Introduction, Branches and Terminologies of

Orthodontics
Introduction
 Orthodontia, also known as orthodontics and dentofacial orthopedics, was the first specialty created
in the field of dentistry.
 The specialty deals primarily with the diagnosis, prevention and correction of malpositioned teeth
and the jaws.

Malocclusion
Abnormal alignment of the teeth or the incorrect relation of the teeth of the two dental (upper and lower)
arches.

CLASSIFICATION (ANGLE’S METHOD)

1. Class I Malocclusion
Molar relation is normal but line of occlusion is incorrect because of malposed teeth, crowding,
spacing, rotations, missing tooth, etc
The mesio-buccal cusp of the maxillary first permanent molar occludes in the buccal groove of
mandibular first permanent molar.
Normal inter-arch molar relationship
Normal muscle function and normal skeletal function.

2. Class II Malocclusion
Lower molar distally positioned relative to the upper molar, line of occlusion not specified.
There are two divisions:

I. Class II Division I – Class II molar relation with anterior teeth proclined.

II. Class II Division II – Class II molar relation with central incisors retroclined and laterals
either tipped labially or overlapping the centrals.

3. Class III Malocclusion

The lower molar is mesially positioned relative to the upper first molar, line of occlusion not
specified.

CLASSIFCATION:
True class III
Pseudo class III
Class III subdivision

Terminologies
There are several deviations in the position of the individual teeth within and between jaws.
Linguoversion Labioversion (Buccoversion)
The tooth is lingual to the normal position The tooth is positioned labially or buccally.
Supraversion Infraversion
The tooth extends above the normal line of The tooth is positioned below the normal line of
occlusion. occlusion.
Torsiversion Transversion (Transposition)
The tooth is rotated along its own axis. Eruption of tooth in place of adjacent tooth .
Crowding Spacing
Malalignment of teeth caused by inadequate Space between teeth that can be generalized or
space localized.
Overbite Overjet
 Vertical overlap of the maxillary incisors over the The horizontal overlap between the labial surface
mandibular incisors. of the mandibular incisors and the lingual surface
of the maxillary incisors.
Deep bite Open bite
It is a condition when there is excessive vertical No vertical overlap of the maxillary and
overlap between the upper and lower anteriors. mandibular teeth.
Cross bite Scissor bite
Transverse or buccolingual discrepancy of teeth Complete posterior crossbite of maxillary teeth is
Can be either anterior or posterior called scissor bite.

Branches of Orthodontics

1. Preventive orthodontics
Preventive orthodontics focuses on the elimination of factors that can lead to malocclusion.
EXAMPLE:
Space maintenance from premature tooth loss.
Elimination of thumb sucking.
2. Interceptive orthodontics
Interceptive orthodontics involves guiding dental and facial development. Usually attempted in
mixed dentition or very early in the permanent dentition.
EXAMPLE:
For space problems, some space can be regained :
10mm space loss serial extractions can be attempted.
3. Corrective orthodontics
Corrective orthodontics involves the use of a fixed orthodontic appliance to correct the malaligned
teeth in adults or adolescents (permanent dentition).
4. Surgical orthodontics
Surgical orthodontics involves a surgical procedure and then applying orthodontic appliance to align
the teeth.

Indications Of Orthodontic Treatment

1. Unattractive facial esthetic.

2. Dysfunction of TMJ.
3. Susceptibility to dental caries.
4. Susceptibility to periodontal disease.
5. Impaired speech caused by malposition of teeth and /or jaws.

Contraindications Of Orthodontic Treatment

1. Poor oral hygiene and lack of cooperation.

2. Lack of bony support for the dentition.
3. Poor general or mental health.
4. Lack of interest.

SCENARIO BASED QUESTION # 1

A 9 yr old girl with 2mm midline diastema was brought to an OPD with the complain of esthetic
issue by her parents. What is the best treatment approach.

a. Finger spring
b. No treatment is required
c. Double cantilever spring
d. Segmental fixed appliance
e. Hawley’s retainer
 SCENARIO BASED QUESTION # 2
A 10 year old boy visits an orthodontist with complain of severe crowding of more than -10mm
space discrepancy in the upper and lower arches. What is the contraindication of serial extraction?

Space discrepancy is greater than 10mm

Normal over jet and overbite
Class 1 molar relation
Straight profile
Skeletal discrepancy of jaws

Concepts Of Growth & Development

Definition of Development
• Physiologic and behavioral phenomenon
• Increase in complexity
• Increase in specialization

Cephalocaudal Gradient of Growth:

Growth occurs along an axis from the head to the feet.
- Pre-natal vs. post-natal body proportion: Post-natal growth in body regions farther from the hypophysis
(pituitary gland) is more pronounced.
- Head proportion in development:
- Around the third month of intrauterine life, the head constitutes approximately 50% of total body
length.
- At birth, the trunk and limbs have grown more, reducing the head's proportion to about 30% of body
length.
- The trend continues with the head's relative size decreasing to around 12% in adulthood.
- Lower limbs development:
- Lower limbs are rudimentary around the 2nd month of intrauterine life but grow to represent almost
50% of body length in adulthood.
- Head and face growth:
- At birth, the cranium is proportionally larger than the face.
- Post-natally, the face grows more than the cranium, indicating an increased gradient of growth even
within the head and face.

