6. Ortho: 9 year old, incompetent lips, affect speech (Summative, 2005) a. What are the effects of thumb sucking on maxillary development?

Proclination of maxillary incisors Anterior open bite Restriction of incisors development and height of maxillary anterior alveolar process Negative pressure making upper arch narrow Taper arch shape (constricted) Skeletal posterior crossbite

6. Ortho: 9 year old, incompetent lips, affect speech (Summative, 2005) c. List three methods of assessing skeletal maturity.

Hand wrist radiograph Lateral cephalometric tracing Average annual growth incremental are read off to predict the change in position of cephalometric landmarks Assessment of height and secondary sex characteristics (Cervical vertebrae radiograph) Gain in height in previous year

7. Ortho: age = 9; study casts, lateral ceph tracing; anterior crossbite (Summative, 2007) a. Problem list (5) b. What is BSI classification for the incisors?

Based on incisor relationship and is the most widely used descriptive classification (qualitative) Class I the lower incisor edges occlude with or lie immediately below the cingulum plateau of upper central incisor Class II the lower incisor edges lie posterior to the cingulum plateau of upper central incisor Division 1 proclined upper central incisors, or increase in overjet Division 2 retroclined upper central incisors, minimum or increased overjet Class III the lower incisal edge lie anterior to the cingulum plateau of the upper central incisors, with reduced or reversed overjet

ORTHODONTOLOGY Flashcards by Anson Tsui

Given the side view of the 12-year old patient, and a left and a right photograph of the upper and lower orthodontic casts.

a. Describe the molar (left and right), canine (left and right) and incisor relationship. (5)

 molar: class III
 canine: class III or I?

 incisor: class II

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Given the side view of the 12-year old patient, and a left and a right photograph of the upper and lower orthodontic casts.

b. What type of malocclusion is it? (2)

 Class II division 1, increased overjet

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Given the side view of the 12-year old patient, and a left and a right photograph of the upper and lower orthodontic casts.

c. List 4 reasons causing this malocclusion. (4)

 biting on lower lip
 mismatching development of mandible and maxilla (mandibular being slower)

 long cranial base
 large cranial base angle
 genetics

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Given the side view of the 12-year old patient, and a left and a right photograph of the upper and lower orthodontic casts.

d. 4 ways to measure craniofacial development (4)

 Ask them about secondary sexual characteristics, e.g. when has their voice

 deepened (boys), when has menarchy first started (girls)
 Hand-wrist X-ray
 Lateral cephalometic radiograph

 Height

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Given the side view of the 12-year old patient, and a left and a right photograph of the upper and lower orthodontic casts.

e. List 5 implications associated with malocclusion(not limit to this case). (5)

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Given the side view of the 12-year old patient, and a left and a right photograph of the upper and lower orthodontic casts.

f. What is “mesiodens”? Where is it commonly located? List the cause. (3)

Definition:
- Supernumerary teeth that develops between the central incisors.
Commonly located:
- Between the maxillary central incisors
Causes
- Cleft Lip and Palate
- Cleidocranial Dysostosis
- Gardner’s Syndrome

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Given the side view of the 12-year old patient, and a left and a right photograph of the upper and lower orthodontic casts.

g. Treatment of mesiodens (2)

Two treatment options: Extraction or Observation

Extraction
- Immediate removal of mesiodens is usually indicated in the following situations:
  - Inhibition or delay of eruption
  - Displacement of the adjacent tooth
  - Interference with orthodontic appliances
  - Presence of pathologic condition
  - Spontaneous eruption of the supernumerary tooth.
There are two methods for extraction of mesiodens
- Early extraction before root formation of the permanent incisors
- Late extraction after root formation of the permanent incisors.
The immediate removal versus delay in surgical intervention following root development of the central incisor and the lateral incisor about the age of eight to 10 years has been mentioned
Some authors recommend extraction of mesiodens in the early mixed dentition in order to facilitate spontaneous eruption and alignment of the incisors.
- In order to promote eruption and proper alignment of adjacent teeth, it is recommended to extract mesiodens in the early mixed dentition, which may reduce the need for orthodontic treatment. It might take six months to three years for an unerupted tooth to erupt after removal of the mesiodens
Delayed extraction of the mesiodens about the age of 10 when the apex of the central incisor nearly forms. If treatment is postponed after this age, more complex surgical and orthodontic treatment may be necessary.

Monitor

Monitoring of mesiodens in the following situations; satisfactory eruption of the succeeding teeth, absence of any associated pathologic lesions and risk of damage to the vitality of the related teeth.

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Given lateral cephalometric analysis of the patient, panoramic radiograph and a periodical radiograph of 53.

14 year old male, seeking treatment for the missing tooth.

a. What is orthodontics extraoral examination? (6 marks)
b. Describe the occlusal relationship (molars, canines, incisors)

 Angle’s Class 1?

 Class 1?

 British xxx Class 1?

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Given lateral cephalometric analysis of the patient, panoramic radiograph and a periodical radiograph of 53.

14 year old male, seeking treatment for the missing tooth.

c. Pathology found on the Panoramic Radiograph?

Pathology found on the periapical radiograph

How does the Pathology impact on the mixed dentition

Anson: No answers given

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Orthodontics: Patient with mixed dentition (photos and study casts) (Formative, 2005) a. Provide orthodontic diagnosis

 E/O MMPA, LFH, Mandible, Maxilla, TMJ

 I/O A P, VERTICAL, TRANSVERSE, OH, Pathology

 SOFT TISSUE lip competence, nasolabial angle, labiomental fold

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Name five ways to relieve crowding and create space (Formative, 2005)

 Extraction

 Distalization of molars

 Arch expansion

 Proclination of incisors / moving teeth forward

 Interproximal enamel stripping

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Ortho: 17 year old female (incompetent lips, skeletal class II div 1). Given: clinical & I/O photos, lateral cephalometric radiograph, computer analysis of lat ceph. (Summative, 2005)
a. Write down the extra oral features of this patient.

