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ABGD study > Ortho - ABGD > Flashcards

Ortho - ABGD Flashcards

1
Q

Maxillary Incisor liability

A

7mm

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2
Q

Mand incisor liability

A

6mm

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3
Q

Transient mandibular crowding-mm

A

0-2.0mm

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4
Q

Where does the space come from the incisor liability?

A
  1. Interdental spacing in primary dentition
  2. Increased intercanine width (2 mm)
  3. Slight labial positioning of the incisors (1-2 mm)
  4. Distal shift of the canines as the primary first molars are lost (mand/1 mm)
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5
Q

Leeway space- measurments

A

Max: 1.5mm/quad, 3mm per arch
Mand: 2.5mm/ qud, 5mm per arch

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6
Q

What is E space?

A

the leeway space with the greatest space gained for the perm dentition

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7
Q

Describe Angle’s Class I

A

max 1st molar MB cusp occludes with the B groove of Mand molar

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8
Q

Describe Angle’s Class I malocclusion

A

The 1st molar relation is normal, but the line of occlusion is off (crowding or irregularity)

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9
Q

Normal occlusion- how should the teeth be aligned

A

The upper and lower teeth should be arranged on a smoothly curving “line of occlusion”

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10
Q

Describe Angle’s Class II

A

The mandibular 1st molar is distal to the maxillary 1st molar (line of occlusion not specified)

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11
Q

Describe Class II Div I

A

Protruding max incisors

Could be associated with:
- Underdeveloped lower jaw
- Protrusive upper jaw
- Narrow arch form

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12
Q

Describe Class II Div II

A

Retruded or bunched maxillary incisors

Could be associated with:
- Underdeveloped lower jaw
- Deep bite
- Laterals and canines tend to be in labioversion while the centrals are upright

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13
Q

How does classification change if the classification varies.

A

subdivide and indicate side. Class I always comes first

ie: “class I, Class II div 1 subdivision Right

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14
Q

Describe angle class III

A

The mandibular 1st molar is mesial to the maxillary 1st molar (line of occlusion not specified)

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15
Q

What are other angle classification system- dental short comings?

A

Crossbite
Depth of bite
Crowding
complexity or severity

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16
Q

What primary occlusion is most common?

A

mesial step- 61.1%

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17
Q

What do mesial steps often develop into?

A

If 1mm of mesial shift:
Class I- 68%
Class II- 22.8%
Class III - 1%

If 2mm of mesial shift
Class I: 68%
Class II: 12%
Class III: 19%

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18
Q

What do distal steps develop into?

A

class II 100%

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19
Q

What do flush terminal planes develop into?

A

56% Class I
but they are not stable and can easily turn into Class II if there is early tooth loss, ectopic eruption, or caries.

(29% are FTP)

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20
Q

What is interceptive ortho?

A

INTERVENE IF THERE IS POTENTIAL TO AFFECT GROWTH AND DEVELOPMENT

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21
Q

What problems may need interceptive ortho?

A

Eruption problems
anter open bite
crossbites
space maint
habits

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22
Q

What % of ectopic eruptions self correct?

A

60%

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23
Q

How could you correct ectopiceruption of a 1M?

A

spacer- ~6 weeks. use a radiopaque one!

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24
Q

What teeth are most likely to ectopically erupt

A

MAX 1M
MAX Incisors
MAX Canines

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25
Q

What are ways to perform a space analysis?

A

compare space available to space required using:
xrays- CBCT or PAX
proportionality tables and equations
Combo

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26
Q

What is one proportionality equation?

A

Tanaka- Johnston

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27
Q

What is the Tanaka-Johnston Equation?

A

1/2(width of the lower 4 incisors) +
MAX: 11 per quad
MAND: 10.5 per quad

THIS IS SPACE NEEDED

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28
Q

What is the name for Tooth size discrepancy

A

Bolton discrepancy

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29
Q

What is the % size difference between max and mand inciors?

A

77% (mand are smaller)

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30
Q

How is bolton discrepancies expressed?

