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Interceptive Ortho Flashcards

1
Q

interceptive ortho aka + definition

A

early treatment

treatment performed in either primary or mixed dentition in order to enhance the dental and skeletal development and minimize prospective future serious problems, before the eruption of the permanent dentition

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2
Q

key to succeess in interceptive ortho

A

timely diagnosis and referal

- know where and what to look at

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3
Q

objectives of interceptive ortho

A
  1. to restore arch length integrity (space management)
  2. to improve skeletal imbalances - (classII, Class III, asymmetries, transverse problems)
  3. to establish functional occlusion
  4. to maintain teeth and perio health
  5. to improve self esteem
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4
Q

benefits of interceptive ortho

A
  1. redirect growht of the jaws **
  2. coordinate the width of the upper and lower dental arches
  3. guide erupting permanent teeth into desirable positions
  4. decrease risk of trauma to protruded upper incisors

may potentially simpify later ortho tx and may decrease number of extractions and might simplify orthognathic surgery if needed

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5
Q

disadvantages to interceptive

A

longer tx time and additional retention
increased cost
potential for cooperation loss
irritation of oral tissues / bulky appliances

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6
Q

indications for interceptive therapy

A
  1. arch length managment
  2. eruption problems
  3. oral habits
  4. developmental problems/ syndromes
  5. dental / skeletal crossbites
  6. skeletal discrepencies
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7
Q

arch length management means

A

making sure we have enough room for the permanent teeth to erupt

strategic spaces exist

  • primate spaces–> usually between lateral and canine on upper and canine and first molar on lower in primary teeth
  • anterior spacing
  • leeway space —> primary canine first and second molar replaced by canine first and second pre molars
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8
Q

early loss of incisors implication

A

early loss of primary incisors causes no space loss if primary canines are erupted

early loss of primary canines causes mesial drift of permanent molars, lingual / distal eruption of permanent incisors and midline discrepencies

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9
Q

early loss of primary canines implication?

A

causes mesial drift of primary molars, lingual / distal eruption of permanent incisors and misline discrepencies

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10
Q

early loss of primary 1st molars?

A

distal movement of canines, and it if happens before eruption of permanent 1st molar, than primary 2nd molar will mesially drift and permanent 1st molar

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11
Q

early loss of primary 2nd molars implication?

A

causes migration and tipping of 1st permanent molar

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12
Q

space loss occurs (time wise)

A

very quickly - more immeditalety after extraction or loss and occurs within a year (crucial 6 months)

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13
Q

space loss occurs with which teeth more in order

A

primary 2nd molar > primary 1st molar > primary canine >primary incisors

most with primary 2nd molar and least with primary incisor

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14
Q

highest prevalence and amount of space loss after premature loss of?

A

highest prevalence and amount of space loss after premature loss of maxillary e’s > mandibular e’s

e= primary second molar

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15
Q

early loss of d’s in primary implication

A

almost equal space loss in both mx and mn arches

- d’s = primary first molar

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16
Q

arch where space loss occurs faster?

A

maxilla

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17
Q

space maintainance

A

preservatino of spaces left by the primary teeth and sometimes the primate spaces

  • avoid future crowding
  • allow normal eruption of the permanent teeth
  • allow for developing class I occlusion
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18
Q

potential space loss in arches depends on

A

position of the permanent teeth and adjacent to the edentulous site

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19
Q

indications for space maintainence in terms of primary 2nd molar

A

premature loss of primary 2nd molar - when more than 6 months delay before permanent molar erupts and if there is adequate space

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20
Q

indications for space maintainence in terms of primary 1st molar

A

needed if premature loss of primary 1st occurs prior to eruption of 1st permanent molar

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21
Q

missing permanent incisors

A

usually due to truama or congenitally - so need to maintain this space

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22
Q

indications for space maintainence in terms of primary canine

A

yes - if these are prematurely lost - need to maintain space

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23
Q

5 main space maintainers used

A

band - crown and loop

distal shoe

removable - partial dent type - space maint

lingual holding arch

nance appliance

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24
Q

band and loop use

A

holding space for missing ONE posterior tooth

most of the time the permanent first molar must be erupted - b/c anchor to this tooth

