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BDS3 - Orthodontics > intro to ortho > Flashcards

intro to ortho Flashcards

1
Q

what is orthodontic

A
  • speciality of dentistry concerned with:
  • diagnosis and development of teeth, face and jaws
  • diagnosis, prevention and correction of dental and facial irregularities
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2
Q

what does orthodontic assessment include

A
  • systematic evaluation of the face and skeletal based in 3D
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3
Q

what do the position of the teeth rely a lot on

A
  • size, shape and relative position of the underlying bones
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4
Q

what is the maxilla attached to

A
  • anterior cranial base
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5
Q

what are teeth invested in

A
  • alveolar bone
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6
Q

what does the mandible articulate with

A
  • posterior cranial base
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7
Q

how do you determine a skeletal relationship

A
  • look at the basal bones

- relationship between two basal bones gives the idea of the skeletal relationship

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8
Q

what are the basal bones

A
  • innermost curvature of the upper lip in maxilla

- innermost curvature of lower lip in mandible

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9
Q

what orientation does the head need to be to assess skeletal relationship

A
  • Frankfurt plane needs to be horizontal to the floor

- top of ear lobe (prion) and the orbitalae

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10
Q

what is a class 1 skeletal relationship

A
  • mandible is 2-3mm behind the maxilla

- expect them to have a normal overjet and overbite and teeth should look ok

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11
Q

what is a class 2 skeletal relationship

A
  • mandible is more than 2-3mm behind maxilla

- expect teeth to have an overjet

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12
Q

what is mandibular hypoplasia

A
  • mandible is smaller than it should be
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13
Q

what is mandibular retrognathia

A
  • mandible is right size but further back in the glenoid fossa
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14
Q

what is a class 3 skeletal relationshp

A
  • mandible is less than 2-3mm behind maxilla

- can get a reverse overjet

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15
Q

what is hemimandibular hypertrophy

A
  • facial asymmetry
  • tends to happen mainly in females in late teens and early 20’s
  • slowly progressive
  • don’t know aetiology
  • condylar cartilage is still growing and producing bone, and ramus is as well but only on one side
  • secondary bowing of ramus on other side and lack of eruption of maxillary teeth on one side
  • complex
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16
Q

what is hemifacial microsomia

A
  • results in failure of development of condyle ramus and body
  • malformed ear and conductive deafness on that side
  • doesn’t have any bone or muscle or nerves to grow on that side
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17
Q

how do you treat a hemifacial microsomia

A
  • costal-chondral graft
  • take a piece of rib and strap to ramus
  • works ok in 1/3 of cases, overgrow in 1/3 and nothin happens in 1/3 of cases
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18
Q

what are lateral cephalograms for

A
  • help define where faults lie
  • trace to help in diagnosis and planning of these patients
  • only take these if you think there is a skeletal problem
  • only do if skeletal classification 2 or 3
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19
Q

what are some growth modification techniques to promote/restrict growth in children

A
  • functional appliances = grow mandible
  • headgear = restrict maxillary growth, rarely use
  • reverse pull facemask and RME = promote maxillary growth
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20
Q

what can be done for treating adults who have skeletal discrepancies

A
  • orthognathic surgery

- single jaw or bimaxillary procedures

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21
Q

how does functional appliances work

A
  • twin block
  • two separate appliances, one on top jaw and one on bottom
  • wore for around 9 months full time
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22
Q

how do you do a bilateral sagittal split orthognathic surgery

A
  • split on outside halfway along and inside behind the nerve and connects the two cuts
  • slide mandible forwards or backwards so very versatile
  • difficulty is that the area where we cut is close to the nerve so could end up with permanent nerve damage
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23
Q

how do you do a le fort 1 orthagnathic surgery

A
  • chop teeth off maxillary base and move forward and up into predetermined position
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24
Q

who is in the orthodontist team

A
  • orthodontist
  • maxillofacial surgeon
  • clinical psychologist
  • maxillofacial technician
  • speech therapist
  • GDP
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25
Q

how common is cleft lip and palate

A
  • 1 in 700 live births

- common

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26
Q

why do cleft lips and palates happen

A
  • don’t understand why
  • multifactorial
  • lifelong condition
  • smoking, genetics, drinking are all factors which may not help
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27
Q

