# Integrated Dental Practice # 1OrthodonticsBeyond straightening teeth! What, Why and How we do Orthodontics CHAPTER 1, Malocclusion and Dentofacial Deformity in contemporary Society J. Mike Razza **UWA-OHCWA**   #### Overview of Modern Orthodontics What, Why and How we do Orthodontics #### Academic Reference - CHAPTER 1: Malocclusion and Dentofacial Deformity in Contemporary Society - J. Mike Razza - UWA-OHCWA A 3D-rendered cartoon figure of a small character resembling a Viking warrior, wearing a helmet with horns and holding a sword. The figure is depicted against a black background. The cover image of the textbook 'Contemporary Orthodontics' by William R. Proffit, Henry W. Fields, and David M. Sarver. The cover features four inset images: a close-up of teeth with braces, an X-ray of a skull, a smiling individual, and a 3D model of a head showing dental alignment issues. Outline What is Orthodontics - What do we Do? Some Basic Orthodontic Procedures Orthodontics in a Nutshell Why Orthodontic Treatment Few Cases What is Orthodontics-What do we Do? What Most People Think . . . #### Presentation Outline - What is Orthodontics - What do we Do? - Some Basic Orthodontic Procedures - Orthodontics in a Nutshell - Why Orthodontic Treatment - Case Studies #### Defining the Field What is Orthodontics and what do we do? #### Public Perception What Most People Think . . . That’s All It’s About **Go From Here . . .**   That’s All It’s About **Go From Here . . .** Clinical intraoral photograph showing the anterior dentition in occlusion. The upper and lower central incisors are visible with mild crowding of the lower anterior teeth. Gingival tissues appear healthy with normal coloration. Clinical intraoral photograph showing the anterior dentition from a slightly different angle or at a different stage (implied by 'Go From Here' context). Mild crowding is still present in the lower arch. This image likely represents the 'before' state compared to an implied 'after' state. . . . To here. What makes up braces   . . . To here. What makes up braces Clinical photo collage showing six views of a patient's teeth and gums: occlusal view of maxillary arch (top left), occlusal view of mandibular arch (top right), frontal view (center bottom), and three angled views (left, center, right). Shows crowded, misaligned teeth without braces; one image has a timestamp 'Center - 6/06/2018'. Used to demonstrate baseline dental condition prior to orthodontic treatment. Clinical photo collage showing six views of the same patient’s teeth after brace installation: occlusal view of maxillary arch with visible wire and brackets (top left), occlusal view of mandibular arch with full archwire (top right), frontal view with aligned teeth (center bottom), and three angled views (left, center, right). Demonstrates how braces physically engage teeth for alignment — directly illustrating ‘What makes up braces’ as stated in OCR context. Some Examples of Basic Orthodontic Procedures Banding tray with various sizes of bands  Some Examples of Basic Orthodontic Procedures Banding tray with various sizes of bands Clinical photograph of a white orthodontic banding tray containing various sizes of metal bands. The image shows multiple compartments arranged in rows, each filled with silver-colored bands of different diameters. Each compartment is labeled with a number indicating the size (e.g., 4, 5, 6, 7, 8, 9, 13, 14, 15, 16, 17, 18). This visual demonstrates the variety of band sizes available for basic orthodontic procedures. Placing separators Placement of Separator(s)   #### Separator Placement - Placing separators - Placement of Separator(s) Product packaging image of a medical device. The box displays the brand 'ORTHO SIGN' and 'AO', with the product name 'Empower 2'. A metallic, complex-looking surgical instrument is depicted on the front. Clinical photograph showing various dental instruments laid out on a green sterile drape. Visible items include a mouth mirror, a curved explorer, a pair of tweezers (one with a red marker), a large metal clamp or plier, blue separator discs, and a coil of suture thread. This visual corresponds to the OCR text 'Placing separators' and 'Placement of Separator(s)'. **Removing separators prior to banding (3-10 days)**  **Removing separators prior to banding (3-10 days)** Clinical photo showing a close-up view of teeth with a blue dental separator placed between two molars. The caption below reads 'Removing separators prior to banding (3-10 days)', indicating this is a procedural step in orthodontic treatment.   Clinical photo showing a close-up of teeth with blue orthodontic bands being placed or adjusted using dental instruments. The image includes visible gum tissue and part of the tongue. Procedure image demonstrating orthodontic banding on molars. A metal instrument is shown manipulating a metallic band around a tooth, likely for securing an appliance. Visible details include the tooth structure, gingival margin, and the mechanical components of the banding device. Operator seats band onto tooth using a Mershon band seater **Operator tries band onto teeth using Mershon band seater** **Bands are positioned on all posterior teeth**  #### Band Seating and Positioning - Operator seats band onto tooth using a Mershon band seater - Operator tries band onto teeth using Mershon band seater - Bands are positioned on all posterior teeth Clinical photo showing the operator trying a band onto posterior teeth using a Mershon band seater. The image displays two metal bands positioned on the lower molars, with the band seater tool visible engaging the bands for seating. Surrounding tissues and adjacent teeth are also visible. Cleaning of the teeth using pumice and water  Cleaning of the teeth using pumice and water Clinical photo showing a patient's open mouth with orthodontic braces on both upper and lower teeth. The image is accompanied by the caption 'Cleaning of the teeth using pumice and water', indicating this is part of a dental hygiene procedure demonstration. Orthodontic Bonding  Orthodontic Bonding Clinical photo demonstrating the 'Orthodontic Bonding' procedure. A patient is lying down with their mouth open while a dental professional wearing latex gloves uses a specialized dental instrument to apply or manipulate material on the patient's upper front teeth. The image captures the specific step of bonding orthodontic brackets. **Lip and cheek retractors in place** **Teeth are rinsed and dried**   #### Preparation - Lip and cheek retractors in place - Teeth are rinsed and dried Clinical photo showing a patient's mouth with red lip and cheek retractors in place, exposing upper and lower teeth. The image is captioned 'Lip and cheek retractors in place'. Clinical photo showing the same patient's mouth after rinsing and drying, with retractors still in place. Teeth appear clean and dry. Caption: 'Teeth are rinsed and dried'.   Clinical photo showing the application of an etching solution to upper anterior teeth. A dental instrument is applying a liquid to the tooth surfaces while a red cheek retractor keeps the mouth open. Clinical photo showing the application of green-colored composite resin material to the upper anterior teeth using a micro-brush applicator. The teeth are being restored. All teeth are etched as brackets will be bonded to all of the teeth Teeth are rinsed  #### Etching and Rinsing - All teeth are etched as brackets will be bonded to all of the teeth - Teeth are rinsed Clinical photo of a child's open mouth with red cheek retractors. The teeth are coated in green etchant gel, indicating the bonding preparation phase for orthodontic brackets as described by the OCR text 'All teeth are etched as brackets will be bonded to all of the teeth' and 'Teeth are rinsed'. Teeth are air dried   Teeth are air dried Clinical photo of a child's open mouth with red cheek retractors. The lower anterior teeth have greenish-white material applied to them, likely fluoride varnish or sealant. A dental instrument is visible in the mouth. Clinical photo showing the same patient's mouth after air drying, as indicated by the OCR text 'Teeth are air dried'. The green material on the lower teeth has been removed or is no longer visible, and the teeth appear clean and dry. Dental instruments are still present in the mouth. Enamel has uniform dull frosty appearance after etching and drying – “Etched” Activator placed over etched areas of teeth  #### Surface Preparation - Enamel has uniform dull frosty appearance after etching and drying – “Etched” - Activator placed over etched areas of teeth Clinical photo showing a close-up of teeth with enamel exhibiting a uniform dull frosty appearance after etching and drying. The image includes red retractors on the sides to expose the teeth. Operator applies activator to etched areas of teeth   Operator applies activator to etched areas of teeth Clinical photo: Close-up view of a gloved hand holding a grey cylindrical dental impression tray. A green-handled brush is applying a black liquid activator to the interior surface of the tray. Clinical photo: Intraoral view showing a green-handled brush applying a black liquid activator to the lower anterior teeth. The caption 'Operator applies activator to etched areas of teeth' applies to this visual sequence. Bonding tweezers used to remove bond from adhesive pad Placing adhesive onto bracket  #### Adhesive Application - Bonding tweezers used to remove bond from adhesive pad - Placing adhesive onto bracket Procedure image showing bonding tweezers used to remove bond from an adhesive pad. The image displays a close-up of a white surface with circular adhesive pads. One pad has a metal bracket attached, another has the bracket removed, and the third shows the tweezers in the process of removing the bond from the