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BDS4 Finals > 12. Orthodontics > Flashcards

12. Orthodontics Flashcards

1
Q

Ortho Rx

  1. 3 aims
  2. 5 advantages
  3. 5 risks/disadvantages
  4. 3 indications
  5. 5 contraindications
  6. 3 limitations of ortho
A
  1. Restore stability, function, aesthetics
  2. Improve function, appearance, dental health, reduce risk of trauma, facilitate other dental treatment
  3. Decalcification, relapse, root resorption, perio attachment loss, loss of vitality, gingival recession, pain and discomfort, soft tissue trauma, length of treatment, appearance during treatment
  4. Significant functional/aesthetic malocclusion, good attendance/motivation, psychological impact
  5. Uncontrolled epilepsy, poorly controlled diabetes, bisphosphonates, poor attendance/motivation, poor dental/oral hygiene
  6. Effects purely dento-alveolar and tooth movement, little effect on skeletal pattern, tooth movement limited by shape and size of alveolar processes, teeth will only remains stable in neutral position
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2
Q

Occlusion

  1. Definition of ideal occlusion
  2. List Andrews six keys
  3. Definition of normal occlusion
  4. Definition of malocclusions
  5. Definition of overjet
  6. Normal overjet
  7. Definition of overbite
  8. Normal overbite
  9. 5 types of overbite
  10. Definition of crossbite
  11. 2 types of cross bite
A
  1. Anatomically perfect occlusion - gold standard by which occlusal irregularities and treatment may be judged
  2. Correct molar relationship, correct crown angulation, correct crown inclination, absence of rotations, tight proximal contacts (absence of spaces), flat occlusal plane
  3. Acceptable variation from ideal, usually minor deviations that do not constitute an aesthetic or functional problem
  4. More significant deviations from the ideal that may be considered aesthetically or functionally unsatisfactory
  5. Extent of horizontal overlap of maxillary central incisors over mandibular central incisors (distance between upper and lower incisors in the horizontal plane)
  6. 1.5-2.5mm
  7. Extent of vertical overlap of maxillary central incisors over mandibular central incisors (overlap of incisors in the vertical plane)
  8. 1/3-1/2 of lower incisors covered
  9. Complete, incomplete, deep, open, traumatic, normal
  10. Deviation from the normal bucco-lingual position
  11. Lingual (lower teeth too lingual) or buccal (lower teeth too buccal)
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3
Q

BSI classification definitions

  1. Class I
  2. Class II division 1
  3. Class II division 2
  4. Class III
A
  1. Incisal edges of lower incisors occlude with/lie immediately below the cingulum plateau of upper central incisors
  2. Incisal edges of lower incisors lie posterior to the cingulum plateau of upper incisors. The upper incisors are proclined/of average inclination. There is an increase in overjet
  3. Incisal edges of lower incisors lie posterior to the cingulum plateau of upper incisors. The upper incisors are retroclined. The overjet is usually minimal/may be increased
  4. Incisal edges of lower incisors lie anterior to the cingulum plateau of upper incisors. The overjet is reduced/reversed
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4
Q

Class II/1

  1. Usually associated with which skeletal classification
  2. Normal cause
  3. Associated soft tissue features
  4. 5 treatment options
A
  1. Skeletal class II or class I
  2. Mandibular retrognathia
  3. Incompetent lips, hyperactive lower lip
  4. Accept, growth modification (twin-block), URA (Roberts retractor + FABP), fixed appliances, orthognathic surgery
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5
Q

Class II/2

  1. Usually associated with which skeletal classification
  2. Normal cause
  3. Associated soft tissue features
  4. 5 treatment options
A
  1. Skeletal class II or class I
  2. Mandibular retrognathia
  3. Reduced FMPA/LAFH, progenia, hyperactive lower lip, accentuated labio-mental fold
  4. Accept, growth modification (modified twin block), camouflage (URA), fixed appliances, orthognathic surgery
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6
Q

Class III

    1. Usually associated with which skeletal classification
  2. Normal cause
  3. Associated dental features
  4. 5 treatment options
A
  1. Class III or class I
  2. Maxillary hypoplasia or mandibular protrusion
  3. Reduced overbite
  4. Accept, interceptive URA, growth modification (reverse twin block, FRIII), camouflage, orthognathic surgery, fixed appliances
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7
Q

