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Ortho > interceptive ortho > Flashcards

interceptive ortho Flashcards

1
Q

definition

A

any procedure aimed at reducing or eliminating the severity of a developing malocclusion
mostly mixed dentition

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2
Q

natal teeth

A

teeth already erupted/erupt within first months
roots often poorly formed - mobile
may need removal if inhalation risk/feeding problems

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3
Q

what supernumeraries do you tend to get in the primary dentition?

A

supplemental

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4
Q

teeth of abnormal morphology in the primary dentition

A

double teeth - fusion/gemination

often don’t extract if not causing problems and exfoliates

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5
Q

what skeletal class are patients often in the primary dentition and why?

A

class 2 initially as get later growth of mandible

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6
Q

hypodontia in the primary dentition

A

usually if missing primary tooth won’t get permanent

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7
Q

what might need intercepting?

A 
crossbites
digit sucking habits
supernumerary teeth
midline diastema
increased OJ
reverse OJ
increased OB
early loss of deciduous teeth
developing crowding
poor prognosis FPMs
impacted FPMs
infraoccluded teeth
hypodontia
delayed eruption
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8
Q

anterior cross bite definition

A

abnormal relationship between opposing teeth in a bucco-palatal or labiopalatal direction

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9
Q

anterior cross bite possible problems

A

tooth wear
gingival recession
displacement on closure

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10
Q

anterior cross bite favourable features for correction with a URA

A

tooth in X-bite palatally tipped
good OB - aids stability
adequate space to move forward

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11
Q

management of an anterior cross bite

A

URA - FPBP and z-spring. often have retention posteriorly so don’t interfere anteriorly
2x4 appliance - tend to use fixed if >1 tooth to move in CB. brackets on incisors and 6s

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12
Q

reasons for early correction of a posterior crossbite

A 
displacement on closure
tooth wear
facial asymmetry
teeth may erupt in "displaced" ICP position
TMJ problems?
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13
Q

what is a scissor bite?

A

if one tooth completely misses the other in CB - common in skeletal C2 in premolars

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14
Q

management of posterior CB

A

maxillary expansion
URA - tipping teeth, high relapse potential, turn screw x2 per week
quad helix - turn to activate buccal arms, shorten or get rid to get differential expansion
RME - tend to use if skeletal problem of narrow maxilla. corrects transverse skeletal issue. teeth don’t move. turn screw x2 a day. hold it for a while to allow bony deposition

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15
Q

reasons for treating an increased overjet in the mixed deniition

A

increased trauma risk - fct?

poor aesthetics - psychosocial problems, teasing at school etc

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16
Q

aetiology of increased OJ

A

skeletal - usually C2, mandibular deficiency most common
soft tissue - L lip trap, hyperactive L lip
dental - U incisor proclination, lingual displacement of L incisors, ? digit habit

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17
Q

management of increased OJ in a growing pt

A

simple retraction of U incisors (URA)

attempt growth modification

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18
Q

growth modification options for increased OJ

A

EO traction - uses the back of the head for anchorage

myofunctional appliances - harness forces generated by the facial and masticatory musculature

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19
Q

pt selection for growth modification for increased OJ

A 
growing pt
pt concerns
pt motivation
dental health risk
large dentoalveolar contribution to aetiology
absence of significant crowding
increased OB
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20
Q

functional appliances for increased OJ

A 
tooth borne
 - activator (andreason)
 - twin block
soft tissue borne
 - myofunctional regulator (Frankel)
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21
Q

therapeutic effect of fct appliances for increased OJ

A

? enhance mandibular growth - weak evidence from studies
? restrain maxillary growth
remodel glenoid fossae
retrocline maxillary incisors and distalise molars
procline mandibular incisors and mesialise molars

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22
Q

reverse OJ problems

A

displacement on closure
incisal edge wear
difficulty eating
speech problems?

