HIGH ANGLE CASES-MANAGEMENT

Control of vertical dimension is recognises as an important as well as often difficult part of

abondomic treatment. In effective vertical control cause downward and backward rotation of
Mandible prolong treatment and compromised treatment results. Vertical ontrol is often difficult as
most methods used to exert vertical central are higly patient dependecncy. Controlling vertical
dentalveolar development if often difficult, because menshodntic merchant tends to produce
vertical movement of him. Vertical movement of teeth one least vertical therefore immediate effecr
is seen.vertical control is difficult also because most methods depends on patient complaits

Features of high angle cases

Skeletal features:

Tapered facial types

Leng cown mind of face

Leng mandills

Short Mandills

Shot rames

Clan II Skeletal relationship

Intracal Features- open file

Clean 2 tendency

Increased everjct

Narrow Upper arch

Growth rolohin-patient /Bacteria and Rotation

Cephalemetric feautures: enlarged adebebd seeing in aph

Incresed dentovascular height in the System <Doubt>

Weak muscles allowing molar erupsion

Bjork is even featurised of protect growth relation

1 Inclination of the Cendylon Head-Straight Proper apt

2 Anvalue of the mandibular card-straight

3 Shape of the mandibular lower bending-Netched

4 Inclination of the symposis(ankir aspect pant showne B point)

5.interiancial angle-acute

Interpremolar & intermolar angle –Acute

Intension lower Facial Height-Tall

Tarabale ratio: 58; Heigh angle case, reduced vertical

-upper anteria Facial height: Growth contain facial Height=less than 5%

Vertical depth indicated (007) less than 680

Cephacelmine feauture

SN/Mp Angle - 40 degree or greter

OP/MI Angle -22 degree or greater

Mandibular angle-32 degree or greater

PFII/AFII (faraba’s Ration = 58 Percent or less

UFH/LFn =0.55 or less

Vertibe Depth indicate (OR)=68

Soft tissue features

Leng lown 1/3 rd of face

Narrow nose

Narrow alar bases

Decresed maxobasial angle

Incepeart lip

Extensive exposure of maxillary antesion term and gowth at rest and smiling which is dull to
dentovascular compensation of the anterior part of maxilla to compensate of anterior open

Retruded Chin

Another factor influency vertical development is the musculature. The so called lens angle cases
tend to have Stronger musculative that will conteract the sxclusive faces of shodentic treatment of
contract, ‘High Angle’ cases are associated with weaker musculative, whcish allows fro the greater
expansion of vertical fore, that are generated during treatment

Profit belated that there are 3 indicators that can be used to product the tendency toward open bit
these are:

1. The cranial base feature angles(suddle angle)

an increased saddle angle predispense to dental and skeletal opentile

2,The metation of the maxilla-being up enterily and down properly

3, a short rames height and these gebital angle profit also suggest that extreme antegenial
matching indicator a deispensity between muscle growth and <doubt> growth

Etiologic consideration:

1,mouth breathing-long face patients(height angle acases oftenlook as if my were breathing

through their mouth, but their may not be the case laboratory studies indicate that men children
and adults with long face <doubt> brethe perfectly through the name on the othr other hnd,
more long face than normal children and adults have a increased sal/nasal<doubt>
It appears therefore that for some patients, mouth breathing may play

A role in the long face condition, but it is difficult in rule as a frequent exologic agent

2,Muscles weakness in a number of muscle weakness syndromes the facial appearance produces
a <doubt> of the typical long face Patient. This observation led to the idea of weak mandibu;ar
elovotes muscles must cause the long face pattern of the muscles are weak, <doubt> would
decrease, altering the<doubt>

To empt to much and the mandibate to roatet downward.Although adult elongface patients do
have below normal occutral forces, pre adolsect children also alredy can be recognised a long
face types decent.The long face patients appears not to gain muscle during solescent, atleast in
the mandibular elevates as do the namal individual;

