Classification of the Teeth
Dr. Angle classified the dentition into three major categories Class I,II and III
Class I
The first molars are in a normal relationship.
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| Crowding (Inset photos A to D) |
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| Before Treatment |
15 Years After Treatment (Extraction) |
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| Spacing (Inset photos E to H) |
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| Before Treatment |
After Treatment (Non - Extraction) |
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Class II
The mandibular molars are posterior to the maxillary molars.
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| Before Treatment |
10 Years After Treatment |
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Class III
The mandibular molars are anterior to the maxillary molars.
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| Before Treatment |
After Treatment |
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Compromised
When a posterior tooth, such as a permanent mandibular first molar, is extracted and is not replaced, deterioration of the entire bite may occur : 1. Adjaccent teeth drift into the extration space; contacts between these teeth are lost; spaces develop, and food becomes lodges between the teeth.
2. The mandibular dentition collapses; a deep overbite occurs; proper contact with the maxillary teeth is lost, and the mandibular incisors impinge on the palatal mucosa.
3. The opposing maxillary molar overerupts and extrudes into the extraction space; the contacts between adjaccent maxillary teeth are lost, and food becomes lodged between these teeth.
4. These conditons can result in periodontal disease and further loss of teeth.
5. With the occlusion now totally disrupted, cusp interference may create a functional displacement of the mandible, resulting in possible involvement of the temporomandibular joint. |
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| Ideal Occlusion |
Compromised Dentation |
| Lateral View |
Anterior View |
Lateral View |
Anterior View |
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| Before Treatment |
After Treatment |
| Right View |
Left View |
Right View |
Left View |
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Etiology of Malocclusion
Crowding of the teeth
Heredity
EXAMPLES of tooth-size, jaw-size discrepancies that result in crowding which may require the extraction of certain permanent teeth for correction.
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Environment
EXAMPLES of malpositon of teeth that may be the result of environmental influences. These often may be corrected by the regaining of space and treated without extraction of permanent teeth.
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Spacing of the teeth
Heredity
EXAMPLES of tooth-size, jaw-size discrepancies that result in spacing. These condition which may require the extraction of certain permanent teeth for correction.
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Environment
EXAMPLES of malpositon of teeth that may be the result of environmental influences which may be corrected by the removal of the causative factor prior to or during orthodontic treatment.
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Treatment
Each patient is evaluated as an individual and each treatment plan is quite specific. These three boys brothers and, even though two are twins, all were treaed differently. For example, one twin required the extraction of teeth while the other did not.
All three enjoy successful and stable results several years after treatment.
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Protocol
Treatment protocol cannot be generalized. Early treatment (carried out prior to the emergence of all the permanent teeth) may be appropiate for some patients but not others. The timing of treatment depends on the circumstances.
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A. Interceptive Guidance (I.G.)
Active Treatment (A.T.) VS One Phase |
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B. First Phase, Interceptive Treatment Observation
Second Phase, Active Treatment VS One Phase |
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C. One Phase, Active Treatment |
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D. Adult Treatment
Adult treatment must be diagnosed and managed somewhat differently from treatment that is carried out prior to maturity. In the adult, growth and development of the face has virtually ceased. Quite often, adult treatment is a compromise due to this lack of growth. Additional complications such as periodontal breakdown, loss of teeth, or temporomandibular disorder frequently make adult care a cooperative effort involving several members of the dental team. |
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Patient Cooperation
The most difficult challenge in orthodontic treatment is patient motivation. If the patient does not cooperate by following instructions, keeping the teeth clean, being on time for and not missing appointments, and caring for the appliance properly, the most sophisticated treatment plan or appliance therapy will fail to produce a satisfactory result.
Patient cleaning his teeth and maintaining appliance in good repair.
Patient scheduling appoinment. It is important that the patient does not miss or come late for appoinments.
Missed appoinments or late arrivals deprive the patient of valuable treatment time that is necessary for a successful result -- completed within the scheduled time.
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