Interceptive orthodontics Flashcards
What is interceptive orthodontics?
Any treatment that eliminates or reduces the severity of developing malocclusion, that should eliminate or simplify the need for future treatment
What is interceptive orthodontics?
Any treatment that eliminates or reduces the severity of developing malocclusion, that should eliminate or simplify the need for future treatment
What are aims of interceptive orthodontics?
- Maintain centrelines
- Maintain class I incisor relationship
- Maintain good vertical and transverse relationships
- Eliminate crossbites associated with displacement
- Prevent trauma
- Minimise crowding and teasing
What is assessed anteroposterior?
EO - Class I, II or III skeletal pattern
IO - Incisal classification, overjet, canine and molar relationship and anterior crossbite
What is assessed vertically?
EO - facial thirds, angle of lower border of mandible to maxilla
IO - Openbite, anterior open bite and lateral open bite
What is assessed transverse?
EO - facial symmetry, IO - centreline shift, posterior crossbite
When is interceptive orthodontics undertaken?
1) Failure/delayed eruption
2) Crossbites with displacement/wear
3) Poor prognosis teeth
4) Trauma to permanent teeth
5) Severe skeletal patterns where early treatment may be appropriate - developing class II/III
When would you investigate an impacted tooth?
If it hadn’t erupted >6 months of the contralateral
What is the aetiology of impacted first permanent molars?
Increased m-d width of 6
Increased eruption angle of 6
Crowding posterior maxilla
Genetic
What can impacted first permanent molars cause?
Caries of second deciduous molar and first permanent molar
Root resorption of second deciduous molar
Space loss if the second deciduous molar is lost
What are the management options for impacted first permanent molars?
Some may be reversible and correct themselves by 7/8 years
Whether the E is viable
If so - disimpact with separator/brass wire or distalise with upper removable appliance with finger spring and button
If not - extract E and distalise 6 when erupted
What can cause an erupted upper central incisor?
Developmental anomaly - supernumeraries, genetic - holoprosencephaly, environmental - dilaceration
What is the management for an unerupted upper central?
Remove cause of impaction/create space then:
Give time for eruption in younger patients - if having intervention usually attach gold chain (if removing supernumeraries)
May need active intervention in older patients/if failure to erupt
What are the causes of infraoccluded deciduous teeth?
Genetic
Disturbed local metabolism
Gaps in periodontal membrane
Local mechanical trauma
Local infection
Why is intervention required for infraoccluded deciduous teeth?
Prevents:
- tipping of adjacent teeth
- periodontal problems
- alveolar ridge defects due to growth restriction
- space loss
- displacement of developing successors
- overeruption of teeth in opposing arch
- caries
- gingival hyperplasia
What does the management of infraoccluded deciduous teeth depend on?
Severity
Presence of permanent successor
Prognosis of deciduous tooth
Malocclusion
When do we palpate for canines?
9 if not palpable by 10 investigate further
What is the aetiology of unerupted maxillary canines?
Long path of eruption
Delayed exfoliation of deciduous canine
Small/developmentally absent 2’s
Presence of supernumeraries
Polygenic inheritance
Crowding
What warning signs may you see in unerupted upper canines?
Prolonged retention of C
Loss of vitality of upper2’s/1
What radiographic assessments can you do when you suspect an ectopic canine?
1) Horizontal parallax - 2 periapicals
2) OPT/vertical parallax and anterior occlusal
3) CBCT
What is the management of unerupted upper canines?
Management - radiographic monitoring (can lead to root resorption and cyst formation)
Interceptive: XLA C
Surgical exposure and orthodontic alignment
Surgical repositioning
Extraction
What makes a good prognosis upper canine that has unerupted?
No horizontal overlap with incisor
Halfway up root of incisor
Angled 0-15 degrees
Apex above canine position
What are the causes of crossbites?
Local causes, skeletal, soft tissues and pathology
What is the interceptive management of crossbites?
URA
Quadhelix - posterior
2x4 - fixed appliance used for anterior crossbites