3,Tongue almost-long face patient with open bite are very likely to a labelled as having a tongue
nearest because they place the toungue tip into thr opening during swallowing and speech the
portion of tongue is a necessary phyoopic adaptation to the open bite not its cause. When the
incresis develop normally, he tongue and places behind the to create the incess overlap
normally, the tongue an be place sbehind them to create the anterior seal necessary, the tongue
an be places behind them to create the anterial seal necessary for swallowing or articulation of
conon are with an pen bite, the tongue must protrude to seal against the lips. Tongue portion
during swallowing and speech adapts to the portion of the teeth, rather than the other way
annual. The best clinical demonstration in the patients response the shognatic surgery to correct
open bite which narly always eliminated tongue throat as it corrects the <doubt>

2 aparts are worth special emphasis with regend to long face patients(1) Although resting
toungue patient can be a signicant energetic factor in dento facial definity, tongue patients
during speech and swalloen in len important and. (2). The patients in when tongue is most likely
he significant and not the long face <doubt> instead certain clan III problem are must likely to he
developed when tongue pesheris abnemal

4,Genetic Factors-provide family studies have made it clear that vertical facial proportion have a
strng intended component.there is a facial difference-long face, open bite problems seem to be
propation Have a strong Intended component that vertical facial propotion have a strong
intended Component. There is a racial difference –long face, opern bite problmes sum to be
proportionately more frequent in blacks than in whites

For any individual patient it seems that both environment influences and inherited indencies
have played a role as the long face developed. The environment factors properly parts
individuals who are possible became of their inherited facial proportions attitude the normal
shape of variation

Treatment of digit sucking habits(BOS guideline row)

A. Non physical method:

B. 2,explanation
C. II, reward
D. III,habir reversal
E. IV, teeth the child carry art alternative activities when they have the urge to such the digit
B. Physical Methods.
Reminder theraphy like finger bandage, finger print or tumb ptint
Intraercial Opplanils
I,have been shown to be effective within 10 months
II, they must be Fitted with the fill understanding and co-operaton of child and must act
compreomise compliance with ant future aantodactic treatment
III, fixed reversal
IV. teeth the child Carry out a;ternativr activities when they have the urge to much the digit
B,Physical methods
Reminder therapy like finger bandage, finger print or finger print
Intera real oppanils
I,Have been Shown to to be effective within 10 months
II,They must be full understanding and co operation of child and must not compromise
complaints with any five treatments
III, Fixed Appearance lite appliance With units
IV,Renuable appliance
V,Funtional Appearance
Habit Breakers Applaince
I, Vertical Units-Restrain the augue from excessivge anteria Movement & Membership
A0040”Support archieve Suddended Bands 1 st Molecules
A vertical Cage is extended Just Behind the anterior
2, Flat Crib-for thumb Sucking
Unics are placed Across the parallel the occlusal Place present the number containg wage
This Appliance is also less molecule and vertical Appliance
3, Lake- For patients that sum to get around all the slot designs
Vertical Sake IS extended Just Behind the Left Arthritis
4, Pearl- Restrain the tongue from excessive anterior Movement
A vertical Cage is extended just behind the left anteriors
To prevent the patient from tongue thumb
A pearl is added in the Caulve of the Palate to Restrain the tong
hyotherapy-It aim to Alter resting tongue and up pushups
A,Exercise
B, Appearance
Hypotheraphy exercises: Ask the Patient correct Swallowing Pattern
By placing the tip of tongue on the palate, else teeth, close lips and swalloe with tongue in
that oin him. After the new swallowing pattern Learnes on the conclusion level it is memory
to refine in sussequency Flat Suggest That drops
Incresred to refine susequebntly by asking the patient to held fruit drops Against the palate
Ask the patient to squeezw teeth together as hard as possible for 15 secs relax and repear
3times for total of 1 minute
This exercise shared the lene 5 times a day (Bouncing exercise)
Hypotheraphy appliances
Spring Loaded bile Block The spring loaded bite block has helical Sprays that are placed
Both lingually and bucally Between the 1 st prender region and last mellarim. The end of the
spring are embedded originallt in the molar regions of the Acrylic part of device .The upper
and lower acrylics occal blood are connected by palatal and ligual Axis which are Connected
by palatal and ligual axis which are actrated to force of 450 gm liberally. Patients are
instructed to use the appliance for an average of 16 cm Daily
 Passive paceria bit block: are functional applliances that are used the Appliance thar are
used to open the bite 3-4 mm beyond the rest for him in growing palats his inhibited the
increses in height of dental dentovascular Process this preventing Downward and Backward
motion of mandible. It also allows Differntial Exception to Scan as the labial symus can
except untindered hence Cling the anterior open click
-The functional Regulatory Appliance (FRIV)
Is establish the mandible forward rotation with edges of shileds rotational senter anternity-
the force of verticular muscle chain being strengthened by lip exercise raises the mandible
Owens Morfomation of a functional regulators differs from other frankel appliances by
A,addition of acrylic blocks to arrest motion encryption
B, has headgear tubes that accept a facebow for an occipital pull headger which prondes the
appearance in the pointive control of the pacteria maxilla
Cochrane review , by olivera in 2007 showed that there is a weak evidence that the is a wak
evidence that the interventors FR-4 with lip seal Training and palatal his associated with high
pull chin up are able to correct anteric open bite
Turn block with modification
1,thick thin block appliance the ramps membrane 5 mm to 8 mm in thivkness in the
premolar region thin Block with headgion to upper 1 st molar
Vertical clasics to upper and lower position numerous regions.

