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FINALS!!! > Ortho > Flashcards

Ortho Flashcards

1
Q

Purpose of study models

A

tx planning
pt motivators
secondary opinion
checking person’s occlusion
ortho design for removable appliance

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2
Q

Advantages of URA

A

tipping teeth
excellent anchorage
OH easier to maintain
cheaper than fixed
shoter chairside time
less specialised training to manage
easily adapted for ob reduction
achieve block movements
non destructive to tooth structure

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3
Q

Disadvatanges of URA

A

less precise control of tooth movement
easily removed by the patient
1-2teeth moved at one time
specialist staff to construct
rotations difficultt to correct

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4
Q

Active componenet

A

What actually moves the tooth

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5
Q

Retention

A

components that are resistant to displacement forces

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6
Q

Anchorage

A

resistance to unwanted tooth movement

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7
Q

Baseplate

A

self cured PMMA
connector, retention, anchorage

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8
Q

S.S wire composed of

A

iron - 72%
chromium - 18%
nickel - 8%
titanium - 1.7%
carbon - 0.3%

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9
Q

Fitting a URA

A

ensure pt details match details of appliance
check appliance matches design specification
run finger over fitting surface looking for sharp areas
check integrity of wirework
insert appliance and look for areas of blanching
check posterior retention - flyover then arrowheads
apply same principle to anterior retention
activate appliance

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10
Q

Patient info and instructions

A

appliance will feel big and bulky
may cause initial excessive salivation
may impinge on speech for short period
initial pain or discomfort
wear 24/7 including mealtimes
remove applaiance when participatating in contact sports
avoid hard and sticky foods
mention about non compliance and lengthening tx
provide emergency contact details

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11
Q

How does a flat anterior bite plane work?

A

it works to decrease the pt overbite
it increases the vertical dimension allowing overeruption of posteriors and raises bite

OJ + 3mm = so lowers don’t stop behind bite plane causing trauma and retroclining them

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12
Q

Flat posterior bite plane

A

will disengage the bite allowing teeth to move forward

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13
Q

Tubing and sheathing do for certain active componenets

A

gives componenets stability and rigidity

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14
Q

Types of ortho movement

A

tipping
extrusion
rotation
torque
bodily movement
intrusion

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15
Q

Andrews 6 keys

A

tight approximal contacts with no rotations
class1 incisors
class 1 molars
flat occlusal plane or slight curve of spee
long axis of teeth have slight mesial inclination
crowns of canines back to molars have lingual inclination

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16
Q

Useages of fixed appliances

A

correction of mold to moderate skeletal discrepancies
alignment of teeth
correct centrelines
OB and Oj reduction
closure or creating spaces
correction of rotations
vertical movements of teeth

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17
Q

Advantages of fixed appliances

A

moves multiple teeth
pt cannot remove the appliance
precise movement
not too bulkly and invasive
can rotate teeth
bodily move teeth through bone

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18
Q

Disadvatanges of fixed appliances

A

poor oh
soft tissue trauma
relapse
resoprtion
expensive
less anchorage
etch can damage teeth
needs specalist training to fit

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19
Q

When is relapse potention high

A

diastemas
ectopic canines
AOB
proclination of lower incisors

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20
Q

Problems with fixed appliances

A

decalcification around brackets
root resorption - mostly intrusion movements
teeth become non vital
trauma from headgear

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21
Q

Extra oral anchorage

A

headgear - head cap with intra oral bow attached to fixed or removable appliance
200-250g for 10-12hrs wear

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22
Q

Transpalatal Arch

A

0.9mm HSSW - attached to first molars
anchorage
rotation

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23
Q

Palatal arch with nance button

A

0.9mm HSSW attached to 1st molars
anchorage

(difficult to clean underneath and can lead to erythematous candidosis)

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24
Q

Quadhelix appliance

A

0.9mm HSSW
bilateral expansion
habit breaker
asymmetrical expansion
fan style expansion
rotation of molars
expansion in cleft palate
modified to procline incisors

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25
Q

Class 2 div 1

A

lower incisors lie posterior to the cingulum pleatu of the upper incisors
Increased overjet and upper centrals proclined or average

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26
Q

Why treat class 2 div 1

A

aesthetics
dental health - trauma from overjet

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27
Q

Skeletal pattern of class 2 div 1

A

class II anterior posterior pattern (retroganthic mandible, the mandible is further back

