Treatment Plans Flashcards
What is phase one treatment
Treatment in mixed dentition
Limited goals duration one year retention may be required second round may be required
Why phase I treatment
Some problems can worsen if untreated
Reduce duration of treatment after wards
Some results may be not achievable oncejaw stops growing or teeth erupt
Phase l for class 3 patients treatment
Maxillary retrusion- reverse pull head gear_ ideally age 810, consider teeth anchored or bone anchored
Early intervention is good: orthopedic changes greater in shorter duration early functional improves avoid anterior open bite causing gingival recession of lower incisors and Incisal wear _
If ethology is mandibular prognathia,more difficult to control chin cup needs to be work from age7 21
Phase I treatment in class 11 patients.
Starting early treatment before growth spurt and during is effective do only if you have overset of more than 8mm
Deep overbite and signs of soft tissue trauma
Use head gear for maxilla, removable bite plate for deep bite (good to do during growth spurt)
Use twin block or fixed appliance for mandibular retronagthia
What to do for constricted maxilla when and how
As early as possible cos traumatic occasion, catch the mid palatial suture
Eliminate the functional shift,increase arch parameter reduce attrition avoid surgical expansion,avoid gingival recession during comprehensive theathent
Maxillary expansionwith removable expander or fixed: quad helix w arch for younger patients, hyrax expander for adolescent
After growth expansion wait 3 months before putting on braces for bone to grow
Re-evaluate maybe still need surgery oh well
What are two types of functional shifts. And why bad
Anterior posterior causing pseudo class 3 lateral causing unilateral cross bite or facial asymmetry Cr - mi slide causing traumatic occlusion and gingival recession
- to prevent adaptive remodeling that result in prognathia or skeletal asymmetry, later correction may require surgery, dento alveolar compensation results in dental asymmetry
When to intervene functional shifts
ASAP
It its primary canines- maybe just equilibration
If its localised displaced, just more affected teeth
It due to skeletal maxillary constriction then expand
Deep over bite due to over eruption what to do
Give 2x4 appliance but difficult cos you might get reciprocal lateral incisor growth
How to correct dental anterior cross bite
Removable 2 springs
Banded maxillary lingual arch with finger springs
Partial fixed appliance (prefered)
What to do for skeletal open bite
Control vertical growth of maxilla
Restrict posterior tooth eruption (Control posterior vertical growth for mandible to grow upwards and forward)
Use high pull head gear,
Maxillary splint to prevent eruption
Bite block to fit over posterior teeth to prevent eruption
Manage mild to moderate problems towards end of growth spurt if not you get super long treatment
Dental open bite how
Stop habit of forward resting tongue or thumb sucking. before full eruption will allow spontaneous resolution,
Habit appliance only useful if child wants to stop the habit eg. tongue crib, bonded tongue spurs, blue grass appliance
Sectional fixed appliance or expander to correct posterior cross bite
What treat AOB
Improve ability to incise
Possible resolution of speech issues
Esthetician
Should you intervene for mild crowding
How to intervene
No unless parents concerned about esthetics
Does not improve stability
Options:
disking or primary
Dental arch expansion
Fix Ed appliance
How to correct moderate to severe crowding
Expander, arch wire, lip bumper (lower lip may push it back after appliance is removed), lingual loop,
Distalize molars with head gear, pendulum appliance
When to do serial extractions
For crowding of >10mm in skeletal class 1 patients (not sure how jaws will grow afterwards)
timed extraction of teeth to reduce severe crowding during transition
Aske ortho to do don’t anyhow extract hor
When and y to maxillary canines investigate
If by ten the primary not mobiles no observable or palpable facial canine bulge then take X ray
Risk ot root resorption of incisors
Check root development, if already more than half formed then intervene
If roots of incense already resorb then you either start tracking h the e canine or extract
If you remove primary canine before age 11 you can correct palatally exotic canines of the canine crown is distal to mid line of lateral
When to care about 6s
Monitor for self correction for 6 months, if still impacted then use separator or soldered spring
After extracting primary tooth use distal shoe, space regainer, space maintainer, premolar extraction
What to do with excess spacing
Don’t intervene unless patient thinks is severe esthetic problem
Next time can do opening space for prosthetic replacement, ortho space closure
What about midline diastema
Some close spontaneously with eruption of maxillary canines
If it’s <2mm, can use removable
Is more than that check for supernumerary, intrabony lesions, missing 2s, frenum, unlikely to close spontaneously, consider fixed appliance
What to do about missing 5s
Maintain Es if got root form till right age for prosthetic replacement
Extract Es at age 7-9 and allow medial drift of 6s when 6 not yet fully developed
Autotrasplantation
What to do about missing 2s
Extract primary lateral and encourage canine to erupt in the lateral incisor no matter if you wanna crease space or canine replace lateral
Do you intervene when premature loss of primary teeth
As and Bs not so big issue cos they usually got space
Cs gg cos lingual collapse of arch and or midline shift towards site of missing tooth (
Ds not big deal
Es medial tipping drifting of 6s
What happens if Cs are prematurely lost and what to do
Midline drift, space for eruption of perm, preserve arch symmetry
Intervene with lingual arch to prevent lingual drift
Add spur to prevent distal drift
If space alr lost, use fixed appliance to recreate space
Balancing extractions are questionable
What to do is Es are lost
Space maintainer if there’s more than 6 months before perm tooth eruption
Can be unilateral band and loop or bilateral: nance (upper) lower lingual holding arch
But if space lost alr then can try to regain space but refer to ortho first to see if got crowding then change treatment plan
When to do ortho surgery before growth ends
Progressivedeformity from growth restriction eg. TMJ ankylosis after trauma or infection
Severe psychosocial issues
Types of brackets
Conventional
Self ligating
Ceramic brackets (not suitable for lower teeth in case ceramic attrits upper incisors)
Lingual appliance (technically challenging)
Clear aligners (aesthetic, ease of hygiene, less dietary restriction, longer appt intervals, but compliance dependent, certain tooth movements challenging, lab based cost, less flexibility)
Timeline of ortho treatment
Multidisciplinary treatment:
Disease control: provisionalisation, prophylactic gingival graft, perio, avoid osseous surgery
During: regular check ups and SAP, debone only after confirmation with other providers
After: definitive resto
Staging of ortho
Alignment and leveling: curve of spee curve of Wilson
Space closure and AP/vertical/transverse: elastics useful
Finishing: detailing interdigitation, mild rotation
If surgery case:
Conventional: remove DAC, then maximise surgical correction, post surgical ortho (less guess work, if patient need both jaws surgery, severe crowding require extraction, initial models cannot get stable bite)
More recent: surgery first then braces (patients w minimal crowding already, shorter treatment time, patient don’t need to go through phase of shittier aesthetics)
Camouflage or surgery
Severity of jaw discrepancy decision made before commencing treatment
Which teeth to extract
Class 2: upper 4 plus lower 5 or upper 4 only
Open bite: 5s
Class 3: lower 4 upper 5, lower 4 only
Midline discrepancy: where you need space
Treatment planning for class 3
Consider if mandibular growth is complete
Thin mandibular symphysis
Chin prominence
Procedure for posterior cross bite
Consider surgically assisted rapid palatial expansion (le fort expansion)
Cos surgical expansion high chance of relapse
