W8 - Orthodontic Referrals - Abdalla Flashcards
5 things you should be looking for in an ortho patients medical history
Craniofacial syndromes
Chronic upper airway obstruction
Allergies
Previous facial trauma
High doses of prostaglandin inhibitors or bone resorption inhibitor meds for osteoporosis or arthritis → will affect ortho tooth movement
What type of questions should you ask ortho pts when first meeting (2)
Open ended questions so they can answer in their own words
- Tell me about your concerns
- What brings you in today
What to look for in a frontal examination of pt (3)
Symmetry
Vertical and transverse facial proportions
Tooth display
What to look for in a frontal examination of pt (3)
Symmetry
Vertical and transverse facial proportions
Tooth display
What structures should the facial midline run through (4)
Glabella
Subnasale
Philtrum
Midline of chin
What causes dental midline shift (4)
Spaces
Rotations
Missing teeth
Incorrect tooth proportion
Ideal anterior tooth display on smile
100% incisal display and up to 2mm of gingiva (for adolescents)
What is this and tx
Vertical maxillary excess
- Orthognathic surgery
Whats wrong with this smile?
Posterior maxillary excess
- would require surgery if she wanted to correct it
- posterior excess will not affect her occlusion
Whats wrong with this smile?
Posterior maxillary excess
- would require surgery if she wanted to correct it
- posterior excess will not affect her occlusion
Whats wrong with this smile
Posteiror maxillary excess
Smile arc does not follow lower lip curvature
How to fix wide buccal corridor (2)
Maxillary expansion device in kids
SARPE / surgery in adults
What are the goals of of profile analysis
To establish whether the jaws are positioned correctly in the AP plane
Evaluate mandibular plane angle, lip posture and incisor prominence
Re evaluate facial proportions from frontal view
What must be done for a correct profile analysis
Natural head position
- Pt stand and look at distant object
- Pt standing and look at mirror positioned at face height
Limitation of angles classification of occlusion
Only checks the molar relationship
Ex. this case is considered a class 1 or slightly class 3, even though incisor relationship is class 2 div 1
What is the angles classification of this occlusion?
past exam question
Class 1
BSI incisor classification
What is the problem with grinding and worn teeth leading to overeruption? Treatment?
As teeth overerupt, gingival margins move down as well → unaesthetic
Need to intrude the teeth to correct gingival margins and make space for restorations
Whats wrong
Class 2 div 2
Impacted canine
Whats wrong (2) + tx
VME, deepbite
11 gingival margin is uneven
- Intrusion of upper incisors and restorative work for short tooth
whats wrong (6) + tx
Midline shift
Lateral open bite
LHS crossbite
Edge to edge molar relationship
Avulsed 11
Lack of space
Tx: create space → RME, braces, maryland bridge
What must be included in referral letters (5)
Any special problems with child (medical & social)
Problems with dental treatment
Radiographs
Your treatment plan
Contact details
Why did they place a 2-winged maryland bridge on this kid?
After ortho tx, the roots are in the right position
- roots would likely converge (esp pon lateral) in the years to come
- Tx plan is to get an implant when old enough → if roots converge, pt would need to redo ortho prior to implant
- Ortho and dentist agreed that a double wing maryland will help ensure the space is maintained until implant can be placed
What can be done here
Orthodontic intrusion of 16
- Makes space for opposing restoration
- Must make sure tooth is not periodontally involved / indicated for exo
