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Ortho Final > 4B > Flashcards

4B Flashcards

1
Q

Growth Modification

● Female at

A

15 is post adolescent (16 for males) - can’t use RPE bc midpalatal suture fused

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2
Q

Treatment options for Skeletal malocclusion ⇒

A

growth modification, camouflage, & surgical treatment

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3
Q

Sites of facial growth:
● Growth centers ⇒
● Growth sites ⇒

A

nasal septum; synchondrosis

sutures; condyle; alveolus

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4
Q

Sutures & alveolus have good ——-; synchondrosis have ——-; condyle/nasal septum ——-

A

modifiability

poor

questionable

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5
Q

Requirements for growth modification:

A

● Growth patient
● Ability to affect sutures
● Condyles require function (including translation)
● Alveolus require teeth (or a functioning unit)

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6
Q

Periods of rapid growth make modification process easier:
● Males
● Females

A

12-14 (13-15) y/o

10-12 y/0

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7
Q

Somatic & facial growth ⇒ loosely related

A

in growth timing

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8
Q

● Growth has variable rates

A

(fastest from 0-2 years & adolescent growth spurt)

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9
Q

● Noses ⇒

A

males have more nose growth than females (esp. post-adolescence)

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10
Q

● Lip competence ⇒

A

increases with age (lips grow vertically more than skeleton)

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11
Q

● Lip protrusion ⇒

A

decreases with age (lips thin with age)

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12
Q

● Chin ⇒

A

Males get more chin button than females

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13
Q

● Late growth:

A

○ Maxilla downward growth & Mandible forward growth post-adolescence

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14
Q

○ Women ⇒ more —— growth; Men ⇒ more ——— growth

A

maxillary

mandibular

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15
Q

Methods for growth assessment:

A

● Ht. & wt. Measurements; secondary sex characteristics; menarche (occurs after peak growth spurt)
● Cervical vertebrae & cephalometric XR

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16
Q

US population ⇒ Class II malocclusion ——-; Class III malocclusion =======

A

15-20%

3-5%

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17
Q

General dentists can diagnose skeletal problems by

A

profile analysis & assessing dental relationships

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18
Q

● Profile analysis difficult for

A

young children (esp. <6 y/o), Class III, & when vertical problems present (profile analysis possible, just need to be careful)

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19
Q

● Dental relationships:

○ Provides good clues in

A

Class II & III malocclusion (esp. when profile agrees)
■ Ie. increased overjet with class II molars & convex profile → likely Class II problem
○ Can be deceptive when habits affect the teeth
■ Ie. anteriors don’t coincide with posteriors in giving info about malocclusion type

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20
Q

Indications for growth modification ⇒

A

growing patient with mild-moderate skeletal problems

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21
Q

Indications for growth modification

A

● Severe problems need surgery

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22
Q

Indications for growth modification
Possibilities for growth modification:
● Maxilla →

A

easier to modify than mandible

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23
Q

Indications for growth modification
Possibilities for growth mod
● Anteroposterior →

A

possible

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24
Q

Indications for growth modification
Possibilities for growth mod
● Vertical →

A

hardest to modify; last dimension to stop growing

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25
Q

Indications for growth modification
Possibilities for growth mod
● Transverse →

A

first dimension to stop growing (why maxillary constrictions need to be treated early)

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26
Q

Types of growth modification:

A

● Ultimate size changes (stimulation/retardation)
● Timing changes (acceleration/deceleration) - no overall change in size
● Redirection

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27
Q

Classic one phase growth modification with comprehensive orthodontic care

A

● Ideal to modify growth & provide comprehensive ortho at the same time - one phase treatment

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28
Q

Class II maxillary protrusion ⇒ Treat with

A

headgear (restricts maxilla & allows for mandibular growth)

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29
Q

● High-pull headgear ⇒

A

force directed posteriorly & superiorly

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30
Q

● Cervical pull ⇒

A

force directed posteriorly & down

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31
Q

● Combination headgear ⇒

A

force directed more horizontal

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32
Q

● Example results of headgear pt:

A

○ maxilla still grows downward, but NOT forward

○ Mandible grows downward & forward, becomes more prominent

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33
Q

Class II mandibular retrusion:

● Treatment with

A

functional appliances
○ Brings mandible forward, unloading condyle & allowing mandibular growth
○ Forces push mandible forward & maxilla backward → upper teeth retrude; lowers protrude

