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73 Cards in this Set
- Front
- Back
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Leeway Space
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Difference between CDE and 345
Nance's Averages Maxilla: 0.9 mm /side = 1.8 Mandible: 1.7 mm /side = 3.4 |
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Tanaka & Johnston Prediction Values
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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 |
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Bolton Analysis
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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) |
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Etiology of Malocclusion
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Disturbances in :
1. embryological Development 2. orofacial structures 3. orofacial functions |
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Biological teratogens:
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TORCHS
Toxoplasmosis O Rubella virus - german measles Cytomegalovirus Syphilis - treponema pallidum spirochete |
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Hutchinson's triad - syphilis
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Dental - mulberry molars, hutchinson's incisors
VIII cranial nerve damage Interstitial keratitis |
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Chemical teratogens
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:
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Antifolic acids
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-induce abortions
-CP |
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Dilantin
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-control seizures
-CLP |
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Mercaptopurine
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-control neoplasm
-CP |
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Retinoic acid
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control acne
-CP |
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Thalidomide
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Sedative
-CP |
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Trimethadione
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Anticonvulsant
CLP |
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Valium
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tranquilizer
CLP |
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Warfarin
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anticoagulant
Macroglossia |
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Alcohol
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FAS
microcephaly short palpebral fissures maxillary hypoplasia short nose smooth philtrum average IQ 63 |
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Cleft lep with or without cleft palate
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5-6 weeks gestation
associated with : club foot, CNS anomalies, Cardiac defects American natives>asians>caucasians>blacks Male>female |
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Cleft lep with or without cleft palate
1. cleft lip |
Unilateral>bilateral
complete>incomplete |
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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 |
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CLEFT PALATE
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7-8 weeks gestation
not race or sex related 1:2000 births |
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CLEFT PALATE - classification
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1. complete cleft of hard and soft palate
2. soft palate only 3. submucous cleft |
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Diagnostic triad of submucous cleft:
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1. blue line at midline
2. notch in the hard palate 3. bifid uvula |
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hypothyroidism
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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 |
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Aperts Syndrome
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(cranial base fuses first)
severe class II severe skeletal openbite severe crowding retained primary teeth delayed eruption of teeth |
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achondroplasia
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midface hypoplasia
crowded teeth hypodontia |
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cleidocranial dysplasia
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-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 |
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Congenitally missing teeth
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L8 > U8 > U2 > L5 > L1L2 > U5t
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hypothyroidism
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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 |
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Aperts Syndrome
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(cranial base fuses first)
severe class II severe skeletal openbite severe crowding retained primary teeth delayed eruption of teeth |
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achondroplasia
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midface hypoplasia
crowded teeth hypodontia |
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cleidocranial dysplasia
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-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 |
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Congenitally missing teeth
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L8 > U8 > U2 > L5 > L1L2 > U5t
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Ortho bracket position
Maxillary |
1 -4.0
2 -3.5 3 -5.0 4 -4.5 5 -4.0 6 -3.5 |
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Ortho bracket position
Mandibular |
1 -4.0
2 -4.0 3 -4.5 4 -4.0 5 -4.0 6 -3.5 |
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Twistoflex
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-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 |
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braided rectangular
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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 |
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NiTi -advantages
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lower stiffness
shape memory flexible; allow engagement of brackets with relatively large deflections and lower forces which act over large ranges |
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NiTi disadvantages
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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 |
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What are the stages of Comprehensive Treatment?
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A. Alignment and Leveling
B. Correction of Molar relationship and space closures C. Detailing-finishing |
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ARCH wire for Alignment
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round wires (ss, Niti, Twist-flex)
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A/W for
B. Correction of Molar relationship and space closures |
Round (0.18) or rectangular
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A/W for
C. Detailing-finishing |
Root paralleling at extraction sites
Midline discrepancies Vertical relationships rectangular wires |
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Instrument
insert or remove arch wire |
howe
weingardt pliers |
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Instrument
cut wire |
Heavy cutter
distal end cutter **NOT ligature cutter |
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Instrument
make bends, loops, stops |
bird beak plier
3 prong plier |
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Indication for early TX in Ortho
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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) |
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Indication for Late TX in ortho
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class III (mandibular excessive growth)
persistent anterior openbite (extrusion of molars) |
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Removable appliances:
Labial bow characteristics |
vertical loop:
cover 2/3 of distal of the canines extend gingivally 6-8mm flexible for insertion and removal |
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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 |
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Removable appliances:
Screws Activation |
screws open 1 mm / compete revolution
tooth movement: not exceed 1-2mm per month (slow expansion) |
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1. Simple Anchorage
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divede forces among enough post teeth that the force acting on individual anchoring teeth are too small to produce movement
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2. Compound Stationary Anchorge
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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)
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3. Recripricol Anchorage
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--distribute forces so that active and reactive foreces produce tooth mvmt that improve occlusion
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4. Extraoral Anchorage-
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-distribute to areas with no teeth (hard palate, neck)
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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 |
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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 |
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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 |
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Occipital HG--
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16 oz, forces of 2-3 lbs commmonly used
• produces a substantial intrusive compoent counteracted by PDL, so high forces well tolerated |
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Headgear
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• 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 |
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• Facial Pattern/Type
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verticle and horizontal relationship or proportions of the lateral facial skeleton
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• Facial Profile
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soft tissue outline of the face
(concave, convex) |
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Brachycephalic
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• 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 |
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Mesiocephalic
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• Class I--responds most favorably to tx
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Dolicocephalic
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• 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 |
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Holdway
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• 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 |
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Ricketts
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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 |
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Steiner
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• 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 |
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3) Facial Growth Trends
Type A |
• Class I-both jaws developing downward and forward equally
• ANB angle <4 1/2 degrees |
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3) Facial Growth Trends
Type A Subdivision |
• Class II--both jaws developing downward & forward equally
• ANB angle >4 1/2 degrees |
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3) Facial Growth Trends
Type B |
• both jaws developing forward & downward
• maxilla developing at greater rate than mand • ANB angle increasing |
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3) Facial Growth Trends
Type B Subdivision |
• mand developing downward
• maxilla developing forward • ANB angle increasing |
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3) Facial Growth Trends
Type C |
• mandble developing downward & forward faster than max
• ANB angle decreasing |
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3) Facial Growth Trends
Type C Subdivision |
• mandible developing forward at greater rate than maxilla
• ANB angle decreasing |
