adolescent orthodontic treatment Flashcards
urgent phase
1 )pain, swelling, infections
control phsae
1) perio, extraction ,endo, caries control
re evaluation
1) holding phase after control phase
definitive phase
1) reassess initial treatment, operative care, prosthodontics, orthodontics
maintenance phase
holding it stable
level and aligning
1) light arch wires (niti)
2) make sure teeth are straight and leveled
working phase
1) heavier wires strong enough to support major movements
2) space closure or occlusion correction
finishing and detailing
1) wires that can be bent
retention
retainers
goals of leveling and aligning
1) bring teeth to arch and control
- incisor position
- vertical position
- transverse relationship
- maintain arch form
2) make sure each thing has a purpose
alignment
1) roots are generally in right spot
- usually mean crowns are tipped
2) maintain light forces
- niti wires
- small round wires to begin with
- no reason to work up to steel wires in this phase
large brackets
1) better control
2) more uncomfortable
properties of a good wire
1) low stiffness
2) high strength
3) high range, formability
4) weldable and solderable
5) no wire with all characteristics
extraction
1) incisors are usually crowded and not bonded
2) bone second molar to canine first
3) close some space to allow for alignment in anterior region
4) now back to level and alignment
non extraction
1) wire sequence
2) bond all teeth
3) engage as many as possible
what should be completed before
1) leveling and aligning done
3) all rotations
4) resets completed
4) main working arch wire in place
goals of the working phase
1) everything else
2) molar correction
3) space closure
4) prep for surgery
molar correction
1) differential growth
- girls mature earlier
- headgear and functional appliance
2) dental movement
- no growth
- headgear and functional appliance
- other distalizing appliances
- elastics
- extractions
differential growth
1) modulate lower jaw growth if you catch it at the right time
when to take out teeth and which ones
1) take out teeth closest to the problem
2) class I anterior
- all first premolars
2) class II occlusion cases
- upper first premolars (fix canine relationship) and lower second premolars (fix molar relationships)
3) class III occlusion (same as above but swapped)
space closure
1) upper first premolar extraction only
- class II cases with no growth potential left
- almost 100% will need absolute anchorage
- difficult with certain class II div 1 cases
2) class II and III
- depends heavily on anchorage considerations (hold posterior teeth in place and bring anterior teeth distally)
mild anchorage concerns
1) symmetrical extractions all first premolars
maximum anchorage
1) need to back up the teeth
2) put lingual arch improve retraction ratios 2:1 (front teeth go back twice as fast)
2) reinforcement and elastics (3:1)
3) segmented canine retraction (3:1)
4) skeletal implants
six keys to occlusion
1) molar relationship MB cusp of first molar sits in Buccal groove
- want a DB cusp to contact lower second molar
2) all upper teeth roots more distal to the crown
3) crown inclination (torque)
4) spaces all contacts tight
5) flat to slight curve of spee
finishing
1) you have
- all spaces closed
- class I occlusion
- OB and OJ corrected
2) final vertical position of teeth
- final in/out positions
- some minor vertical and sagittal corrections (open bite slight OJ)
correcting vertical incisor relationship
1) smile esthetics
2) look for in excessive OB
- vertical jaw relationship
- incisal display
midline discrepancy
1) usually corrected in working phase
2) usually due to
- lateral incisor position
- slight class II and class III
- cr-co shifts because arch coordination is poor
3) fix by
- asymmetric pattern cl II or cl III one side vs the other
- midline elastics
- asymmetric IPR if OJ allows (need topical fluoride)
tooth size discrepancy
1) usually started during first phase but the final adjustments are in finishing
2) build ups
- put lateral slightly closer to central (makes restoration look better)
- or if you leave the space, put the space distal as possible
final settling of teeth
1) is is common for class II or III corrections to relapse slightly
- stop elastics 1-2 mo prior to debond
- slight overcorrect
2) stiff arch wires can hold teeth slightly out of occlusion
- once removed, it will settle in place
settling 101
1) method 1
- remove main arch wire and place light wire
- replace with braided ss wires and some light elastics
2) method 2
- section main wire distal to canines
- add up and down finishing elastics
3) method 3
- have a lab do it with positional
- expensive and hard to wear
debond
1) move all brackets at same time
2) remove brackets
- pinch base and clean up
periodontal rebound
1) relapse
- retainers help
2) overcorrect
- 1-2 mm change in rebound but posturing is 4-5 mm change
- stop elastics 1-2 mo prior to debond
- can place some elastics to slightly overcorrect
- wean off elastics
transverse
1) slightly overcorrect 1-2 mm
2) then debond
rotated teeth
1) overcorrect a little bit
2) no done with detailing stage
3) put root below the crown
break network of elastic fiber memory
1) circumferential supracrestal fibrotomy
2) straight incision into papilla
