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BDS3 CDS > orthodontics refined > Flashcards

orthodontics refined Flashcards

1
Q

what are the three planes of space in ortho?

A

anteroposterior
vertical
transverse

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2
Q

how is lateral cephalogram technique made ALARA? - 4

A

aluminium soft tissue filter
thyroid collar
triangular collimation
fast film

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3
Q

what does ANB angle relate?

A

mandible to maxilla

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4
Q

what is the average value of SNA?

A

81

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5
Q

what is the average value of SNB?

A

79

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6
Q

what is the average value of ANB?

A

3

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7
Q

describe the facial profile of class 2

A

convex profile
increased cranial base angle

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8
Q

describe the profile and jaw relationship of class 3

A

acute cranial base angle
concave profile

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9
Q

where should mandibular plane and Frankfurt plane meet normally?

A

external occipital protuberance - back of head

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10
Q

what is the average Frankfurt mandibular plane angle? FMPA

A

27

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11
Q

which plane runs orbitale to porion cephalogram?

A

Frankfurt plane

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12
Q

which plane runs menton to gonion on cephalogram ?

A

mandibular plane

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13
Q

what is the average value of UAFH to LAFH on cephalogram?

A

55%

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14
Q

describe the FMPA of patients with long facial type

A

> 31*

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15
Q

describe the LAFH to TAFH proportion in patients with long facial type

A

> 55%

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16
Q

name 2 features that contribute to long facial type

A

AOB
backward mandibular growth rotation

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17
Q

describe the FMPA in patients with short facial type

A

<23*

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18
Q

describe the LAFH to TAFH proportion in patients with short facial type

A

<55%

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19
Q

what contributes to short facial type?

A

forward mandibular growth rotation
deep overbite

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20
Q

what causes crowding?

A

small jaws with normal size teeth
macrodontia

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21
Q

Your child patient presents with a single grossly carious first permanent molar. The condition of the other three first permanent molars is reasonably good. Which of the following are the main factors that influence any decisions that need to be made regarding whether or not to balance or compensate the extraction of this grossly carious tooth?
Select one:
a.
Presence of carious deciduous teeth, age of patient, Crowding
b.
Early loss of primary teeth, malocclusion type, age of patient
c.
Age of patient, presence of bilateral crossbite, degree of crowding
d.
Age of patient, degree of crowding, malocclusion type
e.
Presence of crowding, malocclusion type, presence of carious deciduous teeth

A

d.
Age of patient, degree of crowding, malocclusion type

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22
Q

When performing an intra-oral examination of a 9.5 year-old patient which of the following would not be considered a relevant feature to indicate the possibility of an unerupted ectopic canine?
Select one:

a.
Inclination/Angulation of the upper lateral incisor
b.
A palpable palatal elevation of the alveolar mucosa
c.
Mobility of the deciduous canine
d.
Discolouration of the deciduous canine
e.
Presence of an upper midline diastema

A

e.
Presence of an upper midline diastema

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23
Q

Which of the following would you expect to find in a patient with long face syndrome?

Select one:

a.
Backward growth rotation of the mandible.
b.
Increased maxillary posterior dentoalveolar height.
c.
An increased lower anterior face height percentage.
d.
Ante-gonial notching of the mandible.
e.
All of the above.

A

e.
All of the above.

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24
Q

What is the correct term used to describe a mismatch between the size of a patient’s teeth and jaws?
Select one:
a.
Microdontia.
b.
Dento-alveolar disproportion.
c.
Odonto-alveolar disproportion
d.
Dento-skeletal discrepancy.
e.
Severe crowding.

A

b.
Dento-alveolar disproportion.

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25
Q

What is the likely cause of a left-sided unilateral posterior crossbite that is not associated with a lateral displacement of the mandible on closure?

Select one:
a.
Mandibular prognathism.
b.
Vertical maxillary deficiency.
c.
A narrow maxillary dental arch.
d.
An anterior open bite.
e.
A true asymmetry of the mandible with the chin point shifted to the left.

A

e.
A true asymmetry of the mandible with the chin point shifted to the left.

