TONGUE

Presented by:

Dr.Mohd Irfanulla khan

CONTENTS :
 Introduction
 Anatomy
 Development
 Functions of normal tongue
 Tongue in orthodontics
 Swallowing
 Examination of the tongue
• Morphological examination
• Functional examination
• D/D of abnormal tongue posture
 Role of tongue in malocclusion
 Tongue thrust
 Conclusion
 References
Introduction :
 Muscular organ (mass of striated
muscle covered with MM) in FOM
 Functions :
 Taste
 Speech
 Mastication
 Deglutition
Anatomy
 A root – attached to
mandible - above
Hyoid bone - below
 A tip – free ant.
at rest lies behind
upper incisors
 A body / dorsum-
convex,2parts
 ORAL PART (ant 2/3) PAPILLARY-in FOM
- Margins are free contact gums & teeth
- Sup surface-median furrow & papillae,rough
- Inf surface-smooth MM & median fold frenulum
lingue
 PHARYNGEAL PART (Post 1/3)LYMPHOID-in
pharynx
- Post surface,MM,no papillae-lymphoids&
mucous glands
 Seperated by V-shaped sulcus-sulcus terminalis
 Papillae:projections of MM,ant2/3,rough
- Vallate ,fungiform,filiform,foliate
 Muscles:
- Extrinsic- genioglossus,hyoglossus
styloglossus, palato glossus ,
 Intrinsic- sup longitudinal,Inf longitudinal,T/s
& vertical muscle
 Genioglossus-protrusion
 Hyoglossus-retraction
Blood supply:
- Lingual art (br ECA) & Lingual vein
Nerve supply:
 Motor- all muscles-hypogossal n.
Palatgossus-cr accessory n.
 Sensory-
- ant 2/3-lingual (gen sensation)
- Chorda tympani (taste)
- Post 1/3-glossopharyngeal n
- Post most –vagus thro int laryngeal n
Development
 Begins at 4th wk, 1st 3rd & 4th br arches
 Pharyngeal arches meet in midline below the
stomodeum
 Local proliferation of the mesenchyme- 1st
arch
 Tuberculum impar-in midline
 Lingual swellings-laterally
 Lingual swelling enlarge merge with
tuberculum impar- ant2/3 tongue
 Hypobranchial eminence-large midline
swelling-from mesenchyme of 3rd br arch-
grows rapidly than 2nd arch
 It gives-post 1/3 tongue/root
 Post most part-4th arch
 Tongue seperates from the FOM by
downgrowth of the ectoderm around its
periphery-degenerates to form lingual
sulcus-mobility of tongue
 Muscles-occipital myotomes
 Functions of normal tongue
- Has several imp function of intrest to the
orthodontist
- Mastication,deglutition,speech,breathing
- EQUILIBRIUM & DEVELOPMENT OF
THE DENTAL OCCLUSION
 Mastication :
- placing food in position (ant & lateral
portions of body)
- Pushing food buccaly during Mastication
 Deglutition:
- Forming & propelling bolus in to
pharynx(1st stg of swallowing)
- After swallowing tongue contact hard
palate while soft palate is pulled away
downward against the post portion of the
tongue
 Speech:
- Formation of sounds - s,z,t,d,sh,e,g,is
- Elevation of tongue tip behind maxi
incisors as in ‘s’
 Breathing :
 Nasal breathing-tongue in rest position
 In forced mouth breathing-habit,exertion
- Mandible is depressed,lips are opened
- Tongue contacts laterally with lingual
surfaces of mandi teeth dropping away
from maxilla
- The ant portion is lowered lies on lingual
surfaces of mandi ant teeth
 EQUILIBRIUM & DEVELOPMENT
OF THE DENTAL OCCLUSION
EQUILIBRIUM THEORY:
 As applied in engg “An object subjected
to unequal forces will be accelerated &
there by will move to a different position
in space”
It follows that if any object is subjected to
a set of forces but remains in the same
position, those forces must be in balance
or equilibrium
 From this
perspective,dentition is
in equilibrium as they
do not move to a new
location under usual
circumstances
(mastication,swallowin
g,speaking)
 ‘Tooth movement
occurs only when the
equilibrium against
dentition is
unbalanced’
Contributors to the dental equilibrium:
Various factors-effect of
pressures,magnitude & its duration
 Masticatory forces
 Soft tissue pressures from the lips,cheeks
& TONGUE
 External pressures- habits & orthodontic
forces
 Intrinsic pressures-gingival & PDL fibers
Soft tissue pressures from the lips,cheeks &
TONGUE:
 Rest,swallowing,speaking
 Though pressure are much lighter than
masticatory but longer duration
 Studies-very light forcs are succesful in
moving teeth if the force is longer duration
 So light sustained pressures from the
lips,cheeks & TONGUE at rest are imp
determinants of tooth position
 Injury to soft
tissue of lips-
scarring
&contracture
 Incisors moved
lingualy as lips
tightens against
them- altered
equilibrium
 No lip/cheeks
(tropical infection)
 Teeth move
labially/buccaly in
rsponse to
unoposed pressure
from the tongue
 Pressure from the
tongue-
macroglossia/patho
/abnormal posture
 labial displacement
of teeth though lips
& cheeks are
intact-altered
equilibrium
 From this equilibrium theory;light
sustained pressure by the tongue
against teeth has significant role in
development of OB (proffit)
 If a pt has a forward resting posture
of the tongue the duration of the
pressure even light could affect tooth
position(vertical & H/Z)
 SWALLOWING
Acc T.M Graber 1200-2000/day,4pb of
pr/swallow(cl-II div1,openbite-more)
 Normal swallowing
 Abnormal swallowing
 Infantile (visceral) swallowing
 Mature (somatic) swallowing
 Simple -tongue thrust swallowing
 Copmlex-tongue thrust swallowing
 RETAINED INFANTILE SWALLOW
Normal swallowing
 Teeth are in
contact,lips-closed
 Dorsum of tongue
closely touch the
palate
 Tip of the tongue-
interdental papillae
of maxi incisors
 No tongue thrust
Infantile(visceral) swallowing
Acc Moyers
 The jaws are apart
with tongue b/w gum
pads
 Mandible stabilized-
contraction of facial
muscles (buccinator)
& interposed tongue
 Swallow guide -
sensory interchange
b/w lips & tongue
 Change to semi solid & solid food & the
eruption of teeth-mature swallow
(1yr/18mos)
 The normal appearance of feature of both
the infantile & mature swallow-
TRANSITIONAL SWALLOW
- Diminishing of buccinator activity
- Appearance of contraction of mandi
elevators-stabilise occlusion
Mature (somatic) swallowing
 Teeth together
swallow
 Mandible
stabilized-
contraction of
elevators
 Tongue tip touch
palate lightly above
& behind incisors
 Minimal contraction
of the lips
 RETAINED INFANTILE
SWALLOW
Def: ‘As predominant persistance of the
infantile swallowing reflex after the arrival
of perm teeth’
- Rare,may be assoc with craniofacial
developmental syndromes/neural defects
C/F:
 Tongue thrust- ant & lateral
 Contraction of buccinator muscle
 Expression less face(facial muscles –used
for stabilising mandi)
 Difficulty in mastication(as
occlusion only on last molar of
quadrant)
 Mastication-b/w tongue tip &
palate(poor occlusion)
 Gag threshold is low
 AFH - severe AOB
 Adaptive features to OB:
 Tooth apart swallow with T.T
 Infra eruption of incisors & alveolar
development
 Hyperactive mentalis & lips
 Mandible stabilized by facial muscles
Treatm :differentiate this with skeltal OB
- If require-orthodontic & surgery
- Poor prognosis
TONGUE IN ORTHODONTICS
“ By examining the tongue of the
patient,physicians find out the diseases of
the body & philosophers the diseases of
the mind “ – St Justin