adhesive pad. Positioning bracket using bonding tweezers Bond is positioned and bonding tweezers removed   #### Bracket Positioning - Positioning bracket using bonding tweezers - Bond is positioned and bonding tweezers removed Clinical photo showing the process of positioning a bracket using bonding tweezers. The image captures a close-up view of dental instruments holding a bracket in place on a tooth, with adhesive being applied or adjusted. The caption 'Positioning bracket using bonding tweezers' is visible below the image. Clinical photo illustrating the final step of bracket placement. It shows a close-up of teeth with brackets already attached, and one bracket being positioned by bonding tweezers. The caption 'Bond is positioned and bonding tweezers removed' indicates that this stage involves securing the bond before removing the tools. The image provides a clear visual guide for understanding the sequence of orthodontic bracket application. Scaler is used to removed excess adhesive Can Use Chemical or Light Cured Adhesive   #### Finishing and Curing - Scaler is used to removed excess adhesive - Can Use Chemical or Light Cured Adhesive Clinical photo showing a dental procedure where excess adhesive is being removed from brackets on teeth. A scaler instrument is visible in use near the lower front tooth with braces. Clinical photo demonstrating bracket placement or adjustment using a curved dental tool. The image shows multiple metal braces on upper and lower teeth with visible bonding material, illustrating the use of chemical or light cured adhesive as mentioned in context. The archwire is fitted into the bracket slots and buccal tubes   The archwire is fitted into the bracket slots and buccal tubes Clinical photo showing a close-up of the upper and lower dental arches with metal brackets bonded to the teeth. A metal instrument is being used to fit an archwire into the bracket slots and buccal tubes, as described in the OCR context. Procedure image demonstrating the fitting of an archwire into orthodontic brackets. The image shows a person's mouth with braces, and gloved hands holding the archwire in place while it is being inserted into the bracket slots.  Clinical photograph of Howe Pliers used to fit archwires into bracket slots. The pliers feature a metallic finish with a black and orange grip section near the handle. A close-up inset shows the serrated surface of the tip designed for gripping wires.  Clinical photo of Weingart Pliers. The image shows a dental instrument with long handles and two upper beaks designed for gripping tooth roots or bone fragments. A close-up inset on the right highlights the tip of the pliers, showing its serrated surface texture against a blue surgical drape background. Howe Pliers Weingart Pliers **Feeding or threading archwire into the buccal tube**   #### Instrumentation and Insertion - Howe Pliers - Weingart Pliers - Feeding or threading archwire into the buccal tube Close-up clinical photo of the tip of a Howe Plier. The jaws are visible with serrated surfaces designed for gripping. Close-up clinical photo of the tip of a Weingart Plier. The jaws feature a distinct slot or channel in the center, used for feeding archwires into buccal tubes. Alastiks used to secure the archwire onto the brackets. There are available in many colours.   Alastiks used to secure the archwire onto the brackets. There are available in many colours. Clinical photo showing gloved hands manipulating orthodontic brackets and an archwire in a patient's mouth. The image demonstrates the placement or adjustment of Alastiks (small elastic ligatures) to secure the wire onto the brackets. Photo displaying four different colored Alastik orthodontic tools arranged on a green textured surface. From left to right: a blue tool with 'Unitek' branding and a ring handle, a light pink tool with a ring handle, a dark blue rectangular strip labeled 'POWER', and a bright pink rectangular strip labeled 'POWER'. These are examples of the many colors available for securing archwires.  Clinical procedure image showing a dental archwire being tied into place with elastik ligatures. The assistant uses artery forceps to pass the blue-colored elastiks (small rings) through holes in the purple plastic retainer or bracket assembly. The caption indicates this is part of an orthodontic bonding process.  Clinical photo showing a close-up of an orthodontic procedure. A pair of gloved hands is manipulating dental instruments on upper front teeth fitted with brackets and an archwire. The image demonstrates the placement or adjustment of a self-ligating bracket system, as indicated by the visible bracket design and wire engagement. Distal end cutters used to cut archwires  Distal end cutters used to cut archwires Photo of a metallic dental instrument identified by OCR as 'Distal end cutters used to cut archwires'. The image shows two distinct metal cutting components against a white background.  Clinical photo of a metallic surgical instrument, likely an orthodontic or dental plier (such as a tooth separator or clamp), resting on a blue textured medical drape. The tool has two curved handles and serrated jaws at the top. A small engraved marking 'SM' is visible near the pivot joint. Distal end of arch wire is cut using distal end cutters  Distal end of arch wire is cut using distal end cutters Close-up clinical photo showing the distal end of an arch wire being cut by a pair of metal orthodontic distal end cutters. The tool has a black cylindrical handle and metallic jaws gripping the wire, with visible scratches on the surface. A caption below reads: 'Distal end of arch wire is cut using distal end cutters'.   Clinical photo showing a close-up of the upper dental arch with fixed orthodontic appliances in place. Visible are metal brackets bonded to teeth, an archwire running through them, and blue elastik ligatures securing the wire. A gloved hand holds a retractor tool to expose the teeth for examination. Clinical photo displaying the anterior view of the upper dentition fitted with fixed braces. The image shows ceramic or metal brackets on each tooth connected by a horizontal archwire secured with purple/blue elastic ligatures. Gloved fingers retract the lips to provide a clear view of the alignment and bonding setup. * Chair time- cost * Patient Comfort * Accuracy?   #### Considerations - Chair time- cost - Patient Comfort - Accuracy? Clinical photo showing a dental procedure involving the application of orthodontic brackets and wires to patient's teeth. A clear plastic appliance is being manipulated with metal tweezers. The image relates to the OCR context of 'Chair time- cost', 'Patient Comfort', and 'Accuracy?' Close-up clinical photo of an occlusal view of a dental stone model with fixed orthodontic brackets. Metal tweezers are adjusting or examining one of the brackets. This visual supports the evaluation of accuracy mentioned in the OCR text.  Close-up photograph of a hand performing a delicate procedure. The index and middle fingers hold a small metallic object (likely a bracket or base component) with tweezers. A black cylindrical tool is positioned against the object, possibly for adjustment or application. Below the image, the caption reads 'Cover bracket and base'.   Clinical photo of a dental study model showing the upper and lower dental arches with metal brackets bonded to each tooth. The upper arch displays rectangular metal brackets, while the lower arch shows similar bracket placement. This visual demonstrates orthodontic appliance setup on cast models. Clinical photo of another dental study model displaying both upper and lower arches with metallic braces attached to individual teeth. The image provides a clear view of bracket positioning and alignment across the dentition, useful for studying orthodontic treatment planning. **Adding a layer of flexible PVS**   **Adding a layer of flexible PVS** Small visual snippet showing a close-up of a dental material with a bright cyan arrow pointing to it. The text 'Bases' and 'Trimmed flat' appears nearby, indicating the step involves preparing bases before adding flexible PVS. Photo demonstrating the procedure titled 'Adding a layer of flexible PVS'. A hand holds a pink dental cast with teeth models while applying a blueish translucent substance (flexible PVS) using a brush or applicator tool.  Clinical procedure image showing a hand holding a dental cast (model) with metal attachments. A syringe is dispensing liquid onto the model, likely demonstrating an impression technique or application of a material to the dental arch.  Clinical procedure image showing dental models with clear aligners or orthodontic appliances. The top model displays the upper arch, and the bottom model shows the lower arch. A yellow callout box points to the upper appliance with text 'May trim with scalpel', indicating a procedural step for trimming excess material. Additional text below the image reads 'May trim with scalpel', reinforcing the instructional context.  Clinical photograph displaying two halves of a dental cast (likely maxillary or mandibular) separated to reveal the underlying pink stone impression material and the outer translucent blue acrylic border. The left half features a black star-shaped marker drawn on the surface, while the right half bears a handwritten symbol resembling 'S' or 'E'. This visual demonstrates the anatomical detail captured in the mold and serves as a physical record for prosthodontic study.  