BDS4 Seminar 3 - Interceptive Orthodontics Flashcards
what are some anomalies of primary dentition from birth -6yrs?
- Natal teeth
- Hypodontia
- Supernumeraries
- Teeth of abnormal morphology
what might need intercepting?
- Crossbites
- Digit sucking habits
- Supernumerary teeth
- Midline diastema
- Increased overjet
- Reverse overjet
- Increased overbite
- Early loss of deciduous teeth
- Developing crowding
- Poor prognosis first permanent molars
- Impacted first permanent molars
- Infra-occluded teeth
- Hypodontia
- Delayed eruption
what is this
anterior crossbite
what is anterior cross bite and possible problems?
- Abnormal relationship between opposing teeth in a buccopalatal or labiopalatal direction
- possible problems
*tooth wear
*recession
*displacement on closure
what are favourable features for correction with URA for anterior crossbite??
Tooth in x-bite palatally tipped
* Good overbite
* Aids stability
* Adequate space to move forward
what is managment of anterior crossbite?
- URA
- 2x4 appliance
*brakcets on incisors and 6’s
What is this?
posterior crossbite
what are problems of posterior crossbite?
- Displacement on closure
- Tooth wear
- Facial asymmetry
- Teeth may erupt in “displaced” ICP position
- TMJ problems?
what is management of posterior cross bite?
- URA
- Quad helix
- Rapid Maxillary Expansion
why treat increased overjet in mixed dentition?
- increased trauma risk
- poor aesthetics
what is aetiology of increased overjet?
- Skeletal
*Usually class 2
*Mandibular deficiency most common - Soft tissue
*Lower lip trap
*Hyperactive lower lip - Dental
*Upper incisor proclination
*Lingual displacement of lower incisors
*digit habit
what is management of increased overjet?
- growing patient
*simple URA retraction of upper incisors
*attempt growth modifitcation
how does functional applaince work for class II div 1?
- Enhance mandibular growth
- Restrain maxillary growth
- Remodel glenoid fossae
- Retrocline maxillary incisors and
distalise molars - Procline mandibular incisors and
mesialise molars
what is this
reverse overject
problems with reverse overjet?
- Displacement on closure
- Incisal edge wear
- Difficulty eating
- Speech problems?
what is aetiology of reverse overjet?
- Skeletal
*Class 3 jaw discrepancy
*Hypoplastic maxilla
*Prognathic mandible - Dental
*Mandibular displacement
*Retained upper deciduous
incisors
what is management of reverse overjet?
- Growing patient
*Simple proclination of upper incisors (URA)
*Attempt growth modification
what is growth mod for reverse overjet?
Chin strap/cup
Functional appliances
Protraction headgear
what is mode of action for growth modification for reverse overjet?
- Alter force exerted by lips and cheeks
- Disengage occlusion
- Face mask pulls directly on maxillary appliance and pushes on lower incisors
what is this?
deep overbite
what can deep OB lead to?
Palatal ulceration
Gingival stripping
how to do interceptive tx for deep overbite?
- URA with FABP
- Will allow lower molars to erupt
- Pt must be growing to accommodate the increase in vertical dimension
- ? Convert to II div 1 and
Twin block
problems with digit sucking?
- Anterior open bite or reduced OB
- Proclined upper incisors and retroclined lower incisors
- Increased overjet
- Posterior cross-bit
what is aetiology of digit sucking?
- > 6hrs duration
- Prevention of eruption of incisors
- Labio-lingual pressure on incisors
- Lowering of tongue position
- unopposed buccinator pressure on UBS’s
what is management of digit sucking habit?
- Encourage cessation at
home initially - Habit deterrent appliance
*Removable
*Fixed - Appliance to deal with
effect
*Overjet reduction
*Cross-bite correction
*Closure of AOB
what are problems of supernumerary teeth?
- Impeded eruption of associated teeth
- Displaced eruption of adjacent teeth
- Poor aesthetics
what is conical?
- Usually close to midline (mesiodens)
- Usually 1 or 2 in number
- Tend not to prevent eruption but may displace centrals
- Extract only if erupt or impeding tooth movement
what is tuberculate?
- Main cause of failure of eruption of central incisors
- Usually develop palatal to centrals
- Remove +/- surgical exposure of centrals
what is supplemental?
- Normal morphology
- Tend to extract
- Decision based on tooth
form and position
what is odontome
- Less common
- Complex and compound
forms
when is there an increased incidence of supernumerary teeth?
- CLP
- Cleidocranial dysostosis
what is this and problem
median diastema
- poor aesthetics
what is aetiology of media diastema?
- Generalised spacing
- Hypodontia (absent 2s)
- Midline supernumerary (mesiodens)
- Proclination of upper incisors
- Low fraenal attachment
- Pathology
what is management of median diastema?
- None for developmental
- Surgical removal of supernumeraries
*not always needed - Early closure if severe and child concerned
- Fraenectomy?
- Bonded retainer
what varies space loss?
- age loss
- tooth lost
- upper/lower crowding
what is biggest cause of impacted 5’s
early loss of E’s
what to do?
1. early loss of A’s and B’s
2. early loss of C’s
3.D’s and E’s
- nothing
- balance, don’t compensate
- *space loss great in upper
*consider space maintaine
*no need balance
when use space maintainer?
- Early loss of deciduous teeth
- Early loss of first permanent molar
- Traumatic loss or delayed eruption of
maxillary incisor - Preserve Leeway space
- BUT Good dental health required
what is compensating and balancing of 6’s
- upper 6 go don’t compensate
- lower 6 go consider compensating
- consider balancing
*only in lower and if crowded
ideal timing for XLA lower 6’s
- bifurcation of 7 is calcifiying
- age 8-9 years
- good spontaneous closure between 7 and 5
what is effect of early loss and later loss of lower 6’s
early
*distal migration of 5
late
*poor spontaneous closure
*mesial tipping and lingual rolling of 7’s
what is aetiology of impacted 6’s?
- Eruption angle
- Ectopic crypt
- Morphology of second deciduous molar crown
- Small maxilla
what does impacted 6’s result in?
- Pulpitis of E
- Premature exfoliation of E
what is tx options of impacted 6’s?
- Observe ~ 6months
*66% will disimpact by age 7 years - XLA E
*Regain space for premolar or treat crowding at a later stage - Dis-impact
*Separators
*Band E and bracket 6 with open coil
*Discing of E
*URA with finger spring and attachment on 6
what is this?
primary molar infra-occlusion
what is charcteristicsof primary infra-occlusion
- Lower D most common
- Mandible > maxilla
- Percussion sound
- Blurring or absence of PDL on x-ray
what is factors imoportant of primary molar infra-occlusion?
key factors
- prescence or absence permanent successor
- degree infra-occlusion
what is this?
hypodontia
for hypodontia what do you exclude and hwat is most common teeth?
- lower 5’s
- upper 2’s
- upper 5’s
what is interceptive measure for hypodontia?
- Refer as soon as identify
- Combined Ortho/Paeds monitoring
- Guidance of eruption of permanent teeth
- Restorative treatment alone
*Build-ups - Early orthodontics to improve aesthetics
*e.g. Closure of diastema.
