Chapter 1 Malocclusion and Dentofacial Deformity in Contemporary Society The Changing Goals of Orthodontic Treatment Early Orthodontic Treatment Crowded, irregular, and protruding teeth have been a problem for some individuals since antiquity, and attempts to correct this disorder go back at least to 1000 bc. Primitive (and surprisingly welldesigned) orthodontic appliances have been found in both Greek and Etruscan materials.1 As dentistry developed in the eighteenth and nineteenth centuries, a number of devices for the “regulation” of the teeth were described by various authors and apparently used sporadically by the dentists of that era. After 1850, the first texts that systematically described orthodontics appeared, the most notable being Norman Kingsleys Oral Deformities.2 Kingsley, who had a tremendous influence on American dentistry in the latter half of the nineteenth century, was among the first to use extraoral force to correct protruding teeth. He was also a pioneer in the treatment of cleft palate and related problems. Despite the contributions of Kingsley and his contemporaries, their emphasis in orthodontics remained the alignment of the teeth and the correction of facial proportions. Little attention was paid to bite relationships, and since it was common practice to remove teeth for many dental problems, extractions for crowding or malalignment were frequent. In an era when an intact dentition was a rarity, the details of occlusal relationships were considered unimportant. To make good prosthetic replacement teeth, it was necessary to develop a concept of occlusion, and this occurred in the late 1800s. As the concepts of prosthetic occlusion developed and were refined, it was natural to extend this to the natural dentition. Edward H. Angle (Figure 11), whose influence began to be felt about 1890, can be credited with much of the development of a concept of occlusion in the natural dentition. Angles original interest was in prosthodontics, and he taught in that department in the dental schools at Pennsylvania and Minnesota in the 1880s. His increasing interest in dental occlusion and in the treatment necessary to obtain normal occlusion led directly to his development of orthodontics as a specialty, with himself as the “father of modern orthodontics.” FIGURE 11 Edward H. Angle in his fifties, as the proprietor of the Angle School of Orthodontia. After establishing himself as the first dental specialist, Angle operated proprietary orthodontic schools from 1905 to 1928 in St. Louis; New London, Connecticut; and Pasadena, California, in which many of the pioneer American orthodontists were trained.
Thank you orthoebooks for all you have done for us This is a gift for you and others from me :) Dr Tariq Contemporary Orthodontics 5th ed William R Proffit, DDS, PhD Kenan Distinguished Professor, Department of Orthodontics and Chairman Emeritus, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina Henry W Fields, DDS, MS, MSD Professor and Head, Section of Orthodontics, College of Dentistry, The Ohio State University Chief, Section of Orthodontics, Department of Dentistry, Columbus Children's Hospital, Columbus, Ohio David M Sarver, DMD, MS Private Practice of Orthodontics, Birmingham, Alabama Adjunct Professor, Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina James L Ackerman, DDS Formerly Professor and Chairman, Department of Orthodontics, University of Pennsylvania, Philadelphia, Pennsylvania 978-0-323-08317-1 3251 Riverport Lane St Louis, Missouri 63043 CONTEMPORARY ORTHODONTICS ISBN: 978-0-323-08317-1 Copyright © 2013 by Mosby, an imprint of Elsevier Inc Copyright © 2007, 2000, 1993, 1986 by Mosby, Inc., an affiliate of Elsevier Inc All rights reserved No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Details on how to seek permission, further information about the Publisher's permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein) Notices Knowledge and best practice in this field are constantly changing As new research and experience broaden our understanding, changes in research methods, 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Chapter Malocclusion and Dentofacial Deformity in Contemporary Society The Changing Goals of Orthodontic Treatment Early Orthodontic Treatment Crowded, irregular, and protruding teeth have been a problem for some individuals since antiquity, and attempts to correct this disorder go back at least to 1000 bc Primitive (and surprisingly well-designed) orthodontic appliances have been found in both Greek and Etruscan materials.1 As dentistry developed in the eighteenth and nineteenth centuries, a number of devices for the “regulation” of the teeth were described by various authors and apparently used sporadically by the dentists of that era After 1850, the first texts that systematically described orthodontics appeared, the most notable being Norman Kingsley's Oral Deformities.2 Kingsley, who had a tremendous influence on American dentistry in the latter half of the nineteenth century, was among the first to use extraoral force to correct protruding teeth He was also a pioneer in the treatment of cleft palate and related problems Despite the