Clinical photo of a dental or orthodontic setup on a white table. The image includes a tray with metal instruments (forceps, tweezers, explorers), two plaster dental models (one marked 'LF' and another with green star markings), a clear aligner-like appliance, syringes, bottles of liquid, cotton cup, lighter, and an orange tool. A person in blue clothing is partially visible on the left. **Prophy**   **Prophy** Clinical photo showing a dental prophylaxis procedure in progress. Two dental professionals wearing blue scrubs and masks are attending to a patient lying in a dental chair. The scene includes dental instruments on a tray, a computer monitor, and other clinical equipment. Close-up clinical photograph of a dental prophy (prophylaxis) procedure. A gloved hand is holding a dental scaler or polishing instrument against the teeth while the tongue is visible nearby. This image demonstrates the actual cleaning process mentioned in the OCR text 'Prophy'.   Clinical photo of a dental procedure showing an open mouth with a clear cheek retractor in place. A gloved hand uses a purple-tipped instrument to apply or manipulate material on the lower anterior teeth, while another hand holds a blue cylindrical device near the lower lip area. Clinical photo of a dental procedure showing an open mouth with a clear cheek retractor. A gloved hand is manipulating white cotton rolls placed inside the patient’s mouth—one near the lower molars and one being positioned by metal forceps—likely for isolation during treatment. Etch Acid Etching, Rinsing, Air drying adding Bonding resin Isolate   #### Bonding Steps - Etch - Acid Etching, Rinsing, Air drying adding Bonding resin - Isolate Clinical photo showing intraoral view of teeth with blue etching gel applied to lower anterior teeth. A retractor is holding lips apart. Yellow label at bottom reads 'Etch'. Close-up photo of gloved hand holding a dental model or impression tray while applying bonding resin with a syringe-like applicator. Yellow label partially visible at bottom. Air dry Unfilled resin Cure front to back   #### Resin Application - Air dry - Unfilled resin - Cure front to back Clinical photo showing gloved hands holding a translucent dental splint with multiple brackets. A syringe labeled 'AS Space' is applying unfilled resin into the bracket slots. Yellow label at top reads 'Unfilled resin', demonstrating the initial step of filling brackets before curing. Clinical photo showing gloved hands holding the same translucent dental splint. One hand uses tweezers to manipulate or position the splint while another holds a packaged component (possibly a curing light or additional material). Yellow label at bottom right reads 'Air dry', indicating this step involves air drying after resin application but before final curing. Adhesive set and trays ready to remove   Adhesive set and trays ready to remove Clinical photo showing a patient's face with an orange protective shield covering the mouth area. The shield reveals teeth and oral cavity through its translucent material. A gloved hand is visible on the right side. Clinical photo of a patient's open mouth with clear plastic dental trays in place over upper and lower teeth. The caption 'Adhesive set and trays ready to remove' indicates this is part of a dental procedure where adhesive has been applied and is now set.   Clinical photo showing the application of a dental appliance or orthodontic device. A gloved hand is positioning a clear plastic tray over the patient's upper teeth while another hand holds a cheek retractor open. A large green arrow points toward the area being treated. Clinical photo demonstrating an intraoral procedure where a clear plastic appliance (likely a bite guard or splint) is being fitted onto the patient's upper arch. The lower arch shows metal braces. Gloved hands are adjusting the appliance into place.   Clinical photo showing an intraoral dental procedure. A gloved hand holds a transparent retractor to expose the patient's mouth. Two translucent silicone bite registration blocks are positioned in the upper and lower arches. A metal instrument with a serrated tip is being used on the lower block. Clinical photo showing the continuation of the dental procedure. The same setup is visible: transparent retractor, silicone bite registration blocks, and the metal instrument. Green arrow callouts point towards the area of intervention or specific components within the oral cavity.   Clinical photo showing the lower dental arch with fixed orthodontic brackets. A green arrow points to the left posterior buccal mucosa, highlighting a localized area of erythema or inflammation adjacent to the cheek. Procedure image demonstrating the application of a custom-made clear plastic orthodontic appliance (likely an aligner or bite block) over the lower teeth. A gloved hand is adjusting the appliance while a retractor holds the lips apart. The green arrow indicates the same region as in the top image, now covered by the appliance. Clear Plastic Aligners    Clear Plastic Aligners Clinical photo showing a patient's mouth with clear plastic aligners on the upper and lower teeth. A gloved hand uses a metal tool to adjust or inspect the aligner fit around the molars. The image demonstrates the application of Invisalign-style orthodontic treatment. Inset diagram with a large green arrow pointing diagonally down-right toward a magnified section of the tongue area from the main photo, highlighting anatomical detail for closer inspection. Inset diagram with a large green arrow pointing diagonally down-right toward another magnified section of the gumline/teeth area from the main photo, emphasizing alignment details near the molars.   Clinical photo of a clear, transparent dental aligner or orthodontic retainer designed to fit over a full arch of teeth. The device is shown against a white background. Photo of a medical diagnostic display screen mounted on a stand. The screen shows a digital 3D rendering of human teeth and jaw structure, likely for orthodontic planning or diagnosis. # Attachments   #### Attachments ClinCheck Pro software screenshot showing a digital dental model with Invisalign treatment planning. The diagram displays upper and lower teeth with red geometric shapes (attachments) placed on specific tooth surfaces for orthodontic force application. Green markers indicate alignment points or IPR (Interproximal Reduction) zones. Interface elements include toolbars for editing movements, occlusion checks, and arch design. A logo for 'Friedländer Ortodonsia en Exclusivo' appears at the bottom left. Clinical photograph of an Invisalign aligner fitted over a set of dentition models. The transparent plastic aligner is molded to cover the anterior teeth, with visible internal features such as pressure zones and attachment cutouts corresponding to the digital plan shown above. The gingival margin and tooth anatomy are clearly visible beneath the appliance. Intra and Extra-Oral Photography   Intra and Extra-Oral Photography Clinical intra-oral photograph showing the maxillary (upper) dental arch. The image displays the upper teeth in a frontal view with the palate visible centrally. The gingival tissues appear healthy and pink. Clinical intra-oral photograph showing the mandibular (lower) dental arch. The image captures the lower teeth from an anterior perspective with the tongue retracted to expose the lingual surfaces of the posterior teeth and floor of the mouth.    Clinical photo of two transparent plastic cheek retractors on a blue surgical drape, demonstrating their Y-shaped design with curved upper arms and lower stabilizing prongs for oral access during dental procedures. Clinical photo of two white custom-fitted bite blocks or occlusal splints on a blue surgical drape; the top block is rectangular with rounded corners, and the bottom one is elongated and contoured, likely used for mandibular repositioning in orthodontic or TMJ therapy. Intraoral clinical photo showing anterior teeth with significant crowding, rotation (especially lower central incisors), gingival inflammation, and possible early caries on lower right lateral incisor — typical presentation requiring orthodontic intervention.   Clinical intraoral photograph showing the maxillary occlusal view of the dental arch. The image displays the upper teeth in a U-shaped arrangement with visible molars, premolars, and anterior teeth. A clear plastic retractor is used to hold the lips away from the teeth for better visibility. Clinical intraoral photograph showing a lateral view of the dental arch. The image captures the alignment of the upper and lower teeth on one side of the mouth, highlighting the occlusion between the upper and lower molars and premolars. A black retractor is used to pull back the cheek for clearer visualization of the teeth and gums. Chair side assistance # Orthodontics in a Nutshell  Chair side assistance Clinical photo showing a dental procedure in progress. Two professionals wearing blue scrubs and masks are assisting a patient lying in a dental chair. The patient is receiving orthodontic treatment. A tray of dental instruments is visible on the table, along with other equipment like a monitor and suction device. The image demonstrates 'Chair side assistance' as indicated by the OCR text below. Nicola    Nicola Clinical intraoral photo showing anterior teeth with gingival inflammation and possible malocclusion. The image is part of a case study labeled 'Nicola'. Small cropped figure showing sunglasses over eyes, likely used as an anonymization mask for the patient's face in the clinical case study labeled 'Nicola'. Panoramic dental radiograph (orthopantomogram) of the maxilla and mandible, showing both dentitions with red arrows indicating bilateral regions of interest—possibly highlighting jawbone width or pathology. Labeled under 'Nicola'.  Lateral cephalometric radiograph of a human skull showing the profile view including the cranial vault, facial bones (maxilla and mandible), cervical spine, and dental structures. A red upward-pointing arrow is annotated on the image, pointing to the anterior neck region near the hyoid bone area.   