Ortho Tx Planning Primary Dentition (Resident)

Question 1

What are the 5 advantages of early tx?

Answer 1

Increase possibility of achieving better result
Some tx can only be corrected at early age
Some habits tx early avoid ingrained habit reinforcement
Psychosocial considerations important
Younger patients more cooperative

Question 2

What are the 4 goals of interceptive ortho

Answer 2

1= prevent progressive, irreversible soft tissue or bony changes
2= eliminate CR-CO shift (functional shift)
3= improve Skeletal malrelationships by influencing the direction of facial growth
4= prevent excessive dental and skeletal compensation resulting from functional disharmony

Question 3

Identification of problems

Answer 3

Eruption
Space
Occlusal relationship
Habits

Question 4

Eruption problems

Answer 4

Over retained primary teeth
Ectopic eruptions
Supernumerary teeth

Question 5

Space problems

Answer 5

Missing primary molars
Missing anterior teeth

Question 6

Occlusal relationship problems

Answer 6

Posterior crossbite
Anterior crossbite with anterior shift

Question 7

Habit problems

Answer 7

Dental open bite

Question 8

Over retained primary teeth definition

Answer 8

Permanent too should replace its primary predecessor when approximately 3/4th of the root of the permanent too this formed

Question 9

Tx of over retained primary teeth

Answer 9

Extraction of primary tooth - prevent deflected eruption paths (irregularity, crowding, crossbite) and gingival inflammation and hyperplasia (pain and bleeding)

Question 10

Result of extracting primary tooth over retained primary teeth

Answer 10

If space is adequate, moderately abnormal facial or lingual positioning will be corrected by equilibrium forces of lips, cheeks and tongue

Question 11

Ectopic eruption lateral incisors

Answer 11

Permanent lateral incisor erupts, resorption of one or both primary canines is common.
Indicates lack of enough space for all perm. Incisors
May result from aberrant eruption path

Question 12

Ectopic eruption lateral incisors tx

Answer 12

Space analysis, assessment of AP incisor position and the facial profile - determine space maintenance, space management, space regaining or more complex tx

Question 13

Ectopic eruption maxillary canines

Answer 13

~ 10 yrs, primary canine is not mobile and no observable/papable facial canine bulge, ectopic eruptions considered, 1-2% range

Question 14

Problems that Ectopic eruption maxillary canines can cause

Answer 14

Impaction of canine
Resorption of permanent lateral and/or central incisor roots

Question 15

Ectopic eruption permanent first molars

Answer 15

Perm. Tooth causes resorption of primary tooth other than the one its supposed to replace or resorption of adjacent permanent tooth.

Question 16

Ectopic eruption permanent first molars limited resorption vs moderately advanced resorption

Answer 16

Limited = immediate tx not required
Advanced = requires active intervention, self correction unlikely

Question 17

The permanent tooth is dislodged _______ with spring mechanics and erupts past the ________ tooth

Answer 17

Distally, primary

Question 18

Supernumerary teeth

Answer 18

Can disrupt normal eruption of other teeth- crowding, spacing
If not inverted, will erupt before or along the normal tooth, can be extracted before interferences with adjacent teeth

Question 19

Most common location of supernumerary teeth

Answer 19

Anterior maxilla, take any shape

Question 20

Supernumerary teeth tx

Answer 20

Extract supernumeraries as soon as identified, prevent problems or minimize effect on other teeth if already displaced

Question 21

Quantification of a space problem

Answer 21

Space available
Space required

Question 22

Space available

Answer 22

Dividing dental arch into 4 straight segments. Each measured individually with a ruler or sharpened boley gauge

Question 23

Space required

Answer 23

Sum of mesiodistal widths of all individual erupted permanent teeth plus the estimated sized of the unerupted permanent teeth

Question 24

Premature tooth loss with adequate space : space maintainers

Answer 24

Band and loop
Partial denture
Distal show
Lingual arch

Question 25

Band and loop space maintainer

Answer 25

Unilateral fixed appliance - posterior space Loop - limited strength, must be restricted holding space of one tooth not accept functional forces of chewing

Question 26

Bilateral band and loop indication

Answer 26

Single primary molar has been lost bilaterally before eruption of the lower permanent incisors

Question 27

The permanent incisor tooth buds are _______ to the primary incisors and often erupt _______

Answer 27

Lingual, lingually

Question 28

Distal shoe space maintainers

Answer 28

Appliance of choice when primary second molar is lost before eruption of permanent first molar Guide plane must extend into alveolar process, located approximately 1 mm below mesial MR of permanent 1st molar, at or before emergence from bone

Question 29

Lingual arch space maintainer indicated from

Answer 29

Multiple primary posterior teeth missing Permanent incisors have erupted

Question 30

Lingual arch space maintainers attachment

Answer 30

To bands on primary 2nd or permanent 1st molars and contacting incisors

Question 31

What does lingual arch space maintainers prevent

Answer 31

Anterior movement of post. Teeth Post movement of anterior teeth

Question 32

The nance arch is an _________ space maintainer, but soft tissue _______ can be a problem

Answer 32

Effective, irritation

Question 33

Partial denture space mainters

Answer 33

-For bilateral post. Space maintenance when more than 1 tooth been lost per segment and perm. Incisors have not erupted yet - band and loop contraindicated -post. Space maintenance in conjunction with replacement of missing prim. Or delayed perm. Incisors

Question 34

Are anterior teeth required for nutrition or speech development?

