Orthodontic Diagnosis II Flashcards
Evaluation of Facial & Dental Appearance
- ____-esthetics
- facial form, facial appearance, symmetry, proportionality from far away
- ____-esthetics
- that closer view. how much incisal showinng do we have? look at the smile arch
- ____-esthetics
- view from the prostodontics, we look at contacts between teeth, do we see diminishing views of teeth as we move from anterior to posterior?
macro
mini
micro
General facial aesthetics > combination of ____ and ____
subjective and objective
Facial views in extraoral series
- ____ (smile and repose)
- ____ (lip closure and repose)
- ____ (smile)
5 photos we take: 2 front, 2 profile, 1 3/4 smile
- 3/4 smile is most natural / conversational view is more normal smile aesthetic
frontal
profile
three-quarters
Symmetry
• If we drew a line down the face, how often will we see a completely symmetrical face? Almost never. Almost always will have some sort of ____
deviation
Width
• In terms of width dimension, we see ____ or dead/negative space on Michael. Normally, you should see some negative space but not as much as he has
• Most times we will have buccal corridors that cast some shadows, but often when they are substantial like in his case
we will see that they have a ____ maxillary arch
dark triangles
constricted
- On the otherhand, she has a very wide arch and smile aesthetic so she has almost no negative space. She has a very wide arch.
- Most times, an ideal dark corridor range is ____%
10-13
General frontal outline
- ____
- ____
- ____
- combinations of the three
tapered
square
ovoid
Smile Esthetics
• Is there an ideal smile esthetic? The answer is no because most times this is a ____
range
- For males, we generally prefer to see ____% central incisor show. Steph shows a bit more gingival display. Do we measure in mm or do we measure as a percentage? We measure as a ____! Because we have a lot of variation between CI height so when assessing incisal show we use %.
- Typically this is a range for ideal, from 80% to 100% incisal show, even a range of 2-3 mm of gingival show, we see a lot of variation.
100
percentage
Micro-esthetics
The last aspect we look at is microesthetics (even more detailed). How much connection and contact do we have? Do we have diminishing show? This is of utmost importance to ____. If for example, we have an undersized lateral incisor, we work together with the prost to determine how much space to leave (they may want us to leave more space)
prosthodontists
We can view teeth and jaws 3 dimensionally by using a ____ and intraoral ____ scans.. We will talk about a lot of technology merging together
CBCT
3D
General profile outline
____
____
____
straight
convex
concave
From soft tissue ____ to soft tissue ____ point, we have a straight flowing line. So straight!
Typically,
Straight is ____
Convexity is ____
Concavity is ____
Is a class 3 skeletal or dental in nature? It could be caused by a host and combination of factors, prognathic mand, retrognathic maxilla, dental factors. These are things we should ask ourselves but the facial outline just gives us an ____ idea without diving into details of underlying jaw mismatch
nasion
A and B
class I class II class III initial
Facial thirds
- upper
- hairline to ____
- middle
- supraorbital ridges to below ____
- lower
- below alar base to ____
- should all be ____
supraorbital ridges
alar base
soft-tissue menton
equal
Lower third
Maxillary portion (\_\_\_\_) below alar base to \_\_\_\_ Mandibular portion (\_\_\_\_) lip commisure to \_\_\_\_
one-third
lip commisure
two-thirds
soft tissue menton
Chin prominence
People with more of a ____ tendancy like Jay or more of a ____, are going to look a bit more prognathic. This is not always the case and it is not always detrimental to have more soft tissue in your chin
class III soft tissue pogonion
Just becuase we have more soft tissue pogonion does not always mean it is detrimental. When we see these two convex facial outlines, despite them having the same class 2 discrepency with regard to facial form, he has more soft tissue in his chin which helps him look less ____ than her even though that A and B measurement is ____ for these two
More ____ can mask a class 2 appearance. However for a class 3, this soft tissue will make them look even more ____ (Jay leno). The underlying ____ determines if this soft tissue excess is advantageous or disadvantageous
retrognathic
equal
soft tissue menton
prognathic
sagittal relationship
Lip posture
in repose, lips should be close
- once we see open 2-3mm we have ____
lip incompetence
The reasons for his lip incompetence is twofold
1) significant ____ (sagittal)
2) he has a very heightened ____. So excess ____ max (vertical)
So both can cause lip incompetence, so not always sagittal, could also be ____ cause or upper lip shortage
class 2 overjet
maxilla
vertical
vertical
Nasolabial angle
Angle formed from ____ of the nose and ____. Normally we should see about ____ degrees
alar base
upper lip
90
Can we as orthos have an effect on the nasolabial angle? YES based on the ____ of the teeth.
