Orthodontics : diagnosis and management of malocclusion and dentofacial deformities

The third edition is a comprehensive, updated and rejuvenated version with a greater focus on postgraduate students and clinical practitioners. The book covers the entire panorama of science and clinical practice of orthodontics, compiled in 80 chapters and further organised into 18 sections. The content is extensive, in-depth and supported with updated references. The book is a complete resource for orthodontic educators to derive lectures. The clinical chapters are complemented with real-life scenarios and representative case reports. A special effort has been made to include structured information on the subjects of clinical and academic relevance, which are often discussed but found only in journals. Encompasses a wide range of topics covering the entire curricular needs of a postgraduate student in orthodontics and a practitioner Each section is a book by itself and is designed in a manner that allows the student to progressively attain knowledge and clinical training in orthodontics in a stepwise manner Each chapter offers an easy-to-follow outline and a smooth flow in text with subheadings, further supported by boxes and flowcharts to enhance comprehension Provides a detailed approach to orthodontic treatment with contemporary methods and techniques The clinical case scenarios are a significant strength and constitute the practical aspects for an orthodontic practitioner to correlate The book includes updated chapters on Temporary Anchorage Devices (TAD), Impacted and Transposed Teeth, Inter-disciplinary Treatment, Management of Cleft Lip and Palate and Orthognathic surgery Emerging fields such as Clear aligners, Surgically facilitated rapid tooth movement, Distraction Osteogenesis and Obstructive Sleep Apnoea (OSA) are included with updated and clinically relevant information Historical aspects of orthodontics and Development of teeth, dentition and occlusion A whole new section on emerging 3D Digital technologies and their application Orthodontic instruments, armamentarium and operatory design Comprehensive chapters on Tweed philosophy, contemporary pre-adjusted appliance and self-ligation system Evidence-based Orthodontics Autotransplantation of teeth A section on the asymmetry of occlusion and face Additional Features Complimentary access to full e-book Eight online chapters Twelve videos Exhaustive list of references Title page Table of Contents Copyright Dedication Foreword Contributors Preface to the third edition Acknowledgements List of videos Section I: Historical aspects of orthodontics: ancient, yesteryears, yesterdays, today and tomorrow Chapter 1.1: History of dentistry and significant events that revolutionised dentistry The origin of the term Orthodontia History of dentistry before Christ was born (BC) The beginning of dentistry as a profession: early to middle ages (AD) The development of dentistry as a science Dentistry in 19th century Dentistry in 20th Century Dentistry in 21st Century Key Points References Chapter 1.2: History of orthodontics Orthodontics in ancient times Orthodontics in 17–18th century and European dominance American dentistry and orthodontics in mid-19th century Contribution of Edward Hartley Angle to the orthodontic profession (1855–1930)5–8 The first three decades of 20th century, 1900–30: Beginning of biological foundation of orthodontics Orthodontics during 1960–70 Orthodontics during 1970–80: pre-adjusted appliances Orthodontics during 1980–90: clinical success with twin block popularised functional appliance Orthodontics during 2000–18 Orthodontics beyond 2020 Key Points References Chapter 1.3: History of orthodontic speciality in India History of formal dental education in India Postgraduate dental education The first MDS orthodontics course in India Key Points References Section II: Fundamentals of orthodontics Chapter 2: Adverse consequences of malocclusion and benefits of orthodontic treatment Introduction Adverse consequences of malocclusion Benefits of orthodontic treatment Limits of orthodontic therapy Key Points References Chapter 3: Epidemiology of malocclusion and orthodontic treatment needs Need for recording malocclusion prevalence Methods of recording malocclusion for epidemiological data Reasons for large variations in malocclusion prevalence Ethnic trends in malocclusion prevalence Quantification of malocclusion Orthodontic treatment needs Key Points References Chapter 4: Classification and methods of recording malocclusion Recognition of malocclusion Historical review2,3 Systems of classification of