3B Flashcards
(165 cards)
1
Q
Moderate generalized space discrepancy (<4 mm per arch)
● General info:
○ True shortage of
A
space including leeway
2
Q
Moderate generalized space discrepancy (<4 mm per arch)
○ Tooth movement methods will
A
create space
3
Q
Moderate generalized space discrepancy (<4 mm per arch)
○ Prognosis & stability
A
unknown
4
Q
Moderate generalized space discrepancy (<4 mm per arch)
■ Once arch dimensions begin to change, no
A
certainty that it will be stable
5
Q
Moderate generalized space discrepancy (<4 mm per arch)
■ Prognosis good with
A
RETENTION
6
Q
Moderate generalized space discrepancy (<4 mm per arch)
● Arch expansion (NOT palatal expansion) →
A
creates ~ 4mm of space
7
Q
Moderate generalized space discrepancy (<4 mm per arch)
○ Ideal profile for arch expansion:
■ AP position of lips/incisors
A
normal or retrusive (NOT protrusive)
8
Q
Moderate generalized space discrepancy (<4 mm per arch)
○ Ideal profile for arch expansion:
■ Adequate facial
A
keratinized tissue (gingiva) ● Allows for facial movement
9
Q
Moderate generalized space discrepancy (<4 mm per arch)
○ Ideal profile for arch expansion:
■ Adequate
A
overbite & overjet (to allow facial incisor movement of lower arch)
10
Q
Moderate generalized space discrepancy (<4 mm per arch)
IDeal profile for arch expansion
■ Skeletal
A
class I & Dental Class I (or end-to-end) molar
11
Q
Moderate generalized space discrepancy (<4 mm per arch)
Ideal profile for arch expansion
● All teeth should be
A
present clinically/radiographically
12
Q
Moderate generalized space discrepancy (<4 mm per arch)
○ Lip Bumpers
■ Treats
A
lower anterior &/or buccal segment crowding
13
Q
Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
● Best for
A
facial lingual discrepancies
14
Q
Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
○ Facial tipping (& bodily movement) of
A
incisors (NO rotation)
15
Q
Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
○ Distal tip of
A
molar
16
Q
Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
○ Arch width
A
increase
17
Q
Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
● Applies
A
equilibrium theory
18
Q
Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
○ Removes lip force, so
A
resting tongue force causes facial movement
19
Q
Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
● Possible
A
2nd molar impaction
20
Q
Moderate generalized space discrepancy (<4 mm per arch)
lip bumpers
■ Clinical management & fabrication same as
A
lingual arch
21
Q
Moderate generalized space discrepancy (<4 mm per arch)
○ Banded/bonded fixed appliances
■ Treats
A
lower anterior &/or buccal segment crowding
22
Q
Moderate generalized space discrepancy (<4 mm per arch)
○ Banded/bonded fixed appliances
● ——- movements
A
Tipping & bodily
23
Q
Moderate generalized space discrepancy (<4 mm per arch)
○ Banded/bonded fixed appliances
● Rotations
A
possible
24
Q
Moderate generalized space discrepancy (<4 mm per arch)
○ Banded/bonded fixed appliances
● ——– possible (by activating one side more than the other)
A
Midline shift
25
Moderate generalized space discrepancy (<4 mm per arch)
○ Banded/bonded fixed appliances
■ Clinical management →
may need to separate to place bands
26
Moderate generalized space discrepancy (<4 mm per arch)
○ Banded/bonded fixed appliances
● More flexible the wire, the
re-activations can be done less frequently
27
Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
■ Treats
buccal segment crowding (maxillary arch ONLY)
28
Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
● Molar movement
distally &/or buccally
29
Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
○ Interseptal gingival fibers will pull
premolars distally too
30
Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
● Cervical headgear → also does
extrusion
31
Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
● Requires
compliance
32
Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
■ Clinical management:
● Adjustment every
6-8 weeks
33
Moderate generalized space discrepancy (<4 mm per arch)
○ Headgear
● Can expect --------- in a year
3-4 mm
34
Severe space discrepancy >
4-5 mm per arch
35
Severe space discrepancy
● Extraction
○ Based on
crowding & protrusion
36
■ Extraction allows incisors to be
retruded
37
○ Premolars most
```
commonly extracted (~ 7 mm each)
○ Stability unknown - retention required
```
38
Serial extractions ⇒ Severe space discrepancy > 10 mm per arch
● Indications:
○ Class I with good facial form & severe space shortage
39
Serial extractions ⇒ Severe space discrepancy > 10 mm per arch
■ Early loss of 1° canines →
