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Ortho, G+D, CF Flashcards

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1
Q

What three major categories do diagnostic orthodontic evaluations fall under?

A
  • Health of the teeth and oral structures
  • Alignment and occlusal relationships of the teeth
  • Facial + jaw proportions
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2
Q

General considerations + principles of management

A
  • Primary dentition: Beginning in infancy with the eruption of the first tooth, usually ~6mo, and complete from ~3-6yo when all primary teeth are erupted
  • Mixed dentition: 6-13yo, primary + permanent teeth present in the mouth.
    • Early mixed
    • Late mixed
  • Adolescent dentition: All succedaneous teeth have erupted, second permanent molars may be erupted/erupting, third molars have not erupted yet.
  • Adult dentition: All permanent teeth present.
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3
Q

Objectives of dental development evaluation include identification of:

A
  • All tooth number + size anomalies
  • Anterior + posterior crossbites
  • Presence of habits along with their dental + skeletal sequelae
  • Open bite
  • Airway problems
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4
Q

What should you look out for in late mixed dentition, dental development-wise?

A

Ectopic tooth positions (canines, premolars, and second permanent molars)

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5
Q

What should you look out for in adolescent dentition, dental development-wise?

A

Ortho diagnosis and treatment should be planned for Class I crowded, Class II, and Class III malocclusions as well as posterior and anterior crossbites. Third molars should be monitored as to position and space.

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6
Q

What should you look out for in adult dentition, dental development-wise?

A

Evaluate third molars

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7
Q

When should habits and crossbites be addressed?

A

If predicted not likely to be self-correcting, they should be addressed as early as feasible to facilitate normal occlusal relationships

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8
Q

Early mixed dentition treatment considerations

A
  • Habits
  • Arch length shortage
  • Intervention for crowded incisors
  • Intervention for ectopic teeth
  • Holding of leeway space
  • Crossbites
  • Openbite
  • Surgical needs
  • Adverse skeletal growth
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9
Q

Late mixed dentition treatment considerations

A

Skeletal disharmonies + crowding

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10
Q

Adolescent dentition treatment considerations

A

Orthodontic diagnosis and treatment can provide the most functional, stable, and esthetic occlusion

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11
Q

What is the relationship between oral habits + unfavorable dental and facial development?

A
  • Associational.
  • Oral habits may apply negative forces to the teeth + dentoalveolar structures
  • Duration of force is more important than its magnitude
    • The resting pressure from the lips, cheeks, and tongue has the greatest impact on the tooth position as these forces are maintained most of the time.
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12
Q

Oral habits

A
  • Non-nutritive sucking
  • Bruxing
  • Tongue thrust swallow
  • Abnormal tongue position
  • OSAS
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13
Q

What type of malocclusion is commonly associated with long-term non-nutritive sucking?

A

Anterior openbite + posterior crossbite

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14
Q

When should sucking habits be discontinued?

A

36mo or younger

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15
Q

Complications of bruxism?

A

Dental attrition, headaches, TMD and soreness of masticatory muscles

Juvenile bruxism is self-limiting and does not persist in adults.

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16
Q

Tongue thrusting

A
  • Abnormal tongue position + deviation from the normal swallowing pattern
  • May be associated with anterior open bite, abnormal speech, and anterior protrusion of the maxillary incisors
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17
Q

When is a tongue thrust considered clinically significant?

A

If the resting tongue posture is forward of the normal position, incisor displacement is likely. If resting tongue posture is normal, a tongue thrust swallow has no clinical significance.

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18
Q

In what population does self-injurious or self-mutilating behavior occur?

A

Special needs populations – associated w/ developmental delay or disabilities, psychiatric disorders, traumatic brain injuries, and some syndromes

MOST NOTABLY LESCH-NYHAN SYNDROME

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19
Q

Treatment options for self-injurious behavior

A
  • Pharmacologic management
  • Behavior modification
  • Physical restraint
    • Lip bump
    • Occlusal bite appliances
    • Protective padding
    • Extractions
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20
Q

Treatment options for severe lip- and tongue-biting habits

A
  • Monitoring
  • Odontoplasty
  • Bite-opening appliance
  • Extraction

Severe lip- and tongue-biting habits may be associated with profound neurodisability due to severe brain damage.

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21
Q

Clinical presentation of OSAS

A
  • Narrow maxilla
  • Crossbite
  • Low tongue position
  • Vertical growth
  • Increased OJ + OB
  • H/o snoring, apnea, restless sleep, daytime neurobehavioral abnormalities or sleepiness, bedwetting.
  • Growth abnormalities, signs of nasal obstruction, adenoidal facies, enlarged tonsils.
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22
Q

Hypodontia (permanent teeth) – Prevalence

Reference Manual

A

3.5-6.5%

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23
Q

What is the most frequently missing permanent tooth?

A

Excluding thirds, mandibular second premolar, followed by the maxillary lateral incisor.

