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Dentistry in a Nutshell > interceptive orthodontics > Flashcards

interceptive orthodontics Flashcards

1
Q

what is interceptive orthodontics

A

any procedure aimed at reducing or eliminating the severity of a developing malocclusion

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2
Q

what might need interceptive ortho (14)

A

x bite
digit sucking habit
supernumerary teeth
midline diastema
increased OJ
reverse OJ
increased OB
early loss of primary teeth
developing crowding
poor prognosis of FPM
impacted FPM
infra occluded teeth
hypodontia
delayed eruption i.e. u/e canines or max incisors

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3
Q

what is anterior x bite & possible issues

A

abnormal relationship between opposing teeth in a buccopalatal or labiopalatal direction
issues - toothwear, gingival recession, displacement on closure

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4
Q

what features of anterior x bite will make it amenable to correction via URA (3)

A
  1. tooth in x bite palatally tipped
  2. good OB indicated end of tx stability
  3. adequate space to move forwards
    manage via URA (2x4 appliance i.e. brackets on incisors & 6s)
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5
Q

issues with posterior x bite (5)

A
  • displacement on closure
  • tooth wear
  • facial asymmetry
  • teeth may erupt in displaced ICP position
  • potential TMJ problems
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6
Q

mx of posterior x bite

A
  1. URA (mid palatal screw)
  2. quad helix
  3. RME i.e. rapid maxillary expansion
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7
Q

why tx increased OJ in mixed dentition

A
  1. increased risk of trauma
  2. poor aesthetics (teasing / psychosocial problems)
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8
Q

aetiology of increased OJ

A
  1. skeletal - usually class II, mandibular deficiency most common
  2. soft tissue - lower lip trap, hyperactive lower lip
  3. dental - upper incisor proclination, lingual displacement of lower incisors, potentially digit habit
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9
Q

mx of increased OJ in growing pt

A
  1. URA for simple retraction of upper incisors
  2. attempt growth modification by either
    - tooth borne appliances i.e. twin block or activator (andreason)
    - soft tissue borne appliances i.e. myofunctional regulator (Frankel)
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10
Q

patient selection for tx of increased OJ (7)

A
  1. growing pt
  2. pt concerns
  3. dental health risk
  4. pt motivation
  5. large dentoalveolar contribution to aetiology
  6. absence of significant crowding
  7. increased OB
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11
Q

therapeutic effects of growth mod in increased OJ

A

postures mandible down and forwards to encourage mandibular growth
restrains maxillary growth
remodels glenoid fossa
retroclines maxillary incisors & distalises molars
proclines mandibular incisors & mesialises molars

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12
Q

problems with reverse OJ (4)

A
  • displacement on closure
  • incisal edge wear
  • difficulty eating
  • speech problems
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13
Q

aetiology of reverse OJ

A

skeletal - class III skeletal base, hypoplastic maxilla, prognathic mandible
dental - mandibular displacement, retained upper primary incisors

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14
Q

mx of reverse OJ in growing pt

A
  1. simple proclination of upper incisors via URA
  2. attempt growth modification
    - chin strap / cup
    - functional appliances i.e. reverse twin block
    - protraction headgear
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15
Q

mode of action of functional appliances for reverse OJ

A

alter force exerted by lips & cheeks
disengages occlusion

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16
Q

if see anterior x bite must check for

A

mandibular displacement
as this will determine whether we intercept or not i.e. if displacing need to intercept but if not then can leave until age for rest of ortho tx
basically early intervention

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17
Q

issues with mandibular displacement in anterior x bite

A
  1. TMJ problems
  2. occluding then displacing can cause:
    - excess force on lower incisors so they become more mobile & proclines them leading to gingival recession ( can see root shine through)
    - attrition on lingual of lower and labial of upper
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18
Q

to correct anterior x bite in practice

A

URA with z spring & posterior bite plane
make sure no lateral incisor in way of moving central forwards & don’t have clasping arrangement that will get in way of moving teeth
no ABP as will cause over eruption of molars then causing reduced OB but we want significant OB for end of tx stability

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19
Q

issues & tx of deep OB

A

issues - palatal ulceration & gingival stripping
tx -
- URA with FABP; will allow lower molars to erupt. pt must be growing to accommodate the increase in vertical dimension
- potentially convert to class II div 1 with twin block

20
Q

issues with digit sucking habit

A

AOB / reduced OB
proclined upper incisors & retroclined lower incisors
increased OJ
posterior x bite

21
Q

aetiology of digit sucking habit

A

> 6hr duration
prevention of eruption of incisors
labio lingual pressure on incisors
lowering of tongue position
unopposed buccinator pressure against D and E
creates negative IO pressure not a lot but enough to cause unilateral posterior x bite
if no displacement - arch width discrepancy between upper and lower i.e. wide mandible and narrow upper arch; pt will usually have asymmetry

22
Q

key to tx of digit sucking habit

A

habit must be stopped prior to active tx
try BMT / nail polish / removeable habit breaker
want thumb out as early as possible as greater chance of spontaneous closure as 8-9 as opposed to 11-12

23
Q

components for URA habit breaker

A

1-2 palatal goal posts
why 2? - expand upper arch & correct x bite at same time. 2 goal posts so they don’t cross the midline

