Orthodontic Diagnosis Jaspal Singh een Shape of Head ‘+ Mesocephalic-A head of medium proportion with a cephalic index of 76.0 to 80.9. + Dolichocephalic-A relatively long, narrow head with a cephalic index below 76. ‘+ Brachycephalic-A short, broad head with a cephalic index of 81 to 85. + Hyperbrachycephalic round or broad head with a cephalic index of more than 85. Shape of Face ‘+ Buryprosopic-A short or broad face or both with a facial index of 80-85. ‘+ Mesoprosopic-A face of average width with a facial index of 84. 0 to 87.9. ‘+ Leptoprosopic-Long narrow face with a facial index of 88.0 to 92.9. ‘+ Hyperleptoprosopic-A long narrow face with a facial index of 93 or more. + Hypereuryprosopic-A very short broad face with a facial index below 80. * Facial profile-Refers to sagittal outline form of face. It is viewed from the side with patient's Frankfort horizontal plane parallel to the floor. On the photograph, it can be obtained by line joining the forehead and soft tissue point A and line joining point A and soft tissue pogonion. + Straight facial profile is one where line joining the forehead to soft tissue point A and line joining point A to soft tissue pogonion form a straight line * Convex profile is one where line joining the forehead to soft tissue point A and line joining point A to soft tissue pogonion form an acute angle with concavity towards the tissue. Eg, in Class Il div. * Concave profile- is one where line joining the forehead to soft tissue point A and line joining point A to soft tissue pogonion form obtuse angle with convexity facing the tissue. F.g, Class Il. + Facial divergence is the inclination of the lower face relative to the forehead. It is determined by a line joining the forehead and chin. ‘+ Anterior divergence-If the line joining forhead to chin is inclined anteriorly. + Posterior divergence-The line joining forhead to chin is inclined posteriorly. ‘+ Straight facial divergence—The line joining forhead to chin is straight. * Lip incompetence- The lips are said to be incompetent when the lips are unconsciously apart at the mandibular rest position and when the lips are consciously in contact, the lower lip shows an excessive contraction. * Lip competency is defined as the ability of the lip to make an oral seal covering the teeth. * Curve of spee is the anteroposterior curvature of occlusal surfaces. It begins at the tip of the lower cuspid and touches the buccal cusp tips of all the mandibular posterior teeth and continues to the anterior border of the ramus. The pull of the main muscle of mastication, the masseter, is at a perpendicular angle with the curve of Spee to adapt for favorable loading of force on the teeth, It is of importance to orthodontists as it may contribute to an increased overbite. + Curve of wilson-The curve of Wilson is the mediolateral curve that contacts the buccal and lingual cusp tips of each side of the arch. It results from the inward inclination of the lower posterior teeth ‘Curve of Monson~The curve of occlusion in which each cusp and incisal edge touch or conform to a segment of the surface of a sphere eight inches in diameter, with its center in the region of the glabella.Orthodontic Diagnosis 635 Vy) ‘Orthodontic Diagnosis and diagnostic tools * Diagnosis in orthodontics is made through a careful evaluation of case history, clinical examination radiographic analysis, including the cephalometric analysis, study model analysis, mixed dentition analysis. ‘+ Other supplemental diagnostic aids which may be useful in making the orthodontic diagnosis include, photograph, diagnostic set up, occlusogram, hand wrist radiograph, electromyographic examination of muscle activity, computed axial tomography, agnatic resonance imaging, + Extraoral examination is done in order to make the assessment of the size and shape of the head, facial form, facial symmetry, facial profile facial divergence, facial height, shape and size of the nose, nasolabial angle, size, shape and competency of lips. ‘+ Intraoral examination-Includes the examination of soft and hard tissue, The soft tissue examination includes the ‘examination of the gingiva, frenal attachment, tongue, palate floor of the mouth. Hard tissue examination includes the assessment ofthe type of dentition, overjet, over bite, occlusion, midline shift, interincisal distance, freeway space, path Of closure, breathing pattern, swallowing pattern, assessment of speech. sofuopoyHo Diagnostic aids in orthodontics ‘= Radiograph-Panorex * Cephalometric radiograph and analysis * Photograph Study model analysis * Permanent dentition analysis-Pont’s analysis, Linder Harth index, Korkhaus analysis, Ashley Howe's analysis, Wayne ‘A. Bolton analysis, Carey's analysis and Arch perimeter analysis, ‘+ Pont’s analysis —involve the measurement of four maxillary incisors to establish the width of the arch in the premolar and molar region ~ The greatest width of incisors is measured with calipers. The combined width is termed as “sum of incisors” (SD) = The distance between the right and left upper first premolar is recorded and is called as “measured premolar value” (MPV) ~ The distance between the upper right first molar and upper left first molar is recorded and is termed as “measured molar value” (MMV). six 100 ~ The calculated premolar value is calculated by the formula: s1x100 ~ Caleulated molar value: = The difference between the measured and calculated values determines the need for expansion. If the measured value is less, there is need of expansion. The analysis does not take skeletal malrelationship into consideration and cannot be used if anterior teeth are missing. Linder harth index is similar to Pont’s analysis. In linder harth index, there isa variation in the formula to determine the calculated molar value. Itis calculated as follow: 1x10 + Calculated premolar value: 35 s1x100 * Calculated molar value: 7 Ashley howe’s analysis involves the following calculation ‘+ Total tooth material is sum of the mesiodistal width of the teeth from first molar to first molar. + Basal Arch Length(BAL)-It is the perpendicular distance from the tangent drawn on the distal aspect of the first permanent molar to the anterior limit of the arch. + Premolar Diameter(PMD) is the arch width measured from the buccal cusp tips of the first premolar on one side to the buccal cusp tip on other side + Premolar Basal Ach Width(PMBAW) is the diameter of the apical base from the canine fossa of one side to canine fossaf other side, fe) = = el 3 S‘YW 636 Comprehensive Review of Clinical Dental Sciences * To assess if the apical bases of the patient could accommodate the patients teeth, the following measurement are made: 1. IfPMBAW > PMD: It an indication that basal arch is sufficient to allow expansion of premolar. 2. If PMD > PMBAW: There can be three possibilities a. Contraindication for expansion, b. Move teeth distally. Extract some teeth, 3. If PMBAV is less than 37% of the maxillary tooth diameter, the extraction is definitively required: a. if the value is 44%. It isan ideal case and extraction is not required. b, if between 37 to 44% (border line case), the extraction may or may not be required. Orthodontics ‘= Bolton analysis is used to determine disproportion in size between maxillary and mandibular teeth, This analysis involves the following measurement: 1. Sum of mesiodistal diameter of the 12 maxillary teeth. 2. The sum of the mesiodistal diameter of the 12 mandibular teeth 3. The sum of six maxillary anterior teeth, 4, The sum of six mandibular teeth is determined ~ Determination of overall ratio according to Bolton, the sum of MD width of the mandibular teeth anterior to the second permanent molar is 91.3% of the MD width of the maxillary teeth mesial to the second molar. Sum of mesiodistal width of mandibular 12 teeth x 100 Overall ratio= “Sum of mesiodistal width of maxillary 12 teeth + Ifthe overal ratio is less than 91. 3%, the mandibular tooth material isin excess If the overall ratio is less than the mean value, maxillary tooth material isin excess. * Determination of anterior value- The sum of the MD width of the mandibular anterior should be 77. 2% of the MD width of the maxillary anterirs. sum of mesiodistal width of mandibular 6 teeth x 100 sum of mesiodistal width of maxillary 6 teeth Anterior ratio = * If the ratio is more than mean value of 77. 2%, then the mandibular tooth material isin excess. + Ie the ratio is less than mean value, then the maxillary tooth material is in excess + Carey's analy, discrepency. + ‘The arch length is measured with soft brass wire. The wire is placed touching the mesial aspect of lower first permanent ‘molar, then passed along the buccal cusps of premolars, incisal edges of the anteriors and finally continued the some way upto mesial of the first molar of the contra lateral side. The wire can be passed along the cingulum of anterior teeth if anteriors are proclined and along the labial surface if anteriors are retroclined. * The mesiodistal width of teeth anterior to first molar are measured and summed up as total tooth material * The difference between the arch length and the actual measured tooth material gives the discrepancy. + Ifthe arch length tooth material discrepancy is: a. 0-2. 5 mm- proximal stripping can be carried out to reduce the total tooth material. . 2.5-5 mm- extraction of second premolar is indicated. ‘c Greater than 5 mm: extraction of first premolar is usually required. + Arch perimeter analysis-s similar to Carey's analysis and is carried out in the upper arch {is usually done in the lower arch. This analysis aims to calculate the arch length tooth material © Mixed dentition analysis-Prediction of the mesiodistal dimensions of unerupted permanent canines and premolars during the mixed dentition is of clinical importance in diagnosis and planning treatment. © Mixed dentition analysis help to predict the amount of space available in the arch for succeeding permanent teeth and for the transitional changes occurring in the mixed dentition stage © Moyer's mixed dentition analysis is the most widely used mixed dentition analysis method. The method makes use of separate probability chart for upper and lower arch to predict the size of combined widths of the mandibular cuspids and bicuspids forthe given sum of mesiodistal width of sum of incisor. 2 = Ss ze iS = a By} Contd.‘+ Tanaka and Johnston analysis involve the prediction of space required for alignment of unerupted canine and premolars. It is done using the following procedure: 1. The sum of mesiodistal dimensions of the four mandibular incisors are halved. 2. Tosum calculated a respective constants for male and female in the two arches is added. 3. The male and female constant for maxillary arch is 11 and for mandibular arch itis 10.5. Predicted width of maxillary canine and premolar __sum of mandibular incisor +11 = 2 Predicted width of mandibular canine and premolar = Radiographic method or proportional equation prediction method. ‘+ This method involves the following measurement: 1. ‘The width of an unerupted teeth and an erupted tooth is measured on the same periapical film 2. The width of erupted tooth is measured on the plaster cast. ‘+ The width of unerupted tooth on the cast is obtained as follows, + Unepeteathwiah = ETW (SH UT Or) ~ Unerupted tooth width (X-ray) ~ Erupted tooth width (cast) ~ Unerupted tooth width (in X-ray) ~ Erupted tooth width (X-ray) 3 NOLL:ii 638 comprehensive Review of Cinical Dental Sciences Orthodontics < S ~ Pa 2 e iS) irq 7) Q. 1. The normal value of facial height in young adult male is: 2. 9 mm, © 35 mm b. 121 mm 4. 150 mm ‘Ans, (6). 121 mm. The normal value of facial hit in male adult is 121 mum and in female it is 112 mm. Refi: Contemporary Orthodonties-William R. proftt, 2nd edition, page 145. Q. 2. Normal value of nasofrontal angle in young female is: a. 131 b. 140 © 99 4. 134 ‘Ans. (a). 131. In male nasofrontal angle is 134, Ref: Contemporary Orthodontics, William R. Profit, 2nd edition, page 178. Q.3. Which of the following study model analysis neither use radiographs nor use reference table to predict the width of unerupted canines and premolars: a. Tanaka and Johnston analysis . Moyers mixed dentition analysis ©. Carey's analysis dl. All of the above Ans, (a), Tanaka and Johnston method, Ref: Contemporary Orthodontics, Wiliam R. Profit, 2ud edition, page 178 Q. 4. Which of the following indicates the magnitude of the skeletal jaw discre- b. SNB 4. All of the above ‘Ans. (c). The differance b/w SNA and SNB =ANB which indicates the magnitude of the skeletal discrepancy. The magnitude of ANB Is inluenced by the vertical ht of the face and the anterioposterior positon of the Q. 5. Which of the following is a method to study bone growth: a. Vital staining b. Radioisotopes Implanting inert alloys into growing bone 4. All ofthe these ‘Ans. (@). All of the above, Q. 6 A score of 15 on handicapping labio Lingual deviation index indicates: a. Ectopic eruption . Anterior crowding, © Cleft palate 4. Mandibular protrusion Ans, (0). Cleft palate Ref: Orthodontic The art and science-Bhlejhi, 1st edition, page 118 . 7. Orthodontic treatment priority index was given by: a. Grainer RM b. Harry L. darker . Vankiek and pennel d. Summers ‘Ans. (). Grainer RM Ref: Orthodontic: The art end science Balaji, 1st edition, page 119. Q. 8 The morphologically short lips ‘which do not form a lip seal are classified a. Potentially incompetent lips b. Competent lips c. Everted lips 4. Incompetent lips Ans. (d). Incompetent lips Ref: Orthodontic: The Art and Science- Bhalajti, 1st edition, page 132. Q. 9. Condition with absence of vertical overlap is referred to ast a. Overjet . Overbite «. Deep bite . Open bite ‘Ans. (d). Open bite Q. 10. Increased vertical overlap is refer red to as: a. Overbite . Deep bite Ans. (c). Deep bite b. Overjet 4. Open bite Q. 1, Curve of Wilson refers to: a. An imaginary occlusal curve formed by buccal and lingual cusp tips of the mandibular posterior teeth b. An imaginary curve formed antero- posteriorly by the occlusal surfaces of the teeth beginning at the cusp tip of lower premolar and molar and then continuing as an arch through the condyle c. An imaginary curve formed by the ‘occlusal surface of all the teeth of the lower arch 4. None of the above Ans. (a). An imaginary occlusal curve formed by buccal and lingual cusp tips of the mandibular posterior tecth Ref: Orthodontic: The Art and Science- Bhlajhi, Ist edition, page 6. Q.12. Curve of spee is: a. An imaginary occlusal curve formed by buccal and lingual cusp tips of the ‘mandibular posterior teeth b. An imaginary curve formed antero- posteriorly by the occlusal surfaces of the teeth beginning at the cusp tip of lower premolar and molar and then continuing as an arch through the condyle An imaginary curve formed by the occlusal surface of all the teeth of the lower arch 4. None of the above Ans. (b). An imaginary curve formed anteroposteriorly by the occlusal suxfaces of the teeth beginning at the cusp tip of lower premolar and molar and then continuing as an arch through the condyle. Ref.: Orthodontic: The Art and Science Bhalahi, 1st edition, page 68. Q. 13. Deep mento-labial sulcus is seen 4 Class I Di 1 by. Class I Div I 6. Clase I bimaxillay protrusion 4. Class 1 Type 1 ‘Ans. (a), Clase I Div 1 Ref: Orthodontic: The Art and Scence-Bhalsji 1st edition, page 133 Q. 14. Hypermentalis muscle activity is seen in: a. Class Div Tb, Class Il Div IL ©. Class 1 Type HI. Class IIT ‘Ans. (a). Clase 1 Div 1 Ref Orthodontic: The art and science-Bhalgjhi, 1st edition, page 89, Q. 15. The normal value of nasolabial angle is: 1. 90 degree © 110 b. 150 d. 92 ‘Ans (0). 10 the angle reduces in patient with proclined upper anterior or prognathic maxilla. It increases in patient with retrognathic maxilla or retrodlined maxillary anterior. Ref Orthodontic the Art and Science-Bhalajhi, Ist edition, page 134 Q. 16. The normal value of inter-ocelusal clearance in canine region is: a. imm b. 2mm 3mm, damm Ans.(e). 3 mm Ref.: Orthodontic. The Art and Science- Bhalohi, 1st edition, page 137. Q. 17. Backward path of mandibular closure is seen i a. End to end incisor relationship in elass I », Class II Div 1 eases ©. Class It Div It cases 4. All of the above ‘Ans. (@). Class II Div IT cases Ref: Orthodontic. The art and science-Bhalajhi, 1st edition, page 138.Q. 18. Kinesiography is a method to 4. Interocclasal space b. Arch length circumference © TM] movements @. Arch width Ans, (a), Interocelusal space Q. 19, The normal interocclusal distance jam mouth opening i b. 50-55 mm. 4d. 20-30 mm Ans. (2). 40-45 mm Ref: Orthodontic. The art and science-Bhalajhi, 1st edition, page 139, Q. 20, Which of the following is method to assess physical growth: a. Craniometry b. Anthometry . Cephalometric radiography 4d. Allof the above Ans. (d). All of the above. Ref Contemporary Orthodontics, William R. Profit, page 33. Q. 21, The average age of person showing union b/w the epiphysis and faphysis of the distal phalanx of the fle finger is Male 15 yrs and females 13 yrs Male 12 yrs and females 8. 1 yrs Male 15.9 yrs and females 13. 3 yrs Male 14 yrs and females 11. 0 yxs ‘Ans. (b). Male 12 yrs and females 8.1 yrs Orthodontic. The art and science-Bhalajhi, Ast edition, page 175. b 4. (Q. 22. The extraction is indicated in cases ‘with premolar basal arch width value of 2. 37% or less. 40%, © 44% d. 48% Ans. (a). 37% oF less Ref.: Orthodontic, The art and scionce- Bhalajhi, Ist edition, page 180. Q. 23, According to the carey’s analysis, ‘extraction is indicated in cases where the arch lengh tooth material discrepancy . More than 5 mm . More than 10 mim © More than 8 min 4. More than 12 aim ‘Ans. (a). More than 5 mm Orthodontic. The art and sclence-Bhalajhi, Ist edition, page 180 Q. 24, Which of the following method of study model analysis makes use of radiograph: a. Moyer's mixed dentition analysis . Arch perimeter analysis ©. Mixed dentition analysis 4. Korkhas analysis Ans, (@). Mixed dentition analysis Refi Orthodontic. The et and science-Bhalj, 1s edition, page 186 Q. 25. Which of the following method of study model analysis is based on a probability chart: fa. Moyer's mixed dentition analysis B. Carey's analysis, «. Ponts analysis 4. Ashley Howe § analysis ‘Ans. (a). Moyer’s mixed dentition ana- lysis . 26, Broad and short face is classified as: a. Euryprospic __b. Mesoprospic ‘. Dolicoprospic_d. None of these ‘Ans. (a). Buryprosopic. Dolicoprospic is long and narrow facial form and mesoprospic is an average or normal facial form Q. 27, Long and narrow head is classified 1, Dolicocephalic «. Brachycephalic Ans. (a). Dolicocephalic. Mesiocephalic is average head and brachycephalic is broad ‘and short head. b. Mesiocephalic d. Euryprosopic . 28, Lips which are normal but fail to form lip seal due to proclination of upper incisors are called: 1, Incompetent lips , Competent lips «. Everted lips d. Potentially incompetent lip ‘Ans. (d). Everted lips are hypertrophied lips with weak muscular tonicity. Incomplete lips are morphologically short lips which do not form a lip sea in a relaxed state but on active contraction ofthe perioral and mentalis muscles can achieve lip seal. Q. 29, In which of the following radio- ‘graph, both the arches can be viewed: a. Occlusal b, Panoramic © IOPA 4. Bite wing ‘Ans. (b). Panoramic radiograph. Q. 30. Cephalograms are useful in mak- ing: a. Diagnosis b, Treatment planning . Prognosis Orthodontic Diagnosis 639 Ty d. All of the above Ans. (d). All of the above Ref: Contemporary Orthodontcs-Wilian, R. Profitt page 201 Q. 31, The most anterior point on the mid saggital mandibular symphysis is called: a. Gonian . Pogonian, ‘c. Gnathion 4. Menton ‘Ans. (¢). Gnathion Ref: An atlas of advanced orthodontics- Anthony D. Viazis, page 10. Q. 32. The key ridge refers to: a. The Iowermost point on the contour of ‘the anterior wall ofthe inratemporal fossa b. The most anterior point on the alveolar process . The most anterior point on the mandibular symphysis 4. The most prominent patient of the forehead in the midsaggital plane ‘Ans. (a). The lowermost point on the con- tous of the anterior wall of the infratempo- ral fossa Q. 33. Excess of vitamin D during gesta- tion can act as teratogens to induce: fa, Premature suture closure , Cleft lip . Microcephaly 4d. All of the above Ans. ( Refi Premature suture closure. Contemporary orthodontics, William R. Proftt page 131. Premature suture closure Q. 34. Which of the following is caused by birth injusi a. Crouzon syndrome b. Treacher-cllins syndrome «, Both of the above 4. None of the above Ans. (a). None of the above, neither is caused by birth trauma Refs Contemporary Orthodontics, Willian R. Profitt page 132. (Q. 35, Skeletal class IIT may be associated with speech distortion of distortion of ‘which of the following speech sound: a. /£/v/ (abiodentals fricatives) b. /s/z/\sibilants c. /t/d Glingualveolar stops) . All of the above ‘Ans. (a. [ffv/ (labiodentals fricatives) Refe: Contemporary Orthodontice-William R. Profit, page 175. a 3 a 9 es o 8‘Wp 40 comprehensive Review of Cinical Dental Sciences 3 2 3 3 9 = = ° (Q. 36, Patient with anterior open bite and large gap biw incisors have difficulty in pronunciation of: a. /f/v/ (labiodentas fricatives) b. /s/2/(sibilants ©. /t/dQingualveolar stops) 4. All of the above ‘Ans. (b). /s2/(sibilants Ref.: Contemporary Orthodontics-Wlliam R. Profit, page 175. Q. 97, Patient with irregular incisors and Iingoversion of maxillary incisor have difficulty in pronunciation of: a. F/v/Qabiodentals fricatives) b. S//(sibilants © T/d (lingualveolar stops) 4. Th, sh, ch (lingudental fricatives) Ans. (d). Th, sh, ch (lingudental frica- tives) Refi: Contemporary Orthodontic Profit, page 175. William R. Q. 38. Nasolabial angle in young female ist a. 99 b. 121 88 4. 