• If we are going to consider position of maxillary incisors and we have a very good nasolabial angle, we
don’t want to do anything to retract maxillary teeth to go to a more obtuse nasolabial angle as the lip follows the teeth
• Some things like ____ removal could have indirect effects on nasolabial angles because of the
position of the incisors themselves
Danielle already has has an obtuse nasolabial angle and already class II, we would ____ want to remove maxillary premolars because we could become even more obtuse if we lose any more upper lip support
max premolar
NOT
Facial profile analysis
Evaluation of ____ position
Evaluation of ____ and incisor prominence
Evaluation of ____ proportions
sagittal
lip posture
vertical
Importance of esthetic evaluation
____ prediction
Planning surgical Tx
____ v. non-extraction decision Determination of ____ Assessment of Tx timing
growth
extraction
tx mechanics
III. DIAGNOSTIC RECORDS
EVALUATING ____ OF TEETH & ORAL STRUCTURES
RECORDS FOR ____ & OCCLUSION
RECORDS FOR EVALUATION OF ____ & DENTAL APPEARANCE
health
dental alignment
facial
ORTHODONTIC RECORDS
Panoramic Radiograph
Lateral Cephalogram Posteroanterior Cephalogram Hand/Wrist Radiograph
Periapical & Bitewing Radiographs Orthodontic Study Models
intraoral photos
extraoral photos
OR ____ and ____ scans
Most times with single CBCT and intraoral 3D scan plus a set of ____, we have all of our diagnostic records that we need
CBCT
digital intraoral 3D
photos
IV. ANALYSIS OF DIAGNOSTIC
RECORDS
CAST ANALYSIS: ____ symmetry
ALIGNMENT: ____
____ ANALYSIS
____ ANALYSIS
Tooth size analysis, most time we can do the same thing 3D. We are looking at arch circumference available vs arch circumference needed Using a 3D intraoral scan, we can complete a space analysis just like you would if you had a cast analysis. This is better for ____ and ____ when digital.
symmetry & space
crowding/spacing
tooth size
cephalometric
record keeping
faster
Tooth size analysis
If you were to consolidate all the space due to the difference between max and mandibular spacing, we could not get a ____ canine relationship so we typically leave a bit of ____ in the maxillary not only for function but also for ____
class I
space
aesthetics
Cephalometric analysis
This is important in the ____ relationship/ proportionality evaluation. No other ____ can give us what a ceph can give us for this relationship
skeletal to dentoalveolar
diagnostic tool
CLASSIFICATION BY THE CHARACTERISTICS OF MALOCCLUSION
Step1
EVALUATION OF ____ PROPORTIONS & ESTHETICS
Step 2
EVALUATION OF ____ WITHIN THE DENTAL ARCHES
Step 3
EVALUATION OF DENTAL & SKELETAL RELATIONSHIPS IN THE ____ PLANE OF SPACE
Step 4
EVALUATION OF DENTAL & SKELETAL RELATIONSHIPS IN THE ____ PLANE OF SPACE
Step 5
EVALUATION OF DENTAL & SKELETAL RELATIONSHIPS IN THE ____ PLANE OF SPACE
facial alignment & symmetry transverse anteroposterior (sagittal) vertical
Which structures are contributing to the problem?
- 10 mm overjet
Max teeth ____
Mandibular dentition are ____ / recumbent
Maxilla itself is ____
We have a ____ mandible
(rare that we have these distinct, pure dental/ skeletal problems most times , combination
protrusive
retroclined
ahead
retrognathic
Problem list
Ranked in order of importance (____)
____ problems highest ranked
Someone with a skeletal mixmatch or TMJ symptoms will be superior to ____ and aesthetic concerns.
• How does a chief complaint impact our problem list? The cc definitely has to be on the problem list but it does not necessarily mean it must be ____ as us as clinicians are going to assess this with the knowledge that we have.
• A pt may have a cross bite and overjet, despite their cc being that they have mandibular crowding. These problems will come first but of course we will still address the crowding.
most to least
dysfunctional/skeletal
crowding
prioritizing
From the problem list develop an ____ list.
For a patient with crowding, we would want to go to ideal. this list does not tell us how to get there, but just is a ____ list
From here out you have a departure between clinicians. At the problem list level, you are pretty standard but what your plan of action is begining from the ____ list is debatable
objective
goals
objective
DEVELOPMENT OF A TREATMENT PLAN
This tells us ____. Treatment plan and design of mechanotherapy tell us how to achieve our goals
This is part of a treatment plan, and these aspects are where you will see quite a bit of variation between clinicians
how
DESIGN of MECHANOTHERAPY
____
Examples of how to go from class 2 to 1: • \_\_\_\_ • Functional appliances • \_\_\_\_ • Extract teeth Variable between clinicians.
how
coil springs
head gear
These two boards give us pretty strong guidelines of how to do this. The ABO came out with a change as in the past we used to have to take 10 cases and present them to the board and they had a category that we had to adhere to (extraction cases and a certain degree of discrepancy). The big departure under Dr. Chung’s leadership, you change the way the boards are taken. Starting in Feb, you dont need to take a whole host of things like models and such but it is ____ based, and less ____ cases
scenario
clinical
Wear protraction head gear which is used well during growth phases with ____ sutures. This will not work with a patient with non- pliable sutures
open
Looks great, we now see our the emergence of our first molars. we had a good interceptive treatment but this does not mean Cailey will not need ____ later.
