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Orthodontics > Comprehensive orthodontic treatment > Flashcards

Comprehensive orthodontic treatment Flashcards

1
Q

What is the goal of orthodontic treatment?

A

To produce the best combination of occlusion, dental and facial aesthetics and stability of outcome

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2
Q

What does the usual orthodontic treatment consists of?

A
  • Fixed orthodontic appliances or aligners on all teeth
  • possible extractions with/without growth modifications and orthognathic surgery
  • Multidisciplinary coordination for complex cases
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3
Q

How long is Phase I treatment

A

Usually 1 year followed by retention

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4
Q

When is Phase II treatment commenced?

A

After eruption or nearing eruption of 7-7s

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5
Q

When is orthognathic surgery performed?

A

After growth cessation
Except:
- Progressive deformity from growth restriction eg. TMJ ankylosis after trauma/infection
- Severe psychosocial issues

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6
Q

Types of brackets?

A

Conventional edgewise metal brackets
Self-ligating brackets (metal or ceramic) - without band
Ceramic brackets (not done on lowers as they are harder and will wear down teeth + wire can still be seen
Lingual appliances

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7
Q

How are brackets bonded to the tooth

A

With CR adhesives

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8
Q

What are the differences in archwires

A

Material
Size
Arch form

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9
Q

What are the two types of bands

A

Elastomeric modules
Wire ligatures

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10
Q

What is the ultimate aesthetic option?

A

Clear aligner trays with composite attachment for more complex cases to attach to aligners

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11
Q

What are the advantages of clear aligners?

A
  • Aesthetics
  • Comfort
  • Ease of oral hygiene
  • Minimal dietary restrictions (eg worry abt brackets coming off)
  • Longer appointment intervals
  • Control of tooth movement rate
  • Certain mechanical advantages
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12
Q

What are the disadvantages of clear aligners

A
  • Compliance dependent
  • Several tooth movements can be challenging
  • Lab-based fabrication of aligners
    (Duration, cost, less flexibility)
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13
Q

What should be done before orthodontic treatment is begun?

A
  • Develop multidisciplinary treatment plan and sequence
  • Disease control - caries, active perio, endo lesions
    (gingival grafts prophylactically, provisionalisation)
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14
Q

What should be done after orthodontic treatment?

A
  • Good OH control, regular dental checkups and prophylaxis
  • Debond after confirmation from other providers
  • Immediate retention
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15
Q

What are the three stages for conventional fixed appliances?

A
  1. Alignment and levelling
  2. Space closure and AP/vertical/transverse correction (KIV elastics)
  3. Finishing (Interdigitation and rotation)
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16
Q

What are the possible orthognathic surgery cases approaches

A
  1. Surgery first
  2. Surgery early
  3. Conventional three stage method
17
Q

What are the indications for surgery first approach?

A

Minimum crowding, bite stable in Class I
Patients do not want transitional stage in conventional method

18
Q

What are the three stages in the conventional three stage method?

A
  1. Pre-surgical orthodontics (Remove DAC) - worsens aesthetics
  2. Orthognathic surgery
  3. Post surgical orthodontics
19
Q

What are the indications for a conventional three stage method?

A

Significant crowding
Problems in all 3 planes
No stable bite
Severe skeletal discrepancy
Requiring exos
More predictable

20
Q

What are the main treatment considerations prior to growth modification?

A

Compliance
OH
Growth status

21
Q

What are the treatment considerations?
14

A
  1. C/O
  2. Compliance + OH
  3. Med Hx/Medications
  4. Growth Status
  5. Facial balance
  6. Skeletal discrepancies: severity + which planes
  7. Effects of treatment in one plane on another plane
  8. Orthodontic camouflage vs orthognathic surgery
  9. Limits of dentition (recession, instability)
  10. Crowding + Incisor inclination (exo)
  11. Missing permanent teeth (Space opening/closing; ability of canine masking (shape, size, gingival margin; Bolton’s discrepancy –> poor interdigitation –> need for disking)
  12. Long term prognosis of teeth (multidisciplinary)
  13. Anchorage and periodontal support (esp of anchor)
  14. Stability (final outcome)
22
Q

When is chin prominence good

A

When masking Class II patients

23
Q

What is the most important for skeletal discrepancies

A

Normal vertical dimension of lower face

24
Q

Growth modification is most useful and least useful for which planes?

A

Most: AP
Lease: Transverse

25
Q

What are temporary anchorage devices (TADs) used for

A

Mini screws used to expand treatment possibilities for camouflage

26
Q

What is orthodontic camouflage

A

Moving teeth into correct dental relationships but accepting SK discrepancies

27
Q

What are limits of dentition?

A

Anterior limits: Proclination
Posterior limits: accommodating teeth by distalisation/extraction of 2nd and 3rd molars
Lateral limits: ant border of ramus

28
Q

How can space be created?

A
  1. Expansion
  2. Inter-proximal stripping (0.25 per tooth, 0.5 per ant) - for up to 5mm of crowding
  3. Extractions
29
Q

Whats the average max and man leeway space

A

Max: 1.5mm per quad
Man 1.7-2.5mm per quad

30
Q

What is the drawback of a lower lingual holding arch

A

cannot mesialise L6 into Class I

31
Q

Considerations for extractions of teeth
14

A
  1. Med Hx
  2. SK discrepancies + growth
  3. Severity of space deficiency
  4. Incisor inclination
  5. Skeletal or dental open bite
  6. Facial profile
  7. Molar and canine relationships
  8. Position of teeth - exo of tilted/displaced tooth; exo 4/5 depending on which is closer to crowding
  9. Long term prognosis of teeth
  10. External root resorption or thin/tapered roots
  11. Status of periodontium (perio compromised –> exo)
  12. Thickness of alveolar bone
  13. OJ, OB
  14. Midline deviations
32
Q

Surgical cases of Class II usually involves

A

Man adv: 66%
Mx impaction: 15%
Both: 20%

33
Q

Surgical cases of Class II usually involves

A

Man setback
Mx advancement (Lefort I osteotomy)
Both

Orthodontics (18 decks)

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