Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and future

Jeffrey P. Okeson
Lexington, Ky

Am J Orthod Dentofacial Orthopaedics 2015

Presented by Isha Singh

DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS

 CONTENTS

1. INTRODUCTION
2.HISTORY OF OCCLUSION AND TMD IN ORTHODONTICS
3.ROLE OF ORTHODONTIC THERAPY IN TMD
4.TMDS
5.CURRENT FUNCTIONAL TREATMENT GOALS FOR ORTHODONTIC THERAPY
6. FUTURE CONSIDERATION OF OCCLUSION FOR ORTHODONTISTS
7.CONCLUSION
8.REFERENCES
 INTRODUCTION

Occlusion has been an important consideration in orthodontics.

Orthopedic stability in the masticatory structures should be a treatment goal to

help reduce risk factors associated with developing temporomandibular

disorders.

Change of occlusal conditions will influence masticatory functions during

orthodontic therapy.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
future
Jeffrey P. Okeson
 HISTORY
Joseph Fox , 1803, first to classify malocclusion.
1st book on malocclusion by Kneisel in 1836.
Gilford coined the term malocclusion.
In 1890, Dr. E.H. Angle gave concept of occlusion in orthodontics.

History of Orthodontics by Andrews I

 HISTORY OF OCCLUSION AND TMD IN
ORTHODONTICS

The history of orthodontics must begin with the work of Dr Edward Angle,
considered the father of this specialty.
He divided the occlusion into 3 types:
normal, or Angle Class I;
a retrognathic jaw, or Angle Class II; and
a prognathic jaw, or Angle Class III.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
CONCEPT OF OCCLUSION
The key to occlusion is the relative position of
the first molars.
In normal occlusion the mesio-buccal cusp of
the upper first molar is received in the sulcus
between the mesial and distal buccal cusps of
the lower.

Classification of Malocclusion. [Volume: 41, Issue: 3, March, 1899, pp. 248-

264]
LINE OF OCCLUSION
When the teeth are in normal occlusion the line of
greatest occlusal contact.
The mesial and distal inclined planes of the buccal
cusps of the molars and bicuspids.
The cutting-edges of the cuspids and incisors of
the lower arch.

Classification of Malocclusion. [Volume: 41, Issue: 3, March, 1899, pp. 248-

264]
CLASSIFICATION OF MALOCCLUSION

CLASS 1:
Relative position of the dental arches,
mesiodistally, normal, with first molars usually in
normal occlusion,
although one or more may be in lingual or buccal
occlusion.

Classification of Malocclusion. [Volume: 41, Issue: 3, March, 1899, pp. 248-

264]
 CLASSIFICATION OF
MALOCCLUSION
CLASS 2:
Relative mesio-distal relations of the dental arches
abnormal; all the lower teeth occluding distal to
normal.

Classification of Malocclusion. [Volume: 41, Issue: 3, March, 1899, pp. 248-

264]
 CLASS 2 MALOCCLUSION
1. The mesiobuccal cusp of the mandibular first molar
occludes in the central fossa area of the maxillary
first molar.
2. The mesiobuccal cusp of the mandibular first molar
is aligned with the buccal groove of the maxillary first
molar.

Classification of Malocclusion. [Volume: 41, Issue: 3, March, 1899, pp. 248-

264]
 CLASS 2 MALOCCLUSION

3. The distolingual cusp of the maxillary first molar

occludes in the central fossa area of the mandibular
first molar.

Classification of Malocclusion. [Volume: 41, Issue: 3, March, 1899, pp. 248-

264]
 CLASS 2 DIVISION 1 MALOCCLUSION

The first division is characterized by

a narrowing of the upper arch,

lengthened and protruding upper incisors,

accompanied by abnormal function of the

lips and nasal obstruction

and mouth-breathing.

