Week 12 PP Flashcards
What does Orthodontics involve?
-Diagnosing
-Preventing
-Treating
.. the occlusal relationship of the teeth for optimum function & esthetics
What can Orthodontics treat?
-Straightens teeth (rotated, tilted or improperly aligned teeth)
-Corrects crowding/unevenly spaced teeth
-Corrects bite problems
-Aligns upper and lower jaws
How to Become a Orthodontist
-Undergraduate Degree (4 years - Bachelor of Sciences)
-Complete Dental Admission Test
-Four Years of Dental School to become a general dentist
-Complete an advanced ortho program (2-5 years Masters Degree)
-Write the National Dental Specialty Board Cert Exam
General Goal of Orthodontics
The timely diagnosis, prevention and correction (within patient’s limitations) of dental, jaw, and muscular irregularities that are responsible for the patient’s malocclusion
The 7 Specific Goals of Orthodontics
- Advising patients of preventable etiologic agents of malocclusion (bad oral habbits like thumb sucking, tounge thrust)
- Aligning teeth
- Aligning facial skeletal structures
- Improving dental and facial esthetics
- Improving dental function
- Improving comfort during dental fuction
- Improving long tern detnal and periodontal health
The Role of the DA in Orthodontics
Assist with orthodontic procedures performed in a general practice … or become an orthodontic assistant
How to become an Orthodontic Assistant?
in AB, to become an ortho assistant a post grad continuing education module is available
-provides participation with the knowledge and information required to reach a satisfactory level of competency in clinical orthodontics
-empahsis is placed on clinical procedures, obtaining diagnostic records, and patient care procedures
What can Orthodontic Assistants Do?
- place and remove orthodontic separators
- select, fit and cement orthodontic bands
- insert orthodontic appliances
- place and bond orthodontic brackets and bondable attachments
- insert, ligate and remove orthodontic archwires, which were formed by a dentist, using individual elastomeric ligatures, chain elastomeric ligatures, wire ligature ties (separate and continuous) and selfligation mechanisms
- trim and or bend distal ends of orthodontic archwires
- place and remove orthodontic accessories
- remove orthodontic bands, brackets and bondable attachments
Orthodontic treatment can prevent/repair:
-Psychosocial problems (self-esteem, self-worth)
-Oral Malfunction (occlusion)
-Dental disease (dental decay, periodontal disease)
First Step in Ortho Treatment
Initial Consult and Interview
-Medical History
-Physical growth evaluation
-Social & behavioural evaluation
-clinical evaluation
-evaluation of oral health
-evaluation of jaw & occlusal function
Orthodontic Clinical Examination
-Document, measure & evaluate the facial aspects, the occlusal relationship and the functional characteristics of the jaws
-at the intial (records) visit, the orthodontist will decide which diagnosit evaluations are required
-records are necessary for the orthodontitist to make a diagnosis and develop a treatment plan
Diagnostic Records: Photographs
- Taken using a neutral background
- All jewelry and glasses removed
- Ears should be exposed for orientation and eyes should be open and looking straight ahead
- Photos taken Extra-orally and Intra-orally
- Before/After treatment
- Cheek retractors and mirrors are used
-taken from all angles
-before/after
Intra-oral Photographs - how?
- Intra-oral camera
- Lip retractors are used
(DIPG page 458) - Intra-oral mirror
In ortho, the face is examined for:
- Bilateral symmetry
- Size proportion of midline to lateral structures
- Vertical proportionality
In ortho, The facial profile relationship is examined to..
The profile relationship is examined:
* To determine whether the jaws are proportionately positioned
* To evaluate lip protrusion
* To evaluate the vertical facial proportions and the mandibular plane angles
What do Craniofacial images include?
-Panoramic & Cephalometric Xrays
Panoramic Radiographs are used to diagnose..
-Eruption patterns
-Supernumerary teeth or congenitally missing teeth
-Impacted teeth
-Bone levels between teeth
-Root lengths and morphology
-Dental pathology
-TMJ Screening
-Tumors or cysts
-Evaluate root paralleling before band/bond removal (if roots are straight)
What is a Cephalometric Radiograph?