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26
Q

Which of the following can be caused by early loss of primary teeth?
Select one:
a.
Ankylosis of permanent teeth and loss of alveolar bone
b.
Dental centreline shifts and loss of alveolar bone
c.
Drifting of adjacent teeth and caries in the permanent dentition
d.
Space loss and ankylosis of permanent successor
e.
Crowding and dental centreline shifts

A

e.
Crowding and dental centreline shifts

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27
Q

Which two the following categories of supernumerary teeth are the most likely to erupt into the oral cavity?
Select one:
a.
Mesiodens and complex odontome
b.
Supplemental and conical
c.
Compound odontome and tuberculate
d.
Conical and tuberculate
e.
Tuberculate and Supplemental

A

b.
Supplemental and conical

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28
Q

Which of the following is most commonly associated with a Class III jaw relationship?

Select one:
a.
Anteroposterior maxillary deficiency.
b.
True mandibular asymmetry.
c.
Mandibular prognathism.
d.
Vertical maxillary excess.
e.
Anterior open bite

A

a.
Anteroposterior maxillary deficiency.

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29
Q

what causes spacing?

A

large jaws normal size teeth
microdontia

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30
Q

what does local cause of malocclusion mean

A

localised problem within either arch - confined to one-several teeth - producing malocclusion

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31
Q

3 local causes of malocclusion

A

variation in tooth number
variation in tooth size/form
abnormal tooth position

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32
Q

4 causes of variation in tooth number?

A

supernumerary teeth
hypodontia
retained primary teeth
early loss of primary teeth

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33
Q

where are supernumerary teeth most commonly found in the dentition?

A

maxillary anterior

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34
Q

what are the four types of supernumerary teeth?

A

conical
tuberculate
supplemental
odontome

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35
Q

which type of supernumerary teeth are small, peg shaped and close to the midline (mesiodens)?

A

conical

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36
Q

which type of supernumerary teeth are barrel shapes and usually paired?

A

tuberculate

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37
Q

which type of supernumerary teeth tend not to erupt and are one of the main causes of failure of eruption of permanent upper incisors?

A

tuberculate

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38
Q

supplemental supernumerary teeth are most commonly which teeth?

A

upper laterals or lower incisors

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39
Q

which teeth are commonly affected by hypodontia?

A

upper laterals
second premolars

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40
Q

when should you be worried about retained primary teeth?

A

when more than 6 months has passed since the shedding of contra-lateral teeth

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41
Q

4 causes of primary teeth to be retained?

A

absent successor
ectopic successor
infra-occluded (ankylosed) primary molars
pathology/supernumerary

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42
Q

how would you treat a patient with absent successor teeth? 3

A

maintain primary as long as possible
extract early to encourage space closure if crowded
refer early to ortho

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43
Q

what are 5 causes of early loss of primary teeth?

A

trauma
periapical pathology
caries
resorption by successor
crowding

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44
Q

what effect does early loss of primary molars have on the dentition?

A

more space is lost with E than D

6s will drift mesially and steal the space for the 5

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45
Q

Early loss of primary teeth can lead to crowding in the permanent dentition - what 3 factors impact the degree of crowding?

A

which tooth is extracted/lost
when the tooth is extracted/lost
crowding of patient

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46
Q

what influences the impact of loss of 6s?

A

age at loss
crowding
malocclusion

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47
Q

how does age of the patient at loss of their 6s impact the dentition?

A

if lower 7s have erupted there is often poor space closure
if lower 6s lost too early there is distal drift of the 5s

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48
Q

what is the likely result of early loss of a central incisor?

A

drift of adjacent teeth

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49
Q

what is the likely result of late loss of central incisor?

A

long term space

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50
Q

what local pathologies can influence malocclusion?

A

caries
cysts
tumours

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51
Q

what are the effects of digit sucking on the dentition?

A

proclined UI
retroclined LI
anterior open bite
unilateral posterior cross bite - due to narrow maxillary arch

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52
Q

what effect can labial frenum have on the dentition?

A

Median diastema

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53
Q

what are the three ways teeth can vary in size or form?

A

macrodontia
microdontia
abnormal form

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54
Q

what problems are associated with macrodontia?

A

crowding
asymmetry and aesthetics

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55
Q

what problems are associated with microdontia?

A

spacing
linked to hypodontia

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56
Q

give examples of teeth of abnormal form

A

peg shape laterals
dens in dente
germinated/fused teeth
dilaceration
accessory cusps and ridges

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57
Q

what are two abnormalities of tooth position that cause malocclusion?

A

ectopic teeth
transposition teeth -interchange in position of two teeth in same quadrant

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58
Q

ectopic canines have higher incidence in what malocclusion

A

class 2 div 2

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59
Q

from what age should you palpate for buccal canine bulge?