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34
Q

● Example of functional appliance pt:

A

○ Mandible comes forward more than downward

○ Maxilla maintains normal downward growth, but less forward growth

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35
Q

Class III maxillary retrusion

● Treatment with

A

facemask - reverse pull headgear

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36
Q

○ Can expect——-mm of forward maxilla growth in year

A

2-3

○ Mandible rotates down & back → patient profile becomes more convex
○ Upper incisor protrusion

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37
Q

Reverse pull headgear

● Only effective in children

A

< 10-11 y/o - before sutures fuse

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38
Q

Class III mandibular protrusion treatment options:

A

● Functional appliance

● Chin cup → minimal long term success; rotates mandible down & back, but essentially no change

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39
Q

Maxillary constriction treatment

A

● Rapid or slow palatal expansion (depending on age)
● Lingual arch type in primary & mixed dentition
● RPE ⇒ for near & post-adolescent

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40
Q

● Lingual arch type in primary & mixed dentition

○ Opens

A

midpalatal suture in preadolescent

○ Can also correct posterior crossbite (moves teeth)

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41
Q

Skeletal changes can be made in ———–. Skeletal changes tend to go back a little bit during maintenance period

A

growing children

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42
Q

Is early Class II Tx beneficial ⇒

A

No

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43
Q

● Restraining maxilla (headgear) or growing mandible (fxnal appliance) is

A

of NO benefit to ultimate growth if done in early mixed dentition over late mixed dentition

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44
Q

Class II tx ● With early treatment ⇒

A

get to same point, but requires 2 phases of treatment

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45
Q 
Is early class III tx beneficial?
●	In true maxillary retrusion ⇒
A

max. protraction successful if done before 10 y/o

○ ~25% cases still fail; simultaneous expansion questionable

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46
Q

Is early transverse treatment beneficial?

A

● Appears transverse skeletal & dental changes can be made & maintained
○ These changes can affect unerupted teeth
● As arch dimensions change so does available space

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47
Q 
When is early treatment justified:
●	For class II  ⇒
A

based on benefits of esthetics or trauma reduction

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48
Q 
when is early treatment justified;
●	For class III ⇒
A

True maxillary deficiency

and
● Posterior crossbites

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49
Q

Normal biologic variation (mild crowding/spacing; class II or III) ⇒

A

orthodontic treatment

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50
Q

Extremes of normal variation (malocclusion of skeletal origin) ⇒

A

orthodontics & surgery

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51
Q

Dysmorphology (often craniofacial anomaly) ⇒

A

requires craniofacial team

52
Q

Dysmorphology

● Etiology →

A

mostly unknown

53
Q

Dysmorphology

○ Also

A

facial syndromes; postnatal growth disturbances; inherited tendencies; environmental

54
Q

Treatment options for skeletal malocclusion:

A

● Growth modification
● Camouflage
● Surgical orthodontics ⇒ for severe cares (~5% of malocclusions require surgery)

55
Q

Surgical options for A-P discrepancy (Class II or III)

● Le Fort I ⇒

A

most commonly done maxillary procedure for Class II & III
elongation/shortening

56
Q

● Le Fort I ⇒

○ Also treats

A

facial asymmetry, OSA, max. atrophy

57
Q

● Le Fort I ⇒

○ Osteotomy downfracture technique of maxilla →

A

allows for advancement/retrusion &

58
Q

Surgical options for A-P discrepancy (Class II or III)

● BSSO (bilateral sagittal split osteotomy) ⇒

A

most commonly done mandibular procedure

○ To advance or retrude mandible

59
Q

Surgical options for A-P discrepancy (Class II or III)

● Genioplasty (inferior border osteotomy

A

`
○ Increases or decreases prominence of chin (can help either class II or III)
○ Significant esthetic impact

60
Q

Transverse discrepancies:

● Maxillary constriction →

A

most common transverse problem of maxilla

61
Q

Transverse discrepancies:

○ SARPE

A

(surgically assisted rapid palatal expansion)

■ Suture fused, so midline osteotomy and then RPE

62
Q

Transverse discrepancies:

○ 2 piece Le Forte I

A

■ Le Forte I split down the middle

■ Le Forte I, II, III ⇒ natural weak points of anatomy that surgeon cuts

63
Q

Transverse discrepancies:

● Mandibular asymmetry → most common

A

mand. transverse problem (expansion/constriction rare)

