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BDS5 > Ortho > Flashcards

Ortho Flashcards

1
Q

What to check pre examination

A
  • Presenting compliant
  • Patient details and who they are with
  • MH
  • DH: trauma, previous extractions/restoration, digit sucking, previous tx
  • Previous history
  • Family/social history: skeletal 3
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2
Q

What is incisal display

A
  • At rest 3-4mm male, 4-5mm female
  • Smiling: up to 2mm gingivae
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3
Q

What is incisor inclination

A
  • Upper 109 degrees
  • Lower 93 degrees
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4
Q

Why should the Frankfort plane be parallel to the floor

A
  • Reproducible
  • Standardized
  • Used in cephalometry
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5
Q

What is skeletal 2 AP

A
  • 2mm behind the line (zero meridian line)
  • Mandibular retrognathia
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6
Q

What is skeletal 3

A
  • Infront of line
  • Maxillary hypoplasia ?
  • Paranasal hollowing
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7
Q

What is the LAFH averages of male and female

A
  • 16y male 72mm
  • Female 68mm
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8
Q

What is microdonita and incidence

A
  • Teeth smaller than normal
  • 1.5% to 2%
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9
Q

What is crowding

A
  • Contact arch displacement (d in IOTN)
  • 1-4mm mild
  • 5-7mm moderate
  • > 8mm severe
  • Spacing: generalised or localised
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10
Q

What to check when teeth in occlusion

A
  • Incisor relationship
  • Overjet
  • Overbite
  • Molar and canine relationship
  • Crossbite/ displacement
  • Centrelines
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11
Q

What are the incisor relationships

A
  • Class 1
  • Class 2 div 1: overjet is increased and usually incisors proclined
  • Class 2 div 2: retroclined
  • Class 3: overjet reduced or reversed
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12
Q

What are the molar relationships

A
  • Mesiobuccal cusp of upper
  • Mid buccal grove of lower
  • Canine upper occlude posterior to the lower
  • Class 2: mesiobuccal cusp mesial to the mid buccal grove
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13
Q

IOTN

A
  • Dental health component
  • Aesthetic component
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14
Q

What is overbite

A
  • Complete: traumatic/ non traumatic
  • Incomplete: incisor overlap with no incisor contact
  • F is IOTN
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15
Q

What is open bite

A
  • Anterior open
  • Lateral open
  • E on IOTN
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16
Q

What is the definition of displacement

A
  • Movement of mandible on closing from Centric relation (RCP) into centric occlusion as a result of occlusal interference
  • When treatment planning take records in no displaced position as it is reproducible
  • Cross bite: C, l (lingual)
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17
Q

What is the justification for panoramic

A
  • Presence of teeth: unerupted and erupted
  • Assess roots
  • Check bone levels
  • Other pathology: caries
  • Check condyles
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18
Q

What are the aims of treatment

A
  • Improve aesthetics and appearance
  • Establish good occlusal result
  • Good molar relationship
  • Average overbite, overjet
  • Relieve crowding
  • Eliminate displacements/ crossbites
  • Produce a stable occlusion
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19
Q

What are Andrews 6 keys

A
  • Molar relationship
  • Crown angulation
  • Crown inclination
  • Rotations
  • Contact points
  • Curve of spee: flat occlusal plane, no deeper than 1.5mm
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20
Q

What is average adult lip length

A
  • 20mm female
  • 22mm male
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21
Q

Effects of digit sucking

A
  • Procline upper and retrocline lower
  • Unilateral crossbite
  • Anterior open bite
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22
Q

Tell me about hypodontia

A
  • Developmental absence of one or more teeth (excluding 3rd molars)
  • Mild/ mod/ severe (oligodontia: 6 or more, anodontia: all teeth)
  • Aetiology: environment, genetic (MSX1 PAX9)
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23
Q

Tell me about supernumerary tooth

A
  • Incidence = 3% Caucasian permanent dentition
  • Primary <1%
  • Maxilla: mandible 5:1
  • Classification: supplemental, conical (peg shaped, mesiodens), tuberculate (barrel shaped), odontome (complex/compound)
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24
Q

Ectopic teeth

A
  • Fail to erupt in correct position within the dental arch
  • Canines commonly affected (maxillary canines 11-12 palpated 9, mandibular canines 9-10)
  • Maxillary canine: 2%, mandibular canine: 0.35%
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25
Q

Effects of loss of primary teeth

A
  • Crowding
  • Ectopic eruption, impacted teeth
  • Unfavourable molar relationship
  • Centre-line shifts
  • Consider space maintainers
26
Q

Impaction numbers

A
  • Upper central incisors (0.13%)
  • Upper canines (2%)
  • Second premolars (20%)
  • First molars (0.75-6%)
  • Third molars (25%)
27
Q

