpose.
[fig 41.
The anterior bite plon ~ il " mod ified FI.ad appl/anca !herap),
Howley', "pplion<:. with 0 flot ledg e of ocryk
Fix"d orthodontic opp li orxes con be us. d to
beh ind the vpper onterm. Wh en the potient
intrvd. tke ontenors. The following are $Orne of
bit , th e mo~dibular ind SOl"S contact lhe bile
II-e method. used in fIXed opp1ior.:e, to treot deep
plo M thu. di, occluding the po.jerior'> which or~
brn..
lree to e rupt.
n,., ontenor bite plane C"lUilt. of Adorn', Use of onchoroge b""d. , Ancho"'ge bend,
do. ps on the mola" wh ich holp in retoining the are given in the orch wi re me,ia l to th e moIo r
app li ance_ A lobio l bow i. olso incorpornted to tube. so thot tr.e anterior port c< the oreh wire li e,
cov njer ony forwa rd compo""n! offofce on the ging ivol to the lxacket . Io t (fig 5.0) . Th", when
up~r anteri"", these arch wire, are pulled occlu.ally and
The height of th e onlerior bile plone er>gaged inta the brocket., a g in giva ll y direded
shoold be iust onough to ,epa"''''
the posteroo i~tnJ. ive force i. exerted on the inci.orS wh ich
by I ,5 to 2 mm (fig 4.0). A, th" postorior leelh reduce. th o deep bite.
~ rupt th e height of the bite plone i, gradoo lly
i""reo....d .
431 Onhodontics The Art lind Science

B
f", 5 ..-..no. boIo .... __ W """'"_ 1>0........ i .... -"on cJ _ " " -.:iIj _-.. ...In ........ 0.... oJ s_
Un' 01 g,el>w;,e l with leW~,.e c~,,,e 01
i~ ~ Iwcr:ol seom~nl c:J 11> ..,'. 00 0110 prod"""
$pee . Rosil""" o ,ch wi"" tho! ho_e boen cu rved
o intrvsi,.c fon:c on tho ont.';"" (fig 6.8),
in D oir1>dio rl ~I. 10 thot cl the cu"'" of Spee
Rlf.,ene lt
CD n be ",ed 10 inl,u"" o n'erOors Ifig 5, bJ . "''hen

I.
~ofd, wi,,,,, ore in"lrted into The """ort"",,,_
"'e onlario, .egmcnt curves gingivaliy. ii,i,
1, &0 1, ~ .,od """", _ _ ,~o.., ....
bi .. br ,.,I.od,,,ocGod '""local ....... Am 1 o..t.od
onterior ",om""l is Fo<axI oo;l~oolly inlo the 1919011~.1:20

brocket.tor "",uking in on ,nlruSlvelorco on'roe

1. "0<1_'
1980 ; 113
~....,.b>o 00-' Am J o..r.:.d

irdt.Or . 3. c.o.... ~ Po-.,od IIoio , Condt'b poo;;oo CO"<!

U~ 01 ulilily o,cne. : UI;I~y orcll&) 0,. o'ch
0 .... d_bao, .............. ' .,.."occl....... M> J
O<t.6 19B9; 42e_02
wirm 'ho' ore ben! ;, <cd, 0 way thot th e y hypo .. . G<oo.- 1M: ~""'''''''' , P'i"l<iplt/. .... ~.
tho bv<:col scg ment end ore ttrl l/Ogod on ,h ~ we ~"""', l >,&
; ~~ I ,:'g,C,,,,,,, m,, <> b', -", Oi....... ' " "" <ip
in o5O<'S {Iig 6 ,Aj , Th.... ofcho. co n be ",ed to _",,", A", J O<hod 1990 , , 16522
penon" Q number 01 toell> moYeme!lt. ;"eluding
6. KoU., I"~,,, '->'<ron' 01 Clan i . [);,;,;.,. 2
~,Io<r.JOrI<-od 19&9,185191
iotrusion of ;,"",iso<>, proilOdion 0 ' _ rclmdion 7 111.... ....&._. w.,t, UI .... ....d P,.hl-Andonon
of Inooo1>. TheyQre odioorOO by 9mng Q V bend v.:_~ . "'"
J 0 _ 1~92; 509-5 13
8 . 'I.cOowoI1 eod 8okc.- - S I' _10 <>do_"
.... boo """"""'" Iro J Qrtw,d 1991 ,310-315
9 "Ot>do G-t>o.<II patoo-.... ;n .~ _ Iot<G ood
..."" un IroJ ~-"" \ 990, 2~7 2,8
10. "..-.to, ~ ..... , oJ_,'" ~ In 00, II.. J
0"00d 19a5 ; I ro)16
1 I, Ort<> , V' _1 ~01 do"""""", .od tl",..,ou>C </'1.",,",
II", J O'it 199, , 432.'. I
I I, ,.,,,...., ~...,. or.c 0.."., , ,,...,,,,,,,,..
oj <iN,; bi ..
",.IO<.<I~li"" <han,." .... J O,'ho<:l 1995 ,
3.!239l
13. PIoifIM ",,6 G~, CombO-ood ~ ...... ""
do-..: _ .... 11... J o..r.:.d 1982. 185-20 )
u . PrJ,to wa, .:0...
CV ........ 190110\.
_0', Q.1Io-', So lo.~.
I~ ~1 f"..". .. _
IbE book ol on.oc...,<>. v...-
boo!. ~~01 ~.., "'-. "'<.1988
16, Sc~"_.VI, 1'=1.<0 01 O"Oodo""" AI U~ """,
""'~ 1 9~
17, T'"""" "., G<o_, ,",'' '''''l ~ ' I , Orr"""",
f" 6 (AIU' i!;', "'"
II I ..,'" ~_", ' ",,"'-<>ion ' <I , "". ", p-;",-pl ..
boo/; r.e. 111'/4
0""
1o<1v-.i,,,. "Iorl>y )'<0'
""",i""

Palate
left, involvi ng the lip or>:! palot~ ore the
C mo. t co mmo nly .eM congM ito l
deform ities tool occ ur ot th e time of
bi rth, Tn",! Ore u."", lly not life threctening vnb.
,,",odoted with SQrn . , yn drome flo, ;ng ot". ,
systemic compli cation , . Neverthe le .., clefts are
beset with nu merous problem, that the pa tie nt,
po rM! o nd the dodor hoy~ to lockle. Cleft. o f
li p and polate con <xcu, indi"iduolly o r togethe r
in 'o riou> com bina tion. _ They COn ,,1'0 ocCu r
a long w it!, con genita l defect> thot affect ot her
po rts of the body. The oim of this chopt. , i, to
g ive a genero l ova", ;e", of thi' co ng e nito l
deformity a nd e lobore t. on the ro le of the
orthodo ntist in it. mm""gem ent,
INCIDENCE
Tn., incid Mce of deft li p and po lote i, found to
be differertomong differef'l roc.. , Stud.'." r"""""
on incide nce of 1 in every 600 1000 birth .
.,
of Cleft lip
The Neg roid ,<X;" he< the I""" t incidence (0"" in
eve ry 2CXXJ birtn' l whil e the Iv\o<1gobid. hove !he
highest ine>de nee, Cl eft lip i, com mon amo ng
ma le, while d eft po lote i. mo re com mO<1 among
femo le, . Unil ote ra l deft, a ccou nt far 8(),);; of the
ir;cicief'Ke whil e bilolem l c.. fts ocw unt for the
remo iniN;) 2(),);;, hnong th . unilatera l cleft., clefts
irwolviN;l lhe left ,>de o~ seen in 7C1% of the Ctaes.
Th e rooso n why th o reft ~de ;, more ofIe<, i",oW
i. rlCt yet <now n.
~MBRYOLOGICA L BACKGROUND
Th e foco i. focmed by the fu.ion of 0 number of
em bryon ic proc e"M th ol lorm around the
primit;v" ora l cov ily or .tom od eum. Around th e
fou rth we.ok 01 intreute ri ne lile , five bronchio l
arch ... dev,"op at thc , itc of the futu re ned, Th .
first ore h, ca lled , he rno ndibulo r a rch, ploy, a
vita l role ;n th o dev<:lopment of tn., nooo_moxill ory
campi ex.
44Il / ' Orthodontics - nuz An and Sc:ien
The meoode<m coY&ring ..... d_lop;ng
forobro ln prolife'ote, ond o ,hon g' th~
sto/J'lOd eurn , On . il\,. , "de of me . tomod.um is
mo devolopi ng roondi bvla r a rch, th o dorse l en d
of which g i,~, off 0 bvd co il ed th e """ ili o",.
P'OC,," , With Ihe forrooJOoo ollne nO$01pi l., the
IrOnlono:sol P'O<eM gel. d .... odrod into 0 mrod",1
nmol P"Xeu and two lorerol I\OloOl proas.se1.
Th. upper lip ood mO>.lllo is mus formed by the
I..... on 01 me mOlillory proceu with the medial
and la tera l M$OI proceue:s ,
n... mo
IX' )"'" i. form cd by co nm buti0 "
of the mO>.i lla",. proc"" a nd 1""""",0,,,,1p'oc. " .
TM m""iII""" pre<:... gr.-e~ oil po lalol ''''"~ thai
grow mediolfy, Tf>e union 01 lhe two poloro l
..... ~ i. p'"""",rod i"~ion.,. by t .... p'e<&nce 01
..... lOngu . Thustt.e,twv.grow_IIy<hwn.
Somallme during the 7th wook ol lrlll'o-o.rrerine liIe,
Ihe tongue descends OM the polo"'l . hel"".
bor:omto more horizontal , By oround BIn.......,b
The two . hel"", e re in do", o ppro.l"",t'on, The
po lal<o fe rm. by fu,ion of Ih o me.illo ",. .ne lve.
wit" eoch ot"" aM with the j,on\ono ",1 proc.".
Foil ... ,. of f...;on 'esu~ i.... deft. of the polo,.,
The mo""ibulo, proGaIolgl_ riM 10 the
lower lipond jow. DeIecri.e fusion "" incomplete
Moon b.rween the ""no..rI pAX....e. lead. 10
different types 01 clehing.
ETIOLOGY OF CLEFT UP ANO PALATE
Oelt lip ond po lole ere be lit!vrod Ie 00<:"' due 10
~>c; o....! o""';roomenlol 1od0", Me".,. won-.
C". 01 the ....... Inol d. h. o<cur du,'O a .... omber
01 cou.e< and no single etiology c;an b..
pq.ointed.
He re d ity
HlW'rodily hos long been coJ"l$ ide'ctf on important
eli a log ic fado, fo, cleft lip e nd po lote. A <I ud,
condudrod by onl;.", rq>orted tI'Oll in J ch,Id,""
with d.11I hod .ome felative. wim .imilof
cO<1OCl"il al de/KII , Cleft. of tho lip end palate
ca n be tro n"" ittod a. a domin ant 0 ' a rece,s;"'e
lro i!.
Another possjble etiologic Jodor i.lerotogeo ......
"ierologeftS 0'" """'in drulP Of agenll !loot COuse
di#u!bed growth ond de.elopment in the k>otvs.
Some 01 ~,.I<nown terotOlf"'" 0,. :
Rubel la ';r\JS
Corti"",,"
"""-"'"
Ikild""",.
"'''"
""~
M'u lflfe.t o, '. ' tllolat7
Recent .tudies rove ,hovm lhel the etiology of
d. 1t li p "....! po lako co r'lr>:>! be attribulrod solelv to
either ge netic 0 ' ",wironmenioi to ciofS. II le<! m.
10 i""01",, ma'. the n one fe Clor. Th..y e rgue thot
... nleu 0 perx>n i$ ge ""licoll, uno:epli ble. lhe
erMfC<'ImentoIiodorsmcy no! bv~ 0;0"'"
doIn.
PREOISPOSING FACroRS
A nu mbe , af focto" Or. believ. d to incror:r.s.o m~
,iSK01d . lt lip ond palate i"" icla",.,
I nere e . . d ",. tern . 1 ' ,e
Wamen ... hoconoeive lore ...... on inueoled ,ilk
<J r.o.lng on offspring ...lh """"form 01 defring.
The COUH .......,in. unl:nown.
So me nxe~ Ore mOre MCeptibi e 10 delts tnan
.j
Olne" , WIon g o~ ds Ih ow the 9,,,,,,"st percentoge
 \~
\

c D
f l; \ ~'Unlb"",1 d .11 ",,,,,""II 19 ond O~ fBi l)-;~d..ro~ dd- ;".,of.;", I , 0'10 pobt. (0 ! k.INoi , ',,, ~", '.r i
I"p.nd 00"'" ~MoOoo dolt ........... 001010 .....,

of incidence. groups :

Group I _ Pre alveolar clefts : They ",,. defts

B/ood . UpP'Y
in""",,"ng only !he lip & ore .ubdo..ilied OS :
AnVIoetor that red"".,. blood .uppty 10 Iha Unilateral
no,omo.illoty "re e during emh,,/ologicol Silot.rul
~opmen! pm<iispose. 10 d oh,.
/>Ied", n
CLASSIFICATION OF CLEFT G r'O<JP II POST a lvealo' , Iefl< : Th is gro up
LIP ANO PAlAU" comprises 01 dilfe"'~t ~ r e.,. 01 flam a~d soft
palo_ defl1lhot ~nd upto Ih~ olveolo. ridge.
A ....... be<oJ dossilicotions "'- been put IorMIrd
Group III At..oiOt deFto ; They " ... complele
by IIOrious ourl>r::o.
daft< irr.ol.ing the palate. 0'->10, ridge ond me
0".1, .~d Ritchie clullflnflon (1922) lip. They con be s.,bd ... od..d into:
Urliloleml
Thi l i. c me rphologi<:o l dO <$ if""tion boIed en Bilolcml
the IOCOTi o n of the to the c i'veole r
d eh ",Iati v.
r>.'.ed ioo
proce ... Th oy novo d n<sifi ed cfellS inlO tortH!
442 Orthodontics - ThlZ Art and ScilZnclZ

Ven '. c lenmceUo ,. (1931}

H, hO$ cL;... ilied d efts into four groups:
...
Group 1 : They Or"
po lo!e on ly.
deft~ i""o;"lng the soft

L

Grc.up 2 : They ore defT, of lr.. lion:! on d soft

plOle P'OnIIing upro lhe 100...... foramen.
Group 3 : They or" compl~, unilol"",1 deft.
In.o!";l'9 th. so~ palolo, the han:! polOle, lip ond
th. olveolar ndge_
GA:lup 4: Thev ore compl .., bilot,,,ol dell.
ofledi"ll the soft I"' lote, th e Mrd 1"'101<0. the li p

~ ~P. "
onQ olveol"r rid ll" .

CI...III""tlon by Fogh An" ...." (1942)

Group I , They o'e deh 01 the lip. ~ con be
I.rlxli..;dtd imo: V'
Single Unilorerol or modion d.h
Double 6ilo",,,,1 defl1;
Group 2 : Th e, ore del!. 01 the lip ond tho
pa lote. The, are orlCe <>go in . ub. ell", ifi..d into:
Partial eleft
Si"ll ie Unilateral deft.
Doubl . 8;lot"",1 deft.
Group 3 : 1hey ore defts 01 the polol. it>Jending
uplO the ind.iwlioromen.

Sehllehard! a"d
"Ie.. meetlon
Pf."..... y",l>ollc Kerne~en ' frlpp . d 'y' cleulflCltlo n :
Thi, i, """Itoef .ym bol;; de " ili cclion pullooword
Th~ d",.ificotion mak u ~ of 0 , h.;<1 mode up by Kernoh.;n end Sto rk (fig 3).
01" <lico l block 01 th r~o po il! 01 r,,<:lo ngle, The clo ... ficolion use. a stripped 'yo
w;th on In.-e rttld I~o ng" 01 Ih. boIlom (fOg 2)_ having n~mber<od bIod . E ach b~od .. po .... ,,,
The in ~..d mo"Ul" rep,_mlme solt polo'" o specIe 0''''' oi,,,,, 0,01 COiIy.
while the rocmngles represent the I,p, alveolu$
610d I and. . lip
and the hot<! palme as we go down . Amo,
Black 2 and 5 AWooI",
offocred by deItJ ore shod.d on the chort. The
6lack J and 6 . Hat<! pclale ""leriO( to lire
oct.onlOge 01 Itoi. do"i~C<rIion i, as "mplicily
./ inci ...... fo.-omen
willi e the d ioo d,on lag e, include difficulty irl
wr iting, 'Yping and communiCOlion.
aloe_ 7 and 6 . Herd polate pa,terior 10 ind,""
""""",
 ". ,".wlly ur'MknOl'OI. ""eo, i"""t.ed in Ih, deft are
'der!Oled by 'I*;TlCo lly in di<:ati"ll the alp habet
1 4 'Io rnJ ing for it. Fo r exe mpl e,
1 _ . S - .. ,,,,...d. for deft 01 right III' al'd toft
.......
1 A - S - -L oland, 10, deft 01 right lip, oMoolus

and >011 polOle l~e' wilh lei! c~ lip.

PROBLEMS ASSOCIATED WI TH CL EFTS

7 ... deft lip and JlGlotft pati.." is Qllk'-<l by"

8 1.
9
Block 9 Soft polot.
The bo>:e. 01"$ .haded in ",..,
!he dell has occumo:l.
La",I1", cl.ssm""" ""
This is" simple do.silicctlo!1 pre ... nled by Okri,,,,
In 1987 lAH SHAL is a PO"'P""' ''' of the
onotom;c amos affected by the cleft
L top
number of pn::>biflnu. They con be broadly
d"nified", :
Oerotol
2. ErtkolH;
J.
a .nt.1 1"0111. ""
The p.........:e oIlhedofl isosscrioled with d>ision,
di,pI"".mertt ond deliclerq 01 "r"l liwJe. Cloh
lip and poelo!" "",I" nl. co n r..:,vo on. or more of
th e foJ lowi ng leoturel lfig 4) .
Congenital ly mi ..i.... teeth (mo51 commonly
..h.,.
the upper laterals)
Presence 01 notol ar neanotol teeth
Prewnce oI.upemunO'fO'Y l d
Ectopico lf,o erupting IeeIh
Anomo li esof tooth mor~o logy
E no m~ 1 h)'lXlfllcsio
""cmdontio

-
Fu...d~th
A ot.eolu. AberrCllian. in crown .ha~
hord~e
"S loOh ~.,!" iI>obil& cnd e<lr1y . heddinQ of teeth d<JO to
"
A
1
......
hord po lote

lip
poor pc;iodontol. upport
PosIerior ond ont~ria r =.oite
Prolruding p'emc"illc
This clo.. itocalion is based oro the foct Deepbile
thot do#s oIlip, oNealu. orod ho..:! palate con be Spoc:in",crowding.
1;.10101'01 while c10lts invo"""9 t.... ""h polole ar

Esth etic problem.
The cletts invoilli"il the lip Ca n resul ! in fociol
d isfigu reme nt <lM"il from mild to .., .. ere , The
o ro-fodo l structu re. ma y be mallorm"" a nd
cO"ilenito ll y miui"il. Deformiti. s o f nos. OJn
o lso occu r. Thus ~Itheti c. il g reatl, offected.
Hearing a"" speech
00# lip ond po"'" o re sometime. oo<irned with
di .orders of the middle ea r which rr<Jy affod
heo ri "'J . The pre", ",. o f h. o ri ng prob le m. OJn
OJu '" d ifficulties in ., nguoge "Pla ke and speech ,
PsychologIcal problem5
Cleft lip and po lole p-oti ent, ore u nd~ r lot of
p>rchologico l $1"'$$ , Due to their obnormol fociol
a ppea ra nce they flave to put up with , toring, ./
curio,ity, pity, etc.,. They 01'0 foce probl"",. in
obtaini ng job. ond rnolinlllri<ond,_ Stud i"" hove
shown thot these potiMj. fore bodl, in ocod emics_
Th is i, us"", ll , as a result of hearing impoirment,
'I'~ech probl e",. and freq uent ob .. nce from
""hool,
MANAGEMENT OF CLEFT
LIP A.ND PA.LATE
Ch il d re n born with deft li p and ""late f>avc 0
number of p roblem. tho t hov" to be solv~d for
succewu l rehob ilitation, The complexity o f the
problem requ ire. tho t 0 number of hea lth co re
proctit""",rs co-opemte to enwre comprehensive
cOre of the potient. Thi, led to lhe co-ncept of 0
muilld i::<: iplinory d eft "" Iole team compri.ing of
tr.e p.l!dietricion , pedodontist, orthodonti.t, oro l
ond moxillofocia lsurgeon, prosthodonlist, """ie l
wOI-k~ r, g Metic 1cientist, ENT sur(leon, plosti c
 ~ Manage:m",n' of Clefl Lip Clnd Palate
surgoo<>, psychiotri.. and 0 speech polhologiv.
the Ind"iduol, ollhe deft polole loom
.ho uld be lIe.i b~ an d re.p"e! &Oc h olher'6
op; nion. The d"fi lip and poklte !&o m ""s """"
dacribed Os 0 dose, co-operotive. demoemlic.
"",Jtj. proiessOonol union d~1ed 10 !he ";nllle
eauoe of pali enl wellbe in g.
The mono\lt'me<11of cleft lip and palate
,
Con be di",ded into the followinllstoge. :
Stage ane
This comprises 01 ..... treoImenl done from b<rth
10 18 month of 09".
Stege two
This is from th. 18th month to the ~Ith yeorof life.
II generally COfresponcls 10 the primory demmon
"'"
Stag. til,..
Thi. incl. I,eotmentlhot is ccmed out during
I..... mixed de nlition " ""_' II <pO'" from Ihe , i,lh
10 the "Jev.nlh rear ollife.
Stag. ' ou,
This ;"dudes treel""",1done d uMg lhe peo " "" .en!
dentition .toge Le. 12 18 of 0\1'1.
STAG E ONE TREATMENT
The ~I rr.:xkolil;e. oorne<! oul during the
/i'" >loge itdude :
Fa b,iCQTia n 010 ponive obnJ,olO,
P'""''9ic:c1o~ia
Surgiool monogemem cl deft lip
Surgicol monogoement 01 dell palate
Pn.'n m."W.,y oOtu,ata,
The mo>:iIIory obtvootor,' on inlro-o"lll prostheIic
devu !hot ~I" the polatol del! ond......, prov;dM
445
.' " 0 1\01.. rooF'ong ogainst .... i<;h the child con .odd.
(Jig 5J. 111h.... ,od""es the incidence oIleeding
d iflicu lliel 'u' ~ 0:1 i",ufli,,,,n! .vdion , . '0011 .......
a ir inTeke e nd d>ol<i nD. 1101.0 pl"CWide. moxil1c'l'
em.. ard> .Iability pre.en~nll Ihe orch lram
collOJpl.ing.
Th . eh!u rolOr i1 lobn"ed using coki
e w e acrylic cite ' u l.ctive bloeking of e ll
und .. , lrable undercuts . Clasp. 'an oid in
,000...,IOon. In c"'"' oI lnwll;oent retention, wings
rn<ld &01Th " . wire Co;r\ be embedded in tt-.e ee~ 1c
ond rrode 10 lalow the died< oonlOufexlroorOlJ l,
Thesewing. can be stobilim:l ogoinst the o:heeQ
u";ng mO:.roporeadhM .... lop"
P . ... ur"c.' Orthopaedic.
Theoim d pre . surgical oo!hopoed'a islood'lM
0" uppe ' a,ch form thet co nforms TO!he ~
a rch [fig 6) .T... Obsei1C8 of "",,,,,~ e Q rT"(>.Jnt of lip
lis",. and the di';. ion In tt-.e ohoeool", and palate
resuIb in ourwo.,J dioolacemenl coli'" p<em.,.;11a
[i " COte 01 biiaTero l defTS) or the greeTer II>gmenT
(in "'.. cl un;loleral delll). T..... artroodonti.1
.houId try 10 coi'l'fld " -di<ploceo ' ... ill by e>dR:J.
e . ol "rapping aelOl' I'" premooillo. aIIOdoed
dir. e1!y 10 lhe Ieee 0' 10 to me lo'm of h.a d oop
(fig 7). A micropare odn....:... lope oon olIO be
strapped aOOO> the premo' illo.
In eme of 0 ""..ow, ",Ilapsed mo>iI\ofy
""h, IhiI e>qlO!"lSion co n be cch .."OO by 0 suitable
appliono:e incorpora~ng eo<ponsion sc:..... or
springs.
The ad ve nloge. 01 a pre.u rgicol
o~ i cp ho .. a .. :
o . k rtodo.<es the ..... 01 The deIts thereby oiding
in ,u'gery.
-.
1>. Po rtie l oblurol ion oIlhe d eft clli.l. feed in g.
c_ Im~ ~ o. Ii", 01 the defecl II
d . h 'eo5S~re. "'" parenTS a l 0 <;JUC;"'llime.

5urilcIII lip clOlur.
It il not with in the >cope of thil book to dilCU"
the surgicol proced ures und . rtok.,,, How,"",,,, th .
ortnodonti, t .f.o<J ld k~ow ot wh otlimo the . urgery
,hou ld be perf<><med , Surgeon',hoye for 0 loog
ti me diwg ro.d 0" the timing of de# li p $u". ory_
Scme prefer eony .u rgery . ooo 0#'" birth while
othe ... recommend 0 lo te li p , urgery,
Th e &e d, ""hod sugg est< thot . urgery
shov ld be performed within 45 doy. of birth
hcarding to them, Tile ch;ld 500n oller birth shows
B
f ;g 6 p", - ''''If,, 1o'bop(,..' ~' If! "' "",10m! doh tho
Oi<p<>ced ",.,." "i lo " '~ '0 , ork<m .. the crch
(8) In " W ot. ",1 doft, 'n " d.""ocod ~_" '"'11"'''' ;,
coo"""
"",,,, p,,," I> I> I!-.o 0","
f;.g 1 r", .
"-"\l' ,, 1 ~'" br .<To-""" .""W'ng
oem ..... ,....,,0,;10 ,
o morked immun ity to sU'!lico l .h<x: k_ The cony
,urgo ry 01", improve. the Iodol oweoronce ond
therefo re improye, ch ild occepto r>ee cod reduces
porent opprehen$lon ,
The Io le ""hool ,,,,,gest, thot ,urgery
, hou ld bo po,toncd til l the comp letion of
dentilion.They reoson"" thot the tiuues wou ld be
obl e to g'ow ond moture the,eby giyi"ll th e
' U'!l eM more mU1cie mg" towork o~.
Mi llord ha. suggested th e ",Ie 01 tM.
Surgery shou ld not be performed leu thon 10
weeks of 0 1}", when!he body weight i. not Ie ..
thon 10 p.ound. ond the bhod hemoglob in no!
ie .. loon 10 grom.%.
5 ur, 'cal pala te closure
Tm. polota l ,epair should 00 ottempted ""twM n
12 . 24 month, 01 oge. This fodlHotes normal
,peech, heoring and imprm'es swa llowing . The
p""to l repoircon "" IXcomphf>ed by using bone
l ron. pionts toot or~ to ken from rib, i1100 bone,
rno.-.d ibular ' ymph"i" libial bone or out~r lable
of p.o ri eto l bone ,
"
STAGE TWO TREATMENT
Th i, co mpri1e' th e treotme nt corned out during
the primary dentition , TM pr<x:edure, corried ovt
during th;, poo se o re '
I

f"g a 1'Il, . 'I' ~" d e!r I p cod "".,. ..... (5) & fC) '-,'f\>Cr<> ph*; ,~ "" <Ior." "'~, '''''''0''11
orowdi"" and 00100", ''''''''' .. tEl ~c. ,,. "'1I~oI ~ " .0"'; cIoft I;" '1'1 Me,I ..... o.Ik-,,,,,, ~ doo.ly "",',oO '"
t . P'O1Itv.... ':c1 &:GI !ad 01"'""''' ,"<> .. "'" p<''''''
 0, Ad ju. tm Mr< in tM intro oro l o bturotor tt>
oa:ommodO!e the erupting doddC/Ou, teeth_
b, To ma inta in a check o n eruption pattern OM
ti ming
c. Oro l hygi "" " instruction.,
d _ Rerorcti on 01 decoyed teeth .
No ortho do ntic trea tment i, u, uall ,
i n iti ot~d d cring tnis pha,~ 0 . th o "", no" " d ~ <i ,"d
wou ld b-e ki,t a, saon a, the deciduou, teeth are
,hod
STA.G THRE TREATMNT
Stog " three irn:lcd ... treatment carried out during
the mi<ed d entition phose, Th e o rthodontic
procedure, u"Xl II , carried ou t a re :
CorreCT io n o f a nte rior c rm .b ite< u<ing
removob le or t.xed appliorn:e" The onterior
cros;bM . hou ld be correcT . d to oo id
fur>ctioroa l maooibu lor d i' placem enTS 000
retardation ci maxil iory growth due to Icx:W
In mo,i ll o , Remo,ob le app li ance>
irICo rporoting Z 'p ri ng con be u,ed to treot
ccrrodion . ,V!o,t deft li p o n<! pa lote pa tients
,-.,q ui re long term if not permone nt r~t""Tion fo r
the fo llowing reo,on.,
1, Inodequ ote booe !.Uppert
2, Abser\Ce of rome teeth
3, Pfo.e nce of , tretc.h ed scar Ii"""
The Key to the . ucc,,.,ful rehab ilitatio n
of 0 cleM lip and pa lote pati~ nt in d oo", flexibil iry
000 a mu ltidiscip linary opp roocn Morc tha n
tni. the po t;" nt . hould be treated with ')'r"npath,
and coocern.
RefetenceJ
And~" _ Scboc k B",,,", onO Pou i " ~ goi'_
i"ll i" poi..,!> ~i " , I<ft li~ ..-.d cleft po '", . Am J
O"hod 1995 ; 144 ) 52
2 Bck'-; , ,.dono 1-, "'." :"'bIob," 1<oor"","T" b ",_
. 00 1 <;1. # I'p 0"; pokJt., , Am J ONix>d 199 1 ;
297}05
3, !Ihola; ~ ~ - (;wj,, 1""""""I, H:""""" 0"" [Je~ .
opm4'".I, !-JyJ PC"" '"'. "",""", New o.. .~ , 1Wa
4, Bi,I""a, V"~"'" P" ." 0(""""" 0" 0 P..--.i,,,. ,
Oootol''''ol fi"O iol ' io ,, ;10 ~ I " um,pol ,, "
mec ;o" d"" cf I". "'" J eXlhod I ?85 , 15 7_162
5, H, I."" 5, . " , 1, ond O" i, Ei!.ct 01 timi ", 0'
olyool o, , Io't 00 ". 9'0fts. "" J Orthod 1987
2 32_ 2~0

the ante-rior cro"b ite. 6, K. " , W. kh, Mee ," , To'-. Ii, 00" 10"011 0
2 Bucco l segm ont crOI,bites ore o lro troa red
,,,,,,,,,,,,I'<'il ulctc< thercvl '" 0'" "" lot< pOt'... ,
i'<r. J o"hod 19"8 1 , 508_S 2 ~
u, ing q\Xld h. li, or expa n, ioo ,crew" 7_ K....... b<-. wo'"' Korl , lot. det",.,. ,,,,,,,,,I ,,,,, tho
"""",,, I cl<ft. Am J (M-OO 19W il ().;l _11<
8, Nob.roo en" ~""""",,, (~.h"'... , oi
STAG FOUR p'''on'' '; <1-;""" "'.,
J Qrthod 19S3 ;IAO I<6
<Iott i p 'nO/'" ""Iot<_ /<r.

