DEFINITION malocclusion
Abnormal occlusion malocclusion is characterized by harmonious relationship between the arch in every field of spatial or anomalies in the abnormal tooth position. Malocclusion showed intercuspal occlusion conditions in which irregular dentition. The determination may be based on a key malocclusion normal occlusion. Angle made a key statement of the first molar occlusion means is the key to occlusion.
According Angle cited by Morrow, normal occlusion as the relationship of the areas of the tooth cusp inclination at the time of both maxilla and mandible in the closed state, the contact with the proximal and axial position all the right gear, and a state of growth, development and the relation between the position of wide range of normal tissues supporting the teeth anyway.
According to Andrew, quoted by Bisara, there are six keys to normal occlusion, as follows:
Relation molar mesiobuccal cusp shows the maxillary first molar occlude the gap between the central and the mesial of mandibular first molar.
Crown angulation correct.
Crown inclination guarantee of balance malocclusion.
Crown inclination guarantee of balance occlusion.
No rotation of the gear.
There is no gap between the teeth.
The existence of the curve of Spee is flat against the occlusal plane.
Therefore, if the various provisions of above normal occlusion is not appropriate, it will be classified as cases of malocclusion. According to Graber cited by Morrow malocclusion is the second largest after the dental disease dental caries. Overview of malocclusion in adolescents in Indonesia is still very high, ranging from 1983 is 90% until the year 2006 was 89%, while the dental health behavior in adolescents in particular, is still not good enough malocclusion and dental health services is not optimal.
The high prevalence of malocclusion can also be seen from several surveys that have been conducted on populations in various places. The survey proved that most children have irregular teeth or malocclusion. Silva et al study on malocclusion in 2001 in Latin America in children aged 12-18 years are cited from Apsari research shows that more than 93% of children suffer from malocclusion. Apsari research results in SMPN1 Ungaran 1997 in 91 adolescents showed that 83.5% had malocclusion, with a 38.2% malocclusion ringan.10 Goddess Oktavia The results of malocclusion in high school adolescents in the city of Medan in 2007 using HMA scores indicate that amounted to 60.5% prevalence of malocclusion with orthodontic treatment need of 23%.
Causes of malocclusion
Etiology local
factors dental
Gigi is a major place in the etiology of error dentofacial form in a variety of ways. Variations in size, shape, number and Position of teeth can all lead to malocclusion.
It is often overlooked is the possibility that malposisisi can cause malfunctions, malfunctions indirectly alter bone growth. Which is often problematic teeth that are too large Some examples of dental abnormalities that cause malocclusion is hipodontia, supernumerary teeth, conical tooth shape, tooth shape tubercles, mikrodontia, makrodontia, and the tooth is too fast which is not in accordance with the time normally.
The absence of one or more of the tooth germ (hipodontia) can lead to malocclusion. Hipodontia malocclusion severity of these effects depends on the number of teeth that are not formed. For example, no canines tooth formation, the upper jaw and the lower jaw does not get the key proper occlusion. This is what can lead to malocclusion.
Excessive teething or often called supernumerary teeth also affect the development of occlusion. If the person has a jaw that is not too big and someone is having supernumerary teeth abnormalities will occur berjejalnya teeth - teeth that can lead to malocclusion.
In addition to the two examples above abnormalities in tooth deformity and tubercles conical teeth can also affect the development of occlusion. Cone-shaped teeth are usually small and can not be in contact with the opposing teeth, which can lead to malocclusion. In addition, the conical-shaped teeth are often grown as a supernumerary teeth that grow in between the central incisors labial RA. This will affect the growth of the central incisor teeth that can result in central incisor retrusion RA resulting malocclusion. Abnormalities of tooth form tubercles also has an effect similar to the conical shape of the tooth disorder, it's just a different place. Dental tubercles commonly grows on the palate between the central incisor RA. The effects of this disorder affects the growth of the central incisor RA can lead to protrusinya the teeth and ultimately cause malocclusion.
Other dental abnormalities are mikrodontia and makrodontia. Mikrodontia can cause a diastema in the dental arch, causing the occurrence of malocclusion. While makrodontia berjejalnya can cause tooth - teeth in the dental arch, resulting in abnormal tooth contact - teeth or malocclusion.
In addition to the anomalies of teeth - teeth causing dental malocclusion in factors of tooth loss is too fast. Milk tooth that is too fast will affect the eruption of permanent teeth later. Permanent teeth can grow with imperfect or grow to a position that is inconsistent with the position that tapat. This is what can lead to malocclusion.
Etiology general:
hereditary
Hereditary have long been recognized as a cause of malocclusion. Origin of genetic errors can cause the appearance of your teeth before birth / they can not be seen until 6 years after birth (eg, tooth eruption patterns). Hereditary role in craniofacial growth and form errors dentalfacial etiology has been the subject of much research. Genetic similarity in the shape of the teeth are very frequent but keluaraga transmission type / place unknown genetic action except in a few cases (eg the absence of dental / craniofacial appearance of some of the syndrome).