- Lateral side view or posteranterior (back to front view)
- Provide sufficient contrast of the teeth, skull and soft tissues of the mouth face and throat
- Analysis of hard and soft tissues
- Prediction of future growth patterns
- Prediction of treatment-induced changes
- A record of growth and treatment changes
GROWTH PATTERNS **
Computed Tompgraphy (CT)
- Can provide state-of-the-art images for comprehensive orthodontic treatment with minimal increase in radiation dose
- Orthodontist can gain specific information like:
- Accurate measurements
- Localization of impacted teeth
- Asymmetry
- Periodontal structures
- Placement sites for anchorage devices
- Views of condylar joint and TMJ
Why are Impressions taken for orthodontics?
(Alginate impressions and plaster/stone, or 3D scan)
Used as diagnostic tool, for treatment progression, comparision and permanent record of completion of treatment
Ortho Case Presentation
Diagnosis & Treatment Plan
1. The orthodontist will use the diagnostic records
*Determines treatment best suited to the patient’s needs
2. The patient is provided with treatment options
3. Patient chooses a treatment
4. Contract and financial agreement is signed
What 2 documents must the patient sign?
Informed Consent - must be signed by patient or patient guardian
Financial Contract - agreement for costs
Types of Orthodontic Treatment
- Preventive
- Interceptive
- Corrective
What is Preventive Orthodontics?
-Preventing orthodontic problems from occuring
-correcting habbits (like sucking thumb)
-maintaining space
What is Interceptive Orthodontic Treatment?
-Treatment manipulates growth & development
-corrects cross-bite before full development
-creates space for natural elimination of crowding
What is Corrective Orthodontic Treatment?
-Use of fixed or removable orthodontic appliances to correct existing malocclusion
-Braces
-Appliances
-Orthognathic surgery
What is Discing (Preventive Ortho) ?
Discing can gain valuable space even with permanent dentition
IPR/Sandpaper in between teeth - “interproximal reduction” - shave down a little bit of space inbetween all teeth and “gain” some mm. Can straighten out teeth.
What are Space Maintainers (Preventive Ortho)?
-Save space for unerupted teeth
-Hawley space maintainer (passive oral appliance)
-Band & Loop space maintainer (passive or non-functional oral appliance)
-Lower lingual archwire (passive appliance commonly used as a psace maintainer in the lower arch)
What is a Distal Shoe Space Maintainer?
- Purpose: placed when 2nd primary molar is lost before 1st permanent molar erupts
- Guides permanent 1st molar into correct position
When are Bands required?
Bands are not needed for every case - up to the orthodontics. IF they want bands, separators must be placed.
What are some examples of Interceptive Orthodtonics?
- Removal of supernumerary teeth
- Elimination of habits
- Crossbite correction- to normalize occlusal function
- Serial extractions
- Extraction of permanent teeth bilaterally
- Why? Creates space for natural elimination of crowding
- Which teeth? Usually first bicuspids
- Growth manipulation
- With fixed or removable appliances
- Why? Creates space for natural elimination of crowding
(arch expansion)
What is the purpose of expansion appliances
If you have a narrow arch, you are unable to accomodate the teeth.. without correction using this appliaance crowding will be inevitable
orthodontic appliances create pressure which stimulates osteoblasts to build bone in the desired direction in the mandible or maxilla
Interceptive Orthodontics: Expansion Appliances
Max or Mand screw type devices
Maxillary - on palate - spreads mid-palatal suture
Mandible - expands the teeth and bone as there is no suture to open
What is Corrective Orthodontics?
- Use of removable appliances or full fixed
orthodontics - Depends on the severity and the desired result
Sequence of Appointments for Corrective Orthodontics
- Placement of separators
- Cementation of molar bands
- Bonding of brackets
- Insertion of arch wire and tying in with ligature ties
or elastomeric ties - Adjustment check - On a set schedule (1-3-6 month
intervals) - Removal of braces (or other appliances)
- Retention of teeth
What is the purpose of Separators?
Slightly separates the teeth that require orthodontic bands
tight interproximal contacts can make it difficult to properly seat and fit a band; therefore, the teeth must be seprated before fitting bands. A separator is used for this purpose
What are the 3 parts of a Molar Band?
