- split and move Single jaw or bimaxillary procedures

Intro Flashcards by niamh ritchie

orthodontics is

Speciality of dentistry concerned with: - Growth and development of teeth, face and jaws - Diagnosis, prevention and correction of dental and facial irregularities

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what does orthodontic assessment include

systematic evaluation of the face and skeletal bases in 3D Position of the teeth depend to a large extent on the size, shape and relative position of the underlying bones (i.e. the maxilla and mandible)

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position of teeth depend on

depend to a large extent on the size, shape and relative position of the underlying bones (i.e. the maxilla and mandible)

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what is the key skeletal relationship that impacts occlusion

relation ship of jaw Where does maxilla line in relation to mandible – anteroposterior skeletal relationship

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Frankfurt plane

Top of ear hole to orbital rim needs to parallel to floor for orthodontic assessment Reproducible by getting pt to stare into own eyes in mirror

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what is ignored in orthodontic assessment

Chin completely separate from mandible – not used in assessment

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2 bone points used in orthodontic assessment

Basal bone of maxilla –curvature of upper lip, below nose Innermost curvature of lower lip mandible

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Class 1 skeletal relationship

mandible 2-3mm behind maxilla - normal

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class 2 skeletal relationship

maxillary base is in front of mandible significantly (10mm approx.) expect overjet teeth

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class 3 skeletal relationship

maxillary base is in line with mandible reverse overjet expected

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mandibular hypoplasia causes

CLASS 2 Juvenile arthritis condyle crumbling Smaller lower jaw

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mandibular prognathism and maxillary hypoplasia causes

CLASS 3 Large lower jaw And smaller upper jaw

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orthodontic dimensions

3D problem – facial asymmetry - Hemimandibular hypertrophy

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Hemimandibular hypertrophy

3D problem -> facial asymmetry Many female late teen – early 20s Gradual onset Lack eruption on one side undereruption on other side causing maxillary cant

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hemifacial microsomia

syndrome Failure to develop condyle, ramus and body to differing tegress Progressive facial asymmetry Can graft (2/3 successful)

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example of syndrome impacting orthodontics

hemifacial microsomia

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Mandibular retromaphia causes

class 2 point A (maxilla) in front of B (mandible)

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lateral cephalometry taken when

Only take if skeletal problem – so only class 2 or 3

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orthodontic tx options for skeletal discrepancies

Growing patients - Growth modification techniques to promote or restrict growth of either jaw Adults who have completed growth - Orthognathic Surgery

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growing patients orthodontic Tx options for skeletal discrepancies measn

growth modification

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orthodontic appliances to alter growth in skeletal discrepancies of growing pts (3)

Functional appliances – grow mandible (wear 24 hours a day) Headgear – reduce maxillary Reverse pull facemask and RME – promote maxillary growth

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orthognathic surgery

split and move Single jaw or bimaxillary procedures

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orthodontic treatment for adults who have completed growth but have skeletal discrepanacies

orthognathic surgery

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BSSO

Bilateral Sagittal Split Osteotomy

orthognathic surgery for maxilla

le fort 1

orthognathic surgery for mandible

Bilateral Sagittal Split Osteotomy BSSO

le fort 1

Split bone and pull forward Secured my pins and screws

BSSO

Inside behind nerve and mandible around lower molars Slide mandible forwards of back Careful of nerve

orthognathic team (6)

Orthodontist Maxillofacial Surgeon Clinical Psychologist – ensure pt knows what impact will be Maxillofacial Technician Speech Therapist GDP

cleft lip and palate prevalence and causes

1 in 700 live births Multifactorial - Cleft lip or Cleft palate or Cleft lip and palate Unilateral or Bilateral

cleft lip and palate team (7)

Orthodontist cleft surgeon ENT Speech therapy Max-fac surgeon Plastic surgeon Dental practitioner

what can go wrong in growth and development of teet?

Increased overjet Deep overbite Anterior cross bite Posterior cross bite Retained deciduous teeth Early loss of deciduous teeth Ectopic teeth Impacted first molars Crowding Spacing Trauma Habits Anterior open bites Lateral open bites Ankylosis of deciduous teeth Cysts Diastema Supernumeraries Dental asymmetries

role of dentist and orthodontist in diagnosis

Watch developing occlusion for issues and intercept to alleviate

anterior eruption norm

centrals before laterals issue in sequence of eruption -\> refer

orthodontic diagnosis consists of

Careful systematic assessment of teeth, face and jaws (Lecture 2) - Facial anomalies, asymmetries - Skeletal relationship (how the jaws relate to each other) - Skeletal relationship (how the jaws relate the skull base) - Teeth in each arch separately - Occlusion (how they bite together) Study models Radiographs - Orthopantomogram (OPG) - Lateral Cephalogram – if skeletal issue Photographs – before and after Tx Sensibility tests Cone beam CT scan

key aims of orthodontic Tx (3)

stable functional aesthetic occlusion done prior to restorative work try to recreate the ideal occlusion - Andrew's 6 keys

types of orthodontic appliances

Removable Functionals Fixed Others - Aligners, Invisalign replace every 3-4 weeks - Headgear and reverse pull HG - Temporary anchorage devices last 10-15 years, screws to move teeth

removable appliances

tip teeth, open bites, maintain space start the job often - Growing patient

functional appliances

modify jaw growth

fixed appliances

true 3D control of tooth protrusion (traintracks)

benefits of ortho

Improve function - e.g. anterior cross bite or anterior open bite can make it difficult to incise food improve appearance (aesthetics) improve dental health (make teeth more easy to clean) Reduce risk of trauma To facilitate other dental treatment - E.g. rearrange spaces in hypodontia cases prior to bridges or implants – right size for it