Clinical photo of a patient's mouth with orthodontic braces on upper and lower teeth. A red arrow points to the lower left canine/premolar region, accompanied by text 'Advanced around to left', indicating tooth movement or position during treatment. Clinical photo of a patient's mouth with orthodontic braces on upper and lower teeth, showing dental alignment in progress. No annotations present; serves as a comparative view to the annotated image above.    Close-up clinical photo of oral mucosa with a red arrow indicating direction or location; labeled 'Advanced around to left'. Intraoral clinical photo showing lower dental arch with orthodontic appliances including brackets and wires; text label 'Voudouris, Woodside' above. Intraoral clinical photo of upper dental arch with fixed orthodontic appliances (brackets and wires); no additional labels visible.   Clinical intraoral photograph showing a patient’s upper and lower dental arches with fixed orthodontic appliances (brackets and wires). A transpalatal arch or similar intermaxillary appliance is visible connecting molars. The image demonstrates pre-treatment malocclusion with crowding and misalignment of teeth, serving as baseline documentation for orthodontic intervention. Lateral cephalometric radiograph (X-ray) of a human skull in profile view, displaying craniofacial skeletal structures including the mandible, maxilla, cervical spine, nasal cavity, and temporomandibular joint area. Visible dental roots and occlusal relationships are present. This radiograph provides critical diagnostic information on skeletal Class II or III relationships, airway space, and growth patterns relevant to orthodontic treatment planning — information not captured by clinical photos alone.    Lateral cephalometric radiograph of a human skull showing the maxilla, mandible, cervical spine, and dentition in profile view. Clinical intraoral photograph of the maxillary (upper) dental arch from an occlusal perspective, displaying teeth alignment and palatal anatomy. Clinical intraoral photograph of the mandibular (lower) dental arch from an occlusal perspective, showing tooth arrangement and lingual structures.    Clinical intraoral photograph showing a lateral view of the maxillary and mandibular dentition in occlusion. The image captures the alignment of teeth and gingival tissues from one side, likely for orthodontic or periodontal assessment. Frontal clinical intraoral photograph displaying the patient's dental arches in occlusion. Both upper and lower anterior teeth are visible with even spacing and proper alignment, set against healthy-looking pink gums. Lateral clinical intraoral photograph showing the posterior and anterior teeth in profile view. This angle provides insight into the bite relationship and tooth positioning on this side of the mouth.   Clinical photo: Lateral profile view of a patient's head and neck showing the side of the face, ear, nose, and chin. The image appears to be part of a medical or dental case study for assessing facial structure. Clinical photo: Frontal view of a patient's face showing the eyes (obscured by black shapes), nose, mouth with teeth visible, and hairline. This image complements the lateral view above to provide a comprehensive assessment of facial features. What makes you suspicious?     What makes you suspicious? Clinical photo of a young female patient with brown hair against a blue background. The eyes are obscured by blacked-out sunglasses to protect identity. Visible facial features include the nose, lips, chin, and neck. A small earring is visible in the left ear. Close-up cropped view of the upper face showing the eyes area completely covered by blacked-out sunglasses, revealing only the bridge of the nose and forehead skin. Close-up cropped view of the mid-face showing the mouth area partially covered by blacked-out sunglasses, revealing the lower nose, lips, and chin. Extreme close-up cropped view of the right eye area (patient's right) showing a single blacked-out lens covering the eye region, with surrounding skin texture visible. **14 yrs old**  **14 yrs old** Clinical photo of the oral cavity of a 14-year-old patient (as indicated by OCR text '14 yrs old' in cyan). The image shows multiple views: upper left corner displays gingival tissue; top right shows red inflamed gingiva; central view reveals anterior teeth with crowding and misalignment, including rotated incisors and visible spacing; lower portion includes additional dental structures. The images appear to be part of a case study or diagnostic documentation. The image contains text in cyan, which should be formatted as bold. The instructions say to use bold for text in a different colour. Here is the transcription with the cyan text formatted as bold:   The image contains text in cyan, which should be formatted as bold. The instructions say to use bold for text in a different colour. Here is the transcription with the cyan text formatted as bold: Clinical intraoral photograph of a 14-year-old patient's maxillary anterior dentition showing normal eruption guidance with teeth in proper alignment and position. The image includes cyan-colored text overlay '14 yrs old' for age reference. Panoramic radiograph (orthopantomogram) of a 14-year-old patient demonstrating ectopic canine tooth. The image shows abnormal positioning of the maxillary canine relative to adjacent teeth, indicating an eruption guidance anomaly. Includes diagnostic caption 'Eruption Guidance Ectopic canine' below the image. Ectopic Canines - Treatment - Early extraction of the deciduous canines  #### Treatment Options - Early extraction of the deciduous canines Clinical panoramic radiograph (OPG) demonstrating an ectopic canine. A red arrow points to the maxillary right lateral incisor area, indicating the displacement of the permanent canine tooth. The image serves as a diagnostic visual for the condition described in the text.     Medical diagram showing a vertical cross-section of an anatomical structure (possibly bone or soft tissue) with a green region labeled '3' at the top. A blue upward arrow is present along a red vertical line, indicating direction of movement or force. Medical diagram showing a different view of the same anatomical structure, again highlighting a green region labeled '3'. The shape appears more irregular and possibly represents a deformed or pathological state compared to the first panel. Small isolated blue upward arrow on white background, likely indicating directional flow or progression between stages in the sequence of diagrams. Medical diagram showing a yellow region labeled 'C', which may represent cartilage or another tissue type. This panel appears to be part of a comparative series, possibly illustrating a different stage or condition. C  C Vertical diagram labeled 'C' at the top. It shows a green shape with the number '3' inside, connected to a yellow shape below it via a red line and a blue arrow pointing upwards. The bottom part of the diagram contains another yellow shape with the letter 'C' inside. 3 C **80-90% prognosis** **60% and less prognosis**  3 C #### Prognosis Indicators - **80-90% prognosis** - **60% and less prognosis** Panoramic dental radiograph (X-ray) showing a mixed dentition stage with both primary and permanent teeth visible. The image displays the maxillary and mandibular arches, including developing permanent tooth buds in the posterior regions. Associated text indicates prognosis categories: '80-90% prognosis' and '60% and less prognosis', suggesting this radiograph is used to illustrate a specific clinical condition or treatment outcome related to these prognostic values.   Clinical facial photograph of a patient with the eyes redacted for privacy. The image demonstrates a significant anterior open bite and crowding in the upper arch. The patient is smiling, exposing the dental occlusion. Intraoral clinical photograph showing a severe anterior open bite. There is a distinct lack of vertical overlap between the maxillary and mandibular incisors. The teeth exhibit spacing and irregularity, characteristic of a developing skeletal or dental malocclusion. **Missing 12 and impaction 13 23** **Extraction 22 and canine substitution for the lateral incisors**   #### Clinical Findings and Plan - **Missing 12 and impaction 13 23** - **Extraction 22 and canine substitution for the lateral incisors** Panoramic dental radiograph showing maxillary and mandibular dentition. Visual findings include missing tooth 12 (maxillary right lateral incisor) and impacted teeth 13 (maxillary right canine) and 23 (mandibular left canine). The image also shows a restoration or crown on the central region of the mandible. Clinical photograph of the patient's face with black sunglasses covering the eyes. This photo is used to demonstrate the aesthetic outcome of the treatment plan described in the text below, likely showing the final alignment after extraction and substitution.  