contributions of Kingsley and his contemporaries, their emphasis in orthodontics remained the alignment of the teeth and the correction of facial proportions Little attention was paid to bite relationships, and since it was common practice to remove teeth for many dental problems, extractions for crowding or malalignment were frequent In an era when an intact dentition was a rarity, the details of occlusal relationships were considered unimportant To make good prosthetic replacement teeth, it was necessary to develop a concept of occlusion, and this occurred in the late 1800s As the concepts of prosthetic occlusion developed and were refined, it was natural to extend this to the natural dentition Edward H Angle (Figure 1-1), whose influence began to be felt about 1890, can be credited with much of the development of a concept of occlusion in the natural dentition Angle's original interest was in prosthodontics, and he taught in that department in the dental schools at Pennsylvania and Minnesota in the 1880s His increasing interest in dental occlusion and in the treatment necessary to obtain normal occlusion led directly to his development of orthodontics as a specialty, with himself as the “father of modern orthodontics.” FIGURE 1-1 Edward H Angle in his fifties, as the proprietor of the Angle School of Orthodontia After establishing himself as the first dental specialist, Angle operated proprietary orthodontic schools from 1905 to 1928 in St Louis; New London, Connecticut; and Pasadena, California, in which many of the pioneer American orthodontists were trained Angle's classification of malocclusion in the 1890s was an important step in the development of orthodontics because it not only subdivided major types of malocclusion but also included the first clear and simple definition of normal occlusion in the natural dentition Angle's postulate was that the upper first molars were the key to occlusion and that the upper and lower molars should be related so that the mesiobuccal cusp of the upper molar occludes in the buccal groove of the lower molar If the teeth were arranged on a smoothly curving line of occlusion (Figure 1-2) and this molar relationship existed (Figure 1-3), then normal occlusion would result.3 This statement, which 100 years of experience has proved to be correct—except when there are aberrations in the size of teeth, brilliantly simplified normal occlusion Angle then described three classes of malocclusion, based on the occlusal relationships of the first molars: Class I: Normal relationship of the molars, but line of occlusion incorrect because of malposed teeth, rotations, or other causes Class II: Lower molar distally positioned relative to upper molar, line of occlusion not specified Class III: Lower molar mesially positioned relative to upper molar, line of occlusion not specified Note that the Angle classification has four classes: normal occlusion, Class I malocclusion, Class II malocclusion, and Class III malocclusion (see Figure 1-3) Normal occlusion and Class I malocclusion share the same molar relationship but differ in the arrangement of the teeth relative to the line FIGURE 1-2 The line of occlusion is a smooth (catenary) curve passing through the central fossa of each upper molar and across the cingulum of the upper canine and incisor teeth The same line runs along the buccal cusps and incisal edges of the lower teeth, thus specifying the occlusal as well as interarch relationships once the molar position is established of occlusion The line of occlusion may or may not be correct in Class II and Class III With the establishment of a concept of normal occlusion and a classification scheme that incorporated the line of occlusion, by the early 1900s orthodontics was no longer just the alignment of irregular teeth Instead, it had evolved into the treatment of malocclusion, defined as any deviation from the ideal occlusal scheme described by Angle Since precisely defined relationships required a full complement of teeth in both arches, maintaining an intact dentition became an important goal of orthodontic treatment Angle and his followers strongly opposed extraction for orthodontic purposes With the emphasis on dental occlusion that followed, however, less attention came to be paid to facial proportions and esthetics Angle abandoned extraoral force because he decided this was not necessary to achieve proper occlusal relationships He solved the problem of dental and facial appearance by simply postulating that the best esthetics always were achieved when the patient had ideal occlusion As time passed, it became clear that even an excellent occlusion was unsatisfactory if it was achieved at the expense of proper facial proportions Not only were there esthetic problems, it often proved impossible to maintain an occlusal relationship achieved by prolonged use of heavy elastics to FIGURE 1-3 Normal occlusion and malocclusion classes as specified by Angle This classification was quickly and widely adopted early in the twentieth century It is incorporated within all contemporary descriptive and classification schemes pull the teeth together as Angle and his followers had suggested