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    Orthodontic

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    : Ss & cS S a PS, Flis BBK 56.6 69 YK 616.314 Author § PS. Flis — Honoured Worker of Science and Engineering of Head of the Chair of Orthodontics and Prosthodontics Prop lets NMU MA. Omelehuk — Candidate of Medicine, Associate Professor of the dontics and Prosthodontics Propedeutics of 0.0. Bohomolets NI N.V. Rashchenko — Candidate of Medicine, Associate Professor of dontics and Prosthodontics Propedeutics of 0.0. Bohomolets NMU LL. Skrypnyk ~ Candidate of Medicine, Associate Professor of the Chair of Orthodon- ties and Prosthodontics Propedeutics of 0.0. Bohomolets NMU ‘SL. Tril— Candidate of Medicine, Associate Professor of the Chair of Orthodontics and Prosthodontics Propedeutics of 0.0. Bohomolets NMU G.P. Leonenko — Candidate of Medicine, Assistant Lecturer of the Chair of Orthodon- tics and Prosthodontics Propedeutics of 0.0. Bohomolets NMU The textbook has been prepared according to the orthodontics syllabus of higher medi- cal education institutions of the 4 level of accreditation. There has been presented a new definition of orthodontics as a science, investigation and classification methods, etiology, pathogenesis, clinical presentation, diagnostics, methods of treatment and prophylaxis of persistent dentognathic anomalies and deformations. The textbook has been prepared in accordance with the new 2003 curriculum of the MPH of Ukraine and the valid syllabus of higher educational institutions of the 4" level of accreditation. Reviewers: V.L. Hryzodub — MD, Professor, Head of the Chair of Prosthodontics and Orthodontics of the Kharkiv State Medical University MP. Sysoyev— MD, Professor, Head of the Chair of Stomatology of the Crimean State Georgievsky Medical University Translated fromthe Russian edition: Oprogonrma: yeOuu / TLC. @mic, HA. Omesbuyx, H.B. PauteHko u ap. — K.: Meamuuna, 2008 © ILC. nic, M.A. Omenbuyx, H.B. Pamenxo, LJ1. Cxpumnnx, CL Tpins, P.M. Jleonerxo, 2008 ISBN 978-966-10-0034-S © Brmasnuureo “Meamuia”, 2008 Contents CHAPTER 1. Orthodontics History. CHAPTER 2. Morphofunctional Description of Decne Apparatus, 2.1. Norm Notion in Orthodontics 2.2. Physiological Types of Occlusion 2.3. Pathological Types of Occlusion 2.4, Dentognathic Apparatus Development in the Prenatal Period 2.5, Dentognathic Apparatus Formation in the Postnatal Period 2.6. Facial Muscles... = 27. Children’s Mastication Muscles Characteristics 2.8. Structure Peculiarities of the Temporomandibulr Joint in Children of Different Age... 2.9. Temporomandibular Joint Form an: 2.10. Temporary Teeth Occlusion 241. Transitional Dentition .. 2.12. Permanent Occlusion Period. Self-Control Questions. Tests CHAPTER 3. Clinical Methods of aie Fi Patients with Dentognathic Anomalies and Deformations Self-Control Questions. Test . CHAPTER 4. Auxiliary Methods of Examining Patients with eatipsnte'k Anomalies and Deformations . 4.1. Anthropometric Methods of Investigation Self-Control Questions. Tests 4.2. Graphical Methods of Investigation Self-Control Questions. Tests : 4.3. Photometric Methods of Investigation Self-Control Questions. Tests 4.4. Roenigenologic Methods of Investigation Self-Control Questions. Tests... 4.5. Methods of Investigating the Mastication Function.. Self-Control Questions. Tests 4.6. Methods of Investigating the Speech Function Self-Control Questions. Tests : ‘unction Correlation. a 4.7. Methods of Investigating the Swallowing Function. Self-Control Questions. Tests 0... 4.8. Methods of Investeating the Respiratory Function Self-Control Questions. Tests CHAPTER 5. Classification of ey Anomalies and Deformations ...sssssessenee 151 Self-Control Questions. Tests jn. CHAPTER 6. Basic Methods of Prophylaxis and Treatment of Dentognathie ‘Anomalies and Deformations . anierienapereerees OD 6.1, Prophylactic Methods of Treatment. Self-Control Questions. Tests... 6.2. Instrument Methods of Treatment 6.2.1. General Characteristics of Orthodontic Appliances . Self-Control Questions. Tests. $92. Influcnee of Orthodontic Appliances on the Periodontal Tsss.. 6.2.3. Forces in Orthodontics 6.24. Orthodontic Treatment Stage Self-Control Questions and Tests .. 6.25. Orthodontic Treatment Stimulation Methods 6.2.7. Surgical Treatment Methods... ‘Self-Control Questions. Tests CHAPTER 7. Etiology, Pathogenesis, Clinical Presentation, Diagnostics, Treatment, and Prophylaxis of Individual Teeth Anomalies. exes 24 7.1. Colour Anomalies... 7.2. Hard Tooth Tissues Structure Anomalies 7.3. Teeth Form Anomalies. 7.4, Teeth Number Anomalies... 7.5. Eruption Anomalies Self-Control Questions. Tests CHAPTER 8. Etiology, Pathogenesis, Clinical Presentation, Diagnostics, Treatment, and Prophylaxis of Individual Teeth Position Anomalies 8.1. Vestibular Teeth Position Palatine Teeth Position 8.3. Lingual Teeth Position... 8.4. Diastema 8.5. Teeth Torsions (Torsion ‘Anomaly) 8.6, Supraocclusion and Infraocclusion. 8.7. Teeth Transposition... Self-Control Questions. CHAPTER 9. Etiology, Pathogenesis, and Prophylaxis of Distal Occlusios ‘Self-Control! Questions. Tests CHAPTER 10. Etiology, Pathogenesis, Clinical Presentation, Diagnostics, Treatment, and Prophylaxis of Mesial Occlusion : Self-Control Questions. Tests cvwvteierer santas SOL ‘esis: linical Presentation, Diagnostics, Treatment, Contents CHAPTER 11. Etiology, Pathogenesis, Clinical Presentation, Diagnostics, Treatment and Prophylaxis of Deep Bite LLL. Deep Bite Etiology Deep Bite Clinical Presentation an 3, Deep Bite Treatment . Self-Control Questions. Tests - CHAPTER 12. Etiology, Pathogenesis, Clinical Presentation, Diagnostics, Treatment, and Prophylaxis of Open Bite. 12.1. Open Bite Clinical Presentation and Diagnostics .. 12.2. Open Bite Treatment .. ‘Self-Control Questions. Tests .. = : CHAPTER 13. Etiology, Pathogenesis, Clinical Presentation, Diagnostics, Treatment, and Prophylaxis of Cross Bite... 13.1. Cross Bite Clinical Presentation and Diagnostics........ 13.2. Cross Bite Treatment 13.3. Treatment Prognosis .. ‘Self-Control Questions. Tests Literature ... 298 - 306 Foreword What is orthodontics, what is its definition, and what does an orthodontist do? By now these seemingly simple questions have not been answered. Orthodontics term was introduced by Le Foulon in 1840 and consisted of two Greek words: orthos — straight and odontos (odus, odonteus) — tooth, which at first complied with what orthodontics was engaged in at the time — straightening the position of individual teeth. In due course orthodontics coverage changed consider- ably. Doctors began treating anomalies of dental arches form, occlusion violations, children’s dentoalveolar prosthetics and orthopedics. So, what is orthodontics today, what is it engaged in, what is its definition? In different manuals and books these questions are answered indistinctly and dif- ferentially. Taking into account the fact that students and practical doctors use differ- ent sources, we consider it necessary to dwell on the definition — what orthodontics is and what it is engaged in. In the textbook Prosthetic Dentistry (“Oproneameckas cromaronorua”), B.N. By- nin and A.I. Betelman, 1947, it is said: “... orthodontics is understood as a part of prosthetic dentistry, which is engaged in studying the clinical presentation and thera- py of dentognathic deformations”. In the textbook Prosthetic Dentistry (“Opronenm4eckas ctomarostorna”), Y.1. Gav- rilov and ILM. Alshyts, 1970: “Orthodontics is a big part of prosthetic dentistry; it is mainly engaged in studying and correcting children’s dentognathic apparatus ano- malies”, In the Prosthetic Dentistry Guide (“PykozocTso lo opronexM4eckoit CTOMaTO- sorun”), edited by A.I. Yevdokimoy: “Orthodontics” subject is studying the etiology and pathogenesis of dental-gnathic-facial anomalies, their prophylaxis, timely detec- tion of deviations and their elimination”. In the textbook Prosthetic Dentistry (“Oproneamueckas ctomaronorua”), YI. Gav- rilov and I.M. Oksman, 1978: “Orthodontics is a section of prosthetic dentistry, which is engaged in studying the etiology, pathogenesis, prophylaxis and methods of treating persistent anomalies of the dentognathic.” In the textbook