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Cover
Title Page
Preface
Acknowledgements
About the Companion Website
1 Scope of Practice and Competency
1. Dentists
2. Oral Health Therapists
3. Dental Hygienists
4. Dental Therapists
5. Orthodontic Treatment
6. Orthodontic Indices
7. References
8. Further Reading
2 Growth and Development
1. Craniofacial Growth and Development
2. Prenatal Developmental Phases
3. Craniofacial Postnatal Development
4. Tooth Development
5. References
6. Further Reading
7. Self‐Evaluation
3 Orthodontic Assessment and Treatment Planning Strategies
1. Data Collection
2. Clinical Examination
3. Records
4. Treatment Planning Strategies
5. References
6. Further Reading
7. Self‐Evaluation
4 Biomechanics and Treatment Principles
1. Biomechanics
2. The Mechanics of Tooth Movement
3. The Biology of Tooth Movement
4. Orthodontic Forces
5. Anchorage
6. References
7. Further Reading
8. Self‐Evaluation
5 Fixed Appliances and Orthodontic Instruments
1. Fixed Appliances
2. Oral Hygiene and Maintenance
3. Orthodontic Instruments
4. References
5. Further Reading
6. Self‐Evaluation
6 Treatment for Class I Malocclusion
1. Spacing and Crowding
2. Ectopic and Impacted Canines
3. Cross Bite
4. Open Bite
5. Reference
6. Further Reading
7. Self‐Evaluation
7 Treatment for Class II Malocclusion
1. Principles of Treatment for Class II Malocclusion
2. Functional Appliances and Headgear
3. Care Instructions for Functional Appliances
4. Class II Division 1
5. Class II Division 2
6. Reference
7. Further Reading
8. Self‐Evaluation
8 Treatment for Class III Malocclusion
1. Treatment in Mixed Dentition
2. Treatment in Permanent Dentition
3. Summary
4. Reference
5. Further Reading
6. Self‐Evaluation
9 Treatment for Cleft Palate
1. Palate Formation
2. Treatment of Cleft Palate
3. Reference
4. Further Reading
5. Self‐Evaluation
10 Retention
1. Importance of Retention
2. Fixed Retainers
3. Bonding Fixed Retainers
4. Removable Retainers
5. Self‐Evaluation
11 Adult Orthodontics
1. Orthognathic Surgery
2. Maxillary Surgical Procedures
3. Mandibular Surgical Procedures
4. Bimaxillary Osteotomy
5. Post‐Condylar Cartilage Graft
6. Case Study
7. Clear Aligners
8. Lingual Braces
9. References
10. Further Reading
11. Self‐Evaluation
Self‐Evaluation Answers
1. Chapter 2
2. Chapter 3
3. Chapter 4
4. Chapter 5
5. Chapter 6
6. Chapter 7
7. Chapter 8
8. Chapter 9
9. Chapter 10
10. Chapter 11
Index
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List of Tables

Chapter 02
1. Table 2.1 The muscles, cartilages, derivatives and blood supply to the pharyngeal arches.
2. Table 2.2 Tooth eruption dates.
Chapter 03
1. Table 3.1 Medical conditions and orthodontic implications for treatment.
2. Table 3.2 Assessment of canine and molar occlusal relationships: Angle’s classification and the British standard classification of incisor relationships.
3. Table 3.3 Anatomical points and locations.
4. Table 3.4 Summary of vertebral growth stages.
Chapter 04
1. Table 4.1 Some common elastic patterns.
Chapter 05
1. Table 5.1 Average bracket placement.
2. Table 5.2 Some basic functions of auxiliaries and accessories.

List of Illustrations

Chapter 01
1. Figure 1.1 Normal occlusion.
Chapter 02
1. Figure 2.1 The first prenatal phase (weeks 1–3).
2. Figure 2.2 Fertilisation.
3. Figure 2.3 Gastrulation.
4. Figure 2.4 Neurulation.
5. Figure 2.5 Pharyngeal arches.
6. Figure 2.6 Derivatives of pharyngeal pouches.
7. Figure 2.7 Embryo to fetal growth.
8. Figure 2.8 Neurocranium and viscerocranium. The cranial base is composed of three hollow depressions called fossae. It consists of several nerve openings for blood supply to the neurocranium.
