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OSCE CRAM > Interceptive Orthodontics > Flashcards

Interceptive Orthodontics Flashcards

1
Q

Deciduous dentition vs permanent

A

More upright
More spaced
More white
More worn

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2
Q

General pattern of eruption for deciduous teeth

A

ABDCE

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3
Q

Ideal spacing of deciduous to allow no crowding in permanent

A

> 6mm

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4
Q

Eruption dates of maxillary permanent dentition

A

Central - 7
Lateral - 8
Canine - 11
1st premolar - 10
2nd premolar - 10
1st molar - 6
2nd molar - 12

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5
Q

Eruption dates of mandibular permanent dentition

A

Central - 6
Lateral - 7
Canine - 9
1st premolar - 10
2nd premolar - 10
1st molar - 6
2nd molar - 12

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6
Q

What mm of crowding may spontaneously improve

A

Up to 3.5mm

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7
Q

Reason for crowns of laterals distally tipped

A

Developing canines impinging on distal aspect of lateral

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8
Q

What age do majority of kids have a diastema?

A

6

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9
Q

Why do only 7% have a diastema by the age of 12

A

> Canines come in at 11-12

> Take up more space

> Shuffle the incisors together

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10
Q

Course of action for sequence issues

A

History
Examination
Radiographs

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11
Q

When should the contralateral tooth erupt?

A

6mths

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12
Q

List reasons for un-erupted central incisors (4)

A
  1. Supernumeraries
  2. Trauma
  3. Dilacerations
  4. Cysts/tumours
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13
Q

Tx for un-erupted central incisors (4)

A
  1. Remove deciduous teeth + supernumeraries
    -Palpate?
  2. Expose/bond
  3. Create space - URA (tips teeth and makes space for central)
  4. Monitor 1.5yrs
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14
Q

What is a retained deciduous tooth

A

Does not exfoliate once permanent tooth erupts

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15
Q

Implications of a significant dilaceration (3)

A

Poor prognosis

Straightening = root through labial plate

Loss of vitality + XLa

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16
Q

List reasons for median diastema

A
  1. Small teeth
  2. Supernumeraries
  3. Hypodontia
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17
Q

How do missing teeth cause a median diastema

A

More space for the centrals to space out

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18
Q

List some early mixed dentition interception issues (6)

A

> Impacted 6s

> Crowding

> Early loss of deciduous teeth

> Carious 6s

> Xbites

> Habits

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19
Q

Define leeway space

A

Difference between CDE and 345

Maxillary
- 1.5mm wider than permanent

Mandibular
- 2.5mm wider than permanent

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20
Q

What is the minimum space required at 9yrs old, for premolars and canines?

A

18.5mm from 2d to 6m

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21
Q

How and when is a space requirement assessment carried out (3)

A

> Roughly 9yrs

> Measure from 2d to 6m

> Want 18.5mm to make room for permanent successors

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22
Q

Define balancing deciduous teeth

A

Balance by Xla contralateral tooth on other side

If you lose 16 take out 26

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23
Q

Define compensating deciduous teeth

A

Balance by XLa of opposing arch

If you lose U6 XLa L6

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24
Q

What does the effect of early loss of deciduous teeth depend on?

A

Age of loss of teeth
Space available (greater effect if crowded dentition)

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25
Q

Management of early loss of A+B’s

A

No balancing/compensating required

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26
Q

Management of early loss of C’s

A

Balance

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27
Q

Why do we balance C’s?

A

C’s retained until perm incisors erupt
Losing 1 can cause midline shift to that side (if spaced dentition = little effect)

28
Q

Management of early loss of D’s

A

Small centreline shift (not as significant as C’s)

Perhaps balance under GA not REQUIRED

29
Q

Management of early loss of E’s

A

No balance

30
Q

Why do we not balance the loss of E’s?

A

Major space loss but little effect to centreline

Results in significant mesial drift which will cause crowding issues

31
Q

Why does losing an E cause crowding?

A

E’s can be 11mm wide or more

Gap reduced by 2-4mm by mesial drift of the 6

= Less room to fit 3,4,5, causing crowding

32
Q

What arch is a mesial drift a bigger issue in?

