Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
127 Cards in this Set
- Front
- Back
|
Maxillary primary teeth are 2-3 mm ___ than their permanent successors
|
Smaller
|
|
|
Primate space are ___ % prevalence
|
70
|
|
|
Where are the primate spaces
|
Mesial to primary maxillary canines
Distal to primary mandibular canines |
|
|
Ugly duckling stage common in children ___ to ___.
|
9-13
|
|
|
Ugly Duckling stage:
Eruption of laterals tips the centrals ____ from each other |
away
Space corrects itself when canines erupt |
|
|
Localized genetic factors
Maxillary laterals are the ___ most commonly congenitally missing teeth after the 3rds |
2nd
|
|
|
Localized Genetic factors:
Mandibular second bicuspids are also often |
congenitally missing
|
|
|
Localized genetic factors:Impacted permanent canine may cause a _____ when it causes posterior and anterior teeth to drift
|
Diastema
|
|
|
Generalized genetic factors:
|
1. Microdontia
2. Normal-sized teeth in a large arch |
|
|
Generalized genetic factors:
Tooth size discrepancies affect ___% of the population |
5
|
|
|
To determine if a tooth size discrepancy exists:
|
Bolton analysis
Diagnostic Wax-up |
|
|
Inferiorly displaced labial frenum
|
When it doesn't migrate apically like it normally does
|
|
|
Distalizing appliance (Distalizing upper molars will create space)
|
PM will drift distally
Anterior diastemata appear |
|
|
Rotated teeth will create ___ in adjacent sites
|
space
|
|
|
Supernumerary teeth: Mesiodens may cause ___
|
spacing
|
|
|
Close the diastema ___ excision of the inferiorly displaced frenum
|
Before
Cuz frenectomy results in scar tissue formation |
|
|
Implants ARE or ARE NOT appropriate for cleft areas
|
ARE NOT
|
|
|
2 options for congenitally missing laterals
|
1. Create/maintain space for implants
2. "Lateralize" canines (canine substitution) |
|
|
Diastema closure removable appliance
|
Hawley with finger springs
- Small, localized diastema closure - Tooth are tipped into space - Good choice if roots are well-aligned |
|
|
Diastema closure Fixed appliance
|
Generalized and/or large spaces
Teeth are moved bodily Root alignment achieved/maintained |
|
|
Localized genetic factors
|
1. Peg laterals
2. Congenitally missing/impacted teeth (maxillary laterals and mandibular second bicuspids) 3. Impacted permanent canine (posterior and anterior teeth many drift, causing a diastema) |
|
|
Generalized genetic factors
|
1. Microdontia
2. Normal-sized teeth in a large arch (BOlton tooth size discrepancies) |
|
|
Other factors creating diastemas
|
1. Iatrogenic discrepancy from ortho extractions
2. Racial factors 3. Inferiorly displaced labial frenum 4. Clefts 5. Pathological conditions like caries and perio disease and cysts 6. Ortho treatment 7. Rotated teeth 8. Supernumerary teeth 9. Habits 10. Tongue size/posture |
|
|
Should u do something about a <2 mm diastema in an older child?
|
No
Will spontaneously close when permanent canines erupt |
|
|
Microdontia or generalized spacing
|
Usually requires ortho care
|
|
|
Class I Malocclusion is what percent
|
54%
|
|
|
Normal occlusion is what percent
|
30%
|
|
|
Class II malocclusion is what percent
|
15%
|
|
|
Class III malocclusion is what percent
|
1%
|
|
|
Convex profile can be caused by:
|
1. Mandibular retrognathism
2. Maxillary prognathism 3. Combination of both |
|
|
Sunday bite
|
Posturing mandible forward to mask the skeletal and dental malocclusion
Make sure mandible is in CENTRIC RELATION during veal of profile and skeletal relationship |
|
|
Mouth breather does what kind of dental and skeletal changes?
|
1. Face height increased
2. Posterior teeth supra-erupts 3. Mandible would rotate down and back 4. Open the bite anteriorly 5. Increase OJ 6. Narrowing of the maxilla due to stretched cheeks |
|
|
Mouth breather does what do posture?
