4th year Flashcards
(193 cards)
1
Q
Define malocclusion
A
An appreciable deviation from the ideal occlusion that may be considered aesthetically or functionally unsatisfactory
2
Q
Effects of early D, E loss
A
Space loss as 7s drift mesially
3
Q
Effects of early C loss
A
Midline shift as permanent incisors drift into space
4
Q
Effects of early A, B loss
A
Minimal effect
5
Q
Effect of age and early loss of deciduous teeth
A
Effects more severe with earlier loss
6
Q
Effect of degree of crowding in the arch and early loss of deciduous teeth
A
Exaberates the severity
Crowding increases the space loss (D,E) and amount of midline shift (C)
7
Q
2 effects of the prolonged retention of deciduous teeth
A
Delay permanent successor
Deciduous teeth may become infraoccluded due to ankylosis
8
Q
2 signs deciduous teeth may be infraoccluded due to ankylosis
A
Decidious teeth becoming submerged
Tipping of adjacent teeth first molars
9
Q
2 managements of infraoccluded deciduous tooth
A
Monitor, almost all exfoliate naturally
Extract only if becoming completely submerged
10
Q
Define hypodontia
A
Developmental absence of permanent teeth (excluding 3rd molars)
11
Q
Prevalence of hypodontia
A
2-3%
12
Q
Define severe hypodontia
A
Missing 6+ teeth
13
Q
Define anodontia
A
Complete absence
14
Q
3 managements of hypodontia
A
Space closure
Open or maintain space for protheses
Accept
15
Q
2 signs of absent upper laterals
A
Ectopic canines
Small contralateral lateral incisors
16
Q
2 managements of absent upper laterals
A
Space closure with fixed appliances
Maintain space for bridgework/implants
17
Q
3 managements of absent second premolars
A
Accept and retain Es (unlikely to last beyond < age 30)
Close space (extract deciduous early)
Bridgework
18
Q
3 managements of absent lower central incisors
A
Retain As
Close space
Bridgework
19
Q
Prevalence of supernumerary teeth
A
1-2%
20
Q
Where are supernumerary teeth commonly found
A
80% in the anterior maxilla
21
Q
3 clinical effects of supernumerary teeth
A
Delayed eruption of teeth
Crowding
Midline diastema
22
Q
2 managements of supernumerary teeth
A
No treatment
Extract supernumerary then expose and align unerupted teeth
23
Q
Common location of impacted permanent first molars
A
Maxilla
24
Q
3 managements of impacted permanent first molars
A
Monitor, (2/3rds) correct spontaneously, although unlikely to improve after age 8 years
Extraction of E
Upper removable appliance to disimpact
25
Common cause of impacted premolars (usually 5s)
Early loss of E
26
4 managements of impacted premolars (5s)
Extract 4 to allow eruption of 5
Extract 7 and distalise 6 to create space
Surgically extract 5
No treatment and review regularly
27
Clinical feature associated with an abnormally thick upper labial fraenum
Midline diastema
28
A management of an abnormally thick upper labial fraenum
Conduct fraenectomy after upper canines erupt
29
3 effects of early loss of permanent 1st molars
Creates unfavourable residual space
Midline shift with unilateral loss is minimal
Overeruption of opposing first molar
30
A management for carious 1st molars
Extraction: best age 8-9, later extraction increases tipping
31
Common cause of early loss of permanent upper incisors
Trauma (often associated with Class II Div 1)
32
3 managements of early loss of permanent upper incisors
If saveable RCT and re-implant
Bridgework/implant
Close space orthodontically and crown lateral
33
Common cause of permanent upper incisor dilaceration
Trauma to deciduous predecessor, age 4-5
34
Sign of permanent upper incisor dilaceration
Delayed or non-eruption
35
Management of permanent upper incisor dilaceration
Orthodontic alignment sometimes possible
36
What is a peg shaped upper lateral incisor usually associated with
Ectopic canines
37
Define Class II Division 1 malocclusion
Lower incisor edges are palatal to the cingulum plateau of the upper incisors and the upper incisors are proclined or of average inclination, with an increased overjet (>4mm)
38
Prevalence of Class II Div 1 malocclusion
20-30% of all malocclusions, most common
39
Skeletal base associated with Class II Div 1
3/4 have skeletal II base
40
Describe the relationship between Class II Div 1 and upper incisor trauma
Increased risk by 40% for overjets 9mm+
41
Define index of orthodontic treatment need IOTN
Index used to decide which cases are severe enough to warrant treatment under the NHS
42
2 components of IOTN
Dental health component: grades 1 – 5 based on a series of criteria
Aesthetic component: grades 1 – 10 based on a series of 10 photographs
