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Ortho Final > 2B > Flashcards

2B Flashcards

1
Q

Clear aligners

A

● Esthetics highly valued in US more than other countries

○ Treatment is becoming more esthetic → colorful ties; shaped brackets; ceramic brackets/wires; clear braces (aligners)

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2
Q

● Adult vs. Child acceptability of orthodontic appliances:

A

○ Clear trays & ceramic were esthetically acceptable for both child & adult
○ Stainless steel was acceptable for child 70%, but only 50% for adults

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3
Q

Clear aligner advantages:

A

● Esthetics
● Hygiene (bc removable)
● Comfort
● Tooth movements (intrusion of posteriors; other movements more difficult)

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4
Q

Clear aligner Limitations:
● Tooth movements:
○ Translation →

A

difficult to put force & moment with plastic tray

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5
Q

Clear aligner Limitations:
● Tooth movements:
■ Tipping & uprighting

A

easier to achieve

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6
Q

Clear aligner Limitations:
● Tooth movements:
○ Rotation →

A

difficult; possible to rotate round teeth

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7
Q

Clear aligner Limitations:
● Tooth movements:

○ Extrusion →

A

very difficult; esp. for triangular shaped teeth like incisors (only a small area of undercut to grab onto)

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8
Q

Clear aligner Limitations:

● Speed ⇒

A

0.25mm/aligner

○ Often changed 2x month, so total 0.5mm/month

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9
Q

■ Speed disadvantage is overcome when you have

A

multiple movements going on at once, ie. intrusion on some teeth, extrusion & rotation on other teeth)

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10
Q

○ Conventional braces ⇒

A

1mm/month

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11
Q

Clear aligner

● Expense -

A

neutral

○ Added lab expense, but reduced treatment time & less frequent readjustments

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12
Q

Invisalign Process (submitting to company):

A
  1. PVS impression (or intra-oral digital scan) & bite registration
    ● PVS impression of uppers & lowers (even if only treating 1 arch)
    ○ Tray needs to reach distal of terminal molar
    ○ Don’t need to capture palate
    ○ Seat impression vertically without tilting (unlike seating alginate posterior to anterior to express excess)
  2. Panoramic radiograph or full mouth series
  3. Extra & intra-oral photographs
  4. Prescription form (online submission)

Bit registration & panoramic/full mouth series no longer required

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13
Q

Invisalign treatment options:

● Express ⇒ maximum

A

10 stages with some clinical restrictions
○ Maximum extrusion of 0.5mm
○ Max. posterior extrusion of 0.5 mm
○ Max. interproximal reduction of 2mm per arch (treats 2 mm of crowding)
○ No sagittal (AP) corrections required

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14
Q

Invisalign treatment options:

● Full ⇒

A

unlimited stages; up to 3 refinements & mid-course corrections available

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15
Q

Invisalign treatment options:

● Teen ⇒

A

similar to full

○ Has compliance indicators & eruption tabs (maintains space for eruption)

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16
Q

Invisalign treatment options:

● Assist ⇒

A

reboot treatment or have more checkpoints

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17
Q

Invisalign:

● Choose where to place

A

attachments (composite buttons placed to facilitate movement of teeth

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18
Q

Invisalign:

○ Don’t place attachments on

A

implants, 3 unit bridges, or ceramic crowns (will have to repolish)

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19
Q

Invisalign:

● Treatment will affect

A

overbite/overjet & midline - program shows resulting changes after alignment

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20
Q

Invisalign:

○ Interproximal reduction may be necessary to maintain

A

initial position

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21
Q

Invisalign:

● For pts with spacing →

A

can close all spaces or maintain spaces (for implants, etc)

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22
Q

Invisalign:

● For pts with crowding → can correct

A

via lateral expansion of molars/premolars

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23
Q

Invisalign:

● Need to check how they plan to move

A

teeth (some movements are not easily done with invisalign)

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24
Q

Invisalign works like a

A

flexible archwire
● Amount of force determined by amount of distortion & tray material
● Attachments help direct the forces

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25
Q

Before choosing to procline teeth to correct crowding, make sure there’s no

A

recession

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26
Q

Normal physiology of sleep:

● Characterized by

A

decreased body temp, metabolic rate, sympathetics, but active brain

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27
Q

Sleep

○ Decreased sympathetics:

A

↓ HR, BP, RR

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28
Q

Sleep

● Not a ‘time out’ ⇒

A

increased parasympathetics & GH secretion

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29
Q

Non-REM sleep

A

● 3 stages ranging from light dozing to deep sleep

● 75% of sleep

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30
Q

REM (rapid eye movement) sleep

A

● 25% of sleep
● Dreaming occurs
● Characterized by eyelid fluttering, rapid eye movement, irregular breathing
○ Muscle paralysis (prevents moving during dreams)
○ ↓ body temp & changes in HR & BP

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31
Q

Sleep deprivation ⇒ leads to

A

excessive daytime sleepiness (falling asleep during day)

32
Q

● Sleeping < 7 hours ⇒

A

increases risk of falling asleep during day, while driving, & snoring
● Sleep deprivation affects mood & performance

33
Q

Sleep deprivation

● Causes:

A 
○	Voluntary behavior (most common cause)
○	Medical:
■	Dyssomnias ⇒ 
■	Parasomnias ⇒  
■	Medica/psychiatric ⇒
34
Q

■ Dyssomnias ⇒

A

insomnia; narcolepsy, restless leg syndrome, sleep disordered breathing)

35
Q

■ Parasomnias ⇒

A

sleepwalking; bruxism

36
Q

■ Medica/psychiatric ⇒

A

anxiety; depression

37
Q

Continuum of Sleep disordered breathing:

A

● Normal
● Non-sleepy snorer

● Sleepy snorer (Upper Airway Resistance Syndrome)

● Obstructive Sleep apnea (OSA)

38
Q

● Non-sleepy snorer

A

○ Snoring bc windpipe closes slightly during sleep when muscles relax

39
Q

● Sleepy snorer (Upper Airway Resistance Syndrome)

A

○ Smaller windpipe causes inflammation - airway size disturbs sleep

40
Q

Apnea ⇒ cessation of breathing

A

> 10sec

41
Q

Hypoapnea ⇒

A

decreased airflow (30 or 50%) ass. with O2 desaturation of 3-4%

42
Q

Apnea-Hypopnea Index (AHI) =

A

total # of apnea + hypopnea / hours of sleep

43
Q

● Severity of sleep apnea:

A

○ Normal < 5
○ Mild 5-14; Moderate 15-30
○ Severe > 30

44
Q

Normal sleep O2 saturation =

A

94-98%

45
Q

All O2 desaturations

A

90% medically significant

46
Q

OSA ⇒ AHI at least

A

5 + daytime somnolence

47
Q

OSA:

● Prevalence:

A

○ More common in males

○ Worsens with age & increasing weight

48
Q

Obstructive Sleep Apnea:

● Breathing disorder with

A

intermittent hypoxemia & sleep arousals

49
Q

Obstructive Sleep Apnea

○ Apnea →

A

Hypoxia/hypercapnia stimulates sympathetic response → increases ventilatory effort & causes arousal from sleep

50
Q

Obstructive Sleep Apnea

○ Increased sympathetics →

A

cardiovascular complications

51
Q

Obstructive Sleep Apnea

Causes:

A

○ Anatomic airway narrowing
■ Obstruction can be in nasopharynx; oropharynx (70%), hypopharynx
○ Sleep induced loss of muscle tone
■ Neuromuscular compensatory mechanisms keep airway open when awake
○ Insufficient dilator muscle contraction

52
Q

Obstructive Sleep Apnea

● Clinical consequences:

A

○ Excessive daytime sleepiness (affects mood & 2x likely for car accident)
○ Increased sympathetic tone → increases risk for HTN, coronary artery disease, CHF

53
Q

Obstructive Sleep Apnea

■ Treatment of OSA with CPAP reduces

A

HTN

54
Q

Obstructive Sleep Apnea

Comorbidities ass. with OSA:

A 
○	Drug resistant HTN (83%)  -   uncontrolled by 2+ antihypertensives
○	Obesity (77%)
○	Congestive heart failure (76%)
○	Diabetes (50%)
○	Benign HTN (37%)
55
Q

Obstructive Sleep Apnea

● Risk factors for sleep apnea:

A

○ Obesity
■ Neck size better predictor than BMI
● 17+ inches in males & 16+ inches in females increases likelihood of OSA
■ Biggest risk factor for adults, but NOT elderly ( ↓ muscle tone) or children (tonsillar hypertrophy)
○ Increasing age
○ Family history - bc heritable skeletal relationships
○ Smoking & alcohol use (depresses CNS)

56
Q

Obstructive Sleep Apnea

● Findings in clinical examination:

A

○ Retrognathia (increased overjet bc small mandible)
○ Macroglossia
○ Lateral peritonsillar narrowing

57
Q

Metabolic syndrome ⇒

A

group of risk factors that occur together & ↑ risk of CAD, stroke, DM Type II

58
Q

Metabolic syndrome

● Diabetes, impaired glucose tolerance, insulin resistance AND 2 of the following:

A

○ HTN
○ Dyslipidemia
○ Central obesity
○ Microalbuminuria

59
Q

Pediatric sleep apnea ⇒

A

AHI 1 or greater considered OSA; (fussy rather than sleepy throughout day)

60
Q

STOP-BANG model questionnaire:

A 
●	Snoring loudly?
●	Tired during day?
●	Has anyone Observed you stop breathing during sleep?
●	High blood Pressure
●	BMI > 35?
●	Age > 50?
●	Neck circumference greater than 40 cm (16 in)?
●	Gender
61
Q

High risk of OSA if

A

AHI >5 with 3+ above items

● Note: signs & symptoms poorly predict disease severity

62
Q

Diagnosis with Polysomnography

● EGG ⇒

A

monitors brain activity to document sleeps stages

63
Q

Diagnosis with Polysomnography

● EOG ⇒

A

eye movements - determines REM vs. non-REM sleep

64
Q

Diagnosis with Polysomnography

● Nasal/oral capnography ⇒

A

measures air flow from nose & mouth

65
Q

Diagnosis with Polysomnography

● EMG ⇒

A

muscle activity; bruxism & restless leg syndrome

66
Q

Diagnosis with Polysomnography

● EMG ⇒

A

muscle activity; bruxism & restless leg syndrome

67
Q

● Lingual constriction has highest accuracy for

A

invisalign

68
Q

OSA treatment:

● Oral appliance - Mandibular advancement devices

A

○ Advances lower jaw, pulling tongue forward & stretching dilators of pharynx
○ Alternative for patients who won’t tolerate CPAP
○ Indicated for snoring & non-severe apnea

69
Q

OSA treatment:
Mand advancement devices
■ Effective for

A

mild-moderate sleep apnea (less effective for severe)

70
Q

OSA treatment:
Mand advancement devices
■ Improves

A

AHI & EDS, but no effect on blood pressure

71
Q

OSA treatment:
Mand advancement devices
○ Side effects ⇒

A

TMJ/tooth discomfort; changes in occlusion

72
Q

OSA treatment:
Mand advancement devices
○ Contraindications:

A

■ <5 teeth per quadrant (excluding 3rd molars & fixed bridges)
■ Periodontal disease or dental caries
■ TMJ disorder; Inadequate jaw opening for fitting
■ <3 mm of voluntary jaw protrusion
■ < 6-10 teeth per arch
■ Bruxism? - may be indicator

73
Q

OSA treatment:
Mand advancement devices
○ Treatment end point:

A

■ At least 7mm or 75% protrusion

■ Continue advancing till snoring & apnea subjectively resolves

74
Q

OSA treatment:

● Upper airway surgery

A

○ Uvulopalatopharyngoplasty (UPPP)
■ Limited success ~40%
■ Unsuccessful for Type 2 or 3 obstruction (retropalatal / retrolingual)

75
Q

OSA treatment:● Nasal CPAP

○

A

Gold standard, but poor compliance unless severe

Ortho Final (8 decks)

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