Under the leadership of Charles Tweed in the United States and Raymond Begg in Australia (both of whom had studied with Angle), extraction of teeth was reintroduced into orthodontics in the 1940s and 1950s to enhance facial esthetics and achieve better stability of the occlusal relationships Cephalometric radiography, which enabled orthodontists to measure the changes in tooth and jaw positions produced by growth and treatment, came into widespread use after World War II These radiographs made it clear that many Class II and Class III malocclusions resulted from faulty jaw relationships, not just malposed teeth By use of cephalometrics, it also was possible to see that jaw growth could be altered by orthodontic treatment In Europe, the method of “functional jaw orthopedics” was developed to enhance growth changes, while in the United States, extraoral force came to be used for this purpose At present, both functional and extraoral appliances are used internationally to control and modify growth and form Obtaining correct or at least improved jaw relationships became a goal of treatment by the mid-twentieth century The changes in the goals of orthodontic treatment, which are to focus on facial proportions and the impact of the dentition on facial appearance, have been codified now in the form of the soft tissue paradigm.4 Modern Treatment Goals: The Soft Tissue Paradigm A paradigm can be defined as “a set of shared beliefs and assumptions that represent the conceptual foundation of an area of science or clinical practice.” The soft tissue paradigm states that both the goals and limitations of modern orthodontic and orthognathic treatment are determined by the soft tissues of the face, not by the teeth and bones This reorientation of orthodontics away from the Angle paradigm that dominated the twentieth century is most easily understood by comparing treatment goals, diagnostic emphasis, and treatment approach in the two paradigms (Table 1-1) With the soft tissue paradigm, the increased focus on clinical examination rather than examination of dental casts and radiographs leads to a different approach to obtaining important diagnostic information and that information is used to develop treatment plans that would not have been considered without it More specifically, what difference does the soft tissue paradigm make in planning treatment? There are several major effects: 1The primary goal of treatment becomes soft tissue relationships and adaptations, not Angle's ideal occlusion This broader goal is not incompatible with Angle's ideal occlusion, but it acknowledges that to provide maximum benefit for the patient, ideal occlusion cannot always be the major focus of a treatment plan Soft tissue relationships, both the proportions of the soft tissue integument of the face and the relationship of the dentition to the lips and face, are the major determinants of facial appearance Soft tissue adaptations to the position of the teeth (or lack thereof) determine whether the orthodontic result will be stable Keeping this in mind while planning treatment is critically important 2The secondary goal of treatment becomes functional occlusion What does that have to with soft tissues? Temporomandibular (TM) dysfunction, to the extent that it relates to the dental occlusion, is best thought of as the result of injury to the soft tissues around the TM joint caused by clenching and grinding the teeth Given that, an important goal of treatment is to arrange the occlusion to minimize the chance of injury In this also, Angle's ideal occlusion is not incompatible with the broader goal, but deviations from the Angle ideal may provide greater benefit for some patients, and should be considered when treatment is planned TABLE 1-1 Angle Versus Soft Tissue Paradigms: A New Way of Looking at Treatment Goals Parameter Angle paradigm Soft tissue paradigm Primary treatment Ideal dental occlusion goal Normal soft tissue proportions and adaptations Secondary goal Ideal jaw relationships Functional occlusion Hard/soft tissue relationships Ideal hard tissue proportions produce ideal soft tissues Ideal soft tissue proportions define ideal hard tissues Diagnostic emphasis Dental casts, cephalometric radiographs Clinical examination of intraoral and facial soft tissues Treatment approach Obtain ideal dental and skeletal relationships, assume the soft tissues will be OK Plan ideal soft tissue relationships and then place teeth and jaws as needed to achieve this Function emphasis TM joint in relation to dental occlusion Soft tissue movement in relation to display of teeth Stability of result Related primarily to dental occlusion Related primarily to soft tissue pressure/equilibrium effects TM, Temporomandibular 3The thought process that goes into “solving the patient's problems” is reversed In the past, the clinician's focus was on dental and skeletal relationships, with the tacit assumption that if these were correct, soft tissue relationships would take care of themselves With the broader focus on facial and oral soft tissues, the thought process is to establish what these soft tissue relationships should be and then determine how the teeth and