Prosthetic Dentistry (“Optoneanueckaa cromatonorma”), S.1. Krish- tab et al., 1986: “Orthodontics is a part of prosthetic dentistry studying etiology, 6 Foreword pathogenesis, methods of treatment and prophylaxis of dentoalveolar deformations arising as a result of pathology development”. In the Prosthetic Dentistry Guide (“Pyxononcrpo 110 opTonezmuecKoit eromaronorun”), edited by F.Y. Khoroshilkina, 1999: “Orthodontics is a rapidly developing section of dentistry, which is engaged in studying the etiology and patho- genesis of dentognathic anomalies, improving the methods of their diagnostics, de- veloping the ways of prophylaxis and elimination of irregular tecth position, dental arches form, occlusion violation, controlling jaws growth and normalization of den- tognathic functions, eliminating esthetic violations, studying the influence of dento- gnathic anomalies on the development of adjacent organs and the organism as a whole”. As can be seen from the stated above, orthodontics is a part, a big part, ete.: in some Cases anomalies are treated, in other cases — deformations. And these are ab- solutely different notions. According to S.1. Ozhegov (Russian Language Dictionary, 1953), anomaly is “a deviation from the norm, general regularity, an irregularity”. According to V. Dal’s thesaurus (1956), anomaly is “a variance from the com- mon, dissimilarity with the ordinary, deviation in a natural phenomenon, etc.”. According to the Soviet Encyclopedia (1982), anomaly (Greek anomalia) is “a deviation from the norm, general regularity, an irregularity. Anomaly is structural or functional deviations of the organism conditioned by the abnormalities of embryonal development. Full-blown anomalies are named malformations, handicaps”. So, how to interpret the notion of deformation? According to S.I. Ozhegoy, “deformation is a change of the form of some- thing”. According to the encyclopedia (1953), “deformation is a change of the form and proportions of bodies accompanied by strain”, According to the dictionary of foreign words (1979), “deformation is a change of the proportions and form of a body under the influence of external forces or tem- perature change, magnetization, etc. without any change of its weight”. According to the Soviet encyclopedia, “deformation (Latin deformatio) is a change of the position of points of a solid body, at which the distance between them chang- es, under the influence of external forces. The simplest kinds of deformations are stretching, compressing, bending, and rotating”. Summing up everything set forth above, we define orthodontics as a science, which is engaged in studying the etiology, pathogenesis, clinical presentation, diagnos- tics, methods of treatment and prophylaxis of persistent dentognathic anomalies in children and adults, and also the etiology, pathogenesis, clinical presentation, diagnos- tics, methods of treatment and prophylaxis of defects of teeth, dental arches, and face in children, Who is treated by an orthodontist? Because of the faulty idea of the orthodontics definition the patients’ age has been limited to 18 until lately. And what happens next? Who is to treat patients aged 20, 25, 30 and older? Orthopedists were believed to do this, as secondary teeth deformations, which arise in e of untimely prosthet- 1 Foreword ics without orthodontic preparation, do not allow making a qualit appliance. At the same time ‘orthodontics is taught at the majority of Ukrainiar appliance. he chaits of children’s dentistry, Only the National 0.0. Bohomol Medical University (Kyiv) teaches orthodontics at the main Ukrainian Chai Or thodontics and Prosthodontics Propedeutics, and the Ukrainian Me . 9 logic Academy (Poltava) — at the Chair of Orthodontics and Post-Gr tion of Orthodontists. It should be mentioned that Kyiv school of orthodontists is the oldest in Rus, as the first orthodontics chair was founded in Kyiv in 19 dean of the odontologic department of the Kyiv Institute of Public chairs appeared in Moscow and Leningrad in the end of the 1940s. yi In recent years the interest to orthodontics as a science has grown ably. This was facilitated by new materials, methods, and technologies. The culture stan- dard rise of the population of the planet and our country is no less important. Now orthodontists are curing patients since birth, and further their age is not limited. : ——— LARA CNA ORTHODONTICS HISTORY ‘The first information about orthodontics was given in the book of Celsus — De Medicina (1 century BC), and during the next two thousand years there was no men- tion of orthodontics or teeth correction. In 1619 Heronymus Fabricius described a method of correcting individual teeth position. Stomatology as a science originated in the 16 century. At that time it dif- fered considerably from the present-day stomatology. It was Pierre Foshar (Fig. 1) who separated stomatology from general medicine. Foshar began his medical practice with general medicine, and later, when he had to travel a lot on a ship, he encoun- tered numerous maxillofacial diseases. Later on, having a substantial experience in treating these diseases, he opened his own clinic specializing in stomatological dis- eases in Paris. In 1728 Foshar’s Le chirurgien dentiste on traite de dents (Dental Sur- gery, or a Treatise of Teeth), in which metal arches for dentition dilatation were de- scribed, was published. He also presented an apparatus, which dilated jaws and simul- taneously transferred individual teeth with the help of an elastic wire. Foshar improved the obturator for the hard palate at its nonunion, first introduced in the 16" century by famous Parisian surgeon Ambroisi Pare (1510-1590) (Fig. 2). In the 18 century an inclined plane for progenia correction (Hunter, 1771), a device for occlusion elevation (Delabar, 1819), tread rings (Shanzhe, 1841), and a screw (Dwinel, 1848) were introduced. Hades and Harris were the first founders of a dental school at the Maryland University. The Maryland School of Dentistry is the first stomatological educational institution in the world. N. Kingsley (1829-1913) was the first founder of the science of orthodontics. Farrar is considered the father of modern orthodontics. He was the first to voice the idea of dosing the force applied in orthodontic practice. For this purpose he widely used the orthodontic screw. In 1854 Evans offered an arch for treating occlusion anomalies. In 1946 it was offered to use silk, metal, and rubber ligatures for fastening an arch on teeth. In 1879 Kingsley offered a removable orthodontic apparatus. It consisted of a porcelain biting plate and a plate with an elastic loop for upper jaw dilation. In 1892 an intermaxillary pull system was introduced (Case, Bakker), which became known under the name ABC (Angle, Bakker, Case) in orthodontics, Chapter 1. Orthodontics History Fig. 1. Pierre Foshar Fig. 2. Ambroisi Pare Fig. 3. Edward Angle (1678-1761) (1510-1590) (1855-1930) Edward Angle (1855—1930) is the father of modern scientific orthodontics (Fig. 3), the first scholar who gave rise to orthodontics as a science. His teaching at a stoma- tological school of anthropometry ended for him with a refusal to open an individual orthodontic centre. Then, he opened an individual orthodontic centre by his own strength. 