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PAEDS YR5 RESET AGAIN > Orthodontics > Flashcards

Orthodontics Flashcards

1
Q

What are the risks and benefits of orthodontic treatment?

A

Benefit:
- improved function
- improved aestehtics
Risks:
- reduced dental health
- failre to achieve aims

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2
Q

Name the 7 suggested health benefits of orthodontic treatment?

A

Reducing caries susceptibility - however caries progression is multifactoral
Reduces Gingivitis and Periodontal disease - other factors can be important
Reducing trauma risk (Correcting Increased overjet) - >6mm overjet 3 x risk
Masticatory Function - overjet/AOB eating difficulties
Speech - malocclusion little impact
Tooth impaction
Psychological well being (Aesthetic impact) - impact on self-esteem
and quality of life

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3
Q

Name the 4 risks of orthodontic treatment?

A
  • Dental caries (Decalcification) :
  • ↑poor oral hygiene, cariogenic diet
  • Root Resorption (Root shortening)
  • Ginigivitis / loss of attachment ↑ patients
    with unstable periodontal disease
  • Soft tissue trauma (Ulcers
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4
Q

What is the purpose of the index of orthodontic treatment need?

A

developed to help determine likely impact of
malocclusion on dental health and psychological well
being.

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5
Q

Name 3 types of treatment startegies for orthodontic treatment?

A

Orthodontic treatment only
Orthodontic / Surgical Treatment
Orthodontic / Restorative Treatment

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6
Q

What are the 6 requirements for orthodontic treatment?

A
  • Motivated Patient
  • Stable dental health
  • Caries free minimum of 12 months
  • Healthy periodontium
  • Low plaque scores (adequate Oral hygiene)
  • Benefits of orthodontic treatment outweigh risks (IOTN)
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7
Q

Name the 4 contraindicators for orthodontic treatment?

A
  • Poor Dental Health (active caries/periodontal health issues)
  • Oral Hygiene Issues
  • Poor Co-operation / Tolerance issues
  • Low treatment need (Risks vs Benefits-IOTN)
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8
Q

Name the 3 types of orthodontic appliances?

A
  • Removable
  • Functional
  • Fixed
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9
Q

What is the definition of a removable appliance?

A

An orthodontic appliance that can be removed by the patient

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10
Q

Name the 3 main components of an orthodontic appliance?

A
  • Active Components
  • Retentive Components
  • Anchorage (Newtons 3rd Law of motion)
  • Baseplate/ Bite planes
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11
Q

Name a form of retentive components?

A

Adams clasps

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12
Q

Name a form of active component?

A

Palatal finger spring

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13
Q

What is the definition of anchorage?

A
  • Newtons ‘third law of motion’
  • For every force applied there is an equal and opposite reactionary
    force
  • Anchorage relates to control of these reactionary forces
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14
Q

Name the 3 planes of space for anchorage?

A
  • A-P
  • Transverse
  • Vertical
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15
Q

What are the advantages and disadvantages of removable appliances?

A

Advantages
* Can be removed for cleaning (after meals)
* Cheap (cf fixed appliances)
* Less chair-side time
* Palatal Coverage / Good Anchorage
Disadvantages
* Appliance is removable!
* Limited tooth movements possible (tipping)
* Lower appliance poorly-tolerated

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16
Q

What are 12 clinical tips for the use of a removable appliance?

A
  • Fit appliance passively initially
  • Demo fit and removal carefully
  • Stress F/T wear except cleaning
  • Warn re: speech
  • No extractions until compliance confirmed
  • Review every 4 weeks
  • First return appointment
  • Assess progress- is patient wearing it (not in a box or their pocket !)
  • Appliance fit
  • Wear signs – on mucosa
  • Speech returned to normal
  • Gentle activation of active components
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17
Q

Name the 8 indications for the use of a removable orthodontic appliance?

A
  1. Alignment of mesially-inclined canines
  2. Crossbite correction
  3. Overjet reduction
  4. Overbite reduction
  5. Eliminate occlusal interferences
  6. Adjunct to fixed appliances
  7. Space maintenance
  8. Retention
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18
Q

Name the 2 contraindications for removable orthodontic appliances?

A

Multiple tooth movements
* Complex tooth movements required
1. Intrusion/extrusion
2. Bodily movement
3. De-rotation

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19
Q

What is the definition of a functional orthodontic appliance?

A

‘Removable or fixed orthodontic appliances which use
forces generated by the stretching of muscles, fascia
and/or periodontium to alter skeletal and dental
relationships

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20
Q

What are the benefits of using a functional orthodontic appliance?

A
  • Growing Patients
  • Correct Malocclusions of Skeletal Origin
  • May modify growth ? ?
  • Commonly used in Class 2 patients with mandibular retrognathia.
  • Hoping to enhance mandibular growth/restrain maxillary growth
  • Treatment approach often referred to as ‘Growth Modification’
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21
Q

What situation is best for a functional orthodontic appliance?

