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Finals > Orthodontics > Flashcards

Orthodontics Flashcards

1
Q

How can digit sucking be prevented?

A

Behaviour management therapy
Plasters, gloves, bitter flavoured agents
URA with rake
Habit reversal

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2
Q

What are four examples of conditions of tooth movement?

A

Hypodontia
Supernumerary
Early loss of permanent teeth
Late loss of primary teeth

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3
Q

What are the four types of supernumerary teeth?

A

Conical
Tuberculate
Odontome
Supplemental

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4
Q

What are the anatomical features that influence tooth mobility?

A

Width of pdl
Height of pdl
Inflammation
Number, shape, length of roots

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5
Q

What are pathological causes of tooth mobility?

A

Periodontal disease
Periapical abscess
Trauma
External inflammatory resorption

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6
Q

When should we intervene in tooth mobility?

A

Progressively increasing
Symptomatic
Creates difficulty with restorative treatment

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7
Q

What are the treatment options for an impacted 6?

A

Distal disking of the e
Orthodontic separation
Distalise the 6
Extract e
If under 7, wait 6 months

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8
Q

What are the treatment options for an unerupted central incisor?

A

Remove predecessor
If under 9- wait 12 months
If over 9- surgical exposure and orthodontic movement with gold chain

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9
Q

What is a balancing extraction?

A

Removal of tooth from opposite side of the same arch to maintain the position of the centreline

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10
Q

What is a compensating extraction?

A

Removal of a tooth from the opposing quadrant to maintain buccal occlusion

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11
Q

What should you do following Xla of a’s and b’s

A

Do nothing

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12
Q

What should you do following Xla of c’s

A

Balance

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13
Q

What should you do following Xla of d’s

A

Small shift: balance

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14
Q

What should you do following Xla of e’s

A

Space maintainer

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15
Q

What is an example of a removable space maintainer?

A

URA (passive)

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16
Q

What is an example of a fixed space maintainer?

A

Band and loop
Palatal/lingual arches

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17
Q

What factors should be considered for Xla of 6’s

A

Bifurcation of 7’s
8’s present
Class 1 occlusion
Mesial angulation of lower 6
Moderate lower crowding
Mild/moderate upper crowding

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18
Q

What is mild crowding measured as?

A

0-4mm

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19
Q

What are the treatment options for mild crowding?

A

No Xla
Xla 5

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20
Q

What is moderate crowding measured as?

A

5-8mm

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21
Q

What is the treatment for moderate crowding?

A

Xla 5s or 4s

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22
Q

What is the measurement for severe crowding?

A

> 8mm

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23
Q

What is the treatment option for severe crowding?

A

Xla 4s

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24
Q

What are the aims of ortho treatment?

A

Stable
Aesthetic
Functional

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25
Q

What are the indications for ortho treatment?

A

Malocclusion
Risk of trauma/disease
Impaired oral function
Unaesthetic

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26
Q

What are the contraindications to ortho treatment?

A

Uncontrolled epilepsy
Poor attendance
Poor OH

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27
Q

What are the benefits of ortho treatment?

A

Increased confidence
Increase dental health
Decrease trauma

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28
Q

What are the risks of ortho treatment?

A

Relapse
Root resorption
Decalcification

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29
Q

What are the limitations of ortho treatment?

A

Teeth only stable in the neutral zone
No effect on skeletal patterns
Movement limited by size and shape of alveolar process

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30
Q

What does ARAB stand for?

A

Active Component
Retention
Anchorage
Baseplate

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31
Q

What does Active Component mean?

A

Induces a displacement force

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32
Q

What does Anchorage mean?

A

Resistance to unwanted tooth movement

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32
Q

What does Retention mean?

A

Resistance to displacement forces

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33
Q

What does a Baseplate provide?

A

Anchorage
Connection
Cohesion
Adhesion
Stability

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34
Q

What is Newton’s 3rd Law?

A

For every action, there is an equal and opposite reaction

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35
Q

What should be on the lab card for treatment of an anterior cross bite on 12 ?

A

Aim: Please construct a URA to correct and anterior crossbite on 12

A: z-spring 0.5mm HSSW on 12

R: Adams clasp 0.7mm HSSW on 16, 26, 14, 24

A: yes (moving 1 tooth)

B: self cure PMMA + posterior bite plane

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36
Q

What should be on the lab card for treatment of a posterior crossbite?

A

Aim: Please construct a URA to expand the upper arch

A: Midline palatal screw

R: Adams clasp 0.7mm HSSW on 16, 26, 14, 24

A: Reciprocal anchorage

B: Self cure PMMA + posterior bite plane

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37
Q

How often should the active component be activated if in the anterior region?