For example, a parent's men - men have a large jaw and teeth are too big, but has a normal dental arch and neat woman married to a parent who has a small jaw and teeth - geligiyang small - too small, have a normal arch and tooth position - neat teeth. Then the expected offspring can occur circumstances in which children have a small jaw, but the teeth - geligiyang big - so that the occurrence berjejalnya akhrinya teeth that cause malocclusion.
vice
There is an assortment of bad habits in the child's mouth, such as breathing through the mouth, stuck out his tongue, finger biting, finger sucking, lip sucking. The bad habits a person can stand alone or occur together with other bad habits. This means that the same patient may occur a few bad habits
Classification of bad oral habits in children as follows:
1. Breathing through the mouth (mouth breathing) Breathing through the mouth can be classified into three categories as follows:
a. Obstructive: Children who have an interruption in breathing air melaluisaluran nose (nasal passage).
b. Habitual: Due to the habit despite abnormalsudah interference is eliminated.
c. Anatomical: If the anatomy of the upper lip and down short so dapatmengatup not perfect without any attempt to close it.
Children whose mouth breathing is usually a narrow-faced, upper anterior teeth advance to the labial direction, and an open mouth with the lower lip that is located behind the upper incisor. Due to the lack of normal muscular stimulation of the tongue and because excess adanyatekanan canines and molar region orbicularis oris muscle danbucinator, the buccal segment of maxillary contraction resulted maksilaberbentuk V and high palate. Therefore, according to some opinions mouthbreathers likely to provide clinically have the long face (long faced) and sempit.Bila this is done continuously can lead to abnormalities of the upper jaw forward berupagigi mrongos Baas (protusif) and front bite into the open (open bite).
The habit of thumb sucking
Thumb sucking is a common habit in children. Kebiasaanmenghisap prolonged thumb can lead to malocclusion. MenurutProfit (2000), the characteristics associated with malocclusion tekananlangsung combination of thumb and changes in pressure patterns cheeks and lips. Padasudut mouth cheek pressure is the highest pressure, pressure against the cheek muscles gigiposterior maxillary teeth is increased due to muscle contractions buccinators for sucking at the sama.sehingga provide maksilamenjadi curved V-shaped risk
The habit of pushing the tongue (tongue thrusting)
The habit of pushing the tongue can be caused by improper bottlefeeding and is usually accompanied by other bad habits with less sepertikebiasaan thumb sucking, lip biting, and biting nails. If the habit persists initerus will lead to open bite and incomplete, and the tip of the tongue terposisi coverbite more anterior than normal.
The habit of biting objects
Consists of:
a. Biting nails (nail biting) is an oral bad habits which upper incisor tooth position and tooth bawahmengalami emphasis on the part of the nail. Nail biting is a normal habit in children sebelumnyamemiliki sucking habit. In addition, nail biting is caused due to stress, imitation of anggotakeluarga, hereditary transfer of finger sucking habits, and yangtidak neat fingernails. In some cases these habits can lead to attrition of the gigianterior below.
b. biting finger
Finger biting habit in children occurs at age 1-2 years. If allowed to continue until the age of 5 years or more may result kelainanpada gear position. Finger will press forward maxillary teeth and tooth rahangbawah into, so the teeth appear merongos (protusif).
In addition to the above habits, chin resting habits can also lead to the growth of the lower jaw bone is not perfect. This habit can cause not symmetric between the right and left sides of the jaw bone due to this habit chin propped up in part that means most of the lower jaw gets a pressure so that the jaw growth is not perfect. This is what the future may lead to malocclusion.
According to Moyers cited by Suminy, malocclusion can be caused by several factors, including:
Hereditary factors, such as the neuromuscular system, bones, teeth and other parts outside of the muscles and nerves.
Impaired growth.
Trauma, the trauma before birth and trauma during birth and after birth trauma.
Physical state, such as the premature extraction.
Bad habits such as finger sucking can cause maxillary incisors while the incisors to the labial lingual lower jaw, tongue out, nail biting, sucking and biting her lip.
Disease consisting of systemic disease, endocrine disorders, localized disease (respiratory tract disorders, gum disease, tooth supporting tissues, tumors, and cavities).
Malnutrition.
IMPACT malocclusion
Malocclusion can cause a variety of effects which can be viewed in terms of functionality, namely in case of malocclusion in the form will result in crowding of the teeth difficult to clean when brushing teeth. In terms of pain, severe malocclusion can lead to difficulty moving the jaw (TMJ disorders and pain). In terms of phonetics, one of which is distooklusi malocclusion can affect the clarity of the pronunciation of the letters p, b, m while the mesio-occlusion s, z, t and n. In terms of psychological, aesthetic and malocclusion can affect a person's appearance.
Classification of malocclusion
The simplest way to determine the classification of malocclusion is Angle.6 According Angle cited by Rahardjo, classification based on the assumption that the first molars are almost never changed posisinya.Angle classifying malocclusion into three groups, namely malocclusion Class I, Class II, and Class III.
Class I malocclusion: normal anteroposterior relationship of the mandible and maxilla. Mesiobuccal cusp of permanent first molar cusps are on the buccal groove of mandibular first permanent molar. There is a curvilinear relationship normal anteroposterior views of the first permanent molar relationship (netrooklusi). 12Kelainan accompanying malocclusion Class I namely: crowding, rotation and protrusion.
Type 1: Class I with anterior teeth lying crammed or crowded teeth or C ektostem
Type 2: Class I with anterior teeth or protrusions located labioversi
Type 3: Class I with anterior teeth, causing bite palatoversi reversed (anterior crossbite).
Type 4: Class I with posterior crossbite teeth.
Type 5: Class I where there is a permanent molar teeth to shift toward the mesial due to premature extraction.
