Lecture 16 Flashcards
adult orthodontic treatment falls into what two groups?
- younger adults from 20-30 who desired but did not receive comprehensive orthodontic treatment as youths
- older individuals who have other dental problems and need orthodontics as part of a larger treatment plan
T or F:
treatment for older adults has been the fastest growting area in orthodontics during the last decade
true
why is adult orthodontic treatment more difficult than on children?
due to the absence of growth, which means that growth modification to treat jaw discrepencies is not possible, which leaves only camouflage or surgical options
adult orthodontic treatment is often carried out to facilitate other dental procedures, which are necessary for what 3 things?
- control disease
- restore function
- and/or enhance appearance
sometimes adult orthodontics will only involve part of the dentition, with the primary goal of making it easier or more effective to ___
replace missing or damaged teeth
limited adult orthodontic treatment can involve what 3 procedures?
- repositioning teeth that have drifted after extractions or bone loss
- alignemtn of anterior teeth to allow more esthetic restorations
- forced eruption of badly broken down teeth to expose sound root structure
what should the 3 main goals of limited adult orthodontic treatment be?
- improve periodontal health
- establish favorable crown-root ratios and position the teeth so that occlusal forces are transmitted along the long axes of the teeth
- facilitate restorative treatment (implants, optimal esthetics, etc.)
planning limited adult treatment requires what two steps?
- collecting an adequate diagnostic database
- developing a comprehensive but clearly stated list of the patients problems
planning limited adult treatment cannot be overemphasized since the solution to the patients specific problems involve the synthesis of ___
many branches of dentistry
along with the standard orthodontic records, an adults orthodontic records should also include ___, which typically are not included in younger healthier patients, and are important to identify ___ and ___
- a full set of full mouth xrays
- bone height and periodontal health
in addition to full mouth xrays, an adults orthodontic records should include ___ because they facilitate planning of associated restorative procedures
articulator-mounted casts
can we move teeth that have had endodontic treatment?
since the response of the PDL (not the pulp) is the key element in tooth movement, movement of endodontically treated teeth is possible
would you expect damage to the root apex when moving endodontically treated teeth because these teeth are no longer vital?
severe root resorption is not typically seen and should not be expected as a consequence of moving non-vital teeth
T or F:
moving teeth that have received RCT or previous trauma is not a concern, as orthodontics typically does not aggravate pre-existing conditions
false
pre-existing conditions can flare up during orthodontic treatment, so patients should always be informed that teeth with pulpal problems may develop further problems in the affected teeth
what are the guidelines for orthodontically moving a traumatically intruded tooth?
if a tooth has been non-vitalized by intrusive trauma and required pulp therapy, and if the tooth is to be orthodntically extruded, then root resorption is less likely if a calcium hydroxide fill is maintained until the tooth movement is complete and then the root canal filling is placed
treatment time is dependant on what two things?
the severity of the problem and the amount of tooth movement desired
once all of the problems have been identified and categorized, the key treatment planning question is ___
- will orthodontic treatment be necessary
- it is also important to consider the difference between realistic and idealistic treatment planning
when a first permanent molar is lost and is not replaced, the second molar typically drifts mesially and the premolars often tip distally and rotate into the space between them. what issue can this cause?
- as the teeth move, the adjacent gingival tisue becomes folded and distorted, forming a plaque-harboring pseudopocket that may be virtually impossible for the patient to clean
- repositioning the teeth eliminates this potentially pathologic condition and has the added advantage of simplifying the ultimate restorative procedures
it is important to note that uprighting a tipped molar increases ___, while it reduces ___
- crown height
- the depth of the mesial pocket
what is one of the most significant complications of molar uprighting and why?
- a patient developing a high mandibular plane angle
- it can lead to an increased open bite and loss of anterior guidance
after molar uprighting, subsequent ___ decreases occlusal interference and also improves the crown to root ratio of the molar
crown reduction
how long does a molar need to be orthodontically held in place before restorative procedures can be performed?
- an uprighted molar should be held in the correct position to allow the lamina dura and PDL to reorganize for 2 months for simple uprighting
- an uprighting molar should be held in the correct position for 6 months if uprighting plus osseous surgery, grafts have been performed
what are the two different ways to upright a molar, and what are the advantages of each?
- uprighting by distal crown movement leads to increased space for a bridge pontic or implant
- uprighting by mesial root movement reduces space and might eliminate the need for a prosthesis
which is the more difficult way to upright a molar (distal crown movement vs mesial root movement)?
- mesial root movement
- it can be very time consuming to accomplish, especially if the alveolar bone has resorbed in the area where the first molar was extracted and cortical bone has filled into the extraction site
if a third molar is present, should both the second and third molars be uprighted?
- for many patients, distal positioning of the third molar would move it into a position in which good hygiene could not be maintained or it would not be in functional occlusion
- in these circumstances, it is more appropriate to extract the third molar and simply upright the remaining second molar
if there is slow progress of the movement during molar uprighting, it is most likely due to a ___ that is disrupting the molars movement
occlusal interference
if both second and third molars are to be uprighted, a significant change in ___ is required and treatment time will also increase
technique
T or F:
normal angulation of a molar improves the direction and distribution of occlusal forces
true
T or F:
normal angulation of a molar increases the amount of tooth reduction required for parallelism of the abutments for a bridge
false
it decreases the amount
T or F:
normal angulation of a molar decreases the possibility of endodontic, periodontic, or more complex prosthodontic procedures
true
T or F:
normal angulation of a molar compromises the durability of restorations, due to inadequate force distribution
false
it increases the durability of the restorations, due to better force distribution
normal angulation of a molar improves the periodontal environment by eliminating ___
plaque-retentive areas
normal angulation of a molar improves ___ contour and ___ ratio
alveolar bone contour and crown to root ratio
there has been a heightened trend towards ___ in the general public, which has challenged dentistry to look at ___ in a more organized and systematic manner
- esthetics
- dental esthetics
patient treatment is superior when ___ work together to achieve a common goal and to begin with the end in mind
all the different fields of dentistry
interdisciplinary dental treatment requires good communication, and questions my be andswered and agreed upon to obtain optimum ___ and ___ for the patient
dental health and esthetics
what are the 8 guidelines that the dental team should follow when planning interdisciplinary treatment?
- realistic objectives
- create a diagnostic setup
- determine the sequence of treatment
- stabilize/correct any active disease
- position teeth to facilitate restorative treatment
- evaluate gingival esthetics
- take progress radiographs
- all members interact during finishing
two wall periodontal defects are best treated with periodontal surgery with or without adjunctive orthodontics. what case requires orthodontics?
- when two walls are remaining in an interproximal region and the patient cannot maintain the area, it is difficult for a periodontist to completely resolve the defect with resective or regenerative treatment
- these defects often require orthodontic eruption of the affected tooth, followed by crown lengthening to improve the restorability of the tooth