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Pediatrics and Orthodontics > Ortho Final > Flashcards

Ortho Final Flashcards

1
Q

Who established Orthodontics as the first specialty school and also created the 3 classifications of occlusion?

A
  • Edward Angle
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2
Q

What are the three Angle Classifications and what makes them different? (occurrence, relation MB cusp, bite, canine position)

A
  • Class I: Most common (70%), triangular ridge of MB cusp of Max 1st molar articulates with Buccal Groove of Man 1st molar. Overbite 1-2 mm, Max. Canine between Man Canine and 1st premolar.
  • Class II: 25% of population, MB cusp between Man. 1st molar and 2nd premolar (protruded), large overbite, Max. Canine is mesial to Mand. Canine.
  • Class III: 5%, MB cusp between Man. 1st Molar and 2nd Molar (retruded), negative overset (underbite), Max. Canine is is distal to Man. Canine.
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3
Q

What is a termed used to describe an individual that functions as a class I but also has CR/CO shift that allows them to function in a class II?

A
  • Sunday Bite
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4
Q

Class II Angle Classification has two divisions, what makes them different?

A
  • Division I: Class II molars with protruded Max. Incisors.

- Division II: Class II molars and Max. Lat. Incisors are tipped labially and mesially.

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5
Q

There are also skeletal classifications. Straight, Convex and Concave. What Angle classification are they associated with?

A
  • Straight: Class I - Mandible is similar in size to Maxilla.
  • Convex: Class II - Mandible is smaller than the Maxilla.
  • Concave: Class III - Mandible is larger than the Maxilla.
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6
Q

As the mandible grows, Leeway space forms between permanent teeth. What is the usually space in the mandible and the maxilla? When the distal portions of teeth perfectly line up, what is this called and what class does it cause? Shifts in a direction are called “Steps” what does a Mesial Step do and what does a Distal Step do?

A
  • Mandible: 2.5 mm per side
  • Maxilla: 1.5 mm per side
  • Flush Terminal Plane, Class II then shifts to a Class I
  • Mesial: Class I or III
  • Distal: Class II
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7
Q

In primary dentition there are spaces called Primate Spaces that are normal. where are these found in the Maxillary and Mandibular teeth?

A
  • Maxilla: Between the primary Lateral Incisors and the primary Canines.
  • Mandbile: Between the primary Canines and the primary 1st Molar.
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8
Q

Dr. Lawrence Andrews created 6 keys to normal occlusion, what are they?

A
  1. Molar Relationship: Distal surface of Max. 1st Molar contacted with the Mesial surface of the Man. 2nd Molar.
  2. Crown Angulation: Degree of crown tip - mesial/distal direction (Plus: Gingival/Cervical tipped Distally from incisal, Minus: Gingival/Cervical tipped Mesial from incisal)
  3. Crown Inclination: Protrusion vs retrusion of crown - overbite vs underbite (Plus: Gingival is Lingual, Minus: Gingival is Incisal/Buccal) - Minus is more natural.
  4. Elimination of Rotations
  5. Tight Interproximal Contact
  6. Flat Occlusal Plane: Curves of Spee are not desired (this tends to deepen with time)
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9
Q

What is when the functional cusps in a bite are reversed (facial on Max. and lingual on Mand.)? What is a very poor molar relationship where the lingual side of the Max. and the Buccal side of the Mand. are the only touching contact?

A
  • Facial/Buccal Crossbite
  • Lingual Crossbite
  • (Shift in the Mandible is the name of the cross bite)
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10
Q

The mandible can move in a direction in which all points within a body have identical motion (moves condyle forward using lateral pterygoid muscles), what is this called? And a direction in which the body of the mandible is turning on a Horizontal plane and a Frontal plane, what is this called?

A
  • Translation

- Rotation

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11
Q

Posselt constructed a 3D representation of the total envelope of the mandibular movement. What is the most protruded opening and closing stroke called? What is the retruded opening and closing stroke?

A
  • Far Right Below #5

- Far Left Below #1

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12
Q

Anterior movements of the mandible are controlled by what? What is the difference between an Open Bite and a Deep Bite? The more Horizontal overlap of anterior teeth means? The more Vertical overlap of anterior teeth means? What will decrease anterior guidance? What will increase anterior guidance?

