Orthodontics tutorials Flashcards
1
Q
What is the name of the legislation dealing with ** occupational exposures and exposure of the general public** ?
A
Ionising Radiation Regulations 2017 (IRR17)
2
Q
What is the name of the legislation dealing with medical exposures of patients?
A
Ionising radiation Medical Exposure Regulations (IRMER 17)
3
Q
What is the annual radiation dose for radiation workers?
A
6 mSv/year
4
Q
What is the annual radiation dose limit for the members of the public?
A
1 mSv/year
5
Q
What is the job of the REFERRER in IRMER?
A
Provide sufficient medical date to practitioner to justify exposure - patient identification and clinical details
6
Q
What is the job of the PRACTITIONER in IRMER?
A
Carry out justification and authorisation of each exam complying with employer’s procedures - return request to referrer if invalid justification
7
Q
What is the job of the OPERATOR in IRMER 17
A
- Authorisation of justification if not done by practitioner
- Select equipment and method to limit dose and carry out exposure
8
Q
What is the job of the EMPLOYER in IRMER 17?
A
- Provide criteria for referral, authorisation and procedure criteria for carrying out an exposure
- Ensure staff are competent and work by regulations
- Provide facilities for clinical evaluation
- Set procedures for radiographic reporting (indepartment of external)
9
Q
Who is responsible for carrying out ALARP?
A
- Practitioner
- Operator
10
Q
What 3 information must be provided for justifying an exposure before authorising it? (4)
A
- Objectives of exposure and efficacy
- Benefits and risks of alternatives techniques
- Benefits of exposure to patient or society
- Risks of exposure to patient
11
Q
What are Diagnostic reference levels?
A
Tool used to optimise exposures in relation to radiation
12
Q
What are the Diagnostic reference level for intra-oral mandibular molar?
A
1.7 mGy
13
Q
What is the Diagnostic reference level for an OPT in adults and children?
A
- 93 mGy/cm^2 - adults
- 67 mGy/cm^2 - children
14
Q
Give 5 patient selection criteria for taking an OPT for an orthodontic patient?
A
- Presence of ectopic tooth
- State of development
- Presence of supranumerary tooth
- Stages of individual teeth development
- Caries assessment
- Periodontal disease assessment
15
Q
Give 3 contraindications for taking an OPT in any dental situation?
A
- Unable to fit in OPT machine
- Pregnant patient
- Unable to keep still for long time (Parkinson’s)
16
Q
Give 3 reasons why a fault may arise during an OPT exposure?
A
- Patient positioning
- Patient movement during exposure
- Limitation of focal width
17
Q
What is the effects of the patient being too far forward in the OPT machine?
A
- Anterior teeth very blurred and thin roots
18
Q
What is effect of the patient being too far backward in the OPT machine?
A
- Anterior teeth wider
19
Q
Why are ghost images always seen at a higher level?
A
Because the X-ray beam is angled upwards (8 degrees)
20
Q
Give 4 reasons for requesting an UPPER OCCLUSAL radiograph?
A
- Localising pathology
- Confirming Unerupted tooth
- Localising Unerupted teeth
- Assess root resorption
21
Q
Give 4 reasons for requesting a Periapical radiograph?
A
- Assess ankylosis
- Localising pathology
- Localising unerupted teeth
- Assessing root resorption
22
Q
Give 4 reasons for requesting a bitewing radiograph?
A
- Carries assessment
- Depth of restoration
- Tooth prognosis
- Bone level assessment
23
Q
What radiographs to take for HORIZONTAL TUBE SHIFT parallax?
A
Two periapicals
24
Q
What radiographs to take for VERTICAL TUBE SHIFT parallax?
A
Periapical + maxillary oblique occlusal
25
What is the rule of localising unerupted teeth through tube shift?
SLOB ( same lingual opposite buccal)
26
Give 4 reasons for requesting a lateral cephalogram?
* Monitoring growth
* Monitoring orthodontic treatment progress
* Treatment planning
* To aid in research and study
* Aid orthodontic diagnosis
27
What 2 features makes lateral cephalogram useful in orthodontics?
* Standardised
* Reproducible
28
What are the 3 landmarks used in positioning a patient for a lateral cephalogram?
* Ear rods placed in external auditory meatus (porion)
* Frankfort plane parallel to the floor
* Nasion contacting machine
29
In what 3 ways can we reduce patient x-ray dose delivered during **lateral cephalometry**?