jaws would have to be arranged to meet the soft tissue goals Why is this important in establishing the goals of treatment? It relates very much to why patients/parents seek orthodontic treatment and what they expect to gain from it The following sections of this chapter provide some background on the prevalence of malocclusion, what we know about the need for treatment of malocclusion and dentofacial deformity, and how soft tissue considerations, as well as teeth and bone, affect both need and demand for orthodontic treatment It must be kept in mind that orthodontics is shaped by biological, psychosocial, and cultural determinants For that reason, when defining the goals of orthodontic treatment, one has to consider not only morphologic and functional factors, but a wide range of psychosocial and bioethical issues as well The Usual Orthodontic Problems: Epidemiology of Malocclusion Angle's “normal occlusion” more properly should be considered the ideal In fact, perfectly interdigitating teeth arranged along a perfectly regular line of occlusion are quite rare For many years, epidemiologic studies of malocclusion suffered from considerable disagreement among investigators about how much deviation from the ideal should be accepted within the bounds of normal By the 1970s, a series of studies by public health or university groups in most developed countries provided a reasonably clear worldwide picture of the prevalence of various occlusal relationships or malrelationships In the United States, two large-scale surveys carried out by the U.S Public Health Service (USPHS) covered children ages to 11 years between 1963 and 1965 and youths ages 12 to 17 years between 1969 and 1970.5,6 As part of a large-scale national survey of health care problems and needs in the United States in 1989-1994 (National Health and Nutrition Estimates Survey III [NHANES III]), estimates of malocclusion again were obtained This study of some 14,000 individuals was statistically designed to provide weighted estimates for approximately 150 million persons in the sampled racial/ethnic and age groups The data provide current information for U.S children and youths and include the first good data set for malocclusion in adults, with separate estimates for the major racial/ethnic groups.7 The characteristics of malocclusion evaluated in NHANES III included the irregularity index, which is a measure of incisor alignment (Figure 1-4); the prevalence of midline diastema larger than mm (Figure 1-5); and the prevalence of posterior crossbite (Figure 16) In addition, overjet (Figure 1-7) and overbite/open bite (Figure 1-8) were measured Overjet reflects Angle's Class II and Class III molar relationships Because overjet can be evaluated much more precisely than molar relationship in a clinical examination, molar relationship was not evaluated directly Current data for these characteristics of malocclusion for children (age to 11), youths (age 12 to 17), and adults (age 18 to 50) in the U.S population, taken from NHANES III, are displayed graphically in Figures 1-9 to 1-11 FIGURE 1-4 Incisor irregularity usually is expressed as the irregularity index; the total of the millimeter distances from the contact point on each incisor tooth to the contact point that it should touch, as shown by the blue lines For this patient, the irregularity index is 10 (mm) FIGURE 1-5 A space between adjacent teeth is called a diastema A maxillary midline diastema is relatively common, especially during the mixed dentition in childhood, and disappears or decreases in width as the permanent canines erupt Spontaneous correction of a childhood diastema is most likely when its width is not more than mm FIGURE 1-6 Posterior crossbite exists when the maxillary posterior teeth are lingually positioned relative to the mandibular teeth, as in this patient Posterior crossbite most often reflects a narrow maxillary dental arch but can arise from other causes This patient also has a one-tooth anterior crossbite, with the lateral incisor trapped lingually FIGURE 1-7 Overjet is defined as horizontal overlap of the incisors Normally, the incisors are in contact, with the upper incisors ahead of the lower by only the thickness of their incisal edges (i.e., to mm overjet is the normal relationship) If the lower incisors are in front of the upper incisors, the condition is called reverse overjet or anterior crossbite FIGURE 1-8 Overbite is defined as the vertical overlap of the incisors Normally, the lower incisal edges contact the lingual surface of the upper incisors at or above the cingulum (i.e., normally there is a to mm overbite) In open bite, there is no vertical overlap, and the vertical separation of the incisors is measured to quantify its severity FIGURE 1-9 Changes in the prevalence of types of malocclusion from childhood to adult life, United States, 1989-1994 Note the increase in incisor irregularity and decrease in severe overjet as children mature, both of which are related to mandibular growth evaluation, 211-212 vertical clearance, 452 vertical planes, 207f evaluation, 213-214 Space analysis, 182, 427-429 accomplishment, computer algorithm (usage), 431f form, 430f manual