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Ortho > ortho-prosth > Flashcards

ortho-prosth Flashcards

1
Q

minor ortho intervention can

A

improve dental restortations, spae management, abutment prep, root inclination

improves prognosis of tx

increase esthetic results

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2
Q

what can you ask from ortho

A

abutment uprighting

occlusal plane leveling

space managment for fixed work

tooth extrusion, intrusion

ortho extraction

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3
Q

do what before ortho

A

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

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4
Q

benefits of integrating ortho early on in tx

A 
more room for 
more bridges 
more implants 
less extractions
better esthetics 
more ideal proportions 
better long term prognosis
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5
Q

molar uprighting usually needed wen

A

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

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6
Q

consider what with 3rd molars?

A

extract if no opposing 3rd in opposing arch

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7
Q

movement of uprighting molars

A

just crown?

or crown and root? – this will require more comprehensive care

corwn movement is easier, faster, needs less anchorage, generally preferred option

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8
Q

crown movement implications with molars

A

can create interferences and may open bite (may need to extrude after uprighting)

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9
Q

attachment levels after uprighting molars?

A

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

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10
Q

retention with uprighting molars

bridge example

A

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

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11
Q

timing and amount of uprighting

A

4-6 weeks to activate pdl

4 weeks for 10 degrees of distal crown tipping

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12
Q

options for moving molars

A

super-elastic wires

coil springs with brackets

T loops
heavy SS wires with T loops

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13
Q

how to move molar if extrusion not desired

A

Heavy SS wire with T loops – better control if extrusion not desires

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14
Q

breakdown of occlusal leveling

A
  1. pre-prosthetic occlusal leveling will allow corrections of VFO, and give proper space for restorations
  2. correct severe overbites
  3. intrude unopposed overerrupted tteht
  4. correct crossbites
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15
Q

explain skeletal anchorage in orhto

A

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

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16
Q

describe anchor screw

A

what is used in skeletal anchorage in ortho

  • IMMEDIATE loading
  • NO oseointegration required
  • resistane of sufficient load
  • minimal patient trauma
  • easy and quick removal
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17
Q

contraindications for direct skeletal attachment

A

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

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18
Q

can do ortho on patient with CU and PL

A

yes – can make patient better candidate for the partial lower

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19
Q

Considerations with congenitally missing laterals

dental

A

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

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20
Q

esthetic considerations with lateral and canines

A

canines - less enamel, less transparent, darker colors

21
Q

space closure and cuspid replacement?

A

with missing laterals – can close space and shape canine like a lateral

22
Q

space opening and implant replacement

A

for dealing with congenitally missing laterals

if patient young – place temps for now

23
Q

general considerations with missing second mandibular biscupids

A

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

24
Q

extrusion aka

A

forced eruption

25
Q

alternative to CLP or extraction

A

forced eruption

26
Q

indications for forced eruptions

A

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
27
Q

alveolar bone height compromised in extrusin?

A

NO

28
Q

after extrusion may need?

A

some recontouring of the gingiva and or bone may be necessary to produce esthetic contour and bio width

29
Q

criteria for selecting forced eruption

A

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

30
Q

when deciding to extrude what measurmenets take into consideratin>

A

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?

31
Q

implication with extrusion if tooth fractured at the alveolar bone?

A

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

32
Q

extrude dilacerated roots?

A

avoid this

33
Q

root form - external implication on extrusion

A

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

34
Q

internal root form with extrusion

A

root canal should not be larger than 1/3 of the overall width

larger canals could compromise the strength of the final restoration

35
Q

level of fracture defect with extrusion

A

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

36
Q

implication of neighboring teeth and furcations

A

could expose furcations if extrude the neighbor

37
Q

presence of extensive vertical root fracture

A

even after extrusion – likely hopeless –> extract

38
Q

restoration prognosis looks at

A

after all this work — how good will the final restoration be on it

39
Q

soft tissues in terms of extrusion? implication on CLP?

A

depending on perio migration, CLP MAY STILL BE NECESSARY AFTER EXTRUSION - but with less compromise of neighboring teeth

40
Q

mechanics of extrusion

A

position bracket more apical or step down (toward apex) on wire

might require incisal reduction to relieve from occlusion

41
Q

less controlled way of extrusion - but still works

A

heavy wire bonded directly to neighboring teeth, button on tooth to extrude and power chain or ligature - less controlled

42
Q

stabalization after extrusion?

A

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
43
Q

considerations if tooth extrudes with attachment apparatus?

A

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

44
Q

extrusion –> extraction can help?

A

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

45
Q

ortho intrusion or gingival surgery?

A

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

46
Q

congenitally missing laterals considerations

A

orthodontic space closure with cuspid characterization (turn laterals into canines)

  1. 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
47
Q

class III with congenitally missing second premolars? class II?

A

better choice is to bring teeth back and close space

class II -

48
Q

E relative to bicuspid

A

wider than the premolar

soo reshape to proper size (8mm approx)

49
Q

do extrusion to prevent crown lengthening?

A

NO

- may preserve and CLP may be more limited but may still need

Ortho (19 decks)

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