 Convex profile

 Incompetent lips

 LFH
 MMPA

 Facial symmetry

 Midline

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Ortho: 17 year old female (incompetent lips, skeletal class II div 1). Given: clinical & I/O photos, lateral cephalometric radiograph, computer analysis of lat ceph. (Summative, 2005)
b. Write down the intraoral features of this patient.

 Incisor class II division I

 Increased OJ
 OB
 Midline

 Missing teeth
 Extra teeth
 Molar relationship

 Canine relationship

 Crowding? Spacing?

 Crossbite?

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Ortho: 17 year old female (incompetent lips, skeletal class II div 1). Given: clinical & I/O photos, lateral cephalometric radiograph, computer analysis of lat ceph. (Summative, 2005)
c. List two different methods to improve the lip function and reduce the overjet of this patient.

 Normalize overjet of patient by: extraction of upper 4 and lower 5
 Retrocline the UI so that the lips will be competent and have more control

 Procline LI
 Surgery to correct underlying skeletal pattern

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Ortho: 17 year old female (incompetent lips, skeletal class II div 1). Given: clinical & I/O photos, lateral cephalometric radiograph, computer analysis of lat ceph. (Summative, 2005)
d. Sometimes anchorage with headgear is required. What are the three types of pulls using headgear?

 High pull
 Horizontal pull

 Cervical pull

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Ortho: 17 year old female (incompetent lips, skeletal class II div 1). Given: clinical & I/O photos, lateral cephalometric radiograph, computer analysis of lat ceph. (Summative, 2005)
e. List two commonly used upper and two lower retainers.

 Vacuum formed retainer

 Bonded retainer

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Ortho: 9 year old, incompetent lips, affect speech (Summative, 2005)
a. What are the effects of thumb sucking on maxillary development?

Proclination of maxillary incisors
Anterior open bite
- Restriction of incisors development and height of maxillary anterior alveolar process
Negative pressure making upper arch narrow
Taper arch shape (constricted)
Skeletal posterior crossbite

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Ortho: 9 year old, incompetent lips, affect speech (Summative, 2005)
b. Write down two beneficial effects of using a headgear activator.

 Stimulate growth of retrognathic mandible

 Inhibit growth of maxilla

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Ortho: 9 year old, incompetent lips, affect speech (Summative, 2005)
c. List three methods of assessing skeletal maturity.

Hand wrist radiograph
Lateral cephalometric tracing
- Average annual growth incremental are read off to predict the change in position of cephalometric landmarks
Assessment of height and secondary sex characteristics
(Cervical vertebrae radiograph)
Gain in height in previous year

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Ortho: 9 year old, incompetent lips, affect speech (Summative, 2005)
d. List three ways in which the patient can achieve an anterior oral seal.

 Circumferential muscular activity to achieve lip to lip seal

 Mandible is postured forwards to allow the lips to meet at rest

 Lower lip is drawn up behind the upper incisors

 Tongue is placed forward between the incisors to contact the lower lips (often contribute to development of incomplete overbite)

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Ortho: 9 year old, incompetent lips, affect speech (Summative, 2005)
e. What are the mandibular growth rotations associated with: 1.ClassIIdiv1; 2.ClassII div2?

 Class II dis 1: with increased OB, Forward rotation; with decreased OB, backward rotation

 Class II dis 2: Forward rotation

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Ortho: age = 9; study casts, lateral ceph tracing; anterior crossbite (Summative, 2007)
a. Problem list (5)
b. What is BSI classification for the incisors?

Based on incisor relationship and is the most widely used descriptive classification (qualitative)
- Class I the lower incisor edges occlude with or lie immediately below the cingulum plateau of upper central incisor
- Class II the lower incisor edges lie posterior to the cingulum plateau of upper central incisor
  - Division 1 proclined upper central incisors, or increase in overjet
  - Division 2 retroclined upper central incisors, minimum or increased overjet
- Class III the lower incisal edge lie anterior to the cingulum plateau of the upper central incisors, with reduced or reversed overjet

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Ortho: age = 9; study casts, lateral ceph tracing; anterior crossbite (Summative, 2007)
c. History taken for this type of malocclusion

 Crowding of upper arch (premature loss of deciduous teeth)

 Trauma or pathology
 Familial pattern
 Mandibular displacement

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Ortho: age = 9; study casts, lateral ceph tracing; anterior crossbite (Summative, 2007)
d. Mixed dentition analysis for Caucasians (5)

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7. Ortho: age = 9; study casts, lateral ceph tracing; anterior crossbite (Summative, 2007) e. 3 main causes of median diastema

 Supernumerary teeth / high frenum attachment / missing or peg shaped laterals  Actually it is normal during the ugly duckling stage as eruption of canine cause tipping movement of central incisors , self-closure occur if space is small

7. Ortho: age = 9; study casts, lateral ceph tracing; anterior crossbite (Summative, 2007) f. What consideration needed concerning retention after correction of median diastema?

 Relapse if space distal to central incisors has not been closed  Re migration of frenum attachment after frenectomy  Bonded flexible wire can be attached to palatal sides of two central incisors to prevent space reopen

7. Ortho: age = 9; study casts, lateral ceph tracing; anterior crossbite (Summative, 2007) g. Name the stage of treatment provided

 Retention stage (Orthodontic treatment involve 3 stages: planning \> active \> retention)

8. Ortho: 11 year old, class 2 div. 1 (Summative, 2007) a. Patient needs growth modification. What appliance needed and its 4 modes of action? (5)

 Functional appliance (Herbst appliance or Cervical pull headgear with Andresen activator)  Restrict growth of maxilla / promote growth of mandible / dentoalveolar change / remodeling or condylar growth/ clockwise rotation of occlusal plane/ extrusion of upper molars to decrease OB

8. Ortho: 11 year old, class 2 div. 1 (Summative, 2007) b. If patient rejects this treatment, what other ways? (2)

 Accept malocclusion  Functional appliance: twin block  Orthodontic camouflage  Orthognatic surgery in future after growth of jaw is completed

