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4th yr- CCD2- Ortho > interceptive orthodontics > Flashcards

interceptive orthodontics Flashcards

1
Q

What is interceptive orthodontics

A

Any treatment which eliminates or reduces the severity of a developing malocclusion

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2
Q

What should interceptive orthodontics hopefully reduce in the future

A

To eliminate or simplify the need for future treatments

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3
Q

What are the aims of interceptive orthodontics

A
  1. Maintain centrelines
  2. Maintain class I incisor relationship
  3. Maintain good vertical and transverse relationship
  4. Eliminate crossbones associated with displacement./ pathology
  5. Prevention of trauma
  6. Minimise crowding
  7. Minimise psychological factors- bullying
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4
Q

When carrying outage patient history what do we want find out

A
  1. Patients perception of the problem
  2. Medical history
  3. Social history
  4. Dental history
  5. Habits
  6. Growth status
  7. Motivation
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5
Q

What habits do we need to ask about when carrying out our patient history

A
  1. Thumb sucking
  2. Digit sucking
  3. Fingernail biting
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6
Q

Name the 3 planes of space an orthodontic patient is examined in

A
  1. Anteroposterior
  2. Vertical
  3. Transverse
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7
Q

What do we examine extra orally in the Anteroposterior plane

A

Does the patient have a class I, II or III occlusion

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8
Q

What do we examine extra orally in the vertical plane

A
  1. Facial thirds

2. Angle of the lower border of the mandible to maxima

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9
Q

What do we examine extra orally in the transverse plane

A

Facial symmetry

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10
Q

What other information may we want to record extra orally

A
  1. Smile aesthetics
  2. Soft tissues
  3. TMJ
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11
Q

What do we examine intra orally in the Anteroposterior plane

A
  1. Incisal classification
  2. Overjet
  3. Canine relationship
  4. Molar relationship
  5. Do they have an anterior cross bite
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12
Q

What do we examine intra orally in the vertical plane

A
  1. Does the patient have an overbite?
  2. AOB
  3. LOB
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13
Q

What do we examine intra orally in the Anteroposterior plane

A
  1. Closing and opening

2. Posterior cross bite

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14
Q

What other information may we want to record intra orally

A
  1. Teeth present?
  2. Is there any crowding or spacing
  3. Periodontal health
  4. Tooth quality
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15
Q

When dow e carry out interceptive orthodontics?

A
  1. Failure/ delayed eruption
  2. Crossbites with displacement/ wear
  3. Teeth with a poor prognosis
  4. When there is trauma to permanent teeth
  5. If there is severe skeletal patterns where early treatment may be appropriate
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16
Q

What can fall under the category of failure/ delayed eruption?

A
  1. Impacted first permanent molars
  2. Unerupted upper central incisors
  3. Infraoccluded deciduous teeth
  4. Unerupted upper canines
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17
Q

What is the incidence percentage of impacted first permanent molars

A

4.3%

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18
Q

What is the aetiology of impacted first permanent molars

A

Multifactorial:

  1. Increased m-d width of 6
  2. Increased eruption angle of 6
  3. Crowding posterior maxilla
  4. Genetics
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19
Q

What problems can impacted first permanent molars lead to

A
  1. Can cause caries of 2nd deciduous molar tooth and first permanent molar tooth
  2. Can lead to root resorption of 2nd deciduous molar tooth
  3. Space loss if the 2nd deciduous molar tooth is lost
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20
Q

What is management of impacted first permanent molars dependent on

A
  1. Is it reversible?
  2. It is irreversible
  3. Is the E viable
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21
Q

If the impacted first molars is of the reversible when does ti fix itself?

A

90% correct themselves by the age of 7 and 100% by age 8

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22
Q

How do we mange impacted first permanent molars if the E is viable

A
  1. Disimapct the 6 and the E using separators/ brass wire

2. Distalise the 6 with URA

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23
Q

How do we mange impacted first permanent molars if the E is not viable

A

Extract E and Distalise 6 once fully erupted

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24
Q

What is the incidence percentage of unerupted upper central incisors

A

0.13%

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25
Q

What is the aetiology of unerupted upper central incisors

A
  1. Developmental eg supernumerary
  2. Genetic eg Holoprosencephaly
  3. Environmental eg dilaceration
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26
Q

How do we mange unerupted upper central incisors

A
  1. Remove caries of impaction and create space
  2. Give time for eruption in younger patients
  3. Active treatment may be needed in older patients
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27
Q

When is an unerupted maxillary central incisor of high concern

A

If the tooth is not palpable or the contra lateral incisor erupted more than 6-12months ago

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28
Q

How do we treat an unerutped maxillary central incisor of high concern

A
  1. Take an OPT and intra oral periapical (can also take an anterior occlusal radiograph)
  2. Localise the tooth, check morphology and presence of supernumerary
  3. treatment then depends on age
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29
Q