Classification of Malocclusion. [Volume: 41, Issue: 3, March, 1899, pp. 248-

264]
 CLASS 2 DIVISION 2
MALOCCLUSION
The second division is characterized by
less narrowing of the upper arch,
lingual inclination of the upper incisors, and
associated with normal nasal and lip function.

Classification of Malocclusion. [Volume: 41, Issue: 3, March, 1899, pp. 248-

264]
CLASS 3 MALOCCLUSION

1. The distobuccal cusp of the mandibular first

molar is situated in the embrasure between the
maxillary second premolar and first molar.

Classification of Malocclusion. [Volume: 41, Issue: 3, March, 1899, pp. 248-

264]
 CLASS 3 MALOCCLUSION

2. The mesiobuccal cusp of the maxillary first molar

is situated over the embrasure between the
mandibular first and second molar.
3. The mesiolingual cusp of the maxillary first molar
is situated in the mesial pit of the mandibular
second molar.

Classification of Malocclusion. [Volume: 41, Issue: 3, March, 1899, pp. 248-

264]
CLASS 3 SUBDIVISION

This class also has one subdivision.

One of the lateral halves only is in mesial
occlusion.
The other lateral half being normal.

Classification of Malocclusion. [Volume: 41, Issue: 3, March, 1899, pp. 248-

264]
 ANDREWS 6 KEYS TO NORMAL OCCLUSION

• Andrews' Six Keys (1972) to normal (or optimal) are a widely quoted
set of static occlusal goals for tooth relationships in the intercuspal
position:
1. Correct interarch relationships
2. Correct crown angulation (tip)
3. Correct crown inclination (torque)
4. No rotations
5. Tight contact points
6. Flat curve of Spee (0.0 - 2.5 mm)
7. Correct tooth size (Bennett & McLaughlin, 1993)

The Six Keys to Normal

Occlusion
Nasir Alhamian
 Key 1 - Interach Relationships
- The distal surface of the distal marginal ridge of the upper first permanent molar contacts
and occludes with the mesial surface of the mesial marginal ridge of the lower second molar.

The Six Keys to Normal

Occlusion
Nasir Alhamian
 Key 1 - Interach Relationships

The mesio-buccal cusp of the upper first permanent molar falls within the
groove between the mesial and middle cusps of the lower first
permanent molar.
The mesio-lingual cusp of the upper first molar seats in the central fossa
of the lower first.

The Six Keys to Normal

Occlusion
Nasir Alhamian
Key 1 - Interach Relationships
The premolars enjoy a cusp-embrasure relationship buccally, and a cusp
fossa relationship lingually.

The Six Keys to Normal

Occlusion
Nasir Alhamian
Key 1 - Interach Relationships
- Maxillary Canine has a cusp-embrasure relationship with Mandibular
Canine & 1st Premolar. The cusp tip is slightly mesial to embrasure
Maxillary Incisors overlap Mandibular Incisors & midlines of arches match.

The Six Keys to Normal

Occlusion
Nasir Alhamian
Key 2 - Crown Angulation Relation
Crown angulation (tip) Facial axis of the clinical crown (FACC) Best viewed
from the labial or buccal perspective.
For all teeth except molars, is located at the mid developmental ridge
that runs vertically and is the most prominent portion in the central area
of the labial or buccal surface.

The Six Keys to Normal

Occlusion
Nasir Alhamian
Key 2 - Crown Angulation Relation
Crown Angulation or Crown tip. The degree of crown tip is the angle formed by
the FACC and a line perpendicular to the occlusal plane.
A "+ reading" when the gingival portion of the FACC is distal to the incisal
portion.
A "- reading" when the gingival portion of the FACC is mesial to the incisal
portion.

The Six Keys to Normal

Occlusion
Nasir Alhamian
Key 3 - Crown Inclination Relation
Crown inclination angle formed by a line which bears 90°to the occlusal
plane and FACC (as viewed from the mesial or distal).
A + reading is given if the gingival portion of the tangent line is lingual to
the incisal portion.
A - reading is recorded when the gingival portion of the tangent line is
labial to the incisal portion.