Risks if teeth are unerupted due to impaction

A
  • Root resorption
  • Cyst formation
  • Poor aesthetics
28
Q

How to locate unerupted teeth

A
  • Visual examination: bulges, angulation of lateral , colour
  • Knowledge of eruption pattern
  • Palpation (8-10), mobility of the baby tooth
29
Q

Use of OPG

A
  • Unerupted teeth
  • Root position, shape, closure of apex
  • Developing teeth - stage of development
  • Condyles
  • Bone support levels
  • Pathology – cysts, supernumeraries, tumours,
  • periapical radiolucent areas
30
Q

advantages and disadvantages of OPG

A
  • Advantages:
    • Shows all the teeth
    • Shows complete view of both jaws
    • Objects closer or further away from beam will be magnified/diminished helping to localise position
  • Disadvantages:
    • Poor quality especially in midline
    • Narrow focal trough – we do not always see the true picture
    • Often require supplemental view to confirm details
31
Q

Function of a space maintainer

A
  • Maintain arch length and width preservation of leeway space
  • Prevent over eruption
  • Aesthetics
  • Aid in the management if oral habits – digit sucking
  • IDEAL: simple, passive, strong, cleansable
32
Q

Types of space maintainer

A
  • Unilateral: band and loop
  • Bilateral: Transpalatal arch (prevents mesial drift of 6), lingual arch, URA(removable)
33
Q

How much lee way space

A
  • 2.5mm lower
  • 1.5mm upper
34
Q

Why might a primary tooth be retained

A
  • Successor developmentally absent
  • Successor ectopic
  • Local abnormality (infra occlusion)
  • Failure of permanent to resorb tooth
35
Q

Infraocclusion

A
  • Fails to erupt fully
  • 8-14% in 6-11
  • Trauma, absence of successor, ankylosis
  • Mid, moderate, severe
36
Q

Methods to increase arch length or create space

A
  • Molar distal movement (headgear or TADs) / incisor forward movement
  • Arch expansion (removable or fixed appliance)
  • Interproximal enamel reduction
  • Extraction
37
Q

Tell me about growth

A
  • Epigenetics
  • Rate increase during puberty
  • Female develop earlier
  • Difficult to predict
38
Q

Ideal properties of an index of treatment need

A
  • Valid
  • Reproducible
  • Ease of use
  • Acceptable
  • Cheap
  • Clinical audit and research
39
Q

What are limitations of IOTN

A
  • No account for skeletal and soft tissue
  • Only dental factors
  • No account for growth potential
  • Not an index of treatment complexity
  • Incentive to patient concerns/ demands
40
Q

Extractions of first permanent molars

A
  • Erupts 6-7, complete root at 9-10
  • Problems: localised space, over eruption and tipping of adjacent
  • Slightly crowded would have the best effect
41
Q

Prevalence of each malocclusion

A
  • Class 1: 67%
  • Class 2 div 1: 15%
  • Class 2 div 2 10%
  • Class 3: 3%
42
Q

Canine extraction considerations

A
  • Try avoid as cornerstone and involved in canine guidance
  • Can mask premolar if good contact, rotation through fixed appliance
43
Q

What is the class 1 malocclusion

A
  • Maybe be increased VD or dental problem
  • Dentoalveolar disproportion: distalisation of molar using headgear, TADS, interproximal reduction, lee way space, extraction s
  • Hypodontia: accept, camouflage, space closure or opening
  • Supernumerary: extraction
  • Variation in tooth size: macro/micro (composite build up) dens in dente, dilaceration
44
Q

What is class 2 div 1 malocclusion

A
  • Skeletal: mandibular retrognathia (80%), maxillary hyperplasia, vertical any
  • Environmental: digit sucking,
  • Dental: crowding
  • Soft tissue: lower lip trap, lip incompetence
  • Trauma incidence 5mm 22%, under 9mm 24%, 44% over 9mm
  • Accept: mouthguard for trauma
  • Growth modification: growing, mild to moderate, twin block (70% dental, 30% skeletal)
  • Head gear: catch up growth of mandible, difficult compliance
  • Camouflage: upper 4, lower 5s
  • Orthognathic: growth complete, severe, decompensation before (appliances throughout the procedure)
45
Q

Digit sucking habit effects

A
  • Proclination of uppers and retroclination of lowers
  • Increased overjet
  • AOB
  • Narrow upper arch, unilateral posterior cross bite
46
Q

Tell me about class 2 div 2

A
  • Skeletal: 2 or 1, Vertical reduced, progenia
  • Soft tissue: strap lip, high lip line
  • Soft tissue will have obtuse Nasio labial angle
  • Dental: retroclination of uppers (2s might escape), increased IIA, traumatic overbite, crowding increased by retrocline uppers
  • Accept: mouth guard for trauma
  • Growth modification: convert to class 2 div 1 by Proclination of uppers (ura:ELSAA with T/Z spring and anterior bite block to allow over eruption of posterior teeth, twin block with procline spring, sectional fixed appliance)
  • Camouflage: mild/moderate, upper 4s lower 5s, IIA must be corrected or relapse
  • Orthognathic: same as class 2 div 1
  • Usually required long term retention due to relapse
47
Q