Th i, , tog . con, i, t. of tfeo tm. nt during the 9 Pwl " WII, (or.l. """",'1 Orthodo,"'" St lc " ~,
CY"", ;,-,-,1 9U
permane nt denMioo. The pal ient;, trea led u si~g 10, 1" " "T E "'0-,..", ....","
boo!. oi C.hodont~" y""
" fixe d o ft hodonT ic app li ance A ll lOLa I boo< moclcol "" w.o." in<,1 98-!l
irfClluio ritici li<c cr~ing, ,pacing, = bitm ard
II Rabo,., 0'-'; Soot...,, : U" " f", ""'" '"'
'""T",,,,,
"mo~ "'" . . ., 1 ,.,."'. ,,, Am J 0 _ 1.-.00 1988 ,
OV" riei ! OVll rbite prob:em. or~ corrected. Patienll 38-!l_3"94
12 1""""0; , , A.--- con",,,,,, In ,io. .... 'r orl-.op.dc
"- wjjh hypa-pla,tic-maxill a maybe g iven lace ma,k 1",,,,,,-,on' 0; d,i, li p o" d polot. _ Am J Ort~d
to'o dvance tho rnoxill a . PrOltne'i, Con be g ive n 1969,219 _229
in co.o of mi n ing teeth oft. r co mp letion 0; 13 i ...... , ...,..."",," " tr ,~ ", ~ ... " " ,,', of>et- " "" ...
~,;On ..-"f/ o.- ",",o'><h)- bot,. ",oli .., n dolt I" ..-.d
orthodont", th erapy. 00101. A" J Ori--..od 1I'M ; 6~3 _ 6'3
1< ,10,,-, o,d M. I " i ' ~ >.\, ,. ,,,u l '"h"" " eo
Fo ll ow ing the o rthodon Tic t reat me nt
'-"",.,,,, " I "0" ",dol ",.."'-nat.,... "'" J ~
procedur" " the patient . hou ld be p ut 0 11 0 1\'82;26 1_24-8
retention pha," to moi nta in the orthodontic 15 ren ca te AR 0 ,01 HI"olo. , Oo" lo p", o"
St",ct ... ,,,,; f",ct<>", L V"""I, >, io .... ,19&l

Orthodontics
urgia d ol'lhodonlia is 0 term !hot ... fe~ to
S
11I' l1ltol pro<:edur~1 cOrried oul en on
odjun ct to or i n co njunction w ith
on!>odonIic trectmont. These PJrgical procedu res
0 ", 11"",11, <XIm.d out to e!;",inate on etiologic:
foclo r or to corre ct ',v,,' d enlQ. loci o l
obnorm,.lme. thaTcc nno! be salisfadorily t~
by growth rnod ifl c.otion proced ure. or orthodo<1tic
camouflage.
Surgkol o rthodonlic proced ure. 0...
broodly cIouitoed '" minor ,urv>:ol proeed ......
0I'Id rmior . urgl<;ol pnXe<llIret, Wh~. most minor
procedU<8S "~ an inlegml port 01 orthodontlc
Ihempy, the mojo< pmcedufl. 0 "" a imed at
roeol" "" ,I ol _ >l:eIe!d rrdoccIusion or denio-
fClCio! d. lom>iti ., thotCOr'll'\Ol be ooli sklClO rlly
treotod by of'Ihod.:mtic tfootmen! c lo"" , Tobie 1
give, Ihe Ii" of mino r a nd moior SOJf'llicol
ortt.odontic prOCedures. There ""ould be IlQOd
co- erdinotion between the (lr<ll lu r~ ond the
orthodontist whe n undertaking ...ch procedu", .
"
EXTRAcnONS
E><IfQ ctions """ the most com mcn~ under\ck~
min or l urgiall pI'OCedure. in COI"jun c:Tion witt.
onhodoo die llwaP\". E.dtodiot> performed OS "
0/ orthodon6c !heroPI' include thempeulic
p<)rt
e><!fOction, ""rio l 'metion a nd . ><I,odicn 01
, ul*'l"Ull1 ercry co ,lou! or moKorrned teeth,
Tlle re pe,,"" e.frecflon
Th 'optulic e><lrocJlon il ......k~o:>ken 0:>1 0 pori 01
fu li lledo. d orthodonlic: treatment ma in ly to goin
' pOCe. Prior I" !I.eropevtic exIrocIinn " 1Iloro"9 h
d logn<><lic e.en::iIe I ..-mill. Tho inc!icoOOn.
lor . "HOdi" n 01 diffe"",' teeth 01 0 pori 01
o rthodontic treatm ~ nt have been dioeu .." d in
chopttr 23. E,troc~ on . hov ld be 0$ otroumotic
o. poIs;ble. During the pmcedUnt, COnt .hould
be tohln to preooNe !he inlegrity 01 the o:>l...oIul .
Ar'r-/ bfeok Of " ' " cJ oitherthe buccol or b ~
bony plate. moy p","ent ideal r.,,,it!oni r.g of the
L .
 ,
45D ' Orthodontia. Tb~ An <lnd Sc:iCl;nce

supernumerory teeth ore th" mesiade" .

Su~"" .....o>y """" con 0100 occ .... in !he Inci ....,
Mm ~ ...d.... ","" maior ond molo r <"e9i011. ImpcctiorlS in me
\. f>~KIion. mo.ill a ge"ero ll, lXCuf in the con ln~ region .
. T!Jor"""~"~ Prlor To Tr., r= O'>'O I of these TeeI~ Their
Sorioi . ,.."""'"
.. Emdoo.,. ....... _
b. _IO<XI~on <:nJ tt.e;r",l:JtionshijI wim odloce<1T
d&r-..at _ _ .TfU".""hould be otcMoined br nJdiogrophs.
During !he OlIlfOCIion procedu,,", co,," lhould be
.. UIraOoon"'~_
Ioken nolle> do""'!l"the oojocent '"'" 01 roots.
It...-01......,_
t. S!IgiaI ~ 01_ The looth il oJ>PIoodled by 0 buccol 01 pololol
, . Foorlt<lOn'!\' Hcp clepen<ll"9 upo<! ~.Ioc<>1ion. AIle, cc lul
4, P.. _ elevotion of lhe fl op, odeq ucTe amounT 01 tXHle
S. Tr~ .. d _ i. ",m oved us in g ratary cutting inl trum enl!. The
!. e.moo"'l111 in'lpOded or IUptmUm<'>'tlry tooTh io romtI"o'ed ond
MoJor ,. _ _ tI>e .... ,0010 , ood.oI impe::Ied b- my pot+.olagiool
1.~~ ~_. The Hop if. ...,.,....,,,,,,, and """' .... plaood
:. eo.noo;; oorvodK foro....-.
3. s...,o.I ........... ildIIIlpW . . . .
S<rgoW auiIIod '"""' ...nIIIy lopanoion SURGICAl U/ltCOVRI/itG OF
IMPACTED TEETH

lee!~ duri~g
, orthodonti c th..roPI' P...oporoli .,
rg<:!iograp n. ere c voluc ble oid in F>c nni ng <>rid
eMoCVIion of e.:I<ad;"" .
Serial " ',oelion involves remooof 01 .orn"
d.oduol,I$lee!h IoIIowed by spo<;ito; pe<monenl
'Hill in on e,deffy seq","",," to guitle tn. ..., 01
tt.e ~ le<:t. n o0 mort f{l"o'OrQ~ position.
:"',iol .,tred"" is u,,,,,lIv corri ed out durin g tho
mi>:ed dentition peoiod ...nen 0 _ ' " oren
Ieogth
defICiency exists ....ch pr-n no<mol alignment
of rt.e .... ole complement of 'ecllh.
Tn, p"'senr:e of impacted ",em in the dento l oreh
con cou" min or dCflTol ill,,! ula riTie. due 10
d~lIectionof odioceOl leem. Impaction of teeth
uouoUv OCCuR O. 0 ,,,.ult 01 o.ch length
diKrepal\Ct or p .....nce 01 mucosal 00'ld bony
berrien TI'tot p"""'01 their .ruplion. , '- mo5I
commonly im poCied loo th il Ihe mo. illory
parmonent coni ..... In many CQSfl H" pouible
Iorthe M hocionTist Ta guide tho im poc:1ed <XI"'....
into it. no r"", 1Iocotion in the dento l or~h oft
odeq...oTe WIll i ~o l .q><>s.u",. The loJ lowing ,TtPl
o, e underto ~en in the monogement of On
impOdtd rOOIh :

Extra cllon o f ,...'....m.'.".,
IlIIpactecr .I"d ilnk,la."d I tll
Tho presence of . upem ume r(u'!', impccled cnd
onk-,i OHd tooth ore impo rtanT Iocol Couo' 01
ma locclus ion . Tn e mo. t commo n I, ,u n
J
o. locolionolthcloolh
b. Evoluolioll 01 fOVOllfobilfly
c. Evolucr1ion of SJXIce adequocy
d. Svrgico l e.e isio n 000 bon e remova l
Fi>.in g orrOOdonTic oTT""" "",,,Ts
 t"""'.... <J 0 ' .."';ood <0"",1 """'" 'I'l 1",.,1 ""D'''''' ,;ow 01 0 12 ,.." <old _ , ...;,n
Fill 1 So,rgk:o l o"O<k,'",
"", "oW """'" j ",;>O(, 191 1><"'0f0,,", " .""""'.' .; tho ......... 1)01;001 (q <>t>d IDI ,,-~oo l "P<>'" rt 01",.
rig"" <>I,';
...... "'~ __ ill Qr1!,,,",,,,t c ~",,,, .... ., 'rogr'" if) orthc<J""r, .. _ "", ri .,g ""'"""""""

Locatio n of Ih . tooth Evaluallo n of favour.blllty

The exoc:Iloa>lion of !he nnpacted IOOIh hos 10
hedellrmil'lld. Ihiscan bedone"';ng!he CIooN.
tube shift technIque or the right ongle 'echniQue
wnG IWO films. Mwt impacled 111> presonl 0
b.., lge correspoondi ng 10 Iheir !ocolion ",mkh
sho ul d be exom in . d cli nico ll y by in.pe<!lO:>n c nd
polpoliOl1.
In many cases rhe orIenlalian of Ihe impocred
leelh moy be such thol surgicol orthodonbc
guidonce 01 rhe IOOItl into rho Olth mOJ nor be
possible. The ICI'YOUtobiMy sMuld be ...omired
pri or to ur"lderTo king of Ih e proced ure. II I,
c"," ,id. r. d ."orabl. whenevor th o ope> of th e
cani "" i$ dose to ill norma l po'ition .
f;g 2 'I 'l ood (8: P""'ta' ..... , ~ " ph,,, 0 ",,<Orl ..;ih 0 ""bt, ~ ".""dod , on ... ooon "'"' ''''Il~oI " P"'"'" Iq
<V>d (OJ "",' h o'_, ~,"ph. of 'no ""'"
PC'~"',

EvaluatIon of spa". ad .. quacy Surg Ical e ~cI,lon and bone re moel

W'h M the impo<tep tooth i, g uded into the dcnl:l l
arch , oo.qvoto .pace ohou ld be present lor if>
no rmo l alig nm ent. In mony ca,e. invdving the
im pocti o n 01 permo nent con ine' If", OOcid""""
coo ine. a rc over-reta ined. These teeth hoe
be extracted to ""co mmodate the p~rmor\en t
con;"", _ In CMo; n pot;",,\<, lhe 'P"ce ;ntended
h th . permone<1t co nine moy be io>t lry migrotio n
of the a drocent t.... th . In >ue h CO"" , 'P<'C~ 1m
the permonent Can;"" il creot<>d by c"",,, looting
the rest of the teeth ond passJ bly ">d ractin g 0
premokJ,
Tf", crown of If", impeded tooth i. expo.ed b-y
exci ~Ort of lhe o erlying .0H tiss ue ond remoV(l1
01 boo ny covering _ The boone .ho ul d be removed
"pto the moximum heig ht 01 ca ntour.
'0
FI~lng orthodontIc attachmenf$
In mos! ca ... of faou'c bly impeded ca ni"".,
o nCe the "'tt ti"u. and bony Ii,.....,
i, ,"moved,
;h~ con in " orvpt. "" it. own . In ",me core"
arthodonti~ g uidcn co lor eruption of "'" teeth inl:l
the orch may be ' eq uired ,
AIIochmenl> o re pkx~d on jf", im""doO
 w'"
f.. 3 So.. '\lko l c rt"""""'" ' '''' ..... ... of a 13 ,.... old pc,.,nI ""'''i<rI
rrpcdood ..-o~ .., ,, loft n "" ",. Prweo'm6rt
0<01","1 ~ccph. f:cte .he bvIgo prodvcod by to. ," n ~ .:S! 'oclioo 'oph 01 '" "''''" pc''''' p AI, n..... ,, ;n P"'Il'""
(0) >OOn oi'" , ...~~ 01 "pC,"",,, tho rooi"" (E) ood If! N.."..... co.-.plel"" 0' "oct_'.
tooth to guide the e ruptin g tooth into the arch. c 8ondobl. orthodonti c brocket; 0' button.
So me of the ot!ochm enl> thot can be ploced on A ligature ;0re is wound oround the
the im pecled canine are: attoch ment ond tho other e<ld tied to 0 remova~
0. A moto l crown with a hook Or fi d orl hodont ic app liance . The wire is
b A cell uloid crown with an attocrment bonded grodvo ll y hghteoed at reg ular int. I"Vol. to guide
ta it the e rupting too/h.
FREI'tECJOMY
Mo"1 c" .." 01 m;dlir>e dit"t"",c ore be li owd to
be coulod end mo inte in&d by ab na 'mo litiel of
tho mo.i flcry labial fran um . Too p,... noe of 0
ri'i,it. fleshy ",..j fibrou s fro"um P(event~ the IWO
rnadlcry ,*,"",,1 iodoars !.om apptO>.imOling eod>
other. In rhese pahents the frenal twue m""cross
CMI' and gelollo<:hed in the ,"-""",""Ilary sutu~
or.a on "'" pa!otol "'p&<:!.
Frenectomy i. 0 ou'gicol p,oceduro
performed to "'~iI" tho f,&num and ,.move ti, .
deePY "mbaddod ~brO<J' '.we.Cortr~ <:Xi."
rega rding to e timing of the w'Vica l .,.-oced u,e.
According to oom&, fronectomy .hou ld be
pe.wrmed prior to orthodon~c cloture 01 the
midline d,oslema. According 10 a"",he, ",0001
oIlhought.l=edomy""ould be pcrIonn..d oller
'p<Xe do..,,,, 00 i, reduce. the ,isle 01 SCO, t;,.w"
10'100100 Ihol cco P'C"ieflf clow", 0/ the midli""
""'" Reg ord le" of Ih e tim ing wh e n th "
procedure ~ perlormed ... 1oJ'aMng poW. ollould
be flIIT\tt\"1berod
o. Thelrenumohouldnol"......lybedippe<!. It
""ould be tololly exciood 10 If. bone level .
b. Any paloltrlly oHoched ~brou. hUIIe ohould
be remo::wed.
c. Fil:mus ti!.SUe aHochod to the inrer.m.,.;ll""
.uture0''''' shoo.Jld be ,,,,,.,,,,,ed.
d. The mucoso of;he li p i .....Q(ll"mi<wrd 10 p'..-i
reanad1me nt of tke ~brO\Js lillYO.
CORTICOJOMY
Corrkotomy i. (] .urgicol p<occd~'e uwally
....-der1oken 1n patient> hcJ.,.,"II denlOl prodinati(]n
", im opoci"9. Tni. te chnique in."I.eo the
.ecti ooing of the donte.o lveo lar regiOn inte
mu ltiple . mo ll unit' to hClten Orlkodontic toolh
mCMImont. lobiol flops ore lOlled ond 1n1".
dOMol bony CUb Ore mcd. porcl"'l 10 the long
"'* 01 t.e l8()Ih. Tf-.,,,, cuI! ~ ioired foge!her
by 0 kori1OOtol bo ny cut eboy~ tf". apices of tM
'''''I! . u"e should be laloo nat to toIoi ly ocpa rolC
the indi.id",,1 unil>. following Ih. surge,),
oo*"xloo Iric IOOtiI """"""'" is in""'led u.. rog h>oecI
appiOorceo.
PRICISION
Pericilion c' circumf.,. ntiol .upro.c. eSla l
fibroromy. o. it" ollen coiled i. 0 millOr wlll ieel
procedu,e that il vrderlakcn to <OlJ"-"l< "" re~
I!o ndency of the .tr..tched gingr.ol fibres. Tho
~an"HJlIQI 000 olveolorcrellol groupd n",1
hbres ......,in -.:he<! 000 do r.::t ,eo::lily readopt
to the . - tooth pasnion Iollowing COIYedion 01
,otorio". henc;e ClI<J>,ng ""10",,,.
f'eritioion invotve. SUtgicollOdioning 01
thew liMI try ~ng 0 ,herp IIOflOW sca lpel
t~g h th o gin giva l . ulcu. o'ou r,d the toolh to {]
dept h "I 2 mm apica l to II", ol'6Olor crus.
Pooricition i. """.... ally und<nlkcn 'lion adj","""",,
reteotlon procedu~ ohe' Ihe corr'Clion 01
.cAo'''''''
ORTHOClN ...'HIC SURGRIS
O,tnogno,niC lu r~erie. er. moio' lurg ical
pro<;l)-d u, co rried o ut oblQ with orthodo ntiC
lhe<o PI' to com>::! de"", fociol deIe'mit"" o r _
oro.iocOoI di.proportions i"""","ng tj,e m<.i ll o.
!he maooibleor boIh in combin::.!ion. 1Nl1O-1acia1
de'orm". con be congenitol, dovI:!iopmenlol 0'
_./ occqUIJed tn notu"" ond con oIiecl the rn0.011o,
the mDndible 0, both the ~ The poiogy 01
.xnto-lOi;lDI d!!lormrtie< con be claosifoed intothe
lo lbwirog thrM Q'o<!P"
1. Known lPOC ifiCcouse
o. Prenatel
 b. PbsI""",1
2. Hotoo:!iIo..,.
3. E""i,c~rMntol I SPlClfIC CAOUI
~E~ATAI. C~IISES
R.f.... lo Table 2 for th e Ii .. of pos. ible
A, '01" _ 0)'fI<i_
e!i~og i c foCI"" . Orthognathic l urg . ry booico lly
B, _ ocij .-.d _ fIoropr
invo! .... planned lrodu~ng of tho fodol.keletol
ports and ~posi!ioning Ihem 0$ desl~. Thq
c. Htnhdll ,,;0"""'"
o. a.-.., *""",. .
Mlould be performed ,,. a room ""Ih the 0ItI1 1I000_dt_ _
surgeon ond tt... orthodonli<l being Important F ftdlt doIIIIIg oyndrtIrM
membets cJ tt...lIIom. G. _ .. tI I,
Ortllc:9n<;rthir; ""gene.. con be petIoo"otod H. Cr' ,"""""",,",,.~
in the me.i l., c ...., 11 '" lhe mand ible to correct I, ,.,. - . .ynctr"",
jaw disc~pc n ci in a ll the tfvee p., nn cJ sp:xe POSrw.T~l

Ref", to Tobl . 3 fo' the "o ,i o u. procedures, ..,~ " ..... MpI.m
Th. plann,ng and ".cvl lan of
,. ....,.,
'";..y to <o>o'ldl'It
.......

--
orthognothic "'rgoerioM Of. done in a melhod,col ....,., _ _ ...:1_
rnan_. The IoII<l'ling 0ft0 the steps i.......w.ed in
orrhog,., ....., .urge..,. :
f. ~ JiJPI"J I'
o. Diognosi' ~,<Ifu<e' eYOIootion)
HlIIfO!U,"
b. P",.urgicolo>thodomks
.I.. ~_toiorn
c. Mock surg ..,.
d. S ur~ryooid.tobi li ,oti on
~I,~; ')'rId''''''
9 1rQr ~loOli ~~i"l
e. PoSl-so..org ico lorthodontia I~ ENVHI!)NM(HTll

p " -01' .,.!lye ey./".tJ 0 ft

A.
a, iIoop....,._
at.:tol-...

P'e-operotiYe diogno5i. i< ve..,. imponom fo, the c. EII<t"'~_

SU<;SS of orthognalhic ""'lIt..,.. The d".,gnosis
il oimeil 01o:iele<mining the notu~, -"Y ond
The potienl" .oe... 1 .Iolus .hould 01.0 be
the possjble etiologv of the cIo.nto.1ocic1 delormfty,
"""Iuolod,
Ge nor,,1 medica l ""oluol,oo : ThQ poti onf .
Cepha lome lric evo luaHa n Cephalom etric
~nef(l l med ica l hi,tory .noul d b.. recorded 10
ev<l luatl an Is on impo<1<lnt tool in a.1",mining
tVlo out med icol dioom.,r\. The polient'l <rn=ra ll
the nolu", ond _"ty of ~ .l<"'eIol pn:>b!eml.
deni<J1 health should be .""I""ted. Pulpo
The commonly uoed cepholomeltk anolysi. 0'"
periodonlal problems ,hooId be ~Iieed prior to
lhs 8u,._ onoly ... ond the quodriloleral
the SUtgicol interYtlnlion.
anolp~. fronlol cepholometri<:.....,.,.... help' in
Socio _ psychological 8volUOlion : The
det.omining 10001 osymmetry.
polienl is osses...J ledet.,mi .... who""', he I M.
il ow,,,. '" th o ""sting dento1ocic1d.formity and Rod1oQ'O/lhlc uomjnclion : P,io. 10 !h.
whot he I , h. o'p"Ci> wt of tho . urgi co llh o,O\lY ...-gi<:ol in!Qrvertion 1r..loIIowing rad~roph. C~
Th ~ .... po in dele<m ir>ing tr.. pcti.nt'. moti""tion, mandatary.
1. l"tf'(J 'OII periopicol rodiogroph, , Th...
rodiogrophl help in desonn;ning Ihe conda"", of
!he lM1hond efteoIg,bono. rr-..:..d pa1hoIog,
""""ndlhe loellh con 01.., be de/etmined using
tt- rocliogrophs.
2 . I'ono 'omlc ,adiooroph.: Ponc>,c>mie
tOd iogropht off ... "wide view d th e e nlire
den Tc>f"ci,,1 region including th e temp e,c>-
m"nclibuie>, lolnl. The'-\! rodic>grnph. Ore u.eful
in .val"",lion 01 bQ n~ polOO!ogies, """ Iuelie n 01
the temperome>ndibulor ioint and me moxilklry
sinuses .
3. Submenlo.e'le iew ; A rcdi Ollro ph
fOLI1i ..... ~ used is the sub .......10 ..,~ ... ,"_, 10
del",m;,. the buteO.linguol thielrnou 01 the
....
mondible 0$ ..... 11 01 degree of deformity d !he
Studr mocIelltl'Oluolim1 , Slud~ ", od"l. a'.
helpful In lhe $YOlu,,"on of c>cduoioo fmm 011
direclion . Th&y ore uJ.ed to c.ses. inte,-orth
end intro arch diW"ep<lr\C","
TM! evoluctiC>ll , Th. te mpoerom<ltodibulcr ie int
is evo'UOIed boJ inspection, ~ion, ov=botion
ond boJ roo'iogrophic "",,,,...,,,ion 10 ...ouole ;oint
ITIO'YefTIent. and ony pathology.
The abjedMI 01 .,.. .... ryicol orlhoOOnrics is 10
~por. the patient fo, the intended orthognothic
.u~ ..,. ond "'" to mer"," the ocduool relof;e>nohip
os icIeoJ o. possible.
The follc\oin g prcx::edu res or. und"""",,n c. pon
of pre'lUrg-ico l o rtOOdoolb.
1. Teoth oUg nm en t with in the oren es ,-'
Spocjngs oncl "'"'tioN m,, 10 be .liminal&<! dU'ing
Tfle p rellJ~ico l orthodontic treotment. Simple
co " ..ctie n ca n be achieved b~ removobl.
oppliorus. Howeverfured Opplo:roo,," ~
01 they oller belt" """,01ond d i. possible 10
olign >eYerOlleeth. Spec" mer, be needed 10<
the ... monoeu ..... which elln be goined by
I"terd"nlol <fri ppi"l1 or ",,,,, ut,oction .
f ",roQions during p",",u'llicol orthode>n~a ..
generolly~n Io ........ moden:rteto_ ..
cro"..jlng wi lhin Ihe denIa l o,ch.s and 10
occomodole <egm...,tol 00"" out.
2. Alt. relion ond co-ordinati on of th e
orenes, locol cro.sbites involving an individ uol
toQIh c Ol1 be (crrected wilh r~movcble Or {",ad
onhodonl it opp lionoe . Howe.er "'llmenTcl
crossbiln ~ nanow ma>Jtoryon:h ~ ""'"
form 01 orch expansion procedure suc:h ore '''Pod
maxillary ... po .... icn with hyrm opplionee '"
"POn'icn uoing quod hel .. appliance. IU a
general rule orthodcntic ""'I"'mion 01 con1fdion
10 co-or<1;nme tIr .. upper and !he IO'WW o,et..
.hcuId be come<! oul prierlo tire ... rge.y SO 0110
p ,o.ide (o"ect po,top"'Q Ii ... oedusol
inoen:llg itolion.
3. Inciso , inclinaTion. P,eclin e d upp~'
in cisors in 00... II, division I m(l}" r>eed TO be
",t'CKTed 10 mor. normal ox",1 irKl in Olien .
5i mi.,,1y retroc lin ed i""""" in 00" II, divilion
2 he ... 10 be proclined .
~. o.tompensnlion : Moot ,,,,,.r, Ike l,,' ol
jow discrepo""ie> 0"" po~1y compenooted by
c""ngel in 0, .,1 indination 01 the onlOrio, teeth.
For e""rnpl .. , mondibulof ,,,I'ognoth .. m i,
ouocloled w~h prodi...,d lower- ont.riors to
poniQlI , o!foe! the , l eiclol diKreponq. C.,ulll
poIients with proonothic mondible U$UoI/y e""ibOt
lipped low ... ir>eisors to compensate fOf
li"'i100 II~
th e .ke lcto l ,e .,tion. Pre .... rg ico l MnodonTlcs
, hould co"""t tfle .. po.itie n. of compensoTlon
to positie n the Iee1h correctly ev. r the; r ... pponi ng
bone. Tni l pro<:edu,," i. coiled dec:om peruotion.
Sinte mosl po1iem, 'equire posl.
lIJ'lIicol onhodon1ic _nt, ~ is unnKeISO",
 4. &o:DI., - . " . ..tr. ....... SOl
&.. ~ ~ ClI>'>l)W I..,b .~ "_'1'1'/
_\Ii"
4. ~ &PM _~0I'I'If !OI(Il ~ _","""",1 (f~ .)
S. ~ !orwI.rd ..."", ~ " tit chin Il'lI)' t>o roqoirod iI..mon

......,. ....,......(~ .. trICk (fig 5)

1IaduJ""'''''''''''' ~ -...., tor _ _ ,, _
_ ...,_(tv1.)

...... . , 6oIIcIttqo' _ , "'.... 4. Lob'll_...., 01 ...... oct. .... ord in'.,od ....... _
8, ~Jpiit , ,,~ ..tII _ 111_11; 'I

A tJ.II .... r..cI" .prtt b/IO.

umr
oog_ "'''''...",., lIil/Ol'
~ ....:IiillJ&o~ - . , .
dInt._ "'*' _ .".,. ,...,.
c!onIo-_, ~ \II,., tin lot _ try ~ .,1orIor

/I. _ _ Mo (111m 4of/O"o am I or If)

- ..............,.-_........, ........ ~_I
_., . . . .......,_10""'".
C. _ _ ... fWIlII Antl/t., C/uo 41)
I1Int ~ ..., iiOI _It _ ...5cOi ~ ....... 1100J
_ ~ If/! 01 .-.. lfIII _ lxdo'. ~ 0I'III
01....." " '"'" to .,..,. Il.I"'" !>:>ely ....,. .... bO .,..
....... 10 '" _o:I:t\tII _~ '*'<91""" II _ I fttr rw:iory
......... , 10 !WIt. In cat thO palol<l "'" oxhU!._"......,

.... ~_,.....,,,

_..."." _
FOI1I I IOill mllflt)' np.don io <WO.

one"'" _ _ Mgmon\I!
""" 1M 1o....1n!I.
~ .. b:'t!; row _
 C', 1 \
o .
}

V
\,,

r'll ~ s.... cr.... I ";"k.rl.,.~ do. ... .......dt:..1o.

_000''''';'" . - by ""g-...,I..,I.. o.~_
....nIl.. ,"" """""" .......

Fig 6 Clo .. III , 1"01 po,,,,.

d ,., ...... 'b ...... F., 7 0 - 111""""_" dOl '" ...... .,'Y "".,n
.............,.
.."" ...... i.m ~OOI b, >ogillol ."I~ ",,",,,,om, with 0< bypopio,;" . - by Ie fOIl I . . . wit.
_bolo< ... bock. .~-
';; a eta.. II .. _ _ ...... to.-db) .....",."" f9 9 Shiel'" """" biI .. ,1""1/ "' .... C ... II ,bIetoI
.. 'tm";' ClOd ""'''''Ib,.... P""I/'"'Ot; ..., rr..... .... "" I.. 10 fo~ 1"" '0 .,."";1 ;. .... Irn ~"""
po .... ,"
I. f on I ...,"'.......'10 ... ~ II ... od ... -.aom_
tog ...1 .... ~ ~ ..;t, "",""ibo.l", ... !>ad<
God togi"t<1 ""'''''"''''I'!''' _bob< ......,,,.... '

fi~ 10 tGO~ 1.". I, """ II, ",.oa,,'od,.;tt. _,,, I fill I I 8,,,, ,,,11 ,,, 1"0'''''iotI _"~. ""'.;;0 ..... n~
trJ_ _ They ... """"" .... 1. 1'<><11 .-.. ......10.. ""''''' bub< ___ "",I , lor .. bod< 01 0 . _
I"'p<><....... ..-1....d .. """bIo
 10 splinls. The orthadonlic orch wire nne! l>rocktls
con be uMd 10' the inltrMO>.,Jlory fil(O~on.
1"........".110,., Ii:.ootion ~, tpClns lor 6.8 """'"""
following whk h the . piint il remov.d.

" Of t . ur,'e,' o't~odontlc.

Soon nr the ,u""'''y, 0 PM,.. of posI.su""kcl

af\hodon~c !featmont is inilio!ed. During this
phose, the foool detoiling ef 1M occ lu sion end
esthe!ic: r<:<;I! pcrol&ling iJ COIliId eut. ~ CC>IoIII
of posI'''''gicol onhodonlic:s ere compleled by
4.0 men""'.