|
Lower the mandible
Lower the tongue Tip back the head |
|
|
Almost all Class II skeletal patients have a ____ molar relationship
|
Class II
|
|
|
Class II Div 1
|
Maxillary centrals proclined (flares out)
|
|
|
Class II Div 2
|
Max centrals may be retroclined
|
|
|
Class II div 1 has ___ mandibular plane angle, ____ lower face height.
|
Higher/steep mandibular plane angle
Longer lower face height Incisors typically proclined |
|
|
Class II Div 2 has ___ mand. plane angle, ___ lower face height, ___ bite
|
Class II skeletal
Low mandibular plane angle Short lower face height Retroclined maxillary incisors Deep bite |
|
|
Class II: ANB is what?
|
>4
|
|
|
Treating Class II
|
1st phase- late mixed dentition with eruption of 1st permanent molars
2nd phase- eruption of all permanent dentition (full ortho treatment) |
|
|
Orthopedic correction of a skeletal class II may only be attempted in a ____
|
Growing patient
Prior to peak height velocity 12 in girls 14 in boys |
|
|
Patients get only __ opportunity in life for orthopedic corrections
|
1
|
|
|
Necessary EARLY TREATMENT:
|
Distal step in primary 2nd molars
Relationship of the 1st permanent molars are determined by that of the primary molars Bad cuz the best senario from this is an end-on Class II |
|
|
Class II treatments (skeletal correction)
|
1. Orthopedic
2. Orthodontic 3. Surgical |
|
|
Orthopedic
|
1. Head gear (restrains maxillary; allows mandible to catch up; no effect on mandibular teeth)
2. Functional appliance (forces patients to position their mandible forward to enhance mandibular growth) |
|
|
3 types of head gear
|
1. Cervical pull (short or normal face heights; lower angle)
2. Combination (average face height) 3. High pull (long face height and high angle) |
|
|
Surgical approaches
|
1. Mandibular advancement
2. Sliding genioplasty 3. Maxillary setback 4. Maxillary impaction 5. Combination 6. Distraction Osteogenesis |
|
|
Orthodontic treatment
|
Extraction of 2 maxillary PM (camouflage)
Get a class II molar at the end of treatment Best indicated with: maxillary protrusion, excessive over jet, excessive maxillary crowding with minimal mandibular crowding |
|
|
Classification of cross bites:
|
Always defined by the relationship of the maxillary teeth to the mandibular
|
|
|
Bilateral posterior lingual crossbite
|
No mandibular shift
Midlines generally aligned Look for constricted maxilla and expanded mandibular teeth |
|
|
Anterior Crossbite
|
Typically an AP problem
Skeletal Dental |
|
|
Dental crossbite
|
Resulting from malposition of teeth
Can be: Single or multi tooth problem Generally due to ectopic eruption or crowding out of the arch |
|
|
Skeletal crossbite
|
Can involve the transverse dimension and/or sagittal (A-P) dimension
|
|
|
Functional crossbite = most common cross bite in children
|
Altered posture of the mandible from CR caused by occlusal interferences or mild maxillary constriction which causes patient to slide in one direction to intercuspate or avoid interference
|
|
|
#1 cause of functional cross bite is:
|
In the primary canines
Can also be caused by interferences of maxillary buccal cusps related to mild maxillary constriction |
|
|
In CR, ___ are generally coincident and ___ is normal
|
Midlines....overjet
|
|
|
In CO, ____ are often ____ and the patient will have some type of cross bite (Pseudo class III)
|
Midlines...Off
|
|
|
If child has Class I molar occlusion and normal skeletal growth but the appearance of mild maxillary constriction...they may need ____
|
Palatal expansion
|
|
|
Growth is affected ____
|
Bilaterally.
