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BDS5 v1 > Ortho > Flashcards

Ortho Flashcards

1
Q

What to check pre examination

A
  • Presenting compliant
  • Patient details and who they are with
  • MH
  • DH: trauma, previous extractions/restoration, digit sucking, previous tx
  • Previous history
  • Family/social history: skeletal 3
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2
Q

What is incisal display

A
  • At rest 3-4mm male, 4-5mm female
  • Smiling: up to 2mm gingivae
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3
Q

What is incisor inclination

A
  • Upper 109 degrees
  • Lower 93 degrees
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4
Q

Why should the Frankfort plane be parallel to the floor

A
  • Reproducible
  • Standardized
  • Used in cephalometry
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5
Q

What is skeletal 2 AP

A
  • 2mm behind the line (zero meridian line)
  • Mandibular retrognathia
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6
Q

What is skeletal 3

A
  • Infront of line
  • Maxillary hypoplasia ?
  • Paranasal hollowing
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7
Q

What is the LAFH averages of male and female

A
  • 16y male 72mm
  • Female 68mm
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8
Q

What is microdonita and incidence

A
  • Teeth smaller than normal
  • 1.5% to 2%
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9
Q

What is crowding

A
  • Contact arch displacement (d in IOTN)
  • 1-4mm mild
  • 5-7mm moderate
  • > 8mm severe
  • Spacing: generalised or localised
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10
Q

What to check when teeth in occlusion

A
  • Incisor relationship
  • Overjet
  • Overbite
  • Molar and canine relationship
  • Crossbite/ displacement
  • Centrelines
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11
Q

What are the incisor relationships

A
  • Class 1
  • Class 2 div 1: overjet is increased and usually incisors proclined
  • Class 2 div 2: retroclined
  • Class 3: overjet reduced or reversed
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12
Q

What are the molar relationships

A
  • Mesiobuccal cusp of upper
  • Mid buccal grove of lower
  • Canine upper occlude posterior to the lower
  • Class 2: mesiobuccal cusp mesial to the mid buccal grove
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13
Q

IOTN

A
  • Dental health component
  • Aesthetic component
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14
Q

What is overbite

A
  • Complete: traumatic/ non traumatic
  • Incomplete: incisor overlap with no incisor contact
  • F is IOTN
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15
Q

What is open bite

A
  • Anterior open
  • Lateral open
  • E on IOTN
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16
Q

What is the definition of displacement

A
  • Movement of mandible on closing from Centric relation (RCP) into centric occlusion as a result of occlusal interference
  • When treatment planning take records in no displaced position as it is reproducible
  • Cross bite: C, l (lingual)
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17
Q

What is the justification for panoramic

A
  • Presence of teeth: unerupted and erupted
  • Assess roots
  • Check bone levels
  • Other pathology: caries
  • Check condyles
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18
Q

What are the aims of treatment

A
  • Improve aesthetics and appearance
  • Establish good occlusal result
  • Good molar relationship
  • Average overbite, overjet
  • Relieve crowding
  • Eliminate displacements/ crossbites
  • Produce a stable occlusion
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19
Q

What are Andrews 6 keys

A
  • Molar relationship
  • Crown angulation
  • Crown inclination
  • Rotations
  • Contact points
  • Curve of spee: flat occlusal plane, no deeper than 1.5mm
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20
Q

What is average adult lip length

A
  • 20mm female
  • 22mm male
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21
Q

Effects of digit sucking

A
  • Procline upper and retrocline lower
  • Unilateral crossbite
  • Anterior open bite
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22
Q

Tell me about hypodontia

A
  • Developmental absence of one or more teeth (excluding 3rd molars)
  • Mild/ mod/ severe (oligodontia: 6 or more, anodontia: all teeth)
  • Aetiology: environment, genetic (MSX1 PAX9)
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23
Q

Tell me about supernumerary tooth

A
  • Incidence = 3% Caucasian permanent dentition
  • Primary <1%
  • Maxilla: mandible 5:1
  • Classification: supplemental, conical (peg shaped, mesiodens), tuberculate (barrel shaped), odontome (complex/compound)
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24
Q