Clinical intraoral photograph showing a frontal view of the patient's dentition. The image displays an anterior open bite malocclusion where the upper and lower incisors do not overlap vertically. A red arrow is superimposed on the image pointing to the left mandibular canine region, indicating a specific area of interest or pathology. **13 23 reshaped by the general dentist to appear as 12 22**   **13 23 reshaped by the general dentist to appear as 12 22** Clinical intraoral photograph showing anterior teeth with red arrows pointing to specific dental features. The image demonstrates the context for the caption '13 23 reshaped by the general dentist to appear as 12 22'. Close-up cropped view of a patient's eyes and nose bridge, partially obscured by black sunglasses. This visual is included in the document layout but does not contain relevant clinical information or text. WHAT WOULD YOU DO? **Thumb sucking in utero**  WHAT WOULD YOU DO? **Thumb sucking in utero** Clinical close-up photo of a patient's anterior teeth and gingiva. The image shows the upper central incisors with visible wear or chipping on the incisal edges and mild discoloration. A black arrow points from the bottom right towards the left, indicating an area of interest near the gingival margin or tooth surface. The caption below reads 'Thumb sucking in utero', suggesting the image demonstrates dental changes associated with this habit. **2-3 Year Old**   **2-3 Year Old** Clinical or artistic illustration of a fetus in utero, showing detailed anatomical features including the head with visible vascular patterns, facial profile, arms bent at elbows, and legs curled inward. The image is framed within an oval boundary resembling an ultrasound view, likely used to demonstrate fetal development stages. Clinical photograph of a child’s mouth (likely 2–3 years old as per OCR context), showing mixed dentition with primary teeth erupting and some spacing between them. The gums appear healthy pink tissue; this visual demonstrates typical early childhood dental anatomy and eruption pattern. THUMBSUCKING 6 MONTHS AFTER CEASING CROSSBITE STILL PRESENT   THUMBSUCKING 6 MONTHS AFTER CEASING CROSSBITE STILL PRESENT Clinical photo of a child's anterior teeth showing a crossbite malocclusion. The upper incisors are positioned lingually (behind) the lower incisors. Photo of a child demonstrating thumb-sucking behavior with hand placed near the mouth; face partially obscured by sunglasses graphic. GRADUALLY REDUCED IN SIZE   GRADUALLY REDUCED IN SIZE Clinical photo showing a frontal view of a child's open mouth with an upper anterior crossbite. A metal wire appliance is visible on the upper arch, clasping the posterior teeth and engaging the incisors to correct the bite. Clinical photo showing a palatal (top-down) view of the same dental case. The image demonstrates the upper archwire appliance spanning the palate, with clasps extending back over the molars, illustrating the mechanism used to reduce the crossbite. A MORE AGGRESSIVE APPROACH!   A MORE AGGRESSIVE APPROACH! Clinical photo showing the upper dental arch with a metal orthodontic appliance (likely a rapid palatal expander or similar device) in place. The appliance spans from molar to molar and appears to be exerting force on the mid-palatal suture. Clinical photo showing the same upper dental arch after expansion. A U-shaped metal spring is visible between the central incisors, indicating active expansion of the maxillary arch. The caption 'A MORE AGGRESSIVE APPROACH!' suggests this image demonstrates a more intensive treatment method compared to the first panel.   Clinical photo of a dental cast (model) showing an expansion appliance. The image displays the maxillary arch with a metal wire mechanism attached to the posterior teeth (molars), featuring a central screw or hinge designed for expanding the dental arch. Clinical intraoral photograph showing the application of a rapid palatal expander on a patient's upper jaw. The device is visible between the teeth, with fingers holding the cheek aside to provide a clear view of the appliance in situ.   Clinical photograph of a transparent upper dental appliance (likely an orthodontic retainer or expander) fitted on a set of artificial teeth. The appliance includes metal clasps engaging the molars and a central acrylic structure with visible screw mechanism in the palate area. Photograph of a plaster dental cast (upper jaw model) with a metal wire framework appliance bonded to it. The appliance features bilateral vertical arms extending toward the molars and a horizontal connecting bar across the anterior region, likely representing a removable orthodontic device such as a Hawley retainer or similar functional appliance. <img>Quadruple Helix Appliance on maxillary casts with photos. Rapid maxillary expander, Quad Helix, and Slow expansion plate are shown on the labial, showing the modified quad helix.   #### Appliance Types - Rapid maxillary expander - Quad Helix - Slow expansion plate - Modified quad helix Clinical photo of a Rapid Maxillary Expander (RME) appliance mounted on maxillary dental casts. The image shows the acrylic base with metal components and screws for expansion mechanism. Clinical photo showing a patient wearing orthodontic appliances including braces and what appears to be a modified quad helix or slow expansion plate visible in the oral cavity. The patient is wearing sunglasses covering their eyes.   Clinical intraoral photograph showing the maxillary dental arch with fixed orthodontic brackets and a transpalatal arch (TPA) appliance. The TPA is a metal wire spanning the palate, anchored to molar bands on both sides. Lateral profile photograph of a patient wearing a headgear orthodontic appliance. The device includes a black elastic strap around the head and a vertical metal facebow connecting to an intraoral component near the mouth.  Clinical facial photograph of a male patient showing frontal view with prominent dental features including anterior crowding and diastema. The image is annotated with black sunglasses covering the eyes to protect identity. # OPEN BITE SURGERY   OPEN BITE SURGERY Clinical intraoral photograph showing a patient’s anterior dentition with an open bite malocclusion. The upper and lower incisors do not overlap vertically when the patient bites down; there is a visible vertical gap between them. Gingival tissues appear healthy. This image demonstrates the preoperative condition relevant to open bite surgery. Partial clinical photograph of a patient’s face, cropped to show only the eye region. Eyes are digitally blacked out for privacy. Likely accompanies the open bite photo as part of a before/after or case presentation series, though no surgical intervention is visible in this frame. ADULT OPEN BITE  ADULT OPEN BITE Lateral cephalometric diagram of a human skull showing an 'ADULT OPEN BITE' malocclusion. The image displays the maxilla and mandible with teeth; the posterior molars are in contact while the anterior incisors show a vertical gap (open bite). A green curved arrow indicates the direction of movement or correction.   Clinical profile photograph of a male patient showing the side view of the face. The eyes are redacted with a black overlay. The image appears to be part of a medical or surgical case study. Clinical frontal photograph of the same male patient smiling. The eyes are redacted with a black overlay. The image appears to be part of a medical or surgical case study. Pre-Surgical Orthodontics Align Uppers   #### Pre-Surgical Orthodontics Align Uppers Clinical intraoral photo of upper dental arch with fixed orthodontic braces. A red line and partial label 'ne' are overlaid in the top-left corner, likely indicating a measurement or reference point for pre-surgical alignment assessment. Clinical intraoral photo of anterior dentition showing fixed orthodontic appliances. Two blue arrows point to specific brackets on the upper left lateral incisor region, and one red arrow points to the lower central incisor area, highlighting areas of interest for pre-surgical orthodontic intervention under the heading 'Align Uppers'. Maintain **2 levels** Diverge **roots** for **Surgery** Align lowers and place anteriors in skeletal midline (extract 34) CM CM   #### Surgical Preparation - Maintain **2 levels** - Diverge **roots** for **Surgery** - Align lowers and place anteriors in skeletal midline (extract 34) CM CM Clinical intraoral photo showing teeth with orthodontic brackets and wires. An orange diagonal line is overlaid across the image, likely indicating a measurement or reference axis related to dental alignment. 3D rendered figure of a cartoon Viking warrior holding a sword, labeled 'CM' below. The figure appears to be part of a visual demonstration or educational material, possibly representing a character or concept in context with the text instructions above.  Lateral cephalometric radiograph of a human skull showing the craniofacial skeleton in profile. Visible structures include the cervical spine posteriorly, mandible and maxilla anteriorly, nasal cavity, and orbital region superiorly. The patient is identified as Mr Cameron Mclean, examined by Dr M Goonewardene on 24/10/95 (DOB: 18/01/63). Orthodontic appliances are visible on both upper and lower dental arches. This image is pertinent for assessing skeletal relationships, airway dimensions, and orthodontic treatment progress. CM-Post   CM-Post Clinical photo showing a lateral profile view of a male patient's face against a blue background. The subject has short dark hair and is wearing sunglasses (blacked out). This image serves as a facial profile assessment for orthodontic or surgical treatment planning. Clinical intraoral photograph labeled 'CM-Post' (likely indicating Centric Occlusion - Post-treatment). The image displays the anterior dentition with both upper and lower teeth in occlusion. Visible findings include mild crowding in the lower anterior region and yellowish staining on the tooth surfaces. **Aesthetics-Psychosocial Handicap**   **Aesthetics-Psychosocial Handicap** Schematic diagram illustrating dental overjet. It depicts two teeth with a double-headed arrow between them labeled 'Overjet', indicating the horizontal distance between the upper and lower front teeth. Clinical photograph of a person's face wearing sunglasses. The image is cropped to show the area around the eyes and nose, likely used as an example of psychosocial handicap or aesthetic concern related to appearance. # Physical Attractiveness * Considered to be more intelligent * More likely to be seen to make friends * More likely to be trusted. * Favoured by their teachers from a very young age and so on. It is unfair but true   #### Physical Attractiveness Individuals with higher physical attractiveness are: - Considered to be more intelligent - More likely to be seen to make friends - More likely to be trusted - Favoured by their teachers from a very young age It is unfair but true. Clinical photograph of a young patient's open mouth showing severe dental malocclusion. The image demonstrates significant crowding and misalignment of the anterior teeth, with the maxillary central incisors rotated outward and overlapping the mandibular incisors. This visual serves as a direct example of 'Physical Attractiveness' issues that can negatively impact social perception. A small cartoon illustration of a brown bear head with a blue pacifier. It is used to visually represent the concept of being 'favoured by their teachers from a very young age,' illustrating the idea of unfair bias based on appearance.    