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28
Q

Soft tissues of class II div 1

A

incompotent lips due to prominence of incisors and underlying skeletal pattern

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29
Q

Dental factors of class 2 div 1

A

OJ - either crowding or spacing present
lack of spcae on uppers can exacerabte OJ
lack of space on lowers compensate OJ

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30
Q

Habits of class 2 div 1

A

sucking habits - proclinatin of upper incisors, retroclination of lower inciosrs, AOB, narrow upper arch and unilateral postirior crossbite

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31
Q

Erly treatment options for class 2 div 1

A

accept and await development (mouthguard for sports)
Growth modifcation - functional or headgear
URA to tip back upper incisors (mild only)

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32
Q

Treatment options for class 2 div 1 - class 1 or mild skeletal 2 pattern

A

accept
growth modifcation
camouflage

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33
Q

Class 2 div 1 - moderate to severe skeletal class 2 pattern

A

accept
growth modifcation
camouflage
surgery when growth complete

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34
Q

when is growth complete in females

A

16 years

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35
Q

when is growth complete in males

A

18 years

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36
Q

Headgear

A

restrain growth of maxially both horizontally and vertically using elastics - no change in lowers

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37
Q

Functinonal appliances

A

Restrain maxilla and encourage mandibular growth (twin block)
Tooth growth not growth modifcation - distal movement of upper dentition and retrocline of upper incisors, mesial movement of lower incisors and proclination of lower incisors

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38
Q

Camouflage

A

jaw pattern not changed but teeth move
Used for mild or moderate discrepancy
if used for severe can flatten face and poor appearance

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39
Q

Class 2 div 2

A

The lower incisor edges lie posterior to the cingulum plaetu of the upper incisors
upper centrals are retroclines
OJ minimal or can be increased

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40
Q

Skeletal pattern for class 2 div 2

A

mild to moderate skeletal class 2 A/P
promienent chin (progenia)
FMPA reduced and downward growthh of mandible

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41
Q

Soft tissues for class 2 div 2

A

<LAFH - lower lip higher in relation to crown of upper incisors and will retrocline the upper incisors (high lower lip line)

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42
Q

Dental features of class 2 div 2

A

retroclined centrals and upper 2’s being crowded due to incisors being retroclined
increased overbite
Traumatic occlusion
Ectopic canines sometimes

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43
Q

Why treat class 2 div 2

A

aethetics
dental health - traumatic overbite

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44
Q

Treatment options for class 2 div 2

A

accept
Attempt growth modification - functional appliance - convert from class 2 div 2 to class 2 div 1 to increase OJ for functioal appliance
Camouflage
Allign upper only - risk of relapse high and fixed retainer required
Orthognathic surgery - growth has to be complete and severe skeletal discrepanncy

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45
Q

Prognosis of class 2 div 2

A

difficult to treat due to facial growth
Deep bite and rotated laterals likely to relapse so retention is required

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46
Q

Benefits of ortho

A

improves function
improves appearance
inproves dental health
reduces risk of trauma

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47
Q

Risks of ortho

A

Declacificaiton
Relaspe
Root resorption
loss of tooth vitality
Loss of perio support
toothwear
soft tissue trauma
allergy
ulceration
Headgear trauma

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48
Q

Risk factors for root resorption

A

tooth movement - prolonged, high force, torque, large movements, intrusion
Previous trauma
Nail biting
Root form - blunt, pipette, resorbed already

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49
Q

Benefits of hawley retainer

A

removable so OH good
incorporates all teeth
strong
allows occlusal setting
minor tooth movement

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50
Q

Disadvantages of hawley retainer

A

removable so pt not complinant
speech issues
aethetics
expensive and time consuming to make
invasive on tongue space

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51
Q

Benefits of thermoplastic retainer

A

aesthetics
less invasive
cheap
all teeth incorporated
OH good
easier to make
slight tooth movement if needed

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52
Q

Disadvantages of thermoplastic retainer

A

non resilant
does not allow occlusal setting
compliance
easily lost
disorted with heat

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53
Q

Benefits of fixed bonded retatainer

A

compliance as fixed
aesthetics
non invasive
done chairside
cheap

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54
Q

Disadvatnages of fixed bonded retainer

A

does not incorpate all teeth
OH probs
etching damages teeth
easily fail adn debond

