Atlas of Orthodontics - Principles and Clinical Applications - A. Viazis (W. B. Saunders, 1993) WW

320 Pages·1993·41.28 MB·English

\

•

Atlas of
•

Principles and

ical Applications

,

•

Atlas of

Anthony D. VIazis, DDS, MS
Assistant Professor
Department of Orthodontics
Baylor College of Dentistry
Dallas, Texas

Principles and
ical Applications

W.B. Saunders Company
A DiI'isioti if
Ifarra1m Broce & Company
Philadelphia
london Toronto

Montreal Sydney Tokyo

Preface

•

Atlas of Orthodontics: Principles and Clinical Applications was written with the
intention to introduce to the world of clinical orthodontics its first illustrated text.
This colorful. methodological presentation of the most up-t<rdate infonnation and
direct clinical application aims to aid the students of orthodontics in understanding
the logical sequence from diagnosis to a successful treatment. In addition. as the
innovations and revolutionary improvements in clinical orthodontics over recent
years have widened the scope of diagnosis and broadened the horizons of treatment.
this work aims to serve as the most updated illustrated reference of all these new
advances. Thus, the atlas can very easily serve as a guide to students, dentists. and
orthodontists alike.

AlIas of Orthodontics is an array of original photographs and drawings that high-

light the state.of-the-art modern practice of orthodontics with fresh, new ideas on
diagnosis, treatment planning, and, above all, therapy and its clinical application. It
provides the reader with a step-by-step decision-making approach to the practice of
orthodontics. The comprehensive yet easily readable text and the legends that accom-
pany the illustrations span the breadth of the references. The clinician learns various
techniques from photographic material (in color) directly from the patient's mouth.
This atlas offers a system that gives the best results while disclosing invaluable tips on
preventing clinical blunders that would lead to complications. It methodically explains
the reasons for all the clinical techniques used based on fundamental biological and
biomechanical principles, so that the reader will easily understand the orthodontic
thinking process. Furthermore, it will give the practitioner the satisfaction of being
able to apply clinically all that he reads. While reflecting the most current accepted
treatment methods, its structured outline and continuity provide all the information
in an easy, commonsense formal. No other book in the field of orthodontics focuses
on the clinical side of day-to-day practice with such an abundance of illustrations that
educate the reader on critical judgment and clinical modalities that give the best
treatment results. It is an invaluable educational source of the art and science of
clinical orthodontics for the graduate and undergraduate student, for the general
dentist, and even for the most experienced orthodontist.
My sincere appreciation is addressed to the following individuals for their signifi -
cant contributions to my education and academic endeavors in orthodontics: from
Baylor College of Dentistry, Drs. Richard Cecn, Robert Gaylord, Tom Matthews, and
Peter Buschang, Rohit Sachdeva, Doug Crosby, Monte Collins, Joe Jacobs, Richard
Aubrey, Moody Alexander, Wick Alexander, Ed Genecov, Larry Wolford, Mr. Stan
Richardson, and Mr. Chris Semos; from the University of Minnesota, Drs. William
Liljemark, Richard Bevis, Gerald Cavanaugh, T. Michael Speidel, Kevin Denis, Mark
Holmberg, James Swift, Robert Feigal, Robert Gorlin, William Douglas, and the
former President of the American Board of Orthodontics, Lloyd Pearson; from the
University of Maryland, Dr. Dianne Rekow; from Tufts University, Drs. Nicholas
Darzenta and Anthi Tsamtsouris; from the University of North Carolina, Dr. William

vii

viii • l'rtiaw

Proffit; from the University of Southern California. Dr. Peter Sinclair; from the
University of Iowa. Drs. John Casko and Samir Bishara; from the University of
Athens, Drs. Meropi Spyropoulos, Paul Apostolopoulos, and George Vouyouklakis;
from the Medical College of Virginia, Dr. Robert Isaacson; and from Louisiana State
University, Dr. Jack Sheridan; and from the University of Toronto, Dr. Angelo
Metaxas.