1900 is considered the year of the opening of orthodontics as a separate sci- ence. Angle advised his students: “No one can understand a science well if he doesn’t understand its history”. Every 30-40 years a new generation of orthodontists appear. The 1900—-1930s are believed to be the period when the first generation of orthodon- tists appeared. In 1901 Angle founded the first American Orthodontists Union, and in 2001 the centenary of the Union was celebrated in Chicago. Angle was a genius — at that time (1899) he offered a classification of dentognathic anomalies and defor- mations, which is still being used for diagnostics all around the world. There have been attempts to systematize the morphological signs of dentognathic anomalies made by other scientists ~ F. Kneisel (1836), Karabelli (1872), Welker (1862), Wedl (1867), Islai (1891). Angle is the scientist who invented and offered four techniques of treating den- tognathic anomalies and deformations: 1) the dilating arch; 2) the technique for forming space in the dental arch; 3) Begg-technique; 4) edgewise-technique. Every time he improved the technique of treating this or that anomaly — from applying “wedges and pegs” to rings for all teeth. Angle was the first scientist to begin using the Ribban Arch technique — a system with an arch that goes into slots. And it can be called the first bracket system by right. It used a rectangular arch for the first time. Until 1925 the Ribban Arch was being widely used for treating orthodontic pathologies 10 Orthodontics History __ Im 1925 the edgewise bracket, which enabled the regulation of tooth position with the help of a rectangular arch, was introduced. In this case it took Angle a ‘couple of years to acquire a universal patent, which happened in 1929. This method concerns individual teeth regulation, and also the possibility to preserve teeth at den- tal arch dilation. Angle was against extracting individual teeth at treating orthodontic anomalies and deformations. Angle was a talented scholar and a famous orthodontist, who owned a ship company at the time and so was one of the richest people in California. We should dwell on two prominent figures in orthodontics with the family name Andresen as they are often confused. Andresen G.F. (1934-1989) was born in Fremont, New England; took DDS degree at Nebraska University (1959); was a member of the research society of Ox- ford University, Great Britain (1959-1960), Nebraska University (1963), Iowa State University (1963), later — the Head of the Department of Orthodontics (1965-1975); a member of the American College of Stomatologists. The scientist is famous for tesearching the biomechanics of orthodontic treatment. Orthodontic devices made of nickel-titanium alloy, discovered by him, won an award at the 1980 competition “Inventors of Iowa”. Andresen B. (1870-1950) was born in Copenhagen; took DDS degree in Copen- hagen (1889); during three years practiced as a children’s dentist in Switzerland. After that returned to Denmark, where he worked first in Weil, then in Copenhagen. Used to be a free lance member of the maxillofacial department of the State Central Hos- pital since 1910. Professor of the Orthodontics Chair of Oslo Dental School (1925), the head of the Chair since 1927. Began specializing in orthodontics in 1919. Wrote on different themes, but was interested in the demineralizing qualities of sugar during all his life. Is the author of Orthodontics: Regulation for Doctors of General Practice and Students, 1914, Angle Apparatus Improvement, Funktions-Rieferorthopedic (together with Carl Haupl), 1936. In 1908 Andresen presented his first apparatus (later known as activator), mod- cled by analogy with Kingsley’s bite-jumper and similar to Robin’s monoblock. It differed from other apparatus by the passivity of attachment to teeth, transmitting muscular stimuli to the jaws, teeth, and supporting structures. Later Andresen worked with Haupl at the functional orthopedics of jaws known as the Norwegian System or “treating with activators”. Today we use Andresen—Haupl’s apparatus rather often, but with minor changes and modifications. In 1930-1970 a new generation of orthodontists appeared. As all talented people Angle had a lot of doctors, who wanted to get the knowledge and skills he had. Begg, Tweed and Oppenheim are the scientists who were given the honour to be the suc- cessors of Angle’s theoretical and practical knowledge. Begg P.R. (1898-1983) is one of the most famous Angle's students (Fig. 4). He came to America in 1924 and helped Angle in elaborating the edgewise-technique. Oppenheim is considered the “biological father” of orthodontics. He was the first scientist to begin studying bony tissue rearrangement. Thus, Angle made a con- Orthodontics History Chapt clusion that discontinuous forees are the most favorable for bony tissu ment without pathological changes, and Oppenheim broadened and theory. i Tweed Ch. (1895-1970; Fig. 5) held to the theory of treatment. ing teeth, but he noted that this caused the change of individual tee three projections on one arch with dentition dilation, protrusion patients’ discontent and dentition instability. During three years after Tweed was treating dentognathic anomalies and deformations by which allowed him to determine that complications and recurrences Thus, Tweed arrived at a conclusion that if the angle between the mandib lower incisors makes 90°, the result will be stable. But if the angle is b essary to return to the previous position and secure spaces between extracting individual teeth. In 1940 Tweed claimed his discovery at 1 conference of stomatologists and demonstrated 100 cases. Here the demons 4-year models showed that treatment of dentognathic anomalies and deformations without teeth extraction in 98 % cases leads to recurrence and patients’ discontent, whereas treatment with teeth extraction shows practically no recurrence. After the claim Tweed was accused of betraying Angle. Even Hahn George disputed, though he was an instructor at Angle’s school and always a supporter of Tweed’s discoveries. After the conference in 1940 Tweed published his conception, in which he noted that ‘one of the most important criteria is face esthetics (the points of chin, lips and nose are on one line), and also the limit of teeth position, precision of arch bending. Here Tweed made one of the most important conclusions, which says that treatment of dentognathic-facial anomalies and deformations with teeth extraction needs support, and treatment without extraction — not always. In 1943 Tweed opened his school in Arizona, where an intensive course in or- thodontics, in which about 100 students from all around the world participate, takes place every autumn and spring. Tweed’s instrument and room may be seen in the school. In 1941 Tweed conducted the first orthodontics course for 5 students. The scientist studied cephalometry during his medical practice, and now about 80 % doc- tors in the world use Tweed’s cephalometry method. Begg was one of the first scientists to start teaching the edgewise-technique at the University of Australia. Only in some time he saw drawbacks of the technique. Since 1933 Begg began to use the Ribban Arch technique and arrived at the conclusion that if different teeth are acted upon with different forces, the problem of support is solved in itself. Thus, the natural support of molar tecth is sufficient as they have three roots, not one root like incisors. In his technique Begg used tooth movement at the expense of inclination with the use of constant effective forces. From 1932 till 1970 Tweed’s and Begg’s techniques were competitive, but one common feature was extracting teeth at treating dentognathic anomalies. In 1907 the European Association of Orthodontists was founded, How did orthodontics develop in Russia and Ukraine? ‘There were first dentists in Russia in the 18" century, and they were called “teeth extractors” as they mainly extracted teeth. To regulate medical practice the Pharma- 12 Orthodontics History Fig. 4. P.R. Begg Fig. 5. Ch. Tweed Fig. 6. A.K. Limberg (1898-1983) (1895—1970) (1856-1906) ceutical Ordinance was set up in 1600, in 1672 it was renamed into the Pharmaceuti- cal Chamber, and in 1725 turned into the Medical Chancellery. In its turn, in 1763, after another reorganization the Medical Collegium appeared. The title “dental practitioner” was introduced in 1780. In Russia tooth replacement began developing in the 18" century owing to the reforms of Peter I. His founding the Academy of Sciences was a great step forward in the development of medical science. M.V. Lomonosov’s treatise About Reproduction and Preservation of Russian People noted that the state of the whole organism depends on the state of the mouth cavity, especially in children at early stages of teeth forma- tion, The founder of the Russian surgical school I.F. Bush paid much attention to stomatology, tooth replacement, and orthodontics. The textbook Regulation to Teaching Surgery, in which the issues of surgical and therapeutic stomatology are covered, contains data about the reasons for faulty eruption and methods of correct- ing it. In 