AP Problems (Resident) Flashcards
What is early tx?
Either primary or mixed dentition = modify skeletal development (younger kids = more growth potential of jaws), fix minor dental problems before eruption of permanent dentition
What cases benefit from early tx?
Transverse problems
Anterior cross bites
Class III cases (growth modification)
Large overjet
Benefits to the pt
Improvement/resolution developing malocclusion
Improved pt self esteem/parent satisfaction
Prevent potential trauma
Decrease future extraction of perm. Teeth
Decrease tx time in perm dentition
AP skeletal jaw issues
Upper and lower jaws + upper and lower teeth in alveolar processes
Max/mand dental protrusion (bimaxillary protrusion)
Mand dental and alveolar base retrognathia
Max dental and alveolar base prognathsim
Mand dental and alveolar base prognathism
Max dental and alveolar base retrognathia
Tx of skeletal problems in kids
When jaw discrepancy in growing pt, you can sometimes modify facial growth to improve skeletal relationship
3 important principles for preadolescent or adolescent child
- Start growth modification too late, doesn’t work, but start too soon, takes too long (or relapses)
- Growth occurs on different timetable for 3 planes of space = transverse —> AP —> vertical
- Compliance w tx affected by both stage of maturation and difficultly of doing what doctor want
Anteroposterior facial growth
Class II and Class III
2nd plane of growth to finish
Mid teen years, some males late teen
Even later for class III pts
Growth until late adolescence
Mandibular AP growth finishes after maxillary AP
Class III malocclusion diagnosed
Late deciduous or early mixed dentition - growth pattern established in early childhood
Optimal time tx- eruption of upper perm central incisors and 1st permanent molars (~7yrs), before circum-maxillary suture fusion
_____ growth completed before ______ growth
Maxilla, mandible
Class II malocclusion with mandibular deficiency
Tx timing delayed until late mixed dentition
Greater mandibular growth respawn with functional appliances during pubertal growth period
Class II malocclusion in pt age 6-8
Tx may be initiated immediately handle intra arch problems = blocked out canines, narrow arch, risk trauma upper central incisors
Most wait until late mixed dentition to treat pt in one stage
Growth evaluation
CVMS
Hand wrist radiographs
CVMS
Looking at vertebrae notching
Notching (concavity) = older
Peak growth for CVMS
Between CVMS 2 and 3
Class II tendency patients sagittal problems
Most frequent AP discrepancy
Max prognathsim, mandibular retorgnathism, combo of two
Class II division 1
Deepish bite and giant overjet
Usually constricted maxilla
V shaped arch form
Class II division II
Super deep bite
Retroclined maxillary centrals
Maxillary laterals are proclaimed and mesially tipped
Indications for class II deep overbite tx
Esthetics, profile, smile
Removing growth inhibition of the mandible (class II div II)
Prevention of long term periodontal damage
Lower incisors into palatal tissue (palatal impingement)
Tx modalities class II
Inhibit max growth - headgear
Stimulant Mand growth - functions appliance
Appliances to distalize Mx post teeth
Camouflage
Surgery
Mixed dentition class II tx
Headgear
Functional appliance - herbst, MARA
Class II elastics, Forsus
Headgear
Cervical pull
High pull
Combination pull
Two major components of headgears
Intraoral (facebow)
Extra oral (neck strap, chin cup)