Class II malocclusion: posterior relation of the mandible to the maxilla. Mesiobuccal cusp upper first permanent molar cusps are more mesial buccal groove of the permanent mandibular first molar.
Division 1: maxillary central incisors proclination so we get a big bite distance (overjet), upper lateral incisors also proclination, overlapping large bite (overbite), and the curve of Spee positive.
Division 2: retroklinasi upper central incisors, lateral incisors on proclination, overlapping large bite (the bite). Distance bite can be normal or slightly increased.
In a study in New York United States gained 23.8% had Class II malocclusion. Other researchers say that 55% of the US population has a malocclusion Class II Division I.
Class III malocclusion: anterior relation of the mandible to the maxilla. 12 cusp mesiobuccal cusps of the first permanent molars are more distal on the buccal groove of the permanent mandibular first molar and contained anterior crossbite (anterior cross bites).
Type 1: the presence of the dental arch is good, but the relationship is not normal arch.
Type 2: the existence of a good dental arch of the maxillary anterior teeth but there linguoversi of mandibular anterior teeth.
Type 3: underdeveloped maxillary arch; linguoversi of maxillary anterior teeth; mandibular dental arch either.
For crossbite cases there are dividing into anterior and posterior crossbite crossbite.
anterior crossbite
A state of the jaws in centric relation, but there are one or several of the maxillary anterior teeth which position is located in the lingual side of the mandibular anterior teeth.posterior crossbite
Bukolingual abnormal relationship of one or more of the mandibular posterior teeth.
In addition to Angle classification, there are various types of malocclusion, such as:
Deepbite is a situation where the distance to close part of the maxillary incisor incisal incisal mandibular incisors in the vertical direction exceed 2-3 mm. In case deepbite, often linguoversi posterior teeth or tilted mesially and mandibular incisor crowding often, linguoversi, and supra-occlusion.
Openbite is a state of existence occlusal or incisal room of the teeth when the jaw and mandible in centric occlusion. Various open bite by location include:
anterior openbite
Angle Class I anterior openbite occur because of a narrow upper jaw, forward inclination of the front teeth and posterior teeth supra occlusion, while Angle Class II Division I due to bad habits or descent.
b. Openbite posterior region of the premolars and molars.
c. The combination of anterior and posterior / total openbite are both in the anterior,
posterior, can be unilateral or bilateral.
Crowded (Dental crowding)
Crowding of the teeth is berjejalnya circumstances outside the normal arrangement. The cause of crowding is a basalt arch that is too small than coronal arch. Basal arch is curved at prossesus alveolar place of the apex of the tooth embedded, coronal arch is the most wide arch of crowns or the greatest amount of mesiodistal crown teeth. Heredity is one cause of tooth bejejal, for example, the father has a big jaw structure with large teeth, mothers having a small jaw structure with small teeth. Genetic combination between small jaw and large teeth that makes jaws and teeth are not enough berjejal.Kasus crowding divided by degree of severity, namely:
a. Crowding of mild cases
There teeth are a little cramped, often the front teeth, mandible, is considered a normal variation and is considered not require treatment.
b. Crowding of severe cases
There teeth are so cramped that can cause poor oral hygiene.
4. diastema (teeth loose)
Loose teeth is a state presence in the space between the teeth are supposed to be in contact. Diastema there are two kinds, namely: 10
a. Locally, if there are between 2 or 3 teeth. The causes include abnormal labial frenulum, tooth loss, bad habits, and persistence.
b. Generally, if there is in most teeth can be caused by heredity, a large tongue and teeth traumatic occlusion.
orthodontic appliances
Devices used for treating malocclusion can be broadly classified into three, namely: removable devices (removable appliance), functional device (functional appliances) and fixed appliance (fixed appliances).
Removable Devices (Removable Appliance)
Removable device is any device that can be installed and removed by the patient. Some examples as seen in the image (Figure 2.4). The main component is a removable device: 1) the active component, 2) passive components, 3) acrylic plates, 4) anchorage. The active component consists of a spring, bow and expansion screws. Passive components are key grip Adams with some modifications, Southend grip and short arc.
Removable devices can also be connected to the headgear to increase anchorage. The plates can be modified by adding acrylic elevation anterior bite for bite correction in the posterior bite raising impediments to free upper anterior teeth in cases of anterior cross bites. One of the success factors of treatment with a removable device is uncooperative patient to wear the device.
Functional Devices (Functional Appliance)
Functional devices used to correct malocclusions by utilizing, blocking or modifying the power generated by the orofacial muscles, tooth eruption and pertumbuhkembangan dentomaksilofasial. There are also those who say that a functional device can be either removable or fixed device that uses the power that comes from muscle strain, or tissue fascia and the other to change the skeletal and dental relationships. By using a functional device, expected changes in the functional environment in an effort to influence and change the relations jaw permanently. Usually functional devices do not use a spring so it can not move individual teeth.
This tool is only effective in children who are flourishing especially who have passed the pubertal growth spurt. The strength of the muscles that are used depending on the design of functional devices, but the main strength of the muscles that are used to place the mandible down and forward on the Class II malocclusion or down and back on a Class III malocclusion. Placement of the mandible down and back is more difficult than down and forward so that this tool is more effective when used in Class II malocclusion.
indication
Functional devices can be used on a limited basis malocclusion:
- Mandible retrusion in Class II skeletal abnormalities with mild lower incisors were retroklinasi or upright.
