The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Original Title
Rapid Molar Intrusion Device / orthodontic courses by Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
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Treatment of skeletal open bite
with a device for rapid molar
intrusion
ANGLE ORTHODONTIST-sept 2005; vol 75
www.indiandentalacademy.com INDIAN DENTAL ACADEMY
Leader in continuing dental education www.indiandentalacademy.com
A rapid molar intruder for non- compliance treatment
JCO March 2002 ;volume 36
Aldo Carano DO,MS William C Machata DDS www.indiandentalacademy.com Various modalities for intrusion- Coronal reduction Subapical osteotomy Full coverage splints with fixed appliances High pull headgear with functional appliances Magnets Miniplates and screws www.indiandentalacademy.com it has been shown that 25gm of force is sufficient for intrusion of a single tooth along with significant gain of attachment and the max sinus is not an obstacle to intrusion. www.indiandentalacademy.com Appliance design modification of jasper jumper
flexible fixed appliance that delivers light continous forces and can be used to move single teeth,units of teeth,or an entire arch
Delivers functional;bite jumping;headgear like and elastic like forces or a combination of these www.indiandentalacademy.com Modules
L shaped pins Guide the modules into positions parallel to the occlusal plane www.indiandentalacademy.com During occlusion the modules flex and deliver a force upto 900gms against the molars.
Adverse movt-buccal crown tipping Control-use upper and lower lingual arches www.indiandentalacademy.com Case report 11yr old male Chief complaint-anterior open bite difficulty to close lip
Clinically- long face open bite 5mm bilateral posterior crossbite
Cephalometric analysis- straight profile vertical growth pattern mand rotated clockwise www.indiandentalacademy.com www.indiandentalacademy.com Upper arch - Spring Jet palatal expander Lower arch soldered lingual arch RMI www.indiandentalacademy.com Post Rx- www.indiandentalacademy.com M-B inclination of molars - controlled by palatal/lingual arches Molar intrusion and counter clockwise rotation of mandible achieved -6months www.indiandentalacademy.com Discussion-
Although promising a more long term research project needs to be done
Relapse ?
Periodontal status and pseudo pockets ? www.indiandentalacademy.com Treatment of skeletal open bite with a device for rapid molar intrusion
ANGLE ORTHODONTIST-sept 2005; vol 75
Aldo Carno Giuseppe Siciliani S.Jay Bowman
www.indiandentalacademy.com Open bite is one of the most difficult malocclusions to treat
Features- Vertical max excess Backward rotation of mandible Supra eruption of post teeth
Vertical control - directed against posterior maxilla corrections obtained here are relatively stable www.indiandentalacademy.com Design
Elastic modules attached to bands End caps- Straight-maxillary tube Angulated-mandibular tube L shaped annealed ball pins- placed into buccal tubes
Force - 600 900 gms Buccal tipping-always use TPA or lingual arch www.indiandentalacademy.com Clinical application Attach modules to TPA/lingual arch while in attached to plaster models Modifications- with tongue crib with expansion screw www.indiandentalacademy.com Construction- place pin into hole of angulated end of elastic module of lower arch Insert pin through convex side of metal cap with ball end directed buccogingivally Then insert it in the mesial opening of buccal tube.the annealed portion is bent gingivally. Terminal 2mm is bent mesially.
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Put other ball pin through the hole in flat end of force module
Then insert pin into mesial of buccal tube of the maxillary band
Ball end of pin at mesial side is bent gingivally www.indiandentalacademy.com Class II-attach max end of force module to distal of buccal tube
Class III- mand end of force module to distal of buccal tube www.indiandentalacademy.com Appliance is most suitable for growing patients showing excessive vertical growth
More intrusion in maxillary molars Deciduous molars if hypererupt-serial extraction
If 2 nd molars erupt-include using sectional rectangular wire Avg Rx time-5 7 months www.indiandentalacademy.com Case report-
12 yr old female Chief complaint lack of contact bet upper and lower incisors and diff in closing lips Clinical examination-class Imalocclusion open bite 3.6mm moderate posterior contraction Ceph analysis- obtuse mand plane angle vert excess of maxilla and lower 1/3 of face
www.indiandentalacademy.com
www.indiandentalacademy.com Rx time- 4months Open bite reduced to 0mm www.indiandentalacademy.com
www.indiandentalacademy.com Results Moderate intrusion of 1 st molars Anterior rotation of mandible Anterior facial height Counter rotation of occlusal plane
relapse of skeletal correction was seen- Cause Normal growth Return to excessive vertical pattern www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com adult patients
skeletal open bites with class I and II patterns are treated better
Additional anchorage-TPA/lingual arches
Modules need to be replaced as they deform with time causing decay in force level www.indiandentalacademy.com Case report
22yr female Chief complaint-lack of contact bet anterior teeth and poor esthetic appearance of smile
Clinical examination- class II malocclusion 1.9mm openbite posterior cross bite
www.indiandentalacademy.com Ceph analysis-obtuse mand plane angle excess vert dev of maxilla www.indiandentalacademy.com 4months- levelling and alignment Molar rotation and counter clockwise rotation of mandible -5months
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www.indiandentalacademy.com Conclusions Force 600 900 gms on each side Rx time 4 6 months
Adverse buccal tipping Incisor position appears stable TMDs ?