43
Who qualifies for NHS treatment using IOTN
Grade 4, 5 dental health component automatically
Grade 3 dental health component with ≥ Grade 6 aesthetic component
44
Describe how to calculate ANB
ANB = maxillary AP position (SNA) - mandibular AP position (SNB)
45
3 aetiological factors associated with Class II Div 1 malocclusion
Class II AP skeletal discrepancy ( > 70% of cases)
Thumb sucking habits
Maxillary crowding
46
2 extraoral features of Class II Div 1 malocclusion
Mandible relatively behind the maxilla
Reduced lower vertical facial proportions
47
Cephalometric feature of Class II Div 1 malocclusion
ANB angle > 4 degrees
48
5 intraoral features of Class II Div 1 malocclusion
Proclined or average upper incisors
Increased overjet
Increased overbite
Crowding
Class II buccal segment
49
3 benefits of treating Class II Div 1 malocclusion
Improve dentofacial appearance
Reduce trauma
Reduce lip incompetence
50
4 treatments for Class II Div 1 malocclusion
Functional appliances
Upper removable appliances
Fixed appliances
Orthognathic surgery
51
Best timing of treatment for Class II Div 1 malocclusion
10-13 years
Late mixed or early permanent dentitions
52
3 treatments for Class II Div 1 with skeletal discrepancy
Mild: fixed appliances only
Moderate: functional/URA and fixed appliances
Severe: orthognathic surgery and fixed appliances
53
Describe the aim of functional appliance treatment for Class II Div 1 malocclusion
Used to reduce overbite to allow overjet reduction
54
Describe functional appliances
Appliances which alter the sagittal and vertical position of the mandible when worn by the patient
55
3 functional appliances for treatment Class II Div 1 malocclusion
Andresen activator
Bionator
Twin block
56
Describe 3 components of upper removable appliance treatment for Class II Div 1 malocclusion
Extract upper 4s
Roberts Retractor to retract upper canines and incisors
Anterior biteplane to decrease overbite to reduce overjet
57
Describe fixed appliance treatment for Class II Div 1 malocclusion
Commonly used after initial phase of functional appliances (tipping) for mild/mod skeletal
Extract upper 4s, and lower 5s
Bodily retraction of upper incisors with fixed appliances is anchorage demanding may need headgear / orthodontic mini implants
58
Indication for orthognathic surgery treatment of Class II Div 1 malocclusion
Severe skeletal discrepancies in non-growing patients
59
Define fixed appliance and surgery treatment for Class II Div 1 malocclusion
Initial fixed appliances treatment to align and coordinate individual arches
Followed by mandibular advancement surgery (+/- maxillary retraction)
60
Stability and retention following Class II Div 1 treatment
Stability of overjet reduction is enhanced by lower lip control of upper incisors
Functional appliance patients should continue wearing appliances for a period of time
61
4 advantages of functional appliances
Able to correct A-P relationship
Facilitate plaque control
Can be used during mixed dentition phase
Provide efficient anchorage reinforcement prior to fixed appliance treatment
62
3 disadvantages of functional appliances
Cannot produce detailed tooth movement
Do not produce a clinically significant effect on skeletal bases
Demand high level of patient cooperation
63
2 fixed functional appliances
Herbst appliance
Fixed twin block
64
Describe a Herbst appliance
Fixed functional appliances attached to fixed appliances
65
2 advantages of Herbst appliances
Less cooperation required
Use simultaneously with fixed appliance
66
3 disadvantages of Herbst appliance
Complex design
Time consuming to fit
More frequent breakages
67
Describe a clark twin block functional appliance
Interlocking upper and lower bite blocks which restricts maxillary growth and allows the distal movement of upper teeth and mesial movement of lower teeth
68
3 advantages of clark twin block functional appliance
Well tolerated
Full-time wear possible
Possible to secure to fixed appliance
69
3 indications for functional appliance treatment
Mild, uncrowded Class II with well aligned teeth
1st phase in treatment for severe Class II’s before 2nd phase of fixed appliance treatment
Interceptive treatment to reduce very large overjet
70
3 containdications to functional appliance treatment
Poor cooperation
Non-growing patients
Individual tooth movements
71
5 ways to predict growth
Age
Height
Hand-wrist radiographs
Hormone levels
Secondary sex characteristics
72
3 features in the timing of functional appliance treatment