1829 the first Russian book on stomatology, Dentistry, or The Art of Treating Dental Diseases with a Children’s Hygiene Supplement, was published. Its author A.M. Sobolev, dwelled, in particular, on the reasons for faulty eruption, presented his classification of occlusion anomalies and offered methods of their orthodontic treat ment. At the same time the Vagengeil’s book The Dental Practitioner was published Both authors — Sobolev and Vagengeil — pointed out that the level of stomatology teeth replacement, and orthodontics in Russia in the first half of the 19% century was not lower than in European countries. In 1808 in Russia the title “dental practitioner” was officially established, and in 1839 the official title “dentist” appeared. The number of dental practitioners and dentists grew quickly 1809 — 18 doctors and dentists; 13 Chapter 1. Orthodontics History 1826 — 44 doctors and dentists; 1840 — 80 doctors and dentists, 1845 — 114 doctors and dentists; 1853 — 164 doctors and dentists. Despite some success in the development of stomatology there schools in Russia, and manpower training was realized by means of At the end of the 19" century stomatological private schools ¥ Petersburg, Moscow, Kyiv and other cities. According to the med r Russia, from 1891 till 1908 the number of dental practitioners gre’ times, and of dentists — by 3 (in 1891 there were 86 dental practitiaas aeade dentists, and in 1908 — 2531 dental practitioners and 2964 dentists). 7 AP. Sinitsyn (1897) in his article in Stomatologie Bulletin Mes ee then the representatives of stomatological practice were doctor's assistants, foreign dentists, local dentists, and a small number of privat-docents. ee ists were trained at doctor’s assistant schools, dental mechanic workshops and cours- es, foreign medical institutions, dentists’ offices, army medical colleges, and clinical institutes of doctors. Because of the small number of specialists, dental health service was considerably inaccessible. The first Russian Dentists Society was founded in Petersburg in 1883. Since 1885 there was published the first odontologic journal Stomatologic Bulletin, and since 1899 — Odontologic Review. Specifically, in 1906 there was printed the ar- ticle of G.I. Vilga Concerning Faulty Second Eruption; in 1908 — A. Papuzhin’s About Mouth Breathing. in 1909 — G. Efron’s Scientific System of Orthodontics, Kodymskyi’s article on treating the palatine position of upper teeth, Varshaychik’s article on regu- lating teeth position with the help of rubber rings. In 1909, Stomatologic Bulletin published the report of the Odontologic Society for the period of 1899-1909, which said that collections of dentoalyeolar deformations models and apparatus for their treatment had been shown at society meetings during ten years. Interestingly, the idea of oral cavity sanation appeared at the turn of the 19%—20" centuries. The most active representative of this trend was A.K. Limberg (Fig. 6), who popularized the ideas of school stomatology. He gave talks at the meetings of odonto- logic societies of many cities — About Dental Health Service in Schools; About the Bone Beetle in the Schoolchildren of Serpukhovskiy Uyezd; Significance of School Dentists; A Program of Gathering Information on Schoolchildren’s Teeth and Dental Health Service in the Russian Empire; About the Bone Beetle in Schoolchildren and Influence of Some Conditions on Its Prevalence. In 1913 the 6" conference of odontologists took place. A.K. Limberg presented reports on the issues of school stomatology and specifically orthodontics. In the 8" issue of a 1912 stomatological journal the article The Latest Trend in Orthodontics was published. Dental practitioner Dombrovskyi from Smila city of Romny povit (Ukraine) wrote the article On the Casuistics of Faulty Eruption in Childhood (Odontologic Re- view, 1914, pp. 46-47) 14 Orthodontics History Evaluating the state of orthodontics development at those times, I.L. Zlotnyk (1952) writes: “As for orthodontics, we should refute vigorously the belief that before the October Revolution dental practitioners knew nothing of this subject and were not practicing orthodontic therapy. Materials of orthodontic journals irrefutably prove that orthodontics was already being studied at that time, doctors took interest in it and practically worked in the field. The scope of scientific and practical activity was small if to compare with the present-day, but to estimate objectively the state of dentistry and social and political conditions of that time should be taken into ac- count”. Already then stomatologists understood that preserving the temporary occlusion till its physiological wear is important for the correct formation of permanent occlu- sion. This idea was reflected in the report presented by three dentists in 1913 con- cerning the organization of dental health service to schoolchildren in Kharbini city. They wrote: “It proves that it is the absence of care in this important for the child period that leads to uncorrectable consequences in future: faulty teeth growth and jaws occlusion, pernicious habits (sucking fingers), and finally the most important — early loss of teeth” (Stomatologic Bulletin, 1913, pp. 331-335). The articles on orthodontics that appeared in journals were not only translations from foreign issues, but also originals. At societies meetings, conference papers on orthodontics were read and collections of models with dentognathic anomalies and deformations were shown. Such doctors as Chemodanov, Dauge, A.P. Sinitsyn, LI. Vilga, AK. Limberg, E.M. Gofung, Tigerstedt, Zverzhkhovskyi and others went down into the history of domestic orthodontics as champions of higher medical education for stomatologists, as pioneers of scientific domestic stomatology. In December 1914 in Moscow the Central Outpatient Clinic with 15 dentist's chairs and a laboratory for producing splints and dentures was opened (LI. Vilga was appointed director of the Clinic). In December 1916 in Moscow at the 14" confer- ence of Russian surgeons there was opened an exhibition of dental prosthesis, ap- paratus, and splints, which were used for dentognathic patients treatment. But at that time teeth replacement, maxillofacial orthopedics and orthodontics remained the step children of medicine and had no rights and privileges. World War I, October Revolution, and civil war moved away for some time the problems of stomatology development, including orthodontics, in the Russian Empire, and later in the Soviet Union. ‘The first socialistic public health organization was founded on October 26, 1917, when a medical department was confirmed at the Military-Revolutionary Committee of Petrograd Soviet. Later such departments were organized locally at Soviets. In 1918 in Moscow the 5‘ All-Russian Soviets Conference took place, at which the People’s Public Health Commissariat of the Russian Soviet Federative Socialist Re- public was confirmed. N.A. Semashko was appointed the first people's public health commissar. Dental practitioner P.G. Dauge headed the stomatological subsection, which was obliged to work out and apply in life all the undertakings concerning the reform of stomatology on socialistic terms, The organization of dental health service 10 great masses of population became one of crucial issues. Stomatology was included IS research and personnel institutes, centres, and an ambulat Stomatology as a whole and tology and orthodontics in particular ties for their scientific and practical development. In 1923 at the I* All-Russian Orthodontic Conference there was heard L.N. Natanson’s lecture on the inter- relation of otorhinolaryngology and influence of mouth breathing on mations formation). At the 2 Conference M.S. Ne- menov read his lecture “on the results of orthodontic work”, and S.S. Raisman — Prophylaxis and Therapy of Jaws and Teeth Anomalies. A series of monographs and textbooks of domestic authors on stomatology, including orthopedic stomatology, and orthodontics were published. The Soviet orthodontic school has performed remarkably in the biological-func- tional trend of orthodontics development. From the biological-functional position the masticatory apparatus is a compound complex of constituent