-Band
-Tubing
-Hook
What are Orthodontic Bands?
Orthodontic bands are preformed stainless steel bands fitted around the
teeth and cemented into place to provide an anchor to the arch wire.
Bands are placed on the first and second molars and are designed
specifically for maxillary and mandibular, and right and left, to
compensate for individual tooth anatomy. The occlusal edge of the band
is slightly rolled or contoured, whereas the gingival edge is straight and
smooth
What is a Bonded Bracket?
The bonded bracket is a small attachment used to fasten an arch wire to each tooth. This stabilization of the arch wire promotes tooth movement by the forces from the arch wire transmitted to the tooth.
What is an Archwire?
The arch wire is a critical component of fixed orthodontics. It serves as the pattern from which the dental arch will take its shape. When the arch wire is placed into the slots of each bracket and secured, a force is created that guides the teeth in a specific movement.
Ligating the Archwire
After the arch wire has been positioned in each bracket, it must be ligated to be held in place.
What are Ligature Ties?
Ligature ties are 0.01-gauge stainless steel wires that are
used to hold the arch wire in place. There are two unique
ways to tie a ligature; it can be an individual tooth, or a
quadrant or several teeth tied with one ligature, creating a
figure eight to form a chain. With either application, the
operator begins from the most posterior tooth and works
toward the midline
What are Elastomeric ties?
Made from a rubber-like material that is stretched around the bracket to hold the arch wire in place
What are self-ligating brackets?
- Self-ligating brackets have a built-in mechanism in the
bracket to hold the arch wire in place without the use of a
ligature tie or elastomeric tie
What are Power Products
Additional products you can attach to archwires/brackets to assist with tooth movement
Accessory items made of elastic materials help in tooth movement
What does a Power Chain Do?
Closes gaps/spaces between teeth - made of elastic.. looks like a chain going around each bracket
What are Traditional Braces?
Braces are a combo of bands, brackets, arch wires
and auxiliaries that can move a tooth in six
directions: mesially, distally, lingually, facially, apically
and occlusally
What happens at an Adjustment Visit?
-Review the patients progress & make adjustments as necessary (every 3-8 weeks)
At each adjustment appointment, it is the responsibility
of the chairside assistant to check the patient’s appliance
to determine whether any of the following exist:
* Broken or missing arch wires
* Loose brackets and bands
* Loose, broken, or missing ligatures
* Loose, broken, or missing elastics
When a patient has completed ortho treatment?
When a patient has completed the treatment phase of orthodontics, the wires, bands, and bonded attachments are removed.
Retention is necessary for the following reasons:
- To allow gingival and periodontal tissues the required time for reorganization
-To support the teeth that are in an unstable position, so pressure of the cheeks and the tongue does not cause a relapse
-To control change caused by growth
What is an Active Oral Appliance?
Applies force to change the relationship of teeth
What is a Passive Oral Appliance?
To hold teeth in postion (does not move teeth)
What are Functional Oral Appliances?
Uses the patient’s own muscle action to exert forces
What is Headgear?
-Orthopedic device used to control growth and tooth movement
-Used with full corrective orthodontics
-Applies more force to the teeth
-Usually worn for 10-12 hrs day or night
-May be worn full time, never during sports
-brought to each appointment as adjustments may be required
Types of Head Gear - Traction Devices
High Pull Headgear - upper jaw back and up
Cervical Pull - upper jaw back and down
Combination Headgear - upper & lower jaw
Chin Cup With head gear - lower jaw back
Headgear: Face Bow - Purpose
-to stabilize or move maxillary first molar distally
-to create more room in arch
Inner bow - fits into headgear tube on facial side of molar bands
Outer bow - attaches to traction straps
Two Parts of Headgear
The Facebow and the Traction Device
What is the face bow do?
The face bow is used to stabilize or move the maxillary first molar
distally and to create more room in the arch. The intraoral part of the
face bow fits into the buccal tubes of the maxillary first molars. The
outer part of the bow attaches to the traction device.
What does the traction device do?
