Lecture 10 Flashcards
the ___ is one of the most actively adaptable areas of bone growth during the period of transition between the adult and primary dentitions, which is therefore an ideal time for most major orthodontic interventions
alveolar process
from a clinical point of view, there are two very important aspects to the mixed dentition period. what are they?
- the utilization of the arch perimeter
- the adaptive changes in occlusion that occur during the transition from one dentition to another
- therefore, supervision of a child’s development of occlusion is most critical during this mixed dentition stage
phase I orthodontic treatment is ___ treatment performed on a patient before ___
- limited
- all primary teeth are lost
how long does phase I treatment typically last?
6-12 months
after phase I treatment is complete, all braces and ortho appliances are removed and the patient is placed into ___
retainers
phase I treatment is oriented to correct ___ early before the can cause additional problems or damage existing permanent teeth due to ___
- abnormalities
- traumatic occlusal relationships
phase I treatment ideally corrects ___ and places the patient in a position where the dentition can function and develop normally while the remaining primary teeth are lost and the rest of the permanent teeth erupt
-abnormalities
the american association of orthodontists recommends that every child receive an orthodontic evaluation and panoramic x-ray before the age of ___ to identify early orthodontic problems
8
patients who have undergone phase I treatment will typically undergo phase II treatment (full ortho treatment) later when the primary dentition is lost, typically around age ___
11 or 12
what are 4 reasons to refer your patient early for orthodontic treatment and intervention?
- crowding
- abnormal growth and development
- ectopic eruption and impactions
- traumatic occlusal relationships/crossbites
early orthodontic treatment and intervention can help correct what 3 things?
- possibility of trauma from severe deep bites, anterior/posterior crossbites, or protruded maxillary incisors
- abnormal growth (class III occlusion/anterior crossbites)
- abnormal habits (mouth breathing, thumb and finger habits, tongue posture position)
a young child who has a tendency toward a class III malocclusion will have end to end contact of the ___
primary incisors
a true anterior crossbite in the primary dentition is rare because ___
mandibular growth lags behind maxillary growth
an anterior crossbite in the primary dentition is often indicative of a ___ and a ___
- skeletal growth problem and a developing class III malocclusion
- remember: an anterior crossbite in a primary dentition usually indicates a skeletal growth problem
orthodontic treatment typically isn’t started until the eruption of the permanent teeth around ___ years old
7-8
what are 2 major signs that a patient could have crowding problems?
- lack of interdental spacing in the primary dentition
- crowding of the permanent incisors in the mixed dentition, alleviation through skeletal growth
the maxillary anterior primary teeth are about ___% the size of their permanent successors
75%
the mandibular anterior primary teeth (total) are, on average, about ___mm narrower mesiodistally than their successors
6mm
does arch perimeter increase after eruption of permanent incisors?
- yes, however it is a small increase in the maxilla, and essentially non-existent in the mandible
- therefore, arch growth cannot be relied upon to contribute to further dental alignment, and alleviate dental crowding
in the mandibular arch in both sexes, the amount of space for the mandibular incisors is negative (1-2mm) for about 2 years after their eruption, meaning what?
a small amount of crowding in the mandibular arch at this time is normal
the additional space to align mandibular incisors, after the period of mild normal crowding, is derived from what 3 sources?
- a slight increase in arch width across the canines
- slight labial positioning of the central and lateral incisors
- a distal shift of the permanent canines when the primary first molars are exfoliated
the primary molars are significantly larger than the premolars that replace them, and the ___ provided by this difference offers an excellent opportunity for natural or orthodontic adjustment of occlusal relationships at the end of the dental transition
“leeway space” or “E space”
what is the average mandibular and maxillary leeway space?
- mandibular leeway space averages about 2.5mm on each side
- maxillary leeway space averages about 1.5mm on each side
both ___ and ___ tend to decrease during the transition from primary to permanent dentition (ie. some of the leeway space is used by mesial movement of the ___)
- arch length (distance from a line perpendicular to the mesial surface of the permanent first molars to the central incisors) to arch circumference
- molars
the maxillary arch is slightly longer in arch length compared to the mandibular arch. the mesial-distal diameter of the maxillary permanent teeth is approximately ___mm, whereas the sum of the mesial-distal diameter of the mandibular permanent teeth is approximately ___mm. maxillary dental arch is typically ___mm larger than the mandibular dental arch.
- 128mm
- 126mm
- 2mm
some spacing between the primary incisors is normal in the late primary dentition and is necessary to ___
provide enough room for alignment of the permanent incisors when they erupt
at age ___, a gap-toothed smile is what you would like to see
6
what denotes the “ugly ducking” stage, and what age does it occur?
- in some children, the maxillary incisors flare laterally and are widely spaced when they first erupt
- age 9
towards the end of the ugly duckling stage, the position of the incisors tends to improve when the ___ erupt, but this condition increases the possibility that the ___ will become impacted, and these patients should be referred to an orthodontist for evaluation
- permanent canines
- canines
about ___% of 11 year old children have a maxillary diastema between their maxillary central incisors
49%
what are diastemas possibly caused by?
- tooth size discrepancy
- mesiodens
- abnormal frenum
- normal stage of development
the diastema space in a child tends to close as the ___ erupt, but the greater the amount of space, the less likelihood ___
- canines
- the less likelihood it will close on its own
as a general guideline, a maxillary central diastema of ___mm or less will sometimes close on its own
- 2mm
- anything greater than this, and closure is unlikely
premature loss of the primary canines reflects insufficient ___. the crowns of the lateral incisors, during eruption, impinge on the roots of the primary canines, causing them to resorb and they are lost
-arch size in the anterior region
if only one mandibular canine is prematurely lost, the midline will shift in the direction of the lost tooth, with ___ and ___ migration of the mandibular incisors
lateral and lingual
what are possible phase I treatment options for maxillary crowding?