COSMETIC SURGERIES

They o,e ..,,,,,ieol procedures corri.d ou' 10

Improve th, esth'l< OppoOl'Onct alth, pc""nt.
f ig 12 1i""'0","1 <M" d,IHc;o""V oft." '00"'" TheM , u<gerlt! can invo;"., the /"lOSe and !he
"""<>Po.....
ch in. Cosmetic surge ry of th., nose is co il ed
10 cony out -...... p<eolUrgkclloolh 1t..... ' ... '1 .... inoplo.ly. They 0' " und'rl<Jk .... 10 ~o",CI
thotcon beoo::omplished _e<Syooo quickly abnormal confrgumlion of If>e nooe . Cosmerc
during or oher Ihe '''rg.ry. Pre.,urgical 1U'lI"'Y cI!he chin i. ,.fered to !;IS genioplosty.
ortoodonlk pr"""""l,,=", shovId ne_e>Oend more
loon on. yea .

Moc k f ur,. r, I. Cd- TM , ~ , pooo""", end fIIOdIco.

W8~1983
Soon afte r tl1e completion of pre,u rg icol 2. p","" Wk, Ce>n.....",.,., ry ~k ', SI loo,,;'. Oi
Mool.,, 19M.
or!hodonlio; lreelme nt 0 mod< SIJ rgery ;. performed
3. Prc/ .. I'll: S"'Oicol 00!h0d0<rIc , _ .
on the upper ond Iawtr model. mounted on 0 '. _ f _ : Ib-.:I boxrk", c;w...L,.". __
hinged Ofonotomiool aniaJoJor. The mo:Ioh aff: hook """""'".~ "'<.19M
5. n.-:.. M Goabo<, II.>b<.1 t _ _ , ~

cut and ",pofi~ooed in !he d."rab1e poo ition. tiu , ... _ P'in<'.... . o, d *,,,,,,,,,,"',Moo.., __
1M segmtl nls ore secured in the ir nt:w pos ition booI. in< , 11>9~
U$in" s!ic:~ wrut. The mociaUlgery Ih~ helps in
e""I<IOtion and possible modilicarion 0/ the
""""icol If..,tmenl plan. It al.., h .. lps in the
preparation of on oed"..,1splint.

Su r,." 11111 "~Io"'lIl1on

The next step irM>Ives me turgicollmduring ond

repoo ili onlng of the bony HIOlments. Tho!oeth 01
!he upper and lower ClIChe! ore wired in oedusion
 and Relapse

I
PWM l>e)'Ol1d do ubt t~t '"'" mo.ed
t is
lhoog h bone usr,g Oft( ortflodontic o~ic n'~
have Q !efldency 10 ....tum to ..... , original
posiIion. Relenrion 110, been defined bv Moye"
--
0. 'maintaining newly moved IeeIh in posiIion,
Ioog O!'nO"llh to old In stobil;,; ng their corredion.'
Ikstabi1i~ing
Re lop .. has be."
defin ed a. 'In.. lOIs of cny
r"cton
COlf'Khon achieved ~ o,thodoo,!i<; ~tment.'
Retenrion of tmh in ldeol funr;ti<)nol ond esrhetH:

--
p:>t.ition loIIawing Q/!hocboli< IreoIment poses the
grecle!t challe nge to !he or1'ho<lorIiSl, Quile ofIen
we ~om " a ero .. c;g ... thot req ui~ me ,e , kill in
'eto i nin~ thl! tMth thon in "'lIvloti r>g them.
fig I CO""".~ ............
Reter>lion is too often lightly considered.
Stobo1izing the rreotment ",,"0'" by ,~ntion SCHOOlS OF RcrENrJON
procedu .... is on i"~rtli pori 01 orIhodonnc
Thc'cpy ond tflerefore P''''';'''''' .f.ovid be "", de 0.., t.... 1""''' -0"""" philosophiel ~!-...
i~ the Ireo!m. n! plan hx ocleq<JOte rete ntion p~t forward to expIoin post-treatm ont ~
~""p;ng in mind !he de.tabilizing focton (f;g I). n- ore re/errecho 0$ rile >Chaols of" f

<
TIl , occl ..,lon . cll ool
hamr.ng 10 Kinglley, proper occlusion is 0 key
foclO< In deiOtminlng !he stability 01 the n~
mcr.ed teelh . The importance of this factor in
scI!, guordlng the stobility in !he new pO$ilion t.o$
been ogNed upon bv 1e""",1 other OUlno.. and
resea"'" ""'Dri<.....
Tile ep'c" b . . . .chaol
The apica l be ... t<;Moo l Ma. been formu lated
araund Ifle wr~i ng . of ~ I a,,'no.. inclu ding
Ail>.lvnd.t,om, McCauley and No nce.
Ai.,.lurdstrom in the mid 1920'. $U{/Qe$tecl
mOl the op,,:ol be... is an importanlicclar in me
<:anection of molocd ..... ion end moi"""",nce of
the stabolity of _<I case .. McCaulev added
tho! tho i....., -<;Onl"" and in ...molor widths .t.ouId
be mointalned dvting orthodO<l~c th=py 10
m,nimite rettontion problem . No "" .. noted thot
Tt>e arch I""glh co nnol be petm o'lOflli<r" illCf""Md
too mcloreo:r&nl.
Tft e me ndlbuler Incl.ar .cftool
Grie"". and T.... ed MY8 .ug geste<! IMI p<nt.
t~ IIclbiloly WOI incrt!Q~ when ...."..jib .....
inc iIorl - . placed uprighl or s5ghtly ,etroc~
ove'lhe bctol bo"".
TIl e mll. clIl. hl.. lehool
The <lenlilion I.encopsu"''''''' foom outsid .. and
inside by muodes. According to Roj .. rs, functional
m"scle belon", i. neao= 'I in <><der to "". "re
PG'1!1"OOtmjl.!l! ito bi Iit,
CAUSES OF RELAPSE
N.,,,,,,,,,,,,, are the cau .... attribute<! ta rela ......
Na l ingle foClO< con be$Oid to be th e$O~ cOuse
of relo ...... In n.;>OI C""" re.Iopse oc("" <I"" ta a
combinOlion ~ co ....... [fig 1).
Perlodonlel ",. menl I,e ellon
W,,"-lMIh are moved OfthodOOlicolly, ....
periodonroI prirotipol ~bros ond the ging;..,1 Mn.
thar.rw:irde .... -..ore .... do::!. n-lfnIid'Ied
~b,tI con conlmO' 0Ild ore Ih", a potent a>uM
01 relapse. The principol/ibres ol!l.e peo1odooto1
j;ggment l$OrYO"9f! ""''''''''''- quit. rapidly 10 Ihe
<"IiIw POliti c n. Studi My, . noWf"l thot th .
principel fibr@, reorgon ize in oOOuI 4 weeki ti me.
The l uprool. eo lar 9in 9;.,.o l fi bre$ on the olh"
nond f\:T k" (l$ mud> C$ 40 _ .. 10 ,....,r","9'
oround the now pw.iIOon, ond th ... predi~ to
"'opse. All" campr"h .. n.i." arthodonHc
treoTment, Teeth ""Iuire 4-5 months 01 /v1l.M""
<e1ontion $O os to allow tho 'eorgonizolion 01
pe"odonrol ligoment libras. Alter mi, period.
......nhan ohould be conIinued ana rtduced besi.
fO'"o Ivrth" '8 month. $O o. k> ollow lhe more
""IIgish gingival fibros to ....adopt to lhe new
toom pol i~c n .
R, /.p.. d ... to ,ro wlh , .. Ie ted eft.n,..
i'clienf> with . ' . Ietal problem$ ouodated with
Cicil II, Cia .. II I, a",," bite ar deep bile
molocclu . ion moy u hib;1 relopse dlle to
cD<tlh.lotOon 01 the abnormol growth ponemofrer
arthoclontio; /he",PJ. Studies ht>... shown rho! the
original growth ~ resurbces or dominores ~
the onhodonlic: _ e nl i, compleled pr>ot to
the completion eI growth. Hence, prdoogod
retenti"" i. indicated unlil odi.e growlh i.
-"'"
Bone ad.pt.tlon
Teeth Ihol ho. " bee n moved roce ntl y ere
&ufTCU nded b>,. lighrly (o kifi"" osl<>Oid ben . Tn ul
ft1 " ""'In cr" no! od eq uololy .tob iliad ond h"".
o lend&ncy 10 """"" to It..,;, original politlon, The
bony trabeculoe 0'" na'moll y arranged
pe,pencliOJIo, 10 me lang <ru'I' elm, THin.
H~ during orthodol'llic lfemment, they ~
" I;g ned parn ll ,,1!<) th e diredioo of foroe . During
the rer..~on pha .... they ,..,..,rt
bock 10 their
norn\Ol "",,ngoment.
MIt. cllla, fo,e n
T..,th ore encopsuioled in on d"orecrions I:1t 0 b'on
ket of mu.d el. Mu \e imoo kmce at the eo"ld of
the onhodcntic lhernpy con "",uk In ""'PP'Or
oroce of the "",lccdusion. Tho orthodonlill sI-woulel
aim a t M rmoniting the muS<.i e, at the conch,
sion of lite arthodoo ,~c trea!r'ne<>! SO OS 10 inaeooe
t!>t $!obilii')' of t"" t,..,atment ,..,ru~'lXhi.......d.
Fallu." to ellmln,t, t~ e orl, 'n,,1 C,It"
T~e cau.e of the moloccl usion s~o u ld be
deletmil"led ot the lim. of dio~is end 00eqv01e
treo!ment slep, """'lei be planned to eliminoo
the ",me or recl...ce ils ... _ ii')'. Fai lure to ""mcwe
the Miology con result in reiopl.$.
Role of tlol,d mol. ,.
The "'rd moIalS ""'pi.....,
Iota in Ihs deveI ""ment
01 dentition. They erupt in mos1 co .... berween
"'" 00l!' of 1821 yeo ... Bv thil time most potient.
..."."jd have complel..d fhej, orth:xkon!ic "'"""tment.
The p<esoure """,ed I:1t the erupfng rhin:! molo:..,
is be li eved to ca use lot& onte.io. crowd ing,
pradl$pcaing to tela!>".
Role of occhrslon
Good inten:vspolion of !he upperond the lower
teflth is on impo<tont fOClOt in mo,ntoi"';"II1I-..
,\:;l bility of treated m 5M. Tfle ce ntri o rolot1oo a nd
centrio;. oc.dvtion should coincide or rile slide
/rom (,",ric shoulel be n<;I more than I.S 2 mm
in orde, to "".., greater Itobility of t"" trc<ltme nt
results. Pre"", 01 cer10in occlusal mon""ri"",
,""" o. clenching. llfinding. noil biting, lip b~ing
etc., oro imponont roU$O' of ", Io pse.
THEORIES OF RETENTION
RJedej ha, ,ummante(j "'" diffe<ent <Xlt"oCftpn ond
p hil",ophiM .,.isting into nine theories. To thi.
li, t 01 nine """'Me. Mov<o" 1\0, ookl.d anothe,
meaty *'a: II m .nt"ned n.n <IS t+" te~th theorem.
.~
Tloe o,,,,,, 1
'Tooth thor h(Ue Oet~ mewed lend \0 ",h,om 10
th'i' Iormer pooition'.Th"", /lOW ..ems to be
go neral ogre.me nt tnat teeth tord to go bock to
rhei' originol P<l,;~on an.., ortnodon~c tooth
~n!. The co_Io, /hi$ r&l0\ft o'e many
o nd . ingl, etio logy <:O Mot be highlig hred.
fit".""", 2
Eli minotiOl1 of Ih~ <:O Ust of ma locdu. io n will
p.......m ",loose'. The COu,,", for the "",Ioedusioo
.ho~Id be id.rrrilied Of tho ~me of diognool. ond
a d'q uote Slap' , hov ld t>e formu loted In the
treotrnen! pion to el imil'lOte a. Follun: to remove
tho rouse '1lCre<>st$ the relopse po!f!ntiol, This
Ih eo r~m co n on ly be opp li,d in co ... of
molocdu,;on ~ the COtJSOI is obviovt such os
thu mb .udc'''!!, tong...e thrusting, etc., ond not
In a nv moloccl u,ion who re the tou," is elul ive .
'.v.,locduti<;ln ........ d be """"-0:> ,eded "'0 ",' ei')'
foctor'. Many orthodontists 'lO<;om",,,,,d 0VtIr
cor,ection 10 c' to give 1 ....01 lor 0 co""i n
omount 01 relopse. Thi. has been pmdiced in
......,in9 cotr\oin condifions such as rototions,
trealm errr 01 (I",s III 0"", III molocdusiOl1 '
The,.., ii, howe..", no ~i l ol>e dote to volidote
/histh"""",,,
Th e orem"
Proper occlusion i!; a potent !odor in holding
teeth in thei ' cor"",ted position. '. Po.H...alment
.!<;Ibilily is inc..,~ by oood ocdu"Q(\, Th,
a rlhodant i. t shov ld rIOt restri ct treot me nt to
T~rn t
ac "i evin ~ a!;lOO<l' interc", potion wh en the iow.
are o;Ios.d but ,"ou ld oim lurt"e' ol 0 ~ood
I..",diorlol occIUlion i.e. harmaniau. occlulOl
contoc:ts during !..nc:tionol m<MIments oItho jcIw.

TIt,orem 5
----,
1"00II\ N 111>1 _ _ ttnO to IWIIn j) " " Iorrr!oI

_01.:.. ....... _
n..,..m S
... -"'*"'"'.
'ao ne ond adioce nt tissue. mu .t t>e a ll awtd tim e 'Ma!oo:MOn tI"IoI.'It 00 _ ~od III I Woty r.etoc';

-_.......
to rec'll Onile aro un d ""wly positi oned teeth , Tho."," I
When Ieeth are Jl"(>YfKj 0tIh0d0nIiw1ty, n...merouo ""- ~ 10 pwonIloo< io ~ _ io,.,.
chonges occu, in the bone ond .unounding
tlnu .., It !<;Ik con,ide",ble time 10' the
,...",..,nirotion !<;I bewmpl.tect. The new OSIIIOici '!!onoatd ...... _ ...... OO_ .... IO~
bone !ormed arou nd rec:entl, moved tH th off.... - 1IN!y ~-.,
irlCl deq uote rete ntion, Simi .,rty the periodontQ i Tho."m e
01 .... 11 o. the lIinllivollib r'" toke timl to
reorgonize.
.. flo _

&It ....

T_o.1
a.Ir to r_
l:"00o<I eo ~ ~ _
II pol . . . - .
OUII t<fIJ tNy

Th eo ' i m 6 ~wnoct .... ~ poric>:Iool~ .......

1f the I"""" incilOf1 are ploced upright OHtIfba",1 ~ t-o ,....,

n.."m I

-_.
bor1, they ore more li kely to ",moin in good
alig nm ent', Most Jlo l:W . rel ults are obto i,;e.d by 'Tho_ N..,h _ _ ,.,....",. _11 tho 11$1.

plodnll the mond,b.,.lor indlOf1 ur:right over"" 01 roIIpM'.

00101 bone. The mandibular or ocdulOl pia ...
is uMld as the re/er"er'u plane. The arlhodonrill 'MIl tom. ..........,.. in IN 11_ ? .. - . _ bo

should aim at poI~ioning the I"""" Incisors ~ _ III' tPFk...,. ... ow,
perpe ndiculo r to the mond ib..olo r plo,," Of e"," l ...... o.. 10
relrodirl . d. """'" ~..:"" rWo<:<:Iosau roqyi"t pttN.",ot lOCIiIWIg
-000',
TIt""em 7
'Comoolions ca,ried 0111 during periodsof ~rowth the active ~rowth period allow the bu,," systems
0 .. iIIss lilooly to retOP'l'. Orthodontic!heropy 10 adapt weiland therefo<e reduce the ,.,lapse
.hould be ini~at-ed at tho earlie51 po"ibl. age. poI",, ~oI,

Eo , l, treatme nt procedu re. involvi ng g,owth

mod ulat ion, a inlld at Inte rc e ptin g .hletol
mol",lotioos, prevent lull fledge<! molacd",lal"ll
and wmpenwtioo [both dentoIond>keletol) from
occurinll
Such ~tment modohies cotried autdurinll
Theorem 8
'The larlherthe Ir>eIh have been mewed, .he tes-
i<the risk 01 relopse . The 10...... 0 tooth has been
m"""'" the leuer is the risk 01 ~ retuming 10 its
orilliool position. Although this wvnd.logirl ,
it i. de.roble to g u"", the erupting tMth to inWeep!
lutu r<! molocc luoion, Such teeth requ ir<! lesser
toot h mo ve m e nt by compre he nsive fi<ed
mecflonolheropy and 0150 a reduced ret""tio n
period and hence flov. a I",ser riskaf re kl p, e ,
Th eo, em 9
'Arch fo rm, part;";u lo rly in th e mandibu la r arch,
cannot be perma nen tl, altered by appliance
therapy. Alteration o f exi, ti r>g a rch form. re. ull>
in in cr"" sed ri.k of re lop. e , According to
McCau ley, th, marJ il>ukl r inter-corin. and inte.--
mola r width. are unco mprom ising . Th", th.y
.hould be cor>oidered o. fix"'; lorxfma rks oM the
r.,1 oflhe oreh b uil t around th em.
Th eo,em .10
'M any tr""led ma locclus ion, requ ire perma nent
rel:lin ir>g d el'ice. ', Th i. theorem woo . ubsequentl,
added by Moy. ,. . Ce rto in ma locdu. ion. might
require the potiM t to be fi ~"" with a perma nent
retoinin g device , Th i, i. true in co .... thot Mve
rIOt been trMted to ad,ieve ocdu.a l goo l. thot
. tond lor , tabil ity.
RALEIGH WILLIAMS KEYS TO
ELIMINATE l OWER RETENTION
Ra leigh wi lliams p ut forwo rd 6 keY' to el imi ""te
lower retenti on and ad",;"" lower arch 'ta bility
foIlowir>g orthodont;.,; !reotment The following are
th.6 keys:
1. The inci. a l ed ge of th " lower inci=- >houl d
be ploced on Ihe A_P Ii "" '" 1 mm in fronl
of it. Th is po.ition of the lowe r ind=-
en,ure. ~bility fol lowing IfeotmMt. It 01.0
ernote, optimum ba lance of ",ft tissue, in
th" lowe r th ird of the loce
2. The lower inc i. or apico, shou ld be . prood
di.l!o~yto the crowns ~ tho n ;, gMero lfy
comid ered oppropriarn and the apices 01
the lower Io tero l inci<or> mu,t be.preod
more tho n those of !he central ind sors, In
o, he r wocd, the lower inci.Of root, .hould
be d iverg ing
3, The ooex of the lower cuspid .hould be
po. itioned d i ~ 1 tothe crow n.
" All 'oor lowe r inc i50 ' apice, must be in the
.ome klbiol ir>guo l plane .
5, Th e lowe r eu, pi d rool op ex mu. t be
po~ti o,,"d ; Iig htfy bucco l l:l th~ crown a pe:<..
6, The lower in 6""" sfx:.u ld be sienderi,ed 0.
needod oftertreotment
By ob;e Oling the . i. rete nti on keys described
by Ra le igh Willio m. , it i. po;sible to eli minate
l ow~ r inc;,or reten tion fo ll ow ing fixed appliance
therapy,
TYPfS OF RETENTION
Mo!oo:losion occ ..... du e '" numerou. couses 000
th-ey present th om,e lve. in vonov. way" Wh il e
$c m~ treoted ma locc lus ion. do not req uire
re1<rlio n, other maloccl",,,,,,, mny n.ed 0 c~ rto in
period of retention to en,ur. ;!ab ility. Rete ntion
ca n be of th ree ty pe, '
1, Naturo l or no retentio n
2 Limited or , hart term retentio n
3, Problgod or permo,",nt retenti on
Natu,al o. no . etent/on
Some of thc ,ond itions thot do not "'quire any
retention include ,
o Anteri o r cro"bite
b, Sel"ia l exlractk>r1 procedure,
c, Bloded out or hi ghfy ploced co nin e,
in Cia .. 1ex/' action cose.
d Posterior crossbite in potie-nts hov;ng
. teep evops
468 Orthodontics The Art and Science
Llmltert Dr short term retentIon
MOlt co",. treoted routioe fy in the orthodont;c
dn ;c fo il into thi' cot" gory, R"te nt;on ;,
recommende d to ollow th e bone and ot her
pt<k>dootDI t:ssues to "",dor:tto their r>ew b::otion
1, Ciou I non-extroct;on with dento l orche.
show ;ng prod,,,,,tioo and 5p<lcing .
2, Deep bite,
3 Oo .. I, CIo .. II, div, 1 ard dr.. 2 ca.."treoted
by e>droctioo .
, by the potient ond rein,erted ot wi ll.
Pralongert a, petmlln e nt ,etentlon
Co, e. that req uire inde fin ;te or prolong ~ d
retention indud . :
0, Mid li "" dia.temo
b Severe ro\:;ltio no
c Arch e'pon.ion och ie~ed wit""" , ""," unng
good oed",,,,,,
d. C.rtoin 0", II, di,.. 2 deep bite cose,
~. Poti ont. exh ibiting abnorma l mu""u lo ture or
tong ue habits
f, Expor-.ded o rch", ;n d eft polo te po tie nt.
RETAINERS
Reto;""" are poMive orthodont>:: opplionces that
help in mointc ining a nd .tobi lizing tn.. poo ition
of te. th long eno<Jg h to perm it reorganization af
the supporting !lrvdure. o her th e active ,.no"" af
orthodontic th eropy.
Tn.. type 01reto iner ta be u.ed depend, on
.ariau, faOoro weh 0' the ty pe of mo locdusion
trootod. tfoe e,tn..t>:: ""ed. , potient's ornI hygiene,
f'Otie nt ca-operoti on. tfoe d"' ot",,, of ret<trltion.
etc."
Grober no. put fo rwofd certain cfiteria thaT
o good retoin er ,hookJ posse,..
1 , The retainer snoukJ reto in 011 teeth that hove
been mo~ed into de'ired po' itio n.
2 The rotair.er ,"oukJ perm it "",mo l functiono l
forc". to oct freely on the dentition ,
3. It .hov ld be .e lf - d ""n' ing ond ''''''' Id
perm it orol hygiene moinlenon~e.
4, It should be o. inc"",picuoos 0' pO$lib le,
Retoine" can be closs if;ed into:
1, Remoobl e reto;"""
2, Fi>:ed retoin."
REMOVABLE RETAINERS
Th.y ore PO";'- opp~o ncco thJt con be r~mo.ed
HlJw/ey'. lippI/ann
The Howley. oppl iance was de'igned in I 920 by
Coone, Howlay, It i, the mO$lireq ventl y ~
reta iner, Tn.. cI,,ic Howley', retain er (fig 2.0)
~onsi'" of do.". on the molors and " short lo bial
bow extendi ng from co nine to ccnine ha vin g
od justment ioap',
Thi' ,;,."pi e de~gn co n be modified in 'everol
wol" to . uit spodfic req uirement . Th .lol>io l bow
can be mode to e>dend from on<! first p,""",o, to
the opposite li " t premolor {fig 2.b] , This design
he lp, in clo' ing $poces d~to l to can ine. Anoth e,
mod if;catioo i, to ,00de, the bow to th e bridge of
the Adam', d".p . Th i. d .. ign ovoids th e , i. k of
space open ing up betwee n the con ine ond
"",mo lm due to tn.. cro,,_ove r W;fe. {Fig 2.cl.
FiHed labiol bow con olso be cMd to oller ">:,,,I. nt
relent".." Anterior "te pi""", c"" be incorparated
to reto in 0 , corr~ct deep bite "".eo , The
odvontog e' of thi s app liance includ e ease of
Iob rication du e to , imp!., design and mini mol
pa tie nt discomfort d ue to reduced bulk, In
oddition it i. occeptoble to most poti ent. os it i.
relotivefy in can",kuou "
Bell retain er
Th i, r~toine r wo. popIJlo riled by ~ R Begg. It
cansi, ts cf a labia l wire tho t extend. till the Io,t
 A B

c o

r'll 2 W HoooIt!'> ...,;_ III Iio>wIoy'J , ........... Ioo>g Iobiol _ (Q ~ , .... _ ..... Iobiol ""'" ",1dOOOOO 10
AcIomi <loop fO) ~ ..o"..., od _ _

erupted molD' end curve, a,ound it to gel Clip . an ref./n er I sprIng allgne,
e m ~dded in ooyI ic Thot ,po ns t""
paklto (fog Thi s opplia nce is mode of" wire fro .,.,., work lkat
2.d). Th . od""nta~ of this retoi"" , is tflo! Ih Of. r"1Jn l lobio lly ove r the iOOSOf1 cn d th en iX'$1e1
i, no C'OI$_ wi,.
be_ n the con inft and ~ IN roni"" ond ~r:r and i. rew.,.",.j
premola' !l.ereby el,minoting the risk 01 . pa<e to u. ~ the lingool .urfa"" (fig 3). Bolt! the
openi"ll "p. Iobool os well os the lingual wire .....""'''11 Ore

embedded in a . tri p of or"",
acryl ic. The reloirlC r
can be _ d to bnng abootcorroction of rotation.
camm<> nfy ,een in th e lowe' anteri or region , In
.vch Ca'. ' where it i. used a. an acti.e relo iner.
it i. fa bricated on a co.t wherein the teeth are
ploced in id",,1 po.iti on. by wax .et up ,
c onterio r reg ion . The coni"",. a re bonded ond a
W,sp a,ound , e ta/ne,
Th i. i. an e>teroed ."", ion of tr.. .pri ng o lig nor
thot cov. " 011the .teeth. It con. isls of ",ire that
PO"'" along !", la b., 1a. well o. li n9"",I.urioce'
of a ll erupled teeth wnich i, embedded in a .trip
01 a c~ ic . Thi. type of reta in er i. oot routine ly
used in orthodontic pra ctice , It find. oppHcoHon
in".tabi li, ing a periodonto ll y wea k de ntition,
Kes/log tooth. po.'t'oner
The tooth po<iSoner wos described by H,D, K",lin9
in 1 945, It i. mode oi a thermaplostic rvb be r li,e
moterio l that 'pon. the inte< - acc lu",1 SfXlce and
coverS the d inico l crown. of tM uppe< and Iow,o, r
toeth a nd a .mo ll portion of tne gir>g ivo. Th e
tooth po,ti ane r need , no oct""tion at reg ul a r
interva l. and i. d urable. TM drowbocks indvd.
diffIC ulty in .peech or>d ris k of TMJ problem. ,
Invisible retaloer.
They "'" retoirlCrs.tMtfulfy cover- the cl inical crown.
OM a part of the 9i"9i.o l ti ss ue. They are moo e
of ul tro th in lro n.pa re nt thermo-p la.tic .heel$
u,;ng a B-ioSlor moe hin e. They ore". sl"'tie OM
oft"" go unnoticed ,{F ig 41
FIXED RETAINERS
The,e reta iners are fixod or fitted on to the tooth
and connot 00 remo.ed a nd {e in.. ~ed by the
"'''"
The fixed appliance
The fixed oppli""'e that wa.
used for orthodontic
corroct;on con 00 left in piace to ","'e o. c
reto iM r,
Sanded CIInlne to canine retainer
Th, type 01 retn i"", i. common ly u",d i~ tn., lo wO(
thick wire is contoored oyer tM 1i"9,-",1 aspects
ond .o ldered to the conine bond, (fig 61. Th e
bond, pred i' p"'''' to poorOfo l hygiene and are
une.theti c.
 A B

c o

E F
"., S i>.oh ... ~ ",. I'~. _;.."
..... ......,. ;-.0-. ""'o;dlf ........
if!:. U"l.d w.od ,,,.i_
fmr, an .. to C<WIi .. (Q "ood I <>q",,1 <'fil,.,\o- ri>o
_" , m......Ix...... (0) Ung"'" !.rood ..""_ (f) Ke.ing'. """" .-.01_ (fJ
..... "!IO~_

j
Bonded lingual , e taln er. SPECIAL CONSIDERATIONS IN RETEN-

n"'r ore reta;""", thot are bo,..Jed 00 the ling ua l TION OF CERTAIN MALOCCLUSION

aspect. Sta inle" ,teel or blu e E/g i/oy wire i.

adopted linQuelly to loll ow tf><, anterior curvo Cla5S " ma locclu.l on
tvro. Th o ~ds o",',cuNed over tr.e canine. WMre
it j.bO<'>de d,
Clo" 1/ mo lcx:du>ion 9<'n."ol", ore ro,u lt 01
", Voriou, p"'.I~b rica ted li .-.g ua l retain ers aro . .
di=epar<: ie. in growth between the maxill o a nd.
the mandiblo, Relop'" lolkJwing the correcti on 01
ava il abl e thai ca~ be bonded an to the teeth
C l a,~ II ma loccl usion a re du e to continued
ltig 7] An olt.o rnati ve to th" v<e 01 wire. i, to use
differentia l growth 01 maxi ll a ,. klti ve 10 mand ible
etched or perforated me:a l co,t bar< toot cun be
bonded on Ihe li ngoo l ,,00 01 lho ,eet;" Roxentf,- MirIQ' re kJpso tendencies mal be 0 re, ull 01 tooth
fnO'Iement cJu., to ~ng iml and pe<>odc>rmI factors
,orne worlcc rs have recommend ed the u<e 01 0
. pira l wire that ca n be bonded inJivi do,iail, to cach 0"", corredion of th. occ lu sa l ,.lotio",hip ;. an
important foetor in COmp.,fl>o ting for r. lap""
tooth in a .egme~t.
fol lowing treatment, Howeve r long to rm growth
Blin d and spllr re tain er re.,ted chMge, aro mor~ li k.ft to pose 0 problem
in retantiOll, Tr.aso ijrowlh rekJted cha.-.ga, depend
This type ci ",toiner is used in ca "" where a 'ingle
tooth ho, been orthodoolica l:y trcolcd for rotatic<1
carr",tion or kJb io. lin gua l di'p lacement {fig 8],
The tooth that no. bee n moved i, bonded ~nJ
.puf$ are sddered 00 to rile bands w a. to (WCrkJp
tile ad jacent teeth. In ca,e it i. u",d to retoin a
teoth that ho s been bkxked pa latel ly, the spurs
arc made on tr", labia l Ds ped '0 that the tooth
doe, not once oga in get d i ,p l a~ed po lorol fr, In
dero'o' ion case, one .p ur is placed lab'a ll y (on
the ,id e the toct h tends to rotate pa letol",] and
the aj'"", li ng uo lIy to o"oid r"'ap,~,
Fe, 9 p"","",,,. of re,;ng 0 ~ ng '" ModoO', ' <1< .... , ("l Tho -.; ,,;, "opOod on ... 1;..,e, 1 ''''''''' 01 ,ho _I> &om
''''' ... 10 b "W",,10 , on ... . Ia) Tho ,mi_;' robi i,ed on to. <:031 u"'"'J """ ... -~ "'*'0",," (C) Iv-. ;"..". ..;"" ~
,,,,t
."".,je,,;f, 0 " bbe< booed heov,- body ......,..,, 1to 10"" 0 ""' ''' " ~Io Ill) n .. _fng ,......"., .. ~ VIed 10 roo'_
to. "',..,," <>P"" '"" ,ocli, I~) 1...",.,1 _ '-' ~ "" ~ ...... ,

on 0 nu moo r of facio" in dooi"ll a[j<l, '0<, and
motuMty 01 the potiMt. Thi . ,. Iop'. tenderq con
be p reve nted by continued u. e of heodg eo'l to
,. ,trict moxill ory growth in co nju r"lCtion with Q
",toine' to mo inlo in the d enjo l olig nm enj. Some
outhors prescribe the "'. oIfur"ICt",,",ol opp l",nce,
, imi lo. to <>ctivotor o r bionoto r ofier th~ a ctive
phose of clo" II co rrection. The use of the,o
opp lionces mo intoin , the corre<:jed ""'<i llo-
mornJ ib-u lor re lotian oM prevent< growth relo ted
relopse tendendes.
The vse of headgear$ orfunctiono l opplior"ICe5 !o
mo inlo in !he 0o," II correction io indicated ~ !he
octive treatm ent i. c;ompl otod at on .o rl, age ond
co ntinued growth i. e'pe<:ted fo lbwing the <>dive
pf..o", oItre(ltmMt.
472 Orthodontics - Th Art and Science

c.... 11/ 1II.'"clw,'oII

ReJoining 0 CI_ .11 molocdu'ion may be 0
difficuk lOs!< d"" to the contin......:! groMh of the . G<ob. 1M : 01 'ia : f'ltociploo. """ pt<ICfU.

mond ible. The uH of chin cop '0

r".ttic,
we Sc..odoto, ' 98S
2. H",_W,I , Ooiooclomc o;.,g,-.. W!\oj .... h d.
mondibulof g.....tl> her. been nocommended by '981
lOme outhorl to co...nter tIo~ continCJed QrQw1!, J, PI'OIi" ~ c.:...-""""., O1!1.,o","". S/l<Nf,.
t&ndeocy of mond ible. H"""v..-the ...... of ch in 4,
C/ .....".,.19M
_
b<>o< _
E ""'-: Hond b<>o< cI O~
I~bIi""', . ""'.l ~ ae_
'*'"
cap i. bo lieved tQ in crec>e the vertical growth Qf 5, !.how w<, ~.c ond Ocd LO<>! mo ~mo n .
the rrond.bl., Mid CIou III CO"" Qre be.! retain! W'ght, I99J
6. Tkomoo M~, - . . l IIar>orsOol l : Orthocloo-
u"rIg 0051 If I fu"'tionol opp,"''''c", 'L>Ch o. c ok. , ... _ pnnc;piooo <l<I<I o.ciI","_. I0I0<0, ,.",
f.vlrw oo;'oto'. fR 3 or Ckr.. III bienotOi. booI! 1",. )994
Ho .....,.,r ..,Vefe Clou III co,es thot relopY
following DC,"" orrl>odc:.vic tIoeropy moy require
"""!Iieal eo,,,.c:tion oft..- growth ceases.

