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Ortho SAQ2 > Extraoral examination > Flashcards

Extraoral examination Flashcards

1
Q

What are the components of extraoral assessment?
(Exam Q which 3 aspects of the facial skeletal relationship should be assessed as part of an orthodontic diagnosis)

A

AP (anterior posterior skeletal pattern)
Vertical
Transverse

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2
Q

Explain how AP pattern is assessed clinically

A
  • Palpation by placing index finger on the maximum concavity of the maxilla and middle finger in maximum concavity of mandible & assess inclination
    class I - normal
    class II - retroclined mandible
    class III - proclined mandible

-Zero meridian line, draw a line vertical line from the forehead (zero meridian) and a horizontal line (Frankfurt line)
class I: Chin on top or 2 mm behind behind the line
class II: Chin behind the line
class III: Chin in front of vertical line

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3
Q

Explain how vertical skeletal pattern is assessed clinically

A
  • Angular measurement - Frankfurt Mandibular PlaneAngle (FMPA) draw a line from point of the chin and frankfurt plane.
  • Average FMPA - line cross at occiput
  • Low angle - lines cross behind occiput
  • High angle - Line cross in front of occiput
  • Linear measurement-
    looks at facial proportion, distance from base of the nose to base of chin which should be equal.
    Lower anterior facial height only relevant for caucasian pt aged 16
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4
Q

Explain how transverse skeletal pattern is assessed clinically

A

look at the pt from above, assess position from chin and septum of nose for true facial symmetry

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5
Q

which radiographs would you take to assess each of these?

A
  • AP skeletal pattern = lateral cephalogram
  • Vertical skeletal pattern = lateral cephalogram
  • Transverse skeletal pattern = OPG
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6
Q

Pt presents with increased face height. how is this likely to be reflected in their occlusion?

A
  • may have class 3 malocclusion, incisor class 3 and prognathic mandible
  • reduced overbite
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7
Q

Which orthodontic tooth movements are most commonly undertaken before orthognathic
surgery?

A
  • slight proclination of the upper and lower incisors
  • vertical movements to alleviate crowding
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8
Q

what is assessed in the intraoral assessment?

A
  • lip competence
  • incisal display
  • lip protrusion
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9
Q

explain each soft tissue measure

A
  • lips - thin, full, normal?
  • competence? lips meet at rest
    — features of malocclusion that leads to incompetent lips = skeletal class II pattern, lower anterior face height (LAFH)
  • lip (soft tissue) protrusion (Ricketts E line)
  • incisal display
  • At rest: 3-4mm male, 4-5mm female
  • smiling: full upper incisor up to 2 mm gingivae
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10
Q

intra arch assessment

A

ACAI
- Alignment → rotations

  • Crowding → HOW MUCH SPACE IS MISSING IN THE ARCH
    mild (1-4mm), moderate (4-8mm), severe (>8mm)
    Spacing → generalised, maxillary median diastema
  • Angulation → MESIAL TIP ROTATION BETWEEN CROWN AND ROOT- slight mesial tip is normal
  • Inclination → normal, proclined, retroclined
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11
Q

Explain AP relationship
* class 1
* class 2
* class 3

A
  • class 1: Lower central incisor edge occlude to the cingulum plateau of the upper central incisors
  • class 2: Lower central incisal edge occludes posterior to the cingulum plateau of the upper central incisors
  • class 3: Lower central incisal edge occludes anterior to the cingulum plateau of the upper central incisors
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12
Q

explain overjet

A

horizontal distance between incisal edge of upper incisors and labial face of lower incisors
normal 2-4 mm

reversed overjet =
lower incisors are anterior to upper incisor labial face

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13
Q

Overbite

A

vertical overlap of lower incisors by upper incisors

normal - upper incisor covers 2/3 of lower incisors
reduced - upper incisors cover 1/3 or lower incisors
increased - upper incisors cover gingival 1/3

anterior openbite: no vertical overlap

complete ovrbite: contact with teeth
incomplete overbite: no contact
traumatic over bite: complete to palatal mucosa

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14
Q

centrelines

A
  • upper centreline coincident with facial midline
  • lower centreline coincident with chin point
  • non coincident: centreline discrepency
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15
Q

molar relationship
class 1
class 2
class 3

A

class 1: mesio-buccal cusp of upper 6 molar occludes to the mid buccal groove of the lower 6

class 2: mesiobuccal cusp of the upper 6 occludes mesially to the mid buccal groove of the lower 6

class 3: mesiobuccal cusp of the upper 6 occludes distally to the mid buccal groove of the lower 6.

