Escolar Documentos
Profissional Documentos
Cultura Documentos
CEPHALOMETRIC EVALUATION
CEPHALOMETRIC ANALYSIS FOR FUNTIONAL
APPLIANCE
PITCHFORK ANALYSIS
CEPHALOMETRIC ANALYSIS FOR EVALUATING A-P
DISCREPANCY OF THE JAW BASES
CEPHALOMETRIC TONGUE ANALYSIS
VISUALIZED TREATMENT OBJECTIVE
SKELETAL MATURITY INDICATORS FOR
TIMING THE FUNCTIONAL APPLIANCE
THERAPY
CERVICAL VERTEBRAL MATURITY
INDICATOR
HAND WRIST RADIOGRAPHS
DENTAL CALCIFICATION
FRONTAL SINUS
SOMATIC MATURATION STANDING
HEIGHT AND PEAK GROWTH
VELOCITY
Introduction
Wolff (1893) on form and function
Orthognathic surgery
Path of closure - Vertical plane
True deep bite Pseudo deep bite
Infraocclusion of the Normal eruption of the
posterior segments. posterior teeth
Lateral tongue posture or Over- eruption of the
tongue thrust habit incisors.
Large interocclusal gap Small freeway space
Cl II div 2 with adequate Gummy smile & poor lip
lip line line
Elimination of Intruding incisors
environmental factors Distalize maxillary
inhibiting eruption of the molars to control the
posterior teeth. vertical dimension
Fnl appl is beneficial Not of much use
Path of closure - transverse plane
Functional disturbances
1. hypermobility
2. limitation of movement
3. Deviation
2. Floor of the mouth is elevated and visible on each side of the diminutive
tongue.
3. The dental arch reflects the small tongue size and is collapsed and
reduced, with extreme crowding in the premolar area.
7. The localized effects are extreme. In some cases, teeth from the posterior
segments are tipped so markedly to the lingual that they touch each other
in the midline. the effects limited mostly to the dentoalveolar area.
In the case of hypoglossia the functional
abnormality primarily affects the dentoalveolar
region, not the basal skeletal structure. Oral and
vestibular screens incorporated into functional
appliances have similar capabilities. Fixed
appliances also have primarily localized effects,
which is the reason locating the malocclusion
and correcting the sagittal dysplasia are so
important before applying even simple inhibitory
therapy.
Tongue dysfunction
The most common tongue dysfunctions involve selective
outer pressure (pressing) and tongue biting. Tongue
thrusting can be anterior, posterior, or combined. The
consequences of the localization of aberrant pressures
depend on the area of applied pressure:
1. Anterior open bite results from anterior tongue thrust
and posture.
2. Lateral open bite and deep overbite result from lateral
tongue thrust or postural spread that causes infra-
occlusion of the posterior teeth.
3. Edge-to-edge incisal and cuspal relationships.
In a vertical growth pattern th tongue thrust can open the bite, and the lower
incisors may be tipped lingually.
Examination of the lips
1. If only a slight contact or a very small gap is evident between the
upper and lower lips, the lips are competent.
3. If the lips seem normally developed but the upper incisors are
labially tipped, making closure difficult potential lip incompetency.
The lower lip trap then enhances the already excessive overjet,
makes the upper incisors mobile & retrocline and crowd the lower
incisors. Early treatment of these problems is an important
preventive measure.
If the tonsils and adenoids are enlarged, with a compensatory anterior tongue
posture, the patient cannot tolerate a bulky acrylic appliance in the oral cavity.
Lip seal is usually inadequate, tongue is a low posture and disturbed function. If this
condition persists after treatment, relapse will occur. Orthodontic therapy should aim
at establishing normal nasal respiration. Unfortunately in some patients with
allergies or deviated nasal septums, this is not possible during the growth period.
Water hold test can be performed.
The presence and size of the adenoids and tonsils also can be
estimated on lateral head films. An arbitrary scale of small, medium,
or large can be used in both the clinical examination and the lateral
cephalogram.
Class II malocclusion:
Anterior postural rest position of the mandible
Large freeway space,
Mandibular overclosure, and deep bite
Early TMD symptoms with deep overbite, horizontal
growth pattern, and abnormal perioral muscle function.
Uncompensated:
Greater saddle angle + greater articular angle +
Lesser ramal angle-unfavorable
2.Articular angle-
9yrs 9-15yrs
H V H V
Post facial ht. 69.5 64.1 11.05 10.8
Antr facial ht. 103 106.6 12.18 12.71
Hor 67.5%-69.9%
Ver 60.1%-62.7%
5. Antr cranial base length (Se-N)
Horizontal growth 68.8mm at 9 yrs and increases by
4.46mm between 9- 15 yrs
Vertical growth 63.8mm and increases 3.52mm
between 9- 15 yrs.
Therefore greater antr cranial base length in horizontal &
lesser in vertical growth
1.SNA- Sagittal relation of the antr limit of the maxillary apical base
9yrs 15yrs
Avg 79.5 81.28
Hor 79.73 81.57
Ver 79.0 80.57
Mandibular base:
The mandibular base should be 3 mm longer than Se-N until 12th year
and 3.5 mm longer after 12th year. A length 5mm less than this average is
considered normal until 7 years and length 5mm or more is considered normal
until 15 years.
9 yrs 15 yrs
2. Lower incisors:
Incisor to mandibular plane angle:
90* - average
smaller angle lingual tipping of incisors advantageous for
functional appliance treatment. Activators are more effective in the
saggital plane and tend to tip the lower incisors labially.
if lower incisors are already labially tipped anterior repositioning of
mandible and uprighting of incisors is necessary.
3. Positioning of the incisors:
Maxillary incisor to N-Pog line: 2 to 4mm
Mandibular incisor to N-Pog line: -2 to +2 mm
Disadvantages:
1. Although growth and treatment interact in all 3 planes of space, only
a-p changes are considered (because of the authors interest)
If, for example, the cranial-base fiducial lines are superimposed, the
separation of the mandibular and maxillary fiducial lines represents
the translatory growthboth in amount and angulationof the jaws
relative to cranial base.
Measurement of change
Based on the ideas of Wendell Wylie, Jacobsons Wits
analysis (Jacobson, 1975), and the analytic methods of
D. Harvey Jenkins (1955)
The superimpositions are recorded by arbitrary
fiducial lines. Maxillary advancement relative to
cranial base (MAX) is measured at W; Mandibular
displacement relative to maxilla (ARCH) is measured
at D. Both measurements are executed parallel to
MFOP.
The pitchfork analysis uses a functional occlusal plane (FOP) (Jenkins
1955) and defined as ...the average occlusal plane of the buccal teeth,
including canine and first permanent molar
FOP is a best-fit line passing through the occlusal overlap in the region of
the first molars, premolars, and canines (especially when premolars have
been extracted).
the line (sic) is placed by inspection, either with respect to the radio-
opacities created by cuspal overlap or to the radiolucencies scattered
among cusps along the line of the occlusion