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ortho > Interceptive Ortho > Flashcards

Interceptive Ortho Flashcards

1
Q

interceptive ortho aka + definition

A

early treatment

treatment performed in either primary or mixed dentition in order to enhance the dental and skeletal development and minimize prospective future serious problems, before the eruption of the permanent dentition

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2
Q

key to succeess in interceptive ortho

A

timely diagnosis and referal

- know where and what to look at

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3
Q

objectives of interceptive ortho

A
  1. to restore arch length integrity (space management)
  2. to improve skeletal imbalances - (classII, Class III, asymmetries, transverse problems)
  3. to establish functional occlusion
  4. to maintain teeth and perio health
  5. to improve self esteem
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4
Q

benefits of interceptive ortho

A
  1. redirect growht of the jaws **
  2. coordinate the width of the upper and lower dental arches
  3. guide erupting permanent teeth into desirable positions
  4. decrease risk of trauma to protruded upper incisors

may potentially simpify later ortho tx and may decrease number of extractions and might simplify orthognathic surgery if needed

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5
Q

disadvantages to interceptive

A

longer tx time and additional retention
increased cost
potential for cooperation loss
irritation of oral tissues / bulky appliances

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6
Q

indications for interceptive therapy

A
  1. arch length managment
  2. eruption problems
  3. oral habits
  4. developmental problems/ syndromes
  5. dental / skeletal crossbites
  6. skeletal discrepencies
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7
Q

arch length management means

A

making sure we have enough room for the permanent teeth to erupt

strategic spaces exist

  • primate spaces–> usually between lateral and canine on upper and canine and first molar on lower in primary teeth
  • anterior spacing
  • leeway space —> primary canine first and second molar replaced by canine first and second pre molars
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8
Q

early loss of incisors implication

A

early loss of primary incisors causes no space loss if primary canines are erupted

early loss of primary canines causes mesial drift of permanent molars, lingual / distal eruption of permanent incisors and midline discrepencies

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9
Q

early loss of primary canines implication?

A

causes mesial drift of primary molars, lingual / distal eruption of permanent incisors and misline discrepencies

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10
Q

early loss of primary 1st molars?

A

distal movement of canines, and it if happens before eruption of permanent 1st molar, than primary 2nd molar will mesially drift and permanent 1st molar

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11
Q

early loss of primary 2nd molars implication?

A

causes migration and tipping of 1st permanent molar

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12
Q

space loss occurs (time wise)

A

very quickly - more immeditalety after extraction or loss and occurs within a year (crucial 6 months)

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13
Q

space loss occurs with which teeth more in order

A

primary 2nd molar > primary 1st molar > primary canine >primary incisors

most with primary 2nd molar and least with primary incisor

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14
Q

highest prevalence and amount of space loss after premature loss of?

A

highest prevalence and amount of space loss after premature loss of maxillary e’s > mandibular e’s

e= primary second molar

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15
Q

early loss of d’s in primary implication

A

almost equal space loss in both mx and mn arches

- d’s = primary first molar

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16
Q

arch where space loss occurs faster?

A

maxilla

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17
Q

space maintainance

A

preservatino of spaces left by the primary teeth and sometimes the primate spaces

  • avoid future crowding
  • allow normal eruption of the permanent teeth
  • allow for developing class I occlusion
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18
Q

potential space loss in arches depends on

A

position of the permanent teeth and adjacent to the edentulous site

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19
Q

indications for space maintainence in terms of primary 2nd molar

A

premature loss of primary 2nd molar - when more than 6 months delay before permanent molar erupts and if there is adequate space

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20
Q

indications for space maintainence in terms of primary 1st molar

A

needed if premature loss of primary 1st occurs prior to eruption of 1st permanent molar

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21
Q

missing permanent incisors

A

usually due to truama or congenitally - so need to maintain this space

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22
Q

indications for space maintainence in terms of primary canine

A

yes - if these are prematurely lost - need to maintain space

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23
Q

5 main space maintainers used

A

band - crown and loop

distal shoe

removable - partial dent type - space maint

lingual holding arch

nance appliance

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24
Q

band and loop use

A

holding space for missing ONE posterior tooth

most of the time the permanent first molar must be erupted - b/c anchor to this tooth

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25
Q

situations to apply band and loop application

A
  1. premature loss of 1st primary molar
  2. premature loss of 2nd primary molar, after eruption of 1st permanent molar
  3. premature bilateral loss of primary molars before eruption of permanent incisors (2 appliances)
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26
Q

crown and loop

A

when the abutment tooth is:

  • highly carious
  • exhibits marked hypoplasia
  • has been pulpotomized

another approach is to place a band and loop over the crown if tooth is already crowned

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27
Q

distal shoe

A

controls the migration of unerupted teeth

loss of primary 2nd molar prior to eruption of permanent 1st molar

loss of permanent 1st molar prior to eruption of permanent 2nd molar

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28
Q

location of blade in distal show

A

1 mm BELOW mesial marginal ridge of the erupting tooth

loop contoured closely to the ridge

MUST take x-ray to confirm it has gone to the right height

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29
Q

distal shoe avoided in who

A

pts. with risk of bacterial endocarditis

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30
Q

in order to use lingual bar need

A

permanent incisors and permanent first molars

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31
Q

partial denture maintainer use?

A

unilateral loss of more than two primary molars

bilateral posterior space maintainence when more than one tooth has been lost per segment and permanent incisors have NOT yet erupted

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32
Q

advantages of partial denture / flipper maintainence

A

posterior maintenance

esthetics - anterior teeth

prevents supraeruption

restores occlusal function

33
Q

disadvantages of partial denture maintenance

A

cooperation

hygeine

34
Q

lingual holding arch use

A

multiple primary teeth are missing

erupted permanent incisors

premature loss of one or both primary canine s

maintains E space

35
Q

bands placed where on lingual holding arch

A

primary 2nd or permanent 1st molars (ideal)

36
Q

arch positioned where on lingual holding arm

A

on CINGULUM OF INCISORS - 1-11.5 mm FF soft tissue and stepped to the lingual in the canine region to remain away from the primary molars and the unerupted premolars

37
Q

fixed / solder joints or removable on lingual holding arm

A

either - removable more prone to breakage or loss

38
Q

nance button / appliance use

A

basically maxillary counter part to lingual holding arms

provides resistance to anterior movement of posterior teeth

CANNOT prevent lingual tipping of incisors

acrylic button anchors in the anterior portion of palatal vault, 0.5 INCH IN DIAMETER

39
Q

hygeine in relation to nance button / appliance

A

can become embedded in the soft tissue when hygeine is poor pr appliance is distorted

40
Q

three main biomechanical principles

A
  1. anchorage - strong abutment , especially in unilaterally supported appliance (perm 1st molar better than D or E of primary molar)
  2. passivity - any movement of abutment teeth must be avoided
  3. simplicity - easy manipulation by the practiioner and tolerance by the patient
41
Q

importance of leeway space

- include measurements

A

5-8 mm of mandibular crowding in the mixed dentition can be resolved with “E” space and slight arch expansion

the same amount of crowding (5-8mm) in the permanent dentition generally requires extraction

42
Q

space regaining

A

restoration of space lost
localized up to 3mm

DRIFT OF PERMANENT INCISORS / MOLARS

repositioning of teeth followed by space maintainer if needed – allows for further normal development

43
Q

main causes of space loss

A

premature loss of primary teeth

un or poorly restored proximal caries - causes drfit

loss of permanent incisors from trauma

congenitally missing teeth

ectopic eruption of permanent teeth

dental malformation, resulting in small teeth such as peg -shaped laterals

44
Q

regaining easier in which arch?

A

maxillary

  • anchorage fom palatal vault
  • extraoral force
  • max bone structure and quality
45
Q

regaining appliances for the maxillae

A

removable
head gear

fixed

  • pendulum-pend x
  • uses a spring and pendulum force

pendex

distal jet

46
Q

regaining appliances for mandible

A

removable ones

47
Q

lip bumper details

A

can use force of lip slightly to distalize the molars

1.5 mm facial to lower incisors, relieved from gingiva

LIP contacts appliance

change in lip and tongue balance

gain arch length on mandible

48
Q

lingual arch for space regaining on mandible that is active

A

lingual arch with INCORPORATING LOOPS to distalize molars or procline incisors

49
Q

major considerations with the regaining space appliances

A
  1. correct application of force - amount and direction
  2. minimize reciprocal movement
  3. avoid complex movements
  4. eliminate occlusal interferences (btite plate, occlusal grinding)
50
Q

severe localized space loss considered when

A

space loss MORE THAN 3 MM

  • loss of space CANNOT be dealt with removable or fixed simple appliances

attempt to regain space should be done with extraoral force and fixed appliance

51
Q

three ways we can MAKE space

A
  1. expansion
  2. IPR - reducing mesiodistal width of permanent teeth
  3. extractions
52
Q

when does excess space require t

A

NO EARLY TX UNLESS DUE TO THICK LOW ATACHED FRENUM

53
Q

what to do with maxillary midline diastema and generalized anterior spacing

A

NOTHING

  • unless due to thick low attached frenum –> refer it out

supernumerary tooth - refer and fix

mesiodens - treat

54
Q

ectopic eruption implcation

A

can cause resoprtion of a primary tooth other than the one it is suppose to replace or of an adjacent permanent tooth

the basic approach is to move the extopically erupting tooth AWAY from the tooth is resorbing

