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CCD2 - Ortho > Contemporary orthodontics > Flashcards

Contemporary orthodontics Flashcards

1
Q

What are the three types of appliances?

A

1) Growth modification - aims to alter growth
2) Move teeth within existing bony envelope - fixed appliances and removable appliances
3) Retainers

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2
Q

What do we want from any appliance?

A

Comfortable treatment
Acceptable appearance during treatment
Acceptable treatment time
Lowest possible risk during treatment
Long term stability

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3
Q

What are functional appliances?

A

Removable appliances that are worn for 22/hrs a day and removed for cleaning, eating and sport.

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4
Q

What is a twin block functional appliance?

A

Two pieces (upper and lower) that touch when the patient bites and force the patient to bite forward.

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5
Q

What is a medium opening activator?

A

Single piece that patient bites into - metal clips on the upper 6 and 4, patient bites on lower part forcing the patient to bite forward.

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6
Q

What is a fixed functional appliance?

A

Pt wears this full time, it attached from an upper molar to a lower tooth, the piston arms force the patient to bite forward causing muscles to stretch.

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7
Q

What do functional appliances do and what do they need to work?

A

A growing and compliant patient - usually done 11-14 when the patient is at their pubertal growth phase.
Muscle stretch causes proclined lower incisors and retroclined upper incisors that reduces overjet and changes molar relationship from class II to class I.
Can also correct a deep bite when using a medium opening activator the molars are disoccluded so over erupt.

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8
Q

What are the risks and benefits of functional appliances?

A

Risks - failure rate through non compliance
Can impact QoL through speech, eating, discomfort

Benefits - corrects class II malocclusion - overjet and molar relationship
Can have a small improvement in facial appearance and vertical effect
Can be used with fixed appliance and headgear

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9
Q

What can headgear be used for?

A

Correcting class II malocclusions
Can be used in different directions - depending if you just want to pull the teeth distally or restrain maxillary growth at the same time.
Can correct an anterior open bite as it can have an upwards pull on the molars
Has to be worn for 14 hours and when asleep- not used at school, and not when eating or sports/activities

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10
Q

What are the benefits and risks of headgear?

A

Corrects class II malocclusion - overjet and molar relationship
Little change to facial appearance - good for high angle class II
Can be used in combination with functional/fixed appliances with increased vertical proportions

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11
Q

When do we want to see a patient with a class III dental/skeletal pattern?

A

Aged 8-9

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12
Q

What do we aim to do in class III growth modification?

A

1) Promote maxillary growth
2) Restrict mandibular growth
3) Combination

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13
Q

What is the most commonly used class III growth modifier?

A

Protraction face mask - a frame that sits on the chin and forehead with elastics to fixed or removable maxillary appliance pulling the maxilla forward.
Need to wear >14 hrs a day, most of the time except school

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14
Q

What are the benefits and risks of protraction face mask?

A

Benefits - corrects class III malocclusion
Can promote change to facial appearance

Risks - failure due to non-compliance
Can be difficult to get sufficient hours
Impact QoL
May not prevent need for further tx later on 1/3 need ortho later - but is easier and 1/3 may need OGN surgery.

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15
Q

What is a reverse functional appliance?

A

Aims to push mandible back and maxilla forward however in reality the jaw sits open so there is mostly a vertical change rather than antero posterior.
They are not popular in the UK as they are bulky and difficult to wear.

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16
Q

What is a chin cap appliance?

A

Cup on chin and elastic force around the top of head to aim to restrain mandible growth.

17
Q

What do fixed appliances aim to do?

A

Correct malocclusion by repositioning teeth within an existing bony envelope.
They do not significantly alter face shape or soft tissues

18
Q

What are the stages of fixed appliances?

A

1) Align
2) Level - reducing deep bite/anterior open bite
3) Correct inter-arch relationship - how the teeth bite together, could be AP - mild class II/III or crossbite/vertical.
4) Close spaces
5) Root/crown positioning

19
Q

What are some types of fixed appliances?

