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Ortho final > Week 6 Comprehensive ortho treatment > Flashcards

Week 6 Comprehensive ortho treatment Flashcards

1
Q

The primary goal of comprehensive treatment is?

A

Correcting malocclusion and achieving ideal occlusion (Max and mand dentition treatment)

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2
Q

3 goals of comprehensive treatment

A

improve alignment/occlusion

improve function

improve esthetics

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3
Q

comprehensive usually deals with more ______ and less ______

A

bodily control

tipping

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4
Q

2 appliances used in comprehensive treatment

A
  1. Fixed appliance

2. Removable appliances (Invisalign): not as precise as fixed appliances but really popular right now

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5
Q

Treatment stages of comprehensive treatment is divided into…?

A

3 discreet stages

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6
Q

First stage of comprehensive treatment?

A

2 main objectives

  1. Alignment
  2. Leveling
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7
Q

Alignment does what?

A

initial correction of dental malalignment by tipping movement

(not much of movement of roots but more tipping of crown)

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8
Q

Archwires for initial alignment?

A

light flexible arch wires with long activation spans and continuous low level forces

Niti (most common):
SS: used before Niti was made

Braided or multi strand

SS was multi-looped to make it flexible (before Niti was introduced)

Multi looped arch wires

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9
Q

Size and type of archwire for initial alignment?

A

Small diameter round

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10
Q

Extraction vs non-extraction in alignment

A

Extraction when significant crowding/protrusion

Non-extraction if minimal crowding

To do alignment with the flexible wire is pretty simple but it is hard to determine in crowded case.

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11
Q

Leveling is a treatment plan based on?

A

amount of incisor display at rest (e.g gummy smile, deep bite, open bite and etc.)

look for vertical facial height, gingival display

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12
Q

leveling by extrusion can be done by?

A

using continuous archwires

simply by placing an exaggerated curve of spee in the max archwire and a reverse curve of spee in the mandibular archwire

it can level a lower arch with an excessive curve of spee

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13
Q

leveling by extrusion to fix a deep bite?

A

by extrusion of posterior teeth and thereby opening up vertical dimension

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14
Q

True or False?

leveling by extrusion changes the vertical dimension

A

True

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15
Q

Extrusion of ____ cause?

A

posterior teeth

cause mandible to rotate down and back

(need a light force)

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16
Q

leveling by intrusion can be done by?

A

using bypass arches (segmental arches with using auxiliary wires)

intrude anterior teeth

most useful for patients who will have some growth (either mixed or early permanent dentitions)

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17
Q

True or False?

level by intrusion can change the vertical dimension

A

FALSE!

It does not change the VD

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18
Q

leveling by intrusion bypasses?

A

the premolars

With a distal rotational force on the molar, you are using the molar as an anchorage to intrude the incisors

(tipping the incisors distally at the expense of bodily mesial movement of the molars)

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19
Q

True or False

continuous archwire is usually much easier to use by orthodontist?

A

True

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20
Q

What to do at the end of the 1st stage?

A

using rectangular steel archwire

can be placed without an exaggerated curve and without generating excessive forces.

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21
Q

True or False?

It is important not to move to the second stage until both leveling and alignment are adequate.

A

True

near end of stage 1, overbite should be near optimal and alignment should be almost done

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22
Q

True or False?

Treatment plan based on the about of incisor display at rest when using leveling.

A

True

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23
Q

It is important to move onto the 2nd stage even if there is not enough leveling and alignment was done.

A

False

Do not move to the 2nd stage until both leveling and alignment are adequate

24
Q

Second stage of Comprehensive ortho treatment does what?

A
  • A-P correction (to optimal Class 1 molar and canine)
  • Space closure (If it is the extraction case)
  • Anchorage (for optimal anchorage)
  1. Molar relationships
  2. Incisor relationships
  3. Extraction spaces
25
Q

True or false?

Better to adjust midline while closing the spaces than in third stage.

A

True

26
Q

2 mechanics of second stage of comprehensive ortho treatment

A
  1. Sliding mechanics

2. Retraction loop mechanics

27
Q

True or false?

Must retract canines before incisors using sliding mechanics

A

True

28
Q

Sliding mechanics does what?

A

Sliding teeth along the archwire using springs/coils/power chains/rubber bands

29
Q

Pros and Cons of Sliding mechanics?

A

Pros: relatively simple and easy (so this one is used the most in uncomplicated cases)

Cons: Too much friction…. so it takes longer to move teeth, tend to lose a lot of anchorage (the posterior teeth tend to move further forward), because as you’re trying to slide the canine back, the friction helps dispense or waste some of the energy

30
Q

why do we do canine first and then incisors later? why can’t we retract all 6 teeth together?

A

The anchorage demands on the posterior teeth would be more when we try to move all 6 teeth together, especially since the canines are such large-rooted teeth

→ so to conserve anchorage, we get the canines back first and then the incisal segment

31
Q

The goal of second stage?

A

in the end, finish with closed spaces, class I molar, class I canine, and pretty ideal overjet and overbite

32
Q

Retraction loop mechanics does what?

A

the second method of closing spaces

there is NO friction, because these loop mechanics go from the back to the front, and the forces that are used to move teeth back are in the mechanics of the loop as the loop is opened for activation and they deactivate by closing, and as they close, they bring the anterior teeth back

so here the teeth are NOT sliding on the archwire, and therefore there’s no friction!

33
Q

The downsides of retraction loop mechanics?

A
  • it tends to be more complex
  • it tends to be a food trap

◦ patients have a harder time, because of the increased volume of wires in the mouth, to keep things clean

  • it is more prone to distortion

so it is used when more mechanically demanding case

34
Q

Third stage of comprehensive treatment does what?

