Interceptive orthodontics 2 Flashcards
When a patient has an anterior cross bite what would you clinically assess
Displacement?
Mobility of lower
incisor
Tooth wear
Gingival recession
What would the active components be for a appliance design to fix anterior cross bite
Z-spring UL1 ((or whatever tooth applies))(double cantilevered spring) 0.5mm HSSW)
What is the problem with correcting a posterior crossbite
50% relapse
What would aid in the anterior Cross-bite Correction Stability
Creating a overbite as this would stop the relapse
Why would you want to treat a digit habit early
To maximise potential for spontaneous correction of anterior open bite whilst there is still eruptive potential for incisors (8-10 years/ root formation still incomplete)
To prevent effects on vertical and transverse
skeletal development which could lead to
permanent skeletal change if habit persists
How would you manage a digit habit
- Positive reinforcement
- Bitter-tasting nail varnish
- Glove on hand, elastoplast
- Habit breaker appliance (habit deterrent) – fixed or removable
What do you call the bit on a habit breaker appliance that prevents a digit habit
URA – Palatal goal post(s)
Fixed – Tongue rake
How do you know that your patient is still wearing the appliance
- Ask them
- 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 and out without difficulty?
- Are there any signs of wear on the appliance?
- Does the palate look as though the appliance has been in place….. Gingival erythema? Palatal erythema?
- Has the tooth moved? Is the active component now passive?
- Does the appliance still fit
What are the eruption dates
6’s -6yrs
1’s- 7yrs
2’s- 8yrs
4’s- 10yrs
3’s & 5’s- 11-12yrs
7’s- 12-13yrs
Infra occlusion is more likely to occur where
Lower > Uppers
What is the aetiology of infra occluded teeth
Ankylosis of primary tooth. Surrounding
alveolar bone continues to grow. Primary
tooth gets left behind
How could you achieve a diagnosis of infra occlusion
Percussion, the sound it gives is ‘duller’
Check for mobililty
Radiographs ( PA or OPT)
What would you assess the radiograph of a tooth that is infraoccluded for
Presence /absence of successor
Ankylosis of primary tooth (no PDL space/no clear lamina dura)
Root resorption of primary
What would the treatment be for a infraoccluded tooth where the successor is still present
Monitor 6-12 months
Extract if primary tooth is below the interproximal contact point
Consider extraction if root formation of
successor near completion
If extract maintain space
What are the risks of doing nothing with a Infra-occluding Tooth where the Permanent successor is present
Permanent successor can become more ectopic
Infra-occlusion worsens with tipping of adjacent teeth
primary tooth becomes inaccessible for extraction
Caries and periodontal disease
What would the treatment plan be for a infra occluded tooth where the successor is still present
Treatment Plan depends on
-degree of crowding
-degree of infra occlusion
-any other features of malocclusion
Retain primary if in good condition and consider onlay
Extract if below interproximal contact point
If extracting an infra occluded tooth with no successor what would you need to do
plan space management:
Either maintain space for prosthetic tooth
Reduce space to one premolar unit ( requires fixed appliance)
Close space ( fixed appliance)
What would give to the ortho lab fro a space maintainer URA
Please provide an URA to maintain space UL5
A– none
R– Adams clasps UR6 and UL6 (0.7mm HSSW)Southend clasp UR1,UL1(0.7mm HSSW)
A– not required
B– extend baseplate distal to UL4 OR Consider wire stop (either 0.6mm or 0.7mm HSSW
When should a canine be palpable
90% palpable by 11 years
When should radiographs be considered for no canines erupting
Radiograph if unable to
palpate by 11yrs
How would intercept a ectopic maxillary canine
Consider extraction of the c
hen would extraction of the C’s for ectopic maxillary canines be successful
Patient is age between 10-13 years
The canine is distal to the midline
of the upper lateral incisor
There is sufficient space available
The canine is less than 55 degrees to midsagittal plane
What would the risks of doing nothing to ectopic maxillary canines be
Permanent successor can become more ectopic
Permanent canine then fails to erupt (Impacted Canine)
Risk of root resorption of adjacent teeth
Risk of root resorption of canine crown (lower risk)
Risk of cyst formation
around canine (rare)
Permanent canine can become ankylosed (incidence tends to increase with age)
What would the interceptive treatment be for a class III
Growth Modification
-Enhance maxillary growth and /or
reduce mandibular growth
Options:
- Protraction headgear +/- RME (rapid
maxillary expansion)
- Functional appliances e.g.Reverse Twin
Block / Frankel III
Camouflage with URA
When is Growth Modification in class
III most successful
Skeletal I or only mild Class III
Maxillary retrusion
Anterior displacement on closing
Average or reduced lower face height
Patient age 8-10 years
Why is it best to treat increased OJ early
Risk of trauma - incompetent lips
Appearance – bullying/ patient selfesteem
More difficult to achieve correction once patient stopped growing
What does IOTN mean and what is it
Index of Orthodontic Treatment Needed
a scale designed to measure the orthodontic need of a patient
What are the 2 components of IOTN and how are they graded
The Dental Health Component (DHC) scale (1 to 5):
1 = no need
2 = little need
3 = borderline need
4 = need
5 = very great need
The Aesthetic Component (AC) scale (1 to 10):
1 to 4 = little or no need
5 to 7 = borderline need
8 to 10 = great need
If you believe a tooth is going to be infra occluded how long should you wait to carry out treatment
1 year
What would the interceptive treatment for a +ve overjet
Functional appliance
