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BDS3 Orthodontics > Orthodontic Assessment > Flashcards

Orthodontic Assessment Flashcards

1
Q

why complete an orthodontic assessment

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

when to complete an orthodontic assessment

A
  • Brief examination often at aged 9 years
  • Comprehensive examination when premolars and canines erupt (11-12 years)
  • When older patients first present. If a malocclusion develops later in life
    • It is never too late to have orthodontic treatment
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3
Q

ideal occlusion

A
  • Ideal occlusion
    • Hypothetical, rarely found in nature
    • Gold standard by which occlusal irregularities and treatment may be judged

Andrew’s 6 keys (1972)

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4
Q

Andrew’s 6 keys

A
  1. Molar relationship – 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 (Class I)
  2. Crown angulation (mesio-dtal tip)
  3. Crown inclination
  4. No rotations
  5. No spaces
  6. Flat occlusal planes (no curve of spee)

Teeth in right size proportionally

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5
Q

normal occlusion

A

more commonly observed than ideal occlusion

  • Minor deviations
    • Do not constitute an aesthetic or functional problem
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6
Q

malocclusion

A
  • Are more significant deviations from the ideal that may be considered unsatisfactory (aesthetically or functionally)
  • may require treatment, but pt factors may influence decision
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7
Q

orthodontic assessment is undertaken in

A

history and examination

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8
Q

history for orthodontic assessment

A

same as every other dental and medical history

  • presenting complaint (P/C)
    • prioritise them in pt view if multiple
  • how much does it bother patient?
    • Need to be compliant and willing for treatment
  • History of P/C
  • Past medical history
    • Few conditions now are a contra-indication for orthodontics
      • Allergy (Ni or Latex)
      • Epilepsy/drugs (needs to be controlled for removable)
      • Drugs
      • Imaging
  • Past dental history
    • Frequency of attendances (got to be comfortable coming)
    • Nature of previous treatment (high caries rate?)
    • Co-operation with previous treatment
    • Trauma to permanent dentition
      • E.g. of permanent incisors
        • Can cause ortho issues
        • Compared to l incisor lost clear lamina dura
  • Social/family history
    • Travelling distance/time
    • Car owner/public transport
    • Parents work?
    • School exams?
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9
Q

habits that can affect occlusion

A
  • Thumb sucking
  • Lower lip sucking
  • Tongue thrust
  • Chewing finger nails
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10
Q

examination components for orthodontic assessment

A

Extra-oral

  • Skeletal base
  • Soft tissue
  • TMJ

Intra-oral

Compare patient to parent for

  • Malocclusion
    • Especially class III malocclusions
  • Growth potential

Dentoskeletal relationships (teeth on bases attached to skeletal skull)

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11
Q

facial skeletal pattern - components for consideration

A

3 planes

  • antero-posterior
  • vertical
  • transverse
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12
Q

how to do anterior-posterior skeletal assessment

A
  • visual assessment
  • palpate skeletal bases
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13
Q

anterior posterior skeletal assessment

classes

A
  • Class I – maxilla 2-3mm in front of mandible
  • Class II – maxilla more than 3mm in front of mandible
  • Class III – mandible in front of maxilla
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14
Q

vertical skeletal assessment involves

A

frankfort-mandibular plane angle (FMPA)

can be

  • average (meet at occiput)
  • reduced (meet after occiput)
  • increased (meet before occiput)
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15
Q

frankfort mandibular plane angle

A

frankfort horizontal plane parallel to the ground

lower border of mandible

should meet at occiput

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16
Q

lateral skeletal assessment

A

mid-sagittal reference line

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17
Q

extra-oral examination for ortho assessment

A

looks at soft tissues - can influence tooth position

  • Lips
    • Competent/incompetent
    • Lower lip level
    • Lower lip activity
  • Tongue
    • Position
    • Habitual and swallowing
  • Habits
    • Thumb/digit sucking
  • Speech
    • Lisping
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18
Q

