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CCD2 - Ortho > Orthodontic assessment > Flashcards

Orthodontic assessment Flashcards

1
Q

What aspects of a medical history would contraindicate some types of orthodontic treatment?

A

Bisphosphonates - affect turnover of bone
Epilepsy
Allergies - metals
Smoking/diabetes - periodontal risk
Bleeding disorder - extraction risk

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2
Q

What aspect of a social/family history is important to ask about?

A

If a child is missing/retaining teeth does this run in the family?
For children who has right to consent to treatment?
Habits - digit sucking, pen chewing etc

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3
Q

How do we assess extra-orally in orthodontics?

A

View patient’s head from the front and the side and sometimes from above and below
Assessing hard and soft tissues in 3 planes of space - antero-posterior, vertical and transverse

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4
Q

How do we assess antero-posteriorly?

A

Assess in natural head position
Kettle’s method - palpate upper and lower jaws if fingers are pointing downwards suggests a class II skeletal base and pointing upwards suggests class III.
Zero Meridian line - dropped vertically from soft tissue nasion, perpendicular to floor if natural head position.
Class I - upper lip lies on or just ahead from the ZML and mandible lies 2-4mm behind the maxilla on palpation.
Class II - mandible appears further behind the maxilla, chin lies behind the ZML. Generally due to a retrusive mandible.
Class III - mandible appears to be ahead of the maxilla, chin lies ahead of the ZML and upper lip may be closer to or even behind the ZML. Due to a retrusive maxilla, protrusive mandible or often a combination of the two,

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5
Q

What are the characteristics of a retrusive maxilla?

A
  • paranasal hollowing
  • flat infra-orbital margins +/- flat zygomas (cheek bones)
  • in severe cases the sclera (white part of eye) visible below the iris
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6
Q

How do we assess vertical face height?

A

Facial thirds of:
- Trichion (hairline) to glabella (between eyebrows)
- Glabella to subnasale (base of the nose) - Upper anterior face height
- Subnasale to menton (bottom of chin) - lower anterior face height

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7
Q

When assessing lower anterior face height to the upper anterior face height what is average, increased or decreased?

A

Average - LAFH = UAFH
Increased - LAFH > UAFH
Decreased - LAFH < UAFH

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8
Q

How do we assess vertical face height using FMPA (frankfort mandibular plane angle)?

A

FP runs from bony infra-orbital margin to external auditory meatus
The mandibular plane runs along the lower border of the mandible
Average - meets at occiput
Increased - meet before occiput
Decreased - meet behind occiput

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9
Q

How do we assess transverse symmetry?

A

From above and below, drop a midline down the patients face and between the eyes - are they level or not?
Is the chin deviating?
Check asymmetry for nose, maxilla, mandible, whole face
Identify the facial midline and draw line from between the eyebrows, through the top of nose (if straight) and through the philtrum of upper lip

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10
Q

How do we assess the lips?

A

Are lips competent/incompetent
Length
Naso labial angle - 90-110 degrees
Relationship of lower lip to upper incisors - lip trap
Relationship of upper lip to upper incisors - average 3mm of incisor show at rest
Smile aesthetics
Tone/fullness

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11
Q

How do we check for habitually competent lips?

A

They require muscular effort so look for mentalis strain

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12
Q

When does lower lip trap occur?

A

May occur in class II div I malocclusions
The lower lip functions behind the upper incisors at rest, swallowing, eating, smiling and speaking.
The activity of the lower lip proclines the upper incisors further increasing the overjet

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13
Q

When do we see high lower lip lines?

A

One of the aetiological factors in class II div II maloclusions where the lower lip covers the upper centrals and retroclines them and the upper laterals escape the influence of lower lip.

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14
Q

How do we assess the tongue?

A

Position at rest:
Does it rest against the teeth or the palate.
If it sits forward between the incisors - can lead to anterior open bite
If it pushes against the palatal surfaces of the incisors can lead to proclination and spacing.
Size - large compared to size of arch?
Position when speaking:
Can you see the tongue protruding when speaking, if it thrusts forwards can lead to anterior open bite and spacing, often associated with lisping

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15
Q

What is an adaptive tongue thrust?

A

When the lips are incompetent the tongue thrusts forward to contact the lips and create an oral seal
Can lead to reduced overbite/anterior open bite

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16
Q

What is an endogenous tongue thrust?

A

Habitual so correcting malocclusion is unlikely to change this

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17
Q

What are you looking at intra-orally regarding orthodontics?

A
  • Crowding, spacing, rotations
  • Proclined, retroclined
  • Arch form

In occlusion:
- Incisor classification
- Overjet
- Overbite
- Centrelines
- Molar and canine relationship
- Cross bites: anterior/posterior
- Displacements from RCP

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18
Q

What is crowding?