A

in mm- excess or deficiency

ie: You may have maxillary excess or mandibular deficiency to reach a similar outcome

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31
Q

For porportional dentition if the canines are class I, then

A

then the incisors should fit together (also need to look at overjet and bite)

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32
Q

What might look like a Maxillary Deficiency?

A

Class I canines
Ideal overjet
Max spacing, small laterals

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33
Q

What might look like a Mandibular Excess?

A

Class II canines
Ideal overjet
Laterals width acceptable

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34
Q

How to tx a bolton descrepancy?

A

IPR
Bonding/restorations
Extractions

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35
Q

When would you likely need to do IPR or max bonding?

A

with mand excess of 2mm or more

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36
Q

if you planned to extract a tooth for space, what is the gold standard for eval/setup?

A

Kesling Set up which is teeth moved in wax

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37
Q

What four things do you need to consider with treating tooth size discrepancy?

A

OJ, OB, canine relationship, and INTRA arch size relationship

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38
Q

When would it be appropriate to consider serial extractions?

A

severe crowding >10mm
mixed dentition
class I skeletal without other skeletal abnormalities
class I molar w normal OJ and OB

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39
Q

What is key to serial extractions?

A

Extract 1st premolars prior to cuspids erupting.

almost ALWAYS need to finalize with ortho

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40
Q

What is the serial eruption pattern?

A

Extract C’s to allow 2’s to erupt
Extract D’s when 4’s are 1/2-2/3 form
Extract 4’s to allow 3’s and 5’s to erupt

Full appliance therapy is initiated to align, close spaces, and upright roots

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41
Q

Common errors with serial extraction are?

A

-ext of primary molar prior to the root formation of the perm tooth being 1/2 to 2/3 complete
-not ext symmetrically
-not having good records

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42
Q

Normal maxillary width of the intra molar @ gingiva

A

36mm ~cotton roll

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43
Q

Unilateral cross bite? how can you tell?

A

uni if asymmetry
Bilateral if functional shift

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44
Q

what could a posterior crossbite be caused by?

A

canine interference- check first contact and adjust if needed

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45
Q

Correction by expansion indications? What is it?

A

-Bilateral/unilateral posterior crossbites
-Cleft lip/palate
-To gain arch length

Tx: A combination of dental tipping and opening of the midpalatalsuture

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46
Q

For a rapid palate expander, does it stay open?

A

no, it spontaneously closes shut

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47
Q

What is the ratio of dental to skeletal changes with palate expansion

A

~50/50. increases dental changes as the pt ages

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48
Q

What parts open more with expansion?

A

ANt and Occlusal

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49
Q

What are 6 types of palate expansion?

A

Haas, Bonded, Fan, Hyrax, removable, quad helix or W arch(less force)

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50
Q

When and what happens when using a quad helix or W arch

A

Slow expansion
use in Early mixed dentition
Mostly dentoalveolar changes
Some orthopedic effect in young children
Molar control
De-rotation

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51
Q

What is a MARPE

A

MARPE
Mini-screw Assisted Rapid Palatal Expander

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52
Q

Abbreviation and where: Stella

A

S - Center of the hypophyseal fossa

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53
Q

Abbreviation and where: Nasion

A

N
Most anterior point of the sagittal junction of the frontonasal suture

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54
Q

Abbreviation and where: A point

A

A:
Innermost curvature of the maxilla between ANS and crest of maxillary alveolar process
–Usually located just opposite the root tip of the central incisor

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55
Q

ANS

A

Anterior Nasal Spine
Most anterior bony point on the maxilla at the base of the nose

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56
Q

PNS?

A

Posterior Nasal Spine
posterior limit of bony palate

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57
Q

Palatal Plane connects what?

A

ANS and PNS

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58
Q

B point

A

B
Most posterior point on the curvature from bony chin to alveolar junction
Anterior limit of mandibular apical base

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59
Q

Whats the order of the chin points?

A

Superior to Inferior: Pg, Gn, Me

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60
Q

Pogonion?

A

Pog or Pg
Most anterior point on the anterior curvature of the mand symphysis

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61
Q

Menton?