De.p bil e
Deep 0 - biles 0" best retainod by ,...."..,ble
uppe' retoi,.,.... made in ",ell wttt tMt tIoe lower
on",rion conla<;< the bOH plat. b. hirnl !he
moKl II oty onllriO<l, Th il is .im ilor te enterio<- bite
pI"""fbut the mol," """" r<>t be separated. Thi .
type of IGlOlnor help' in mClinto ini ng tn., corrected
deep bitl.

Open Olte
ReIopse /oI1oooOng CCITOdion d open bile is usually
re.ul. d moIo' .,aru,;on or insis.or inlrusion.
InC"", """"'on may occur dUll 10 continued
indullfC"C' In hobits $OKh (JO !humb oucking 0 '
'ong'" thru.ting . Th". e'imino.ion of the
onociotod etiologic Ioctor would help in long .
t"""'.na...
lerm ll<:lbil itv. E..:eo.e.e """"", g,.,..,.n
and conTin<Jed eruption of flO,t."orS may pose
the rn k d relopse, In the ... potie n!, opoen bite.
are belt retoined by high pu ll heodgoorS to upper
mokm Or US<! of bite block "pp li o", och 01
po$!lr;or bite pOe", thot st",1<:h... the m""",.,t"",
ond j)I'Oduo:es on intrw"" force on the o.ntilion.
 .,
,,
Procedures
SOLDERING
Soldering is defined os 0 pro<:"" <i join.'ng me!Ols
by 1M u... of" IiI ler "",lei ",M,t, f>g , a ,.n.tontio lf,-
lower f",ion temperature !han thot of the metel.
beOng joined, If the Ivsion t. mF"""tu", oIlhe
fill., metal "MId e>:ceed. (5O"C, then th ..
p,oced""" is termed broling. 50Idenng makes
vsecJfiler rnetoI, hoving Ius.on 1e"""""""",!e"I
.... .45O'C. Thus Ihetermo$Oldering..-.d brwing
sign!tylhe ....... prece6JN, b .... ""'Y in the fusion
temporotures 01 tho inlermediory meIol. used.
SoItiering invot-Ihe How 01 the molten
/iU", melCl due 10 copil lo ry oHroc:!;'" between !he
m "to lli ~ pori. to be joif'lOd _
Dfontol .o lde .. afe o llo. thot are u ..d as
intonnediory 0<" flU.., metal to join two 0< mom
metallic pO.tt. The-,o should possess the IoIowing
icleol t&Quili! :
i) The soldo< s.ho.Jd . >hibit ",cell. ntlomish ..-.d
co " ",ion resi,l:l nce in tho 0f01 erMronm. nt.
i i) Th. fu .;on temperntu ,. of the dofllO l,oIdto,
should be lOW<!' lhan that oHhe po'" being
P<l6d. kkIol ly the fvsion 1oempem\vre of me
told., ohouId be 50"<: 1OO"C leu thon !he
pom being [oined.
ii Q II shoul d be I,,, .. /lowing and should
odequOlll'ly wet the melol pori< ~ un~" so
!hot good odhesion i!. ochieYed.
iv) The .trongrh 01 the solde'.houId be "milo,
10 mol 0/"'. metols be;ng joined.
v) Tf.e coIO<Jr 01 th e de nlol ooIder """'Id rI'I(1IdI
with thot of tf>o part. to be soldered,
Mo, t de nta l solders ore compased d
1;IQId, .ilver, cop per, ,in<:, hn ond nickel. Whae
c.op~ g iV1O. 0 ~ I ow Opt>eOEUE..., to tr.e JOIdec.
lIS lijl!viMion bynidc"j giveso rTIOf'O ";'i!e ccIour
to ..... toIder,
Flux
Flux is a Lati n word meaning flow, The , ucee ..
of a good $Oldereo' joint depefid$ on no.,. well the
denta l $Older flows over the port. to be joined ,
Dental $01d ~" do not odequote ly llow or wet
meta ll >:: ,urioce. !hot 00",", an oxidi".d loye r, The
flu, o id. in remove l of th . o,iOO cooting .0 o. to
rooo.. the flow of the molten ",kler. I ~ oddltion,
th. fl ux 0 1", d i"o Ne. ony .urface imp uriti ... ,
pre.ent. oxidatian of the meta ls and a l.o
"9~ificontly reduce<!he molting poinloflhe dento l
",Id. r.
The flux u",d com monfy in denti.try 005
the fol lowin g comp:>~tion :
Bornx glo.. 55%
Boricocld 35%
Sika 10);
Ruorkle I;..,,,,. conl:;l ini ng boric acid Olnd
pot"'5illm fluo ri de in a I : 1 ratio, a l", produce
c' cc llont $OIdeo-cd foints ,

Anti-flux
Antiflux i. 0 mater.,1that i, u;ed to co nfine the
fl ow of th . molten .old . r over th . "",I:;l l. be in g
ioined, The common ly vscd onti.fl u,", ore lood
peoo l marking" graphite li nes Qt>d iroo rouge.

Typu of .o,de,'nll
In denta l proctiee, ,,,dering c@beearried o ut
in two method.
, ,
Q, Inve'tment ,oldering ond
b, Free l>::lnu solderin g
Investment . olde ring ,Investment .old erin g
i. ca rri . d out whenever th e Or"a of COrl tact
betw",,~ the "",tollie f>CIrj. being joir>ed i< Iorg "
@dwhoneverprecisionisneeded in foining the
"",te l. The pra<:odu re invo lve. the "",bedd ing
of the meta ll ic port. in an investment lea.ing a
gop of obovt 0 , I 3 mm betw"" n the meta l,
Frce hand solde ring : Mo.t of the .olderin g
!>,oced ures ca rried out by on orthodo nti,t fall
vcder this category. The pracc .. itwoIve, ooide(ing
two meto llic pa rt. to get her after od equ~te
.tabiliration, without the use of ime, tment, to
predsely hold the parts togetMr.
Step. In .older/nil
I. Cleo~ing the ,ur/ace, to 00 joined.
2. Assemb lin g th e port; to be joined .
3, Selecti ng the right ""lder a nd flu>.
4, Selectio n ofa proper jo int

A ,
r, 2 s.r~ o! '"'""" ~",~ ""'... , ....... <if... ~,~ (Ili W"""'"'" ~ "" '" O'ocnd
'tPO o! ,,",j ~l l ""9O" """" of ;0; " ",'p In<t>1O ,foe i<rl "'-"\If>
5. Application of Au .
6. H",,~ng and inrroduc:t;on of ..,lder.
7. Quenching,
Clea nj~g th ~ .uricce, to M jo in&<!: Tho
pam to be joined sI>o<.ld b.o, <JMq<lO!oI, d""ned
to rernCM'> d irt and 011.- ""rfoce COtItominonb
whim irworiobl, resuh in poor solder flow ond
~ failure oIlfle procedure.
Anemb ling Ihe parI. to b ~ lolnad The
po .... to be joined ore sloMized in the dosi...d
fashion using pI".",, O/Ihopho$phote cement.
While- =ernbli"9lhe...,;t, Iogelher oro odeqoole
gop ,""uld exist between TM e<'''' 10 be reined.
A gop of c bout 0.5 mm is con.id!tf'ed adequote.
Selufion 01 the right .olde' and fluK ,
The opproprioredentol wider should be $eIeded
based on the metollic porls being joined. The
J.O ldec $e~ed shou ld be compatible wi!h th e
metc~ in a.peds 01 strength a cd cobJr. H""""""
II>ey .hould ... hlbOt 0 """"" fusion ItImperotu<e.
Similor!y" good Au- Is 01.., sdected.
Selection 01 0 proper jOi,,' : A PfOp.' joint
belWeo n the mo:tIc ls be;ng joined g~1ty et'honc: ...
the slrength 01 In.. joint. Po<nl COl1tocts do not
oIIe<odeq""", Ih'etlQm. When Iwo"',.,o<e beng
,
c
,
+. 0+., io "'" boo!
joir.ed togeIher"a would be beMfociol1Q""'lpone
01 the ..;.... around th_ ~ (~\I 2).
;,pprorolion of fIVlI :The fl .... ;. applred in !he
gop bet"",.n t~" pe rt. a nd ,,1 00 co_era 0 portion
O( tno port> being i",ned. Th e (low olin.. "'cIe,
can be (imilod by using on~ -Hv .
Heolinll and introduction 01 ,olde, ; Th ..
oteO 10 be joined il MoIed uoi"ll 0 $OItle<ing Iorch
{f ig 1). At, soon (H tne flux bog ins ta (",e . the
solder;' introduced . The ",,'de< me lts and onw>eO
"'e joinl. The Rome ........1d be maintained until
lhe filler _ I ho.1Iowed co.,-pMr!/y into the joint.
Qvenching : TM ossembly i. immediotely
q uencMd in wcter JO ". to li mit the JPte(ld of
""'.
P'e cllc,,1 c OR. ,de , etloRs In ,oldlrlnX
T h.. ,e o,e ~erto i n loctors thOl ,"ould be
conlido red.
1) Use too red...orrg flame dthe soldering torch.
21 Use _t cotton ond o,be."" ta limit the
.preod of heol.
3) Thrtr soldered joint .hould not be pOlrshed (H
il ..... c~e n . the jo;nt.
4) Anti . fIv:< ","",Id be used to ~nt "-,cessi""
lIl"",d oholde,.
iUS Orthodontics , The Art and Science

WELDINO

Welding ~""'joiningcJlwoor"""" ;"eIOl

pieces d i'ectly under prcnure withoUI me
introduction o f on intorm .dio,,!, or fill er mat.riol.
Cold welding" done by I>ommering or
preuurc. An e:I<Omp~ 01 cold welding Is the gold
Ioil ~lIing. Hot welding uses 11.01 of . ufficiem
Ir.e
inle<' siiy to mo ll rneI:JI. bein g jo ined. n ... type
o l_lding used to ioin Mr.odonti( componentl
is arlled !opOf wtoid,ng. The heol..,urce is ..... ually
o high omperoge elecfriciry. Orrhodormc >pOI
weld..... "mploy tile oIectrodo teO>niq'!" and ore
used i",tood o f .oI oorirIQ in co..,s where the
"-o!ing cyd$ m.....t be -., ohorI, In etdertop--"
changes in the physicol propenies 01 the
compo""n!> being joined.

Principl e af 'pa t weldillt

He.;rt ond pressure are the I"wO bosic principles

involved in spot _Iding. EIectnc CVtrent Wq
is mod. 10 poss Ih roUllh 0 S!lO!'.<bwn tron,former
10 ohlein 0 low _olle ge gnd high e mperago
Ullrenl lhal is ,0000uctO'ld through two copper
electrodes (fig 3) on eithe.sidlcJ the metals being
jained. Thr"etiston ofIerod by 51oinl"....lo.l to
current of hig h om"" rog o generote. _cry hig h
remperolure 01 the e""lroOes. Thus the 0..., of
meIOl undo< the .Iedrod... becon.. plwlic. The
capper eledfodM sim"llaneously Cl!'ply P"'ssure

-
f .. J ~\ 50>0< ....!do. 11: eo..".. .,,_,,=100 o! '"" """

A ppnullons of told. , 'nt tn

o ,th odon t lcs
on t"" m"to ll o nd th~ r"foro sqvee' e
into each oth-e,.
I""
m eta~

The COIlPO' elec.lrOdes In a welding un~

lerve th,,/o/fowmg purposes :
o. Tr'm, rnifthec" rr~nt to the melal. 10 be ,,"ned
.0 os to couse 0 ropid incree s. in
c. SoOdoring ~ u..d 10 ioin port, 01 o ~hodonh::
Icmperolure.
oppl."'(85.
b. The IwO electrodes help in holding <ogethe.
b. SoIdeting con be used 10 Ie""n onochmen ..
to bond l. the IwO met\llilo be joined.
c. The cI"'trodes ore do'igfllll:l to opply pre"'-U'<'
 on !he -'Ols being joined. As ooon ",rhe
lempe"""'" il"lCl1lO.e>.1I-oe pr=ure e>.er1ed
by It.. ,Iectrode..... Ips in .'III..... 'ng lho
meloll in!o eoc~ othe r.
d. The eledroOes help in con ducting Ih . heol
~ed ~ from lhe """" so 0.10 ~
the propertie. of .loinl. " . teel oround Ih e
weJd .pot.
ill . W'lr'f importanl 1hol the possog" of
eumont Ollhe ...aId $pol be of ""'Y short duralion
i.e. not more rhan I 1 10 rh of a ""ond. In COOfI
!he ~ is paSHd foro iOng<l""d...otion of ~ .....,
~ ,,"ulb In weld decay due 10 pttICipilulion of
anbides from the -'01. Tl-us most 0I!he modem
_ldeB ha<e on electronic timer /hot helps In
dischorging curren! 01 ""'Y short dumlion.
Weh5ng of ,loinless sleel depen,h on !he
proper use of eoch 0I1he 101 b.;ng th"", ...-iobles:
\. The cu rrent flOoing tfuough Ih. circuit.
2. The time during whlch tho cu r",nt is oll owM
lellow.
3 The med>onh;o l pre"",e opf>l ie<l at !he
_Iding hectd .
,
Plou d.,e 01 s pot we ld' '!t
Select th, proper electrode lor !he Ihid<ness or
>hope 01 the moIetioll" be ....,lded. A btood
.Irtd"rodo should be u<ed /0, thin mot..,;ol ond 0
I'IClrlOW one.ler thick mote ri ol. TM el.ctrodc!. 01
he welder 0 '" d eo r>ed SO (IS 10 '" """'" 0 "'Y ccrl>ide
prod pitotes . The . urface of each electrod e mu .t
be smooth, flol, ocod pe rpe<1dicu kl r 10 its long
""s. 'M1en!he .ledrodcs ore IOgetw, Ihev 5hoY1d
be in IOIaI conla", If not. theV ,Iiould be ~ Ied
"nhl totol conI<Id i, oct."'""""
The welder has 0 ~mer /hot i, ..t to !he
required reeding . The meto" 10 b& joined ore
ploted bet ,e. ,!he 1wD.lectrodesondlhe1Witch
istumed on . The eledmde pressure con be
mcin!oined 10' 0 low se.;onds to help obloin 0
good ioinT,
Appl/ce llon . al weldlnt In o, tllodantlCl
We lding li nd, Q nu mbe r of o ppkelien, in
O"f>odont~l, They irduOe:
0, Joining of """"I , trip" dUfing bonding.
b. FiJring ollochment. .uch 01 bmck~ end
molar lubes onto bond,.
418 Orthodontics Thl;! Art Olnd Sc:I'lncl;!

ORTHODONTIC STUDT MODElS p""'" bw.a I!.ol SlJppofIs ,n. onolOmic ponOon.
This porlion 01 the sludy model helps in dO'pkti"ll
SIvdy models ()~ oceurtl!e plaI'e, rep!Odlldion. the 00",,1 o,ienkllion ond occlusion oj the sludy
oj the leelh ond thei' .urroundi"ll .of! riuuH, mode" OM 0150 g ..... 0 ple(J$inll ond ..,.",meIri
They ere on impol'lOn! diDgnostw:: oid in crlhodon- col oppeoroncc to the models.
fia ond make- ~ pouiblc 10 vllJW Ih, ocdU$lon In 0 _lIlobricoted <eI of study mode"
from ell Ospedl '9 ~), The impMonce ailJudy the mlio of the onotomic portion to or1istic por
mode" o:s on _01 orthod",mc "ag"""",, oid tion "'OOIld be 3: 1. The slepo involwod ,n the
ho. been diKvued in cnople' 11 , The oim 01 ,onsJn.odion 01 study model indude:
the p,esenl cnop1e' .. 10 describe 0 ",..hod 01 1. Impression moking
lcbrico1ing . Judy mode", 2. Dilinfec~on 011108 iml"=ion
3. Cooling the ;",pression
Idee l ,cQII,.'It o f II I/dy mod, " 4. 80":"" ond !rimming of !he co<l
Dnhodonli<: .Judy model ......... 1d fulMi the Io~ 5. Finishing ond poliohing
lowing critetio :
;1 The modek should occuro~v reprodvcc the
leel!. ond !heir lurroonding soil !inuts ",ill\.
out 0..., distO<tlOn.
iii Tho modehoretobetnmmed in til'*' 0 mew>-
ne . tr.ot they ore Il m"""rloo l ond p1co5irog
10 1M e)'8 . Thi s eMble. insto nt id&nlili cOllc n
of e'ymmetrie. in lhe crc h lorm.
iii) Th e mode~ c~ to be lrimm ed in IVC h 0 WO I
1",,1 ",hen plcxed on lhei' 00<:1:,. th o:y ccc u
rotefy reprod",e lhe occ l u~o n . ) f ;; 5 0" ' 0,
i'l The $Iudy mode ll ,r.ou ld flo .. 0 cl.on, _ ' " im..,. ....",
smooTh and oodu le free surioce. ,."... W ond l&l
M<loI~ "..;.......
vi The sl...ay modelss ........ id no! onlV depict the ,...,.. IQ ond (llj
, ... Ih but 'hould olso reprod"" 01 m",~ 01 Pt~o,,""" ""'''"'
"oJ> .. ~h ~iUh
the olw:olor PfOCOU OJ pol5ibl .

P"H 0 1 , . tudy mod"

.....-
"""- "" ouk ..

Ort/>odonlie; "udy models.:....... 0I1wO ports :

1. Anotomic portion ond
2. Misbcporlion .
Tho onotomic portion "Ihot PO" of the
study modo! which il ,he OC/uol ito'tl,esslon 0I1he
denial orm ond it> .... round,ng Slruc;lures. This
po<1ion ...... uollv mode of lion, plos'e'. The
om.~c poflion 01 the ,Judy modGl con$l.1S 01 0
, La b hoc:cdurs US

Imp ....lon m.llllt'

Obtoining o !food impres!ion" the I>on:! ond
10ft ti"ue, of the dentook-eolor rog ion i. on im
potion! fo.;!Qr in!.... proper k.br".cotion 01ort+>.
odontic .tudy co,... The Imp"","on hould "".
tMd to the limit. 01 th. buccol ..,:.;". ond imo
t.... li "\luol ." IOJ, of l"e lowe r arch. The ." axi l.
lory i"lOfe.~on .oo.,ld ~ the hcln:! polo:.. but
,I>ould not _nd on 10 the wft polote.
The de-rrt ..t .ho uld be relo.-ed eml ""t
be nervous. Th e pofie<lt lhovld be esked 10 rin ..,
the mouth to eliminate food port;,;I ek ..
h II ...commended 10 1M Mgh fIc~ge
orthodoo"ltk: trlJ")"> lhol Mend deep into th e bu c
co l oM ling",,1",kii jfig 5). This i. on im portonl
considelOlion 01 orthodon1ic study model, oh:Juld
,.product 01 mum of 111$ ,upp<:o1ing ,trvdu..,
0, po" ible . The t ",V' I""led . hould in dud e
!he lost eruiDd molo" 01Id ad""",,,,,,, ola round
3 mm ,houId exI$lberwoen the Iee'iI ond the ~
Fig 6 (.>.: ~_ be .. 10"..." (to) ~ """ ;........
U... of I",Y' thot 0 '" loa wide 0' too no,,,,,,,, in
;"-0 '" 1>0.. 10..,.,,"
vo riobJy cO u'" . oft liss ue dil!ortion and th erefore
_ulto in inoccuml<! ,tudy modell. entin, th. ,mp .... ,pn
I,~,,"ble hyd,ocolfoo.ds (olgina~) ore The impress;"ns obtained 0 ... ('.(ls\ed"';ng orth
wid.-iy uled for imp r. lSion me~ing. During th e odon'i~ ito" . or model.,one , II II boer>eliciol to
procedure, th e potiont IlteelM in a .erticol po. u... $01\'\0 lorm of vibrgtorlo el im inme inco'l""p
smon to avoid entry alth. imo",ssion "",!<!rial lion cI. ai. bubbles.
into 1M phorytU..
Satin, ' anel trlmm/n, of f~ ' ca.f
Dls/nfectlD' th l Impruslon
Once 1M """lornic Oree of the study mocIeIllI
The impressions ore ri......d tl>oroughly in -....let" ~, !he ortistic portion 01 me
study ""t il
ond 0', d~I"""'t.,d to I," them of mlcroo'gon. b uih 10 I,om 0 bme ave< th. O'iOlomi<: portlcwl.
i, m" pia,!'" or>:J other or"I =.,tio", thot mcy 10 help in rM ki "l) th o OOse , rubbe< bose formers
beprmenton them, D~inlectioo('.(lnbedooe bv (ln! (MJlloble (fig 6.0). Once 1M onaIc>mic per.
socking !he impreuion in 0 d"infectont IOlution tion althe model is poured. 1M impre$SiOn!roy II
wen <IS 8ioci,," , The durotio" of immeBion turned upside down ond p",hed info me
plaster
should be oKe<teined Iro m th e man ufectu re", lillod into tM be,.
fanner (fi g 6 .b) .
A/te.di!linfecnon. the impreos;ons 0'" once again The pies .... bose is ,,11owed 10 lei Ie< 30
rinsed In "'OIorlO cleo. th. m aI "1"rJ rosid",,1 " ... 60 m,nulOS. Thft himming <>f the bose is" me
ii'll""", I'll. tiOJbn la.k Ihrn contrib..Jte, t" 1M beoutyal the
 -<. -

4Btl Orthodontics - The Art and Sciom<e

,,

~ ,
~
,
'--------
A B C

I:
~ \
~

)
I

D E F

FlI 7 Tho ,.,,,,,.1"11 cI

.... o~1i< ",ocIoI
1"1 Soop 1 (BI Slop 1 fC)
..... 1110) ..... "'(1:)
s..
!.lop v f) loIoo:M!GI
VII (hi SIopWi " SIoo>
G H II( III Slop ~

'. '.

,
'C"c,'._____________,7,""
J

mode ~ (fig 7), Th e trimmin g 01 the orThodontic
model i. done "" an ,,"eclne Po$!C!" trimm ing
machine ho.ing a mediumilril corbotundum
....t
5100p I: The ba ... of the mondibulor CCllhould
be porollel to the occlusol pk"''' , The lower mode l
i:I in""rted 0 ""'" a 'T' lr.opo>d " ieee of rubbe r ond
a marl:;ng is cin:umsaibed all o",.,nd the ba ...
0/ the model using a marker maumee! an a -em
calltond, Once ~ mc.l<ir.g is mode, lne ba ...
of the co$! is trimmed upto the "", rl:in g,
Step Ii: The bock 01 tn., mond ibu lor m ~ i.
trimmed petD<lndicularlO the midline. The bock
cJ the mod,1 should ollo be W to the ba ... of
the model. While trimming !he bode core should
beto ke n to ~ 5 mmofthe P"'* base di$!ol
to th e mo.t po,te<ior teeth,
Step III: Ckdude the uppe r and lower model.
togeIherand lrim th, maxillary bocks ..... rfoce. so
thot the maxillary back is in Hush with ~ mono
dibv"r bode,
Ste p 1'1: Th e u~pe' end lowe, modell Ore oc
dudeQ togeth e' ond Ore p"c;ed on their booo
on the modellrimmer. The ba ... of the maxil"ry
COlt il trimmed SO thOl ~ il ,..,,,,lIellO ~ base of
~ Iowermodel, AltheendoithilStep, the b>se,
01 th e moxil lory and the mc ncl ibula, coot. ore
para ll el to oocn otr.erand 10 1M occlulIO l plone
and the bodes of bolt> the UPP<" and lawer casts
are 01 right ongles to the bases.
s.~p V: The buccol cuts 0'" mode on IhI: mon
dibulor co,t 56 mm a....,y from the bc.;.;o l , u,
lace 01 the postorior -n, The bucca l cull Ore to
be mode 60' to tho bock of the model.
Srep VI: The anterior "'"9"'"'" of the lower arch
is trimmed ink> 0 curve !hOI foil",", the tv""","""
01 the I"""" , on",,,,,, leeth. The "ntenor Cu ",e
should be 5 6 mm owoy from tf>., lobiol svrfcce
of me anterior teet+..
SIep VII: The posIerior- 011< of the mondibulm
Lab PrOCII:durcs 481
model e ~ trirr."ed at oppm.<'!latef,- 11 5' to the
bock cJ ..... ,..,ode . The linear meosUNment 01
the poster'or cuts lhould be 13 1S mm.
S,OIp VIII, Th. b...:col cuI> e'. made <YI me mo><
ilklry CMt 5 mm owoy from the bu cco l wrfoce o!
tl,I mo.t p:osterio' Iee'h, Th. bYoco l cuts ,f'IOV'd
be 65- to me bock of thl m""lIery COlt
Step IX: Th amerior CI.I1l 0'" mode on me max
illary co,t. The cuts on e~he' s;de should be 01 ,
eovo l len9th on d '''''''OJ li e 56 mm ohecd 01
t+oe lobi ol , uricce o! the ont".;o, t~t+. . Tn. ont~
riorCVllon e;lIt" "de $houid ~ 01 the midline
of the rnst end .hould exlend till the mdli,.., 0/
the conire , rne or'erio, c....ts are mode 30" 10
t~e bod 01 tho! ca,t.
S'ep X, The posteri or cvt, of the ""'><ilkl ry co$l
ore mode in . uch a wa, Il10, they c.... in ~",h with
.he posterior~uts cJ the mandibular CO". This;s
done by occlud;ng lne moOeIs and trimm,ng!he
mO>ci lklry poste'ior cvts till th..,. are in line with the
mo ndibuler po,te<ior cut.
FIMsltlng ud p ollsltlng
The ""i.tic partion 0/ !he denlol co,t II poIilhe:l
U"fIg f,ne g,ained sond peper. Core shcddbe
to ken not to roun d off 'he Mg e, 01th e models..
Th li r.o l polis hi ng of tn.a ",.Is is done by ~
them in soop solution lor one hau,. The cosIs ore
,
remov. d from th o .cop both ond are rinsed un
d. r WO rm "",ter, The 0 0,," ore t+, en o llowed to
dtyond or. buffed 00 that tt..y Qcq~i .. 0 smoot!.
cnd Ihlny oppeORlnce. The fin;.hed lIud, mod -
ell 0 ... storeel ... bo.:es lafurure~. Model
POtoge bo>efusunlly'1Ore2 4 _01 model .
An im pe rlo nt compo_1 of most ....,."""" bl. "nd
lunotiona l orthod ontje "l'I' li O"""" is the IXry li c
00I0Il p/<:lt . The be ... pia", _ _ to join 0111M
componenll 1o::>geIh.,.. i~ 0 tingl,lufldi<:w"o:lllril,
belides helping in retention 01 !he opplionce ond
onchoRlge. The bose pi"", ...-lIn on orrhodon-
tic opplion", iJ Iobricoied us.ng meI",1 metha<lY
lote ... siO$. BoIh heot cure o. well o. self cure
C>Cr)"i ic relin s ore vsed lor 1M purpose,
Un of h.~t cure .crylle r llin.
Heat o.JJ ",')lie reoin. "'" not """"nely used lor
IobtW;otion 01 on olfhodontic bose pIote o. the
procedure involved i. ~"'" consuming ond tft--
diou" Ne'YW!heless fIeot CUt<! ...,...,. gfve 0 prod.
uct tt.ot i. rroc:u stobie with mlnimol poI"Osll)',
Th.. heet cure c c:ryi i'otiOl1 i. corned wt
in tn. fo llowing .tep. '
0, Th e ... ire co mpone nt. of th e oppllance ore
.",b lli ,ed "sing Itidcy"'0< or pl",t".
b. n.ecoslisthend ippe<!in...-g!et!ot 1015
mlnures ond the ..nace_ i. ollowed to
d.
c. A !.Ingle Iheer cd pink""", ;. o.oIIened ~ 0
IIome cnd is pr.>Sed ~!he model , Exce",
prOllur. i. to be cvoK:led 01 ~ con re",~ in
th;'-'-;ng of tn. """'. In oree ....here e><I<Il Iha
nell is nMded, on e>dditio no l sheet 01 ""'.
con bII applie<;j,
d. &con. ""'. prese<>t o",r tn. teet!. is trimmed
off using 0 W(JK knift, 0' 0 Iron'.~.
e. Tho edge 01 .... _""","""" t!.. retIh is IIcmtd
ond pressed IM-mly inlO po<dion,
I. The clo.ps ond ethe, 0""'" 01 the melotlic:
component. the! "'. to be kepi I"", lrom
acrylic ~uld be covered ... ith "IOllor.
Q, Th e opp lio nc. i. Ile . k. d, d.... o. ed ond
ac<yl izod similo r to 0 pro.the~c app li ance.
h. The appliance isdeHosked, lfimmed gnd pol-
'''''.
u 01 .. " ell errlle 1".
The sell cu.e 0. cold cure cerylic .fl,in. ore mOSl
lre<!venlfy vsod for the le bnwliOl1 01 orthodOl1tiC
be.. ~ot ... The use of self Cur" ,,, in l doe. net
klke vp a l mvc h Tim n end effort e. the ",e of
 Lab P'rocc:dunl li '\ 483

c
~ 11 SdI <ad _
_ ... ocryI~"";O;'" Cro<I'l c_ bolo<-. ~ ......... to) Com._ '"
. . - ot .ayb>f.. W ,.-d III '~Floafo", oi poI,moo loko.od br """"""'" IQ ~ ,J
.""",or..
h..,1c~,. res in . AcryIizolion <Jting cold cllfll res layer 01 <I selXlroting mediu m vo ing 0 lmel r.cir
In. l. co 'ried out in the f~lowing ' te ps brvs h (fi g 9).
Pretrea!me nt of ffoe ca.!: The cas, is In Slabifimlion of the ""re compon"nll: The
speQed Iorpla_ nodules orai, boJJbles. These wi~ components of The oppfionce ore $lQbililed
noduIM must be trimmed uoir9 0 sharp knihtand in their ideal position using sticky """" or piasTer
a"l' pore< p"""m on .... ..noc. a! the cosl should mi. (fig 10).
be fill ed wilh pla ,Ie '. The l'1to be ooyI r.ed .. ktyIi.o llon: Acrylizolion v,ing cold cvre ~ .
""" ked in "",ler fo, 10 . 15 mir"IUte . Thi. proce in . co n be carried o ut in two ""'vs. They are tM
dure pre...enl$ !h e liqu id monom ... from being soil and pepper me!hod on d the 'ingle mi.
obsotbed into The dry plolleor. mOhod.
Application 01 cald mould "'0/: The area Soh lind pepper m~hoc:f : This me-rhod of
thOl is 10 be oc ryliled i, (<>CIted with 0 un;/o.m ouylilo!ion irwofwls odding a! the powder and

