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Orthodontics > 25. Concepts of primary and secondary prophylaxis of malocclusion preadolescents and adolescents ( 7-19 years old) > Flashcards

25. Concepts of primary and secondary prophylaxis of malocclusion preadolescents and adolescents ( 7-19 years old) Flashcards

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1
Q

Primary prophylaxis and when it is performed

A
  • Performed when malocclusion has not yet developed
  • Targets environmental factors that can lead to malocclusions
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2
Q

Environmental factors targeted in primary prophylaxis to prevent malocclusion

A
  • Oral hygiene
  • Oral gymnastics
  • Healthy diet
  • Regular dental check-ups
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3
Q

Secondary prophylaxis

A

Performed when malocclusion is already present

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4
Q

How secondary prophylaxis usually carried out

A

Performed using orthodontic appliances

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5
Q

Why education important during pregnancy in preventing malocclusions

A
  • Inform patient about environmental factors=>
  • Prevent injury of unborn child=>
  • Preventing malocclusions
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6
Q

Normal sequencing of permanent dentition in preadolescents

A

-

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7
Q

Importance of maintaining tooth shedding timetable in preadolescents

A
  • So interval between shedding of primary teeth and eruption of permanent teeth not > three months=>
  • Delayed eruption=> over-retained deciduous teeth roots
  • Non-resorbed deciduous root fragments
  • Supernumerary teeth, cysts and tumors
  • Overhanging restorations, and ankylosed primary teeth.
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8
Q

Possible causes of open bite in preadolescent children

A
  • Normal transition as primary teeth replaced by permanent teeth
  • Habits=>finger sucking
  • Tooth displacement by resting soft tissues
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9
Q

Importance of extracting supernumerary teeth in preadolescents

A
  • Interfere w/ eruption of nearby normal teeth=>
  • Deflect adjacent teeth
  • Erupt in abnormal positions
  • Identified and extracted before displacement of other teeth
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10
Q

Interceptive orthodontics and when is it used

A
  • When problem already manifested=>
  • Prevent potential malocclusion from progressing
  • Some procedures from preventive orthodontics can also be carried out in interceptive orthodontics
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11
Q

Serial extractions and when they are indicated

A
  • Planned extraction of certain primary teeth=>
  • Guide erupting permanent teeth into more favorable position
  • Indicated=»
  • Class I malocclusions showing harmony between skeletal and muscular systems
  • In cases of arch length deficiency
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12
Q

How developing anterior crossbite corrected in preadolescents

A
  • Aka reverse overjet=>
  • Tongue blades
  • Catalan’s appliance
  • Double cantilever springs
  • Functional anterior crossbite=> Eliminating occlusal prematurity
  • Skeletal anterior crossbite=> Myofunctional or orthopedic appliances

-Should be intercepted and treated early

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13
Q

How abnormal oral habits controlled in preadolescents

A

Habit-breaking appliances and behavioral training

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14
Q

Space regaining and how its performed in preadolescents

A
  • Counteracts reduction in arch length due to early loss of primary molars and failure to use space maintainers=>
  • Distal movement of first molar=>
  • Gerber’s Space Regainer
  • Jack Screws
  • and Cantilever Spring
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15
Q

Optimal period for using functional appliances in adolescents(11-18)

A
  • End of mixed dentition stage until permanent dentition established=>
  • Help guide proper development of dental and skeletal structures
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16
Q

Monoblock characteristics

A
  • Tooth borne appliance(can be combined)
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17
Q

Monoblock elements

A
  • Bi maxillary acrylic base
  • Labial bow(0.8-0.9mm)
  • Retention claps(0.7mm)
  • Active springs and or expansion screws
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18
Q

Monoblock uses

A
  • Maxillary prognathism-II
  • Mandibular prognathism- III
  • Symetrical bimaxillary compression
  • Lateral deviation of mandible
  • Deep and open bite
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19
Q

Monoblock working bite registration

A
  1. Sagittal plane-Mesial and distal/Class II/Class III
  2. Vertical plane
  3. Sagittal plane

  1. Mesial and distal occlusion recorded in class I/ In class II mandible protruded forward, in class III mandible retracted until edge to edge
  2. 1-2 mm bite opening between incisal edges of max and man teeth
  3. Midlines aligned
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20
Q

Monoblock acrylic base borders in maxilla

A
  • Incisal egde of incisors and canines buccally
  • Middle of occlusal surfaces of premolars and molars
  • Distally-distal surface of molars
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21
Q

Monoblock acrylic base borders in mandible

A
  • Lingual surfaces of mandibular anteriors-2-3 mm under cervices
  • 5-6mm below mylohoid line in molars and premolars
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22
Q

