Current Orthodontic Theory and Treatment 1 CE credit A Peer-Reviewed Publication

Earn
1 CE credit
This course was
written for dentists,
dental hygienists,
and assistants.
Current Orthodontic Theory
and Treatment
A Peer-Reviewed Publication
Written by Cathy Seckman, RDH
Abstract
The history of orthodontics began in ancient times,
leading us to assume that humankind has always seen
value in an attractive smile. Orthodontics was first
recognized as a specialty in the 19th century. In modern dentistry, with evidence-based practice gaining
ground, treatment options address malocclusions as
well as problems in the transverse and vertical dimensions. Present-day practice includes the use of both
fixed and functional appliances. Dental hygienists
with a working knowledge of orthodontic practice can
serve as valuable resources to patients and parents
from diagnosis to post-treatment questions.
Learning Objectives:
At the conclusion of this educational
activity participants will be able to:
1. Name and describe common
orthodontic appliances.
2. List the actions of and purposes for
which different appliances are used.
3. Knowledgeably discuss invisible
orthodontics technology and use.
4. Customize oral hygiene recommendations for orthodontic appliances.
Author Profile
Cathy Hester Seckman, RDH, is a pediatric hygienist as well as an
indexer, writer, and novelist. She has worked in dentistry 33 years, including eight years in a practice that includes orthodontic treatment.
She presents CE courses on topics including pediatric management,
nutrition, pre-natal to pre-school care, communication, and
adolescent risk behaviors. She is a member of the American Dental
Hygienists Association and the Tri-County Ohio Dental Hygienists
Association. She can be reached at [email protected] .
Author Disclosure
Cathy Hester Seckman has no potential conflicts of interest to
disclose.
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Publication date: September 2012 Supplement to PennWell Publications
Expiration date: August 2015
PennWelldesignatesthisactivityfor1ContinuingEducationalCredit
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“ThiscoursemeetstheDentalBoardofCalifornia’srequirementsfor1unitofcontinuingeducation.”
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AcademyofGeneralDentistry.Theformalcontinuingdentaleducationprogramsofthis
programproviderareacceptedbytheAGDforFellowship,Mastershipandmembership
maintenancecredit.Approvaldoesnotimplyacceptancebyastateorprovincialboardof
dentistryorAGDendorsement.Thecurrenttermofapprovalextendsfrom(11/1/2011)to
(10/31/2015) Provider ID# 320452.
This educational activity was developed by PennWell’s Dental Group with no commercial support.
This course was written for dentists, dental hygienists and assistants, from novice to skilled.
Educational Methods: This course is a self-instructional journal and web activity.
Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or
services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or
third party has had any input into the development of course content.
Requirements for Successful Completion: To obtain 1 CE credit for this educational activity you must pay the
required fee, review the material, complete the course evaluation and obtain a score of at least 70%.
CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with
products or services discussed in this educational activity. Heather can be reached at [email protected]
Educational Disclaimer: Completing a single continuing education course does not provide enough information
to result in the participant being an expert in the field related to the course topic. It is a combination of many
educational courses and clinical experience that allows the participant to develop skills and expertise.
Image Authenticity Statement: The images in this educational activity have not been altered.
Scientific Integrity Statement: Information shared in this CE course is developed from clinical research and
represents the most current information available from evidence based dentistry.
Known Benefits and Limitations of the Data: The information presented in this educational activity is derived from
the data and information contained in reference section. The research data is extensive and provides direct benefit to
the patient and improvements in oral health.
Registration: The cost of this CE course is $20.00 for 1 CE credit.
Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full
refund by contacting PennWell in writing.
Course Objectives:
At the conclusion of this educational activity participants will
be able to:
1. Name and describe common orthodontic appliances.
2. List the actions of and purposes for which different appliances are used.
3. Knowledgeably discuss invisible orthodontics technology
and use.
4. Customize oral hygiene recommendations for orthodontic
appliances.
