Oct 10 Knobloch Lecture Flashcards
What are the different techniques for determining growth status?
Serial Cephalometric Radiographs
Hand-wrist radiographs
Cervical Vertebral Maturaiton
Serial Cephalometric Radiographs
6 mo intervals
No growth over a one yr period
Assumed that growth has reached adult levels
Provides an evaluation of the amount and direction of growth in the AP direction
Hand-wrist radiograph
Most standardized method Evaluates long bone growth Facial growth is slightly behind long bone growth Look for maturation indicators Helpful as a general assesment only
What are long bone maturation indicators?
Appearance of adductor sesamoid of thumb
Capping of ephysis
Fusion of epiphysis and diaphysis of radius
Cervical Vertebral Maturation
Effective technique for evaluation of the adolescent growth peak
Stage of growth can be determined form a single radiograph
High reproducability
Commonly used as a diagnostic image
What is a criticism of Cervical Vertebral Maturation?
Questioned the sensitivity of this method in detecting skeletal maturation in periods away from the growth spurt
What is the recommended technique for determining skeletal maturation in a growing patient with congenitally missing laterals?
Serial Cephs
What is a clinical situation where implants can be considered in a growing patient?
Ectodermal dysplasia patients with severe partial or complete anadontia
Implants in a growing patient in the Mandibular anterior quad
Best site to place implants before skeletal maturaiton
Symphyseal sutures close in the first two weeks of life
Prosthesis design - retrieveable
Stabilization of a prosthesis may slow posterior resorption
Implants in a growing patient in the Maxilary anterior quad
Greatest potential for compliations
Prosthesis modification/soft tissue problems
Implant placement delayed until completion of growth
Describe the clinical implications of placing a dental implant before the completion of growth
Local vertical growth of the anterior maxillary was not inhibited by implant placement
Implant fixtures remained stable and did not move with adjacent teeth
Fistulas were the most common soft tissue complication
Clinicians should delay implant placement until the postpubertal phase
Describe the treatment planning guidlines presented in class for a young patient with missing teeth during the active years of growth
1) Restoration of edentulous spaces with removable prostheses
2) Early restoration with complete denture
3) Retention of primary teeth
4) Retention of permanent teeth
5) Maintenance of existing teeth with composite for esthetics
6) Early ortho consult for alignment and space distribution
7) Placement of implants in the anterior mandible when indicated around age 6 for the edentulous mandible
Describe the process of mandibular growth in the AP direction
Grows in length at condyle and ramus
Bone is resorbed in the anterior border of the mandible
Bone is deposited on the posterior border of the mandible
Describe the process of mandibular growth in the vertical direction
Occurs as permanent teeth erupt
9-15 years of age
Increase in height measured form cusp tip to inferior border of the mandible
Without teeth, there is no vertical growth
Describe the process of mandibular growth in the transverse direction
The way you get widening is you get bone deposited on buccal surface and resorbed on lingual surface
Lets you place implants ectodermal dysplasia patients when they’re 6-7 yo
Transverse growth is done by age 7
