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Ortho Final > 3B > Flashcards

3B Flashcards

1
Q

Moderate generalized space discrepancy (<4 mm per arch)
● General info:
○ True shortage of

A

space including leeway

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2
Q

Moderate generalized space discrepancy (<4 mm per arch)

○ Tooth movement methods will

A

create space

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3
Q

Moderate generalized space discrepancy (<4 mm per arch)

○ Prognosis & stability

A

unknown

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4
Q

Moderate generalized space discrepancy (<4 mm per arch)

■ Once arch dimensions begin to change, no

A

certainty that it will be stable

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5
Q

Moderate generalized space discrepancy (<4 mm per arch)

■ Prognosis good with

A

RETENTION

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6
Q

Moderate generalized space discrepancy (<4 mm per arch)

● Arch expansion (NOT palatal expansion) →

A

creates ~ 4mm of space

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7
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Ideal profile for arch expansion:
■ AP position of lips/incisors

A

normal or retrusive (NOT protrusive)

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8
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Ideal profile for arch expansion:
■ Adequate facial

A 
keratinized tissue (gingiva)
●	Allows for facial movement
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9
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Ideal profile for arch expansion:
■ Adequate

A

overbite & overjet (to allow facial incisor movement of lower arch)

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10
Q

Moderate generalized space discrepancy (<4 mm per arch)
IDeal profile for arch expansion
■ Skeletal

A

class I & Dental Class I (or end-to-end) molar

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11
Q

Moderate generalized space discrepancy (<4 mm per arch)
Ideal profile for arch expansion
● All teeth should be

A

present clinically/radiographically

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12
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Lip Bumpers
■ Treats

A

lower anterior &/or buccal segment crowding

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13
Q

Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
● Best for

A

facial lingual discrepancies

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14
Q

Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
○ Facial tipping (& bodily movement) of

A

incisors (NO rotation)

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15
Q

Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
○ Distal tip of

A

molar

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16
Q

Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
○ Arch width

A

increase

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17
Q

Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
● Applies

A

equilibrium theory

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18
Q

Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
○ Removes lip force, so

A

resting tongue force causes facial movement

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19
Q

Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
● Possible

A

2nd molar impaction

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20
Q

Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
■ Clinical management & fabrication same as

A

lingual arch

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21
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Banded/bonded fixed appliances
■ Treats

A

lower anterior &/or buccal segment crowding

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22
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Banded/bonded fixed appliances
● ——- movements

A

Tipping & bodily

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23
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Banded/bonded fixed appliances
● Rotations

A

possible

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24
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Banded/bonded fixed appliances
● ——– possible (by activating one side more than the other)

A

Midline shift

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25
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Banded/bonded fixed appliances
■ Clinical management →

A

may need to separate to place bands

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26
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Banded/bonded fixed appliances
● More flexible the wire, the

A

re-activations can be done less frequently

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27
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
■ Treats

A

buccal segment crowding (maxillary arch ONLY)

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28
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
● Molar movement

A

distally &/or buccally

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29
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
○ Interseptal gingival fibers will pull

A

premolars distally too

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30
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
● Cervical headgear → also does

A

extrusion

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31
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
● Requires

A

compliance

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32
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
■ Clinical management:
● Adjustment every

A

6-8 weeks

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33
Q

Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
● Can expect ——— in a year

A

3-4 mm

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34
Q

Severe space discrepancy >

A

4-5 mm per arch

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35
Q

Severe space discrepancy
● Extraction
○ Based on

A

crowding & protrusion

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36
Q

■ Extraction allows incisors to be

A

retruded

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37
Q

○ Premolars most

A 
commonly extracted (~ 7 mm each)
○	Stability unknown - retention required
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38
Q

Serial extractions ⇒ Severe space discrepancy > 10 mm per arch
● Indications:

A

○ Class I with good facial form & severe space shortage

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39
Q

Serial extractions ⇒ Severe space discrepancy > 10 mm per arch
■ Early loss of 1° canines →

