ORTHODONTIC WIRES (SIZE) 2) Square Wire - fixed; ex.

16 x 16"
A. Gauge of Wires 3) Rectangular Wire - fixed;
1) Thick Wire (e.g. 16 x 22" / 17 x 25%)
a. 0.060" - outer wire of face bow
b. 0.045" - inner wire of face bow; palatal crib
c. 0.036"
- Space maintainers: Nance appliance,
Transpalatal arch, lingual holding arch
FACE BOW
• Consist of outer bow or wire
• Consist of inner bow or wire
• Part of a headgear which is used for a child to inhibit
excessive growth of maxilla

COMPOSITION OF ORTHODONTIC WIRES

1) Stainless Steel (SS) - 1929
High stiffness, low springiness, low range, good formability,
and corrosion resistant
Used for space closure after extractions in orthodontic
treatments
2) Cobalt-Chromium-1950
Marketed as ELGILOY; Co (40%), Cr (20%), Fe (16%) and Ni
(15%)
Increased resilience and strength; however, its stiffness was
weak
Blue Elgiloy (soft), Yellow Elgiloy (ductile), Green Elgiloy
(semi-resilient) and Red Elgiloy (resilient)
THICK WIRE: SPACE MAINTAINER 3) Nickel-Titanium (NiTi) - 1960
Orthodontic appliance that is 55% Nickel and 45% Titanium
indicated when there is early Shape Memory and Superelasticity
loss of deciduous tooth/teeth 4)Titanium Molybdenum Alloy (TMA) or Beta-Titanium
Fixed or removable Better formability and springback than the stainless steel
• Some fixed space maintainer wires
are the following: lingual Ti (79%), Mo (11%), Zr (6%), and Sn (4%)
holding arch, transpalatal, Advantage: Allergic to Nickel
Nance Appliance
ORTHODONTIC PLIERS
A. Bird beak or 139 Plier
• Universal plier; versatile plier
• Has pyramidal and conical beak
used for making bends in
orthodontic wires.

CROSS SECTION OF
ORTHODONTIC
WIRES
1) Round Wire - removable and fixed
 OSTEOGENESIS
2 Basic Modes of Bone Formation:
ORTHODONTIC PLIERS
1. Intramembranous
B. Howe Plier or 110 Plier
2. Endochondral
Howe utility pliers have serrated tips for
- Can be classified as Endosteal or Periosteal,
gripping wires. It is useful for placement and
depending on the site of formation.
removal of archwires as well as placement of
- Endosteal bone formation may either be
pins and other auxiliaries.
intramembranous or endochondral depending on
Types of Howe Plier
the site.
a. straight howe plier (# 110 )
- Periosteal bone formation is intramembranous in
b. curved howe plier (# 111)
nature.

BONE FORMATION

INTRAMEMBRANOUS ENDOCHONDRAL
OSSIFICATION OSSIFICATION

- Formation of bone - Bone is formed from

directly from cartilaginous anlage
osteogenic cells

- This occurs in sites of - Original mesenchymal

tension (periosteum, tissue becomes
sutures, periodontium cartilage first.
has its own
ORTHODONTIC PLIERS
remodeling processes)
C. Specialized Orthodontic Pliers - Tooth movement - Allows for morphogenic
1. Nance Plier occurs via resorption adaption of the bones
Used to make uniform heights of vertical loops of bone and providing continued
2. Mathieu Plier intramembranous production of bone in
The Mathieu plier has a quick release locking and ossification special regions that
unlocking mechanism which is used for the involves high levels of
placement of elastomeric ligatures. compression.
3. Weingart Plier
Serrated tips hold wire firmly at a convenient
working angle. Tapered tips fit easily between DIFFERENCE BETWEEN CARTILAGE AND BONE
brackets. Rounded for patient comfort.
CARTILAGE BONE

- Rigid and firm - Rigid and

calcified
 - Pressure- - Tension-
REMODELING
tolerant, tolerant , does
- Change of shape and size of bone due to constant
provides not grow in
deposition and resorption of bone
growth in areas areas of heavy
- Differential rates of deposition and resorption cause
of compression pressure and
a change in morphology
(ex. Articular dependent on
cartilage and vascular
epiphyseal membrane
growth in long
bones)

- Grows via - Grows via

appositionally apposition and
and endochondral
interstitially (NEVER DRIFT
interstitial) - Apparent movement of the bone due to remodeling
and not due to the bone moving.
- Requires the
CONCEPTS combination of
deposition and
DEPOSITION resorption that
- The laying down of bone via, Intramembranous or results in the growth
endochondral means. movement towards
- Represented by "+" in diagrams side of deposition.
- Ex. Mandibular
RESORPTION Foramen: in a child the mandibular foramen is
- The removal of bone via the activity of osteoclast located below the occlusal plane and in adult it is on
- Represented by "-" in diagrams average located at the occlusal plane.

GROWTH SITE GROWTH CENTER

Serves as a location in Area of bone that CONCEPTS
the bone controls the
where the actual overall growth of bone DISPLACEMENT
growth occurs from its - The physical movement of the whole bone as it
locations through remodels
different signaling - Experienced when bone deposition is greater than
mechanisms. Growth at resorption. Enlargement displaces the bone.
these
centers are genetically EXTERNALROTATION
controlled. - Surface or soft tissue changes due to rotation
Dependent on the All growth centers can
growth centers be growth INTERNAL ROTATION
for growth. sites but not all growth -Rotation of the core of the jaw or body
sites can be -Tends to be masked or compensated by tooth eruption
growth centers. = 2 TYPES:
1.MATRIX ROTATION
The apparent location Ex. Mandibular Changes due to the rotation of the condyle or body
of bone condyle, 2.INTRAMATRIX ROTATION
growth synchondrosis of the Rotations centered around the body of the
basicranium, mandible
membranous bones of
cranium. TYPES OF DISPLACEMENT
Ex. Mandibular ramus, 1. Primary Displacement
maxillary Displacement of the bone due to the bone growth
tuberosity, Ex, mandible continually grows upward and backward and is
synchondrosis of the displaced forward and donnward.
basicranium, sutures of 2. Secondary Displacement
the Displacement of the bone due to another bone's growth.
Ex. Secondary Displacement - the maxilla and glenoid fossa https://www.youtube.com/watch?v=N1uu8Ot2zPE (Links to
enlarges and grows downward and forward displacing the
mandible downward and forward as well.

CONCEPTS
ENLOW'S EXPANDING "V" PRINCIPLE
-V-shaped bones tend to follow this type of remodeling an external site.)
-Deposition occurs on the inner portion of the "V"
-Resorption occurs on the outer portion of the "V"
-As the "V" moves towards the open
part of the "V", it increases in all c. Restoration - carious lesion must be restored to keep
dimensions. the deciduous teeth till the time of exfoliation. Primary teeth
will serve as guide for eruption of permanent
teeth. Restoring proximal lesions is important to preserve
arch length/perimeter.
CANVAS!
M1-Lesson 1 Definition of Term

From British Society of Orthodontists: Orthodontics

Ø includes the study of growth and development of

the jaws and face

particularly, and the body generally, as influencing the

position of the teeth;

Ø includes the study of action and reaction of internal and

external influences on the development;

Ø includes also the prevention and correction of arrested

and perverted development

d. Space Maintainer - an orthodontic appliance, fixed or

M1-Lesson 2 Categories of Orthodontics Part 1 removable, that maintains the space left by a prematurely
lost tooth.
1. Preventive Orthodontics – action taken to preserve the
integrity of what appears to be normal occlusion at a
specific time
Band and Loop Fixed
Preventive Measures:
Type
a. Oral Prophylaxis - is cleaning of the teeth by a dentist
Space Maintainer
or dental hygienist, including removal of plaque, material
alba, calculus, and extrinsic stains; done as a preventive
measure for control of gingivitis.
e. Habit Breaking Appliances - presence of oral habits
b. Topical Fluoride Application - hydroxyapatite crystals of like thumb sucking, tongue thrusting and lip biting when not
enamel in the presence of fluoride becomes fluoroapatite arrested with the use of habit breaking appliances will lead to
crystals which strengthen enamel. The tooth becomes more malocclusion. See the following illustrations of the different
resistant to tooth decay. Fluoride can be found in toothpaste, oral habit breaking appliances. Detail discussion of this topic
mouth wash, in communal water and can be applied by the will be in Orthodontics II
dentist every 3 - 6 months depending on the child whether
he is high/low caries risk.

Watch this video to deepen understanding of Topical

Fluoride Application Palatal Crib -
thumb sucking habit
 The following are illustrations of the different interceptive
appliances that will deepen understanding of the topics
above:

Tongue Crib -
tongue thrusting habit

Bionator - a
Lip
type of myofunctional appliance for Class II case
Bumper - Lip Biting Habit

M1-Lesson 2 Categories of Orthodontics Part 2

2. Interceptive Orthodontics – recognizes and eliminates

potential irregularities and malposition in the developing
dentofacial complex. This is due to hereditary factor.

Interceptive Measures :

a. myofunctional appliance – for developing Class II and

Class III cases; principle of using this appliance is to stretch
active muscles that restrict growth of maxillary and
mandibular bones.
Extra oral Chin Cup
b. chin cup – indicated for developing Class III case
(excessive mandibular growth); this is worn by the child for 14
to 16 hours daily to redirect growth direction of
mandible. Chin cups are divided into two types: 1. The 3. Corrective Orthodontics - recognizes existence of a
occipital-pull chin cup, more frequently used in cases of malocclusion and needs technical procedures to eliminate the
mandibular prognathism 2. Vertical-pull chin cup that is used problem
in cases of steep mandibular plane angle and excessive
a. Limited Corrective Orthodontics – simple cases that
anterior facial height, the so-called “backward rotator”
can be treated in a few weeks or few months
patient with openbite.
b. Extensive Corrective Orthodontics –
c. serial extraction – indicated when there is excessive
complicated cases that are referred to Orthodontist
crowding of teeth after computation of mixed dentition
analysis. It is a planned extraction of certain deciduous teeth
and specific permanent teeth in an orderly sequence to
guide the erupting permanent teeth into a more favorable The illustrations below are example of appliances under
position. Eventually there is a need of extraction of premolars Limited Corrective Orthodontics:
 M1-Lesson 3 Brief History Part 1

Edward Hartley Angle (June 1, 1855 – August 11, 1930)

was an American dentist, widely regarded as "the father of
Mandibular American orthodontics ". He was trained as a dentist, but
Incline Plane - cemented for few weeks; made orthodontics his specialty and dedicated his life to
for standardizing the teaching and practice of
treating anterior crossbite (1-2teeth) in the maxillary arch orthodontics. During his lifetime, Angle has been credited
with introducing following appliances to the field of
Orthodontics. His Edgewise bracket was his most important
contribution to Orthodontics.

Anterior Bite Plate - removable orthodontic appliance use to

treat deep bite case by allowing unopposed tooth to
continue to erupt until it comes into contact with another
surface, this appliance holds the anterior teeth while allowing
the posterior teeth to erupt.

• E (expansion) Arch Appliance (1907) - There were two

types: Basic & Ribbed. This appliance only allowed
tipping movement and provided poor control of
individual tooth position.
• Pin & Tube Appliance (1910) - Consisted of Gold and
Platinum bands and had attachment to all the teeth.
These bands had vertical tubes that were soldered to
them and a Pin was passed through it to achieve tooth
movement. Root parallelism and rotation was difficult to
achieve with this appliance. In addition, the pins had to
be repositioned every appointment through the process
of re-soldering.
• Ribbon Arch Appliance (1915) - This appliance was
created after the Pin and Tube appliance. This device
consisted of a Vertical bracket soldered to a band. It
allowed rotation to be possible. Dr. Raymond Begg (Links
to an external site.) eventually used this appliance to
create his light wire technique.
• Edgewise Appliance (1925) - These were identical
brackets for all teeth and it allowed tooth movement in
all 3 planes of space by adding bends to the rectangular
arch-wire, one of its disadvantages. The wire was held in
the slot by metal ligature. In this appliance, the slot was
changed from vertically to horizontally. Therefore, the
bracket was wide mesio-distally and its slot size was .022
x .028 inch. These brackets were initially referred to as
"open face" or "tie brackets".
o The edgewise bracket has been later modified to
Single Width Bracket, Siamese Bracket, Lewis
Bracket, Steiner Bracket, Broussard Bracket.
His increasing interest in dental occlusion and in the
treatment necessary to obtain normal occlusion led directly
to his development of orthodontics as a specialty, with
himself as the "father of modern orthodontics". The
development of Angle's classification of malocclusion in the
1890s was an important step in the development of
orthodontics because it not only subdivided major types of
malocclusion but also included the first clear and simple
definition of normal occlusion in the natural dentition. He was
concerned with the aesthetics of orthodontics as well as
functionality
The Angle Orthodontist (Links to an external site.),
founded in 1930, is the official publication of the Edward H.
Angle Society of Orthodontists. The Society of Orthodontists
later became American Society of Orthodontists. He also
founded the Angle School of Orthodontia (Links to an external
site.) in St. Louis and schools in other regions of the United
States.
Dr. Martin Dewey (1881–1933) was an American
orthodontist and a past president of the American
Association of Orthodontists (Links to an external site.) and
the American Dental Association (Links to an external site.).
Dewey represented the "New School" of Edward Angle (Links
to an external site.) in the great Extraction Debate of 1911
held in New York City. He was the founding editor of
International Journal of Orthodontia, later known
as American Journal of Orthodontics and Dentofacial
Orthopedics (Links to an external site.). He served as the
editor of the journal for 17 years and wrote many interesting
articles Before his death, Dr. Dewey began publishing a
journal called Orthodontic Review (Links to an external
site.) which was designed as an open forum journal to discuss
orthodontic related topics. The journal was however
discontinued later. He played an important part in opposing
the "Arizona Orthodontic Law''.
Dewey established Dewey School of Orthodontics at
the Dental School in Kansas City, Missouri. The first classes
were given in the summer of 1911 for a period of ten weeks.
The school was moved to Chicago (Links to an external
site.) in 1917 and then to New York City (Links to an external
site.) two years later. He served as faculty member at both
Chicago and New York dental schools.
Dewey stressed the importance of a blend of the
biologic and mechanical aspects of orthodontics.
Dewey's Modification (1915) he divided Angle's class I &
III into further types.
M1-Lesson 3 Brief History Part 2
 Norman William Kingsley attained skills in sculpturing
and was well known for his crafts in crafting dental
prosthesis. He published a report of the case, a child with a V-
shaped alveolar arch, in 1858 in the New York Dental
Journal (Links to an external site.). In 1859, Kingsley created
an artificial palate of soft vulcanized India rubber for his first
patient with a cleft palate. He eventually moved into teaching
and became the Founder of the New York College of
Dentistry, serving as its first dean from 1865 to 1869. Kingsley
was also known for his work related to the vulcanite palatal
plate which consisted of anterior incline which allowed a
person to bite forward with their lower jaw. His appliance
was later modified by Hotz and it was known as Vorbissplatte.
In 1880, he published, A Treatise on Oral Deformities
as a Branch of Mechanical Surgery, which was published in
New York and later in Germany and Britain. This was the
first comprehensive textbook that talked about orthodontic
problems and treatments. This textbook discussed the
etiology, diagnosis and treatment planning that should be the
foundations of practice of a working orthodontist. The
textbook was the first to discuss cleft palate treatment in
terms of orthodontics. He was also a prolific writer with over
100 articles on cleft lip and palate rehabilitation.
Contributions
• During 1860s, he introduced the concept of "jumping the
bite" with the use of bite plate.
• In 1879, he introduced occipital traction into the field of
orthodontics.
• In 1859, he perfected gold obturator and artificial vellum
of soft rubber.
• In 1858, he published the first paper on modern
orthodontics
Dr. Case was known to have ideas that were
opposite to Dr. Edward Angle (Links to an external site.).
Primarily, both these figures were divisive due to their views
on extraction of teeth vs non-extraction of teeth when
treating malocclusions in the speciality of Orthodontics. The
entire controversy between Angle and Case started when Dr.
Angle claimed that the use of Intermaxillary elastics (Links to
an external site.) were first used by Dr. Henry Albert
Baker (Links to an external site.), as opposed to first used by
Dr. Case. Calvin claimed that in 1890 he started using the
elastics first when he reported this use to Chicago Dental
Society (Links to an external site.) and Columbian Dental
Congress (Links to an external site.) in 1893.
Case was one of the first to stress the importance of
root movement(1892); he was one of the first to use rubber
elastics in treatment; he was one of the first to use small
gauge, light and resilient wires for tooth alignment. He
pioneered the use of retainers to stabilize orthodontic results.
M1-Lesson 3 Brief History Part 3
Albert Ketcham (August 3, 1870 – December 5, 1935)
was an American orthodontist and a past president of the
American Society of Orthodontists. The American Board of
Orthodontics (Links to an external site.) created the Albert H.
Ketcham Award to commemorate Ketcham's
achievements. This award is currently known has the highest
achievement award given in the field of Orthodontics.
 He investigated the problem of root resorption. His
study awakened a feeling of "biologic sense"; and existence
of pathologic results of improperly guided orthodontic
treatment.
Milo Hellman was an American orthodontist and an
instructor at Angle School of Orthodontia and Chair of NYU
Orthodontic Program. He is known for his contributions to the
field of Orthodontia via his research on the relationship
between teeth, jaws and face.
He was a student of Angle. He made the first
paleontologic analysis of Angle Classification of
Malocclusion. He pioneered the use of Hand and Wrist
radiograph to determine the growth age of the patient. In
1919, he demonstrated occlusal relationship of the upper and
lower molars and emphasizied on the evolutionary trend of
the cuspal interdigitation. He studied the development of the
human denture and face with precise anthropometric
techniques.
M1-Lesson 4 Correlation to other Dental Disciplines
A. Restorative Dentistry
Preventing the children from dental caries will decrease
future need for orthodontic treatment.
Restorative management of patients with teeth
following orthodontic treatment is often necessary.
Ideally, restorative treatment is done before start of
the orthodontic treatment. These are situations where the
buccal surface of the teeth is broken or fractured, so it needs
to be restored for proper bracket placement.
The primary goal of modern orthodontics is to establish
the best possible occlusal relationship between the maxillary
and mandibular arches while maintaining or enhancing facial
esthetics. In order to do this, the orthodontist will often have
to rely on restorative procedures to obtain the optimal
esthetic result
B. Esthetic Dentistry
Attractive people have a much better chance of being
successful. Failure to adhere to proper orthodontic
technique could have adverse consequences. Simple closure
of a maxillary midline diastema often creates spacing
distally, restorative dentistry may also be required to achieve
proper esthetics.
Patients presented significant differences in the esthetic
perception of midline diastema and gummy smile
anomalies after they had completed orthodontic treatment.
Gender influenced the perception of smile esthetics, whereby
women were significantly more critical of midline diastema,
black triangle and gingival margin of the upper central incisor
than men.
Dr. Ricketts was concerned that in the name
of occlusion and alignment, orthodontists were actually
making the esthetic appearance of some patients worse by
not paying attention to what he called the “Esthetic Plane” or
“E” plane. Fundamentally the “E” plane is simply a line drawn
from the tip of the nose to the tip of the chin.
C. Pediatric Dentistry
Children & Orthodontics malocclusions, or
misalignments of the teeth, can be recognized as early as 2 to
3 years of age. Often, early steps can be taken to reduce the
need for major orthodontic treatment at a later age. Pediatric
dentist can help identify these early signs of malocclusion
present in a child.
D. Periodontics Dentistry
While orthodontics can promote periodontal disease,
orthodontics also can help reduce the symptoms of
periodontal disease. Poor oral hygiene and abnormal occlusal
forces during orthodontic treatment could result in the fairly
rapid development of periodontal pockets.
Orthodontic therapy has lead to an improved periodontal
status by helping in easy removal of plaque and reducing the
occlusal trauma.
E. Oral Surgery
Patients who have jaw and facial deformities need
both oral surgery and orthodontic treatment. When
corrective jaw surgery is necessary, oral surgeons work
together with orthodontists to develop comprehensive
treatment plans.
F. Prosthodontic Dentistry
Some prosthodontic treatments are not possible or would
be severely compromised without
first doing orthodontic therapy.