60 Ans. (3). Ref: Contemporary Ortiodontics-William R. Profit, page 178. Q. 39. Zygomatic width in young mal 2. 100 mm b. 120 mm 130 mm . 137 mm ‘Ans, (d). In female it is 130 Q. 40. Lower facial height in young male a. 30 mm. 66 mm b. 50 mm 4. 72mm Ans. (d). 72 mm, in female it 1s 66 mm Q. 41, Which width of lateral incisor as, compared to central incisors ie considered. to be golden proportion: a. 98% of width of central incisor . 50fé of the width of CI 62% of the width of Cl 4. 80 % of width of CL Ans. (0. 62%. For best appearance, the apparent width of the lateral incisor should be 62% of the width of the central incisor, the apparent width of the canine should be (62% of that of the lateral incisor, and the apparent width of the fist premolar should be 62% of that of the canine. This ratio of recurring 62% proportion appears in a number of other zelationships in human ‘anatomy, and sometimes is referred to as the “golden proportion.” Q. 42. Canine guided occlusion ie: a. Canine to canine contact on working as ‘well as balancing side ». Canine to canine contact on working side with no contact on balancing side €. Canine to canine contact on balancing side with no contact on working side 4. None of the above ‘Ans. (c). Canine to canine contact on balancing Q. 43. According to Tanaka and Jhonston prediction values, the estimated width of mandibular canine and premolar is: fa, One half of the MD width of lower incisors +10. 5 b, One half of the MD width of lower incisors +14, 5 ©. One half of the MD width of lower incisors +11. 5 a. One half of the MD width of lower inciaors +8. 5 ‘Ans. (a). For upper maxillary canine premolar width, 11 instead of 10. is added to the sum of one half of the MD width of lower incisors Ref: Contemporary Orthodontics, Wiliam R, Profit, page 198. Q. 44, The cephalic index of brachyce- phalic head is a. 75-80 b. 81-85 . 86-90 4. 90-95 Ans. (b). 81-85. Q. 45. The focal film distance for a lateral cephalogram i a. One feet b. 3 feet ©. 4 feet d. 5 feet Ans. (d). 5 feet Q. 46. ANB angle is used to assess: a. Vertical jaw discrepancy . Saggital jaw discrepancy ¢. Dental alignment 4. All ofthe above ‘Ans. (a). Vertical jaw discrepancy . 47, Anterior Bolton ratio is a. 772% b. 91.0% ©. 83.2% a. 99.1% Ans. (a). 77. 2% Q. 48, Intercanine width at the age of 18, in male i a. 278 b. 29.7 ©. 325 4. 323 mm Ans. (4). 32.3 mm Ref: Contemporary Orthodontics, Willian R. profit 2nd edition page 226) O49. of accommodation is known a. Lateral movement of the mandible to ‘establich maximum intercuspation in the cases of bilaterally narrow maxilla ». Clase Il positioning of the mandible dae to the presence of premature contact c. Habitual movement of the mandible from class II to class I dd. None of the above ‘Ans.(a). Lateral movement of the man ble to establish maximum intercuspation in the cases of bilaterally narrow maxi Q. 50. Cortical drift is « growth process which involves which of the following. changes in the bone: Deposition of bone ’. Resorption of bone . Bone bending 4, Both resorption and deposition of bone ‘Ans. (d). Both resorption and deposition of boneClassification and Etiology of Malocclusion Jaspal Singh, Urvashi Sharma + Maxillary Dental Midline-A line drawn perpendicular to the maxillary occlusal plane through the proximal contacts of the central incisors. ‘+ Mandibular Dental Midline-A line drawn perpendicular to the mandibular occlusal plane through the proximal contacts of the central incisors. + Lip Line-The amount of tooth and/or gingival tissue that is exposed at rest. + Smile Line~The amount of tooth and/or gingival tissue exposed upon smiling, + Labio-or buccoversion-AThis isa tooth that is misplaced to the labial or buccal side of the dental arch. « Linguo-or palatal version~This sa tooth thats misplaced to the lingual or palatal side ofthe dental arch. Buccoversion- ‘A posterior tooth outside the arch toward the cheek. * Distoversion-A tooth in the arch located more distal than normal ‘+ Mesioversion-A tooth in the arch located more mesial than normal. ‘+ Supraversion-A tooth the has over-erupted. + Infraversion-A tooth that has not erupted to the occlusal level * Torsiversion-A tooth rotated on its axis. « Transversio-Refers to the situation in which one tooth has displaced another, such as when a lateral incisor and canine are interchanged. © Overjet'is a term used to describe the distance between the labial surfaces of the mandibular incisors and the incisal edge of the maxillary incisors. ‘© Overbite~The amount of overlap of the mandibular anterior teeth by the maxillary anterior teeth measured perpendicular to the occlusal plane. * Scissor-bite-It is the condition when one or more of the adjacent posterior teeth are either positioned completely buccally or lingually to the antagonistic teeth and exhibit a vertical overlap. * Crossbite-A condition where a tooth or teeth in one arch are positioned either buccal or lingual than its corresponding antagonist tooth or teeth of the opposing arch. # Open Bite-An open bite is present when there is no vertical overlap of the maxillary and mandibular anterior teeth or ro contact between the maxillary and mandibular posterior teeth. Malocclusion is a developmental condition which results due to the abnormalities in the process of normal development. * The etiology is mutifactorial. Both systemic or localized factor influencing the growth and development during the ‘prenatal, perinatal and postnatal period of orofacial development are the implicating factor in the etiology of malocclusion. + The general or systemic etiological factor Heredity or genetic factor. Prenatal trauma. Prenatal german measles infection, maternal diet, maternal metabolism, Postnatal birth injury, cerebral palsy, TMI injury. Endocrinal disturbances in prenatal and postnatal period. Metabolic disturbances Infectious disease eg. polymyelitis , Nutritional deficencies Childhood disease / radiation |. Hypo or hyper tonicity of the muscles 11. Respiratory abnormalities 12. Enlarged tonsils or acienoid 13, Psychogenetics ape‘Wit 642. comprehensive Review of Clinical Dental Sciences * Local Factor 1. Presence of parafumnctional oral habits Premature loss of primary teeth Anomalies of tooth size, shape and number Overretained deciduous teeth Delayed eruption of permanent teeth Abnormal eruptive pattern /sequence Ectopiceruption Ankylosis Cleft lip and palate 10. Traumatic injuries to jaw and TMJ 11. Abnormal frenal attachment 12. Enlarged tongue 13. Congenital absence of teeth * Hereditary factor in the etiology of malocclusion-Heredity or the genetic play a major role in the etiology of the maloociusion. There is strong tendency of inheritance of the jaw and the dentition form from parents. The heredity or genetic factor can influence the hard and soft tissue development of oral cavity. + Heredity has a strong influence on the development of following trait Size, shape and rumber of the teeth Width and length of the arch Height of the palate Position of tooth germ and the path of eruption Position and formation of perioral musculature Size of the jaw (macro and micrognathia) Mandibular retrusion and protrusion Crowding and rotation of the teeth Overbite, diastema and frenal attachment Size and shape of the frenum Size of the tongue Ankyloglossia m. Cleft ip and palate ‘+ Endocrinal factorin the etiology of malocclusion-Endocrine glands havea strong bearing on the formation, calcification, and eruption of the teeth, and on the growth pattern of the jaws, face and the cranium. + Endocrinal disturbances and their clinical manifestation on the craniofacial development Orthodontics ere Pe mPa TE Hypothyriodism * Clinical manifestation include-Retardation of growth, delayed eruption of the teeth, narrowing of dental arches and cranial base length, retarded vertical growth of the face, retardation of growth of paranasal sinuses, diminished rate of bone formation, maxillary protrusion. Hyperthyriodism * Clinical manifestation-Accelerated skeletal growth, irregular eruption of the teeth, increased vertical facial height, open bite, mild prognathism and osteoporosis. Hyper pituitarism + Clinical manifestation-Accelerated growth of the alveolar processes, tongue, and paranasal sinuses, thickening of cortical bone, early eruption of the teeth, hypercementosis, poor maturation and osteoporosis, = 5 @ = ~ B Hypopituitariom * Clinical manifestation-Retardation of growth, reduced linear facial measurement, reduced cranial base measurement, delayed eruption ofthe teeth, incomplete apical formen closure, reduced size of mandible and manilla, reduced growth of parnasal sinuses.Classification and Etiology of Malocctusion 643 iyi Hyper parathyriodism + Clinical manifestation-Hypocalcification of dentin, loss of lamina dura, , mobility of the teeth due to marked resorption of the alveolar bone. Hypoparathyriodism-Retarded eruption, early exfoliation of the teeth, enamel and dental defect. Different system of classification of malocelusion Angle's classification of malocclusion-In 1890, Edward H. Angle published the first classification of malocclusion. The classifications is based on the mesio-distal relation of the teeth, dental arches and jaws. The maxillary first permanent molar is considered as fixed anatomical point and as key to occlusion. Angle classified malocclusion into three classes. ‘= Class I- The mesiobuccal cusp of the maxillary first Permanent molar occluces in the buccal groove of the mandibular first permanent molar. © Class Il-The distobuccal cusp of the maxillary first Permanent molar occludes in the buccal groove of the mandibular first permanent molar. © Class I division 1~The maxillary incisor teeth are proclined or in labioversion. ‘Class II division 2- The maxillary lateral incisor are tipped labially or mesially and maxillary central incisors in near ‘normal anterioposterior position are slightly in linguo version. ‘© Class Il subdivision js a condition in which a class If molar relationship exists on one side of dental arch and class Ion other side + Class I ~The mesiobuccal cusp of the maxillary first permanent molar occludes in the interdental space between permanent mandibular first molar and second molar. ‘Pseudo class IIT is the habitual anterior positioning of the mandible due to premature contact of the teeth or some other reason when the jaws are brought together in centric occlusion. Drawbacks of angle’s classification 1L. Permanent molars are considered as fixed points within the jaws but these are not. 2. Classification is not possible if first permanent molar are missing. 3, Tt cannot be used in primary dentition. 4, Malocclusion in the transverse and vertical planes and individual tooth malrelationship are not considered. 5, Classification does not differentiate between skeletal and dental malocclusion. Dewey's modification of angle’s classification Modification of angle's class |: ‘Type 1: Crowding in maxillary anterior teeth. ‘Type 2: Proclination of maxillary incisor ‘Type 3: Anterior crossbite Type 4: Posterior crossbi ‘Type 5: Permanent molars are in mesioversion due to premature loss of teeth mesial to them. ‘Moalfications of angle’s class Ill + Type 1: Individual arches when viewed individually are in normal alignment, but when in occlusion the anterior are in edge to edge bite. «Type 2: The mandibular incisors are crowded and lingual to the maxillary incisors. + Type 9: Maxillary incisors are crowded and in crossbite. The mandibular arch is well developed and well aligned o a Eg 3 a ° es g (U8Te- 0) WAN e) lO EIS‘Hip 644 Comprehensive Review of Clinical Dental Sciences Lischer’s modifications of angle's cl ification 1. Neutroocclusion-Synonymous to Angle's Class 1 2. Distoocclusion-Synonymous to Angle's Class IL 3. Mesioocclusion-Synonymous to Angle's Class II. {scher defined the individual tooth malpositions as follow: 1. Mesioversion 2. Distoversion 3. Linguoversion 4. Labioversion 5. Infraversion 6. 7. 8. 9. Orthodontics Supraversion Axioversion Torsive Transversion Bennett's classification * Class I-Abnormal location of one or more teeth due to local disturbance, * Class I-Abnormal formation of a part or a whole of either arch due to developmental defects of bone. * Class ILI-Abnormal relationship b/w the upper and lower archs and b/w either arch and the facial contour, due to developmental defects of bone. Simon's classification:Simon has given craniometic classification of malocclusion that relate the dental arches to the face and cranium in the three planes of space-i.e. Frankfort horizontal plane, Orbital plane and Median Sagittal plane * Frankforthorizontal plane-F-H plane classifies the malocclusion in vertical plane. The plane connects the upper margins of the external auditory meatus to the infraorbital margin. The term used to describe abnormal relation of teeth to this plane are 1. Attractions-When the dental arch or part of this is closer to the F-H plane 2. Abstraction- When a dental arch or part of it is further away from the F-H plane. * Orbital plane is perpendicular to the F-H plane. This plane should pass through the distal third of the upper canine. This, is called simon’s law of canine. + The orbital plane is used to classify malocclusion in anteroposterior or sagittal plane 1, Protraction-The dental arches are placed farther or forward from the plane. 2 Retraction-Dental arches are placed posterior or closer to the plane. + Median sagittal plane-Define malocclusion in transverse plane as: 1. Contraction-A part or all ofthe dental arch is closer towards the median sagittal plane. 2. Distraction-A part oral of the dental arch is placed away from the mid-sagittal plane. ‘+ Skeletal classification Salzmann in 1950 was the frst to classify malocclusion on skeletal structure basis. Skeletal class 1 Skeletal cass 2 and Skeletal class 3. *+ Skeletal class 1- Malocclusion were purely dental with the bones of the face and jaws being in harmony with one another and with the rest of the head. The profile is further divided as: ~ Division 1: Local malrelations of incisors, canine and premolars. ~ Division 2: Maxillary incisors protrusion. ~ Divison 3: Maxillary incisor in linguoversion. = Division 4: Bimaxillary protrusion. + Skeletal class 2-These include malocclusion with a subnormal distal mandibular development inxelation to the maxilla. It further divided into two division. Division 1-The maxillary dental arch is narrower with crowding in the canine region. The cross bile may be present and the vertical face height is decreased. The profile is retrognathic. Division 2~The maxillary incisors are lingually inclined and the lateral incisors may be normal or in labioversion, ‘Skeletal class 3-Itis characterized by an overgrowth of the mandible with an obtuse angle. 5 2 = Pe 2 © = SECClassification and Etiology of Malocctusion 645 Wil) = Ackerman-profitt system of classification-Classify malocclusions in three planes of space. The classification is based on. the Vern symbolic logic diagram. The classification consists of 9 groups and 5 characteristics or steps with in. + Five characteristics or steps in ackerman-profit system of classification. ‘+ Step 1 (alignment)-Intra arch alignment and symmetry are assessed and classified as ideal crowded /spaced. * Step 2 (profile)-Profileis assessed and described as convex//straight/ concave. The facial divergence is also assessed and classified as anterior or posterior divergence. © Step 3-(type)-Transverse skeletal and dental relationship are assessed. ‘The cross bites are further sub classified as unilateral bilateral skeletal /dental cross bites. + Step 4-(class)-Involves the evaluation of sagittal relationships ofthe teeth and classified using the angle’s class I/class Il/ class IIL Differentiation is made between skeletal dental malocclusion. * Step 5-(overbite)-Malocclusion in vertical plane is assessed and described as anterior openbite/ posterior openbite/ anterior deepbite/ posterior collapsed bite. Distinction between Skeletal or dental malocclusion is made. Incisor classification * Class 1-The lower incisor edges occlude with or lie immediately below the cingulam plateau of the maxillary central incisors. ‘+ Class 2-The lower incisor edges lie posterior to the cingulam plateu of the maxillary central incisors. + Division 1-The maxillary Cl are proclined or of average inclination and there is increase in over jet. * Division 2-The maxillary Cl are retroclined, the overbite is normally minimum but may be increased. ‘+ Class 3-The mandibular incisor edge lies anterior to the cingulam plateau of the upper central incisor. The over jet i reduced or reversed. Canine classification ‘© Class I-The mesial incline of the upper canine overlaps the distal slope of the lower canine. © Class I1-Distal slope of the maxillary canine oceludes or contact with the mesial slope of the lower canine. ‘© Class IlI-The lower canine is displaced anterior to the upper canine with no overlapping of the upper and lower canine. soJUOPOYYO a g in) a} .o) 3 Sg Bi =! a 3 2tt & a 3 2 = 6 646 Comprehensive Review of Clinical Dental Sciences Q. 1, Class 1 malocclusion refers to: 2. MB cusp of upper first permanent molar wecluding in the buccal developmental groove of lower frst permanent mola . DB cusp of upper first permanent molar ccciuding in the buccal developmental groove of lower frst permanent molar . MB cusp of upper first permanent molar occluding in the interdental space b/w lower first permanent molar and 2nd permanent molar 4. MB cusp of upper 2nd permanent molar occluding, in the interdental space b/w lower first permanent molar and 2nd permanent molar ‘Ans. (a), MB cusp of upper first perma- nent molar occluding in the buccal deve- lopmental groove of lower first perma- nent molar , 2. Classs II malocclusion refers to: a. MB cusp of upper frst permanent molar ‘occluding in the buccal developmental {groove of lower first permanent molar ». DB cusp of upper first permanent molar ‘occluding in the buccal developmental {groove of lower first permanent molar ©. MB cusp of upper first permanent molar ‘occluding in the interdental space b/w lower first permanent molar and 2nd permanent molar <4. MB cusp of upper 2nd permanent molar ‘occluding in the interdental space b/w lower first permanent molar and 2nd permanent molar ‘Ans. (8). DB cusp of upper first permanent molar occluding in the buccal develop- ‘mental groove of lower first permanent molar Q. 3. Class IIT malocclusion refers to: 2. MB cusp of upper frst permanent molar ‘occluding in the buccal developmental ‘groove of lower first permanent molar . DB cusp of upper first permanent molar ‘occluding in the buccal developmental groove of lower first permanent molar ©. MB cusp of upper fist permanent molar ‘occluding in the interdental space b/w lower first permanent molar and 2nd permanent molar <4. MB cusp of upper 2nd permanent molar ‘occluding in the interdental space b/w lower first permanent molar and 2nd permanent molar Ans, (0. MB cusp of upper first permanent molar occluding in the interdental space ‘jw lower first permanent molar and 2nd permanent molar Q. 4. MB cusp of upper first permanent molar occluding the buccal develop- ‘mental groove of lower first permanent molar, retroclined upper CI and labially inclined upper LI are feature of which of the following malocclusion: a. Class I Type Tb, Class Uf, Div IL ©. Class Div. Clase I type Il ‘Ans. (b). Clase Ul, Div It .5. Axioversion refers to: a. Transposition of the two teeth D. Rotation of a tooth around its long axis Abnormal axial inclination of a tooth 4. None of the above Ans. (b). Rotation of a tooth around its Tong axis ©. 6. Classi type 1 is: a. Class I with the crowding of the tooth . Class I with anterior erossbite «. Class I with posterior crossbite 4. Class I with prociined maxillary incisors Ans (a), Clas I with the crowding ofthe tooth (Q. 7. Which is false about angle’s classi- cation of malocclus 1. Angle did not consider malocclusion in the transverse and vertical plane , There is no differentiation b/w skeletal and dentyal malocclusions ©. No mentioning of ind postions 4. None of the above ‘Ans, (d). All of the above jual tooth, Q. 8 Mesioocclusion is synonyms with: 2. Angle's class 1 '. Angle's class Il div Il Angle's class It 4d, Angle's class II div It ‘Ans, (a). Angle's class I . 