- expansion
- limited orthodontics on maxillary first molars and incisors
- extraction of primary canines (or others as needed) to create space for erupting permanent teeth
T or F:
palatal expansion can be done at any time prior to the end of the adolescent growth spurt
true
what are 4 major reasons for doing early expansion?
- to eliminate mandibular shifts on closure
- provide more space for the erupting maxillary teeth
- lessen dental arch distortion and potential tooth abrasion from interferences of anterior teeth
- reduce the possibility of mandibular skeletal asymmetry
what are 4 appliances that often leave indentations in the superior surface of the tongue? how long do the indentations typically last after removal of the appliance? what is the treatment?
- W-arches, quad helixes, expanders, and habit appliances
- up to 1 year
- no treatment is recommended, but patients and parents should be warned of this possibility
what are possible phase I mandibular crowding treatment options?
- expansion - schwartz, lip bumper
- limited orthodontics on mandibular permanent teeth
- extraction of primary canines (or others as needed) to create space for erupting permanent teeth
patients with a class III skeletal growth pattern are typically in a ___ crossbite with ___ constriction, and can be in full posterior crossbite
- anterior
- maxillary
class III growth patterns are very difficult to control, especially in ___, and referral to an orthodontist should be initiated as soon as possible
males
treatment for class III patients typically consists of ___
-limited orthodontic treatment on the permanent dentition in association with expansion and reverse pull head gear
when treating a class III patient, what might happen if forward traction is applied at an early age?
it is possible to produce displacement of the maxilla rather than just displacement of the maxillary teeth
is phase I treatment more common for skeletal class II or class III patients?
class III
T or F: in class II phase I treatment, skeletal changes are not likely to be produced by early treatment with headgear or a functional appliance but tend to be diminished or eliminated by subsequent growth and later treatment
- false
- changes are likely
T or F: in class II phase I treatment, skeletal changes account for only a portion of the treatment effect, even when an effort is made to minimize tooth movement
true
T or F: in class II phase I treatment, after later comprehensive treatment, alignment and occlusion are very different in children who did and those who did not have early treatment
- false
- alignment and occlusion are very similar
T or F: in class II phase I treatment, early treatment reduces the number of children who require extractions during a second phase of treatment or the number who eventually require orthognathic surgery
- false
- it does not reduce the number
T or F: in class II phase I treatment, the duration of phase II treatment (full ortho treatment) is quite similar in those who had a first phase of early treatment aimed at growth modification and those who did not
true
T or F: based on research results, it seems clear that for most class II children with a skeletal class II relationship, early treatment is no more effective than just one phase of later treatment
- true
- however, that isn’t to say there aren’t certain dental situations that a class II patient could benefit from phase I treatment (crossbite, traumatic deep bite, crowding, etc.)
thumb sucking and finger sucking are very difficult habits for some patients to break on their own, and often patients require help though ___
removable and fixed appliances
T or F:
the need to suck a finger or thumb can be very subconscious, and some patients suck their thumb without even realizing they are doing it
true
to break thumb/finger sucking habits, orthodontic appliances work to make the experience ___ or ___, and is intended to remind the patient, who may be doing it subconsciously, that they want to stop, and that they need to make the conscious decision to take their thumb out of their mouth
weird or painful
sucking habits often produce a ___ maxillary arch, and tendency toward bilateral ___ crossbite
- narrow
- posterior
children who thumb/finger suck may sometimes shift the mandible to one side on closure, termed ___, which can guide permanent molars and premolars into a crossbite relationship. this can cause ___
- functional crossbite
- this can cause damage to the dentition and can influence how the patient grows
with patients with thumb and finger sucking habits, the maxillary incisors are typically flared ___, and the mandibular incisors are reclined ___ causing a ___. also, as the hand rests on the chin, it can retard growth of the mandible, resulting in a class ___ profile.
- bucally
- lingually
- anterior open bite
- II
___ is a descriptive term for the appearance of the tongue when there are indentations along the lateral borders of the tongue
crenated tongue (or scalloped tongue)
what is crenated tongue caused by?
- compression of the tongue against the adjacent teeth
- this usually results from habits where the tongue is pressed against the lingual surfaces of the dental arches, or could be due to macroglossia
pressure from the tongue against the teeth can move the teeth into abnormal positions and can prevent the teeth from coming together through ___ or through ___, which can cause open bites on both ___ and ___
- impeding eruption
- orthodontic movement of the teeth
- lateral
- anterior
___ habits are very difficult for orthodontists to manage, and if patients are not willing to cooperate, a high tendency for orthodontic relapse will occur once the braces are removed
tongue
___ and ___ can be associated with tongue pressure parafunctional habits, which place the teeth in a situation comparable to a traumatic occlusion
- root resorption and bone and gingival loss
- the tongue continues on and off pressures, creating mobility in the tooth, which creates a constant inflammatory response in the dentoalveolar complex
in younger patients, ___ and ___ is a key element in orthodontic treatment planning
growth and the potential for growth
many orthodontic options are only available during periods of growth, and once growth is complete, ___ is often the only alternative for these patients
- orthognathic
- unfortunately, even with the best early intervention, some patients growth cannot be corrected and the patient will require surgery once their growth is complete
___ is a difficult, complex problem and an orthodontist must complete a full ortho analysis and treatment plan before initiating any ___ treatment
- growth modification
- growth modification
for the growth of the maxilla and mandible, growth in the ___ is completed first, then growth in the ___, and then growth in the ___ direction
- width
- vertical
- anterior-posterior
orthodontic force applied to teeth has the potential to radiate outward and affect ___ locations
- distant skeletal
- it is now possible to apply force to implants or temporary anchorage devices to affect a patients growth