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Ortho > risks and benefits of ortho tx > Flashcards

risks and benefits of ortho tx Flashcards

1
Q

benefits

A

improve:
appearance - QOL - dental and facial
function - mastication
dental health - trauma/resorption

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2
Q

improvement in function

A

mastication - when associated with severe malocclusion - large AOB, large OJ or reduced OJ
rarely improves speech defects - lisp can be associated with AOB but speech is established early in life

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3
Q

IOTN DHC

A

1 and 2 - no/low need (min benefit)
3 - borderline need (some benefit)
4 and 5 - need/high need (significant benefit)

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4
Q

MOCDO

A 
Missing Teeth
OJ
Crossbites
Displacement of contact points
Overbites
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5
Q

how are impacted/missing/ectopic teeth a dental health risk?

A

can cause resorption and be associated with cyst formation

supernumerary teeth can prevent normal eruption

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6
Q

dental health risk of OJ >6mm

A

risk of trauma to upper incisors increases with size of OJ

worse with incompetent lips

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7
Q

anterior cross bite dental health risk

A

loss of perio support, gingival recession
toothwear
if associated with mandibular displacement may lead to TMJ issues

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8
Q

posterior cross bite issue

A

a significant displacement may lead to asymmetry

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9
Q

crowding and caries

A

crowding per se not directly linked to increased risk of caries - more to do with diet and fluoride
crowded teeth are more difficult to clean and take longer

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10
Q

crowding and periodontal disease

A

weak association between irregular teeth and PDD
crowding can make surfaces less accessible and harder to clean
individual motivation rather than tooth alignment has greater effect on effective brushing
better OH/awareness in pts with prev ortho

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11
Q

deep traumatic overbite dental health risk

A

can cause gingival stripping - L labial, U palatal

loss of perio support

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12
Q

TMJ dysfunction and ortho

A

TMD multifactorial
ortho/TMD - evidence is v weak
small association between TMD and some malocclusions
- CB with displacement (fct shifts)
- class 2 with retrusive mandible
- class 3
- AOB
but no guarantee correction will improve TMD
never offer ortho to improve TMD in isolation
if malocclusion does not warrant tx, ortho will not be offered to pts with TMD
conservative tx must be offered before any ortho
ortho tx could aggravate existing TMD e.g. using inter maxillary elastics

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13
Q

risks

A 
decalcification
root resorption
relapse
ST trauma
others
 - recession
 - loss of perio support
 - headgear injuries
 - enamel fracture and toothwear
 - loss of vitality
 - allergy
 - poor/failed tx
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14
Q

decalcification

A

picture frame opacities
weakens enamel to caries
- ranges from staining to frank cavitation/gross caries

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15
Q

preventing decalcification

A

case selection
oral hygiene
diet advice
fluoride

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16
Q

preventing decalcification - good case selection

A

motivated pt
good OH pre-tx
low caries risk
if low or borderline need - no tx

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17
Q

how is caries risk indicated?

A

number and location of restorations - esp if anterior

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18
Q

indications of high risk of decalcification

A

pre-existing decalcification
erosion
caries history

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19
Q

preventing decalcification - maintaining good OH

A 
before start and during
 - toothbrushing - target areas
 - interdental brush
OHI
 - min x2 per day VERY thoroughly
 - after every meal
 - disclosing tablets
 - target gingival margins and around each bracket
GDP help
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20
Q

preventing decalcification - diet advice

A

encourage non-cariogenic diet
sugar amount and freq - critical pH 5.5
- avoid snacks between meals
- avoid fizzy drinks etc
- sports drinks
- lollipop type sweets, haribos - stick to brackets and prolongs time sugar in mouth
sugar free gum - with care - stimulate salivary buffers

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21
Q

preventing decalcification - fluoride

A

toothpaste
MW
Duraphat varnish
others - F releasing GIC

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22
Q

preventing decalcification - fluoride - toothpaste

A

check which they use - switch to adults
F exposure at least x2 daily
spit don’t rinse
for high risk pts Duraphat 2800 or 5000 ppm x2 daily, ordinary at other times, warn re overdose if tendency to swallow

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23
Q

preventing decalcification - fluoride - MW

A

daily 0.05%/225ppm
use in between brushing not after
beneficial but often low compliance
£ may be prohibitive - cheaper options - supermarket antiseptic MW now with F

