2. Orthodontics I Flashcards
• Had to use ____ to place the bands
• Used phosphate cements instead of the current cements (now they have fluoride)
○ ____ below the bands have decreased
• ____ brackets are common in older patients
○ Stain resistant
• Self ligating brackets (on the right)
○ ____ brackets - have a cover slip that locks the wire in place vs the conventional rubber band that ligates the wire into the slot
separators
calcifications
ceramic
damon
• Fixed palatal expanders - bands cemented on posterior teeth and expanison in the center (____) that gives tranverse width expansion
○ Used ideally in ____ treatment to create space and avoid posterior ____
• Fixed category
○ Space maker appliances - lingual holding arch
§ Has bands around posterior space
§ Maintains arch ____ in order to conserve primary molar space
jack screw
early
crossbites
perimeter
• Work with OS to uncover palately exposed tooth
○ If no ____ assistance, can never get the tooth in its proper place
surgeon
• Removable
○ Conventional hawley appliance
○ Most commonly used as ____/fixed ortho treatment
• Can add ____ and finger springs in order to get desired tooth movement
post treatment retention
jack screws
• Corrective aligners - invisalign
○ Comprehensive treatment modality
○ Series of aligner trays that move the teeth in small increments over time
§ Changed every ____ weeks
○ Initial scan/impression > invisalign > virtualized version of tooth movement sent back > amend things that practioners change (number of ____, stages of tooth movement)
○ Esthetic and ____ benefit; but patients don’t wear ____ hours a day > cannot get a result close to braces
Bodily movements [???]
• Semi removable - head gear
○ Face bow and a head band
○ [???]
1-2
changes
hygienic
24
• Bands set on posterior teeth
• Bow on labial bow (similar to facebow of headgear)
• Takes away labial and buccal ____ around dentition to allow for arch development
○ Narrowness in ____ segments
○ Teeth are retroclined and set back > allows for ____ arch development
musculature
posterior
passive
- Maloocclusion
- ____ is shifted 3mm to right hand side; primary canine is still present
- Max lateral incisor is ____
maxillary midline
undersized
- Undersized L lateral incisor
* Primary canine with no sign of permanent ____
canine/lateral incisor
- Under primary canine is perm canine
- Missing the lateral, OH NOES!
- Third molars are developing
- Do we substitute the canine for the lateral? Do we make space for the lateral and move canine back?
YAY
• ____ give evaluiont into skeletal arrangement
cephalometrics
- 20 ____ (10 max 10 man)
- Interdental spacing
- 11-12+ phase ____ (comprehensive treatment)
primary
II
• Less interdental spacing
• Maxillary aspect, the posterior segments have a narrow inclination
○ Maxillary arch constriction
○ No crossbites of posteriors
• Consider both cases
○ Higher probability - less space
§ No interdental space > FOR SURE going to have a ____ problem that you will have to handle once reaching mixed dentition
○ Would rather have as much ____ as possible - when perm’s replace > will be large > the extra space will allow more space
crowding
space
- At 7 y/o - early mixed dentition
- Perm ____ in
- Exfoliated of six primaries - emergence of permanent first molars
- Recommendation of AAO > treat patients in interceptive manner at ____, but not every patient needs treatment at same time
first molars
7
• 8 y/o
• Early mixed dentition
○ Exfoliated prim laterals, and centrals and same in man
○ Perm first molars emerged
• ____
○ Bites in MIC > upper right CI is locked behind man CI
• Definitely ____ the patient (interceptive treatment)
○ If left in this scenario:
§ Patients who are younger are more amenable to ____ > maximize orthopedic potential and allow for teeth to come into better placement > do not have luxury on patients who are older (fusion on mid palatal suture)
§ Patient will be more susceptible to ____
§ ____ wear on max incisor
§ Perio: when patient in MIC > the lower CI > can procline and come forward even more > ____
anterior crossbite treat palatal expanders caries facial recession
- ____ is set to keep a palatal force on CI to bring it labial
- ____ built on to increase arch perimeter
finger spring
jack screw
• Increasing perimeter (with ____ expansion) to give room for lat incisor, and the sagittal dental correction (finger spring) to fix the ____
• Most patients still need future treatment > so many factors:
○ Replacement of teeth
○ Aspects of functional occlusion
transverse
crossbite
• Anterior crossbite, spacing
• Open bite (on bottom)
• Dental, skeletal problem?
• Class III diagnosis
○ Is it dental? Molar/canine relationship?
○ Is it skeletal? Mismatch of maxilla and mandible?