8. Ortho: 11 year old, class 2 div. 1 (Summative, 2007) c. 3 accessory orthodontic appliances for effective control of ↓overjet

 2 by 4 appliance  Z spring

8. Ortho: 11 year old, class 2 div. 1 (Summative, 2007) d. Name the term for this patient’s overbite

 Deep bite (when incisors’ overlap exceeds 1/3 of crown height of lower

8. Ortho: 11 year old, class 2 div. 1 (Summative, 2007) e. 2 fixed appliances to expand maxilla (4)

 Rapid maxillary expansion appliance  Quadhelix appliance

8. Ortho: 11 year old, class 2 div. 1 (Summative, 2007) f. Treatment options for questionable 26 occlusal caries

 Topical fluoride / preventive resin restoration / caries restoration

8. Ortho: 11 year old, class 2 div. 1 (Summative, 2007) g. What topical fluoride regime for this patient?

 Fluoride varnish (22600 ppm 5% NaF) ?

a. List out the extra oral orthodontic diagnosis. (5)

see question 10a on page 193-195

b. List out the intra oral orthodontic diagnosis. (5)

 See Question 15b page 209-210

c. Write down the formula for “Facial proportion” and calculate it with the data obtained from cephalometric analysis. (2)

 The facial Proportion  This is the ratio of the lower facial height to the total anterior facial height measured perpendicularly from the maxillary plane, calculated as apercentage

d. What are the other measurements that indicate the vertical skeletal patterns? (2)

* Maxillary Mandibular plane angle (MMPA) * Average is 27 + 4 degree * Frankfort Mandibular plane angle (FMPA) * Average is 28 + 4 degree * Difficult to locate accurately than MMPA so not preferred * Increased angle indicate either an increased lower anterior face height or reduced lower posterior face height

e. What is the reference line for wits analysis? (1)

 Functional occlusal plane (between cusp tips of molars and premolars / primary molar)

f. What are the two factors that we should consider when making space analysis? (2)

 Nationality and gender if we were to use tanaka’s space analysis method

g. What are the three aspects of etiology for the malocclusion regarding to the information provided? (3)

 Skeletal factors: retrognatic maxilla with normal mandible / normal maxilla with prognathic mandible  Backward rotation of mandibular growth  Soft tissue factors: tongue thrusting habit

h. What are the 5 methods for creating space to relieve crowding? (5)

* Extraction of teeth * Factors to consider – prognosis of tooth, position of tooth, space analysis, incisor relationship, lateral facial profile, anchorage required, types of appliances to be used * Extract incisor – rare, as it will cause lingual tilting of remaining lower labial segment + reduction of inter-canine width * Extract canine – rare (only when severely displace or crowded canine case) as its position is at turning point of arch which provides canine guidance + its long root is favorable for anchorage * Extract PM1 – common method to relieve moderate to severe crowding in arch * Extract PM2 – indicated in mild to moderate crowding cases with * hypoplastic PM2 (poor bracket bonding) * severe displacement of PM2 itself * space closure by forward mvt of M1 instead of labial segment retraction is wanted * Extract M2 – in cases you want to facilitate distal mvt of buccal segment / relieve mild premolar crowding / provide additional space for third molar eruption * Arch expansion (make sure there is adequate buccal supporting bone before starting) * Removable appliances with midline screw and buccal capping * Rapid maxillary expansion (RME) * Large forced generated to open the midline suture of palate to achieve skeletal expansion * Used in teens (10-11 years old) with midline suture not yet fused * 0.25mm expansion on arch per day * 2-time adjustment needed per day * left in mouth as retainer for few months later * not stable, can cause transverse problems * usually for cases together with CB or OB * Proclination of incisors * Distalization of molars * Functional appliance (rare) – E/O force by headgear * Removable appliance – screw appliance * Fixed appliance (usually for lower) – with spring * Enamel stripping –1-2mm enamel removal only * beware of dentine exposure + apply F- after stripping

A 10 years old girl complaining of her front teeth “sticking out”. (Class II div 1) E/O photographs: incompetent lips, average MPA & facial proportion, slightly acute nasio labial angle Intra-oral photographs: Class II incisor and molar relationship, increased overjet Cephalometric analysis: everything normal except SNA and “A, B on OP” increased Study cast: no apparent spacing or crowding in both arches a. What are your extra oral diagnoses in the sagittal dimension of this case? (5)

 Average MPA & facial proportions  Slightly acute nasio labial angle Anson: More on pages 193-195

A 10 years old girl complaining of her front teeth “sticking out”. (Class II div 1) E/O photographs: incompetent lips, average MPA & facial proportion, slightly acute nasio labial angle Intra-oral photographs: Class II incisor and molar relationship, increased overjet Cephalometric analysis: everything normal except SNA and “A, B on OP” increased Study cast: no apparent spacing or crowding in both arches b. What type of growth pattern does this patient have? (2)

 Backward downward

A 10 years old girl complaining of her front teeth “sticking out”. (Class II div 1) E/O photographs: incompetent lips, average MPA & facial proportion, slightly acute nasio labial angle Intra-oral photographs: Class II incisor and molar relationship, increased overjet Cephalometric analysis: everything normal except SNA and “A, B on OP” increased Study cast: no apparent spacing or crowding in both arches c. What type of appliance is suitable for correction of her malocclusion? (1)

 Functional appliance

Twin block appliance / Herbst appliance / Bionator / Van beek high pull headgear / Andresen activator

A 10 years old girl complaining of her front teeth “sticking out”. (Class II div 1) E/O photographs: incompetent lips, average MPA & facial proportion, slightly acute nasio labial angle Intra-oral photographs: Class II incisor and molar relationship, increased overjet Cephalometric analysis: everything normal except SNA and “A, B on OP” increased Study cast: no apparent spacing or crowding in both arches e. State two desirable actions that this type of appliance can achieve. (2) e. State two desirable actions that this type of appliance can achieve. (2)

