Keys of Occlusion Flashcards
As defined by the AAO
Orthodontics is that area of dentistry concerned with the growth, guidance, correction, and maintenance of the ____ complex, with special emphasis on developmental disturbances and those conditions that cause or require movement of the teeth.
The area of orthodontic practice includes the ____, prevention, ____ and treatment of all forms of malocclusion of the teeth and associated alterations in their supporting structures, the design application and control of functional and corrective appliances, and the guidance of the developing dentition to attain optimum occlusal relations in physiologic and esthetic harmony with other facial and cranial structures.
dento-facial
diagnosis
interception
Goal of Orthodontic Treatment
The goal of Orthodontic treatment is to obtain optimum proximal and occlusal ____ of the teeth within the framework of acceptable facial esthetics and ____, normal function, and reasonable ____.
• Cannot fix a skeletal problem by \_\_\_\_ teeth
contact
self image
stability
straightening
• First thing people see is your ____
smile
• Anatomical harmony of all parts
○ Do not need ____
• Anatomical disharmony of parts
○ Either adequate adaption and no ortho treatment is necessary
○ Or inadequate adaptation and treatment is necessary
• First dental examination: emergence of first \_\_\_\_ tooth, but no later than \_\_\_\_ y/o ○ No teeth at age 1 > see a peds and why there's no teeth § Child has \_\_\_\_% less dental expenditures by age 5/6, than a kid that doesn't see a dentist until age 3 • First ortho examination: emergence of first \_\_\_\_ tooth, but no later than \_\_\_\_ y/o ○ Initial examination at no cost, won't cost the parents anything
deciduous 1 40 permanent 7
Prevalence of Malocclusion
• 1/3 \_\_\_\_ malocclusion • 1/3 \_\_\_\_ malocclusion • 1/4 \_\_\_\_ malocclusion ○ Skeletally involved • 1/12 \_\_\_\_ malocclusion
normal
moderate
severe
handicapping
• Three types:
○ ____
○ ____
○ ____
preventive and interceptive
corrective
adjunctive
Mechanism of making treatment decisions
• Patient walks into office > clinical assess the patient before you walk over to the patient (see them walk in) > diagnose how you treat depending on how face goes together • Arrive at a tentative diagnosis based just on \_\_\_\_ • Cannot finalize diagnosis without \_\_\_\_ • C II, D I ○ Skeletal and dental ○ 70% of this pattern has a \_\_\_\_ mandible, may also have a protrusive maxilla ○ Passive eruption § Upper teeth into lower teeth, and lower teeth in upper mouth § Deep vertical \_\_\_\_ ○ Intrude overerupted \_\_\_\_ teeth, you don't retrude posterior teeth • Decide the treatment plan • What are you going to move it with?
clinical labs and x-rays retrusive overbite anterior
Order of Treatment
• \_\_\_\_ ○ First thing you do is make sure the teeth and supporting tissues are healthy - PA lesions - supporting tissues - teeth
• Correct the \_\_\_\_ ○ Move teeth in the middle - ortho treatment - orthognathic surgery - stabilization
• \_\_\_\_ ○ Don't do crown first before you have malocclusion checked out! - supporting tissues - placement of implant fixtures - final restorations
control infection
occlussion
complete functional/esthetic treatment
Hallermann-Streiff Syndrome
\_\_\_\_ (abnormal head) with bird facies and hypoplastic mandible Congenital cataracts Proportionate nanism (\_\_\_\_) * Micropthalmia (small eyeballs) \_\_\_\_ (congenital lack of hair) Dental anomalies
Cutaneous atrophy primarily limited to the face and/or scalp
____ (shortness of the head) with frontal and parietal bossing
Open sutures and fontanels
High arched ____
Nystigmus (oscillatory eyeball movement
• When there is one eruption anomaly > there are often \_\_\_\_ eruption anomalies ○ When look at x-rays > look at the teeth last
dyscephaly dwarfism hypotrichosis brachycephaly palatal vault
Initial records of HM syndrome
- ____ facies
- ____ mandible
- ____ bite
- partial anodontia
- ____ molar
- large ____
- high narrow ____
- congenitally missing teeth• Only has one lower incisor
○ Has to be a ____, cause laterals grow from an invagination of the central incisor bud
○ If you don’t have a central incisor, you cannot have a lateral incisor
• Thumb into child’s mouth, if doesn’t fit > maxilla is too ____
○ Palatal vault is set by age 3
○ No growth in the tooth bearing area
