Escolar Documentos
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Orthodontics 3311/3312
3rd Year
2013
Unit Guidebook
Coordinators: Samuel Bennett
Mithran Goonewardene
Orthodontics
Contact details
Unit coordinator:
Sam Bennett
Mithran Goonewardene
e-mail:
Samuel.bennett@uwa.edu.au
Phone:
Mithran.goonewardene@uwa.edu.au
9346 7671
Fax :
9346 7666
Clinical Tutors:
Mike Razza
Carl Sim
Consuelo Loza
Graeme Bond
Andrew Savundra
Frank Furfaro
All material reproduced herein has been copied in accordance with and pursuant to a statutory licence administered by
Copyright Agency Limited (CAL), granted to the University of Western Australia pursuant to Part VB of the Copyright Act
1968 (Cth).
Copying of this material by students, except for fair dealing purposes under the Copyright Act, is prohibited. For the purposes
of this fair dealing exception, students should be aware that the rule allowing copying, for fair dealing purposes, of 10% of
the work, or one chapter/article, applies to the original work from which the excerpt in this course material was taken, and not
to the course material itself.
The University of Western Australia 2001
Table of Contents
I.
II.
How You Do It
III.
IV.
V.
Supplementary Materials:
Laboratory Exercise 1- Basic Wire bending
Laboratory Exercise 2-Wire Components for URA
Laboratory Exercise 3- Wire Components for URA (contd)
Laboratory Exercise 4- Acrylic finishing/repair
Laboratory Exercise 5- Diagnostic Model Preparation
Laboratory Exercise 6- Facial Form Analysis
Cephalometric and Space Analysis
Cephalometric illustrative tracings
Cephalometrics glossary
Laboratory Exercise 7- Case records
Laboratory Exercise 8,9- Typodont/Lingual Arch
Outline the graphs for average somatic growth changes from birth to
adulthood, describing the impact of early and late development, gender
effects and factors which may affect the growth patterns, timing and rates.
Explain the theories of craniofacial growth and outline and explanation for
the aetiology of facial growth problems
List the timings of tooth eruption and identify the dental age of a patient
Describe the four major theories of tooth eruption and provide and
explanation for clinical problems associated with tooth eruption
The seven goals above correspond to the four instructional units of the course but in
no means aims to prepare you for comprehensive management of orthodontic
problems. On occasion, young children will present to the clinic with problems
which lie outside the scope of this course. For interest, students will be encouraged
to research issues associated with these problems but this will not be included in the
examination process.
Like Growth and Development(Level 1), this course is largely selfinstructional. In addition to types of self-instructional material you have seen
previously, this course has laboratory exercises in which diagnostic techniques are
employed and laboratory and clinical simulation techniques are performed. You
will have personal contact with faculty in seminars and clinic to discuss material
you have learned from computer teaching programs and reading assignments, and
also in the clinical component of the course in which you work up a child patient
and develop a treatment plan in the orthodontic clinic. Simple procedures may be
undertaken in the clinic by the dental student or referred on to the specialist clinics
for more extensive treatment An amount of lecture time equivalent to what you
would have spent in lectures to cover the self-instructional materials once has been
set aside, but of course you can view the self-instructional materials at any time
during their unit.
The course is in four didactic units in two levels. The first two units in level
2, in which the self-instructional material is concentrated, span over the first two
months. Superimposed in this time are the laboratory sessions which two
formative on-line tests on the UWA MOODLE system. The material from Level
2 will constitute the Semester 1 Examination.
The third and fourth units in level 3 may be reviewed at any time, but will be
formally reviewed in semester 2. The material from Level 2 and 3 will be reviewed
in the Semester 2 Examination.
JFS McGIBBON AWARD - 2013
The Australian Society of Orthodontists (WA Branch), on behalf of the dental
profession, has established a fund to endow an award in memory of the late JFS
McGibbon, who was an eminent orthodontist in Perth and part-time teacher of
orthodontics for many years. The fund will be administered in accordance with
the following regulations.
The Award will be made by the School of Dentistry, on the recommendation of
two examiners appointed by the School of Dentistry on the recommendation of
the Australian Society of Orthodontists (WA Branch) to the student enrolled for
the degree of Bachelor of Dental Science, who, in the opinion of the examiners,
has submitted the best essay on a topic directly or indirectly related to
orthodontics.
Essays must be in typescript and must not exceed the length prescribed by
examiners at the time the topic is determined. Tables, diagrams and illustrations
should be used where appropriate.
Learning Strategies
Study materials for this course consist of
1) computer teaching programs
LOCATION OF MATERIALS: Access to modules and self tests is
the same as you used for Level I, so you may not need to do the
following.
Group 2
Group 3
Group 4
Group 5
Group 6
Abdel-Messih
DePiazzi
Kierath
Loh
Rasmussen
Tan, V
Al Kadhi
Di Francesco
Koh
Mark
Rijks
Tan, Y
Ang
Doucas
Kong
Natalwala
Rogers
Tay
Baskar
Esselle
Neoh
Saeedi
Chang
Fernando
KorhonenBannister
Koshal
Ong
Shelton
Chao
Gandhi
Kwoh
Oversby
Sivapatham
Chen
Goh
Lemut
Pham
Staer
Chong
Han
Leow
Pothukuchi
Sutedja
Choy
Hwang
Leung
Pritchard
Tai
Crane
Joppich
Lo
Qiu
Tan, C
Tedja
Teh
Verma
Voola
Walker
Yang
Zhang
It is important to review the learning objectives for each Unit prior to the
review session and formulate your responses individually to gain maximum
value form the experience. Although faculty will present a summary of these
focus points, it is not the intention to provide students with another lecture to
learn verbatim. This is an opportunity to discuss the learning objectives.