M1-Lesson 5 Tissue Systems of Human Dental Occlusion
a. Teeth
Human teeth are divided into classes on the basis of
form and function. The primary and permanent dentitions
include the incisor, canine, and molar classes. The fourth
class, the premolar, is found only in the permanent dentition
(link (Links to an external site.)). Tooth form predicts the
function of teeth; class traits are the characteristics that place
teeth into functional categories. Because the diet of humans
consists of animal and plant foods, the human dentition is
called omnivorous.
Occlusion is very important to the actual dentistry in
terms of providing patients with a stable occlusion so they do
not have too much force on any particular teeth, which could
damage the teeth in the short or long term. It refers to the
position of your teeth when your jaw is closed, or
more simply, your bite. Unknown to many, the alignment of
your bite contributes greatly to your oral health, as well as
your overall wellbeing. For example, if undiagnosed and left
untreated, bite misalignments can induce a variety of issues,
including: Loosening of teeth.
b. Bone
Alveolar bone is that part of the maxilla (Links to an
external site.) and mandible (Links to an external site.) which
supports the teeth by forming the “other” attachment for
fibres of the periodontal ligament (Links to an external
site.) (Fig. 1.148). It consists of two plates of cortical
bone (Links to an external site.) separated by spongy
bone (Links to an external site.) (Fig. 1.149). In some areas,
the alveolar bone is thin with no spongy bone (Fig. 1.148).
The alveolar bone and the cortical plates are thickest in the
mandible. The spaces between the trabeculae (Links to an
external site.) of the spongy bone are filled with marrow,
which consists of haematopoietic tissue (Links to an external
site.) in early life and of fatty tissue later (Fig. 1.149). The
shape and structure of the trabeculae reflect the stress-
bearing requirements of the particular site. The surfaces of
the inorganic parts of the bone are lined by osteoblasts (Links
to an external site.), which are responsible for bone
formation (Links to an external site.): those which become
incorporated within the mineral tissue are
called osteocytes (Links to an external site.) and maintain
contact with each other via canaliculi; osteoclasts (Links to an
external site.) are responsible for bone resorption (Links to an
external site.) and may be seen in the Howship's lacunae (Fig.
1.150). Cortical bone adjacent to the ligament gives the
radiographic appearance of a dense white line next to the
dark line of the ligament (see Figs 1.144, 1.145). Bone is a
dynamic tissue, continually forming and resorbing in response
to functional requirements. In addition to such local response
to needs, bone metabolism (Links to an external site.) is
under hormonal control (Links to an external site.). It is easily
resorbed under the influence of inflammatory
mediators (Links to an external site.) at either the periapex or
the marginal attachment. In health, the crest of the alveolus
lies about 2 mm apical to the cemento–enamel
junction (Links to an external site.) (Fig. 1.151) but,
in periodontal disease (Links to an external site.), it may lie
much more towards the apex of the root.
(Links to an external site.)
c. Muscle
The four muscles of mastication are the temporalis,
masseter, medial pterygoid, and lateral pterygoid muscles.
These muscles receive motor innervation from the
mandibular nerve branches. The masseter muscle functions
to elevate and protract the mandible. The temporalis muscle
functions to elevate and retract the mandible. The medial
pterygoid functions to further assist the elevation and
protrusion of the mandible, but can also facilitate side-to-side
grinding. The temporalis, masseter, and medial pterygoid
muscles work synergistically to close the jaw vertically during
mastication. The lateral pterygoid muscle is thought to
control jaw movement, but there is a limited understanding
of its function. The lateral pterygoid has a superior head and
an inferior head that are thought to have different functions.
The inferior head of the lateral pterygoid muscle is thought to
play a role in the opening, protrusion, and contralateral
movements of the jaw. The superior head of the lateral
pterygoid muscle is thought to play a role in the closing,
retrusion, and ipsilateral movements of the jaw.[link] (Links to
an external site.)
Bite guards, dental splints, or occlusal splints are placed
on the maxillary or mandibular teeth in order to alter the
occlusion of the bite by virtue of jaw muscle
relaxation. Muscle and neurological pain in the head and
neck is the result of a dysfunctional occlusion. The link here
will help us understand
better https://www.dentaleconomics.com/science- M2-Lesson 3 Review of Prenatal Growth
tech/article/16390305/is-occlusion-important (Links to an
external site.) Three Stages of Development

d. Nerve 1. Period of Ovum - from fertilization to the end of 14th day

The dental occlusion mediates proprioceptor information 2. Period of Embryo - from14th day to 56th day
about the position and movement of the head and neck in
space via the trigeminal nerve. The trigeminal nerve is the 3. Period of Fetal - from 56th day to 270th day/birth
largest and most complex of the twelve cranial nerves. Here is an illustration for the review of development of the
Itsupplies sensations to the face, mucous membranes, and face
other structures of the head. Neuromuscular Dentistry is
based upon restoration of the dental occlusion to a position
along an isotonic condition (minimal energy required) to bring
the teeth into intercuspation (Myocentric). Myocentric is
defined by minimal muscle electrical activity of the
mandibular posturing muscles (Rest Position of the Mandible)

M2 - Introduction to Craniofacial Complex

A comprehensive knowledge in craniofacial growth and

development is essential for every dentist and orthodontist as
they are greatly involved in the development of not just the
dentition but the entire dentofacial complex. These
practitioners may be able to manipulate facial growth for the
benefit of the patient and it is not possible to do so without a
thorough understanding of both the pattern of normal
growth and the mechanisms that underlie it (Proffit).
Branchial Arches

• 1st branchial arch (Mandibular arch) – its cartilage is

M2-Lesson 1 Importance of Craniofacial Complex
Understanding the principles and complexity of craniofacial
growth is of paramount importance to orthodontists, since
timely recognition and intervention of an abnormal jaw
growth pattern by appropriate orthodontic appliances can
restore the normal occlusion and facial harmony using the
active growth period.
M2-Lesson 2 Difference between Growth and Development
Growth
known as the Meckel's cartilage. It gives rise to the
following structures: incus and malleus of the ear,
maxilla, mandible, muscles of mastication, body of the
tongue.
• 2nd branchial arch (Hyoid arch) – its cartilage is known as
the Reichert's cartilage. It gives rise to the following
structures: muscles of facial expression, base of the
tongue, lesser horns and upper part of the body of hyoid,
styloid process, stylohyoid ligament, stapes.
• 3rd, 4th, 6th branchial arches– they contribute to the
muscles and cartilages of the neck
• 5th branchial arch - is a transient structure

• “An increase in size or number.” - Profitt. (1986)

• Developmental increase in mass.’’- Stewart.(1982)
• “Increase in size, change in proportion, progressive
complexity” -Krogman
• “increase, expansion or extension of any given tissue.” -
Pinkham.(1994)

Development

• progress towards maturity (Todd)

• maturational process involving progressive

differentiation at the cellular and tissue levels” (Enlow)

 • hypopharyngeal eminence will form the mucosa of the
posterior 1/3 of the tongue
The PowerPoint Presentation below will explain the prenatal • structures that form the anterior 2/3 of the tongue will fuse
development of the perioral region, tongue, and palate. with the components that form the posterior 1/3
• line of fusion is indicated in the adult tongue by the V-
Introduction
shaped terminal sulcus
• A background on craniofacial growth and development is
• pit in the center of the terminal sulcus is called the foramen
necessary for
cecum, represents the origin of the thyroid gland, before it
every dentist
migrated inferiorly to take its final position in the neck
• It is important to distinguish normal variation from the
effects of abnormal
Development of the Palate
or pathologic processes
• palate is formed from a primary palate and a secondary
Development of the Perioral Region
palate
Schematic representation of the
• secondary palate is formed from 2 palatine shelves, which
contribution of the embryonic
are tissue extensions from the
facial processes to the structures
maxillary prominences
of the adult face
• 2 palatine shelves, fuse together to form the secondary
palate.
4th week
Olfactory placodes
• This transverse section shows the development of the
(dashed circles) are
palate from a primary palate
visible on the surface of
(formed by intermaxillary segment) and a secondary palate
the frontonasal
(formed from left & right
prominence, the tissue
palatine shelves that fuse together)
that envelopes the
• The incisive foramen represents the anatomic boundary
forebrain
between the primary palate and
secondary palate
6th week
• When the palatine shelves completely fuse, they also form
Growth centers that surround the nasal pits are termed the
the uvula
medial (mnp) and lateral (lnp) nasal prominences,
• If they don’t fuse? BIFID UVULA; CLEFT PALATE
premaxillary (premax) segment, two components of the
maxillary region (max and max′) and the mandibular (man)
portion of the first pharyngeal arch
M2-Lesson 4 Growth Of Craniofacial Skeleton
7th week Understanding the core concepts of growth
Stomodeum and development of the craniofacial skeleton and the impact
(primitive oral cavity of treatment on growth potential is vital to successful patient
management. The knowledge of growth and development of
craniofacial structures are necessary to attain a positive result
Development of the Tongue in orthodontic and orthopedic treatments as they are
• tongue begins its development during the 4th week specialization that works with the growth.
• forms on the floor of the pharynx from portions of the
arches 1,2,3,4, and the occipital somites (not
shown) Osteogenesis:
• first pharyngeal arch forms the median tongue bud, the Intramembranous bone formation
tuberculum impar and two lateral lingual Fontanelles of a newborn skullThe cranial vault is made up of
swellings a number of flat bones that
• as the two lateral lingual swellings expand, they completely are formed directly by intramembranous bone formation,
overgrow the median tongue bud without cartilaginous precursors
• these components will eventually form the mucosa of the
anterior 2/3 of the tongue As growth of surrounding soft tissues translates the maxilla
downward and forward, opening up space at its superior
• during the late 4th week, the 2nd arch forms an and posterior sutural attachments, new bone is added on
embryologic structure called copula both sides of the sutures by intramembranous ossification
• 3rd and 4th arches form a structure called the
hypopharyngeal (hypobranchial) eminence Osteogenesis: Endochondral bone formation
• during the 5th & 6th wks, the copula is overgrown by the From the Greek word, endon within and chondros meaning
hypopharyngeal eminence, copula eventually disappears cartilage
• Remember: Intramembranous and endochondral • The direction of movement is toward the wide end
ossification do not imply that there are two kinds of bone of the V
tissue (membrane bone and cartilage bone), they refer • Simultaneous growth movement and enlargement
merely to the environments in which bone of the same kind proceeds by additions of bone on the inside with
develops removal from the outside
.
Difference between Cartilage and Bone .
Image
Features Cartilage Bone Mechanisms of Bone Growth
Surface Soft, provide Rigid, hard,
characteristic flexibility to provides Mandible and palate
joints protection
Direction of Remodeling
growth Bidirectional Unidirectional Functions of remodeling:
.
Haversian .
system and Absent, non- Present, Mechanisms of Bone Growth
Volkmann’s calcified calcified
canals 1. Progressively create the changing size of each whole
bone
Bone marrow Absent Present 2. Sequentially relocate each of the component regions
of the whole bone to allow for overall enlargement
3. Progressively shape the bone to accommodate its
Cells Chondrocytes Osteocytes various functions
4. Provide progressive fine-tune fitting of all the
separate bones to each other and to their contiguous,
Blood supply Nonvascular Vascular growing, functioning soft tissues

Response to Pressure Pressure Growth Movements:

pressure tolerant sensitive
A. Deposition and Resorption
• Bone deposition (+) – part of the overall process of bone
enlargement; it is one
phase of a multi-phase growth system; bone addition
• Bone resorption (-) – must accompany deposition; bone
subtraction
. .
. Mechanisms of Bone Growth
Image
Mechanisms of Bone Growth
• as the mandible grows in
length, the ramus is extensively
modeled
• bone at the tip of the condylar
process at an early age can be
found at the anterior surface of
the ramus some years later
Enlow’s V-principle
• Based on the basic concept that many facial and
cranial bones have a V-shaped configuration in 3-
dimensions; facial growth process
• Bone deposition occurs on the inner side of the V;
resorption takes place on the outer surface
• The V moves from position A to B and, at the
same time, increases in overall dimensions
• Drift is movement towards depository surface
• Displacement is movement of the entire
bone as a whole unit
• Bone simultaneously remodels by resorption
and deposition (to an equivalent extent)
• As the bone enlarges, it is simultaneously
carried away from other bones in direct
articulation with it
.
Growth movements: drift and displacement
Mechanisms of Bone Growth
• As bone moves, there’s simultaneous
remodeling with deposition and resorption
• Remodeling of the palatal vault (which is
also the floor of the nose) moves it in the
same direction as it is being translated;
bone is removed from the floor of the nose
and added to the roof of the mouth.
• On the anterior surface, however, bone is
removed, partially canceling the forward
translation.
• As the vault moves downward, the same
process of bone remodeling also widens it.
M2-Lesson 5 Theories of Craniofacial Growth

Suture, cartilage and soft tissue are structures that will

influence growth and development of bone.

The following are the different theories of craniofacial

growth:

1. Genetic Theory

Sutures, cartilages and soft tissue are considered as growth

centers. These are bone forming elements and primarily
under the control of heredity.

2. Sutural Theory by Sicher

Sicher believed that craniofacial growth occurs at the

sutures. Paired parallel sutures that attach the facial areas to
the skull and the cranial base region push the nasomaxillary
complex downward and forward to pace its growth
with mandible

4. Functional Matrix Theory by Moss

Moss believed that bone growth within craniofacial

skeleton is influenced primarily by function. This theory was
developed complimentary to the original concept of
functional cranial component by Van der Klaauw. This theory
explained that as the soft tissues grow, both bone and
cartilage also grow in response to soft tissue growth.

3. Cartilaginous Theory by Scott

Scott believed that cartilaginous areas of skull are the

primary centers of growth. Sutures play little or no direct role
in the development of craniofacial skeleton. According to
him, the intrinsic controlling factors are present in the
cartilage
 M2-Lesson 7 Postnatal Development of Craniofacial Complex

A. Cranial Case

Growth of the cranial case/calvarium is linked to growth

of the brain. The cranial vault initially grows much more
rapidly than the facial bones in order to keep pace with the
developing brain, 90% of which is complete by 5 years of age.

Growth Site: Sutures

Increase in Width – coronal, lamdoidal, interparietal

sutures, parietosphenoidal,parietotemporal sutures

Increase in Height – temporal, occipital, sphenoidal

sutures

Increase in Length – coronal suture

5. Petrovic's Theory

This theory is about growth of bone as a response to a

feedback mechanism that occur as a result of bone growth of
adjacent bone structures.

B. Cranial Base

The cranial base is of crucial importance in integrated

craniofacial development. As distinct from facial bones, it is
formed through endochondral
Summary of Controlling Factors Of Craniofacial Growth ossification. Cranial base growth is due to
proliferation of cartilage and its replacement by bone,
1. Intrinsic genetic factors - genetic influences originating primarily at synchondrosis.
from the skull tissues. Example RNA, DNA
Growth Site: Synchondrosis
2. Local epigenetic factors - genetically determined
influences originating from adjacent structures. Example 1. Intersphenoidal synchondrosis – disappear at birth
brain, eyes
3. General epigenetic factors - genetically determined 2. Intraoccipital synchondrosis – disappear during 3-
influences originating from distant structures. Example 5yrs old
sex hormones
4. Local environmental factors - non - genetic influences 3. Spheno-occipital synchondrosis -disappear during
originating from external environments. Example muscle 20th yr
forces
4. Spheno-ethmoidal synchondrosis - disappear during 5-
5. General environmental factors - non - genetic influences
25yr
originating from external environment . Example food
and oxygen supply
 Scammon's Curve

Stages of maxillary growth

1. Sutural Growth. It continues till 10 years of age then

becomes less significant
2. Alveolar process development. It will add to the
height of the maxilla
3. Subperiosteal bone formation. Occurs throughout life
serves as a main factor for the growth of the maxilla.
4. Enlargement of the maxillary sinus
5 Bone resorption & bone deposition

Maxilla is joined to cranium by 4 sutures: frontomaxillary

suture, zygomaticomaxillary suture, zygomaticotemporal
suture, pterygopalatine suture
M2-Lesson 7 Postnatal Development of Craniofacial Complex
Part 2

C. Maxilla

Growth of the cranial base influences the growth of

maxilla. Position of maxilla is dependent on the growth of
sphenospheno-occipital synchondrosis. Growth of maxilla is
mainly intramembranous and similar to cranial vault. The
development/growth of maxilla is completed early when
compared to mandible. Maxilla (especially width) also follows
closely neural growth curve more than the general growth
curve in Scammon’s curve. Maxilla cannot be considered as a
separate bone, it has to be nasomaxillary complex because of
close association or attachment of maxilla to cranial base.