B- Repelling are each magnets in the occual bile blocks.

True block into perkins with blocket

Bile underperking in incleared to the deep write creation

Bike is to be spered above the normal being vehind demind

Blocks in melon prevert this expantion, and the expending of bike speech the vehicles.

Low mandibution lip Bumpes and Lingual Arch:

Certain and ten thove adverced the case of a lip bumps for the development of the lewels dental
and, they marggerted that by the lip bumper were adjusted low, he cheek and lep muscles would
best above the appealce and then will inhibit vehicles mandibular development

Enbracral brachon:

There are several possible approaches to the long face patter of growth in <doubt> childrens. The 2
brade hand method of impeding examine vehicle growth have been

1) high pull head gear to the mailing fixed applicans.

2) mechanical applicans that imorparcules bike blocks brought the cath.

The Headgear applies a direct exlonal force to appove vehicle mandiary development, the functional
applicans decisions indirectly, by spartching the muscullans and the facial soft musicians to crak a
machine force, which is then applied to this occusal surfaces of his teeth via the blue blocks. In the
arcles of their clinical effective they are”

High pull headger to functional applicans with blue blocks.

Blue blocks on functional applicances

High pull headgear to mancillany applicant high pull headgear to melons.

High Pull headgear to the melon mainclains the vehicle portion to the maxilla and infunction the
expantion of maxillary portion sath.

Force Prexiption for headgeon to resolution maxillary growth.

Force of 500 – 1000 gm C half an each gile)

Force direction highly above the occution france (throught the cuter of relations of melon)

Force direction at least 12 has 1 day, everyday, with exphasis in weary in from early evening (eight
after dining)

Uncle the mext mering

When Compansions are made using varied vehical and herizoned vectors of fore, there with the
greatest high pull vector dermontrased the mest vehicle control of the upon melon the biggest
problem with high pull headgear Is that a purely vehicle pull in abot almost impossible to archive
trustead, the force has a significant backward componance for sorce particulas, the maxilla is not
prorosire and only vehicle face in needed. Brother problem, is that it does not control exphases of
both mullans, which can be a problem in cure patients.

Lower melon exphasis way contribute to me vehicle financial changes 2 outtrip the changes made by
controlling the up melon into the headger.