The course has been revised each year, almost exclusively based on student
feedback. We have added material as an outcome of student suggestions and
deleted/revised material as an outcome of student concerns. Please continue to let
me know of any comments or concerns that you think would improve the course.
Evaluation
Formative
15%
Formative
Formative
10%
Semester 1 Exam
20%
(2 hours-MCQ)
15%
McGibbon Essay
Formative
Clinical Grade
10%
30%
100%
Professionalism
Pass/Fail
Prior G&D Coursework Information from prior course
reading/modules may be on future G&D exams. Any questions
from prior coursework material will be very general concepts.
UNIT OUTCOMES :
At the end of this 8
week term, students
will:
THEME
Integrated Science
of Medicine and
Dentistry
Integrated Science
of Medicine and
Dentistry
Dental Health in
the Community
Sno
STRAND
TEACHING and
LEARNING
EXPERIENCES
ASSESSMENT
YLO
No
YEAR OUTCOMES
Normal Structure
and Function
Lecture
Summative, Written
Examination, Short
Answer Questions
2.3.1
Abnormal Structure
and Function
Formative, Written
Assignment, Short
Answer Questions
3.3.1
Demonstrate knowledge of
relevant normal human
structure and function
including aspects of
development, growth and
aging
Identify abnormal human
structure, function and
behaviour and their effects
on health
Discuss population
perspectives to health and
dental health care in
communities
10
Population
Perspective on
Health
10.3.1
Demonstrate orthodontic
diagnostic procedures
for developmental
problems and outline
rudimentary treatment
plans
Integrated Science
of Medicine and
Dentistry
Normal Structure
and Function
Lecture
Summative, Written
Examination, Short
Answer Questions
2.3.1
Demonstrate knowledge of
relevant normal human
structure and function
including aspects of
development, growth and
aging
Integrated Science
of Medicine and
Dentistry
Abnormal Structure
and Function
Formative, Written
Assignment, Short
Answer Questions
3.3.1
Clinical Dental
Practice
Pathological
Structure and
Function
Integrated Science
of Medicine and
Dentistry
Normal Structure
and Function
Lecture
Summative, Written
Examination, Short
Answer Questions
2.3.1
Integrated Science
of Medicine and
Dentistry
Abnormal Structure
and Function
Formative, Written
Assignment, Short
Answer Questions
3.3.1
Clinical Dental
Practice
Pathological
Structure and
Function
Clinical skills
Summative,
Practical/Clinical,
Practical task
5.3.1
Clinical Dental
Practice
Patient Assessment
and Management
5.3.1
6.3.1
UONo
Perform simple
orthodontic therapy to
children at the general
practitioner level and
describe principles of
comprehensive
treatment.
Explain
the
biomechanical principles
involved in orthodontic
tooth movement in
children
Clinical Dental
Practice
Patient Assessment
and Management
Clinical skills
Summative,
Practical/Clinical,
Practical task
6.3.1
Demonstrate appropriate
patient assessment and
management in clinical
settings under supervision
Integrated Science
of Medicine and
Dentistry
Lecture
Summative, Written
Examination, Short
Answer Questions
1.3.1
Formative, Written
Assignment, Short
Answer Questions
Clinical skills
Summative,
Practical/Clinical,
Practical task
Summative,
Practical/Clinical,
Structured exam
4.3.1
Demonstrate some
advanced clinical
procedures correctly and
safely in simulated clinical
settings
4.3.2
Demonstrate simple
operative procedures
correctly and safely in
clinical settings
Clinical Dental
Practice
Skills and
Procedures
Clinical skills
Clinical Dental
Practice
Skills and
Procedures
Laboratories
UNIT OUTCOMES
: At the end of this 8
week term, students
will:
SUONo
Demonstrate
orthodontic diagnostic
procedures for
developmental
problems and outline
rudimentary treatment
plans
Perform simple
orthodontic therapy to
children at the general
practitioner level and
describe principles of
comprehensive
treatment.
Demonstrate orthodontic
diagnostic procedures for
developmental problems in the
clinical situation.
Explain
the
biomechanical
principles involved in
orthodontic
tooth
movement in children
UONo
GENERIC
OUTCOMES
Describe and explain orthodontic problems and the implications on the patient's
health status and society
DisciplineSpecific
Knowledge
and Skills
Understanding
Health and
Society
2
Perform simple orthodontic therapy to children at the general practitioner level and
describe principles of comprehensive treatment.
