Treatment Plans

Question 1

What is phase one treatment

Answer 1

Treatment in mixed dentition

Limited goals duration one year retention may be required second round may be required

Question 2

Why phase I treatment

Answer 2

Some problems can worsen if untreated
Reduce duration of treatment after wards
Some results may be not achievable oncejaw stops growing or teeth erupt

Question 3

Phase l for class 3 patients treatment

Answer 3

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

Question 4

Phase I treatment in class 11 patients.

Answer 4

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

Question 5

What to do for constricted maxilla when and how

Answer 5

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

Question 6

What are two types of functional shifts. And why bad

Answer 6

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

Question 7

When to intervene functional shifts

Answer 7

ASAP
It its primary canines- maybe just equilibration
If its localised displaced, just more affected teeth
It due to skeletal maxillary constriction then expand

Question 8

Deep over bite due to over eruption what to do

Answer 8

Give 2x4 appliance but difficult cos you might get reciprocal lateral incisor growth

Question 9

How to correct dental anterior cross bite

Answer 9

Removable 2 springs
Banded maxillary lingual arch with finger springs

Partial fixed appliance (prefered)

Question 10

What to do for skeletal open bite

Answer 10

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

Question 11

Dental open bite how

Answer 11

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

Question 12

What treat AOB

Answer 12

Improve ability to incise
Possible resolution of speech issues
Esthetician

Question 13

Should you intervene for mild crowding

How to intervene

Answer 13

No unless parents concerned about esthetics
Does not improve stability

Options:
disking or primary
Dental arch expansion
Fix Ed appliance

Question 14

How to correct moderate to severe crowding

Answer 14

Expander, arch wire, lip bumper (lower lip may push it back after appliance is removed), lingual loop,

Distalize molars with head gear, pendulum appliance

Question 15

When to do serial extractions

Answer 15

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

Question 16

When and y to maxillary canines investigate

Answer 16

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

Question 17

When to care about 6s

Answer 17

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

Question 18

What to do with excess spacing

Answer 18

Don’t intervene unless patient thinks is severe esthetic problem

Next time can do opening space for prosthetic replacement, ortho space closure

Question 19

What about midline diastema

Answer 19

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

Question 20

What to do about missing 5s

Answer 20

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

Question 21

What to do about missing 2s

Answer 21

Extract primary lateral and encourage canine to erupt in the lateral incisor no matter if you wanna crease space or canine replace lateral

Question 22

Do you intervene when premature loss of primary teeth

Answer 22

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

Question 23

What happens if Cs are prematurely lost and what to do

Answer 23

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

Question 24

What to do is Es are lost

Answer 24

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

Question 25

When to do ortho surgery before growth ends

Answer 25

Progressivedeformity from growth restriction eg. TMJ ankylosis after trauma or infection

Severe psychosocial issues

Question 26

Types of brackets

Answer 26

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)

Question 27

Timeline of ortho treatment

Answer 27

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

Question 28

Staging of ortho

Answer 28

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)

Question 29

Camouflage or surgery

Answer 29

Severity of jaw discrepancy decision made before commencing treatment

Question 30

Which teeth to extract

Answer 30

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

Question 31

Treatment planning for class 3

Answer 31

Consider if mandibular growth is complete
Thin mandibular symphysis
Chin prominence

Question 32

Procedure for posterior cross bite

Answer 32

Consider surgically assisted rapid palatial expansion (le fort expansion)
Cos surgical expansion high chance of relapse