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5 OSCE > Ortho > Flashcards

Ortho Flashcards

1
Q

Describe class I incisors

A

The lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incirors

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2
Q

Describe class II div 1 incisors

A

The lower incisor edges lie posterior to the cingulum lateral of the upper incisors
The upper incisors are proclined or of average inclination and there is an increase in overjet

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3
Q

Describe class II div 2 incisors

A

The lower incisor edged lie o sterile to the cingulum lateral of the upper incisors
The upper central incisors are retroclined
The overjet is usually minimal or may be increased

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4
Q

Describe class III incisors

A

The lower incisor edges lie anterior to the cingulum plateau of the upper incisors
The overjet is reduced or reversed

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5
Q

What are the dental factors of a class II div 1 malocclusion?

A

Increased OJ - incisors proclined or average
Variable OB
Can have good alignment, crowding or spacing in dentition
Habitually parted lips may lead to drying of the gingivae and exacerbation of any pre existing gingivitis

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6
Q

What are the reasons for treating a class II div 1 malocclusion?

A

Concerns re aesthetics
Concerns re dental health
Prominent incisors at risk of trauma esp with incompetent lips
If OJ>9mm, pt 2x more likely to suffer trauma - IOTM 5A

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7
Q

What are the tx options for a class II div 1 malocclusion?

A

Accept - leave and monitor
Attempt growth modification
URA
Orthognathic surgery

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8
Q

When can a class II div 1 be accepted and monitored?

A

When there is a mildly increased OJ and if pt isn’t concerned
Can give advice and use of mouth guard for trauma protection

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9
Q

How is growth modification used in a class II div 1?

A

Headgear - try and restrain grown of maxilla
Functional appliance - utilise, eliminate or guide the forces of muscle function, tooth eruptions and growth to correct the malocclusion - should be used during growth and coincide with pubertal growth spurt

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10
Q

How can URAs treat class II div 1?

A

Limited role unless very mild class II, when OJ is due to incisor proclination and if OB is favourable

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11
Q

How is orthognathic surgery used to treat class II div 1?

A

Carried out when growth is complete and only when there is severe skeletal A/P discrepancy or vertical direction
Usually involves mandibular surgery but may involve maxilla
Fixed appliances will be required before, during and after surgery

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12
Q

What are the components of URAs?

A

A - active component (moves teeth, 0.5mm)
R - retention (holds the brace in, 0.7mm in permanent, 0.6mm in primary)
A - anchorage (resists unwanted tooth movement)
B - baseplate (+ any modification) - self cure PMMA, provides retention and is a connector

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13
Q

Why is self cure PMMA used over heat cured in baseplates?

A

Quicker and easier to fabricate - takes 14 minutes rather than 14 hours

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14
Q

Design a URA to reduce an overbite

A

A -
R - 16,26 Adam’s class 0.7m HSSW
A - Y
B - self-cure PMMA, FAMP OJ+3mm

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15
Q

Design a URA to reduce OJ and continue to reduce OB

A

A - 22, 21, 11, 12 Robert’s retractor 0.5mm HSSW + 0.5mm ID tubing
R - 16, 26 Adams clasps 0.7mm HSSW + 3/3 mesial stops
A - (not ideal, keep eye on it)
B - Self-cure PMMA and FABP OJ+3mm

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16
Q

Design a URA for retracting canines

A

A - 13, 23 ala tal finger spring + guard 0.5mm HSSW + ID tubing
R - 16, 26 Adams class 0.7mm HSSW + 11, 21 Southend clasp 0.7mm HSSW
A -
B - self-cure PMMA

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17
Q

Design a URA for retracting buccally placed canines

A

A - 13, 23 buccal canine retractor 0.5mm HSSW + 0.5mm ID tubing
R - 16, 26 Adams class 0.7mm HSSW + 11, 21 Southend class 0.7mm HSSW
A -
B - self cure PMMA

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18
Q

Design a URA for correcting an anterior crossbite

A

A - Z-spring 0.5mm HSSW
R - 16, 26 Adams class 0.7mm HSSW + 14, 24 Adams class 0.7mm HSSW
A -
B - self cure PMMA + posterior bite plane

19
Q

Design a URA for a posterior crossbite

A

To expand upper arch
A - midline palatal screw
R - 16, 26 Adams clasps 0.7mm HSSW and 14, 24 Adams clasps 0.7mm HSSW
A - reciprocal anchorage
B - self cure PMMA + posterior bite plane

20
Q

Name some common component faults in a URA

A

Z-spring incased in acrylic
Adams clasp flyover or arrowhead fault

21
Q

Name some common prescription faults for URAs

A

Southend clasp inclusion so appliance won’t work
Adams clasp on wrong tooth
FABP instead of PBP

22
Q

How can you rectify errors on URAs

A

Re-make appliance by taking new imps

23
Q

How do you activate a palatal finger spring?