operation, 427-428 principles, 427-428 requirement, 417 results, 400 Space closure, 274 anchorage control, 334-335 appearance, 248f bracket advantage, 328 closing loop archwire, usage, 453f edgewise appliance, usage, 586 goal, 455-457 management, 395 problem, 659 prosthetic replacement, contrast, 652-660 segment arch approach, 575 Space deficiencies severity, documentation, 467f usage, 438-440 variation, 400-402 Spaced incisors, 440-442 Space problems consideration, 427 management, 427-429 preadolescents, 400-402 quantification, 427-429 treatment, 429-443 Space-related problems, 450-458 Specialist, natural bias, 150 Speech, problems, 11 malocclusion, relationship, 157 Spheno-ethmoidal synchondrosis, 37 Sphenoid bones, location, 37 Spheno-occipital synchondrosis, 37 Splints patient functions, 720f usage, 483f, 719 Split plate appliances, 348-349 Spring clip, usage, 376f Springiness, improvement, 323f Spring retainers, 618-619 Springs activation, 561f-562f assembly, diagrammatic representation, 354f attachment, ease (factors), 384 consideration, 312 properties, closing loops, 570 Stability considerations, 224 influences, 709 Stabilization, usage, 719 Stabilizing archwires, 717-718 Stabilizing components, usage, 500 Stabilizing lingual arches addition, 576 attachment, 335f Stainless bracket, scanning electron microscope view, 371f Stainless steel alloys, 314 archwires, springiness/range (improvement), 323f bending nomograms, 319f gold replacement, 328 relative strength/stiffness/range, 317f titanium, alternative, 369-370 torsion nomograms, 320f Stationary anchorage, 297-298 Steel bracket, contact (effect), 372 Steel closing loop, spring characteristics, 570 Steel separating springs, usage, 363f Steel spring clip separator, 418 Steel spring separators, tolerance, 363 Steiner analysis, 190-192 problems, 192 SNA/SNB angles, usage, 191f upper incisor, NA line (relationship), 191f Stem cell transplantation (SCT), prevalence (increase), 447-448 Step bends, 340 impact, 341t intrusive force, 341f Stereolithographic (SL) casts, fabrication, 357f Stiffness, equation, 314 Straight anterior incisor segment, anterior crowding (combination), 440f Straight calipers, usage, 161f Straight-wire appliance, production, 377f Straight-wire brackets/tubes, 375-378 Straight-wire prescriptions, 361-362 Streaming potential, 281 Strength properties, 314 springiness, combination, 322 stress unit measurement, 313 Stress-generated signals, importance, 281 Stress-strain curve resilience/formability, defining, 314f superelasticity, demonstration, 315f Stress-strain diagram, 312-313 Subdivision of desired movement, 334 Submental procedures, 707 Submental tissues, contour, 167f Succedaneous permanent teeth, eruption, 83 Succedaneous teeth, eruption absence, 77f characterization, 85f Suck-down materials, usage, 354 Sucking comparison, 138f habit, 137-139 cessation, 140 effects, 413 open bite, association, 415 Sunday bite, 158 Superelastic A-NiTi archwires, usage, 670f-671f Superelastic auxiliary archwire (A-NiTi) archwire, advancement, 534f effectiveness/efficiency, 532 flexibility, 426f objections, 534 usage, 532 wires, force-deflection curves, 533f Superelasticity, 315 defining, 315f Superelastic material, usage, 316 Superelastic NiTi (A-NiTi) wires, performance, 586-587 Superelastic wires addition, 536 problem, 535f springiness, impact, 534 usage, 395 Supererupted lower incisors, 554f Superficially positioned permanent maxillary right central incisor, eruption (absence), 425f Supernumerary teeth, 128-129, 424 disruption, 424 location, 129f, 400, 424 panoramic radiograph, 424f preadolescents, 400 result, 129 Supported beams, 319-320 illustration, 313f Supporting structures, aging changes, 111-113 Supracrestal elastic fibers, surgery, 596 SureSmile technique, 381 intraoral scan recommendation, 381 outcomes, University of Indiana study, 381-382 system, 381f Surface irregularities, interlocking, 329 Surface remodeling impact, 96-97 occurrence, 38 Surgery camouflage contrast, 241, 690-695 decision, 694-695 final surgical planning, 718-719 indication, malocclusion severity (impact), 690 orthodontic preparation, steps, 716-717 patient management, 718-719 timing, 709-714 Surgically assisted rapid palatal expansion (SARPE), 699 advantage, 709 dental/skeletal dimensions, changes, 702f implication, 699-701 usage, 702f Surgical mandibular advancement, 242f Surgical techniques, 695-709 Surgical treatment orthodontic treatment, combination, 715-720 planning considerations, 709-715 Sustained force teeth response, 281 Sustained force, bone response, 281-295 Swallowing occlusal force, comparison, 137f problems, 11 Symmetric bases, usage, 179f Symmetric bends, 338-340 Symmetric crowding alignment, 533-534 archwires, selection, 533-534 Symmetric V-bend, 338-339 placement, 340f Symmetry cast analysis, 181-184 evaluation, 211 Symphysis, distraction, 703-705 Synchondroses, diagrammatic representation, 37f Synostosis, 119-122 Synthetic cephalometric radiograph, standard cephalometric radiograph (comparison), 202f Systemic disease problems, 266-267 T Tanaka and Johnson prediction values, 429b Tangential force, application, 329 Teenagers, imaginary audience, 63 