DDC ASSESMENT

Group-A
1. Define ideal occlusion and normal occlusion. Mention the risks of orthodontic treatment.
Ans:
Ideal occlusion:
It is a pre-conceived theoretical concept of occlusal structural & functional relationships that include
idealized principles and characteristics that an occlusion should have.
Normal occlusion:
An occlusion within the accepted deviation of the ideal.
Risks of orthodontic treatment:
Intra oral risks:
1. Enamel demineralization.
2. Enamel trauma.
3. Enamel wear.
4. Pulpal reaction.
5. Root resorption.
Extra oral risks:
1. Allergy
2. Trauma
3. Temporomandibular disorder
Systemic risks:
1. Cross infection
2. Infective endocarditis.
2. Mention the causes of cleft palate. What are the anomalies occur due to cleft lip and palate?
Ans:
Causes of cleft palate:
1. Maternal infection & toxicity:
• Infection: Rubella, influenza.
• Toxicity: Hypoxia
• Teratogenic drug: cortisone, methotrexate.
2. Maternal dietary imbalance:
• Folic acid deficient diet.
• Deficiency of riboflavin.
3. Maternal hormonal imbalance.
4. Syndrome associated with cleft palate:
• Pierre robin’s syndrome.
• Apert syndrome.
5. Increased maternal age.
6. Intermarriage.
7. Radiation during pregnancy.
8. Developmental.
9. Heredity: Family history of cleft.
The anomalies occur due to cleft lip and palate are:
1. Dental:
• Anomalies of tooth morphology.
• Enamel hypoplasia.
• Microdontia.
• Fused teeth.
• Supernumerary teeth.
2. Aesthetic:
• Facial disfigurement.
• Deformities of nose.

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 3. Disorders of the middle ear that may affects hearing.
4. Midfacial hypoplasia.
3. A 15-years boy attends your department with anterior cross bite. What types of malocclusion of anterior
cross bite? Draw and label the vertical plane malocclusion.
Ans:
Types of malocclusion of anterior cross bite:
Transverse plane malocclusion due to abnormal transverse relationship between anterior upper & lower
arch.
Vertical plane malocclusion is given below:

4. Mention the abnormal oral habit. How you will manage the tongue thrust?
Ans:
Abnormal oral habit:
1. Thumb sucking
2. Lip biting / Lip sucking
3. Tongue thrusting
4. Mouth breathing
5. Bruxism
6. Frenum thrusting
7. Cheek biting
8. Nail biting
9. Pencil /pen biting
10. Bobby pin opening
Management of tongue thrust:
1. Construction of a vertical crib which prevent forward thrusting of tongue.
2. Tongue guard appliance fixed type & removable type may be used to stop tongue thrusting.
3. The other method requires oral habits training, an exercise technique that re-educates the muscles
associated with swallowing by changing the swallowing pattern.

5. Mention the types of bone grafting. Write the source and advantage of bone grafting for orthodontic cleft
patient.
Ans:
Types of bone grafting:
1. Auto graft: It is transplanted from one region to another in same individual.
2. Allograft (Homograft): It is transplanted from one individual to a genetically non identical individual of
same species.
3. Xenograft (Heterograft): It is transplant from one species to another species.
4. Isograft: This graft is exchanged between genetically identical individual such as identical things.
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 Sources of bone grafting for orthodontic cleft patient:
1. Rib
2. Illiac bone
3. Mandibular symphysis.
4. Outer table of parietal bone.
Advantage of bone grafting for orthodontic cleft patient:
1. It provides a firm bony support for the alar base to minimize nasal deformity.
2. Elimination of oronasal and nasolabial fistula, hence avoiding nasal reflex of fluid and air.
3. Stabilization of maxillary segments.
4. Facilitation of teeth eruption into the cleft site and achieve orthodontic movement adjacent to cleft side.
5. Facilitates normal speech, hearing, and improve swallowing.
6. Write short notes on-l). Lee way space II). Primary and secondary growth.
Ans:
Lee way space:
The combined mesio-distal width of permanent canines (3) and premolars (4,5) is usually less than that of
deciduous canines(C) and molars (D, E). The difference in mesiodistal width between the CDE and 345 is
called leeway space.
• Mesio-Distal width of: C+D+E> 3+4+5
• In Maxilla, 0.9mm on either side.
• Mandible, 1.7mm on either side.
Importance:
• It is the excess space available after the exchange of the deciduous molars and canines with
permanent teeth.
• It is utilized for mesial drift of mandibular molars to establish class I molar relation.
Primary displacement (growth):
If a bone gets displaced as a result of its own growth, it is called primary displacement.
For example-growth of the maxilla at the tuberosity region results in pushing of the maxilla against the cranial
base which results in the displacement of the maxilla in a forward and downward direction.
Secondary displacement (growth):
If the bone gets displaced as a result of growth and enlargement of an adjacent bone, it is called secondary
displacement.
For example -the growth of the cranial base causes the forward and downward displacement of the maxilla.
Group-B
1. Define preventive orthodontics. What is the preventive procedure in orthodontics? How can you prevent
developing anterior cross bite?
Ans:
Preventive orthodontics:
It is the action taken to preserve the integrity of what appears to be normal occlusion at a specific time.
Preventive procedure in orthodontics:
1. Parent counselling
2. Caries control
3. Anatomical dental restoration
4. Space maintenance
5. Management of abnormal frenal attachments
6. Extraction of supernumerary teeth
7. Care of deciduous dentition
8. Checkup of oral habits & habit breaking appliance
9. Management of ankylosed tooth
Prevention of developing anterior cross bite:
1. Tongue blade therapy: it is a flat wooden stick, placed inside the mouth contacting the palatal aspect of
the tooth in crossbite for 1-2 hours for 2 weeks.
2. Catalan’s appliance
3. Placing a metallic crown on upper incisor tooth.
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2. Mention the causes of delay eruption of permanent teeth. Mention the predisposing metabolic factors and
endocrine imbalance causing malocclusion.
Ans:
Causes of delay eruption of permanent teeth:
1. Congenital absence of the permanent tooth.
2. Presence of supernumerary tooth or pathology such as odontomes can block the erupting permanent
tooth.
3. Presence of a heavy mucosal barrier can prevent the permanent tooth from emerging into the oral cavity.
4. Premature loss of deciduous teeth can result delayed eruption of the underlying permanent teeth due to
formation of bone over the erupting permanent tooth.
5. Endocrinal disorders such as hypothyroidism can cause a delay in eruption of the permanent teeth.
6. Presence of deciduous root fragments that are not resorbed can block the erupting permanent teeth.
Predisposing Metabolic Factors causing Malocclusion:
1. Endocrine imbalance.
2. Metabolic disturbance.
3. Infectious disease.
Endocrine imbalance causing malocclusion:
1. Hypothyroidism.
2. Hyperthyroidism.
3. Hypoparathyroidism.
4. Hyperparathyroidism.
5. Hypopituitarism.
6. Hyper pituitarism.
3. Mention the diagnostic aids. Explain why OPG essential diagnostics aids?
Ans:
The diagnostic aids are:
A. Essential diagnostic aids
1. Case history.
2. Clinical examination
3. Study model
4. Certain radiograph
• Periapical radiograph
• Bite wing
• Panoramic
5. Facial photographs
B. Supplemental diagnostic aids
1. Specialized radiograph
Cephalometric radiograph
Occlusal intra-oral films.
2. Hand wrist radiograph.
3. Diagnostic setup
4. Occlusograms.
OPG essential diagnostics aids, because:
1. They are useful in assessing the dental development by studying deciduous root resorption and root
development of permanent teeth.
2. They can be used to view ankylosed and impacted teeth.
3. To study the path of eruption of teeth.
4. To diagnose the presence and extent of pathology and fractures of the jaws.
5. To diagnose the presence or absence of multiple supernumerary teeth.
6. They are useful aids in serial extraction procedures to study the status of erupting teeth.
7. They are useful in the mixed dentition period to study the status of unerupted teeth.