Molar and Canine Relationships

  1. Describe Angle’s classification
  2. Describe canine relationship
A 
1. Class I - neutron-occlusion - MB cusp of U6 occludes with MB groove of L6
Class II - disto-occlusion - MB cusp of L6 occludes distal to class I position (post-normal)
Class III - mesio-occlusion - MB cusp of L6 occludes mesial to class I position (pre-normal)
2. Class I - cusp of U3 occludes with embrasure of L3 and L4. Mesial slope of U3 is continuous with distal slope of L3
Class II - cusp of U3 occludes mesial to class I position
Class III - cusp of U3 occludes distal to class I position
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8
Q

Skeletal Base classification

  1. Definition of each skeletal base
A

Class I - maxilla 2-3mm in front of mandible
Class II - maxilla >3mm in front of mandible
Class III - maxilla <2mm in front of mandible or maxilla behind mandible

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9
Q

EO Exam

  1. 5 key features
  2. How to assess AP relationship clinically
  3. How to assess vertical relationship clinically
  4. How to assess transverse relationship clinically
  5. Key features of TMJ
  6. Key features of lip assessment
A
  1. AP relationship, vertical relationship, transverse relationship, TMJ, lips
  2. Visual, palpate skeletal bases
  3. FMPA, AFH
  4. Asymmetry, mid-sagittal reference line
  5. Path of closure, deviation
  6. Competent/incompetent, lip trap, lower lip activity (if too high, may retrocline incisors), smile line, habits, speech, oral seal
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10
Q

IO Exam

  1. 5 features
  2. 2 techniques for crowding assessment
A
  1. OH and perio health, crowding/spacing/rotations, inclination/angulation of teeth, tooth shape/size, tongue (thrusts, habits, swallowing), OJ, OB, centre line, BSI, MR, canine relationship
  2. Space required vs space available, overlap technique
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11
Q

Treatment aims

  1. 4 aims of treatment
  2. 3 categories of crowding and treatment options for lower crowding
  3. Treatment options for upper crowding
A
  1. Class I BSI, MR, canine; Andrews six keys, plan around LLS, build upper around lower
  2. Mild (0-4mm) - non-extraction stripping, XLA5, moderate (4-8mm) - XLA5, XLA4, severe (8+mm) - XLA4
  3. If lower extraction - compensating extraction for MR class I; non-extraction - upper extraction (MR class II), distalise UBS with headgear (MR class I)
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12
Q

Malocclusions

  1. 8 normal AP cephalometric values
  2. Class I, class II and class III cephalometric values for SNA, SNB, ANB
  3. 2 normal vertical cephalometric values
  4. 2 features of long face type
  5. 2 features of short face type
A 
1. SNA - 81±3
SNB - 78±3
ANB - 3±2
FMPA - 27±4
UI/MxP - 109±6
LI/MnP - 93±6
Ui/Li - 135±10
Li-APo - 0-2mm
  1. Class I - SNA 81±3, SNB 78±3, ANB 3±2
    Class II - SNA usually average, SNB usually decreased, ANB >5
    Class III - SNA usually decreased, SNB usually average, ANB <1
  2. FMPA - 27±4
    LAFH - 50/50 clinical (45/55 radiographically)
  3. Increased FMPA, increased LAFH
  4. Decreased FMPA, decreased LAFH
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13
Q

Ectopic teeth management

Give management options for an ectopic:

  1. Central incisor
  2. First molar
  3. Third molar
  4. Canine
  5. When to palpate canine and what to do if no buccal bulge
A
  1. Surgical exposure, remove supernumerary, bonding gold chain, ortho, bonded retainer
  2. Attempt to distalise 6, otherwise extract e
  3. Extract if symptomatic
  4. XLAc, retain c and observe, surgical exposure and orthodontic alignment, extract, transplant
  5. 9yrs old; radiograph to localise, refer if appropriate
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14
Q

Tooth Movement

  1. List 6 types of orthodontic tooth movement and the ideal forces associated with them
  2. 4 factor responsible for affecting response to orthodontic forces
A
  1. Tipping/tilting (35-60g), bodily movement (150-200g), intrusion (10-20g), extrusion (35-60g), rotation (35-60g), torque (50-100g)
  2. Magnitude, duration, age, anatomy
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15
Q

Orthodontic Forces

  1. Give some key features of light ortho forces
  2. Give some key features of moderate ortho forces
  3. Give some key features of excessive ortho forces
A
  1. PDL hyperaemia, osteoclastogenesis and osteoblastogenesis, resorption of lamina dura from pressure side, apposition of osteoid on tension side, socket remodelling, periodontal fibres reorganise, gingival fibres remain distorted
  2. Occlusion of vessels of PDL on pressure side, hyperaemia of vessels of PDL on tension side, cell-free areas on pressure side (hyalinisation), period of stasis, increased endosteal vascularity (undermining resorption), relatively rapid movement of tooth with bone deposition on tension side, PDL healing (reorganisation and remodelling)
  3. Necrosis, undermining resorption, resorption of root surfaces, pain, permanent change
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16
Q