- High surface normal or slightly reduced.
- Mandible protrusion on mild Class III skeletal abnormalities
- No teeth were crowded
Class II malocclusion with the lower incisors are proclination is contraindicated the use of functional devices. In skeletal Class II malocclusion, severe functional device used as a preliminary treatment to change the jaw relation when there is still growth (phase one) and then fixed appliance is used to correct the location of the teeth and sometimes required the extraction of permanent teeth (phase two).
Type Functional Devices
1. Tooth-Borne Removable Appliance or Passive Tooth-Borne
This tool is only dependent on the operation of the soft tissue that stiffens and muscle activity resulting effect to correct the malocclusion. Included in this type are: a. activators
Also called Andresen devices, activators of the original design consisted of an acrylic block that covers the upper and lower arch teeth and palate, this block because it does not have a loose grip. Activators can advance the mandible a few millimeters to correct the Class II malocclusion and open bite is approximately 3-4 mm.
This tool affects the growth of the jaw and passive device that can move the anterior teeth in the tipping and controlling dental eruption of teeth to change the vertical dimension. This tool gives the opportunity to grow vertically below the posterior teeth while the upper posterior teeth retained by an acrylic plate to reduce overlap bite. This tool is used for 14-16 hours a day.
b. Bionator
Sometimes called Balters device according to its inventor. The principle is as an activator but less bulky and thus more desirable. Plate section was removed and there is still a palatal lingual wings to stimulate in order to be positioned to the anterior mandible and the presence of an acrylic plate in between the teeth up and down to control the vertical dimension. Use for 24 hours a day is highly recommended.
2. Twin Block Appliance
This tool consists of top and bottom of the device when the patient occlude form a unity in the buccal. As well as having a slab which serves to place the mandible forward during the closing. Twin block appliance is suitable for patients who have normal or slightly overlapping bite and possible reduced worn for 24 hours every day even during the night can still be used. Reducing the distance bite can occur in the not too long.
3. Removable Tissue-Borne
The only tool of functional tissue-borne removable type is functional or functional regulator corrector Rolf Frankel's creation so that the device is known as a tool Frankel. This tool consists of acrylic with a skeleton of wire, designed to reduce unwanted tooth movement and regulate muscle located close to the tooth and placing the jaw in the desired location. Wings acrylic mandibular lingual put forward while bearing in labial acrylic and acrylic wings wide in buccal (buccal shield) to withstand the pressure of the lips and cheeks. The use of devices Frankel began gradually 2-3 hours per day on the first week, and then used the night every day until the end for 24 hours every day except during meals.
There are four types of devices Frankel:
- FR I for correcting malocclusion Class I and Class II Division 1
- FR II to correct the Class II Division 2 malocclusion
- FR III to correct Class III malocclusion
- FR IV to correct anterior open bite
4. Fixed Tooth-Borne Appliance
The third type is the fixed tooth-borne appliance that has the sense that this device attached to the tooth. An example is the Herbst Appliance and Jasper jumper. Herbst appliance was originally a removable device later in its development into fixed appliance consisting of a splint is cemented to the upper and lower dental arch, usually the upper first molar and first premolar bottom, connected by pins and tube telescopic arm that determines how much of the mandible moved forward. Therefore a fixed appliance, the appliance herbst used constantly so successful for correcting malocclusion higher. Disadvantages of this device could lead to lower incisors are pushed to the labial. Herbst appliance that does not interfere with the new lower jaw lateral movement and is made of a stronger material that is not easily broken.
Jasper jumper is also fixed tooth-borne appliance, using a principle similar to the device herbst appliance, but the metal sleeve is replaced with a strong spring encased in a flexible plastic which then attached directly to the bow on a fixed appliance.
TIME MAINTENANCE
old treatments
Orthodontic treatment in a mixed dentition period lasted about a year, commonly called the intial phase. This was followed by observation until all the teeth erupt. The advantage of this treatment is an increase / increase space by using a molar as anchoring. In addition, it can also be used transpalatal arch in the maxilla, can also be used on the mandibular lingual arch after the eruption of permanent teeth filled up with occlusion (except third molars). Then proceed with the installation of fixed appliance to align and to spruce up your teeth into normal occlusion. The final phase of therapy can be started with the installation of transpalatal arch, installed about 6 months before all fitted perfectly erupted premolars. Usually orthodontic treatment will continue approximately 12-18 months with fixed appliance.
timing
Time determination of therapy should be considered carefully, must be seen also abnormalities teeth (malocclusion type). For example, Class I malocclusion with the relatively large size of the teeth, crowding, the state can begin to be treated at the age of 9 years. In general, patients with Class I malocclusion abnormalities may begin after the four incisors treated mandibular and maxillary central incisors fully erupted. In many cases, it is seen running out of space so that the lateral upper incisors to erupt blocked. For this, it must be considered whether the treatment will be carried Serial extraction or jaw expansion will be done.
When the incidence of class III malocclusions there during the early mixed dentition. The concept of therapeutic possibilities first treated, when compared with treatment for malocclusion Class I. Interventions too early will result in a long time between initial treatment phase until the end of treatment after all the permanent teeth erupt. When therapy for less-developed mandible (deficiency) will be different in terms of therapy, so it should be postponed for the treatment of functional jaw orthopedics. Ideally, functional therapy will be followed immediately by the installation of fixed appliance.
