Interceptive Orthodontics 2 Flashcards
name 4 possible reasons for interception in the early mixed dentition
impacted 6s
unerupted central incisors
early loss of deciduous teeth
carious 6s
discuss impacted 6s and how this might be managed by orthodontic intervention (3)
occurs if FPM gets stuck beneath the distal portion of the E and fails to fully erupt
management: if patient under 7 wait 6 months and hope for spontaneous resolvement, place orthodontic separator between contact point of 6 and E to create space, Distal disking of E (remove some enamel on distal portion to create space)
what is the most common reason for unerupted central incisors
supernumerary in the way
management of unerupted central incisors
try and define cause e.g suprnumerary , trauma
remove any primary or supernumerary teeth , create and maintain space , monitor for 1 year if patient under 9 (immature root apex)
if over 9 or more than 1 year has passed expose and bond gold chain to unerrupted tooth and apply orthodontic traction
what deciduous teeth require a balancing extraction if they are lost early
c and d
balancing extraction - removal of tooth from opposite side of same arch to maintain centreline
what is the most ideal situation if needing to extract carious first permanent molars
bifurcation of 7s beginning to calcify, 8s present, class I occlusion with moderate crowding
what are the general rules, for class I occlusions, when extracting 6s early
if extracting a lower take the upper to (compensating extraction - prevents overeruption)
if extracting an upper a compensating extraction of the lower is not required
no need to balance if contralateral tooth is sound
IOTN
index of orthodontic treatment need
tells us whether a patient needs treatment, is borderline or does not need treatment for functional purposes
short term and long term issues of a developing posterior cross bite
short term - permanent teeth will also erupt into a cross bite
long term - risk of TMJ problems
mandibular displacement from a cross bite of what size indicates need for orthodontic treatment
more than 2mm
why is it recommended that posterior crossbites are ‘overcorrected’
theyre prone to relapse, around 50% will relapse
name 7 things a patient should be told when we fit a removable appliance
- wear full time
- keep teeth and appliance clean, brush minimum twice daily, preferably everytime after eating
- should be worn for eating but not brushing
- use a daily fluoride mouthwash
- avoid sugary foods and drinks
- avoid hard sticky foods
- may want to remove for contact sports
- speech will initially be affected but this will improve
- excess saliva will initially be produced but this will improve
- eating might feel awkward
anterior cross bites put a jiggling force on the lower incisors , what consequences might this cause
tooth mobility
tooth wear
gingival recession
what type of bite is desirable for patients getting their anterior cross bite corrected
over bite
acts as a retainer that stops anteriors drifting back to their original position and the new bite relapsing
name 4 possible management strategies from least to most interventive that might be used to stop a child digit sucking
positive reinforcement
bitter tasting nail varnish
glove on hand or elastoplast
habit breaker appliance - fixed or removable
habit breaker appliances
used to break habit of digit/ thumb sucking
on their own , habit breaker appliances are passive , have anterior and posterior retention, a base plate and a metal goal post (small piece of metal that feels uncomfy when patient tries to suck digits
why might a dual function appliance be used in children with a digit or thumb sucking habit
they are prone to developing an AOB, retroclined lower incisors and a narrowed upper arch which can result in a unilateral cross bite
A habit breaker appliance with an added active component to widen the maxillary arch may be useful (contains goalpost and active component)
give 5 ways you might assess if a patient has been wearing their removable appliance
ask them
did they walk in wearing it
can they speak with it in
are they still suffering from excess salivation (this should settle if its being worn )
can they take it in and out easily
does the palate show signs of it being worn (erythema)
has the tooth moved / is the active component now passive
what were infraoccluded deciduous teeth previously known as
submerging teeth
aetiology of infra occluded teeth
ankylosis of primary tooth, surrounding alveolar bone continues to grow and the primary tooth gets left behind
diagnosis of infra occluded primary tooth
percussion - ankylosed teeth will have dull percussion tone
check for mobility
radiographically ankylosed teeth will have no PDL space and no clear lamina dura
management of infra occluded deciduous teeth
monitor for 6 -12 months
extract if primary tooth is below the interproximal contact point
consider extraction if successors root formation is near completion
(if extracting remember to maintain space)
risks of doing nothing to a infra occluded primary tooth
permanent successor can become ectopic
infra occlusion worsens and adjacent teeth tip making ankylosed tooth inaccessible for extraction
caries and perio due to oral hygiene difficulties
at what age should upper canines be palpable
almost all should be palpable by 11 years old , if not radiograph to investigate
management of ectopic maxillary canines
extract Cs and maintain space
if canine has not passed midline of lateral incisor , 90% chance of spontaneous improvement in positioning
if canine has passed midline of laterals this reduces to 60%
most likely to be successful if patient is 10-13 years old
when assessing overjets, increased and reversed, what must be assessed
is the aetiology dental or skeletal
what are the maximum proclinations and retroclinations of incisors before stability becomes at risk
(think management of class IIIs)
max upper incisors can be proclined is 120 degrees (with regards to the frankfort plane)
max lower incisors can be retroclined is 80 degrees
(with regards to the mandibular plane)
if pt already has these angulations another method of management must be considered
management of a reverse overjet (class III)
- growth modification - enhance maxillary growth and/or reduce mandibular growth via protraction headgear / rapid maxillary expansion / functional appliance
- camouflage effects using a URA to tip teeth
why should increased overjets be treated early
increased risk of trauma
incompetent lips
appearance - self esteem , bullying
more difficult to achieve correction once patient has stopped growing
management of increased overjets
growth modification via functional appliances aiming to restrain maxillary growth and promote mandibular growth
