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Ortho SAQ2 > ortho section of exam > Flashcards

ortho section of exam Flashcards

1
Q

What are the components of extraoral assessment?

A

Anterior posterior (AP)
Vertical
Transverse

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2
Q

How to assess AP skeletal pattern and what radiograph?

A

Radiograph: lateral cephalogram

  • palpation
  • place index and middle finger in the concavities of the maxilla and mandible and assess change in inclination

-zero meridian
* draw imaginary frankfurt (horizontal) and zero meridian line
skeletal class 1: chin 2 mm behind or on top of the line
skeletal class 2: chin behind the line
skeletal class 3: chin over the line

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3
Q

how do you assess vertical skeletal relationship

A
  • Angular measurement
    FMPA
    intersection between the frankfurt and mandibular plane at the occiput.
    high angle = above the occiput
    average angle = at the occiput
    low angle = behind the occiput
  • linear measurement
    LAFH
    assess the proportions of the face from mid eyebrow to tip of nose and from nose to chin.
    The proportion should be equal
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4
Q

how do you check the transverse skeletal pattern

A

check pt facial symmetry
look at the pt from the top and mid eyebrow, nose, lip and chin should all line up

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5
Q

soft tissues

A
  • lip competence
    how lips meet at rest
  • Incisal display
    (when smiling 2 mm from upper incisal edge)
  • lip protrusion (rickets E line)
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6
Q

intra arch assessment

A

ACAI
Alignment
Crowding
1-4 mm = mild
4-8 mm = moderate
<8 mm = severe

Angulation (mesio distal tip relationship between crown and root)

Inclination (buccal lingual orientation)

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7
Q

interarch assessment

A

incisal relationship
overjet
overbite
centreline
molar relationship
canine relationship
crossbite

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8
Q

define incisal relationship for all classess

A

class 1 - lower central incisors occlude to the cingulum plateau of the lower central incisors

class 2 lower central incisors occlude posterior to the cingulum plateau of the upper incisors

class 3 lower central incisors occlude anterior to the cingulum platea of the upper incisors

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9
Q

define overjet

A

horizontal distance between the incisal edge of the upper incisors and labial face of lower incisors
NORMAL = 2-4 MM

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10
Q

define reverse overjet

A

lower incisors are anterior to upper incisors labial face

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11
Q

define overbite

A

vertical overlap of lower incisors by upper incisors

normal = upper incisors cover 2/3 of lower incisor

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12
Q

how does centreline of teeth have to be?

A

upper centreline should be aligned with the facial centreline

lower centreline should align chin point

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13
Q

define crossbite

A

upper teeth should occlude buccal to lower teeth

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14
Q

what is the ideal time for puberty growth spirt?

A

11-13 girls
12-14 boys

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15
Q

define class 2 div 1

A
  • lower central incisors occlude posterior to the cingulum plateau of the upper central incisors
  • always overjet
  • upper central incisors are proclined or of average inclination

BSI classification

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16
Q

Aethiology of skeletal class 2 div 1

A

SKELETAL
- skeletal class 2 AP
- variable vertical relationship
maxilla is prognatic
mandible is retrognatic

DENTAL
Crowding
Overjet
Class 2 molar relationship

SOFT TISSUE
lower lip is lower than average hence teeth free to move forward

HABITS
- digit sucking
- proclines upper central incisors
- retroclines lower central incisors
- anterior openbite
- narrowing of maxillary arch

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17
Q

management of class 2 div 1

A

1) accept
2) growth modification with
- functional appliance
- twin block appliance
(ACRYLIC REMOVABLE -
MOVES MANDIBLE FORWARD)

3) headgear (maxillary restraint by restricting AP growth allowing mandible to catch up 500g for 14 hours)

4) camouflage
accept maloclusion
XLA upper 4 (posterior anchorage)
XLA lower 5 (prevents anteriors to move)

5) Orthognatic surgery (18+)

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18
Q

define functional appliance

A

an ortho device which utilises the forces generated when stretching the muscles of mastication, facial expressions and peridontium of teeth and jaw relationship in an actively growing patient