A 10 years old girl complaining of her front teeth “sticking out”. (Class II div 1) E/O photographs: incompetent lips, average MPA & facial proportion, slightly acute nasio labial angle Intra-oral photographs: Class II incisor and molar relationship, increased overjet Cephalometric analysis: everything normal except SNA and “A, B on OP” increased Study cast: no apparent spacing or crowding in both arches f. Which method of space analysis is the best for this case? (1)

 Tanaka Johnston mixed dentition analysis

A 10 years old girl complaining of her front teeth “sticking out”. (Class II div 1) E/O photographs: incompetent lips, average MPA & facial proportion, slightly acute nasio labial angle Intra-oral photographs: Class II incisor and molar relationship, increased overjet Cephalometric analysis: everything normal except SNA and “A, B on OP” increased Study cast: no apparent spacing or crowding in both arches g. What measurements do you need for the space analysis? (3)

 Sum of mesiodistal width of lower 4 incisors → Calculate predicted width of unerupted canine and premolars  Arch length from distal aspect of permanent lateral incisors to mesial aspect of permanent first molar → Space available  Differences between space available and required = spacing / crowding

A 10 years old girl complaining of her front teeth “sticking out”. (Class II div 1) E/O photographs: incompetent lips, average MPA & facial proportion, slightly acute nasio labial angle Intra-oral photographs: Class II incisor and molar relationship, increased overjet Cephalometric analysis: everything normal except SNA and “A, B on OP” increased Study cast: no apparent spacing or crowding in both arches h. After space analysis, you found out that there is spacing in the upper arch, but you can’t find any spaces from the study cast, why? (2)

 Individual variation among populations  Errors in measuring width of lower incisors when they are crowding or overlapped

A 10 years old girl complaining of her front teeth “sticking out”. (Class II div 1) E/O photographs: incompetent lips, average MPA & facial proportion, slightly acute nasio labial angle Intra-oral photographs: Class II incisor and molar relationship, increased overjet Cephalometric analysis: everything normal except SNA and “A, B on OP” increased Study cast: no apparent spacing or crowding in both arches i. State three methods to assess her skeletal maturity. (3)

* Direct method * Longitudinal records of cephalograms * Indirect method * Chronological age * Height increase (peak growth velocity) * Secondary sex characters * Hand-wrist X rays * Cervical Vertebral Maturation (CVM) Anson: More on pages 197-199

A 10 years old girl complaining of her front teeth “sticking out”. (Class II div 1) E/O photographs: incompetent lips, average MPA & facial proportion, slightly acute nasio labial angle Intra-oral photographs: Class II incisor and molar relationship, increased overjet Cephalometric analysis: everything normal except SNA and “A, B on OP” increased Study cast: no apparent spacing or crowding in both arches j. If an adult patient has exactly the same malocclusion, then what is your best treatment option? What disciplines would be involved in this treatment option? (2)

* With dental problems only * Fixed appliance – to align arch + intrude incisors + procline lower incisors * With both skeletal and dental problems * Orthognathic surgery (for marked class II skeletal pattern or altered vertical skeletal proportions cases) * Pre-surgical fixed appliance – correct dental problems * Surgery (VSSO) – advance mandible * Post-surgical fixed appliance – alignment and levelling * Need the help of Oral Maxillofacial Surgeon

A 10 years old girl complaining of her front teeth “sticking out”. (Class II div 1) E/O photographs: incompetent lips, average MPA & facial proportion, slightly acute nasio labial angle Intra-oral photographs: Class II incisor and molar relationship, increased overjet Cephalometric analysis: everything normal except SNA and “A, B on OP” increased Study cast: no apparent spacing or crowding in both arches k. To retract the upper incisors, which one, bodily movement or tipping movement, would be more suitable? Briefly describe how you can achieve such movement. (2)

 Bodily by fixed appliance  Apply force close to its centre of resistance, use of rectangular wire

A 10 years old girl complaining of her front teeth “sticking out”. (Class II div 1) E/O photographs: incompetent lips, average MPA & facial proportion, slightly acute nasio labial angle Intra-oral photographs: Class II incisor and molar relationship, increased overjet Cephalometric analysis: everything normal except SNA and “A, B on OP” increased Study cast: no apparent spacing or crowding in both arches l. What type of appliance would you use to achieve such movement? (1)

 Fixed appliance 2x4

- A 8.5 years old girl complaining of irregular teeth, no family member shows similar ma locclusion - Panoramic radiograph: mixed dentition, apical radiolucency at 85 (over 45) - Extra-oral photographs: Straight profile at both CO & CR (even slightly convex at CR) - Intra-oral photographs: Class III incisor relationship at CO, edge to edge occlusion at CR - Cephalometric analysis: In both CO & CR positions, everything is normal except decreased SNA & increased SNB - Study cast: mandibular displacement shown at CO a. Is the patient having pseudo Class III or skeletal Class III? What reasons support your answer? (5)

answers too large to include page 200-202

- A 8.5 years old girl complaining of irregular teeth, no family member shows similar ma locclusion - Panoramic radiograph: mixed dentition, apical radiolucency at 85 (over 45) - Extra-oral photographs: Straight profile at both CO & CR (even slightly convex at CR) - Intra-oral photographs: Class III incisor relationship at CO, edge to edge occlusion at CR - Cephalometric analysis: In both CO & CR positions, everything is normal except decreased SNA & increased SNB - Study cast: mandibular displacement shown at CO b. What types of appliance would you use to correct her malocclusion? (2)

 Fixed appliance 2x4  Removable

- A 8.5 years old girl complaining of irregular teeth, no family member shows similar ma locclusion - Panoramic radiograph: mixed dentition, apical radiolucency at 85 (over 45) - Extra-oral photographs: Straight profile at both CO & CR (even slightly convex at CR) - Intra-oral photographs: Class III incisor relationship at CO, edge to edge occlusion at CR - Cephalometric analysis: In both CO & CR positions, everything is normal except decreased SNA & increased SNB - Study cast: mandibular displacement shown at CO c. What is the term best describe the treatment provided at this stage? (1)