Ectopic teeth

A
  • Fail to erupt in correct position within the dental arch
  • Canines commonly affected (maxillary canines 11-12 palpated 9, mandibular canines 9-10)
  • Maxillary canine: 2%, mandibular canine: 0.35%
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25
Effects of loss of primary teeth
- Crowding - Ectopic eruption, impacted teeth - Unfavourable molar relationship - Centre-line shifts - Consider space maintainers
26
Impaction numbers
- Upper central incisors (0.13%) - Upper canines (2%) - Second premolars (20%) - First molars (0.75-6%) - Third molars (25%)
27
Risks if teeth are unerupted due to impaction
- Root resorption - Cyst formation - Poor aesthetics
28
How to locate unerupted teeth
- Visual examination: bulges, angulation of lateral , colour - Knowledge of eruption pattern - Palpation (8-10), mobility of the baby tooth
29
Use of OPG
- Unerupted teeth - Root position, shape, closure of apex - Developing teeth - stage of development - Condyles - Bone support levels - Pathology – cysts, supernumeraries, tumours, - periapical radiolucent areas
30
advantages and disadvantages of OPG
- Advantages: - * Shows all the teeth - * Shows complete view of both jaws - * Objects closer or further away from beam will be magnified/diminished helping to localise position - Disadvantages: - * Poor quality especially in midline - * Narrow focal trough – we do not always see the true picture - * Often require supplemental view to confirm details
31
Function of a space maintainer
- Maintain arch length and width preservation of leeway space - Prevent over eruption - Aesthetics - Aid in the management if oral habits – digit sucking - IDEAL: simple, passive, strong, cleansable
32
Types of space maintainer
- Unilateral: band and loop - Bilateral: Transpalatal arch (prevents mesial drift of 6), lingual arch, URA(removable)
33
How much lee way space
- 2.5mm lower - 1.5mm upper
34
Why might a primary tooth be retained
- Successor developmentally absent - Successor ectopic - Local abnormality (infra occlusion) - Failure of permanent to resorb tooth
35
Infraocclusion
- Fails to erupt fully - 8-14% in 6-11 - Trauma, absence of successor, ankylosis - Mid, moderate, severe
36
Methods to increase arch length or create space
- Molar distal movement (headgear or TADs) / incisor forward movement - Arch expansion (removable or fixed appliance) - Interproximal enamel reduction - Extraction
37
Tell me about growth
- Epigenetics - Rate increase during puberty - Female develop earlier - Difficult to predict
38
Ideal properties of an index of treatment need
- Valid - Reproducible - Ease of use - Acceptable - Cheap - Clinical audit and research
39
What are limitations of IOTN
- No account for skeletal and soft tissue - Only dental factors - No account for growth potential - Not an index of treatment complexity - Incentive to patient concerns/ demands
40
Extractions of first permanent molars
- Erupts 6-7, complete root at 9-10 - Problems: localised space, over eruption and tipping of adjacent - Slightly crowded would have the best effect
41
Prevalence of each malocclusion
- Class 1: 67% - Class 2 div 1: 15% - Class 2 div 2 10% - Class 3: 3%
42
Canine extraction considerations
- Try avoid as **cornerstone** and involved in **canine guidance** - Can mask premolar if good contact, rotation through fixed appliance
43
What is the class 1 malocclusion
- Maybe be increased VD or dental problem - Dentoalveolar disproportion: distalisation of molar using headgear, TADS, interproximal reduction, lee way space, extraction s - Hypodontia: accept, camouflage, space closure or opening - Supernumerary: extraction - Variation in tooth size: macro/micro (composite build up) dens in dente, dilaceration
44
What is class 2 div 1 malocclusion
- Skeletal: mandibular retrognathia (80%), maxillary hyperplasia, vertical any - Environmental: digit sucking, - Dental: crowding - Soft tissue: lower lip trap, lip incompetence - Trauma incidence 5mm 22%, under 9mm 24%, 44% over 9mm - Accept: mouthguard for trauma - Growth modification: growing, mild to moderate, twin block (70% dental, 30% skeletal) - Head gear: catch up growth of mandible, difficult compliance - Camouflage: upper 4, lower 5s - Orthognathic: growth complete, severe, decompensation before (appliances throughout the procedure)
45
Digit sucking habit effects
- Proclination of uppers and retroclination of lowers - Increased overjet - AOB - Narrow upper arch, unilateral posterior cross bite
46
Tell me about class 2 div 2