malocclusion Angle's classes of malocclusion Strang's classification based on the body of mandible1 Skeletal classification (Fig. 4.19 A–C) Simon's classification and canine law13–16 Incisor classification (1964)17–19 Katz's premolar classification (1992)20–22 Ackerman and Proffit's classification (1969)23 Classification in primary dentition (Baum 1959)30 Key Points References Chapter 5: Recording the severity of malocclusion: orthodontic indices Introduction Qualitative methods of recording malocclusion Quantitative methods of recording malocclusion3 Diagnostic classification index Handicapping malocclusion assessment record (HMAR) Dental aesthetic index (DAI) Index of orthodontic treatment needs (IOTN)14–16 Peer assessment rating (PAR) Index of complexity, outcome and need (ICON) American Board of Orthodontics (ABO) grading system and discrepancy index(DI)28–32 Key Points References Chapter 6: Psychological implications of malocclusion and orthodontic treatment Introduction Psychological implications of malocclusion Psychological factors motivating patient to seek orthodontic treatment Motivational factors in adults Orthognathic surgery patients Functional factors Traumatic occlusion Articulation of speech Cleft lip and palate Malocclusion due to trauma Key Points References Section III: Growth of face and craniofacial complex Chapter 7: Development of teeth, dentition and occlusion Introduction Molecular basis of tooth development Stages of tooth development Aberrations in tooth development Dental eruption and development of occlusion Dental eruption Age related changes in dental arches Key Points Chapter 8: Prenatal development of the foetus concerning the craniofacial region Introduction Pre-somite period (14–21 days)1–3 Post-somite period (32–56 days) Development of craniofacial structures Genetic regulation of craniofacial development Clinical implications Key Points Chapter 9: Concepts of growth and development Introduction Factors affecting somatic growth Canalised growth Methods of growth assessment Graphical representation of height General interpretations of graphical data Mechanism of bone formation Basic concepts involved in bone growth Principles of skeletal growth22 Principles of skeletal growth22 Theories of growth Current concepts of the functional matrix: the molecular basis45–49 Bone as an osseous connected cellular network (CCN) Genomic thesis Epigenetic antithesis and resolving synthesis Current views on growth at the turn of the 21st century Key Points References Chapter 10: Postnatal growth of face and craniofacial region Introduction Timing of growth Growth in adolescence and puberty Growth spurts Growth of the craniofacial complex8,9 Growth trends and patterns Growth rotations20–22 Growth of the soft-tissue integument of face Growth of the soft tissue of midface Ageing and soft-tissue integument of face Key Points References Chapter 11: Functions of stomatognathic system and their implications on occlusion Orofacial function and craniofacial development Mastication Swallowing (deglutition) Respiration Speech Deleterious oral habits Non-nutritive sucking habits Tongue thrusting habit Mouth breathing habit Bruxism Nail biting Lip biting Key Points References Section IV: Orthodontic diagnosis Chapter 12: Clinical evaluation Introduction Features of malocclusion in deciduous dentition Clinical assessment of a child with developing or established malocclusion Examination of face Evaluation in vertical dimensions of face in lateral profile The lips Dynamics of smile and its orthodontic implications Functional examination of TMJ Speech and malocclusion30–35 Dental alignment and speech30–32 Clinical examination of child for suspected deleterious habit(s) Examination of oral health and periodontium Examination of dentition and occlusion Clinical assessment of an adult seeking orthodontic treatment Key Points References Chapter 13: Diagnostic records and their evaluation Introduction Minimum set of orthodontic records Analysis of arch length during mixed dentition Factors influencing estimation of the tooth size–arch length analysis Tooth size–arch length discrepancy Tooth size ratio Facial photographs19 Orthopantomogram (panoramic radiography of the maxilla and mandible) Assessment of growth Analysis of supplementary records and investigations Key Points References Chapter 14: Practical clinical photography Why photography in orthodontics Camera basics The digital basics The science of photography Using flash for intraoral photograph Practical tips Intraoral images Facial photography Key Points References Section V: Radiation and