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ortho > week 4 > Flashcards

week 4 Flashcards

1
Q

how is the maxilla attached to the cranium

A

Numerous sutures

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2
Q

maxillary hypoplasia leads to what classification

A

Class III

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3
Q

maxillary prognathism leads to what classification

A

Class II

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4
Q

a transverse deficiency leads to what classification

A

Posterior crossbite

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5
Q

do you need more or less force for orthopedic or orthodontic foces

A

More for orthopedic (500-1000) because distributed over large bone area and bumber of teeth

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6
Q

how long do you have to restrain maxillary growth

A

12-16 hours a day (not 6)

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7
Q

how is force frequency applied for maxillary growth restraint headgear

A

Intermittend (not cont)

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8
Q

what headgear is used to restrain maxillary

A

High pull
cervical pull
Combi

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9
Q

what do maxillary protraction face maska and reverse pull headgear attach to

A

Maxillary molars

Ideal: temporary implants and ankylosed teeth

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10
Q

when is maxillay protraction face mask and reverse pull headgear

A

10-11 years old for 6-8 months

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11
Q

how much change can maxillary protraction-face mask and reverse pull headgear move the skeleton

A

3mm of skeletal movement

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12
Q

when is a maxillary transverse deficiency seen

A

Seen in patients with Class III malocclusion
seen in patients with Class II with vertical (long problems)
isolated problems

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13
Q

when do you use a palatal expaspander

A

To correct maxillary transverse deficiency

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14
Q

what is the target of palatal expansion

A

Midpalatal suture

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15
Q

how fast is rapid palatal expansion

A

1mm/day over 2-3 weeks

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16
Q

when do you use rapid palatal expansion

A

adolescent patients

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17
Q

what type of expanders are used for preadolescent children and preschool for palatal expansion

A

W-arch and Quad helix appliances (not jackscrew-type expanders)

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18
Q

how fast is slow expansion

A

1mm/week

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19
Q

when is slow expansion done

A

used for late adolescent and young adults

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20
Q

what is done after palatal expansion

A

3-6 months of retention for bone consolidation

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21
Q

why is it difficult to do RPE in older people

A

Interdigitation (not fusion) of midpalatal suture increases with age

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22
Q

what is the comparison between skeletal and dental movement in rapid palatal expansion

A

50% skeletal

50% dental

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23
Q

what happens in RPE if the suture is highly interdigitated

A

Production of mostly dental movement

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24
Q

how can you do RPE in adults

A

Surgically assisted RPE

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25
Q

how does the mandible groe

A

Mainly at the condyls (endochondral formation)

posterior and lateral surfaces (intramembrouanous formation)

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26
Q

what does mandiblar hypoplasia/retrognathism lead to in classification

A

Class II

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27
Q

what does mandibular prognathism lead to in classification

A

Class III

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28
Q

what does a transverse constriction of the mandible lead to

A

Brodie bite

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29
Q

how can we affect mandibular growth

A

Functional appliances can accelerate mandibular growth but may not increase the final size of the mandible

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30
Q

what is the typical outcome of functional appliances to stimulate mandibular growth

A

Combined skeletal and dental changes

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31
Q

what accounts for the inconsistent skeletal effect of mandibular growth control

A

loading pattern

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32
Q

what negative consequence do functional appliances have on the teeth

A

Lower incisor proclination

upper incisor retroclination

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33
Q

when would functional appliances not be a good choice

A

when patient has already proclined lower incisors and retroclined upper incisors

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34
Q

why don’t we use mandibular growth chin cup headgear

A

Reduced protrusion by increasing anterior face height rather than shortening size

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35
Q

what is the most common treatment for mandibular prognathism

A

Mandibular surgical setback after cessation of mandibular growth

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36
Q

when does the symphysis of the mandible fuse

A

fuses at 7-8 moths

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37
Q

what can mandibular expansion appliances expand

A

the dento-alveolus, not the basal bone

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38
Q

what does expansion of the mandibular base bone require

A

Surgical procedure via distraction osteogenesis

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39
Q

what is distraction osteogenesis

A

used to lengthen bones via bone fragments gradually opening to create a gap and remodeling