Abnormal occlusion malocclusion is characterized by harmonious relationship between the arch in every field of spatial or anomalies in the abnormal tooth position. Malocclusion showed intercuspal occlusion conditions in which irregular dentition. The determination may be based on a key malocclusion normal occlusion. Angle made a key statement of the first molar occlusion means is the key to occlusion.
According Angle cited by Morrow, normal occlusion as the relationship of the areas of the tooth cusp inclination at the time of both maxilla and mandible in the closed state, the contact with the proximal and axial position all the right gear, and a state of growth, development and the relation between the position of wide range of normal tissues supporting the teeth anyway.
According to Andrew, quoted by Bisara, there are six keys to normal occlusion, as follows:
Relation molar mesiobuccal cusp shows the maxillary first molar occlude the gap between the central and the mesial of mandibular first molar.
Crown angulation correct.
Crown inclination guarantee of balance malocclusion.
Crown inclination guarantee of balance occlusion.
No rotation of the gear.
There is no gap between the teeth.
The existence of the curve of Spee is flat against the occlusal plane.
Therefore, if the various provisions of above normal occlusion is not appropriate, it will be classified as cases of malocclusion. According to Graber cited by Morrow malocclusion is the second largest after the dental disease dental caries. Overview of malocclusion in adolescents in Indonesia is still very high, ranging from 1983 is 90% until the year 2006 was 89%, while the dental health behavior in adolescents in particular, is still not good enough malocclusion and dental health services is not optimal.
The high prevalence of malocclusion can also be seen from several surveys that have been conducted on populations in various places. The survey proved that most children have irregular teeth or malocclusion. Silva et al study on malocclusion in 2001 in Latin America in children aged 12-18 years are cited from Apsari research shows that more than 93% of children suffer from malocclusion. Apsari research results in SMPN1 Ungaran 1997 in 91 adolescents showed that 83.5% had malocclusion, with a 38.2% malocclusion ringan.10 Goddess Oktavia The results of malocclusion in high school adolescents in the city of Medan in 2007 using HMA scores indicate that amounted to 60.5% prevalence of malocclusion with orthodontic treatment need of 23%.
Causes of malocclusion
Etiology local
factors dental
Gigi is a major place in the etiology of error dentofacial form in a variety of ways. Variations in size, shape, number and Position of teeth can all lead to malocclusion.
It is often overlooked is the possibility that malposisisi can cause malfunctions, malfunctions indirectly alter bone growth. Which is often problematic teeth that are too large Some examples of dental abnormalities that cause malocclusion is hipodontia, supernumerary teeth, conical tooth shape, tooth shape tubercles, mikrodontia, makrodontia, and the tooth is too fast which is not in accordance with the time normally.
The absence of one or more of the tooth germ (hipodontia) can lead to malocclusion. Hipodontia malocclusion severity of these effects depends on the number of teeth that are not formed. For example, no canines tooth formation, the upper jaw and the lower jaw does not get the key proper occlusion. This is what can lead to malocclusion.
Excessive teething or often called supernumerary teeth also affect the development of occlusion. If the person has a jaw that is not too big and someone is having supernumerary teeth abnormalities will occur berjejalnya teeth - teeth that can lead to malocclusion.
In addition to the two examples above abnormalities in tooth deformity and tubercles conical teeth can also affect the development of occlusion. Cone-shaped teeth are usually small and can not be in contact with the opposing teeth, which can lead to malocclusion. In addition, the conical-shaped teeth are often grown as a supernumerary teeth that grow in between the central incisors labial RA. This will affect the growth of the central incisor teeth that can result in central incisor retrusion RA resulting malocclusion. Abnormalities of tooth form tubercles also has an effect similar to the conical shape of the tooth disorder, it's just a different place. Dental tubercles commonly grows on the palate between the central incisor RA. The effects of this disorder affects the growth of the central incisor RA can lead to protrusinya the teeth and ultimately cause malocclusion.
Other dental abnormalities are mikrodontia and makrodontia. Mikrodontia can cause a diastema in the dental arch, causing the occurrence of malocclusion. While makrodontia berjejalnya can cause tooth - teeth in the dental arch, resulting in abnormal tooth contact - teeth or malocclusion.
In addition to the anomalies of teeth - teeth causing dental malocclusion in factors of tooth loss is too fast. Milk tooth that is too fast will affect the eruption of permanent teeth later. Permanent teeth can grow with imperfect or grow to a position that is inconsistent with the position that tapat. This is what can lead to malocclusion.
Etiology general:
hereditary
Hereditary have long been recognized as a cause of malocclusion. Origin of genetic errors can cause the appearance of your teeth before birth / they can not be seen until 6 years after birth (eg, tooth eruption patterns). Hereditary role in craniofacial growth and form errors dentalfacial etiology has been the subject of much research. Genetic similarity in the shape of the teeth are very frequent but keluaraga transmission type / place unknown genetic action except in a few cases (eg the absence of dental / craniofacial appearance of some of the syndrome).
