Ortho Assessment

Question 1

Why do we do an ortho assessment?

Answer 1

1. To determine if any malocclusion is present
2. Identify any underlying causes
3. Decide if tx is indicated

Question 2

What causes asymmetry issues to occur?

Answer 2

Issues with growth of condyles

Question 3

What age do ortho assessments occur?

Answer 3

1. Brief exam at 9 years

2. Comprehensive exam when premolars and canines erupt (11-12yrs)

Question 4

What do we look for in an ideal occlusion? (6)

Answer 4

1. Molar relationship
   - Distal side of upper molar occluding with mesial side of lower molar
2. Crown angulation
3. Crown inclination
4. No rotations
5. No spaces
6. Flat occlusal planes

Question 5

PMH:

List some conditions that are now a contra-indication to orthodontic tx (3)

Answer 5

1. Allergy
2. Epilepsy
3. Drugs
   - Certain drugs lead to gingival inflammation
   - Could be difficult cleansing or cleaning brackets

Question 6

Questions to ask in PDH

Answer 6

1. Frequency of attendance
2. Nature of previous tx
3. Co-operation w previous tx
4. Trauma to perm dentition

Question 7

What are some habits that can influence ortho issues?

Answer 7

1. Thumb sucking
   - Procline uppers
2. Lower lip sucking
   - Procline uppers
3. Tongue thrust
   - OJ
4. Chewing finger nails
   - Root resorption

Question 8

What are the steps of an ortho assessment (5)

Answer 8

Hx
Examination - look at skeletal bases
SI
Diagnosis
TX

Question 9

Extra-oral exam

Answer 9

1. Skeletal base
2. Soft tissues
   Lips:
   Competent / incompetent
   Tongue:
   Position, habitual + swallowing
   Habits:
   Thumb sucking
   Speech:
   Lisping
3. TMJ

Question 10

What 3 planes should a facial skeletal pattern be considered in?

Answer 10

1. Antero-posterior
2. Vertical
3. Transverse

Question 11

What are the 2 ways to carry out an AP skeletal assessment? (2)

Answer 11

1. Visual assessment
   - Skeletal assessment vertical + lateral (asymmetry)
2. Palpate skeletal bases

Question 12

How do we carry out a vertical assessment?

Answer 12

Involves the Frankfort - Mandibular planes angle (FMPA)

2 lines should meet at the back of the head

Question 13

How does a reduced FMPA angle present?

Answer 13

2 lines don’t meet at the back of the head

Question 14

How does an increased FMPA angle present?

Answer 14

2 lines meet well before the back of the head

Question 15

Define incompetent lips

Answer 15

Lips that don’t meet at rest

Question 16

What can a lip trap cause?

Answer 16

Proclined upper incisors

May lead to relapse of OJ if persists at the end of tx

Question 17

What can a hyperactive low lip cause?

Answer 17

Retroclined lower incisors

Question 18

What is a tongue thrust associated with?

Answer 18

AOB

Some people push their tongue forward when they swallow (ant tongue thrust)

2 types:

Adaptive
- we can close the AOB

Endogenous
-tx will relapse

Question 19

What does digit sucking cause? (4)

Answer 19

1. Proclined upper incisors
2. Retroclined lower incisors
3. Localised AOB or incomplete OB
4. Narrower upper arch +- unilateral posterior Xbite

Question 20

What do we check the TMJ for as part of the extra-oral exam?

Answer 20

1. Path of closure
2. Range of movement
3. Pain
4. Click from joint
5. Deviation on opening
6. Muscle tenderness

Question 21

What is mandibular displacement?

Answer 21

Displacement of the mandibule up and to the right from RCP to ICP

Question 22

What to check as part of intra-oral exam (7)

Answer 22

1. OHI + Perio health
2. Count teeth from back
3. Teeth of poor prognosis
4. Assess crowding/spacing/rotations
5. Inclination/angulation
6. Palpate for canines if not erupted
7. Note teeth of abnormal shape/size

Question 23

What are the 3 main risks of ortho tx?

Answer 23

1. Decalcification
2. Root resorption
3. Relapse

Question 24

Course of action for mesially tipped canine?

Answer 24

Extract 4 and canine will just tip back

Question 25

How do we assess the angulation of incisors to the mandibular plane?

Answer 25

- Pull down the lower lip | - Assess the angle the lower incisors make to your finger

Question 26

What should the angulation of incisors to the frankfort plane be?

Answer 26

110 degrees

Question 27

Where does the FF measure from?

Answer 27

Top of the ear to bottom of the orbit

Question 28

What do we look for when studying teeth in occlusion (7)

Answer 28

1. Incisor relationship (BSI) 2. OJ 3. OB/ open bite 4. Molar relationship (angles classification) 5. Canine relationship 6. Cross bites 7. Centre lines

Question 29

What are the incisor relationship classifications? (4)

Answer 29

1. Class I 2. Class II (Div 1 +2) 3. Class III 4. OJ,OB + Centrelines

Question 30

Class I incisor relationship

Answer 30

Normal OJ + OB

Question 31

Class II div 1 incisor relationship

Answer 31

Increased OJ, front teeth beyond lowers

Question 32

Class II div 2 incisor relationship

Answer 32

Centrals retroclined

Question 33

Class III incisor relationship

Answer 33

Anterior positioning of mandible to maxilla

Question 34

What teeth do we measure for an OJ?

Answer 34

Any of the 4 incisors

Question 35

Canine relationship classification (3)

Answer 35

Class I - Upper canine distal to lower Class II - Upper canine anterior to lower Class III - Upper canine posterior to lower

Question 36

Function of lateral ceph

Answer 36

Measurement on angles and distances between points of the skull

Question 37

Ortho checklist for basis of referral letter (7)

Answer 37

1. Name/age/sex of patient 2. H/CO 3. Incisor relationship - Skeletal base (AP, V, T) 4. Teeth present/absent - OH - Poor prognosis 5. Lower + upper arch 6. OJ - OB - Centrelines - Molar relationship - Xbites 7. IOTN score