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BDS3 - Orthodontics > interceptive orthodontics 2 > Flashcards

interceptive orthodontics 2 Flashcards

1
Q

what are the eruption dates of the permanent dentition

A 
- 6's = 6 years 
1's = 7 years
2's = 8 years 
4's = 10 years
3's and 5's = 11-12 years
7's = 12-13 years
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2
Q

what can happen if there is a retained deciduous tooth

A
  • adult teeth can be pushed buccally

- or can cause the permanent teeth to erupt lingually

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3
Q

how can you fix a retained deciduous tooth

A
  • extract it relatively soon
  • adult teeth can drift easily when erupting but once erupted can only move with appliance so the sooner we remove the retained tooth the sooner the adult tooth can get into position and the better the outcome
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4
Q

what is another name for infra-occluded teeeth

A
  • submerging teeth
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5
Q

what is infra-occluded tooth/submerging tooth

A
  • deciduous tooth has become ankylosed to the bone

- it is not really submerging into the soft tissue but everything else is just growing up around it

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6
Q

how common are submerging teeth

A
  • 10%

- lowers > uppers

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7
Q

how can you diagnose a submerging tooth

A
  • visually
  • percussion = taping it and if it is ankylosed it will give a dull, cup sound
  • radiographs
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8
Q

how do you manage submerging teeth if there is a permanent successor

A
  • observe 1 year later

- studies show these teeth are generally exfoliated normally

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9
Q

how do you manage submerging teeth if there is no successory

A
  • extract
  • extract when there is only 1mm of crown showing
  • if it hasn’t submerged too much sometimes deciduous tooth can last for a long time and be useful to keep in
  • but once it has submerged too much and threatens to go sub-gingival it needs to be extracted
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10
Q

what is something that orthodontists want GDP to be looking at in every mixed dentition

A
  • canines
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11
Q

what is the normal development of the canine

A
  • development palatal = just below the orbits, have quite a low migration to come into mouth
  • migrate and lie labial and distal to the root apex of upper laterals
  • 90% palpable by 11
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12
Q

what is the ugly duckling phase

A
  • upper laterals are distally tilted
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13
Q

why is it good if the upper laterals are distally tilted during development

A
  • means that the canine is pressing against the distal aspect of them
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14
Q

how do you palpate the canine

A
  • use your pinky finger
  • try to feel the bulge of where it is
  • if you cannot feel it, then consider a radiograph
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15
Q

what should you do if there is delayed eruption or an Coptic position of the canine

A
  • take a radiograph
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16
Q

what is one way to do parallax

A
  • periodicals with a horizontal shift
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17
Q

if asked what 2 radiographs to take to demonstrate the position of an ectopic canine what would it be

A
  • OPT and an anterior maxillary occlusal radiograph
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18
Q

what is an ICAT scan or a CBCT used

A
  • when we are not sure where the canine is or if we want to find out whether there has been any damage to the roots of eat adjacent teeth
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19
Q

what can happen if there is an ectopic maxillary canine

A
  • resorption of centrals in 15%

- resorption of laterals in 34%

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20
Q

what should you do if you detect a canine is ectopic

A
  • extract the C’s
  • works up until the age of 13 with reasonable success = depends on how high canine is and how much of the adjacent incisor it overlaps
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21
Q

what is the success rate if the permanent canine doesnt overlap the incisor by more than half

A
  • means that if you extract the C’s there is a 90% chance that the tooth will self-align
  • but only when under 13
  • if over 13 then and permanent dentition is established then patient may need a surgical procedure and 2-3 years of ortho treatment
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22
Q

how common is an ectopic canine

A
  • 1-2% of population
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23
Q

what happens if the permanent canine is over half of the lateral

A
  • the C’s are still extracted
  • but chances of success is reduced to 60%
  • assess the patient 1 year after extractions
24
Q

what is RME

A
  • rapid maxillary expansion
  • way of expanding the upper arch
  • do this alongside extracting the upper c’s and the success rates will be improved even further for the patient with ectopic canine
25
Q

what is high pull headgear

A
  • keeps the molars from coming back and generates a bit of space in the buccal segment can again push the success rate even higher for ectopic canines
26
Q

what is a reverse OJ

A
  • where the lower teeth are biting in front of the upper teeth
27
Q

how do reverse OJ occur

A
  • dental/skeletal/combination
  • can occur because of dental problems such as upper teeth tipped back and lower teeth tipped forward in which case could be fixed with removable or functional appliance
  • could be because of a bigger skeletal discrepancy such as small upperjaw and big lower jaw
28
Q

what should you do if there is a reverse OJ

A
  • refer for advice early
29
Q

in the assessment of reverse IJ what is important to find out

A
  • if patient can bring incisors edge to edge

- if they can then it means there is the potential for patient to be treated simply using an URA