Abstract
The history of orthodontics began in ancient times, leading us to assume that humankind has always seen value in
an attractive smile. Orthodontics was first recognized as
a specialty in the 19th century. In modern dentistry, with
evidence-based practice gaining ground, treatment options
address malocclusions as well as problems in the transverse
and vertical dimensions. Present-day practice includes the
use of both fixed and functional appliances. Dental hygienists
with a working knowledge of orthodontic practice can serve
as valuable resources to patients and parents from diagnosis
to post-treatment questions.
ously treated.”5 As orthodontic methodologies have advanced
with the availability of more socially acceptable hardware, acceptance of treatment has improved. Braces had been seen as
having a negative social impact, but the stigma of “tin grins”
and “braces faces” has been alleviated in the popularity of
lingual braces, clear brackets, and invisible aligners. In fact,
braces are now seen as a desirable status symbol by some
adolescents. A few years ago, it was possible for teens in Thailand to buy do-it-yourself kits of brackets and multicolored
rubber bands and apply them as a fashion statement, but a
consumer protection board has cracked down on the trend.6
In the absence of a handy kit, any fashion-conscious teen can
build her own set of fake orthodontic hardware by using tin
foil, opened paper clips, and metal earring backs.7 The focus
of this article is to present a history of the science, along with
common diagnoses and treatment.
Figure 1: A stage tooth positioner
Introduction
One in three children, according to the British Orthodontic
Society, needs orthodontic intervention.1 The physical and
psychological consequences of malocclusions can be disabling. Malocclusions have been shown to be a contributing
factor in the development of TMD; the likelihood of dental
trauma; gingival recession; masticatory efficiency and ability;
nutritional status; periodontal disease; and speech abnormalities. Psychological consequences include damage to one’s
self-concept and self-confidence in both adolescence and
adulthood.2 Adolescents with a history of orthodontics have
been shown to be less likely than those without such history
to report condition-specific impacts on their quality of life.3
Since orthodontics as a science was developed in the 19th
century, its focus has broadened from correction by force to
correction by design. Jaw growth and expansion can be influenced at an early age, avoiding the need for serial extractions.
Conventional banded orthodontics has been supplemented
by the use of aligners and positioners, both removable and
fixed. Orthodontic therapy can be mixed and matched to each
individual case, providing the best possible outcome for even
the most difficult cases.
A study eliciting information on current trends indicated
that extraction rates have declined to 29.28% of cases.4 Although adult orthodontics appears to be on the rise, a 2010
British study that attempted to discover the numbers of
adults being treated came up short. The study found “no
comprehensive figures regarding the number of adults previ-
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History of orthodontics
Evidence of what might have been orthodontic work – metal
bands wrapped around individual teeth – has been found in
ancient mummies. Both Hippocrates and Aristotle wrote
on ways to stabilize teeth with wires, and both Etruscans
and Romans used appliances and ligature wire to maintain
space and move teeth.8 Within the last 250 years, though, the
science of orthodontics has advanced exponentially. Pierre
Fauchard, in 1728, discussed ways to straighten teeth in his
book,The Surgeon Dentist. His bandeau, a horseshoe-shaped
implement, was intended to expand the arch. Another
French dentist, Ettienne Bourdet, did further work with
the bandeau and is the first dentist on record to recommend
extraction of premolars in cases of crowding. His book, The
Dentist’s Art, was published in 1757. It was nearly a hundred
years later that the term “orthodontia” was first used by
Joachim Lafoulon in 1841. Gum elastics were first used to
straighten teeth in 1843, and bands cut from rubber tubing
in 1850.
In the late 19th and early 20th centuries, several men are
credited with bringing orthodontics into the modern age.
Norman Kingsley, in his Treatise on Oral Deformities (1880),
discussed orthodontic and cleft palate therapy.9 J.N. Farrar
wrote A Treatise on the Irregularities of the Teeth and Their
Corrections, and was the first to advocate moving teeth with
mild force at timed intervals.10
The next important figure in the history of orthodontics
was Edward H. Angle, DDS (1855-1930). Under Angle’s
leadership, orthodontics was recognized as a dental specialty,
and he was the first to limit his practice to it. In 1899, his
article in Dental Cosmos described the classification of malocclusion that we use today. His belief was that the best result
of orthodontic treatment used a full complement of teeth,
with no extractions.
