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BDS3 Orthodontics > Textbook > Flashcards

Textbook Flashcards

1
Q

orthodontics

A

branch of dentistry concerned with facial growth, development of the dentition and occlusion and the diagnosis, interception and treatment of occlusal anomalies

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2
Q

ideal occlusion

A

term given to dentition where the teeth are in the optimum anatomical position, both within the mandibular and maxillary arches (intramaxillary) and between the arches when the teeth are in occlusion (intermaxillary)

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3
Q

malocclusion

A

term used to describe dental anomalies and occlusal traits that represent a deviation from the ideal occlusion

In reality, rare to have a truly perfect occlusion and malocclusion is a spectrum – variation around the norm

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4
Q

prevalence of occlusal abnormalities

A

depends on population studied (e.g age and racial characteristics), criteria used for assessment, methods used by examiners (e.g. if radiographs used)

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5
Q

rationale for orthodontic treatment

A

Malocclusion may cause concerns related to the dental health and/or oral health related quality of life issues arising from appearance, function and psychosocial impact of teeth

Need for treatment depends on the impact of the malocclusion and whether treatment is likely to provide a demonstrable benefit to the pt

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6
Q

Need for ortho Tx depends on

A

the impact of the malocclusion and whether treatment is likely to provide a demonstrable benefit to the pt

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7
Q

to judge treatment need

A

potential benefits of Tx balanced against the risk of possible complications and side effects in a risk-benefit analysis

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8
Q

benefit of ortho Tx (4)

A

Improved dental health

Improved oral health related quality of life

Improved aesthetics

Improved function

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9
Q

risks of ortho Tx (3)

A

Worsening of dental health

Failure to achieve aims of Tx

Relapse

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10
Q

why do people need ortho Tx

A

Health and wellbeing benefits are the most appropriate determinant of Tx need

Orthodontic indices have been developed to help objective and systematic evaluation of the potential risk to dental health posed by malocclusion and the possible benefits of orthodontic treatment

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11
Q

reason for orthodontic indices

A

been developed to help objective and systematic evaluation of the potential risk to dental health posed by malocclusion and the possible benefits of orthodontic treatment

While indices were mainly developed to measure treatment need, due to high treatment demand in many countries they are also used to manage demand and support prioritisation through some form of rationing

e.g. Uk acceptance for NHS orthodontics is based on need for treatment determined by the Index of Orthodontic Treatment need (IOTN), Sweden treatment priority is estimated using priority index developed by Swedish Orthodontic Board and the Medical Board – most severe first

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12
Q

unmet ortho Tx depends on (3)

A

Individuals desire for treatment

Organisation factors – availability and access to services,

Cost

UK unmet ortho treatment need for children from deprived houses is 40% 12 yo and 32% 15 yo (higher than average)
Similar inequality patterns for access to Tx seen in other countries

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13
Q

demand and willingness for ortho care

A

higher in females, and higher SES, smaller population: orthodontist ratio (assumed to be because increase awareness and acceptance of appliances)

Demand for treatment does not reflect the objective treatment need

Some pts very aware of minor deviations- e.g. mild rotation upper incisors – whilst others refuse Tx for severe malocclusions

Demand increasing as rise in less visible appliances (ceramic brackets, lingual fixed appliances, orthodontic aligners). As well as increasing dental awareness and desire for straight teeth – more acceptance also means many adults who didn’t have tx when young now want

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14
Q

ortho role with restorative

A

adjunctive

- People keeping teeth for longer is contributing for more requests for interdisciplinary care

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15
Q

ortho relation to caries, plaque induced perio and TMD

A

insufficient evidence that ortho treatment beneficial
- Complex and multifactorial in origin, thus direct casual relationship with malocclusion ins difficult to measure effectively

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16
Q

ortho relation to localised periodontal problems

A

certain occlusal anomalies can predispose, particularly where the gingival biotype is thin, here orthodontic intervention can have a long term health benefit

e. g.
- Crowding causing tooth/teeth to be pushed out of the bony trough, resulting in recession
- Periodontal damage related to traumatic overbits
- Anterior crossbites with evidence of compromised buccal periodontal supported on affected lower incisors
- Increase overjet with increased risk of dental trauma
- Unerupted impacted teeth with risk of pathology
- Crossbites associated with mandibular displacement