DisciplineSpecific
Knowledge
and Skills
Critical
Thinking and
ProblemSolving Skills
Personal and
Professional
Skills
DisciplineSpecific
Knowledge
and Skills
Critical
Thinking and
ProblemSolving Skills
DisciplineSpecific
Knowledge
and Skills
DisciplineSpecific
Knowledge
and Skills
DisciplineSpecific
Knowledge
and Skills
DisciplineSpecific
Knowledge
and Skills
Critical
Thinking and
ProblemSolving Skills
Course Introduction
Dr. Goonewardene
12.30 pm
1.30 pm
1.30 pm
Wire Components
Dr. Bennett
OHCWA 211
OHCWA 202
OHCWA 215
OHCWA G04
OHCWA 205
Orthodontic Clinic
1.30 pm
Cephalometric Tracing
Model Analysis-Space Analysis
Facial Form Analysis
12.30 pm
1.30 pm
1.30 pm
Lingual Arch
Molar Uprighting
Premolar Extrusion
Complete (Ideally before commencing Clinical Rosters) Formative tests on Moodle titled:
Facial Form and Cephalometrics Quiz-Formative
Space Analysis Quiz-Formative
1.30 pm
Group 1
Group 2
OHCWA 211
OHCWA 202
Group 3
Group 4
Group 5
Group 6
1.30 pm
OHCWA 215
OHCWA G04
OHCWA 205
Ortho Clinic
*NOTE- Wire exercises, URA and models to be submitted by Friday 12th April
Lingual Arch, Molar Uprighting and Premolar extrusion projects to be submitted by
Friday 20th September
Reduction of 5% per day for late submission
8.00 am
Group 1
Group 2
Group 3
Group 4
Group 5
Group 6
OHCWA 211
OHCWA 202
OHCWA 215
OHCWA G04
OHCWA 205
Ortho Clinic
8.00 am
Group 1
Group 2
Group 3
Group 4
Group 5
Group 6
OHCWA 211
OHCWA 202
OHCWA 215
OHCWA G04
OHCWA 205
Ortho Clinic
9.00 am
Invisalign Technique
Dr Razza OHCWA LT
9.00 am
*NOTE- Lingual Arch, Molar Uprighting and Premolar extrusion projects to be submitted by
Friday 20th September
Reduction of 5% per day for late submission
*Written McGibbon Essay Submission date Friday 27th September
Reduction of 5% per day for late submission
IV. DOING IT
Level 2-UNIT I. THE NATURE OF ORTHODONTIC PROBLEMS
Directions:
1) Go through the instructional materials
Part 1. Malocclusion: what is it and why should we treat it?
(a) Read Contemporary Orthodontics Chapter 1, pp. 3-23.
(b) Malocclusion: Definition and Prevalence. Then take the self-test.
Part 2. The etiology of malocclusion
(a) Read Contemporary Orthodontics Chapter 5, pp. 130-161.
(b) Known Causes of Malocclusion, and do the computer self-test.
(c) Equilibrium Theory and the Etiology of Malocclusion, and the computer self-test.
2) Review the educational objectives below. They are an outline of what you are expected
to know when you have completed the unit. If you aren't sure you can meet the objective, look back
at the appropriate instructional material.
Part 1. Malocclusion: what is it and why should we treat it?
Describe ideal occlusion in terms of the relationship of the teeth to the line of occlusion.
Describe ideal occlusion in terms of the occlusal relationship of the teeth in all three planes of
space (transverse, antero-posterior and vertical).
List the dental characteristics on which the Angle classification is based.
Discuss the advantages of the Angle system for classification.
Describe the functional, health and psychosocial reasons for orthodontic treatment, and place
them in perspective in terms of their relative importance.
Describe realistic goals for orthodontic treatment, and indicate the way they have changed as
modern dentistry developed.
Discuss how need for orthodontic treatment compares with demand in the US at present and
how demand is likely to change in the near future.
Part 2. The etiology of malocclusion
Describe known causes of malocclusion in terms of major categories, and put the known
causes in perspective relative to the total number of patients with malocclusion.
Indicate the two types of malocclusion most likely to be due to inherited jaw proportions, and
describe the evidence to support your categorization.
Indicate the mechanism by which trauma to the mandible can affect its future growth.
Identify the magnitude of force needed to cause movement of a tooth, and relate this to the
observed threshold for tooth movement.
Identify the duration of force needed to cause movement of a tooth, and relate this to the
impact of habits like thumb sucking on the dentition.
Describe the maturation of oral function from infancy to adult life, with particular emphasis on
the pattern of swallow.
Discuss myofunctional therapy for tongue thrusting as a potential therapy for anterior open
bite in children, with emphasis on its underlying assumptions and their validity.
Describe the possible role of nasal obstruction in the etiology of malocclusion, and indicate
the probable mechanism by which it would have an effect.
Space Analysis
(a) Read Contemporary Orthodontics, Chapter 6, pp. 195-201
(b) Space Analysis and Its Interpretation, and take the computer self-test.
(c) Complete Online Space Analysis Quiz-Formative
Dentofacial Proportions
Describe ideal dentofacial proportions from the full face aspect, indicating the role of
symmetry and the relationship of the width of upper to lower face characteristics.
Describe ideal dentofacial proportions from the lateral aspect, indicating the a-p and vertical
relationships of the upper, mid and lower face.
Describe the method and objectives of facial form analysis.
Discuss the limitations of facial form analysis.
Carry out a facial form analysis
Principles of Cephalometric Analysis
Space Analysis
Identify the four major assumptions about growth and development on which space analysis is
based.
Discuss the rationale for expecting decreased accuracy of space analysis in children who do
not have a Class I jaw relationship.
Identify the diagnostic materials needed to perform a space analysis.
Carry out a space analysis, as described in Laboratory exercise 2.
Indicate how you would interpret a space analysis result in a child whose facial form or
cephalometric analysis indicated that the incisors were retrusive or protrusive.