A

a finding of severe crowding

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40
Q

Serial extractions ⇒ Severe space discrepancy > 10 mm per arch
○ Gingival defects from

A

abnormal eruption

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41
Q

Serial extractions ⇒ Severe space discrepancy > 10 mm per arch
○ Impactions

A

imminent (from crowding)

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42
Q

Serial extractions ⇒ Severe space discrepancy > 10 mm per arch
● Advantages:

A

○ Spontaneous incisor alignment, improved psych, & reduced treatment time

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43
Q

Serial extractions

■ Proven benefits

A

○ Better canine position; improved gingiva; improved hygiene, ↓ retention time, better stability

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44
Q

Serial extractions

● Disadvantages:

A

○ Incisor lingual tipping & remaining teeth may not erupt or have poor form
■ Thus requiring future treatments
■ Substantiated by data
○ Deep bite; Reduced vertical growth & alveolar development; Poor facial esthetics

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45
Q

Serial extraction

● Begins with

A

extraction of 1° teeth → Facilitates alignment of erupted permanent teeth & encourages eruption of the premolars that will be extracted

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46
Q

Serial extraction

● Sequence:

A
  1. Primary canine (for anterior crowding & alignment)
  2. Primary 1rst molar (when > ½ PM root formed to expedite eruption)
    ■ In mandibular arch → want premolars to erupt before canine
    ■ In maxillary arch → 1rst premolars usually erupt before canines anyway
  3. 1rst premolar (provides space in permanent dentition)
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47
Q

Serial extractions

■ In mandibular arch →

A

want premolars to erupt before canine

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48
Q

Serial extractions

■ In maxillary arch →

A

1rst premolars usually erupt before canines anyway

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49
Q

Space regaining - Localized space shortage

● Localized space shortage is an

A

opportunity to regain space if < 3 mm per quadrant

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50
Q

Space regaining Localized space shortage

● Adhere to

A

maximum space loss amount & use reliable appliances

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51
Q

Space regaining Localized space shortage

● Causes ⇒

A

Interproximal caries, ectopic eruption, tooth loss

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52
Q

Moderate localized space discrepancy

A

(<3mm per quadrant)

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53
Q

Moderate localized space discrepancy

1. Permanent molar ectopic eruption

A

○ 1rst permanent molar erupts mesially → may cause 1° molar resorption & loss

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54
Q

Moderate localized space discrepancy
○ 1rst permanent molar erupts mesially → may cause 1° molar resorption & loss
■ ⅔

A

self-correct; Painless occurrence common in maxillary arch

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55
Q

Moderate localized space discrepancy

1. Permanent molar ectopic eruption■ 1rst permanent molar continues shifting

A

mesially, taking up space

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56
Q

Moderate localized space discrepancy
1. Permanent molar ectopic eruption
■ Diagnosed with

A

bitewings

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57
Q

Moderate localized space discrepancy
1. Permanent molar ectopic eruption
○ Space regaining treatment plans:
■ If NO succedaneous premolar →

A

space regaining NOT necessary
● Mesial shift of 1rst permanent molar will close space

● Brackets bonded on dentition with spring inbetween

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58
Q

Moderate localized space discrepancy
1. Permanent molar ectopic eruption
○ Space regaining treatment plans:

■ BRASS WIRE (or separator) for

A

minimal interference/resorption (<1mm)

● Placed in between contacts, pushing permanent molar distally

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59
Q

Moderate localized space discrepancy 1. Permanent molar ectopic eruption

○ Space regaining treatment plans:
■ BAND & SPRING

A

● 1° molar banded and spring pushes 2° molar back
● Uncontrolled distal crown tip
○ Short roots bc still erupting - very easy to tip
● Fabrication → made by lab, so need to band and separate tooth for impression; wire bend & soldered by lab
○ Activated 3-4 mm
○ Treatment completed after 2-3 activations
● No retention required