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23
Q

aetiology of reverse OJ

A

skeletal - class 3 jaw discrepancy, hypoplastic maxilla, prognathic mandible
dental
- mandibular displacement
- retained upper deciduous incisors

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24
Q

key factors in planning tx of a reverse OJ

A 
pt concerns
expected future growth
severity of skeletal pattern
ability to achieve E to E?
degree of incisor compensation
degree of crowding/spacing
OB
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25
Q

management of reverse OJ

A 
simple proclination of U incisors (URA)
attempt growth modification
 - chin strap/cup
 - fct appliances e.g. reverse twin block
 - protraction headgear
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26
Q

how does protraction headgear work?

A

alter force exerted by lips and cheeks
disengage occlusion
facemask pulls directly on maxillary appliance and pushes on L incisors

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27
Q

potential problems with a deep OB

A

palatal ulceration

gingival stripping

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28
Q

management of a deep OB

A

URA with FABP
will allow L molars to erupt
pt must be growing to accommodate the increase in vertical dimension
? convert to class 2 div 1 and twin block
posterior teeth erupt much better in a growing pt

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29
Q

problems associated with a digit sucking habit

A

AOB or reduced OB
proclined U incisors (increased OJ)
retroclined L incisors
posterior CB

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30
Q

aetiology of problems associated with a digit sucking habit

A 
6 or more hours duration
prevention of eruption of incisors
labio-lingual pressure on incisors
lowering of tongue position
unopposed buccinator pressure on UBS
31
Q

management of digit sucking habit

A

encourage cessation at home initially
habit deterrent appliance (passive) - removable/fixed
appliance to deal with effect
- if stop habit early might get spontaneous resolution esp of AOB - wait a year
- OJ reduction
- CB correction
- closure of AOB

32
Q

problems with supernumerary teeth

A

impeded eruption of associated teeth
displaced eruption of adjacent teeth
poor aesthetics
?damage to adjacent teeth - not common

33
Q

conical supernumerary teeth

A

usually close to midline (mesiodens)
usually 1 or 2
tend not to prevent eruption but may displace centrals
extract only if erupt or impeding tooth movement (but warn pt of rare risk of cyst)

34
Q

tuberculate supernumerary teeth

A

main cause of failure of eruption of central incisors
barrel shaped, usually develop palatal to centrals
remove +/- surgical exposure of centrals - radiograph to check not fused first

35
Q

supplemental supernumerary teeth

A

normal morphology

tend to extract - decision based on tooth form and position

36
Q

what is a less common form of supernumerary tooth?

A

odontome - compound/complex

37
Q

prevalence of supernumerary teeth in permanent dentition

A

2%

38
Q

are supernumerary teeth more common in the maxilla or mandible?

A

maxilla

39
Q

gender distribution of supernumeraries

A

M>F

40
Q

where are 80% of supernumerary teeth found?

A

anterior maxilla

41
Q

what is the most common cause for failed eruption of upper incisors?

A

supernumeraries

42
Q

what % of diastema are due to supernumeraries?

A

10%

43
Q

give some conditions that have an increased incidence of supernumeraries

A

CLP
cleidocranial dysplasia
Gardners syndrome

44
Q

problem with upper midline diastema

A

poor aesthetics

45
Q

aetiology of upper midline diastema

A 
developmental: 98% at 6, 49% at 11, 7% 12-18
generalised spacing
hypodontia (absent 2s)
midline supernumerary (mediodens)
proclination of U incisors
low frenal attachment
pathology
46
Q

management of upper midline diastema

A

none for developmental
surgical removal of supernumeraries - not always necessary, risks vs benefits
early closure if severe and child concerned
fraenectomy? - carried out at point of space closure as contraction of fibres can help to maintain it
bonded retainer - v high relapse rate (but need excellent OH)

47
Q

space loss varies with:

A

age at loss
tooth lost
U/L - lose space quicker in U arch
inherent crowding

48
Q

early loss of deciduous teeth - As and Bs

A

minimal effect on centreline, don’t balance or compensate

49
Q

early loss of deciduous teeth - Cs

A

consider balance to maintain centreline in crowded dentition, do not compensate

50
Q

early loss of deciduous teeth - Ds and Es

A

space loss esp in U, consider space maintenance

little effect on centreline, no need to balance

51
Q

what are loss of Es a major cause of?