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40
Q

what is distraction histogenesis

A

Adaptation of soft tissues (blood vessels, ligaments, muscles, nerves)

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41
Q

what are the 4 major sequential phases of DO

A

latency
Distraction
Consolidation
Remodeling

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42
Q

what is latency

A

Interval between osteotomy operation and start of distraction

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43
Q

what is distraction

A

Period that distractor activation takes place

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44
Q

what is consolidation

A

Post-distraction period to allow for new bone formation while appliance is still in place

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45
Q

what is remodeling

A

Period that the regenerated bone continues to remodel after appliance removal

46
Q

what is the stability of different symphyseal distractors

A

Hydrid>tooth borne>bone borne

47
Q

what is the reliablity of transferrring expansion force to bone of different symphyseal distractors

A

Tooth borne>hybrid

48
Q

what can we change in the skeleton without using surgery

A

Maxillary protrustion
Hpoplasia and trasverse constriction
mandibular retrognathia

49
Q

can you use growth modification to fix severe skeletal problems

A

No(must do surgery)

50
Q

what is the soft tissue connecting teeth to the alveolar bone

A

PDL

51
Q

how big is the PDL

A

.5mm in width

52
Q

what are the fibers of the PDL

A

parallel collagenous fibers

53
Q

what are the Cells of the PDL

A

fibroblasts
Osteoblasts
mesenchmal stem cells
Cells from the vascular structures

54
Q

what strucutres are present in the PDL

A

Blood vessels and nerve endings (unmyelinated for perception of pain, pressure and position)

55
Q

what is the roll of the tissue fluids in the PDL

A

viscoelastic elements

Dampening effects

56
Q

what kind of force does the PDL resist

A

Short duration forces(act as a shock absorber)

57
Q

what do prolonged forces on the PDL do

A

Remodel PDL and adjacent bone

58
Q

what is needed to be remodeled for tooth movement

A

PDL fibers (especially the sharpey’s fibers)

59
Q

what does most of the remodeling of the PDL fibers

A

Fibroblasts already present in the PDL

60
Q

what needs to be done for the tooth to move beyond the PDL Space

A

Bone resorption

61
Q

what is the roll of the alveolar bone

A

Support teeth and keep them relatively stable

62
Q

how do osteoclasts resorb bone

A

Produce acid and enzymes

63
Q

where do osteoclasts come from

A

Hematopoietic stem cells-> monocytes-> osteoclasts

(not in PDL need to be recruited from BV or bone marrow)

64
Q

what is the bioelectric theory for tooth movment

A

Bony chnaged by electrical signals that then chage cell acitivty

65
Q

what is the pressure-tension theory

A

Pressure and tension alter blood flow causing a release of chem messengers
- chem messenger change cell activities

66
Q

what happens in 1-2 sec after sustained light presssure

A

Tooth displaced within PDL

67
Q

what happens in 3-5 seconds in sustained light pressure

A

blood flow changes

68
Q

what happens in minutes of light presssure

A

Ozygen tension at compression side decreases leading to a release of prostaglandins and cytokines

69
Q

what happens hours after sustained light pressure

A

Chemical messenger cause metabolic change and second messengers (such as cAMP) release
- osteoclast recruitment (blood flow), maturation and activitation-> frontal bone resorption

70
Q

what happens 2 days after sustained light pressure

A

Tooth movement beyond the PDL space

71
Q

what happnes in 1-2 sec after heavy pressure

A

Tooth displaced in PDL space

72
Q

what happens 3-5 sec after heavy pressure

A

Blood vessels occluded on the Pressure side

73
Q

what happens after minutes of heavy pressure

A

Blood flow cut off to compressed PDL

74
Q

what happens after hours of heavy pressure

A

CEll death in compressed area

75
Q

what happens after 3-5 days of heavy compression

A

Osteoclasts recruitment from bone marrow in the alveolar bone, mature and activate to do undermining bone resorption

