4 (P)- treatment plan optimisation

What factors effect the child’s behaviour?

Dental anxiety, React to strangers, Previous dental experiences 

Age, cognitive level

How can you encourage a patient to keep up with treatment at home?

Present educational material- headings stand out, short sentences

Their preferred colours

What is the major problem with removable functional appliances like bionator, activator, twin block and frankel appliance?

Compliance

Bulky, difficult to wear, must remove to eat and clean 

Used less in US- favour fixed functional- herbst, Mara

Missed appointment can…

Lengthen treatment

Increase chances of root resorption, white spots and periodontal problems

when elastic wear is scheduled…

Sufficient time needed to instruct patient how to place and remove elastics and how often to wear

What 3 types of retainers are offered at the end of treatment?

Bonded lingual 

Clear 

Hawley retainers 

What 2 adjuvant procedures (recent research) optimise efficiency?

Resonance vibration and low level laser therapy- weekly vibration of 60Hz increases 15% tooth movement

Low level laser photobiomodulation- in vitro effects, low intensity light stimulates biological responses around tooth

Why are results of orthodontic treatment in adults limited?(4)

Orthodontic tooth movement is slow

Less cellular response in pdl 

Increased risk of root resorption 

Periodontal problem under long and heavy forces 

5 goals of modern ortho treatment?

Do no harm- protect aesthetic and functional attributes

Improve smile and facial appearance

Normal function 

Optimal occlusion 

Stability of dentition

If late treatment initiated…(late mixed or permanent)

Single phase of comprehensive orthodontic treatment- usually between 18-24 months

If treatment in early mixed dentition…

2 phases- 

1- expansion for around 1 yr

Interim period- depends on how long it takes for permanent teeth to erupt 

2- non extraction around 14-18 months, full fixed or clear aligners  

What is the goal of early treatment protocol?

Correct existing/developing skeletal, dentoalveolar and neuromuscular imbalances

Improve oro facial environment before perm eruption

Reduces need for surgery

What is the ideal age to intervene with RME?

Cs1 or 2

When are tooth size/arch size discrepancy problems treated?

7-9 yrs (in mixed dentition)

After eruption of permanent incisors 

Combine with space maintainers, serial extraction, expansion depending on size of permanent teeth 

How can you solve tooth size arch length discrepancies in permanent dentition?

IPR

extraction

expansion

When is the treatment of class 3 malocclusion initiated?

Earlier than class 1

Primary dentition or incisors and 1st perm molars erupted 

When are class 2 malocclusions treated?

cs3- circumpubertal growth period

functional appliances with skeletal mand retrusion

IF have maxillary prognathism- timing not as critical- use extraoral traction in mixed and perm dent

Differential diagnosis between skeletal compression, functional and dental crossbite?

Analyse basal dimensions, cephalometry 

Crossbite in mic but disappears in CR 

check individual tooth inclinations 

Treat skeletal transversal malocclusion with…

Hyrax disjunctor

Miniscrews disjunctor