ID ortho

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Author:
emm64
ID:
244116
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ID ortho
Updated:
2013-10-31 07:08:09
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Interdisciplinary ortho
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Interdisciplinary ortho
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  1. alveolar bone loss sequelae
    • Center of resistance moves apically
    •  Less force = higher Mf
    • Larger MF = Larger MC needed for bodily movement (vs. tilting)
    • PDL area decreases
    • same force = greater pressure, must use lighter force
    • larger moments, to control the root position
  2. Removable appliances
    • more esthetic
    • Harder to control the root position
    • Harder to control the rotations and to extrude the teeth
  3. adjunctive orthodontic treatment?
    • Control Disease
    • Restore function
    • Enhance appearance
    • vs Comprehensive treatment
    •  To produce the best combination of dental occlusion, dental and facial appearance and stability of the result to maximize benefit to the patient.
  4. sequelae of missing teeth:
    • tipping
    • alveolar resorbtion
    • supraeruption (extrusion)
  5. molar uprighting
    • distally tip crown(easier, req restoration)
    • mesially move root(harder(esp if resorption), no rest)
    • options:
    • - Continuous AW
    • - Open-coil spring
    • - Helical spring
    • - Single T-loop
    • - Modified T-loop
    • - TMA U-loop
    • Mini implants
  6. Alignment methods
    • 1) Partial fixed appliance: 2 molars x 4 max incisors (2x4 appliance)
    • 2) Clear aligners: in-clinic aligners, Invisalign, OrthoClear
  7. crowding solns:
    • Expansion: clear(esthetic), fixed(efficient)
    • Interproximal reduction (IPR): may effect overjet, overbite, posterior icp, esthetics
    • Extraction
    • Extensive IPR and incisor extraction should always follow a diagnostic set-up to verify feasibility.
  8. As teeth are extruded, the attached gingiva should:
    follow the cementoenamel junction. This returns the width of the attached gingiva to its original level.
  9. endodontic therapy should be completed ______ extrusion of the root begins
    before
  10. smile framework
    • 1. Lip Line (vertical display)
    •  Rest
    •  Posed smile
    •  Low (20%)
    •  Average (75%)
    •  High (10%)
    • 2. Smile Arc (untreated)
    •  Parallel (85%)
    •  Straight (14%)
    •  Reverse (1%)
    • 3. Upper Lip Contour
  11. Height width relationships
    •  Golden proportions
    •  80/100 (width /height)
  12. intrusion requires ______ force than extrusion
    less
  13. ortho extrusion indications
    • Expose sound root structure
    • Facilitate Rubber dam isolation for Endodontic
    • Therapy
    • Reduce periodontal vertical pockets
    • Help erupt Impacted canines
    • Close anterior open bites
    • As an adjunct to implant treatment
    • Settling the bite
  14. After active tooth movement has been completed, at least _______ of stabilization is needed to allow reorganization of the periodontal ligament
    3 weeks
  15. extrusion can be done as fast as _______ without damage to the PDL
    1mm per week (3-6 weeks)
  16. Circumferential Supracrestal Fibrotomy (CSF)
    used after extrusion to prevent relapse
  17. continuous flexible wire produces the desired extrusion but must be managed carefully because:
    • tends to tip the adjacent teeth toward the tooth being extruded,
    • reducing the space for subsequent restorations and disturbing the interproximal contacts within the arch!