A

9 years onwards

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60
Q

ectopic canine teeth are most commonly where?

A

palatal

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61
Q

what are buccal canines associated with?

A

crowding

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62
Q

how do you clinically assess ectopic canines?

A

visualisation/palpation of 3
inclination of 2
mobility of c and 2
colour of c and 2

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63
Q

what radiographs are required to localise position of ectopic canines?

A

OPT AND upper anterior oblique occlusal

64
Q

what are the management options for ectopic canines?

A

prevention - monitor and assess from age 9
interceptive -extraction of c to encourage improvement
accept - its position and observe
exposure - surgically expose and ortho realignment
surgical extraction
autotransplantation

65
Q

what age would you extract c to encourage eruption of ectopic 3

A

10-13

66
Q

if extracting upper C to encourage eruption of ectopic 3, where is the ideal location of the 3 in relation to the lateral incisor

A

distal to the midline of upper lateral

67
Q

what risks are associated with not treating ectopic maxillary incisors?

A

becomes more ectopic
root resorption of adjacent teeth
failure to erupt

68
Q

what are possible causes of ectopic upper centrals?

A

no cause
supernumerary - tuberculate or odontome
trauma to primary - ankylosis or displacement of tooth germ or dilaceration of root

69
Q

what are the classifications of transposition teeth?

A

true - whole root and crown are found in transposed position
pseudo - only the crowns or the roots are transposed, one stays in same place

70
Q

what is hemifacial microsomia

A

half of the face is underdeveloped and does not grow normally

71
Q

3 features of hemifacial microsomia

A

malformed ear (deafness)
progressive facial asymmetry
occlusal issues

72
Q

what can removable appliances be used for

A

tip teeth
maintain space
to correct overbite/crossbites

73
Q

what are the 3 major risks of orthodontic treatment

A

decalcification
relapse
root resorption

74
Q

what age do you briefly ortho assess a patient

A

9 Years

75
Q

when do you carry out a comprehensive ortho assessment

A

11/12 years old when premolars and canines erupt

76
Q

Andrews 6 keys of ideal occlusion

A

molar relationship

crown angulation

crown inclination

no rotations

no spaces

flat occlusal plane

77
Q

4 contraindications to ortho

A

allergy to nickel or latex
Epilepsy - Can’t have URA
drugs - gingival hyperplasia
imaging - if need MRI can’t have braces

78
Q

how can the tongue and lips influence tooth position

A

incompetent lips - lip trap - proline UI
lip activity - hyper active will retrocline LI
tongue thrust - AOB

79
Q

causes of AOB

A

tongue thrust on swallowing - relapse after ortho if endogenous tongue thrust

digit sucking

80
Q

occlusal features of sucking habit

A

proclined upper anterior
retroclined lower anterior
localised AOB
unilateral posterior cross bite

81
Q

what is the average angulation of upper incisors to Frankfort plane

A

110 degrees

82
Q

average overbite covers how much of lower incisor crown

A

1/2-1/3

83
Q

describe class 1 2 and 3 buccal segment relationship

A

class 1 - mesiobuccal cusp upper 6 sits in buccal groove of lower 6

class 2 - mesiobuccal cusp infront of lower 6

class 3 - mesiobuccal cusp behind lower 6

84
Q

when is it not possible to move teeth with orthodontic force

A

if a tooth has no PDL or is ankylosed

85
Q

what does RANKL stand for

A

Receptor Activator of Nuclear factor Kappa-b Ligand

86
Q

what secretes osteoprotegerin (OPG)

A

osteoblasts

87
Q

function of OPG

A

prevents osteoclastic differentiation and suppresses their activity

88
Q

the balance between which 2 molecules regulates bone remodelling

A

OPG and RANKL

89
Q

Which force range would be most appropriate to apply when trying to tip teeth?

A

35-60g

90
Q

how do functional appliances work

A

mandible postured away from normal rest position

facial muscles stretched generating force on teeth and alveolus

91
Q

how can a functional appliance affect facial growth on a class 2 patient 3 marks

A

restrict maxillary growth
promote mandibular growth
remodel glenoid fossa

92
Q

what dento alveolar changes do functional appliances cause

A

retrocline upper
procline lower
mesial migration lower teeth
distal migration upper teeth

93
Q

which movements require optimal force of 35-60g

A

tipping
extrusion
rotation

94
Q

which movement requires optimal force of 10-20g

A

intrusion

95
Q

which movement has optimal force of 50-100g

A

torque

96
Q

Which force range would be most appropriate to apply when causing bodily movement of teeth with a fixed appliance?