Maxilla is joined to cranial base by 2 synchondrosis

namely spheno-occipital synchondrosis and spheno-
ethmoidal synchondrosis

Increase in Height of maxilla is contributed by alveolar

bone, downward growth of orbital, nasal, palate (nasal
floor:resorption, inferior of palate:deposition), palate in
Expanding V
Increase in Width of maxilla is contributed by pterygoid
process, buccal segment, palate (Expanding V), sutures:
ethmoid, lacrimal, nasal, zygomatic:
Increase in Length of maxilla is through maxillary
tuberosity
D. Mandible
At birth, the two rami of mandible are quite short.
Condylar development is minimal and there is no articular
eminence in the glenoid fossa. A thin line of fibrocartilage and
connective tissue exists at midline of symphysis to separate
right and left mandibular bones. Between 4 months of age
and the end of first year, the symphysial cartilage is replaced
by bone. During the first year of life, appositional growth is
especially active at the alveolar border, at the distal and
superior surfaces of the ramus, at the condyle, along the
lower border of the mandible and on its lateral surfaces
Mandible is an “expanding V”. Additive growth at the
ends of this “V” naturally increase the distance between the
terminal points. Continued growth of alveolar bone with the
developing dentition increases the height of the mandibular.
Condylar cartilage of mandible serves as articular cartilage in
TMJ, characterized by a fibrocartilage which is a growth
cartilage analogous to epiphysial plate of a long bone. The
formation of bone within the condylar heads causes the
mandibular rami to grow upward and backward , displacing
the entire mandible in an opposite downward and forward
direction.
Mandible
1. Increase in Height:
- ramus, condyle, alveolar process
2. Increase in Width:
- Expanding V, posterior border of ramus
- apposition on all surfaces
3. Increase in Length or Depth:
- condyle, posterior border of ramus
 - lingual tuberosity
M2-Lesson 8 Dynamics of Facial Growth
The growth in each region of the face involves two basic
factors: (1) the amount of growth by any given part and (2)
the direction of growth by that part. The brain
establishes the various boundaries that determine the
amount of facial growth. This is because the floor of the
cranium is the template upon which the face is constructed.
A. Differential Growth
In the face, height or vertical growth shows the greatest
incremental change followed by depth or anteroposterior
length and width. The width of the face showed the least
change.
In the differential growth of the various parts of the face,
the height of the cranium and the width of the face are the
closest to adult size by birth. Then growth is generally
completed first in the head then width of the face and last in
length or depth of the face
B. Clinical Application
Growth factors are important to pedodontist and
orthodontist. Mandibular intercanine width is relatively
complete by nine to ten years of age in both boys and girls. In
the maxilla, intercanine width is complete by 12 years of age
in girls but continue to grow until 18 years of age for boys.
The final horizontal growth of the mandible of boys will lead
to a forward movement of mandibular base and the maxillary
intercanine dimension serves as a "safety valve" for this basal
discrepancy.
Most of the malocclusion cases confronting the
orthodontists involve disturbance of anteroposterior
relationship of jaw and teeth. The redirection of growth using
appliances offers the greatest hope to the orthodontist to
improve this type of malocclusion. The best time to influence
growth will be the period just before and during puberty.
Growth spurt is sex linked. The first growth spurt for both
boys and girls is age 3, second peak is from 6 to 7 years in girls
and 7 to 9 in boys. The third peak is 11 to 12 years in girls and
14 to 15 in boys.
M2 While Task-2
Biophysical Consideration in Orthodontics
• The dentition is in equilibrium even while teeth are
subjected to a variety of forces. They do not move to a
new location under normal circumstances like chewing,
swallowing, and speaking.
• When a tooth is subjected to a continuous force, it
moves, as the force applied altered the previous
equilibrium.
• These continuous forces that move teeth may be caused
by abnormal oral habits like thumb sucking, or by
orthodontic forces delivered by appliances, brackets and
wires.
• This module will deal with the biophysical considerations
in moving teeth using orthodontic appliances specifically
the wires.
Module 3
Biophysical Considerations in Orthodontics
Definition of Terms
The elastic behavior of any material is
defined in terms of its stress–strain response
to an external force (load).
Both stress and strain refer to the internal
state of the material being studied:
Stress – pressure when force acting upon an
object distorts or produces deformation; is the
internal distribution of the load, defined as
force per unit area
Strain - the internal distortion produced by
the load, defined as deflection per unit length
Definition of Terms
Stress may assume one of several forms
depending on the manner of force application:
Tension – tends to pull the molecules apart
Compression – tends to crowd molecules
together
Shear or torsion twisting – causes molecules
to slide over one another
Elasticity – mechanical property of solids which
appear rigid and unyielding that can be
deformed temporarily or permanently
Elastic Properties of Orthodontic Wires
• For analysis, orthodontic archwires and springs can be
considered as beams, supported either only on one
end (e.g., a spring projecting from a removable
appliance) or on both ends (the segment of an archwire
spanning between attachments on adjacent teeth)
• If a force is applied to such a beam, its response can
be measured as the deflection (bending or twisting)
produced by the force.
• Force and deflection are external measurements
• Stress and strain are internal measurements
• Internal stress and strain can be calculated from force
and deflection by considering the cross-sectional area
and length of the beam
Cantilever and supported beams
Source: Proffit, W.R et.al. (2019). Contemporary Orthodontics
(6th Ed). Philadelphia: Elsevier Inc
Elastic Properties of Orthodontic Wires
1. Stiffness (load deflection rate) – a means of resistance to
deformation; a measure of force required
to deform or bend a material to a definite distance; other
things being equal, a stiffer wire delivers
proportionally more force to a tooth
The mechanical property is described as:
2. Strength (maximum load) – a measure of maximum
possible load; it indicates the total capacity for
delivering forces. Measures in units of stress, megapascals
(Mpa), gm/cm2 and psi (1MPa=10,197
gm/cm2 = 145 psi)
The mechanical property is described as:
3. Range – (maximum deflection) – a measure of how far a
wire can be bent without permanent
deformation or breakage; it indicates how far a tooth can be
moved with a single adjustment
The mechanical property is described as proportional
to L
*Stiffness and strength are directly proportional to the width
in rectangular wires.
*Doubling the width will double the total capacity and the
force required for the same amount of
bending deflection. Source: Proffit, W.R et.al. (2019).
Contemporary Orthodontics (6th Ed). Philadelphia: Elsevier
Inc
Elastic Properties of Orthodontic Wires
• For orthodontic purposes, strength, stiffness, range can be
defined by appropriate reference to a
force (load)–deflection or stress–strain diagram:
• Stiffness: given by the slope of the linear portion of the
curve; the more vertical the slope, the stiffer the wire, the
more horizontal the slope, the more flexible the wire
• Range: distance along the x-axis to the point at which
permanent deformation occurs (yield point, at which 0.1%
permanent deformation has occurred); measured in mm
• Springback: occurs if the wire is deflected beyond the yield
point (as to the point indicated here as “arbitrary clinical
loading”), but it no longer returns to its original shape
• Failure point: the wire breaks
• Strength: measure of force a material can withstand before
it permanently deforms; Strength = stiffness x range
Typical force–deflection curve for an elastic
material: orthodontic archwire
Source: Proffit, W.R et.al. (2019). Contemporary Orthodontics
(6th Ed). Philadelphia: Elsevier Inc
Elastic Properties of Orthodontic Wires
• Three different points on a stress–strain diagram can be
taken as
representative of the strength of a material
• The first two points attempt to describe the elastic limit of
the material, the
point at which any permanent deformation is first observed.
• The most conservative measure is the proportional limit,
the highest
point where stress and strain still have a linear relationship
(this linear
relationship is known as Hooke’s law).
• Precisely determining this point can be difficult, so a more
practical
indicator is the yield strength—the intersection of the stress–
strain curve
with a parallel line offset at 0.1% strain.
• Typically, the true elastic limit lies between these two
points, but both
serve as good clinical estimates of how much force or
deflection a wire
can withstand before permanent deformation occurs.
• The maximum load the wire can sustain—the ultimate
tensile strength
—is reached after some permanent deformation and is
greater than the
yield strength.
• This ultimate strength determines the maximum force the
wire can deliver
if used as a spring, so it also is important clinically, especially
because
yield strength and ultimate strength differ much more for the
newer
titanium alloys than for steel wires.Elastic Properties of
Orthodontic Wires
• Three different points on a stress–strain diagram can be
taken as
representative of the strength of a material
• The first two points attempt to describe the elastic limit of
the material, the
point at which any permanent deformation is first observed.
• The most conservative measure is the proportional limit,
the highest
point where stress and strain still have a linear relationship
(this linear
relationship is known as Hooke’s law).
• Precisely determining this point can be difficult, so a more
practical
indicator is the yield strength—the intersection of the stress–
strain curve
with a parallel line offset at 0.1% strain.
• Typically, the true elastic limit lies between these two
points, but both
serve as good clinical estimates of how much force or
deflection a wire
can withstand before permanent deformation occurs.
• The maximum load the wire can sustain—the ultimate
tensile strength
—is reached after some permanent deformation and is
greater than the
yield strength.
• This ultimate strength determines the maximum force the
wire can deliver
if used as a spring, so it also is important clinically, especially
because
yield strength and ultimate strength differ much more for the loops into the archwire, as shown in
newer the lower arch here, to increase the
titanium alloys than for steel wires. length of the beam segments between
Effect of Wire Diameter or Cross-Section on Properties of adjacent teeth; or using multistranded
Wire or small-diameter steel wires, as
shown in the upper arch
• Each of the major elastic properties, strength, stiffness and Orthodontic Wires
range, is affected by the geometry of a wires
• Both the cross-section (rectangular, round, square) and the • Stainless Steel – has 18% chromium and 8% nickel. It is
length of the wire are of great significance in sometimes called 18-8
determining its properties stainless steel
• Changing the diameter (d) of a beam, no matter how it is • Cobalt – Chromium Alloys – marketed as Elgiloy by RMO.
supported, greatly affects its properties It can be heat-treated.
• As the figures below the drawing indicate, doubling the The softest Elgiloy when heat treated can become
diameter of a cantilever beam makes it 8 times as strong equivalent to a regular stainless
and 16 times as stiff and reduces the range by half steel
• More generally, when beams of any type made from two • Nickel – Titanium (NiTi) Alloys – marketed as Nitinol (Ni
sizes of wire are compared, strength changes as a cubic for nickel, Ti for titanium
function of the ratio of the two cross-sections; and NOL for Naval Ordnance Laboratory). It is well known for
• Springiness changes as the fourth power of the ratios; its shape memory and
• Range changes as a direct proportion (but the precise superelasticity
ratios are different from those for cantilever beams) • Beta – Titanium – marketed as TMA by Ormco / Sybron. The
Effect of Length on Properties of Wire acronym TMA stands
for Titanium Molybdenum Alloy. It is used for later stages of
• Changing either the length of a beam or the way in which it Edgewise treatmentOrthodontic Wires
is attached dramatically affects its properties
• Doubling the length of a cantilever beam cuts its strength in • Stainless Steel – has 18% chromium and 8% nickel. It is
half, reduces its stiffness by 8 times, and gives it 4 times the sometimes called 18-8
range stainless steel
• More generally, strength varies inversely with length, • Cobalt – Chromium Alloys – marketed as Elgiloy by RMO.
whereas stiffness varies as a cubic function of the length It can be heat-treated.
ratios and range as a The softest Elgiloy when heat treated can become
second power function equivalent to a regular stainless
• Supporting a beam on both ends makes it much stronger steel
but also much stiffer than supporting it on only one end • Nickel – Titanium (NiTi) Alloys – marketed as Nitinol (Ni
• Note that if a beam is rigidly attached on both ends, it is for nickel, Ti for titanium
twice as strong and 4 times as stiff as a beam of the same and NOL for Naval Ordnance Laboratory). It is well known for
material and length its shape memory and
that can slide over the abutments superelasticity
• For this reason, the elastic properties of an orthodontic • Beta – Titanium – marketed as TMA by Ormco / Sybron. The
archwire are affected by whether it is tied tightly or held acronym TMA stands
loosely in a bracket for Titanium Molybdenum Alloy. It is used for later stages of
Effects of Diameter and Length on Elastic Properties of Wires Edgewise treatment
Orthodontic Wires
• A removable appliance
incorporating a cantilever spring for • Useful archwire sizes in various materials
initial tipping of a maxillary canine (dimensions in mils)
toward a premolar extraction site. • 0.016 inch = 16 mil
• Note that a helix has been bent into
the base of the cantilever spring,
effectively increasing its length to
obtain more desirable mechanical
properties
Effects of Diameter and Length on Elastic Properties of Wires

• Improved springiness and range with

steel archwires can be obtained by
either of two strategies: bending

STRENGTH
 How easily a material will break and how much force it can
deliver
 The stonger the wire, the higher force it can deliver
 Related to 3 factors in the stress-strain curve
 Proportional limit: wire is purely elastic and will return back
to its original shape
 Yield strength: where measurable permanent deformation
starts
 Ultimate tensile strength: maximum amount of stress the
material can handle
 Failure point is when the wire breaks
STIFFNESS
 How flexible a wire is and how much force it
will deliver as it returns back to its original
shape
 Represented by the slope of the elastic
portion of the stress-strain curve
 Stiffness and springiness are indirectly
proportional to each other
 Distance the wire can deflect elastically before permanent
deformation occurs
 How far a wire can be deflected while maintaining its
elasticity (loading/activation)
 How far and by extension how long the wire can remain
active (unloading/deactivation)
 Strength = stiffness x range
springback
Wire is deflected beyond the yield point, but it no longer
returns to its original shape
Wire material size
 Stiffest to least strong: SS > TMA > NiTi
 Increasing the diameter: Increases
strength and decreases range
 Increasing the length: Increases range
and decreases strength and stiffness
 Rectangular wire is stronger and stiffer
than a round wire of the same dimension
M3 Introduction-2
Spot welding is the process of joining two pieces of
metals by means of heat generated by a blow of electric
current of a special equipment known as the spot welder. A
spot welder is a very useful equipment for fabricating
appliances like space maintainers, habit-breaking
appliances, minor tooth movement appliances, etc. Prior to
band formation, the tooth or teeth to be banded must be
separated from the tight contact with the adjacent tooth or
teeth. Molar bands may be fitted and fabricated directly in
the mouth of the patient or indirectly on stone models.
M3 Pre-Task
Tooth Separation
Tight interproximal contact of the posterior teeth
necessitates tooth separation prior to placement of the
molar bands. Tooth separation is made possible by inserting
a device to push the teeth apart long enough for the teeth
to be separated and create space wherein, bands are to be
fitted. There are several types of separators that can be
used, these are: separating springs, ligature wire or copper
wire, elastomeric separators (ring or doughnut), and the like
which can be left in place for several days to not more than
two weeks.
Separation is an orthodontic procedure which aims to slightly
loosen tight interproximal contacts between teeth to create
space for accurate fitting of the orthodontic bands. The
following are the step by step procedure.
1. Oral Examination
With the use of the mouth mirror and explorer, check for
tight contacts of the permanent upper or lower first
permanent molars.
2. Separation with an elastomeric separators (ring or
doughnut)
• Two loops of dental floss is placed on the ring to
stretched the separator.
• The floss is slipped through the interproximal contacts of
the molar and the separator is pulled below the contact.
• The dental floss is removed. Indication
• Teeth with tight contact
Contraindication
• Teeth with no adjacent tooth

Armamentarium
2 sets of Sterilized four basic instruments
Articulator with complete set of
permanent teeth (Typodont)
Disposable gloves
Patients’ disposable bib
Aligator clip
Enamel tray
Disposable tray cover
Cotton dispenser
Waist receiver
Alcohol
Dental floss
Step 2 Elastic separators
In the completion of the activity, elastic separators must be Laboratory uniform
placed into the tight contact of adjacent teeth with elastic
separators properly in placed as shown in the picture. Procedure
1. Oral Examination
With the use of the mouth mirror and explorer, check for
tight contact of the permanent upper or lower first
permanent
molars.

.
Image or icon
Procedure
2. Separation with elastomeric separators
2.1 Two loops of dental floss is placed on the
ring to stretched the separator.
2.2 The floss is slipped throughout the
interproximal contact of the molar and
the separator is pulled below contact.
2.3 The doughnut is pulled upward and
slipped into position
2.4 The dental floss is removed
2.5 Have it checked by the teacher •

Other Types Of Tooth

Separators

Molar Separation
Objectives
• Enumerate the materials used in molar separation
• Explain the step by step procedure in molar separation Separating spring Brass wire

.
 firing switch is pressed continuously
firing switch
on/off switch +
heat selector
Parts of a spot welder
4. turrets
upper turret
-has 3 copper electrodes and 1 carbon tip which
may be rotated into position for whatever tip is desired
lower turret
Elastic separators -has 4 copper electrodes, each is capable of being
rotated into position for use
-this turret is attached to the pressure pad (when
the pressure pad is depressed, the upper and lower
turrets are separated)
-note: it is important to keep the electrode tips
clean and not corroded to maintain the good working
condition and to expect an ideal result of the weld or
solder
lower turret
upper turret
electrode
Dumbbel separator Parts of a spot welder
5. pressure pad
-spring-loaded to give firm pressure between
the electrodes
-has a locking switch underneath
-current may be routed through the extension
cables if pressure pad is locked open
6. 2 extension cables
-usually attached on top or at the side of the
unit housing
-each of these cables has 2 reversible tips,
one is a notched brass tip and the other is a
brass alligator clip or tapped carbon tip
Image or iconMolar Separation Using Pliers
• The elastomeric ring is
placed over the beaks of the
pliers and stretched
• One side is snapped
through the contact area
• The pliers is slipped out so
that the doughnut or
separator surrounds the
contact area of the teeth.Image or icon
.

Parts of a
spot welder
1. unit housing (including the controls)
2. on/off switch + heat selector
-note: the thickness of the metal to be welded is directly
proportional to the setting of the rheostat
3. weld/solder firing switch
-for spot welding, press the firing switch
2-3 times
-for soldering, the heat selector switch is
moved to the soldering position (S) and the
 red polishing
stone bur
Spot welding procedure
1. Using your explorer, scrape off 0.5-1 mm
around the subgingival area of the molar to be
banded.
2. Wrap the molar band strip encircling the
molar then using your How pliers, then draw
the free ends of the band tightly to the middle
of the lingual surface.

Spot welding procedure

3. Still using your How pliers, pinch the excess
band material on the lingual as close as
possible to the surface of the molar. On the
opposite surface, adapt the band material
securely on the buccal groove using the
amalgam plugger.
The joint of the excess band material should be
kept vertical and parallel to the long axis of the
tooth.