Variability
Variability in growth arises due to normal variation or from influences outside the normal experience—
illness. Variation in timing arises because the same event happens for different individuals at different
times and is influenced by:
1. Genetics
2. Sex related differences
3. Physique related
4. Environmental influences

Definitions
Differentiation – “It is a change from generalized cells or tissues to a more specialized kind during
development”

Translocation –
“ It is a change in position”

Maturation –
“It is the emergence of personal characteristics and behavioral
 phenomenon through growth processes”

Importance of growth and development to Orthodontist

Etiology of malocclusion

Health and nutrition of children

Comparison of growth

Identification - abnormal occlusal development at an earlier stage

Use of growth spurts

Surgery initiation

Planning of retention regime

Growth spurts
Defined as periods of growth acceleration
Sex-linked
Normal spurts are
1. Infantile spurt: at 3 years age
2. Juvenile spurt: 7-8 years (females); 8-10 years (males)
3. Pubertal spurt: 10-11 years(females); 14-15 years(males)
Growth modification can be done during this phase.
Any sort of surgical procedure should be avoided as it will recur because growth is occurring.

Differential growth:
Human body growth varies among organs and throughout life.

Scammon's curve of growth:

Different tissues have distinct growth patterns.

1. Lymphoid tissue: Rapid growth in late childhood, reaching nearly 200% of adult size by 18 years.
2. Neural tissue: Rapid growth, almost adult size by 6-7 years, with minimal growth thereafter.
3. General (visceral) tissue: "S" shaped curve with rapid growth until 2-3 years, a slower phase from 3-
10 years, and a final rapid phase, ending by 18-20 years.
4. Genital tissue: Negligible growth until puberty, followed by rapid growth to adult size, then ceases.

LONGITUDINAL GROWTH STUDIES.

Theories of Growth control

What controls the growth of the jaws?

Genetic theory
Bone theory
Cartilage theory
Functional matrix theory
Petrovic servosystem theory
Combination of theories

Sites vs. Centers of Growth

Growth Site:
A location at which growth occurs
Responds to external influences
Example, sutures
Growth Center:
a location at which independent, genetically controlled growth occurs
All centers are also sites but the reverse is not true
Example, hyaline cartilage, synchondroses

Genetic theory
Genetic simply states that genes determine and control the whole process of craniofacial growth.

Based on two mechanisms:

Transmission genetics
Molecular genetics

Bone theory

Bone is the primary determinant of its own growth

Genetic influence lies within the bone
Cartilage theory

Cartilage is the primary determinant of skeletal growth, while bone responds secondarily and
passively.
Cartilage theory

Experimental evidence PARTLY supports this theory

Epiphyseal plates of long bones have innate growth potential

Nasal septal cartilage grew in transplanted sites
Cartilage theory
Experimental evidence PARTLY supports this theory
Early loss of nasal septum results in midface deficiency
Conclusion

Cranial base synchondroses and nasal septum act as independent growth centers, pushing the maxilla
forward
Mandibular condyle is merely a growth site
Functional matrix theory
Soft tissue matrix in which the skeletal elements are embedded is the primary determinant of growth,
both bone and cartilage are secondary followers.

Growth of the face occurs in response to functional needs and neurotrophic influence sand is
mediated by the soft tissue in which the jaws are embedded.

Example : Growth and development of mandible occurs at a site of division of inferior alveolar
nerve.
Functional Matrix Theory
EXAMPLE:
Microcephaly due to small brain size and vice versa
Enlarged eye causes a corresponding increase in size of the orbit
Enlargement of nasal and oral cavities in response to functional needs
Mandibular growth impaired by ankylosis
Functional Matrix Theory
Clinical applications:
Rapid maxillary expansion
Functional Matrix Theory
Distraction osteogenesis
Induction of bone growth at surgically created sites

Petrovic servosystem theory of growth

This theory state that ”occlusion provides a constantly changing input which influences the
horizontally regulated growth of midface and anterior cranial base.
Combination of theories
Growth of cranium is a response to growth of brain (sutures+ periosteum=growth sites)
Growth of cranial base is a result of endochondral growth at synchondroses (growth centers)
Growth of the maxilla is primarily a result of apposition and remodeling as the bone is translated by
soft tissues (sutures+periosteum=growth sites)
Growth of the maxilla may result from endochondral growth at the nasal septum cartilage (growth
center)
Growth of the mandible occurs by endochondral growth at condyle and surface remodeling as the
bone is translated by soft tissues (condyle+periosteum=growth sites)
Experimental approaches

Vital staining
Implant radiography

Vital staining
Dyes that stain mineralizing tissues are injected into an animal

Alizarin dye reacts with calcium at sites of bone calcification and marks sites of active growth

Tetracycline binds in the same way as Alizarin

Technetium 99 TM—Gamma emitting isotope used to detect areas of rapid bone growth
Implant radiography

Inert metal pins placed in bone

Easily visualized on cephalograms

Improves accuracy of longitudinal cephalometric analysis of growth pattern

Provide landmarks for superimposition