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16
Q

canine relationship

A

class 1 - upper canine tip meets the embrasures of lower 3 and 4
class 2 - upper canine tip meets embrasures of lower 3 and 2
class 2 (1/2 unit) - cusp to cusp relationship with canines
class 3 - edge to edge relationship of upper 3 and lower 2

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17
Q

crossbite

A

Upper teeth should occlude buccal to the lower teeth
- anterior crossbite
- posterior crossbite

if there is crossbite need to identify if there is displacement

displacement - shift between retruded contact and maximum interspace occlusion

Get pt to relax so we can guide occlusion to check if there is any interference in anyway that they are biting
e.g. is there a teeth that is standing higher than the rest?

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18
Q

whats the ideal time of puberty growth spurt?

A

girl - 11-13 years
boy - 12-14 years

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19
Q

what are some factors effecting malloclusion?

A

Skeletal
Soft tissues
Dentoalveolar
Habits

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20
Q

what is a space maintainer?

A

appliance designed to prevent or reduce the severity of malocclusion following premature tooth loss

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21
Q

What factors are considered when deciding whether to use a space maintainer?

A

TOAST
Tooth lost
Occlusion
Age
Space analysis
Time passed since tooth loss

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22
Q

what type of space maintainers are there

A

distal shoe
band and loop

23
Q

what is a balancing XLA

A
  • xla same tooth of opposite arch
  • prevents midline shift
  • carried out for decidious D’s and occasional C’s
24
Q

what is a compensating xla

A
  • xla same tooth from same side but opposite arch
  • maintains occlusion relationship by preventing over eruption of opposing tooth
25
Q

if you xla the 6’s would you consider any balancing or compensating xlas

A

balancing no
compensating if xla the lower then you may consider to prevent over eruption.
this may not be required if there is occlusal stop for the maxillary tooth

26
Q

what is supernumery teeth

A

Definition: Excess of teeth compared to the normal dental formula

27
Q

Aetiology of supernumerary

A

genetic and environmental factors, off-shoots of the dental lamina, represent the third dentition
Common cause of delayed maxillary incisor eruption

28
Q

classification of supernumerary

A
  • supplemental
    extra tooth of normal form
  • conical peg shaped
    Midline of anterior maxilla (mesiodens)
  • XLA if erupted
  • leave and monitor regular radiographs to prevent any cystic changes
  • tuberculate barrel shaped
  • urgent XLA before 6 y/o,
    can disrupt eruption of permanent incisors
  • odontome
  • complex: haphazard of tooth
  • compound: discrete tooth like structures
  • refer to OS for XLA, prevent any cystic changes in future
29
Q

ortho rads

A

OPG - used as general screening tool in ortho
to assess condyles, caries, root length and shape, developing dentition

LCPA - used when horizontal parallax is needed
-ve = does not show complete alveolus

Upper standard occlusion - if vertical parallax is needed
-ve = does not show complete alveolus

Lateral cephalogram - assess AP and vertical skeletal relationship & assess proclination of upper and lower incisors
-ve = exposes whole head and neck

CBCT - when 2D image is not enough

30
Q

on lateral cephalogram what does ANB tell?

A

it tells where the upper jaw value is in relation to the lower jaw

if ANB is greater than average it means the lower jaw is class 2

if ANB is reduced of minus value, the lower jaw is class 3

31
Q

define class 2 div 1

A

lower central incisor edge occludes posterior to the cingulum plateau of the upper central incisors

  • upper incisors are proclined
    -there is always an increased overjet

British standards institute classification (BSI)

32
Q

aethiology of Class 2 div 1

A

Skeletal
- AP class 2 skeletal pattern
- variable vertical skeletal pattern

Dental
- crowding in upper anterior arch
- increased overjet
- class 2 molar relationship

Soft tissue
- lip is lower than normal resting position, so teeth free to move forward

habits
- digit sucking
> causes proclined upper incisors
> retroclined lower incisors
> anterior open bite
> narrowing of the upper dental arch

33
Q

management of class 2 div 1

A
  • accept
  • growth modification
    skeletal:
  • maxillary growth restain
  • mandibular growth
  • increased vertical dimension

Dental:
* retract upper incisors
* distal tipping of upper molars
* proclined lower incisors
* mesial tipping of lower molar

