Week 6 Comprehensive ortho treatment

Question 1

The primary goal of comprehensive treatment is?

Answer 1

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

Question 2

3 goals of comprehensive treatment

Answer 2

improve alignment/occlusion

improve function

improve esthetics

Question 3

comprehensive usually deals with more ______ and less ______

Answer 3

bodily control

tipping

Question 4

2 appliances used in comprehensive treatment

Answer 4

1. Fixed appliance

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

Question 5

Treatment stages of comprehensive treatment is divided into…?

Answer 5

3 discreet stages

Question 6

First stage of comprehensive treatment?

Answer 6

2 main objectives

1. Alignment
2. Leveling

Question 7

Alignment does what?

Answer 7

initial correction of dental malalignment by tipping movement

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

Question 8

Archwires for initial alignment?

Answer 8

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

Question 9

Size and type of archwire for initial alignment?

Answer 9

Small diameter round

Question 10

Extraction vs non-extraction in alignment

Answer 10

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.

Question 11

Leveling is a treatment plan based on?

Answer 11

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

look for vertical facial height, gingival display

Question 12

leveling by extrusion can be done by?

Answer 12

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

Question 13

leveling by extrusion to fix a deep bite?

Answer 13

by extrusion of posterior teeth and thereby opening up vertical dimension

Question 14

True or False?

leveling by extrusion changes the vertical dimension

Answer 14

True

Question 15

Extrusion of ____ cause?

Answer 15

posterior teeth

cause mandible to rotate down and back

(need a light force)

Question 16

leveling by intrusion can be done by?

Answer 16

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)

Question 17

True or False?

level by intrusion can change the vertical dimension

Answer 17

FALSE!

It does not change the VD

Question 18

leveling by intrusion bypasses?

Answer 18

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)

Question 19

True or False

continuous archwire is usually much easier to use by orthodontist?

Answer 19

True

Question 20

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

Answer 20

using rectangular steel archwire

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

Question 21

True or False?

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

Answer 21

True

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

Question 22

True or False?

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

Answer 22

True

Question 23

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

Answer 23

False

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

Question 24

Second stage of Comprehensive ortho treatment does what?

Answer 24

• 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

Question 25

True or false? Better to adjust midline while closing the spaces than in third stage.

Answer 25

True

Question 26

2 mechanics of second stage of comprehensive ortho treatment

Answer 26

1. Sliding mechanics | 2. Retraction loop mechanics

Question 27

True or false? Must retract canines before incisors using sliding mechanics

Answer 27

True

Question 28

Sliding mechanics does what?

Answer 28

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

Question 29

Pros and Cons of Sliding mechanics?

Answer 29

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

Question 30

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

Answer 30

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

Question 31

The goal of second stage?

Answer 31

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

Question 32

Retraction loop mechanics does what?

Answer 32

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!

Question 33

The downsides of retraction loop mechanics?

Answer 33

- 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

Question 34

Third stage of comprehensive treatment does what?

Answer 34

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)

Question 35

Tooth movement by Torque?

Answer 35

Not an easy tooth movement | To do Bucco-Lingual tipping of teeth is hard to do with just using an archwire

Question 36

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

Answer 36

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)

Question 37

What time is the best to do the midline correction?

Answer 37

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.

Question 38

What is settling and how do you do it?

Answer 38

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

Question 39

What is the weak orthodontic regimen?

Answer 39

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

Question 40

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

Answer 40

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

Question 41

Periodontal responses to tooth movement?

Answer 41

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

Question 42

Time table for tissue recovery? PDL? Gingival fiber?

Answer 42

PDL: 3-4 months Gingival fiber recovery: Longer than PDL, esp. supracrestal and circumferential fibers can take up to (1 year)

Question 43

Relapse due to growth...

Answer 43

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...

Question 44

Removable retainers?

Answer 44

Hawley: most common, acrylic component, labial bow and adam's clasps Others: Wrap-around acrylic, clip-on, positioner, vacuu-formed/essix (invisagline type)

Question 45

Hawley retainer?

Answer 45

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

Question 46

What is an advantage of using Hawley retainer?

Answer 46

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

Question 47

What about vacuum formed retainers? disadvantages?

Answer 47

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

Question 48

Advantages of Removable appliances?

Answer 48

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

Question 49

Disadvantages of Removable appliances?

Answer 49

Esthetics Patient can damage or misplace Palatal coverage (uncomfortable) Wire may interfere with occlusion COMPLIANCE REQUIRED!!! (most important)

Question 50

2 types of Fixed retainers (Bonded)

Answer 50

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

Question 51

When each tooth is bonded, what do u use?

Answer 51

Light braided twist wire

Question 52

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

Answer 52

Bonded (Rigid): use 0.03 wire

Question 53

so.. When do you use fixed retainers?

Answer 53

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

Question 54

Major indications of fixed retainers?

Answer 54

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

Question 55

Advantages of Fixed retainers?

Answer 55

Esthetics Permanent retention No compliance required

Question 56

Disadvantages of Fixe retainers?

Answer 56

Hygiene Max lingual bonded retainer may interfere with occlusion does not maintain posterior transverse dimension Cannot support relapse of bite depending