3. Orthodontics Flashcards
When to use ortho in perio patients
- Uneven gingival margins
- Significant eruption or supra eruption
- Open gingival embrasures
- Close edent spaces
- Impl site development
- Hemi septal defects
- Fractured teeth
- Tooth position unfavorable due to perio dx
Uneven gingival margins how to decide ortho or surgery
- If not visible at high animation do nothing
- If short tooth has deep sulcus do surgery
- Locate CEJ is it at the depth of the sulcus
- If short central longer than lateral, extrude it and equilibrate the incisal edge
- Has the incisal edge been abraded? see next question
What to do if short central, unaesthetic gingival margins and worn incisal edge
Intrude the short central, must retain for 6 months
Causes open gingival embrasures
- Perio Bone loss
- Tooth shape
- Root angulation
Manage open gingival embrasures
- Squeeze papilla by moving teeth together to increase length
- Correct root angulation
- Restore tooth shape - flatten contact, close with ortho
Use of implants in ortho patients
- Replace congenitally missing teeth
2. Provide absolute anchorage
Management of retained primary molars
- If no arch length issues dont extract
- Reduce width of primary
- If infra occluded extract to no vertical defect and move man 1st premolar distally and impl at first premolar site
Management of congenitally missing laterals
Goal: Match space and size of present lateral, if none existing base on size of central.
Need 1 mm between roots, look out for B/L bone thickness.
Using implants for anchorage
Needs very careful planning. Must be interdisciplinary
Treating hemi septal defects with ortho
Must control perio inflamm before starting ortho!
If tooth tipped can correct defect by up righting.
Watch out if bone level flat and the teeth have a marginal ridge discrepancy, this will create a hemi septal defect!!
Managing Trauma with extrusion
Used for horizontal root fractures. Erupt the tooth to reduce the vertical bony defect.
Must assess:
- Crown to root ratio
- Root shape
- Internal Root anatomy
- Level of the fracture
- Importance of the tooth
- Aesthetics - lip line
- Eruption Speed
Managing advanced horizontal bone loss
- Align brackets with bone levels NOT with teeth
- May require occlusal equilibration
3.
Management of furcation defects
For Mandibular class 3 furcations. Move tooth orthodontically, then endo, then section then restore.
However if the plan is for an FDP you would endo and section first then move the roots so you have ideal positioning
What if roots are naturally too close together
Can make OH challenging
Move to have 2-3 mm between roots
How fast should you erupt teeth
Depends:
Fast: Do with firerotomy and root planing so that no bone comes
Slow: Brings bone
Must hold final position at least 6 months.