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19
Q

mode of action of growth modification in class 2 div 1

A

DENTALVEOLAR
- retroclines upper central incisors
- proclines lower central incisors
- mesial eruption of lower molars
- distal tipping of upper molars

SKELETAL
maxillary restain
mandibilar growth
increase vertical dimension

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20
Q

define class 2 div 2

A
  • lower central incisors occlude posterior to the cingulum plateau of the upper central incisors
  • upper central incisors are retroclined
  • minimal overjet (but can be increased)

BSI classification

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21
Q

whats the aetiology for class 2 div 2

A

SKELETAL
- Skeletal class 2 AP
- reduced vertical pattern (both FMPA and LAFH)
maxilla prognatic
mandible retrognatic

DENTAL
- acute crown root
- thin labio palatal thickness
- increased overbite

SOFT TISSUE
- lower lip is higher than normal resting position hence retroclined upper incisors

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22
Q

management of class 2 div 2

A

1) accept

2) growth modification
with ELSAA
Anterior bite plate - ↓overbite
Recurve spring - procline upper incisors

turn into CLASS 2 div 1 and change to a TWIN BLOCK APPLIANCE

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23
Q

define class 3

A
  • lower central incisor occludes anterior to the cingulum plateau of the upper central incisors
  • may be anterior crossbite

BSI classification

24
Q

aethiology of class 3

A

SKELETAL
- class 3 AP
maxilla retrognatic
mandible prognatic
can be combiation of both

  • vertical
  • can be increased, average, reduced
  • transverse
  • facial assymmetry
  • hypoplastic maxilla so narrow maxillary arch and posterior crossbite

DENTAL
microdontia/hypodontia/ impacted teeth in upper arch so less tooth tissue in upper arch than lower arch so class 3

25
Q

management of class 3

A

1) accept
2) interceptive TX for anterior crossbite
-URA
-2x4

3) Growth modification
- functional appliance
- protraction headgear

4) camouflage without XLA or with XLA (upper 5 and lower 4)

5) orthognatic surgery
depends on aethiology of skeletal pattern
pre-surgery -
retrocline upper incisors
procline lower incisors

26
Q

what is the mode of action of class 3 growth modification?

A

DENTALVEOLAR
- proclination of upper incisors
- retroclination of lower incisors
- mesial eruption of upper molars

SKELETAL
- maxillary growth
- mandibular restraint
- slight increase of vertical dimension

27
Q

indications for camouflage of class 3

A
  • correct incisor relationship
  • pt can achieve edge-edge incisor
  • minimal dentalveolar compensation
  • good overbite
  • no facial concern
28
Q

risks of crossbite

A
  • traumatic occlusion
  • displacement
  • periodontal breakdown
  • occlusal wear
  • aesthetic
  • TMJ disfunction
29
Q

2x4 appliance?

A
  • brackets on upper incisors and 6’s
  • wire used to align teeth
  • push coil procline incisors
30
Q

advantages and disadvantages of 2x4

A

+ve
- 3D control of teeth
- More efficient compared to URA

-ve
- risk of root resorption

31
Q

what is the difference between fixed vs removable appliance

A

fixed (bodily movements)
- 3D control
- force couple
- control of crown and root
- usually permanent dentition
- compliance (OH, diet)
- comprehensive

removable (tipping)
- tipping
- single point
- partial control of crown
- mixed permanent dentition
- compliance = KEY
- interceptive & adjunctive

32
Q

what do fixed appliance do?

A

CICMAS

Camouflage mild/moderate skeletal discrepency
Intrusion/extrusion of teeth
Correction of rotations
Multiple tooth movements in 1 arch
Active space closure
Space distribution (hypodontia)

33
Q

what are the clinical uses of URA

A

COTHS

Correction of anterior/posterior crossbite
Overbite reduction
Test patient compliance
Habit breaking appliance
Simple tooth movements

34
Q

what are the components of URA

A

ARAB
Active component (springs, screws, elastics)
Retentive component ADAMS CLASP
Anchorage “resists unwanted tooth movements”
Base plate - connects all components together

35
Q

anterior bite plane function of an URA

A
  • reduce overbite
  • disengage occlusion
36
Q

posterior bite plane uses of URA

A
  • correct anterior crossbite
  • disengage the occlusion
37
Q

what are the advantages VS disadvantages of URA

A

+ve
- cheap
- less chair time
- simple mechanism
- good vertical and horizontal anchorage

-ve
- pt coorporation
- diffucult to tolerate (esp. lowers)
- limited tooth movement
- needs labwork
- risk of candida infection

38
Q

what is hypodontia and what are the tx options?