A

Once a month

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38
Q

How often should the active component be activated if in the posterior region?

A

Once a week

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39
Q

What is the rule for tooth movement in association with bone remodelling?

A

Only 1-2 teeth should be moving 1mm per month

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40
Q

What are the options for retentive components?

A

Adams clasp 0.7mm (0.6mm in deciduous)
Southend clasp 0.7mm
Labial bow 0.7mm
C-clasp 0.7mm

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41
Q

What is the effect of thumb sucking on the skeletal pattern?

A

Proclamation of upper anteriors
Retroclination of lower anteriors
Localised anterior open bite
Incomplete open bite
Narrow upper arch with unilateral posterior cross bite

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42
Q

What is a class I incisor relationship?

A

The lower incisors occlude with or lie immediately below the cingulum plateau of the upper incisors

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43
Q

What is a class I incisor relationship?

A

The lower incisors occlude with or lie immediately below the cingulum plateau of the upper incisors

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44
Q

What is a class II div I incisor relationship?

A

The upper incisors are proclined (increased overjet).
The lower incisors occlude posterior to the upper incisors

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45
Q

What is a class II div II incisor relationship?

A

The upper incisors are retro lines (decreased overjet).
The lower incisors occlude posterior to the upper incisors

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46
Q

What is a class III incisor relationship?

A

The lower incisal edge occludes anterior to the cingulum plateau of the upper incisors

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47
Q

What is a class I molar relationship?

A

The mesiobuccal cusp of the upper first permanent molar occludes with the mesiobuccal groove of the lower first permanent molar

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48
Q

What is a class II molar relationship?

A

The mesiobuccal cusp of the upper first permanent molar occludes anterior to the mesiobuccal groove of the lower first permanent molar

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49
Q

What is a class III molar relationship?

A

The mesiobuccal cusp of the upper first permanent molar occludes posterior to the mesiobuccal groove of the lower first permanent molar

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50
Q

What is a class I canine relationship?

A

The mesial slope of the upper canine lies within the canine-first premolar embrasure

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51
Q

What is a class II canine relationship?

A

The mesial slope of the upper canine lies in front of the distal slope of the lower canine

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52
Q

What is a class III canine relationship?

A

The mesial slope of the upper canine lies behind the distal slope of the lower canine

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53
Q

What is local malocclusion?

A

Where the occlusion of 1-3 teeth on either arch prevents the teeth from exhibiting ideal occlusion

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54
Q

What are reasons for abnormalities in tooth number?

A

Early exfoliation
Unplanned loss of permanent teeth
Hypodontia
Loss of permanent teeth

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55
Q

How can we measure anterio-posterio skeletal relationship?

A

Measuring the ANB angle in a cephalogram
Measuring clinically using two fingers to establish the relationship between the maxilla and mandible

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56
Q

How can we measure the vertical skeletal relationship?

A

FAMP
LAFH:FAFH

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57
Q

How should the head be positioned for a cephalogram?

A

Frankfort plane

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58
Q

What factors promote osteoclastic bone resorption?

A

Interleukin-1
Prostaglandin E2
RANKL
Colony Stimulating Factor

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59
Q

What is the force applied for tooth movement?

A

10-20g

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60
Q

What are the factors affecting the rate of tooth movement?

A

Magnitude of force
Age of patient
Duration of force
Anatomy of bone

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61
Q

Why is an orthodontic assessment carried out?

A

Determine the nature of any malocclusion present
Identify underlying causes
Decide if treatment is indicated and either refer or devise a treatment plan

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62
Q

When is an orthodontic assessment carried out?

A

Brief examination aged 9 years
Comprehensive examination when premolars and canines erupt (11-12 years)
When older patients first present
If malocclusion develops later in life

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63
Q

What are the features of an ideal occlusion in regard to molar relationship?

A

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

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64
Q

What are the features of an ideal occlusion? (Andrews 6 keys)

A

Molar relationship
Crown angulation
Crown inclination
No rotations
No spaces
Flat occlusal planes

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65
Q

What is normal occlusion?

A

More commonly observed than ideal occlusion
Minor deviations that do not constitute an aesthetic or functional problem
Malocclusions are more significant deviations from the ideal that may be considered unsatisfactory
May require treatment, but patient factors may influence decision

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66
Q

What are the features of a history for an orthodontic patient at assessment?

A

Presenting complaint
How much does it bother the patient
History of presenting complaint
Past medical history
Past dental history
Social/family history

67
Q

What medical conditions are a contra-indication to orthodontic treatment?