A

150-200g

97
Q

what factors affect the response to orthodontic force - 4

A

magnitude
duration
age
anatomy

98
Q

ideal amount of tooth movement per month

A

1mm

99
Q

type of resorption related to light forces

A

frontal resorption

100
Q

type of resorption related to moderate forces

A

undermining resorption

101
Q

describe the difference in speed of tooth movement between light, moderate and heavy forces

A

light - slow and steady movement

moderate/heavy - rapid initial movement then 10-14 days with little movement while undermining resorption occurs

102
Q

what are the unwanted side effects of excessive forces

A

pain

Undermining resorption

root resorption

loss of vitality

anchorage loss

103
Q

In order to promote eruption of an upper second premolar we are considering extracting the deciduous second molar. What would be the ideal stage of root development of the unerupted second premolar to produce an optimal result?
a. More than two thirds root formed

b.Less than one half root formed

c.One half to two thirds root formed

d.Less than one third root formed

e.Root formation not started but crown formation complete

A

c.One half to two thirds root formed

104
Q

With regards to the mechanism by which bodily orthodontic tooth movement takes place during fixed appliance treatment, which of the following statements is true:
Select one:
a.
Bone is laid down in response to compression of the periodontal ligament on the same side of the tooth as the direction of intended tooth movement
b.
Bone is removed in response to tension of the periodontal ligament on the same side of the tooth as the direction of intended tooth movement
c.
Bone is laid down in response to tension of the periodontal ligament on the opposite side of the tooth to the direction of intended tooth movement
d.
Bone is removed in response to compression of the periodontal ligament on the opposite side of the tooth to the direction of intended tooth movement
e.
Bone is laid down in response to compression of the periodontal ligament on the same side of the tooth as the direction of intended tooth movement

A

c.
Bone is laid down in response to tension of the periodontal ligament on the opposite side of the tooth to the direction of intended tooth movement

105
Q

Which of the following force ranges would be most appropriate to apply when trying to intrude teeth with a fixed appliance?
a.
50-100g
b.
35g -60g
c.
150-200g
d.
10-20g
e.
100-150g

A

d.
10-20g

106
Q

Which of the following histological features is thought to play the biggest role in tooth eruption
a.
Epithelial root sheath ( Hertwig’s root sheath )
b.
Dental Follicle
c.
Gubernacular cord
d.
Reduced enamel Epithelium
e.
Epithelial cell rests (of Malassez)

A

b.
Dental Follicle

107
Q

Which of the following is NOT a factor which can influence the rate of tooth movement?
Select one:
a.
Magnitude of force
b.
Anatomy of bone in the area
c.
Duration of force
d.
Age of the patient
e.
Direction of force

A

e.
Direction of force

108
Q

order of eruption for deciduous teeth

A

abdce
lowers before upper

109
Q

when do deciduous teeth erupt

A

6months to 2.5 years

110
Q

when is extraction of neonatal teeth indicated

A

if mobile - risk of inhalation
difficulty breast feeding

111
Q

what are natal/neonatal teeth

A

teeth present at or just after birth

112
Q

3 phases of tooth eruption

A

pre eruptive
eruption - intra-osseous and extra-osseous
post eruption

113
Q

what are the fibres formed at the periphery of the eruption pathway, that guide the tooth into the oral cavity called

A

gubernacular cord

114
Q

when is the correct time to extract deciduous tooth to encourage permanent teeth to erupt

A

one half to two thirds root development of permanent tooth

115
Q

what is the leeway space in upper arch

A

1.5mm

116
Q

what is the leeway space in lower arch

A

2.5mm

117
Q

how do you calculate leeway space

A

width of CDE minus width of 345

118
Q

when does a diastema close usually

A

12 when canines erupt

119
Q

management of ectopic 6

A

if <7 years wait 6 months and review

orthodontic separator

distalise 1st molar

extract E

file down distal of E

120
Q

management of unerupted central incisors

A

remove primary teeth and supernumeraries

maintain/create space

monitor for 12 months if less than 9

if 9+ or still not erupted, expose and ortho traction

121
Q

how do you manage early loss of an E and why

A

consider space maintainer as 6 will drift mesial and space will be lost

122
Q

when is the optimum result gained when extracting 6s of poor prognosis - 4

A

7s bifurcation is calcifying
8s are present
moderate crowding
class 1

123
Q

URA design for anterior cross bite

A

A - z spring for tooth that is behind LI 0.5mm HSSW

R - Adams clasps 0.7mm HSSW on 4s and 6s

A - only moving one tooth

B - self cure PMMA with posterior bite plane

124
Q

how do you manage a digit habit - 4

A

bitter nail polish
positive reinforcement
glove on hand
habit breaker appliance - deterrents such as goal posts

