ORTHODONTIC KEY POINTS

Compiled by Danesh Kumar-SIOHS/ JSMU

• Passive appliances--- retain tooth after treatment
• Space maintainer & Retainer---- passive instrument
• Methods of bite opening includes--Extrusion of posterior teeth and intrusion of anterior
• Cortical drift is a growth process involving—deposition& Resorption
• The focal film distance for a lateral cephalogram is—05 feet
• Moment is--- Force x Distance from centre of rotation.
• Minimum anchorage----2/3rd of extraction space is utilized by the movement of anchor unit.
• Classical pattern of extraction in Class II camouflage is--- Extraction of upper 1st premolars and lower
2nd premolars.
• Frontal cephalogram is used to--- Assess facial symmetry
• Natal teeth are defined as--- Teeth present at the time of birth, neonatal—after 30 days.
• 1st order bends are—in & out bands, 2nd – angle, 3rd order= torque & twisted
• 1st order bend compensate—difference in thickness, 2nd order—tipping, root positioning in mesio
distal direction & 3rd order compensate torquing/ facial inclination.
• Cleft lip and palate patient often requires expansion. Appliance of choice in such cases is--- Cap splint
type of expansion appliance.
• Sequence of eruption of permanent dentition in upper arch is---6-1-2-3-4-5-7.
• Face mask is primarily used to produce---AP effect.
• Relapse in rotated teeth can be avoided—by CSF
• Extraction is mandatory in the treatment of crowding if crowding is-- More than 10mm.
• Decompenstaion is done as part of--- pre surgical extraction
• ANB angle is used to assess----Sagittal jaw discrepancy.
• Anterior Boltan ratio is—77.2% & Holdway ratio--- 1:1
• Flush Terminal Plane means---Distal surface of upper ‘e’ flushes with distal surface of lower ‘e’.
• Sunday bite is defined as--- Habitual forward posturing of mandible to Class I.
• Pseudo-Class III is defined as---Posturing of mandible to Class II due to a premature contact.
• Early loss of upper ‘e’ leads to anchorage loss of upper 1 st molar as-- Mesial tipping, mesio-palatal
rotation and mesialization.
• Extraction pattern for Class II surgical cases is-- Lower 4′s only.
• Dental compensation in skeletal Class III cases is--- Retroclined lower and Proclined upper incisors.
• Optimal force for Bodily movement is---75-125 gm force per tooth.
• In RPE activation is done--- twice daily
• Most ectopically erupted tooth is-- Upper 1s t molar
• Prognathic profile is seen in patients with--- Skeletal Class III malocclusion.
• Unfavorable mixed dentition analysis is an indication for--- Space supervision and gross discrepancy.
• Excess in lower anterior Bolton is an indication for---Stripping in lower incisors or lower incisor
extraction.
• Absolute anchorage--Means Zero Anchorage Loss.
• Bite of accommodation means---Posturing the mandible laterally to establish maximum cuspation in
bilaterally narrow maxilla cases.
• Method of Intra-oral anchorage reinforcement is---Nance appliance.
• Mesiodens is a supernumerary tooth---Between central incisors.
• Tissue borne RPE appliance is---Hass appliance.
• Aspirin is a teratogen for--- Cleft lip and palate.
• Muscle involved in torticollis is---Sternocleido-mastoid.
• Class II elastics are given from---Upper canine to lower 1s t molar
• Co-Cr shift is normal---1-2 mm
• Canine guided occlusion---Canine to canine contact on balancing side, no contact on working side.

Orthodontic Key Points by Danesh Kumar-SIOHS/ JSMU(03312415069)

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 • RPE (evidence of mid sagital suture break) is assessed by---Upper occlusal radiograph.
• Well aligned deciduous dentition is an indication for--Potential crowding.
• Most commonly congenitally missing tooth is--Upper lateral incisors.
• Esthetic brackets are---Ceramic brackets.
• Retention in removable appliances is obtained by---Adams clasps.
• Distal shoe--- Permanent space maintainer
• Lingual arch--- provide anchorage
• Co/ Cr discrepancy in AP plane--- 2 mm
• W arch--- for skeletal cross bite
• Mini appliances--- for class 2 & 1
• Role of keyhole appliances—for hypo divergent case
• Serial extraction when space discrepancy is—10 mm
• Pattern of serial extraction—CD4
• Rx of mandibular deficiency--- functional appliances
• Valium--- cleft lip & palate
• Primate space—mesial to primary Maxillary canine
• Drug increase tooth movement--- prostaglandins
• Frontal Resorption—light force & underlying Resorption—heavy forces
• Tissue born( Frankel)—2 & 3
• Tooth born—active- expansion screws & passive= twin block, herbust & bioneter
• Monoblock--- activator & bioneter, twin block--- clerk B & herbust
• Frankel 2—for class 2, retrognathic Mandible, deep bite, growing patient
• Frankel 3—growing patient & open bite
• Pierre Robbins syndrome--- short Mandible & cleft palate, glossoptosis, airway obstruction
• Fetal alcohol syndrome--- Discriminating features ( short palpebral fissures, flat midface, short
nose, thin upper lip, indistinct philtrum), associated features (low nasal bridge, epicanthal fold,
micrognathia, ear anomalies).
• Ectodermal dysplasia/ HED—hypodontia, conical tooth, thin sparse hair, absence of sweat gland, dry
skin, hyperthermia, lack of development of alveolar process.
• Treacher collin syndrome— or mandibulofacial dystosis= lack of mesenchymal tissues in lateral part,
small Mandible, ear & nasal deformity, conductive hearing loss, underdeveloped lateral orbital &
zygomatic areas.
• Torticollis— facial asymmetry, affect muscle= SCM muscle
• Cleidocranial dysplasia---partial or complete absence of clavicle, narrow arched palate, retained
primary teeth & dentigerous cyst.
• Muscle weakness syndrome—increased anterior face height, open bite, supra eruption of posterior.