Teeth absence, 652-660 aging changes, 111-113 anchorage value, 296 Angle's line, relationship, 207f appearance enhancement, 245-250 improvement, 656f bodily movement, decision, 509-511 bone loss, 651f cheek, vertical relationship, 208f color, 175 correction, 248f congenital absence, 128 contact points, stripping, 637 contour, correction, 248f crowding/malalignment, 8-9 crown, force (application), 286f decay, susceptibility, 11 development, chronology, 67t permanent dentition, 82t displacements, 440-443 anterior crossbite, impact, 537 display improvement, gingiva (recontouring), 597 inadequacy, 241 early alignment, 331 emergence, 83 estimation, proportionality tables (usage), 428-429 exposure, increase, 112-113 extraction, 694-695 extrusion, 663f facial surface, variation, 362 follicle, labial/buccal drift, 74 force, application, 482 fossil records, 9-10 full-time retention, requirement, 607 health, 176 heavy pressure, physiologic response, 280t height-width relationships, 172-174 intrusion, 287f, 677-679 lips relationships, 167-172 vertical relationship, 208f malformation, 128-129 measurement, radiographs (usage), 428 movement, 449-450 forced eruption, impact, 634f number, reduction, 10f occlusion, patient concern, 152 open apices, absence, 450f oral structures, health, 176 overtreatment, 596 position adjustment, 583-589 alveolar bone height, relationship, 304 mean changes, 562f-563f positioner, usage, 592, 594 positioning, anchorage (usage), 667 pressure application, 299-300 physiologic response, 280t proportions, 172 change, 245 improvement, gingiva (recontouring), 597 protrusion, complaint, 600f regulation devices, reshaping, 597-599 respiration, impact, 142 retraction, 291 roots, shortening, 302 settling, 591-594 laced elastics, usage, 592f methods, 592 shade, 175 splaying, 134f stabilization, periodontal ligament (role), 280-281 structure, loss (problems), 652 supernumerary teeth, 128-129 surface contamination, 423f preparation, 365 sustained force, impact, 285 sustained pressure, physiologic response, 284t tetracycline staining, 32f tipping decision, 509-511 uprighting process, 628 translation, 286f trauma susceptibility, 475f traumatic displacement, 129-130, 448-450 unilateral repositioning, 407-408 vertical displacement, 449 vertical position control, 610f description, roll (usage), 209f vertical tooth-lip relationships, 241-242 visibility, 66-67 vitality, loss, 300 wear, 81 width relationships, 172 frontal view, 173f Teeth, alignment figure-8 wire ligature, usage, 547f magnets, bonding, 324f patient concern, 152 Teeth, bone bionator, 490f loss, 266f relationships, expansion limit, 222 Teeth, eruption absence, caution, 395 alveolar bone, relationship, 304 amount, 80f jaw rotation, interaction, 102-103 obstacles, removal, 541 periodontal ligament (PDL), role, 280-281 Teeth, forces application, 278 concentration, 287f magnitude/duration, 135t Teeth, movement, 76-78 acceleration, 290-295 aligner, usage, 354-355 biologic control, 281-282 clast cells, attack, 301f corticotomy-assisted tooth movement, treatment outcomes, 293 couples, 325-326 direction, 283f efficiency, 285 duration, contrast (theoretical plot), 287f force, 325-326 duration threshold, 306 force, relationship, 296 moments, 325-326 removable appliances, springs (inclusion), 353 side effect, 306 subdivision, impact, 334 time course, diagrammatic representation, 286f types, 286-287 Teeth, size, 88f analysis, 182-184 Bolton analysis, 183f cast analysis, 181-184 decline, 9f discrepancies, 182-183, 585 creation, 586f problems, 585 relationships, 183t Template analysis, 196-198 dentofacial structures, relationship, 198 measurements, series, 198 steps, 197 Templates computer analysis, usage, 198 superimposition, 198 Template schematic, 196-197 Temporary anchorage devices (TADs), 382-388 helpfulness, 455-457 intraoral TAD function, 383 molar distalization support, 466f skeletal anchorage, 395 TAD-supported molar-distalizing appliances, usage, 463 usage, 453-454 Temporary skeletal anchorage, orthognathic surgery (contrast), 690 Temporary skeletal anchor units, effectiveness, 552-553 Temporomandibular articulation, maintenance, 304-305 Temporomandibular dysfunction (TMD), malocclusion/adaptive function, relationship, 11-12 orthodontic treatment, 624, 642-644 problems, types, 642-643 risk factor, 232 symptoms, 642f cause, 642 development, 644 extent, 643-644 treatment indications, 643-644 Temporomandibular (TM) fossae, displacement/remodeling, 484 Temporomandibular joint (TMJ) ankylosis, impact, 46 damage, 123 dysfunction, 11 formation, 31-32 jaw function relationship, 158 screening exam, 158b problems, malocclusion (correlation), 12 Teratogens, impact, 114 list, 115t Testosterone production (increase), Sertoli cells (impact), 94 Tetracycline staining, 32f Therapeutic diagnosis, 240 Third molars horizontal impaction, pressure, 110f mesial drift, 657 pressure, 108-109 Third-order bends (torque bends), 362 compensation, 373-374 usage, 372f Thompson, D'Arcy mathematical transformation, 30f proportions/growth changes, similarities, 29 Thought processes, 61 Threaded connector, stop, 478f 3dMD camera, 29f 3-D superimpositions, frontal view, 487f Three-dimensional