elements, related to one another not only morphologically but also functionally. A.Y. Katz is considered the founder of the functional trend in orthodontics. In 1933 he grounded it on the basis of I.P. Pavloy’s studies. At the heart of the functional trend lies the interrelation of the masticatory apparatus form and function. A.Y. Katz offered his classification of dentognathic anomalies, the base of which was the state of mastication muscles, and also functional-directional equipment. Time passed, and science and practice proved the appropriateness of the further development of the functional trend in orthodontics, which served as the basis in elaborating rational constructions of. functional-directional equipment (Katz’, Schwarz’, Bruckl’s, Basharova’s apparatus, modern trainers, etc.). Rolf Frankel (born in Germany in 1908; Fig. 7) has worked out rather complicated in terms of produc- tion but effective functionally acting apparatus (Frankel’s function regulator). Science and practice have proved that in the diagnostics and treatment of dentognathic ano- malies and deformations it is equally important to take into account both morpho- logical and functional deviations in the masticatory apparatus. Disturbances in den- tognathic apparatus development should be viewed not as a local pathology but as a disease of the human organism as a whole. The main task of orthodontic prophylaxis and treatment, according to LL. Zlot- nyk (1952), is creating such conditions, at which the masticatory apparatus could develop normally. On October 1, 1918, the People’s Public Health Commissariat and People’s Educa- tion Commissariat issued a decree on stomatological education reform which read: “Henceforth stomatological education will be inseparably linked with the whole sys- tem of higher medical education”. On March 24, 1920, a resolution was passed on 16 Fig. 7. Rolf Frankel (1908) Orthodontics History Fig. 8. E.M. Gofung Fig. 9. A.1. Betelman Fig. 10. S.1. Kryshtab (1876-1944) (1889-1980) (1924-1984) establishing orthodontics chairs, which were to teach all sections of stomatology in the form of special courses, at medical departments of state universities. In 1919 in Kyiv on the basis of nationalized private stomatological schools there was established an odontologic institute with a 4-year course of studying, but for the lack of theo- retical discipline specialists and proper financial support the odontologic institute was joined as a department to the Kyiv Public Health Institute. K.P. Tarasov was appointed the first dean of the odontologic department. He also headed the just opened chair of orthodontics. The Odontologic polyclinic in Khreshchatyk Street, 6, served as the clinical basis for the chair. There was established the first chair of or- thodontics in Ukraine, which existed from 1920 till 1930. K.P. Tarasov prepared a textbook on orthodontics, but because of the author's death in 1930 the textbook was not published. In 1921 on the instructions of the Ukrainian Chief Professional Education Au- thority (Ukrholovprofosvita) E.M. Gofung organized an odontologic department in the Kharkiv State Medical Institute, and became the dean of the department (Fig. 8) In 1930 odontologic departments were renamed to stomatological, and in 1931 these departments were reorganized into stomatological institutes. Sp | chairs were re named accordingly: preventive, operative, prosthetic dentistry. Orthodontics was taught at prosthetic dentistry chairs. Since then orthodontics became a part of pros- thetic dentistry. In 1931 L.P. Dudkin, who had no higher education, was appointed the head of the prosthetic dentistry chair in Kyiy. Nevertheless, L.P. Dudkin, as a highly-quali fied practical man, a cultured and progressive person, did a lot for the formation and basis of the chair. In 1939 Proceedings of the Kyiv State Stomatological Institute were published. The bulletin generalized the first results of the scientific development of the chair. Specifically, in the bulletin D.S, Aisenberg’s work on orthodontics Simpli Sied Methods of Mass Treatment of Teeth and Jaws Position Anomalies was published. 7 History Shortly before World War II D.S. Aisenberg became the head of the much attention to the problems of applied orthodontics. At the time sociate professor Z.G, Shepshelevych headed the chair of prosthetic also paid attention to the problems of orthodontics. The further development of Kyiv Stomatological Institute chairs by the war. In 1941 the institute was evacuated to Kharkiv, and tl the Kharkiv Stomatological Institute — to Frunze city, where it functi matological department of the Frunze Medical Institute. In 1943, after the liberation of Kyiv, the institute returned to. Ukraine and as a stomatological department joined the Kyiv Medical e; 1945 it was again reorganized into a stomatological institute. Because ok of pedagogic specialists in medical and theoretical disciplines the stor ygical insti- tute again became a department of the me« ical institute in 1955, and has remained such till now. From 1946 till 1949 I.L. Zlotnyk, Candidate of Medicine, graduate of the Frun- ze Medical Institute, headed the chair of prosthetic dentistry. At the time Z.G. Sepshelevych’s students, Candidates of Medicine M.M. Khotymska and ALL. Pozdniakova were invited from Kharkiv to work as teachers at the Kyiv Stoma- tological Institute. ‘As for a long time orthodontics used to be taught at the chairs of prosthetic den- tistry, and was even considered a part of prosthetic dentistry, the majority of scientists went into the enquiry of orthodontics during writing their theses. Moreover, it should be mentioned that most of them either worked in Ukraine or were Ukrainians. Pro~ fessor A.I. Betelman (1889-1980) was a famous prosthetic dentist and a rather well- known orthodontist. He taught a number of famous orthodontists, who contributed to the development of orthodontics in the USSR and Ukraine (Fig. 9). Associate Professors A.I. Pozdniakova, Y.M. Aleksandrova, A.D. Mukhina, V.S. Kurylenko, and F.D. Lohvyniuk were among them. Professor S.1. Kryshtab, a student and follower of A.I. Betelman, studied the peculiarities of lower jaw growth (Fig. 10). In 1975 S.1. Kryshtab’s monograph Lower Jaw Anomalies was published. In 1967 Professor Y.Y. Vares defended his thesis Regularities of Human Bones Growth and Their Meaning for Orthodontic Practice. Professor M.A. Napadov (Kharkiv) not only wrote a thesis in orthodontics, but also published the first atlas of orthodontic equipment in 1967. Professor V.P. Nespriadko, a student and follower of S.1. Kryshtab, devoted his researches to the problems of pathogenesis, clinical presentation, diagnostics, and treatment of retained teeth. It should be pointed out that alongside with the Kyiv school of orthodontists Kharkiv, Odesa, Poltava, and Lviv schools began developing. Associate Professor A.D. Osadchyi (Odesa) worked out the basics of the health examination of children, including those with dentognathic anomalies. In Poltava Professor L.P. Grigoryeva has taught a number of scientists-orthodon- tists - M.D. Korol, N.V. Holovko, L.I. Smahliuk. 