Clinical intraoral photograph showing the upper right quadrant of a patient's dentition. The image displays teeth with visible wear or discoloration and gingival tissue. A green text overlay reads '5%'. Green graphic elements are present in the corners. Clinical intraoral photograph showing the upper anterior region of a patient's mouth. The view focuses on the central incisors and canines with surrounding gum tissue. A green text overlay reads '9-10%'. Green graphic elements are present in the corners. Clinical intraoral photograph showing the maxillary anterior teeth from a frontal perspective. The image captures the upper central and lateral incisors along with the lip area. A green text overlay reads '16%'. Green graphic elements are present in the corners. 16% **9-10%** 5% Reduced risk with more ideal occlusion but risk still present ## Trauma Untreated Class II malocclusion has about a one in three chance of experiencing trauma to the maxillary incisors #### Risk Statistics - 16% - **9-10%** - 5% Reduced risk with more ideal occlusion but risk still present. #### Trauma Risk Factors Untreated Class II malocclusion has about a one in three chance of experiencing trauma to the maxillary incisors. Soft Tissue Trauma **Soft Tissue Trauma** Mandibular incisors impinging on the palatal soft tissue and/or maxillary incisors impinging on the facial soft tissues   #### Soft Tissue Trauma Mandibular incisors impinging on the palatal soft tissue and/or maxillary incisors impinging on the facial soft tissues. Clinical close-up photograph of a patient's anterior teeth demonstrating soft tissue trauma. The image shows the maxillary incisors positioned significantly forward (protruded) relative to the mandibular incisors. A visible fracture or chipping is present on the edge of a maxillary central incisor. The lower lip and chin area appear bruised and discolored, indicating injury caused by the impingement of the upper teeth. Schematic diagram illustrating dental overjet and its relationship to soft tissue trauma. It features two yellow cross-sectional representations of teeth: an upper tooth and a lower tooth. A horizontal blue double-headed arrow spans the gap between them, explicitly labeled 'Overjet'. This visual explains how excessive horizontal overlap causes the mandibular incisors to strike the palatal soft tissue and/or maxillary incisors to strike the facial soft tissues.    Schematic diagram illustrating the dental condition 'Overbite'. It shows two stylized teeth (one upper, one lower) with a vertical double-headed arrow indicating the vertical overlap between them. The word 'Overbite' is labeled next to the arrow. Clinical photograph of an open mouth showing a severe anterior overbite. The upper front teeth completely cover the lower front teeth when the jaw is closed. Clinical photograph of a close-up view of the mouth showing an anterior overbite. The upper incisors are positioned vertically over the lower incisors.    Clinical intraoral photograph showing a frontal view of the dentition with malocclusion. The image displays crowded upper and lower anterior teeth, open bite in the central incisors, and gingival inflammation. Schematic diagram illustrating different types of occlusion: Normal occlusion (upper left), Class I malocclusion (upper right), Class II malocclusion (lower left), and Class III malocclusion (lower right). Each panel shows stylized tooth outlines demonstrating the relative positioning of upper and lower dental arches. Set of clinical intraoral photographs demonstrating ideal occlusal function. Top row includes three views of dental alignment. Bottom row shows two labeled examples: 'Canine guidance' (left) and 'Group function' (right), each depicting specific jaw movement patterns during lateral excursions.     Composite diagram illustrating mandibular movement and occlusion. Top left: Lateral skull profile with a red arrow indicating the forward path of the mandible (protrusion) from rest to maximum excursion. Top right: Clinical photo showing the resulting edge-to-edge incisor relationship. Bottom panel: Schematic occlusal view of posterior teeth with a red arrow demonstrating lateral excursion (side-to-side movement), accompanied by a condylar displacement indicator. Clinical intraoral photograph showing an anterior view of the maxillary and mandibular dentition. The image demonstrates an edge-to-edge bite where the incisal edges of the upper and lower central incisors meet directly without vertical overlap. Clinical intraoral photograph displaying a slightly improved overbite compared to the previous image. The upper incisors overlap the lower incisors vertically, while the anterior teeth are aligned relatively straight. Clinical intraoral photograph showing a corrected bite alignment. There is a distinct vertical overlap between the upper and lower incisors, indicating a normal overbite has been established. More ideal occlusion – more ideal function of the dentition Little evidence to support the idea that crooked teeth are more susceptible to dental caries. Oral hygiene appears to be the important issue Tooth Decay - C-A-R-Y-E-S Periodontal Disease Some specific problems which have been shown to predispose people to periodontal breakdown Protrusive teeth (incompetent lips)  #### Occlusion and Oral Health - More ideal occlusion – more ideal function of the dentition. - Little evidence to support the idea that crooked teeth are more susceptible to dental caries. - Oral hygiene appears to be the important issue. #### Specific Conditions - Tooth Decay (Caries) - Periodontal Disease - Protrusive teeth (incompetent lips) Illustration showing a cartoon dentist brushing the teeth of an anthropomorphic tooth character. Contextual text indicates this relates to oral hygiene and its importance in preventing dental caries. Gingival inflammation Some specific problems which have been shown to predispose people to periodontal breakdown Teeth caught under lip-gingiva dries out  #### Periodontal Breakdown Factors - Gingival inflammation - Teeth caught under lip (gingiva dries out) Clinical photo of the upper dental arch showing gingival inflammation. A metal cheek retractor is visible on the left side holding the lips back to expose the teeth and gums. The gingiva appears erythematous (red) and swollen. A white arrow points specifically to the interdental papilla between the maxillary central incisors, highlighting the inflamed tissue. Periodontal Disease Some specific problems which have been show to predispose people to periodontal breakdown #### Periodontal Disease Some specific problems which have been shown to predispose people to periodontal breakdown. Isolated teeth in crossbite or trapped behind other teeth Periodontal Disease **It is tempting to consider that the crooked teeth may cause inflammation**  #### Periodontal Disease Considerations - Isolated teeth in crossbite or trapped behind other teeth. - **It is tempting to consider that the crooked teeth may cause inflammation.** Clinical photo showing an open mouth with visible teeth and gums. A white arrow points to a specific tooth in the upper arch, illustrating the concept of 'Isolated teeth in crossbite or trapped behind other teeth' as mentioned in the OCR context. NO! A Few Orthodontic Cases   NO! A Few Orthodontic Cases Clinical intraoral photo showing an upper anterior view of teeth with a cheek retractor in place. The image is marked with a large purple 'NO!' overlay on the right side, indicating this represents an undesirable or incorrect orthodontic presentation. Clinical intraoral photo showing an upper anterior view of teeth with a cheek retractor in place. The image is marked with a large purple 'D!' (likely part of 'DO!') overlay on the left side, indicating this represents a desirable or correct orthodontic presentation.     Clinical figure showing a patient's facial and dental features. Top row: three photos of the patient (frontal at rest, frontal smiling, profile) with eyes blacked out. Middle row: intraoral photos showing maxillary occlusal view, mandibular occlusal view, right lateral view, and left lateral view. Bottom row: close-up intraoral photos of anterior teeth showing alignment and gingival health. Close-up photo of the patient's face from the front, with eyes blacked out for privacy. Close-up photo of the patient's face from the front, with eyes blacked out for privacy. Close-up photo of the patient's face in profile, with eyes blacked out for privacy. _full-fixed appliances_  _full-fixed appliances_ Clinical photo collage titled 'Full-Fixed Appliances' showing five intraoral views of teeth with full-fixed orthodontic braces: top-left and top-right are occlusal views of upper and lower dental arches respectively; bottom row shows three frontal/lateral views demonstrating bracket placement on both upper and lower teeth.     