Condylar and dentoalveolar remodeling may occur Early treatment is warranted to avoid development of skeletal asymmetry |
|
|
Unilateral dental posterior crossbite (without mandibular shift)
|
Much less prevalent than functional cross bite due to a shift
Midlines coincident Cause- usually unilateral maxillary dentoalveolar constriction |
|
|
Relative crossbite
|
Class II malocclusion
No crossbite in CO |
|
|
Rare crossbites:
|
Bilateral buccal crossbite
- "Brodie-bite" - "Scissor-bite" - entire maxillary arch telescopes out and over the mandibular arch - Patient is usually Class II deep bite Unilateral posterior buccal crossbite - Unilateral maxillary expansion with or without mandibular constriction - Supra-eruption of maxillary posterior segment on affected side may produce vertical maxillary excess (VME) |
|
|
You can only do limited treatment for simple dental cross bite when:
|
There's:
1. Sufficient space M-D 2. Sufficient overbite to retain the tooth 3. Root in a normal position within the dental alveolus 4. Normal cuspid and molar occlusion If any of these are not met or if patient has skeletal malocclusion, --> need MORE COMPREHENSIVE treatment |
|
|
Correct ___ single tooth cross bites ASAP
|
Anterior
|
|
|
Treatment for simple dental cross bite:
|
1. Full/limited ortho with cross bite elastics
2. Hawley retainer (corrects 1 or 2 teeth in crossbite) 3. Anterior inclined bite plane 4. Tongue blade therapy (limited uses) |
|
|
Limited treatment modalities for anterior teeth:
|
Inclined plane/bite plan
- ideal for interlocked incisors - should engage tooth at a 45 degree angle - Cemented with temp cement for easy removal - close monitoring needed to evaluate supra-eruption of the posterior dentition Tongue blade therapy (for minor anterior cross bite): - Requires compliance, encouragement - Teeth must be in the initial stage of eruption with minimal interlocking - Tongue blade placed lingual to maxillary teeth and labial to mandibular teeth - Constant pressure for 10min/hr |
|
|
Posterior crossbite correction:
|
1. Maxillary expansion (rationale for max orthopedic skeletal therapy)
2. Rapid palatal expansion (minimizes tooth movement and maximizes skeletal displacement) - Primarily accomplished with tooth-borne appliances - Period of 1-6 weeks of activation - 1 turn/day or more (0.25mm per turn) - Maximizes skeletal displacement - Typically lose 25-33% of total expansion to relapse - Need to retain for 3-6 months to allow suture to reorganize and form new bone |
|
|
Brands of rapid palatal expanders
|
1. Hyrax appliance
- Tooth borne and hygienic 2. Haas appliance - Provides more palatal support during expansion and retention - Tissue and tooth-borne - Less hygienic 3. Bonded RPE - Bite plane effect - Mixed dentition -Primary teeth often extracted upon removal |
|
|
Temporary side effects from maxillary expansion
|
1. Temporary diastema
- usually closes spontaneously in 1-2 weeks 2. Buccal tipping of teeth 3. Bite opening 4. Excessive dental expansion vs skeletal can cause fenestration of the PM and molar roots through the buccal cortical bone |
|
|
Skeletal Class III
|
1. Attempt to treat with an expander and/or face mask in the pre-pubertal years and hope that the correction will be maintained...or
2. Accept that skeletal growth is predetermined and wait for growth to stop, and treat with ortho/orthognathic surgery approach |
|
|
Treatment for Class III
|
1. Protraction facemask
- moves maxillar downward and forward - 8 oz to 1 lb of pressure per side - Usually preceded by palatal expansion to "loosen" circummaxillary sutures and promote maxillary protraction |
|
|
Adult Class III surgical intervention
|
1. dental and/or mild skeletal Class III
- Class III elastics -Lower incisor extraction 2. Skeletal correction requires - Maxillary advancement and/or mandibular setback -May also require maxillary downdraft and transverse surgical expansion or SARPE |
|
|
Surgically assisted rapid palatal expander
|
Indicated when more than 10 mm of expansion is needed
-Orthopedic expansion in non-growing patient Midline osteotomy and Le Fort I (minus down-fracture) |
|
|
Ectopic eruption: which is most likely
|