18 The Chair of Orthodontics and Prosthodontics Propedeutics of the 0.0. Bohomolets NMU. ‘The Chair of Orthodontics and Prosthodontics Propedeutics of the National 0.0. Bohomolets Medical University On June 28, 1982, according to the decree No. 802-49 of the Ministry of Public Health of Ukraine, the Chair of Orthodontics and Prosthodontics Propedeutics was founded. The new chair was headed by Doctor of Medicine, Professor Z.S. Vasylenko (Fig. 11). Together with Z.S. Vasylenko a group of active and qualified teachers came to the chair — Associate Professor Y.M. Aleksandrova, assistants Z.P. Vasylevska, L.M. Hrekova, V.S. Kurylenko, F.D. Lohvyniuk, V-P. Nespriadko, S.1. Doroshenko, and P.S. Flis. As there had not been such a chair in Ukraine before, the teachers were posed a problem to develop documentation, write methodical guides, create an edu- cational museum. There was only one room for 10 dental units. In a brief space of time there was developed material and technical basis, which could provide the high level of training stomatologists in orthodontics and children’s teeth replacement, methods of diagnostics in prosthetic dentistry, teaching prosthodontic technique and materials science. The research investigations of the chair developed in two directions: improving the diagnostics and complex treatment methods of primary and secondary dento- gnathic deformations, and improving the clinical and technological processes of pro- ducing orthodontic equipment and dentures for children and adults. Under the direction of Professor Z.S. Vasylenko five Candidate of Medicine the- ses were written (by P.S. Flis, H.1. Liutik, V.P. Potapov, Y.O. Samoylov, S.1. Tril) Invention and rationalization activity also developed. Since the foundation day teachers of all medical schools pass through the cours- es of professional development at the chair. This enables to hand on the experience of organizing dental health service in our country. Till 2000 Professor Z.S. Vasylenko was responsible for this work as during 35 years he was the chief stomatologist of the MPH of Ukraine, combining work with heading the chair. He participated actively in organizing and conducting stomatologists’ conferences and congresses in Ukraine. Chair workers have defended three Doctor of Medicine theses (V.P. Nespriadko — 1985, P.S. Flis — 1990, S.1. Doroshenko — 1991). V.P. Nespriadko’s thesis had the name Pathogene Clinical Presentation and Treatment of Unerupting Teeth (Clinicolaboratory Investigations) and offered new origi- nal methods of retained teeth treatment Candidate of Medicine (1986) and Doctor of Medicine (1990) th of P.S. Flis were dedicated to the relevant problem of prosthetic dentistry — developing of the laboratory and clinical methods of making integrally cast dental bridges and remov- able dentures, developing methods of casting, new alloys, fireproof masses, and facing materials, The author offered the industrial production of inte ast prostheses. Owing to P.S. Flis’ theses the production of these modern dentures has been estab lished in Ukraine. Since 1986, work began on developing domestic light curing poly- mers for dentures facing and brackets fixation. For the first time in stomatology the possibility, effectiveness, and expediency of using millimeter range microwave reso: 19 Chapter 1. Orthodontics History wha) aif Fig. 11. Z.S. Vasylenko Fig. 12. P.S. Flis (1924-2004) nant therapy were proved. P.S. Flis is the author of more than 200 published research papers, 7 teaching aids, over 40 author's certificates (inventions and patents). In 1991 S.1. Doroshenko defended the thesis Preparation of Oral Cavity and Or- thopedic Treatment at Dentognathic Deformations. The author determined the fre- quency of anomalies and deformations incidence, and also dental arches defects in children; offered and proved the effectiveness of using electrofulguration during the preparation to prosthetics; developed original methods of treating fused teeth; studied the influence of vibration on hard dental tissues and pulp; offered a classification of secondary dentognathic deformations. Since 1990 the chair has been headed by Doctor of Medicine, Professor P.S. Flis (Fig. 12). As the head of the Coordinating Committee of the MPH of Ukraine on stomatology issues he has done very much for tuning Ukrainian industry in stomato- logy needs, establishing contacts with foreign producers, aiming at bringing Ukrai- nian stomatology up to modern standards. Constant work with personnel is being carried out. Not to lose the achievements of more experienced teachers they (V.S. Kurylenko, F.D. Lohvyniuk, Z.F. Vasylevs- ka) were advanced to the positions of doctors, and new teachers were taken on from amongst doctors. The chair maintains the traditions of Kyiv orthodontic school with dignity. Re- search is aimed at the further development of the methods of orthopedic and ortho- dontic treatment of children and adults, development of new materials and technolo- gies of making dentures and orthodontic appliances. Since 1997 the chair is the main in the country in orthodontics and children’s dental prosthetics. Chair workers have developed new curriculums and syllabi in orthodontics for higher medical education institutions of Ukraine, have composed a typical curriculum and syllabus for interns in the “orthodontics” specialty, and also the qualification description of the ortho- dontist. 20 The Chair of Orthodontics and Prosthodontics Propedeutics of the O.0. Bohomolets NMU n 2004 by the decision of the 0.0. Bohomolets NMU Academic Council the ‘was to the Chair of Orthodontics and Prosthodontics Propedeutics, ee 0 its description. i doctors from abroad are trained at the clinical residency, magistracy, id post-graduate course at the chair. During the last 10 years there have been over 100 of such students, and these are not only graduates of the 0.0. Bohomolets NMU, but also of other universities — Ukrainian Stomatological Academy (Poltava), Odesa Medical University, Damascus University (Syria), Belgrade University (Yugo- slavia), Stockholm University (Sweden). Foreign doctors are representatives of Jor- dan, Syria, Morocco, Israel, Palestine, Greece, Iran, Sweden, Lebanon, and China. Two doctors from Syria have graduated from the clinical residency and post- graduate course at the chair and defended theses, having received their PhD degrees: Hasan Farah, a graduate of the Damascus University, defended the thesis The Tactics of Orthodontic Treatment at Supplemental Teeth at the chair in 1993. Djarbue Mahmud graduated from the clinical residency and post-graduate course at the chair and in 2000 defended the thesis The Tactics of Orthodontic Treatment at Teeth Congestion. The thesis used the most modern methods of examining patients and treating this widespread pathology. There has been proved the effectiveness of using removable apparatus at a certain stage, and then of fixed apparatus (bracket systems); the indica- tions to teeth extraction or dental arches dilation have been detected. In 1992 S.I. Tril defended the thesis Clinical Presentation, Diagnostics, and Treat- ment of Included Defects of Dental Arches in Children and Teenagers, in which he in- vestigated the frequency and incidence of dental arches defects in children after the Chornobyl catastrophe. He was the first to develop the way of detecting the parodon- tium tissues functional endurance to vertical load in children and teenagers, offered a classification of dental arches defects in children. In 1994 N.V. Rashchenko defended the Candidate of Medicine thesis Stimulating Therapy in the Complex Treatment of Posterior Occlusion. The thesis cites the fre- quency of posterior occlusion and its forms incidence; on the basis of teleroentgeno- graphy investigates the most characteristic morphologic derangements in the structure of facial skeleton at this anomaly in different age periods. Original methods of stimu- lating therapy have been developed (vacuum, vibratory influence, magnetic-reso nance reflexotherapy). In 1995 H.V. Novakivska defended the Candidate of Medicine thesis Prophy- ‘axis of Enamel Demineralization at Orthodontic Treatment with Fixed Apparatus. The hesis aimed at preventing the demineralization of enamel at orthodontic treatment The influence of the new light curing domestic material ESTA-F on the oral cavity nicroflora, and also the penetration depth of the fluorine contained in it into the ard tooth tissues have been studied. On the basis of toxicological, sanitation-chemi al, electronic-microscopic, and clinical investigations the expediency and effective ess of ESTA-F application in the orthodontic practice of preventing enamel demine- alization at instrument treatment have been proved. M.A, Omelchuk defended the Candidate of Medicine thesis Development and jubstantiation of Using New Cobalt-Chromic Alloys “Ceradent" and “Plasteryst” in 21 Chapter 1. Orthodontics History Fig. 13. Collective of the teachers of the Chair of Orthodontics and Prosthodontics Propedeuties of the National 0.0. Bohomolets Medical University Prosthetic Dentistry in 1997. He developed and introduced to the treatment practice new high-grade and economically sound domestic alloys “Ceradent” and “Plast- cryst”; studied and selected the optimal composition of main alloying elements, esti- mated