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Diagnosis Of Orthodontic Problems Flashcards

1
Q

In order to make the correct diagnosis, the orthodontist must consistently develop a ____

A

Diagnostic database

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2
Q

What comprises the diagnostic database?

A

Composted of multiple clinical, functional, and record analyses that allow the clinician to formulate a comprehensive diagnosis and begin to work toward a treatment plan that is most beneficial to the patient.

Case history
Clinical examination 
Functional analysis 
Radiologic examination 
Photographic analysis 
Cephalometric analysis 
Study cast analysis
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3
Q

What are some things identified in the functional analysis?

A

Head posture

Freeways space

Functional discrepancies (shifts and pseudo-bites

Swallowing function (tongue thrust)

TMJ palpation and auscultation

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4
Q

What is the cephalometric analysis used for?

A

Evaluate the formation of the facial skeleton

Relationship of the jaw bones

Axial inclination of incisors

Soft-tissue morphology

Growth patterns

Localization of malocclusion

Treatment limitations

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5
Q

What is a prioritized problem list?

A

Places the orthodontic/developmental problems into priority order to help evaluate the interaction, compromise, and cost/benefit of treatment for each of the problems in order to determine the appropriate course of action that maximizes benefit to the patient

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6
Q

How do you created a prioritized problem list?

A

Group all related findings into major categories

For example, facial convexity, mandibular retrognathism, upper incisal protrusion and proclination, and excessive overjet may all be manifestations of a skeletal class 2 malocclusion

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7
Q

Dental and skeletal posterior crossbite, as well as intercanine and intermolar widths, are in the ___ plane.

A

Transverse

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8
Q

What is included in the frontal analysis?

A

Evaluation of overall relationship between face and the dentition. The four main areas of interest are:

Midline

Lip posture

Buccal corridor space

Smile

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9
Q

How is lip posture evaluated in the frontal view?

A

Lip posture should be evaluated both at rest and with lips lightly touching. Watch for evidence of lip strain on closure (which may indicated need for extraction)

Evaluate the upper lip length and the amount of tooth and gum display at rest and on full smile

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10
Q

What should you do if no amount of tooth is displayed at rest in the frontal view?

A

Teeth are dried, utility wax placed at the incisal edges and the length indented on the wax. The amount of vertical deficiency can then be read from the wax.

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11
Q

In females __-___mm of incisal display should be present at rest; at full smile, the upper lip should reach the height of the centrals or slightly above.

A

3 - 4mm

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12
Q

____ can be due to lingually set or lingually tipped premolars

A

Dark buccal corridor spaces

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13
Q

What is the danger in indiscriminate expansion?

A

Questionable long-term stability and can create buccal root dehiscences

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14
Q

What is evaluated in the smile line in the frontal view?

A

The relationship of the upper teeth to the lower lip should be evaluated for parallelism among their curvatures. Treatment should be aimed at keeping or creating parallelism and avoid a flat or reverse smile line

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15
Q

What aspects are evaluated in the profile view?

A

Evaluate the AP relationship of the maxilla and mandible to the overall face, the nose, lip posture, and vertical discrepancies

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16
Q

What is the E line?

A

Point on tip of nose and tip of chin (soft tissue pogonion)

Lower lip should be 1-2mm from the line

Upper lip should be 2-3mm from the line

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17
Q

In the profile view, the height of the lower face, from subnasale to menton can be subdivided. ___ of the distance is measured from subnasal to stomion, and ___ is measured from stomion to menton

A

1/3

2/3

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18
Q

Deviations from the ratio of height of lower face in profile view may indicate what four things

A

Vertical maxillary excess

Short upper lip

Skeletal open bite

Increase in anterior facial height

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19
Q

The normal ratio of the lower facial height to the posterior facial height is ___

A

0:69

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20
Q

What is the 3D-3T diagnostic grid?