A
  • Class 2 malocclusions-
  • Class 3 malocclusions (Less common)
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22
Q

Describe an ideal functional orthodontic appliance patient?

A
  • Growing patient
  • Class 2 div 1 malocclusion (or Class 2 Div 2 )
  • Mandibular Retrognathia
  • Average or reduced vertical proportions
  • Increased OJ/OB
  • (Well aligned arches) also crowded cases as first stage treatment
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23
Q

Explain how to construct a functional appliance?

A
  • U + L Alginate impressions
  • Working bite
  • Teeth out of occlusion
  • Postured forward (the facial musculature is stretched
    and forces are generated)
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24
Q

Explain how to take a working bite for a functional appliance?

A
  • Patient postures to Class 1 or edge to edge
  • Record the postured occlusion with wax or silicone registration paste
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25
Q

Name 3 types of mode of action for rothodontic appliances?

A
  • Dentoalveolar (Dental Effects)
  • Tipping movements
  • Eruption guidance
  • Skeletal (Orthopaedic or Growth Effects)
  • Restriction of maxillary growth
  • Increased rate of mandibular growth
  • Remodelling changes in the TMJ
  • Modification of soft tissue activity
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26
Q

When is dental tipping most effective?

A
  • Typical Class 2 div 1
  • Upper incisor retroclination
  • Lower incisor proclination
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27
Q

What is the definition of eruption guidance?

A
  • Achieved with bite planes/capping
  • Anterior
  • Posterior
    Produce
  • Differential eruption
  • Inhibits eruption of upper posteriors
  • Encourages mesial eruption of lower posteriors (Class 2
    correction)
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28
Q

What is the defintion of skeletal mode of action?

A
  • Enhanced Mandibular
    Growth ?
  • Elongation is brought about
    by deposition at the condyle
    and the posterior border of
    the ramus.
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29
Q

What is the definition of modifying soft tissues?

A
  • Lip competency
  • Changing the linguo-facial muscle balance
  • Shields
  • Screens
  • Teeth erupt into a position of balance
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30
Q

WHich modes of action do functional appliances use?

A
  • Eruption guidance
  • Bite planes
  • Mandibular repositioning
  • Working bites
  • Altering soft tissue balance
  • Shields and modifying lip activity
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31
Q

Name the 3 classifications for functional appliances?

A
  • Tooth borne (‘Twin block’)
  • Mostly dental tipping
  • Good retention
  • generally well tolerated
  • Soft tissue borne
  • Less retention
  • Difficult to achieve 24 hr wear
  • Fixed functionals
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32
Q

Name 3 examples of tooth borne functional appliances?

A
  • Twin Block
  • Frankel
  • Bionator
  • Herbst
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33
Q

Describe a twin block functional appliance? - retention?

A
  • Tooth borne via Clasps
  • Most commonly used
  • Well tolerated
  • F/T wear possible
  • In 2 parts, one upper, one lower
  • Bite blocks posture the mandible forward
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34
Q

Describe a frankel functional appliance? - dentition type? soft tissue? probelms?

A
  • Soft tissue borne appliance
    (‘Monobloc’)
  • Good in mixed dentition
  • Tooth loss does not affect retention
  • Good when soft tissues significantly
    contribute to the malocclusion
  • Expressive lower lip, lip trap
  • Problems : bulky, P/T wear only and
    breakages+
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35
Q

How to maximise the success of a functional appliance?

A
  • Keen patient and family support
  • Mild / moderate skeletal problem
  • Patient actively growing
  • Coordinate treatment with pubertal growth spurt
  • Boys age 12-14
  • Girls age 11-13
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36
Q

Do functional appliances grow mandibles?

A
  • Controversial
  • Early studies (Animal) suggested significant skeletal effects
  • Recent RCTs suggest mainly dental effects 90% and 10 % skeletal
  • Large individual variation in response
  • Difficult to predict
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37
Q

Explain why to use a functional appliance to correct an increased overjet?

A
  • Reduce risk of trauma
  • Improve profile
  • Help to allow lips to become competent
  • Improve smile aesthetics
  • Makes subsequent fixed orthodontics easier or can
    even be the only treatment required
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38
Q

What is the definition of a fixed appliance?

A
  • ‘Orthodontic appliance that
    is ‘fixed’/attached to teeth’.
  • Many different systems /lots of
    manufacturers
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39
Q

Describe the differences in force betweeen fixed and removable appliances?

A

Bodily movement: - 1 area of tension
- Heavier forces
100-150 gms
Tipping: - different areas of tension (2)
- Lighter forces 25-
30 gms

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40
Q

Name the 7 indications for the use of fixed appliances?

A
  • Multiple tooth movements
  • Space closure with bodily movement
  • Intrusion/extrusion of teeth
  • Rotation correction
  • OB control with incisor intrusion
  • Mild to moderate skeletal discrepancies (camouflage treatment)
  • Severe Skeletal Discrepancies (+ Surgery)
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41
Q

Name the advantages and disadvantages of using a fixed appliance?

