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Ortho Final > 2B > Flashcards

2B Flashcards

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1
Q

Clear aligners

A

● Esthetics highly valued in US more than other countries

○ Treatment is becoming more esthetic → colorful ties; shaped brackets; ceramic brackets/wires; clear braces (aligners)

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2
Q

● Adult vs. Child acceptability of orthodontic appliances:

A

○ Clear trays & ceramic were esthetically acceptable for both child & adult
○ Stainless steel was acceptable for child 70%, but only 50% for adults

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3
Q

Clear aligner advantages:

A

● Esthetics
● Hygiene (bc removable)
● Comfort
● Tooth movements (intrusion of posteriors; other movements more difficult)

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4
Q

Clear aligner Limitations:
● Tooth movements:
○ Translation →

A

difficult to put force & moment with plastic tray

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5
Q

Clear aligner Limitations:
● Tooth movements:
■ Tipping & uprighting

A

easier to achieve

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6
Q

Clear aligner Limitations:
● Tooth movements:
○ Rotation →

A

difficult; possible to rotate round teeth

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7
Q

Clear aligner Limitations:
● Tooth movements:

○ Extrusion →

A

very difficult; esp. for triangular shaped teeth like incisors (only a small area of undercut to grab onto)

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8
Q

Clear aligner Limitations:

● Speed ⇒

A

0.25mm/aligner

○ Often changed 2x month, so total 0.5mm/month

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9
Q

■ Speed disadvantage is overcome when you have

A

multiple movements going on at once, ie. intrusion on some teeth, extrusion & rotation on other teeth)

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10
Q

○ Conventional braces ⇒

A

1mm/month

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11
Q

Clear aligner

● Expense -

A

neutral

○ Added lab expense, but reduced treatment time & less frequent readjustments

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12
Q

Invisalign Process (submitting to company):

A
  1. PVS impression (or intra-oral digital scan) & bite registration
    ● PVS impression of uppers & lowers (even if only treating 1 arch)
    ○ Tray needs to reach distal of terminal molar
    ○ Don’t need to capture palate
    ○ Seat impression vertically without tilting (unlike seating alginate posterior to anterior to express excess)
  2. Panoramic radiograph or full mouth series
  3. Extra & intra-oral photographs
  4. Prescription form (online submission)

Bit registration & panoramic/full mouth series no longer required

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13
Q

Invisalign treatment options:

● Express ⇒ maximum

A

10 stages with some clinical restrictions
○ Maximum extrusion of 0.5mm
○ Max. posterior extrusion of 0.5 mm
○ Max. interproximal reduction of 2mm per arch (treats 2 mm of crowding)
○ No sagittal (AP) corrections required

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14
Q

Invisalign treatment options:

● Full ⇒

A

unlimited stages; up to 3 refinements & mid-course corrections available

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15
Q

Invisalign treatment options:

● Teen ⇒

A

similar to full

○ Has compliance indicators & eruption tabs (maintains space for eruption)

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16
Q

Invisalign treatment options:

● Assist ⇒

A

reboot treatment or have more checkpoints

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17
Q

Invisalign:

● Choose where to place

A

attachments (composite buttons placed to facilitate movement of teeth

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18
Q

Invisalign:

○ Don’t place attachments on

A

implants, 3 unit bridges, or ceramic crowns (will have to repolish)

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19
Q

Invisalign:

● Treatment will affect

A

overbite/overjet & midline - program shows resulting changes after alignment

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20
Q

Invisalign:

○ Interproximal reduction may be necessary to maintain

A

initial position

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21
Q

Invisalign:

● For pts with spacing →

A

can close all spaces or maintain spaces (for implants, etc)

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22
Q

Invisalign:

● For pts with crowding → can correct

A

via lateral expansion of molars/premolars

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23
Q

Invisalign:

● Need to check how they plan to move

A

teeth (some movements are not easily done with invisalign)