3 key risks of ortho

Decalcification Relapse Root resorption

risks of ortho

Decalcification Relapse – hence retainers Root resorption - Pain, discomfort - Soft tissue trauma - Failure to complete treatment - Loss of tooth vitality - Inhale or swallow small components - Candidal infections

who do orthodontists treat

not limited to adolescence 30% of our patients are adults treatment in the mixed dentition for some cases (interception) Early treatment of facial anomalies Cleft lip and palate cases may require very early treatment (just after birth)

why do we do orthodontics studying

Interesting Stimulating Technically demanding and hands on Infinite variety of malocclusions and problems Good patient population

Which of the following may be used to assess the antero-posterior skeletal pattern CLINICALLY? a. Incisor relationship (BSI) b. Mandibular unit length c. Maxillo-mandibular planes angle (MMPA) d. Palpation of the skeletal bases e. Molar relationship

d. Palpation of the skeletal bases

Which of the following can be used to assess the vertical skeletal pattern CLINICALLY? a. Lower anterior face height /upper anterior face height x 100 b. The Frankfort-Mandibular Planes Angle (FMPA) c. Lower anterior face height + upper anterior face height x 100 d. Frankfort-Maxillarly Planes Angle (FMxPA) e. Total anterior face height /upper anterior face height x 100

d. Frankfort-Maxillarly Planes Angle (FMxPA)

Which two soft tissue landmarks are used to construct the Frankfort Plane? a. Porion and Pogonion b. Gonion and Pogonion c. Gonion and Menton d. Porion and Orbitale e. Alar and Tragus

d. Porion and Orbitale Prosthodontists use the Alar-Tragus Line as an approximation to the Maxillary Plane

Which two soft tissue landmarks are used to construct the Manibular Plane? a. Porion and Menton b. Alar and Tragus c. Gonion and Menton d. Porion and Orbitale e. Gonion and Pogonion

c. Gonion and Menton

What is the definition of a Class 1 incisor relationship? a. The lower incisor edges are in contact with or below to the cingulum plateau of the upper incisors. b. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors, there is an increased overjet. c. The lower incisor edges in contact with or below to the cingulum plateau of the upper incisors, there is an increased overjet and the incisors are usually proclined. d. The lower incisor edges in contact with or below to the cingulum plateau of the upper incisors, there is an reduced overjet and the upper central incisors are retroclined. e. The lower incisor edges lie anterior to the cingulum plateau of the upper incisors, the overjet is reduced or may be reversed.

a. The lower incisor edges are in contact with or below to the cingulum plateau of the upper incisors.

What is the definition of a Class II division 1 incisor relationship? a. The lower incisor edges lie anterior to the cingulum plateau of the upper incisors, there is an increased overjet and the incisors are usually proclined. b. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors, there is an increased overjet and the incisors are usually proclined. c. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors, there is an increased overjet and the incisors are usually retroclined. d. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors, there is an decreased overjet and the incisors are usually retroclined. e. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors, there is an decreased overjet and the incisors are usually proclined.

b. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors, there is an increased overjet and the incisors are usually proclined.

What is the definition of a Class II division 2 incisor relationship? a. The lower incisor edges lie anterior to the cingulum plateau of the upper incisors, there is an increased overjet and the upper central incisors are usually proclined. b. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors and the upper central incisors are usually proclined. c. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors, there is an increased overjet and the upper central incisors are usually retroclined. d. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors and the upper central incisors are usually retroclined. e. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors and the upper lateral incisors are usually proclined.

d. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors and the upper central incisors are usually retroclined.

What is the definition of a Class III incisor relationship? a. The lower incisor edges lie anterior to the cingulum plateau of the upper incisors, there is an increased overjet and the incisors are usually proclined. b. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors, there is an increased overjet and the incisors are usually retroclined. c. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors, there is an decreased overjet and the incisors are usually retroclined. d. The lower incisor edges lie posterior to the cingulum plateau of the upper incisors, there is an decreased overjet and the incisors are usually proclined. e. The lower incisor edges lie anterior to the cingulum plateau of the upper incisors, the overjet may be reduced or reversed.

e. The lower incisor edges lie anterior to the cingulum plateau of the upper incisors, the overjet may be reduced or reversed.

What is Orthodontics? a. Is all about straightening teeth b. Involves fixed appliances only c. A way to get rich quickly and retire early d. Treating patients with orthodontic appliances e. Managing the developing occlusion

e. Managing the developing occlusion

Skeletal relationships... a. have some influence on the observed malocclusion but can be safely ignored b. can be one of the most important influences on the observed malocclusion c. should be assessed in 3 dimensions; Antero-posterior, Vertical and Transverse d. have little or no influence on the observed malocclusion and can be safely ignored e. should be assessed in a careful and systematic way

c. should be assessed in 3 dimensions; Antero-posterior, Vertical and Transverse and e. should be assessed in a careful and systematic way

What are the orthodontic treatment options for a patient who has a significant skeletal discrepancy and is still growing? Select one or more: a. Functional appliances b. Headgear c. Facemask therapy with RME d. Accept the malocclusion e. Orthognathic surgery

a. Functional appliances b. Headgear c. Facemask therapy with RME d. Accept the malocclusion

Maxillary Incisors were commonly ectopic. This is true to an extent but which maxillary tooth is more commonly ectopic than the incisor? a. Canine b. Second Premolar c. Third Molar d. First Premolar e. First Molar

a. Canine

Which of the following Orthodontists named the '6 Keys to the Occlusion'? a. Anderson b. Andrew c. Angle d. Angel e. Agnew

b. Andrew