11/12 years of age
Mixed dentition phase after eruption of 1st premolars
Avoid significant pause between functional and fixed appliances
73
Describe taking a bite registration for functional appliances and why it is used
Used to estimate amount of sagittal advancement of mandible needed
Apply wax to proJet jig and position in mouth against the upper teeth and get patient to bite down edge-to-edge (protruded)
74
3 pieces of advice given following provision of functional appliances
Full-time wear essential
Remove appliance for eating, cleaning, sports
Use box to store appliance when not being worn
75
Retention following functional appliance treatment
Night-time wear only
76
Define an increased overbite
Increased overlap of upper incisors over lower incisors by > 4mm (3-4mm normal)
77
Timing of treatment for increased overbite
10-13 years
Growing patients, usually in the late mixed or early permanent dentitions
78
Describe the correction of increased overbite for adult patients
Often requires surgery, very difficult
79
4 benefits of treating increased overbite
Improves dentofacial aesthetics
Allows overjet reduction
Reduces trauma to soft tissues of anterior palate
Improves post-treatment stability
80
2 extraoral features of increased overbite
Reduced lower face height
Often relative mandibular retrusion
81
Malocclusions associated with increased overbite
Most Class II Div 2 malocclusions
Many Class II Div 1 malocclusions
Some Class III and Class I malocclusions
82
4 aetiological features of increased overbite
Class II or III AP skeletal discrepancy
Increased interincisal angle
Reduced lower face height
Unopposed lower incisors
83
3 treatments for an increased overbite for growing patient <14 years old
Anterior biteplane
Functional appliance eg. Twinblock
Fixed appliances
84
Mechanism of anterior biteplane in treatment of an increased overbite
Biteplane contacts with lower incisors, facilitates eruption of molars
85
Mechanism of functional appliances in treatment of an increased overbite
Posterior teeth are separated vertically when wearing the appliance, eruption of posterior teeth
86
Mechanism of functional appliances in treatment of an increased overbite
Molar extrusion and some incisor intrusion
87
2 treatments for an increased overbite in a non-growing patient
Orthognathic surgery often required
Sometimes fixed appliances only
88
Describe Class II Division 2 malocclusion
Lower incisor edges are palatal to the cingulum plateau of the upper incisors and the upper central incisors are retroclined
89
Prevalance of Class II Division 2 malocclusion
5-10% of the population
90
Cephalometric feature of Class II Div 2 malocclusion
ANB angle > 4 degrees
91
2 extraoral features of Class II Division 2 malocclusion
Reduced lower face height
Mandible retruded behind maxilla
92
3 intraoral features of Class II Division 2 malocclusion
Retroclined upper and lower incisors
Increased inter-incisal angle
Deep overbite
93
3 benefits of treating Class II Division 2 malocclusion
Improves dentofacial aesthetics
Reduce traumatic overbite
Produce a stable incisal relationship
94
2 treatment options for Class II Division 2 malocclusion
Fixed appliances and URA to help overbite reduction
Fixed appliances and surgery
95
Describe URA and fixed appliance treatment for Class II Division 2 malocclusion
Anterior biteplane used to reduce the overbite
Usually extract upper 4's
Fixed appliances to torque, upright, then bodily retract upper incisors
96
Timing of fixed appliance treatment for Class II Division 2 malocclusion
10-13 years
Growing patient
97
Describe aim of surgical treatment of Class II Division 2 malocclusion
Correct incisor inclinations following treatment with fixed appliances
98
3 indications for surgical treatment of Class II Division 2 malocclusion
Adult patients
Poor facial profile
Deep overbite
99
Stability and retention following treatment of Class II Division 2 malocclusion
Stability depends on correction of the inter-incisor angulation (must achieve Class I incisors)
Retention usually with lower fixed retainer
100
Define Class III malocclusion
Lower incisor edges are anterior to the cingulum plateau of the upper incisors
101
Prevalence of Class III malocclusion
3-5%
102
2 benefits of treating Class III malocclusion
Improve dentofacial appearance
Treat anterior mandibular displacement
103
2 aetiological features of Class III malocclusion
Genetics
Cleft lip and palate patients
104
Cephalometric feature of Class III malocclusion
ANB angle < 2 degrees
