Treatment planning Flashcards
What are some different causes of an ulcer?
Traumatic ulcer, ROU, shetts, stephen johnston, viral, primary or recurrent stomatitis, crohns.
What are the important steps to diagnosing an orthodontic problem?
Description of the malocclusion
e.g. class II div I incisor relationship
Determine the causes of the malocclusion
small teeth = spacing,
early loss of deciduous teeth = crowding
digit sucking = proclination and increased OJ
Are the causes dentoalveolar or skeletal?
What does IOTN stand for?
Index of orthodontic treatment need.
What does PAR stand for?
Peer assessment rating.
What radiograph is used to diagnose orthodontic problems?
Lateral Cephalogram -AP skeletal -Vertical skeletal -Class III incisors Cephalometry.
Why is correct orthodontic diagnosis important?
Orthodontic appliances can move teeth very well, but can modify skeletal relationship minimally.
A severe skeletal discrepancy may require surgical intervention.
What are the general principles for orthodontic diagnosis and treatment planning?
History: co/PMH/PDH/SH Examination: extra and intra oral Diff. diagnosis: list of probables Special tests: sm’s/rads/photo’s/3D Diagnosis: description/IOTN Treatment plan Treatment: accept/appliances Outcome: PAR index.
What are the three main objectives of orthodontic treatment?
Stable
Functional
Aesthetic
and to facilitate other forms of dentistry (crowns, bridges).
What different factors go into a patient’s treatment plan?
Stability Retention Patients soft tissue profile Aetiology of malocclusion Future growth changes Patients wishes Access to treatment Compliance Space requirements Aims of treatment Prognosis of individual teeth.
What are the aims of treatment for full correction of malocclusion?
Class I incisor relationship (OJ/OB normal)
Class I canine relationship
Class I molar relationship (can accept class II)
No rotations, spaces, flat occlusal plane (Andrew’s
six keys).
What are the aims of treatment for compromised treatment of malocclusion?
Correct certain aspects accepting others
(e.g. accept buccal crossbite with no displacement)
may have to work within adverse skeletal pattern and leave residual OJ particularly in adults.
What are the stages of treatment planning?
- Plan around the lower arch (angulation of LLS is stable)
- Decide on treatment in lower (ext/nonext)
- Build upper arch around lower
Aim for class I incisor and canine relationship (OJ and OB normal*) - Decide on molar relationship
Class I or full unit class II molar relationship
* (if upper and lower incisors normal size, shape and number)
What do you look for when examining the lower arch?
Crowding
Angulation of incisors and plane
Curve of spee.
What do you look for when examining the upper arch?
Crowding
Angulation of incisors to the maxillary plane
Angulation of the canines/centrelines.
When the teeth are in occlusion (ICP) what do we have to assess?
Incisor relationship OJ OB (curve of Spee) Centrelines Canine relationship Molar relationship.
What are the two ways of assessing crowding?
Measure space available and space required
Overlap technique.
How long does the treatment last to move the upper central incisor forward?
6 weeks.
*There is a few case studies on these slides but i cant insert pictures.
*
What is realistic dentistry?
Every patient is not treated as a shopping list.
When the patient has an overjet- what percentage is the mandibles fault?
80%.
How do you estimate the space available when assessing crowding?
Measure to see how much space you have there- divide arch into 4 sections (mesial of 6 to distal of 2, distal of 2 to centreline)
- measuring how much bone we have got there
- then measure width of every individual tooth
What instrument do you use to assess crowding measurements?
Callipers.
What is stripping?
Interproximal enamel reduction (take tiny bit of contact point of both teeth).
Why if you take out the lower 5’s for crowding you will have less space than when taking out the 4’s?
Take out lower 5’s- much less space because of mesial drift- 6 will come forward and take up space without taking up space- if you take out the 4 this mesial drift wont be as much
- only take out 5s if you have towards mild end of crowding
- severe- take out 5’s- wont have enough space- mesial drift and will still get crowding.
What teeth do you take out if you have severe crowding (8+mm)?
4’s.
What teeth or other procedure do you take do if you have mild crowding (0-4mm)?
Complete stripping
OR
Take out 5’s.
What teeth do you take out if you have moderate crowding (5-8mm)?
5mm- extract 5’s
5-8mm- extract 4’s.
If your doing a lower arch extraction what do you have to do to the upper arch?
Extract in upper arch (MR class 1).
If your not doing a lower arch extraction what do you do to the upper arch?
Extract in upper arch Distalise UBS using headgear (MR class 1).
If all the space from extractions will be used what do we need to do?
Reinforce anchorage.
What does PBR mean?
Permanent bonded retainer.
What are the disadvantages of a PBR?
Time consuming- don’t always work- wire can be bent over time if chewing hard foods- thermoplastic retainer might be better to wear in bed at night, unless spacing/rotations/lls crowding- will relapse so need fixed.
What do you need to consider when writing a treatment plan?
Diagnosis: orthodontic summary
Problem list: main points
Treatment plan
List successive stages stating tooth movements to be carried out and appliances to be used.
Estimate length of treatment.
If it is not possible to give a detailed plan,
indicate when it will be reviewed (ie following eruption of teeth).
What are the different treatment options in orthodontics?
- Accept malocclusion
- Extractions only
- URA
- Functional appliances +/- extractions
- Fixed appliances
- Complex treatment involving orthodontics and restorative treatment or orthodontics and orthognathic surgery.
What are the limitations of orthodontic treatment?
Effects of orthodontic treatment are almost purely dento-alveolar and tooth movement, with little effect on the skeletal pattern
Tooth movements are limited by the shape and size of the alveolar processes
Teeth will only remain stable in a position where there is equilibrium between the forces of the soft tissues, the occlusion and the periodontal structures. All other positions are unstable and will be prone to relapse.
Who will do simple orthodontic treatment?
Simple treatment may be carried out by the general dental practitioner (relatively straightforward and can be managed by an URA).
Who will do complex orthodontic treatment?
Complex treatment requires the skill of a specialist practitioner or a hospital specialist.
How should orthodontic treatment be timed?
Some treatments rely on growth for success and should be used during the adolescent growth spurt for maximal effect (eg overbite reduction, functional appliance therapy).
What are temporary anchorage devices?
Screws into bone- pulls on that- puts anchorage balance on your side.
How long should treatment last with an extraction?
24 months.
How long should treatment last without an extraction?
18 months.
How long should treatment last when canines are removed from the palate?
2 and a half years.
What is the right appliance for patients with a buccally placed canine and have poor oral hygiene?
Buccal canine retractor.
