Orthodontic Competancies Flashcards by Harry Wheeler

What does ANB indicate?

Soft tissue A point, to soft tissue B point via the nasion.

Increased indicates skeletal class II

Decreased indicates skeletal class III

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How is LAFH calculated?

Ratio of Glabella subnasale and menton

50/50 clinically
55/45 ceph

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What does SNA indicate?

Relative AP development of the maxilla to the cranial base.
Decreased indicates maxillary retrognathisism
Increased indicates maxillary prognathisism

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What does SNB indicate?

Relative AP development of the mandible to the cranial base.
Decreased indicates mandibular retrognathisism
Increased indicates mandibular prognathisism

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What does FMPA angle tell you?

Angle of lower mandible border to Frankfort plane
Increased indicates a more class II relationship
Decreased a more class III

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What does MMPA angle tell you?

It can give you an indication as to which way the face is growing, and the relationship between the maxilla and mandible.

A decreased one may indicate decreased LAFH and an increased may indicate and increased one.

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What is the average naso-labial angle?

100 degrees

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What habbits should we be aware of?

Digit sucking (AOB, Pro Ui, Ret Li, narrow upper arch, uni-lateral crossbite)

Lip sucking ( Ret Li, irritation to labial tissues)

Nail biting (linked to root resorption)

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What are the components of MOCDO?

Missing teeth
Overjet
Crossbites
Displacement
Overbite

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Outline what should be on the problem list?

Skeletal pattern

Mandibular/maxillary growth

Soft tissue problems (lip trap, incompetant lips)

MODCO problems

Dental problems (spacing, diastema etc.)

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Classification of class I incisors?

Lower incisal edges occlude to cingulum plateu of upper incisors.

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Classification of class IId1 incisors?

Lower incisal edges occluse posterior to cingulum plateu of upper incisors

Uppers are proclined or average, there is an increase in overjet.

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Classification of class IId2 incisors?

Lower incisal edges occlude posterior to cingulum plateu of upper incisors

Uppers are retroclined, there is a reducded but increases in overjet.

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Classification of class III incisors?

Lower incisal edges occlude anterior to cingulum plateu of the upper incisors.

There is a reduced or reversed overjet.

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What is the average coverage of an overbite?

Covers 1/2 to 1/3 of lower incisor crowns.

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How can you tell if an overbite is complete or not?

Incisors will occlude in complete.

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How do you determine the midline of a patients face?

Glabella to subnasale

What are the degrees of crowding?

Mild - 2 to 4mm
Moderate - 4 to 8mm
Severe - >8mm

Compare space required to space available
Overlap technique

What indications may there be to suspect hypodontia (before taking a radiograph)?

Delayed or asymmetric eruption
Retained or infraoccluded deciduous teeth
Absent deciduous tooth (if no primary = no permanent)
Tooth form

What are the main treatment options for orthodontics?

Accept
Growth modificaiton
Extractions only
Camouflage
Orthognathic surgery

What are Andrew’s six keys for orthodontic treatment?

Class 1 molars
Class 1 incisors
Tight contacts with no rotations
Flat occlusal plane or curve of spee
Long axis have slight mesial inclination
Crowns of the posteriors have lingual inclination

What are the main risks of orthodontics?

Treatment failure
Relapse
Gingival recession
Root resorption (1-2mm normal)
Decalcification

Which features have a high potnetial for relapse?

Rotations
Diastemas
AOB
Instanding U2s
Lower incisor crowding

How can you create space for orthodontics?

Extraction of teeth (4s and 5s typically)
Expansion of maxilla (RME or mid palatal screw)
Distalise buccal segment (fixed ortho)
Modifiy skeletal growth (twin block, headgear)

If a patient presents with an orthodontic emergency, what is the general procedure you should follow?

Ask how it happened Account for missing components Deal with problem Account for retention Refer to orthodontist

A patient presents with a URA, with a fractured southend clasp where the wire is emanating from the acrylic. What should you do?

Cut southend in the middle Turn remainder back to create C clasp Smooth rough edges Check retention Can't soulder as too close to acrylic

A patient presents with a fixed bonded retainer, which has debonded from two teeth. The wire is still stable, what should you do?

Remove as much composite as possible around the two teeth. Check tooth health Check wire integrity Rebond if all fine

A patient presents with a fixed appliance with molar bands. A bracket has come loose on the LR3, the archwire is stable, but the bracket can freely rotate. What should you do?

Potential risk of aspiration/ingestion Remove the bracket by removing ligature Keep archwire in place Hand bracket to PT, and refer to orthodontist

A patient presents with a URA, with a fracture at the midpoint of the southend clasp. What should you do?

Bend both ends into c clasps Can't soulder as its an area of flex

A patient presents with a fixed bonded retainer, which has a fracture in the middle and is no longer passive. What should you do?

Remove as no longer fit for use Check tooth health Consider prescribing a new retainer

A patient presents with a fixed appliance with molar bands and a TPA. The TPA is fractured where it meets the band, what should you do? What is a TPA for?

A TPA is used mainly for anchorage Can't bend or solder TPA not fit for purpose. Remove TPA at other band, with irrigation, high volume aspiration, and a floss tie around it so you don't drop it. Smooth area Refer to orthodontist

A patient presents with a URA, one of the adams clasps has fractured at both points where it leaves the acrylic. What should you do?

Account for missing component Refer for chest X-ray if unsure Smooth edges If retentive then all good If not then: - Replace clasp - Send lab prescription, working cast, and the appliance - If OG cast lost, then take new impression with URA in. Cannot simply put on new cast as wont fit and will lead to creep during cure.

A patient presents with a fixed bonded appliance with molar bands. A bracket has come off. It is not freely rotating, and is secure with the ligature. What should you do?

Little risk of it coming off as it can't rotate Check its secure Instruct patient to move bracket from side to side to clean Refer to orthodontist

A patient presents with a URA that has shattered in their pocket. What should you do?

Do not attempt to wear Do not super glue as cannot be repaired Account for all the pieces Offer thermoplastic retainer in meantime Refer to orthodontist

A patient presents with archwire slippage on their fixed appliance. What should you do?

Remove excess wire on one side Create retetentive tag on other side to prevent further slipage Refer to orthodontist

A patient presents with a URA, with a fracture through the arrowhead of the clasp. What should you do?

Not an area of flex, and away from acrylic so can be soldered if equipment there. If not remove all but the normal arrowhead, turning it into a c-clasp. Check for retention, if not there then needs replacing.

A patient presents with a fixed appliance with molar bands. One of the bands has become loose. What should you do?

Do not cement on, may interfere with treatment. Cut archwire mesially to band, create a retentive tag. Tak eband off Give to patient and refer to orthodontist.

A patient presents with a fixed bonded appliance, and has sustained a trauma. Multiple brackets have debonded, and there are ligatures missing. What should you do?

Account for the missing components. Archwire likely not fit for purpose so remove. Leave any bonded components in place. Give all components to patient and refer back to orthodontist with trauma stamp. Consider placing eax over brackets to smooth them off.

A patient presents with a fixed bonded retainer, which has debonded on one tooth. It has distorted slightly, and is pointed away from tooth. What should you do?

Would not want to rebond as would apply force to tooth. Cut off that portion of retainer. Refer for new retainer if its going to be a problem.

A patient presents with a URA, the adams clasp has fractured mesially where it eminates from the acrylic. What should you do?

Cut at distal arrowhead. Turn it into a C-clasp. Check for retentionl. If not retentive enough then send to lab to get new component attached. Requires appliance, prescription, and origional working cast.