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Ortho Final > 1B > Flashcards

1B Flashcards

1
Q

Transverse skeletal & dental problems:

● Skeletal ⇒

A

true facial asymmetry & maxillary constriction

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2
Q

Transverse skeletal & dental problems:

● Dental ⇒

A

posterior crossbite

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3
Q

○ —–population has posterior crossbite

A

5%

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4
Q

True facial asymmetry ⇒ usually a

A

mandibular asymmetry (midface asymmetry rare)

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5
Q

True facial asymmetry

● Causes:

A

○ Post trauma (condylar fx with scarring of soft tissues)

○ Growth deficiency/excess (of condyle)

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6
Q

Apparent facial asymmetry ⇒ most common cause of

A

facial asymmetry

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7
Q

Apparent facial asymmetry

A

● Mandibular shift (CR-CO shift)

● Dental interference uncomfortable, so pt shifts to crossbite

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8
Q

Maxillary constriction treatment:

Adolescent

A

○ RPE or SPE (Jack screw type can do both)

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9
Q

■ RPE =

A

1-2 quarter turns/day (quarter turn = 0.25 mm)

● Tx time 2-4 weeks

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10
Q

■ SPE =

A

1 quarter turn every other day

● Tx time 4-8 weeks

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11
Q

Max constriction treatment
adolescent
○ Retention for

A

3 months

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12
Q

Max constriction treatment
● Adolescent:
○ Problemss:

A

■ Pain/soft tissue irritation; maxillary diastema; breakage/debonding

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13
Q

Max constriction treatment

Preadolescent w/ 1° or mixed dentition:

A

○ Lingual arch type appliances (quad helix)

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14
Q

Maxillary expansion summary:

● Relative light forces

A

○ Primary & mixed dentition
○ Lingual arch type (W-arch or Quad Helix)
○ Tx time months (usually 3 months) & retention for months
○ 50% dental & 50% skeletal change

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15
Q

Maxillary expansion summary:

● Heavy forces (Rapid or slow)

A

○ Adolescent or adult
○ Jack-screw expansion device (or heavy spring)
○ Tx lasts days/weeks & retention done for months
○ 50% dental & 50% skeletal change

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16
Q

Posterior dental crossbites etiology:

A

● Retained 1° teeth or crowding/tipped teeth (causes arch to be narrower)

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17
Q

Types of Posterior Dental Crossbites

A

● Bilateral Maxillary Constriction
● Unilateral maxillary constriction
● Max. lingual dental displacement or Mand. facial dental displacement

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18
Q

● Bilateral Maxillary Constriction -

A

symmetric maxillary arch

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19
Q

Bilateral max constriction
○ When CO = CR, there is no shift
○ When CR does NOT equal CO ⇒ teeth DON’T

A

intercuspate comfortably, so CR-CO shift leads to facial asymmetry

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20
Q

Bilateral max constriction

○ Tx ⇒

A

bilateral maxillary expansion for both

■ Doesn’t matter if CO = CR or not, as long as maxilla symmetric

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21
Q

● Unilateral maxillary constriction

A

○ Asymmetric maxillary arch & CR = CO

○

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22
Q

● Unilateral maxillary constriction

Tx ⇒

A

Asymmetric maxillary expansion

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23
Q

● Max. lingual dental displacement or Mand. facial dental displacement
○ Tx ⇒

A

max & mand dental movement with cross elastics

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24
Q

Dental Posterior Crossbite - posterior tooth position analysis
● Maxillary arch ideal alignment

A

○ central grooves should align & there is buccal offset of 2° 1rst molar

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25
Q

● Mandibular arch ideal alignment

A

○ Central grooves & buccal cusps should align

○ Offset of 1rst molar

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26
Q

Rationale for treating posterior dental crossbite - 90% success rate
● Improves

A

underlying premolar position (if moving 1° teeth)

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27
Q

Rationale for treating posterior dental crossbite - 90% success rate

● Increase

A

arch perimeter

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28
Q

Rationale for treating posterior dental crossbite - 90% success rate
● Reduce

A

abrasion (esp. In anteriors as pt moves from CR - CO

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29
Q

Rationale for treating posterior dental crossbite - 90% success rate

● Eliminates

A

CR-CO shifts (simplifies diagnosis & reduces potential for asymmetric growth)

