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ortho all Flashcards

1
Q

why might space need to be created?

A

crowding relief
correct incisor relationship - OJ/OB
correction of molar relationship
compensate for skeletal discrepancy

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2
Q

how can space be created?

A 
growth + functional appliance
distal movement
expansion
ID enamel reduction
extractions
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3
Q

how is distal movement done?

A

implants

non compliance distaliser

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4
Q

how is expansion caused?

A

quadhelix

rapid maxillary expiser

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5
Q

why might a’s and b’s be extracted?

A

caries
trauma
ectopic perm teeth

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6
Q

why might c’s be extracted?

A 
caries
trauma
transitional incisor crowding
correct centre line
ectopic perm canine
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7
Q

when should you be able to palpate the canines?
what age should you take radiographs if not palpable?
what xrays should be taken to find them?
if palatally ectopic canine how would you treat?

A
  • age 9 onwards
  • 10 years
  • parallax
  • extract c and allow to erupt
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8
Q

when would you extract d’s?

A 
caries
infraocclusion
hypodontia
ectopic perm teeth
ectopic perm canine crowding
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9
Q

when would you extract e’s?

A 
caries
ectopic 5s
infraocclusion
hypodontia
impacted 6
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10
Q

why would max centrals be extracted?

A

trauma
pathology
severe ectopia/dilaceration

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11
Q

why would you extract max laterals?

A

contralateral absent
inavginated odontome
palatal exclusion
resorption by 3

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12
Q

why would mandibular incisors be extracted?

A

lingual exclusion
fanned incisors
tooth size discrepancy

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13
Q

why would you extract canines?

A

severely displaced/crowded out of arch

palatal/buccal ectopic 3

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14
Q

why are first premolars extracted?

A

ant/post crowding
OJ reduction
common tx with fixed appliance for class 1 crowding

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15
Q

why are second premolars extracted?

A

crowding
hypoplasia
poor 4-6 contact
correctino of tooth size discrepancy

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16
Q

why might 1st perm molars be extracted?

A

poor prognosis

compensation

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17
Q

why might 2nd molars be extracted?

A

remote from ant crowding
extract 7 as prophylaxis for crowding, 8 to erupt normally
extract upper 7s to aid distal movement
severe displacement

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18
Q

why might third perm molars be extracted?

A

orthognathic surgery

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19
Q

what is the definition of a fixed appliance?

A

any appliance attached to the teeth by bands and brackets
moves teeth by means of the brackets and their attachment on the bands
appliance cant be removed by the patient

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20
Q

what movements can removeable appliance cause?

A

tipping

intrusion/extrusion

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21
Q

what movements do fixed appliance causes?

A

bodily movements
intrusion/extrusion
rotation
torque

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22
Q

what are edgewise appliances?

A

straight slot cut into brackets

tooth position determined by bends in archwire or orientation of bracket slot/base

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23
Q

what are pre adjusted

A

minimal archwire bends

: slot pre angulated/pre torqued?

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24
Q

what movements can contemporary fixed appliances cause?

A 
optimal tooth control
bodily movement - space closure/OJ reduction
rotations
intrusion/extrusion - OB reduction
uprighting
root torqueing
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25
Q

what types of fixed appliance exist?

A

labial - pre adjusted edgewise
tip edge
- lingual

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26
Q

what are methods of ligation?

A

conventional ligation

self ligation

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27
Q

what type of bends can be caused?

A

1st order - in/out
2nd order - tipping
3rd order - torque

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28
Q

what are the components of fixed appliances?

A 
brackets
molar bands/buccal tubes
archwires
ligatures
auxilliaries
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29
Q

how are fixed appliances fixed to the tooth?

A

composite resin sandwhich
- unfilled resin/filled resin/unfilled resin
etch - 37% phsophoric acid, self etch primer

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30
Q

how are brackets placed?

A

apply to tooth with tweezers

position using - probe and bracket gauage

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31
Q

what tubes are situated on molar bands?

A

archwire tubes
auxillary tubes
headgear tube

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32
Q

how are molar bands placed?

A

band cement - reinforced GI, compomer

position with finger, mershon band pusher and bite stick

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33
Q

what materials are used as archwires?

A

nickel titanium
stainless steel
beta titanium
glass/composite

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34
Q

what are nickel titanium wires used for?

A

alignment/levelling

finishing/detailing

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35
Q

what are stainless steel wires used for?

A

OB reduction
OJ reduction
space closure

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36
Q

what are auxillaries?

A

elastic bands
springs
palatal/lingual arches
headgear

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37
Q

what is elastic traction used to treat?

A

class 2 and 3

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38
Q

what are temporary anchorage devices used for?

A

anchorage

distal movement

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39
Q

what are the 6 points to a good occlusion?