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24
Q

Hypodontia (primary teeth) – Prevalence

Reference Manual

A

Less frequent than permanent teeth.

0.1-0.9%

Almost always affects the maxillary incisors + 1st primary molars

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25
Q

What other dental features are seen in patients w/ congenitally missing teeth?

A
  • Asymmetric eruption sequence
  • Over-retained primary teeth
  • Ankylosis of primary mandibular second molar
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26
Q

Supernumerary teeth – Prevalence

A
  • 5x more common in the permanent dentition but do occur in primary teeth.
  • Primary: 0.3-0.8%
  • Mixed dentition: 0.52-2%
    • Early mixed: 79-91% of anterior permanent supernumerary teeth are unerupted.
  • 80-90% in the maxilla, w/ ½ in the anterior and almost all palatally positioned.
  • Supernumerary primary followed by a supernumerary permanent tooth in ⅓ of cases.
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27
Q

Percent of mesiodens eruption with age

A

25%

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28
Q

Effect of mesiodens on adjacent teeth

A
  • Can prevent or cause ectopic eruption of central incisor
  • Cause dilaceration or resorption of permanent incisor’s root (less frequent)
  • Dentigerous cyst formation
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29
Q

Imaging that can determine supernumerary’s position

A

Pano, occlusal, PA can reveal supernumerary’s presence.

  • Determine position:
    • CBCT
    • 2 PAs/occlusals reviewed by the parallax rule
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30
Q

Timing for extraction of mesiodens

A
  • Early mixed dentition (6-7yo, permanent root length
  • Later removal reduces likelihood that the adjacent normal permanent incisor will erupt on its own, especially if the apex is completed
  • Inverted conical supernumerary teeth can be harder to remove if removal is delayed, as they can migrate depper into the jaw.
31
Q

Supernumerary tooth extraction follow up

A

Clinical + radiographic follow up 6m post-op to determine if the normal incisor is erupting. If there is no eruption after 6-12m, and there is sufficient space, sx exposure + orthodontic extrusion may be needed.

32
Q

When can ectopic eruption of permanent molars be dx’d?

A

From BWX or pano in early mixed dentition

33
Q

What type of crowding is ectopic eruption of first permanent molars associated with?

A

Transverse + sagittal

More common in the maxillary arch + CLP

34
Q

Likelihood of self-correction of ectopically erupting permanent molars

A

66% self-correct by 7yo

71% self-correct by 9yo

35
Q

What factors indicate a need for early intervention with ectopically erupting permanent molars?

A
  • Increased magnitude of impaction
  • Increased resorption of the primary tooth
  • Bilateral occurrence
36
Q

Impacted maxillary canine %

A

1.5-2% of the population

37
Q

When should you suspect impacted U3s?

A

Canine bulge is not palpable, asymmetric canine eruption, peg=shaped lateral incisors

38
Q

When should you expect ectopic eruption of permanent incisors?

A
  • After trauma to primary incisors
  • Pulpally treated primary incisors
  • Asymmetric eruption
  • Supernumerary incisor
39
Q

Ectopic eruption of 1st permanent molars – Treatment

A

Determined by severity.

  • Mild – Little of the tooth is impacted under the primary second molar
    • Elastic or metal orthodontic separators can be placed to wedge the permanent first molar distally.
  • Severe – Distal tipping of 1st permanent molar is required.
    • Brass wires, removal appliances w/ springs, fixed appliances such as sectional wires w/ open coil springs, sling shot-type appliances, Halterman appliances
40
Q

Ectopic eruption of U3s – Treatment

A
  • Depends on etiology
  • Extraction of Uc’s (when canine bulge cannot be palpated + radiographic overlap with lateral during mixed dentition)
  • RPE + cervical pull headgear in mixed dentition.
  • EXT of Ud’s has been reported to allow eruption of U4s and to assist in eruption of U3s
41
Q

Uc extraction when impacted U3 diagnosed at a later age (11-16yo)

A

If the canine is not horizontal, EXT of Uc lessens the severity of the permanent canine impaction and 75% will erupt

42
Q

Process of ankylosis

A

Cementum of tooth root fuses directly to surrounding bone. PDL is replaced w/ osseous tissue, rendering the tooth immobile.

Can occur rapidly or gradually; may be transient, where only a small bony bridge forms and then is resorbed by osteoclastic activity

43
Q

Ankylosis – Incidence

A
  • Primary: 7-14%
  • Permanent: Occurs most frequently following luxation injuries
44
Q

Ankylosis – Management

A
  • Maintain until interference w/ eruption or tipping/drifting of adjacent teeth, and when that does occur → EXT and place LHA or fixed appliance if needed.
45
Q

Ankylosed primary molars w/o permanent successor – Management

A
  • If severe infraocclusion → EXT before a large vertical occlusal discrepancy develops or decoronation to maintain alveolar width and prevent further loss of vertical height.
46
Q

What is an alternative to premature extraction of ankylosed permanent teeth?