 Active stage

- A 8.5 years old girl complaining of irregular teeth, no family member shows similar ma locclusion - Panoramic radiograph: mixed dentition, apical radiolucency at 85 (over 45) - Extra-oral photographs: Straight profile at both CO & CR (even slightly convex at CR) - Intra-oral photographs: Class III incisor relationship at CO, edge to edge occlusion at CR - Cephalometric analysis: In both CO & CR positions, everything is normal except decreased SNA & increased SNB - Study cast: mandibular displacement shown at CO d. What are the benefits of receiving treatment at this stage? (3)

 Increase likelihood of proper jaw growth  Enhance self-esteem and esthetics while reducing adverse psychological impact  Reduce incidence of impacted permanent teeth  Make future orthodontic treatment less complicated  More efficient treatment and potential of correction when growth is incomplete

- A 8.5 years old girl complaining of irregular teeth, no family member shows similar ma locclusion - Panoramic radiograph: mixed dentition, apical radiolucency at 85 (over 45) - Extra-oral photographs: Straight profile at both CO & CR (even slightly convex at CR) - Intra-oral photographs: Class III incisor relationship at CO, edge to edge occlusion at CR - Cephalometric analysis: In both CO & CR positions, everything is normal except decreased SNA & increased SNB - Study cast: mandibular displacement shown at CO e. What factors do you need to watch for after the correction of malocclusion has completed? (2)

 Retention, review stability of ortho treatment  Monitor eruption of permanent teeth  Growth and development  Reassess for further ortho treatment need

- A 8.5 years old girl complaining of irregular teeth, no family member shows similar ma locclusion - Panoramic radiograph: mixed dentition, apical radiolucency at 85 (over 45) - Extra-oral photographs: Straight profile at both CO & CR (even slightly convex at CR) - Intra-oral photographs: Class III incisor relationship at CO, edge to edge occlusion at CR - Cephalometric analysis: In both CO & CR positions, everything is normal except decreased SNA & increased SNB - Study cast: mandibular displacement shown at CO f. After this stage of treatment has finished, if later the patient requires further treatment in the permanent dentition, what is the term best describe the whole treatment process? (1)

 Two phase orthodontic treatment

- A 8.5 years old girl complaining of irregular teeth, no family member shows similar ma locclusion - Panoramic radiograph: mixed dentition, apical radiolucency at 85 (over 45) - Extra-oral photographs: Straight profile at both CO & CR (even slightly convex at CR) - Intra-oral photographs: Class III incisor relationship at CO, edge to edge occlusion at CR - Cephalometric analysis: In both CO & CR positions, everything is normal except decreased SNA & increased SNB - Study cast: mandibular displacement shown at CO g. List one way that you can make room for her permanent lateral incisor to erupt. (1)

 Arch expansion / proclination of central incisors

12. Orthodontics (photos and study casts are provided) On a Cephalometric tracing diagram, 5 lines are marked. (Formative 2009) a. List out the extra oral orthodontics diagnosis. (5)

* Skeletal pattern * Anteroposterior * Class I – the mandible is 2 – 3 mm posterior to maxilla * Class II – the mandible is retruded relative to the maxilla * Class III – the mandible is protruded relative to the maxilla * Vertical * Lower facial height * Frankfort mandibular planes angle * Transverse * Extent of asymmetry and whether only the lower facial third or the maxilla or orbits are involved should be recorded. * Soft Tissues * Lips * The form, tonicity, and fullness of the lips. * Lip competence * Lower lip position relative to the upper incisors * The smile aesthetics * Tongue * Temporomandibular joints * Habits * Lip-sucking habits

12. Orthodontics (photos and study casts are provided) On a Cephalometric tracing diagram, 5 lines are marked. (Formative 2009) b. List out the intra oral orthodontics diagnosis. (5)

12. Orthodontics (photos and study casts are provided) On a Cephalometric tracing diagram, 5 lines are marked. (Formative 2009) c. 3 questions i. Is there any genetic factor causing the malocclusion of the patient? What is it? (1)

* Supernumerary teeth or small arch * More number teeth will need to fit in a small arch * Space required more than space available

12. Orthodontics (photos and study casts are provided) On a Cephalometric tracing diagram, 5 lines are marked. (Formative 2009) c. 3 questions ii. Is there any environmental factor causing the malocclusion of the patient? What is it? (1)

* Sucking habits and mouth breathing * Sucking habits will lead to an overbite * Mouth breathing will lead to oral musculature imbalance hence the teeth will be more protruded

12. Orthodontics (photos and study casts are provided) On a Cephalometric tracing diagram, 5 lines are marked. (Formative 2009) c. 3 questions iii. What is a common quantitative assessment of malocclusion? What are the two elements included in this assessment? (3)

Index of orthodontics treatment needed, include dental health and aesthetics components

12. Orthodontics (photos and study casts are provided) On a Cephalometric tracing diagram, 5 lines are marked. (Formative 2009) d. 3 questions i. Which line is the one that stands for the relationship between the growth of the cranial base and the maxilla? Name it. (2)

 B (Maxillary plane)

12. Orthodontics (photos and study casts are provided) On a Cephalometric tracing diagram, 5 lines are marked. (Formative 2009) d. 3 questions ii. Which line is the one that stands for the relationship between the growth of the cranial base and the mandible? Name it.

