Ortho revision notes Flashcards
Purpose of study models
pt motivators
to assess the pt’s occlusion
to design a URA
secondary opinion
tx planning
Advantages of ura
tipping teeth
excellent anchorage
pt can maintain oh
shorter chariside time than fixed
does not special training to fit applaince
can achieve block movements
non destructive of tooth tissue
Disadvantages of ura
specility training to design appliance and make
can only move one or two teeth
pt can easily reomove from mouth
cannot really achieve rotation movements
Active compoentn
the compontent which moves the tooth
Retention
the resitance to displacement forces
gravity
mastication
speech
tongue
active component
Anchorage
the resistance to unwanted tooth movement
Base plate
slef cured pmma - connector, retention, anchorage
S.S
itron -72
chromium -18
nickel - 8
titanium -1.7
carbon 0.3
durable, cariogenic, ductile, corrsion resistant due to presence of chromium, good asthetics, strong
Fitting a ura
ensure the pt details matches the details of the ura
ensure the design mataches the ura
run finger over the fitting surface to check for sharp edges
check the wirewokr intergrity
insert the appliance in the mouth and check for areas of blanching
check posterior retention - flyover then arrowheads
check anterior retention
acitve appliance
demo to pt
review 4-6weeks
Pt intructions for appliance
the appliance may feel big and bulky
may impinge on pt
initial pain and discomfort
exxcessive salivation my be presentable
remove for contact sports
wear appliance 24/7 including mealtimes
only remove appliance to clean after every meal
provide contact details
talk about complaince and appts
avoid hard and sticky foods
Benefits of ortho
improves speech, function and aesthetics
improves dental health
reduces trauam risk
Risks of ortho
relapse
root resorption
loss of vitiality
perio support issues
headgear trauma
decalcification
allergy
soft tissue trauma
ulcerations
toothwear
Root resoprtion
due to excessive movements, migh force, torque root movement, intrusion, prolonged
relpase high in
diastemmas, instanding 2’s lower incisors crowding, roations
Fixed retainer advatanges
fixed to teeth so good for compliance
done chair side
non invaasive
cheap
aesthetics
Fixed retainer disadvangates
OH maintaince hard
etch damages teeth
can easily debond
doen’t incoprate all teeth
Thermoplasitc retainer advatantages
cheap
aesthetics
non invasvie
oh better as can be removed by pt
incorpartes all teeth
thermoplastic retainer disadvantages
can easily be removed by pt so no complaince
distorts when applied to heat
easily lost
non resilant
Hawley retainer - advatnages
allows occulsal setting
strong
removable so oh good
minor tooth movement
incorpartes all teeth
disadvatanges of hawley retainer
aesthetics
intrudes on tongue space
expensive and time consuming to make
pt can remove
speech issues
Types of rothomovement
rotation
bodily movement
intrusion
extrusion
torque
tension
Components of fixed applaince
brackets
modulaes
archwire
force generating component - elasitic power chain, niti coils
anchorage - simple, compound, reciprocial, absolute (TAD), cortical - quadhelix, nance, transpaltal arch
Advantages of fixed
precise tooth movement
bodily movement forces of root
non invasive
can fix rotations
not bulky
pt cannot remove applince
Disadvatanges of fixed
etch can damage teeth
soft tissue trauam
relapse
root resoprtion
special training to fit
poorer anchroage
poor oh
expensive
Extra oral anchorage
headgear with intral oral bow attached to appliance
200-250g
Transpalatal arch
0.9mm hssw - rotation and anchirage
Palatal arch with nance button
anchorage but can cause erythamtous candidisosi due to being unable to clean underneath appliance
quadhelix
fan shape expansion
bilateral and asymmetrical expanision
habit breaker device
expansion in cleft paalte
rotation of molars
andrews 6 keys
class 1 incisors
class 1 molars
flat occlusal plane or slight curve of spee
long axis of tooth have slight mesial inclination
canine backs to molars have slight lingual inclination
tight approximal contacts between teeth
Expanding upper arch
please provide a ura to expand the upper arch
A - midpline paaltal screw
R - adamas clasps on 16,26,14,24
