Interceptive Ortho Flashcards
interceptive ortho aka + definition
early treatment
treatment performed in either primary or mixed dentition in order to enhance the dental and skeletal development and minimize prospective future serious problems, before the eruption of the permanent dentition
key to succeess in interceptive ortho
timely diagnosis and referal
- know where and what to look at
objectives of interceptive ortho
- to restore arch length integrity (space management)
- to improve skeletal imbalances - (classII, Class III, asymmetries, transverse problems)
- to establish functional occlusion
- to maintain teeth and perio health
- to improve self esteem
benefits of interceptive ortho
- redirect growht of the jaws **
- coordinate the width of the upper and lower dental arches
- guide erupting permanent teeth into desirable positions
- decrease risk of trauma to protruded upper incisors
may potentially simpify later ortho tx and may decrease number of extractions and might simplify orthognathic surgery if needed
disadvantages to interceptive
longer tx time and additional retention
increased cost
potential for cooperation loss
irritation of oral tissues / bulky appliances
indications for interceptive therapy
- arch length managment
- eruption problems
- oral habits
- developmental problems/ syndromes
- dental / skeletal crossbites
- skeletal discrepencies
arch length management means
making sure we have enough room for the permanent teeth to erupt
strategic spaces exist
- primate spaces–> usually between lateral and canine on upper and canine and first molar on lower in primary teeth
- anterior spacing
- leeway space —> primary canine first and second molar replaced by canine first and second pre molars
early loss of incisors implication
early loss of primary incisors causes no space loss if primary canines are erupted
early loss of primary canines causes mesial drift of permanent molars, lingual / distal eruption of permanent incisors and midline discrepencies
early loss of primary canines implication?
causes mesial drift of primary molars, lingual / distal eruption of permanent incisors and misline discrepencies
early loss of primary 1st molars?
distal movement of canines, and it if happens before eruption of permanent 1st molar, than primary 2nd molar will mesially drift and permanent 1st molar
early loss of primary 2nd molars implication?
causes migration and tipping of 1st permanent molar
space loss occurs (time wise)
very quickly - more immeditalety after extraction or loss and occurs within a year (crucial 6 months)
space loss occurs with which teeth more in order
primary 2nd molar > primary 1st molar > primary canine >primary incisors
most with primary 2nd molar and least with primary incisor
highest prevalence and amount of space loss after premature loss of?
highest prevalence and amount of space loss after premature loss of maxillary e’s > mandibular e’s
e= primary second molar
early loss of d’s in primary implication
almost equal space loss in both mx and mn arches
- d’s = primary first molar
arch where space loss occurs faster?
maxilla
space maintainance
preservatino of spaces left by the primary teeth and sometimes the primate spaces
- avoid future crowding
- allow normal eruption of the permanent teeth
- allow for developing class I occlusion
potential space loss in arches depends on
position of the permanent teeth and adjacent to the edentulous site
indications for space maintainence in terms of primary 2nd molar
premature loss of primary 2nd molar - when more than 6 months delay before permanent molar erupts and if there is adequate space
indications for space maintainence in terms of primary 1st molar
needed if premature loss of primary 1st occurs prior to eruption of 1st permanent molar
missing permanent incisors
usually due to truama or congenitally - so need to maintain this space
indications for space maintainence in terms of primary canine
yes - if these are prematurely lost - need to maintain space
5 main space maintainers used
band - crown and loop
distal shoe
removable - partial dent type - space maint
lingual holding arch
nance appliance
band and loop use
holding space for missing ONE posterior tooth
most of the time the permanent first molar must be erupted - b/c anchor to this tooth
situations to apply band and loop application
- premature loss of 1st primary molar
- premature loss of 2nd primary molar, after eruption of 1st permanent molar
- premature bilateral loss of primary molars before eruption of permanent incisors (2 appliances)
crown and loop
when the abutment tooth is:
- highly carious
- exhibits marked hypoplasia
- has been pulpotomized
another approach is to place a band and loop over the crown if tooth is already crowned
distal shoe
controls the migration of unerupted teeth
loss of primary 2nd molar prior to eruption of permanent 1st molar
loss of permanent 1st molar prior to eruption of permanent 2nd molar
location of blade in distal show
1 mm BELOW mesial marginal ridge of the erupting tooth
loop contoured closely to the ridge
MUST take x-ray to confirm it has gone to the right height
distal shoe avoided in who
pts. with risk of bacterial endocarditis
in order to use lingual bar need
permanent incisors and permanent first molars
partial denture maintainer use?