 Examination of the tongue

 Role of tongue in malocclusion
 Tongue thrust
Examination of the tongue
- From an orthodontic point of view
other than color,texture
 Morphologic examination (size &
shape)
 Functional examination (tongue
posture)-imp
 D/D of abnormal tongue posture
 Morphologic examination
 size & shape – subjective observation,related to
patient ,Position imp than size
 Length-long tongue can touch tip of nose(not
confirmed method)
- Microglossia-rare
- Macroglossia –scalloping on lateral borders
 Asymmetry-placing tongue out
- Functional asymmetry-change from one position to
other
- Morphological asymmetry-persists in drapped
position
Clinical implications of asymmetry:
Tongue asymmetry is imp in
 dental arch symmetry
 dental midlines
 Maintenance of treated incisal
relationships
 Open bite etc
 Not easily corrected, as treatm involve
some compromise
Functional examination
- imp than clinical,position imp than size
- Tongue & lips often integrated
- Examine normal tongue function w/o displacing it
or the lips
 Posture of the tongue while mandi in its
postural position
- Clinically- upright position
- Cephalometry-METRIC EVALUATION
- normal -Dorsum of the tongue touches the palate
lightly,tip rest in the lingual fossae/crevices of
mandi incisors
Proffit –”Tongue posture is far more adapt to
cause of an openbite than tongue
thrust,becoz the tongue is always there
exerting a mild continous force”