Monoblock advantages

A
  • Treats occlusal problems
  • Changes muscle function
  • Eliminates bad habits
  • Acceptable wear time-14-16 hours
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23
Q

Monoblock therapeutic principle

A
  • Mandibular protraction to class I
  • Mandible moved mesially and condyle position changed
  • Anterior interocclusal acrylic intrudes mandibular front teeth
  • Posterior interocclusal acrylic discludes bite-corrects deep overbite(vertical discrepancies)
  • Acrylic grinded distally in maxilla and mesially in mandibe-> posterior teeth eruption guidance and bite opening
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24
Q

Monoblock therapeutic principle when expansion screw added

A
  • Interocclusal acrylic transfers active force to posterior teeth
  • Moved buccally
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25
Monoblock time of use
At night and 2-3 hours during the day
26
Activator characteristics
* **Tooth borne passive myotonic appliance** * Effective for **class II**=> * *Correction of muscle function* * *Growth spurt utilisation* * *Eruption guidance*
27
Activator elements
* *Labial bow* (0.8-0.9mm)-Anterior area for retention and/or tooth movement * *Retention clasps* (0.7-0.8mm)-Adams, circumferential clasps * *Supplemental elements*-Active springs, coil springs for headgear, expansion screws * *Acrylic base* ## Footnote circumferential clasp where molar tubes for headgear are present
28
Activator construction bite
1. Sagittal plane=>maximal mandible protrusion then 3mm distally 2. Vertical plane-=>bite opened between incisal edges of maxillary and mandibular anterior teeth- 4,8,10 3. Sagittal plane-=>midlines aligned
29
Activator indications
* Class I open bite/deep bite * Class II division 1 and 2 * Class III * Laterognathia * Post treatment retention
30
Activator contra-indications
* Class I problems w/ crowding * Nasal stenosis ## Footnote Nasal stenosis-narrowing of nasal cavity
31
Activator advantages
Little routine adjustments
32
Activator disadvantages
* Bulky * Requires good patient co-operation * No precise detailing of occlusion
33
Difference between activator and monoblock
* Working wax bite * Increased vertical opening * Midlines aligned * Greater length of lingual wings
34
Activator fabrication requirements
* **Precise impression taking** * Lower impression tray extended manually to reach **mylohoid line=>** * Where lower border of activator lies
35
Acrylic base of activator
* Extends to palate, interocclusal space between posterior teeth and then to lingual surfaces of mandiular anteriors * In mandibular posterior area- extends 12 mm apically to first molar gingival margin * Mandibular anterior teeth area relieved with wax ## Footnote Wax seperation to avoid acrylic lodging in area of mylohyoid line Wax relief to present mandibular anterior teeth proclination
36
Activator time use
* Optimal time during **second premolar eruption phase-peak of pubertal growth** * Worn at **night(12-14 hours)** * Can be used **w/ facebow headgear**
37
Upper anterior inclined bite plane use in adolescents
* **Tooth-borne active functional appliance applied in maxilla**=> * *Mesial protraction of mandible*
38
Frankel functional regulator characteristics
* **Tissue borne passive functional appliance** * *Myodynamic and myotonic action*
39
Frankel regulator indications
* Class I w/ mandibular anterior teeth retroclination * Class II div 1 w/ severe overjet * Class II div 2 w/ maxillary constriction * Class III w/ mandibular anterior teeth proclination * Open bite
40
Frankel regulator types
* Type I- **Functional regulator(Class I and mild Class II)** * Type II- **Class II div 1 and 2** * Type III- **Class III** * Type IV- **Anterior open bite and bimaxillary proclination** * Type V- **W/ headgear**
41
Frankel regulator parts of appliance
* Acrylic base-Buccal shield, lingual shield, acrylic pads * Labial bow * Lingual, Palatal, Labial support wire * Canine extension loop
42
Frankel working bite registration
* Sagittal plane- mandible advanced to Class I * Vertical plane- Enough vertical opening(2.5-3mm) for cross over wires to pass through interocclusal area * Sagittal plane- midlines aligned
43
Fabrication technique for Frankel appliance
* Requires very precise impressions * Well imprinted vestibular sulcus in labial and buccal area * Frenula of lips and tongue * Bucco-gingival frenula and sublingual area
44
Frankel regulator acrylic base components
* Two labial pads * Two buccal shields * One lingual shield
45
Frankel regulator buccal shields
* 2mm thickness * **Borders**=>vertically-deep into vestibular sulcus of maxilla and mandible * **Anterior**=>to mesial surface of first permanent premolar or primary molar in maxilla or mandible * **Posterior**=>To distal surface of maxillary and mandibular first molar
46
Acrylic base of frankel I and II
* Wax layer added=>*relief between acrylic parts and dentoalveolar region* * Thickness=>*3mm in area of teeth and 2.5mm in vestibular sulcus* ## Footnote Wax relief done w/ care to ensure correct adjustment of apppliance and expansion of ridge
