Orthodontics: Examination and Diagnosis

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Questions and Answers

What is a common issue associated with supernumerary teeth besides displacement?

Enhanced facial aesthetics

Eruption of adjacent teeth

Dental crowding (correct)

Increased tooth sensitivity

Which type of supernumerary tooth is most likely to create spacing issues between central incisors?

Mesiodens (correct)

Conical

Supplemental

Tuberculate

What management step is typically taken first when addressing a supernumerary tooth?

Cystic formation assessment

Crown placement on adjacent teeth

Orthodontic space closure

Removal of the supernumerary (correct)

What dental condition relates to a failure of eruption without any identifiable cause?

Primary failure of eruption (PFE) Signup and view all the answers

Which statement about supernumerary teeth is true?

They can lead to cystic formation. Signup and view all the answers

What is a likely consequence of leaving a supernumerary tooth in situ?

Increased risk of orthodontic complications Signup and view all the answers

What type of appliance is typically used after the removal of a supernumerary tooth?

Fixed appliances Signup and view all the answers

In what scenario can supernumerary teeth produce spacing issues?

When they create a maxillary diastema Signup and view all the answers

What is the primary reason for extracting deciduous canines in a crowded upper arch?

To prevent lateral incisors from erupting palatally. Signup and view all the answers

How can extracting lower deciduous canines influence periodontal support?

It can improve labial periodontal support. Signup and view all the answers

Under what condition might the extraction of lower deciduous canines be particularly beneficial?

In a Class III malocclusion. Signup and view all the answers

What is a potential complication of not extracting deciduous canines in a crowded lower labial segment?

Incisor may breach the labial plate of bone. Signup and view all the answers

What is generally considered easier and more predictable regarding orthodontic treatment?

Undertaking premolar extraction during early permanent dentition. Signup and view all the answers

What might happen if deciduous canines are not extracted in time?

Crossbites can develop with lateral incisors. Signup and view all the answers

What is a common consequence of retaining crowded deciduous canines?

Difficulty in later correction of positions. Signup and view all the answers

Why are the timing and choice of extraction important in orthodontic treatment?

They can determine the complexity of future treatment. Signup and view all the answers

What may be needed if the urge to suck arises and alternative activities are not effective?

An alternative treatment phase Signup and view all the answers

What are common resources used to make sucking habits less satisfying?

Bitter-flavored agents or gloves Signup and view all the answers

What is a consequence of not diagnosing sucking problems until the patient has permanent dentition?

High likelihood of oral surgery Signup and view all the answers

What is the typical duration for using a fixed habit-breaker appliance?

6 to 12 months Signup and view all the answers

What is considered a poor prognosis for first permanent molars?

Presence of molar incisor hypomineralisation (MIH) Signup and view all the answers

What is one of the most common reasons for the early loss of permanent teeth?

Trauma or extensive caries Signup and view all the answers

What condition often compromises the integrity of permanent maxillary incisors?

Hypoplasia due to childhood illness Signup and view all the answers

What is a common dental issue associated with the first permanent molars?

Caries or hypoplasia Signup and view all the answers

What is the primary unknown factor in the aetiology of supernumerary teeth?

Genetic component Signup and view all the answers

Which gender is more commonly affected by supernumerary teeth?

Males Signup and view all the answers

Where are supernumerary teeth most frequently found?

Anterior maxilla Signup and view all the answers

What classification is NOT used for supernumerary teeth?

Origin Signup and view all the answers

What is a major consequence of the presence of a supernumerary tooth?

Failure of tooth eruption Signup and view all the answers

Which type of supernumerary tooth is classified as 'mesiodense'?

A tooth located between the central incisors Signup and view all the answers

Which of the following is NOT a recommended management approach for supernumerary teeth that are causing dental problems?

Leaving them untreated Signup and view all the answers

What happens to the majority of supernumerary teeth in the permanent dentition?

