Phase 2

Question 1

Problems that cannot be addressed are considered ____ and must be discussed with the patient

Answer 1

Treatment compromises

Question 2

A good general rule is this: If an orthodontic problem exists in a single dimension and can be treated in ___ months or less, it is a problem that generally can be treated in general practice. Name some examples.

Answer 2

9 months or less

Space maintenance
Single tooth crossbite correction
Class 1 mild alignment problems

Question 3

What orthodontic problems should be referred to an orthodontist?

Answer 3

Multi-dimensional malocclusion problems

Skeletal imbalances

Problems that take longer than 9 months

• note that orthodontic care provided to the patient must be to the level of the specialist even if that care is provided by a generalist

Question 4

What are some diagnostic criteria that aids in determining if a patient presents with a single dimension or multidimensional orthodontic problem?

Answer 4

Facial symmetry and proportions and relationship of the jaws

Irregularities of tooth development

Analysis of arch length available

Question 5

Opening paths that are not straight or smooth may foretell ____ or ____. The closing path is evaluated to detect the presence or absence of ___.

Answer 5

Mandibular asymmetry
TMD

A functional shift of the mandible into MI

Marked asymmetry of facial structures or presence of a functional shift signifies referral to a specialist

Question 6

What is a draw back to a lower lingual holding arch?

Answer 6

The leeway space cannot be used by the mandibular molars to shift mesially into a class 1 molar relationship if they are in an end-on position with the maxillary molars

Question 7

Interproximal reduction is a treatment option for class 1 malocclusion with crowding of __-___mm

Answer 7

1 - 5mm

Question 8

True or false… tipping incisors that are invested in thin attached gingival tissue in an anterior direction can result in loss of periodontium

Answer 8

True

Question 9

Extraction of mandibular first premolars provides approximately ___mm of space. Mandibular second molar extraction results in ___mm more of space (similar amount of space gained by ___)

Answer 9

14mm

2.7mm

IPR

Question 10

True or false… headgear/anterior biteplate treatment provides no additional AP dental/skeletal benefits over headgear treatment alone

Answer 10

True

Question 11

The success rate of full class 2 correction in children has been reported to exceed __% with both headgear and functional appliance treatment (followed by fixed appliance treatment)

Answer 11

90%

Question 12

The available evidence suggests that over the long term, functional appliances do/do not modify the inherited facial growth pattern significantly

Answer 12

Do not

Adaptive changes in condylar growth in animals subjected to altered mandibular position forms the historical basis for the clinical use of functional appliances

It was suggested that the findings of increased mandibular length from functional appliance use in humans may be a result of adaptive change in condylar growth direction rather than growth magnitude.

Question 13

Bionator therapy appears to result in altered condyle growth in a more ___ direction, but no difference in ___. More importantly, bionator therapy appears to alter the normal pattern of downward and forward displacement of the mandible by limiting ___ mandibular rotation during growth.

Answer 13

Posterior

Total growth magnitude

Forward

Question 14

Bionator therapy followed by edgewise appliance therapy appears to show treatment changes in the ___angle that is remarkably similar to those found for ___ traction headgear followed by edgewise appliance therapy

Answer 14

SNB

Cervical

Question 15

True or false… the results of many long term studies of the Herbst appliance suggest that the skeletal effects of the appliance are temporary

Studies also suggest the short-term effect of mandibular protrusion on condylar growth is directed more ___ than ___, promotion a temporary ___ mandibular rotation

Answer 15

True. Over the long term, facial growth reverts to the inherited pattern with no evidence of enhanced skeletal growth

Posteriorly than superiorly
Posterior

Question 16

In summary, there is insufficient evidence to support the belief that functional appliances increase…

Answer 16

Mandibular growth beyond that normally achieved by the patient in the long term. In the short term, functional appliances DO accelerate growth of the mandible.

In earlier studies, the acceleration of growth was misinterpreted as true growth enhancement. However, later studies support the concept that, following this initial growth acceleration, mandibular growth of patients treated with functional appliances decreased, and control subjects eventually caught up with no distinguishable differences between treated and control long term.

Question 17

If functional appliances do not cause mandibles to grow MORE than they normally would, how are they beneficial?

Answer 17

They are effective in moving teeth

In addition, there is some restrictive effect on the forward growth of the maxilla

Question 18

The available evidence, based largely on retrospective nonrandomized studies, suggests that reduction of the ___ angle by treatment is largely stable, the ___ angle is largely unaffected by treatment or continued growth, and any increase in ___ caused by treatment is recovered during continued facial growth.