I
414 Orlhodonlia . 'hI: Art and 5cill:nu
monomer oherrootivelv to build up the oppl;ora
~ig 11). Aeryl""tion il do"" g,oduolfy b<)' divid
ing tne """king Of00 into uno ll po rtl . Th e mo.il
lary cost Ca " be d" >:!.d into lour .eg ment. 100 1
are """"Ii d ind ividuo ll y.
n-... cosl " O<'..,.,~ in .uch 0 manner
thot the segment to be "c:ryIized il partlilel to the
floorond 0 layer-oI a c:rylic powde, is pao..otIIod oYe'
the COlt. The liew>:! monome, " appl,ed to the
powder until ~ get. >tJhJro1ecl. r ..... p,octodu'e"
'epeeled in tl>o athef..eg_ 01 ..... colllo com
plete th e "c~ i""fon . Th e d:iKld-"'l nto gel 01 th .
!.O Il and pepper tedmiqve indcod e :
0. Diffi~u ~y in obtoining a unil""," Ihkitnes. 01
baMplolII
b. ~"fmecansuming
C. Potes hillh ".k 01 pa,OlrIy
Single mi, method : In th;'lec;hniqve odequole
omoun! 0/ polyme , " ploced OYer' 0 gloss llab or
a pon;&Io ir OJp. /,I.onom . , is odtlod "nd is mi. ed
"" II u, ing Q wtl. knif. Or cement spotu la . Whe<>
lhe """ erie l r""~hes,, slringy cen.i. teney, it i.
tron5f....-ed """ r the co.t and is odOllIltd urubmlV
"""'it .....:ng ~nge( moisl!l!'ed with monomet. The
e>.aIM is te~ uling" lecron'l co .... '.
C.",nQ in the p'...,,'e pot, lhe ocryli,.d
opptonce '. ,,,",,"edOcteiv ploxed in 0 preuure pol
",h id> i. filled witn compres..d a " M> O. to pre
'I nt gi, bubbJe' from d@,.1op in g in th. oppli .
0"'. The oppl;o noe oho<J>:! be lei! within th e
pres ...... pat for oot I... than 10 minut .... AI>. al
ternotivo 10 the u,," 01 p,......,. pat Is 10 Cure the
oc;rvlic in 0 bowl 01 hoI""" "rf", "bout 20 min-
utel ohe, oc:rylimfjan.
T,imm,ng ond polisloing, Alt., allowing the
oc:ryIi~ to cure, the oppl",,,,. I, OOnlly ,~move d
I'e m til e OO,t usi .... a we< knile wedged belWeen
tne bolO plot. ond the COSi. Grou trlmm in ~ Con
be d""e using 0 sI""" mcunled e n a la the Ilig
~ .o). Fin ..., trimming i> w rricd out ..... ,ng appro-
priOlo ocrylic lrimmin~ bur>. Core .hoo.old be tclen
to C'/C'ej "",,,erotion 0/ ""cess fleat during the tri m-
ming proc:ed ure CIS it oon di, ton tfle opop licr'ICo.
Th. oppliance shou ld be frequ ently immersed in
....,Ie,
d""';RQ !i>e trimming procedu,," . The oppli.
once is smooIher.ed using 0 ~ ... grit sond pape .
finally ~ is poIished .....ing Ir-ench chalk and pum.
I On 0 rog wheell~g ~ .b).
Ac ,yUl8f'an us ' n. tb8. ma pl tle . 1I.etl
Bose pla tef Cg " be fa bri oated u .jr-~ tf.erm epla .
ti ~ oc~ic .heets. Tf>e,. , neet, ore ova ll oble in
vancVf thicl<nel$es and coIou". n.,. c,," wom>ed
on" Blasia, "loch<"" (I;g 5) to 0 ~mpertltu ... of
'nI1'C foro tpOCified period d ~me C<1d adopted
over the COli by mea", 01 yoccuum p ..........
1he odvantage 01 using thil technique
i. that u,,;Io,m Ihidu>ess 0/ the """ plate con be
obteined with need lor minimum polishing.
I Va 'l1' o..-d 1.'""'01,, Moo", 1m
2. C;"' .. , 1M. s,.., ., Sf O<fhxlon'<' : c.,,.,,
,..r..:t. .. CO'd _q.. .., $I to. .. CI Moot>,. 1985
3. (oroo .... J ...... ""'""'. P",I", ""'... cI 0..<01 Mo .
_10 .5ou""'. 11'Wi.
4 Prof. WR. eo..-oon;ry 0," t na. !II La..n. CV
. ......", 11'86
S. J.oIm>oo JO, , _ .. ~ :I, Ja LW"'01
_.,."", 1960\
6. Tf.omol M G!<.bo '. Rob. .. lllo "",><Io l , 0<1_
, ~. ce re.,.' ~"' ; pI .. and '-<""""",. MOIb) ~.
000i< ... . 1;09.
I ".", .. Ie c.:.o "", ," , l<>;l h"oo iIC ,~Ico
!O< 400 .. , ""d.c<~ Moc.. I"".198S
r

Factor In

Influenced by tho hypotr.e.,. 01 '0'0,00<.1$ prominent

Y
Ou may rcve hod 0 '.ry il'u $lriovo great.
gr&Ot grcndfothe r, but by the lo w. of pf1 ilosophelt, !\<no"," th em tr.e forerunne"_,,,
chance 'p'CI<J hove recei\ied only obov- one Pythogora l. Empedoci . s, Aristo tl o, Ho ..... ey,
. IM"., "!h of 'IO'J< go"'" ftom him. You reaorved Ad<Im., Darwin etc ,,, In 18 14 Joseph Adorn.
i~.tOlmonyg,_ from m. horJe thi~, '""" ~ ma".,. o f the bo", priro::ip~ of mediocll
-gamblero and o!l.er und ...."'ble. ","0 may n<J\'tl . He ,seven Jenne<! bV """'" OU"'O<1 OS
been in rhot generation of your fumil, free .
A. M. Wind-este'
s.r-1heM lines 0/ ........ >OIC<I'Im ~es
lhesorre uncerlO,ntywilhwhich_ crowd...,..nd
o n_ bom oobv Itying to embli'" whom .... f;9 t G,.~o'
'eHmbl,. pulling into KnJ~nv ...,oh ond"",,"1
po,; of ....bod,o.
Genetic. ill th e wone. <on<: .... nw with
~ ......
. - . f"",", 01

the ' tructure 8. lundion of 011 gene. in different

o rgon lsml. GeneTicJ ;1 0 rapid ly develop ing
sciera tnat he," "",dwod an adva nced level of
~ ~edion & cloning .
Stud;e. 01 g'ne~c ;"lefeSt can bo !meed
bock to 6000 S.c. in ce<1<Jin . !<In. C<>Mngs of
Bobylan. Genehc theories and concepls were
Th . $Iud,,,, regard ing g' '''''o hod 0
break mrough""""'" an """rian monk, Grega,
Mandel {tog I! ",ad .. hi, lo, "",ching d<sccwerie>
by OlfQlullr a""lyting ...........11> aI hio CkpeMIeo '"
415 Orthodontia The Art and Science
f;g 2 _ .od CI-d, .......,....I ... ,~"" ....
"",,"",.10
on cross brwding ",n::Ion pea (Pilum ootivumJ.
Mendol odopted the mOIl simple mtthods ond
studied 0 sin91e chorocteri.~c IhrOU9h mony
generations, He i. optfy nomed the Fother 01
Mo<UIrn Goonetko' lor h" out>!....dng contribution
in tfle fi old of genetics. Mando l pvt forward the
low of SegregotiC<"l occording 10 ...t1ith "~
Ing"';duol pDMesses two IadOfl' ...t1lch determine
o specific choroderiflic. Among IhIM two, one
poir is Jronsmitted Iran >dl po.... This iI; coled
~.-.dels 1" low Or ......-rt;..
of Sltgregolion_
After Mendo>ts .tud'oes o.-.d dilCD'leries,
the .. wei 0 ",,,,,wed owerenest in tfle li. ld 01
ge netic. , In 1903, Su lton o.-.d Boveri proposed
tho Oromosom e TMor)' of In "-o-iTOl"I(e'.
Tl-.:;.-no. Hunt Mo<gcn ,t 01 in 1935,
.....,.-0 owo<ded !he Nobel prize, for Ihe<, pten';""
studil. on the om:mQCment 0I91'\eS 010n9 rhe
chromoso..,.,s. Wmson ond Crick in 1953,
demon"""ed the >lructure ol ..... DI'VI molecule_
The compl ....ity of the ch""""*,",,, ,tNC'ure ....,
fu~her un", iled when t.... 'Soieng;d model' 01
ch r(>T\osome slNd urn was proposed by Finch end
KJu ng,
MOlECULAR BASIS OF INHERITANCE
TI eoll
n ... ,, 11 11 tM bo,iC unit 01 any living body. It i.
mode up of d,lle"'nt orgoneJ los, i, o. rh, " II we ll.
q1CIpiclm, endoplasmic .... iculum, ribolCmes.
milochondrio, nucIeu., ~,.
Within the nuc~ of eoch ",II ,Jr'
thread like
>!ruClure. 01di!l.ro nt IO","!M and .nc.pel co iled
ch romosomes. Th e nu mber 01 chromosomes
pre"n! in I .. r)' ce ll of on organ ism il constont
01 ON>. but II chanoes from one <pedes 10 onollw.
rII. D.N.A.
ChromOlCmes Ore modo> up 01 long chain. of
De<::otyrIbonudeiC odd {DNA) moiecvln, !..-"ted
andlWin-ed in a specif.: men ....... Each Ior>g "rami
of 0 DNA molecu le il a dl<lin 01 nudectic/es ,
Th . ba sic nucleo Ti de un iT ~omprilU a l 0
dec..".ibose .....or. c p/l<>spMte mcIeaAiI <:nd one
prallin eITher purine or pyrimidine. The
nudeorid... bIT! a poir by a """,kl\ydroglll bond
be-..lheproqi.... Althe., ..... ~ ...... lhesugor
molecul.. on both lides 9ftr onoch, d ta on
adioant pair by mea ... of phoophole bordo. The
"ruClure honce r.... mbles c .tap laddo>r,
The comple' structvre 01 a chromcoome
Ca n mero cleo rl, be exp kl iMd by the 'Sc>cncid
~ 01 CM>mosome Strvcn"re' 01 pfOl)Oled by
Finch ond Klung. The ladder lik. ~ructure of
DNA occon;Iing 10 rhem undergoes ~ of !he
DNA duple< liscH, """erdary coiling 01 these
twioted duple. oraund spherical pror";n becdo
<.OIled hl.lOneI, !O Ioo-m nudeolC"..... ",~;gry
co iling 01 nudeosomes To lorm chromaTin lib""
cl"ld quaTomo r)' coi li ng to form !fIe chremotic
Icops. The" Iocps a re then t;g htfy ",:xmd Ta bIT!

rile . .n.
The gene k>r"" tho bo.k un~ 01 inh~rilOnc& by
delerminl"ll me moke up ond "'veluO'll 0/ 0
portlclJlor chc rC>de~.ti c in en organ ism. A gene
can.sJ sh 0/ 0 portion ollte dooble stre nded DNA
~ecule v.itn 300 10 11)(Xl nuclootide pili". Ecd1
chrom<ome corui.ts of hundred. cl thouso",b
of n...deoNde poi .., ...t-.ich COn be considered a.
(I Hlquena!l c1~.
T"", f:,lpt/ol!
T",n=iplion i. tho, II"""""' by wMch In/co'moticn
is tren.minc-d Ircm DNA 10 tn, messenger RNA
cl in e initia l. tage 01 re plicotion.
TroMlolion is lhe porocess in whith me gene!ic
;"'",motlon is octw lly con.. rIo>d inlo proIein
. ynthesiS.
PATTER NS OF GENEnC TRANSMISS I ON
The pel""'" 0/ geno~c Imnsminion IOithin the
denoo-Iocial cornpltxcon II<'ne<nUy be 0/3 type"
R .II. tll/ ~.
II is wroderi.ed by reoJrren<:e of a dento-Ioc:icl
d-e'''lion wilhin the immedicle fomify arid its
progen ilors.
OIICOntl" \/OU.
II i. chorocteri.ed by Ihe recurrence of 0
"",Iocch"ion Ir'O/IIhat """,pea" within the Iomilr
background cr<er se..rol generation, but 001
comi"'-'OOJs!,o.
V",I""'e
II i. chorode<ilod by lhe occ ur",,,,,. of different
boJI r. lated 1)'11'" 01 malocdus;on ...!hin _re i
Qe.",,,,Nons olthe so ...... fomily.
GENE MUr..rfONS
Prot.in Il"'thai.lor the process 01 ",pIicolioo , i.
controfec'by ~ Acro"l/O ~byc;ertoin
agent. in the compositi on of the OO"!l poi. of th e
[)NA molea. lo fnO}' I"" d to the 'I"'''''''i,of on
altered protoin. Thi' ""'y ",.ul! in (I gro",
..Ldion OfCMIn (I complfl.lossolf>e biological
oc:Jr,;Iy ...,tti"ll ln on ~..... . .,oIO!J1ain
specifit cho",cIe<isria. of the inctMduct.
Ge.... mulolion con be 01 diIIerenr typeS
Ike, vis"tlle rnvrofoont, d.trimenlol rn..r!o6on, Jet,ol
mulol"", etc .. ,
Mulo""" . 0'" ogenl1 tho! induce genelic
 -
488 Orthodontics - The Art ilnd Scicttlcc
mUlotiorll. They ore of dill.rent IypOt
I, Ionlling rt><!iotion
2. CarIOin d"'ll', chomkcl. or.c! food odd i!;_
3. C&na in vi",_
4, High temperotu re
Ml>O<.>;jh g""etic mutation. ate ,,"velly
OIsoc:iO!ed ";!h 0 ,peci~c mutogen, IOfMfime.
~IO""""" mutations take Poco. AAhough ...,
do I\Ot hove any >uppotling .... idflt'Ke, some
_rches ollriw., ~ en the botiJ of Oorwinion
eYolution and adoptive mU l etto" 10 the
~iroM1.nt.
CHROMOSOMfS IN MAN
In 1956, Tiioond Levon,ond .w;IepeodM~Fotd
and Home""" demonSlml9d rhOI the numberoF
chro_es in ....::m io ~6 I.e. 23 pa,rs. Among
Ihel4, u rn poirs) "'" aulO$OlYlO$ and 0 po.. of
sell chrcmosomes. The ouloscm.. in the mole &.
lem ol. ce ll . ore ident icol while Ina .e x
chromosome. aro different, Mo lel, o ut of 2 ... ,
c hro mo so me . , hove One X end o ne Y
chro mosome while Inmale. ho,., 2 X
chrOMOlOml!1. This form, the bo,i, 01 .ex
de"rm,nohon in !he offspring. Normal human
tells hove 46 ,h,o_" whi'- the "",mele.
hove only 23 chromowma i.... haploid cdl.
OuO'\"I/ /ertili,(>!ion, the union 012 hoploid ", II,
IrOm eoo::h pore n! results in en cff.pring with ~ 6
cIvornruome.,
GENErIC DISORDERS
Genehc disaders in a general "'peel can be
con,ide-red to be oIlwO type, '.e.
nurneriOll
d'"orden...-.:l "",,;tv'ol d'oo'dets.
Num. rlcal dlsord.,.
N""'&ri ca l dioo rders ore tho.e In which there is c
chanoe in the nu mbe< of chrornotemel within
the call. The /oIlowing 0"" >orne elIOrnp/es of
""......ncol dosord .... :
l. ""fypleOly: A ~oo:Iition where ther. is.on
additiona l fu ll set of dvomooornel ,
2. Mo ne lo my: A c on dit ion wh.r. ane
outotomei. mi" ing.
3. Trisomy : A condition when the.e il on
oddirion of a $Ingle chrornoteme only.
4. Kline/eller's Syndrome: It 11 0 I
chromosom. aboormclity in moles ~,e
the", ore odd~iont>!X chtomO$Olnel.
5, Turn,,', Synd"""" : A .... chramesom .
cbnorrna lity in fe male. wit h o ne X
ch",mesome mis.ing .
S tructural dl. ord".
Struc:lurol dison:Iers 0"" thO<tl in which the .. il 0
chong. In !he bosic:composition ond >It\IdUfe of
In. dvomos.orne. Slrvdun:rl disorders Can be 0/
the lollawlng type. ,
1. Tran.location ' An exchc n9" 01 segme nt.
between non-homoi Oil ous chramO$Of'T1e$.
'2. De letion. Lo" of " segment of th e
~-.
3. Rkog OromotQrl"or>$: Deletion o!both!he ends
01 ..... chromosome. IDI .... In. d.t.rad ends
sride togeme. to Ionn a ring.
GrNETICS - IN AN ORTHODONTIC
PERS"ECTIVr
The Jignilicance 01 gcn ctk stvdi", in the ~.d al
mlldlclne ond ""fc:rt.,d brooch", cannot be OWI!"'
emphasized, H!ndilary preO"posirion of ",noin
diseo_ like Hernophr1ig, the importonce 0/ Rh
Ioclor In pregnancy and childbirth, congenilol
obnom>ol~ies like Dow", syndrom e etc" are 0
lew .,omples toot hi ghlight tho impor!Qnce of
ge n(lti c . tu d;.,. orld genetic co un seling .
Uke any oth . r disc" li "" in medl r;;ne, the
irnporlOnce d genetic ,nII""ro:;e wilWn !he dento S,milarly anoth", 'h.ody on relaPM 01
alveolar campi ... and related .IrudU'et W<!f<! IreoIo:od COSCI.lhowed Ih:rt relapoeWrl be COVMd
fflCognized qu~ "'~ 1. In I SJ6 flederick G. by ;"';e.::l ito ry !e'1dercies mot come into ploy and
Ku ne l e fto r ede",i~ ,tudy re p o rted th a t up.et th e relu ltl altor ,,"oatme nt h OI booen
moloce lu sion, bath ske!ex,1ond de nte l con be romple!ed. Ocduto l monnerisms, ,"w posiIioring
trcmmitted frem ene l1""'" rotion to orlO!tl&r. loter on" obnerma l ~reuure hablto whic h ind uce
mony i""'9Sti90t<:n 10110W<ed hiJ poth ond come unloword forces thaI lend 10 m ove lhe
up with thel' obse rvations ",hich attributed orthodontlcallv lfeoted teoth bock Into
malocclusion mOI"8 10 on int-ited trend tIw:In the m<>locd~lion con olto be 01 genetic: origin.
result d ony ...... iron""""'" influences.
OenlOlocial di.lurbance. of 9"ne~c BUTLJt'S FIno THE.oRY
origin con briefly be Ii,ted a,lollows:
Ar:<::Cl'd ing to mi l theory. mo mmalian dent~ion
1 MiO'Ognothio
CO" bo d:,;OOd into SC"<)ro l deveiopmenlOl totlds,
2. Mocrognothic
Th" develo~enlo l fie ld. inc lvde !he molorl
3. Cleft 'ipond po"''' P",",Olcf ~eld. the coni .... and the incisor fields.
4. Downuyndrorne (1risomy 21)
Among the IieIds, denlol voriobtlily moniIesrs ilseH
5. Gardners $'fIIdrome
strongly in !he d,s'I:Jl thon in the mesial ditection.
6. Morlan..yndrome
For """mple the Ia!eral indwr i. fT"oOI'e prone 10
7. CherW...
voria'ion t'lOn me cenlml iOO ......
8. C",oo croniol dyoplooic
9. Mondibufo../adol dys<><Ioois
METH.o.o5 .oF 5TUDYING
10. OstKIgonesi. imperineta
ROLE .oF GENES
11 . B.im o,il loryprotru.ioo
12. B.imo, illoryolr.s.,
13. ReIordod eruplion oI1ee!h TwIn Ifudlu
I ~ . Hypodordio, onodontio. oIilJOdorltia, 'Ie., Th" generic ,nfh.... nce of inhe ritance .... alwop
IS. Ahnormol 0\'II'jet and overbite beenaCOUMdoon~ Someof ........ _~
16. OpenDte in the mediall f...kI ~ me pOSSibilily of
17. High on;l\ed polol<> ..,me gene~c component, which hel~d in
IS. ~ I numbe r and arrongemont o ftocth t",n ,miu ion of cerlC in !roito. However, omer!
R.soor<:h into the """eti<: influence o f the believed thot the ma k~ d on indi"iduc l i. enti re ly
dento-la cia l comp le x have thrawn light on new d ve to e n';ronm . nlO l inR<>ences. Twinnin g of

vislos of thO"llnt. o nd at the ..,me time disproved
lOme 01 the miKoncepOO'" within the .ubio<:1.
For e:comple, previously, rocial """,ng omong
humons was comider..d 10 be one 01 me foCfOn;
of maloa;lVlion. In"" mi, was displ'O'oled by
tudiel i!Oling that human faciol craning
prtstnte d littl e Of n","li~ibl o risk to den ta l
ocd",iQn.
-,
human embryo ,"",.10 be nature', onower to
this heeled CQnircwersy. Human Iwin1 con be of 2
I . MonorygahC:!wi....
2. 0iqgo!lc!wi ....
Monozyyolic /Wins, They are Iw<> indMduolt
d",," 'oped from a oing le fe rtilized ovum, whk:h
dMdM into IWO 01 on early >loge at development.
Monozygotic 1Wi... thus hove 0 genetic moke-up
idenlicol to eodl other.
Drzygo.tic /win. : They or", two ind;~;d"o l.
d_1opec:I !rom two seporol<! 0"', """lated ond
lertili.ed 01 Ine 10"'" ~""'. The 1...0 "..., ore
"'rtil ilOd by two d ilfere<ll .""ma.They ore not
~!Ico l l.,. ide nliccl o. th ol deve lop from Iwo
diflere nl embryos. Tn..y ore WHl lr>gOlJ l to . ibli ng.
UC lpT ! ~ot t hey hoye on olmos! .imi lar
d.",lopmento l enyironmont in dvd ing th o inTro
"lOtinIM .
Twin .. udiu or", done b y onol,. lng
monaqgotic ond d~oIic twins in 0 specific
monn.r. In CO$e at monMygOlir: twi ..... they hove
o _milOt 9.nehc mofce..up, but po>! nololly some
01 them 1-eJ... dillenon, """;1"01",..",nlol condihono.
Thi. helps u.1O Itvdy lire exp<esSio<r 01 the..,enri:
Ioctofl 0"" 01 tho so"", ~m. , the "'nviron""",toi
inftuellC.eS 0<1 th.i'lJI!'"'CIic .,., ..... ioo. 5im~o rt,- in
t.... to~ of d ilygotic twin . who hove 0 li mi lo r
. nYiron rne ntc l cond itio n, the inl lve""e of goneTic
01 we ll 01 the envi'on menta l facto ," in the
e,Pt11Sion......d de-.-elopmen! of on ioor.id" aI cat!
be ",,,died.
A1thou!1h twin ,Iudi ... ho ,,,,,erol
limilolior>s lile idcntilicction 01 different types 01
t win. 01 well 0< their de~elopm.nIOI
envrron"",nr.tho ""Ori; 01 many researches hos
thrown light inlO the undentonding 01 genet;c
contribution in tho growrh and d.",lopmenl of
on indiyjduol.
attributed 10 hered~ory inhemo", . While doing
"-If!.da DnIII shoo.Jd beUWIJ.. dtheclcm ......
ond 1WCt$:I..... troib. ond their e.opression .
Irt~'. . d lrt'
Th, modo d Ifc"",", ission ok_in Ifoil! COn be
lIydied cnd their dominant and tlce ll l.,
c.aroderistio. cMletm i""d I,y ono l\'Zing certain
co mmunities where p r(J(ti cesl ile polygo m~ o nd
' morri<:l~ within th e fam il y' . ti ll uis! .
Re lapse i, not en uncommon
p .... """*"' ....
Orthodontic>. While r_ri"9 0
par"nt cd>odonlicolly, _do cho"ll' the generic
""'Pression d!he poIient On", tht treatment ..
completed, and the oppliona! iI. re~, there
is oIwayo: 0 dll.r.,., !hoi the genetic upmIicn d
tho patien' re ...."'b!i"-. Ruling out oil oth"
poa;bililies like misdiognosis. ~oppronce
Iheropyond i"'ll'O\>Of patient CO"" a great ",fiery
cf relopose con pou;bly be allfibvted 10 the ...
generic fcctot" lol u. hop e thcl tho OVOl'
inno.ctNe field o f genelia find. the rig ht o n.w&r1
tc m""y of t......ti ll lHlO n, wered que,ti"". in thl .
field.
.... ~. 0"Id JoIv..on , H_a., cJ ..,1 I 01 .....
Nto j ()rh,d 1\191 ; 1~268
1 r:::"", - . . ood loIkrr ' HorioWl, cJ.I ... j .."
...".,.",..... NtoJ Oothod 1993; 121131
3. _ '. S.".., ...... Oriofig ...., H"o~ ond
Wot ....... : _ ..t.tod '" molo<doolon. Nto I
O<t>od 1911; t -18
. "-,~~....d_ . ","1
Ookod 1981; 36617S
S. l'<oIi~ Wlc c.",_""""l Orl+>odonll<>, 51 !.owl>.

