Ortho - Lecture 16: Ortho Ext Patterns

Question 1

Father of modern ortho

Answer 1

Dr Edward Angle

Question 2

Has a non-extraction treatment philosophy

Answer 2

Dr Edward Angle

Question 3

His theories:

❖ People are capable of obtaining ideal occlusion with all 32 teeth
❖ Skeletal problems can be corrected with elastics
❖ Less attention paid to facial proportions and esthetics

Answer 3

Dr Edward Angle

Question 4

A student of Dr Edward Angle

Answer 4

Dr Charles Tweed

Question 5

Reintroduced extraction treatment in the 1940s and 1950s to enhance facial esthetics and achieve better stability of occlusal relationships

Answer 5

Dr Charles Tweed

Question 6

T/F: Goals/limitations of ortho treatment are
determined by soft tissues of the face, not by
the teeth and bones

Answer 6

True

Question 7

Primary goal = _______ _______ relationships and
adaptations

Secondary goal = functional ____________

Answer 7

soft tissue; occlusion

Question 8

How much crowding?

Ext rarely indicated
Expand arches or IPR

Answer 8

< 4 mm

Question 9

How much crowding?

Either non-ext or ext based on soft tissue profile and gingival tissues

Answer 9

5-9 mm

Question 10

How much crowding?

Ext almost always indicated

Answer 10

> 10 mm

Question 11

What limits the ability to protract or retract
incisors?

Answer 11

Soft tissue

Question 12

What can create fuller lips?

Answer 12

Proclining the incisors

Question 13

In a pt with thin lips, large nose, and strong chin, what can prematurely age the pt?

Answer 13

Ext and retracting incisors

Question 14

T/F: Generally, non-ext is the first choice in
borderline cases

Answer 14

True

Question 15

What can help in maintaining alignment in
patients who may be at higher risk for relapse?

Answer 15

Bonded lingual retainer

Question 16

What are the 3 alternatives to exts?

Answer 16

Move incisors facially
Expansion of arch
IPR

Question 17

What are the following potential problems of?

Relapse
Perio concerns (recession, fenestration)
Open bite

Answer 17

Non-ext

Question 18

Lip pressure increases if lower incisors move greater than _______ mm forward from their original position

Answer 18

2

Question 19

Expansion across lower __________ is not as stable as expansion across premolars and molars

Answer 19

canines

Question 20

What should you do for a pt with class I crowding (moderate to severe)?

Answer 20

Ext four 1st premolars OR
Ext four 2nd premolars

Question 21

Which tx option should you choose for a pt with class I crowding (moderate to severe)?

Crowding is in the anterior, so we want to create space closest to the crowding

Answer 21

Ext four 1st premolars

Question 22

Which tx option should you choose for a pt with class I crowding (moderate to severe)?

Want to reduce effects on soft tissue

Pts with thin lips are more susceptible to the “dished in” appearance, so we want to avoid extracting the 1st premolars to bring back the lips any further

Answer 22

Ext four 2nd premolars

Question 23

Which tx option should you choose for a pt with class I w/ dentoalveolar protrusion?

Answer 23

Ext four 1st premolars

Question 24

Which malocclusion?

Anterior teeth flare out during eruption
Lip fullness
Mentalis muscle strain
Lip incompetence

Answer 24

Class I w/ dentoalveolar protrusion

Question 25

Which tx option should you choose for a pt with class I crowding or dentoalveolar protrusion?

Answer 25

Ext four 1st premolars

Question 26

Which tx option should you choose for a pt with class I crowding w/ retrusive lips?

Answer 26

Ext four 2nd premolars

Question 27

Which tx option should you choose for a pt with class II crowding or need for skeletal camouflage?

Answer 27

Ext upper 1st premolars and lower 2nd premolars

Question 28

Which tx option should you choose for a pt with class II but is non-growing, has a good mandible/profile, little mandibular crowding, and 5-10 mm of excess overjet?

Answer 28

Ext upper 1st premolars (if > 10 mm overjet, surgery is preferred option)

Question 29

Which tx option should you choose for a pt with class III and needs skeletal camouflage?

Answer 29

Ext upper 2nd premolars and lower 1st premolars

Question 30

Which tx option should you choose for a pt with class III but the maxillary arch is not crowded and the mandibular arch has moderate/severe crowding?

Answer 30

Ext lower 1st premolars or single lower incisor

Question 31

What can help shift the dental midline to the center of the face?

Answer 31

1-2 premolars ext on one side only

Question 32

What helps correct class II and/or close an open bite and relies on third molars to erupt later and take the second molar position?

Answer 32

Ext 2nd molars (rarely done)

Question 33

The timed sequence of extraction of primary teeth and, ultimately, permanent teeth to relieve severe crowding (>10 mm)

Answer 33

Serial exts

Question 34

Increase available space for erupting permanent teeth by extracting certain deciduous teeth

Answer 34

Serial exts

Question 35

Allows teeth to erupt over the alveolus and through keratinized tissue (rather than B/L displacement)

Answer 35

Serial exts

Question 36

Originally advocated as a method to treat severe crowding; goal was to eliminate any future need for appliance therapy However, nearly all patients still require fixed appliance therapy for ideal results

Answer 36

Serial exts

Question 37

What is the serial ext pattern?

Answer 37

Primary canines Primary 1st molars 1st premolars

Question 38

What is indicated if the following are present? -Severe mesial tipping or ectopically erupting permanent 1st molars -Early loss of mandibular deciduous canines -Fanned out U/L permanent incisors due to crowded or unerupted permanent canines -Abnormal resorption of primary teeth -Permanent cuspids erupting buccally

Answer 38

Serial exts