105
2 extraoral features of Class III malocclusion
>70% have a protruded mandible
Maxilla is often narrow
106
3 intraoral features of Class III malocclusion
Upper incisors proclined
Lowers incisors retroclined
Upper arch often narrow and crowded creating crossbite
107
2 treatment options for Class III malocclusion
Upper removable appliances and fixed appliances
Orthognathic surgery
108
4 pre-treatment indications for upper removable appliances and fixed appliances treatment of Class III malocclusion
Pre-treatment overbite
Ability to bite edge-edge
Anterior displacement
Small or no skeletal discrepancy
109
Timing of upper removable appliances and fixed appliance treatment for Class III malocclusion
Upper removable appliances often in the mixed dentition 11 years
Followed by fixed appliance treatment age 15-16
110
Describe 2 components of the treatment using upper removable appliances for Class III malocclusion
Double cavantilier spring to procline upper incisors
Posterior biteplanes to give space for upper incisors to move labially over the lower incisors
111
Describe the treatment using fixed appliances for Class III malocclusion
Extract lower 4’s to allow retroclination of lower incisors
Class III interarch elastics to produce mesial force on the upper arch and distal force lower arch
112
Describe fixed appliance and surgical treatment for Class III malocclusion
After fixed appliances treatment to align individual arches and produce decompensation
Surgical mandibular setback and/or maxillary advancement
113
2 indications for surgical treatment for Class III malocclusion
Severe skeletal discrepancies
Vertical problems and anterior open bites
114
Stability after treating Class III malocclusion
Stability of incisor correction depends on the presence of a positive overbite
Surgically treated cases are usually stable
115
Prevalence of ectopic canines
2%
116
1 benefit of treating ectopic canines
Decreases risk of root resorption of adjacent incisors
117
3 positions of ectopic canines and their prevalence
Palatal 61%
Line of arch 34%
Buccal 4.5%
118
4 aetiological factors for ectopic canines
Crowding/shortening of arch length
Adjacent lateral incisor missing or abnormal in shape (peg-shaped)/ size
Long path of eruption
Genetics
119
When to assess for ectopic canines
9-10 years
120
Describe parallax technique
Used to determine the position of an unerupted tooth relative to its neighbours
121
Most accurate parallax technique to use
Horizontal parallax
122
Radiographs required for horizontal parallax
Two IOPAs (at least 20 degree of tube shift)
Anterior occlusal and an IOPA
123
Radiographs required for vertical parallax
Anterior occlusal and OPT
IOPA and OPT
124
4 clinical signs of an ectopic impacted canine
Delayed eruption of 3 or prolonged retention of the C
Absence of normal labial bulge in the 3 region
Delayed eruption, distal tipping of migration of the lateral incisor
Loss of vitality and increased mobility of the central or lateral incisor
125
Describe how determine canine positions from parallax
Moves with tube: palatally ectopic
Doesn’t move: in line of arch
Moves away from tube: buccally ectopic
126
5 treatment options for ectopic canines
No treatment and observe long term for cystic change
Interceptive treatment: extraction of C
Open or closed exposure and alignment with fixed appliances
Extraction of ectopic canines
Transalveolar transplant or surgical repositioning
127
Timing of extracting deciduous canine
10-13 years
But not always indicated if ectopic canine is not alignable
128
Describe open exposure of ectopic canines
Overlying mucosa removed and canine exposed to allow attachment to the orthodontic appliance
129
Describe closed exposure ectopic canines
Overlying mucosa cut and canine exposed to allow attachment of gold chain attached to orthodontic appliance before replacing the mucosa
130
4 indications for treating ectopic canines with exposure and alignment with fixed appliances
Willing to wear fixed appliances
Well motivated and have good dental health
Unsuitable for interceptive treatment
Degree of malposition not too severe
131
5 disadvantages of treating ectopic canines with exposure and alignment with fixed appliances
Risk of root resorption to adjacent teeth
Risk of pulpal obliteration to canine and adjacent teeth causing colour mismatch
Risk of discontinued treatment due to prolonged treatment times
Canine ankylosis
High tendency to relapse
132
Define anterior open bite
Absence of vertical overlap of the upper and lower incisors
