CHAPTER 60: ORTHODONTICS Flashcards
the specialized branch of dentistry that diagnoses, prevents, and treats dental and oral facial irregularities.
ORTHODONTICS
is a term used when a fixed or removable appliance is positioned inside or outside the mouth to correct problems that involve movement of teeth or growth of the jaws.
dentofacial orthopedics
Orthodontic treatment includes the following types of treatment:
- Straightens teeth
- Corrects crowded or unevenly spaced teeth
- Corrects bite problems
- Aligns the upper and lower jaws
Orthodontic treatment can eliminate or reduce adversity for the patient in three areas:
psychosocial problems
oral malfunction
dental disease
Malocclusion can compromise all aspects of oral function,
as follows:
- Chewing difficulties
- Jaw discrepancies can force changes in the manner of swallowing.
- difficulty making certain speech sounds
-Temporomandibular joint (TMJ) problems ( bruxism, clenching)
Malocclusion can contribute to ____and _____disease.
DENTAL DECAY
PERIODONTAL DISEASE
If advancing in the profession of orthodontics is your goal, you have opportunities to:
(1) continue specialized training within a program
(2) take the Dental Assisting National Boards specialty examination in orthodontic assisting to obtain an additional credential of certified orthodontic assistant (COA).
The patient care area of the office can be sectioned off to serve three functions:
- Obtain records
and create more private setting - take radiographic images
- provide clinical care at all stages of treatment
which type of appointments are scheduledd early in the morning and which are scheduled late in the late afternoon
longer appointments : morning, early afternoon (obtaining records, bonding of brackets)
shorter appointments : early morning late afternoons
Most malocclusions are caused by _____ factors that affect the contours of the face and the size of the teeth and jaw.
heredetary
most common cause of malocclusion is a dispoportion in size between the__ and the teeth or between the ___ and __ jaws.
jaw
upper
lower
Orthodontic problems result from the interaction of:
developmental
genetic
environmental influences
The most common developmental disturbances include the following:
- Congenitally missing teeth
- Malformed teeth
- Supernumerary teeth
- Interference with eruption
- Ectopic eruption
A child who inherits a mother’s small jaw and a father’s large teeth may have teeth that are too big for the jaw, causing _____
overcrowding
Injuries can occur at birth in two major categories:
- fetal molding
- trauma during birth
occurs when an arm or leg of the fetus is pressed against another part of the body, such as when an arm is abnormally pressed against the mandible. This pressure can lead to distortion of rapidly growing areas.
fetal molding
an injury to the jaw, may occur during the actual birth, particularly with the use of forceps in delivery.
trauma during birth
Dental trauma can lead to the development of malocclusion in the following three ways:
- Damage to permanent tooth buds when an injury to primary teeth has occurred
- Movement of teeth as the result of premature loss of a primary tooth
- Direct injury to permanent teeth
As a rule, sucking habits that involve the thumb, tongue, lip, or finger during the PRIMARY dentition years are considered normal.
TRUE
The tongue rests on the lingual surfaces of the maxillary teeth. Pressure causes the teeth to move forward.
Anterior tongue thrust
The pressure of the tongue causes the bite to close down, preventing the permanent teeth from erupting.
Lateral tongue thrust
The tongue thrusts out at the occlusal surfaces.
Fan tongue thrust:
The tongue presses forward against the anterior teeth with each swallow, placing a forward pressure against the teeth.
Tongue thrust swallowing
May be a result of narrowing of the maxilla, which can cause a pinched facial appearance.
Mouth breathing
Habits that contribute to malalignment must be corrected if orthodontic treatment is to be successful.
t or f
TRUE
the maxillary and mandibular teeth, when closed correctly, are referred to as being occluded or as having ______ occlusion
normal
refers to the abnormal or malpositioned relationship of the maxillary teeth to the mandibular teeth when occluded.
Malocclusion
this class of occlusion consists of a normal relationship with the molars, but the anterior teeth will be out of alignment with malpositioned or rotated teeth
class I
also known as
distoclusion.
The mesiobuccal cusp of the maxillary first molar occludes in the interdental space between the mandibular second premolar and the mesial cusp of the mandibular first molar.
CLASS II Malocclusion
also known as
mesioclusion
mesiobuccal cusp of the maxillary first molar occludes in the interdental space between the distal cusp of the mandibular first permanent molar and the mesial cusp of the mandibular second permanent molar.