High pull headger to a machinery spilint:

Another Headger approach for children with excerse vehicle development is the use of an arylic
closed spline to which the face how is attached. Anto a applice, all the feet and controlled – not font
melons, this allows vehicle force to the directed against all the machinery with and appean to above
a substantial mammillary detail and filled effect in the good vehicle control. Perhaps must important,
be band cap can be allared be bring the live of force more entirely, user to the cull of resistance of
mammilla, with headgear to the 1st melon, of the line of the fore in to vehicle of the for entirely, at
will pass in pent of the centre of resistance of these teeth. & the melan will up forward, with a splint,
the centre of resistance in that of the entire mammilla, and a more vehicle pull is priset.

An appliance of this type would be most unful in child in the excessive vehicle development of the
illine maxlland are and too much expanse of the mammillary in curis from beneath the lip. Cie long
face child who does not have the entire open bite) To achieve both sheletal and dental correction,
the patient must be compliant through tent what can be a very long mercent period. Unfortunately,
the mammilla apliant mandibution perkins with to except foresly, and if this occurs, there may be
neither reduces of growth ner forcable upond and forward notion of mandible.

Funtional appliance with bite bleachs:

A more effective attentive is the use of functional appliance that includes perkins bite blocks. The
retraction force of headgear in replaced by somewhat losses “headgear effect” of the purchases
appliance. The promony purposes of the appliance in the inhibit expantion of perkin each and
vehicle decent of mammilla, in a mandebution deplient patient, it would be a mandibular depent
palients, it would be advantagions to advance the mandible when the functional appliance
important was when, where in patients with a normal size mandible and a longly vehicle problem,
the banks would the possible with ant any mandibilon advancement. When the mandible in brought
fine and in the worhing bike, the breach of the self shine events a vehicle intrusive force an the
parinans both. In children with ancerin open bike, the anterior open bike, the antheir both are
allowed to except with reduces the force that, while in children withour pen hut, all seen and held by
bite blocks. Because, then in no compensatory pertein explain, all mandibulon growth be divided
more entirely.

In that soon, this style of functional applians fore breach in effective in controlling maxmillary vehicle
should and deatal growth, this un to project mandebulon growth entirely and hips to clove arkins
open inves.

High pull head geans to functional applians with bite high pulls headger to a applicans with bike
blocks, appears thurch to be the best approach to control the long petter 1 growth, the entroral
force increases the control manmmillary growth and allows the force to the delivered to the whole
manmmila Nathen than to the permanent 1 st melon. The high pull headger improves machine of the
functional appliance of produces a force direction near the estimated center of resistances of
mamilla. The functional appliance provides the problity o f entirely mandibution growth while
controlling the emphasis of perkins teath.

Vertical control during fixed approdentic therarpy, Vehicle pul chin cup:. The vehicle chin cup has
been used an a supplementary service with in bread fixed applicans of clain cup and a head bonnet
connected at then by clastic or an elastic shop to generate vehicle years described the use of the
vehicle pull chin cup alone bin clan I parent with over vehicle appliances) or in conjuplect in lists
certical gear (when accuranpanied with an antrophasis pallans the vehicle chen cup displays an
antrip of mandible, with the force vehicle parriary throught the anteire font of the mandibution
emphasis and 3 cm from the ants canthe of the eye. Even shelied the effects of vehicle chin cap
deline and fund a decrease in the mandibulan plane angle, perkins while of the mammilla, decrease
in the tower perkins heighs and an increase in over teech in open bike cases.

The vehicle control pat Is requested to wear the clin cap 12 hrs 1 day, the forces used is a millians of
16 owens an each side and the disclaims of pull on of forward as poosible.