 Tongue during mastication:

- Difficult test
- Assoc with neurological problems
 Tongue during swallow :
Normal -Tip touches interdental papillae just
behind the maxi incisors

 The unconscious swallow – most imp

 The command swallow of saliva
 The command swallow of water
 The unconscious swallow during mastication
 During speech :
-Is abnormal tongue activity
adaptive/etiologic/unrelated to
malocclusion
- Usually- adaptive
- Ask pt to count 1-10,check for tongue
adaptivity,consonants sound
- ‘s’-sound (lisping) most affected
Functional analysis:
 Metric evaluation- lateral ceph
 Palatography
 Cineflourography
Metric evaluation of tongue
posture:
 Tranparent plastic
template in mm
 Mark-contours of
bony palate &
dorsum of tongue
 Measuring the
distance b/w sup
surfce of tongue &
roof mouth-size- but
it must be supported
by clinical
examination
 Retracted & elevated
tongue
 Downward & forward
tongue posture
Palatography
 Recording the contact areas of the tongue
with the palate & teeth during
speech/certain tongue functions
 A thin layer of contrasting imp material is
applied on tongue
 Tongue movements-speech/swallowing
 Palatogram records photographically
eg:lisping-defect S sound,T.T
 Evaluation of the influence of functional
orthodontic appliance therapy
 Speech assessment is also desirable
from an orthodontic point of view
 In malocclusions with malposed teeth,
there can also be a malposition of the
tongue, which can impair normal speech
 An important diagnostic tool as the
clinician establishes a treatment plan
and a probable prognosis for functional
appliance therapy.
 Cineflourography-tongue movements
using camera & film is made during
swallowing
Tracing-T.T is measured by drawing str line
thro labial surfaces of U/L incisors
D/D of abnormal tongue posture
 Abnormal tongue posture is more
frequent problem than abnormal size
 Tongue posture is Related to skeletal
morphology
 In class-II
 Mandi short
 Tongue positioned
forward
 In class-III

 Tongue lie below

the plane of
occlusion
2 significant variations:
 The retracted tongue posture
 The protracted tongue posture
The retracted tongue posture/COCKED
TONGUE:
 Tongue tip is withdrawn from all ant
teeth
Variations in tongue posture
2significant variations:
The retracted tongue posture
The protracted tongue posture- retained infantile
The retracted tongue posture/COCKED TONGUE:
Tongue tip is withdrawn from all ant teeth
 Retracted posture seen-10% children
 Assoc with lateral OB
 Edentulous adults/pt with bilateral loss
of several post teeth
 Due to positional sense it retract itself to
establish tactile contact laterally with
alveo mucosa for better seal during
swallowing
 Complic:unsettling of mandi denture
The protracted tongue posture:
 Tongue b/w incisors
 Serious ,results in AOB
 Endogenous & acquired adaptive
Endogenous protracted tongue posture:
 Retention of the infantile postural pattern
 Not unesthetic,stable incisor relationship
 Mild AOB
 Protracted tongue is adaptation to AFH
 Is Endogenous protracted tongue posture
caused OB? Or AFH/skeletal dysplasias
predispose to tongue protraction?
 Treatm:surgery relapse - poor prognosis
Acquired adaptive protracted tongue
posture:
 Transient-adaptation to
tonsilitis/pharyngitis
 Treatm:removal of cause(tonsillectomy)
 Correctable – good prognosis
Role of tongue in malocclusion
 SIZE
Microglossia: small tongue
 Congenital,piere-robin syndrome
 C/F: tongue tip lower level
 FOM is elevated& visible
 Dental arch-collapsed & reduced
 Extreme crowding in premolar area
 Severe class-II relation
Macroglossia :
Congenital,
GH,amyloidosis,tumo
rs,edentulous pt
 Difficult diagnosis-
ceph,cineradiography
 Scalloping of lateral
borders
 Mandi prognathism??
keeping mandi
forwards always
 Wide,broad & flat tongue
 OB
 Mandi prognathism / Class III
 Chronic positioning tongue b/w teeth at rest
 Buccal tipping of post teeth
 Incre T/S width of dental arch
 Inability in ortho treatment
 Difficult diagnosis-tongue some times adapt
to contracted narrower space after ortho
treatment
POSTURE
 In neonate more
forward
 Abnomal posture-
Generalised
spacing,proclination
 Prognosis-depends
on cause-good in
respiratory problems
 TONGUE REFLEXES
 Most significant is posture –imp for the
maintenance of the phayrngeal airway
 Base of the tongue forms ant wall of the
pharynx
 Maintenance of phayrngeal airway cause
base of the tongue to not to intrude into
airway
 Genioglossus muscle performs this reflex
function
Genioglossus reflex (initiated by large
tongue/tonsils/mouthbreathing)

