Management Of Malocclusion Orthodontics Question And Answers

Management Of Malocclusion Important Notes

• Overbite
  • It is a vertical overlapping of anterior teeth
  • Value – 2-3 mm
  • Normal over-bite percentage – 33.33%

Management Of Malocclusion Long Essays

Question 1. Discuss a treatment plan for Angle’s Class 2 malocclusion.
Answer.

Treatment Objectives:

Class 2 Div. 1:

• Reduction of overjet
• Reduction of over-bite
• Correction of crowding
• Correction of molar relationship
• Correction of posterior cross-bite
• Normalizes muscles

Class 2 Div. 2:

• Correction of incisor relation
• Relief of gingival trauma
• Correction of crowding
• Correction of molar relation

Treatment Plan:

Growing Patient:

• Skeletal Class 2
  • Maxillary Prognathism
    • Headgear
  • Maxillarly Prognathism and Mandibular Retrognathism
    • Headgear & Myofunctional Therapy
  • Mandibular Retrognathism
    • Myofunctional Therapy
• Dental Class 2
  • Orthodontic Treatment

Non-Growing Patient:

• Skeletal class 2
  • Mild to Moderate Class 2
    • Orthodontic Camouflage
  • Severe Class 2
    • Maxillarly Prognathism
      • Surgical Maxillary Setback
    • Mandibular Retrognathism
      • Surgical Mandibular Advancement
    • Dental Class 2
      • Orthodontic Treatment

Treatment Approaches:

Growth modification:

• Reduces the severity of skeletal relationship
• Carried out during mixed dentition period before cessation of growth
• Involves

Correction of mandibular deficiency

• Mixed dentition period – Activator, FR 2
• After growth cessation – Herbst appliance
• Jasper Jumper

Correction of maxillary prognathism

• Face bow with headgear

Camouflage:

• Done by extraction of teeth
• To reduce overjet, overbite, molar relation, crowding, deep bite
• In excellent inter occupation – Extraction of the upper first premolar
• In unstable molar relation – Extraction of all first premolars

Surgical Correction:

• After cessation of growth
• mandibular advancement and maxillary set back is done

Question 2. Define Preventive, Interceptive orthodontics. Enumerate various modes of bilateral posterior cross bite correction and discuss any one.
Answer.

Definitions: Refer to Interceptive Orthodontic topics

Treatment Of Bilateral Posterior Cross Bite:

Crossbite elastics:

• Stretched between palatal surfaces of maxillary molars and buccal surfaces of mandibular molars
• Worn day and night
• Not worn for more than six weeks as it extrudes teeth

Coffin Spring:

Parts:

• Omega-shaped wire – In mid mid-palatal region
• Free ends of wire – Over slopes of the palate

Read And Learn More: Orthodontics Short And Long Essay Question And Answers 

Quad helix:

• Consist of four helices
• 2 anterior helices
• 2 posterior helices
• Connected by anterior bridge and palatal bridge

Rapid maxillary expansion:

Incorporating screws by splitting of mid-palatal suture

Management Of Malocclusion Short Essays

Question 1. Rotations.
Answer.

• They are tooth movements occurring around the long axis

Types Of Rotations:

• Mesiolingual/Disto-buccal rotation
• Disto lingual/Mesio-buccal rotation
  • Rotated interiors occupy less space
  • Rotated posterior occupies more space

Treatment Of Rotations:

• Space Management – For rotated anterior
• Removable appliances – Z spring along with labial bow
• Fixed appliances
  • Rotation wedges
  • Elastic threads engaged in lingual attachments
  • Force couple
• Retention – By circumferential suprarenal fibrotomy/precision

Question 2. Features of openbite.
Answer.

• Skeletal features:
  • Increase in lower anterior facial height
  • Decrease in upper anterior facial height
  • Increase in anterior and decrease in posterior facial height
  • Vertical maxillary increase
  • Long and narrow face
  • Steep anterior cranial base
  • Downward and forward rotation of mandible
  • Steep mandibular angle
  • Upward tipping of maxillary skeletal base
  • Divergent cephalometric planes
• Dental features:
  • Proclination of upper anterior
  • Narrow maxillalry arch
  • Upper and lower anteriors fail to over lap each other resulting in space between incisal edges of maxillary and mandibular anteriors

Question 3. Midline Diastema.
Answer.

Refers to any spacing/gaps existing in the midline of the dental arch

Etiology:

• Abnormal frenal attachment
• Ugly duckling stage
• Mesiodents
• Congenital missing teeth
• Trauma
• Hereditary
• Pressure habits

Diagnosis:

• Blanch test

Management Of Midline Diastema:

Removable appliance:

• Hawley’s appliance along with finger springs
• Split labial bow along with Adam’s clasp

Fixed Appliances:

• M springs
• Elastic threads
• Elastic chains
• Closed coil spring

Question 4. Management of Class 2 Div. 1 Malocclusion.
Answer.