* Thyroid collar
* Appropriate Field of view
* Triangular collimation
30
Give 3 errors that may occur during lateral cephalometry?
* Projection errors = magnification
* Measuring errors
* Landmark identification errors
** errors may occur due to poor operator expertise **
31
Give 2 reasons for taking a CBCT in orthodontics?
* Localising impacted teeth
* Unerupted canine
* Viewing developmental abnormalities
32
Give 4 advantages for taking a CBCT?
* No magnification or distortion
* Can be viewed from any angle
* no superimposed tissues
* 3D reconstruction
33
Give 4 contraindications for taking a CBCT?
* High radiographic dose that is not justified
* Patient medically unsuitable (kyphosis or on wheelchair)
* Soft tissue visualisation is needed
* High risk of streak artefact (metals inside patients)
34
* 9 year old
* concerned that front tooth is not coming out after XLA of deciduous
* PDH = trauma at age of 7, prone to accidents , # on incisal of 12
* O/E - 11 is absent, 3mm spacing in upper arch (well aligned)
What initial clinical examination would you undertake (1)?
* Palpate soft tissues for obvious bump of 11
35
* 9 year old
* concerned that front tooth is not coming out after XLA of deciduous
* PDH = trauma at age of 7, prone to accidents , # on incisal of 12
* O/E - 11 is absent, 3mm spacing in upper arch
What other special investigations would you undertake?
* PA or maxillary oblique occlusal ± OPG ( might not justifiable unless future ortho treatment is indicated)
* If indicated , pre-op CBCT
36
* 9 year old
* concerned that front tooth is not coming out after XLA of deciduous
* PDH = trauma at age of 7, prone to accidents , # on incisal of 12
* O/E - 11 is absent, 3mm spacing in upper arch
What is the likely aetiology for the missing 11?
* Dilacerated from trauma to 51
* Loss of space due to early loss of 51 impacting the eruption of 21
37
* 9 year old
* concerned that front tooth is not coming out after XLA of deciduous
* PDH = trauma at age of 7, prone to accidents , # on incisal of 12
* O/E - 11 is absent, 3mm spacing in upper arch
What are 4 risks of doing nothing?
* Worsening of anterior malocclusion
* Resorption of 11 crown
* Resorption of adjacent teeth roots
* Cyst formation
38
Describe how you would reposition the unerupted (impacted) 11 into the line of the arch?
* CBCT to assess position of 11
* Create space (9mm for 11) using URA
* Closed exposure + orthodontic traction with gold chain to URA
## Footnote
URA = split labial bow type arm and z-spring on 12
39
What are 4 risks associated with repositioning an impacted 11 into arch using gold chain traction?
* Ankylosis of 11
* Resorption of 11
* Poor gingival margin of relocated 11
* Failure of traction
40
What 3 indications may require extraction of the unerupted 11?
* Patient wishes
* Failure of traction
* Ankylosis
* very severe dilaceration ( tooth not aligned with alveolar bone width)
41
What 3 risks are associated with the extraction of an impacted 11? (3)
* Damage to adjacent tooth roots
* Loss of space in arch (if not managed)
* loss of alveolar bone in area
42
* 9 year old
* concerned that front tooth is not coming out after XLA of deciduous
* PDH = trauma at age of 7, prone to accidents , # on incisal of 12
* O/E - 11 is absent, 3mm spacing in upper arch
The patient wants the tooth to be exracted (11)
What 4 ways in which you can manage the missing incisor from the arch?
* Resin bonded bridge
* RPD
* Essix retainer with pontic 11 for future implant
* Space closure and veneer in the future
43
Give 5 local causes of an unerupted central incisor?
* Supernumeraries
* Early loss of deciduous primary
* Retained primary tooth
* Crowding
* Ectopic tooth position
44
Give 5 Generalised causes of an Unerupted central incisors?
* CLP
* Down's syndrome
* Turner's syndrome
* Cleidocranial dysplasia
* Rickets
45
What is the most common reason for obstructed permanent maxillary incisor eruption?
* Tuberculate supernumerary
46
What is primary failure of eruption? (PFE)
Failure of tooth eruption with no identifiable cause
47
What are the 3 features of PFE?
* Can be bilateral
* Commonly involving posterior teeth
* Posterior open bites
48
What happens when you apply traction to a tooth affected by PFE?
Ankylosis
49
What 2 factors affect whether you should delay or go ahead with managing an unerupted central incisor?