during growth -limits normal eruption of molar and induces change of mand plane Adults-molar intrusion and anterotation of mandible www.indiandentalacademy.com Noncompliant treatment of skeletal open bite
AJODO December 2005 Volume 128 Number 6
Aldo Carano William Machata Giuseppe Siciliani www.indiandentalacademy.com AIM
to illustrate the effects of the rapid molar intrusion appliance, a treatment alternative that does not require patient compliance, for counteracting excessive vertical dimensions in growing patients and adults. www.indiandentalacademy.com Anterior dental open bite backward-rotation mandible Overeruption of molars
passive system -relative intrusion potential of molar eruption during growth active system -physically intrude the molars into their bony support www.indiandentalacademy.com Appliance design
intrusive force - 800 g each side 450 g - end of 1 st week 250 g - end of 2 nd week
www.indiandentalacademy.com Material and methods 19 patients 11 - mixed dentition; 7 girls, 4 boys; avg age, 11.9 yrs, SD 1.8 years 8 - permanent dentition; 5 women, 3 men; avg age, 19.9 years, SD 3.9 year criteria S-N Go-Gn > 37 palatal plane Go-Gn > 32 UFH/LFH < 0.70 ODI < 68 1-mm opening when the incisal edges were projected perpendicularly the facial plane (N-Me).
www.indiandentalacademy.com growing patients maxillary and mandibular soldered stabilization arches were used 8 pts-spring jet appliance -maxillary expansion with a force of 470 g 9 pts,deciduous teeth interfered-the teeth were extracted If 2 nd molars erupted- banded and connected with the 1 st molars by a full-size rectangular wire Rx time -4 to 5 months
www.indiandentalacademy.com adult patients No anterior vertical elastics 6 pts-RMI + stabilization arches +fixed appliances variation -some pts,1 st and 2 nd molars - only contacting teeth, other patients, when the premolars were also in contact www.indiandentalacademy.com guidelines in the clinical management of patients
1 st molars were stabilized with soldered palatal and lingual arches (1 mm diameter). ball stops of the pins did not impinge on the gingival tissues. Patients were recalled at 4-week intervals. www.indiandentalacademy.com The RMI intruded only the molars to which it was attached.
Occlusal contacts, other than the first molars, were eliminated to allow for the intrusive effects of the RMI deciduous tooth extraction, leveling of the occlusal plane extraction of the maxillary 2 nd molars in difficult adult cases, extraction of the 3 rd molars when erupted www.indiandentalacademy.com Lingual arches were adjusted every 2 months to compensate for compression of the gingival tissue as the molars intruded. After the intrusion was completed and the open bite closed, the palatal and lingual stabilization arches were left in place for retention. www.indiandentalacademy.com Results
Mean closure at the incisors - 5.15 mm range 3.1-6.21 mm
Rx time- 5.45 months
Avg rate of 0.94 mm/month of open- bite correction
utility arch was used to disocclude the incisors and allow the mandible to autorotate
Molar intrusion - 5 months
www.indiandentalacademy.com occlusion -Class III
lip bumper - move teeth into the extraction sites of the mandibular 2 nd molars. Class III elastics - maxillary 1 st molars to lip bumper www.indiandentalacademy.com www.indiandentalacademy.com counterclockwise rotation of mandible and decrease in anterior facial height.
more mandibular molar intrusion than maxillary www.indiandentalacademy.com Discussion
intrusive force simultaneously to the maxillary and mandibular molars No patient compliance buccal crown tipping
skeletal vertical dimension is accompanied with advancement of the chin; suited for treating Class I and Class II skeletal open bites
www.indiandentalacademy.com Conclusions
Initial experiences with the RMI are promising, but a more structured research project is needed to demonstrate the long- term stability of the results
The Use of Osteopathic Manipulative Treatment in The Newborn Nursery and Its Effect On Health in The First Six Months of Life: A Retrospective Observational Case-Control Study