They fail to erupt and are asymptomatic Signup and view all the answers

What is a potential consequence of extracting the first molar in a patient with crowded labial segments?

It has little effect on the crowded labial segment. Signup and view all the answers

Why should the extraction of the first molar be delayed until the second permanent molar has erupted?

To utilize the space for correction of labial segment crowding. Signup and view all the answers

What happens to the second premolar following the extraction of an upper first permanent molar?

It may drift distally into the extraction space and rotate. Signup and view all the answers

What is a reason to consider extracting the opposing upper first permanent molar when a lower molar is extracted?

To avoid over-eruption of the opposing upper molar. Signup and view all the answers

Why should compensating extractions in the lower arch be avoided?

They lead to a less likely spontaneous result in the mandibular arch. Signup and view all the answers

What is the primary aim of interceptive orthodontic treatment?

To eliminate or reduce developing malocclusion Signup and view all the answers

What condition does the term 'Leeway space' refer to?

The difference in space between primary and permanent molars Signup and view all the answers

Which of the following is a sign of normal dental development?

The mixed dentition phase begins at ages 5-6 Signup and view all the answers

What is the psychosocial factor mentioned in the context of orthodontic treatment?

Aesthetic satisfaction Signup and view all the answers

What is indicated by an abnormality during routine dental screening?

Further investigation including radiographs Signup and view all the answers

What happens during the transition to Class I molars?

Early mesial drift of mandibular molars occurs Signup and view all the answers

What should dentists monitor during routine screening in children aged 8-10?

Developing dentition and abnormalities Signup and view all the answers

What does calcification and eruption time help assess?

Normal dental development Signup and view all the answers

At what age do the upper permanent incisors typically erupt?

After age 7 Signup and view all the answers

What is the primary focus of treatment planning according to a patient’s socio-economic status?

Creating a personalized treatment plan Signup and view all the answers

When does the mixed dentition phase typically begin?

From age 5-6 Signup and view all the answers

What is the influence of abnormalities in eruption and exfoliation?

May affect normal dental development Signup and view all the answers

What is the general characteristic of normal dental development?

Eruption patterns follow average timelines Signup and view all the answers

What is the first step for dealing with a suspected dental abnormality?

Conduct a clinical examination Signup and view all the answers

Study Notes

Course Learning Outcomes (CLOs)

CLO1: Define orthodontic patient examination and diagnosis related to malocclusions (etiologies). Differentiate skeletal and dental malocclusions, and distinguish between minor tooth movement and major malocclusions.
CLO2: Assess orthodontic records (models, cephalometric X-rays, facial photographs) to create a problem list.
CLO3: Discuss different tooth movement types and biological theories. Describe growth modification principles and orthodontic force effects on the maxilla and mandible.
CLO4: Determine treatment options based on analysis, select the best option considering patient factors, and establish a final treatment plan.

Outline

Definition
Main aims
Normal dental development
Eruption and exfoliation abnormalities
Mixed dentition problems
Planned extraction of deciduous teeth
Other dental and skeletal problems

Definition

Interceptive orthodontic treatment: any procedure reducing a developing malocclusion, potentially simplifying or eliminating future treatment.
Main aims: minimizing malocclusion progression, maintaining midline, minimizing crowding, preventing Class II molar relationships, preventing trauma, and considering psychosocial factors.

Normal Dental Development

Mixed dentition phase spans from age five or six, to the exfoliation of the last primary tooth.
Typically, first molars erupt into a half unit II molar relationship guided by the distal surfaces of the second primary molars (flush terminal plane).
Transition to a Class I molar relationship happens due to early mesial drifting of the lower six into primate space and late mesial drift into the leeway space, plus differential mandibular growth.
Leeway space: maxilla (1.5mm per side), mandible (2-2.5mm per side).
Upper permanent incisors erupt into a wider and more proclined arc than the primary incisors (Incisor Liability).
Upper canines develop palatally, then migrate buccally to be distal to the lateral incisor root apices.

