ortho

Question 1

general benefits and risks of orthodontic treatment (7/6)

Answer 1

benefits:
- improved function/speech/mastication
- improved aesthetics
- psychological benefits
- (possibly) improved cleansability
- (possibly) improved dental awareness
- (possibly) decreased occlusal anomalies affecting perio
- (possibly) decreased trauma risk
risks:
- root resorption
- demineralisation
- periodontal attachment loss
- loss of vitality
- soft tissue trauma
- retention indefinitely

Question 2

what can increase the risk of root resorption with orthodontic treatment? (4)

Answer 2

resorbed, blunted or pipette-shaped roots
previous trauma
excessive force applied
prolonged treatment time

Question 3

how much root resorption is expected with orthodontics?

Answer 3

~1mm over a 2 year period

Question 4

what may increase the risk of loss of vitality with orthodontics? (2)

Answer 4

excessive force or speed of movement
previous trauma to teeth

Question 5

why might someone be referred for orthodontic treatment? (5)

Answer 5

facial appearance/severe skeletal issues
functional issues
increased/traumatic overbite
moderate-severe crowding
adverse growth or soft tissue pattern

Question 6

where might you refer a patient for orthodontic treatment and how do you choose? (2)

Answer 6

specialist practice for simpler cases, private and NHS
hospital for severe cases (IOTN 4/5, multidisciplinary)

Question 7

what are the different hospital orthodontic clinics that you might refer to? (5)

Answer 7

orthognathic
orthodontic-restorative
orthodontic-paediatric
orthodontic-oral surgery
cleft clinic
(all are multidisciplinary team management)

Question 8

which patients qualify for NHS orthodontic treatment? (4)

Answer 8

<18yo
IOTN 4/5 or 3 with AC 6+
dentally fit
motivated to wear appliances
(only one course covered by NHS)

Question 9

at what age would you refer for orthognathic surgery?

Answer 9

adults, after pubertal growth spurt
(may refer earlier for assessment)

Question 10

at what age would you refer for cleft or craniofacial abnormalities?

Answer 10

ASAP if not already under a MDT/cleft team

Question 11

at what age would you refer for growth modification and what features may these pts have? (up to 9 features)

Answer 11

9-10yo in females, 12-13yo in males
features:
- severe class III
- class II with severe teasing or trauma risk
- delayed eruption of permanent incisors
- impacted/UE FPMs or poor prognosis
- marked mandibular displacement
- anterior crossbite affecting perio
- hypodontia
- ectopic canines, pathology
- MH (for monitoring)

Question 12

at what age would you refer for orthodontic camouflage?

Answer 12

when child has permanent dentition
(also for class II growth modification)

Question 13

what habits may you ask about in the orthodontic assessment and why? (3)

Answer 13

• digit sucking - AOB, needs to stop
• parafunction - can increase risk of RR and breaking appliance
• chewing items - can increase risk of RR and breaking appliance

Question 14

what factors are important regarding digit sucking? (3)

Answer 14

• hours per day (>6)
• current/previous, when did they stop?
• manner/strength of force

Question 15

what extraoral features should be included in orthodontic assessment? (9)

Answer 15

• AP plane = I/II/III
• vertical height = increased or decreased
• transverse plane = acceptable symmetry or not
• lips = competency, length, smile line, lips to E line
• NL angle
• LM fold
• chin
• TMJ
• mandibular displacements