47
Acrylic base in Frankel III
* In mandible=>fits tightly on alveolar ridge buccally * Wax relief only to upper model in ridge area * Interocclusal acrylic ## Footnote Design blocks unfavourable mandibular growth
48
Acrylic base of frankel IV
* **Buccal shields acrylic base same as frankel I and II**=> * Interocclusal acrylic designed individually taking into account their form and location * They should avoid interfering with distal translation of mandible and additional bite opening ## Footnote Interdental embrassures and rests of buccal shields have to be avoided
49
Acrylic base of Frankel V
* Buccal shields have molar tubes in maxillary molar area=> * Insertion of inner bow of headgear appliance
50
Lingual shield of frankel
* Present in Frankel I and II * In sublingual area and on lingual surfaces of mandibular teeth * Extends from left to right second premolars(primary second molars) * Holds mandible in mesial position * Retentive inflections of lingual bow and springs connecting wires are embedded in acrylic of shield
51
Acrylic pads position on Frankel
* On lateral sides of upper and lower labial frenuli * 6mm apical of cervices of central incisors * Deep in vestibular sulcus * Oval shape and thickness of 2mm * Stimulate apical base development ## Footnote In mandible in Frankel I, II, IV and V, Maxilla in Frankel III
52
Wire elements of frankel
* Maxillary labial bow * Canine extension (canine loop) * Lingual and Palatial support wire * Support wires for labial pads
53
Labial bow of Frankel regulator
* **9mm round stainless steel wire** * In **maxilla in Frankel I, II, IV and V, mandible in III** * Starts from **buccal sheilds w/ rententive inflections, half loops and crosses incisors at midpoints** ## Footnote Loop portion must be 2mm away from tissue above canines-important when permanent canines erupting as may be hit if bends incorrect
54
Klammt elastic open activator characteristics
* **Tooth borne passive myodynamic appliance** * Eliminates abnormal function and re-establishes balance between perioral muscles and tongue * 24 hour wear
55
Klammt appliance indications
* Class II w/ deep overbite * Mixed dentition ## Footnote Other indications include: * Open bite * Anterior teeth proclination and retroclincation * Biprotrusion of anterior teeth
56
Klammt appliance elements
* Acrylic base * Maxillary and mandibular labial bow (0.9mm) * Maxillary and mandibular protrusion springs (0.7mm) * Palatal bow (1.2 mm)
57
Labial bow for klammt appliance
* **Identical for maxillary and mandibular teeth=>** * **Parallel at most prominent buccal surface of anteriors** * Initially, retention inflections on left and right side bent=> * Wire continues buccally from contact point of canines and first premolars(first primary molars) to midpoint of buccal surface of first molars distally=> * Formed into loop and guided back from where they are bent-palatal or lingual into retension
58
Protrusion springs for klammt appliance
* Extend from distal surface of left canine to distal surface of right canine in maxilla and mandible * For incisor extrusion-springs in gingival third of incisor crown * For incisor intrusion- springs in incisal third * Protrusive force enhanced by tongue function * Flexibility of springs increased when cut through middle ## Footnote To protect tongue-cut ends inserted w/ plastic tube
59
Palatal bow for Klammt appliance
* Bent similar to coffin spring * Connects acrylic parts * Adapted to shape of palate and located 1.5-2mm from soft tissue * Functions to Support the appliance
60
Acrylic base for klammt appliance
* Two lateral parts extending from mesial surface of canines to first molars in maxilla and mandible * Occlusal surfaces of posterior teeth half covered with acrylic ## Footnote * Occlusal acrylic surfaces are grinded gradually after a certain period of appliance wear(14 days), first trimmed distally to allow eruption of posterior teeth
61
Modifications of klammt appliance with regards to wire elements
* **Tongue barrier crib**-instead of protrusion spring in open bite treatment * **Zig-zag shaped mandibular labial bow** for lip sucking habit * **U-loop in canine area of labial bow**-anterior teeth retraction * **Maxillary and mandibular acrylic pads**-stimulation of apical base development
62
Balters bionator Characteristics
* **Removable myodynamic functional appliance** * Restores balance between muscles of tongue, lips and cheeks
63
Balters bionator indications
**Class II div 1 in mixed dentition** under the following conditions: * *Well aligned dental arches* * *Functional retrusion* * *Mild to moderate skeletal discrepancy*
64
Balters bionator contraindications
* **Class II caused by maxillary prognathism** * **Labially tipped lower incisors**
65
Balters bionator elements
* Labial bow * Palatal bow * Acrylic base

Orthodontics (103 decks)

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