A

It represents a diagnostic summary of the findings in three tissue categories (skeletal, soft tissue, and dental) in the three dimensions (saggital, transverse, vertical)

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21
Q

What are the advantages of using the 3D-3T diagnostic grid in treatment planning?

A

Ensures that all factors and possibilities for a given case are considered before a treatment plan is established.

The side effects of correcting one problem, which may help or worsen another problem, are more clearly evaluated before a list of objectives and the best possible treatment plan is selected.

The immediate insight into the difficulty of a case is another advantage

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22
Q

What are the four steps of the 3D-3T treatment plan method?

A

1) creation of the 3D-3T grid
2) creation of an orthodontic problem list
3) listing of treatment objectives
4) formation of a treatment plan

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23
Q

Describe what should be done in the 3rd step of the 3D-3T treatment plan method

A

List treatment objectives in order of importance for each patient

The patient’s chief concern is always given the high priority

There are some cases in which one or more limiting factors will force the clinician to limit the goals to those most beneficial to the patient. (For example if a non-grower presents with skeletal class 2 and is opposed to surgerythe only realistic option if camouflage treatment)

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24
Q

When class 1 molar correction is unlikely, a better aim may be to get the ___ into a class 1 relationship.

A

Canines

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25
In cases of upper premolar extractions (without extraction in the lower arch), the cuspids are positioned into a class 1 relationship, however the molars are kept at a full step ___ position. However, to establish an ideal occlusion, the normal molar ____ degree rotation must be corrected to ___ degrees if it is in a class 2 molar relationship
Class 2 14 0
26
Soft tissue problems of the AP plane are best seen through a ___ analysis. With the patient sitting in profile position, an imaginary line connects the bridge of nose to the base of upper lip and extending to chin. When this line is ____, the soft tissue profile of the patient is harmonious.
Profile Straight
27
True or false... the soft tissue profile analysis can determine if the face is convex or concave, however, it does not by itself indicate which jaw is at fault. That information is derived from examining the skeletal tissue in this plane of space.
True
28
In general, a very steep mandibular angle coincides with a ___ face. The facial musculature of a doliochocephalic patient shows masseter muscles that are ___.
Long and narrow Weak and hypotrophic
29
Strong hypertrophic masseter muscles are characteristic of a ___ patient with mandibular ___. The facial form of this patient tends to be ___ in appearance
Brachycephalic Hypodivergence Short and square
30
In a class 2 division 2 malocclusion, there typically is a [lack/surplus] of upper lip support
Lack
31
In addition to the E-line, another way to assess the position of the lips is by looking at the ___ plane, which is created by connecting a point at the base of the nose (subnasale) to the soft tissue pogonion. The lips should appear relaxed in the repose position.
Lower facial
32
True or false.. thin lips respond more readily than thick lips to orthodontic retraction of the incisors. Extractions followed by retraction of incisors behind the Sn-Pog line should be avoided
True
33
Normal overjet is the horizontal overlap of he upper incisors to the lower incisors. It is ideally ___mm
2mm
34
When there is negative overjet, or when the lower incisors are anterior to the upper incisors, the condition is called ___
Anterior crossbite
35
To determine if an anterior crossbite has a skeletal component and not just a functional expression of a dental malocclusion, what should the orthodontist do?
Look for the presence of an anterior CO-CR shift. When the malocclusion is a functional one, the incisors show negative overjet in MI, but touch edge to edge in CR. An anterior dental crossbite tends to be easier than one with a functional shift or of a skeletal nature
36
Excessive incisal ___ is related to crowding. The upper incisor should be proclined ___ degrees to the SN plane, whereas the lower incisors should be proclined ___ degrees to the mandibular plane
Proclination 103 93
37
