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BDS3 1 > Orthodontic Assessment > Flashcards

Orthodontic Assessment Flashcards

1
Q

when do we carry out orthodontic assessment? (4)

A

Ages 9: brief examination

11-12: Comprehensive examination when canines are premolars erupt

When older patients first come to you (if never been before)

If malocclusion develops in later life

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2
Q

what is an ideal occlusion based on?

A

Andrews 6 keys

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3
Q

list Andrew’s 6’s keys

A 
Molar relationship 
Crown angulation 
Crown inclination 
No rotations 
No spaces 
Flat occlusal planes

teeth must all be the correct size

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4
Q

define the ideal molar relationship in relation to Andrew’s 6 keys.

A

The distal surface of the distobuccal cusp on the upper 1st permanent molar occludes with the medial surface of the mesiobuccal cusp if the lower 2nd molar.

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5
Q

define malocclusion.

A

More significant deviations from the ideal occlusion. May be considered as unsatisfactory aesthetically or functionally.

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6
Q

what are contraindicators to orthodontic treatment?

A

Allergy to Ni or latex

Epilepsy and the drugs used to control it

Some medications

Problems with imaging i.e. radiographs

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7
Q

when carrying out an orthodontic assessment what is important to note from their past dental history?

A

Frequency of attendance

Nature of previous treatment

Co-operation of previous treatment

Trauma to the dentition

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8
Q

when carrying out an orthodontic assessment what is important to note from their social history?

A 
Habits:
Thumb sucking 
Lower lip sucking 
Tongue thrust 
Chewing nails (can cause root resorption)
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9
Q

when carrying out an extra-oral examination which head position should the patient be in?

A

looking straight ahead with their frankfort plan parallel to the floor.

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10
Q

what should be examined in an extra-oral examination during orthodontic assessment?

A

Skeletal bases
Soft tissues
TMJ

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11
Q

what is it important to compare the patient to when carrying out an orthodontic assessment?

A

Compare the patient to their parent (especially class III)

look for Malocclusion
Growth potential

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12
Q

what 3 skeletal planes do we examine in a patient?

A

Antero-postero
Vertical
Transverse

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13
Q

how do we position the patient when examine the skeletal relationship? (3)

A

Patient can either be standing or seated

Ensure the Frankfort plane is horizontal to the floor = the superior border of the EAM to the lower border of the orbit

Or get the patient to look into their own eyes in the mirror which is a distance away

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14
Q

define a class I antero-postero skeletal pattern.

A

Maxilla 2-3mm in front of the mandible

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15
Q

define a class II antero-postero skeletal pattern.

A

Maxilla is > 3mm in front of the mandible)

These patients are retronathic: DONT have a small mandible it’s just further back on the skeletal base

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16
Q

define a class III antero-postero skeletal pattern.

A

Mandible is in front of the maxilla (maxilla is less than 2-3mm infront)

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17
Q

how do we assess the vertical skeletal pattern clinically ? (2)

A

We use the FMPA
- normal angle is 27 +/- 4

LAFH:TAFH - lower anterior face height to total AFH ratio

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18
Q

describe how the line from the frankfort plane and the mandibular plane interact in normal vertical skeletal patterns.

A

converge at the back of the head

normal angle is 27 +/- 4 degrees

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19
Q

describe how the line from the frankfort plane and the mandibular plane interact in increased vertical skeletal patterns.

A

lines meet way before the back of the head around the ear - Patient will have an AOB

long face angle is 31 degrees

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20
Q

describe how the line from the frankfort plane and the mandibular plane interact in decreased vertical skeletal patterns.

A

lines don’t converge at the back of the head - patient will have a deep bite

short face angle is = < 23

21
Q

what does the lateral skeletal pattern assess?

A

asymmetry

22
Q

what reference line do we use to assess asymmetry in the lateral skeletal pattern?

A

We use the mid sagittal reference line: draw a line down the inter-pupillary line (between the pupils) and down the cupids bow and chin.

23
Q

what are competent lips?

A

Competent: Lips meet at rest when the mentalis muscle is relaxed

24
Q

what are incompetent lips?

A

Incompetent: Lips do not meet at rest when the mentalis muscle is relaxed

25
Q

what impact does a lip trap have on orthodontic treatment?