9. Figure 2.9 The infant skull compared with the adult skull.
10. Figure 2.10 Mandibular growth. Generally, growth at the condyle takes place in two directions: upwards and backwards. The mandible displaces forwards and downwards.
11. Figure 2.11 Maxillary growth.
12. Figure 2.12 Growth rotation. The forward growth presents with a convergent mandibular angle. Backward growth presents with a steep divergent mandibular angle.
13. Figure 2.13 Growth rotation: A) Increased facial height is evident with backward growth rotation. B) Reduced facial height is seen in forward growth rotation.
14. Figure 2.14 Tooth development: a) Initial development. b) Bud stage. c) Cap stage. d) Bell stage. e) Root formation. f) Eruption.
15. Figure 2.15 Initial tooth development.
16. Figure 2.16 Bud stage.
17. Figure 2.17 Cap stage.
18. Figure 2.18 Bell stage.
19. Figure 2.19 Root formation.
Chapter 03
1. Figure 3.1 Facial types. A) Mesofacial: well‐balanced facial features with average cranial width. B) Brachyfacial: square‐shaped faces with a prominent chin and a broad forehead, giving the appearance of a short, wide face. C) Dolichofacial: long narrow face with a small cranial width.
2. Figure 3.2 Skeletal patterns and facial profiles.
3. Figure 3.3 A) The lateral cephalometric radiograph confirms the bimaxillary protrusion of the anterior segment. B) Intraoral photograph shows the protruded upper and lower incisors.
4. Figure 3.4 Facial height.
5. Figure 3.5 Types of occlusal curvature: A) Curve of Spee. B) Curve of Wilson.
6. Figure 3.6 Normal occlusion.
7. Figure 3.7 Class I: A) molar and canine relationship. B) Class I Incisor relationship.
8. Figure 3.8 Class I malocclusions: A) Cross bite. B) Scissor bite.
9. Figure 3.9 Ectopic central incisor.
10. Figure 3.10 Class II: A) Molar and canine relationship. B) Incisor relationship, division 1. C) Incisor relationship, division 2.
11. Figure 3.11 Class II division 2; retroclined upper central incisors with proclined lateral incisors.
12. Figure 3.12 A) 100% overbite. B) Overjet.
13. Figure 3.13 Traumatic bite.
14. Figure 3.14 Class III malocclusion: A) Molar and canine relationship. B) Incisor relationship.
15. Figure 3.15 Pseudo class III: A) Centric relation: edge to edge bite. B) Centric occlusion.
16. Figure 3.16 Terminal planes: 1) Flush terminal plane. 2) Distal step. 3) Mesial step.
17. Figure 3.17 Leeway spaces: the differences in the mesiodistal width between the primary teeth and their permanent successors.
18. Figure 3.18 A) Primate spaces. B) Example of leeway spaces; the mesiodistal width of the deciduous molars is larger than the width of the permanent premolars.
19. Figure 3.19 Ectopic canine not detected at an early stage; initial records.
20. Figure 3.20 Three‐dimensional scan of the ectopic canine reveals the damage that it has caused to the upper left central incisor.
21. Figure 3.21 Space was created using fixed appliances to allow eruption of the upper left canine in the central incisor position. This is termed transposition.
22. Figure 3.22 Composite resin restoration of the canine was indicated to resemble the central incisor.
23. Figure 3.23 End of treatment records.
24. Figure 3.24 A series of ideal extra‐ and intraoral photographs.
25. Figure 3.25 Camera position for: A) Extraoral photographs. B) Intraoral photographs.
26. Figure 3.26 Intraoral photography accessories: cheek retractors (top), lip retractor and occlusal mirror (bottom).
27. Figure 3.27 Intraoral photography accessories.
28. Figure 3.28 Ideal impression on the left side, showing sufficient detail of hard and soft tissue coverage. On the right side, there is dragging of the posterior region, sufficient details are not captured and the impression material mix was of a poor quality as it was set prior to insertion so the teeth are not fully captured.