55
Q

brass wire use

A

with abnormal eruptions
- 20 mm brass wire looped and tightened around contact between primary 2nd molar and permanent molar

if limited moveemnt is needed, but little or none of the permanent molar is visible clincially

tighten approx every 2 weeks

56
Q

appliance to use for severe resorption?

A

cantilever arm
-place band on second primary molar supported by lingual arch if maximum control desired, wih cantilever arm extending distally behind unerupted molar

spring or elastic hooked from the cantilever to button on molar

  • for ectopic eruptions
57
Q

interproximal reduction

A

sequential selective slenderizing of primary teeth in order to allow a more favorable eruption path for the permanent teeth

mesial or distal on lower primary canines
mesial on lower second primary molars

disk or needle shaped bur

58
Q

interproximal reduction in posterior?

A

after require a space maintainer – lingual arch

always perpendicular to the occlusal plane and in order to create a favorable path for alignment

59
Q

extraction of primary teeth

A

extraction of primary maxillary canine in order to allow a more favorable eruption path for the permanent canine or correct midline deviations if contralateral was exfoliated prematruely

when permanent tooth is there and no signs of exfoliation or movement in the primary

60
Q

serial extraction - general overview

A

sequential extraction of primary and permanent teeth in order to relieve severe crowding and guide the eruption of permanent teeth into the dental arches

** when MORE than 10 mm of mandibular crowding exisits and extractions of 4 premolars is require

specific order and follow up for next ones required

61
Q

most common teeth involved in serial extraction and rationale for each

A

most common are decidous canines, first molars, and first pre-molars

primary canines – improve incisor alignment

1st primary molars – accelerate erruption of the 1st premolars

then 1st pre-molars – permit the eruption of the permanent canines into proper position

62
Q

extraction / enucleation

A

supernumerary teeth, cysts, odontomas; eruption interference or diestam

*contribute to eruption problems

treat cause!

63
Q

oral habits implication

A

can cause distortions with dental alveolar like thumb sucking and tongue thrusts

64
Q

appliance to help with oral habits

A

tongue crib

- prevent tongue from putting pressure on the dentition

65
Q

tongue habit appliance

A

acts as a reminder of where to position the tongue

66
Q

tongue spurs

A

interfere with the tongue

tongue learns not to go there

67
Q

thumb crib

A

patients that suck thumb

block area where thumb would go

68
Q

schwartz appliance helps with

A

transverse imbalances

  • like posterior crossbites
  • seems like a palatal expander

on the lingual too

69
Q

quad helix is

A

fixed - helps with posterior crossbites

70
Q

bonded hyrax expander

A

acrylic - may open bite but will have no extrusion of molars - so no increase in vertical dimension

71
Q

bands where on haas expander

A

bands on 6’s and 4’s

72
Q

hass expander details

A

bands on 6’s and 4’s
metallic framework
expansion screw
acrylic palatal coverage

NON PARALLEL suture opening
teeth
extrusion of posterior

73
Q

hass expander vs bonded hyrax expander

A

with bonded have acrylic on occlusal coverage - may open bite but will have no extrusion of molars - so no increase in vertical dimension

hass expander may have extrusion

bonded hyrax has bands on 6’s

74
Q

bonded hyrax expander details

A

vertical control

long AFH (anterior facial height) - do not want any bite opening

no extrusion desired

when bite opening is contraindicated

75
Q

KD appliance for

A

anteiror crossbite

76
Q

fixed appliance for anteiror crossbite

A

yes

- can do this with KD appliance

77
Q

skeletal imbalances dealt with how - general

A

maxillary and mandibular excessive and deficient growth
- modify accordingly

like head gear
face mask
fixed / removable

see last weeks lectures

78
Q

when to interfere with early treatment

A

primary or mixed – as soon as patient can tolerate impressions

ortho (19 decks)

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