9. Which of the following classi- fications classify malocclusion in all the three planes: a Angle's ©. Simon's Ans, (0. Simon's Q. 10, Which of the following system of classifications is based on Venn-symbolic b. Dewey's 4. Bennet’s diagram: a. Ackerman-proffit b. Angle's . Simon's a. Lischer's ‘Ans. (a). Ackerman-proffit, Q. 11, Which of the following is a feature of teacher ~collins syndrome: a. Hypoplastie zygomatic arches », Micrognathaia . Maliormed ear d. All of the above ‘Ans, (d). All of the above Q. 12, Which of the following is the cause of the malocclusion: Parafunctional oral habits Premature loss of primary teeth Over retained deciduous teeth Developmental anomalies of teeth » All of the above Ans. (d). All of the above Q. 13. Which of the following is a terato- gen affecting the dentofacial develop- ment: a. Aspirin . Bthyl alcho! c. Rubella virus d._ All of the above Ans, (€). All of the above Ref.: Contemporary Orthodontics-William R. Profit, 2nd edition, page 106. Q. 14. Which of the following is a cause of malocclusion: ‘a. Intrauterine molding b. Acromeagly >. Congentially missing teeth 4. All of the above page Ans. (d). All of the above page Ref: Contemporary Orthodontice-Williant R. Profitt, 2nd edition, page106-10. Q. 15. Short mandible, enlarged tongue and cleft palate are seen in: 2. Pierre robin syndrome b. Treacher Collins syndrome . Steven Johnson syndrome dd. Martie Sainton’s syndrome Ans. (a), Pierre robin syndrome b. Cleidocranial dysostosis Congenital syphilis d. None of the above ‘Ans. (€). Congenital syphilis, . 17. The etiology of the tooth transpor- tation may involve any of the following except fa. Genetic factor ». Dental abnormality © Oral habits 4. Trauma to the deciduous dentition ‘Ans. (@. Oral habits ©. 18. Benjamin » theory is a theory of: 2. The physiology of tooth eruption b. The etiology of thumb sucking . Blology of dental caries 4. Bliology of tongue thrusting ‘Ans (b). Benjamin was of the view that thumb sucking arises fom the rooting reflex seenin all mammalian infants. Rooting reflex refers to the movement of head and tongue towards an object touching his ox her check. Rooting reflex normally dispappear in infants around 7.8 months of ageQ. 19, The severity of malocclusion due to the parafunctionsl oral habit depends on which of the following attributes of the habit: a. Duration b. Intensity «, Frequency of the habits d. All of the above ‘Ans, (@). All of the above , 20, Unilateral cleft accounts for: ‘80%of the cleft cases 20%%of the cleft cases 50% of the cleft cases 30% of the cleft cases. ‘Ans. (a). 80% of the cleft cases Q. 21, Bilateral cleft accounts for: 8. 20% of the cleft cases, b. 40% of the cleft cases ©. 60% of the cleft cases 4d. 80% of the cleft cases ‘Ans, (a). 20% Q. 22, Unilateral cleft are more in left side. The percentage of unilateral clefts seen on left side is: a. 30% b. 60% 70% 4. 90% Ans. (e). 70% . 23, Which of the following is a tera- togen in the etiology of cleft lip and palate: a, Rubella virus b. Cortisone and mercaptopurine c. Methotrexate and valium d. All of the above ‘Ans. (d). All of the above Q.24, Which of the following is true about the etiology of cleft lip and palate: ‘2. Increased risk with increased maternal age . Mongoloids are at greater risk . Decreased blood supply to nasomaxil- lary area during embryological develop- ment predisposes to clefting 4. All of the above Ans. (d). All of the above Q. 25. According to Veau’s classification complete unilateral cleft involving soft palate, hard palate, lip and alveolar ridge are grouped as: a. Group 1 b. Group II . Group II) 4. Group IV ‘Ans. (). Group IIL The cleft involving, soft palate is grouped as Group 1. Group Il include clefts of hard and soft palate extending up to the incisive foramen. Group IV include complete bilateral cefts affecting the soft palate, hard palate, ip and alveolar ridge. Q. 26, The ‘rule of ten’ for the treatment of cleft lip and palate is suggested by: a. Millard b. Fogh Anderson . Kemahan| @. Yeu ‘Ans. a), Millard has suggested the rule of 10, He suggested the surgery of cleft lip and palate patient should not be performed tuntil the child is less than 10 weeks of age swith body weight not less than 10 pounds land the blood hemoglobin not less than 10 gram’. 2. 27. Adenoid facies are seen in: a, Mouth breathers b. Bruxism cc Tongue thruster d. Tumb sucker ‘Ans. (a). Adenoid fais or long, face syndrome is characterized by long and narrow face. Q. 28. Deforming anterior tongue thrust is classified by james braner and holt a ‘a, Type I tongue thrust . Type Il ©. Type I 4. Type IV ‘Ans, (a). Type T tongue thrust Q. 29. Deforming anterior and lateral tongue thrust is classified as: a. Type ». Type IL ¢. Type Ill 4. Type 1V ‘Ans, (d). Type TV 30, Absence of constriction of which of the following muscle is seen in complex tongue thrust: ‘8. Masseter b. Medial pterygoid ce, Lateral pterygoid d. Temporalis Ans. (d). Temporalis. Q. 51. Which of the following changes in the mouth breathers explain the patho- physiology of the clinical feature seen in mouth breathers: a. Lowering of the mandible . Downward and forward positioning, of the tongue . Tipping back of the head 4d, All of the above ‘Ans, (d). All of the above. Q. 32, Sunday bite is: 1, Pseudo class II positioning of the ‘mandible due to premature contact b. Habitual forward positioing of the ‘mandible to class I Classification and Etiology af Malecciusion 647 VYpi) &, Positioning of the mandible laterally to establish maximal intercuspation in cases of bilaterally retruded maxillae dd, None of the above ‘Ans. (b). Habitual forward positioing of the mandible to class T (Q. 33, Which of the following is true {8, The growth of nasal bone is complete at about age of 10 b, Both endochondral and periosteal activity are important in the growth of mandible cc. Manilla postnataly grow purely through {ntramembrancous means 4. All of the above Ans. (d), AUl of the above. ‘ontemporary Orthodonties- William R. Profit, page 45-47. Q. 34, Which of the following is true for ‘crouzen syndrome: a. Itis characterized by the underdevelop- ‘ment of midface and eyes b. Ttarises due to prenatal fusion of supe- rior and posterior sutures of the maxilla, ‘along the wall of the orbit c. Premature fusion of suture extending to cranium, may leads to distoration of cranial vault 4. All of the above ‘Ans, (d). All of the above. Ref: Contemporary Orthodontics-William R Profit, page 76. Q. a5, Before puberty, mandibular ramus height increases: a, 1-2 mm per year b. 2:3 mm per year 546 m per year 4, 02 to 06 mm per year ‘Ans, (b).2-3 mm per year. The mandibular body length increase by 2-3 mm per year before puberty profit growth Refs Contemporary Orthodontics-William_ R. Profit, page 76 Q, 36, Which of the following is a terato- gen for the development of cleft lip and b. Dilantin d._ All of the above ‘Ans. (d). All of the above. Refi: Contemporary Orthodontics-Wiliam R. Profit, page 131 , 37, Rubella virus can induce which of the following dentofacial deformations: ‘8, Microphathalmia b, Cataracts Deafness: <4. All of the above ‘Ans. (d). All of the above. Refi: Contemporary Orthodontice-William R. Profitt, page 131. c. Valium 9 Es ey 3 a 2 2 8Cephalometry Jaspal Singh * Dr. BH. Broadbent (1981), an orthodontist, developed radiographic cephalometrics as a method to study the growth and development of the craniofacial complex. *+ Cephalometric radiography isa standardized and reproducible form of skull radiography utilized to assessthe relationship of the teeth to the jaws and the jaws to the facial skeleton. * Cephalometry-A scientific study of the measurement of the head with relation to specific reference points to assess facial growth and development. ‘+ Cephalometric equipment consists of 1. An X-ray apparatus 2. An image receptor system 3. A cephalostat or head holder. The image receptor in lateral cephalometric technique consists of extraoral film, intensifying screen, A cassette, grid and a soft tisoue shield. ‘The distances between X-ray source and the center of the subject are 5 feet (152.4 em) or 150 cm. The distance between subject and film is usually 12cm butmay be standardized at a different value or varied with patient size and recorded for each exposure. ‘+ The rationale of cephalometry is to study craniofacial growth, to diagnose the craniofacial deformity, to plane the orthodontic treatment and to evaluate the progress of treatment and treated cases. ‘+ The two standard cephalometric orientations are lateral and posteroanterior. ‘The detail discussion of cophalometry has been taken in the chapter 93 of section 6. The readers are referred to the section 93. 1. Which of the following is called subspinale: a. PLA bv PB ©. Gonlon a. Menton Ans. (a). Point A which represents the deepest point in the midline between the anterior nasal spine and the alveolar erest between the two central incisors. Point A is also known as subspinale, . 2. The plane which connect orbitale and porion refers to: ‘a, Frankfort horizontal plane ». Bolton’ plane ©. Occlusal plane . Mandibular plane ‘Ans. (a). The plane which connect porion ‘and orbitale is known as Frankfort plane. Q. 3, The line which connect nasion to pogenian is called: a. Facial plane », Facial axis . Mandibular plane dd. Occlusal plane ‘Ans, (a), Facial plane. Facial axis is a line from Pim pont to gnathion. Q. 4, According to steiner, mandibular plane is: a. A line connecting gonian and menton . A line connecting gonian and gnathion «. A line connecting nasion and pogonian d. A line connecting basion and nasion Ans, (b), In down’s anolysis, mandibular pplaneisaline connecting gonian and menton. In Tweed analysis, Mandibular plane is tangent to the lower border of the mandible. Q. 5. The facial angle is in the range of: a. 82-95 b. 62.75 80-65 4. 100-120 Ans, (a). 82-95 degree with an average value of 87. 8 degree Q. 6. An increase indicat a. Class It div 11 . Class It div IL ©. Clase 11 . None of the above ‘Ans, (d), Facial angle inereases in skeletal class IIT with prominent chin. It decreases fn skeletal class 1 facial angle will Q. 7. The mean value of mandibular plane angle a. 21.9 degree ——b.-46 degree ©. 878 degre d._-9.3 degree ‘Ans. (a). 21. 9 degree. The range is 17-28, degree. Q.8. Y axis is: a. Angle formed by joining the sella ~gna- thion ine with Frankfurt horizontal plane b. A line connecting nasion to pogonion c. Angle formed b/w the occlusal plane and Frankfurt horizontal plane 4. None of the above ‘Ans, (a). Angle formed by joining the sella “gnathion line with Frankfurt horizontal plane >. Y axis Cant of ocelusal plane 4d. SNA angle ‘Ans. (b). ¥ axis is also known as growth ‘axis as it indicates the growth pattern of the individual. The mean value of y axis is 59 degree with a range of 53-66 degree Q. 10, The average value of SNA angle is: 1. 80 degree b. 82 degree 87. 8dogree —d. 60 degree ‘Ans. (b). 82 degree. SNA angle is formed by the intersection of SN plane and a line joining nasion and point A. This angle indicates anterioposterior postioning of the maxilla in relation to the cranial base. Q. 11, An increase in SNB angle indicates 9 Class IIE b. Class If div c. Class Iidiv Id. Class 1 ‘Ans. (a). Increase in SNB angle indicates ‘lass II or prognathic mandible. Decrease in this angle indicates class I. The average value ofthis angle is 80 degree. SNB is the angle formed b/w the SN plane and a line joining nasion to point B Q. 12, An increase in SNA indicates: a. Class It ’. Class It €. Pseudo clase Id. Class 1 Ans, (b). Class IT Q.13. The highest point in the upward curvature of the retrocondylar fossa of the occipital bone: ‘a. Bolton point —_b. Baslon « Prion 4. Pogonion ‘Ans. (a). Bolton point Refs Contemporary orthodontics-William R. Profitt, page 206. Q. 14. The lowest point on the anterior margin of the foramen magnum, at the base of the clivus: ‘2. Bolton point «. Porion Ans. (b). Basion . Basion 4. Pogonion Gephalomety exo thy Ref: Contemporary orthodontics William R. Profit, page 206. Q. 15, The point of intersection between, the shadow of the zygomatic arch and the posterior border of the mandibular a. Articular ©. Gorion ‘Ans, (2). Articular Ref: Contemporary orthodontics-William R. Profit, page 206. b. Orbitale 4. Pogonion. Q. 16, The midpoint of the upper contour of the external auditory canal: a Porion . Pogonion © Menton 4. Point B Ans. (). Porion Ref Contemporary Orthodontics- William R. Profit, page 206. Q. 17. The innermost point on the contour of the premaxilla between anterior nasal spine and the incisor tooth: 1 Point A. b. Point B . ANS a Sella ‘Ans. (a). Point A {Q. 18. The innermost point on the contour of the mandible between the incisor tooth and the bony chin: a. Point A ANS (b). Point B ‘ontemporary Orthodontice-William R, Profit, page 206 (Q. 19, The most anterior point on the con- b. Point B 4. Sella Ans, (b). Pogonion. Menton -the most inferior point on the mandibular symphysis Ge, the bottom of the chin). Gonion is the midpoint of the contour connecting the ramus and body of the mandible Ref: Contemporary orthodontics-William R. Profit, page 206. Q. 20, The best anatomic indicator of the true or physiologic horizontal plane is: a. SN plane b. Frankfort plane ©. Y ads 4. Bolton plane ‘Ans. (b). Frankfort plane Refs Contemporary ortiodonties-William R Proftt, page 207 Q. 21. The norm for ANB angle is: a2 b.8 © 16 a. 80 soquopoy0 a cs a = S = 2 iS =‘Ans. (a). The mean value is 2 degree. An ‘increase in this angle indicat class Il skeletal tendency. Deerease in angle or a negative angle indicates class It relationshiy Q. 22. If SNA is greater than 84 degree, ‘which of the following is interpreted: a. Maxillary protrusion 1b. Maxillary retrusion ‘©. Mandibular protrusion @. Normal maxillary architecture ‘Ans. (a). Maxillary protrusion Ref: Contemporary orthodontics-William: R. Profit, page 208. (Q. 23. The magnitude of ANB angle is influenced by: 8 Antsiopoteie diference in jaw post . Vertical ht of the face ‘. Abnormal anterioposterior position of nasion 4d. All of the above ‘Ans. (d), All of the above. As the vertical distance between nasion and points A and B increase, the ANB angle will decrease. As SNA and SNB become larger and the jes are more prorusive (evn if thelr horizontal ‘elationship is unchenged) ANB angle, will also be larger Contemporary orthodontics William R. Profit, page 208. Q. 24. Holdaway ratio refers to: 4. Relationship b/w SNA and SNB ’. B/W Pogonion and the prominence of chin, . Relationship b/w SNA, SNB and ANB 4. Relationship b/w point A and mention Ans. (b). More is the prominence of chin, ‘more prominent willbe the lower incisors or vice versa. This relationship is referred to as, Hold away ratio. Q. 25. The normal mean value of occlusal plane angle is: a. 14.5 degree —_b. 25.5 degree c. 40 degree . 82.5 degree Ans. (a). 145 degree. The occlusal plane angle is formed between the occlusal plane and the SN plane. This angle indicates the :elation ofthe occlusal plane to the cranium and the face. It also indicates the growth pattern of an individual Q. 26. The average value of interincisal angle is: a. 100 b, 1354 © 10.5 d. 90 Ans. (b). The range is 130-1505 degree, The angle is decreased in class 1 bimaxillary protrusion and class Il div J, whereas itis. Jnezeased in class I! div I, (0. 27. The average value of incisor mandi- ular plane angle is: ald b 123 e155 d. 38.4 Ans. (a). 14 the range is-85 to 7 degree. ‘An increase in this angle indicates lower ‘incisor proctination. {Q.28. The lower most point on the contour of the anterior wall of the infratemporal fossa is called: b. Glabella 4. Articulace ‘Ans. (a). The lower most point on the contour of the anterior wall of the indratemporal fossa is called Kay ridge.Biomechanics of Tooth Movement Jaspal Singh, Sudanshu Kansal Biomechanics is the study of the biological reaction to the mechanical forces. Factor affecting the tooth movement T. Type and the amount ofthe force applied-The force applied may be continuous, interrupted and intermittent type. The amount of force applied is either light or heavy. 2, Duration of the force applied~A continuous light force may be more detrimental than the heavy force applied for a shorter duration. 3. Direction of the force applied. ‘4. Age of the patient-In adult the tooth movement is slower as compared to that in children. ‘Type of the tooth movement * Physiological-Normal or natural tooth movement- Example 1. Tooth eruption. 2. Axial movement of tooth from developmental site to the occlsual plane. 3. Tooth migration or drift 4. Changes in tooth position during mastication. ‘+ Pathological-Tooth movement secondary to periodontal pathology. or trauma, + Orthodontic tooth movement-The intentional induced movement ofthe tooth in response to applied orthodontic force. “The type of the orthodontic movement depends on the amount, direction and the duration of the force applied. ‘The type of the orthodontic tooth movement © Tipping-it is the simplest form of orthodontic. Tooth movement produced when single force is applied. The tooth rotates around its center of resistance producing diagonal opposite areas of compression and tension within the periodontal ligament. During tipping the crown of the tooth moves much more than does the root ‘Translation or bodily movement of the tooth-In this type of movement, crown and root are moved in the same direction at the same time. Rotation-The movement of the tooth around its long axis. Ibis a difficult type of tooth movement to correct and retain. ‘There is high relapse risk with rotation because of presence of elastic fibers in supra alveolar tissue. Intrusion-The movement of the tooth in an apical direction. This movement requires very light forces. Extrusion-The movement ofthe tooth in an occlusal or incisal direction. This is the easiest of all movements. ‘Torque-The movement of the root with minimal movement of crown. + Uprighting-The orthodontic tooth movernent results from the consistent force or pressure application on the healthy tooth.iii 652 comprehensive Review of Ginical Dental Sciences 8 e 5 3 8 2 = 6 ‘Theories of tooth movement * Pressure tension theory of Schwarz~This is the simplest and the most widely accepted theory. According to this theory, the pressure and tension zone are created on application of force on the tooth. The pressure zone is characterized by ‘compression of periodontal ligament and subsequent bone resorption on the side of the pressure. On the side of the tension, there occurs stretching of the periodontal ligament and subsequently apposition or deposition of the bone. * Fluid dynamic or blood flow theory-This theory was proposed by Bein. According to this theory, the tooth movement occurs as result of alterations in fluid dynamics of the periodontal ligament. When an orthodontic force is applied, it leads to compression of the vasculature of periodontal ligament on the Pressure side, with the subsequent stenosis of the blood vessels. The blood vessels beyond the stenosis balloons up, resulting in the formation of aneurysms. The formation of the aneurysm causes the escape of the blood gases out of the vessels into the interstitial spaces. This alteration create a favorable environment far resorption and cellular activity. *+ Piezoelectric theory~This theory is of view that piezoelectric phenomenon is observed in the crystalline structure of the bone. Piezoelectric phenomenon is seen in collagen, hydoxyapatite, collagen-hydroxyappatite interface and mucopolysaccharide component of the ground substance. Peizoelectric phenomenon is flow of electric current on application of force to the crystalline structure. ‘On application of orthodontic farce, the adjacent alveolar bone bends. The cancave area of the deformed bone is associated with negative charge and the bone deposition. The convex area of the deformed bone are associated with positive charge and bone resorption. Phases of the tooth movement * Initial phase is characterized by a sudden displacement of the tooth within its socket. + Lag phase is characterized by no or very litle tooth movement. The lag phase is more longer if heavy forces are applied as more hyalinized area is created. + Post-lag phase is characterized by removal of the hyalinized area and the subsequent tooth movement. ‘= Frontal and undermining resorption * Frontal resorption is seen on the application of the lighter orthodontic forces which leads to slight compression of the Periodontal ligament with intact or patent blood vessels. There occurs litle or no hyalinization, The frontal resorption occurs in the bone immediately adjacent to the ligament. Frontal resorption facilitates orthodontic tooth movement * Undermining bone resorption is seen on application of heavy forces. The heavy force application result in compression of the blood vessels which leads to a gradual shrinkage of the periodontal ligament, with sterile necrosis of cellular structure of periodontal ligament. The area of necrosis have diminished cellularity and are avascular. These are known as hyalinized area, The adjacent undamaged periodontal ligament begin to invade the hyalinized area and the osteoclasts within the adjacent bone marrow spaces begin to remove the bone adjacent to the necrotic periodontal ligament. This process is known as undermining resorption, since the resorplion is from the underside of the lamina dura rather than the periodontal as in frontal resorption. The tooth movement occur following a lag phase, only when the hyalinized tissue disappear. Undermining resorption impedes orthodontic tooth movement. Type of orthodontic forces * Continuous force is the consistent force which is maintained in the subsequent visit of the patient. Such forces are generated by means of spring or elastics, ‘+ Interrupted force are the one in which the force level decline to zer0 after activations. This type of force is produced by certain appliances including the screws. *+ Intermittent force-Ccharacterized by force level declining abruptly to zero intermittently when the orthodontic appliances are removed by the patient. Such force applications are seen with removable appliances, and headgear. * Optimum orthodontic force is the force which produces tooth movement through frontal resorption with minimum tissue damage. The optimum force should maintain the vitality and patency of the periodontal ligament. The calculated ‘optimum orthodontic force is equivalent to capillary pressure or 20-26 gm/sq. cm of the root surface areas. With this foxce application the tooth movement rate equals to 1 mm per month.