A general strategy of cephalometric analyses used to evaluate vertical problems is to compare the ___ to ___ facial heights. The more equal these measurements are, the more likely it is that the patient will display a ___ face type.
Posterior to anterior Brachyfacial (short, square facial type with low MPA, decreased anterior vertical dimension, and a deep bite)
38
When the anterior facial height is excessively long compared to the posterior portion, a ___ face type is typically evident
Doliochofacial (long and narrow)
39
In the ____ analysis, the vertical position of the mandible is measured by the relationship between the anterior cranial base (defined by the SN plane) and the mandibular plane (extending from points gonion to gnathion). The mean value is ___ degrees for SN-MP angle. An increase in this angle correlates with an increase in ____
Steiner’s 32 Anterior facial height
40
The MPA is helpful in locating the vertical chin. It is formed by the intersection between the ___ and the ___ line and relates the cant of the mandibular plane to the ___ plane. The mean value for MPA is ___ degrees
FH GoGn (gonion-gnathion) FH 25 degrees
41
A well-proportioned face can be divided into approximately equal vertical thirds, with the upper third extending from the ___ point (top of the forehead) to the ___ (most anterior point of the forehead. The second vertical third extends from the ___ to the ___ (point at which the columella of the nose merges with the upper lip in the midsagittal plane. The lower third begins with the ___ and ends with the ___ (the lowest point on the contour of the soft tissue chin, found by dropping a perpendicular line from a horizontal line through skeletal menton)
Trichion (Tr) Soft tissue glabella (G) G Subnasale (Sn) Sn soft tissue menton (Me)
42
A “sunken appearance” of the midface in the middle third may be an indication of a ____ deficiency or ___ associated with ___ malocclusion.
Maxillary AP deficiency Maxillary retrognathism Skeletal Class 3 This finding should be confirmed with cephalometric analysis
43
The middle third to lower third vertical height of the face should have a __:__ ratio
5:6
44
The upper lip length should make up ___ of the lower facial height. The distance from lower lip to soft tissue menton should be ___.
1/3rd 2/3rds
45
_____ - the vertical overlap of the upper and lower incisors, is normally ___mm
Overbite 2mm
46
When overbite is positive and excessive, a ___ exists. When there is a negative overbite, a ___ exists.
Anterior deep bite Anterior open bite
47
Anterior open bites are the result of undereruption of the the ___ teeth or an overeruption of ___ teeth.
Anterior Posterior Likewise, when the posterior teeth are undererupted, the clinical observation is an anterior deep bite.
48
If the anterior open bite is derived from an undereruption of the anterior teeth themselves, this is indicative of ____. The treatment aim is to ___. If the open bite is a result of overeruption of the posterior teeth, this is indicative of ____. The treatment mechanics should be aimed toward___.
Tongue or digit habit Extrude the anterior teeth Skeletal open bite Intruding the posterior teeth and usually leaving the incisors in their original position. If one sees a greater underlying skeletal cause of the open bite (through a cephalometric analysis), it is more likely that the patient tends a combination of orthodontics and orthognathic surgery to correct the malocclusion.
49
What are some dental factors that may cause midline shifts?
``` Crowding Rotations Blocked-out teeth Missing teeth Irregularly sized teeth ```
50
A facial asymmetry caused by a mandibular lateral displacement may be a sign of ___ or of a more complicated ___
Posterior crossbite Skeletal disorder
51
How can deviation of the mandible to one side, accompanied by a cant of the occlusal plane be detected?
Have the pt bite on a wooden spatula with the projected interpupillary line parallel to the floor. The parallelism of the wooden spatula is then evaluated to this interpupillary line
52
When a posterior crossbite exists in MI but disappears in CR, the bite is functional in nature, and often results from the combination of ___ and ___
Constricted maxillary arch Shift of the mandible to the affected side on closure
53
In a posterior crossbite, to find if the constricted maxilla is caused solely by a constricted dental arch or also by a narrow bony palate, one should measure the ____ dimensions of the study models. ___ and ___ widths are measured and compared with a chart of norm for the patient’s age and gender.
Palatal transversal Intercanine Intermolar
54
When intercanine and intermolar widths are very narrow compared to the norm, the crossbite is most likely ___
