Interceptive Orthodontics 1

Question 1

At birth, what are your jaws and gums like?

Answer 1

Gum pads
Upper rounded
Lower U shaped
Often appear very class 3
Anterior open bite
Thin layers of enamel

Question 2

In mm, what width should a diastema close?

Answer 2

Under 2.5mm.

Question 3

How many 6 year olds have a diastema (in percentage)?

Answer 3

96%.

Question 4

What will no spacing, under 3mm, 3-6mm and over 6mm cause crowing in the permanent dentition (in percentage)?

Answer 4

No spacing- 66% will dev crowding
Under 3mm- 50% crowding
3-6mm- 20% crowding
Over 6mm- no crowding.

Question 5

What is interceptive orthodontics?

Answer 5

Any procedure that will reduce or eliminate the severity of a developing malocclusion.

Question 6

What are the teeth like in a deciduous dentition?

Answer 6

Incisors more upright
Spaced
Wear.

Question 7

When do the 6’s, 1’s and 2’s erupt?

Answer 7

6- 6 years
1- 7 years
2- 8 years.

Question 8

What is a diastema?

Answer 8

A diastema is a space (gap) between two teeth, most often noticeable between the two front teeth. This condition usually occurs when there is a disproportionate relationship between the jaw and the size of the teeth, but can also be caused by alignment problems, protruding teeth, or over-sized tissue.

Question 9

What do you do when you notice the sequence of eruption is wrong?

Answer 9

Take a history, do an examination, palpate and take radiographs.

Question 10

How many months should the contra lateral tooth erupt within?

Answer 10

6 months.

Question 11

What might cause unerupted central incisors?

Answer 11

Supernumeraries
Trauma/Dilaceration
Other pathology.

Question 12

What do you do when a central incisor hasn’t erupted due to a supernumerary?

Answer 12

Remove deciduous and supernumerary

Expose/bond

Create space

Monitor (over 1 and a half years).

Question 13

When removing a supernumerary tooth due to an unerupted central incisor- what percentage of people will this tooth erupt within 16 months?

Answer 13

80%.

Question 14

What happens if we lose one C?

Answer 14

The permanent incisor shifts off to one side- might not have an effect if you have a spaced dentition.

Question 15

What would you do if your patient lost a C on one side and the permanent incisor shifts off to one side?

Answer 15

Extract the other C.

Question 16

Does mesial drift happen quicker in the upper or lower arch?

Answer 16

Upper arch.

Question 17

What is the aetiology of a median diastema?

Answer 17

Normal (small teeth)
Supernumerary
Missing teeth

TAKE A RADIOGRAPH!

Question 18

What does compensating mean?

Answer 18

If you take something out in the upper take it out in the lower.

Question 19

If a central incisor isn’t erupting- what should you ask them?

Answer 19

If they have had a traumatic episode in the past.

Question 20

What is a dilaceration?

Answer 20

dilaceration is defined as the deformity of a tooth due to a disturbance between the unmineralized and mineralized portions of the developing tooth germ.

Question 21

What are the general rules of a 6 extraction (class 1)?

Answer 21

If extracting lower take upper
Don’t balance with sound tooth
If extracting upper don’t necessarily need to take lower.

Question 22

Do lowers or uppers tend to overerupt?

Answer 22

Lowers.

Question 23

What is the leeway space?

Answer 23

The differences in space between edc and 345

Maxillary- 1.5mm
Mandibular- 2.5mm.

Question 24

What is the space required at 9 years for premolars and canines?

Answer 24

Minimum 18.5mm from lateral - first molar for no crowding.

Question 25

When is the ideal circumstance to extract a first molar?

Answer 25

7’s furcation forming
8s are present
Class 1 av/reduced overbite
Moderate lower crowding 
Mild/moderate upper crowding.

Question 26

There is a few examples of interceptive orthodontics on these slides but you would have to look at the radiograph to understand them (can’t insert pictures into this).

Answer 26

*

Question 27

How is a posterior unilateral cross bite treated in orthodontics?

Answer 27

A midline screw- adams clasps on 4&6, base plate with posterior bite plane. They have to wear it all of the time and turn it 2 quarters per week. This causes the palate to expand.

Question 28

How do you fix an anterior cross bite?

Answer 28

Z spring
Double adams clasps at the front
Can put adams clasps on the 6a and ds if can’t get them on the anterior as appliance will displace down if no retention at the front
Posterior bite plane
This is a simple tipping of the tooth which takes 6-8 weeks.

Question 29

What percentage of posterior cross bites relapse?

Answer 29

50%- this is why we over correct.

Question 30

What effects does a thumb or digit sucking habit have on the dentition?

Answer 30

Proclaimed upper incisors
Retro lined lower incisors
Asymmetric AOB or reduced OB.

Question 31

*If a patient was going to have a big anyway because they are a class 2 with mandibular retrognathia and they suck their thumb as well then their overheat is going to be more increased.

Answer 31

*

Question 32

What habit is easier to get rid of- thumb or pacifier?

Answer 32

Pacifier.

Question 33

What appliances are used to stop a digit sucking habit?

Answer 33

Removable habit breaker (double adams on the es and 6s and a goal post is at the front to remind the patient that the thumb should not be there)
-should stop within 2-3 months

Fixed habit breakers- cemented to permanent teeth and cannot be removed- they are only a reminder that the patient should not be sucking their thumb.

Question 34

At what age should you get the patient to stop sucking their thumb by?

Answer 34

Age 10 years old.

Question 35

Does a unilateral cross bite and displacement need treated?

Answer 35

YES!

Question 36

What do you do if you lose a C on one side?

Answer 36

Consider balancing it by taking out the c on the other side- however it is not critical and can be fixed later.

Question 37

What do you do if a carious lower 6 needs removed?

Answer 37

Remove this tooth and the upper 6 as well even if there is no pathology on it.

Question 38

From what ages is there not a lot of change to the mixed dentition?

Answer 38

8-10 years.

Question 39

Should you be bothered by a complaint of lower labial segment crowding in the mixed dentition?

Answer 39

No as you know the patient has the potential to grow transversely- up to 3.5mm by the age of 10.

Question 40

When removing a lower 6 in the mixed dentition- what happens if you remove it and the premolar (5) is distally inclined?

Answer 40

It can drift off significantly before it emerges into the mouth and this often pleads to unsightly spacing in the lower buccal augments and can impact the erupting lower second molar.