Sustained jaw opening

Sustained tongue posture (T.T)

MALOCCLUSION
(proclination /OB/ prevent tooth
eruption-post open bite/deep
overbite)
Consequences of tongue posture
& functional abnormalities on
skeletal pattern:
 In HGP:
- Forward position/T.T-Bimax dental
protrusion(as tongue pressing on
lingual surfaces of both U/L incisors)
- Spacing(incisors), AOB
 In VGP:
- T.T- tip the upper incisors to labialy &
Lower incisors-lingually tipped
Movements of the tongue
 Protrusion- Genioglossus (both side)
 Retraction- Styloglossus & Hyoglossus
(both side)
 Depression- Genioglossus & Hyoglossus
(both side)
 Retraction & elevation- Styloglossus &
palatoglossus (both side)
 Intrinsic muscles - Alters shape tongue
 In the mid line,a fold of MM-frenulum
of the tongue connects the ventral
surface of the tongue to FOM
ANKYLOGLOSSIA:
 Complete ankyloglossia: fusion of
tongue & FOM
 Partial ankyloglossia / tongue tie:
Short lingual frenum /attachment of
lingual frenum too near the tip of
tongue
Tongue tie : is most common
 Restricted tongue movements
 Speech difficulties (consonants)
 Some cases are self corrective
 Majority : surgical (frenectomy)
Mesurement of tongue volume
 True FISP-true fast imaging with
steady precession
 MRI
 CT scan
 Measuring tongue vol :using true FISP
 2D-study,in healthy & acromegaly pts
 In healthy pts-M-140ml F-90ml
 Acromegaly pts-M-180ml, F-145ml
 After treatmnt of acromegaly –M-
154ml,F-125 ml
MRI:
 In 19 adults-coronal & sagittal sections
 Series of images & multiplying the
thickness of each slice & the gap b/w
each slice in th series
 Avg vol 72.1cc (coronal) 79.3cc
(sagittal)
 Results-reproducible
-Well definable anatomy of tongue
 MRI experiment on rabbits:
 MRI measured vol & actual vol after
removing tongue compared-closer to
actual vol but slightly underestimated
CT scan: reliable measuring vol
 Used in measuring vol of tumours in
Ca of tongue
Tongue presssure
 EMG
 cineradiography
 Palatograpic
 EMG- activity of extrinsic & intrinsic
muscles of the tongue
 Measured –potraction,retraction
 Genioglossus –most imp
 Protrusion & maintaining shape
 maintaining pharyngeal airway
TASTE :
Basic tastes:
 Salt
 Sour (acidic)
 Sweet (sugar)
 Bitter (vallate
papillae)
 Umami- new taste
to a.a like
gluatamate,aspatate
 Taste sensation –taste buds (4600),in
papillae
 Taste buds-sensory,neuro epi cells
 Seen in tongue,soft palate & pharynx
 Circum vallate-large, numerous taste
buds- sour/bitter
 Foliate -numerous taste buds – sour
 Fungiform-ant part
 Filiform- mechanical, NO TASTE BUDS
 TONGUE THRUSTING
Defin:
Proffit- “placement of the tongue tip
forward b/w the incisors during
swallowing” (1950&60s)
OR
It is the habit of thrusting tongue forward
against teeth/in b/w swallowing