A

It is called the “Finishing” stage

  • Root paralleling (M-D tipping)
  • Torque (B-L tipping)
  • Individual tooth precise positioning
  • Midlines (better if addressed earlier)
  • Tooth size discrepancies
  • Settling (Bringing to optimum intercuspation)
35
Q

Tooth movement by Torque?

A

Not an easy tooth movement

To do Bucco-Lingual tipping of teeth is hard to do with just using an archwire

36
Q

What kind of order is used in Torque and what do you need to make the teeth movement?

A

to achieve this third order of control over tooth positioning, it is mandatory that the orthodontist uses a RECTANGULAR archwire that fits pretty snugly into the rectangular bracket slot

Once placed a precise torque, you can move roots of teeth as desired (B-L direction)

37
Q

What time is the best to do the midline correction?

A

Best achieved when the buccal space closing is occurring. It is difficult to do once spaces are closed.

It the midline shift is minor, you can use asymmetric elastics to fix it.

38
Q

What is settling and how do you do it?

A

It brings the teeth to the optimum intercuspation.

where after the gross stage 2 mechanics are completed, it’s possible that there may be some up and down settling of teeth that are needed so that each posterior tooth will optimally sit in the cusp-to-fossa relationship that’s desired

sometimes this would need second order activations in the archwires, meaning up and down (Flexible wire: NITI)

or sometimes it needs the use of elastics and rubber bands from top to bottom to bring the teeth together

39
Q

What is the weak orthodontic regimen?

A

RETENTION

for retention, we are typically dependent on significant patient participation and many times, this doesn’t occur

40
Q

Why is retention necessary? and what are the 3 primary causes for the relapse?

A
  1. when teeth are repositioned, there’s a tendency for the tissues surrounding the teeth to want to recoil or relapse (Elastic recoil of gingival fibers)
  2. then the constantly changing pressures of the lip, cheek, and tongue put pressures on the teeth to move (Cheek/Lip/Tongue pressure)
  3. in younger individuals whose treatment is completed by 12-14, there is still a chance for differential jaw growth (Differential jaw growth)
    ◦ more in males than in females?
    ◦ late mandibular growth spurt

1,2 are more controllable with retention, while the third, growth, is NOT

41
Q

Periodontal responses to tooth movement?

A

PDL widening
Disruption of collagen fiber bundles
Gingival and periodontal fibers (supracrestal, transseptal, oblique) are closed.

42
Q

Time table for tissue recovery?

PDL?

Gingival fiber?

A

PDL: 3-4 months

Gingival fiber recovery: Longer than PDL, esp. supracrestal and circumferential fibers can take up to (1 year)

43
Q

Relapse due to growth…

A

we are more concerned about the late mandibular growth, which is somewhat more unpredictable, and could occur in both males and females later in age

males sometimes as late as 17
females in the 14-16 time frame

This is not controllable with retention…

44
Q

Removable retainers?

A

Hawley: most common, acrylic component, labial bow and adam’s clasps

Others: Wrap-around acrylic, clip-on, positioner, vacuu-formed/essix (invisagline type)

45
Q

Hawley retainer?

A

Active element: Wire component
Passive element: Acrylic

retentive-clasps on molar teeth, labial bow, limited tooth movement possible

Not as popular now but this still is the most advantageous retainer as it holds the teeth labial-lingually in a pretty precise position, at the same time allowing for some occlusal settling after the braces are off

46
Q

What is an advantage of using Hawley retainer?

A

that the wire elements can be adjusted to make minor changes in tooth position if there happens to be any relapse

47
Q

What about vacuum formed retainers? disadvantages?

A

the vacuum formed retainer is esthetically very pleasing and very comfortable for the patient to wear

-it doesn’t last as long as a hawley
retainer

  • it doesn’t allow for any settling of
    teeth because they’re held pretty precisely where they are
48
Q

Advantages of Removable appliances?

A 
Hygienic
Can be active: to adjust minor movement
Can control bite depth 
Can maintain the posterior dimension 
Indicated in extraction cases
49
Q

Disadvantages of Removable appliances?

A

Esthetics
Patient can damage or misplace
Palatal coverage (uncomfortable)
Wire may interfere with occlusion

COMPLIANCE REQUIRED!!! (most important)

50
Q

2 types of Fixed retainers (Bonded)

A
  1. Braided - light braided “twist” wire allows physiologic movement, bonded to the lingual of teeth (canine to canine), bond each to the wire
  2. Rigid wire - only bonded to the more
    terminal teeth: the canines

◦ in the remaining teeth, you just have the rigid bar resting on the lingual surfaces, preventing any significant movement

◦ the advantage of this type is that cleaning is a little easier since each tooth is not bonded

51
Q

When each tooth is bonded, what do u use?

A

Light braided twist wire

52
Q

When only the canines are bonded, what do you use?

A

Bonded (Rigid): use 0.03 wire

53
Q

so.. When do you use fixed retainers?

A

When intra-arch instability is anticipated and/or prolonged retention is desired

54
Q

Major indications of fixed retainers?

A

Maintenance of:

  1. Lower incisor position (during late growth)
  2. Space closure
  3. Pontic space
  4. Extraction spaces in adults (for implants)
  5. Retain anterior teeth that were severely rotated
  6. Keep diastema space closed
55
Q

Advantages of Fixed retainers?

A

Esthetics
Permanent retention
No compliance required

56
Q

Disadvantages of Fixe retainers?

A

Hygiene

Max lingual bonded retainer may interfere with occlusion

does not maintain posterior transverse dimension

Cannot support relapse of bite depending

Ortho final (20 decks)

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