- Skeletal: 2 or 1, Vertical reduced, progenia - Soft tissue: strap lip, high lip line - Soft tissue will have obtuse Nasio labial angle - Dental: retroclination of uppers (2s might escape), increased IIA, traumatic overbite, crowding increased by retrocline uppers - Accept: mouth guard for trauma - Growth modification: convert to class 2 div 1 by Proclination of uppers (ura:ELSAA with T/Z spring and anterior bite block to allow over eruption of posterior teeth, twin block with procline spring, sectional fixed appliance) - Camouflage: mild/moderate, upper 4s lower 5s, IIA must be corrected or relapse - Orthognathic: same as class 2 div 1 - Usually required long term retention due to relapse
47
Tell me about class 3
- Genetic: cleft lip (maxilla less growth) - Skeletal: maxillary hypoplasia, mandibular prognathism, vertical (can be any) - Soft tissue: macroglossia (tongue pushes lls), not a big effect - Skeletal pattern 3 (55% maxillary problem) or 1 - Soft tissue factors: increased sclera show, paranasal hollowing, obtuse NLA - Dental factors: reduced overbite or anterior open bite, more crowding in upper dentition, microdontia/hypodontia causing narrow upper arch - Masticatory problems, speech problems - Accept: patient not concerned, OHI, acceptable aesthetics - Early Interceptive treatment (pre 10): URA, good overbite, able to go edge to edge, bone loss trauma - Growth medication (intermediate): headgear, rapid maxillary expansion, reverse twin block , not guaranteed treatment - Camouflage: mild to moderate, edge to edge, good overbite - Orthognathic surgery:
48
Tell me about ARAB
- Active component – t spring - Retention – Adam’s clasps and c clasps - Anchorage – baseplate and Adams - Baseplate – cold cure acrylic – bite block incorporated
49
Fixed appliance
50
Problems associated with fixed appliances
- Demineralisation: poor OHI and diet , plaque score below 20% before treatment, can remove arch wire, plaque retentive factors - Gingivitis and periodontal disease - Root resorption: majority - minor around 1mm, 5% cases 5mm loss, Risks (history of trauma, treatment duration, apical movement, genetic) - Pulpitis: transient in majority of patients, caution treating trauma teeth - Soft tissue ulcers: brackets can use wax, no sharp ends of wire - Inhalation: chest x ray
51
Maxillary incisors and impaction
- 7-8 central eruption (root formation completes around 11) - On eruption there is midline diastema - 0.13% in 5-12year olds: impacted maxillary central incisors - Concerns: contra lateral over 6 months, lower incisors over 1 year (uppers unerupted), lateral erupt before central - Radiograph: parallax with upper standard occlusal or CBCT
52
Reasons for maxillary central incisor impaction
- Early loss of primary centrals - Trauma: e.g. scar tissue preventing eruption - Macrodont: fusion of 2 teeth into one , not enough space - Supernumerary tooth: tuberculate most common impaction causer - Dilaceration: distortion or bend in the root of a tooth: idk how this affects - Ankylosis: following trauma, fixed appliance on ankylosed tooth will not move - Other: cysts, cleft lip
53
Treatment for unerupted central
- Remove obstruction - Maintain space (URA) - Monitor for 12months – 80% erupt - Expose and bond if unerupted (closed if high, open if superficial) - Over 10: straight to expose and bond
54
Maxillary canines and impaction
- F:M > 2:1 - 2% (85% palatal, 15% buccal), absent is 0.08% - Corner stone of arch, canine guidance, erupts distally along the 2, long route of eruption, palpable at 9, late is 12-13 - Small lateral, missing laterals (increases incidence to 5%)
55
Radiograph and maxillary canine
- Prior to 10 little benefit, above 11 where 3s aren’t palpable - Cbct or parallax (pa, USO)
56
Management of 3s
- Interceptive: extract c, need space for 3 - Surgical expose and bond: extract premolar if need space, closed and open technique - Surgical repositioning (ankylosis risk), surgical removal
57
Prognosis of canine
58
Risks of aligning impacted canines
- Root resorption to adjacent teeth - Loss of vitality - Poor tissue contour at completion of treatment - Increased pocket depths - Canine root resorption - Ankylosis
59
Define impaction
- Tooth that is prevented from erupting into its normal functional position by bone, tooth, fibrous tissue.
60
Functional appliances
- Use forces generated by the oral facial musculature to produce dental and skeletal changes. Force generated by stretching the facial muscles in a postured position
61
Considerations for class III treatment
-Ability to achieve edge to edge occlusion -Ability to retain occlusion with a positive overbite -Extent of displacement -Extent of dento-alveolar decompensation -Age of patient -Cause of malocclusion (maxillary growth stops before mandibular growth) -Is patient happy with facial profile

BDS5 v1 (10 decks)

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