Keys of Occlusion Flashcards by J L

As defined by the AAO
 Orthodontics is that area of dentistry concerned with the growth, guidance, correction, and maintenance of the ____ complex, with special emphasis on developmental disturbances and those conditions that cause or require movement of the teeth.

 The area of orthodontic practice includes the ____, prevention, ____ and treatment of all forms of malocclusion of the teeth and associated alterations in their supporting structures, the design application and control of functional and corrective appliances, and the guidance of the developing dentition to attain optimum occlusal relations in physiologic and esthetic harmony with other facial and cranial structures.

dento-facial
diagnosis
interception

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Goal of Orthodontic Treatment

The goal of Orthodontic treatment is to obtain optimum proximal and occlusal ____ of the teeth within the framework of acceptable facial esthetics and ____, normal function, and reasonable ____.

• Cannot fix a skeletal problem by \_\_\_\_ teeth

contact
self image
stability
straightening

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• First thing people see is your ____

smile

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• Anatomical harmony of all parts
○ Do not need ____
• Anatomical disharmony of parts
○ Either adequate adaption and no ortho treatment is necessary
○ Or inadequate adaptation and treatment is necessary

• First dental examination: emergence of first \_\_\_\_ tooth, but no later than \_\_\_\_ y/o
	○ No teeth at age 1 > see a peds and why there's no teeth
		§ Child has \_\_\_\_% less dental expenditures by age 5/6, than a kid that doesn't see a dentist until age 3
• First ortho examination: emergence of first \_\_\_\_ tooth, but no later than \_\_\_\_ y/o
	○ Initial examination at no cost, won't cost the parents anything

deciduous
1
40
permanent
7

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Prevalence of Malocclusion

	• 1/3 \_\_\_\_ malocclusion
	• 1/3 \_\_\_\_ malocclusion
	• 1/4 \_\_\_\_ malocclusion
		○ Skeletally involved
	• 1/12 \_\_\_\_ malocclusion

normal
moderate
severe
handicapping

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• Three types:
○ ____
○ ____
○ ____

preventive and interceptive
corrective
adjunctive

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Mechanism of making treatment decisions

• Patient walks into office > clinical assess the patient before you walk over to the patient (see them walk in) > diagnose how you treat depending on how face goes together
• Arrive at a tentative diagnosis based just on \_\_\_\_
• Cannot finalize diagnosis without \_\_\_\_
• C II, D I
	○ Skeletal and dental
	○ 70% of this pattern has a \_\_\_\_ mandible, may also have a protrusive maxilla
	○ Passive eruption
		§ Upper teeth into lower teeth, and lower teeth in upper mouth
		§ Deep vertical \_\_\_\_
	○ Intrude overerupted \_\_\_\_ teeth, you don't retrude posterior teeth
• Decide the treatment plan
• What are you going to move it with?

clinical
labs and x-rays
retrusive
overbite
anterior

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Order of Treatment

	• \_\_\_\_
		○ First thing you do is make sure the teeth and supporting tissues are healthy
- PA lesions
- supporting tissues
- teeth

	• Correct the \_\_\_\_
		○ Move teeth in the middle
- ortho treatment
- orthognathic surgery
- stabilization

	• \_\_\_\_
		○ Don't do crown first before you have malocclusion checked out!
- supporting tissues
- placement of implant fixtures
- final restorations

control infection
occlussion
complete functional/esthetic treatment

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Hallermann-Streiff Syndrome

 \_\_\_\_ (abnormal head) with bird facies and hypoplastic mandible
 Congenital cataracts
 Proportionate nanism (\_\_\_\_) *
 Micropthalmia (small eyeballs)
 \_\_\_\_ (congenital lack of hair)
 Dental anomalies

 Cutaneous atrophy primarily limited to the face and/or scalp
 ____ (shortness of the head) with frontal and parietal bossing
 Open sutures and fontanels
 High arched ____
 Nystigmus (oscillatory eyeball movement

• When there is one eruption anomaly > there are often \_\_\_\_ eruption anomalies
	○ When look at x-rays > look at the teeth last

dyscephaly
dwarfism
hypotrichosis
brachycephaly
palatal vault

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Initial records of HM syndrome