* Center of resistance-A point at which resistance fo movement can be concentrated for mathematical analysis. The center of resistance of the single rooted tooth is between one third and one half of the root length apical to the alveolar crest. In multirooted teeth, the center of resistance lies between the roots 1-2 mm apical to the fuzcation. The center of resistance varies with the root length, alveolar bone height and the no of roots. Center of resistance is the most important parameter for the adjustment of a desired movement in orthodontic treatment. Center of rotation is a point around which rotation occurs when an object is being moved. This point will vary depending on the force /moment/couple being applied. ‘Moment-A moment isa force acting ata distance from the Center of resistance. A moment is produced when the line of action of a force is at a distance from the center of resistance, the force will produce some rotation. The moment will cause some rotation and translation. The magnitude of a moment = Force x Distance. ‘Torque is a force system. Itis produced by torsion in an arch wire that ereates a couple when interacted with a bracket slot, which is the result of twist in the wire compared to the bracket slot. In orthodontics mechanics, 3rd order twist n the arch wire only produces a couple (torque). When a single force without a couple is applied to a tooth, the apex moves in the opposite direction of the applied force. When a single force is combined with a couple, the tooth spins about a center Of rotation apical to its center of resistance.‘Wal 654 Comprehensive Review of Clinical Dental Sciences g = 6 3 8 2 = 6 Q. 1. The amount of masticatory forces exerted while chewing soft substances is in the range of: a 12 kg D. 25-28 kg. ©. 40-50 kg. 4. 30-35 kg Ans, (a). 1-2 kg. The amount of force exerted on the tooth while chewing soft substances is in the range of 1-2 kg, whereas a hard object may exert up to 50 kg of the food Refi Contemporary Orthodontice-Profil, 2nd dition, page 267. Q. 2, The optimum orthodontic force for moving the tooth is: ‘2. 20-26 gm/sq cm of the root surface , 22-28 gm/sq em of the root surface . 30-32 gm/sq om of the root surface 4. 16-18 gm/sq cm of the root surface ‘Ans. (a) 20-26 gm/sqem of the root surface Q.3. The optimum force for orthodontic tipping movement is: a. 50-75 gram b. 100-150 gram ©. 75-125 gram — d. 15-25 gram ‘Ans. (a). 50-75 gram Q. 4. The optimum force for bodily movement of the the tooth is: a, 50-75 gram b. 100-150 gram ©. 75-125 gram d. 15-25 gram ‘Ans.(b), 100-150 gram . 5. The optimum force for rotation of the tooth is in the range of: a. 50-75 gram b. 100-150 gram © 75-125 gram d. 15-25 gram ‘Ans, (). A optimum orthodontic force for tipping, extrusion, and rotation is in the range of 50-75 gram. Optimum orthodontic force for bodily movernent is 100-150 grams. Optimum orthodontic force for root uprighting is 75-125 gram. Refs: Contemporary orthodontics-profitt, 2nd edition, page 274 Q. 6 The tissue degeneration charac terized by the formation of clear eosino- hillic homogenous substance is called: a. Coagulation necrosis b. Hyalinization <. Liquefacative necrosis, . None of the above ‘Ans. (b). Hyalinization Hiyalinization is a tissue degeneration which histologically gives an appearance as the cells disappear and is characterized by the formation of a clear eosinophilic homo- genous avascular substance. Hyalinization of periodontal ligament results due to compression and subsequent degeneration of the tissue following the application of heavy orthodontic forces. It is a reversible process, however hyalinization in other tissue of the body isa irreversible process. Ref Contemporary Orthedonties-Profitt, 2nd dition, page 272. Q. 7. Hammock ligament theory of tooth eruption was given by: a. Ponts . Sicher . Ashley's howes d. Mayers Ans. (b).Sicher . 8 Fluid dynamic theory of tooth move- ment was given bj a. Bien ©. Farrar b. Oppenheim 4. Ponts Ans. (a) Bien Q.9. The orthodontic force where the force evel decline to zero b/w activation is Known a a. Continuous force >. Intermittant force ¢. Interrupted force . None of the above ‘Ans. (¢). The force where the level decline to zero b/w activation is known as interrupted force. Intermittent force is one ‘here the force level decline abruptly to 2er0 intermittently when the pt remove the ‘appliance. In continuous, the force is maintained at some approciable fraction of ‘the original from one pt vist to the next. Ref: Contemporary Orthodontics, -William R. Profit, page 275. . 10, The force exerted by light wire appliance is of which of the following nature: ‘a. Continuous force bi. Intermittant force €, Interrupted force 4, None of the above ‘Ans.(a). Continuous force. Q. 11, Which of the following tooth move- ment are not physiological: a. Tooth eruption . Mesial drifting of teeth ¢. Alteration of tooth positioning during mastication 4, Tooth movement following fixed ortho- dontic therapy Ans. (). Tooth movement following fixed ‘orthodontic therapy Q. 12. The likely chances of root resorp- tion following orthodontic therapy are more in which of the following cas 1, Teeth with conical root having pointed apices . Dilacerated root c. History of trauma 4. All of the above ‘Ans, (@) In all the cases the root resorption chances following orthodontic therapy are ‘more, Other risk factors include lingual plate approximation, maxillary surgery, torque, extraction, mandibular surgery Ref: Contemporary Orthodontics, Wiliam B. Profit, page 279. Q.13, Bone and piezoelectric theory of tooth movement was given by: a. Farrar b. Oppenheim «. Schwarz 4. Sicher ‘Ans. (a), Farrar. Oppenheim proposed pprosoure tension theory. Q. 14. The ‘movement is: a. Intrusion ©. Tipping Ans. (0. implest form of the tooth >. Extrusion 4. Uprighting Tipping Q. 15, The center of resistance of maxilla Ties: a. Canine fossa b. Infraorbital region ¢. Pterygomaxillary fissure . Maxillary tuberosity Ans. (0. Plerygomaxillary fissure Q. 16, Which of the following has piezo- electric properties: a. Collagen b. Hydoxryapatite ‘c. Mucopolysaccharide . All of the above ‘Ans, (d). All of the above Q. 17. Center of resistance in multirooted ‘tooth lies in: a. Middle of the root apical to the alveolar crest b. B/W 1/3 and 1/2 of the root apical to the alveolar crest inthe apical third ofthe root ©. B/W the root 1-2 mm apical to the furcation 4d, Cervical thd of the root ‘Ans. (d). B/W the root 1-2 mm apical to the furcation. Q. 18. Center of resistance in single rooted tooth Les in: 1a. Middle of the root apical to the alveolar b. B/W1/3 and 1/2 of the root apical to the alveolar crest in the apical third of the rootB/W the root 1-2 mm apical to the farcation 4. Cervical third of root ‘Ans. (b). B/W 1/3 and ¥4 of the root apical to the alveolar crest Q. 19. Which of the following factor can change the position of the center of resistance: 1. Root length and alveolar bone height . Thickness of the root 4. All ofthe above 1d. None of the abowe ‘Ans. (a). Root length and alveolar bone height, (Q. 20. The simplest ofthe tooth movement b. Extrusion 4. Uprighting ‘a. Intrusion ©. Tipping Ans. (0. Tipping Q.21. The extra oral appliance for maxi mum skeletal change should be worn daily for atleast: 2. 68 hee b. 8.10 hrs/day © I2ld hrs/day 4. 4-6 hrs/day Aas. (@). 12-14 hrs/day Q. 22. The forward mandibular displace- ‘ment of 1mm will create an extra force of a. 100 gm b. 200 gm ©. 300 gm 4. 500 gm ‘Ans. (2). 100 gm Q. 25. Functional appliances should be dest used during following period of growth and development 8. Prepubescent —-b. Pubescent . Adulthood d._ Adolescence Ans. (a). Prepubescent Q. 24. the periodontal pain is normally experienced after how many second of heavy force application: a. Immediately b. <1s cc 1-2second 3-5 second ‘Ans. (@). 35 seconds. Periodontal pain is experienced after 35 second of heavy force Biomechanics of Tooth Movement 655 tat application, indicating that the fluids are ‘expressed and crushing pressure is applied against the PDL in this amount of time. (0.25. Which of the following is true about ITI wire: fa. Have sharp memory b. Are superelastic ¢. Can exist in more than one crystal form 4. All of the above ‘Ans. (d). All of the above. The two of the remarkable properties of NITT wire that are ‘unique in dentistry is its sharp memory and superelasticity lke stainless steel and other ‘metal alloy it can exist in more than one crystal form. The martensite form exists at lower temperature, the austenite form at higher temperature. Refi: Contemporary orthodontics, -Willian R. Profit, page 281. Q. 26. The bodily movement of tooth. requires a moment to force ratio of: a. 81 to 10, b. 2A to 3d ©. 5 to 6 4. 0.51 to ta ‘Ans, (2), Bodily movement requires a moment to force ratio of 8:1 to 10;1 depending on the length ofthe root. Higher moment to root ratio produces more root movement than the crown movement. The ‘amount of force exerted on the tooth while ‘chewing soft substances is in the range of I= 2 kg, whereas a hard object may exert up t0 50 kg of the food. Ref: Contemporary Orthodontics-Profit, 2nd tition, page 267. Q.27. The moment is defined as: ‘2. Force x modulus of elasticity 1b. Force x distance from center of resistance «. Force x distance from center of rotation 4. Force * velocity Ans. (Q. Force x distance from center of rotation Q. 28 The level of which of the following mediator increases within few minutes after the application of pressure: a. Prostaglandin ’. Interleukin-1 beta level ©. Nitric oxide 4. All of the above ‘Ans. (@). The level of prostaglandin, interleukin-lbetalevel is increased within short time of pressure application to the tooth. Other chemical messenger parti- cularly, member of eytokiene, nitric oxides are also involved. Ref: Contemporary Orthodontice-Profit, 2nd edition, page 33. Q. 29. With application of light pressure the tooth movement begin: ‘a. Immediately . Within a day Within 2 days d. By 10th day ‘Ans. (c). Within 2 days Ref: Contemporary Orthodontics-proftt, 2nd edition, page 338. Q. 30, Which of the following produces intermittent forces: a. Removable appliances b. Headgear ©. Elastics 4. All ofthe above ‘Ans. (2). All of the above. Ref: Contemporary Orthodontce-Profit, 2nd edition, page 341. Q.31. Orthodontic tooth movement may be difficult in pt taking: a. Corticosteroid b. Indomethacin «. Biophosphonates such as alendronate 4. All of the above ‘Ans, (All of the above. Prostaglandin is fa primary mediator of tooth movement. Corticosteroids inhibits the synthesis of arachidonic acid from which prostaglandin fare formed. Indomethacin is a prostaglandin inhibitor. Biophosphonates inhibits the ‘osteoclast mediated bone resorption and thus interfere with bone remodeling essential for tooth movement. 2 = 3 3 S =Anchorage Jaspal Singh, Sudanshu Kansal + Anchorage in orthodontics refers to the nature and degree ofthe resistance to displacement offered by an anatomic anit when used for their purpose of effecting tooth movement. + Itis the site of delivery from which force is exerted. Sources of Anchorage Intraoral-Teeth, oral mucosa, underlying bone , implants, + Extraoral-Head, occipital bone , parietal bone, cervical area, facial bone and chin, ‘Types of Anchorage ** Stationary anchorage is one in which the manner and application of force tend to displace the anchorage unit bodily in the plane of the space in which the force is applied. Example of stationary anchorage is the retraction of maxillary incisors, using the first molars as the anchorage unit, + Simple anchorage is one in which the manner and application of force is such that it tends to change the axial inclination, of the tooth or teeth that form the anchorage unit in the plane of space in which the force is applied. Example of simple anchorage -retraction of upper teeth with the hawleys appliance, the movement of a single tooth using screw appliance. * Reciprocal anchorage is one in which the resistance of one or more dental units is utilized to move one or more opposing dental units. Example-Crossbiteelastis- to correct molar cross bite closure of midline diastema and expansion appliances + Intraoral anchorage is one in which all the resistance unit are situated in the oral cavity + Extraoral anchorage is one in which one of the anchorage unit is situated extraorally * Intramaxillary anchorage~All the anchorage unit are within the same jaw. + Intermaxillary anchorage-The resistance unit or anchorage from one jaw is used to effect tooth movement in the opposite jaw. Intermaxillary anchorage is also known as baker's anchorage. ‘+ Multiple anchorage or reinforced anchorage-Anchorage utilizing more than one type of anchorage unit. Example- The use of head gear along with routine mechanotherapy or extraoral anchorage, the intra arch compound anchorage or the use of a transpalatal arch in fixed mechanotherapy single or primary anchorage. Factor affecting anchorage * Tooth factor-The variation in size, shape, length, periodontal support of the teeth are the factor which can influence the individual anchoring potential ofthe teeth * Root form of the teeth-The roots of al the teeth may have either Round, flat and triangular shape or form. The round root form can tense 50 percent of the periodontal fibers to resist force. The resistance is same in all the direction. Flat root can also tense 50 percent of their periodontal fiber. They resist the tooth movement better in mesiodistal direction . The resistance in buccolingual direction is comparatively less. ‘The triangular root can tense two third of their periodontal fiber and provide better anchorage. * Size of roots-The longer or larger root have more anchorage potential ‘+ Number of roots-The multirooted teeth have greater surface area and due to the reason, have greater anchorage potentialRoot formation-Incompletely formed root have less anchorage potential Position of the tooth-The respective position of the tooth within the arch can influence the anchorage potential of the ‘teeth. For example the mandibular second premolar due to its location between extemal oblique ridge and mylohyoid sidge have a better anchorage potential. ‘Tooth inclination-The teeth inclined in a direction opposite to the force applied have a better anchorage potential. Contact points-Teeth with wide, tight and broad contact exert greater anchorage potential. Intercuspation of the teeth-Good intercuspation result in better anchorage. Tripod arrangement of roots in maxillary molar increases the anchorage potential of the maxillary molar. ‘The round palatal root resists the extrusion, while the fat buccal roots resist intrusion and the mesiodistal stresses. ‘The basal bone (hard palate and lingual surface of the mandible), cortical bone and musculature may be used to augment the anchoring potential of the anchorage unit. Individual anchoring potential ofthe teeth in order of decreasing anchoring potential—Mandibular molars>maxillary ‘cuspids>mandibular cuspids>maxillary molars>maxillary central>mandibular bicuspids>maxillary bicuspids> maxillary laterals>mandibular centrals and laterals. “Anchorage loss is the movement of the anchor unit instead of the teeth to be moved. ‘Sign of Anchorage loss-Mesial migration of posterior teeth, closure of extraction space by movement of posterior ‘teeth, increase in overjet, proclination of anterior teeth, Buccal crossbite of posterior teeth and change in molar relationship.‘Wii 658 Comprehensive Review of Gnical Dental Scienoss Orthodontics < Co g nN a Q = is) ra 7) Q. 1. Which of the following root form provides the maximum resistance to displacement: a. Round root form b. Flat root form €. Triangular root form 4. Resistance is equal in all cases ‘Ans. (€). Triangular root form. Maxillary ‘canine and the root of lateral incisors have the maximum resistance to displacement compared to other form. Q. 2. The example of reciprocal anchorage fs a. Correction of midline diastema by moving two teeth towards ench of ther b. Dental arch expansion . The use of crossbite elastics d. All of the above Ans. (d). All of the above Q. 3. Anchorage for maxillary retraction is obtained from: a Skull plus forehead . From chin . Chin plus forehead 4. All of the above Ans. (d). All of the above Q. 4. Which of the following can be dee- cribed as absolute anchorage: a. Skelatal anchorage . Reinforced anchorage . Reciprocal anchorage 4. Sationary anchorage ‘Ans. (a). Skeletal anchorage Ref: Contemporary Orthodontics Profitt 2nd edition, page 347 .5. Absolute anchorage meat a, No other tooth movement other than the desired tooth movement b. Minimal anchorage loss ©. Anchorage provided by multiple no of teeth 4. Anchorage provided by ankylosed teeth ‘Ans. (a). There is zero anchorage loss in absolute anchorage. Reference- Ref.: Contemporary orthodontics-profit 2nd edition page 347 Q. 6. Which of the following is an example raoral reinforced anchorage: a. Face mask and head gear b. Reverse head gear © Chin cup 4, Tranpalatal arch or nance type arch ‘Ans. (@). Tranpalatal arch or nance type arch . 7. Minimal anchorage is: 1. Also known as absolute anchorage b. Anchorage in which 1/2 of the extraction space is utilized by anchor unit and the rest of space by moving unit . Anchorage in which 2/8 ofthe extraction space is utilized by movement of the anchor unit and rest by the moving unit 4. 3/4 of the extraction space is utilized by the moving unit and restby the anchor Ans, (0), Anchorage in which 2/3 of the ‘extraction space is utilized by movement of the anchor unit and rest by the moving, unit Q. 8. The ratio of PDI. area in anchorage ‘unit to PDL area in tooth movement unit (without friction) should be at least ak be Ls: d et a2 ‘Ans. (c). 2 with fiction the ratio should be 1 Ref Contemporery Orthodontics Profit, 2nd edition page 380 . 9, Which of the following anchorage is also known as bakers anchorage: a. Intermaxillary anchorage ». Intramaxillary anchorage . Extraoral anchorage 4. None of the above ‘Ans. (a). Intermaxillary anchorage Refs Textbook of Orthodontics, Curkirat singh, Ast edition, page 237. . 10, Which of the following can be used for intraoral anchorage: 1. The alveolar bone, cortical bone and basal bone b. Teoth and musculature . Cortical bene and basal bone 44. All of the above Ans. (d). All of the above. Refs Grabber, 3rd edition, page 522. Q. 11, Which of the following is true: a. The larger or longer the roots the more is their anchorage potential ’. When the tooth is inclined inthe opposite direction to that of the force applied, it provides greater resistance to anchorage ce. Teoth with incomplete root formation provide lesser anchorage 4d. All of the above ‘Ans. (d). All of the above. Ref: Textbook of Orthodontes-Guakinat singh, Ist edition, page 235. Q. 12, Arch expansion using the midline screw is an example of fa. Stationary anchorage ». Reciprocal anchorage ©. Compound anchorage 4. Reinforced anchorage Aas. (b). Reciprocal anchorage. Cross elastics to correct molar cross bite and the molar rotator are also the example of reciprocal anchorage. Ref: Textbook of Orthodontics, Gurknat singh, 1st edition, page 238 Q. 13. According to tweed , third degree anchorage preparation is indicated in the ‘eases with: 1. ANB angle less than or equal to 5 degree ‘and the total discrepancy of 14-20 min b. ANB angle exceeding 4. 