INTERCEPTIVE ORTHODONTICS Flashcards
what are the responsibilities of a primary care dentist
Timely valid referrals
Patients referred:
Need
Want
Suitable for orthodontic treatment or advice.
What is interceptive orthodontics?
Any treatment which eliminates or reduces the severity of a developing malocclusion.
It should eliminate or simplify the need for future treatment.
Aims of interceptive orthodontics?
Maintain centrelines
Maintain Class I incisor relationship
Maintain good vertical and transverse relationship
Eliminate crossbites associated with displacement/pathology
Prevention of trauma
Minimise crowding
Minimise psychological factors/teasing
what to look for in clinical exam
Patient history
Patient perception of problem-ask pt what is bothering them, how sever do they think problem is
MH
SH
DH - trauma
Habits-nailbiting, digit sucking
Growth status
Motivation
what to look for in AP plane
Extra oral:
check if pt is class I,II,III skeletal pattern
Intra oral:
Incisal classification
OJ
Canine relationship
Molar relationship
Anterior crossbite
what to check for in vertical plane:
Extra oral:
Facial thirds
Angle of lower border of mandible to maxilla
Intra oral:
over bite
anterior open bite
LOB
what to check for in transverse plane:
extra oral:
facial asymmetry
Intra oral:
C/L
posterior crossbite
what additional things to look for
extra oral:
Smile aesthetics
Soft tissues
TMJ
intra oral:
Teeth present
Crowding/spacing
Periodontal health
Tooth quality
When is interceptive orthodontics undertaken?
Failure/delayed eruption
Crossbites with displacement/wear
Poor prognosis teeth
Trauma to permanent teeth
Severe skeletal patterns where early treatment may be appropriate e.g. developing class II/III
- Failure/delayed eruption
Incidence
4.3%
M>F
Aetiology
Multifactorial
Increased m-d width of 6
Increased eruption angle of 6
Crowding posterior maxilla
Genetic
Symmetry and timing - >6months investigate (5-6 yrs)
problems impacted first molars can cause:
Potential problems
Caries of second deciduous molar tooth and first permanent molar tooth
Root resorption of second deciduous molar tooth
Space loss if the second deciduous molar tooth is lost
management of first impacted molars
Management will be dependant on:
Reversible
90% will self correct by 7yrs 100% self correct by 8yrs
Irreversible
Whether the E is viable
Disimpact by placing separator/brass wire
Distalise 6 with URA
If non viable xla E and distalise 6 once erupted
- Failure/delayed eruption ii) Unerupted upper central incisor
Incidence
0.13% impacted
M:F 2.7:1
Aetiology
Developmental - supernumeraries
Genetic - Holoprosencephaly
Environmental – dilaceration
Symmetry and timing - >6months investigate (7-8yrs)
management of unerupted upper central incisor
Management
Remove cause of impaction/create space
?Give time for eruption in younger patients – if having intervention usually attach gold chain
May need active intervention in older patients
RCS guidleines for unerupted maxillary molars
learn flowchart on slide 15
- Failure/delayed eruption iii) Infraoccluded deciduous teeth
Incidence
1-9%
Aetiology
Genetic
Disturbed local metabolism
Gaps in the periodontal membrane
Local mechanical trauma
Local infection
what can Infraoccluded deciduous teeth cause
Tipping of adjacent teeth
Periodontal problems
Alveolar ridge defects due to growth restriction
Space loss
Displacement of developing successor teeth
Overeruption of teeth in the opposing arch
Caries
Gingival hyperplasia
management
Management
Will depend on:
Severity
Presence of 2o
Prognosis of 1o
Malocclusion
good flowchart on slide 18 to explain
iv) Unerupted upper canine
Symmetry and timing – palpate at 9yrs
Incidence
2% impacted (61%palatal,in line of arch 34%, buccal 5%)
0.08% developmentally absent
Initial management
Clinical examination at 9yrs
Palpate for canine bulge buccally
If not palpable by 10yrs investigate further
Aetiology
Long path of eruption
Delayed exfoliation of the deciduous canine
Small/developmentally absent 2s
