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ortho exam 1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the 3 steps in the systemic exam of Facial and Dental Appearance?

A
  1. Facial Proportions in all 3 planes (macro-esthetics)
  2. Dentiiontion in relation to the face (mini-esthetics)
  3. The teeth in relation to one another (micro-esthetics)
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2
Q

Frontal Exam

A

1st step in facial appearance
Look for:
* Bilateral Symetry in the fifths of the face
* Proportions of the of eyes, nose and mouth width
* Facial Index, Vertical Facial thirds

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3
Q

Bilateral Symmetry in the fifths of the face

A

Ideal proportional face can be divided into fifths
Central Fifth:
*determined by space b/w eyes
* Nose & chin are centered
* nose width is equal or slightly wider

Medial Fifth:
* determined by eye width
Lateral Fifth

Interpupillary line=width of mouth

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4
Q

Anthropometric analysis

A

Facial Measurements during clinical exam
* made with: Bow or Straight calipers

Used before Cepalometric radiography

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5
Q

Facial Index

A

Facial Height to Width ratio
* can’t eval height unless width is known

Establishes:
* overall facial type
* Basic proportions of face

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6
Q

Vertical Facial Thirds

A

Upper 1/3:
* hairline to base of nose

Middle 1/3:
* Base of nose to bottom of nose

Lower 1/3:
* Bottom of nose to chin
* Mouth=1/3 b/w bottom of nose and chin
* 1/3 above mouth
* 2/3 below mouth

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7
Q

Excessive Display of maxillary Gingiva

A
  • Eval postion of the Lips & teeth relative to vertical 1/3s of face
  • Common cause=Long Lower 1/3
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8
Q

What is another name for Profile Analysis

A

Aka Poor Man’s Cephalometric analysis

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9
Q

What are the 3 Goals of Profile Analysis?

A
  1. Establish whether the jaws are proportionately positioned in the AP plane of space
  2. Evluation of Lip Posture & Incisor Prominence
  3. Re-evaluation of Vertical Facial Porportions & eval mandibular plane angle
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10
Q

Establish whether the jaws are proportionately in the AP plane of space?

A

Place pt in physiologic NHP
* head position w/o other cues
* sitting upright or standing; Not reclines
* Look at horizon or distant object

2 Lines:
* Bridge of nose to base of upper lip
* base of upper lip to chin

Straight Profile=Ideal
* Skeletal Class I

Convex Profile
* Large angle (> 10)
* prominent upper jaw relative to chin
* Skeletal clas 2
* maxilla projects to far forward
* Mandible projects to far back

Concave Profile
* Upper Jaw behind chin
* Skeletal Class 3
* maxilla to far back
* mandible protrudes to far forward

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11
Q

What does Concave or Conex Profiles result from?

A

Disproportion in Jaw size

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12
Q

Incisor Prominence

A

Incisor Protrusion or retrusion
* effects dental arch space
* protrusion=more space; alleviates crowding
* Retrusion=Less space; worse crowding

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13
Q

Bimaxillary Dentoalveolar Protrusion

A

aka Bimaxillary Protrustion
Extreme Incisor Protrusion w/ideal alignment

Must meet 2 conditions:
* Lips are prominent and everted
* Lip incompetence (Lips seperated at rest by > 3-4mm)

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14
Q

Lip Incompetence

A
  • Lips seperated are rest >3-4mm
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15
Q

Lip Prominence Eval

A

Distance that each lip projects forward from a true vertical line through the depth of the concavity at its base
* Forward of line=Prominent
* Behind line=retrusive

Helpful to Draw E-line (Esthetic)
* nose to chin
* Lips should be on e-line

Consider size of nose and chin:
Larger the nose
* more prominent the chin needs to be to balance
* greater amount of lip prominence accepted
Nasolabial Angle
* Normal=Mild obtuse

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16
Q

What defines facial Attractiveness?

A

Smile

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17
Q

What are the 2 types of smile?

A

Posed/Social
* reproducible
* focus of ortho dx

Enjoyment (Duchenne)
* varies w/emotion

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18
Q

Smile Analysis consists of:

A

Amount of Incisor & Gingival Display

Transverse dimensions of smile relative to upper arch
* Buccal Corridors

Smile Arch

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19
Q

Amount of Incisor and gingival display

A

IDeal elevation of lip when smiling:
* slightly below gingival margin
* most of upper incisor can bve seen

Tooth Display:
* range: 1-4 mm of tooth coverage
* > 4 mm=less attractive

Gingival Display:
* ideal: 2.3 mm of tooth coverage
* Male: 0.5-1.0 mm
* Female: 0.5 mm