Crowded at age 3, will be crowded by age 33 unless you intervene
bird-face retrusive open CIII OJ palatal vault central incisor
Initial records
- ____ hyperdivergent skeletal pattern with retrusive mandible
- altered ____ w partial impactions• Very steep ____
○ Should be falling at base of the occipital
○ Has a lot of interception of the occipital bone by the mandibular plane
§ More common to occur in ____ than C2
CI II
eruption timing
mandibular plane
CIII
Rx of HM syndrome
- ____ placement• Average lifespan is about age ____
• Remove one ____ in order to create the same amount of tooth material bilaterally and symmetrically for her
• One lower ____ right in the middle
○ No one sees if you have missing ____
appliance
premolar
central incisor
incisors
Improvement following Rx
- Class III corrected by mesial U molar and distal L molar movement
- OB/OJ improved by ____ and improved ____ of incisors
extrusion
axial inclination
Facial comparison
- face ____, but no ____ change
lengthened
sagittal
6 Keys
- ____ relationship
- Crown ____ (mesio-distal tip)
- Crown ____ (labio/bucco-lingual)
- Absence of ____
- Absence of ____
- Almost flat ____
molar angulation inclination rotations spacing occlusal plane
Angle classification
• Point B is slightly \_\_\_\_ point A ○ \_\_\_\_ degrees in Caucasian ○ 6 degrees in AA
behind
4
Class I
____ mandibular plane
Normal molar & canine
M-Li cusp of U 1st molar rests in CF of L 1st molar
Class II division 1 subdivision left
• Normal occlusion • \_\_\_\_ cusp of max first molar occluded with \_\_\_\_ of man first molar • Now: ML cusp of max first molar, is in the CF of the man first molar • Was located under the T ridge/malar process • Is there enough room for all of the teeth? ○ Patient with crowded dentition: § Make the jaws bigger § Make the mass of tooth material smaller § [???]
steep to flat
MB
buccal groove
Class I
Ant crowding
Bimaxilalry dental protrusion
• Alters the \_\_\_\_ of the face with bimaxillary dental protrusion • Move the teeth back > only way to do that is to take the \_\_\_\_ teeth out • Class I crowded > arch bigger, tooth material smaller ○ Do I have enough room, do I have enough support • What the fuck is this guy talking about • More than 6mm of crowding > requires \_\_\_\_
lower third
permanent
extractions
Class I
Bimaxillary skeletal protrusion
• Upper and lower jaws are too much forward • The teeth are upright, but the jaws are too far \_\_\_\_ • Throwback to \_\_\_\_ • Class I ○ Mandibular plane that ranges from slightly above to slightly below normal
forward
ancestors
Class II div 1
Normal to steep mandibular plane 70 % have retrusive mandible
• Present with a \_\_\_\_ face, and a \_\_\_\_ mandibular plane • Mandible further back than it should be • MB cusp of max molar is not lined up with buccal of man molar (first) ○ Located at the proximal contact • Class II on one side and Class I on the other > class II \_\_\_\_ (meaning one-sided); the side that's out of \_\_\_\_ is the side named
longer
steeper
subdivision
wack
Class II div I
U teeth protrusive
L teeth retrusive
• Can be caused by uppers being too far \_\_\_\_, or lower being too far \_\_\_\_
Maxilla protrusive
Mandible retrusive
• Or can be because \_\_\_\_ is too far forward, and the \_\_\_\_ is too far back * Or \_\_\_\_ can be implicated * Don't fix what's not broken
forward
backward
upper jaw
lower jaw
both
Class II div 2
____ mandibular plane
____ skeletal
Maxillary central incisors ____
* Have a \_\_\_\_ mandibular plane * Vertical overbite is \_\_\_\_ * CI are tucked \_\_\_\_, and LI are flared \_\_\_\_ * With anterior crowding: CI go forward and LI go back
normal to flat class I or class II flat deep back forwardC
Class II div II
____
____
• Mostly have \_\_\_\_ and a strong chin
orthognathic
convex
orthognathic
Class III
____ mandibular plane
Strong ____
Longer ____ span, often into early 20’s
• Half of people have significant enough malocclusion that should be treated • Of the people who have malocclusion, about half have a class I malocclusion, about a 1/3 have a C2, D1; about a 1/6 C2, D2; about a 1/2 have a C3 malocclusion • All mechanics have do not work as well for \_\_\_\_ • Malocclusions of C3 grow longer and later ○ Cannot do a thing until patient stops \_\_\_\_ so they can get surgery > stop growing into 20's for males • Normal to steep mandibular plane and a strong anti-gonial notch (when the mandible bends)