A - reciprocal anchroage
B - self cured PMMA + PBP
URA to redue oj and ob
please provide a ura to reduce oj and ob
A - roberts retractor 0.5mm with 0.5mm i.d tubing
R - adams clasps on 16, 26, mesial stops placed on 13,23, flattended 0.7mm hhsw
A - good as smal root teeth
B - self cured PMMA FABP - OJ +3mm
URA to retract 13,23
please provide a ura to retract the 13,23
A - 13,23 paaltal finger spring and guard - 0.5mm
R - 16,26, adams clasps 0.7mm hssw
A - goood as only moving 2 teeth
B - self cured PMMA
URA to crrect anterior crossbite
please provide a ura to correct anterior crossibite
A - z spring 0.5mm hssw
R - 16,26,14,24, adams clasps 0.7mm hssw
A - as on ly moving one tooth
P - self cured PMMA - PBP
URA to retract 13,23 and reduce ob
A - 13,23, paltal finger spring and guard
R - 16,26, amadams clasps 0.7mm hssw
A - only moving 2 teeth
B - self cured pmma - FABP - oj = 3mm
Why use flat anterior bite plane when correcting overbite
it allows the vertical dimension to be increased to allow overeuption of the posterior teeth
you add 3mm to oj to prvent the lowers from hitting the bite plane and causing truaama and relapse
Tubing and sheathing for some components
to improve stability and rigidity
URA to retract buccal placed 13 and 23 and redue ob
A - 13,23, buccal canine retratractors - 0.5mm hssw and 0.5mm id tubing
R - 16,26, adams clasps 0.7mm hssw
A - good as only moving 2 teeth
B - self cured pmma - FABP - OJ +3mm
Class 2 div 1
when the lower incosirs lie postieroir to the cingulum plateau of the upper incisors
theres is an increased oj
Problems
dental - OJ cause trauma issues
aesthetics - lip trap/ incomptent lips
ging drying causing gingivitis
Skeletal class 2
retrogntathic mandible - manidble further back than maxila
Could have sucking habits
Tx options for class2 div 1
accept and monitor
gorwth mod/ura to tip incosrs/ camoflaguage and severe cases surgery
Class2 div 2
when the lower incoors lie posteiror to the cingulum plataue of the upper incosirs
there upper incisors are retroclined
Issues - aethetics, deep overbite which can be trauamatic
higher lower lip line
crowding of 2’s caused by incosrs being retorclined
ectopical canines sometimes
Prognosis of class 2 div 2
diffcult to treat due to facial growth and rotated laterals likley to relaspe
retention required
tx for class2 div 2
accept and moniotr
functional applaince by converting to class 2 div 1
camofluage
align the upper only - difficult and chance of relapse
orthognathic surgery when growth is complete and severe discrepnancy, poor facal appearance
Class 3 issues
traumatic overbite
tmj issues
aestehtics
function and speech
ging recession
Class 2 div 1 issues
aesthetics
lip trap or incomptenent lips
retrgnthanic manidble
oj - which casues trauma
drying of ging leads to gingivities
habits - digit sucking
Class 2 div 2 issues
aesthetics
deep overbite
traumatic occlusion
ectopical cancines
crowing of 2’s due to retrcline of incisors
<LAFH
high lower lip line
Class 3
traumatic occlusion
ging recession
tmj issues
aesthetics
speech and function
AOB
posterioer crossbite biltateral
Functional applainces to treat class 3
Frankel III
reverse twin block
protraction headgear with maxiallry expansion
MOCDO
misssing teeth
overjet
crossbite
displacment
overbite
Extra oral assessment
transverse - aymmetry, tmj assessment
vertical - FMPA - frankort -morbital to porion and mandibular - mention to gonion
ratio of upper to lower anterior face height (glabella to subnasal and subnasal to menton)
anterior-postreo - measured by palaptating the skeletal bases or by assesing the pts profile and frankfort plane parallel to the floor
skeletal classes
class 1 - maxialla 2-3mm in front of mandbile
class 2 - maxiall 3mm in front of mandible
class 3 - mandible in from of maxialla
Soft tissue assessment
tongue
smile line
tmj
nasio labial angle
lips
habits
Intra oral assessment
teeth
perio
mobility
eriosion
OH
crossbits
AOB
OJ
OB
crowding
centrelines
molar relationship
incisor relationship
symmetry
Crowding
mild 1-3mm
mod 4-8mm
severe >8mm
OJ
the horizontal distance betweewn the labial surface of the upper incosrs and the labial surface of the lower incisors
usually 2-4mm
OB
the vertical overlap of teeth