non-radiation imaging in orthodontics Chapter 15: Cephalometrics: historical perspectives, methods and landmarks Introduction Longitudinal growth studies The cephalometric apparatus (Fig. 15.2) Posteroanterior (PA) cephalogram Fundamentals of cephalometric analysis Cephalometric landmarks Key Points References Chapter 16: Downs’ analysis Introduction Basis of Downs’ analysis Reference planes Graphic presentation Population groups Key Points References Chapter 17: Tweed's analysis Introduction Facial triangle and clinical implications Key Points References Chapter 18: Steiner's analysis Introduction Rationale on the choice of landmarks Composite analysis Steiner's norms for various ethnic groups Key Points References Chapter 19: Ricketts’ 12-factor analysis Robert Murray Ricketts Ricketts’ cephalometric analysis Ricketts’ 12-factor summary analysis Key Points References Chapter 20: Vertical linear dimensions of face and Sassouni's analysis Introduction Sassouni's cephalometric analysis3–5 Jarabak's6 ratio of anterior and posterior facial heights Signs of vertical growth rotation Key Points References Chapter 21: Cephalometric analysis of the soft tissue of the face Introduction Methods of obtaining a soft tissue profile on a cephalogram General appraisal of the soft tissue profile Soft tissue cephalometric analysis Schwarz analysis9,10 Subtelny analysis (1959)11 Steiner's S line Holdaway's analysis4,5 Merrifield's profile line: Z angle13–15 Ricketts’16,17 E line Inclination of nasal base Mentocervical angle Submental neck angle Arnett's soft tissue cephalometric analysis (STCA) Bergman's18 comprehensive analysis Indian norms19–26 Key Points References Chapter 22: Posteroanterior cephalometric analysis Introduction Evaluation of PA cephalogram Grummons’ analysis (Figs 22.3 and 22.4) Frontal vertical proportions Ricketts’ analysis Limitations of PA cephalometry Key Points References Chapter 23: Interpretation and clinical applications of cephalometric data in diagnosis, treatment planning and prognosis Introduction Interpretation of cephalometric variables Floating norms Morphometrics Key Points References Chapter 24: Lateral, PA and 3D cephalometric superimposition Introduction Superimposition of lateral cephalogram on cranial base structures Superimposition on cranial planes Ricketts Five-step method of cephalometric superimposition I-point and I-curve superimposition Regional superimpositions Superimposition of PA cephalogram Superimposition requirements of American Board of Orthodontics34 Automatic superimpositions 3D superimposition Key Points References Chapter 25: Errors in cephalometrics Introduction Five features of a good cephalogram A good PA cephalogram Errors during making a cephalogram Errors during X-ray tracing1 Errors of cephalometric landmark identification Errors in cephalometric measurements Digital cephalometry Calibration and magnification correction of digital images Calibration and magnification correction of analogue films scanned to digital images Key Points Section VI: Digital orthodontics Chapter 26: Digital and computerised cephalometrics Introduction Acquisition of digital image DICOM Computerised cephalometric analysis Cephalometrics without X-rays8-10 Digital radiography/cephalometry Computed radiography/cephalometry Direct digital radiography (ddR) (Fig. 26.4) CR radiography/cephalometrics Steps in computerised cephalometric analysis Key Points References Chapter 27: 3D data acquisition and orthodontic triad Introduction Digital workflow in orthodontics Non-radiation 3D face scanning ‘4D’ imaging 3D Skeletal imaging Key Points References Chapter 28: 3D digital models Introduction Evolution of dental scanners Intraoral scanners/direct scanners Indirect scanners (impression/model scanners) Digital model orientation Coordinate system ABO method of orientation of digital models (Fig. 28.6)15 Clinical applications of digital models Key Points References Chapter 29: Three-dimensional imaging in orthodontics Introduction Basic concepts and terminologies in radiology Principles of radiation safety and protection Evolution, historical perspective and limitations of two-dimensional imaging in orthodontics Fundamental principles of CT and CBCT Types of CT scanners Operational principles of CBCT Classification of CBCT scanners Field of view (Fig. 29.7) Image artefacts (Fig. 29.8) Applications of MDCT imaging Applications of CBCT in orthodontics Imaging goals and protocols25 Limitations of CBCT Radiation safety pertaining to CBCT Radiation guidelines Non-radiation imaging techniques Research and recent advances in 3D orofacial imaging23 