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30
Q

Pediatric Posterior Crossbite Correction:

A

W arch or quad helix

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31
Q

Bilateral max constriction with CO-CR shift ⇒ Tx with

A

W-arch (pediatric0

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32
Q

● W-arch:

○ Reciprocal

A

anchorage

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33
Q

● W-arch:

○ W-configuration →

A

increases wire length ( ↑ flexibility)

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34
Q

● W-arch:

○ Force applied near

A

palatal CEJ (not thru Cres)

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35
Q

● W-arch:

■ Compression on

A

facial surfaces of molars

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36
Q

● W-arch:

■ 50%

A

skeletal & 50% dental

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37
Q

● W-arch:

○ Fabrication ⇒

A

1rst molars to place band

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38
Q

● W-arch:

○ Treatment ⇒

A

3-4 months

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39
Q

● W-arch:

■ Adjustments made every

A

4 weeks

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40
Q

● W-arch:

■ Goal to have teeth on

A

both sides overcorrected - should have overjet in max. arch

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41
Q

● W-arch:

○ Retention ⇒

A

~ 3 months (will relapse into normal occlusion)

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42
Q

Bilateral max constriction with finger habit ⇒ Tx with

A

Quad Helix

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43
Q

● Quad Helix

○ Reciprocal

A

anchorage

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44
Q

● Quad Helix

○ Quad wire

A

(increases length); wire 038SS (needs to provide orthopedic forces)

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45
Q

● Quad Helix○ Treatment duration & goal same as

A

W-arch

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46
Q

● Quad Helix

○ Only issue may be patient compliance →

A

pt may bend lingual wire

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47
Q

Cross-Elastics

● Treats

A

max. lingual & mand. facial displacement

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48
Q

Cross-Elastics

● Biomechanics ⇒

A

moves upper posteriors facially & lower posteriors lingually

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49
Q

Cross-Elastics

○ Reciprocal forces corrects

A

cross bite & extrudes tooth (may cause open bite)

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50
Q

Cross-Elastics

● Tx for

A

several weeks (if compliant)

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51
Q

Cross-Elastics

○ Worn all times, except

A

when eating

52
Q

Cross-Elastics

○ No retention -

A

overcorrect & rebound should normalize occlusion

53
Q

Anterior crossbite =

A

negative overjet (< 5% population)

54
Q

● Only treat dental anterior crossbite

A 
(Skeletal class I with class III molar + negative overjet)
○	If straight or concave profile as well → likely skeletal class III
55
Q 
Cephalometric analysis:
●	Skeletal class III  ⇒
A

SNA reduced; SNB increased; ANB reduced

56
Q 
●	Dental anterior crossbite (class I skeletal)
○	1 to FH (or SN)  ⇒
A

retrusive

57
Q 
●	Dental anterior crossbite (class I skeletal)
○	1 to mandibular plane  ⇒
A

protrusive

58
Q

Dental anterior crossbite etiology:

A

● Tooth bud position; ectopic eruption; retained 1° teeth; supernumerary teeth
● Trauma, crowding
● Pseudo Class III

59
Q

● Pseudo Class III

A

○ Class I, but interference causes CR-CO shift leading to anterior crossbite

60
Q

Dental anterior crossbite treatment:

● Removable appliance ⇒

A

if only tipping movement needed

61
Q

Dental anterior crossbite treatment:● Extraction ⇒

A

gives lingually erupting tooth space to erupt more facially

62
Q

Dental anterior crossbite treatment:
○ Max. removable with double helical cantilever
■ Steel

A

round wire .022

63
Q

Dental anterior crossbite treatment:
○ Max. removable with double helical cantilever
● Double helix →

A

increases length, thus ↑ range & springiness

64
Q

Dental anterior crossbite treatment:
○ Max. removable with double helical cantilever
● If too small →

A

deformed by pt; if too big → heavy forces

65
Q

Dental anterior crossbite treatment:
○ Max. removable with double helical cantilever
■ Biomechanics ⇒

A

Uncontrolled tipping force

66
Q

Dental anterior crossbite treatment:
○ Max. removable with double helical cantilever