> functional appliance
ortho device which utilises the forces generate when stretching the muscles of mastication, facial expressions and peridontium effect the position of teeth and jaw of actively growing patient.
twin block (removable, has acrylic block that postures the mandible forward)
head gear
camouflage
without XLA or if XLA (upper 4 (more posterior anchorage, lower 5 to prevent anteriors to move)
comprehensive tx
orthognatic surgery

34
Q

who are the best candidates

A

well motivated pt
actively growing
mod/sev AP discrepency
increased OJ
increased OB
reduced LAFH
proclined upper incisors and retroclined lower incisors

35
Q

upper removable appliance (URA)

A

ARAB
Active component - springs, elastic bands
Retention - clasps
Anchorage - resistance to unwanted tooth movements
Base plate - connects all components

36
Q

What are the differences between fixed and removable appliance?

A

fixed (can keep inclination whilst retracting)
- 3D control
- force couple
- control of crown and root
- usually permanent dentition
- compliance (OH, diet)
- comprehensive

Removable (not able to change the position of the root)
- tipping
- single point
- partial control of crown
- mixed or permanent dentition
- compliance important
- interceptive and adjustive

37
Q

define class 2 div 2

A

lower central incisor edge occludes posteriorly to the cingulum plateau of the upper central incisors
- the upper central incisors are retroclined
- minimal overjet

BSI classification

38
Q

what is the aethiology of class 2 div 2?

A

skeletal:
- AP mild class 2 (maxilla = prognatic, mandible = retrognatic)
- reduced vertical skeletal pattern (both LAFH and FMPA)

dental:
- acute crown root angle
- thin labial palatal thickness
- increased overbite

soft tissues:
- lower lip is higher than normal resting position so more force from the muscle activity retroclines the incisors

39
Q

how would you manage class 2 div 2

A
  • accept
  • growth modification with ELSAA appliance
  • anterior base plate to reduce overbite
  • recurve spring to procline upper incisors
    then treat like class 2 div 1 and change appliance to twin block appliance
  • camouflage
  • orthognatic surgery
40
Q

define class 3 malloclusion

A

lower central incisors occlude anterior to the cingulum plateau of the upper central incisors

BSI classification

41
Q

what is the aethiology of class 3

A

skeletal
- class 3 (maxilla = retrognatic, mandible= prognatic)

dental
- class 3 incisor (BSI classification)
- class 3 molar (angles classification)

genetic

42
Q

how would you manage class 3

A
  • accept and monitor
  • interceptive tx: early stage (8-10Y/O)
  • growth modification w functional appliance or reverse headgear (bring upper jaw forward)

skeletal management:
restrain mandibular growth
promote maxillary growth

dental management:
procline upper incisors
retrocline lower incisors

  • camouflage
    no XLA if XLA then
    lower 4’s - help with anchorage balance
43
Q

why would you do interceptive treatment of class 3

A

with class 3 everytime pt bites down it causes displacement therefore:
- wear of enamel, gingival recession of central incisors and mobility of tooth

having interceptive treatment relieves this trauma

44
Q

define hypodontia

A

Fewer than normal teeth
Can be mild/moderate/sever or adontia (no teeth)

45
Q

aethiology of hypodontia

A

Aetiology:
* Genetic
* Syndrome-associated hypodontia e.g. ectodermal dysplasia, down syndrome, cleidocranial dysplasia, cleft lip and palate
* Local factors- radio/chemotherapy

46
Q

management of hypodontia

A
  • accept
  • restorative only e.g. composite bonding
  • ortho restorative combined, either:
  • open space -> replace missing unit w restorative method (life long restorative burden)
  • closed space -> camouflage space (ideal as avoids restorative burden)
47
Q

define impacted teeth

A

when the teeth is at a good location but something is blocking the eruption such as sumernumery or crowding

48
Q

what are the risks of impaction

A

root resorption
cyst formation
infection
poor aesthetics

49
Q

how to manage impacted teeth?

A

exposure (open/closed) & ortho traction & alignment

50
Q

what is the aetiology of impacted canines?

A
  • crowding
  • ankylosis
  • pathology
  • clefts
51
Q

what is ectopic

A

deviation of normal path of eruption and overlap between canine and lateral incisor

52
Q

what is the management for ectopic canines

A
  • accept and warn pt of root resorption and cyst formation
  • interceptive - xla of upper c’s (depending on position)
  • exposure and bond + orthodontic tracton (attach gold chain & apply force to align)
  • surgical removal: poor prognosis 3, upper 4 favourable for aesthetics
  • surgical repositioning (rare option)
53
Q

IOTN

A

Ortho SAQ2 (2 decks)

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