Routine Screening

General dentists screen children eight to ten years old for developing dental abnormalities.
Clinical examination detects unusual traits.
Radiographs (panoramic X-rays) are used when needed.
Use the ALARP principle for radiography (as low as reasonably practicable).
Palpate the buccal sulcus to detect permanent maxillary canine eruption abnormalities (around age nine to eleven).

Natal Teeth

Natal teeth erupt within the first few weeks after birth, usually anterior mandibular primary incisors.
Natal teeth can be mobile, but usually become firmer relatively quickly.
Management: If asymptomatic, leave in situ. Remove if interfering with breastfeeding or if mobility poses inhalation risk.

Eruption Cysts

Fluid or blood accumulation in the follicular space over an erupting tooth's crown.
Management: Frequently rupture spontaneously but marsupialization sometimes needed.

Failure/Delayed Eruption

Wide individual variations in eruption time.
Observe for a period, if disruption or asymmetry noted investigate: radiographic examination.

Causes of Delayed Eruption

Local factors (mechanical obstruction)
Congenital absence; crowding; trauma
Ectopic tooth germs; supernumerary teeth; retained primary teeth; premature primary tooth extraction; dilaceration.
Systemic conditions: Downs syndrome, cleidocranial dysplasia Turner syndrome, hereditary gingival fibromatosis, cleft lip/palate, rickets.

Unerupted Maxillary Incisors

Maxillary central incisor is the third most impacted tooth (after third molars and maxillary canines).
Diagnostic criteria: discrepancy of greater than six months between contralateral maxillary incisor eruption, or lateral incisor prior to central incisor eruption merits radiographic investigation.
Etiology: barrel-shaped/tuberculate supernumerary tooth, trauma to primary dentition.

Treatment of Unerupted Maxillary Incisors

Remove physical obstructions.
Surgical exposure with or without orthodontic traction.
Open exposure (simple elliptical incision, mucoperiosteal flap with attachment).
Closed eruption technique.
Apically positioned flap.
Incisor removal.
Autotransplantation.

Unerupted Permanent Maxillary Canines

Deviation from normal eruption path (palatal in ~85%): impacted.
Aetiology: long eruption path, reliance on lateral incisor root guidance (diminished or absent), retained primary canines, delayed eruption in maxillary arch relative to premolars.
Diagnosis: family history, intraoral examination (palpation from 8-10 years), radiographic examination if palpation negative.
Management mostly surgical exposure followed by orthodontic alignment, autotransplantation, extraction, or leaving in situ.

Enforced vs Elective Extractions

Enforced extraction: necessary due to poor prognosis.
Elective extraction: optional, part of a treatment plan.
Balancing extraction: opposite side of same arch.
Compensating extraction: opposing quadrant to maintain buccal occlusion, allow forward molar drift.

Early Loss of Primary Teeth

Reasons: extraction due to caries or trauma.
Consequences: implications on developing occlusion, space distribution and symmetry, affecting successor eruption timing

Early Loss of Primary Canines

Consequences: midline shift (unilateral loss), leading to unbalanced dentition (often in crowded dentition), balancing extraction potentially needed to maintain midline.

Early Loss of Primary First Molars

Consequences: unilateral early loss can lead to midline shift (especially in crowded dentition).
Early loss often creates space loss by forwards movement of the buccal segments, potentially increasing premolar crowding.
Balancing extraction in some cases, but primarily monitored, as most cases won't automatically require additional extraction.

Early Loss of Primary Second Molars

Least effect on midline, but affects position of first permanent molar potentially causing tipping, rotation and space loss through buccal movement.
Early extraction allows movement of adjacent teeth forward, consideration of a space maintainer may be required.
Rarely needs balancing/compensatory extractions unless restoration or general anesthetic is needed.

