Benefit of orthodontic treatment for patients with a pre-existing periodontal compromise

 # A key benefit of orthodontic treatment for patients with a pre-existing periodontal compromise (e.g., reduced but healthy periodontium) is:

A. Elimination of all PDL forces in the compromised teeth

B. Complete regeneration of lost alveolar bone and attachment

C. Increased tooth mobility for better functional adaptation

D. Optimization of axial loading to distribute occlusal forces more favorably

The correct answer is D. Optimization of axial loading to distribute occlusal forces more favorably

In patients with pre-existing periodontal compromise (e.g., reduced but stable attachment levels), orthodontic treatment aligns malpositioned teeth—such as flared or tipped incisors—to promote more vertical (axial) force transmission during occlusion, minimizing deleterious lateral or eccentric loads that exacerbate mobility, attachment loss, or alveolar stress in weakened areas. This biomechanical optimization, achieved via controlled intrusion and torque control with light forces (5–15 g/tooth), enhances long-term periodontal stability and function without regeneration, as evidenced by systematic reviews showing probing depth reductions (avg. 3.31 mm) and clinical attachment gains (avg. 5.28 mm) through improved force distribution and hygiene access. Options A (impossible, as PDL forces drive movement), B (not achievable orthodontically alone), and C (contraindicated, as mobility worsens prognosis) are inaccurate.

Potential adverse consequence of rapid maxillary expansion (RME)

 # One potential adverse consequence of rapid maxillary expansion (RME) in a patient nearing skeletal maturity is an increase in:

A. Anterior Bolton Ratio Discrepancy

B. Apical Base Width

C. Mandibular Plane Angle

D. Palatal Vault Depth

The correct answer is C. Mandibular Plane Angle

In patients nearing skeletal maturity, the midpalatal suture is partially or fully interdigitated, reducing skeletal expansion efficacy and promoting dentoalveolar effects like buccal tipping and posterior molar extrusion (1–2 mm on average), which increases the mandibular plane angle (MPA) by 1–3° via clockwise mandibular rotation and bite opening. This vertical change exacerbates hyperdivergent tendencies, potentially worsening facial height and stability, as noted in cephalometric studies of late mixed/early permanent dentition cases. In contrast, apical base width (B) is the intended skeletal gain (though diminished); anterior Bolton discrepancy (A) is unrelated; and palatal vault depth (D) typically decreases with RME due to transverse widening.

Relapse due to late anterior mandibular crowding

 # A key finding from long-term stability studies following orthodontic treatment is that late anterior mandibular crowding is often independent of the pre-treatment malocclusion. This relapse is primarily attributed to:

A. A continued, anteriorly-directed component of natural craniofacial growth

B. The patient's failure to wear a maxillary removable retainer

C. Improper arch form used during the alignment phase

D. A rebound effect from temporary root resorption during treatment

The correct answer is A. A continued, anteriorly-directed component of natural craniofacial growth

Long-term stability studies, including serial cephalometric analyses by Björk and Skieller, demonstrate that late mandibular anterior crowding (developing or worsening 5–10+ years post-treatment) arises from physiologic late mandibular growth—a forward (anteriorly directed) rotation and elongation of the chin relative to the stable incisor apices, which displaces the lower incisors lingually against lip and tongue pressures, reducing arch perimeter by 1–2 mm on average. This process is largely independent of initial malocclusion severity or treatment modality (e.g., extraction vs. non-extraction), occurring in 60–80% of cases regardless of pre-treatment alignment, as confirmed in cohorts like the University of Washington Post-Retention Study (Little et al.). Patient compliance with maxillary retainers (B) influences upper arch stability but not lower growth; improper arch form (C) affects short-term relapse; and root resorption (D) shows no causal link to late crowding. Indefinite lower retention remains essential to mitigate this growth-driven tendency.

Dental Health Component of Index of Orthodontic Treatment needs (DHC of IOTN)

 # From a public health perspective, the Dental Health Component (DHC) grade 4 of the IOTN classifies conditions where the adverse consequences are severe enough to require treatment for health reasons. Which Grade 4 sub-criterion is most directly linked to the risk of dental trauma?

A. 4a: Increased overjet 6 mm to 9 mm with incompetent lips

B. 4h: Extensive hypodontia requiring restorative dentistry

C. 4i: Submerged deciduous teeth

D. 4e: Severe skeletal discrepancy requiring surgery

The correct answer is A. 4a: Increased overjet 6 mm to 9 mm with incompetent lips

In the IOTN DHC, grade 4a specifically addresses increased overjet of 6–9 mm, which significantly elevates the risk of traumatic dental injuries to the maxillary incisors (relative risk ~2.8–4.0 compared to normal overjet <3 mm), as proclined incisors are more protrusive and vulnerable to impacts. Incompetent lips exacerbate this by failing to provide protective coverage, further increasing exposure—though standard IOTN 4a criteria focus on overjet magnitude alone, with lip incompetence noted in grade 3a for moderate cases. Public health guidelines prioritize this sub-criterion for early intervention due to its direct link to injury incidence (e.g., 20–30% higher in affected children), unlike hypodontia (B, 4g/4h: restorative needs without trauma risk), submerged teeth (C, typically 5s: ankylosis-related eruption issues), or severe skeletal discrepancies (D, often 4p or 5a: functional/surgical needs but indirect trauma association via secondary malocclusions).