 Misnomer-implies tongue is forcibly thr

ust forward
 T.T-an adaptive mechanism to maintain
OB caused by something else-
thumbsucking
 T.T term-1958 force teeth out of
alignment
 School age children-67-95%(5-8yrs)
 Assoc with/contributing to an
orthodontic/speech problem
 In US 20-80% ortho pts have some
form of T.T
 Etiology
- No one specific cause
- Acc to Fletcher
1.Genetic factors -anatomic/neruomuscular
eg:hypertonic orbicularis oris activity
2.Learned behavior (habit)-acquired as habit
- prolonged thumb sucking,tonsillitis &
URTI,improper bottle feeding
3.Maturational –infantile swallow persists in
adulthood
4.Mechanical restriction-
macroglossia,constricted dental
arches,enlarged adenoids
5.Neurological disturbances -hypersensitive
palate,motor disability of tongue
6.Psyhcogenic factors – forced discontinuation
of thumbsucking
7.Younger children with reasonably normal
occlusion-trasitional stage in physiologic
maturation
Classification
 According to Moyers (1970)
a. simple tongue thrust swallow
b. complex tongue thrust swallow
 Backlund (1963)
a. Ant tongue thrust
b.Post tongue thrust
 Pickett’s (1966)
a.Adaptive-missing teeth/thumb sucking
b.Trasitory
c.Habitual-postural problem,habit/OB
James S.Braner and Holt
 Type I: Non-deforming tongue thrust
 Type II: Deforming ant tongue thrust
sub group 1- assoc with AOB
sub group 2- ant proclination
sub group 3- post cross bite
 Type III: Deforming lateral tongue thrust
sub group 1- posterior open bite
sub group 2- posterior cross bite
sub group 3- deep overbite
 Type IV- Deforming ant & lateral tongue
thrust
sub group 1- ant & posterior open bite
sub group 2- ant proclination
sub group 3- post cross bite
Non-deforming: occlusion & profile within
normal range & acceptable
Deforming: dentoalveolar defect
C/F
- Seen from birth
- School age children-67-95%(5-8yrs)
- If retained after 4yr-concerned&need
correction
 Proclination of ant teeth
 AOB
 Bimax dental protrusion
 Post cross bite
 Post open bite in lateral T.T
Simple T.T Complex T.T
 Simple T.T Complex T.T
 Teeth together  Teeth apart
swallow –T.T to swallow –T.T
seal OB
 Well circumscribed  Diffuse OB/no OB
OB
 Precise occlusion  Poor occlusion-
-reinforced by teeth no reinforcing
together swallow
 Contraction of
 Contraction of lips,mentalis &
lips,mentalis & facial muscles.NO
mandi elevators mandi elevators
 H/O thumb  H/O
sucking -T.T as breathing/chronic
adaaptive URTI & allergies
mechanism to OB
 No respi problems  Respi problems
 Diminishes with  Does not
age Diminishes with
age
 Prognosis - good  Prognosis - poor
Diagnosis
 Extra oral-facial profile ,OB,AFH
 Examination of- tongue posture
- tongue function
 Careful differentiation should be made of
 Simple tongue thrust
 Complex tongue thrust
 Retention of infantile swallowing
pattern
 Faulty tongue posture
Tests for diagnosis
1. swallowing: jaw drops- lips,mentalis muscle
contracts strongly-tongue thrust
2.Seperate the lips while swallowing to watch
tongue thrust,and in doing so,strong muscle
contractions can be felt
Methods of examination tongue dysfunction:
 Position & size- LATERAL CEPH
 Tongue pressure- EMG,cineradiography
palatograpic,neurolophysiologic examin
 Treatment
Simple tongue thrust: 3 phases
1.Conscious learning of the new reflex
2.Transferal of control of the new swalow
pattern to the subconscious level
3.Reinforcement of the new reflex
- If proclination is severe- correct the
habit after retraction
- Simple T.T-correct by itself during ortho
treatment
Conscious learning of the new
reflex:
 Teaching correct tongue position by
tactile signals (index finger)
 Tip of tongue & palate
 Put tongue tip-close teeth & lips-swallow
 40times/day
 With little water/food
 Small ortho intraoral elastics-held by
tip of tongue aginst palate during
swallowing
 If correct swallow- elastic will be
retained
Incorrect swallow- elastic will be
swallowed
 2-3times /day
Reinforcing the new swallow
subconsciously:
 To avoid abnormal
unconscious
swallow-2nd visit
 Flat sugarless fruit
drops-citric
flavoured(lemon)
 Fruit drop on Tip of
tongue-hold
against palate until
dissolves
 Record timing
 Initialy-less
time,later more
time
 Distraction & self
competition
 Ones/day
 Timing
distraction-Best
technique
Reinforcing the new reflex:
 Appliance therpy-
Tongue crib
 Should not as the
1st step of
treatment
 As it traumatic to
pt/ do not wear
properly
Tongue crib:
 Ni-cr/S.S, 3-4 projections (spurs)
 Follow the palatal contour
 Forms barrier/picket fence just
behind cingulum of mandi incisors
 Duration:depends on severity of
OB(4-9mos)
MOA:
 Eliminate the strong T.T & plunger like
action during swallowing
 Reeducate the tongue posture -Dorsum-to
touch palate vault
Tip - palatal rugae
 Effects: as tongue confines with in
dentition-rests on occlusal surfaces of post
teeth-maintains IOD-supra eruption &
narrowing of max post teeth prevented-
NO OB
 After habit interception
 Treat malocclusion assoc with T.T-
with removable / fixed ortho
appliances
 By these above 3 sequential therapy
simple T.T is correctable
 Prognosis - good
Complex tongue thrust :
 Occlusion treatm – 1st
 Muscle exercises smilar to simple T.T
with minor modification
- Swallowing with teeth together
- Prolonged appliance therapy
 Prognosis – Poor
 More relapses
Management of tongue thrust
Factors to be considered:
 Diagnosis –
GDP,orthodontist,pedodontist/pediatri
cians
 Majority –by Orthodontist - when
child displays dental/speech problem
1.Type of malocclusion: The common
types of malocclusion associated with
tongue thrust habits are
 a.Class I malocclusion with incr over jet.
b.Angle’s Class II division I malocclusion with