Key Points References Chapter 30: Three-dimensional cephalometry Evolution of 3D imaging: from 2D to 3D imaging 3D volumetric imaging Indications of CBCT imaging Evolution of 3D cephalometric measurements Craniofacial anatomical structures visualisation and 3D landmarks 3D cephalometric analysis Automatic landmark detection and cephalometric analysis Three dimensional virtual orthognathic surgical planning Key Points References Chapter 31: 3D volumetric analysis, and clinical implications of the upper airway and sinuses Introduction Imaging modalities of upper airway space Radiological anatomy of upper airway Segmentation of paranasal air sinuses Reliability of using CBCT and imaging software for volumetric airway analysis Factors affecting the volumetric airway measurements Clinical implications of volumetric airway analysis Clinical relevance of paranasal air sinuses volume Recent advancements Key Points Section VII: Removable orthodontic appliances Chapter 32: Role of removable appliances in contemporary orthodontics Introduction History of removable appliance Indications of removable appliances Advantages Limitations and disadvantages Treatment effectiveness Hawley appliance and bite plate Expansion of the arch Steps in appliance fabrication and clinical management Laboratory requisition and appliance design Considerations for efficient removable appliance Appliance delivery and activation Indications of removable appliances therapy Correction of cross-bite of anterior teeth due to a local cause Correction of anterior proclination Class II division 2 malocclusion Correction of ectopic canine Integration with fixed appliance Avoidable complications of removable appliances Crozat appliance Key Points References Chapter 33: Invisible removable appliances: The Clear Aligners Introduction Historical development Overview of steps in clear aligner treatment The Invisalign system The Clear Smile system The K Clear system from K-Line Europe The ClearPath system The Donatello aligners Orthodontic tooth movement in treatment with aligner Aligners and root resorption Discomfort and acceptability Key Points References Section VIII: Orthodontic armamentarium Chapter 34: Concept of orthodontic operatory design Introduction Ideal orthodontic office Orthodontic operatory Reception area (waiting area) Consultation room Records room and laboratory Sterilisation area Office decor Indoor plants Parking provision Paperless orthodontic office Key Points Chapter 35: Instruments and equipment in orthodontic use Introduction Instruments for specific use in orthodontics Instruments for banding Separators placing plier Chapter 36: Components of fixed orthodontic appliance Introduction Evolution of fixed orthodontic appliance: antiquity to the ‘orthodontia’ Pierre Fauchard era: founder of modern dentistry and orthodontics (1728–46) Foundation of orthodontics Building treatment into appliance The era of pre-adjusted appliance and modern orthodontics Components of fixed orthodontic appliance Limitations of current bracket and appliance systems Futuristic appliance design Appliance and treatment customisation Bracket customisation Key Points References Chapter 37: Orthodontic archwires: material and their properties Introduction Evolution of orthodontic wires Stainless steel wires Cobalt–chrome wires3,6,7 Nickel–titanium wires Copper NiTi β-Titanium wires Titanium wires Nickel-free stainless steel and TMA wires Titanium–niobium–aluminium (Ti–Nb–Al) shape memory alloy wires Dual flex archwires Supercable wire Turbo wire or braided nickel–titanium rectangular wire Variable modulus orthodontics Aesthetic wires Shape memory polymers (SMP) in orthodontics Effects of oral environment on orthodontic archwires and brackets Key Points References Chapter 38: Rubber and synthetic elastic accessories Introduction Elastic bands Storage and dispensing of elastics Instructions on wearing of elastics Complications of use of natural latex elastics Force decay Elastomeric accessories Elastic chains (power chains) Ligation of archwire to brackets with elastic module Key Points References Chapter 39: Bonding orthodontic appliances Introduction Historical aspects of adhesion on dental tissues Enamel etching Bonding agents Orthodontic bonding adhesives Bonding techniques in orthodontics Direct bonding technique Bonding to amalgam and Co–Cr/Ni–Cr alloys Bonding to porcelain surfaces Indirect bonding technique Lingual-bonded retainers Fixed lingual retainer using DuraLay resin transfer Fixed lingual retainer failures Curing of the adhesive composite Key Points References Section IX: Contemporary