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ortho > phase i treatment > Flashcards

phase i treatment Flashcards

1
Q

Dental features in mixed dentition that warrant further investigation/orthodontic intervention

A
  • Functional shift
  • Reverse overjet with MAXILLARY RETRUSION (no intervention for mandibular prognathia)
  • Increased overjet that poses high risk of trauma to upper central incisors
  • Deep overbite with soft tissue trauma
  • Difference in occlusal plane between posterior and anterior teeth
  • Unilateral marked displacement
  • Uni/bilateral prolonged retention of primary teeth
  • Unilateral delayed eruption of primary teeth
  • Ectopic 6s
  • Premature loss of C/E (uni/bilateral)
  • Non palpable canines at 11 years old
  • Missing permanent teeth
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2
Q

When should the first ortho visit be

A

7 years old or when ortho problem is first noticed

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3
Q

When does phase 1 treatment occur

A

When patient is in mixed dentition. Short duration ~1 year, limited orthodontic goals, as patient may need second round of treatment

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4
Q

Rationale for doing phase 1 ortho treatment

A
  • Shorten duration of second round of treatment
  • Some problems can get worse if left untreated
  • Some results may be unachievable once the face and jaws have stopped growing and teeth have erupted
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5
Q

Objectives of phase 1 treatment

A
  • Guide skeletal growth
  • Provide adequate space for/guide eruption of permanent teeth
  • Correct habits
  • Eliminate presence/risks of trauma to oral tissues
  • Improve function: incision, mastication, speech
  • Improve facial harmony and dental aesthetics
  • Simplify future treatment
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6
Q

Considerations for phase 1 treatment

A
  • Compliance/motivation
  • Effectiveness
    • Undesirable side effects eg too old, instead of growth modification you just get movement of teeth
    • Effects on Phase II treatment — does this phase I treatment actually make phase II treatment easier and quicker?
  • Overall treatment fees
  • Duration of treatment —> Burnout
  • Duration of retention —> Burnout
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7
Q

How much correction can class II growth modification achieve

A

Not more than 3-4mm usually

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8
Q

How to carry out growth modification for class II malocclusion

A
  • Max protrusion
    • Headgear
    • Removable biteplate
      • Disclude molars, molars erupt mesially
  • Mand retrusion
    • Twin block
    • Herbst/MARA (fixed appliance)
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9
Q

What are the indications for phase 1 treatment in patient with class II malocclusion

A
  • Risk of trauma (OJ more than 7-8mm poses increased risk)
  • Incompetent lips
  • Deep overbite with trauma
  • Psychosocial concerns
  • Facial aesthetics
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10
Q

When should reverse pull face mask/headgear be used?

A

To address maxillary retrusion (pulls the upper jaw forward)

Use from 8-10 years old, after 10 years old, may have more dental movement than maxillary protraction

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11
Q

What is a common source of failure in phase 1 treatment of maxillary retrusion?

A

Mandibular growth resulting in relapse of negative overjet

Movement of teeth instead of maxillary protraction (can be solved by using mini screws)

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12
Q

Why can early intervention in skeletal class III be beneficial

A
  • Greater orthopedic change in shorter duration
  • Earlier functional improvement
  • Avoid sequelae of anterior crossbite
    • Gingival recession labial to lower incisors
    • Incisal wear
  • Facial and dental aesthetics
  • Psychosocial benefits
  • Better patient compliance
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13
Q

What are the limitations of interceptive treatment for mandibular prognathia

A
  • Prolonged duration of wear required- chincup worn from age 7 all the way to 21
  • Mandibular growth difficult to control
  • Small transitory improvement
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14
Q

What are the specific indications for two phase interceptive treatment for skeletal Class II patients

A
  • Risk of dental trauma
  • Deep overbite with soft tissue trauma
    • Palatal tissue of upper incisors
    • Buccal gingiva of lower incisors
  • Psychosocial concerns
  • Facial aesthetics
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15
Q

Why do you need specific indications before commencing two phase interceptive treatment for skeletal class II patients

A

Comprehensive treatment during adolescent growth spurt is as effective as early treatment before adolescent growth spurt