A

Advantages:
* Treating complex cases
* High standards of finishing
* Wear co-operation is not as essential as with removable appliances
but still OH and diet care !
* Less bulkier than removable appliances
* Do not affect speech
Disadvantages
* Diet restriction and meticulous OH
* Can cause iatrogenic effects (decalcification)
* Cause Orthodontic root resorption (shortening)
* Require special skill and training
* Require close monitoring

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42
Q

Describe the differences between Fixed and Removable?

A

Fixed:
- Bodily Movement
- Multiple tooth movements
- Rotations corrected
- OH more difficult
- Less Co-op ??
Removable:
- Tipping movements only
- Simple tooth movements
- Rotations not corrected
- OH easier (Removable)
- More Co-op (Wear compliance)

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43
Q

Name the components of fixed appliances?

A

Brackets
Archwire
Elastic ligature

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44
Q

What is the defintion of a bracket?

A

‘Handles on the teeth’ – control tooth position in combination with
archwire.
* 0.022’’ (inch) slot width size
commonest
* 0.018’’ (inch) more common in
past
* Slot design specific for each tooth
(prescription)

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45
Q

Describe the material of a bracket?

A
  • Base of bracket
  • Curved to fit each tooth
  • Mesh base / retains composite
    resin
  • Pre –coated (APC) with
    composite .
  • Non pre-coated
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46
Q

Name the 7 bracket types?

A
  • Metal – standard SWA brackets ↑
  • Metal – Self ligating
  • Metal- ‘tip-edge’
  • Aesthetic Systems
  • Ceramic
  • Lingual
  • (Aligners)
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47
Q

What are the benefits of self ligating brackets?

A
  • Claims by manufacturers
  • Quicker treatment
  • Allows expansion/favours non-extraction tx
  • Controversial as no evidence to support
  • Studies / RCTs
  • No difference Tx time
  • ? Longer appt intervals
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48
Q

Describe a self ligating bracket type?

A
  • Self Ligating
  • eg‘Damon’, Speed, Innovation,
    Smartclip
  • Active or Passive clip or gate
  • Less friction cf normal ligation
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49
Q

What is the definition of tip edge brckets?

A
  • Different tx philosophy
  • 2 stage tooth movement
  • Easy tipping – bracket ‘cut away’
    design
  • Tip crowns and then upright roots
  • Lighter on anchorage
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50
Q

What is the defintion of a lingual bracket type?

A
  • Lingual
  • ‘Incognito’ 3M system
  • Expensive
  • Cast Gold
  • Customised for each tooth
  • Bonded – indirectly with
    preformed trays
  • Different instruments
  • Archform shape -‘mushroom’
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51
Q

Explain the process to bond brackets to the teeth?

A
  • Isolate
  • Pumice/Prophylaxis
  • Acid Etch (Phosphoric acid)
  • Irrigate/Dry
  • Apply Bonding agent
  • Place bracket with composite resin on bracket base
  • Remove excess composite
  • Light Cure
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52
Q

What is the definition of an orthodontic band?

A
  • Now – used on molars
  • Different sizes
  • Cemented with G.I.C
  • Separators / 1 week before
    placement
  • Can pre-select on model
  • Cemented with glass ionomer
    cement or light cured compomer
  • Glass ionomer / fluoride release
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53
Q

What is the definition of an archwire?

A
  • Interaction archwire/bracket slot → tooth movement
  • Archwire Variations
  • Shape
  • Size
  • Alloy type
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54
Q

Describe the different types of archwire shapres?

A
  • Round
    eg .014 Niti
  • Square
    eg .020 x .020 NiTi
  • Rectangular
    eg .019 x .025 NiTi
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55
Q

Name the 3 alloy types of archwire?

A
  • Nickel Titanium
  • Stainless Steel
  • B-Titanium (TMA)
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56
Q

What is the definiion of NiTi archwire alloy?

A
  • Thermally active / non thermally
    active
  • Super-elastic
  • increased Flexible
  • Shape memory
  • Initial alignment stages of
    treatment
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57
Q

What is the defintiion of stainless steel archwire?

A
  • increased Stiffness
  • increased Rigidity
  • decreased Flexibility* - if multistrated it increases
  • Working archwires
  • Levelling
  • Space closure
  • Finishing (add bends)
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58
Q

What is the definition of Beta - Titanium archwire?

A
  • Beta – Titanium (TMA)
  • Half way between NiTi and SS
  • Some flexibilty but more rigid
    than NiTi
  • Useful finishing stages of
    treatment eg adding torque or
    bends to archwire
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59
Q

What is the definition of a elastic modules ligature?

A
  • Used to retain archwire
  • Varied colours
60
Q

What is the definition of a elastic chain ligature?

A
  • ‘Linked’ elastic modules
  • Used to space close
61
Q

What is the definition of a transpalatal arch?