● Force applied

A

lingually

67
Q

Dental anterior crossbite treatment:
○ Max. removable with double helical cantilever
● Retention via

A

adams clasps (Lots of retention required; many clasps)

68
Q

vDental anterior crossbite treatment:
○ Max. removable with double helical cantilever

● Anchorage to teeth that are

A

clasped (No anchorage from palate)

69
Q

Dental anterior crossbite treatment:
○ Max. removable with double helical cantilever

○ If anterior teeth were moving lingually, there would be anchorage on

A

palate (but NOT facially)

70
Q

Dental anterior crossbite treatment:
○ Max. removable with double helical cantilever

● No labial bow → eating)

A

common feature of removables, but labial bow interferes with desired facial movement)

71
Q

Dental anterior crossbite treatment:
○ Max. removable with double helical cantilever

■ Tx for

A

1-3 months

72
Q

Dental anterior crossbite treatment:
○ Max. removable with double helical cantilever

● Activate 2 mm →

A

gives 1 mm of movement in 1 month

73
Q

Dental anterior crossbite treatment:
○ Max. removable with double helical cantilever
● Retention for several months with

A

same appliance (not activated tho)

74
Q

Dental anterior crossbite treatment:
○ Max. removable with double helical cantilever

■ Problems with device:

A

● Not activated appropriately
● Not enough retention in device
● Compliance (should be worn always except when

75
Q

Dental anterior crossbite treatment:
○ Fixed appliance (with round wires → tipping & rotation)
■ NiTi ⇒

A

for initial movement

● Flexible with high range; Not formable

76
Q

Dental anterior crossbite treatment:
○ Fixed appliance (with round wires → tipping & rotation)
● Round wire (rectangular wire would not provide any benefit)
○ Allows for

A

rotation & sliding along wire

○ For case example, some bodily movement to close diastema

77
Q

Dental anterior crossbite treatment:
○ Fixed appliance (with round wires → tipping & rotation)

■ Biomechanics:

A

● Uncontrolled tipping
● Anchorage from adjacent teeth
● Retention via brackets/bands
● Ties with elastics or steel

78
Q

Dental anterior crossbite treatment:
○ Fixed appliance (with round wires → tipping & rotation)

■ Adjustment:
● For NiTi wires →

A

adjustments every 6-8 weeks or longer (expect ~2 mm movement); then switch to steel wire for detailing

79
Q

Dental anterior crossbite treatment:
○ Fixed appliance (with round wires → tipping & rotation)

■ Problems:

A

● Hygiene

80
Q

○ Fixed appliance for AP bodily movement:

A

■ Rectangular wire

81
Q

M-D bodily movement achieved with

A

round wire

82
Q

Vertical skeletal problems ⇒

A

long face & short face

83
Q

Vertical skeletal problems ⇒

● Long face with or without

A

anterior open bite

84
Q

Vert skeletal problems

○ Variation in

A

lower face

● Short face (deep bite) - variation in lower face

85
Q

Nhanes III:

● < 10% have deep bite

A

> 5mm

86
Q

Nhanes III:

● < 5% have

A

anterior open bite

87
Q

Ceph vertical proportions

A 
●	Mandibular plane angle
●	% face height
     ○	ANS-Me / Na-Me
●	Y-axis (growth direction)
     ○	Angle between FHP &amp; Se-Gn
88
Q

Dental open bites

● Simple open bites -

A

anterior teeth only
○ Normal transition from 1° to 2° dentition
○ Close prior to adolescence - no treatment required

89
Q

● Complex open bites

A

○ Includes posteriors
○ Fails to close prior to adolescence
○ Sometimes ass. with skeletal problems

90
Q

Dental open bite treatment:
● Erupt anteriors
○ Via

A

anterior elastics

91
Q

Dental open bite treatment:
● Intrude posteriors
○

A

High pull headgear

92
Q

Dental open bite treatment:

● Use facial proportions and lip to tooth information for

A

objective judgements

93
Q

Dental deep bite treatment:

● Posterior eruption

A

○ Via anterior bite plane

94
Q

Dental deep bite treatment:

● Level curve of spee

A

○ Reverse curve of spee with archwire - erupts middle segment

95
Q

Dental deep bite treatment:
● Intrude anterior teeth
○ Via

A

upper intrusion arch (archwire from posteriors intrudes anteriors)
○ Via lower intrusion arch

96
Q

Ankylosed 1° teeth

● 1° dentition with successors

A

○ Majority exfoliate on time & situation resolves

97
Q

Ankylosed primary teeth

● 1° dentition w/o successors

A

○ Ankylosis worsens, so when extracted greater vertical defect (greater periodontal injury & attachment loss)
○ Consider early extraction

98
Q

Basic infant reflexes ⇒

A

rooting, placing, sucking

99
Q

Infantile swallow:

A

● Tongue to lower lip

● Jaws apart & lips together

100
Q

Adult swallow

A

● Teeth together & lips relaxed

● Tongue to palate

101
Q

Adult swallow appears

A

3-10 years

102
Q

Nonnutritive sucking

A

● Normal childhood behavior (50-60% at age 1); relationship to breast/bottle feeding unclear

103
Q

Nonnutritive sucking

● Spontaneously ends by

A

2-4 years (70-80% by 5 or 6)

104
Q

Nonnutritive sucking

○ Persistent digit habits more common in

A

females

105
Q

Nonnutritive sucking

● Dental effects based on

A

equilibrium theory

106
Q

Nonnutritive sucking

○ Equilibrium theory ⇒

A

Light continuous forces move teeth & elimination of light continuous forces move teeth (go back to original position)

107
Q

Nonnutritive sucking

● Ideally, intervention precedes

A

permanent dentition

○ Anterior open bite with 1° dentition will close when 2° dentition erupts (if habit stopped)

108
Q

Thumb sucking →

A

uppers proclined & lowers retroclined ( ↑ overjet); possible intrusion

109
Q

Thumb sucking →

A

● Asymmetric or symmetric open bite
● Maxillary constriction
● Sucked finger usually clean

110
Q

Nonnutritive sucking

Treatment:

A 
●	Counseling (if near adolescence)
●	Rewards
●	Reminders
●	Adjunctive therapy:
○	Fixed appliance  ⇒  reminder/obstruction
111
Q

Nonnutritive sucking

● Adjunctive therapy:

A

○ Elastic bandage ⇒ around elbow; only at night
■ Bulkiness reminds child; not a tight restraint
■ For 6-8 weeks

112
Q

Nonnutritive sucking

○ Fixed appliance ⇒

A

reminder/obstruction

113
Q

Nonnutritive sucking
Fixed appliance
■ Band

A

6’s or E’s (reduces length of moment arm, thus less flexible)

114
Q

Nonnutritive sucking
Fixed appliance
■ Consider

A

quad helix is posterior crossbite present

115
Q

Nonnutritive sucking
Fixed appliance

● Anterior helixes would disrupt

A

habit

116
Q

Nonnutritive sucking
Fixed appliance

■ Maintained 6 months following

A

termination of habit (prevents relapse)

117
Q

Nonnutritive sucking
Fixed appliance

● Few

A

replacement habits; not often

118
Q

Pacifiers:

A

● All designs comparable & produce dental changes if used long enough

119
Q

Pacifiers

● Dental effects:

A

○ Symmetric open bite

○ Maxillary constriction

120
Q

Post-habit spontaneous dental changes

A

● When habit stopped, dental changes reverse

121
Q

● Traumatic intrusion:

○ May lead to

A

pulpal necrosis

122
Q

● Traumatic intrusion:

○ Orthodontic extrusion can allow for

A

endodontic access

123
Q

● Traumatic intrusion:

○ Surgical intervention for

A

intrusion > 6 mm

124
Q

● Don’t treat deep bite in

A

mixed dentition → unless soft tissue trauma

125
Q

Treatment options for ankylosed 2nd 1° molars without successors:

A

● Maintain 1° molars (if no bony defects)
● Extraction before vertical discrepancy too great
● Decoronation - remove crown & leave root tip (facilitates vertical bone growth)

126
Q

Spontaneous correction of ectopic eruption depends on

A

how far ectopic & angle

Ortho Final (8 decks)

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