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25
situations to apply band and loop application
1. premature loss of 1st primary molar 2. premature loss of 2nd primary molar, after eruption of 1st permanent molar 3. premature bilateral loss of primary molars before eruption of permanent incisors (2 appliances)
26
crown and loop
when the abutment tooth is: - highly carious - exhibits marked hypoplasia - has been pulpotomized another approach is to place a band and loop over the crown if tooth is already crowned
27
distal shoe
controls the migration of unerupted teeth loss of primary 2nd molar prior to eruption of permanent 1st molar loss of permanent 1st molar prior to eruption of permanent 2nd molar
28
location of blade in distal show
1 mm BELOW mesial marginal ridge of the erupting tooth loop contoured closely to the ridge MUST take x-ray to confirm it has gone to the right height
29
distal shoe avoided in who
pts. with risk of bacterial endocarditis
30
in order to use lingual bar need
permanent incisors and permanent first molars
31
partial denture maintainer use?
unilateral loss of more than two primary molars bilateral posterior space maintainence when more than one tooth has been lost per segment and permanent incisors have NOT yet erupted
32
advantages of partial denture / flipper maintainence
posterior maintenance esthetics - anterior teeth prevents supraeruption restores occlusal function
33
disadvantages of partial denture maintenance
cooperation hygeine
34
lingual holding arch use
multiple primary teeth are missing erupted permanent incisors premature loss of one or both primary canine s maintains E space
35
bands placed where on lingual holding arch
primary 2nd or permanent 1st molars (ideal)
36
arch positioned where on lingual holding arm
on CINGULUM OF INCISORS - 1-11.5 mm FF soft tissue and stepped to the lingual in the canine region to remain away from the primary molars and the unerupted premolars
37
fixed / solder joints or removable on lingual holding arm
either - removable more prone to breakage or loss
38
nance button / appliance use
basically maxillary counter part to lingual holding arms provides resistance to anterior movement of posterior teeth CANNOT prevent lingual tipping of incisors acrylic button anchors in the anterior portion of palatal vault, 0.5 INCH IN DIAMETER
39
hygeine in relation to nance button / appliance
can become embedded in the soft tissue when hygeine is poor pr appliance is distorted
40
three main biomechanical principles
1. anchorage - strong abutment , especially in unilaterally supported appliance (perm 1st molar better than D or E of primary molar) 2. passivity - any movement of abutment teeth must be avoided 3. simplicity - easy manipulation by the practiioner and tolerance by the patient
41
importance of leeway space | - include measurements
5-8 mm of mandibular crowding in the mixed dentition can be resolved with "E" space and slight arch expansion the same amount of crowding (5-8mm) in the permanent dentition generally requires extraction
42
space regaining
restoration of space lost localized up to 3mm DRIFT OF PERMANENT INCISORS / MOLARS repositioning of teeth followed by space maintainer if needed -- allows for further normal development
43
main causes of space loss
premature loss of primary teeth un or poorly restored proximal caries - causes drfit loss of permanent incisors from trauma congenitally missing teeth ectopic eruption of permanent teeth dental malformation, resulting in small teeth such as peg -shaped laterals
44
regaining easier in which arch?
maxillary - anchorage fom palatal vault - extraoral force - max bone structure and quality
45
regaining appliances for the maxillae
removable head gear fixed - pendulum-pend x - uses a spring and pendulum force pendex distal jet
46
regaining appliances for mandible
removable ones lip bumber -
47
lip bumper details
can use force of lip slightly to distalize the molars 1.5 mm facial to lower incisors, relieved from gingiva LIP contacts appliance change in lip and tongue balance gain arch length on mandible
48
lingual arch for space regaining on mandible that is active
lingual arch with INCORPORATING LOOPS to distalize molars or procline incisors
49
major considerations with the regaining space appliances
1. correct application of force - amount and direction 2. minimize reciprocal movement 3. avoid complex movements 4. eliminate occlusal interferences (btite plate, occlusal grinding)
50
severe localized space loss considered when
space loss MORE THAN 3 MM - loss of space CANNOT be dealt with removable or fixed simple appliances attempt to regain space should be done with extraoral force and fixed appliance