their toxic-hygienic and medical-biological properties; proved the expediency of using them in making integrally cast constructions of dentures. In 2001 two Candidate of Medicine theses were defended. Y.O. Babaskin pre- pared the paper Peculiarities of Orthopedic Treatment of Dental Arches at Partial Aden- tia, in which he offered new constructions of orthopedic apparatus at adentia, the way of using temporary teeth for fixing nonremovable dentures. IL, Skrypnik defended the thesis dedicated to the methods of facing materials fixation on nonremovable dentures. She offered new methods, which considerably increased dental prosthetics efficiency In 2003 A.M. Bobokal defended the Candidate of Medicine thesis Clinicoexperi- mental Substantiation of Using “Ultropalin” Ceramic Mixture at Fixed Dental Prosthet- ics. He developed and introduced into practice the first domestic ceramic mixture for making metal-ceramic dentures. The offered mixture is highly competitive with for- eign analogues. In 2004 O.A. Kaniura defended the Candidate of Medicine Thesis Peculiarities of Treating Canine Teeth Vestibular Position in Age Aspect, in which he detected the in- cidence of this pathology, and also offered several new orthodontic apparatus and methods in compliance with patients’ age 2 ‘The Chair of Orthodontics and Prosthodontics Propedeutics of the 0.0. Bohomolets NMU In 2006 H.P. Flis defended the Candidate of Medicine thesis Treatment of Form and Color Anomalies of Separate Staying Teeth, in which she offered a new method of color detecting at teeth restoration, a new method of restoring the anatomic form of anomalous teeth, and also the methods of orthodontic preparation at teeth form anomalies at the absence of place for their full value restoration. In 2006 V.P. Vozniuk defended the Candidate of Medicine thesis Diagnostics and Orthopedic Methods of Treating Teeth Coronal Part Defects in Children. At the present moment at the Chair of Orthodontics and Prosthodontics Prope- deutics 11 young doctors are working at their Candidate of Medicine theses. Today the Chair of Orthodontics and Prosthodontics Propedeuties is a methodi- cal, scientific and treatment centre. 15 teachers are working at the chair (Fig. 13); there are 5 equipped propedeutic rooms, 6 clinical rooms with 35 modern dental units. A department of orthodontics and prosthodontics propedeutics (10 doctors and 20 dental technicians) works at the chair. In the clinical work practically all known methods of orthodontic and orthopedic treatment of children and adults are used Scientific research is now aimed at the development of methods of prophylaxis, diag- nostics, and treatment of dentognathic anomalies and deformations, and also of teeth and dental arches both in children and adults. At the same time the chair continues to develop, research, and study effective and high quality materials for making ortho- dontic apparatus for children and adults. In May 1999 the Association of Orthodontists was founded, and Professor P.S. Flis was elected the President of the Association. Owing to the active work of the chair and Association members the first international orthodontics conference was held in 2000. Ukraine was introduced for the first time in orthodontics specialty in the World Dentists Association. The scientific journal of the Ukrainian Association of Orthodontists Modern Orthodontics is being published since 2005; Honoured Worker of Science and Engineering of Ukraine, Academician of the Ukrainian Academy of Sciences, member of the European and World Orthodontists Association, Honorary President of the Belarus Orthodontists Union Professor P.S. Flis is the editor-in-chief of the journal. 23 Chapter 2 MORPHOFUNCTIONAL D: OF DENTOGNATHIC APPARATUS 2.1. NORM NOTION IN ORTHODONTICS Orthodontics is a complex many-sided discipline, which is engaged not only in the correction of teeth, dental arches, and occlusion, but also studies jaws growth, corrects the facial skeleton form, normalizes dentognathic apparatus functions, re- stores the esthetic harmony of face. During the development of orthodontic diagnostics the authors tried to word the notion of norm and pathology of the development, structure, and functioning of the dentognathic apparatus. The norm in orthodontics is a generalized notion, characterised by extra~ and intraoral signs (morphologic functional balances of the dentognathic apparatus and esthetic harmony of face on the whole). There are facial and jaw extraoral signs. Facial signs: characteristics of cutaneous coverings (color, absence of pathologi- cal damages, scars, new formations, swellings, etc.). The esthetic harmony of face was based on the studying of the head in coordinate system, founded by Van Loon (1916) and followed by P. Simon (1922), On the basis of the obtained results the scientists detected the proportionality, symmetry, and in- terrelation of the parts of face sizes. « Face proportionality is conventionally divided into three equal parts: from the scalp to the superciliary arches, from the superciliary arches to the nose base, from the nose base to the chin. « The right and left parts of face were found to be symmetrical. * The idea of harmonious interrelation between separate parts of body was bor- rowed by orthodontists from anatomy, art, and architecture, and developed into the hypothesis of the proportional structure of separate parts of the dentognathic appara- tus. The facial skeleton should be viewed as a whole, as a structural unity, taking into account racial, family, and individual peculiarities. Jaw signs: correct harmonious development of the branch and body of the lower and upper jaws; the lower jaw angle in newborns makes 164°, in adults — 117-124"; 4 Physiological Types of Occlusion full value and harmonious face profile. The credit of introducing the concept of the dentognathic apparatus normal position in the facial skeleton is given to V. Andresen (1925, 1930). Intraoral signs. In 1939 Y. Katz introduced the notion “functional norm of den- tal arches”. This is the pathologic function correction to the transition of quantitative changes into qualitative and formation of correlation between the form and function in the dentognathic apparatus. The main parameter for their characteristics became the type of dental arches closure — occlusion. Orthognathic occlusion is considered normal, it provides the optimal functioning of the dentognathic apparatus. 2.2. PHYSIOLOGICAL TYPES OF OCCLUSION In the clinical picture of orthodontics there are distinguished four forms of physio- logical occlusion: orthognathic, straight, biprognathic, and opisthognathic (Fig. 14). Alll these occlusions have identical signs of closure in the region of molar and premo- lar teeth, and different signs — in the region of incisors and canine teeth. The sign of the correct sagittal occlusion of molar tecth is the position of the anterior buccal tubercle of the 1* upper molar in the transverse sulcus of the similar lower tooth. Orthognathic bite of permanent teeth in central occlusion is characterised by the following: * the upper frontal teeth cover the lower ones by 1/3 length of the lower teeth crowns; * the tubercle of the upper canine tooth crown is located between the lower canine tooth and the 1* premolar; * the centerline between the central incisors of the upper and lower jaws coin- cides; * the mesial-buccal tubercle of the upper 1* molar is located in the transverse sulcus of the similar lower tooth; * every tooth of the upper jaw has two antagonists — similar and standing be- hind (except for the lower central incisors and upper wisdom teeth); « the buccal tubercles of the upper lateral teeth cover the buccal tubercles of the lower ones, and the palatine tubercles of the upper teeth are located between the buc- cal and lingual tubercles of the lower teeth; * the upper dental arch is semielliptical, the lower — parabolic; in temporary occlusion — a semicircle on both jaws; * the dental arches of the upper and lower jaws are symmetrical; + in the state of central occlusion there is a full occlusive contact between all teeth (except for unerupted ones); * in the state of physiological rest an interocclusive space varying within 2 mm arises between dental arches. The highest esthetic optimum, the est indexes of mastication function, the best conditions for the formation of somatic swallowing, and full value tongue func- tion are characteristic of this occlusion. 