Polygenic inheritance
Presence of supernumeraries;
Crowding
clinical signs of unerupted upper canine
Visual inspection of the canine bulge
Palpation
Prolonged retention of C
Loss of vitality U2/1
Radiographic assessment
Localising views required
Horizontal parallax – 2 periapicals (20o tube shift)
Vertical parallax - Anterior occlusal (70–75°) and OPT/ PA
CBCT
Assessment for interceptive treatment for unerupted canines
Management
The management of impacted
canines usually involves five treatment options:
No active treatment and monitor radiographically
Possible sequelae if left:
Root resorption
Cyst formation
Interceptive treatment – xla upper c
Surgical exposure and orthodontic alignment
Surgical repositioning
Extraction
incidence of crossbites
Anterior x-bite incidence 2.2-11.9%
Posterior x-bite incidence in 1o dentition 1-16%
aetiology of crossbites
Local causes
Skeletal
Soft tissues
Pathology/trauma
management of crossbites
URA
Quadhelix
2x4 appliance
Treatment is only carried out early to:
Eliminate displacements
Prevent perpetuation into permanent dentition
Prevent periodontal breakdown/wear
aetiology and problems of poor prognosis Deciduous teeth
Aetiology
Caries
Trauma
Problems
Centreline shift
Localisation of pre-existing crowding
management of poor prognosis decisuous teeth
Management depends on
Age
Existing space requirements
Tooth type
aetiology and problems caused by poor prognosis first permanent molar
Aetiology
Caries
MIH
Problems with loss of first permanent molars
Spacing
Occlusal interferences
Anchorage concerns
Alveolar defects
Tipping of teeth
how to manage poor prognosis first permanent molar
For best spontaneous occlusal results:
Age 8-10
Dental development – after eruption of lateral incisors but before eruption of second permanent molar and/or premolar
Class I occlusion
All permanent teeth present
Minimal incisor/moderate buccal segment crowding
If extracting mandibular first permanent molar consider compensating extraction of opposing maxillary molar – seek orthodontic opinion
incidence and management of early loss of maxillary central incisor
Incidence
3% of children
M>F
Immediate intervention
Reimplantation – to act as space maintainer
Management following subsequent failure
Extraction of poor prognosis incisor +
Space maintainer if lost EARLY – reduce length of subsequent treatment and complexity.
Premolar transplant
Orthodontic space closure
Long term management
Denture
Bridge
Implant
The options above may require orthodontic treatment prior to restorative work.
how to treat severe skeletal patterns: class II
Management
Early class II correction
Trauma limitation
Pyschosocial benefits
Early class II intervention
Digit sucking dissuasion
aetilogy of severe skeletal patterns: class II
Aetiology
Skeletal
Soft tissues
Habits
how to manage digit sucking in class II pts
Common in the mixed dentition
12% 9yr olds
2% 12yr olds
Extent of malocclusion dependant on:
Frequency
Intensity
Duration - >6hrs
Management
Conservative management
Encouragement
Positive reinforcement
Bitter nail varnish
Gloves worn to bed
If habit persists
Removable
Fixed palatal arch with dissuader
Characteristic features
of digit sucking in class II pts
Characteristic features
Proclination of upper incisors
Retroclination of lower incisors
Asymmetrical AOB
Narrowed upper arch
Posterior crossbite
aetiology and management of sever skeletal patterns : class III
Aetiology
Skeletal
Genetic
Management
Early class III correction- using protraction facemask
Reduces need for OGN surgery
If poor prognosis A or B needs extracting how to mange contralateral tooth
Minimal effect on midline so No interceptive treatment
If poor prognosis C needs extracting how to mange contralateral tooth
Balance XLA to preserve midline
If poor prognosis D needs extracting how to mange contralateral tooth
Spaced arch - no interceptive treatment
Crowded arch - balance Xla to preserve midline
if poor prognosis E needs extracting how to balance contralateral tooth
No interceptive treatment