A
  • Horizontal/Vertical overlap of the anterior teeth.
  • Open Bite: Negative overbite/negative overjet. No anterior guidance/no gliding contact.
  • Deep Bite: Overbite/Overjet is greater than 3 mm. Retrusive force on the mandible.
  • Posterior cusps are shorter
  • Posterior cusps may be taller
  • Increase of Horizontal overlap
  • Increase of Vertical overlap
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13
Q

The TMJ is capable of hinging and gliding, what type of joint does that make it? What two bony structures make up this? What are these bones covered with? What sits in the middle of these bones? Posteriorly is is attached to? Anteriorly? What is the inclined slope that the condyle slides down called?

A
  • Ginglymoarthrodial
  • Glenoid Fossa (max.) and Condylar Process (man.)
  • Avascular Fibrous Tissue
  • Articular Disc of dense connective tissue that is avascular and has no nerves.
  • Posterior: Retro-discal tissue
  • Anterior: Capsule and Lateral Pterygoid muscle.
  • Articular Eminence (Condylar Guidance)
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14
Q

What must the cusp inclines on premolars be for them to disocclude?

A
  • 45 with 45 or 60 with 60 degrees
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15
Q

What is when the Max. and the Mand. teeth contact simultaneously when the condylar processes are fully seated in the fosse in a slightly translated position and the teeth do not interfere? What is when the condyles articulate with the thinnest avascular portion of their articular discs in an anterosuperior position independent of tooth contact?

A
  • Maximum Intercuspation or Centric Occlusion

- Centric Relation

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16
Q

There are Functional (supporting) cusps and Nonfunctional (non-supporting) cusps on the teeth. On what is the functional/nonfuctional cusp of each arch? Where do the contacts of these cusps occur on the opposing tooth?

A
  • Max: Functional: Lingual, Non-Functional: Facial.
  • Mand.: Functional: Facial, Non-Functional: Lingual.
  • On the corresponding faciolingual center on a marginal ridge/fossa.
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17
Q

What is when the mandible is moves straight forward in relation to the maxilla? What is when the condylar movement takes place on the working side during lateral excursion? What is when the condylar movement takes place on the nonworking side during lateral excursion?

A
  • Protrusion
  • Laterotrusion
  • Mediotrusion
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18
Q

What is the most stable relationship in regards to centric cusp contact? What is an Angle Class I centric cusp contact? Class II or Class III?

A
  • Tooth to tooth, cusp to two adjacent marginal ridges.
  • Tooth to tooth, cusp to one marginal ridge.
  • Tooth to tooth, cusp-fossa contact.
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19
Q

With functional contacts, what is different in Class II than in Class I?

A
  • Loses functional cusp occlusion on the DB cusp of the Mand. 2nd molars and on the Max. 1st premolars. The rest of the functional contacts shift posteriorly.
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20
Q

With functional contacts, what is different in Class III than in Class I?

A
  • Loses the functional cusp occlusion on the Mand. 1st Premolars and the central fossa of the Max. 1st molars. The rest of the functional contacts shift anteriorly.
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21
Q

NEED TO MEMORIZE CONTACTS ON SLIDES 46-50

A

-

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22
Q

Equilibration is a three step procedure, what are the steps?

*(Each is very detailed, re-read these slides)

A
  • Correction of Centric Contacts and Functional Cusps. (Centric Relation)
  • Adjustment of Mediotrusive and Laterotrusive contacts.
  • Improvement of Anterior guidance and Canine guidance. (Anteriors adjustment for protrusive movements)
23
Q

The mandible is attached to the base of the skull by what three ligaments and what do they do and origin/insertion? (ligaments don’t stretch much)

A
  • Temporomandibular Ligament (Limits rotation on opening) Origin: Articular Eminence, Insertion: Neck of condyle.
  • Sphenomandibular Ligament (Limits separation between the condylar process and the articular disk), Organ: Spine of sphenoid, Insertion: Below the lingula.
  • Stylomandibular Ligament (Limit the separation between the condylar process and the articular disk as well as limits forward protrusive movement of the mandible) Origin: Styloid process, Insertion: Mandibular Angle.
24
Q

There are two groups of muscles responsible for mandibular movements, the muscles of mastication and the suprahyoid muscles. What muscles are in the muscles of mastication and what do they do?