A

Me
Most inferior point on the mand symphysis

62
Q

Gnathion

A

Gn
Most outward and everted point on the curvature of the symphysis
Half way between Pg and Me

63
Q

Gonion

A

Go
Point at the middle of the curvature at the angle of the mandible

64
Q

Orbitale

A

Or
the lowest po$int on the inferior margin of the line bisecting orbits

65
Q

Porion

A

Po
Most superior point on the bisected anatomical external auditory meatus

66
Q

Condylion

A

Co
The most posterior superior point on the outline of the bisected mandibular condyle

67
Q

What does SNA and SNB indicate?

A

the position of the maxilla and mandible relative to the cranial base

68
Q

What doe sa high value of the SNA/SNB mean?

A

the jaw has prognathism

69
Q

What kind of value SNA/SNB would a retrognathic jaw have?

A

lower value

70
Q

How do you find the ANB?

A

SNA-SNB = ANB

Determines the relative relationship of the maxilla to the mandible

71
Q

ANB angle of 0-4 is what class?

A

class 1

72
Q

ANB angle of -2-0 is what class?

A

Class III

73
Q

ANB angle of >4 is what class?

A

Class II

74
Q

What is the normal SNA? SNB?

A

82, 80

75
Q

Normal value of the maxillary incisor to the SN plane?

A

103

measures the relative proclination of the incisor to the cranial base

76
Q

What the normal value of the mandibular incisor to the mandibular plane?

A

91 degrees

measures proclination of incisors

77
Q

What is the Sassouni Analysis?

A

In a well proportioned face, a series of horizontal planes will project toward a common meeting point

78
Q

What is the lower lip to E line (in mm)?

A

determines if the lips are too far in front or behind this esthetic line. Measured from tip of nose to soft tissue Pogonion

79
Q

what are the three types of face shapes?

A

Brachycephalic
Dolicocephalic
Mesocephalic

80
Q

What are two ortho movements theories?

A
  1. Pressure- Tension
  2. Piezoelectric theory
81
Q

What happens in the first phase of pressure?

A

Hyalinization.

82
Q

What is Hyalinization?

A

Pressure prevents blood flow and cell differentiation
creates a layer of sterile, necrotic zone “hyalinized layer”

83
Q

What are the 3 components of Hyalinized layer

A
  1. Degeneration
  2. Elimination of destroyed tissue from bone marrow space “undermining resorption”
  3. Re-establishment
84
Q

6 Types of tooth movement

A
  1. Translation/body movement
  2. Tipping
  3. Rotation
  4. Extrusion
  5. Intrusion
  6. Torque
85
Q

What happens in the secondary period of tooth movement?

A

after the initial phase where movement stops, there is a period of increased tooth movement. which has reduced deposition of new bone and move efficient tooth movement.

86
Q

At what grams is forced eruption?

A

35-60

87
Q

What is the rate of forced eruption?

A

no more than 1-2mm/month

88
Q

Force eruption: How do you calculate extrusion distance?

A

x(apical margin to alveolar crest + BW(2.04mm), +1mm

crown to root ratio should be >/= 1:1

which means you need at least 3-4mm total eruption above crestal bone

89
Q

How long do you keep retention on in force eruption?

A

1 month for ever month that it took… so ~ additional 3-4 months.

90
Q

What is the orthodontic technique for forced eruption?

A

-Anchorage from adjacent teeth is usually sufficient
–Need rigidity over the anchor teeth and flexibility where it attaches to the tooth to be extruded
–2 methods -with or without brackets

91
Q

When do you do a supracrestal fiberotomy?

A

trauma, subgingival caries, resorption, iatrogenic perforation

DONT do it for implant site development

92
Q

How do you distal crown tip?

A

Anchorage, open coil spring, gable bend to counteract the the DL forces

93
Q

What are the periodontal risks of ortho?

A
  • uncontrolled periodontal disease
  • reduction of attached gingiva/recession
    -fenestration and dehiscence
    root resorption–> both external apical and invasive cervical
94
Q

What are the types of External apical resorption?