A
  • Across upper arch between molars
  • Soldered or removable attached to molar bands
  • Increases posterior anchorage
  • Maintains molar widths
62
Q

What is the definition of a Nance appliance?

A
  • Similar to TPA
  • Anchors upper molar position
  • Acrylic button for additional anchorage from palate
63
Q

What is the definition of a coil spring?

A
  • Orthodontic Coil Springs
  • Open/closed
  • Used space closure and openig
64
Q

What is the definition of a Zing String (Power thread)

A
  • Elastic thread or tubing
  • Used to apply traction forces to teeth during fixed
    appliance treatment
65
Q

What is the definition of an expanders-RME?

A
  • Rapid maxillary expander (RME)
  • Commonly cemented with bands on 1st permanent molars and
    1st premolars
  • Midline screw
  • Activated to expand upper arch (1/2 mm per day hence ‘rapid’)
66
Q

What is the defintion of an expanders-Quad helix?

A
  • Fixed expansion appliance
  • Bands on 1st permanent molars
  • Has 4 circle loops (helices) to give flexibility and good range of action
67
Q

What is the definition of temporary anchorage device?

A
  • ‘TADS’
  • Titanium screws
  • Inserted intra-radicular alveolar
    bone
  • Topical/LA
  • Common sites- between upper 5
    and 6.
68
Q

Describe the 4 general categories of elastics?

A
  • Class I – Intra-arch
  • Class II – Inter –arch :To correct Class II malocclusion
  • Class III – Inter –arch :To correct Class III malocclusion
  • Vertical – To correct open bites
    Others
  • Anterior cross elastics - correct dental centreline discrepancies
  • Posterior cross elastics
69
Q

When to be concerned about eruption pattern?

A

After 6 months or more in contralateral

70
Q

Give a description of deciduous dentition appearance?

A

Incisor spacing
Tooth wear of incisors (natural attrition)
Edge to edge incisors common

71
Q

Describe the deciduous dentition calcification, eruption start, fully established and sequence?

A

Calcification - 12 weeks in utero
Eruption starts 6-9 months
Lower - ABCDE
Upper- ABDCE
Fully established 2.5-3 years

72
Q

Name the calcification times for the permanent dentition (key teeth)

A
73
Q

What is the importance for the calcification times being delayed?

A

Can help identify timing and aetiology of disturbance in tooth development
Systemic:
- illness/systemic upset
Localised:
- Trauma to deciduous precursor (commonly incisor)
- Persistent pathology (dental infection)

74
Q

Describe the apperance of Molar Incisor Hypoplasia?

A

Molar Incisor Hypoplasia (MIH)
- yellow-white chalky apperance

75
Q

Describe the aetiology of chronological enamel hypoplasia?

A
  • Systemic upset
  • Metabolic disturbance
  • Chronological Hypoplasia
    due to systemic upset at
    around 1 year of age (GI
    illness)
76
Q

Describe the apperance of chronological enamel hypoplasia?

A

reduced enamel
yellow dentine shine through

77
Q

Describe the aetiology of Molar Incisor Hypoplasia?

A

Aetiology ? Genetic/
Systemic upset third trimester-
birth

78
Q

Describe the aetiology of Enamel Hypoplasia? (localised-single tooth)

A

Local Factors:
* Trauma to deciduous incisor
* Second premolar due to carious second deciduous molar and
chronic infection
* (‘Turners Tooth’)

79
Q

Describe the eruption times for permamnent teeth in upper and lower arches?

A
  • Variance common (1 in 20 patients 2 SD from normal ie 12 months variation)
  • Eruption pattern/sequencing important to monitor ( 6 month delay cf
    Contralateral)
  • Females earlier (6 months)
80
Q

Describe the eruption sequence for the permamnet dentition upper and lower arches?

A
  • Upper – 61243578
  • Lower - 61234578
81
Q

Accomodating permanent dentition - incisor regions? describe the eruption development and changes?

A

Spaced primary dentition
Increased intercanine width due to transverse growth (9-10 years old)
* Permanent incisors more proclined especially upper

82
Q

What is the definition of the Leeway space?

A

Leeway space
Permanent teeth (3,4,5) < Deciduous precursors (C,D,E)
On average:
* Mx = 1.5 mm/side
* Md = 2.5 mm/ side

83
Q

What to manage a developing occlusion? 0-3 years and 3-6 years?

A

Deciduous Dentition
0 -3 years (erupting primary)
* Monitor Eruption
* Preventative advice / reinforcement
3- 6 years
* Retain/preserve deciduous teeth
* Future problems predictors – lack of incisor spacing, early loss of
deciduous teeth (due to caries)

84
Q

Deciduous dentition anomalies? - types? and issues?

A
  • Natal teeth : present at birth
  • Neonatal teeth : soon after birth (within 30 days)
  • Usually tooth of normal series/ often mobile due to little root development
  • May firm up with time
  • Potential Issues : trauma / Inhalation risk if very mobile
85
Q

What is the definition of a fused/geminated tooth?