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24
Q

Invisalign works like a

A

flexible archwire
● Amount of force determined by amount of distortion & tray material
● Attachments help direct the forces

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25
Before choosing to procline teeth to correct crowding, make sure there’s no
recession
26
Normal physiology of sleep: | ● Characterized by
decreased body temp, metabolic rate, sympathetics, but active brain
27
Sleep | ○ Decreased sympathetics:
↓ HR, BP, RR
28
Sleep | ● Not a ‘time out’ ⇒
increased parasympathetics & GH secretion
29
Non-REM sleep
● 3 stages ranging from light dozing to deep sleep | ● 75% of sleep
30
REM (rapid eye movement) sleep
● 25% of sleep ● Dreaming occurs ● Characterized by eyelid fluttering, rapid eye movement, irregular breathing ○ Muscle paralysis (prevents moving during dreams) ○ ↓ body temp & changes in HR & BP
31
Sleep deprivation ⇒ leads to
excessive daytime sleepiness (falling asleep during day)
32
● Sleeping < 7 hours ⇒
increases risk of falling asleep during day, while driving, & snoring ● Sleep deprivation affects mood & performance
33
Sleep deprivation | ● Causes:
``` ○ Voluntary behavior (most common cause) ○ Medical: ■ Dyssomnias ⇒ ■ Parasomnias ⇒ ■ Medica/psychiatric ⇒ ```
34
■ Dyssomnias ⇒
insomnia; narcolepsy, restless leg syndrome, sleep disordered breathing)
35
■ Parasomnias ⇒
sleepwalking; bruxism
36
■ Medica/psychiatric ⇒
anxiety; depression
37
Continuum of Sleep disordered breathing:
● Normal ● Non-sleepy snorer ● Sleepy snorer (Upper Airway Resistance Syndrome) ● Obstructive Sleep apnea (OSA)
38
● Non-sleepy snorer
○ Snoring bc windpipe closes slightly during sleep when muscles relax
39
● Sleepy snorer (Upper Airway Resistance Syndrome)
○ Smaller windpipe causes inflammation - airway size disturbs sleep
40
Apnea ⇒ cessation of breathing
>10sec
41
Hypoapnea ⇒
decreased airflow (30 or 50%) ass. with O2 desaturation of 3-4%
42
Apnea-Hypopnea Index (AHI) =
total # of apnea + hypopnea / hours of sleep
43
● Severity of sleep apnea:
○ Normal < 5 ○ Mild 5-14; Moderate 15-30 ○ Severe > 30
44
Normal sleep O2 saturation =
94-98%
45
All O2 desaturations
90% medically significant
46
OSA ⇒ AHI at least
5 + daytime somnolence
47
OSA: | ● Prevalence:
○ More common in males | ○ Worsens with age & increasing weight
48
Obstructive Sleep Apnea: | ● Breathing disorder with
intermittent hypoxemia & sleep arousals
49
Obstructive Sleep Apnea | ○ Apnea →
Hypoxia/hypercapnia stimulates sympathetic response → increases ventilatory effort & causes arousal from sleep
50
Obstructive Sleep Apnea | ○ Increased sympathetics →
cardiovascular complications
51
Obstructive Sleep Apnea | Causes:
○ Anatomic airway narrowing ■ Obstruction can be in nasopharynx; oropharynx (70%), hypopharynx ○ Sleep induced loss of muscle tone ■ Neuromuscular compensatory mechanisms keep airway open when awake ○ Insufficient dilator muscle contraction
52
Obstructive Sleep Apnea ● Clinical consequences:
○ Excessive daytime sleepiness (affects mood & 2x likely for car accident) ○ Increased sympathetic tone → increases risk for HTN, coronary artery disease, CHF
53
Obstructive Sleep Apnea | ■ Treatment of OSA with CPAP reduces
HTN
54
Obstructive Sleep Apnea | Comorbidities ass. with OSA:
``` ○ Drug resistant HTN (83%) - uncontrolled by 2+ antihypertensives ○ Obesity (77%) ○ Congestive heart failure (76%) ○ Diabetes (50%) ○ Benign HTN (37%) ```
55
Obstructive Sleep Apnea ● Risk factors for sleep apnea:
○ Obesity ■ Neck size better predictor than BMI ● 17+ inches in males & 16+ inches in females increases likelihood of OSA ■ Biggest risk factor for adults, but NOT elderly ( ↓ muscle tone) or children (tonsillar hypertrophy) ○ Increasing age ○ Family history - bc heritable skeletal relationships ○ Smoking & alcohol use (depresses CNS)
56
Obstructive Sleep Apnea | ● Findings in clinical examination:
○ Retrognathia (increased overjet bc small mandible) ○ Macroglossia ○ Lateral peritonsillar narrowing
57
Metabolic syndrome ⇒
group of risk factors that occur together & ↑ risk of CAD, stroke, DM Type II
58
Metabolic syndrome | ● Diabetes, impaired glucose tolerance, insulin resistance AND 2 of the following:
○ HTN ○ Dyslipidemia ○ Central obesity ○ Microalbuminuria
59
Pediatric sleep apnea ⇒
AHI 1 or greater considered OSA; (fussy rather than sleepy throughout day)
60
STOP-BANG model questionnaire:
``` ● Snoring loudly? ● Tired during day? ● Has anyone Observed you stop breathing during sleep? ● High blood Pressure ● BMI > 35? ● Age > 50? ● Neck circumference greater than 40 cm (16 in)? ● Gender ```
61
High risk of OSA if
AHI >5 with 3+ above items | ● Note: signs & symptoms poorly predict disease severity
62
Diagnosis with Polysomnography | ● EGG ⇒
monitors brain activity to document sleeps stages
63
Diagnosis with Polysomnography | ● EOG ⇒
eye movements - determines REM vs. non-REM sleep
64
Diagnosis with Polysomnography | ● Nasal/oral capnography ⇒
measures air flow from nose & mouth
65
Diagnosis with Polysomnography | ● EMG ⇒
muscle activity; bruxism & restless leg syndrome
66
Diagnosis with Polysomnography | ● EMG ⇒
muscle activity; bruxism & restless leg syndrome
67
● Lingual constriction has highest accuracy for
invisalign
68
OSA treatment: | ● Oral appliance - Mandibular advancement devices
○ Advances lower jaw, pulling tongue forward & stretching dilators of pharynx ○ Alternative for patients who won’t tolerate CPAP ○ Indicated for snoring & non-severe apnea
69
OSA treatment: Mand advancement devices ■ Effective for
mild-moderate sleep apnea (less effective for severe)
70
OSA treatment: Mand advancement devices ■ Improves
AHI & EDS, but no effect on blood pressure
71
OSA treatment: Mand advancement devices ○ Side effects ⇒
TMJ/tooth discomfort; changes in occlusion
72
OSA treatment: Mand advancement devices ○ Contraindications:
■ <5 teeth per quadrant (excluding 3rd molars & fixed bridges) ■ Periodontal disease or dental caries ■ TMJ disorder; Inadequate jaw opening for fitting ■ <3 mm of voluntary jaw protrusion ■ < 6-10 teeth per arch ■ Bruxism? - may be indicator
73
OSA treatment: Mand advancement devices ○ Treatment end point:
■ At least 7mm or 75% protrusion | ■ Continue advancing till snoring & apnea subjectively resolves
74
OSA treatment: | ● Upper airway surgery
○ Uvulopalatopharyngoplasty (UPPP) ■ Limited success ~40% ■ Unsuccessful for Type 2 or 3 obstruction (retropalatal / retrolingual)
75
OSA treatment:● Nasal CPAP | ○
Gold standard, but poor compliance unless severe

Ortho Final (8 decks)

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