Childrens 4

Front 1

Occlusion classification

Back 1

MB cusp occluding in mesiobuccal groove of mandibular first molar is Class I

DB cusp of maxillary first molar occludes in embrasure between lower first and second molars

If classification is unilateral, classify as subdivision side

Front 2

Class 1 Malocclusion

Back 2

Normal class I molar relationship with teeth crowded, rotated, etc

Front 3

Class II malocclusion, Divisions, and subdivisions

Back 3

Lower molar is distal to upper molar
- Relationship of other teeth to line of occlusion is not specified
- Division 1 is flared upper incisions
- Division 2 is deep bite with retroclined incisors with laterals usually overlapping centrals

- If class II is only on right side, define as Class II subdivision Right

Front 4

Simon's system of classification

Back 4

Based on relationship of teeth to skeleton
Three reference planes
- Midsaggital: Divides head into left and right
- Frankfurt plane: Eye-ear plane line through margin of orbit uder pupil of eye to upper margin of auditory meatus.
- Orbital plane: Perpendicular to Frankfurt plane at margin of bony orbit directly under pupil of eye

Law of cuspid: Orbital plane frequently passes through distal 1/3 of maxillary canine in Normal occlusion

Front 5

Classification of malocclusion by Ackerman-Proffit

Back 5

Step 1 - Evaluate facial proportions and esthetics. Base of nose should be same as interinnercanthal distance and width of mouth should be distance between irises. 1/3s rule

Step 2 - Evaluate alignment and symmetry within arches. From occlusal, symmetry, spacing, excessive incisor protrusion according to lip separation at rest.

Step 3 - Evaluate skeletal and dental relationships in transverse plane. Describe posterior crossbite in terms of skeletal crossbite or dental crossbite.

Step 4 - Evaluate skeletal and dental relationships in anteroposterior plane of space. Skeletal discrepancy or teeth discrepancy.

Step 5 - Evaluation of dental relationships in the vertical plane of space. Anterior open bite, anterior deep bite, or posterior open bite. What anatomic location is the discrepancy.

Front 6

Classification of Malocclusion related to primary site of disharmony

Back 6

Skeletal or osseous - Determined by ceph

Muscular or functional - Muscular appears to be dominant, ex. Thumb sucking

Dental: Primary source is teeth

Front 7

Bimaxillary (Bidental) protrusion

Back 7

Upper and lower dental protrusion
- Average facial pattern of Chinese, Japanese, Black and Australian aborigine

Front 8

Hereditary factors

Back 8

Tooth size-arch length discrepancies are most often seen in Class I malocclusion

Discrepancies in jaw relationships
- Class 2 and 3 malocclusions are genetically determined. Class 2 more common in caucasians than blacks and unknown in eskimos.

Abnormalities in tooth number - Aenesis, Hypodontia, Anodontia, Oligodontia

Front 9

Congenitally missing teeth

Back 9

Excluding 3rd molars ranges from 2.3% to 9.6%
Most frequently missing in decreasing order
- 3rd molars
- Maxillary laterals or mandibular second premolars
- Maxillary second premolars

- Most frequently affected primary teeth are maxillary laterals and mandibular centrals and laterals. Primary are less affected.

Front 10

Hyperdontia

Back 10

Supernumerary teeth - Do not resemble normal teeth
Supplemental teeth - Resemble normal teeth

Front 11

Abnormal labial frenum

Back 11

Large frenum frequently associated with diastema

Blanch test - Consider frenum abnormal if blanching of frenal tissue occurs lingual to maxillary incisors when upper lip is pulled forward

Front 12

Root development and normal tooth eruption

Back 12

- Most teeth attain 3/4 root development at time of eruption
- Less than 1/4 root length or closing apex was never observed for an erupting teeth
- Mand 1st molars and centrals erupt with only 1/2 root
- Mand canines and 2nd molars passed 3/4 root

Front 13

Embryology of face

Back 13

Face and oral primordia can be seen in 4th week.