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60
Q

Moderate localized space discrepancy
1. Permanent molar ectopic eruption
○ Space regaining treatment plans:

■ MODIFIED BAND & SPRING
● Direct

A

(Intraoral) fabrication with no soldering → tooth banded & bent wire used as spring

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61
Q

Moderate localized space discrepancy

■ BONDED SPRING
● Most modern & efficient way →

A

No banding; intraoral fabrication

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62
Q

Moderate localized space discrepancy
1. Space regaining for posterior tooth loss (maintains space for erupting teeth)

○ Max. removable appliance -

A

Hawley finger spring

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63
Q

Moderate localized space discrepancy
Max. removable appliance

■ Biomechanics:

A

● Resistance/anchorage via adams clasps & anterior palate
● Uncontrolled distal crown tip

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64
Q

Moderate localized space discrepancy
Max. removable appliance
■ Lab fabrication;

A

2-3 mm activation; 1mm movement per month

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65
Q

Moderate localized space discrepancy
Max. removable appliance
■ Retention & stabilization

A

required (with band & loop)

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66
Q

Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring
■ ————- biomechanics

A

Open coil spring

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67
Q

Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring
● Reciprocal force applied

A

buccal to C-res

68
Q

Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring

● Distal force & moment produces

A

rotation

69
Q

Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring

○ Mesial rotation of

A

PM & Distal rotation of molar

70
Q

Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring

■ Contralateral 1rst permanent molar

A

banded as well

71
Q

Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring

● Mandibular arch →

A

Anchorage via anteriors with LLHA

72
Q

Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring

● Maxillary arch →

A

Anchorage via nance button on palate

73
Q

Moderate localized space discrepancy

  1. Space regaining for anterior & posterior space discrepancy
A

(<3mm)

74
Q

Moderate localized space discrepancy

  1. Space regaining for anterior & posterior space discrepancy
    ○ Treatment with
A

Lower lingual holding appliance (LLHA)

75
Q

Moderate localized space discrepancy

  1. Space regaining for anterior & posterior space discrepancy
    Lower lingual holding appliance
    ■ Tips
A

molars distally & anteriors facially (~roughly equal distance)

76
Q

Moderate localized space discrepancy

  1. Space regaining for anterior & posterior space discrepancy
    Lower lingual holding appliance
    ● Inefficient way to
A

move teeth bc wire is heavy with little range of movement, but good way to gain space

77
Q

Severe localized space discrepancy

A

( > 3mm per quadrant)

78
Q

Severe localized space discrepancy

● Possible treatment options include:

A

palatal anchorage appliances, headgear, &/or extraction

79
Q

Severe localized space discrepancy
● Palatal anchorage device (with coil springs)

○ Posteriors ⇒

A

distal bodily movement

■ Distal force on palatal side near level of Cres → more bodily movement

80
Q

Severe localized space discrepancy
● Palatal anchorage device (with coil springs)

○ Maxillary incisors move

A

forward (make sure pt. profile not protrusive)

81
Q

Severe localized space discrepancy
● Mini screw supported distalizing appliance
○ Provide true anchorage with

A

TADs - no maxillary anterior movement

82
Q

Severe localized space discrepancy
● Mini screw supported distalizing appliance

○ No acrylic button →

A

reduced tissue tissue anchorage; better compliance

83
Q

Space maintenance

● Used when space is adequate following tooth loss (or marginally adequate with extraction)

A

● Good prognosis

84
Q

Factors to consider with space maintenance:

  1. Normal timing of eruption (when will permanent dentition begin erupting?)
    ○ Assessed by root development ⇒
A

active eruption begins when ½ - ⅔ root formation

85
Q

Factors to consider with space maintenance:

  1. Effects of early & late primary tooth extraction
    ○ Early loss/extraction (before ½ root formation) ⇒
A

slows permanent tooth eruption

86
Q

Factors to consider with space maintenance:
2. Effects of early & late primary tooth extraction
○ Late loss/extraction (after ½ root formation) ⇒

A

speeds up eruption

87
Q

Factors to consider with space maintenance:

  1. Location of tooth loss in the arch
    ○ 1° anterior tooth loss ⇒
A

No space maintenance required

■ NO overall space loss (but some minor space redistribution)

88
Q

Factors to consider with space maintenance:
3. Location of tooth loss in the arch

○ 1° posterior tooth loss ⇒

A

Space maintenance required

89
Q

Factors to consider with space maintenance:
4. Eruption of anterior teeth
○ Anteriors erupt lingually, so

A

DONT use a lingual arch for space maintenance if primary anteriors are not lost yet. Erupting teeth will get caught in the wire

90
Q

Factors to consider with space maintenance:

  1. Presence of succedaneous teeth (& supernumerary teeth)
    ○ Don’t need to
A

maintain space if no succedaneous tooth replacement

91
Q

Factors to consider with space maintenance:

  1. Cause of
A

tooth loss (ie. is there an ectopic eruption causing root resorption & tooth loss)

92
Q

Space Maintenance treatment options:

A

Band and loop
Distal shoe
Lingual arch type appliances

93
Q

● Band & loop

A

○ Simple & 60% successful

94
Q

Band and loop

○ Clinical management:

A

■ Separate, band, impression, stabilize, pour, loop form & position
● Loop contacts, but doesn’t encompass 1° canine → allows lateral canine movement when lateral incisor erupts

95
Q

Band and loop

● Loop wide enough for

A

premolar eruption

96
Q

Band and loop

● Poor oral hygiene will cause

A

decalcification of banded tooth (usually permanent 1rst molar - primary 2nd molar difficult to band bc convergent)

97
Q

Band adn loop

■ Recall every

A

3-6 months

98
Q

Band and loop

■ Potential problems if

A

lose abutment tooth or if loop becomes distorted downward into tissue

99
Q

● Distal shoe

○ Indication ⇒

A

ONLY when primary 2nd molar lost before eruption of permanent 1rst molar
■ 65% successful

100
Q

● Distal shoe
○ Clinical management:

■ Tooth banded & blade placed into tissue

A

1-1.5 mm below marginal ridge of unerupted 1rst permanent molar

101
Q

● Distal shoe
○ Clinical management:
● Blade placement based on

A

radiographs (factoring magnification distortions), required distance measured

102
Q

Distal shoe

● Prevents

A

mesial shift of erupting 1rst permanent molar & maintains space for succedaneous premolar

103
Q

Distal shoe

■ Placement of device requires

A

gingival incision (if tooth extracted at the same time as delivery of device, use extraction space as site of blade insertion)

104
Q

Distal shoe concerns;

■ Permanent molar may

A

erupt mesially into blade if position gauged incorrectly

105
Q

Distal shoe concerns

■ ——— in patient with heart or vascular problems

A

Infectious endocarditis

106
Q

● Lingual arch type appliances (55% successful)

○ Types:

A 
■	Lower lingual holding appliance (LLHA)
■	Maxillary transpalatal arch (TPA)
■	Maxillary Lingual arch (MxLHA)  
     ●	Not used often
■	Nance appliance
107
Q

● Lingual arch type appliances (55% successful)
■ Maxillary transpalatal arch (TPA)
● Can be used when

A

one side of arch broken but the other is not?

