1. Maxillary incisors in proclination 2. Increased overjet 3. Prognathic maxilla and/or retrognathic mandible

1. The maxillary central incisors are retroclined (tipped back) 2. The maxillary lateral incisors have tipped labially and mesially, sometimes overlapping the central incisors

midterm Flashcards by Madyson Flax

Goals of orthodontics

form esthetics
-smile design, facial harmony, symmetry, psychological well being
function
-optimize occlusion, best possible masticatory function, breathing, speech (lips)

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Establish harmonious occlusal relationship in the three planes of space

Curve of spee
Curve of wilson
Line of occlusion

and

Establish anterior coupling
(anterior guidance→protrusive movements)
Correct anterio-posterior and vertical discrepancies
(patient needs: ideal overbite and ideal overjet)
Establish or normalize the transverse dimension
Crossbites (posterior crossbite)

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Interdisciplinary care

(Before doing any treatment, need to get together with perio, ortho, endo etc)
Involves several specialties of dentistry
Requires careful planning
Start with end in mind
Result is dependent on the team proficiency and the patient motivation

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Dr. Angle’s Definition of the correct occlusion and tooth position:
based on:

Based on the relationship of the upper and lower first permanent molars in the AP (anterior-posterior) position
“Mesiobuccal cusp of the upper first permanent molar is in occlusion with the buccal groove of the lower first permanent molar and a full complement of teeth is present”

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Class I malocclusions are the most frequent malocclusions
Present in

70% of population

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Malocclusions are present in the three dimensions of space

sagittal (spee)
transverse (wilson)
vertical

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disto occlusion

class II
The upper first permanent molar is positioner mesially in relation to the lower first permanent molar

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mesio occlusion

class III
The upper first permanent molar is positioned distally in relation to the lower first permanent molar

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5 roles of orthodontics in oral health

esthetics
functional (occlusal level)
functional (sleep apnea)
functonal (TMJ care)

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improve quality of life by improving facial appearance
Role of orthodontics in oral health

esthetic

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QOL by improving function and mastication
Role of orthodontics in oral health

functional occlusal level

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QOL improvement by improving breathing and sleep-multidisciplinary approach

Role of orthodontics in oral health

functional sleep apnea

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applicable to a small group of patients (10%)
Can very easily cause TMJ issues
Role of orthodontics in oral health

functional TMJ care

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What do we mean by classification? (of maloocclusions)

grouping of CLINICAL CASES SIMILAR APPEARANCE appearance for ease in handling and discussion; it is not a system of dx, method for determining prognosis, or a WAY OF DEFINING TREATMENT

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why do we classify

Traditional reasons
Ease of reference
Communication

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angles classification is based on

relationship of the first permanent molars and the alignment (or lack of it) of the teeth relative to the LINE OF OCCLUSION

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Angles classification,
Normal occlusion:

Normal or class I molar relationship, teeth are well aligned with proper overbite and overjet
PM occlude at embrasure and canine too

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Class I malocclusion

Normal or class I molar relationship but teeth are crowded, rotated, spaced

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Angle classification: class II

Class II malocclusion: “distocclusion” ← reference to mand first molar
Lower molar is distal to upper molar, relation of other teeth to line of occlusion not specified

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Class II division I

Maxillary incisors in proclination
Increased overjet
Prognathic maxilla and/or retrognathic mandible

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Class II division II

The maxillary central incisors are retroclined (tipped back)
The maxillary lateral incisors have tipped labially and mesially, sometimes overlapping the central incisors

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Class III malocclusion

“Mesioocclusion” ← mand molar relationship
Lower molar is mesial to the upper molar, relation of other teeth to line of occlusion not specified

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Subdivision

Asymmetric occlusion where one side is class II or III and the other is usually class I

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Six keys of normal occlusion

molar relationship
crown angulation
crown inclination
rotations
contact points
occlusal plane

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Key #1: molar relation

The distal marginal ridge of the max first molar occludes on the mesial marginal ridge of the mandibular second molar The mesio lingual cusp the max 1st molar must occlude on the central fossa of the mand 1st molar

Key #2: crown angulation “mesial-distal tipping”

+ reading, distal tip of the crown - reading, mesial tip of the crown [tipped in] The gingival(cervical) portion of the long axis of each tooth was distal to the incisal portion

Key #3: crown inclination “torgue”

Labiolingual / buccolingual + reading, cervical is lingual to incisal (incisal facial to cervical) - reading, cervical is facial to incisal aka Gingival portion is lingual to perpendicular (+ reading) Gingival portion is buccal to perpendicular (- reading)

which posterior is continuous in its inclination

maxillary test question

which posterior progressively increases from canine to 2nd molars

mandibular

relatinoship between inclination and angulation:

rato 4:1 for every 4 degrees of lingual root torque(inclination), there is 1 degree of mesial root tip

Key #4: rotations

Rotated molar occupies more mesiodistal space than rotated anterior tooth (occupies less MD space)

Key #5: tight contacts

In the absence of genuine tooth size discrepancies, “ideal” occlusions should have tight contacts

Key #6: occlusal plane

Flat occlusal plane should be a treatment goal Intercuspation of teeth is best when the plane of occlusion is relatively flat (easier to slide brackets on straight line/straight curve of spee) want flat curve of spee

how many teeth in primary dent

perm teeth erupt ____to primary

distal

once the permanent 1st molars erupt =

mixed dentition

erupting perm teeth ages

6 to 14 about 7 years of mixed dent

how many perm teeth

order of primary teeth erupting (emergence)