51
three ways we can MAKE space
1. expansion 2. IPR - reducing mesiodistal width of permanent teeth 3. extractions
52
when does excess space require t
NO EARLY TX UNLESS DUE TO THICK LOW ATACHED FRENUM
53
what to do with maxillary midline diastema and generalized anterior spacing
NOTHING - unless due to thick low attached frenum --> refer it out supernumerary tooth - refer and fix mesiodens - treat
54
ectopic eruption implcation
can cause resoprtion of a primary tooth other than the one it is suppose to replace or of an adjacent permanent tooth the basic approach is to move the extopically erupting tooth AWAY from the tooth is resorbing
55
brass wire use
with abnormal eruptions - 20 mm brass wire looped and tightened around contact between primary 2nd molar and permanent molar if limited moveemnt is needed, but little or none of the permanent molar is visible clincially tighten approx every 2 weeks
56
appliance to use for severe resorption?
cantilever arm -place band on second primary molar supported by lingual arch if maximum control desired, wih cantilever arm extending distally behind unerupted molar spring or elastic hooked from the cantilever to button on molar * for ectopic eruptions
57
interproximal reduction
sequential selective slenderizing of primary teeth in order to allow a more favorable eruption path for the permanent teeth mesial or distal on lower primary canines mesial on lower second primary molars disk or needle shaped bur
58
interproximal reduction in posterior?
after require a space maintainer -- lingual arch always perpendicular to the occlusal plane and in order to create a favorable path for alignment
59
extraction of primary teeth
extraction of primary maxillary canine in order to allow a more favorable eruption path for the permanent canine or correct midline deviations if contralateral was exfoliated prematruely when permanent tooth is there and no signs of exfoliation or movement in the primary
60
serial extraction - general overview
sequential extraction of primary and permanent teeth in order to relieve severe crowding and guide the eruption of permanent teeth into the dental arches ** when MORE than 10 mm of mandibular crowding exisits and extractions of 4 premolars is require specific order and follow up for next ones required
61
most common teeth involved in serial extraction and rationale for each
most common are decidous canines, first molars, and first pre-molars primary canines -- improve incisor alignment 1st primary molars -- accelerate erruption of the 1st premolars then 1st pre-molars -- permit the eruption of the permanent canines into proper position
62
extraction / enucleation
supernumerary teeth, cysts, odontomas; eruption interference or diestam *contribute to eruption problems treat cause!
63
oral habits implication
can cause distortions with dental alveolar like thumb sucking and tongue thrusts
64
appliance to help with oral habits
tongue crib | - prevent tongue from putting pressure on the dentition
65
tongue habit appliance
acts as a reminder of where to position the tongue
66
tongue spurs
interfere with the tongue tongue learns not to go there
67
thumb crib
patients that suck thumb | block area where thumb would go
68
schwartz appliance helps with
transverse imbalances - like posterior crossbites - seems like a palatal expander on the lingual too
69
quad helix is
fixed - helps with posterior crossbites
70
bonded hyrax expander
acrylic - may open bite but will have no extrusion of molars - so no increase in vertical dimension
71
bands where on haas expander
bands on 6's and 4's
72
hass expander details
bands on 6's and 4's metallic framework expansion screw acrylic palatal coverage NON PARALLEL suture opening teeth extrusion of posterior
73
hass expander vs bonded hyrax expander
with bonded have acrylic on occlusal coverage - may open bite but will have no extrusion of molars - so no increase in vertical dimension hass expander may have extrusion bonded hyrax has bands on 6's
74
bonded hyrax expander details
vertical control long AFH (anterior facial height) - do not want any bite opening no extrusion desired when bite opening is contraindicated
75
KD appliance for
anteiror crossbite
76
fixed appliance for anteiror crossbite
yes | - can do this with KD appliance
77
skeletal imbalances dealt with how - general
maxillary and mandibular excessive and deficient growth - modify accordingly like head gear face mask fixed / removable see last weeks lectures
78
when to interfere with early treatment
primary or mixed -- as soon as patient can tolerate impressions

Ortho (19 decks)

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