orthodontic treatment Chapter 40: The biological basis for orthodontic tooth movement Introduction Forces in orthodontics Optimal orthodontic force Theories of OTM Phases of tooth movement Alveolar bone response to orthodontic force Cellular behaviour in sites of PDL tension and compression Blood vessel reorganisation and neovascularisation Neural responses to mechanical forces Does inflammatory responses follow orthodontic force application? OTM–inflammation or mechanotransduction? Iatrogenic effects of orthodontic mechanics Key Points References Chapter 41: Principles of biomechanics and appliance design Introduction Basics of biomechanics Intrinsic characteristics of materials Orthodontic archwire materials Characteristics of ideal appliance Key Points References Chapter 42: Preservation of normal occlusion and interception of malocclusion during early mixed dentition Introduction Management and preservation of arch length Space maintenance appliances Serial extraction protocol Anterior cross-bite in deciduous and mixed dentition Unilateral cross-bite with mandibular shift Dental anomalies and malocclusions during mixed dentition Key Points References Chapter 43: Orthodontic treatment with contemporary fixed appliance Phase I: laying the foundation Introduction First appointment and records Designing a treatment plan and execution strategy Banding and bonding Separation of teeth Bracket positioning Buccal tubes Bracket positions on anterior and premolars Key Points References Chapter 44: Anchorage in orthodontic practice Introduction Anchorage loss Anchorage sources for removable appliance Anchorage for fixed appliance Factors affecting anchorage requirements Treatment planning anchorage savers Key Points References Chapter 45: Tweed philosophy, biomechanics and principles of treatment Tweed's journey as Angle's Student to an accomplished orthodontist Human face as related to orthodontic diagnosis Treatment planning—Tweed's objectives of treatment The standard edgewise appliance Stages of treatment Tweed principles as applied to clinical practice at AIIMS Key Points References Chapter 46: Orthodontic treatment with contemporary fixed appliance. Phase II: major tooth movements Introduction Steps of the active orthodontic treatment Levelling and alignment Bite opening Space closure Retraction of incisors into extraction spaces Key Points References Chapter 47: The pre-adjusted edgewise appliance Pre-adjusted appliance Evolution of building the treatment into brackets The first integrated pre-adjusted appliance system and philosophy by C. F. Andrews The features of straight wire appliance The biomechanics Roth's philosophy of functional occlusion and pre-adjusted appliance MBT appliance and philosophy of treatment Limitations of pre-adjusted appliance Treatment customisation Key Points References Chapter 48: Orthodontic treatment with self-ligating bracket systems Introduction Self-ligation in orthodontics Active self-ligating brackets Passive self-ligating brackets Biomechanics and stages of treatment with self-ligating bracket system Features of self-ligation and their impact on biomechanics Stages of treatment and archwire sequence Biomechanical challenge of self-ligation brackets versus conventional brackets Evidence on claims of self-ligating brackets Key Points References Section X: Non-extraction treatment Chapter 49.1: Non-extraction treatment with maxillary expansion and interproximal reduction Introduction Methods to gain space to resolve limited crowding and protrusion Preservation of leeway or ‘E’ space for resolution of crowding in the lower arch Expansion of the narrow maxilla and arch development Diagnosis of maxillary transverse deficiency and case selection Study models Posteroanterior cephalogram Clinical and histological basis of maxillary expansion Types of expansion appliances Rapid maxillary expansion (RME) Indications for RME Contraindications for RME Design of RME Structural and functional effects of RME Adverse effects of RME Activation schedule Forces involved in RME Slow maxillary expansion Parallel expansion screw Wire framework expander appliances NiTi expander Retention and relapse Rapid vs. slow expansion Mini-implant attached rapid palatal expansion Retention Schedule Interproximal reduction Key Points References Chapter 49.2: Non-extraction treatment with non-compliance molar distalisation Introduction and historical review Palatal acting appliance Skeletal anchorage Biomechanics of molar distalisation Timings of molar distalisation Clinical efficacy and anchorage loss Key Points References Section XI: Class II malocclusion