Condition Failure of fusion between

Midline upper lip cleft
Uni/ bilateral cleft lip
Oblique face cleft
Isolated cleft palate
Lip clefting
02 median nasal process
Maxillary & median nasal process
Maxillary & lateral nasal process
02 palatine shelves
Median & lateral nasal process

• One couple appliances--- Centilever

• Most common used bracket system--- Andrew
• Band same for all--- off set band.
• Most stable point on ceph--- sella.
• S shaped curve—general body
• Debonding of bracket by—by cutting bracket & removing it.
• After age of 06 years, increase in mandible occurs at—distal to first molar

Orthodontic Key Points by Danesh Kumar-SIOHS/ JSMU(03312415069)

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 • Placement of fixed lingual retainer with--- indirect technique
• Premature loss of upper primary first molar lead to---loss of arch Length
• Palatine Process fuse at the age of---06 weeks post fertilization.
• Facial asymmetry--- frontal cephalometry is done.
• Alveolar bone grafting Indication—during Late mixed dentition stage before eruption of canine.
• Most efficient tooth movement by – light & Continuous force.
• Vertical downward movement of Nasion—increased LAFH
• Minn Appliance is suitable in cases of—class 2 division 1
• Role of Kloehn Head Gear (cervical pull)--- hypo divergent case
• Retention for the gingival fibers requires a period of—12 month
• Third stage of treatment involves—space closure
• Generally extraction of premolars is done when there is a space—discrepancy> 9mm
• Cleft lip and palate is usually associated with—cross bite
• tooth size arch size discrepancies may be due to—microdontia
• Most common metal involved in allergic reaction is--- nickel
• In a case of diastema in children-- Best approach is to do nothing until permanent canines erupt.
• Recent method to get absolute anchorage is-- Use of micro-implant
• Common facial feature of patient with class II div 2 is--- skeletal deep bite
• Class II jaw relation,10mm overjet, short mandible--- functional appliance
• Appropriate for correction of a Class II malocclusion---Cervical headgear, Class II intermaxillary
elastics & Mandibular advancement surgery.
• Regarding straight wire appliance--- It is contemporary edgewise appliance
• Dental compensation in class III case involves--- procline upper and retrocline lower
• Role of orthodontist in the treatment of cleft lip and palate starts from--- birth
• For diagnosis of impacted maxillary canine, additional radiograph is--- occlusal view
• Lateral tongue thrusting--- cause posterior open bite
• Rapid Palatal Expansion is assessed by--- upper occlusal view
• Serial latral ceph--- useful in observing changes due to growth and treatment.
• Reliable tools for estimating skeletal age ----1.Cervical vertebrae from the lateral cephalogram
2.Hand-wrist film.
• Root resorption is mostly associated with--- intrusion
• Heavy, continuous forces--- Occlusion of the PDL blood vessels, Aseptic necrosis, Hyalinization,
Undermining resorption.
• Tooth in the mandibular arch most likely to be malposed in cases of arch space discrepancy is 2nd PM
• In stationtionary anchorage---- Movement teeth are allowed to tip and anchor teeth allowed to
translate.
• Factor has no effect on Root resorption during an orthodontic treatment— decay
• RPE—maximum separation of mid Palatal suture occurs at—between02 central incisor
• Least stable orthodontic correction—rotation
• Teratogen for trecher Collins syndrome---13 cis retinoic acid
• Area of Hyalinization – in lag phase
• Pressure Greater in Mandibular region—tongue pressure
• Ratio of width to height of maxillary incisors in perfect smile—8:10
• Measurements of skull--- craniometry
• IMPA—angle between Long axis of lower incisors & mandibular plane
• Not property of nitinol—Stiffness
• Cleft lip treatment—3-6 month & cleft palate—6-18 months
• TAD contraindicated before—12 years
• Material that have super elasticity---A nitinol
• Etchant for orthodontic bonding—37% phosphoric acid
• Tooth movement for facilitate other procedure--- adjunctive orthodontics

Orthodontic Key Points by Danesh Kumar-SIOHS/ JSMU(03312415069)

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 • Extraction pattern for Class 1 bi Maxillary protusion—Upper & lower 1st PM
• Method to determine discrepancy between size of max & mandibular permanent teeth—bolten’s
analysis.
• In Steiner’s method—SN – MP used to access--- vertical growth pattern
• Naso alveolar molding is pre surgical procedure to---For reduce severity of initial cleft, alveolar &
nasal defect.
• Face mask is used to produce—anterio posterior effect
• Thumb sucking—Quad helix
• Best Rx option for leveling of excessive curve of spee in class 2 growing patient—relative intrusion
• Skeletal Class 3 ---speech difficulty in production of Labiodental furcative(f,v).
• Prominent anterior teeth---fusion of sesamoid
• Bone enlargement because of Adjacent bone growth--- secondary displacement
• Supra crestal fiber capable of displacing tooth upto— 01 year
• Straight wire appliance develop by --- andrew
• In begg’ s technique, extraction space closed by—bodily movement of canine followed by retraction
of incisors.
Teratogen Effect
Aminopterin Anencephaly
Aspirin , cigarettes, dilantin Cleft lip & palate
CMV, toxoplasma Micro+ hydrocephaly, microphthalmia
Ethyl alcohol Central midface deficiency
6- mercaptopurine Cleft palate
13-cis retinoic acid, thalidomide, Valium Craniofacial microsomia & TCS
Rubella virus Microphthalmia, cataracts, deafness
X ray Microcephaly
Vitamin D- excess Premature suture closure
Zika virus Microcephaly, brain damage
• Labial bow –0.7 mm wire, coffin-1.25, T,Z & finger spring--- 0.5mm
• Normal midline diastema during mixed dentition---2 mm
• Slowest phase of eruption--- Juvenile occlusal equilibrium
• Short face type--- short anterior lower face height
• Stainless steel—18% chromium & 8% nickel
• Material of choice for initial alignment in ortho appliances—A- NiTi
• Class 2 division 2---lingually inclined upper canine & labially tipped upper lateral
• Second order Band compensate--- mesio distal tipping
• Well aligned Deciduous dentition—indication for Potential crowding
• Blench test--- for abnormal frenal attachment
• Ideal orthodontic wire---High strength, low stiffness, high range, High formability
• Esthetic bracket—ceramic bracket, disadvantage= friction between plastic bracket & metal arch wire
• Mc/ Mf ratio= 0=pure tipping, <1= controlled tipping, 1= bodily movement, >1= torque
• Causing Only cleft palate--- mercaptopurine
• Most aggressive treatment option for White spot lesion—Porcelain veneer
• Level decline to zero between activation--- interrupt force
• Stationary anchorage, anchorage from—most stable tooth
• Intrusion, center of resistance at--- root tip
• Mal occlusion don’t need retention---Anterior criss cross bite
• Interceptive/ preventive ortho not effective after Eruption of – permanent 2nd molar
• Smile arc—contour of incisal edge of Maxillary anterior followed by Lower lip curvature.
• Range= elastic bending of wire before permanent deformation