Spot welding procedure

4. Very carefully remove the band from the
model cast and examine its contour. The
excess band material on the lingual should be
on the same level.
5. Now using the spot welder, weld the legs of
the band close to the joint at three individual
points. More than one weld secures a strong
weld. Don’t press the firing switch unless the
per
parts to be welded are touching each other in
Recognizing a good weld order to prevent a spark gap which can burn
A weld is considered a good one if the metal seems to these points
clump together with no burned area. This is achieved if the Spot welding procedure
following factors are considered: 6. Using a sharp pair of laboratory scissors, cut
off the excess leaving around 2 mm tab.
7. Fold the tab close to the band, press it using
the How pliers then weld the tab at another 2–3
points.
8. Smoothen or polish all sharp or rough
surfaces of the band using red stone. Spot welding procedure
Spot welding
6. Using a sharp pair of laboratory scissors, cut
ORTHODONTICS 1 LABORATORY
off the excess leaving around 2 mm tab.
MODULE 7
7. Fold the tab close to the band, press it using
LESSON 2
the How pliers then weld the tab at another 2–3
Materials for spot welding
points.
model cast
8. Smoothen or polish all sharp or rough
Roach carver
surfaces of the band using red stone.
molar band (0.005”X0.18”)
2 inches long
9. Seat the band back to the model cast and try to
How (110) plier
better the fit with the use of the amalgam plugger.
Bird Beak (139) plier
10. Remove the band again and crimp its occlusal
laboratory scissors
and gingival peripheries using the 139 pliers prior to
amalgam
cementation. Try your best to achieve close
plugger no. 3
proximity between the band and the tooth to assure
micromotor
good retention.
Note that retention is not dependent on the cement
for the thicker the cement layer between the tooth
and the band, the weaker its retention is
M3 Lesson 2 Types of Band Fabrication
The actual band fabrication is almost identical for the
direct and indirect techniques. The only difference being is
that in the indirect technique, bands are made on model
casts of the patient’s teeth. On the other hand, most of the
shaping of the band material in the direct technique is done
directly on the patient's oral cavity.
Nowadays, preformed bands are widely used.
Bands are
being shaped to approximate the anatomical contours of all
teeth. Conveniently, a wide range of sizes are readily
available in the market. In using preformed bands, it is
critical to select the proper size of band as you fit it either
on a cast or intraorally. There are permanent markings on
the mesial surface of preformed bands signifying the size
and quadrant. Trim and recontour if deemed necessary.
M4 Introduction-2
A study cast is a positive copy of the maxillary and
mandibular arches for the purpose of further study,
examination, treatment planning, and as a guide for further
comparison after a series of treatments.
Accurate trimming of orthodontic study models facilitates
proper diagnosis and treatment planning. Well-trimmed,
esthetically pleasing models reflect the practitioner’s
attention to detail and are a part of the patient’s legal
treatment record.
M4 Lesson 1 Definition/Uses/Parts
What is orthodontic study model
It is an essential diagnostic record which help
to study the occlusion and dentition from
all 3 dimensions. The models are used as pre-treatment
models, stage models and post treatment models.
Uses of Orthodontic Study Models
1. Represent the case prior to orthodontic treatment.
2. Aid the dentist in diagnosing and analyzing the case.
3. Permit inspection from perspectives that are impossible
to obtain when looking in the patient’s mouth.
4. Permit extended observations and comparisons far
beyond the patient’s endurance for holding his/her
mouth open and are available for study during patient’s
absence.
5. Be used in educating the patient about her/his case
(dental need and treatment plan).
6. Show the orthodontic treatment progress.
Parts of a Study Model Cast
The orthodontic study model cast is composed of two parts:
A) Art portion: The part that serves as the plaster base to
the anatomic portion.
B) Anatomic portion: The part which reproduces the dental
arch and its surrounding soft structures pdf file
M4 Lesson 2 Impression taking and Bite registration
MATERIALS
Orthodontic plaster
Plaster bowl and spatula
Base former
Carving knife
Fine sandpaper
Cast trimmer pencil &ruler
IMPORTANT CRITERIA WHEN TAKING IMPRESSION FOR A
STUDY MODEL
1. All details are reproduced, including the complete
peripheral turn and a portion of retromolar pads or
tuberosities.
2. Detail is sharp, not blurred or indistinct. 3. Fill the base formers with orthodontic plaster.
3. Free of voids in critical areas and free of large folds of
alginate. • Ensure a degree of centralization
4. No areas where alginate has pulled away from the tray. • Do not push the impression tray too deeply
5. Free of rips and tears except in interproximal areas. • Make sure the bottom of impression tray, the occlusal
6. Alginate thoroughly covers the tray, no tray visible surface of impression, and the bottom of the base
through alginate. former are all parallel
7. Free of bulges or depressions that indicate a subsurface
bubble.
4. Allow the time for orthodontic plaster to set.
8. Alginate is smooth, not sponge-like.
5. Once it sets, remove the tray and alginate carefully to avoid
fracture.
Characteristics of a good impression

1. NO BUBBLES OR VOIDS
2. ALL TEETH ARE WELL REPRODUCED STEPS IN TRIMMING PREPARATION
3. VESTIBULES ARE INCLUDED IN THE IMPRESSION 1. Remove all nodules and imperfections with sharp
4. NO DISTORTIONS OF THE SOFT TISSUE ANATOMY instrument.
2. Soak the models in water for 5-15 minutes. Use the gentle
trimmer and firm pressure.
BITE REGISTRATION

M4 Lesson 4 Trimming, Labeling, Polishing and Glazing

Articulating paper is used to check if the patient has After base-forming, the model casts are now to be prepared
balanced bite contacts on the left and right side. for trimming.
Always rehearse biting into maximum intercuspation with the Steps in trimming preparation
patient prior to expressing the bite registration material onto
the preparations. 1. Remove all nodules and imperfections with sharp
instrument.
Put the bite registration material onto the occlusal surfaces of
the teeth and have the patient bite, make sure that the 2. Soak the models in water for 5-15 minutes. Use the gentle
rehearsed bite is done correctly. trimmer and firm pressure.

Once the bite is set, try it back into the mouth to verify its fit.
M1 Lesson 4 Trimming, Labeling, Polishing and Glazing

TRIMMING TECHNIQUE
The easiest way to trim the registration is with a scalpel or A) Starting with upper model
carver. Trim away any area where the registration was in 1. Occlude upper model on rubber pad.
contact with soft tissue, or any excess material beyond the 2. Trim the base until case exhibit 1/3 art
occlusal surfaces. portion and 2/3 anatomic portion.
The trimmed bite registration should only cover the occlusal 3. Check the paralellism of the occlusal
or the incisal thirds of the teeth. plane by placing the teeth on the
horizontal surface and comparing the base
of cast to the horizontal surface.
STEPS IN POURING THE STUDY MODEL 4. Occlude the upper and lower models
with wax bite in place.
1. Mix the mixture of orthodontic plaster (50% stone; 50%
plaster of paris) 5. Check the relationship of the last
2. Pour the alginate impressions with orthodontic plaster. molars to each other. If the lower
molars extend significantly further
• Flow into the tooth portions from the palate in maxilla than the upper molar, mark a line
• Flow into the tooth position from the posterior aspect the distance of the extension to the
and around the arch in mandible 1 cm distance from the last molar of
the lower molar.

B) Upper model posterior side
1. Mark a light pencil line down the midline
suture of the model for reference.
2. Mark the line of posterior side
perpendicular to midline suture of the model.
3. Trim the posterior side following the line.
C) Upper model lateral sides
1. Mark the line of lateral sides at 60° from
posterior side at the right and left side of the
model.
2. The line should be 1 cm from buccal surfaces
of the teeth (the side should not be trimmed
beyond the depths of the buccal fold).
3. Trim the lateral sides following the line.
D) Upper model anterior sides
1. Mark the line of anterior sides at 30° from the
lateral sides to a point beginning at the midline and
ending at the cuspids-preserving the anterior buccal
fold.
2. The line must be equal on both sides of the cast.
3. Trim the anterior sides following the line.
E) Upper model heel sides
1. Mark the line of heel sides at
120° from posterior side.
2. The line must be equal on both sides
of the cast.
3. Trim the heel sides follow the line.
F) Establishing the base of mandibular cast
1. Occlude the mandibular cast with
the maxillary cast using the wax.
2. With the base against the grinding wheel,
cut the base of mandibular cast (parallel to
maxillary cast)
3. Trim the base until case exhibit the 1/3
art portion and 2/3 anatomic portion.
G) Lower model posterior sides
1. With the wax bite still in place, position the models
in a vertical position on the trimming table.
2. Place the base of maxillary cast on the trimming
table.
3. Trim until the posterior borders of mandibular cast.
4. Preserve the retromolar pad of mandibular cast
and tuberosity of maxillary cast.
F) Establish lower model heel sides and
lateral sides according to the upper cast
G) Lower model anterior side
1. With the occluded models, trim the anterior sides of
the model.
2. Maintained the same amount of anatomy extension
as on the upper model.
3. Both sides the same length and angulations of the
corners.
3. Take the mandibular cast, trim the anterior
region 3-3
cuspid to within 7 mm of the most
protruded anterior tooth or
from the mucobuccal fold, whichever most
labial.
5. Carefully, round off the anterior borders
of the cast. There
is no tool to assist you in rounding the
anterior border, you
must use your dexterity.
6. Lightly touch all trimmed surfaces of
both models on
the fine wheel until heavy scratches are
removed.
H) Model finishing and glazing
1. Sculpting and repairs can be done prior to
soaping and finishing the complete models.
2. With a lab knife or other suitable
instrument, even up irregularities of the
maxillary cast and lingual portion.
3. Remove the bubbles and other artifacts
with scale.
4. Make the depth of the vestibule visible.
5. Fill in and patch air bubbles in models
where needed any small holes while the
models are still wet with a thin mix of plaster.
6. Set models aside to dry.
7. After models have dried, using a wet-dry
grade of fine-grit sandpaper wet sand the
casts to remove the scratches left by
grinding wheel.
8. When sanding the posterior borders, the sides and the
heels of the models, it must be in centric occlusion and
the borders made smooth at the same time.
9. Allow models to thoroughly dry (at least 24 hours).
10. Soak 20 minutes in warm concentrated soap solution.
11. Permit models to dry and rub with chamois skin or
nylon until glossy.
STUDY CAST LABEL
I) Label the casts
• Label models with:
1. Patient’s Name
2. Age in YEARS.MONTHS (e.g. 30.8)
3. Gender
4. Date Taken
5. Clinician’s Name
Placed at the back of the maxillary and mandibular casts using
printable vinyl sticker paper
 CRANIAL VAULT
• Made up of a number of
flat
bones that are formed
directly
by intramembranous bone
formation, without
cartilaginous
precursors
• Apposition of new bone at
these
sutures is the major
mechanism
for growth of the cranial vault

• Although the majority of growth in the

cranial vault occurs at the sutures, there
is a tendency for bone to be removed
GROWTH OF THE CRANIOFACIAL COMPLEX from the inner surface of the cranial
vault, while at the same time, new bone
AREAS OF THE CRANIOFACIAL COMPLEX is added on the exterior surface.
• Cranial Vault • This remodeling of the inner and outer
• Cranial Base surfaces allows for changes in contour
Maxilla (Nasomaxillary Complex) during growth,
• Mandible Enter
Theories of Growth Control
• Sutural Dominance Theory (Sicher') CRANIAL BASE
Hypothesis)
• Cartilaginous Theory / Nasal Septum
Theory (Scott's Hypothesis)
• Functional Matrix Theory (Moss'
Mypothesis)
• Servosystem Theory (Petrovic')
Hypothesis)

1. The cranial vault, the bones that cover the upper and
outer surface of the brain
2. The cranial base, the bony floor under the brain, which
also is the dividing line between the cranium and the
face
3. The nasomaxillary complex, made up of the nose, • Formed initially as bands of cartilage
maxilla, and associated small bones called synchondroses and are later
4. The mandible transformed by endochondral
ossification to bone
- Growth centers of the cranial base:
 1. Spheno-occipital synchondrosis ● Interestingly, as the maxilla grows downward and
2. Intersphenoid synchondrosis forward, its front surface are remodeled, almost the
3. Spheno-ethmoidalsynchondrosis entire anterior surface of the maxilla is an area of
resorption, not apposition.
Page 2 ● The alveolar process is a resorptive area, so removal
of bone from the surface here tends to cancel some
MAXILLARY (NASOMAXILLARY COMPLEX) of the forward growth that otherwise would occur
● Develops postnatally entirely by intramembranous because of translation of the entire maxilla.
ossification
● Since there is no cartilage replacement growth
occurs in two ways:
1. By apposition of bone at the sutures that
connect the maxilla to the cranium and
cranial bone
2. By surface remodeling
● Growth through a considerable distance downward
and forward relative to the cranium and cranial bone
● This is accomplished in two ways:
1. By a push from behind created by cranial
base growth
- Since the maxilla is attached to the
anterior end of the cranial base,
lengthening of the cranial base
pushes it forward which is an
important part of its growth up
until about age of 6
2. By growth at the sutures ● Remodeling of the maxilla produces an additive
effect on the ROOF OF THE MOUTH
● This area is carried downward and forward along
with the rest of the maxilla, but at the same time,
bone is removed on the nasal side and added on the
oral side, thus creating an additional downward and
forward movement of the palate.

Part of the posterior border of the maxilla is a free surface in

the tuberosity region. Bone is added at this surface, creating
additional space into which the primary and then the
permanent molar teeth successively erupt.

● Gows via endochondral ad periosteal activity

● Grows via displacement created by the cranial base
growth
● Principal growth sites:
1. Posterior surface of the ramus
2. Condylar process
3. Coronoid process

PAGE 3 ORTHO
MANDIBLE
• Conceptually, it is correct to view the mandible as
being translated downward and forward, while at
the same time increasing in size by growing upward
and backward
• The translation occurs largely as the bone moves downward
and forward along with The soft tissues in which it is
embedded.
MANDIBLE
• In infancy the ramus is located at about the spot
where the primary first molar will erupt.
• Progressive posterior remodeling creates space for
the second primary molar and then for the
sequential eruption of the permanent molar teeth
M4 ORTHODONTIC STUDY CAST
• More often than not, however, this growth ceases
orthodontic study model cast is composed of two parts:
before enough space has been created for eruption
of the third permanent molar, which becomes
impacted in the ramus.
THEORIES OF THE GROWTH CONTROL
• SUTURAL DOMINANCE THEORY (Sicher’s Hypothesis)
- Sutures caused most of the growth
- Proliferation of connective tissue between 2 bones
causes bones to separate, hence the need to create
more bone
• Cartilaginous Theory / Nasal Septum Theory ( Scott’s
Hypothesis )
- Cartilage plays a dominant role in facial growth.
- Sutural growth is only a response to the growth of
the cartilaginous tissue
- Scott stated that the cartilage of the nasal septum
plays a major role in the pacing of the growth of the
maxilla
• Functional Matrix theory (Moss’ Hypothesis)
- Bone and Cartilage lack growth determination and
only grow in response to the growth of other tissues
associated with it, which is called as the "functional
matrix"
• Genetic character of bone is found not in bone but in
the "functional matrix”
• Skeletal tissues only grow in response to the function of
the soft tissue matrix.
A) Art portion: The part that serves as the plaster base
to the anatomic portion.
B) Anatomic portion: The part which reproduces the
dental arch and its surrounding soft structures
Impression taking
• Details of the dentition and soft
tissue structures are completely
reproduced
• Free of voids/bulges
Bite registration
• Rubber impression material
• Bite wax
- To record the patient's bite in
passive centric occlusion
CHARACTERISTICS OF A GOOD IMPRESSION
Pouring
• Orthodontic plaster
Base-forming
• Orthodontic base formers
These are measurement guides that may vary depending on
the vertical dimensions
I) Label the casts
• Label models with:
1. Patient's Name
2. Age in YEARS.MONTHS (e.g. 30.8)
3. Gender
4. Date Taken
5. Clinician's Name
Danielle O. Lim
Danielle O. Lim 21.2/F
March 19, 2013 Dr. Christine S. Chny
Placed at the back of the maxillary and mandibular casts
using printable vinyl sticker paper
FINISHING AND GLAZING
• After models have dried, using a wet-dry grade of fine-grit
sandpaper wet sand the casts to remove the scratches left
by grinding wheel.
• When sanding the posterior borders, the sides and the
heels of the models, it must be in centric occlusion and the
borders made smooth at the same time.
• Allow models to thoroughly dry (at least 24 hours).
• Soak 20 minutes in warm concentrated soap solution.
• Permit models to dry and rub with chamois skin or nylon
until glossy
 Neonatal Jaw Relationship
• No teeth, therefore no bite
• Neonatal jaw relationship can not be used as
diagnostic criterion for prediction of occlusion
• Mouth of the neonate however is provided
with a rich sensory guidance system that allow
vital neuromuscular functions such as:
suckling
swallowing
respiration
coughing
yawning
mastication
speech

Swallowing in utero
• Observed in utero in the last few
months of fetal life.
• It is believed that this plays an
important role in the activation of
the immune system of the infant
• It is also believed that the intake of
amniotic fluid helps with the
development of the GIT.
LIST OF MATERIALS
Suckling and Swallowing
• After respiration is established, the infant
needs to physiologically obtain milk
• To obtain milk, the infant does not suck it from
the mother's breast (it can not do so
physiologically as the tongue occupies the
M6: Wire bending entire oral cavity) rather it suckles
- 139 Plier (Bird beak plier) • Suckling and Infantile swallowing disappear
- 110 Plier (Howe plier) during the first year of life as milk is replaced
- Wire cutter
by solid food.
- Permanent marker – fine point
- Ruler - transparent
Page 2 - Feb. 22
- 0.030" SS wires (2 pcs)
- 0.028" SS wires (4 pcs)
● Suckling - consists of small nibbling movements of
PART 1 the lips, a reflex action in infants that stimulates the
MOUTH OF THE NEONATE smooth muscles causing them to contract to squirt
• Gum Pads milk into the mouth.
• At birth, the alveolar process are covered by gum ● Swallowing (infantile swallowing) - the tongue is
pads placed anteriorly where it contracts the lower lip to
ensure that the tongue receives the milk. The tongue
• These are segmented to indicate the sites of the grooves to allow the milk to flow posteriorly into the
developing teeth, pharynx and esophagus.
• Gums are firm (like that of an edentulous adult) ● Terms:
• Basic arch form is determined - Natal teeth - teeth present at birth
- Neonatal teeth - teeth erupt during the first
Prenatally
month
 - Pre-erupted teeth - teeth erupt during the uter uter 2
o o yr.
2nd to 3rd months 2nd 19 18 11 10 29 27 3 3 yr.
mola wk. wk. mo. mo. mo mo. yr.
r in in .
uter uter
o o
Baby teeth
eruption
Tooth Max. Mand.
Central 10mo. 8mo.
Lateral 11 mo. 13 mo.
Canine 19 mo. 20 mo.
PRIMARY TEETH and OCCLUSION 1st molar 16 mo. 16 mo.
2nd molar 29 mo. 27 mo.

Calcification of the Primary Dentition

Normal sequence of primary tooth eruption (short-cut)
● Hardening of mineralization of tooth matrices

Primary tooth Onset of

ossification (IU,
weeks)

Central 14

Lateral 16

Canine 17

1st Molar 15% Development of the primary occlusion

2nd Molar 18 (mandi), 19 Neuromuscular consideration

(max)
ERUPTION
● The movement of teeth toward occlusion
● Variable, nut does not begin until root
formation has begun
● Precise arrival of teeth is not significant
unless it deviates greatly from the average.
- As the teeth touch starting from the incisors, the muscles
learn to effect the necessary functional occlusal
movements
- Lesser variation in occlusal movements is seen in primary
dentition that permanent dentition since the primary
occlusion is being established during periods of ready
developmental adaptation
- Teeth are guided to their occlusal position by the functional
matrix of muscles during very active growth of the facial
skeleton

Primary dental arches

- Ovoid and display less variability in confrontation than the
permanent arch
- Generalized anterior interdental spacing is observed
- Primate space- a large space found mesial to the upper
Chronology of tooth development, primary dentition canine and distal the lower canine
Calcification Crown eruption Root
begins completed completed - Maxillary:1.5mm
Toot Max Man Max. Man ma man Ma man - Mandbular:2.5mm
h . d. d. x d x d
Centr 14w 14w 1 2 10 8mo 1 1½ Development of the Primary Dental Arch
al k. in k. in 1/2m 1/2m mo . ½ yr.
uter uter o. o. . yr.
o o • Tongue plays an important role, in the
Later 16w 16w 2 3 11 13 2 1
al k. in k. in 1/2m mo. mo mo. yr. 1/2 shaping of the dental arch, because the arch
uter uter o. . yr.
o o
follows the position of the tongue.
Cani 17w 17w 9 9 19 20m 3 3 • Role of the tongue diminishes when the
ne k. in k. in mo. mo. mo o. 1/ 1/4
uter uter . 2 yr. occlusal reflex, mature activity of the lips
o o yr.
1st 15w 15w 6 5 1/2 16 16 2 2 and cessation of nursing occurs.
mola k. in k. in mo. mo. mo mo. 1/ 1/4
r . yr.
 • Anterio-posterior changes to the dental • The mesiolingual cusp of the maxillary
arch are minimal though changes in the molars occludes in the central fossae of the
maxilla is greater than that of the mandible mandibular molars
• Posterior width increases markedly than
that of the anterior width
• Palatal vault width increases from birth to 12
months and remains constant throughout the first

2 years

Occlusal Relations
• When the gum pads are in contact, the
mandibular arch is posterior to the • The mandibular second primary molar usually is
maxillary somewhat wider mesiodistally than the maxillary
• It is only upon the eruption of the primary giving rise to a the usual flush terminal plane.
molar that occlusion is established.
• The incisors are vertical with minimal
overjet and overbite.
• The primary posterior teeth occlude so that
the mandibular cusp articulates just ahead
of its corresponding maxillary cusp

• Interproximal caries, sucking, skeletal pattern,

tooth wear, etc. may cause the presence of a step
rather than a flush.