* Age of patient
* Maturity of apex
50
What is the suggested way in which to manage an impacted dilacerated permanent maxillary incisor?
Aligned into arch using closed surgical exposure and orthodontic traction
51
* 13 year old patient
* Does not like the appearance of her teeth
* O/E -
retained 53 and 63
bucally placed 13
clinically absent 23
Class II div 2 incisors
Class 3 molar relationship (left and right)
What 3 clinical examination would you undertake?
* Palpate soft tissues for ectopic 23
* Check mobility and inclination of 22,53,63
52
* 13 year old patient
* Does not like the appearance of her teeth
* O/E -
retained 53 and 63
bucally placed 13
clinically absent 23
Class II div 2 incisors
Class 3 molar relationship (left and right)
What special investigations would you undertake?
* opt and maxillary oblique occlusal or
* CBCT
53
What 4 aetiological factors are linked to ectopic maxillary canines?
* Long path of eruption
* Ectopic position of tooth germ
* Crowding
* Genetics
54
* 13 year old patient
* Does not like the appearance of her teeth
* O/E -
retained 53 and 63
bucally placed 13
clinically absent 23
Class II div 2 incisors
Class 3 molar relationship (left and right)
What are the 4 risks of doing nothing to the ectopic canine (23)?
* Resorption of adjacent teeth roots
* Resorption of 23 crown
* Ankylosis of canine crown
* Cyst formation
55
* 13 year old patient
* Does not like the appearance of her teeth
* O/E -
retained 53 and 63
bucally placed 13
clinically absent 23
Class II div 2 incisors
Class 3 molar relationship (left and right)
What are 5 indications for surgical extraction of the ectopic canine?
* Canine not deemed alignable
* Good prognosis of primary canine and patient happy to retain
* Unwilling to wear fixed appliances
* Low risk of iatrogenic damage with XLA
* Evidence of early resorption of adjacent teeth
56
* 13 year old patient
* Does not like the appearance of her teeth
* O/E -
retained 53 and 63
bucally placed 13
clinically absent 23
Class II div 2 incisors
Class 3 molar relationship (left and right)
What would be the 3 main goals for providing a growth appliance for this patient? and which appliance would you use?
* Convert into class 1 incisor relationship
* Facilitate mandibular growth
* Overbite reduction
** twin block appliance ** §
57
* 13 year old patient
* Does not like the appearance of her teeth
* O/E -
retained 53 and 63
bucally placed 13
clinically absent 23
Class II div 2 incisors
Class 3 molar relationship (left and right)
Describe how you would resposition the 23 into the line of the arch?
* XLA of primary tooth (63)
* Open or closed exposure
* Place gold chain
* Apply orthodontic traction with fixed appliance
58
Give 4 indications for autotransplantation of an ectopic canine?
* Canine not deemed alignable
* Patient unwilling to wear fixed appliances
* Patient wants a quick solution
* No evidence of ankylosis
59
Give 2 risks the patient should be aware of with autotransplantation?
* Will become non vital = need RCT
* Will almost always become ankylosed
60
What factors that may indicate that a canine cannot be aligned?
* too close to midline
* too high (above apices of adjacent teeth)
* horizontal angulation
61
At what age should you palpate for ectopic canines?
* from the age of 8
* if not palpable on buccal sulcus by age 10-11 = suspect ectopic
62
What are 4 dental abnormalities that can be detected by 6 years of age?
* Hypodontia
* Supernumeraries
* Natal teeth
* Teeth of abnormal morphology
63
When do the first permanent molars begin to calcify?
At birth
64
When do the third molars begin to calcify? and why is this date significant in interceptive orthodontics?
* 7-10 years
* It can determines if XLA of 6's is indicated
65
When do the third permanent molars complete crown formation?
12-16 years
66
When do the 3rd permanent molars erupt?
17-21 years
67
when do the third permanent molars complete root formation?
18-25 years
68
At what age have all the primary teeth erupted?
2.5 Y
69
Give the order for eruption of all primary teeth?
A B D C E
70
At what age have all the permanent teeth erupted?
* 12 years excluding 3rd molars
71
Give the order for eruption of all the permanent teeth?
* 6 = Upper 6s , lower 1
* 7 = lower 1 , upper 2
* 8 = Upper 2
* 9 = Lower 3
* 10 = 4s and 5s
* 11 = Upper 3
* 12 = 7s
72
What is interceptive orthodontics?