The Six Keys to Normal

Occlusion
Nasir Alhamian
Key 4 - No Rotation
• Teeth should be free of undesirable rotations. Rotated molar, would
occupy more space than normal, creating a situation unreceptive to normal
occlusion.

The Six Keys to Normal

Occlusion
Nasir Alhamian
Key 5 - Tight Contacts

• Contact points should be tight contacts (no spaces).

The Six Keys to Normal

Occlusion
Nasir Alhamian
Key 6 -Flat Curve of Spee
• Occlusal plane (curve of spee), depth of curve of Spee ranges from flat
plane to slight concave surface (0- 2.5 mm).

The Six Keys to Normal

Occlusion
Nasir Alhamian
Key 7 - Correct tooth size (Bennett & McLaughlin,
1993)
Correct tooth size Bennett & McLaughlin.
If Andrews' non orthodontic models have shown tooth size discrepancy, it
would have resulted in either spacing or crowding in either of arches,
until compensated by tip & torque in anterior segment Prior to treatment
by Bolton analysis.

The Six Keys to Normal

Occlusion
Nasir Alhamian
 HISTORY OF OCCLUSION AND TMD IN
ORTHODONTICS

Role of joint position in jaw function ?

Dr. Ronald Roth began to write a series of article in the orthodontic literature
suggesting importance of joint positions in orthodontic therapy.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
future
 ROLE OF ORTHODONTIC
THERAPY IN TMD

A thorough review of the literature shows that there are at least 5 major
etiologic factors that can be associated with TMD:
occlusion
trauma
emotional stress
deep pain input and
parafunction.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
 ROLE OF ORTHODONTIC
THERAPY IN TMD

There were claims of orthodontic therapy's always causing TMD.

But the data did not suggest that orthodontic therapy was a significant risk
factor for the development of symptoms of TMD.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
future
 ROLE OF ORTHODONTIC THERAPY
IN TMD

Perhaps poorly completed orthodontic therapies do reveal risk factors for

TMD.

Another consideration patients receiving the orthodontic therapy were

young, healthy, and adaptive.

Providing orthodontic therapy in a developing masticatory system may

help patients to adapt to the occlusal changes and joint positions.

Evolution of occlusion and temporomandibular The Importance of the Diagnostic Setup in the
disorder in orthodontics: Past, present, and Orthodontic Treatment Plan By Claudia Trindade
future
 ROLE OF ORTHODONTIC
THERAPY IN TMD
The concept of patient adaptability is an important issue.
Variation in genetic makeup appeared to have different pain perception.
Role of the enzyme Catechol-O-m-transferase in pain perception.
Role of pain sensitive haplotype.

Evolution of occlusion and temporomandibular Are catechol-O-methyltransferase gene

disorder in orthodontics: Past, present, and polymorphisms genetic markers for pain
future sensitivity after all? - A review and metaanalysis Annabel Vetterlein
 ROLE OF ORTHODONTIC
THERAPY IN TMD
Orthodontic therapy can be used to minimise any risk factors relating to TMD.
Since occlusal factors may be a cause for TMD.
Developing an occlusal relationship can minimise risk of TMD.

Fig. Mandible shift accompanied by

a lower
midline deviation to right side
secondary to joint effusion on the
opposite
temporomandibular joint.