Answer 18

SNA

SNB

Mandibular plane angle

Question 19

True or false… when compared to controls, the changes in mandibular position are not significantly different, suggesting the effect of cervical traction on chin projection is, on average, clinically ___

Answer 19

Insignificant

However, study reports that mandibular posterior rotation, as a result of cervical reaction treatment did not recover after 4 years

Question 20

With class 2 elastics, usually worn from the ___ to the ___, the maxillary teeth tend to be moved ___ whereas the mandibular teeth tend to move ___.

The effect is to change a class 2 canine and molar relationship to a class 1 relationship.

In addition, class 2 elastics tend to tip the patient’s occlusal plane in the Sagittal view such that the posterior aspect tips ___ and the anterior aspect tips ___.

Answer 20

Maxillary canines
Mandibular molars

Posteriorly
Anteriorly

Superiorly
Inferiorly

Question 21

When a patient wishes class 2 camoflauge treatment, when would you extract maxillary first premolars vs second premolars?

Answer 21

Extracting first premolars will result in more distal movement of anterior segment, whereas extracting second premolars will result in less distal movement of anterior segment.

Extracting second premolars is often desirable when maximum incisor retraction is not required

Question 22

What is a fulll step class 2 molar relationship?

Answer 22

The maxillary MB cusp is seated interproximally between the mandibular second premolar and first molar

Question 23

What are the skeletal effects of a reverse-pull facemask? What does it result in?

Answer 23

Forward maxillary movement

Downward and backward rotation of mandible

It results in improvement of the abnormal class 3 molar and canine relationship. The dental effects include maxillary incisor labial inclination and mandibular incisor lingual inclination

Late correction produces more dental effects and less skeletal effects

Question 24

Class 3 elastics extend from the mandibular __ to the maxillary ___. It causes the mandibular teeth to move ___ while the maxillary teeth move ___. In addition, class 3 elastics tend to tip the patients occlusal plane, in the Sagittal view such that the posterior aspect tips ___ and the anterior aspect tips ___.

Answer 24

Canine
Molar

Posteriorly
Anteriorly

Inferiorly
Superiorly

Question 25

In camofluage treatment of a class 3 patient, the mandibular 1st premolars can be extracted in ___ cases, where as the 2nd premolars can be extracted in ___ cases. Why?

Answer 25

Moderate

Mild

With extraction of mandibular first premolars, the canines and incisors are pitted against the molars and second premolar, this can lead to excessive canine distalization. This is undesired if the case is mild.

In a mild case, only slight canine distalization is wanted so the first premolar, canine, and incisors are pitted against the molars so that less canine distalization while more molar mesialation occurs

Question 26

Extracting either of the mandibular premolars in a class 3 case will correct the ___ relationship. In order to correct the ___ relationship, ___ should be extracted. What is the risk though?

Answer 26

Canine

Molar
Maxillary second premolars
(This will allow for maxillary molar mesialization)

The risk of extracting premolars in the maxillary arch is that during space closure, the maxillary canines can be retracted distally, making correction of the class 3 canine relationship even more difficult

Question 27

How does a skeletal openbite occur?

Answer 27

When the maxilla grows downward more than the mandibular ramus lengthens, the mandible will be rotated downward and backward.

Question 28

What is the treatment of a developing skeletal anterior openbite?

Answer 28

Trying to either decrease the vertical descent of the maxilla or decrease eruption of the molars. High-pull headgear, vertical-pull headgear, biteplates, biteplates with repelling magnets in the posterior, exercises, and even LLHAs.

In adults, surgery may be necessary or the use of TADs to intrude posterior teeth

Question 29

Name 6 cases in which extraction of a single mandibular permanent incisor may be useful.

Answer 29

Class 1 with moderate to severe lower anterior crowing without deep bite

Class 3 tendency with good buccal occlusion, lower incisor crowding without deep bite

Class 1 with anterior tooth size discrepancy (mandibular anterior excess)

Class 2 with mandibular anterior crowding AND two maxillary extracted teeth

Class 1 with one mandibular incisor missing with moderate/severe mandibular anterior crowding (with two maxillary extractions)

Class 1 with missing mandibular incisor

Question 30

What is extrusion to extraction?

Answer 30

If a tooth is deemed hopeless and is to be extracted, but an implant will be placed in its site, the tooth may first be extruded in order to raise bone and soft tissue for the future implant site.

Question 31

True or false… in adult orthodontics, teeth requiring extensive restorative treatment, such as crown, should generally receive provisional restorations until orthodontic movement is complete.

Answer 31

True

Question 32

True or false.. although active periodontal disease should be assessed and treated, bone removal (perio surgery) should usually be minimized until orthodontic tooth movement is complete.

Answer 32

True