Interceptive Orthodontics 2 Flashcards
What are the key components of an orthodontic diagnosis and treatment planning process?
History (CO/PMH/PDH/SH)
Examination (extra-/intra-oral)
Differential diagnosis
Special tests (sm’s/rads/photo’s/3D)
Diagnosis (description/IOTN)
Treatment plan
Treatment acceptance and appliance selection
Outcome assessment (PAR index)
What skeletal and dentoalveolar factors contribute to malocclusion?
Dentoalveolar causes: Small teeth (spacing), early loss of deciduous teeth (crowding), digit sucking (proclination, increased OJ)
Skeletal causes: AP skeletal discrepancy, vertical skeletal patterns
What is the primary limitation of orthodontic appliances in modifying skeletal discrepancies?
Orthodontic appliances primarily move teeth but can only minimally modify skeletal relationships; severe skeletal discrepancies may require orthognathic surgery.
How do you determine if an anterior crossbite is skeletal or dental?
Dental crossbite = Correctable with orthodontics
Skeletal crossbite = Requires orthognathic surgery
What are the three primary objectives of orthodontic treatment?
Stable occlusion
Functional occlusion
Aesthetic improvement
What factors should be considered in treatment planning?
Stability & retention
Patient’s soft tissue profile
Aetiology of malocclusion
Future growth changes
Prioritised problem list
Prognosis of individual teeth
Space requirements
Compliance & access to treatment
Patient’s wishes
What are the key aims of a definitive orthodontic treatment plan?
Class I incisor relationship (normal OJ/OB)
Class I canine relationship
Class I molar relationship (or accept class II)
No rotations, spaces, or occlusal plane discrepancies (Andrew’s six keys)
When might a compromise treatment plan be necessary?
When working within adverse skeletal patterns (e.g., accepting a residual overjet in adults) or when certain aspects of malocclusion are corrected while others are accepted (e.g., leaving a buccal crossbite without displacement).
How do you estimate space available in an arch?
Measure arch length (A + B + C + D)
Measure width of all teeth anterior to first permanent molars
Calculate space discrepancy (space required - space available)
What are the classifications of crowding and their respective treatment options?
Mild (0-4mm): Non-extraction (stripping) or extract 5s
Moderate (5-8mm): Extract 5s or 4s
Severe (>8mm): Extract 4s
Why is treatment planning centered around the lower arch?
The angulation of the lower labial segment (LLS) is stable, making it a reliable reference point.
What are key considerations for space assessment in the lower arch?
Crowding
Angulation of incisors (mandibular plane)
Canine angulation
Centrelines
Curve of Spee
How do you determine molar relationship treatment goals?
Class I molar relationship = Ideal
Full unit Class II molar relationship = Acceptable if necessary
What are the extraction options depending on molar relationship?
MR Class I: Extract in upper arch
MR Class II: Extract in upper arch or distalise upper buccal segment (UBS) using headgear
What extractions are needed for a Class II Div 1 malocclusion with severe lower and moderate upper crowding?
UR4, UL4, LR4, LL4 extractions
When should anchorage be reinforced, and what methods are used?
If extraction space will be fully utilized
Methods: Headgear, Transpalatal arch (TPA), Temporary anchorage devices (TADs)
Why is retention crucial after orthodontic treatment?
Prevents relapse
Maintains new tooth positions in equilibrium with soft tissues, occlusion, and periodontal structures
What are the main limitations of orthodontic treatment?
- Primarily dentoalveolar (tooth movement), with little skeletal modification
- Limited by alveolar bone shape and size
- Teeth remain stable only where equilibrium exists between soft tissue forces, occlusion, and periodontal structures
Who can provide different levels of orthodontic treatment?
General dental practitioners: Simple treatments (e.g., removable appliances)
Specialists or hospital orthodontists: Complex cases requiring fixed appliances or surgery