When is an unerupted maxillary central incisor of moderate concern

A

If the tooth is not palpable but the contra lateral incisor hasn’t erupted

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30
Q

How do we treat an unerutped maxillary central incisor of moderate concern

A
  1. Take an OPT and intra oral periapical (can also take an anterior occlusal radiograph)
  2. wait till contra lateral incur has erupted for more than 6-12 months
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31
Q

What is the incidence percentage of infra occluded deciduous teeth

A

1-9%

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32
Q

What is the aetiology of infra occluded deciduous teeth

A
  1. Genetics
  2. Disturbed local metabolism
  3. Gaps in the periodontal membrane
  4. Local mechanical trauma
  5. local infection
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33
Q

Why is intervention of infra occluded deciduous teeth important

A

To prevent:

  1. Tipping of adjacent teeth that could lead to Periodontal problems
  2. Alveolar ridge defects due to growth restriction
  3. Space loss
  4. Displacement of developing successor teeth
  5. Over eruption of teeth in the opposing arch
  6. caries
  7. Gingival hyperplasia
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34
Q

What does the management of infra occluded deciduous teeth depend on

A
  1. Severity
  2. Presence of class permanent 2
  3. The prognosis of the primary 1s
  4. Malocclusion
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35
Q

How do we classify the severity of infra occluded deciduous teeth

A

Mild
Moderate
Severe

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36
Q

Describe mild infra occluded deciduous teeth

A

When the occlusal surface is 1mm below the expected occlusal plane for the tooth

37
Q

Describe moderate infra occluded deciduous teeth

A

When the occlusal surface is approx level with the contact points of one or both adjacent tooth surfaces

38
Q

Describe severe infra occluded deciduous teeth

A

When the occlusal surfaces are level with or below the inter-proximal gingival tissue of one of both adjacent tooth surfaces

39
Q

How do we treat mild infra occluded deciduous teeth

40
Q

If we diagnose a patient with moderate/ severe infra occluded deciduous teeth what is the next step

A

Take a radiograph to determine if their is a permanent successor for the tooth

41
Q

If there is a permanent successor and the patient has moderate infra occluded deciduous teeth what is the treatment

42
Q

If there is a permanent successor and the patient has severe infra occluded deciduous teeth what is the treatment

A

Orthodontic referral
or
If pathology present extract

43
Q

If there is NOT a permanent successor and the patient has moderate infra occluded deciduous teeth what is the next thing we check

A

Does the patient have malocclusion

44
Q

If malocclusion is present in a patient with moderate infra occluded deciduous teeth and no permanent successor what do we do

A

Orthodontic referral

45
Q

If malocclusion is not present in a patient with moderate infra occluded deciduous teeth and no permanent successor what do we do

46
Q

If there is NOT a permanent successor and the patient has severe infra occluded deciduous teeth what is the treatment

A

Orthodontic referral

47
Q

What is the incidence percentage of unerupted upper canines

A

2% due to impaction

0.08%. due to developmentally absent

48
Q

What is the initial management for unerupted upper canines

A
  1. Clinic examination at 9 years old
  2. Palpate for canine bulge buccally
  3. If not palpable by 1- years investigate further
49
Q

What is the aetiology of unerupted upper canines

A
  1. Long path of eruption
  2. Delayed exfoliation of the deciduous canine
  3. Small/ developmentally absent 2s
  4. Polygenic inheritance
  5. Presence of supernumeraries
  6. Crowding
50
Q

What are the clinical signs of an unerupted upper canine

A
  1. Visual inspection of the canine bulge
  2. Palpation
  3. Prolonged retention of the C
  4. Loss of vitality of the U2/1
51
Q

Which radiographs might we take to assess unerupted upper canines

A
  1. Horizontal parallax (2 periapicals)
  2. Vertical parallax (Anterior occlusal and OPT)
  3. CBCT
52
Q

What do we look at when assessing the prognosis of an unerupted upper canine

A
  1. Overlap of the incisors
  2. Vertical height of incisor
  3. Angulation
  4. Position of the apex
53
Q

Talk through an unerupted upper canine with a good prognosis

A
  1. No horizontal overlap between canine and incisor
  2. CEJ is halfway up the root
  3. Angulation of 0.15 degrees
  4. The apex of the canine is in the correct position
54
Q

Talk through an unerupted upper canine with an average prognosis

A
  1. Horiztonal overlap up to half the root width between the canine and incisor
  2. Vertical height of the canine is 0.5 to full root length
  3. Angulation of 16-30 degrees
  4. The apex of the canine is above the 1st premolar
55
Q