64
Q

Transverse discrepancies:

○ Distraction osteogenesis →

A

can corrects midline asymmetry

65
Q

Transverse discrepancies:

○ Mandibular midline osteotomy

A

uncommon

66
Q

Social-psychological status

A

● Many adult pts have underlying psychopathologic conditions which need to be managed (ie. depression)
○ Correction will not result in happiness for these pts
● Patients need to be internally motivated for long treatment times

67
Q

● Discrepancies due to deficient growth →

A

finish growing earlier than excessive growth discrepancies & can be treated earlier

68
Q

Sequence of treatment:

A

● Pre-surgical orthodontics
● Surgical procedure

● Post-surgical orthodontics

69
Q

● Pre-surgical orthodontics -

A 
orthodontic preparation for the planned surgical procedure
○	Eliminate dental compensations (ie. correct upper protrusion/lower retrusion in class III)
○	Dental alignment
○	Facilitates optimal surgery  -  although it make pt look worse (ie increases negative overjet in CL III), maximizes surgical outcome &amp; pts feel better bc something’s being done
70
Q

● Surgical procedure

○ Note: one of the least stable surgeries is

A

setting mandible back; may need elastics post-operatively

71
Q

● Post-surgical orthodontics -

A

finishing & detailing occlusion
○ Keep post-surgical ortho to minimum
○ Potential for relapse if pt still growing (in case example pt had psychosocial issues, so had to start treatment earlier than ideal)

72
Q

Surgery that stretches muscle/soft tissue →

A

more unstable

73
Q

Exception to rule →

A

moving mandible forward stretches soft tissue & moving mandible back relaxes soft tissue
● Soft tissues don’t determine stability

74
Q

Craniofacial Distraction osteogenesis (DO)
● Bone lengthening via gradual expansion of created osteotomy
● DO indicated for more severe situations -

A

can lengthen 2-3 cm

75
Q

● Use DO over BSSO when you want

A

> 1 cm bone lengthening

76
Q

Fracture healing phases:

A

● Inflammation → bone fractured
● Soft callus → soft tissue starts to form around & inside fracture site
● Hard callus → minerals start to form inside/around fx site; bone reunites
● Remodeling → newly formed bone remodeled; bone resorbed to its original condition

77
Q

DO phases of healing

A

● Latency → phase between osteotomy & activation of distractor
● Distraction → when distractor activated & osteotomy gap widened
● Consolidation → distractor maintained & new bone formed inside gap
○ Gap becomes more radiopaque → indicates new bone formation

78
Q

Distraction force ⇒ main driving force for new bone formation in distraction gap
● During early phase of distraction →

A

only minimal bone formation around distraction site

○ Direction of new bone parallel to distraction force

79
Q

Distraction force

● By consolidation phase →

A

lot of new bone formation

80
Q

○ General pattern of new bone follows

A

main direction of the distraction force

81
Q

Ossification modes ⇒

A

intramembranous & endochondral (intermediate cartilage phase)

82
Q

● Distraction has another ossification mode ⇒

A

transchondroid
○ Intermediate mode between endochondral & intramembranous
● All 3 modes occur at distraction site

83
Q

Periosteum critical for

A

DO site bone formation

84
Q

● Lateral side of mandible →

A

osteotomy entry site so greater trauma to periosteum than medial side

85
Q

○ Medial side periosteum more intact →

A

so formation initially greater, but after weeks of consolidation, lateral side periosteum is restored & new bone formation on lateral side catches up to medial side

86
Q

DO requires good

A

angiogenesis & blood supply

● Vessel formation during distraction; vessel mature during consolidation phase

87
Q

DO site bone formation controlled by multiple factors:

A

Distraction factors, bone factors, other mechanical factors

88
Q
  1. Distraction factors:

○ Latency time -

A

variable
■ Some believe craniofacial bone requires 5-7 days latency, while others believe no latency period required b/c of good blood supply

89
Q

○ Distraction rate -

A

1 mm/day commonly used

90
Q

○ Consolidation time -

A

at least double duration of distraction time

91
Q
  1. Bone factors:
A

○ Blood supply & periosteum

○ Mesenchymal cells - differentiate into osteoblasts

92
Q
  1. Other mechanical factors:
A

○ Stability of DO site

○ Functional loading

93
Q

Advantages of DO

● No need for

A

bone graft (DO can grow bone)

94
Q

Advantages of DO

● Significantly larger

A

bone movement ( > 20mm of mandibular advancement)

95
Q

Advantages of DO

● Applicable to

A

infants & young children

96
Q

Advantages of DO

● Can lengthen bone in

A

multiple dimensions simultaneously thru distraction vector control

97
Q

Advantages of DO

● Surgical procedure less invasive than

A

conventional orthognathic surgery

98
Q

Advantages of DO

● Less soft tissue resistance bc of

A

gradual distraction

99
Q

Advantages of DO

● Better long term

A

stability & less relapse (?)