 C (Mandibular plane)

12. Orthodontics (photos and study casts are provided) On a Cephalometric tracing diagram, 5 lines are marked. (Formative 2009) d. 3 questions iii. What is line E? (1)

 Rickett’s E plane (from soft tissue chin and tip of nose)

12. Orthodontics (photos and study casts are provided) On a Cephalometric tracing diagram, 5 lines are marked. (Formative 2009) e. Five methods to relieve crowding. i. What are the methods to relieve crowding by increasing the arch length? (3)

 Arch expansion  Distalization of molars  Proclination of incisors

12. Orthodontics (photos and study casts are provided) On a Cephalometric tracing diagram, 5 lines are marked. (Formative 2009) e. Five methods to relieve crowding. ii. What are the methods to relieve crowding by decreasing the need of teeth length? (2)

 Interproximal enamel stripping  Extraction

 Frankfort mandibular plane angle, mandibular position, maxillary position, paranasal deficiency, nasolabial angle, labiomental fold

 Skeletal factors: normal maxilla with retrognatic mandible / prognatic maxilla with normal mandible  Forward rotational growth pattern of mandible  Soft tissue: incompetent lip  Dental factors: Presence of crowding, result in proclination of upper incisors  Habits: Digit sucking

 Hand wrist radiograph  Height  Secondary sexual characteristics, menarche and voice change  Cervical vertebral maturity

 %, mm, incomplete?

 Normal, within 1 SD

 Functional appliance: Twin block, van beek headgear, herbst, andreasen activator  Fixed appliance

A 13 years old patient, her mother with similar malocclusion. Habit: biting of lower lips Increased overjet Cephalometric analysis: LI/MnPI lower than normal but within normal value g. In the same case but for a 30 years old patient, what is your treatment plan for the patient? What disciplines would be involved in this treatment option? (2)

 Functional appliance allow growth modification to stimulate growth of mandible and restrain maxillary growth  Fixed appliance provide detailed alignment after application of functional appliance

A 10 years 4 month girl patient, no family history of the similar malocclusion. C/O: irregular teeth MH: allergic to an antibiotic E/O, I/O: Anterior cross bite of 21, edge to edge incisal condition Lateral cephalomatric all values within normal range except Me-MxPl PA shows an odontome mesial to unerupted 13 with 53 in place a. Relationship of the molars and incisors? What are the skeletal patterns of this patient? (5)

 Class I molar in rest while shift to Class III in C.O., Class III incisor  Skeletal class I

A 10 years 4 month girl patient, no family history of the similar malocclusion. C/O: irregular teeth MH: allergic to an antibiotic E/O, I/O: Anterior cross bite of 21, edge to edge incisal condition Lateral cephalomatric all values within normal range except Me-MxPl PA shows an odontome mesial to unerupted 13 with 53 in place b. Is the patient having pseudo class III or skeletal class III? Why? (4)

* Pseudo class III * Patient has skeletal Class I pattern * True class III can never achieve edge-to-edge position * Class I molar relationship in rest position → shift to Class III towards C.O * No dentoalveolar compensation * True class III usually has proclined upper incisors and retroclined lower incisors to decrease reversed overjet * Cephalometric analysis (not learnt yet)

A 10 years 4 month girl patient, no family history of the similar malocclusion. C/O: irregular teeth MH: allergic to an antibiotic E/O, I/O: Anterior cross bite of 21, edge to edge incisal condition Lateral cephalomatric all values within normal range except Me-MxPl PA shows an odontome mesial to unerupted 13 with 53 in place c. List two types of appliance that you would like to use to correct her malocclusion. Which one do you prefer? Why? (4)

 Fixed and removable appliance  Prefer removable appliance as patient is in mixed dentition that sufficient overbite and tilting movement will suffice  Fixed appliances will be suitable for permanent dentition and comprehensive correction

A 10 years 4 month girl patient, no family history of the similar malocclusion. C/O: irregular teeth MH: allergic to an antibiotic E/O, I/O: Anterior cross bite of 21, edge to edge incisal condition Lateral cephalomatric all values within normal range except Me-MxPl PA shows an odontome mesial to unerupted 13 with 53 in place d. In the cephalometric radiograph, which tooth, 11 or 21 is used to trace for lateral cephalometric radiograph? What is your plan to treat the anterior crossbite? What 2 appliances can be used? Which one do you prefer? Why (6)

 11?  Goals for early treatment are to correct anterior displacement of mandible before eruption of canines and premolars  Rapid maxillary expansion  Mandibular bite plane to free occlusion, allowing bringing upper incisors out of crossbite

 Odontoma

* Space creation prior to surgery as sufficient space increase chance of spontaneous eruption of impacted tooth * Surgical removal of supernumerary tooth * Observe occurrence of spontaneous eruption by radiographic monitoring * Secondary surgery to expose impacted tooth if there is no eruption within 6 to 12 months * Surgical exposure of impacted tooth (open or close technique) * Orthodontic traction and alignment

A 13 years old patient, her mother with similar malocclusion. Habit: biting of lower lips Increased overjet Cephalometric analysis: LI/MnPI lower than normal but within normal value Given: lateral cephalograph, study model, clinical photos History: 22 year old, Father also has similar facial profile. Tongue thrusting habit a. List out extra oral orthodontic diagnosis

See answers to question 10a on page 193-195

A 13 years old patient, her mother with similar malocclusion. Habit: biting of lower lips Increased overjet Cephalometric analysis: LI/MnPI lower than normal but within normal value Given: lateral cephalograph, study model, clinical photos History: 22 year old, Father also has similar facial profile. Tongue thrusting habit b. List out intra oral orthodontic diagnosis

long answer, look on pages 209-210

A 13 years old patient, her mother with similar malocclusion. Habit: biting of lower lips Increased overjet Cephalometric analysis: LI/MnPI lower than normal but within normal value Given: lateral cephalograph, study model, clinical photos History: 22 year old, Father also has similar facial profile. Tongue thrusting habit c. Is there any genetic factor causing the malocclusion of this patient? What is it?

 Skeletal factors: Normal maxilla with retrognatic mandible / prognatic maxilla with normal mandible

A 13 years old patient, her mother with similar malocclusion. Habit: biting of lower lips Increased overjet Cephalometric analysis: LI/MnPI lower than normal but within normal value Given: lateral cephalograph, study model, clinical photos History: 22 year old, Father also has similar facial profile. Tongue thrusting habit d. Is there any environmental factor causing the malocclusion of this patient? What is it?