Orthodontic Key Points by Danesh Kumar-SIOHS/ JSMU(03312415069)

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 • Distal shoe contraindicated in --- bacterial endocarditis
• Maxillary intercanine dimensions complete in – boys= 18 year & girls= 12 years
• Chronic mouth breather—prominent anterior, Convex profile & long face
• Short face type—rotation= excessive forward
• Transverse expansion not possible in lower—across canine
• Ideal CVM stage to correct class 3--- CS2-CS3
• No discomfort, Cellular activity, no blood vessels occluding—optimal force
• IOTN exception→ dental health
• Class 2 elastics→ mesial movement of molars
• Inter labial distance→ 2-4 mm
• Lower lip→ 2 mm posterior to B line.
• Rotation due to → trans septal fibers.
• Thumb Sucking pattern→ first year of life
• Banding→ heavy intermittent force
• Intrusion center of rotation→ infinity
• Mesial part of rotation is not pressed→ rotation
• Steel→ soft by annealing & hardened by cold working
• Anterior cross bite→ transverse plane
• Inhibit tooth movement→ prostaglandins inhibitor
• Not a functional component (functional appliance)→ wing shield
• X ray doesn’t cause macrocephaly.
• Mandibular growth→ translated down , forward, & up
• Soft tissue→ decreased exposure of UI , both at smile & rest
• Tooth( bone loss)→ small force, large moment
• Spacing between inciosr, frenum→ frenectomy before treatment
• Ankylosed tooth, trauma→ decoronation.
• Fusion of mandibular Condyle cartilage→ 4 months
• Thumb sucking, nasal breather→ complex tongue thrust
• Intra membranous growth→ cranial vault & Mandible
• Ugly duckling stage→ physiologic
• Rx for class 2→ head gear, psudo class 3+ short face—chin cup therapy, Ortho surgery→ lefort 1
• Class 3, retrognathic maxilla, short or normal face--- face mask/ reverse pull headgear.
• Most relapse→ rotation
• Infantile swallowing→ first year
• Point of first deformation→ elastic limit
• PDL space—0.5 mm
Sound Malocclusion
S,z( sibilant) Anterior Open bite & incisors gap
T, d( linguo alveolar) Irregular incisors/ lingual position
F, v( labiodental) Skeletal Class 3
Th, sh, ch( linguodental) Anterior open bite
• Tissue growth 200% growth before puberty--- lymphoid
• Spheno occipital synchondrosis--- complete by 16-18 years
• Example of moss functional matrix Theory---- hydrocephaly
• Indirect growth control--- epigenetic
• Ceramic bracket greater strength---- mono crystalline
• Increased SNA= prognathic maxilla , decreased show retrognathic maxilla.

Orthodontic Key Points by Danesh Kumar-SIOHS/ JSMU(03312415069)

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 • Wit’s analysis (-1-0mm), <-1= class 3, > skeletal class 2.
• Increased facial Angle= prominent chin & decreased= retrusive chin.
SNA 80-84° Facial Angle 83-91°
SNB 78-82° SNMP 28- 36°
ANB 0-4(>4- clas -2) FHMP 21-29°
Y axis 56-64° MMA 21-29°
Facial axis 90° UI- SN 97-107
IMPA 86-94° UI- NA°/ distance 22°/ 2-6
Z angle 73- 83 Naso labial angle 90-100°
• Increased SNMP= high angle face, decreased= low angle face.
• Increased MMA = long anterior face, decreased= short anterior face.
• Class 2= division 1= increased overjet, convex profile, v shaped arch, short lips.
• Class 2= division 2= decreased overjet, straight, Normal lips, u shaped arch
• Adenoid faces--- open bite & clockwise growth
• Most first appeared sounds-m/p/b/b
• Pre emergent growth--- Resorption of primary tooth & root
• Analgesic for ortho treatment—ibuprofen
• Hasburg/ rocher’s--- prognathic Mandible
• Cement for cementation of molar band--- Zinc phosphate
• Material of choice for bonding of bracket--- resin/ composite, other= modified GIC
• Arch wire for alignment, leveling, space closure—NiTi
• Radiolucency at mesial & distal surface of tooth--- cervical burn out
• Example of absolute anchorage—mini screw
• Class 2 elastic—e.g of intermaxillary anchorage
• Method of growth prediction before development of x ray--- chronological age
• Minimize anchorage loss due to friction—loop mechanics
• Most accurate method for estimating size of un erupted 2° teeth—Staley kerber
• Bolten ratio> 77.2% -- Mandibular anterior excess
• Box elastics--- intermittent force
• Anterior cross bite with deep bite--- Z spring
• Andrew’s 06 key of normal occlusion= 1= class 1 molar relationship, 2= correct crown angulation, 3=
correct Crown inclination, 4= no rotations, 5= no space, 6= flat to slight curve of spee
• Intra membranous ossification→ secretion of matrix, e.g cranial vault, maxilla & body of Mandible.
• Endochondral ossification→ cartilage to bone, e.g cranial base, condyle of Mandible.
• Synchondrosis--- growth center
• Mixed dentition, high arc palate, retained upper deciduous—incisors liability
• Development—increase in complexity
• In vital staining experiment, all are principal sites of growth of Mandible except—anterior surface of
ramus
• Gene for growth of alveolar process--- MsX2
• In vital staining—common dye= alizarin
• Class 2 molar relation--- ectopic eruption of 2° max 1st molar, premature exfoliation of 2nd Pm.
• Lingual inclination of CI, DBC of upper 1st molar in MBG of lower 1st Molar—Class 2/ division 2
• Greatest amount of cranial growth—birth-05 years
• Leeway space in mandible= 2.5 mm & greater in Mandible than Maxilla
• Primate space physiological space, in maxilla(mesial to 1° canine),in Mandible(distal to deciduous
canine).

