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BDS3 Orthodontics > Interceptive orthodontics 2 - Late mixed dentition > Flashcards

Interceptive orthodontics 2 - Late mixed dentition Flashcards

1
Q

What is a URA design to correct anterior cross bite with 21 out of line of arch?

A

Active - Z-spring UL1 (double cantilevered spring) 0.5mm HSSW
Retentive - Adams clasps 16,17 and 26,27 0.7mm
HSSW
- Southend clasp 11 0.7mm HSSW
Anchorage - Only moving one tooth
Base plate - Self cure PMMA acrylic

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2
Q

What is the digit habit management?

A
  1. Positive reinforcement
  2. Bitter-tasting nail varnish
  3. Glove on hand, elastoplast
  4. Habit breaker appliance (habit deterrent ) fixed or removable
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3
Q

Why should you treat a digit habit early?

A
  • Maximise potential for spontaneous correction of anterior open bite whilst still eruptive potential for incisors
  • 8-10 years whilst root formation still incomplete
  • Prevent effects on vertical and transverse skeletal development which could lead to permanent skeletal change if habit persists
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4
Q

What URA can be used as deterrents for digit habit?

A
  • One piece baseplate with single goal post
  • Split baseplate with expansion screw and 2X palatal goal posts
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5
Q

What fixed appliance can be used as deterrents for digit habit?

A
  • Tongue rake
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6
Q

How do you know if pt is wearing their appliance?

A
  • Ask
  • Did they walk into surgery wearing it?
  • Can they speak with it?
  • Can they take it in and out without difficulty?
  • Does appliance still fit?
  • Does palate look as though appliance has been place - Gingival erythema? Palatal erythema?
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7
Q

What are infra-occluded teeth?

A
  • One or more teeth fail to project as far as normal occlusal plane
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8
Q

What is the probability of infra-occlusion?

A
  • 10%
  • Lower > uppers
  • Permanent successor absent
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9
Q

What is the aetiology of infra-occluding teeth?

A
  • Ankylosis of primary tooth
  • Surrounding alveolar bone continues to grow
  • Primary tooth tooth gets left behind
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10
Q

What should you assess the radiographs for when think it’s infra-occluding teeth?

A
  • Presence/ absence of successor
  • Ankylosis of primary tooth (no PDL space/ no clear lamina dura)
  • Root resorption of primary
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11
Q

What is the treatment for infra-occluding teeth if permanent successor is present?

A
  • Monitor 6-12months
  • Extract if primary tooth below IP contact point
  • Consider XLA if root formation of successor near completion
  • If XLA then maintain the space
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12
Q

What are the risks of doing nothing with an infra-occluding tooth?

A
  • Permanent successor become more ectopic
  • Infra-occlusion becomes worse and tipping of adjacent teeth
  • Caries and Periodontal disease
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13
Q

What is the treatment for infra-occluding teeth is permanent successor is absent?

A

Depend on
- Degree of crowding
- Degree of infra-occlusion
- Any other features of malocclusion

  • Retain primary if in good condition and consider onlay
  • XLA if below IP contact point and plan space management
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14
Q

What is the treatment for plan spacing management for infra-occluding teeth if permanent successor absent?

A
  • Either maintain space for prosthetic tooth
  • Reduce space to one premolar unit (needs fixed appliance)
  • Close space with fixed appliance
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15
Q

What is an URA design to maintain space of 25?

A

A - None
R - Adams clasps 16 and 26 0.7mm HSSW
Southend clasp 11 and 21 0.7mm HSSW
A - Not required
B - Extend baseplate distal to 24 or consider wire stop (0.6mm or 0.7mm HSSW) Self cure PMMA acrylic

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16
Q

What is the normal development of upper Canines?

A
  • Development starts high and palatal
  • Migrate and lie labial and distal to root apex of upper lateral
  • 90% palpable by 11 years
17
Q

When should you assess position of upper canines?

A
  • 9-10 years
  • Palpate by 11
  • Mobile C’s and symmetry
  • Angulation of lateral incisors
  • Radiograph if unable to palpate
18
Q

What can occur with ectopic maxillary canines?

A
  • Central incisors resorb by 15%
  • Lateral incisors resorb by 66.7% using CBCT
  • Most root resorption occurs before age 13
19
Q

What is the management of ectopic maxillary canines?

A
  • XLA of C
  • Consider if need space maintainer
  • Wait 12months for eruption then reassess
20
Q

When is the XLA of C’s for ectopic maxillary canines likely to be successful?

A
  • Age between 10-13years
  • Canine is distal to midline of upper lateral incisor
  • Sufficient space available
  • Canine less then 55° to mid-sagittal plane
21
Q

What are some risks of doing nothing for ectopic maxillary canines?

A
  • Permanent successor 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
  • Risk of cysts formation around canine
  • Permanent canine become ankylosed (incidence increases with age)
22
Q

What should you be aware of with reverse overjet?

A
  • Is it Skeletal or is it dental?
  • Is there incisor angulations
  • Is it edge-edge
  • Is there mandibular displacement on closing?
23
Q

What is the interceptive treatment of Class III?

A
  • Growth modification
  • Camouflage with URA
24
Q

What are the growth modification options for Class III?

A
  • Enhance maxillary growth and/or reduce mandibular growth
  • Do this by
    • Protraction headgear +/- Rapid maxillary expansion (RME)
    • Functional appliances e.g. Reverse twin block / Frankel III
25
Q

When is growth modification in class III most successful?

A
  • Skeletal I or only mild class III
  • Maxillary retrusion
  • Anterior displacement on closing
  • Average or reduced lower face height
  • Patient age 8-10yrs
  • Needs to wear for 14+hrs per day
26
Q

What implants are used for anchored maxillary protractions?

A
  • Bollard implants
  • Into bone
27
Q

Why should you treat an increased overjet early?

A
  • Risk of trauma due to incompetent lips
  • Appearance (bullying, self esteem)
  • More difficult to achieve correction once pt stopped growing
28
Q

What is the IOTN of increased OJ?

A

> 6mm = 4a
9mm = 5a

29
Q

What is the interceptive treatment of Class II?

A
  • Growth modifications with functional appliances or headgear
  • Restrain maxillary growth
  • Promote mandibular growth
30
Q

Summary of interceptive orthodontics?

A

Spaced primary dentition = ok
Unerupted incisors = remove ob. / space/ obs
Balance c’s = not critical
Carious lower 6’s = Take upper
Unilateral cross bites = displacement
Habits = stop before 9yrs
Infra occluded decidious teeth = wait 1yr
Canines = Look at 11
-ve OJ = Growth
+ve OJ = functional app

31
Q

What is an unusual tooth movement following interceptive XLA?

A
  • Submerging left or right lower e
  • Use band and loop space maintainer
32
Q

What are the digit habits outcome?

A
  • Posterior crossbite
  • Anterior open bite
  • Increased overjet
  • Proclined upper anteriors
  • Retroclined lower anteriors
33
Q

What is the maximum angulation of the incisors if we are looking to procline them?

A
  • Max is 120° so if they are already at this we can’t do anymore
34
Q

What is the maximum angulation of lower incisors?

A
  • 80°
  • If already have this then can’t retrocline them anymore
35
Q

What does ankylosis of tooth mean?

A
  • Tooth root becomes fused to underlying bone typically as result from trauma or injury
  • Can prevent eruption and lead to infra-occluded teeth
  • Can lead to ankylosis-related root resorption and requires extraction

BDS3 Orthodontics (10 decks)

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