133
Prevalence of anterior open bite in children and adults
2-4% of children
4% of adults
134
2 advantages of treating anterior open bite
Improve dentofacial appearance
Improve function for eating and speaking
135
6 aetiological factors for anterior open bite
Genetic
TMJ/condyle trauma
Thumb and digit sucking habits
Macroglossia
Muscular dystrophy
Extrusion/over-eruption of molars
136
3 classifications of anterior open bite
Dental
Skeletal
Combination of skeletal and dental
137
Cephalometric feature of dental anterior open bite
Normal skeletal pattern ANB 2-4 degrees
138
Extraoral feature of a dental anterior open bite
No unusual extra-oral features
139
3 intraoral features of a dental anterior open bite
Proclined upper incisors
Retroclined lower incisors
Upper arch may be narrow
140
Frequency of digit/dummy sucking habits
Finger / thumb sucking: 15% children up to age 7 (7.5% continue after age 7)
Dummy sucking: 50% children (1% after age 6)
141
Duration required for digit/dummy sucking habits to effect teeth
> 6 hours day for effects on teeth
142
Effects of the management of digit/dummy sucking habits on anterior open bite
Cessation of habit tends to resolve anterior open bite
143
2 cephalometric features of skeletal anterior open bite
Reduced ramus height
Increased maxillary mandibular plane angle
144
2 extraoral features of skeletal anterior open bite
Increased lower facial height
Lip incompetence
145
4 intraoral features of skeletal anterior open bite
Only posterior teeth occlude
Upper occlusal plane canted upwards
Lower occlusal plane canted downwards
Gingival hypertrophy due to mouth breathing
146
3 treatment options for anterior open bite
Stop digit sucking habits, goalpost/rake appliances to discourage habit
Fixed appliances
Fixed appliances and orthognathic surgery
147
2 indications for treating anterior open bite with fixed appliances
Dental anterior open bite
Mild skeletal anterior open bite with acceptable facial appearance
148
Describe 3 components of fixed appliance treatment of anterior open bite
Fixed appliances with elastics to extrude incisors
High pull headgear to intrude upper molars
Temporary anchorage device to intrude buccal segments
149
2 indications for treating anterior open bite with orthodontics and surgery
Severe dental anterior open bite
Skeletal anterior open bite
150
Timing for orthodontics and surgery treatment of anterior open bite
Wait until growth has stopped
151
Describe orthodontics and surgery treatment of anterior open bite
Fixed appliances to align arches
Le Fort I osteotomy maxillary impaction procedure to elevate upper posterior teeth
152
Stability of treatment of anterior open bite
If due to habit, prognosis is good if habit stops
1/3 of fixed appliance cases relapse
Surgical correction is usually stable
153
Describe a posterior crossbite
Buccal cusps of the mandibular teeth occlude lateral to the buccal cusps of the maxillary teeth, can occur bilaterally or unilaterally
154
Describe a buccal crossbite
Buccal cusps of mandibular teeth occlude buccal to the buccal cusps of the maxillary teeth
155
Describe a lingual crossbite
Buccal cusps of mandibular teeth occlude lingual to the lingual cusps of the maxillary teeth
156
Prevalence of crossbites in the population and in orthodontic patients
Affects 8-22% of the population (2% are bilateral)
10% of orthodontic patients
157
Describe the relationship between Class III malocclusions and crossbites
Crossbites are 3x more common in Class III malocclusions
158
5 aetiological factors for crossbite
Genetic
Unilateral cleft palate
Condylar hyperplasia
Digit sucking
Mouth breathing
159
2 benefits of treating crossbites
Minimise displacing contacts may predispose individual to TMD
Preparation for bone grafting in patients with CLP
160
Treatment of unilateral crossbites without displacement and bilateral crossbites
Not treated
161
3 treatments for unilateral or bilateral dentoalveolar crossbites with displacement
Upper removable appliance: midline expansion screw appliance or coffin spring appliance
Quadhelix
Fixed appliances
162
Timing of treatment for crossbites with displacement
< 11 years
Mixed dentition
163
Describe the treatment for crossbites using a Quadhelix
Fixed expansion spring that creates movement through buccal tipping and skeletal expansion (6:1)
164
3 advantages of Quadhelix compared to upper removable appliance for treatment of crossbites
Does not rely on patient co-operation
Can de-rotate 1st molars
Cheaper
165
Describe the treatment for crossbites using fixed appliances