CBCT images, analysis, 181 Three-dimensional imaging, 27 Throat form, evaluation, 166 Through the bite elastics horizontal/vertical force production, 633f usage, 631-632 Thumbsucking anterior open bite, association, 138 cessation, 414f comparison, 138f negative pressure, 138-139 placement, 138f prevalence, 141f prolongation, 440-441 Time-out (omission), 54 Timing, difference, 475-476 Tipback bends, reduction, 562f Tip bends (second-order bends), 362 compensations, 372-373 effect, 374f Tip-Edge appliance, change, 357-358 Tipped molars crown height (increase), uprighting (impact), 629f extrusion, 628 uprighting, distal crown movement (impact), 628f Tipped teeth, uprighting process, 628 Tipping, 286, 334 extreme tipping, 299f lower molar, loss (impact), 628f Tissue-borne, functional appliance category, 351 Tissue punch, necessity, 384 Tissues differentiation, 114 interaction, 32 systems, growth (Scammon's curves), 22f Titanium, stainless steel alternative, 369-370 Titanium bracket contact, effect, 372 scanning electron microscope view, 371f T-loop appliance, indication, 630 T-loop spring, 17×25 steel wire, 632f TMA wires bending nomograms, 319f strength/stiffness/range, 317f torsion nomograms, 320f usage, 317 Tongue forward resting posture, 140-141 lip-cheek pressures, imbalances, 606-607 lowering, 141 placement, 71f resting pressures, 280f superior surface, indentations, 406f thrust swallowing, prevalence, 141f term, misnomer, 140 thrusting, 139-141 transitional stage, 140 thrust swallow, appearance, 140f Tonsillectomy, requirement, 143 Tooth-borne functional appliances, expansion screws (incorporation), 502f Torque, 587-589 effective torque, 589t expression, 589 factors, 588 forces, 578f recommendation, 374 Torque bends (third-order bends), 362 compensation, 373-374 Torquing arch, placement, 583f Torquing auxiliary, Burstone torquing arch, 588 Torquing auxiliary archwires, impact, 588f Torquing force, impact, 587 Torquing movements, limitation, 298 Torsion nomograms, 320f Torticollis, facial asymmetry, 126f Total arcial analysis, Sassouni description, 192 Total body irradiation (TBI), prevalence (increase), 447-448 Total nasal obstruction effect, cephalometric superimposition, 143f rarity, 142-143 Traction, impact, 450f Transpalatal lingual arch, usage, 540 Transparent ruled grid, placement, 180f Transplantation autotransplantation, 457-458 usage, 458 Transposition, 446-447 Transverse maxillary constriction, treatment, 476-480 Transverse maxillary deficiency, 226-229 Transverse maxillary expansion, midpalatal suture (opening), 537-540 Trauma, susceptibility, 11 Traumatically injured anterior teeth, restoration (problem), 450 Traumatized teeth, multiple vertically positioned radiographs, 449f Treacher Collins syndrome (mandibulofacial dysostosis), 396-397 example, 117f Treatment approaches, alternatives (development), itr, 148 changes, evaluation, 202-203 limitation attempt, 398f interarch mechanics, usage, 398f motivation, 59-60 order, 598-599 outcomes, computer simulation, 692 plan, patient-parent understanding, 150 possibilities, 221-240 proposal, complexity, 221 retention, usage, 399f Treatment planning issues, 221 patient input, 221 problem-oriented approach, 150 uncertainty, reduction, 239-240 Triage scheme, 403 True distal movement (improvement), skeletal anchorage (usage), 234 True horizontal line, usage, 189-190 True unilateral maxillary constriction (correction), asymmetric W-arch (usage), 407f True unilateral maxillary posterior constriction, 407f True vertical line upper lip, backward incline, 223f usage, 194 Truth, goal, 150 Tube/bracket prescription, molars, 374t Tube design, straight-wire concept, 372-374 Turkey gobbler, correction, 707 Tweed, Charles, 3-4 Tweed approach, 576 22-slot appliance, 548-549 sliding space closure, 574f usage, 577 22-slot bracket, effective torque, 589t 22-slot edgewise, usage, 574-575 Twin-Block appliance components, 351f usage, 506f Twin-Block functional appliance, retention, 491f Twin wire appliance, 359 2×4 appliance, 410-411 span, impact, 550f 2×6 appliance placement, 397f usage, 343f Two-couple archwires, impact, 342 Two-couple configuration, utility arch (usage), 339f Two-couple systems, 338-346 lingual arch usage, 343-345 Two-dimensional (2D) images, CBCT images (contrast), 422 Two-point contact, 324-327 Two-stage retraction, 574-575 Two-stage space closure, 334f Two-wall vertical pockets, problems, 635 Typodont, bonded expander (usage), 539f U Ugly duckling stage, 89f, 442 Ultrasound, 294-295 Unconditioned stimulus conditioned stimulus, association, 52 pain, association, 52 Uncontrolled diabetes, bone loss, 266f Undermining resorption, 285 frontal resorption, contrast, 286f Undifferentiated mesenchymal cells, presence, 50f Unerupted incisor, initial traction, 426f Unerupted lower second molars, 544-545 Unerupted permanent maxillary left central incisor, dilacerated root (impact), 459f Unerupted permanent teeth estimation, proportionality tables (usage), 428-429 measurement, radiographs (usage), 428 size, estimation, 428-429 Unerupted teeth alignment, 540-545 mechanical approaches, 542-544 caution, 395 movement, orthodontic traction (usage), 542 surgical