YAY
Orthodontic Classification Developed by \_\_\_\_ Originally based upon the relationship between the \_\_\_\_ \_\_\_\_ groups of occlusion
edward angle
first molars
four
Normal occlusion
• [???] • Max-canine relationship ○ Cusp of canine sits in between embrasure between \_\_\_\_ and \_\_\_\_
mandibular first PM
canine
Class I malocclusion
• Identical molar relationship of original • Max-man anterior \_\_\_\_ • Increase \_\_\_\_ from CI • Most common malocclusion in \_\_\_\_ ○ Other parts of world > different forms of malocclusion
crowding
overjet
north america
Class II malocclusion (division 1 and 2)
• Different molar relationship all together ○ MB of man molar sits \_\_\_\_ to the buccal groove ○ Max canine is a full step \_\_\_\_ of where it should be (should be in embrasure between PM and canine) • Div 1 vs 2 ○ Position of the maxillary \_\_\_\_ ○ I: excess \_\_\_\_, spacing between teeth or teeth can be well \_\_\_\_ ○ II: minimal overjet, often \_\_\_\_ bite, and the LI are normally \_\_\_\_ or proclined; CI have a \_\_\_\_ back position to them
anterior ahead incisors overjet aligned deeper inclined tipped
Class III malocclusion
• Opposite of Class II ○ MB of max molar sits \_\_\_\_ to the buccal groove ○ Canine is also \_\_\_\_ to the the canine/PM
distal
distal
History of Cephalometrics 1931 \_\_\_\_ (United States) 1931 \_\_\_\_ (Germany) Primarily a\_\_\_\_ tool \_\_\_\_ radiographic technique
broadbent
hofrath
research
standardized
• Purpose on stadnardizing on film of 2D
○ ____ distance from x-ray source to the sensor/cassette
○ Why? > compare ____ ceph’s in order to see what changes have occurred
fixed
pre- and post-treatment
Types of Cephalometric Radiographs
n Lateral
–____
n Posteroanterior
–____
• \_\_\_\_ radiographs
sagittal and vertical
transverse and vertical
2D
• Lateral ceph
○ ____
○ ____ dimension
front to back
vertical
• PA ceph
○ ____ width as it relates to mandible
• Need ____ 2D radiographs to give the 3D aspect
transverse
two
Horizontal Reference Planes
Anterior Cranial Base (____)
Frankfort Horizontal (____)
Palatal Plane (____)
Occlusal Plane
Mandibular Plane (____)
• HRP - connect two points to give basis of other points ○ 4/5 of have specific landmarks that denote the HRP • OP > going from \_\_\_\_ > doesn't have any \_\_\_\_
MANDIBLE 1. Mandibular pts hv higher probabilities of location bc no \_\_\_\_. 2. Bone type makes a difference. Here we have cortical bone, which is much more defined than cancellous bone that can be masked by \_\_\_\_ (e.g. maxilla)
sella to nasion
porion to orbitale
posterior nasal spine to anterior nasal spine
gonion to gnathion or lower mandibular border
superior to inferior
landmarks
overlying structures
connective tissue and musculature
- Most superior HRP > ____
- Second > ____
- Next > ____ plane
- Next > ____ plane (no landmarks)
- Last > ____ plane
sella to nasion porion to orbitale palatal occlusal mandibular
Cephalometric Analyses
n 2 Types of Measurements ANGULAR (in ____) LINEAR (in ____)
n Evaluation of ____, DENTOALVEOLAR & ____
n Various Analyses
degrees
millimeters
skeletal
profile esthetics
Evaluation of the Sagittal Dimension
n SKELETAL Evaluation Class I
Class II Class III
n DENTOALVEOLAR Evaluation
• Apply angle classification to skeletal aspects for patient ○ I, II, or III? Apply to \_\_\_\_ aspects
skeletal
Angle Classification
Originally, ____ relationship
CEPHALOMETRICS; Applied to ____ SKELETAL MALALIGNMENT
molar
sagittal
Which structures are contributing to the problem?
Good max/mand alignment; but max teeth are ____
Upper teeth line up well with maxilla, but it’s ahead of the ____
Mandibular teeth are ____; everything else is in good alignment
____ mandible (underdeveloped) though everything is aligned properly
proclined
mandible
retroclined
retrognathic
Class I skeletal
◼ Maxilla & Mandible are ____
well-aligned
ANB ANGLE
◼ Evaluates the magnitude of the discrepancy between the ____
In Class I, ANB angle is minimal ~____o (normal), so ____ should sit 2o ahead of B pt when we measure.