what is the team for cleft lips and palates

A
  • orthodontist
  • cleft surgeon
  • ENT
  • speech therapy
  • max-fax surgeon
  • plastic surgeon
  • dental practitioner
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28
Q

how can you treat cleft lip and/or palate

A
  • at about age 12, have an alveolar bone graft

- take bone from hip and pack in to allow canine to come through

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29
Q

what can go wrong in development

A
  • lots
  • increased overjet
  • deep overbite
  • anterior cross bite
  • posterior cross bite
  • retained deciduous teeth
  • early loss of deciduous teeth
  • ectopic teeth
  • impacted first molars
  • crowding
  • spacing
  • trauma
  • habits
  • anterior open bite
  • lateral open bite
  • ankylosis of deciduous teeth
  • cysts
  • supernumeraries
  • dental asymmetries
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30
Q

what do you do for a submerging deciduous molar

A
  • can watch tooth till it gets to 1mm of gum, then have to think about taking it out
  • if it disappears then need to go in surgically and remove it so other tooth can erupt
  • quite tricky to treat
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31
Q

what can you do for tuberculate supernumeraries

A
  • centrals should always erupt before laterals
  • should think taking a radiograph as these laterals appear
  • teeth are in the way
  • take out a’s and supernumerary and keep space open and fingers crossed centrals will come in
  • if anything ever goes wrong with eruption sequence thank about taking a radiograph
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32
Q

what are some occlusal and dental anomalies

A
  • crowding
  • spacing
  • increased overjet
  • reverse overjet
  • anterior open bite
  • deep bite
  • hypodontia
  • supernumeraries
  • anterior cross bite
  • posterior cross bite
  • ectopic teeth
  • delayed dental development
  • macrodont
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33
Q

what are the two types of supernumerary teeth

A
  • tuberculate

- conical

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34
Q

which of the two supernumerary teeth types will erupt

A
  • tuberculate never erupt

- conical sometimes erupt

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35
Q

which type of cross bite is easiest to treat

A
  • anterior cross bite can be treated in couple months

- posterior cross bite needs 9 months to be treated

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36
Q

what stages help in orthodontic diagnosis

A
  • systematic assessment of teeth, face and jaws
  • study models
  • radiographs
  • photographs
  • sensibility tests
  • cone beam CT scan
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37
Q

what is included in a systematic assessment for ortho diagnosis

A
  • facial anomalies, asymmetries
  • skeletal relationship
    = how jaws related to each other
    = how jaws related to skull base
  • teeth in each arch separately
  • occlusion
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38
Q

why are photographs good for ortho diagnosis

A
  • can record the start of treatment and end

- see the improvement

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39
Q

what are the aims of orthodontic treatment

A
  • provide a stable, functional and aesthetic occlusion

- if missing teeth, then teeth they do have are rarely in right position

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40
Q

what are different types of appliances

A
  • removable
  • functional
  • fixed
  • others = aligners, Invisalign, headgear, temporary anchorage devices
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41
Q

what are removable appliances used for

A
  • tip teeth, open bites, maintain space
  • good at reducing overbites in growing patients
  • start with this for a lots of patients
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42
Q

what are functional appliances used for

A
  • modify jaw growth

- trying to grow lower jaw and tip teeth in better position

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43
Q

what are fixed appliances for

A
  • true 3-dimensional control of tooth position

- can correct tooth position in all 3 directions

44
Q

what are the benefits of orthodontic treatment

A
  • improve function
  • improve appearance
  • improve dental health
  • reduce risk of trauma
  • facilitate other dental treatment
45
Q

how can ortho improve function

A
  • can make it easier for patient to eat
46
Q

how can ortho improve function

A
  • make teeth easier to clean
47
Q

how can ortho reduce risk of trauma

A
  • if teeth were sticking out they are at risk
48
Q

what are the 3 main risks of ortho

A
  • decalcification around brackets from not brushing well
  • relapse = everyone gets it to some extent, but can be worse if don’t follow guidelines
  • root resorption = 1in 500 get a lot
49
Q

