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73 Cards in this Set

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Leeway Space
Difference between CDE and 345

Nance's Averages
Maxilla:
0.9 mm /side = 1.8
Mandible:
1.7 mm /side = 3.4
Tanaka & Johnston Prediction Values
Maxillary (3,4,5) =
(1/2) sum of the widths of the mandibular incisors + 11mm

Mandibular =
(1/2) sum of the widths of the mandibular incisors + 10.5mm
Bolton Analysis
Compatibility of tooth size

-must be on permanent dentition
-normal (+/-) 1mm
-Anterior ratio (Mandibular 6/maxillary 6) = 77.2
- >77.2 =excess mandible
- <77.2 =excess maxilla

(posterior ratio: 91.3)
Etiology of Malocclusion
Disturbances in :
1. embryological Development
2. orofacial structures
3. orofacial functions
Biological teratogens:
TORCHS
Toxoplasmosis
O
Rubella virus - german measles
Cytomegalovirus
Syphilis - treponema pallidum spirochete
Hutchinson's triad - syphilis
Dental - mulberry molars, hutchinson's incisors

VIII cranial nerve damage

Interstitial keratitis
Chemical teratogens
:
Antifolic acids
-induce abortions

-CP
Dilantin
-control seizures

-CLP
Mercaptopurine
-control neoplasm

-CP
Retinoic acid
control acne

-CP
Thalidomide
Sedative

-CP
Trimethadione
Anticonvulsant

CLP
Valium
tranquilizer

CLP
Warfarin
anticoagulant

Macroglossia
Alcohol
FAS

microcephaly
short palpebral fissures
maxillary hypoplasia
short nose
smooth philtrum

average IQ 63
Cleft lep with or without cleft palate
5-6 weeks gestation

associated with : club foot, CNS anomalies, Cardiac defects

American natives>asians>caucasians>blacks
Male>female
Cleft lep with or without cleft palate
1. cleft lip
Unilateral>bilateral
complete>incomplete
Cleft lep with or without cleft palate
2. cleft palate
class I: soft palate only
class II: soft and hard palate
class III: soft and hard palate and alveolar ridge
class IV: bilateral
CLEFT PALATE
7-8 weeks gestation
not race or sex related
1:2000 births
CLEFT PALATE - classification
1. complete cleft of hard and soft palate
2. soft palate only
3. submucous cleft
Diagnostic triad of submucous cleft:
1. blue line at midline
2. notch in the hard palate
3. bifid uvula
hypothyroidism
Before birth: cretinism:
-short cranial base
-retraction of bridge of nose
-wide but short maxilla
-edematous tongue
-anterior openbite
-spaced and flared teeth
-over-retained primary teeth
-possible spontaneous root resorption
-delayed dental development

After birth: juvenile myxedema - less severe
Adult: myxedema : edematous tongue
Aperts Syndrome
(cranial base fuses first)

severe class II
severe skeletal openbite
severe crowding
retained primary teeth
delayed eruption of teeth
achondroplasia
midface hypoplasia
crowded teeth
hypodontia
cleidocranial dysplasia
-partial or complete aplasia of the clavicles with delayed closure of the cranial sutures

-high arched and narrow palate
-small maxilla
-increased incidence of cleft palate
-prolonged retention of primary teeth
-delayed eruption of secondary teeth
-high incidence of supernumerary teeth
Congenitally missing teeth
L8 > U8 > U2 > L5 > L1L2 > U5t
hypothyroidism
Before birth: cretinism:
-short cranial base
-retraction of bridge of nose
-wide but short maxilla
-edematous tongue
-anterior openbite
-spaced and flared teeth
-over-retained primary teeth
-possible spontaneous root resorption
-delayed dental development

After birth: juvenile myxedema - less severe
Adult: myxedema : edematous tongue
Aperts Syndrome
(cranial base fuses first)

severe class II
severe skeletal openbite
severe crowding
retained primary teeth
delayed eruption of teeth
achondroplasia
midface hypoplasia
crowded teeth
hypodontia
cleidocranial dysplasia
-partial or complete aplasia of the clavicles with delayed closure of the cranial sutures

-high arched and narrow palate
-small maxilla
-increased incidence of cleft palate
-prolonged retention of primary teeth
-delayed eruption of secondary teeth
-high incidence of supernumerary teeth
Congenitally missing teeth
L8 > U8 > U2 > L5 > L1L2 > U5t
Ortho bracket position
Maxillary
1 -4.0
2 -3.5
3 -5.0
4 -4.5
5 -4.0
6 -3.5
Ortho bracket position
Mandibular
1 -4.0
2 -4.0
3 -4.5
4 -4.0
5 -4.0
6 -3.5
Twistoflex
-3 strands of round SS wire twisted together into a round wire
-very flexible, and an excellent choice as an initial alignment wire

0.015, 0.0175, 0.0195
braided rectangular
o small round SS wires braided together into a square or rectangular wire
o flexible in comparison to a single SS rectangular wire

.016x.016
.017x.025
.018x.025
NiTi -advantages
 lower stiffness
 shape memory
 flexible; allow engagement of brackets with relatively large deflections and lower forces which act over large ranges
NiTi disadvantages
 expensive
 flexibility prevents space closure in some situations
 cannot be permanently bent therefore cannot compensate for bracket misplacement
 will tend to change arch form to the preformed shape, which may be undesirable in some cases
What are the stages of Comprehensive Treatment?
A. Alignment and Leveling
B. Correction of Molar relationship and space closures
C. Detailing-finishing
ARCH wire for Alignment
round wires (ss, Niti, Twist-flex)
A/W for
B. Correction of Molar relationship and space closures
Round (0.18) or rectangular
A/W for

