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BDS3 ORTHODONTICS > Interceptive Orthodontics > Flashcards

Interceptive Orthodontics Flashcards

1
Q

what does the dentition of a child at birth typically look like?

A
  • gum pads only
  • upper rounded
  • lower U shaped
  • often appear class II
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2
Q

what is the eruption order of deciduous teeth?

A

a b d c e

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3
Q

What is the most common site for a natal tooth?

A

lower incisors (at/just after birth)

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4
Q

what is the pre-eruptive phase of tooth eruption?

A

starts when the crown starts to form and ends when crown formation is complete/root formation about to start

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5
Q

what is the eruptive phase of tooth eruption?

A

starts as soon as the root starts to form and ends when the teeth reach the occlusal plane

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6
Q

what is the eruptive phase split into?

A
  • intra-osseous stage
  • extra-osseous stage
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7
Q

what is the post-eruptive phase of tooth eruption?

A

tooth movement / eruption continues as the root forms and throughout life in extremely small increments

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8
Q

During the eruptive phase, what do movements occur in response to?

A
  • positional changes of neighbouring crowns
  • growth of the mandible & maxilla
  • resorption of the deciduous tooth roots
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9
Q

What occurs during the intra-osseous part of the eruptive phase?

A
  1. root formation
  2. movement of the developing tooth (in an occlusal or incisal direction)
  3. the reduced enamel epithelium fuses with the oral epithelium
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10
Q

what occurs during the extra-osseous part of the eruptive phase of a tooth?

A
  • penetration of the tooth’s crown tip through the epithelial layers
  • the crown continues to move through the mucosa in an occlusal direction until it contacts opposing tooth
  • environmental factors such as muscle forces from cheeks, lips and tongue help determine final tooth position
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11
Q

What is thought to guide the teeth to erupt in the oral cavity?

A

the Gubernacular cord

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12
Q

what is the Gubernacular cord formed from?

A

fibres from the dental follicle

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13
Q

what is the post-eruptive phase of tooth eruption?

A

Movement after tooth has already reached the occlusal plane
- occurs in response to increases in height of the growing alveolar bone & jaws

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14
Q

What causes teeth to erupt?

A

Multifactorial, likely a combination of:
- root formation
- remodelling of the alveolar bone
- development of the periodontal ligament
- dental follicle involvement

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15
Q

What gene may have an influence on tooth eruption?

A

PTHR1 gene (parathyroid hormone receptor gene)

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16
Q

What are the roles of the dental follicle in terms of tooth eruption?

A
  • initiates resorption of the bon overlying the tooth
  • facilitates connective tissue degradation and creates the eruption pathway
  • promotes alveolar bone growth at the base of the tooth
  • provides traction forces within the periodontal ligament (special fibroblasts with contractile properties)
  • ectomesenchymal cells from follicle contribute to root formation
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17
Q

What does interceptive orthodontic treatment involve?

A

The utilisation of tooth eruption to minimise the impact of a developing malocclusion
- permanent teeth can be encouraged to erupt if the deciduous tooth is extracted at the correct stage

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18
Q

when is the correct stage to extracted deciduous teeth to encourage permanent tooth eruption?

A

one half to two-thirds root development of permanent tooth

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19
Q

where do the permanent incisors develop in relation to the primary incisors?

A

palatal / lingually

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20
Q

Additional space is required to accommodate the larger anterior teeth of the permanent dentition, how is this space gained?

A
  • increase in the intercanine width through lateral growth of jaws
  • upper incisors erupting onto a wider arc (more proclined)
  • the leeway space
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21
Q

what is the leeway space of of the upper arch (between primary & permanent teeth)?

A

1-1.5mm

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22
Q

what is the leeway space of of the lower arch (between primary & permanent teeth)?

A

2-2.5mm

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23
Q

What size of diastema should close on its own?

A

< 2.5mm

24
Q

How would you treat a patient with impaction of the first permanent molar?

A
  1. if patient <7y/o wait 6 months (90% self correct)
  2. place orthodontic separator
  3. attempt to distalise the first molar
  4. extract E
  5. distal disking of ‘e’
25
Q

How would a patient with an unerupted central incisor with supernumeraries be treated?

A
  1. remove primary teeth & supernumeraries
  2. create space/maintain space
  3. monitor for 12 months

still fails to erupt OR patient is > 9 y/o
4. expose/bond gold chain and apply orthodontic traction

26
Q

what can early loss of deciduous teeth lead to?

A

localised crowding

27
Q

what is a balancing extraction?

A

removal of a tooth from the opposite side of the same arch to maintain the position of the dental centreline (symmetry)

28
Q

what is a compensating extraction?

A

removal of a tooth from the opposing quadrant to maintain the buccal occlusion

29
Q

A patient has early loss of As and Bs, what is your treatment?