5 degree with a class Il profile ¢. ANB angle equal to or leas than to 4 degree 4. None of the above Ans. (9. First degree or minimal anchorage ‘Preparation is forthe cases where the facial, esthetics were good with an ANB angle equal to or less than 0 to 4 degree and the total discrepency of less than oF equal to 10, ‘mm. Second degree anchorage preparation, {is usually required in cases where the ANB. angle exceeds 4. 5 degree with a class I profile Ref: Textbook of Orthodontics-Gurkirat singh, 1st edition, page 241 Q-14. Upper anterior teeth retraction with help of a hawleys appliance is an example of a. Stationary anchorage bi, Simple anchorage . Reinforced anchorage 4. Compound anchorage Ans. (d). Compound anchorage Ref: Textbook of Orthodontics-Curkiat singh, 1st edition, page 237.Preventive and Interceptive Orthodontics Jaspal Singh © Preventive orthodontics are the treatment modalities that are intended to prevent the development of a malocclusion by maintaining the integrity of an otherwise normally developing dentition. ‘© Graber has defined preventive orthodontic as the action taken to preserve the integrity of what appears to be a normal ‘occlusion at the specific time. + ‘The procedure undertaken as a part of preventive orthodontics include pit and fissure sealant, space maintenance, treatment of ankylosis, management of high frenal attachment, removal of occlusal prematurities, extraction of supernumery teeth and patient education, ‘ Interceptive orthodontics is that phase of orthodontics which is concemned with elimination or reduction of the severity of a developing malocclusion. + "The procedure undertaken in interceptive orthodontic include those treatment modalities which are undertaken to ‘recognize and eliminate the potential irregularities in the developing dentofacial complex. «© The procedure taken as a part of interceptive orthodontics include serial extraction, interception of parafunctional oral habits, correction of diastema, interception of developing crossbite, removal of hinderance to the eruption of teeth, space regaining and muscle exercises. ‘The suibject has been reviewed in chapter 100 and 101 of the section 6.‘Wil 660 Comprehensive Reviewof inical Dental Sciences Orthodontics = ~ z S = G hy a Q. 1. Lingual arch space maintainer is indicated in: 4. Bilateral multiple loss of primary molars in lower arch b, Bilateral maltiple loss of primary molar in upper arch ©. Unilateral multiple loss of primary molars in upper arch 4. Unilteral loss of single primary molar in the lower arch ‘Ans. (b). Bilateral multiple loss of primary molar in upper arch Q. 2, Serial extraction therapy was introduced by a, Hotz ©. Nance Ans. (b). Kjellgren b. Kjellgren @. Dewel Q 3, Serial extraction is contraindicated in case of: 1. Oligodontia . Open bite /deep bite . Class If /class IIT malocclusion d. All of the above ‘Ans (@). All of the above Q. 4. Which of the following is the sign of arch Length deficiency: a. Localized gingival recession in the lower anterior region ’. Unilateral or bilateral premature loss of deciduous canine with midline shift ‘c. Malpositioned lateral incisors 4. All of the above ‘Ans, (d). All of the above Q. 5. Dewel’s method of serial extraction indicates extraction of: a. CD4 b. 4DC . DC4 4. Dac Ans. (a). CD4 Q. 6. Nance method of serial extraction indicate extraction sequance of: a. DAC ©. 4DC ‘Ans. (a), D&C Q. 7. Which of the following is a method of gaining space: ‘a. Uprighting of molars Db. Distalization of molars . Derotation of molars a. All of the above ‘Ans, (d). All of the above Q. 8. Transpaltal arch space maintainer is indicated in: a, Bilateral multiple loss of primary molars in lower arch b. Bilateral multiple loss of primary molar in upper arch ©. Unilateral multiple loss of primary molars in upper erch 4. None of the above Ans. (Q. Unilateral multiple loss of primary molars in upper arch . 9. The amount of space which can be ined by tipping back the permanent first molar distally after the mesial ‘migration of later following premature Joss of primary second molar: a imm b 2mm ©. 3mm d. 5mm, ‘Ans. (€), 8 mm for bilaterally premature loss of primary second molar, the space regaining limit is 5-6 mm. Q. 10. The rate of slow expansion of ‘maxilla by mean of expansion screw is: a.imm/day —b. 2mm/day Lmm/week — d. 3 mm/week Ans. (@). 1 mm/week. Rapid maxillary expansion is done at the rate of 0. 5 to. 1 mm/day. Ref: Contemporary Orthodonties-Profit, 2nd edition, page 285 Q. 11. One centimeter of maxillary expansion can be obtained by RME in: a. 27 days b. 812 days: ©. 2-3 weeks 4. 45 weeks ‘Ans. (@), 2-3 weeks. Refs Contemporary Orthodontics-Proft, 2nd edition, page 286. Q. 12, Anterior tongue thrust is classified by james braner and holt as: a. Typel b. Type I ©. Type Il 4. Type IV ‘Ans. (6). Type IT Q. 13. Which of the following may leads to anterior open bite: a. Anterior tongue thrust bs, Digit sucking habit . Mouth breathing 4. All of the above ‘Ans, (d), All of the above. Refi: Text book of Orthodonties-Gursewak singh, Ist edition, pag 598. Q. 14. Which of the following is a mean to treat posterior crossbite: a. Quad helix appliance b. Ni Ti Expander ¢. Hyrax screw type of expansion appliance 4. All of the above ‘Ans. (d). All of the above. Ref. Textbook of Orthodontics-Gursewak singh, Ist edition, page 613-15, . 15. Which of the following is a mean to treat developing class IIT malocclusion: ‘a. Frankel I appliance . The chin cup ©. RME with anterior face mask d. All of the above ‘Ans. (d). All of the above. Ref: Textbook of Orthodontics-Gursewak singh, 1st edition, page 586. Q. 16, Serial extraction is indicated i 2. Class T . Class I Class 11 4. Class Il div 1 ‘Ans, (a). Class 1 Q..17. Which of the following is a indi- cation of serial extraction: 2. Lingual eruption of lateral incisors 1b, Mesial drift of buccal segments © Unilateral deciduous canine loss and shift to the same side 4. All of the above ‘Ans. (d). All of the above Ref: Graber, page 717. Q. 18. The most common problem with lingual arch space mainter is: 2. Patient compliance 1b. Breakage distortion and loss ©. Cost 4. Difficulties in fabrication Ans, (b), Breakage distortion and loss Ref: Contemporary Orthodonties-Profit, 2nd edition, page 475 Q. 19, Amount of ant ‘can be space which ined by the procedure of disking, in order to relieve the anterior ‘crowding: a. 12mm b. 3-4 mm 5.6mm 4. 7-8 mm Ans. (b). 34mm, Refs Contemporary Orthodontis-Profitt, 2nd edition, page 481 Q. 20. Which appliance is best to hold the maxillary molars in their postionafter ‘their distilisation till from their ectopic position: a. Hawley’s appliance ', Transpalatal arch, «. Nance appliance 4. Lingual arch ‘Ans.(). Nance appliance Refi: Contemporary Orthodontcs-Profit 2nd edition page 489 Q. 21. Which of the following is a inter- ceptive procedure: a. Managment of developing parafunc- tional habit 1. Space regaining . Serial extraction, 4. All of the above Ans. (@). All of the above. 22. Which of the following is a preven- five procedure: 4. Space maintenance '. Pit and fissure sealant «. Topical fluoride application €. All of the above ‘Ans, (d), All of the abo Q. 23. Sved appliance ‘8. Modified anterior bite plane ’. Posterior bite plane ‘c. Haviley appliance incorporating Z spring 4, Distal shoe space maintainer ‘Aas. (a). Modified anterior bite plane Q. 24, Roche appliance ist f. Upper lingual arch with acrylic button ». Removable expansion appliance . Hawley appliance incorporating Z spring, 4. Distal shoe space maintainer ‘Ans, (@). Distal shoe space maintainer Q. 25, Free ended spring used for the la- bial movement of tooth in erossbite ‘a. Mattress spring b. T spring . Finger spring d. None of the above Aas. (a). Mattress spring, Q. 26, The objective of interceptive ortho- dontic is: a. Attain genetic growth potential \. Establish normal relationships . Remove functional interferences 4. All ofthe above ‘Ans. (d), All of the above Q. 27. Dunlop hypothesis is an approach to manay a. Mouth breathing habit . Thumb sucking ©. Tongue thrusting 4d. All of the above Ans. (b). Thumb sucking Q. 28, Blue grass appliance is used to ‘manage: 1. Mouth breathing habit '. Thumb sucking . Tongue thrusting . All of the above ‘Ans. (b). Thumb sucking Q. 29. The optimal time of placement of (thumb sucking appliance is: a. 23 year Bb. 25 to 45 yoar 65-75 yer d. 89 year Ans. (b) 3.5 to 45 year 30. The tongue thrusting can be inter cepted through: a. Cab appliance '. Oral sereen ‘c. Myofunctional trainer d. Al of the above ‘Ans. (@). All of the above Q. 31. Developing anterior crossbite can be intercepted through: ‘a. Tongue blade therapy . Catlans appliance ‘¢. Hawley appliance with double cantilever spring 4. All of the above ‘Ans. (@). All of the above (2, The apace cam be regained through the eo uh 1. Activated lingual arch © Open col eping @. Allo the above ‘Ans. (All of the above Q..33, Lee way space of nance aids in: ‘a. Permanent molar occlusion. - . Overcoming the incisal liability ‘Ib also known as anthropoid spaces 4. All of the above ‘Ans. (a). Permanent molar occlusion Q. 34. Who said, the tumb sucking habit is due to inherent sucking reflex: a. Johnson and Larson 1. Benjamin ©. Froud . Sear and wise Ans. (a). Johnson and Larson Q. 35. Thumb fully contact with palatal vault without any contact with mandibular incisors is classified according to subtenley at a. Group T b. Group It Group IIT . Group 1V ‘Ans. (@. Group Tit Q. 36. Hay rake appliance is used to manage: ‘a. Mouth breathing habit . Thumb sucking ‘c. Tongue thrusting 4. Lip sucking. ‘Ans. (b). Thumb sucking Q. 37. Type IIT is: a. Deforming anterior tongue trust . Deforming lateral tongue thrust ©. Deforming anterior and lateral tongue thrust 4, Nondeforming tongue thrust ‘Ans. (b). Deforming lateral tongue thrust Q. 38. Correction of dental crossbite in mixed dentition is recommended due to one of the following reasons: 1s eliminates early the functional shit ‘i. Eliminates wear of erupted permanent teeth ¢. Bliminate early the dentoalveolar asymmetry 4. All of the above ‘Ans. @. All of the above. ‘Ref: Contemporary Orthodontics-Proft, 2nd edition, page 437. . 39, Heavy forces and rapid expansion ace not indicated in children due to one Of the following reasons: fa. There is a significant risk of nose distortion 'b, Can cause speech problem ©. There may be aceleraton of the growth of mandible 4. All of the above ‘Ans. (a). There is a significant risk of nose distortion f ef: Contemporary Orthodontce-Profit, 2nd edition, page 47. . 49, Moderate crossbite in children can bbe treated by: ‘a, Equiliberation to climinate the ‘mandibular shift , Expansion of the constricted maxillary arch «. Repoitioning of individual teeth to deal with intraarch symmetries 4. All ofthe above ‘Ans. (. All ofthe above. Refi: Contemporary Orthodonties-Profitt, 2nd edition, page 437. Q. 41, The most frequent ectopic eruption is associated with: a. Permanent maxillary first molar . Permanant maxillary second molar . Permanent mandibular second premolar 4, Permanant mandibular canine Ans. (a). Permanent maxillary first mola Ref: Contemporary Orthodontcs-Proftt, 2nd edition, page 457, Q. 42, Distal shoe space maintainer is indicated in the cases of: ‘2. Unilateral premature loss of primary second molar before the eruption of permanent frst molar Unilateral premature loss of primary first molar before the eruption of permanent first molar «. Unilateral premature loss of primary second molar after the eruption of permanent first molar |. Unilateral premature loss of primary second molar after the eruption of permanent first molara). Unilateral premature loss of ‘Primary second molar before the eruption ‘of permanent first molar ©. 43, Which of the following ‘maintainer will be indicated in patent ‘with bilateral multiple loss of molar in the lower arch with mandibular incisors yet to erupt: a, Partial denture space maintenance i. Bilateral band and loop © Lingual arch 4. Alf the above Ans, (b) Bilateral band and loop. In these cases, because of the Iongth of the eden- tulous space, band and loop space ‘maintainers are contraindicated, and the lingual position of the unerupted incisors and their ikely lingual sition at initial eruption make the lingual arch a oor choice. The partial denture also has the advantage of replacing occlusal function. Ref Contemporary Orthodontis-proft, 2d edition, page 473. . 44. Which space maintainer will be ‘most useful in case of premature bilateral loss of primary molar in child patient with mandibular incisors yet to erupt: 2. A pair of band and loop type of SM . Lingual arch Distal shoe 4. Transpalatal arch, ‘Ans, (a). Before the eruption of permanent incisors if there is premature bilateral loss of primary molar, a pair of band and loop ‘maintainers are recommended instead of the lingual arch, This is advisable because the ‘permanent incisor tooth buds are lingual to the primary incisors and often erupt Lingually, The bilateral band and loops. ‘enable the permanent incisors to erupt ‘without interference from a lingual arch ‘wire. At a later time the two band-and- appliances can be replaced with a single lingual arch if necessary.Removable Orthodontic Appliances Jaspal Singh ‘The removable orthodontic appliances are the appliances which can be removed from the oral cavity and consist of acrylic and wire component. ‘Type of removable appliance * Active removable appliances are designed to bring orthodontic movement of the tooth through the application of forces ‘exerted by active component of appliance which include bow, spring, screw, etc. * Passive removable appliances do not put any pressure on to the teeth and are designed for retentive purpose, e.g. Hawley appliance. ‘Component of removable appliance 1. The acrylic baseplate that covers the palate of the maxilla or the lingual tissue of the mandible. 2. The retentive wire component clasps, pinheads. 3. The active elements-Labial bow, spring, screw and elastic. * Retentive clasp-C dasp, adam dasp, ball clasp, southend calsp, crozat clasp, triangular clasp Schwartz clasp. ‘Adam clasp is one of the most efficient retentive clasp. Its made of 0.7 mm stainless stel wire and consist of two arsow head andl a arrow bridge and two retentive arm. ‘© Schwartz clasp is made of a number of arrowheads which engage proximal undercut between the molars and between premolar and molar. Itis rarely used. + Crozat clasp is a full clasp which has an additional piece of wire soldered which engages the mesial and distal undercut. * Southend clasp is indicated for the anterior region. The wire is adapted along the cervical margin of both the central incisors + Ball-end clasp has a knob or ball like structure on one end. The ball engages the proximal undercut between two adjacent posterior teeth. The clasp is indicated for additional retention. + Spring are the active component of removable appliance and are made up of 05, 0.6 or 0.7 mun in diameter stainless steel wire. Simple spring have no helix and compound spring have helix. The flexibility of the spring is dependent on thickness, length of the spring and the force or pressure applied. The flexibility of spring is related to a formula which =PLS / TA. Dis the deflection, P is pressure/ force and T is thickness, [Type of spring + Finger spring or cantilever spring-It is indicated for mesiodistal movement of teeth. The spring is made of 0.5 mm. stainless steel wire. It consist ofa coil or helix near the point of attachment, free active arm (12-15 mm in length) and a retentive arm which is embedded in the acrylic portion of appliance. The finger spring is activated by opening the coil + Zspring/Double cantilever spring-Itis indicated for moving one or more teeth labially. The spring when used for one tooth is made in 0.5 mum stainless steel wire and in 0.6 to 0.7 mm wire when used for more than two teeth. Spring has ‘a shape of letter Z and has two helix. The spring is activated by opening one or both the helix up to 2-3 mm.‘T- spring is indicated for moving the premolars and canine buceally. Activation is done by pulling the free end of the T- spring towards the buceal direction. Mattress spring free end spring is indicated for labial movement of tooth in cross bite, ‘Helical coil spring are indicated for regaining the space. Coffin spring Omega shaped spring is indicated to bring arch expansion in narrow maxillary arch. ‘Canine retractor are used to bring the distal movement of canines. It an be placed buccally or palaally. There are two design helical or loop. Labial bow is both active and retentive component of removable appliance. It is made of stainless steel wire and consist of two U shaped loop, a bow and two retentive arm. Labial bow are indicated for correction of minor proclination, anterior diastema closure and for retentive purpose. It is activated by compressing the loops of bow by 1-2 mm. Labial bow can be long or short or split in its deisgn. Short labial bow span from canine to canine. Long labial bow span from first premolar to another. Split labial bow is split in the middle and is used for midline diastema closure. Fitted labial bow has the wire adapted to conform to the contor of the labial surfaces and has small U loop. Itis indicated for retention after fixed orthodontic treatment. Robert's retractoris highly flexible labial bow and is designed to have a helix at the base of u loop and is made from thin ‘gatige wire (0.5 mm). Itis used for correction of anterior proclination as it produces lighter forces over a longer span of activation. “Mill's retractor has extensive looping in the bow portion to increase its flexibility and range of action Its indicated for treatment of large overt. [Reverse labial bow has U-loop placed distal tothe canine. This labial has more flexibility It may be indicated for overjet reduction and space closure.Q.1. Mills retractor is: a. Used for retraction of tongue . Is modified labial bow . Is used for palatal expansion . Is used to treat posterior crossbite ‘Ans. (b). Is modified labial bow Q. 2. Finger spring are made in: a. 0.3 mm wire b. 05 mm wire 08 mm wire 4. 1mm wire Ans. (b). 0.5 mm wire Q. 3. Coffin spring is used: a. To bring buccal movements of premolar . Mesiodistal movement of incisors . To bring slow dentoalveolar arch expan- 4, For labial movernent of incisors Ans. (¢). To bring slow dento-alveolar arch expant . 4. The removable springs used to bring labial movements of incisors is: Ans. (e). Z-spring Q.5. Which of the following is also called as a double cantilever spring: a. Z-spring b. Tspring cc Finger spring. Coffin spring ‘Ans, (a). Z-spring, Q. 6 Active component in removable orthodontic appliances is: a. Bows, ‘Springs screws ©. Elastics All of the above Ans. (@). All of the above ©. 7. Midline diastema may be due to fone of the following: ‘a. Parafunctional oral habits b. Midline pathologies or unerupted ‘mesiodens ¢. Abnormal frenum attachment 4d. All of the above Ans. (d). All of the above Q. &. Anterior bite plane is indicated to correct: ‘2 Single tooth crossbite ». Increased overiet «. Increased overbite . Retrociined lower anteriors Ans. (9. Increased overbite Q. 9, Deep bite is corrected through: 2 Intrusion of anteriors ». Extrusion of posteriors ‘c. Fixed appliance therapy using. archwire with reverse curve of spee 4. All of the above ‘Ans. (@). All of the above Q. 10. The anterior bite plane should separate the posterior teeth by: a. 3-4 mm. b. £5 mm 152mm 4. 05-1 mm ‘Ans, (@). 15-2 mm Q. 11. Sved appliance is: ‘2. Modified anterior bite plane with an added upper incisor cap that prevents, anterior proclination Hawley appliance with finger spring. Hawley appliaice with jack screw |. Hawley appliance with Z spring. 2. (a). Modified anterior bite plane with an added upper incisor cap that prevents anterior proclination hie Q. 12, Barrer appliance is: 1. Device used to align anterior teth ». Is device used to expand the dental arch c. Anterior bite plane 4. Posterior bite plane ‘Ans, (a). Device used to align anterior teeth Q. 13. Plumpers are appliances used: a. Maintain the arch perimeters ’, To position molars distally c. Used to intercept the habit of lip suck: ing/biting 4. All of the above ‘Ans, (d), All of the above. Plumper appli ‘ance is another term for lip bumper appliance Q. 14. The management of thumbsucking, habit should begin in: ‘a. Phase I-Normal + subclinically signi- fiacant sucking , Phase Hl- clinically significant sucking , Phase intractable sucking d. Can be started in any phase of develop- ment ‘Ans, (a). Phase LNormal + subclinically signifiacant sucking Q. 15. Thumbsucking habit is managed by: Psychologically conditioning, '. Removable or fixed cibs or rake «. Blue grass appliance 4. All of the above ‘Ans, (d), All of the above Q..16. The father of rapid maxillary ex pansion 1a. Emerson C Angell b. Profitt ©. Andreason a. Blaters ‘Ans, (a). Emerson C Angell Q. 37, The rate of rapid maxillary expan- sion is: ‘4, 0.05 - 0.1 mm per day 'b. 0.2-0.5 mm per day 081.5 mm per day d 2-3 mm per day ‘Ans. (b). 