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17
Q

dental trauma and orthodontics

A

Increased overjet is associated with trauma to upper incisors – 2 systematic reviews found risk of injury is more than double in individuals with an overjet greater than 3mm, risk increases with overjet size and lip incompetence
- Increased risk of dental trauma – indicated ortho Tx

Mouthguards – imp in reducing risk of dental trauma esp in contact sports

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18
Q

tooth impactation

A

when normal tooth eruption is impeded by another tooth, bone, soft tissues or other pathology

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19
Q

supernumerary teeth

A

cause impaction and if judge to be impeding normal dental development – orthodontic intervention needed

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20
Q

ectopic teeth

A

that have been formed, or subsequently moved into, wrong position
- Often become impacted

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21
Q

unerupted impacted teeth

A

may cause localised pathology – commonly resorption of adj roots or cystic change

Most frequently seen in relation to ectopic maxillary canine teeth – can resorb roots of incisors and premolars

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22
Q

uncontrolled caries and orthodontic appliance placement

A

Caries reduction is rarely an appropriate justification for orthodontic treatment and placement orthodontic appliances with uncontrolled caries risk factors is likely to cause significant harm

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23
Q

when may orthodontic Tx help resolve caries

A

Malignment in caries suspectable children (e.g. special needs) may reduce capacity for natural tooth cleansing capacity and increase caries risk

Orthodontic solution sought to reduce food stagnation
- Extraction or alignment to alleviate localised crowding

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24
Q

plaque control

A

if poor contraindication for orthodontic Tx

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25
Q

before ortho Tx it is essential

A

OH is satisfactory and any periodontal condition is controlled prior to considering orthodontic treatment

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26
Q

what may hinder effective brushing

A

Reduced dexterity or restricted cleaning access may find irregular teeth a hinderance in effective brushing

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27
Q

TMD

A

compromises a group of related disorders with multifactorial aetiology including psychological, hormonal, genetic, traumatic and occlusal factors

  • Depression, stress and sleep disorders are major factors in aetiology of TMD
  • Parafunctional activity (bruxism) can contribute to muscle pain and spasm

Due to multifactorial aetiology ortho is neither “cause” or “cure” of TMD

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28
Q

how to manage TMD

A

Conservative and reversible approaches are advised to help manage TMD

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29
Q

oral health related quality of life (OHRQoL) 4 components

A

appearance

masticatory function

speech

psychological well being

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30
Q

appearance components of OHRQoL

A

Often principle reason

Psychological benefit of improved appearance

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31
Q

masticatory function components of OHQoL

A

Significant interarch discrepancy including anterior open bits (AOB) and markedly increased or reverse overjet often report difficulty with eating particularly incising food
- Avoidance certain foods (apples, sandwiches), embarrassment eating in public

Severe hypodontia – hard as fewer teeth to bite on and concerns about dislodging mobile teeth and prosthetic teeth

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32
Q

speech components of OHRQoL

A

Complex Neuromuscular process
- Respiration, phonation, articularion and resonance

Orthodontic Tx unlikely to significantly change speech (formed early life prior to permanent dentition)

Lisp – if cannot get contact between incisors (interdental sigmatism) – need to correct incisor relationship and interdental spacing – improve confidence

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33
Q

articulation

A

formation of different sounds through variable contact of the tongue with surrounding structures inc palate , lips, alveolar ridge and dentition

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34
Q

lisp due to and Tx

A

if cannot get contact between incisors (interdental sigmatism)

need to correct incisor relationship and interdental spacing – improve confidence

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35
Q

psychological wellbeing OHRQoL

A

Malocclusion – reduced self conficence and self esteem, possible mediator

Attractive dental appearance – friendlier, more interesting and intelligent, more successful and more socially competent

Deviation from norm can cause stigmatisation and high correlation between victimisation, malocclusion and quality of life

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36
Q

6 intra oral risks of orthodontic Tx

A

root resorption

loss of periodontal support

demineralisation

enamel damage

soft tissue damage

loss of vitality

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37
Q

Avoidance/management of

root resorption due to ortho

A

avoid treatment in patients with resorbed, blunted or pipette shaped roots. In teeth judged to be at risk, monitor roots radiographically and terminate Tx if root resorption evident

recognised risk factors for root resorption during ortho Tx

  • Shortened roots with evidence of previous root resorption
  • Pippette shaped or blunted roots
  • Teeth which have suffered previous episode of trauma
  • Patient habits (e.g. nail biting)
  • Iatrogenic – use excessive forces, intrusion, prolonged treatment time
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38
Q