Maxillary 1st molars erupting mesially and resorbs distal of primary 2nd molar so it gets lost early
|
|
|
Causes of premature space loss
|
1. Caries (most common)
2. Trauma 3. Ectopic eruption 4. Ankylosis leading to extraction 5. Congenitally missing teeth |
|
|
Congenitally missing teeth most commonly found:
|
Maxillary lateral incisor
Mandibular second premolar |
|
|
Band and Loop
|
Maintains space of prematurely lost 1st or 2nd PRIMARY molar
Primary 2nd molar or permanent 1st molar can be banded Wire loop has limited strength (can only hold space of 1 tooth) |
|
|
Nance holding arch
|
Maxillary palatal arch and an acrylic button
Does not contact the anterior teeth Uses palatal tissue to provide resistance to anterior movement of posterior teeth Indicated if primary maxillary molars have been lost bilaterally Acrylic button can become embedded in soft tissue |
|
|
If molars are lost bilaterally
|
Nance or lingual arch is indicated
|
|
|
Functions of primary teeth
|
1. Mastication
2. Esthetics 3. Space maintenance |
|
|
Management of arch length deficiencies
|
1. Maintain leeway space
2. Advance/flare incisors 3. Distal movement of molars 4. Expansion of arch 5. Interproximal enamel reductions 6. Serial extractions |
|
|
Maintain leeway space
|
The amount by which the space occupied by the primary C,D,E exceeds that occupied by permanent 3,4,5
Maxillary: 1.5 mm per side Mandibular: 2.5 mm per side |
|
|
Distal movement of molars
|
Maxilla:
1. Pendulum 2. Distal Jet 3. Nance and coil spring 4. Head Gear (distalizes posterior teeth w/out reciprocal protrusion of anterior teeth Mandible: 1. Lip bumper (remove lip pressure to allow incisors to come facially and flare and tips molars distally) |
|
|
Serial extractions
|
1. Severe crowding
2. Primary canines are extracted to provide space for alignment of the incisors 3. Primary 1st molars are extracted when 1/2 to 2/3 of the 1st PM root is formed to speed eruption of the 1st PM 4. When the 1st PM have erupted they are extracted and the canines erupt into the remaining extraction space REMBER CD4 |
|
|
Influences on vertical development
|
Specific causes
Muscular function Respiratory pattern Skeletal growth Habits |
|
|
Specific causes:
|
1. Disturbances in embryologic development (rare <1%)
2. Fetal molding and birth injuries 3. Childhood jaw fractures - Condylar process is susceptible to injury - Tends to regenerate well after early fractures (<5% are problematic) 4. Acromegaly (1/25,000) - Anterior Pit Tumor: will lead to High levels of GH leads to excessive mandibular growth in adults and skeletal class III - Abnormal growth stops once tumor removed but skeletal deformity persists 5. Idiopathic condylar resorption and hemimandibular hypertrophy |
|
|
Idiopathic condylar resorption
|
Resorption of one or both condyles leading to asymmetry
|
|
|
Hemimandibular hypertrophy
|
Unilateral excessive growth of mandible causing variable ants of asym
|
|
|
2 ways facial muscle can affect jaw growth:
|
1. Formation of bone at the point of muscle attachment
2. Muscle's role as part of the ST matrix whose growth normally carries the jaw growth downward and forward |
|
|
Decreased facial muscle strength
|
Mandible drops down and back leads to excessive eruption of posterior teeth and narrowing of maxillary arch leads to anterior open bite
|
|
|
Mouth breather
|
Lowered mandibular and tongue position
|
|
|
Adenoid facies
|
familiar facial pattern to obstructing adenoid tissue
Any chronic respiratory obstruction could lead to this type of facial morphology (Long Face Syndrome) |
|
|
Anterior open bites
|
Blacks > whites
|
|
|
Deep bite
|
Whites> blacks
|
|
|
Vertical excess
|
Excessive eruption of the maxillary and mandibular posterior teeth
|
|
|
Treatment goals for vertical excess
|
1. Control vertical dimension through management of posterior eruption and alveolar development
2. Growth redirection through mandibular autorotation |
|
|
Treatment for vertical deficiency
|
1. incisor intrusion
2. posterior tooth extrusion 3. surgical intervention 4. combination of ortho and surgical treatment |
|
|
Treatment options for vertical deficiency:
|
Dental correction:
1. Archwires 2. Bite plate 3. Bite raiser/turbo Surgical correction: 1. Lefort Osteotomy 2. Mandibular osteotomy |
|
|
Etiology of open bite malocclusion
|
1. Disturbances in embryologic development
2. Skeletal growth disturbances 3. Hemi-mandibular hypertrophy |
|
|
Muscle dysfunction results in:
|
1. Increased anterior facial height
2. Excessive eruption of posterior teeth 3. Narrowing of maxillary arch 4. Anterior open bite |
|
|
Open bites:
|
Longer anterior facial height, longer lower facial height, increased genial angle
|
|
|
Thumb sucking
|
Most important determinant is DURATION (>6 hrs can produce malocclusion)
Sequelae of thumb sucking: 1. Increased buccinator muscle contraction 2. Tongue lowers vertically away from maxillary teeth affecting cheek/tongue pressure balance 3. Upper molars move lingually and arch width narrows 4. Maxillary arch becomes V-shaped due to constriction of corners of mouth in canine area 5. Hindered eruption of incisors 6. Displacement of incisors (Flared and spaced max incisors and lingually positioned mandibular incisors) 7. Posterior teeth erupt as jaw is positioned downward 8. Anterior open bite develops |
|
|
What is least likely to correct spontaneously
|
The constricted maxillary arch
|
|
|
Take a ceph to:
|
distinguish between dental and skeletal problems
|
|
|
Infantile swallow
|
Jaws apart
Lips contracted Tongue contacts the lower lip |
|
|
Transition swallow
|
Lips contracted
Separation of posterior teeth Forward protrusion of tongue between teeth |
|
|
Adult swallwo
|
Teeth together
Lips relaxed Tongue to palate In children by age 6 |
|
|
Tongue thrust
|
too little pressure and frequency to affect tooth position
Not the cause for open bite |
|
|
Forward resting tongue posture
|
Can be very influential on teeth position
|
|
|
Functional Appliances are used to address:
|
1. Habit control
2. Functional re-education 3. Growth stimulation |
|
|
Functional matrix
|
Includes all muscles ass with deglutition, breathing, swallowing and speech
|
|
|
Balters' objectives for functional appliances
|
1. Elimination of the lip entrapment (lip bumper)
2. Elimination of mucosal damage due to deep bite (anterior and posterior bite plates) 3. Correction of mandibular retrusion and the associated malposition of the tongue 4. Correction of the occlusal plane |
|
|
___ is usually considered a sequellae of an infantile suckle pattern.
|
Tongue thrust
|
|
|
Underlying cause of a tongue thrust may be ___,___ or ___ problems
|
Physiological
psychological or neurological |
|
|
Treatment for tongue thrust: Tongue crib or lower lingual tongue thrust appliance or tongue rollers/beads
|
Can be removable or fixed appliance
Fixed are more effective |
|
|
Removable appliance can be a helpful reminder for ___ children.
|
Older
|
|
|
When an open bite extends from the anteriors to the posteriors..
|
you should suspect more serious etiological factors
|
|
|
Other causes of open bites
|
Enlarged adenoids
Enlarged turbinates Enlarged tonsils Macroglossia (enlarged tongue) Constricted nasal airway |
|
|
Lateral tongue thrust
|
Can be either bi-lateral or unilateral
Less obvious Often overlooked Usually result in a posterior open bite |
|
|
Low resting tongue position
|
Can contribute to the development of mandibular prognathism pushing the mandible forwards
|
|
|
___ and ___ are often related
|
Digital habits and tongue thrusts
|
|
|
Monobloc type appliance
|
Includes:
Monobloc, activator, bionator, andresen, woodside and many others Eliminates deep bite and prevents tongue from going forward |
|
|
Herbst
|
Many forms but all share the same basic design of 2 bucally placed piston hinges
|
|
|
WHy is retention necessary?
|
1. Reorganization of the perio and gingival tissues
2. Soft tissue pressures from cheeks lips and tongue) 3. Occlusal changes related to post-treatment growth |
|
|
Classic work of John Edwards
|
Elastic recoil of gingival fibers esp in correction of rotation
|
|
|
Positioners:
|
may be used as an interim retainer for achieving final occlusion following alignment (used to make a good case better)
|
|
|
Occlusal adjustment/equilibration
|
may be helpful for improved interdigitation in cases where some teeth have not previously been in occlusion
|