Expands maxillary arch in combination with through-the-bite elastics
166
2 treatments for skeletal crossbites
Rapid maxillary expansion
Surgery
167
Describe the treatment for skeletal crossbites using rapid maxillary expansion
Non-spring loaded jackscrew turned by patient once a day (0.2-0.5mm/day) for 1-3 weeks to expand the maxilla
168
3 indications for rapid maxillary expansion in the treatment of crossbites
Maxillary molars and premolars buccally inclined
Discrepancy > 4mm between maxillary and mandibular molars
Patients aged 13 – 15 years
169
1 indication for surgery in the treatment of crossbites
Discrepancy > 12mm between maxillary and mandibular molars
170
6 adverse effects of orthodontic treatment
Enamel damage
Periodontal disease
Root damage
Loss of vitality
Soft tissue trauma and ulceration from appliances
Soft tissue burns from acid etchant
171
3 types of enamel damage caused by orthodontic treatment
Decalcification
Enamel wear due to bracket abrasion
Enamel fracture during debonding
172
Describe decalfication
White spot lesion that is a precursor of enamel caries due to accumulation of plaque adjacent to brackets
173
5 ways to prevent decalcification
Keep appliances as simple as possible
Fluoride mouthrinse at different time of day
Oral hygiene instruction
Diet advice
Chlorhexidine mouthwash
174
3 managements for decalcification
Inform patient
Reinforce previous advice: OHI, diet, fluoride toothpaste
Finish treatment as soon as possible and remove appliances
175
Treatment of decalcification
Allow time for slow remineralisation from saliva and toothpaste
176
3 ways to prevent gingivitis in orthodontic patients
Oral hygiene instruction
Particular focus on gingival areas above brackets
Single tufted brushes for below archwires
177
4 ways to prevent periodontitis in orthodontic patients
Ensure control of periodontal inflammation before active treatment
Keep appliances simple
Bond molars rather than place bands
Regular professional cleaning and scaling every 3 months during treatment
178
Prevalence of external apical root resorption in orthodontic patients
High prevalence
179
Teeth commonly affected by external apical root resorption
Upper incisors
180
Percentage of patients affected by external apical root resorption > 5 mm
5 %
181
2 treatments of root resorption in orthodontic patients
Debond early in severe cases
Fixed retainers or splinting in severe cases
182
7 ways to improve stability following orthodontic treatment
Avoid expansion/contraction
Maintain inter-canine and inter-molar widths
Ensure lower lip covers 1/3 height of upper incisor
Reduce overjet to 2-4 mm
Achieve positive incisal overbite (1/2-1/3 lower incisors)
Correct inter-incisal angle to 125-135 degrees
Ensure good buccal overlap and interdigitation
183
3 cases that are difficult to achieve stability
Lower incisor crowding
Median diastema
Generalised spacing
184
Stability and retention after treatment of lower incisor crowding
High probability of post treatment change (70%)
Permanent retention is the only way to guarantee stability
185
Prevalence of cleft lip and palate
1 in 700 births
186
Aetiology of cleft lip and palate
Abnormal embryological development of the intermaxillary segment
187
5 presentations of cleft lip and palate
Lip only
Palate only
Complete unilateral
Complete bilateral
Submucous cleft
188
4 problems for patients with cleft lip and palate
Feeding
Speech development
Growth restriction in upper jaw
Dental problems
189
4 dental problems created by the disruption of the dental lamina for cleft lip and palate patients
Hypodontia of upper lateral incisors
Supernumerary teeth
Malformed/hypoplastic teeth
Delayed dental development
190
5 stages in treatment of patients with cleft lip and palate
Lip repair at 10 weeks
Palate closure at 12-18 months
Pre-graft orthodontics at 8/9 years
Alveolar cleft grafting at 9-10 years
Fixed orthodontic appliances 12/14 years
191
Describe the use of upper removable appliance in the pre-graft treatment of cleft lip and palate
Double cantilever (“Z”) spring 0.5mm stainless steel wire for 6-8 months for transverse expansion of the upper jaw
192
4 aims of alveolar cleft grafting for cleft lip and palate patients
Fill the bony defect
Allow eruption of the canine tooth
Close any oronasal fistulas
Provide support for the alar base of the nose
193
Describe final stage of orthodontics for the treatment of cleft lip and palate
Treatment with fixed appliances at 12-14 yrs for 18-24 months +/- extractions