A
  • Muscles of Mastication:
    • Temporal – Elevator, retracts and assists the mandible in rotation and lateral movements.
    • Masseter – Elevator and protracts mandible. Assists in lateral movement of mandible
    • Medial Pterygoid – Elevates mandible and enables lateral movements and protrusion.
    • Lateral Pterygoid: Inferior head - Inserts onto the neck of condyloid process of the mandible.
    • Lateral pterygoid: Superior headd - Inserts onto the articular disc and fibrous capsule of the temporomandibular joint.
25
Q

There are two groups of muscles responsible for mandibular movements, the muscles of mastication and the suprahyoid muscles. What muscles are in the suprahyoid muscles and what do they do?

A
  • Suprahyoid Muscles:
    • Geniohyoid – Elevates and draws hyoid bone forward. Assists in respiration by dilating the upper airway. Also assists in depressing the mandible.
    • Mylohyoid – Elevates and stabilizes hyoid bone and tongue. Important during swallowing and speaking. Can depress the mandible if other muscles are used to stabilize the hyoid bone.
    • Digastric – Elevates hyoid bone and depresses mandible.
    – Posterior belly – Longer than the anterior belly and is attached to the mastoid process and hyoid bone.
    – Anterior belly – Attached to the lower boarder of the mandibular symphysis and the hyoid bone.
    – The Posterior belly and anterior belly are connected by an intermediate tendon through the greater cornu of the hyoid bone through a fibrous loop.
26
Q

**(The geniohyoid and myhlohyoid muscles initiate the opening movements and the anterior belly of the digastric completes mandibular depression. When the muscles of mastication are in a state of contraction, the suprahyoid muscles elevate the hyoid bone. However, if the infrahyoid muscles (which anchor the hyoid bone to the sternum and clavicle) are contracted, the suprahyoid muscles depress and retract the mandible. The stylohyoid muscle (which also belongs the suprahyoid group) may contribute indirectly to mandibular movements through fixation of the
hyoid bone, but it does not play a significant role in mandibular movement.

A

-

27
Q

What tissue is the primary determinant of its own growth and the other tissues respond indirectly or epigenetically? What tissue is the primary determinant of skeletal growth? What tissue has the skeletal elements are embedded is the primary determinant of growth, and both bone and cartilage are secondary followers?

A
  • Bone
  • Cartilage
  • Soft Tissue Matrix
28
Q

What is the major difference between the theories of growth? What has a major role in in growth outside of genetics?

A
  • Location at which the genetic control is expressed.

- The environmental factors on growth.

29
Q

Is jaw growth and function inherited?

A
  • Genetics do not actually govern their own function but are controlled by epigenetic (indirect) influences.
30
Q

Why is the theory that cartilage controls growth incorrect? Why is the theory of sutures, condyles, synchondroses and mater growth centers incorrect?

A
  • Because mandibular condyles are growth Sites not growth Centers.
  • Because once these tissues are taken out of a body and placed in another growth does not occur (sutures/condyles) or that they continue growth without stopping (synchondroses).
31
Q

Wolff’s law and the Mechanostate model state what? What appear to relate to the triggering of osteoblastic and osteoclastic responses?

A
  • Bone will adapt to the loads under which it is placed.

- Bioelectrical Signals

32
Q

What is the difference between a growth site and a growth center?
What are examples of these locations? What is the difference between primary and secondary cartilage and example?

A
  • Site: A location where growth occurs. (Sutures, Condyles)
  • Center: Location at which independent growth occurs regardless of the growth/development of adjacent structures. (Synchondroses)
  • Primary: Reacts to systemic growth stimuli such as hormones (Growth Centers).
  • Secondary: Reacts after additional modulation by local growth factors (Growth Sites).
33
Q

What is the most correct theory of growth and what does it entail? IS the nasal septum considered an important growth center in this process?

A
  • The Functional Matrix method: Growth of the face occurs as a response to functional needs and neurotrophic influences the nasal and oral cavities that are mediated by SOFT Tissues in the jaw. (Both bone and cartilage react to this form of epigenetic [indirect] control)
  • Yes
34
Q

At the _____ month of development the head takes up almost ___% of the total body length. This axis of increased growth from the head toward the feet is called what?