29. Figure 3.29 Taking an impression: A) Standing behind the patient for the upper. B) Standing in front of the patient for the lower impression for a better field of vision.
30. Figure 3.30 Pouring impressions with plaster of Paris.
31. Figure 3.31 Trimmed plaster models.
32. Figure 3.32 Digital scanner; the iTero machine uses a powder‐free technology for accurate scanning; a gentle stream of air disperses from the wand.
33. Figure 3.33 The TRIOS POD is another example of a digital scanner. This innovative technology is a much smaller scanner with dramatically reduced chair time and provides more patient comfort. This scanner can easily be connected to multiple laptops or computers and the pod solution allows the scanner to easily be relocated and shared among various treatment rooms.
34. Figure 3.34 Example of an orthopantomogram.
35. Figure 3.35 Some commonly known anatomical landmarks and points; the same anatomical points are not used for all analyses. A, A‐point (subspinale); ANS, anterior nasal spine; Ar, articular; B, B‐point (supramentale); Ba, basion; Co, condylion; G, glabella; Gn, gnathion; Go, gonion; Me, menton; N, nasion; Or, orbitale; PNS, posterior nasal spine; Po, porion; Pog, pogonion; Pr, prosthion.
36. Figure 3.36 Commonly used horizontal planes
37. Figure 3.37 Commonly used vertical planes
38. Figure 3.38 Sagittal jaw (skeletal) discrepancies. Radiographic diagnosis will confirm whether the jaws are in a normal position, retrusive or protrusive. A diagnosis is required for each jaw.
39. Figure 3.39 Digital cephalometric analysis.
40. Figure 3.40 Three‐dimensional radiograph.
41. Figure 3.41 Hand–wrist radiograph.
42. Figure 3.42 Different combinations of morphological features in the bodies of C2, C3, and C4 are presented for the new method.
Chapter 04
1. Figure 4.1 Force: A) Force (F) must be applied directly to the centre of resistance (CR) of an object to move it in the direction of the force. B) If force (F) does not pass through the centre of resistance (CR), rotation occurs.
2. Figure 4.2 The centre of resistance (CR) is towards the denser side and not in the centre of the object.
3. Figure 4.3 The tooth is embedded in bone, therefore the centre of resistance (CR) is not in the centre of the tooth. As the bone is more dense, the centre of resistance is located further apically.
4. Figure 4.4 Centre of rotation.
5. Figure 4.5 Tension and compression.
6. Figure 4.6 Frontal resorption.
7. Figure 4.7 Undermining resorption.
8. Figure 4.8 Extraoral appliances used as anchorage (to see how these appliances move teeth please refer to chapters 7 and 8). 1) Cranium: (occipital/parietal anchorage) headgears with a face bow to restrict maxillary growth or distalise the upper arch. 2) Cervical: back of the neck as anchorage using a cervical head gear/neck strap. 3) Facial: face masks use frontal bone and the mandibular symphysis as anchorage during treatment. Face masks are also known as reverse head gears.
9. Figure 4.9 Some common elastic patterns. 1) Class I. 2) Class II. 3) Class II triangle. 4) Class III. 5) Class III triangle. 6) Delta. 7) Anterior cross elastic. 8) Posterior cross elastic. 9) Anterior box elastic. 10) Posterior box elastic.
10. Figure 4.10 Examples of intramaxillary anchorage. A) Nance with an acrylic button. B) Class I mechanics. C) Transpalatal arch. D) Lower lingual holding arch.
11. Figure 4.11 Intramaxillary anchorage used to retract the anterior segment and close extraction spaces.
12. Figure 4.12 Skeletal plates used as a source of anchorage in combination with elastic wear to extrude the ectopic canines.