A 
class I molars
no spaces
no rotations
normal angulation
normal inclination
flat occlusal plane
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40
Q

how are fixed appliances removed?

A

bracket removing forceps

band removing forceps

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41
Q

what are types of retainers?

A

removeable - hawley type, pressure formed

fixed - wire/other

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42
Q

what problems can occur during fixed appliance tx?

A 
demineralisation/caries
gingivitis
perio destruction
soft tissue trauma
root resorption
pulp death
enamel fracture
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43
Q

what are functional appliances used for?

A

growth modification and guidance

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44
Q

what occlusions are functional appliances used to treat?

A

class 2 and 3

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45
Q

what are indications for functional appliances?

A 
good dental health
motivated pt
pre adolescent growth phase
skeletal discrepancy mild/mod
increased OJOB
proclined max incisors 
well aligned arches
co incident centre lines
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46
Q

what are contraindications for functional appliances?

A 
poor motivation
age over 14
poor dental health 
condylar disease
unfavourable facial growth
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47
Q

wht are advantages of functional appliances?

A

removeable - easy to clean around
avoid extractions if good response to tx
accelerates skeletal growth
reduce trauma incidence

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48
Q

what are disadvantages of functional appliances?

A 
bulky appliances
compliance
speech
soft tissue trauma
lack of detailed movements
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49
Q

what are types of functional appliances?

A

removeable - energy in muscles and ligaments used to move teeth
fixed - energy in appliance moves teeth

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50
Q

what are removeable functional appliances?

A 
flat ant biteplane
twin block
bionator
activator
fraenkel
teuscher
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51
Q

how does a biteplane work?

A

discludes the mandible

allows growth potential to be realised

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52
Q

what are types of fixed functional appliances?

A

herbst
jasper jumper
twin block

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53
Q

what are the commandments for functional appliance use?

A

25 hour wear
removed only for cleaning, sport and musical intstruments
work best during meals and talking

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54
Q

what is full success with a functional appliance use?

partial success?

A

2mm overjet

reduction is less than 50% value of OJ at start of tx

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55
Q

treatment timing…
in deciduous dentition?
mixed?
permanent/adults?

A
  • unstable, skeletal pattern re establishes
  • 1-2 years pre adolescent growth spurt
  • functional appliances are not an alternative to surgery
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56
Q

at what age should a functional appliance/headgear used?

A

age 10

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57
Q

how is bone laid down?

A

within cartilage - endochondreal
within membrane - intramembranous
bone then remodels by laying down or removing bone form the surface

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58
Q

what are the joints in the head?

A

all bones connect to each other via sutures except the TMJ joint

59
Q

describe the calvarium?

A

6 fontanelles at birth
fontanelles allow compresison of head during birth
intramembranous ossification
5/6 fontanelles fuse during first year of life - ant fontanelle closed by 18 months

60
Q

what is craniosynostosis?

A

premature fusion of sutures on the calvarium - abnormal shaped head

61
Q

describe the cranial base?

A

2 main areas of cartilage that lay down bone by endochondreal ossification
cartilage areas - sychondroses - sphenooccipital, sphenoethmoidal, inthersphenoid
bone lays down here and causes growth of cranial base

62
Q

describe the nasomaxillary complex?

A

maxilla, nasal septum, zygomatic bones
intramembranous ossification
pushed forwards and down

63
Q

describe the mandible?

A

endochondreal activity at the condyle

periosteal activity/surface remodelling

64
Q

when is facial growth complete by?

A

16-17 yrs females
17-19 years males
mandible late growth in 20’s

65
Q

what are supernumeraries?

A

additional teeth - can be exact copies - supplemental teeth or conical/tuberculates - tooth material but dont look like teeth

66
Q

where do SN’s occur?
what are they called in the max midline?
what can they impede?

A

premaxilla
mesiodens
impede eruption

67
Q

what are peg shaped incisors?

A

affects laterals
probs with spacing and aesthetics
associated with absent contra lateral
increased risk of ectopic canines

68
Q

what is hypodontia?

A

congenital absence of one or more teeth
can be hereditary
U2’s L5’s

69
Q

where is hypodontia most common?

what does it present with?

A

permanent dentition
delayed deciduous exfoliation
delayed perm eruption

70
Q

what are neonatal teeth?

A

deciduous teeth that erupt at birth
can cause feeding problems
very mobile should be extracted

71
Q

eruption cyst?

A

blue mucosa overlying an unerupted tooth
most common over es and 6s
asymptomatic
resolves as tooth erupts

72
Q

what are impacted teeth?

A

deciduous or perm teeth that fail to erupt fully

73
Q

what can eruption be due to?

A

obstruction
primary failure of eruption
insufficient space
ectopic teeth

74
Q

what are infraoccluded teeth?

