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BDS3 Orthodontics > Orthodontic Assessment > Flashcards

Orthodontic Assessment Flashcards

1.5e be able to identify the pertinent features of a child or adolescent patient relating to potential orthodontic problems 1.9a be familiar with the limitations of orthodontic treatment

1
Q

Why complete an orthodontic assessment?

A
  • Determine if any malocclusion is present
  • Identify any underlying causes
  • Decide if treatment is indicated (either refer or devise treatment plan)
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2
Q

When do you perform a orthodontic assessment?

A
  • Brief assessment at aged 9years
  • Comprehensive examination when premolars and canines erupt (11-12years)
  • When older patients first present
  • If a malocclusion develops later in life
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3
Q

What is ideal occlusion?

A
  • Hypothetical and rarely found in nature
  • Gold standard by which occlusal irregularities and treatment may be judged
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4
Q

What is normal occlusion?

A
  • More commonly observed than ideal occlusion
  • Can include minor deviations that do not constitute an aesthetic or functional problem
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5
Q

What are the 6 keys of Ideal occlusion?

A

I - Molar relationship
II - Crown angulation (mesio-distal tip)
III - Crown inclination
IV - No rotations
V - No spaces
VI - Flat occlusal planes

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6
Q

What is the molar relationship in the ideal occlusion?

A

The distal surface of the disto-buccal cusp of the upper first permanent molar occludes with the mesial surface of the mesio-buccal cusp of the lower second permanent molar

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7
Q

What is malocclusion?

A
  • More significant deviations from the ideal that may be considered unsatisfactory (aesthetically or functionally)
  • May require treatment but patient factors may influence decision
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8
Q

Process of a Examination

A
  • History
  • Examination
  • Special investigations
  • Diagnosis
  • Treatment
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9
Q

How to take a History?

A
  • PC
  • HPC (Trauma/growth problem/Perio problems/ how long had it)
  • How much does it bother patient themselves?
  • PMH
  • PDH
  • SH/FH
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10
Q

How does PMH contraindicate orthodontic treatment?

A
  • Allergy to Nickel or latex
  • Epilepsy or drugs
  • Drugs
  • Imaging (pt who are getting MRI can’t have braces)
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11
Q

How does PDH affect Orthodontic treatment?

A
  • Frequency of attendance to practice
  • Nature of previous treatment
  • Co-operation with previous treatment
  • Trauma to permanent dentition
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12
Q

History of trauma

A
  • Take radiographs to check trauma
  • Root resorption can occur (don’t want to be accused of this if already present due to trauma)
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13
Q

How can SH/FH influence orthdontic treatment?

A
  • Travelling distance/ time
  • Car owner/ public transport
  • Parents work?
  • School exams
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14
Q

How can habits affect orthodontic treatment?

A
  • Thumb sucking
  • Lower lip sucking
  • Tongue thrust
  • Chewing finger nails
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15
Q

When performing an examination what do you compare the patient to the parent for?

A
  • Malocclusion
  • Growth potential
  • Especially in Class III malocclusions
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16
Q

How do you assess the skeletal pattern clinically?

A
  • Visual assessment
  • Palpate skeletal bases
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17
Q

What 3 planes is the facial skeletal pattern considered in an extra-oral examination?

A
  • Antero-posterior (Class I, II or III)
  • Vertical
    -Transverse
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18
Q

What is the Class I AP Skeletal assessment?

A
  • Maxilla 2-3mm in front of mandible
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19
Q

What is Class II AP Skeletal assessment?

A
  • Maxilla more than 3mm in front of mandible
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20
Q

What is Class III AP Skeletal assessment?

A
  • Mandible in front of maxilla
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21
Q

How do you directly palpate skeletal bases?

A
  • Gloved hand push lips apart and asssess
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22
Q

What is involved in soft tissues examination?

A
  • Lips (Competent/incompetent, Lower lip level, Lower lip activty)
  • Tongue (Position, habitual and swallowing)
  • Habits (Thumb, digit sucking)
  • Speech (Lisping)
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23
Q

What is involved in soft tissues examination?

A
  • Lips (Competent/incompetent, Lower lip level, Lower lip activity)
  • Tongue (Position, habitual and swallowing)
  • Habits (Thumb, digit sucking)
  • Speech (Lisping)
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24
Q

What does Competent lips mean?

A
  • Lips meet at rest
  • Relaxed mentalis muscle
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25
Q

What does Incompetent Lips mean?

A
  • Lips do not meet at rest
  • Relaxed mentalis muscle
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26
Q

What does a lip trap mean?

A
  • May procline upper incisors
  • May lead to relapse of overjet if persists at end of treatment
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27
Q

How does lower lip activity affect ortho treatment?