13. Figure 4.13 Temporary anchorage devices inserted in the palatal region. A) directly loaded. B) Indirectly located.
Chapter 05
1. Figure 5.1 A cross‐section showing the difference between a round and a rectangular arch wire in a bracket slot.
2. Figure 5.2 Evolution of brackets from the initial appliance introduce by Fauchard 1); evolving over several years to the ribbon arch 2); Begg 3); and the most commonly used bracket systems today, which are the conventional edgewise brackets 4); and the self‐ligating brackets 5).
3. Figure 5.3 Lingual brackets.
4. Figure 5.4 Direct bonding. 1) Prophylaxis with pumice. 2) Wash and dry thoroughly. 3) Prepare all the teeth with etch and primer lollipop (it is recommended to microetch prior to this step to enhance bonding and minimise bonding failure). 4) Bracket directly placed on to the enamel surface. 5) Remove excess adhesive. 6) Check bracket placement using a height gauge. 7) Bracket placement is checked and the adhesive is set.
5. Figure 5.5 Indirect bonding. 1) The brackets are placed in the tray and adhesive applied to the base. 2) The enamel surface is cleaned. 3) Pumice is washed and dried. 4) Etch and primer lollipop is applied over the tooth (after the enamel surface is micro etched). 5) The trays are secured over the teeth. 6) A firm pressure is applied with a pusher. 7) The adhesives are cured. 8) The trays are gently removed. 9) Excessive adhesive is polished surrounding the brackets.
6. Figure 5.6 A height gauge is used to measure the height of the bracket from the incisal edge.
7. Figure 5.7 Bite ramps bonded to the palatal of the upper central incisors to prevent the upper teeth occluding on to the lower and causing bracket breakages.
8. Figure 5.8 Debonding brackets. Clear brackets are removed from the base to prevent ceramic fracture.
9. Figure 5.9 Separators and banding. 1) and 2) Place separators between the teeth 2–7 days before the procedure and removed prior to banding. 3) Dispense the appropriate powder to liquid ratio. 4) Mix glass ionomer cement (GIC) to achieve a uniform material. 5) Load the band with GIC. 6) Adjust the band position with the band pusher. 7) Wipe the excess GIC. 8) and 9) Check the position of the band before setting the cement.
10. Figure 5.10 Some common orthodontic accessories. 1) Elastoguard (left), o‐ring or module (right). 2) Open and closed power chains. 3) Close‐up of open (left) and closed power chains (right). 4) Steel ligature. 5) Drop in pin. 6) Crimpable hooks. 7) Traction hook. 8) Elastic tubing or bumper sleeve. 9) Spring coil. 10) Close‐up of closed spring coil (top) and open spring coil (bottom). 11) button.
11. Figure 5.11 A long steel ligature tie in a figure of eight around the brackets.
12. Figure 5.12 Orthodontic oral hygiene.
13. Figure 5.13 Some common wire adjustment instruments: 1) Weingart pliers. 2) Ligature cutter. 3) Distal end cutter. 4) Example of a self‐ligating opening tool.
14. Figure 5.14 Some common bracket placement instruments: 1) Anterior bracket tweezers. 2) Posterior bracket tweezers; the curvature in the tip allows better access posteriorly. 3) Height gauge.
15. Figure 5.15 Bracket‐removing pliers: 1) Posterior debonding pliers. 2) Anterior debonding pliers. 3) Debonding pliers for ceramic brackets.
16. Figure 5.16 Banding instruments: 1) Band remover. 2) Band pusher. 3) Band seater/band biter.
17. Figure 5.17 Wire‐forming pliers: 1) Adams pliers. 2) Torque pliers. 3)Tweed. 4) Bird‐beak plier.
18. Figure 5.18 Other instruments: 1) Mathieu needle‐holding pliers. 2) Ligature tucker. 3) Mosquito forceps.
19. Figure 5.19 1) Lingual weingart pliers. 2) Lingual cutter (the curve in the tip makes this cutter resemble a distal end cutter. 3) Lingual ligature tucker. 4) Lingual mosquito forceps.