- Minimal growth differential
- forward growth of mandible
- shift of teeth
Normal Signs of Primary Dentition
1. Ovoid arch
2. Spaced anteriors
3. Presence of Primate space
4. Vertical inclination of the anteriors
5. Shallow overjet and overbite
6. Straight/flush terminal plane
M3-Lesson 1 Normal versus Ideal Occlusion
NORMAL vs IDEAL OCCLUSION
Normal occlusion was first described by Edward Angle in
1899. Lawrence Andrews in 1972, mentioned about the
six keys to normal occlusion. Then Roth in 1981 added
some characteristics of normal occlusion like exclusion
of posterior teeth during protrusion, inclusion of canine
teeth only during lateral excursion of the mandible etc.
On the other hand, ideal occlusion is a hypothetical goal.
It is the perfect occlusion which can never be found in
nature.
NORMAL VS IDEAL
OCCLUSION
CONCEPTS OF NORMALITY
• concept of normality must not be equated with with the
ideal
• normality should be thought of as central tendency for
the group
• to use normal values for a group as the best goal of
treatment for an individual is not only illogical, it may
indeed be harmful
NORMAL OCCLUSION
• 28 teeth in proper arrangement and in balance
with all environmental and functional forces
•time-linked nature of normalcy
IDEAL OCCLUSION
• perfect interdigitation
• admirable goal
• therapeutic impossibility
M3-Lesson 2 Development of Concept of Occlusion
DEVELOPMENT OF CONCEPT OF OCCLUSION
The development of concept of occlusion can be divided
into three periods, namely fictional, hypothetical and
factual. During the fictional period, the observations
were sporadic and only interrelated by chance. In the
hypothetical period, there was a provisional acceptance
of certain logical entities which sort of filled in the gaps
for a tentatively complete picture. It was during the
factual period that paved the way from static to dynamic
concept of occlusion.
M3-Lesson 3 Development of Dental Occlusion Part 1
Primary dentition is the guide for permanent
dentition. It is kept healthy till the time of exfoliation and
it is to be replaced later by their permanent counterparts.
A. Mouth of the Neonate
1. alveolar processes are covered by segmented
gum pads, indicating
developing teeth
 2. horse shoe shaped maxillary arch, gum pads
extend labially and bucally

beyond those in mandibular arch

3. mandibular arch is posterior to maxillary arch

when gum pads contact

4. Gum pads are separated in the anterior region,

whereas in the back,

they touched.

5. jaw relationship is not yet established

B. Primary Dentition

1. Calcification
Spacing seen mesial to maxillary canines and distal to
Central Incisor = 14 weeks the mandibular canines are wider than in other spaces
First Molar = 15 weeks The physiologic spaces are called PRIMATE SPACES
Lateral incisor = 16 weeks or SIMIAN SPACES
They help in placement of canine cusp of the opposing
Canine = 17 weeks arch
this space is use for EARLY MESIAL SHIFT
Second Molar = 18 weeks

Eruption

- it is movement of tooth toward occlusion;

- eruption starts when root formation has begun

- timing of eruption is hereditary

- associated by height rather than weight

AB D C E

8---- 12----- 16-- - -20---- 24--- 28 MONTHS

A B D C E

2. Neuromuscular Considerations

- teeth are guided by functional matrix of Three types of terminal planes

muscle

3. Normal Signs of Primary Dentition

a. ovoid arch form

b. with interdental spaces

c. with primate spaces

d. shallow overjet and overbite

e. almost vertical inclination of incisors

f. straight/flush Terminal Plane - due to wider

lower primary second molar

g. Class 1 molar and cuspid relationship

Mixed Dentition Period
MIXED DENTITION PERIOD between primary and
• Both primary and permanent teeth permanent incisors.
are in the mouth together
• Critical period of tooth exchange
INCISOR LIABILITY
STAGES Three sources of space
1.Early Mixed Dentition Period 1. Increased intercanine width
6-8 years old
Upper and lower 1st molars, central and lateral
incisors
2. Middle Dentition Period
8-10 years old
Upper and Lower 1st premolars, lower canines

3. Late Mixed Dentition Period

10-12 years old 2. Interdental spacing
2nd premolars, 2nd molars and upper canines

STAGES OF TOOTH DEVELOPMENT

Nolla arbitrarily divided the
development of each tooth
into ten stages.
Important stages to
remember are stage 2
(initial calcification), stage 3. Labial eruption of incisor
6 (crown completed/time
teeth begin to erupt), and
stage 8 (2/3 root
completed/eruption).
Girls are more advanced
in calcification.

UGLY DUCKLING STAGE

• It is the period from eruption of the lateral
incisors to the eruption of the canine.
• Space may develop between maxillary
central incisors.
• Maxillary lateral crowns flare laterally. EEWAY SPACE
• Space difference between the
UGLY DUCKLING PATTERN combined mesio-distal crown
• The crowns of the cuspid impinge on the dimensions of the unerupted
roots of the developing lateral incisors 3,4,5 and C, D, E
• Moving the roots medially causing the COMPARATIVE TOOTH SIZE DIMENSIONS
crowns to flare laterally OF PRIMARY VS. PERMANENT TEETH
• The roots of the central incisors are Early Mesial Shift
forced toward each other
• As the laterals erupt further, the narrow
portion of the roots are in proximity to
the developing canines

• With the further migration of the canine

occlusally, its influence in the laterals shift
incisally
• The laterals crowns are moved medially Late Mesial Shift
• Effecting closure of the space between the
central incisors.

COMPARATIVE TOOTH SIZE DIMENSIONS

OF PRIMARY VS. PERMANENT TEETH
Incisor Liability
Discrepancy in size
 FAVORABLE SEQUENCE OF ERUPTION
FOR PERMANENT DENTITION
CENTRO ESCOLAR UNIVERSITY
• 6-1-2-4-5-3-7 for maxillary arch
• 6-1-2-3-4-5-7 for mandibular arch

OCCLUSAL STAGES OF ERUPTION

CHANGES IN THE
MIXED 1. Pre-eruptive stage
DENTITION 2. Intra-alveolar stage
3. Intra-oral stage
4. Occlusal stage

DEVELOPMENTAL PROCESSES DURING ERUPTION

• elongation of the permanent root
• resorption of the primary predecessor
• movement of the permanent tooth occlusally
• growth of alveolar process

ARCH DIMENSIONS
CENTRO ESCOLAR UNIVERSITY
• Intercanine Width – from cusp tip of canine to the cusp
MOLAR RELATIONSHIP OF PRIMARY tip of the other canine across the arch
SECOND MOLAR • Arch Width – from central fossa of first permanent
• Flush terminal plane: The distal surfaces of maxillary molar to the central fossa of the other first permanent
and molar across the arch
mandibular primary second molars lie in the same • Arch Length – measured at the midline from a point
vertical plane. midway between the central incisors to a tangent
• Distal step: The distal surface of the mandibular touching the distal surfaces of second primary molars or
primary second second premolars
molar is distal to that of the maxillary primary second • Intercanine Perimeter – from mesial of canine to the
molar. mesial of the other canine, over the incisal edges
• Mesial step: The distal surface of the mandibular following the contour of the arch
primary • Arch Perimeter – from mesial of first permanent molar
second molar is mesial to that of the maxillary primary around the arch over the contact points and incisal
second edges in a smooth curve to the mesial of the first
molar. permanent molar on the opposite side

PHYSIOLOGIC RAISING OF THE BITE

CENTRO ESCOLAR UNIVERSITY
• Eruption of first permanent molars at 6
M3-Lesson 3 Part III • Eruption of second permanent molars at 12
• Eruption of the third molars at 18
PERMANENT DENTITION

The permanent dentition replaces the primary dentition

in a person from 6-13 years of age. By then, there are 28 SIX KEYS TO NORMAL OCCLUSION
permanent teeth present in the oral cavity. Coming from CENTRO ESCOLAR UNIVERSITY
the transitional period, when one is in the permanent • molar relationship
dentition, all changes in the mixed dentition should have
been accomplished favorably. The permanent molars • crown angulation (tip)
must have attained a Class I molar relationship as a • crown inclination (torque)
result of late mesial shift after the loss of primary second
molar, greater forward growth of mandible than maxilla • absence of rotations
or combination of both.
• tight contacts
 Reflexes are involuntary movements or actions.
• flat occlusal plane Some movements are spontaneous and occur as
part of the baby's normal activity while others are
M4-Lesson 1 Classes of Neuromuscular Activities responses to certain actions. Willful acts under
cortical control such as crawling, walking and the
like, are categorized as voluntary actions.
Unconditioned reflexes are present at birth. A good
example is crying. As soon as the baby is born,
he/she already knows how to cry though it was not M4Lesson 2 Development of Oropharyngeal Functions
taught by the mother. Unconditioned reflexes are
part of the prenatal neuromuscular maturation. While Prenatal Stage
the fetus is still inside the mother’s womb, these • 16 week – respiration
reflexes are already present because it’s the way of
the infant to communicate. Furthermore, • 18 ½ week – gag reflex
unconditioned reflexes are automatic, instinctive, • 32 week – fetal suckling and swallowing
and unlearned reaction to a stimulus. Neonatal Stage
• mouth as sensory instrument
Because of limited and underdeveloped • infantile suckling and swallowing
neuromuscular capabilities, an infant’s cry could • maintenance of airway
mean a lot of things: the infant could be hungry, full,
wants to pee or poop, etc. Adults would have to take • infant crying
hints from a simple cry. Prenatal neuromuscular • gagging
maturation, therefore, is important because it is a
Postnatal Stage
means for the neonate to survive. Other examples
include respiration, gagging, vomiting, coughing, • mastication
infantile suckling and swallowing, tongue posture, • mature swallow
and maintenance of mandible.
• facial expression
• speech: voice, language, rhythm, articulation

Conditioned reflexes, on the other hand, appears with

normal growth and development. Meaning, they are Comparison between Infantile and Mature Swallow:
not present as soon as the baby’s born but develops
with age. These are learned activities and behaviors
that children could be trained for or accustomed to. Infantile swallow Mature swallow
Condition reflexes include even the unwanted "bad
habits" like thumb sucking, tongue thrusting, etc.
Jaws are apart Teeth are together

Tongue is between Tip of the tongue is against

the gum pads the palate, behind the incisors

Mandible is
When a child is 6-8 months old, the pediatrician may stabilized by the Mandible is stabilized by the
advise for the child to be fed with semi-solid food contraction of the contraction of the muscles
already. Even later at 1-year old, solid food may be muscles supplied
allowed. As the infant matures, there is increasing supplied by the 5th cranial nerve
by 7th cranial nerve
activation of the elevator muscles of the mandible
whenever the child swallows. As semisolid and
eventually solid foods are added to the diet, it is Active lip
Minimal lip contraction
necessary for the child to use the tongue in a more contraction
complex way to gather up a bolus, position it along
the middle of the tongue, and transport it posteriorly
for deglutition. Development of oropharyngeal functions

Prenatal oropharyngeal functions

14 weeks
-lip stimulates the tongue to move
18 ½ weeks
-gag reflex (the fetus already knows how to
swallow, as in drinking the amniotic fluid)
25 weeks
-respiration
29 weeks
-suckling
32 weeks
-more developed suckling and swallowing
Neonatal oropharyngeal functions
Maintenance of airway
-at birth, if the newborn infant is to survive, an airway
must be established within a few minutes and must be
maintained thereafter to open the airway, the mandible
must be positioned downward and the tongue moved
downward and forward away from the posterior
pharyngeal wall
-this allows air to be moved through the nose and
across the pharynx into the lungs.
Neonatal oropharyngeal functions
Infant cry
-crying of infants as a response to an
internal or external stimulus.
-infants cry as a form of basic instinctive
communication
Gagging
-nature's way of protecting the baby's
airway and a normal response to new tastes,
temperatures, or textures
Neonatal oropharyngeal functions
Suckling
-newborns feed by suckling, consisting of
small nibbling movements of the lips, a reflex
action in infants The infant will just nibble the
nipples
What will happen to the nipples?
-become hard because there is presence
of smooth muscle
-in the areola, there is smooth muscle and
when smooth muscle becomes hard, milk
comes out
Neonatal oropharyngeal functions
Suckling
-when the milk is squirted into the mouth, it
is only necessary for the infant to groove the
tongue and allow the milk to flow posteriorly
into the pharynx and esophagus
-the tongue, however, must be placed
anteriorly in contact with the lower lip so that
milk is in fact deposited on the tongue
-this tongue-to-lower lip apposition is so
common in infants that this posture is usually
adopted at rest
Neonatal oropharyngeal functions
Sucking
-effort is exerted
-infant needs to use its lips, tongue, and
cheeks because the child now has to create a
partial vacuum in order to forcefully get the
milk
In bottle feeding:
-no suckling because no smooth muscle
Neonatal oropharyngeal functions
Digit sucking
-habitual, non-nutritive sucking
-sucking a thumb, finger, or a similarly
shaped object
-vast majority of infants do so during the
period from 6 months to 2 years or later
-children allowed ready access to the
mother's breast for rarely suck any other
object
Postnatal oropharyngeal functions
Acquisition of speech
1. bilabial sounds /m/, /p/, and /b/
-first speech sound which is why an infant's first word is
likely to be “mama” or “papa”
2. tongue tip consonants like /t/ and /d/
-appears somewhat later
3. sibilant /s/ and /z/ sounds
-require the tongue tip be placed close to but not against
the palate, come later still
4. /r/
-last speech sound which requires precise positioning of
the posterior tongue, often is
not acquired until age 4 or 5Postnatal oropharyngeal
functions
Acquisition of speech
1. bilabial sounds /m/, /p/, and /b/
-first speech sound which is why an infant's first word is
likely to be “mama” or “papa”
2. tongue tip consonants like /t/ and /d/
-appears somewhat later
3. sibilant /s/ and /z/ sounds
-require the tongue tip be placed close to but not against
the palate, come later still
4. /r/
-last speech sound which requires precise positioning of
the posterior tongue, often is
not acquired until age 4 or 5
Postnatal oropharyngeal functions
Transition from infantile to adult swallowing
-when sucking activity stops, a continued transition in the
pattern of swallow leads to
acquisition of an adult pattern
-lips relaxed, tongue tip against the alveolar process
behind the upper incisors, and
the posterior teeth brought into occlusion during
swallowing
-as long as sucking habits persist, however, there will
not be a total transition to the
adult swallow
Postnatal oropharyngeal functions
Transition from infantile to adult swallowing
Infantile swallowing Adult swallowin
Jaws are apart Teeth are together
Tongue is between the Dorsum of tongue
gum pads touches the palate;
Tip of the tongue is
 against the palate By classifying, it is easier to discuss with a fellow
behind the incisors dentist your cases if ever you need to refer the
Mandible is stabilized by Mandible is stabilized by patient for other dental treatment. It also aids in self-
the the communication by giving you the idea on how to
contraction of the contraction of the handle the case with different strategies and if there
muscles of the CN7 muscles of the CN5 are appliances necessary in the treatment.
Active lip contraction Minimal lip contraction
M5 Lesson 2 Angle's Classification of Malocclusion

Occlusion is defined as the way the teeth meet when the

mandible and maxilla come together. It is how the teeth
contact in any type of functional relationship. Normal
occlusion is desirable as it allows oral functions to
operate properly, provides the best esthetics and is
helpful in the prevention of disease.
M5 Lesson 1 Purposes of Classifying Malocclusion Anytime normal occlusion does not occur in the mouth, it
is termed malocclusion. Malocclusion can have an effect
on dental diseases, chewing, speech and esthetics
You may be wondering, why is there a need (especially facial profile) and other functions of the oral
to classify malocclusion when we can easily see it cavity. Malocclusion can occur for a variety of reasons.
through oral examination on the patient? According These include, but are not limited to, heredity, trauma,
to Strang, classification is a process to analyze diseases, and habits (such as thumb sucking).
cases of malocclusion for the purpose of
segregating them into a small number of groups, Occlusion is designated according to certain
which are characterized by certain specific and classifications. The figure below shows the relationship
fundamental variations from the normal occlusion of of the teeth and the variations of the malocclusion
teeth. Thus classifying malocclusion gives us the classifications. It is based on how the maxillary and
following purposes: mandibular first molars come into contact with one
another when closing the teeth.
1. FOR TRADITIONAL REASONS
Historically, classifying a case of malocclusion will The common system used to classify occlusion is
give you the concept of how does one malocclusion termed Angle’s classification system. Class I is
appear or look like. According to Strang, classifying considered normal occlusion. Class II and III are
the malocclusion of teeth becomes influential and a considered malocclusion and have different divisions.
deciding factor for the correct treatment plan. But
bear in mind that not all cases are and should be
treated the same way all the time. This is where our
next purpose will come in.
2. FOR EASE OF REFERENCE
As said in the first purpose, we already have an idea
of how the malocclusion looks like and not all cases
in the same classification looks the same and is
treated the same way. For example, an Angles Class
II Division 1 may appear different depending on the
case. Some cases also present different problem list
not present in the same classification. This is where
the other necessary details or references can be
filled in to the case which will aid to our next
purpose.
3. FOR PURPOSE OF COMPARISON
M5 Lesson 3 Systems of Classification of Malocclusion-2
Now that you know the classification and the
presence of other problems in the malocclusion of
the patient. You now have the idea on how you will
treat the patient by being able to compare it to the
cases you may have already handled. You will also
be able to foresee the problems that you may
encounter during the treatment hence, making you
able to prepare on the case.
4. FOR EASE OF COMMUNICATION

