2. Orthodontics I Flashcards by J L

• Had to use ____ to place the bands
• Used phosphate cements instead of the current cements (now they have fluoride)
○ ____ below the bands have decreased
• ____ brackets are common in older patients
○ Stain resistant
• Self ligating brackets (on the right)
○ ____ brackets - have a cover slip that locks the wire in place vs the conventional rubber band that ligates the wire into the slot

separators
calcifications
ceramic
damon

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• Fixed palatal expanders - bands cemented on posterior teeth and expanison in the center (____) that gives tranverse width expansion
○ Used ideally in ____ treatment to create space and avoid posterior ____
• Fixed category
○ Space maker appliances - lingual holding arch
§ Has bands around posterior space
§ Maintains arch ____ in order to conserve primary molar space

jack screw
early
crossbites
perimeter

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• Work with OS to uncover palately exposed tooth

○ If no ____ assistance, can never get the tooth in its proper place

surgeon

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• Removable
○ Conventional hawley appliance
○ Most commonly used as ____/fixed ortho treatment
• Can add ____ and finger springs in order to get desired tooth movement

post treatment retention

jack screws

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• Corrective aligners - invisalign
○ Comprehensive treatment modality
○ Series of aligner trays that move the teeth in small increments over time
§ Changed every ____ weeks
○ Initial scan/impression > invisalign > virtualized version of tooth movement sent back > amend things that practioners change (number of ____, stages of tooth movement)
○ Esthetic and ____ benefit; but patients don’t wear ____ hours a day > cannot get a result close to braces
Bodily movements [???]
• Semi removable - head gear
○ Face bow and a head band
○ [???]

1-2
changes
hygienic
24

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• Bands set on posterior teeth
• Bow on labial bow (similar to facebow of headgear)
• Takes away labial and buccal ____ around dentition to allow for arch development
○ Narrowness in ____ segments
○ Teeth are retroclined and set back > allows for ____ arch development

musculature
posterior
passive

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Maloocclusion
- ____ is shifted 3mm to right hand side; primary canine is still present
- Max lateral incisor is ____

maxillary midline

undersized

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Undersized L lateral incisor

* Primary canine with no sign of permanent ____

canine/lateral incisor

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Under primary canine is perm canine
- Missing the lateral, OH NOES!
- Third molars are developing
- Do we substitute the canine for the lateral? Do we make space for the lateral and move canine back?

YAY

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• ____ give evaluiont into skeletal arrangement

cephalometrics

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20 ____ (10 max 10 man)
- Interdental spacing
- 11-12+ phase ____ (comprehensive treatment)

primary

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• Less interdental spacing
• Maxillary aspect, the posterior segments have a narrow inclination
○ Maxillary arch constriction
○ No crossbites of posteriors
• Consider both cases
○ Higher probability - less space
§ No interdental space > FOR SURE going to have a ____ problem that you will have to handle once reaching mixed dentition
○ Would rather have as much ____ as possible - when perm’s replace > will be large > the extra space will allow more space

crowding

space

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At 7 y/o - early mixed dentition
- Perm ____ in
- Exfoliated of six primaries - emergence of permanent first molars
- Recommendation of AAO > treat patients in interceptive manner at ____, but not every patient needs treatment at same time

first molars

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• 8 y/o
• Early mixed dentition
○ Exfoliated prim laterals, and centrals and same in man
○ Perm first molars emerged
• ____
○ Bites in MIC > upper right CI is locked behind man CI
• Definitely ____ the patient (interceptive treatment)
○ If left in this scenario:
§ Patients who are younger are more amenable to ____ > maximize orthopedic potential and allow for teeth to come into better placement > do not have luxury on patients who are older (fusion on mid palatal suture)
§ Patient will be more susceptible to ____
§ ____ wear on max incisor
§ Perio: when patient in MIC > the lower CI > can procline and come forward even more > ____

anterior crossbite
treat
palatal expanders
caries
facial
recession

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____ is set to keep a palatal force on CI to bring it labial
- ____ built on to increase arch perimeter

finger spring

jack screw

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• Increasing perimeter (with ____ expansion) to give room for lat incisor, and the sagittal dental correction (finger spring) to fix the ____
• Most patients still need future treatment > so many factors:
○ Replacement of teeth
○ Aspects of functional occlusion

transverse

crossbite

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• Anterior crossbite, spacing
• Open bite (on bottom)
• Dental, skeletal problem?
• Class III diagnosis
○ Is it dental? Molar/canine relationship?
○ Is it skeletal? Mismatch of maxilla and mandible?