Two contemporaries of Angle, Calvin S. Case (18471923) and Martin Dewey (1881-1933), disagreed with Angle
on the need for extractions, and the difference of opinion
caused serious contention among orthodontists for years.
Orthodontic appliances including vertical tubes and the
loop wire became standardized in the early 20th century.
Herbert A. Pullen wrote on reintroduction of the maxillary
suture opening in 1902; and Charles A. Hawley introduced
his self-named appliance, still in use today, in 1908.
Figure 2: Upper Hawley with Adams clasps, a 2-2 labial bow, and a
2-2 lingual bar
Insurance reimbursement for orthodontics was first introduced in the 1950s, and the 1970s saw a surge in the numbers
of orthodontic appliances available. Using acid etch bonding
to attach orthodontic brackets became accepted clinical practice in the mid-1970s.12 Invisible orthodontic technology – in
other words, braces without all the ugly braces – has become
popular in the past decade. Today it’s possible for a patient
to choose between clear-bracket braces such Damon Clear®;13
braces applied only to lingual surfaces, as with the 3M Incognito Appliance System®;14 and nearly invisible tray-style
braces such as Clear Correct®15 and Invisalign®.16
Some of the current issues concerning the field include
treatment of the adult patient, increased use of orthognathic
surgery, problems with TMD,11 and a continuing pressure for
evidence-based practice.17
Need for orthodontic treatment
Malocclusions in modern society have recently been linked to our
habitual masticatory forces. Von Cramon-Taubadel published a
study in 2011 analyzing the relationship between mandibular
shape variations and a subsistence society. Her results show that
a decrease in masticatory stress causes the mandible to grow and
develop differently.18 In simpler terms, the processed and softer
diet common in industrialized societies may lead to the increased
prevalence of dental crowding and malocclusions.
In planning a treatment strategy, multiple problems can be
present. Orthodontists must consider not only malocclusion,
but tooth and arch size and transverse and vertical dimensions.
Malocclusion
Determining the classic Angle classifications of malocclusion
is the first step to diagnosing orthodontic issues. Class I is
neutrocclusion, with the mesiobuccal cusp of the upper first
molar aligned with the buccal groove of the mandibular first
molar. Class II distocclusion occurs when upper first molars
are anterior to the lower first molars. This is also known as
overjet. Class II Division 1 includes protruded anterior teeth;
Class II Division 2 presents with retroclined centrals and
overlapping laterals. Class III mesiocclusion, or prognathism
is diagnosed when the lower front teeth are more prominent
than uppers. In any of these classes, there may also be crowding, space issues, overeruption or undereruption.19
Cephalometric radiography, tracing, and evaluation were
developed by B. Holly Broadbent in 1931. Milo Hellman, in
the 1930s, was the first to use research in anthropology to advance the understanding of dentofacial growth and development. Serious research activity began in the 1940s, pioneered
by Wilton M. Krogman, who developed criteria for child
growth and development.
Transverse dimension
In transverse dental relationships, problems can occur because of narrowing of the maxillary arch or because of posterior crossbites. A too-narrow arch can occur congenitally
or because of breathing or finger sucking problems. With
crossbites, typically the upper posterior teeth are positioned
lingually to the lower teeth. In rare cases, there is no occlusal
contact at all. To influence transverse dimension, orthodontists consider both conventional fixed appliance therapy and
growth modification with rapid maxillary expansion (RME).
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If skeletal malrelationships are 5 mm or greater, surgical correction may also be considered.