competent lips

A

meet at rest with relaxed mentalis muscle

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19
Q

incompetent lips

A

do not meet at rest when relaxed mentalis muscle

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20
Q

lip trap

A
  • may procline upper incisors;
  • may lead to relapse of overjet if persists at the end of Tx
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21
Q

lower lip activity

A
  • hyperactive lower lip may retro cline lower incisors
  • indicates likely instability at end of tx
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22
Q

tongue position and swallowing pattern

A
  • tongue thrust on swallowing can be associated with an anterior open bite (AOB)
  • can be either endogenous or adaptive tongue thrust (cause or effect?)
    • may cause relapse of AOB at end of treatment if endogenous
      • lisp can be a sign
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23
Q

occlusal effects of thumb and digit sucking

A
  • proclination of upper anteriors
  • retroclination of lower anteriors
  • localised AOB or incomplete OB (partially covered)
  • narrow upper arch +/- unilateral posterior crossbite (upper posterior teeth get narrowers)

remember that effects will be superimposed on existing skeletal pattern and incisor relationship

aymmetric or symmetric

24
Q

TMJ in orthodontic assessment

A
  • path of closure
  • range of movement
  • pain/click from joint
  • deviation on opening
  • muscle tenderness
25
Q

mandiular displacement is

A

Discrepancy in retruded contact position and inter-cuspal position

RCP does not = ICP

e. g.Displacement of mandible up and to the right from RCP to ICP
* note centre line positions

26
Q

how to ensure to get thorough orthodontic assessment

A
  • always look for (and expect) the unexpected
    • almost ignore/put to one side the obvious, to ensure to check full state
27
Q

what to check on intra oral examination

A
  • oral hygiene and periodontal health
  • count the teeth (from the back)
  • teeth of poor prognosis
  • assess crowding/spacing/rotations
  • inclination/angulation
  • palpate for canines if not erupted
  • note teeth of abnormal shape/size e.g. peg laterals
28
Q

teeth present here

A

Upper lateral missing 22,

29
Q

teeth present here

A

supernumerary lower lateral (lower L)

30
Q

why is it imp to consider oral hygiene in orthodontic assessment

A

mindful that orthodontics can go wrong and thus have a knock on negative effect on oral health

31
Q

4 aspects of orthodontic assessment for lower arch

A
  • Degree of crowding
    • Uncrowded
    • Mild
    • Moderate
    • Severe
  • Presence of rotation
  • Inclination of canines
    • Mesial
    • Upright
    • Distal
  • Angulation of incisors to mandibular plane
    • Upright
    • Proclined
    • Retroclined
32
Q

4 aspects of orthodontic assessmet for 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
33
Q

orthodontic assessment when teeth in occlusion

A
  • Maximum interdigitation or RCP
    • Incisor relationship (BSI definitions)
    • Overjet
    • Overbite/open bite
    • Molar relationship (Angle’s classification)
    • Canine relationship
    • Cross bites
    • Centre lines
34
Q

british standards institute of incisor classification (BSI)

A
  • Class I
  • Class II
    • Division 1
    • Division 2
  • Class III

Overjet, overbite, centrelines

35
Q

BSI incisor class I

A

The lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incisors.

36
Q

BSI incisor class II

A

The lower incisor edges lie posterior to the cingulum plateau of the upper incisors.

  • Division I - The upper incisors are proclined or of average inclination and there is an increase in overjet.
  • Division 2 - The upper central incisors are retroclined. The overjet is usually minimal or may be increased.
37
Q

BSI incisior class II div 1

A

The lower incisor edges lie posterior to the cingulum plateau of the upper incisors.

Division I - The upper incisors are proclined or of average inclination and there is an increase in overjet.

38
Q

BSI incisor class II div 2

A

The lower incisor edges lie posterior to the cingulum plateau of the upper incisors.