 Soft tissues factors: Incompetent lip  Dental factors: Presence of crowding, result in proclination of upper incisors  Habits: Digit sucking

A 13 years old patient, her mother with similar malocclusion. Habit: biting of lower lips Increased overjet Cephalometric analysis: LI/MnPI lower than normal but within normal value Given: lateral cephalograph, study model, clinical photos History: 22 year old, Father also has similar facial profile. Tongue thrusting habit e. What 2 components would you compare in space analysis?

 Space required and space available

A 13 years old patient, her mother with similar malocclusion. Habit: biting of lower lips Increased overjet Cephalometric analysis: LI/MnPI lower than normal but within normal value Given: lateral cephalograph, study model, clinical photos History: 22 year old, Father also has similar facial profile. Tongue thrusting habit f. What are the errors for space analysis in this patient?

 Permanent dentition has already erupted no need for space analysis???

A 13 years old patient, her mother with similar malocclusion. Habit: biting of lower lips Increased overjet Cephalometric analysis: LI/MnPI lower than normal but within normal value Given: lateral cephalograph, study model, clinical photos History: 22 year old, Father also has similar facial profile. Tongue thrusting habit g. Name two common quantitative assessment of malocclusion.

 Peer assessment rating (PAR index)  Index of orthodontic treatment needed (IOTN)

A 13 years old patient, her mother with similar malocclusion. Habit: biting of lower lips Increased overjet Cephalometric analysis: LI/MnPI lower than normal but within normal value Given: lateral cephalograph, study model, clinical photos History: 22 year old, Father also has similar facial profile. Tongue thrusting habit h. Name two common qualitative assessment of malocclusion.

 Angle’s classification  British standard institute classification

Given: 12 year old patient has anterior open bite, with tongue thrusting History: no familial history of anterior open bite a. What are your extra oral diagnoses?

 See Question 10a pages 193-195

Given: 12 year old patient has anterior open bite, with tongue thrusting History: no familial history of anterior open bite b. What are your intra oral diagnoses?

See Question 15b page209-210

Given: 12 year old patient has anterior open bite, with tongue thrusting History: no familial history of anterior open bite c. What is the name of the line responsible for soft tissue analysis?

* *_Holdaway line_** : from the soft tissue chin to upper lip * *_Rickett’s E plane_** : join soft tissue chin and tip of nose * *_Facial plane_** : between soft tissue nasion and soft tissue chin

Given: 12 year old patient has anterior open bite, with tongue thrusting History: no familial history of anterior open bite d. Give the formula of facial proportion.

Given: 12 year old patient has anterior open bite, with tongue thrusting History: no familial history of anterior open bite e. What is IOTN? What are the components?

 Index of orthodontic treatment need  Dental health and aesthetics components

Given: 12 year old patient has anterior open bite, with tongue thrusting History: no familial history of anterior open bite f. Give 2 types of appliance for management of anterior open bite.

 Functional appliance: high pull headgear  Removable appliance: maxillary intrusion splint

Given: 12 year old patient has anterior open bite, with tongue thrusting History: no familial history of anterior open bite g. Are there any genetic factors behind the patient’s condition?

 Skeletal backward rotation of mandible  Localized failure of development like cleft lip

Given: 12 year old patient has anterior open bite, with tongue thrusting History: no familial history of anterior open bite h. Are there any environmental factors behind the patient’s condition?

 Soft tissue factor: tongue thrusting  Behavioural factor: digit sucking habit  Mouth breathing result in overdevelopment of buccal segment teeth

Given: 8 1⁄2 year old patient, with edge to edge biting at CR and class 3 malocclusion at CO History: no familial history of class 3 malocclusion a. Is it skeletal or pseudo class 3? Why?

 Pseudo class 3  Since true class 3 can never move mandible backward to edge to edge position  Both pseudo and true class 3 will have class 3 centric occlusion, but pseudo will shift from class 1 to class 3 upon closure

Given: 8 1⁄2 year old patient, with edge to edge biting at CR and class 3 malocclusion at CO History: no familial history of class 3 malocclusion b. Give ways to create space by reducing space requirement.

 Extraction  Distalize molars  Enamel stripping

Given: 8 1⁄2 year old patient, with edge to edge biting at CR and class 3 malocclusion at CO History: no familial history of class 3 malocclusion c. Give ways to create space by increasing arch length.

 Arch expansion  Procline teeth

Given: 8 1⁄2 year old patient, with edge to edge biting at CR and class 3 malocclusion at CO History: no familial history of class 3 malocclusion d. What is the name of the treatment to treat the condition?

 Interceptive treatment

Given: 8 1⁄2 year old patient, with edge to edge biting at CR and class 3 malocclusion at CO History: no familial history of class 3 malocclusion e. What is the name of the line responsible for soft tissue analysis?

 Esthetic line, Rickett’s E plane

Given: 8 1⁄2 year old patient, with edge to edge biting at CR and class 3 malocclusion at CO History: no familial history of class 3 malocclusion f. What do you need to pay attention to in retention stage?

 Review and monitor growth  Tendency of relapse: derotation, presence of definite occlusal stops, closure of extraction space, competent lips, growth potential  Patient compliance  OH, periodontal status

Background: 22 year old. Unsatisfied with his appearance. His father has similar skeletal and dental profile. Trauma happened on his anterior teeth. Cephalometric radiograph, clinical photos, pan, study cast are provided. a. Define space available and space required (4)

 Space required: total measured or predicted mesiodistal widths of relevant permanent teeth  Space available: available arch length

 Crowding

Perio Given I/O photos of upper occlusal, lower occlusal and frontal view. 22 pontic, 23 abutment. Upper missing 16 or 18? And missing 26. Lower missing 35-38, 45-48. Spacing for lower incisors and gingival recession a. Which teeth are present (1) b. What are the possible mechanisms for the spacing between 42 and 41, 41 and 31 (6)

 Bone loss, loss of periodontal support  Posterior bite collapse, increased loading to anterior teeth --\> trauma  Pressure produced from inflammatory tissues within periodontal pockets

20. Ortho - C/O stick out teeth; MH clear; DH irregular; FSH no familial history (Formative, 2013) a. List the extra oral features (5)