Any measure taken to reduce the severity of a developing malocclusion
73
What is an anterior cross-bite?
* abnormal relationship between opposing anterior teeth in a buccopalatal or labiopalatal direction
74
What are 3 risks associated with anterior cross-bites?
* tooth wear
* gingival recession
* displacement upon closure
75
What are the indications for favourable interceptive treatment of an anterior crossbite?
* palatally tipped tooth
* Good overbite - aids stability
* adequate space to move forward
76
Design a URA for the correction of an anterior crossbite of 11
77
What is a posterior crossbite?
Abnormal relationship between opposing posterior teeth in a buccolingual direction
78
What are 3 risks associated with posterior cross-bite?
* Facial asymmetry
* Tooth-wear
* Displacement upon closure
79
What is the aetiology of a posterior cross-bite? (skeletal)
* Class 2 skeletal relationship - commonly mandibular deficiency
80
What is the aetiology of an anterior cross-bite? (soft tissues)
* hyperactive lower lip
* lower lip trap
81
What is the aetiology of a anterior cross-bite? (dental)
* Upper incisor proclination
* Lingual displacement of lower incisors
* Digit sucking
82
What 2 URA components are used to manage a posterior crossbite?
* Mid-palatal screw
* T-Spring
83
Design a URA for the correction of a unilateral posterior crossbite?
84
How can you manage a posterior crossbite?
* Simple retraction of upper incisors
* Attempt growth modification
85
What is the therapeutic effect of a twin block?
* enhance mandibular growth
* restrain maxillary growth
* remodel glenoid fossa
* Retrocline maxillary incisors and distalise molars
* Procline mandibular incisors and mesialise molars
86
What are 2 risks associated with an increased overjet?
* Increased trauma risk
* Reduced self-esteem
87
What 4 aetiological reasons for an increased overjet?
* Class II skeletal pattern
* Lower lip trap
* thumb sucking
* tongue thrust
88
What component is used in a URA to correct an increased overjet?
* Labial bow
89
What is a reverse overjet?
When the lower incisors are infront of the upper incisors
90
What 4 problems are associated with a reverse overjet?
* Eating difficulties
* Speech difficulties
* Displacement upon closure
* Incisal toothwear
91
What 4 etiological reasons for a reverse overjet? (4)
* Class III skeletal pattern
* Hypoplastic maxilla
* Prognathic mandible
* Retained upper primary incisors
92
How can a simple URA be used to manage a reverse overjet?
* Posterior bite plane with z-springs on upper incisors
* this is an early management for a reverse overjet and promotes dentoalveolar compensation
93
What growth modification options would you use for a reverse overjet?
* Reverse twin block
* Frankel III
* Protraction headgear ± rapid maxillary expansion
94
What does orthodontic camouflage entail in reverse overjets?
* Accepting skeletal discrepancy
* XLA U5's and L4s
* Fixed orthodontics to procline uppers and retrocline lowers
95
What are the 3 main actions of a functional appliance used in treating a reverse overjet through growth modification?
* Remodel glenoid fossa
* Restrict growth of mandible
* Promote growth of maxilla
96
What are 2 patient related factors which limit the effectiveness of interceptive treatment in reverse overjets?
* Unfavourable growth
* Poor compliance to treatment
97
What is deep overbite?
* A vertical overlap of the upper inciors over the lower incisors (more than 3mm)
98
What are 2 risks associated with a deep overbite?
* palatal ulceration ( trauma to soft tissues)
* gingival stripping ( loss of periodontal support)
99
What is the main goal of a URA in interceptive treatment of a deep overbite?
* lower molars eruption
* achieved with URA with FABP
100
Design a URA for a deep overbite
* FABP
* Adams cribs on D's and 6's
* southend clasp on incisors
101
What are the occlusal effectcs of a thumb habit?
* Proclined uppers
* Retroclined lowers
* Anterior open bite
* Posterior crossbite
102
Describe the way in which a digit sucking habit produces a malocclusion?
* Thumb sucking proclines upper anteriors
* Cheeks push and narrow posterior teeth
* Crossbite as upper arch size
* It also prevent the eruption of lowers
103
Give 4 management methods for a digit sucking habit?
* Positive reinforcement
* Bitter tasting nail varnish
* Glove on hand
* URA palatal goal post
* Fixed othrodontics with tongue rake
104
How long do thumb sucking patients usually do it to cause a malocclusion?