A

Allergy to Ni or Latex
Epilepsy/drugs
Drugs
Imaging

68
Q

What are the features of past dental history for an orthodontic patient at assessment?

A

Frequency of attendance
Nature of previous treatment
Co-operation with previous treatment
Trauma to permanent dentition

69
Q

What are the features of social/family history for an orthodontic patient at assessment?

A

Travelling distance/time
Car owner/public transport
Parents work
School exams

70
Q

What are the features of a habit history for an orthodontic patient at assessment?

A

Thumb sucking
Lower lip sucking
Tongue thrust
Chewing finger nails

71
Q

What are the features of an extra-oral exam for an orthodontic patient at assessment?

A

Palpate skeletal bases
Soft tissue
TMJ

72
Q

What should you compare an orthodontic patient to their parent for?

A

Malocclusion
Growth potential

73
Q

What planes is the facial skeletal pattern considered in?

A

Antero-posterior
Vertical
Transverse

74
Q

How can a skeletal assessment be carried out?

A

Visual assessment
Palpate skeletal bases

75
Q

What are the options for AP skeletal relationship?

A

Class I
Class II
Class III

76
Q

What is a Class I skeletal relationship?

A

Maxilla 2-3mm in front of mandible

77
Q

What is a Class II skeletal relationship?

A

Maxilla more than 3mm in front of mandible

78
Q

What is a Class III skeletal relationship?

A

Mandible in front of maxilla

79
Q

What are the vertical measurements for a skeletal assessment?

A

Frankfort-Mandibular Plane Angle (FMPA)

80
Q

What are the lateral measurements for a skeletal assessment?

A

Mid saggital reference line

81
Q

What are the soft tissue features of an intra-oral exam for an orthodontic patient?

A

Lip: competence, lower lip level, lower lip activity
Tongue: position, habitual and swallowing
Habits: tongue, digit sucking
Speech: lisping

82
Q

What does lip incompetence indicate?

A

End of treatment instability

83
Q

What does a hyperactive lower lip indicate?

A

End of treatment instability

84
Q

What can a hyperactive lower lip result in?

A

Retroclined lower molars

85
Q

What is tongue thrust associated with?

A

Anterior open bite

86
Q

What are the occlusal features of a digit sucking habit?

A

Proclination of upper anteriors
Retroclination of lower anteriors
Localised AOB or incomplete OB
Narrow upper arch +/- unilateral posterior crossbite

87
Q

What should be focused on when carrying out an extra oral exam on the TMJ?

A

Path of closure
Range of movement
Pain, click from joint
Deviation on opening
Muscle tenderness
Mandubular displacement

88
Q

What should be focused on when carrying out an intra-oral exam on an orthodontic patient?

A

Oral hygiene and periodontal health
Teeth present
Teeth of poor prognosis
Assess crowding/spacing/rotations
Inclination/angulation
Palpate for canines if not erupted
Note abnormal teeth

89
Q

What should be looked at when carrying out out an intra-oral exam for an orthodontic patients 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, proclaimed, retroclined

90
Q

What should be looked at when carrying out out an intra-oral exam for an orthodontic patients upper arch?

A

Degree of crowding: mild. moderate, severe
Presence of rotations
Inclination of canines- mesial, upright, distal
Angulation of incisors to Frankfort plane- upright, proclaimed, retroclined

91
Q

What is the approximate angle of the incisors to Frankfort plane?

A

110 degrees

92
Q

What should be focused on when assessing teeth in occlusion for orthodontic patients?

A

Incisor relationship
Overjet
Overbite/open bite
Molar relationship
Canine relationship
Cross bites
Centre lines

93
Q

What is a class I incisor relationship?

A

The mandibular incisor edges lie or are below the cingulum plateau of the maxillary incisors

94
Q

What is a class II div 1 incisor relationship?

A

Mandibular incisor edges lie posterior to the cingulum plateau of the maxillary incisors
Maxillary incisors proclined

95
Q

What is a class II div 2 incisor relationship?

A

Mandibular incisor edges lie posterior to the cingulum plateau of the maxillary incisors
Maxillary incisors retroclined

96
Q

What is a class III incisor relationship?

A

Mandibular incisors edges lie anterior to the cingulum plateau of the maxillary central incisors

97
Q

What is a class I molar relationship?

A

The MB cusp of the maxillary first permanent molar occludes with the MB groove of the mandibular first permanent molar

98
Q

What is a class I canine relationship?