Orthodontic Key Points by Danesh Kumar-SIOHS/ JSMU(03312415069)

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 • Leeway space( combined mesiodistal width of 1° canine, 1st & 2ns molar is > 2° canine, 1st & 2ndPM,
the difference is leeway space, maxilla= 1.5 mm, Mandible= 2.5).
• Forces required for movements (in gm)=> tipping, rotation & extrusion = 35-60, bodily movement=
70-120[HIGHEST], root uprighting= 50-100, intrusion,= 10-20[LOWEST].
• Grade 4- IOTN= severe treatment need
• Habit of keeping jaw forward--- Sunday bite
• Shifting into anterior cross bite due to incisors interference= pseudo class 3
• Chipped upper CI--- class 2, division 2
• 70% overbite= deep bite, diastema in mixed dentition= 2mm
• Difference between width of 2° & primary incisors= incisor liability
• Fast early growth & then minimal growth after 6-7 years= neural tissue
• Uglying ducking stage—physiologic, disto angular inclination of incisors with midline diastema
• Scott theory—primary determinant of growth= synchondrosis
• Experimental approach for physical growth study—vital staining
• Most accurate method to access growth deformity—CT scan
• Structure causing secondary Maxillary displacement—cranial base
• Ideal CVM stage for orthodontic treatment--- stage 3
• Furcation of tooth will be visible—at Nolla stages-07
• Trauma at nolla stage-06 cause--- root dilaceration of permanent tooth
• Eruptive tooth movement—at 2/3rd of root formation
• Practical method of growth prediction before x ray analysis—peak height velocity curve
• Extraction advised—nolla stage 8-9
• Most common cause of late lower incisors crowding—late Mandibular growth
• FTP- of primary molar relationship in Early mixed dentition—molar relationship in permanent= class 1
• Maturation of oral function--- anterior to posterior gradient
• Dental age -08 = Maxillary lateral incisors eruption
• Stage of rapid eruption from the time a tooth 1 st penetrate gingiva until reach occlusal level= post
emergent tongue.
• Last speech sound a child speak—r, require precise position of posterior tongue
• Adult swallowing--- relax lip & posterior teeth
• Juvenile to adult chewing--- during eruption of permanent canine at 12 years.
• Epiphysis is wide as metaphysis & distinct lateral border of epiphysis—MP3-FG stage
• Growth occurs more anterior than posteriorly—backwards rotation
• Age changes in facial soft tissue--- lip become thin with less vermilion border display
Mutation Gene Condition
IFR6 Cleft palate
TCOF Mandibular dysostosis/ TCS
FGRR2 Crouzen syndrome
RUNX2 Cleidocranial dysplasia
• Infraocclusion—ankylosis
• Midface deficiency at nasal bridge & prognathic Mandible--- synchronous defect
• Thumb sucking best described by—sears & wise
• Syndactyly--- features of apert’s syndrome.
• Acromegaly associated with--- class 3 malocclusion
• Congenital defect of cleft lip & palate— bilateral posterior cross bite
• Mouth breathing with enlarged tonsils & adenoids--- obstructive
• Thumb Sucking--- anterior cross bite & Maxillary constriction, flared max incisors.
• Tongue thrusting--- increased overjet, Narrow maxillary arch,Open bite & incisal protusion.
• Mouth breathing→ increased facial height, supra eruption of posterior teeth, increased overjet,
anterior open bite, convex profile, narrow arches.

Orthodontic Key Points by Danesh Kumar-SIOHS/ JSMU(03312415069)

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 • Macro esthetic→ facial view/ symmetry( apply rule of 5th & 3rd) & profile analysis( jaw, lip
• posture, inciosr prominence, lip competence, Mandible plane angle etc).
• Mini esthetic → tooth lip relationship ( dental Midline, incisor stomion, occlusal cant), smile
• analysis ( teeth & gum display, buccal corridors, smile arc).
• Micro esthetic → Dental appearance ( tooth height, gingival shape, contour, embrasures, shade).
• Frontal Resorption→ when light forces applied to tooth, blood flow is partially occluded, painless,
smooth progression pf tooth.
• Undermining Resorption→ heavy forces, painful, blood flow cut off, cell death, step wise fashion of
tooth movement.
• Tooth mobility due to---- PDL space widening & disorganization of ligaments.
• Pain is due to---- heavy pressure, hyalinized area, mild pulpitis.
Anchorage Key Feature/ definition
Simple Active movement of single tooth VS several anchor tooth.
Single/ primary Tooth moved against a tooth with a greeter alveolar support.
Compound Teeth of greater resistance to movement are utilized
Stationary By pitting bodily movement on 01 group of teeth against tipping
of other.
Reinforced Reinforcing resistance area either by adding more resistant unit.
Cortical More resistance, slow tooth movement.
Skeletal Anchorage by structures other than tooth, e g intra oral screw,
implant, extra oral headgear, facemask, TAD
Absolute 100% retraction of incisors.
Maximum 80% retraction of incisors,20% forward molar movement.
Moderate 50% retraction of incisors,50% forward movement of molar or
60% incisors retraction & 40% forward molar movement
Minimum 20% retraction of incisors & 80% forward molar movement.
Reciprocal Applying equal force to arch segment & PDL
• Fusion facial process—at 6th week of development.
• Complex tongue thrust activity--- naso respiratory distress, contraction of mentalis & lower lip during
swallowing, absence of contact teeth during swallow.
• Mouth breather—pigeon face appearance
• Diagnosis of tongue thrust by --- lower lip held lightly by thumb & asked to swallow.
• Suckling reflex & infantile swallowing diminished by—1 year age
• Defect because of intrauterine molding---pierce Robbin syndrome
• PHV( peak height velocity)→ greatest annual increment during puberty or 0.9 to 01 year before
puberty, it’s between C3-C4 stage.
• Most common congenital deformity= clubfoot, ( 2nd=cleft lip and palate).
• Competent lips= upper & lower lip meet @ rest, in competent= lips separated by 3-4 mm, potentially
incompetent= lips have ability to meet but due to some factors,they are separated, gap 4-5 mm.
• Broad smile is more esthetic than narrow smile, flattened smile arc/ non consonant is less attractive .
• Tanaka & Johnston analysis→ use width of Lower incisors to predict the size of unerupted canine and
pre-molars.
• Z angle→ Angle formed by intersection between Z line & Frankfort plane, indicate prominence of soft
tissues chin. Normal= 80-76.
Spheno ethmoidal Complete in 6-7 years
Spheno occipital In last- 15-18 years
Inter sphenoid Complete at birth
• Lisp in speech--- because of anterior open bite
• Increased SNA= prognathic maxilla
• SNA angle represent—relationship of Maxilla to cranial base