30
Q

what skeletal class are those with reverse OJ

A
  • class III
31
Q

how does incisor angulation affect treatment for reverse OJ

A
  • if uppers are <120 and the lowers are >80 then there is some scope to tilt the teeth
  • but if uppers are already 120 and lowers are already 80 then there isn’t any room to correct this
32
Q

what is class III camouflage

A
  • giving the patient a class I teeth and accepting the underlying skeletal relationship
33
Q

why is a lateral cephalogram taken for reverse OJ

A
  • to check what are the angles of the upper and lower incisors to their respective jaws
  • if uppers are >120 relative to maxillary plane then there is no slack to push them any further forward because it would be aesthetically poor
  • and if lowers are <80 to mandibular plane there is no scope to retrocline them any further
34
Q

if a class III is identified early what are the treatment options

A
  • growth modification

- camouflage URA

35
Q

what happens to class III as patient gets older

A
  • it gets worse

- mandible is the last thing to stop growing

36
Q

why are orthodontist wary of class III patients

A
  • not too ambitious in case the mandible grows significantly
  • don’t want to have to repeat the treatment and take the patient to theatre already having had a course of ortho treatment and then needing a second course as part of orthognathic treatment
37
Q

what functional appliances are used for class III

A
  • functional regulator (FR)

- Frankel (FR) III

38
Q

what is the difference between an FR III and an FR II

A
  • FR III is an FR II put on upside down

- FR III tries to change the soft tissues environment to make sure that the teeth can more in the desired direction

39
Q

what do buccal shields do on appliance

A
  • golds the cheek and buccinator away from the teeth and this allow the teeth to naturally expand
40
Q

what do the pelots fo on appliance

A
  • these are little acrylic pads

- there to hold the lips away rfrom the teeth to allow the teeth to tip forward

41
Q

what does the tight lower labial bow do on appliance

A
  • tip teeth back
42
Q

what is the problem with the FR appliances

A
  • don’t work that well and they are difficult to wear and because they are so big they are difficult to make
  • patients don’t like them as they cannot eat or talk with them in
  • success probably about 30%
43
Q

what are some methods of maxillary protraction fro growth modification of class III

A
  • reverse pull headgear with facemark
  • RME
  • 70% success rate
44
Q

what is reverse pull headgear with face mask

A
  • headgear which sits on the chin and forehead

- heavy elastics to the maxilla to then pull the maxilla downwards and forwards

45
Q

by what age do you need to have fixed the class III for it to stay

A
  • if we can get the upper teeth beyond the lower teeth by age 10 then it will grow downwards and forwards meaning they may not have to be considered for surgery later on
46
Q

what is strong class III elastic traction

A
  • worn full time
  • for class III
  • uses really strong class III elastics = go from top to the back to the bottom to the front
  • applied to bone screws or plates fixed to maxilla na mandible = in between roots of the teeth or onto plates screwed in under GA
  • really heavy elastic
  • 90% success rate but it is a lot for the child to have to go through so it is not that common
47
Q

how is camouflage class III done

A
  • removable appliance
  • using z-springs
  • or a screw selection = appliance is sectioned and there is a screw attached to it in the midline and it is rotated twice a week for as long as need be to correct it
48
Q

what causes an increased OJ

A
  • dental/skeletal/combination
  • dental = upper teeth are tipped
  • true skeletal problem where there is mandibular retrognathia = class II division 1 patient
49
Q

why is there a risk of trauma with increased OJ

A
  • incompetent lips

- loss of tooth at age of 12 would be a serious problem

50
Q

what are some of the scores for the OJ in the IOTN

A
  • > 6mm = 4

- >9mm = 5 = highest score

51
Q

how can class II be treated for growth modification using functional appliance

A
  • quite good at treating this
  • appliance harnesses the forces generated by the big muscle that sit around the jaw to promote mandibular growth, to restrict maxillary growth, to tip the lower teeth forwards and the upper teeth backwards
  • 80% of these patients will have mandibular retrognathia so promoting mandibualr growth is good
52
Q

how does headgear work to restrict maxillary forward growth for class II

A
  • the other 20% of these patients will be because the maxilla is too far forward so what we would want to do instead is to restrict maxillary growth and this is done using high pull headgear
  • generally unaccepted by patients and most clinicians
53
Q

why is the twin block most universally used appliance-

A
  • made up of 2 individual components and when these come together the patient has to posture forwards
  • the success rate of compliance with these is about 80%
54
Q

what is the normal inclination of upper incisors

A
  • 110
55
Q

what movement do functional appliances cause in treating class II

A
  • 75% dental = tipping back of upper incisors, proclamation of lower
  • 25% due to changes in skeletal bases = growth promotion in lower jaw and restriction in upper
56
Q

what ages is there a window to get canines back on track

A
  • between ages 10-13 there is an interceptive window
57
Q

how can positive/increased overjet be treated

A
  • in late mixed dentition

- using functional appliances can be treated successfully

BDS3 - Orthodontics (14 decks)

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