24
Q

problems with supernumerary teeth

A
  1. impeded eruption
  2. delayed eruption
  3. aesthetics
  4. damage to adjacent teeth
  5. 10% diastemas due to supernumerary
  6. maxilla > mandible
  7. M > F
25
Q

types of supernumerary

A
  1. conical - close to midline, 1-2 in no, tend not to prevent eruption but may displace centrals, xla only if erupt / impede tooth movement
  2. tuberculate - main cause of failure of eruption of centrals, usually palatal, remove +/- surgical exposure of centrals
  3. supplemental - normal morphology, tend to XLA, decision based on tooth form & position
  4. odontome - less common, compound & complex forms
26
Q

aetiology of median diastema

A

developmental
generalised spacing
hypodontia (absent 2s)
midline supernumerary (mesiodens)
proclination of upper incisors
low fraenal attachment
pathology

27
Q

FPM poor prognosis

A

wouldn’t routinely balance as too far posterior to cause centre line shift
rule of thumb - consider compensation in U if L needs to go (7 will get caught behind if 6 over erupts)
don’t have to take L if taking U as L doesn’t tend to over erupt and space closure is more rapid in the maxilla (roots more distal & crown more mesially angulated so quickly moves forwards)

28
Q

guidance on FPM

A
  • don’t routinely take FPM in upper unless specific occlusal reasons for doing so or else significant risk for over eruption
  • angulation lower 2nd molar makes with occlusion i.e. if mesial & 8s forming this is favourable; 8 is appropriate age to be looking at this
    gold standard = refer to centre with combined paediatric & orthodontic services for opinion
29
Q

impact of early loss of Es

A

major cause of impacted 5s

30
Q

compensating & balancing of FPM

A

upper 6 xla - do not compensate
lower 6 xla - consider compensating
balance - only in lower & if crowded
guideline = RCS clinical effectiveness committee 2009

31
Q

loss of mandibular FPM summary

A

ideal timing for xla = bifurcation of 7s forming / age 8-9yrs / good spontaneous closure between 7 & 5
early loss = distal migration of 2nd premolar
late loss = poor spontaneous space closure & mesial tipping & lingual rolling of 7s

32
Q

loss of maxillary FPM summary

A

timing less critical than in mandible as better space closure
if space required consider delaying until eruption of 7 & place space maintainer is possible

33
Q

early loss of primary teeth

A

early loss of a and b
- minimal effect on centre line
- don’t balance or compensate

early loss of c
- consider balance to maintain centreline in crowded dentition
- do not compensate

early loss of d and e
- space loss especially in upper
- consider space maintenance
- little effect on centre line no need to balance

34
Q

impact of early loss of primary teeth

A
  1. loss of Es = major cause of impacted 5s
    will often erupt inside of the arch if given time
  2. effect in upper arch more severe than lower
  3. the further back in the arch the more marked the effect on crowding
35
Q

when to use space maintenance

A
  1. early loss of primary teeth
  2. early loss FPM
  3. traumatic loss / delayed eruption of maxillary incisor
  4. preserve Leeway space
    note - good OH crucial & best space maintainer is primary tooth itself
36
Q

factors influencing rate of space closure following xla

A
  • age at loss; too early slows eruption of permanent teeth & too late speeds up eruption
  • degree of crowding
  • which arch i.e. upper shows quicker space closure
37
Q

development of FPM

A

derived from primary dental lamina
coronal development complete by 3yrs
erupts at 6-7yrs
root formation complete at 9-10

38
Q

predictors of successful SPM eruption following interceptive FPM removal

A
  1. SPM within alveolar bone
  2. early mineralisation of bifurcation
  3. mesio-distal angulation
  4. presence of TPM
39
Q

when to xla FPM

A

when SPM is developing i.e. between 8-10yrs as this will cause the least disruption to the occlusion
if <8yrs or >8yrs SPM & 2nd premolar can drift into xla space, tip, rotate & produce spacing within dental arch with poor occlusal contacts

40
Q

types of space maintainer available

A
  1. tooth (even badly decayed primary molars can be restored for a few years)
  2. band & loop - design of choice for a single tooth space
  3. lingual / palatal arch - best for bilateral spaces
  4. URA - avoid unless appliance can be used for active orthodontic tx
41
Q

3 features of primary dentition than indicate good development

A
  1. incisor spacing
  2. anthropoid spacing - mesial to max primary canine and distal to mandibular primary canine
  3. straight or mesial step primary 2nd molar occlusion
42
Q

impacted FPM aetiology & effect

A

aetiology - eruption angle, ectopic cyst, morphology of 2nd primary molar crown, small maxilla
effect - pulpitis of E / premature exfoliation of E

43
Q

tx options for impacted FPM (3)

A
  1. observe for ~6mths as 66% disimpact by age 7
  2. XLA E - regain space for premolar or tx crowding at later stage
  3. dis impact - separators / band E and bracket 6 with open coil / distal discing of E / URA with finger spring attachment on 6
44
Q

primary molar infra occlusion key factors

A

temporary ankylosis 8-14%
lower D most common
mandible > maxilla
M : F =
percussion sound
blurring or absence of pdl on radiograph
usually shed normally if perm successor present

45
Q

mx of infra occluded primary molars

A

premolars come down between roots of primary so won’t be able to palpate if developing normally
MX DEPENDS ON PRESENCE / ABSENCE OF 5S
5s present & in good position = xla & space maintenance
(if no xla, adjacent teeth tip, e becomes submerged & gets much worse)
5s absent = must consider prognosis of E & how it will fit with rest of dentition i.e. other features of malocclusion that need addressed so can xla & close space via ortho or retain for as long as possible & place onlay
if infra occluded primary molar below contact point mark as urgent

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