Evolution of occlusion and temporomandibular Occlusal changes secondary to temporomandibular joint conditions: a critical
disorder in orthodontics: Past, present, and review and
future implications for clinical practice Waleska CALDAS
Jeffrey P. Okeson
 Temporomandibular
joint disorders
OKESONS’S Other classifications
CLASSIFICATION
 1. Bont’s classification
2. Peterson classification
3. Dworkin and Leresche
classification
4. Bells’s classification

Jeffrey P. Okeson; Management of temporomandibular Joint Disorders and

CURRENT FUNCTIONAL TREATMENT GOALS FOR
ORTHODONTIC THERAPY

The most orthopedically stable joint position as dictated by the muscles

is where the condyles are located in their most superoanterior positions
in the articular fossae, resting against the posterior slopes of the
articular eminences.
The definition of the most orthopedically stable joint position is when the
condyles are in their most superoanterior positions in the articular
fossae, resting against the posterior slopes of the articular eminences,
with the articular discs properly interposed.-GPT 2023 10th edition.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
future
 CURRENT FUNCTIONAL TREATMENT GOALS FOR
ORTHODONTIC THERAPY
The major muscles that stabilize temporomandibular joints are the elevators:
temporalis, masseter, and medial pterygoid muscles.
These three muscles are primarily responsible for joint position and stability.

• Fig.Posterior force to the mandible can displace the condyle from the
musculoskeletally stable position.
• Fig.Forward movement of the mandible brings the condyles down the articular
Evolution of occlusion and temporomandibular
eminences.
disorder in orthodontics: Past, present, and
 CURRENT FUNCTIONAL TREATMENT GOALS FOR
ORTHODONTIC THERAPY
The purpose of the articular disc is to separate, protect and stabilise the
condyle in mandibular fossa during functional movements.
Positional stability is determined by the muscle pull across the joint which
prevent separation of the articular surfaces.

Fig.The directional force of the primary elevator muscles

(temporalis, masseter, and medial pterygoid) is to seat
the condyles
in the fossae in a superoanterior position.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
future
Jeffrey P. Okeson
 CURRENT FUNCTIONAL TREATMENT GOALS FOR
ORTHODONTIC THERAPY
Developing an orthopedically stable occlusal condition can minimise risk
factors of TMD.
Stable masticatory system includes stable occlusal position in harmony with
stable joint.
In establishing an orthopedically stable occlusal condition the anatomic
structures of TMJ should be closely examined.

Evolution of occlusion and temporomandibular Fig.the most superoanterior position of the condyle
disorder in orthodontics: Past, present, and
future (solid line)
 CURRENT FUNCTIONAL TREATMENT GOALS FOR
ORTHODONTIC THERAPY

Fig The directional forces applied to the

condyles
(upper thick arrow) by the temporal
muscles .
The directional forces applied to the
condyles
by the masseter and the medial
pterygoid muscles
(lower thick arrow) are to seat the
condyles in a
superior anterior position
in the fossae (thin arrow).
Evolution of occlusion and temporomandibular
disorder in orthodontics: Past, present, and
future
 CURRENT FUNCTIONAL TREATMENT GOALS FOR
ORTHODONTIC THERAPY

An easy and effective method of locating the musculoskeletally stable position is

the bilateral manual manipulation technique.

Fig.A.the patient in reclined position and directing the chin upward.

B. 4 fingers of each hand are placed along the lower borders of the
mandible.
C, The thumbs meet over the symphysis of the chin.
D and E, Downward force is applied to the chin, while
superior force is applied to the angle of the mandible.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
future
CURRENT FUNCTIONAL TREATMENT GOALS FOR
ORTHODONTIC THERAPY
Locating the musculoskeletally stable position begins with the anterior
teeth no more than 10 mm apart.
The mandible is positioned with a gentle arcing until it freely rotates.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
 Most orthopaedically stable position

The occlusal contact pattern influences stability of the masticatory system.

Teeth should occlude in maximum intercuspation.

• Fig. The amount of force that can be generated between the teeth depends on the
distance from the temporomandibular joint and the muscle force vectors.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
 Summary of the conditions that provide maximum
orthopaedic stability in the masticatory system.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
future
Jeffrey P. Okeson
 Optimum occlusal
condition

• Fig.A When only right side occlusal contacts are present, activity of the elevator
muscles tends to pivot the mandible using the tooth contacts as a fulcrum.

• Fig. B With bilateral occlusal contacts, mandibular stability is achieved at the same
time there is condylar stability.