A

The mesial incline of the maxillary canine occludes with the distal incline of the mandibular canine

The distal incline of the maxillary canine occludes with the mesial incline of the mandibular first premolar

99
Q

What is a class II molar relationship?

A

MB groove of mandibular first molar is distal to the MB cusp of the maxillary first molar

100
Q

What is a class III canine relationship?

A

The mesial incline of the maxillary canine occludes anteriorly with the distal incline of the mandibular canine
The distal surface of the mandibular canine is posterior to the mesial surface of the maxillary canine by at least the width of the premolar

101
Q

What is a class III molar relationship?

A

MB cusp of the maxillary first premolar occludes distally to the MB groove of the mandibular first molar

102
Q

What is a class III canine relationship?

A

Distal surface of the mandibular canines are mesial to the mesial surface of the maxillary canines by at least the width of a premolar
Mandibular incisors are in complete crossbite

103
Q

What special investigations can be carried out for patients at the orthodontic assessment?

A

Radiogrpahic: OPT, maxillary anterior occlusal, lat ceph
Vitality tests
Study models
Photographs

104
Q

What do you do with the information gathered from an orthodontic assessment?

A

Summarise the important points
Assess treatment need (IOTN)
Devise treatment aims if appropriate
Plan treatment

105
Q

What are the risks with orthodontic treatment?

A

Decalcification
Relapse
Root resorption

106
Q

What is the IOTN?

A

Index of Orthodontic Treatment Need
A rating system that was developed to assist in determining the potential impact of malocclusion on an individual’s dental health and psychosocial well-being

107
Q

What is the aesthetic component of the IOTN?

A

10 colour photographs showing different levels of dental attractiveness
Orthodontist must match the patients to these photographs

108
Q

What is the dental component of the IOTN?

A

Records the various occlusal traits of a malocclusion that would increase the morbidity of the dentition and surrounding structure
Measured in 5 grades

109
Q

What would grade 1-4 aesthetic component of the IOTN indicate?

A

No or minor requirement for treatment

110
Q

What would grade 5-7 aesthetic component of the IOTN indicate?

A

Moderate/borderline need for treatment

111
Q

What would grade 9-10 aesthetic component of the IOTN indicate?

A

Requires orthodontic treatment

112
Q

When are coloured vs black and white photographs used for the IOTN?

A

Coloured photographs used with patients displaying range of dental attractiveness

Monochrome photographs used for the assessment on dental casts

113
Q

What is the advantage of monochrome photographs in the aesthetic component of the IOTN?

A

Advantage that whoever is rating will not be influenced by a patient’s oral hygiene, gingival conditions or poor colour matches in restorations

114
Q

What does MOCDO stand for?

A

Missing Teeth
Overjets
Crossbones
Displacement of contact points
Overbites

115
Q

What is 5i on the IOTN?

A

Impacted teeth (except 8s) due to crowding, displacement, the presence of supernumerary teeth, retained deciduous teeth and any other pathological cause

116
Q

What is 5h on the IOTN?

A

Extensive hypodontia with restorative implications (more than 1 tooth missing in any quadrant) requiring pre-restorative orthodontics

117
Q

What is 5a on the IOTN?

A

Increased overset greater than 9mm

118
Q

What is 5m on the IOTN?

A

Reverse overject greater than 3.5mm with reported masticatory and speech difficulties

119
Q

What is 5p on the IOTN?

A

Defects of cleft lip and palate and other craniofacial anomalies

120
Q

What is 5s on the IOTN?

A

Submerged deciduous teeth

121
Q

What does grade 5 on IOTN indicate?

A

Severe dental health problems requiring treatment

122
Q

What is grade 4 on IOTN indicate?

A

Dental health problems requiring treatment

123
Q

What is grade 4h on IOTN?

A

Less extensive hypodontia requiring pre-restorative orthodontics or orthodontics to obviate the need for a prosthesis

124
Q

What is grade 4a on IOTN?

A

Increased overjet greater than 6mm but less than or equal to 9mm

125
Q

What is grade 4b on IOTN?

A

Reverse overset greater than 3.5mm with no recorded masticatory or speech difficulties

126
Q

What is grade 4m on IOTN?

A

Reverse overjet greater than 1mm but less than 3.5mm with recorded masticatory and speech difficulties

127
Q

What is grade 4c on IOTN?

A

Anterior or posterior crossbites with greater than 2mm discrepancy between retruded contact position (RCP) and intercuspal position (ICP)

128
Q

What is grade 4l on IOTN?

A

Posterior lingual crossbite with no functional occlusal contact in one buccal segment

129
Q

What is grade 4d on IOTN?

