INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
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IO
ROGRESSIVE
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HERAPY
INTRODUCTION • The Management Umbrella • Principles of Bioprogressive Therapy • Orthopedics in Bioprogressive Therapy • Forces Used in Bioprogressive Therapy • Triple - Control Bioprogressive • Bioprogressive Mixed Dentition Treatment • Finishing Procedures and Retention • Visual Treatment Objective www.indiandentalacademy.com
Management Umbrella • •
Leadership Evolution Management System Transitional Leader • Organization proliferates • Committees increase • Assistants multiply • Volume increase • Profit falls Planning • Best people leaves • No management successioni Organizing Leading Controlling
Natural Leader • Spontaneous • Centric Quality Quantity • Specialized in tech work Effectiveness of Treatment • Centralizes decision making • Control by inspection
Management Leadership Primary goal • Domination of group Practice objectives • Decentralized Oldest decisions specialty making • Logical action Authority • Control by exception Quantity Communication skill time
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Diagnostic & Treatment Design Forecast System Diagnostic Programme Planning
Develop Objectives Program Scheduling Budget
Superimposition Areas Chin Maxilla Teeth in mandible and maxilla Profile Lower arch
Clinical Examination Describe Malocclusion Describe Face Describe Functional Req. • Evaluation of Airway • Evaluation of Habits • Evaluation of Soft Tissue Construct V.T.O.
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Evaluation Areas Chin Maxilla Lower incisor and molar Upper incisor and molar Soft tissue Arch form
Appliance Evaluation
function
mechanical Biological • Facial type • Musculature • Cortical bone
Headgear Auxiliary Appl. Selection Quadhelix R.M.E Bumper Nance Facemask Plates Activator www.indiandentalacademy.com
Select Fixed Mechanics
Sequence of Mechanics
Vehicle • Bands • Direct bonding Arch Wires
Time Schedule
Budget
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Principals Of Bioprogressive Therapy The Use of System Approach to Diagnose and Treatment by Application of V.T.O Torque Control Through Out Treatment Muscular and Cortical Bone Anchorage Movement of All Teeth in Any Direction With Proper Application of Pressure Orthopedic Alteration www.indiandentalacademy.com
Treat Overbite Before Overjet Sectional Arch Therapy Concept of Over treatment Unlocking the Malocclusion in a Sequence of Treatment in Order to Establish or Restore More Normal Function Efficiency in Treatment With Quality Results Utilizing a Concept of Prefabrication of Appliance
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Torque Control Throughout Treatment Importance of Torque • Keep roots in vascular bone • Anchorage • Torque to model • Position teeth in final occlusion
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Muscular and Cortical Bone Anchorage
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Movement of All Teeth in Any Direction With Proper Application of Pressure • Work of Brian Lee • Bpt Suggest
Orthopedic Alteration
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Treat Overbite Before Overjet
Sectional Arch Therapy • Lighter forces to individual teeth • Effective root controlling • Maxillary orthopedic alterations • Reduces binding and friction
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Concept of Over treatment • To overcome muscular forces against tooth surface • Root movements needed for stability • To overcome orthopedic rebound • To allow settling in retention
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Unlocking the Malocclusion in a Sequence of Treatment in Order to Establish or Restore More Normal Function • Concept • According to B.P.T • 3 Areas of diagnosis
• Position of teeth • Facial type • Functional influence www.indiandentalacademy.com
Efficiency in Treatment With Quality Results Utilizing a Concept of Prefabrication of Appliance Efficiency • Thorough understanding of mechanical procedures • Effect of mechanics on underlying anatomy and physiology • Failure will result in cook book • Monitor and upgrade ones self. Quality • Considered from the beginning • Finish in mind before starting the case • To relieve burden of detailing Use prefabricated appliance www.indiandentalacademy.com
ORTHOPEDICS IN BIOPROGRESSIVE THERAPY • Introduction • Is There A Difference • Evaluation Methods
Normal Growth Anticipated Growth
Areas of Superimposition
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Mechanical Response
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ANALYSIS OF AN ORTHOPEDIC PROBLEM
Microrhino Dysplasia General Characteristics
1. Upward Tilt Of Palate 2. Short Vertical Height Of Nose 3. Upward Cant Of Nares 4. High Convexity 5. Excessive Anterior Overjet 6. Abnormal Habits 7. Hypertonic Lower Lip 8. Retruded Lower Arch 9. Fractured Upper Incisors 10. Hypotonic Upper Lip 11. Blocked Upper Laterals 12. Mandible Unrelated www.indiandentalacademy.com
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CLASSICAL RESPONSES WITH DIFFERENTIAL HEADGEAR THERAPY ( CERVICAL HEADGEAR) ORTHOPEDIC RESPONSE
ORTHODONTIC RESPONSE
REVERSE RESPONSE
EXPANSIVE RESPONSE
SOFT TISSUE RESPONSE www.indiandentalacademy.com
GENERALIZED RESPONSE TO COMBINATION TYPE HEADGEAR • Usage • • •
• Differentiation between orthopedic and orthodontic movements
Other Factors
1. 2. 3. 4.
