5B Flashcards
Adjunctive therapy:
● Goal to
reposition teeth to facilitate other dental procedures (restore fxn & control disease)
Adjunctive therapy:
○ Main goal is
NOT ideal occlusion/alignment
Adjunctive therapy:
● Generally limited in
scope (ie. doesn’t fix overjet, but creates space for implant placement)
Adjunctive therapy:
● Always inter-disciplinary →
Prosthodontist, Perio, OMFS, &/or Endo
Adjunctive therapy:
● Patient characteristics:
○ Adults with underlying dental disease
○ Sequencing care is critical
Adjunctive therapy:
■ Orthodontics to realign teeth for
better restorative treatment
○ Control/eliminate disease process - primary goal
Adjunctive therapy
■ No orthodontics or restorative until
underlying perio or caries stopped
○ These pts have very specific biomechanical treatments
Effect of reduced periodontal support
● Many pts requiring adjunctive therapy have
reduced periodontal support
● Reduced periodontium (changes C-res) ⇒
alters amount of orthodontic force
○ Apical migration of C-res
Common Adjunctive Procedures
1. Uprighting molars ⇒ common scenario where
molar/PM extracted & adjacent teeth or abutments drift into unrestrained extraction spac
Common Adjunctive Procedures
Uprighting molars
○ Need to consider
of teeth being uprighted & anchorage
Common Adjunctive Procedures
Uprighting molars
■ Uprighting molars can be
difficult & requires a lot of anchorage
Common Adjunctive Procedures
Uprighting molars
○ 2 methods of uprighting molars:
■ Distal crown tip
■ Mesial root tip
■ Combination of distal crown tip & mesial root tip
■ Distal crown tip ⇒ Maintains
space for pontic
Distal crown tip
● If NO antagonist →
distal tipping will extrude tooth
Distal crown tip
○ Coil
spring mechanism
Distal crown tip
○ ↑ crown ht &
↓ mesial pocket
DISTAL CROWN TIP
○ May require
crowd reduction to improve crown:root ratio
■ Mesial root tip
● Reduces
pontic space (eliminates need for pontic, but more difficult)
Mesial root tip
○ Requires
T-loop, spring, or helical mechanics (more complicated)
Mesial root tip
● Intrudes tooth
■ Combination of distal crown tip & mesial root tip
● Goal is
distal crown tip, but want to prevent extrusion
Combination of distal crown tip and mesail root tip
○ To prevent extrusion →
use T-loops or helical mechanics to intrude tooth &/or move roots mesially
- Forced eruption:
○ Indications:
■ Subgingival tooth fx
- Forced eruption:
○ Indications:
● Can’t restore
subgingival fx; will either need to extract or extrude tooth to provide tooth structure for restoration
- Forced eruption:
○ Indications:
■ Periodontal disease & vertical bony defect
○ Treatment options:
■ Perio crown lengthening - limitation is crown-root ratio
■ Orthodontic rapid extrusion
- Forced eruption:
○ Indications:
■ Orthodontic rapid extrusion
● Spring helical mechanism (straight wire would tip adjacent teeth)
- Forced eruption:
○ Orthodontic extrusion ⇒
orthodontic forces used for extrusion
Ortho extrusion
■ PDL/alveolar bone follows
extruding tooth
- Forced eruption:
○ Rapid extrusion ⇒
heavier forces & more frequent activations
- Forced eruption:
■ Tooth extruded without
periodontium following (partial extraction)
- Forced eruption:
■ Lengthens
clinical crown - to expose sound tooth & root structure
- Forced eruption:
○ Retention period important -
long retention period to prevent re-intrusion
- Intrusion for supra-erupted teeth
○ Anterior tooth intrusion ⇒
possible with conventional orthodontics
Intrusion for supra-erupted teeth
○ Posterior tooth intrusion ⇒
possibly ONLY with reinforced anchorage - TADs or implants
Intrusion for supra-erupted teeth
Intrusion ⇒ one of the most
difficult orthodontic movements to accomplish
Intrusion for supra-erupted teeth
● Often with extrusion, patients have
vertical periodontal defects (bc bone following extruded tooth)
Skeletal anchorage ⇒ utilizes
osseointegration (implants) or TADs (temporary anchorage devices)
● TADs ⇒ allow
previously difficult tooth movements possible (ie. posterior tooth intrusion)
TADs
○ Simplifies
ortho biomechanics & speeds up treatment
TADs
■ Allows for
symmetric force. (ie. placing TAD’s buccally & lingually to extruded tooth allows intrusion w/o tipping)
Tooth Proportions:
● Maxillary incisors: ideally ~
10mm tall & 8.5 mm wide
Tooth proportions
○ Ideal width to height ratio
80-84%
● Golden proportion
● Recurring Esthetic Dental Dimension
○ 70% proportion recommended for average teeth length (lateral width 70% of central)
Maxillary & mandibular anterior attrition & supra-eruption
● As teeth undergo attrition →
tend to supra-erupt & gingival margins change
○ Laterals should have the most
cervical gingival margin
● Intruding anteriors will create
open bite for general dentist to restor
Congenitally missing maxillary lateral incisors
● Canines can erupt in place of
missing laterals (good bc brings alveolar bone with it; allows for future implant if decide to distalize canines)
Congenitally missing maxillary lateral incisors
● Treatment plan depend on pt:
○ Class II with overjet →
treat canine as lateral & close space to reduce overjet
Congenitally missing maxillary lateral incisors
● Treatment plan depend on pt:
○ Class I →
distalize canines to class I position & restore w/ implants
Congenitally missing maxillary lateral incisors
■ Adj. roots must be
upright to allow for implant placement
