Crowding and Management

Question 1

Why we do space analysis

Answer 1

A disciplined approach to treatment planning ( Make diagnosis and treatment plan)

Defining whether the objectives are attainable ( To determine if treatment objective is feasible)

Anticipating shortage of anchorage or excess of space
Identifying whether extractions are necessary

Planning the mechanics of anchorage

Planning the mechanics of arch relationship correction

Improving pretreatment patient information

Obtaining valid informed consent

Question 2

Why do we need space

Answer 2

Crowding and management
Retraction of proclined teeth
Correction of molar relationship
Derotation of anterior teeth
Leveling of curve of spee
Intrusion

Question 3

Methods on how to gain space

Answer 3

Proximal stripping
Arch expansion
Distalization of molars
Uprighting of tilted teeth
Derotation of posterior teeth
Proclination of anterior teeth
Extraction

Question 4

Space regainers

Answer 4

Fixed appliances
Removable appliances

Question 5

Fixed appliances

Answer 5

Open coil space regainer (Herbst Space Regainer)

Jackscrew space regainer

Gerber space regainer

Question 6

Indications of maxillary expansion

Answer 6

Scissor bite
Mouth breathers (growing individuals)
Posterior crossbites (when severe)
Class III malocclusion
Interceptive orthodontics

Question 7

Indications of slow expansion RME

Answer 7

1. Correction of unilateral cross bites.
2. Correction of ‘V’ shaped arches as in “thumb suckers”.
3. Preparation for bone grafts in cleft cases.
4. Minimal crowding in the upper arch (1-2 mm).
5. Elimination of a displacement.

Question 8

Proximal stripping

Answer 8

Proximation/Slenderization

Done mainly on mandibular incisors/premolars and maxillary incisors

Done when space required is minimal 2.5-3 mm

Stability as contact points are widened
Contraindicated in patients susceptible to caries and young patients with large pulpal horns

Use a thin fissure bur, metal abrasive strips, perforated diamond disks, safe sided corborundum disks then apply fluoride
Long cone technique can be used to to assess enamel thickness

Question 9

Maxillary arch expansion

Answer 9

Type of expansion
1. Orthodontic (finger springs)
2. Orthopedic (RME)
3. Passive (lip bumper)

Rate of expansion
1. Rapid
2. Slow

Indications of expansion
-Crossbites
-Mild crowding
-Expansion along with functional appliances
-Skeletal class III
-Distal molar movement
-Surgical orthodontics

Question 10

Crossbite

Answer 10

Can be
-dental
-functional
-skeletal

Appliances
-Composite inclines
-Quad Helix
-Tongue blade therapy
-Inclined planes
-Hawley appliance with Z spring
-Double cantilever spring (1/2 teeth)