Traction devices apply the extraoral force needed to achieve desired
treatment results
What are Teeth Aligners? (Invisalign)
Recent technology has developed a new way to straighten teeth without the use of fixed appliances. Clear aligners, also termed invisible aligners, is a type of orthodontic treatment that corrects misaligned or crooked teeth with the use of a vacuum-formed clear aligner. Two positive aspects of this type of treatment are that it is less visible, and the aligner can be removed during eating and oral hygiene. A series of clear “aligners” is computer generated to gradually guide the teeth into alignment
- gives more control of each tooth, can move one tooth at a time and not effect the other teeth around it
-100% reliant on patient compliance
What is an Orthodontic Positioner?
The positioner is a custom appliance constructed of rubber or pliable acrylic and fits over the patient’s dentition after ortho treatment. T
The orthodontic positioner is designed to accomplish the following..
- retain the teeth in their desired position
-permit the alveolus to rebuild support around the teeth before the patient wears a retainer
-massage the gingiva
What is the Hawley Retainer?
The Hawley retainer is a removable retainer worn to
passively retain the teeth in their new position
What are Lingual Retainers?
A fixed lingual canine-to-canine retainer is designed to be bonded to the lingual surfaces
What is Occlusion?
The relationship between maxillary and mandibular teeth
- Centric Occlusion
-Functional Occlusion
-Malocclusion
What is Centric Occlusion?
Also called habitual occlusion
is the voluntary position of the dentition that allows the maximum contact when the teeth occlude
-occurs when the jaws are closed in a position that produces maximum stable contact between the occluding surfaces of the max and mand teeth
What is Ideal Occlusion?
Complete, harmonious relationship of teeth, as well as all other mouth structures.
- A specific pattern that includes 138 occlusal contacts on all 32 permanent teeth
- This ideal relationship rarely exists
How would you identify occlusion when your patient is missing 1st permanent molars?
By the Canines!
Canine Classifications
Class 1 - cusp of max canine occludes between the distal of Mn canine and M of Mn 1st premolar
Class 2 - Cusp of Max canine is moved forward and occludes between the D of Mn lateral incisor and M of Mn canine
Class 3 - Cusp of max canine is moved back and occludes behind the Mn canine and in the middle of the Mn 1st premolar
Developmental Causes of Malocclusion
-disturbances in dental development can cause major congentital defects (ex cleft palate)
-congenitally missing teeth
-malformed teeth
-supernumerary teeth
-interference with eruption
-ectopic eruption
What is Ectopic Eruption?
Is an abnormal direction of tooth eruption
Genetic Causes of Malocclusion?
-Responsible for malocclusion when there are discrepances in the size of the jaw and/or teeth
-A child who inherits a mother’s small jaw and a father’s large teeth may have teeth that are too big for the jaw, causing overcrowding
-If you have a missign tooth, it can be likely that your parent or grandparent may be missing the same tooth
Birth injuries can occur in two major categories:
-Fetal molding is when an arm or leg of the fetus is pressed against another part of the body
*This pressure can lead to distortion of rapidly growing areas such as the head and jaw
-Trauma during birth, such as an injury to the jaw
Environmental Causes of Malocclusionn-Dental trauma can lead to the development of malocclusion in three ways:
Injury Throughout Life:
1. Damage to permanent tooth buds when an injury to primary teeth has occured
2. Movement of a tooth or teeth as a result of premature loss of a primary tooth
3. Direct injury to permanent teeth
Habits must…
Must be corrected if orthodontic treatment is to be
successful!
* Tongue thrusting
* Tongue-thrust swallowing
* Thumb and finger sucking
* Bruxism (tooth grinding
Why Correct Malocclusion?
- Esthetics
- Function
- Plaque control
- Increased risk of trauma
- Fracture
- Speech problems
3 ways a tooth can move:
Physiologic
Pathologic
Orthodontic
What is Physiologic tooth movement?
slight tipping of the tooth in it’s
socket and also to the changes in tooth position
that occur during and after tooth eruption
What is Pathologic tooth movement?
change in tooth position resulting
from forces that maintain teeth in normal position
in relation to their arch
What is Orthodontic tooth movement?
application of force induces bone
resorption on the pressure side and bone deposit
on the tension sid
What is Natural tooth Movement?
