ortho-prosth Flashcards
minor ortho intervention can
improve dental restortations, spae management, abutment prep, root inclination
improves prognosis of tx
increase esthetic results
what can you ask from ortho
abutment uprighting
occlusal plane leveling
space managment for fixed work
tooth extrusion, intrusion
ortho extraction
do what before ortho
clear perio and basic restorative
dont do final treatment if ortho is planned –> think about crown damage, alteration of finish line and gingiva relation
if doing temps –> permanent cement for now
benefits of integrating ortho early on in tx
more room for more bridges more implants less extractions better esthetics more ideal proportions better long term prognosis
molar uprighting usually needed wen
loss of posterior teeth leading to adjacent teeth drifting into space, tipping and rotating
soft tissue folds and distorts and can form plaque- harboring pseudopockets
consider what with 3rd molars?
extract if no opposing 3rd in opposing arch
movement of uprighting molars
just crown?
or crown and root? – this will require more comprehensive care
corwn movement is easier, faster, needs less anchorage, generally preferred option
crown movement implications with molars
can create interferences and may open bite (may need to extrude after uprighting)
attachment levels after uprighting molars?
may decrease
gingival tissue may present localized enlargment – may be lip or collar on the mesial aspect of the uprighted molar
consider extract and implant if these side effects outweight
retention with uprighting molars
bridge example
need to maintain the space created – so temp bridge will act as retainer
or if delay is expected – or RPD planned - make retainer to keep results achieved
timing and amount of uprighting
4-6 weeks to activate pdl
4 weeks for 10 degrees of distal crown tipping
options for moving molars
super-elastic wires
coil springs with brackets
T loops
heavy SS wires with T loops
how to move molar if extrusion not desired
Heavy SS wire with T loops – better control if extrusion not desires
breakdown of occlusal leveling
- pre-prosthetic occlusal leveling will allow corrections of VFO, and give proper space for restorations
- correct severe overbites
- intrude unopposed overerrupted tteht
- correct crossbites
explain skeletal anchorage in orhto
utalized for
- non-compliant patients
- no reciprcal moement in anchorage unit (kinda acts like head gear)
- ideal for incomplete dentition
less movement of other teeth because not using them as anchorage
describe anchor screw
what is used in skeletal anchorage in ortho
- IMMEDIATE loading
- NO oseointegration required
- resistane of sufficient load
- minimal patient trauma
- easy and quick removal
contraindications for direct skeletal attachment
mixed or deciduous dentition
active infection
blood limitations or bone quantitiy less than 5 mm in depth
mental or neurological limitations - cant follow post op
severe disease or immunocompromised
can do ortho on patient with CU and PL
yes – can make patient better candidate for the partial lower
Considerations with congenitally missing laterals
dental
Dental considerations:
skeletal and
dental classification
space analysis
tooth size
profile considerations
- lip support and skeletal class
esthetics
- major differences between lateralls and canines – need to know these before make latertals into canines
esthetic considerations with lateral and canines
canines - less enamel, less transparent, darker colors
space closure and cuspid replacement?
with missing laterals – can close space and shape canine like a lateral
space opening and implant replacement
for dealing with congenitally missing laterals
if patient young – place temps for now
general considerations with missing second mandibular biscupids
if ortho diagnosis allows it - close space
if not - maintian it (like keep primary if not sign of tooth to maintain bone) and reshape to proper size
wait until growth is complete for implant
extrusion aka
forced eruption
alternative to CLP or extraction
forced eruption
indications for forced eruptions
teeth with defects in the cervical 3rd or the root that may need care for restoration
- horizontal or oblique fractures
- internal or external resorption
- decay
- iatrogenic perforation
- perio disease
- recession, alterered gingival architecture
alveolar bone height compromised in extrusin?
NO
after extrusion may need?
some recontouring of the gingiva and or bone may be necessary to produce esthetic contour and bio width
criteria for selecting forced eruption
root length - final crown/ root ratio
- will you have at least 1: 1 left after??
- if not consider prosthetic replacement
root form
level of fracture or defect
relative importance
esthetics
prognosis of the tooth and restoration
when deciding to extrude what measurmenets take into consideratin>
mm from defect
sound tooth structure for proper margins is 1-1.5
perio tissues - bio width is 2-2.5
example - like 5 mm of extruson is that going to be good?
short or long root?
implication with extrusion if tooth fractured at the alveolar bone?
tooth fractured at the level of alveolar bone would optimally require a total of 4 mm forced eruption providing a 1:1 crown root ratio is preserved
extrude dilacerated roots?
avoid this
root form - external implication on extrusion
if broad and non - tapering this is good
thin and tapering roots– result in a narrower cervical region after the tooth has been erupted, potentially compromising esthetics and embrasure shape
internal root form with extrusion
root canal should not be larger than 1/3 of the overall width
larger canals could compromise the strength of the final restoration
level of fracture defect with extrusion
tooth fragment for extrusion must be accessible
if the fracture is more than 2-3 mm below the level of the alveolar bone - it is difficult - if not impossible to access the tooth in order to extrude it
think about extraction in these cases where fracture is too apical
implication of neighboring teeth and furcations
could expose furcations if extrude the neighbor
presence of extensive vertical root fracture
even after extrusion – likely hopeless –> extract
restoration prognosis looks at
after all this work — how good will the final restoration be on it
soft tissues in terms of extrusion? implication on CLP?
depending on perio migration, CLP MAY STILL BE NECESSARY AFTER EXTRUSION - but with less compromise of neighboring teeth
mechanics of extrusion
position bracket more apical or step down (toward apex) on wire
might require incisal reduction to relieve from occlusion
less controlled way of extrusion - but still works
heavy wire bonded directly to neighboring teeth, button on tooth to extrude and power chain or ligature - less controlled
stabalization after extrusion?
yes - 6 months retentino with passive arch wire recommended to avoid significant relapse
- b/c during extrusion - PDL fibers are stretched so need time to reorient and re-establish new attachment
considerations if tooth extrudes with attachment apparatus?
may be left with shorter clinical crown due to incisally positioned gingival margin – esthetics a problem
bio width?
may need surgery CLP to create ideal margin heights and bone levels
extrusion –> extraction can help?
yes – keep bone in tact longer
better tissue preservation - keritinized tissue stays
- can better gingival architecture for extracting and place graft and implant
limits bony defects
ortho intrusion or gingival surgery?
evaluate labial sulcular depth of the teeth
uniform depths indicate uneven wear or trauma of the incisal edges
differences in sulcular depths indicate a need for gingival surgery
congenitally missing laterals considerations
orthodontic space closure with cuspid characterization (turn laterals into canines)
- space reopening and implant placement
consider - skeletal and dental (class II may want to close space and convert because less room -- vs class III open up and create more space ) - space analysis - tooth size - profile considerations
class III with congenitally missing second premolars? class II?
better choice is to bring teeth back and close space
class II -
E relative to bicuspid
wider than the premolar
soo reshape to proper size (8mm approx)
do extrusion to prevent crown lengthening?
NO
- may preserve and CLP may be more limited but may still need