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20
Q

Amount of Incisor and gingival display

A

Tooth Display:
* range: 1-4 mm of tooth coverage
* > 4 mm=less attractive

Gingival Display:
* ideal: 2.3 mm of tooth coverage
* Male: 0.5-1.0 mm
* Female: 0.5 mm

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21
Q

Buccal Corridors

A

Distance b/w max posteriors (premolars) to inside of cheek
Another way to eval dental arch width
* Max dental arch width is proportional to midface width
* Broad smile=large midface/zygomatic arch width
* Narrow Smile=Narrow midface width
* ideal: 16%
* Male: 15-24%
* Female: 10-17%

Negative Space:
* Very Wide BC’s
* unesthic
* improve smile by: widen max arch

Minimal BCs:
* Females

No BCs:
* Unesthetic
* broad upper arch

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22
Q

Smile Arc

A

Incisal edge contours of max anterior teeth relative to lower lip curvature during a social smile
* Best apperance: Consonant-curvature of Lower lip is parallel to curvature of max incisors
* M/F: 1.8-3.8 mm K9 above incisal edge

Most important factor in smile esthetics
* only factor that can change smile to unesthetic by itself

Flat Smile Arc (non-consonant)
2 problems:
* less attractive
* Look oldder

23
Q

Inclination of Upper teeth: Tip L or R

A
  • > 2 mm from normal=Unesthic
24
Q

What are 2 important components of appearance in Tooth Proportions

A
  1. Tooth widths in relation to one another
  2. Height-Width prooprtions of individual teeth
25
Q

Ideal Tooth Width Proportion

A

Golden Proportion: 62%
* 1.0:0.62:0.38:0.24
* Lateral Incisor: 62% of central incisor width
* Through 1st premolar

26
Q

Central Incisor Tooth Proportions

A

Max Central Incisors:
* Height: 10.4-11.2
* Width: 80% of Height (8.37-9.3)

27
Q

If Maxillary Central Incisor Height is short, what are the possible causes? Possible Tx?

A

Possible Causes:
* Incomplete eruption in childhood=further development corrects
* Attrition in adults= restore missing part of crown
* Xs gingival height: Crown Lengthening
* Crown form distortion: facial Lamenette or complete crown

28
Q

Connector

A

aka interdental contact
Where adjacent teeth appear to touch
Includes:
* contact point
* area above and below contact point

Decrease in size from centrals to posteiors
* moves apically

Short Connector=part of problem w/black triangles

29
Q

Embrassures

A

Triangular spaces incial and gingival to contact
* ideal=larger than connectors

Gingival Embrasure:
* filled w/interdental papilla

Incisor Embrasure:
* Larger from central to premolars
* contact points move more gingival from central to premolars

30
Q

Black Triangle

A

Short interdental papilla
* open gingival embrassure above connector

Adults: Due to:
* perio disease=loss of gingival tissue
* ortho corrects crowded and rotated max incisors; connetor moves incisal

Reshape teeth to correct
* move contact pt apically
* lengthen connector

31
Q

Ideal Gingival Margin Levels for Centrals/Lateral/K9s

A

Centrals:
* highest gingival margin level

Lateral:
* 1.5 mm lower than centrals

K9:
* Same level as centrals

32
Q

Gingival Contour of Centrals/Lateral/K9s

A

Centrals:
* Horizontal half ellipse
* zenith=distal to midline

Laterals:
* Half-circle
* Zenith=midline of tooth

K9:
* vertical half ellipse
* zenith=distal to midline

33
Q

Norman Kingsley

A
  • 1850s-1st text describing ortho
  • 1st to use extraoral force
  • Pioneer in cleft palate tx
34
Q

Edward H. Angle

A

Father of Modern Ortho
* 1890: Concept of Occlusion

35
Q

Angles Postulates

A

Upper 1st molars were the key to occlusion
* MB cusp of upper molar occlueds in B groove of lower molar
* Normal Occlusion=correct line of occlusion (caternary line) + normal molar relationship

Best esthetics were achieved when pt had ideal occlusion

36
Q

Angles Classes of Malocclusion

A

Class 1:
* Normal relationship of molars
* Incorrect line of occlusion due to malposed teeth, rotations, other causes

Class 2:
* Lower molar distally positioned relative to upper molar

Class 3:
* Lower molar mesially positioned relative to upper molar

37
Q

Soft Tissue Paradigm

A

Soft Tissue Relationships
* determine Goals & Treatment of modern ortho & orthognathic tx
* Not teeth and bones

Increased Focus on clinical exam
* instead of dental casts and radiographs

38
Q

Compare Angle vs Soft Tissue Paradigm:
1. Primary Tx Goal
2. Secondary Tx Goal
3. Hard & Soft Tissue Relationships
4. Diagnostic emphasis
5. Treatment Approach
6. Functional emphasis
7. Stabliiity of result

A
39
Q

Compare Angle vs Soft Tissue Paradigm:
1. Primary Tx Goal
2. Secondary Tx Goal
3. Hard & Soft Tissue Relationships
4. Diagnostic emphasis
5. Treatment Approach
6. Functional emphasis
7. Stabliiity of result

A
40
Q

Posterior Cross Bite

A

Lingually positioned Max posterior teeth
* relative to mandibular teeth

Narrow max dental arch

41
Q

What differences does soft tissue paradigm make in planning tx?