Force Amount Direction Force Duration
Sinus Development Distal Root Tip Stacking Factors Sutural Freedom
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Cervical Headgear
Combination Headgear
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Mechanical Application of Cervical Headgear
Force Level Intermittent Wear Outer bow Length and Position Expansion – Rotation Freedom of movement of Maxillae www.indiandentalacademy.com
Factors Causing Excessive Mandibular Rotations
Weak Muscular Pattern Not Retarding Effective Eruption of Lower Molars Severe Tipping of Upper Molars Full Arch Therapy Without Freeing Anterior Occlusion
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FORCES USED IN BIOPROGRESSIVE THERAPY • Physiology of Tooth Movement
Biological response to the forces applied to our mechanical procedures
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Force levels • Work by Brian Lee following the work of Storey and Smith • According to bioprogressive therapy – 100gm cm2
• Control of force
Work by Thurow
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Support
Cortical Bone Support
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Muscular Support
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Standard Appliance
Full Torque Appliance
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Triple Bioprogressive Appliance NonExtraction Series
Extraction Series
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FINISHING & RETENTION • Commitment and Motivation • Differing Occlusal Concepts • Sectional Arch Treatment • Prefabrication of Appliance • Functional Influences • Three Phase of Retention www.indiandentalacademy.com
Occlusal Check List for Lower •
Molar - upright , mesial slightly outward to accommodate distal incline of upper first bicuspid.
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Bicuspid (2) - slightly depressed to seat the upper second bicuspid.
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Bicuspid (1) – buccal to lower canine and should be well elevated, mesial contact also buccal to canine.
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Lingual crown torque from bicuspid (2).
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Canine – position to produce smooth curve.
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Distal of lateral placed slightly labial to mesial of canine.
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Smooth curve of contacts of the incisors. www.indiandentalacademy.com
Occlusal Check List for Upper • Molar – well expanded to prevent collapse of arch later. • Molar – upper molar rotation . Line should pass through canine. • Bicuspid (2) – distal margin is well occlusal to marginal ridge of upper first molar. Slightly inclined mesially. • Bicuspid (1) – slightly distally inclined. • Bicuspid (1) – offset buccally to cuspid to avoid area of premature contact with lower first bicuspid. • Canine – slight mesial rotation. • Lateral – kept labially. • Central – proper contact, midlines coincide with lower, level incisal edges. www.indiandentalacademy.com
VISUAL TREATMENT OBJECTIVE
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1.
Trace the nasion –basion plane. Put a mark at point CC.
2.
Grow nasion 1mm/yr. Treatment time – 2yrs.
3.
Grow basion 1mm/yr for 2yrs.
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Mandibular Growth Prediction - Rotation
Mechanics 1. Convexity reduction – Facial axis opens 1deg / 5mm. 2. Molar correction – Facial axis opens 1deg / 3mm. 3. Crossbite correction – Facial axis opens 1-11/2, recovers half the distance 4. Overbite correction – Facial axis opens 1deg / 4mm. 5. Facial pattern – Facial axis opens 1deg – dolichofacial ; 1deg closing in brachyfacial www.indiandentalacademy.com
1.
Superimpose at basion along basion – nasion plane. Rotate up at nasion – open bite and down to close the bite using DC as fulcrum.
2.
Trace condylar axis coronoid process and condyle.
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1.
On condylar axis, make mark 1mm / yr. Down from point DC.
2.
Slide mark up to the basion – nasion plane along the condylar axis. Extend the condylar axis to XI point, locating a new XI point.
