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xD3 Ortho Exam 1 > Missing or Ankylosed Teeth (Tufecki) > Flashcards

Missing or Ankylosed Teeth (Tufecki) Flashcards

1
Q

What are 2 things to be done before initiating therapy on a paired ortho / restorative case?

A
  1. Establish realistic objectives

2. Determine sequence of treatment

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2
Q

In a paired ortho / restorative case, how are the teeth to be positioned by the ortho?

A

Positioned to facilitate restorative treatment

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3
Q

When are gingival esthetics assessed during a paired ortho / rest case?

A

During orthodontic finishing

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4
Q

What else should be done during finishing of the ortho in an ortho / rest case?

A

Radiographs

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5
Q

During treatment planning, what should be ideal endpoint of treatment be compared to?

A

Patient’s current condition

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6
Q

When is ortho / restorative treatment indicated?

A

When the desired end point and current condition do not match

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7
Q

What are 3 goals of the treatment plan in an ortho / restorative case?

A
  1. Esthetics
  2. Function
  3. Stability
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8
Q

What are 7 factors determining treatment?

A
  1. Predictability of esthetics
  2. Preservation of tooth structure
  3. Preservation of bone and periodontal tissue
  4. Optimal function
  5. Finances
  6. Longevity
  7. Biocompatibility
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9
Q

When a patient requires ortho / restorative treatment, what type of treatment objectives must be established?

A

Realistic, not idealistic treatment

Economically, occlusally, and restoratively realistic

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10
Q

Who makes the restorative decisions in an ortho / rest case?

A

Restorative dentist

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11
Q

What guides the orthodontist’s positioning of teeth in an ortho / rest case?

A

Restorative dentist’s plan

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12
Q

What are 2 times when restorative dentist should be involved in the ortho treatment in an ortho / rest case?

A
  1. The beginning, to determine the treatment plan

2. The final 6 months of treatment (finishing phase)

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13
Q

What patient type would gingival height be a consideration?

A

Patient with high smile line

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14
Q

What is the ideal gingival height of contour relationship, with respect to the facial gingival margin of anterior teeth?

A

The height of central incisors is equal to height of canines with lateral incisors slightly below this line

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15
Q

Is an equal gingival height of contour, i.e. the facial gingival margins of all anterior maxillary teeth on the same line, acceptable esthetics?

A

Yes

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16
Q

What is the least desirable gingival height of contour esthetics for anterior maxilla?

A

Lateral incisors have highest gingival contour and Central incisors and canines are below this line

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17
Q

Why is a radiograph important during finishing stages of ortho in a pt who will be receiving an implant in their restorative phase?

A

Require adequate space between roots of teeth adjacent to implant site for proper implant placement

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18
Q

What are 4 common problems with maxillary lateral incisors?

A
  1. Congenitally missing
  2. Laterals with incorrect mesiodistal width
  3. Peg laterals
  4. Poor gingival height of contour
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19
Q

What are 2 treatment options for missing teeth?

A
  1. Orthodontic space closure

2. Replace missing tooth with FPD, resin-bonding bridge, implant, RPD

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20
Q

What are the results from the fusion of some portion of the cementum of the root, no matter how small, to some portion of the adjacent alveolar bone?

A

Ankylosis

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21
Q

What are 6 etiologies for ankylosis?

A
  1. Changes in local metabolism
  2. Trauma
  3. Injury
  4. Chemical or thermal irritation
  5. Local bone growth failure
  6. Abnormal tongue pressure
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22
Q

What is a common complication with the replantation of an avulsed tooth?

A

Ankylosis

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23
Q

What tooth is most often replanted after avulsion?

A

Maxillary incisor

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24
Q

When is the only time when the clinical diagnosis of ankylosis can be made?

A

When the affected tooth gives positive evidence of an inability to move

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25
Q

What are 2 instances where a tooth gives positive evidence of inability to move and can be diagnosed as ankylosed?

A
  1. Dental infraocclusion

2. Failure to move under orthodontic forces

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26
Q

What is dental infaocclusion?

A

Uneven occlusal plane due to tooth failing to move with normal vertical dental alveolar growth

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27
Q

What are 3 other diagnostic means leading one to believe a tooth is ankylosed?

A
  1. Metallic sound on percussion
  2. Lacks normal mobility
  3. Absence of radiographic PDL space
28
Q

How long is an ankylosed tooth in the primary dentition maintained?

A

Until an interference with eruption or drift of other teeth begins to occur

29
Q

What is done with the space left by an extracted ankylosed tooth in the primary dentition?

A

Some type of space maintenance (LLHA, band and loop, Nance)

30
Q

What will be indicated if adjacent teeth have already tipped over the ankylosed tooth?

A

They will need to be repositioned to regain space

31
Q

Should vertical bony discrepancies be a concern after the extraction of an ankylosed tooth and why?

A

No, because erupting succedaneous tooth brings bone with it during eruption

32
Q

What is indicated if a primary tooth is ankylosed and radiography shows no permanent successor and why?