usually about 50%
average - upper incisors overlap about 1/3rd of the lowers
complete - the nicisors of the lowers occlude with the palatal mucosa or the incisors
incomplete - the lower incisors do not occlude with anything on the maxillary teeth
Molar relationship
class 1 the mesiobuccal cusp of the upper molar occludes with the buccal groove of the lower 1st molar
class 2 - the mesiobuccal cups of the upper molar occlues anterior to the mbuccal groove of the lower
class 3 - the mesiobuccal cups of the upper molar occludes posterior to the buccal groove of the lower
Reasons for lateral ceph in orth
assessment of facial growth
tx planning and progronosis
comparision of soft tissues to hard tissues
to montitor and assess dentoskeltal relationships
inspection of anatomy and pathology
mandibular plane
menton to gonion
menton
the lowest point on the mental symphsis
gonion
the most posterior inferior part on the anlge of symphsis
orbitale
the most anterior inferioer part on the orbital margin
poriorn
the uppermost outmost part on the bony exteranl audioty meatus
nasion
the anterior portion on the frontalnasal suture
lateral ceph vavlues
fmpa = 55+/-2
mmpa = 27+/-4
UI - 109+/-6
Li - 93+/-6
SNA 81+/-3
SNB 78 +/-3
ANB 3+/-2
Cleft lip and paltae
1 in 700
Team involved in cleft lip and palate
cleft nurse
dental team
psycholigist
cardiologist
gentitises
sppech therapsist
hearing team
Classification of cleft lip and palate
Lips
Alveolus
Hp
SP
HP
alveolus
lips
occurs in males more than females
casues of cleft lip and palate
genetic - syndromes such as vand eer woude sydrome, family hx, sex ratio, ethinicity
enviormental - smoking, alocohl, mutli vitts, anti-eptileptics, social deprivation
the journey for cleft lip and palate
3months = lip closure
6-12months = palatal closure
8-10years = aloveolar bone grate
12-15years - definiftive ortho
18-20 years - surgery
dental implications ofr cleft lip and palate
hypodontia -missing teeth
crowding
caries - hypoplastic enamel
impacted teeth
class 3 malocclusion
Movements of tooth and grams
tipping 35-60g
extrusion 35-60g
rotation 35-60g
intrusion 10-20g
bodily 150-200
torque - 50-100
Factors affecting the movement of tooth
magnitiude of force
the duration of force
the pts age
pts anatomy
Excessive force casues
necrosis
root resportion
pain
permanent change
Tooth movement
frontal resoprtion to occur where on one side there is osteoclasts laid down and the other blood vessels disengae
pressure side - the osteoclasts are laid down and lamina dura moves
tension side - ostebloasts working and osteoid laid done
perdiontal fibres are reorganised
remodelling of socket and disotroition of giningval tissues
Theroies for tooth movemetn
differential pressure theory
pzioelectric theroy
mechano-chemical theory
Aperts syndrome
premature closure of all suures
parrot beak, deafness, narrow space teeth, class3
Crouzon’s syndrome
preamture close of cornoal suture
class 3 , narrow spaced arch
Treacher collins syndrome
deformity in the 1st and 2nd brachial pharngeal arches
loss of zygomatic arch
hypolasitc mandible
diformed pinna
Foetal alcohol syndrome
occurs on day 17
small head
long upper lip
defienct philtrum
small mandible
flat face
short nose
Achondraplsia
deofrmitity of the endochrondiral ossification
dwarfism
affects on long bones causing short bones
Hemifacial microsoma
develops around day 19-28
asymmetry
hypoplastic mandible
malformed pinna
high arched palate
Supernumerary teeth
common in males more than females and in the upper arch
across the mdiline = mesiodens
conical - peg shaped - usually close to midline
tuberculate - barrel shaped - upper incisors
supplemental - additional - upper lateral or lower incisors
odotome - compound - discrete denticals or complex disorgansied deninte pulp in enamel
Casues of supernumrary
gentics
midline diastema
crowding
aob
posterior crossbite
Problems with an extra tooth
crowding
spaceing
poor aethetics
impeded eruption
displaced eruption
Hypodontia
femlaes more than males
3rd moalrs
lwer 2nd premolars
upper laterals
lower incisors
Casues of hypodontia
genetic/enviornmental
cleft lip and palate
down’s syndrome
ectodermal dysplaasia
trauam
Issues with missing teeth
crowding
spacing
drifting
