ortho-prosth

Question 1

minor ortho intervention can

Answer 1

improve dental restortations, spae management, abutment prep, root inclination

improves prognosis of tx

increase esthetic results

Question 2

what can you ask from ortho

Answer 2

abutment uprighting

occlusal plane leveling

space managment for fixed work

tooth extrusion, intrusion

ortho extraction

Question 3

do what before ortho

Answer 3

clear perio and basic restorative

dont do final treatment if ortho is planned –> think about crown damage, alteration of finish line and gingiva relation

if doing temps –> permanent cement for now

Question 4

benefits of integrating ortho early on in tx

Answer 4

more room for 
more bridges 
more implants 
less extractions
better esthetics 
more ideal proportions 
better long term prognosis

Question 5

molar uprighting usually needed wen

Answer 5

loss of posterior teeth leading to adjacent teeth drifting into space, tipping and rotating

soft tissue folds and distorts and can form plaque- harboring pseudopockets

Question 6

consider what with 3rd molars?

Answer 6

extract if no opposing 3rd in opposing arch

Question 7

movement of uprighting molars

Answer 7

just crown?

or crown and root? – this will require more comprehensive care

corwn movement is easier, faster, needs less anchorage, generally preferred option

Question 8

crown movement implications with molars

Answer 8

can create interferences and may open bite (may need to extrude after uprighting)

Question 9

attachment levels after uprighting molars?

Answer 9

may decrease

gingival tissue may present localized enlargment – may be lip or collar on the mesial aspect of the uprighted molar

consider extract and implant if these side effects outweight

Question 10

retention with uprighting molars

bridge example

Answer 10

need to maintain the space created – so temp bridge will act as retainer

or if delay is expected – or RPD planned - make retainer to keep results achieved

Question 11

timing and amount of uprighting

Answer 11

4-6 weeks to activate pdl

4 weeks for 10 degrees of distal crown tipping

Question 12

options for moving molars

Answer 12

super-elastic wires

coil springs with brackets

T loops
heavy SS wires with T loops

Question 13

how to move molar if extrusion not desired

Answer 13

Heavy SS wire with T loops – better control if extrusion not desires

Question 14

breakdown of occlusal leveling

Answer 14

1. pre-prosthetic occlusal leveling will allow corrections of VFO, and give proper space for restorations
2. correct severe overbites
3. intrude unopposed overerrupted tteht
4. correct crossbites

Question 15

explain skeletal anchorage in orhto

Answer 15

utalized for

• non-compliant patients
• no reciprcal moement in anchorage unit (kinda acts like head gear)
• ideal for incomplete dentition

less movement of other teeth because not using them as anchorage

Question 16

describe anchor screw

Answer 16

what is used in skeletal anchorage in ortho

• IMMEDIATE loading
• NO oseointegration required
• resistane of sufficient load
• minimal patient trauma
• easy and quick removal

Question 17

contraindications for direct skeletal attachment

Answer 17

mixed or deciduous dentition

active infection

blood limitations or bone quantitiy less than 5 mm in depth

mental or neurological limitations - cant follow post op

severe disease or immunocompromised

Question 18

can do ortho on patient with CU and PL

Answer 18

yes – can make patient better candidate for the partial lower

Question 19

Considerations with congenitally missing laterals

dental

Answer 19

Dental considerations:
skeletal and
dental classification

space analysis

tooth size

profile considerations
- lip support and skeletal class

esthetics
- major differences between lateralls and canines – need to know these before make latertals into canines

Question 20

esthetic considerations with lateral and canines

Answer 20

canines - less enamel, less transparent, darker colors

Question 21

space closure and cuspid replacement?

Answer 21

with missing laterals – can close space and shape canine like a lateral

Question 22

space opening and implant replacement

Answer 22

for dealing with congenitally missing laterals

if patient young – place temps for now

Question 23

general considerations with missing second mandibular biscupids

Answer 23

if ortho diagnosis allows it - close space

if not - maintian it (like keep primary if not sign of tooth to maintain bone) and reshape to proper size

wait until growth is complete for implant

Question 24

extrusion aka

Answer 24

forced eruption

Question 25

alternative to CLP or extraction

Answer 25

forced eruption

Question 26

indications for forced eruptions

Answer 26

teeth with defects in the cervical 3rd or the root that may need care for restoration - horizontal or oblique fractures - internal or external resorption - decay - iatrogenic perforation - perio disease - recession, alterered gingival architecture

Question 27

alveolar bone height compromised in extrusin?