YAY

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Orthodontic Classification
Developed by \_\_\_\_ 
Originally based upon the relationship
between the \_\_\_\_ 
\_\_\_\_ groups of occlusion

edward angle
first molars
four

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Normal occlusion

• [???]
• Max-canine relationship
	○ Cusp of canine sits in between embrasure between \_\_\_\_ and \_\_\_\_

mandibular first PM

canine

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Class I malocclusion

• Identical molar relationship of original
• Max-man anterior \_\_\_\_
• Increase \_\_\_\_ from CI
• Most common malocclusion in \_\_\_\_
	○ Other parts of world > different forms of malocclusion

crowding
overjet
north america

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Class II malocclusion (division 1 and 2)

• Different molar relationship all together
	○ MB of man molar sits \_\_\_\_ to the buccal groove
	○ Max canine is a full step \_\_\_\_ of where it should be (should be in embrasure between PM and canine)
• Div 1 vs 2
	○ Position of the maxillary \_\_\_\_
	○ I: excess \_\_\_\_, spacing between teeth or teeth can be well \_\_\_\_
	○ II: minimal overjet, often \_\_\_\_ bite, and the LI are normally \_\_\_\_ or proclined; CI have a \_\_\_\_ back position to them

anterior
ahead
incisors
overjet
aligned
deeper
inclined
tipped

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Class III malocclusion

• Opposite of Class II
	○ MB of max molar sits \_\_\_\_ to the buccal groove
	○ Canine is also \_\_\_\_ to the the canine/PM

distal

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History of Cephalometrics
1931 \_\_\_\_ (United States) 
1931 \_\_\_\_ (Germany)
Primarily a\_\_\_\_ tool 
\_\_\_\_ radiographic technique

broadbent
hofrath
research
standardized

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• Purpose on stadnardizing on film of 2D
○ ____ distance from x-ray source to the sensor/cassette
○ Why? > compare ____ ceph’s in order to see what changes have occurred

fixed

pre- and post-treatment

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Types of Cephalometric Radiographs n Lateral –____ n Posteroanterior –____ • ____ radiographs

sagittal and vertical transverse and vertical 2D

• Lateral ceph ○ ____ ○ ____ dimension

front to back | vertical

• PA ceph ○ ____ width as it relates to mandible • Need ____ 2D radiographs to give the 3D aspect

transverse | two

Horizontal Reference Planes Anterior Cranial Base (____) Frankfort Horizontal (____) Palatal Plane (____) Occlusal Plane Mandibular Plane (____) • HRP - connect two points to give basis of other points ○ 4/5 of have specific landmarks that denote the HRP • OP > going from ____ > doesn't have any ____ ``` MANDIBLE 1. Mandibular pts hv higher probabilities of location bc no ____. 2. Bone type makes a difference. Here we have cortical bone, which is much more defined than cancellous bone that can be masked by ____ (e.g. maxilla) ```

sella to nasion porion to orbitale posterior nasal spine to anterior nasal spine gonion to gnathion or lower mandibular border superior to inferior landmarks overlying structures connective tissue and musculature

* Most superior HRP > ____ * Second > ____ * Next > ____ plane * Next > ____ plane (no landmarks) * Last > ____ plane

``` sella to nasion porion to orbitale palatal occlusal mandibular ```

Cephalometric Analyses n 2 Types of Measurements ANGULAR (in ____) LINEAR (in ____) n Evaluation of ____, DENTOALVEOLAR & ____ n Various Analyses

degrees millimeters skeletal profile esthetics

Evaluation of the Sagittal Dimension n SKELETAL Evaluation Class I Class II Class III n DENTOALVEOLAR Evaluation • Apply angle classification to skeletal aspects for patient ○ I, II, or III? Apply to ____ aspects

skeletal

Angle Classification Originally, ____ relationship CEPHALOMETRICS; Applied to ____ SKELETAL MALALIGNMENT

molar | sagittal

Which structures are contributing to the problem? Good max/mand alignment; but max teeth are ____ Upper teeth line up well with maxilla, but it’s ahead of the ____ Mandibular teeth are ____; everything else is in good alignment ____ mandible (underdeveloped) though everything is aligned properly

proclined mandible retroclined retrognathic

Class I skeletal | ◼ Maxilla & Mandible are ____

well-aligned

ANB ANGLE ◼ Evaluates the magnitude of the discrepancy between the ____ In Class I, ANB angle is minimal ~____o (normal), so ____ should sit 2o ahead of B pt when we measure.

maxilla and mandible 2 maxilla

``` Class II skeletal ◼ Maxilla & Mandible MALALIGNED cDue to: 1. ____ Protrusion 2. Mandibular ____ 3. Combination of Above ```

maxillary | retrognathia

Figure 3 • Measure ANB ○ More signifcant angle than in Fig 2 § Now have an ____ degree angle: □ ____ discrepancy □ CANNOT MAKE ANY MORE INFERENCES - only tells ____ is well ahead of mandible ® But it can be ANY of the three ____ from above