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4. Draw and label an appliance to expand upper arch to correct posterior cross bite.
Ans:
An appliance to expand upper arch to correct posterior cross:

5. Classify the of bite planes. Mention the mechanism of action of anterior and posterior bite plane.
Ans:
Classification of bite planes:
A. Bite planes may be classified according to their position as-
a) Upper anterior
b) Lower anterior
c) Upper posterior
d) Lower posterior
B. According to the angulation as-
1. Flat Bite planes
2. Inclined Bite planes
Mechanism of action of anterior and posterior bite plane:
Anterior Bite planes: Supra-eruption of upper posterior teeth & relative intrusion of lower anterior teeth.
Posterior Bite plane: Creates occlusal clearance.
a) Disoccludes the posterior teeth allow tooth movement.
b) Continuous pressure exerts on the lower incisor and may cause little intrusion.
c) Increased TMJ dysfunction syndrome, it helps in relieving pain by disoccluding the teeth repositioning the
mandible.
d) By virtue of opening the bite if helps in elimination of occlusal interference but it does not help in guiding
the mandible in new position.
6. Write short notes on-i) Profile of the patient. ii) Dental midline examination.
Ans:
Profile of the patient:
The profile is examined from the side by making the patient view at a distant object, with the FH plane
parallel to the floor.
The profile is assessed by joining two reference lines:
• Line joining forehead and soft tissue point A (deepest point in curvature of upper lip).
• Line joining point A and soft tissue pogonion (most anterior point of the chin).
Points that are important for facial profile analysis:
1. Nasal bridge or Glabella
2. Base of the upper lip or Philtrum
3. Highest point of the chin
Types of facial profile:
Based on the relationship between these two lines, three types of profiles are seen―
1. Straight or Orthognathic profile: The two lines form a nearly straight line.
2. Convex profile: The two lines form an acute angle with the concavity facing the tissues.
3. Concave profile: The two lines form an obtuse angle with the convexity facing the tissues.
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 Fig: Face Profile
Dental midline examination:
1. Take Medical/ dental history.
2. Take family history.
3. Perform Clinical examination.
4. Perform Radiographic survey.
On radiograph check for a notching in the interdental alveolar bone, it shows thick & fleshy frenum.
5. Perform Blanch Test: Done to diagnosis fleshy labial frenum. It is done by-
a) Pulling the upper lip outwards. Presence of a thick and fleshy frenum is confirmed by the blanching of
the tissue in the incisive papilla region palatal to the two central incisors.
6. Model analysis: tooth material-arch length discrepancies can be determined.

Group-C
1. Define center of resistance and center of rotation. Draw and level of teeth in uncontrolled tipping.
Ans:
Center of resistance:
Centre of resistance can be defined as that point on the tooth when a single force is passed through it, would
bring about Its translation along the line of action of the force.
Center of rotation:
Centre of rotation is a point, about which a body appears to have rotated, as determined from its initial and
final positions.
Teeth in uncontrolled tipping:

Fig: Teeth in uncontrolled tipping.

2. Mention the source of intra-oral anchorage. How a removable orthodontic appliance get anchorage from
intra orally?
Ans:
Source of intra-oral anchorage:
1. The teeth:
• Root form
• Root length
• Number of the roots
• Anatomic position of the teeth
• Ankylosed tooth

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 2. Alveolar bone
3. Basal bone
• Hard palate
• Lingual surface of mandible
4. Mucosa & underlying bone.
5. Musculature
Removable orthodontic appliance get anchorage from intra orally by:
1. Retentive components:
• From Teeth, usually 1st molar.
2. Acrylic base plate:
• From hard palate
• From the mucosa & underlying bone
3. Draw and label the various types of tooth movement. Mention the 3 difference between tipping and
bodily tooth movement.
Ans:
Various types of tooth movement:
Tipping Movement:

Bodily Movement:
Rotation:

Extrusion:
Torque:

Uprighting:
Intrusion:

3 differences between tipping and bodily tooth movement:

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 SL. Features Tipping Tooth Movement Bodily Tooth Movement
1 Direction of movement between Opposite Same
root and crown
2 Produced by appliance Usually removable appliance Fixed
3 Type 2 types: i. Controlled tipping Not such
ii.Uncontrolled tipping
4 Force required 35-60 gm 70-120 gm
5 Prefer ability Less More
6 Figure See Above See Above

4. Mention the causes of canine impaction. Explain why upper canine impaction rate greater than lower
canine?
Ans:
Causes of canine impaction:
1. High developmental position of canine.
2. Long path of eruption.
3. Early loss of deciduous teeth
4. Crowding.
5. Retained deciduous tooth.
6. Canine erupts late in the series and the space taken by other teeth.
7. Narrow arch.
8. Retroclination of incisors.
9. Advanced state of development of crown at an early age.
10. Cleido-cranial dysostosis-generalized non-eruption of teeth.
11. Cleft palate and lip.
12. Local pathological condition e.g. cysts, tumors.
13. Hypopituitarism- eruption generally delayed.
Upper canine impaction rate greater than lower canine, because:
1. The path of insertion of maxillary canine is long than lower canine.
2. Last erupted tooth in the dental arch. So there maybe a possibility of lack of space in the dental arch.
5. What are the theories of tooth movement? Draw and label the histological change following mild pressure
on an anterior tooth.
Ans:
Theories of tooth movement:
1. Pressure tension theory by Schwarz.
2. Fluid dynamic theory by Bien or Blood flow theory.
3. Bone bending & piezoelectric theory.
Histological change following mild pressure on an anterior tooth:

Bone resorption
Bone deposition
PDL
Cementum
Dentin
Pulp
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6. Write short notes on- i) Frontal resorption. ii) Optimum orthodontic force
Ans:
Frontal resorption:
When the forces applied are within the physiologic limits, the alveolar plate immediately adjacent to the
ligament called frontal resorption.
• Frontal resorption implies that osteoclasts are formed directly along the bone surface in the area
corresponding to the compressed periodontal fibers.
• The first step in orthodontic tooth movement is the activation of osteoclasts. The osteoclasts initiate the
process of resorption. Some of the osteoclasts are derived from local population while others are
brought from distant areas through blood supply. The activated osteoclasts start the resorption process
by attacking the adjacent lamina dura, removing bone in the process.
• It is also called periosteal resorption or direct resorption.
• In frontal resorption, resorption is initiated from the PDL side of the alveolar bone. It usually takes place
after 2 days. Resorption of cementum and dentin appears less frequent, judging from clinical and
radiographic evidence. The newer differential light force techniques of tooth movement claim to operate
in this manner.
Optimum orthodontic force:
Optimum orthodontic force is one, which moves teeth most rapidly in the desired direction, with the least
possible damage to tissues and with minimum patient discomfort.
• Optimum orthodontic force is equivalent to the capillary pulse pressure, which is 20-26 gm/sq. cm of
root surface area.
Characteristics from a clinical point of view:
1. Produces rapid tooth movement.
2. Minimal patient discomfort.
3. The lag phase of tooth movement is minimal.
4. No marked mobility of the teeth being moved.
Characteristics from a histologic point of view:
1. The vitality of the tooth and supporting periodontal ligament is maintained.
2. Initiates maximum cellular response.
3. Produces direct or frontal resorption.
Advantages of optimum orthodontic force:
1. Tooth movement is efficient with optimum orthodontic force.
2. Resorption is mainly of the periosteal type.
3. Elimination of lag phase.
4. Elimination of hyalinized zone with optimum force.
5. Pain is lessened.
6. Damage to the supporting structures is avoided.
7. Chances for root resorption are minimized.
Group-D
1. Mention the causes of class III malocclusion. Write the treatment modalities of class II division
1malocclusion.
Ans:
Causes of class III malocclusion:
A. Pseudo Class III:
1. Presence of occlusal prematurity.
2. Premature loss of deciduous tooth.
3. Child with enlarge adenoids.
B. True class III:
1. Excessively large mandible.
2. Forwardly placed mandible.
3. Smaller than normal maxilla.
4. Retro-positioned maxilla.
5. Combination of the above cause.
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 Treatment modalities of class II division 1 malocclusion:
1. Lower arch:
a) If there is crowding and which need treatment -Extraction must be undertaken and canine retracted to
align the incisor.
b) Lower 1st premolars on both sides most frequently are selected for extraction.
2. Upper arch
• Upper arch treatment is planned after the planning of treatment of lower arch.
• Upper canine and at the end of the treatment should ideally be Class-I relation with lower canine.
• It is required to retract the upper canine. Space is require & obtained by:
a) Distal movement of upper buccal teeth with or without extraction of upper right and left 2 nd molar:
• Where the space is required is small, this process is ideal.
• But upper first molar should be mesially inclined
b) Extraction of premolar:
• When space requirement is large Extraction of upper 1st premolar of both sides, then retraction of
canine.
c) Extraction and distal movement:
• This is done in severe case with marked crowding.
B. Reduction of over bite:
• By Removable appliance with anterior bite plane during canine retraction.
C. Reduction of overjet:
• This is done by removable appliance with labial bow.
D. Retention -
• This is given with a suitable retainer for at least six months.
3. A 9-years girl came with the complaint of forwardly placed upper jaw. After examination she is diagnosed
as class II skeletal malocclusion. To manage this case when will you use orthopedic appliance and when
myofunctional appliance and why?
Ans:
Management:
If the maxilla is prognathic:
• Used head gear to resist & prevent the growth of maxilla
If the mandible is retrognathic:
• Class II activator is used to reposition the mandible forwardly by harness the muscular force and
remodeling of temporomandibular joint.
4. Define and classify myofunctional appliances. Write the mode of action of activator.
Ans:
Myofunctional appliance:
Myofunctional appliances are defined as, loose fitting or passive appliances, which harness natural force of
the oro-facial musculature that are the transmitted to the teeth and alveolar bone through the medium of
appliance.
Classification of myofunctional appliances:
A. Basic classification of Myofunctional appliances:
1. Removable functional appliances: e.g. Activator, Frankel etc.
2. Fixed functional appliances: e.g. Herbst appliance and Jasper jumper.
3. Semi-fixed functional appliances: e.g. Den holtz, Bass appliances etc.
B. Classification by Tom Graber:
1. Group-A: Teeth supported appliances e.g. Catalans, inclined planes, etc.
2. Group-B: Teeth or tissues supported appliances e.g. Activator, Bionator, etc.
3. Group-C: Vestibular positioned appliances with isolated support from tooth/tissue e.g. Oral
screens, Frankel appliance, Lip bumpers.
C. Classification by Profile:
1. Tooth borne passive appliances: e.g. Activator, Bionator and Herbst appliance.
2. Tooth borne active appliances: e.g. modifications of activator and bionator, expansion screws.
3. Tissue borne appliances: e.g. Functional Regulator of Frankel.
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 D. Classification based on the transmission of force:
1. Group-I appliances: e.g. Oral screen and inclined planes.
2. Group-II appliances: e.g. Activator and bionator.
3. Group-III appliances: e.g. Frankel appliance and vestibular appliances
Mode of action of activator:
Activator induces musculoskeletal adaptation by introducing a new pattern of mandibular closure.
1. Prevention of further forward growth of the maxillary dento-alveolar process.
2. Movement of the maxillary dento-alveolar process distally.
3. A reciprocal forward force on the mandible.
5. Mention the minor surgical procedure done during orthodontic treatment. Write the indication of
orthognathic surgery for orthodontic patients.
Ans:
Minor surgical procedure done during orthodontic treatment:
1. Extraction
a) Therapeutic extraction
b) Serial extraction
c) Extraction of grossly carious tooth
d) Extraction of supernumerary tooth
e) Extraction of impacted tooth.
2. Frenectomy.
3. Surgical exposure of impacted tooth.
4. Pericision.
5. Corticotomy.
6. Transpositioning of teeth.
7. Orthodontic implants.
Indication of orthognathic surgery:
1.Vertical facial Pattern
a) Long face
b) short face
2.Severe antero-posterior Jaw discrepancy
a) Severe class I skeletal discrepancy
b) Server class III skeletal discrepancy
3.Very severe dento-alveolar Problems
a) Crowding >4-6mm
4.Transverse skeletal problem
a) Facial asymmetry
b) Hemifacial microsomia
5. Congenital cranio facial syndrome
a) Cleft lip and palate
6. Define relapse and retention. How you will prevent the relapse after orthodontic treatment.
Ans:
Relapse:
According to Moyer, retention is defined as “Maintaining newly moved teeth in position, long enough to aid
in stabilizing their position.”
Retention:
It is the tendency of tooth to return or back to their original position after the active orthodontic treatment.
Prevention of relapse after orthodontic treatment:
1. Adequate and prolong retention.
2. Placement of tooth in occlusal and cuspal equilibrium.
3. Placement of teeth in soft tissue balance.
4. Treatment should be done at early stage.
5. Over correction of teeth in case of rotation.
6. Pericision.