A
  • 3rd month, 50% is head

- The Cephalocaudal Gradient of Growth (not all tissues grow at the same rate)

35
Q

What do Growth Charts help with? If you are taller/larger than 90% where would you be plotted? If you were smaller than 90% where would you be plotted? Normal? What is considered abnormal? What is the average peak growth for girls? For boys? *(usually the earlier the growth spurt the shorter it lasts)

A
  • In measuring how much an individual deviates from the usual pattern of development.
  • 90% line
  • 10% line
  • 50% line
  • > 95%, <5%
  • Age 12 girls, Age 14 boys
36
Q

At the cellular level, what are the three possibilities of growth? *(Once mineralization occurs interstitial growth becomes impossible and can only occur on the surface)

A
  • Hypertrophy: Increase in size.
  • Hyperplasia: Increase in the number of cells (most prominent).
  • Secretion of extracellular material: Increase in size independent of the number or size of cells themselves. (Bone mineralization)
37
Q

Cartilage makes up a majority of the skeletal structures of the body. Since it is nearly avascular how does it receive nutrients?

A
  • Diffusion (meaning cartilage must be thin)
38
Q

The Chondrocranium comes from what three pairs of cartilaginous precursors? The ossification process of this occurs in which direction? At what month does blood vasculature occur?

A
  • Ethmoid, Sphenoid and Occipital cartilages.
  • Posterior to anterior
  • 4 month
39
Q

Is bone ever a primary tissue? There are two types of bone formation, what are they, what makes them different, what are examples and what are specifics about the development of each?

A
  • No, it always develops from another tissue.
  • Intramembranous: Develops from CT, and forms flat bones such as the skull/sutures, maxilla, zygomatic/temporal, bone fractures and MOST of the Mandible. Osteoprogenitor cells in CT differentiate into osteoblasts that lay down Osteoid near Trabeculae, collagen (not cartilage, its CT) is formed which undergoes ossification.
  • Endochondral: Develops form cartilage and forms MOST bones including the Chondrocranium (Base of the skull), Ethmoid, Sphenoid and Occipital bones. Uses Synchondroses that appears like a two sided epiphyseal plate.
40
Q

In what part of long bones is the major center for growth? What does the Periosteum do? What is the removal of bone called? The formation of bone? When is the greatest period of cranial growth? What are portions of the head near sutures that allow the skull to be deformed during birth? What is the most complex structure of the human skeleton and is also the first region of the skull to reach adult size? The inter-sphenoid and sphenoid-ethmoid synchondroses are used to ossify the bands of cartilage in the skull, at what age does this fuse and become stable?

A
  • Epiphyseal Plate (The rate of cartilage cell proliferation must be equal to or greater than the rate that they mature or growth will stop - this plate will disappear if it does not)
  • Adds thickness and reshapes bone
  • Resorption
  • Apposition (bone formation)
  • Birth to 5 years old
  • Fontanelles
  • The Cranial Base
  • 7 years old
41
Q

Where is the center of ossification of the maxilla? The maxilla grows in what direction? Age range for ossification?

A
  • Angle between the Anteriorsuperior alveolar nerve and the inferior orbital nerve.
  • Downward and forwards.
  • Cranial growth stops at age 7, Sutural Growth continues after age 7 that brings the maxilla forward. As it progresses forward bone is removed/remodeled at the anterior portion and new bone forms from the posterior portion pushing it forward.
42
Q

In which direction is the palatal vault formed? What suture fuses the palatal shelves?

A
  • Downwards and forwards. Bone is removed on the nasal side and added on the oral side.
  • Intermaxillary Suture (contains cartilage)
43
Q

Does the development of the mandible include Meckel’s Cartilage? In what direction does it grow? When they meet at the middle they are separated by what fibrous tissue? Where is the point of divergence where the ramps of the mandible intramembranous formation turns away from Meckel’s Cartilage? What does Meckel’s Cartilage become? When does secondary cartilages (condylar, coronoid and symphyseal) develop? What happens to condylar cartilage? Time-line for condylar growth? What does Symphyseal cartilage do?