Orthodontic Key Points by Danesh Kumar-SIOHS/ JSMU(03312415069)

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 • ANB= SNA- SNB

Landmark Definition
Nasion Anterior point of intersection b/w nasal & frontal bone.
Basion Median point of anterior border of foramen Magnum
Sella Midpoint of concavity of sella turcica
Orbitale Lowest point on inferior margin of orbit
Porion Mid point of upper contour of EOC
Ptm Point @ base of fissure where anterior & posterior wall meet
Pogonion Most anterior point on contour of chin
Menton Most inferior point on Mandible symphysis
• When distance from ANB to point A increase--- angle decrease
• Distance between Maxillary posterior & the inside of cheek on smile= buccal corridors
• Amount of incisor display at rest--- incisors stomion
• When width of LI is 62% & wrt CI because of curvature of dental arch= golden proportion
• When the contour of incisal edge of maxillary anterior Wrt contour of lower lip during social smile is
called Consonant smile.
• Most apical point of gingival tissue= gingival zenith.
• Distance between max posterior & inside of cheek—buccal corridors/ negative space
• Compression side→ decreased blood flow, decreased oxygen level, increased CO2 level,
osteoclastic activity & bone resorption.
• Tension side→ increased blood flow, increased oxygen level, decreased CO2 level, osteoblastic
activity & bone remolding.
• Hyalinization area--- a narcotic area or a vascular area in PDL, it’s histological appearance, cause
delay in tooth movement.
• Controlled tipping ---if center of rotation at apex, uncontrolled tipping--- when center of rotation is
very close to center of resistance.
• Drugs increase tooth movement= prostaglandins, relaxin & vitamin D.
• Drugs decrease tooth movement= prostaglandins inhibitor (indomethacin), corticosteroids, NSAID,
bisphosphonates, TCA, anti arrhythmic, anti malarial, phenytoin.
Intermittent Force Force level decline abruptly to zero intermittently. Eg
Removal plates.
Continuous Force Force maintained at some appreciable fraction of original
from 01 patient visit to next, heavy continues forces are
destructive. E g fixed appliances & springs.
Interrupting Force Force level decline to zero between activation, e.g fixed
appliances.
• Average inclination of Frankfort horizontal plane to SN plane= 6-7°
• Horizontal planes= Frankfort, palatal, occlusal, Mandibular & SN plane.
• Frankfort plane→ porion to orbitale.
• Palatal or Maxillary plane→ from ANS to PNS.
• Occlusal plane→ line bisecting the distal cusps of molars & pre molars.
• Mandibular plane→ gonion to Menton.
• Wit’s more reliable because --- ANB is affected by facial height, position of nasion, jaw rotations.
• Roll is --- vertical positioning of teeth/ upward & downward deviation of jaw, yaw is--rotation of jaw
or dentition to one side around the vertical axis, produce skeletal/ dental Midline shift.
• 02 forces create couple--- equal in magnitude but opposite in direction.
• In patients with greater loss of periodontal attachment, center of resistance move in--- apical
direction.
• Elastic—Reinforced anchorage
• Single Force applied against the crown of toot—tipping movement, simplest movement

Orthodontic Key Points by Danesh Kumar-SIOHS/ JSMU(03312415069)

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 Elastic limit Point at which any permanent deformation is 1st observed.
Range Distance that wire will bend elastically before permanent
deformation occurs.
Yeild point Point at which 0.1% permanent deformation occurs.
Proportional limit Highest point where stress & stain still have linear relationship/
Hook’s law.
Strength Greatest force a wire can sustain or deliver without undergoing
change.
Stiffness Force required to bend a material to a definite distance
Formability Amount of permanent deformation that a wire can withstand
before it break.
Resilience Maximum amount of energy absorbed by wire
• Lichers’s classification— Angle’s class 1= Neutro occlusion, class2= disto occlusion, class 3= mesio
occlusion.
• Angle’s classification→ maxillary 1stmolar is key to occlusion. Class 1- incorrect line of occlusion but
normal molar relation , Class2- MB cusp of Max 1st molar ahead/anterior/mesial to Buccal groove of
mandibular molar. Class3- MB cusp behind/ distal to buccal groove.
• Canine classification→ class 1- mesial slope coincide distal slope, class2- mesial slope ahead &
class 3- mesial slope behind distal slope.
• Incisal classification→ class 1- incisal edges of upper incisor at/below Cingulum plateau. Class 2-
Incisal edges posterior to Cingulum( Division 1- proclined & division 2- retroclined) ,class3-Incisal
edge anterior to Cingulum plateau.
• Curve of spee,---anterio posterior, start@ tip of incisal edge to distal cusp of 3rd molar.
• Curve of Wilson---mesio distal, contact buccal & lingual cusp of molars on both sides.
Overjet/ horizontal overlapping Normal= 2-3mm, mild 3-4, moderate 5-6,
severe 7-10mm
Reverse overjet/ negative overjet/anterior Normal- O, moderate 1-2, severe 3-4 or
cross bite greater.
Overbites/ vertical overlapping Normal—1-2mm
open bite/ negative overbite moderate 0-2, severe 3-4 mm
Deep bite/increased or severe overbite/ moderate 3-4, Severe 5-7 mm.
traumatic overbite
Sunday bite / dual bite Habitual forward posturing of Mandible
into class 1 & severe Class 2
• In Steiner’s analysis, SN -MP is used to Assess—vertical growth pattern.
• Chin prominence wrt lower incisors prominence---- Holdway ratio
• Emphasize Vertical & horizontal analysis both—sassouni analysis
• Deformation of bone Create current--- pizo electric current
• Closing diastema by --- reciprocal anchorage
• Source of osteoclasts in undermining Resorption—adjacent bone marrow
• Compressed PDL – increased CO2
• Primary physiologic response to heavy pressure against tooth= bending of bone
• Distraction osteogenesis—bone can be induced to grow by surgically created site
• Physiological response to heavy force 3-5 sec= blood vessels within PDL occlude on pressure site
• Physiological response to light force after 4 hours= increased cAMP level & cellular differenciation.
• Movement by headgear—heavy intermittent
• Nolla stages of tooth development: stage 1-5 duration- 6 years, stage 6-8 duration- 2-3 years, stage 9-
10 duration- 2-3 years.