108
Q

● Lingual arch type appliances (55% successful)
■ Nance appliance
● Anchorage from

A

palate, but acrylic can cause palatal irritation

109
Q

● Lingual arch type appliances (55% successful)

○ Fabrication:
■ Arch always made with

A

adjustment loops

110
Q

● Lingual arch type appliances (55% successful)
Fabrication
■ Keyhole design →

A

allows incisor alignment, but steps away from premolar area to allow for eruption

111
Q

● Lingual arch type appliances (55% successful)

○ Follow up every

A

3-6 months

112
Q

● Lingual arch type appliances (55% successful)
○ Problems:
■ Don’t use lingual arch before

A

permanent incisors have erupted ⇒ arch will get caught on erupting teeth

113
Q

Space management

● Used with

A

adequate space & irregularity

114
Q

Space management

○ Transitional irregularity & crowding due to

A

incisor liability

115
Q

Space management

● Ideal for managing

A

leeway space (up to 9 mm)

116
Q

Space management

○ Leeway space (E-space) managed to

A

resolve crowding

117
Q

Space management

○ E-space

A

(extra space of 2nd primary molar compared to succedaneous premolar)

118
Q

Space management

● Potentially can manage up to

A

75% of crowded pts with resulting < 1mm crowding

119
Q

Space management

○ Space management must continue until

A

transition complete & arch perimeter stable

○ Good prognosis

120
Q

Space management

■ Very stable procedure bc

A

arch circumference not being changed

121
Q

Space management

■ Note: when arches are expanded or changed, prognosis is not

A

known in the end

122
Q

Space management treatment options (pt with adequate space with irregularity):

  1. No treatment
    ○ Allow for
A

normal transition to take place

123
Q

Space management treatment options (pt with adequate space with irregularity):

No treatment
○ Results in

A

anterior crowding with Class I molar relationship

124
Q

Space management treatment options (pt with adequate space with irregularity):

■ To treat later would require

A

expansion or extraction treatment

125
Q

Space management treatment options (pt with adequate space with irregularity):

  1. Disking
    ○ Used with
A

minor irregularity

126
Q

Space management treatment options (pt with adequate space with irregularity):

■ Normal dentition (with adequate space) usually has

A

1-2 mm of crowding during transition, so not worth doing in many cases

127
Q

Space management treatment options (pt with adequate space with irregularity):

○ Must be

A

vertical reduction of teeth of primary teeth

128
Q

Space management treatment options (pt with adequate space with irregularity):

■ Consider disking

A

mesial or distal of 1° canines & molars

129
Q

Space management treatment options (pt with adequate space with irregularity):

■ Consider Fluoride varnish to reduce

A

sensitivity

130
Q

Space management treatment options (pt with adequate space with irregularity):

○ Do NOT disk

A

permanent teeth in mixed dentition

131
Q

Space management treatment options (pt with adequate space with irregularity):

■ Skews analysis if done before all

A

permanent teeth have erupted

132
Q

Space management treatment options (pt with adequate space with irregularity):

  1. Holding arches
    ○ Construct with
A

ideal arch form (facilitates tooth alignment)

133
Q

Space management treatment options (pt with adequate space with irregularity):

■ Soldered arches most reliable;

A 
typically keyhole design used
○	Resolves faciolingual discrepancies
○	Limitations as a tooth mover:
■	No rotation
■	Difficult to move teeth with heavy wire (can be uncomfortable)
134
Q

Space management treatment options (pt with adequate space with irregularity):

  1. Disking & holding arches
A

○ When more crowding needs to be resolved

○ Helps guidance and tooth position

135
Q

Space management treatment options (pt with adequate space with irregularity):

  1. Holding arches with tooth movement
A

○ LLHA controls arch form & coordination

■ Can control arch length and move teeth (primarily via tipping)

136
Q

Space management treatment options (pt with adequate space with irregularity):

■ NOTE: Flat anterior segment does

A

NOT resolve around an ideal arch form

137
Q

Space management treatment options (pt with adequate space with irregularity):

○ LLHA can be used as

A

retainer

138
Q

Space management treatment options (pt with adequate space with irregularity):

○ LLHA biomechanics may require

A

adjustment

139
Q

Space management treatment options (pt with adequate space with irregularity):