Whenever we examine a patient we
subconsciously classify them in many different
ways. For example, an eight year old boy does not
have a permanent central incisors. In that sentence,
we classified the patient in to three standard; age,
sex, and the time of eruption. However, this does will
not tell you the treatment plan and the prognosis yet.
So a classification system is done to group clinical
cases of similar appearance for ease in handling and
discussion.
A number of systems for classification of
malocclusion has made an impact in the world of
orthodontics This includes the following:
1. Angle’s Classification with Dewey Modification
2. Lischer’s Nomenclature
3. Simon Classification
4. Ackerman-Profitt Classification
This systems of classification of malocclusion has
made a concept of organization in the discipline of
orthodontics making it simpler to identify problems.
Lischer modified angle’s classification by giving substitute
names to its classes:
- Angle’s class I- NEUTROCCLUSION
- Angle’s class II- DISTOCCLUSION
- Angle’s class III- MESIOCCLUSION
LISCHER’S NOMENCLATURE
MESIOVERSION- MESIAL TO THE NORMAL POSITION
DISTOVERSION- DISTAL TO THE NORMAL POSITION
LINGUOVERSION- LINGUAL TO THE NORMAL POSITION
LABIO/BUCCOVERSION- LABIAL/BUCCAL TO THE NORMAL
POSITION
INFRAOCCLUSION- INFERIOR TO THE LINE OF OCCLUSION
SUPRAOCCLUSION- SUPERIOR TO THE LINE OF OCCLUSION
AXIVERSION- AXIAL INCLINATION IS WRONG
TORSIVERSION- ROTATED ON THE LONG AXIS
TRANSVERSION- TRANSPOSED OR CHANGE IN THE SEQUENCE
OF THE POSITION
SIMON CLASSIFICATION
This system utilized the 3 anthropological planes based on the
cranial marks:
These planes are:
o Orbital plane- this plane is used to described malocclusion
- Protraction- anterior to the plane
- Retraction- posterior to the plane
-
o Midsagittal plane- it classifies maloclussion
according to transverse deviation
- Distraction- away from the plane
buccoversion
- Contraction- towards the plane palato
linguoversion
-
o Frankfort horizontal plane- it classifies
malocclusion in vertical direction
- Attraction- away from the plane
buccoversion
- Abstraction- towards the plane
palato/linguoversion
-
ACKERMAN-PROFFIT’S CLASSIFICATION
- IT IS A SYSTEM OF CLASSIFICATION IN WHICH FIVE
CHARACTERISTICS AND THEIR INTERRELATIONSHIP ARE
DESCRIBED
- THE FIVE CHARACTERISTICS ARE:
1. GROUP1: ALIGNMENT
2. GROUP2: PROFILE
3. GROUP 3: ABNORMALITIES IN THE TRANSVERSE OR
LATERAL DIRECTION
4. GROUP4:ABNORMALITIES IN THE SAGITTAL OR
ANTEROPOSTERIOR DIRECTION
5. GROUP5: ABNORMALITIES IN THE VERTICAL DIRECTION
RECENTLY profit added 3 more characteristics in his
classification system. These are:
Group6: yaw (transvers and sagittal)
Group7: pitch (sagittal and vertical
Group8: Roll (vertical and transverse)
Group9:transverse, sagittal and vertical
THE MIXED DENTITION
Period which both primary and permanent teeth
are together present in the oral cavity
1. Successional teeth
(succeedaneous)
Teeth that replace primary teeth
2. Accessional teeth
Teeth that erupt posterior to the primary 2nd
molar
STAGES OF MIXED DENTITION
1. Early Mixed Dentition (6-8 years old)
• Teeth present:
Maxillary: 1, 2, C, D, E, 6
Mandibular: 1, 2, C, D, E, 6
2. Middle Mixed Dentition (8-10 years old)
• Teeth present:
Maxillary: 1, 2, C, 4, E, 6
Mandibular: 1, 2, 3, 4, E, 6
3. Late Mixed Dentition (10-12 years old)
• Teeth present: Maxillary: 1, 2, 3, 4, 5, 6
Mandibular: 1, 2, 3, 4, 5, 6, 7
THE MIXED DENTITION
“UGLY DUCKLING STAGE”
The maxillary central incisors can be quite
distally inclined when they first erupt, which
produces a midline diastema between them.
PAGE 2
UGLY DUCKLING STAGE
- The combined effect of the maxillary incisor
apices being initially quite close together in
the anterior maxilla as the incisors erupt
and lateral pressure from the erupting
maxillary lateral incisors and canines.
THE MIXED DENTITION “UGLY DUCKLING STAGE”
- As the maxillary canines erupt, this places
mesial force from the apical region of the
maxillary incisors more coronally, improving
their inclination and usually closing the
diastema.
INCISOR LIABILITY
• The difference in the size of the
primary incisors versus that of the
permanent incisors
 • (A+B+B+A) - (2+1+1+2)
Maxillary C+D+E>3+4+5
-7mm Premolars are smaller than the primary molars they
Mandibular replace
-5mm

OCCLUSAL CHANGES
The initial occlusal relationship of the first
permanent molars is directly influenced by the
INCISOR LIABILITY primary second molar position.
Establishing the permanent incisor dentition
Space for permanent incisors obtained from Flush Terminal Plane Cusp to cusp
• residual deciduous spacing (black arrows) Mesial step Class III
• labial eruption path (green arrows) Distal step Class II
• primate spaces (red arrows)

As larger permanent incisor erupts, it should find

space because:
1. There was generalized spacing in the primary
dentition
2. Permanent incisors are tipped labially
3. The primary canines are moved distally
4. There is a slight increase in intercanine arch
width

NANCE LEEWAY SPACE

The space difference between the primary molars
and the permanent premolars that erupt in its
place
• Maxillary: 1.5mm per quadrant
• (Graben 0.9mm)
• Mandibular : 2.5mm per quadrant
• (Graber: 1.7mm)
Page 4 2 Initial calcification
OCCLUSAL CHANGES 3 1/3 of crown completed

4 ⅔ pf crown is completed

5 Crown is almost complete

6 Crown completed, tooth eruption

begins

7 ⅓ of root completed

However it should be remembered that all of these 8 ⅔ of root completed

relationships affecting the primary molars and
9 Root is almost completed, open apex
therefore establishment of the molar occlusion will
be significantly influenced by the relative amounts 10 Root completed, closed apex
of forward maxillary and mandibular growth that
occur during this time.

NOLLA’S STAGES OF TOOTH DEVELOPMENT

DEVELOPMENT OF PERMANENT DENTITION

Calcification
DEVELOPMENT OF THE PERMANENT DENTITION
- Calcification of the teeth can be observed in
Eruption
the radiograph
- Developmental process that moves a tooth
- Nolla classified these into 10 stages.
from crypt position through the alveolar
process into the oral cavity and to occlusion
Stage Description with its antagonist
- As eruption occurs, the primary tooth
0 Absence of crypt
resorbs, the root of the permanent tooth
1 Presence of crypt elongates, alveolar process increases in
 height and the permanent teeth moves
through the bone.

- Eruptive movement does not occur until the

crown is completed.
- It makes 2-5 years for the posterior teeth to
reach the alveolar crest.
- It takes 12-20 months for the tooth to reach
occlusion after reaching the alveolar margin
- Roots are usually completed a few months after
occlusion is attained. The paper is oriented in such a way that the
horizontal line follows the Sella-Nasion Plane and
the intersecting line falls on the frontonasal suture.

ORIENTATION OF TRACING PAPER

● Vertical Orientation
● Make vertical line 6cm from the right side
● Make a horizontal line at 8cm from the top,
CEPH TRACING PAPER ORIENTATION
extending to the edge of the paper.
● Ease of reference
● To help with the superimposition of the pre-
op and post-op tracing.
 Section 3: Maxilla and related structures
● Pterygomaxillary fissures, PNS, nasal bone,
orbital margins, ANS, anterior outline of
maxilla, Maxillary 1st molars and most
anterior incisor.
WRITE THE PATIENT’S NAME, AGE, DATE THE
RADIOGRAPH WAS TAKEN AND CLINICIAN’S NAME
ON THE LOWER LEFT HAND CORNER OF THE
TRACING PAPER.
Ex. Carl O. Ligon /22.5
May 5, 2015
Dr. CJ S. Chny

CEPHALOMETRIC TRACING
Section 1: Soft tissue profile, external cranium and
vertebrae (C1 and C2)
Section 4: The Mandible
● Condyle, Ramus, Mandibular 1sr molar, and
most anterior incisor, inferior border of the
mandible.

Section 2: Cranial base (Sella turcica, clinoid

processes, foramen magnum), external auditory
meatus.

CEPHALOMETRIC TRACING
- Averaging of bilateral landmarks with
broken lines
 - The most posterior point on the border of
the hard palate in the sagittal plane.

CEPHALOMETRIC LANDMARKS
- A CONSPICUOUS POINT ON CEPHALOGRAM
Subspinale (Point A)
THAT SERVES AS A GUIDE FOR
- The most posterior in the concavity
MEASUREMENT OR CONSTRUCTION OF
between the anterior nasal spine and
PLANES (JACOBSON)
inferior prosthion (IPr: most inferior point
- Marked and labeled in the cephalogram
on the alveolar bone overlying the maxillary
using their abbreviations
incisors.
- 2 Types
1. Anatomic: represent actual
anatomic structures of the skull
2. Derived: constructed or obtained
secondarily from anatomic
structures in the cephalogram

NASION (N)
- The junction of the frontonasal suture in the
midsagittal plane or the most posterior
point on the curvature at the bridge of the
nose.
Supramentale (Point B)
- The most posterior part in concavity of the
mandible between the most superior point
(SPr) on the alveolar bone overlying the
lower incisors and pogonion.

POSTERIOR NASAL SPINE (PNS)

Pogonion (Pog)
- The most anterior point on the chin. Orbitale (Or)
- The lowest point on the inferior rim of the
bony orbit
- If the landmark has bilateral anatomic
structures,the label is placed on the
averaging mark

Gnathion (Gn)
- The most anterior inferior point in the
lateral shadow of the chin. This is located by
taking the midpoint between pogonion and
menton points.

Basion(Ba)
- The inferior point on the anterior rim of the
foramen magnum

Gonion (Go)
- A point on the curvature of the angle of the
mandible located by bisecting the angle
formed by lines tangent to the posterior
border of the ramus and the inferior border
Porion(Po)
of the mandible.
 - The most superior point on the curvature of Articulare(Ar)
the external auditory meatus(anatomic Po) - A point at the intersection of the posterior
the top of the ear rod of the cephalostat border of the neck of the condyle and the
(mechanical Po) inferior surface of the posterior cranial base

Bolton point (Bo)

Sella (S) - The junction of the outline of the occipital
- The center of the pituitary foss condyle and the foramen magnum at the
highest point on the notch posterior to the
occipital condyle

Pterygomaxillary fissure (Ptm)

- The bilateral teardrop shadow formed
anteriorly by the tuberosity of the maxilla
and posteriorly by the anterior curve of the Cephalometric landmarks
pterygoid process of the sphenoid bone.
The landmark is the lowest point of the
fissure

Planes/lines for the ten-angle analysis

- Obtained by connecting two landmarks
- Classification: horizontal and vertical
Horizontal planes
1. SN plane- constructed by connecting Sella and
Nasion. This represents the cranial bone
2. Frankfort Horizontal Plane (Po-Or)- it connects
the porion and orbitale point
3. Maxillary plane (PNS-ANS)
4. Occlusal plane- it is a denture base bisecting
the posterior occlusion of molars or premolars
(deciduous molars) and extends anteriorly
5. Mandibular plane (Go-Gn)- connects gonion
and gnathion
Vertical planes
1. NA (N-Point A)- connects Nasion and Point A
2. NB (N-Point B)- connects Nasion and point B
3. Facial Plane (N-Pog)- connects Nasion and
Pogonion
4. Y-axis plane (S-Gn)- connects sella to gnathion
5. U1- connects incisor tip and root tip at the
upper incisor
6. L1- connects incisor tip and root tip of the
lower incisor
M8 Introduction-2
The success of removable orthodontic appliance mainly
depends upon good retention of the appliance. Adequate
retention of a removable orthodontic appliance is
achieved when you incorporate certain wire
components, called clasp, which engages the undercuts
on the teeth.
Clasps are the retentive components of removable
orthodontic appliances. You can choose from many
designs of clasps depending on your purpose for making
it.
In this module you will learn about types of clasps in
orthodontic appliance, what is commonly used, and how
to fabricate one.
M8 Lesson 1 Adam's Clasp
The Adams clasp was seen as a development of the Schwarz
arrowhead clasp and was introduced as the modified
arrowhead clasp. It was actually designed in 1950 by Charles
Philip Adams, a lecturer in orthodontics at Liverpool Dental
School, so the clasp has also been referred to as the Liverpool
clasp and the term universal clasp has been used too. The
clasp works by engaging the mesiobuccal and distobuccal
undercuts of a single tooth either standing in isolation or in
proximal contact with the adjacent teeth. Click Adams Tags
Clasp.pdf Download Adams Clasp.pdf • Closely fitted to the contact points,
down to the interdental embrassure
Adams clasp remains the most popular retention component • No sharp bends
for removable orthodontics due to the following benefits: • Space between the tag arms and
palate for flow of acrylic
Takes up minimal space in the buccal sulcus and in the
baseplate Advantages
Can be used on any primary or permanent tooth 1. Small and unobtrusive
Can be used on a semi-erupted tooth 2.Used on both deciduous and
Strong, although resilient enough for every retention purpose permanent teeth
Construction does not require specialised pliers. 3.Rigid and resilient to give a firm grip
4.No specialized pliers are required
5. Variations of clasp in certain
Adams Clasp circumstances
•Clasps are the retentive components of the orthodontic
appliances Disadvantages
1. Unwanted palatal tipping if gets
Adams’ Clasp activated
•By C. Philips Adams in May 1950 2. Leads to elongation of tooth if is fitting
•Most widely used clasp tightly
•Uses distobuccal and mesiobuccal undercuts 3. Repaired only if fractured through the
arrowheads
Parts 4. Cannot be given on proclined anteriors.
• Bridge
• 2 Arrow heads Materials
• Tags or retentive arms 0.28 inch stainless steel wire
Model cast
Wire marker
No.139 pliers
Wire cutter
Ruler

Other Clasps
1. C- Clasp ( Circumferential)

Bridge
• Is 2/3rd the mesio - distal width of the
tooth, slightly less than the distance
between mesiobuccal and distobuccal
undercuts, or length should be equal to
the intercuspal distance.
• Is 1 - 2 mm away from the buccal surface -
of the tooth 2. Ball end clasp
• Is at 45 degree to the buccal surface of the tooth

Arrow heads
• They should lie in the disto and
mesio buccal undercuts
• Shaped according to the curve of
the gum margins into the interdental
papilla
• Long enough to keep the bridge at a
proper distance not touching the
adjacent teeth
M8 Lesson 2 Other Clasps
1. C –clasp
It is also known as three-quarter clasp (3/4 clasp) or
Circumferential clasp. They are very simple clasp and engage
bucco-cervical undercut.
Advantages : : The science of cephalometric through the years gained
Easy to construct
Disadvantage
It can’t be used in partially erupted teeth
Simple design
Prevent mesial migration of tooth
2. Ball end clasp
This clasp is also known as Scheau anchor clasp. This clasp has
a ball at the end which engages the proximal undercut
between two adjacent teeth (interdental area). Preformed
wires having a ball at the end are used for making this clasp.
The ball can also be made using silver solder. This clasp is
used whenever additional retention is required.
M7 Introduction-2
This module is intended to be an introductory overview of the
science of radiographic cephalometry or cephalometrics.
Anthropometrics or the measurement of man, is a
measurement of the size and proportion of the human body
and as a specialized part of anthropometrics, study of the
head became craniometrics or cephalometrics.
Cephalometry is the analysis and interpretation of
standardized radiographs of the facial bones. Consequently,
this is to provide the students with a basic language and
understanding of the techniques and principles involved in
utilizing oriented head radiographs in the study of craniofacial
morphology, growth and treatment results.
M7 Learning Outcomes
At the end of the module, you will be able to:
Discuss the use of lateral cephalogram.
Locate anatomic landmarks and points on a cephalogram.
Trace the skeletal and dental structures.
Cephalometrics
| 1. Cephalostat or Head holder
Definition of terms
| 3. Cassette holder
Parts of Cephalometric
Apparatus
| 2. Higley method
Uses of cephalogram
| Conventions in taking cephalograms
Identification of cephalometric landmarks
(Anatomical and Derived)
|
Procedure
M7 While Task
the reputation of being difficult to learn and even more so to
teach. For the undergraduate dental student, cephalometric
is viewed as a region of mystery, to be studied only by the
specialist in orthodontics but that is not true. The
cephalometric will provide the students with a valuable
instrument to confirm the diagnosis, as well as to follow the
growth patterns of the person on a longitudinal basis to
observe the directions of his growth and development.
Cephalometrics
Introduction
• Origin: Cephalo means head and Metric is
measurements
• Discovery of X-rays- measurements of the head from
shadows of bony and soft tissue landmarks on the x-
ray image, known as Roentgenographic Cephalometry.
• Popularized by the classic work of Broadbent of the
United States and Hofrath in Germany, cephalometrics
has enjoyed wide acceptance.
Definition
• According to Grabers, Cephalometrics is a scientific
study of the measurements of the head with relation to
specific reference points; used for evaluation of facial
growth and development, including soft tissue profile.
• According to Moyers, Cephalometric is a radiographic
technique for abstracting the human head into
geometric scheme and is used to describe
morphology and growth, to diagnose anomalies, to
predict future relationships, to plan treatment, and to
evaluate treatment results.
Uses of Cephalogram
Its purpose is always for comparison due
to 5 reasons:
1. To describe morphology or growth
2. To diagnose anomalies
3. to predict future relationship
4. To plan treatment
5. To evaluate the result of treatment
Cephalometric Equipment
The Cephalometric apparatus consists of the followings:
2. An x-ray source or x-ray cone holder
Cephalostat are of 2 types:
1. Broadbent-Bolton method
.1.The Lateral Projection or cephalogram
2.The Posteroanterior Projection or cephalogram
3.The Oblique Projection
Lateral Projection
• Also referred to as lateral ceph.
• The midsagittal plane of the subject’s head is conventionally
placed 60 inches ( 152.4 cm ) from the target of the x-ray tube
with the left side toward the film. The central beam of the x-
rays coincides with the transmeatal axis that is, with the ear
rods of the cephalostat. Under most circumstances, the
distance from the midsagittal plane to the fiml is held
constant, usually at 7.0 inches ( 18 cm ). The patient’s head is
placed with the Frankfurt Plane parallel to the floor and the
subjects teeth together in their usual occlusal position.
Uses of lateral cephalogram
• Important in orthodontic growth analysis
• Diagnosis and Treatment planning
• Monitoring of therapy
• Evaluation of final treatment outcome
Uses of Posteroanterior Cephalogram
• Provides information related to skull width
• Skull symmetry
• Vertical proportions of skull, craniofacial
complex and oral structures
• For assessing growth abnormalities and
trauma
The typical Oblique Cephalogram
Armamentarium
• Cephalogram
• Tracing box or X-ray viewer or View box
• Acetate matte tracing paper 0.003 inch thick,
8x10”
• Pencil with lead 0.3 to 0.5 mm tip
• Scotch or masking tape
• Eraser
• Ruler
• Pencil sharpener
Cephalometric landmarks
A. Anatomic Landmarks
• Specific points used as reference guides in
the construction of lines and angle
1. Nasion (Na). The junction of the frontonasal
suture in the midsagittal plane or the most posterior
point on the curvature at the bridge of the nose.
2.Anterior Nasal Spine (ANS) . The most anterior
point of the maxilla at the lower margin of the anterior
nasal opening.
3. Subspinale (Point A) . The most posterior point in
the concavity between the anterior nasal spine and
prosthion (most inferior point on the alveolar bone
overlying the maxillary incisors).
4. Gnathion (Gn) . The most anterior inferior point
in the lateral shadow of the chin. This is located by
taking the midpoint between pogonion and menton
points.
5. Supramentale (Point B) . The most posterior point
in the concavity of the mandible between the most
superior point on the alveolar bone overlying the
lower incisors (infradentale) and pogonion
6. Pogonion(Pog).The most anterior point on
the chin.
7. Menton (Me) . The lowest point on the
symphyseal outline of the chin.
8. Orbitale (Or) . The lowest point on the
inferior rim of the bony orbit.
9. Posterior Nasal Spine (PNS). The most
posterior point on the bony hard palate in the
sagittal plane.
10. Basion (Ba). The inferior point on the
anterior rim of the foramen magnum.
11. Condylion (Co). the most superior point
of the head of the mandibular condlye.
12. Gonion (Go). A point on the curvature
of the angle of the mandible located by
bisecting the angle formed by lines tangent
to the posterior border of the ramus and the
inferior border of the mandible.
Derived Landmarks
1. Porion (Po). The most superior point on the
curvature of the external auditory meatus (anatomic Po).
The top of the ear rod of the cephalostat (mechanical
Po).
2. Sella (S). The center of the pituitary fossa.
3. Pterygomaxillary fissure (Ptm). A bilateral teardrop
shadow formed anteriorly by the tuberosity of the maxilla
and posteriorly by the anterior curve of the pterygoid
process of the sphenoid bone. The landmark is the lowest
point of the fissure.
4. Articulare (Ar) . A point at the intersection of the
posterior border of the neck of the condyle and the inferior
surface of the posterior cranial base.
5. Bolton point (Bo) . The junction of the outline of the
occipital condyle and the foramen magnum at the highest
point on the notch posterior to the occipital condyle.
6. Key ridge (Kr) . The lowest point on the outline of
zygoma
 THE PERMANENT DENTITION
DURING INTRA-ALVEOLAR ERUPTION, THE TOOTH'S POSITION
IS AFFECTED BY:

1. THE PRESENCE OR ABSENCE OF THE ADJACENT TEETH

2. RATE OF RESORPTION OF PRIMARY TEETH
3. EARLY LOSS OF PRIMARY TEETH
4. LOCALIZED PATHOLOGIC LESIONS
5. FACTORS THAT ALTER THE GROWTH OR CONFORMATION
OF THE ALVEOLAR PROCESS.

