Ortho Flashcards
Components of a URA?
Benefits/cons of heat cure PMMA vs Self cure PMMA
Active component - 0.5mm
Retention - 0.7mm
Anchorage - resists unwanted tooth movement
Baseplates - plus any modification
Self cure - quicker and easier fabrication but can produce knife edge acrylic, and residual monomer may be an irritant
How would you deliver the URA and what to check for?
Instructions to pt:
- check the appliance is for the patient and the prescription is suitable
- check there is no faults on the appliance, the active component is active and not damaged
- run finger over appliance to check for any sharp edges
- fit appliance and check for any blanching or trauma
- check the retention from the clasps
- check the active component is active
- check patient can insert and remove it themselves
Instructions to pt
- it will feel bulky, but persevere wearing it
- may be uncomfortable but its a sign its working
- more saliva for 24/48 hours
- remove and clean with soft brush after each meal
- take out during contact sports
- avoid hard sticky foods with it in
- be cautious with hot foods and drinks as baseplate will act as insulator
- non-compliance will only make treatment longer
How to check patient has been wearing their URA
Ask them!
- signs of wear and tear
- they will be able to speak without a lisp
- no hypersalivation
- they come in wearing it
- parent says they’ve been wearing it
- active component no longer active and needs activating again
Identify and Management options for CII DI - IOTN 5A
Class 2 skeletal = maxilla more than 2/3mm in front of mandible, increased overjet and increased ANB
Incisor
- lower incisors lie posterior to cingulum plateau of upper incisors
- upper incisors are proclined and OJ increased
Dental features
- trauma
- incompetent lips
- digit sucking often
Reasons for tx
- aesthetics concerns
- trauma risk with OJ >9mm - IOTN 5A
Management
Accept
- mild cases, no pt concerns
Growth modification - utilise or guide the forces of the developing occlusion to our benefit
- headgear - restrain growth of maxilla
- twin block with Robert’s retractor to guide mandible forward
- followed by fixed orthodontics
Orthographic surgery
- when growth stopped
- extreme cases with severe AP discrepancy
Management options for CII DII?
- Accept - pt not concerned and overbite not significant problem
- Growth modification - modified twin block to procline upper incisors
- often followed by fixed appliance - Camouflage - accept underlying skeletal
- for mild class II - Orthognathic surgery - for severe cases where orthodontics alone will not help
How is an orthodontic assessment carried out?
When are they carried out?
- comprehensive around 11/12
- History
- ask about malocclusion, functional or aesthetic issue?
- habits such as digit sucking or nail biting
- previous dental trauma - Extra oral
- AP relationship
- FMPA angle and LAFH:UAFH
- midline
- TMJ deviation
- lip competence and smile line - Intra oral
- IOTN
- soft tissues such as frenum
- oral hygiene
- missing / extra teeth
- crowding or spacing
- incisor and molar class
E.g upper arch is misaligned and crowded and lower arch is alligned but spaced
Give the risks associated with orthodontic treatment
Decalcification - where brackets are placed enamel can be decalcified. Must ensure OH is good with cleaning around the bracket - use of single tuft brush
Root resorption - from movement of teeth - this will happen for all pts in some shape or form
Relapse - must wear retainer or orthodontics will relapse back to original position
Decalcification - how manage this and inform pt to mitigate this?
Diet advice
- the bracket with attach to the tooth and weaken enamel to decay
- diet control while wearing braces is essential, minimal sugar
- sugar at mealtimes,and decrease frequency of sugar intake
Oral hygiene measures
- use of teepee brushes or single tufted brushed for cleaning around brackets
- minimum brushing twice per day thoroughly with fluoride toothpaste
Consider high fluoride toothpaste
- or fluoride varnish
- or mouthrinse
Why may there be a retained ULA?
- what investigations and treatment options?
Why?
- trauma to ULA resulting in ankylosis, dilaceration of permanent tooth, arrested formation of 21
- lack of permanent successor due to hypodontia
- ectopic tooth
- crowding so cannot erupt
SI
- palpate buccal and palatal
- take 2 radiographs and parallax them to identify position of successor or if present
Management
- leave and monitor - possible cyst
- extract A and maintain space
- refer to orthodontist for opinion
Treatment options for class 3 malocclusion?
Accept
- very minor with no concerns from pt
Growth modification
- pubertal growth spurt
- reverse twin block, to retract mandible and procline uppers
- followed by fixed ortho
Surgery
- older pts with more severe skeletal discrepancies
Construct URA to reduce overjet
A - Robert’s retractor 0.5mm SSW + 0.5mm ID tubing
R - Adam’s clasps 6’s and 4’s 0.7mm SSW with mesial stops
A - baseplate self cure PMMA
B - baseplate self cure PMMA FABP OJ+3mm
Construct URA to reduce overbite
A - none
R - Adam’s clasps 6s, Southend clasp 11,21
A - nil
B - FABP - OJ+3mm
Construct URA to reduce overbite
A - none
R - Adam’s clasps 6s, Southend clasp 11,21
A - nil
B - FABP - OJ+3mm
Construct URA to retract canines
A - palatal finger spring with guard 0.5HSSW
R - Adam’s clasps and Southend clasp
A - nil
B - self cure PMMA
How is an IOTN formulated?
Missing teeth
Overjet
Crossbites
Displacement
Overbite
Missing teeth
Overjet
Crossbites
Displacement
Overbite