Avoidance/management of

loss of periodontal support due to ortho

A

maintain high level of oral hygiene

avoid moving teeth out of alveolar bone

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39
Q

Avoidance/management of

demineralisation due to ortho

A

diet control, high level of oral hygiene, regular F exposure

abandon Tx

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40
Q

Avoidance/management of

enamel damage due to ortho

A

avoid potentially abrasive components e.g. ceramic brackets where there is a risk of occlusal contact

use of appropriate instruments and burs to remove appliances and adhesives

41
Q

Avoidance/management of

soft tissue damage due to ortho

A

avoid traumatic components

orthodontic wax or silicone to protect against ulceration

manage allergic reaction promptly

42
Q

Avoidance/management of

loss of vitality due to ortho

A

if history of previous trauma to incisors counsel pt

43
Q

2 extra oral problems due to ortho

A

worsening facial profile

soft tissue damage

44
Q

Avoidance/management of

worsening facial profile due to ortho

A

careful treatment planning and appropriate mechanics

45
Q

Avoidance/management of

soft tissue extra oral damage due to ortho

A

use of appropriate safety measures with headgear

manage allergy promptly

46
Q

ineffective ortho treatment risks

A

relapse

failure to achieve treatment objectives

47
Q

Avoidance/management of

ortho relapse

A

avoidance of unstable tooth positions at end of treatment

long term retention

48
Q

Avoidance/management of

failure to achieve ortho Tx objectives

A

thorough assessment and accurate diagnosis

effective treatment planning

appropriate use of appliances and mechanics

49
Q

reasons for failure to achieve ortho treatment objectives are:

A

Operator factors:

Patient factors: poor oral hygiene/diet, failure to wear appliances/elastics, repeated appliance breakages, failure to attend appointments, unexpected unfavourable growth

50
Q

operator factors for failure to achieve ortho treatment objectives (6)

A

error on diagnosis,

errors of treatment planning,

anchorage loss,

technique errors,

poor communication,

inadequate experience/training

51
Q

patient factors for failure to achieve ortho treatment objectives (5)

A

poor oral hygiene/diet,

failure to wear appliances/elastics,

repeated appliance breakages,

failure to attend appointments,

unexpected unfavourable growth

52
Q

3 key points when discussing orthodontic treatment needs

A

The decision whether to embark on orthodontic treatment is essentially a risk-benefit analysis

The perceived benefits of orthodontics intervention should outweigh any potential risks associated with treatment

Patients and families have an important role in determining whether treatment is likely to address issues caused by malocclusion

53
Q

which occlusion state is more important - functional or static

A

FUNCTIONAL
- Occlusion which is free on interferences of smooth gliding movements of mandible with no pathology

Orthodontic treatment should aim to achieve a functional occlusion

54
Q

aim for ortho Tx

A

FUNCTIONAL OCCLUSION

Occlusion which is free on interferences of smooth gliding movements of mandible with no pathology

55
Q

malocclusion is

A

not disease – variation around ideal

56
Q

classes of factors for aetiology of malocclusion

A

genetic or
environmental or

both

57
Q

3 things to consider their role in aetiology when planning ortho Tx

A
  1. Skeletal pattern – in all 3 places of space
  2. Soft tissue
  3. Dental factors
58
Q

why do we categorise ortho issues

A

salient features is helpful for describing and documenting a pts occlusion

  • Classification and indices allow prevalence in population to be determined
59
Q

qualitative assessment of malocclusion is

A

Descriptive – diagnostic classification of malocclusion

Occlusion is a continuous variable so that the clear cut off points between different categories does not always exist
- Issue in classifying borderline malocclusion

Helpful shorthand method of describing features

No help in indicating difficulty of Tx

E.g. British Standards Institutes classification of incisor relationship (1983)

60
Q

quatative assessment of malocclusion

A

has 2 approaches

Each feature of malocclusion is given a score and the summed total is then recorded (e.g. Peer Assessment Rating (PAR) index)

