POST-ORTHODONTIC BALANCING

POST-ORTHODONTIC BALANCING

Post-orthodontic or post-therapeutic occlusion refers to the occlusion achieved after orthodontic treatment. Obviously, this occlusion does not always correspond to the ideal occlusion.

But first, it is important to see if the objectives of the orthodontic treatment still correspond to the ideal occlusion, how to analyze it, and what solutions exist if an imbalance persists at the end of treatment.

1. REMINDERS AND DEFINITIONS:
   1. Definition of occlusion:

Occlusion refers to both the act of closing and the state of closing of the jaws.

This term refers to both the closure of the dental arches and the various functional movements during which the maxillary and mandibular teeth come into contact.

• A) The maximum intercuspidation position (MIP):

Relates to teeth in maximum mesh.

• B) Centered relation (CR):

The CR is therefore a mandibular-cranial relationship in which the condyle is in the highest and most posterior medial position.

2. POST-ORTHODONTIC OCCLUSION:

2-1 Study of post-orthodontic occlusion:

The most advanced orthodontic techniques do not seem precise enough to achieve perfect intercuspation associated with RC.

It is therefore necessary to carry out a functional analysis and occlusal equilibration after each treatment.

Choosing a reference position:

Resting position: this is changing, variable and should therefore not be used as a reference point for occlusal analysis .

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ICM position: it depends on the position of the cusps that the practitioner must precisely move, therefore unreliable.

Relationship Centered: This is the reference position of choice, used in all specialties. The search for CR must be an integral part of the diagnosis and must be repeated throughout treatment.

Occlusal analysis itself: should allow the location of defects which disrupt function; it is carried out on study models mounted on a semi-adaptable articulator.

Separate arch examination:

It is necessary to start with an assessment of oral hygiene with periodontal status, insertion of the frenulum

• Examination of teeth: shape, condition and position.
• Analysis of the Spee curve.
• Analysis of the Wilson curve.
• Arch shape and symmetry.
• Median incisors.
• Level of the proximal ridges.
• Number of proximal contact points (presence of diastemas).
• Examination of the arches in occlusion:

• Relationship between the incisors in the sagittal and vertical direction.
• Relationship between canines and molars (Angle classification).
• The location of the wear facets and their direction as well as the occlusal defects will guide the functional examination.

• Functional examination:
• The functional examination should include:

• Look for RC, a possible gap between RC and ICM
• If there is a gap between the two positions greater than 2mm, you must:

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• – Look for a deviation from the closing path.
• – Look for prematurities responsible for these deviations.

• Examine the ATMs.
• Examination of lateral and propulsion movements.
• Examination of mastication and symmetry of AFMPs.
• Additional examinations:

• Periodontal examination: must complement the occlusal analysis. The tooth-by-tooth examination allows us to choose the type of function to adopt.
• Radiological examination: dental panoramic to check the parallelism of the roots and to see the position of the wisdom teeth.
•  TLR: end of treatment (overlay).

2-2- Post-orthodontic occlusal possibilities: 2-2-1-post-therapeutic Class I occlusion:

Angle: defined the class I molar by the contact of the tip of the MV cusp of the 1st ^M sup (non-centered cusp) at the level of the vestibular groove of the 1st ^lower molar.

2-2-2-Post-therapeutic Class II occlusion:

The extraction of the upper 1st ^PM is a therapeutic remedy frequently used in orthodontics. This treatment results in the

creation of occlusion reports of canine I and molar II.

2.  3-post-therapeutic Class III occlusion:

The lower molars are more than half a cusp mesial to the upper molars.

This therapeutic relationship should be AVOIDED as much as possible.

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2-4-post-therapeutic occlusion after symmetrical and homologous exo (14/24 and 34/44 or 15/25 and 35/45):

Indication: DDM and biproalveolia.

2-5-post-therapeutic occlusion after mono-arch exo 16/26, 36/46):

Extraction of 16/26: several authors have shown that the replacement of maxillary molars is carried out without major problems.

