interceptive orthodontics Flashcards by David Jack

What is interceptive orthodontics?

Any procedure that will reduce or eliminate the severity of a developing malocculsion

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What problems can be caused by an anterior crossbite?

Toothwear
Gingival recession
Displacement on closure

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How are anterior crossbites managed?

URA
Posterior bite plane
Z-spring to tip incisor forwards

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Why should posterior crossbites be fixed early?

So permanent dentition will erupt into a normal position

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How are posterior crossbites managed?

Maxillary expansion with a URA using a quad helix

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Why are increased OJs often treated in the mixed dentition?

Trauma risk
Poor aesthetics - psychosocial problems

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What is the aetiology of an increased OJ?

Skeletal - usually class 2, mandibular deficiency most common
Soft tissue - lower lip trap, hyperactive lower lip
Dental - upper incisor proclination, lingual displacement of lower incisors, digit sucking habit

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What are the therapeutic effects of functional appliances?

Retrocline maxillary incisors and distalise molars
Procline mandibular incisors and mesialise molars
Remodel glenoid fossa
May enhance mandibular growth and restrain maxillary growth - limited evidence

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What are the problems with a reverse OJ?

Displacement on closure
Incisal edge wear
Difficulty eating
Speech problems

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Describe the aetiology of a reverse OJ

Skeletal - class 3, hypoplastic maxilla, prognathic mandible
Dental - mandibular displacement, retained upper deciduous incisors

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How are reverse OJs managed?

Growing pt - procline upper incisors (URA) or attempt growth modification
Be careful of expected future growth

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How can growth modification treat a reverse OJ?

Chin strap/cup
Functional appliance
Protraction headgear

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What are the consequences of a deep overbite?

Palatal ulceration
Gingival stripping

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How can a deep OB be treated?

URA with FABP
Will allow lower molars to erupt
Pt must be growing to accommodate the increase in OVD
May convert div II to div II then twin block

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What are the problems of digit sucking habits?

AOB or reduced OB
Proclined upper incisors and retroclined lower incisors
Increased OJ
Posterior crossbites

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What is the aetiology of a digit sucking habit?

≥6 hours duration
Prevention of eruption of incisors
Labio-lingual pressure on incisors
Lowering of tongue position

How are digit sucking habits managed?

Encourage cessation at home initially
Conservative - positive reinforcement, bitter nail varnish, plaster on thumb
Removable or fixed habit deterrent appliance
Appliance to deal with effect - OJ reduction, closure of AOB, cross-bite reduction

What can be used in appliances for habit deterrent?

Palatal goal post
Or
Fixed tongue rake

What are the problems with supernumerary teeth?

Impeded eruption of associated teeth
Displaced eruption of adjacent teeth
Poor aesthetics
Damage to adjacent teeth - not common

Describe conical supernumeraries and their management

Usually close to midline (mesiodens)
Usually 1 or 2
Tend not to prevent eruption but may displace centrals
Extract only if erupt or impeding tooth movement

Describe tuberculate supernumeraries and their management

Main cause of failure of eruption of central incisors
Usually develop palatal to centrals
Remove and possible exposure of centrals

Describe supplemental supernumeraries and their management

Normal morphology
Tend to extract
Decision based on tooth form and position

What conditions increase the incidence of supernumeraries?

Cleft lip and palate
Cleidocranial dysostosis

What is the aetiology of midline diastemas?

Developmental
Generalised spacing
Hypodontia (absent 2s)
Proclination of upper incisors
Low fraenal attachment
Pathology

How are midline diastemas managed?

None if developmental Surgical removal of supernumeraries - not always necessary Early closure if severe and child is concerned Fraenectomy (probs not) Bonded retainer

What are the consequences of early loss of deciduous teeth?

Es - impacted 5s, will often erupt to inside of the arch As + Bs - minimal effect on centreline don’t balance or compensate Cs - consider balance to maintain centreline if crowded, do not compensate Ds + Es - space loss, consider space maintenance, little effect on centreline, no need to balance

When is space maintenance required?

Early loss of deciduous teeth Early loss of first permanent molar Traumatic loss or delayed eruption of maxillary incisors Preserve Leeway space

When is the XLA of a mandibular first permanent molar ideal?

Calcification of bifurcation of 7 Mesial angulation of 7 Presence of 8 Age 8-9

What are the consequences of early and late loss of mandibular first permanent molars?

Early - distal migration of second premolar Late - poor spontaneous space closure and mesial tipping and lingual rolling of 7s

What is the aetiology of impacted first permanent molars?

Poor eruption angle Ectopic crypt Morphology of second deciduous molar crown Small maxilla

What are the consequences of impacted first permanent molars?

Pulpitis of E Premature exfoliation of E

How are impacted first permanent molars treated?

Observe - 6 months XLA E - space maintain or treat crowding later Dis-impact - separators, band E and bracket 6 with open coil, discing of E, URA with finger spring and attachment on 6

What is the aetiology of primary molar infra-occlusion?

Temporary ankylosis Lower D most common Mandible > maxilla M:F equal Percussion sound Blurring or absence of PDL on X-ray