normal to steep anti-gonial growth CIII growing
Class III
U teeth ____
L teeth ____
* Rarely caused by maxilla being \_\_\_\_ * Seen most often in youngsters with \_\_\_\_ * Lower teeth are protrusive, and the lower jaw is protrusive
retrusive
protrusive
retrognathic
down syndrome
• Used to get 40% relapse in surgical cases because of ____
• Now with titanium plates/screws > only ____% relapse
○ Preform the plates before going into the OR, so now it fits passively
steel ligature
5
VENN DIAGRAM
LOOK ME UP
Alignment problem = \_\_\_\_ Profile problem = \_\_\_\_ Also have transverse, sagittal, vertical space planes Depending on group = how long it will take to fix it \_\_\_\_ = higher number \_\_\_\_ is most serious • Gives an idea of the \_\_\_\_ of the malocclusion • If the malocclusion includes skeletal, it doubles the \_\_\_\_
group 1
group 2
overlap
9
severity
severity
Narrow maxilla
Functional shift to right
• Mandible has shifted off to his right • Crossbite of teeth on right side, and no crossbite on the left • Closed in initial contact, molars bet buccal cusp tip to tip, and shifted to right side to get functional MIC • \_\_\_\_ the maxilla > the earlier it's done, the easier to do ○ Less likely to \_\_\_\_ erupts
widen
maxillary canines
Dental midlines centered
Mandibular skeletal midline shifts right
• Damage to LI > root of forming \_\_\_\_ went into the crown of the forming permanent LI
deciduous LI
Phase I Rx
Haas RME
15 days expansion @ ____mm ____x/day
• \_\_\_\_ the maxilla ○ Whatever space you had will be larger ○ \_\_\_\_ the space stays the same, when finished widening > return to crowding if it exists ○ Correcting \_\_\_\_ not tooth! § The arch is wider, but the teeth return to normal
0.2 2 widen dentally bone
3 years post-expansion
dental midline ____
dental ____ right canines
deep ____
problematic maxillary ____
• Mandibular shift to the right, canine blocked out to buccal and incisors behind it
shift
x-bite
OB
labial frenum
- Still have primary molars, the secondary primary molar is much ____ than the PM that will replace (3.5 mm difference) > hold molars back where they are and bring the premolars back, and canine go back > will not have to ____ any permanent teeth
- Do not ____ until all the primary teeth fall out!
larger
remove
wait
Phase II Rx
- corrective appliances placed
- 18 month Rx
Frenectomy 3 mo. prior to ____
deband
Cannot treat only the social six, will have ____ that aren’t moving properly
roots
Records must include
____ Hx
____ Hx
Facial examination \_\_\_\_ Proportions \_\_\_\_ Muscle tone \_\_\_\_ defects Palpate TM
medical dental symmetry vs. asymmetry orientation speech
Records
Oral examination
Visually examine and palpate all ____ tissues
Examine occlusion, relationship of teeth and jaws in all 3 ____ of space
____
Sagittal
____
____
____ and intra-oral photographs
hard and soft planes transverse vertical height & weight facial
Records
Orthodontic models
Trimmed ____ so that arch asymmetry can be
viewed in comparison to symmetric bases
Heel trimmed in ____ or articulator mounted
Impressions made deeply into the ____ to allow visualization of tooth position as it relates to bone support
Utilization of models to accomplish an ____ analysis
symmetrically
RC
muccobuccal fold
arch-length
Records
\_\_\_\_ for vertical/sagittal analysis \_\_\_\_ for transverse analysis prn PA’s prn \_\_\_\_ \_\_\_\_, especially if periodontally involved \_\_\_\_ to view palate
Cone beam CT prn
Any other pertinent views
lateral ceph PA ceph BW's FMXR upper occlusal
Records
These are the minimum diagnostic records required to do an Orthodontic evaluation
Failure to include these data in your analysis may increase your ____
Must have evidence that the records were ____, not just ____
liability
evaluated
gathered
Andrea M
Class II D I
____ mandible
Deep ____
- palatal impingement
- midline deviation; u spacing
- larger ____
U teeth relate well to maxilla
L teeth relate well to mandible
retrusive
OB
OJ
Andrea M
Symmetric maxilla
- anterior spacing
- rotated U molars
- upright incisors
- adequate arch length
To Rx this case we need to:
Maintain relationships of teeth to underlying bone support, keeping incisors ____
Advance ____ to improve OJ and correct buccal segment sagittal relationship from Class II to Class I
Intrude ____ (not extrude buccal segments) to improve OB
Eliminate rotations, tip, & torque, etc.