• Fig. C Bilateral occlusal contacts continue to maintain

mandibular stability.
Evolution of occlusion and temporomandibular
disorder in orthodontics: Past, present, and
future
Jeffrey P. Okeson
 FUNCTIONAL OCCLUSION AND
TMD IN ORTHODONTICS

4-7 According to Roth, orthodontic treatment goals can be divided into 5

categories: facial esthetics, dental esthetics, functional occlusion,
periodontal health, and stability.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
future
 ROTH CONCEPT OF SELECTION OF TREATMENT
MECHANICS

• Mounted models for tooth positions

During treatment and at the end of appliance therapy.
Functional occlusion
Thorough diagnosis -Establishing treatment goals-Dynamic treatment
planning

Temporomandibular Pain-Dysfunction and Occlusal Relationships RoNALD H. RoTH,

D.D.S., M.S
 Roth treatment goals

1. Facial aesthetics -
* It allows us to determine the position of the
maxilla,
mandible and chin, as well as the position and
angulation of maxillary and mandibular teeth, and
the orthodontic procedures to achieve the desired
results.

Temporomandibular Pain-Dysfunction and Occlusal Relationships RoNALD H. RoTH,

D.D.S., M.S
Roth treatment goals

2. Dental esthetics-
The teeth should be perfectly aligned, free of rotations,
spacing or crowding thus providing the patient with a
healthy, esthetic smile.

Temporomandibular Pain-Dysfunction and Occlusal Relationships RoNALD H. RoTH,

 Roth treatment goals

* Roth's criteria for a functional occlusion are as follows:

1. Teeth in maximum intercuspation.
2. On closure into occlusion, the stress on the posterior teeth
should be directed down the long axis of the posterior teeth.
3. Adequate overbite and overjet .

Temporomandibular Pain-Dysfunction and Occlusal Relationships RoNALD H. RoTH,

 CURRENT CONSIDERATION OF
OCCLUSION FOR ORTHODONTISTS
T scan

Use of T-Scan IIl in analyzing occlusal changes in molar fixed denture

placment Hi chen
 CURRENT CONSIDERATION OF OCCLUSION
FOR ORTHODONTISTS

Completely Adjustable Virtual Articulator :

• It records /reproduces exact movement paths of the mandible using an
electronic jaw registration system called Jaw motion analyser (JMA).

The Role of Virtual Articulator in Prosthetic and Restorative

Dentistry
Pavankumar Ravi Koralakunte 1,*, Mohammad Aljanakh 2
 FUTURE CONSIDERATION OF OCCLUSION FOR
ORTHODONTISTS

The static relationship is concerned from aesthetic and tooth contact

perspective.
Orthopaedic stability affects the dynamic functions of the masticatory
system.
Parafunction ability and TMD leads to breakdown?
Individual adaptable variation can cause change in outcomes.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
future
 Types of Mandibular Movements

Two types of movement occur in the TMJ:

rotational and
translational.
1. Rotational: Dorland's Medical Dictionary
defines rotation as "the process of turning
around its own axis”

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

Okeson, DMD
 Types of Mandibular Movements
Mandibular movement around the horizontal axis
is an opening and closing motion.
It is referred to as a hinge movement, and the
horizontal axis is referred to as the hinge axis.

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

 Terminal hinge axis.
When the condyles are in their most superior position in the articular
fossae and the mouth is purely rotated open, the axis around which
movement occurs is called the terminal hinge axis.

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

 Frontal (Vertical) Axis of Rotation
Mandibular movement around the frontal axis occurs when one condyle
moves anteriorly out of the terminal hinge position with the vertical axis of
the opposite condyle remaining in the terminal hinge position.

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

 Sagittal Axis of Rotation
Mandibular movement around the sagittal axis occurs when one condyle
moves inferiorly while the other remains in the terminal hinge position.