unilateral loss of more than two primary molars
bilateral posterior space maintainence when more than one tooth has been lost per segment and permanent incisors have NOT yet erupted
advantages of partial denture / flipper maintainence
posterior maintenance
esthetics - anterior teeth
prevents supraeruption
restores occlusal function
disadvantages of partial denture maintenance
cooperation
hygeine
lingual holding arch use
multiple primary teeth are missing
erupted permanent incisors
premature loss of one or both primary canine s
maintains E space
bands placed where on lingual holding arch
primary 2nd or permanent 1st molars (ideal)
arch positioned where on lingual holding arm
on CINGULUM OF INCISORS - 1-11.5 mm FF soft tissue and stepped to the lingual in the canine region to remain away from the primary molars and the unerupted premolars
fixed / solder joints or removable on lingual holding arm
either - removable more prone to breakage or loss
nance button / appliance use
basically maxillary counter part to lingual holding arms
provides resistance to anterior movement of posterior teeth
CANNOT prevent lingual tipping of incisors
acrylic button anchors in the anterior portion of palatal vault, 0.5 INCH IN DIAMETER
hygeine in relation to nance button / appliance
can become embedded in the soft tissue when hygeine is poor pr appliance is distorted
three main biomechanical principles
- anchorage - strong abutment , especially in unilaterally supported appliance (perm 1st molar better than D or E of primary molar)
- passivity - any movement of abutment teeth must be avoided
- simplicity - easy manipulation by the practiioner and tolerance by the patient
importance of leeway space
- include measurements
5-8 mm of mandibular crowding in the mixed dentition can be resolved with “E” space and slight arch expansion
the same amount of crowding (5-8mm) in the permanent dentition generally requires extraction
space regaining
restoration of space lost
localized up to 3mm
DRIFT OF PERMANENT INCISORS / MOLARS
repositioning of teeth followed by space maintainer if needed – allows for further normal development
main causes of space loss
premature loss of primary teeth
un or poorly restored proximal caries - causes drfit
loss of permanent incisors from trauma
congenitally missing teeth
ectopic eruption of permanent teeth
dental malformation, resulting in small teeth such as peg -shaped laterals
regaining easier in which arch?
maxillary
- anchorage fom palatal vault
- extraoral force
- max bone structure and quality
regaining appliances for the maxillae
removable
head gear
fixed
- pendulum-pend x
- uses a spring and pendulum force
pendex
distal jet
regaining appliances for mandible
removable ones
lip bumper details
can use force of lip slightly to distalize the molars
1.5 mm facial to lower incisors, relieved from gingiva
LIP contacts appliance
change in lip and tongue balance
gain arch length on mandible
lingual arch for space regaining on mandible that is active
lingual arch with INCORPORATING LOOPS to distalize molars or procline incisors
major considerations with the regaining space appliances
- correct application of force - amount and direction
- minimize reciprocal movement
- avoid complex movements
- eliminate occlusal interferences (btite plate, occlusal grinding)
severe localized space loss considered when
space loss MORE THAN 3 MM
- loss of space CANNOT be dealt with removable or fixed simple appliances
attempt to regain space should be done with extraoral force and fixed appliance
three ways we can MAKE space
- expansion
- IPR - reducing mesiodistal width of permanent teeth
- extractions
when does excess space require t
NO EARLY TX UNLESS DUE TO THICK LOW ATACHED FRENUM
what to do with maxillary midline diastema and generalized anterior spacing
NOTHING
- unless due to thick low attached frenum –> refer it out
supernumerary tooth - refer and fix
mesiodens - treat
ectopic eruption implcation
can cause resoprtion of a primary tooth other than the one it is suppose to replace or of an adjacent permanent tooth
the basic approach is to move the extopically erupting tooth AWAY from the tooth is resorbing
brass wire use
with abnormal eruptions
- 20 mm brass wire looped and tightened around contact between primary 2nd molar and permanent molar
if limited moveemnt is needed, but little or none of the permanent molar is visible clincially
tighten approx every 2 weeks
appliance to use for severe resorption?