02-0.5 mm per day Q. 18. The increase in maxillary width ‘that can be achieved by rapid maxillary expansion is: a. 5mm >. 10 mm 20mm 4.15 mm ‘Ans. (b). 10 mm (Q. 19. Which ofthe following is true about RME: 4. There occurs downwards and backwards rotation of the mandible following RME . Leads to increase in intranasal space «. Aieflow resistance decreased by 45-605 4. All of the above ‘Ans. (d). All of the above , 20. Which of the following appliance "uses ‘MINNE expander’ 2. Derichsweler ». Hyrax type . Hass type 4 Isaacson type ‘Ans, (Isaacson type Q. 21. The force used for RME 1, 10-20 pounds b. 2-4 pounds . 5-8 pounds , 50-100 pounds ‘Ans. (a). 10-20 pounds Q. 22. The force used for slow expansion 2-4 pounds . 6-8 pounds 10-12 pounds |. 15-20 pounds ‘Ans. (a). 2-4 pounds Q. 23, Which of the following appliance screw are slow arch expanders: a. Jack serew 'b. Coffin spring. Quad helic —d._ All ofthe above ‘Ans. (@), All of the above ao‘Wit 686 Comprehensive Review of Clinical Dental Sciences Orthodontics Ee Bs g iS = fe) = is i a Q. 24, Retention of removable appliances is obtained through the use of: a. Finger spring b. Z-spring ©. Adam clasp d. Elastics Ans. (@). Adam clasp 25. The rate of slow maxillary expan- (05 to 1mm per week 02-0. 5 mm per week 18-3 mm per week 23 mm per day ‘Ans. (a). 05-1 mm per week v. 4, Q. 26. Rapid maxillary expansion is contraindicated in: 1. Single tooth cross bite , Vertical grower with stoop mandibular plane angle «. Poor patient compliance and cessation of the growth potential 4. All of the above Ans. (d). All of the above Q. 27, Fitted labial bow is used for: a. Retention . Overiet reduction ©. Diastema closure 4. All of the above ‘Ans. (a). Retention Q. 28. Arrow head of adam clasp are inclined at an angle a. 15 degree to the long, axis of the tooth . 30 degree to the long axis of the tooth ©. AB degree to the long axis of the tooth 4. 60 degree to the long axis of the tooth, ‘Ans. (). 45 degree to the long axis of the tooth Q. 28. Adam clasp is also known a. Southend clasp b. Liverpool clasp © Crozat clasp d. Ball end clasp ‘Ans. (b). Liverpool clasp Q. 30. Universal clasp is also known at a Southend clasp b. Adam’s clasp Crozat clasp. Ball end clasp ‘Ans. (b). Adam's clasp Q. 31. The clasp with additional piece of wire soldered so as to engage mesial and distal undercut i a. Southend clasp ». Triangular clasp ‘e. Crozat clasp dd, Ball end clasp. ‘Ans. (@) Crozat clasp Q. 82. The clasp in which number of arrowhead engages the inter proximal undercuts between premolars and molar: a. Schwartz clasp b. Crozat clasp . Universal clasp 4. Southend clasp ‘Ans, (a). Schwartz clasp Q. 83. Posterior bite plate is used for a. Deep bite ‘Open bite b «. Diastema 4. Digoccluding anterior ‘Ans. (d). Disoceluding anterior . 84, Catlan appliance is used for: a. Crossbite b. Open bite «. Diastema &. Crowding ‘Ans. (a), Crossbite . 35, Double cantilever spring a. Zepring b. Tspring . Mattress spring 4. Coffin spring ‘Ans. (a), Z-spring Q. 36. Which of the following is known full clas Jackson clasp . Universal clasp cumferential clasp Crozat clasp Ans. (a), Jackson clasp, ». 4 Q. 37. U-elasp is a. Jackson clasp 1b. Universal clasp «. Circumferential clasp 4. Crozat clasp ‘Ans, (2) Jackson clasp Q, 38, Robert retractor is: a. Cheek retractor '. Modified labial bow ©. Modified adam clasp i, Jack serew expansion appliance ‘Ans. (b). Modified labial bow Q. 89, Indication for Robest retractor is Severe proclination Crossbite Diastema closure All of the above Ans. (a). Severe proclination Q. 40. Which of the following is a remo- vable appliance: a. Activator ’, Anterior bite plane . Hawley appliance 4. All of the above Ans, (d). All of the above Q, 41, Labial bow is fabricated with: 2. 0.022" wire b. 025" wire ©. 0.082" wire d. 0.18" wire ‘Ans, (0. 0.032" wire b a. Q. 43, Adam clasp is made with: a. 0,022" wire b. 0.25" wire «©. 0.092" wire 4. 0.18" wire Ans, (b). 0.25 " wire Q. 44. Free ended spring is: Zespring Mattress spring Helical coil spring All of the above ‘Ans, (d). All of the above Q. 45. Removable appliances result in: . Tipping movement . Bodily movement «. Rotation 4. All of the above Ans. (a). Tipping movement Q. 46. The wire with shape memory: a. Stainless ste! b. Nitinol TMA wire 4d. All of the above Ans, (b). NitinolOrthodontic Functional Appliances Jaspal Singh, Abhay Jain, Mo. Akram Ansari Functional appliances are the appliances which ansmil, eliminate and guide the natural forces to eliminate the ‘morphological aberrations and create condition favorable for the harmonious growth and development of the dentofacial ‘complex. + "These appliances uses forces generated by muscles to alter the skeletal or dental relationship. Indication * Primary indication is Class I malocclusion. + Less commonly Class II Classification + Removable functional appliances-Activator, bionator, frankel, twin block, ete + Semi-fixed functional appliances-Denholtz, Bass appliances. Fixed functional appliances-Herbst, jasper jumper, churro jumper, mandibular repositioning appliance, klapper super spring. ‘Tooth borne passive appliances~These appliances uses soft tissue stretch and muscular activity to produce treatment effect. Example-Activator, bionator, twin block, herbst appliance and Herren activator. ‘Tooth borne active appliances~These myofunctional appliances include active component (expansion screw or spring) in their design in order to move the teeth. Example-Elastic open activator, Bimler’s appliance, stockfish appliance and modified bionator, + ‘Tissue borne passive appliances are myofunctional appliances which have little or no contact with the teeth. Example- Oral screen and lip bumper. Tissue bome active appliances-Frankel or functional regulator. + Group I appliances are appliances which transmit the muscle force directly to the teeth, Example-Inclined plane, Oral screen and Catlans appliances. + Group Il appliances are tooth /tissue supported appliances. Example -Activator and bionator. + Group Ill appliances are vestibular positioned appliances which rely mainly on the mandibular postural changes to produce the effect. Example-Frankel or the functional regulator and lip bumper. + Active appliances reposition the mandible so, that the condyle is forced outof the glenoid fossa and this in tur, stimulate the posterior/ superior growth of the condyle. + Passive appliances act by repositioning the musculature associated with the mandible so, that the jaw bone itself responds by growing to the new equilibrium position * Duration and timing of wear Functional appliance treatment should be started before the pubertal growth spurt. This i the time when the mandible ‘may exhibit increased growth which may be influenced. Functional appliances should be worn for at least 10-12 hours 1 day. These appliances should be worn at night time as this is when growth takes place.hh 668 comprehensive Review of Cinical Dental Sciences Orthodontics S a is = S si i a Changes induced by functional appliances Functional appliance can produce following changes: 1. Orthopedic changes. 2. Dentoalveolar changes. 3. Muscular changes. Orthopedic changes-Restriction of maxillary growth, increased rate of mandibular growth, remodeling changes in the ‘TM. Dentoalveolar-Tippng, retrclnation of upperincisor,proctnaton of lower incisor, mesial eruption oflower posterior tee ‘Muscular-Improve tonicity of the oro facial musculature, ‘Activator-Loose fitting removable orthodontic appliance which redirect the pressures of the facial and masticatory ‘muscles onto the teeth and their supporting structures to produce improvements in tooth arrangements and occlusal relations. Activator is indicated in Class Il div I, Class Il div I, Class IH, Class I open bite, Class I deep bite, decreased or deficient vertical development, in post treatment retention and as prelimnary treatment before fixed treatment. The appliance is contraindicated in Class [with arch length tooth material discrepancy, excessive vertical mandibular growth and in patient with nasal stenosis. Bionator (Double retainer) is a functional appliance developed by Balters Its indicated in Class [div Land Class I with narrow dental arch. The reverse bionator is indicated for treating mandibular prognathism. Another variant of bionator is used for treating open bite cases. Twin block sa functional appliance developed by Dr, Claek in 1982. Itisindicated to treat Class II malocclusion in mixed dentition period. Itcan also be indicated for Class I open bite, Class I closed bite and in Class Il malocclusion. The Twin- block therapy induces supplementary lengthening of the mandible by stimulating increased growth at the condylar cartilage and restriction of the maxillary growth. Itis the most comfortable and esthetic functional appliances consisting of two separate upper and lower bite block component which interlock with each other at 70 degree angle and posture the mandible to favorable Class I molar zelationship. Herbst appliance isa fixed, tooth-bome, functional orthodontic appliance in which jaw position is influenced by a pin- | and-tube spring-loaded appliance that is cemented or bonded to the teeth. Its indicated for treating class Il malocclusion | and as anterior repositioning splint in patient having temporomandibular joint disorder. | Jasper jumper appliance is a fixed functional appliance developed by James Jasper and designed to deliver light | continuous force for the correction of class If malocclusion. It consists of a bilateral flexible spring that exert continuous light forces to both arches, The upper end of the spring is attached posteriorly to the maxillary arch by a ball pin that is | placed through the distal attachment of the spring and then extends anteriorly through the face-bow tube on the upper first molar band. The lower end of the spring is blocked by a small teflon ball positioned in the mandibular arch. | Oral screen is a thin sheet of acrylic processed over the occluded waxed working cast extending deep into the sulcus both | labially and buccally which act asa screen between teeth and musculature. It is indicated in Mouth breathing, Thumb | sucking, Tongue thrusting, Lip biting and for Muscle exercise. Its contraindicated in patients with mouth breathing due to nasal obstruction. Type of functional regulator and thei Frankel functional regulator or oral gymnastic appliance was developed by Dr. Rolf Frankel of Zwickau, East Germany, as an alternative to the activator type appliances. The appliance serves as a template against which the cranio facial muscle function and removes muscle forces in labial and buccal areas that restricts skeletal growth thereby providing an environment which enables skeletal growth. ation ER I: Indicated in Class I and Class II division 1 malocclusion. Itis further subdivided into three types: FRI a: Class I with mild to moderate crowding and in Class I deep bite cases. FRI b: Indicated in Class Il division I with overjet less than 5 mm. ER Ic: Indieated in Class Il division I with overjet of more than 7 mm. FR2: Indicated in Class Il division I and Il FR3: Indicated in Class I. FRé: Indicated for open bite and bimaxillary protrusion . FR5: They are functional regulator which incorporate head gear and are indicated in long face patients having a high mandibular plane angle and vertical maxillary excess.Orthodontic Funcional Appliances 669 Whe! ‘= Head gear or Klochn head gear. It is most widely used orthopedic appliance to intercept or correct some skeletal malocclusion as well as to distalize the maxillary dentition or maxilla. It also work as an adjunct to control or gain anchorage. It consist of three component face bow, the force element and head or cervical strap. + Uses of head gear: 1. Restriction of downward and forward growth of the maxilla 2. To reinforce the intraoral anchorage. 3. Distalization of upper molars. 4. To derotate molar. 2 = = 3 3 S 3 a ‘Types of head gear * Cervical pull head gear, High pull (Occipital pul), Combination pull head gear, Reverse pull head gear, Vertical pull head ‘gear and J Hook. + Cervical pull head gear get anchorage from the nape of the neck. Itis indicated in patient with low mandibular angle. Ithas the tendency to produce an extrusive force on the attached teeth, Therefore, the cervical gear is contraindicated in an open bite type of malocclusion, since molar extrusion would complicate this type of problem. + High pull or occipital pull head gear produces a more superiorly directed vector of force and prevents the extrusion of the upper molars, but its efficacy in causing distal movement is relatively slight * Combination head gear A combination head gear can be used to take the advantage of the distal pull of the cervical gear and the high pull of the head gear. + Face mask or reverse pull head gearis used to treat maxillary retrusion and mandibular prognathism. Itis also indicated for selective rearrangement of palatine shelves in cleft patient and for correction of postsurgical relapse after surgical osteotomies. + The reverse head gear consist of chin cup, forehead cap, intraoral appliance, elastic and metal frame. “= Chin Cup is used to place orthopedic forces on the mandible to restrict the forward and downward growth of the ‘mandible in Class II skeletal malocclusion. Chin cup are of two types Occipital pull chin cup isthe most commonly wsed and indicated in Clas It malocclusion with mild to moderate prognathism. + Vertical pall chin cup get anchorage from the parietal region and i indicated in patient with steep mandibular plane angle and exceaive anterior facial heightit 670 Comprehensive Review of Clinical Dental Sciences < ei S iS z e) = is he ba . 1. Bionator was developed by: a. Anderson b. Balters ©. Graber 4. Angle Ans. (a). Anderson Q. 2, Functional appliance should be used during the following period of growth and development: 2. Prepubescent b, Adolescence . Pubeseent d. Adult Ans. (a). Prepubescent Q. 3. Which of the following is fixed functional appliance: a. Bionator Db. Activator . Herbst’s appliance 4. Twin block appliance Ans. (@). Herbst appliance is a fixed functional appliance indicated for the correction of class I malocclusion due to retrognathic mandible. They can also be used as anterior repostioning splint in Patient with TMJ problem. a I. Herbst’s appliance is worn: a. Ghours/day —b. 12 hours/day © 16 hours/day d. 24 hours/day Ans. (d). 24 hours/day Q. 5. Type of Frankel’s functional regu lators indicated for treating open bite plus bimaxitlary protrusion is: a. FRI b, FRE c. FRA 4. FRI Ans. (0). FRA Q. 6 Which of the following appliance also known as the oral gymnastic appliance: a, Oral screen, b. Activator ©. Bionator d. Functional regulator Ans, (d). Functional regulator Q. 7. Which of the following is the contraindication for activator therapy: fa. Class T open bite cases . Class I deep bite cases © Class It div 1 4. Class I crowding due to archlength tooth material discrepancy Ans. (d). Class I crowding due to archiength tooth material discrepancy Q. 8. Which of the following myofunc- tional appliance is also known as ‘norwegian appliance’: 1. Functional regulator b. Herbst’s appliance «. Bionator 4. Activator Ans. (d). Activator. 2.9. Vestibular screen was introduced by: a. Newell b. Kinglsey «. Schwartz . Balters Ans. (a). Newell in year 1912 introduced this appliance. Q, 10. Vestibular screen is used to: Intercept the habit of tongue thrusting i. Intercept the habit of thumb sucking <. Intercept the habit of mouth breathing d. All of the above Ans. (d). All of the above. Q. 11. Which of the following myofune- tional appliances are tooth borne passive appliance: a. Activator . Bionator . Herbst appliance d. All of the above ‘Ans. (), All of the above. The tooth borne ‘appliances have no intrinsic force generating, ‘component such as spring or screw and depend upon the soft tissue stretch and, ‘muscular activity to produce the desired cffect. Q. 12. Which of the following is tis Dorne myofunctional applianc a. Functional regulator of Frankel b. Activator «. Bionator <. Twin block ‘Ans. (a). Functional regulator of frankel The tissue borne appliances are mostly located in the vestibule and have no contact ‘with the dentition, Q.13. Twin block was developed by: a. Kingsley b. Clark © Moyers 4. Frankel ‘Ans, (d). Clark Q. 14, Which of the following is a part of reverse pull head gear assembly: a. Chin cup and fore head cap ». Intraoral appliance © Metal frame and elastics 4. All of the above ‘Ans. (d). All of the above Q. 15. The type of force exerted by the occipital head gear on teeth plus maxilla: a. Superior and distal force . Inferior and distal force Superior and downward force 4. Inferior and upward force Ans. (a). Occipital head gear exerts a ‘superiorly and distally directed force on the, ‘maxilla and maxillary teeth (Q. 16. Which ofthe following is true about cervical head gear: 4. Bring extrusion of maxillary molar and. thus increased lower facial height . Distalize the maxillary dentition Are indicated in low mandibular angle 4. All of the above Ans, (d). All of the above. Q. 17. Which of the following is not a function of head gear: ‘a. Anchorage augmentation b. Distalization of molars Molar derotation plus space maintainer 4. None of the above Ans. (d). None of the above all are the function of a head gear. Q. 18. Which of the following is an indi- ‘ation for face mask therapy: a. Maxillary retrusion . Mandibular protusion ©. For selective dearrangement of palatal shelves in cleft patients 4d. All of the above ‘Ans, (d). All of the above. Q. 19. The amount of force required to Dring the skeletal change is about a. 1/2 of pound . 1/3 pound per side . 2/8 of pound 1 pound per side ‘Ans, (d). I pound (450 gm) per side. Q. 20, Vertical pull chin cup derives the anchorage from: 22. Occipital region of the head, b. Frontal region of the head ©. Parietal region of the head 4d. From the neck Ans. («). Parietal region of the head. Vertical chin cup isa indication for patients with steep mandibular plane angle and excessive anterior facial height. Q. 21. The extraoral orthopeadie app- Tiances for maximum skeletal change should be worn daily for at least: a. 6-8 hours ’b. 810 hours © Wldhours ——d. 46 hours Ans. (¢). 12-14 hours. . 22. The minimum tooth movement but maximum skeletal change is achieved by ‘wearing extraoral orthopeadic appliances daily for atleast: a. 1244 hours b. 10-11 hours © 3-4 hours 4. 7-8 hours Ans. (a). 12-14 hours,Q. 25. To bring about the skeletal change, the force exterted should be more than: a. 200 gm b. 100 gm ©. 300 gm 4. 400 gm ‘Ans. (@). It should be more than 400 gram. Q. 24, Hyalinization of the PDL is seen ith a force more than: a. 50 gm b. 150 gm 250 gm d. 400 gm. Ans. (€). 400 gram, 25, Head gear function is to a. Intercept or correct developing skeletal malrelationship b. To distalize the maxillary dentition As an adjuncts to control or gain ancho- rage 4. All of the above ‘Ans, (d). All of the above Q. 26, The force element of the head gear assembly is: 2. Facebow b. Headeap or neck strap ©. Spring or elastic €. All of the above Ans. (€). Spring or elastic Q. 27. Face mask is used primarily to pro- duce: a. Anterioposterior effect b. Ventral effect «. Dorsal effect 4. Transverse effect ‘Ans. (a). Anterioposterior position 28. lf the force of application is parallel to the occlusal plane which of the follo- ‘wing movement will occur: a, Forward translatory motion of the maxilla . Upward rotation © Both of the above 4. None of the above ‘Ans. (d). Both of the above Orthodontic Functional Appliances 671 Vivi Q. 28, Forces applied below the center of resistance of molar result in which type of movement: a. Distal root tipping b. Distal crown tipping ©. Bodily movement 4. No movement ‘Ans. (b). Distal erown tipping. ‘Q. 30, Forces applied above the center of resistance of molar result in which type of movement: a. Distal root tipping . Distal erown tipping «. Bodily movement 4, No movement Ans, (2). Distal root tipping. Q. 31. The ideal patient for functional appliance treatment of excessive mandi- bular growth has which of the following, characterstic: a. A mild skeletal problem, with the ability ofthe patient to bring the incisors end to end of nearly b. Short vertical facial height . Normally positioned or protrusive but rot retrusive incisors 4. All of the above ‘Ans, (d). All of the above Ref. Contemporary Orthodonties-Profitt, 2nd edition, page 302. Q. 82, VTO (Visual treatment objective) a. A cephalometric tracing b. Treatment planning too! Represent any growth changes induced by the treatment 4. All of the above ‘Ans, (@), All of the above Ref: Contemporary Orthodontics-Profitt 2nd edition, page 274 Q. 33. With rapid maxillary expansion, ‘one centimeter of expansion may be ob- ‘tained within: 2. 