A

impacted 5s
will often erupt to the inside of the arch if given time (palatally/lingually)
in L arch may not erupt

52
Q

how does location of space loss in the arch have an effect on crowding?

A

the further back in the arch, the more marked the effect on crowding

53
Q

space maintenance as a possible interceptive measure

A

early loss of primary teeth
early loss of FPM
traumatic loss or delayed eruption of U incisor
preserve leeway space
BUT good dental health required - best space maintainers are intact primary teeth

54
Q

types of space maintainers

A

lingual arch
stops - SS wire
band and loop
acrylic baseplate

55
Q

poor prognosis FPMs - timing of interceptive FPM extraction

A

if arches well aligned then ext as early as possible to allow maximum mesial drift of 7s
more crucial in L arch than U

56
Q

why are FPMs rarely the tooth of choice for ortho extractions?

A

space provided is remote from labial segments
much of space often lost through mesial drift of 7 - esp in U
eruption of L7 unpredictable

57
Q

poor prognosis FPM extractions - compensation and balancing

A

ext U6 - don’t necessarily compensate
ext L6 - consider compensating, need to be sure U molar won’t continue to erupt otherwise compensate
consider balancing ext only in L arch and if crowded - usually premolar unless opposite first molar is of doubtful prognosis

58
Q

ideal timing for XLA of L FPM

A

bifurcation of 7 is forming
age 8-9yrs
good spontaneous space closure between 7 and 5

59
Q

early loss of L FPM

A

distal migration of 5

60
Q

late loss of L FPM

A

poor spontaneous space closure

mesial tipping and lingual rolling of 7s

61
Q

loss of U FPM

A 
timing less critical than in mandible - better space closure
if space required e.g. class 2 div 1 cases consider delaying ext if possible until eruption of 7 and place space maintainer prior to ext of FPM. may not be possible given tooth condition and age of pt
62
Q

aetiology of impacted FPMs

A

eruption angle
ectopic cyst
morphology of E crown
small maxilla

63
Q

consequences of impacted FPMs

A

pulpitis of E/premature exfoliation of E

64
Q

tx options for impacted FPMs

A

observe 6m
- 66% will disimpact by 7yrs
- but spontaneous disimpaction rare after 8 years
XLA E
- regain space for premolar or tx crowding at later stage
- can get adjacent tooth tipping over it - lose space so if ext E need space maintainer
disimpact
- separators
- band E and bracket 6 with open coil
- discing of E
- URA with finger spring and attachment on 6

65
Q

what is primary molar infra occlusion?

A 
temporary ankylosis (8-14%)
tooth fails to achieve/maintain its occlusal relationship with adjacent/opposing teeth
66
Q

which is the most common tooth for primary molar infra occlusion?

A

lower D

67
Q

which jaw is primary molar infra-occlusion most common in?

A

mandible

68
Q

S and S of primary molar infraocclusion

A

percussion sound

blurring/absence of PDL on xray

69
Q

management of primary molar infra occlusion

A

if permanent successor present and in good position it is usually temporary - observe (usually shed normally)
permanent successor missing - build up occ surface (maintaining tooth will preserve bone) or ext

ext if:

  • danger or tooth disappearing below gingival level
  • root formation of permanent tooth is nearing completion (eruptive forces reduced after this)
70
Q

hypodontia

A

developmental absence of one or more teeth, excluding 8s

71
Q

prevalence of hypodontia

A

6%

72
Q

what is hypodontia associated with?

A

microdontia

73
Q

most common teeth affected by hypodontia

A

L5s
U2s
U5s

Ortho (21 decks)

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