Level 3-UNIT 1.
Orthodontic Diagnosis & Treatment Planning
Recognize and evaluate skeletal and dental relationships in all three planes of space.
Recognize and quantify the patient's arch length status.
Evaluate the skeletal and arch length considerations, interactions and appropriateness of
treatment or non-treatment.
Recommend treatment or referral of specific problems based upon case evaluation.
Define and apply the principles of anchorage in appliance design to control and minimize
unwanted tooth movement.
Describe and recognize different types of removable orthodontic appliances in the following
categories: (a) functional appliances; (b) Crozat; (3) Hawley type; and (4) Clear Aligner
Therapy.
Describe and make correct appliance designs of the active Hawley type with specific
recommendations for these components: (a) active; (b) retention; (c) connector; and (d)
reactive or anchorage.
Select the correct wire size for active and retentive elements of active Hawley type
appliances.
Define and explain the biomechanical principles that pertain to orthodontics, specifically the
meaning of terms such as "force", "moment", "fulcrum", "center of rotation", and
"anchorage" as applied to biomechanics.
2. Demonstrate the relationship between wire size, strength, stiffness and the force
produced for a given deflection.
3. Explain the difference between tipping and bodily tooth movement, and how an
applied force can produce either.
Describe the reaction of a tooth to a single force placed against the crown.
Describe the reaction of a tooth to a two-force system placed against the crown as a function
of the moment-to-force ratio.
Indicate the changes in orthodontic forces and
moments needed for successful movement of a tooth that has lost alveolar bone support (as
from previous periodontal disease).
Describe the adaptations in the contemporary edgewise appliance to reduce in-out (first
order) bends in arch wires.
Describe the adaptations in the contemporary edgewise appliance to reduce angulation
(second order) bends in arch wires.
Describe the adaptations in the contemporary edgewise appliance to reduce torque (third
order) bends in rectangular arch wires.
Discuss the indications and contraindications for the selection of space maintaining
appliances.
Discuss the indications and contraindications for the selection of various space regaining
appliances.
Discuss the construction of different appliances.
Explain the indications for molar uprighting in adjunctive orthodontic treatment as part of
general dental care.
Describe the technique used to upright a tipped molar.
Identify appropriate appliances for different clinical problems.
Explain types of appliances, in terms of active and reactive units.
Explain appliance placement, adjustments and timing.
Identify potential side effects or sequela of treatment.
Describe patient tolerance of the appliances.
Identify expected treatment time.
Describe retention procedures.
SUPPLEMENTAL
MATERIALS
LABORATORY EXERCISE 1
Basic Wire Bending
These simple exercises are to familiarize you to some simple wire bending tasks
1. Follow the lines and ensure that the bends are accurate and the wire remains in the
same plane. Use 0.7 mm wire
2. This is a small finger spring constructed out of 0.6 mm wire-ensure that the helices are
3mm in diameter and lie in the same plane.
3. This is meant to represent a type of expansion wire which is attached to two bands on
the upper molars. Bend this out of 0.9 mm wire and follow the lines accurately.
Ensure that it lies in one plane.
4. These two wire are formed out of 0.5mm wire and represent two possible fixed
appliance archforms with 3mm helices used to attach elastics-ensure that you follow
the lines and that the wire is as flat as possible when it lies on the bench top.
Use:
Supplies:
The free end of the wire is bent upon itself and turned toward the incisal edge of tooth to
protect the mucosa.
The most anterior horizontal section of wire contacts the lingual of the distal marginal ridge of
the incisor
The helices is formed from 1.5 turns and is 2-3 mm in diameter. The first helix will open
when the tooth is moving in the appropriate direction and is wound away from the palate when
going from the free end to the tag end.
Neither helix extends laterally beyond the distal edge of the central incisor.
The horizontal sections converge with respect to each other but they do not overlap.
The second helix is wound palatally when going from the second horizontal section to the tag
end.
At no point is the lingual portion more than 1 mm from contact with the free gingival margin.
The tag end extends posteriorly 15 mm, parallel to the midpalatal-sagittal suture and within 1
mm of it. The tag end has at least one bend to aid retention in the acrylic and contacts the
palatal tissue 20-25 mm from the incisor at the midline.
Labial Bow
Use:
Can be used to tip incisors lingually when they have been displace by a sucking
habit and there is adequate vertical clearance and space within the arch; can be
used to control position of the incisors . May also be used for retention and anchorage
Supplies:
The horizontal portion of the bow should contact the labial surface of the incisors at the center
of the clinical crown.
The vertical U loops should start at the mesial one-third of the canine.
The U loop should not contact the tooth or gingival tissue but should lie parallel and 1 mm
to the buccal.
The U loop should be about 6 mm in length the exact height and configuration of the loop
depends on the depth of the vestibule and the amount of intended tooth movement. The
greater the movement required, the larger must be the U loop. (Increasing the length of the
wire increases the range of activation and reduces the force per unit deflection.)
The distal leg of the U loop should be adapted to follow the buccal contour and pass
occlusal to the distal canine contact, where it must be closely adapted to avoid occlusal
interferences.
The wire should be closely adapted to the palatal interproximal area, yet avoiding contacting
the palatal surface of the teeth.
The ends of the wire should be turned down sharply towards the palate and cut off to maintain
a 0.5 mm space between the wire and the palate so the wire may be completely embedded in
acrylic.