  18. intrusion indications
    • Intrusion of posterior teeth to close an anterior open bite (TPA)
    • Intrusion of incisors for deep bite correction (COS, TAD, intrusion arch)
    • Intrusion of supra-erupted teeth to facilitate restorations (TAD)
    • Unilateral intrusion of maxillary teeth to correct canting
    • Facilitate treatment of the multidisciplinary cases
  19. which transverse discrepency is most common
    posterior transverse
  20. expansion indications
    • 1. crossbites
    • 2. rowding
    • 3. axial inclination of maxillary posterior teeth
    • 4. Esthetics
  21. target of max expansion
    mid-palatal suture (becomes more interdigitated with age and doesn't fuse)
  22. expansion key ages
    • before 14 ideal
    • refer by age 7
  23. expansion appliances
    • TPA (tip)
    • quad-helix (tip)
    • RPE (skeletal)
    • surgically assisted RPE
    • mini-implants (limit tipping)
  24. undesired consequence of conventional expansion
    anterior open bite
  25. perio problems prevalence
    • pocketing increases w/ age
    • inadequate attached gingiva peaks in 20's
  26. perio risk groups
    • 80% moderate
    • 10% rapid
    • 10% none
  27. perio problems and ortho
    NO contraindication as long as disease is UNDER CONTROL
  28. high probing depth areas
    • interprox: maxillary molars
    • M of 1st premolar
    • buccal furcations
    • mandibular canine/lateral
  29. attached gingiva ___ requires further evaluation
    <2mm, likely to need graft
  30. min perio considerations
    • OHI
    • probing
    • width of attached gingiva
    • thickness
    • graft before ortho
  31. moderate perio considerations
    • control before ortho
    • 3-6 month observation
    • fully bonded (vs banded)
    • steel ties (vs elastomeric)
    • 2-4 month maintenacne
    • CHX etc
  32. severe perio considerations
    • 4-6 WEEK maintenance
    • VERTICAL BWX
    • MINIMAL FORCES
    • CONSIDER using teeth to be extraction for leverage
    • control before ortho
    • 3-6 month observation
    • fully bonded (vs banded)
    • steel ties (vs elastomeric)
    • CHX etc
  33. gingival perio problems
    • recession
    • attached gingiva (<2mm)
    • embrasures: divergent roots, abnormal shape, perio disease (crestal bone, papilla destruction)
    • Graft BEFORE ortho
  34. bony defects
    • 1.1,2, and 3 wall defects
    • hemiseptal (mesially tipped, supraerupted)
    • -1 wall ortho tx
    • -2 wall ortho & crown lengthening
    • stabilize 6 months
    • 2.Interproximal craters: NO ORTHO, reshape, reduce
    • 3-wall defect: tx bone graft/membrane, wait 2-3 months for maturation of the graft and take an xray. If bone levels are stable, over 3-6 months, then begin ortho.
    • 3.Furcation defects: can worsen, 2-3 month recall
    • class I: osseous sx
    • Class II: grafting & barrier membrane before ortho
    • Class III: Root amputation with endo and crown, Hemisection,Extraction and implant
    • 4.Horizontal bone loss: bone levels guide brackets vs clinical crown
    • reduce: 1. crown/root ration & mobility 2. prevent bony defects during alignment
  35. Goals of Adjunctive Tx
    • perio health
    • crown/root ratio
    • axial loading optimization
    • facilitate restorative
  36. diverging roots, open embrasures
    • position bracket slots perpendicular to lonx axes of roots
    • roots align, contact lenthens, move apically toward papilla
  37. abnormal shaped crowns
    recontour interproximal, close space ortho
  38. hemiseptatl defect
    • bone level guide and equilibrate
    • beware endo and crown (INFORMED CONSENT)
    • 2-3 month monitoring
  39. canine impaction
    • 1/3 labial
    • 2/3 palatal
    • 64% mesial to lateral will come down
    • 91% distal to lateral will come down
  40. preferred radiograph for locating canine
    lateral cone-shift, multiple PAs vs. vertical parallax (pano/occlusal)
  41. Open Eruption
    Traction is placed after the canine erupts autonomously into the palate
  42. Closed Eruption
    • Expose and remove bone. Reposition flap and guide tooth into the arch.
    • 1. Simple excision when crown is coronal to MGJ
    • 2. Apically positioned flap if apical to MGJ BUT, canine tends to intrude after treatment
    • 3. Closed eruption if in the center of the alveolus and/or significantly apical to the MGJ
  43. mechanical canine extrusion appliances
    • Auxiliary NiTi wire
    • Elastic Thread
    • Cantilever mechanics
    • Ballista Loop
  44. ______is ideal time for surgery
    • Growth completion
    • o Females complete growth before males
    • o Each patient is unique: serial cephs taken one year apart is NECESSARY
  45. Mandible sx
    • •BSSO Advancement/Setback Bilateral Sagittal Split Osteotomy
    • RIF allows patient/doctor to avoid intermaxillary fixation
    • •Distraction Osteogenesis:
    • -Manipulation of a healing bone
    • -Stretch osteotomized area before calcification
    • -Great tool for correcting facial deformities
    • -ADVANTAGES
    • o larger movements are possible
    • o deficient jaws can be corrected at an earlier age
    • - DISADVANTAGE
    • o Precise movements are not possible
  46. Maxilla sx
    • •Impaction/Downgraft
    • •Lefort Advancement
    • •Segmentalization: between lateral/canine
    • •SARPE: LeFort I except DOWNFRACTURE
    • •Distraction Osteogenesis
  47. most stable surgery
    • max up
    • mand forward
    • chin anywhere
  48. least stable surgery
    • mandible back
    • maxilla down
    • maxilla wider

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