____ facies
____ mandible
____ bite
partial anodontia
____ molar
large ____
high narrow ____
congenitally missing teeth• Only has one lower incisor
○ Has to be a ____, cause laterals grow from an invagination of the central incisor bud
○ If you don’t have a central incisor, you cannot have a lateral incisor
• Thumb into child’s mouth, if doesn’t fit > maxilla is too ____
○ Palatal vault is set by age 3
○ No growth in the tooth bearing area
Crowded at age 3, will be crowded by age 33 unless you intervene

bird-face
retrusive
open
CIII
OJ
palatal vault
central incisor

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Initial records

____ hyperdivergent skeletal pattern with retrusive mandible
altered ____ w partial impactions• Very steep ____
○ Should be falling at base of the occipital
○ Has a lot of interception of the occipital bone by the mandibular plane
§ More common to occur in ____ than C2

CI II
eruption timing
mandibular plane
CIII

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Rx of HM syndrome

____ placement• Average lifespan is about age ____
• Remove one ____ in order to create the same amount of tooth material bilaterally and symmetrically for her
• One lower ____ right in the middle
○ No one sees if you have missing ____

appliance
premolar
central incisor
incisors

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Improvement following Rx

Class III corrected by mesial U molar and distal L molar movement
OB/OJ improved by ____ and improved ____ of incisors

extrusion

axial inclination

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Facial comparison

face ____, but no ____ change

lengthened

sagittal

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6 Keys

____ relationship
Crown ____ (mesio-distal tip)
Crown ____ (labio/bucco-lingual)
Absence of ____
Absence of ____
Almost flat ____

molar
angulation
inclination
rotations
spacing
occlusal plane

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Angle classification

• Point B is slightly \_\_\_\_ point A
	○ \_\_\_\_ degrees in Caucasian
	○ 6 degrees in AA

behind

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Class I

____ mandibular plane
Normal molar & canine

M-Li cusp of U 1st molar rests in CF of L 1st molar

Class II division 1 subdivision left

• Normal occlusion
• \_\_\_\_ cusp of max first molar occluded with \_\_\_\_ of man first molar
• Now: ML cusp of max first molar, is in the CF of the man first molar
• Was located under the T ridge/malar process
• Is there enough room for all of the teeth?
	○ Patient with crowded dentition:
		§ Make the jaws bigger
		§ Make the mass of tooth material smaller
		§ [???]

steep to flat

MB
buccal groove

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Class I

Ant crowding

Bimaxilalry dental protrusion

• Alters the \_\_\_\_ of the face with bimaxillary dental protrusion
• Move the teeth back > only way to do that is to take the \_\_\_\_ teeth out
• Class I crowded > arch bigger, tooth material smaller
	○ Do I have enough room, do I have enough support
• What the fuck is this guy talking about
• More than 6mm of crowding > requires \_\_\_\_

lower third
permanent
extractions

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Class I

Bimaxillary skeletal protrusion

• Upper and lower jaws are too much forward
• The teeth are upright, but the jaws are too far \_\_\_\_
• Throwback to \_\_\_\_
• Class I
	○ Mandibular plane that ranges from slightly above to slightly below normal

forward

ancestors

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Class II div 1

Normal to steep mandibular plane 70 % have retrusive mandible

• Present with a \_\_\_\_ face, and a \_\_\_\_ mandibular plane
• Mandible further back than it should be
• MB cusp of max molar is not lined up with buccal of man molar (first)
	○ Located at the proximal contact
• Class II on one side and Class I on the other > class II \_\_\_\_ (meaning one-sided); the side that's out of \_\_\_\_ is the side named

longer
steeper
subdivision
wack

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Class II div I

U teeth protrusive

L teeth retrusive

• Can be caused by uppers being too far \_\_\_\_, or lower being too far \_\_\_\_

Maxilla protrusive

Mandible retrusive

• Or can be because \_\_\_\_ is too far forward, and the \_\_\_\_ is too far back

* Or \_\_\_\_ can be implicated
* Don't fix what's not broken

forward
backward

upper jaw
lower jaw

both

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Class II div 2

____ mandibular plane
____ skeletal

Maxillary central incisors ____

* Have a \_\_\_\_ mandibular plane
* Vertical overbite is \_\_\_\_
* CI are tucked \_\_\_\_, and LI are flared \_\_\_\_
* With anterior crowding: CI go forward and LI go back

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normal to flat
class I or class II
flat
deep
back
forwardC

Class II div II

____

• Mostly have \_\_\_\_ and a strong chin

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orthognathic
convex
orthognathic