A

Fused/Geminated teeth (‘double tooth’)
* Primary dentition (usually incisor region)
* Fusion of two teeth of normal series (normal complement reduced by one unit)
* Fusion of normal tooth and supernumerary tooth
* Fusion – separate canal sytems. Gemination – single canal
* May predict anomaly in permanent dentition but not always
* May predict missing or extra tooth or smaller tooth

86
Q

Name the 3 consequences of early loss of deciduous teeth?

A

Space Loss/ Crowding
Dental mid- Line Shifts (crowded cases)
Delayed eruption of permanent successor

87
Q

What are the consequences of space loss/crowding with loss of deciduous teeth?

A
  • Buccal segments
  • Earlier the loss
  • increased Upper arch (mesial drift 6)
  • increased Crowded case

e.g. Early loss of 2nd DMs (Es) at 4 years of age with resulting
crowding in 2nd premolar regions at 9 years of age
(‘secondary crowding’)

88
Q

What is the definition of Dental mid- Line Shifts (crowded cases) for decidious tooth loss?

A
  • Asymmetric extractions in crowded cases
  • Particularly loss of ‘Cs’
  • May complicate future orthodontic tx
  • Need for balancing extractions / ‘Low level Evidence’
  • ? Consider when asymmetric loss of C in crowded case

e.g. LR C lost earlier than
LL C with Lower CL
shift to right

89
Q

What is the definition of Delayed eruption of permanent successor for decidious tooth loss?

A
  • early loss – less than ½ root developed of permanent- delay eruption possible
  • later loss – greater than 2/3 root developed of permanent- accelerated eruption possible
90
Q

What are the consequences with early mixed denition (6-9 years)

A

Phase of eruption of 6s and incisors
* Transitional Problems (‘normal’ development features)
* Ectopic upper 6s
* Delayed eruption of upper centrals
* Lateral incisor anomalies
* Median diastema
* Habits
* Crossbites
* Traumatic Overbite

91
Q

What is the definition of transitional probelms for early mixed dentition?

A

May be parental concerns
* Slow eruption – may be normal eruption time variation (check for normal sequence)
* Early lower incisor crowding common- permanent incisors develope lingual to deciduous incisors

e.g. Watch for ‘over retained’ deciduous teeth

  • Transitional Anterior Open Bite (as incisors erupt)
  • Distal ‘fanning’ of upper lateral incisors with spacing (‘ Ugly Duckling Stage’)
  • Tends to ‘self correct’ as teeth erupt
92
Q

What is the definition of ectopic upper first molars for early mixed dentitions?

A
  • Impacts under distal 2nd DM (E) with resorption of distal root
  • generally asymptomatic
  • Not uncommon 2%
  • FH 20%
  • Male = female
  • Related to crowding (Arch length discrepancy)
93
Q

Describe the possible management options for ectopic upper first molars for early mixed dentition?

A
  1. Observe 6 – 9 months: Some mild cases resolve spontaneously
  2. Trim distal of Upper E to allow 6 eruption
  3. Consider extraction of upper E (if grossly resorbed / symptomatic/ compromising OH around 6)
  4. Distalise 6 – separators (elastomeric or brass wire)
  5. Distalise 6 – ortho treatment – rare to consider this stage as will benefit from comprehensive ortho treatment
    later
94
Q

What is the defintiion of Delayed Eruption of Upper Incisors for early mixed dentition?

A

History may be relevant e.g. trauma to deciduous incisors
* Delayed eruption of incisor compared with contralateral (6 month delay) or
both delayed
* Careful history and clinical examination (inspect/palpate)
* Local aetiological factors
- Supernumerary teeth
- Dilacerated incisor
*Radiographs - Intra-oral views, occasionally lateral Ceph useful (dilacerated),
increasingly 3 D imaging
*Careful multi-disciplinary planning on MDT clinic with Orthodontist/Surgeon

95
Q

What is the definition of supernumerary teeth? and their associations?

A
  • 3 % incidence
  • more in Boys (2:1)
  • 90 % premaxilla (‘mesiodens’)
  • Systemic associations
    • Cleidocranial Dysostosis
    • CLP
    • Gardners Syndrome (Familial Adenomatous Polyposis)
96
Q

Name the 4 types of supernumerary teeth?

A

Supplemental – resemble tooth normal series
* Conical – develop early / often erupt
* Tuberculate – develop later / seldom erupt
* Odontomes (complex/compound)

(mesiodens and dens in dens)

97
Q

Name the 2 problems supernumerary teeth can cause?

A
  • Delayed eruption
  • Median Diastema
98
Q

Explain the management of surgery for supernumerary teeth?