A

Upper

33
Q

General rules for the XLa of 6s (Class I) (3)

A
  1. Compensate lower with upper to prevent over eruption
  2. Don’t balance with sound tooth
  3. If XLa upper dont need to XLa lower as don’t tend to OE as much
34
Q

Why do you want to compensate a 46 with a 16? (1)

A

Prevent overuption
If not it will prevent mesial movement of the 2nd molar

35
Q

When should 6s be XLa? (4)

A

> Bifurcation of 7s forming

> 5s forming

> 8s follicle forming

> Class I malocclusion

> Moderate lower/upper crowing

36
Q

What issues can a 5 cause if a 6 is XLa?

A

Usually use the mesial part of 6 to slide up vertically

Some are distally inclined and removing the 6 can cause it to drift leading to spacing or impinge on 7

37
Q

What appliance would be provided for a posterior unilateral Xbite?

A

Active component:
Midline screw

Retention:
Adams clasps on 4s+6s

Baseplate:
PBP

38
Q

Instruction for posterior Xbite appliance?

A

Wear it 24/7
Turn screw 1/4 no more than 2x a week

39
Q

How long can it take to correct a posterior Xbite?

A

6-9mths

Following this pt should wear the appliance inactivated at bed at night to prevent relapse

40
Q

Effects of an anterior Xbite

A

Wear on incisal edge
Gingival recession

41
Q

What appliance would be used for an anterior Xbite on 11?

A

Active component:
Z spring 21

Retention:
Double adams on E’s+6’s

Anterior retention:
Adams clasps on 11

Baseplate:
PBP

42
Q

Why do we need anterior retention?

A

If no anterior retention the appliance will just drop down when Z is activated

43
Q

Timeframe for successful anterior Xbite tx?

A

6-8wks

Quicker than posterior

44
Q

Why do we need a PBP to tx anterior/posterior XBites?

A

Pt must disocclude so we can push the tooth over the bite

45
Q

What are the % for relapse for an anterior/posterior Xbite

A

ANTERIOR
> Won’t relapse
> Once incisors over lower bite remains corrected

POSTERIOR
> 50% relapse
> Why we over-correct

46
Q

What are the features of a thumb sucking habit?

A

> Proclined upper incisors
Retroclined lower incisors
Posterior Xbite
AOB or reduced OB

47
Q

Digit sucking habit breaker tx

A
  1. Fixed habit breaker
  2. Removable habit breaker
    - Double adams on Es+6s
48
Q

What is the ideal age to get a habit sorted?

A

Under 10yrs - within 3yrs of eruption

49
Q

What are some late mixed dentition issues? (4)

A
  1. Retained deciduous teeth
  2. Infraoccluded deciduous teeth
  3. Canines
  4. OJ
50
Q

What is an infra-occluded tooth?

A

Submerged tooth below the occlusal surface
Ankylosed to bone

51
Q

How do we diagnose an infra-occluded tooth?

A

> Visual
Percussion - dull cracked sound
Xrays

52
Q

What is the treatment for a submerging molar?

A

> Take xrays

> If permanent successor present observe for 1yr and submerging deciduous should exfoliate

> Xla when only 1mm of crown left showing and threatens to go subgingival

53
Q

Management of unerupted upper canine

A
  1. Visual - tipping of laterals + wiggle C’s for mobility
  2. Palpate by 9-11
  3. Take xray - PA/OPT
54
Q

What does mobility of C show?

A

Means canine is resorbing the C

55
Q

Which 2 radiographs would you take to demonstrate the position of an ectopic canine?

A

OPT + anterior maxillary occlusal

56
Q

What does the chance of success for XLa of ectopic canine depend on? (2)

A

> How high the ectopic canine is

> How much the ectopic canine overlaps the adjacent incisor

57
Q

% success if ectopic canine doesn’t overlap the adjacent lateral by more than 1/2

A

90%

58
Q

% success if ectopic canine is more than halfway over the adjacent lateral

A

60%

59
Q

What values for incisal angulation allow some room to correct a class III relationship?

A

Upper - <120
Lower - >80

60
Q

Why can’t we tip teeth over 120 to maxillary plane?

A

Gives us an OJ

61
Q

Why can’t we tip teeth less than 80 to mandibular plane?

A

No scope to retrocline

62
Q

What is camouflage tx?

A

Changing incisor relationship but accepting the underlying skeletal relationship

63
Q

Example of growth modification functional appliances

A

Functional regulator
Frankel 3

64
Q

What class patient would you consider for maxillary protraction?

A

Class 3 under 10

65
Q

How does a functional appliance work?

A

> Promotes mandibular growth
Restrict maxillary growth
Tip top teeth back

This all reduces OJ

OSCE CRAM (40 decks)

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