Labial Bow
-------------------------------------------------------------------------------------------------------------------------Adams Clasp and Double Adams Clasp, Ball clasp
Use:
Supplies:
Cut away mesial and distal gingival margin(1mm) to expose undercut for Adams clasp
retention
Clasp arrowheads must converge towards the undercut to ensure that they are retentive.
Pass Adams clasp over contact point between teeth so as to prevent disruption to occlusion,
The wire should be closely adapted to the palatal interproximal area, yet avoiding contacting
the palatal surface of the teeth.
The ends of the wire should be turned down sharply towards the palate and cut off to maintain
a 0.5 mm space between the wire and the palate so the wire may be completely embedded in
acrylic.
Pass ball clasp over contact point between teeth so as to prevent disruption to occlusion,
LABORATORY 4
Fabricating and Finishing Cold-cure Acrylic
Use:
Supplies:
Models, mixing bowls, slow speed handpiece, large E-cutter, wax spatula, pliers,
scaler, and buffalo knife
Exercise 4
Finishing with Cold Cure Acrylic
Supplies:
Slow speed handpiece and E-cutter, models and cured appliance, mixing bowl, pliers
Wax spatula, scaler, and buffalo knife
The appliance must be inspected to make sure the wires have not become distorted. Replace
the broken appliance on the model. The two halves must fit passively. It may be necessary to
recontour certain wires.
The appliance should be removed from the model and a trough cut approximately 3 mm wide,
which incorporates dovetails for mechanical retention with the remaining acrylic. The trough
must be cut the total depth of the acrylic.
The stone model should be coated with separating medium in the area of the break.
The broken pieces of the appliance should be replaced on the model and if necessary
stabilized with wax on the labial surface of the teeth.
Cold-cure acrylic must be applied in a salt and pepper fashion to the area of the prepared
trough. The acrylic should be extended over the palatal surface of the appliance halves, but do
not thicken excessively.
The resin must polymerize completely prior to removing the appliance and polishing the
surface to a smooth non-porous finish, of similar thickness to the rest of the appliance.
LABORATORY 5
(2)
Verify that you have the Facial Profile Analysis and Space Analysis forms
(3)
Complete the Facial Profile Analysis form and the Space Analysis form
(4)
1.
2.
3.
4.
5.
Analysis used:
Tanaka-Johnson Analysis
Applicability:
Materials needed:
When you are performing a space analysis using real dental casts, you should consider using a
modified Boley gauge to make the necessary measurements. The Boley gauge must be modified to
accurately measure the widths of teeth. Using your slow-speed handpiece and a heatless stone, grind
the square ends of the measurement tips to points as shown in the diagram (left).
Procedure for the Facial Profile Analysis and Space Analysis Exercise using Digital Images
You will have to upload the following digital images for this patient:
- Right facial profile
- Maxillary occlusal
- Mandibular occlusal
- Right buccal occlusion
- Left buccal occlusion
a). Facial Profile Analysis
Using the right facial profile image for your patient complete the Facial Profile Analysis form. Carefully
follow the instructions on the form to draw the patients profile on the form in the correct location. After
drawing their profile answer the questions at the bottom of the form as they relate to this patients profile
b) Space Analysis
Using the preceding information complete the Space Analysis Form for your patient. The following
paragraph numbers refer to section numbers on the Space Analysis Form.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Molar Shift
This mesial shift is measured for patients with a Class I skeletal pattern and end-to-end
molars. The right and left sides are totaled. The sum will need to be subtracted from the
space discrepancy figures for section #5 to obtain a realistic analysis.
10.
Lip Support
This information is also taken from the Facial Profile analysis. If lips are over-supported or
under-supported, this may indicate that the incisor teeth are protrusive or regressive
respectively. A correction for this effect will be necessary in interpreting space analysis
results. Arch expansion is contraindicated when incisors are protrusive.
Interpretation
This is the most important section. The numerical results obtained in sections 5 and 6 need to be
adjusted and interpreted in light of the skeletal relationships, molar occlusion, molar shift, and lip support.
If more information is necessary or you need to review this material, please see the slide tape The
Space Analysis and Its Interpretation.
FACIAL PROFILE ANALYSIS FORM AND SPACE ANALYSIS FORM ARE ON THE NEXT
TWO PAGES.
V. Supplemental Materials
THE FOLLOWING TRACING PROCEDURES ARE PROVIDED AS A REFERENCE AND STUDY AID
Part 1. Techniques for cephalometric tracing and landmark identification
Place the acetate paper, rough side up, exactly over the film, with the film oriented so the face is to the
right. Tape them together, making sure the top and right side of the film and the tracing paper coincide.
Trace the outline of sella turcica (S). (For this and all remaining steps, follow the illustration in the
syllabus. The procedure is exactly the one outlined in detail Cephalometric Tracing.) Determine the
midpoint and place a dot at point S.
Part 2. Protocol for Cephalometric analysis
(1) Reference lines
Begin the analysis by drawing the five important horizontal planes:
-S-N plane (extend the S-N line posteriorly beyond S)
-true horizontal plane (perpendicular to true vertical, through Or)
premolars
or
primary
Drop a true vertical line (parallel to the chain) from nasion. Draw a segment of a true vertical line, as a
dashed line, though points A and B.
Draw the long axis of the maxillary and mandibular incisors.
(2) Analysis
Observe the orientation of the horizontal reference lines, and the position of points A and B relative to
the true vertical line from nasion.