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 • Stages: 0-no crypts, 1- crypts, 2-initial calcification, 3- 1/3 of Crown Calcified, 4-2/3 crown Calcified, 5-
complete crown, 6- crown complete ( flat cervical region & start of root formation), 7- 1/3 of root, 8-
2/3 of root, 9- complete root (open apex), 10- closed apex.
• Trauma BEFORE stage 6 cause Turner tooth, trauma AFTER or at stage 6 cause dilaceration.

Force< 1 second PDL fluid incompressible, bone bends, & piezoelectric current
generate.
Force for 1-2 sec PDL fluid expressed, tooth move within PDL space.
Force for 3-5 sec immediate pain, fluid squeeze out
• Highest root resorption—maxillary central incisor
• Alveolar height loss per year because of ortho movement—0.5-1 mm
• Anchorage—resistance to undesirable force
• Greatest frictional resistance—beta titanium
• Property of shape memory—NiTi
• A- NiTi--- used for initial alignment, preferred, long range, relatively constant force, flatter load
deflection.
• M- NiTi--- later stage, flexible but larger & somewhat stiffer wire , at low temp & high stress
• Fully annealed stainless steel wire—soft & highly formable—called dead soft wire.
• When 02 solid surface are pressed together orone slide over other, real contact occurs only for a
limited time—Asperities
• Diameter of Centilever wire double—strength increase by 08 times
• If length of Centilever beam double—bonding strength cut into half
• First consideration during fabricating Spring design—adequate strength
• Example of preventive orthodontic---- distal shoe
• Functional components of bioneter—lingual flanges
• Rate of screw activation fir RPE--- 0.5- 1mm/ day
• Anteriors Deep bite--- cervical pull headgear along with Hawley retainer
• Multiple upper posterior missing teeth—space maintain by – lingual arch
• Clear aligners therapy—for mild anterior crowding
• Age for surgical repair of cleft palate—12-18 months
• Class 1 skeletal, 11 mm crowding--- Rx= serial extraction
• Maxilla grow---- downward & forward, frontal surface is remolded, & bone removed from most
anterior portion(resorption) & deposition at back.
• Growth order in Maxilla => transverse→ anterio posterior→ vertical
• Mandibular Development from Meckel’s cartilage ( it disappear after mandibular growth, remnants
convert into 02 small bones.
• Condyle cartilage develop as secondary cartilage , initially as separate area of condensation at 08
weeks & fuse with body at 4 months.
• Thumb Sucking --- first line of approach= counseling
• Quad helix--- for correcting bilateral posterior cross bite & thumb sucking
• Prominent lower jaw, class 3--- Rx = class 2 elastics attached to mini plates
• Concave profile--- improvement by mandibular set back
• Missing 2nd 1° molar & mesially drifted 2° 1 st molar, space loss of 2-3 mm= Rx segmental arch wire with
push oil
• Class 2 malocclusion—extraction pattern= upper 2 nd PM, lower 1st pre molar
• Serial extraction--- part of interceptive orthodontic
• Possible cause of gummy smile--- excessive downward growth lf Maxilla
• Concave profile, anterior croaa Bite, developing—Maxillary protusion with facemask
• Adult, class 1 malocclusion, arch discrepancy-3mm—Rx= interdental stripping
• Ugly duckling stage of dentition—seen at 8-11 years
• Correction of ugly duckling stage by --- canine eruption

Orthodontic Key Points by Danesh Kumar-SIOHS/ JSMU(03312415069)