RME (sometimes known as rapid palatal expansion
(RPE)) has been in use for 40 years and has the advantage
of increasing transverse dimension quickly and easily in
children and adolescents, thus allowing a Class I relationship without extractions. It is mainly used to correct two
discrepancies. In the case of a crossbite, applying lateral
force to the posterior maxillary molars causes separation
of the mid-palatal suture very quickly. For a tooth-size to
arch-size discrepancy, RME uses the same force to eliminate
crowding. The suture separation is temporary, and will fill in
with new osseous tissue. Transeptal fibers between the upper
central incisors will also close the midline diastema caused by
the expansion.20
RME is normally used in mixed dentition, where it
produces significant changes in measurements of sagittal,
vertical, and transverse dimensions.21,22 Studies done in
adults, however, have shown no evident or significant skeletal changes after RME.23 This reinforces the advisability of
beginning orthodontic treatment as early as possible.
Vertical dimension
Increasing vertical dimension is more problematic, with varying degrees of effectiveness. Types of vertical malocclusion
include an open bite and deep bite, which are dentoalveolar in
nature; and hyperdivergent or hypodivergent patterns of the
skeletal structure.
An open bite is defined as a malocclusion in which front
or back teeth do not make contact with each other.24 Common
causes of open bite are prolonged thumbsucking and airway
obstruction that causes mouth breathing. Airway obstruction
results in adenoid facies, which is the long, open-mouthed
look children develop with habitual mouth breathing.25 Behavior modification and conventional banded orthodontics
are used to correct an open bite, as well as extraoral traction
with headgear, and removable appliances such as bionators
and function regulators (described below). Posterior acrylic
bite blocks can also be used to inhibit molar eruption, thereby
encouraging closure of the anterior open bite.20
A deep or closed bite occurs when the upper front teeth
overlap the bottom front teeth by an excessive amount.26 To
correct a deep bite, orthodontists open the bite by extrusion
of posterior teeth, and by making changes in the masticatory
muscle balance.
An anterior bite plate to encourage posterior extrusion
can be used with extraoral traction or with fixed appliance
treatment. Functionally, orthodontists may use a Frankel appliance, twin blocks, or a Herbst appliance as well (described
below).
Orthognathic surgery is a common treatment to increase
vertical dimension. The maxilla can be moved inferiorly, and
mandibles can be advanced.27
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Common types of appliances
Conventional fixed appliance therapy
This is the traditional bracket and band therapy with which
we are most familiar, and which is still most commonly used.
Each orthodontist will have specific preferences for angle,
torque, and style.
After teeth are banded and bracketed, resilient nickel
titanium archwires are used to align and level the brackets.
Teeth are then rotated and roots torqued as necessary with a
transpalatal arch. Elastomeric chains may be used to prevent
unwanted rotation. Interarch elastics are then used to correct
sagittal relationships. Maxillary anterior teeth are retracted if
necessary with looped closing arches. The last step, called a
finishing sequence, seats the occlusion with archwires of high
formability and triangular maxilla-to-mandible elastics.
Class II functional appliances
Bionators
Removable Bionators are versatile appliances first used to
treat mandibular retrusion in the 1960s. They are tooth-borne
appliances that produce a forward positioning of the lower
jaw. As a Bionator repositions the lower jaw, it can simultaneously be designed either to open the bite by facilitating
posterior eruption; to close the bite in cases of dentoalveolar
open bite or skeletal open bite; or to maintain the bite when
existing vertical dimension is adequate.28
Herbst
A cantilever bite-jumping Herbst appliance is a complex
fixed metal appliance that is designed as a bilateral telescoping
mechanism to reposition the lower jaw as the patient closes into
occlusion. It can be combined with RME if necessary. The device was developed by Emil Herbst in the early 1900s, but came
into modern use after it was reintroduced by Hans Pancherz in
1979. A Herbst can be anchored either by bands or stainless
steel crowns on the first molars and premolars. Pivots soldered
to the buccal sides of the maxillary mounts secure tubes, into
which are inserted plungers attached to the lower first premolars. As the patient opens and closes, the plungers ride up and
down inside the tubes, guiding the jaw into correct occlusion.29
Figure 3: Herbst appliance
MARA (mandibular anterior repositioning appliance)
With these fixed appliances, “elbows” attached to maxillary
molars, and “arms” that protrude from mandibular molars,
force the patient to bite with the mandible in a forward position. They can also be combined with RME.30
Figure 4: Molar distalizing appliance
Twin block
The original twin blocks were developed in the 1980s by Scottish
orthodontist Dr. William Clark for Class II correction, and
consist of upper and lower acrylic appliances. The upper usually
includes expansion screws so the upper arch can be widened as
the lower arch moves forward to its new position. The upper and
lower inclined occlusal planes, or wedges, interlock to hold the
mandible forward and reposition the condyles.31
Schwarz appliance
A Schwarz appliance is an acrylic plate that includes embedded
expansion screws. Typically, ball clasps extend through the interproximals of posterior teeth for retention. The screw is turned
by the patient or parent weekly until desired expansion is gained.