8 class II maxilla criteria

• How to determine fault is in max or man ○ Look at two more angles > ____ angles § Looking at HRP • Anterior cranial base (____) to look at maxilla separate form mandible ○ SNA • SNA ○ 83 dgerees, should be ____ SNA Angle n Evaluates the position of the ____ using the anterior cranial base (Sella- Nasion) as a reference plane

SNA and SNB sella to nasion 82 maxilla

SNB Angle n Evaluates the position of the ____ using the anterior cranial base (____) as a reference plane • USE TO TEST MANDIBULAR VERSION2 • Now 75 degrees in comparsion to ____ degrees ○ Much lesser now • WE NOW KNOW THE CLASS II IS DUE TO ____ MANDIBLE ○ The three angles (sagittal), and how the maxilla aligns to the mandible

mandible sella to nasion 80 retrognathic

``` Class III skeletal n Maxilla & Mandible MALALIGNED Due to: 1. Maxillary ____ 2. Mandibular ____ 3. Combination of Above ```

retrusion | prognathia

Figure 4 • A point sits well behind B point > -8 (but should be ____) ○ The converse of the class II patient • Use SNA and SNB to determine the jaw at fault ○ SNA: 73 ○ SNB: 81 § The problem has to do with the fact that that maxilla is ____

+2 | retrognathic

Dentoalveolar Evaluation (Maxillary) ``` n Angular Measurement (____) Describes how the tooth is ____ Described as: PROCLINED RETROCLINED NORMAL INCLINATION ```

incisor to nasion-A | tipped

Figure 5 • Measure is 37; the norm should be ____ degrees ○ These teeth are much more flared ____ (the greater the angle) ○ In order to get teeth back into more ideal position > decrease the angle by 15 degrees

22 | forward

``` Dentoalveolar Evaluation (Maxillary) n Linear Measurement (____) Describes how the tooth is related to its ____ Described as: PROCUMBENT RECUMBENT NORMAL POSITION ```

incisor to nasion-A | supporting bone

Figure 5 • Measurement is 7mm, normally it should be ____mm ○ The teeth are ____ positioned forward compared to the skeletal/maxilla itself

4 | bodily

Dentoalveolar Evaluation (Mandibular) n Angular Measurement (____) Describes how the tooth is ____ Described as: PROCLINED RETROCLINED NORMAL INCLINATION Figure 6 • Measure is 34 degrees, and 8mm from incisor ○ Normal should ____ degrees, and ____mm like the maxillary aspect

incisor to nasion-B 24 4

Dentoalveolar Evaluation (Mandibular) n Linear Measurement (____) Describes how the tooth is related to its ____ Described as: PROCUMBENT RECUMBENT NORMAL POSITION

incisor to nasion-B | supporting bone

Dentoalveolar Evaluation (Mandibular) n Angular Measurement (____) Describes how the tooth is ____ Described as: PROCLINED RETROCLINED NORMAL INCLINATION • Intersection of line through ____ of incisor, and line of anteiror plane • Should be 87 degrees/90 degrees ○ Important angle > in past > essential angle orthodontically because some practioners thought if angle was violated to ____ > unstable teeth and much greater tendency of relapsing and things ____ back

incisor to Go-Gn tipped 95+ shifting

Evaluation of the Vertical Dimension n Evaluates ____ pattern n ____ Described as: HIGH PLANE ANGLE LOW PLANE ANGLE NORMAL PLANE ANGLE Bill has a very low, flat mandibular plane angle and will have a tendency toward counter-clockwise growth, more towards a ____ face height. Conversely, Vanessa has a steep mandibular plane angle and thus greater lower and higher face heights in proportion to middle third. The tendency is towards a clockwise, or ____ mandibular growth pattern. So the vertical aspect is not just one dimension, but is dynamically related to the other dimensions as well. Ppl w steeper Mandibular plane angles are also more susceptible to an ____ bite tendency. We’d want to target extruding posterior teeth which can produce a more significant anterior overbite.

vertical skeletal | mandibular plane to frankfort horizontal

``` Evaluation of Profile Esthetics n Evaluation of the patient’s lips to the E-line (____) Described as: ____ RETRUSIVE NORMAL ``` E-line: consists of the most forward position of the ____ in relation to the most forward position of the mandibular lip along with tangents to the tips of the nose and chin This patient has positive values. There are normal values, but also negative ones. In the past, it was ideal for the lips to be behind the E-line, but now we prefer the lips to be on the line, or slightly____ of the line

esthetic line protrusive maxillary lip

Advantages of Cephalometrics ◼ Evaluation of ____L relationships ◼ Assessment of ____ ◼ Assessment of ____ ◼ ____ of treatment effects with growth & surgical treatment ---We use cephmetrics when a patient requires corrective jaw surgery to give us and pinpoint how we really want the maxilla and mandible to move. Is it a one jaw, or 2 draw surgery? It helps us quantify how much movement we need specifically in the mandible and maxilla. ◼ evaluation of ____