Class III

____ mandibular plane

Strong ____

Longer ____ span, often into early 20’s

• Half of people have significant enough malocclusion that should be treated
• Of the people who have malocclusion, about half have a class I malocclusion, about a 1/3 have a C2, D1; about a 1/6 C2, D2; about a 1/2 have a C3 malocclusion
• All mechanics have do not work as well for \_\_\_\_
• Malocclusions of C3 grow longer and later
	○ Cannot do a thing until patient stops \_\_\_\_ so they can get surgery > stop growing into 20's for males
• Normal to steep mandibular plane and a strong anti-gonial notch (when the mandible bends)

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normal to steep
anti-gonial
growth
CIII
growing

Class III U teeth ____ L teeth ____ * Rarely caused by maxilla being ____ * Seen most often in youngsters with ____ * Lower teeth are protrusive, and the lower jaw is protrusive

retrusive protrusive retrognathic down syndrome

• Used to get 40% relapse in surgical cases because of ____ • Now with titanium plates/screws > only ____% relapse ○ Preform the plates before going into the OR, so now it fits passively

steel ligature | 5

VENN DIAGRAM LOOK ME UP Alignment problem = ____ Profile problem = ____ Also have transverse, sagittal, vertical space planes Depending on group = how long it will take to fix it ____ = higher number ____ is most serious • Gives an idea of the ____ of the malocclusion • If the malocclusion includes skeletal, it doubles the ____

group 1 group 2 overlap 9 severity severity

Narrow maxilla Functional shift to right • Mandible has shifted off to his right • Crossbite of teeth on right side, and no crossbite on the left • Closed in initial contact, molars bet buccal cusp tip to tip, and shifted to right side to get functional MIC • ____ the maxilla > the earlier it's done, the easier to do ○ Less likely to ____ erupts

widen | maxillary canines

Dental midlines centered Mandibular skeletal midline shifts right • Damage to LI > root of forming ____ went into the crown of the forming permanent LI

deciduous LI

Phase I Rx Haas RME 15 days expansion @ ____mm ____x/day • ____ the maxilla ○ Whatever space you had will be larger ○ ____ the space stays the same, when finished widening > return to crowding if it exists ○ Correcting ____ not tooth! § The arch is wider, but the teeth return to normal

``` 0.2 2 widen dentally bone ```

3 years post-expansion dental midline ____ dental ____ right canines deep ____ problematic maxillary ____ • Mandibular shift to the right, canine blocked out to buccal and incisors behind it

shift x-bite OB labial frenum

* Still have primary molars, the secondary primary molar is much ____ than the PM that will replace (3.5 mm difference) > hold molars back where they are and bring the premolars back, and canine go back > will not have to ____ any permanent teeth * Do not ____ until all the primary teeth fall out!

larger remove wait

Phase II Rx - corrective appliances placed - 18 month Rx Frenectomy 3 mo. prior to ____

deband

Cannot treat only the social six, will have ____ that aren't moving properly

roots

Records must include  ____ Hx  ____ Hx ```  Facial examination  ____  Proportions  ____  Muscle tone  ____ defects  Palpate TM ```

``` medical dental symmetry vs. asymmetry orientation speech ```

Records  Oral examination  Visually examine and palpate all ____ tissues  Examine occlusion, relationship of teeth and jaws in all 3 ____ of space  ____  Sagittal  ____  ____  ____ and intra-oral photographs

``` hard and soft planes transverse vertical height & weight facial ```

Records  Orthodontic models  Trimmed ____ so that arch asymmetry can be viewed in comparison to symmetric bases  Heel trimmed in ____ or articulator mounted  Impressions made deeply into the ____ to allow visualization of tooth position as it relates to bone support  Utilization of models to accomplish an ____ analysis

symmetrically RC muccobuccal fold arch-length

Records ```  ____ for vertical/sagittal analysis  ____ for transverse analysis prn  PA’s prn  ____  ____, especially if periodontally involved  ____ to view palate ```  Cone beam CT prn  Any other pertinent views