A
  • missing teeth

management
- accept and do nothing
- restorative only
- ortho restorative
= open space - restorative treatment (life long restorative burden)
= close space - camouflage space (avoids restorative burden)

39
Q

what are the most common impacted teeth?

A
  • upper insicors
  • upper canines
  • 5’s (early loss of E’s)
40
Q

clinical assessment of impacted canines

A

PPE TMMS
- Palpation from 9 y/o
- Presence/mobility of C
- Eruption of contralateral canine

  • Tip or inclination of lateral incisor
  • Missing lateral incisor
  • Mobility of lateral incisors, vitality test (suspected root resorption)
  • Space available
41
Q

when best to take rads for impacted canine and what type?

A

over 11 y/o where 3’s are not palpable (karol et all, 1997)

OPG
upper standard occlusion
periapical
CBCT

horizontal parallax - 2PA’s or OPG &PA
vertical parallax - upper standard occlusion & OPG

42
Q

on radiographic assessment

A
  • presence/absence, root resorption of C
  • position of canine
  • buccal/palatal
  • AP
  • vertical
  • angulation
  • apex
  • pathology (cysts,root resorption of 2’s and 1’s)
43
Q

impacted vs ectopic

A

impacted teeth has good location but something is blocking such as supernumery/ crowding

ectopic teeth has deviation of normal path of eruption so on rad = overlap between canine & lateral incisor

44
Q

prognosis on radiograph of ectopic/impacted canine

A

OVAP good/ average/ poor
Overlap of incisor no overlap, 1/2 root width, complete overlap
Vertical height CEJ, >half, >full root length
Angulation 0-15, 16-30, >30
Position of apex above 3, above 4, above 5

45
Q

management of impacted teeth

A

1) accept but warn pt of root resorption and cyst formation
2) interceptive tx
XLA of upper C’s, depending on position of 3 & available space
RCS guidelines say - if a lot of crowding XLA wont help

3)Expose, bond and ortho traction (attack gold chain and force to re-align)

4) surgical removal
5) surgical repositioning

46
Q

aethiology and management of unerupted maxillary incisors

A

aethiology
- supernumeries, hypodontia
- dilaceration due to trauma to primary teeth

management
-remove obstacle + primary incisor
- create/maintain space
- expose, bond and orthotraction

47
Q

why XLA 6’s in children

A

MIH, caries, enamel hypoplasia

48
Q

which guidelines state XLA of 6’s in children?

A

RCS, 2023

49
Q

TX goals of XLA 6’s

A
  • age 8-10y/s
  • bifurcation of 7
  • 5 lying in the roots of E
    after XLA 6
    7 erups and replace 6
    8 erupts and replace 7
50
Q

what is tx goal of XLA of 6’s

A

1) space requirement
- space to relieve crowding

51
Q

space to correct incisor relationsip with incisor traction?

A

class 2: retract upper incisors
class 3: retract lower incisors

52
Q

what are other things to consider for XLA of 6’s

A

2) requirement of GA for XLA
3) pt factors suitable for Ortho TX
- OH
- medical conditions
- social and financial status

53
Q

what is balancing XLA?

A

rarely indicated in 6’s
XLA from opposite side of the same arch, prevent centreline shift.

54
Q

compensating XLA

A

XLA from same side different arch to prevent overeruption of opposing arch hence maintain occlusal relationship

55
Q

Aetiology of impacted/ectopic canine

A

• crowding
• Long path of eruption
• Absence/ abnormality of the lateral incisor
• Prolonged retention of c/c
• Ankylosis
• Pathology
• clefts

Ortho SAQ2 (2 decks)

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