aesthetics
delayed eruption
function probs
infra occluded primary molar
impaction
Retained primary teeth
concerned if not eruption controlateral within 6months
dilacterated successor
absent succesor
ectopical canine
infra occluded primary molar
Infra occluded primary molar
lower d most common
mandible>maxilla
if permantn tooth present and primary goes subging or that the root formation of permanent is complete then xla
absent permanent - depends on tx and crowidng
Digit sucking
proclined upper inciros
retroclined lower incors
aob
posterior unilateral cross bite
tx for digit sucking
positive reinforcement
elastoplast on thumb
gloves on hands at night
bitter nai lvarnish
removable habit breaker (palatal crib)
tongue rake
causes of a diastema
presence of supernumary
low labial frenum
spacing
genetics
missing laterals
Casues of posterior cross bite
digit sucking habit
crowding
supernumeray
displacment on closure
toothwear
cleft lip and palate
probelsm with ectopical cancine
cyst formation
ankylosis
impeded eruption
damage to adjacent teeth
crown resoprtion
root resoprtion
crowding
casues of early loss of primary teeth
trauam
caries
severe crowding
preamture exfoliation
when are ecotpic canines not alignable
too close to midline
above apical 1/3 of incisor
greater that 55degrees to midsaggital plane
aob casues
digit sucking
presence of supernumary
endogenous tongue thrust
delayed eruption
cerbral plasy
what reduces ob in a ura
the flat anterior bite plane
midline diastema
6yrs = 95%
12-18 = 7%
Expand maxillary arch
URA
Quadhelix
rapid maxiallry expansion
Impacted 1st molars casues
eruption cysts
crowiding
eruption angle
morophology of 2nd decidoous molars
tx for impacted 1st miolars
do nothing accept and monitor
xla e’s - pontential pulpitis risk
seperators may need to be placed
distalise 6
ura?
features of normal development that prevent crowing od dentition
growth of maxiallry and mandible arches
spacing in the primary dentition
proclined upper teeth
tx for hypodontia
do nothing and accept
ortho
resotratvie
resotrative and ortho
Class 2 div
proclined upper incosrs
retroclined lower incisors
increased oj
class2 molar and canine relation
narrow maxiallry arch
incomptent lips, lip trap, trauma/tongue thrust
dry ging leading to gingivitis due to incomptent lips
tx for class 2 div 1
accept and monitor
functional appliance - headgear, twin block
tipping of teeth with ura (limited help)
camofluage - non growing pt
orthgnathic surgery
class 2 div 2
retrolcined upper incisors
proclined lower incisors
deep overbite
class 2 molars and incisors
upper laterals procline and mesiolabial rotation
crowind
poor cingulum on 2’s
high lower lip line, palatal or ging trauma, lip tap
<fmpa
prominent chin (pyogenia)
tx for class 2 div 2
accept and montor
functional applaince
camofluage
orthgnathic surgery
class 3
procline upper
retroclined lower
crossbites
aob
reduce overbite
class 3 molars
mandible aligned
tongue proclines uppers
lower lip retrolcines lower
tx for class 3
accept and monitor
interceptive ortho - frankel III, chin strap, reverse twin block
camoflauge - aim for class 1
orthgnathic surgery
population with ectopica cancines
2% and 85% pallatlly
issues with ectopic canines
crowining = buccally placed
spaced = paltally placed
long path of insertion
cryt displacment
retention of deciduous
genetic
after crown formation how long does root growth take
1-2 = primary
3-5years = permannent
root sheath of hertwigs
controls the root growth
ugly ducking stage
occurs between 7-12years, where there is a midline diastema and splaying of the lateral incisors, due to rpessure on the roots by the developing canines
leeway space
the extra space mesio-distal from the primary molars whichare wider than the permanent molars coming in
2.5mm = lowers each side
1.5mm = uppers each side
Fucntinal appliance
increase in lafh
retricts the mandibular growth
promotes mandibular growth
expansion of arch through buccal shileds of frankel or midline screw of twin block
allws posterior teeth upward and forward movement of lowers
retrolcination of upper inciosrs
proclinatino of lower incisors
casues mandibular growth by growth of condylar cariltage and forward migration of glenoid fossa