THE PERMANENT DENTITION

M9 Introduction-2
Construction of an orthodontic appliance like a simple
space maintainer would require mastery of several
techniques. Aside from good wire bending, filing and
soldering are essential procedures in fabrication of an
appliance. Filing is an indispensable step in the joining of
metals with the use of metallic alloy called solder which is
melted over the metals to be joined. In this module we will
learn the step by step procedure of filing and soldering.
MESIAL DRIFTING
• THE INHERENT TENDENCY OF TEETH TO MOVE
MESIALLY EVEN BEFORE THEY MOVE INTO
OCCLUSION
• TEETH TEND TO DRIFT INTO SPACES CREATED BY
EXTRACTIONS
ANTERIOR COMPONENT OF FORCE
• MESIAL MOVEMENT AS A RESULT OF MUSCLE
FORCES ACTING THROUGH INTERCUSPATION
• DEPENDS ON THE ANGULATION OF THE TEETH AND
THE STEEPNESS OF THE OCCLUSAL PLANE

PART 1 March 8, 2022

ARCH DIMENSIONS
1. ARCH WIDTH
2.ARCH LENGTH (ARCH DEPTH)
3 ARCH PERIMETER (ARCH
THE PERMANENT DENTITION CIRCUMFERENCE)
•MAXILLARY:
6-1-2-4-5-3-7
50% OF ALL CASES

• MANDIBULAR:
6-1-2-3-4-5-7
40% OF AIL CASES

ARCH WIDTH
•THE DISTANCE BETWEEN THE 2 CENTRAL
FOSSAE OF THE 1ST PERMANENT MOLARS
•INCREASE IN ARCH WIDTH IS CLOSELY
RELATED TO THE EVENTS OF DENTAL
DEVELOPMENT THAN IT IS TO THE
OVERALL SKELETAL GROWTH
INTERCANINE WIDTH
•THE DISTANCE FROM THE CUSP TIP OF A CANINE OF ONE
SIDE TO THE
CUSP TIP OF THE CANINE OF THE OPPOSITE SIDE
ARCH LENGTH (ARCH DEPTH)
● Measured at the midline from the point midway
between the central incisors to a tangent touching
the distal surfaces of the 2nd primary molar or 2nd
premolar.
● It decreases during treatment due to the movement
of the molar into the leeway space.
ARCH PERIMETER / ARCH CIRCUMFERENCE
● Most important of all the dimensions.
● Measured from the mesial surface of 6 (or the distal
surface of EJ), around the arch over the contact
points and incisal edges in a smooth curve to the
mesial surface of 6 (or distal surface of E) pf the
opposite side
ARCH PERIMETER / ARCH CIRCUMFERENCE
*ASPECTS THAT SHORTEN THE ARCH PERIMETER
1. Skeletal Pattern
2. Steepness of the occlusal plane
3. Vertical Alveolar Growth
4. Caries Experience
5. Lingual Tipping of the Incisors
6. Mesial Tipping of the molars
MAXILLARY ARCH PERIMETER
● Increased angulation of the permanent anteriors vs
the primary
● Arch perimeter is maintained by greater increases in
width in spite of the decrease in arch length.
MANDIBULAR ARCH PERIMETER
Reduction of mandibular arch perimeter
● Late mesial shift
● Mesial drifting tendency of the posterior teeth
● Interproximal wear
● Lingual positioning of the incisor as a result of
maxillo-mandibular growth
● The original tip position of the incisors and molars.
THE PERMANENT DENTITION
 OVERJET OVERBITE

● Horizontal ● Vertical
overlapping of overlapping of
incisors (2- incisors (1-
3mm) 2mm)

● Usually a ● Related to the

reflection of vertical
the antero- dimension of
posterior the face such
relationship of as the ramus
the skeletal height
relationship

● Affected by lip DEVELOPMENT OF THE 2ND MOLAR

and tongue • ERUPTS AFTER ALL THE TEETH ANTERIOR TO IT HAS
function ERUPTED.
• PROBLEMS OCCUR WHEN IT ERUPTS PRIOR TO THE 2ND
PREMOLAR
- CONSIDERABLE ARCH LERGTH REDUCTION AND
CROWDING CORD PREMOLAR OOTH
OF TIE SECOND PREMOLAR TOOTH
• THE MANDIBULAR 2ND MOLAR ERUPTS BEFORE THE
MAXILLARY 2ND MOLAR

DEVELOPMENT OF 3, 4, AND 5 DEVELOPMENT OF THE 3RD MOLAR

- SUCCESSFUL ALIGNMENT OF THE CANINE AND PREMOLAR
TEETH WITHIN EACH QUADRANT RELIES UPON A NUMBER OF
FACTORS:
1. THE SIZE OF THE LEEWAY SPACE
2. PREVIOUS ENCROACHMENT BY THE INCISORS INTO
THE CANINE REGION
3. THE MECHANISM OF MOLAR RELATIONSHIP
CORRECTION
- LATE CROWDING OF THE LOWER INCISORS DUE TO 3RD
MOLAR:
- CROWIND IS SEEN MORE FREQUENTLY IN MEN THAN
WOMEN
- IT HAS BEEN FOUNF THAT EXTRACTION OF THE LOWER 3RD
MOLARS DOES NOT INDUCE THE AMOUNT OF INCISOR
CROWDING
- INCISOR POSITION AND STABILITY IS THE ESTABLISHED WITH
THE 1ST MOLAR BEFORE THE 3RD MOLAR EVEN DEVELOP

DIFFERENTIAL GROWTH THEORY/ LATE MANDIBULAR

GROWTH THEORY
- STATES THAT THE GROWTH OF THE MANDIBLE FORWARD
COWES A POSTERIOR FORCE ON THE LOWER INCISORS AS IT
TOUCHES THE UPPER TEETH AND UPS, WHICH UPRIGHTS THE
INCISORS CAUSING CROWDING

IMPACTION OF THE 3RD MOLAR
- OCCURS DUE TO LACK OF SPACE IN THE ARCH
- MANDIBULAR 3RD MOLAR IMPACTION IS SEEN IN CLASS II
SKELETAL PATTERN WHERE THE MANDIBLE IS NERCIENT IN
SIZE
DEVELOPMENT OF DENTITION AND OCCLUSION
- NORMAL OCCLUSION: ALL TEETH ARE OCCLUDING IN A
HEALTHY, STABLE AND PLEASING MANNER BUT WITH
VARIATIONS IN POSITION WITHIN MEASURABLE NORMAL
LIMITS.
- IDEAL OCCLUSION: A HYPOTHETICAL CONCEPT SEEN IN A
DENTURE AND THE BASIS OR THE GOAL OF ORTHODONTIC
TREATMENT EVEN IF IT CAN NOT BE ACHIEVED.
6 KEYS TO NORMAL OCCLUSION (ANDREWS)
1 .CLASS I MOLAR RELATIONSHIP
2. NORMAL TIP LAMIAL INCLINATION)
3 .NORMAL TORQUE ILABIO-LINGUAL INCLINATION
4. ABSENCE OF ROTATIONS
5. TIGHT CONTACTS (ABSENCE OF SPACING)
6.SLIGNT OR FLAT CURVE OF SPEE (NOT MORE THAN 15MM)
TEMPOROMANDIBULAR JOINT
• The area where the mandible
articulates
with the temporal bone of the cranium
• One of the most complex joints in the body:
- Hinging movement (ginglymoid joint)
- Gliding movements (arthrodial joint)
• Thus, it has been technically considered a
ginglymoarthrodial joint
• The TMJ is formed by the
mandibular condyle fitting into the mandibular fossa of the
temporal bone
• Separating these two bones
from direct articulation is the
articular disc
• The articular disc is composed of
dense fibrous connective tissue, for the most part devoid of
any blood vessels or nerve fibers.
• Acts as a nonossified bone (3rd bone)
contributing to upper and lower joint
systems (TMJ = compound joint)
• In the sagittal plane, it can be
divided into three regions
according to thickness:
1. Intermediate zone - thinnest
2. Anterior border
3. Posterior border – thickest
The articular surfaces are divided
into 2 cavities:
1. Upper or superior cavity
• Bordered by the mandibular fossa and the superior
surface of the disc
2. Lower or inferior cavity
• Bordered by the mandibular condyle and the
inferior surface of the disc
• The lining on the internal surface of cavities, along with a
specialized synovial fringe located at the anterior border of
the retrodiscal tissues, produces synovial fluid, which fills
both joint cavities (TMJ= SYNOVIAL JOINT)
TEMPOROMANDIBULAR JOINT
• SYNOVIAL FLUID
1. Acts as a medium for providing metabolic requirements to
the articular surfaces 2. Serves as a lubricant between the
articular surfaces during function
FRONTAL (VERTICAL) AXIS OF ROTATION
• Mandibular movement around the frontal axis occurs when
one condyle moves anteriorly out of the terminal hinge
position with the vertical axis of the opposite condyle
remaining in the terminal hinge position

TEMPOROMANDIBULAR JOINT
BOUNDARY LUBRICATION
• Occurs when the joint is moved and the synovial fluid is
forced from one area of the cavity into another.
• Boundary lubrication prevents friction in the moving joint
and is the primary mechanism of joint lubrication,
WEEPING LUBRICATION
• This refers to the ability of the articular surfaces to absorb a
HORIZONTAL AXIS OF ROTATION
small amount of synovial fluid to prevent sticking. • Helps
• TERMINAL HINGE AXIS —the axis around which movement
eliminate friction in the compressed but not moving joint
occurs when the condyles are in their most superior position
TYPES OF MOVEMENT
in the articular fossae and the mouth is purely rotated open •
1. ROTATIONAL MOVEMENT
This pure rotational opening occur until the anterior teeth are
• In the masticatory system, rotation occurs when the mouth
20 — 25 mm apart
opens and closes around a fixed point or axis within the
condyles
• In the TMJ, rotation occurs as movement within the inferior
cavity of the joint
• Occur in all three reference planes: horizontal, frontal
(vertical), and sagittal

FRONTAL (VERTICAL) AXIS OF ROTATION

Mandibular movement around the frontal axis occurs when
one condyle moves anteriorly out of the terminal hinge
HORIZONTAL AXIS OF ROTATION position with the vertical axis of the opposite condyle
• Mandibular movement around the horizontal axis is an remaining In the terminal hinge position
opening and closing motion
• Referred to as hinge movement (HINGE AXIS)
• Only example of mandibular activity in which "pure"
rotational movement occurs

SAGITTAL AXIS OF ROTATION

• Mandibular movement around the sagittal axis occurs when
one condyle moves inferiorly while the other remains in the
terminal hinge position
• Occurs in conjunction with other movements when the
orbiting condyle moves downward and forward across the
articular eminence
TYPES OF MOVEMENT
2. TRANSLATIONAL MOVEMENT
• In the masticatory system, it occurs when the mandible
moves forward, as in protrusion
• The teeth, condyles, and rami all move in the same
direction and to the same degree • Occurs within the
superior cavity of the joint
NORMAL MOVEMENT OF THE CONDYLE AND DISC DURING
MOUTH OPENING
AS THE CONDYLE MOVES OUT OF THE FOSSA THE DISC
ROTATES POSTERIORLY ON THE CONDYLE. ROTATIONAL
MOVEMENT PREDOMINATELY OCCURS IN THE LOWER JOINT
SPACE WHILE TRANSLATION PREDOMINATELY OCCURS IN
THE SUPERIOR JOINT SPACE. El
M5 - Introduction to Stomatognathic System
Stomatognathic system is a system comprises of highly
coordinated structure of the human masticatory
apparatus that are capable of acting as a single unit in
the process of mastication, deglutition, phonation,
respiration and other behavioral activities. Salzmann
defines stomatognathics as the approach to the practice
of orthodontics, which takes into consideration, the
interdependence of form and function of the teeth, jaw
relationship, temporomandibular articulation, craniofacial
conformation and dental occlusion.
M5-Lesson 1 Functional Osteology
Form and function are intimately related. Like your
incisors, with its anatomy it functions to cut food. Another
example is the size of the tongue. When a tongue is big
it is positioned low in the floor of the mouth and causes
the teeth in the lower arch to have spaces.
Oral habits will also affect the form of your mouth. One
example of this wound be thumb-sucking. The greater
inward forces brought about by the buccinator muscles
during thumb-sucking will most likely deform the
maxillary bone (constrict the maxilla) and forces from the
thumb will move the teeth labially.
The orthodontist in establishing perfect occlusal
relationship of the teeth, must take into consideration
the effects of the use of these teeth during functions of
mastication, swallowing and speech. As the bony
structures respond to change, the tooth positions will
change with them since form and functions are strongly
related.
A thorough knowledge of the physiology of the bone will
help us deal with the patients more effectively and
efficiently. Now let us discuss bone turnover.
Bone turnover is balanced with coupling of bone
formation and resorption at various rates leading to
continuous remodeling of bone. Physiologic concept of
burn turnover is largely attributed to important biologic
activities, like modeling and remodeling.
Bone Modeling is a mechanically mediated adaptive
process for changing a bone’s size, shape, or position.
The important element of growth is bone modeling and
functions as incremental process for bone mass
adaptation and architecturing to its functional need over
lifetime.
Bone Remodeling is a physiological turnover of
mineralized tissue without changing its overall
appearance . This is active throughout life and serves to
modify the shape of skeleton, bone volume and repair
micro-damage.
Regulatory factors that affect bone turnover are genetic
factors, mechanical factors vascular/nerve factors/
nutritional factors, hormonal factors, and local regulators
of bone remodeling.
Murray gave an excellent summary of the principal
theories relating to the mechanical structure of bones.
These are Trajectional Theory of Bone Formation
by Meyer and Culmann, Law of Orthogonality by Julius
Wolff and Law of Transformation of the Bone by Roux.
Let us discuss each theory briefly.
1. Trajectorial Theory
Noted by Meyer and Culmann in femur. He pointed out
that the alignment of bony spongiosa followed definite
engineering principles. These trajectories crossed at the
right angles – an excellent arrangement to resist the
manifold stresses on the condyle of the femur. The
picture shows the representation of the alignment of the
bony trabeculae in stress trajectories to better prepare
the femur to resist a variety of functional stresses.
2. Law of Orthogonality
Julian Wolff carried this theory and he claimed that
trabeculae alignment was primarily due to functional
forces. Changes in intensity and direction of forces
produce change in internal and external form of bone.
3. Law of Transformation of the Bone
Roux, a German surgeon introduced this law. In
essence, the law stated that the stresses of tension and
pressure on bone stimulate bone formation.
Tension = bone formation
Pressure = bone resorption
There are common effects of functional forces to our
bone. One of them is osteoporosis which is common in
females and is caused by lack of function that eventually
lead to reduction of bone density. Another
is osteosclerosis which is due to increased function that
lead to greater bone density.
Stress Trajectories/Benninghoff Lines
Benninghoff studied the architecture of the cranial and
facial skeleton and the so-called stress trajectories. He
showed that these trajectories, or lines of stress, involve
both the compact and spongy bones. Let us go over the
stress trajectories of the maxilla and mandible.
Stress Trajectories of Maxilla
There are 3 vertical pillars, all arising from the alveolar
process and end at the base of the skull.
1. Canine pillar
2. Zygomatic pillar
3. Pterygoid pillar
Stress Trajectories of Mandible
It radiates from beneath the teeth in the alveolar
process and join together in a common stress pillar, that
terminates in the condyle of the mandible.
M5-Lesson 2 Myology
How do you think your teeth can maintain their position
in the dental arch?
The major factor in environmental balance is the
musculature. Muscles are a potent force whether they
are in active function or at rest. Even a resting muscle is
performing a function that is to maintain posture and
relationship of contiguous parts. The teeth and
supporting structures are constantly under the influence
of the contiguous musculature. The integrity of the dental
arches and the relations of the teeth to each other within
each arch and with opposing members are the result of
the morphogenic pattern as modified by the stabilizing
and active functional forces of the muscles.
Buccinator Mechanism
is a continuous muscle band that encircle the dentition
and is anchored at the pharyngeal tubercle. Abnormal
posture and function of oro-facial muscle may be
causative or at least contributory to formation of dental
malocclusion Hence muscle of oro-facial region are of
great importance to one of the main aims of orthodontics
that is to achieve structural balance and harmony which
is achieved only when there is harmony between the jaw
, teeth, and muscles.
Components:
• Orbicularis oris
• Buccinator
• Ptrygomandibular raphe
• Superior constrictor of pharynx
Tongue
opposes the buccinator mechanism. The buccinator
mechanism exerts inward forces while the tongue exerts
outwards forces.
Anterior segment
Inward force (orbicularis oris muscle), opposed by
outward force (tongue)
Net effect: balanced
Posterior segment

Inward force (buccinator), opposed by lateral or outward Rotational movement

force (tongue)
Dorland’s Illustrated Medical Dictionary defines rotation
Net effect: balanced as “the process

of turning around an axis; movement of a body about its

axis, called the axis of
The following are the muscles of mastication:
rotation
Muscle Action In the TMJ, rotation occurs as movement within the
Temporalis Elevates the jaw inferior cavity of the joint. Thus it is movement between
the
Masseter Elevates the jaw
superior surface of the condyle and the inferior surface
Medial Pterygoid Elevates the jaw of

the articular disc.