Answer 27

NO

Question 28

after extrusion may need?

Answer 28

some recontouring of the gingiva and or bone may be necessary to produce esthetic contour and bio width

Question 29

criteria for selecting forced eruption

Answer 29

root length - final crown/ root ratio - will you have at least 1: 1 left after?? - if not consider prosthetic replacement root form level of fracture or defect relative importance esthetics prognosis of the tooth and restoration

Question 30

when deciding to extrude what measurmenets take into consideratin>

Answer 30

mm from defect sound tooth structure for proper margins is 1-1.5 perio tissues - bio width is 2-2.5 example - like 5 mm of extruson is that going to be good? short or long root?

Question 31

implication with extrusion if tooth fractured at the alveolar bone?

Answer 31

tooth fractured at the level of alveolar bone would optimally require a total of 4 mm forced eruption providing a 1:1 crown root ratio is preserved

Question 32

extrude dilacerated roots?

Answer 32

avoid this

Question 33

root form - external implication on extrusion

Answer 33

if broad and non - tapering this is good thin and tapering roots-- result in a narrower cervical region after the tooth has been erupted, potentially compromising esthetics and embrasure shape

Question 34

internal root form with extrusion

Answer 34

root canal should not be larger than 1/3 of the overall width larger canals could compromise the strength of the final restoration

Question 35

level of fracture defect with extrusion

Answer 35

tooth fragment for extrusion must be accessible if the fracture is more than 2-3 mm below the level of the alveolar bone - it is difficult - if not impossible to access the tooth in order to extrude it think about extraction in these cases where fracture is too apical

Question 36

implication of neighboring teeth and furcations

Answer 36

could expose furcations if extrude the neighbor

Question 37

presence of extensive vertical root fracture

Answer 37

even after extrusion -- likely hopeless --> extract

Question 38

restoration prognosis looks at

Answer 38

after all this work --- how good will the final restoration be on it

Question 39

soft tissues in terms of extrusion? implication on CLP?

Answer 39

depending on perio migration, CLP MAY STILL BE NECESSARY AFTER EXTRUSION - but with less compromise of neighboring teeth

Question 40

mechanics of extrusion

Answer 40

position bracket more apical or step down (toward apex) on wire might require incisal reduction to relieve from occlusion

Question 41

less controlled way of extrusion - but still works

Answer 41

heavy wire bonded directly to neighboring teeth, button on tooth to extrude and power chain or ligature - less controlled

Question 42

stabalization after extrusion?

Answer 42

yes - 6 months retentino with passive arch wire recommended to avoid significant relapse - b/c during extrusion - PDL fibers are stretched so need time to reorient and re-establish new attachment

Question 43

considerations if tooth extrudes with attachment apparatus?

Answer 43

may be left with shorter clinical crown due to incisally positioned gingival margin -- esthetics a problem bio width? may need surgery CLP to create ideal margin heights and bone levels

Question 44

extrusion --> extraction can help?

Answer 44

yes -- keep bone in tact longer better tissue preservation - keritinized tissue stays - can better gingival architecture for extracting and place graft and implant limits bony defects

Question 45

ortho intrusion or gingival surgery?

Answer 45

evaluate labial sulcular depth of the teeth uniform depths indicate uneven wear or trauma of the incisal edges differences in sulcular depths indicate a need for gingival surgery

Question 46

congenitally missing laterals considerations

Answer 46

orthodontic space closure with cuspid characterization (turn laterals into canines) 2. space reopening and implant placement ``` consider - skeletal and dental (class II may want to close space and convert because less room -- vs class III open up and create more space ) - space analysis - tooth size - profile considerations ```

Question 47

class III with congenitally missing second premolars? class II?

Answer 47

better choice is to bring teeth back and close space class II -

Question 48

E relative to bicuspid

Answer 48

wider than the premolar | soo reshape to proper size (8mm approx)

Question 49

do extrusion to prevent crown lengthening?

Answer 49

NO | - may preserve and CLP may be more limited but may still need