For example, a parent's men - men have a large jaw and teeth are too big, but has a normal dental arch and neat woman married to a parent who has a small jaw and teeth - geligiyang small - too small, have a normal arch and tooth position - neat teeth. Then the expected offspring can occur circumstances in which children have a small jaw, but the teeth - geligiyang big - so that the occurrence berjejalnya akhrinya teeth that cause malocclusion.
vice
There is an assortment of bad habits in the child's mouth, such as breathing through the mouth, stuck out his tongue, finger biting, finger sucking, lip sucking. The bad habits a person can stand alone or occur together with other bad habits. This means that the same patient may occur a few bad habits
Classification of bad oral habits in children as follows:
1. Breathing through the mouth (mouth breathing) Breathing through the mouth can be classified into three categories as follows:
a. Obstructive: Children who have an interruption in breathing air melaluisaluran nose (nasal passage).
b. Habitual: Due to the habit despite abnormalsudah interference is eliminated.
c. Anatomical: If the anatomy of the upper lip and down short so dapatmengatup not perfect without any attempt to close it.
Children whose mouth breathing is usually a narrow-faced, upper anterior teeth advance to the labial direction, and an open mouth with the lower lip that is located behind the upper incisor. Due to the lack of normal muscular stimulation of the tongue and because excess adanyatekanan canines and molar region orbicularis oris muscle danbucinator, the buccal segment of maxillary contraction resulted maksilaberbentuk V and high palate. Therefore, according to some opinions mouthbreathers likely to provide clinically have the long face (long faced) and sempit.Bila this is done continuously can lead to abnormalities of the upper jaw forward berupagigi mrongos Baas (protusif) and front bite into the open (open bite).
The habit of thumb sucking
Thumb sucking is a common habit in children. Kebiasaanmenghisap prolonged thumb can lead to malocclusion. MenurutProfit (2000), the characteristics associated with malocclusion tekananlangsung combination of thumb and changes in pressure patterns cheeks and lips. Padasudut mouth cheek pressure is the highest pressure, pressure against the cheek muscles gigiposterior maxillary teeth is increased due to muscle contractions buccinators for sucking at the sama.sehingga provide maksilamenjadi curved V-shaped risk
The habit of pushing the tongue (tongue thrusting)
The habit of pushing the tongue can be caused by improper bottlefeeding and is usually accompanied by other bad habits with less sepertikebiasaan thumb sucking, lip biting, and biting nails. If the habit persists initerus will lead to open bite and incomplete, and the tip of the tongue terposisi coverbite more anterior than normal.
The habit of biting objects
Consists of:
a. Biting nails (nail biting) is an oral bad habits which upper incisor tooth position and tooth bawahmengalami emphasis on the part of the nail. Nail biting is a normal habit in children sebelumnyamemiliki sucking habit. In addition, nail biting is caused due to stress, imitation of anggotakeluarga, hereditary transfer of finger sucking habits, and yangtidak neat fingernails. In some cases these habits can lead to attrition of the gigianterior below.
b. biting finger
Finger biting habit in children occurs at age 1-2 years. If allowed to continue until the age of 5 years or more may result kelainanpada gear position. Finger will press forward maxillary teeth and tooth rahangbawah into, so the teeth appear merongos (protusif).
In addition to the above habits, chin resting habits can also lead to the growth of the lower jaw bone is not perfect. This habit can cause not symmetric between the right and left sides of the jaw bone due to this habit chin propped up in part that means most of the lower jaw gets a pressure so that the jaw growth is not perfect. This is what the future may lead to malocclusion.
According to Moyers cited by Suminy, malocclusion can be caused by several factors, including:
Hereditary factors, such as the neuromuscular system, bones, teeth and other parts outside of the muscles and nerves.
Impaired growth.
Trauma, the trauma before birth and trauma during birth and after birth trauma.
Physical state, such as the premature extraction.
Bad habits such as finger sucking can cause maxillary incisors while the incisors to the labial lingual lower jaw, tongue out, nail biting, sucking and biting her lip.
Disease consisting of systemic disease, endocrine disorders, localized disease (respiratory tract disorders, gum disease, tooth supporting tissues, tumors, and cavities).
Malnutrition.
IMPACT malocclusion
Malocclusion can cause a variety of effects which can be viewed in terms of functionality, namely in case of malocclusion in the form will result in crowding of the teeth difficult to clean when brushing teeth. In terms of pain, severe malocclusion can lead to difficulty moving the jaw (TMJ disorders and pain). In terms of phonetics, one of which is distooklusi malocclusion can affect the clarity of the pronunciation of the letters p, b, m while the mesio-occlusion s, z, t and n. In terms of psychological, aesthetic and malocclusion can affect a person's appearance.
Classification of malocclusion
The simplest way to determine the classification of malocclusion is Angle.6 According Angle cited by Rahardjo, classification based on the assumption that the first molars are almost never changed posisinya.Angle classifying malocclusion into three groups, namely malocclusion Class I, Class II, and Class III.
Class I malocclusion: normal anteroposterior relationship of the mandible and maxilla. Mesiobuccal cusp of permanent first molar cusps are on the buccal groove of mandibular first permanent molar. There is a curvilinear relationship normal anteroposterior views of the first permanent molar relationship (netrooklusi). 12Kelainan accompanying malocclusion Class I namely: crowding, rotation and protrusion.
Type 1: Class I with anterior teeth lying crammed or crowded teeth or C ektostem
Type 2: Class I with anterior teeth or protrusions located labioversi
Type 3: Class I with anterior teeth, causing bite palatoversi reversed (anterior crossbite).
Type 4: Class I with posterior crossbite teeth.
Type 5: Class I where there is a permanent molar teeth to shift toward the mesial due to premature extraction.