A

Surgical luxation with forced orthodontic eruption.

47
Q

Permanent incisor decoronation

A
  • RCT
  • Removal of clinical crown + cervical portion of the root to a level at least 2mm below marginal bone height, followed by reflecting, repositioning, and suturing a mucoperiosteal flap over the root.
48
Q

Primary failure of eruption

A

An eruption disorder characterized by partial or complete non-eruption of permanent teeth in the absence of any mechanical obstruction or syndrome.

49
Q

What teeth are most commonly affected by primary failure of eruption?

A

Posterior teeth; one or all four quadrants may be involved

50
Q

Two main phenotypes of primary failure of eruption

A
  • All teeth distal to the most mesial non-erupted tooth are affected
  • Unerupted teeth do not follow the pattern that all teeth distal to the most mesial involved are also affected
51
Q

Hallmark features of primary failure of eruption

A
  • Posterior open bite in the presence of normal vertical growth
  • Infra-occlusion of affected teeth
  • Inability to move affected teeth orthodontically
52
Q

Primary failure of eruption vs. ankylosis

A

PFE: Eruption fails to occur due to an imbalance in resorptive + appositional factors related to tooth eruption.

Teeth w/ PFE are not initially ankylosed but may become ankylosed when orthodontic forces are applied.

53
Q

Primary failure of eruption etiology

A
  • 85% of patients w/ PFE have another family member w/ the condition.
  • Variable expression and has been associated w/ mutations in the autosomal dominant parathyroid hormone receptor gene (PTH1R)
54
Q

Contraindications w/ patients that have primary failure of eruption

A

Early orthodontic intervention of the affected teeth. There are no established mechanotherapeutic methods of modifying dentoalveolar growth for these patients

55
Q

Primary failure of eruption treatment objectives

A

Reassurance + education about the eruption disorder and preparation for future prosthetic rehabilitation.

Early extraction can improve normal development of the alveolus and permanent dentition in some cases.

56
Q

When can you suspect ectopic eruption of permanent first molars?

A
  • Asymmetric eruption
  • Mesial marginal ridge is under the distal prominence of the second primary molar
57
Q

Percentage of ectopic permanent molars that self-correct?

A

66% self-correct by age 7

71% correct by age 9

58
Q

Treatment considerations: Mildly impacted permanent molars

A

Elastic or metal ortho separators can help wedge permanent first molars distally

59
Q

Treatment considerations: Severely ectopic permanent molars

A

Distal tipping of permanent molar is required by tipping w/ brass wires, removable appliances using springs, fixed appliances such as sectional wires w/ open coil springs, sling-shot appliances or Halterman appliance

60
Q

When can you clinically suspect impacted U3s?

A
  • Canine bulge is not palpable
  • Asymmetric canine eruption
  • Peg-shaped lateral incisors
61
Q

When can you radiographically suspect impacted U3s?

A
  • Pan may show if canine has abnormal inclination
    • If canine crosses the lateral root long axis midline, it will self-correct only 64% of the time; if it does not, it has a 91% chance of self-correcting.
  • Enlarged follicular sac
  • Lack of root resorption of primary canines
  • Presence of premolar impaction
62
Q

If canine crosses the lateral root long axis midline, what percent of the time will it self-correct?

A

If canine crosses the lateral root long axis midline, it will self-correct only 64% of the time; if it does not, it has a 91% chance of self-correcting.

63
Q

Bolton discrepancy

A

Arch length discrepancies, include inadequate arch length + crowding of the dental arches, excess arch length + spacing, tooth size discrepancy.

May be found w/ complicating + other etiological factors: missing teeth, supernumerary teeth, fused or geminated teeth

64
Q

When do transseptal fibers develop?

A

Not until the CEJ of erupting teeth pass the bony border of the alveolar process

65
Q

When should initial assessment of tooth size/arch length discrepancy and crowding be done?

A

Early mixed dentition, when mandibular incisors begin to erupt.

66
Q

The loss of what tooth in the mouth is the most detrimental?

A

Primary second molar

67
Q

When do the biggest changes happen in space loss following extraction?

A

4-8 weeks after extraction

68
Q

Fixed space regaining appliances

A
  • Holding arch
  • Pendulum appliances
  • Halterman-type appliances
  • Jones jig
69
Q

Removable space regaining appliances

A
  • Hawley w/ springs
  • Lip bumper
  • Headgear
70
Q

Unilateral crossbites are a manifestation of what most often?

A

Bilateral crossbite w/ a functional mandibular shift

71
Q

When should functional shifts be addressed?

A

Should be eliminated ASAP w/ early correction to avoid TMD and/or asymmetric growth

72
Q

When is skeletal expansion w/ fixed or removal palatal expanders no longer an option?

A

When the midline suture fuses [11-13yo girls, 14-16yo boys]

73
Q

What is a OJ >3mm associated with?

A

Increased risk of incisor injury.

Large (>8mm) resulting in trauma >40% of children

* (22 decks)

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