■ Heavy tipping force, so needs to be

A

placed passively on teeth you want to move

140
Q

Space management treatment options (pt with adequate space with irregularity):

  1. Holding arches & selective extraction of primary teeth
    ○ Necessary for
A

greater irregularity (but still adequate space)

141
Q

● Expansion of lower canine

A

least stable

142
Q

● Removable denture for missing 1° anteriors indicated for

A

esthetics (NOT space maintenance or speech)

○ Can be used for posterior space maintenance, but compliance a problem (Nance preferred)

143
Q

● Class II occlusion with crowding extraction pattern:

A

○ Extract upper 4s & lower 5’s

144
Q

● Minimal crowding doesn’t mean you

A

NEVER do extractions

145
Q

● TADs cannot be used

A

< 12 y/o

146
Q

● Space maintenance is NOT more stable than

A

space management or space regaining

147
Q

Majority of crowding issues ass. with

A

Class I

148
Q

● Maxillary irregularity/crowding

○ Ideal group (0-1 mm crowding) ⇒

A

worsens from preadolescence to adolescence

○ Hispanics > white > black

149
Q

● Mandibular irregularity

○ Ideal group ⇒

A

worsens from pre-adolescence to adolescence to adult

○ Hispanic > white > black

150
Q

Classification of Crowding based on:

A

● Facial form analysis (esp. lip protrusion - protrusive/retrusive/normal)
● Appropriate radiographs
● Space analysis - Tanaka Johnson prediction values
○ ½ M-D distance of mand. Incisors + 10.5 = width of mand. canine/PM in quadrant
○ ½ M-D distance of mand. Incisors + 11 = width of max. canine/PM in quadrant

151
Q

Excess space

● Good for

A

transitional dentition, so usually NO treatment

152
Q

Excess space

● Treated for

A

esthetic concerns or risk of trauma (with protrusive teeth)

153
Q

Excess space

○ Intervention also required if

A

eruption problems or pathology (ie. cyst) exists

154
Q

Excess space classification:

● Normal transition

A

(usually closes with canine eruption)

○ Oral habit → treating with oral habit appliance will correct. No other treatment needed

155
Q

Excess space classification:
● Generalized spacing
○ Caused by

A

large arches or small teeth

156
Q

Excess space classification:

● Generalized spacing with protrusion:

A

○ Fixed appliance
■ Bracket & tube;
2 point contact
■ Bodily movement with anchorage on molars

157
Q

Excess space classification:
Generalized spacing with protrusion

○ Removable appliance with labial bow

A

■ One-point contact → tips uppers lingually
■ Anchorage to posterior attachment (& palate)
● Retention via adams clasp
■ < 6 month treatment
● Activated 2 mm for 1 mm movement per month

158
Q

Midline diastema

● Diastemas reduce considerable from

A

preadolescence to adolescence (when canine erupt)

159
Q

Midline diastema

● Occurs significantly more in

A

african american

160
Q

Midline diastema

● Causes &/or associated problems:

A 
○	Normal transition
○	Supernumerary teeth between centrals
○	Missing laterals
○	Frenums
■	Space closed first
■	Frenectomy performed after space closure if there will be a problem with retention
●	Morphology of frenum poor indicator of problem
■	Idiopathic
161
Q

Midline diastema

■ Frenectomy performed after

A

space closure if there will be a problem with retention

162
Q

Midline diastema

● Morphology of frenum

A

poor indicator of problem

163
Q

Midline diastema

● Treatment options:

A

○ Tipping with finger spring

○ Bodily movement with any archwire (round or rectangular) - reciprocal anchorage

164
Q

Midline diastema

○ Tipping with finger spring

A

■ Reciprocal anchorage

■ Removable provides short term retention; long term with lingual bonded retainer

165
Q

Midline diastema

○ Bodily movement with any archwire (round or rectangular) - reciprocal anchorage

A

■ Long term retention with lingual bonded retainer

Ortho Final (8 decks)

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