31. Orthodontics II Flashcards
3 classifications of Posterior crossbites based on the cause
✅ What is the treatment?
Dental - abnormal eruption
Functional - thumbsucking habit
Skeletal - bone constriction
✅Palatal expansion
Palatal expanders for PRE-ADOLESCENT (<12 y/o)
Expansion lingual arch
W arch
Quad helix
Most common / most conservative palatal expander
Expansion lingual arch
“Modified W arch”
Indications:
✅thumbsucker
✅needs palatal expansion
Quad helix
Palatal expanders for ADOLESCENT (>12 y/o)
Jackscrew
Surgery - cleft palate
BQ: Case:
👶🏻: 4y/o
#51 = non vital; rx none; asymptomatic; discolored
A. No tx
B. Exo
C. Pulpo
D. Pulpec
A. No tx
- most conservative tx!
BQ: Case: #51 = swelling, pain, what initial procedure?
A. Exo
B. Pulpo
C. Pulpec
D. Ask for parents consent
D. Ask for parents consent
1 to 2 in anterior crossbite
Dental cause
Multiple teeth in anterior crossbite (>=3)
Skeletal cause
What is the most common cause of single tooth anterior crossbite?
Overly retained primary tooth/incisor
Treatment for single/2 teeth anterior crossbite? (Dental cause)
Inclined plane
✅Anchorage on: 4 perm mn incisors
Skeletal cause/>=3 anterior crossbite indicates that:
Developing skeletal class III *Established skeletal class III
Tx for dev skel class III
Reverse pull/ facemask or chincup
SA BOARDS: ✅Refer to orthodontist!!!!
Tx for established skeletal class III
Surgery - BSSO
“bilateral sagittal split osteotomy”
Example of Functional anterior crossbite
Pseudoclass III - Skel class 1 but during fxn = Skeleta class III
Patient adapts a jaw position upon closure which is forward to normal
Pseudoclass III
Vertical overlap
Overbite
Negative overbite
Openbite
Opposite arches cannot be brought into occlusion
Openbite
BQ: Most common cause of anterior openbite
Thumbsucking
Equilibrium/ balanced forces between muscles determines position of the teeth
Buccinator mechanism
Muscles involved in Buccinator mechanism
Buccinator
Orbicularis oris
Superior pharyngeal constrictor
(VS) Tongue
BQ: What is the triad of Thumbsucking?
Duration - 6hrs; most impt
Frequency - Am/pm
Intensity - 1 room away
BQ: What is the initial treatment for Thumbsucking?
- Observe!!! - INITIAL ✅
- Psychological therapy
- Tape thumb
- Tape elbow
- Palatal crib - last resort
BQ: What is the appliance of choice for Thumbsucking?
Palatal crib
BQ: What is the treatment for OPEN BITE?
if caused by habit: ✅ Remove thumbsucking habit
If caused eruption pattern: ✅ no tx/ observe
Tongue protrudes during swallowing, speech, or even at rest
Tongue thrusting
BQ: most common cause of tongue thrusting
Thumbsucking
thumbsuck - openbite - tongue thrust
Infantile swallowing: what age
<1 y/o
Cranial nerve used during infantile swallowing
CN VII - Facial muscles are used by infants to swallow
BQ: Location of tip of tongue in infantile swallowing
Bet U/L lips or Bet gumpads
BQ: Loc of tip of tongue during adult swallowing
Premaxilla
Cranial nerve used in adult swallowing
CN V
BQ: What is the tx for tongue thrusting
If thumbsucker: Remove habit
If eruption pattern or born with open bite: No tx/observe!
BQ: Appliance of choice for tongue thrusting
Tongue crib (mx arch)
BQ: Appliance of choice to correct swallowing
Blue grass
BQ: What is the best space maintainer?