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7. Write short notes on- i) lip bumper. ii) chin cap.
Ans:
Lip bumper:
A lip bumper is a device which is used to push the molar on the lower jaw back to create more space for
other teeth.
Another name:
1. Lip plumber
2. Removable-fixed appliance
3. Modified vestibular screen

Uses:
1. Lip sucking.
2. Patients with Hyperactive mentalis that causes flattening or crowding of the lower anteriors.
3. To augment anchorage.
4. Distalization of first molars.
5. As space regainer.
6. Labialization of lower anterior teeth.
Advantage:
1. Reduce crowding.
2. Decrease excessive overbite.
Chin cap:
An extraoral orthopaedic device that covers the chin to restrict the forward and downward growth of the
mandible.
Components:
1. A chin cup that covers the chin.
2. A head cap.
3. An adjustable elastic that connects the chin cap with the head cap.

Effects of Chin cup:

1. Redirection of mandibular growth in a downward and backward direction.
2. Remodeling of the mandible and a decrease in mandibular plane angle and gonial angle.
3. Lingual tipping of lower incisors.
4. Improvement in skeletal and soft tissue profile.
Types:
a) Occipital pull chin cup
b) Vertical pull chin cup
Indication:
1. It is indicated in high angle cases or long face patients as it helps to close the angle of the mandible and
increase the posterior facial height.

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 DDC REASSESMENT
Group-A
1. Define orthodontics. Mention various methods for classification of malocclusion. Mention the drawback of
angles classification.
Ans:
Orthodontics:
It is a Branch of dentistry that concerned with prevention, interception and correction of malocclusion and other
abnormalities if dentofacial region.
Methods for classification of malocclusion:
1. Angle's classification.
2. Dewey’s modification of Angle classification.
3. Lischer's modification of Angle classification.
4. Simon’s system.
5. Bennet's classification.
6. Ackermann and profit.
7. Ballard’s.
8. Premolar.
9. Newly proposed system.
Drawback of angles classification:
1. Angle's considered malocclusion only in the anterior posterior plane. He did not consider transverse and
vertical plane.
2. Angle’s considered first permanent molar as fixed points in the skull. But this is not found be so.
3. The classification can't be applied if the first permanent molars are extracted or missing.
4. The classification can't be applied in deciduous dentition.
5. The classification doesn’t differentiate skeletal and dental malocclusion.
6. The classification doesn’t highlight the etiology of malocclusion.
7. Individual tooth malposition has not been considered by angles.
2. Mention the environmental causes of cleft palate. What are the dental anomalies occur due to cleft lip and
palate?
Ans:
Environmental causes of cleft palate:
1. Exposure to Rubella and other infections.
2. Early pregnancy.
3. Maternal hormonal imbalance
4. Smoking cigarette.
5. Radiation during pregnancy
6. Increased maternal age.
7. Maternal dietary imbalance:
i. Folic acid deficient diet
ii. Dietary deficiency of Riboflavin
iii. Hypervitaminosis A
Dental anomalies due to cleft lip and palate:
1. Congenitally missing teeth (most commonly the upper laterals)
2. Presence of natal or neonatal teeth
3. Presence of supernumerary teeth
4. Ectopically erupting teeth
5. Anomalies of tooth morphology
6. Protruding premaxilla
7. Deep bite
8. Spacing/crowding.
9. Microdontia
10. Fused teeth

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3. Draw and label the sagittal and vertical plane malocclusion.
Ans:
Sagittal Plane Malocclusion:

Vertical plane malocclusion: See Above.

4. Mention the effect of thumb sucking. How you will manage the tongue thrust?
Ans:
Effects of Thumb Sucking:
A. Effects on Maxilla:
1. Constricted maxilla
2. V Shaped narrow palate
3. Posterior cross bite may occur
4. Increased SNA angle.
B. Effects on Maxillary teeth:
1. Proclination of maxillary incisors.
2. Spacing of anteriors
3. Increased arch length
C. Effects on Mandibular teeth:
• Retroclination of mandibular anteriors.
C. Effects on Inter-arch relationship:
1. Increased overjet
2. Decreased overbite
3. Open bite
D. Effects on Upper Lip:
• Incompetent upper lip
E. Effects on Lower Lip:
• Hyperactive lower lip with increased mentalis activity.
F. Effects on Tongue:
• Lower tongue position.
Management of tongue thrust:
1. The patient is instructed to put the tip of the tongue at the correct position and swallow with lips pursed
and teeth in occlusion. This helps the patient to learn a new reflex on the conscious level. (40 times/day
in 2-3 sessions)
2. Various muscle exercise of the tongue
3. Place a flat sugar less fruit drop on the back of the tongue and held against the palate in the correct
position until it completely dissolves. This is practiced once/twice a day.
4. The appliance therapy is initiated for children above 9 years. Appliances for discontinuing tongue
thrusting habits are- i) Removable Hawley’s retainer with palatal crib.
ii) Fixed appliance with racks
5. Mention the types of bone grafting. Write the source and advantages of bone grafting for orthodontic cleft
patient.
Ans: See Above

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6. Write short note on- i. Primate space. ii. Ugly duckling stage.
Ans:
Primate Space:
These physiologic spaces are present invariably on mesial side of maxillary canines and distal side of mandibular
canines. As these spaces are commonly seen in primates, these are known as primate spaces.

• These spaces help in the placement of the canine cusps of the opposing Arch. During early shift, in children
with open primary dentition, the mandibular 1st molars close the primate space distal to canine. The flush
terminal plain gets converted into a mesial step.
• This allows the permanent maxillary first molars to erupt into class I molar relationship.
Ugly Duckling Stage:
Ugly duckling stage is a transient form of malocclusion wherein midline diastema is present between the
maxillary central incisors.
Occurrence of Ugly Duckling Stage:
1. Ugly duckling stage is seen between 7 and 11 years of age.
2. During the eruption stages of canine, canine will be impinging on the roots of lateral incisors.
3. This pressure causes the lateral incisor to erupt into the oral cavity with divergence of crown distally.
4. Even after the lateral incisors fully erupts, this pressure effect from the erupting canine persists.
5. This pressure is transmitted to the central incisors also, which causes the crowns to diverge distally and
roots to converge towards midline.
6. This bilateral effect causes a midline diastema, which is temporary.
7. This temporary spacing that occurs between the central incisors and sometimes between central and
lateral incisors gets closed automatically as the canine comes into occlusion.
8. This stage is called ugly duckling stage because it represents a metamorphosis from an unaesthetic phase
to an aesthetic phase.

