adjunctive ortho treatment

Question 1

What can the loss of a lower molar lead to

Answer 1

Tipping and drifting of adjacent teeth

Poor interprox contact

Poor gingival contour

Reduced interradicular bone

Overeruption of unopposed tooth, leading to trauma

Question 2

What is adjunctive ortho treatment

Answer 2

Tooth movement carried out to facilitate other dental procedures necessary to

• Control disease and/or
• restore function + aesthetics

Question 3

What are the aims of ortho techniques in ortho-resto domain

Answer 3

• Level occlusal plane
• Normalise occlusion
• Distribute (and close) interdental spaces eg after exo tooth with poor prognosis
• Attain a favourable crown:root ratio compared to CLS via orthodontic extrusion
• Uprighting to appropriate space for prosthesis

Question 4

What are the aims of ortho techniques in ortho-perio domain

Answer 4

• Alter anatomic conditions to facilitate the improvement in periodontal health
• Improve gingival aesthetics — prevent gingival recession/traumatic occlusion

Question 5

What is a consideration you must take note of during molar uprighting?

Answer 5

Increase in posterior occlusal plane- should attempt to intrude molar during uprighting to prevent this

Question 6

When would you upright tilted molar via movement of root instead of the crown?

Answer 6

When there is presence of teeth distal to and in contact with mesially tilted molar

Question 7

How can ortho be used to improve restoration of crown fractured teeth with subgingival cracks

Answer 7

Rapid extrusion

• Gingival margin follows tooth down
• Tooth extruded to expose more tooth structure, expose sufficient tooth for crown to be fabricated
• Vertical directed force applied along the long axis of the tooth

Question 8

How long is the duration of rapid extrusion?

Answer 8

2-4 weeks, elastic bands to be changed every week, palatal portion of crowns must be relieved as occlusal interference will occur

Question 9

What must be done after tooth has been extruded and why?

Answer 9

Must be retained and stabilised with brackets or ligature wires.

• Periodontal and supracrestal fibres are stretched
• Bone remodelling takes time
• Tooth will be pulled back into alveolar socket
• 1 month of retention for every mm of extrusion

Question 10

What can intrusion be used to do in restorative dentistry

Answer 10

Overerupted teeth intruded to provide sufficient vertical space to replace missing teeth in opposing arch

Question 11

How can orthodontics be used with perio?

Answer 11

• How can orthodontics be used with perio?
  
  • Bony pocket elimination through anterior-posterior movement of posterior teeth
    
    • In conjunction with surgical debridement
  • Tooth movement to prevent further gingival recession
    
    • Lack of occlusal stop leading to overeruption and gingival stripping
      
      • Upright and intrude teeth to remove scissors bite