Clinical photographic composite showing a patient's facial and dental features. Top row displays three headshots (frontal relaxed, frontal smiling, and profile) with eyes obscured by black masks. Middle row shows intraoral photos of the maxillary and mandibular arches from an occlusal view, revealing orthodontic brackets and wires. Bottom row presents close-up views of the anterior teeth in various angles to demonstrate alignment and gingival health. Close-up crop of the patient's face focusing on the nose and mouth area, with the eyes covered by a black mask for privacy. Close-up crop of the patient's face focusing on the nose and mouth area, with the eyes covered by a black mask for privacy. Small detail crop showing the lower portion of the patient's face, specifically the chin and mouth, with the upper eye area masked.   Composite clinical figure showing orthodontic case analysis. Top row features three photos of a female patient (frontal rest position dated 2/02/2017, smiling frontal, and lateral profile) with eyes obscured by black rectangles. The middle section contains the text 'Do You See Anything Wrong?' in yellow. Below this are six intraoral photographs arranged in two rows: top row shows maxillary occlusal view and mandibular occlusal view; bottom row shows left, right, and anterior frontal views of the dental arches, displaying mixed dentition. Close-up crop showing the upper portion of a patient's face, specifically focusing on the nose bridge and the area around the eyes which are covered by a solid black rectangular mask. <b>Do You See</b> <b>Anything</b> <b>Wrong?</b> Do You See Anything Wrong? <b>Does Something Look Abnormal?</b> <b>Surgical Periodontal Exposure of the Impacted Canines</b>  #### Clinical Assessment Do You See Anything Wrong? Does Something Look Abnormal? Panoramic dental radiograph showing the maxillary and mandibular arches. The image is presented in the context of 'Surgical Periodontal Exposure of the Impacted Canines', as indicated by the OCR text below the image. It displays the teeth, jawbones, and surrounding structures relevant to identifying impacted canines. #### Clinical Procedure Surgical Periodontal Exposure of the Impacted Canines 2 **Does Something Look Abnormal?** --- **Full-Fixed appliances and Intra-Oral Elastics**    2 Does Something Look Abnormal? Composite clinical photograph showing multiple intra-oral views of a patient's dentition: top row includes occlusal view of maxillary arch (top left) and mandibular arch (top right); bottom row includes two lateral views with red arrows pointing to specific teeth (likely indicating malocclusion or appliance placement), and one frontal view of the full dental arch. These images demonstrate diagnostic findings relevant to 'Does Something Look Abnormal?' in context of full-fixed appliances and intra-oral elastics. Close-up clinical photo of anterior teeth with a red diagonal line drawn across them, likely highlighting incisal edge alignment or an abnormality such as crowding or wear — relevant to diagnosis under ‘Full-Fixed appliances and Intra-Oral Elastics’. Another close-up clinical photo of anterior teeth with a red diagonal line drawn across them, possibly illustrating another angle or feature of the same malocclusion or appliance effect — complementary to the above image for comparative analysis. #### Orthodontic Mechanics Full-Fixed appliances and Intra-Oral Elastics 3  3 Clinical composite figure showing a patient's facial and dental features. Top row: three photos of the patient (frontal, angled frontal, profile) with eyes obscured by black sunglasses for privacy; a label 'Frontal' is visible under the left photo. Middle row: two intraoral images — one of the maxillary arch with red 'X' marks on the first premolars indicating sites of interest or pathology, and another of the mandibular arch showing a dark spot on a molar. Bottom row: three views of the dentition in occlusion — right lateral, frontal, and left lateral — revealing malocclusion, crowding, and spacing issues.   Clinical photo showing a pair of sunglasses covering the eyes of a person. The lenses are dark and opaque, obscuring the facial features below them. Close-up clinical photo of a single dark lens (likely a sunglass lens) against a skin-toned background, possibly part of a face or medical model.  Clinical photography panel showing a female patient's facial and intraoral condition. Top row displays frontal (resting and smiling) and profile views with eyes obscured by black bars; a label reads 'Frontal Rest - 11/16/2016'. Middle row shows maxillary occlusal view and mandibular occlusal view. Bottom row presents close-ups of the right posterior teeth, anterior bite, and left posterior teeth.  Clinical dental case study figure showing pre-treatment photos of a female patient: frontal and profile facial views with sunglasses; occlusal views of upper and lower arches; and intraoral lateral and frontal views of dentition.  Clinical profile photograph (labeled 'B' in red) of a patient's face against a blue background. The image shows the side view of the head and neck with dark hair. A black rectangular overlay obscures the eye region, likely for privacy or to highlight facial features such as the nose, lips, and jawline. How did we get from A to B A B   #### Treatment Progression How did we get from A to B A B Clinical photo labeled 'A' showing a side profile of a patient's face with dark hair and eyes obscured by a black rectangle. The image is set against a blue background. Clinical photo labeled 'B' showing the same side profile of the patient's face as in image A, but after an apparent procedure or treatment. The image is set against a blue background. Following Restorative Treatment **What is the Dental Problem?**  #### Post-Treatment Evaluation Following Restorative Treatment **What is the Dental Problem?** Clinical dental figure showing multiple intraoral views of teeth following restorative treatment. Top row includes occlusal views of upper and lower arches; middle row shows frontal view of anterior teeth and lateral views of right and left quadrants. The images demonstrate alignment and restoration outcomes across all visible teeth.  Clinical photography montage showing a patient's facial and dental features. Top row: three views of the face (frontal neutral, frontal smiling with caption 'Frontal Smile - 23/11/2015', and lateral profile), with eyes redacted for privacy. Middle and bottom rows: six intraoral photographs displaying occlusal views of upper and lower arches, and multiple anterior and posterior views of the dentition in occlusion. Bone Plates as Anchorage for Intrusion   Heading text 'Bone Plates as Anchorage for Intrusion' serves as the title for the collage of clinical photos below. Collage of five clinical photos demonstrating orthodontic treatment. Top row shows occlusal views of maxillary and mandibular arches with bone plates and brackets. Bottom row shows frontal and lateral intraoral views with red arrows indicating force direction or tooth movement related to intrusion using bone plate anchorage.     Clinical dental case study figure showing a patient's facial and intraoral views. Top row includes frontal (left), smiling (center), and lateral profile (right) photos with eyes obscured by black rectangles. Middle row displays occlusal views of the upper (left) and lower (right) dental arches. Bottom row shows frontal (center) and right (left/right flanking) occlusal views from the side. All images demonstrate tooth alignment and dental structure. Close-up photo of a person's nose with eyes obscured by a black rectangle. Likely part of a facial analysis or orthodontic case documentation set. Another close-up photo of a person's nose with eyes obscured by a black rectangle. Similar to the previous image, likely for comparative or diagnostic purposes in an orthodontic context. Small cropped photo showing a portion of a face with one eye area obscured by a black shape. Appears to be a fragment of a larger facial image used in clinical documentation. 7. Procedure: Soft tissue grafting (free gingival graft) was performed to address severe gum recession on the mandibular anterior teeth. Images: Facial photos showing pre-treatment and post-treatment results. Intraoral photos displaying the dental arches with noticeable gum recession, treated areas with improved gum coverage, and final aesthetic outcome.  Clinical photo grid showing pre- and post-treatment results of a soft tissue grafting (free gingival graft) procedure on mandibular anterior teeth. Top row: three facial views (frontal, smiling frontal, profile) with eyes redacted for privacy, demonstrating overall facial aesthetic improvement. Middle row: two intraoral occlusal views of maxillary and mandibular dental arches, revealing improved gum coverage and reduced recession. Bottom row: three intraoral frontal/angled views of the treated area, displaying healthy pink gingiva, proper tooth alignment, and successful integration of the graft. Bone Plates as Anchorage to Retract Entire Dental Arch  Composite clinical figure showing dental arches with orthodontic braces and bone plates used as anchorage. Top panels display upper and lower dental arches from occlusal view with brackets and wires in place. Bottom panels show frontal intraoral views of maxillary and mandibular arches with red arrows indicating direction of retraction force applied to the entire dental arch using bone plate anchorage system. How do we resolve Severe Skeletal Malocclusions?  Clinical photograph showing a lateral profile view of a patient's face against a solid blue background. The image captures the head and neck region from the ear to the chin. A black digital mask obscures the eye area for privacy. Visible features include brown hair, an ear, the nasal bridge, lips, and jawline. The visual serves as a baseline reference for facial structure assessment.  