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Ortho Part B > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What is the most common cause of posterior cross bite? What are the other causes?

A

Most common: mandibular shift (CR->CO), dental interference uncomfortable so Px shifts to cross bite

Rare: true skeletal asymmetry - midface asymmetry, growth deficiency due to trauma, etc

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2
Q

How does your treatment for posterior cross bite differ between preadolescents and adolescents?

A

Preadolescents: lingual arch or quad helix (light forces)

Adolescents/Adults: Rapid Palatal Expansion or Slow Palatal Expansion (heavy forces)

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3
Q

How frequently do you turn RPE’s and SPE’s During treatment?

How long do you need to keep the device in for retention?

A

RPE: 1-2 turns per day for 2-4 weeks

SPE: 1 turn every other day for 4-8 weeks

Retention: 3 months

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4
Q

What problems are associated with RPE/SPE treatment?

A

Pain
Soft tissue irritation
Maxillary diastema
Device breakage/debonding

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5
Q

How much change can be attributed to skeletal and dental change in heavy force and light force treatment of posterior cross bite?

A

Both treatment options are 50 skeletal / 50 dental

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6
Q

What are common etiologies of posterior cross bite?

A

Retained primary teeth

Crowding/tipped teeth

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7
Q

What are the three types of posterior DENTAL crossbite and their associated treatment?

A

Bilateral Maxillary Constriction -> bilateral maxillary Expansion

Unilateral Maxillary Constriction -> Asymmetric Maxillary Expansion

Maxillary/Mandibular Lingual Dental Displacement -> Dental Movement with Cross Elastics

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8
Q

Should you use CO or CR to determine the symmetry of a posterior cross bite?

A

Symmetry of constriction should be based on CR.

CO shift can make it look asymmetric

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9
Q

What are the benefits of Posterior Dental Cross bite correction?

A

90% success rate
Improves premolars position (if moving primary teeth)
Eliminates CO-CR shift which reduces abrasion
Increase Arch perimeter

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10
Q

When would you use a W Arch vs a Quad helix?

A

Uses both in pediatric posterior cross bite cases.

Quad helix can also help with a thumb habit. Px have a tendency to bend the wire.

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11
Q

Attributes of Quad Helix and W Arch

A

Attributes: reciprocal anchorage, thick stainless steel, increased flexibility due to length of wire.

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12
Q

What forces are generated by cross elastics?

A

Tipping (correction of cross bite) and extrusion (may cause open bite)

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13
Q

How do you achieve retention with cross elastics?

A

You don’t. You overcorrect and let the teeth drift back to ideal.

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14
Q

What type of anterior cross bite should a general practitioner consider treating? Which should he refer?

A

Class 1 Skeletal, class III molar with a nagative overjet

General Practitioners should not try to treat skeletal class III issues.

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15
Q

What are possible etiologies of Dental anterior cross bites?

A 
Ectopic eruption/tooth bud placement
Supernumerary/retained teeth that deflect others out of position
Trauma
Crowding
Thumb sucking
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16
Q

What is a Psuedo Class III anterior cross bite?

A

A CR-CO shift from Class I into Class III to avoid discomfort/malocclusion.

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17
Q

Crowding in the maxillary anteriors is directing a lateral to erupt towards cross bite. What is a possible treatment?

A

Extract adjacent canine to make room, tooth will likely self correct out of cross bite if done early enough.

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18
Q

When would a Maxillary Removable Double Helical Cantilever device be indicated?

What are it’s characteristics?

A

For correcting a dental class III with retrusive Upper incisors.

Stainless steel round wire with good springiness with a double helix for increased range and decreased stiffness. Held in an acrylic retainer with Adams clasps for retention. No labial bow-the would impede the desired facial movement.

Puts force on the lingual of the incisors coronal to CRes to create an uncontrolled tipping that corrects the retrusion. No bite plate required.

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19
Q

What is uncontrolled tipping?

A

When the root tip and the crown are rotating opposite directions.

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20
Q

How long is Tx with a removable maxillary double helix cantilever device and how long for retention?

A

1-3 months for Tx.

Activate for 2mm -> gives you 1 mm in 1 month.

Retention for several months (inactivated)

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21
Q

Common problems with the Maxillary Double Helix Cantelever Tx

A

Not activated properly
Not enough retention
Patient compliance

22
Q

Patient has malrotated retruded incisors in a dental class III relationship. What device is indicated?

A

Fixed Appliance with round wire is required because rotation and tipping is required.

NiTi wire will help with initial alignment. (Short segmental wire across the anteriors)

Once generally aligned, a thicker wire is run from banded molars across the entire arch for AP correction. Retainer after treatment would be wise.

Adjustments every 4-6 weeks

23
Q

If patient in dental class III needs bodily movement, what appliance is indicated?