Class II malocclusion: posterior relation of the mandible to the maxilla. Mesiobuccal cusp upper first permanent molar cusps are more mesial buccal groove of the permanent mandibular first molar.
Division 1: maxillary central incisors proclination so we get a big bite distance (overjet), upper lateral incisors also proclination, overlapping large bite (overbite), and the curve of Spee positive.
Division 2: retroklinasi upper central incisors, lateral incisors on proclination, overlapping large bite (the bite). Distance bite can be normal or slightly increased.
In a study in New York United States gained 23.8% had Class II malocclusion. Other researchers say that 55% of the US population has a malocclusion Class II Division I.
Class III malocclusion: anterior relation of the mandible to the maxilla. 12 cusp mesiobuccal cusps of the first permanent molars are more distal on the buccal groove of the permanent mandibular first molar and contained anterior crossbite (anterior cross bites).
Type 1: the presence of the dental arch is good, but the relationship is not normal arch.
Type 2: the existence of a good dental arch of the maxillary anterior teeth but there linguoversi of mandibular anterior teeth.
Type 3: underdeveloped maxillary arch; linguoversi of maxillary anterior teeth; mandibular dental arch either.
For crossbite cases there are dividing into anterior and posterior crossbite crossbite.
anterior crossbite
A state of the jaws in centric relation, but there are one or several of the maxillary anterior teeth which position is located in the lingual side of the mandibular anterior teeth.posterior crossbite
Bukolingual abnormal relationship of one or more of the mandibular posterior teeth.
In addition to Angle classification, there are various types of malocclusion, such as:
Deepbite is a situation where the distance to close part of the maxillary incisor incisal incisal mandibular incisors in the vertical direction exceed 2-3 mm. In case deepbite, often linguoversi posterior teeth or tilted mesially and mandibular incisor crowding often, linguoversi, and supra-occlusion.
Openbite is a state of existence occlusal or incisal room of the teeth when the jaw and mandible in centric occlusion. Various open bite by location include:
anterior openbite
Angle Class I anterior openbite occur because of a narrow upper jaw, forward inclination of the front teeth and posterior teeth supra occlusion, while Angle Class II Division I due to bad habits or descent.
b. Openbite posterior region of the premolars and molars.
c. The combination of anterior and posterior / total openbite are both in the anterior,
posterior, can be unilateral or bilateral.
Crowded (Dental crowding)
Crowding of the teeth is berjejalnya circumstances outside the normal arrangement. The cause of crowding is a basalt arch that is too small than coronal arch. Basal arch is curved at prossesus alveolar place of the apex of the tooth embedded, coronal arch is the most wide arch of crowns or the greatest amount of mesiodistal crown teeth. Heredity is one cause of tooth bejejal, for example, the father has a big jaw structure with large teeth, mothers having a small jaw structure with small teeth. Genetic combination between small jaw and large teeth that makes jaws and teeth are not enough berjejal.Kasus crowding divided by degree of severity, namely:
a. Crowding of mild cases
There teeth are a little cramped, often the front teeth, mandible, is considered a normal variation and is considered not require treatment.
b. Crowding of severe cases
There teeth are so cramped that can cause poor oral hygiene.
4. diastema (teeth loose)
Loose teeth is a state presence in the space between the teeth are supposed to be in contact. Diastema there are two kinds, namely: 10
a. Locally, if there are between 2 or 3 teeth. The causes include abnormal labial frenulum, tooth loss, bad habits, and persistence.
b. Generally, if there is in most teeth can be caused by heredity, a large tongue and teeth traumatic occlusion.
orthodontic appliances
Devices used for treating malocclusion can be broadly classified into three, namely: removable devices (removable appliance), functional device (functional appliances) and fixed appliance (fixed appliances).
Removable Devices (Removable Appliance)
Removable device is any device that can be installed and removed by the patient. Some examples as seen in the image (Figure 2.4). The main component is a removable device: 1) the active component, 2) passive components, 3) acrylic plates, 4) anchorage. The active component consists of a spring, bow and expansion screws. Passive components are key grip Adams with some modifications, Southend grip and short arc.
Removable devices can also be connected to the headgear to increase anchorage. The plates can be modified by adding acrylic elevation anterior bite for bite correction in the posterior bite raising impediments to free upper anterior teeth in cases of anterior cross bites. One of the success factors of treatment with a removable device is uncooperative patient to wear the device.
Functional Devices (Functional Appliance)
Functional devices used to correct malocclusions by utilizing, blocking or modifying the power generated by the orofacial muscles, tooth eruption and pertumbuhkembangan dentomaksilofasial. There are also those who say that a functional device can be either removable or fixed device that uses the power that comes from muscle strain, or tissue fascia and the other to change the skeletal and dental relationships. By using a functional device, expected changes in the functional environment in an effort to influence and change the relations jaw permanently. Usually functional devices do not use a spring so it can not move individual teeth.
This tool is only effective in children who are flourishing especially who have passed the pubertal growth spurt. The strength of the muscles that are used depending on the design of functional devices, but the main strength of the muscles that are used to place the mandible down and forward on the Class II malocclusion or down and back on a Class III malocclusion. Placement of the mandible down and back is more difficult than down and forward so that this tool is more effective when used in Class II malocclusion.
indication
Functional devices can be used on a limited basis malocclusion:
- Mandible retrusion in Class II skeletal abnormalities with mild lower incisors were retroklinasi or upright.