More than 6 hours
105
Ideally at what age should sucking habit stop?
9 years , after the age of 9 the changes to the occlusion may need a more complicated orthodontic treatment
106
What are 4 risks associated with supernumerary teeth?
* Failure of eruption
* Ectopic teeth
* Impaction
* Crowding
107
What are 4 morphological types of supernumerary teeth?
* Conical
* Tuberculate
* Odontome
* Supplemental
108
Which two conditions have an increased risk of supernumeraries?
* Gardner's syndrome
* Cleidocranial dysplasia
* Cleft lip and palate
109
What type of supernumerary is the most common aetiological cause of an unerupted upper permanent incisor?
Tuberculate
110
What is the incidence of supernumeraries?
* more in males
* more in maxilla
* 80% in anterior maxilla
111
How many % of diastemas are caused by supernumeraries?
10%
112
What are the two types of odontome supernumerary?
* Complex
* Compound
113
When to extract a conical supernumerary?
* If it erupts or imeding tooth movement
114
What is a diastema?
Space between 2 teeth
115
What is the biggest complaint for an upper midline diastema?
Aesthetics
116
What are 5 aetiological factors for an upper midline (median) diastema?
* Developmental
* Generalised spacing
* Hypodontia (absent 2s)
* low frenal attachment
* Midline supernumerary
* pathology
* proclined upper incisors
117
What soft tissue abnormality is linked to formation of an upper midline?
* Low frenal attachement
118
What is the management options for a midline diastema ?
* Monitor
* Close space using Fixed orthodontics
* Frenectomy
119
At what age is a midline diastema most common?
Age 6 , 98%
120
What risks are associated with first molar impaction?
* Pulpitis of E
* Premature exfoliation of E
121
What risks are associated to caries in the developing dentition?
* Early loss of deciduous teeth
* Enforced loss of first molars
122
What are 4 aetiological factors for an impacted FPM?
* Eruption angle
* Ectopic crypt
* morphology of E crown
* Small maxilla
123
How can you manage an impacted ectopic FPM?
* Monitor for 6 months - may spontaneously erupt
* XLA E - regain space for premolar or treat crowding later
* Disimpact E
124
In what ways will you dis-impact an E to manage a FPM?
* Separators - to distalise E
* Band E and bracket 6 with open coil
* Discing of E
* URA with finger-springs and attachment on 6
125
What is the aetiology of primary molar infra-occlusion? (2)
* Ankylosed E
* Absence of successor
126
What are 3 clinical features of an infraoccluded primary molar? (3)
* High pitched percussion note
* No physiological mobility
* Below interproximal contact
127
What are three radiographical signs of an infraoccluded primary molar?
* Blurring or absence of PDL
* Absence of successor
* Root resorption of primary
128
What 2 key factors would you consider when managing an infra-occluded tooth?
* Degree of infraocclusion
* Absence of successor
129
What primary tooth is most likely to get infraoccluded?
* Lower D
130
Incidence of **infraocclusion**?
* more common in mandible
* M=F
131
What is the management of primary molar infra-occlusion if the successor is present?
* Monitor for 6-12 months if younger than 7 - will correct spontaneously
* XLA of primary + maintain space if older than 7 and did not correct itself
132
Give the management of an infraoccluded primary molar if successor is not present?
* Maintain E if in good condition
* Bad condition =
* consider XLA and
* close space or maintain space for future implant/prosthesis
133
What are the 3 aetiological factors related to hypodontia?
**non syndromic**
* familial
* mutations
**Syndromic**
* CLP
* incontintenta pigmenti
* hurler syndrome
* ectodermal dysplasia
**Enviromental**
* trauma
* chemotherapy
* radiotherapy
134
What is hypodontia?
* The developmental absence of one or more teeth excluding the 8's
135
What are 4 clinical signs of hypodontia?
* Absent primary
* Retained primary
* Delayed eruption
* Abnormal tooth form (microdontia)
136
What are the most 3 commonly affected teeth by hypodontia by order?
* 8s
* Lower 5s
* Upper 2s
* Upper 5s
| 6% of the population , more common in females
137
What dental abnormality is commonly associated with hypodontia?
Microdontia
138
Which is the most rarely affected tooth by hypodontia?
Maxillary canine
139
How do you manage missing U2s with early intervention? (3)
* XLA 52/62 (remove obstructions)
* Close space between 11-21
* maintain space for eruption of 3s
140
How do you manage missing U2 without early interception with space open?