Fig: Ugly Duckling Stage in the developmental dentition.

Treatment:
As the condition is physiological, so it does not require any orthodontic intervention.

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 Group-B
1. Define interceptive orthodontics. What is the preventive procedure in orthodontics? How can you prevent
developing anterior cross bite?
Ans:
Interceptive orthodontics:
It is that phase of the science and art of orthodontics, employed to recognize and eliminate potential
irregularities and malposition in the developing dentofacial complex. e.g. Serial extraction, space regaining.
Preventive procedure in orthodontics:
1. Prenatal Parental education.
2. Caries control in deciduous tooth.
3. Care of deciduous dentition.
4. Management of ankylosed teeth.
5. Management of teeth shedding time table.
6. Extraction of supernumerary teeth.
7. Space maintainer
8. Management of abnormal renal attachment.
9. Extraction of Natal and neonatal teeth.
10. Elimination of occlusal interference.
Prevention developing anterior cross bite: See Above
2. Mention the causes of early eruption of permanent teeth. What are the pre request for serial extraction.
Ans:
Causes of early eruption of permanent teeth:
local cause:
• Premature loss of the primary predecessor tooth
• Localized hemangiomata
Systemic cause:
• Hormonal disturbances
• Excess growth hormone
• Excess thyroid hormones.
Pre request for serial extraction:
1. Dental base should be Class-I with normal overjet and overbite
2. First molars in Class-I relation
3. All deciduous teeth should be present.
4. All successor teeth should be present and normal in size, shape, position and inclination. Permanent
canine must be mesially inclined.
5. No caries untreated.
6. First premolars should be ahead of the canines developmentally.
7. Patient should be available for close supervision.
3. Mention the diagnostic aids. Explain why intra oral peri apical radiography essential diagnostic aids?
Ans:
Diagnostic aids: See Above
Essentiality of intra oral peri apical radiography as a diagnostic aid:
1. To confirm the presence or absence of teeth.
2. To establish the presence or absence of supernumerary teeth.
3. To assess the extent of calcification and root formation of teeth.
4. To confirm the presence and study the extent of periapical pathology and root fractures.
5. To study the alveolar bone and periodontal ligament space.
6. To study the height and contour of alveolar bone crest.
7. To study the axial inclination of roots.
8. To detect retained root fragments and root stumps.
9. To determine the size and shape of unerupted teeth.

16
4. Draw and label an appliance to upper removable appliance for proclination of upper anterior teeth in cross
bite case.
Ans:

5. Classify the of bite planes. Mention the mechanism action of anterior and posterior bite plane.
Ans: See Above
6. Write short notes on- i) Labial bow ii) Facial symmetry
Ans:
Labial Bow:
Labial bow is that active component of removable orthodontic appliance which helps in retracting and retaining
the anterior teeth and also contributes for retention of the appliance.
Parts:
Labial bow consists of three parts:

Horizontal Bow Portion

Vertical Loop

Retentive Arm

Modifications of Labial Bow:

1. Short labial bow
2. Long labial bow
3. Split labial bow
4. Reverse labial bow
5. Robert's retractor
6. Mill's retractor/Extended labial bow
7. High labial bow with apron spring
8. Fitted labial bow
9. Labial bow with elastics
10. Labial bow with self-straightening wires
Facial asymmetry:
It is examined both in rest position of the mandible and in occlusion.
Midline of face is assessed by five points:
1. Tricion
2. Nasal bridge
3. tip of the nose
4. midpoint of philtrum of upper lip
5. midpoint of the chin.

17
• Midline of nose, lips, chin, face should co-incident.
• The important point to be examine are symmetry of the structures of the right and left side of the face.
Asymmetry that are gross and detected easily should be recorded. It can occur as a result of -
i. Congenital defect.
ii. Hemi facial atrophy or hypertrophy.
iii. Unilateral condylar ankylosis, hyperplasia.
iv. Muscular dystrophy.
v. Cerebral palsy

Group-C
1. Define center of resistance and force. Draw and level of teeth in tipping movement.
Ans: See Above
Force: Orthodontic force can be defined as, “the force applied for the purpose of effecting tooth movement,
generally having a magnitude lower than an orthopedic force.”
2. Mention the source of anchorage. How a removable orthodontic appliance get anchorage from intraorally.
Ans: See Above
3. Draw and label the various stages tooth movement. Mention the 3 difference between controlled tipping
and uncontrolled tipping tooth movement.
Ans: See Above
3 differences between controlled tipping and uncontrolled tipping tooth movement:
Controlled Tipping Uncontrolled Tipping
It occurs when a tooth tips about a center of rotation It occurs about a center of rotation apical to & very
at its apex. close to the center of resistance.
Lingual movement of crown with minimal labial Here, crown move in one direction while root moves
movement of the root in the opposite direction.
Minimal stress at the root apex Maximum pressure at the root apex.

4. Mention the causes pf canine impaction. Explain why upper canine impaction rate is greater than lower
canine?
Ans: See Above.
5. Define growth and development. Draw and label the histological change following mild pressure on an
anterior tooth.
Ans:
Growth:
According to Todd, growth can be defined as, " An increase in size and number. "
Development:
According to Todd, " Development is progress towards maturity. "
Histological change following mild pressure on an anterior tooth: See above.

6. Write short note on: i) Frontal resorption ii) Bite plane

Ans:
Frontal Resorption: See Above
Bite Plane: Bite Planes are myofunctional appliances which are usually incorporated into the design of a
removable orthodontic appliance as an extension or modification of the acrylic base plate.
Classification of bite planes:
A. Bite planes may be classified according to their position as-
e) Upper anterior
f) Lower anterior
g) Upper posterior
h) Lower posterior
B. According to the angulation as-
3. Flat Bite planes
4. Inclined Bite planes
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 Mechanism of action of anterior and posterior bite plane:
Anterior Bite planes: Supra-eruption of upper posterior teeth & relative intrusion of lower anterior teeth.
Posterior Bite plane: Creates occlusal clearance.
a) Disoccludes the posterior teeth allow tooth movement.
b) Continuous pressure exerts on the lower incisor and may cause little intrusion.
c) Increased TMJ dysfunction syndrome, it helps in relieving pain by disoccluding the teeth repositioning the
mandible.
d) By virtue of opening the bite if helps in elimination of occlusal interference but it does not help in guiding
the mandible in new position.