1. mand CI= 6-10mo 2. max CI= 8-12mo 3. max LI= 9-13mo 4. mand LI= 10-16mo 5. max 1M= 13-19 6. mand 1M= 14-18 7. max K9= 16-22 8. mand K9= 17-23 9. mand 2M= 23-31 10. max 2M= 25-33

order of exfoliation primary dent

1. mand CI= 6-7 yo 2. max CI= 6-7yo 3. max LI= 7-8yo 4. mand LI= 7-8yo 5. max 1M= 9-11 6. mand 1M= 9-11 7. max K9= 10-11 8. mand K9= 9-12 9. mand 2M= 10-12 10. max 2M= 10-12

order of eruption permanent teeth

1. mand 1M= 6-7 2. max 1M= 6-7 3. mand CI= 6-7 4. mand LI= 7-8 5. max CI= 7-8 6. max LI= 8-9 7. mand K9= 9-10 8. max 1PM= 10-11 9. Mand 1PM= 10-12 10. max 2PM= 10-12 11. mand 2PM= 11-12 12. max K9= 11-12 13. mand 2M= 11-13 14. max 2M= 12-13 15. mand 3M= 17-21 16. max 3M= 17-21

what teeth are "missin" in primary dent

premolars

primary crown shape: permanent crown shape:

primary: symmetrical squares and completely parallel and positioned 90 degrees in the occlusal plane (NO angulation in prim) permanent crowns: not symmetryical, triangles, and have some tilt

in primary we want interdental spacing and have larger spaces called ______ which are found where in max and where in mand

primates max: mesial to cuspid(canine) mand: distal to cuspids (canine)

rule #1: if there is not interdental spacing in the deciduous dentition=

crowding of perm dent will most probably occur 75% probability

Intercanine width/growth of mandible is established at_____years old(this is when you know whether or not child will have enough space for permanent teeth)

8-9

etween anterior primary teeth are important to get space for permanent incisor eruption (primate spaces are very important)

diastemas

The upper incisors erupt to the _____ (in front of) primary teeth Lower incisors tend to erupt to the ____ (behind)

labial lingual

no significant increase in arch size after the eruption of

permanent incisors (arch size established at 9 years old width and length)

True or false: are ALL primary teeth larger than their successor?

FALSE

true or false: anterior primary teeth smaller than permanent teeth

True

which are wider MD, primary molars or permanent PREMOLARS

primary molars primary molars: upper:8.9mm and lower: 9.9 permanent PM: both 7mm mandible has more space (2.5mm each side) max has 1.5mm

primary molars are end to end meaning

flush terminal plane

“If you have a flush terminal plane, and 2nd primary molar is wider than 2nd PM, things will shift _____ and it will end in a class 1 relationship typically”

mesially

-An imaginary surface that passes through the occlusion of the teeth -This surface is usually curved and is strictly speaking, not a plane but commonly is approximately by one (straight line in the lateral view) based on specific reference points within the dental arches

occlusal plane

Curve displayed in the sagittal plane (or rather in plan parallel with body of mandible on either side) by the cusps and incisal edges of mandibular teeth.

curve of spee CONVEX aspect of curve of spee is pointing inferiorly

curve of spee is ____in primary dentition

flat

3 occlusal relationships in deciduous dentition

1. upper and lower incisors are vertical 2. minimal overbite and overjet 3. upper canine tip is positioned in the embrasure between the lower canine and first primary molar

Distance between the labial surface of the mand incisors and the labial aspect of the incisal edge of the maxillary incisors, usually measured parallel to the occlusal plane

overjet

according to him, first tooth (lower incisor) appears around age ____

8 months

by ____ months all primary teeth should be present

30 months

if maloocclusion is present in primary dent,

will probably get worse with age and in the perm dent

tooth eruption sequence of permanent teeth: 1. 2.

1. variability 2. sex differences

are deciduous teeth or permanent teeth more variable

perm

Girls are ahead of boys in calcification and except for the third molars, girls are ahead of boys by an average of

5 months

girls are ahead of boys in puberty by

2 years

timing is consistent within an detention meaning:

children who erupt any tooth early or late tend to acquire others early or late

both sides of perm dent should approx erupt at the same time. what is fine and what to do if not

<6 months apart is fine if it takes longer take an xray

Different eruption sequences explain most frequently crowded teeth:

1. maxillary perm cuspids(canines) and 2. mand 2nd PMs (bicuspids)

local influence which ACCELERATES perm tooth eruption

if the primary tooth is ext DURING active eruption of perm tooth **more than 2/3 of perm tooth's root is formed can ext

local influences which SLOW permanent tooth eruption

when a primary tooth is extract BEFORE active eruption of permanent tooth (before the root is formed aka before 2/3 formed)

arch width changes: 1. the arch width _____as perm teeth come in.

broadens

the arch width increases are tide to the ___ ____ ___ (both dental eruption and vertical process growth)

alveolar process growth

vertical alveolar process growth occurs during

general growth spurts

vertical alveolar process growth is different in max and mand. divergent _____process translate into more arch width growth

max

1. Wider placement of the permanent teeth 2. Apposition of alveolar bone to support these teeth will result in increase in arch width this is

dental eruption

maxillary arch: increases occur during 1 2 3. large increases

1. growth spurts 2. eruption of incisors 3. eruption of canines (cuspids)

factors which limit loss of maxillary arch space in perm dent include 1 2 3

greater labial angulation of incisors and greater increases in arch width and smaller leeway space

if primary incisors are proclined or protrued, you typically need to do what because there is a spacing issue

ext

if i have a deep curve of spee and need to level it that means there is

hidden crowding

this is reasonable option for impacted 3rd molars

prophylactic ext

ext of 3rd molars to avoid orthodontic relapse has

weak correlation

3rd molars (DO NOT/DO) cause lower incisor crowding, you do not always need to ext them

do not