34 days b. 2:3 weeks 78 weeks 4. 3-4 months Ans, (b). 2-3 weeks. With rapid maxillary ‘expansion rate of 0. 5-1 mm perday an ‘expansion of 1 cm or more may be obtained within 23 weeks. Refe: Contemporary Orthodontics-Profitt, 2nd edition, page 286 . 34. With slow arch expansion method {an expansion of 10 mm may be oblained within: a. 2-3 weeks b, 10-12 weeks ©. 18-20 weeks 4. 5-6 months ‘Ans. (b). 10-12 weeks. With slow arch expension rate of 0. 5-1 mm per week, an expansion of 1 om may be obtained within, 10-12 weeks. Refi: Contemporary Orthodontics-Profitt, 2nd edition, page 286 Q. 35. Camouflage orthodontic treatment should be avoided in: a. Severe class II and severe class III ‘malocclusion . Sevre crowding of incisors ©. Adolescent with good growth potential 4d. All of the above Ans. (d). All of the above. Q. 36. Chin cup should be worn for at least: a. 6-8 hours b, 12414 hours ©. 24 hours 4. 3-4 hours ‘Ans, (b). 12-14 hours Q. 37, Which of the following is not a myofunctional applainace: a. Vestibular sereen . Oral gymnastic appliance . Twin block 4. Catlans appliance ‘Ans. (d). Catlans appliance, souopoyo, ey id a) = fo) Zz x 2 & 2Component of Fixed Orthodontic Appliances Jaspal Singh Pawandecp Kaur, Urvashi Sharma + Fixed appliance as the name indicates are the appliances which are fixed on to the tooth surfaces and cannot be removed. by the patient. + Fixed orthodontic appliances have attachment which are fixed on to the tooth surfaces. These appliance exert the forces ‘on the tooth through these attachment using archwires and other auxillaries, + Fixed appliances have advantage of precise control of tooth movement and to carry out multiple tooth movement at the same time, ‘Component of fixed orthodontic appliance + Active components-Arch wire, Springs, Elastics and Separators. + Passive components-Bands, Brackets, Buccal tubes, Lingual attachments, Lock pins and Ligature wire. * Separators are the wires or elastic used to create the spaces in between the adjacent teeth in order to facilitate the ‘banding of the tooth. These are placed approximately a week before braces are placed. Example: 1. Soft brass wires of 05 or 0.6 mm diameter. 2. Kesslying separtors-are made of 0.016’ special plus Australian wire with helices at the closed end. 3. Ring separators-are small elastic ring which are stretched with the help of separator placing plier and are passed through the interdental spaces. 4, Dumb-bell separators- are dumb-bell shaped elastic which are stretched and passed through the interdental space in order to create space between the adjacent teeth. + Arch wire is the active wire which conform to the alveolar or dental arch and is used with dental braces as a source of force to bring the orthodontic tooth movement in desired position. It can also be used to maintain existing dental positions. It come in different shape and may be fabricated from stainless steel, nickel-titanium alloy (Ni titanium alloy Beta titanium, Alpha titanium and Titanium niobium alloy. ‘+ Arch wire should have the following characteristic a. Lowstiffness-tffnessis the measure ofthe force magnitude delivered by the appliance. Low stiffness ensures more constant force application with greater ease and accuracy. b. Large spring back (maximum elastic deflection)-Spring back is a measure of the extent of deflection of the wire without being permanently deformed. Higher value ensures more working time or more of activation and thus, less no of arch wire changes, ‘+ High formability-Formability is a measure of ability of the wire to be bend into the desired configuration, + Other characteristic ofthe arch wire should include, low surface friction, high stored energy, biocompatibility, and the capacity to be welded to other auxiliaries. * Arch wire may have the following cross-section-Round, Square and Rectangular. + Arch wire diameter: — Round-0.08", 0.10", 0.12, 0.14" ~ Square-0.016" x 0.16" and 0.17" x 0.17" ~ Rectangular-0.17" x 0.25" and 0.17" x 0.2 * Stainlesssteel ~ It is was introduced by Wilkinson. It is composed of the iron-71%%, chromium-18%, nickel-8%, carbon < 0. 2%. Advantage of stainless steel include its high stifiness, resiliency, high yield strength, adequate spring back, good formability, join ability and biocompatibility.Component of Fixed Orthodontic Appliances 673 Whi) = Disadvantage are its high modulus of elasticity, requirement of more frequent activation and lower spring back than the NITi wire. The form of stainless steel most commonly used is austenitic ‘+ Elgiloy or chrome cobalt wire ~ This wire is composed of cobalt-40¥%, chromium-20%, nickel-15%, iron-15.4%%, molybedenum-7%%, manganese-2%, beryllium-4%%. The wire is available in four tempers-blue(soft), yellow (ductile), green(semi resilient) and red (resilient). ‘The wire has advantage of better tarnish and corrosion resistance, greater resistance to fatigue and distortion and ‘good formability. The disadvantage inciude requirement to be heat treated as mostly supplied in ductile form, soldering requirement and high modulus of elasticity. + Nickel-ttanium wire also known as nitinol, isa meta alloy of nickel (55%) and titanium (45%). Italso contain traces of other element like cobalt, copper and chromium. The term Nitinol is derived from its composition and its place of discovery: (nickel titanium naval ordnance laboratory). William. F Buehler along with Frederick Wang discovered its properties. Nitinol alloys exhibit the property of shape memory and super elasticity. These two properties are related to the phase transition from martensite to austentite. The wire has excellent spring back resiliency and range. At high temperatures, Nitinol assumes an interpenetrating simple cubic crystal structure referred to as austenite (the parent phase). ‘+ Atlow temperatures, Nitinol spontaneously transforms to a more complicated “monoclinic” crystal structure known as ‘martensite. Nitinol wire cannot be soldered or welded and cannot be moulded into shape. ‘+ BLTi or TMA wires or Titanium molybdenum wire-TMA wire has desirable property of strength, springiness and good formability. Itis composed of 77.8% of titanium, 11.3% of molybdenum, 6.6% of zirconium and 4.3% of tn. tis the only ‘orthodontic wire possessing true weld ability when compared to elgiloy and stainless steel. Ithas excellent stability and resistance to tarnish and corrosion. The frictional resistance is high and it is expensive. ‘+ Optiflex wire is a transparent nonmetallic arch wire with a silicon core, a silicon resin middle layer and a stain resistant ‘outer layer. These wires provide light continuous forces. Elastics ° Ela ics are either made of latex or nonlatex(less deterioration). Different type of elastics ‘Class I elastics are the intraarch elastics placed between the molars and the anterior in the same arch. ‘These elastic function in closing the extraction spaces by retracting the anterior and protracting the posterior. ‘+ Class If elastics areintermaxillary elastics placed between the mandibular molars and maxillary anteriors. These elastics are indicated to intrude the maxillary anterior and to retract the maxillary anterior. ‘Class Ill elastics are intermaxillary elastics placed between the maxillary molars and mandibular anterior. These elastic are indicated in the treatment of Angles class III malocclusion. ‘+ Cross bite elastics are the intermaxillary elastics used to correct erossbite in the buccal segments. ‘© Box elastics are used to correct the anterior crossbite, They extend between manillary and mandibular anterior like a box. These elastic cause distal tipping of the maxillary anterior and forced eruption of maxillary and mandibular anterior. * Diagonal clastics are indicated for the correction of midline deviations. Elastomerics ‘+ Blastomerics are the active component in fixed orthodontics and are made up of polyurethane materials. These elastomerics come in different forms. — Elastic chains or E chains are used for space closure and come in three different form (continuous, closed short and long) depending on the distance between the subsequent rings. ~ Elastic thread or cotton threads are used for the correction of derotations and closure of anterior spacing. ~ Elastics ligatures are used to secure the ~ Flastic modules or elastomeric chains are made up of two elastic rings separated by a variable distance. The indication is for closing the spaces or for derotation of teeth. cchwire, * Springs are the active force generating component. Spring are used mainly for tooth uprighting and torquing in the ‘bogg’s appliance therapy and the tip edge appliance. Springs may be used to open spaces or to close the spaces. Contd... soUOpOYrO a 2 a a fo} = Ss Sj EIWhi 674 Comprehensive Review of Cinical Dental Sciences Orthodontics ory) fc ie: is S = fe) = 5 i a * Open coil springs are often placed over arch wires to open space for blocked out teeth or for other purposes. It can be made up of stainless steel or nickel titanium wire. + Closed coil springs are meant to clase spaces and can be either made of stainless steel or nickel titanium wire + Up righting springs are used for moving the tooth root in mesial or distal direction. + Rotating springs are used to rotate the tooth about its axis. + Torquing springs-Which move the root in a lingual or parallel direction “= Passive component (non force delivering oF retaining component) in fixed orthodontics * Brackets-Act as devices or handle to transmit the force from the active components to the teeth. Brackets have one or more slots that accept arch wire. Bracket can be made of either metal, plastic, polycarbonate, polyurethane, ceramic or titanium, Type of bracket 1. Badge wise bracket are used in edge wise and straight wire technique and has a horizontal slot facing labially. These bracket provide good control over tooth movement and do not permit the tipping of teeth. 2. Ribbon arch bracket has a vertical slot facing the occlusal or gingival direction. These brackets are used with round wire Ribbon arch bracket are used in the begg technique. 1. Bondable brackets-directly bonded on to the tooth 2. Weldable bracket-welded or soldered over bands cemented on to the surface. Metallic bracket steel brackets are commonly used. Ceramic bracket Plastic bracket Bands—A thin closed ring of metal, usually stainless steel, that secures orthodontic attachments to a tooth. The band, with orthodontic attachments welded or soldered to it, is closely adapted to fit the contours of the tooth and then is cemented into place. Band can be either custom made or are prefat various sizes, ‘© Buccal tubes are the attachment generally used on molars. It can be weldable or bondable. ‘© Lingual attachment: are accessory attachment placed on the lingual aspect ofthe teeth or bands. These attachment are used for the attachment of elastics or elastomeric Example Lingual buttons, lingual eyelets, lingual cleats, Lingual ball hooks ingual sheaths used for attachment of transpalatal arches, expanders or NiTi molar rotators ‘+ Lingual seating lugs help in seating of bands ‘© Lock pins~They are small pins used to secure arch wire to brackets with vertical slots such as ribbon arch bracket. The lock pins are usually made of brass. + Ligature wires are soft thin stainless wire (0.008-0.010") used to tie an arch wire in bracket or to the band attachments. te + Stages in fixed orthodontic treatment 1. Leveling and alignment 2. Over bite reduction: It should precede overjet reduction in order to have a smooth movement of teeth in the horizontal plane. Deep over bite are corrected by intrusion of the anteriors or by extrusion of the posterior teeth. 3, Overjet reduction and space closure 44. Final tooth positioning and finishing - is achieved by making use of smaller diameter wires such as. 016 inches stainless steel or rectangular beta titaniumQ. 1. The thickness of the brass wire used as separator is: a0,102mm — b. 0809mm Ans. (b). 0.5-0.6 mm Q. 2. The elastics which are stretched between molar and anterior within same arch are known fa, Class Lelastics b. Class II elastics . Class If elastics. Elastic chains ‘Ans, (a), Class I elastics 05.0.6 mm 1.0-1.2 mm Q. 3: Blastics stretched between upper molars and lower anteriors are known a8: 1. Class Telastics b. Class I elastics ©. Class Ill elastics. Cross bite elastics ‘Ans, (c). Class TIT elastics. Class II elastics are intermaxillary elastic stretched b/w lower molars and the upper anteriors. Q.4. Nitinol arch wire was invented by: a. William R Buchler b. Ion Goldberg © MF Talass Q. 5. The diameter of the stainless steel igature wire is in the range of: ‘a. 0,002-0.004 inches i. 0,005-0.007 inches «. 0,009-0.011 inches 4. 0.02-0.05 inches ‘Ans. (¢). 0.009-0.011 inches Q. 6, The plastic brackets used in ortho- dontics is made up of: a. sillea b, Polycarbonate . Aluminium oxide 4. Zirconium oxide ‘Ans.(b), Polycarbonate . 7. Active component in fixed ortho- b. Bands 4. Ligature wire . Brackets Ans. (a). Arch wire .8. Which of the following is the passive component in fixed orthodontics: fa. Lock pins b. Elastics ©. Spring . Separators ‘Ans. (a). Lock pins Q. 9, Which of the following is passive ‘component: a. Lingual cleats b. Lingual buttons . Buccal tubes 4. All of the above Ans. (@). All of the above Component of Fixed Orthodontic Appliances 675 fall (Q. 10, The light wire fixed appliance were designed by: a, Edward H Angle b. PR Begg ©. Nance d. Moyers ‘Ans. (a). Edward H Angle Q. 11. The edge wise mechanism was invented by: a. Edward H angle b. Kingsley ¢. Anderson d. Tweed ‘Ans. (a), Edward H Angle Q. 12, Port a. Cross bite b, Increased over bite «, Increased overjet 4. Rotation ‘Ans. (a). Porter appliance is a W-shaped. appliance used for the correction of posterior cross bite appliance i used to correct: Q. 13. Myofunctional appliances should be worn at least for: a. 2-4 hours b. 5:7 hours ©. 89 years 4. 12 -14 hours Ans, (@). 12 16 hours Q. 14, Which of the following is the consequence of orthodontic expansion: ‘a. Root resorption . Buccal dehiscence «. Gingival rocession €. All ofthe above ‘Ans, (@). All of the above Q. 15. Nickel titanium archwire is the composition of: ‘a, 85% nickel and 45% titanium , 45% nickel and 55% titanium €. 35% nickel and 65% titanium 4. 70% nickel and 30% titanium ‘Ans. (a). 85% nickel and 45% titanium Q. 16, The preferred angle to be formed in the archwire in any given plane of space: frontal, saggital, and occlusal is: a. 45 p b. 0p «60 4. 90p Ans. (a). 45 p Q. 17. The wire bracket relationship having limited clinical application: a. Center bend . The off centered bend «. Parallel bend 4. Cantilever bend ‘Ans, (@). Cantilever bend Q. 18, Which is tru 1. Austenite is a high temperature phase . Martensite is a low temperature phase ¢. NiTi become superelastic when austenite phase is reached a. All of the above ‘Ans, (d). All of the above 18 Contr of reitance of maxi He Above the roots of incisors Above the roots of canine Above the roots of premolars ‘Above the roots of molars ‘Ans. (c). Above the roots of premolars Q. 20, Lingual seating tugs helps in: - Seating the bend ‘Attachment of elastics Attachment of expanders Al of the above ‘Ans, (a). Seating the bend Q. 21, The main problem encountered during molar intrusion is: ‘a. Buccal crown tiping b. Rotation ©. Nonvitality d. All of the above ‘Ans, (a), Buccal crown tipping. Q. 22, Amount of force requiced to move teeth with tip edge technique 1a, About 2 ounce” b. About 4 ounce . About 6 ounce d. About 8 ounce ‘Ans, (a). About 2 ounce Q. 23. Which of the following is a maxil- Iaty device for skeletal anchorage: ‘a. Onplants . Implants . Miniserews 4. All of the above Ans, (d), All of the above Q. 24, Amount of force required to move teeth with straight wise technique ‘2, About 2 ounce b. About 4 ounce ©. About 6 ounce d. About 8 ounce ‘Ans. (@). About 8 ounce Q. 25. Moving the root of a tooth facially or lingually will be ‘a. Torque movernent b. Tipping . Bodily movement 4. Uprighting movement Ans. a). Moving the crown of tooth mesially or distally is tipping. Movement of root me- sially and distally i uprighting movement. ‘Moving the tooth in entire direction is bodily movertent. Q, 26, Frankel Ill is used for: ‘8. Open bite and bimaxillary protusion . Correction of class It divl and divil . Correction of class I and class I div 4, For class I correction ‘Ans.(d), For class 1 correction. soljuopoyo ry oa i) = Ss Zz N is) (Vv‘thal 676 comprehensive Review of Cinical Dental Sciences Orthodon' Ee & ics = iS) is hy a Q. 27. Which of the following malocclu- sion is difficult to treat: a. Cross bite . Open bite . Deep bite 4. Proclination Ans. (b). Open bite Q. 28, Advantage of tip edge technique over straight wire technique is: a. Less force 1b. No need to bracket second molar «. Less wire bending . All of the above ‘Ans. (d). All of the above Q. 29, Twin wire appliance was deve- oped by: a. Angle . Tweed b. Joseph Johnson 4. Begg ‘Ans. (b). Joseph Johnson Q. 30. The arch wire shape most com- monly use: a. Round, b, Rectangular . Square d. Triangular ‘Ans. (2). Round Q. 31. Maxillary retrognathism is gene- rally associated with a. Vertical facial pattern, . Horizontal facial pattern ¢. Transverse facial pattern 4. All of the above Ans. (a). Vertical f pattern Q. 32, Mandibular prognathia is asso- ciated with: 4. Horizontal facial pattern », Proclination of maxillary incisors «, Retroclination of mandibular incisors 4. All of the above Ans. (@). All of the above (Q. 33, Face mask therapy is indicated in: a. Clase I b. Clase Hl div 1 ©. Class div Id. Class IIL Ans. (@). Class 111 Q. 34. Treatment of apertognathi Anterior inclined plane Posterior bite plane . Anterior inclined plane . FR4 applinace ‘Ans. (d). ERS applinace Q. 35, Bracket design which let tooth tip freely and promotes fast tooth movement: a. Begg b. Tip edge wise ¢. Straight wire bracket 4. None of the above Ans. (a). Begg Q. 36, Which is true for straight wire appliance: ‘a, Results in bodily movement of tooth ’. Requires increased force and anchorage to pull the tooth along the wire ¢. Often require anchorage from second molar 4. All of the above Ans, (€). All of the above Q. 37. Tip edge bracket was invented by: 1. Dr. Peter Kesling b. Edward H angle ©. Begg a. Tweed Ans. (a). Dr. Peter kesling . 38, Wilkinson's extraction i a. Extraction of all permanent Ist promolars b. Extraction of all permanent 2nd premolars «Extraction of all permanent 2nd molars 4d. Extraction of all permanent Ist molars ‘Ans. (d). Extraction of all permanent 1st molars Q. 39. The Edgewise mechanism was invented by: fa. Edward Hangle b. Kingsley ©. Andreason—— d. Tweed ‘Ans, (a), Edward HB angle Q. 40. The light wire fixed appliances ‘were designed by: a. Edward H angle. ©. Nance a. Kingsley Ans. (b). P. R begs . 41, In orthodontics, space for aligning crowded dentition is achieved by: f. Extraction of premolar 1 Reduction in tooth size . By increasing the arch perimeter d. All of the above ‘Ans, (d). All of the above Q. 42, Kessling separator are made up of 8. 0.5 to 0.6 mm soft brass ligature wire . 0.016" special plus Australian wire «. 30 gauge stainless steel wire 4. Elastic ‘Ans. (b). 0.016" special plus Australian . 43. The edge wise bracket has a slot dimension of: a. 0.022" « 0.01 fe 0.022" 0.028 Ans. (a) 0.02 Q. 44, Third order bends of archwire are meant for: a. To make the wire {0 conform anato- tically to the Inbal and buccal contour 0,022" x 0.020" 4. 0.032" 0.016" x 0.018" b. Anchorage preparation or uprighting teath ¢. To tip the crown or roots labially or Lingually, d. All of the above ‘Ans. (c). To tip the crown or roots labially or lingually. Q. 45. Second order bend of archwire are ‘meant for: ‘a. For anchorage preparation 'b. For paralleling of roots «. Elevation or depressing certain teeth d. All of the above ‘Ans. (d). All of the above. Q. 46. Torsion bends of archwire is also Known as: a. First order bend Bb. 2nd order bends . Grd order bends 4. None of the above ‘Ans.(e) 3rd order bends . 47, Which of the following ingredient of occlusion are essential to achieve harmony if occlusion according to Lawrence Andrews: ‘a, Molar relationship, crown angulation ', Rotational control and crown inclination Good proximal contact and flat curve of spee 4. All of the above ‘Ans, (d). All of the above. Q. 48. The first initial archwire used in. readjusted edgewise appliance is: ‘4. 0.016 NITI Bb. 04016 special plus wilocks ©. 0.016 stainless steel 4. 0.012" Australian aj wilock Ans, (a). 