Diagnosis and tx planning Flashcards
What are the general principles of diagnosis
history examination diff diagnosis special tests diagnosis treatment plan treatment outcome
How do we get the history off of a patient
CO
PMH
PDH
SH
How do we do an examination
extra/intra oral
How do we get a diagnosis
description
IOTN
How can we measure the outcome
PAR index
When doing a diagnosis what info do we want in it
description of malocclusion
determine the case of malocclusion
are the causes dent-alveolar or skeletal
What do we look at on a lateral cephalogram
AP skeletal
vertical skeletal
class III incisors
Why is a correct orthodontic diagnosis important
orthodontic appliances can move teeth very well but can modify skeletal relationship minimally
a severe skeletal discrepancy may require surgical intervention
What are the objectives of orthodontic treatment
to produce an occlusion which is stable functional aesthetic and to facilitate other forms of dentistry such as crowns and bridges
What things should be considered when making a tx plan
px wishes stability access to tx compliance space requirements aims of tx prognosis of individual teeth feature growth changes etiology of malocclusion px soft tissue profile retention stability
What are the 2 different aims of treatment
full correction of malocclusion
compromise treatment
What is a full correction of malocclusion consist of
class I incisor relationship (OJ/OB normal) class I canine relationship class I molar relationship (can accept class II) no rotations, spaces, flat occlusal plane (andrew six keys)
What does compromise treatment consist of
correct certain aspects and accept others
e.g accept buccal cross bite with no displacement
may have to do work within adverse skeletal pattern and leave residual OJ particularly in adults
What are the stages of tx planning
plan around the lower arch (angulation of LLS is stable)
decide on tx in lower (extraction or non extraction)
build upper arch around lower aim for class I incisor and canine relationship (OJ and OB normal)
decide on molar relationship (class I or full unit class II molar relationship)
What do we look at when examining the lower arch
crowding/angulation of incisors and plane angulation of the canines/centre lines curve of speech space required? what are the options? extraction or non extraction
What is the examination of the upper arch
crowding / angulation of incisors to the maxillary plane
angulation of the canines/centrelines
What should we look at when the teeth are in ICP
incisor relationship OJ OB (curve of spee) centrelines canine relationship
When looking at crowding assessment what can we do to
measure the space available and space required
overlap technique
How do we measure the arch length / space available
by measuring distal of 2 to mesial of 6 + distal of 2 to mesial of 1 and do this both sides and add together
If we estimate the width of all teeth anterior to first permanent molars what does this tell us
space required
What is the overlap technique
looking at how far teeth are out of alignment
doesn’t have to be that accurate
What is mild crowding
only 0-4mm required
What is moderate crowding
5-8mm required
What is severe crowding
8+ mm required
What are the options for mild crowding
non extraction (stripping) extract 5
What are the options for moderate crowding
extract 5 or 4s
What is done for severe crowding
extract 4
If you extract from lower arch what must you do
extract upper or u get MR class III
If you only extract an upper tooth what do u get
MR II
What are other considerations regarding overjet
if the overjet needs to be reduced can it be done by tipping movement or by bodily movement
What are considerations for the molar relationship
will there be residual space in the buccal segments at the end of treatment
what will the final molar occlusion be (class I or II)
What is the retention phase
retainers are needed to hold the teeth in position after active movement
When writing a tx plan what should we put down
diagnosis
problem lost
treatment plan
What should your treatment plan consist of
list of successive stages stating tooth movements to be carried out and appliances to be used
estimate length of tx
if it is not possible to give a detailed plan, indicate when it will be reviewed (i.e following eruption of teeth)
What are the 6 treatment options
- accept malocclusion
- extractions only
- URA
- functional appliance
- fixed appliance
- complex treatment involving orthodontics and restorative treatment or orthodontics and orthographic surgery
What are the limitations of orthodontic treatment
effect of orthodontic treatment are almost purely dento-alveolar and tooth movement with little effect on skeletal pattern
tooth movements are limited by shape and size of alveolar processes
teeth will only remain stable in a position where there is equilibrium between forces of the soft tissues, the occlusion and the periodontal structures. All other positions are unstable and will be prone to relapse
Who will do the treatment for ortho
single treatment - GDP
complex tx - specialist practitioner or hospital specialist
What is the best timing of ortho tx
some tx rely on the grow for success and should be used during the adolescent growth spurt for maximal effect (e.g overbite reduction and functional appliance therapy)