A

Primary Goal of Tx=Soft tissue relationship and adaptations
* Major determinants of facial appearance
* Determine stability of ortho

Secondary Goal=Functional Occlusion
* TMJ Dysfunction: result of soft tissue injury around TMJ
* arrange occlusion to minimize

Reverse Thought process in solving the patients problems
* Past: Focus on Dental & Skeletal relationships and ST would take care of itself
* Now: Establish ST relationship then determine how teeth and jaws would have to arrange to meet goal

42
Q

Overjet

A

Horizontal overlap of incisors
* Ideal AP incisor relationship=1/3 US pop
* Overjet + Class 2 malocclusion=more prevalent (Vs reverse overjet + class 3)

Normal: upper incisors ahead of lower by incisal edge thickness
* 2-3 mm

Reverse Overjet
* Aka anterior crossbit
* lower incisors are in front of upper incisors

43
Q

Overbite

A

Vertical overlap of incisors
* Ideal Vertical Relatinship: 50% of US
* Deep bite is more prevlaent than open

Normal: Lower incisor edge contact lingual surface of upper
* 1-2 mm

Openbite:
* no vertical overlap
* quantify by measuring the seperation of incisors

44
Q

Line of Occlusion:

A

Catenary Curve: passes through
Maxilla:
* molar=central fossa
* k9/incisors=cingulum

Mandible:
* Molar: B cusp
* Mandible: incisal edges

45
Q

Irregularity index

A

incisor irregularity
* total mm distance from contact pt on each incisor to contact point it should have
* More prevalent in mandibular arch
* 1/3 US Pop have at least moderate irregular incisors
* 15% severe/extreme

46
Q

Diastema

A

Space b/w adjacent teeeth
Maxillary Midline Diastema:
* common in mixed dentition
* disappears or decrease width when permanent K9 erupt
* Spontaneous correction if width < 2 mm

47
Q

Girls Stages of Development:

A

3 stages: 3.5 years
Stage 1:
* start of growth spurt
* breast buds appear
* pubic hair appears

Stage 2: 1 year after stage 1
* Peak Velocity of Physical growth
* noticeable breast development
* Pubic hair: darker and widespread
* Axillary hair appears

Stage 3: 1-1.5 years after after stage 2
* Start of Menstruation=start of stage 3
* hips broaden
* Adult fat distribuiton
* Breast development is complete
* Growth spurt complete

48
Q

Boys stages of development

A

4 stages: 5 years
Stage 1: Fat Spurt=initial sign
* Almost chubby-feminine fat distriubtion
* Appears Obese and Awkward
* Scrotum increase in size (pigmentation change)

Stage 2: 1 year later
* growth spurt starts
* redistribution/decrease in fat
* Pubic hair appears
* Penis growth begins

Stage 3: 8-12 months later
* Peak Velocity of Growth
* Axillary hair appears
* Facial hair appears-Upper lip only
* Muscle growth
* Decrease fat: harder/more angular body form
* Pubnic Hair: Adult distribution
* Penis & Scrotum near adult size

Stage 4: 15-24 months later
* Growth spurt ends
* Facial hair: Chin & Upper lip
* Increase muscle strength
* Pubic & Axillary Hari: Darker and widespread

49
Q

Tooth Size Analysis

A

Aka Bolton Analysis
Assume comparable inclinations of teeth

Steps:
1. measure M-D width of every tooth
2. add each arch
3. Calculate overall and anterior ratios by dividing Mandibular/Maxillary
4. Compare to Table

Idea:
* overall ratio=0.913
* anterior ratio: 0.772

50
Q

Tooth Size discrepancy

A

Tooth Size disproportion
* upper centrals=most common
* <1.5=not significant

Anterior Tooth size discrepancy
* compare upper and lower lateral incisors
* If uppers NOT wider than lowers=discrepancy

Posterior tooth size discrepancy:
* compare 2nd premolars
* should be equal

51
Q

Speech difficulties related to malocclusion

A
52
Q

Speech difficulties related to malocclusion

A
53
Q

Class 2 Division 1: Could be caused by:

A

Maxillary teeth protrusion
* normal jaw relationship

Mandibular dficiency
* Normal relationship of teeth to jaws (Both arches)

Downward-backward rotations of mandible
* excessive vertical growth of maxilla

ortho exam 1 (10 decks)

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