what are some other risks of ortho

A
  • pain, discomfort
  • soft tissue trauma
  • failure to complete treatment
  • loss of tooth vitality
  • inhale or swallow small components
  • candida infections
50
Q

how many ortho patients are adults

A
  • around 30%
51
Q

what is ankylosis

A
  • teeth are fused together
52
Q

how are aligners and invisalign used

A
  • patient changes every couple weeks
53
Q

what is used to assess the antero-posterior skeletal pattern

A
  • palpation of skeletal bases
54
Q

what is used to assess the vertical skeletal pattern clinically

A
  • Frankfort Mandibular Plane Angle

- FMPA

55
Q

which two soft tissue landmarks are sued to construct the Frankfort plane

A
  • porion and orbitale
56
Q

which two soft tissue landmarks are used to construct the mandibular plane

A
  • gonion and menton
57
Q

what 3 dimensions should skeletal relationships be assessed

A
  • antero-posterior, vertical and transverse
58
Q

what maxillary tooth is more commonly ectopic than incisor

A
  • canine
59
Q

what does ideal occlusion mean

A
  • term given to dentition where teeth are in optimum anatomical position
60
Q

what does malocclusion mean

A
  • term given to describe dental anomalies and occlusal traits that represent a deviation from the ideal occlusion
61
Q

how common is malocclusion in adolescents

A
  • moderate-severe is around 40-50%
62
Q

how can ortho treatment help speecj

A
  • won’t significantly change speech

- but if someone can’t get contact between incisors anteriorly, may contribute to a lisp

63
Q

what is another name for lisp

A
  • interdental stigmatism
64
Q

how much root resorption is normal after ortho

A
  • over a 2-year fixed appliance period, 1mm or root resorption will happen
65
Q

how can ortho lead to loss of periodontal support

A
  • increase in gingival inflammation is commonly seen following placement of appliance
66
Q

how can ortho cause soft tissue damage

A
  • ulceration can occur as a result of direct trauma

- allergic reactions are rare but have happened = nickel and latex

67
Q

what are operator factors that could lead to failure of ortho

A
  • errors of diagnosis
  • errors of treatment planning
  • anchorage loss
  • technique errors
  • poor communication
  • inadequate experience
68
Q

what are patient factors than can lead to failure of ortho treatment

A
  • poor OH
  • failure to wear appliance
  • repeated appliance breakage
  • failure to attend appointments
  • unexpected unfavourable growth
69
Q

what is a functional occlusion

A
  • free of interference to smooth gliding movements of the mandible with no pathology
70
Q

what are the causes of malocclusion

A
  • skeletal pattern
  • soft tissues
  • dental factors
71
Q

what is Angle’s Classification

A
  • molar relationship
72
Q

what is class 1 Angle’s

A
  • mesiobuccal cusp of upper first molar occludes with mesiobuccal groove of lower first molar
  • normal
73
Q

what is class 2 Angles

A
  • mesiobuccal cusp of lower first molar occludes distal to class 1 position
74
Q

what is class 3 angles

A
  • mesiobuccal cusp of lower first molar occludes mesial to class 1 position
75
Q

what is index of orthodontic treatment need (IOTN)

A
  • has two elements
    = dental health component
    = aesthetic component
  • determine impact of malocclusion on health and mental well-being
76
Q

what does the dental component of IOTN includes-

A
  • single worst feature of malocclusion is noted and categorised
  • grade 1 (no need) - grade 5 (very great need)
  • or look consecutively at all these features = missing teeth, overjet, crossfire, displacement, overbite
77
Q

what does the aesthetic component of IOTN include

A
  • 10 photographs which are graded from score 1 (best) to score 10 (worst)
  • scores are categorised into need for treatment
  • score 1 and 2 = no
  • score 3 and 4 = slight
  • score 5 6 ad 7 = moderate
  • score 8 9 or 10 = definite
78
Q

what is peer assessment rating (PAR) used for

A
  • measure success of treatment
79
Q

what is index of complexity, outcome and need (ICON)