Orthodontic appliances

  1. Indication for removable appliances
  2. How removable appliances work
  3. 5 indications for fixed appliances
  4. 4 components of fixed appliances
  5. Advantage of fixed appliances
  6. 3 palatal components of fixed appliances and what they are used for
A
  1. Correct/camouflage minor malocclusions
  2. Tilt/tip teeth
  3. Correct/camouflage mild to moderate skeletal discrepancies, alignment of teeth, correct rotations, centreline correction, reduce OJ and OB, space closure/creation, vertical movement of teeth (intrusion/extrusion)
  4. Brackets, bands, arch wires, auxillaries
  5. Can move teeth by 3D movement, fixed so good compliance
  6. Quadhelix - expansion of arch
    Removable palatal arch with nance button - anchorage
    Transpalatal arch - anchorage, retention
17
Q

Retention

  1. Definition
  2. 4 features with high relapse rates
  3. 2 main types of retainers, with 3 indications for 1 type
A
  1. Maintaining final tooth position with a passive orthodontic appliance
  2. Diastema/space closure, rotations, palatally ectopic canines, proclamation of lower incisors, AOB
  3. Removable - thermoplastic pressure-formed or Hawley
    Fixed - space closure, proclanation of LLS, correction of rotations
18
Q

IOTN

  1. Function
  2. What are the 2 components
  3. What acronym can be used to help identify the worst occlusal feature
A
  1. Indicate the need for ortho Rx
  2. DHC - indicates need for treatment
    AC - scale of photographs showing different levels of dental attractiveness
  3. MOCDOO - missing teeth, overjet, crossbite, displacement of contact points, overbite, other
19
Q

Growth

  1. What are the 2 main bones of the skull that form in utero
  2. How does the skull vault form
  3. How does the base of the skull form
  4. How do the maxilla and mandible develop and what is unique about how they develop
  5. What are 5 units of the mandible and why do 4 of these develop
  6. What are 3 sites of secondary cartilage formation and when do they disappear
A
  1. Neurocranium, viscerocranium
  2. Intramembranous ossification
  3. Endochondral ossification
  4. Intramembranously, but preceded by cartilaginous facial skeleton (nasal capsule, Meckel’s cartilage)
  5. Condylar, angular (medial pterygoid and masseter), coronoid (temporalis), alveolar (if teeth are developing), body (IAN)
  6. Condylar cartilage (continues until 20yrs old), coronoid cartilage (disappears after birth), symphyseal cartilage (disappears before birth)
20
Q

Facial syndromes

  1. Give 3 features of foetal alcohol syndrome
  2. Give 3 features of hemifacial microsomia
  3. Give 3 features of Treacher Collins syndrome (mandibulofacial dysostosis)
  4. Give 3 features of achondroplasia
  5. Give 3 features of Crouzon’s syndrome (craniofacial dysostosis)
  6. Give 3 features of Apert’s syndrome (acrosyndactyly)
A
  1. Short palpebral fissures, short nose, long (thin) upper lip, indistinct philtre, small mid face and mandible, varying degrees of mental deficiency
  2. 3D progressive facial asymmetry, unilateral mandibular hypoplasia, zygomatic arch hypoplasia, high arched palate, malformed pinna, normal intellect
  3. AD condition, anti-mongloid slant palpebral fissures, coloboma of outer third of lower eyelid, hypoplastic/aplastic zygomatic arches, hypo plastic mandibular with antiphonal notch, deformed pinna, conductive deafness
  4. AD condition, problems with endocohodral ossification, defects in long bones (short limbs/stature) and base of skull, retruded middle third of face, frontal bossing, depressed nasal bridge
  5. AD condition, premature closure of cranial sutures (coronal, lambdoid), proptosis, orbital hysteria, mild hypertelorism, recursion and vertical shortening of mid face, prominent nose, class III malocclusion, narrow spaced teeth
  6. AD condition, premature closure of almost all cranial sutures, exophthalmos, hypertelorism, maxillary hypoplasia, class III occlusion, AOB, narrow spaced teeth, Parrot’s beak nose, narrowed high-arched palate, conductive deafness, syndactyly of fingers and toes
21
Q