maxilla and mandible
2
maxilla
Class II skeletal ◼ Maxilla & Mandible MALALIGNED cDue to: 1. \_\_\_\_ Protrusion 2. Mandibular \_\_\_\_ 3. Combination of Above
maxillary
retrognathia
Figure 3
• Measure ANB ○ More signifcant angle than in Fig 2 § Now have an \_\_\_\_ degree angle: □ \_\_\_\_ discrepancy □ CANNOT MAKE ANY MORE INFERENCES - only tells \_\_\_\_ is well ahead of mandible ® But it can be ANY of the three \_\_\_\_ from above
8
class II
maxilla
criteria
• How to determine fault is in max or man
○ Look at two more angles > ____ angles
§ Looking at HRP
• Anterior cranial base (____) to look at maxilla separate form mandible
○ SNA
• SNA
○ 83 dgerees, should be ____
SNA Angle
n Evaluates the position of the ____ using the anterior cranial base (Sella- Nasion) as a reference plane
SNA and SNB
sella to nasion
82
maxilla
SNB Angle
n Evaluates the position of the ____ using the anterior cranial base (____) as a reference plane
• USE TO TEST MANDIBULAR VERSION2
• Now 75 degrees in comparsion to ____ degrees
○ Much lesser now
• WE NOW KNOW THE CLASS II IS DUE TO ____ MANDIBLE
○ The three angles (sagittal), and how the maxilla aligns to the mandible
mandible
sella to nasion
80
retrognathic
Class III skeletal n Maxilla & Mandible MALALIGNED Due to: 1. Maxillary \_\_\_\_ 2. Mandibular \_\_\_\_ 3. Combination of Above
retrusion
prognathia
Figure 4
• A point sits well behind B point > -8 (but should be \_\_\_\_) ○ The converse of the class II patient • Use SNA and SNB to determine the jaw at fault ○ SNA: 73 ○ SNB: 81 § The problem has to do with the fact that that maxilla is \_\_\_\_
+2
retrognathic
Dentoalveolar Evaluation (Maxillary)
n Angular Measurement (\_\_\_\_) Describes how the tooth is \_\_\_\_ Described as: PROCLINED RETROCLINED NORMAL INCLINATION
incisor to nasion-A
tipped
Figure 5
• Measure is 37; the norm should be \_\_\_\_ degrees ○ These teeth are much more flared \_\_\_\_ (the greater the angle) ○ In order to get teeth back into more ideal position > decrease the angle by 15 degrees
22
forward
Dentoalveolar Evaluation (Maxillary) n Linear Measurement (\_\_\_\_) Describes how the tooth is related to its \_\_\_\_ Described as: PROCUMBENT RECUMBENT NORMAL POSITION
incisor to nasion-A
supporting bone
Figure 5
• Measurement is 7mm, normally it should be \_\_\_\_mm ○ The teeth are \_\_\_\_ positioned forward compared to the skeletal/maxilla itself
4
bodily
Dentoalveolar Evaluation (Mandibular)
n Angular Measurement (____) Describes how the tooth is ____
Described as:
PROCLINED RETROCLINED NORMAL INCLINATION
Figure 6
• Measure is 34 degrees, and 8mm from incisor
○ Normal should ____ degrees, and ____mm like the maxillary aspect
incisor to nasion-B
24
4
Dentoalveolar Evaluation (Mandibular)
n Linear Measurement (____)
Describes how the tooth is related to its ____ Described as:
PROCUMBENT RECUMBENT NORMAL POSITION
incisor to nasion-B
supporting bone
Dentoalveolar Evaluation (Mandibular)
n Angular Measurement (____)
Describes how the tooth is ____ Described as: PROCLINED RETROCLINED
NORMAL INCLINATION
• Intersection of line through ____ of incisor, and line of anteiror plane
• Should be 87 degrees/90 degrees
○ Important angle > in past > essential angle orthodontically because some practioners thought if angle was violated to ____ > unstable teeth and much greater tendency of relapsing and things ____ back
incisor to Go-Gn
tipped
95+
shifting
Evaluation of the Vertical Dimension
n Evaluates ____ pattern
n ____
Described as: HIGH PLANE ANGLE
LOW PLANE ANGLE
NORMAL PLANE ANGLE
Bill has a very low, flat mandibular plane angle and will have a tendency toward
counter-clockwise growth, more towards a ____ face height.
Conversely, Vanessa has a steep mandibular plane angle and thus greater lower and
higher face heights in proportion to middle third. The tendency is towards a
clockwise, or ____ mandibular growth pattern. So the vertical aspect is not just
one dimension, but is dynamically related to the other dimensions as well.
Ppl w steeper Mandibular plane angles are also more susceptible to an ____ bite tendency. We’d want to target extruding posterior teeth which can produce a more significant
anterior overbite.
vertical skeletal
mandibular plane to frankfort horizontal
Evaluation of Profile Esthetics n Evaluation of the patient’s lips to the E-line (\_\_\_\_) Described as: \_\_\_\_ RETRUSIVE NORMAL
E-line: consists of the most forward position of the ____ in relation to the most forward position of the mandibular lip along with tangents to the tips of the nose and chin
This patient has positive values. There are normal values, but also negative ones. In the past, it was ideal for the lips to be behind the E-line, but now we prefer the lips to be on the line, or slightly____ of the line
esthetic line
protrusive
maxillary lip
Advantages of Cephalometrics
◼ Evaluation of ____L relationships
◼ Assessment of ____
◼ Assessment of ____
◼ ____ of treatment effects with growth & surgical
treatment
—We use cephmetrics when a patient requires corrective jaw surgery to give us and pinpoint how we really want the maxilla and mandible to move. Is it a one jaw, or 2 draw surgery? It helps us quantify how much movement we need specifically in the mandible and maxilla.