Tell me about class 3

A
  • Genetic: cleft lip (maxilla less growth)
  • Skeletal: maxillary hypoplasia, mandibular prognathism, vertical (can be any)
  • Soft tissue: macroglossia (tongue pushes lls), not a big effect
  • Skeletal pattern 3 (55% maxillary problem) or 1
  • Soft tissue factors: increased sclera show, paranasal hollowing, obtuse NLA
  • Dental factors: reduced overbite or anterior open bite, more crowding in upper dentition, microdontia/hypodontia causing narrow upper arch
  • Masticatory problems, speech problems
  • Accept: patient not concerned, OHI, acceptable aesthetics
  • Early Interceptive treatment (pre 10): URA, good overbite, able to go edge to edge, bone loss trauma
  • Growth medication (intermediate): headgear, rapid maxillary expansion, reverse twin block , not guaranteed treatment
  • Camouflage: mild to moderate, edge to edge, good overbite
  • Orthognathic surgery:
48
Q

Tell me about ARAB

A
  • Active component – t spring
  • Retention – Adam’s clasps and c clasps
  • Anchorage – baseplate and Adams
  • Baseplate – cold cure acrylic – bite block incorporated
49
Q

Fixed appliance

50
Q

Problems associated with fixed appliances

A
  • Demineralisation: poor OHI and diet , plaque score below 20% before treatment, can remove arch wire, plaque retentive factors
  • Gingivitis and periodontal disease
  • Root resorption: majority - minor around 1mm, 5% cases 5mm loss, Risks (history of trauma, treatment duration, apical movement, genetic)
  • Pulpitis: transient in majority of patients, caution treating trauma teeth
  • Soft tissue ulcers: brackets can use wax, no sharp ends of wire
  • Inhalation: chest x ray
51
Q

Maxillary incisors and impaction

A
  • 7-8 central eruption (root formation completes around 11)
  • On eruption there is midline diastema
  • 0.13% in 5-12year olds: impacted maxillary central incisors
  • Concerns: contra lateral over 6 months, lower incisors over 1 year (uppers unerupted), lateral erupt before central
  • Radiograph: parallax with upper standard occlusal or CBCT
52
Q

Reasons for maxillary central incisor impaction

A
  • Early loss of primary centrals
  • Trauma: e.g. scar tissue preventing eruption
  • Macrodont: fusion of 2 teeth into one , not enough space
  • Supernumerary tooth: tuberculate most common impaction causer
  • Dilaceration: distortion or bend in the root of a tooth: idk how this affects
  • Ankylosis: following trauma, fixed appliance on ankylosed tooth will not move
  • Other: cysts, cleft lip
53
Q

Treatment for unerupted central

A
  • Remove obstruction
  • Maintain space (URA)
  • Monitor for 12months – 80% erupt
  • Expose and bond if unerupted (closed if high, open if superficial)
  • Over 10: straight to expose and bond
54
Q

Maxillary canines and impaction

A
  • F:M > 2:1
  • 2% (85% palatal, 15% buccal), absent is 0.08%
  • Corner stone of arch, canine guidance, erupts distally along the 2, long route of eruption, palpable at 9, late is 12-13
  • Small lateral, missing laterals (increases incidence to 5%)
55
Q

Radiograph and maxillary canine

A
  • Prior to 10 little benefit, above 11 where 3s aren’t palpable
  • Cbct or parallax (pa, USO)
56
Q

Management of 3s

A
  • Interceptive: extract c, need space for 3
  • Surgical expose and bond: extract premolar if need space, closed and open technique
  • Surgical repositioning (ankylosis risk), surgical removal
57
Q

Prognosis of canine

58
Q

Risks of aligning impacted canines

A
  • Root resorption to adjacent teeth
  • Loss of vitality
  • Poor tissue contour at completion of treatment
  • Increased pocket depths
  • Canine root resorption
  • Ankylosis
59
Q

Define impaction

A
  • Tooth that is prevented from erupting into its normal functional position by bone, tooth, fibrous tissue.
60
Q

Functional appliances

A
  • Use forces generated by the oral facial musculature to produce dental and skeletal changes. Force generated by stretching the facial muscles in a postured position
61
Q

Considerations for class III treatment

A

-Ability to achieve edge to edge occlusion
-Ability to retain occlusion with a positive overbite
-Extent of displacement
-Extent of dento-alveolar decompensation
-Age of patient
-Cause of malocclusion (maxillary growth stops before mandibular growth)
-Is patient happy with facial profile

BDS5 (10 decks)

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