The appliance can be designed for the maxilla or mandible, and
can include occlusal acrylic for a bite block effect if desired.33
Fixed expansion appliances (RMEs and RPEs)
These appliances are used to improve transverse dimension on
the maxilla or mandible. The bonded type encloses all of the
posterior teeth in occlusal pads that control torque and vertical
opening. The banded type is built on bands fitted to the first molars and may include metal arms that extend across the palate or
anteriorly to the incisors. Many have expansion screws in palatal
acrylic that are adjusted daily by the patient or parent. Maxillary bones are separated to the desired width, and the appliance
is bonded or wired in place until bone remodeling is complete.34
Figure 6: Lower spring retainer
Class III functional appliances
Fränkel Function Regulator (FR-3)
Used for Class III malocclusions, the FR-3 features vestibular
acrylic shields and labial acrylic pads. The shields and pads
counteract surrounding muscular forces that are restricting
skeletal development. They stimulate maxillary alveolar development while restricting mandibular alveolar development.32
Figure 7: Upper expander already closed
Removable expansion appliances
A vulcanite appliance using an expansion screw was first
described by Kingsley in 1877. Removable expansion appliances are considered to be “active plate” appliances rather
than functional appliances because force is generated within
the appliance itself by screws, wires, springs, or elastics that
are adjusted by the patient or parent. They are typically used
prior to RME treatment to tip posterior teeth in a lateral direction by activating the expansion screw once a week.33
Figure 8: Lower removable expansion appliance
Figure 5: Rapid palatal expander with face crib hooks, low archwire
tubes, and 7 wires
Dental hygiene considerations
Orthodontic treatment includes increased caries risk, especially with fixed appliances. Experts agree that communica-
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tion among patients, parents, orthodontists, and dentists
needs to improve to reduce the incidence of lesions.35 In one
study, metallic brackets in use for one month were found to
be colonized by cariogenic microorganisms and periodontal
pathogens.36 In another study, a negative effect on microbial
flora was observed with long-term utilization of orthodontic
appliances. The study recommended patients be put on short
recare intervals during therapy.37 During treatment, there
are strategies that can be used to minimize caries and its
precursor, demineralization. When used to bond brackets,
resin-modified glass ionomer cement and fluoride-releasing
resin composite have been successfully used to inhibit demineralization.38 During and after orthodontic treatment,
fluoride mouthrinses and at-home applications of fluoride
have been proven to reduce the occurrence and severity of
white spot lesion demineralization.39 Products containing casein phosphopeptide-amorphous calcium phosphate (CPPACP) have also been found to be useful in remineralization
of white spot lesions.40 Adjuncts to oral care such as dental
floss, water flossers, and interproximal cleaners are helpful.
Non-floss users have been found to have significantly higher
means of plaque index, gingival index, pocket probing depth,
and clinical attachment loss than floss users.41 Using dental
floss is admittedly problematic when archwires, springs, and
bands interfere. Floss threaders made by Butler GUM®,
DenTek®, Crest Glide®, Thornton®, and Bridgeaid® have
been recommended for years. A new option is the Platypus
ortho flosser, which is a U-shaped floss holder with one flat
side to slide beneath an archwire.