exposure, 540-541 Unilateral anterior crossbite, 678f Unilateral cleft lip, 119f long-term treatment observation, 270f-271f Unilateral condylar fracture, appearance, 524f-527f Unilateral mandibular space, regaining, 436 Unilateral maxillary posterior constriction, 407f Unilateral molar distalization, indication, 564 Unilateral open bite, development, 665f-666f Unilateral orthodontic space closure, avoidance, 457 Unilateral repositioning, 407-408 Unilateral space closure, facilitation, 453-454 opening, 458-459 Unilateral space regaining, 435 Unilateral toe-in bends, rotation, 344f Unstable mothering, 57 Upper arches alignment, 561f-562f crowding, development, 473f-474f Crozat appliances, 348f maxillary removable splint, usage, 483f smile, transverse dimensions, 170 Upper first molars extraction, treatment (cephalometric superimposition), 568f mesiolingual rotation, 234f Upper first premolars, extraction, 564-567 Upper incisors angulation, improvement, 263f-264f appearance, patient complaint, 249f forward flare, 441 lingual surface, lower incisal edges (contact), 6f NA line, relationship, 191f overjet, excess, 403 position, 691f positioning, 292f protrusion retraction, inability, 441-442 sucking habits, impact, 140 retraction, 223f premolar extraction space, 232 Upper lip backward incline, 223f base, soft tissue (stretching), 480f Upper molars distal movement, 557-564 extrusion, Class III elastics (impact), 591f lingual, cross-elastics (usage), 541f mesial rotation, 559f Upper molars, archwire placement, 373f Upper posterior teeth, eruption (limitation), 503 Upper teeth, distal movement, 232-235 Uprighting, 334 auxiliary spring, usage, 631f springs, placement, 583f, 587f U.S children, incisors (alignment), U.S population incisor irregularity, 7f occlusion, normalcy (percentage), 115f open bite/deep bite relationships, 8f orthodontic treatment, percentage, 17f overjet (Class II), 8f reverse overjet (Class III), 8f U.S Public Health Service (USPHS) guidelines, dental radiographic examination, 176t U.S Public Health Service (USPHS), surveys, Utility arches activation, 339f intrusion arch, comparison, 339f usage, 338 V Vacuum-formed retainers (clear retainers), 614 limitations, 614 V-bends impact, 341t position, 584 Velocity curve, 25f menarche, times, 26f Vertebral ages, calculation, 75f Vertebral development, stage (usage), 155 Vertebral pathology, observation, 186f Vertical control components, 499-500 Vertical development control, functional appliance treatment (response), 521f increase, 515f Vertical deviations, overbite, Vertical elastics anterior box elastic, combination, 591f side effects, 395 Vertical facial growth, 476 continuation, 518 Vertical facial proportions reevaluation, 167 Vertical facial proportions, frontal/lateral views, 163f Vertical forces, production, 341 through the bite/cross elastics, usage, 633f Vertical growth continuation, 610 expectation, 254 Vertical incisor relationships, correction, 589-591 Vertical mandibular posture, lingual pad/flange, 498f Vertical maxillary deficiency, 480-484 importance, 686f-688f Vertical position control, 610f description, 209f Vertical problems, 237-239 anteroposterior problems, combination, 514-520 correction, 714-715 cause, 162 preadolescents, 397 severity, cephalometric analysis, 214f Vertical tooth-lip relationships, 241-242 Very large forces, differential effect, 298 Vibratory method, 293 Virtual articulators, 180 Virtual casts, physical casts (contrast), 176-178 Virtual dental cast, measurements, 182f Vital staining, 29-30 studies, 29-30 Vital stains, studies, 30 Voice control, punishment, 54 W W-arches, 403f flexibility, 404-405 indentations, 406f length arms, variation, 407 lingual arches, demonstration, 477 reliability, 404 usage, 407f Wax biet, usage, 177 Weight, increase (data), 30f White spots lesions, treatment, 369 problem, 368 treatment, 369 White youths, orthodontic need, 17f Wide brackets, narrow brackets (contrast), 327-328 Wildsmiles, shaped brackets, 378 Wire-bending robots, 381-382 precision, 381f Wires bonding, 616f material, properties, 314 surface qualities, 329 Wisdom, treatment planning goal, 150 Wits analysis, 193-194 conception, 193-194 Harvold analysis, contrast, 194 Working bite mandible, forward movement, 520 obtaining, steps, 504f production, 486 usage, 502-503 Wrinkles, decrease, 242f Wrist, radiograph (assessment), 73f X X-occlusion (buccal crossbite), 8-9 Y Young adults facial anthropometric measurements, 160t facial indices, 162t orthodontic care, 60 Z Zygomatic arch base bone anchor, attachment, 235f miniplate, placement, 386f, 486f miniplates, placement, 384-385 shadow, 187f ... Congress Cataloging-in-Publication Data Proffit, William R Contemporary orthodontics / William R Proffit, Henry W Fields Jr., David M Sarver – 5th ed p ; cm Includes bibliographical references and... Philadelphia, Pennsylvania 978-0-323-08317-1 3251 Riverport Lane St Louis, Missouri 63043 CONTEMPORARY ORTHODONTICS ISBN: 978-0-323-08317-1 Copyright © 2013 by Mosby, an imprint of Elsevier Inc... Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina James L Ackerman, DDS Formerly Professor and Chairman, Department of Orthodontics, University