Ortho Flashcards
general implications of large overjet
trauma risk psychological impacts teasing difficulty eating difficulty speaking
dental implications of retainer?
fixed: difficult to clean around,
can debond,
wire fracture
increased gingivitis risk
vacuum formed: low compliance chipped/fractured become lost alter occlusion
design appliance to correct posterior crossbite
Aim: appliance to correct posterior crossbite
Active: mid-palatal screw
Retentive: adams clasps 6s, 4s 0.7 HSSW
Anchorage: yes
Baseplate: self cured PMMA, posterior bite plane
what is right deviation on closing and
complications that could come from this?
mandibular displacement on closure due to interarch discrepency
tooth wear
TMD
parafunctional habits
List 10 potential risk of orthodontic treatment
decalcification
relapse
root resorption
gingival recession
mucosal irritation loss of vitality loss of periodontal support failure to complete ulceration wear of adjacent teeth
pt aged 30 concerned about appearance has class III incisor relationship
what condition could be causing this? what intraoral features would a pt with class III have?
acromegaly
- hormone disorder, pituitary gland secretes too much growth hormone. occurs in middle aged pts
reduced/reversed overjet
attrition
retroclined lower incisors
displacement on closure
design a URA to treat anterior crossbite of 12
what features of dentition would make this good URA case
A - palatal z-spring on 12 - 0.5 HSSW
R - adams clasps 6s 0.7 HSSW
A -yes
B - self cure PMMA w/ post bite plane
enough space
only one tooth needing tilted
palatal tipped 12
good overbite for stability
5 factors that can resist displacement forces
gravity mastication active component speech tongue
pt w/ fixed ortho comes in with loose bracket
check if any other brackets loose
if missing account for them - if unknown chest x-ray
check health of tooth
check if wire round or square -
if round- need to remove as can swivel and come off
if square - keep in place, give OHI (moving bracket from side to side)
refer back to orthodontist
inform pt of decal if present
risks of extracting sound teeth due to aesthetics
reduction in labial profile
resorption of bone
drifting
6 uses of a URA
tipping of teeth space maintainer retainer reduce of OB expand arch habit breaker
6 pieces of advice to give on delivery of URA
- will feel uncomfortable
- will feel bulky
- practice reading aloud to help with speech
- avoid hard and sticky foods
- take out for contact sport
- clean by brushing over with dry toothbrush after meals
- wear as much as can 24/7 if possible
- poor compliance increases tx time
outline the 10 steps of URA delivery
- check correct pt and correct appliance
- check correct appliance for prescription/ design
- check for sharp edges
- check wire integrity
- insert- check for blanching of gingiva
- posterior retention - flyovers then arrowhead
- anterior retention
- ACTIVATE
- demonstrate insertion and removal, get pt to demonstrate back
- book in for review 4-6 weeks
design URA for an anterior crossbite. pt 8 y/o
A- z-pring 0.5 HSSW R- Adams clasps on 6s 0.7 HSSW Adams clasps on Es 0.6 HSSW A - yes B- self cure PMMA w/ post bite plane
self retentive after reverse over bite fixed
single tooth movement
increases overbite
incidence of hypodontia in the uk
6%
most common teeth to be missing (in order of prevalence)
mand 6s
max 2s
max 6s
how may hypodontia present to you as GDP
delayed/ abnormal eruption infraocclusion missing primary teeth ectopic 3 CLP
tx options hypodontia
accept and monitor
restorative - bridge, rpd, implant
ortho
ortho + restorative
how would you localise ectopic canines?
vertical parallax
age to intervene with ectopic canines
start palpating at 9
if not present at 11 intervene
how long after XLA cs for ectopic canines tx to review?
6 months
4 tx options ectopic canines
open exposure palatal +/- bone removal
open buccal apically repositioned flap +/- bone removal
closed exposure w/ gold chain
surgical extraction of 3
What is a supernumerary
Most likely location
an extra tooth to the permanent dentition
maxilla - between centrals. mesioderm
Types of supernumerary - explain features
COST
odontome - denticles OR mass of disorganised dental tissue
tuberculate - barrel shaped
conical - peg shaped
supplemental - extra tooth of normal dentition
implications of supernumerary teeth
prevention or delay in eruption of permanent dentition occlusal interference crowding traumatic eruption failure to erupt
4 intraoral signs of thumb sucking
proclined upper incisors
retroclined lower incisors
AOB/ incomplete open bite
narrow upper arch +/- unilateral posterior crossbite
BSI definition class 1 incisal
lower incisor edge occludes with or sits just below cingulum plateau of upper incisor
normal OJ
BSI definition class II div 1 incisal
lower incisal edge occludes posterior to cingulum of upper incisor
overjet is increased
upper incisors are proclined or normal
BSI definition class II div II incisal
lower incisal edge occludes posterior to cingulum of upper incisor
overjet is increased
upper incisors are retroclined
BSI definition class III incisal
lower incisal edge occludes in anterior to cingulum of upper insicors
Angle’s molar classification
Buccal groove of mandibular first molar occludes with mesiobuccal cusp of maxillary first molar
II: buccal groove mand occludes posterior to mb cusp of max
III: occludes anterior to
Ways in which functional appliance works
a.k.a twin block for pt with class II occlusion
promoted mandibular growth and restricted maxillary growth
dento-alveolar compensation- retroclined uppers, proclined lowers
constant wear
clinical signs of impacted canines? (5)
delayed eruption asyymetrical eruption loss of vitality of 2s discolouration of 2s retained cs distal tipping of 2s unable to palpate 3
risks of impacted canines?
