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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 score and assoc need

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/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

4a

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

deep traumatic overbite dental health risk

A

can cause gingival stripping - L labial, U palatal

loss of perio support

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11
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
ortho tx could aggravate existing TMD e.g. using inter maxillary elastics

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12
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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13
Q

what can decalcification lead to

A
  • weakens enamel to caries
  • unsightly staining - opacity
  • frank cavitation
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14
Q

preventing decalcification

A

case selection
oral hygiene
diet advice
fluoride

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15
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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16
Q

how is caries risk indicated?

A

number and location of restorations - esp if anterior

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17
Q

indications of high risk of decalcification

A

pre-existing decalcification
erosion
caries history

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18
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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19
Q

preventing decalcification - diet advice

A
  • encourage non-cariogenic diet
  • drink with straw
  • keep snacks in meal time
  • sugar amount and freq - critical pH 5.5
  • sugar free gum - with care - stimulate salivary buffers
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20
Q

preventing decalcification - fluoride

A

toothpaste
MW
Duraphat varnish
others - F releasing GIC

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21
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
warn re overdose if tendency to swallow

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22
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

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23
Q

preventing decalcification - fluoride - Duraphat varnish

A

22600 ppm
4 monthly

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24
Q

root resorption

A

inevitable consequence of tooth movement

can also see RR even with no prev ortho

25
Q

prevalence of RR

A

nearly everyone
25% radiographically
90% histologically
mostly unnoticed

26
Q

average amount of RR

A

1mm over two years fixed appliances

27
Q

site of RR

A 
any teeth but
U incisors (esp 2s) > L incisors > 6s
28
Q

prevalence of severe RR

A

1-5%

29
Q

risk factors for RR

A

multifactorial

  • type of tooth movement
  • root form
  • prev trauma
  • nail biting?
  • length of tx
30
Q

risk factors for RR - type of tooth movement

A

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

31
Q

risk factors for RR - root form

A 
short
blunt
apical bend
PIPETTE shape
resorbed already
32
Q

prevention of RR

A

light forces

3m treatment pause

33
Q

relapse

A

the return of the features of the original malocclusion following correction

34
Q

difficulty with relapse

A

common but unpredictable

tx all cases as if potential to relapse

35
Q

features more prone to relapse

A 
L incisor crowding
rotations
instanding 2s
spaces and diastemas
class 2 div 2
AOB
reduced perio support/short roots
36
Q

managing relapse

A

retainers - maintenance cost of retention
case selection/informed consent - tx severe malocclusions, leave mild

37
Q

pressure-formed retainer thickness

A

usually 1-1.5mm - robust

38
Q

removable retainers types

A

COR - clear occlusal retainer
PFR/VFR - pressure/ vacuum
Essix
Hawley type - robust, can eat, good for holding prosthetic lateral in hypodontia cases

39
Q

pros of removable retainers

A
  • remove for OH
  • can wear part-time
  • pt control
  • easy to spot problem

after discharge - GDP to supply replacement

40
Q

fixed retainers cons

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

41
Q

where do you place a fixed retainer?

A

at contact points to avoid ST damage and allow cleaning

42
Q

soft tissue trauma management

A
  • pain/discomfort - analgesics
  • ulceration - ortho wax or babybel cheese wax
43
Q

recession

A

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

44
Q

management of recession

A

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

45
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

46
Q

periodontal health risk

A

gingivitis - common
active perio disease
recession
loss of perio support

47
Q

headgear trauma risk

A

ocular injuries - blindness/loss of eye

48
Q

prevention of headgear trauma

A

safety mechanism - 2minimum

  • Nitom facebow
  • snap away traction spring
49
Q

toothwear or enamel fracture

A

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

50
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
51
Q

allergies

A

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

52
Q

poor/failed tx

A 
poor diagnosis/tx planning
operator technique error
poor cooperation 
 - appliance wear
 - repeated breakages
 - non-attendance
unfavourable growth
53
Q

chance of tx success increases with:

A

severity of malocclusion
motivation of pt
operator expertise

54
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

55
Q

what is ortho tx mostly?

A

elective

56
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

57
Q

which pts have the most and least to gain?

A

most - those with severe malocclusions treated by experts

least - mild malocclusions

58
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 (22 decks)

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