Clefts

  1. Give 3 causes of clefts
  2. Give 3 members of a cleft MDT
  3. What do cleft palates affect primarily
  4. What do cleft lips and palates primarily affect
  5. How are clefts classified
  6. Give 4 key implications of clefts
  7. Give 5 dental implications of clefts
  8. Describe the standard surgical journey for a cleft patient
A
  1. Environmental (smoking, alcohol, anticonvulsants, social deprivation) and genetic (syndromes, FH)
  2. Orthodontics, cleft surgeon, ENT, psychologists, CNS, geneticist
  3. Speech
  4. Teeth, speech, growth
  5. LAHSHAL classification
  6. Aesthetics, hyper-nasal speech, dental, hearing/airway problems, cardiac anomaly, Apert’s syndrome
  7. Missing teeth, impacted teeth, crowding (usually maxilla), class III growth pattern, caries, aesthetics (low lip line)
8. 3mths - lip closure
6-12mths - palate closure
8-10yrs - alveolar bone graft
12-15yrs - definitive ortho
18-20yrs - orthographic surgery ± aesthetic revision surgery
22
Q

Interceptive Ortho

  1. Give 5 indications for interceptive ortho
  2. When is the ideal time to extract 6s
  3. How can anterior crossbones be treated interceptively
  4. How can posterior crossbones be treated interceptively
  5. Give 4 dental features of digit sucking habits
  6. List 5 IO forces that can dislodge appliances
A
  1. Impacted 6s, potential crowding, early loss of deciduous teeth, carious 6s, crossbites, transpositions, habits
  2. Beginning of calcification of bifurcation of 7, 5s and 8s all present, class I, average/reduced OB, moderate lower crowding, mild-moderate upper crowding
  3. URA with z-spring + FABP
  4. URA with midline palatal screw + PBP
  5. Proclined upper incisors, retroclined lower incisors, localised AOB/incomplete OB, narrowed upper arch ± unilateral posterior crossbite
  6. Gravity, muscles (tongue), speech, mastication, active components
23
Q

URA

  1. Describe the lab prescription for a URA
  2. Give the definition of each section and give the appropriate wire diameter where appropriate
  3. For the last section of the lab prescription, name the material that is used to make It and give 3 functions of this component
  4. List 5 active components and what they would be used for
A 
1. Aim
Active components
Retention
Anchorage
Baseplate
  1. Active component - any component that uses forces to try to move teeth. 0.5mm HSSW
    Retention - resistance to displacement forces. 0.7mm HSSW
    Anchorage - resistance to unwanted tooth movement
    Baseplate
  2. Self-cure PMMA. Connector, anchorage, retention through adhesion-cohesion
  3. Palatal fingerspring (retract canines)
    Z-spring (correct anterior crossbite + FABP)
    Buccal canine retractor (retract and distalise canine)
    Roberts retractor (reduce OB and retrocline upper incisors + FABP)
    Midline screw (expand arch, correct crossbite + PBP)
24
Q

URA 2

  1. List the key features to check when fitting a URA for the first time
  2. List the key patient instructions when fitting a URA for the first time
A
  1. Check it’s for right patient
    Check design of URA matches prescription
    Check for sharp areas
    Check for any pre-existing damage
    Try in and check for trauma/blanching
    Check posterior retention (Adams clasps – check for flush flyover and arrowhead engages undercuts)
    Check anterior retention
    Activate appliance for 1mm movement per month
    Demonstrate to patient how to get it in and out
    Get patient to demonstrate they can put it in and take it out
    Review every 4-6 weeks to reactivate for 1mm movement per month
  2. URA is big and bulky, will get used to it
    Practice reading out loud for speech
    Excess salivation but only for first 24 hours
    Might be achy and mild discomfort – means it is working
    Avoid hard and sticky foods
    Be careful with hot foods and hot drinks
    Wear all the time
    Take out if doing contact/active sports
    Take out and clean after every meal
    Poorer compliance = longer treatment
    Emergency contacts – if something breaks off, get in touch
25
Q

Adult ortho

  1. Give 3 indications for adult ortho
  2. Give 5 key differences between adult and child ortho and describe the importance and relevance of these
  3. Name 3 groups of aesthetic appliances
A
  1. Improve dental appearance, adjunctive to restorative treatment, adjunctive to periodontal treatment, part of orthognathic surgery
  2. Lack of growth (accept skeletal discrepancy or surgery required), presence of perio disease (reduce anchorage value of teeth if periodontally involved), missing/heavily restored teeth, physiological factors (reduced cell turnover, slower initial movement - light forces), adult motivation (often well motivated - may want aesthetic appliances)
  3. Lingual appliances, aligner technology, short-term ortho

BDS4 Finals (19 decks)

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