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

Okeson, DMD
 Translational Movement
Translation can be defined as a movement in which every point of the
moving object has simultaneously the same velocity and direction.
In the masticatory system, it occurs when the mandible moves forward,
as in protrusion.

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

Okeson, DMD
 Sagittal Plane Border and Functional Movements

Mandibular motion viewed in the sagittal plane can be seen to have four
distinct movement components:
1. Posterior opening border
2. Anterior opening border
3. Superior contact border
4. Functional.

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

Okeson, DMD
Posterior Border Movements
Posterior opening border movements in the
sagittal plane occur as two-stage hinging
movements.
In the first stage the condyles are stabilized
in their most superior positions in the
terminal hinge position.
The mandible can be lowered(mouth
opening) in a pure rotational movement
without translation of the condyles.

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

Okeson, DMD
 Anterior Border Movements
With the mandible maximally opened, closure accompanied by contraction
of the inferior lateral pterygoids (which keep the condyles positioned
anteriorly) will generate the anterior closing border movement.

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

Superior Contact Border Movements
• Fig.1 Common relationship of the teeth when the condyles are in the centric
relation position (CR).

• Fig.2 Force applied to the teeth when the condyles are in centric
relation (CR) will create a superoanterior shift of the mandible
intercuspal position (ICP).

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

 Superior Contact Border Movements
• Fig.3 As the mandible moves forward, contact of the incisal edges of the
edges of the mandibular anterior teeth with the lingual surfaces of the
maxillary anterior teeth creates an inferior movement.

• Fig. 4 Horizontal movement of the mandible as the incisal edges of maxillary and
mandibular teeth pass across each other.

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

 Functional Movements

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

 Horizontal Plane Border and Functional Movements

• Fig. A Gothic arch tracer is used to record the mandibular border

movements in the horizontal plane.

• Fig. B Functional range within the horizontal border movements.

CR, Centric relation; EC, area used in the early stages of mastication; EEP, end-to-end position
of the anterior teeth; ICP, intercuspal position; LC,area used in the later stages of mastication
Horizontal Plane Border and Functional Movements

Left and right lateral border movement recorded in the

horizontal plane.

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

Okeson, DMD
 Frontal (Vertical) Border and Functional Movements

• Fig. Mandibular border movements in the frontal plane. 1, lateral

superior: 2, left lateral opening: 3, right lateral superior: 4, right lateral
opening. ICP, Intercuspal position; PP, postural position.

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

Okeson, DMD
Envelope of Motion
By combining mandibular border movements in the three planes (sagittal,
horizontal, and frontal), a three-dimensional envelope of motion can be
produced.

Management of Temporomandibular Disorders and Occlusion 8TH EDITION Jeffrey P.

Okeson, DMD
 Conclusions

Occlusion has been an important consideration in orthodontics.

Achieving orthopedically stable relationship between the occlusal position
and joint position is important.
It is important for proper masticatory function throughout patient lifetime.
Achieving these goals will most likely reduce patient risk for developing
TMD.

Evolution of occlusion and temporomandibular

disorder in orthodontics: Past, present, and
future
 References
Evolution of Occlusion and Temporomandibular Disorder in Orthodontics: Past, Present, and Future
Jeffrey P. Okeson. (n.d.). Evolution of Occlusion and Temporomandibular Disorder in Orthodontics: Past,
Present, and Future.

From Angle EH: Dental Cosmos 41:248-264; 350-357, 1899.

From Andrews LF: Am J Orthod 62:296-309, 1972

Temporomandibular Pain-Dysfunction and Occlusal Relationships RoNALD H. RoTH, D.D.S., M.S

The maintenance system and occlusal dynamics R H Roth

A 20-Year Follow-up of Signs and Symptoms of

Temporomandibular Disorders and Malocclusions in Subjects With and Without Orthodontic Treatment
in Childhood
The Importance of the Diagnostic Setup in the Orthodontic Treatment Plan By Claudia Trindade Mattos
THANK YOU