Well restored natural tooth
Space maintainer: unilateral; single tooth loss
Band and loop
Space maintainer: bilateral;single/multiple tooth loss
✅unilateral but must have multiple tooth loss
Lingual holding arch
What teeth must be present in LHA
2 Mn 6s
4 Perm mn incisors
BQ: Appliance for premature loss of primary mn canine
LHA (w/ spurs)
Space maintainer: Early loss of Primary 2nd molar before permanent 1st molar erupts
Distal shoe
Disadv of distal shoe
Infection
Space maintainer: (MAXILLARY) unilateral;multiple tooth loss
Transpalatal arch
Space maintainer: (MAXILLARY) bilateral; single/multiple tooth loss
Nance appliance
Disadv of nance
Acrylic button-irritant/allergy
BQ: What is the most common space maintainer?
Band and loop
Recommended app: Thumbsucking
Palatal crib
Recommended app: bruxism
Night guards/ bite plate
BQ: Most common cause of Bruxism
Malocclusion
Recommended app: Hyperactive mentalis
Lip bumper/ plumber/ Mayne/ Denholtz
Recommended app: Cheek or lip biting
Oral screen
Recommended app: Tongue thrusting
Tongue crib
Recommended app: Mouth breathing
Oral vestibular screen/ shield
Determines the future antero-posterior position of perm 1M
Compares distal portion of E
Primary molar relationship
normal “CUSP to CUSP” permanent 6; may lead to class I by MESIAL SHIFTING
Flush terminal plane
Mesial movement of permanent 1st molar to achieve class I molar relationship
Mesial shifting
with immediate AVAILABLE SPACE
Early
- happens in early mixed dent (6-8)
without immediate available space
✅space = because of exfoliation of one tooth
Late (10-12y/o)
Molar relationship in Distal step
Distal step ➡️ Class II ➡️ Class II
Molar relationship in Mesial step
Mesial step= Class I ➡️ Class I / Class III (mesial shift!)
Primate space in maxillary
Mesial of canine
distal of Li
Primate space in Mandibular
Distal of Canine
mesial of primary molar
BQ: 7 y/o with multiple spaces in teeth
Diastema
Causes of diastema
- Normal part of development
- Tooth size discrepancy - microdontia
- Mesiodens
- Abnormal frenal att
Tx for mesiodens
Exo asap
What age can you do diastema closure
Once erupted na yung Mx Canine (around 11-12 y/o)
Tx for high frenal attachment
1st - ortho
2nd - surgery
(pag inuna surgery magrrelapse lang bec of scar formation)
Maxillary midline diastema = ?
- common during mixed dentition
- usually closes after canine erupts
<2mm (normal)
Large mx midline diastema = ?
- unlikely to close even after canine erupts!!
Large diastema = >2mm
> 2mm mx midline diastema usually caused by
Supernumerary teeth (mesiodens)
BQ: Remember before treating a DIASTEMA..
Always wait for the canine before treating the diastema!!!
BQ: What is the primary determinant of diastema
Canines
BQ: What is the treatment for an 8y/o px with a 3mm diastema?
Take a radiograph (to know if there’s supernumerary)
BQ: What is the treatment for a 12yr old px with 2mm diastema?
Diastema closure
Principle of cephalocaudal growth curve
Structures farther from the brain GROWS MORE but GROWS LATER
BQ: Which is first to mature?
cranial base
Maxilla
Mandible
Cranial base (accdg to cephalocaudal growth curve)
BQ: Which has the highest growth?
Cranial base
Maxilla
Mandible
Mandible
-bec farthest from the brain
Increases in size until puberty then starts to decrease in size
Lymphoid growth curve
Ex. Thymus 10-12y/o: 200% then shrinks
Indirect bone formation
Endochondral bone formation
“ESPECOLS”
Direct bone formation
Intramembranous bone formation
Bone formation in Cranial vault:
- frontal
- parietal
- squamous temporal
- squamous occipital
Intramembranous
Type of bone formation in CRANIAL BASE - “OSET”
Endochondral
Bone lengthening
Interstitial bone growth
Bone widening
Appositional (IL-AW)
BQ: Tension (+) side = bone ___
Facing the direction of growth
Deposition
BQ: Pressure side (-)
Facing away
Resorption
BQ: Deposition + resorption = a gradual movement of the growing area of the bone which is called?
