INTERCEPTIVE ORTHODONTICS Flashcards by Deleted Deleted

what are the responsibilities of a primary care dentist

Timely valid referrals
Patients referred:
Need
Want
Suitable for orthodontic treatment or advice.

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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.

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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

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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

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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

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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

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what to check for in transverse plane:

extra oral:
facial asymmetry
Intra oral:
C/L
posterior crossbite

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what additional things to look for

extra oral:
Smile aesthetics
Soft tissues
TMJ
intra oral:
Teeth present
Crowding/spacing
Periodontal health
Tooth quality

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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

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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)

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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

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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

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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)

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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

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RCS guidleines for unerupted maxillary molars

learn flowchart on slide 15

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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