PIe/II'" lIue/I
c:v "",",,"1986.
6. ~n JA , _ 01 ~""'. AI upp;.-
com..,...,.,1966
f>o<!igrOG studils are th o mo. t COmmon among
ge netic , tud ie.. Horo 0 definite tro il of on
indiY-.oua l is , tudied otot.g his famil, I,,,.,' so <II
1. ~ : ... fMl<, .. .." cJ
;" ... i!. 0ing1on ~
19&0; 39 <00
c._ <~",Ioc;o l dimo","""
.., mpjo.,." J Orrkod

8. 5",0;., gnd M o l ~"''' , 1.\0'. 1001 infl .... nc., C"

10 lind any hered",,'Y inflve", . Meny 01 t.... ''''''''"......... oiob;ol ...b - . . . Mo J Orrhcx!
Ira'" like bim"';lIary protrusion, milSing l'i'82 ; 261268
Iomi"
_~. I,;gh orched pulot", etc.. con _di" be
9 SydoofH"""""'" o.bomo:'" ..w,cJ er .. I' 1 1
.. _ .. ad .. ' - - ~ o.t.ocl:lO ) 1-5

4 j.
 , ,
,
10
he worldwide ~c rev<> lulion r.aS !oOcy
T
loKC.ed . d to the point whoroln th or. i.
OOrdfy Q P'<'O<' Ieft~ li!e fie. rIOt been
a/!o::rod, diftldly Of ind i~ I by compulorisalion.
0en~"'Y. be,ng thot bm""h of medicine which
.. toes hecwily on technology and whid> embraces
n_lochniqu". with greo! gUlto, woo quic~ 10
hilch 01'110 lhe p.c. bondw<>gon ond employ
campu,"" 10 . nho",,! r10I O!'1fy 'Ko,d kHping,
bvI proClico rlXlnogerroorl, patient ~otion end
mctivotion. Lei u' briefly go over 80ch oSp.eCl of
u$Oge of comput<ors in cientj.lfy. A CompuTe' ron
be descnbed 0' on oulomo~c electtOnic; device
copobled occep!iog information (data!. perform
opetOlions and calculation< oordinil 10 the
l"slIverion. given and supply the _ults o! the
opoJOliom.
~,IWI., If>o ...,." 01 'hi ,.. rem. Mo<;hines
o~t. in IN. ,ea lm of data. Dokl oro row met.
while in!e lmolion Con be wid to be dele th ol is
"
,,'
pklced 11'110 " meo ningful (o nlo>o:l lor ul. by
h umon . HUm<ln . """"Ie informotion betlerthan
doto, while compute" "",ndle doto bette. thon
inlo<ma~on,
V;!1I.o:Ily ~n91hot _<10 in derfi...,.
that involve. ,.seotdI, leaching, odmlnillfOlion
or patient co.. i, 00....1 on generolion, Ito'.
or-.! mon;pulo!ion 01 inbmot;on. CompUl\lrs ore
c" lX'bie o! hond ling large """""nl
"I 0010. They
co:ompl ~ h "'undone, repetitive l",ko ce",l:slen~
well whilre '" hUrr<;l n r>e rformence is li<ely to
ded i"" .,......~me. Ccmpule<s con perlorm fOOIine
ocmmunlo:J~ons wi!h greolo< speed ond oCOJr'OCt'
thon i. hu_nly "ossible. They 0... copable 01
mossive (o"'pr.rtoIion end ceiculOlionl tn()ft!
' cpidly thon humonl. They hove 0 g'e<l1eI"
<cpcbilily 10' Dec ...",,, ond ",p.dily. The
p ,cce";ng '''"'' l:s rnorooge,,,,,nt ello ~ """"'"'"
ci dl:sco nn er:red piece. cI dela, with retrie'ol
fCOlTOn~&n1 "rod relocotion in .torage areGS.
492 Orthodontin - nu~ Art and kh:nt~
CHARA CTERISTICS 01' A COMPUTER
Spu d
CompuleflO 0'" C<lpab.'o 01 mobng Ifevk";"""
at Q very fa " rote tt,at i. not po.. ib! e by tr..
"v"rooe hum"" brain, The '''"''''''~ oYOilcble
modium .l18d compu,,"" In """"',., .....,.. 0
miff,on ......... ctIon. per- se<:ond. To """",pI.'ly !his il
.....ould nor be on e)gge rotion to so y thot 0
computer CCIIl periorm co lculo/"'" in ornl mirwre
thcl on ind...;d"",1 would requ .... his..".,., !deli"",.
Ac c urlCY I"d r."",,lIIfy
Computers Or. de.,.ned in Ivch 0 w<Jy t~ot /h~y
... hob;! 0 Mllh level 01 .ndVfOnce mpocily SO thol
thercon work wiIi>oot 6ring. Compvlel'$ W()fkon
the principal of ..red ..c impui$e tmrlSlllinion ...!,ich
meke. it v~ry re l;.,b l. and mi, take proof. They
ore copable of repe<i"llthe ",me job......,.. ond
"""'" egoin without ony decline in their eflic:iancy.
Me m o ry
, Atyp ica l comput'" ' Il tem oon.i . t. 01 e
Compu ters ore capable 01 storing 10'll0 omounr
01 dolo ond informohon In thei' inbui~ and
o ..... llory memory ,)"Iem. Iniormation thot i,
Itor.d in ml C<lmpulC r memo<y COn be "",i.....:!
at on a.ton i, hing .peed wh.""".r 'eq uirod.
Modem o:Ioy compu"" <;on relr""", dOl<> from ~s
memory in 0 few nonO>8COnch (I naOOMoCond=
O.OOOOQ(X)()I >=>ndI
Inr l,rlry
" " ..... obWly 10 toM. In ond "ore 0 seq......at 01
instrudioN to be obeyed. Svch a sequellCll 01
in,trvo1on l g;"" n to th o co mpuler i. coil ed a
program e nd it mu.t be writlen in 0 lon9'-"9O
that me <;O"Pute, con un~nd. The cempul~
performs OJIOJIotiono Ot moniputot... tho dol(! that
has been Iod to it Vl I"1I the in'truc~"". tnct hos
be"n g iven te it and furni shes the d.,ired ",. ults
Ve,sa tlllty
Compuler> pone the <>bili.,. 10 communicote
with othe, '\"'Ilem. ond odept ......".,1 mod ... c$
prG ... ""'tion Iud! c< cvdic, . iwal, ani motion,
etc".
COMPON/lfrs OF A COAtPVUR SI'STM
A co mputer ' 1, le m compri ll. 01 two ba liC
component., T~ 8)' a re the hordWGl"c (omponent
ond the soh.,,;o.., component /!;g 1).
The hordwo"'compoo ... ' ind.desol the
me.onicol de.;ce. in !he 'ys.lCm, the mrli ncry
and the e lecrron ic Compol'Hll nl' thot perform
ph)"ieel func~ol\l. The soiIwo'e lion orgonized
181 01 ready-mode Otspedally wri ...... instrucrion,
thot mo l<e, 1M equipment .....10:, In s<mple ~,
whole.er we con lee ond loud, in a oomput.,
<;on be said to be the hOt"<!..o.., while, the ... _
il'lltrvcticns that moM. the machine Nn is tho
""-.
ce nt'ol proc... ing u nil ICPU), inpuT d"vlc~',
1IOt'09O devicel, OM oulput devie ....
The cenlro! processing unit COn be said
I<> be the b<ttin of me comP<Jler, Tr.. lur.::tion l 01
lhe C pu indude 1I0r0g~ of 0010 ond in,tnxlionl,
conying our II>. dolo processing O. per th.
In,!Nctions gi...en, controlling the soquan" 01
ope'C~CIU os 11'1' ...... tOfed in",,",cliolU, i.. uing
com moM . to a ll ports ollhe com puter Iy$!em
end ... ndi ng the r.. uflo to th e outpul dovice. The
CPU """"IS 01 an arilhmeftc: logic un~, "'11-'"
control >Cdion, ond in~1 bu . The arimmeKc
logic unit co r'; ," out orim metie ond log ica l
operoIio ... , The reg ill<!" liore Oate aO>d Iccep trod:
01 operolicns. The control un~ 'egulo"", ond
conlrol. voriovs operofionl. The internel bul
connect. me unilS of the CPU wim eo::h o!\'~
ond with c)(\&mQ 1compon en .. o f tr.. system,
 , ROM

Inlemal Memory ExlemalMemo~

R'gllttf
 P;;;;;;;;;;;;;;;;;;;;;;;;;; as n, me, Igt. " ',
P,U.nl ,dd,. and t.l.phon. number.
Chlefcomplalnl
Medlcal.nII OentiL history
DQ frOID tr.. ~nlcal . .,.mlndlon
Olag-"<: t..w and thelr ......1t.
Slo,. of I*Ilnl p/Io(ogl1lpN,
Sto of pItnt r.dlogr.tplla
Stor~ of pltltnt tilidy n1O<Mls
DI"gnOII ,..,d tr..tment ptan
p"ijent progr...
I

~ 1. AfIP_" _...".. _ 'Y"' '''

The input devi(cs ore components 01 " d""$Iliad OJ: ,

compulerlhol <n mccrIlo presenllhe nol1l'lOtion 1) hlmln;'!roIive Appko!ion.
10 th e co mputer. A computer '1" .. m clln h<Ne 21 O inicol Applicotion. o nd
one or mO rO type, of i ~p vt delllcel. For mol 3) O theropoplicclicn .

..,..,,,.
,o mpute .., the princ ipa l i ~put de. ice i. a
compU!&r
Adm ini , trat ive appli ca tionl 0 1 a
0'. o im.d ot .moolh (\Jnning 01 Ike
Tho ""rage d"""., compri of the den!(ll dinie. Theyindooe:
In ... nol memory ol'd !he e<te....,1 memooy. The 0) Po~",' oppoinlmen1> and .'>COlls
inlemol _"""y 01 a (:Ompll'" ore the P..AM b) Bill'ng
(Random Ace .... Memory) ond the ROM (R..oo <) Aou nM 9
0nI, Memory), n,.., ex!emo! memory Cllmp'.... 01 d) Co"espondenc.
th e floppy disk dri ve, CD- Rom, hord dis k d.r.. e] I n ~ nlory conlro l, a nd supply orde"
li nd mag neTic tope. _ n D~nlcl iMura nce clo im.
OY\pYl ,"","co. diJ!)loy tr.e rew l!! o f the gl [)oc(jmc<11 p: p" ratio<1 orld IYOfd pnxel~ nll
compulOlions. The output deo<ices i!ldudo the h) Refeollnfo,"",~",,
..;"",1 displa, unn 0<" rho monitor and yorio", ij Missed oppoinlmenh follow up
Iypes 01 prirlters. Oinicol applico~on. 01 computers 0
tho.& Ihol help the denti.t in hi. o. h.
usn OF COMPUnRS IN OIITHOIH)NnCS prc/es"onal pmctke. They ind...de:
1) Potionl ,!'Cord Iom ge ond .e!r'ovol
M Ofthocionlic eslc~i ,hm . nl '''"' use C(lmpute"
2] Poli en ! e .a luol ion . xamino tio n and
for 0 r'IIJmbe r of pv rpose. , Th eso Can be brood l,
treotme nT pla nning
3) I'ohen! moh",rion
. ) Appli1lnc:.. ~i"ninll usinll CAD. CAM
5) Computerized imolling
6) Co mpu!eri,ed c&phc bme!ric.
7) Compuleri,od growl" pred id iol1
8) Clinicc l diognosi. ond IfJtmenl pianning
Computers h".,., 0 number 01 other
opplicotion< be.ideo Ihe dinicol ond
cdmini.troll". ""'. menlioned abov . They
In clude .
I) CfO<I~n Q 0 do ", bo ... 01 MVOV Inlormalilln
2) Continuing mod;,;.,1 educotion
3) Reviewing oIldettllu ...
. ) RO$eOrO>
5) C""c pre",ntoti c n. coo oth.,. conference
presenl:ltiM
6) Enlertoinment 000 Iomily u""
COMPUTER IZI!D SCHEDULING
Se.erol oIlh. componiu produCing Dentul
oHice monogoment .eftwo,e . todoy eHe,
computcri , ed ", hed uling modu l. With these
p'ogrotr.' , it i. no longe, ne.cessary to moin1O in "
poper oppointmenl book. The "heeluler ollowo
the receplionist tu ~nd OOiiablotfimes for pot~
oppointment> 000 log II>om on the computer.
COMPUTERIZED DENTAL PATIENT
RE CORD
One 01 the opp!icolion, 01 <omput ... in Denlol
pt"OClice i. 1M 81"",e ni< storo(l'l el dicgnostic
inlorn"lO Ticn Electro niC dento l p(llienT rocc rd
(E .O.P'R.) i. sJ0v.4y 000 steadily ,"pi06I\Q bu lky
pope' record . Electronic dentol patient record.
help in JIo<in g pc!i",,! inlormoti on in c dig il,, 1
which con be re rrie.ed, dupliCCl'.d,
forro"!(l!
caIologed, Ircnsmilred or<! or<:hMod os needed.
11>8 opplic01Iont 01 $\Kh 0 compur.;riled .)'S!em
01 denlol poioent reeord ore listed in Ag.2.
Rocotd I1OIOge probl"'" inoeo.esos the
proct.ce ages Study models a"" bulky and ........,.,
p'uenrlng considerabl e problems for
OI'gQnilo~on and .ton:rge a. they con~n ..... to
ac.o..mylali!.
C u"e nt teehnoJogy i. <:J">"Oilcb le lor in
office ute of com puter1 com b ined with . ideo
comer," 10 cOpy rad iog roph' . study mod ell .
phc:obgrophs, end hc ~ records lor 51orog.
in CC<"I1pocl digilcl loom. Wouldn\ i! be wond.rfvl
10 be obi .. to ,ICOlI II...!y model. in the lo,m 01
hologroms thor woufd al low ';ewing from off
poin lS 0/ odvo ntog ei Such !ech""logy, Tho ug h
no! commonly "voilobl . doe, o.;,r today.
PR.4CrtC MANAGEMENT
Derntiltry, o~. off is a profe'Slon fike ony ""'..
ond roday, fiYing in 0 wn,umeril! soc,ety
prodd""'e" h""" 10 prolessionaliy manege thol'
hospi!al. and clinic< in sud> " wey rhor. ther ...
pol i,nt klli.I",""" and iab ""'i.I,,,~on. To cater
10 tnil nood of pr"fessiooo l m"flO lO"n>fInt, lOme
of the d e nto l adm inistrative $01twore$ go one step
;",yend pc!i e nt adm in i' !",lion end worlc 00 the
cicIO Th ol il fOld in, creotin g report. tOOl a""Iy'e
the ""Iu'e of ,he worJ: being daM ove r" PGriod
01 ~m., the COlI .,if""'i .,n.... of lime spenl on
the voriou. procedures, I;'" produCIiv~y of the
f;; 5. 0',">1"
........ <11 .. _
(tI...-I ..J ....... ,_
'-'01 f - o t _ ...
lot ""'" ....... R p>aiblo to __
denli,t ""er a period 01 ~me and 'a on, !hu.
pro.;d ing .ol""ble manogement l"furm(>!ian
re port. wh i ~h ono ly1e the plcti ce within the
, ho rtest ti me .
P... TlfNT EDuc ... nDN
There hal a\wcryl been a need in all b,onches of
me<l.o .... to educote pofienb about diHO ....
p......"Han and cure . Most d""~lb '"II"n:! !hi,
olped ve<y highly and spend 0 101 r:J th eir tim .
inform ing th . poti ""t. about the _aric u. de nto l
prob lems. hea lth guid e lir't!l . etc." Howaver.
comp uter> can SO"" th i. "" Iuot> e tim e of the
denlist by !ISing the latest mJlimed'oo technology.
Multimldia simply means using mu~ipl. media
like tu:'I, pidu'"', gmphics, rTIO\Iics and lound
to """I..I a p,eseo/ufion (~9 J). Inlern(>!;or.olly,
vorlou. multime d ia pDli en! education
p'e.entclion. oro a'o ilab le, which con be
pu'chosed and ployed "'" th. co mpu"" .)'Stem
~~ <nI
."
lor the benelit of lhe poIienl . iust like a video
C05~t. is ploved.
CA SE PRESENT...TlONS
M.ost 01 VI d"n~ SIS oon"der <>J r1"IYes 0' lifoIot,g
studenIS ond ",.eo..:h... and ou' prdeo"on;s
not limited to practice olon,,_ Malnlo lning
reoea,eh dOlO ond oe:mng p~entotio<'d Is one
01 the 9'eotell boono <i co"'o"",ri",ticn, Most
0';""";1"'0 og.encies u'" in'emo!.",,,lIv "",'hted
pre,.ntotion sohwo ,. , li ~e Microsoft Office,
POW(l<' Point to pu , h thei' produ cts. This some
tool oon be used by dontis" to moke slide
pte<ento~ont. ",herein one C<ln USOI t.... colour,
pictu,es ond octvol photog,opm. TheSOllQQ1o are
extremely u_ friendly and !hey not anI, moke
p rewntOl'oon elol.$yond iMormativ6, but also ......
,oI",,1>Ie ~m ITIDf'IIIy ord efortthot woo ~
pont on t fle 10"""

lhis iI 0 tool thOi .. 0 God """I gill lor rnol.l
dentists. Since denti,.ry, nowdeols wi1h r:h:Jngin"
/h& look 01 0 p&rson'. /cree, record keeping
nalurolly Involves" 101 01 pi>otogrophs Ihal
doarmeolm. 1 _. But rntn.rol photog",phy
i. rime e<rnwmlng, lobonovt and e,.;penoi"" <MI'
" period 0111"... ond it nos ilS l i m ita~on .,;/h
intraora l pic;! ures . Mo'oo'o', it (,eates mo,e
ptlp&rw<rrl<. Oi!nlo l imog i" Q i$ U $Olulion whe<'ein,
Q 'm(l ll Inl'QOt(l I CQm",a i. in te rfaced 10 Ih.
compvlC', 'O IfIcll If>\! user M. 10 iu. llocu. the
cam&ro 10 ccplu 'e lhe i"",9" Ol> the moniIO',
di(\; ond me ImOQ' con be $Ove<l o. a port of a
picture a lbum lor each po~ent in me compute r
ilnll. nen image, can be , ie ... ed, ed~ed,
Ironslormod into slides, ond printe<l, Not only iJ
II m. m.... ,K&<;ti"" rec:ord keepinlilooi. but ~ is
olso the m .... eilective mo<leting tool . J"he<e is
hord!, ony patient who is unimpressed by /he
phoro recording 01 his/herlreotment and ~ 01..,
creat&!; oworene .. omong pa~e"" Oboul the
need of denlistry and ilS eIIects.
O i9~ol e<rnieros a re av<l il ,,~e mal ccn
be used to ccp/u'" inrmornl 000 I,ao", 1p iclu'M
wkid1 Ort 101., .to ,,,d in " co mputer for futu re
vie";ng . Th"", d ig ita l comero . do nol w... lhe
tOfWenliona l pholograp hic l il m . Thoy recoro
imegel on memery tord, whith e,e le le'
tronllerred 10 a compule, lor . IOrO,," and
revewing (/"'11 5).
CONTINUIN G MI!"DI CAl EDUCATION AN D
RESEARCH REFERENCES
COI\~MiMg med iOlI edvc;ati"n ;. ,.,...,...tial fOf tt.e
professior.:;Jle>:tIM_ ond growth el...-, dodo.,
Willi ~mitoIio,," ellime, 101\g distanc.es ond tra!f"
d,ff;tuftje, ~ be<;ome, InO'lKJlll\g1y dJ/licu~ /Qt the
d." 'ol 'vrgooon 10 orr.nd WO<'ksl-.op; '" omOl"
con l;nving "ducotion pro grom. Ace "n to
med icol ond de ntol tou ma~, and ow... 10 I".,..
valume 01 medirnl refe.ence mate,;ol i. t!Os ily
oYOilobie on the I n _ ond 01", on CD-ROMs
(flg 4 ). Numerou<d.nrol "",bsiteson the intern.t
ofI ... ofI.. ""II omount o! informotOon 100ed to
d.nti"ry.Comm unic;otion cnd ,o n su ~otion with
, ,, lI eogue. in 011 po rts of th e world is pOll ibl.e
uling Email and Internel,
Multimedia me dicol and dentol
publicotions ore now wid.l y marketed .
Multimedia ~blicotionl not or.iy indvde ~ ond
piclu, , but 01.0 video clip. ond 'ound
,eco rdil\g" Vi rtu a l rt!(ll ily pres. nto ti o n. ond
on imoted sim ulation, olto form on impc<1o nt po ~
ofmultimedo. Curren!!y M'YeItII hundred modical
and dental books ore oYOiloble 0$ CO ROM's
Anybody who is invalved in research
knows lhot 0 very "''tie pori o! rcseorch w<:rl is
te dl ou, tob~ l otlonl , dO le o"oly, i, ond
poi nllo king . toti. ti col o"o ly, il. All thi . co n be
greo lly focil itoted uSil\g a co mpute r Ie<>ving
""I""ble fime 10. the researcher to 'p""'d on
octuol Kienli~c ....,.king.
COMMUNICATIOHS '" ENTERTAINMEHT
Bes ides o il tho," VI." co mput ers hoye
re~u~on i led ou r concepti of communico~ "nl
too. A camputer in our dinics C<ln func~on o.
on onswering mar;hine ond 0 fa . Rcan link you
10 the I n _ ond con be u!oed "'"' inlemotionol
COmmunication> viO the Emoil. II con 01", be
""
"sed lIS a rool for enler1ainmenl, ""r onl, for
ploying fO K inotlng gQme~, but con be "no' to
watch tellIYil i"n progrom. , O. I> CD plol"" a nd
CO mQ'O'ie CitJl"'"
COMI'UTERIZEO CPHA l OMETlC
s rsrofs
Pri o r to the int ro duct io n of co mputerized
ce phol om et. y. 011 e ng ulor and lineo.
moo .... re."'enlJ _ <:ol::vloted mOflvoUI'. Be.o&e.
being ~me COfISuming. il in""lva. the pou;biIity
0: humen e<TC
Computerized oephoIomelry preMdes,'"
o ddition 10 reliClbl lity. the <>dronIng<! of r.peed. 11
con be perIo.med in 10% of the tim e of 0 nonnol
ma nua l registrot ion a nd co lc ulotlo n.The
advantogM olthl~ ""tem include :
1. Ea.,.lIOroge ond retri"",,1 of cephalometric:
tracings ond ""I.....
1. Inle9ra~on of cephalometric regillralions
..ithi n on oIfice. mon"ll "ment co mput ... i:Ied
~-
3. Gombin<l1ion of the cephalometric dota witt.
<:rl>e, po~ent re>n:h.
The IoIlowing ere >lime el the popvlarly
.......d computerized cept-.olomelric: .,..~ml.
RMO'. Jllly O,thodontlc EVlIlulIt/o n
RMO(Rod<y MevnlO in O rthodonlic::sj...".the r.rst
to pt<>Vide the de<1tol profession with 0 computer
a ided oepholomerric diagnosis in rho 1960'1. A
recently deoigned software podcoge the JOE,
\jene. atu troGings of lol e.ol O. Ironlo l
cephol ogrom s u'iflg Rickell$. Jorobok . Ste iner.
s.o ..
oun i ond Grummono enalyse . It con also
provide a vis uol le~ of normollor
comparison to me porien!'s trocingo. generale o
collection of cepho/omeJrir: "'I.... IMtotd in 0
logicol ord.,... olong with the """'" ond _
ol do.io#O" f.om normoI and put togethe< 0 &s:
5Ill1 Orthodontia The Art and $gcnc:'i:
01 orthodonti<; problem analylis.
PorDlo. (Pu'pau an Re que. t Dil ltlre,
Input Output sr.! . m)
A p rod uct o f th a In , titulo o f Onho d o nt ic
~e' ~, Cienrnar.. ~ il a c&pt.obnelric
I)"tem aimed ct prO'o'iding denti'" with a u_ .
M.ndty pragron. Thi. progrom con be easily
changed to . ati</y indivldllol need. and
pre/er...-.ces.
Po.- Dios WQrk. wim a dlgm .." in the
ltandclrd ~ or><! oloo .-.abIM me
uM! of a ,;deal
1C0 nrle' as men,," c1 d igili:otion ol)(.ro)". ~ u,e,
pop ulo, ono l),,", ir>dud iog Bjo rk. Bu",one,
Caber>, Oow"., McNamara, Rickettl "...j Stei n. r.
Po.- 010. ha, built-in lunctionll(> coleulola d i._
crepond8$ ~ the oc::Ivol and its deviation
from the nonnI. The roarrn.1or eodo ..,rioble con
be dlonged Iordiffer-ent ethn,c 1I""'p". It is muhi.
lingual and the u..,' can dloo ... tmrn fnglish,
fT ..d.. Gefm(ln.llo li O)l\ Dutdo. Spanish, Danish
ond G ree k.
1"" .ySIern f""~i"'to. dovble dig itizotion
mlnlmi'ing ..-rar and en.un'"9 trot yolid ity af th e
.. hole reg ..tratian pnXcdure . Th, drowinlil' con
be prlnled eitlw on a moti... prinl", low printer
or a ealor Po-- An impo" . eq>ort ladlity ITKlW
~ p<.ib!e to 1TKli<e calculallon, on all ttored
parien ll. It Con prod uce a dalobau file
co ntaining th e resu ll. of tr.e digiti,otion ,
01, 1 G,.. ph
Product 01 Odflhin ImoOing S)"lern. USA. The
Digi Graph i< a ' ynlhesi. 01 ~,deo 'mag ing,
comp",e' technology and .anic dig,tiLing. The
D'gl Graph work nltion equ'pment meosu"'" 5'
3 7' . It cnable. the dinidan 10 perlorm non
i.was:--. and "",, -radiographic cepholom . tnc
o nalyli. Cephobmct'ic londmor'u 0'" digitized
by li g htll tovch ir>g th e <on ic d ig itiling p robe. to {)
point on Ih, porianf. skin cOfTcsponding to~.
Th;1 em,1S a sound ..... hich '" men ..corded by
me mic'aphone or><! moni1<>,ed os ~ Y end Z
coo rd ioot8$ .
Tnt .y.te m a ll o w. ce pha lome tri c
evaluation ond treolment prog rOIl 0 1 aften (l.S
M<:8$lOry wolhovt rod,otion e. pawre, The Digi
Graph work station'. hordWQre a nd .01.....,.
enoble the p.,fu,mance 01 c:eph-olometric
aooty,es, rmcingt, superimposition and .... uol
treat..-t obi.er ...... . The pmgl1Jm ;1 copoble <J
14 0001)' ... . . Moo.u'. "",nlS for any ... Iect..d
aoo lyli' oon b. d i . ~ oyed an Ih o monitor and
the observed value. ore 'Mwn e long with lhe
pctitnI oorm odju.1ed b-c ",", .... fOal ond r.eod
siIe including stcndard deviarions. The Digi
Groph allows all potienlt' rodiagraphf trod"""
cephalagroml. ph",,,. and madelll(> be ~
on m. eampvter t.::.rd di, k, mer.by- reducing
ltaroge requi",,,,,,nts.. fu rt!-.etmtn ~ is a ""Iuable
too l /0' imp r a~ing communicati o n amo ng
<Ii nid eo. potienl and .Ioff. Opti"",,1compo ",",,"
inc l...d e:
1. A con""ftalion un~: ~ lron.po~. infe,ma!ion
inlo t hc aper olary. d OClOr'1 oHice J
COtIIuhalicn """', thus allowing ....... ng and
comparl,on of in/o,malion and Ihe
development oI .... ual ~tment Objec:hveS.
2. A high . ...,<olu~"" .;deo comara with Q
telepholo len , for toking intra orol ~i.w> by
freeze Iromir>g If", ~id .o imoge .
l. A lig),! bo>c !" r X. ray. and a study mod , 1
hokitr Ior,.;d"" imagi.-.glhot .,.;11 be included
in Ih. AePP"f di.k.
4. Camero ond vid eo print.. , lor producing
copl.. 01 vidao mannorinlamlohon .
COMPUTERAIDED DIAGNOSIS
R~~ea,dl i, CUff. nlly in pregroll a nompting to
creote a ~om pul"" .)"tem thct wo uld, in eHoct,
~ mu lote the diagnosli c obi litie. of Ike pr<lclicit"Jg
phvtdo n Severo l progro,.,. he", been dHg ned
to oid the physician to mo~. m"hlpl" and
complex diagnose,. Experi.nc. with the ...
pragr"",,, hawever. conlinns the belief that
med ica l di "," nosi. i. a com plex prOcen_ The
comp ute r is ob le 10 co n.Irue:! a differenlio l
diagnosi. after being pre ... ntl the n.ceuary
hlstoricol items, symptom., physical.lgn., and
ioborolory obnormalilie. o ..oclatld .. ~h a
.pecilic med ico l dirotdtr, H"""",.r. the P'09ro m
am"ol reoog niIII'Vb<;Qm pon MIs 01 Ill ness , wen
01 i\lific 0'9<'n i\'ltem invol""",,,nl Or Ihe
degrH of severity of the pathologic Or'OCes>cs..
Th. computer iIiIIlim~ed in its obilityto reoson
cnd is """ble to simulcte thethoughl proce .. e.
a nd p'c blem , olvir>g melt.OO. employed by Ihe
human miM. Thus, the proclice 01 med ici ....
remain. 0" 'art' rother thon an _ I 1I:itt>c;e.
ond !he camp ....... c",...tI, ",mol.. on!,.. a tool
to aid, ,olher thon reploe., the physician.
M EO/CAl IMAO/NO
The advent 01 camp""''' 00. ollowed ropid
lechnologic oo.onces in the ~eld oJ diagnostic
imag ing, including X. ,oy., "lIro.o"nd . an d
nvdeor imagi ng syslems, C li nica l applical ions
of ultra.avnd diogno . i. hay" broadened
considembl,. Such technology i. now ""ed to
dtlocI dison::l." in",,""rog lhe Ii_ and biliary
'yslem. kidn...,. and in obotetrics and gynecology.
Th . y a rc 01.0 ",.d 10 diogno cro ni olodo l
patholog ie.bylfle donto l . u r~,
The media" profession i. V<!ry fomilior
..;th th" U50 01 the CAT :Kanner os on i!'\Strume'"
10 provide non,irwosi", inlormalion 'ego,ding
th e . i.e . sho,.. a nd hcc ll'l1 01 maio r bod., o rga ns.
Hcrwever-, a new mort ,""ooti l. and ",Ie, method
of prowiding th"",.do'mensioMlview1 of !he inne'
body ho .......ged in NCen1)'11O'" This technique,
ca ll ed NMR INucillllr Mognetk Resono n~.) . he.
Ine rol odvantogn O" or CAT. 01 g ' oo test
tlg"if;conce is itt oofety. ~ is .... hrely noninvas ....
ord doss no1 ~uire tile use d. dve injections or
the "'"pasu,", oJ the patient 10 iorIizing ",dialion.
Th e NMR ,",an~r i. 0110 , uperior to lhe CAT
K.Qn .... r in that it I;an image th "",," h bo ..... thus
d;lI:lo",ng p","iou,.,. ;,idde" pam Ollh. body,
'''I;h o. Ihe .o lnol cord. NMR CO" olso
d;f;erom;ot. ""'0t'III blood, liver, and mva, Dnd
in 10. luture the sensilfyi!), may h.lp di.tingu i.h
be_ n be ni g n ond molig""nt ti ss ue.
NMR """". by .....,..-"11 111. patient to a
Iotge magnetic f;eld end low1e....I r'Od"drequerq
pul ..... Electrical charges gen.roted by !he r.d,;
o f atom. composir>glhe mole<:u'es olIO. body
prod uc .. 0 . ubmil; rosc op ic mag neti c li e ld.
a llowing them to be o nfO l;t.d to on &xIem ol
mognetic ~eld p"",;ded by the NMR oconne,.
After the nudei h""" been oligl"Old til' NMR, rhe,-
are bombo,cIed ..;th ,odio """""'. The mdio
wove. or. t"'e n tvrn ed off. and the nudei are
a ll owed to ... 0 ",-em ittin g the radio .\;IM I. thot
are con""rted by Ihe NMR ",o...ne/, comput.,.-
.nto images of the body. Th... imoll'" 0'"
.u,..,io, 10 II>o.e obtained w~h all p..tviOVi
~h no \ogy.
Conc/ wslan
Thul i" conciu,"on !he compuloo,..;11 provide !he
Doctor "nd hil stoll ..;th immediate OCCe" to
mare info rmol ion Ih on ever befo r.
Corrom un icotior1s i. improved dromotico liy 0,"",
otto"r lorm . 01 mo,l<,tting, W;th detailed potient
hilton ..., diagnostic Information and treotment
j)lons stored in the comp ...... " , ...,'ch and
prochce o""lysil can be do"" ..;th eo ... n",...
a dva ntag e. a re more impo rta nt to " good
,Iin;':ion thon any initial incon""n ience. lhat he
may foOl ...nile compute.-isirog hi< clin;,:.
,
502 Orthodontics The Art and Scl~nc:~

Alilhilia poMiblB IOday tIl a ",asa""bIo

casI-..hi<h j6CQ,en itoeII in a >ha<1 ~ a/fi .......
ComIHrifi ... !orAl ha>.e further dri...n
!he prices at computer hardwareloaftwo", lawe.
orod 1-." eoch 1". thy, bringing dawn the
palient. an ~ Oactar'. ca.t It> bene~t ",fio . The
cam~can truly be <a Iled C 'Vrecm Mach ine>,

I, Abo l"'" , I n"od,~''''' 10 ,,,,,,~"',,~a' ,,,,, 01 .....

