DIFFRENTIAL DIAGNOSIS DENTAL DISHARMONY
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Environmental Disharmony: The most challenging area of the Orthodontic treatment is to correct the Environmental abnormality. Bones Muscles Blood supply Nerve supply Soft tissue
Make up the environment
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ENVIRONMENT
Functional Element Joints
Muscles
Static Elements 1.Bone 2.Cartilage
Facial expression
3.Soft tissue
Mastication.
that forms final Contour of the face.
Deglutition Speech respiration.
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It is important to recognize the deformities and disharmonies in the environment and every effort be made to harmonize all the elements of the environment. Final results of the treatment cannot be stable unless Environmental harmony is achieved. No matter how good the mechanotherapy has been. Ex:- Habit correction. Treatment of joint disorders. www.indiandentalacademy.com
Dental Disharmony: ď Ž
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The teeth and their relationship to each other and to the bones supporting them have been the overriding concern of the orthodontist, since the time of Angel. Orthodontic treatment is a space management procedure. It is crucial to identify the areas of dentition space deficit or space surplus. www.indiandentalacademy.com
DENTAL DISHARMONY Total dentition space analysis This division is made for two reasons: 1)simplicity in identifying the area of space deficitor space surplus and 2) accuracy in differential diagnosis.
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The entire arch divided into three areas: - Anterior arch area (from canine to canine) - Mid arch area (first and second premolars and first molar) - Posterior arch area (area distal to first molar)
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Anterior space analysis. Anterior space analysis includes the measurement in millimeters of the space available in the mandibular arch from canine to canine and a measurement of the mesiodistal dimension of each of the six anterior teeth. The difference is referred to as a surplus or deficit.
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The Tweed diag-nostic facial triangle is also used to further analyze this area. Lateral headfilm discrepancy is the amount of space required to position the mandibular incisors for facial balance. This value is added to the anterior space measurement.
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The thickness of the soft tissue (upper lip versus total chin) must also be considered as part of the anterior space analysis. Total chin thickness should equal upper lip thick-ness. If it is less than upper lip thickness, the anterior teeth must be uprighted further to create a more balanced profile because lip retraction follows tooth uprighting.
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The sum of the anterior tooth arch surplus or deficit, the cephalometric discrepancy, and the soft tissue thickness im-balance is referred to as the anterior discrepancy. Each of the three values in the anterior discrepancy calculation has been given a difficulty factor so that an anterior space analysis dif-ficulty value can be calculated.
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Mid-arch space analysis. The mid-arch area includes the mandibular first molars and the first and second premolars. Careful analysis of this area may show mesially inclined first molars, rotations, spaces, a deep curve of Spee, crossbites, missing teeth, habit abnormality, blocked out teeth, and occlusal disharmonies. This is an extremely important area of the dentition. Because it is in the center of the arch, this area allows the easiest and most direct method of space management for malocclusion correction when it can be so used. www.indiandentalacademy.com
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Crowding, a deep curve of Spee, and end-on or full-step Class II occlusions, not accompanied by anterior discrepancy, indicate a need for second premolar extraction in the mandibu-lar arch. Careful measurement of the space from the distal of the canine to the distal of the first molar should be recorded as available midarch space.
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An equally accurate measurement of the mesio-distal width of the first premolar, the second pre-molar, and the first molar must also be recorded. To this is added the space required to level the curve of Spee ° From these measurements the orthodontist can determine the space deficit or surplus in this area.
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Occlusal disharmony, a Class II or III buccal segment re-lationship, though not a part of the actual midarch space analysis, must be measured because an occlusal disharmony adds a great deal to the difficulty of correction of any maloc-clusion and requires a careful treatment strategy as well as space management.
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Occlusal disharmony is measured by articulating the casts and using the maxillary first premolar cusp as a reference. Measure mesially or distally from the maxillary first premolar buccal cusp to the embrasure between the mandibular first and second premolars. This measurement is made on both sides and is then averaged to determine the occlusal disharmony
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The difficulty factor is °2," so the averaged disharmony is doubled and added to the midarch difficulty because it has to be corrected by moving teeth that are in the midarch of the dentition. Movement of these posterior teeth require space management.
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ANTERIOR Tooth arch discrepancy Headfilm discrepancy Soft tissue modified MIDARCH Tooth arch discrepancy Curve of Spee Total Occlusal disharmony POSTERIOR Tooth arch discrepancy Expected increase (-) Total Space analysis difficulty total =. Time of cessation of ramus resorption Gender Age
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A review of the literature38 reveals that a consensus of researches suggests that 3 mm of increase in the posterior denture area occurs per year until age 14 for girls and age 16 yrs in boys. This is an increase of 1.5 mm on each side per year is important determine of posterior area..
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it is not prudent to create a posterior discrepancy while adjustments in other areas such as the midarch, is imprudent not to use a posterior ' surplus to help alleviate midarch and anterior deficits. Most easily recognizable symptom of a posterior space it in the young patient is the late eruption of the second molar.
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If space is not available for this tooth by the age of its normal eruption, it should be obvious that a posterior space problem exists. A good cephalogram can immediately confirm a clinical observation by using the previously mentioned guidelines. The posterior space analysis surplus or deficit has been given a low difficulty factor of 0.5 because a posterior space deficit can be easily resolved by third molar removal. www.indiandentalacademy.com
Total Space Analysis-Tooth Arch Discrepancies Space Management A. Anterior Surplus or Deficit + to -2 mm Nonextraction 3 mm to 5 mm without crowding Extract 3 mm to 5 mm with crowding Extract 5 mm to 7 mm with less than 3 mm anterior crowding Extract 5 mm to 7 mm with more than 3 mm anterior crowding Extract 7 mm to 1 5 mm anterior deficit Extract 16 mm and above Extract B. Mid-arch Surplus or Deficit-Anterior Deficits Override Mid-arch Deficits to 3 mm Nonextraction 3 mm to 5 mm without crowding Extract 3 mm to 5 mm with Class II molar Extract 5 mm to 7 mm with upper anterior protrusion Extract 5 mm to 7 mm Extract 8 mm to 15 mm Extract' Over 15 mm Extract C. posterior Surplus or Deficit- The space analysis in this area is of great importance, although in corrective procedures anterior z--mid-arch deficits are overriding. The posterior must be carefully measured and projected. No orthodontic treatment is complete --til all decisions and treatment procedures are completed in this area. - to -5 mm with good position of the third molars Await full development of the third molars - to -5 mm with poor position of the third molars Extract Note: Wait for maxillary third molars until age 16. Have the mandibular third molars out immediately if other treatment is necessc-, 5 mm to 15 mm Extract Note: Determine the timing of these extractions in relationship to other treatment that is necessary. www.indiandentalacademy.com
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