A special acknowledgment is addressed to one man who is an inspiration to many

in the field of orthodontics: Dr. T.M. Graber, Editor-in-Chief of the American Journal
of Orthodontics 011(1 Denlofadal Orthopedics. I am deeply grateful to him for his
advice, recommendations, endless energy and enthusiasm, and the wonderful support
that all my academic endeavors have enjoyed from him.

I am also grateful to all the students with whom I have had the distinct pleasure of
working, from the undergraduate junior dental class at the University of Minnesota
that presentcd me with the greatest honor of my academic life, the "Teacher of the
Year Award" after my very first year in teaching, to the graduate students at the same
school and at Baylor College of Dentistry for their excellent work on all the cases that
we treated together. Their critical thinking and quest for knowledge have certainly
influenced me and the way I teach.

ANTttONY D. VIAZIS, DDS, MS

•

Contents

Part A
Preliminary Examination of the Patient

Chapter I
Chief Complaint
3

Chapter 2 Dental Development
5

Chapter 3 Articulated Casts
7

Chapter 4
Radiographic Evaluation
13

Chapter 5 The Temporomandibular Joint
21

Chapter 6 Nasorespiralary Function
27

Chapter 7 Oral Hygiene Considcrdtions
29

Chapter 8 Periodontal Plastic Surgery
35

Part B
Facial and Cephalometric Evaluation

Chapter I
Natural Head Position
41

Chapter 2
Bolton and Michigan Standards
45

Chapter 3 Cephalometric Landmarks
47

Chapter 4 Soft-Tissue Evaluation
49

Chapter 5 Anteroposterior Skeletal Assessment
59

Chapter 6 Vertical Skeletal Assessment
67

Chapter 7 Cephalometric Dental Evaluation
73

Chapter 8 Posteroanterior Cephalometries
75

Part C
Growth

Chapter I
Growth Considerations
79

ix

x • Conl('lI/.f

Chapter 2 Growth Superimposition/ Evaluation
89

Chapter J
Hand-Wrist Radiograph Evaluation
97

Chapter 4
Nasal Growth
99

Part D
Orthodontic Mechanotherapy

Chapter J Biomechanics of Tooth Movement
105

Chapter 1 Orthodontic Metal Fixed Appliances
117

Chapter 3 Esthetic Brackets
121

Chapter 4
Direct Bonding of Bmckets/Adhesive
129

Systems

Chapter 5
Basic Orthodontic Instruments: Wire
141
Bending

Chapter 6 Orthodontic Wires
153

Chapter 7 Archfonns
163

Chapter 8 Coil Springs
167

Chapter 9 Elastometric Chain Modules
179

Chapter 10 Orthodontic Elastics
189

Chapter II Class I Cuspid Relationship
199

Part E
Adjunctive Appliances

Chapter J Rapid Maxillary Expansion (RME)
205

Appliances

Chapter 1
Lip Bumper
215

Chapter 3 Headgear
219

Chapter 4 Removable Appliances
223

Chapter 5 Functional Appliances
227

Chapter 6 Chin-Cup Therapy
233

Chapter 7 Thumb-Sucking and Habit Control
235

Chapter 8
Protraction Faccmask
239

Chapter 9 Active Vertical Corrector
243

COn/enls • xi

Pari F
Orthodontic Treatment Modalities

Chapter J Early Treatmcnt
249

Chapter 2 Tooth Guidance (Serial Extraction)
261

Chapter J Tooth Reconto uring
265

, ,
Chapter $
Treatment Planning in thc Permancnt·
271

Dentition

Chapter 5 Incisor EXlnlction/ Missing Incisor/
307

Second Molar Extraction ThcnlPY

Chapter 6 Intrusion Mechanics/Compromised
323

Periodontium Thcmpy

Chapter 7 Retention
33 1

Indu
343

C"
e r

Chief Complaint

The examination or the patient in the office should always stan with the medical history, as is

