4. Adjunctive Orthodontics Flashcards
Adjunctive Orthodontics
- Definition; ____ movement carried out to facilitate other dental procedures necessary to control disease, restore function and/or enhance appearance
- involve only a ____ of the dentition
tooth
part
Adjuctive vs Comprehensive Tx
Adjunctive
• Goals; make it more ____ to replace missing or damaged teeth and easier for the patient to control periodontal problems
• Duration: a few ____
• Retention by the ____
Comprehensive
• Goals: produce the best ____ of dental occlusion, dental and facial appearance, and stability of the result to maximize benefit to the patient
• Duration: exceed ____ year
• Retention by the ____
effective
months
restoration
combination
1
removable/fixed retainer
Goals of Adjunctive Tx
• Improve ____ health by eliminating plaque-harboring areas and improving the alveolar ridge contour adjacent to the teeth
- Establish favorable ____ ratios and ____ the teeth so that occlusal forces are transmitted along the long axes of the teeth
- Facilitate restorative treatment by positioning the teeth so that;
i) More ideal and conservative ____ (including implants) can be used
ii) Optimal ____ can be obtained with bonding, laminates or full coverage porcelain restoration
periodontal crown-to-root position techniques esthetics
Indications (ADJUNCTIVE)
• ____ harmony in all three planes
• A fully ____ patient with good oral ____
• Acceptable ____
skeletal
cooperative
hygiene
occlusion
Contraindications (ADJUNCTIVE)
• Severe ____ discrepancies
• ____ mandibular plane angle • ____ roots
• ____ lower molars
• Significant centric relation to centric occlusion ____
skeletal high short or blunted extruded discrepancy
Treatment Sequence; Complex Problems
- Before any tooth movement, active ____ and ____ pathology must be eliminated.
- Endodontically treated teeth respond ____ to orthodontic force, providing all residual chronic inflammation has been eliminated.
- ____ disease MUST be controlled before any orthodontics begins because orthodontic tooth movement superimposed on poorly controlled ____ health can lead to rapid and ____ breakdown of the periodontal support apparatus.
- ____ : clinical indication of the presence of plaque-related gingival inflammation
- Scaling, curettage, gingival grafts should be undertaken as appropriate
- Surgical pocket elimination and osseous surgery should be ____ until completion of the ____ phase of treatment because significant soft tissue and bony recontouring occurs during orthodontic tooth movement.
- The Optimal approach is as follows: (1) complete the ____ therapy, (2) establish a stable ____, and (3) wait a minimum of ____ months before requesting the periodontist to intervene for definitive periodontal procedures.
active caries
pulpal
normally
periodontal
periodontal
irrevrsible
bleeding upon probing
delayed
orthodontic
orthodontic
occlusion
6
Adjunctive Orthodontic Procedures
____ space for restorative dentistry or tooth replacement
____ correction: anterior and posterior
____ Eruption
____ Uprighting
regaining
crossbite
forced
molar
Alignment of Anterior Teeth
• Anterior diastema closure and space redistribution
• ____ for build-ups, veneers or implants
• “____ setup”
- Alignment of crowded, rotated, and displaced incisors
- ____: stretched gingival fibers are a potent force for relapse after rotations have been corrected
preparation
diagnostic
fiberotomy
Fiberotomy
• Especially maxillary and mandibular ____ teeth (e.g. maxillary lateral incisors with Class ____, Division ____ problems)
- Should be done ____ debonding ____ mild overcorrection (3 to 5 degrees)
- Overcorrection is removed ____ week after the surgical procedure and before ____ for retainers are taken.
- ____ gingivectomy or ____ flap reflections with interproximal sutures or just cutting ____ around the tooth using a periotome or blade
anterior
II
2
before
after
1
impressions
internal bevel
labiolingual
periodontal ligaments
Forced Eruption
• An excellent alternative to extensive crown-lengthening surgery
• Endodontic therapy should be completed ____ extrusion of the root begins.
• Distance the tooth should be extruded;
A. Location of the ____
B. Space to place the margin of the restoration (____ mm)
C. An allowance for the ____ of the gingival attachment (about 2 mm)
—> If a fracture is at the height of the alveolar crest, the tooth should be extruded about ____ mm.
- Crown-to-root ration: ____ or better
- ____mm per week without damage to the PDL, so ____ weeks is sufficient for most cases.
before
defect
1
biological width
3
1:1
1
3 to 6
Forced Eruption
• Every ____ weeks to reduce the occlusal surface of the tooth being
extruded if this is needed, control inflammation and monitor progress
• At least ____ but not more than ____ weeks of stabilization is needed to allow reorganization of the PDL.
• If periodontal surgery is needed to recontour the alveolar bone and/or reposition the gingiva, this can be done a ____ after completion of the extrusion.
1 to 2
3
6
month
Missing Mn 1st molar
; Common Clinical Occurrence
- ____ inclined second and/or third molars
- ____ drifting of the premolars
- ____ of the maxillary molars
- Altered gingival form
- ____ defect mesial to the inclined molar
- Stepped marginal ridges
- ____ impaction
- Posterior bite collapse
mesially distal extrusion infrabony food
Tx Objectives of Uprighting Posterior Teeth — Periodontally Compromised
- ____ abutment teeth for proper tooth preparation
- Re-establishment of ____ bony architecture
- Improvement of force distribution down the ____ of the tooth
- Correction of abnormal gingival ____
paralleling
positive
long-axis
topography
Uprighting Posterior Teeth • How to upright? A. \_\_\_\_ crown tipping; preferred B. Mesial root movement; skeletal anchorage, \_\_\_\_ tx time • Eliminate \_\_\_\_ interferences • Tx period; \_\_\_\_ wks ~ \_\_\_\_ wks
distal longer occlusal 8-10 20-24
Bonding brackets for Molar uprighting
• 22 slot brackets
• Brackets are placed in an ____ position only on teeth to be moved, and the remaining teeth to be incorporated in the anchor system are bracketed so that the arch wire slots are closely ____. —> anchorage segments of the wire to be engaged ____
ideal
aligned
passively