Depresses the mandible
Lateral Pterygoid and protrudes the
mandible
Horizontal Axis of Rotation
- Mandibular movement
around the horizontal axis
In order to evaluate abnormal form and function for the is an opening and closing
purpose of correction, it is necessary to understand motion. It is referred to
normal anatomy, normal growth, and normal function of as a hinge movement, and
the stomatognathic system, Click the file below to know the horizontal axis around
more about the functional movement and positions of the which it occurs is
mandible. therefore referred to as
the hinge
axis

Functional Movements and Positions of the Mandible

Frontal Axis of Rotation
- Mandibular movement
around the frontal axis
Mandibular Movements occurs when one condyle
Mandibular movement occurs as a complex series of moves anteriorly out of
interrelated three dimensional the terminal hinge
rotational and translational activities. It is determined position while the vertical
by the combined and axis of the opposite
simultaneous activities of both temporomandibular condyle remains in the
joints (TMJs) terminal hinge position
To better understand the complexities of mandibular
movement, it is beneficial first
to isolate the movements that occur within a single TMJ. Sagittal Axis of
The types of movement that Rotation
occur are discussed first, and then the three-dimensional
movements of the joint are Mandibular movement
divided into movements within a single plane. around the sagittal axis
occurs when one condyle
moves inferiorly while the
other remains in the
Types of Movement terminal hinge position
Rotational Movement Translational Movement
- Sagittal Axis of
- Rotation
- Horizontal Axis of Translational movement
Rotation Translation can be defined as a movement in
- Frontal Axis of which each point of the moving object has
Rotation simultaneously the same velocity and
direction. In the masticatory system it occurs
when the mandible moves forward, as in
protrusion. The teeth, condyles, and rami all
move in the same direction and to the same
degree
Translation occurs within the superior cavity of the joint
between the
superior surface of the articular disc and the inferior
surface of the articular
fossa (i.e., between the disc-condyle complex and the
articular fossa)
ROTATIONAL MOVEMENT OF THE
Chewing stroke
MANDIBLE WITH THE CONDYLES
Each opening and closing movement of the
IN THE TERMINAL HINGE
mandible represents a chewing stroke.The
POSITION. This pure rotational
complete chewing stroke has what is described as a
opening can occur until the
tear-shaped movement pattern. It can be divided into
anterior teeth are some 20 to 25
opening and closing movements. The closing movement
mm apart.
has been further subdivided into the
crushing phase and the grinding phase

Single Plane Border Movements

Mandibular movement is limited by the ligaments and
the articular surfaces
of the TMJs, as well as by the morphology and
alignment of the teeth. When the
mandible moves through the outer range of motion,
reproducible describable limits
called border movements result as a
tear-shaped movement pattern.

Border Movements
Sagittal SECOND STAGE OF
-Posterior Opening Border ROTATIONAL
-Anterior Opening Border MOVEMENT DURING
-Superior Contact Border OPENING. The condyle is
-Functional translated down the articular
eminence as the mouth rotates
Horizontal open to its maximum limit.
-Left Lateral Border
-Continued Left Lateral Border 2. Anterior Opening Border
with Protrusion Anterior closing border
-Right Lateral Border movement in the sagittal
-Continued Right Lateral Border plane
with Protrusion

Vertical
-Left Lateral Superior Border
-Left Lateral Opening Border
-Right Lateral Superior Border
-Right Lateral Opening Border
Functional

Sagittal Border
Movements
Mandibular motion viewed in the sagittal plane can be
seen to have four distinct
3. Superior Contact Border
movement components
Force applied to the teeth when the
1. Posterior opening border 3. Superior contact border
condyles are in centric relation (CR) will
2. Anterior opening border 4. Functional create a superoanterior shift
of the mandible intercuspal position (ICP).
1. Posterior Opening Border
Horizontal movement of the mandible as
 thenincisal edges of maxillary and 4. Right lateral
mandibular teeth pass across each other border movement
recorded in the
horizontal plane.
4. Continued right lateral
border movement with
protrusion recorded in the
horizontal plane.
Functional range
4. Functional within the horizontal
Functional movements occur during border movements.
functional activity of the mandible. Usually
take place within the border movements
and therefore are considered free
movements.

Horizontal Vertical / Frontal

Border Border
Movements Movements
When mandibular movements are viewed in the When mandibular motion is viewed in the frontal
horizontal plane, a rhomboid-shaped pattern can plane, a shield-shaped pattern can be seen that has
be seen that has four distinct movement components four distinct movement components along with the
plus a functional component: functional component:
1. Left lateral border 3. 1. Left lateral superior border 3. Right lateral superior
Right lateral border border
2. Continued left lateral border with protrusion 4. 2. Left lateral opening 4. Right lateral opening border
Continued right lateral border with protrusion Mandibular border movements in the frontal plane have
Traditionally a device known as a Gothic arch tracer has not been traditionally “traced,” but an understanding of
been used to record mandibular movement in the them is
horizontal plane. useful in visualizing mandibular activity three
1. Left lateral border dimensionally.
movement recorded in 1. Left lateral superior
the horizontal plane. border movement
recorded in the frontal
plane.
2. Left lateral opening
border movement
recorded in the frontal
plane.

2. Continued left lateral

border movement with
protrusion recorded in
the horizontal plane.

3. Right lateral superior

border movement
recorded in the frontal
plane.
4. Right lateral opening
border movement
 recorded in the frontal POSITION
plane. - the relationship of the maxilla &
5. Functional movement the mandible when the teeth are
within the mandibular in occlusion.
border movement recorded Five Positions in which
in the frontal plane. ICP, occlusion takes place:
Intercuspal position. 1. Intercuspal occlusion
2. Protruded occlusion
3. Retruded occlusion
4. Left lateral occlusion
5. Right lateral occlusion

POSTURAL OR MANDIBULAR REST POSITION

Envelope of Motion
By Dr. Ulf PosseltBy combining mandibular border
movements in
the three planes, a three-dimensional envelope of
motion can be produced that represents the
maximum range of movement of the mandible
The superior surface of the envelope is
determined by tooth contacts, whereas the other
borders are primarily determined by ligaments and
joint anatomy that restrict or limit movement
- teeth not in function, mouth is closed by the tonic
contraction of the muscles of mastication & facial
expression & the teeth are not in contact.
- there is intercuspal or freeway space of 2-5mm
between
teeth.
OCCLUSAL VERTICAL DIMENSION
- teeth are in intercuspal occlusion.
(* The difference between the RVD & OVD represents
the freeway space.)
REST VERTICAL DIMENSION
- the face is in an involuntary
relaxed state.
- a distance measured from the
inferior border of the nose to
the point of the chin
M5-Lesson 3 TMJ

Temporomandibular joint is a ginglymoarthrodial joint

and it enables us to move our jaw to chew and
Centric Relation VS Centric Occlusion speak. TMJ affects the spine structure and the nervous
Centric Relation system. Movement of the TMJ is very closely related to
• The relationship of the mandible to the maxilla where the second cervical vertebra, C2 or also known as Axis.
the condyle One might think that when the mandible opens and
of the mandible is located at its most superior and closes, its movement is centered around the condyle in
anterior position, the TMJ itself. However, this is not the case. According
resting on the glenoid fossa against the articular to the Quadrant Theorem of Guzay, the axis of rotation
eminence with the of the mandible lies exactly at the odontoid of C2. When
articular disc properly interposed. the mandible moves downwards, this generates a pulling
• Centric Occlusion force, loosening the muscles around C2. Likewise when
– Relationship of the mandibular teeth with the maxillary closing the mouth, it generates a pressure which
teeth, ideally, at maximum intercuspation. tightens the muscles around C2. This means that in an
– Not always the case, if patient has malocclusion, or occlusion with decreased vertical dimension will
faulty aggravate muscle tension around C2 when the mouth is
restoration closed. Therefore distortion in TMJ will affect the position
• If present, it is termed as the Habitual Occlusion or of the Axis too.
Position.
POSITION Click the file below to understand the parts of TMJ and
- the relationship of the maxilla & its supporting structures.
the mandible when the teeth are
in occlusion.
Five Positions in which
occlusion takes place: Module 6Lesson 3
1. Intercuspal occlusion Temporomandibular
2. Protruded occlusion Joint
3. Retruded occlusion
4. Left lateral occlusion
5. Right lateral occlusion
TMJ IS A COMPLEX JOINT COMPOSED OF • Because it is avascular it
FOUR MAIN STRUCTURES acts as a medium for
Condyle providing metabolic
Portion of the requirements to these
mandible that tissues
articulates with the • Serves as a lubricant
cranium, around between articular
which movement surfaces during function
occurs
Temporal Bone
The articular portion Mechanism of
of the temporal lubrication
bone is made up of a BOUNDARY LUBRICATION
concave mandibular
fossa, in which the occurs when the joint is moved
condyle is situated and the synovial fluid is forced
from one area of the cavity into
Articular Disc
another prevents friction in the
The most important
moving joint
anatomic structure
of the TMJ and WEEPING LUBRICATION
made of dense ability of the articular surfaces to
fibrous connective absorb a small amount of
tissue synovial fluid helps eliminate
Ligaments friction in the compressed but
The ligaments of the not moving joint
joint are composed
of collagenous
connective tissues
that have particular LigamentsLigaments do not enter actively into joint
length function but instead act as passive
restraining devices to limit and restrict border
movements
Functional • Collateral ligaments
TMJ IS A GINGLYMOARTHRODIAL JOINT • Capsular ligament
Ginglymoid joint • Temporomandibula
r ligament
• Permit motion only in one plane
Accessory
• Movement in a joint around a
• Sphenomandibular
transverse axis, as occurs in the lower
ligament
compartment at the beginning of jaw
opening when the occluding teeth are • Stylomandibular
separated ligament

Arthrodial Joint Collateral Ligaments

Responsible for the
• Allow the bones to glide past one
another in any direction along the hinging movement of
plane of the joint the TMJ
Strain on these
• It take space in the upper
ligaments produces
compartment of as it moves with the
pain
condyle and the inferior surface of the
glenoid fossa Capsular Ligament
Act to resist any
medial, lateral, or
Synovial fluidThe internal surfaces of the cavities are inferior forces that
surrounded by specialized tend to separate or
endothelial cells that form a synovial lining that produces dislocate the
synovial fluid articular surfaces

Temporomandibular
Purpose Ligament
Outer oblique portion
resists excessive 6. Help further develop or allow jaw bone
dropping of the condyle, to grow
therefore limiting the
extent of mouth opening
Inner horizontal portion
Mechanical process of chewing
limits posterior
1. Voluntary
movement of the
• Initial chewing action is a
condyle and disc
voluntary action
2. Involuntary
• From the moment chewing has s
Sphenomandibular started, it becomes
Ligament involuntary.
This ligament is • Reflex movement of the different
passive during jaw structures like jaw, lips, cheeks &
movements, tongue in a very integrated
maintaining relatively manner.
the same degree of
tension during both
opening and closing Phases of chewing
of the mouth Opening
Closing
Occlusal

Stylomandibular
Ligament
Limits excessive Stages of chewing
protrusive 1. Incisal
movements of the
The incisal edge of incisors is the working edge
mandible
Lips are in contact & there is the presence of oral seal

M5-Lesson 4 Functions of Stomatognathic System 2. Direct Crushing

Involves shearing movement of the mandible.

The different functions of stomatognathic system are Include
intimately related and occur simultaneously. Click the cuspids and bicuspids
PowerPoint Presentation below to understand better the Working side is where the food is & the other side will be
different functions of stomatognathic system and their the
importance. balancing side
FUNCTIONS OF THE
STOMATOGNATHIC SYSTEM 3. Mortar and pestle
1. Mastication Complete trituration of the food & this involves all
2. Deglutition occlusal surfaces. Involves all occlusal surfaces.
3. Speech There is harmonious relationship between the cranial &
4. Respiration facial structure and mastication is soundless

Mastication Deglutition -once the food is chewed, the next step is

-is a physiologic activity formed when there to swallow it.
is normal occlusion in a cyclic movement. -swallowing is a complex group of reactions
- simply the chewing process. to move food onwards in the digestive tract
Purposes: while preserving the airway
1. Physiological transformation of food. -transport of material from mouth to
2. Enhances growth & development of esophagus
dento-alveolar structures through Adult
stimulation. deglutition/swallowing
3. Stimulates salivary flow. Infant
4. There is volatilization of food to increase suckling – earliest means of food transport
appetite. sucking/drinking – fluid transport
5. Protection of the individual from Mechanical Process:
undesirable food components. 1. Voluntary – Initial act is voluntary.
 2. Involuntary – Action becomes a. seat of learning & memory
involuntary when food comes in contact b. seat of habits & condition habits
with the oropharynx. c. cerebral cortex & motor centers
3. Efferent mechanism – involves the nerves
that innervates the muscle involved in speech.
*touch, smell & taste will compensate for
Stages of Deglutition
hearing & sight
1. Oral

voluntary act where you elevate the anterior

aspect of
the tongue pressing against the palate pushing the food
Actual Process of Speech
towards the pharynx Respiration
2. Pharyngeal -simultaneous breathing to have
begins as the bolus of food is carried between
stream of air from the lungs
the tongue, is needed to produce vibration
the soft palate, the constrictor wall & the epiglottis - absorption of oxygen & elimination of
3. Esophageal
carbon dioxide from
involuntary transport phase whereby the food passes the atmosphere & cells of the body.
along
the esophagus through a relaxed lower esophageal Phonation
sphincter
into the gastric cardia
-actual production of speech sounds.
-utterance of vocal sounds by means
of vocal cord vibrations.
Infantile Swallowing Mature/Adult
Swallowing Resonance
-is the process by which sound is
Jaws are apart intensified or amplified.
Teeth are together
-it is made possible by the nasal
Tongue is in between Tongue is behind
cavity, oral cavity, pharynx,
the maxillary & upper incisors, chest cavity & air sinus
mandibular gum pads touching the palate
Articulation
Mandible is stabilized Mandible is stabilized
-is the breaking up of sound &
by contraction of by contraction of modification of sound coming
muscles supplied by muscles supplied by from the larynx.
7th cranial nerve 5th cranial nerve
-act of speaking
With mandibular Without mandibular
thrust thrust
Respiration -a
With active lip continuous process closely associated
contraction With minimal lip
contraction with deglutition.
-also referred to as ventilation wherein
Speech there is the entrance of oxygen &
-an expression of thought either release
written or spoken
Normal Development of Speech is of carbon dioxide
Affected by the Following
1. Afferent mechanism – those involved in Kinds of Respiration:
hearing & sight
2. Association areas – involves the: 1. External – exchange of air

between blood & environment
2. Internal – exchange of air
between blood & cell
means of ahead holder or cephalostat which
holds the subject's head in a fixed relationship
to the central ray of the x-ray source so that x-
ray coincide with the transmeatal axis.
There are three Conventions in taking
Cephalograms:

Stages of Respiration
Inspiration -intake of oxygen
-also called inhalation
Characteristics:
1. Increase in size of the thoracic
cavity.
2. There is backward movement of the
thoracic cage.
3. Spinal column moves backward & The Oblique
diaphragm moves Cephalogram is very popular for analysis of
downward. patients in the mixed dentition.
The right and left oblique cephalograms are
taken at 45 degrees and 135 degrees to the
Articulation lateral projection. The central ray entering
behind one ramus to obviate superimposition of
-release of carbon dioxide the halves of the mandible. it is necessary that
-outflow of air the subject be maintained on the Frankfurt
plane to avoid distortion.
Characteristics:
1. Decrease in size of the thoracic
cavity.
2. Ribs moves downward & backward
while the
diaphragm moves upward in a relax
stage.

M6-Lesson 3
Conventions in
taking
Cephalograms Lateral
Cephalogram is taken with teeth together in
A cephalogram is a standardized centric occlusion
radiograph of the head and face. The
standardization usually is accomplished by
 The midsagittal plane of the subject's
head is placed 60 inches from the target of the
x-ray tube with the left side of the subject
toward the film. The central beam of the x-rays
coincides with the transmeatal axis, which is
the ear rods of the cephalostat. The distance
from the midsagittal plane to the film is held
constant at 18cm.
The PosteriorAnterior
Cephalogram with standard horizontal
relationship of the head
The head is rotated 90 degrees so that
the central ray bisects the transmeatal axis. If
the head will be tilted, distortions occur and
measurements of vertical distances are
unreliable.
M6-Lesson 4
Landmarks
Cephalometric landmarks are specific
structures, dental and skeletal, that can be
easily recognized on a radiograph. These
landmarks are used as reference guides in the
construction of planes and angles. Training and
familiarization with the location
of cephalometric landmarks is essential
because landmark identification errors are
considered a major source of cephalometric
errors .
Definition of the different Cephalometric
Landmarks:
A. Anatomic Landmarks
1. Nasion (N) - junction of frontonasal
suture in the midsagittal plane or the most
posterior point on the curvature at the bridge of
the nose
2. Anterior Nasal Spine (ANS) - the most
anterior point of the maxilla at the lower margin
of the anterior nasal opening
3. Subspinale (Point A) - most posterior
point in the concavity between anterior nasal
spine and superior prosthion
4. Superior Prosthion (SPr) or Supradentale
- the most anterior inferior point on the
maxillary alveolar process usually found near
the cementoenamel junction of maxillary
central incisors
5. Inferior Prosthion (IPr) or Infradentale -
the most anterior superior point in the
mandibular alveolar process usually
found near the cementoenamel junction of
mandibular central incisors
6. Supramentale (Point B) - the most
posterior point in the concavity of the mandible
between Infadentale and Pogonion
7. Pogonion (Pog) - the most anterior point
on the chin
8. Gnathion (Gn) - the most anterior
inferior point in the lateral shadow of the chin.
This is located by taking the midpoint between
Pogonion and Menton points
9. Menton (Me) - the lowest point on
the symphyseal outline of the chin
10. Orbitale (Or) - the lowest point on the
inferior rim of the bony orbit
11. Posterior Nasal Spine (PNS) - the most
posterior point on the bony hard palate in the
sagittal plane
12. Condylion (Co) - the most superior
posterior part of the head of the condyle
13. Gonion (Go) - a point on the curvature
of the angle of the mandible located by
bisecting the angle formed by lines tangent to
the posterior border of the ramus and the
inferior border of the mandible
14. Basion (Ba) - the inferior point on the
anterior rim of the foramen magnum
B. Derived Landmarks:
 1. Sella (S) - the center of the pituitary
fossa
2. Key Ridge (KR) - the lowest point on
the outline of zygoma
3. Pterygomaxillary Fissure (Ptm) - a
bilateral teardrop shadow formed anteriorly by
maxillary tuberosity of maxilla and posteriorly
by the anterior curve of the pterygoid process
of sphenoid bone. The landmark is the lowest
point of the fissure
4. Porion (Po) - the top of the ear rods
shadow (mechanical Porion); the superior point
on the curvature of the external acoustic
meatus (anatomic Porion)
5. Articulare (Ar) - a point at the
intersection of the posterior border of the neck
of the condyle and the inferior surface of the
posterior cranial base
6. Bolton Point (Bo) - the junction of the
outline of the occipital condyle and the foramen
magnum at the highest point on the notch
posterior to the occipital condyle
Video: Watch the video to better understand
the proper location of landmarks