A
  • little impact
  • don’t balance or compensate
30
Q

A patient has early loss of Cs, what is your treatment?

A

BALANCE occlusion

31
Q

A patient has early loss of Es, what is your treatment?

A
  • tend not to balance
  • major space loss
  • consider space maintainer
32
Q

What might early loss of LRe lead to?

A

mesial drift of LR6

33
Q

Space maintainers can be ______ or ______ ?

A

removable or fixed

34
Q

A patient enters the surgery with first molars of poor prognosis, what factors play into your decision to extract or not?

A
  • age of patient/stage of dental development
  • degree of crowding
  • malocclusion type
  • condition of other teeth
  • LA or GA
35
Q

Extraction of first molars in a child is most ideal when?

A
  • 7s bifurcation calcifying
  • 8s present
  • Class 1 av/reduced OB
  • moderate lower crowding
  • mild/moderate upper crowding
36
Q

If you extract a lower 6, what must you also do?

A

EXTRACT UPPER also

37
Q

How can a child with digit sucking habit be managed?

A
  1. positive reinforcement
  2. bitter tasting nail varnish
  3. glove on hand, elastoplast
  4. habit breaker appliance
38
Q

How can you tell if your patient is wearing their appliance?

A
  • did they walk into surgery wearing it?
  • can they speak with it in
  • are they still suffering from excess salivation
  • can they take it in & out easily
  • any signs of wear on appliance
  • any gingival/palatal erythema
  • tooth movement?
39
Q

By what age must digit sucking habits be stopped for best prognosis?

A

< 9 yrs

40
Q

Why should sucking habits be treated early?

A
  • maximise potential for spontaneous correction of anterior open bite whilst there is still potential for incisors
  • to prevent effects on vertical and transverse skeletal development which could lead to permanent skeletal change if habit persists
41
Q

How is a digit habit managed?

A
  1. positive reinforcement
  2. bitter-tasting nail varnish
  3. glove on hand, elastoplast
  4. habit breaker appliance
42
Q

What orthodontic appliances can be used as deterrents for digit habits?

A
  • one piece baseplate with single goal post
  • split baseplate with expansion screw and 2x palatal goal posts
43
Q

What is the aetiology of infra-occluding teeth?

A

Ankylosis of primary tooth. Surrounding alveolar bone continues to grow. Primary tooth gets left behind

44
Q

How can infra-occlusion of teeth be diagnosed?

A
  • percussion
  • check for mobility
  • radiographs
45
Q

In determining the presence of an infra-occluded tooth on a radiograph, what are you looking for?

A
  • presence/absence of successor
  • ankylosis of primary tooth
  • root resorption primary tooth
46
Q

How should infra-occlusion of a tooth be treated when the permanent successor is present?

A
  • monitor for 6-12 months
  • extract if primary tooth is below the interproximal contact point
  • consider extraction if root formation successor near completion
  • if extract… MAINTAIN SPACE
47
Q

What are the risks of doing nothing when a patient has an infraoccluded tooth with present permanent successor?

A
  • permanent successor can become more ectopic
  • tipping of adjacent teeth (leads to hard extraction as cannot access infra-occluded tooth)
  • caries and periodontal disease
48
Q

How should infra-occlusion of a tooth be treated when the permanent successor is absent?

A
  • retain primary if in good condition and consider onlay
  • extract if below interproximal contact point (if extract maintain space for prosthetic tooth or reduce space with ortho)
49
Q

If you are unable to palpate permanent canines by age 11 years old, what should you do?

A

Radiograph to check for permanent successor

50
Q

How can we intercept ectopic teeth?

A

consider extraction of the c

51
Q

When will an extraction of the c be a successful treatment option for ectopic teeth?

A
  • patient is age between 10-13 years
  • canine is distal to the midline of the upper lateral incisor
  • sufficient space available
52
Q

What are the risks associated with doing nothing about an ectopic maxillary canine?

A
  • permanent successor can become more ectopic
  • permanent canine then fails to erupt
  • risk of root resorption of adjacent teeth
  • risk of root resorption of canine crown
  • risk of cyst
53
Q

What interceptive treatment can be done for Class III occlusion?

A

Growth modification
- enhance maxillary growth / reduce mandibular growth
- protraction headgear ± rapid maxillary expansion
- patient needs to wear for 14 hours a day

Camouflage with URA

54
Q

When will growth modification treatment in class III occlusions be most successful?

A
  • mild class III
  • maxillary retrusion
  • anterior displacement on closing
  • average or reduced lower face heigh
  • patient aged 8-10 years old
55
Q

Why should an increased overjet be treated early?

A
  • risk of trauma
  • appearance
  • more difficult to achieve correction once patient has stopped growing
56
Q

Why do we tap on the infra-occluded tooth?

A

Ankylosed tooth sound different on percussion (dull thud)

BDS3 ORTHODONTICS (8 decks)

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