A
  • Hyper active lower lip activity may retrocline lower incisors
  • Indicates likely instability at end of treatment
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28
Q

How does tongue position and swallowing pattern affect ortho treatment?

A
  • Tongue thrust on swallowing can be associated with an anterior overbite (AOB)
  • Can be either endogenous or adaptive tongue thrust (Cause or effect)
  • May cause relapse of AOB at end of treatment if endogenous
29
Q

What are the occlusal features of a sucking habit?

A
  • Proclination of upper anteriors
  • Retroclination of lower anteriors
  • Localilised AOB or incomplete OB
  • Narrow upper arch +/- unilateral posterior crossbite
  • Effects are superimposed on existing skeletal pattern and incisor relationship
30
Q

What are you feeling for during TMJ inspection of E/O examination?

A
  • Path of closure
    -Range of movement
  • Pain, click from joint
  • Deviation on opening
  • Muscle tenderness
  • Mandibular displacement
  • Discrepency in retruded contact position and inter-cuspal position
  • RCP does not = ICP
31
Q

What is mandibular displacement?

A
  • Displacement of mandible up and to right from RCP to ICP
  • Note center line positions
32
Q

What lines do you use for a vertical skeletal assessment?

A
  • Frankfort - Mandibular Planes Angle (FMPA)
33
Q

What is an increased FMPA angle?

A
  • Frankfort horizontal plane horizontal
  • Lower border of mandible line crosses the Frankfort line
34
Q

What is reduces FMPA angle?

A
  • Lower border of mandible line is almost parallel to the Frankfort line
35
Q

What to look for when looking at Lateral skeletal assessment?

A
  • Use mid sagittal reference line
  • Cupids bow usually in centre of face
36
Q

What to check for during Intra-oral?

A
  • OH and periodontal health
  • Count teeth (Absent/extra)
  • Teeth of poor prognosis
  • Assess crowding/ spacing/ rotations
  • Inclinations/ angulation
  • Palpate for canines if not erupted
  • Teeth of abnormal shape/size e.g. peg laterals
37
Q

What to look for in lower arch?

A
  • Degree of crowding (Uncrowded, Mild, Moderate, Severe)
  • Presence of rotations
  • Inclination of canines (Mesial, upright, distal)
  • Angulation of incisors to mandibular plane (Upright, proclined, Retroclined)
38
Q

What to look for in upper arch?

A
  • Degree of crowding (Uncrowded, Mild, Moderate, Severe)
  • Presence of rotations
  • Inclination of canines (Mesial, upright, distal)
  • Angulation of incisors to Frankfort plane (Upright, Proclined, Retroclined)
39
Q

What is the angulation of incisors to Frankfort plane?

A
  • Frankfort plane to long axis of upper incisors is about 110°
40
Q

What are the incisor relationships according to British Standards Institute classification?

A
  • Class I
  • Class II (Division 1 or Division 2)
  • Class III
  • Overjet, Overbite, Centrelines
41
Q

What is class I Incisor relationship?

A

Class I - Lower incisor edges occlude with or lie immediately below cingulum plateau of the upper central incisors

42
Q

What is a Class II Division 1 Incisor relationship? Division I

A

Class II - Lower incisor edges lie posterior to cingulum plateau of the upper incisors
Division 1 - Upper incisors are proclined or of average inclination and there is increase in overjet

43
Q

What is Class II Division 2 incisor relationship?

A

Class II - Lower incisor edges lie posterior to cingulum plateau of the upper incisors
Division 2 - Upper central incisors are retroclined. Overjet is usually minimal or may be increased

44
Q

What is Class III incisor relationship?

A

Class III - Lower incisor edges lie anterior to cingulum plateau of the upper incisors. Overjet is reduced or reversed

45
Q

How can Overbite be classed?

A
  • Average (upper incisors covers 1/2 to 1/3 of lower incisor crown)
  • Reduced
  • AOB
  • Increased and complete contacts tooth
  • Increased and complete contacts palate
  • Increased but incomplete
46
Q

How can Buccal Segment Relationship be classified?

A
  • Classified by Angles classification
  • Class I
  • Class II
  • Class III
  • Crossbites
47
Q

What is Class I Buccal Segment relationship?

A
  • Mesiobucall cusp of upper 6 is in central groove of lower 6
  • Upper canine fit into lower canine and premolar
48
Q

What is Class II Buccal Segment relationship?

A
  • Mesiobuccal cusp of upper 6 in groove between lower 5 and 6
  • Upper canine in front of lower canine
49
Q

What is Class III Buccal Segment relationship?