Interception of Habits associated with it:

• By habit breaking appliances

During Mixed Dentition period:

• In maxillary Prognathism – Headgear
• In mandibular deficiency – Activator

Management of Dento alveolar – Class 2:

• Maintenance of premolar – to prevent mesial drifting of molars
• In premature loss of premolars – Space regainers

Management in Adults

• Camouflage
• Orthoguathic surgery
  • Mandibular advancement in mandibular retrognathism
  • Maxillary setback in Maxillary prognathism

Question 5. Treatment of Class 3 malocclusion.
Answer.

In Pre – Adolescent Child:

• Frankel 3
• Chin cup
• Anterior Facemask
• RME with anterior facemask
• 3D – screws

In Adolescent Child:

• Camouflage

Treatment During Adulthood:

• Orthognathic surgery
• Maxillary advancement by Lhefort 1 osteotomy
• Mandibular setback

Question 6. Open Bite.
Answer.

Condition in which there is lack of vertical overlap between maxillary and mandibular teeth.

Classification of Open Bite:

Based on location:

• Anterior open bite
• Posterior open bite

Based on components:

• Skeletal open bite
• Dental open bite

Etiology:

• Habits
• Abnormal tongue size
• Inherited

Abnormal Growth Pattern:

Management of Open Bite:

• Anterior open bite
  • Interception of habits
  • Box elastics
  • Chin cup with vertical pull head cap
  • Skeletal Open bite
  • Lefort I osteotomy
  • Muscle retraining exercises
• Posterior open bite
  • Interception of habits
  • Vertical elastics

Question 7. Anterior Crossbite.
Answer.

Crossbite: Condition where one/more teeth may be malposed abnormally, buccally or lingually, or labially about the opposing tooth/teeth.

Classification:

• Single tooth crossbite
• Segmental crossbite

Treatment of Anterior Crossbite:

• Use of tongue blade
• Catlan’s appliance
• Z spring
• Screw appliances
• Face mask
• Frankel 3
• Chin cup appliances

Question 8. Deepbite.
Answer.

Excessive vertical overlapping of mandibular anterior by maxillary anterior

Classification of Deepbite:

• Skeletal deep bite
• Dental deep bite

Etiology:

• Over eruption of anteriors
• Infra occlusion of molars

Treatment of Deepbite:

Removable appliances:

Anterior bite plane:

Parts: Adam’s clasps on molars

• Labial bow
• Acrylic behind maxillary anteriors

Mode of action:

As the posteriors erupts upto height of bite plane, its height is further increased.

Myofunctional appliances:

• Activator – Trimmed to allow extrusion of teeth
• Bionator.

Fixed Appliance Therapy:

Use of anchorage bends:

• Bends given in arch wire mesial to molar tubes
• Creates intrusive force on incisors

Reverse curve of spee:

• Resilient arch wires curved in a direction opposite to curve of spee

Utility arches:

• Arch wires are bent to by pass buccal teeth and engaging incisors

Question 9. Cross bite.
Answer.

Cross bite: Condition where one/more teeth may be malposed abnormally, buccally or lingually or labially with reference to the opposing tooth/teeth.

Classification of Cross bite

• Based on location
  • Anterior cross bite
    • Single tooth
    • Segmental
  • Posterior cross bite
    • Unilateral
    • Bilateral
• Based on the nature of crossbite
  • Skeletal crossbite
  • Dental crossbite
  • Functional crossbite

Etiology of Cross bite:

• Persistence of a deciduous teeth
• Arch length – tooth material discrepancy
• Presence of habits such as thumb sucking and mouth breathing
• Retarded development of maxillalry
• Narrow upper arch
• Collapse of maxillary arch
• Unilateral hypo or hyperplastic growth of any of the jaws
• Persistence of a deciduous teeth
• Arch length – tooth material discrepancy
• Presence of habits such as thumb sucking and mouth breathing
• Retarded development of maxilla
• Narrow upper arch
• Collapse of maxillary arch
• Unilateral hypo or hyperplastic growth of any of the jaws

Question 10. Anterior cross bite – etiology and management
Answer.

Definition of Anterior cross bite:

• It is defined as malocclusion resulting from lingual position of the maxillary anterior teeth in relationship with the mandibular anterior teeth.

