Problems In The Mixed Dentition (Resident)

Question 1

What are the two major causes of irregular and misaligned teeth in the early mixed dentition?

Answer 1

Interferences
Lack of space

Question 2

_______ with eruption, which prevent a permanent tooth from erupting on a normal schedule and secondarily can lead to space problems because other teeth drift to improper positions

Answer 2

Interferences

Question 3

__________ for adequate alignment, which causes an erupting tooth to be deflected from its normal position in the arch

Answer 3

Lack of space

Question 4

Space analysis

Answer 4

Amount of space available vs amount of space needed

Question 5

Space available

Answer 5

Measure the arch length

Question 6

Space needed

Answer 6

Add together widths of each tooth

Question 7

What if tooth is unerupted?

Answer 7

Estimate width by radiographs, proportionality tables (Moyers and Tanaka and Johnston), combo of both

Question 8

Leeway space

Answer 8

Difference between the size of the larger primary molars and the smaller permanent premolars
sometimes called e space

Question 9

Leeway space for maxilla

Answer 9

1.5 mm per side

Question 10

Leeway space for mandible

Answer 10

2.5 per side

Question 11

Space regaining

Answer 11

Required not enough space or if Succedaneous teeth are missing (space maintenance alone is inadequate)

Question 12

How much space can be re-established in a localized area with relative simple appliances and a good prognosis?

Answer 12

Up to 3 mm

Question 13

How much space is a discrepancy between the amount of space available for the teeth and the amount of space required a severe problem?

Answer 13

More than 3-4 mm

Question 14

Maxillary space regaining

Answer 14

Easier than mandible bc increase anchorage for removable appliances afforded by the palatal vault and possibility for use of extra oral force (headgear)

Question 15

What can tip permanent maxillary first molars distally to regain space

Answer 15

Fixed appliance or removable appliance

Question 16

What can molars be bodily moved with to regain space

Answer 16

Fixed appliances only

Question 17

Because molars tend to tip ______ and rotate ___________, distal tipping for ___________ of space regaining is often satisfactory.

Answer 17

Forward, mesio-lingually, 2-3 mm

Question 18

Appliances that help regain space in maxilla

Answer 18

Hawley retainer with finger spring
Pendulum appliance
Distal jet appliance
Headgear

Question 19

Hawley retainer with finger spring

Answer 19

Removable retainer worn to regain space by tipping the permanent first molar distally
After regaining, space should be maintained with a band and loop or lingual arch

Question 20

Pendulum appliance

Answer 20

Fixed appliance used to distalize molars bilaterally
Gains anchorage from the palate but uses helical springs to supply the distalizing force

Question 21

Distal jet appliance

Answer 21

Fixed appliance used to distalize unilaterally or bilaterally
Uses palate as anchorage

Question 22

Headgear

Answer 22

Most effective and straightforward method to move molars distally

Question 23

Headgear advantage

Answer 23

No reciprocal incisor protrusion

Question 24

Headgear disadvantage

Answer 24

Compliance (minimal 14 to 16 hours per day)

Question 25

Once space is regained what is required in maxillary space regaining?

Answer 25

A space maintainer Fixed is preferred

Question 26

Mandibular space regaining

Answer 26

Not as effective as maxillary space bc appliances are more fragile and prone to breakage Do not fit as well and lack the palatal anchorage support Bone dentistry

Question 27

How to regain space in the mandible

Answer 27

Lip bumpers

Question 28

Lip bumper indications

Answer 28

Minimal space regaining Arch development Unraveling of mildly crowded incisors

Question 29

Lip bumper location

Answer 29

2-5 mm from the facial surfaces of the lower incisors Lip pushes back and creates distal force to tip

Question 30

Lip bumper purpose

Answer 30

Lip pushes back and creates distal force to tip molars poseirorly

Question 31

Lip bumper side effect

Answer 31

Forward movement of incisors

Question 32

Lip bumper follow up

Answer 32

Monthly to maintain 2-5 mm clearance of incisors, monitor progress

Question 33

Do you use a lip bumper to maintain space?

Answer 33

No it should be replaced with a LLHA once space is gained

Question 34

Children with moderate crowding and inadequate space in early mixed dentition

Answer 34

-arch will need to be expanded to accommodate the permanent teeth -some permanent teeth will need to be extracted

Question 35

Severe crowding

Answer 35

Limited tx of problem will not be sufficient and permanent tooth extraction is most likely the best alternative

Question 36

Two major symptoms of severe crowding in the early mixed dentition

Answer 36

1 severe irregularity of the erupting permanent incisors 2 early loss of primary canines caused by eruption of the permanent lateral incisors

Question 37

Serial extractions

Answer 37

Timed extraction of primary and ultimately permanent teeth to relieve severe crowding

Question 38

Indications for serial extractions

Answer 38

No skeletal problems exists Large space discrepancy (greater than 10 mm per arch)

Question 39

Typical extraction pattern - cd4

Answer 39

Primary canine, primary first molar, permanent first premolar

Question 40

Maxillary midline diastema

Answer 40

-Usually close spontaneously when canines erupt and incisor root and crown positions change

Question 41

What do you do if a diastema is due to a large frenum attachment?

Answer 41

Frenectomy performed after space closure

Question 42

When a larger diastema (>2mm) is present what should you suspect?

Answer 42

Midline supernumerary tooth or intrabony lesion (look at radiographs)

Question 43

Frenum attachments

Answer 43

Insertion of labial frenum into a notch in the alveolar bone Band of heavy fibrous tissue lies between the central incisors

Question 44

Frenectomy

Answer 44

-Frenum is removed while there is still space, scar tissue forms between the teeth, making closure more difficult and increasing relapse potential -Best to align teeth before

Question 45

Retention of diastemas

Answer 45

Best retainer- bonded section of flexible wire, wire contoured lies near cingulum keep out of occlusal contact, hold teeth together while allowing some ability to move independently during function

Question 46

Ugly duckling stage

Answer 46

-Spacing and mesial root position of max incisors (diastemas) results from position of unerupted permanent canines -space decrease/disappear when canines erupt

Question 47

What happens with the greater amount of space in the ugly duckling stage?

Answer 47

The less likely the diastema will close on its own -2 mm or less will probably close spontaneous -greater 2mm need ortho

Question 48

Other spacing etiology

Answer 48

Obstruction Insufficient tooth mass

Question 49

Obstruction

Answer 49

Supernumerary teeth (mesiodens) Frenum attachment Large mandibular incisors (occlusion) Macroglossia Habits - thumb, fingers, tongue

Question 50

Insufficient tooth mass

Answer 50

Microdontia Hypotonia Peg laterals Missing teeth