A

The space required for all the teeth vs the space available in the desired archform, mesial to the 6’s
0-4mm crowding = mild
>4-8mm crowding = medium
>8mm crowding = severe

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19
Q

What is a class I incisor relationship?

A

Lower incisor edges occlude or lie immediately below the cingulum plateau of the upper central incisors.

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20
Q

What is a class II div I relationship?

A

The lower edges lie posterior to the cingulum plateau of the upper incisors. Generally the upper incisors are proclined and there is an increase in overjet.

21
Q

What is a class II div II relationship?

A

The lower incisor edges lie posterior to the cingulum plateau of the upper incisors and the upper central incisors are retroclined. The overjet is usually minimal but may be increased.

22
Q

What is a class III incisor relationship?

A

The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or negative.
If only one or 2 incisors affected - anterior crossbite

23
Q

What is overjet?

A

The horizontal distance between the upper and lower incisors

24
Q

What is normal overjet?

A

2-4mm

25
Q

What is reverse overjet?

A

The lower incisors lie anterior to the upper incisors

26
Q

What is overbite?

A

Vertical overlap of the upper and lower incisors.

27
Q

What is normal overbite?

A

One third to one half of the lower incisors covered

28
Q

What is increased overbite?

A

Greater than one half of the lower incisors covered

29
Q

What is reduced overbite?

A

Less than one third of the lower incisors covered

30
Q

What is anterior open bite?

A

No vertical over lap of the lower and upper incisors

31
Q

How do we assess centrelines?

A

Upper centreline in relation to facial midline
Lower in relation to chin point
Upper and lower centrelines in relation to each other

32
Q

What is a class I molar relationship?

A

MB cusp of upper 6 lying in anterior buccal groove of the lower 6

33
Q

What is a class II molar relationship?

A

MB cusp of upper 6 lies anterior to the anterior buccal groove of lower 6

34
Q

What is a class III molar relationship?

A

MB cusp of upper 6 lies posterior to the anterior buccal groove of lower 6

35
Q

What is a half unit class II molar relationship?

A

MB cusp of upper 6 occludes to MB cusp of lower 6 (cusp to cusp)

36
Q

What is a half unit class III molar relationship?

A

MB cusp of upper 6 occludes to DB cusp of lower 6 (cusp to cusp)

37
Q

What are class I, II and III canine relationships?

A

Class I - direct intercuspation
Class II - U3 tip mesial to embrasure space
Class III - U3 tip distal to embrasure space

38
Q

What is a posterior crossbite?

A

Transverse discrepancy in the buccolingual relationship of the upper and lower posterior teeth.

39
Q

What is a buccal crossbite?

A

The buccal cusps of the lower teeth occlude buccal to the buccal cusps of the upper teeth.

40
Q

What is a lingual crossbite?

A

The buccal cusps of the lower teeth occlude lingual to the palatal cusps of the upper teeth.

41
Q

What is a mandibular displacement?

A

On closure from the rest position there is a premature occlusal contact which causes the mandible to be displaced to the left or right and/or anteriorly, into maximum intercuspation.
If there is a crossbite always check for mandibular displacement!

42
Q

What is an anterior displacement?

A

Often class I or mild III skeletal relationship, usually displace forward from edge to edge incisal relationship and may be related to palatally displaced upper lateral incisors.

43
Q

What is lateral displacement?

A

Often seen with narrow maxilla/broad mandible (class III skeletal relationship, increased vertical proportions, digit sucking habit)
Displace from cusp to cusp buccal segment relationship to a more comfortable occlusion (look for unilateral crossbites)
If there is a unilateral buccal crossbite and lower centreline shift without displacement then a true mandibular asymmetry is present

44
Q

Why do we use OPT’s?

A

Screening for pathology, assessment of root form, length and pathology, assessment of bone levels and confirming the presence, position and morphology of unerupted teeth.

45
Q

What intra oral radiographs do we use for orthodontics?

A

PARALLAX
Root form and length
Pathology
Bitewings - Caries assessment
Lateral cephalogram - assess skeletal relationship and incisor position, aids treatment planning and progress
Cone beam CT - more accurate localisation of teeth

46
Q

What is the SLOB rule?

A

If the object of interest moves in the same direction as the X ray source compared to the other object - LINGUAL
If the object of interest moves in the opposite direction to the Xray source compared to another object it is BUCCAL
If no change likely objects in the same plane

47
Q

What is the IOTN?

A

Aims to rank malocclusion in terms of significance of occlusal traits and identifies patients who are most at need/most likely to benefit from treatment.

48
Q

What is the hierarchal structure of IOTN?

A

MOCDO
Missing
Overjet
Crossbites
Displacement of contact points
Overbite inc open bite

CCD2 - Ortho (5 decks)

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