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 • Deficient Maxilla & Normal Mandible--- reverse pull headgear
• Direct bonding of bracket by – mechanical
• Generalized spacing—Rx fixed appliances
• 2× 4 mechanics--- 02 molar band & 04 bracket on anterior
• Mild & thick Labial frenulum—Rx after Eruption of permanent canine
• Generalizd spacing occurs mostly because of--- tooth arch discrepancy
• Clear aligners used—for unwilling patients for bracket
• Suitable age for extra oral appliances--- 8-9 years
• Anchorage after extraction when retracting anterior--- TAD
• Black gingival triangle--- Rx= IPR
• Class 3, axial inclination of Lower incisors & class 2-axial inclination of upper incisor—procline
• Class 2—axial inclination of lower--- procline
• Disadvantage of ceramic bracket--- enamel fracture during debonding.
• Surgery for Mandibular advancement & set back—sagittal split osteotomy( SSO)
• Class 3 decompression--- upper 1st Pm, lower 2nd Pm
• Stable orthognathic surgery--- Lefort 1 osteotomy with down fracture.
• Transposition--- positional interchange of 02 adjacent teeth within same quadrant.
• Class 1 bi Maxillary protusion--- extraction pattern= upper 1st PM & lower first PM
• Region most unstable after expansion of arch 2mm --- canine region
• Successful reposition of Maxilla before age of--- 8 year
• Begg technique—space closed by tipping, & in tweed technique= bodily movement
• Alveolar bone grafting better during--- late mixed dentition stage before canine eruption
• Removable appliances most retained by – adam clasp
• Poor control of root position by – ribbon arch system
• Anterior bite block--- for correcting deep bite with Short face
• Primary indication for banding--- teeth receiving heavy intermittent force
• Most aggressive treatment for white spot lesion—porcelain veneers
• Preferred site for debonding--- between bonding material & bracket
• Incidence of ectopic eruption of canine--- 1-2%
• Impacted canine visualization by--- CBCT
• Retention suitable after midline diastema--- fixed
• Retainer control overbite--- Hawley retainer
• Single most examination of TMJ--- maximum opening
• Supracerstal fiber re organize within—12 months
• Formation of new layer over preformed bone---Apposition growth of bone
• Cephalo caudal growth pattern--- head complete first
• Serial extraction indication—severe class 1 with potential crowding
• 07 key of occlusion—bolten analysis
• 20 year old , posterior cross bite--- fixed appliances & SARPE
• 0.5 SS Centilever have `X ` strength, double the diameter, strength will be---,8x
• 25 years old, Maxillary deficiency--surgery needed
• Pizo electric current--- organic crystal in bone
• Class 2- Malocclusion—25%
• Retention after diastema—by fixed appliances
• Most important phase in adjunctive orthodontics—disease control
• Most common sequelae of loss of 1 st molar—tipping/ drifting of adjacent tooth
• No retention needed--- anterior cross bite
• Collagen fibers within gingiva reorganize in 4-6 months
• Periodontal fiber reorganize in--- 3-4 months
• Molar up righting with mesial root movement--- reduce space & eliminate need of prosthesis
• 05 year, 1° 2nd molar loss before eruption of permanent 1 st molar,-- space maintainer—DISTAL SHOE

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 • 5 years, extracted lower 1° 2nd molar because of caries, space maintenance for unerupted 2 nd PM—
distal shoe
• Appliances for only one missing tooth & low limited strength---band & loop
• 6 yr, extracted lower right & left 2nd primary molar, no eruption of lower 2° incisor --- space
maintenance by--- bilateral band & loop.
• 6 yr, multiple caries, lower right & left D & E extracted, lower 2° incisor not erupted—space maintained
by—bilateral partial denture
• 5 yr, right & left lower D & E are extracted, space maintenance—by distal shoe+ partial denture
• 08 yr, when examined , R & L upper D & E extracted, space maintenance by – Lingual arch
• 8 yr, R & L upper D & E are extracted, short lower facial height, deep bite—space maintainer—nance
arch
• Final phases of spurt growth---- adult occlusal equilibrium, slowest phase—juvenile equilibrium
• Anterior crooked tooth, convex profile, 78% overbite, 2mm overjet, retroclined CI—Class 2/1
• ANB indicate—sagittal jaw discrepancy
• Ceph --- for assessing tooth- tooth, bone -tooth & bone- bone
• Increased LAFH, downward rotation of Mandible, High mandibular plane angle, large gonial angle—
open bite
• Dental compensation in class3— by retroclined lower & proclined upper incisor
• RPE activation—twice daily
• Excessive lower anterior bolten--- stripping in lower incisors or lower incisors extraction.
• Prognathic profile--- skeletal class 3
• Most ectopically erupted--- upper first moalr
• Initial alignment--- by round wire
• Ideal property of alignment wire—excellent strength
• Phase 2—correction of molar relationship & Extraction, and space closure
• Headgear force—350-450 g, pendulum appliances—200-250 g
• Final step of bringing teeth into occlusion--- final settling of tooth
• Tooth positioners--- For gingivitis
• Most effective way to intrusion of Posterior--- skeletal anchorage
• Supplemental tooth—supernumerary tooth resemble adjoining tooth.
• Activator--- monoblock, tooth born
• Active finger spring --- movement= tipping
• Leveling & alignment→ correction of molar relationship, extraction, space closure, anchorage--→
finishing-→ retention
• Most common complication after treatment with severe crowding & rotation—appearance of black
triangle—Treatment by IPR( inter proximal reduction)
• Pull headgear most effective--- at 8-9 years
• Serial extraction= interceptive, lip guard, thumb sucking correction, topical flouide= preventive
• Serial extraction contraindicated in --- canine impaction, missing pre molars, class 2/ division 2, class
3, spaced dentition, anodontia, oligodontia, open bite, deep bite, midline diastema.
• Serial extraction indicated in--- potential crowding, class 1, arch Length deficiency, straight profile
• Method of serial extraction—dewel= CD4, tweed/ nance method= D4C
• De rotation in posterior teeth—with fixed appliances incorporating spring or elastics.
• Isolated cleft palate--- deformity affect female mostly.
• Diameter double—strength increased 08 time & springiness decrease by 16, range decrease by 02.
• Length double—strength half, springiness increase 08 times, range increase 04 time.
• Edward H angle—father of modern orthodontic
• Whip spring—for correction of rotation
• Synostosis--- early closure of suture or early fusion of bone by bone
• E line ( -3 -2)--- decreased E line= RECOMBANT, increased value—PROCOMBANT
• Incomplete bite— no incisal stop but overlapping of incisor.

Orthodontic Key Points by Danesh Kumar-SIOHS/ JSMU(03312415069)