3. CONSEQUENCES OF AN OCCLUSAL IMBALANCE:

• This imbalance can be compensated through individual capacity

adaptation which can manifest itself on the different elements of the masticatory system:

• the dental system:

• The phenomenon of abrasion of dental enamel;
• The pulp becomes sclerosed or calcified;
• The gum which strengthens its collagen framework;
• The periodontal ligament, a highly specialized connective tissue, is highly capable of adaptation;
• Alveolar bone, due to its malleability.
• At the level of the joint system:

• In children there is an adaptive bone capacity thanks to the growth of the condyles;
• In adults, adaptive capacity thanks to meniscal connective tissue.

4. POST ORTHODONTIC BALANCING:

• 1-Definition:

It is the post-orthodontic correction of certain minor anomalies resistant to any therapy or having appeared secondarily,

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which can disrupt occlusion and compromise the stability of post-orthodontic results.

2-Goals of post-orthodontic occlusal equilibration:

Improve occlusal function with:

• Removal of persistent anomalies,
• Interference suppression,
• Improve mandibular kinetics and protect the TMJs,
• Improve intra- and inter-arcade relationships,
• Prevent recurrence or reduce risks.

3-Indications :

1. It is systematic in adults.
2. When there is a gap between RC and ICM greater than 1 mm at the end of treatment.
3. When prematurity persists.
4. When the last molars could not be incorporated into the multi-attachment device.
5. When orthodontic treatment has led to a therapeutic Class II or Class III occlusion.
6. In the absence of extraction or in the case of unilateral extraction, maxillary uni.
7. When diastemas persist, there is a lack of continuity of the arches, and there are no contact points.
8. When the posterior teeth are mesialized, there is a change in the shape of the arch, a reduction in the transverse diameter of the arch.

3-Equilibration at the end of treatment:

1. The ideal bows in Edgewise technique:

^{Thanks to 1st} , 2nd ^and 3rd ^order plications and the coordination of the 2 upper and lower arches.

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2. The tooth positioner:

This is a gutter that can be made of soft resin, rubber or transparent silicone (elastic materials give it ideal flexibility for retention).

• It allows the closing of spaces left by the thickness of the rings.
• It coordinates the two arches.
• It improves low axial tilts and slight rotations.
• It allows occlusal rebalancing without grinding.
• It maintains the result obtained after treatment (active retention).

3. Post-orthodontic equilibration by grinding the occlusal surfaces:

• Occlusal equilibration by selective grinding is an operation which consists of shaping the occlusal morphology to obtain optimal intercuspation.
• The best time to perform it is after the retention has ended, especially for cases treated with fixed appliances.
• Balancing techniques:
• Direct method (Shore or minimum grinding)

Grinding is done directly in the mouth and consists of adjusting interferences during different mandibular positions (RC, propulsion and laterality).

• Indirect method (Lauritzen and Graf or complex grinding):

It is used for complex cases requiring more extensive grinding. It involves grinding the plaster models and transferring them to a semi-adaptable articulator before grinding them onto the teeth, to avoid damaging the dental element.

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1st ^step : elimination of premature contacts preventing ICM in RC: 2nd step: Realization of ICM

3rd step: interference in induction: working side, non-working side.

: interferences in propulsion: at the level of the anterior teeth, at the level of the cuspid teeth.

^Step 4 : Polishing and finishing

D-Equilibration by addition:

Application of adhesive material and sculpting of the grinding surface of a tooth under guidance.

CONCLUSION:

One of the goals of orthodontic treatment is to establish a good dental occlusion, in harmony with the temporomandibular joints and the musculature, and which ensures the efficiency of the masticatory apparatus and the health of the periodontium.

Dentistry has not yet taken the step of uniting these different treatment objectives into a single one, which would be defined by all the criteria concerning occlusion, and which would become common to all the specialties of our profession.

POST-ORTHODONTIC BALANCING

  Wisdom teeth can cause pain if they erupt crooked.
Ceramic crowns offer a natural appearance and great strength.
Bleeding gums when brushing may indicate gingivitis.
Short orthodontic treatments quickly correct minor misalignments.
Composite dental fillings are discreet and long-lasting.
Interdental brushes are essential for cleaning narrow spaces.
A vitamin-rich diet strengthens teeth and gums.

POST-ORTHODONTIC BALANCING