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55
Q

What are fixed bonded retainers good for

A

diastemas
rotations

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56
Q

Class 3 malocclusion

A

lower incisor edge occludes anterior to the cingulum plaetu of the uppers
OJ i reduced or reversed

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57
Q

Why do you treat class 3

A

aesthetics
function and speech
traumatic occlusion
TMD
ging recession

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58
Q

Class 3 skeletal features

A

anterior/posterior - occur in class 1, 2 or 3 skeletal base
vertical - increased FMPA and AOB
transverse - may be bilateral crossbites due to maxiallart deficinency, lowers may be more buccally placed than uppers

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59
Q

Class 3 soft tissues

A

natural attemps at compensation or camouflage
uppers proclined and lowers retroclined
tongue proclines uppers
lips retrocline lowers

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60
Q

Class 3 enviornmental factors

A

cleft lip and palate
acromegagly - disorder of pituarty gland so increased growth hormone causing enlargement in mandible

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61
Q

Early mixed dentition tx for class3

A

upper centrals develop palatally to A’s
if A fails to exfoliate can leave central behind lower incisors
premature contact on central incisors
Use URA to treat

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62
Q

Late mixed dentition tc for class 3

A

growth modifcation - functional (Frankel III or reverse twin block or protraction headgear with maxiallry expansion)

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63
Q

Early permanent dentition tx for class 3

A

camouflage - produce class 1 incisors - XLA lower 4’s and upper 5’s

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64
Q

Ortho and orthgnathic surgery for class 3

A

moderate to severe class 3 with severe vertical discrepancy
1) decompensate the incisors and make reverse OJ worse
2) UI/MxP = 104 degrees, LI/MnP = 90 degrees pre treatment
3) surgery to reposition jaws
4) post surgical ortho

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65
Q

Class I

A

maxialla 2-3mm in front of mandible

66
Q

Class II

A

maxilla 3mm in front of mandible

67
Q

Class III

A

mandible infront of maxilla

68
Q

2 ways to assess the anterior positerior position

A

visually by pts profile and frankfort plane parallel to the floor
Palpation of skeletal bases

69
Q

Frankfort plane

A

porion to orbitale

70
Q

Mandibular plane

A

menton to gonion

71
Q

Types of crowding

A

mild = 1-3mm
mod = 4-8mm
severe = >8mm

72
Q

Overjet

A

horizontal distance between labial surface of upper incors and labial surface of lowers
average = 2-4mm

73
Q

Overbite

A

vertical overlap of incisor teeth
Average = upper incisors overlap the incisal 1/3rd of crowns of lowers (50%)

74
Q

Molar relationship class 1

A

mesiobuccal cusp of upper molar will occlude with buccal groove of lower 1st molar

75
Q

Molar relationship Class II

A

mesiobuccal cusp of upper molar will occlude to the buccal groove of lower 1st molar

76
Q

Molar relationship Class III

A

mesiobuccal cusp of upper molar will occlude posterior to buccal groove of 1st molar

77
Q

Gonion

A

most poterior inferior point of angle of symphysis

78
Q

Menton

A

lowest point on madibular symphsis

79
Q

Nasion

A

most anteiror point on frontonasal suture

80
Q

Orbitale

A

infeior anterior poart on margin of orbite

81
Q

Porion

A

upper most outermost part of bony external meatus

82
Q

Mandibular plane

A

line joining mention and gonion

83
Q

Uses of lateral cephs

A

gross inspection of antomy and physiology
assess dentoskeletal relationships
soft tissue relationship to hard tissues
prognosis and tx planning
monitoring facial growth