increased over jet.

c. Deep bite
d. Marked open bite.
2. Degree of malocclusion
3. Scope of the problem:
habitual,severe tongue thrusting-needs
immediate attention.
4. Maturity of the child.
5. Attitude and the degree of cooperation-from the
parents.
6. Progressive malocclusions should be considered
for immediate treatment.
7. Structural considerations to be eliminated are
a. Nasal air blockage.
b. Extremely narrow palatal arch.
c. Maxillary posterior teeth in extremely,
lingual position
d. Macroglossia.
Probability of correction:
 Sincere commitment & cooperation of pt
& parents
 No neuromuscular problems- successful
 70%- successful
 25%- unsuccessful (poor cooperation of
pt & parents/both)
 5%- unsuccessful (factore that make
treatm impossible
 Case reports
Tongue muscle activity after ortho treatm
of AOB-AJODO1999;115:660-66
 Class I with AOB & bimax dental
protrusion-T.T,lisping
 Prior to treat- EMG activity of GG & OI
(protrusion)
 After treat – activity
Severe dental OB with tongue reduction after
ortho treat AO2001;71:228-36
 21yr,Class III with OB,macroglossia
 Edgewise with crib & begg retainer
 Relapse –mandi arch-spacing,flaring of ant
teeth,incre mobility
 Partial glossectomy-1/3 middle dorsum
 Improvement itself w/o further appliance
after surgery in 4months
 Shows - EQUILIBRIUM
A cineradiographic study of deglutive
tongue movement & nasopharyngeal
closure in pt with AOB
AO 2000;70:284-89
 Results-tongue tip protrusion
 Slow movement of ppost part of dorsum
 Suggest – compensatory coordination of
tongue
Conclusion
 Hence position of tongue & its
function plays an important role or a
contributing factor in dental
malocclusion (T.T,macroglossia)
 Tongue thrust troubled orthodontic
treatment, discouraged orthodontists
as there is more relapses due to
continuous force by tongue
(protrusion)
 Accomplishment of successful
orthodontic treatment is pssible
through proper diagnosis & treatment
plan taking into consideration of all
the surrounding oral structres
References
 Hand book of orthodontics,4th
edition,Robert E.Moyers
 Contemporary orthodontics,3rd
edition,William R.Proffit
 Color atlas of dental medicine-ortho
diagnosis,Thomas Rakosi
 Human anatomy vol3 head &
neck,3rdedition, B.D Chaurasias
 Tencate’s Oral histology,6th edition