Correction of a severe anterior open bite in an adult through combined orthodontic and orthognathic surgery

 # Correction of a severe anterior open bite (greater or equal to 4 mm) in an adult through combined orthodontic and orthognathic surgery (e.g. Le Fort I impaction) primarily improves masticatory function by:

A. Increasing the number of simultaneous bilateral posterior occlusal contacts

B. Increasing the vertical dimension of occlusion

C. Eliminating the need for tongue-thrust habit adaptation

D. Preventing future TMJ derangement and pain

The correct answer is A. Increasing the number of simultaneous bilateral posterior occlusal contacts

Severe anterior open bite in adults often stems from vertical maxillary excess, leading to reduced or eccentric posterior occlusal contacts due to mandibular posturing or supraeruption, which impairs efficient bolus grinding and mixing during mastication (e.g., 20-40% lower chewing cycles for particle size reduction pre-treatment). Combined orthodontic-orthognathic intervention, such as Le Fort I impaction with mandibular autorotation, closes the anterior gap while enhancing posterior coupling—typically increasing functional contact points by 2-3 pairs per quadrant—as confirmed by pre/post-surgical occlusal analyses and electromyographic studies showing 30-50% gains in masticatory efficiency. This restores symmetric force distribution and excursion freedom, outperforming habit correction (C, adjunctive at best) or VDO changes (B, actually decreased here); TMJ benefits (D) are secondary and inconsistent.

Adverse consequences of an uncorrected deep overbite (Class II Div 2)

 # Adverse consequences of an uncorrected deep overbite (Class II Div 2) are most directly related to the biomechanical factor of:

A. Lack of freedom in centric relation to centric occlusion slide

B. Inability to achieve canine-protected occlusion

C. Increased horizontal components of force on posterior teeth

D. Traumatic contact leading to gingival impingement or pathologic wear

The correct answer is D. Traumatic contact leading to gingival impingement or pathologic wear

In uncorrected Class II Division 2 malocclusion, the deep overbite (>5 mm typically) with retroclined maxillary central incisors positions the mandibular incisors to make direct, forceful contact with the palatal gingiva, mucosa, or incisal edges of the maxillary incisors during closure and excursions, imposing high compressive and shear stresses that biomechanically precipitate gingival recession (up to 2-3 mm loss), periodontal attachment breakdown, and localized enamel abrasion. Finite element analyses quantify these forces as 2-4 times normal vertical loading on anterior units, directly linking to the most prevalent adverse sequelae like palatal impingement and wear patterns. Options A and B relate more to condylar positioning or lateral guidance deficits in other Class II variants; C pertains to protrusive overload in open bite or Div 1 cases.

Impact of orthodontic treatment on TMD signs and symptoms based on high-quality systematic reviews

 # Which of the following is the most consistent finding regarding the impact of orthodontic treatment on TMD signs and symptoms based on high-quality systematic reviews?

A. Correction of a deep overbite is the only proven method to prevent TMD in high-risk patients.

B. Orthodontic treatment significantly decreases the risk and severity of TMD for all patients.

C. Orthodontic treatment significantly increases the risk and severity of TMD due to prolonged appliance wear.

D. Orthodontic treatment neither prevents nor causes TMD 

The correct answer is D. Orthodontic treatment neither prevents nor causes TMD

High-quality systematic reviews and meta-analyses, including those by Kim et al. (2002), Manfredini et al. (2016), and Jeong et al. (2024), consistently find no causal relationship between orthodontic treatment and TMD development or resolution, with pooled odds ratios near 1 (e.g., OR 0.75, 95% CI: 0.37–1.51; p=0.42) and qualitative syntheses showing only transient, mild signs (e.g., clicking) without prevalence increases. Methodological heterogeneity in TMD diagnostics (e.g., RDC/TMD vs. questionnaires) limits definitive claims, but no evidence supports causation, prevention, or exacerbation across diverse populations and techniques. Claims of increased risk (e.g., OR 1.84 in a 2023 review) stem from flawed designs (e.g., excluding RCTs, selection bias) critiqued in Evidence-Based Dentistry. Deep bite correction (A) shows inconsistent TMD benefits; universal risk reduction (B) or increase (C) lacks substantiation in longitudinal cohorts.