About 80% of patients even if they had good interceptive treatment will still need ____ treatment //braces later on. Just want to make sure we use the head gear during her ____, and this guides her skeletal and dental dev.
ortho
comprehensive
peak height velocity
With the palatal expander we had a spontaneous correction of ____,
• If we are correcting cross bite it self from a posterior perspective we dont always get this corrected simultaneously because there is not ____ on that tooth
• However, sometimes the ____ itself can allow the tooth to come into a better position without putting a direct force. itself can fix the anterior cross bite
anterior crossbite
direct pressure
tongue
Early (Phase I Tx)
v.
Comprehensive (Phase II Tx)
When do we do early vs comprehensive?
The american association of orthodontics recommend seeing kids first by the age of ____
- at that time only 10-20% are ready to begin treatment if we are dealing with ____ mismatches like skeletal problems
• most at the time are not yet ready for treatment to actually ____ yet.
7
serious
begin
Space Management
Developmental Mechanisms to Alleviate Crowding
____ spacing among primary teeth
____ eruption of permanent incisors
____ space
Increases in ____ (minor)
interdental
labial
leeway
arch length
Dental Development
Increase in arch length with eruption of ____ (incisor labiality)
Second Primary Molars Contribution to Leeway Space
Maxilla - ____mm/side
Mandible - ____mm/side
maxillary incisors
- 5
- 5
Space gaining
Space creating: slight ____ due to arch size/ tooth size discrepancy, no space loss occurred
> > > >
Increase ____
crowding
arch circumference
Space gaining
Distal movement of ____ is very difficult and rarely occurs in the mandible
Labial movement of ____ depend on patient’s facial profile, periodontal status etc
Expansion occurs mainly in the ____
- ____ teeth with head gear and springs
- ____ anterior teeth but sometimes we are limited (better if teeth are recumbant or reclined)
- ____ (most common) we expand the maxilla with expansion tipe devises
first permamnent molar
permanent incisors
maxilla
distalize
labialize
transversely
Treatment Timing
Maintenance of the primary second molar is sufficient to align all of the permanent teeth within the arch in ____ percent of children.
seventy
Early Orthodontic Tx
with crowding
____ (i.e. palatal expansion, headgear, etc.)
____ (to preserve Leeway space)
Serial ____
• Lastly, if the crowding is too excessive, can we always treat the in a non extraction case even if they are 6 or 7? NO. It is extraction of primary teeth followed by extraction of ____. This is for cases of 10 mm or more of crowding
space gaining
space maintenance
extraction
permanent teeth
what is Serial Extraction?
Sequential extraction of ____ teeth followed by extraction of ____
Indicated in cases of severe crowding of ____+ mm per arch
Skeletal ____ exists
Minimal ____
Minimal ____
Will require ____ tx in many instances
This is different than typical extractions in comprehensive treatment (like in Neel’s case) where he was already in perm dentition! This is a method of EARLY treatment, we do a series of removing to push crowding from Anterior to posterior . Ultimately, this will lead to extraction of premolars because while we attempted to make space initially, there is still 10mm of crowding and we need to make up for it somehow
primary first premolars 10 harmony overjet overbite comprehensive
Early treatment
Indications for orthodontic treatment in early or midchildhood
Functional ____
Susceptibility to trauma of the maxillary incisors due to excessive ____
____ loss of primary molars
Severe ____ compromising periodontal health
posterior crossbite
overjet
premature
malalignment
She is NOT a candidate for serial extraction because of the ____ discrepancy she presents with
class II
Mandibular arch same with fixed appliances, we have little spurs on either side of ____ to make room for canines and we still have E’s present so we want to conserve that to gain that last bit of space we need for her permanent canines
lateral incisors
Quad helix
Different than the key activated appliances that parents turn daily, these will be activated periodically during each ____
Schwarz Appliance
This is a lower ____ device. This is a ____ steady (unlike the palatal that is fixed and we activate once to two time per day basis) these ____ devices are activated once or twice per week
visit
mandibular
slow
removeable
He had a digit habit which digit and which hand?____ finger because more open on the left side which indicates that his parafunctional habit was likely on that side
left handed index
Issue at hand in josh’s, even if you have a great correction like this we must monitor him closely because if we have a recurrence of his habit it will go back. We not only must maintain the use of devices followed by hawley devices to keep our correction, but also a patient who used to have a habit, wewant to maintain ____. If the patient relapses even partially the arch could shift back on us
habit cessation
Indications for early treatment
Elimination of harmful or damaging ____
Digit and /or tongue
Prevent ____ to protruded front teeth
Management of ____
Correction of ____ disproportions
- We have Unilateral crossbite set, as a result the pt has a midline deviation and jaw shift towards that side. If we correct this early, we can swing the mandible back on center. Best corrected at an ____ stage
Atypical cases
An example is a ____ tooth
We had a surgeon remove the ____, and allow the displaced left central incisor back onto center to create space for lateral central incisor
habit injury crowding jaw early supernumerary mesiodent
Benefits of early treatment
- reduce the need to remove ____ teeth
- simplify or ____ the time for full braces
- influence the growth of the jaws in a ____ manner
- reduce ____-consciousness during critical development years
permanent
shorten
positive
appearance