Skeletal
55
What is the discrepancy index used by the ABO?
It is a grading system used to assess the complexity of an orthodontic case
56
In the discrepancy index (by the ABO), there are ___ target disorders evaluated and scored depending on the severity of their manifestation. What are they?
11 ``` Overjet Overbite Anterior/lateral open bite Crowding Occlusion (angle classification) Lingual/buccal crossbite ANB angle SN-MP angle U1-SN angle ``` Other features may add to the complexity of the case such as congenitally missing teeth, supernumerary teeth, ectopic eruption, transposition, impaction, size anomalies, significant skeletal asymmetries, significant midline discrepancies, MI-CR shifts, and excessive curve of Wilson
57
In a borderline extraction case, orthodontists tend to not extract in a ___ case but will tend to extract in a ___ case.
Low MPA High MPA
58
True or false... if a narrow maxillary dental arch is determined to be of dental origin, the correction may be similar for either the adult or the child in terms of mechanotherapy. If, on the other hand, the transverse discrepancy is due to a maxillary basal bone constriction, the treatment will be considerably different for the adult and the child
True
59
In a mixed dentition, how can a dental maxillary transverse deficiency spontaneously correct itself?
If the permanent teeth erupt in a more buccal position relative to the deciduous teeth.
60
If, in the mixed dentin, a maxillary transverse discrepancy is due to a basal bony problem, what is the treatment of choice?
Rapid maxillary expansion
61
True or false... in an adult patient who presents with a dental posterior crossbite, mechanical expiation is an acceptable treatment as in a child
True. But in adults, it is important to include a periodontal evaluation prior to instituting expansion mechanics. In the presence of untreated mild-moderate periodontal disease mechanical expansion may be somewhat risky
62
If, in an adult patient, the maxillary transverse problem is due to narrowness of the basal bone, what is the treatment of choice?
SARPE (surgically assisted rapid palatal expansion)
63
During correction of a posterior crossbite, one might typically expect an increase in the ___ dimension. Why?
Anterior vertical This usually results as the buccal cusps of the maxillary teeth override the buccal cusps of the mandibular teeth. Under normal circumstances this phenomenon is of a temporary nature, since the cusps achieve a more normal buccolingual relationship. It is more difficult to control in adults because of lack of growth. Adult patients who present with these types of malocclusion often exhibit other characteristics of the so-called long face syndrome.
64
When a tooth is determined to be ankylosed, what are the three treatment options?
Surgical removal of the tooth Distraction osteogenesis of the tooth-bone segment Corticotomy of the surrounding bone and luxation of the tooth
65
Which are the most commonly ankylosed teeth?
Mandibular primary second molars
66
Although many originally thought the anime trans potion was caused by over-retention of a deciduous canine, it is now known that canine-first premolar transpositions are due to...
An underlying genetic basis
67
What are the possible treatment options for transposition?
Alignment of teeth in their transposed positions Extraction of one or both transposed teeth Orthodontic movement to their proper positions in the arch (this may cause possible gingival recession and may have a long treatment time)
68
Chapter 6
Question 23
69
What things may cause root resorption?
Caries Trauma Crowding Orthodontic tooth movement Physiological movement in the transition from primary to permanent dentin
70
True or false... root resorption resultin gfrom orthodontic treatment has been found to be more common and more severe in initially resorbed teeth, but even in these cases it is usually without significant clinical consequences for the patient.
True
71
What is the difference between dilaceration and flexion?
Dilaceration - severe distortion of the root of the tooth Flexion - sharp curve or twist
72
Which three superimpositions are required by the ABO?
Cranial base Maxilla Mandible
73
How do you properly superimpose on the cranial base? What does it accomplish?
Allows assessment of overall or total changes including toothmovements that occurs within the maxilla and mandible as well as the displacements of the teeth due to jaw growth or treatment It requires the use of structures that do not change or grow over time. The anterior and middle cranial base includes structures that have been shown to exhibit little or no growth after 8 years of age. Two of the most important structures for cranial base superimposition are the anterior wall of sella turcica below the anterior clinic processes, and the cribiform plate
