ORTHO Flashcards
What are the 3 general subsections for aetiologies of malocclusion
- Skeletal patterns - in all 3 planes of space
- Soft tissues
- Dental factors
Medical conditions relevant to ortho
- Epilepsy (EO headgear risk, seizure)
- Latex allergy
- Nickel allergy
- Diabetes - perio etc
- Heart defects - risk of infective endocarditis
- Bleeding disorders
- Asthma
- Bisphosphonates
How much of upper incisors should show on smiling
Whole height of upper incisors with only interproximal gingivae visible
What is the normal nasolabial range
90-110 degrees
What is the importance of competent lips
- when reducing overjets in class 2 cases, stability of case = improved if you have incisors controlled by competent lips at end of treatment
Ricketts esthetic line
Upper lip; 3-4mm
Lower lip: 2mm
What is normal overjet
2-4MM
What is normal overbite
1/3 coverage of crown of lower incisor
(Upper incisor contacting middle third of lower incisor)
IO exam layout
START WITH LOWER ARCH
- Soft tissues, OH, any perio or caries
- Tooth chart: SCAARID
Spacing
Crowding (mild moderate or severe)
Arch shape
Angulation canine (upright, mesial or distal)
Rotations (any clear/severe rotations)
Incisal inclination
Displacement - Incisal class relationship
- Overjet
- Overbite
- Centreline - Canine class relationship
- Molar class relationship
- Crossbites
Average widths of teeth
Upper:
Central = 8mm
Lateral = 6mm
Canine = 7-8mm
1st premolar = 7mm
2nd premolar = 7mm
1st molar = 10mm
Lower:
Central = 5mm
Lateral = 5.66mm
Canine = 9mm
1st premolar = 6.7mm
2nd premolar = 6.73mm
1st molar = 10.69mm
What is mild moderate severe crowding
Mild:
< 4mm
Moderate:
4-8mm
Severe:
>8mm
EO exam layout
- AP skeletal
- FMPA
- LAFH
- Symmetry (Transverse)
- Lips:
a) competency
b) nasolabial angle
c) gingival show on smiling
d) behind/on/in front of Rickett’s E plane
GENERAL TREATMENT LAYOUT
Treatment Plan:
- EXT / NON-EXT
- Growth modification / Camouflage / Surgery
- Fixed / Functional / Removable
- Is Anchorage support :
- Retention:
- Growth & Stability:
REFERRAL decision?
Will you refer?
Why will you refer?
When will you refer?
Where will you refer?
Is patient Dentally Fit- caries/OH/Perio
Is patient Mixed Dentition
Attitude Orthodontic treatment
Write NP referral Letter:
IOTN: all 5
Risks of ortho
- gingival recession
- dehiscence
- gingivitis
- caries (decay of the teeth)
- devitalisation of teeth,
- demineralisation (white/brown spots on teeth)
- root resorption
- discomfort/ulcers,
- multiple appointments required,
- long treatment times
- relapse/failure of treatment
- ankylosis
- breakages (of ortho appliance)
Benefits of ortho
- speech
- masticatory function
- psychosocial wellbeing
- aesthetics
Risks of doing nothing for ortho for unerupted tooth
UNERUPTED TOOTH:
cyst formation, root resorption, ectopic eruption, eventual loss of the deciduous incisor, space loss, eventual prosthetic replacement with a resin-bonded bridge
Risk of doing nothing for tooth for class 2 div 1 incisal
Increased risk of trauma to the upper incisors due to increased overjet, potentially leading to
devitalisation/fracture/loss of teeth, no treatment of facial aesthetics and function,
malocclusion can worsen over time
Retention regime
likely retention regime after treatment will be for the patient to wear
their removable retainer for 3 months with 24/7 use except when swimming, eating, and playing
contact sports. If the patient has an Essix vacuum formed retainer (PVC), then he cannot eat
with this in, whereas with a Hawley retainer you can eat with it in. Then, the patient must wear
the retainer at night every night for a year, and then once that year has been completed, the
patient wears their retainer for 2-3 nights a week forever. The orthodontist should be reviewing
the patient’s retention regime for the first year, as well as reminding the patient about retainer
hygiene, and then after this the patient’s retention can be regularly reviewed by the GDP. This is
the minimum for retention, and the orthodontist may decide to choose prolonged retention
with a Hawley retainer for example to help ensure that no relapse occurs depending on severity
of the malocclusion in the first place. If any of the third molars erupt, the retainer may need to
be adjusted/re-made to also cover the third molars to prevent overeruption of the third molars.
Fixed retention can be provided with a composite-bonded orthodontic wire across a short span
of teeth, which can improve compliance, but this is more difficult to clean and may de-bond
over time.
