ortho Flashcards
general benefits and risks of orthodontic treatment (7/6)
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
what can increase the risk of root resorption with orthodontic treatment? (4)
- resorbed, blunted or pipette-shaped roots
- previous trauma
- excessive force applied
- prolonged treatment time
how much root resorption is expected with orthodontics?
~1mm over a 2 year period
what may increase the risk of loss of vitality with orthodontics? (2)
- excessive force or speed of movement
- previous trauma to teeth
why might someone be referred for orthodontic treatment? (5)
- facial appearance/severe skeletal issues
- functional issues
- increased/traumatic overbite
- moderate-severe crowding
- adverse growth or soft tissue pattern
where might you refer a patient for orthodontic treatment and how do you choose? (2)
- specialist practice for simpler cases, private and NHS
- hospital for severe cases (IOTN 4/5, multidisciplinary)
what are the different hospital orthodontic clinics that you might refer to? (5)
- orthognathic
- orthodontic-restorative
- orthodontic-paediatric
- orthodontic-oral surgery
- cleft clinic
(all are multidisciplinary team management)
which patients qualify for NHS orthodontic treatment? (4)
- <18yo
- IOTN 4/5 or 3 with AC 6+
- dentally fit
- motivated to wear appliances
(only one course covered by NHS)
at what age would you refer for orthognathic surgery?
adults, after pubertal growth spurt
(may refer earlier for assessment)
at what age would you refer for cleft or craniofacial abnormalities?
ASAP if not already under a MDT/cleft team
at what age would you refer for growth modification and what features may these pts have? (up to 9 features)
- 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)
at what age would you refer for orthodontic camouflage?
when child has permanent dentition
(also for class II growth modification)
what habits may you ask about in the orthodontic assessment and why? (3)
- 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
what factors are important regarding digit sucking? (3)
- hours per day (>6)
- current/previous, when did they stop?
- manner/strength of force
what extraoral features should be included in orthodontic assessment? (9)
- 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
how can AP class be assessed clinically? (2)
- Kettle’s method
- zero Meridian line
how do soft tissue points A and B relate in a class I AP patient?
point A is 2-4mm anterior to point B
how can vertical facial height be assessed clinically? (2)
- facial thirds
- FMPA
how can the transverse plane be assessed clinically? (2)
- rule of fifths
- midline (glabella, philtrum, pogonion)
what is the average value for NL angle?
90-110º
what is the average height of the smile line?
showing from 75% of upper incisors to 100% with 2mm gingiva
what is a consonant smile arc?
when the incisal edges of the upper incisors and the top of the lower lip are parallel when smiling
what intraoral features should be included in orthodontic assessment of each arch separately? (8)
- teeth present/missing from mouth
- caries, restorations
- OH
- soft tissues
- arch form (U/V/square) and symmetry
- crowding or spacing (in mm)
- inclination/angulation
- rotations
list the 5 anterior occlusal features to be assessed
- incisor relationship
- overjet
- overbite
- centrelines
- crossbites +/- displacements