Talk through an unerupted upper canine with a poor prognosis

A
  1. There’s complete overlap between the canine and upper incisors
  2. Vertical is root is more than the full root length
  3. Angulation is more than 30 degrees
  4. The apex of the canine is above the 2nd premolar
56
Q

how do we manage impacted Canines

A
  1. No active treatment
  2. Interceptive treatment
  3. Surgical exposure and orthodontic alignment
  4. Surgical repositioning
  5. Extractions
57
Q

Name the 2 different types of crossbite

A
  1. Anterior X bite

2. Posterior X bite

58
Q

What is the anterior x bite incidence percentage

59
Q

What is the posterior x bite incidence percentage

A

In primary dentition 1-16%

60
Q

What is the aetiology for crossbites

A
  1. Local causes
  2. Skeletal
  3. Soft tissues
  4. Pathology/trauma
61
Q

How do we manage crossbites

A
  1. Removal appliance
  2. Quadhelix
  3. 2x4 appliance
62
Q

Why might treatment for cross bite be carried out early

A
  1. Eliminate displacements
  2. To prevent perpetuation into permanent dentition
  3. To prevent periodontal breakdown/ wear
63
Q

What can poor prognosis deciduous teeth be due to

A
  1. Caries

2. Trauma

64
Q

What problems can poor prognosis deciduous teeth lead to

A
  1. Centreline shift

2. Localisation of pre existing crowning

65
Q

What is the management of poor prognosis deciduous teeth dependent on

A
  1. Age
  2. Existing space requirements
  3. Tooth type
66
Q

If we were to extract a primary incisor how would we manage the contra lateral tooth

A

No interceptive treatment as there is minimal effect on the midline

67
Q

If we were to extract a primary canine how would we manage the contra lateral tooth

A

Balance the dentition and extract the other canine to preserve midline

68
Q

If we were to extract a primary first molar how would we manage the contra lateral tooth

A

1, Spaced arch no interceptive treatment

2. Crowded arch: balance extraction to persevere midline

69
Q

If we were to extract a primary second molar how would we manage the contra lateral tooth

A

No interceptive treatment

70
Q

What can poor prognosis first permanent molar teeth be due to

A
  1. Caries

2. Molar incisor hypominerlaisation

71
Q

What problems can arise if we extract the first permanent molars

A
  1. Spacing
  2. Occlusal interferences
  3. Anchorage concerns
  4. Alveolar defects
  5. Tipping of teeth
72
Q

What is the best course of treatment for a poor prognosis first permanent molar

A

Extraction

73
Q

What might we consider if we extract a mandibular first molar

A

Compensating and extracting the opposing maxillary first molar

74
Q

For the best sponateoud occlusal results when should we extract the first primary molar

A
  1. Between ages of 8-10

2. After eruption of lateral incisors but before eruption of 2nd permeant molars

75
Q

In which type of dentition can we best predict the outcome of first molar extraction

A

Class I occlusion where all permanent teeth are present

76
Q

What is the incidence percentage of early loss of maxillary central incisors due to trauma

A

3% (more common in boys)

77
Q

What immediate intervention of we give to a child who has most their permeant maxillary central incisor due to trauma

A

Reimplantation to act as a space maintainer

78
Q

If preimplantation fails how do we mange early loss of the permanent maxillary central incisor

A
  1. Space maintainer if lost EARLY
  2. Premolar transplant
  3. Orthodontic space closure
79
Q

What is the longterm management for the early loss of the permanent maxillary 1

A
  1. Denture
  2. Bridge
  3. Implant
80
Q

What is the aetiology of a class II skeletal pattern

A
  1. Skeletal
  2. Soft tissues
  3. Habits
81
Q

What habits can cause class II skeletal pattern

A

Digit suckign

82
Q

why do we need to manage class II skeletal patterns

A
  1. Trauma limitation

2. Psychosocial benefits

83
Q

How common is digit sucking in 9 year olds

84
Q

How common is digit sucking in 12 year olds

85
Q

What is the extent the malocclusion due to digit sucking dependant on

A
  1. Frequency of digit sucking
  2. Intensity of digit sucking
  3. Duration of digit sucking
86
Q

How can we manage digit sucking

A
  1. Encouragement
  2. Positive reinforcements
  3. Bitter nail varnish
  4. wearing gloved to bed
  5. Removable appliance
87
Q

List the characteristic features of digit sucking

A
  1. Proclamation of upper incisors
  2. Retroclination of lower incisors
  3. Asymmetrical Anterior open bite
  4. Narrowed upper arch
  5. Posterior cross bite
88
Q

What is the aetiology of class III skeletal patterns

A
  1. Skeletal

2. Genetic

89
Q

Why might we carry out early class III management

A

To reduce the need for OGN surgery in the future

4th yr- CCD2- Ortho (7 decks)

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