0.016 NITE Q. 49, Which of the following is a fixed functional appliance: 8. Herbst appliance ’. Klapper super spring Jasper jumper 4. All. of the above Ans, (d). All of the above Q. 50, Jumping the bite concept for patient with mandibular retrusion was introduced by: fa. Kingsley b. Simmon ©. Angle 4d. Larson ‘Ans. (a). Kingsley. . 51. FRIV is used for a. Openbite and bimaxillary protusion b. Correction of classll divi and divtl ©. Correction of class! and classi div 4. For class II correction, ‘Ans. (@), Openbite and bimaxillary pro- tusion,Q. 52. The Klapper super spring ist 2. A fixed functional appliance indicated. for dental class II malocclusion b. Removable expansion appliance © Appliance for correction of ectopic eruption 4. Removable appliance for regaining space ‘Ans. (a). Fixed functional appliance indi- cated for dental class I, Q. 53. Oral drive theory is put to explain the etiology of: a. Digit ducking . Tongue thrusting © Mouth breathing 4. Lip sucking Ans. (a). Digit ducking Q.54. The process of bite opening involve: a. Mesial movement of posterior teeth b. Intrusion of anterior and extrusion of posterior teeth € Proclination of upper incisors and rotroclination of lower incisors 4. Intrusion of posterior teeth and extrusion of anterior teeth ‘Ans. (b). Intrusion of anterior and extru- ‘sion of posterior teeth. Q. 55. Pattern of extraction for class II camouflage treatment is: a. Extraction of all the second bicuspids b. Extraction ofall the first bicuspids «. Extraction of upper first bicuspid and lower 2nd premolar 4d. Extraction of upper2nd bicuspid and lower first bicuspid Ans. (c). Extraction of upper first bicus- id and loer 2nd premolar, Q. 56, Fitst order bends are: a, In and out bends b. Tipping bends . Torguing bends d. Anchorage bends ‘Ans. (a). In and out bends. (Q. 87. Extraction pattern for class HI sur Bical cases are: 8. Extraction of upper and lower first premolar ». Extraction of upper first bicuspid only «. Extraction of lower first bicuspid only, d. Extraction of lower second bicuspid only ‘Ans, (). Extraction of lower first bicuspid only Q. 58. The unique property of NITI wire 2. Shape memory b. Superelasticity ©. Both of the above d. One of the above ‘Ans. (c). Nit alloys have two remarkable property which are unique in dentistry= Component of Fixed Orthodontic Appliances 677 Wei shape memory and super elasticity profit, page 362. Q. 59. Which of the following drug can slow down the orthodontic tooth move- ment: a. Tricyclic antidepressant b, Antiarrhythmic drug (procaine) Antimalarial drugs 4. All of the above Ans. (d). All of the above. Tricyclic antidepressant (doxepin, amitriptyline, Imipramine), antiacchythmie agents (pro- caine), anti-malarial drags (quinine, quini- dine, chloroquine), and methyl xanthenes. could affect the response to orthodontic forces Refs: Contemporary orthodontics-proftt 2nd edition, page 343. Q. 60. Dimension of bends used for molar include: ‘a, 0.003 or 0.004" x 0.125, b, 0.004" » 0.150 , 0.005 or 0.006 x 0.180 to 0.200" wide 4. 0.008 » 0.180 Ans. (@). A for incisors, B for canine and premolar 2 C for Molars Grabber, 3d edition, page 553, Q. 61, Which of the following appliances ‘was introduced by Edward H angle: a, Pin and tube appliance b. Ribbon arch appliance ©. Edgewise attachment 4. All ofthe above Ans. (@) All of the above Ref Grabber, 3rd edition, 530, 534 Q. 62, Which of the following is also known as Elgiloy: a. Chrome-cobalt b. Nitinol , Beta titanium 4. Titanium niobium alloy ‘Ans. (a). Chrome-cobalt. Refs Testhook of Orthodontics-Gurkitat Singh, It edition, page 300. Q. 63. Titanium composition of TMA or beta titanium wire is: a. 79% b. 59% ©. 39% 4. 19% ‘Ans, (a). TMA wire consist of ttanium-79%, molybdenium-11%, zireonium-06%, and tin-04%. ©. 64. Nitinol consist of: 59% nlckel and 45% titanium 35% nickel and 65% titanium 25% nickel and 75% titanium 65% nickel and 35% titanium Ans. (a). 55% Nickelandt5%Titanium, Ref: Texthook of Orthodontics-Gurkirat Singh, 1st edition, page 302. 2. 65, Which of the following is a advan- tage of copper Niti allo a. More resistance to permanent defor- mation b. Better spring back as compared to other NiTi wires ©. More constant forces are exerted over smaller areas 4. All of the above ‘Ans. (d). All of the above. Ref.: Textbook of Orthodontics-Gurkirat Singh, Ist edition, page 308, . 66. Which of the following is a dis- tinctive feature of TMA wire: 1. Good spring back b. Low force delivery ©. Good formability and weld ability 4. All of the above ‘Ans. (d). All of the above, Ref: Text book of orthadontce-Gurkirat Sing, 1st edition, page 303-4 Q. 67, Class If elastics are: a, Intermaxillary elastics placed b/w the maxillary molars and the mandibular anterior b. Intermaxillary elastics placed b/w the mandibular molars and maxillary anterior «. Intraarch elastics placed b/w anterior and molar in the same arch 4. Intermaxillary elastics used to correct cross bite in the buccal segments ‘Ans. (b). Intermaxillary elastics placed bjw the mandibular molars and maxillary anterior. . 68. The bracket on the maxillary lateral incisors are placed: 1. 3mm from the incisal edge tothe bracket base b. 35 mm ©. 45 mm, 4.25 mm ‘Ans, (a). 3 mm from the incisal edge to the bracket base. so1juopoyyiO wo is) = S Si ‘s) & 2Wit c7s comprehensive Review of Cinical Dental Scienoss Orthodontics Q. 69. The bracket on the maxillary ccaspids are placed: 1. 3mm from the incisal edge to the bracket base b. 35 mm © 45 mm d. 25 mm Ans. (¢). 4.5 mm. The brackets on the maxillary centrals, lateral and cuspids are placed 3. 5 mm, 3mm and 4. 5 mm res [pectively from the incisal edge to the bracket base. Ref: Textbook of Orthodontcs-Gurkirat Singh, st edition, page 428 Q. 70, The bracket on the mandibular incisors are placed: a, 3mm from the incisal edge tothe bracket base 35 645. 4.25 mm ‘Ans. (d), 2.5 mm Mandibular cuspids bracket are placed 3.5 mm and on ‘mandibular bicuspids, they are placed 3 mm from the incisal tips Ref Textbook of Orthodontcs-Gurkirat Singh, 1st edition, page 428. Q. 71. Which of the following bends of archwire is made in vertical plane: a. First order b. Second order . Third order d, All of the above ‘Ans, (b). Second order bends are made in vertical plane and are used for anchorage ‘preparation or uprighting of the teeth. Refs Textbook of orthodontics-Gurkira singh, Ast edition, page 429. Q. 72. Second order bends are used for: a. Uprighting of teeth b. Paralleling of roots ¢. Extrusion or intrusion of certain teeth 4. All of the above ‘Ans. (@). All of the above. Q. 73, Which of the following bend is used to tip the crowns or roots labially or Lingually or buccally: 1. Third order bends . Second order bend ¢. First order bends 4. All of the above ‘Ans. (a). Third order bends. First order bends are made in horizontal plane, They aze used to make the wire conform to the labial and buccal contours of the tooth in a manner that arranges these teeth in the most {deal position in respect to the inter, intra arch and the underlying structure. Ref Textbook of Orthotontcs-Gurkirat Singh, 4st edition, page 420. Q. 74. The objective of stage I of begg’s fechniqi ‘8. Open or close the anterior overbite , Eliminate anterior crowding or spacing . Overcorrect rotated cuspids and bicus- pide 4. All of the above ‘Ans, (€) In addition other objective include ‘correct any posterior crossbite, to overcorrect, any mesiodistal relationship of the buccal segments. Ref: Textbook of Orthodonties-Guikirat Singh, Ist edition, page 435. Q. 75. Overbite control in preadjusted ‘edgewise appliance is achieved by: a. Usilty wires b. Wire with reverse curve of spee ©. Both of the above 4. None of the above ‘Ans, (b). Wire with reverse curve of spee Refs Text book of orthodontic-Gurkivat Singh, Ist edition, page 440. Q. 76. In fixed appliances the space clo- sure is achieved by: a. Flsties modules b. Elastic chain . Closed coll spring 4. All of the abobve ‘Ans. (d). All of the abobve Ref: Teathook of orthodontcs-Gurkirat Singh, Ist edition, page 441. Q. 77, Finishing is accomplished in fixed appliances by making use of: 1, Niti wires b. Stainlos stoel wire ©. TMA wire d. Any of the above As .(b). Stainless steel wire Refs Textbook of Orthodontics-Gurkvat Singh, It edition, page 442 Q. 78. Lingual fixed appliances will be more effective in which of the following a. Intrusion of teeth , Maxillary arch expansion . Distilisation of maxillary molars 4. All of the above ‘Ans. (d). All of the above. Refs Textbook of Orthodontics-Gurkirat Sing, st edition, page 452. Q. 79. Which of the following can en- hhance the orthodontic tooth movement: a, Vitamin D administration , Injection of prostaglandin «. Both of the above . None of the above Abs, (@). Both of the above. Ref Contemporary Orthodontics-Profitt, 2nd edition, page 343Treatment of Different Malocclusion Jaspal Singh Method of g: 19 space in orthodontics © Methods of gaining space: To render the orthodontic treatment for crowded, retracted and derotated teeth, space must be created in the jaw. The different mean to achieve the space requirement include: 1. Proximal stripping or slicing is the reduction of the tooth material on the proximal side ofthe tooth. It is important that no more than half the thickness of enamel should be removed using metal abrasive strips, diamond discs, and carborundum discs. Its indicated when the space requirement is minimal. 2. Arch expansion-Involves the splitting or opening of the mid palatal suture with the help of rapid or slow maxillary expansion devices. a. Rapid maxillary expansion is recommended for: i. Correction of unilateral or bilateral crossbite ii, Class II with mid facial deficiency ii, Increasing maxillary arch width fv. Reducing nasal resistance v. Cleft palate Sign of arck expansion—The open diastema makes the rapid palatal expansion evident. Rapid maxillary appliances can be removable or fixed. ‘The fixed maxillary appliance include Hyrax appliance, Hass appliance, Derichsweiler appliance, Isaacson appliance. Rapid palatal expansion has been shown to produce forces ranging from 3 to more than 20 pounds. ‘With RME appliances, 0.2-0.5 mm of expansion can be achieved per day. ‘The activation of appliance varies with age and design of the appliance. . Slow expansion make use of less forces in the range of 2-4 pounds and over longer period 2-6 month, Indication-1. Correction of unilateral cross bite, 2. Correction of constricted maxillary arch. Slow expansion appliances include appliances incorporating coffin spring, Quad helix appliance, Schwarz appliance, “Appliance incorporating NiTi, ‘Schwarz appliance is a removable lower arch expansion appliance indicated in early mixed dentition with the objective of correcting mild to moderate crowding in the anterior region of the lower arch and for correcting the| lingually tipped posterior teeth. The appliance is activated once a week and can produce an expansion of 0.25 mm inthe midline. 3. Molar distalization a. Intraoral method to distalize molar-First class appliance, distal jet appliance, pendulum appliance, magnets, bumper, sewartz appliance, sagittal appliance, and fast back appliance. . Extraoral appliances for molar distalization include head gear. 4, Uprighting of tilted posterior teeth-1-1.5 of arch length increase can be obtained by up righting molar. Lip bumper, space regainer and fixed appliance are used to upright the tilted molar. 5. Derotation of posterior teeth-Space can be gained by derotating the rotated posterior teeth and it can be best accomplished with fixed orthodontic appliances. 6. Proclination of retroclined anterior teeth-Appliances used for proclining the retroclined anterior include removable appliances incorporating Z spring or mattress spring or screw and fixed orthodontic appliances. 7. Extraction Extracting the teeth to create space are indicated in severe arch length tooth material discrepancy. Extraction are not indicated for arch length tooth material discrepancy of less than 4 mm and are indicated almost always in discrepancy of 10 mm or more. ip * Balancing extraction is the extraction of tooth from the opposite side of the same arch, designed to minimize centre line shift.tet E 3 2 = 6 S 8 = = S iS) = is} i Cy 680 Comprehensive Review of Clinical Dental Sciences * Wilkinson extraction-Wilkinson recommended extraction of all four first permanent molar at the age of 85-9 year for the reason that these teeth are susceptible to caries. Another benefit is prevention of third molar impaction. * Compensatory extraction means extraction of a tooth from the opposing quadrant to the enforced extraction. It is designed to minimize occlusal interferance by allowing teeth to maintain occlusal relationships as they drift. * Therapeutic extraction-Extraction carried out for treatment purpose. * Teeth to be extracted in orthodontic treatment depend on: 1. Arch length tooth material discrepancy. 2. Direction and amount of jaw growth. * First premolar is the tooth most commonly extracted as a part of orthodontic treatment due to its position, due to fact that it least likely upset molar occlusion, and there is adequate posterior anchorage after its extraction. Cross Bite and Its Management * Anterior cross-bite an abnormal labiolingual relationship between one or more maxillary and mandibular anterior teeth. Its characterized by one or more mandibular anterior teeth in a labial relationship to their antagonist tooth or teeth of maxillary arch in centric occlusion * Posterior cross-bite condition in which one or more mandibular posterior teeth are in bucco-version ox complete lingu- version to the one or more maxillary posterior teeth. * Scissor bite is a condition where mandibular dentition is completely contained within the maxillary dentition in a habitual position. + Skeletal crossbite~The crossbite due to constricted maxilla or wider mandible. * Dental cross bite-The crossbite due to abnormal relationship of upper and lower teeth with normal jaw relationship, + Functional crossbite-Crossbite resulting due to the functional shift of the mandible. + Btiology of erossbite ~ Skeletal crossbite-Hereditary, cleft palate, parafunnctional habit (Thumb sucking). = Dental crossbite-Arch length tooth material discrepancy, over-retention of primary teeth, trauma to primary dentition, presence of supplemental teeth, abnormal axial inclination of teeth, parafunctional habit, repaired cleft palate, enlarged tongue. = Functional crossbite-Abnormal incisal interferences or occulsal prematurities, and abnormal mandibular posture * Management of anterior cross-bite ‘Tongue blade therapy-indicated for single tooth developing crossbite with adequate available space. Catalans appliance oF lower anterior inclined plane. Banded inclined plane. Bonded resin-composite slope to the incisal edge of the mandibular incisor at an angle 45° to the longitudinal axis of the tooth. Reverse stainless steel crown. Hawley appliance incorporating Z spring. Appliances incorporating expansion screw. Fixed appliance-Manillary lingual arch with whip spring, Labial arch with vertical spring loops. ‘Treatment of posterior crossbite ‘Arch expansion using removable or fixed appliances. Fixed appliances-W arch appliance, Quad helix appliance, Jack screw appliance, ranspalatal lingual arch. Removable appliances-Split plate removable appliance incorporating expansion screw, Saggital appliance, Y plate of Schwarz, * T spring for single posterior tooth cross bite + Use of cross elasticTreatment of Different Malocclusion 681 Wa) Open bite (apertognathia) and its management * Open bite is a deviation in the vertical relationship of the dental arches which is characterized by absence of vertical ‘overlap between the upper and the lower teeth, * Anterior open bite-An anterior open bite is defined by a vertical space between the upper and lower front teeth. It can bbe caused by a number of conditions. It is usually associated with vertical growth problems + Posterior open bite is defined by absence of contact between the posterior teeth when the teeth are brought in occlusion, Posterior open bite result due to lateral tongue thrust or due to submerged /ankylosed posterior teeth + Skeletal open bite-The open bite resulting due to skeletal aberration in growth. ‘+ Etiology of open bite = Hereditary ~ Parafunctional oral habits- thumb and finger sucking, lip and tongue habits, = Airway obstruction. ~ True skeletal growth abnormalities-excessive vertical growth. * Iatrogenic Open Bite-Poor mechanics during fixed-appliance treatment may cause extrusion of the molar teeth or hanging palatal cusps, which open the bite. + Pathological open bite may be associated with. 2. Cleft lip and palate. b. Acromegaly. Trauma to the facial skeleton, such as condylar fractures or Le Fort fractures of the maxilla. 4. Neurogenic disturbances ¢. Muscular dystrophy. ‘+ Treatment of open bite-Correction of skeletal open bite is one of the most difficult problems in orthodontic practice. Different treatment modalities for open bite include, a. Myofunctional therapy. b. Orthodontic mechanotherapy (using fixed or removable appliances). © Surgical correction-orthognatic surgery. . Combination procedure + Myofunctional therapy-Passive posterior bite blocks are functional appliances that are used to open the bite 34 mm beyond the rest position. In growing patients this inhibits the increase in height of the buccal dento-alveolar processes, thus preventing a downwards and backwards rotation of the mandible. High pull headgear to the bite blocks may increase their efficiency Functional regulator appliance -highpull headgear tothe bite blocks may increase their efficiency. + Fixed appliances-Anterior open bites can be closed using fixed appliances and vertical intermaxillary elastics to extrude the anterior teeth. This may be combined with a transpalatal arch and high pull headgear to limit vertical development of the maxillary molar teeth. © Vertical pull chin cup therapy has been used to limit excessive vertical growth. High pull headgear applied to the maxillary molar teeth and worn for 14 hours per day has been used to inhibit eruption of the posterior teeth and hence limit vertical growth ‘Treatment of deep bite ‘© Deep bite or closed bite or excessive overbite is a condition characterized by excessive overlap of lower incisors by upper incisors to the extent that lower incisors bite too closely to or into the gingival tissue or palate behind the upper teeth. ‘Treatment is based on the intrusion of the anterior teeth and extrusion of posterior teeth. # Treatment modalities include-Removable anterior bite plane and fixed orthodontic treatment including the use of auxiliary; Guray bite raiser. souopoyyo, re ih a SI iS) ra S 2 @ o &Wy 682 comprehensive Review of Clinical Dental Sciences Orthodontics < = S ~ Fa fo) ie is) in 7) ©. 1. Wilkinson recommended extraction of all four permanent molar: a. At the age of BS to 9 yr 1b. Due to their susceptibility to carious ¢. In order to prevent the third molar impaction 4. All of the above Ans, (d), All of the above . 2. Extraction of a tooth from the oppo- ‘sing quadrant to the enforced extraction is known as: a. Compensatory extraction ». Therapeutic extraction . Willkinson extraction 4. Balanced extraction Ans (2). Compensatory extraction Q. 3. Tooth to be extracted in orthodontic treatment depend on: a. Arhe length tooth material discrepancy b. Direction ©. Amount of jaw growth 4. All of the above ‘Ans. (d). All of the above Q. 4. First premolar is most commonly extracted tooth as part of orthodontic treatment duc to: a. Due to its position ‘As it least likely upset molar occlusion ¢. Adequate posterior anchorage 4. All of the above ‘Ans. (d). All of the above (Q. 5. Which of the following is used for treatment of posterior cross bite? a. W arch appliance b. Quad helix appliance ©. Transpalatal lingual arch 4. All of the above Ans, (d)-All of the above Q. 6. Maximum force which can be gene rated through RME is: a. 10 pounds 15 pounds «. 20 pounds 4. 30 pounds ‘Ans, (c). 20 pounds Q. 7, Which of the following appliance is slow expanders: a. Quad helix appliance b. Schwarz appliance . Appliance incorporating NiTi 4d. All of the above ‘Ans, (d). All of the above Q. 8 Which of the following is lower arch expansion appliance? a. Schwarz appliance ». Sved appliance ‘ Porter appliance 4. All of the above ‘Ans. (a). Schwarz appliance Q. 9, Which of the following appliance is uused to distalize the molar? a. Pedulum appliance b. Fast back appliance , Saggittal appliuance . Allof the above ‘Ans. (d). All of the above Q. 10. The maximum amount of the space which can be obtained by uprighting a molar is? a. 0.5 mm b. 15 mm. © 3mm 4. 4mm Ans. (6). 1.5 mm Q. 11, Apertognathia refers to: a. Deep bite ’b, Small and deviated jaw c Open bite 4. Scissor bite Ans. (¢). Open bite . 12. Closed bite refers to: a. Anterior crossbite b. Deep bite «. Posterior open bite 4. Anterior open bite Ans. (b). Deep bite