""i dc-'" ......., . A... J Q.t.;.I I992 ; ~0-3n
~, _ , I'roct<o ~ <om"_"", _~
""" J omIOd 1992; . 71. 7'
1 _0' '._". DOS , C""'p',.ri"'/ Awt"-
_ ..... J ",. Orf,oo 1966; 61J7~l
......... "<1 c-....,... OIod -.I ,n. .fIO ...... "'"
J 0nfI0d 1930 ; ' 165
~ i;". ........ ". DOS. DO. O;",goo flo",' ;. DOS .
a_oa; Coo-po.. ..,.Bo....:t ."'""",,,"""*<Ior. J
d .. Omod 199. ; 136-1<1
6. OtMIt M. Killloo ,. ~OS. !.IoSO , Nool , ~cal
0", J .... c...._ ' ''''""'.Jd .. Ocl.od 1985
,U5U!
1, f 'G,am lj" : Tho 1"./-0'" ,"mp,t. , '0 ' ,h.
~t'c .'1;.:0, "'" j o "kc<J19aJ ; I I 512.
a H"",,, W, ,,,II ',,,:
fMoncod Of1;" """,,,,,,,,,,,,J
d n O+od 1m, 5J 9 ~ 50
9, ~I<l>a" G, .......... C05. ".~: k>!.n C. Ga.""""
CI~ D. MS, 0..,,,,, C. 0.-"""",; Tho o..iGrao>h_
!o",,,", J d" Clthod 1990,.(12 . 0]
)0. ~ob,,' G K.I",. DOS, ot.od.,.,or; ,'''" K.
fconornldoo. om. MSO: Ib,j HoIimo" Jr., DO . JCO
""...-. eo......._ '"
1987, 591-597
Or+<>a_",- J d. """""

11. ""boot" SchoIi. DDS: Updoh> on O""odomk

~ .... J <In Oothod 1987; lJ5-7J9
12. to~n , $< ....... DOS' I"J.ron;'. S' o.o-ge of
~ _~ J do" Om.od 1928; 13-0'15
13. R,d." , I....... p"'~;G . . .""""em.",, v""11
t.obj<opfo;,; 1 _ ..... J 0""'-:1 1932 ; 3100313
I., Sol,o.;da. I""oe. Voondo. ""' .... 0;..,-.
,o.,d.,d,1, _ . . " h:o.;o , c:""", _""<hi,<!.
_
' ' - ., o.tt.odo,..,.. AM J 0"""" 199:1 ; 2 10220

MuIt
o thodontics
n the bot/e<w )'e<:lrs!!-.ere 1.0. been c~8fOble
I
inte"" ! in ,,~r.odo ntic treotment lor th~ adv lt
poIieot. A 'ee,,'ot W<Ye'/ conducIed bv II>!J AN)
~ an Increase in "'" ~e cl patie""
over '2 1 'f"''''
of 011" from " lruc:tion mor" Il>on
~% te n yeors Clgo to olmoll 7% Too ay. Neorty
11 %i "P"'Cted ofl..- another decode
There is .... de~niIe oge wh"" Ihe mole
or me lemale _the. ph)'>icol molurity and it II
The,e/ore imprcCTiecl to '''I to ciela rmi "" ""'l,tt.,.
wh en odu lthood begins . Since on od ult is defll'l6d
a. one ...too il lull, grown, fI'>OSt male, of 18 or
19 ond mOSll.moles 0116 con be con,;dttec! OS
00"'1>.
Accordi ng to Ad erman , ' odu ll
... ...do.,,'tiC$ is concerned ... t!o SI1iI<ing" boIarg
,hod<
~ odWwingoptimoi P"l"imal Md O<:d.osol
<onrod 01"', 'MIh, occeplobl. denloiociol
e.thelic<, n<)rrncl fu nction and rea.onabl,
ITCbi lity.'
IU'ASOHS FOR INCREASE IN
ADUlT PATIENTS
The percenloge of odull po~.. n.. who ho ...
f&Coied olflu:lontic Jreolment hot incrcooed
';gnifw;onte,. in the lost decode. From 1970 to
1990 On 800':1\ increo.e in cdu lt patie nts ""'.
0 ........
An incr~.e in the number of odult
poIien .. in th e poll lew yeo" h", IIndOllb~IV
b$en due to d"",,,,, sed number:! 01 child po!iem.
with tn, ~t ~otioo 01 oro,;I)' in rhe lield 01
p.-m.. de~ Ho.-, G_ Bo.... obseM!d
!bot tho child populclion i. dec;'''''stng ond !ho!
the numb." 01orthodor\!i.!. ;. i n<:~. i ng . N t~e
Klme ~me. _ find an increase in rhe r>umberol
od uk con.ulto~on.. The te<ervoir 01 adult
ollhodonlics is Iorgo& becovse 01 ..... nywhocould
r>OI (Ml il th om. efvet 01 !,,,,,!men! IwO or T~ ......
decod el ago.
~ Orlhodontics - The Art and Sch::nce
The In~ re o.in\l number 01 odult.
requiring Ot requahng onhodontic Ifeah ... ~ can
0100 be aocribed to :
I. Innovorions in opplionce" especially !he
"""-enl 01 direc' bonding. celOmic brocke!1
ond 100"'<010'00 wi,e. he"" cougnt 1M
o"ention of mon i 00,,1!> who woul d not
0.foerw;5II...eI< orlhoda ntio treot""""t,
2, Imprcwed oppIioro:::. pioo,menttedmiqoJe,. The
Iotost deve lopment I. li n900 1orthodontics o.
;.w;sib.,. orthodontic whic~ mo;ry ..hartly be 0
p, ....., teo;tonque.
3. Iroco-HIIed .....,..... nce with oduh orthodontic
llootmorot and Ine ocn"'vemen. of good
(1Isults.
4. Increo5lld public awo""""" of "'e possobililies
oladu" treolrner"l.
S. InCl8O..,.j dosi", oi polien!1 and ,""orol;""
den'"ls fa, !footmenl oi denlol mvtilo~an
~rablem l, using 100'" """,emenl or.d li><ed
<1iSIcrtI'iono rathor than re~ prosIhe ....
6. More sop hi sti ca te d an d s ucc.ufu l
rMr"Kl~lt 0I1he .ymplom. auocioted willi
lein! dysfuncti-on.
7. Mario ellec~ve mo""Il"'-" of ,keletal iow
dysplasia., using advonced ol"fhog",,"'ic
W'lIitol tedlniquas..
Wim!he __ <honging times, "'e ad,,"
nos ov-ol<ened 10 the benefits 01 orthodomicL His
inaeosed OOCIol and buoi'-'l octiily 1-00. mode
n.m OWO(1l of viSible "'' '.,0:: .non commings,
\I~r>g personal affl""nce OM 0<<:.". to "'i<d
polly portiopotion h",e p<Jt h im in reado of
t.eotmen! previously difficu lt to obloin but nOW
Il)Qd il-, oveltoble, With this, the orthodont ist ha l
D n . ... re,pon, ibility of developing ote ri c
procoduroslo. t"",ting adu~ po'ienl"
Th, Increal.d demand 10' ad,,!!
O~hodontitl 'oday COn 0100 be DSCribed to the
following fo~ .
I . Media . Nu ............ orlicles in mogozj_and
fll'WSpopers, os wefl os od...."tioing by dentisl$
increooe publi~ OWOrerllOSS.
2. mwmro:::e . Thi<d pooty payment 10. poNto"
of olhe< phil"", 01 denlol co", con make funds
O'V<Iilobie forodult Drtt.odantia wnido il O<1l y
OCC05<on,,11-, cove red by in.u",,,,e ,
3, Affluence Totol denta l treotment i. more
occoplobie i" iodoy'. odu lt> becau~ th ey am
aHard it.
4, Fomily denli$1 oware n.,. . Th e family
den'i" i. more 0"''''' al Ihe p,oblems 01
olu,ion 00ld me role of propel 'ooln
ol.gnme'" in enhoncing ....to,",_ den~..,.
Paralleling obutmen! teeth simplifi.. tooIh
p(1lpo.olion 10. ~.own., bridge$, portlal
c!onlU .... , ..,.in bonded relDiners and other
_"'~o"' .
S, fi/heJin; Tode l the<-e is g rooter OWOlentu
of "(!(lIm cnd appeoro",e. To och>cvG benl!<"
fodo l est heli"" the teeth mu5! be prcoper1y
a lig nod, with all mi .. irog teeth reploc. d.
Ot1toodonlic lroolment 10. odullS ho.
been the kl ...., !lrowing or"" in orthodontics in
,IKt"' ~.TM", oppea. to boo two reru.o", 10'
!hil, and the.efore two group' 01 adult patients :
The ftrsl g'oup, comprioing 01 )'Oung
adult. who dell red but d id nol reco
camp"'''''''.... OIShodon/iC 1 _ 0 ' " 01 )'Ouihs,
now "ek il 01 'hey beco me financiall y
;. odepeoodoont. OM are"..,..., a"",,", af tI>e benoli"
of a nliod ontic !fe'>lm<oo!.
Tho secood group con.isting of odullS
loll&n oJcIor tha n ,foo.e in 'M first gra up) ...no
haV(! oth """", I~,ob""n . ore being rocog nizod
al torodiOO!i!$ for odi"""""" orthodorlic Ireatment
to make ~o",rol 01 0.,,101 d""""" OM ''''!Q((!!ion
01 miuing teeth eosie< and mo.e effec, .....
 '01:1.. Adull C"lld

. _..._-,.....,
Boot- ~ ~ ....,.,. HOll r_ ~ , !"OOI'I.,..e:tlf:I!'<l1ft ~
tt 100" ..,......rt lddIion ~ iIlOdi'i:l.'iort
""""...,. <t ~ ~ ~ '" """"" I.IlIud!' tIOI d "'f _
m. ... _to . .
-~

-
.... ...r_""
'h ' _ .... bo ...

.... ~I_dn;ut \\'I 401 00icII'/

F'Oi'Iodon1;il dQl..

-- -_.--
May be . <O<?IPI1cM1'll
000r nl l':f(>!t lit

..
whwO: tt .......
U"UJ ""'" Of r>:."I'''''''

- ...
_ <OI'Odor '"'" ~"",I-

, I ' ....

lr ...rr.tnI ~
,- .,. -~
~nl""-lIlon
... tIOI. prd:Ie<n

Uo ually m y
.-.
Rqoo km f""I" 10

Not , ..,. lIlPIe<illil'lt

aw-

DIFFfRf Nf:E BETWEflW ADULT AIWD
AOOtESCf NT PAnrNrs
'Nho! ere m~ differences between ed\rfl end r;t.1d
erthocio nt l<:.? The bo.1<: diffe rence II !hot in
child ren we mu , t concern ov rJ.eI~, with 100lh
mo,_nt ~ ~. growlh, whe<eo$ in cclo.J lts we c r.
dcollng ItO::n, wirl> tooth m,,,,,,,,,,nl. We cannot
coun! upon growth 10 help u. (or hinder U$) in
odi...o-og ou' he<>h"",d objo>divss In CWOJ, then,
OOull c.~hodc"lics i impler, ./0, "" hove one
1," lond oIren vnptedicloblot) IoCIO' w/Jh ......ich
10 cont""d.
The need for orthodontic I"",tment in the
odult il ofT&rI . ym ptom relot&d wh ich co n be
deJeded by rhe poIient. while mot in childretl is
bo...d mo .. ohen by,ig"" detected bylhe porenII
0' the proCl~,one,. n-. 0"'. """"""'" ........,1
ol her diHe,en~ belwun odult and ~h i ld
onhodo nlicl lreforlOblo I]
INDICATIONS FOR ADULT ORTHODONTIC
TR fATMfNT
RoY" dearly OUIined rhe """"""" lor otf-oodonfic
mempy :
1. To imp'o~e loolh -pe,iodonlol li"va
rnlotiOr'lllhip.
2_ To eslobl ish on im proved plone of occ l u~on
in o rd. , to di. tribute force. thro ugh th e
 brocclest meo possible ,
3. To bolonce the ...;,ring space beIwe9n leeth
lor be"- prosrhetic seplocernen'.
4. '10 imp""'" sp<K1!s!Q p,mi<le normcIl toolt.
rotootn conto et,
5. To impl'O'V<l oed",,,,, 0..:1 oo o,dinotion with
the mo,ticmory mUld.. 0..:1 the 1MJ.
6. To IOIilfy !he ae.t!w1C d....<es 01" the ptI~cnt.
CONT/UIND/CATIONS FOR A DULT
ORTHODONTICS
Ill",., discussed ,e~'ol conl,oindicatia ...
relalir>g 10 odu ll orth odo ntic thero P\'". They orc ,
J, ~ .hielo l discreponcies
2. Advanced Iowl 0, JVSlemic disease
3. be_.... olveolar bot>e lou
4, Inobili ry 10 obloin a le.u lt thot the po lient or
doc:lor will pe ,eei... a, "'tisloelor)'
5. Poet llobility IIfO/IJ'IOSi.
6. lod< 01 patient mollYOlion
BIOMECHANICAL CONSIDERAnONS
Since odull polien" who need orthodontic
_ ' " o Jt..n hove perioOonl<Jl problem. , the
a mounl of baM >lJpporT of eocn toolt. i. on
im porlCnl consiclelllt"", Whcn bone foo . been
101, Ihe pe"odonlol ligomenl {POL) O'co
doo.Ioses,ond tho .orne force ogoinst thecrown
produco. grc ate r p reuu,. in the POL of 0
periodonlo lly C<>11prOrnised Iooth than 0 r"IO rrl'lo~y
supporled one. The obsolute molln~ude of Iorce
u<ed to move leeth mU$! be ,educed wn.,n
periodontol support ha, boe<1lost. ta P"""""
damage Ie the PD l, boor>e, e"",," ntum. a nd root
Th. lIreotcr lhe fo.. 01 aHoch menl, tho
small., the 0"'" 01 >lJpporIed root 0..:1 the lurther
apic:oJ the cenIfe 01 ",,",""nee will become. The
ce ntre 01 re sisto""e 01 a singl . rooted tooth I>e.
app lll. imotei y , ,,.tentn, 01tn o di. lo nee betw""'"
lhe apex of the IooIh and <:rei! of lhe suppM i,,\!
ol.eolo, bon . Lo .. 01 o~or bone height or
periodontal OItOchment Ieod:s ta opiool n!IocoIIon
oh he ""'tre 01 flIsi sto n",. The mo~ni!1J de of Ike
lipping moment prod uced by 0 lorce i. eq",, 110
the for<:e times the d"lonce lrom the point 0/ force
opplirotion 10 the <:ent,,, 0/ _osronce.
Onhodo<1~c Iorce$ m~$1 be opplOed!Q
tn e Crown of 0 looth, ood the fu rth. , I", po int 01
Ioruo opp lieDl"" 111,om the cenr~ 0/ =illooce,
tl>e greoter will be the fippit'tg mon>er>l produced
~ any given Iofl;e ond C<>nseq""rrtly a 10'11'"
eovnte"'<l iling oo upi e 1m) wou id be necosso l')' 10
ellect bod ify """""", ent.
Ad ult If"" tn\erlt mccMnics r-.::l no! d ille , from
tn. standa rd tochniq ue,; they a r. mod ified only
10 ,,-t speciliclre<llment req.oiromenls. Si~ciIy
with mo. i",um control is the bywo,d. All denlOl
movements oro consid.".,d to be pos' ible. 01
tf;eSft intrU lion is dil/icull. rO()j reso<ption i. a
hq",,1\! per><>~V' E. tr"';on i. the leo" drflicu~ .
Tip~ng i. no! diltlCuh. bul Hpiol ere>! bone loss
moy be 0 >enOWI ""ron:!. Rotation is simple and
rop id but hos the high<tst relc p$!il foetor.
Wi!n we ll des ignod op plion ces ,
contro lled dentol movem.nt and """ilobilily 0/
booic requi,emonlS, tr""trnenI con be no mote
8\"<1"""110< the odult tho n fo, tho child, pe mop$
IeI' ' 0.
At_ ,.,,,ted
ell" ,,'les j " flle
"",'odont. / /l1l.me llt
Theprimo",tisJuolO be in~ ue<ICOd by m~ 1
lorc ... a pplied 10 lhe teeth i. If", pericxlonta l
ligament. u.ogen is produced by the librob/osls,
which 0'" the mO$l frequentfy occvrring cella 01
tl.e periodonla l li gom e nt . The ostcocleltl
occu rrin ~ within 0 few nou,s afto r orthod ontic
.timul.... 0,. most t.I:ely derived from th .. locol
mOflOC)'les ond! or mooophoges. All", the initiol
wave, 0 second populc:ticn of resorbing ~e l l;
cppear IfIo! Cr. blood borne. Some of these c" ll.
migrole from Ih e ""K ulor ""two r' 01 l he cenlre
10000000rcb th e bony wri<;>:;e, senoing 01 progen iTOr
all. fo,.o~blOIt..
A med>oniool"'-mulu., IUa. 01 0 force
applied 10 0 Tooth. will resuk In on increased
proliferoti ..... of the cell. in th. periodon1ol
ligorr>erf. ~ Im!.ml ~!hot the insufficient
OO<JI'<:<I 01 preosteoblosl; mig~1 oc~ou nl lor Ihe
delayed re!~ n se 10 me<:Mnioo l . Iimulu .
Norton wgg e<!ed lhol Ihe d oO"OO~r>g
blood lIow and ..,,,u lonly thot oc""", .. ith
incNQling oge"..,., provide on GlCj:IIOrlOIion for
th" il\luf~OenT source of progenitors cells thc:t
choroc~ri.., the (Jging patient. The oge reloled
change. In vooevlorirolion may e. plo,n Ih ..
delayed ,eoc;tion 10 "rthodoo~i<: forces described
in odu ill.
A,. ,e,. r.,. Oone chan,..
O..modo,,~c too!!. ""","",cnl 01 0 "",,,it of bene
modeling ond ,emodeling 0100 depcro(h greody
on oge ",laltd chong ... oIthe skeleton. Corneal
bone bocom.< more dense who1e the spongeous
bone reduces wiIh oge ond the Ih\Idute changes
fromtho! of 0 honeycomb 10 0 nelWotl:.
l ot.' .,e c ft en,e5
The 0",00 1 di'f'ia cemMI of the marg ina l bor1c
Ievtolls 0 10001 1a00< t!.ot influences the bdogical
btxkground for tooth movemenl in odults. The
man;Jinol bone loss i. og .. related but is olso the
",wi! of prog'essive periodonIol diJ.eose. Woth
man;Jlnol bene lou the cern", 01 ,... i>tonoe of the
tooth is displO<:ed apica lly.
Anolh er foetor of importonce i. occJus.ol
function. This is hi ghly relot..d to beth the quolity
end quonldy of the IM"Iinc duru ond surrounding
bene. Teeth thol hove los! occlusal contom
bKoVS(! 01 ,,"'roc;tion develop di,ul-e otroph)- in
the ir ,up~"in g bone.
Together, the ho rd a nd lOft lill ue
ci>or.ges dicro te 0 con.",,"otive oppro.;"h to
mllchonics. The b iologic bockground for
orthodonlic root!. fI\OettIenl in odult. Indloo~
.~
1. 1hoolorcelu,..G inodul!sshouldbeoto~
"""" II-on !hose used ;., children.
2 n, initicllon:es I~ould j"rTh er be keprluw
beoo ul-e the ."mftd;ate pool 01 cellI ovc iiablo
for bone relo'plion i. low.
3. The """""nt to lorce ro\iob-a port;cvb-"lOoth
mo... """, lhould be i"~ ocoording to
the periodontol Slahl!l oj !he indMd",,1teeth.
4_ Wdh inc " (ISIng mo,ginol 00"" lon, light
conlinuou! int ,usive to'ce' should be
moimoined during tooth displocement.
DIACNOSIS AND ADULT ORrHODONnCS
ont.odontic ding""';. deal:! .. ith recogniti on of
!he voriovs chorocteris~CI of the malocdu,,"on . k
i"""""," <;<>Ilodion 01 pertinerl dote in 0 systemoric
mon"", to help In idenlilying!he .....ture ond COuse
oI , he problem. Di(Jgnosis in..,.,....developm""
01 0 comprehensive dolo be..., of perllnen!
tion. The dote ~ derived from case hStory.
; """ i' ..
clinico l exominOlion ond other diagnoslic aid.
, ueh o . study co.ts. radiogroph , and
p/lotogrophs. The SlMoo rd diognQ!~c oid , ore
mondolOr1. Because of 0 greeter pos~bility !o<
donnllnl ~IhOlil, buried moh, i m~diom.
penodonlol break"""", ond otrophic a.""II'",
penopicol, occ!usol one! TMJ lilm. should be
oblDined roulin,fy in oddilionto' tho ponorcgrom
ond cephoklgrom. A ly!.terrKlhc oPl'roo ch 10 "'"
e. ominotion is essenliel to ~n.ure lMt nothing is
o.. erl ool-.ed. Th e probl em oriented diognoslic
 pr<Xedure ... d.scribed b')' Profitt ar.d Ac ke,,,,,,,,
il rec.ommended ro _ure thol no o'PO(t 01 the
patient "-<I is iglIOIlId.
Adult patients COM. to y, ak", reors 01
u, ing e nd ab~,in g their dentition s. Tfleir t.eth
htl>'. ,
1. More-.,,,,,,,"
2. Sl>o<te'cusps
3. 5/xl lb""ed" 'lOe
4. Man~ koy .. had exten. iye <Hntel work
orncl9<'m., oownI or inlays
S. Bro. or>d portiol denture.
For th o adult, me cl inical .""minotion
toK., e n ,peel,, 1sig niii<:cnce in iooloting exiOling
01 POIeMiol pothQll, or>d t.... etiologi<:cl foelon.
oIlroYrnc. mandibular Ihila, """" /oclh, ocdusr::rl
di,hormonies, ond levity dental ,e"orotion .
I
Add itional di" 900, ti c ~ed u'o. thot we should
<Oruide, In odult ~i..,u ere:
1. Afull TM! series 01 X.rays
I 2. Muscle ["",min""on
3. Strell &O l"otion
4 . Diet EVIlluotion
Pe,lodOnla l .,on. ,llleralloll. Itt
dl.,no,"
Molt adu lt patient, who - " ortOOdonli c nctment
how. some lorm 01 pe'ioOontol b'lKIkdown.
Orthodontic treatment in the presenc" 0/
periodontal di"",se (lJVits in ~ sepl<ll bono
10. more tooth mobility du~ng trectm ont and
"""" .aduol ""'*' Ity P!I'!.t~. PrUect"""""
consultation with the periodontist should be
routine and orIhodonhc objediYet should be
a ltered if requ ired On his od-.-ice .
R., ",luot"'" 0I'Id cor>s!c r\! periodonlcl
therClPY during e~hodc:>mk Ifealmet'll will furthet-
"""',. 0 mO'e positr.oe progAO$is. They require
-Ij)CdIic: post.tr.Jotmen! period<lt'tol con: ar-od 1""It
telm retention procec!...-e., often d 0 fi:.:ed cIosig n.
Multldl.clpllnary app,oach
Mo>I odull poIients requ~re 0 multidisciplinary
leam ior-rne;rcomfl' .......... r$hobo1iltrtion. The
team rncy i"",lude
I . Gen erol d,nti, t
2 . Orthodor~dt
3. Resroratr.oe dentist
4, Pmsrt.ooMtist
5. 0",1orld "",. illofoci al , urgoon
O. Pkr,~c Wigeon.
TREATMENT ASPECTS IN ADULT
ORTHDDDNnCS
ProIiH I-m dDuiIied cduh orthodorrtic,~
Into the IoIIowing three OtlOl :
1. Com~tn""'" orthodo!>tic t"",,!mont
2. Ad ju""ti ... orthodontic troorment
3. SU'lliwi orthodontic: treatment
Ad/tlnol/ ... O 'I~odantlo I" alment
Adjuncti", M hodontic t"",rment is, by defin ition,
tooI~ movement corried out 10 focili!clo otk..-
dental p><:edures ne<:e>sory to conlrol disease
ond "'$lOtI IUndion. AJrh~ malocdvsLon ...
dassiccily deocibed is 001 nee"",,", on ..meolf,y
r;ondir;on, >erne tooth posit"",. are I'IOt cor><;!ur;iw
10 long""m orol heolrh. The gools 01 odjundi'f$
treatment lhovid be to:
1. Fedli"''' resta<'Clff..... treotment by pc.itio<1ing
the teeTh 00 thot more ideo l ond conn "",Ti",
te<;hniq1>8S COn be u>ed.
2. ImprtlYlthe periodontal heoIrtl byelimintslt ....
plaque ho,borinll areOI, improvif\Q the
oJv.,oIor ridQO contou r ad iace nt to the TeeTh.
3. E. tab lish favoro ble crowt>-fo.root rol"" a<,d
position the _th so thel cx;dusol forc.s ore
IronYrtined olong the long 0_ 01 the teeth.
Ad ivnQivo t(~tment impli~. limited
orthodontic goals. im proving a particular asped
\
 ~ th e occiu Jion rolhe r thon compr&ho"' ively
, Q ~eri"9 it. Typ ico lly, QP~ i Qnc&. ore fOq~i red in
only a pofIion of rhe denial "rei. ord for only "
... o~ time.
n... odivnoive """""'em procedures
ir\Ck.oda:
" Uprig hti ng of teeth
2. f orced enopticwl
J . Alignment of!Oem
Cg mp,e" e ndv, Ire"tment for .dulf.
Com preher1~"11 orth odontic treolmen! occo rd ing
10 I'rofj~, implies otthodoolk Ifeotment which
would toke more than six monlh$ duration.
Comp ... l>ensioe _en! in odu~, ;1 similor to
t~at in odo l~lC'ent., Howeve r Ihe lollowing
conside rati on s lho.ild be kept in mind wh i' e
trea~ng 00011'$.
J. K. ..p in mrnd the biologkol I.mitations'
Adult. ""h ibit decreasing b lood II ...... ond
>'OKIJlorilyond ;nwllidentsourte of ~Ior!
"" II . at th e ,ite of tooth move ment. In odditi on
!he cortical bone be.:omes memo denoa ..nil. Ito..
spongeous bone ,educes with age. The . ..
biological limilOlions didute 0 come""";""
opprocch to moc;n""i in oduh orthodontic
_ enl
2. La""" /o-ce level. : The 1"'(;0$ u.ed in
odults .hould be or 0 Iower-I.,.,I/ho" those o.-d
in children. The Iniliollorr.~ should lum.el be
kOl'PI low bew .."" the immedklloe pOOl 01 (elts
ava iloble f", bo"" ",.a'plicn i, low.
3. PeriocMnlal caMideroriOfl. ; Adulr. are
mono likely to be perioclo,rtaUy compromised.
Petiodanlol cole ,hould be undella~en o.
lrequ enrlv os needed dunng lhe o rlhodoolic
I," ei moni te keep 0 check on ~'iodonto l
InRo!lY11<J1ion.
4- . Mullid ioc ipf,"nory epproach , Mo.1 odull
paliMn ,equire " mu llid isdp li na,.,. leam klr th ei'
comprehen"" .... obilitorion. The team may
includ e Orthodontisl. Restorative dentist,
P'OSthodonhll ond Qrnlsutgeon.
5 . Esrh eli( requlremeM Mu lll ore u. uolly
m<:<"e (o"""mod of e"Mlies. They ore likel y to be
put olfby ""plio"""," lhoto re not eolhek Use 01
esthelic toolh colored brackets ond linguol
~ con beoonside<t:d lor oduh porienb.
6. (om lor! requi,.o.,."""IS , Adults a,e uluo lly
Ie .. ado pta ble to 1M app li an ce Iho n you ng
po!ien1>. Thu I .. mple cornlortoble appliance. 0 ro
prefemod in odults.
7. 6iom"c honkol conoide,elie'" : Adultl
exhibit Q,rwter be"" 10.. and loS$ 01ol!O(hment,
I.eod ing 10 apicol . hih ol!he cenlre of ,..i$lonce .
n....r weoterw.ll be the ~pping _ I pr'oc:h.ad
for 0 given foto:e.
Aduh IreoVnerf I I oed>or t.::s need no! diller
f 'om th e 'loOOo,d le<;h niq_; lhev ore modified
011 11 10 moet . peeifi , t,eotment req ui ren>enl$.
~Ii<;i!y wilh mg,jmum contfoll, 111. byword.
Adults a", turned oK by :
I . Unoestheric oppliono,"
2 . Fear of poin
3. Ext. r>d .d lreolmenTTime
<I. Pef1O<>al inconvl;"nc"
'.Coo>
The opp li o nce. used i~ adull
ortho de nliCS .hoyl d l ullill. the lollowing
leq ui remenls :
1. SOOuId be " mple in ocder 10 moodmi:te co-
...-
2 . They should respond to light ""-lor be.!
phy>iolog'oc IS jX>r'ISe.
3. Th e)' 1hov1d I:>e fi.ed Ie> mo inloln lreotment
cootroJ .
4 . They sIr""ld be long oding 10 ""'-'... !he
 nUmNr d a ppOintments
S. Tho y .hould req ulr. !he snorlUI over.oll
trl"JrI'"IOoI'\l porio<! .",.;,je offo rdi ..... .... rr.. h\;l'-' 1. ..... 11 O" ~ odo"ti,, ,J.din;,.1 "'~ 19~ 1 ;
6G6~ le.
polenlic l ior 0 >loble co rrection with mini mum 2. S<rlo ~ ... : C.... '" ",," ..~ .. I, o,,~ .... :
rOll nli"" req .... remeots. O""I~, 19"91
3 ! I". M. I.., 0' ",.,1, O"n o' .,"" , JCO
1............ 19M,6~1 .
Surlleel or!haolont/c tru tm e nt ~. ~ Hoobaoo, fWloWI. o-.d _ , Com_
.on 01 .. ~...., OM o"'",,:b",,c, I. bo<do~".
N adults do nO g row a ny longer, dem060ciol odJoo : Al.o 1993. ~55--4}0.
o rthognolhic su rg eries ore major .uogicol 5. Vonc.pr aod eo..........."IY' Ad.~ OrthodaOllco :
J.dncd ~19n, 45J1.4n.
ptOCedures ",mod out along with orthodontic
6. GoI...., Ad.h _''''' open b; .. , Al.O 1990 ,
~lOcweCI denJo..locim driormiOelor_ m.s16.
oroleda l ciilprtlporticm in..,l"ir;g or... ma.illo, 7 . GI ......... , N",,~ lo, . 1.'-1_" d ....0...,.;" ,
Co , ,,,,." " , , 'g'c. 1 o"'odo' ''' .dull rap id.
Ih e mand ib le o r bolh in co m b inal io n. po<>-ol _ oIon, "-J.O 198.,207213.
O rth og nothic ,urg<WY l:<>. ico lly in"a f...es pkl nned S. H ONO, l. L.t. ;n , Adu lt Ort'od."; ,, , J. cHnil 1
."...,..1 971; 13().10.5 .
Iracturing 0 1 th e lociol . kolatol port. an d '" Mo 1 H ..... " H.,....,.c." , ....... 01 """h
"posi~oning Ji1em '" desired.k requi .... 0 team o. 1 .... , too."" 1'0 1989
10 . ~ _omde : A.J.OI990 , 06J...<71 .
approoch with Ihe orol surgeon ond }he II . S"",,,,"I CoNI_on. 10, Moh Ot- ,d, ,Ha
... ~ odor ,liII being irnpor1<rnl "*"'*' d
Orlhog nolhic .urge';e. con be
the lecm. J.cIrito:JI ~ 1916: ~5<5..
12.lotw Ad~ .. arn.oo......,od;.............
~< . ._
Al.O 1981 ;:)(IS.315..
per/ormod ill tr... mroillo o. well all'" mandible 13. T _ M. G.obor.o<I Rd:oo<r t _..doll. """"" .
to ca rrecl p.. c>screporrcies in a ll 1M rhree pI-one.
o/spc><:e .
H. "" ...,.j Go ,o:;.,(o ..,."
101,,.,, \on.pod of O<Ii>odon'".c.
on adui po''''' : A.J.O 199~ , 142 U 8.
IS. I'I, ,,. n Hom, lo : 0 ,10000", ;' OH'co O 'gn
REfENtlOH IN ADUU" ORlHODDNnCS
~i"..g M"I ""to. ,
J d ;,,,,,1 ",rl,O<J 1m ,
J ~H/IO .