A
  • Upper Premolar fit into central groove of lower 6
  • Upper canine tip hit tip of lower 4
50
Q

Crossbite definition

A
  • Abnormal relationship of one or more teeth of one arch to the opposing tooth or teeth of the other arch due to labial, buccal, or lingual deviation of tooth position, or to abnormal jaw position
51
Q

What radiographic special investigations are useful for Orthodontic assessment?

A
  • O.P.T
  • Maxillary anterior occlusal
  • Lateral cephalogram
52
Q

What special investigations can be useful for Orthodontic assessment?

A
  • Vitality tests
  • Study models
  • Photographs
53
Q

What do we do with the info collected from the examination?

A
  • Summarise important points
  • Assess treatment need (ION)
  • Devise treatment aims if appropriate
  • Plan treatmetn
54
Q

What are the key points for Orthodontic Summary?

A
  • Name, age, sex of patient
  • HPC, MH, DH
  • Incisor relationship, Skeletal base, Soft tissues
  • Teeth present/absent, OH, Poor prognosis
  • Lower arch, incisor inclination, crowding
  • Upper arch, Incisor inclination, crowding
  • OverJet, OverBite, Centrelines, molar relationship, crossbites and miscellaneous
  • IOTN (index of orthodontic treatment need) score
55
Q

What is orthodontics?

A
  • Speciality of dentistry concerned with:
  • Growth and development of teeth, face and jaws
  • Diagnosis, prevention and correction of dental and facial irregularities
56
Q

What is Hemimandibular hypertrophy?

A
  • 3 dimensional developmental enlargement of one side of mandible including condyle, condylar neck, ramus and body along with medial rotation
57
Q

What is Hemifacial microsomia?

A
  • Condition which half of one side of face is underdeveloped and doesn’t grow normally
  • Hemi means one side
  • Microsomia means smallness
58
Q

What can Hemifacial microsomia lead to?

A
  • Malformed ear (deafness)
  • Progressive facial asymmetry
  • Occlusal problems
59
Q

What is Cephalometry?

A
  • Measurement and study of the proportions of the head and face especially during development and growth
60
Q

What treatment is available for skeletal discrepancies in growing patients?

A
  • Growth modification techniques to promote or restrict growth of either jaw
  • Functional appliances
  • Headgear
  • Reverse pull facemask and RME (rapid palatal expansion)
61
Q

What treatment is available for skeletal discrepancies in adults who have completed growth?

A
  • Orthognathic surgery (bilateral sagittal split osteotomy (BSSO)
  • Single jaw or bimaxillary procedures
62
Q

Who is in the Orthognathic team?

A
  • Orthodontist
  • Maxillofacial surgeon
  • Clinical Psychologist
  • Maxillofacial technician
  • Speech therapist
  • GDP
63
Q

What is difference between cleft lip and palate?

A
  • Cleft lip is unilateral
  • Cleft palate is bilateral
  • Both multifactorial
  • 1 in 700 births
64
Q

Who is involved in cleft lip and palate surgery?

A
  • Orthodontist
  • Cleft surgeon
  • ENT
  • Speech therapy
  • Max-fac surgeon
  • Plastic surgeon
  • Dental practitioner
65
Q

What can go wrong with growth and development of teeth?

A
  • Increased overjet
  • Deep overbite
  • Anterior or posterior cross bite
  • Retained deciduous teeth
  • Early loss deciduous teeth
  • Ectopic teeth
  • impacted first molars
  • Crowding
    -Spacing
  • Trauma
  • Habits
  • Anterior open bites
  • Lateral open bites
  • Ankylosis of deciduous teeth (abnormal stiffening and immobility of joint due to fusion of bones)
  • Cysts
  • Diastema (Space separating teeth of different function)
  • Supernumeraries
  • Hypodontia (fewer than norm number of teeth)
  • Dental asymmetries
66
Q

What can you use to help orthodontic diagnosis?

A
  • Study models
  • Radiographs (OPG and Lateral cephalogram)
  • Photographs
  • Sensibility tests
  • Cone beam CT scan
67
Q

What are the aims of orthodontic treatment?

A
  • Stable
  • Functional
  • Aesthetic occlusion
  • Prior to restorative work
68
Q

What are the type of appliances available for Orthodontic treatment?

A
  • Removables
  • Functionals
  • Fixed
  • Aligners, Invisalign
  • Headgear and reverse pull HG
  • Temporary anchorage devices
69
Q

What are some risks of orthodontic treatment?

A
  • Decalcification
  • Relapse
  • Root resorption
  • Pain, discomfort
  • Soft tissue trauma
  • Failure to complete
    treatment
  • Loss of tooth vitality
  • Inhale or swallow small
    components
  • Candidal infections

BDS3 Orthodontics (10 decks)

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