Impacted First Permanent Molars

Common in maxillary arch.
Impaction against second deciduous molars suggests crowding.
Some cases resolve spontaneously but rare after 8 years.
Management: Mild cases might respond (2mm overlap between second deciduous and permanent molars) to tightening separating wire over two months, or moderate-severe requires appliance for molar distalization.
Other options: observation, extraction for abscess or caries concerns, addressing potential space loss later with restorative measures.

Prolonged Retention of Primary Teeth

Presence of permanent successor, retained primary (causing deflection of permanent tooth) needs extraction, particularly if causing deflection.
Possible for permanent successor to not resorb overlying primary root. Encourage self-exfoliation, or extraction under local anesthesia.

Ankylosis and Infraocclusion

Infraocclusion: tooth fails to achieve or maintain proper relationship.
Primary infraocclusions often erupt into occlusion, but later seem submerged.
Reasons: genetic, permanent successor resorption failure, agenesis of permanent successor, trauma, infection.
Management (permanent successor present): observation, restoration, or extraction based on space and position, or other teeth position. If no successor, extraction is often the long-term management strategy.

Ankylosed Permanent Teeth

Ankylosis most frequent in maxillary central incisors, often due to trauma (intrusion, avulsion).
Replacement resorption, ankylosis, infraocclusion possible consequences.
Management varies based on factors like space availability and position of the unerupted/permanent tooth. Potential for space closure, restorative replacement, or extraction.

Hypodontia

Developmental absence of one or more teeth (excluding third molars).
Hypodontia: 1-6 absent teeth.
Oligodontia: >6 missing teeth.
Anodontia: complete tooth absence in one or both dentitions.
Consequences: Centerline shift, spacing, malposition, retained deciduous teeth.

Supernumerary Teeth

Additional teeth beyond the normal series.
Genetic component, more common in males.
Occur uniquely or in groups, frequently in maxillary anterior region, but also in premolar/molar areas.
Consequences include eruption failure, displacement, crowding.
Management: removal for eruption issues or displacement, or if causing crowding, or cystic formation; otherwise, monitoring usually sufficient.

Primary Failure of Eruption (PFE)

Rare, isolated condition.
Localized disruption to molar eruption.
Possible cause: autosomal dominant mutations in PTH1R (also associated with osteoarthritis).
Management: difficult. Extraction usually followed by space closure/prosthetic replacement, sometimes segmental bony osteotomy and orthodontic extrusion, or localized coronal buildup.

Transposition

Complete positional switching of adjacent teeth.
Causes include positional interchange of developing tooth/buds, alteration of eruption paths, retention of primary teeth, or trauma.
Decision to correct order of transposition or accept it, or extract an affected tooth.

Dilaceration

Distortion/bend in a tooth root.
Aetiology: developmental (crown turned upward, labially, without enamel/dentine disturbance)—or trauma from incisor intrusion, causing underlying permanent crown being deflected palatally.
Mild cases might be treated by exposure and traction; severe cases often need extraction and space maintenance.

Median Diastema

Normal spacing between maxillary central incisors in developing dentition ("ugly duckling" stage, aged 8-9 years).
Usually closes as laterals and canines erupt.
Causes: physiological (normal development); familial/racial; small teeth in large jaws (spaced dentition); missing teeth; midline supernumerary tooth.
Proclination, prominent fraenum also contribute.

Oral Habits

Thumb/digit sucking, mouth breathing, tongue thrusting, lip sucking, etc.
Frequency and intensity influence malocclusion severity.
Prolonged habits affect tooth eruption in various ways (anterior open bite, incisor proclination, narrow maxillary arch, posterior crossbite, increased lower face height).
Management: initial non-invasive methods (psychological, habit reversal), otherwise simple fixed appliances using palatal arches. Intervention early lessens later correction complexity (especially for malocclusion).

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Description

This quiz covers the fundamentals of orthodontic patient examination and diagnosis, focusing on malocclusions and their etiologies. Participants will assess orthodontic records and explore treatment options based on various factors. With a strong emphasis on growth modification principles and tooth movement types, this assessment will enhance your understanding of orthodontic practices.