Answer 34

No, children adapt readily to missing teeth, replacements is for appearance

Question 35

Space deficiency largely due to allowance for molar shit

Answer 35

-Some children, more severe transitional crowding occurs when incisors erupt -analysis shows that space availed is adequate or nearly so -major component of the projected space deficiency is due to mesial movement of the perm. First molar to a class I relationship when the second primary molars are lost -loss of leeway space could be prevented, little or no space deficiency

Question 36

Posterior crossbite mixed dentition %

Answer 36

Pretty common 7.1% age 8 - 11

Question 37

Crossbite reasons

Answer 37

Skeletal - narrow maxilla Dental - lingual tipping of max teeth

Question 38

When is early correction indicated in posterior crossbite

Answer 38

If the child shifts on closure or if the constriction is severe enough to significantly reduce the space within the arch

Question 39

Posterior crossbite tx deferred

Answer 39

Comprehensive ortho needed later

Question 40

Is the tx usually the same if the crossbite is skeletal or dental?

Answer 40

Yes, since relatively light forces will move teeth and bones Expansion of palatal arch is best choice

Question 41

Equilibration to eliminate mandibular shift

Answer 41

-Prim or early mixed dentition, shift into posterior crossbite will be due to occlusal interferences caused by the canines or prim. Molars, can be diagnosed by positioning mandible and comparing CR to CO -width of maxilla is adequate, no crossbite without the shift -child requires limited equilibration of primary teeth (reduction of prim canines), eliminate interferences and resulting lateral shift into crossbite

Question 42

Expansion of a constricted maxillary arch

Answer 42

-More commonly, lateral shift into crossbite = constriction of maxillary arch -even small constriction creates dental interferences that force mandible to shift to a new position for maximum intercuspation and moderate expansion of maxillary dental arch needed from correction -general guideline = expand to prevent the shift when diagnosed

Question 43

Appliance for expansion of constricted maxillary arch

Answer 43

Quad helix W arch

Question 44

Anterior crossbite

Answer 44

-Usually all incisors, rare who do not have skeletal class III jaw relationship -relationship of one or two ant teeth, may develop in child who has good facial proportion - ~3% with mixed dentition

Question 45

Planning tx for anterior crossbite

Answer 45

Critically important to differentiate skeletal problems (deficient max or excessive mand) from cross bites due only to displacement of teeth (eruption problems)

Question 46

Truly skeletal problem anterior crossbite

Answer 46

Changing the incisor position is inadequate tx

Question 47

Non skeletal anterior crossbite

Answer 47

One or two teeth Almost always due to lingual displaced max central or lateral incsiros Teeth erupt to lingual because of lingual position of developing tooth buds and may be trapped in that location, especially if not enough space

Question 48

In a young child, one way to tip the maxillary and mandibular anterior teeth out of crossbite is with a __________ appliance, using ______ ________ for facial movement of maxillary incisors

Answer 48

Removable, finger springs

Question 49

Non skeletal anterior crossbite

Answer 49

Tip the maxillary incisors forward with 2x4 fixed appliance 2 bands on first molars 4 bonded incisor brackets Rare- no skeletal , this is best choice for mixed dentition for - crowding, rotations, need for bodily movement, more perm. Teeth in crossbite

Question 50

Open bite causes

Answer 50

-normal transition perm teeth erupting - habit, finger sucking or tooth displacement by resting soft tissue (lip entrapment) -skeletal problem (excessive vertical growth and rotation of jaws that would create a disproportionately large lower anterior face height)

Question 51

What happens to many of the transitional and habit problems?

Answer 51

Resolve with either time or cessation of the sucking habit

Question 52

Open bites that persist until adolescence, with the exception of those related to habits, or those that involve more than just the incisors almost always have a significant ______ _____ and careful diagnosis of the contributing factors is requires. These are termed _______ _____ bites and require _______ treatment

Answer 52

Skeletal component, complex open, advanced

Question 53

What happens if the habits stop before the eruption of the permanent incisors?

Answer 53

Most of the changes resolve spontaneously with the exception of posterior crossbite

Question 54

What happens if a child does not want to quit a habit?

Answer 54

Therapy is not indicated

Question 55

Non dental habit intervention

Answer 55

As the time of eruption of the perm incisors approach, simplest approach is straightforward discussion “Adult approach” more effect with older children

Question 56

Appliance therapy habit intervention

Answer 56

Child who wants to stop - fitted with cemented appliance impedes sucking Appliances can be deformed and removed by children - not compliant Need cooperation