Drift
BQ: “Piezoelectric Theory” Negative ions (-) = Positive ions (+) =
BQ: “Piezoelectric Theory”
✅OPPOSITE!!!!!
Negative ions (-) = deposition Positive ions (+) = resorption
BQ: What is the first thing that happens in orthodontic treatment / when a tooth is moved?
Bone BENDING
Principle: Most of the facial bones are “V-shaped”
✨”RODI”✨
Inner side:
Outer side:
Enlow’s V principle of growth
Inner side: depostion
Outer side: resorption
Examples of V - shaped bones which follows Enlow’s V principle
Mandible
Maxilla
Palate
Orbit
BQ: Palate: Roof of oral cavity= bone ____
Roof of oral cavity = + deposition
BQ: Palate: Floor of nasal cavity = bone ____
Floor of nasal cavity = resorption (-)
BQ: Growth Theory: “genes/genetic influence”
Genetic theory
BQ: Growth Theory: “sutures/ sutural growth”
Sicher’s (sounds like “sutures”)
BQ: Growth Theory: “cartilage”
Scott’s (“scott-lage”)
BQ: Most accepted craniofacial growth theory:
➡️ Soft tissue vs Bone = BONE YIELDS/gives way
Moss’ (“Most”)
Supports all the theories
Van limborg’s theory
Servosystem theory
Petrovic’s theory
Area of cellular hyperplasia?
Synchondroses
Growth site for cranial base: closes 3-5 y/o
Intraoccipital synchondroses
BQ: Growth site for cranial base: until 20 y/o
Spheno-occipital synchondroses
Growth site for cranial base: at the age of 6-7
Spheno-ethmoidal synchondroses
Growth site for cranial base: during birth
Intersphenoidal synchondroses
Growth center of maxilla (nasomax complex)
Nasal septum
3 bones of nasal septum “VaPeS”
vomer
Perpendicular plate of ethmoid bone
Septal cartilage
Site of bone deposition; controls growth of adjacent structures
growth center
REMEMBER:
ALL growth centers are growth sites
But NOT ALL growth sites are growth centers
REMEMBER:
ALL growth centers are growth sites
But NOT ALL growth sites are growth centers
Growth direction (deposition) in Maxilla:
Superior-Posterior
Upward-backward
Growth displacement (resorption) in maxilla
Downward-forward
Inf - ANTERIOR
BQ: Exception~ bone deposition on the ANTERIOR of MAXILLA
Anterior nasal spine
Growth center of Mandible
Condylar cartilage
Growth direction in Mandible
Sup-Post
Up/back
Growth displacement in the Mandible
Downward and forward
Inf-Anterior
BQ: Exception~ bone deposition on the ANTERIOR of MANDIBLE
Tip of chin
BQ: Sites of bony depostion in Maxilla
- Condyle
- Posterior border of ramus
- Coronoid process
- Tip of chin / Pog
BQ: Sites of bone resorption in the mandible
- Anterior
2. Ant border of ramus
gives space to erupting 2nd/3rd molars
Resorption of ant border of ramus
BQ: What causes the increase length in the mandible
Bone resorption
BQ: At the age of 6 the greatest increase in size pf mandible occurs where???
Distal to the first molar
BQ: Maxillary arch = how many mm?
Maxillary = 128mm
BQ: Mandibular arch = how many mm?
126mm
1st growth spurt
Female =
Male =
1st growth spurt
Female = 3
Male = 3
2nd growth spurt
Female =
Male =
2nd growth spurt
Female = 6-7
Male = 7-9
3rd growth spurt
Female =
Male =
3rd growth spurt
Female = 11-12
Male = 14-15
What is the general rule for growth?
The earlier the growth spurt; the lesser the growth; the earlier it will stop
Used in predicting the time of the pubertal growth spurt
Hand and wrist radiograph
BQ: How many bones are there in the hand and wrist radiograph?
Puberty:
Adults:
Puberty = 28-30* Adults = 27-29*