  • Division 2 - The upper central incisors are retroclined. The overjet is usually minimal or may be increased.
39
Q

BSI incisor class III

A

The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or reversed.

40
Q

overjet

A

upper teeth protrude outward and sit over the bottom teeth.

Having an overjet doesn’t only affect your appearance.

You can have also difficulty chewing, drinking, and biting.

HORIZONTAL

41
Q

overbite

A
  • Average
  • Reduced
  • AOB
  • Increased
    • Incomplete?
    • Complete?
      • Tooth or palate?

VERTICAL

42
Q

classification for buccal segment relationship (canine)

A

Angle Classification

I, II, III

MB upper FPM occlude MB groove lower FPM

  • Anterior – class II
  • Posterior – class III
43
Q 
Angle Classification 
class I
A
  • (upper canine behind lower canine – need for good ortho Tx)

MB upper FPM occlude MB groove lower FPM

44
Q

Angle Classification

Class II

A

(upper canine anterior to lower canine (can get half))

MB upper FPM occlude MB groove lower FPM

Anterior – class II

45
Q

Angle Classification

Class III

A
  • (upper canine is well behind lower canine (between 4 and 5 rather than 3 and 4))

MB upper FPM occlude MB groove lower FPM

Posterior – class III

46
Q

crossbite

A

form of malocclusion where a tooth (or teeth) has a more buccal or lingual position (that is, the tooth is either closer to the cheek or to the tongue) than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.

47
Q

centrelines in orthodontic assessment

A
  • Looking at how would relate the upper to lower centrelines and the two centrelines to the facial midline
48
Q

4 special investigations that can be used in orthodontic assessment

A
  • radiographs
  • vitality tests
  • study models
  • photographs
49
Q

radiographs used in orthodontic assessment

A

usually good to have 2 views to localise position of unerupted teeth, length and position of roots

  • OPT
    • Any pathology/unerupted teeth/length roots
    • Not overly clear in midline due to spine superimposition
  • Maxillary anterior occlusal
  • Lateral cephalogram
    • See pt in profile view
    • Measurements – angles, distances – between points on skull
    • Help plan Tx – skeletal bases, cranial bases relationship
    • Monitor changes in pt
50
Q

why are vitality tests used in orthodontic assessment

A

Trauma

  • e.g. Chip and discolouration – vitality test prior to ortho Tx
51
Q

study models use specific to orthodontic assessment

A
  • Monitoring changes in Tx
  • Monitoring development of dentition
52
Q

whats in the orthdontic summary

A
  • HPC, RMH, RDH, RSH (R = relevant)Name, age, sex of patient
  • Incisor relationship, Sk base (AP, V, T), ST
  • Teeth present/absent, OH, poor prognosis
  • Lower arch, incisor inclination, crowding
  • Upper arch, incisor inclination, crowding
  • OJ, OB, centrelines, molar relationship, crossbites, and miscellaneous
  • IOTN score

Basis of referral letter

53
Q

purpose of incisior relationship

A

to class malocclusion

54
Q

what to do with the information gathered in orthodontic assessment

A
  • Summarise the important points
  • Assess treatment need (IOTN)
    • Benefits to dental health
    • Benefits to social wellbeing
  • Help decide extent of treatment needed
  • Devise treatment aims if appropriate
  • Plant treatment
55
Q

how to get frankfort plan parallel to the floor

A

eye contact with themselves in mirror

56
Q

how and points to chek when assessing transverse midline skeletal relationship

A

Hold mirror handle over glabella and see if points align

  • Chin
  • Lip fulcrum
  • Nasal septum
57
Q

when trying to remember what to consider in deciding malocclusion

think of (3)

A
  • How does the lower incisor edge relate to the cingulum plateau of the upper incisor? (class I/II/III)
  • What is the incisor angulation? (class II/1 or class II/2)
  • Describe the overjet (class II/ class III)

BDS3 Orthodontics (13 decks)

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