Etiology of Cross bite:

• Persistence of a deciduous teeth
• Arch length – tooth material discrepancy
• Presence of habits such as thumb sucking and mouth breathing
• Retarded development of maxilla
• Narrow upper arch
• Collapse of maxillary arch
• Unilateral hypo or hyperplastic growth of any of the jaws

Management of Anterior Cross bite:

• Use of removable appliances
  • Use of tongue blade
    • It is used to treat single tooth anterior cross bite
    • It resembles ice cream stick
    • It is placed inside the mouth contacting th epalatal aspect of the tooth in crossbite
    • Rest the blade on the mandibular tooth
    • Patient is asked to rotate the oral part of blade upwards and forward
    • Repeat the exercise for 1-2 hours for about 2 weeks
  • Catlan’s appliance
    • It is lower inclinded plane constructed on maxillary arch
    • Have 45 angulation
    • Forces the maxillary teeth to a more labial position
  • Use of Z spring
    • Used to treat anterior cross bites involving one or two maxillary teeth
    • Used when there is adequate space for labialization
• Use of fixed appliances
  • Multilooped archwires or nickel titanium arch-wires are used for corrections
  • Indications
  • Dental anterior crossbites involving one or more teeth
  • Requirement of more tooth movement along with correction of crowding and rotations
  • Patients who exhibit minimal overbite

Management Of Malocclusion Short Questions And Answers

Question 1. Camouflage treatment.
Answer.

• Done by extraction of teeth
• To reduce overjet, overbite, molar relation, crowding, deep bite
• In excellent inter cuspation – Extraction of upper first premolars
• In unstable molar relation – Extraction of all first premolars

Question 2. Treatment of cross bite.
Answer.

Cross bite: Condition where one/more teeth may be malposed abnormally, bucally or lingually or labially with reference to the opposing tooth/teeth.

Classification Of Cross bite:

• Single tooth cross bite
• Segmental cross bite

Treatment Of Cross bite:

• Use of tongue blade
• Catlan’s appliance
• Z spring
• Screw appliances
• Face mask
• Frankel 3
• Chin cup appliances

Question 3. Imbrication.
Answer.

• Imbrication denotes especially lower incisors arranged in an irregular manner within the arch due to lack of space

Etiology of Imbrication:

• Tooth material-arch length deficiency
• Presence of supernumerary teeth
• Discrepancy in individual tooth size and shape
• Abnormal eruption path
• Rotation and transposition of tooth
• Premature loss of deciduous or prolonged retention of primary tooth

Question 4. Spacing.
Answer.

Etiology of Spacing:

• Disproportion between arch length and tooth material
• Alteration in tooth morphology
• Habits
• Macroglossia
• Premature loss of permanent

Treatment of Spacing:

• Interception of habits
• Removable appliances – labial bow
• Fixed appliance – Elastic chains/threads
• Use of crowns and prosthesis

Question 5. Causes of Crowding.
Answer.

• Arch length – tooth material discrepancy
• Supernumerary teeth
• Prolonged retentiono f deciduous
• Abnormal tooth size and shape
• Premature loss of deciduous causing drifting of adjacent
• Late mandibular growth
• Pressure from erupting third molars
• Reduction of inter-canine width

Question 6. Inclined Plane/Catlan’s Appliance.
Answer.

Uses Of Catlan’s Appliance:

• Treatment of anterior cross bite
• Palatally displaced maxillary incisor

Design Of Catlan’s Appliance:

• Acrylic/metal covering the maxillary incisor at 45 angulation

Disadvantages Of Catlan’s Appliance:

• Problem in speech
• Dietary restriction
• Supra eruption of posteriors

Question 7. Midline Diastema.
Answer.

Refers to any spacing/gaps existing in the midline of the dental arch.

Etiology Of Midline Diastema:

• Abnormal frenal attachment
• Ugly duckling stage
• Mesiodens
• Congenital missing teeth
• Trauma
• Hereditary
• Pressure habits

Management Of Malocclusion Viva Voce

• Rotated posterior teeth occupy more space than normal
• Rotated anterior teeth occupy less space than normal
• Brodie syndrome is scissor bite of first premolar of patient with class 2 division 1 malocclusion
• Narrow upper arch is feature of skeletal posterior cross bite
• Cross bite is abnormal occlusion occuring in transverse plane
• Cross elastic is stretched from palatal surface of maxillary posterior teeth to buccal surface of mandibular teeth
• Cross elastic is best to treat single posterior cross bite
• Coffin spring causes slow and bilateral symmetrical expansion
• Tongue blade therapy is used for anterior cross bite correction
• Flat anterior bite plane is used to correct deep bite in angle class 2 division 2 malocclusion
• Skeletal deep bite is seen in skeletal class 2 division 2
• Deep bite is increased overbite
• Skeletal open bite is treated in adults by surgical correction
• Anterior openbite can be treated in mixed dentition by vertical pull head gear with chin cup
• Closure of space in midline is done by composite build up it th espace is upto 0-2 mm
• Abnormal labial frenum is cause of midline diastema
• Class 3 bionator and Frankel appliance type 3 is used for class 3 malocclusion
• Sagittal split osteotomy is used for management of class 3
• Class 3 malocclusion management involves extraction of lower first premolars and second premolars
• Class 3 elastics are placed between upper molar to lower canine
• For management of class 2 requires correction of maxillary retrognathism
• Class 2 malocclusion is most difficult to treat
• Mild rotations can be treated by NiTi arch wires
• Face mask is used for treatment of class 3 malocclusion