3.
With the old and new XI point coinciding trace corpus axis, extending it 2mm / yr. Forward of old PM point.
4.
Draw posterior border of the ramus and the lower border of the mandible. www.indiandentalacademy.com
1.
Slide back along the corpus axis superimpositioning at new and old PM. Trace the symphysis and draw in mandibular plane.
2.
Construct facial plane from NA to PO.
3.
Construct facial axis from CC to GN.
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Maxillary Growth Prediction 1.
To locate the “new” maxilla within the face, superimpose at nasion along the facial plane and divide the distance between “original” and “new” mentons into third by drawing two marks
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1.
To outline the body of the maxilla superimpose mark #1 on the original menton along the facial plane. Trace the palate, exception of point A.
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Maxillary Growth Prediction Point A changes with various mechanics HG - -8mm Class II – -3mm Activator - -2mm Torque - -1-2mm Class III - +2-3mm Facial mask - +2-4mm 1.
Point A can be altered distally with treatment. Place according to orthopedic problem and treatment objective. For each mm of distal movement, point A will drop ½ mm
2.
Construct new APO plane.
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Occlusal Plane Position 1.
Superimpose mark # 2 on original menton and facial plane, then parallel mandibular planes rotating at menton. Construct occlusal plane.
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Lower Incisor 1.
Superimpose on corpus axis at PM. Place a dot representing the tip of the lower incisor in the ideal position to the new occlusal plane, which is 1mm above the occlusal plane and 1mm ahead of APO plane.
2.
Aligning over the original incisor outline or using a template, draw in the lower incisor in the final position as required by arch length. Angle is 22 deg at =1mm to occlusal plane, but the angle increases 2 deg with each mm of forward compromise. www.indiandentalacademy.com
Lower Molar 1.
Without treatment the lower molar will erupt directly upward to the new occlusal plane. With treatment 1mm of molar movement equals 2mm of arch length. Lower incisor moved 2mm in this case + 4mm of leeway space. Therefore the calculation allows us to move the molar forward 4mm on each side.
2.
Superimpose the lower molar on the new occlusal plane at the molar www.indiandentalacademy.com
Upper Molar 1.
Trace the upper molar in good class I position to the lower molar. Use the old molar as template.
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Upper Incisor Place upper incisor in good overbite – overjet position = 2mm; interincisal angle 130 deg. 1.
Trace the upper incisor in its proper relationship aligning over the original incisor using it as a template. www.indiandentalacademy.com
Soft Tissue – Nose 1.
Superimpose at nasion along the facial plane. Trace bridge of the nose.
2.
Superimpose at anterior nasal spine (ANS) along the palatal plane.
3.
Move prediction “back” 1mm / yr. Trace tip of nose fading into bridge. www.indiandentalacademy.com
Soft Tissue – Pt. A and Upper Lip 1.
2.
3.
4.
Superimpose along the facial plane at the occlusal plane. Divide the horizontal distance between the “original” and “new” upper incisor tips into thirds by using two marks. Point A remains the same, superimpose new and old bony point A and make a mark at soft tissue Point A. Keeping the occlusal planes parallel, superimpose mark # 1 on the tip of the original incisor (slide forward 2/3). Trace upper lip connecting with point A. www.indiandentalacademy.com
Lower Lip, Point B, Soft Tissue Chin 1.
Superimpose interincisal points keeping occlusal planes parallel. Trace lower lip and soft tissue B point. The soft tissue below lower lip remains in the same relation to point B as in the original tracing. Soft tissue point B drops down as lower lip recontours.
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Completed V.T.O 1.
Superimpose on the symphysis and arrange the soft tissue of the chin. It should be evenly distributed over the symphysis.
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BIOPROGRESSIVE IN MIXED DENTITION Objectives of Early Treatment Resolve Functional Problems Resolve Arch Length Discrepancy Correct Vertical Problems Growth Concepts Work by
Bjork Moffett
Moss Ricketts www.indiandentalacademy.com
Traditional Growth Concept
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Current Growth Concept
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Laminagraphy
Functional Problems • Cross Mouth Interference • Anterior Crossbite • Open Bite • Excessive Range of function • Distal Displacement • Loss of Posterior Support • Habits • Airway problems • True Class III Problems www.indiandentalacademy.com
Laminagraphic Norms for Condylar Position
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