``` lateral ceph PA ceph BW's FMXR upper occlusal ```

Records These are the minimum diagnostic records required to do an Orthodontic evaluation Failure to include these data in your analysis may increase your ____ Must have evidence that the records were ____, not just ____

liability evaluated gathered

Andrea M Class II D I ____ mandible Deep ____ - palatal impingement - midline deviation; u spacing - larger ____ U teeth relate well to maxilla L teeth relate well to mandible

retrusive OB OJ

Andrea M Symmetric maxilla - anterior spacing - rotated U molars - upright incisors - adequate arch length To Rx this case we need to:  Maintain relationships of teeth to underlying bone support, keeping incisors ____  Advance ____ to improve OJ and correct buccal segment sagittal relationship from Class II to Class I  Intrude ____ (not extrude buccal segments) to improve OB  Eliminate rotations, tip, & torque, etc.  Correct ____  Achieve Andrew’s Six Keys

upright mandible incisors midline

• Lining up teeth will not fix a ____ malocclusion

skeletal

After 18 mo observation - no change • Not doing any favors of waiting - if seeing today: ○ Divided treatment into 2 phase: § Enhance horizontal growth of ____ □ Go from CII to CI § ____ up the teeth, easier to line them up and it's more smooth * She grew down on y-axis, but not ____ * CII molar relationship did not change much

mandible line very much

• Can fix skeletal problem by increasing ____, and by enhancing growth at the ____

orthopedic force | growth plate

LOOK UP STUFF WITH BABY

JULIE P Not lip contour because of bi-____ Immovable ____ LR Immovable ____ LL Protrusion & Crowding * Molar that is tipped - difficult to care for ____ * Instead of having tooth uprighted • Not an ____ implant

``` maxillary protrusion bridge implant periodontally integrate-able ```

Corrective Rx ____ to permit reduction of bimaxillary protrusion • Remove four ____ in order to treat bi-maxillary protrusion Note facial contour improvement * Shouldve had teeth straighten, then implant integration * Looks younger when the bi-maxillary protrusion was adjusted

extractions | premolars

Julie P - spaces due to intractability of ____ segments

buccal

Hard & Soft Tissue Damage Patient and parent taken through extensive oral hygiene program General Dentist & Hygienist reinforced importance of good oral hygiene during Orthodontic care ____ was reviewed at every visit and written reports proved to patient/parent When braces removed mother said, “Why didn’t you tell us?”

hygiene

 Age 1, first dental check-up  Children who see Pediatric Dentist by age ____ have ____% less dental expenses by age 5 than children who do not see General Dentist until age 2-3  ____ is best able to track dentitional development, facial development, fluoride balance, diet recommendations, oral hygiene, etc.  Age 7, first orthodontic check-up  5 most dangerous words in the English language, “Maybe it will go away.”  After age 3 jaws develop in the ____, not in the tooth bearing area  There are problems best intercepted in the ____ transitional dentition  Don’t ____ a compromised time table on the orthodontist. Let the Orthodontist determine the best time to treat  Note that skeletal age and dental age ____ well to each other and relate poorly to ____ age

1 40 pedodontist ``` back early force relate chronologic ```

 When the environment is ____, many muscle function problems disappear  ____ teeth  When viewing x-rays, look at the teeth ____  When there is one eruption anomaly there are often multiple ____ anomalies. I cannot emphasize this enough  Use the ____ of the toothbrush. Optimum oral hygiene is essential to successful Orthodontic treatment  ____>____ Plan>____. Don’t fall into the “Gadget Trap” just because it looks cool at a dental meeting.

``` normalized count last eruption fuzzy end diagnosis treatment mechanotherapy ```

 Staying at a Holiday Inn Express and taking a weekend course doesn’t make you an Orthodontist or even a gadget guru  Begin corrective Orthodontic treatment prior to “e” ____ and ____ loss. Don’t wait for all the deciduous teeth to fall out before referring a patient to an Orthodontist for care  It’s better to be ____ than reactive  Fix what’s ____, not what isn’t  Treat the ____, not the malocclusion  Problems may be ____ but not homologous. Understand the differences between cases  Do not expand teeth and alveolar bone off of basal bone support or you will cause ____

``` exfoliation leeway space proactive broken patient analogous fenestrations and dehiscences ```

 There is nothing the Orthodontist can do that will overcome what the patient will not do  Autograph your work with excellence  Blessed are those who treat the ____, for they shall be known as “Dentists”  ____: Someone who keeps talking after everyone has stopped listening  If things improve with age, I’m approaching magnificence

episodically mute | teacher

Keys of Occlusion Flashcards

(53 cards)