* RRB
* RPD
* Fixed bridged
* Implant (maintain space)
141
How do you manage missing U2 with space closure plus?
* Close space between central incisors
* Extrude canine to replace laterals - remove cusp ,recountour and bleach
* Intrude premolar to replace canine - rotate slightly and add composite build up or veneer
142
What is the effect of early loss of A's and B's on the midline?
No long term effect on midline
* treatment = do nothing
143
What is the effects of early loss of C's on midline?
* Midline shift in crowded dentitions
144
What is the treatment for Early loss of C's to prevent midline shift?
* Balancing extractions if dentition is crowded
145
What the effects of early loss of D's and E's ?
* Space closure leading to crowding
* Only D - midline shift if arch is crowded
146
How to manage early loss of D's and E's?
Maintain space
147
How to manage the early loss D's ?
Balance extraction
148
What factors affect space loss?
* Age at loss
* Tooth lost
* Upper or lower tooth
* Genetics = inherent loss
| Effects on upper arch more severe than lower
## Footnote
the further back in the arch the more marked the effect on crowing
149
What is the major cause of impacted 5s?
* early loss of E's
* may erupt to the inside of the mouth
150
What is balancing extractions?
XLA same tooth on the same arch to minimise midline shift
151
What is a compensating extraction?
XLA of same tooth from opposite arch to maintain buccal occlusion
152
In what 4 situations would a space maintainer be indicated?
* Early loss of D's and E's
* early loss of FPM
* Traumatic loss
* delayed eruption of maxillary incisor
* to preserve leeway space
153
Give 4 favourable indications for extracting FPM for space closure? and why?
* Bifurcation of 7 is forming
* Patient age 8-9
* Evidence of calcification of 8
* Mesio-angulation of 7
** allows spontaneous space closure between 7 and 5**
154
A situation when you should not compensate for FPM XLA?
When extracting upper 6
155
A situation when you should compensate for FPM XLA?
When extracting a lower 6 and upper 6 will be unopposed for a prolonged period of time
156
A situation where you should balance XLA of FPM?
Only in lower arch and if crowded
| Usually premolar unless poor prognosis of first molar
157
What risk is associated with early loss of FPM?
* Distal migration of second pre-molar
158
What risks are associated with late loss of FPM?
* Poor spontaneous closure = spacing
* Mesial tipping and lingual rolling of 7s
159
Which arch is usually more problematic when it comes to early FPM XLA?
Mandibular arch
160
What is orthodontic decalcification?
Demineralisations of hard tissues surrounding fixed orthodontic components
161
Give 4 ways in which you can prevent decalcification?
* Encourage oral hygiene with super floss and interdental brushing
* Diet advice - low sugar, avoid sticky and erosive food
* Chew sugar free gum
* Use fluoridated toothpaste, MW and supplements
162
List 4 fluoride delivery methods?
* Mouthwash (225ppm)
* Varnish (22,600)
* Fluoridated water
* GIC
* High fluoride prescription toothpaste (2800/5,000)
163
What is orthodontic root resorption?
* Horizontal loss of external apical tooth substance associated with orthodontic movements
164
What are the risk factors for root resorption? (4)
* Large bodily movements
* Torque/root movements
* Prolonged orthodontic treatment
* Root form
* History of trauma to tooth
165
What is the average rate of root resorption in fixed orthodontics? and what is
1mm per 2 years
166
What percentage of cases have severe root resorption in orthodontics?
2-5%
167
Which teeth are most at risk of root resorption? by order
* Upper 1
* Lower 1
* 6s
168
What is orthodonitc relapse?
Gradual movement of orthodontically repositioned teeth into their original position
169
Give 5 dental features that have a high relapse potential?
* Diastemas and spaces
* Rotations
* Proclined lower anteriors
* Ectopic canines
* Instanding Upper 2s
170
Give 3 ways in which orthodontic-related soft tissue trauma may arise
* Arch-wire breakage
* Arch-wire not made safe
* Rubbing of brackets on mucosa - ulceration
171
Give 3 reasons of failed orthodontic treatment related to the clinician ?
* Poor diagnosis
* Poor treatment planning
* Poor mechanics
172
Give 3 reasons for failed orthodontic treatment related to the patient?
* Poor compliance with appliance wear
* Poor attendance to appointments
* Unfavourable growth while treatment
173