A

Severe contact displacements greater than 4mm

130
Q

What is grade 4e on IOTN?

A

Extreme lateral or anterior open bites greater than 4mm

131
Q

What is grade 4f on IOTN?

A

Increased and complete overbite with gingival or palatal trauma

132
Q

What is grade 4t on IOTN?

A

Partially erupted teeth, tipped and impacted against adjacent teeth

133
Q

What is grade 4x on IOTN?

A

Presence of supernumerary teeth

134
Q

What is grade 3 on IOTN?

A

Borderline treatment need

135
Q

What is grade 3a on IOTN?

A

Increased overjet greater than 3.5mm but less than or equal to 6mm with incompetent lips

136
Q

What is grade 3b on IOTN?

A

Reverse overset greater than 1mm but less than or equal to 3.5mm

137
Q

What is grade 3c on IOTN?

A

Anterior or posterior crossbites with greater than 1mm but less than or equal to 2mm discrepancy between RCP and ICP

138
Q

What is grade 3d on IOTN?

A

Contact displacements greater than or equal to 4mm

139
Q

What is grade 3e on IOTN?

A

Lateral or anterior open-bite greater than 2mm but less than or equal to 4mm

140
Q

What is grade 3f on IOTN?

A

Deep overbite complete on gingival or palatal tissues, but no trauma

141
Q

What is grade 2 on IOTN?

A

Negligible treatment need

142
Q

What is grade 2a on IOTN?

A

Increased overjet greater than 3.5mm but less than or equal to 6mm with competent lips

143
Q

What is grade 2b on IOTN?

A

Reverse overset greater than 0mm but less than or equal to 1mm

144
Q

What is grade 2c on IOTN?

A

Anterior or posterior crossbite with less than or equal to 1mm discrepancy between RCP and ICP

145
Q

What is grade 2d on IOTN?

A

Contact point displacements greater than 1mm but less than or equal to 2mm

146
Q

What is grade 2e on IOTN?

A

Anterior or posterior open bite greater than 1mm but less than or equal to 2mm

147
Q

What is grade 2f on IOTN?

A

Increased overbite greater than or equal to 3.5mm without gingival contact

148
Q

What is grade 2g on IOTN?

A

Pre-normal or post-normal occlusions with no other anomalies (inc up to half a unit discrepancy)

149
Q

What is a unit in orthodontics?

A

Length of a premolar

150
Q

What is grade 1 IOTN?

A

No treatment need
Extremely minor malocclusions including contact displacements less than 1mm

151
Q

What rules apply when using the dental health component of the IOTN on study casts?

A

Overjets 3-5-6mm: assume incompetent lips and award grade 3a

Crossbites: assume a discrepancy between RCP and ICP of 3mm and award grade 4c

Reverse overjets: assume masticatory or speech problems are present

152
Q

What does the top left of the IOTN ruler measure?

A

Overjet

153
Q

What does the bottom left of the IOTN ruler measure?

A

Reverse overjet

154
Q

What does the right of the IOTN ruler measure?

A

Contact point displacement and open bite

155
Q

When can a tooth be regarded as impacted?

A

If the space between the two teeth next to it is less than or equal to 4mm

156
Q

When is there considered to be an anterior crossbite?

A

1 to 3 incisors are in lingual occlusion

157
Q

When is there considered to be a posterior crossbite?

A

Cusp to cusp or in full crossbite

158
Q

When are submerged deciduous teeth considered in IOTN?

A

If only 2 cusps are visible and/or the adjacent teeth are severely tipped towards each other and closely approximated

159
Q

What IOTN is necessary for NHS treatment?

A

DHC- >4 (borderline 3)
Aesthetic component- >6

159
Q
A
160
Q

What are the indications for orthodontic referral during the deciduous dentition?

A

Severe skeletal discrepancies
Severely delayed dental development
Missing/supplemental teeth
History of head and neck radiotherapy with/without chemotherapy
Advice for balancing/compensating extractions

161
Q

What are the indications for orthodontic referral during the mixed dentition?

A

Severe skeletal patterns where early treatment may be appropriate e.g. developing class II/III
Dental anomalies e.g. double teeth, dens in dente, talon cusps
Developmentally missing permanent teeth
Supernumerary teeth
Teeth in unfavourable positions e.g. canines
Impacted first permanent molars
Infraoccluded teeth
Crossbites
Extraction advice where severe crowding evident or first molars have poor prognosis
Advice following trauma to permanent teeth

162
Q

What are the indications for orthodontic referral during the permanent dentition?

A

Based on IOTN

163
Q
A

Finals (20 decks)

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