a finding of severe crowding
40
Serial extractions ⇒ Severe space discrepancy > 10 mm per arch
○ Gingival defects from
abnormal eruption
41
Serial extractions ⇒ Severe space discrepancy > 10 mm per arch
○ Impactions
imminent (from crowding)
42
Serial extractions ⇒ Severe space discrepancy > 10 mm per arch
● Advantages:
○ Spontaneous incisor alignment, improved psych, & reduced treatment time
43
Serial extractions
| ■ Proven benefits
○ Better canine position; improved gingiva; improved hygiene, ↓ retention time, better stability
44
Serial extractions
| ● Disadvantages:
○ Incisor lingual tipping & remaining teeth may not erupt or have poor form
■ Thus requiring future treatments
■ Substantiated by data
○ Deep bite; Reduced vertical growth & alveolar development; Poor facial esthetics
45
Serial extraction
| ● Begins with
extraction of 1° teeth → Facilitates alignment of erupted permanent teeth & encourages eruption of the premolars that will be extracted
46
Serial extraction
| ● Sequence:
1. Primary canine (for anterior crowding & alignment)
2. Primary 1rst molar (when > ½ PM root formed to expedite eruption)
■ In mandibular arch → want premolars to erupt before canine
■ In maxillary arch → 1rst premolars usually erupt before canines anyway
3. 1rst premolar (provides space in permanent dentition)
47
Serial extractions
| ■ In mandibular arch →
want premolars to erupt before canine
48
Serial extractions
| ■ In maxillary arch →
1rst premolars usually erupt before canines anyway
49
Space regaining - Localized space shortage
| ● Localized space shortage is an
opportunity to regain space if < 3 mm per quadrant
50
Space regaining Localized space shortage
| ● Adhere to
maximum space loss amount & use reliable appliances
51
Space regaining Localized space shortage
| ● Causes ⇒
Interproximal caries, ectopic eruption, tooth loss
52
Moderate localized space discrepancy
(<3mm per quadrant)
53
Moderate localized space discrepancy
| 1. Permanent molar ectopic eruption
○ 1rst permanent molar erupts mesially → may cause 1° molar resorption & loss
54
Moderate localized space discrepancy
○ 1rst permanent molar erupts mesially → may cause 1° molar resorption & loss
■ ⅔
self-correct; Painless occurrence common in maxillary arch
55
Moderate localized space discrepancy
| 1. Permanent molar ectopic eruption■ 1rst permanent molar continues shifting
mesially, taking up space
56
Moderate localized space discrepancy
1. Permanent molar ectopic eruption
■ Diagnosed with
bitewings
57
Moderate localized space discrepancy
1. Permanent molar ectopic eruption
○ Space regaining treatment plans:
■ If NO succedaneous premolar →
space regaining NOT necessary
● Mesial shift of 1rst permanent molar will close space
● Brackets bonded on dentition with spring inbetween
58
Moderate localized space discrepancy
1. Permanent molar ectopic eruption
○ Space regaining treatment plans:
■ BRASS WIRE (or separator) for
minimal interference/resorption (<1mm)
| ● Placed in between contacts, pushing permanent molar distally
59
Moderate localized space discrepancy 1. Permanent molar ectopic eruption
○ Space regaining treatment plans:
■ BAND & SPRING
● 1° molar banded and spring pushes 2° molar back
● Uncontrolled distal crown tip
○ Short roots bc still erupting - very easy to tip
● Fabrication → made by lab, so need to band and separate tooth for impression; wire bend & soldered by lab
○ Activated 3-4 mm
○ Treatment completed after 2-3 activations
● No retention required
60
Moderate localized space discrepancy
1. Permanent molar ectopic eruption
○ Space regaining treatment plans:
■ MODIFIED BAND & SPRING
● Direct
(Intraoral) fabrication with no soldering → tooth banded & bent wire used as spring
61
Moderate localized space discrepancy
■ BONDED SPRING
● Most modern & efficient way →
No banding; intraoral fabrication
62
Moderate localized space discrepancy
1. Space regaining for posterior tooth loss (maintains space for erupting teeth)
○ Max. removable appliance -
Hawley finger spring
63
Moderate localized space discrepancy
Max. removable appliance
■ Biomechanics:
● Resistance/anchorage via adams clasps & anterior palate
● Uncontrolled distal crown tip
64
Moderate localized space discrepancy
Max. removable appliance
■ Lab fabrication;
2-3 mm activation; 1mm movement per month
65
Moderate localized space discrepancy
Max. removable appliance
■ Retention & stabilization
required (with band & loop)
66
Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring
■ ------------- biomechanics
Open coil spring
67
Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring
● Reciprocal force applied
buccal to C-res
68
Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring
● Distal force & moment produces
rotation
69
Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring
○ Mesial rotation of
PM & Distal rotation of molar
70
Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring
■ Contralateral 1rst permanent molar
banded as well
71
Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring
● Mandibular arch →
Anchorage via anteriors with LLHA
72
Moderate localized space discrepancy
Max. removable appliance
○ Banded & bonded appliance with coil spring
● Maxillary arch →
Anchorage via nance button on palate
73
Moderate localized space discrepancy
1. Space regaining for anterior & posterior space discrepancy
(<3mm)
74
Moderate localized space discrepancy
1. Space regaining for anterior & posterior space discrepancy
○ Treatment with
Lower lingual holding appliance (LLHA)
75
Moderate localized space discrepancy
1. Space regaining for anterior & posterior space discrepancy
Lower lingual holding appliance
■ Tips
molars distally & anteriors facially (~roughly equal distance)
76
Moderate localized space discrepancy
1. Space regaining for anterior & posterior space discrepancy
Lower lingual holding appliance
● Inefficient way to
move teeth bc wire is heavy with little range of movement, but good way to gain space
77
Severe localized space discrepancy
( > 3mm per quadrant)
78
Severe localized space discrepancy
| ● Possible treatment options include:
palatal anchorage appliances, headgear, &/or extraction
79
Severe localized space discrepancy
● Palatal anchorage device (with coil springs)
○ Posteriors ⇒
distal bodily movement
| ■ Distal force on palatal side near level of Cres → more bodily movement
80
Severe localized space discrepancy
● Palatal anchorage device (with coil springs)
○ Maxillary incisors move
forward (make sure pt. profile not protrusive)
81
Severe localized space discrepancy
● Mini screw supported distalizing appliance
○ Provide true anchorage with
TADs - no maxillary anterior movement
82
Severe localized space discrepancy
● Mini screw supported distalizing appliance
○ No acrylic button →
reduced tissue tissue anchorage; better compliance
83
Space maintenance
| ● Used when space is adequate following tooth loss (or marginally adequate with extraction)
● Good prognosis
84
Factors to consider with space maintenance:
1. Normal timing of eruption (when will permanent dentition begin erupting?)
○ Assessed by root development ⇒
active eruption begins when ½ - ⅔ root formation
85
Factors to consider with space maintenance:
2. Effects of early & late primary tooth extraction
○ Early loss/extraction (before ½ root formation) ⇒
slows permanent tooth eruption
86
Factors to consider with space maintenance:
2. Effects of early & late primary tooth extraction
○ Late loss/extraction (after ½ root formation) ⇒
speeds up eruption
87
Factors to consider with space maintenance:
3. Location of tooth loss in the arch
○ 1° anterior tooth loss ⇒
No space maintenance required
| ■ NO overall space loss (but some minor space redistribution)
88
Factors to consider with space maintenance:
3. Location of tooth loss in the arch
○ 1° posterior tooth loss ⇒
Space maintenance required
89
Factors to consider with space maintenance:
4. Eruption of anterior teeth
○ Anteriors erupt lingually, so
DONT use a lingual arch for space maintenance if primary anteriors are not lost yet. Erupting teeth will get caught in the wire
90
Factors to consider with space maintenance:
5. Presence of succedaneous teeth (& supernumerary teeth)
○ Don’t need to
maintain space if no succedaneous tooth replacement
91
Factors to consider with space maintenance:
6. Cause of
tooth loss (ie. is there an ectopic eruption causing root resorption & tooth loss)
92
Space Maintenance treatment options:
Band and loop
Distal shoe
Lingual arch type appliances
93
● Band & loop
○ Simple & 60% successful
94
Band and loop
| ○ Clinical management:
■ Separate, band, impression, stabilize, pour, loop form & position
● Loop contacts, but doesn’t encompass 1° canine → allows lateral canine movement when lateral incisor erupts
95
Band and loop
| ● Loop wide enough for
premolar eruption
96
Band and loop
| ● Poor oral hygiene will cause
decalcification of banded tooth (usually permanent 1rst molar - primary 2nd molar difficult to band bc convergent)
97
Band adn loop
| ■ Recall every
3-6 months
98
Band and loop
| ■ Potential problems if
lose abutment tooth or if loop becomes distorted downward into tissue
99
● Distal shoe
| ○ Indication ⇒