A
  • No it begins just next to it. (Intramembranous Bone formation)
  • Anterior and Posterior directions.
  • Mandibular Symphysis
  • Lingula
  • Portion of the middle ear
  • Between the 10-14 week
  • Part is replaced by bone, but the upper end persists in the condyle and becomes articular cartilage.
  • Peaks at age 12-14 and completed by 20 - Condylar growth.
  • At each end of Meckel’s Cartilage and seals the Symphysis between the two bones of the mandible and is replaced by bone after the first year of birth.
44
Q

Why remove third molars? Why does this crowding happen?

A
  • To prevent mandibular/incisor crowding. (This does not occur in individuals without 3rd molars).
  • As the maxilla finishes growth the mandible continues to grow. The mandibular teeth either must crowd or the maxillary teeth must develop spaces. Can also be caused by posterior wear, stress/clenching and changes in muscular forces.
45
Q

What is caused by pressure against the developing face prenatally and can lead to distortions of rapidly growing structures?

A
  • Intrauterine Molding
46
Q

What is a condition present at birth where the infant has smaller than normal lower jaw, difficulty breathing, cleft palate, Gastroesophageal reflux, and feeding difficulties? Changes near what gene may cause this? What surgeries are done to fix this?

A
  • Pierre Robin Sequence
  • SOX9 Gene
  • Osteotomy (bone fracture) of the mandible with a small metal distraction device.
    2 days later the device is turned using a screw to slowly move the jaw forward at 0.5 mm to 1.5 mm per day (this also helps the tongue to move forward and increases breathing).
    After the jaw has moved 15 to 20 mm the osteotomy heals over 6 to 8 weeks and the device is removed.
    At 12-18 months the clef palate will be repaired.
    Tracheostomy may be needed if breathing obstruction is severe, can also do a Glossoptosis and move the tongue forward.
    Tympanostomy tubes if hearing is affected.
47
Q

When the Condyle is fractured what happens?

A
  • It usually fractures on the opposite side of the blow and the fractured portion is lodged anteriorly by the lateral pterygoid muscle. If it occurs in a child there is an 80% chance that it will regenerate. In adults it can lead to ankylosis of the TMJ joint due to scar tissue. It is the most common cause for occlusal asymmetry.
48
Q

What drugs can cause cleft lip?

A
  • Phenytoin (anticonvulsant)
  • Vit. A (Accutane)
  • Methotrexate (Cancer/Arthritis/Psoriasis)
49
Q

When does cleft palate from the failure of the palate shelves to fuse occur? How does cleft lip occur? What ethnicities are more likely to have a cleft lip/palate? What state has teh highest incidence of cleft lip and palate?

A
  • 7-10 weeks
  • Failure of the medial nasal process and the maxillary process to fuse.
  • Native Americans, Asians and Latinos.
  • Utah (double the national average)
50
Q

What devices are used as a pre surgical orthopedic treatment for cleft lip and cleft palate?

A
  • Nasoalveolar Molding Device (protection)

- Latham Device (brings the two pieces of the cleft palate closer together, requires surgery)

51
Q

When is surgery for cleft lip done? Cleft palate?

A
  • Before the age of 12 months

- Before 18 months

52
Q

What occurs due to the brain not sending the proper signals to control breathing? What is when you can’t breathe due to upper airway obstruction? What risk factors are there with these? What physical signs may they have? What can be done to treat this? *(Extractions don’t cause sleep apnea)

A
  • Central Sleep Apnea
  • Obstructive Sleep Apnea
  • Large tonsils/adenoids, obesity, syndromic usually have a higher chance of getting it.
  • Small chin, retruded mandible, high and long palate, anterior openbite, and mouth breather. (Dentists should not diagnose this)
  • Maxillary expansion (retainer), or Surgical Advancement. Early class II treatment.
53
Q

How much sleep should individuals 0-12 months get, 1-3 years, 3-6 years, 7-12 years, 12-18 years?

A
  • 0-12 months: 14-15 hours
  • 1-3 years: 12-14 hours
  • 3-6 years: 10-12 hours
  • 7-12 years: 10-11 hours
  • 12-18 years: 8-9 hours

Pediatrics and Orthodontics (3 decks)

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