Measure the following angles and record the values on the analysis sheet:
-ANB
-SN-GoGn
-maxillary incisor to palatal plane
-mandibular incisor to mandibular plane
-interincisal angle
Measure the following linear distances and record them on the analysis sheet:
-max incisor facial surface to true vertical line through NA
-mand incisor facial surface to true vertical line through NB
-pogonion to true vertical line through NB
From your observation of jaw positions relative to the reference lines and the measurements, you can
summarize the patient's dentofacial relationships by evaluating:
-Vertical skeletal relationships
-Anteroposterior skeletal relationships
-Maxillary tooth-jaw relationships
-anteroposterior
-vertical
-Mandibular tooth-jaw relationships
-anteroposterior
-vertical
a composite superimposition tracing, first reproducing the red tracing in solid lines, then using dashed lines to
show differences between this and your tracing.
2. Maxillary superimposition. Superimpose the two tracings on the lingual contour of the maxillary
anterior alveolar process and the palatal plane. Make a composite tracing of the maxillary area only, showing
the changes in the position of the maxillary teeth.
3. Mandibular superimposition. Superimpose the two tracings on the lingual contour of the
mandibular symphysis, the outline of the inferior alveolar canal and the crypt of the unerupted lower third
molar. Make a composite tracing of the mandibular area only, showing the changes in the position of the
mandibular teeth and the external contours of the mandible.
Co
Po
ANS
A
Co
B
Pg
Gn
Me
PP
IAN
MP
OP
L1-MP
SNA
SNB
ANB
SN-GoGn
Maxillary incisor to SN plane
Mandibular incisor to Mandibular plane
Interincisal angle
Maxillary incisor to NA
Mandibular incisor to NB
Pg to N-Perpendicular
Normal
White
Black
81
78.2
2.8
32
103.8
97.3
84.7
79.2
5.5
38.2
108.9
100
126.8
3.mm
23.2
5.4mm
27.3
-4 to -2mm
113.8
7.4mm
24.1
11.4mm
36.7
56
Initial
Final
Nasion (N)
Literally the "Turkish Saddle." The center of the bony crypt occupied
by the hypophysis cerebri (pituitary gland). Roentgenographically a
very constant profile outline seen in its lateral aspect.
Porion (P)
Orbitale (Or)
The lowest point on the inferior bony margin of the orbit (average of
two sides if two images seen).
Gnathion (Gn)
The most outward and everted point on the profile curvature of the
symphysis of the mandible. It is located by bisecting the angle formed
by the mandibular plane and the facial plane.
Pogonion (Pg)
Menton (M)
The most inferior point on the cross section of the symphysis of the
mandible.
Gonion (Go)
The most outward and everted point on the angle formed by the
junction of ramus and body of the mandible on its posterior inferior
aspect (average of two sides if two images seen).
Anterior nasal
spine
(ANS)
Occlusal plane
(OP)
Frankfort plane
(FH)
The general plane of the molars and premolars (use left side if two
images apparent).
Established on lateral headfilms by connecting the lowest point on the
shadow of the
left bony orbit with the uppermost part of the ear-rod.
Mandibular plane
(MP)
(SN)
Palatal plane
(PP)
ANS to PNS
Inferior alveolar
nerve
(IAN)
The shadow cast by the bony canal in the mandibular ramus. A stable
landmark for mandibular superimposition.
U1-SN
L1-MP
LABORATORY 6
Case records- models, photos and radiographs will be provided for the group to
outline a problem list and establish treatment objectives
LABORATORY 7 and 8
MOLAR UPRIGHTING- PREMOLAR EXTRUSION-LINGUAL ARCH
Components of a Fixed Appliance Part I (A and B)
Preparation:
Use:
A canine to canine stabilizing lingual arch is used to group the anterior teeth
together to act as anchorage for creating movement in posterior teeth. It can
also be used for retention.
Supplies:
The wire must be adapted so that it contacts the lingual surface of the mandibular incisor
in a smooth curve (see drawing).
The ends of the wire are extended to the disto-lingual line angle of the canines and contact
a broad surface of the lingual surface with a hook-shaped bend.
(B)
The occlusal surface of the bracket should be parallel with the occlusal surface of the
tooth and located gingival to the marginal ridges.
The bracket base should fit into the developmental groove on the buccal surface of the
right mandibular molar.
Center the bracket on the buccal surface and mark guidelines with a lead pencil.
Mix the composite (referring to the Appendix section titled Bonding Orthodontic
Attachments;
(B)
Preparation:
Use:
A segmental stabilizing arch wire is used group the premolars and anterior
teeth (using the canine to canine stabilizing lingual arch wire) together as
anchorage in order to produce movement in the molar teeth.
Reference:
Supplies:
Brackets are bonded to the facial surface of the premolars and canine in the quadrant
where the molar is to be uprighted. (In the clinic, an acid-etch composite bonding system
is used.)
Bracket placement depends on the intended tooth movement. Each bracket is designed to
fit on the central portion of the facial surface of the tooth. Ideal placement is with the arch
wire slot of each bracket perpendicular to the long axis of the tooth, parallel to the
occlusal surface, and in the center of the mesio-distal tooth surface. However, quite often
in adult adjunctive orthodontic treatment, it is neither necessary nor desirable to move
malposed teeth in the anchorage segment. If this is the case, ignore the long axis
placement rule and position the brackets for maximum convenience so that a straight
length of edgewise wire may be placed with minimum adjustment. In either case, the
brackets must be placed free of occlusal interferences.
