adolescent orthodontic treatment

Question 1

urgent phase

Answer 1

1 )pain, swelling, infections

Question 2

control phsae

Answer 2

1) perio, extraction ,endo, caries control

Question 3

re evaluation

Answer 3

1) holding phase after control phase

Question 4

definitive phase

Answer 4

1) reassess initial treatment, operative care, prosthodontics, orthodontics

Question 5

maintenance phase

Answer 5

holding it stable

Question 6

level and aligning

Answer 6

1) light arch wires (niti)
2) make sure teeth are straight and leveled

Question 7

working phase

Answer 7

1) heavier wires strong enough to support major movements
2) space closure or occlusion correction

Question 8

finishing and detailing

Answer 8

1) wires that can be bent

Question 9

retention

Answer 9

retainers

Question 10

goals of leveling and aligning

Answer 10

1) bring teeth to arch and control
- incisor position
- vertical position
- transverse relationship
- maintain arch form
2) make sure each thing has a purpose

Question 11

alignment

Answer 11

1) roots are generally in right spot
- usually mean crowns are tipped
2) maintain light forces
- niti wires
- small round wires to begin with
- no reason to work up to steel wires in this phase

Question 12

large brackets

Answer 12

1) better control
2) more uncomfortable

Question 13

properties of a good wire

Answer 13

1) low stiffness
2) high strength
3) high range, formability
4) weldable and solderable
5) no wire with all characteristics

Question 14

extraction

Answer 14

1) incisors are usually crowded and not bonded
2) bone second molar to canine first
3) close some space to allow for alignment in anterior region
4) now back to level and alignment

Question 15

non extraction

Answer 15

1) wire sequence
2) bond all teeth
3) engage as many as possible

Question 16

what should be completed before

Answer 16

1) leveling and aligning done
3) all rotations
4) resets completed
4) main working arch wire in place

Question 17

goals of the working phase

Answer 17

1) everything else
2) molar correction
3) space closure
4) prep for surgery

Question 18

molar correction

Answer 18

1) differential growth
- girls mature earlier
- headgear and functional appliance
2) dental movement
- no growth
- headgear and functional appliance
- other distalizing appliances
- elastics
- extractions

Question 19

differential growth

Answer 19

1) modulate lower jaw growth if you catch it at the right time

Question 20

when to take out teeth and which ones

Answer 20

1) take out teeth closest to the problem
2) class I anterior
- all first premolars
2) class II occlusion cases
- upper first premolars (fix canine relationship) and lower second premolars (fix molar relationships)
3) class III occlusion (same as above but swapped)

Question 21

space closure

Answer 21

1) upper first premolar extraction only
- class II cases with no growth potential left
- almost 100% will need absolute anchorage
- difficult with certain class II div 1 cases
2) class II and III
- depends heavily on anchorage considerations (hold posterior teeth in place and bring anterior teeth distally)

Question 22

mild anchorage concerns

Answer 22

1) symmetrical extractions all first premolars

Question 23

maximum anchorage

Answer 23

1) need to back up the teeth
2) put lingual arch improve retraction ratios 2:1 (front teeth go back twice as fast)
2) reinforcement and elastics (3:1)
3) segmented canine retraction (3:1)
4) skeletal implants

Question 24

six keys to occlusion

Answer 24

1) molar relationship MB cusp of first molar sits in Buccal groove
- want a DB cusp to contact lower second molar
2) all upper teeth roots more distal to the crown
3) crown inclination (torque)
4) spaces all contacts tight
5) flat to slight curve of spee

Question 25

finishing

Answer 25

1) you have - all spaces closed - class I occlusion - OB and OJ corrected 2) final vertical position of teeth - final in/out positions - some minor vertical and sagittal corrections (open bite slight OJ)

Question 26

correcting vertical incisor relationship

Answer 26

1) smile esthetics 2) look for in excessive OB - vertical jaw relationship - incisal display

Question 27

midline discrepancy

Answer 27

1) usually corrected in working phase 2) usually due to - lateral incisor position - slight class II and class III - cr-co shifts because arch coordination is poor 3) fix by - asymmetric pattern cl II or cl III one side vs the other - midline elastics - asymmetric IPR if OJ allows (need topical fluoride)

Question 28

tooth size discrepancy

Answer 28

1) usually started during first phase but the final adjustments are in finishing 2) build ups - put lateral slightly closer to central (makes restoration look better) - or if you leave the space, put the space distal as possible

Question 29

final settling of teeth

Answer 29

1) is is common for class II or III corrections to relapse slightly - stop elastics 1-2 mo prior to debond - slight overcorrect 2) stiff arch wires can hold teeth slightly out of occlusion - once removed, it will settle in place

Question 30

settling 101

Answer 30

1) method 1 - remove main arch wire and place light wire - replace with braided ss wires and some light elastics 2) method 2 - section main wire distal to canines - add up and down finishing elastics 3) method 3 - have a lab do it with positional - expensive and hard to wear

Question 31

debond

Answer 31

1) move all brackets at same time 2) remove brackets - pinch base and clean up

Question 32

periodontal rebound

Answer 32

1) relapse - retainers help 2) overcorrect - 1-2 mm change in rebound but posturing is 4-5 mm change - stop elastics 1-2 mo prior to debond - can place some elastics to slightly overcorrect - wean off elastics

Question 33

transverse

Answer 33

1) slightly overcorrect 1-2 mm 2) then debond

Question 34

rotated teeth

Answer 34

1) overcorrect a little bit 2) no done with detailing stage 3) put root below the crown

Question 35

break network of elastic fiber memory

Answer 35

1) circumferential supracrestal fibrotomy 2) straight incision into papilla