A

Surface: outer layer, can regen
Deep resorption: cementum and dentin, may not be same shape, even regens a little
Circumferential root resorption: tridimentional resorption at apex, root shortening evident. not repairable

95
Q

What is the prevalence of EARR? Severe?

A

> 90%…severe only 1-5%= 4mm or 1/3 root

96
Q

Risk factors of EARR?

A

hx of resorption, increased length of tx, genetic predisposition.
MAYBE: asthma, dysostosis, endocrine issues

97
Q

Management of EARR?

A

take xrays to monitor progress, stop or pause tx, perio tx.

98
Q

Invasive Cervical Root Resorption- external or internal?

A

external.

99
Q

How to treat ICRR?

A

proper diagnosis, refer to endo who they might sx exposure endo therapy, remove infected dentin, repair with GI and BECAUSE, then monitor

100
Q

Which wire type allows for the tipping of crowns?

A

Round

101
Q

Which wire type provide torque and root movement?

A

Rectangular

102
Q

How many grams are needed to perform intrusion?

A

10-20 grams

103
Q

How many grams are needed to perform rotation?

A

35-60 grams

104
Q

How many grams are needed to perform tipping?

A

35-60 grams

105
Q

How many grams are needed to perform translation?

A

70-120 grams

106
Q

How many grams are needed to perform root uprighting?

A

50-100 grams

107
Q

What is the arch wire Sequence?

A

Early Alignment
Later Alignment
Leveling
Space Closure Preparation
Space Closure and Molar Correction
Finishing and Detailing

108
Q

What wire is used for early alignment?

A

0.014 or 0.016 NiTi

109
Q

What wire is used for later alignment?

A

17x25 or 19x25 NiTi if rotation correction is needed.
0.018 NiTi if only few problems

110
Q

What wire is used for leveling?

A

0.018 or 0.020 SS

111
Q

What wire is used for space closure preparation?

A

17x25 SS

112
Q

What wire is used for space closure and molar correction?

A

18x25 or 19x25 SS

113
Q

What wire is used for finishing and detailing?

A

19x25 SS or TMA

114
Q

What is the benefit of NiTi?

A

good shape memory and less stiff

115
Q

What is the benefit of SS

A

Stiff, can place bends

116
Q

What is the benefit of TMA (Titanium Molybdenum Alloy)/Beta Titanium

A

More spring/room for error. can place bends

very expensive!

117
Q

What is PoG or Pg?

A

Pogonion (top one)

118
Q

What is Me?

A

Menton (bottom one)

119
Q

What is Gn?

A

Gnathion - middle one

120
Q

What is Po?

A

Porion - most superior part of EAM (ear)

121
Q

What is Co?

A

Condylion - superior and back part of condyle

122
Q

What kind of wires do you need for aligning and level?

A

Align: Round NiTi
Level: large rectangular wires

123
Q

What wires would you use for Finishing and Detailing?

A

Steel or TMA

124
Q

What cases would you utilize interceptive ortho treatment?

A

Eruption problems
Anterior open bite
Posterior open bite
Anterior cross bite
Space maintenance
Habits (thumb sucking

125
Q

Describe the following facial types:
Brachycephalic

A

Brachycephalic:
-short, square facial type
-low mandibular plane angle
-decreased anterior vertical height
-often presents with anterior deep bite

126
Q

Describe the following facial types: Dolicocephalic,

A

Dolicocephalic:
-long, narrow facial type
-high mandibular plane angle
-increased anterior vertical height
-sometimes presents with an anterior open bite

127
Q

Describe the following facial type:
Mesocephalic

A

-average facial proportions

128
Q

What are indications for forced eruption of a tooth?

A

to obtain access for endodontic and restorative procedures
-to reduce pocket depth
-when extensive crown lengthening would be unaesthetic or produce poor C:R ratio
-to improve site for implant
-impaction or delayed eruption

129
Q

What are some of the periodontal risks associated
with orthodontic treatments?

A

-uncontrolled perio disease
-root resorption: external apical or invasive cervical
-reduction of the attached gingiva/recession
-fenestrations and dehiscences

130
Q

How much force (in grams) should you extrude a tooth and at what rate?