A

often called submerging
usually due to ankylosis adjacent teeth erupt and ankylosed teeth remain unchanged vertically - gives submerging appearance
- no perm successor, idiopathic

75
Q

why might deciduous teeth be retained?

what is the tx?

A

missing perm successor or ankylosis
require xla if due to ankylosis because can defelct perm successor
leave in situ if missing permanent successor

76
Q

how can trauma affect eruption?

A

can result in centre line shift
delayed eruption of perm successor - fibrous mucosa
intrustion of deciduous incisors can cause deflection of perm successor

77
Q

what is a balancing extraction?

A

tooth xla on one arch take out contra lateral tooth

- do stop effect on centre line shift

78
Q

what is a compensating extraction?

A

extract in one arch consider extracting the same tooth in opposing arch

79
Q

what are serial extractions?

A

planned sequence of extractions to relieve incisor crowding in the mixed dentition
minimise demands of ortho

80
Q

where do crossbites commonly affect?

what can they cause?

A

incisors and molars
displacement of tooth/jaw
tooth wear
easily corrected in mixed dentition

81
Q

what does thumb sucking cause to teeth?

A

proclined upper ants
retroclined lower ants
buccal segment crossbites
reduced overbite/ant open bite

82
Q

why might a median diastema cause?

A 
normal dental development
small teeth and large jaws
missing teeth
midling supernumerary
prominent frenum
proclined upper incisors
83
Q

what are advantages of removeable appliances?

A 
easy to clean
good anchorage
can move blocks of teeth
cheap
less chairside time
less inventory
easy to adjust
84
Q

what are disadvantages of removeable appliances?

A 
dependent on pt co operation
tipping only
speech can be affected
retention difficult
lower hard to wear
85
Q

what tooth movements do removeable appliances cause?

A 
tipping
space maintenance
bite opening
crossbite correction
single tooth movemetn
86
Q

what are the components of a removeable appliance?

A

baseplate
activation
retention
anchorage

87
Q

what materials are used to make removeable appliances?

A

stainless steel
elgiloy
acrylic

88
Q

what is the job of the baseplate?

A

hold components together
active/passive
add biteplanes
minimise bulk so comfortable

89
Q

what are ant biteplanes used for?

posterior?

A

ant - OB reduced by allowing eruption of perm teeth, and true intrusion of ant teeth
post - eliminates occlusal interferences anteriorly - can push tooth over the bite

90
Q

what is the force of the appliance dependent on?

A

length, radius and stiffness of wire

91
Q

how is the length of the wire increased in a mouth with reduced space?

A

add coils to wire

92
Q

how do teeth move in a removeable appliance?

A

perpendicular to point of contact with tooth

93
Q

what are palatal springs?

A

cause mesio distal and buccal movement
guard wire stops spring coming too far away from baseplate
point of application at 90 degrees to intended tooth movement

94
Q

what are buccal canine retractors?

A

buccally placed canine to be moved palatally as well as distally
activated by winding up coil or adjusting ant arm

95
Q

what is a z spring?

A

increases wire length where space is limited
spring perpendicular to palatal surface
activated by pulling a couple of mm away from baseplate at an angle of approx 45 degrees in direction of desired movement

96
Q

what are t springs?

A

used to move teeth buccally - canine/premolar

activated by pulling away from baseplate at angle of 45 degrees

97
Q

what are bows?

A

active/passive

retract proclined incisors

98
Q

what is a roberts retractor?

A

0.5mm bow used to retract incisors

99
Q

what are screws?

A

move teeth labio-lingually
transmits force via acrylic contacting the teeth
transversely expand
turn once a week then twice

100
Q

what are adams clasps/cribs?

A

engage undercuts at mesial and distal

101
Q

what are southend and c clasps?

A

use undercut beneath contact point

102
Q

what are ball ended hooks?

A

engage undercuts interprpximally

103
Q

what is anchorage?

A

resistance to unwanted tooth movements - force created as a reaction to actove component

104
Q

how is anchroage increased?

A

clasp more teeth/move one or two teeth at a time, use lighter forces

105
Q

what is used to fit an appliance?

A

adams pliers, spring forming pliers
marker
measuring device
acrylic trimmer

106
Q

what is normal occlusion?

A

acceptable variation from the norm
- well aligned teeth
no crowding
class 1 incisor molar relationship

107
Q

what is malocclusion?

A

irregularity in the occlusion beyond the accepted range of normal

108
Q

what are genetic causes of malocclusion?

A

skeletal pattern
size of jaws and teeth
syndromes - cleft lip/palate

109
Q

what can cause crowding?

A

big teeth small jaws

110
Q

what is spacing?

A

small teeth

big jaws

111
Q

what are environmental causes of malocclusion?