``` skeletal dental treatment effects prediction pathology ```

Disadvantages of Cephalometrics ◼ 3-DIMENSIONAL patient portrayed on a 2-dimensional film --Because when you superimpose 3D images into 2D, esp structures with varying bone densities, ____ can result. ◼ ERRORS in ____ ◼ Difficulty in developing ____ --When comparing the ceph angles, normative values will differ based on ____. Must be aware of this. Mixed race ppl may defy any particular set of norms. So how do you evaluate and treat Pt?

inaccuracies and distortions measurement normative data race

CBCT Provides cone-shaped x-ray beam versus linear beam In conventional radiography ____ digital image with high ____ ____ radiation emission versus conventional CT scan ____ cost for equipment (~$150,000ormoretoinstall) Newer ____ for ceph analyses With this very precise technology, we expect the normative values to change and refine over time.

``` 3D resolution lower high standardization ```

We can even make specific cuts to give us what you would have with conventional 2D radiography, but main use of CBCT is to locate ____ teeth, specific ____ issues for certain teeth.

malpositioned | angulation

Still the elephant in the room concerns how much ___ the patient is exposed to. It’s much less than medical CT’s but greater than some aspects of ___.

UV | conventional 2D radiography

____ to locate ceph points using digital radiographs You still have to locate the points, but the values will be given to you, making this process much faster. We can even lay over Patient profiles and simulate ____ outcomes for them to view.

faster | patient

Postero-anterior Ceph Evaluates the ____ dimension Uses the ____ Evaluates the skeletal width of the ____ to the mandible

skeletal transverse rocky mountain transverse analysis maxilla

Lateral ceph is limited in the sense that it only gives you the ____. But, if we also want to look at the transverse skeletal aspect, we need to take a ____ (e.g. PA or AP cut of CBCT).

sagittal | PA ceph

Orthodontic Records Study models/Digital 3D intraoral scan ____ Periapical & Bitewing Radiographs ____Photographs Lateral Cephalometric Radiograph ____ Radiograph or CBCT

panorex intraoral & extraoral posteroanterior cephalometric

____ due to maxilla itself is further ahead than where it should be Angle of upper incisors in comparison to the norm, we see a lot of ____ , teeth that are tipped forward. Lower are a bit ____ but still central incisors are close to the norm; we’re just lacking space for the lateral lower incisors. So, we need to make space to bring them forward.

class II proclination retroclined

TREATMENT: Removed all her ____ (4 total) With fixed appliances, we created space for her ____ We’re attracting mandibular canines to the positions of the extracted premolars. ____ have been brought forward and look “good” positionally. However, their roots are still in the back. So, bear in mind, some tx, like Invisalign, are limited in ____ movement potential. Correcting the root position requires stronger, ____ wires to do

``` first premolars lat incisors lat incisors crown-root rectangular ```

JOSH Extraoral Eval. (profile) - outline: extremely convex - nasolabial angle: WNL - soft-tissue chin: adequate - lip posture: competent Presents with this malocclusion: minimal ____ (~3mm); ____ shift quite a bit to his right

overjet | midline

JOSH We see a ____molar relationship (mesial buccal cusp of max molar sits well ahead of where the buccal groove should be. Max canine is almost blocked out bc no space between 1st premolar and lateral incisor.

class II

From ceph details, we find cause of malocclusion to be ____. Unlike Kathleen, bc he’s 16/17, we don’t anticipate any more ____ growth, which in some cases may correct the problem. Upper incisors are ____, hence, the minimized overbite of 3mm.

retrognathic mandible developmental retroclined

JOSH TREATMENT Treatment: Created space for blocked out canine; retained ____ molar relationshp. We now have a Class II “canine” relationship - the max canine should be sitting between lower canine and premolar. The overjet has increased significantly improving the ____ The patient had corrective ____ surgery (a bi-sagittal split mandibular osteotomy, a ____ advancement procedure).

class II midline jaw surgery

Explains what a bisagittal split mandibular osteotomy entails: 1. Remove ____ molars, 2. Split the ____, keeping ____ intact, 3. They reposition upper and lower jaws and stabilize the mandible with ____ screws.

third mandible infr-alveolar nerve

2. Orthodontics I Flashcards

(66 cards)