Critical adjustable correctors, John P. devincern designed the VAC with one buceal bar, a trans and
shoblining wire and 3 slutetal implants is which 2 whole placed in the pekins superin to mommilany
while one ancuire was placed dispal 1 merical to the central increase, the forces were applied with
the help of power control which in attached to pufs of malon implants to the each user between the
brief 2nd melon. In products an initial force of 300-450 grams in the perkins jons and 125-250 son of
force in the procedure and anclair region. It was deserved not persolling artier with introted at the
rale of 1mm personal and melons at 0.6 mm for month. It was observed that the vertical adjustically
carrector ca be used for instruction of as well as certain along with the re of Archive vertical crechar
it is an applicance consisting of repetting magnets placed in blocks which cover the pills delligin
indicted that vehicle can the controlled by conduct in forces by achive vehicle corrector which the
organised field cases increased cellucon activity with probability of microcurrent flow acting as an
positive harms with soliver aching flow achivg as an positive hims with solivar Kalra replaced an
increased in mandibilon length, inproducting with ad an upward 2 forward autrotoion of mandible
with the use of fixed magretic applicance. Belive and replaced making 2 mandibolan, melon
introduction and with achive vehicle correction. Be Mention, on dying the effect of bike block on
with and without repelling magnets in which monkey shidid the effects and mentioned meding
inboth the play go maxillary, with and in products. Kension and ingervall composed the are of spring
loaded bike blocks with bite blocks with repelling magnets. Their reshlt observed an average
improvements in punbite of 1.3 mm in the spring loaded group and born in magnet group.

Vertical no deep Appliance:

The vertical society appliance was introduced by debardini all who modified the transpullate and in
an attempt to control the vertical dimension of high angle partiches. The button of the modified
vertical holdly appliance was of a uniform direction of 12mm and the lives which was positioned
midway between the mommilary 1st melon and 6 mm away from the place to allow the pressure
from the unique to act as an force an described try chitra et al. recommended initial force of 500gms
will et al suggeed chat 90gm/foot for melon is growing children.

Use of Class II or Class III Elastics is in high Angle Case:

It has been replaced that attached of class II elastics to the tower 2 nd melon created to more
herizoned vehicle of force (throuogh, 1970). Peason (1997) recommended evidence of elastic
applications to the owen 2nd melons. The slated that of elastic, engagement in obviously necessary,
short class II elastic could be attached from upon 1 st melon to a class II hook and then to the distal of
the own premelon both (1985) replaced that one, two, three short class II classes an each ride may
be applied from the mention peat of the two 1th melon to be messal of upper 2n promotion, from
the distal of the lower 2nd premelon of the mesial of the upper 1 st premelon, 2pm distal of the lower
1st premises to the upper canive.

Ebtraction of teeth for vehicle control:

Accordingly to peason, entraction of premelon leads to menal draft of perticlar teeth which causes
classes of mendible plane angle. Lighting a logan find the encleation of grandibution 2 nd promotion in
beneficial, in selected cases, to control the vertical demonsion, the criteria for selection in cluded
minimal lower and discrepney, a mandibulon plane angle grater than 38˚,hyproducged sheltal
pattern and increased lower then facial height. Famaguchi and Nanda concluded that the changes in
hential and vehilcal fraction of the melon are dependent on the type of force application, and not on
the entraction or non entraction shalgy, when entroction are fant of the treatment plan, it is
important to control the vehicle pention of molinory I mandibulon melon leath to avind him vertical
occulsed invenmant, which nullify the demansable desing introduction of the thandibal, particularly
in adult. Midhloopedgeuire Aech Aise->

Vom pupulovized anuthloop edgeviae arch wie (MEAW) for corvecton of penbit rerloceltion. The
MEAW untain, hrodet and vhlid coopo faticates from be 16X22SS his in on I shoped forin the vhtial
upto act with break behaven the teeth, within the wod deflection rare and pardn horizandal control.
The horizandal loops faith reduce the load deflection rele and provdn vehial control. Typical tip hach
bendo of 3-5 deguo orgine on eaclhard elartic and placed behaveen is loops that the mercial of
opening compids.

Miniimplant encharage ogstem:-

Recently, the one of implants as a served fabelutx shelesal ancnge tha been repered. Human that
end the wanium in miniplant to intrude protin ketn, thnely reducing the vhical dercmin inadults in
the blanium reinplants was hired to the rrlen teeth and who and to inhrude the perten heath the
lown mulam wou intruded 3-5mm, and the paenbit was rejnfethy endued with almost no vichel
moment of another with. A lown lugial grch in neguied to couneact the buccel moment gennved ny
mlan intruvin when form are applied from the bunnel.
Adoleunts wuith quirentable growthplacinal:-

The best been plan for adulb with questionable growth prtheil from-> attempt growyj modification
being heedgm we paid functional application, and camel the peth and parents but if the connevative
attempt does not succedd, regired nehind will be recoded. Until attempts at comferage,growth
midpoint reatrent does no larn, and it can in have be behind and sagettal realation.