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16
Q

What appliances are used for interceptive treatment for skeletal Class II

A
  • Headgear→ hold maxilla growth back, has some distalising effect on molars
  • Removable biteplate→ for patients with deep overbite
    • Acrylic is thicker at anterior, disclude posterior, give posterior teeth space to erupt, posterior teeth also erupt in mesial direction, so will lead to correction of molar Class II
  • Functional appliances
    • Removable (twin block) — forces mandible to posture forward prolong forwards to correct mandibular retrognathia
    • Fixed (Herbst and MARA) — same mechanism, just that it does not rely on patient compliance
17
Q

When should constricted maxilla be treated

A
  • As early as feasibly possible
    • Especially if shift on closure
    • Constriction severe enough to reduce space within arch
  • With increasing age: Mid-palatal suture more interdigitated.
18
Q

Appliances used for constructed maxilla

A

Removable expander for maxillary expansion

Quadhelix/w arch

Hyrax expander

19
Q

Why is quadhelix/w arch used in younger patients vs hyrax expander

A

Midpalatal suture not so interdigitated, less rigid appliance still effective

20
Q

What are 5 benefits of correcting skeletal crossbites early

A
  • Eliminate functional shift
  • Increase arch perimeter
  • Achieve dentoalveolar symmetry
  • Reduce attrition of teeth
  • Simplify future treatment
    • Avoid surgical expansion (one of the more unstable surgeries)
    • Avoid gingival recession (excessive dental expansion, movement of teeth too buccally leading to dehiscence)
21
Q

Why correct functional shift early?

A
  • Prevent adaptive remodelling
  • Later correction of skeletal discrepancies may require surgery
  • Dental asymmetry due to DAC
  • Prevent traumatic occlusion (mobile over time, or gingival recession)
22
Q

Appliances for increased overjet

A
  • Dental etiology- fixed appliances eg MARA, Herbst
  • Skeletal etiology- cervical-pull headgear→ hold maxilla growth back + headgear may be used for dental etiologies also, using the skeletal base as anchorage to distalise upper molars and eliminate molar class II
23
Q

What are the early treatment options for deep overbite?

A
  • Wait for pubertal spurt/early permanent dentition unless dental/soft tissue trauma or other indications
    • Growth modification, increase eruption of posterior teeth (cervical pull head gear or biteplate)
  • Overeruption of anteriors
    • 2X4 fixed appliance
24
Q

What are the early treatment modalities for anterior crossbite?

A
  • Skeletal
    • Maxillary retrusion→ Reverse pull headgear growth modification
    • Mandibular prognathia→ leave and monitor growth
  • Pseudo-class III
    • Eliminate functional shift ASAP
  • Dental- etiology due to lack of space
    • Can choose to leave alone
    • Can realign tooth
      • Partial fixed appliances
      • Removable appliance- Z springs
      • Banded maxillary lingual arch with finger springs
25
Q

What are the early treatment modalities for open bite?

A
  • Skeletal open bite
    • Restrict vertical growth of maxilla
    • Restrict posterior tooth eruption
    • USE high pull headgear+/- maxillary splint
    • Functional appliance with bite blocks
  • Dental open bite
    • If habit stops before eruption of teeth, usually spontaneous resolution
    • Non dental intervention
    • Habit appliance therapy only if the patient wants to stop eg tongue crib, bonded tongue spurs, blue grass appliance
26
Q

What can you do for early intervention of moderate/severe crowding

A
  • Expansion/proclination
    • Expander
    • Archwire
    • Lip bumper (neutralise force from lower lip)
    • Lingual arch (procline incisors, distalise molars)
  • Distalisation of molars
    • Headgear
    • Pendulum headgear (use palate and premolars as anchorage)
  • Serial extractions
    • Skeletal class I crowding >10mm
    • Timed extraction of primary and permanent teeth →reduce crowding and irregularity during transition
    • May still require Phase II treatment
27
Q

What is a sign that indicates surgical exposure and orthodontic traction of permanent 3s

A
  • If permanent incisor root resorption has occurred, should extract primary canines and expose permanent 3s surgically
  • Extracting upper primary canines may be sufficient for permanent 3s to erupt
    • Removal of primary canines before age 11 will normalise palatally ectopic canines
28
Q

At what age should you extract Es to allow mesial drift of 6s in the case of missing 5s

A

Age 7-9

ortho (8 decks)

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