Reverse Orthodontics (KU)

Introduction
Of several treatment modalities to treat severe skeletal malposition (malocclusion), orthodontic camouflage and orthognathic surgery are most commonly used modalities. Before we actually plan for orthognathic surgery in correcting skeletal mal relation, dental malocclusion is treated first, referred to as pre-surgical orthodontics.


Compensation is a natural phenomena of developmental adjustment towards working in balance and maintaining homeostasis. This has been defined as," process or mechanism by which development of dental and alveolar arches are controlled so as to secure occlusion of teeth and adaptation to basal parts of the jaw." - Bjork

Examples:

  • In cases of skeletal class II, to compensate for the skeletal discrepancies the upper incisors are retroclined and lower incisors are proclined. 
  • In cases of skeletal class III, lower incisors are retroclined and upper incisors are proclined. 
  • In skeletal open bite cases, posteriors dentoalveolar segments (both maxilla and mandible) intrude whereas anterior dentoalveolar segment extrude.  
  • In Skeletal deep bite, posterior extrude and anterior intrude

These are natural phenomena that has to be decompensated before orthognathic surgery is planned. 
Reverse orthodontics is a pre-surgical orthodontics that aims to decompensate the natural phenomena of compensation in malocclusion and in doing so, the malocclusion gets worse for a period of time. Although, final objective of this treatment is to correct the malocclusion, the state worsen temporarily, thus called Reverse orthodontics.

Rationale:
  • to position the teeth in almost ideal axial inclination to basal bone
  • to optimize the magnitude of surgical advancement or repositioning.
  • better esthetic, stability and function.
  • to limit the hindrance caused by teeth during surgical repositioning. 

In reverse orthodontics,
In case of skeletal class II, Class III elastics are used that will upright the maxillary incisors and extrude the mandibular molars. Since, class III elastics are placed in mandibular canines and maxillary molars which will worsen class II condition temporarily.

Similarly, In class III cases, class II elastics are used such that elastics are extended from upper canine to lower molars. This results in uprighting of lower incisors but advance maxillar molars to further worsen class III.


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