Adults with little or no growth prennal:-

For long face palient with nofroput for successful growth moorfacin, then is no real attention to
energy. A faith who has a genune long face problem and who refer is unside surgical correction is
better left unhide.

Timing of surgery:-

As a gennal nule, early jansugery has little inhibet effection on further growth. For the unseen,
chroganei purley react be delayed inlil growth in senhaly impuiled:

Planning Surgical-Ghodinthi Trealmat:-

Sungical APPROACH-> Doessive long facial hight in the forgin dihngurihing chinnal chanoclabi of long
face peat of followers logically ner nureg to decur the regcal of the chain and more in the hey to
product of him problem. A dicsore in face high can to acccrablished in 3 ways.

1)Left 1 aslcohry: to rupently the rnenills. When the marila mans up the rnansbil taken meud the
horizandal confylas are to move up with it, both the chain upwand and forword inducetty, menulley
jurgey repetation the mandible.

2)mansibulton rang storeny: to bring the lowjwq forword and upward, with could be accrrrplished in
an open but patient. The protin of the reantt6s would but the atterd at all.

3)Mandibulan infair brave sushurry: to reparation the chain upward and forword. Renetly in the
proedue by ibely in an adult, but it in a upwrd adjunct to greth of the new 2 regical prmbills.

In paatein who face hight shald be neduced, mainly orney in the program produce, learn astaory is
recommendable only as annessday produced, after the marilla has been repenined hielly.

The manivlla in the found rngical hrattut in long face of 2 only reaction.

1) The mainvilla nearly always for essier vertical developers when the mandbit ray not be
invalid beyond be indinet whend the reculley ray not be indiviul beyond be indent notation
and revullay sungry urrects. Neethu need jaw the found in more good anbetin can be
aechied unwant curried manually depering for must pater.
2) 2) Maj the marelle up productions a stable angical correct what the mandbil at the ramno
obeby abe in a counlocked dincent reft fibe proteinly and in refouany unreblt.

Orhodonhi approach-> As with any facial ghrowdefin cat, the author proppch in reach whons
pentiony the teeth pre-surgcally in all 3 plane of space so their punishment will facilitate the
regical plan and the teeth will fior approprepely when the sugeny in compled. To accerrmfiled
for 2 2 thing quite specipuily:

1) When the reasulla will be kept of frmans of orgented ranonellyy or into ankieprokier all be
reprotined, ot when chain- lip alance is to be ached by ahodnally responding the incoins.
 Long face fallith ranely have a recently engged because of space in the manalbil even if a delp
rabit in presnt as a general rule, it in prefoable is level me lower and before surgery on the did
hard, a long face fatiant with reach anhire open hise often has ans enhave even of free in the
upper each, in the partr the behind steps enbit in unuslly to help and double to conine, the rare
servent has the more developers it in to surgment the mavill during surgery luvd the each
hydeponding the denaleved the rehodomits role in to see net the energy space behaveen the
who of the involved kept to allow individual unkohwmin and to level pre-surgerally with the
suggent but nut acccoress the rehurry stain.

The more rece the rensw morilla and the red the prent, the better the deibnt to enpand angicelly.
Of the patti in yump energy that decision to enpand anagically of thr pattied facesurfical empamcin
upto afacction is appliance in a acephablesure idly asshed plalal expamin to walen a narroe mindek
in a patient also will be reheduced for left-1 abously lean is but recommended nethein main any
reson to empland whodoingcally if the detonatangent be uncant with left 1 or the who don’t role in
to see that there is energy space between the rools of the included teeth to allow introduced
inleomics and to level pre syically which the symat but not access the machinery soles.

