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My BDS4 > Ortho - Class II Division I (A) > Flashcards

Ortho - Class II Division I (A) Flashcards

1
Q

Define a class II division I incisor relationship?

A

Where the lower incisal edges lie posterior to the cingulum plateau of the upper incisors

There is an increased overjet

The upper central incisors are proclined or of average inclincation

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2
Q

Why should we treat a C2D1 incisor relationship? (2)

A
  1. Poor aesthetics
  2. Dental health concerns i.e. trauma (risk increased if px also incompetent)
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3
Q

What IOTN score does an overjet of 9mm get?

A

5a

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4
Q

What causes a C2D1 incisor relationship? (4)

A
  • Skeletal pattern
  • Soft tissues
  • Dental factors
  • Habits
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5
Q

What A/P skeletal pattern is a C2D1 incisor relationship usually associated with?

A

class 2 AP relationship

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6
Q

What vertical skeletal pattern is a C2D1 incisor relationship usually associated with?

A

variety of low, high and average

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7
Q

What is the normal SNA value?

A

SNA = 81 +/- 3

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8
Q

What is the normal SNB value?

A

SNB = 78 +/- 3

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9
Q

What is the normal ANB value?

A

ANB = 3 +/- 2

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10
Q

What is the normal MxP/MnP value?

A

27 +/- 4

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11
Q

What is the normal UI/MxP value?

A

109 +/- 6

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12
Q

What is the normal LI/MxP value?

A

93 +/- 6

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13
Q

How do we measure the LAFH/TAFH?
What is the ideal value clinically and on a lateral ceph?

A

Measured via;
Nasion – anterior nasal spine
Anterior nasal spine – menton

Clinically =50/50
LC = 55%

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14
Q

Why are lips incompetent? (don’t contact at rest) (2)

A
  • prominent incisors

and/or

  • underlying skeletal pattern
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15
Q

What are incompetent lips usually accompanied by? (1)

A

lip trap

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16
Q

Why is it important to make an anterior oral seal?

A

Incompetent lips = no anterior oral seal

lip trap can cause proclination of upper anterior teeth during grown and development

17
Q

How do we achieve an anterior oral seal? (3)

A
  • Lip to lip seal achieved by the activity of circum-oral musculature and mandible postured to allow lips to meet
  • Lower lip drawn up behind the upper incisors and tongue is place forwards between the incisors and lower lip
  • Or both in combination
18
Q

What is the consequence of having habitually parted lips?

A

dry gingivae and worsens pre-existing gingivitis

19
Q

Provide examples of non-nutritive sucking habits (5)

A
  • Thumb
  • Fingers
  • Blanket
  • Lip
    (combination)
20
Q

What do the effects of a sucking habit depend on? When does it start to cause dental related problems? (3)

A

Effects depend of duration and intensity;

Sucking for 6 or more hours per day = increased problems

21
Q

What are the occlusal features of a sucking habit? (4)

A
  • Proclined upper anterior incisors
  • Retroclined lower anterior incisors
  • Localised AOB or incomplete openbite
  • Narrow upper arch (potentially unilateral posterior CB)
    Caused by mandible being held in a lower position with the buccinator unopposed
22
Q

How do we treat those with a sucking habit/the dental implications of a sucking habit? (3)

A
  • Stop the habit
  • Reinforcement of instructions
  • Glove or ointment
  • Removable habit breaker
  • Fixed habit breaker: palatal arch with a goalpost bheing the upper incisors
    These are more successful
  • Allow spontaneous improvement
  • Difficult if a laip trap present
  • Treat residual malocclusion
23
Q

Provide examples of how we stop a sucking habit. (4)

A
  • Reinforcement of instructions (first line tx)
  • Glove or ointment
  • Removable habit breaker
  • Fixed habit breaker: palatal arch with a goalpost bheing the upper incisors
    These are more successful
24
Q

List the treatment options for a class II div 1 malocclusion. (5)

A
  1. Accept
  2. Attempt growth mods – act on underlying skeletal bases to improve growth
  3. Simple tipping of teeth
  4. Camouflage – fixed appliances correct incisor relationship without influencing the growth of the jaws
  5. Orthognathic surgery
25
Q

What is camouflage treatment?

A

fixed appliances correct incisor relationship without influencing the growth of the jaws

26
Q

When is no treatment acceptable? (2)

A
  • In a mildly increased overjet
  • In a significant overjet but patient not concerned
    Provide a mouthguard to reduce trauma risk
27
Q

What must we advise patients with C2D1 relationships that don’t want treatment as a child?

A

must advise patients that treatment in the future is more difficult once the patient gets older and has stopped growing.

28
Q

What are functional appliances?

A

Appliances which utilise, eliminate or guide forces of muscle function, tooth eruption and growth to correct a malocclusion

29
Q

When are functional appliances used?

A

During growth – coincide with pubertal growth spurt

30
Q

What are functional appliances mostly used for?

A

Mostly for class 2 div 1’s
- However can use for C2D2

31
Q

What are the 2 ways we can use functional appliances. Describe when each are used.

A
  1. Early use = 10 years old (2 phase tx – 2nd phase when all permanent teeth erupted)
  2. Later use = late mixed or early permanent (1 phase tx – straight on to fixed appliances)
32
Q

What are the advantages of early use of functional appliances? (3)

A
  • Reduce trauma risk
  • Address aesthetic concerns earlier i.e. going to secondary school and self-conscious
  • Better compliance with appliance wear
33
Q

What are the disadvantages of early use of functional appliances? (2§)

A
  • Effects not maintained long term
  • Treatment time is increased as 2 phases required
34
Q

List the types of functional appliances for C2D1. (4)

A
  • Removable
  • Tooth borne = twin block
  • Tooth borne = activator/bionator
  • Soft tissue borne = frankel (II)
  • Fixed
  • Herbst
35
Q

How do functional appliances work in reducing C2D1’s?

A

They restrain maxillary growth and posture the mandible down and forwards to encourage mandibular growth

36
Q

When can functional appliances be used in treatment of increased oversets? (3)

A
  • It’s a very mild class I or II
  • The overjet is caused by proclined and spaced incisors
  • The overbite is favourable
37
Q

When do we carry out orthognathic surgery?

A

Once growth is complete:
- Females = minimum 16 (17,18)
- Males = 18/19/20

38
Q

Why do we surgical techniques in orthodontics?

A

When there is a severe anteroposterior skeletal discrepancy or vertical discrepancy

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