Chapter 06
1. Figure 6.1 A) Nance B) LLHA (Lower Lingual Holding Arch C) TPA (Transpalatal Arch).
2. Figure 6.2 Comparing the initial and mid‐treatment photographs, it is evident that space is gained mesial and distal to the peg lateral incisors to allow sufficient space for restorative composite resin build‐up.
3. Figure 6.3 Composite resin build‐up of peg lateral incisors. Final detailing and space closures were achieved. Fixed lingual retainers are used for retention post treatment to enhance the stability.
4. Figure 6.4 Treating crowding using fixed appliance therapy; initial records.
5. Figure 6.5 Treating crowding using fixed appliance therapy; final records.
6. Figure 6.6 Exposure and alignment of an impacted canine; initial records.
7. Figure 6.7 Exposure of the impacted canine: A) Upon exposure. B) one month post‐exposure. C) Three months post‐exposure. D) Five months post‐exposure. E) Two years post‐exposure. F) Two years post‐exposure, issued with a lower bite plane to traction the canine into the arch.
8. Figure 6.8 Extraction of the overretained deciduous canine took place and the left canine was aligned in the arch. The next stages of the treatment involved creating space for the build‐up of the upper lateral incisors and bonding lower arch braces to bring the dental arches in harmony
9. Figure 6.9 A rapid maxillary expander (RME) with hex screw: A) Bonded RME; the acrylic‐based RME covers more teeth and offers higher anchorage. This expander is typically used in open bite cases to prevent further extrusion of the molars and mitigate the open bite effect. B) Banded RME; the expander is designed with bands on the upper first molars and first premolar. Some expanders are designed with rests on the premolars or primary first molars instead of bands as shown. Upon expansion, the molars are extruded to a degree.
10. Figure 6.10 Bonded rapid maxillary expander with a superscrew.
11. Figure 6.11 Expanders designed for the lower arch.
12. Figure 6.12 Anterior open bite in mixed dentition; initial records
13. Figure 6.13 Partial braces.
14. Figure 6.14 Anterior open bite in mixed dentition; final records
Chapter 07
1. Figure 7.1 A wax bite for functional appliances.
2. Figure 7.2 Biting edge to edge.
3. Figure 7.3 A twin block.
4. Figure 7.4 A bionator with a face bow.
5. Figure 7.5 Headgear components: A) The fabric strap that sits on the head, around the neck or a combination of the two. B) Safety strap to allow the appliance to disengage easily. C) A face bow with whisks that is usually attached to the intraoral appliance to allow attachment to the fabric and safety strap.
6. Figure 7.6 Vector and direction of force. Cervical (left): a low pull, as the strap rests on the neck and attaches to the bow; the force is generated below the centre of resistance of the upper molars. Occipital (centre): a high pull, allowing the force vector to pass through or close to the centre of resistance of the upper molars. A combination of cervical and occipital (right): a straight pull, as the vector force also passes through or close to the centre of resistance of the upper molars.
7. Figure 7.7 Angle class II division 1 malocclusion; initial records
8. Figure 7.8 Angle class II division 1 malocclusion; final records
9. Figure 7.9 A Herbst appliance.
10. Figure 7.10 A Forsus appliance.
11. Figure 7.11 Patient presenting with class II division 1 malocclusion in mixed dentition; initial records
12. Figure 7.12 Class II division 1 malocclusion in mixed dentition; end of phase I treatment.
13. Figure 7.13 Class II division 1 malocclusion; end of phase II treatment and correction of the premolar relationship.
14. Figure 7.14 Patient presenting with class II division 2; initial records
15. Figure 7.15 Patient presenting with class II division 2; an edge‐to‐edge bite is achieved using a Forsus appliance.
16. Figure 7.16 Patient presenting with class II division 2; records at the end of treatment.
17. Figure 7.17 Palatal bite ramp.
18. Figure 7.18 A lower bite plane used to create space between the upper and lower jaws to traction the upper left lateral incisor labially with an auxiliary wire.