Group-D
1. Mention causes of class II Division 1 malocclusion. Write the treatment modalities of class III malocclusion.
Ans:
Causes of class II Division 1 malocclusion:
1. Skeletal pattern:
• Protruded maxilla
• Retrognathic mandible.
• Decrease mandibular size
• Increase mandibular size.
2. Soft tissue.
• Incompetent lips.
• High lip line
3. Dental factors
• Crowding in upper arch.
4. Local factors
• Habits such as thumb sucking.
Treatment modalities of class III malocclusion:
A. In growing age:
• Growth modification by:
⁻ Reverse pull headgear in maxillary deficiency.
⁻ Chin cap with headgear in mandibular prognathism.
• Anterior cross bite corrected by:
⁻ Catalan’s appliance.
B. In adult age:
• In reduced overjet or edge to edge bite:
⁻ Correction of crowding by distal movement of upper buccal segment then canine retraction then
alignment of incisors.
• In reverse overjet but increased overbite:
⁻ Proclination of upper anterior segment & extraction usually avoided.
⁻ Mild crowding: extraction of upper 2nd premolar & alignment of anterior segment.
⁻ Moderate crowding: extraction of lower 1st premolar & alignment of anterior segment.
⁻ Severe crowding: Proclination of upper anterior segment & retrocliantion of lower labial segment.
• In reverse overjet but normal or reduced overbite:
⁻ Proclination of upper anterior segment by fixed appliance.

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2. Write down the difference between slow and rapid expansion.
Ans:
Difference between slow and rapid expansion:
SL. Feature Slow Expansion Rapid Expansion
1 Type of expansion Mostly dental Skeletal
2 Rate of expansion Slow Rapid
3 Type of tissue reaction More physiologic More traumatic
4 Force used Milder force Greater force
5 Frequency of activation Less frequent More frequent
6 Duration of treatment Long Short
7 Type of appliance Either fixed or removable Mostly fixed appliance
8 Age Any age Before fusion of mid-palatal suture
9 Relapse Lesser chance of relapse More chances of relapse
3. Define and classify myofunctional appliances. write the mode of action of activator
Ans: See Above
4. Mention the major surgical procedure done during orthodontic treatment. Write the indication of
orthognathic surgery for orthodontic patients.
Ans:
Major surgical procedure:
1. Orthognathic surgeries / resections.
2. Cosmetic surgeries.
3. Cleft lip and palate surgery.
4. Surgically assisted rapid maxillary expansion.
5. Distraction osteogenesis.
Indication of orthognathic surgery for orthodontic patients: See Above.

5. Define relapse and retention. How will you prevent the relapse after orthodontic treatment?
Ans: See Above.
6. Write short notes on- i) Lip bumper ii) Pericision.
Ans:
Lip bumper: See Above
Pericision:
Pericision is a surgical Sectioning of the gingival fiber or after derotation of the tooth.
Another name:
1. Circumferential supra-crestal fibrotomy.
2. Supra- crestal fibrotomy
3. Sulcus slice procedure

Fig: Stretch of supra crestal fibers following rotation correction.

It is done because-
During aesthetic tooth movement the gingival fibers react slowly, the trans-septal and alveolar crystal fibers
remain stressed and do not readily re-adapt to the new position following correction of rotation hence causing
relapse.

20
 SDC ASSESMENT
Group-A
1. a 14-year-old girl came with complaints of aesthetic problems due to malposition of teeth. After
consultation her parents refused to go for orthodontic treatment.
a. Mention the unfavorable sequelae of malocclusion?
b. What is orthodontic index? Enumerate 4 indices to measure malocclusion and treatment need among public
health care services.
Ans:
Unfavorable sequelae of malocclusion:
1. Poor appearance of the Patient.
2. Predisposition to dental caries and periodontal disease.
3. Predisposition of trauma.
4. Abnormal muscle function.
5. Abnormal oral function.
6. Interference with normal growth and development.
7. TMJ problems,
8. Impacted or unerupted tooth.
Orthodontic index:
An index has been defined as a numerical value describing the relative status of a population on a graduated
scale with definite upper and lower limits, which is designed to permit and facilitate comparison with other
populations classified by the same criteria and methods. -A.L.Russel.
Indices to measure malocclusion and treatment need:
1. Diagnostic Classifications
• Angle's classification
• Incisor classification
• Skeletal classification
2. Epidemiologic Indices
• The FDI method
• Summer's occlusal index
3. Treatment need indices
• Index of treatment need (IOTN)
• Grainger's treatment priority index
4. Treatment outcome Indices
• Peer Assessment Rating (PAR) index
• Summer's index
5. Treatment Complexity Indices
• Index of complexity, outcome & need (ICON)

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2. a. Mention the intra-arch malocclusion.
b. Draw & level incisor classification of malocclusion.
Ans:
Intra-arch malocclusion:
1. Mesial inclination 4. Buccal inclination 7. Lingual displacement

2. Distal inclination

5. Mesial displacement 8. Buccal displacement

3. Lingual inclination
6. Distal displacement

9. Intrusion

10. Extrusion 11. Rotation 12. Transposition

Incisor classification of malocclusion:

Fig: Incisor classification

3. A 10-year-old male patient referred from pediatric dept, for orthodontic consultation. On examination there
was anterior crossbite.
a. Define crossbite. Classify it.
b. Write down the differences between true & pseudo class III malocclusion.
Ans:
Cross Bite:
According to Graber, crossbite is a condition where one or more teeth may be abnormally malposed buccally or
lingually with reference to the opposing tooth or teeth.

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Classification of Cross Bite:
A. Based on location:
1. Anterior crossbite: i. Single tooth crossbite
ii. Segmental crossbite
2.Posterior crossbite: i. Single tooth crossbite
ii. Segmental crossbite
iii. Unilateral crossbite
iv. Bilateral crossbite
B. Based on nature of crossbite:
1. Skeletal crossbite
2. Dental crossbite
3. Functional crossbite
Differences between true & pseudo class III malocclusion:
SL. Feature True Class III Pseudo Class III
1 Profile Concave Straight to concave
2 Etiology Hereditary Habitual/ Developmental
3 Premature contact Absent Present
4 Path of closure Forward Deviated
5 Gonial angle Increased/Decreased Normal
6 Retrusion of mandible further Not possible Possible
7 If left untreated No further changes Turns into True Class III malocclusion

4. a. Define growth & development.

b. Draw & level Scammon's growth curve.
Ans: a. See Above
b. Scammon's growth curve:

5. a. What are the deleterious abnormal habits that cause malocclusion?

b. Write down the effect of strap like lower lip on occlusion.
Ans:
Deleterious abnormal habits that cause malocclusion:
1. Thumb sucking
2. Tongue thrusting
3. Lip biting
4. Nail biting
5. Mouth breathing
6. Bruxism
Effect of strap like lower lip on occlusion:
• When the lips specially the lower lip retracts excessively during expressive behaviors, this is called strap like
lower lip.

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Effects:
A. With low lip line:
• Retruded mandible with protruded chin.
• Retroclination of lower incisor
• Class II Division 1 malocclusion
B. With high lip line:
• Retroclination of upper incisor producing Class II Division 2
• Proclination of upper incisor producing Class II Division 1
6. a. Mention the physiological space found in 5 years of age with their importance.
b. Describe flush terminal plane with figure.
Ans:
Physiological space found in 5 years of age:
Spaces existing between the deciduous teeth called as physiologic spaces.
• In maxilla it is 4 mm & in mandible it is 3 mm.
Importance:
• For normal development of permanent dentition.
• This is present due to antero-posterior growth of jaw
Flush terminal plane:
The distal surfaces of the upper and lower second deciduous molars are in one vertical plane. This type of
relationship is called flush terminal plane.