- High surface normal or slightly reduced.
- Mandible protrusion on mild Class III skeletal abnormalities
- No teeth were crowded
Class II malocclusion with the lower incisors are proclination is contraindicated the use of functional devices. In skeletal Class II malocclusion, severe functional device used as a preliminary treatment to change the jaw relation when there is still growth (phase one) and then fixed appliance is used to correct the location of the teeth and sometimes required the extraction of permanent teeth (phase two).
Type Functional Devices
1. Tooth-Borne Removable Appliance or Passive Tooth-Borne
This tool is only dependent on the operation of the soft tissue that stiffens and muscle activity resulting effect to correct the malocclusion. Included in this type are: a. activators
Also called Andresen devices, activators of the original design consisted of an acrylic block that covers the upper and lower arch teeth and palate, this block because it does not have a loose grip. Activators can advance the mandible a few millimeters to correct the Class II malocclusion and open bite is approximately 3-4 mm.
This tool affects the growth of the jaw and passive device that can move the anterior teeth in the tipping and controlling dental eruption of teeth to change the vertical dimension. This tool gives the opportunity to grow vertically below the posterior teeth while the upper posterior teeth retained by an acrylic plate to reduce overlap bite. This tool is used for 14-16 hours a day.
b. Bionator
Sometimes called Balters device according to its inventor. The principle is as an activator but less bulky and thus more desirable. Plate section was removed and there is still a palatal lingual wings to stimulate in order to be positioned to the anterior mandible and the presence of an acrylic plate in between the teeth up and down to control the vertical dimension. Use for 24 hours a day is highly recommended.
2. Twin Block Appliance
This tool consists of top and bottom of the device when the patient occlude form a unity in the buccal. As well as having a slab which serves to place the mandible forward during the closing. Twin block appliance is suitable for patients who have normal or slightly overlapping bite and possible reduced worn for 24 hours every day even during the night can still be used. Reducing the distance bite can occur in the not too long.
3. Removable Tissue-Borne
The only tool of functional tissue-borne removable type is functional or functional regulator corrector Rolf Frankel's creation so that the device is known as a tool Frankel. This tool consists of acrylic with a skeleton of wire, designed to reduce unwanted tooth movement and regulate muscle located close to the tooth and placing the jaw in the desired location. Wings acrylic mandibular lingual put forward while bearing in labial acrylic and acrylic wings wide in buccal (buccal shield) to withstand the pressure of the lips and cheeks. The use of devices Frankel began gradually 2-3 hours per day on the first week, and then used the night every day until the end for 24 hours every day except during meals.
There are four types of devices Frankel:
- FR I for correcting malocclusion Class I and Class II Division 1
- FR II to correct the Class II Division 2 malocclusion
- FR III to correct Class III malocclusion
- FR IV to correct anterior open bite
4. Fixed Tooth-Borne Appliance
The third type is the fixed tooth-borne appliance that has the sense that this device attached to the tooth. An example is the Herbst Appliance and Jasper jumper. Herbst appliance was originally a removable device later in its development into fixed appliance consisting of a splint is cemented to the upper and lower dental arch, usually the upper first molar and first premolar bottom, connected by pins and tube telescopic arm that determines how much of the mandible moved forward. Therefore a fixed appliance, the appliance herbst used constantly so successful for correcting malocclusion higher. Disadvantages of this device could lead to lower incisors are pushed to the labial. Herbst appliance that does not interfere with the new lower jaw lateral movement and is made of a stronger material that is not easily broken.
Jasper jumper is also fixed tooth-borne appliance, using a principle similar to the device herbst appliance, but the metal sleeve is replaced with a strong spring encased in a flexible plastic which then attached directly to the bow on a fixed appliance.
TIME MAINTENANCE
old treatments
Orthodontic treatment in a mixed dentition period lasted about a year, commonly called the intial phase. This was followed by observation until all the teeth erupt. The advantage of this treatment is an increase / increase space by using a molar as anchoring. In addition, it can also be used transpalatal arch in the maxilla, can also be used on the mandibular lingual arch after the eruption of permanent teeth filled up with occlusion (except third molars). Then proceed with the installation of fixed appliance to align and to spruce up your teeth into normal occlusion. The final phase of therapy can be started with the installation of transpalatal arch, installed about 6 months before all fitted perfectly erupted premolars. Usually orthodontic treatment will continue approximately 12-18 months with fixed appliance.
timing
Time determination of therapy should be considered carefully, must be seen also abnormalities teeth (malocclusion type). For example, Class I malocclusion with the relatively large size of the teeth, crowding, the state can begin to be treated at the age of 9 years. In general, patients with Class I malocclusion abnormalities may begin after the four incisors treated mandibular and maxillary central incisors fully erupted. In many cases, it is seen running out of space so that the lateral upper incisors to erupt blocked. For this, it must be considered whether the treatment will be carried Serial extraction or jaw expansion will be done.
When the incidence of class III malocclusions there during the early mixed dentition. The concept of therapeutic possibilities first treated, when compared with treatment for malocclusion Class I. Interventions too early will result in a long time between initial treatment phase until the end of treatment after all the permanent teeth erupt. When therapy for less-developed mandible (deficiency) will be different in terms of therapy, so it should be postponed for the treatment of functional jaw orthopedics. Ideally, functional therapy will be followed immediately by the installation of fixed appliance.
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