A

Extract ankylosed tooth to avoid a large vertival occlusal discrepancy

33
Q

If an ankylosed tooth is extracted and there is no permanent successor, what can be done to maintain that bone in the edentulous space until some restorative treatment (e.g. a FPD) can be placed?

A

Move teeth partially into the edentulous space

34
Q

Can space maintenance in the primary dentition be sometimes contraindicated?

A

Yes, in the instance of wanting to move teeth into a space left by ankylosed tooth with no successor in order to avoid a large vertical occlusal discrepancy

35
Q

What are 4 characteristic clinical and radiographic appearances of ankylosed permanent teeth?

A
  1. Reduced height of occlusal table
  2. Tilting of neighboring teeth
  3. Supereruption of opposing dental units
  4. Lack of associated alveolar process development
36
Q

What are 6 treatment options for ankylosed permanent teeth?

A
  1. No treatment
  2. Prosthetic buildup
  3. Extraction
  4. Decoronation
  5. Ortho-surgical
  6. Segmental osteotomy
37
Q

What will occur if an ankylosed tooth is bracketed an ortho treatment?

A

It will not move and / or will intrude the anchor teeth

38
Q

What must be done to keep and ankylosed tooth and move it orthodontically?

A

Luxate it and immediately apply ortho forces

39
Q

What is ortho-surgical treatment of anklosed teeth?

A

Surgically luxating ankylosed tooth and applying extrusive orthodontic forces

40
Q

How many times can ortho-surgical treatment of an ankylosed permanent tooth be done and at what interval?

A

2 times, wait 6 months after each

41
Q

What is indicated after 2 failed laxations of ankylosed teeth?

A

Extraction

42
Q

Is it common for an ankylosed tooth that was luxated and had immediate ortho forces applied to re-ankylose?

A

Yes

43
Q

What can be done with an ankylosed tooth and its associated born to move the tooth to a new position?

A

Distraction

44
Q

What is the moth commonly impacted tooth?

A

Mandibular 3rd molars (78%)

45
Q

What is the second most commonly impacted teeth?

A

Maxillary canines (13%)

46
Q

How many times more common is a maxillary canine impaction than a mandibular canine impaction?

A

Ten times

47
Q

What percentage of ortho patients have impacted canines?

A

2%

48
Q

Which direction of maxillary canine impaction is more common: palatal or labial?

A

Palatal (85%)

49
Q

Which is more common with maxillary canine impaction: unilateral or bilateral impaction?

A

Unilateral

50
Q

At what age should you be looking radiographically for maxillary canine impaction?

A

9-10 years old

51
Q

What clinical finding usually indicates a favorable eruption position of a maxillary permanent canine?

A

A buccal bulge apical to the primary canines

52
Q

What should be expected if there is an absence of canine buccal bulge?

A

Eruption disturbance of maxillary permanent canines

53
Q

What is indicated if maxillary canine impaction is confirmed?

A

Extract the corresponding primary canines

54
Q

Why extract primary canines if the permanent canines are impacted?

A

Primary canine root will not resorb and will be an obstacle to normal permanent canine eruption

55
Q

What is the percentage and time of eruption of palatally displaced canines that spontaneously erupt?

A

78% have normal eruption position and erupt over a 6-12 month period
62% of cases have normal eruptive position

56
Q

Is extraction of primary canine alone an effective procedure to increase the rate of normal eruption of palatally displaced canines?

A

No

57
Q

If the cusp tip of an unerupted permanent canine is mesial to the long axis of the erupted lateral incisor root, will canine palatal eruption occur?

A

Yes

58
Q

If the cusp tip of the unerupted permanent canine overlays the distal half of the erupted lateral incisor root, will palatal impaction usually occur or not occur?

A

Usually will occur

59
Q

What percent of unerupted canines in ideal eruptive position (canine cusp tip on the distal border of the erupted lateral incisor root) still were impacted?

A

22%

60
Q

What modifies the success rate of orthodontic treatment for palatally impacted maxillary canines?

A

Age

>30 yrs old, 60% success rate <20 yrs old, 100% success rate

61
Q

What is increased in adult pts having orthodontic treatment of palatally impacted maxillary canines versus younger pts having the same procedure?

A

The treatment time is longer (30 months or more)

62
Q

What arch wire is required to pull down and impacted canine?

A

Heavy archwire

63
Q

What should an adult patient with an impacted tooth be informed or before treatment?

A
  1. Possibility of failure
  2. Increased treatment time
  3. Alternative options: implant, bridge, tooth substitution
64
Q

What must be considered when planning pulling down an impacted canine?

A

Is there space for the tooth in the arch?
Will pulling it down damage adjacent roots?
Is there a tooth to anchor for pulling it down?
How long will it take?

65
Q

What is required after diagnosis of impaction has been made what must be done and why?

A
  1. Prompt treatment

2. Avoid ankylosis or dentigerous cyst formation

66
Q

When are orthodontic appliances placed when the decision is made to surgically expose the canine and provide an attachment for traction: before exposure or after exposure?

A

Before exposure

xD3 Ortho Exam 1 (5 decks)

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