Chapter 50: Class II division 1 malocclusion: features and early intervention of growing maxillary excess Introduction Clinical findings Nature of class II malocclusion Interception of developing class II malocclusion Treatment of growing maxillary excess Key Point References Chapter 51: Evolution of functional appliances and treatment with one piece removable appliances Introduction Classification of functional appliances Activator or monoblock Balters’ bionator Frankel appliance Relative indications of activator/bionator/Frankel appliance Key Points References Chapter 52: Treatment approaches with twin block appliance Introduction Clinical examination Skeletal maturity indicators Diagnostic records and analysis Fundamentals of bite recording Appliance design and construction49,51 Clinical management Treatment effects of removable functional appliance Modification of twin block Key Points References Chapter 53: Interception and treatment of mandibular retrusion with non-compliant fixed functional appliances Introduction Rigid fixed functional appliances Herbst appliance Mandibular anterior repositioning appliance (MARA) Mandibular protraction appliance (MPA) Flexible fixed functional appliance (FFFA) Hybrid fixed functional appliances Effects of fixed functional appliance Implant supported FFA Key Points References Chapter 54: Mode of action of functional appliances Introduction Effects of functional appliances Condyle glenoid fossa complex (CGF) remodelling and neuromuscular adaptations Clinical evidence of CGF remodelling Condyle adaptation based on growth relativity hypothesis Molecular and genetic control on CGF remodelling Can the mandible be grown longer than it's pre-determined genetic potential? Key Points References Chapter 55: Dentofacial orthopaedics for class II malocclusion with vertical maxillary excess Introduction Case selection1,3,6,8 Appliance concept and desired effects Clinical management of the appliance1,3,6,8 Treatment effects15,18 van Beek activator22,23 Key Points References Chapter 56: Management of class II malocclusion with fixed appliance Introduction Class II treatment options Treatment sequence Occlusion and profile after extraction treatment Factors affecting soft tissue profile outcome Key Points References Chapter 57: Class II division 2 malocclusion Introduction Features of class II division 2 Aetiology Treatment considerations Stability and retention Key points References Section XII: Class III malocclusion Chapter 58: Class III malocclusion in growing children Introduction Prevalence of skeletal class III malocclusion Aetiology of class III malocclusion Components of class III malocclusion Ethnicity and gender differences Diagnosis of class III malocclusion Prediction of class III skeletal growth Management Maxillary protraction appliances Bone anchored maxillary protraction (BAMP) Micro-implant supported maxillary protraction Camouflage treatment Orthognathic surgery Key Points References Chapter 59: Orthodontic treatment of borderline class III malocclusion Introduction Nature of skeletal class III malocclusion Clinical features of a class III face (Fig. 59.2A–B) Maxillo-mandibular relationship Classification of class III malocclusion by Delaire Glenoid fossa and cranial base Growth considerations in treatment of class III patients Borderline class III patient Treatment considerations Camouflage treatment Treatment approaches Retention protocol Key Points References Section XIII: Newer trends in orthodontics Chapter 60: Temporary anchorage devices Introduction Historical perspective Definition and classification Safe zones for MSI Miniscrew placement protocol Loading of implant Miniscrew removal Direct versus indirect loading Biomechanical considerations in a miniscrew anchorage system Risks and complications with the use of MSIs25 Failures in miniscrews Key Points References Chapter 61: Surgically facilitated rapid tooth movement (SF-RTM) Introduction Historical perspective (Table 61.1) Biological basis of SF-RTM Techniques of alveolar surgery Corticotomy facilitated orthodontic treatment (CFOT) Osteotomy facilitated orthodontic treatment (OFOT) Mono-cortical tooth dislocation and ligament distraction (MTDLD) Surgery first Key Points References Chapter 62: Orthodontic considerations of inter-disciplinary treatment Introduction Objectives of inter-disciplinary treatment Pre-restorative/pre-orthodontic periodontal status Conditions commonly treated with inter-disciplinary care Communication Key Points Reference Chapter 63: Evidence-based orthodontics Introduction A historical perspective of evidence-based