The worst feature of malocclusion is recorded (e.g. the index of orthodontic treatment need (IOTN))

61
Q

4 important attributes of an index

A

Validity – can the index measure what it is designed to measure

Reproducibility – does the index give the same result when recorded on 2 different occasions and by different examiners

Acceptability – is the index acceptable to both professional and pts

Ease of use – in the index easy to use

62
Q

angle’s classification

A

Based upon first permanent molar erupted in a constant position within the facial skeleton – used to assess the anterior posterior relationship of arches
- Incorrect assumption

Issue as well with forward dift or loss of FPM – thus superseded

But Still used to describe molar relationship

3 groupings

63
Q

3 groupings in angle’s classifcation

A

class I or neutrocclusion

class II or distoocclusion

class III or mesiocclusion

64
Q

angle’s

class I

A

neutrocclusion

The mesiobuccal cusp of the upper first molar occludes with the mesiobuccal groove of the lower first molar

65
Q

angle’s

class II

A

distooccclsuion

The mesiobuccal cusp of the lower first molar occludes distal to the Class I position

Postnormal relationship

66
Q

angle’s

class III

A

mesioocclsuion

The mesiobuccal cusp of the lower first molar occludes mesial to the Class I position

Prenormal relationship

67
Q

british standard institute classification

A

Based on incisor relationship

Most widley used descriptive classification

Similar terms to Angles – but not to do with molar relationship –

68
Q

british standard institute classification

groupings

A

class I

class II

  • division 1
  • division 2

class III

69
Q

british standard institute classification

class I

A

the lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incisors

70
Q

british standard institute classification

class II division 1

A

the lower incisor edges lie posterior to the cingulum plateau of the upper incisors
- the upper central incisors are proclined or of average inclination and there is an increase in overjet

71
Q

british standard institute classification

class II division 2

A

the lower incisor edges lie posterior to the cingulum plateau of the upper incisors
- the upper central incisors are retroclined. The over jet is minimal usually or may be increased

72
Q

british standard institute classification

class III

A

the lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or reversed

73
Q

IOTN

A

index of orthodontic treatment need

74
Q

IOTN Shows

A

Likely impact of malocclusion on individuals dental health and psychosocial well being

2 elements

75
Q

2 elements of IOTN

A

dental health component

aesthetic component

76
Q

dental health component of IOTN

A

Occlusal traits that could effect the function and longevity of dentition

Single worst feature of malocclusion is noted (index not cumulative) and categorised into one of the 5 grades reflecting need for treatment

  • Grade 1 – no need
  • Grade 2 – little need
  • Grade 3 – moderate need
  • Grade 4 – great need
  • Grade 5 – very great need

Rule developed to help assessment of dental health component

Since only single worst feature noted an alternative approach is to look consecutively for the following features (MOCDO)

  • Missing teeth
  • Overjet
  • Crossbite
  • Displacement (contact points)
  • Overbite
77
Q

dental health component of IOTN grades

A
  • Grade 1 – no need
  • Grade 2 – little need
  • Grade 3 – moderate need
  • Grade 4 – great need
  • Grade 5 – very great need
78
Q

dental health component of IOTN measures

A

Since only single worst feature noted an alternative approach is to look consecutively for the following features (MOCDO)

  • Missing teeth
  • Overjet
  • Crossbite
  • Displacement (contact points)
  • Overbite

NOT CUMULATIVE

79
Q

aesthetic component of IOTN

A

Thus the likely psychosocial impact upon pt

Set of 10 standard photographs, graded from score 1 (most aesthetically pleasing) to score 10 (least aesthetically pleasing)

  • Colour for assessing pt in clinical setting
  • Black and white for study models

Teeth in occlusion viewed from anterior aspect and appropriate score determined by choosing the photograph that is thought to pose equivalent aesthetic handicap

Scores categorised in need for treatment:

  • Score 1 or 2 – none
  • Score 3 or 4 – slight
  • Score 5, 6, or 7 – moderate/borderline
  • Score 8, 9 or 10 – definite
80
Q

aesthetic component of IOTN scores

A
  • Score 1 or 2 – none
  • Score 3 or 4 – slight
  • Score 5, 6, or 7 – moderate/borderline
  • Score 8, 9 or 10 – definite
81
Q

how is aesthetic component of IOTN measured

A

Set of 10 standard photographs, graded from score 1 (most aesthetically pleasing) to score 10 (least aesthetically pleasing)