A 
soft tissues - incompetent lips
habits - thumb sucking
pathology
trauma - intrusion
local factors
112
Q

what are local factors affecting malocclusion??

A

additional teeth
missing teeth
fraenum
retained deciduous/early loss

113
Q

what are risks of ortho tx?

A 
demineralisation
root resorption 
pulp damage
gingivitis/perio damage
soft tissue damage
114
Q

what is demineralisation?

A

white marking = eventual cavitation
fixed appliances predispose to plaque accumulation bc cleaning is more difficult
labial side of fixed appliances, palatal surfaces of removeable

115
Q

why does demineralisation occur?

A

poor oh
acidic attack
plaque, refined carbs, susceptible tooth, contact time with tooth surface

116
Q

how to manage pts with demineralisation risk?

A 
OHI 
diet advice
F mouthwash
identify and remove stagnation areas
reduce flash around brackets
use GI cement on bands bc F release
117
Q

how much root resorption tends to occur during tx?
what teeth are commonly affected?
what are risk factors?

A 
1mm
incisors
pts with resorption pre tx
prev trauma
root filled may increase risk
118
Q

how can you lessen the risk of root resorption?

A

lighter forces
min tx length
repeat radiographs every 6 months

119
Q

why is pulpal pain caused during ortho?

A

pulpal ischaemia as tooth starts to move

120
Q

what are risk factors for pulp damage during ortho tx?

A

prev traumatised teeth - monitor with vitality testing

121
Q

how can you manage pulp pain during ortho?

A

ischaemia is transient

2-7 days after fit/adjustment

122
Q

how can perio tx be treated with ortho?

A

take care bc reduced support
use lighter forces
ensure perio disease controlled prior to tx

123
Q

how can soft tissue trauma be caused from ortho tx?

A

traumatic ulceration
friction against appliance
archwire ends not tucked out the way
clumsy instrumentation

124
Q

what can be used to relieve soft tissue trauma caused by appliances?

A

chlorhexidine to calm ulceration

wax application

125
Q

what mechanisms are put in place in headgear to prevent injury?

A

neckstraps should prevent displacement

recoil prevented

126
Q

what risks to ortho implants cause?

A

poor success bc no osseo integration

risk of perforation of roots/infection

127
Q

what may pts be allergic to that you could come across in ortho?

A

latex

nickel

128
Q

what are you looking to identify by viewing the patient anteroposteriorly?

A

view form side
look at position of maxilla to mandible
class1- mandible 2-3mm posterior to maxilla
class2 - mandible retruded relative to maxilla
class3 - mandible protruded relative to maxilla

129
Q

what are you looking to indentify in the vertical?

A

pt viewed from side with teeth in ICP

  • lower facial height - distance from eyebrow to base of nose should be equal from base of nose to lower chin
  • FMPA - increased - lines meet before back of head, reduced, cross after head
130
Q

what are you looking to identify when looking at pt in transverse?

A

degree of symmetry

occlusal plane symmetry

131
Q

what should you examine re ortho about the lips?

A

lip competence
lip position relative to upper incisors
smile line

132
Q

what should be noted about the tongue?

A

variations in shape/size

133
Q

what habits should be enquired about re ortho?

A

thumb sucking

134
Q

what do you want to know about the labial segment alignment?

A

aligned crowded or spaced
angulation relative to jaw base
rotations/displacements
inclincation of canines

135
Q

what do you want to know about the labial segment?

A

overjet
overbite
ant crossbites
centrelines

136
Q

what do you want to know about buccal segment alignment?

A

gen alignment and presence of spacing or crowding

rotated teeth or any displaced from arch

137
Q

what is a class 1 incisor relationship?

A

lower incisor edges occlude or lie below cingulum of upper incisor

138
Q

what is a class 2 incisor relationship?

A

div 1 - central incisors are proclined or of avergae inclincation and increased overjet
div 2 - upper incisors are retroclined and OJ is minimal or decreased

139
Q

what is a class 3 incisor relationship?

A

lower incisor edges lie ant to cingulum

140
Q

what are the divisions of a molar relationship?

A 
class 1 - MB cusp of upper first molar occludes with MB groove of lower 1st
class 2 - MB cusp occludes mesial to the groove
class 3 - MB occludes distal to groove
141
Q

what radiographs can be taken for ortho screening?

A

DPT
lareral ceph
upper ant occlusal

142
Q

what is IOTN comprised of?

A

dental health component

aesthetic

143
Q

what are the IOTN tx grades?

A 
1 - no need
2 - little need
3 - moderate need
4 - great need
5- very great need
144
Q

what is the IOTN aesthetic score component?

A

score 1 or 2 - none
score 3/4 - slight
score 5,6,7 - mod
8,8,10 - definite

Ortho (10 decks)

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