84
Q

Normal SNA

A

81 +/-3

85
Q

Normal SNB

A

78+/-3

86
Q

ANB

A

3+/-2

87
Q

MMPA

A

27+/-4

88
Q

FMPA

A

55+/-2

89
Q

Ui/max

A

109+/-6

90
Q

Li/max

A

93+/-6

91
Q

Common supernumary teeth

A

anterior region in maxilla
males more common

92
Q

Mesiodens

A

supernumary tooth between centrals

93
Q

Syndromes with supernumary teeth

A

cleft lip and alveolus
celdicranial dysplasia
gardner syndrome

94
Q

Conical tooth

A

peg shaped
erupt and XLA

95
Q

Tuberculate

A

paired and barrel shaped
tend not to erupts

96
Q

Suppplmental

A

extra tooth with normal morphology

97
Q

Odontome

A

can prevent tooth eruption
XLA

98
Q

Compound odontome

A

discreet denticles

99
Q

Complex odontome

A

disorganised mass of dentine pulp in enamel

100
Q

Causes of a supernumary

A

midline diastema
crowding
AOB
X bite

101
Q

Problems with supernumary teeth

A

Poor aesthetics
impreded eruption
displaced eruption of adjacent teeth

102
Q

Common hypodontia teeth

A

3rd molars
lower 2nd premolar
upper laterals
lower incisors

Females more common

103
Q

Causes of hypodontia

A

environmental or genetics
trauma
down syndrome
cleft lip and palate
Ehler’s Danbs syndrome
Ectodermal dysplasia

104
Q

Problems with hypodontia

A

Cleft lip and palate
malformation of other teeth
short root anamely
impaction
delayed eruption
crowding
enamel hypoplasia
altered cranifacial growth
spacing
infra occluded primary molar
drifitng
aethetics
fucntion issues

105
Q

Management for hypodontia

A

spacing opening
space closure
accept

106
Q

Concerns of retained primary tooth

A

retained primary teeth when difference of 6months between shedding in contra-lateral

107
Q

How much space is required for 2 missing lower incisors

A

6mm each tooth

108
Q

Tx of absent succesor

A

kept as long as possible
XLA early to encourage space closure

109
Q

Tx of infra occluded primary molar

A

permanent tooth present - kept under review and XLA of contact going subging or root formaion on succesor 2/3rds
permanent tooth absent - depends on crowding, retained with onlay or XLA for space management

110
Q

Causes of early loss of primary teeth

A

Caries
Trauma
severe crowding
premature exfoiation

111
Q

Digit sucking causes

A

proclined upper incisors
retroclined lower incisors
AOB
Posterior cross bite

112
Q

How is a posterior crossbite formed in digit sucking

A

the thumb goes in the mouth casues the mandible to dop down and tongue held in lower position
sucking action caused by cheeks narrows maxiallry dentition and posterior croos bite forms

113
Q

Mangement of digit sucking

A

positive reinforcement
bitter nail varnish
socks on hands at night
habit breaker device (palatal crib)
tonge rake
elastoplasst on digit

114
Q

Anterior cross bite managemtn

A

z spring with posterior bite plane
(if needs more than just tipping then fixed applaicnes afterwards)

115
Q

Posterior cross bite maangemetn

A

URA or quadhelix to expand maxiallry arch

116
Q

Casues of posterior cross bite

A

digit sucking
TMD
Ging reciession
crowding
cleft lip and palate
supernumerary
displacement on closure
tooth wear
mobility of lower incisors
retention of primary teeth

117
Q

Causes of a diastema

A

midline supernumary
genetics
abnormal frenum
missing or small upper laterals

118
Q

Mangement of diastmea

A

fixed applaince
palatal bonded retainer

119
Q

when is the best time for extraction of 6’s

A

bifurcation of 7’s are forming, morec crucial on the lowers
too early = poor space closure
too late = distal drift of 5’s

120
Q

Management of ectopic canines

A

XLA of c’s, retain 3 and observe
surgical exposure and ortho (gold chain if canine buccally placed)
autotransplantation

121
Q

What 2 radiographs do you take for ectopic canines

A

OPT and occlusal

122
Q

what to check for in ectopic canines

A

check at 9 years old
palpate to check bulge present
inclination of the 2’s
mobility and colour change of C or 2

123
Q

Caues of ectopic canines

A

genetic and enviornment factors
long bath of eruption
displacement
demintitve lateral incisors
smaller maxillary arch
increased crowding

124
Q

Problems with ectopic canines

A

cyst formation
root resoprtion

125
Q

what can a labial frenum do

A

cause a midline diastema

126
Q

what can tongue thrusting do

A

push incisors out

127
Q

Causes of an AOB

A

Digit/thumb sucking
endogenous tongue thrust
supernumerary tooth present
delayed eruption
disabilties - cerbral palsy

128
Q

How much of an AOB would you do orthognathic surgery

A

> 4mm

129
Q

Indications for a functinoa lappliance

A

average or reduced FMPA
uncrowded arches
lower incisor upright
mild to moderate class II