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24
Q

preventing decalcification - fluoride - Duraphat varnish

A

22600 ppm

4 monthly

25
Q

root resorption

A

inevitable consequence of tooth movement

can also see RR even with no prev ortho

26
Q

prevalence of RR

A

nearly everyone
25% radiographically
90% histologically
mostly unnoticed

27
Q

average amount of RR

A

1mm over two years fixed appliances

28
Q

site of RR

A 
any teeth but
U incisors (esp 2s) > L incisors > 6s
29
Q

prevalence of severe RR

A

1-5%

30
Q

risk factors for RR

A

multifactorial

  • type of tooth movement
  • root form
  • prev trauma
  • nail biting?
  • length of tx
31
Q

risk factors for RR - type of tooth movement

A

prolonged, high force
intrusion
large movements
torque (root movement)

32
Q

risk factors for RR - root form

A 
short
blunt
apical bend
PIPETTE shape
resorbed already
33
Q

prevention of RR

A

light forces

3m treatment pause

34
Q

relapse

A

the return of the features of the original malocclusion following correction

35
Q

difficulty with relapse

A

common but unpredictable

tx all cases as if potential to relapse

36
Q

features more prone to relapse

A 
bridgework post-ortho (quickly fit retainer)
L incisor crowding
rotations
instanding 2s
spaces and diastemas
class 2 div 2
AOB
reduced perio support/short roots
37
Q

IOTN AC and relapse

A

1-5 if relapse hard to distinguish before and after

6-10 even if some relapse would see improvement

38
Q

managing relapse

A

retainers - maintenance cost of retention

case selection/informed consent - tx severe malocclusions, leave mild

39
Q

PFR thickness

A

usually 1-1.5mm - robust

40
Q

removable retainers

A 
COR/PFR/VFR
Essix
Hawley type - robust, can eat, good for holding prosthetic lateral in hypodontia cases
remove for OH
can wear part-time
pt control
easy to spot problem
after discharge - GDP to supply
41
Q

fixed retainers

A 
prone to plaque and calculus build up
can break and not notice
need excellent OH
tend to leave in situ for life
require more care/long term maintenance
VFRs often on top in case bonded breaks
42
Q

where do you place a fixed retainer?

A

at contact points to avoid ST damage and allow cleaning

43
Q

soft tissue trauma

A

pain/discomfort - analgesics

ulceration - ortho wax or babybel cheese wax

44
Q

recession

A

increasing problem
expansion, more adult tx
may not manifest until years later

45
Q

management of recession

A

correct tx planning - teeth within bone, avoid over expansion (out of cortical bone)
thin biotype
warn pt
gingival graft

46
Q

periodontal health - active perio disease

A

must be txed, stabilised and maintained before ortho tx starts
- min 6m - 2 visits 2m apart with no active pockets
during ortho tx - accelerates alveolar bone loss and perio destruction
txed as priority over continuing tx

47
Q

periodontal health

A

gingivitis - common
recession
loss of perio support

48
Q

headgear trauma

A

ocular injuries - blindness/loss of eye

49
Q

prevention of headgear trauma

A

safety mechanism - 2minimum

  • Nitom facebow
  • snap away traction spring
50
Q

toothwear or enamel fracture

A

tooth vs bracket
greater risk with ceramic brackets - ceramic harder than E
E fracture during debond

51
Q

loss of vitality

A 
rare
more risk if prev trauma or compromised tooth
warn pt
discolouration or darkened? lat incisors
Xs force? idiopathic cause
52
Q

allergies

A

latex - may be in elastics
Ni - on rise due to wearing cheap jewellery/piercings etc
adhesive - colophony

53
Q

poor/failed tx

A 
poor diagnosis/tx planning
operator technique error
poor cooperation 
 - appliance wear
 - repeated breakages
 - non-attendance
unfavourable growth
54
Q

chance of tx success increases with:

A

severity of malocclusion
motivation of pt
operator expertise

55
Q

social 6 smiles plus

A

cosmetic quick fixes - 6 month smiles etc
mild problems
unrealistic pt expectations
informed choice
relapse
litigation prone in hands of inexperienced operator

56
Q

what is ortho tx mostly?

A

elective

57
Q

describe risks/benefits throughout tx timescale

A

risks throughout course of tx
benefits more apparent at end of tx
risks must not outweigh benefits

58
Q

which pts have the most and least to gain?

A

most - those with severe malocclusions treated by experts

least - mild malocclusions

59
Q

risk reduction

A 
excellent OH
highly motivated pt
tx more severe malocclusions
properly inform pts of risks
retention for life or accept some relapse

Ortho (21 decks)

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