 See Question 10a page 193-195

20. Ortho - C/O stick out teeth; MH clear; DH irregular; FSH no familial history (Formative, 2013) b. List the occlusal features (5)

 See Question 15b see page 209-210

20. Ortho - C/O stick out teeth; MH clear; DH irregular; FSH no familial history (Formative, 2013) c. 4 anteroposterior features on cep (4)

 ANB  SNA  SNB  AO-BO

20. Ortho - C/O stick out teeth; MH clear; DH irregular; FSH no familial history (Formative, 2013) d. 4 vertical features (4)

 MMPA  Frankfort Mandibular Plane Angle  Facial Proportion  Anterior facial height and posterior facial height

20. Ortho - C/O stick out teeth; MH clear; DH irregular; FSH no familial history (Formative, 2013) e. 2 soft tissue analysis (2)

 Rickets E-Plane  Holdway Line  Facial Plane

20. Ortho - C/O stick out teeth; MH clear; DH irregular; FSH no familial history (Formative, 2013) f. Dental alveolar analysis

 UI/ MxP  LI/ MnP  Inter-incisal angle  LI/APO

20. Ortho - C/O stick out teeth; MH clear; DH irregular; FSH no familial history (Formative, 2013) g. 1 component of space analysis (1)

 Space required / space available

Information given: 13 1/2 year-old boy A set of E/O and I/O photos. Class II div 2? Spacing of upper arch. Missing 13 and 23. a. List 5 E/O features. (5)

 See Question 10a see page 193-195

Information given: 13 1/2 year-old boy A set of E/O and I/O photos. Class II div 2? Spacing of upper arch. Missing 13 and 23. b. List 5 I/O features. (5)

 See Question 15b see page 209-210

Information given: 13 1/2 year-old boy A set of E/O and I/O photos. Class II div 2? Spacing of upper arch. Missing 13 and 23. c. List 5 clinical features that you will suspect of an ectopic pathway of eruption of permanent upper canine. (5)

 Retention of deciduous canine  Delayed eruption of permanent canine  Congenitally missing lateral incisors / Peg-shaped or diminutive lateral incisors  Rotation, tipping, drifting or displacement of adjacent teeth - Presence of palatal bulge or absence or displacement of buccal bulge

Information given: 13 1/2 year-old boy A set of E/O and I/O photos. Class II div 2? Spacing of upper arch. Missing 13 and 23. d. At what age can you palpate an upper permanent canine from the buccal sulcus? (1)

 10 - 11 y.o.

Information given: 13 1/2 year-old boy A set of E/O and I/O photos. Class II div 2? Spacing of upper arch. Missing 13 and 23. e. Apart from palpation, name a technique that you can locate an impacted canine. (1)

 Parallax technique, following SLOB rule

Information given: 13 1/2 year-old boy A set of E/O and I/O photos. Class II div 2? Spacing of upper arch. Missing 13 and 23. f. What radiographic views will you want to locate the impacted canine? (2)

 Vertical: Anterial occlusal + periapical radiograph or panoramic  Horizontal: 2 peripaical or 1 with panoramic

Information given: 13 1/2 year-old boy A set of E/O and I/O photos. Class II div 2? Spacing of upper arch. Missing 13 and 23. g. At what age will you extract a deciduous upper canine to facilitate eruption of the succeeder? (1)

 11 y.o?

Information given: 13 1/2 year-old boy A set of E/O and I/O photos. Class II div 2? Spacing of upper arch. Missing 13 and 23. h. What are the management if the canine do not erupt even after extraction of the deciduous upper canine? (4)

 Check the presence of obstacles (e.g. supernumerary) and remove if present  Ensure there is sufficient space for canine eruption (i.e. space creation first)  Surgical exposure either closed or open technique used  Orthodontic traction - Align with subsequent orthodontic treatment

Information Given: 10-year-old boy A set of E/O and I/O Clinical photos showing incompetent lips and Class II Div. 2?? a. List 2 E/O features of skeletal discrepancy of the patient that make him suitable for functional appliance. (2)

 Class II  Convex

Information Given: 10-year-old boy A set of E/O and I/O Clinical photos showing incompetent lips and Class II Div. 2?? b. List 3 mode of action of Functional Appliance. (3)

* Functional appliances posture the mandible forward in a growing patient which produces the following effect * Dento-alveolar effects (major) – distal movement of upper dentition and mesial movement of lower dentition + tipping of upper incisors palatally and lower incisors labially * Skeletal changes (minor) – restrain maxillary growth and enhance mandibular growth * Orofacial soft tissues – produce disnificant improvement in the sodt tissue environment surrounding the dentition. * Muscles of mastication – stretches and alters the activity of the muscles of mastication.

Information Given: 10-year-old boy A set of E/O and I/O Clinical photos showing incompetent lips and Class II Div. 2?? c. List 4 method of indirect estimation of age. (4)

Indirect methods * Chronological age * Height increase (peak growth velocity) * Secondary sex characters * Hand-wrist X ray * Cervical Vertebral Maturation (CVM)

7 years old patient presented with sharp pain during eating hot and cold food of short duration sensitivity during toothbrushing Pain located mainly at lower molars. . Clinical photo of upper and lower occlusal view provided.(first permanent molar enamel worn away?) A panoramic radiograph also provided a. What is anterior open bite? (1)

 There is no vertical overlap of incisors when buccal segment teeth are in occlusion

 Skeletal factor: backward rotation of mandible  Soft tissue factor: tongue thrusting  Behavioral factor: digit sucking habit  Localized failure of development like cleft lip  Mouth breathing result in overdevelopment of buccal segment teeth

 Digit sucking habit due to asymmetrical AOB

* Simple movement of displaced single tooth into the arch (extraction may be necessary to relieve crowding) * By fixed appliance (with cross elastics) * Quadhelix appliance * Rapid maxillary expansion * Generate force to open midline suture and expand upper arch skeletally rather than movement of teeth

 Can’t answer

ORTHODONTOLOGY Flashcards

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