Interceptive Orthodontics Flashcards
What is meant by interceptive orthodontics?
any procedure that will reduce or eliminate the severity of a developing malocclusion
Ectopic eruption. - impaction of the first permanent molar - management (first molar stuck behind ‘e’ and fails to fully erupt)
if patient >7 years old wait 6 months
- 90% self correct
orthodontic separator
attempt to distalise first molar
- extract E
- distal disking of e
causes of unerupted central incisors
supernumeraries
trauma to primary tooth
- dilaceration to permanent tooth
other pathology or developmental anomaly
congenital absence - rare
what is meant by the term ‘dilaceration?
An abnormal bend in the root or crown of a tooth, caused by trauma or developmental disturbances
unerupted central incisors - management
remove any retained primary teeth and supernumeraries
create/maintain space
monitor for 12 months if pt <9 years (immature root apex)
- still fails to erupt or patient >9 years then surgically expose/bond gold chain and apply orthodontic traction
Closed exposure technique for maxillary incisor
- mucoperiosteal flap raised
- orthodontic traction hook bonded to palatal surface
- flap replaced leaving gold chain entering oral cavity through attached mucosa
open exposure technique for maxillary incisors
rarely done for upper incisors
- simple epithelial flap cut over crown of tooth
- reserved for impactions which are soft tissues only, and tooth crown is superficial
when is interception indicated for early mixed dentition?
- early loss of deciduous teeth
- potential crowding
Early loss of deciduous teeth - consequence
localised crowding
Balancing extraction - meaning
removal of a tooth from opposite side of the same arch
- in order to preserve symmetry and reduce midline shift
Compensating extraction - meaning
removal of a tooth from the opposing quadrant
- to maintain the buccal occlusion
Early loss of primary teeth - management
As and Bs
- little impact
- don’t balance or compensate
Cs
- balance
Ds
- small centreline shift
- balance under GA?
- more likely if patient is corwded
Es
- tend not to balance
- major space loss
- upper>lower space loss
- consider space maintainer
Cs, Ds and Es - compensating extractions not required
removable space maintainer - features
passive URA
typical components:
retention
- e.g. clasp 6s 0.7mm HSSW
- labial bow U3-3 0.7mm HSSW with southed clasp
baseplate
- extend acrylic around teeth to prevent unwanted mesial drift
mesial stop 0.6mm HSSW on individual teeth if required
fixed space maintainer - features
palatal and lingual arches
band and loop
First molars of poor prognosis - considerations before extraction
- age of patient/stage of dental development
- degree of crowding
- malocclusion type
- condition of teeth
- capacity of patient to receive complex dental care
- availability of services
- willingness of child and parent to engage log term with ongoing dental care
6s extractions - considerations
Lower 6
- consider compensating if upper will remain unopposed for a prolonged period of time and there is clear occlusal requirement
- seek orthodontic advice
upper 6
- unerupted 7 can be expected to drift medially into contact with second premolar as it erupts
don’t balance with sound tooth
don’t balance if well aligned or speed
first molar extraction - most ideal time to extract
- 7s bifurcation calcifying
- 8s present
- mesial angulation of lower permanent molar
- class 1/reduced overbite
- moderate lower crowding
- mild/moderate upper crowding
anterior cross bite - things to assess clinically
displacement
mobility of lower incisor
tooth wear
gingival recession
digit habit management
positive reinforcement
bitter tasting nail varnish
glove on hand, Elastoplast
habit breaker appliance
- fixed or removable
Give examples of habit breaker appliances
URA with palatal goal posts
Fixed appliance with tongue rake
Early mixed dentition age
6-8
late mixed dentition age
10-13
interceptive orthodontic indications in late mixed dentition
retained deciduous teeth
infra occluded deciduous teeth
canines
overjets
hypodontia
indications for extracting retained deciduous tooth
- permanent successor present and partially erupted
- primary is causing deflection in its path of eruption