Force applied to tooth without intervention
(eruption sequences, occlusal forces, mesial drift)
What is Mechanical tooth movement?
Force applied to tooth with intervention
-parafunctional habits
-appliances
-braces
Principles of Tooth Movement
Teeth are suspended in a tooth socket by periodontal
ligaments. One end to the cementum and the other
end to the bony alveolous
Forces applied to tooth > periodontal ligaments respond by stretching/compressing > signals to cells of periosteum to produce osteoblasts/osteoclasts
Osteoblast & Ortho
Stretched periodontal ligaments > signals cells to produce osteoblasts > bone forms > teeth will be supported as they move in direction of applied force
Osteoclasts & Ortho
Compressed periodontal ligaments > signal cells to produce osteoclasts > bone resorbs > teeth will move in direction of applied force
What happens if too much pressure is applied, too quickly?
Possible damage to the tooth and/or surrounding tissues
-Root resorption
-Bone Loss
-Periodontal pocket formation
Why do Roots Resorb? in Ortho
Caused by quick treatment - which causes damage to tissues
How does a peridontal pocket form? In Ortho
Caused by quick treatment - given insufficient time for osteoblasts to react
What does “Ideal” Occlusion Look Like?
-Mesognathic profile: slightly protruded jaws, which give the facial outline a relatively flat appearance
- The MB cusp of the max 1st perm molar occludes in the B grove of the mandibular 1st molar
- Occlusal force is greater on the posterior teeth than the anterior teeth
- Max anterior teeth overlap the incisal edge of the mandibular anerior teeth by 2mm
What is Dynamic or Functional Occlusion?
Describes the relationship of the teeth during biting and chewing, swallowing or other normal action
Functional contacts are the normal contacts that are made between the maxillary teeth and the mandibular teeth during chewing and swallowing
Masticatory (chewing) performance depends on the type and severity of the maoloccusion as well as he number and location of the teeth
What are Malocclusions?
The abnormal relationship of the maxillary teeth to the mandibular teeth when they are in centric occlusion
Class I: Neutrocclusion
-Both permanent first molar and canine relationship are in ideal position
-Mesiobuccal cusp of max first molar rests in mesiobuccal groove of mandibular first molar
-max canine occludes with distal inclined plane of mandibular canine and first premolar
-Can be deviations of the anterior teeth but the molars will have ideal positioning
Class II: Distocclusion
MB cusp of the max 1st molar occludes between mandibular 2nd premolar and M cusp of mandibular 1st molar
Maxillary anteriors protrude (2 divisions)
What is Class II Division 1
Mandible is retruded and maxillary teeth are protruded
What is Class II Division 2
Mandible is retruded and one or more maxillary incisors are retruded
- centrals are in linguoversion
What is Class III Mesiocclusion?
-Permanent mandibular first molar and canine are more anterior
- by at least the width of a premolar more than normal postion
-When molars are more mesially located, other conditions can also occur such as anterior cross bite and edge-to-edge contact
-mandible appears prognathic
What is Torsoversion?
Tooth is rotated or turned
What is Mesioversion?
Tooth is mesial to normal position
What is Distoversion?
Tooth is distal to normal position
What is Linguoversion?
Tooth is lingual to normal position
What is Labioversion?
Tooth is tipped toward lip or cheek
What is Supraversion?
Tooth is above normal line of occlusion
What is Transversion/transposition
Tooth is in the wrong order in the arch
What is overjet?
Horizontal overlap creating a protrusion or space
between the labial surface of the mandibular incisors and the lingual surface of the maxillary incisors
What is Cross bite?
Crossbite is facially positioned mandibular tooth, or teeth
Can be anterior or posterior - buccal or lingal
What is underjet?
Also known as underbite
- max anteriors are positioned lingually to the mandibular anteriors with excessive space between the labial of the mand anteriors and the lingual of the maxillary anteriors
What is open bite?
lack of vertical overlap of max incisors
What is Edge-to-Edge?
Incisal surface of max anterior occlulde with incisal surface of mand teeth
What is End-to-End?
Molars and premolars occlude cusp to cusp