Primary palate is triangular premaxilla from lateral to lateral incisors to incisive foramen
Secondary palate is everything else

Front 14

Veau's classification

Back 14

Group I - Cleft of soft palate only
II - Hard and soft palate to incisive foramen
III - Complete unilateral cleft of soft and hard palate, lip and alveolar ridge on one side
IV - Complete bilateral cleft lip and palate

Front 15

Incidence of Cleft lip

Back 15

Indians highest followed by Asians, Caucasians and least in Blacks

Male to Female 2:1
Left to Right 2:1

Unilateral more common

Front 16

Incidence of Cleft Palate

Back 16

Same between all races
But twice as common in Females

Front 17

Pierre Robin Syndrome

Back 17

Cleft palate, Micrognatic mandible, Glossoptosis

Front 18

Treacher Collins Syndrome

Back 18

Mandibulofacial Dysostosis
- Both maxilla and mandible are underdeveloped as generalized lack of mesenchymal tissue
- Excessive cell death in trigeminal ganglion and affects neural crest derived cells.

Front 19

Trisomy 13

Back 19

aka Patau's Syndrome
- Cleft lip and or palate, polydactaly, deafness, Microcephaly, abnormal ears, sloping forehead, mental retardation

Front 20

Apert syndrome

Back 20

Cleft lip and or palate
Premature fusion of cranial sutures
syndactaly
Hydrocephaly

Front 21

Crouzon's syndrome

Back 21

Underdeveloped midface and eyes that seem to bulge
- Arises because of prenatal fusion of superior and posterior sutures of maxilla along wall of orbit

Front 22

FAS

Back 22

Deficiencies of midline tissue of neural plate early in embryonic development

- Flat midface, thin upper lip
- Growth retardation
- CNS development problems with fine motor skills, learning, mental handicap

Front 23

Waardenburg syndrome

Back 23

Cleft lip and or palate
Diminished color of hair, skin, eyes
Congenital deafness
Wide nasal bridge

Front 24

Van der Woude syndrome

Back 24

Cleft lip and or palate
Maxillary hypodontia
High arched palate

Front 25

Best age for lip and palatal surgery

Back 25

Lip is within 48hrs of birth
Best age for palatal surgery is 18months

Front 26

Obturator

Back 26

Palatal Prosthesis
- Adjusted every week and process takes 3 months. So surgical repair of lip is delayed 1-2 months
- Useful for bilateral cleft lip and palate

Front 27

Grayson Appliance

Back 27

Nasal extension that rises up and lifts nose and nasal cartilages into place

- Adjusted once a week to reshape roof of mouth and gum pads to bring them together

Front 28

Latham device

Back 28

Indicated for babies with complete clefts of lip and palate

- Brings two halves together 3/4 turn per night
- Lip closure performed when latham is removed

Front 29

Lip adhesion

Back 29

Rule of 10
10 wks age
10 pounds
10gm of hemoglobin

Front 30

Cleft palate repair time

Back 30

Debate because early repair helps speech but later repair improves midfacial growth

- Most done between 8-12 months

Front 31

Pharyngeal Flap

Back 31

Performed usually after 4-5 when speech and velopharyngeal competence can be assessed before child begins school

Front 32

Ear disease

Back 32

Isolated cleft lip pts have higher incidence of hearing loss

Cleft palate is more associated with eustacian tube dysfunction resulting in conductive hearing loss.
- Cleft palate has greater incidence of middle ear disease and hearing loss

Front 33

Timing of bone grafting

Back 33

Primary - Less than 2
Early secondary - 2 to 6
Late secondary - 7 to 12
Delayed bone grafting - Adult

Front 34

Secondary bone grafting

Back 34

Early is done between 2-6 and primarily to support lateral incisor

May create more significant anteroposterior and transverse growth effect
- Since most anteroposterior and transverse growth is done by 8, most common time for alveolar cleft grafting is between 9 and 11 before eruption of canine when its root is 1/2 to 2/3 formed