  • Colour for assessing pt in clinical setting
  • Black and white for study models

Teeth in occlusion viewed from anterior aspect and appropriate score determined by choosing the photograph that is thought to pose equivalent aesthetic handicap

82
Q

IOTN score calculates

A

as average of dental health component and aesthetic component

83
Q

IOTN

grade 5

A

very great

84
Q

IOTN

grade 4

A

great

85
Q

IOTN

grade 3

A

moderate

86
Q

IOTN

grade 2

A

little

87
Q

IOTN

grade 1

A

none

88
Q

what component of IOTN is more widely used alone

A

Dental health component alone is more widely used

Aesthetic component is criticised for being subjective – esp Class III malocclusion or anterior open bites as photos are of Class I and II cases

89
Q

peer assessment rating PAR

A

Success of treatment

Before and end of treatment measures using study models

Scores cumulative (unlike IOTN), weighting is accorded to each component to reflect current opinion in UK as to their relative importance

  • Crowding – by contact point displacement (x1)
  • Buccal segment relationship – in the anterioposterior, vertical and transverse planes (x1)
  • Overjet (x6)
  • Overbite (x6)
  • Centrelines (x4)
90
Q

how is PAR calculated

A

Scores cumulative (unlike IOTN), weighting is accorded to each component to reflect current opinion in UK as to their relative importance

Difference between PAR scores at start and completion of treatment calculated
% change in PAR score reflects success of treatment
- High standard of treatment indicated with mean reduction of greater than 70%
- No appreciable improvement when 30% or less mean reduction

Size of PAR score at beginning gives indication of severity of malocclusion

Obviously hard to achieve a significant reduction in PAR score when there is a low pre-treatment score

91
Q

ICON

A

index of complexity, outcome and need

92
Q

ICON

A

incorporates features of IOTN and PAR

Following scored and multiplied by their weighting:

  • Aesthetic component of IOTN (x7)
  • Upper arch crowding/spacing (x5)
  • Crossbite (x5)
  • Overbite/open bite (x4)
  • Buccal segment relationship (x3)

Total sum gives a pre treatment score – reflects the need for and likely complexity of the treatment needed
- More than 43 is said to indicate a treatment needed

Index scored again after treatment to give an improvement grade (outcome of treatment)

Improvement grade = pre-treatment score – (4x post-treatment score)

Criticised for large weighting given to aesthetic component – not widely accepted

93
Q

ICON improvement grade =

A

= pre-treatment score – (4x post-treatment score)

94
Q

ICON scores

A

Following scored and multiplied by their weighting:

  • Aesthetic component of IOTN (x7)
  • Upper arch crowding/spacing (x5)
  • Crossbite (x5)
  • Overbite/open bite (x4)
  • Buccal segment relationship (x3)

Total sum gives a pre treatment score – reflects the need for and likely complexity of the treatment needed
- More than 43 is said to indicate a treatment needed

95
Q

IOFTN

A

index of orthognathic functional treatment need

96
Q

IOFTN

A

IOTN has limitation – severe malocclusions are not amenable to routed appliances alone
- This tries to address IOTN shortcomings

5 point scale - with Grade 5 – very great need need for Tx, Grade 1 – no need for Tx

97
Q

andrew’s 6 keys use

A

not method of classifying occlusion - serve as a goal

Occasionally end of Tx not possible to achieve a good Class I occlusion
- Look at 6 keys to evaluate why

98
Q

Andrew’s 6 Keys

A

Correct molar relationship

  • The mesiobuccal cusp of the upper first molars occludes with the groove between the mesiobuccal and middle buccal cusp of the lower first molar
  • The distobuccal cusp of the upper first molar contacts the mesiobuccal cusp of the lower second molar

Correct crown angulation
- All tooth crowns are angulated mesially

Correct crown inclination

  • Incisors are incline towards the buccal or labial surface
  • Buccal segment teeth are incline lingually, in the lower buccal segments this is progressive

No rotation

No spaces

Flat occlusal plane

BDS3 Orthodontics (13 decks)

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