A 12-year-old female presented with a class II division 1 malocclusion on a moderate skeletal class II pattern, with increased vertical dimensions complicated by an increased overjet (12mm), crowding of both dental arches and teasing in relation to her dento-facial appearance.
What is treatment plan?
1) Functional appliance like Dynamax or Twin block (more preffered as overjet reduction is more effective) = maxillary retroclination, mandibular incisor proclination, guides the eruption of posterior dentition.
2) Need of Headgear with torqueing spurs = restricts maxillary forward growth and tipping of maxillary incisors.
3) Extraction of four second premolars followed by edge to edge appliances for stability of class II correction.
Highly elevated alkaline phosphatase is a good marker of Paget’s disease of bone in the appropriate clinical setting. Bone sequestration is often secondary to chronic osteomyelitis in the jaws. Bisphosphonates are used to treat Paget’s disease and also have been linked to jaw osteonecrosis.
Study the two radiographs which are of the same patient at (a) 19 years and (b) 34 years of age.
1 . What is the most likely periodontal diagnosis at 34 years of age?
Generalised aggressive periodontitis. The severity of bone resorption and the radiographic absence of signs of resorption at 19 years preclude a diagnosis of chronic periodontitis.
2 . What does the initial phase of treatment involve?
Initially conventional cause-related treatment is instigated: instruction in toothbrushing and use of adjunctive aids for interproximal and subgingival cleaning, RSI, prophylaxis. Ultimately, treatments such as surgery and the adjunctive use of antimicrobials might be indicated, but conventional treatment is first in line.
3 . The patient has a sister who is aged 29 years. What advice might you offer?
Periodontal screening and radiographic examination. There is evidence that certain subjects are at high risk from developing aggressive periodontitis and this risk may be under genetic control. Siblings should be screened and affected individuals with children warned that early signs may develop from around puberty onwards
A 35-year-old man presents with gross loosening of both his lower left premolar teeth. The gingiva around them looks swollen and is purple–brown in colour. A radiograph shows irregular bone destruction to the apices. Incisional biopsy shows multinucleated osteoclast-like giant cells in a haemorrhagic fibrous stroma.
Which investigations should now be performed? The serum calcium level should be measured and radiographs reviewed to exclude hyperparathyroidism.
If these prove negative, what treatment should be undertaken? The lesion should be treated by local removal with curettage.
Which other lesions in the jaws contain multinucleate giant cells of this type? Osteoclast-like giant cells are found in
brown tumour of hyperparathyroidism
Pagetʼs disease of bone
aneurysmal bone cyst
some fibro-osseous lesions, particularly cherubism.
A 58-year-old woman noticed that her front teeth had become spaced and seeks advice from her dentist. On entering the surgery, the dentist notices that she has difficulty in walking and does not respond to his questions. She has become increasingly deaf and her vision has also deteriorated. On examination, the maxilla and zygoma are enlarged and there is enlargement of the forehead.
1. What diagnosis would you suspect? Pagetʼs disease of bone results in enlargement of cranial bones and deformation of weight- bearing bones. The cranium is usually expanded in thickness and symptoms may arise from cranial nerve compression.
2. What information might be gained from oral radiographs and blood tests to support this diagnosis? Radiographs of the jaws may show hypercementosis, cemental masses, abnormal trabeculation and a cotton-wool appearance in the jaws. The alkaline phosphatase level is markedly raised.
3. What are the principal histological features of this disorder?
Disordered bone remodelling is seen; larger osteoclasts are present and the trabeculae show a scalloped outline. Numerous resting and reversal lines, resulting in a mosaic pattern, are seen and the vasculature may be increased. Globular cementum-like masses are seen in the jaws.
DEFINITION = Functional appliances are defined as ‘loose fitting or passive appliances which harness the natural forces of the orofacial musculature that are transmitted to the teeth and alveolar bone through the medium of appliance’.
Given by anderson and haul
Also called as norwegian appliance or loose fitting appliance
It doesn’t have any clasp to hold onto dentition normally
Only one wire component = labial bow
Mechanism of action 2m
Pt has to forcibly hold the appliance in its place aka maxilla as its loose appliance with no clasps
This causes the pt to bring his mandible forward and keep mouth closed so the activator doesn’t fall down.
When pt swallows = muscles get stretched, continous remodeling at TMJ and mandible stays in forward direction
Mandible is staying forward due to a REFLEX – myotatic reflex = due to continuous stretch of muscles, kinetic energy is generated and transferred to maxillary and mandibular dentition and skeletal base. Leading to:
Distal force on maxilla
Mesial force in mandible
Hence, condylar adaptation occurs
‘viscoelastic property’ = passive tension caused by stretching of muscles, soft tissue, tendinous tissue, etc. are responsible for the action
Class II division 1 malocclusion
Class II division 2 malocclusion
Class III malocclusion
Class I open bite malocclusion
Class I deep bite malocclusion
As a preliminary treatment before major fixed appliance therapy to improve skeletal jaw relations
For post treatment retention
Children with lack of vertical development in lower facial height.
Too much proclination of lower anteriors
Increased lower anterior facial height
pt can remove it
oral hygiene is maintained
no food restrictions
chair side time is less
Disadvantage = pt compliance
TYPES of activator
Horizontally growing pt
Vertically growing pt
Bite registration = gives us an idea how much mandible needs to be displaced. U shaped wax is placed on the oral cavity and asked to bring it forward and the bite is also opened posteriorly.
Acrylization of appliance
Trimming = to bring about certain movements of the dentition
WUNDERER MODIFICATION = Given in class 3
CYBERNATOR = similar to bionator = activator with reduced palatal acrylic