100
Q

Advantages of DO

○ Studies show less relapse from DO at

A

8 weeks. But at 3 & 6 months → no significant difference (when compared to orthognathic surgery)

101
Q

Advantages of DO

○ Maxillary protraction DO study →

A

no relapse at 2 years; better results with max. protraction, but only 1 study

102
Q

Advantages of DO

● Mandibular DO →

A

less distortion & loading of TMJ than BSSO (?)

103
Q

Disadvantages of DO

A

● Technique sensitive surgery
● Equipment sensitive surgery
● Less precise control for correction of occlusion
● Pt. compliance required
● Possible secondary surgery to remove devices (if internal distractor being used)
● Increased chance of infection
● Longer treatment time; increased number of office visits & higher cost

104
Q

Indications for craniofacial DO

● Severe

A

micrognathia in infants & children with airway obstruction (ie. Pierre-Robine sequence)

105
Q

Indications for craniofacial DO

● =========== with severe ———— hypoplasia

A

Hemifacial microsomia

mandibular

106
Q

Indications for craniofacial DO

● Mx. deficiency ass. with cleft lip/palate ⇒

A

DO at Le Fort I level

107
Q

Indications for craniofacial DO

● Mx. deficiency ass. with craniofacial dysostosis ⇒

A

DO at Le Fort III level

108
Q

Indications for craniofacial DO

● Mandibular lengthening

A

> 10 mm

109
Q

Indications for craniofacial DO

● Severe sleep apnea due to

A

Mx/Mn hypoplasia

110
Q

Indications for craniofacial DO

● Widening of

A

constricted mandible

111
Q

Indications for craniofacial DO

● Correction of syndromic

A

craniosynostosis & syndromic midfacial deformities

112
Q

Contraindications of DO

● Lack of

A

adequate bone stock to distract - important; bone needs to be thick & strong enough
● Deficiency/defect can be corrected by traditional orthognathic surgery without bone graft
● Lack of pt compliance (pt needs to activate?)

113
Q

DO vs. orthognathic surgery

A

● DO can be done in growing children

● Long-term stability unclear for both BO & traditional surgery; should only be used for severe cases

114
Q

Camouflage treatment for skeletal problems

A

● Alternative treatment for non-growing or slow growing pts
● Best for pts with acceptable facial esthetics for minor to moderate skeletal problems
● Adjusts dental relationships with orthodontics &/or extraction

115
Q

Camouflage treatment preference depends on

A

POV

116
Q

● Traditionally Class II’s were acceptable for

A

females & Class III for males

117
Q

● Newer data:

○ Consumers & oral surgeons believe that both Class II & Class III are more

A

acceptable in males than females

118
Q

■ Moderate class II equally

A

acceptable in male & female

119
Q

○ Orthodontists believe that Class II is more acceptable in

A

females than males

120
Q

Class II camouflage treatment:

● Non-extraction →

A

elastics to retrude upper incisors; reduces overbite
● Extraction in upper or lower jaw
● Facial profile same?

121
Q

Class III camouflage can be difficult

A

● Retrude lower incisors

122
Q

● Start growth modification at

A

CVMS 2 or 3

123
Q

○ Stage 3 indicates

A

peak growth

124
Q

● CVMS cannot tell us when

A

growth stops; need to do serial cephs

125
Q

● High-pull headgear ⇒

A

ideal use with high mandibular plane

○ Intrudes molars

126
Q

● Cervical pull headgear ⇒

A

ideal use with low mandibular plane; deep bite

○ Extrudes molars (would make open bite worse)

127
Q

Need to decide on camo vs. surgery initially →

A

bc extraction pattern are opposite

- Surgical cases occur at different times for maxilla & mandible (wait longer for mandible)

Ortho Final (8 decks)

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