A

Force level: 35-60grams
Rate of extrusion: no more than 1-2mm/month

131
Q

You have a 4 year old patient who lives in an area where the fluoride in the drinking water is between 0.3-0.6ppm. Should you provide Fl supplement…if so, how much?

A

Yes, 0.25mg per day

132
Q

What are some treatment options for correction of a posterior cross bite in a growing child?

A

Rapid palatal expansion for bilateral or unilateral
Mixed dentition > permanent
Cleft lip
Gains arch length
Basically dental tipping as you use on older patients
Opens up mid-palatal suture
Ex: HAAS, Hyrax,
MARPE (mini-screw assisted RPE): screws are in palate, crank open, needs CBCT
SARPE (surgery assisted RPE)

133
Q

Describe appropriate orthodontic forces

A

Bodily Movement: 70-120g
Uprighting: 50-100g
Rotating/extrusion/tipping: 35-60g
Intrusion: 10-20g

134
Q

Does ortho treatment cause
root resorption? Why?

A

Yes
Etiology is not fully understood but it appears
to be an effect of mechanical stimulation,
pressure on the PDL, activates osteoclasts.
90% of ortho treated teeth exhibit some, 1-5%
are severe. Key is to utilize lighter, sustained
forces. Most common are incisors.
Pre-disposing factors: Hx of resorption,
trauma, extended ortho treatment

135
Q

What is Steiner’s Analysis?
Key Points..

A

First modern analysis. Relates
A/P position of maxilla and
mandible to cranial base.
SNA, SNB, ANB
ANB ≅2°
If >2 then Class 2
If < 2 then Class 3

136
Q

What is Tweed’s Analysis?
Key Elements

A

Simple, clinically useful analysis that used a triangle
to establish ceph norms, identifies tendencies
FMS: frankfurt mand angle, normal 25* 30+=high FMA
FMIA: Frankfurt mand inxisal Angle
IMPA: incisal mand plane angle

Frankfurt plane = Porior and orbitale

137
Q

What is Wit’s Appraisal?

A

Compares the A/P position of the maxilla and mandible to the occlusal plane, measured in MM

138
Q

What is Stephan’s curve?

A

Describes the change in pH that occurs
following a cariogenic challenge
Critical pH of enamel = 5.5
Point at which enamel demineralizes
Cementum: 6.0-6.7

139
Q

Molar Uprighting- why?

A

-allow occlusal forces to be directed along long axis of the tooth
-create a more favorable C:R ratio (after occlusal adjustment) increase space for pontic/replacement
-will increase height of uprighted molar: interferences need to be reduced *endo or intrusion

Potentially improve perio diagnosis:
-eliminate plaque harboring areas
-improve alveolar bone profile

140
Q

What are the basics for clear aligners? how long you wear, how muhc movement?

A

-worn 22 hours/day
-movement: 0.25mm/aligner; 0.1mm for finishing
(may involve IPR)

141
Q

Wht are the indications of clear aligners?

A

ndications:
-Class I, mild malocclusion
-Can move teeth 1-5mm in permanent teeth
-patients who previously had ortho, stopped
wearing retainers

142
Q

What are the contraindications for clear aligners?

A

Contraindications:
-skeletal changes >2mm, crowding >2mm, open
bites, short clinical crowns, severely tipped or
rotated (>20°), difficult for canines, multiple missing
teeth, molar translations that would require TAD,
extrusion of impacted teeth, poor patient
compliance, TAD, patients still growing

143
Q

When should thumb sucking
be addressed?

A

ASAP
- >3 years: damage will be long-lasting and
detrimental to success
- >4 years: finger habit can be well established
and much harder to stop

144
Q

What is this and what it is used for?

A

Modified bluegrass and thumbsucking

145
Q

What is this?

A

W ARCH

146
Q

What is this?

A

Quad Helix

147
Q

What is this?

A

Haas

148
Q

WHAT IS THIS

A

Hydrax

149
Q

What cephalometric points
can be used to analyze facial
profile?

A

Glabella
Subnasale
Soft Tissue Pogonion

150
Q
A

ABGD study (15 decks)

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