A

Lip trap: may proline the upper incisors and lead to a relapse of the overjet if the LT persists after treatment.

26
Q

describe how lower lip activity leads to relapse after orthodontic treatment?

A

hyperactive/tight lower lips can lead to retroclined lower incisors and instability/relapse after treatment

27
Q

what malocclusion is tongue thrust associated with?

A

AOB

28
Q

name the 2 types of tongue thrust.

A

endogenous or adaptive i.e. have they got an AOB because they have a tongue thrust or is the tongue thrust there because they have an AOB (adaptive)

29
Q

what type of tongue thrusts can result in a relapsed AOB?

A

ENDOGENOUS

30
Q

What are he dental implications of digit sucking?

A

Proclined upper incisors
Retroclined lower incisors

Localised anterior open bite or incomplete open bite

Narrow upper arch +/- a unilateral posterior cross bite

31
Q

Why do patients who suck their thumb develop a posterior crossbite?

A

The mandible drops due to the position of the digits and the tongue is held lower

The cheeks moving in and out from the sucking narrows upper buccal segments.

The upper jaw is now the same width as the lower jaw

The patient unconsciously decides to bite down on one side to get maximum intercuspation.

32
Q

what should you examine in terms of the TMJ for an orthodontic assessment? (6)

A 
Path of closure
Range of movement 
Pain and clicking from the joint 
Deviation on opening 
Muscle tenderness 
Mandibular displacement
33
Q

what is mandibular displacement?

A

When there is inter-arch width discrepancies that cause the upper and lower cusps to meet
- mandible has to deviate to one side to avoid this and achieve ICP

34
Q

what can a severe mandibular displacement of >4mm lead to in the future?

A

TMJ disease

35
Q

what should the angle between the Frankfort plane and the long axis of the upper incisors be?

A

110 degrees

36
Q

define a class I incisor relationship.

A

the incisal edges of the lower incisors occlude the cingulum of the upper incisors

37
Q

define a class II div I incisor relationship.

A

the incisal edges of the lower incisors lie posterior to the cingulum of the upper incisors and the upper incisors are proclined or of average inclination

38
Q

define a class II div II incisor relationship.

A

the incisal edges of the lower incisors lie posterior to the cingulum of the upper incisors and the upper central incisors are retroclined

39
Q

define a class III incisor relationship.

A

the incisal edges of the lower incisors lie anterior to the cingulum of the upper incisors/the incisal edges occlude - reversed overjet

40
Q

list the types of overbites (6)

A

Average - upper incisors overlaps/covers 1/2 to 1/3rd of lower incisor crown

Reduced

AOB - record how large it is and the maximal extent of teeth involved

Increased and complete contacts tooth

Increased and complete contacts the palate - doesn’t have to be traumatic

Increased but incomplete (doesn’t contact anything)

41
Q

define a class I buccal segment relationship.

A

MB cusp of the upper 6 occludes with the buccal grove of the lower 6

42
Q

define a class II buccal segment relationship.

A

MB cusp of the upper 6 occludes anterior to the buccal fissure/groove

43
Q

define a class III buccal segment relationship.

A

MB cusp of the upper 6 occludes posterior to the buccal fissure/groove

44
Q

define a class I canine relationship.

A

upper canine is posterior to the lower

45
Q

define a class II canine relationship.

A

upper canine is anterior to the lower

46
Q

define a class III canine relationship.

A

the upper canine is very posterior to the lower canine

47
Q

what should be included on the orthodontic referral letter?

A

Name, age, sex of patient

HPC, RMH, RDH (relevant)

Incisor relationship and Skeletal base

Teeth present/absent, OH status and teeth with poor prognosis

Lower arch incisor inclination and crowing
Upper arch incisor inclination and crowing

OJ, OB centrelines, molar relationships, crossbites and any other information

IOTN (index of orthodontic need) score: this is how much the patient requires treatment from the point of dental health and improving their psychosocial wellbeing.

48
Q

What is the IOTD score?

A

index of orthodontic need score: this is how much the patient requires treatment from the point of dental health and improving their psychosocial wellbeing.

49
Q

how do we assess the anter-postero skeletal relationship clinically (2)

A

Palpate the skeletal bases

visual assessment

BDS3 1 (75 decks)

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