resorption of 2s
cyst formation
aesthetics
tx options impacted canines
monitor
xla of c at 10-13 y/o
surgical extrusion with gold bonded chain
autotransplantation
incidence of CLP uk
1/700 births
general health indications CLP
aesthetics speech hearing cardiovascular defects assoc/w/ down's syndrome
dental implications CLP
hypodontia impaction increased risk of caries high vaulted narrow palate crowding class III
5 members of CLP team
paediatric dentist orthodontist ENT speech therapist psychologist maxillofacial surgeon cleft nurse geneticist
outline stages of CLP tx
1 month - lip closure 3 month - palate closure 8-10 years- bone graft 15 years - definitive ortho 18+ years - definitive surgery
what is dentoalveolar compensation
process whereby development of dental and aveolar arches are controlled so as to secure occlusion of the teeth and adaptation to basal parts of jaw
e.g proclination uppers
retrocline lowers
pt presents with Class III incisors. what other dental features are usually associated with this?
tx options
AP class III class III canines and molars AOB Reverse overjet crowding crossbite
tx:
- accept and monitor
- orthodontic camouflage
- orthognathic surgery w/ fixed app before and after. if ANB >5mm
- interceptive orthodontics - URA -anterior crossbites/+ to procline uppers over lowers
name 4 components of fixed orthodontics
wire
molar bands
brackets
modules
name 4 types of anchorage for orthodontics
baseplate
transpalatal arch
nance button (prevents mesial drift of 6s)
temporary anchorage device TAD
how does tooth movement work in orthodontics?
frontal resorption
tension side- bone deposition
pressure side- hyperaemia .:. increased osteoclasts and blasts .:. bone resorption
dental/oral features associated with class II div II
class II molars and canines
increased overbite
retroclined upper incisors
crowding
higher lip line
lip trap
trauma to gingiva/palate from traumatic overbite
dental/oral features assoc/ w/ class II div I
tx?
proclined upper incisors
class II molars and canines
increased OJ
incompetent lips
lip trap
tongue thrust
- accept and monitor
- URA
- growth mod - main use here for twin blocks. frankel 3. headgear
- camouflage
- orthodontic surgery
how to manage 4 main risks of ortho
Relapse → pt education and consent. Advised will require some form of retention e.g. fixed bonded retainer, vacuum
retainer lifelong esp. diastema and rotation.
Decalcification → pt education. OHI, Diet, Fluoride.
Resorption →
advised pt of risk. Radiographs pre-treatment to assess, not excessive ortho forces to limit. Advised 1mm is normal.
4 reasons for a diastema
high fraenum natural space supernumerary at midline proclined incisors hypodontia
3 ways of expanding arch
mid-palatal screw
quadhelix
rapid maxillary expansion
Which teeth are most commonly infraoccluded?
How do they appear radiographically and clinically?
tx options?
Lower Ds
8-14%
appear:
clin: no physiological mobility, low in arch, metallic percussive note
rads: no pdl radiographically, root resorption
tx: if permanent successor present, monitor only- usually resolves w/o tx
if doesn’t resolve, XLA
if no successor XLA as can get worse
SNA?
SNB?
ANB?
SNA- anterior cranial base to maxilla, 81 +/-3
SNB- anterior cranial base to mandible, 78 +/- 3
ANB = SNA-SNB, 2-4
Average FMPA
27 degrees
Average incisal angle
109/93 degrees
4 methods to stop non nutritative sucking habit
positive reinforcement, removable habit breaker, fixed habit breaker, plaster on finger, gloves, swap for dummy as less likely to continue past school age, preventative nail varnish
Explain long term effects of digit sucking on posterior dentition
habit causes mandible to drop open tongue held in lower position than previously cheeks suck in narrowing maxillary dentition causing crossbite
4 reasons for an unerupted 1?
supernumerary
crowding
trauma to a
dentigerous cycts/ other pathology
when might you consider balancing a primary tooth extraction
upper cs in crowded dentition
what 4 factors make early loss of primary teeth worse
age
tooth - es are worst
maxilla rather than mandible
if already crowded
4 signs a pt has been wearing URA
pt arrives wearing URA active component now passive tooth has moved pt can speak with URA in can take out and put in URA well signs of wear on palate signs of wear on URA
design a URA to retract Upper 3s
A- buccal canine retractors UR3, UL3, 0.5mm HSSW w/ tubing 0.7 diameter sleeve for 0.5mm HSSW wire R- adams clasps UR6, UL6- 0.7 HSSW Southend clasp 0.7 HSSW A- yes b- self cure PMMA
design a URA to retract upper 3s and reduce overbite
????
B - self cure PMMA w/ anterior bite plane
design a URA to retract buccally placed 3s and reduce overbite
palatal finger spring 0.5
adams clasps
yes
self cure PMMA
design a URA to correct anterior crossbite of 12
z-spring 0.5
adams clasps 6s and es/4s
yes
self cure pmma, posterior bite plane
design a URA to expand upper arch
mid palatal screw 0.5
adams clasps 6s and es/4s
design a URA to reduce oj and ob
????
B- self cure PMMA w/ anterior bite plane
name 5 active components, measurements, uses
All 0.5mm HSSW.
Palatal finger spring → 0.5mm HSSW w.guard. Retract teeth.
Buccal canine retractor → 0.5mm
HSSW w/0.5mm tubing. Retract buccally placed canines.
Z-Spring → 0.5mm HSSW. Anterior crossbite.
Mid-palatal screw → expand upper arch.
Robert’s retractor → 0.5mm HSSW w/ 0.5mm tubing. Reduce overjet.
What could cause a first molar to be impacted?
shape/size of e
size of maxilla
angle of eruption
ectopic crypt
figures for leeway space
- 5/Qmandible
2. 5per quadrant maxilla