74
The anterior wall of the sella turcica below the anterior clinoid processes is stable after age __-__ The cribriform plate is stable after approximately age __-__
5-64-5
75
what is the walker point?
The anterior wall of sella as it intersects with the anterior clinoid process. This point is stable after 5-6 years of age and serves as an important stable landmark for superimposition
76
In order to superimpose cephs to evaluate the AP orientation, two points need to be identified. The walker point and ___
The greater wings of the sphenoid
77
In order to superimpose cephs to evaluate the vertical orientation, the two points that must be identified is the walker point and the ___
Cribriform plate If the cribriform plate is not clearly seen, then the ethmoidal crests should be used.
78
The most stable surface of the midface during growth is the ___
Zygomatic process located just above the anterior to key ridge (The lower aspect of the key ridge is not reliable because it models downward and backward with growth. You also cannot rely on the region just below the orbital rim where the zygomatic process and orbital floor meet. The orbital rim and the orbital floor model upward during growth. Consequently, it is the region between the orbital and key ridge that should be used for structural superimposition.
79
The second set of structures that help when superimposing the maxilla To evaluate AP changes are the ____ sulci.
Maxillo-zygomatico-temporal The sulci are the two vertical or almost vertical lines located behind the lateral contour of the orbits that extend below the orbits.
80
When superimposing the maxilla to evaluate vertical changes, focus on the __ and the ___
Orbital floor Nasal floor Orbitale, which is approximately where the lateral contours of the orbits and thr orbital floor meet, normal models upward with growth. In contrast the nasal floor models downward. The result of growth at these structures is an increase in disatnace between the orbital and nasal floor . Superimposing on the palatal plane ignores these changes, producing an inaccurate interpretation of the dental changes
81
The structures that need to be used for proper maxillary superimposition are the ___, ___, __, and ___
Right and left zygomatic processes Right and left maxilla zygomatic-temporal sulci Orbital floors Nasal floor
82
The distance between the orbital and nasal floors increases during growth. Approximately ___ of the increase is due to apposition at the orbitale and ___ is due to resorption of the nasal floor
3/5ths 2/5ths
83
In summary, in superimposing the maxilla, first focus on the ____ as you begin the superimposition. Then slide along the anterior zygomatic process until ___ of the increase in the distance between the nasal and orbital floors is due to apposition on the orbital floor.
Anterior surface of the zygomatic process 3/5ths
84
Due to modeling and remodeling with growth, mandibular surfaces cannot be evaluated by superimposition of the mandibular outline, thus the ___ method is used. Bone is either being added or removed from the borders, except for the ___ just below ___.
Structural Periosteal contours just below the pogonion
85
The most reliable primary structure of the anterior mandible in superimposition of cephs is the ____. What is another primary structure? What is a secondary structure?
Anterior contour of the chin just below pogonion The inner contour of the cortical plate at the lower border of the symphysis located at the most inferior aspect of the trabecular bone Secondarily, the trabecular bone itself can aid superimposition
86
Posteriorly, the mandible is superimposed on ____. Secondarily, ___ may also be used.
The contours of the alveolar canal. (Try to use the two most anterior or posterior contours) Lower contour of a mineralized tooth germ (the third molar germ can be used if there is no root development)
87
How do you verify that the mandibular superimposition is correct?
Check the anterior border of the ramus. It usually moves posterior with growth, indicating resorption of bone. It should never move anteriorly with growth. Also, mandibular growth is often rotational with resorption at the inferior border, so the mandibular plane should not be perfectly aligned on the inferior border
88
What is the most common in superimposing mandibular cephs?
Selecting different outlines of the IA canals on the different tracings

ABO (22 decks)

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