125
Q

4 signs a patient is wearing their URA

A

active components now passive
wore into surgery
no excess salivation and speech adapted
signs of wear on appliance and tissues

126
Q

how can you diagnose an infra occluded tooth

A

percussion note
radiograph - no PDL space
no mobility

127
Q

why is it important to treat over jet early

A

trauma risk
aesthetics - bullying
more difficult to treat when pt stops growing

128
Q

which arch do you treatment plan first

A

lower - then plan upper around the plan for lower

129
Q

when assessing crowding, how is space available measured?

A

measure arch length anterior to FPM

130
Q

you are going to extract a premolar to alleviate crowding in the lower arch -
when would you extract the 4 and when would you extract the 5?

A

4 - moderate to severe crowding

5 - mild to moderate crowding

131
Q

define mild, moderate and severe crowding

A

Mild: <4
Moderate: 4-8
Severe: >8

132
Q

stainless steel constituents

A

iron - 72%
chromium - 18%
nickel - 8%
titanium - 1.7%
carbon - 0.3%

133
Q

what is iron combined with to form steel

A

carbon

134
Q

what property does chromium give to stainless steel

A

corrosion resistance

135
Q

what properties do nickel give to stainless steel

A

corrosion resistance and strength

136
Q

why is titanium added to stainless steel

A

to prevent precipitation of chromium carbides at grain boundaries

carbon preferably binds to titanium over chromium

137
Q

how is stainless steel hardened

A

work hardening - drawing metal in a cold state through a series of dies of successively smaller diameter

138
Q

what is the function of a baseplate

A

anchorage
retention
connect components

139
Q

what is ID tubing used for in URA and give two examples of active components that require ID tubing

A

added to buccally placed active components to increase strength and rigidity
Roberts retractor
Buccal canine retractor

140
Q

how to you fit a URA - 9

A

Correct patient
Correct design
Inspect acrylic
Integrity of wire
Insert and check for blanching or trauma
Posterior retention - flyover then arrow head
Anterior retention
Activate appliance
Demo pt insertion and removing
Review app. 4-6 weeks

141
Q

advice given to pt after fitting URA

A

big and bulky
affect speech for short time
salivation
discomfort or ache
wear 24/7 inc. meal times and sleep
remove after meal and clean
remove for contact sports
avoid hard or sticky foods
cautious with hot and cold
non compliance increases treatment time
emergency contact

142
Q

what is the result of neural tube fusion failure

A

spina bifida

143
Q

where are pulp dentine cementum and PDL derived from

A

ectomesenchyme

144
Q

what deformity occurs when palatine processes fail to fuse

A

cleft palate formation

145
Q

why can cleft lip and alveolus occur independently of cleft palate and vice versa

A

upper lip and anterior palate have different embryological origins to the posterior palate
fuse at different times

146
Q

where are mandibular and maxillary processes derived from

A

first pharyngeal arch

147
Q

what cartilage precedes the mandible

A

meckels cartilage

148
Q

3 genetic causes of cleft lip and palate

A

monozygotic twins

familial pattern

syndromes

149
Q

3 environmental causes of cleft lip and palate

A

social deprivation
smoking
alcohol

150
Q

3 dental features of cleft lip and palate

A

impacted teeth
crowding
hypodontia

151
Q

3 sites of facial growth

A

sutures
synchondroses
surface deposition

152
Q

what is a suture

A

fibrous joint between intramembranous bones that fuse when growth is complete

153
Q

where are synchondroses found

A

midline of sphenoid, occipital and ethmoid bones - cartilage based growth centres

154
Q

what causes growth rotations

A

imbalance in growth of anterior and posterior face heights

155
Q

UI-Mx and LI-Md measure the angulation of incisors to maxilla and mandible - what are their normal values

A

UI Mx 109
LI Md 93

156
Q

average inter-incisal angle (UI/LI)

A

135

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