(D)
Use 0.018 x 0.025 stainless steel arch wire extending from the distal aspect of the
premolar to the mesial of the canine.
Bend the wire to lie passively in the premolar and canine brackets.
The mesial end of the wire must be turned gingivally and towards the tooth at a point 1
mm beyond the mesial of the canine bracket. This will prevent soft tissue irritation.
A continuous figure-eight ligature tie should be placed from premolar and canine bracket
to consolidate this section of the dental arch prior to seating the braided archwire.
The arch wire must be ligated into each bracket using a dead soft 0.010 stainless steel
ligature wire.
Each twisted ligature wire should be cut at approximately 2 mm length and the pig-tails
tucked gingivally and under the wire to avoid soft tissue irritation.
(C)
(D)
Read Syllabus
Use:
A segmental arch wire and compressed coil spring is used to upright the
mesially tipped molar by tipping it distally.
Reference:
Supplies:
Use 0.018 x 0.025 braided arch wire extending from the distal aspect of the molar tube
to the mesial of the canine.
The wire should be contoured to the shape of the arch (when looking from the occlusal)
The mesial end of the wire must be turned gingivally and towards the tooth at a point 1
mm beyond the mesial of the canine bracket. This will prevent soft tissue irritation.
The braided wire should be placed in the occlusal of the two upper molar tubes, extending
approximately 1 mm distal from the tube. The arch wire must be ligated into each bracket
using a dead soft 0.010 stainless steel ligature wire.
Each twisted ligature wire should be cut at approximately 2 mm length and the pig-tails
tucked gingivally and under the wire to avoid soft tissue irritation.
The distal end of the wire should project no more than 1 mm beyond the distal of the
molar tube.
(B)
Segmental Archwire and Compressed Coil Spring to Upright Molar (See p 34, Illustration
band p. S27)
Use 0.017 x 0.025 stainless steel rectangular wire extending from the distal aspect of the
molar tube to the mesial of the canine.
A continuous figure-eight ligature tie should be placed from premolar and canine bracket
to consolidate this section of the dental arch prior to seating the archwire.
The mesial end of the wire should be bent 90 degrees gingivally to minimize gingival
irritation.
A 0.0009 x 0.036 coil spring 2 mm longer than the distance from the mesial of the
molar tube to the distal of the terminal premolar bracket should be placed over the 0.017
x 0.025 arch wire and compressed between the molar tube and premolar bracket.
The archwire must be securely tied at each premolar and canine bracket with individual
stainless steel ligature ties which should be carefully cut and tucked gingival to the
brackets.
Place model in hot water to soften wax and observe movement of the molar.
Adjunctive Treatment with Limited Fixed Appliances
(A)
(B)
85)
Segmental Archwire and Compressed Coil Spring to Upright Molar (See also pages 80 -
Read Contemporary Orthodontics 4th Edition, pp. 474-476. See Figure 12-71
on page 477
Use:
Reference:
Supplies:
E-cutter, Buffalo knife (large lab knife), wire bending pliers, wire cutters
The performed band should be well adapted to the contour of the tooth and the superior
margin of the band should be approximately 1 mm below the mesial and distal marginal
ridges
You will spot weld the sheath to the molar band. When you weld the sheath to the
band, the horizontal sheath should be positioned on the lower band so that the locking
attachment (the area designated with triangle) is located distally. (See Syllabus, page
S22). The sheath is located in the occlusal one-third of the band and its mesial most
extension is in the middle of the mesio-lingual cusp.
The sheath should be angulated so that the mesial aspect is angled superiorly to allow a
clear path of removal of the lingual arch over the incisal edges of the lower incisors
START HERE
The lingual arch portion is fabricated from a .036 preformed lingual arch. The anterior
component of the wire should rest on the cingulae of the central and lateral incisors above
the soft tissue. The anterior arch should be bent in an ideal arch so that it will not
maintain existing arch irregularity.
At the distal of the lateral incisors, the wire is stepped approximately 1 mm lingual to the
surface of the canine and existing primary teeth to allow eruption.
The vertical adjustment loops are contoured so that they will not impinge on the gingiva.
The lingual arch must be passive in the transverse, anteroposterior and vertical planes of
space when either end of an arch is removed from the lingual sheath.
Preparation:
Use:
Reference:
Supplies:
The wire must project 1 mm beyond the distal of the molar tube.
The T-Loop must be formed at the mid-point between the premolar brackets.
The T-loop should follow the buccal contour of the premolar teeth and should not contact
any tooth material, soft tissue, nor project unnecessarily into the buccal vestibule.
The posterior part of the wire should engage the molar and second premolar passively.
The anterior part of the wire should lie about 2 mm occlusal to the bracket on the first
premolar.
The mesial 2 mm of the wire must be bent gingivally and toward the tooth just anterior to
the mesial wing of the first premolar bracket.
The cut ends of the wire must be smoothed and rounded to prevent tissue irritation.
The arch wire must be securely ligated into each bracket and the individual ligature ties
cut carefully and tucked gingivally.
Clinical Sessions
Students are rostered to Clinic weekly (Monday and Wednesday mornings). If a
student requires a change of the roster, this must be requested in writing to Dr
Razza.