ONLY when primary 2nd molar lost before eruption of permanent 1rst molar
■ 65% successful
100
● Distal shoe
○ Clinical management:
■ Tooth banded & blade placed into tissue
1-1.5 mm below marginal ridge of unerupted 1rst permanent molar
101
● Distal shoe
○ Clinical management:
● Blade placement based on
radiographs (factoring magnification distortions), required distance measured
102
Distal shoe
| ● Prevents
mesial shift of erupting 1rst permanent molar & maintains space for succedaneous premolar
103
Distal shoe
| ■ Placement of device requires
gingival incision (if tooth extracted at the same time as delivery of device, use extraction space as site of blade insertion)
104
Distal shoe concerns;
| ■ Permanent molar may
erupt mesially into blade if position gauged incorrectly
105
Distal shoe concerns
| ■ --------- in patient with heart or vascular problems
Infectious endocarditis
106
● Lingual arch type appliances (55% successful)
○ Types:
```
■ Lower lingual holding appliance (LLHA)
■ Maxillary transpalatal arch (TPA)
■ Maxillary Lingual arch (MxLHA)
● Not used often
■ Nance appliance
```
107
● Lingual arch type appliances (55% successful)
■ Maxillary transpalatal arch (TPA)
● Can be used when
one side of arch broken but the other is not?
108
● Lingual arch type appliances (55% successful)
■ Nance appliance
● Anchorage from
palate, but acrylic can cause palatal irritation
109
● Lingual arch type appliances (55% successful)
○ Fabrication:
■ Arch always made with
adjustment loops
110
● Lingual arch type appliances (55% successful)
Fabrication
■ Keyhole design →
allows incisor alignment, but steps away from premolar area to allow for eruption
111
● Lingual arch type appliances (55% successful)
| ○ Follow up every
3-6 months
112
● Lingual arch type appliances (55% successful)
○ Problems:
■ Don’t use lingual arch before
permanent incisors have erupted ⇒ arch will get caught on erupting teeth
113
Space management
| ● Used with
adequate space & irregularity
114
Space management
| ○ Transitional irregularity & crowding due to
incisor liability
115
Space management
| ● Ideal for managing
leeway space (up to 9 mm)
116
Space management
| ○ Leeway space (E-space) managed to
resolve crowding
117
Space management
| ○ E-space
(extra space of 2nd primary molar compared to succedaneous premolar)
118
Space management
| ● Potentially can manage up to
75% of crowded pts with resulting < 1mm crowding
119
Space management
| ○ Space management must continue until
transition complete & arch perimeter stable
| ○ Good prognosis
120
Space management
| ■ Very stable procedure bc
arch circumference not being changed
121
Space management
| ■ Note: when arches are expanded or changed, prognosis is not
known in the end
122
Space management treatment options (pt with adequate space with irregularity):
1. No treatment
○ Allow for
normal transition to take place
123
Space management treatment options (pt with adequate space with irregularity):
No treatment
○ Results in
anterior crowding with Class I molar relationship
124
Space management treatment options (pt with adequate space with irregularity):
■ To treat later would require
expansion or extraction treatment
125
Space management treatment options (pt with adequate space with irregularity):
1. Disking
○ Used with
minor irregularity
126
Space management treatment options (pt with adequate space with irregularity):
■ Normal dentition (with adequate space) usually has
1-2 mm of crowding during transition, so not worth doing in many cases
127
Space management treatment options (pt with adequate space with irregularity):
○ Must be
vertical reduction of teeth of primary teeth
128
Space management treatment options (pt with adequate space with irregularity):
■ Consider disking
mesial or distal of 1° canines & molars
129
Space management treatment options (pt with adequate space with irregularity):
■ Consider Fluoride varnish to reduce
sensitivity
130
Space management treatment options (pt with adequate space with irregularity):
○ Do NOT disk
permanent teeth in mixed dentition
131
Space management treatment options (pt with adequate space with irregularity):
■ Skews analysis if done before all
permanent teeth have erupted
132
Space management treatment options (pt with adequate space with irregularity):
1. Holding arches
○ Construct with
ideal arch form (facilitates tooth alignment)
133
Space management treatment options (pt with adequate space with irregularity):
■ Soldered arches most reliable;
```
typically keyhole design used
○ Resolves faciolingual discrepancies
○ Limitations as a tooth mover:
■ No rotation