25 c d At straight occlusion all the listed above correlations are kept, except for the oc- clusion character of frontal teeth, which contact with the lower sculpri. Physiological biprognathism — all the listed above correlations are kept, except for the character of frontal teeth occlusion — they have a vestibular inclination of the upper and lower incisors and canine teeth at minor covering of the lower teeth by the upper ones. At opisthognathic occlusion the canine teeth and incisors on both jaws are in- clined into the oral cavity, contacting with each other by means of covering the lower teeth by the upper ones at the level of teeth tubercles or by means of marginal occlusion; all the listed above occlusive correlations are preserved. Angle’s occlusion key — fissure-tubercle contacts between the 1* permanent molar teeth of the upper and lower jaws at the right inclination of the longitudinal axes of these teeth to the occlusal plane: * the mesial-buccal tubercles of the upper 1* molar teeth are to be located in the intertubercular fissure of the lower molar teeth; the distal-buccal tubercles of the upper I* molar teeth are to tightly contact with the distal-buccal tubercles of the lower I* molar teeth and the mesial clivus of the buccal tubercles of other lower molar teeth. Andrews’ occlusion keys (optimal occlusion). In 1972 L. Andrews described 6 keys characterizing optimal occlusion. Some of them had been known before, but. their pooled estimate is important for clinical practice. ¢ The I* key — regular tubercle-fissure contacts between the lower and upper 1* permanent molar teeth at the right inclination of their longitudinal axes to the oc- clusal plane; the mesial-buccal tubercles of the upper 1* molars are to be located in the intertubercular fissure of the lower molars. The distal-buccal tubereles of the up- per molars are to contact tightly with the distal-buccal tubercles of the lower 1* mo- lars and the mesial clivus of the buccal tubercles of other lower molars (Fig. 15). The 1* key allows to detect occlusion violations of the 1 permanent molars in the mesiodistal direction taking into account the location and contacts of the apices 26 Physiological Types of Occlusion ma Fig. 15. The 1* Andrews’ occlusion key: @— fegular inclination of the 6* tooth axis, its mesial-buccal tubercle is in the intertubercular fissure of the 6% lower tooth; the distal-buceal tubercle contacts regularly with the mesial-buccal tubercle; 6d — variants of molars closure in case of the 1* Angle's class: irregular inclination of the 6* tooth axis violating its closure of the 1* permanent molar mesial-buccal and distal-buccal tubercles on the right and on the left of dental arches relative to the intertubercular fissure of the lower 1* per- manent molar and the clivus of the mesial-buccal tubercle of the 2" molar. © The 2” key (crown angulation) — regular angulation in degrees (mesiodistal inclination) of the longitudinal axis of all teeth crowns. It is characterised by the size of the angle formed at the intersection of the tangent to the clinical crown of every tooth and the perpendicular to the occlusal plane. At optimal occlusion angulation is Positive in case the occlusion segment of the tangent to the medial line of the tooth crown vestibular surface is mesial relative to the gingival margin, and negative — at reverse correlation. The latter is characterised as abnormality (Fig. 16, 17). At optimal occlusion every tooth has the angulation, characteristic of it. Fig. 16. Incisors angulation (the 2 Andrews’ occlusion key). ig. 17. Angulation of the up. @~ normal; b — positive violated; c ~ negative violated per id lower frontal and lat. eral teeth (the 2" Andrews occlusion key) 27 Chapter 2. Morphofunetional Description +P -r Puc. 18. Teeth torque (the 3% Andrews’ occlusion key): a — positive of incisors; b— negative of incisors; c, d— correct of other teeth * The 3 key (torque) — vestibulooral inclination of the crowns and roots of teeth. It is characterised be the size of the angle formed at the intersection of the tangent to the medial line of the tooth crown vestibular surface and the perpendicular to the occlusal plane. At normal position of the incisors’ crowns their occlusive part is located vestibularly relative to the gingival part. Normally, the lingual inclination of the occlusive part of the upper lateral teeth crowns increases in the direction from canine to molar teeth (Fig. 18). If to place a direct arch in the horizontal direction parallel to the tooth occlusion surface (interdental line direction) and draw a tangent to its fascial tubercles there will be an angle equal to 10° on average. The knowledge of its size is important for the calculation of the curve of the third order on the arch in the region of every upper I* permanent molar. Such curves are made when using the standard edgewise-tech- nique. * The 4" key (rotations) — the teeth located in dental arches should not be turned round. Frontal teeth, which are turned round, take less space in the dental arch causing its flattening and shortening. Turned round premolars and molars take more space in the dental arch causing its deformation and lengthening, and thus oc- clusion violation (Fig. 19). When a tooth is turned round the vertical axis, dental arch length changes. If frontal teeth, being in the dental arch, are turned round, the arch flattens and short- ens; if lateral teeth — it lengthens, which violates dental arches correlation. * The 5’ key — the presence of tight contact between the teeth of every dental arch without diastems and diaereses. Not infrequently gaps arise at the violation of the myodynamic balance of the muscles surrounding dental arches from external and internal surfaces. Such anomaly is observed at nonoclosure of lips, infantile swallow- ing, bad habits — sucking of fingers, tongue, lips, different objects. Spaces between teeth can be conditioned by excessive jaw growth, more often of the lower one, at gnathic varieties of mesial occlusion. 28 Physiological ‘Types of Ocelusion Fig. 19. Teeth torsion around the vertical axis (the 4" Andrews’ occlusion key); @—a tumed frontal tooth takes less space in the dental arch, a tumed lateral one — more; b — the absence of place for the 5" tooth as a result of the ‘6 tooth torsion and mesial shift; c — correct posi- tion of the 6 tooth provides space increase in the ental arch for the 5* tooth b c * The 6 key — the concavity of Spee’s curve should not exceed 2 mm, which is detected at measuring the biggest distance between the plane, tangent to the lower central incisors scalprum and to the last permanent molars distal tubercles, and the most low located occlusion surface of lateral teeth. The shorter the dental arch and the longer the apical arch are, the deeper Spee’s curve is, which causes irregular teeth position and the deviation of their longitudinal axis. Spee’s curve reflects the teeth-alveolar height in the anterior and posterior re- gions of the dental arches of both jaws and normally makes up to 2 mm (Fig. 20). ‘The curve is interdependent with the length of dental arches and their apical basis. It can be concave, flat or convex (Fig. 21). Fig. 20. The Spee’s curve a— shortened at pronounced Spee’s curve; 6 — length increases after the nor- alization of the Spee’s curve form 8 Fig. 21. Spee’s curve types (the 6” Andrews’ occlusion key): b ‘a — concave; 6 — straight; ¢ — convex 29 Chapter 2. Morphofunctional Description of Dentognathic Apparatus _ According to L. Andrews, the most common treatment errors ares « irregular position of the incisors’ axes in the mesiodistal directions, which was observed at the distal transfer of incisors to the permanent premolars, extracted by orthodontic indications; a; © unclosed spaces between teeth after the distal transfer of of the extracted 1* premolars; oa ‘© preserved rotation of tecth round the vertical axis; ; * mesial angulation of supporting molars.

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