A

Fixed appliance with rectangular wire

Unless the bodily movement is mesial-distal : round wire can do that too

24
Q

What % of the population had an anterior cross bite?

A

Less than 5%

25
Q

What % of the population has vertical problems?

Open bite:

Deep bite:

Ethnic considerations?

A

Open bite: 10% (more in African Americans)

Deep Bite: 5% (more in whites)

26
Q

At what point in the course of treatment would you recognize a vertical problem?

A

During the Facial Form Analysis.

27
Q

What is considered normal Incisal display with a posed smile?

A

Lip coming up just below the CEJ. Up to 3 mm of gingival display is considered acceptable.

28
Q

What cephalometric measurements/angles would indicate a long face?

A

An wider than usual mandibular place angle (formed by Frankfort Horizontal and Mandibular Plane

% face height: middle and lower thirds should be roughly equal. If lower third is more than long face is likely

Y axis: wider than normal (angle formed by Frankfort Horizontal plane and Sella-Gonian line)

29
Q

What is the difference between a Simple and Complex anterior open bite?

A

Simple: just canine to canine. Occurs naturally in transition from primary to permanent teeth. Will resolve without treatment during adolescence.

Complex: includes the posteriors as well. Usually due to a skeletal problem. Fails to close during adolescence.

30
Q

How to treat dental anterior open bite in a patient with little incisal display

A

Erupt the anteriors with anterior elastics.

31
Q

How to treat a patient with anterior open bite and a gummy smile

A

Intrude the posteriors with high pull headgear

32
Q

Three methods of correcting a dental deep bite

A

Posterior Eruption: place an anterior bite plate in to allow posteriors to erupt

Leveling the Curve of Spee: reverse curve of spee archwire will erupt the middle section.

Intruding the Anterior Teeth: via upper or lower intrusion Arches.

33
Q

What is a side effect of extracting ankylosed tooth with out successors late?

A

There will be a massive vertical defect and attachment loss of adjacent teeth. Consider early extraction if ankylosed teeth.

34
Q

What are the three basic infant reflexes?

A

Rooting
Placing
Sucking

35
Q

What type of vertical problem is associated with oral habits?

A

Dental Anterior Open Bite

36
Q

Compare Infantile Swallowing to Adult Swallowing

A

Infant:
Tongue to the lower lip
Lips together
Jaws apart

Adult:
tongue to the palate
Teeth together
Lips Relaxed

37
Q

What is disrupted when nonnutritive sucking (thumb sucking) has too much intensity, duration, or frequency?

What type of force is this an example of?

A

The Equilibrium Theory (equal pressures from the lips and the tongue, leading to migration towards an open bite.

This is an example of light forces moving teeth.

38
Q

What are the directions of the forces produced by thumb sucking and what type of malocclusion does it result in?

A

Protrusion of Uppers and Retrusion if Lowers, leads to overjet

Intrusion/inhibited eruption of all anteriors leads to anterior open bite.

Sucking force from buccinator forms constriction, creates a posterior crossbite.

39
Q

When should counseling be considered for thumb habit, and what should be emphasized?

A

For older children.

Focus on the dental effects and stress maturity.

40
Q

What are adjunctive treatments for thumb sucking?

A

Elastic Bandage: fit around the arm at night to restrict arm from bending.

Fixed Appliance: band the molars, run an 036 wire to obstruct sucking space. Quad helix should be considered in posterior crossbite is present as well.

41
Q

Is it common to see a replacement habit arise after cessation of a thumb sucking habit.

A

No.

42
Q

best practices for successful reminder appliances (thumb sucking)

A 
Not a punishment, just a reminder
Maintain after 6 months after termination of habit 
Ensure good retention
Must occupy the right part of the mouth 
Patient comfort is critical
43
Q

Can you tip teeth with bands and bonds?

A

Yes. Round wires would do this.

44
Q

Can you rotate teeth with removable appliances?

A

No. Fixed appliances are required for rotation.

45
Q

Can you move teeth bodily with a removable appliance?

A

No, Fixed appliances are required for bodily movement.

46
Q

Who would you treat earlier for class III correction? Male or female?

A

Female. They stop growing earlier, and you don’t want to correct a class III till after the mandible stops growing.

47
Q

Generally speaking, how many millimeters of crowding do you need to consider extractions?

A

5mm

48
Q

What is a decoronation?

A

When you have an ankylosed tooth and the occlusion is poor, you can cut the crown off the tooth 2mm below the alveolar ridge and leave the root in to prevent ridge resorption.

49
Q

What are tongue cribs used to correct?

A

Thumb sucking habit.

50
Q

What are you treatment options for an ankylosed tooth?

A

1) If occlusion is fine, retain.
2) If poor/causing problems, extract sooner than later.
3) Decoronation.

Ortho Part B (5 decks)

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