orthodontics4 A hierarchy of evidence Evidence-based clinical practice in orthodontics Key Points Section XIV: Impactions and transpositions Chapter 64: Orthodontic aspects of impacted anterior teeth Introduction Prevalence/incidence of impactions Aetiology of tooth impaction Diagnosis of an impacted tooth Treatment considerations for impacted teeth Relocation of an impacted tooth Extraction of impacted tooth Key Points References Chapter 65: Transposition of teeth Introduction Prevalence Aetiology Treatment considerations Management of complete transpositions in the maxillary arch Management of complete transposition in mandibular arch (Fig. 65.3) Key Points References Chapter 66: Auto-transplantation of teeth in orthodontic practice Introduction Indications in orthodontic practice Case selection Surgical sequence and technique Orthodontic tooth movement of auto-transplanted teeth Auto-transplantation versus osseointegrated dental implants The success of auto-transplantation Key Points Section XV: Surgical aspects of orthodontic treatment Chapter 67: Ortho-surgical management of skeletal malocclusions Introduction Historical perspective Pre-surgical orthodontic treatment Motivational factors involved in seeking orthognathic surgery Case selection for orthognathic surgery History and clinical evaluation Diagnostic records and investigations Cephalometric and computer-based prediction technology 3D models Stereophotogrammetry (3dMDTM) Special considerations during surgical treatment planning Steps involved in an orthognathic surgery procedure Retention and follow-up after orthognathic surgery Complications following orthognathic procedures3 Key Points References Chapter 68: Maxillomandibular distraction osteogenesis for orthodontist Definition and biological basis Historical perspective and philosophy of maxillo-mandibular distraction osteogenesis Indications25–27 Contraindications Advantages of distraction osteogenesis over orthognathic surgery Disadvantages Classification of distractors Surgical considerations Orthodontic considerations30–32 Maxillary transverse distraction osteogenesis (Fig. 68.10A–C) Mandibular transverse distraction osteogenesis (Fig. 68.11A–D) The future of maxillomandibular distraction osteogenesis Key Points References Section XVI: Treatment of complex malocclusions Chapter 69: Malocclusion and asymmetries of the face The essence of facial symmetry Aetiology Identifying the asymmetry Evaluation of facial symmetry in three planes of space Prevalence of dentofacial asymmetries Key Points References Chapter 70: Dental midline deviations Midline deviations Definition and evaluation Reference planes Prevalence of midline deviations (Tables 70.1, 70.2) Clinical presentation of dental midline deviations Aetiology of the dental midline shift (Figs 70.6–70.12 and Table 70.3) Management of dental midline shifts of purely dental origin Retention protocol Key Points References Chapter 71: Asymmetry of occlusion Definition and criteria of asymmetric occlusion Development of asymmetries within dental arches Common traits of asymmetrical occlusion Prevalence and features of asymmetrical occlusion Management Class II subdivision malocclusion Molar distalisation (Fig. 71.10) Asymmetric extractions Orthopaedic asymmetrical approach Class III subdivision malocclusion Key Points References Chapter 72: Cant of occlusal plane in transverse direction Introduction and definition Aetiology of occlusal cant Prevalence Clinical presentation and diagnosis Reference planes Management Key Points References Chapter 73: Asymmetries of the face The essence of facial asymmetry Types of facial asymmetry Prevalence Classification of facial asymmetry Aetiology Evaluation of facial asymmetry Management strategy Key Points Chapter 74: Temporomandibular disorders and orthodontics Introduction What are TMDs? Historical relationships between orthodontists and TMDs Orthodontic treatment and TMD Centric relation and orthodontics Functional occlusion and orthodontics Articulators for orthodontic diagnosis Management of TMD signs and symptoms Patient self-directed care and education Home care instructions Psychological approaches to treatment Oral appliances (splints) TMD informed consent in orthodontics Key Points References Section XVII: Expanding role of orthodontist and inter-disciplinary care Chapter 75: Inter-disciplinary management of cleft lip and palate Introduction Developmental aspects of CL ± P Syndromic and non-syndromic clefts Aetiology of CLP Intrauterine diagnosis Risk of recurrence Sex ratio Laterality of CLP Classification of cleft Inter-disciplinary team ca