C. Detailing-finishing
Root paralleling at extraction sites
Midline discrepancies
Vertical relationships


rectangular wires
Instrument

insert or remove arch wire
howe
weingardt pliers
Instrument

cut wire
Heavy cutter
distal end cutter
**NOT ligature cutter
Instrument

make bends, loops, stops
bird beak plier

3 prong plier
Indication for early TX in Ortho
Crowding - extractions of bicuspids, congenital missing teeth (allow mesial drift), regaining space and space maintenance

early expansion of maxillary arch
pt with habits (before 6: spontaneous correction)
ectopic eruption (retained primary teeth/abnormal growth of permanent teeth)
class III pt(maxillary def + normal mandible)
Growth modification (early skeletal class II: protrusion of incisors, severe skeletal class II, short face height class II pt)
Indication for Late TX in ortho
class III (mandibular excessive growth)

persistent anterior openbite (extrusion of molars)
Removable appliances:

Labial bow characteristics
vertical loop:
cover 2/3 of distal of the canines

extend gingivally 6-8mm

flexible for insertion and removal
removable appliances:

Labial bow - types
short : six ant. teeth. btw canine and first premolar

long: distal of first molar, soldered to the clasp

wrap-around: eleminates the possibility of occlusal interferences or opening interproximal contacts

contoured: hold teeth in final position
Removable appliances:

Screws Activation
screws open 1 mm / compete revolution

tooth movement: not exceed 1-2mm per month (slow expansion)
1. Simple Anchorage
divede forces among enough post teeth that the force acting on individual anchoring teeth are too small to produce movement
2. Compound Stationary Anchorge
divide forces so that reactive forces result in complex forces that produce typres of mvmt which are SLOW to occur (ie bodily mvmt) and the active forces are FAST to occur (ie. tipping)
3. Recripricol Anchorage
--distribute forces so that active and reactive foreces produce tooth mvmt that improve occlusion
4. Extraoral Anchorage-
-distribute to areas with no teeth (hard palate, neck)
2) High-Pull to Molar Headgear
Application:
• intrusive effect on molars--closes the bite
• distal force component--much smaller than cervical HG, may be inadequate to move molars
• forces enuf for anchorage purposes
3) High-Pull to Archwire headgear (J-hook headgear)
Application:
for malocclusions with the following characteristics--
1. good Buccal occlusion
2. max centrals in labioversion with unusually long clinical crowns (substantial overbite)
• requires simultaneous intrusion and retraction fo the max centrals
Forces
Cervical systems
Occipital HG--16 oz, forces of 2-3 lbs commmonly used
• produces a substantial intrusive compoent counteracted by PDL, so high forces well tolerated
12oz min on each side
• >30 ox unnecessary and not tolerated
Occipital HG--
16 oz, forces of 2-3 lbs commmonly used
• produces a substantial intrusive compoent counteracted by PDL, so high forces well tolerated
Headgear
• start tx with low forces, work up to optimal levels within 1-2 weeks
• 12hrs wear per 24 hr day is minimal time requirement

• HG should be checked every 4-6 weeks
• Facial Pattern/Type
verticle and horizontal relationship or proportions of the lateral facial skeleton
• Facial Profile
soft tissue outline of the face

(concave, convex)
Brachycephalic
• deepest bite, flattest face, most molar anchorage
• least favorable for ortho extractions
• responds most favorably to Class II correction
• least adversely affected by cervical HG, elastic or bite plate mechanics
Mesiocephalic
• Class I--responds most favorably to tx
Dolicocephalic
• most convex face
• shallowest overbite, least molar anchorage
• extractions affet it least adversely
• avoid mechanics that extrude molars--bite plates, cervical HG and elastics--opens bite that is too shallow already
• most difficult to treat
Holdway
• H line: tangent from the chin to the upper lip
• Ideal: 9-11 degree angle to the NP plane, A lies behind the NP plane
• Optimal esthetics: H line almost parallels the Na-Po plane
Ricketts
E line (aesthetic): tangent from the chin to the tip of the nose
• Childhood: lips should be ahead of this line
• Adolescent: lips should be on or close to the line
• Adult: lips should be behind the line
• recognizes the reduction in convexity of the profile and the growth of the nose and chin with maturation
Steiner
• line that runs from the chin thru a point "S" midway down the lower border of the nose
• Well balanced: lips should fall on line
• makes allowance for pts with smaller or lger noses
3) Facial Growth Trends
Type A
• Class I-both jaws developing downward and forward equally

• ANB angle <4 1/2 degrees
3) Facial Growth Trends
Type A Subdivision
• Class II--both jaws developing downward & forward equally

• ANB angle >4 1/2 degrees
3) Facial Growth Trends
Type B
• both jaws developing forward & downward
• maxilla developing at greater rate than mand
• ANB angle increasing
3) Facial Growth Trends
Type B Subdivision
• mand developing downward
• maxilla developing forward
• ANB angle increasing
3) Facial Growth Trends
Type C
• mandble developing downward & forward faster than max
• ANB angle decreasing
3) Facial Growth Trends
Type C Subdivision
• mandible developing forward at greater rate than maxilla
• ANB angle decreasing