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BDS4 CDS Ortho > fixed appliances > Flashcards

fixed appliances Flashcards

1
Q

definition of fixed appliances

A

An appliance which is fixed to the teeth and cannot be removed by the patient

Consists of brackets, bands, archwires and auxillaries

Precision tooth movers

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2
Q

fixed vs removable appliances
tooth movements

A

fixed - 3D
removable - simple

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3
Q

fixed vs removable appliances
root movement

A

fixed - control over, able to do complex tooth movement
removable - no control over root

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4
Q

fixed vs removable appliances
pt compliance

A

fixed - no dependent
removable - dependent on

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5
Q

fixed vs removable appliances
OH level

A

fixed - needs excellent
removable - can be taken out to aid OH

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6
Q

fixed vs removable appliances
risk of iatrogenic damage

A

fixed - greater
removable - less

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7
Q

fixed vs removable appliances
intrinsic anchorage

A

fixed - poor
removable - good (baseplate)

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8
Q

when to use fixed appliance

7

A

Correction of mild to moderate skeletal discrepancies
* Camouflage (accepting underlying mild skeletal discrepancy and trying to get class I incisor relationship)

Alignment of teeth

Correction of rotations

Centreline correction

Overbite and overjet reduction

Closure of spaces/ creating spaces

Vertical movements of teeth (extrusion/intrusion)

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9
Q

tx goal

A

andrew’s 6 keys

Tight approximal contacts with no rotations.
Class I incisors.
Class I molars
Flat occlusal plane or slight curve of Spee.
Long axis of the teeth have a slight mesial inclination except the lower incisors.
The crowns of the canines back to the molars have a lingual inclination.

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10
Q

andrew’s 6 keys

A

Tight approximal contacts with no rotations.
Class I incisors.
Class I molars
Flat occlusal plane or slight curve of Spee.
Long axis of the teeth have a slight mesial inclination except the lower incisors.
The crowns of the canines back to the molars have a lingual inclination.

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11
Q

7 components of a fixed appliance

A

Bracket/tube

Band –* good if heavily restored/MIH for bonding, good robust end point of appliance
*
Archwire – changed at most visits, depending on prescription

Modules / doughnuts –* bands that are changed every visit*

Auxiliaries – chains etc

Anchorage components

Force generating components – coils, springs etc

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12
Q

molar bands and molar tubes

used for

A

good if heavily restored/MIH for bonding, good robust end point of appliance

molar tube – more discreet and less harsh than molar bands, for particular tooth – not universal

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13
Q

most commonly used type of archwire

A

straight wire
in/out/tip/torque already built in, no need for wirebending

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14
Q

3 components of brackets

A

Bracket slot
Tie wings
Bracket base

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15
Q

materials brackets can be made of

3

A

Metal
SS, CoCr, Ti, Au

Polymers

Ceramics

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16
Q

molar bands
made of and how to place

A

Stainless steel with prewelded attachments
* Tubes or cleats

Require space before placement
* Separator visit

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17
Q

bonding ortho appliances to teeth

2 types

A

Composite via acid etch technique
* Used for brackets and tubes NOT bands
* Photo-initiation reaction using light cure 440-480nm wavelength of light
* Micromechanical retention

Glass Ionomer
* For molar bands

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18
Q

composite via acid etch bonds

A

ortho brakets and tubes to teeth

Photo-initiation reaction using light cure 440-480nm wavelength of light
Micromechanical retention

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19
Q

glass ionomer bonds

A

molar bands only

20
Q

composite applied to brackets how

A

can get pre-coated brackets - less flash, more efficient but £££

or apply one by one from composite tube

21
Q

etch system options for ortho

A

one system etch and bond - less concern over isolaation (no need ti wash/dry in between) so more efficient

so seperate etch and bond system not preferred

22
Q

materials for archwires

A

various materials, shapes and sizes

Stainless Steel (SS)
Nickel Titanium (NiTi)
Cobalt Chromium (CoCr)
Beta-Titanium (TMA)
Composite/glass

23
Q

nickel titanium properties as an archwire

4

A

Flexible

Light continuous force

Shape memory
* Return to original shape
* Cannot bend

Higher friction than SS

24
Q

stainless steel properties as an archwire

2 main

A

**Working archwires to slide teeth (low friction) **

Formable
* Archwire bends
* Loops

25
Q

force generating components of fixed appliances can be

4

A

Teeth move by utilising the energy stored in the elastic or spring

Sliding mechanics
* elastic power chain
* NiTi coils
* Intra-oral elastics
* Active ligature