A 2008 study reported that plaque removal using a water flosser with a manual toothbrush was three to five times
greater than patients who used a manual toothbrush alone.42
The dozens of interdental cleaners on the market offer enough
variety to please any reluctant teen. Butler GUM Soft-Picks
and Go-Betweens®, Proxabrushes®, Proxi-floss®, TePe®, and
others work well to clean interproximally.
Conclusion
A wide and deep array of fixed and removable appliances is
in common use today in the field of orthodontics. The specialty has evolved over hundreds of years of trial and error
as researchers and practitioners strive to achieve the best
outcomes in the most efficient manner. Research continues
to refine the specialty, and evidence-based practice appears
to be increasing. A 2010 study reported on articles in the
American Journal of Orthodontics and Dentofacial Orthopedics. The percentage of original articles using statistics rose
from 43.1% in 1975 to 92.9% in 2008. The percentage of
articles using inferential statistical analyses rose from 74.2%
in 1985 to 84.4% in 2008.17
The role of hygienists is as a resource for parents and patients in all phases of treatment, from initial assessments to
post-treatment questions.
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38.Wilson RM, Donly KJ. Demineralization around orthodontic
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39.Benson PE, Shah AA, Millett DT, Dyer F, Parkin N, Vine RS.
Fluorides, orthodontics and demineralization: a systematic review. J
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40. Llena C, Forner L, Baca P. Anticariogenicity of casein phosphopeptideamorphous calcium phosphate: a review of the literature. J Contemp
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41. Zanatta FB, Moreira CH, Rösing CK. Association between dental
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Dentofacial Orthop. 2011 Dec; 140(6):812-21.
42.Sharma NC, Lyle DM, Qaqish JG, Galustians J, Schuller R. The
Effect of a Dental Water Jet with Orthodontic Tip on Plaque and
Bleeding in Adolescent Orthodontic Patients with Fixed Appliances.
Am J Ortho Dentofacial Orthop 2008; 133(4):565-571.
Author profile
Cathy Hester Seckman, RDH, is a pediatric hygienist as well
as an indexer, writer, and novelist. She has worked in dentistry
33 years, including eight years in a practice that includes orthodontic treatment. She presents CE courses on topics including
pediatric management, nutrition, pre-natal to pre-school care,
communication, and adolescent risk behaviors. She is a member
of the American Dental Hygienists Association and the TriCounty Ohio Dental Hygienists Association. She can be reached
at [email protected]
Acknowledgement
The author would like to thank David Spokane, DMD, MS, for
photographs and resources.
Author Disclosure
Cathy Hester Seckman has no potential conflicts of interest to
disclose.
Online Completion
Use this page to review the questions and answers. Return to www.ineedce.com and sign in. If you have not previously purchased the program select it from the “Online Courses” listing and complete the online
purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the “Take Exam” link, complete all the program questions and submit your answers. An
immediate grade report will be provided and upon receiving a passing grade your “Verification Form” will be provided immediately for viewing and/or printing. Verification Forms can be viewed and/or printed anytime
in the future by returning to the site, sign in and return to your Archives Page.
Questions
1. According to the British Orthodontic
Society, the numbers of children who need
orthodontic intervention are:
a.
b.
c.
d.
2 in 10
1 in 20
1 in 3
2 in 20
2. Adolescents with a history of orthodontics
are less likely to report:
a.
b.
c.
d.
Condition-specific impacts on their quality of life
Fewer cavities
Dissatisfaction with outcome
b and c
3. The first dentist to limit his practice to
orthodontics was:
a.
b.
c.
d.