The more sevens the nanrow monilla and the older the patient, the better the decisions to expand
engically. It the patient is jump enough that it is possible to open the nature enough that it is
possible to open the nature who phychycical empasician with a Jackson is appliance is acception
surgically palagal expansion to uncles a narrow maxilla in a patient who will be scheduled or lefost 1
later is not recommended neither is theif any reason to expand who dentically if the
dentrolweargement can be created with defect 1 colonary.

Devisions on these parents mart be made before the orthendetik can set the detailed plan or the
presuplied and pentsurgical who don his. Canfuce import planning between the surgean and to
establish the general approach to breadcast and make then initial decision is essential before any
fread begins. Hisband contract to requires a discussion of these disses.

Pre-Surgical Orthodontics:

3 Points one of special inperent for high angle spetical 1) A left 1 requires a long incresion in the
mainallly veriblue and a mandibulton infire burdon almony requires an increan in the mandibulan
enterin vestibute. Scan can during treating pulls the grangiral attachment aplically when the
attachment is questionable, the attachment should be augmelod by planning girgiral grofts in
doubtful was at least 2-3 months before the orthogretic ranging, frefably before the authentic
begings.

2). In a patient with an entries open bite where plan calls for a regimented maxillary victory with
entire open their dentoalvelon oldmants, it is important with entire open their dentalverton
alymonts, it is important to level the upper each during the presungical who desires.

3) If the maxillary and will be expanded who dentically, this should the done at the very beginning of
the pre surgical who desires, so the expansion can the maintained as long as possible before the
expansion appliance in eventually reserved

Introdentic Appliance canndiction:

In contemporary surgical – trodutic corrected, a forced, dotic appliance serves a purposes.

(1) Accemplish the worth movement needed in prepanatio from energy.

(2) Stablize the teeth and basal bone at the born of anging and during healing.
 (3) Allens be necessary presurgical both movement whole relaining the surgical change.

The appliance most permit the case of fill dimension selection such with for strength 2 stebility,
during the phase of broadcast.

Stabilizing anchiwised It should be placed atleast as weels before surgery so that they are passive
when the impressions are takens for the surgical splint (urcally 1-2 weeler before surgery). Then
ensolves that there will he no both ments, the sholbing when are full dis edgewise wires (i.e. 17725
ss in 18 slot appliance, that a steel in 22 shat applians) nobls attachment to tice the jaws hag chat
whill regred final in is placed are needed there can be added at be him of spliant importance. They
can bran wises attended to tech stabling wire

Post surgical orthodontics:

As him all surgentics surgery patents, the entrodents some the splint when the patients in ready for
post-surgical satroducts the splint should the reserved until the patient is already to have the
slabiting achievents resolgved so that passively strodestings can be proced

With mammillary surgery only, authendic beat ment probably can reserve 3-6 week post signically,
with 2 jams surgery a length healing time seems predent.

When the shobbing waives are served, they should be replaced at the same apartment with wholing
achivements and light vertical elastics, light vehicle, elastics are needed he critical impubes
permission been that mention would cause the patient to seek a new portions of maximum
intercuspillon.

The mickiest part of post surgical for long face patient is maintaining maximillary expansion,
particularly surgical expansion, of causes attent 6 months following surgery for the mallionary
remarks to shitting broad so they must be held in their expanded position deney the printing
authenticas using a transplaced a such. The tramplacal such should not the reached during the first
put surgical team the potents who had brances expansion mant wear the maximillary retair diligency
full pains for atteach 6 months.

Course of relapse:

a) Cannuced unforcatable pertain mandibulon growth retion.

b) unforcable brogens portion.

c) cantuid haitut

d) Eressive entrosion of incross

e) relapose after energy.

Management of Relapose:

1) Incorrection

2) Using high pull headgear attached to upper memorable appliance

3) Relation with possive bite blocks, which super edy place inprassive heth, served he used the sould
be contributed until facial growth haralment reach a mins flims will into care teens.

4) Some Recommend up 2 tongue muncle exercise.