Correct ____
Achieve Andrew’s Six Keys
upright
mandible
incisors
midline
• Lining up teeth will not fix a ____ malocclusion
skeletal
After 18 mo observation - no change
• Not doing any favors of waiting - if seeing today: ○ Divided treatment into 2 phase: § Enhance horizontal growth of \_\_\_\_ □ Go from CII to CI § \_\_\_\_ up the teeth, easier to line them up and it's more smooth * She grew down on y-axis, but not \_\_\_\_ * CII molar relationship did not change much
mandible
line
very much
• Can fix skeletal problem by increasing ____, and by enhancing growth at the ____
orthopedic force
growth plate
LOOK UP STUFF WITH BABY
YA
JULIE P
Not lip contour because of bi-____
Immovable ____ LR
Immovable ____ LL
Protrusion & Crowding
* Molar that is tipped - difficult to care for \_\_\_\_ * Instead of having tooth uprighted • Not an \_\_\_\_ implant
maxillary protrusion bridge implant periodontally integrate-able
Corrective Rx
____ to permit reduction of bimaxillary protrusion
• Remove four ____ in order to treat bi-maxillary protrusion
Note facial contour improvement
* Shouldve had teeth straighten, then implant integration * Looks younger when the bi-maxillary protrusion was adjusted
extractions
premolars
Julie P
- spaces due to intractability of ____ segments
buccal
Hard & Soft Tissue Damage
Patient and parent taken through extensive oral hygiene program
General Dentist & Hygienist reinforced importance of good oral hygiene during Orthodontic care
____ was reviewed at every visit and written reports proved to patient/parent
When braces removed mother said, “Why didn’t you tell us?”
hygiene
Age 1, first dental check-up
Children who see Pediatric Dentist by age ____ have ____% less dental expenses by age 5 than children who do not see General Dentist until age 2-3
____ is best able to track dentitional development, facial development, fluoride balance, diet recommendations, oral hygiene, etc.
Age 7, first orthodontic check-up
5 most dangerous words in the English language, “Maybe
it will go away.”
After age 3 jaws develop in the ____, not in the tooth bearing area
There are problems best intercepted in the ____ transitional dentition
Don’t ____ a compromised time table on the orthodontist. Let the Orthodontist determine the best time to treat
Note that skeletal age and dental age ____ well to each other and relate poorly to ____ age
1
40
pedodontist
back early force relate chronologic
When the environment is ____, many muscle function problems disappear
____ teeth
When viewing x-rays, look at the teeth ____
When there is one eruption anomaly there are often multiple ____ anomalies. I cannot emphasize this enough
Use the ____ of the toothbrush. Optimum oral hygiene is essential to successful Orthodontic treatment
____>____ Plan>____. Don’t fall into the “Gadget Trap” just because it looks cool at a dental meeting.
normalized count last eruption fuzzy end diagnosis treatment mechanotherapy
Staying at a Holiday Inn Express and taking a weekend course doesn’t make you an Orthodontist or even a gadget guru
Begin corrective Orthodontic treatment prior to “e” ____ and ____ loss. Don’t wait for all the deciduous teeth to fall out before referring a patient to an Orthodontist for care
It’s better to be ____ than reactive
Fix what’s ____, not what isn’t
Treat the ____, not the malocclusion
Problems may be ____ but not homologous. Understand the differences between cases
Do not expand teeth and alveolar bone off of basal bone support or you will cause ____
exfoliation leeway space proactive broken patient analogous fenestrations and dehiscences
There is nothing the Orthodontist can do that will overcome what the patient will not do
Autograph your work with excellence
Blessed are those who treat the ____, for
they shall be known as “Dentists”
____: Someone who keeps talking after everyone has stopped listening
If things improve with age, I’m approaching magnificence
episodically mute
teacher
