Ortho - Examination Flashcards
When are orthodontic assessment routinely carried out?
When the patients approximately 9 years old for an initial assessment.
Then when the patient has all of their permanent teeth for a more comprehensive examination (11-12 years)
When taking a patient history, what kind of questions would you ask to gauge there motivation to having braces?
What don’t you like about your teeth? give a list.
Guage if they are motivated for braces (better prognosis) Do you want braces?
Possible contraindications to ortho?
There isn't very many. Poor OH and diet Past trauma Allergy to Ni or latex (but not really a factor anymore) Epilepsy Drugs
Questions relating to dental history?
Have you experienced trauma? (risk of root resorption)
Guage their attendance to the dentist, OH levels and caries risk.
Past treatments are were the co-operative
Social history?
Is the practice easily accessed
public transport
Do Mum and dad work? can they get you to appointments?
List some possible bad habits which might be of note?
Thumb sucking
Biting of nails (root resorption of UI)
Tongue thrust
What are the main areas of consideration for an E/O in ortho?
Skeletal bases
Soft tissues
TMJ
(Look at the parent as can be an indication of how the children will develop and grow)
What is the main cause of a class ll div l
In 80% of cases. The mandible isn’t smaller It is just placed further back in the skull.
There are 3 planes that are examined in relation to the facial skeletal pattern. What are they?
Anterior posterior dimension
Vertical dimension
Transverse/lateral dimension
Before running any facial skeletal assessment what must the Frankfort plane be?
Horizontal
What is the Frankfort plane?
It is a line that runs from the superior border of the external auditory meatus to the inferior border of the orbit.
The AP skeletal assessment can be classed by what?
The gap between the maxilla and the mandible.
Class l - 2-3mm
class ll - more than 3mm
class lll - less than 2-3mm
In growing children how is a class ll fixed to bring the mandible forward?
A functional appliance
What is the FMPA?
This is where the Frankfort plane meets the mandibular plane. (runs along the border of the mandible).
In a class l relationship, what is the value of FMPA?
25 degrees
What are some reasons for the FMPA increasing?
This can be due to a reduced overbite or an anterior open bite.
This causes the mandible to become more vertically angled, increasing the FMPA.
What is a possible reason for a decrease in the FMPA?
The patient has a very deep bite.
Causing the mandible to be more horizontal.
Name two ways in which you can assess the vertical skeletal relationship?
Anterior face height ratio
FMPA
The transverse skeletal relationship is looked at how?
Look at the patient front on, down the mid-sagittal reference line.
What is included in an E/O soft tissues assessment?
Lips
Tongue
Habits - thumb sucking etc
Speech
What are lips classified by?
Competent (lips meet naturally at rest)
In-competent (lip don’t meet at rest)
What can happen with in-competent lips?
A lip trap can occur where the upper incisors rest on the lower lips and can cause them to be pro-clined.
What can hyperactive lower lips cause
Lower incisors become retroclined
What can tongue thrusting when swallowing cause?
Anterior open bite
What assessments of habits are relevant to ortho?
Thumb and digit sucking
What can thumb and digit sucking cause in the mouth?
Thumb sucking can cause the uppers to be proclined and lowers retroclined.
It can also cause the upper jaw to be smaller as the tongue isn’t there to prevent the check and other soft tissues from putting external force on the upper arch. Causing a unilateral posterior crossbite. Which affects occlusion.
Localised AOB with finger sucking
WIth speech what can happen?
Lisping can occur and the tongue causes spacing and anterior open bite
Brief TMJ assessment.
Path of closure Range of movement Tenderness of muscle Pain or clicking from joint Deviation on opening mandibular displacement
RCP stands for
Retruded contact position
This is the first contact before ICP
if the patients RCP is the same as the ICP what does this mean?
That there is problems with the patients bite which can severely impact the TMJ and must be treated
What is included in the I/O
Teeth present Oral hygiene and periodontal health Quality of teeth Assess crowding spacing and rotation Inclination and angulation of teeth Palpate for canines if not erupted Not abnormal sized teeth (peg laterals)
From what age do you palpate looking for canines and what are you looking for?
9 years of age
Ectopic canines
Can you continue ortho if patients have bad OH, caries or periodontal disease
No
As will further decalcification
What are the 3 main risks of ortho treatment?
Decalcification
Relapse
Root resorption
What should a normal overbite be %?
33-50%
Angles classification of molar buccal segments?
Class l - the mesiobuccal cusp of U6 occludes with the mesial buccal groove of the lower 6. class ll - the lower 6 now occludes further back in mouth class lll - the lower 6 occludes more mesial in the mouth
Canine relationship?
Class l - the upper 3 mesial slope occludes with the lower 3 distal slope.
class ll - lower 3’s move distally
Class lll - lower 3’s move mesially
What is more important in achieving the perfect canine or molar relationship, and why?
Canine
As if the canines are in the right place then the incisors will move into right place also and this is the aesthetic zone
Special investigations in ortho?
Radiographs - Lateral Cephs - OPT - Maxillary anterior occlusal Scanning Study models Photographs
What is the score used to assess treatment
IOTN