Clinical sessions will consist of one hour for administration, case presentation,
records keeping and three hours of clinical time.
Orthodontics
You will demonstrate on assigned child and adult patients the ability to
provide competent dental service including a range of preventive and
orthodontic treatment.
You will perform those preventive procedures, which are indicated for the
patient. The services will include prophylaxis, topic fluoride application,
home care instruction and dietary counselling.
You will demonstrate the ability to refer when necessary, for consultative
evaluations from Orthodontics, Oral Surgery, Endodontics, Periodontics
and the Paediatric Specialist.
You will demonstrate the ability to influence and control the childs
behaviour, motivate and gain the patients co-operation.
A.
B.
You are responsible for the clinical correlation of lecture and reading
materials and should be prepared to discuss any anticipated treatment
procedures with an instructor, including general dental needs.
C.
Be in the clinic at 8:00AM review all clinical records and determine all
procedures expected to be completed on the day. Be ready to seat the
patient by 8:30am. Do not keep a patient waiting until 8:45am for an
8:30am appointment.
D.
Be well organised and know where your instruments are materials are
located. All instruments and materials should be readily accessible before
you bring the patient into the clinic. As soon as the patient is seated you
should be ready to begin treatment. Careful planning will help you to
anticipate your needs.
Clinic Policy
A.
B.
For clinical procedures the instructor will be called for the following
steps:
- Always before beginning procedures and any time for questions
- Following appliance adjustments
- Following impressions and a wax bite
- Before functional appliance wax bites
- Prior to dismissing the patient
C.
If the patient arrives more than 15 minutes late, there may not be
sufficient time to complete the planned treatment and the patient will be
so informed. This may result in the patient being dismissed at the
discretion of the instructor.
D.
Have a clean mirror and probe from the pre-set tray ready for the
instructor to use.
E.
F.
For any patients who require general dental assessments or treatment, the
student will complete an appropriate referral letter. The referral letter is
to be submitted to the instructor and modifications completed prior to
posting.
1.
2.
Some patients are just beginning treatment with us, while some are in the
middle of a treatment plan formulated last year. Each patient should be
re-examined and have an up-to-date treatment plan.
3.
4.
5.
Record all data in the patients chart (Titanium) and have the chart signed
or authorised by the faculty member. The receptionists at the front desk
can make appointments, but you must indicate the timing of the next
appointment in Titanium or you may schedule the patients next
6.
You must ensure that you make an appointment note in Titanium to advise
the reception team of your patients next appointment requirements and
advise the patient to make their appointment before they leave OHCWA.
If a patient does not need a next appointment, you should set the patients
RECALL date with the appointment code *UORTHO in Titanium on the
Recalls tab in the patient file. All students should know how to do this as it
is included in your Titanium training at the beginning of the year.
7.
8.
Other Leave - The procedure for students in the School of Dentistry to apply
for Leave for reasons other than illness or compassionate reasons is as
follows:
A copy of the School of Dentistrys student Leave Form is supplied
as an Appendix in the Course Guide Book for Years 1-4 of the
BDSc course. All students will be supplied a copy of this Course
Guide Book.
The student should firstly seek in principle approval for the
Leave from the Head of School. An explanation of the reasons for
the Leave will be required and, where applicable, supporting
documents should be supplied. Students should note that this is not
a guarantee of final approval for the Leave; instead it is only to
ensure that there is a valid reason for the Leave.
If approved in principle by the Head of School, then the student
must meet with each Unit Co-ordinator for any Units where
lectures, laboratory clinical, other teaching or assessment sessions
will be missed or otherwise affected. The student should discuss the
possible arrangements for catching up all missed
work/assessments with each Unit Co-ordinator. The Unit Coordinator will then sign the Leave Form and outline the work to be
done, or otherwise make comments if they are unable to make
alternate arrangements for the missed work.
Students should note that it is not always possible to arrange catch
up sessions or examinations due to logistical reasons. Students
should also understand that, any such extra work may be
inconvenient, may not feasible, or may otherwise affect the staff
members work requirements. Students should be considerate of
the possible effects that their Leave may have on patients, staff and
other students.
Final approval is then to be obtained from the Head of School once
all affected Unit Co-ordinators have provided their signed
comments. If any Unit Co-ordinator is unable to make alternate
arrangements for the student to catch up on all work, then the
Leave may not be granted. Such situations will be considered by
the Head of School in consultation with staff and students involved
or affected.
Board of Examiners
Should a student perform poorly in an examination or other assessment, to enable
them to achieve a pass they may be required to undertake additional assessments
(ie viva, remediation, practical work etc). Further assessments can be
scheduled anytime prior to the BoE meeting which is held in December.
All Students MUST ensure that they can be contacted by the School and that they
are available to attend any further examination at short notice during the
University's examination period which extends to the day the Board of Examiners
in Dentistry meets.
Therefore it is the students responsibility to make sure that they are readily
available should they be required to sit any further assessments during this time.
Academic dishonesty
All forms of cheating, plagiarism and copying are condemned by the University as
unacceptable behaviour. The Facultys policy is to ensure that no student profits
from such behaviour. Generally a failure will be recorded for the subject in which
the cheating has occurred. Serious cases shall be referred to the Universitys
Board of Discipline. All students should note that cases of copying are
automatically reported to the Sub-Dean and documentary evidence along with
associated correspondence is placed on the students permanent record.