Ortho_II.pdf - Orthodontics II Course Review Enoch Ng DDS...

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Orthodontics II Course Review Enoch Ng, DDS 2014 Adjunctive Orthodontics - Tooth movement to carried out to facilitate other dental procedures necessary to control disease, restore function, or enhance appearance o Facilitate other dental work o Limited in time and scope (specific goals) o Adults only Records - Traditional ortho records - Additional radiographs to confirm absence of caries and perio disease - Mounted models Indications - Pre-prosthetic positioning of teeth - Alignment of teeth in traumatic occlusion - Forced eruption (subgingival caries or fracture) - Orthodontic extraction Sequencing - Comprehensive treatment plan - Disease control o Re-evaluate - Establish occlusion (ortho) o Stabilize - Definitive perio/restorative treatment - Maintenance Molar Uprighting o Direction/distribution of occlusal forces o Decreased reduction needed for draw o Decreased possibility of endo/perio/other tooth complications o Increased restoration durability, eliminates plaque retentive areas o Improves alveolar contour, crown/root ratio - Considerations o Incisor position crowding, OB/OJ, proclination, midline o Anchorage support o Space present, status of edentulous area o Distal crown movement vs mesial root movement Easier to tip crown distally Molar will try to extrude include intrusion mechanics, crown reduction Premolar alignment/spacing may be affected - Mild Tipping o No special mechanics o Leveling and aligning with continuous superelastic archwire, or with SS wire with push coil spring o Reinforce anchorage unit, ideal bracket positioning o Requires relieving of occlusion - Severe Tipping o Rigid wire for anchorage units plus auxiliary spring (19x25 SS, 17x25 TMA) o Molar tends to extrude, anchorage unit tends to procline and intrude o Bend back wire to provide mesial root movement - Retention after Uprighting o Relapse can occur quickly o Retention needed until final prosthesis is placed
Orthodontics II Course Review Enoch Ng, DDS 2014 Pre-Prosthetic Alignment - Fixed Appliances o Distribution of spaces o Leveling and alignment - Removable Appliances o Limited number of aligners o Spring aligners - Indications longevity of perio and restorative, better gingival architecture, easier tooth preparations Forced Eruption - Fractures/caries crown involving cervical third of root - Access for rubber dam for endo treatment - Allows for adequate tooth structure to be exposed for restoration - Reduction of perio defects - Localized effect (does not compromise bone support of adjacent teeth) - In healthy individs, bone and gingiva follows dental movement - Fiberotomoy of junctional epithelium and supracrestal CT attachment to avoid bone formation OR post- orthodontic recontouring of bone and gingiva - Tooth should be erupted at least 4mm from alveolar crest (2mm ferrule and 2mm biologic width) - Importance of C:R ratio - Erupt at 1mm/wk, stabilize for 6 weeks Orthodontic Extraction - As bone follows tooth, ridge can be developed for implant placement - Frequent recalls needed to equilibrate crown, or fiberotomy - Re-contouring of gingiva or bone may be required

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