Calvin S. Case
Joachim Lafoulon
Charles A. Hawley
Edward H. Angle
4. Class II malocclusion is characterized by:
a.Distocclusion
b.Neutrocclusion
c.Prognathism
d.Mesiocclusion
5. Rapid maxillary expansion is used to correct:
a.Crossbite
b.Thumbsucking
c. Tooth-size to arch-size discrepancy
d. a and c
6. Adenoid facies can be defined as:
a. A deep or closed bite
b. Facial appearance caused by mouthbreathing
c.Prognathism
d.Malocclusion
7. A deep bite is defined as:
a. Upper front teeth overlapping lowers by an excessive
amount
b. Upper front teeth overlapping lowers by a small amount
c. Upper front teeth behind lower front teeth
d. Lower molars inside upper molars
8. An appliance that uses tubes and plungers
is a:
a.Bionator
b.Fränkel
c. Twin block
d.Herbst
9. A Schwarz appliance includes this element:
a. Ball clasps
b.Pivots
c. Elbows and arms
d. Vestibular acrylic shields
10. Caries and demineralization during
and after orthodontic treatment may be
minimized with:
a.
b.
c.
d.
Shorter recare intervals
Interdental cleaners
Glass ionomer cement
All of the above
11. Malocclusions have been shown to be a
contributing factor in:
a.
b.
c.
d.
Efficiency and ability in mastication
Nutritional status
Speech abnormalities
All of the above
12. The decline in extraction rates for current
orthodontic care is:
a.
b.
c.
d.
32.17 percent
47 percent
29.28 percent
16.80 percent
13. The earliest book on orthodontics in
modern times was:
a. The Dentist’s Art
b. The Surgeon Dentist
c. Treatise on the Irregularities of the Teeth and Their
Corrections
d. Orhtodontics and Dentofacial Orthopedics
14. Milo Hellman developed this important
orthodontic tool
a.
b.
c.
d.
Cephalometric radiography
Clear aligners
Vertical tubes
Rapid palatal expanders
15. An open bite can be caused by
a.
b.
c.
d.
Airway obstruction
Too-narrow maxillary arch
Prolonged thumbsucking
a and c
www.DENTALECONOMICS.com | 02.2014
99
ANSWER SHEET
Current Orthodontic Theory and Treatment
Name:
Title:
Specialty:
Address:E-mail:
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Requirements
for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all
information above. 3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn
you 1 CE credit. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp. For Questions Call 216.398.7822
Educational Objectives
If not taking online, mail completed answer sheet to
Academy of Dental Therapeutics and Stomatology,
1. Name and describe common orthodontic appliances.
A Division of PennWell Corp.
2. List the actions of and purposes for which different appliances are used.
P.O. Box 116, Chesterland, OH 44026
or fax to: (440) 845-3447
3. Knowledgeably discuss invisible orthodontics technology and use.
4. Customize oral hygiene recommendations for orthodontic appliances.
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Objective #2: Yes No
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AGD Code 371
PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS.
COURSE EVALUATION and PARTICIPANT FEEDBACK
We encourage participant feedback pertaining to all courses. Please be sure to complete the survey included
with the course. Please e-mail all questions to: [email protected]
INSTRUCTIONS
All questions should have only one answer. Grading of this examination is done manually. Participants will
receive confirmation of passing by receipt of a verification form. Verification of Participation forms will be
mailed within two weeks after taking an examination.
COURSE CREDITS/COST
All participants scoring at least 70% on the examination will receive a verification form verifying 1 CE credit.
The formal continuing education program of this sponsor is accepted by the AGD for Fellowship/Mastership
credit. Please contact PennWell for current term of acceptance. Participants are urged to contact their state
dental boards for continuing education requirements. PennWell is a California Provider. The California
Provider number is 4527. The cost for courses ranges from $20.00 to $110.00.
PROVIDER INFORMATION
PennWell is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association
to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP
does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours
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Concerns or complaints about a CE Provider may be directed to the provider or to ADA CERP at www.ada.
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The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General
Dentistry. The formal continuing dental education programs of this program provider are accepted by the
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Completing a single continuing education course does not provide enough information to give the
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IMAGE AUTHENTICITY
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© 2014 by the Academy of Dental Therapeutics and Stomatology, a division of PennWell
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