done in any dental offiCC. I - 3 The dental clinical evaluation should follow, where
general notes, as well as an evaluation of the intraoral soft tissue, teeth, and oral
function, and panoramic radiograph are made.2•1 Any operative, periodontaL and
endodontic work (if needed) should be completed before initiation of onhodontic
treatment, whereas any tcmporomandibular joint (TMJ ) pain or dysfunction should
be addressed before the onset of onhodontic treatment (Table A 1.1). Permanent
prosthetic work should be done afterward.

Inquiring about the patient's chief complaint, i.e .. the reason he or she seeks
orthodontic treatment, is of utmost importance. The chief complaint must have been
met by the end of treatment, otherwise the patient will not be happy, even if the
orthodontic therapy is of the highest standards. If the patient or guardian has unrealis-
tic expectations that may not be met with treatment, the clinician ought to educate
him or her so that he or she understands the limitations of the various therapeutic
modalities in modern orthodontics. A good example is the change of the soft tissue
(lips) as a result of extraction therapy. A patient will not be satisficd if. after 2 years of
orthodontics, he or she has a beautiful occlusion accompanied by late nasal growth
that makes the lips appear more retrusive.· In addition, the low degree of predictability
associated with the upper lip in rcsponse to orthodontic tooth movemcnt, possibly
caused by the complex anatomy or dynamics of the upper lip, I might cause undesir-
able changes in the soft-tissue profile in crowded cases that involvc extractions of
permanent teeth. Nononhodontic measures (i.e .. rhinoplasty or genioplasty) should be
discussed with the patient before the stan of the orthodontic treatment. I

4 • Pan A Preliminary EXaminOlian of/he Parieni

Table 1.1
Clinicul Information Form (DenIal)

General Information

Parent name
Guardian name

Address

P'Jtient name
Goad<
Hobbies

Do"

Telephone

Chief complaint

Patient height
Father's height
Mother's height
• Patient motivation

Prepubenal
Cireumpubenal
Postpubenal
Habits

Family history of malocclusion

Intraoral Soft Tissue Evaluation
-

Pathology
Oral hygiene
Attached gingiva
Gingival recession

Attachment
Pocket depth > 3mm
Frenum

Intraoral DenIal Evaluation and Panoramic Radiograph
"".,
Extracted
Root length

Uypoc;alcilication
Fractured CW" i11
Crownjbridgc

Missing
Fractured root
Supernumerary

Impacted
Stained
Wisdom teeth

Ankylosed
Endodontically treated
Bone pathology

Unerupted
Condylar outline:
Alveolar bone

F ne"
• IOna I Eval ation
•

Speech pathology
Muscle tenderness
Internal dernngement

Breathing
Clenching
Stage I (early or late clicking)

Swallowing
Bruxism
Stage II (morning lock)

Tongue size
Deviation upon opening
Stage III (acute lock)

lip tonicity
Deviation upon closing
Stage IV (function off disk)

Tonsil size
Range of motion (ROM)
Stage V (pain, grating sound)

CO/CR discrepancy
TMJ pain
TMJ dysfuOCIion

References

I. Talass MF, Tallas L, and Baker RC: Soft tissue profile changes resulting from retraction of maxillary
incisors. Am J Onhod Dc:qtofacial Onhop 9 1 :385-394, t987.

2. Proffit WR, and White RP, Jr.: Surgical·Orthodontic Treatment. St. Louis. MO: Mosby Year Book. 199 1.
3. Proffit WR: Contem{IQraryOrrhodolUicJ. SI. Louis, MO: C. V. Mosby Co .. 1986.
4. Buschang PH, Viazis AD, DelaCruz R, and Oakes C: Horizontal growth of the soft·tissue nose relative

to maxillary growth. Jain Orthod 26:111 - 118, 1992.

I