Fig: Flush Terminal Plane

Clinical importance:
1. This occurs by utilization of the physiologic spaces and leeway space in the lower arch and by differential
forward growth of the mandible.
2. This is a normal feature of deciduous dentition, because the mesio-distal width of the mandibular molar
is greater that the mesio-distal width of the maxillary molar.

Group-B
1. A 15 years old male has class III skeletal malocclusion due to maxillary deficiency.
a. What would be the expected face profile? Draw different type of face profile.
b. What would be the expected findings in lateral cephalogram.
Ans:
Expected face profile: Concave face profile.
Types of face profile: See Above
Findings in lateral cephalogram in class III skeletal malocclusion due to maxillary deficiency:
1. SNA angle value decreased – maxilla is retrognathic in relation to the anterior cranial base.
2. SNA angle value normal or increased – because of class III skeletal malocclusion with maxillary deficiency.
3. ANB angle value less than 2°. Where normal value is 2° to 4°.
2. a. What are the diagnostic aids in orthodontics?
b. What is tooth jaw discrepancy? How it can be assessed from a dental model.
Ans:
Diagnostic aids in orthodontics: See Above
Tooth jaw discrepancy:
Tooth jaw discrepancy referrers to the difference between the arch length and tooth material.
Assessment from a dental model by:
1. Determination of space required:
• Measure the mesiodistal dimension of anterior to the first molar.

24
2. Determination of space available:
• Measure the arch perimeter using brass wire.
• Mark the wire and measure the wire, which gives the space available.
3. Determination of the discrepancy:
• The difference between the space required and space available gives the arch discrepancy or excess.
3. a. What are the components of a removable appliance?
b. What is the universal clasp? Enumerate its modification.
Ans:
Components of a removable appliance:
1. Retentive Component. E.g. Clasps
2. Active components. E.g. Labial bows, Springs, Screws, Elastics, etc.
3. Base plate.

Fig: Components of a removable appliance

Universal clasp:
It is also known as Adam’s clasp, Liverpool clasp and modified arrowhead clasp. It is constructed using 07.mm
stainless-steel wire.
Parts:
1. Two arrowheads
2. Bridge
3. Two retentive arms

Modifications: Fig: Parts of Adam’s clasp

1. Adam’s clasp with soldered hook
2. Adam’s clasp with soldered buccal tube
3. Adam’s clasp with single arrow head
4. Adam’s clasp with additional arrow head
5. Adam’s clasp with distal traction
6. Double clasps
4. a. Define preventive & interceptive orthodontics.
b. Define serial extraction. Write down the indication of serial extraction.
Ans:
Preventive orthodontics:
It is the action taken to preserve the integrity of what appears to be normal occlusion at a specific time.
Interceptive orthodontics: See Above.
Serial extraction: According to Tweed, serial extraction can be defined as, “the planned and sequential removal
of the primary and permanent teeth to intercept and reduce dental crowding problem.
Indication of serial extraction:
• Arch length deficiency
• Absence of physiologic space
• Malpositioned or impacted lateral incisors that erupt palatally out of the arch.
• Crowded upper and lower anterior
• Ectopic eruption of tooth
• Mesial migration of buccal segment
• Abnormal eruption pattern and sequence
• Ankylosis of one or more teeth

25
5. A 5-year-old boy came with pain and swelling on lower left side. On examination there was non-restorable
caries on lower left second molar.
a. What are the effects of early loss of deciduous second molar?
b. What type of appliance you will prefer to avoid the effect? Draw the figure with labeling.
Ans:
Effects of early loss of deciduous second molar:
1. Marked forward shifting of the permanent first molar thereby blocking the eruption of the second
premolar.
2. Impaction or malpositioned eruption of second premolar.
3. Mesial drift of the permanent first molar.
4. Development of crowding in the posterior region.
Type of appliance you will prefer to avoid the effect:
• Intra alveolar appliance or distal shoe pace maintainer is given, after extraction of non-restorable lower
left second molar.

Fig: distal shoe pace maintainer

6. A 13-year-old patient had class II division 1 MALOCCLUSION WITH TRAUMATIC BITE. you HAD SUPPLIED A
REMOVABLE APPLIANCE WITH ANTERIOR BITE PLANE.
a. Mention the different types of anterior bite plane.
b. How anterior bite plane correct traumatic bite?
Ans:
a. See Above.
b. anterior bite plane corrects traumatic bite by:
• Supra-eruption or extrusion or overeruption of upper posterior teeth & relative intrusion of lower
anterior teeth.

Fig: anterior bite plane to corrects traumatic bite

26
 Group-C
1. a. What do you mean by optimum orthodontic force? Mentioned the ideal force required for tipping &
bodily tooth movement.
b. Write down the difference between bodily and tipping movement.
Ans: See Above
2. Draw and label the pressure and tension area during tipping movement.
Ans:

Fig: pressure and tension area during tipping movement

3. a. Write down the source of anchorage.
b. Write down the different means to increase the anchorage value.
Ans:
a. See Above
b. Means to increase the anchorage value:
1. Inter-maxillary traction
2. Inclined anterior bite plane
3. Extra-oral traction
4. Using good number of teeth for anchorage
5. Moving small number of teeth at a time
6. Use palatal and lingual arches
7. Use of vertical springs on anchor teeth to encourage bodily movement only
4. a. What is the phase of tooth movement?
b. What are the factors influence the tooth movement?
Ans:
Phases of tooth movement:
A. Initial phase
1. During the initial phase, very rapid tooth movement is observed over a short distance that then stops.
2. The tooth movement in the initial phase is between 0.4 to 0.9 mm and usually occurs in a weeks time.
B. Lag phase
1. During this phase, little or no tooth movement occurs.
2. This phase is characterized by formation of hyalinized tissue in the periodontal ligament, which has to be
resorbed before further tooth movement can occur.
3. The lag phase usually extends for 2-3 weeks but may at times be as long as 10 weeks.
C. Post lag phase
• After the lag phase, tooth movement progresses rapidly as the hyalinized zone is removed and bone
undergoes resorption.
Factors influencing the tooth movement:
1. The value of force application
2. Surface area of roots
3. Age of the patient (e.g. rapid tooth movement happens in young age)
4. Direction of tooth movement (e.g. slow movement in distal direction)
27
 5. Type of movement (e.g. rapid movement in case of tipping movement)
6. The physiologic activity of the tissues that surround the tooth.
7. The anatomic characteristics of the supporting bone into which the tooth is to be move (e.g. slower
movement in compact bone)
5. A 14-year-old boy came to you with the complaint of space between upper front teeth.
a. What are the causes of midline diastema.
b. What type of anchorage you will get treating midline diastema? Describe it.
Ans:
Causes of midline diastema:
1. Midline spacing can occur in ugly duckling stage in the mixed dentition period.
2. Tooth material-arch length discrepancy with resultant drifting of adjacent teeth:
• Missing teeth
• Microdontia
• Extractions
3. Presence of unerupted mesiodens between the two central incisors.
4. Presence of supernumerary tooth in the midline between the roots of the incisors.
5. Presence of thick and fleshy labial frenum.
6. Thumb sucking
7. Tongue thrusting
8. Midline pathology like, cysts, tumors, etc.
Type of anchorage you will get treating midline diastema:
 Reciprocal anchorage. Eg. finger spring is used to close a midline diastema.
• When two teeth or two sets of teeth move to an equal extent in an opposite direction.
• Here, the effects of forces exerted is equal, the sets of two teeth are displaced in the opposite direction
but the same amount.

