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BDS4 EXAM STUDY > Orthodontics Treatment Guide > Flashcards

Orthodontics Treatment Guide Flashcards

1
Q

Where might a newly qualified GDP seek orthodontic advice?

A
  • dentist with specialist interest in orthodontics
  • orthodontic specialist practitioner
  • community orthodontist
  • consultant orthodontist
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2
Q

What should be included in a orthodontics referral letter?

A
  • pts name
  • pts address
  • pt DOB
  • pt GMP
  • reason for referral
  • pt OH status
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3
Q

How is the extra size of the permanent teeth (compared to primary teeth) accommodated?

A
  • spacing of primary dentition
  • growth of alveolus
  • eruptive pattern of upper incisors (proclined eruption pattern)
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4
Q

When would the eruption of an upper incisor be considered delayed?

A
  • contralateral tooth has occurred more than six months previously
  • lower incisors erupted more than 1 year previously
  • significant deviation from the normal eruption sequence (eg laterals erupting before central)
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5
Q

What are some possible causes of a median diastema?

A
  • unerupted supernumeraries
  • narrowness of maxilla
  • developmentally missing laterals
  • peg-shaped laterals
  • abnormal frenum
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6
Q

What are some causes of delayed eruption of permanent teeth?

A
  1. crowding/lack of space
  2. abnormal developmental position
  3. supernumerary teeth
  4. trauma to deciduous teeth (causing ankylosis, displacement of permanent teeth, dilaceration)
  5. retained deciduous teeth
  6. impaction
  7. eruption cysts
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7
Q

What should you palpate for around age 9?

A

canines

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8
Q

What radiographic views can be used for parallax to check for ectopic tooth position?

A
  • OPT & upper maxillary occlusal
  • two periapical views
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9
Q

A patient experiences early loss of one of their deciduous canines, what should you do & why?

A

Extract contra-lateral deciduous canine
- prevents centre line shift
- allows spontaneous alignment of incisors

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10
Q

Where crowding is present, what is the result of early loss of deciduous teeth?

A
  • space loss is greater in upper arch than lower
  • early loss of Es leads to more space loss than early loss of Ds
  • very early loss of Es leads to complete loss of second premolar space
  • unilateral extraction of Cs & Ds is likely to cause shift of centreline
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11
Q

What dentition anomalies should be referred for specialist orthodontic advice?

A
  • severe skeletal problems where early treatment may be appropriate
  • unfavourably positioned canines or other teeth
  • developmentally missing permanent teeth
  • poor quality FPMs where timing extractions may simplify subsequent treatment
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12
Q

What tool can be used to assess the need & eligibility of patients for NHS orthodontic treatment?

A

IOTN (The Index of Orthodontic Treatment Need)

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13
Q

To be eligible for treatment, what are the minimum IOTN scores a patient can have?

A

DHC score of 3 ALONG WITH an AC grading of 6 or above

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14
Q

What does an IOTN DHC score of 5i refer to?

A

impeded eruption of teeth (due to crowding, displacement, supernumeraries, retained deciduous, pathology)

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15
Q

What does an IOTN DHC score of 5h refer to?

A

extensive hypodontia (more than 1 tooth missing in any quadrant)

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16
Q

What does an IOTN DHC score of 5a refer to?

A

increased overjet >9mm

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17
Q

What does an IOTN DHC score of 5m refer to?

A

reverse overjet >3.5mm with masticatory & speech difficulties

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18
Q

What does an IOTN DHC score of 5p refer to?

A

cleft lip & palate and other craniofacial anomalies

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19
Q

What does an IOTN DHC score of 5s refer to?

A

submerged deciduous teeth

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20
Q

What does an IOTN DHC score of 4h refer to?

A

Less extensive hypodontia

21
Q

When planning extractions for orthodontic treatment, which teeth are usually picked?

A

first or second premolars (unless upper canines are ectopic, 2nd premolars are absent or FPMs are of poor prognosis)

22
Q

What guidance is commonly used in orthodontics?

A
  • Royal Collage of Surgeons of England (management of unerupted maxillary incisors)
  • Royal Collage of Surgeons of England (management of palatally ectopic canines)
  • British Orthodontic Society (managing the developing occlusion)
  • Index of Orthodontic Treatment Need (IOTN)
23
Q

What other inherited dental anomalies increase the likelihood of failure of eruption of maxillary central incisors?

A
  • enamel hypoplasia
  • supernumerary teeth
  • ectopic teeth
24
Q

When taking a history of a patient with unerupted maxillary central incisor, what is the most important thing to find out?