76
Q

what happens after 7-14 days of heavy pressure

A

Tooth movement beyond PDL space

77
Q

where do Osteoclasts come from in light and heavy pressure

A

Light: blood flow
heavy: bone marrrow in alveolar bone

78
Q

what resorption is done in heavy and light pressure

A

Light: frontal bone resorption
heavy: undermining bone resorption

79
Q

what kind of force is needed to move tooth

A

Sustained force is required but continuous is not absolutely necessary

80
Q

how long should you apply force to induce movement

A

4-8 hours (longer is more efficient

81
Q

what determines the compression/tension regions

A

Force application pattern

82
Q

what has larger compression area, translation or tipping

A

Translation`

83
Q

do adults or kids have faster tooth movement

A

Kids are faster

84
Q

why do kids have faster tooth movement than adults

A

children have remaining alveolar growth and relatively less dense bone

85
Q

what is the effect of osteopetrosis and osteoporosis on tooth movement in the jaw bones

A

osteopetrosis slows down tooth movement

osteoporosis accelerates

86
Q

does the mandible or maxilla move the teeth faster

A

Maxilla is faster due to less dense bone

87
Q

what drugs can inhibit ortho movement

A

Prostaglandin inhibitor: NSAID, corticosteroids

Bisphosphonates

88
Q

what can be done to accelerate tooth movement

A

Local injury (regional acceleratory phenomenon)
Corticotomy assisted tooth movement (Wilckodontics)
vibration
phottherapy
ultrasound

89
Q

what is the roll of anchorage

A

Resist unwanted tooth movement and to resist reaction force

90
Q

what is the goal of efficient orthodontics

A

Maximizing tooth movement and minimize unwanted reactionary effects

91
Q

does incraseing pressure increase tooth movement

A

Yes, but only to a certain extent

92
Q

what does optimal force depend on

A

the tooth and the pressure produced at the PDLs

93
Q

what is reciprocal space closure

A

where two teeth are pulled together with no anchorage

94
Q

how do you do Differential space closure

A

Use anchorage control using different anchorage values of different teeth

95
Q

what is an anchorage valve

A

Depends on the root surface

96
Q

what force should be used in differential space closure

A

Light force

97
Q

what is stationary anchorage control

A

only allows bodily movement of the molars to pull the anterior teeth forward

98
Q

what is a skeletal anchorage

A

Uses Temporary anchorage devices(TADs) to prevent unwanted tooth movement

99
Q

how does the pulp react to ortho

A

Generally is minimal

100
Q

why might the pulp lose vitality

A

due to previous trauma (ask about pt’s dental history)

101
Q

what teeth can be moved ortholy

A

Proper RCT

102
Q

what teeth should be avoided in major tooth movements

A

CaOH filled teeth in the anterior with open apices

103
Q

is root remodeling a common theme of ortho

A

yes. but most people aren’t severe

104
Q

where may permanent loss of root surface occur

A

Primarily at the apex

105
Q

what teeth tend to have root resorption

A

Incisors and second premolar

106
Q

how common is severe root resorption

A

1-2%

107
Q

when is root resorption severe

A

greater than 1/4 root gone

108
Q

what are the risk factors for excessive root resorption

A

Abnormal root morphology (conical roots, pointed apices, dilacerations)
Prolonged treatment time, excessive and prolonged ortho forces
Genetic predisposition
History of root resorption

109
Q

how much alveolar bone height is loss due to ortho

A

less than .5mm

110
Q

what happens if perio conserns during treatment

A

Evaluated/addressed by perio and active disease should be controlled prior

ortho (22 decks)

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