cantilever arm
-place band on second primary molar supported by lingual arch if maximum control desired, wih cantilever arm extending distally behind unerupted molar
spring or elastic hooked from the cantilever to button on molar
- for ectopic eruptions
interproximal reduction
sequential selective slenderizing of primary teeth in order to allow a more favorable eruption path for the permanent teeth
mesial or distal on lower primary canines
mesial on lower second primary molars
disk or needle shaped bur
interproximal reduction in posterior?
after require a space maintainer – lingual arch
always perpendicular to the occlusal plane and in order to create a favorable path for alignment
extraction of primary teeth
extraction of primary maxillary canine in order to allow a more favorable eruption path for the permanent canine or correct midline deviations if contralateral was exfoliated prematruely
when permanent tooth is there and no signs of exfoliation or movement in the primary
serial extraction - general overview
sequential extraction of primary and permanent teeth in order to relieve severe crowding and guide the eruption of permanent teeth into the dental arches
** when MORE than 10 mm of mandibular crowding exisits and extractions of 4 premolars is require
specific order and follow up for next ones required
most common teeth involved in serial extraction and rationale for each
most common are decidous canines, first molars, and first pre-molars
primary canines – improve incisor alignment
1st primary molars – accelerate erruption of the 1st premolars
then 1st pre-molars – permit the eruption of the permanent canines into proper position
extraction / enucleation
supernumerary teeth, cysts, odontomas; eruption interference or diestam
*contribute to eruption problems
treat cause!
oral habits implication
can cause distortions with dental alveolar like thumb sucking and tongue thrusts
appliance to help with oral habits
tongue crib
- prevent tongue from putting pressure on the dentition
tongue habit appliance
acts as a reminder of where to position the tongue
tongue spurs
interfere with the tongue
tongue learns not to go there
thumb crib
patients that suck thumb
block area where thumb would go
schwartz appliance helps with
transverse imbalances
- like posterior crossbites
- seems like a palatal expander
on the lingual too
quad helix is
fixed - helps with posterior crossbites
bonded hyrax expander
acrylic - may open bite but will have no extrusion of molars - so no increase in vertical dimension
bands where on haas expander
bands on 6’s and 4’s
hass expander details
bands on 6’s and 4’s
metallic framework
expansion screw
acrylic palatal coverage
NON PARALLEL suture opening
teeth
extrusion of posterior
hass expander vs bonded hyrax expander
with bonded have acrylic on occlusal coverage - may open bite but will have no extrusion of molars - so no increase in vertical dimension
hass expander may have extrusion
bonded hyrax has bands on 6’s
bonded hyrax expander details
vertical control
long AFH (anterior facial height) - do not want any bite opening
no extrusion desired
when bite opening is contraindicated
KD appliance for
anteiror crossbite
fixed appliance for anteiror crossbite
yes
- can do this with KD appliance
skeletal imbalances dealt with how - general
maxillary and mandibular excessive and deficient growth
- modify accordingly
like head gear
face mask
fixed / removable
see last weeks lectures
when to interfere with early treatment
primary or mixed – as soon as patient can tolerate impressions