■ Difficult to move teeth with heavy wire (can be uncomfortable)
```
134
Space management treatment options (pt with adequate space with irregularity):
2. Disking & holding arches
○ When more crowding needs to be resolved
| ○ Helps guidance and tooth position
135
Space management treatment options (pt with adequate space with irregularity):
1. Holding arches with tooth movement
○ LLHA controls arch form & coordination
| ■ Can control arch length and move teeth (primarily via tipping)
136
Space management treatment options (pt with adequate space with irregularity):
■ NOTE: Flat anterior segment does
NOT resolve around an ideal arch form
137
Space management treatment options (pt with adequate space with irregularity):
○ LLHA can be used as
retainer
138
Space management treatment options (pt with adequate space with irregularity):
○ LLHA biomechanics may require
adjustment
139
Space management treatment options (pt with adequate space with irregularity):
■ Heavy tipping force, so needs to be
placed passively on teeth you want to move
140
Space management treatment options (pt with adequate space with irregularity):
1. Holding arches & selective extraction of primary teeth
○ Necessary for
greater irregularity (but still adequate space)
141
● Expansion of lower canine
least stable
142
● Removable denture for missing 1° anteriors indicated for
esthetics (NOT space maintenance or speech)
| ○ Can be used for posterior space maintenance, but compliance a problem (Nance preferred)
143
● Class II occlusion with crowding extraction pattern:
○ Extract upper 4s & lower 5’s
144
● Minimal crowding doesn’t mean you
NEVER do extractions
145
● TADs cannot be used
< 12 y/o
146
● Space maintenance is NOT more stable than
space management or space regaining
147
Majority of crowding issues ass. with
Class I
148
● Maxillary irregularity/crowding
| ○ Ideal group (0-1 mm crowding) ⇒
worsens from preadolescence to adolescence
| ○ Hispanics > white > black
149
● Mandibular irregularity
| ○ Ideal group ⇒
worsens from pre-adolescence to adolescence to adult
| ○ Hispanic > white > black
150
Classification of Crowding based on:
● Facial form analysis (esp. lip protrusion - protrusive/retrusive/normal)
● Appropriate radiographs
● Space analysis - Tanaka Johnson prediction values
○ ½ M-D distance of mand. Incisors + 10.5 = width of mand. canine/PM in quadrant
○ ½ M-D distance of mand. Incisors + 11 = width of max. canine/PM in quadrant
151
Excess space
| ● Good for
transitional dentition, so usually NO treatment
152
Excess space
| ● Treated for
esthetic concerns or risk of trauma (with protrusive teeth)
153
Excess space
| ○ Intervention also required if
eruption problems or pathology (ie. cyst) exists
154
Excess space classification:
| ● Normal transition
(usually closes with canine eruption)
| ○ Oral habit → treating with oral habit appliance will correct. No other treatment needed
155
Excess space classification:
● Generalized spacing
○ Caused by
large arches or small teeth
156
Excess space classification:
| ● Generalized spacing with protrusion:
○ Fixed appliance
■ Bracket & tube;
2 point contact
■ Bodily movement with anchorage on molars
157
Excess space classification:
Generalized spacing with protrusion
○ Removable appliance with labial bow
■ One-point contact → tips uppers lingually
■ Anchorage to posterior attachment (& palate)
● Retention via adams clasp
■ < 6 month treatment
● Activated 2 mm for 1 mm movement per month
158
Midline diastema
● Diastemas reduce considerable from
preadolescence to adolescence (when canine erupt)
159
Midline diastema
| ● Occurs significantly more in
african american
160
Midline diastema
| ● Causes &/or associated problems:
```
○ Normal transition
○ Supernumerary teeth between centrals
○ Missing laterals
○ Frenums
■ Space closed first
■ Frenectomy performed after space closure if there will be a problem with retention
● Morphology of frenum poor indicator of problem
■ Idiopathic
```
161
Midline diastema
| ■ Frenectomy performed after
space closure if there will be a problem with retention
162
Midline diastema
| ● Morphology of frenum
poor indicator of problem
163
Midline diastema
| ● Treatment options:
○ Tipping with finger spring
○ Bodily movement with any archwire (round or rectangular) - reciprocal anchorage
164
Midline diastema
| ○ Tipping with finger spring
■ Reciprocal anchorage
| ■ Removable provides short term retention; long term with lingual bonded retainer
165
Midline diastema
○ Bodily movement with any archwire (round or rectangular) - reciprocal anchorage
■ Long term retention with lingual bonded retainer
