Space Maintenance

Question 1

During the mixed dentition, the “Golden Stage of Dentition”,
both (2) change concurrently

Answer 1

skeletal and dental structures

Question 1

For a child with all developmental spaces, prediction goes
towards a

Answer 1

well aligned permanent dentition

Question 2

On the other hand, any disturbance in these spaces, either
increased or decreased, can

Answer 2

potentially altered the outcome

Question 3

Space analysis quantifies

Answer 3

the amount of needed space (crowding/
spacing) within the arches estimating the severity of space
discrepancy.

Question 4

Space analysis requires a comparison between the

Answer 4

amount of space
available for the alignment of the teeth and the amount of space
required to align them adequately

Question 5

Space Available and Space Required Comparison has 3 results:
(3)

Answer 5

• Excess
• OK
• Deficiency

Question 6

Space management
* – of spaces in the arches is more common, however we should
not ignore excess space in the arch.
* Most of the time space deficiency (crowding) is divided to 3 group:
(3)
* For excess space there is not such a category. Each case will
be assessed based on its ….

Answer 6

Lack
1. Mild
2. Moderate
3. Severe
etiology and other factors

Question 7

What is Spacing?
* Spaced dentition is characterized by …
* It is a common — problem for many patients.
* In studies related to young populations, it was found that
spacing in both arches was more common in —
* Spacing can be localized or generalized due to the —
included.

Answer 7

interdental spaces and lack
of contact points between the teeth.
esthetic
boys than girls.
number of teeth

Question 8

Etiology
* The causes of generalized spacing
may be:
(3)

Answer 8

• Hereditary
• Acquired
• Functional

Question 9

Hereditary causes include
(7)

Answer 9

• Tooth size-arch size discrepancies
• Protrusive teeth
• Congenitally missing teeth
• Macroglossia
• Supernumerary teeth
• Small teeth
• Hypertrophic frenum

Question 10

Acquired problems can be
classified as:
(4)

Answer 10

• Pathologic conditions increasing tongue
  size
• Missing teeth
• Delayed eruption of permanent teeth
• Periodontal disease

Question 11

Functional causes include:
(1)

Answer 11

• Oral habits

Question 12

What can we do?
* Orthodontics plays an important role in the management of spaced
dentition, often in cooperation with other dental departments such
as oral surgery, periodontology, esthetic dentistry, and
prosthodontics.
* To achieve the most esthetic and functional result,
orthodontists must carefully evaluate the —
* — of dental casts may be useful in treatment
planning and informing the patient.

Answer 12

etiologic factors.
Diagnostic set-up

Question 13

Why should we correct spacing?
* Spacing should be corrected because it can:
(3)

Answer 13

1. Result in gum problems due to the lack of protection by the teeth.
2. Prevent proper functioning of the teeth.
3. Make the smile less attractive.

Question 14

How to treat spacing?
* Three treatment options are available for generalized spacing:
(3)

Answer 14

1. Esthetic intervention using composite resin, Veneer, Crowns,…
2. Orthodontic space closure.
3. Closure of anterior spaces and opening posterior spaces

Question 15

After orthodontic treatment, it is frequently necessary to apply
— as these cases have a high risk of relapse

Answer 15

fixed retention

Question 16

What is a Diastema?
(2)

Answer 16

• The midline diastema is a space (or gap) between the
  maxillary central incisors.
• The space can be a normal growth characteristic during the
  primary and mixed dentition.

Question 17

• Prevalence of diastema in 10 to 12 years old children:
  (3)

Answer 17

• More in maxilla. Between central incisors.
• African American 19%
• Caucasians 8%

Question 18

Diastemas may also be caused
by:
(5)

Answer 18

• Tooth size discrepancy
• Missing teeth
• Oversized labial frenum.
• Overjet
• Protrusion of the teeth.

Question 19

Once the reason has determined. Options may
include:
(4)

Answer 19

• Keep the diastema.
• Orthodontic treatment.
• Composite/Porcelain veneers
• Crown and bridge work or replacement of
  teeth with implants (adults only)

Question 20

If oversized labial frenum is the reason, pt
may be referred for a frenectomy.
(2)

Answer 20

• If the frenectomy is conducted on a child, the
  space may close by itself.
• If it is a teenager or adult, the space may need to
  be closed with braces prior to frenectomy. It is due
  to scar tissue which may prevent space closure by
  orthodontic forces.

Question 21

In most cases, diastemas will close spontaneously as the

Answer 21

canines
erupt.
* Little disagreement can be found that intervention to close the
diastema should be deferred until the canines have fully erupted

Question 22

Generally diastemas more than – mm require active intervention.
* Removable appliances generally close diastemas by tipping the crowns of
incisors vs fixed appliances provide better control of dental alignment

Answer 22

2

Question 23

In the mixed dentition, caution is necessary to avoid tipping the
roots of lateral incisors distally such that they interfere with the

Answer 23

erupting path of the canines

Question 24

There is a strong tendency toward relapse, hence a ---is nessecary.