◼ evaluation of ____
skeletal dental treatment effects prediction pathology
Disadvantages of Cephalometrics
◼ 3-DIMENSIONAL patient portrayed on a 2-dimensional film
–Because when you
superimpose 3D images into 2D, esp structures with varying bone densities, ____ can result.
◼ ERRORS in ____
◼ Difficulty in developing ____
–When comparing the ceph angles, normative values will differ based on ____. Must be aware of this. Mixed race ppl may defy any particular set of norms. So how do you evaluate and treat Pt?
inaccuracies and distortions
measurement
normative data
race
CBCT
Provides cone-shaped x-ray beam versus linear beam In conventional radiography
____ digital image with high ____
____ radiation emission versus conventional CT scan
____ cost for equipment (~$150,000ormoretoinstall)
Newer ____ for ceph analyses
With this very precise technology, we expect the normative values to change and refine over time.
3D resolution lower high standardization
We can even make specific cuts to give us what you would have with conventional 2D radiography, but main use of CBCT is to locate ____ teeth, specific ____ issues for certain teeth.
malpositioned
angulation
Still the elephant in the room concerns how much ___ the patient is exposed to. It’s much less than medical CT’s but greater than some aspects of ___.
UV
conventional 2D radiography
____ to locate ceph points using digital radiographs
You still have to locate the points, but the values will be given to you, making this process much faster.
We can even lay over Patient profiles and simulate ____ outcomes for them to view.
faster
patient
Postero-anterior Ceph
Evaluates the ____ dimension
Uses the ____
Evaluates the skeletal width of the ____ to the mandible
skeletal transverse
rocky mountain transverse analysis
maxilla
Lateral ceph is limited in the sense that it only gives you the ____. But, if we also want to look at the transverse skeletal aspect, we need to take a ____ (e.g. PA or AP cut of CBCT).
sagittal
PA ceph
Orthodontic Records
Study models/Digital 3D intraoral scan
____
Periapical & Bitewing Radiographs
____Photographs
Lateral Cephalometric Radiograph
____ Radiograph or CBCT
panorex
intraoral & extraoral
posteroanterior cephalometric
____ due to maxilla itself is further ahead than where it should be
Angle of upper incisors in comparison to the norm, we see a lot of ____ , teeth that are tipped forward.
Lower are a bit ____ but still central incisors are close to the norm; we’re just lacking space for the lateral lower incisors. So, we need to make space to bring them forward.
class II
proclination
retroclined
TREATMENT:
Removed all her ____ (4 total)
With fixed appliances, we created space for her ____
We’re attracting mandibular canines to the positions of the extracted premolars.
____ have been brought forward and look “good” positionally. However, their roots are still in the back.
So, bear in mind, some tx, like Invisalign, are limited in ____ movement potential.
Correcting the root position requires stronger, ____
wires to do
first premolars lat incisors lat incisors crown-root rectangular
JOSH
Extraoral Eval. (profile)
- outline: extremely convex
- nasolabial angle: WNL
- soft-tissue chin: adequate
- lip posture: competent
Presents with this malocclusion: minimal ____ (~3mm); ____ shift quite a bit to his right
overjet
midline
JOSH
We see a ____molar relationship (mesial buccal cusp of max molar sits well ahead of where the buccal groove should be. Max canine is almost blocked out bc no space between 1st premolar and lateral incisor.
class II
From ceph details, we find cause of malocclusion to be ____. Unlike Kathleen, bc he’s 16/17, we don’t anticipate any more ____ growth, which in some cases may correct the problem.
Upper incisors are ____, hence, the minimized overbite of 3mm.
retrognathic mandible
developmental
retroclined
JOSH TREATMENT
Treatment: Created space for blocked out canine; retained ____ molar relationshp.
We now have a Class II “canine” relationship - the max canine should be sitting between lower canine and premolar. The overjet has increased significantly improving the ____
The patient had corrective ____ surgery (a bi-sagittal split mandibular osteotomy, a ____ advancement procedure).
class II
midline
jaw surgery
Explains what a bisagittal split mandibular osteotomy entails: 1. Remove ____ molars, 2. Split the ____, keeping ____ intact, 3. They reposition upper and lower jaws and stabilize the mandible with ____ screws.
third
mandible
infr-alveolar nerve