Class III Malocclusion
Underbite
is the most common contributor to malocclusion
crowding
excessive protrusion of the maxillary incisors, causing space or distance between the facial surface of the mandibular incisors and the lingual surface of the maxillary incisors
overjet
an increased vertical overlap of the maxillary incisors.
in extreme cases the mandibular incisors may not be visible
overbite
a lack of vertical overlap of the maxillary incisors, creating an opening of the anterior teeth when the posterior teeth are closed
open bite
indicates that a tooth is not properly aligned with its opposing tooth.
If a maxillary tooth is inward or touches end to end with another tooth, this exists
cross bite
The scope of corrective orthodontics includes conditions that require the movement of teeth and the correction of ________ & _________
malrelationships and malformations.
Corrective orthodontics includes the following:
- Fixed appliances (e.g., cemented or bonded in place; cannot be removed by the patient)
- Removable appliances for the correction or maintenance of orthodontic treatment
- Orthognathic surgery when the orthodontic problem is too severe to be corrected by other means
The first step in determining a treatment plan is for the orthodontist to learn as much about the orthodontic condition as possible.
t or f
True
Because orthodontic treatment in children is closely related to growth stages, it is necessary to evaluate the child’s _____ ______ status.
physical growth
A major motivation for orthodontic treatment of children is the parent’s ______ for treatment
desire
A thorough hard and soft tissue examination, _______ assessment, and ______ must be completed before orthodontic treatment can begin.
oral hygiene
prophylaxis
Before the clinical evaluation can be completed, diagnostic records are required in the form of :
photographs, radiographs, and diagnostic casts
capture the color, shape, texture, and characteristics of intraoral and extraoral structures. is also useful as an aid in patient identification, treatment planning, case presentation, case documentation, and patient education.
Photographs
Two standard extraoral photographs are taken, as follows
• The frontal view,
(with the lips in a relaxed position)
• A profile view of the patient’s right side, with the lips in a relaxed position
Three standard intraoral photographs are also routinely taken:
• The full direct view
(which includes all teeth in occlusion)
• The maxillary occlusal view,
(which includes the palate and all maxillary occlusal surfaces)
• The right buccal view (which includes the distal of the canine to the distal of the last molar view)
the face is examined for the following:
- Bilateral symmetry
- Size proportion of midline to lateral structures
- Vertical proportionality
frontal analysis
the profile relationship is examined for the following reasons:
- To determine whether the jaws are proportionately positioned
- To evaluate lip protrusion
- To evaluate the vertical facial proportions and the mandibular plane angle
profile analysis
The types of radiographic images commonly taken in the orthodontic setting are as follows:
- The panoramic projection
- cephalometric projection
Specific information the orthodontist can gain from this technology includes accurate measurements, localization of impacted teeth, asymmetry, periodontal structures, placement sites for anchorage devices, and views of the condylar joint and TMJ
CT tomography
are used for the diagnosis and case presentation of the orthodontic patient, as well as for space analysis of the dentition. Is made from plaster
diagnostic casts
Approximately __ hour is reserved for the case presentation visit.
1
When insurance coverage is in place, it is usually the responsibility of the subscriber, not the orthodontic practice, to submit periodic progress claims for reimbursement.
t or f
TRUE
treatment that refers to the use of fixed or removable appliances or a combination of the two types to mechanically move the teeth or jaw.
orthodontic treatment
are a combination of bands, brackets, arch wires, and auxiliaries that can move a tooth in six directions: mesially, distally, lingually, facially, apically, and occlusally
braces aka fixed appliances
teeth must be separated before fitting bands. A
_____ is used for this purpose
A device is placed to force or wedge the teeth apart long enough for initial tooth movement to occur. The separator slightly separates the teeth before the time of the appointment during which bands are to be fitted.
separator
The two main methods of separation used for posterior teeth are:
steel separating springs
elastomeric separators.
are preformed stainless steel bands fitted around the teeth and cemented into place to provide an anchor to the arch wire.
orthodontic bands
placed on the first and second molars and are divided into maxillary and mandibular, and right and left
how is the maxillary molar band seated on the tooth ?
by finger pressure from the mesial and distal surfaces.
is used on the mesiobuccal and distolingual edges to seat the band into place
band pusher
Cementation of orthodontic bands is like cementation of a cast restoration; the difference is that the cement adheres exclusively to ______
enamel
which cement is commonly selected for cementation of orthodontic bands ?
glass ionomer cement
commonly selected b/c of its strength to aid in retention with enamel and its timed-release fluoride properties
is a small attachment used to fasten an arch wire to each tooth.