A
  • Surgical removal of supernumerary if obstructing eruption
  • If not interfering with eruption and no associated pathology may opt to monitor
  • Expose and bond upper central incisor
  • In past often removal only and observe
  • Studies – up to 50 % failed to erupt
  • Now – always bonded ‘gold chain’ to allow traction
  • Followed up Ortho to apply traction (fixed)
99
Q

Name and describe the aetiology for dilacerated incisors?

A
  1. Developmental (more girls)
    * crown displaced labially (usually 1 incisor only)
    * no enamel/dentine disturbance
  2. Trauma (more Boys ) Intrusion of As
    * crown displaced palatally
    * often enamel/dentine disturbance
100
Q

Which radiograph is useful to assess crown/root position?

A

Lateral Cephalogram

101
Q

Which radiograph is useful for information on positioning and corwn/root angulation?

A

3 D imaging with CBCT

102
Q

Explain the management for a dilacerated incisor?

A
  • Can be challenging
  • Careful Multidisciplinary planning with Ortho/Resto/Surgery input
  • Assess Position/Crown form/Root position
  • Consider exposure and alignment but often challenging and aesthetics
    unpredictable
    If alignment not feasible-
  • Retain until end of growth(preserve bone)
  • Consider replacement with implant later
103
Q

What are the 4 aetioloigcal factors causing a median diastema?

A

Aetiological factors
* Midline supernumerary (mesiodens)
* Small teeth (Microdontia)
* Missing teeth/hypodontia (2s)
* Proclination of ULS
( Low fraenum (no evidence cause/effect relationship)

104
Q

What is the definition of a median diastema?

A

Gap inbetween insicors
- May be transitional and close as canines erupt

105
Q

Explain the management for a median diastema?

A
  • Accept
  • Small teeth/missing teeth – when older restorative
    only or ortho + restorative
  • Orthodontic space closure (Perm retention)
106
Q

Name 2 lateral incior anomalies?

A

Missing Upper lateral Incisors (hypodontia)
Diminutive lateral Incisor (‘peg lateral’)

107
Q

What is the definition of a Missing Upper lateral Incisors (hypodontia)?

A
  • Common (3% pop 1 or more missing unit exc 8)
  • FH/Genetic aetiology
  • Isolated or part of more severe hypodontia
  • Associated conditions – Ectodermal Dysplasia, CLP
  • Contra-lateral tooth frequently missing or diminuitive
108
Q

What associated occlsual problems can occur with missing upper lateral incisors?

A
  • Spacing / median diastema
  • Asymmetry – CL shift if unilateral
  • Mesial eruption of 3 with retention of C
109
Q

Explain the 2 phases for missing upper lateral incisor managment?

A

Mixed dentition
* Retain deciduous teeth (preserves space and bone)
* Reassure regarding future management
* Refer to specialist centre when older (around 14-15 years)
Later Management
- Careful Multi-disciplinary planning
* Space closure (crowded cases / increased OJ)
* Opening space (bridge/implant)

110
Q

What is the definition of Diminutive lateral Incisor (‘peg lateral’)?

A

Contra-lateral small or absent
* Strong association with impaction of upper 3s
* if aesthetic concerns – could consider comp build up
* may be considered later as orthodontic extraction

111
Q

What habits may contribute to Diminutive lateral Incisor (‘peg lateral’)?

A
  • Digit /Thumb sucking
  • Common in most of the world (80-90 %)
  • Eskimos – 0 % …
  • Majority stopped 7 years
  • Emotional factors may play a part with a persistent habit
112
Q

What effects can Diminutive lateral Incisor (‘peg lateral’)? have on the occlusion?

A

Depend on habit duration (6 hours +)
* increased OJ – U Incisors proclined and L Incisors retroclined
* decreased OB / AOB (asymmetrical)
* Narrowing Upper arch – crossbite due to lower tongue
position

113
Q

What is the management for digit sucking?

A
  • Deciduous dentition (reassure should gradually stop)
  • If persists into mixed dentition (beyond 7 years)
  • Encourage cessation of habit
  • Gentle encouragement 1: 1 with child (demo with models)
  • Simple deterrant techniques – ‘glove’ / Elastoplast on thumb
  • Family supportive
  • Good spontaneous improvement if stop
114
Q

What other deterrent appliances can be used for chronic digit suckers?

A
  • Persistent habit
  • Patient struggling to stop
  • Removable/Fixed appliances
    Persistent habit/older child
    *More difficult
  • Less spontaneous improvement
  • Stability of orthodontic treatment
115
Q

What is the definition of inciosrs in crossbite?

A

Careful orthodontic assessment
* May be related to Class 3 skeletal problem ?
* Pros/Cons of early or correct later
* Trauma to lower incisors/recession may consider

e.g. Anterior Crossbite
UL 1 with traumatic
occlusion LL1 with
recession

116
Q

Explain the management of an anterior crossbite?

A
  • Patient co-operative
  • Short phase of treatment
  • URA with a screw section or spring
117
Q

Explain the management of an anterior crossbite?