A

Was there previous trauma to primary dentition

25
Q

What management options are available for unerupted maxillary incisors?

A
  • removal of physical obstruction (without or with the creation of space)
  • surgical exposure of maxillary incisor & traction (open vs closed… closed more common)
  • incisor removal (significan dilaceration or ankylosis)
  • autotransplantation of premolar & reshaping
26
Q

What treatment options are available for patients with ankylosed permanent maxillary incisors?

A
  • composite build up for minor intra-occlusion
  • surgical repositioning of incisor
  • XLA of incisor and orthodontic space closure
  • XLA of incisor and replacement with implant
27
Q

In a patient <9 years old, how long should you wait after removal of obstruction for spontaneous eruption of maxillary incisor?

A

9-12 months

28
Q

What is the prevalence of impacted maxillary canines?

A

1.5%

29
Q

What time period does root resorption of maxillary incisors most commonly occur when the pt has an ectopic canine?

A

11-12 years (rarely starts after 14 years)

30
Q

When should practitioners suspect that a canine is ectopic?

A
  • If they are not palpable in the buccal sulcus by 10-11 years old.
  • asymmetrical palpation
  • malpositioned adjacent teeth
31
Q

What treatment options should be considered for ectopic canines?

A
  1. Interceptive treatment by XLA of primary canine
  2. Surgical exposure and orthodontic alignment
  3. Surgical removal of the palatally ectopic permanent canine
  4. Transplantation
  5. No active treatment/leave and observe
32
Q

When is XLA of primary canine appropriate for a pt with ectopic canine?

A

when ectopic permanent canine is not severely displaced
- pt should be 10-13 years old
- give permanent canine 12 months to move, if not move onto other treatment

33
Q

What patient factors are essential if you are to surgically expose and orthodontically align an ectopic canine?

A
  • pt should be willing to wear fixed orthodontic appliances
  • pt should have good OH
  • pt should be motivated
34
Q

When might surgical exposure and orthodontic alignment of an ectopic canine be impractical?

A

Ectopic canine is:
- lying close to midline
- close to apices of adjacent teeth
- severely horizontally angulated

35
Q

When might an orthodontic consider surgical removal of an ectopic canine?

A
  • pt declines active treatment and/or is happy with dental appearance
  • radiographic evidence of early root resorption of adjacent incisor teeth
  • already good contact between the lateral incisor and first premolar
36
Q

What option may an orthodontist resort to if active/interceptive treatment of an ectopic canine has failed/is inappropriate?

A

Transplantation
- no evidence of ankylosis
- remove ectopic canine with minimal trauma
- canine may require RCT within 10 days of transplantation

37
Q

When would it be appropriate to leave and observe an ectopic canine?

A
  • pt doesn’t want treatment
  • no evidence of root resorption of adjacent teeth or other pathology
  • good contacts between lateral incisor and 1st premolar
38
Q

If a patient has their ectopic canine surgically removed & they used fixed ortho to move 1st premolar into canine space, what else can be done to simulate a canine?

A

Fixed ortho can:
- bring 1st premolar forward to simulate canine
- mesiopalatal rotation of premolar
- grinding of palatal cusp

[all improve aesthetics]

39
Q

Is the prognosis of transplanted ectopic canines good?

A

NO (disappointing results)
- stabilisation of transplanted tooth with a sectional archwire for 6 weeks can improve outcome

40
Q

What are the risk associated with ectopic canines?

A
  • root resorption of adjacent teeth (one study showed 66.7% of permanent lat incisors had root resorption)
  • resorption of canine crown
  • cystic change
41
Q

At what age is root resorption of teeth adjacent to ectopic canines most frequent?

A

between 11-12
- rarely starts if pt is >14 years old

42
Q

What is the ideal average SNA angle?

A

81 +/- 3

43
Q

What is the ideal average SNB angle?

A

78 +/- 3

44
Q

What is the ideal average ANB angle?

A

3 +/- 2

45
Q

How can the profile of a class II skeletal malocculsion pt be described?

A

convex (cranial base angle increased)

46
Q

How do the cephalometric values of a Class II malocclusion patient differ?

A

SNA - usually average (increased if maxilla prognathic)

SNB - usually decreased <75

ANB - >5

47
Q

How do the cephalometric values of a Class III malocclusion patient differ?

A

SNA = decreased if maxilla deficient (<78)

SNB = may be increased if mandible prognathic (>81)

ANB = <1 or negative

48
Q
A

BDS4 EXAM STUDY (39 decks)

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