130
Q

How does a functiona appliance work

A

enhacnement of mandibular growth is brought about by movement of the mandibular condyle out of fossa prmoting growth of condylar cartilage and forward migration of glenoid fossa
Restrain of forward maxiallry growth
increase in lower face height

131
Q

Advantages of a functional appliance

A

reduced overbite
corrects molar relationship
conrrect angulation of upper incisors
encourages favourable skeletal growth

132
Q

Tipping movement

A

35-60 grams - URA can only carry out this one movement

133
Q

Bodily movement

A

150-200 grams
movement of whole tooth
slide along wire

134
Q

Intrusion

A

10-20grams
pressure evenly distributed on supporting structures which will cause required bone resorption
Too much force and will tear blood supply at apex

135
Q

Extrusion movement

A

35-60 grams
tension induced along perio ligament producing bone despoition

136
Q

Rotation movement

A

35-60 grams

137
Q

Torque movemetn

A

50-100 grams
movement of root but tooth in same position

138
Q

What are the factors affecting tooth movement

A

magnitiude of force
patients age
patients anatomy
the duration

139
Q

Light forces on tooth

A

hyperamia within perio ligament
osteoclasts and osteoblasts appear
resorption of lamina dura
remodelling of socket (frontal resorption)
ging remains distorted and stored energy leads to relapse

140
Q

Moderate forces on tooth

A

occlusion of blood vessels on side with pressure
tooth may be slighlty loose after movement

141
Q

Excessvie forces on tooth

A

necrosis of tooth with undermining resorption present
resorption of root surfaces by osteoclasts

142
Q

Syndrome

A

a group of anomalies that can be tied to a common origin - e.g - trisomy of 21 in down syndrome

143
Q

agensia

A

absence of organ due to failed development during embryonic period

144
Q

secondary abnormaility

A

interuptino of the normal development of an organ that can be traced back to other influences
(infections - rubella, trauama)

145
Q

Primary abnormaility

A

defect int he structure of an organ or part of an organ which can be traced back to an anomaly in development
(spina bifida, congenitial heart defect)

146
Q

Foetal alcohol syndrome

A

develops around day 17
small head
short palpbral fissures
short nose
long upper lip
deficient philitrum
flat midface
small mandible

147
Q

Hemifacial Microsoma

A

multifactorial - potentially due to neural migration at day 19-28
assymmetry
unuilateral mandibular hyperplasia
zygomatic arch hypoplasia
high arched palate
malformed pinna

148
Q

Treacher collins syndrome

A

deofrmity of 1st and 2nd brachial pharyngeal arches
hypoplasitc or missing zygomatic arch
hypoplastic mandible
deformed pinna
anti monoyloid slant palpebral fissures

149
Q

Achondraplasia

A

deformity of the endochondrial ossification ]defects in long bones, casues short bones = dwarfism
defects in base of skull
depressed nasal bridge
retrusive middle thrid of face

150
Q

Couzon’s syndrome

A

premature closure of cranial sutures - coronal and lambdoid
poptosis
prominent nose
Class 3
narrow spaced teeth

151
Q

Apert’s syndrome

A

premature closure of all crainal sutures
maxiallry hypoplasia
AOB
Class III
narrow spaced arch
deafness
Parrot beak nose

152
Q

Neurocranium

A

forms protective case around the brain
flat bones of the vault - develop intramembraously
endochondral elements of base of skull

153
Q

Viscerocranium

A

forms the skeleton of the face

154
Q

Meckel’s cartilage

A

prceeds the mandible

155
Q

Nasal capule

A

primary skeleton of upper face

156
Q

What are the 3 main sites of secondary cartilage formation in mandible

A

condylar cartilage
coronoid cartilage
the symphyseal end of each half of bondy mandible

157
Q

What can happen if there is a failure of fusion of maxiallry process and nasal elevations

A

cleft lip/palate

158
Q

formation of face

A

first 8weeks after fertilisation
formed from migrating neural crest cells

159
Q

Pharyngeal arches formed

A

week 4 from migrating neural crest walls and migrate to form frontonaasal process
Contains cranial nerve V

160
Q

2nd pharnygeal arch

A

33days
grows over 3rd and 4th pharyngeal arches which form the sinus crevicalis

FINALS!!! (20 decks)

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