Constructed from stainless steel, titanium, ceramic, or a combination of these materials.
bonded bracket
The bracket is attached to a _____ ___, which is bonded to the enamel surface of anterior and premolars.
backing pad
an integral part of the contemporary edgewise appliance. These can be attached to molar bands or to single brackets
Auxiliary Attachments
are round tubes that are placed routinely on maxillary first molar bands.
They are used for insertion of the inner bow of a face-bow appliance.
headgear tubes
rectangular tubes that are placed gingival to the plane of the main arch wire.
edgewise tubes
are located on the facial surfaces of the first and second molar bands and brackets for both arches.
These hooks hold the interarch elastics.
labial hooks
is a button or bracket that is located on the lingual portion of the bands to stabilize the arch and to reinforce anchorage and tooth movement.
lingual arch attachment
is a critical component of fixed orthodontics. It serves as the pattern from which the dental arch will take its shape.
arch wire
types of arch wire
stainless steel wire
beta titanium (TMA)
Optiflex
also referred to as Ni-Ti, is very useful for movement because of its flexibility.
nickel titanium
this shaped wires are used during initial and intermediate stages of treatment. Their main functions are to correct crowded and crooked teeth and to level the arch
round wires
this shape wire are used during the final stages of treatment to position the crown and the root in the correct maxillary and mandibular relationship.
These wires also give the tooth better stability and apply greater force.
square or rectangular wires
After the arch wire has been positioned in each bracket, it must be ligated to be held in place. Methods used for this include :
ligature ties or elastomeric ties
thin wires that are twisted around the bracket to hold the arch wire in place.
ligature wires
made from a rubber-like material that is stretched around the bracket to hold the arch wire in place.
elastomeric ties
are 0.01-gauge stainless steel wires that are used to “tie” arch wires in two unique ways.
The dentist can indicate each bracket to be tied with this or can designate a quadrant or a group of teeth to be tied with one of this, creating a figure-eight to form a chain.
ligature tie
are ligature ties that have been spot-welded at the tip to form a hook for the attachment of elastics.
kobayashi hooks
are accessory items made of elastic materials that help in tooth movement
power products
are continuous “Os” that form a chain. They are used to close space between teeth or to correct rotated teeth.
Elastic chain ties
commonly referred to as rubber bands, are placed from one tooth to another in the same arch or from one tooth to another in the opposing arch.
Help in closing space between teeth and correcting occlusal relationships
elastics
a type of tubing that is used to close space or aid in the eruption of impacted teeth.
elastic thread
enhances patient comfort by covering an arch wire that may be causing discomfort.
comfort tubing
At each adjustment appointment, it is the responsibility of the chairside assistant to check the patient’s appliance to determine whether any of the following exist:
- Broken or missing arch wires
- Loose brackets and bands
- Loose, broken, or missing ligatures
- Loose, broken, or missing elastics
types of foods to avoid
sugar containing food
sticky food
hard food
husk food
chewing gum
is an appliance that can be used before braces or work together with braces to move and realign teeth. This is an orthopedic device that is worn partially outside the mouth and is used to control growth and tooth movement.
headgear
Headgear is composed of two parts:
face bow
traction device
is used to stabilize or move the maxillary first molar distally and to create more room in the arch.
facebow
these devices apply the extraoral force needed to achieve desired treatment results.
traction
is a custom appliance that is made of rubber or pliable acrylic and fits over the patient’s dentition after orthodontic treatment
positioner
is a removable retainer worn to passively retain the teeth in their new position after fixed appliances have been removed.
constructed of clear, self-polymerizing acrylic designed to hold wire clasps on molar teeth
hawley retainer
is a canine-to-canine retainer is designed to be bonded to the lingual surfaces
lingual retainer
this arch wire is stiffer and stronger than other types of wire and is used to apply greater force and give better stability to control the teeth.
stainless steel
this type of arch wire provides a combination of strength, flexibility, and memory. The orthodontist may choose this type of arch wire when many bands must be placed.
Beta titanium (TMA)
is a newer type of arch wire that is made from a composite material with a top coating of optical glass fibers, making it esthetically pleasing.
optiflex