A

Using spring former pliers - 1-2mm activation

24
Q

How do you fit a URA?

A

Check appliance for correct pt and what you asked for
Run finger over all surfaces to check protruding wires and sharp acrylic
Check wirework integrity
Fit appliance
Check for blanching or trauma
Check posterior retention - flyovers first, then arrowheads
Check anterior retention
Activate to reduce 1mm movement/month
Demo to pt insertion and removal
Review 4-6 weekly

25
What instructions should you give pts re URAs?
Will feel big and bulky Likely to impinge on speech - start reading book aloud to speed up adjustment May have mild discomfort - particularly on teeth being moved - sign appliance is working Initial increase in saliva 24-48 hours Wear 24 hours/day inc meal times Can remove to clean with soft brush after meals or when participating in active/contact sports - store in safe place Avoid hard and sticky foods Be cautious with hot foods and drinks as baseplate is insulator Non-compliance will lengthen tx Give emergency contact number
26
How can you explain decalcification to a pt?
Stained spot on the tooth with the same shape of the bracket Weakens the enamel to caries
27
When is decal most likely?
History of caries Evidence of decal NCTSL
28
What OHI should be given to ortho pts?
Toothbrushing + single tufted brush for brackets ID brushes + suerfloss Brush minimum 2x daily very thoroughly Dry toothpaste - work from upper right clockwise to lower right, brush at 45º angle, between gum and tooth, brush in short scrubbing motion for min 2 minutes, spit don’t rinse Brush after meals as brackets trap food and plaque Use disclosing tablets to identify missed areas
29
What diet advice should be given to ortho pts?
Limitation sugar amount and frequency Avoid snacks between meals - limit sugar to <3 times daily Avoid hard/hot foods, fizzy drinks, sports drinks, sticky sweets, chewing gum Ideal drinks are water or milk, crackers, cheese, fruit is acceptable but be careful of fat in cheese and natural sugar/acid in fruit Watch out for hidden sugars eg - ketchup Rinse mouth after eating
30
What flouride toothpaste can be given to ortho pts?
Duraphat - 2800ppm (0.619%) - 5000ppm (1.2%) Twice daily, ordinary toothpaste at other times Warn re overdose and keep away from children
31
What mouthwash can be used for ortho pts?
Daily 0.05% fluoride mouthwash (225ppm) Use in between brushing, not before or after
32
What is the fluoride varnish advice for ortho pts?
Proflurid (22,600ppm) - not duraphat Every 4 months This is for prevention, not used for decal as it seals it in
33
What fluoride prescriptions can be given for ortho pts?
Sodium fluoride toothaste 0.619% (2800ppm) - 75ml, brush for 1 minute after meals using 1cm before spitting out 2x daily Sodium fluoride toothpaste 1.1% (5000ppm) - 51g, brush for 3 minutes after meal using 2cm, before sitting, 3x daily
34
Give 2 dental health implications from ectopic canines?
Risk of root resorption Risk of cyst formation
35
What are the causes of a retained A/uneruted 1?
Trauma to A causing damage to 1 - complications: ankylosis, arrested tooth formation (1), dilaceration, displacement Lack of permanent successor (hypodontia) Ectopic tooth germ Crowding Supernumerary - tuberculate most common
36
What investigations should be taken for a retained A/uneruted 1?
Radiograph localisation for ortho tx Another A or anterior occlusal Alternately OPT and occlusal CBCT for 3D view
37
What are the signs that an A is retained and 1 is unerupted?
Discolouration of A Retained A Lateral erupted before central Seen on radiograph
38
What are the management options for retained As/unerupted 1s?
Always palpate - usually 1 is buccal and central (high) Leave and monitor- inform of possible cyst formation Extract A (leave 1) and save maintenance (warn of cyst formation) Surgical removal of both teeth and space maintenance Refer for orthodontic opinion/tx - inform of possible ortho tx benefits/risks Auto-transplantation Extract A and hope for spontaneous eruption - unlikely if dilacerated Expose (close or open) +/- bonding/traction - won’t work if dilacerated
39
What are the tx options for a class III malocclusion?
Accept and monitor Internet with URA - proclined upper incisors Growth modification Camouflage with fixed appliance Orthognathic surgery
40
41
How can growth modification be used to treat a class III?
Functional appliance - reverse twin block or RME + protraction headgear
42
How can camouflage be used to treat a class III?
Accept underlying skeletal class problem, move teeth with fixed ortho to hide it Proclined users and retro line lowers Risks - decal, root resorption, relapse, gingival recession Usually together with XLA U5s and 4s
43
How can orthognathic surgery be used to treat a class III?
With combined orthodontics Need MDT - orthodontist, Maxfax surgeon, clinical psychologist, GDP Pre-surgical ortho - 12-18 months - arch alignment, arch coordination, de-compensation Post-surgical ortho - 12 months Total time 36 months

5 OSCE (21 decks)

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