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 • Complete bite—have incisal stop.
• Distance from X Ray source to mid sagittal plane—5 feet ,film= 15 cm.
• Major reason for orthodontic treatment--- psycho social effect
• Reposition alveolar segment—03 segment or large is preferred, 02 tooth segment- less Predictable.
• Most stable Orthognathic procedure is—superior reposition of Maxilla followed by mandibular
advancement.
• Least stable Orthognathic surgery – surgical widening of Maxilla
• Widening of Mandibular symphysis—not by orthognathic surgery
Condition Management Time
Lip closure 2-4 weeks
Palate closure 12-18 months
Alignment of maxillary incisors 7-8 years
Alveolar bone grafting 7-9 years
Orthognathic surgery Late adolescence
• Rule of 10= weight of 10 pounds, hemoglobin of 10 g, age of 10 weeks
• Veau classification= class 1- soft palate only, class-2= soft tissue & hard palate, class 3- complete
unilateral soft, hard, lip & alveolar ridge, class 4- defect complete bilateral.
• U6R35= U- maxillary, 6- Molar, R- right, 35= size
APPLIANCES INDICATIONS/ FUNCTIONS
Labial bow Retraction of anteriors, overjet reduction, anterior space closure, retention
Z spring/ double helical Centilever Labial movement of incisor
T spring Buccal movement of canine or pre molar
Finger spring/01 helical Centilever Mesio distal movement of tooth
Coffin spring Arch expansion, transverse cross bite correction
Canine retractor Palatal and distal movement of angulated canine
Screw Arch expansion, lateral expansion, labial movement of blocked tooth
Adam clasp For 1st molar retention
South end clasp Retention of anteriors
Labial bow Retention, prevent proclination of upper & lower
Ball end clasp For interproximal area
Circumferential clasp Engagement of bucco cervical undercut
Base palate Hold wire & screw, as one unit, transmit force, prevent engulfment
Removable appliances Arch expansion, bite correction, space maintenance, single malposition tooth
Anterior bite block Deep bite & short face
Posterior bite block Open bite & long face
Fixed appliances Precise tooth movement, intrusion/ extrusion, retraction, bodily movement
E arch Only tipping movement, apply heavy intermittent force
Ribbon arch Provide vertical rectangular slot
Band Heavy intermittent force, short crown, extensive restoration, labial & lingual
Ceramic bracket Esthetic, more bulky than plastic, durable & resist staining
Class 2 elastics From upper canine to lower molar
Class 3 elastics From upper molar to lower canine
Removable appliances Activator, bionator, twin block, franklel
Fixed appliances Herbust, forsus, jasper jumper
Mono block Activator, bioneter
Twin block Clerk B & herbust
Passive Bioneter, herbust & twin block
Herbust Create artificial joint that keep Mandible in forward position
Activator Advancement of Mandible in growing age, bulky

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Bioneter Deep bite correction, Class2, growing age, arch expansion, open bite (II)
Twin block Growing, class 2, short face, overjet reduction, expansion
Frankel 2 Class 2, retrognathic Mandible, deep bite, growing patient
Frankel-3 Growing patient, open bite
Functional appliances Class 1& 2, 3- rare, long face/ open bite, short face/ deep bite
High pull headgear Class 2 - prognathic maxilla, high angle case, growing face, class 2 long face-
OPEN BITE— Effect= decrease facial height
Straight pull headgear Class 2, normal angle case, growing age
Low pull / cervical headgear Class 2- prognathic maxilla, low angle face, class2-DEEP BITE/ short face,
growing—Effect= increase lower facial height
Face mask/ reverse pull headgear Class3- retrognathic maxilla, growing age, short face ( duration-12-14 hours)
Chin cup therapy Pseudo class 3, short Vertical facial height
Band & loop Single unilateral 1° posterior, single primary Molar, duration= 14 hours
Distal shoe Loss of 1° 2nd molar before Eruption of permanent 1st molar
Lingual arch Multiple missing primary tooth, bilateral E & D missing
Nance lingual arch Deep bite ( for Maxilla)
Trans palatal arch One side of arch is intact, > 1 missing on other side
Fixed arch expander W arch, Quad helix, FPE with jack srew
Removable arch expander Coffin spring, split palates, active plates, Frankel
Quad helix Bilateral maxillary contraction, Thumb Sucking, cross bite
W arch For early mixed dentition, bilateral maxillary expansion, skeletal CB in 2°
Bonded hyraxe Long facial profile
Banded Short face profile
Hass type Band on 1st Pm & molar
Minn implant Class 2 division 1
• Average voice change start 1.8 years after onset, pubertal voice change0.2 years before PHV.
• Internal rotation--Bone surround the inferior alveolar nerve is called core, rotation in core, move jaw
forward & upward , internal rotation have 02 components, 1)Intra matrix rotation→ within body of
mandible, & 2) matrix rotation → rotation around condyle.
• 15° rotation occurs from 4 years, 25% at condyle & 75% from Body of Mandible.
• Surface changes in rate of tooth eruption is external rotation, that move jaw backward & downward.
• Backward rotation--when growth occurs more anteriorly than posteriorly & gives positive sign..
• Forward rotation—Negative, posteriorly growth
• Short face height→ excessive forward mandibular rotation, Horizontal palatal plane, low mandibular
plane angle, deep bite & crowded incisors.
• Long facial height→ palatal plane rotate down posteriorly, excessive backward mandibular rotation,
anterior open bite, inc mandibular plane angle, mandibular deficiency.
• Age changes→ decreased exposure of UI, Lower exposure of LI, thin lip with less vermilion display,
occlusal wear, dec width & height, mesial drift of molar.
• Most common cause of late mandibular incisors crowding is late mandibular growth.
• With age→ decrease in enamel thickness & pulp thickness, inc dentin thickness & crown exposure.
• Gingival migration of attachment without any eruption is passive eruption.
Class Camouflage / compensation—Extraction of
Class1 Bi Maxillary proclination—all 4s
Class 2 Upper 4 & lower 5
Class 3 Upper 5 & Lower 4

Orthodontic Key Points by Danesh Kumar-SIOHS/ JSMU(03312415069)

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GROWING PATIENT
Class 2 Excessive Maxilla
Head gear
Long face—high pull headgear
Low face—low pull headgear
Normal face—straight pull
Class 3 Deficient Maxilla
Reverse pull headgear
Frankel 3
Skeletal class 3 elastics
Deficient Mandible
Functional appliances—
removable or fixed
Excessive Maxilla
Chin cup
Class 3 elastics

NON GROWING
Class 2 Retrognathic Mandible Prognathic Maxilla
BSSO Lefort 1 osteotomy
Lower border osteotomy Maxillary segmental osteotomy
Class 3 Prognathic Mandible Retrognathic Maxilla
BSSO Lefort 1
Mandibular set back Maxillary segmental osteotomy

Errors & Omission are accepted

Feedback is welcomed…
Compiled by – Danesh Kumar-SIOHS JSMU

Contact Info—kumardanesh058@gmail.com/ 0331241059

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