Answer 24

fixed retainer

Question 25

Crowding * Crowding is the

Answer 25

lack of space for all the teeth to fit normally within the jaws.

Question 26

Crowding could be as the result of: (4)

Answer 26

* Twisted or displaced teeth. * Disharmony in the tooth to jaw size relationship. * Early or late loss of primary teeth * Improper eruption of teeth.

Question 27

Etiology * The exact cause of crowding or malocclusion in general is unknown. * Several researchers have suggested that the problem is (3)

Answer 27

hereditary and is associated with the evolutionary development of modern humans. * These investigators attributed the main cause of crowding to a progressive reduction in the jaw size as compared with tooth size. * Another author believed there are true signs of hereditary and environmentally induced tooth-size/jaw-size discrepancy “Signs of a True Hereditary Tooth-Size/Jaw-Size Discrepancy” and “Environmental Factors Causing Crowding.”

Question 28

Given the size of these lists, the etiology of crowding must be considered ---.

Answer 28

multifactorial

Question 29

Crowding should be corrected because it can: (5)

Answer 29

* Prevent proper cleaning of all the surfaces of your teeth. * Promote dental decay. * Increase the chances of gum disease. * Prevent proper functioning of teeth. * Make your smile less attractive

Question 30

What are the Treatment Options? * Proper management of space in the primary and mixed dentitions can prevent unnecessary loss in arch length. * Based on diagnosing the space problems, it could be divided to : (3)

Answer 30

* Mild crowding less than 4.5 mm * Moderate crowding 5 to 9 mm * Severe crowding >10mm

Question 31

* Mild crowding less than 4.5 mm can be resolved through; (3)

Answer 31

* Preservation of the leeway space, * Regaining space * Limited expansion in the late mixed dentition.

Question 32

* Moderate crowding 5 to 9 mm can be approached with: (2)

Answer 32

* Expansion * Some of these cases may require extraction of permanent teeth

Question 33

* Severe crowding >10mm will need: (2)

Answer 33

* Extraction * Serial extraction or guidance of eruption is reserved for treatment of severe tooth-size/arch-size discrepancies.

Question 34

Bolton Analysis * The Bolton analysis was introduced by Bolton in 1958. * It determines the ratio of ... * It shows whether there is any tooth --- discrepancy between the upper and lower teeth. * It is recommended for --- dentition, after eruption of all permanent teeth from 1 st molar to 1 st molar

Answer 34

the MD widths of the Max teeth to Man teeth. size permanent

Question 35

Bolton analysis determines: (2)

Answer 35

* Overall ratio. * Anterior ratio.

Question 36

Calculation of Bolton Analysis Step 1:

Answer 36

* Sum of Mandibular 12: * The M-D width of all permanent teeth from 1st molar on one side to the 1st molar on the other side, is measured and summed up. (2nd and 3rd molars are excluded) * Sum of Maxillary 12: * The M-D width of all permanent teeth from 1st molar on one side to the 1st molar on the other side, is measured and summed up. (2nd and 3rd molars are excluded)

Question 37

Calculation of Bolton Analysis Step 2: * Overall ratio:

Answer 37

* According to Bolton, the sum of the MD width of mandibular teeth to maxillary teeth (12 teeth, 6-6) is 91.3%

Question 38

Calculation of Bolton Analysis Step 3: * Interpretation: (Overall ratio)

Answer 38

* If the overall ratio is less than 91.3%, it indicates maxillary tooth materials excess. (vice versa) * The maxillary teeth are relatively too large compared to the mandibular teeth. (vice versa)

Question 39

Calculation of Bolton AnalysisStep 4: * Anterior ratio:

Answer 39

* According to Bolton, the sum of the MD width of the anterior mandibular teeth to the anterior maxillary teeth (6 teeth, 3-3) is 77.2%.

Question 40

Calculation of Bolton Analysis Step 5: * Interpretation: (Anterior ratio) (2)

Answer 40

* If the overall ratio is less than 77.2%, it indicates maxillary tooth materials excess. (vice versa) * The maxillary teeth are relatively too large compared to the mandibular teeth. (vice versa)

Question 41

Calculation of Bolton Analysis Step 6: * Calculation in mm: (3)

Answer 41

* After calculation of the Bolton ratio (Overall and Anterior), the arch with the relatively smaller tooth material is determined and the actual figure/value corresponding to the arch tooth size is located in the table. * The ideal value for the size of the opposing teeth is read off from the accompanying column. * The difference between the actual value and the ideal value (according to the table) for the relatively enlarged tooth material represents in mm the amount of excess tooth size in the arch.