A
  • incorporates both IOTN and PAR
80
Q

what are Andrew’s 6 keys

A
  • correct molar relationship
  • correct crown angulation -
  • correct crown inclination
  • no rotations
  • no spaces
  • flat occlusal plane
81
Q

what is the correct molar relationship

A
  • mesiobuccal cusp of upper first molar occludes with groove between mesiobuccal and middle buccal cusp of lower first molar
  • distobuccal cusp of upper first molar contacts mesiobuccal cusp of lower second molar
82
Q

what is correct crown angulation

A
  • all tooth crown are angulated mesially
83
Q

what is correct crown inclination

A
  • incisors are inclined towards the buccal or labial surface
  • buccal segment teeth are inclined lingually
  • in the lower buccal segments this is progressive
84
Q

what is Andrew’s key 1

A
  • molar relationship
  • distal surface of distal marginal ridge of upper first permanent molar occludes with mesial surface of mesial marginal ridge of lower second molar
  • mesiobuccal cusp of upper first permanent molar falls within groove between mesial and middle cusps of lower first permanent molar
85
Q

what is Andrew’s key 2

A
  • crown angulation or mesiodistal tip
  • gingival portion of long axis of each tooth crown is distal to the occlusal potion of that axis
  • degree of tip varies with each tooth type
86
Q

what is Andrew’s key 3

A
  • crown inclination or labiolingual torque
  • for upper incisors the occlusal portion of the crowns labial surface is labial to gingival portion
  • in all other crowns, occlusal portion of the labial or buccal surface is lingual to the gingival portion
87
Q

what is Andrew’s key 4

A
  • rotations

- there should be an absence of any tooth rotations within the dental arches

88
Q

what is Andrew’s key 5

A
  • spacing

- there should be an absence of any spacing within the dental arches

89
Q

what is Andrew’s key 6

A
  • occlusal plane

- should be flat

90
Q

what is class 1 occlusion

A
  • position of dental arches is normal, with first molars in normal occlusion
91
Q

what is class 2 division 1 occlusion

A
  • relations of dental arches are abnormal, with all mandibular teeth occluding distal to normal
  • upper incisors are protruding
92
Q

what is class 2 division 2 occlusion

A
  • relations of dental arches are abnormal, with first molars in normal occlusion
  • upper incisors are lingually inclined
93
Q

what is class 3 occlusion

A
  • relations of the dental arches are also abnormal, with all mandibular teeth occluding mesial to normal
94
Q

what is retruded contact position (RCP) or centric relation (CR)

A
  • gnathological term that describes position of mandible in relation to maxilla with condyles in most stable and reproducible position
95
Q

what is intercuspal position (ICP) or centric occlusion (CO)

A
  • occlusion that occurs with the teeth in a position of maximum intercuspation
96
Q

what is canine guidance

A
  • present when contact is maintained on the working side canine teeth during lateral excursion of mandible
97
Q

what is group function

A
  • present when contacts are maintained between several teeth on the working side during lateral excursion of mandible
98
Q

what is canine class 1

A
  • the maxillary permanent canine should occlude directly in the embrasure between mandibular canine and first premolar
99
Q

what is canine class 2

A
  • maxillary permanent canine occludes in front of the embrasure between mandibular canine and first premolar
100
Q

what is canine class 3

A
  • maxillary permanent canine occludes behind the embrasure between mandibular canine and first premolar
101
Q

what is incisor class 1

A
  • lower incisor tips occlude or lie below the cingulum plateau of upper incisors
102
Q

what is incisor class 2 division 1

A
  • the lower incisor tips occlude or lie posterior to the cingulum plateau of upper incisors
  • overjet is increased with upright or proclined upper incisors
103
Q

what is incisor class 2 division 2

A
  • lower incisor tips occlude or lie posterior to cingulum plateau of upper incisors
  • upper incisors are retro-inclined, with a normal or occasionally increased overjet
104
Q

what is incisor class 3

A
  • the lower incisor tips occlude or lie anterior to the cingulum plateau of upper incisors
105
Q

what can cause malocclusion

A
  • genetics
  • lip trap = lower lip rests behind upper incisor
  • sucking habits
  • pathology = childhood fractures, juvenile rheumatoid arthritis, excess GH, PD
  • early loss of primary teeth

BDS3 - Orthodontics (14 decks)

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