26
Q

anchorage is

A

resistance to unwanted tooth movement

newton’s 3rd law:Every force has equal but opposite reactionary force

27
Q

newton’s 3rd law

A

Every force has an equal but opposite reactionary force

28
Q

first aspect of ortho tx planning is

A

anchorage

plan carefully to avoid unnecessary complications

29
Q

simple anchorage

A

1 larger tooth and 1 smaller tooth so smaller tooth moves

30
Q

compound anchorage

A

Inc SA size against tooth going to move – inc movement of smaller tooth area

less unwanted tooth movement, more favourable

31
Q

reciprocal anchorage

A

equal weighting so move at same rate

e.g. for Diastema

32
Q

absolute anchorage

A

High anchorage demanding case but v imp that no unwanted tooth movement - Hard

options:
* Temporary anchorage devices (TADS)
* Non osseointegrating mini screw
* Major development in orthodontics
* Anchorage control
* Tooth movement mechanics

33
Q

5 options for absolute anchorage

A
  • Temporary anchorage devices (TADS)
  • Non osseointegrating mini screw
  • Major development in orthodontics
  • Anchorage control
  • Tooth movement mechanics
34
Q

cortical anchorage

A

Cortical plates provide ↑ resistance to tooth movement
Maintains Intermolar width

e.g. Using transpalatal arch, palatal nance button

35
Q

anchorage options

6

A

simple
compound
reciprocal
absolute
cortical
intermaxillary

36
Q

headgear in fixed appliances

A

use is in decline

Must ensure appropriate safety mechanisms
* Written and verbal instructions

37
Q

retainers

A

Appliances designed to prevent relapse
* Fixed
* Removable

Must be stressed at consent stage of treatment lifelong retention required

38
Q

retention is

A

maintaining the final tooth position with a passive orthodontic appliance

lifelong retainers - fixed or removable

39
Q

malocclusion features with high relapse potential

6

A
  • Diastema/ space closure
  • Rotations
  • Palatally ectopic canines
  • Proclination of lower incisors
  • Anterior open bite
  • Instanding upper lateral incisors
40
Q

removable retainers

A

Pressure formed retainers Clear overlay retainers)
* Variety of materials and thickness
* Can include prosthetic tooth for aesthetics

Well tolerated !

Retainer wear pattern for removable pressure formed retainer
* Varies between clinicians
*2 weeks full time wear except for eating and drinking, night only thereafter
or Straight to nights only *

Hawley is old metal removable retainer

41
Q

fixed orthodontic retainers

used for what situs esp

A

higher relapse situ, need enough space and clearnace

  • Spaced closure
  • Diastema
  • Proclination of lower labial segment
  • Periodontal cases
  • Ectopic canines
  • Instanding upper 2’s

For some Orthodontists all cases

42
Q

fixed ortho retainers
made of
require

A

Bonded wire retainer - can be lab made (better) or chairside

Requires careful monitoring and interdental cleaning
* Ensure composite attachments intact and sound
* Refer back to orthodontist if problems

43
Q

main risks of fixed appliances

3

A

Decalcification
Root Resorption
Relapse

44
Q

enamel in fixed appliances due to

A

From opposing brackets
Higher risk with ceramic brackets

45
Q

5 stages in the pt journey of fixed appliance tx

A

Assessment & diagnosis
* Treatment aims

Treatment plan

Commence treatment
* Average case 18-24months
* Hypodontia case 24-30 months
* Orthognathic case 24-30 months

Routine adjustments
* Every 4-8 weeks

retention

46
Q

intial problems encountered in fixed appliance tx

4

A
  • Pain
  • Mucosal irritation
  • Ulceration
  • Appliance breakage
47
Q

role of GDP in fixed appliance pt management

6

A
  • Continue to see patient for routine care and check ups
  • Reinforce OHI and Diet advice
  • Liaise with orthodontist if concerns
  • Make appliance safe in case of an “orthodontic emergency”
  • Snipping of jaggy wire
  • Removal of loose component

BDS4 CDS Ortho (9 decks)

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