A
  • Patient co-operative
  • Short phase of treatment
  • URA with a screw section or spring
118
Q

What is the definition of a traumatic OB?

A
  • Deep OB common ( early treatment not indicated)
  • Traumatic OB less common
  • If soft tissue/gingival damage
  • Early Treatment may be indicated
  • Simple Upper Removable Appliance (URA) a with flat
    anterior bite plane
119
Q

Name the 4 problems with a mixed dentition at 9-11 years old?

A
  • First permanent molars (poor prognosis)
  • Canine problems
  • Premolar problems
  • Skeletal problems
    (CLP patients ABG around 9 years of age)
120
Q

Why does a mixed dentiiton at 9-11 years old affect the first permanenet molar teeth?

A
  • Careful assessment of poor prognosis first permanent molar teeth around 9 years
  • Caries/ MIH
  • Longterm prognosis poor
  • Decision regarding extraction optimal time
  • Maximising spontaneous space closure OR
  • Extraction required for orthodontic reasons
  • To manage crowding or reduction of increased overjet
  • BUT will need to retain 6s until eruption of 7s
121
Q

Describe the careful clinical assesment for first permanent molar teeth?

A
  • History – symptoms / previous restorations
  • Radiographic assessment to check all teeth present and stage of developement (OPG
    recommended)
  • Prognosis of all 6s
  • Potential Orthodontic space requirements (Crowding / Increased Overjet)
  • Refer to Orthodontic Specialist for opinion
  • No Orthodontic Space Concerns (Class 1 minimal or no crowding incisor regions can
    relieve PM crowding)
  • Maximise spontaneous space closure
  • Extraction of poor prognosis 6s chronological age around 9-10 years
  • All teeth present on ra`diograph
  • Second permanent molar root developement started (Bifurcation forming)
122
Q

Why does a mixed dentiiton at 9-11 years old affect the canines?

A

Ectopic eruptuin/impaction
Lower canine problems:
delayed eruption not uncommon
* Impaction is rare
* generally buccally placed
* failure to resorb deciduous
* mesially positioned (overlying laterals)
* continue to migrate
* rarely – pathology/cyst

123
Q

Describe the incidence of ectopic canines?

A
  • 1-2 % population
  • More common female 70:30
  • 8% bilateral
  • 60% palatal ; 35 % line of arch ; 5% Buccal
124
Q

Name the 5 aetiologic al factors for ectopic canines?

A
  • Long developmental / eruptive path
  • Environmental/local factors
  • Lateral Incisor Anomalies : loss of eruption guidance
  • Crowding common with buccally impacted canines
  • Suggested genetic pattern especially with palatal impaction ( supported by link with
    hypodontia/microdontia and different racial prevalence rates- more common European
    population groups)
125
Q

Name the 4 potential complications for ectopic canines?

A
  • Non eruption
  • Resorption (12.5 % conventional imaging; Higher rates 3 D imaging)
  • Cystic Change (Rare)
  • Occlusal Disturbances:
  • Retained UR C due to non-eruption of UR 3 with occlusal wear and
    over-eruption of LR 3.
126
Q

How to clinically assess ectopic canines?

A

Importance of Early Detection
Clinical Assessment
* 3 ‘P’s Presence, Position and Pathology
* Inspect (Have a look)
* Palpate (Have a feel)
* Younger patients (mixed dentition)
* Palpate buccally for canines 9-10 years of age

Normal development
Upper 3s ‘bulges’ visible and palpable buccally

127
Q

What signs cause concern for ectopic canines?

A
  • Delayed eruption relative to age
  • Retention of deciduous canine
  • Asymmetrical eruption
  • Non-palpation 10-11 years
  • Tipping/migration of adjacent teeth- commonly upper lateral incisor
    Consider radiographic evaluation
128
Q

Name the 2 objectives for radiographic evaluation of ectopic canines?

A
  • Determine canine position
  • Check for pathology e.g. cystic change / resorption of adjacent teeth
129
Q

Explain the conventional imaging technique for radiographic evaluation of ectopic canines?

A
  1. Conventional imaging
    * OPG – magnification of canine if impacted palatally
    * OPG and Anterior Occlusal view ( Vertical parallex technique in combination)
    * 2 periapical views at different horizontal angles (Horizontal parallax technique)

e.g. Demonstration of Vertical Parallax
UL 3 magnified image on OPG and ‘moves’ apically with the tube shift (vertical parallax technique) confirming
palatally positioned. UR 3 slight occlusal ‘movement ‘ in opposite direction to tube shift suggests buccally
positioned.

130
Q

Explain the 3D imaging technique for radiographic evaluation of ectopic canines?

A

Will give accurate image of canine positioning and evidence of resorption /
pathology

131
Q

Explain the treatment options for impacted canine teeth?

A

Management Options for Impacted Canine Teeth
1. Early Interceptive management (10-13 years)
2. No treatment
3. Surgical exposure and orthodontic alignment
4. Surgical removal
(Transplantation)

132
Q

Explain what is included for interceptive management for impacted canine teeth?