ReI.nIion mechanics.hauld N pond rho onginal

~1101""" ~ plcn. _ """I' indude .....oIbIe ~""'"
oper01ive p,OXftdures, and/or toted r'lennon.
Whe-n!he patient has abnormol lip, longue or
cheek muscle cdi"';li. >, rt if incum bent o n I.....
orthodonli ll to preP'l r" Ih . potlent f.... long lerm
use Gf fi.oced rckliners. Retention is a criti ca l cnd
challqing o >pad 01 adult orItoodo<>ria. Tho
general principl ... oI,.,terIion hold good foroduh
polienls.
In ma ny "'''''' 01 a d uk onhodonlil:s the
need lor post crl-odonIk .tobilirolion wit cDincidll
with Ihl roeed 10 ' boIh , ... Ioratio" 01 mutilated
denlit"", ond cross ",ch slabili<olio n.
 , ; , .
1i',-"";~t1>~"""",-.".,,c,._,",;j~;, ....,,,,", .. ,:,. . '" .. ~, ...
~<" "-~'-~"'''','(~''-'' '~

Index 511

Inlra -f.'""I I'o')'.207
Ir!ro.Oral, 206
'"'.ax;"u"'. 21 0
,
.... n;mum, 210
~.21 0

g .ndex ,.,.,hiole, 208

""'><vb", 2(17
Oc.cipib',20<1
i':om ;'Q . 209
, ~=1.20S
Ro;n~,2011
SiT4'ie.205
II point, 1 ~7 S;<ulo. 2(18
J\bno.....,t.">Jpf... path. 93 So...cH.203.2D4
,I>I"I<"'no l .,1>.. Ir"",,",. 91 , 3B6 5101""'"'1, 205
~c<rm l p"" 01 ,Iooure . 129 Ar>dre.or. owl"",ol... adi'otor)
.......!noel.225 AI'Id-. sa
~Io E H,5
'"\'S.
59.62
kid -"<.~, 307
~~n -~ o~,.,u r~,~ k-oQl. '. c amiCQllon
klyto<,~82
b., 69 70
O,...;/iceti"", 69
.o.ctivo!or 0;,."1,,,,'11"9"'.7$.76
M.o:>nb,j.,.339
Co",j""I"", Bitfl. 339
Contrnind CU!iono . 33.6
,.,.. ,\1.od:fioot""'", 76-77
... .s~aroo. ISl
Oisodvo""'on. 339 A.N.B... 154
fab"-.34 1 ~,lS1
facial, 151
1""~339 frurMoo! MOo>dbulor i"c;"". 1 ~
Monagoomont.341
Modo 01 CC1Cf1, 339
f..",lde<! "..,rd,bular plene, 1sa
Ir>d """",cod it."b- plane, 158
MOO.1ml""'.344 Ind"" ",,01, ..,1pl."", 151
Tnmm;,g, 342 10\0" "",,,,", 151
_ <:om""""elo to-indoofloN.8.137
fo.:.d appiioncn, 309 Madbulo'p ...... I5-4
Ro:_bI oppi...-.oo.s, 286295 Oeduool pia .... 154
Adom,cImp S.N"", 154
SNB.l54
Mvoel<>QOS.28O tIppo r jr cisor to N A. T57
CC<I$IrudiCf\, 261262 Y-ox;" l S I
M<>d;~~. 280-28 3 ~",~a. 51, ' 27
Parts, 280 AryI<>,;., 9~
SroOO"'.. 280 Anodoma. 8586
""'-'oidfad, 104 Anitfoor bile pkn., 437
,loge loci", . 211 214 AnIoriDr crouJ.,., 75 . 07, 423, 42e~29.
1o,;mo 01 orthodCf\fia. 23
1\1;.0 ,; , .1 2 ""Ie,,,,,
ArlIe","" '0",1 ""' . , 148
<>po" bit.
Clo,~f; oo""", ~ 15
~~,.437 . 436 D..,,,I, 16-4 I 1
Etiology, ~ 1S.(16

""""""'"
eaker' . 107
Cr."",!. 106
O....mOO'iCfl, 205
f ........... (17( L8
5ke1eld, 4 17.4 18
l ,",,*,"onl. 41 a.~20
Cm"",t. W. .....,.,JtIPOid """"'. ~1
'"'Picol bose, ~62
DoI" it"",.703
O1ra.O", I.206 '"'P ~ '""<Ii
""" "",274
f"';01.204 F~, 301 326
I"""-Ma>oilloty, 207 Fundional. 329
51l . Orthodontics - The Art and Sc.ienc:Cil
MyciuncOOoe L 329 Birrw:il bry protr"",n, 70
O rt"O~'k. 365 -376 B"' o.0>:>o>:., 181 _1 94
Po,,,,,",,274 Bionato r
ROfr<lV<lOIo , 277300 8;10 re9.tratioo, 35 7
Arch ~r i ".,. .. rooo ~ ~, . 175
Ge" III applionc. , 356
Arch ...i"" loci"ot"'0!.35 7
be roq"ir<;men" , 3 14
s..to ti:on:um, 3 15 ap.., bite "PP'once, 356
CIc .. ifbltk>o,314 Slondard "Pfl"""o, 356
Elgiloy,3 15 TYP">, 35S
Gold, 3 1~ Bite plane
Gold al loy"3 14
~/J lti .-anded , 3 14 """riot", 2 9'1, 473
Po.te rior, 299, . 18
Niti nol , 3 15 Bite r09 i.1<Otioo, 332
~b-, 3 14
Biorl<,1 43
Roo nd,3 14
801100', ""o ~ ~. , 178 _I 79
>q",,~ , 3 1 4
SoltOO'. plano , 149
Sta i, I" ..... ,,1, 31 5 Bondod "",b" oPP!iooco, 359
Arrowllwd dmp (s.ee ,',do,," d esp) Bond ing
A.ymmetry, 121 M.-oolago., 30 7
~"''', fixodoppl",= [);!OdyortO'J!'.,309
So l oodhook, 3 12
Proced ure, 309
6rockets . 3 10_3 11 ",""
B-ut1On , 3 12
Dopo<ition , 14, 190-192
CIeot, 3 12 Fo rrooti"", 15 _1 6
Eyelot, 3 12
RO"'1'tion, 14, 192
li ng",, 1aHoci1monl!, 3 12 Romodel">i , 14, 190
Moie rtu bo., 311
~"

8 PO;"!, 14 7
Short, 286
long, 287
Spot, 28 7
R.ve",", 287
1loker'. onchorag< , 207 FiHed , 289
Bockword po!it oi """"re, 129 Mi ll., 2SB
BoIaocing eAroc!i"o" 268 Robert', ,28 7_ 2S8
Bol l ond cbsp , 285
High, 289
Bond ond ba, .pa co me;"!o;'"" , 225 &",kot.
Bond ond b;::.p opoco maintaine r, 2 23
Btw, 3 10
Bond 000 ' pm retaine r, 470 Bondable,3 10
Eknd i"ll Cerami c, 31 1
lodicotio.u , 303
Cb"il>:ot"," , 3 10
P"",",","", 303 _305
Edgewise, 3 10
Bo nd" 309 ] 10 Motal l.. , 3 11
fIo", 1"",Iobolic rato, 11 6
F1o"",, 311
flo", 10",.."", 479 RibbcnAr<h , 310
Bo.. of model, 47B We kieblo, 3 10
Bo", plato, 295. 298 -299 Brooch., 1"",he., 27
So.ion ,1 4 7
6"""h;"g
Bmion"mion piooe, 149 Om l,1 29
"ow N.,,,, 1, 12 9
App/i"""'. , 3Z/ Oro-No"", 129
i<olo ine<, 466. 67 8",x;,.n,106
Bolchi .., 12
B"ccinator mechoniorn , 5253
Beo1nelf, ,*",il>:ot"o, 78
S",I.. ', fieki """ry, 489
Bonrin<;Jhoff, S3 8u'lt-o .. , 535.
Bolo h ypolhc~., 101
 00 .. II, di,;,,,,,, 1
Eto'<>Iogr. 379
ColllOlAogo. 402 Feoru .... 311.391
Conne 11010 01 extmctior. 402
Irdtolionl lor _ ,fiM. 264 5ic."",II"",...,., 399
'oT po<!i "", 26. T'oo' '''''''', 300. 405
Rot"" r.,."327 ( .." II, di,.ioi"" '2
".,"><10 .... 292 294 fee!1J .... 72.405
Caml __ <pring T_ont, 405406
Sing!...190 Ckmlll
o.,..,blo.291 D-X;il..409
Co r.,. ', c ",,~ .175 Ef 409
C ~ i nd.,. 16 1174 FlIQlu",. , 407_40'1
Case C" 5 Sk" OIo l leol...... , 409
C. . (_ ..... dy models) T<ioatmorl, 41341
Co1o"'. opplo~ CIoo..ifW:oriot, 01 0Ii~ 01 malocdu .....
Indir;olio.,. 429 GfoWs, 82
Droodvo rl"ll"'. 429 M..,..,., 82
Conlra 01 IVIIi,. end Go rdner, 62
R... ,t.)oce . I96 Ck>o~f<:c,ion 01 "", Ioccf usio n
ilaluli"", 197.198 kioo rl'ron oed P~" 18&1
CerJrlc ~.69 . J7
Corrodo.58 BtmotI,78
Hoki"ll '"opt, S6 UKhe,.77
Oed J' ""' . 57 &rr>Oo, 78
~ ot .,.,. 57 C... ~ II ~ po lo'"
Cop ...10 caudGl g_ II"'d",.,. 10-1 I Oa"'k()~"", 4.1 .00J
(Apholomolric: 0"0.,...' ~~4l3
0.:-..,151.153 Etiology. H O
Sloi"'~ 15.). 157 l.dd....,..o)1
""-d. 156 Mo'''II",,..,,. 4H ' ' ' 8
Wit. , 158 Pc ,,;,,.. obtoroklr, .45
C.p ~olo"",ma ""...... "i........... ..5
~_,lH Prober.. """"""ted,
Surgical ~p do...... ((6
3
lDndnoo~.l Sl 48

Uoe., I,.
Lm .. or pto ...... H S-l50

Corom;: "'",ket. 311

Su'll'cd polol. cIc., .... ~~
0'<:01 """mFKmon. 121).128
C r, p .,., ,"1:> ,." , 461
c."...,,1hMd 11"<". 366 . CoHin .\>"ing . 256, .30
o.iolo:o" """",,.116 Coli !pring<
Ch"~cup
lodicollon,. 375 CIooed.31 8
Type., 375 OJ>*n,318
Cht."...".og " <>ge, 21 1 Col d cur. " c".le. 4S248B
Ci raJ mleremo l d o.p, 279 Com _ ,ing ";"'oli""". 268
00._
~~ Ib.oI:rn,. ~ Com$:tOo>tO<ig "" 110", ,,. IOJ
Compoo.. <Min, 307-309
Co....,.". .... 91-502
M<m' 28G-283
1101- e'<l. 285 Co ........ ",oIile. In
Ci r<:u mloren'lol. 279 Corodylo,36
C(Ow' , 286 C"'"'" ~ ioo1 ,
148
Jo::bon' .. 280 Cong~ i"' l0.10<_ ... 83 8.
Mode "I """on. 278
Roq ............... 279
Conotno:riOtl bite, 332
c.::ww. pro';!o. In
Xhwo",286 c.,.".,c.;d proc ..... 36
~. 28J Cortical dM!, 15
T''''''l'Jior, 2aS C""'c:otOI1Ij, .5.
00,, 1,70 Cosmetic "''IF!', . 60
514 Onhodonlics ThQ: Art .and Science:

CoupIo, 196 0...1011 ....... 01

Cronlol boM Ctu ....1t...., 2123. 2'931
flt.w,,",24 o...tif;on,31-39
Po.-.aIQI do.Iopmoot, 2931 Mondlole, 27-29,33-36
~~ dsvoIoptr ...... 21 -24 Mo>illo, 24.2 7, 3 I .J3
CtIb (_ habit b_kotJ Pol ...., 26-27
Cn",bite o....r. method 01 serial Cldmdion, 231
""_,423 o.w.,,71
CIo .. iIio:J..... , 423 mag""",,1151 4 2
Dental,425 O~""";, o;d., 1 15 _I 16, 138. I 42
f""",cnoI,425 Ologroc><ti< .. t "Po 130 131
Po."',Io-, 423 0 .""'''''',385.390
5.01 0'01, 424 0 'oeoroti on, 90
Troot......... 428 432 a.',1ungIS.. ",o.in>o l .tripp ing)
sect"" . ...., 314
.
CroM D"Pocome'"
C"'""~
0=_,393
'"
PM .,. 15
Soco.dcry,15
Oiotol.~"" _ mointo ..... 22.
T,-",""'.393..J94
c,."..." ord bo, __ ",oi.raino<, 125 Ois1ot.ati,.,
C~. Intn:>-orol moshod.. 243
Mor ><>r, 57 f:rlro .......1mothod, . 243
Spo.o, 56 Di....ocd...,;on, 71
W,l",,", 57 0.",..., ord,.io,

... OOri.....d. 12
Dirt<;!. 12
Drift, 15

Ecrop<; ..-wtion. 93
Ind ired. I 2 Edgo"'IO, 32 1
Elo..1o chain, 3 I 7
"-Prc.i "",1.94 EIa$li, " ,..d, 3 I 7
Coer"", I.94 Eiootl<o,3 15
OeccmponlO'fon, 45. EIo.Ie ..... ,,, .. pa tolon. 3 I9
0..,:, b~ o E~cm!'Oll'op", .133
Oofioillon, 433 EIQIIr:!,. 315
Incompl ..., ' 33 Embryo,21
''''''''''' 433
CIo..~':ca1""'. ' 33
Ske ..... , . 3.
"""'"0ecaIc;I"",",",,309
""ochono'rial 0Bifit0~,." 15
00ntr;,I, ' 34 E";0<Jin0, 94.95
DH>gr>oo;" '35 Enlow',
T,OOI<"II"', >137 438 c..""Io,p,uf pmtiplo. 19
OOloi .. 1000 ....... 37.
Delayed .... """n, 93
00I......-f '""'P_. 92
V principlo. 19
E__ Ieoti,., 01 PfO"I1ob. 231
a...001 og 213
en""onm...I01.84115
fpIdomiolog-r of "",\ocd",ioo. I 091 I ~
Dental: C<lSIi_ ",do, r.>Odol ,! Epigentlic. 19
o.n\:;l l \:;l mina, 37
Ep<;f1)'$1.I_ ho",,-wriot X.Royo)
~tit""
o..idJ OVl I 42 E''''''ion
M~od, 4246 00 ... ,45 46
Pw"", no n! 8 Thee .... 01. 182
0. 01010001""I~Q ff iolo-g)'
E..,.... ol opplo""",. 366-376 G.norol ",00,,- 82
Furcrlonol oppl""" ... 329 31>5 lotolloclon. 82
D.mation. 395-396 . 0.:...; .. 100.:" 185
C-IopmoM,8 -.~
 Arc!I,2('2S8
0.....1,256
kopid. 2~7.2S6
x-. 25_
5"1tIaI,2H
Slow. 256
e"p.; ..... ttolop~. 12
b..., . "",I oret....."""
(.Meal,368
Occip1ro l,369
(....,101,369
F""io l,371
E>:!rodion
Coo i.,.,26(
f ir'll molor, 266
First _lori, 265
Ind ....... 262
Need 100; 260
Second 1"1010" 261
s..:o..:I "'"'_... 265
s.lol,2'28-233
The-.mc.260
ThOd ",ob. 26&
199
bIn,oo;on,

, '""',, 128. 130

1819

Gen",l, TTQ....,..,~.io" 67
Gonlll;,., 085(90
Gnomlon. '46
GooIi<>n, 148
G_
o.I\nib, 1
DiIIe ..... ol.l0
Fo< .... cII.d!"9. 89
Moddlcotion. 401--,1)1, (13
Spu-,9.10
Guidone. oI ... pIO>o, 728_233
G.fYlpad, 40

Hobl tnc ...

R.<ncvabl_, 101
F"'ed . 101
Hobilt, 97. ' oe
Hond...rll
A.noIO",.162
~ph.162.171
l-Icw.Ie,...q>pIlono::e, 466
Hood cop. 366
518 ' OrthodDnlics - The Art and SciEnce

Heod ge<n
C"'-"';c:oI,36 1
Ce'""'netiCf', 3 I
Ocdp ilcl, 3 6 1 K e~ i n;o ' . set up, 130_1 32
fl.~i c:ol coo i'. '."0<10:<, 293 Kin;o ."y,
Herbs:app (or co KorHeL> ordy,~, 178
Inc ice,,,,,,,359
AdYart"9",,359 ,
D ~adva n!a9"" 36 1
So r ,",",359 Lobio l [.0"" (>eo bow,!
Bonded,359 Lebie llren,-,"" , 127
Dosai"'i"", 3 59 Loo dmo,b, 145 148
T,"o'",oot of;od., 35 9 lolo ral path oi de,,,., 129
rl . ,od il)',81 -S3 Lo.,roi ",leu., 40
HigIl "" II heed go,,," , 36 1 lalo,0I""0, 315
Hi>loc" le-ewoYIpOCO, . .
O f OroOOonI"., 46 l""li on, 3 12 3 13
Rocordin;o,116 !,;goturll ...i ," , 3 12
Hoo'em) 1 pk:"", li , .. , cophc lemet''', 148_1 50
Bo.;"".No'''o, 149 Lin.,o ll,emm, 127
fH 010 ' ., 148 l ".,o l o"".oeci ""o, 424
,v .o,d bJ o,, 148
Ceckno! plono , 1.8
'e Bem pe ,,207
Po"to l, 148 Compo''''''. , 125
SH plono , 148 U>e'..-'. ck",'fimt<>n , 77
l+;oI i";<o' """, 183 loco l loc!or,,82
""rex, 252 Lon-;li:ud:nol >Iud.., II
loop" 327

Ideo! oed""",, (~ .4;-,;j, ...... ,;" k"I')

Im.."t",,", 4 50453 Moo,edoot;, , 89
Implo rt., 13 Mc lhmed te-eth
locioo llio bilit)',4 4 [);le<o,,,n , 9{)
Ir d ",," pk:"". fusion, 89
l "",,,, ontorior, 20 8 MU:ber" malor. , 9{)
I,d" ci "-"!<>cd",,o", 110- I I oj Pey ,hoped krt. ", I" 90
Irlo nf l. , ,,,,,110""9, 50, 102 ~docd",;oo
I,,,,, , bow, 366 O""fi oot:oo, 63 80
1"t(1(-,"o,il o" fi,otio o, 460 fp;dern"logy, l iJ9 11 4
ct"logy, 8 196
l, tefof1Co,rio" or-d!oo'Ogo , 207 Ind" .., 11 ()' 11 4
I,.toru>pl .... ortr.::.dor.tics MondiUe
D~i ,.;ti "" ,
2<7 Po,tnotai d~v"lc.pment, 33 -36
Procod " e, , 227-2 38 PreNlto l doYelop"",nl, 27 _29
Inte<m itten 10.- " 20 1 Moodib.h
lot..-ruptod I",,,,,, 20 I Plone, 148
l "tro.ma~l loryo",'or<:l\l., 207 Proc= , 27
Ir.tro _oro! pe<>opoai lil m>, 134 Mo,tkotion, .950
IOI,cn;"", 199 ~"' tu re ,wo llo-.irl\l, SO 5 1

, ~"'xil la
Expo"~"" of. 247258
~' tn a bl deydopment, 3 134
Preoetal de,dopme ot, 24-27
Joc"" n'. ck<. p, 280 ~", i ffi um n noho",(/",
2 10
.Io".on', moo, 3 ~....ct>;. n >o . , 195-202
 IndCII 5f7
Med.f. ",, ~; Iog 2728 Neo"o,," t ...!h.'; 1
Mtd'a:dlO""'I'.116 Noo_ph ...... , 20
Mtn-alis, 126 Nid<.I tito.IUI'II "re, 315
M_lobd ....'cuo. 126 Nilinol.315
MtnIon.1 48
MeI.,1 N""".;,aI "..,tt-.. 93
Oi ,piocOlT.ent. 15. 3 1 N",moI oecl,,"'". 5562
,'Ajgrnti(le. 182 Newegi<o1 opp'Jaooe l_Odi""totj
Step. 43
TippiN;),66 o
M.. <>oo:Iuo...... 75
Mto:f>od. oj Dbsrat", . 12
Go ;;;"", '1><'0.. 2392 46 O::dp~o l hood g"""'. 369
Gott-.."", g~ dote. 11 OtdlIOCI l olon 14e
StWyieg bat>o g.owtt.. 12
Or.duoal td-ool. 462
Miaod"I!tiu, 89
MOi pdatol """'e, 248 O"d ... a..55
Mdi,," d"""omo Opo,nb ..... 1S.422
Oia9""",, , 386 O~ ........ l'
Erd "l/'l.395386 Dpi ", "m O!"hodoolio:: 10", 185 186
~<lon_, 3116 0'" hob;"
r"",-.38839O S"",*".I06-107
MI"",r,he brooo, 8S Cloui"omtion. 98
M ........ m o.t~orcv . 21 0 Up bIti"ll. 107
Mr..., do,M"". 4o..e Mouth I:<e<>M i '1l. 1OS- I 07
Mi .., do .... ;t;o. """Mi. 179
Noil b)<; .... 107
~O<dro;o. 175 1 80
Modtl .... ~...." 460
Mc>dols. 130, "78
Mc>d_ 0"'"""'9". 21 0
r.,.... """<>;I. 97.1 02
Th ..... b
Oml hJg;en., 270.27.
"".oIing. 102103

Modilicoion 01 0'"",""" . 01.02 Oml '"Piroi"". 129

Mo"",ot. 197
M~ kx;. 338
Om l ""'*".
335337
D .t:-ilolo , I <7
Mot 17 D!tl.odonk~ l;,ooe
""""""b.-hiog.I04101 kIM. 274
Multiolme.ded - - . 31.
Mood . .... ..;...., 236-237 CIob1icafon.271
Muocvlo, onchornll". 207 Oef;o;t;on.271
MOKulot" . K~ . 462 E>:t,o.ornI, 365.376
Mullti"".4 67 Fr,ed,301 32 8
MyoIuo<ti<wll 0IlI01.,1laI, 329364 Fu""""",,1. 32936_
I'oosIv.. 27.
N Rem_b'e,277.300
Roov .... ..-m, 2] . 276
Non.:;. hol ding .,c,. 22 4 Oif-oodonr..: bond., )o9
Nonc. "",thod '" 1Cf<O ."rot""', 23 1 ~ tio:: loct\, """"""""'t, 183 194
Nasal ph. plococle. 26 Drt!>od""k.
Nosol ..op;ro'iOllo 129 o.f;nition. I
Noool ",p'u..,. 11 NMd to.- _ _ 13
Noool <pi"" s...;,.. ""..-d. 3.
""Ie""'. 148
Pool""" 14e
Ot-thoQnothio:: ""90'\'.
449. _6-0
Or+,opoodc Q!l!>io",.., 3653 76
Nasion, 147 D~ .. 190
Naoion-b:J.ion II 149 o.~192
NoooIob;ol..-.glo, 126 DolOO\lOoOlis. 15- 16
Nola! Ieeth 1 o-bfot. 127
Notu", 1mo,ke ... 1. o..~". 12 7
Ned:rn. p, 366
~Im 26.27, 127
'. . o
~"' ''' Oc oodOo\l ropt1 136 Q,od '-1"'. 257256
Pot-lo l do rlu ", , poco mo in"" ;,,,' 22 1 Quootit.,"", ~"'m< nt., 12
!\lo~ .. "PIl I.,,,,., 274
I'crn" doo ".
F~ , 129
lo!erol. 129 ~W ..
Poohrio~ 129 8irfr,.,;ng. 135
P.g "'-<110..,10. 9(1 Infn:>.o<ol, 134-136
"-riapi<ol ",diogropho, 13-1 e.no..""I, 136138
IWiWion. 454 c.phol_ric.137. H3-160
"-iodonIaI Ligcm.m. 186 Hand.WrisT, 137. 161112
P. ...""' m.3J2 Occmol,135
""""""en! donI;';"", 48 1\:1<>0"''''",, 136
P'hoIphQ r'", oO d. 379 fIori.cpi""I, 134
P'tIo!ogrop.hi, 132 13 3 Ra rUog, \ ~
'io,<*ocm.: 1",,0"'" 169 Ra pid ", l lc,", o.:po"'''''' j
P......... <.op/1alom olfic, loiS-ISO ~~;a.,ca uood. 25 1252
f'b,,,,"11 toto","*". 371-Ja.4 ~~iod cna .......... 248
Pogo""'., H8 Oiognooi .. 249
Ponf.onoll"-. l 77 fR..,..249.250
II>rIop. l47 ndOCQliono.248249
"""oIiont~ K.osii"l"" 468
~'''f\'Ijcal~. 460
",",,'"
Rori"ll. 12
I'bor.. io, ~pfOCDI.r.c:~~, 205
Ooubile , .2 9 Rec"''''1J''' .... i.. , 314
No"' l spne, 148 Rogo lrl"ll >poco, 234 236
Opo;o "t. 20 R.... ;,trction ~nt. 148
Pr.,....-gica l o,,"odontic>, 456
l'oo/o"Mid band<. 309
" ' _ , . loa of ""':h.
9192
......CoJ_.
~"fOfCed DI\d1o""lle, 208

462463
Prenotal ~OP""'"' DoN.IIion. 461
Co";al ba .., 2124 IIemovoblo app/iao o<e
McwH:IbIo.27-28 AdwoIllOg ... 212
Ma.iIID.2. -27 Cc ............ 278
Pblor., 25 o.Jinitk> 271
" ' - .. 40M,,,o "K><)'.
188 D"osodYonlOge., m
PrevootiYo <>rTr.o.;on"", RorT1<>'Ioblo 'poo. mo in" i_,. 220.222
Dof.., iT iOO,215 Ropro,.;mot"",,239-241
Proaod u..... 215-226 Rosin .
1'.1"",,,. dootioon, 41-42 Cald """, 48 2
!'>in,a" 1p<I<e, 41 "'-oto..o-..482
Pdile, facial
Concove.l'2'2
Canoe.<, 1:n .... '"
Ro..otplion <II

Ren:o_ ....

,,,
Sttoighl. 1:n 0cdu001.94
Prolonged '''''"'k>, 466 f'rooOmoI,94
P"*OQIondi ..... 192 Re<olned ;"Iont;1o """I""", 50
Pro>iO'lOl
PM UOO
,,,,i... 94
ao.. III, 75
Roloinorl
@.egg.466
,
p.)dd ogical coo~do ra; oo 10 1 a ipcn, 467
P~I,9 De&.iticn, 466

I
 fI<ed. 466-H O Fu.tlio:>n<>l, :2:20
_~. 466 R. _blt.2:zo.222
Ideo l r<\qoireme"'" ~66 lypo 220
..,,;,~ ~68 $p<>:;ng
W"'P Cl<WO'd. ~ 68 Diog""",, 391
~"";"'" 461 Et>oI0(I'f.391
~ 0.<'0<1 cI ~, 43/1 T,,,,,h,,,"ot. 391.39:2
~ ~ood goo, (Me lac. mao.Io:j ~, 130
~~~b~,Jl0 :;pn'9'
R.. ~. un;a-r, 29()'29:2
~1,,,,Ii,,,,. 396 ( bo. ~ic"' io!'I. 290
T,eaTme'_',394 (o#io, 292
R"",dl'i " , J I. F i , ~ r, 29'0 I
, I~I """,i ... """II, 289
T Spring, m

...
s.::.-s bh, 424
:Icon'.h,I>OI"""s. 16_17
,
~!~~. 2$4
SI".:.,,, . 254
Torq.,o"'''41. 318
Z Spring. 291
StobMy. 377
!oinT....1M! ...... 31 4
S",. io",,'1 a~ g.o. 205
S'".,'" ono ~" 15-3 157
*.10< ..."Is. 8
'SejIa,141
Slud.,- mOO.l., 130. 478
S"bm. 'Il od tHIII. 94
s.l1a """on pano, I 46 Svb<p;noie, 146
s-llongitudnal >Iud ..., 11 S""kling,50
' -11.0-..,319 S...,."U"""""I '-Ih. 6586
Suppltm"",1 d"'ll.-;c o'*- 116
o.,,,,boIl. 319 5ouppler:>e",ol ~~. 6586
E~ ... ic'''g.31 9 5ou"", ... uotion, 434
K."~"II'" 320 5ourg;d <>rt'"""nli "
~. of ""' p..... , 48 o.fi , i'io!'I.449
So""I.ma.cfooo 1/<*" ll<O<edu.... 454.60
M...,.-pRXed..-.449 _4$4
Sctu.a gro...th. 3 1
s...d appl;ona.. 208
Swollow;,g
l..IomiTt.50
MafIJr 50
Srm""',",,1 2 1
~"", I ry of 10::0, 121
~ph,.<s, 35
Syochondrosi.
f...... - .~d.31
fn'rn-occipilof,3 \
Sphono.........,....31
Sphono-ocop"foI.30
,
10",,_, H O
Thoori... of~
c.:u,;iagl ........, 16-17
f ~_.IB
Genolic.16

____ ~b __________________. . . . . . . . . . .
526 ~' Orthodonlics The Art and Science

SuN"",16
Vt>o Lftobo~h. 18
The~ _<TOns. 2~ 2, 259_269
Th_ ~.g plio", 258
Tlvo..gn the bile ...... a, 317
Th..mb -..do,.oQ, 97102
TiWO"l1, 198
"",."
EIIode,428 Yo';', 151
ThM tl"g, 1021 03
Tie, 127
r"",h
Buu. 37 Z ""log . 29 1
Mo.ro..". 181. 194
To_,32 1
To"",,,,; o,,-.Jl b'l\ 31 8
T,ojoQOf"" oIlota., 5354
1"""""lotol orch, 224
T..",.........loti",....., 67
l_em pblrong, 377384
T,;gd 0110"",,,, 99

....'.
Trimm"'g oIopplonoo., 299-484
,\now., 158
"".d>od 01..001 .... o><>i>n. 23 1
f...;" 1IUdi.., 48949(1
TYf'tO of
I
EIody, 120.121
Hood, I21
I

llIl~ d..;l: I "il .togoo . 4 8

1Jndeml1";"il ....... pfOoo'l. 165
U","_,GbI. >t<I.oIoo cI Mo:.:o<d",000'1 1-2
Unlole<ol
Clolt H l.44 :;>
Croub ... , 4 23 ~24
Upflg hf"il ....... 317
UoehA hoOts, 98
~.,...:Jl .,,;... ~ ..,..I:.slI ~ l.,.b,. ~
~ \o,;,.,oo ~ :J:-'jl ..... s-
....... diog"'"', 79 I..a. ' ..... , .J
_. ".~ ' "
~.,- :;""'W -<.'-~ J,~
. ~ .....
_. ",
V..,;td ma'oo::lJ,ion, 6 7
V. " ibou lot KI'_ , 33$.337 ~ '&0 .. ~ l,;';-:: 'j .J
Visual traolm",,' ob)o<li,.., 335
Vi!QI oIoioiog , 12. 13

w
W"" biIo ( ... bile '''11 ... 01 ...)
W~kinoon' .....,<..,...
207
Wi,.. (0-. 0'''' ,."os)