A

Design - conventional winged, self ligating
Attachment surface - buccal, lingual
Material - metal, ceramic and plastic

20
Q

How can fixed appliances correct malocclusions?

A

They have 3D control, due to variable force teeth can be moved bucco-lingually, rotational movement or crown to root apex.

21
Q

What does the bracket and wire do?

A

Enables force to be transmitted to tooth, the design and material has little impact.

22
Q

What does the bracket slot determine?

A

Wire size - start with a small round wire that fits loosely in the slot to align.
When aligned use a bigger rounder wire so more force can be applied.
Then square or rectangular wires that click into the slot - can’t go straight into these as the teeth wouldn’t be straight enough and would cause pain to the patient.

23
Q

What is important when aligning teeth with fixed appliances?

A

Wire size, shape and material

24
Q

What are the risks and benefits of fixed appliances?

A

Benefits - excellent for aligning teeth, easily adapted by a clinician, can correct less severe AP, vertical and transverse issues and can use with other appliances to increase the scope of tooth movement.
Risks - can be uncomfortable, risk of decalcification - need to manage diet and OH, can cause root resorption, risk of gingival recession if tooth movement not planned well and can only move teeth in an existing bony envelope so would not correct large skeletal issues.

25
Q

What are quadhelix appliances and what are they used for?

A

An appliance that sits in the palate with four loops of wire and has arms that attach to a premolar, they are used to expand the maxillary arch. They only give dental change and are used for less severe crossbites.

26
Q

What is a transpalatal arch?

A

Support anchorage and keep the arch in place whilst fixed appliances are being used.

27
Q

What is a transpalatal arch?

A

Support anchorage and keep the arch in place whilst fixed appliances are being used.

28
Q

What are temporary anchorage devices?

A

AKA mini screws
They do not osseointegrate into bone so can be removed
They provide a traction point for force application - to support anchorage
Can be placed in buccal/palatal bone and in the mandible and maxilla

29
Q

What are removable orthodontic appliances?

A

They correct malocclusion by repositioning teeth within an existing bony envelope and do not significantly alter the face shape or soft tissues.
They have limited tooth movement and are an adjunctive appliance for fixed.

30
Q

How is tooth movement achieved in removable orthodontic appliances?

A

Active wire components - URA, Barre
Thermoplastic material - aligners

31
Q

What are the 4 aspects of a traditional upper removable appliance?

A

A = active component
R = retention
A = anchorage
B = baseplate

32
Q

What are the risks and benefits for removable appliances?

A

Benefits - correct minor tooth movements, highly adaptable, good adjunct to other treatment and can be used with a fixed appliance and can be a useful interceptive device.
Risks - can be uncomfortable and impact on speech and have a limited scope for tooth movement

33
Q

What is a Barre appliance?

A

A double spring appliance with a labial bow that correct rotation and tip only in the labial segment. But can be uncomfortable and impact speech, they are limited in scope of movement.

34
Q

What are aligners made from and what do they do?

A

Thermoplastic appliances that move teeth incrementally (up to 0.2mm per aligner), full records then digital transfer to the lab with prescription and CAD-CAM is used to reposition teeth according to prescription.

35
Q

What are the risks and benefits of clear aligners?

A

Benefits - good appearance, can be removed for social/OH reasons, increasing scope for correcting a malocclusion - considered an alternative to fixed appliances.
Risks - can be uncomfortable, removable so compliance can be an issue, limited tooth movement, not easily adjusted by clinician - need to send back to lab, software uses average values so may not get outcome that is predicted.

36
Q

What do retainers do?

A

Used at end of treatment and resist relapse by holding teeth in new position

37
Q

What types of retainers are there?

A

Removable - Essix (vacuum formed) and hawley
Fixed - direct or indirect, type of material and design

38
Q

What are advantages of hawley retainers?

A

You can eat in them and teeth can be added if the patient suffers from hypodontia

39
Q

What should patients be informed of to keep their teeth straight?

A

Life long retention is needed as relapse is difficult to predict

CCD2 - Ortho (5 decks)

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