A
  • Extraction of deciduous canine to ‘normalise’ eruption of permanent canine
  • Early case series studies (Ericson and Kurol 1987)- suggested can normalise eruption
    in 78 % of cases (Other studies less favourable success rates 50-60 %)
  • More successful with younger patients, adequate space available and displacement of
    canine is less than ½ way across lateral incisor
  • successful in carefully selected cases
    emphasize early detection, careful case selection, adequate space and
    maintenance of this space and importance of follow up
    risk of non-eruption and need for possible
    surgical exposure and orthodontic alignment
133
Q

Name the 3 premolar problems for mixed dentition in 9-11 year olds?

A

Ectopic eruption
Supernumerary teeth
Congenital absence

134
Q

What happens to result in ectopic eruption of the first premolar? How common? What to do?

A

Transposition with upper canine i.e. position switch
Rare ( < 1 %)
Management – accept or orthodontic input- extraction may be option if crowding

135
Q

Ectopic eruption of the second premolar - how common? Why happens? Where does it usually erupt? What to do?

A

Common due to crowding (secondary due to early loss of 2nd DM due to caries)
Or idiopathic (often with over-retained 2nd DM tooth)
Erupt on lingual/palatal aspect of arch (may impact)
Accept / consider removal for relief of crowding

136
Q

Supernumerary premolar teeth - how common? Which patients more likely?

A

Rare
More common in Asian /African patients
Usually supplemental

137
Q

Congenital absence of second premolars - how common? Cause? Clinical relevance?

A

common 3%
More often lower 5s
Genetic link
Localised or more severe hypodontia
Clinically : retained 2nd DMs (Es)

138
Q

Management of retained 2nd DMs (mixed dentition)?

A

Depends on prognosis of 2nd DMs
Degree of infra-occlusion
In general retain Es if possible in mixed dentition (perserving space and bone)
Seek early orthodontic opinion
Future orthodontic /restorative considerations
Future options : Maintain space with restorative replacement of Es or Orthodontic space closure

139
Q

Infraoccluded 2nd DMs (Es) - when is this common? What might happen? What should you monitor for?

A

Common with missing 5s
Loss of vertical development maybe ankylosed (adjacent teeth erupt with alveolar development)
Monitor closely for vertical change in growing patient

140
Q

Infraoccluded 2nd DMs (Es) - stages?

A

Stage 1 (above contact point)
Stage 2 (At contact point)
Stage 3 (Below contact point)

141
Q

Stage 1/2 Infraoccluded 2nd DMs (Es) - what should you do? Why?

A

Retain and monitor for change
Good OH/low caries risk

Stage 1 (above contact point)
Stage 2 (At contact point)

142
Q

Stage 3 Infraoccluded 2nd DMs (Es) - what should you do? Why?

A

Infra occluded UL and LR Es
Stage 3 = Below contact points +
OH difficult/ Increased caries risk
Removal difficult (surgical)
Risk of further change

143
Q

Class 2 malocclusion with increased overjet and Class2 profile - what should you do and at what age?

A

Consideration of growth modification with Functional appliance (Class 2 malocclusions)
Referral to Orthodontic specialist around 10-11 years
Most effective during peak pubertal growth spurt (Girls 11-12 years, Boys 12-14 years)
First premolar teeth erupted (retain twin block appliance)

144
Q

Reverse overjet and class 3 profile - What to do? What to consider?

A

Growth modification less successful (Facemask treatment)
Main effects dental tipping (difficult to restrain growth of mandible)
Potential for continued Class 3 growth (Family history important)
Patient may opt for alignment of upper arch only in early teens accepting Class 3
Best to monitor Class 3 growth and review patients concerns when older

145
Q

Describe the management of late mixed dentition/early perm dentition (12-15)?

A
  • Continuing to monitor maxillary canine eruption and second molars
  • Assessing patients malocclusion and any concerns (awareness of IOTN)
  • Consider referral to orthodontist for assessment as appropriate
  • Majority of routine orthodontic treatment fixed appliances at this stage
  • MDT patients a little later so orthodontic treatment ‘dovetails’ with restorative and
    surgical phases (end of growth)
  • Referral of combined orthodontic/restorative patients (hypodontia) at 15 – 16 years for
    planning
  • Referral of combined orthodontic/surgical patients at 15 -16 years for planning
146
Q

Describe the management of young adulthood dentition (16-18 YO)?

A
  • Following MDT planning
  • Start pre-restorative orthodontic treatment e.g. Hypodontia patients
  • Start pre-surgical orthodontic treatment e.g. Severe Class 2 and Class 3 patients
  • Restorative phase (implant placement ) at end of growing period (18-20 years)
  • Surgical phase (Orthognathic surgery ) at end of growing period (18-20 years)

PAEDS YR5 RESET AGAIN (4 decks)

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