Clinical profile photograph of a patient showing lateral facial features. The image captures the head and neck region from the side view, revealing hair tied back, ear anatomy, and soft tissue contours of the face. Two blacked-out regions obscure the eye area and another small section below, likely for privacy or redaction purposes. The patient is wearing a light pink collared garment.   Clinical photo showing the neck and upper chest region of a person. The individual is wearing a pink collared shirt under a patterned reddish-orange garment. A small metallic object (possibly a button or part of an accessory) is visible at the center of the collar. The image appears to be focused on demonstrating anatomical features or clothing details relevant for study purposes. Small cropped photo showing a portion of a dark-colored bowl-like object with a smooth surface, placed against a light background. The context suggests it may be related to food preparation or serving, but lacks additional visual or textual information for full interpretation.  Clinical or portrait photograph of a young person with dark curly hair tied up and wearing sunglasses (blacked out), a pink collared shirt under a textured reddish-pink cardigan. The image appears to be taken indoors against a plain light-colored wall. No visible text or labels are present.   Clinical profile photograph of a patient showing the side view of the head and neck. The image highlights facial features including the nose, lips, chin, and ear. A black privacy mask obscures the eye region. Close-up crop focusing on the nasal and perioral region from the main clinical photo, with the eye area masked for privacy.    Clinical or portrait photograph of a young female subject with dark hair pulled back, wearing a reddish-brown top and small earrings. Her eyes are obscured by black sunglasses-style masks. The image appears to be part of a medical or anthropometric study, possibly for facial feature analysis or anonymization. Close-up cropped view showing the left eye area of the subject, partially covered by a black mask representing an eyeglass lens or occlusion. This is likely a detail crop from the main photo used for localized analysis or annotation. Close-up cropped view showing both eyes of the subject, fully obscured by black masks shaped like sunglasses lenses. This panel emphasizes bilateral occlusion and may serve as a comparative or annotated region for visual data extraction. <img>A clinical side-profile photo of a young woman with teeth and eyes obscured, wearing sunglasses, a red top, and hair tied back.  Clinical side-profile photo of a young woman with teeth and eyes obscured, wearing sunglasses, a red top, and hair tied back.  Clinical profile photograph of a young patient showing facial features. The image includes two small cropped thumbnails at the bottom left, likely for comparison or detail emphasis. **Mandibular Distraction**  Clinical photo set titled 'Mandibular Distraction' showing a patient's facial profile (frontal and lateral views with eyes obscured) and intraoral views of dental arches. **Distractors and RME**  Clinical photo of a patient's face showing facial features and two distinct skin lesions on the neck. The eyes are obscured with black bars for privacy. Distractors and RME    Clinical profile photo of a patient with orthodontic appliances. The image shows a side view of the face with white elastics (interarch rubber bands) attached to brackets on the upper and lower molars. A small white object is visible at the chin area. This visual demonstrates the use of 'Distractors and RME' (Rapid Maxillary Expansion) as indicated by the OCR context. Close-up crop showing a single black shape representing an eyewear lens or occlusion mask against a skin-toned background. This appears to be a detail from the main clinical photo. Close-up crop showing a pair of black sunglasses covering the eye region of a face. This is another detail extracted from the main clinical photo.  Clinical radiograph of the mandible showing bilateral sagittal split osteotomy (BSSO) fixation. Two large titanium plates with multiple screws are visible on both sides of the mandibular rami, indicating surgical intervention for jaw realignment or fracture repair.  Lateral cephalometric radiograph of the skull showing skeletal anatomy including mandible, maxilla, cervical spine, and cranial vault. Metallic dental implants or orthodontic hardware are visible in the anterior mandible region, appearing as bright linear structures with screw-like features.  Clinical profile photograph of a child's head and neck against a blue background. The image displays the right lateral view of the face, including the ear, nose, lips, and chin. A black rectangular redaction mask covers the eye region. This visual is pertinent for assessing craniofacial anatomy or orthodontic evaluation.    Clinical profile photograph of a patient's head and neck from the left side. The subject has blonde hair pulled back. A black censor bar is applied over the eye region to anonymize the patient. Visible anatomical features include the ear, mandible, and cervical spine area against a solid blue background. Small cropped inset image showing a close-up view of an eye region with a black censor overlay. This appears to be a detail crop or alternative view from the main clinical photo. Small cropped inset image showing a close-up view of an eye region with a black censor overlay. Similar to the previous inset, this serves as a detailed visual component of the study documentation.  Clinical photographic composite of a patient's facial and intraoral features. Top row shows three views: frontal neutral expression, frontal smiling with visible teeth, and lateral profile view (all with eyes obscured by black bars). Middle row displays occlusal views of the maxillary and mandibular arches showing dental alignment and crowding. Bottom row presents anterior intraoral views from left, frontal, and right angles, revealing significant overjet, midline shift, and malocclusion.  Clinical intraoral photograph showing the anterior dentition. The image reveals a significant diastema (gap) between the maxillary central incisors and an irregular spacing in the upper arch. There is visible gingival inflammation with erythema and edema of the marginal and interdental gums, particularly around the central incisors. One of the maxillary central incisors exhibits brown discoloration on the incisal edge and proximal surface, suggestive of caries or external staining. The lower anterior teeth appear relatively aligned compared to the upper arch.  Portrait photo of a young person with dark hair pulled back, wearing a light-colored collared shirt. The eyes are obscured by black sunglasses. The image appears to be a personal photograph or ID-style picture.    Clinical profile photograph of a patient's head and neck showing facial features from the side view. The image includes blacked-out regions over the eye area and mouth, likely for privacy or redaction purposes. Close-up cropped region focusing on the upper face area with blacked-out eyes, possibly highlighting orbital or periorbital anatomy in context of the main clinical photo. Additional close-up cropped region showing lower facial structure with blacked-out mouth area, continuing the focus on specific anatomical regions from the main clinical photo.  Clinical photograph showing a patient in profile undergoing orthodontic treatment with a headgear appliance. The device includes a pink horizontal bar secured to the head and a vertical post extending downward to an attachment on the upper dental arch. The image captures the functional application of the orthopedic appliance for jaw correction.  Clinical photo showing a patient with an extraoral orthodontic appliance (likely a facemask or headgear) fitted. The device includes a purple horizontal bar across the forehead and a vertical component attached to the nose area, likely for anchorage or force application. The patient is wearing sunglasses over their eyes.     Clinical photograph of a patient's face with a cephalometric headgear (Hawley-type) in place, featuring metal rods and pink acrylic components. The eyes are obscured by blacked-out sunglasses for privacy. Close-up crop showing the upper portion of the face, specifically the forehead and nose bridge area, partially covered by blacked-out sunglasses. Close-up crop showing the mid-face region, including the nose tip and mouth area, partially obscured by blacked-out sunglasses. Extreme close-up crop focusing on the left eye area, heavily obscured by the blacked-out sunglasses.  Clinical profile photograph of a patient's head and neck in lateral view. The image shows the side profile with dark hair pulled back, revealing the ear and jawline. A black redaction mask covers the eye area. The patient is wearing a light-colored collared shirt against a plain background. This appears to be part of a medical case study or diagnostic documentation. Thank You!    Clinical photo of a patient with a headframe device attached to the skull for orthodontic or surgical treatment. The frame includes horizontal and vertical components secured around the head. A blacked-out region covers the eyes, likely for privacy. Close-up view of a blacked-out region covering the eyes, possibly part of a larger figure or separate annotation for privacy. Another close-up view of a blacked-out region, potentially another part of the same figure or additional annotation for privacy. At the end of this course you **DO NOT** have the didactic knowledge or clinical skills to treat **comprehensive orthodontic cases**. 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