Chapter 08
1. Figure 8.1 Vestibular J hook incorporated in the design of a bonded rapid maxillary expander for wearing with a face mask.
2. Figure 8.2 Face mask with elastics at a downward angle to protract the maxilla downwards and forwards.
3. Figure 8.3 Insertion of a rapid maxillary anchorage device with a super screw supported by a temporary anchorage device for treatment of class III with an ovoid upper arch.
4. Figure 8.4 Surgical insertion of skeletal plates.
5. Figure 8.5 Correction of anterior cross bite with elastic wear from the skeletal plate to the rapid maxillary expander. Active self‐ligating brackets are used on the upper incisors to correct crowding.
6. Figure 8.6 Correction of a class III malocclusion.
7. Figure 8.7 Correction of a class III malocclusion; initial records.
8. Figure 8.8 Correction of a class III malocclusion; records from the end of treatment
9. Figure 8.9 Correction of a class III malocclusion in an adult; initial records.
10. Figure 8.10 Correction of a class III malocclusion in an adult; final records
Chapter 09
1. Figure 9.1 Formation of the palate.
2. Figure 9.2 Cleft palate (left); cleft lip (centre); cleft palate and lip (right).
3. Figure 9.3 A cleft lip may be unilateral A) or bilateral B).
4. Figure 9.4 Complete cleft lip and palate on the left side: before and after treatment.
Chapter 10
1. Figure 10.1 A) Flexible multistranded wires. B) V‐loop to allow better access for flossing.
2. Figure 10.2 Hawley retainer with a labial bow.
3. Figure 10.3 Vacuum‐formed retainer.
Chapter 11
1. Figure 11.1 Le Forte osteotomy.
2. Figure 11.2 Surgically assisted rapid palatal expansion case prior to surgery.
3. Figure 11.3 Development of a large median diastema gained from surgically assisted rapid palatal expansion.
4. Figure 11.4 Bilateral split osteotomy.
5. Figure 11.5 Genioplasty.
6. Figure 11.6 Orthognathic treatment; initial records.
7. Figure 11.7 Orthognathic treatment; pre‐surgical photographs. As a result of an asymmetric occlusion, after decompensation, the patient presented with an asymmetric class III malocclusion, which was addressed at the time of surgery with a mandibular osteotomy.
8. Figure 11.8 Orthognathic treatment; final records.
9. Figure 11.9 Aligners precision cut for elastic wear. The cut‐out on the molar region is to allow bonding of buttons for elastic wear.
10. Figure 11.10 Attachments bonded to teeth with a button on the lower first molars for class II elastic wear from the lower molars to the precision cut on the upper canines on the aligner.
11. Figure 11.11 Bonding attachments: 1) Prophylaxis with pumice. 2) Wash and dry thoroughly. 3) Prepare the enamel surface with self‐etching primer lollipop (etch and bond can be used instead of the lollipop). 4) Load the template aligner with composite. 5) Fit the template aligner on the teeth. 6) Gently press attachments with a band pusher and set the composite. 7) Remove the aligner and the excess composite. 8) Check that all the attachments are bonded on the teeth.
12. Figure 11.12 Interproximal reduction keys to measure the amount of interproximal reduction achieved.
13. Figure 11.13 A diamond coated disc with a straight handpiece used for interproximal reduction.
14. Figure 11.14 Orthodontic interproximal reduction strip.
15. Figure 11.15 Invisalign treatment; initial records
16. Figure 11.16 Invisalign treatment; final records
17. Figure 11.17 Customised lingual arch wire.
18. Figure 11.18 Treating class II division 2 with lingual braces; initial records
19. Figure 11.19 Expansion of the upper arch is evident over time as the anterior maxillary teeth are proclined.
20. Figure 11.20 A Forsus appliance used to posture the mandible forwards and address the skeletal class II after correction of the deep bite and proclination of the upper incisors has been achieved.
21. Figure 11.21 Treating class II division 2 with lingual braces; final records