6. a. What are the possible complications of a removable appliance at the first week of insertion?
b. What instruction will you give the patient after insertion of a removable appliance?
Ans:
Possible complications of a removable appliance at the first week of insertion:
i. Discomfort
ii. Plastic Taste
iii. Increased salivation
iv. Difficulty in swallowing
v. Difficulty in speech
vi. Mild pain
Instruction given to the patient after insertion of a removable appliance:
1. Appliance should be worn all the time even during sleeping.
2. It is better to take out the appliance during major meal time due to avoid distortion of the appliance. But
in certain conditions it is necessary to wear the appliance even in meal time. E.g. Anterior bite plane.
3. Initially the appliance will feel strange and uncomfortable and may occur a few minor problems. But this
will subside within 48-72 hours, if the patient wears it regularly.
4. Every time after insertion of the appliance check that active components and retentive components are
in correct position.
5. Remove the appliance using the retentive component only.
6. Clean the appliance using tooth brush and running water.
7. Clean the appliance after every meal.
8. The difficulty in speech can be overcome by reading loudly at home.
28
 9. When the appliance is not in use it should be preserved in a container full of water.
10. If the appliance is broken, immediately contact with the orthodontics. Do not try to fix it.

Group-D
1. A 6-year-old girl with cleft palate, repaired cleft lip & narrow maxilla is referred by plastic surgeon.
a. Who are the members of the multidisciplinary team for management of cleft palate & lip?
b. Write down the orthodontic management of this patient.
Ans:
Multidisciplinary team for management of cleft palate & lip:
1. The pediatrician
2. Orthodontist
3. Oral and maxillofacial surgeon
4. Prosthodontist
5. Social worker
6. Genetic scientist
7. ENT specialist
8. Plastic surgeon
9. Psychiatric
10. A speech pathologist
Orthodontic management of this patient:
1. Expansion screw or quad helix is given for Maxillary arch expansion
2. Correction of anterior crossbite using removable or fix appliance.
3. Continue speech therapy.
4. Orthodontic preparation for Alveolar Bone Grafting.
5. Alveolar bone graft. (ABG)
2. A 23-year-old female came with a complaint of rotation on both upper central incisors. She had a history of
orthodontic treatment 5 years back due to this rotation.
a. What are the precautions you will take to prevent relapse of a rotated tooth?
b. Classify the retention appliances.
Ans:
The precautions you will take to prevent relapse of a rotated tooth:
6. Over rotation of tooth in case of rotated teeth. e.g. if a tooth is 30° rotated clockwise, it should be
derotated and then over rotated to 30° anti-clockwise.
7. Prolonged period of retention is needed particularly for rotated teeth.
8. Treatment in rotated tooth should be performed at an early age.
9. Placement of tooth or teeth in oro-facial soft tissue balance.
10. Placement of teeth in occlusal equilibrium
11. Pericision-Surgical resection of supra-alveolar fibers.
Classification of Retention Appliances:
A. Removable retainer:
1. Hawley's retainer and its modifications
2. Begg's retainer
3. Clip-on retainer/spring aligner
4. Wrap around retainer
5. Kesling's tooth positioner
6. Invisible retainers / Essix retainers
7. Appliance using reverse loop labial bow
B. Fixed retainer:
1. Banded canine to canine retainer
2. Bonded canine to canine retainer
3. Bonded lingual retainers
4. Band and spur retainer
5. Anti-rotation band

29
3. a. What are the components of a fixed appliance?
b. What are the parts of a standard edgewise brackets?
Ans:
Components of a fixed appliance:
A. Passive components:
i. Bands
ii. Brackets
iii. Molar tube
iv. Accessories:
a. Lock pins
b. Ligature wire
c. Modules
B. Active components:
i. Arch wires
• Spool arch wire
• Pre-fabricated plain arch wire
• Multi-stranded arch wire
ii. Springs
• Upright spring
• Torque spring
iii. Elastics
• Box elastic
• Elastic chain
• Elastic modules
iv. Separators
• Brass wire separator
• Ring separator
Parts of a standard edgewise brackets:
1. Slot
• Horizontal
• Rectangular
2. Base
3. Wings

4. A 13-year-old girl came to you with > 7mm crowding on both jaws. She had class I molar relationship.
a. What are the causes of crowding?
b. What would be your treatment plan?
Ans:
Causes of crowding:
1. Dento-alveolar disproportion
2. Narrow dental base in the labial segment
3. Short antero-posterior extra teeth
4. Presence of supernumerary teeth
5. Prolong retention of primary teeth
6. Premature loss of primary teeth
7. Thumb sucking may cause narrowing of upper arch
8. Lower lip sucking
9. Forward developmental position of the buccal teeth
10. Abnormalities in tooth size (Macrodontia)
Treatment plan:
1. Extraction of first premolars
2. Alignment & leveling
3. Retraction of canine.
30
 4. Retraction of incisors.
5. Finishing
• Individual tooth position
• Vertical incisor relationship
• Micro-esthetic procedure.
6. Retention
5. Draw & label an upper removable appliance for correction of lock bite of upper right lateral incisor.
Ans:

Fig: upper removable appliance for correction of lock bite of upper right lateral incisor
6. a. What is myofunctional appliance? Enumerate 2 removable & fixed myofunctional appliances.
b. Write down the indication of activator.
Ans:
Myofunctional appliance: See Above
Removable myofunctional appliances: 1. Activator
2. Frankel
Fixed myofunctional appliances: 1. Herbst appliance.
2. Jasper Jumper
Indication of activator:
1. Actively growing induvial with favorable growth pattern.
2. Class II division 1 malocclusion
3. Class II division 2 malocclusion after aligning the incisors
4. Class I deep bite correction
5. Class I open bite correction
6. Children with decreased lower facial height
7. As a habit breaking appliance
8. As a retention appliance

“Healing is a matter of time, but it is sometimes also a matter of opportunity.”

31